What Alzheimer’s Disease Taught Me About Food

My grandmother passed away in February after several years of gradually sliding into the Alzheimer’s fog. As with most deaths after a long battle with Alzheimer’s, my family met hers with sadness, tempered by a good amount of relief that her suffering was over.

One of my grandmother's paintings.

I regret to admit that my grandmother and I weren’t particularly close. At her memorial service, my older cousins told funny stories about their adventures with grandma as kids. I didn’t have the same memories. Throughout my childhood, when I thought of my grandmother, I thought of her fear. By the time I was old enough to form memories, she was afraid of everything. We had a dog named Sandy when I was growing up. If, god forbid, Sandy would make her way into the house when my grandparents were visiting, my grandmother would stand on the couch and scream. (I’ll assure you that as kids, my brothers and I never did this on purpose to see the show.) My grandmother would never eat in a restaurant or travel on an airplane, as both were deemed unsafe.

As much as she feared our killer attack Labrador, planes, and tainted restaurant food, her anxiety manifested itself most prominently through her diet. Throughout her fifties and sixties, she gradually gave up most foods. She was ripe for the picking for every exaggerated health-related headline designed to sell fear and newspapers. She would read an article about the dangers of a food and unceremoniously discard it from her diet, becoming a vegetarian long before being vegetarian was en vogue. She did this food by food until there was almost nothing left. At one point, she only ate bean soup, some fruits and vegetables, and yogurt.

During the last 10 years, my grandmother’s life changed dramatically. My grandfather passed away in 2001. A couple years after my grandfather died, a man named George left a message on my parent’s voicemail.  My family has a unique last name, and George found my parents in the phone book while searching for my grandmother. George and my grandmother knew each other as young teenagers and always had a thing for each other. Then life happened; both married other people and they lost touch.

My parents forgot about the voicemail from George. My mom inadvertently deleted the message. A few weeks later, my dad mentioned this voicemail to my grandmother in passing. And that began my grandmother’s frantic search for her childhood crush.

A few days later, my mom realized that George’s number would be on her old caller ID. She called my grandmother with the number. Later that day, my grandmother called my mother back. She was excited. She had talked to George for an hour and they had plans to see each other.

Thus began their septuagenarian romance. George and my grandmother moved in together fairly quickly. At the urging of his priest, George insisted that they stop “living in sin” and get married. They went to the courthouse and eloped.

During this time, we saw remarkable changes in my grandmother. The woman who was once afraid of everything moved in with George and his dog, raved about her new favorite restaurants, and took the 12-hour flight from the East Coast to Hawaii. All of these changes were surprising, but we knew something was wrong when my long-time vegetarian grandmother asked for extra gravy on her meat.

When I think of the early signs of Alzheimer’s, I think of Junior Soprano and numerous other characters in movies and on TV, out wandering around the streets, unable to find their way home. But maybe there’s something before the first bouts of major forgetfulness. Maybe before Alzheimer’s takes everything away, it gives some relief from the negative stuff we’ve been carrying around with us.

Earlier this year, The New York Times featured an article entitled “Finding Joy in Alzheimer’s” written by a man whose grandmother forgave old grudges and patched up relationships during the early stages of Alzheimer’s. Maybe Alzheimer’s (and reconnecting with the love of her life) melted away decades of my grandmother’s anxiety. Just maybe, for a short time, Alzheimer’s helped my grandmother enjoy life, and food, more.

I find food to be a huge source of enjoyment and lately I’ve felt like I’ve been falling down a rabbit hole. Last month, Experience Life magazine published an article comparing two extreme diets: Paleo (eat things only available to cave people and avoid starch, sugar, and processed foods) and vegan (no animal products). After reading the article, I felt that the Paleo folks made valid points about why sugar and starch were toxic and the animal-loving side of me sided with the vegans.

Think May is bad? This is December's menu.

The article stuck with me. Every time I ate an animal product, I felt guilty. Every time I ate a grain, I felt guilty. Every time I ate just about anything other than locally-grown, organic, raw fruits and vegetables, I felt guilty. So, in May, in Maryland, I had the option of eating locally grown asparagus, spinach, and strawberries. Fabulous.

