He Said, She Said: Halloween Candy

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He Said

Halloween is when I first learned the meaning of the word “nauseous.” After returning home from trick or treating, I sat at the kitchen table eating candy until I no longer felt well. “Do you feel nauseous?” my mom asked. A loose definition formed in my childhood mind: Nauseous (adjective): Feeling completely gross from eating too much Halloween candy.

My brother, in contrast, always paced himself. While I blew through my own candy in a few days tops, he made his candy last for weeks, if not months. Eventually I realized that eating small amounts of candy at a time not only spared me from feeling nauseous, but the candy lasted longer. Preservation became fun, and at some point I started freezing candy. As springtime flowers bloomed, I would be eating last fall’s frozen Snickers.

Upon returning home from trick or treating, my brother and I dumped out our candy sacks, sorted our bounties into piles by kinds of candies, and traded with each other so we each had our favorites. In order to make our trades with each other, we each needed a foundational hierarchy of our candy likes and dislikes so we each knew which pieces we wished to keep and obtain more of and which ones we hoped to trade. In other words, we had to mindfully eat our candy in order to assess enjoyment.

Halloween and its associated candy provide opportunities for children to build their relationships with food. The healthiest relationships are built on a foundation of internal-cue recognitions and responses: having the ability to not only ask ourselves questions like “Am I hungry?” “How hungry am I?” and “What is it that I really want?” but more importantly, to be in touch with our bodies enough to be able to appropriately answer.

Building these skills involves trial and error. As I did on that Halloween so long ago, sometimes kids overeat and regret it. Sometimes they burn through their stash too quickly, not even truly enjoying a large portion of it, and wish they had conserved some for later. It is through these and similar lessons that we build the intuitive-eating skills that can serve us so well throughout our lives.

The alternative is to regulate children’s candy experience for them by forcing or coercing them to donate, trade, or throw out all or some of their candy, or by rationing the candy for them. Using external cues to regulate our eating may seem to work in the short term, but in the long run the approach almost always fails us. One particular patient comes to mind, a teenage girl who ignores her body’s hunger signals and eats according to the commands of an app. She tells me that she does not trust herself to listen to her body and that obeying the app is already “ingrained” in her. I think of the countless adults who sit across the table from me, fold their arms, lean back, and say, “Just tell me what to eat,” because for most of their lives they have been taught that they cannot trust themselves.

Well-intentioned parents want to help, but the assistance is often misplaced. Help your children to build their relationships with food by giving them the freedom to manage their Halloween candy themselves. Consider prompting your children to ask themselves how hungry they are and what do they really want before the eating begins, but not in a leading or coercive way. Give them the space to answer honestly and to follow up their candy experiences with more candid questions: “How full am I?” “How am I feeling now?” “How did I enjoy it?” and “What, if anything, would I do differently next time I have candy?” Give them the freedom to make mistakes and learn through experience, for it is partly through these lessons that we build healthy relationships with food.

 

She Said

The other day, Jonah told me about a local news story he had seen about a bunch of people who are now going to put signs on their front doors proclaiming that they are a “candy-free” house and that, as such, they will not be handing out any candy on Halloween this year. Instead, these individuals will be handing out small toys to the youngsters who come trick-or-treating to their door. Of course, the intention of these individuals is to not promote the “obesity epidemic” by handing out sugary treats to little ones.

The first thing that came to my mind about Halloween candy and kids was, “What would Ellyn Satter say?” Ellyn is a registered dietitian and eating specialist focusing primarily on children. She has written a number of pivotal books about how to feed children and how to prevent and/or help rectify problematic eating early on to promote a healthy relationship with food in years to come.

As luck would have it, Ellyn wrote an article in 2008 about the topic of Halloween candy and kids. In her opinion, she believes that Halloween candy should be treated the same way other sweets are treated and that the child needs to learn how to manage his sweets and how to “keep sweets in proportion to the other food he eats.” She cites a 2003 research study that found that girls that were “treat-deprived” (i.e., were restricted by their mothers in particular around treats and sweets) were more likely to overeat forbidden foods even if they weren’t hungry. Conversely, the study found that girls that were allowed treats on a regular basis ate them moderately and sometimes not at all.

Given the above study, Ellyn’s advice is to use Halloween candy as a “learning opportunity,” in which the child should work toward being able to manage his or her candy stash with minimal interference by the parent. What does that look like? Well, she would suggest that upon returning from trick-or-treating, the parent should let the child “lay out his booty” of Halloween candy, sort it out, and “eat as much of it as he wants.” After letting the child do this on the evening of Halloween and the next day, the child should put away the rest of the candy, and it will then be “relegated to meal- and snack-time: a couple of small pieces at meals for dessert and as much as he wants for snack time.” She goes on to say that “if [the child] can follow the rules, he gets to keep control of the stash. Otherwise [the parent does], on the assumption that as soon as the child can manage it, he gets to keep it.” Finally, she recommends offering milk with the candy to make sure the child is getting some good nutrition.

Now, when I first read the above, I found my inner skeptic coming up front and center. How could one possibly trust that his or her child could regulate his or her sweets intake? Isn’t that the parent’s job? Otherwise, wouldn’t we have a bunch of little kids gorging themselves on any sweets they could get their hands on? What’s next? Letting kids start drinking at a young age to help them learn to do so moderately as adults? It all sounded a bit too much to me.

But the more I thought about it, the more it made sense. By taking the taboo off sweets and treats, kids will be less likely to overdo it when they are faced with them. I have a colleague who regularly has a rotation of sweet treats and salty snacks in her house and does not limit her kids around this. What ends up happening, she says, is that her kids don’t see these foods as “off-limits” and therefore not so tempting. They know that if they want these foods, they can have them, but since they are always available, the forbiddenness is no longer an issue, and they eat them in moderation or sometimes not at all.

So what’s the take-home message from the above? Restricting sweets and treats can lead kids (and adults) to view these foods as “forbidden” and then when faced with them, they will find themselves overdoing it on these foods even if they aren’t hungry or in the mood for them. By incorporating these types of foods into one’s meals and snacks on a regular basis, they become less charged, and the individual will view them simply as part of their diet, not as forbidden fruit.

He Said, She Said: Nutrition Facts Labels

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He Said

Those working in policy are often charged with impossible tasks. Given the differences that make us each unique, coming up with guidelines that will work for some will inevitably alienate others. My suggestion is to abandon attempts to use food labels as nutrition-education tools and instead focus on accurately conveying the contents of the food itself.

Said attempts to provide education and context frequently result in nothing but confusion. Consider the inclusion of percent-of-daily-value calculations. If people understood that these percentages refer to the needs of a fictitious, generic example, fine, but I know from experience that all too often people are misled into believing these percentages pertain to them. Consider the differences in sodium needs of an individual with hypertension versus a marathoner who leaves white streaks of dried salt on his singlet.

