Tag Archives: intuitive eating

We are all going to die!

Posted on by
Reply

One of my patients, who has been working hard to refine their intuitive eating skills, recently asked me to explain the concept of gentle nutrition in general terms. Although I already wrote a piece about this topic just last year, I want to revisit it because I realize in hindsight that I failed to adequately emphasize a basic truth that is of upmost importance to remember: We are all going to die!

Yes, yes, eye roll, we are already aware of our mortality, but thinking about our demise can be so unpleasant that it can be easy to put to the side and ignore. As scary and sad as it can be to think about, sometimes we need to remind ourselves that no matter how fast and how far we run, death will always chase us down. Always. Unless we get hit by that proverbial bus or suffer some sort of other physical trauma, a health condition of some form will do us in. That’s just how it is.

While death is a certainty, how exactly it will happen will remain a mystery until it actually unfolds. Some smokers never develop lung cancer while some non-smokers do. Predictions, like weather forecasts, are still just guesses. Sometimes the weatherman calls for a 5% chance of precipitation and we get a downpour.

Of course our overall dietary pattern has some influence, albeit limited influence, over our health, but the impact of any single eating occasion is likely negligible. Unless the food blocks or closes our airway or somehow inflicts catastrophic injury to our gastrointestinal system, tonight’s dinner is not going to kill us, nor will it save us from our ultimate fate. Given that an elementary eat-this-not-that approach fails to account for our nuanced reality, how, then, are we supposed to make decisions about what, when, and how much to eat? This is where intuitive eating and gentle nutrition can help.

My patient gave me an example of a situation they found themselves in, and we talked through how one might approach it using intuitive eating and gentle nutrition, but I am going to tweak the specifics a bit for the sake of their privacy. My patient is reassessing their intake of red meat after reading an article linking such meat with colon cancer, which runs in their family. Furthermore, their go-to order at the local pizzeria is a steak and cheese sub. Should they be reducing their intake of red meat and perhaps be ordering something else, they questioned, or would that be running counter to intuitive eating?

My response began by reminding them that having a steak and cheese tonight will not kill them, nor will opting for a salad save them. We talked about using matching questions to help guide their food choice. If the matching process squarely lands on the steak and cheese, then yes, of course, go ahead and order it. On the other hand, if the criteria they identify are broader, they anticipate that they could take or leave the steak and cheese and be equally happy, and since reducing their intake of red meat is a goal they are trying to achieve, then opting for a different menu item probably makes the most sense. In essence, gentle nutrition utilizes medical nutrition therapy as a tiebreaker of sorts, not a driving factor.

Furthermore, we talked about increasing their options by considering items on the pizzeria’s menu that perhaps they had overlooked. In other words, the choice need not be binary between a steak and cheese sub or a garden salad, but also include a pizza with chicken and broccoli, a Greek salad with shrimp, or any of the other menu items that omit red meat.

During the course of our conversation, my patient realized that sometimes they order the steak and cheese by default, not because they necessarily have a craving for it, and that sometimes it leaves them with a stomach ache. This information is important to consider too. Sometimes their desire for the steak and cheese is so strong that it will feel worth risking a stomach ache, but other times the craving will be low enough that it will be overshadowed by wanting to feel good the rest of the night. Even more importantly, realizing and acknowledging that they sometimes make their ordering choice on autopilot offers an opportunity to make more conscious decisions going forward.

Hopefully, this addendum to the piece I wrote last year helps to clarify the concept of gentle nutrition. Perhaps, as I continue to think of better ways of explaining, you will see me release a third installment at some point. That is, if I live long enough to write it, and if you are still around to read it.

“Food Noise”

Posted on by
Reply

Over the past year or so, a concept has been popping up on my radar: “Food Noise.” It seems like with the growing popularity of the newish weight loss/diabetes medications Ozempic, Wegovy and Mounjaro, there has been more discourse around how these drugs are getting rid of the “food noise” in many people’s brains. Anecdotally, most individuals who take higher doses of these medications report feeling “less obsessed” about food. In fact, they almost stop thinking about food altogether. For many of these folks, this comes as a welcome change, as previously their brains felt like they were constantly perseverating on food and on what, when, or how much they should or should not be eating. People describe feeling relieved to no longer be overly focused on food and the “noise” that their brains create around it.

On the surface, I can completely understand how getting rid of the “food noise” can come as a relief for so many people. Constantly thinking about food uses a lot of mental energy and can be exhausting. To be freed from these thoughts can feel like one is breaking out of diet prison. But, as a dietitian who helps folks with intuitive eating, I also have some concerns around this concept. A number of my patients who are on these prescriptions report having no hunger cues whatsoever, that they have to remind themselves to eat, and when they do, they do only want to eat a little and get full quickly. While this might seem like a dieter’s dream, it is in exact opposition to what our bodies were built to do. We are born as intuitive eaters from the start; babies are quite adept at communicating when they need nourishment. It is normal for us to experience hunger multiple times per day, and, in response, to fuel ourselves as the need arises. Hunger is a basic biological function that is vitally important for survival. When hunger cues are removed, we are at risk for undernourishment and malnutrition.