And that was when I realized how much I really had in common with my grandmother. For as much as we both loved oil painting, exercise, nutrition, and the Democratic Party, I always saw one huge difference between my grandmother and me that I couldn’t get past. My grandmother let her terror of sickness, injury, and death steal a lot of joy from her life; I always thought of myself as more balanced and fun loving. But could it be that I’ve taken my first steps down this dark, scary path? In 20 years, will I rid my diet of everything but the bare necessities? This is unequivocally not what I want.

I’ve made the decision to climb out of my self-made rabbit hole. No matter what I read or hear, I’m going to opt out of “extreme eating.” I will eat a spoonful of Nutella or a sandwich without guilt or anxiety because it makes me feel good.

Spending decades eliminating foods from her diet did nothing for my grandmother’s mental health, and it won’t do anything for mine. My grandmother didn’t find joy in food until she forgot to be afraid of it. 

If I had to sum up what I learned about food from Alzheimer's disease, it would be this: Life’s short. Savor it.  

Spaniards (and American Tourists in Spain) Don’t Get Fat

Clearly, all drinks should
come in a chocolate cup.

My husband and I went to Madrid in March. He went on business and I went to see how much I remembered from Spanish II almost 20 years ago (not much), drink sangria (a lot), and sample the local cuisine (a whole lot). On the day we arrived, we went on a great tapas (no, I didn’t say topless) tour of the city, stopping at three tapas bars to sample their specialties, cervesa, and sangria; plus a pit stop for a shot of liquor inside an edible chocolate cup. This was by far my belly’s favorite 14 Euro expenditure of all time.

The next morning, feeling guilty about our night of overindulgence, we went for a run through Parque del Retiro, Madrid’s central park. It was ridiculously crowded, even for a 70-degree Saturday morning. People were running, walking, rollerblading, and biking wherever there was room. And everybody was fit.

Examples of Spaniards. You're welcome.

While the only trees we saw in Spain we safely constrained within park gates, the Spaniards in-shape physiques were everywhere. As we walked around taking in the sites (mostly restaurants and bars), we noticed that these tapas-loving, ham-eating, partying-until-6-am, cigarette-smoking locals were all thin. 

Pig at the airport:
He is only smiling because he
is getting the hell out of Spain.

The food wasn’t particularly healthy. At times I felt hard pressed to find a fruit or a vegetable. A lot of the foods were fried (my mouth is watering thinking about the calamari). And then there’s the jamón (ham). Ham is ubiquitous (i.e., freaking everywhere) in Madrid. Madrid is home to a chain of restaurants called Museo de Jamón (ham museum), not to be out done by Palacio del Jamón (ham palace). In the touristy parts of Madrid, one of these shops is on pretty much every block.

Perhaps Spaniards wouldn't
be so slow if they invested
in big-girl size cups of coffee.

While the Spaniards spent a lot of time in the park, we also saw them sitting around eating—A LOT. Things in Spain take a really long time. They eat dinner at 11 pm; it takes FOREVER to bring the check; the lines at the airport stretch into oblivion while the three United employees leisurely check passports. Spaniards are god-awful slow when they’re not running around the park.

As with the end of every vacation, we were scared to weigh ourselves when we came home. It turned out that there was no need to worry. I lost a pound and my husband only gained half a pound. It appears that the super-awesome Spanish thinness wore off on us too.

This octopus was so fresh that it swam
to the bar on its own accord. This
ain't no Red Lobster.

The main difference between eating out in Madrid and eating out in America seemed to be the level of processing. Things just seemed a lot fresher, a lot more natural in Spain.

Processed foods tend to by higher in fat and sugar, both known culprits in the battle of the bulge. They also are engineered to taste good and to play to our natural caveperson instincts to take in as much fat and as many calories as possible since the next food shortage is immanent. Our trip to Madrid sparked my curiosity about whether there was something a little more complicated at work. Is there a difference in how our bodies process whole foods versus processed foods?

I did a Google search and found a lot on this topic—a lot of really questionable theories, that is. There were blog posts about how toxins from processed foods collect in body fat and, uh, make the body fat weigh more (or something like that); articles about how processed foods make the body work harder (which would actually burn more calories, not less); and Kirstie Alley’s new diet plan (yes, she’s at it again). Just a couple of minor issues—none of these articles cited research or made a lick of sense.