Along those same lines, people misunderstand the term “serving” and think they are supposed to have the specified amount. Aiming for the serving size can lead to overeating or undereating and trigger negative feelings, such as guilt. In reality, serving size is not a mandate, but rather a unit label that gives us shorthand language with which to talk about and compare foods. I would like to see the term “serving” removed and replaced with less loaded term, such as “unit,” that still serves the function of easy discussion but without the baggage.

Another one of my gripes with food labels is the rounding off that manufacturers are legally allowed to do with their numbers. For example, if a food has less than 0.5 grams of trans fat per serving, they can round down to zero. In a way, it makes sense. A piece of paper is so thin that we might call it two-dimensional. Gather a bunch of papers together into a ream, however, and suddenly the thickness is substantial. That is the problem with rounding. Joanne has a patient who was using a pump margarine that stated it was calorie-free, but she was using such a high quantity that the calories, which had legally been rounded down to zero, significantly accumulated.

Rounding also happens in a qualitative sense on the ingredient list. What exactly are “natural flavors,” for example? People should have the right to know exactly what they are consuming, and more detailed information would surely make life easier for people with food allergies.

Nutrition education is certainly needed in our society, but food labels are not the place for it.

She Said

Ah, the nutrition label. As a practitioner specializing in eating disorders (EDs), I am well aware of how the nutrition label has the potential to be used (and abused). Many of my clients could spend an hour or more in the grocery store, looking at label after label to find the healthiest food option. I had one patient tell me that she spent 30 minutes in the cereal aisle comparing labels for different types of granola, determined to find the one that had the least amount of carbohydrates and fat, while also boasting at least five grams of fiber. And, of course, the ingredient label needed to have less than 10 ingredients listed, most of the items needed to be organic, etc.

You see, for those struggling with EDs, the nutrition label is not usually their friend. Nutrition label reading is a practice in self-torture for most of them. Having that information listed on the box or bag gives the eating disordered individual the information he or she needs to make choices about his or her eating, and it often causes them to analyze and over-analyze their food choices. In some cases, my patients will refuse to look at labels altogether for fear of getting sucked down the rabbit hole of “healthiest choice.”

For most of my ED patients, I suggest that they avoid reading the nutrition labels. Why? Well, for one, to prevent the above scenario from playing out at every grocery shopping trip. Also, my goal for most of my patients is to learn to engage in Intuitive Eating (IE), and using nutrition labels to make food-based decisions (when one is struggling with an ED) is anything but intuitive; instead, it is using an external control to decide what one should eat. Ideally, I would prefer the patient choose the type of granola she enjoys eating the most, regardless of the amount of carbs, fat, or fiber grams it contains. As I have noted before, when we enjoy what we are eating, we are more likely to absorb the nutrients in that food than if we simply choke down a less yummy version of that food.

Of course, if someone has a health condition that warrants them to read labels (e.g. diabetes or celiac disease), I would suggest that they do so in order to be safe and as a health-promoting behavior. But if someone has no dietary restrictions placed upon them by their doctor, and they are struggling with an ED, avoiding the nutrition label is the way to go.

He Said, She Said: Protein

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He Said

Most Americans get more than enough protein. Dietitians think about protein needs in terms of grams of protein per kilogram of body weight (g/kg). For the average person, 0.8 to 1.0 g/kg is perfectly adequate. For a 160-pound individual, this translates to a range of 58 to 73 grams per day of protein. Someone who is extremely active or has elevated protein needs due to a medical condition, such as recovery from surgery, may need more in the range of 1.2 to 1.5 g/kg. Those of us who suffer the misfortune of life-threatening traumas, infections, and burns need upwards of 2.0 to 3.0 g/kg as our bodies fight to survive and rebuild themselves. Under these circumstances, my example of a 160-pound person would need 146 to 219 grams per day during recovery.

So why is it then that we routinely see patients who are feeding themselves as much protein as a hospitalized third-degree burn victim? Among the multiple reasons, the most significant seems to be misinformation that spreads rapidly in our weight-centered society. Those of you who are my age or older have been around long enough to remember the low-fat fad that passed through a couple of decades ago. Just like fat phobia, today’s high-protein craze is based less on science and more on fear and a desperate feeling to grab hold of something, anything, that might be an answer to weight control. Accuracy of said answer is a distant concern.

An excessive protein intake comes at a cost. If we are consuming too much protein, only two possible scenarios exist: (1) We are consuming too few of other nutrients in order to make room for the protein, so we face the risks associated with inadequate intakes of other necessary nutrients. (2) We are still consuming adequate amounts of other nutrients, which means our overall caloric intake is excessive, and we have to deal with the ramifications of taking in more energy than our bodies need. Joanne offers additional concerns in her She Said section below.

When my patients work on building their intuitive-eating skills, oftentimes they discover that they feel better (i.e., greater energy, more regular bowel function, happier mood, etc.) when their protein intakes decrease to the recommended ranges in order to create appropriate room for healthy carbohydrates and fats.

 

She Said

In my work with those struggling with eating disorders, it seems as if protein can do no wrong. Nine times out of 10, my patients find protein to be much more benign than carbohydrate or fat. It is not unusual for a patient to report to me that all she has been eating is vegetables, some fruit, and egg whites/cottage cheese/boneless, skinless chicken breast/fish, while steering clear of bread, sweets, oils, and butter. When posed with the question about why she is avoiding the other macronutrients, the fallback answer is, “Well, protein is healthy for you, and carbs and fats will make me fat, so I don’t eat them.”

The logic behind this assumption is flawed for a few reasons. First, while it is possible to gain weight if one eats too much carbohydrate or fat, the same could be said for protein as well. Excess calories from any macronutrient will result in weight gain (to varying degrees). 500 extra calories of protein equal 500 extra calories of carbohydrate equal 500 extra calories of fat. It doesn’t matter a whole lot where those calories are coming from: If your body doesn’t need that extra fuel, it will store it.

Second, by eschewing carbohydrates and fats, one is losing out on a ton of nutrients. For example, fat-soluble vitamins A, D, E, and K are virtually impossible to absorb if they aren’t eaten in the presence of fat. This means that all of that vitamin A found in your carrots and all of that vitamin K found in your dark leafy greens will pass right through you if you don’t eat them with fat (like that found in salad dressing). Carbohydrates are also a gold mine of nutrients: Whole grains found in many breads, crackers and pastas provide fiber to keep us regular and can help manage our cholesterol levels. Carbohydrates are also the building blocks of serotonin, a neurotransmitter in the brain that is responsible for feelings of well-being and happiness. Protein can’t do any of the above by itself.

Finally, there is such a thing as too much protein. In general, it is recommended that healthy adults take in 0.8-1.0 grams of protein per kilogram of body weight. That translates to approximately 67 grams per day for an average man and 57 grams per day for an average woman. Most Americans get more than enough protein in their diets without cutting back on carbohydrates or fats. What does a typical day of protein intake look like? Well, let’s say you have two scrambled eggs for breakfast – there’s 12 grams of protein already. For lunch, you have a turkey and cheese sandwich – there’s another 32 grams of protein. Dinnertime is fish with veggies – another 25 grams of protein. That amounts to 69 grams of protein, which is more than enough. Many of my patients will confess to having double or sometimes even triple that amount, which is troubling. Excess intake of protein can take a serious toll on your kidneys, as they will work overtime to filter out the byproducts of protein breakdown. What could that mean? Kidney failure.

