Tag: Food

Covid Survivors Smell Foods Differently

Marcel Kuttab first sensed something was awry while brushing her teeth a year ago, several months after recovering from Covid-19.

Her toothbrush tasted dirty, so she threw it out and got a new one. Then she realized the toothpaste was at fault. Onions and garlic and meat tasted putrid, and coffee smelled like gasoline — all symptoms of the once little-known condition called parosmia that distorts the senses of smell and taste.

Dr. Kuttab, 28, who has a pharmacy doctoral degree and works for a drug company in Massachusetts, experimented to figure out what foods she could tolerate. “You can spend a lot of money in grocery stores and land up not using any of it,” she said.

The pandemic has put a spotlight on parosmia, spurring research and a host of articles in medical journals.

Membership has swelled in existing support groups, and new ones have sprouted. A fast-growing British-based Facebook parosmia group has more than 14,000 members. And parosmia-related ventures are gaining followers, from podcasts to smell training kits.

Yet a key question remains unanswered: How long does Covid-linked parosmia last? Scientists have no firm timelines. Of five patients interviewed for this article, all of whom first developed parosmia symptoms in late spring and early summer of last year, none has fully regained normal smell and taste.

Brooke Viegut, whose parosmia began in May 2020, worked for an entertainment firm in New York City before theaters were shuttered. She believes she caught Covid in March during a quick business trip to London, and, like many other patients, she lost her sense of smell. Before she regained it completely, parosmia set in, and she could not tolerate garlic, onions or meat. Even broccoli, she said at one point earlier this year, had a chemical smell.

She still can’t stomach some foods, but she is growing more optimistic.

“A lot of fruits taste more like fruit now instead of soap,” she said. And she recently took a trip without getting seriously nauseous. “So, I’d say that’s progress.”

Optimism is warranted, said Claire Hopkins, president of the British Rhinological Society and one of the first to sound the alarm of smell loss linked to the pandemic.

“There are daily reports of recovery from long haulers in terms of parosmia improving and patients being left with a fairly good sense of smell,” Professor Hopkins said.

Ms. Viegut, 25, worries that she may not be able to detect a gas leak or a fire. That is a real risk, as shown in January by the experience of a family in Waco, Texas, that did not detect that their house was on fire. Nearly all members had lost their sense of smell because of Covid; they escaped, but the house was destroyed.

Parosmia is one of several Covid-related problems associated with smell and taste. The partial or complete loss of smell, or anosmia, is often the first symptom of the coronavirus. The loss of taste, or ageusia, can also be a symptom.

Before Covid, parosmia received relatively little attention, said Nancy E. Rawson, vice president and associate director at the Monell Chemical Senses Center in Philadelphia, an internationally known nonprofit research group.

“We would have a big conference, and one of the doctors might have one or two cases,” Dr. Rawson said.

In an early 2005 French study, the bulk of 56 cases examined were blamed on upper respiratory tract infections.

Today, scientists can point to more than 100 reasons for smell loss and distortion, including viruses, sinusitis, head trauma, chemotherapy, Parkinson’s disease and Alzheimer’s disease, said Dr. Zara M. Patel, a Stanford University associate professor of otolaryngology and director of endoscopic skull base surgery.

In 2020, parosmia became remarkably widespread, frequently affecting patients with the novel coronavirus who lost their sense of smell and then largely regained it before a distorted sense of smell and taste began.

An article last June in the journal Chemical Senses, based on questionnaires, found that 7 percent of post-Covid patients experienced smell distortion.

A later study based on an online survey in Britain found that six months after Covid’s onset, 43 percent of patients who initially had reported losing their sense of smell reported experiencing parosmia, according to an article in the journal Rhinology. The onset occurred a median of 2.5 months after the patients’ loss of smell, the article reported.

That matches the experience of Monica Franklin, 31, of Bergenfield, N.J., who was accustomed to having a keen sense of smell.

Ms. Franklin, a outpatient occupational therapist, said she lost all sense of taste and smell in early April 2020, immediately after contracting Covid.

Two months later, she found herself with both parosmia and phantosmia, or detecting phantom smells. She was constantly inhaling the smell of cigarettes at times when no one was smoking, and she was in her room alone.

Garlic and onions are the major triggers for her parosmia, a particularly taxing issue given that her boyfriend is Italian-American, and she typically joins him and his family on Fridays to make pizza.

She now brings her own jar of sauce, without garlic.

Monica Franklin of Bergenfield, N.J., was accustomed to having a keen sense of smell. “I would be the one who could tell when the garbage had to go out,” she said.
Monica Franklin of Bergenfield, N.J., was accustomed to having a keen sense of smell. “I would be the one who could tell when the garbage had to go out,” she said.Melissa Bunni Elian for The New York Times

For Janet Marple, 54, of Edina, Minn., coffee, peanut butter and feces all smell vaguely like burning rubber or give off a sickly sweetness. It’s like nothing she has ever smelled in her lifetime.

“I literally hold my breath when shampooing my hair, and laundry is a terrible experience. Even fresh-cut grass is terrible,” said Ms. Marple, a former corporate banker.

Confounded by the cavalcade of smell and taste problems, scientists around the world are paying unusual attention to the human olfactory system, the areas of the nose and brain where smells are processed.

They have focused on a piece of tissue the size of a postage stamp called the olfactory epithelium, behind the bridge of the nose. It is the literal nerve center for detecting smells, and it sends messages to the brain.

When people suffer from the common cold, mucus and other fluids may plug the nose so that smells can’t reach the nerve center. But no such blockage typically occurs in patients with Covid-caused anosmia and parosmia.

Some researchers initially speculated that the virus was shutting down smells by attacking the thousands of olfactory neurons inside that nerve center. But then they found the process was more insidious.

Those neurons are held together by a scaffolding of supporting cells, called sustentacular cells, that contain a protein called the ACE2 receptor. A study published last July led by Harvard researchers found that the protein acts as a code for the virus to enter and destroy the supporting cells.

In short, parosmia appears to be caused by damage to those cells, distorting key messages from reaching the brain, according to a leading theory among some scientists.

As those cells repair themselves, they may misconnect, sending signals to the wrong relay station in the brain. That, in turn, could lead to parosmia and phantosmia.

A host of metaphors have sprung up as scientists try to convey this complex process to the public. Some describe a damaged piano, with wires missing or connected to the wrong notes, emitting a discordant sound.

Or you could imagine an old-fashioned telephone company switchboard, where operators start pushing plugs into the wrong jacks, said Professor John E. Hayes, director of the Sensory Evaluation Center at Pennsylvania State University.

Full-scale clinical trials are sorely needed to better understand what causes parosmia and other smell problems, scientists agree.

The National Institutes of Health issued a call in February for proposals to study the long-term side effects of Covid. Dr. Patel, at Stanford, is now enrolling people in a parosmia trial, preferably those who have suffered from the disorder for six months or more, but not as long as a year.

Meanwhile, many patients are turning to support groups for guidance. Such organizations existed in Europe before Covid, but none operated in the United States.

That’s why Katie Boeteng and two other women with anosmia formed the first known U.S. group for those with smell and taste disorders in December.

It is called the Smell and Taste Association of North America, or STANA. The women are now working to get it nonprofit status, with guidance from the Monell center, to raise funds for studies of smell and taste disorders.

Ms. Boeteng, 31, of Plainfield, N.J, lost her sense of smell more than 12 years ago, from an upper respiratory infection. In 2018, she started The Smell Podcast, and has recorded more than 90 episodes, interviewing patients, advocates and scientists around the world.

The best-known group worldwide helping people with such disorders is AbScent, a charity registered in England and Wales. AbScent only had 1,500 Facebook followers when coronavirus arrived; it has more than 50,000 today.

“People are so desperate about their smell loss, because, after all, your sense of smell is also your sense of self,” said the charity’s founder, Chrissi Kelly, who lost her ability to smell for two years after a sinus infection in 2012. She also experienced parosmia.

She was infected with Covid in April 2020 and developed parosmia again five months later. It is lingering, she said.

Ms. Kelly and fellow British researchers have produced numerous articles exploring the impact of the coronavirus on the olfactory system.

Several other groups have emerged in Europe over the years, including Fifth Sense, also in England, founded in 2012, and groups in France and the Netherlands.

The pandemic also spawned the Global Consortium for Chemosensory Research, which is conducting surveys in 35 languages about the link between taste and smell loss and respiratory illness.

Garlic and onions are Ms. Franklin’s triggers for her parosmia, a vexing issue given that her boyfriend is Italian-American, and she typically joins him and his family on Fridays to make pizza. She now uses her own jar of sauce, without added garlic.Melissa Bunni Elian for The New York Times

“Covid has been a magnifier of the gaps of knowledge that we have,” said the group’s chairwoman, Valentina Parma, a research assistant professor in the psychology department at Temple University in Philadelphia.

Online sites are awash with homegrown cures for parosmia and other smell disorders, although experts urge caution. At Stanford, Dr. Patel has treated patients who sprayed zinc into their nostrils, which can cause an irreversible loss of smell.

Smell training can help repair the function of people suffering parosmia, according to a study reported in November in the journal Laryngoscope. The process involves repetitive sniffing of potent scents to stimulate the sense of smell. AbScent offers a kit with four scents — rose, lemon, clove and eucalyptus — but also says people can make their own.

Ms. Franklin uses scented soaps. Dr. Kuttab has a collection of essential oils, and almost all of them smell normal, which she finds encouraging. But while she and her fiancé plan to get married in late June, they’re delaying the party until she’s better.

“I don’t want to be nauseous,” she said.

For some who work in the medical field, the altered smells can be confounding. Tracy Villafuerte developed parosmia about a year ago, and just as her sense of smell started coming back, the scents of coffee and other food turned rancid.

Like some others interviewed, Ms. Villafuerte, 44, is seeing a therapist. “I want to say it and say it loud. You need to learn mechanisms about it so that you can cope every day,” she said.

She is expecting her first grandchild in early July, and hopes she will be able to smell the girl’s new-baby scent.

She works as a certified medical assistant in Bolingbrook, Ill. “People say, ‘You work in urology, so this must be a blessing,’” she said. “I would do anything to smell urine.”