One of the ways that these weight loss/diabetes medications works is by slowing down our digestive process so food lingers longer in the stomach. Unsurprisingly, when our digestive system slows down, we feel less hungry and feel hungry less often, which results in eating less. This process also helps our body to improve its ability to manage its blood glucose. While smaller/moderate doses of these drugs have been shown to be helpful for those with type 2 diabetes to manage their blood sugar, doctors are now prescribing them in much larger doses to “aid in weight loss.” The higher the dose, the more likely it is that one will experience gastrointestinal side effects such as nausea, vomiting, diarrhea, cramping, and bloating, which in turn leads to a decrease in appetite and ensuing weight loss.

Is this (or any kind of intentional weight loss) healthy? I would argue not in the slightest. These drugs are basically making it easier for folks to underfeed their bodies. It makes food restriction tolerable. It can seemingly get rid of the “food noise,” but at what cost? As we have learned over the years, intentional weight loss, especially when it is rapid, takes a huge toll on one’s health and almost inevitably results in weight regain. Weight cycling is a risk factor for many health conditions that the medical community blames on weight, such as cardiovascular disease and metabolic disorders. While we do have plenty of research on these medications and their efficacy in managing type 2 diabetes, the research on using these medications for weight loss is much sparser and of shorter duration. In a way, these weight loss medications feel like the weight loss medications of the past (e.g., Phen-Fen in the 1990s), promising to be the “miracle cure” for so many struggling with weight issues, only to be eventually pulled from the market due to the serious health risks they inevitably cause.

I would argue that for those who are able to eat intuitively – listening to their bodies’ hunger and fullness cues, responding accordingly, and rejecting the diet messages we get constantly in our weight-obsessed culture – “food noise” is not really a thing. Many folks feel like they are “food addicts.” While I certainly want to validate someone’s feelings, the research we have at this point does not confirm that this is a real, physiological issue, such as substance addiction. Much of the “food addiction” research that is out there currently does not account for the subjects’ previous or current dieting behavior which has had a considerable effect. Restriction, whether it is mental or physical, begets food preoccupation.

When someone learns to listen to their body’s cues and feed oneself in accordance with these cues, and when one gives oneself unconditional permission to eat, food preoccupation lessens greatly and, in some cases, disappears. We are supposed to feel hungry several times per day; this is our body’s way of telling us we need fuel throughout the day. Our bodies are constantly giving us cues and feedback, but we are taught that our hunger cues are “wrong” and are not to be trusted.

I will be curious to see how those who are taking these medications will fare in the future, specifically around “food noise.” Many studies have shown that most people are unable to tolerate these medications for more than a couple of years (despite the medical community and drug companies saying that these drugs need to be taken for the rest of one’s life). And for those who continue with these medications, we have yet to see the long-term health effects that they will cause. My hope is that more and more people will come to realize that we do not need to be at war with our bodies and that listening to our bodies’ wisdom is the best course of action.

The Lingering Effect of Scarcity

Posted on by
Reply

Cleaning up the house earlier this week, I came upon a bottle of hand sanitizer that was functionally empty, as the remaining liquid was too shallow for the pump to reach. If I had found it in 2019 or earlier, I would have dumped out the little bit of sanitizer and recycled the bottle without even considering any other option. But that was before COVID-19, before cleaning products became precious commodities, before I went from store to store in search of them only to find empty shelves, before opportunists were reselling them online for ten times their sticker prices, and before a friendly pharmacy clerk discreetly slipped me a pocket-sized bottle of sanitizer as though she was passing off a top-secret document in a spy movie.

After all of that, even four years later, no way could I bring myself to waste any amount of hand sanitizer. And really, that comes as no surprise. Several decades after the Great Depression, my grandparents still could not bring themselves to leave any food uneaten, so much so that they once finished Chinese food leftovers despite knowing that my brother and I had found a boiled insect in the rice.

As I was doing my best to transfer the remaining hand sanitizer to another bottle without spilling a drop, I thought about patients of mine who are still working to recover from food scarcity that ended many years ago. Remember, food scarcity has several etiologies, including famine, financial hardship, political blockades, food deserts, and limitations imposed by oneself or by someone else. Intellectually, we know the difference between going hungry because flooding destroyed this year’s crop and putting a cap on our eating because we are on a diet, but on a biological level, all our bodies know is that they are not getting what they need. When the restriction ends, we are driven to get as much as we can of what we missed for fear that another period of restriction will come.

The solution is indefinite abundance. The more we surround ourselves with food, especially ones that were previously restricted, and the more we reaffirm that we are done with self-imposed limitations, the more the drive to overconsume decreases. (Side note: Overeating can have several different roots. Here, I am referring specifically to overconsumption that comes from restriction.) If someone finds that a specific food is particularly a trigger, the stocking technique might be helpful.

Certainly, the concept of abundance entails a great deal of privilege, such as access to foods, money to buy them, and places to store them. Some of the factors that influence access are beyond our control. To the extent that we are able to give ourselves consistent and ongoing access to a wide variety of foods and pledge that the days of restricting ourselves are over and never to return, we help to curb the frenzied drive for more and more.

And of course it takes time, maybe even a long time, to shake scarcity’s impact. Understandably, we want to reach a more peaceful relationship with food sooner rather than later, but there is no way to rush the process. We just have to be patient, ride the wave of everything that comes up along the way, and continually remind ourselves that we will always do our best to maintain our access to hand sanitizer – I mean food – going forward.

“Why can’t I eat dessert all the time?”