Protein is a valuable nutrient, to be sure. But overdoing it on any one macronutrient is not only potentially harmful to one’s body; one could be missing out on many other nutrients from other sources.

He Said, She Said: Lessons from Mom

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He Said

1) Food Can, and Should, Be Fun

I often went grocery shopping with my mom, and I helped her make meals, too. Because I enjoyed baking, she let me experiment with various recipes, including many of which I made up on my own. Some turned out well, others not so well. Regardless of the results though, by involving me in the food selection and preparation process, my mom taught me to have an appreciation for food that I would not have developed if food just suddenly appeared on my dinner plate. I learned that food can, and should, be fun.

2) Listen to Hunger/Fullness Cues

Perhaps in part because they lived through the Great Depression, my grandparents’ generation seemed to emphasize finishing everything on the plate. “There are people starving in China,” I would hear; as if by overeating, I would somehow lend a hand to somebody in need on the other side of the globe. My mom stood up to this misguided notion and taught me to listen to and honor my hunger and fullness cues. Forcing food down past the point of comfortable fullness helps nobody. Uneaten food can be packed up and saved for later. If we must throw it out, at least we learn a lesson to take or make less next time.

3) Where Food Comes From Matters

My brother and I were raised mostly eating organic foods, especially fruits and vegetables. The potential advantages of organic versus conventional foods are debatable, but I learned several lessons from my mom’s emphasis on eating organic: A food’s identity does not automatically indicate its quality; where it comes from and how it is grown/produced/raised matter.

4) Balance Is Key

When parents restrict their children from eating certain foods, the resulting irony is that the children often end up overeating on the forbidden foods as soon as they get access to them. In recognition of this reality, my mom instituted a “Sweet of the Day” policy, whereby my brother and I got to have a small treat each day. We enjoyed our favorites in quantities that did not ruin our health, and we learned not to see any foods as “bad.” In short, this policy was my initial exposure to the concept of nutritional balance.

5) Always More to Learn

Even though she has no formal study in the field, and her employment has nothing to do with the subject, my mom has always taken an interest in it, reading articles, newsletters, and magazines. Research is constantly yielding new insights into nutrition and health. Not only do I have to stay on top of new developments in the field, but I have to be open-minded enough to consider new information and opinions that challenge the status quo.

 

She Said

My mom is one of the most amazing women I know, and she inspires me in many different ways. One of the areas she has the most expertise in is cooking. Just looking at her kitchen, one can see all of the evidence of an experienced chef – tons of dog-eared and worn cookbooks, various cooking gadgets, and binders filled with old family recipes passed down from her mother (and her mother’s mother). Along the way, I have learned a number of nutrition lessons from her, and here are just a few of them.

1) Food is more than just fuel.

In nutrition school, a lot of the focus is on the science of nutrition – chemistry, physiology, nutrient metabolism, etc. But there is so much more to nutrition than just calories in/calories out. Food is family, love and connection. Some of my earliest memories are of my mom cooking and baking, so calm and happy in her kitchen. Of course, every holiday has its traditional meals – roasted turkey and Saltine stuffing on Thanksgiving, brisket and matzo ball soup on Passover, and chocolate brownies for dessert on July 4th. Aside from the holidays, though, my mom’s food can elicit such strong feelings of warmth and comfort. Her oxtail soup is a hearty, thick stew, perfect for cold winter nights. Her sweet and sour tomato cabbage soup is perfectly balanced and is the perfect meal with a piece of crusty French bread. More than anything, her food nourished the soul, and, in turn, inspired me to learn more about the wonderful world of nutrition.

2) When cooking or baking, always use real, fresh ingredients.

Whether the trend was low-fat, low-carb or just plain low-calorie, when it came to cooking and baking, my mom rarely ever made ingredient substitutions in her recipes. Butter, cream, and sugar were regularly used in her kitchen to concoct delicious desserts. Likewise, if the recipe called for bone-in, skin-on chicken, then boneless, skinless chicken breasts wouldn’t cut it. Foods that are made with real, whole, unadulterated ingredients are not only so much better tasting than the diet-y, low calorie stuff, they are more satisfying and satiating. Think about this – on a hot summer’s day, when you are craving an ice cream cone, will fat-free frozen yogurt really satisfy you? In all likelihood, you will eat the frozen yogurt and then, still feeling deprived, munch on other stuff afterwards. Better off sticking with the real treat; it will take less of it to satisfy you, and you won’t feel deprived.

3) You can make your own food rules.

While most of the time we had traditional meals in our household, every once in a blue moon, we would do something out of the ordinary. One time, my mom and I had ice cream for dinner! Obviously, this is not something I would recommend anyone do on a regular basis, but once in a while won’t kill you. We would also occasionally do “breakfast for dinner,” which meant omelets, cereal or bagels for dinner. At the end of the day, you don’t need to follow the food pyramid guidelines (or MyPlate) to be a healthy eater. Mixing it up can be fun and can get you out of a food rut, too.

4) Food tastes so much better when you let yourself enjoy it.

It is not unusual to hear my mom voice her love of food. Dinnertime was (and is) often filled with “mmmm’s” and “yummm’s” and other sounds of pleasure. While this habit of my mom’s has embarrassed me on occasion (mostly during my teenage years), more often than not, I find myself doing the very same thing! It is okay to enjoy your food! Let me rephrase that: The enjoyment of one’s food is a wonderful part of life. Not only is delighting in one’s food a wonderful part of life, there are studies that show that nutrients are absorbed better when the eater is enjoying his or her meal. So go ahead, savor, enjoy and delight in your food – it’s human nature!

5) There are few things more satisfying than planting, harvesting and eating veggies from your own garden.

I have many fond memories of my mom tending to her vegetable and herb gardens. She would grow everything, from tomatoes and zucchini to snap peas and basil. There is a certain joy in watching these plants grow from seedlings to ready for picking. And there is nothing better than crunching into a snap pea straight off the vine. Oftentimes, zucchini in my mom’s garden would be so numerous that it would be difficult to figure out what to do with all of it! Aside from a tasty side veggie, my mom incorporated this bounty into zucchini bisque and zucchini bread, which to this day are some of my favorites. Unfortunately, the next-door neighbor’s trees have grown so tall that my mom’s garden can’t grow anymore. But she still has her herbs, and they show up in many of her recipes.

I owe a lot to my mom in regard to my appreciation and interest in food. She taught me to be adventurous and try new things. She showed me how nourishing a well-prepared meal can be. And most of all, she taught me that food is so much more than just food.

He Said, She Said: Meal Plans

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Creating meal plans based on calorie needs has been a staple of nutrition counseling for years. Is it time to say good-bye?

