Vegan Blog Going On Holiday & 3 Most Popular Posts

While my posts have been sporadic at best over the past 7 years, my blogging efforts for the months to come will be found elsewhere.

For those of you who just stumbled upon this blog, here are the 3 most popular posts over time:

The #1 Favorite: How Can Vegans Be Overweight?

Eliminating animal foods is one step in a healthy direction, but for many it's not the only step that is needed. This post explores a few reasons why people eating a vegan diet can still struggle with their weight. So what to do if you're still struggling? Find a vegan-friendly dietitian to work with and consider slowly picking up serious weight training or running. If that fails, a lifestyle medicine doc might be a good ally.

Many people write looking for a vegan-friendly PCP or Lifestyle Medicine MD. Some potential leads are here:

http://www.lifestylemedicine.org/search
http://www.pcrm.org/
https://eu-lifestylemedicine.org/member-directory/

The #2 Runner Up: Why SOME People Struggle With A Vegan Diet

Each year, tens of thousands of people are inspired to go vegan out of deep concern for animals, the environment and their health. Sadly, the majority of those return to a regular diet of animal foods. Yes, it can be hard to not eat like everyone else and the effort of going out of your way to find vegan options can become hard to sustain for many. But some don't feel they are thriving on a vegan diet. Why is that? It's a topic that's almost never discussed, but one I encounter in clinic periodically and explore in this post. And no, the answer is not because we need to eat meat or combine proteins!

From my clinical experience, the first issue mentioned in this post - not eating enough calories - is the most common problem and is one that can be easily addressed if recognized. The common pattern is someone who switches to a vegan diet, loses a few pounds, feels fantastic at first but as the weeks and months go by they continue to lose too much weight or feel fatigued. Essentially, they need to learn how to eat more calories and monitor for weight periodically.

Dr. Furhman, one of the few docs with extensive clinical experience in this realm, also cites a need for some of his patients to supplement zinc, DHA/EPA and in rare cases possibly taurine, iodine, vitamin k2. Dr. Greger cites a rare Carnitine deficiency caused by a genetic disorder that might be unmasked by a vegan diet here. These are worth considering if other measures fail.

While cutting out a good 1/3 to 1/2 of your diet and replacing it with plants requires some learning for most people, it's definitely a doable (and highly worthwhile) challenge. But for those who struggle, don't revert back to the standard awful diet that is the norm. In the least, eat as many vegan meals as you can during the week and you'll be making a great difference in all realms. Sometimes, compromise is the answer. Adaptation takes a different time course for us all.

The #3 & Original Post: The Fears Of A Suspecting Vegan. Answered. 

Having been vegan for about 24 years, I have encountered innumerable health concerns borne of fear and propaganda along with every possible iteration of "You're vegan?!? Well, where do you get your protein/nutrients/vitamins/etc?". That inspired me to start a blog for some general responses. In this first post, I tried to spell out from my vantage point which things do actually warrant some attention. There's no reason to have fear on the menu, but there are a few important nutritional items those on a vegan diet should head. The list is much longer for those not on a vegan diet, and those can be found elsewhere.

Want More?

I highly recommend Dr. Greger's site - NutritionFacts.Org

Thanks Thanks Thanks!!!

Thanks to you for taking time to read my blog and share both feedback and your appreciation. Can't say how much that has given me over the years. Eventually, I'll get back to blogging more on these and other related topics.

But for now,
Much love to you all,
And thank you for all you do to make this a better world,

Mark

The Impeccable Doctor Murthy & Why He Deserves Your Help

Why the hoopla over your Surgeon General To Be? 

Recently, the NYT wrote about my dear friend and colleague Vivek Murthy, MD MBA - the US Surgeon General nominee whose Senate confirmation vote is being delayed in part because of intense efforts from the National Rifle Association. The NRA claims that Dr. Murthy is a rabid gun activist who is out of touch with the people and doesn't belong in office. To my knowledge, the NRA hasn't even met with Dr. Murthy. Their policy is clear - anyone who mentions the word 'gun' in anything but favorable terms is their Enemy #1.  Their agenda is singular, and it certainly has nothing to do with improving America's health.

As you might guess, I'm not a proud member of the NRA, but that is beside the point. Their efforts are a distraction and a disservice to this nation. Dr Murthy is the perfect candidate for the Surgeon General post, in a time of emerging technology, endemic obesity and disturbing health disparities. This is why he has been endorsed by a phenomenal array of medical groups and individuals.

A few personal words, about the good Dr.

In all of our lives, some people just stand out. I've lived in 3 countries, trained at 5 institutions and worked in 4 distinct sectors. I've been extremely fortunate to cross paths with thousands of truly phenomenal people over the past several decades. Vivek stands out amongst them. Why?

It could be that he possesses a very rare combination of traits. Vivek is as humble, down-to-earth and mild mannered as people come. He's earnest, self-sacrificing, works tirelessly and selflessly for the good of others. His accomplishments range from admission to the world's top academic institutions, to starting several grassroots non-profit organizations, to launching successful businesses. But this might not be noteworthy if he also weren't such an amazing human being. His ability to truly listen and to connect and understand others is stunning. There's a presence about Vivek that is other worldly.

