Slow Food

By Richard P. Holm
Why does food satisfy the appetite? If we could understand what tells us when to stop eating, then maybe we could understand the cause for obesity.

We know that a hormone called ghrelin delivers feelings of hunger to the brain and that two hormones called cholecystokinin and leptin bring feelings of satiation. So far, however, scientists, and especially those of the pharmaceutical industry, have failed in efforts to safely manipulate these natural signals to stimulate or suppress hunger.

Another direction of research comes with understanding how certain foods like oatmeal, boiled potatoes, or fresh fruit fill you up, and others like donuts, French fries, or even dried fruit do not. It is interesting to note that drinks of any kind seem very poor in providing feelings of fullness or satiety. It makes perfect sense then that if one is struggling with obesity, foods that do not satisfy hunger, especially those that are highly caloric, should be avoided.

And what about eating too fast? We know it takes time for the food we eat to stimulate our satiety hormones. We all know it is not very satisfying when we shove fast food into our mouths and swallow it down with a big gulp. No one can argue that the obesity epidemic could be related to oh-so-convenient fast food, which seems to match the fast-paced, unsatisfying rush of modern life.

In contrast, there is the Slow Food movement founded in Italy in the 1980s. Slow Food asks us to preserve regional cuisine and local flavors, and to promote local gardens and local family farmers. Slow Food asks us to shop the farmer’s markets, raise our own gardens, teach our children to cook, take time around the supper table to eat slowly, savor the food, and enjoy the company of family.

Bottom line, and the pun is intended: all the rush, with our busy frenetic modern lives, and especially with all that fast-fast food, has left us weighing more and satisfied less. It is time to slow down and savor our food and our lives. to slow down.

When Grandma Wants to Pull the Plug

By Richard P. Holm MD

“We will all be dead one day, we should not pretend that it won’t happen, and we should all prepare for the experience rather than ignore it.” Recently I was asked to give a talk about the value of the Living Will, and I remember that it became very quiet after those words.
I spoke to a room full of mostly retired people, some of them quite elderly, and I explained that, too often, I have watched helplessly while desperate, fruitless, excessive, and painful health care was provided to a person certainly dying. Put it down as one more paradox in medicine. The fear of death and not facing the reality of dying can be responsible for much of the suffering that can occur at the end of life.

A Living Will, also called an Advanced Directive, is simply a tool to communicate about how you would like to die. It is not about a legal document, it is all about talking to your family. We know there is a time to intervene with fancy medical care and there is a time to let go. My final talking point: the Living Will makes it easier for families to allow a natural and comfortable death when the time is right.

After the presentation one guy told me his wife purposefully avoided coming because she didn’t want to think about such gloomy things. He said wryly, “We are all going to die. Why shouldn’t we talk about it?”

Another asked, “I still don’t know the definition of a Living Will. Does it have anything to do with death squads pulling the plug on Grandma?” I responded, “No, just the opposite. It is all about Grandma telling us when not to put tubes in, so no one has to pull a plug.”
I can’t say it was my happiest audience, and I’m afraid I may have offended some of them by being so blunt. But in this age of external chest massage, shocking paddles, breathing machines, feeding tubes, and the potential for years of vegetative bedridden life, there is hardly a more important message.