Posted on by
Reply

In our quest to find entertaining and educational television shows for our kindergartner, I stumbled across an animated show on Netflix called “Ask the StoryBots.” In each episode, a child asks a question of the StoryBots, and they try to answer it by traveling to different locations and talking with different “experts” or individuals who might have answers. Most of these questions are about the world we live in, such as “why is the sky blue?” and “how do ears hear?” and they are answered in an accessible way. My daughter and I have found most of the episodes funny, entertaining, and interesting, as the show uses lots of humor and catchy songs to educate its audience. The StoryBots themselves are cute and silly and full of boundless curiosity. And the show also has guest appearances from a number of recognizable celebrities, including Snoop Dogg, Zoe Saldana, and Jason Sudeikis, among others.

When I came across the title for episode 2 in Season 2, I automatically cringed a little bit: “Why Can’t I Eat Dessert All the Time?” Teaching kids, especially little ones, about nutrition can be a tricky thing to do. I remember when our daughter came home from preschool one day and told us that her teacher made her eat lunch in a certain way (i.e., sandwich and veggies first and then dessert), I knew that we would have to step in and explain our food philosophy. The teacher was open to our request to let Lorelai eat her lunch in any order she would like, thankfully. But as the days and weeks went by, we started hearing Lorelai talk about “good/healthy foods” and “bad/unhealthy foods,” phrases we never use in our home, and I knew that it was going to be an uphill battle to maintain her intuitive relationship with food and her body.

Lorelai and I immediately skipped over episode 2 of Season 2 because I was afraid that it would be just another fearmongering treatise on why sugar is bad for us. Later on, I watched the episode by myself, and while I did not find it as harmful as it could have been, it definitely was not ideal.

The StoryBots field a question from a young girl named Lilyn who asks them why she cannot just eat dessert all of the time, as she does not like other food. The StoryBots are stumped and tell Lilyn that they will find the answer to this question and get back to her. The first stop for the StoryBots is at a bakery to ask the baker (played by Christina Applegate) why we can’t eat dessert all of the time. In an attempt to answer the question, the baker rolls out a chalkboard filled with formulaic equations and organic chemistry and begins a very lengthy (and swiftly spoken) explanation, using complicated terms that a child most certainly could not understand. She tells them that “an excess of monosaccharides can have an inherently negative effect on everything from our teeth to our metabolism.” She also explains that given the standardized 2,000-calorie diet, “the ratio of calories to nutrients found within your average sugary sweets deviates significantly from what has come to be widely accepted healthy percentages for what one’s caloric intake should be derived from.” Not surprisingly, the StoryBots are confused and at a loss for words.

Obviously, there is a lot that I don’t love about this explanation, but I especially disliked the part about the standardized 2,000-calorie diet. As we know, the 2,000-calorie standardized diet was created as part of the Nutritional Labeling and Education Act in 1990 as a way of simplifying the nutrition label to make it easier to calculate percentages of daily values. 2,000 calories was settled on after the USDA surveyed men and women and asked them how many calories they ate in a day via self-report. Women reported eating between 1,600-2,200 calories per day while men reported taking in between 2,000-3,000 calories/day. So, using these calorie ranges, researchers decided on 2,000 as it was a “nice round number” that would be easy to use for calculations. That being said, 2,000 calories is an arbitrary amount as we truly do not know how many calories one “should” be eating each day. Some folks need much more and others need much less, and the factors that determine this are largely genetic.

As the StoryBots stare at the baker with utter confusion, Jake the Supreme Cupcake (a cupcake that is a “bad boy”) tells them that they can, in fact, eat dessert all of the time and invites them to join him on a journey. The group ends up at Tummy University, where Jake brings the StoryBots to the Alpha Kobbler Pie fraternity. There the partiers (sweets including cake, Twinkies, and gummy bears) are having a sugar rave and initiating new frat pledges, one of which is a piece of broccoli named Brock. Jake explains that the parties at this fraternity are the best because they are “packed with sugar, which gives you short bursts of energy.” All of the attendees are basically bouncing off the walls and acting “crazy,” which they attribute to being “full of sugar.” Brock finds himself at a ritual initiation called “The Dunk,” where pledges are dunked into chocolate, and he decides to bow out.

At the same time, one of the StoryBots, Bing, gets swept up in the rave and is goaded into chugging a two-liter bottle of soda. Brock warns the StoryBots that drinking a two- liter bottle of soda is bad as “it’s almost 100 times the amount of sugar you find in a carrot!” Terrified, the StoryBots try to stop Bing from drinking the soda, but they arrive too late and find him chugging away. Of course, directly after this, Bing starts acting “crazy” like the others, sliding down the stairs on a sled, doing a cannonball into a glass of soda, etc. The StoryBots look on in horror and ask Brock what they can do. He tells them that they will just have to wait as “sugar gives you lots of energy, but you crash and burn pretty quickly.” Almost immediately, the partiers run out of energy, and all of them have sugar hangovers.

The StoryBots end up leaving with Brock as they do not feel that they got their question answered. Brock also wants to find his place at Tummy University. The group runs into the campus police, who are “healthy fats” including avocado and fish. The police chastise Bing for eating too much sugar and are surprised to see Brock coming out of the rave. The police recommend that Brock speak with Dean Banana who is known to say “every food can make the body a better place.” The police then go on to explain that they are healthy fats that are good for protecting the cells in the body. On the way to finding Dean Banana, the group comes across the “Protein Gym,” where a large sweaty T-Bone steak runs over to the group. He has an Austrian accent (reminiscent of Arnold Schwarzenegger) and tells them that protein is needed for building big muscles, and he challenges them to lift heavy weights. Brock does not feel that this is a good fit for him either.

