Men and dieting part 2

I interviewed one man who was 30, six foot three, weighed 15 stone and would prefer to weigh 13 stone. Although he said he would prefer to weigh less, he felt that his weight was not that important. He said: 'I don't feel that my fatness has any effect on my attractiveness. Size and attractiveness are separate. People don't notice.'

I also asked him if being heavier than he wanted to be affected how he felt about himself. He replied: 'My self-esteem comes from being able to function to a standard set by myself both in my job and socially. Attractiveness comes from attitudes and personality.' He did admit that he felt more attractive in nice clothes but that 'people are more interested in what you have between your ears than in muscle'.

I interviewed another man who was five foot eleven and weighed 13¹/2 stone. He said: 'Although I would like to be lighter I don't get depressed about it. I'm more concerned about being fit since there are so many other qualities related to my attractiveness. If I lost a stone I wouldn't be or feel any more attractive, I would simply be a stone lighter.'

He also felt that his worries about his weight were 'my own silly concerns, no one else notices or is affected by how much I weigh. My attractiveness is associated with many other factors.'

Although these men would have preferred to weigh less this did not influence how attractive they felt.

I also interviewed a 26-year-old man who was 101/2 stone and five foot eleven. He wanted to be a stone heavier. I asked him if he felt that this affected his feelings of attractiveness. He felt that, even though he was aware of the ideal man: 'I am not strongly influenced by how men are supposed to look. The world of looking good is a completely separate world to mine and I choose to have no contact with it. I don't really think about attractiveness any more, there are too many other things to worry about.'

Self-satisfaction can be understood in terms of body image and self-image and the relationship between the two. Body image simply refers to the individual's satisfaction with their body, whereas self-image is a more global concept relating to a form of general self-appreciation. Perhaps self-satisfaction reveals a difference between men and women. Women's weight has a greater effect on their body image which in turn has a greater influence on their self-image. Although men may prefer to be of a certain weight, this has little effect on their body image, which is therefore not detrimental to their self-image.

However, some men do report a concern about their weight. I interviewed a 25-year-old man who was six foot three and weighed 15 stone. His ideal weight was about 12¹/2 stone. I asked him why he wanted to be thinner.

I would feel better about myself. It's not to do with health, but mainly to be attractive to women. Fat is unattractive. When I take my clothes off in front of someone I don't feel embarrassed but neither do I feel proud. I think 'I hope they don't mind and still want to go through with this'.

He felt that being his size was not 'a good selling point'.

So how do men respond to their dissatisfaction with their weight? Two per cent of Weight Watchers' members are men. So men do not seem to go to clubs. But do they diet at home?

I interviewed one man who said:

I don't really do anything, I just worry about it. I try to eat less and drink wine instead of beer, but it's more a matter of thinking about it than doing anything. . . .I would like to be thinner, but I don't want to pay the price. It is not worth the sacrifices.

Another man who was two stone heavier than his preferred weight said: 'I sometimes think about eating less but I never really manage it. It is too much effort.' Yet another who was a stone heavier than he wanted to be said: 'I undereat continuously. I can't remember the last time I ate till I was full. I find it difficult giving up things I really enjoy such as butter, but I generally cut down and eat salad.' However, he did add that he ate salad in addition to other foods!

What else do they do? Most men seem to get fit or go jogging rather than actually diet. They try to change their bodies through exercise not eating less. Maybe this is because food does not play such a central role in their lives, maybe it is more acceptable for women to say 'I'm on a diet'. But they are still pressurised to conform to a specific shape.

If weight is a concern for some men, maybe they also worry about other physical characteristics.

In 1955 a study was carried out to see which parts of the body were of most importance to men and women. Whilst women focused on hips, thighs and waist, the results for the men showed that their equivalent weak point was their height. Height seemed to be the factor which had the greatest effect on their body image. Men associated height with power, sexual strength and intellectual capacity.

Society expects a man to be taller than his female partner, and associates male height with other desirable qualities such as authority and social status. A study in 1968 evaluated the relationship between perceived height and power. Students were introduced to a Mr England and were told that he was either a fellow student, a lecturer, a senior lecturer or a professor. They were then asked to estimate his height. The results showed that his estimated height increased with his supposed seniority. Height was associated with power. Interestingly, this association also extends to politics. As a sociologist, Feldman, said in 1971, 'It is not by chance that every American president since 1900 has been the taller of the two major political candidates.' In addition, in 1960, American voters were asked whom they preferred, and whom they thought was the taller out of Kennedy and Nixon. It was found that preference and perceived height went together.

