Archive for August, 2011

To Vitamin Supplement Or Not…That Is The Question

August 27, 2011

When I turned 50, I started taking a multivitamin and mineral supplement, not previously having taken a vitamin since I took Zestabs or Chewable Chocks as a kid.  I figured I was on the back nine of life and needed all the help I could get.  Being the value-oriented consumer that I am, I headed over to Costco and picked up One-A-Day Men’s Health Formula that claimed to support prostate health, heart health and healthy blood pressure…sounded really good to me!  Each tablet contained Vitamins A, C, D, E, K, B1, B2, B3, B6, folic Acid, B12, biotin, calcium, pantothenic acid, iron, magnesium, zinc, selenium, copper, manganese, chromium, potassium and lycopene.  It seemed like a lot of bang for the buck.

I continued taking the vitamins for a year or so, but did not notice any tangible kind of benefit—I did not feel better, was not more energized, stronger, more potent in any way imaginable, did not get less colds, and my annual blood chemistries were unchanged.  I came to the realization that I derived a lot more benefit from my morning caffeine infusion than from the daily vitamin!  Frankly, I had felt pretty good before starting the vitamin and mineral supplement and since I felt absolutely no different after using them, I stopped taking them and have never looked back.  That stated, I eat a very healthy diet with an abundance of vegetables, fruits, legumes, whole grains, and lean sources of protein and have little doubt that my diet leaves me in good shape in terms of sufficient vitamin and mineral intake.

Approximately one in three Americans use multivitamins and mineral supplements on a regular basis.  There is no question that we need these micronutrients in sufficient quantity to sustain our health.  A nutritious and well-rounded diet should most certainly provide these essential micronutrients.  The exceptions to this are the following: If your diet is poor; if you are pregnant; if you are a child; or if you are ill or immuno-compromised due to certain medical conditions.  Under such circumstances, supplementation is important.  According to Tufts University Professor of Nutrition Susan Roberts, “multivitamins can fill in the gaps if you get too little of some vitamins and minerals from your food.”  Specifically, there are five micronutrients that many Americans do not get enough of: vitamin D, folic Acid, B12, iron and calcium.

Vitamins and minerals that exist within vegetables, fruits or other nutrients are advantageous because these foods contain important enzymes, peptides, and phyto-nutrients that are necessary to the utilization of the vitamins and minerals.  Many scientific studies have concluded that vitamins and minerals derived from dietary sources are superior to synthetic or formulated vitamin pills.  Bioavailability, as defined in Mosby’s Medical dictionary, is the degree of activity or amount of an administered drug or other substance that becomes available for activity in the target organ/tissue.  In short, the bioavailability of the vitamins and minerals within a multivitamin is often very much less than that of the vitamins and minerals in their natural form.

The other issues aside from bioavailability are that multivitamins vary greatly in quality, some have only trivial amounts of some micronutrients, and many have claims that are not clinically proven.  Nobody even knows if the recommended quantities (the RDA or Recommended Dietary Allowances) are accurate or relevant.  Another point is that the fat-soluble vitamins D, E, A, and K are stored in the body, and excessive quantities can be problematic.  On the other hand, excessive intake of the water-soluble vitamins B and C end up being urinated out into the toilet bowl.

The Bottom Line:  In my humble opinion: If you eat a healthy, well-balanced diet that includes fruits, vegetables, lean protein, and whole grains, don’t waste your dollars on a multivitamin or mineral supplement.  You are better off spending your money at Starbucks!  However, this does not refer to children, pregnant women, those suffering certain illnesses and those with a poor diet.  If you are deficient in D, B12, folic acid, iron or calcium, it is of paramount importance to supplement your diet appropriately.

Andrew Siegel, M.D.


My “Freshman Fifteen”

August 20, 2011

‘Tis the season for the start of the academic year so I thought it would be worthwhile doing a short blog on the weight gain that many college freshman experience…also known as “The Freshman Fifteen.”

Many moons ago, as a freshman at Middlebury College, I developed a very bad habit of consuming two glazed doughnuts every evening at around 10PM!  An enterprising fellow student made the doughnut rounds in the dormitory and I found them to be an irresistible and soothing tonic to the stress and anxiety brought upon by the first semester in college and a demanding premedical curriculum. My nocturnal habit of regularly downing these gooey, sticky, sugary treats contributed towards my gaining 20 lbs or so by winter break.

The following is a breakdown of the behavioral chain of events in psychological terms: The prompt to eat was stress, the impulse to eat led to the act of the doughnut consumption and the compensation was the stress relief derived. Fortunately, I was ultimately able to give up this seemingly innocent but pernicious behavioral pattern that was not doing me nor my waistline any good at all. I came up with the following thought process: doughnuts have more than 500 calories; they make me feel disgusting; my weight gain, which I find abhorrent, is in a large part on the basis of these late-at-night unnecessary calories; my tight pants repulse me; I went jogging in Florida with my brother over winter break and could not keep up with him because I was so out of shape. This is opposed to the following lines of thought that goaded me to consumption: doughnuts taste great and are something to look forward to after the tedium of studying for hours on end; they soothe, calm and sedate me; I owe myself this reward because of my hard work; I do not wish to deprive myself.