6 U.S. Destinations for a Remote-Working Vacation

As workers prepare to return to the office in coming months, here are six towns and cities to consider squeezing in a working vacation or two.

Those who’ve been able to work from home over the last year have had to get creative about their workstations, setting up makeshift offices on balconies, couches or even kitchen counters. Some temporarily relocated to new cities and towns from early in the pandemic.

But a new convergence of factors in the United States — easier access to vaccinations, loosening domestic restrictions, falling coronavirus cases and good weather — has led to a golden opportunity for those tempted to take their work on the road after a year of staying put.

Remote workers who are vaccinated but are not yet required back in an office are enjoying what may be a once-in-a-lifetime window, if they’re in a privileged position to take advantage of it — to hit the road with laptops in tow, and explore the country while getting paid.

Bookings on Airbnb of 28 days or more have nearly doubled in 2021 compared to 2019, with more than half of surveyed guests saying they used the time to work or study, according to a recent Airbnb report. And 71 percent of guests booking long-term stays said they planned to book a similar stay next year.

But as many employees prepare to return to the office in coming months, this summer will probably be the last hurrah of remote work.

Whether you hope to try out a new city for a permanent move or just want to take advantage of the last few months outside the office, here are six cities or towns to consider for remote work this summer.

For remote workers in Honolulu, Hawaii, who are on East Coast time, an early start can mean spending an afternoon at the beach. 
For remote workers in Honolulu, Hawaii, who are on East Coast time, an early start can mean spending an afternoon at the beach. Michelle Mishina-Kunz for The New York Times

If you like the beach …

Honolulu, Hawaii

Sarah Sheu, 29, who is a product lead for the travel app Hopper, has been working from Honolulu since mid-May. Ms. Sheu works from her parents’ home, which they bought after they retired a couple of months ago. At first, she thought the time difference between Hawaii and the East Coast, where many of her colleagues are based (the company is headquartered in both Montreal and Boston), would make it difficult to communicate with them. But it has worked out, she said, and her early start — she logs on at around 5:30 a.m. — leaves her afternoons free to explore Honolulu.

Remote workers might consider staying in one of the many condos overlooking Waikiki Beach, one of Oahu’s most well-known beaches. On your off time, Ms. Sheu recommends bicycling to and around Diamond Head, a state park with a large crater at its center that has well-marked bike lanes and stellar coastal views. You might also go surfing at Waikiki Beach or stand-up paddle boarding at Ala Moana, which Ms. Sheu said usually has small or no waves.

Hawaii currently has the most stringent Covid-19 restrictions in the country, requiring a negative test to travel and a 10-day quarantine for some inter-island travel. Check the latest rules and advice before you go.

Petaluma, Calif., lends itself to remote work while offering access to San Francisco, some of the region’s most popular vineyards and its beautiful coast.Eric Risberg/Associated Press

If you want to be in wine country …

Petaluma, Calif.

When Joanna Faltys, 31, moved to Petaluma from Boston in 2015, it felt like the perfect compromise between her desire to be in Sonoma County, where she’d grown up, and her now-husband Brian’s need to be close to the San Francisco Bay for his work in the boating industry.

“It was only once we moved here that we realized what a perfect fit it was for our lifestyle as well,” said Ms. Faltys, who managed group travel programs for more than five years before transitioning to higher education this year. “Petaluma really offers everything we love, beautiful scenery, proximity to outdoor activities, great restaurants and coffee shops and good entertainment options.”

The city also lends itself to remote work, she said, with two centrally located co-working spaces and several coffee shops with Wi-Fi, while offering access to San Francisco, some of the region’s most popular vineyards and its beautiful coast.

“One of the best things about Petaluma is that it has the amenities of a larger city, yet still feels like a small, tight-knit community,” said Ms. Faltys.

Ms. Faltys recommends Acre Coffee, located in the city’s downtown, which she said attracts a good mix of students, remote workers and families. The city is known for its craft breweries, including both Lagunitas and Hen House Brewing Company. There are several beer gardens, including The Block, which features a rotating selection of food trucks. And it also boasts its own mini wine region, the Petaluma Gap.

As home of the landmark U.S. Supreme Court case, Brown vs. Board of Education, Topeka has a strong undercurrent of social justice, said a spokesman for Choose Topeka, which encourages remote workers to come.Getty

If you want a manageable city …

Topeka, Kansas

For a city with a spirit of social justice and an array of cultural offerings, try Topeka. The city opened Evergy Plaza in 2020, a central hub with free Wi-Fi where people can work or enjoy a monthly concert series, complete with food trucks and pop-up beer gardens.

This summer, Topeka Music Week will be held at venues across the city, culminating in Country Stampede, which is estimated to bring up to 100,000 country music fans to the city. (Proof of vaccination or a negative test is not required to attend, so consider your personal risk first.)

As home of the landmark U.S. Supreme Court case, Brown vs. Board of Education, Topeka has a strong undercurrent of social justice, said Bob Ross, a spokesman for Choose Topeka, which lures remote workers to the city with financial incentives. One of his recommendations for long-term stays is Liberty House, an Airbnb rental which puts profits toward supporting L.G.B.T.Q. youth in the Midwest.

During their off time, people can explore the North Topeka Arts District, known as NOTO, which was restored in 2008 to include murals, galleries and restaurants housed in historic buildings.

Kelly Edkin, a fifth generation Topekan who owns a coffee shop and bistro called Juli’s Cafe, said she regularly sees remote workers there. She recommends people visit the Topeka Zoo and Conservation Center, or take advantage of the Kansas River, which flows through the city, or nearby Lake Shawnee for swimming, fishing or kayaking.

But what makes Topeka special, she said, are the people who live there.

“I really think the best part of any place you go, whether you’re working remotely or not, are the people and the attitude,” she said, adding that Topekans are “very friendly and helpful.”

Stargazing, desert monsoons and 23 miles of Mexican food: Tuscon has everything you need for a working vacation.John Burcham for The New York Times

If you’re a foodie…

Tucson, Ariz.

Named a UNESCO Creative City of Gastronomy in 2015 for its heritage foods and dishes that draw from its Mexican and Indigenous history and location in the Sonoran Desert, Tucson is ideal for culinary enthusiasts.

Visitors can explore the city’s Best 23 Miles of Mexican Food, a trail of restaurants and food trucks featuring Mexican cuisine, or local favorites like Barrio Bread, known for its bread made of Sonoran wheat.

Gina Catalano, who co-founded La Suprema Works and Events, a co-working site based in an old tortilla factory, said that about 20 percent of guests over the last year have been remote workers, with an uptick in the beginning of this year. When they signed up, people reported coming from bigger cities like New York, Pittsburgh and Chicago.

“I’ve lived in this area on and off for the last 20 years and never have I seen such a diversity of people coming from all over the place,” Ms. Catalano said.

Malvika Agarwal, 34, and Niraj Sheth, 36, who both work for Silicon Valley start-ups, moved to Tucson in December, after an earlier trip left Ms. Agarwal struck by the area’s desert landscape and its monsoon season, which is from June to September. She said it reminded her of her home country, India.

“We were amazed that there’s life here, because it’s so dry,” Ms. Agarwal said, “but it’s green, surprisingly, and there’s these giant 60-feet tall cactus that are blooming right now.”

Tucson is also the headquarters of the International Dark-Sky Association, and has large observatories where people can go look at stars and constellations. “We love the stargazing here,” Ms. Agarwal said.

The neighboring towns of Bath and Brunswick, Maine, offer access to beaches, lakes and rivers as well as hundreds of miles of recreation trail. Getty

If you want a twofer …

Bath and Brunswick, Maine

Bath and Brunswick, two neighboring towns along the coast of Maine, are distinct, but their proximity to one another — about 8 miles — by car or a river trail, makes it easy to explore both during an extended stay.

Brunswick, the home of Bowdoin College, has a thriving downtown and, before 2020, had a steady stream of international visitors drawn to the college and the town’s rich arts scene. Bath is on the Kennebec River, has lots of green space and is a more community-driven town, according to Nate Wildes, the executive director of Live + Work in Maine, which recruits remote workers to the state through networking events and direct marketing.

“The culture and the feel together is really well balanced,” he said, though the towns are “very distinct and different.”

He added that most people who come to the state through the remote worker program don’t end up settling in its cities, like nearby Portland, he said, but rather in surrounding towns that offer a better quality of life.

Marie Thompson, 29, a Bath native who moved back after graduating from design school in Boston, agrees. She works as a design lead for Pakt Bags, a travel gear company with remote staff, and said she chose Bath because “there’s so much more space, opportunities for great places to live and work,” while still offering proximity to Portland’s food scene.

Both Bath and Brunswick are near beaches, lakes and rivers, like Popham Beach or the Androscoggin River, as well as “hundreds of miles of recreation trail,” Mr. Wildes said.

Ithaca’s central location in New York’s Finger Lakes region offers easy access to many attractions, such as Taughannock Falls State Park.Tony Cenicola/The New York Times

If you like nature …

Ithaca, N.Y.

For New Yorkers looking to escape their tiny apartments, the travel blogger Gerry Isabelle, who asked to be identified by her first and middle name to protect her privacy, recommends this city in the lush region in upstate New York. She has traveled to the Finger Lakes region for several short stints of remote work throughout the pandemic. “There’s a little bit of everything,” she said.

The Finger Lakes, named for its 11 long, narrow lakes, is home to a number of colleges and universities, state parks and wine trails. And Ithaca’s central location at the foot of Cayuga Lake offers easy access to urban amenities as well as many of the region’s towns and attractions.

“You won’t just be working from home,” Ms. Isabelle said. “You’d literally be working with views of the lake from your window.”

Watkins Glen State Park and the Finger Lakes National Forest are within 30 minutes of Ithaca, and Buttermilk Falls State Park’s stunning water falls and trails are only a 10-minute drive away.

There are also a number of museums to explore within an hour of Ithaca, like Harriet Tubman’s house in Auburn, or the Rockwell Museum in Corning.

In Ithaca and its surrounding areas, it’s common to encounter people selling homemade goods and food, whether at a farmer’s market or on the side of the road. Ms. Isabelle mentioned an ice cream shop called The Spotted Duck whose owners source ingredients from their own farm, or F.L.X. Table, a communal dining experience where one meets people from “all walks of life.” (During the pandemic, the restaurant traded in its signature communal table for smaller, socially distanced tables.) “The energy there is so safe and cozy,” she said about the Finger Lakes.


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How Food May Improve Your Mood

The sugar-laden, high-fat foods we often crave when we are stressed or depressed, as comforting as they are, may be the least likely to benefit our mental health.

As people across the globe grappled with higher levels of stress, depression and anxiety this past year, many turned to their favorite comfort foods: ice cream, pastries, pizza, hamburgers. But studies in recent years suggest that the sugar-laden and high-fat foods we often crave when we are stressed or depressed, as comforting as they may seem, are the least likely to benefit our mental health. Instead, whole foods such as vegetables, fruit, fish, eggs, nuts and seeds, beans and legumes and fermented foods like yogurt may be a better bet.

The findings stem from an emerging field of research known as nutritional psychiatry, which looks at the relationship between diet and mental wellness. The idea that eating certain foods could promote brain health, much the way it can promote heart health, might seem like common sense. But historically, nutrition research has focused largely on how the foods we eat affect our physical health, rather than our mental health. For a long time, the potential influence of food on happiness and mental well-being, as one team of researchers recently put it, was “virtually ignored.”

But over the years, a growing body of research has provided intriguing hints about the ways in which foods may affect our moods. A healthy diet promotes a healthy gut, which communicates with the brain through what is known as the gut-brain axis. Microbes in the gut produce neurotransmitters like serotonin and dopamine, which regulate our mood and emotions, and the gut microbiome has been implicated in mental health outcomes. “A growing body of literature shows that the gut microbiome plays a shaping role in a variety of psychiatric disorders, including major depressive disorder,” a team of scientists wrote in the Harvard Review of Psychiatry last year.

Large population studies, too, have found that people who eat a lot of nutrient-dense foods report less depression and greater levels of happiness and mental well-being. One such study, from 2016, that followed 12,400 people for about seven years found that those who increased their consumption of fruits and vegetables during the study period rated themselves substantially higher on questionnaires about their general levels of happiness and life satisfaction.

Large observational studies, however, can show only correlations, not causation, which raises the question: Which comes first? Do anxiety and depression drive people to choose unhealthy foods, or vice versa? Are people who are happy and optimistic more motivated to consume nutritious foods? Or does a healthy diet directly brighten their moods?

The first major trial to shed light on the food-mood connection was published in 2017. A team of researchers wanted to know whether dietary changes would help alleviate depression, so they recruited 67 people who were clinically depressed and split them into groups. One group went to meetings with a dietitian who taught them to follow a traditional Mediterranean-style diet. The other group, serving as the control, met regularly with a research assistant who provided social support but no dietary advice.

At the start of the study, both groups consumed a lot of sugary foods, processed meats and salty snacks, and very little fiber, lean proteins or fruits and vegetables. But the diet group made big changes. They replaced candy, fast food and pastries with whole foods such as nuts, beans, fruits and legumes. They switched from white bread to whole grain and sourdough bread. They gave up sugary cereals and ate muesli and oatmeal. Instead of pizza, they ate vegetable stir-fries. And they replaced highly processed meats like ham, sausages and bacon with seafood and small amounts of lean red meats.

Importantly, both groups were counseled to continue taking any antidepressants or other medications they were prescribed. The goal of the study was not to see if a healthier diet could replace medication, but whether it could provide additional benefits like exercise, good sleep and other lifestyle behaviors.

After 12 weeks, average depression scores improved in both groups, which might be expected for anyone entering a clinical trial that provided additional support, regardless of which group you were in. But depression scores improved to a far greater extent in the group that followed the healthy diet: roughly a third of those people were no longer classified as depressed, compared to 8 percent of people in the control group.

The results were striking for a number of reasons. The diet benefited mental health even though the participants did not lose any weight. People also saved money by eating the more nutritious foods, demonstrating that a healthy diet can be economical. Before the study, the participants spent on average $138 per week on food. Those who switched to the healthy diet lowered their food costs to $112 per week.

The recommended foods were relatively inexpensive and available at most grocery stores. They included things like canned beans and lentils, canned salmon, tuna and sardines, and frozen and conventional produce, said Felice Jacka, the lead author of the study.

“Mental health is complex,” said Dr. Jacka, the director of the Food & Mood Centre at Deakin University in Australia and the president of the International Society for Nutritional Psychiatry Research. “Eating a salad is not going to cure depression. But there’s a lot you can do to lift your mood and improve your mental health, and it can be as simple as increasing your intake of plants and healthy foods.”

A number of randomized trials have reported similar findings. In one study of 150 adults with depression that was published last year, researchers found that people assigned to follow a Mediterranean diet supplemented with fish oil for three months had greater reductions in symptoms of depression, stress and anxiety after three months compared to a control group.

Still, not every study has had positive results. A large, yearlong trial published in JAMA in 2019, for example, found that a Mediterranean diet reduced anxiety but did not prevent depression in a group of people at high risk. Taking supplements such as vitamin D, selenium and omega-3 fatty acids had no impact on either depression or anxiety.

Most psychiatric professional groups have not adopted dietary recommendations, in part because experts say that more research is needed before they can prescribe a specific diet for mental health. But public health experts in countries around the world have started encouraging people to adopt lifestyle behaviors like exercise, sound sleep, a heart-healthy diet and avoiding smoking that may reduce inflammation and have benefits for the brain. The Royal Australian and New Zealand College of Psychiatrists issued clinical practice guidelines encouraging clinicians to address diet, exercise and smoking before starting patients on medication or psychotherapy.

Individual clinicians, too, are already incorporating nutrition into their work with patients. Dr. Drew Ramsey, a psychiatrist and assistant clinical professor at the Columbia University College of Physicians and Surgeons in New York, begins his sessions with new patients by taking their psychiatric history and then exploring their diet. He asks what they eat, learns their favorite foods, and finds out if foods that he deems important for the gut-brain connection are missing from their diets, such as plants, seafood and fermented foods.

Dr. Ramsey published a book in March, “Eat to Beat Depression and Anxiety,” and founded the Brain Food Clinic in New York to help people struggling with mood disorders improve their diets. He often recites a jingle so people can remember the basics of his dietary advice: “Seafood, greens, nuts and beans — and a little dark chocolate.”

Dr. Ramsey said these foods help to promote compounds like brain-derived neurotrophic factor, or BDNF, a protein that stimulates the growth of new neurons and helps protect existing ones. They also contain large amounts of fiber, unsaturated fat, antioxidants, omega-3 fatty acids and other nutrients that have been shown to improve gut and metabolic health and reduce inflammation, all of which can affect the brain.

Dr. Ramsey said he does not want people to think that the only factor involved in brain health is food. “Lots of people get their food exactly right, live very active lives, and still have significant troubles with their mental health,” he said.

But he also teaches people that food can be empowering. “We can’t control our genes, who our parents were, or if random acts of trauma or violence happen to us,” he said. “But we can control how we eat, and that gives people actionable things that they can do to take care of their brain health on a daily basis.”

5 Takeaways From the New Food Allergy Law

Sesame becomes a “major allergen,” joining milk, eggs, fish, shellfish, tree nuts, peanuts, wheat and soybeans.

If you have a food allergy, or your child does, chances are you spend a lot of time reading labels to figure out whether something will trigger an allergic reaction.

If you’re allergic to sesame, it’s more complicated. While federal law since 2004 has required companies to warn people when certain allergens are used to make a product, sesame has not been one of them. That has meant someone with an allergy to sesame couldn’t know for sure whether the foods they bought at the store were safe.

That is changing. On Friday, President Biden signed into law the FASTER Act, which adds sesame to the list of foods that manufacturers must identify on prepackaged labels. Here are some key takeaways.

Sesame becomes the ninth food to be considered a “major allergen.”

The other eight foods — milk, eggs, fish, shellfish, tree nuts, peanuts, wheat and soybeans — were part of legislation that was signed into law in 2004. That law required manufacturers to indicate on labels when a product was made using any of those eight ingredients, describing them as “major food allergens” because they collectively accounted for “90 percent of food allergies.”

If something is made using any of those eight products, you can be certain to find it on the label, either within the ingredients list or nearby with a special “contains” warning — “contains wheat,” for example.

The legislation was a breakthrough for people with food allergies. The right words on a label can be the difference between an uneventful lunch and an allergic reaction — including an anaphylactic one, which can be fatal.

But because sesame wasn’t part of the initial law 17 years ago, companies were not required to include it, making it hard to know for sure whether packaged food contains sesame. According to the Food and Drug Administration, in some cases, sesame is described on the label as “spices” or “natural flavors.”

In the years since the 2004 law was passed, studies have found that sesame allergy is more common than was previously known in the United States. Although it’s much less prevalent than peanut allergy, it is comparable with certain tree nut allergies. Tree nuts were on the original list of major allergens.

Now that the FASTER Act is the law, sesame will need to be included on labels, just like the other eight allergens.

The ingredient must be listed on labels starting in 2023.

It may be a while before you see the effects of the FASTER Act. The law gives manufacturers 20 months to make sure any products they’re making that include sesame reflect that on packaging.

Starting on January 1, 2023, if food contains sesame, you should see it indicated on the label.

In the meantime, if you or someone in your family is allergic, look for ingredients that could be sesame-based, like tahini, sesamol and gomasio, according to Food Allergy Research & Education, a nonprofit organization in McLean, Va. And continue to keep an eye out for “spices” and “natural flavors,” which could include sesame.

It also helps to be aware of the types of foods that tend to include sesame, like falafel, hummus and certain rices. And sesame oil is a common ingredient in Asian cuisine. But keep in mind that sesame can also be found in chips, cereals, snack bars and a variety of other foods.

The good news is that some companies, such as General Mills and Hershey’s, already include sesame on labels when it’s used as an ingredient.

It’s welcome news for over a million Americans.

The new law brings a sense of reassurance to people dealing with a sesame allergy. In the United States, that’s about 1.1 million children and adults, according to a 2019 study published in the journal JAMA Network Open. The study found that less than one quarter of 1 percent of children and adults were estimated to have sesame allergy.

Still, Lauren E. Krigbaum is among the parents who is breathing a sigh of relief. Ms. Krigbaum’s 2-year-old daughter has five different food allergies, including sesame. But until now, sesame had been the only one of her daughter’s allergies that wasn’t part of the federal labeling law.

“When you have a child with food allergies, your life kind of centers around food,” said Ms. Krigbaum, a financial aid counselor in Boise, Idaho. “So being able to take a stress out of that is going to be huge.”

The law will also make grocery shopping easier for adults. The 2019 study, as well as previous studies in 2007 and 2008, found that most children don’t outgrow a sesame allergy. And like other allergies, you can develop it as an adult — about one in four adults who suffer from it developed it after childhood.

The inbox of Lisa G. Gable has been “overwhelmed” with messages of relief. Ms. Gable is the chief executive of FARE, which has been pushing for sesame to be added to the list of allergens.

“It was critically important to get this on the label and we’re excited to have it advancing so quickly with bipartisan support,” said Ms. Gable.

Other allergens still remain off the government’s list.

The new allergen law extends the federal government’s list of “major allergens” to nine foods. But other less common allergens can still go into foods without being printed on packaging.

Other countries have longer lists of allergens required for labeling. Canada has a list of 11 foods, including mustard, required for packaging. Australia’s list comprises 10 foods, one of which is lupin, a type of legume. And the United Kingdom mandates that 14 allergens be declared on labels.

When Nili M. Patel, of Raleigh, N.C., heard about the FASTER Act, she was relieved.

“It was like, finally!” said Ms. Patel, whose 4-year-old daughter has multiple food allergies, including sesame. “The most frustrating allergen for me is sesame because it’s hidden.”

Sesame allergies often appear alongside other food allergies, like peanut, tree nut and egg. Ms. Patel’s daughter is also allergic to certain types of legumes that aren’t part of the labeling law. She said she makes “99 percent” of meals from scratch, including bread, and will continue doing that out of caution.

“I hope that maybe eventually other allergens will make their way into the labeling laws,” said Ms. Patel. “Maybe there’s some hope for that.”

But the law opens the door for future food allergy research and policy.

In addition to the sesame requirement, the new law also has broad implications for food allergies. It says that the Secretary of Health and Human Services must compile a wide-ranging report on food allergies within the next 18 months.

The report should document any work the federal government does related to a spectrum of food allergy issues, including research into the prevalence of food allergies, treatment options and possible prevention methods.

It also calls for “a regulatory process and framework” to determine a food as a “major food allergen,” which could open the door for other allergens to be added to the list.

Dr. Ruchi S. Gupta, a professor of pediatrics at Northwestern Medicine in Chicago, said these sections of the FASTER Act put food allergies on a similar level with other health conditions because it centralizes efforts to monitor food allergies.

“We need to do a deeper dive into what is 10, 11, 12” on the list of top allergens, said Dr. Gupta, a senior author of the 2019 study. “And what is potentially on the horizon to be a bigger problem than it is now.”

Dogs Can Have a Little Charcuterie, as a Treat

“Barkuterie” boards are a new way to spoil your beloved pets.

For well over a year now, elaborate charcuterie boards have been taking over the social feeds of food enthusiasts. There have been artful assemblages of the usual items, like cheese, meat and fruit, as well as plates topped with desserts and colorful candy.

If by chance you’ve seen boards stacked with cookies shaped like dog bones and homemade jerky strips, those aren’t for human consumption.

They’re called “barkuterie.”

Kristine Boyd, 51, first caught wind of the trend on Pinterest. She lives with three dachshunds — Riley, Brody and Jasper — in Orlando, Fla., and decided to make them a barkuterie board after a bit of positive news from her veterinarian.

Brody, the oldest of the trio, had been declared cancer-free after a biopsy. “I was so excited. So I decided, ‘You know what? I’m going to the Woof Gang Bakery to get some treats,’” said Ms. Boyd, who works in retail management. She splurged on specialty Snoopy and heart-shaped cookies, just because.

What started as a plate of their favorite dog treats evolved into an artistic project. “My guys love blueberries, so I thought, ‘OK, let’s add some fruit in to give it a little bit of variety and color,’” she said.

Her dachshunds seemed pleased with the result. “They have bottomless stomachs but did steer toward the fruits and veggies because they don’t get those every day,” Ms. Boyd said. She plans on making boards again for their birthdays.

Shelters across the country are recording high adoption numbers, and people are spending more time than ever around their dogs. Last year Americans spent a record $103 billion on their pets, according to the American Pet Products Association. For many of those owners, dogs are more than just pets; they’re part of the family. Barkuterie is one way to affirm that bond.

Riley, Brody and Jasper with their celebratory no-cancer barkuterie.
Riley, Brody and Jasper with their celebratory no-cancer barkuterie.

Lyndsay Shackelford, 28, made a St. Patrick’s Day board for her Beagle mix, Wilson. She whipped up “pup-sicles” with goat’s milk and kale, sweet potato chews, and sliced vegetables, then served them to Wilson with a cup of dog beer (which can be made with water, chicken or pork, and malt extract).

“He went straight for the dog beer that I put on it,” said Ms. Shackelford, who lives in Baltimore and owns the website Dogs of Charm City. “He avoided the vegetables, but he had fun with it.”

Social media’s charcuterie-board trend has been widely documented, but barkuterie has received less attention since photos of the boards began popping up on Instagram in 2019. Their popularity seems to be growing thanks to new companies selling dog-friendly snack boards, the proliferation of how-to posts on pet blogs and people seeking creative outlets for stress.

In January, Heather Raeder, a 29-year-old hospital pharmacist in Chicago, channeled her own creativity into an artfully arranged board of homemade dog biscuits, peas and jerky for her two corgis, Ellie and Crouton. Since then, she’s turned her hobby into a side hustle, selling arrangements for around $20 to dog owners throughout Chicago.

Similarly, Amanda Yu-Nguyen, 35, welcomed the chance to pursue a creative deviation from her day job. Her dining room table is now covered in the trappings of barkuterie boards featuring locally made dog biscuits and antelope jerky.

Ms. Yu-Nguyen, who works in student affairs at Emory University in Atlanta, said that her 6-by-6 boxes, which start at $30 always include a mélange of hard treats, fresh fruits and veggies (like blueberries), and dried sweet potato. Sometimes she’ll use a fancy garnish like a cucumber rose.

She’s recently started making boards that reflect her upbringing. “I’m Chinese, so going to dim sum was a big part of my childhood,” Ms. Yu-Nguyen said. “Some of the items that I put in the doggy dim sum steamers are trying to mimic what a human would eat at dim sum.” Treats that might appear in the steamers include duck feet and tripe.

From a health standpoint, Aziza Glass, a 32-year-old veterinarian, said the boards, made with dog-safe food (hold the cured meats and sweets), could be “a great way for pet parents to become involved in the nutrition in the meal preparation of their pets.”

She recommends using crudités like carrot and cucumber strips, blueberries, bananas and strawberries, as well as a low-sodium turkey jerky. Going this route, Dr. Glass said, rather than piling the boards with biscuits, helps prevent gastrointestinal issues.

There’s a fine line between nurturing and spoiling one’s pets, and portion control is key to that distinction. After snapping a picture of her dachshunds with their platter, Ms. Boyd served them individual plates to keep them from overeating.

“I don’t have kids of my own, so I definitely treat mine like kids,” Dr. Raeder said of her corgis. And what do kids love more than snacks made just for them?

In ‘Hooked,’ Michael Moss Explores the Addictive Power of Junk Food

In “Hooked,” Michael Moss explores how no addictive drug can fire up the reward circuitry in our brains as rapidly as our favorite foods.

In a legal proceeding two decades ago, Michael Szymanczyk, the chief executive of the tobacco giant Philip Morris, was asked to define addiction. “My definition of addiction is a repetitive behavior that some people find difficult to quit,” he responded.

Mr. Szymanczyk was speaking in the context of smoking. But a fascinating new book by Michael Moss, an investigative journalist and best-selling author, argues that the tobacco executive’s definition of addiction could apply to our relationship with another group of products that Philip Morris sold and manufactured for decades: highly processed foods.

In his new book, “Hooked,” Mr. Moss explores the science behind addiction and builds a case that food companies have painstakingly engineered processed foods to hijack the reward circuitry in our brains, causing us to overeat and helping to fuel a global epidemic of obesity and chronic disease. Mr. Moss suggests that processed foods like cheeseburgers, potato chips and ice cream are not only addictive, but that they can be even more addictive than alcohol, tobacco and drugs. The book draws on internal industry documents and interviews with industry insiders to argue that some food companies in the past couple of decades became aware of the addictive nature of their products and took drastic steps to avoid accountability, such as shutting down important research into sugary foods and spearheading laws preventing people from suing food companies for damages.

PenguinRandomHouse

In another cynical move, Mr. Moss writes, food companies beginning in the late 1970s started buying a slew of popular diet companies, allowing them to profit off our attempts to lose the weight we gained from eating their products. Heinz, the processed food giant, bought Weight Watchers in 1978 for $72 million. Unilever, which sells Klondike bars and Ben & Jerry’s ice cream, paid $2.3 billion for SlimFast in 2000. Nestle, which makes chocolate bars and Hot Pockets, purchased Jenny Craig in 2006 for $600 million. And in 2010 the private equity firm that owns Cinnabon and Carvel ice cream purchased Atkins Nutritionals, the company that sells low-carb bars, shakes and snacks. Most of these diet brands were later sold to other parent companies.

“The food industry blocked us in the courts from filing lawsuits claiming addiction; they started controlling the science in problematic ways, and they took control of the diet industry,” Mr. Moss said in an interview. “I’ve been crawling through the underbelly of the processed food industry for 10 years and I continue to be stunned by the depths of the deviousness of their strategy to not just tap into our basic instincts, but to exploit our attempts to gain control of our habits.”

A former reporter for The New York Times and recipient of the Pulitzer Prize, Mr. Moss first delved into the world of the processed food industry in 2013 with the publication of “Salt Sugar Fat.” The book explained how companies formulate junk foods to achieve a “bliss point” that makes them irresistible and market those products using tactics borrowed from the tobacco industry. Yet after writing the book, Mr. Moss was not convinced that processed foods could be addictive.

“I had tried to avoid the word addiction when I was writing ‘Salt Sugar Fat,’” he said. “I thought it was totally ludicrous. How anyone could compare Twinkies to crack cocaine was beyond me.”

But as he dug into the science that shows how processed foods affect the brain, he was swayed. One crucial element that influences the addictive nature of a substance and whether or not we consume it compulsively is how quickly it excites the brain. The faster it hits our reward circuitry, the stronger its impact. That is why smoking crack cocaine is more powerful than ingesting cocaine through the nose, and smoking cigarettes produces greater feelings of reward than wearing a nicotine patch: Smoking reduces the time it takes for drugs to hit the brain.

But no addictive drug can fire up the reward circuitry in our brains as rapidly as our favorite foods, Mr. Moss writes. “The smoke from cigarettes takes 10 seconds to stir the brain, but a touch of sugar on the tongue will do so in a little more than a half second, or six hundred milliseconds, to be precise,” he writes. “That’s nearly 20 times faster than cigarettes.”

This puts the term “fast food” in a new light. “Measured in milliseconds, and the power to addict, nothing is faster than processed food in rousing the brain,” he added.

Mr. Moss explains that even people in the tobacco industry took note of the powerful lure of processed foods. In the 1980s, Philip Morris acquired Kraft and General Foods, making it the largest manufacturer of processed foods in the country, with products like Kool-Aid, Cocoa Pebbles, Capri Sun and Oreo cookies. But the company’s former general counsel and vice president, Steven C. Parrish, confided that he found it troubling that it was easier for him to quit the company’s cigarettes than its chocolate cookies. “I’m dangerous around a bag of chips or Doritos or Oreos,” he told Mr. Moss. “I’d avoid even opening a bag of Oreos because instead of eating one or two, I would eat half the bag.”

As litigation against tobacco companies gained ground in the 1990s, one of the industry’s defenses was that cigarettes were no more addictive than Twinkies. It may have been on to something. Philip Morris routinely surveyed the public to gather legal and marketing intelligence, Mr. Moss writes, and one particular survey in 1988 asked people to name things that they thought were addictive and then rate them on a scale of 1 to 10, with 10 being the most addictive.

“Smoking was given an 8.5, nearly on par with heroin,” Mr. Moss writes. “But overeating, at 7.3, was not far behind, scoring higher than beer, tranquilizers and sleeping pills. This statistic was used to buttress the company’s argument that cigarettes might not be exactly innocent, but they were a vice on the order of potato chips and, as such, were manageable.”

But processed foods are not tobacco, and many people, including some experts, dismiss the notion that they are addictive. Mr. Moss suggests that this reluctance is in part a result of misconceptions about what addiction entails. For one, a substance does not have to hook everyone for it to be addictive. Studies show that most people who drink or use cocaine do not become dependent. Nor does everyone who smokes or uses painkillers become addicted. It is also the case that the symptoms of addiction can vary from one person to the next and from one drug to another. Painful withdrawals were once considered hallmarks of addiction. But some drugs that we know to be addictive, such as cocaine, would fail to meet that definition because they do not provoke “the body-wrenching havoc” that withdrawal from barbiturates and other addictive drugs can cause.

The American Psychiatric Association now lists 11 criteria that are used to diagnose what it calls a substance use disorder, which can range from mild to severe, depending on how many symptoms a person exhibits. Among those symptoms are cravings, an inability to cut back despite wanting to, and continuing to use the substance despite it causing harm. Mr. Moss said that people who struggle with processed food can try simple strategies to conquer routine cravings, like going for a walk, calling a friend or snacking on healthy alternatives like a handful of nuts. But for some people, more extreme measures may be necessary.

“It depends where you are on the spectrum,” he said. “I know people who can’t touch a grain of sugar without losing control. They would drive to the supermarket and by the time they got home their car would be littered with empty wrappers. For them, complete abstention is the solution.”

¿Hay alimentos adictivos?

La comida muy procesada no solo es dañina, también podría ser adictiva

Los investigadores intentan saber si son adictivos los alimentos ultraprocesados, como las papas fritas o el helado, y si hacen que nuestro cerebro envíe la señal de que comamos en exceso.

Credit…Richard A. Chance
Anahad O’Connor

  • 27 de febrero de 2021 a las 05:00 ET

Hace cinco años, un grupo de científicos especializados en nutrición estudiaron lo que comían los estadounidenses y llegaron a conclusiones sorprendentes: más de la mitad de todas las calorías que consume el estadounidense promedio procede de alimentos ultraprocesados, los cuales definen como “fórmulas industriales” que combinan grandes cantidades de azúcar, sal, aceites, grasas y otros aditivos.

Pese a que se les asocia con la obesidad, las cardiopatías, la diabetes tipo 2 y otros problemas de salud, los alimentos altamente procesados siguen siendo predominantes en la dieta de los estadounidenses. Son baratos, prácticos y están diseñados para que sepan bien. La industria de los alimentos los comercializa de manera entusiasta. Pero una cantidad cada vez mayor de científicos afirma que otra razón por la que estos alimentos se consumen tanto es porque para muchas personas no solo son apetecibles, sino adictivos, una idea que ha provocado controversia entre los investigadores.

Recientemente, la revista American Journal of Clinical Nutrition analizó la ciencia detrás de la adicción alimentaria y si los alimentos ultraprocesados podrían estar contribuyendo a comer en exceso y a la obesidad. Destacó un debate entre dos de los principales expertos en el tema, Ashley Geardhardt, profesora adjunta en el Departamento de Psicología de la Universidad de Míchigan, y Johannes Hebebrand, director del Departamento de Psiquiatría, Psicosomática y Psicoterapia para Niños y Adolescentes de la Universidad de Duisburgo-Essen, en Alemania.

Gearhardt, psicóloga clínica, ayudó a desarrollar la Escala de Adicción a los Alimentos de la Universidad de Yale, que es un estudio que se emplea para determinar si una persona muestra indicios de comportamiento adictivo hacia la comida. En un estudio en el que participaron más de 500 personas, ella y sus colegas descubrieron que ciertos alimentos tenían una especial propensión a provocar comportamientos relacionados con la alimentación “parecidos a los de las adicciones”, como compulsión intensa, pérdida del control e incapacidad de reducir su consumo a pesar de experimentar consecuencias perjudiciales y muchas ganas de dejar de comerlos.

Al principio de la lista estaba la pizza, el chocolate, las galletas, el helado, todo tipo de papas fritas y las hamburguesas con queso. Geardhardt ha descubierto en su investigación que estos alimentos tan procesados tienen mucho en común con las sustancias adictivas. Al igual que los cigarrillos y la cocaína, sus ingredientes se derivan de plantas presentes en la naturaleza y de alimentos a los que se les retiran los componentes que ralentizan su absorción, como la fibra, el agua y la proteína. Posteriormente, sus ingredientes más atractivos se refinan y procesan para crear productos que se absorben con rapidez dentro del torrente sanguíneo, lo cual aumenta su capacidad para activar las regiones del cerebro que regulan la sensación de gratificación, las emociones y la motivación.

Gearhardt señaló que la sal, los espesantes, los sabores artificiales y otros aditivos de los alimentos muy procesados refuerzan su seducción al mejorar algunas propiedades como la textura y la sensación que produce en la boca, lo cual se asemeja a la manera en que los cigarrillos contienen una serie de aditivos diseñados para aumentar su potencial adictivo. Por ejemplo, el mentol ayuda a enmascarar el sabor amargo de la nicotina, mientras que otro ingrediente usado en algunos cigarrillos, el cacao, dilata las vías aéreas y aumenta la absorción de la nicotina.

Según Geardhardt, un común denominador de los alimentos ultraprocesados más irresistibles es que contienen grandes cantidades de grasa y carbohidratos refinados, una combinación poderosa que pocas veces se encuentra en los alimentos de origen natural que el ser humano ha evolucionado para consumir, como frutas, vegetales, carne, nueces, miel, frijoles y semillas. Muchos alimentos que encontramos en la naturaleza son ricos en grasas o carbohidratos, pero por lo general no son altos en las dos cosas.

“Las personas no presentan una respuesta conductual adictiva a los alimentos naturales que son buenos para la salud, como las fresas”, afirmó Gearhardt, quien también es directora del Laboratorio de Ciencia de la Alimentación y la Adicción y su Tratamiento en Míchigan. “El subconjunto de alimentos muy procesados está diseñado de un modo muy parecido a cómo producimos otras sustancias adictivas. Estos son los alimentos que pueden ocasionar la pérdida de control y los comportamientos compulsivos y problemáticos que se asemejan a lo que observamos con el alcohol y los cigarrillos”.

En un estudio, Gearhardt descubrió que cuando las personas reducían el consumo de alimentos muy procesados, experimentaban síntomas parecidos a la abstinencia que se observa en los drogadictos, como irritabilidad, fatiga, tristeza y compulsión. En estudios de imágenes del cerebro, otros investigadores han descubierto que las personas que a menudo consumen comida chatarra, con el tiempo pueden desarrollar tolerancia a ella, lo que hace que cada vez requieran mayores cantidades para obtener la misma satisfacción.

En su práctica clínica, Gearhardt ha visto pacientes —algunos obesos y otros no— que luchan en vano para controlar su ingesta de alimentos muy procesados. Algunos intentan comerlos con moderación, pero solo terminan perdiendo el control y comen hasta el punto de vomitar y sentirse angustiados. Muchos de sus pacientes ven que no pueden dejar estos alimentos pese a que tienen dificultades para controlar su diabetes y presentan un aumento excesivo de peso y otros problemas de salud.

“Lo sorprendente es que mis clientes son casi siempre muy conscientes de las consecuencias negativas de su consumo de alimentos altamente procesados, y normalmente han probado docenas de estrategias como dietas de choque y limpiezas para intentar controlar su relación con estos alimentos”, dijo. “Aunque estos intentos pueden funcionar durante un corto periodo de tiempo, casi siempre acaban recayendo”.

Sin embargo, Hebebrand rebate la idea de que algún alimento provoque adicción. Aunque las papas fritas y la pizza pueden parecer irresistibles para algunas personas, él sostiene que no ocasionan un estado mental alterado, lo que es característico de las sustancias adictivas. Por ejemplo, señaló, fumar un cigarrillo, beber una copa de vino o recibir una dosis de heroína provocan una sensación inmediata en el cerebro que los alimentos no producen.

“Siempre sucede que con cualquier droga adictiva casi toda la gente experimenta un estado mental alterado después de consumirla”, señaló Hebebrand. “Eso indica que la sustancia está causando un efecto en nuestro sistema nervioso central. Pero todos ingerimos alimentos muy procesados y nadie siente este estado mental alterado porque la sustancia no llega directamente al cerebro”.

En los trastornos por consumo de sustancias, las personas se vuelven dependientes de una sustancia química específica que actúa en el cerebro, como la nicotina de los cigarrillos o el etanol del vino y el licor. Al principio buscan esta sustancia química para obtener un subidón, y luego se vuelven dependientes de ella para aliviar las emociones negativas y depresivas. Pero en los alimentos altamente procesados no hay ningún compuesto que pueda señalarse como adictivo, dijo Hebebrand. De hecho, la evidencia sugiere que las personas obesas que comen en exceso tienden a consumir una amplia gama de alimentos con diferentes texturas, sabores y composiciones. Hebebrand argumentó que comer en exceso se debe, en parte, a que la industria de alimentos comercializa más de 20.000 productos nuevos cada año, lo que da a la gente acceso a una variedad aparentemente interminable de comidas y bebidas.

“Es la diversidad de alimentos la que resulta tan atractiva y causa el problema, no una sola sustancia en estas comidas”, añadió.

Quienes argumentan en contra de la idea de la adicción a los alimentos también señalan que la mayoría de las personas consumen diariamente alimentos altamente procesados sin mostrar ningún signo de adicción. Pero Gearhardt señala que las sustancias adictivas no enganchan a todos los que las consumen. Según las investigaciones, alrededor de dos tercios de las personas que fuman cigarrillos acaban convirtiéndose en adictos, mientras que un tercio no lo hace. Solo un 21 por ciento de las personas que consumen cocaína a lo largo de su vida se convierten en adictos, mientras que solo un 23 por ciento de las personas que beben alcohol desarrollan una dependencia de este. Los estudios sugieren que hay una amplia gama de factores que determinan que las personas se vuelvan adictas, como su genética, sus antecedentes familiares, su exposición a traumas y sus antecedentes ambientales y socioeconómicos.

“La mayoría de la gente prueba sustancias adictivas y no se vuelve adicta”, dijo Gearhardt. “Así que si estos alimentos son adictivos, no esperaríamos que toda la sociedad se convirtiese en adicta a ellos”.

A las personas que tienen problemas para restringir su ingesta de alimentos muy procesados, Gearhardt les recomienda llevar un registro de todo lo que comen para poder identificar los alimentos que ejercen una mayor atracción, es decir, los que producen una fuerte compulsión y que no se pueden dejar de comer una vez que se inicia el consumo. No se debe tener esos alimentos en casa y, en cambio, es recomendable llenar el refrigerador y la despensa con otras alternativas que les gusten y sean más saludables, señaló.

Se recomienda llevar un registro de los factores desencadenantes que provocan antojos y atracones. Pueden ser emociones como el estrés, el aburrimiento o la soledad. O puede ser el Dunkin’ Donuts por el que pasas en carro tres veces a la semana. Elabora un plan para controlar esos factores desencadenantes como, por ejemplo, tomar una ruta diferente para volver a casa o realizar actividades no alimentarias para aliviar el estrés y el aburrimiento. Y evita saltarte las comidas, porque el hambre puede desencadenar antojos que conduzcan a decisiones lamentables, dijo.

“Con el fin de poder transitar mejor un entorno alimentario muy desafiante, es importante asegurarte de proporcionarle a tu cuerpo alimentos nutritivos y muy poco procesados que te gusten con regularidad”, comentó Gearhardt.

Anahad O’Connor cubre temas de salud, ciencia, nutrición y otros. También es el autor de libros de salud exitosos como Never Shower in a Thunderstorm y The 10 Things You Need to Eat.


Weekly Health Quiz: Addictive Foods, Exercise and Heart Health

1 of 7

Certain foods may elicit “addictive-like” cravings, some research suggests, prompting us to overeat. All of the following foods were near the top of the list of “addictive” foods except:

French fries

Pizza

Ice cream

Bacon

2 of 7

A large analysis of more than 90,000 people found that to bolster heart health you need to complete at least how many minutes of moderate to vigorous exercise a week?

30 minutes

60 minutes

120 minutes

Almost any amount of exercise showed benefits for cardiovascular health

3 of 7

Which statement about asthma is not true?

Cold weather can trigger asthma attacks in some people

More adults suffer from asthma than children

People with asthma are suffering much higher rates of Covid than the general population

Both genetics and environment play a role in who gets asthma

4 of 7

The Covid vaccines currently available in the United States have not been approved for children younger than:

18 years

16 years

12 years

5 years

5 of 7

Which statement about multisystem inflammatory syndrome in children is true?

Symptoms include fever, rash, red eyes or gastrointestinal problems, which typically arise several weeks after infection with coronavirus

It is still rare, but cases are rising, and it has caused about 30 deaths in children in the United States

The median age of infected children is 9 years, but infants and older teenagers can also get it

All of the above

6 of 7

In otherwise healthy people, the main reason someone would experience neutropenia, or a dangerous drop in white blood cell levels, would be a:

Vitamin B12 deficiency

Viral illness

Medication side effect

Covid side effect

7 of 7

The most effective mask against coronavirus is the:

N95 mask

KN95 mask

KF94 mask

Cloth mask

Are Some Foods Addictive

Are Addictive Foods Making Us Fat?

Food researchers debate whether highly processed foods like potato chips and ice cream are addictive, triggering our brains to overeat.

Credit…Richard A. Chance
Anahad O’Connor

  • Feb. 18, 2021, 5:00 a.m. ET

Five years ago, a group of nutrition scientists studied what Americans eat and reached a striking conclusion: More than half of all the calories that the average American consumes comes from ultra-processed foods, which they defined as “industrial formulations” that combine large amounts of sugar, salt, oils, fats and other additives.

Highly processed foods continue to dominate the American diet, despite being linked to obesity, heart disease, Type 2 diabetes and other health problems. They are cheap and convenient, and engineered to taste good. They are aggressively marketed by the food industry. But a growing number of scientists say another reason these foods are so heavily consumed is that for many people they are not just tempting but addictive, a notion that has sparked controversy among researchers.

Recently, the American Journal of Clinical Nutrition explored the science behind food addiction and whether ultra-processed foods might be contributing to overeating and obesity. It featured a debate between two of the leading experts on the subject, Ashley Gearhardt, associate professor in the psychology department at the University of Michigan, and Dr. Johannes Hebebrand, head of the department of child and adolescent psychiatry, psychosomatics and psychotherapy at the University of Duisburg-Essen in Germany.

Dr. Gearhardt, a clinical psychologist, helped develop the Yale Food Addiction Scale, a survey that is used to determine whether a person shows signs of addictive behavior toward food. In one study involving more than 500 people, she and her colleagues found that certain foods were especially likely to elicit “addictive-like” eating behaviors, such as intense cravings, a loss of control, and an inability to cut back despite experiencing harmful consequences and a strong desire to stop eating them.

At the top of the list were pizza, chocolate, potato chips, cookies, ice cream, French fries and cheeseburgers. Dr. Gearhardt has found in her research that these highly processed foods share much in common with addictive substances. Like cigarettes and cocaine, their ingredients are derived from naturally occurring plants and foods that are stripped of components that slow their absorption, such as fiber, water and protein. Then their most pleasurable ingredients are refined and processed into products that are rapidly absorbed into the bloodstream, enhancing their ability to light up regions of the brain that regulate reward, emotion and motivation.

Salt, thickeners, artificial flavors and other additives in highly processed foods strengthen their pull by enhancing properties like texture and mouth-feel, similar to the way that cigarettes contain an array of additives designed to increase their addictive potential, said Dr. Gearhardt. Menthol helps to mask the bitter flavor of nicotine, for example, while another ingredient used in some cigarettes, cocoa, dilates the airways and increases nicotine’s absorption.

A common denominator among the most irresistible ultra-processed foods is that they contain large amounts of fat and refined carbohydrates, a potent combination that is rarely seen in naturally occurring foods that humans evolved to eat, such as fruits, vegetables, meat, nuts, honey, beans and seeds, said Dr. Gearhardt. Many foods found in nature are rich in either fat or carbs, but typically they are not high in both.

“People don’t experience an addictive behavioral response to naturally occurring foods that are good for our health, like strawberries,” said Dr. Gearhardt, director of the Food and Addiction Science and Treatment lab at the University of Michigan. “It’s this subset of highly processed foods that are engineered in a way that’s so similar to how we create other addictive substances. These are the foods that can trigger a loss of control and compulsive, problematic behaviors that parallel what we see with alcohol and cigarettes.”

In one study, Dr. Gearhardt found that when people cut back on highly processed foods, they experienced symptoms that were comparable to the withdrawal seen in drug abusers, such as irritability, fatigue, feelings of sadness and cravings. Other researchers have found in brain imaging studies that people who frequently consume junk foods can develop a tolerance to them over time, leading them to require larger and larger amounts to get the same enjoyment.

In her clinical practice, Dr. Gearhardt has encountered patients — some obese and some not — who struggle in vain to control their intake of highly processed foods. Some attempt to eat them in moderation, only to find that they lose control and eat to the point of feeling ill and distraught. Many of her patients find that they cannot quit these foods despite struggling with uncontrolled diabetes, excessive weight gain and other health problems.

“The striking thing is that my clients are almost always acutely aware of the negative consequences of their highly processed food consumption, and they have typically tried dozens of strategies like crash diets and cleanses to try and get their relationship with these foods under control,” she said. “While these attempts might work for a short time, they almost always end up relapsing.”

But Dr. Hebebrand disputes the notion that any food is addictive. While potato chips and pizza can seem irresistible to some, he argues that they do not cause an altered state of mind, a hallmark of addictive substances. Smoking a cigarette, drinking a glass of wine or taking a hit of heroin, for instance, causes an immediate sensation in the brain that foods do not, he says.

“You can take any addictive drug, and it’s always the same story that almost everyone will have an altered state of mind after ingesting it,” said Dr. Hebebrand. “That indicates that the substance is having an effect on your central nervous system. But we are all ingesting highly processed foods, and none of us is experiencing this altered state of mind because there’s no direct hit of a substance in the brain.”

In substance use disorders, people become dependent on a specific chemical that acts on the brain, like the nicotine in cigarettes or the ethanol in wine and liquor. They initially seek out this chemical to get a high, and then become dependent on it to alleviate depressed and negative emotions. But in highly processed foods, there is no one compound that can be singled out as addictive, Dr. Hebebrand said. In fact, evidence suggests that obese people who overeat tend to consume a wide range of foods with different textures, flavors and compositions. Dr. Hebebrand argued that overeating is driven in part by the food industry marketing more than 20,000 new products every year, giving people access to a seemingly endless variety of foods and beverages.

“It’s the diversity of foods that is so appealing and causing the problem, not a single substance in these foods,” he added.

Those who argue against food addiction also point out that most people consume highly processed foods on a daily basis without showing any signs of addiction. But Dr. Gearhardt notes that addictive substances do not hook everyone who consumes them. According to research, about two-thirds of people who smoke cigarettes go on to become addicted, while a third do not. Only about 21 percent of people who use cocaine in their lifetimes become addicted, while just 23 percent of people who drink alcohol develop a dependence on it. Studies suggests that a wide range of factors determine whether people become addicted, including their genetics, family histories, exposure to trauma, and environmental and socioeconomic backgrounds.

“Most people try addictive substances and they don’t become addicted,” Dr. Gearhardt said. “So if these foods are addictive, we wouldn’t expect that 100 percent of society is going to be addicted to them.”

For people who struggle with limiting their intake of highly processed foods, Dr. Gearhardt recommends keeping a journal of what you eat so you can identify the foods that have the most pull — the ones that cause intense cravings and that you can’t stop eating once you start. Keep those foods out of your home, while stocking your fridge and pantry with healthier alternatives that you enjoy, she said.

Keep track of the triggers that lead to cravings and binges. They could be emotions like stress, boredom and loneliness. Or it could be the Dunkin’ Donuts that you drive by three times a week. Make a plan to manage those triggers by a taking a different route home, for example, or by using nonfood activities to alleviate stress and boredom. And avoid skipping meals, because hunger can set off cravings that lead to regrettable decisions, she said.

“Making sure you are regularly fueling your body with nutritious, minimally processed foods that you enjoy can be important for helping you navigate a very challenging food environment,” said Dr. Gearhardt.

Can Technology Help Us Eat Better?

Can Technology Help Us Eat Better?

A new crop of digital health companies is using blood glucose monitors to transform the way we eat.

Credit…Leann Johnson
Anahad O’Connor

  • Feb. 8, 2021, 5:00 a.m. ET

A new crop of digital health companies is offering consumers an unusual way to transform the way they eat, with the promise of improving metabolic health, boosting energy levels and achieving a personalized road map to better health. Their pitch: Find the foods that are best for you by seeing how they impact your blood sugar levels.

The companies, which include Levels, Nutrisense and January, provide their customers continuous glucose monitors — sleek, wearable devices that attach to your arm and measure your body’s glucose levels 24 hours a day, no skin pricks required. The devices transmit that data to your smartphone, allowing you to see in real time how your glucose levels are affected by your diet, sleep, exercise and stress levels.

The devices can show users in real time which of their favorite foods and snacks can make their blood sugar levels spike and crash, leaving them feeling tired and sluggish after meals. They can reveal how engaging in regular exercise, or simply going for a short walk after a big meal, helps to improve blood sugar control. And for some people, the devices can provide warning signs that they may be at increased risk of developing Type 2 diabetes and other forms of metabolic disease.

Continuous glucose monitors were originally developed decades ago to help people with diabetes manage their blood sugar. For people with Type 1 diabetes, the devices, which require a doctor’s prescription, are considered the standard of care, freeing them from the burden of having to prick their fingers multiple times a day to check their blood sugar. But now digital health companies are using the devices to market programs that tap into the growing demand for personalized nutrition, a multibillion-dollar industry.

“We’ve had trackers for many other things like sleep, stress and fitness,” said Dr. Casey Means, a surgeon who co-founded Levels and serves as its chief medical officer. “But a continuous glucose monitor measures an internal biomarker like a tiny lab on our arms. This is the first time it’s been used for a mainstream population for the specific purpose of making lifestyle decisions.”

While most people know that eating sugary junk foods like cookies, cake and soda can wreak havoc on their blood sugar levels, studies show that people can have a wide range of responses to many foods. In one intriguing study from 2015, researchers in Israel followed 800 adults for a week, using continuous glucose monitors to track their glucose levels. They found that even when people ate identical foods — such as bread and butter or chocolate — some people had substantial blood sugar spikes while others did not. The researchers concluded that a variety of factors unique to every person, such as your weight, genetics, gut microbiome, lifestyle and insulin sensitivity, determine how you respond to different foods.

In general, health authorities consider a healthy fasting blood sugar level — measured after an overnight fast — to be below 100 milligrams per deciliter. It is normal for blood sugar to rise after meals. But in a 2018 study, researchers at Stanford found that when they had 57 adults wear continuous glucose monitors for two weeks, many people considered “healthy” by normal standards saw their blood sugar soar to diabetic levels on frequent occasions, a signal that they might be on the road to developing Type 2 diabetes. Other research shows that such large blood sugar swings are linked to heart disease and chronic inflammation, which is increasingly thought to underlie a wide range of age-related ailments, from heart disease, diabetes and cancer to arthritis, depression and dementia.

“The nice thing about using a C.G.M. is that it’s an early way of catching what’s going on, and it gives you a chance to change your behavior before you’re diabetic,” said Michael Snyder, a senior author of the 2018 study and a professor in genetics at Stanford.

Nationwide, about 88 million adults, or more than one in three Americans, have pre-diabetes, a precursor to Type 2 diabetes that causes chronically high blood sugar levels. But according to the federal government, more than 84 percent of people with the condition do not know that they have it.

Dr. Snyder’s research led him to co-found January. The company provides its customers with continuous glucose monitors and then uses artificial intelligence to help them make decisions about what to eat, including predictions about how they might react to different foods before they even eat them.

The programs, which are not covered by insurance, are not cheap. The starting price for Levels is $395, which includes a telemedicine consultation and two Abbott FreeStyle Libre glucose monitors that are programmed to run for 14 days each. Nutrisense offers its customers a variety of packages that range in price from $175 for a two-week program to $160 a month for an 18-month commitment. And January charges $288 for its “Season of Me” introductory program that includes two glucose monitors, a heart rate monitor, and access to the company’s app for three months.

But are they worth it?

To get a better sense, I signed up to use the Levels program for one month. As a health reporter who writes about nutrition, I try to follow a fairly healthy diet and exercise regimen with plenty of fresh foods and few junk foods or sugary snacks, so I wasn’t expecting to learn much from the program. But I kept an open mind.

To get started, I filled out a brief health questionnaire online. Then Levels shipped me two FreeStyle Libre glucose monitors, which were prescribed by a doctor affiliated with the company. As instructed, I attached the device — a small patch with a tiny sensor about the size of a human hair — to the back of my arm. The sensor measures “interstitial fluid” beneath the skin, which it uses to estimate blood sugar levels.

The monitor helped me identify foods that I had no idea were spiking my blood sugar, like protein bars and chickpea pasta. But through trial and error, it also helped me find alternatives. One day I ate a salad with grilled salmon and noticed that it caused my blood sugar to soar. I soon realized why: I had drenched my salad in balsamic vinegar, which, it turns out, contains a lot of sugar. The next day I repeated the meal but with red wine vinegar, which contains no sugar. The result? My continuous glucose monitor showed there was no blood sugar spike or crash.

Dr. Means said that people are often surprised to learn just how much sugar is hiding in their foods, especially in things like sauces, condiments and dressings. But not everyone is the same, and people learn tricks, such as pairing carbs with protein or fats — for example, by adding almond butter to oatmeal or an apple — to blunt the blood sugar response to certain foods.

The monitor also reinforced the value of exercise. I noticed on days when I went for a run, or even a 15-minute walk, that the physical activity helped to keep my blood sugar in a steady range after meals.

I reached out to Dr. Aaron Neinstein, an endocrinologist at the University of California, San Francisco. Dr. Neinstein prescribes continuous glucose monitors to most of his patients with diabetes and has used them himself to monitor his blood sugar and make changes to his diet. By wearing a C.G.M. he found, for example, that a particular type of soup that he regularly ate at his hospital cafeteria was causing a “surprisingly sustained elevation” in his blood sugar levels, leading him to cut back on it.

Dr. Neinstein said there was evidence from rigorous studies that wearing a C.G.M. benefits people with Type 1 diabetes, leading to improved blood sugar control. He predicted that by 2025 every person with any form of diabetes would be using a C.G.M. But he said he hoped there would be more research looking into whether they can improve health in people without diabetes before they become more widely adopted by the general public.

“Anecdotally, I have seen it have benefit in people without diabetes,” he said. “But I think it’s really important that it be rigorously tested. It’s an expense to people and to the health care system, so we really do need to have evidence of benefit.”

Dr. Neinstein said he encourages people who try programs like Levels to treat their glucose devices as part of a personal science experiment.

“There is so much unhealthy food all around us, and we’re in an epidemic of metabolic disease,” he said. “If people can use these devices to test different foods and get a little feedback on what are the behaviors that are making them less healthy, then that seems like a valuable thing to me.”

The Toll of Fried Foods on Heart Health

The Toll of Fried Foods on Heart Health

Eating fried foods increased the risk of heart disease, stroke, heart failure and premature death.