Why is height so important?

On the whole, men are up to 5 —10 per cent taller than women. Girls tend to have finished their significant growth by the time they reach 13 or so, just after they start to menstruate. They will reach their adult height by the age of 18. Boys start to grow a couple of years later but keep growing for a longer period of time. It seems to be because of this longer growth period that men end up taller.

Performance enhancement in perspective

There are countless nutritional products aimed at the sportsperson, which claim to have some performance-enhancing ability. These substances, called `ergogenic aids', theoretically improve performance to a point above that obtainable through a good training programme. Athletes are very susceptible to any claims for even the slightest improvement in performance, as fractions of a second could mean the difference between winning or losing.

Many ergogenic aids are basically expensive forms of proteins, minerals and vitamins. Their effectiveness is often unproven, based on folklore and reliant on the ignorance of the consumer (for example, substances such as Royal Jelly and wheat germ oil). On the other hand, some performance-enhancing principles are based on reputable scientific evidence that have been shown to improve performance in the laboratory (such as carbohydrate supercompensation - see overleaf).

However, it is interesting that even in cases where the supplement or _special diet has no physical basis, an athlete can sometimes gain purely psychological benefit from consuming something he or she believes in.

Proteins and amino acids

Although certain athletes may need an increased amount of protein, taking excessive amounts in the form of powdered or liquid supplements is unnecessary. Despite the claims of manufacturers, large quantities of protein will have no beneficial effects on muscle growth, strength or on performance. Any excess will simply be used as an energy source or stored as fat. In addition, kidney function may be hampered and dehydration caused as a result of taking in too much protein.

The supplements currently in vogue - especially among body builders and weight lifters - are amino acids, the 'building blocks' of proteins. The theory is that certain amino acids stimulate growth hormones. The increase however is slight and has no practical effect. Amino acids are not 'fat burners' or detoxifiers as has been claimed. Although tablets taken for this purpose are extremely expensive, the amount of amino acids in them is very small. In fact, a single egg contains far more than that found in seven or more amino acid tablets!

Vitamins and minerals

As mentioned earlier in this chapter, supplementing vitamins and minerals has no performance-enhancing properties in an athlete whose normal diet is not deficient. The effects of taking megadoses of certain vitamins may even impair performance.

Manufacturers and quasi-nutritionists have given certain substances vitamin status, although they are not scientifically classified as vitamins. For example, pangamic acid (otherwise known as vitamin B15) supposedly prevents various diseases, slows the ageing process and improves physical performance. None of these claims has been substantiated. Laetrile or vitamin B17 is a source of cyanide and has been banned. Other `pseudovitamins' are orotic acid (vitamin B13), bioflavenoids and vitamin B-T (or carnitine), all of which do not function as vitamins.

Carbohydrate loading

`Carbo-loading' is a phrase which has passed into common use. It has been proved scientifically that carbohydrate loading (otherwise known as carbohydrate supercompensation) is one of the practices which is effective in improving performance. It may be explained in the following way: Exercise which lasts for longer than 60-90 minutes is dependent on the amount of glucose available. Glycogen (glucose) stores in the muscle and liver are small, so enlarging them allows an athlete to continue exercising at a higher intensity for longer. A carbohydrate-loading programme increases the amount of muscle glycogen stored before you need to use it.

The best method of doing this is to gradually reduce the amount of training you do during the six days preceding an event and, during the final three days, eat a diet that is high in carbohydrate (500-600 grams per day). The extra glycogen stored in this way allows the athlete to continue exercising for longer.

Carbohydrates, fluids and sodium during exercise

It has been proved that supplying the body with carbohydrate during endurance-type exercise has a glycogen sparing effect which allows an athlete to exercise for longer. Many studies have been done in attempts to find a solution that will allow the maximum amount of water to be absorbed, while at the same time providing an optimal amount of carbohydrate. So far, it seems that a form of carbohydrate known as 'glucose polymers' has the best absorption rate. These are chains of glucose molecules linked together. A solution containing about 10 per cent carbohydrate in the form of glucose polymers supplies the most glucose to the body during exercise, and at the same time provides sufficient water replacement. (It is important to remember that a carbohydrate solution is only of benefit during prolonged exercise.)