He Said

“The first session is about food. Every session after that is about why they [the patient] are not doing what I told them to do.”

That is how a seasoned colleague explained her work as a nutrition counselor to me when I was just starting out as a dietitian. With all due respect, the quote illustrates nutrition counseling gone awry, the result of an outdated, archaic, and ineffective approach that puts too much emphasis on information and too little on individuality and motivation.

A popular tool in dysfunctional nutrition counseling is the meal plan. While meal plans can take on different forms, the kind that I am referring to is based on an estimation of the patient’s calorie needs; those calories are then broken down into numbers of servings that said patient should consume from various food groups over the course of the day.

In theory, meal plans sound like a useful tool. From a dietitian’s standpoint, meal plans are easy to create, they give patients flexibility, and they put the responsibility for execution entirely on the patient’s shoulders. From a patient’s perspective, meal plans give a welcome sense of certainty and control, thereby temporarily relieving feelings of confusion and powerlessness. Just follow the meal plan and everything will be okay, right?

Unfortunately, the problems with these meal plans are extensive:

  • Estimates of the patient’s nutritional needs are not tremendously accurate. The most accurate means of measuring one’s resting metabolic rate is through direct calorimetry, which involves spending time in a chamber that measures the heat he or she generates. To my knowledge, direct calorimetry never happens outside of a research setting.  Even direct calorimetry has its problems, and every other method available has larger sources of error. Practitioners like us use algorithms that estimate calorie needs based on height, weight, age, gender, and similar data. Attempts to quantify calories expended through physical activity introduce additional error. Calculations of one’s calorie needs are at best just rough ballpark estimates. Therefore, the whole foundation of the meal plan is shaky.
  • The reported calorie content of different foods can also be inaccurate. Whether due to faulty assumptions used in the calculations or labeling laws that allow for rounding off, what we believe to be the nutritional content of a given food is sometimes not quite true. Yet the numbers are taken too literally, and patients exhaust themselves with kitchen scales and measuring cups trying in vain to consume the exact number of prescribed calories, a goal that is virtually impossible to achieve.
  • The expectations put on meal plans are unrealistic. With genetics, environment, stress, and other variables heavily influencing health and weight outcomes, the notion that a meal plan can guarantee virtually any measure of success is nonsense and misleads patients.
  • Meal plans fuel the inaccurate “good food, bad food” dichotomy. Foods present on the plan are seen as “good,” while those that are absent are considered “bad.” One meal plan form that I used to use omitted some fruits for no other reason than space did not allow for a complete list, yet countless patients expressed criticism and fear of the fruits that did not appear on the plan.
  • Meal plans focus heavily on individual foods, but much of the foods we consume in real life are combined with other foods in unknown quantities. Even when we prepare foods at home, estimating, for example, the volume of beans in minestrone soup, or cheese on pizza, or oil used in a stir-fry with any degree of accuracy is a time-consuming and tedious challenge. When eating in a restaurant or buying prepared foods, forget it; there is virtually, or in many cases literally, no way to know. The meal plan paradigm of tracking portion sizes fails when portion sizes are uncertain.
  • Meal plans teach patients to follow external cues for their eating. This may work in the short term, but not in the long run. At best, relying on a meal plan delays the development of mindful-eating skills. If long-term change is to occur, it is virtually inevitable that one must learn to eat in response to internal cues.

Following in the footsteps of my more experienced colleagues, I put hundreds of patients on meal plans at the beginning of my career. Some of these patients saw short-term improvements in their health or weight, but I cannot recall even a single instance of a meal plan approach spawning long-term behavior change. When things inevitably fell apart, patients blamed themselves, but really the problem was the approach. For that reason, I recognized meal planning as the dated and ineffective technique that it is and almost entirely removed it from my counseling tool box.

The only exception is that I still use meal plans for some patients with eating disorders. Sometimes the stakes are so high that inadequate nutrition risks hospitalization or admission to an inpatient program, so in these cases I temporarily use meal plans in an effort to keep the patient safe. In the long run though, as the eating disorder is overcome, we leave the meal plan behind and work on mindful eating.

There are times I do devise lists of meal and snack ideas with my patients, but do not confuse these with the meal plans that I have discussed up to this point. Working together with my patients to devise individualized ideas for what they can eat in certain situations can be very helpful due to the customization and collaboration. The utility is quite different than just writing in some numbers on a meal plan sheet, handing it over to them, and then getting together next session to discuss why they are not following it.

 

She Said

To meal plan or not to meal plan, that is the question. A lot of people assume that since the majority of my patients are those with eating disorders, that I must use meal plans with all of my patients. This most definitely is not the case. When a patient first comes to see me, I spend the initial session (or two) learning about that patient: Why are they coming to see me? How have they been eating? At what point in their recovery are they? These are all questions that can help me decide whether a meal plan is indicated or not.

Meal plans, in my opinion, are training wheels for those struggling with feeding themselves adequately. Usually, if a patient has just left an inpatient or residential eating disorder treatment facility and is having a hard time eating all of her meals and snacks at home, I find that a meal plan can be very helpful to get her back on track. But, just like training wheels, the meal plan should not be permanent, and eventually the patient should be weaned off of it.

The ultimate goal that I want to help my patients achieve is the ability to engage in intuitive eating. In a nutshell, intuitive eating is eating when you are hungry, stopping eating when you are satiated, and eating what feels best to your body. This also means not eating according to external rules, but rather listening to your body and honoring its cues.

As I’ve mentioned before in other blogs, we are born with the innate ability to regulate our food intake. When a baby is hungry, she will cry until she is fed. When she is full, she will turn away from the offer of more food. Even toddlers still use internal cues to determine when and how much they want to eat. But, eventually, we begin to lose the ability to listen to our body’s cues when we start placing external regulations on our eating (e.g., eating according to a strict schedule, dieting, being a member of the clean plate club, etc.). This behavior causes us to lose touch with our body’s innate wisdom and can lead to disordered eating.

I rarely, if ever, use meal plans with my non-ED patients, although I’ve had many of them ask for one. I find that those patients who ask for meal plans are the ones that want to be told what, when and how much to eat and don’t trust themselves to feed themselves appropriately. They want to rely on external regulations around their eating, as they feel that if left to their own devices, they would devour an entire sheet cake in one sitting. In these instances, using a meal plan is not a good idea, as it just reaffirms in that patient’s mind that she is incapable of feeding herself solely by using her internal wisdom.

In sum, while I think meal plans can be a useful tool in ED recovery, they are not indicated in every instance. The ultimate goal is to relearn how to eat intuitively, and that means not relying on a meal plan, but instead listening to one’s gut.

He Said, She Said: Chocolate

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Does chocolate deserve to be seen as a guilty pleasure, and what sort of place can it have in a healthy lifestyle?

He Said

If chocolate and coffee were people, they would probably get along great. Together, they could commiserate over being unfairly portrayed as guilty pleasures when really they each have much to offer. Their reputations are not based on themselves, but rather on the company they keep.

