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.

Anybody who has read our What Makes Us Different section knows that I am not crazy about oversimplifications.  Yet, I can understand why they happen.  Some topics are just too complex to be explained in a factoid, meme, or sound bite, so information is rounded off and oversimplified in order to shove it into said formats.  This is most certainly the case when it comes to answering the question, “Which cooking method is best for retaining nutrients in vegetables?”

For example, I look on one site and see an illustration endorsing steaming while vilifying microwaving, while another suggests microwaving.  Who is right?  They are both oversimplifying, which is what leads to the apparent contradiction and confusion.  The true answer depends on the exact question being asked, including such factors as the particular vegetable, cooking conditions, and specific nutrient(s) of interest.

To give yourself a sense of the complexity, take a look at this 2009 article in the Journal of Food Science.  Scroll down to pages four and five where you see the tables showing the changes in antioxidant activity in the various vegetables after being cooked in different ways.  Don’t worry about the numbers or what the acronyms and terminologies mean.  Let me just call your attention to a few themes.

1. Cooking a given vegetable in a particular fashion can help in one way and hurt in another.  Multiple tables, not just one, show antioxidant activity because individual nutrients react differently as they are cooked.  For example, according to the tables, microwaving celery reduces its LOO radical scavenging capacity (again, don’t worry about the acronyms and terminology – that’s not the point) while the same exact cooking method actually boosts its OH radical scavenging capacity.
2. Anybody who preaches the virtues of always eating raw is overgeneralizing; in some cases, cooking can help you get more nutrition out of your foods.  Look at Table 4 and notice all the dashes and negative numbers.  Those dashes indicate no losses after cooking compared to when the vegetable was raw, and negative numbers indicate that the antioxidant activity was increased, not reduced, by cooking.
3. No single cooking method is going to be best for all vegetables.  Pick almost any column in Table 2, 3, or 4, and you will see it is comprised of positive numbers, negative numbers, and dashes.  Check out the griddling column in Table 2, for example, and you will see eight positive numbers, six negative numbers, and six dashes.  This indicates that griddling reduced LOO radical scavenging capacity in eight of the vegetables, boosted it in six other vegetables, and left it unchanged in the remaining six.
4. No single study is going to tell us everything we want to know.  Science is much more complex than that.  Consider that this is just one of many studies that investigated the effects of cooking methods on vegetable nutrients.  It examined this particular group of vegetables for changes in three nutrients according to the specific cooking conditions explained in Table 1.  Do you think it might make a difference if they baked the vegetables at 150^oC or 250^oC rather than 200^oC?  What if they cooked the vegetables for half the time, or twice the time?  What if they fried them with sunflower oil instead of olive oil?  What if they used a different variety of onion?  What if they had chosen to examine other nutrients, such as vitamin C or calcium?

Wow, this is getting confusing, isn’t it?  If you are even still reading this, you are probably one of the few (Hi, Mom!) who kept going after the first paragraph or two.  You can see then how tempting it is to oversimplify.  I almost want to do it myself right now, but instead I will leave you with a question.

How do you like your vegetables?

I am reminded of a conversation I had with a patient a few months ago after he switched to me from another dietitian.  His previous dietitian told him which vegetables he should eat raw, which ones he should cook, how he should cook them, etc.  I know she meant well, and I am sure some patients are looking for those kinds of orders.  As this man said to me though, “She should just be happy I am eating any vegetables at all!”  We need to remember that you are neither a lab animal nor a case study in some nutrition school homework assignment.  You are a free-living person with feelings and other factors that influence your decisions.  It isn’t all about numbers.  We need to remember the context.

Personally, I don’t care that microwaving my celery would boost its OH radical scavenging capacity by approximately 39.3%; the idea of softening a vegetable that I enjoy for its crunch sounds pretty unappealing to me.  Just let me have my ants on a log and I’ll go on my merry way.

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. 

Before the Boston marathon bombings caused me to shift gears, I had intended on writing last week’s blog entry about our recent trip to Costa Rica.  In the very early morning hours of Patriot’s Day, Joanne and I returned from a short vacation there.  As was the case on our honeymoon, we took particular interest in the food.

For better or worse, much of the food at the two resorts where we stayed was Americanized.  In other words, the menus contained several items that were not traditional in Costa Rica, but rather were attempts to provide American tourists with familiar foods: cheeseburgers, pasta, pizza, French fries, etc.

We did, however, learn that rice and beans are prevalent in Costa Rican cuisine and many Costa Ricans start their day with a dish of gallo pinto, a traditional dish made with these two staples.  I had gallo pinto for breakfast a handful of mornings and really enjoyed it.

I find that when the topic of breakfast first comes up in my sessions, patients initially feel like they are limited to the usual options: cold cereals, hot cereals, bagels, eggs, bacon, waffles, muffins, pancakes, yogurt, etc.

What they come to realize though is that breakfast is just like any other meal of the day and we need not limit ourselves to the traditional breakfast options.  In other words, while breakfast options certainly include the typical options I listed above, they also include salads, sandwiches, entrees, or anything you might have at any other time of the day.  Gallo pinto is a perfect example.  Not too many Americans would typically consider rice and beans a breakfast option, yet they fill that role quite well for millions of Costa Ricans.

What might you consider having for breakfast if you expand your options beyond typical breakfast foods?

The following blog entry appeared as a letter to the editor in the Wellesley Townsman on April 25, 2013.

I ran my last Boston marathon years before Joanne and I met.  Since then, she has occasionally asked me if I would ever consider running another one.   My response was always no, I could not envision a reason to do so.

The stretch of Boylston Street where Monday’s bombings occurred is special ground.  Every time I was on the verge of finishing the marathon, I took off my sunglasses as I made the left onto Boylston because I wanted the most raw, unfiltered absorption of the experience and atmosphere as I could have.  The straightaway is long, much longer than it appears on TV.  The finish line, in sight the entire time it takes to cover the distance, cues each runner to remember the reasons why he or she decided to race in the first place.  Throughout their unpleasant, cold, and mushy winter training, runners fantasize about running down Boylston with the crowd roaring, the finish line in sight.

That stretch of Boylston might be the only spot in the entire city where dreams literally come true for thousands of people every single year.

For many runners, finishing the marathon would be impossible without the support and encouragement of those along the route, including not just the volunteers, but also the spectators. They make the day what it is.  Without them, the marathon would not be an event, but rather just a bunch of people going out for a jog.  When I had to drop out of the 2004 race due to a medical problem, a complete stranger ran out her front door after seeing me collapse at the end of her driveway and cared for me until I was loaded into an ambulance.  More times than I can count, I saw struggling racers break out of their shuffling walks and back into jogs because somebody on the side of the road told them they could still do it.

A tragedy like Monday’s bombing would have been wrong no matter where it occurred.  If they blew up the local diner or bus stop instead of the Boston marathon finish line it would have still been wrong, but it would have been a different kind of wrong.  In a city where we tend to keep to our own circles, cut each other off and exchange middle fingers in traffic, and walk past each other without even batting an eye, the marathon is the antithesis: strangers act like best friends in order to build something overwhelmingly positive.  Somebody attacked that and tainted it.  They went after the city at its finest and hit us in the heart.

We need to get that back; we need to make that stretch of Boylston special again.

Many ways exist in which we can make that happen, none of which will be more significant than when thousands of spectators line Boylston Street again for next year’s race.  As for me, I am a runner, I have been my whole life.  It’s what I do.  Given that, I aim to establish a 2014 marathon charity team to fundraise for Monday’s victims, to enter the race as a member of that team, and to run down that Boyston straightaway slapping hands with every spectator I can reach.