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How Sweet It Is

I’m baaack!  Sorry I have been away so long. I just got busy. While I am “retired,” I do teach in the spring semester.  Then I got to doing some home renovations, got sidetracked by life, etc. etc. Please bear with me and the fact that this is just a hobby.  I hope you don’t mind the infrequency of my musings.

What brought me back to the keyboard was the debate that has emerged again over artificial sweeteners. As many of you may have read, the World Health Organization (WHO) and the International Agency for Research on Cancer (IARC) recently issued the results of a hazard and risk assessment on aspartame, an artificial sweetener that has been used since the 1980’s in a lot of things, including diet drinks and foods. Citing “limited evidence” of carcinogenicity in humans, the IARC determined that aspartame should be classified as “possibly carcinogenic to humans.”  This caused the WHO’s Joint Expert Committee on Food Additives (JECFA) to “reaffirm” that the acceptable daily intake of aspartame is 40 mg/kg of body weight.  See, https://www.who.int/news/item/14-07-2023-aspartame-hazard-and-risk-assessment-results-released.

To be honest, as a fan of Diet Coke, my first reaction to this news was DUH.  I mean, did anyone ever think the stuff was good for you? I’m not sure I needed a study to tell me to keep artificial sweeteners to a minimum.  I think it was the word “artificial” that tipped me off.  It is true that when I was diagnosed with diabetes and needed to change my diet radically that it would have been very easy to simply substitute artificially sweetened foods for sugar sweetened foods and leave it there.  I made a choice not to do that based on reading and education that everyone should undertake if they need to reduce their sugar intake or improve their nutrition.   I chose to continue to drink Diet Coke but to limit my intake to no more than one per day.  Plus, my aspartame intake is pretty much limited to that one Diet Coke.  Otherwise, for sweeteners, I try to use natural ones like stevia, monk fruit or apples. Of course, other sweeteners like maltitol and xylitol make their way into my diet.  They claim not to be “artificial” or harmful, but who knows what the next study will find.  For me, this feels like a reasonable balance that allows some sweetness in my diet without overloading on substances known to be harmful.  As my mother used to say: “everything in moderation.” 

But what is most fascinating to me here is the debate itself.  First, the way this was covered in the news frankly makes me want to scream.  This was such a Nothing Burger it was hardly worth the airtime (and news flash: a Nothing Burger is definitely healthier than a Cheeseburger). It’s unclear where the blame lies, but the lack of credence this study deserves is evident from the WHO’s own press release.  The quote from the IARC representative cites the “limited evidence of carcinogenicity in humans and animals,” that “underscore the need for more research to refine our understanding on whether consumption of aspartame poses a carcinogenic hazard.”   The quote from the JECFA representative explaining their decision not to change the recommended daily intake level states that “JECFA also considered the evidence on cancer risk, in animal and human studies, and concluded that the evidence of an association between aspartame consumption and cancer in humans is not convincing.”  Both of these statements can be found at the link above.

The WHO release also notes that the JECFA recommended daily intake level of 40mg/kg of body weight would translate to roughly 9-14 cans of diet soda per day in a person weighing about 150 pounds! I think it’s fair to say that is more than the average person – or really any person – drinks. This makes the impact of this study on the average consumer even more tenuous. 

The U.S. Food and Drug Administration (FDA) immediately issued a statement disagreeing with the WHO’s classification of aspartame as a possible carcinogen based on this study, see, https://www.fda.gov/food/food-additives-petitions/aspartame-and-other-sweeteners-food, and to be fair, many media outlets did cover that statement at the same time.  However, I don’t believe that cleared up the confusion in any significant way.  I know people that I consider to be extremely intelligent and well-informed who have said to me in the last few weeks – “Did you hear? The WHO found that Diet Coke causes cancer!”

As a crusty old diabetic environmental lawyer/consumer advocate this makes my blood boil.  The environmental lawyer in me knows that we are surrounded by things that can give us cancer or otherwise make us sick.  As a diabetic, I need good information so I can make informed nutritional choices to manage this complicated disease. As a consumer advocate, I believe we should be able to count on government to provide us with reliable information on the safety of the products they allow on our shelves.  