Adding sodium to replacement fluids increases the concentration of the fluid. It was initially thought that this would hamper the absorption of the fluid, but the most recent findings suggest that the addition of a very small amount of salt (1-2 grams per litre) is in fact necessary for absorption.

Alcohol

Not surprisingly, it has been proved that alcohol has no beneficial effect on exercise. In reality alcohol is a depressant that slows reaction time, impairs muscle reflexes and disturbs coordination. In addition, it causes dehydration which interferes with fluid balance and has a negative effect on performance.

Caffeine

Some athletes use caffeine as a stimulant and to increase the amount of free fatty acids in the blood. Theoretically, more fat is then available to be used for energy, resulting in glycogen sparing (see above). However, an excessive amount of caffeine is necessary to produce this effect and, apart from the fact that a very high concentration of it in the urine can disqualify a competitive athlete, there are several other disadvantages to using caffeine in this way. The main one is that it has a diuretic effect, which results in increased fluid losses and a greater risk of dehydration. In addition, overconsumption of caffeine can result in headaches and nausea and it is therefore not advisable to use large doses of this stimulant in an attempt to enhance performance.

Other imposters

Royal jelly, wheat germ oil, ginseng, extracts of various herbs and numerous other products have all at one time or another been touted as performance-enhancers. The truth is, however, that the only possible effect most of these substances could have would be a psychological one.

Must Know: Facts about fat in Your Diet

Although the effect of the total amount of fat in the diet on blood cholesterol levels has been well documented, the most important effectrelates to the type of fat.

Saturated fats have a profound hypercholesterolemic effect (in other words, they increase blood cholesterol levels significantly) and simultaneously increase concentrations of LDL or 'bad' cholesterol. Sources: Saturated fatty acids are found in both animal and plant products, but animal products (such as butter, cheese, full-cream milk, cream, ice-cream, beef, pork and lamb) are the major source of saturated fat in the average South African diet. Similarly, hard or brick margarine (the product packaged in a wrapper) is high in saturated fat; soft of 'tub' margarine is the healthier alternative, since it is low in this type of fat and higher in polyunsaturated fats. Using a polyunsaturated fat will also help to improve your P:S ratio (see below). Coconut oil, cocoa butter, palm oil and palm kernel oil are common 'saturated' vegetable fats which are generally found in many commercially baked goods such as biscuits, also in non-dairy creamers, cake mixes and chocolates. Read labels carefully if youwant to avoid these products.

Mono-unsaturated fats were previously thought to be 'neutral' intheir action on blood cholesterol levels, but recent studies suggest that these fatty acids may play a useful role in the dietary prevention of CHD, since they appear to have most of the benefits of polyunsaturated fatty acids.

Sources: Olive oil, avocado pears and nuts are rich sources of monounsaturated fat.

Polyunsaturated fats lower blood cholesterol levels as well as the concentraton of LDL cholesterol.

Sources: Sunflower oil, tub margarine.

There are two classes of polyunsaturated fatty acids, namely omega-3 and omega-6, which have a variety of functions in the body. Omega-3 fatty acids are found in some vegetable oils and, in particular, in fatty fish. Eicosapentanoic acid (EPA) - a fatty acid which falls into thissub-class - is derived from fish and is highly concentrated in fish oils. Research suggests that this fatty acid may play a beneficial role in a diversity of biological processes including arthritis, eczema and even cancer. However, the role of omega-3 fatty acids - and specifically EPA - in the treatment of hypertension and raised serum cholesterollevels remains controversial.

It seems from studies done so far that fish and fish oil supplements may lower triglyceride levels, reduce clot formation, decrease blood viscosity (or thickness) and lower blood pressure levels. However, the optimal doses of these fatty acids have not been established and until answers to these questions are known, the widespreadsupplementation of omega-3 fatty acids is not recommended. It is a better idea to substitute fish, especially fatty fish (such as salmon, galjoen, snoek, pilchards and tuna) as a source of protein in two or three meals a week, thus consuming a whole spectrum of nutrients and not just a single fatty acid fraction.

