For as long as I can remember, the “experts” have been telling us to cut down on our sugar and fat intake in order to be healthy.  On the government’s “MyPlate,” the latest version of the healthy food pyramid, there are plate sections for fruits, vegetables, grains, protein, and dairy, but nowhere is there any plate section for sugar or fat.  In fact, if you go to the MyPlate website, the only place you can find sugar is under the “Empty Calories” heading.  And while fats (or oils) are listed under the “Food Groups Overview,” they do not make an appearance on, or anywhere near, the plate.

So, is anyone truly able to cut out both sugar and fat?  Well, it seems like it’s a lot harder than it sounds.  A recently-published review in the journal Critical Reviews in Food Science and Nutrition looked at 53 scientific papers and found that people who follow a diet low in sugar also had a significantly higher percentage of calories coming from fat, and low-fat dieters had a significantly higher percentage of calories coming from sugar.  This phenomenon, which many nutritionists have dubbed the “sugar-fat seesaw,” seems to occur because most sources of sugars, such as fruit, grains, and juices, are low in fat, while most sources of fat, like butter, oils and meat, are low in sugar.

So, what is the average health-conscious person supposed to do about this?  Well, instead of trying to cut out one major nutrient, how about trying a more moderate approach?  How about focusing on eating a healthy, balanced diet that includes all of the nutrients and not branding specific nutrients as either virtuous or evil?  Sugar and fat have a place in our healthy, balanced diets, and they should definitely be represented somewhere on MyPlate.

Lately, a lot of my patients have been coming in with questions about seeds: What kind should they eat?  How much?  What are the benefits?  I thought it might be a good idea to come up with a little seed cheat sheet (say that 10 times fast!) to break it down and help my patients figure out what seeds (if any) would be best for them.

Flaxseeds

One of the most popular seeds around these days, flaxseeds are famous for being nutrient powerhouses. They are rich in B vitamins, magnesium, omega-3 fatty acids, fiber, and antioxidants. B vitamins and magnesium are essential for cell metabolism. Omega-3 fatty acids play an important role in reducing inflammation in the body. Flax has both soluble and insoluble fiber, which have been shown to help lower total cholesterol, stabilize blood sugar, and promote intestinal function. Antioxidants help to protect our cells from damaging free radicals that can occur from exposure to certain chemicals, radiation, pollution, and smoking.  

2 tablespoons of ground flaxseed contains 4 grams of fiber, 2.4 grams of the omega-3 fatty acid alpha-linolenic acid (ALA), and 300 milligrams of lignans (an antioxidant).  It’s important to grind flaxseeds into flaxseed meal before eating them to ensure that you will get all of these nutrients. Flaxseed can be added to almost anything to get its benefits – cereal, oatmeal, smoothies, or even into baked goods.

Hemp Seeds

Hemp seeds are very versatile.  They can be eaten raw, sprouted, ground into a meal, made into milk, steeped like a tea, or used in baking.  Like flaxseeds, hemp seeds are a good source of ALA and fiber. They are also one of the few plant sources that are considered a “complete” protein, meaning that it contains all 21 known amino acids (building blocks of protein), including the 9 “essential” ones that cannot be produced by the human body, making it a helpful addition for those who follow a vegetarian or vegan diet.

2 tablespoons of hemp seeds contains 882 milligrams of ALA, 2 grams of fiber, and 5 grams of protein. Hemp seeds can be eaten whole or shelled. Add them to your salad for some extra crunch!

Chia Seeds

While they might be the new seed on the block to many North Americans, chia seeds are native to South America and have been a staple of the Mayan and Aztec diets for centuries.  Like flaxseeds and hemp, chia is a good source of antioxidants.  Due to their high antioxidant content, they have a long shelf life, and they can last nearly 2 years without refrigeration. Chia is an excellent source of fiber, with 10 grams in just 2 tablespoons. It also boasts an impressive amount of calcium (18% of the Daily Recommended Intake), phosphorous, magnesium, and manganese, nutrients that are important for cell metabolism, preventing hypertension, and maintaining a healthy weight. Unlike flaxseeds, chia seeds can be digested whole and do not need to be ground to get their nutrition benefits. Interestingly, chia seeds can be used as an egg replacement: the outer layer of the seeds swells when mixed with liquid, causing it to form a gel. This gel can be used in place of eggs (for those who are vegan) in baked goods. To make the egg replacement, mix 1 tablespoon of chia seeds with 3 tablespoons of water and let sit for 15 minutes.

Earlier this week, Governor Chris Christie, who has been lambasted for his weight for years, announced that he underwent “secret” gastric band surgery in February.  In an interview with NBC Rock Center’s Brian Williams, Christie said that after turning 50 last fall, he began to reflect on his life and realized that he wanted to get his weight “under control” so that he could be healthier for his wife and children.  His weight-loss doctor likened Christie’s obesity to having cancer, asking Christie, “If you came in here with cancer and I told you that I had a 40-minute surgery that’d give you a 90 percent chance of cure, would you sign up?”  Of course, Christie answered in the affirmative.

