Tag Archives: needham nutritionist

Experimenting With Food

Posted on by
Reply

Once upon a time, many years ago, I packed myself a peanut butter and broccoli sandwich for lunch and brought it to work. Peanuts are legumes, just like chickpeas, I reasoned, so I had a reasonable basis for thinking that swapping out hummus for peanut butter would taste good. Not only was I wrong, but the sandwich was horrendous and bordered on inedible.

When I recently reminded Joanne about my experiment gone wrong, she was unsympathetic, insinuating that I was nuts for inventing such a strange combination of foods. Some of her own food experiments have turned out poorly as well, but she defended them by explaining that she has generally gotten her ideas from TikTok and elsewhere on social media. But someone out there was the first person to try each of those ideas, I explained, and they had to have the flexibility and imagination to try something new before discovering that they liked the result enough to post about it for others to see. If my peanut butter and broccoli combination had turned out great, I would have told other people about it, and maybe it would have become a thing.

Just as the results of experimenting with food are all over the place, so are the reasons for trying new combinations in the first place. Out of mayo earlier this month, Joanne made tuna salad with yogurt, and the tangy result was terrible. Unsure what to do with leftover Halloween candy corns a couple of decades ago, I put some on top of mint Oreo ice cream, and I loved the weird combination so much that I have made it every fall for the last 20 years. After finding that her breakfasts were not holding her for very long, Joanne tried adding Orgain powder to her coffee and cottage cheese to her eggs, and the increased protein leaves her satiated for a longer duration. Because I wanted to increase my fiber intake, I tried marinara sauce on chickpeas and found that I like it just as much, if not better, than on pasta. On paper, drinking soda during endurance events is a questionable choice, but after some experimentation with different hydration options, I set my marathon personal record on Coca-Cola Classic. Without allowing her to experiment, we never would have learned that one of our daughter’s favorite drinks is pickle juice.

While necessity sometimes leads to new creations, imagination is often a driving force, but creativity means little without the freedom to experiment. If you have food rules, consider how they are affecting your ability to experiment with food. While I am not advocating for food rules, I do acknowledge that they can have some upside. For example, someone who feels that they must have a vegetable with dinner may feel inspired to try a wide array of vegetables for the sake of variety and keeping things fresh within the limitations that their food rule demands. On the other hand, one of the many downsides of food rules is that they limit the scope of creativity. For example, the aforementioned individual who insists on having a vegetable with dinner has fewer options than someone who is flexible regarding a vegetable’s inclusion. Given that, if you have food rules, consider downgrading them to food guidelines in order to give yourself more freedom.

If you put food rules and norms to the side and give yourself permission to put your creativity to work, what might you try?

“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.

A Con Or A Pro?

Posted on by
Reply

At some point in my clinical training, I learned the basic guideline, “When the gut works, use it.” In other words, do not utilize TPN (intravenous feeding) if the gastrointestinal tract is healthy enough for at least enteral (tube) feeding. If the latter is called for, depositing into the stomach rather than the small intestine is better, if medically possible, in order to utilize as much of the gastrointestinal tract as possible. If the patient can eat by mouth, even better.

Working in an outpatient setting, I use meal plans similarly to how clinical dietitians utilize TPN. Both are treatment options that have their place, but better to avoid them if possible. Whereas clinical dietitians resort to TPN only when the patient’s gastrointestinal tract is not functioning well enough to rely on other options, I use meal plans only when a patient’s ability to make sound eating decisions on their own is significantly compromised, as can be the case when one is in the early stages of recovering from a restrictive eating disorder.

In these situations, meal plans can help in a multitude of ways. By making some of the decisions regarding what, when, and how much to eat, meal plans streamline the choices that patients have to make themselves. Rather than patients and their parents arguing over meal compositions and quantities, they can refer to the meal plan, thereby reducing the strain that eating disorders can place on families. When followed, meal plans provide enough nutrition for the body to rebuild itself and hopefully keep the patient out of a higher level of care.