Next the group comes upon a group of foods (including a bowl of pasta, a loaf of bread, and a potato) lined up at the starting line of a track, getting ready to run a race. Brock tries racing with the group who explain that they are “packed with the good carbohydrates,” which give the body sustainable energy, unlike simple sugar. Brock is unable to keep up with the runners and ends up collapsing at the track and then waking up in a hospital bed at the campus medical center. The doctors are fruits and vegetables and introduce themselves as “vitamins and minerals” that “prevent people from getting sick, make the cells in the body strong, and strengthen the immune system.” The doctors share that Brock’s vitamin and mineral levels are “off the charts,” as he has tons of folate, vitamin C, potassium, and calcium, and they tell him that he would be a great fit at the medical center. Dean Banana shows up and confirms that Brock has found his place among the nutrients. He explains that “while a little bit of sugar tastes good,” it’s protein, healthy fats, complex carbohydrates, and vitamins and minerals that “make people strong, smart, and healthy.” The StoryBots believe that they have finally found the answer to their question and are excited to share it with Lilyn.

Overall, the episode is not completely terrible. It is amusing and interesting and provides some solid nutrition education. What I take issue with though is how the simple carbohydrates are portrayed as “naughty crazy partiers,” while the other nutrients are shows as the “good” ones. Young children have very binary thinking, and setting up this “good food/bad food” dichotomy is not necessarily helpful. The message that children will hear from this is that “good foods” such as protein, healthy fats, complex carbohydrates, and vitamins and minerals are to be put up on a pedestal while simple sugars make you sick. This also gives simple sugars the allure of the forbidden food and can result in children over-valuing these foods rather than just having a neutral place in the diet. Kids are naturally born with the ability to be intuitive eaters, and the more that we intervene and try to push them in the direction of “healthy” foods, away from “bad” foods and scare them about the consequences of eating said “bad” foods, the more likely that they will lose their ability to eat intuitively.

Aside from very general nutrition education, namely telling kids that eating a wide variety of foods will help their bodies grow and feel good, I don’t think that getting into the nitty-gritty of how protein, fat, and carbohydrates function is particularly helpful. In our diet-obsessed culture that demonizes sugar and is responsible for the “childhood obesity epidemic,” these types of messages around nutrition do more harm than good. If you do end up watching this episode with your child, please be sure to explain that sugar is not the enemy and that there is more to food than just the nutrients they contain. Food is about connection, tradition, history and pleasure, not just nutritional content.

Working With a Running Coach: Why I Started, Why I Stopped

Posted on by
4

In February 2019, I had one of the best racing performances of my life. My finishing time was just shy of the personal record that I set 12 years earlier, and had I better understood the course, I think I could have beaten it. Despite my age and three surgeries in the preceding five years, I was still running close to my best. Then, for reasons that I still cannot completely identify, my running ability abruptly fell off a cliff.

Sometimes I have dreams in which I struggle to run, like I am knee-deep in molasses, and this struggle became real in the summer of 2019. My legs were not tired, nor were they sore, but they just would not go. It was the oddest feeling, and the best way I can describe it is to compare it to having a limb that has fallen asleep: There is nothing structurally wrong with it, but it just does not work as it should. One morning, Joanne watched from the front door as I slowly jogged down to the end of the block, stopped, threw my hands up in exasperation and frustration, and walked back home.

From the summer of 2019 to early 2023, my running rebounded to a small extent. My endurance returned but my speed did not when I ran another marathon in 2022. In fact, my speed continued to worsen over those years at a pace that getting older alone does not explain. Each time I had an inexplicably slow run, each one seemingly slower than the preceding outing, my confusion and frustration grew and began to morph into disgust. In the midst of these runs, sometimes I thought about stopping – not just that day’s workout, but giving up running entirely.

After hearing of my frustration, a generous friend gifted me three months with a running coach who works remotely with distance runners all around the world. During our first conversation, the coach offered his opinion that I was running too fast during most of my training runs. Running slower in order to run faster sounded counterintuitive, but I was willing to try his approach for a few reasons. One, the training approach I had been taking clearly was no longer working for me. Two, he had helped numerous runners – including my friend – dramatically improve their running, which gave me hope that he could do the same with me. Three, in my line of work, I am used to offering suggestions that seem counterproductive at first glance, such as stocking, so I know to keep an open mind.

The coach used the workout pattern that I was already following as a starting point, but he made some significant changes. He added an additional day of running per week, increased my mileage, and significantly slowed my pace. Even during my interval workouts, he wanted me to refrain from running as hard as I could.

He gave me a training plan to follow, and while the specifics varied from week to week, the overall pattern was the same. Tuesdays were interval workouts at the track, Thursdays were recovery runs, and Saturdays were long and slow jogs. At first, the workout’s distances and paces were easy for me to achieve, which gave me confidence that I would be able to keep up with the coach’s training plan, and I felt optimistic.

Then problems arose. While I never got injured under the coach’s watch, I began getting sick more often than I ever had in adulthood. The frequent illnesses were more correlation than causation, as I suspect they were mostly due to exposure to the germs that our daughter brings home from kindergarten. However, I was pushing myself too hard. Sure, my speeds were slower than what I would have run on my own, but I also pushed myself to achieve the workout goals even when I was overtired or otherwise not feeling up to it because skipping or modifying a prescribed workout felt like failure. Instead of sleeping relatively late on Saturday mornings, I was waking up and starting my runs in the dark in order to fit in the mileage before beginning daddy duty. Between the decreased sleep and pushing myself too hard in my training, I was wearing myself out.

