“Real” Science

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Some of you may or may not know that one of my favorite activities is solving crossword puzzles. Not just any puzzles, mind you, but the Sunday New York Times crossword found in the very back of the magazine. Every Sunday, I eagerly sift through my newspaper and find the magazine, ready to start working on the puzzle and figure out all of those elusive answers. This week, as I was thumbing through the pages, I came across an article under the “Well” section of the magazine, which caught my eye: “Mind What You Eat: Can ‘intuitive’ eating be as effective as calorie counting?” written by Gretchen Reynolds. The picture accompanying this article was that of a corpulent, blind-folded man, whose stomach was feeding itself a piece of pizza.

Given the nature of the work that Jonah and I do, I was intrigued to see what Ms. Reynolds had to say about intuitive eating, especially since the idea of intuitive eating is still relatively unknown to most of the general public. As I read on, however, my curiosity turned to disappointment and frustration. The article was riddled with inaccuracies, and, above all, truly missed the point of what intuitive eating is all about.

Although the idea of intuitive eating (also called the “non-diet approach”) has been around for many years, Evelyn Tribole and Elyse Resch, two registered dietitians, brought the topic to the public’s attention in their 1995 book “Intuitive Eating.” In the book, the authors explain the 10 Principles of Intuitive Eating, including such ideas as “Reject the Diet Mentality,” “Honor Your Hunger,” and “Make Peace with Food.” The authors assert that by following these principles, an individual can create a healthy relationship with food, mind, and body. The basic “rules” of intuitive eating are quite simple: eat when you are hungry, eat what you are hungry for (not what someone else or some diet is telling you to eat), and stop eating when you are satiated.

While the book does discuss the likelihood that by eating this way one will reach their “healthy weight,” it is in no way meant to be a diet book or a how-to weight loss treatise. One’s “healthy weight” is not based on the BMI or what popular culture says is healthy – it’s the weight that one’s body arrives at when he or she is engaging in healthy behaviors such as eating intuitively, engaging in pleasurable physical activity, and managing stress.

Since weight loss is not the ultimate goal of intuitive eating, I was confused as to why Ms. Reynolds decided to compare the approach with calorie counting to see which resulted in more weight loss. In addition to this, the article was flawed in a number of ways.

Ms. Reynolds begins her article by saying that intuitive eating has not been studied extensively by researchers. This statement could not be further from the truth! Per the Intuitive Eating website, there have been over 40 studies which have looked at the health benefits of intuitive eating. According to Ms. Tribole who posted her reaction to Ms. Reynolds’ article on her own Facebook page, “last month a systematic review was published on Intuitive Eating with 24 studies, totaling over 9,000 people.”

Ms. Reynolds’ article goes on to discuss a study in which 16 overweight men and women were split up into two groups of eight: one group was assigned to a restricted-calorie diet between 1,200 and 1,800 calories per day, while the other group was to engage in intuitive eating. At the end of the study, which ran a total of six weeks, the researchers found that those in the calorie-controlled group lost more weight than those in the intuitive eating group. Given these results, posits Reynolds, limiting one’s calories is a more effective way to lose weight than engaging in intuitive eating.

Yikes. This article is problematic for a number of reasons. Firstly, the study itself is a poor one to use, as it has an extremely small sample size of 16 subjects and is conducted over a measly six-week time period. Secondly, to draw any conclusions about health outcomes from this study is wildly irresponsible. And thirdly, duh, of course the calorie-restricted group lost weight! This study literally gives us no useful information!

We all know that going on a diet results in weight loss for the vast majority of people. The question is: how likely is it that those individuals will actually keep the weight off for a significant period of time? Given that we know that approximately 95% of people regain the weight they lost through dieting, I’m willing to bet dollars to donuts that all of the individuals in this silly little study regained the weight they lost during the first six weeks of the study. In fact, I wouldn’t be surprised if they ended up heavier than when they started!