Take chocolate for instance. A tablespoon of pure cocoa powder is low in calories (12) and virtually free of sugar (0.09 g), provides a bit of fiber (1.8 g) and even a little protein (1.06 g), and contains calcium, iron, magnesium, phosphorus, potassium, zinc, trace amounts of vitamins, and other antioxidants, too. Sure, it contains caffeine as well (12 mg), but not enough to be a concern for most people.

Despite pure chocolate’s health benefits, consuming it plain is a rough experience. In fact, some of my high school friends used to do it as a dare. To make pure chocolate more palatable and enjoyable, people typically add sugar and fat. These added ingredients, when consumed in excess, are what can be detrimental to our health, not the chocolate itself.

If you want to capitalize on chocolate’s health benefits while minimizing the sugar and fat, opt for dark chocolate, or make hot cocoa from scratch so you are in charge of the recipe. For those of you who are truly adventurous with your eating, add a spoonful of plain cocoa powder to your morning oatmeal.

Alternatively, if you are like me and no form of chocolate quite hits the spot like full-of-fat-and-sugar milk chocolate, leave the guilt part of “guilty pleasure” aside and just go for it. Balanced eating and a healthy relationship with food certainly have room for some candy.

She Said

Among my patients, there doesn’t seem to be a more polarizing food than chocolate. Many of my patients have a love/hate relationship with it. On the one hand, it’s the quintessential indulgence, one to be savored on special occasions and eaten with gusto. On the other hand, especially for those who are struggling with an eating disorder, chocolate can be a fear food, one that they feel  they cannot control themselves around, that once they start eating it, they won’t be able to stop, resulting in exponential weight gain.

While everyone can agree that chocolate does have some well-documented health benefits due to its antioxidants, a great number of my clients treat chocolate with kid gloves, oftentimes limiting it or completely omitting it from their intake. When I try to explain to these clients that chocolate, like every other food, can have a place in one’s diet, the common response is: So you’re trying to tell me that a Snickers bar and a plate of broccoli are nutritional equals?! Isn’t it better to be eating only foods that are nutritious and cut out all the other junk?!

My response to the above question is this: Food is not just fuel. Yes, our bodies use the food we eat for a number of physiological functions, but there is a lot more to the act of eating. Food is enjoyment, pleasure, connection, and memories. Sometimes food is fun, and sometimes it’s more functional. Would I suggest that someone eat only a diet of chocolate? Of course not. Similarly, I would not suggest that someone eat only a diet of the most nutrient-dense foods possible. Balance is key, and there is room for all different kinds of food in your life.

So, if you are really having a craving for chocolate, I say go ahead and have it! Just make sure to savor and enjoy every bite.

He Said, She Said: New Year’s Resolutions

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You already know that New Year’s resolutions do not typically last, but you have not yet heard our opinions as to why and what you can do about it.

He Said

A few weeks is not yet enough time for most New Year’s resolutions to have fallen apart, but if past statistics are any indication, by the end of the year only 8% of us will have been successful in achieving our resolutions.  The poor rate of conversion from resolution to reality is partly due to the goals themselves, as Joanne will discuss below, but being honest with ourselves about how ready we are for change is of utmost importance, too.

According to the Transtheoretical Model describing behavior change, individuals can fall into any one of five stages.  The preceding link gives detailed explanations of each stage, which I will concisely summarize below.

  • Precontemplation: The person does not see a problem and therefore has no intention of changing.
  • Contemplation: The person recognizes that a problem may exist but feels ambivalent about what to do.
  • Preparation: The person has decided to make changes and is formulating a plan.
  • Action: The person is implementing changes but has not yet maintained them for six months.
  • Maintenance: The person has maintained the given changes for six months or longer.  (Note: Some versions of the Transtheoretical Model also throw in an additional stage, Termination, but often this stage is considered part of the Maintenance stage.)

Classically, the idea is that a person moves from one stage to the next in the sequence in which I listed them, but in reality someone can jump from any one stage to another at any point in time.  The Model is not perfect, but it expresses an invaluable truth: Not everybody is ready to change.

This truth, by the way, is perfectly fine.  Change is a process, as the Model indicates.  When Joanne describes our counseling approach to people unfamiliar with how we work, she often tells them, “We meet our patients where they are.”  She does not mean that literally as if we make home visits; rather, she is referring to their stage of change.  Recognition of said stage is critical to successful counseling.

What do you think would happen if I counseled a patient on the changes he can make to his eating (thereby treating him as if he is in the Preparation stage) while he does not even see a problem with his diet and came to my office only because his doctor insisted he see a dietitian (which suggests he is in the Precontemplation stage)?  He would not feel heard, the session would be unproductive, in all likelihood he would not return for another session, and whatever health condition he is dealing with would remain a problem.

Conversely, if I listen to him without judgment as he shares his emotions and opinions, acknowledge the validity of his feelings and point of view, and discuss his doctor’s concerns with him, he may transition to the Contemplation stage and move closer to ultimately making and sustaining behavior changes that will improve his health.

Alternatively, perhaps after learning more about his condition and the potential consequences, he decides that he will maintain his current lifestyle anyway, at least for now.  It is his life, he can do what he wants with it, and I respect his choice without judgment.  At least he will have had an opportunity to weigh his options and make an informed decision.

Similarly, we each have to meet ourselves where we are at, too.  In other words, when we make New Year’s resolutions, we have to be honest with ourselves about how ready we are to make the given change happen.  The calendar’s flip from December to January does not automatically transition us to the Action stage.  In all likelihood, if we were truly in the Action stage, we would have implemented the change before New Year’s rather than wait for the holiday.  Willpower can only force change for so long.  Whatever was holding us back before New Year’s will remain and ultimately catch up to us after the holiday and bring an end to the resolution.

Instead of setting yourself up for failure by setting a goal that is unfit for your readiness to change, use the New Year as an opportunity to be honest with yourself about your health and how you feel about it.  In other words, meet yourself where you are instead of forcing yourself to take an action before you are truly ready for it.  Reach out for whatever information or support you need.  Consider the following examples:

  • A husband in the Precontemplation stage might give in to his wife’s urging to finally make an appointment with a dermatologist to have his strange-looking mole examined if for no other reason than to appease her.
  • Perhaps a diabetic in the Contemplation stage might decide to schedule an appointment with his doctor to discuss his ambivalence regarding monitoring his blood sugar at home.
  • An individual in the Preparation stage might meet with me to plan specific and achievable changes to his eating that will improve his cholesterol, then go home and discuss the upcoming changes with his family.
  • An osteoporosis patient in the Action stage might continue to use the package of personal training sessions she bought so she can continue learning how to lift weights safely and preserve her bone structure.

Most important, remember that New Year’s is just an arbitrary point, and one need not wait for a new calendar year to start the process of making change.  Said differently, we do not need an exterior cue to trigger internal change.  When we are truly ready, we will make the change happen no matter what date it is.  One of my favorite quotes is from Andre Agassi’s Hall of Fame induction: “ . . . every journey is epic, every journey is important, every journey begins today.”

