Quick and Easy Pasta

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  • 1 cup white flour pasta, dry
  • 1/2 cup marinara sauce
  • 2 cups broccoli, frozen
  • 1/4 cup walnuts


  1. Bring a pot of water to a boil.
  2. Add the pasta to the boiling water. Stir occasionally.
  3. Place the broccoli in a microwave-safe bowl and thaw in microwave just until defrosted.
  4. Add marinara sauce to broccoli, cover the bowl with wax paper, and set aside.
  5. As pasta is nearing readiness, microwave the broccoli and sauce until desired temperature.
  6. While the broccoli and sauce are warming, remove the pasta from the heat and drain it.
  7. Immediately add the pasta to the broccoli and sauce mixture.
  8. Garnish with walnuts.

When consumed the day of or the day before a race, meals lower in fiber tend to be better tolerated; hence, the white flour pasta. Broccoli may similarly cause gastrointestinal distress for some runners, so feel free to switch in your favorite vegetable(s).

Regardless of the meal you intend on eating the night before your race, be sure to try it the night before a practice run in order to make sure you tolerate it well and feel your best.

He Said, She Said: Meal Plans

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

He Said

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

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 With all due respect, the quote illustrates nutrition counseling gone awry, the result of an outdated, archaic, and ineffective approach that puts too much emphasis on information and too little on individuality and motivation.

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

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

Unfortunately, the problems with these meal plans are extensive:

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

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

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

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


She Said

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

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

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

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

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

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

Noms: Margarita’s, Framingham

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One of our favorite cuisines is Mexican food. In fact, we had our engagement party at a favorite Mexican restaurant. That place has since closed, so we have been on the lookout for a new favorite Mexican spot. Recently, we decided to give Margarita’s Mexican Restaurant in Framingham a try. Margarita’s is a chain with 24 locations throughout the Northeast.

When we walked in at 5:30pm on a Saturday, the place was already packed, which was surprising. While we waited for a table, we had a chance to peruse the lengthy menu, which was divided into numerous sections, including appetizers, salads, vegetarian dishes, fajitas, tacos, grill and “Los Favoritos.” Needless to say, the number of menu options was overwhelming. In the end, we opted to share the appetizer of guacamole with tortilla chips. Jonah got the “Burrito Vegetariana” (aka vegetarian burrito), and Joanne ordered the shrimp fajitas.

The meal started off well, as our waiter was prompt and courteous. We were given a complimentary basket of tortilla chips with salsa, which was deliciously salty and spicy, and our drinks were brought quickly and refilled as needed. We were pleasantly surprised by the guacamole appetizer, as it tasted freshly made and authentic.

After that, the meal took a turn for the worse. While Jonah was excitedly expecting the variety of vegetables promised in his burrito, he was sorely disappointed by the lack of peppers, mushrooms, black beans, and rice, and completely overwhelmed by the sheer abundance of under-sautéed onion in and on top of the burrito. Jonah likened his experience to “pulling a raw onion straight out of the ground and eating it like an apple,” and, unfortunately, his breath smelled like onion for the rest of the weekend.

While the shrimp in Joanne’s fajitas were perfectly cooked and the presentation was impressive, she was put off by the overly-salty seasoning used on the fajita vegetables (again, an overabundance of onion) and felt like the veggies were undercooked. The fajita platter did not come out of the kitchen sizzling on a cast iron skillet like most fajita platters do; instead, the food looked like it had been sautéed and then placed on a cast iron skillet afterwards. All in all, it was a disappointing entrée.

To top it all off, the meal ended up being more than $40 for just the two of us, which seemed unreasonably high for the quality and quantity of the food. Thus, we will continue our search for our new favorite Mexican restaurant. If any of you have suggestions, we’d love to hear them!