Despite these upsides, meal plans also have their downsides, one of which is that they simplify nutrition to a fault. Rather than specifying what a patient is supposed to eat at a given time, meal plans typically utilize an exchange system that allows the patient to select the foods that fit the indicated criteria. For example, one patient’s meal plan might say to have one protein and one grain at snack time, so then the patient would survey the provided list of foods that qualify as proteins and their respective quantities and decide which one to have, and then they would make a similar decision about which grain to have.

The problem is the oversimplified rounding off necessary in order to force foods with complex nutrient profiles into these basic categories. For example, we classify chickpeas as a “protein” when in reality only approximately 23% of their calories come from protein and 10% and 67% come from fat and carbohydrate, respectively. How does that make sense? Cashews are 19% protein, 42% fat, and 39% carbohydrate, but our exchange list says a patient can count them as a protein or a fat. Huh? We treat all cooked vegetables the same even though spinach is significantly higher in protein than carrots are (48% versus 8%, respectively) and much lower in carbohydrate (41% versus 89%, respectively). What?

But is this oversimplification really a flaw? Consider that many (but certainly not all) patients with restrictive eating disorders are high achievers with perfectionist tendencies, and their disorder drives them to seek out and consume exactly what and how much they believe they are supposed to eat. Part of their recovery entails helping them to understand that a drive for perfection, which might be an asset in some realms of life, is unnecessary and counterproductive when applied to eating.

The human body is adaptable and can thrive under a variety of eating conditions. Some populations rely heavily upon starches, fruits, and vegetables, while others get by subsisting on fatty meats. Looking at our country’s own nutrition guidelines, the recommended ranges for protein, fat, and carbohydrate are quite wide. For example, the acceptable macronutrient distribution range for carbohydrate is 45% to 65% of one’s total energy intake, which is quite broad.

Barring certain medical conditions, we do not need to be exact in our eating in order to provide our bodies with the nutrients they need. In that sense, whether we classify chickpeas as a protein or a carbohydrate, or cashews as a protein or a fat, etc., really does not matter; the body will still receive the nutrition it needs regardless. So, while we could view such oversimplifications as cons, I see them as pros, as they teach and reinforce flexibility and freedom in eating, which are important aspects of recovery, rather than rigidity and precision.

“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
2

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.

Pinkalicious

Posted on by
Reply

Mondays are our kindergartener’s “media day,” which means she and her classmates visit her elementary school’s library and have an opportunity to borrow a book for the upcoming week. During one Monday afternoon walk home from school, she gave me a synopsis of the book she was taking home, something along the lines of, “She [the main character] eats a lot of pink foods and turns pink, then she eats more pink food and turns red, and then she eats green foods and her color turns back to normal.”

Uh-oh.

Right off the bat, I had a feeling where this was going. My intuition proved correct once I read the book myself. Pinkalicious is a funny and cute book, but it is problematic in certain ways. If your child is going to read it, an accompanying and clarifying conversation will be important in order to mitigate harm.

The story begins with the main character, a young girl named Pinkalicious, baking pink cupcakes on a rainy day. She disregards her parents’ commands and eats so many of them that she wakes up in the morning and discovers that she has turned pink. Her doctor diagnoses her with a case of “Pinkititis” and advises her, “For the next week, no more pink cupcakes, pink bubble gum, or pink cotton candy.” The doctor continues, “To return to normal, you must eat a steady diet of green food.” Immediately thereafter, the book reads, “(YUCK!)”

The accompanying illustration shows several pink foods crossed out, indicating that Pinkalicious is to abstain from them. While the picture does include strawberries, grapefruit, and watermelon, the vast majority of the foods are desserts: lollipops, jelly beans, cotton candy, ice cream, donuts, milk shakes, jello, and cupcakes.

Following her trip to the doctor, Pinkalicious suffers various consequences as a result of her altered color: Her friend cannot spot her because she is camouflaged among the pink peonies, a bee mistakes her for a flower and lands on her nose, and she cries for her mother to take her home after bees, butterflies, and birds surround her.