While people are blogging about this subject ad nauseam, few are researching it. Hours of searching the peer-reviewed literature turned up exactly one article. Pomona College researchers experimented on 18 subjects to see if a processed cheese sandwich a la Kraft Singles Prepared Cheese Product on white bread reacted differently than a slice of natural cheddar on multigrain. It turns out there was a pretty substantial difference.

Our bodies burn energy three ways: basal metabolic rate (BMR) (the calories that the body burns doing normal bodily functions like breathing), activity, and through the thermal effect of foods (TEF) (i.e., the energy our bodies use to breakdown food, digest it, use nutrients, and do all sorts of other things). On average, 10% of our calories are burned through TEF, but that number can fluctuate quite a bit. Protein takes the most energy to metabolize, followed by carbohydrates, then by fats. Foods that are structurally more complex, that is they have more nutrients, more fiber, and more protein, take more energy to process. Whole foods are generally more complex than processed foods.

Step away from the processed cheese
food and no one gets hurt.

The Pomona College researchers carefully matched the two cheese sandwiches fed to their subjects; both sandwiches contained the same number of calories, and the same ratio of bread to cheese (60% bread and 40% cheese). The researchers measured the subjects' metabolic rate before eating to get a baseline and then every hour after that.

The researchers found that after eating the processed cheese sandwich, the subjects burned 50% less calories than after eating the natural cheese sandwich. 


And by tapas, I mean wine.

Even with such limited research, I believe that our bodies respond better to real food than to processed crap. Really, I just like the idea of eating and drinking my way through Madrid guilt free. Bring on the unprocessed, all natural tapas! Lots of them! 

The one article I could find:

Barr, SB, Wright, JC. (2010). Postprandial energy expenditure in whole-food and processed-food meals: implications for daily energy expenditure. Food & Nutrition Research. 54: 5144.





Obesity Scans and the Real Hunger Games

I’m a really awkward cheerleader. As my neighbors can attest, cheering for sporting events comes natural to my husband; he’s loud and passionate. Meanwhile, I make weird arm motions and say “go” and “yeah” in my normal speaking voice. Sometimes I say inappropriate things at the defense like “Kill him!” (Because football is supposed to be a fight to the death, right?)

Magic obesity-crushing
DXA scanner.

A story on the Nightly News with Brian Williams earlier this week had me yelling at the TV with gusto that I’ve never been able to muster during a Ravens game. Said story was on the future of obesity measurement. The segment covered research claiming that far more Americans, especially older women, are obese than previously thought. Using a DXA scan that can separately measure bone density, muscle weight, and body fat for “a few hundred dollars” a pop, the researchers found that an additional 13% of people are actually obese given their body fat.

Researcher Eric Braverman, MD criticized BMI, our standard obesity measurement, saying, “BMI is an insensitive measure of obesity, prone to under-diagnosis, while direct fat measurements are superior.” He goes on to say that these tests “will pay off enormously” as “fat is costing the country a fortune by not measuring.”

Brian Williams called this a “game changer.”

Magic wand cures obesity
when used with
a healthy diet and regular
exercise.  

The report worked off the assumption that obesity is worse because we don’t know how to measure it. Perhaps if we had a good screening test, we could make everyone thin and healthy by using, ugh, magic. (Yeah, the magic part is where the logic broke down for me too.)

I was surprised that this story made the news, let alone elicited shock and awe. It must have been a slow news day. I guess neither Mitt Romney nor Joe Biden made a gaffe to fill up three minutes of the broadcast.

It’s non-news, because at best, this test will have zero effect on obesity. I think that there are also ways that it could make our problems worse. A more expensive test for obesity further separates our haves (money, health insurance) from our have-nots (crappy food, no health care). It also takes the focus away from actual solutions to the obesity problem.

The DXA scan, while less expensive than a heart transplant, is more expensive than stepping on a scale. Even a cheaper alternative test suggested on the broadcast, a leptin blood test, comes with obstacles (e.g., need for health insurance, needles hurt).