 

She Said

Mid-January through the beginning of February is a tricky time for many of my patients.  Their motivation for keeping all of their nutrition resolutions is starting to dwindle, and many people feel like they have failed in one way or another.  What I often find is that many of my patients had set the bar too high in terms of nutrition goals.  They expect too much from themselves and have no other option than to not meet their goals.  Most of these goals are so overly ambitious that it would be very difficult for almost anyone to follow through with them.

So what’s a person to do?

When my patients ask me for help setting nutrition goals, I tell them to think S.M.A.R.T., as in goals that are Specific, Measurable, Attainable, Relevant, and Time-bound. No, I didn’t invent this clever mnemonic; it has been attributed to George T. Doran who wrote a paper called There’s a S.MA.R.T. way to write management’s goals and objectives in the November 1981 issue of Management Review.  But I really like the simplicity of this handy acronym.

Specific goals are those that are clear-cut and unambiguous.  Examples of specific goals could be “I will make a kale smoothie for breakfast…,” or “I will prepare a new salmon recipe…”  Measurable means that the goal must be quantifiable in some way so that you can clearly assess your progress.  This can be accomplished by adding to the above goals; for example, “I will make a kale smoothie for breakfast 2 times….” and “I will prepare a new salmon recipe one night….”

Attainable goals are those that are ones that realistic for you.  If, for instance, you know that making a kale smoothie for breakfast 5 mornings per week isn’t likely to happen (e.g., you often sleep late and don’t have time, you have difficulty going to the grocery store to get the ingredients, etc.), then shoot for something you absolutely know you can do.  In other words, it’s much better to start with smaller goals and then build on them than to start with goals that are too ambitious for you.

Relevant goals are ones that are worthwhile and applicable to you.  If upping your omega-3 intake isn’t that important to you, then don’t set a goal to eat more salmon.  By the same token, if you are already succeeding at one area of your nutrition (say, getting your leafy greens), then maybe it’s time to focus on something else, like increasing your nut intake.

Finally, it’s important that your goals are time-bound, that there is a particular time frame for achieving them.  You could add on to the examples given above: “I will make a kale smoothie for breakfast 2 times this week,” and “I will prepare a new salmon dish one night per week for two months.”  By giving yourself a deadline, you will be more likely to achieve your goal on or before that deadline.

If the above seems a bit much, the one piece of advice I give all of my patients is to keep it simple.  When goals are overly complicated and ambitious, it can be overwhelming.  And be kind to yourself – you are human, after all!

He Said, She Said: Weight Management

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Weight concerns are one of the main opportunities for improvement that bring people to our practice. Our approach may ring true for you or elicit skepticism.  Either way, we invite you to share your reactions and questions on our Facebook page.  Also feel free to contact us directly if you prefer to voice your questions in private.

He Said

“Weight Management.”  According to my business cards, that’s what I do.  Because weight is such a loaded term that quickly brings to mind so many thoughts, feelings, and expectations, coming up with concise language that accurately reflects my approach is a challenge that I am still trying to settle.

Indeed I do help with weight management, but not in the direct fashion that some people might expect.  We know from working with patients, collaborating with our colleagues, and reading the research that weight-centered approaches to losing weight almost always fail.  That’s the irony: The more we emphasize and focus on weight, the harder it tends to be to keep weight off.

This fact is hardly a secret.  In October, I wrote about a conference I attended where presenters showed that over 20 diets resulted in the same pattern of weight change: sharp initial weight loss followed by gradual and steady weight regain.  A few years back, I had a telephone interview with a commercial weight-loss program that was interested in hiring me.  A study they had posted on their own website showed that approximately 85% (I forget the exact number.) of their clients regained their lost weight after one year, so I asked the interviewer what strategies they had developed since that study to help prevent this rebound.  She said they realized that clients are unable to successfully transition off of the commercial meal replacements and must stay on them for life.  This is very similar to the diet drugs on the market, which also must be taken for life or else the weight will come back, as well as commercial weight-loss programs where leaders tell clients they should be prepared to be lifetime members if they want to keep the weight off.  Sounds like a great business strategy.  As you can imagine, I did not get the job, which was fine by me.  Philosophically, we were not a good fit.

It may come as a surprise to learn that the healthcare community is still uncertain to what degree weight in and of itself matters in terms of health.  The folks who officially declared obesity a disease state this past summer can cite research supporting their view.  The “Health at Every Size® supporters, who argue that health and body weight are independent, have supportive research as well.  Personally, I have been talking about the concept of “Health at Every Size” for a decade, long before it even had that label.  As a guy whose BMI labeled me as overweight despite a very low body fat percentage, excellent labs, and solid athletic capabilities, I could see firsthand that weight was not necessarily a good indicator of health.  Lest you think that the unimportance of body weight is a fringe theory or an excuse that overweight individuals use to stay that way, my energy metabolism professor, a lean and athletic guy himself, taught us the same concept back when I was studying nutrition at a large state university.

Clearly, there is still much that we need to understand about how important weight is when it comes to our health, but how much does this question even matter?  On one hand, determining the importance of weight is of course important from a public health standpoint.  In order to best help people be healthy, we need to understand the factors at play as well as their roles.

Speaking pragmatically, however, the importance of weight is largely irrelevant.  We know from epidemiological data that overweight and obesity have become more prevalent, not more scarce, over the years.  Closer to home, even if you have not tried to lose weight and keep it off through various permutations of food restriction and/or overexercise without long-term success, you at least know several people who have.  When Joanne and I listen to our new patients share their histories, tales of weight lost and regained are par for the course.  Society as a whole has been acting under the assumption for decades that weight matters, yet this assumption has not helped us to get any thinner.  In fact, quite the opposite is true.

If we remember that weight-centered approaches almost always fail, the only alternative is lifestyle change.  Even more radical approaches, such as bariatric surgery and lifetime medications, have to be coupled with lifestyle change in order to be effective.  There is just no getting away from it.  Whether weight matters or not, or whether somebody wants to undergo a radical approach or not, the bottom line is that lifestyle change is still necessary in order to improve health.

What constitutes healthy lifestyle change is based more upon one’s baseline than it is on some idealistic vision of what one should be doing in theory.  The efforts and constructs of lifestyle change are usually limited by other factors (e.g. time, finances, personal preferences, etc.) rather than by guidelines, so in a sense guidelines do not even matter all that much when it comes to helping people in real life.  The idea is just to start wherever you are and move towards better health one small step at a time. 

More specifically, instead of gravitating towards a particular mode of exercise because it burns the most calories per unit of time, find ways of being physically active that are fun and agree with your body.  You will be happier and more likely to make the activities long-term habits.  Instead of counting grams and calories, restricting your intake, and cutting out whatever food group is being scapegoated this week, learn to eat mindfully and listen to your body’s hunger/fullness cues.