Still, I kept going, as I was clinging to the hope that following the coach’s training plan would make me a better runner, just like he had done for others. A few months into our training plan, coach began to prescribe faster workouts. After running so slowly for so long though, the goal paces felt lightning quick, and I failed to achieve them. At the beginning of our work, I routinely returned home from my training runs feeling optimistic, happy, and proud that I was able to achieve the goals that coach set out for me, but soon failure became the norm. Before leaving my house for a training run, I looked at the prescribed workout knowing I would need a miracle to achieve the day’s goals. Instead of feeling positive, I felt guilty and ashamed, and I wondered what was wrong with me.

Coach and I ended up working together for somewhere around six or seven months before I called it quits. He is a super nice guy, an elite runner himself, and he has vast coaching experience, loads of knowledge, and a long list of runners he had helped, but I seemed to be some sort of outlier in that my body was not responding positively to his training plan. We seemed to be bumping up against whatever mysterious factors had eroded my running abilities in the first place.

As you have read through my story, I wonder if you have picked up on the common themes between my work with the running coach and diet culture: turning to someone who “looks the part” for guidance, optimism based on testimonials that may or may not be indicative of typical results, reliance on external prescriptions rather than internal cues, and self-blame in the face of failure. Ultimately, realizing these commonalities is why I stopped.

Now I take a similar approach to running that diet survivors do to eating. My body’s internal cues are the primary factors in the decisions I make regarding when, how far, and how fast to run. Instead of focusing on my slow speed and feeling frustrated about it, I am working on accepting that all bodies change over time and the amount of control that I have over mine is limited. These days, I try to approach my running with a spirit of enjoyment and adventure, a fun and relaxing way to be outside, and feeling proud about covering ground on my own two feet – even if they do move much slower than they once did.

Prep

Posted on by
Reply

At the beginning of this month, I had my very first preventive colonoscopy. For those of you in your mid-40s and over, you may know that the procedure is now being recommended at the age of 45 (previously it was age 50) to screen for colon cancer and other bowel issues. So when I turned 45 earlier this year, I booked my colonoscopy for this fall and thought it would be “no big deal.” But as the months went by and the procedure day drew nearer, I found myself getting more and more stressed about it.

I was not feeling anxious about the actual procedure itself because people I had spoken to who had had one told me that it is the easiest part. I was more distressed about the prep for the procedure. I knew that for several days prior, I would need to be on a “low residue” diet (basically low fiber), and then on the day before, I could only have clear liquids (but no red, purple, or blue).

I’ve been eating intuitively for over a decade and have not restricted or changed what I have eaten during that time other than while fasting for blood labs. Even though I knew the low residue diet was important for the procedure, it still filled me with dread, and honestly, I felt quite depressed. I found myself becoming preoccupied with what I “could” or “could not” eat. I obsessively looked at the lists of foods to avoid, and I felt such sadness. Despite the fact that now I was supposed to be eating foods lower in fiber (no seeds, nuts, beans, whole grains, or high fiber fruits and vegetables), it felt reminiscent of my dieting days.

Interestingly, I also found myself eating past the point of fullness more often during this time. It felt like I was having my “last supper” before the prep day, as I knew I would not have solid food for over 24 hours. Even though I rationally knew that food deprivation almost always leads to food preoccupation, I was still surprised at how difficult it felt.

The day of the “prep” was the worst day by far. I had stocked up on Jell-O, tea, apple juice, and vegetable broth, but it was (not surprisingly) completely unsatisfying. On the tip of a friend, I learned that I could also have gummy bears and Jolly Ranchers (just not the red, purple, or blue ones) as they liquify at body temperature, so I had some of those as well. Overall, I was a cranky, hangry person, and all I wanted to do was isolate.

By the time I started drinking the liquid laxative that early evening, I was pretty miserable. I will not go into the details of this part other than to say that I spent a lot of time in the bathroom that night and in the wee hours of the morning.

Luckily, I had booked the colonoscopy for first thing in the morning, which meant that I would be done with it all sooner. And, as advertised, the procedure itself was quick, easy, and painless (I was thankfully asleep for it all.) Of course, I was thrilled to hear that my colonoscopy results were excellent, with no areas of concern, and I will not need to get another one for 10 years.

Once I was able to eat normally again, I quickly noticed that my food preoccupation subsided, and I started feeling more relaxed around food. I was no longer a cranky, hangry mess and was able to eat in tune with my body’s cues.

I am very grateful that my procedure went well. And despite the discomfort, stress, and anxiety I felt during the days prior, I am glad that I had this experience. It reminded me that I never want to go through the restriction/food obsession cycle of dieting again. And it also reminded me that my body is amazing and always trying to protect me – that survival instinct is no joke! My advice to those of you who will be getting a colonoscopy? Take off the day before, make sure you have plenty of supplies at the ready, and remember that this too shall pass.

The End Is Near!

Posted on by
Reply

Seven years ago, when I saw Chic in concert for the first time, Nile Rodgers used the interlude in one of their songs as an opportunity to tell the crowd about his recent cancer battle, which he ultimately won. The songwriter and producer explained that receiving the news inspired him to go on a music-making binge, as he figured he only had a short window of time left to express his art.