I guess the thing that bothers me most about this article is how it completely misses the point of what intuitive eating is all about. Intuitive eating is about eating in a way that promotes one’s health, not in a way that is meant to result in weight loss. Ms. Reynolds reinforces the diet mentality of the general public by her assertion that cutting calories is what is necessary to reach a healthy weight. Articles like this one just create more confusion for Jonah’s and my patients, as it backs up the ideas that weight loss should be one’s ultimate goal and that long-term maintenance of weight loss is achievable.

One Step Backward for Dietitian-Kind

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With National Nutrition Month upon us, I have been reflecting upon the work that I and my dietetic peers are doing with our patients. Are we helping to guide our patients toward better health? Are we presenting them with the most accurate, up-to-date, and appropriate nutrition advice based on peer-reviewed, evidence-based research in the field of nutrition and health? Are we acting ethically in our profession? I would like to think that most dietitians would answer yes to the above questions. We entered this field to help people, right? Well, unfortunately, some dietitians really get it wrong. And this can damage the dietetic field as a whole.

Recently, an article came across my radar screen, which illustrates the above point to a tee. In the article, entitled “I’m a Nutritionist. Here is How I Plan to Lose 20 Pounds,” Erica Sawers, a chiropractor and registered dietitian (RD), talks about how after giving birth to two children in the past three years and “indulging in croissants and treats” during both pregnancies, she wants to lose twenty pounds to get back to her pre-pregnancy weight. She then goes on to list seven ways that she plans to achieve her goal.

For the most part, this article is plainly ridiculous. In her first bullet point, Sawers delineates that she is going to set a “realistic goal” of losing one to two pounds per week. In the very next step, however, she says that she plans to “banish the scale,” by focusing on how her clothes fit rather than focusing on a number. She then follows that sentiment with “the most I will allow myself to step on the scale is once a week, and even once a month will do.” Um, ok. I’m totally confused now. So, are you going to weigh yourself or not? Because in my lexicon, banishment means “none.” And if the number isn’t that important to you, why set twenty pounds as your goal? Am I missing something here? Seriously.

Later in the article Sawers advises, “find a diet that works for you.” She then goes on to say that she herself avoids gluten, dairy and refined sugar, but doesn’t deny herself a few squares of dark chocolate or homemade cookies on occasion. Ugh. What she is describing sounds pretty restrictive to me. Honestly, who could stick to that regimen for an extended period of time without feeling horribly deprived? It is unrealistic to think that this way of eating would be sustainable for most people. And while someone might indeed lose some weight following her regimen, I would be willing to bet that the individual would regain the lost weight and then some.

As an RD, Sawers should know better than to write an article like this. As we all have heard many times before, diets fail 95 percent of the time, meaning only 5 percent of weight-loss attempts are sustainable. In fact, most people will end up regaining the lost weight and then some when they go off the diet. Research is also starting to point at yo-yo dieting as being more dangerous than just maintaining a higher weight, as it puts more stress on the body to chronically lose and regain weight. What Sawers is presenting is a diet, pure and simple. How can she publish something like this with the knowledge that the outcome will be failure for most people who try it and could result in increased health risks?

Instead of writing an article about how to lose weight, how about writing one about how to achieve better health? As Jonah and I have written about too many times to count, weight is not an accurate indicator of health – behaviors are. The research shows time and time again that the more healthy habits an individual has (e.g. not smoking, being physically active, eating five servings of fruits and veggies daily, and drinking moderately), the better that person’s health outcomes will be. These findings are independent of weight. Let me repeat that: it’s the behaviors, not the weight!

Unfortunately, Sawers’ article is not unique. I often see these types of nonsense blogs pop up all over the internet. If this was some random person’s article about wanting to lose weight and her strategies to do so, I wouldn’t have as much of a problem with it. But, Sawers is a registered dietitian. That means that many people will take her weight-loss guide as a how-to for themselves. As dietitians, we have a responsibility to present accurate information in an ethical way. This article misses the mark.

I Get Knocked Down

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The first six weeks of 2015 have been pretty rough for me. It started on January 4th. I made the fatal mistake of running down our wooden steps in just my socks. What happened, you ask? Well, I slipped and fell down the steps with such a thud that Jonah thought a piece of furniture had fallen on me! Luckily, the fall only resulted in a broken baby toe and a whopping bruise on my butt, but I was still pretty shaken up about it.