Lap-band surgery, in which an inflatable silicone device is placed around the top portion of the stomach to slow the consumption of food, is not the “cure” that Christie’s doctor says it is.  For nearly half of the patients who have the surgery, the devices need to be removed due to erosion or other malfunctions.  While most patients lose between 48 and 99 pounds in the first year after having the procedure, a number of studies have shown that the procedure is not successful over the long-term, resulting in sub-optimal weight loss and increase in failure rates.  One of those studies saw a 36.9% failure rate (defined as an excess weight loss of <25% or major reoperation) after seven years.

Now, I am not saying that weight-loss surgery is necessarily the wrong choice for Christie – everyone has the right to make his or her own health decisions – but I am concerned about his doctor’s message that weight-loss surgery is the cure for obesity.  While such surgery might be helpful in the short-term, it often leads to weight regain and numerous complications.  I am hopeful that those who take particular interest in Christie, and perhaps want to emulate him, will do their own research and make informed decisions. 

Before the Boston marathon bombings caused me to shift gears, I had intended on writing last week’s blog entry about our recent trip to Costa Rica.  In the very early morning hours of Patriot’s Day, Joanne and I returned from a short vacation there.  As was the case on our honeymoon, we took particular interest in the food.

For better or worse, much of the food at the two resorts where we stayed was Americanized.  In other words, the menus contained several items that were not traditional in Costa Rica, but rather were attempts to provide American tourists with familiar foods: cheeseburgers, pasta, pizza, French fries, etc.

We did, however, learn that rice and beans are prevalent in Costa Rican cuisine and many Costa Ricans start their day with a dish of gallo pinto, a traditional dish made with these two staples.  I had gallo pinto for breakfast a handful of mornings and really enjoyed it.

I find that when the topic of breakfast first comes up in my sessions, patients initially feel like they are limited to the usual options: cold cereals, hot cereals, bagels, eggs, bacon, waffles, muffins, pancakes, yogurt, etc.

What they come to realize though is that breakfast is just like any other meal of the day and we need not limit ourselves to the traditional breakfast options.  In other words, while breakfast options certainly include the typical options I listed above, they also include salads, sandwiches, entrees, or anything you might have at any other time of the day.  Gallo pinto is a perfect example.  Not too many Americans would typically consider rice and beans a breakfast option, yet they fill that role quite well for millions of Costa Ricans.

What might you consider having for breakfast if you expand your options beyond typical breakfast foods?

The following blog entry appeared as a letter to the editor in the Wellesley Townsman on April 25, 2013.

I ran my last Boston marathon years before Joanne and I met.  Since then, she has occasionally asked me if I would ever consider running another one.   My response was always no, I could not envision a reason to do so.

The stretch of Boylston Street where Monday’s bombings occurred is special ground.  Every time I was on the verge of finishing the marathon, I took off my sunglasses as I made the left onto Boylston because I wanted the most raw, unfiltered absorption of the experience and atmosphere as I could have.  The straightaway is long, much longer than it appears on TV.  The finish line, in sight the entire time it takes to cover the distance, cues each runner to remember the reasons why he or she decided to race in the first place.  Throughout their unpleasant, cold, and mushy winter training, runners fantasize about running down Boylston with the crowd roaring, the finish line in sight.

That stretch of Boylston might be the only spot in the entire city where dreams literally come true for thousands of people every single year.

For many runners, finishing the marathon would be impossible without the support and encouragement of those along the route, including not just the volunteers, but also the spectators. They make the day what it is.  Without them, the marathon would not be an event, but rather just a bunch of people going out for a jog.  When I had to drop out of the 2004 race due to a medical problem, a complete stranger ran out her front door after seeing me collapse at the end of her driveway and cared for me until I was loaded into an ambulance.  More times than I can count, I saw struggling racers break out of their shuffling walks and back into jogs because somebody on the side of the road told them they could still do it.

A tragedy like Monday’s bombing would have been wrong no matter where it occurred.  If they blew up the local diner or bus stop instead of the Boston marathon finish line it would have still been wrong, but it would have been a different kind of wrong.  In a city where we tend to keep to our own circles, cut each other off and exchange middle fingers in traffic, and walk past each other without even batting an eye, the marathon is the antithesis: strangers act like best friends in order to build something overwhelmingly positive.  Somebody attacked that and tainted it.  They went after the city at its finest and hit us in the heart.

We need to get that back; we need to make that stretch of Boylston special again.

Many ways exist in which we can make that happen, none of which will be more significant than when thousands of spectators line Boylston Street again for next year’s race.  As for me, I am a runner, I have been my whole life.  It’s what I do.  Given that, I aim to establish a 2014 marathon charity team to fundraise for Monday’s victims, to enter the race as a member of that team, and to run down that Boyston straightaway slapping hands with every spectator I can reach.