Day 26: Mindful Movement

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This morning I went for a 14-mile walk, which was miles farther than I had intended when I left home. Carrying my MBTA pass with me, my plan was to walk from station to station in Newton and then take the green line home whenever I got tired. But the fatigue never came, so I ended up walking home instead.

This afternoon, I called my surgeon’s office just to make sure it is okay that I am walking that kind of distance at this point in my recovery. They told me that 14 miles has to be some sort of record for this soon after major back surgery, but as long as I am feeling good (which I am) then they see no problem with it.

Joanne and I talk about mindful eating with our patients, but the concept of mindfulness extends beyond just dietary habits. Adjusting mode, frequency, duration, and intensity of physical activity yields all sorts of permutations of movements, and our bodies are great at giving us feedback regarding which ones work for us. We just need to make sure we listen.

Approaching physical activity with a spirit of mindfulness means paying attention to and honoring the feedback that our bodies give us in response to our movement choices. Today, for example, I was fully prepared to end my walk as soon as my body told me it was time to stop, but instead I felt great so I honored that and kept going. Yesterday, in contrast, I was hoping to go for a long walk, but my left heel felt uncomfortable just a couple of blocks from home, so I turned around and called it a day. Although I was disappointed to go home early, better to nip whatever it was in the bud and let it heal immediately, rather than push it and risk a long-term injury.

Besides injuries, other consequences can arise from not being mindful with our movements. We risk increased stress, overtraining, undertraining, burnout, and simply not enjoying ourselves. Although I was never the type of personal trainer to push my clients past the point where their bodies were telling them to stop, holding myself to the same standard and listening to my own body’s feedback has been a challenge at times, and I have paid the price via overuse injuries and getting sick of activities I once enjoyed. Moving our bodies can, and should, be fun.

Given my personal challenges, I consider yesterday’s aborted walk a greater accomplishment than today’s 14-mile trek. By listening to my body and honoring its signals, even as it was telling me something I did not want to hear, I put myself in a position that made today’s walk possible.

Body Image and Self-Acceptance

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Between the blogs Joanne and I have written, as well entries by others that we have shared, we have posted quite a bit lately about body image and self-acceptance. While the link between these topics and nutrition is likely obvious to some readers, it occurs to me that it might not be so apparent to others and an explanation is probably in order.

The driving force behind our food choices is multifaceted. When I gave a talk to the FDA last month, the participants and I brainstormed a list of factors that influence our eating: perceived nutritional value, health concerns, availability, cultural norms, emotions, ethics, allergies, culinary expertise, previous experiences, finances, taste, time, and personal goals, just to name a few.

Within personal goals often lies a desire to look different. Consider the following examples: A model severely restricts his or her eating, becoming anorexic in the process, in order to gain a certain look. A naturally-slender man, convinced that his lean frame is responsible for him still being single, forces himself to overeat in hopes of gaining weight and finding a partner. A husband tells his wife that she is “not ready for that dress yet” and so she diets, convinced that he will not be attracted to her until she loses four more pounds. A young lifeguard, self-conscious about being in a bathing suit all day, becomes bulimic.

Those are all real people who we know, either through our work or our personal lives, and they are all examples of individuals adapting unhealthy eating behaviors because of how they feel about their appearances. Therein lies the problem: More often than not, dissatisfaction with how we look leads not to healthier lifestyles, but to harmful behaviors.

Oftentimes, a deep issue is being displaced and playing itself out through one’s food choices. Therefore, in addition to working together with us on their eating, we encourage our patients, when appropriate, to work with a qualified therapist on severing any link they may have between their appearance or weight and their self-worth, and to love and accept themselves the way they are regardless of their size or shape.

As these issues fade away, space is created for a healthier, simpler, and more satisfying relationship with food.

The Best Way I Know How

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Q: Hey, whatever happened to your stated intention of running the Boston Marathon this April to raise money for the victims of last year’s bombings?