Back at home, Pinkalicious requests and is denied another pink cupcake. After pretending to eat her dinner of “mushy, dark vegetables,” she sneaks back into the kitchen in the middle of the night and devours a cupcake that her mother had hidden. In the morning, a horrified Pinkalicious awakens to discover that her condition has worsened: She is now red.

Desperate to return to her normal self, Pinkalicious says, “I opened the fridge, held my nose, and squeezed a bottle of icky green relish onto my tongue. I ate pickles and spinach, olives and okra. I choked down artichokes, gagged on grapes, and burped up Brussels sprouts.” The accompanying illustration shows a few fruits – limes, honeydew, green apple, and grapes – and a bunch of vegetables, including broccoli, cucumber, celery, asparagus, cabbage, and peas. After ingesting these green foods, Pinkalicious loses her discoloration and becomes “beautiful.”

Left to their own devices to interpret this story, a child has likely internalized the following messages: (1) Pink foods are almost exclusively sweets. (2) Too many sweets will make them sick. (3) Sweets have an addictive-like quality. (4) The way to get healthy is to completely avoid sweets and to instead eat green foods. (5) Green foods are almost exclusively vegetables. (6) Vegetables are yucky. (7) Vegetables make them pretty.

Unfortunately, all of these messages are problematic. Let’s take a look.

Problematic Message 1: Pink foods are almost exclusively sweets.

Plenty of pink foods exist that have zero to mild sweetness, including corned beef, edible flowers, beets, dragon fruit, rare steak, and Himalayan salt, yet the only examples of pink foods that the authors cite are sweets because the former is really just code for the latter.

Problematic Message 2: Too many sweets will make them sick.

Sure, too many sweets can make someone sick, a lesson that I learned on Halloween many years ago. However, we tend to single out and villainize sweets, as if they are somehow the only food group that can sicken us in excess, while ignoring the reality that too much of anything can be detrimental to our health. Remember that even water, when consumed excessively, can kill someone.

Problematic Message 3: Sweets have an addictive-like quality.

Admittedly, this message is more subtle than the others, and I can imagine that it will go over the heads of some children. However, for those of us familiar with the apparent fallacy of sugar “addiction,” we can see its theme in the way that Pinkalicious eats another cupcake despite already having turned pink and gone to the doctor as well as in the lengths that she goes to – deceiving her family, waking up in the middle of the night, and sneaking around – in order to obtain the cupcake. Nevertheless, research suggests that sugar “addiction” is not a true addiction, but rather a byproduct of how we tend to demonize and restrict sugary foods.

Problematic Message 4: The way to get healthy is to completely avoid sweets and to instead eat green foods.

If this general sentiment sounds familiar, maybe that is because our culture oftentimes splits foods into dichotomies and presents one side as sin and the other as salvation. Whole30®, detoxes, “clean eating,” etc., are all based on this basic – and flawed – premise.

Alan Levinovitz, a religion professor who has taken to writing about nutrition because of the intersectionality of spirituality and food, sums up the situation very well, “It’s terrifying to live in a place where the causes of diseases like Alzheimer’s, autism, or ADHD, or the causes of weight gain, are mysterious. So what we do is come up with certain causes for the things that we fear. If we’re trying to avoid things that we fear, why would we invent a world full of toxins that don’t really exist? Again, it’s about control. After all, if there are things that we’re scared of, then at least we know what to avoid. If there is a sacred diet, and if there are foods that are really taboo, yeah, it’s scary, but it’s also empowering, because we can readily identify culinary good and evil, and then we have a path that we can follow that’s salvific.”

Sickness and health are never entirely within our control and are certainly way more complex than eat this, not that.

Problematic Message 5: Green foods are almost exclusively vegetables.

To acknowledge the obvious, yes, many vegetables are green. However, for all the green veggies in the world, we also have pistachios, pumpkin seeds, avocados, and other fruits that the book excludes. Are sweets, such as lime jello and green apple jelly beans included? What about – gasp – green cupcakes? Of course not, and I think we all know why.

Problematic Message 6: Vegetables are yucky.