The P:S ratio

The ratio of polyunsaturated to saturated fatty acids in a diet is known as the P:S ratio. The typical South African diet has a P:S ratio of 0.5:1.0 (in other words, twice as much saturated as polyunsaturated fat). However, the eating plan recommended for the prevention of CHD suggests a ratio of at least 1:1 (or an equal quantity of both), which for most of us means restricting our saturated fat intake and replacing it, where practical, with polyunsaturated fat such as fish or sunflower oil. Most of the comparisons between the effects of saturated and polyunsaturated fat have indicated that gram for gram, the blood cholesterol-raising effect of saturated fat is up to two times greater than the cholesterol-lowering effect of polyunsaturated fat.

Many studies have shown that so-called 'intervention trials' aimed at lowering raised blood cholesterol levels, reduce the CHD risk and slow the progress of arterial damage. These studies provide strong support for recommendations for a considerable overall decrease in dietary fat by the general public, from the present 35-38°/o to 30% of total kilojoule intake, and a decrease in saturated fat to 10% of total kilojoule intake.

How fibre affects the body

The whole subject of food residue is a complicated one because of the variety of indigestible compounds and the different ways in which they influence the digestive and absorption processes in the body. In the simplest terms, dietary fibre acts in the digestive tract by binding or absorbing water and other substances, thus causing 'bulking' of the contents of the gut. It influences the speed with which food moves through the various parts of the digestive tract. However, the ways in which fibre affects digestion, absorption and the movement of food in the digestive tract are diverse, far-reaching and not always well understood. To illustrate this, fibre in the diet may affect blood sugar levels, the production of bile, the transport of cholesterol in the body and your chances of developing colon cancer. It can even affect the hormonal responses to a meal.

A variety of factors influence the effect of a particular fibre or high- fibre food. The chemical composition of the fibre, its particle size, the age of the plant source and methods used in the processing of the food, all affect the physical properties of the fibre. It is these characteristics which account for the different functions of fibre in addition to its main effect of causing in^creased bulk formation in the digestive tract.

Fibre effects are also influenced by the total composition of the meal and the amount of fibre in it. Short-term effects - for example on the blood sugar level - can be seen immediately after a person has eaten a single high-fibre meal. Long-term effects, such as lowering of blood cholesterol levels, occur only after a regular and prolonged intake of fibre. The effect of fibre in the different parts of the digestive tract (stomach, small and large intestine) also differs and may vary between individuals.

Fibre and the diseases of affluence

As already mentioned, research on dietary fibre was initially stimulated by studies which showed that population groups who follow high-fibre diets suffer far less from the 'diseases of affluence' - the medical term used to describe degenerative diseases and disorders which have been linked to a prosperous Western lifestyle. Among these are colon cancer, appendicitis, gall stones, varicose veins and constipation. Their causes are many; what has been established is that a variety of environmental factors, including dietary habits, can trigger these diseases in people who are genetically 'vulnerable' to them. This explains why they tend to run in families and why some people, even though they follow a Western lifestyle, do not develop a particular disease.

Let's look at those diseases which are known to be associated with the amount of fibre in our daily diets:

Constipation

Constipation is probably one of the most common disorders in the world and is also the cause of other diseases (see diverticular disease and colon cancer below.) It can be defined as the relatively slow movement of unduly firm waste matter through the large bowel, which results in the infrequent passing of small, hard and dry stools - often accompanied by straining.

Including enough fibre in your diet prevents constipation in various ways. Firstly, fibre is not digested in the small intestine. It therefore moves to the large bowel where it has a bulking effect, increasing the volume of the bowel content. Because it binds water, fibre prevents the absorption of water from the large bowel to some extent, ensuring that the contents remain large in volume and soft in consistency. Fibre also stimulates the growth of microbes in the large bowel, which contributes to larger, softer stools. The larger volume in the bowel stimulates peristaltic movements and eases the process of defecation so that straining is not necessary. In addition, during the partial fermentation of fibre in the large bowel by microbial enzymes, substances such as methane and hydrogen gasses, water and the short-chain fatty acids are produced. There is now convincing evidence that these acids play an important role in maintaining a healthy bowel.

Diverticular disease

It is now recognised that constipation - and the resultant increase in pressure in the colon (large bowel) because of strained bowel movements - is the underlying cause of diverticular disease. In this disorder, small, blown-out pouches or sac-like swellings (diverticula) form in the wall of the colon and project into the abdominal cavity. Inflammation of these pouches is known as diverticulitis and may cause abdominal discomfort and pain.