A: Back surgery put an end to those plans. Although I am disappointed that I am unable to participate in the race in the fashion that I envisioned, my intention to form a fundraising team to benefit the victims had nothing to do with putting myself in the spotlight and little do with running. Rather, I was just trying to help in the best way that I knew how.

My ability to run might be temporarily on hold, but the spirit of my intentions and my desire to help the victims still holds true. Out of all the important charities that are fielding marathon teams, at least two, The One Fund and Team Collier Strong, directly grew out of last year’s tragedies, so I have thrown my support behind them and the One Run for Boston event.

As time elapses after an event that once gripped us so tightly, new stories and circumstances phase it out from the forefront of our minds. Most of us have the luxury of moving on, while those directly impacted by the event follow a much different trajectory. To the credit of people all around the world, The One Fund successfully raised millions of dollars for the victims in the immediate aftermath of the tragedy. However, because their costs are ongoing, so should our support.

In addition to our financial support, Joanne and I look forward to cheering on runners as they finish the Haunted Mile and make their turn onto Beacon Street. Back surgery or not, I can still help in the best way that I know how.

Day 15: Acceleration

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A few years ago, I spoke with a woman at the gym about the time she had to take off from work for cancer treatment. Upon her return, some of her co-workers treated her as if she had been on vacation, which infuriated her. As she explained to me, and I know first-hand, there is a big difference between using vacation time and going on medical leave.

Spending all day on the couch watching television might be fun and relaxing when you do it by choice, but being forced into it because there is virtually nothing else you are capable of doing is an entirely different matter. My first week home from the hospital was the slowest seven-day span I can remember.

As that first week came to a close, I made the decision to focus less on what I could not do and to instead emphasize the small indicators of progress that came with each passing day. Each evening right before going to bed, I wrote myself a quick note about what I had accomplished that day.

My whole perspective shifted. Powered by a more positive outlook, I have nudged myself to do just a little bit more each and every day, and the results have come at a rate so accelerated that I never would have expected it. Just one week ago, for example, I went outside for the first time after my operation and slowly shuffled around the block with Joanne’s help. Today, I walked six miles by myself.

Yesterday was my first post-operative appointment with my surgical team and they could not believe how well I am doing. They were floored that (1) I am already off of all of my pain medications, and (2) that I have been off of them for a week already. My baseline fitness going into the operation and my generally-healthy diet, they said, are likely significant factors into why I am recuperating so quickly.

That is probably true, but I like to think that my resolve to get off the couch and do something productive with my days also has something to do with it.

Day 11: Small Victories

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My spirits have been pretty dismal, to be honest. As somebody who values independence and taking care of myself, being stuck at home and needing my wife’s help for nearly everything I do has been sad and depressing.

On the other hand, I am mindful of my own advice: long-term success grows out of patience, perseverance, and the tempered resolve to wake up each morning and inch just one day closer to the goal. With that in mind, rather than focus on what I cannot do right now, a much more positive mindset is to focus on the small indicators of progress that have come with each passing day:

Day 7: I was able to get up and sit at my computer for the first time since my surgery.

Day 8: I was able to step outside for the first time since getting home from the hospital.

Day 9: I was able to walk around the block by myself.

Day 10: I was able to go for two walks in a single day.

These are basic activities of daily living that never would have crossed my mind as anything special before my surgery, but now they are small victories showing me that I am well on my way to regaining my freedom and independence.

Day 7: Picking My Poison

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Given the dearth of diversity in the NHL, I was surprised to turn on the Boston/Montreal game the other night and see two players of color skating side by side. Upon further inspection though, I realized I was not seeing two teammates; rather, I was seeing a single player twice due to double vision.

The days since my surgery have been a constant struggle of picking my poison between the direct effects of the surgery itself versus the side effects of the drugs designed to cover up the former. These side effects go well beyond just double vision. My constipation was so awful that the hospital staff felt compelled to pursue it aggressively, which resulted in overtreatment and approximately 30 bouts of diarrhea in a 24-hour span. The nausea was so stubborn that one of the most powerful oral medications they could give me did little more than to turn down the volume just a little bit. My sleep and concentration were both so disrupted that I had difficulty discerning actions that happened in real life from those that occurred in a dream state. Dizziness kept me in bed. A lack of appetite kept me from consuming the nutrition my body needs to heal.