The attitude that we have towards various foods shapes how our children come to see them. In our culture, adults often teach children to view eating vegetables as a chore. For example, earning dessert by first eating vegetables teaches the child that consuming vegetables is the suffering that one must endure in order to be able to eat what they really want.

My first job as a dietitian was a traveling research position that sent me all over the country examining the foods and eating behaviors in elementary school cafeterias. All these years later, I still remember two specific schools. In one suburban Chicago school, the kids saw eating vegetables as uncool and would not eat them, so the cafeteria monitors would proactively remove the vegetables from the trays for fear that the uneaten veggies would be ammunition for a food fight. Peas were on the menu the day I was there, and I remember seeing the bottom of the trash bin lined with confiscated peas. Meanwhile, eating vegetables was the in thing to do in one northern Tennessee school. The problem the cafeteria workers faced there was that kids were taking too many vegetables from the self-serve salad bar, thereby exceeding the allowed serving sizes. The contrast between these two schools stuck with me because it illustrates how cultural views of a food shape its consumption.

Of course we all have our own unique food preferences and aversions, and some people genuinely just do not care for vegetables, but teaching kids that they are “yucky” is mostly a self-fulfilling prophecy.

Problematic Message 7: Vegetables make them pretty.

“I was me, and I was beautiful,” says Pinkalicious after eating green foods and returning to her normal hue. With beauty being the subjective entity that it is, the use of the first-person perspective is significant and raises questions to which we will never know the answers.

On the surface, this quote reads as a self-affirming statement, but does Pinkalicious – who loves the color pink – really think she looks better now than she did when she was pink, or is she rather expressing relief that her color now matches the necessary criteria for societal beauty standards? In other words, does she really think she is beautiful in her own eyes, or because others – her parents, her doctor, and society as a whole – have taught her that being pink was wrong?

Unsaid but certainly implied is the message that if Pinkalicious returned to her beauty after eating green foods, then she must have been less than beautiful when she was eating pink foods, which tells kids that eating sweets makes them less attractive. If that sounds like too much of a stretch, consider the multitude of my adolescent patients (and sometimes their parents, too) who scapegoat sweets for their acne.

Given how many people – including kids – learn to dislike their bodies and yearn to conform to whatever media, peers, doctors, family, friends, etc., say they should look like, the notion that vegetables can make someone beautiful is surely enticing. The problem is that this message is false. Regardless of what one considers beautiful, no food group has the power to dramatically alter appearance.

Do you really want to indoctrinate your kindergartener into diet culture? If not, make sure that enjoying a reading of Pinkalicious is accompanied with a conversation discussing these messages.

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.

Thoughts on the New Weight Loss Drugs

Posted on by
1

I’ve been meaning to write a blog about the new weight loss drugs for months now, but every time I start, I find myself having trouble with what I want to say, especially since so many of the anti-diet and fat-positive activists I admire have already written such important and insightful pieces on these drugs. For anyone looking for some in-depth research study analysis, I want to point you towards Ragen Chastain, a speaker, writer, and amazing fat activist, in addition to being a certified “statistics nerd” (her words, not mine!). Her Weight and Healthcare Substack is an invaluable resource that takes a hard look at “weight science, weight stigma and what evidence, ethics, and lived experience teach us about best healthcare practices and public health for higher weight people.” Ragen is adept at sifting through the research studies that the drug companies publish to sell the efficacy of these drugs and finding the myriad issues, conflicts of interest, and straight-up bad statistics that these studies exhibit. So please read what she has written on the topic of GLP-1 agonists.

In this piece, I am not going to get into the science behind how GLP-1 agonists such as Ozempic and Wegovy actually work. Instead, I want to talk about how these drugs (and the weight loss drugs that came before them) have become such a lightning rod in the discussion of weight. I was a teenager in the 90s, and I clearly remember when the drug Fenfluramine/Phentermine (Fen-Phen) entered the weight loss scene. There was such a fervor about it on the nightly news, and the marketing by the drug companies was intense. It was touted as a “miracle drug” that could “cure” o*esity, and everyone was going to their doctor to get a prescription. I also remember the news stories that came out. Famously, there was one in the Boston Herald about how Fen-Phen was linked to mitral valve dysfunction, pulmonary hypertension, and other cardiac abnormalities. Subsequently, it was removed from the market due to these risks. It took years before people were convinced that the harms that these medications caused outweighed the “benefits” of weight loss for higher weight people.