Mindfulness is a useful tool when applied to figuring out what drives internal prompts and how to deal with them in an appropriate and healthy manner.  So, the concept of mindfulness disrupted what had become an ingrained pattern of behavior. Essentially, in psycho-speak, mindfulness functioned to de-condition the link between the compensation and the prompt, to disrupt the cycle.  Both the internal prompt of stress/anxiety and the external prompt of seeing the tray of doughnuts being paraded around the dormitory helped drive my behavioral pattern.  The stress and anxiety from the change of life of moving away from home and starting college, as well as the intensity of studying, etc., drove the desire for “compensation.” As we all have to adapt in response to changes in our environment, so would I adjust to this new life, and I would need to learn to deal with my emotions in a healthier and more appropriate fashion. I substituted swimming for the doughnut habit, a much more suitable activity! Once again, it came down to the mindfulness of swapping an alternative behavior—exercise—equally effective as a doughnut or two in terms of dealing with stress and anxiety, believe it or not. An additional effective tool is that in knowing how we may succumb to our weaknesses, we can limit our exposure to such external prompts, which in my case was by purposely avoiding the doughnut vendor.

Whether the prompt is “managed” by comfort foods or exercise, the same “cocktail” of internal chemicals, including endorphins, is released into our bloodstreams, resulting in compensatory relief of the altered emotional state. We are all stressed to some extent, and one thing for sure is that stress is unlikely to disappear any time soon.  If it is not one source of stress, it will be another. So when the root cause is not necessarily remediable, the next best bet is to deal with it in a healthy way—healthy in terms of psychological, emotional and physical health. So why not seek relief with the more appropriate and healthy means? I could also have had the mindfulness to trade the doughnut consumption for a healthy replacement food item such as an apple.

I realized that by giving in to my impulses, I merely received the benefits of a short-term and temporary reward that did not truly address the problem at hand. In psychological terms, this enabled and facilitated a vicious cycle and a dysfunctional habit and thus the creation of a secondary problem . . . .now I faced stress over school as well as new stress over my unseemly weight gain. By actively not indulging my impulses, I managed to weaken the behavioral pattern that had been established, helping to break the cycle. I did lose those 20 lbs., but by no means was that an easy feat.

Andrew Siegel

What Is The Best Diet For Us?

August 6, 2011

What is the best type of diet for us?  There are a lot of zealots and fanatics out there touting the advantages of one diet over another.  What to believe?

Vegetarian? Vegan?  Raw? Flexitarian (mostly vegetarian, but some meat)?  Pescatarian (fish)?   Paleolithic (like our cavemen ancestors)?  Carnivorous (like lions)?  Herbivorous (like deer)?  Granivorous (nuts and seeds) like squirrels?  Frugivorous (fruits) like lemurs?  Foliovorous  (leaves) like koalas?  Omnivorous?

When it comes to eating—like religion—I don’t like other people foisting their views on me.  That stated, when it comes to diet, eating and nutrition, there are some basic facts that are relevant to our health and wellness. In our modern society, if you want to stay on track regarding diet and weight, it is not so much what you choose to eat, but what you elect not to eat that count.  Essentially, by avoiding the “bad,” by default you will be fueling yourself with the “good.”  In other words, there are a great variety of healthy, high quality foods that can nourish us, and it is not important what your specific choices are as long as there is balance, sufficient intake of macro-nutrients (protein, fats and carbs) and micro-nutrients (vitamins and minerals), and avoidance of excessive calories. The key is to stay away from processed, reconstituted, unhealthy, mystery, faux foods. Processed food can be defined as real food that has been altered in order to lower its production cost, lengthen its shelf life, make it look more appealing and make us want to eat more of it, resulting in a reduction of nutritional content and an increase in chemicals, dyes, preservatives and toxins.

Humans are remarkably omnivorous, meaning that there are a great variety of different foods—plants and animal in origin—that can both provide energy for our metabolic processes and sustain us in terms of cellular and tissue replenishment. Regarding what to eat to maintain good health, the celebrated author Michael Pollen famously stated: Eat food, not too much, mostly plants.  I borrow his maxim and reverse it in an effort to summarize what to eat to promote poor health: Eat imitation food, eat a lot of it, mostly animal-based. And there we have the Western diet—processed foods, lots of meats, refined carbs, fats and sugar—the eating style that has contributed to two-thirds of Americans being overweight or obese. The Western diet is largely responsible for the diseases of Western civilization, namely hypertension, diabetes, cardiovascular disease and some cancers.