Just as I was healing from my trip down the stairs, I woke up the following Wednesday with my throat on fire and feeling feverish. My doctor told me to come in to her office so she could do a strep test on me. While the rapid strep test came up negative in her office, she took another swab and sent it to the lab. What are the chances that the second test would be positive? Well, apparently, they were pretty good – I had strep. I haven’t had strep since I was a kid, and boy, was this a bad strain. After taking a course of antibiotics, however, I started feeling better and thinking to myself that I was finally out of the woods.

How wrong I was! Just a week after recuperating from strep, I again woke up with another sore throat. This time there was no fever, and it was definitely better than the strep I had previously, but this illness along with a cough that is driving me crazy, just won’t seem to go away! Today I feel like I might finally be kicking this cold in the butt, but it has really wreaked some havoc on my mood.

All of these illnesses and injuries got me thinking – you know, I never really appreciated how wonderful it is to just be healthy until all of a sudden I wasn’t. I wish that I wouldn’t be so hard on my body when I feel like it has let me down. My body has gotten me through 36 (almost 37) years of life, most of which have been relatively healthy and safe. I should feel lucky that I can walk, swim, ride a bike or play tennis. Many people cannot do these things.

So, while the start to 2015 may not have been the best ever, I am determined not to let these past six weeks get me down. I love my body and everything it allows me to do. I will do my best to take better care of it, and that’s all I can do!

Eating Disorders Are No Laughing Matter

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Last week after a tennis match, I was chatting with some of the women on my team. One of them asked me what I do for a living and when I told her that I specialize in nutrition counseling for eating disorders (EDs), she giggled. After an awkward pause, she said, “Oh, how I wish I had an eating disorder! I can’t seem to lose these last 10 pounds.” The other women grinned sheepishly, but I was not amused in the slightest. Unfortunately, I have heard this sentiment too many times to ignore, and whenever I do, I make sure to nip it directly in the bud.

EDs are not a laughing matter. In fact, they have the highest mortality rate of any mental illness out there, including depression, bipolar disorder, and schizophrenia. EDs are not something I would wish on anybody. They are ruthless, devastating illnesses that not only take a huge toll on one’s life, but also on those around them. EDs are not something that one can just choose to have for a short period of time to “lose the last 10 pounds,” and they are not a phase or a diet. Most of my clients are desperate to not have an ED, as it has robbed them of a normal, happy, healthy life.

I hear jokes about EDs on nearly a daily basis. Turn on any TV show or watch a popular teen movie and you are bound to hear one. Most often, the jokes are in the form of the characters using ED behaviors to lose weight, such as consuming “nothing but Ex-Lax and water ‘til prom!” or not eating anything until feeling faint and then having a piece of cheese. The movie Jawbreaker jokes about having a “Karen Carpenter table” in the cafeteria, alluding to the singer who died of anorexia years ago. These jokes are rampant, and worse, they perpetuate the idea that EDs are no big deal, that it’s cool or trendy to starve oneself or throw up after eating a large meal. Nothing could be further from the truth.

Please, if you hear a friend or a loved one joking about having an ED, don’t laugh. In response to the comment my tennis teammate made above, I made sure she knew that EDs are a serious mental illness and that it wasn’t cool to joke about them like that. Hopefully she got the message, and I hope others will, too.

Really, Giada?

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Recently a news story came across my radar about Food Network chef and TV personality Giada de Laurentiis. According to an article by Fox News, a source on de Laurentiis’ show Giada at Home insists that the real secret to how Giada maintains her size 2 figure is not by “eating in moderation,” as the chef has often stated. Instead, the source reports that Giada refuses to actually eat any of the food she prepares on her show. But what about all of the scenes in which she takes a bite of the delicious food she prepares during the show? According to the source, Giada has a “dump bucket” on hand to spit out every bite she takes on TV.

Needless to say, I was disturbed to read about this. While I am not insinuating that Giada has an eating disorder, the act of chewing and spitting out one’s food is actually an eating disorder behavior that a number of my patients admit to engaging in. The individual who chews and spits out her food is trying to get the flavor of the foods she deems “unhealthy” without having to ingest the calories.