So where does this leave us? Are we on our own? To a certain extent, yes.  But not completely.  The FDA web page linked above is actually very informative, and it links to other very informative pages. If you have the time and desire to really learn about alternative sweeteners, you can probably find the information you are looking for by starting on that page.  But it is up to us to do the work. There is so much misinformation out there you will never get a clear and accurate answer without spending some time and doing some reading.  The FDA web page is a good place to start.  Here is the link again https://www.fda.gov/food/food-additives-petitions/aspartame-and-other-sweeteners-food

I can’t end this blog piece though without saying a few words about misinformation and shaming.  Some people just don’t like the taste of aspartame and diet sodas and so they prefer – if they drink soda at all – to drink regular soda with sugar. That is certainly their choice.  However, sometimes people purport to drink regular soda over diet soda because they claim it is the healthier choice over diet soda because it does not contain aspartame or other artificial sweeteners. That is bonkers. Regular soda contains high fructose corn syrup which comes with its own health consequences.  Over consumption of high fructose corn syrup can lead to obesity, fatty liver disease, increased risk of colorectal cancer, diabetes, heart disease and other illnesses.  Mexican Coke, if you can find it, is made with natural cane sugar. However, the regular Coke you get in the United States is not and it is not any “healthier” than Diet Coke or Coke Zero.  I just roll my eyes when people get self-righteous about choosing regular Coke claiming it is a healthier choice because it does not contain aspartame.  

Certainly, foregoing sweetened beverages altogether is a healthier choice. I like an unsweetened iced tea myself or a seltzer with lime. They also now make sodas sweetened with stevia, although I have not tried enough of them to make any specific recommendations (perhaps a future blog entry?).  But it’s not fair to ask diabetics to drink only water all the time. Nor is it realistic to expect them to do so. People will want something sweet once in a while, so we do need alternative sweeteners. Please don’t shame them for wanting that and don’t get judgmental if they have a diet soda occasionally.  Anything sweet or artificial is going to come with risks.  It’s all about balance, self-restraint, and making choices.  We need to inform ourselves and create diets that we can realistically stick to.  “Everything in moderation” is a good place to start. 

It sure would be a lot easier though if the people doing studies like this and the people reporting on those studies strove to inform us rather than get the most headlines or “clicks.” Until then, I guess we will just have to educate ourselves. 

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Resolutions

I’ve often felt that New Year’s resolutions are a trap. You wake up after a night when you either stayed up too late drinking and eating, or you fell asleep before midnight trying to do so.  Either way, you wake up on New Year’s Day feeling somewhat disappointed in yourself and vulnerable to the suggestion that you should resolve somehow to be better. Then you are bombarded immediately – and by that, I mean if you don’t turn off your television before the first commercial break after midnight – with ads for gym memberships, diet programs, nutritional supplements, and minor surgical procedures that are going to make you a better you. It makes you want to either pour yourself another drink, grab another cookie or go to bed. 

Please don’t misunderstand.  I think it is an excellent idea to take stock periodically, think about how we can improve ourselves, and hit the reset button on parts of our lives that could be working better. New Years is as good a time as any, especially if you want to take advantage of January sales at yoga studios or fitness centers, but really you can do this at any time of year.  Where the “trappy” part comes in though, in my view, is in the expectations department. We’ve just come out of a time of year when everyone is talking about miracles and wonderment.  People have been watching Hallmark movies, reindeer are flying, snowmen are singing, and even the Scroogiest of people are showing goodwill. It may not be the best time to set our expectations for what we can realistically accomplish in the new year. Then, with expectations high, we set out with that all-important earnestness to those yoga studios and fitness centers and flood them in the early weeks of January.  Can’t find a parking spot near the gym?  No problem! I’ll walk there!  But a few weeks later when it’s 20 degrees and dark and you can’t find a parking spot you start to give up and say you will try again tomorrow. Tomorrow becomes the next day. February becomes March. Your resolution goes by the wayside, and you feel disappointed in yourself again. 

I think the solution is to make little resolutions throughout the year. Ones you can accomplish.  You can start in January, but if you succeed by February, good for you! Make another one. Don’t resolve to “lose 30 pounds.”  Losing 30 pounds is hard. It can take a very long time.  While that may be something you ultimately want to do, resolve first to do something more manageable. For example, you could resolve only to eat savory breakfasts, or only to eat whole grain breads, or to cut out one thing like bacon or fast food. These things may lead to weight loss, maybe even 30 pounds worth over time, but they are much more manageable and will allow you to declare victory and feel good about yourself sooner (even if you end up cheating occasionally). It’s about setting yourself up for success and then building on that success. 