Earlier today, as I was driving home from the beach with our daughter, that memory crossed my mind. Since she will soon be restarting school, we have been trying to cram in as many daddy-daughter activities and outings – the Museum of Science, the Butterfly Place, farms, the zoo, fruit picking, restaurants, train rides, the aforementioned beach, etc. – as we can before the start of the school year interferes and forces these bonding experiences from frequent occasions to relative rarities. Before we have even left the parking lot of one activity, I am already thinking about the next one and all of the others that I hope to shove into our remaining time before it runs out. We have fun, but part of me is distracted, anxious, and sad as I think about the end.

Deadlines have their upsides because they can push us to accomplish tasks and achieve goals that might otherwise remain unfulfilled, but they bring with them stress and general feelings of unease that detract from the experience.

Life-threatening illnesses and the school calendar are examples of deadlines imposed upon us, realities that we just have to do our best to roll with, but sometimes we needlessly impose deadlines upon ourselves. A person who wants to get married by a certain age may settle because the timing is right even though the partner is wrong. Someone I know recently spent a hot summer evening in the emergency room with heat exhaustion and dehydration because they stubbornly kept hacking away at a tree they really wanted to cut down before dinnertime rather than conceding they should take an additional day to complete the project. When we were adolescents, a friend of mine wanted to bench press a particular weight before a school dance, and he ended up having to fight to free himself as the much-too-heavy bar laid across his chest.

Because this is a nutrition blog, I am of course thinking about the predicaments we can put ourselves and our relationships with food in due to self-imposed deadlines. An obvious example is the melancholy and frantic overconsumption that precedes a scheduled diet. Trying to lose weight before a wedding or another similar function is a common – yet problematic – behavior that is most likely to result in eventual weight gain and increased risk for developing a wide range of health woes. Someone I know severely dehydrated himself on his birthday and spent much of it at the gym because he had set a goal to be at a particular weight by his new age, and while he did survive and recover, he put himself in a dangerous situation for the sake of an arbitrary goal.

Imagine what these scenarios could look like instead without the needless deadlines. No diet on the horizon could mean more peaceful and intuitive eating without the threat of self-imposed food insecurity looming. Foregoing an attempt to lose weight before an event reduces the chances of harmful and discouraging weight cycling and creates space for the person to focus their time and attention on the big day itself and to go into it full of energy instead of depleted. Personally, I can think of more fun ways to spend a birthday than sweating out as much fluid as possible on an elliptical machine.

Time and opportunities are finite resources, and while we never know when they will run out, we can make life easier for ourselves by leaving self-imposed deadlines in the past.

What We Can Learn From Eating While Sick

Posted on by
Reply

We managed to avoid it for over three years, but COVID finally got us. Joanne and I developed strange sensations in our throats virtually simultaneously and then tested positive a couple of days later. Whether due to the disease itself or as a side effect of Paxlovid, we developed terrible tastes in our mouths. Joanne described it as tasting like gasoline, while to me it seemed more a combination of cheese, bad breath, and metal. Additionally, I experienced waves of queasiness and a drastically reduced appetite.

Some of my patients talk about how much easier it is for them to eat intuitively when they are sick versus when they are fully healthy, and my experiences were somewhat similar to their own. When our appetites are diminished and food seems off-putting, our range of tolerable eating options shrinks considerably, which ironically makes food selection easier because foods we are willing and able to eat stand out in greater contrast to the rest.

Sometimes my patients, when they are ill, have an easier time practicing unconditional permission for a couple of reasons. First, because their array of appealing foods is so small, their only realistic option is to go with these foods. Second, because they are sick, they feel they are more deserving of self-care than when they are healthy, so they worry less about their perceived nutritional quality of food or about what they “should” be eating.

Being sick is so unpleasant and disruptive that at least making food choices can be easier for the aforementioned reasons, yet we can learn lessons from eating while sick that we can apply when we are healthy.

Choosing from a vast sea of eating options can be difficult and overwhelming, which is why deciding what to order from the Cheesecake Factory’s massive menu can be challenging. It is why, when our daughter demands “Choices!” when I ask her what she wants for a given meal, I offer her a small selection of different foods. We do advocate for having a wide variety of foods on hand at home so we have a reasonable shot at being able to satisfy whatever criteria our intuitive eating questions lead us to, but selection can nevertheless be hard if every option feels appealing. As when we are sick, having a smaller range of options that sounds good can make the process easier, but we can accomplish the same objective without being ill by eating before the magnitude of our hunger grows to unwieldy levels.

Only some of my patients utilize a hunger/fullness continuum, as it can sometimes be counterproductive if misused, but those who do know that we define a “3” as a comfortable hunger where we are ready for a meal and we are able to discern which foods sound like they will best hit the spot. In contrast, we define a “2” as a hunger that has grown uncomfortable, where we may feel irritable and stressed, and choosing what to eat can be especially challenging because our bodies are essentially telling us, “I don’t care what you feed me, just give me food!”

By eating before we get to a “2,” we give ourselves an opportunity to separate the most appealing foods more easily from the rest of our options. The practicalities of real life sometimes preclude us from being able to have our meals and snacks exactly when our body’s hunger cues suggest we are best off eating, but through experience, we can learn how to incorporate well-timed snacks that have us arriving at mealtime comfortably hungry rather than ravenous.

