I know that many people might not believe it, but sometimes I need to “sneak” vegetables into my diet.  Being a registered dietitian, I am sure this seems odd!  Sometimes I do find myself craving a big, crispy salad or string beans, but there are also many other times when I am not feeling like vegetables, no matter how healthy I know they are. We all know that veggies have so many wonderful vitamins and minerals and are important for overall health. So, what’s a dietitian to do when veggies do not seem so appealing?

Well, in times like these, I try to squeeze veggies into my meals and snacks as much as I can.  At breakfast, I will add spinach or broccoli to my omelet and have it with salsa.  For a post-workout snack, I have been making a green smoothie using baby spinach or kale, almond milk, yogurt, and banana.  It’s amazing how you cannot taste the spinach at all in the smoothie – it tastes just like a banana shake!  With dinner, I try to mix cooked veggies into at least one part of the meal.  If I am having mac and cheese, for example, I will mix in some frozen peas or broccoli florets.  If pizza is for dinner, I will add peppers and onions for toppings.  And of course, veggie-based soups, like zucchini bisque, are an easy way to increase one’s veggie quotient.

Many of my clients struggle with their vegetable intake, and I completely understand this.  However, it is easier to sneak these nutrient-packed superstars than you may think.  Get creative! 

The other night, I was watching the show 20/20 on ABC, and I was horrified to see a story they were doing on the “Tongue Patch Diet.”  The procedure entails having a piece of hard plastic mesh temporarily sewn onto one’s tongue, the purpose of which is to inflict pain if the individual tries to eat any solid food.  Apparently, this technique originated in Latin America and is all the rage, with 800 individuals undergoing the procedure at one Venezuelan clinic.  After the patch is put in place, the individual is then put on a strict, 800-calorie-per-day liquid diet or shakes and low-calorie beverages for one month.  In addition, the individual must exercise 45 minutes per day.  After all is said and done, the individual would be expected to lose between 18-20 pounds.

This bizarre intervention made me think back to the absolutely crazy “K-E Diet” aka “Feeding Tube Diet” featured on a number of news shows last year, which involves having a doctor place a nasogastric feeding tube into an individual for 10 days, preventing the person from being able to orally eat anything for that period of time.  The patient carries around a solution in a bag or purse, which delivers 800 calories per day of protein, fats, and water through the nasogastric tube directly into the stomach.  Given that the patient is not taking in any carbohydrates, he or she will be put into a state of ketosis, during which the body burns fat instead of carbohydrate.  In similar fashion to the “Tongue Patch Diet,” the individual can expect to lose up to 20 lbs in only 10 days.

There are many things that disturb me about the above procedures. Both are unrealistic and potentially life-threatening techniques to achieve weight loss.  Obviously, since both are basically very low-calorie diets, the individuals will lose weight quickly.  And as I have spoken about numerous times, using drastic measures to lose weight quickly almost always results in gaining the weight back and then some.  As for the “Feeding Tube Diet,” while being in ketosis might not be harmful in the very short-term, long-term ketosis can result in serious kidney and liver damage.  And since our brain almost exclusively uses glucose (the breakdown of carbohydrate) for energy, going low-carb leads to “brain fog,” where the individual feels groggy, fatigued, unable to concentrate, and irritable.

The “Tongue Patch Diet,” honestly makes me feel queasy. The thought of putting something into one’s body to inflict pain on oneself for eating solid food just seems barbaric.  Why don’t you just hire someone to hit you over the head with a hammer every time you pick up a French fry?!

What I think disturbs me the most about the above is that there are doctors out there who believe these procedures are totally legit and health promoting.  This sends a really hurtful and potentially dangerous message to millions of people who are desperate to lose weight.  If a patient came into my office and mentioned wanting to try out one of these procedures, I would recommend considering the following: Does this seem extreme?  Does he or she feel like this is something that will promote or hinder his or her health?  When the tongue patch/feeding tube comes out, how is he or she going to eat healthfully?  Hopefully after thinking things through, he or she will reconsider these dangerous methods and instead work on healthy, safe, and maintainable nutrition changes.

Having worked with hundreds of eating disorder (ED) patients and their families, the question I am most often asked by the patients’ parents is “How did I miss the signs?” EDs by nature are a very secretive disease, and those who suffer with them are pros at hiding them.  Despite this, there are some red flags that might signal that your daughter/son/sister/brother/friend could be struggling with an ED.