Diverticular disease is very common in affluent societies, especially among elderly people. The treatment of constipation with high-fibre diets will not only help prevent the development of the disease, but will also improve - and may even 'cure' - an existing condition.

Colon cancer

Although the role of diet in the development of this disease is still unclear, some scientists believe that high energy and fat and low fibre intakes are important contributing factors (see Cancer - can Your Diet Make the Difference?, page 181). The way in which fibre may protect against colon cancer is probably very complex. It is thought that the rapid movement of a bigger volume through the large bowel shortens the bowel wall's exposure time to substances which may induce cancer (carcinogens).

Because of its bulking and water-binding effects, fibre dilutes the concentration of carcinogens in the gut. It may even bind these substances and help with their excretion in the faeces. New research has showed that butyric acid, one of the short-chain fatty acids produced from fibre fermentation in the large bowel, also protects the bowel against the development of cancer. In addition, changes in colonic pH as a result of the fermentation process may be of importance.

Diet and Drug Interaction

The use of drugs or medication to maintain or restore health has increased tremendously during the past 20 years.

A 'drug' may be defined broadly as any chemical substance that is not one of the basic nutrients (proteins, carbohydrates, fats, minerals and vitamins) and which, when taken in, changes the body's structure or function. Incidentally, according to this definition, even ordinary table salt could be labelled a drug! For the purpose of this article, however, the term 'drug' will mean a non-food substance that is deliberately introduced into the body in order to produce some physiological or psychological effect. Of course drugs act in a variety of different ways, depending on their particular applications, which may be any of the following:

• relief of symptoms (such as headaches)
• prevention of illness (as in the case of vaccines used against diseases such as polio)
• control of chronic conditions such as high blood pressure
• treatment of certain diseases (for example, antibiotics which are used to treat tuberculosis).

How do drugs work?

What determines how a certain drug acts on a specific problem? Why does one have an effect on the blood vessels and another on the lungs? The answer to these questions has to do with the concept of 'receptor sites' - the idea that a drug has its effect only at specific spots within cells where the drug molecule 'fits'. (A molecule is the smallest unit of a chemical substance such as a drug.) These drug molecules do not act on the whole cell, but only at the receptor sites - and only on those cells with receptor sites that are compatible with the drug molecule. The diagram on the following is a representation of the way in which this compatibility works.

Prescription drugs - handle with care!

Whenever your doctor prescribes a medication, make sure that either he/she or your pharmacist gives you the following information:

• The name of the drug (many drugs go by different names)
• The reason you are taking it
• How the drug should be taken (before or after meals, with water, fruit juice or milk, etc)
• The dosage safety level of the drug (to prevent overdosing if you have to use the drug in an emergency)
• How often you should take the drug
• The length of time you should continue to take it
• Whether taking the drug requires any change in your diet or activities (For example, certain drugs may not be taken with alcohol and others may cause drowsiness or interfere with your coordination.)
• What side effects can you expect? (All drugs cause side effects,ranging from the trivial to the serious.)

The drug/diet link

After many years of research, health professionals have established that foods and nutrients do interact with drugs to a significant extent. In other words, medication can have an effect on a person's health and conversely, food can influence a drug's effectiveness. The risk that a drug might have an adverse nutritional effect or that drugs and food might be incompatible becomes particularly relevant when:

• the drug is an 'anti-nutrient' (in other words, it acts like a nutrient even though it is not one)
• a drug which has adverse nutritional effects is taken for a long time
• the patient is taking more than one drug at a time
• a patient's diet is either nutritionally inadequate or the patient is already malnourished
• drugs are used excessively (or there is abuse of prescription or over- the-counter drugs)
• food and/or drugs are not being properly absorbed due to disease
• the patient is not given special diet instructions when necessary
• physicians, pharmacists and dietitians are unaware of the risks involved.

The use of medication may influence nutrient intake, absorption, metabolism or excretion; in the same way, foods or their components may affect the absorption, metabolism and excretion of drugs. To paraphrase this, drugs and foods can interact by one of the following mechanisms:

• Drugs plus foods (nutrients) = changed drug effect
• Drugs plus foods (nutrients) = changed nutritional balance