There has been a seemingly significant theoretical shift in the medical community over the past few years regarding higher weight (the “o” words”) and weight loss. Unlike previous decades, when people were told that their high weight was their “fault” and was caused by their “unhealthy lifestyle behaviors,” many medical professionals are now putting forth the message that one’s weight is largely out of one’s control (true) and is not necessarily due to “unhealthy lifestyle behaviors” (also true). Most physicians acknowledge that the BMI is a flawed measurement and that there are many factors that play into health other than weight (true again). But instead of pivoting away from using weight as an indicator of health, there has been a push by the medical community to classify o*esity and o*erweight as “chronic health conditions” that must be managed over one’s lifetime. In essence, the medical community is saying that while being fat isn’t your “fault,” it is still a problem and one that needs to be managed.

In our fat-phobic, image-obsessed culture, it makes sense why these new “miracle weight loss drugs” are creating such a stir. Higher weight people are being told, “Hey, we know that your weight is out of your control, but we can help you manage your ‘condition’ with these medications!” In addition, there is a lot of pressure on higher weight people to “get healthy” (even if many of them are healthy by every measure other than weight), and losing weight is still seen as something that will improve people’s health. The marketing that the drug companies have put forth is simply astounding. I feel like I can’t watch a TV show, peruse social media, or even read the New York Times without sponsored content popping up about these drugs. Add to this all of the celebrities and influencers who have been publicizing their weight loss “success,” I would be surprised if any person in a larger body wouldn’t be affected. Currently, I am in a small-mid fat, abled body, and I’d be lying if I said that I hadn’t thought about turning to these drugs. I can only imagine how those who are in much larger bodies than mine and/or in disabled bodies are tempted to try them.

The studies that have been put forth by Novo Nordisk (the drug company who makes Wegovy and Ozempic) have shown that while participants lost about two pounds per month over a 68-week time period (during which they were also dieting and exercising 30 minutes per day, six days per week), at 60 weeks, those who were still taking the medication experienced a plateau in their weight loss, and in a follow-up study the following year, two thirds of the weight they had lost was regained. Conveniently, the studies all concluded at the second year of testing, as we know that the majority of weight regain occurs between two to five years post weight loss attempt. Novo Nordisk also reported that taking their medication leads to positive health outcomes, but a closer look at their studies shows that there were no statistically significant improvements in HBA1C (a measure of diabetes), triglycerides, cholesterol, or inflammation markers.

I don’t blame anyone who feels like they need to try these drugs. For some folks, losing 10-15% of their body weight (the average weight loss reported by researchers) could feel like it makes a huge difference in their quality of life. What I find distressing about these drugs is how hard they are being pushed by the media and medical community despite the long list of side effects and potentially harmful health outcomes that can occur. Wegovy has a Boxed Warning (the FDA’s most serious warning) due to it increasing one’s risk for thyroid cancer, acute pancreatitis, acute gallbladder disease, stomach paralysis, as well as an increase in suicidal ideation, among other risks. But it seems that the medical community feels that losing weight is worth the risk to fat people’s lives. That even though folks report nausea, diarrhea, vomiting, constipation, and stomach pain while on these drugs, it’s okay as it is just the price to pay for one to become “healthy.”

I wish that instead of telling higher weight people that their weight is a problem that can be “solved” by taking these medications, the medical community could instead focus its energy on reducing weight stigma in healthcare, as this (along with weight cycling or yo-yo dieting and healthcare inequalities) has been found to have much more of a profoundly negative effect than weight on one’s health. I wish that we lived in a society that didn’t prize thinness so much. And I wish that everyone could see that weight is just another human characteristic that exists on a continuum and that bodily diversity is a real thing, not something that has to be “managed” or “controlled.”

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.