Processed garbage foods are ubiquitous in the United States of Obesity. These run the gamut from doughnuts to hot dogs to the myriad of chemical-laden, nutritionally-depleted food-like substances that are readily available, aggressively marketed and promoted, relatively inexpensive, and potentially addictive.  Fast foods, junk foods and many packaged foods—cheap, easy, and a staple of many adults and children—are in this category. Much of this is not actually food, but enhanced food-like matter, highly processed and laden with additives, preservatives, and loaded with fat, sugar, salt and other chemicals (most of which are unknown, unpronounceable, unrecognizable, un-food-like concoctions)—engineered in a science lab.  The “killer” triad of processing is enriched wheat flour, high fructose corn syrup and partially hydrogenated vegetable oils.  In contrast to wholesome, slow-digesting, natural foods that contain abundant fiber—which slows and regulates glucose absorption and leaves us feeling full and satisfied—nutritionally-void, packaged foods laden with fat, sugar, and salt promote addiction.  These highly-refined food substances are essentially pre-chewed, pre-digested, melts-in-your-mouth adult baby food that is absorbed very rapidly because of the fiber-stripping and refinement process.

The term processed is a derivative of the word procession. A procession is a movement that occurs in an orderly fashion, for example, a parade. The procession that results in processed food on our plates involves the farmer, the processor, the baker, the distributor, the retailer, and ultimately us, the consumer. For example, wheat is grown and harvested by the farmer and the process of threshing separates the wheat kernels from the chaff (husks of the wheat grains). The process of milling enables the wheat kernel components to be separated such that the bran and germ are removed, leaving the pure, silky, highly refined powder that we know as wheat flour. This wheat flour is then used as one of the many unhealthy components of processed foods, for example—a Twinkie. After the Twinkie is configured, baked, sealed in plastic wrap and boxed, the distributor trucks and ships the product to our local supermarket retailer where it can be purchased. So what starts out as a healthy and natural grain, after much processing, ends up as unhealthy junk food. The final product bears little relationship to the original farmed product. The bottom line is that the more that is done to our food, the more it gets depleted of its nutritional value.

Remember the game called “telephone” we used to play when we were kids? A bunch of us would sit in a circle and the first person would whisper a few sentences into the ear of the person sitting next to him or her. That person would repeat it to the next person, and soon around the circle. The last person would announce the message they heard. The message that the final person announced was virtually always very different and distorted from the original message, usually in a very funny way. My point is that the processing of food is not unlike this game in that the final product bears little, if any, relationship to the original, with each step in the production process resulting in increasing adulteration.

Minimizing one’s exposure to processed foods, as difficult as that might be, is a noble idea in terms of avoiding being overweight or obese and maintaining good health. Examples of processed foods are: Pop Tarts, Hostess Twinkies, Spam, Doritos…the list is virtually endless. Processed foods can be as detrimental to our health as tobacco has been proven to be, contributing to diabetes, obesity, hypertension, cardiovascular disease and cancer.

As much as I am denigrating processed foods, it is important to understand that not all processed foods are bad and that food processing is a necessity. We cannot all be farmers and grow a variety of vegetables and fruits and raise cattle and other livestock and must rely upon intermediaries to transform a raw product such as wheat grain into an edible form. However, the desirable goal is to eat a healthy, nutritious, robust, wholesome processed product, for example, 100% whole grain wheat bread vs. the infamous un-wholesome Twinkie. Obviously, the closer any food item resembles its original and natural form, the healthier it is, but many original forms do need to be processed to some extent to make the food available to us. In general, real food comes from the earth and not the laboratory, and the less processing the better. The corollary of this is that the more processed and highly altered the food is, the less nutritious—and oftentimes more hazardous—it becomes.  Processed foods in addition to being unhealthy and nutritionally void, have an abundance of sugar, salt, fat, additives, preservatives, flavor enhancers, chemicals, and dyes. Some processed foods are filled with mystery components. Often, to make up for loss of nutrients during processing, synthetic vitamins and minerals are added.

I am a pragmatist and am not advocating absolute purism with complete avoidance of processed and junk foods, but am a big supporter of minimizing our intake of them.  I suggest making a concerted effort to eat healthy, wholesome and natural foods as much as possible, but the occasional succumbing to the urge and craving to consume some processed junk food is acceptable…everything in moderation.

Bottom line: In my opinion, the healthiest kind of diet is a non-processed diet.  Any diet that provides sufficient but not excessive calories, is balanced in terms of macro and micronutrients, and is largely non-processed should prove to be a healthy diet. Non-processed will ensure the intake of an abundance of natural and wholesome foods.  The surest way to ruin the health benefits of a vegetarian or a vegan diet—those diets that are touted as quite healthy—is to couple them with the intake of processed foods!  There are way too many vegetarians who are overweight for this reason.  I am an omnivore who espouses avoiding processed foods and encourages a diet that emphasizes vegetables, fruits, legumes, whole grains, and lean animal products in moderation. I believe that if this kind of diet was adhered to, it would contribute positively to curtailing the American obesity epidemic.

Andrew Siegel, M.D.

This is just a taste of what you will find in Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food. The website for the book is:

It provides information on the book, a trailer, excerpts, ordering instructions, as well as links to a wealth of excellent resources on healthy living.  It is also available on Amazon Kindle.

To see my YouTube video on Processed Foods: