NYTimes
November 27, 2006
Gilded Paychecks
Very Rich Are Leaving the Merely Rich Behind
By LOUIS UCHITELLE
A decade into the practice of medicine, still striving to become “a well regarded physician-scientist,” Robert H. Glassman concluded that he was not making enough money. So he answered an ad in the New England Journal of Medicine from a business consulting firm hiring doctors.
And today, after moving on to Wall Street as an adviser on medical investments, he is a multimillionaire.
Such routes to great wealth were just opening up to physicians when Dr. Glassman was in school, graduating from Harvard College in 1983 and Harvard Medical School four years later. Hoping to achieve breakthroughs in curing cancer, his specialty, he plunged into research, even dreaming of a Nobel Prize, until Wall Street reordered his life.
Just how far he had come from a doctor’s traditional upper-middle-class expectations struck home at the 20th reunion of his college class. By then he was working for Merrill Lynch and soon would become a managing director of health care investment banking.
“There were doctors at the reunion — very, very smart people,” Dr. Glassman recalled in a recent interview. “They went to the top programs, they remained true to their ethics and really had very pure goals. And then they went to the 20th-year reunion and saw that somebody else who was 10 times less smart was making much more money.”
The opportunity to become abundantly rich is a recent phenomenon not only in medicine, but in a growing number of other professions and occupations. In each case, the great majority still earn fairly uniform six-figure incomes, usually less than $400,000 a year, government data show. But starting in the 1990s, a significant number began to earn much more, creating a two-tier income stratum within such occupations.
The divide has emerged as people like Dr. Glassman, who is 45, latched onto opportunities within their fields that offered significantly higher incomes. Some lawyers and bankers, for example, collect much larger fees than others in their fields for their work on business deals and cases.
Others have moved to different, higher-paying fields — from academia to Wall Street, for example — and a growing number of entrepreneurs have seen windfalls tied largely to expanding financial markets, which draw on capital from around the world. The latter phenomenon has allowed, say, the owner of a small mail-order business to sell his enterprise for tens of millions instead of the hundreds of thousands that such a sale might have brought 15 years ago.
Three decades ago, compensation among occupations differed far less than it does today. That growing difference is diverting people from some critical fields, experts say. The American Bar Foundation, a research group, has found in its surveys, for instance, that fewer law school graduates are going into public-interest law or government jobs and filling all the openings is becoming harder.
Something similar is happening in academia, where newly minted Ph.D.’s migrate from teaching or research to more lucrative fields. Similarly, many business school graduates shun careers as experts in, say, manufacturing or consumer products for much higher pay on Wall Street.
And in medicine, where some specialties now pay far more than others, young doctors often bypass the lower-paying fields. The Medical Group Management Association, for example, says the nation lacks enough doctors in family practice, where the median income last year was $161,000.
“The bigger the prize, the greater the effort that people are making to get it,” said Edward N. Wolff, a New York University economist who studies income and wealth. “That effort is draining people away from more useful work.”
What kind of work is most useful is a matter of opinion, of course, but there is no doubt that a new group of the very rich have risen today far above their merely affluent colleagues.
Turning to Philanthropy
One in every 825 households earned at least $2 million last year, nearly double the percentage in 1989, adjusted for inflation, Mr. Wolff found in an analysis of government data. When it comes to wealth, one in every 325 households had a net worth of $10 million or more in 2004, the latest year for which data is available, more than four times as many as in 1989.
As some have grown enormously rich, they are turning to philanthropy in a competition that is well beyond the means of their less wealthy peers. “The ones with $100 million are setting the standard for their own circles, but no longer for me,” said Robert Frank, a Cornell University economist who described the early stages of the phenomenon in a 1995 book, “The Winner-Take-All Society,” which he co-authored.
Fighting AIDS and poverty in Africa are favorite causes, and so is financing education, particularly at one’s alma mater.
“It is astonishing how many gifts of $100 million have been made in the last year,” said Inge Reichenbach, vice president for development at Yale University, which like other schools tracks the net worth of its alumni and assiduously pursues the richest among them.
Dr. Glassman hopes to enter this circle someday. At 35, he was making $150,000 in 1996 (about $190,000 in today’s dollars) as a hematology-oncology specialist. That’s when, recently married and with virtually no savings, he made the switch that brought him to management consulting.
He won’t say just how much he earns now on Wall Street or his current net worth. But compensation experts, among them Johnson Associates, say the annual income of those in his position is easily in the seven figures and net worth often rises to more than $20 million.
“He is on his way,” said Alan Johnson, managing director of the firm, speaking of people on career tracks similar to Dr. Glassman’s. “He is destined to riches.”
Indeed, doctors have become so interested in the business side of medicine that more than 40 medical schools have added, over the last 20 years, an optional fifth year of schooling for those who want to earn an M.B.A. degree as well as an M.D. Some go directly to Wall Street or into health care management without ever practicing medicine.
“It was not our goal to create masters of the universe,” said James Aisner, a spokesman for Harvard Business School, whose joint program with the medical school started last year. “It was to train people to do useful work.”
Dr. Glassman still makes hospital rounds two or three days a month, usually on free weekends. Treating patients, he said, is “a wonderful feeling.” But he sees his present work as also a valuable aspect of medicine.
One of his tasks is to evaluate the numerous drugs that start-up companies, particularly in biotechnology, are developing. These companies often turn to firms like Merrill Lynch for an investment or to sponsor an initial public stock offering. Dr. Glassman is a critical gatekeeper in this process, evaluating, among other things, whether promising drugs live up to their claims.
What Dr. Glassman represents, along with other very rich people interviewed for this article, is the growing number of Americans who acknowledge that they have accumulated, or soon will, more than enough money to live comfortably, even luxuriously, and also enough so that their children, as adults, will then be free to pursue careers “they have a hunger for,” as Dr. Glassman put it, “and not feel a need to do something just to pay the bills.”
In an earlier Gilded Age, Andrew Carnegie argued that talented managers who accumulate great wealth were morally obligated to redistribute their wealth through philanthropy. The estate tax and the progressive income tax later took over most of that function — imposing tax rates of more than 70 percent as recently as 1980 on incomes above a certain level.
Now, with this marginal rate at half that much and the estate tax fading in importance, many of the new rich engage in the conspicuous consumption that their wealth allows. Others, while certainly not stinting on comfort, are embracing philanthropy as an alternative to a life of professional accomplishment.
Bill Gates and Warren Buffett are held up as models, certainly by Dr. Glassman. “They are going to make much greater contributions by having made money and then giving it away than most, almost all, scientists,” he said, adding that he is drawn to philanthropy as a means of achieving a meaningful legacy.
“It has to be easier than the chance of becoming a Nobel Prize winner,” he said, explaining his decision to give up research, “and I think that goes through the minds of highly educated, high performing individuals.”
As Bush administration officials see it — and conservative economists often agree — philanthropy is a better means of redistributing the nation’s wealth than higher taxes on the rich. They argue that higher marginal tax rates would discourage entrepreneurship and risk-taking. But some among the newly rich have misgivings.
Mark M. Zandi is one. He was a founder of Economy.com, a forecasting and data gathering service in West Chester, Pa. His net worth vaulted into eight figures with the company’s sale last year to Moody’s Investor Service.
“Our tax policies should be redesigned through the prism that wealth is being increasingly skewed,” Mr. Zandi said, arguing that higher taxes on the rich could help restore a sense of fairness to the system and blunt a backlash from a middle class that feels increasingly squeezed by the costs of health care, higher education, and a secure retirement. The Federal Reserve’s Survey of Consumer Finances, a principal government source of income and wealth data, does not single out the occupations and professions generating so much wealth today. But Forbes magazine offers a rough idea in its annual surveys of the richest Americans, those approaching and crossing the billion dollar mark.
Some routes are of long standing. Inheritance plays a role. So do the earnings of Wall Street investment bankers and the super incomes of sports stars and celebrities. All of these routes swell the ranks of the very rich, as they did in 1989.
But among new occupations, the winners include numerous partners in recently formed hedge funds and private equity firms that invest or acquire companies. Real estate developers and lawyers are more in evidence today among the very rich. So are dot-com entrepreneurs as well as scientists who start a company to market an invention or discovery, soon selling it for many millions. And from corporate America come many more chief executives than in the past.
Seventy-five percent of the chief executives in a sample of 100 publicly traded companies had a net worth in 2004 of more than $25 million mainly from stock and options in the companies they ran, according to a study by Carola Frydman, a finance professor at the Massachusetts Institute of Technology’s Sloan School of Management. That was up from 31 percent for the same sample in 1989, adjusted for inflation.
Chief executives were not alone among corporate executives in rising to great wealth. There were similar or even greater increases in the percentage of lower-ranking executives — presidents, executive vice presidents, chief financial officers — also advancing into the $25 million-plus category.
The growing use of options as a form of pay helps to explain the sharp rise in the number of very wealthy households. But so does the gradual dismantling of the progressive income tax, Ms. Frydman concluded in a recent study.
“Our simulation results suggest that, had taxes been at their low 2000 level throughout the past 60 years, chief executive compensation would have been 35 percent higher during the 1950s and 1960s,” she wrote.
Trying Not to Live Ostentatiously
Finally, the owners of a variety of ordinary businesses — a small chain of coffee shops or temporary help agencies, for example — manage to expand these family operations with the help of venture capital and private equity firms, eventually selling them or taking them public in a marketplace that rewards them with huge sums.
John J. Moon, a managing director of Metalmark Capital, a private equity firm, explains how this process works.
“Let’s say we buy a small pizza parlor chain from an entrepreneur for $10 million,” said Mr. Moon, who at 39, is already among the very rich. “We make it more efficient, we build it from 10 stores to 100 and we sell it to Domino’s for $50 million.”
As a result, not only the entrepreneur gets rich; so do Mr. Moon and his colleagues, who make money from putting together such deals and from managing the money they raise from wealthy investors who provide much of the capital.
By his own account, Mr. Moon, like Dr. Glassman, came reluctantly to the accumulation of wealth. Having earned a Ph.D. in business economics from Harvard in 1994, he set out to be a professor of finance, landing a job at Dartmouth’s Tuck Graduate School of Business, with a starting salary in the low six figures.
To this day, teaching tugs at Mr. Moon, whose parents immigrated to the United States from South Korea. He steals enough time from Metalmark Capital to teach one course in finance each semester at Columbia University’s business school. “If Wall Street was not there as an alternative,” Mr. Moon said, “I would have gone into academia.”
Academia, of course, turned out to be no match for the job offers that came Mr. Moon’s way from several Wall Street firms. He joined Goldman Sachs, moved on to Morgan Stanley’s private equity operation in 1998 and stayed on when the unit separated from Morgan Stanley in 2004 and became Metalmark Capital.
As his income and net worth grew, the Harvard alumni association made contact and he started to give money, not just to Harvard, but to various causes. His growing charitable activities have brought him a leadership role in Harvard alumni activities, including a seat on the graduate school alumni council.
Still, Mr. Moon tries to live unostentatiously. “The trick is not to want more as your income and wealth grow,” he said. “You fly coach and then you fly first class and then it is fractional ownership of a jet and then owning a jet. I still struggle with first class. My partners make fun of me.”
His reluctance to show his wealth has a basis in his religion. “My wife and I are committed Presbyterians,” he said. “I would like to think that my faith informs my career decisions even more than financial considerations. That is not always easy because money is not unimportant.”
It has a momentum of its own. Mr. Moon and his wife, Hee-Jung, who gave up law to raise their two sons, are renovating a newly purchased Park Avenue co-op. “On an absolute scale it is lavish,” he said, “but on a relative scale, relative to my peers, it is small.”
Behavior is gradually changing in the Glassman household, too. Not that the doctor and his wife, Denise, 41, seem to crave change. Nothing in his off-the-rack suits, or the cafes and nondescript restaurants that he prefers for interviews, or the family’s comparatively modest four-bedroom home in suburban Short Hills, N.J., or their two cars (an Acura S.U.V. and a Honda Accord) suggests that wealth has altered the way the family lives.
But it is opening up “choices,” as Mrs. Glassman put it. They enjoy annual ski vacations in Utah now. The Glassmans are shopping for a larger house — not as large as the family could afford, Mrs. Glassman said, but large enough to accommodate a wood-paneled study where her husband could put all his books and his diplomas and “feel that it is his own.” Right now, a glassed-in porch, without book shelves, serves as a workplace for both of them.
Starting out, Dr. Glassman’s $150,000 a year was a bit less than that of his wife, then a marketing executive with an M.B.A. from Northwestern. Their plan was for her to stop working once they had children. To build up their income, she encouraged him to set up or join a medical practice to treat patients. Dr. Glassman initially balked, but he was coming to realize that his devotion to research would not necessarily deliver a big scientific payoff.
“I wasn’t sure that I was willing to take the risk of spending many years applying for grants and working long hours for the very slim chance of winning at the roulette table and making a significant contribution to the scientific literature,” he said.
In this mood, he was drawn to the ad that McKinsey & Company, the giant consulting firm, had placed in the New England Journal of Medicine. McKinsey was increasingly working among biomedical and pharmaceutical companies and it needed more physicians on staff as consultants. Dr. Glassman, absorbed in the world of medicine, did not know what McKinsey was. His wife enlightened him. “The way she explained it, McKinsey was like a Massachusetts General Hospital for M.B.A.’s,” he said. “It was really prestigious, which I liked, and I heard that it was very intellectually charged.”
He soon joined as a consultant, earning a starting salary that was roughly the same as he was earning as a researcher — and soon $100,000 more. He stayed four years, traveling constantly and during that time the family made the move to Short Hills from rented quarters in Manhattan.
Dr. Glassman migrated to Merrill Lynch in 2001, first in private equity, which he found to be more at the forefront of innovation than consulting at McKinsey, and then gradually to investment banking, going full time there in 2004.
Linking Security to Income
Casey McCullar hopes to follow a similar circuit. Now 29, he joined the Marconi Corporation, a big telecommunications company, in 1999 right out of the University of Texas in Dallas, his hometown. Over the next six years he worked up to project manager at $42,000 a year, becoming quite skilled in electronic mapmaking.
A trip to India for his company introduced him to the wonders of outsourcing and the money he might make as an entrepreneur facilitating the process. As a first step, he applied to the Tuck business school at Dartmouth, got in and quit his Texas job, despite his mother’s concern that he was giving up future promotions and very good health insurance, particularly Marconi’s dental plan.
His life at Tuck soon sent him in still another direction. When he graduates next June he will probably go to work for Mercer Management Consulting, he says. Mercer recruited him at a starting salary of $150,000, including bonus. “If you had told me a couple of years ago that I would be making three times my Marconi salary, I would not have believed you,” Mr. McCullar said.
Nearly 70 percent of Tuck’s graduates go directly to consulting firms or Wall Street investment houses. He may pursue finance later, Mr. McCullar says, always keeping in mind an entrepreneurial venture that could really leverage his talent.
“When my mom talks of Marconi’s dental plan and a safe retirement,” he said, “she really means lifestyle security based on job security.”
But “for my generation,” Mr. McCullar said, “lifestyle security comes from financial independence. I’m doing what I want to do and it just so happens that is where the money is.”
Sunday, November 26, 2006
Anorexic story
NYTimes
November 26, 2006
One Spoonful at a Time
By HARRIET BROWN
On a sweltering evening in July of last year, I sat at the end of my daughter Kitty's bed, holding a milkshake made from a cup of Häagen-Dazs coffee ice cream and a cup of whole milk. Kitty (the pet name we've used since she was a baby) shivered, wrapped in a thick quilt. "Here's your milkshake," I said, aiming for a tone that was friendly but firm, a tone that would make her reach for the glass and begin drinking. Six-hundred ninety calories — that's what this milkshake represented to me.
But to Kitty it was the object of her deepest fear and loathing. "You're trying to make me fat," she said in a high-pitched, distorted voice that made the hairs on the back of my neck stand up. She rocked, clutching her stomach, chanting over and over: "I'm a fat pig. I'm so fat."
That summer, Kitty was 14. She was 4-foot-11 and weighed 71 pounds. I could see the angles and curves of each bone under her skin. Her hair, once shiny, was lank and falling out in clumps. Her breath carried the odor of ketosis, the sour smell of the starving body digesting itself.
I kept my voice neutral. "You need to drink the milkshake," I repeated. She lifted her head, and for a second I saw the 2-year-old Kitty, her mouth quirked in a half-smile, her dark eyes full of humor. It was enough to keep me from shrieking: Just drink the damn milkshake! Enough to keep me sitting on the end of the bed for the next two hours, talking in a low voice, lifting the straw to her lips over and over. The milkshake had long since melted when she swallowed the last of it, curled up in bed and closed her eyes. Her gaunt face stayed tense even in sleep.
Kitty's anorexia was diagnosed a few weeks before, at the end of that June. My husband and I knew something was wrong for several weeks; we just didn't know what. She'd started reading Gourmet and planning lavish dinner parties. She called me at work several times a day, needing to know what dinner would be the next night and the next. She exercised for hours each night, doing situps and push-ups in her room. On Mother's Day she worried that she might have obsessive-compulsive disorder, because she couldn't stop thinking about meals and food.
My husband and I told ourselves, She's 14, we can't be overprotective. We said to each other, I wouldn't be that age again for anything. Kitty didn't want to see a therapist; we didn't want to insist. Yet.
She was thin, too thin. She ate fruit and vegetables, turkey and low-fat yogurt — healthful choices. But as she crossed the floor at her eighth-grade graduation, we saw that something had changed; suddenly she looked emaciated. I called the pediatrician the next morning.
The day anorexia was diagnosed, the doctor told Kitty to eat more and told us to find her a therapist. Two weeks later we met with an eating-disorders specialist who talked to Kitty as if she were 3 years old. That's when we panicked; we'd been pinning our hopes on the therapist, but clearly she was not going to save the day. So we tried to get Kitty to eat: we encouraged, we reasoned, we yelled. Kitty cried, said she wasn't hungry, her stomach hurt; she would eat at her friends' houses, at camp, tomorrow.
On a hundred-degree day that July, she spent hours frying chicken and baking carrot cake, then ate almost none of it. I begged her to drink water; she swore she wasn't thirsty. Late that night, she put her hand on her chest. "My heart feels funny," she said. The emergency room doctor admitted her with an abnormal EKG; she was dehydrated, and her resting heart had slowed to 31 beats a minute (normal is 60 to 80). When she didn't eat, they moved her to the I.C.U., where a frazzled doctor ordered a feeding tube. Kitty wept. "I won't be able to taste my food!" she cried.
I wanted to shout, "But you're not eating anything!" The doctor gave her a choice: eat a protein shake and a small bowl of spaghetti in half an hour, or he would order the tube. She did it — and she kept eating, three tiny hospital meals a day, more than she'd eaten in weeks.
That first night in the hospital, we asked Kitty's pediatrician where her other anorexic patients went for treatment. "When they're this sick, they go away," she said, referring to inpatient eating-disorder clinics, where people often stay for two or three months. The nearest was an hour away and cost $1,000 a day, most of which would not be covered by our HMO. Kitty was terrified at the prospect. "Don't make me leave you," she cried. It would have been easier on one level to send her away to some place that could help her. But we couldn't send her off when she was so frightened.
We visited an adolescent day program at a local psychiatric hospital; it felt like the set of "One Flew Over the Cuckoo's Nest." On every subject except food, Kitty was completely rational; how would rehashing eighth grade in the hospital's "school" help her?
Had the diagnosis been, say, diabetes, we would have been given a list of guidelines and medications — a road map for recovery. We would have looked at research and treatment protocols. Look anorexia up on Amazon, and you'll find hundreds of titles, but we couldn't sort the useful books from the flaky ones. And in terms of treatment, there isn't much systematic scientific research on the disease. No one could tell us exactly how to make our daughter well. All they could say for sure was that the odds weren't good. Anorexia is one of the deadliest psychiatric diseases; it's estimated that up to 15 percent of anorexics die, from suicide or complications related to starvation. About a third may make some improvement but are still dominated by their obsession with food. Many become depressed or anxious, and some develop substance-abuse problems, like alcoholism. Almost half never marry. It is thought that if anorexia is not treated early on, during adolescence, it tends to take an average of five to seven years for the person to recover — if it happens at all. I pictured Kitty, starved and weak, at 16 and 18 and 21, and felt sick.
I went home and started researching, hoping to find another option. Among the few studies done on anorexia treatment, I came across one from 1997, a follow-up to an earlier study on adolescents that assessed a method developed in England and was still relatively unknown in the United States: family- based treatment, often called the Maudsley approach. This treatment was created by a team of therapists led by Christopher Dare and Ivan Eisler at the Maudsley Hospital in London, in the mid-1980s, as an alternative to hospitalization. In a hospital setting, nurses sit with anorexic patients at meals, encouraging and calming them; they create a culture in which patients have to eat. The Maudsley approach urges families to essentially take on the nurses' role. Parents become primary caretakers, working with a Maudsley therapist. Their job: Finding ways to insist that their children eat.
The two studies showed that 90 percent of the adolescents recovered or made significant gains; five years later, 90 percent had fully recovered. (Two other studies confirmed these results.) In the world of eating disorders, I was coming to understand, this was a phenomenally high success rate.
The idea that parents should be intimately involved in the refeeding of their children can be quite controversial, a departure from the conventional notion that the dynamic between parent and child causes or contributes to the anorexia. Many therapists advocate a "parentectomy," insisting that parents stay out of the treatment to preserve the child's privacy and autonomy. They say that a child must "choose" to eat in order to truly recover. Maudsley advocates see the family as the best chance a child has for recovery; no one else knows the child as well or has the same investment in the child's well-being. That felt right to us.
Over the last few years, most eating-disorders researchers have begun to think that there is no single cause of anorexia, that maybe it's more like a recipe, where several ingredients — genetics, personality type, hormones, stressful life events — come together in just the wrong way. Maudsley practitioners say that focusing on the cause is secondary, ultimately, because once the physiological process of starvation kicks in, the disease takes on a life of its own, unfolding with predictable symptoms, intensity and long-term consequences. Anorexics become almost uniformly depressed, withdrawn, enraged, anxious, irritable or suicidal, and their thinking about food and eating is distorted, in part because the brain runs on glucose, and when it has been deprived over a long period of time, when it's starved, it goes haywire. It's important to get the patient's weight up, fast, because the less time spent in starvation, the better the outcome. Adult anorexics who have been chronically ill for years have much poorer prognoses than teenagers.
I called Daniel Le Grange, an associate professor of psychiatry at the University of Chicago, who directs the eating-disorders program there. Le Grange spent five years training at Maudsley Hospital in England, and he and James Lock, a professor of child and adolescent psychiatry and pediatrics at Stanford, have written Maudsley treatment manuals for physicians and therapists and a book for parents. The two are in the middle of a $4 million N.I.H.-financed study designed to measure the effectiveness of the Maudsley approach. Le Grange compared anorexia to cancer. "If you leave it, it's going to metastasize," he said. "You need to figure out an aggressive way to eradicate it as quickly as you can. You're not going to hear an oncologist say, 'Oh, it's Stage 0 cancer, let's wait till it becomes Stage 3.' "
I asked Le Grange what he thought about a critique of Maudsley: that it violates the usual boundaries between child and parent, derailing the adolescent work of separation and individuation. "If your child has diabetes and doesn't check her blood sugar often enough, you'd make sure she did," Le Grange reassured me. "What we're trying to achieve is taking anorexia away so the child can go on her way unencumbered by the eating disorder. What could be more respectful of adolescent development?"
There were no local Maudsley therapists, so my husband and I lined up a pediatrician (in whose office Kitty was weighed weekly), a psychiatrist (whom she saw weekly, then twice a month), a therapist (weekly) and a nutritionist (two or three visits). We didn't know if Maudsley would work. We didn't know if it was, objectively speaking, the best choice. But anything was better than watching Kitty disappear, ounce by ounce, obscured by the creature who spoke with her voice and looked out through her eyes. Anything.
On Day 2 of refeeding Kitty, our younger daughter, Lulu (also her nickname), turned 10. We had cake, a dense, rich chocolate cake layered with raspberry filling — one of Kitty's favorites. Of course she refused it. I told her that if she didn't eat the cake, we'd go back to the hospital that night and she would get the tube. I hated saying this, but I hated the prospect of the hospital more. The tube felt like the worst thing that could happen to her, though of course it was not. Five minutes after Kitty was born, I fed her from my own body. Now the idea of forcing a tube down her throat, having a nurse insert a "bolus" every so often, seemed a grotesque perversion of every bit of love and sustenance I'd ever given her.
She sat in front of the cake, crying. She put down the fork, said her throat was closing, said that she was a horrible person, that she couldn't eat it, she just couldn't. We told her it was not a choice to starve. We told her she could do nothing until she ate — no TV, books, showers, phone, sleep. We told her we would sit at the table all night if we had to.
Still, I was astonished when she lifted the first tiny forkful of cake to her mouth. It took 45 minutes to eat the whole piece. After she'd scraped the last bit into her mouth, she lay her head on the table and sobbed, "That was scary, Mommy!"
At age 4, Kitty went for a pony ride and was seated on an enormous quarter horse. When the horse reared, she just held on. Afterward I asked if she'd been scared. "Not really," she said. "Can I go again?"
This was the child who was now terrified by a slice of chocolate cake.
That night, when I checked on her in bed, she mumbled, "Make it go away." I now knew what "it" was. It seemed as if she were possessed by a vicious demon she must appease or suffer the consequences. I pictured its leathery wings and yellow fangs inside her. Each crumb Kitty ate was an act of true bravery, defiance snatched from its curved talons. I've heard women joke, "I could use a little anorexia!" They have no idea.
This demon was described nowhere in the books I was frantically reading. It wasn't until I stumbled on a 1940s study led by Dr. Ancel Keys, a physiologist at the University of Minnesota, that I began to understand. During World War II, Keys recruited 36 physically and psychologically healthy men for a yearlong study on starvation. For the first three months they ate normally, while Keys's researchers recorded information about their personalities, eating patterns and behavior. For the next six months their rations were cut in half; most of the men lost about a quarter of their weight, putting them at about 75 percent of their former weight — about where Kitty was when she was hospitalized. The men spent the final three months being refed.
Keys and his colleagues published their study in 1950 as "The Biology of Human Starvation," and his findings are startlingly relevant to anorexia. Depression and irritability plagued all the volunteers, especially during refeeding. They cut their food into tiny pieces, drew meals out for hours. They became withdrawn and obsessional, antisocial and anxious. One volunteer deliberately chopped off three of his fingers during the recovery period. The demon, I thought.
"Starvation affects the whole organism," Keys wrote. Given what I'd seen of Kitty, that made sense to me. But I wondered why — if starvation triggers the cognitive, emotional and behavioral changes that are so uniform in anorexia — the Minnesota volunteers did not develop the intense fear of eating and gaining weight that characterizes the disease. And what about the millions of people around the world who are starving because they don't have enough food — why don't they develop anorexia?
Once more I turned to Le Grange, who explained that at the core of anorexia is the notion of starvation in the midst of plenty; starvation when food isn't available doesn't usually trigger the same response. As for the Minnesota volunteers, he said, they were males (most anorexics are female), and they were beyond adolescence, outside the developmental window when anorexia tends to strike. More important, the volunteers ate about half their caloric requirements for six months; most anorexics eat far less, over a much longer period of time. "We're talking about a 14- year-old who is profoundly starved for 12 months," he said. "These guys were semistarved for a relatively brief period." It's not just the weight; it's the pattern of behavioral reinforcement. Each time an anorexic restricts what she's consuming, the anorexic thoughts ("I'm so fat, I'm such a pig") and behaviors (constant exercising, for example) are strengthened. Which is why it takes not just weight gain but the experience of eating meal after meal after meal to truly cure the disease.
Of course this brings up the question: which comes first, physiological starvation or the mental and emotional changes of anorexia? "You or I would earn the Nobel Prize if we figured that out," Le Grange said. "It's a bit of both, probably, and the two impact each other. So if you are constitutionally slender and it's easy for you to diet, and you like ballet, and you live in the United States, and you're 13, and your personality is perfectionist, your chance of developing this illness is very, very high."
Switch gymnastics for ballet, and Le Grange had just described Kitty. I used to hope she'd get a B in school so she'd see that the world didn't come to an end. Clearly, she wasn't going to be O.K. in a week or a month or six months. We were embarking on a long journey, one that would change us all.
A week into refeeding, I'd become an expert in high-calorie cooking. I made macaroni and cheese with butter and whole milk, chicken breasts dredged in egg, rolled in bread crumbs, fried in butter. Carrot cake with cream-cheese icing. Thousand-calorie milkshakes and muffins. When a body is in a state of starvation, it isn't enough to simply eat a normal diet, Dr. Walter H. Kaye, director of the eating-disorders program at the University of California at San Diego, explained to me. The body requires huge numbers of calories to gain weight and maintain it. Every few days we added 300 calories; by Day 9, Kitty was eating 2,100 calories a day. Still, she'd lost another half pound, which panicked me until the pediatrician explained that Kitty's metabolism, slowed by starvation, was now revving high. It's not unusual to lose weight at first, she said; just keep feeding her.
A heating pad helped with the stomachaches and bloating that followed each meal. But nothing helped with the thoughts and feelings. Faced with a plate of food, the demon inside my daughter bargained, cried, lashed out. Her anxiety was so great that there was no reward that could motivate her to eat. Her fear of the tube was what kept her eating in those first few weeks. I wondered what would happen when she'd gained a few pounds and the tube was no longer a possibility.
Meanwhile, the demon sat at our table and spewed venom: "I'm a lazy pig. You're trying to make me fat." And, one night, terrifyingly: "I just want to go to sleep and never wake up."
With that comment, Kitty's younger sister, Lulu, looked up from her plate, her face full of anguish, and bolted from the table. I found her in the basement. "I don't want to go to my sister's funeral!" she cried. "Neither do I," I told her.
Later that night, when Kitty and Lulu were asleep, I stood in the middle of the kitchen and thought of how our lives had shrunk to the confines of these four walls. The counter and sink were piled high with dirty plates, ice cream tubs, glasses and pans. Between shopping, cooking, eating with Kitty, spending time with Lulu and going to work, my husband and I had no time for cleaning, much less anything else. Suddenly I was filled with fury. I grabbed a dish and smashed it on the linoleum, where it broke into half a dozen pieces. I broke another, and another, and another. There were so many things I couldn't fix or make right, so many feelings I couldn't handle. I swept the pieces into a bag and carried them outside. Tomorrow we would eat off paper plates.
Three weeks into refeeding, Kitty was consuming 3,000 calories a day; she'd gained about eight pounds. My husband or I would sit with her while she ate three meals and two snacks each day; we needed to know she was eating, and she needed us to compel her to eat, to get past the demon's grip on her. One of us brought her to work, as we had when she was an infant. In many ways this process felt like reparenting as well as refeeding, taking her back to a time when she was totally dependent on us.
Some parents don't want to or can't go backward like this. Some don't have flexible work schedules and can't be home for every meal and snack. Some are overwhelmed by the relentless and exhausting work of refeeding. For any of these parents, Maudsley may be impossible. It works best when two parents are involved — so they can take turns losing it, offstage — and when those parents agree that their top priority is refeeding. I heard stories from other families about anorexics who slipped meals into the trash when softhearted Dad was in charge, or about weight-conscious mothers who couldn't bring themselves to serve their daughters that much food. When we started refeeding Kitty, my husband had never thought much about nutrition, and the idea took some getting used to. By late August, though, he could tell you how many calories were in a pat of butter, a chicken breast, a glass of milk. And he was often far more patient with Kitty than I.
During that first month, Kitty smiled once or twice, which made us feel hopeful for the first time since the spring. We watched movies together and took walks around the block — the only exercise she was allowed. We had moments that seemed almost normal.
But the night before she was set to start high school, four weeks in, the demon re-emerged. This time it was far worse than anything we'd experienced, maybe because Kitty was stronger now. At the dinner table, she put her matchstick arms around herself and shouted, "I don't want to go to high school and have everyone say, 'Look at Kitty, look how fat she got over the summer!' "
She refused to eat anything. We cajoled and begged and threatened. She wept and flailed and lashed out. I left messages for the psychiatrist, the therapist, the pediatrician. I told her we'd have to go back to the hospital, though I suspected she now weighed too much to be admitted. Finally I reached a psychiatrist on call, who suggested that we give her a tranquilizer and put her to bed. "If she won't eat in the morning, bring her in," advised the psychiatrist. I was relieved, and also terrified: What if this was the start of a new downward slide?
But the next morning she ate breakfast as usual. After school, she came home with a couple of friends she hadn't seen since spring. As I made milkshakes for all of them, I was surprised to hear Kitty say jokingly, "We know all the ice creams with the most calories!"
One friend said, "We want to know which ones have the least!"
"Yeah," chimed in another, "because my butt is huge!" Another girl said,
"I hate my thighs!" There was a chorus of agreement.
I offered, "You girls are beautiful and healthy and strong." But I felt incredibly sad. Even face to face with the devastating effects of this disease, they were criticizing their bodies.
I've heard the arguments that media depictions of unrealistic female bodies are what drive girls to starve themselves — the Kate Moss syndrome. And it's tempting to see anorexia as a metaphor, a result of a cultural crisis in the zeitgeist. If this were true, though, millions of American girls and women would become anorexic instead of the roughly 1 to 3 percent who do. Clearly there are other factors involved.
My nightly Internet prowling turned up some interesting research by Kaye, the director of the eating-disorders program at the University of California. While Kaye suspects that social and cultural factors contribute to anorexia, he says that recent studies suggest that genetics is the most significant factor for anorexia and bulimia. He has found chromosomal abnormalities in anorexics, as well as irregular levels of the neurotransmitters dopamine and serotonin. The National Institutes of Health is currently spending $10 million in a five-year study to look at the genetic links of the disease.
I grew up in a household where disordered eating was the norm. My aunt was bulimic; my mother enrolled us both in Weight Watchers when I was 15. She recorded her weight each morning on a chart and went on to become a Weight Watchers lecturer, delivering weekly pep talks to a roomful of people who were engaged in an ongoing war with their own bodies. You had to stay vigilant, lest your appetite betray you and the pounds creep back on. I'd tried to teach my daughters to enjoy good food and to love their bodies, but maybe I hadn't gotten over my dieting-obsessed childhood. Or maybe I'd passed along a genetic predisposition that triggered Kitty's illness. The deeper into refeeding we got, though, the less I worried about causes. We could figure that out later. The important thing was to get Kitty to eat and gain weight.
By October, we'd settled into a pattern. My husband, whose work schedule is flexible, ate lunch with Kitty most days; I covered that meal when he couldn't. Kitty gained another six pounds and, encouragingly, grew an inch. But she hadn't felt hungry since before the diagnosis. I worried that anorexia had permanently short-circuited her brain-body connection; how would she ever regulate her own eating?
The rough days were predictable only in the sense that they kept coming. One night she sat at the table, hands over her eyes, in front of a plate of salmon and squash. "I'm bad! I'm bad!" she said, sobbing. "I won't eat, I won't!"
Calmly I said, "Food is your medicine and you've got to take it." Long minutes ticked by. Eventually she said: "I want to eat, but I can't. If I eat now I'll be a total failure!" The anorexia talk spilled out of her, on and on and on. I wanted to wrap her in my arms and say, "Of course you don't have to eat, poor baby." But I couldn't give the disease an inch. If I did, the same thing would happen the next day and the next day. We had to sit there until she ate, no matter how long it took.
By the first week of November, Kitty was up to 90 pounds, 10 pounds short of her target weight. More important, her mood improved significantly. But later in the month, she developed an upset stomach, which isn't unusual during refeeding, and began refusing the daily milkshakes. She complained of dizziness, wanted to know what I would be serving her, then argued for something else. She raged at me and at herself. One afternoon she cried so much she "accidentally" threw up her lunch. Back in September she tried to make herself throw up a few times; about half of all anorexics do become bulimic. Luckily, Kitty was never able to do it. I hoped she hadn't learned how.
In December, Kitty gained and lost the same pound over and over. At the end of the month she was still, frustratingly, at 90 pounds, still deeply in the grip of the disease. We boosted her intake to 4,000 calories a day. In mid-January, finally, her weight went up four pounds. It was astonishing, how much food she needed, but not unusual. Anorexics become metabolically inefficient; their temperatures rise, and they tend to burn off calories rather than put on flesh. "That's one reason for the high rate of relapse," Dr. Kaye told me. It's hard to gain enough weight to truly recover, and even harder to maintain it.
As went the fall, so went the spring. The pounds came on, very slowly, and Kitty's spirits continued to lift. More and more, she hung out with boys. "They don't talk about how fat they are," she explained. And they didn't make her feel self-conscious about eating. "Yo, Kitty, you done with your 10,000-calorie milkshake yet?" one boy said one afternoon in March, and she actually giggled.
In April, Kitty grew another two inches, which meant that her target weight went up, too. I felt despair at the thought that it would take longer now for her to gain enough weight, longer for her to get well. I told myself that her health was more complex than a number on the scale, that she was recovering. But I couldn't forget the sunken, unspeakably sad look in her eyes that past summer and fall.
One day in May, she came home from school grinning. "Guess what?" she said. "Sue brought cake to school, and I ate a piece. Aren't you proud of me?" All year she'd avoided parties, potlucks, lunches — any get-together that involved food. The fact that she ate a piece of cake, one of her "scary" foods, meant that she gave up, for a moment, being the anorexic at the back of the room. She became one of the group.
But the next day I made her and Lulu bagels with melted cheese, and Kitty complained, "You know I don't like sesame bagels." "You used to," I said. I knew what was behind this, and I wanted her to say it. I wanted it out in the open.
"They have more calories than plain bagels!" she burst out. But she calmed down quickly. "I know that was an eating-disordered thing to say. I couldn't help it," she said quietly, and ate the bagel.
I felt proud of her ability to name the demon and defy it. I wished we could just yank it out of her, unhook the claws that tormented her body and mind.
On a morning this past June, she called me at work to say the two most beautiful words in the English language: "I'm hungry!"
"I'm so happy!" I blurted out.
"I'm happy, too, Mom," she said.
She reached her target weight a few weeks later, and maintained it through the summer and early fall. Maudsley therapists say that true recovery entails weight restoration and functioning well psychologically and socially. Kitty would continue to see a therapist from time to time, to work on perfectionism and other issues. For now, though, she seemed happy and whole. The phone rang for her; friends trooped through the house. Life seemed normal again.
But one night recently I dreamed I was running through a strange house, looking for my daughter. I found her — though it wasn't really her — and grabbed her by the arm. "You didn't eat dinner last night, did you?" I shouted. "What did you have for breakfast?" Not-Kitty smiled. "A teaspoon of air," she said sweetly. I woke with my heart pounding, full of rage and hatred for Not-Kitty, the demon who lived on air, who wore my daughter's face and spoke with her voice.
The Maudsley approach advocates separating the disease from the sufferer, the anorexia from the adolescent. And this helps, especially on the worst days. But it's also true that the demon is part of our family now, lurking in the shadows. We will never forget it. We don't know if or when it will re-emerge — two months from now, two years, five years. We don't know if we've done the right thing. Is Kitty cured? Will she ever be cured? There are so many questions I can't answer.
That morning, I got out of bed in the gray predawn and went down to the kitchen. I pulled out eggs, milk, butter and raspberry jam and set to work making crepes. It was all I could think of to do.
November 26, 2006
One Spoonful at a Time
By HARRIET BROWN
On a sweltering evening in July of last year, I sat at the end of my daughter Kitty's bed, holding a milkshake made from a cup of Häagen-Dazs coffee ice cream and a cup of whole milk. Kitty (the pet name we've used since she was a baby) shivered, wrapped in a thick quilt. "Here's your milkshake," I said, aiming for a tone that was friendly but firm, a tone that would make her reach for the glass and begin drinking. Six-hundred ninety calories — that's what this milkshake represented to me.
But to Kitty it was the object of her deepest fear and loathing. "You're trying to make me fat," she said in a high-pitched, distorted voice that made the hairs on the back of my neck stand up. She rocked, clutching her stomach, chanting over and over: "I'm a fat pig. I'm so fat."
That summer, Kitty was 14. She was 4-foot-11 and weighed 71 pounds. I could see the angles and curves of each bone under her skin. Her hair, once shiny, was lank and falling out in clumps. Her breath carried the odor of ketosis, the sour smell of the starving body digesting itself.
I kept my voice neutral. "You need to drink the milkshake," I repeated. She lifted her head, and for a second I saw the 2-year-old Kitty, her mouth quirked in a half-smile, her dark eyes full of humor. It was enough to keep me from shrieking: Just drink the damn milkshake! Enough to keep me sitting on the end of the bed for the next two hours, talking in a low voice, lifting the straw to her lips over and over. The milkshake had long since melted when she swallowed the last of it, curled up in bed and closed her eyes. Her gaunt face stayed tense even in sleep.
Kitty's anorexia was diagnosed a few weeks before, at the end of that June. My husband and I knew something was wrong for several weeks; we just didn't know what. She'd started reading Gourmet and planning lavish dinner parties. She called me at work several times a day, needing to know what dinner would be the next night and the next. She exercised for hours each night, doing situps and push-ups in her room. On Mother's Day she worried that she might have obsessive-compulsive disorder, because she couldn't stop thinking about meals and food.
My husband and I told ourselves, She's 14, we can't be overprotective. We said to each other, I wouldn't be that age again for anything. Kitty didn't want to see a therapist; we didn't want to insist. Yet.
She was thin, too thin. She ate fruit and vegetables, turkey and low-fat yogurt — healthful choices. But as she crossed the floor at her eighth-grade graduation, we saw that something had changed; suddenly she looked emaciated. I called the pediatrician the next morning.
The day anorexia was diagnosed, the doctor told Kitty to eat more and told us to find her a therapist. Two weeks later we met with an eating-disorders specialist who talked to Kitty as if she were 3 years old. That's when we panicked; we'd been pinning our hopes on the therapist, but clearly she was not going to save the day. So we tried to get Kitty to eat: we encouraged, we reasoned, we yelled. Kitty cried, said she wasn't hungry, her stomach hurt; she would eat at her friends' houses, at camp, tomorrow.
On a hundred-degree day that July, she spent hours frying chicken and baking carrot cake, then ate almost none of it. I begged her to drink water; she swore she wasn't thirsty. Late that night, she put her hand on her chest. "My heart feels funny," she said. The emergency room doctor admitted her with an abnormal EKG; she was dehydrated, and her resting heart had slowed to 31 beats a minute (normal is 60 to 80). When she didn't eat, they moved her to the I.C.U., where a frazzled doctor ordered a feeding tube. Kitty wept. "I won't be able to taste my food!" she cried.
I wanted to shout, "But you're not eating anything!" The doctor gave her a choice: eat a protein shake and a small bowl of spaghetti in half an hour, or he would order the tube. She did it — and she kept eating, three tiny hospital meals a day, more than she'd eaten in weeks.
That first night in the hospital, we asked Kitty's pediatrician where her other anorexic patients went for treatment. "When they're this sick, they go away," she said, referring to inpatient eating-disorder clinics, where people often stay for two or three months. The nearest was an hour away and cost $1,000 a day, most of which would not be covered by our HMO. Kitty was terrified at the prospect. "Don't make me leave you," she cried. It would have been easier on one level to send her away to some place that could help her. But we couldn't send her off when she was so frightened.
We visited an adolescent day program at a local psychiatric hospital; it felt like the set of "One Flew Over the Cuckoo's Nest." On every subject except food, Kitty was completely rational; how would rehashing eighth grade in the hospital's "school" help her?
Had the diagnosis been, say, diabetes, we would have been given a list of guidelines and medications — a road map for recovery. We would have looked at research and treatment protocols. Look anorexia up on Amazon, and you'll find hundreds of titles, but we couldn't sort the useful books from the flaky ones. And in terms of treatment, there isn't much systematic scientific research on the disease. No one could tell us exactly how to make our daughter well. All they could say for sure was that the odds weren't good. Anorexia is one of the deadliest psychiatric diseases; it's estimated that up to 15 percent of anorexics die, from suicide or complications related to starvation. About a third may make some improvement but are still dominated by their obsession with food. Many become depressed or anxious, and some develop substance-abuse problems, like alcoholism. Almost half never marry. It is thought that if anorexia is not treated early on, during adolescence, it tends to take an average of five to seven years for the person to recover — if it happens at all. I pictured Kitty, starved and weak, at 16 and 18 and 21, and felt sick.
I went home and started researching, hoping to find another option. Among the few studies done on anorexia treatment, I came across one from 1997, a follow-up to an earlier study on adolescents that assessed a method developed in England and was still relatively unknown in the United States: family- based treatment, often called the Maudsley approach. This treatment was created by a team of therapists led by Christopher Dare and Ivan Eisler at the Maudsley Hospital in London, in the mid-1980s, as an alternative to hospitalization. In a hospital setting, nurses sit with anorexic patients at meals, encouraging and calming them; they create a culture in which patients have to eat. The Maudsley approach urges families to essentially take on the nurses' role. Parents become primary caretakers, working with a Maudsley therapist. Their job: Finding ways to insist that their children eat.
The two studies showed that 90 percent of the adolescents recovered or made significant gains; five years later, 90 percent had fully recovered. (Two other studies confirmed these results.) In the world of eating disorders, I was coming to understand, this was a phenomenally high success rate.
The idea that parents should be intimately involved in the refeeding of their children can be quite controversial, a departure from the conventional notion that the dynamic between parent and child causes or contributes to the anorexia. Many therapists advocate a "parentectomy," insisting that parents stay out of the treatment to preserve the child's privacy and autonomy. They say that a child must "choose" to eat in order to truly recover. Maudsley advocates see the family as the best chance a child has for recovery; no one else knows the child as well or has the same investment in the child's well-being. That felt right to us.
Over the last few years, most eating-disorders researchers have begun to think that there is no single cause of anorexia, that maybe it's more like a recipe, where several ingredients — genetics, personality type, hormones, stressful life events — come together in just the wrong way. Maudsley practitioners say that focusing on the cause is secondary, ultimately, because once the physiological process of starvation kicks in, the disease takes on a life of its own, unfolding with predictable symptoms, intensity and long-term consequences. Anorexics become almost uniformly depressed, withdrawn, enraged, anxious, irritable or suicidal, and their thinking about food and eating is distorted, in part because the brain runs on glucose, and when it has been deprived over a long period of time, when it's starved, it goes haywire. It's important to get the patient's weight up, fast, because the less time spent in starvation, the better the outcome. Adult anorexics who have been chronically ill for years have much poorer prognoses than teenagers.
I called Daniel Le Grange, an associate professor of psychiatry at the University of Chicago, who directs the eating-disorders program there. Le Grange spent five years training at Maudsley Hospital in England, and he and James Lock, a professor of child and adolescent psychiatry and pediatrics at Stanford, have written Maudsley treatment manuals for physicians and therapists and a book for parents. The two are in the middle of a $4 million N.I.H.-financed study designed to measure the effectiveness of the Maudsley approach. Le Grange compared anorexia to cancer. "If you leave it, it's going to metastasize," he said. "You need to figure out an aggressive way to eradicate it as quickly as you can. You're not going to hear an oncologist say, 'Oh, it's Stage 0 cancer, let's wait till it becomes Stage 3.' "
I asked Le Grange what he thought about a critique of Maudsley: that it violates the usual boundaries between child and parent, derailing the adolescent work of separation and individuation. "If your child has diabetes and doesn't check her blood sugar often enough, you'd make sure she did," Le Grange reassured me. "What we're trying to achieve is taking anorexia away so the child can go on her way unencumbered by the eating disorder. What could be more respectful of adolescent development?"
There were no local Maudsley therapists, so my husband and I lined up a pediatrician (in whose office Kitty was weighed weekly), a psychiatrist (whom she saw weekly, then twice a month), a therapist (weekly) and a nutritionist (two or three visits). We didn't know if Maudsley would work. We didn't know if it was, objectively speaking, the best choice. But anything was better than watching Kitty disappear, ounce by ounce, obscured by the creature who spoke with her voice and looked out through her eyes. Anything.
On Day 2 of refeeding Kitty, our younger daughter, Lulu (also her nickname), turned 10. We had cake, a dense, rich chocolate cake layered with raspberry filling — one of Kitty's favorites. Of course she refused it. I told her that if she didn't eat the cake, we'd go back to the hospital that night and she would get the tube. I hated saying this, but I hated the prospect of the hospital more. The tube felt like the worst thing that could happen to her, though of course it was not. Five minutes after Kitty was born, I fed her from my own body. Now the idea of forcing a tube down her throat, having a nurse insert a "bolus" every so often, seemed a grotesque perversion of every bit of love and sustenance I'd ever given her.
She sat in front of the cake, crying. She put down the fork, said her throat was closing, said that she was a horrible person, that she couldn't eat it, she just couldn't. We told her it was not a choice to starve. We told her she could do nothing until she ate — no TV, books, showers, phone, sleep. We told her we would sit at the table all night if we had to.
Still, I was astonished when she lifted the first tiny forkful of cake to her mouth. It took 45 minutes to eat the whole piece. After she'd scraped the last bit into her mouth, she lay her head on the table and sobbed, "That was scary, Mommy!"
At age 4, Kitty went for a pony ride and was seated on an enormous quarter horse. When the horse reared, she just held on. Afterward I asked if she'd been scared. "Not really," she said. "Can I go again?"
This was the child who was now terrified by a slice of chocolate cake.
That night, when I checked on her in bed, she mumbled, "Make it go away." I now knew what "it" was. It seemed as if she were possessed by a vicious demon she must appease or suffer the consequences. I pictured its leathery wings and yellow fangs inside her. Each crumb Kitty ate was an act of true bravery, defiance snatched from its curved talons. I've heard women joke, "I could use a little anorexia!" They have no idea.
This demon was described nowhere in the books I was frantically reading. It wasn't until I stumbled on a 1940s study led by Dr. Ancel Keys, a physiologist at the University of Minnesota, that I began to understand. During World War II, Keys recruited 36 physically and psychologically healthy men for a yearlong study on starvation. For the first three months they ate normally, while Keys's researchers recorded information about their personalities, eating patterns and behavior. For the next six months their rations were cut in half; most of the men lost about a quarter of their weight, putting them at about 75 percent of their former weight — about where Kitty was when she was hospitalized. The men spent the final three months being refed.
Keys and his colleagues published their study in 1950 as "The Biology of Human Starvation," and his findings are startlingly relevant to anorexia. Depression and irritability plagued all the volunteers, especially during refeeding. They cut their food into tiny pieces, drew meals out for hours. They became withdrawn and obsessional, antisocial and anxious. One volunteer deliberately chopped off three of his fingers during the recovery period. The demon, I thought.
"Starvation affects the whole organism," Keys wrote. Given what I'd seen of Kitty, that made sense to me. But I wondered why — if starvation triggers the cognitive, emotional and behavioral changes that are so uniform in anorexia — the Minnesota volunteers did not develop the intense fear of eating and gaining weight that characterizes the disease. And what about the millions of people around the world who are starving because they don't have enough food — why don't they develop anorexia?
Once more I turned to Le Grange, who explained that at the core of anorexia is the notion of starvation in the midst of plenty; starvation when food isn't available doesn't usually trigger the same response. As for the Minnesota volunteers, he said, they were males (most anorexics are female), and they were beyond adolescence, outside the developmental window when anorexia tends to strike. More important, the volunteers ate about half their caloric requirements for six months; most anorexics eat far less, over a much longer period of time. "We're talking about a 14- year-old who is profoundly starved for 12 months," he said. "These guys were semistarved for a relatively brief period." It's not just the weight; it's the pattern of behavioral reinforcement. Each time an anorexic restricts what she's consuming, the anorexic thoughts ("I'm so fat, I'm such a pig") and behaviors (constant exercising, for example) are strengthened. Which is why it takes not just weight gain but the experience of eating meal after meal after meal to truly cure the disease.
Of course this brings up the question: which comes first, physiological starvation or the mental and emotional changes of anorexia? "You or I would earn the Nobel Prize if we figured that out," Le Grange said. "It's a bit of both, probably, and the two impact each other. So if you are constitutionally slender and it's easy for you to diet, and you like ballet, and you live in the United States, and you're 13, and your personality is perfectionist, your chance of developing this illness is very, very high."
Switch gymnastics for ballet, and Le Grange had just described Kitty. I used to hope she'd get a B in school so she'd see that the world didn't come to an end. Clearly, she wasn't going to be O.K. in a week or a month or six months. We were embarking on a long journey, one that would change us all.
A week into refeeding, I'd become an expert in high-calorie cooking. I made macaroni and cheese with butter and whole milk, chicken breasts dredged in egg, rolled in bread crumbs, fried in butter. Carrot cake with cream-cheese icing. Thousand-calorie milkshakes and muffins. When a body is in a state of starvation, it isn't enough to simply eat a normal diet, Dr. Walter H. Kaye, director of the eating-disorders program at the University of California at San Diego, explained to me. The body requires huge numbers of calories to gain weight and maintain it. Every few days we added 300 calories; by Day 9, Kitty was eating 2,100 calories a day. Still, she'd lost another half pound, which panicked me until the pediatrician explained that Kitty's metabolism, slowed by starvation, was now revving high. It's not unusual to lose weight at first, she said; just keep feeding her.
A heating pad helped with the stomachaches and bloating that followed each meal. But nothing helped with the thoughts and feelings. Faced with a plate of food, the demon inside my daughter bargained, cried, lashed out. Her anxiety was so great that there was no reward that could motivate her to eat. Her fear of the tube was what kept her eating in those first few weeks. I wondered what would happen when she'd gained a few pounds and the tube was no longer a possibility.
Meanwhile, the demon sat at our table and spewed venom: "I'm a lazy pig. You're trying to make me fat." And, one night, terrifyingly: "I just want to go to sleep and never wake up."
With that comment, Kitty's younger sister, Lulu, looked up from her plate, her face full of anguish, and bolted from the table. I found her in the basement. "I don't want to go to my sister's funeral!" she cried. "Neither do I," I told her.
Later that night, when Kitty and Lulu were asleep, I stood in the middle of the kitchen and thought of how our lives had shrunk to the confines of these four walls. The counter and sink were piled high with dirty plates, ice cream tubs, glasses and pans. Between shopping, cooking, eating with Kitty, spending time with Lulu and going to work, my husband and I had no time for cleaning, much less anything else. Suddenly I was filled with fury. I grabbed a dish and smashed it on the linoleum, where it broke into half a dozen pieces. I broke another, and another, and another. There were so many things I couldn't fix or make right, so many feelings I couldn't handle. I swept the pieces into a bag and carried them outside. Tomorrow we would eat off paper plates.
Three weeks into refeeding, Kitty was consuming 3,000 calories a day; she'd gained about eight pounds. My husband or I would sit with her while she ate three meals and two snacks each day; we needed to know she was eating, and she needed us to compel her to eat, to get past the demon's grip on her. One of us brought her to work, as we had when she was an infant. In many ways this process felt like reparenting as well as refeeding, taking her back to a time when she was totally dependent on us.
Some parents don't want to or can't go backward like this. Some don't have flexible work schedules and can't be home for every meal and snack. Some are overwhelmed by the relentless and exhausting work of refeeding. For any of these parents, Maudsley may be impossible. It works best when two parents are involved — so they can take turns losing it, offstage — and when those parents agree that their top priority is refeeding. I heard stories from other families about anorexics who slipped meals into the trash when softhearted Dad was in charge, or about weight-conscious mothers who couldn't bring themselves to serve their daughters that much food. When we started refeeding Kitty, my husband had never thought much about nutrition, and the idea took some getting used to. By late August, though, he could tell you how many calories were in a pat of butter, a chicken breast, a glass of milk. And he was often far more patient with Kitty than I.
During that first month, Kitty smiled once or twice, which made us feel hopeful for the first time since the spring. We watched movies together and took walks around the block — the only exercise she was allowed. We had moments that seemed almost normal.
But the night before she was set to start high school, four weeks in, the demon re-emerged. This time it was far worse than anything we'd experienced, maybe because Kitty was stronger now. At the dinner table, she put her matchstick arms around herself and shouted, "I don't want to go to high school and have everyone say, 'Look at Kitty, look how fat she got over the summer!' "
She refused to eat anything. We cajoled and begged and threatened. She wept and flailed and lashed out. I left messages for the psychiatrist, the therapist, the pediatrician. I told her we'd have to go back to the hospital, though I suspected she now weighed too much to be admitted. Finally I reached a psychiatrist on call, who suggested that we give her a tranquilizer and put her to bed. "If she won't eat in the morning, bring her in," advised the psychiatrist. I was relieved, and also terrified: What if this was the start of a new downward slide?
But the next morning she ate breakfast as usual. After school, she came home with a couple of friends she hadn't seen since spring. As I made milkshakes for all of them, I was surprised to hear Kitty say jokingly, "We know all the ice creams with the most calories!"
One friend said, "We want to know which ones have the least!"
"Yeah," chimed in another, "because my butt is huge!" Another girl said,
"I hate my thighs!" There was a chorus of agreement.
I offered, "You girls are beautiful and healthy and strong." But I felt incredibly sad. Even face to face with the devastating effects of this disease, they were criticizing their bodies.
I've heard the arguments that media depictions of unrealistic female bodies are what drive girls to starve themselves — the Kate Moss syndrome. And it's tempting to see anorexia as a metaphor, a result of a cultural crisis in the zeitgeist. If this were true, though, millions of American girls and women would become anorexic instead of the roughly 1 to 3 percent who do. Clearly there are other factors involved.
My nightly Internet prowling turned up some interesting research by Kaye, the director of the eating-disorders program at the University of California. While Kaye suspects that social and cultural factors contribute to anorexia, he says that recent studies suggest that genetics is the most significant factor for anorexia and bulimia. He has found chromosomal abnormalities in anorexics, as well as irregular levels of the neurotransmitters dopamine and serotonin. The National Institutes of Health is currently spending $10 million in a five-year study to look at the genetic links of the disease.
I grew up in a household where disordered eating was the norm. My aunt was bulimic; my mother enrolled us both in Weight Watchers when I was 15. She recorded her weight each morning on a chart and went on to become a Weight Watchers lecturer, delivering weekly pep talks to a roomful of people who were engaged in an ongoing war with their own bodies. You had to stay vigilant, lest your appetite betray you and the pounds creep back on. I'd tried to teach my daughters to enjoy good food and to love their bodies, but maybe I hadn't gotten over my dieting-obsessed childhood. Or maybe I'd passed along a genetic predisposition that triggered Kitty's illness. The deeper into refeeding we got, though, the less I worried about causes. We could figure that out later. The important thing was to get Kitty to eat and gain weight.
By October, we'd settled into a pattern. My husband, whose work schedule is flexible, ate lunch with Kitty most days; I covered that meal when he couldn't. Kitty gained another six pounds and, encouragingly, grew an inch. But she hadn't felt hungry since before the diagnosis. I worried that anorexia had permanently short-circuited her brain-body connection; how would she ever regulate her own eating?
The rough days were predictable only in the sense that they kept coming. One night she sat at the table, hands over her eyes, in front of a plate of salmon and squash. "I'm bad! I'm bad!" she said, sobbing. "I won't eat, I won't!"
Calmly I said, "Food is your medicine and you've got to take it." Long minutes ticked by. Eventually she said: "I want to eat, but I can't. If I eat now I'll be a total failure!" The anorexia talk spilled out of her, on and on and on. I wanted to wrap her in my arms and say, "Of course you don't have to eat, poor baby." But I couldn't give the disease an inch. If I did, the same thing would happen the next day and the next day. We had to sit there until she ate, no matter how long it took.
By the first week of November, Kitty was up to 90 pounds, 10 pounds short of her target weight. More important, her mood improved significantly. But later in the month, she developed an upset stomach, which isn't unusual during refeeding, and began refusing the daily milkshakes. She complained of dizziness, wanted to know what I would be serving her, then argued for something else. She raged at me and at herself. One afternoon she cried so much she "accidentally" threw up her lunch. Back in September she tried to make herself throw up a few times; about half of all anorexics do become bulimic. Luckily, Kitty was never able to do it. I hoped she hadn't learned how.
In December, Kitty gained and lost the same pound over and over. At the end of the month she was still, frustratingly, at 90 pounds, still deeply in the grip of the disease. We boosted her intake to 4,000 calories a day. In mid-January, finally, her weight went up four pounds. It was astonishing, how much food she needed, but not unusual. Anorexics become metabolically inefficient; their temperatures rise, and they tend to burn off calories rather than put on flesh. "That's one reason for the high rate of relapse," Dr. Kaye told me. It's hard to gain enough weight to truly recover, and even harder to maintain it.
As went the fall, so went the spring. The pounds came on, very slowly, and Kitty's spirits continued to lift. More and more, she hung out with boys. "They don't talk about how fat they are," she explained. And they didn't make her feel self-conscious about eating. "Yo, Kitty, you done with your 10,000-calorie milkshake yet?" one boy said one afternoon in March, and she actually giggled.
In April, Kitty grew another two inches, which meant that her target weight went up, too. I felt despair at the thought that it would take longer now for her to gain enough weight, longer for her to get well. I told myself that her health was more complex than a number on the scale, that she was recovering. But I couldn't forget the sunken, unspeakably sad look in her eyes that past summer and fall.
One day in May, she came home from school grinning. "Guess what?" she said. "Sue brought cake to school, and I ate a piece. Aren't you proud of me?" All year she'd avoided parties, potlucks, lunches — any get-together that involved food. The fact that she ate a piece of cake, one of her "scary" foods, meant that she gave up, for a moment, being the anorexic at the back of the room. She became one of the group.
But the next day I made her and Lulu bagels with melted cheese, and Kitty complained, "You know I don't like sesame bagels." "You used to," I said. I knew what was behind this, and I wanted her to say it. I wanted it out in the open.
"They have more calories than plain bagels!" she burst out. But she calmed down quickly. "I know that was an eating-disordered thing to say. I couldn't help it," she said quietly, and ate the bagel.
I felt proud of her ability to name the demon and defy it. I wished we could just yank it out of her, unhook the claws that tormented her body and mind.
On a morning this past June, she called me at work to say the two most beautiful words in the English language: "I'm hungry!"
"I'm so happy!" I blurted out.
"I'm happy, too, Mom," she said.
She reached her target weight a few weeks later, and maintained it through the summer and early fall. Maudsley therapists say that true recovery entails weight restoration and functioning well psychologically and socially. Kitty would continue to see a therapist from time to time, to work on perfectionism and other issues. For now, though, she seemed happy and whole. The phone rang for her; friends trooped through the house. Life seemed normal again.
But one night recently I dreamed I was running through a strange house, looking for my daughter. I found her — though it wasn't really her — and grabbed her by the arm. "You didn't eat dinner last night, did you?" I shouted. "What did you have for breakfast?" Not-Kitty smiled. "A teaspoon of air," she said sweetly. I woke with my heart pounding, full of rage and hatred for Not-Kitty, the demon who lived on air, who wore my daughter's face and spoke with her voice.
The Maudsley approach advocates separating the disease from the sufferer, the anorexia from the adolescent. And this helps, especially on the worst days. But it's also true that the demon is part of our family now, lurking in the shadows. We will never forget it. We don't know if or when it will re-emerge — two months from now, two years, five years. We don't know if we've done the right thing. Is Kitty cured? Will she ever be cured? There are so many questions I can't answer.
That morning, I got out of bed in the gray predawn and went down to the kitchen. I pulled out eggs, milk, butter and raspberry jam and set to work making crepes. It was all I could think of to do.
Saturday, November 25, 2006
E-mail signoffs
NYTimes
November 26, 2006
‘Yours Truly,’ the E-Variations
By LOLA OGUNNAIKE
CHAD TROUTWINE, an entrepreneur in Malibu, Calif., was negotiating a commercial lease earlier this year for a building he owns in the Midwest. Though talks began well, they soon grew rocky. The telltale sign that things had truly devolved? The sign-offs on the e-mail exchanges with his prospective tenant.
“As negotiations started to break down, the sign-offs started to get decidedly shorter and cooler,” Mr. Troutwine recalled. “In the beginning it was like, ‘I look forward to speaking with you soon’ and ‘Warmest regards,’ and by the end it was just ‘Best.’ ” The deal was eventually completed, but Mr. Troutwine still felt as if he had been snubbed.
What’s in an e-mail sign-off? A lot, apparently. Those final few words above your name are where relationships and hierarchies are established, and where what is written in the body of the message can be clarified or undermined. In the days before electronic communication, the formalities of a letter, either business or personal, were taught to every third-grader; sign-offs — from “Sincerely” to “Yours truly” to “Love” — came to mind without much effort.
But e-mail is a casual medium, and its conventions are scarcely a decade old. They are still evolving, often awkwardly. It is common for business messages to appear entirely in lower case, and many rapid-fire correspondences evolve from formal to intimate in a few back-and-forths.
Although salutations that begin messages can be tricky — there is a world of difference, it seems, between a “Hi,” a “Hello” and a “Dear” — the sign-off is the place where many writers attempt to express themselves, even when expressing personality, as in business correspondence, is not always welcome.
In other words, it is a land mine. Etiquette and communications experts agree that it is becoming increasingly difficult to say goodbye.
“So many people are not clear communicators,” said Judith Kallos, creator of NetManners.com, a site dedicated to online etiquette, and author of “Because Netiquette Matters.” To be clear about what an e-mail message is trying to say, and about what is implied as well as what is stated, “the reader is left looking at everything from the greeting to the closing for clues,” she said.
Mr. Troutwine is not alone in thinking that an e-mail sender who writes “Best,” then a name, is offering something close to a brush-off. He said he chooses his own business sign-offs in a descending order of cordiality, from “Warmest regards” to “All the best” to a curt “Sincerely.”
When Kim Bondy, a former CNN executive, e-mailed a suitor after a dinner date, she used one of her preferred closings: “Chat soon.” It was her way of saying, “The date went well, let’s do it again,” she said.
She may have been the only one who thought that. The return message closed with the dreaded “Best.” It left her feeling as though she had misread the evening. “I felt like, ‘Oh, that’s kind of formal. I don’t think he liked me,’ ” she said, laughing. “A chill came with the ‘Best.’ ” They have not gone out since.
“Best” does have its fans, especially in the workplace, where it can be an all-purpose step up in warmth from messages that end with no sign-off at all, just the sender coolly appending his or her name.
“I use ‘Best’ for all of my professional e-mails,” said Kelly Brady, a perky publicist in New York. “It’s friendly, quick and to the point.”
Because people read so much into a sign-off, said Richard Kirshenbaum, chief creative officer of the advertising firm Kirshenbaum Bond & Partners, he has thought deeply about his preferred closing to professional correspondence, “Warmly, RK.” He did not want something too emotional, like “Love,” or too formal, like “Sincerely.” “ ‘Warmly’ fell comfortably in between,” he said. “I want to convey a sense of warmth and passion, but also be appropriate.”
Which is just what a professional e-mail message should be, many executives say. Surprisingly, the sign-off “xoxo,” offering hugs and kisses, has become common even for those in decidedly nonamorous relationships. Ms. Bondy, who received from 300 to 500 e-mail messages a day while at CNN, was no fan of the “xoxo” farewell, especially when it came from a stranger pitching a story idea. “They’re trying to be warm and familiar when they shouldn’t be,” she said. “It’s inappropriate, and that’s probably the e-mail I’m not going to return.”
Robert Verdi, a fashion stylist and a host of “Surprise by Design,” a makeover reality show on the Discovery Channel, is a self-described “xoxo offender.” “Never in the first or second communication,” he clarified. But after a few friendly phone conversations or e-mail exchanges, he feels comfortable with the affectionate and casual sign-off, though he generally waits for the other party to make the first move. “The other person gives you the cues,” he said. “They send a ‘You’re the best! Love, Alison,’ and you send a ‘Hugs and kisses’ and all of a sudden you’re over that awkward hump and you’re best friends.”
Ms. Kallos said Mr. Verdi’s approach is the correct one. “In business you want to maintain the highest level of formality until the other person indicates otherwise,” she said. “Mirroring isn’t a bad thing to do. You’re letting the other side set the level of familiarity.”
It is also important that the closing is in keeping with the spirit of the message or it may create some sort of cognitive dissonance, said Mary Mitchell, the author of “The Complete Idiot’s Guide to Etiquette.” “If you’re complaining to a company about a product and you sign off with ‘Warmly,’ you are miscommunicating,” she said.
Many e-mail users don’t bother with a sign-off, and Letitia Baldridge, the manners expert, finds that annoying. “It’s so abrupt,” she said, “and it’s very unfriendly. We need grace in our lives, and I’m not talking about heavenly grace. I’m talking about human grace. We should try and be warm and friendly.”
But it is important not to have too much fun with sign-offs, Ms. Baldridge cautioned, before recalling a closing from a man in his early 20s that read, “Don’t let the bedbugs bite.” It was “so pedestrian and boring and such an unattractive image to leave with people,” she said. “You want to leave an attractive warm image. Bedbugs are disgusting.”
Not to mention they prove a point Ms. Mitchell makes about e-mail correspondence. “While on the one hand e-mail encourages people to write,” she said, “on the other hand it discourages people to write thoughtfully.”
November 26, 2006
‘Yours Truly,’ the E-Variations
By LOLA OGUNNAIKE
CHAD TROUTWINE, an entrepreneur in Malibu, Calif., was negotiating a commercial lease earlier this year for a building he owns in the Midwest. Though talks began well, they soon grew rocky. The telltale sign that things had truly devolved? The sign-offs on the e-mail exchanges with his prospective tenant.
“As negotiations started to break down, the sign-offs started to get decidedly shorter and cooler,” Mr. Troutwine recalled. “In the beginning it was like, ‘I look forward to speaking with you soon’ and ‘Warmest regards,’ and by the end it was just ‘Best.’ ” The deal was eventually completed, but Mr. Troutwine still felt as if he had been snubbed.
What’s in an e-mail sign-off? A lot, apparently. Those final few words above your name are where relationships and hierarchies are established, and where what is written in the body of the message can be clarified or undermined. In the days before electronic communication, the formalities of a letter, either business or personal, were taught to every third-grader; sign-offs — from “Sincerely” to “Yours truly” to “Love” — came to mind without much effort.
But e-mail is a casual medium, and its conventions are scarcely a decade old. They are still evolving, often awkwardly. It is common for business messages to appear entirely in lower case, and many rapid-fire correspondences evolve from formal to intimate in a few back-and-forths.
Although salutations that begin messages can be tricky — there is a world of difference, it seems, between a “Hi,” a “Hello” and a “Dear” — the sign-off is the place where many writers attempt to express themselves, even when expressing personality, as in business correspondence, is not always welcome.
In other words, it is a land mine. Etiquette and communications experts agree that it is becoming increasingly difficult to say goodbye.
“So many people are not clear communicators,” said Judith Kallos, creator of NetManners.com, a site dedicated to online etiquette, and author of “Because Netiquette Matters.” To be clear about what an e-mail message is trying to say, and about what is implied as well as what is stated, “the reader is left looking at everything from the greeting to the closing for clues,” she said.
Mr. Troutwine is not alone in thinking that an e-mail sender who writes “Best,” then a name, is offering something close to a brush-off. He said he chooses his own business sign-offs in a descending order of cordiality, from “Warmest regards” to “All the best” to a curt “Sincerely.”
When Kim Bondy, a former CNN executive, e-mailed a suitor after a dinner date, she used one of her preferred closings: “Chat soon.” It was her way of saying, “The date went well, let’s do it again,” she said.
She may have been the only one who thought that. The return message closed with the dreaded “Best.” It left her feeling as though she had misread the evening. “I felt like, ‘Oh, that’s kind of formal. I don’t think he liked me,’ ” she said, laughing. “A chill came with the ‘Best.’ ” They have not gone out since.
“Best” does have its fans, especially in the workplace, where it can be an all-purpose step up in warmth from messages that end with no sign-off at all, just the sender coolly appending his or her name.
“I use ‘Best’ for all of my professional e-mails,” said Kelly Brady, a perky publicist in New York. “It’s friendly, quick and to the point.”
Because people read so much into a sign-off, said Richard Kirshenbaum, chief creative officer of the advertising firm Kirshenbaum Bond & Partners, he has thought deeply about his preferred closing to professional correspondence, “Warmly, RK.” He did not want something too emotional, like “Love,” or too formal, like “Sincerely.” “ ‘Warmly’ fell comfortably in between,” he said. “I want to convey a sense of warmth and passion, but also be appropriate.”
Which is just what a professional e-mail message should be, many executives say. Surprisingly, the sign-off “xoxo,” offering hugs and kisses, has become common even for those in decidedly nonamorous relationships. Ms. Bondy, who received from 300 to 500 e-mail messages a day while at CNN, was no fan of the “xoxo” farewell, especially when it came from a stranger pitching a story idea. “They’re trying to be warm and familiar when they shouldn’t be,” she said. “It’s inappropriate, and that’s probably the e-mail I’m not going to return.”
Robert Verdi, a fashion stylist and a host of “Surprise by Design,” a makeover reality show on the Discovery Channel, is a self-described “xoxo offender.” “Never in the first or second communication,” he clarified. But after a few friendly phone conversations or e-mail exchanges, he feels comfortable with the affectionate and casual sign-off, though he generally waits for the other party to make the first move. “The other person gives you the cues,” he said. “They send a ‘You’re the best! Love, Alison,’ and you send a ‘Hugs and kisses’ and all of a sudden you’re over that awkward hump and you’re best friends.”
Ms. Kallos said Mr. Verdi’s approach is the correct one. “In business you want to maintain the highest level of formality until the other person indicates otherwise,” she said. “Mirroring isn’t a bad thing to do. You’re letting the other side set the level of familiarity.”
It is also important that the closing is in keeping with the spirit of the message or it may create some sort of cognitive dissonance, said Mary Mitchell, the author of “The Complete Idiot’s Guide to Etiquette.” “If you’re complaining to a company about a product and you sign off with ‘Warmly,’ you are miscommunicating,” she said.
Many e-mail users don’t bother with a sign-off, and Letitia Baldridge, the manners expert, finds that annoying. “It’s so abrupt,” she said, “and it’s very unfriendly. We need grace in our lives, and I’m not talking about heavenly grace. I’m talking about human grace. We should try and be warm and friendly.”
But it is important not to have too much fun with sign-offs, Ms. Baldridge cautioned, before recalling a closing from a man in his early 20s that read, “Don’t let the bedbugs bite.” It was “so pedestrian and boring and such an unattractive image to leave with people,” she said. “You want to leave an attractive warm image. Bedbugs are disgusting.”
Not to mention they prove a point Ms. Mitchell makes about e-mail correspondence. “While on the one hand e-mail encourages people to write,” she said, “on the other hand it discourages people to write thoughtfully.”
Stamford art on traffic boxes
NYTimes
November 25, 2006
On Traffic-Signal Boxes, Art That Stops Traffic
By ALISON LEIGH COWAN
STAMFORD, Conn., Nov. 24 — A blown-up version of the green-and-yellow crayon box familiar from childhood sits by the Boys and Girls Club. Down the road is a white takeout carton that could feed the Chinese Army. The box outside the firehouse on Washington Boulevard appears to be aflame. And there is a half-painted picket fence on Palmers Hill Road, the brush hovering in midair as if Tom Sawyer himself had momentarily stepped away, with a sign warning, “wet paint.”
What began four years ago as a tiny, grass-roots experiment to beautify the unsightly boxes that control traffic signals around town has become an unexpectedly impressive public art collection, with head-turning installations cropping up constantly to transform drab streetscapes into outdoor galleries.
About 50 of the city’s 190 boxes, once covered with graffiti, are now suitable for framing.
“They appear overnight,” said Renée Kahn, a local preservationist and a fan. “One weekend you drive by and there’s nothing, and the next weekend it’s suddenly there.”
When civic boosters first asked local artists to paint the boxes, the results often looked like shrubs or faux stone walls. But the artists grew bolder and began to riff on Stamford’s pastimes and passions as more neighborhood groups began to commission the boxes, which are usually 58 inches tall, 44 inches wide and 27 inches deep.
Thus, bag-laden shoppers were soon spotted at a shopping center, knicker-clad golfers teed off near the links, and a pigtailed girl scribbled on a chalkboard filled with equations outside an elementary school.
Two must-sees, resembling Pop Art at its wackiest, popped up in recent weeks. They give anyone stuck in traffic along Broad Street much to look at — too much, perhaps, if traffic suddenly starts moving. That crayon box, with the legend “Crazola,” holds an assortment of “X-tra Big” crayons. And the fine print on the oversize takeout carton, paying homage to a nearby Chinese restaurant, says, “No msg.”
“They make you smile,” said Sandy Goldstein, who as head of a downtown business group enlisted artists to decorate a dozen boxes in and around the central business district.
Most of the boxes in Ms. Goldstein’s collection, which received an award last year from the International Downtown Association, were the work of Zora Janosova, a former set designer for the Palace Theater. Ms. Janosova carried an oxygen tank with her as she scrambled to complete several boxes around town before her death last year from breast cancer at age 33.
On one she left behind near Curley’s Diner, a cow tumbles mysteriously from the sky, and on another, over by the Palace Theater, silhouetted heads ring the bottom, giving the audience on the street a figurative glimpse of the audience inside.
There is a range of motifs and styles on display around town. Springdale, a residential neighborhood in the northeast part of town, is dominated by Anne Salthouse’s subdued pastoral scenes. Hubbard Heights, a neighborhood of older homes, looks as if Andy Warhol or Claes Oldenburg moved in.
The Hubbard Heights Garden Club fell in love with the idea of commissioning boxes to beautify the streets because, as one 87-year-old member explained, she and the others were getting to the age where they were “a little beyond digging.”
The club hired Liz Squillace, 29, a graduate of the Rhode Island School of Design who lives in Greenwich, to do 20 boxes. Among her works are the crayons, the Chinese takeout, the flames outside the firehouse, and another on Washington Boulevard that looks like a carton whose contents are spilling out. Stamped on the outside are warnings like “handle with care.”
Looking back, civic boosters say they never set out to create public art on a grand scale. But in wrestling with what to do with the large boxes that had become graffiti magnets, they knew that hiding them was not possible.
Joseph Andrews, Stamford’s traffic signal supervisor, said that special turning lanes and signal synchronization had made suburban traffic boxes more complex; the electronics need to be above ground, he said, for ventilation and other reasons. In New York and other cities, Mr. Andrews said, signal boxes are usually smaller and hang on poles, while the newfangled ones here in Stamford are equipped with sensors that count the cars and adjust accordingly.
By most accounts, the first painted box here appeared, circa 2003, at Bouton and Hope Streets, in the form of whimsical trompe l’oeil blossoms sprouting along a classic picket fence. Marilyn Trefry, president of the Springdale Neighborhood Association, had hired Ms. Salthouse, a local artist, to do a few boxes, with the proviso that they had to “melt into the background,” according to Ms. Trefry.
Before work could begin, however, Ms. Trefry had to get permission from the city, which owns the boxes. Officials worried that dark colors absorb sunlight, and that the resulting heat could throw off the electronics. They warned the artists and neighborhood groups that if the boxes were hit by cars, too bad — the city would not pay to have the art replaced or repaired.
Finally, Ms. Trefry recalled, “the city was worried that if we did it, everybody else in town would want to, and they were right.”
Eventually, the city not only signed off on the idea, but also helped get grant money that the neighborhood groups have used to pay the artists, who generally get a few hundred dollars per box.
The boxes also seem to have won the approval of graffiti scrawlers, who have generally left the painted boxes alone. Civic groups and the police both interpret that hands-off response as a sign that the work has earned the respect of those who fancy themselves street artists.
At least four of the decorated boxes have been done in by wayward cars, just as city officials feared. Some of those now sit in a makeshift graveyard outside Mr. Andrews’s office until he figures out what to do with them.
Another casualty awaits replacement at the corner of Greyrock Place and Broad Street. It is a Janosova original, with painted caryatids that look as if they may crumple from the stress. The dents and dings are rusty rebukes to those who wish they had made time to see the piece in its better days, a reminder that this is one art show with an uncertain closing date.
Ms. Goldstein, the downtown business booster, said there are no plans as yet to offer tours of the collection, but said she would look into creating an official map. John Ruotolo, her operations director, joked that someone should “start selling maps to the signal boxes, the way they sell maps to the stars’ houses.”
Wednesday, November 08, 2006
Slow prep bread technique
NYTimes
November 8, 2006
The Minimalist
The Secret of Great Bread: Let Time Do the Work
By MARK BITTMAN
INNOVATIONS in bread baking are rare. In fact, the 6,000-year-old process hasn’t changed much since Pasteur made the commercial production of standardized yeast possible in 1859. The introduction of the gas stove, the electric mixer and the food processor made the process easier, faster and more reliable.
I’m not counting sliced bread as a positive step, but Jim Lahey’s method may be the greatest thing since.
This story began in late September when Mr. Lahey sent an e-mail message inviting me to attend a session of a class he was giving at Sullivan Street Bakery, which he owns, at 533 West 47th Street in Manhattan. His wording was irresistible: “I’ll be teaching a truly minimalist breadmaking technique that allows people to make excellent bread at home with very little effort. The method is surprisingly simple — I think a 4-year-old could master it — and the results are fantastic.”
I set up a time to visit Mr. Lahey, and we baked together, and the only bad news is that you cannot put your 4-year-old to work producing bread for you. The method is complicated enough that you would need a very ambitious 8-year-old. But the results are indeed fantastic.
Mr. Lahey’s method is striking on several levels. It requires no kneading. (Repeat: none.) It uses no special ingredients, equipment or techniques. It takes very little effort.
It accomplishes all of this by combining a number of unusual though not unheard of features. Most notable is that you’ll need about 24 hours to create a loaf; time does almost all the work. Mr. Lahey’s dough uses very little yeast, a quarter teaspoon (you almost never see a recipe with less than a teaspoon), and he compensates for this tiny amount by fermenting the dough very slowly. He mixes a very wet dough, about 42 percent water, which is at the extreme high end of the range that professional bakers use to create crisp crust and large, well-structured crumb, both of which are evident in this loaf.
The dough is so sticky that you couldn’t knead it if you wanted to. It is mixed in less than a minute, then sits in a covered bowl, undisturbed, for about 18 hours. It is then turned out onto a board for 15 minutes, quickly shaped (I mean in 30 seconds), and allowed to rise again, for a couple of hours. Then it’s baked. That’s it.
I asked Harold McGee, who is an amateur breadmaker and best known as the author of “On Food and Cooking” (Scribner, 2004), what he thought of this method. His response: “It makes sense. The long, slow rise does over hours what intensive kneading does in minutes: it brings the gluten molecules into side-by-side alignment to maximize their opportunity to bind to each other and produce a strong, elastic network. The wetness of the dough is an important piece of this because the gluten molecules are more mobile in a high proportion of water, and so can move into alignment easier and faster than if the dough were stiff.”
That’s as technical an explanation as I care to have, enough to validate what I already knew: Mr. Lahey’s method is creative and smart.
But until this point, it’s not revolutionary. Mr. McGee said he had been kneading less and less as the years have gone by, relying on time to do the work for him. Charles Van Over, author of the authoritative book on food-processor dough making, “The Best Bread Ever” (Broadway, 1997), long ago taught me to make a very wet dough (the food processor is great at this) and let it rise slowly. And, as Mr. Lahey himself notes, “The Egyptians mixed their batches of dough with a hoe.”
What makes Mr. Lahey’s process revolutionary is the resulting combination of great crumb, lightness, incredible flavor — long fermentation gives you that — and an enviable, crackling crust, the feature of bread that most frequently separates the amateurs from the pros. My bread has often had thick, hard crusts, not at all bad, but not the kind that shatter when you bite into them. Producing those has been a bane of the amateur for years, because it requires getting moisture onto the bread as the crust develops.
To get that kind of a crust, professionals use steam-injected ovens. At home I have tried brushing the dough with water (a hassle and ineffective); spraying it (almost as ineffective and requiring frequent attention); throwing ice cubes on the floor of the oven (not good for the oven, and not far from ineffective); and filling a pot with stones and preheating it, then pouring boiling water over the stones to create a wet sauna (quite effective but dangerous, physically challenging and space-consuming). I was discouraged from using La Cloche, a covered stoneware dish, by my long-standing disinclination to crowd my kitchen with inessential items that accomplish only one chore. I was discouraged from buying a $5,000 steam-injected oven by its price.
It turns out there’s no need for any of this. Mr. Lahey solves the problem by putting the dough in a preheated covered pot — a common one, a heavy one, but nothing fancy. For one loaf he used an old Le Creuset enameled cast iron pot; for another, a heavy ceramic pot. (I have used cast iron with great success.) By starting this very wet dough in a hot, covered pot, Mr. Lahey lets the crust develop in a moist, enclosed environment. The pot is in effect the oven, and that oven has plenty of steam in it. Once uncovered, a half-hour later, the crust has time to harden and brown, still in the pot, and the bread is done. (Fear not. The dough does not stick to the pot any more than it would to a preheated bread stone.)
The entire process is incredibly simple, and, in the three weeks I’ve been using it, absolutely reliable. Though professional bakers work with consistent flour, water, yeast and temperatures, and measure by weight, we amateurs have mostly inconsistent ingredients and measure by volume, which can make things unpredictable. Mr. Lahey thinks imprecision isn’t much of a handicap and, indeed, his method seems to iron out the wrinkles: “I encourage a somewhat careless approach,” he says, “and figure this may even be a disappointment to those who expect something more difficult. The proof is in the loaf.”
The loaf is incredible, a fine-bakery quality, European-style boule that is produced more easily than by any other technique I’ve used, and will blow your mind. (It may yet change the industry. Mr. Lahey is experimenting with using it on a large scale, but although it requires far less electricity than conventional baking, it takes a lot of space and time.) It is best made with bread flour, but all-purpose flour works fine. (I’ve played with whole-wheat and rye flours, too; the results are fantastic.)
You or your 8-year-old may hit this perfectly on the first try, or you may not. Judgment is involved; with practice you’ll get it right every time.
The baking itself is virtually foolproof, so the most important aspect is patience. Long, slow fermentation is critical. Mr. Lahey puts the time at 12 to 18 hours, but I have had much greater success at the longer time. If you are in a hurry, more yeast (three-eighths of a teaspoon) or a warmer room temperature may move things along, but really, once you’re waiting 12 hours why not wait 18? Similarly, Mr. Lahey’s second rising can take as little as an hour, but two hours, or even a little longer, works better.
Although even my “failed” loaves were as good as those from most bakeries, to make the loaf really sensational requires a bit of a commitment. But with just a little patience, you will be rewarded with the best no-work bread you have ever made. And that’s no small thing.
Recipe: No-Knead Bread
Adapted from Jim Lahey, Sullivan Street Bakery
Time: About 1½ hours plus 14 to 20 hours’ rising
3 cups all-purpose or bread flour, more for dusting
¼ teaspoon instant yeast
1¼ teaspoons salt
Cornmeal or wheat bran as needed.
1. In a large bowl combine flour, yeast and salt. Add 1 5/8 cups water, and stir until blended; dough will be shaggy and sticky. Cover bowl with plastic wrap. Let dough rest at least 12 hours, preferably about 18, at warm room temperature, about 70 degrees.
2. Dough is ready when its surface is dotted with bubbles. Lightly flour a work surface and place dough on it; sprinkle it with a little more flour and fold it over on itself once or twice. Cover loosely with plastic wrap and let rest about 15 minutes.
3. Using just enough flour to keep dough from sticking to work surface or to your fingers, gently and quickly shape dough into a ball. Generously coat a cotton towel (not terry cloth) with flour, wheat bran or cornmeal; put dough seam side down on towel and dust with more flour, bran or cornmeal. Cover with another cotton towel and let rise for about 2 hours. When it is ready, dough will be more than double in size and will not readily spring back when poked with a finger.
4. At least a half-hour before dough is ready, heat oven to 450 degrees. Put a 6- to 8-quart heavy covered pot (cast iron, enamel, Pyrex or ceramic) in oven as it heats. When dough is ready, carefully remove pot from oven. Slide your hand under towel and turn dough over into pot, seam side up; it may look like a mess, but that is O.K. Shake pan once or twice if dough is unevenly distributed; it will straighten out as it bakes. Cover with lid and bake 30 minutes, then remove lid and bake another 15 to 30 minutes, until loaf is beautifully browned. Cool on a rack.
Yield: One 1½-pound loaf.
LAST month I wrote about Jim Lahey, the owner of Sullivan Street Bakery on West 47th Street in Manhattan, and his clever way to produce a European-style boule at home. Mr. Lahey’s recipe calls for very little yeast, a wet dough, long rising times and baking in a closed, preheated pot. My results with Mr. Lahey’s method have been beyond satisfying.
Happily, so have those of most readers. In the last few weeks Jim Lahey’s recipe has been translated into German, baked in Togo, discussed on more than 200 blogs and written about in other newspapers. It has changed the lives (their words, not mine) of veteran and novice bakers. It has also generated enough questions to warrant further discussion here. The topics are more or less in the order of the quantity of inquiries.
WEIGHT VS. VOLUME The original recipe contained volume measures, but for those who prefer to use weight, here are the measurements: 430 grams of flour, 345 grams of water, 1 gram of yeast and 8 grams of salt. With experience, many people will stop measuring altogether and add just enough water to make the dough almost too wet to handle.
SALT Many people, me included, felt Mr. Lahey’s bread was not salty enough. Yes, you can use more salt and it won’t significantly affect the rising time. I’ve settled at just under a tablespoon.
YEAST Instant yeast, called for in the recipe, is also called rapid-rise yeast. But you can use whatever yeast you like. Active dry yeast can be used without proofing (soaking it to make sure it’s active).
TIMING About 18 hours is the preferred initial rising time. Some readers have cut this to as little as eight hours and reported little difference. I have not had much luck with shorter times, but I have gone nearly 24 hours without a problem. Room temperature will affect the rising time, and so will the temperature of the water you add (I start with tepid). Like many other people, I’m eager to see what effect warmer weather will have. But to those who have moved the rising dough around the room trying to find the 70-degree sweet spot: please stop. Any normal room temperature is fine. Just wait until you see bubbles and well-developed gluten — the long strands that cling to the sides of the bowl when you tilt it — before proceeding.
THE SECOND RISE Mr. Lahey originally suggested one to two hours, but two to three is more like it, in my experience. (Ambient temperatures in the summer will probably knock this time down some.) Some readers almost entirely skipped this rise, shaping the dough after the first rise and letting it rest while the pot and oven preheat; this is worth trying, of course.
OTHER FLOURS Up to 30 percent whole-grain flour works consistently and well, and 50 percent whole-wheat is also excellent. At least one reader used 100 percent whole-wheat and reported “great crust but somewhat inferior crumb,” which sounds promising. I’ve kept rye, which is delicious but notoriously impossible to get to rise, to about 20 percent. There is room to experiment.
FLAVORINGS The best time to add caraway seeds, chopped olives, onions, cheese, walnuts, raisins or whatever other traditional bread flavorings you like is after you’ve mixed the dough. But it’s not the only time; you can fold in ingredients before the second rising.
OTHER SHAPES Baguettes in fish steamers, rolls in muffin tins or classic loaves in loaf pans: if you can imagine it, and stay roughly within the pattern, it will work.
COVERING BETWEEN RISES A Silpat mat under the dough is a clever idea (not mine). Plastic wrap can be used as a top layer in place of a second towel.
THE POT The size matters, but not much. I have settled on a smaller pot than Mr. Lahey has, about three or four quarts. This produces a higher loaf, which many people prefer — again, me included. I’m using cast iron. Readers have reported success with just about every available material. Note that the lid handles on Le Creuset pots can only withstand temperatures up to 400 degrees. So avoid using them, or remove the handle first.
BAKING You can increase the initial temperature to 500 degrees for more rapid browning, but be careful; I scorched a loaf containing whole-wheat flour by doing this. Yes, you can reduce the length of time the pot is covered to 20 minutes from 30, and then increase the time the loaf bakes uncovered. Most people have had a good experience baking for an additional 30 minutes once the pot is uncovered.
As these answers demonstrate, almost everything about Mr. Lahey’s bread is flexible, within limits. As we experiment, we will have failures. (Like the time I stopped adding flour because the phone rang, and didn’t realize it until 18 hours later. Even this, however, was reparable). This method is going to have people experimenting, and largely succeeding, until something better comes along. It may be quite a while.
November 8, 2006
The Minimalist
The Secret of Great Bread: Let Time Do the Work
By MARK BITTMAN
INNOVATIONS in bread baking are rare. In fact, the 6,000-year-old process hasn’t changed much since Pasteur made the commercial production of standardized yeast possible in 1859. The introduction of the gas stove, the electric mixer and the food processor made the process easier, faster and more reliable.
I’m not counting sliced bread as a positive step, but Jim Lahey’s method may be the greatest thing since.
This story began in late September when Mr. Lahey sent an e-mail message inviting me to attend a session of a class he was giving at Sullivan Street Bakery, which he owns, at 533 West 47th Street in Manhattan. His wording was irresistible: “I’ll be teaching a truly minimalist breadmaking technique that allows people to make excellent bread at home with very little effort. The method is surprisingly simple — I think a 4-year-old could master it — and the results are fantastic.”
I set up a time to visit Mr. Lahey, and we baked together, and the only bad news is that you cannot put your 4-year-old to work producing bread for you. The method is complicated enough that you would need a very ambitious 8-year-old. But the results are indeed fantastic.
Mr. Lahey’s method is striking on several levels. It requires no kneading. (Repeat: none.) It uses no special ingredients, equipment or techniques. It takes very little effort.
It accomplishes all of this by combining a number of unusual though not unheard of features. Most notable is that you’ll need about 24 hours to create a loaf; time does almost all the work. Mr. Lahey’s dough uses very little yeast, a quarter teaspoon (you almost never see a recipe with less than a teaspoon), and he compensates for this tiny amount by fermenting the dough very slowly. He mixes a very wet dough, about 42 percent water, which is at the extreme high end of the range that professional bakers use to create crisp crust and large, well-structured crumb, both of which are evident in this loaf.
The dough is so sticky that you couldn’t knead it if you wanted to. It is mixed in less than a minute, then sits in a covered bowl, undisturbed, for about 18 hours. It is then turned out onto a board for 15 minutes, quickly shaped (I mean in 30 seconds), and allowed to rise again, for a couple of hours. Then it’s baked. That’s it.
I asked Harold McGee, who is an amateur breadmaker and best known as the author of “On Food and Cooking” (Scribner, 2004), what he thought of this method. His response: “It makes sense. The long, slow rise does over hours what intensive kneading does in minutes: it brings the gluten molecules into side-by-side alignment to maximize their opportunity to bind to each other and produce a strong, elastic network. The wetness of the dough is an important piece of this because the gluten molecules are more mobile in a high proportion of water, and so can move into alignment easier and faster than if the dough were stiff.”
That’s as technical an explanation as I care to have, enough to validate what I already knew: Mr. Lahey’s method is creative and smart.
But until this point, it’s not revolutionary. Mr. McGee said he had been kneading less and less as the years have gone by, relying on time to do the work for him. Charles Van Over, author of the authoritative book on food-processor dough making, “The Best Bread Ever” (Broadway, 1997), long ago taught me to make a very wet dough (the food processor is great at this) and let it rise slowly. And, as Mr. Lahey himself notes, “The Egyptians mixed their batches of dough with a hoe.”
What makes Mr. Lahey’s process revolutionary is the resulting combination of great crumb, lightness, incredible flavor — long fermentation gives you that — and an enviable, crackling crust, the feature of bread that most frequently separates the amateurs from the pros. My bread has often had thick, hard crusts, not at all bad, but not the kind that shatter when you bite into them. Producing those has been a bane of the amateur for years, because it requires getting moisture onto the bread as the crust develops.
To get that kind of a crust, professionals use steam-injected ovens. At home I have tried brushing the dough with water (a hassle and ineffective); spraying it (almost as ineffective and requiring frequent attention); throwing ice cubes on the floor of the oven (not good for the oven, and not far from ineffective); and filling a pot with stones and preheating it, then pouring boiling water over the stones to create a wet sauna (quite effective but dangerous, physically challenging and space-consuming). I was discouraged from using La Cloche, a covered stoneware dish, by my long-standing disinclination to crowd my kitchen with inessential items that accomplish only one chore. I was discouraged from buying a $5,000 steam-injected oven by its price.
It turns out there’s no need for any of this. Mr. Lahey solves the problem by putting the dough in a preheated covered pot — a common one, a heavy one, but nothing fancy. For one loaf he used an old Le Creuset enameled cast iron pot; for another, a heavy ceramic pot. (I have used cast iron with great success.) By starting this very wet dough in a hot, covered pot, Mr. Lahey lets the crust develop in a moist, enclosed environment. The pot is in effect the oven, and that oven has plenty of steam in it. Once uncovered, a half-hour later, the crust has time to harden and brown, still in the pot, and the bread is done. (Fear not. The dough does not stick to the pot any more than it would to a preheated bread stone.)
The entire process is incredibly simple, and, in the three weeks I’ve been using it, absolutely reliable. Though professional bakers work with consistent flour, water, yeast and temperatures, and measure by weight, we amateurs have mostly inconsistent ingredients and measure by volume, which can make things unpredictable. Mr. Lahey thinks imprecision isn’t much of a handicap and, indeed, his method seems to iron out the wrinkles: “I encourage a somewhat careless approach,” he says, “and figure this may even be a disappointment to those who expect something more difficult. The proof is in the loaf.”
The loaf is incredible, a fine-bakery quality, European-style boule that is produced more easily than by any other technique I’ve used, and will blow your mind. (It may yet change the industry. Mr. Lahey is experimenting with using it on a large scale, but although it requires far less electricity than conventional baking, it takes a lot of space and time.) It is best made with bread flour, but all-purpose flour works fine. (I’ve played with whole-wheat and rye flours, too; the results are fantastic.)
You or your 8-year-old may hit this perfectly on the first try, or you may not. Judgment is involved; with practice you’ll get it right every time.
The baking itself is virtually foolproof, so the most important aspect is patience. Long, slow fermentation is critical. Mr. Lahey puts the time at 12 to 18 hours, but I have had much greater success at the longer time. If you are in a hurry, more yeast (three-eighths of a teaspoon) or a warmer room temperature may move things along, but really, once you’re waiting 12 hours why not wait 18? Similarly, Mr. Lahey’s second rising can take as little as an hour, but two hours, or even a little longer, works better.
Although even my “failed” loaves were as good as those from most bakeries, to make the loaf really sensational requires a bit of a commitment. But with just a little patience, you will be rewarded with the best no-work bread you have ever made. And that’s no small thing.
Recipe: No-Knead Bread
Adapted from Jim Lahey, Sullivan Street Bakery
Time: About 1½ hours plus 14 to 20 hours’ rising
3 cups all-purpose or bread flour, more for dusting
¼ teaspoon instant yeast
1¼ teaspoons salt
Cornmeal or wheat bran as needed.
1. In a large bowl combine flour, yeast and salt. Add 1 5/8 cups water, and stir until blended; dough will be shaggy and sticky. Cover bowl with plastic wrap. Let dough rest at least 12 hours, preferably about 18, at warm room temperature, about 70 degrees.
2. Dough is ready when its surface is dotted with bubbles. Lightly flour a work surface and place dough on it; sprinkle it with a little more flour and fold it over on itself once or twice. Cover loosely with plastic wrap and let rest about 15 minutes.
3. Using just enough flour to keep dough from sticking to work surface or to your fingers, gently and quickly shape dough into a ball. Generously coat a cotton towel (not terry cloth) with flour, wheat bran or cornmeal; put dough seam side down on towel and dust with more flour, bran or cornmeal. Cover with another cotton towel and let rise for about 2 hours. When it is ready, dough will be more than double in size and will not readily spring back when poked with a finger.
4. At least a half-hour before dough is ready, heat oven to 450 degrees. Put a 6- to 8-quart heavy covered pot (cast iron, enamel, Pyrex or ceramic) in oven as it heats. When dough is ready, carefully remove pot from oven. Slide your hand under towel and turn dough over into pot, seam side up; it may look like a mess, but that is O.K. Shake pan once or twice if dough is unevenly distributed; it will straighten out as it bakes. Cover with lid and bake 30 minutes, then remove lid and bake another 15 to 30 minutes, until loaf is beautifully browned. Cool on a rack.
Yield: One 1½-pound loaf.
LAST month I wrote about Jim Lahey, the owner of Sullivan Street Bakery on West 47th Street in Manhattan, and his clever way to produce a European-style boule at home. Mr. Lahey’s recipe calls for very little yeast, a wet dough, long rising times and baking in a closed, preheated pot. My results with Mr. Lahey’s method have been beyond satisfying.
Happily, so have those of most readers. In the last few weeks Jim Lahey’s recipe has been translated into German, baked in Togo, discussed on more than 200 blogs and written about in other newspapers. It has changed the lives (their words, not mine) of veteran and novice bakers. It has also generated enough questions to warrant further discussion here. The topics are more or less in the order of the quantity of inquiries.
WEIGHT VS. VOLUME The original recipe contained volume measures, but for those who prefer to use weight, here are the measurements: 430 grams of flour, 345 grams of water, 1 gram of yeast and 8 grams of salt. With experience, many people will stop measuring altogether and add just enough water to make the dough almost too wet to handle.
SALT Many people, me included, felt Mr. Lahey’s bread was not salty enough. Yes, you can use more salt and it won’t significantly affect the rising time. I’ve settled at just under a tablespoon.
YEAST Instant yeast, called for in the recipe, is also called rapid-rise yeast. But you can use whatever yeast you like. Active dry yeast can be used without proofing (soaking it to make sure it’s active).
TIMING About 18 hours is the preferred initial rising time. Some readers have cut this to as little as eight hours and reported little difference. I have not had much luck with shorter times, but I have gone nearly 24 hours without a problem. Room temperature will affect the rising time, and so will the temperature of the water you add (I start with tepid). Like many other people, I’m eager to see what effect warmer weather will have. But to those who have moved the rising dough around the room trying to find the 70-degree sweet spot: please stop. Any normal room temperature is fine. Just wait until you see bubbles and well-developed gluten — the long strands that cling to the sides of the bowl when you tilt it — before proceeding.
THE SECOND RISE Mr. Lahey originally suggested one to two hours, but two to three is more like it, in my experience. (Ambient temperatures in the summer will probably knock this time down some.) Some readers almost entirely skipped this rise, shaping the dough after the first rise and letting it rest while the pot and oven preheat; this is worth trying, of course.
OTHER FLOURS Up to 30 percent whole-grain flour works consistently and well, and 50 percent whole-wheat is also excellent. At least one reader used 100 percent whole-wheat and reported “great crust but somewhat inferior crumb,” which sounds promising. I’ve kept rye, which is delicious but notoriously impossible to get to rise, to about 20 percent. There is room to experiment.
FLAVORINGS The best time to add caraway seeds, chopped olives, onions, cheese, walnuts, raisins or whatever other traditional bread flavorings you like is after you’ve mixed the dough. But it’s not the only time; you can fold in ingredients before the second rising.
OTHER SHAPES Baguettes in fish steamers, rolls in muffin tins or classic loaves in loaf pans: if you can imagine it, and stay roughly within the pattern, it will work.
COVERING BETWEEN RISES A Silpat mat under the dough is a clever idea (not mine). Plastic wrap can be used as a top layer in place of a second towel.
THE POT The size matters, but not much. I have settled on a smaller pot than Mr. Lahey has, about three or four quarts. This produces a higher loaf, which many people prefer — again, me included. I’m using cast iron. Readers have reported success with just about every available material. Note that the lid handles on Le Creuset pots can only withstand temperatures up to 400 degrees. So avoid using them, or remove the handle first.
BAKING You can increase the initial temperature to 500 degrees for more rapid browning, but be careful; I scorched a loaf containing whole-wheat flour by doing this. Yes, you can reduce the length of time the pot is covered to 20 minutes from 30, and then increase the time the loaf bakes uncovered. Most people have had a good experience baking for an additional 30 minutes once the pot is uncovered.
As these answers demonstrate, almost everything about Mr. Lahey’s bread is flexible, within limits. As we experiment, we will have failures. (Like the time I stopped adding flour because the phone rang, and didn’t realize it until 18 hours later. Even this, however, was reparable). This method is going to have people experimenting, and largely succeeding, until something better comes along. It may be quite a while.
Baking Tasty Turkey
NYTimes
November 8, 2006
As Six Turkeys Tussle for a Title, Degrees Challenge Pedigrees
By MARIAN BURROS
SOME of the greatest discoveries are inadvertent. Columbus sailed for China and landed in the Bahamas. And while a turkey taste test by the Dining section took us on a far shorter voyage, at least we stayed on course — and learned something more significant than what we set out to find.
In two experiments, we roasted six kinds of turkey: Bourbon Red and American Bronze, both heritage birds; farmed “wild” turkeys; the common broad-breasted whites, one raised organically and one bearing the “natural” label; and finally a Butterball, the national best seller. We wanted to see if the wild turkeys and heritage breeds, reintroduced to the American public in 2002, were worth the premium price.
In the end we concluded that temperature is nearly as important as breed. When most turkeys are properly cooked, the differences diminish.
Anyone who wants a flavorful, juicy main course this Thanksgiving can dispense with the brining pail, the cheesecloth and the propane-fueled deep-fryer. The only necessities are a properly calibrated oven, a basting brush, some aluminum foil and an instant-read digital thermometer.
And, crucially, the will to ignore the Agriculture Department’s advice to cook the bird until dry as dust or risk poisoning all your guests.
Every November the battle over turkey roasting is joined: the Agriculture Department insists that the temperature between the thigh and the breast should be 165 to 180 degrees (the department has given different advice in different places), but professional chefs scoff, saying that’s a guaranteed formula for dryness and for a texture that crumbles like plaster.
The government’s advice about harmful bacteria in poultry parallels its suggestion for ground beef: cook it until everything is killed, including the taste. The chances of running into harmful bacteria in both poultry and red meat are reduced if the animals have not been raised in confinement, but instead on pasture, as are all the premium turkeys.
Most nervous cooks take the government’s advice, making quarts of gravy and cranberry sauce not just an option but a necessity.
Caught between these irreconcilable differences, over the years I have finessed the thermometer and simply cut into the thigh to see if the juices run clear instead of pink. My turkeys have been moist and flavorful, and no guests have been harmed yet. (If any of your guests are elderly, children or women who are pregnant, or if their immune systems are compromised, err on the side of caution and return their servings to the oven till they reach an internal temperature of 165 degrees.)
In a first taste test more than half the birds were inadvertently overcooked (prompting someone to say that they were probably closest to what most people get on Thanksgiving).
Despite that, two things stood out in a blind tasting. The Butterball, though not overcooked, was tasteless. It was juicy because it was injected with broth and salt (not butter, as the name implies). The Bourbon Red heritage turkey, from a limited supply at Blue Hill at Stone Barns, and the American Bronze heritage turkey from D’Artagnan, though cooked too long, had the best flavor.
In a second test, we cooked two heritage birds, a Bourbon Red and an American Bronze from Heritage Foods; a domesticated wild bird from Quattro Farm; an organic free-range broad-breasted white from D’Artagnan; and two naturally raised broad-breasted whites, one from Griggstown Quail Farm, the other from Eberly Poultry.
This time, with the help of a professional chef, the turkeys were cooked to a uniform 150 degrees, removed from the oven and then tented with foil and allowed to rest until they reached 160 degrees.
Dan Barber of Blue Hill and Peter Hoffman at Savoy follow similar procedures, cutting off the thighs before or after roasting and cooking them longer, since they are not quite done when the breast is.
When we were finished I would not have been ashamed to serve any of the following birds on Thanksgiving, though the heritage turkeys were still my favorites.
HERITAGE Both the white meat and the dark delivered the essence of old-fashioned turkeyness. The white was succulent; even the richer dark meat was tender. If this turkey were a wine, it would be a fine old red. The additional cost is considerable, but for a once-a-year treat I will spend extra for either a Bourbon Red or an American Bronze. Available from heritagefoodsusa.com for $119 for a bird weighing 8 to 10 pounds, shipping included, or from dartagnan.com for $71.50.
ORGANIC The D’Artagnan organic free-range turkey was moist; the white meat had a mild turkey flavor and a fine, firm texture, and the dark had deeper flavor and was slightly chewier. This would be a Beaujolais. At retail stores for $3.49 to $3.99 a pound.
NATURAL The turkeys from Griggstown Quail Farm and from Eberly were similar to the organic: tender and juicy. The white meat had the light turkey flavor that most Americans are used to. The dark meat was a bit richer. Griggstown turkeys are available from www.griggstownquailfarm.com; a turkey weighing 15 to 18 pounds costs $100.95. Whole Foods sells the Eberly for $3.69 to $3.99 a pound.
WILD These turkeys were a little disappointing: somewhat chewy, a little dry. To my surprise, the white meat was not bursting with turkeyness. The dark meat, however, was moist and had a nice gamey flavor. Maybe even 150 degrees was too high a temperature for such lean birds. The Quattro Farm birds are available at the farm’s stand at the Union Square Greenmarket on Saturdays, and on Wednesday, Nov. 22, for $5.79 a pound. The birds must be ordered in advance from (845) 635-8202, and are available now. Quattro birds are also sold through dartagnan.com, where one weighing 8 to 10 pounds costs $71.50.
November 8, 2006
As Six Turkeys Tussle for a Title, Degrees Challenge Pedigrees
By MARIAN BURROS
SOME of the greatest discoveries are inadvertent. Columbus sailed for China and landed in the Bahamas. And while a turkey taste test by the Dining section took us on a far shorter voyage, at least we stayed on course — and learned something more significant than what we set out to find.
In two experiments, we roasted six kinds of turkey: Bourbon Red and American Bronze, both heritage birds; farmed “wild” turkeys; the common broad-breasted whites, one raised organically and one bearing the “natural” label; and finally a Butterball, the national best seller. We wanted to see if the wild turkeys and heritage breeds, reintroduced to the American public in 2002, were worth the premium price.
In the end we concluded that temperature is nearly as important as breed. When most turkeys are properly cooked, the differences diminish.
Anyone who wants a flavorful, juicy main course this Thanksgiving can dispense with the brining pail, the cheesecloth and the propane-fueled deep-fryer. The only necessities are a properly calibrated oven, a basting brush, some aluminum foil and an instant-read digital thermometer.
And, crucially, the will to ignore the Agriculture Department’s advice to cook the bird until dry as dust or risk poisoning all your guests.
Every November the battle over turkey roasting is joined: the Agriculture Department insists that the temperature between the thigh and the breast should be 165 to 180 degrees (the department has given different advice in different places), but professional chefs scoff, saying that’s a guaranteed formula for dryness and for a texture that crumbles like plaster.
The government’s advice about harmful bacteria in poultry parallels its suggestion for ground beef: cook it until everything is killed, including the taste. The chances of running into harmful bacteria in both poultry and red meat are reduced if the animals have not been raised in confinement, but instead on pasture, as are all the premium turkeys.
Most nervous cooks take the government’s advice, making quarts of gravy and cranberry sauce not just an option but a necessity.
Caught between these irreconcilable differences, over the years I have finessed the thermometer and simply cut into the thigh to see if the juices run clear instead of pink. My turkeys have been moist and flavorful, and no guests have been harmed yet. (If any of your guests are elderly, children or women who are pregnant, or if their immune systems are compromised, err on the side of caution and return their servings to the oven till they reach an internal temperature of 165 degrees.)
In a first taste test more than half the birds were inadvertently overcooked (prompting someone to say that they were probably closest to what most people get on Thanksgiving).
Despite that, two things stood out in a blind tasting. The Butterball, though not overcooked, was tasteless. It was juicy because it was injected with broth and salt (not butter, as the name implies). The Bourbon Red heritage turkey, from a limited supply at Blue Hill at Stone Barns, and the American Bronze heritage turkey from D’Artagnan, though cooked too long, had the best flavor.
In a second test, we cooked two heritage birds, a Bourbon Red and an American Bronze from Heritage Foods; a domesticated wild bird from Quattro Farm; an organic free-range broad-breasted white from D’Artagnan; and two naturally raised broad-breasted whites, one from Griggstown Quail Farm, the other from Eberly Poultry.
This time, with the help of a professional chef, the turkeys were cooked to a uniform 150 degrees, removed from the oven and then tented with foil and allowed to rest until they reached 160 degrees.
Dan Barber of Blue Hill and Peter Hoffman at Savoy follow similar procedures, cutting off the thighs before or after roasting and cooking them longer, since they are not quite done when the breast is.
When we were finished I would not have been ashamed to serve any of the following birds on Thanksgiving, though the heritage turkeys were still my favorites.
HERITAGE Both the white meat and the dark delivered the essence of old-fashioned turkeyness. The white was succulent; even the richer dark meat was tender. If this turkey were a wine, it would be a fine old red. The additional cost is considerable, but for a once-a-year treat I will spend extra for either a Bourbon Red or an American Bronze. Available from heritagefoodsusa.com for $119 for a bird weighing 8 to 10 pounds, shipping included, or from dartagnan.com for $71.50.
ORGANIC The D’Artagnan organic free-range turkey was moist; the white meat had a mild turkey flavor and a fine, firm texture, and the dark had deeper flavor and was slightly chewier. This would be a Beaujolais. At retail stores for $3.49 to $3.99 a pound.
NATURAL The turkeys from Griggstown Quail Farm and from Eberly were similar to the organic: tender and juicy. The white meat had the light turkey flavor that most Americans are used to. The dark meat was a bit richer. Griggstown turkeys are available from www.griggstownquailfarm.com; a turkey weighing 15 to 18 pounds costs $100.95. Whole Foods sells the Eberly for $3.69 to $3.99 a pound.
WILD These turkeys were a little disappointing: somewhat chewy, a little dry. To my surprise, the white meat was not bursting with turkeyness. The dark meat, however, was moist and had a nice gamey flavor. Maybe even 150 degrees was too high a temperature for such lean birds. The Quattro Farm birds are available at the farm’s stand at the Union Square Greenmarket on Saturdays, and on Wednesday, Nov. 22, for $5.79 a pound. The birds must be ordered in advance from (845) 635-8202, and are available now. Quattro birds are also sold through dartagnan.com, where one weighing 8 to 10 pounds costs $71.50.
Friday, November 03, 2006
Marathon factors
NYTimes
November 3, 2006
New York City Marathon
Everything You Know About Marathons Is Wrong
By GINA KOLATA
Most runners have heard the marathon lore: Your time will be best if the weather on race day is about 55 degrees and overcast, or even drizzly. And avoid dehydration at all costs, because it will cause your muscles to cramp and you could collapse at the finish line.
But none of that is true, researchers said at a recent marathon medicine and science conference in Chicago.
The weather theory “needs adjusting,” said Scott J. Montain, a research physiologist at the United States Army Research Institute of Environmental Medicine in Natick, Mass.
“Most of what we know comes from the lay literature,” he said.
Thousands of runners are no doubt monitoring the weather forecast for Sunday, when the New York City Marathon makes its annual tour of the five boroughs. (As of yesterday, it looked promising, with temperatures expected to be in the upper 40’s and partially cloudy skies.) But the weather nostrums for marathoning that are cited so authoritatively in journal articles and textbooks are not always borne out in legitimate science. Montain and his colleagues set out to conduct a proper study.
They gathered data from 28 years of the New York City Marathon, 35 years of the Boston Marathon and 23 years of the marathons in Hartford, Vancouver, Duluth, Minn., and Richmond, Va. The routes for those marathons have barely changed over the years, and each had a large field — more than 10,000 runners. The investigators looked at the average times for the top three men and women, and at the times for the runners who placed 25th, 50th, 100th and 300th.
Elite runners ran fastest in the coldest conditions — 41 to 50 degrees. But the slowing effect with heat was not as great as had been previously reported. For every five-degree increase in temperature, times slowed by 0.4 percent.
Warmer weather had a greater effect on slower runners. On a 77-degree day, an elite runner would be about 5 percent slower than on a 41-degree day. But a runner who finished in three hours on a 41-degree day would be slowed by about 12 percent on a 77-degree day, finishing in 3 hours 21 minutes.
One reason, Montain said, could be that slower runners spend more time on the course, and the temperature generally rises through the day. Or it could be because slower runners tend to run with a larger pack. A tightly clustered group of runners generates heat and blocks it from dissipating.
Montain and his colleagues also looked at whether marathon times were better under sunny or overcast skies. Only 13 percent of records were set on cool and cloudy days.
“It is more likely that a record will be set when it is sunny or when there are scattered clouds,” Montain said. He is not sure why that is; perhaps sunny conditions put runners in a better mood, he suggested.
Then there is the issue of cramping, that often excruciating, spasmodic, involuntary contraction of muscles that can occur during or, more often, just after a marathon. It almost always involves the muscles that were used to run — the hamstrings or calf muscles, for example. And it can last a minute or two — or much longer.
Conventional wisdom says cramps are caused by dehydration and that the solution is to consume salt and drink more fluids. Not true, says Martin P. Schwellnus, a professor of sports medicine at the University of Cape Town in South Africa.
At the conference in Chicago last month, he reported that he could find no relationship between dehydration and cramping. He has studied cyclists, marathoners and triathletes, measuring levels of electrolytes and body-weight changes, both of which are indicators of dehydration. Those who cramped were no different from those who did not.
Two other studies looked at how much weight ultramarathon runners and triathletes lost during races — a measure of fluid loss and a direct indicator of dehydration. Those who cramped lost no more weight than those who did not. If anything, Schwellnus said, those who did not have cramps were slightly more dehydrated.
The cause of cramps, Schwellnus believes, is an alteration in the electrical signals going to exhausted muscles so that the balance between those signals activating muscles and those inhibiting them is distorted. One way to protect yourself is with proper marathon training and proper pacing. “Racing at too high of an intensity is one of the single most important risk factors,” Schwellnus said.
When muscles cramp, there is a simple and effective treatment: stop running and stretch that muscle. And, Schwellnus said, realize that the cramping will soon stop.
“Almost no matter what you do, if you stop the activity, the muscle will come back to normal,” he said.
Beyond the finish line of every marathon are runners who feel dizzy, and some of them collapse. It is not as common as muscle cramps, but the condition can afflict up to about 5 percent of marathon runners, said Michael N. Sawka, head of the thermal and mountain medicine division at the United States Army Research Institute of Environmental Medicine. He wondered whether the cause could be dehydration, a commonly evoked mechanism.
Sawka looked at published studies. One compared 45 athletes who collapsed after an ultramarathon to 65 who completed the race and did not collapse. There were no obvious differences between the two groups: their body temperatures were the same (dehydration makes the temperature rise), as were their electrolyte levels. But those who collapsed were pushing themselves as hard as they could, were at or close to their personal records, or were medal winners in the race. Perhaps, Sawka said, “that final effort might contribute to collapse.”
The actual cause, though, does not appear to be dehydration, Sawka said. Instead, it is a pooling of blood in the lower legs and feet when vigorous exercise suddenly stops and the heart rate slows markedly.
Timothy Noakes, a professor of exercise and sports science at the University of Cape Town, said he had stopped giving intravenous fluids to collapsed runners.
“We completely changed the way we treat patients,” Noakes said. “All we do is have them lie down and put their feet higher than their head.”
Postmarathon collapse, Noakes added, “is a benign condition.”
“Just lift their legs and you will help the majority of patients,” he said. “That’s all you need to do to make most people recover very, very quickly. You can infuse as much fluid as you want, and you will not get the same response.”
November 3, 2006
New York City Marathon
Everything You Know About Marathons Is Wrong
By GINA KOLATA
Most runners have heard the marathon lore: Your time will be best if the weather on race day is about 55 degrees and overcast, or even drizzly. And avoid dehydration at all costs, because it will cause your muscles to cramp and you could collapse at the finish line.
But none of that is true, researchers said at a recent marathon medicine and science conference in Chicago.
The weather theory “needs adjusting,” said Scott J. Montain, a research physiologist at the United States Army Research Institute of Environmental Medicine in Natick, Mass.
“Most of what we know comes from the lay literature,” he said.
Thousands of runners are no doubt monitoring the weather forecast for Sunday, when the New York City Marathon makes its annual tour of the five boroughs. (As of yesterday, it looked promising, with temperatures expected to be in the upper 40’s and partially cloudy skies.) But the weather nostrums for marathoning that are cited so authoritatively in journal articles and textbooks are not always borne out in legitimate science. Montain and his colleagues set out to conduct a proper study.
They gathered data from 28 years of the New York City Marathon, 35 years of the Boston Marathon and 23 years of the marathons in Hartford, Vancouver, Duluth, Minn., and Richmond, Va. The routes for those marathons have barely changed over the years, and each had a large field — more than 10,000 runners. The investigators looked at the average times for the top three men and women, and at the times for the runners who placed 25th, 50th, 100th and 300th.
Elite runners ran fastest in the coldest conditions — 41 to 50 degrees. But the slowing effect with heat was not as great as had been previously reported. For every five-degree increase in temperature, times slowed by 0.4 percent.
Warmer weather had a greater effect on slower runners. On a 77-degree day, an elite runner would be about 5 percent slower than on a 41-degree day. But a runner who finished in three hours on a 41-degree day would be slowed by about 12 percent on a 77-degree day, finishing in 3 hours 21 minutes.
One reason, Montain said, could be that slower runners spend more time on the course, and the temperature generally rises through the day. Or it could be because slower runners tend to run with a larger pack. A tightly clustered group of runners generates heat and blocks it from dissipating.
Montain and his colleagues also looked at whether marathon times were better under sunny or overcast skies. Only 13 percent of records were set on cool and cloudy days.
“It is more likely that a record will be set when it is sunny or when there are scattered clouds,” Montain said. He is not sure why that is; perhaps sunny conditions put runners in a better mood, he suggested.
Then there is the issue of cramping, that often excruciating, spasmodic, involuntary contraction of muscles that can occur during or, more often, just after a marathon. It almost always involves the muscles that were used to run — the hamstrings or calf muscles, for example. And it can last a minute or two — or much longer.
Conventional wisdom says cramps are caused by dehydration and that the solution is to consume salt and drink more fluids. Not true, says Martin P. Schwellnus, a professor of sports medicine at the University of Cape Town in South Africa.
At the conference in Chicago last month, he reported that he could find no relationship between dehydration and cramping. He has studied cyclists, marathoners and triathletes, measuring levels of electrolytes and body-weight changes, both of which are indicators of dehydration. Those who cramped were no different from those who did not.
Two other studies looked at how much weight ultramarathon runners and triathletes lost during races — a measure of fluid loss and a direct indicator of dehydration. Those who cramped lost no more weight than those who did not. If anything, Schwellnus said, those who did not have cramps were slightly more dehydrated.
The cause of cramps, Schwellnus believes, is an alteration in the electrical signals going to exhausted muscles so that the balance between those signals activating muscles and those inhibiting them is distorted. One way to protect yourself is with proper marathon training and proper pacing. “Racing at too high of an intensity is one of the single most important risk factors,” Schwellnus said.
When muscles cramp, there is a simple and effective treatment: stop running and stretch that muscle. And, Schwellnus said, realize that the cramping will soon stop.
“Almost no matter what you do, if you stop the activity, the muscle will come back to normal,” he said.
Beyond the finish line of every marathon are runners who feel dizzy, and some of them collapse. It is not as common as muscle cramps, but the condition can afflict up to about 5 percent of marathon runners, said Michael N. Sawka, head of the thermal and mountain medicine division at the United States Army Research Institute of Environmental Medicine. He wondered whether the cause could be dehydration, a commonly evoked mechanism.
Sawka looked at published studies. One compared 45 athletes who collapsed after an ultramarathon to 65 who completed the race and did not collapse. There were no obvious differences between the two groups: their body temperatures were the same (dehydration makes the temperature rise), as were their electrolyte levels. But those who collapsed were pushing themselves as hard as they could, were at or close to their personal records, or were medal winners in the race. Perhaps, Sawka said, “that final effort might contribute to collapse.”
The actual cause, though, does not appear to be dehydration, Sawka said. Instead, it is a pooling of blood in the lower legs and feet when vigorous exercise suddenly stops and the heart rate slows markedly.
Timothy Noakes, a professor of exercise and sports science at the University of Cape Town, said he had stopped giving intravenous fluids to collapsed runners.
“We completely changed the way we treat patients,” Noakes said. “All we do is have them lie down and put their feet higher than their head.”
Postmarathon collapse, Noakes added, “is a benign condition.”
“Just lift their legs and you will help the majority of patients,” he said. “That’s all you need to do to make most people recover very, very quickly. You can infuse as much fluid as you want, and you will not get the same response.”
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