I haven’t decided yet if I am going to make a resolution this year. Last year I didn’t make one till spring when I decided I wanted to “kayak more.”  I bought kayaks at my beach house, and I did, indeed, kayak more (that was an easy one).  The year before I resolved to “waste less food.”  That one was a little harder, but I succeeded there too, mostly by targeting my produce buying to what I could realistically eat and then prioritizing its use by what was going to go bad first. I decided to stack on top of that cutting down on my use of plastic film wrap (which wreaks havoc at recycling facilities) by using plates and pot tops etc. to cover food in the fridge instead. All doable, all done.  This year I’m thinking of cutting down on processed meats.  While I really try to eat healthy, I haven’t been able to eliminate bacon from my diet or escape my love of Jewish deli.  I know I will never be able to eliminate them entirely as long as they continue to serve hot dogs at baseball games, but maybe I can at least eat less. I’ll let you know how that goes. 

We all have the hard things we want to change about ourselves and the somewhat easier things.  Changing the hard things frankly needs to be a 365 day a year multi-year venture.  It’s not the stuff of resolutions.  Resolutions should be about the easier stuff. The things you can accomplish so you can give yourself some confidence for that 365-day struggle to address the big issues. Resolutions are for the things you can check off the list and then move on, patting yourself on the back as you go. Because when it comes to the hard stuff, simply resolving to be different doesn’t make it happen. That requires changing habits, changing expectations, reorienting priorities, and a lot of time and hard work. You should no doubt resolve to do these things, but you will still be working on them next January, the January after that, and the January after that, G*d willing! For now, for this January, pick something simple and doable.  Give yourself a win. 

So here’s hoping we don’t set traps for ourselves in 2023. Happy New Year!! Champagne glasses with solid fill

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Cheatworthy

There is a Seinfeld episode where Elaine, concerned about the fact that she could no longer buy Today contraceptive sponges, puts her boyfriend through a rigorous examination to determine whether he is worthy enough to justify using up her dwindling supply. “Sponge-worthy” was the term she used to describe the threshold he needed to meet.  I apply a similar (though very different) analysis to cheating when it comes to eating things I shouldn’t. I can’t really cheat much on dairy – maybe the occasional taste of a sauce that has a little butter in it – but I can cheat occasionally and have something sweet.  When I was first diagnosed with diabetes, my doctor said, “You can have birthday cake,” but, as I like to point out, he never said specifically that the only birthday cake I could have was my own birthday cake.

Of course, I don’t want to push it.  I don’t want one torrid affair with a good-looking cookie to throw me off my whole program.  To justify cheating on my low-carb low-sugar life, that cookie has to not only look good, it has to be good.  It must taste at least as good as it looks. It must be worth the extra walking, carb deprivation or disappointment-at-your-meter-reading that comes later. In short, it must be cheat-worthy.  

Everyone’s definition of cheat-worthy is going to be different. Mine generally involves chocolate. Not just any chocolate. Milk chocolate isn’t chocolate enough.  The darker the better (and this is good because dark chocolate is better for me anyway).  Give me one of those flourless chocolate cakes filled with molten chocolate covered with chocolate sauce with shaved dark chocolate on top. I recently discovered a Nutella-dipped chocolate chip cookie at an Italian bakery near me.  Now that’s worthy of throwing caution to the wind!  Maybe you’re a strawberry shortcake person, or perhaps strudel floats your boat. Whatever it is, find what you think is worth it.  Then, limit your cheating to things that are truly cheat-worthy. Treat “cheating” as if, like Elaine, you only have a limited number of sponges left to use. 

I find that over the years figuring out what is cheat-worthy for me has become instinctual. I can walk up to a dessert tray at a party and immediately scan it to determine the cheat-worthiness of its contents.  I no longer even desire things that are not cheat-worthy.  If there’s nothing on the dessert tray that fits the bill I don’t settle, I have nothing. In the Seinfeld episode, Elaine ultimately decides her boyfriend is worth a sponge, but when he comes back for a second go-around the next morning she demurs because she doesn’t think he’s worth two. That’s why I don’t bother settling if there’s nothing cheat-worthy available.  It’s a lousy feeling to have eaten something you shouldn’t have, to find it unsatisfying, and then have to deal with the consequences even though you didn’t really enjoy the good parts.  I know you know what I mean.  We’re still talking about high meter readings, right? 

I do think allowing some small level of cheating is necessary for me.  It actually keeps me in line. Cold turkey with no exceptions is not a discipline I can maintain.  But mostly saying “no” with infrequent exceptions is something I can maintain.  Just knowing that at some point if something good enough comes along, something cheat-worthy, I can have it, allows me to take a pass when something only so-so comes my way.  I find this is a good way to keep my cheating to a minimum.  It’s also a way to justify the occasional molten flourless chocolate cake or Nutella-dipped cookie.  For which I am eternally grateful to Elaine.  