Better obesity measurement: muffin-topometer

Money used towards this new high-tech test that tells us what we already know based on our muffin tops—we need to lose weight—could be better spent in a variety of ways: improving our food supply, making fresh produce more affordable, encouraging mixed land-use developments, adding sidewalks to neighborhoods, getting me out of my pesky underwater mortgage. (Okay, the last one might not have much effect on the obesity epidemic, but would be a solid use of money.)

Adam Drewnowski: I <3 him.

There’s also the minor detail that people who can afford more expensive versions of medical tests, groceries at Whole Foods, a gym membership, a personal trainer, a bike, high-tech running shoes, and race entrance fees, are not obese. That’s because, according to Adam Drewnowski, my favorite researcher, “Deep down, obesity is really an economic issue.”

Dr. Drewnowski’s research has shown that only 4% of those who shop at a Seattle Whole Foods are obese, compared with nearly 40% who shop at lower-priced Albertsons stores.

This all feels very Hunger Games-esque to me. Money is spent on needless medical testing for those who have disposable income, while so many others eat dollar-menu, pink-slime laced burgers and have no access to healthcare outside of emergency rooms.

It makes me think of the Hunger Games scene where Katness and Peeta are at the celebration in the affluent capitol. Because of the abundance of food, the hosts offer a cocktail to help the party goers throw up so they can continue to eat. Meanwhile, the majority of the population, living in the poorer districts, is starving.

Of course, today’s American poor are not hungry. They are overfed on high-fructose corn syrup and genetically modified fat manufactured from soy beans.

I think that movement towards urban gardens; WIC/SNAP (née food stamps) acceptance at farmers markets; food revolution movies, documentaries and books; and eating-local movements are moving us in the direction of a real “game changer.” But I’m sad to say, Brian Williams, we just ain’t there yet.

The Best Field Trip Ever: The White House Garden

Sam Kass

I am compelled to share this slightly off-topic experience because I feel so honored to have had the opportunity yesterday to tour the first lady's garden with White House chef, Sam Cass. I was presenting on marketing healthy foods to adolescents to a conference of food service managers and a trip to the White House happened to be on our conference agenda. And it was the best field trip ever.


A baby papaya tree.



It was a beautiful September day and after a little shuffling around the White House because of a helicopter landing and issues at security, we made our way through the garden and had the opportunity to ask questions. According to Mr. Cass, the Obamas like simple, fresh foods; ingredients come from the garden every night; while organic practices are used while gardening, the garden is not certified organic; and the glamour of being the White House chef eventually wears off.

After the White House tour, we headed back to the hotel for more presentations. A woman named Corey, whose job title is urban farm coordinator, gave an amazing presentation about farming at her Job Corps center. The center was awarded an ARRA grant to develop an acre of farmland on their inner-city property. On the farm, Corey, a friendly San Francisco native, not only grows all of the standard fruits, vegetables, and flowers, she also has a fish pond and a chicken coup. Corey also provides a much bigger service to the at-risk youth at her center; she uses the farm to teach them about growing food, healthy eating, and opportunities to decrease health disparities, like food deserts, in poor communities.

Admittedly, I have a bit of a black thumb. In fact, I made a joke about it several years ago and touched a leaf on a plant. A few weeks later, that leaf was dead. I'm not even kidding. But my trip to the White House (even if I didn't get to meet Michelle) and Korey's presentation made me want to get out there and rent a piece of an urban farm. Any tips for those of us who aren't naturals in the botanical world?





Why do people choose healthy foods?

For our fifth anniversary, my husband and I went to Top Chef runner-up Mike Isabella’s new restaurant, Graffiato. In preparation of our big dinner, I read every Yelp review written about the place. I wanted to order just right. The restaurant serves small plates—a little bigger than tapas, a good bit smaller than a meal. A lot of the reviews were divided; many people loved the chicken thighs with pepperoni sauce that was called “orgasmic” by Top Chef judge Gail Simmons; others referred to it as overrated. The pizza was also polarizing; some called it perfect; others called it bland and overpriced. Nearly every dish has as many lovers as haters, except for the roasted cauliflower, that is.

Yelpers raved about the roasted cauliflower. Perfectly cooked so it was crisp on the outside and creamy in the middle in a good quality olive oil with pecorino romano cheese, lemon zest, and mint. I couldn’t wait to order this vegetable. It most certainly didn’t disappoint. I truly could have eaten 10 times the portion of this wonderful cauliflower. And, as an added bonus, it might possibly be the healthiest thing on the menu.