As a result of these changes, weight loss does oftentimes occur, and when it does, it tends to stay off, but it may or may not be the magnitude that you, your friends, your parents, your partner, a BMI chart, society as a whole, etc. would like.  Therefore, part of establishing a healthy lifestyle means learning to love and accept yourself the way that you are and severing any link you may have between weight and self-worth.

It is really about putting forth your best effort to be healthy while still maintaining balance in your life.  This is what I help people to do; that is what I mean by “Weight Management.”

She Said

Well, we are closing in on the end of 2013. Inevitably, after the ball has dropped and the New Year’s celebration has ended, many people start to think about their New Year’s resolutions.  What’s at the top of the list for most people?  Weight loss.  Every January we become inundated with new patients looking to us for help with their weight goals. Most of them have tried every diet and eating program in the book (losing and regaining many pounds in the process), but they are certain that this time things will be different. This time I will find the perfect diet, most people think to themselves.  This time I will have more willpower, and I will lose the weight for good!

I truly understand why so many people want to lose weight.  Every day we are bombarded by messages about our weight. Whether it is from doctors, the media, family, friends or partners, the message seems to be that it is desirable to be thin and it is bad to be fat.  Those who try to lose weight through dieting are to be admired, while those who are fed up with diets are viewed as weak-willed and lazy.  Fat is not only disliked but also feared.  According to a 2006 study by the Rudd Center for Food Policy and Obesity at Yale University, nearly 50% of the 4,000 people surveyed said they would rather give up a year of their life than be fat.  The same study found that 15-30% of the respondents would rather become unable to conceive, be depressed or become alcoholic than be obese. 5% would rather lose a limb. 4% would rather be blind.

Given most people’s dislike and, in some cases, fear of fat, it makes sense that weight loss is on the forefront of many of our patients’ minds.  But as much as I understand our patients’ feelings, focusing all of our energy on losing weight and fighting obesity by dieting restrictively and exercising excessively hasn’t helped anyone reach and maintain their goals.  I mean, if these methods really worked, would we still have a billion dollar weight-loss industry?  Of course not.

It is time to take the focus off of weight and put it on health.  As I’ve blogged about many times before, health and weight are not synonymous.  Numerous studies have shown that when talking about health, it is lifestyle behaviors that make the difference, not just weight loss.  When patients come into my office with the sole goal of losing weight, I try to help them shift their view to one that is health-focused rather than weight-focused.  By implementing healthy lifestyle changes such as eating intuitively, being more physically active, and dealing with stress appropriately, one’s weight will often settle into a “healthy weight range.”  This weight range might not be what the media or the BMI chart says is desirable, but it is one that is sustainable and will result in the best health outcomes.

To a large extent, our individual genes determine where our weight will settle.  There really is not much we can do about that.  But what we can do is work on becoming the healthiest person we can be, regardless of what we weigh.  By honoring our body’s hunger and fullness cues, being active in a way that is enjoyable to our body, and accepting and appreciating our body where it is now (not 20 pounds less than now), we will truly reach our health goals.  Now that’s a resolution worth keeping.

 

He Said, She Said: The Paleo Diet

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Even if you have not tried to “go Paleo” yourself, you at least know someone who has.  Running neck and neck with gluten-free, the Paleo Diet seems to be one of the most popular diets these days.

The idea is to eat how some of our ancestors supposedly ate: inclusion of meat and seafood, fruits, vegetables, eggs, nuts, seeds, and some oils, and exclusion of grains, legumes, dairy, potatoes, refined sugar, salt, certain oils deemed unhealthy, and anything processed.

Should you go Paleo?  Here is what we think.

He Said

Last month while I was at a wedding, I asked a child psychiatrist seated next to me if any experiences from her own childhood inspired her choice of profession.  She smiled, leaned in, and asked me, “Oh, Jonah, do you have a week?”  Both the scope and depth of the topic were much too large to cover in the few minutes before the bride was due to walk down the aisle.  Similarly, how can I possibly do justice to all of my concerns with the Paleo Diet in this small space?  I can’t, so here are just a few of them.

  • No Legumes: Legumes are a staple of the Mediterranean diet, which has been shown in research to reduce the risk of strokes, heart attacks, and cardiovascular disease deaths.  One such study published this summer in the New England Journal of Medicine found the Mediterranean diet’s benefits to be so significant that the study was stopped early because it would have been unethical to delay publishing the findings.  Legumes are a great source of cost-effective and environmentally-friendly lean protein.  Their fiber keeps us satiated, regulates our bowel function, stabilizes our blood sugar, and lowers our cholesterol.
  • No Dairy: One can live perfectly fine without dairy, and many people around the world do just that.  We can get dairy’s nutrients, including calcium and vitamin D, from other sources.  However, anytime we cut out a food group, we have to pay that much more attention to making up for the nutrients it provides, or else we face the possibility of deficiencies.  Such deficiencies are real and do happen, even in our community.  A doctor recently referred an otherwise healthy young athlete to me because it took the woman nearly a year to heal from a simple fracture.  Her body was so deficient in nutrients after going gluten-free and dairy-free that her body was unable to heal itself until the deficiency was corrected.  When we include a wide variety of food groups, such deficiencies are less likely to occur, and we do not need to pay such close attention to the minutiae of our day-to-day eating.
  • Saturated Fat: The Paleo Diet is not necessarily high in saturated fat, as one could choose fat sources that are higher in polyunsaturated and monounsaturated fats, such as fish, nuts, seeds, and certain oils.  However, the potential for excess saturated fat exists if one overconsumes red meat or coconut oil.  One point that really bothers me though is the Paleo Diet’s notion that saturated fat is not actually detrimental to our health.  As I explained in one of my blog entries, it could come to pass that saturated fat is found not to be the concern that we currently think it is, but as of now, the overall body of research does not support that conclusion.  Experts around the world (literally) agree that we should keep our saturated fat intake low in order to protect our cardiovascular health.  To expose our bodies to high levels of saturated fat while banking on the hope that doing so is not detrimental to our health is to take a heck of a risk with our cardiovascular health.
  • Environmental Impact: Even if we were best off consuming animals as our only significant protein source, the planet cannot sustain it.  The United Nations tells us that we as a global society need to move towards a more plant-based dietary pattern for environmental reasons.  Recently, one of my colleagues attended a lecture given by a pro-Paleo author, and she asked him about the environmental impact of the diet.  “Not my problem,” was reportedly his answer.  But it is his problem.  It is all of our problem.  If the earth cannot handle its inhabitants eating a certain way, we have to adjust our ways.
  • Sustainability: As with any diet, the results are only as good as the changes are sustainable.  There are thousands of life events that can bring a diet to its end: the diet worked great, but then the holidays came around, or I started a new job, or someone brought leftover Halloween candy into the office, or I got sick, or I went on vacation, or I didn’t have the willpower to keep it up, and so on.  For reasons I can only hypothesize, when a diet is working, people praise the diet, but when the diet stops working, people blame themselves or some exterior event.  For a nutritional approach to be successful, it has to work for the long term, not just at first, and it has to be flexible enough to weather the challenges that life brings our way.  Ask yourself honestly whether the Paleo Diet meets these criteria.
  • Accuracy: According to archaeologists, the Paleo Diet does not even accurately reflect how our ancestors ate.  Not only did the diets of paleolithic man vary greatly depending on geography and season, but archaeologists also have evidence that their diets did include legumes and grains, two food groups excluded from the Paleo Diet.  Furthermore, virtually all (if not literally all) of our food supply has changed with agriculture, so our blueberries, carrots, lettuce, tomatoes, and bananas, for examples, barely resemble those that our ancestors ate.