I first met Vivek at Yale School of Medicine 15 years ago, where he was a year ahead of me. I followed in his foot steps to train at Harvard's Primary Care and Population Medicine residency program. I've seen him in many a trying situations, from comforting ailing patients to the ER-like-drama of "coding" a patient to bring them back to life. Above all, Vivek consistently brings his intense focus, his immense compassion, his calm level-headedness and far-beyond-his-years wisdom to everything he does.

In case it's not clear, this man is not only a brilliant physician and entrepreneur, he's a phenomenal human being who will energize the national conversation around nutrition, exercise and obesity.

What you can do NOW & how you can help. 

Do we really want the NRA to pick the nation's Surgeon General? They've outright said that they will be counting Senators' votes on the matter - which is about as close to [legal] political blackmail as it comes. Even if you support gun ownership, do you think the NRA is qualified to determine who should be Surgeon General?

One small thing you can do right now:

Go to standwithvivek.com and add your name to the Million plus people who support Vivek for Surgeon General.

Then help us spread the word. Join us on Team Vivek. 

Then reward yourself with this little Daily Show clip on the matter.

The Daily Show
Get More: Daily Show Full Episodes,Indecision Political Humor,The Daily Show on Facebook

Obesity: A Tale of Success Gone Awry

Source: flickr/tjmartins

There are now 1 billion overweight or obese humans on earth. Why is that?

Well, it's not because 1 billion people are lazy, incompetent fools.

Here's a blog I wrote for onegreenplanet.org with my historical perspective and one big piece of the obesity puzzle.

More posts on the topic to come...

Obesity and The First Law of the Jungle

Check out my first blog on onegreenplanet.org

Obesity has to be viewed through many lenses.

The first is "the population lens". We have to understand that weight gain is happening to almost everyone around the world. It's happening because we are biologically programmed to consume food when it is available to us and the food that is now available is more plentiful and energy-dense then ever before in history.

Read more here. 

What happened when I nuked my spinach?

Tonight out of shear boredom I nuked a large bowl of spinach leaves.

Initially I was going to make a hearty salad to accompany my dinner. But I had the same meal last night and felt like a change. Plus the spinach was a touch too woody for my liking.

What happened when I nuked my spinach?

60 seconds later I reduced a large bowl of spinach into a very small pile. I added some lemon juice, salt and extra virgin olive oil. 5 bites and 60 seconds later it was in my stomach and I was still quite hungry.

The same bowl of raw spinach last night took me 10 minutes to eat and helped to tip me over into "I'm a little too full to do anything productive" land.

Why did this happen?

Clearly the nuking started digesting the leaves, extracting the water, breaking down some of the structure, freeing up some nutrients to be better absorbed and destroying others.

What's the point?

There is both value and detriment to cooking or processing food.

The value is that cooking and processing allow us to make food more dense and easier to consume. This can be critically valuable to people who struggle for whatever reason to get enough calories or nutrients. You might know a few of these folks.

This is why the processing and cooking of grains are credited for rapid expansion of the human population. It's one reason why we feed frail people liquid diets. And it's why cooked or processed foods can be important for highly active thin or growing folk.

The detriment is that it makes food more dense and easier to consume. This can be harmful to people who are sedentary and live near an over abundance of food. You might know many of these folks.

This is why cutting out soda, juices, smoothies, breads, baked goods, white rice, etc. tends to lead to weight loss. It's yet another reason why increasing our intake of fresh raw fruits and veggies is a good idea.

The more important reminder: food is context dependent.

There is rarely an absolute right or wrong when it comes to food.

Understanding our choices and the context we live in, however, can enable us to see what is right for us and those around us.

Inspiration from TED

I find myself a little short on time and inspiration for blogging these days, and so will try to experiment with some shorter posts.

I'm also going to cheat a little and borrow some inspiration, often from TED.

STEP 1 - Watch this awesome 15 min TED talk by Dan Ariely:
The first half is entertaining but somewhat less relevant...still, stick it out.



STEP 2. Pause for thought:

The cognitive problems Dan Ariely discusses apply completely to our choices about food and the habits that lead to obesity. As he says, we are "predictably irrational" creatures.

Although there is the prevailing idea that we actually "choose" what we eat, in reality the vast majority of food decisions are not a conscious rational choice.

The "food environment", that is the physical and experiential setting in which food is available to be eaten, is par none the strongest determinant of what we eat. If there is lots of food around, we will eat lots. If there is none, we will eat none. Give us a bigger box of cereal with a bigger bowl and spoon and we will eat more cereal, no matter how hungry we are. If the normal behavior is to finish our plate (or eat meat), we will be much more likely to do that.

Of course, the food and restaurant industry discovered this reality decades ago and has been exploiting it ever since.

Yes, highly motivated individuals can be taught strategies to overcome the influence of the food environment. This is why doctors and nutritionists write diet books and open clinics. This is something we are obligated to do! But, this strategy has and never will work for the majority of people.