Graffiato is no Applebee’s. There’s no Weight Watcher’s menu and no little heart icon pointing people to the healthy dish, yet a lot of customers are noshing on this delight. So why is this $6 mini plate of cauliflower so popular?

For starters, it’s delicious. In order for people to choose a healthy dish it has to taste good. Vegetables aren’t cooked properly so much of the time. They are often over or undercooked and almost always under seasoned.

Second, people order this cauliflower because other people like this cauliflower. Yelp and the DC food blogs have seen to it that people know about this dish. People order it because others like it.

Mike Isabella’s intention wasn’t to convince people to eat their vegetables. His purpose is to sell food of all kinds that tastes good. It just happens that he makes a rocking cauliflower. But could the lack of a health claim be the reason why people fawn over the dish?

Companies market so many foods, from chips with whole grain to sugary cereals with immunity boosters to organic blueberries, with health claims. In this series of posts, I’m going to explore what makes people choose to eat a healthy food.


Stay tuned for part two "Do health claims on food make a difference?" 

Why are cigarettes legal and raw milk illegal?

After reading impassioned documents from the FDA about the potential harm of raw milk, equally passionate rebuttals from the Campaign for Real Milk, and somewhat-unbiased scientific-research articles, I have decided that unpasteurized milk has gotten a raw deal (pun intended). A classic tale of intrigue, unpasteurized milk is a victim of money, power, and politics.

In the briefest of summaries, raw milk carries some risk of food-borne illness, as do all foods, but also comes with health benefits. The potential risks are miniscule when compared to the risks of, say, cigarettes, yet still raw milk is illegal in many states. The rational behind the laws governing raw milk are convoluted, as are the answers to the following Q and A.

Question #1: Is raw milk safe?

Totally convoluted answer #1: For the most part. The FDA provides a good number of case studies describing the ill effects of raw milk, including serious food-borne illness and an occasional death. Proponents of raw milk find fault with each of these case studies and disagree that raw milk was the real culprit. After reading these studies, raw milk appears to be safer than lunchmeat (which I may never eat again).

Bottom line: The safety of raw milk depends on how cows are raised, a sanitary milking procedure, and frequent testing of milk for harmful bacteria. Every raw milk advocacy website strongly recommends that consumers “know their farmer.” Incidentally, if raw milk were made legal and regulated, it would be a lot safer than the current black market milk. There are valid and reliable bacteria testing procedures, that when uniformly applied, effectively screen out any contaminated raw milk samples.

Question #2: Why is raw milk illegal in some states?

Totally convoluted answer #2: On the surface, raw milk is illegal because of controversy surrounding the safety, but I don’t think that this is the real reason. Like big oil and big pharm, big dairy has a good deal of pull. Regional big dairy associations (the “Got Milk?” people) have launched ad campaigns under the guise of public service announcements to outline the hazards of raw milk, most notably in Texas where legislation supporting raw milk has been introduced. A rise in consumer confidence in raw milk translates to revenue loss for mainstream dairy farms. Laws tend to follow the money and obviously big, factory farms out earn your small, organic, free-range dairy farmer by about a zillion to one (citation needed).

Question #3: Is raw milk a magical health food?

Totally convoluted answer #3: We’ll probably never totally know. There are a good number of studies that show that kids who are raised on farms with lots of dirty farm animals and germs are healthier than their counterparts raised in Lysol-polluted homes on pasteurized skim milk. These kids suffer fewer allergies to pollen, animals, and food; less asthma; and are overwhelmingly healthier.

As for the other health claims…. There’s a good chance that we won’t know for some time as, like laws follow the money, so does scientific research. The FDA, the same agency that vehemently opposes raw milk, funds much of the research on health benefits of foods. It’s my guess that organic, free-range dairy farmers could write grant proposals until the cows come home (again, pun intended) without receiving funding.

Question #4: Can people with lactose intolerance drink raw milk?

Totally convoluted answer #4: Not people with true lactose intolerance, but a lot of people who get an upset stomach after drinking pasteurized milk who are not truly lactose intolerant can handle raw milk. Click here for a good summary.