In terms of unconditional permission and the relative ease with which we can practice it when we are sick, remember that we are always deserving of self-care – including having the freedom to eat what, when, and how much we want without justification – regardless of our state of health. Think of self-care as something to be practiced not just when we are ill and need to get better, but also when we are already well and hope to stay that way. Personally, I can remember many times over the last few decades when I put self-care to the side, disregarded what my body was asking for, and ended up in a state of illness that was arguably avoidable if I had taken better care of myself.

Next time you are sick, consider the lessons about your eating that you can take with you as you leave the illness behind.

Gentle Nutrition

Posted on by
Reply

What is gentle nutrition? Imagine a Venn diagram. In one circle, we have intuitive eating, which is an approach to making decisions about what, when, and how much to eat centered around our body’s internal cues. In the other circle, we have medical nutrition therapy, which is the use of nutrition to treat various health problems. In the area in the middle where the two circles overlap lives a concept that we call gentle nutrition.

For my patients who are working to rebuild their intuitive eating skills, getting a firm handle on what gentle nutrition means and how to implement it in their lives are often two of the trickiest steps they face. The most common reason is that people oftentimes do not trust that their body’s internal cues will steer them in the direction of eating in a way that is conducive to their health. This fear, which I otherwise think of as the “If I allow myself to eat whatever I want, all I will do is have [insert the name of your taboo food] all the time” expectation, implies that eating for health means overriding intuitive eating cues.

My counter to that concern is to cite the food journal analyses that I perform on some of my patients. When I look at the intakes of my seasoned intuitive eaters, their nutrient consumption almost always falls within their estimated needs because their body naturally guides them towards the food it requires. In other words, my clinical experience suggests that when we eat intuitively, the eating-for-health part largely takes care of itself.

But what if our body is an imperfect guide? What if we face a gap between how far our intuitive eating takes us and where medical nutrition therapy suggests we should be?

For starters, take a step back and remember that our behaviors have limited influence on our health. One of my patients recently told me about a colleague who was diagnosed with cancer, and as word spread around the office, her co-workers reacted with surprise because the woman is so “thin and healthy.” (And as my patient astutely pointed out, if her colleague was fat rather than thin, people likely would have felt that she brought her health woes upon herself, which is a whole other problem.) Hearing the story reminded me of a fellow healthcare practitioner who was diagnosed with cancer herself despite being clearly orthorexic. For people who erroneously believe that they can control their medical fates if only they engage in certain behaviors, counter examples like these can rock their world.

Given that we may suffer whatever ailment we hope to avoid regardless of our best efforts to steer clear of it, we have to consider the lengths that we are willing to go to – and what we are willing to sacrifice – in hopes of reducing our risk. Focusing on medical nutrition therapy may sound sensible in theory, but doing so can come at the expense of our relationship with food. Consider the following scenarios that someone with hypertension might face.

  • What if you feel like you should never have salty food because of your high blood pressure, or when you do allow yourself to have it, you feel like you are being “bad”?
  • What if you have a history of restriction and the mere thought of cutting down on salt feels traumatic?
  • What if you are a recovering binge eater and stocking salty foods is an important step in your treatment?
  • What if you are on the road and happen upon a restaurant famous for a high-salt dish you really want to try, but you feel like if you do, you are asking for a cardiac event?

Who wants this level of angst interwoven with their eating when the fact of the matter is they could die of a heart attack no matter how much or how little sodium they consume? Unfortunately, stress, guilt, second-guessing, and inner turmoil can be significant issues when we practice not-so-gentle nutrition.

We advocate for gentle nutrition because of the downsides that come with focusing too hard on medical nutrition therapy and because of the upsides of taking a more moderate approach that still respects intuitive eating. Consider how someone practicing gentle nutrition would approach the same scenarios that I listed earlier.

  • What if you feel like you should never have salty food because of your high blood pressure, or when you do allow yourself to have it, you feel like you are being “bad”? They understand that complete abstinence of salty food is neither necessary nor practical, and they can enjoy such foods without guilt.
  • What if you have a history of restriction and the mere thought of cutting down on salt feels traumatic? Before even tackling gentle nutrition for their blood pressure concerns, they first do the necessary work to heal their relationship with food, thereby making medical nutrition therapy feel less triggering.
  • What if you are a recovering binge eater and stocking salty foods is an important step in your treatment? They recognize that in order to make peace with salty foods and get to a place where “a little” does not automatically turn into “a lot,” they have to practice unconditional permission and abundance, which entails exposure, continuous access, and predictable overconsumption for a period of time.
  • What if you are on the road and happen upon a restaurant famous for a high-salt dish you really want to try, but you feel like if you do, you are asking for a cardiac event? They understand that no single eating experience is going to save nor doom their health, that food is part of culture and travel, and that they would probably regret forgoing a rare opportunity.*

How then is the nutrition part of gentle nutrition implemented? That same person with hypertension may use their intuitive eating cues to determine that they feel like having a piece of fruit for a snack, but both the apple and the banana sound equally appealing, so they opt for the latter since it has more potassium than the former. On the other hand, if they feel like solely the apple would hit the spot, they eat it, enjoy it, and look for other places in their day to get their potassium. If the whole day goes by without consuming much potassium, they do not worry, but rather trust that their intuitive eating cues guide them in different directions day to day, and tomorrow they could very well find themselves taking in a high amount of potassium.