In every interview with Giada that I’ve read, the subject of her weight comes up. Of course, it’s not terribly surprising that these questions are asked since she is a chef who prepares decadent meals and desserts and yet manages to stay stick thin. And I guess I can’t blame her for her standard answer of “I eat a little bit of everything and not a lot of anything. Everything in moderation.” I mean, who wants to hear that a TV chef actually never eats her own creations on the show? And spitting out one’s food isn’t something that most people would admit to.

It makes me sad that Giada feels the need to do this. Given our fat phobic culture, I imagine she must feel a lot of pressure to stay thin as a TV personality. My guess is that if she actually did eat at least some of the food she prepared on the show, her figure wouldn’t be much different. Genes play a huge role in weight, and eating a few extra bites shouldn’t affect her waistline dramatically. It also makes me think of Paula Deen and how ruthlessly she has been attacked for her weight and “unhealthy” cooking style. I wonder how Paula would be viewed if it was discovered that she also has a “dump bucket.” Would she be praised for her “restraint?”

More than anything, I worry that stories like Giada’s will start a troubling new trend among young girls trying to “stay skinny.” No matter what, chewing and spitting out one’s food for the purposes of weight control is not a healthy behavior. Hopefully this will not catch on as the new weight loss “solution.”

Eating in School

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Lately, it seems like a lot of my teenage clients have been having issues with eating in school. Lunch times can run the gamut, with some students having lunch as early as 10:40AM and others not having it until 1PM or later. And, each individual student’s lunch schedule can vary daily, meaning that she might have Monday lunch at 12:30PM but Tuesday and Thursday lunches are at 11AM. In my opinion, all of this unpredictability around lunchtime can create or worsen eating issues in kids, especially those struggling with eating disorders.

In addition to the lunchtime disorganization, many of my patients tell me that they are not allowed to eat snacks in the classroom. I understand that eating can be disruptive during class, and I am not in favor of letting kids just snack willy-nilly during algebra. But, if a student is having lunch at 10:40AM and doesn’t get out of school until 3:30PM, that’s a huge stretch of time to not have a snack. This can lead to large dips in blood sugar, which causes lethargy, brain fog and in some cases dizziness and fainting. Oftentimes, my patients will tell me that they are starving by the time they get home and those who struggle with overeating tend to binge.

I really think snack time should be incorporated into the school day, even for older students. It would help them to concentrate better, feel more energized, and would also help prevent reactionary overeating later in the day. It wouldn’t need to be a long snack time, maybe just 15 minutes, but I think it would be helpful. I think it would be beneficial not only for the students without eating issues, but for those with eating disorders, it would normalize snacking for them.

What are your experiences with school lunches or eating in school?

Kate Hudson’s “Flawless” Physique

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A story popped up in my “Trending” column on Facebook this morning about Kate Hudson. Apparently, US Magazine asked the actress how she manages to maintain such a “flawless” physique. Her answer? “Working my ass off!” Hudson, a Pilates devotee and avid runner, says the key to her bod is consistency – that is, she works out nearly every day. Later in the article, she also mentions that she enjoys doing cleanses “twice a year for five to seven days, or food elimination cleanses where [she eats] super clean.” Ugh.

Can we just stop with this already? We get it – Kate Hudson and the like are held up as body role models due to their leanness and seeming perfection. What these types of articles fail to mention is that genetics play a huge role in body shape and weight. Now, am I saying that if Kate Hudson did nothing but sit around and eat bon-bons all day she would look the same? Maybe not. But I highly doubt she would morph into a zaftig lady if she backed off the exercise a bit. These types of articles perpetuate the idea that if we all worked hard enough, we could look like Kate Hudson one day, which, of course, is complete and utter B.S.

As for the cleanses? Well, I’ve already written about cleanses, so I won’t belabor the point, but they provide nothing for the body. In fact, most cleanses do more harm than good as you lose fluid, break down muscle and miss out on numerous nutrients, all while feeling like complete junk. Not to mention, your body is perfectly capable of cleansing itself without any help from you, thank you very much.