Question #5: Would I buy a raw-milk product again?

Finally a straightforward answer: I would need to know about where it came from, bacteria testing procedures, and refrigeration and shipment processes. In short, I do not plan on buying retail raw milk again and feel that I would need to better know my farmer.

Coming back to my original question, why are cigarettes legal and raw milk illegal? Cigarettes with their extremely well documented cancer-causing properties are legal because of money. Raw milk, with its somewhat sketchy documentation of food-borne illness and potential health benefits is illegal because it is going against big money. And in our society, those with money win.

Raw Milk: Cuddly Disease Preventing Hero or Death Causing Uber Villain?

The yogurt in question.

A few weeks ago, I went grocery shopping at an Amish market. This market is a completely unique experience with all of the cute Amish 10 year olds breaking child labor laws serving up stuffed pork chops, fruits and veggies, baked goods, and this amazing pit roasted turkey, all while wearing their traditional attire. Vendors from various farms set up shop in the open-area building and the customer pays for his or her selections in each department. A section of the market is dedicated to breads, another section to meat, other sections to furniture and jewelry, etc. My story takes place in the dairy department.

Upon entering the market, a case of prepared salads, including my husband’s favorite, Amish macaroni salad, beckons. I knew that I might as well not return home if I forgot the Amish macaroni salad, so I made a beeline for the counter. The counter wraps around into the cheese and dairy section. I grabbed a few cheeses, paid for my goods and moved to the bread department. It was after I visited the produce and meat vendors that I realized that I missed my Saturday morning farmer’s market and didn’t have yogurt for breakfast. By that time, I was in a hurry and rushed back to the dairy department, grabbed a maple yogurt off the shelf and went on my merry way.

It wasn’t until a few days and half the yogurt container later when I was preparing my breakfast at work that I fully comprehended the label. I had bought yogurt made with raw, unpasteurized, fresh-from-the-farm milk. First, I sent an email to a coworker to inform him that if I suddenly died, he should point the investigators toward the yogurt in the fridge. Then I set about eating my breakfast. This maple, full-fat, unprocessed yogurt was admittedly pretty awesome. In fact, it was awesome enough that I threw food-borne illness caution to the wind and finished the container that day. It’s now a week later and my stomach is a-okay.

I first became interested in the raw milk controversy in May when a Facebook friend posted pictures from the Rally for Food and Farm Freedom on the National Mall. People gathered for this rally to protest the government’s regulation of raw milk. For the past two years the FDA has been organizing stings on Amish farms that illegally sell or ship unpasteurized milk. The rally was organized to help protect the small farms affected by these laws and the consumers who prefer to drink raw milk.

Confusingly, both state and federal laws regulate raw milk sales. There are a myriad of baffling, ever changing state laws on the books about raw milk. (I have to disclose that the concept of state laws confuses me. I don’t grasp the purpose of different laws in different states, like why you can buy beer and wine in grocery stores in both the District and Virginia, but not in my current state of Maryland. That being said, my analysis of these state laws should be taken with a grain of salt.) Apparently cows, and their milk, are healthier and carry less bacteria in some states than others. It appears by this fancy color-coded map that cows are very dangerous in Maryland, West Virginia, Nevada, Louisiana, Montana, Michigan, the state southwest of Michigan, and New Jersey and cows in the other states are relatively safe. Unfortunately, I bought my apparently illicit raw-milk yogurt in Maryland. Damn! I can only hope that it was smuggled illegally (per FDA federal regulations) across state lines from Pennsylvania Amish country, where apparently the cows are happy and healthy. Of note, Ron Paul, an unlikely advocate for the hippie-base of raw milk consumers, recently introduced a bill in Congress to allow raw milk transport across state lines.

So, why go to all of the trouble to smuggle and protest to buy raw milk? Proponents of raw milk feel passionately that it prevents allergies, asthma, heart disease, cancer, and autism, and that it does not cause more food-borne illness than pasteurized milk, as long as it is handled correctly.

The FDA claims that raw milk is responsible for a lot of lost bodily fluids from outbreaks of salmonella, E. coli, listeria and campylobacter.

Both sides are passionate and throw journal articles and case studies around like it’s nobody’s business. Get ready for a throw down like no other!