To affect change in the majority, we must learn how to change the food environment and the social norms that operate in them. That is our great task.

How can vegans be overweight?

Recently I visited Portland OR, a wonderful city that is especially vegan friendly. I found myself returning again and again to same vegan restaurant/yoga studio a few blocks from my hotel. And every time I went, I was reminded of a question I ponder often:

Why are many progressive, health-conscious, yoga-doing vegans overweight?

Before I offer my answer, let me point out two basic facts. First, on average vegans weigh less than lacto-ovo vegetarians who weigh less (on average) than omnivorous humans. A vegan dietary pattern can protect people from some excess weight gain but it's obvious that many vegans (including raw-foodists) are still overweight. On the other hand, it's fair to presume that these folks are probably a few pounds (if not many) lighter than they would be if they were not vegan.

Second, almost everyone in the US is gaining excess weight. Over two-thirds of US adults are overweight and the entire population weight distribution has shifted drastically over the past 4 decades. This means that even "normal weight" people probably weight 5-10 pounds more than they would had they been born 40 years earlier. Vegans aren't exempt from this phenomenon. We live in a world that makes it easy to eat a lot and hard to expend much energy.

So the main reason why vegans struggle with their weight is the same reason why most people in developed countries are struggling with their weight. (Actually it's a set of reasons which deserve a separate blog or perhaps a book to address)

Let's touch on a few factors that are particularly relevant for vegans:

Vegan Restaurant Portions. If you eat too much healthy food you will gain weight. Vegan restaurants consistently offer mammoth portions. I've eaten at Vegan restaurants in a few dozen cities. One meal typically provides me with enough leftovers for another 1-3 meals. Granted, I am one of those rare cursed folks who has a real hard time eating an enormous volume of food in one sitting. Most people (vegans included) don't have this problem. Think about some of the vegan animals you know (gorillas, elephants, hippos, cows, pigs) and you'll conclude that given ample food any vegan animal can grow enormously large.

Why do vegan restaurants serve so much?! Well, the same reason most restaurants do - economics. Large quantities for little money is considered "good value" by consumers and the cost of the extra portion of food is usually much less than the small additional price increase of the meal. Cheap food means a higher volume of consumers which means more profit. Vegan restaurants often cater to students who are particular sensitive to the value proposition of restaurant meals. And larger portions may broaden the amount of people willing to eat at an all vegan restaurant. Hey Joe Omnivore, want to check out this new vegan restaurant with me? They give you tonnes of food and it doesn't cost much.

Optimistic bias and health halos. Two fun psychological concepts worth understanding. In the context of eating, optimistic bias means you don't think anything bad will happen to you because of your food choices. Other people might gain weight from vegan food, but not me. (This is the same phenomenon that leads most people to think they are not going to die from a heart attack, even when they know that most people do die from heart attacks). We have an intense innate need to feel in control and routinely fool ourselves into believing that is the case. It's hard for us to imagine that a healthy whole foods vegan meal could contribute to weight gain, even in ample quantity.

What's a "health halo"? Here's an example to explain - you see the word "organic" on the front of a cereal box and then throw it in the shopping basket without scrutinizing the nutritional facts or ingredients. The label "vegan" acts as a health halo, magically transforming anything vegan into a healthy food. Vegan smoothie. Healthy! Vegan pizza. Healthy! Vegan donut. Can't be too bad!

In no way am I trying to say you shouldn't be choosing the vegan option. What I'm saying is that all of us are prone to overestimating how good it is for us because it fits a small (albeit valid) list of requirements (no animals killed, organic, etc.). This is particularly true when it comes to calorie content and weight management. We are likely less stringent about portion sizes and calorie monitoring for vegan food then we would be for non-vegan food. And this applies to health conscious vegans too. I do yoga everyday for 2 hours and eat only vegan food. I shouldn't be overweight.

More Options. There are many reasons why a vegan diet causes less weight gain. One simple reason is that it restricts the sheer volume of convenient, readily available calorie heavy food options. At one point this seemed like a bad thing. What do you actually eat? It must be really hard to eat out. My friends used to say this all the time 10 years ago. That's less and less the case, which makes me happy. But in terms of weight management, the more vegan calorie-dense foods available the more vegans will struggle with their weight. Of course, I rejoice at the launch of a new brand of vegan cupcakes, but there is a down side for some.

Basic energy expenditure. We are living in an age of unprecedented calorie-density (e.g. 1200 calorie smoothies) and technological advancement (I have sat unmoving for the past 3 hours only lifting my fingers, but I can honestly claim to be "working"). For most, it's so easy to eat more calories than you use. Adding one hour of exercise a day will make you healthier and happier but it may not fully protect you from weight gain, even on a vegan diet.

A concluding thought.

It is possible for us to create a vegan-friendly world that makes it easier for us all to have a healthy weight. If you are struggling with your weight, adopting a whole-foods vegan diet can be a great step in the right direction. But our work does not stop there.