Given these side effects, yesterday I made the decision to stop all of my pain medications except for over-the-counter Tylenol. My clarity and nausea have both improved somewhat (Although later I will likely realize that this entry is filled with typos and lines that make no sense.), but now I am dealing more directly with the aftermath of the surgery itself. The pain keeps me horizontal and unable to sit or stand for more than a few minutes at a time. As a result of a chronic low-grade fever, which the surgeon tells me is fairly typical after an operation like mine, I alternate between bouts of chills and sweats. When I’m really lucky, I simultaneously experience both.

Joanne is right when she tells me that my first experience with back surgery probably set me up for false expectations this time around. Although the aftermath of my first surgery was long and difficult from a psychological standpoint, physically my recovery was rapid. After just a couple of days in the hospital, I was discharged to my parents’ house. Just one week later, I was back on campus at Tufts and resuming classes.

This time around, my recovery seems to be on a much different trajectory. Then again, the procedures themselves, while on the same part of my back, were quite different. Last time, the surgery was little more than a resection of the tumor. This time, the surgeon used rods, screws, and bone grafts to reconstruct a portion of my spine.

I need to keep my expectations in check and remember to heed my own advice about patience, perseverance, and waking up each day with nothing more than the simple goal of getting one day better before going back to bed and doing it all over again.

What Not to Say to Someone With an Eating Disorder

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It’s National Eating Disorder Awareness Week, so to stay with that theme, I thought it might be worthwhile to write about one of the most common questions I get from parents of my eating disorder (ED) patients: “What should I not say to my daughter/son who has an active ED?” Working with hundreds of ED patients and their families, I have compiled a list of “what not to say to or around your loved one who is struggling with an ED.” Here are three comments that could be triggering to your loved one.

1) “You look so healthy! How could you possibly have an ED?”

On the surface, this seems to be an innocuous and even positive comment. But, all the ED patient hears is: “You don’t look emaciated enough to have an ED. So therefore, you are fat.” Clearly, this is not what the speaker intended, but someone with an ED has a very distorted view of themselves and how others perceive him or her. It’s important to remember that people with EDs come in all shapes and sizes and it really isn’t possible to determine the severity of someone’s ED just by looking at him or her.

2) “I can’t believe how fat I’ve gotten! That’s it, no more carbs ‘til Christmas!”

I can’t tell you how many times my patients tell me that one of their parents has uttered the above. A parent might think that since the comment is about himself or herself, it shouldn’t be triggering to the child. This is incorrect. Kids learn by example and if they hear you talk badly about yourself and be critical of your body, they will think it’s okay for them to talk badly about themselves and criticize their bodies. This just fuels the ED even more.

3) “I know she needs to gain weight to be healthy. But we don’t want her to gain too much weight, right?”

Yes, I have heard these words from a number of parents and in front of their kid, no less. Weight gain is often a requirement in the recovery for anorexia nervosa. But weight isn’t the only factor that needs to be measured. Vital signs such as heart rate and blood pressure both lying down and standing up are very important indicators of health. Other measures of health include blood tests to look at nutrition status, whether or not a menstruating female has lost their period, and bone density. EDs take a toll on the entire body, not just weight. By keeping the focus on weight, we are fueling the idea that weight is the end all and be all. This is just not true.

Obviously, none of the above comments are meant to be malicious – we all want the best for our loved ones. But, it’s important to think about how your comment might be perceived by your son/daughter/sister/friend. We can’t edit ourselves every minute of every day, but by being aware of your words, you could spare your loved one (and yourself) a lot of unnecessary grief.