1. She is obsessed with watching the Food Network and/or cooking shows, finding recipes online, and with baking and/or cooking for others, but rarely partakes in her own creations.

This is a subtle, but clear sign that something is up.  People with EDs are preoccupied with thoughts about food – where to get it, how to prepare it, and what they can/cannot eat.  Therefore, it is natural that they would turn to TV shows about food, cooking magazines/books, and finding online recipes to fuel this obsession.  Of course there is nothing wrong with doing these things per se, but the key is that a person with an ED rarely, if ever, will eat any of the foods she creates.  Instead, she will bake an elaborate cake and offer it to her family and friends to eat while she has none.  In this way, the individual can vicariously enjoy the food without having to eat any of it.

2. He used to eat dinner with the family every night, but now he always says he ate dinner out or at a friend’s house.

Parents want to be able to trust their son or daughter.  If your child tells you that he already ate, you, like most parents, would believe him. But if your child has always eaten dinner with the family and this new behavior becomes a daily occurrence, then something could be up.

3. She used to love going out to eat and to the movies with her friends.  Now it seems like she finds any excuse to avoid these activities.

As mentioned above, one of the cornerstones of EDs is secrecy.  Most teens with EDs are not open about their disorders with their friends, so it would become pretty clear to her friends that something was wrong if she went out to eat with them and did not order any food.  For most individuals with EDs, simply avoiding these situations is the easiest way to keep their ED under wraps.

4. He used to love a wide variety of food, but lately he seems to only eat a few different foods.

There are plenty of kids who are picky eaters.  The red flag arises in the case of a child that formerly was an omnivore who has now started to cut out certain foods/food groups in an obsessive manner.  Usually this elimination happens in the context of a diet (e.g. “I want to lose some weight to be better at running track,”), so he might begin by limiting carbohydrates and fats, but soon the list of unacceptable foods starts to grow.  This could translate to no longer eating fruit because it has “too many carbs,” eating salad without dressing as it has “too much fat,” etc.  If your child will only eat certain “safe” foods and balks at the idea of increasing food variety, you might have a problem on your hands.

5. She all of a sudden wants to be a vegan, but is unclear about why.

Veganism (the omission of any and all animal products from the diet) is not inherently indicative of an ED.  The question to ask would be why the individual wants to become a vegan.  Is it because, for example, she feels that eating animals and their products is cruel or bad for the environment?  Or could it be another way for her to eliminate foods from a previously varied diet?  By declaring oneself vegan, that means that meat, fish, poultry, eggs, dairy, and a slew of other food groups will be off the table.  In a way, veganism can be used by ED individuals as way to legitimize their restriction.  Of course, this is not always the case, and there are plenty of vegans who are not disordered, but figuring out the motive behind this decision is paramount.

Now, am I saying that if your child exhibits one of these red flags that he/she definitely has an ED?  Of course not.  But I think it is important for parents, siblings, and friends to be aware of these subtle signs and to take action if necessary by talking to a professional such as a doctor, therapist, or dietitian who specializes in EDs.  Forewarned is forearmed.

Is it just me, or does it feel like almost every celebrity out there has been talking about their latest and greatest cleanse?  You know, the one that helped them to lose 20 pounds in only two weeks, gave them abundant amounts of energy, and helped their bodies remove all of those pesky toxins. 

There are numerous cleanses and detox diets out there, but perhaps the most famous one is the Master Cleanse.  Championed by celebrities like Beyonce and Pink, the Master Cleanse is basically a modified juice fast which promises to detoxify the body while also helping you lose weight fast.  For 4-14 days, the individual must abstain from solid food and is only allowed to ingest a drink made with lemon, maple syrup, cayenne pepper, and water.  After the cleanse is over, the individual is instructed to slowly add solid food back into their diet, starting with things like vegetable soup, followed by fruits and vegetables and so on.

As you can probably guess by now, I am not a fan of the Master Cleanse or any cleanse or detox diet, for that matter.  First of all, yes, you will lose weight on a cleanse, but that is mainly just because you are creating a serious calorie deficit.  Most of that weight will likely be water and muscle tissue, not fat tissue, and your metabolism will slow down to a crawl.  Once you stop the cleanse and return to your old eating habits, you will gain the lost weight back and then some! 