Realize that people are much more likely to be vocal about their dietary successes than their disappointments.  For example, if a given diet works for 5% (which is actually a pretty typical success rate for most diets) of the 10,000 people who try it, 9,500 disappointed people will stay relatively silent about their experiences while 500 individuals rave about it online, at the gym, in the grocery store, at the office, over Thanksgiving dinner, etc.   Therefore, the impression we get of a given diet’s success is skewed and not reflective of reality.  If you have gone Paleo yourself and you feel great, it works in your life, and you are enjoying it, great, more power to you.  For most people though, the Paleo Diet is much too strict to integrate with their lifestyles in any sort of sustainable way. 

She Said

While the Paleo Diet might seem to be a relatively new eating style to many people, it has actually been around in one form or another for almost 40 years.  In 1975, a gastroenterologist named Walter L. Voegtlin published The Stone Age Diet: Based on In-Depth Studies of Human Ecology and the Diet of Man, in which he suggested that following a diet similar to that of our caveman ancestors from the Paleolithic Era would improve one’s health.  The diet, which consists of a higher protein, fiber, and fat intake and a lower carbohydrate intake, is said to minimize one’s risk of chronic disease as well as result in weight loss.

The diet recommends a high intake of fruits and vegetables, which in addition to supplying a plethora of vitamins and minerals, also provides fiber (which helps with GI function and blood sugar levels) and antioxidants (which help fight the trouble-causing free radicals that try to wreak havoc on our cells).  Fruits and veggies are also an excellent source of potassium, which helps regulate blood pressure.

There is some evidence that a Paleolithic diet can be beneficial for those with type 2 diabetes at risk for cardiovascular disease.  A 2009 study compared the Paleo Diet and the diabetes diet to see which was more successful at managing patients’ blood sugar, weight, cholesterol levels and other health factors.  Overall, the patients that followed the Paleo Diet for 3 months had better blood sugar management levels, increased levels of “good” HDL cholesterol, lower blood pressure measurements, and greater weight loss than those who followed the diabetes diet.  After looking at the patients’ food recalls, the investigators found that the patients who followed the Paleo Diet had a higher intake of fruits, vegetables, meat and eggs compared to the patients who followed the diabetes diet.  In addition, the Paleo group took in fewer total calories, carbohydrates, and saturated fat while having a higher intake of unsaturated fat and several vitamins than the diabetes diet group.  All of these results point to the Paleo Diet being a viable option for those looking to better control their type 2 diabetes and manage cardiovascular risk factors.

I am a fan of decreasing one’s intake of processed foods in general.  These foods are often made with large amounts of sugar and sodium, and some even contain trans fats to improve the food’s taste and/or make it more shelf-stable.  According to the Academy of Nutrition and Dietetics, about three-quarters of our sodium intake comes from processed foods.  High sodium intake is linked with high blood pressure, which is associated with a higher risk for stroke and heart attack.  Aside from increasing our calorie intake and possibly leading to weight gain, high sugar intake has been linked with the development of type 2 diabetes.  Trans fats, or manmade fats, raise our “bad” or LDL cholesterol while lowering our “good” or HDL cholesterol.

In general, I am not a fan of “diets,” that is, any eating plans that lay out a set of diet rules that one should follow in order to reach his or her health goals.  But, the Paleo Diet has some interesting principles and could be advantageous for certain individuals.

He Said, She Said: Vegetarian vs. Omnivore

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Due in part to the rise and fall of the Atkins diet as well as the current popularity of the paleo diet fad, we frequently receive questions about which is healthier, eating meat or being a vegetarian.

He Said

Eating healthy and eating animals are not mutually-exclusive behaviors.  However, a vegetarian lifestyle offers several advantages compared to living life as an omnivore.

  1. Vegetarian protein sources tend to be lower in saturated fat, the type of fat that experts across the world agree raises the risk of cardiovascular disease.  For example, a three-ounce grilled steak contains approximately five grams of saturated fat while an equivalent serving of tofu has less than half that amount.
  2. Vegetarian sources are much higher in fiber.  One cup of black beans contains 15 grams of fiber, whereas one cup of chicken breast contains none.  Among fiber’s benefits are bowel regularity, cholesterol management, and reduced cardiovascular disease risk.
  3. Vegetarian options are typically cheaper in comparison to meats.  For example, most meat-based burritos with guacamole at Chipotle cost $8.45, while a vegetarian burrito with guacamole is only $6.25.
  4. A vegetarian lifestyle reduces the environmental impact that comes with raising animals for their meat.  According to a 2011 report from the United Nations Environment Programme, “Impacts from agriculture are expected to increase substantially due to population growth increasing consumption of animal products.  Unlike fossil fuels, it is difficult to look for alternatives; people have to eat.  A substantial reduction of impacts would only be possible with a substantial worldwide diet change, away from animal products.”
  5. A vegetarian diet spares the lives of countless animals that would otherwise be slaughtered for their meat.  According to statistics that the USDA released in September, 2,820,000 cattle, 64,500 calves, 9,560,000 pigs, and 208,100 lambs were slaughtered in the month of August alone.

Nothing says one has to declare himself or herself a vegetarian in order to reap these benefits.  Consider incorporating more meatless meals and snacks into your routine in order to improve your health, the environment, and the welfare of animals.

She Said

While vegetarianism definitely can be a very healthy lifestyle, life without meat can come with consequences.

  1. Meat, fish, and poultry are packed with a number of nutrients that are important for the body.  All of them are excellent sources of protein, which is essential for numerous body functions, including building tissues and fortifying the immune system.  While one can get proteins from plant sources, they tend to be less concentrated; that is, you would need a lot more of the plant to get the same amount as found in meat.
  2. Meat also is an important source of iron, which is essential for the formation of red blood cells.  And again, while one can get iron from non-meat sources, it is not as readily absorbed by the body as iron from meat sources.
  3. Finally, vitamin B12, found only in meat, fish and poultry, is essential for a myriad of functions, including cell differentiation and fetal spinal cord formation during pregnancy.  Vegetarians need to be extra careful about getting enough B12, as it can result in a type of anemia.  Most doctors would suggest that those who do not eat any meat, fish or poultry should receive monthly B12 shots administered by a health practitioner.

Bottom line: If you lead a vegetarian lifestyle, you will need to be especially careful about getting enough protein, iron, and B12 in order to be healthy.