Credit…Max Whittaker for The New York Times
Nicholas Bakalar

  • Jan. 22, 2021, 4:28 p.m. ET

Most of us know that a diet rich in fried foods is bad for us. A review of studies quantifies just how bad it can be.

In a meta-analysis of 19 studies that included diet and health data on more than 1.2 million men and women from around the world, Chinese researchers calculated the effect of eating French fries, fried fish, fried snacks and other fried foods on cardiovascular health.

Comparing the groups with the highest intake of fried food with people who ate the least over an average period of nine years, they found that high consumption of fried foods increased the relative risk for coronary heart disease by 22 percent; for stroke by 37 percent; for heart failure by 37 percent; for death from cardiovascular disease by 2 percent; and for death from any cause by 3 percent.

The analysis, in the journal Heart, found no evidence that one kind of fried food was any better than another. Using the combined data, the researchers calculated that each additional weekly 114-gram (about 4-ounce) serving of fried food increases the risk for heart failure by 12 percent and for a major cardiovascular event by 3 percent.

The Dietary Guidelines for Americans discourages fried food consumption, but it offers no specific limits on amounts in a healthy diet.

The senior author, Dr. Fulan Hu of the Shenzhen University Health Science Center in Shenzhen, China, offered this advice: “Reduce restaurant meals. Reduce fast-food intake. Use healthier boiling, steaming, baking or grilling cooking methods instead of frying for home-cooked food.”

Some Covid Survivors Haunted by Loss of Smell and Taste

Some Covid Survivors Haunted by Loss of Smell and Taste

As the coronavirus claims more victims, a once-rare diagnosis is receiving new attention from scientists, who fear it may affect nutrition and mental health.

Katherine Hansen used to be able to recreate a restaurant recipe just from tasting a dish. “I’m like someone who loses their eyesight as an adult,” she said.
Katherine Hansen used to be able to recreate a restaurant recipe just from tasting a dish. “I’m like someone who loses their eyesight as an adult,” she said.Credit…Jovelle Tamayo for The New York Times
Roni Caryn Rabin

  • Jan. 2, 2021, 10:26 a.m. ET

Until March, when everything started tasting like cardboard, Katherine Hansen had such a keen sense of smell that she could recreate almost any restaurant dish at home without the recipe, just by recalling the scents and flavors.

Then the coronavirus arrived. One of Ms. Hansen’s first symptoms was a loss of smell, and then of taste. Ms. Hansen still cannot taste food, and says she can’t even tolerate chewing it. Now she lives mostly on soups and shakes.

“I’m like someone who loses their eyesight as an adult,” said Ms. Hansen, a realtor who lives outside Seattle. “They know what something should look like. I know what it should taste like, but I can’t get there.”

A diminished sense of smell, called anosmia, has emerged as one of the telltale symptoms of Covid-19, the illness caused by the coronavirus. It is the first symptom for some patients, and sometimes the only one. Often accompanied by an inability to taste, anosmia occurs abruptly and dramatically in these patients, almost as if a switch had been flipped.

Most regain their senses of smell and taste after they recover, usually within weeks. But in a minority of patients like Ms. Hansen, the loss persists, and doctors cannot say when or if the senses will return.

Scientists know little about how the virus causes persistent anosmia or how to cure it. But cases are piling up as the coronavirus sweeps across the world, and some experts fear that the pandemic may leave huge numbers of people with a permanent loss of smell and taste. The prospect has set off an urgent scramble among researchers to learn more about why patients are losing these essential senses, and how to help them.

“Many people have been doing olfactory research for decades and getting little attention,” said Dr. Dolores Malaspina, professor of psychiatry, neuroscience, genetics and genomics at Icahn School of Medicine at Mount Sinai in New York. “Covid is just turning that field upside down.”

Smell is intimately tied to both taste and appetite, and anosmia often robs people of the pleasure of eating. But the sudden absence also may have a profound impact on mood and quality of life.

Studies have linked anosmia to social isolation and anhedonia, an inability to feel pleasure, as well as a strange sense of detachment and isolation. Memories and emotions are intricately tied to smell, and the olfactory system plays an important though largely unrecognized role in emotional well-being, said Dr. Sandeep Robert Datta, an associate professor of neurobiology at Harvard Medical School.

“You think of it as an aesthetic bonus sense,” Dr. Datta said. “But when someone is denied their sense of smell, it changes the way they perceive the environment and their place in the environment. People’s sense of well-being declines. It can be really jarring and disconcerting.”

Many sufferers describe the loss as extremely upsetting, even debilitating, all the more so because it is invisible to others.

“Smell is not something we pay a lot of attention to until it’s gone,” said Pamela Dalton, who studies smell’s link to cognition and emotion at the Monell Chemical Senses Center in Philadelphia. “Then people notice it, and it is pretty distressing. Nothing is quite the same.”

British scientists studied the experiences of 9,000 Covid-19 patients who joined a Facebook support group set up by the charity group AbScent between March 24 and September 30. Many members said they had not only lost pleasure in eating, but also in socializing. The loss had weakened their bonds with other people, affecting intimate relationships and leaving them feeling isolated, even detached from reality.

“I feel alien from myself,” one participant wrote. “It’s also kind of a loneliness in the world. Like a part of me is missing, as I can no longer smell and experience the emotions of everyday basic living.”

Another said, “I feel discombobulated — like I don’t exist. I can’t smell my house and feel at home. I can’t smell fresh air or grass when I go out. I can’t smell the rain.”

Loss of smell is a risk factor for anxiety and depression, so the implications of widespread anosmia deeply trouble mental health experts. Dr. Malaspina and other researchers have found that olfactory dysfunction often precedes social deficits in schizophrenia, and social withdrawal even in healthy individuals.

“From a public health perspective, this is really important,” Dr. Datta said. “If you think worldwide about the number of people with Covid, even if only 10 percent have a more prolonged smell loss, we’re talking about potentially millions of people.”

The most immediate effects may be nutritional. People with anosmia may continue to perceive basic tastes — salty, sour, sweet, bitter and umami. But taste buds are relatively crude preceptors. Smell adds complexity to the perception of flavor via hundreds of odor receptors signaling the brain.

Many people who can’t smell will lose their appetites, putting them at risk of nutritional deficits and unintended weight loss. Kara VanGuilder, who lives in Brookline, Mass., said she has lost 20 pounds since March, when her sense of smell vanished.

“I call it the Covid diet,” said Ms. VanGuilder, 26, who works in medical administration. “There no point in indulging in brownies if I can’t really taste the brownie.”

But while she jokes about it, she added, the loss has been distressing: “For a few months, every day almost, I would cry at the end of the day.”

Michele Miller developed anosmia following a bout with Covid-19 in March. She did not smell the gas from the oven filling up her kitchen.
Michele Miller developed anosmia following a bout with Covid-19 in March. She did not smell the gas from the oven filling up her kitchen.Credit…Joshua Bright for The New York Times

Smells also serve as a primal alarm system alerting humans to dangers in our environment, like fires or gas leaks. A diminished sense of smell in old age is one reason older individuals are more prone to accidents, like fires caused by leaving burning food on the stove.

Michele Miller, of Bayside, N.Y., was infected with the coronavirus in March and hasn’t smelled anything since then. Recently, her husband and daughter rushed her out of their house, saying the kitchen was filling with gas.

She had no idea. “It’s one thing not to smell and taste, but this is survival,” Ms. Miller said.

Humans constantly scan their environments for smells that signal changes and potential harms, though the process is not always conscious, said Dr. Dalton, of the Monell Chemical Senses Center.

Smell alerts the brain to the mundane, like dirty clothes, and the risky, like spoiled food. Without this form of detection, “people get anxious about things,” Dr. Dalton said.

Even worse, some Covid-19 survivors are tormented by phantom odors that are unpleasant and often noxious, like the smells of burning plastic, ammonia or feces, a distortion called parosmia.

Eric Reynolds, a 51-year-old probation officer in Santa Maria, Calif., lost his sense of smell when he contracted Covid-19 in April. Now, he said, he often perceives foul odors that he knows don’t exist. Diet drinks taste like dirt; soap and laundry detergent smell like stagnant water or ammonia.

“I can’t do dishes, it makes me gag,” Mr. Reynolds said. He’s also haunted by phantom smells of corn chips and a scent he calls “old lady perfume smell.”

It’s not unusual for patients like him to develop food aversions related to their distorted perceptions, said Dr. Evan R. Reiter, medical director of the smell and taste center at Virginia Commonwealth University, who has been tracking the recovery of some 2,000 Covid-19 patients who lost their sense of smell.

One of his patients is recovering, but “now that it’s coming back, she’s saying that everything or virtually everything that she eats will give her a gasoline taste or smell,” Dr. Reiter said.

The derangement of smell may be part of the recovery process, as receptors in the nose struggle to reawaken, sending signals to the brain that misfire or are misread, Dr. Reiter said.

After loss of smell, “different populations or subtypes of receptors may be impacted to different degrees, so the signals your brain is used to getting when you eat steak will be distorted and may trick your brain into thinking you’re eating dog poop or something else that’s not palatable.”

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Patients desperate for answers and treatment have tried therapies like smell training: sniffing essential oils or sachets with a variety of odors — such as lavender, eucalyptus, cinnamon and chocolate — several times a day in an effort to coax back the sense of smell. A recent study of 153 patients in Germany found the training could be moderately helpful in those who had lower olfactory functioning and in those with parosmia.

Dr. Alfred Iloreta, an otolaryngologist at Mount Sinai Hospital in New York, has begun a clinical trial to see whether taking fish oil helps restore the sense of smell. The omega-3 fatty acids found in fish oil may protect nerve cells from further damage or help regenerate nerve growth, he suggested.

“If you have no smell or taste, you have a hard time eating anything, and that’s a massive quality of life issue,” Dr. Iloreta said. “My patients, and the people I know who have lost their smell, are completely wrecked by it.”

Mr. Reynolds feels the loss most acutely when he goes to the beach near his home to walk. He no longer smells the ocean or salt air.

“My mind knows what it smells like,” he said. “And when I get there, it’s not there.”