Secondly, you will feel completely cruddy while on the cleanse; most people report nausea, headaches, sluggishness, fatigue, dizziness, and numerous gastrointestinal issues (usually diarrhea and/or constipation).  Thirdly, the lemon-maple syrup-cayenne concoction is almost completely devoid of any nutrition, save for the carbohydrates from the maple syrup and the vitamin C from the lemon.  Your body not only needs protein, fat, and carbohydrate to function, but also the myriad vitamins and minerals that a healthy diet provides.

Finally, your body does a perfectly good job of detoxification without the aid of a cleanse.  Your liver, spleen, lungs, and kidneys are already pros at keeping you healthy!

So, skip the cleanse. Your body will thank you.

For as long as I can remember, the “experts” have been telling us to cut down on our sugar and fat intake in order to be healthy.  On the government’s “MyPlate,” the latest version of the healthy food pyramid, there are plate sections for fruits, vegetables, grains, protein, and dairy, but nowhere is there any plate section for sugar or fat.  In fact, if you go to the MyPlate website, the only place you can find sugar is under the “Empty Calories” heading.  And while fats (or oils) are listed under the “Food Groups Overview,” they do not make an appearance on, or anywhere near, the plate.

So, is anyone truly able to cut out both sugar and fat?  Well, it seems like it’s a lot harder than it sounds.  A recently-published review in the journal Critical Reviews in Food Science and Nutrition looked at 53 scientific papers and found that people who follow a diet low in sugar also had a significantly higher percentage of calories coming from fat, and low-fat dieters had a significantly higher percentage of calories coming from sugar.  This phenomenon, which many nutritionists have dubbed the “sugar-fat seesaw,” seems to occur because most sources of sugars, such as fruit, grains, and juices, are low in fat, while most sources of fat, like butter, oils and meat, are low in sugar.

So, what is the average health-conscious person supposed to do about this?  Well, instead of trying to cut out one major nutrient, how about trying a more moderate approach?  How about focusing on eating a healthy, balanced diet that includes all of the nutrients and not branding specific nutrients as either virtuous or evil?  Sugar and fat have a place in our healthy, balanced diets, and they should definitely be represented somewhere on MyPlate.

Lately, a lot of my patients have been coming in with questions about seeds: What kind should they eat?  How much?  What are the benefits?  I thought it might be a good idea to come up with a little seed cheat sheet (say that 10 times fast!) to break it down and help my patients figure out what seeds (if any) would be best for them.

Flaxseeds

One of the most popular seeds around these days, flaxseeds are famous for being nutrient powerhouses. They are rich in B vitamins, magnesium, omega-3 fatty acids, fiber, and antioxidants. B vitamins and magnesium are essential for cell metabolism. Omega-3 fatty acids play an important role in reducing inflammation in the body. Flax has both soluble and insoluble fiber, which have been shown to help lower total cholesterol, stabilize blood sugar, and promote intestinal function. Antioxidants help to protect our cells from damaging free radicals that can occur from exposure to certain chemicals, radiation, pollution, and smoking.  

2 tablespoons of ground flaxseed contains 4 grams of fiber, 2.4 grams of the omega-3 fatty acid alpha-linolenic acid (ALA), and 300 milligrams of lignans (an antioxidant).  It’s important to grind flaxseeds into flaxseed meal before eating them to ensure that you will get all of these nutrients. Flaxseed can be added to almost anything to get its benefits – cereal, oatmeal, smoothies, or even into baked goods.

Hemp Seeds

Hemp seeds are very versatile.  They can be eaten raw, sprouted, ground into a meal, made into milk, steeped like a tea, or used in baking.  Like flaxseeds, hemp seeds are a good source of ALA and fiber. They are also one of the few plant sources that are considered a “complete” protein, meaning that it contains all 21 known amino acids (building blocks of protein), including the 9 “essential” ones that cannot be produced by the human body, making it a helpful addition for those who follow a vegetarian or vegan diet.

2 tablespoons of hemp seeds contains 882 milligrams of ALA, 2 grams of fiber, and 5 grams of protein. Hemp seeds can be eaten whole or shelled. Add them to your salad for some extra crunch!

Chia Seeds

While they might be the new seed on the block to many North Americans, chia seeds are native to South America and have been a staple of the Mayan and Aztec diets for centuries.  Like flaxseeds and hemp, chia is a good source of antioxidants.  Due to their high antioxidant content, they have a long shelf life, and they can last nearly 2 years without refrigeration. Chia is an excellent source of fiber, with 10 grams in just 2 tablespoons. It also boasts an impressive amount of calcium (18% of the Daily Recommended Intake), phosphorous, magnesium, and manganese, nutrients that are important for cell metabolism, preventing hypertension, and maintaining a healthy weight. Unlike flaxseeds, chia seeds can be digested whole and do not need to be ground to get their nutrition benefits. Interestingly, chia seeds can be used as an egg replacement: the outer layer of the seeds swells when mixed with liquid, causing it to form a gel. This gel can be used in place of eggs (for those who are vegan) in baked goods. To make the egg replacement, mix 1 tablespoon of chia seeds with 3 tablespoons of water and let sit for 15 minutes.

Earlier this week, Governor Chris Christie, who has been lambasted for his weight for years, announced that he underwent “secret” gastric band surgery in February.  In an interview with NBC Rock Center’s Brian Williams, Christie said that after turning 50 last fall, he began to reflect on his life and realized that he wanted to get his weight “under control” so that he could be healthier for his wife and children.  His weight-loss doctor likened Christie’s obesity to having cancer, asking Christie, “If you came in here with cancer and I told you that I had a 40-minute surgery that’d give you a 90 percent chance of cure, would you sign up?”  Of course, Christie answered in the affirmative.

Lap-band surgery, in which an inflatable silicone device is placed around the top portion of the stomach to slow the consumption of food, is not the “cure” that Christie’s doctor says it is.  For nearly half of the patients who have the surgery, the devices need to be removed due to erosion or other malfunctions.  While most patients lose between 48 and 99 pounds in the first year after having the procedure, a number of studies have shown that the procedure is not successful over the long-term, resulting in sub-optimal weight loss and increase in failure rates.  One of those studies saw a 36.9% failure rate (defined as an excess weight loss of <25% or major reoperation) after seven years.

Now, I am not saying that weight-loss surgery is necessarily the wrong choice for Christie – everyone has the right to make his or her own health decisions – but I am concerned about his doctor’s message that weight-loss surgery is the cure for obesity.  While such surgery might be helpful in the short-term, it often leads to weight regain and numerous complications.  I am hopeful that those who take particular interest in Christie, and perhaps want to emulate him, will do their own research and make informed decisions. 

Body Mass Index (BMI), or the relationship of one’s height and weight, is most often used by the medical community to determine someone’s health risk.  BMI is really meant to assess the health of populations, not individuals.  If a researcher wanted to assess the health of adults in Massachusetts, for example, BMI could work quite well.  The problem is that it is inappropriately applied to individuals, partly because it is easy to do so as opposed to monitoring other markers that require more expensive testing and/or equipment.

There are a number of examples that call the BMI’s accuracy and usefulness into question.  For instance, Tom Brady’s BMI of 27.4 and Paul Pierce’s BMI of 26.5 put them squarely in the “overweight” BMI category, which is associated with increased risk for heart disease, diabetes, and a number of other health problems. Obviously, both of these athletes have a great deal of muscle mass and are in top physical shape. Would you call them “overweight?”  Of course not!

On the flip side, there are numerous people who fall into the “normal weight” BMI category that can’t even climb a flight of stairs without getting winded and have high cholesterol or high blood pressure.  In other words, lack of muscle mass can contribute to somebody being labeled as “normal weight” even though they are actually pretty unhealthy.  Some individuals with eating disorders also have “normal” BMIs, as do some formerly overweight patients who have lost weight due to diseases such as cancer or AIDS.  So clearly being healthy is about more than just one’s BMI.

Instead of just focusing on one number, there are so many other factors we need to take into consideration. Measuring blood pressure, cholesterol levels, and waist-to-hip ratio are just a few ways to get a better picture of someone’s health status. Other things to look at could be an individual’s physical fitness, mental and emotional health, as well as feelings of well-being. I think it’s important for all of us to remember that one number cannot tell us everything about a person’s health and that there are many ways to define what health is.