More than anything, I am concerned about the message that this article sends to young girls and women, many of whom I end up seeing in my office. I can’t tell you how many times I’ve had a patient tell me she wants to look just like Gwyneth or Gisele or Jennifer Aniston. It’s an unhealthy obsession with celebrity bodies, and it has to stop. We aren’t meant to look like these specimens of “perfection;” we are meant to look like ourselves. And constantly striving to look like someone else will only backfire in the long run.

All we can do is take the best care of our bodies as they are by eating intuitively, moving our bodies in ways that feel good, getting enough sleep and managing stress. And most importantly, we need to appreciate our bodies for what they give us every day, not punish them for not looking like Kate Hudson’s.

What I Love About Thanksgiving

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Ever since I was little, Thanksgiving has been my favorite holiday. My mom was usually the one to host the festivities, and every year she would make it special. While I didn’t really help much with preparing the meal, I was in charge of setting the table and making the place cards and would make sure to decorate each one with the appropriate Thanksgiving flair (i.e. turkeys, pilgrims, and various fall leaves).

What always amazed me about the Thanksgiving meal was how seamlessly my mom would pull it off, or at least how seamlessly she made it appear! No doubt she has had a lot of practice doing this over the years, and I’m sure her first few attempts were filled with errors of timing and, perhaps, trying too hard. But by the time I was old enough to understand, I came to see my mom as a culinary genius.

I firmly believe that my mom’s real expertise was in editing herself. She always focused on a few staple dishes every year and never made too much food. Unlike some Thanksgivings I’ve heard about, there were never three kinds of mashed potatoes, obscene amounts of bread or endless desserts. She kept it simple – salad for starter, turkey with stuffing, sweet potato casserole, two kinds of homemade cranberry sauce, cranberry bread and usually steamed green beans for the main meal. Dessert usually consisted of a couple of baked goods, like brownies made from scratch and maybe some pecan pie with Brigham’s vanilla ice cream. Lots of food, to be sure, but it never felt like too much.

Aside from the food, I really enjoy the family togetherness of it all. My siblings don’t live locally, so the holidays are usually the only times I get to catch up with them and their kids. Some of my fondest memories are those in which we would gather together after the meal to hang out in the den either watching sports on TV or playing a friendly game of Trivial Pursuit. My father passed away from dementia 2 years ago, and one of the last really good memories I have with him was the last Thanksgiving he spent in our home. All of us gathered in his bedroom to spend some time with him before the meal. Even though he struggled to communicate at that time, I am hopeful that it was a special Thanksgiving for him, too.

A lot of my patients who struggle with eating disorders have a difficult time with Thanksgiving, as it can feel like a very food-centered holiday. I can definitely understand where they are coming from, as it must be difficult to be surrounded by delicious food when sometimes food feels like the enemy. What I try to remind all my patients is that Thanksgiving is only one day. Try not to be too hard on yourself if you eat a bit more than you usually do. And if there is a particular dish that you absolutely love and don’t get to eat it often, give yourself permission to enjoy it. Life is too short to not enjoy the delicious food and heart-warming company of the holiday. I hope all of you are able to relax, spend some quality time with your family and friends and savor the day.

Snack Ideas

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Lately it seems like almost all of my patients have been asking for snack ideas. In general, I have a few guidelines regarding snacks. First would be timing. Is the snack in question something that you just need to help you bridge a short gap between breakfast and lunch? Or is it something that will need to hold you over for several hours? Perhaps it is heading into “mini meal” territory, for those days when a sit down meal just isn’t going to cut it.

Of course, if it’s just a small snack to keep you from being ravenous for lunch or dinner, I would suggest picking a carbohydrate and then having it with a protein or a fat. What does that look like? An apple (carb) with a piece of cheddar cheese (pro/fat), pretzels (carb) with hummus (pro/fat), or a handful of trail mix made with nuts (pro/fat) and dried fruit (carb) are all great examples. Basically, the combination of carbohydrate and fat/protein is the best way to fuel your body between meals as it gives you some quick energy (carbs) and some energy that will satisfy you and keep your blood sugar levels steady (fats/proteins).