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“I Guess I’ll Just Eat Dirt”

That was the line I read in a comment on a web discussion by someone who was diabetic and had just found out they were also lactose intolerant. It was, in a way, the impetus for this blog.  I knew the feeling.  By the time I figured out that I was lactose intolerant, I was very used to being diabetic.  I had gotten used to a low carb, low sugar diet.  I was used to being on insulin, detecting the symptoms of lows and staying away from the things that caused my blood sugar from getting too high.  I was consistently getting A1C test results below 7 and even below 6.5.  It had become a way of life for me.  While some might be shocked to hear that I was used to taking three shots of insulin a day, I really am.  

But cutting out sugar was not that hard for me.  Sure I missed chocolate chip cookies and certain sweets, but on insulin I could still have an occasional cookie and that seemed to be enough for me.  I never really had a sweet tooth. I found that I was ok with a single bite of something sweet after dinner and a square of dark chocolate or a piece of fruit was enough to satisfy that urge. But give up cheese????  Stop eating pizza????  I didn’t think that was going to work. 

My doctors told me that everyone has a different tolerance for lactose and that I had to find my level.  They also told me that the pills that were supposed to help this worked for some people and not for others and that I had to experiment with the pills to figure out what dosage worked for me.  I was hopeful that if I just popped a couple of pills before sitting down to a Caprese salad everything would be fine. 

The package on the “Dairy Relief” pills suggested 2-3 pills before a meal containing dairy so I started with two.  Then 3.  I tried 4, 5, 6. I think there may have been some benefit but not much really.  Certainly not enough to enjoy a Caprese salad.  At this point I don’t even bother with the pills.  I have just concentrated on figuring out what level of dairy in my meal I can and can’t tolerate. And it’s not much.  Often, I can get by ok with small amounts of butter in cooking.  But pretty much anything else causes uncomfortable digestive symptoms.  I know other people for whom it’s a question of amount.  They can have a little dairy but not a lot. Or for others, the pills allow them to have butter or at least some cooked dairy.  

The fact is that every person is different and will have different levels of tolerance.  There are no tests to help you figure it out and the only way to do so is by trial and error. You need to pay attention to: (1) ingredients, (2) amounts, (3) means of preparation, and (4) your own tolerance for the symptoms that result.  It’s not a bad idea to keep a food diary and a diary of how different foods affect you at least at the beginning.  That will help you map out the quantities and parameters of what you can eat. 

With respect to ingredients, look for hidden forms of dairy.  There have been many times I thought I ate a meal that did not have dairy and then I subsequently had digestive issues.  I was convinced I had some other form of food intolerance until I learned that something in that meal had dairy hidden within.  For example, some brands of cold cuts have dairy in them.  I had no idea and thought I had some sort of intolerance to nitrates or some types of ham until I did some research and realized that it was hidden lactose.

Quantities and preparation are also important factors.  For me, most baked goods are fine.  I can even eat a croissant.  I have seen how they are made.  I know that they are filled with layers and layers of butter.  But for some reason they do not affect me.  I also know that I can tolerate a meal when a little bit of butter was used when cooking it. But I can’t have something cooked in “butter sauce” and I would never eat a buttered roll.  

I only know these things because of trial and unfortunate error.  As I said, everyone is different and there is no other way that I know of to map out your particular level of tolerance. You need to understand both the timing and severity of the likely symptoms if your meal results in the “error” part of trial and error. This can be very helpful in deciding whether a particular meal is a good time to take a risk (given who you are with, what you have to do, ability to get to a bathroom etc.).  If a meal is good enough, a little discomfort might be worth it.  But if you’ve got a big presentation later that day or you are on a first date, maybe not. 

A couple of important things to remember and myths to bust: 

  • Mayonnaise is not dairy – it is made from eggs and oil.
  • Sorbet does not have dairy – although it does have sugar!
  • Yogurt is dairy but there are now many forms of non-dairy yogurt. You just have to be careful about sugar content.  More on this to come.

The most important thing is to read labels and ask questions.  The more you know, the better choices you can make to eat food that makes you feel good. If you are in a restaurant, don’t be afraid to ask questions. Understanding what you are eating and how it is affecting you is the only way you are going to get a handle on this.  You will get better and better at it as you go along, and you will feel better and better as a result.  Most restaurants are very accommodating about your questions and there are usually at least a few things on the menu that will be fine.  If someone gives you attitude, don’t go back. No one should make you feel bad about asking about what you are about to eat.  Remember, a good restaurant wants you to enjoy your meal.  So don’t feel bad about asking the questions you need to ask in order to make that happen.