After reading all this, you might be thinking to yourself, “Yeah, okay, I get that my health is not entirely within my control, but I want to do everything I can to minimize my risk.” If so, that is entirely your right. You are the expert in your own life, nobody is in a better position to decide your path forward than you are, and I commend you for weighing the pros and cons and making an informed decision that feels right for you.

However, that same autonomy applies to each of us, and many people conclude that not-so-gentle nutrition is just not worth its cons and that gentle nutrition is the way to go.

* Speaking from personal experience, I remember spending a night at a church on a Native American reservation in Montana during my Seattle-to-Boston bicycle trip. My hosts offered me one of their traditional dishes – something that I can only describe as a French-fried donut, although I am sure that is not at all what it was – and it turned out to be literally the best tasting food I have ever had in my life. Sometimes I think about what I would have missed had I turned down the food due to nutrition concerns.

Pancakes

Posted on by
Reply

Some months, coming up with a newsletter topic is unusually challenging. For the last few weeks, Joanne and I were both scratching our heads, as the ideas we had were for research pieces that would demand more time than either of us is able to dedicate at this point in time. Being silly, I facetiously asked our four-year-old daughter what I should write about this month. “Pancakes,” she responded, “Pancakes and maple syrup.” Joanne and I laughed, and I walked out of the room, but I quickly returned and told them I was going to use her idea.

Our daughter’s suggestion reminded me of a quote from one of my earliest patients many years ago, and what the latter said to me felt significant enough that I wrote it down as soon as she left my office. “One day, you will have a baby boy who will love you,” my patient said, “and then he will grow up to hate you. But then one day he will love you again and say, ‘Hey, Dad, let’s go out to breakfast, just us guys,’ and then you will go to Bickford’s, and you will have an apple pancake, too.”

At that point in my career, I was still doing the kind of work that most people figure dietitians do: putting people on diets in the pursuit of weight loss. My prescribed diets were low in carbohydrates, especially grains, and so restrictive of calories that if my patients were living in a different region of the world, the United Nations would have sent cargo ships full of food to help them. While I did not author these diet plans, which seemed concerning to me at the time because of their restrictive nature and the good/bad food dichotomy they established, I did dole them out as instructed, and for that I have nobody to blame but myself.

These diet plans typically “worked” in the sense that my patients lost weight, but rarely – if ever – did the weight suppression last long term. At the time that I left the medical center where I was working and stopped doing that kind of work, I did have some patients who had maintained their weight loss thus far, but I have no idea what happened to them later. Given that most weight regain happens two to five years after baseline, I can only assume that at least some of these patients, if not all of them, regained weight after I was out of the picture.

Diets fail for a number of reasons. Most significantly, the physiological mechanisms that kept our ancestors alive through periods of starvation kick in when we restrict and promote weight regain. Another factor, the one that my patient was trying to make me aware of via her aforementioned quote, is that diets are incompatible with real life. After all, if I were following the low-carb, low-grain, low-calorie diet that I had put her on, I would be unable to both remain on the plan and partake in her breakfast scenario. The dietary expectations I had set out for her were unrealistic, which was exactly the point she was trying to get me to see. Point taken.

Now that I am a dad myself, I have greater first-hand life experience to reinforce my theoretical understanding. Numerous times over the last few years, I have eaten foods I was not in the mood for because sharing an eating experience with my daughter was more important to me than eating exactly what I wanted. For example, the food at Chick-fil-A rarely sounds good to me, and I certainly would have preferred something else for dinner last Tuesday night, but I took her there because she loves it, she asked me if I would take her, and I prioritized making her happy and sharing one of her favorite meals over eating what I really wanted.

If I was on some diet plan that restricted foods like Chick-fil-A, such as the plan I had given to the patient in question, I would have had to choose between breaking the diet or missing out on a family bonding experience. When I was a young adult and somewhat orthorexic, I prioritized “healthy behaviors” to the detriment of other important areas of my life. After turning down plans with friends so I could exercise after work and go to bed early, some of them began to distance themselves from me and stopped extending invitations. My insistence on only eating food I had brought from home kept me from joining co-workers for lunch, and my rapport with them weakened. If you have ever been on a diet yourself, consider the ways in which sticking to the plan came at the expense of other facets of your life. My guess is that if you look back, you will find examples in your own life similar to the ones I just described.

Furthermore, remember how you felt when you inevitably deviated from your diet. In Reclaiming Body Trust, authors Hilary Kinavey and Dana Sturtevant succinctly describe the pattern of dieting with a diagram that they entitle “The Cycle.” At the 12 o’clock position, the circular diagram begins with “The Problem,” which then leads to “The Shame Shitstorm” at three o’clock, followed by “The Plan” at six o’clock, then “Life” at nine o’clock, and then back to “The Problem” as the pattern indefinitely repeats. Delving into the particulars of these positions is beyond the scope of this blog, but the overall pattern is one to which many of us can relate: We identify a problematic eating behavior, feel bad about it, desperately grab for a plan that will supposedly rescue us from ourselves, abandon the plan when it proves itself to be incompatible with life, and the cycle repeats.

If a diet puts us in a position to choose between (A) sacrificing important parts of life, such as sharing a bonding experience with our kids, in order to remain on the plan, or (B) breaking the diet and perpetuating a cycle of shame and unsustainable attempts to deal with our problems, then perhaps dieting and living a full life are simply incompatible.