If a bigger snack is in order, I would recommend having at least a protein, a carbohydrate AND a fat. That could look like a peanut butter and banana sandwich; a homemade pizza bagel made with ½ a bagel, tomato sauce, some shredded mozzarella and perhaps a few slices of pepperoni; or a bowl of oatmeal with a tablespoon of peanut butter and a sliced banana. The main purpose of the bigger snack is to bridge a larger gap between meals while also making sure you will be hungry for the following meal.

Even if a patient knows that she is hungry for a snack, sometimes figuring out what exactly she is hungry for can be a challenge. In this instance, I would suggest going through a quick list of food qualities to help narrow it down. Am I hungry for something hot or cold or room temperature? Do I want something creamy and soft? Crunchy or hard? Am I in the mood for something savory or sweet or perhaps a mix of the two? Do I want something spicy? Salty? Bland? Sour? Am I hungry for something cheesy? Meaty? Chocolate-y? It may feel a little silly to go through a list like this, but sometimes it can just take a minute or two to figure out what will really hit the spot.

Some more snack ideas:

-cut up vegetables with ranch or bleu cheese dressing

-turkey slices with cheese and some crackers

-pretzels with peanut butter

-animal crackers with Nutella

-yogurt with granola and/or fruit

-1/2 of a turkey or roast beef sandwich

-tortilla chips with guacamole

-hardboiled egg and a piece of fruit

Something is better than “all or nothing”

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Lately it seems like I have a number of patients who are struggling. Whether it’s sticking to their prescribed meal plan, trying to incorporate more fruits or veggies into their diet or eating more intuitively, many of them are just finding themselves at a loss. When they are stressed out due to life’s challenges, they revert to their old ways of coping. For some that might mean restricting their intake and counting calories obsessively, for others that might mean zoning out on the couch watching TV with a bag of chips. Oftentimes I will hear the same reasoning: “I just couldn’t do [healthy habit] this week; it felt like too much effort.”

When we dig deeper, I often find that many of my patients have an “all or nothing” mindset about their eating. Either they are 100% committed to making healthy eating choices or they throw their hands up and say “screw it!” It might look something like this: a patient who has stated a goal that she only wants to eat out at restaurants twice per week found herself overworked and stressed and ended up eating out five times during that week. Or perhaps someone has set a goal of meal planning and grocery shopping every Sunday, but he just never gets around to it.

A lot of the time, these patients will come in to our appointment with their heads held low and feeling like failures. This isn’t the case! I look at these “failures” as data that we can use to help us in the future. Maybe the goals that were set were too much for that person at the time. Or perhaps there is another area of change that we should focus on. The best thing we can do in our session is to rework the goals that aren’t being met. Sometimes that means making these goals a bit more achievable (e.g. aiming for eating out 4 or fewer times per week for someone who is used to eating out 5 or more times per week).

The other idea I think is important is the “good enough,” concept. No one is perfect and similarly, when we expect ourselves to never fail, we are setting ourselves up for failure. Sometimes achieving parts of our goals is better than totally giving up completely. For instance, let’s say someone is really struggling with eating healthy lunches during the week. She is buried under paperwork and totally overextended at work and has been just grabbing a bag of chips from the vending machine. Ideally, she’d like to be packing her home-cooked lunches the night before and bringing them with her to work every day. But, it just isn’t happening. How about working on a middle ground solution? That could be bringing frozen meals for lunch instead of either buying potato chips or bringing home-cooked lunches. Are frozen meals ideal? No. But are they “good enough,” i.e. better than nothing? Absolutely!

The above example might feel uncomfortable for many people. Oftentimes, a patient will come into our session feeling like they have been “bad” because she didn’t achieve the goals we set last session 100%. What I say to that is: 1) maybe we didn’t set the right goal and 2) all you can do is the best you can do in that moment. Even if you don’t fully reach all of your goals, try to ease up on yourself a bit and realize that you are human. Something is always better than “all or nothing.”