Tag Archives: wellesley dietician

Eating Flowers

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If you are like me, your eating pattern is somewhat repetitive.  Your grocery shopping involves focusing on the usual suspects while consciously or subconsciously dismissing most of the foods in the store due to cost, lack of knowledge about how to prepare them, ethical reasons, bad experiences last time you had them, or a variety of other reasons that can eliminate them from consideration for purchase.

Once upon a time, my shopping trips were so consistent from one to the next that my visits to Whole Foods were showcases of machine-like precision and efficiency.  Within 10 minutes of turning off my car’s ignition in the parking lot, I was buckling my seat belt with a trunk full of groceries in the back.

While routine has its upsides, at some point along the line I realized that I was doing myself a disservice by always eating the same foods.  From a health standpoint, I was missing out on nutrients that were deficient in my regimen.  In terms of enjoyment, I often felt bored with what I was eating.  Food can and should be fun, and as Joanne pointed out, we tend to absorb more nutrients if we enjoy what we are eating.  The grocery store is full of foods that I might have really liked if only I was adventurous enough to give them a chance.

Once I realized that, I decided that each time I went to the store I would purchase one food that was either brand new to me or that I had not had in a very long time.  I tried all sorts of things, some of which probably sound mundane to you, but they were departures from the norm for me: exotic melons, crab cakes, pies, tabouli, strange-looking vegetables I had no idea how to prepare, dairy-free “ice creams,” pumpkin pasta sauce, teff, vegan hot dogs, etc.  Each week I came home with something new.  No, I did not like everything I tried and many of them I never bought again, but there was still value in the experimentation.  I expanded my palette, rediscovered foods I had forgotten, and realized that some foods I used to dislike now hit the spot.

Although I maintained this tradition for years and got a lot out of it, recently I found myself sliding back.  Once again, I gravitated towards particular shelves while ignoring the vast majority of the inventory.  As soon as I caught myself doing this, I reminded myself how much I enjoyed my years of experimentation.  At that moment, I was standing in the produce section in front of a package of edible flowers.  My hesitation reminded me, “I am not someone who eats flowers.”  As I reached for the package and put it in my cart, I thought to myself, “I am now.”

EdibleFlowers

How should one measure health?

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“I really like your blog posts.  They’re really well thought out and are a step above what I imagine normal nutrition blogs are like.  It’s like the philosophy of nutrition or something.  Question, though, when you say this: ‘Joanne and I advocate focusing on health rather than weight.  In that sense, weight outcomes are only somewhat interesting to us.’  I think you’re right, but it also seems challenging to measure one’s health without focusing on weight.  There are very few things a person can do other than stepping on a scale (without regular blood draws and periodic EKGs [electrocardiograms]) to measure their health.  In other words, how do you recommend someone measure their health to see if their health is improving?”

The above email arrived in response to a blog I posted earlier this month in which I compared the slim hopes of winning the lottery to the poor success rate of weight-loss endeavors.  Indeed, Joanne and I do advocate adapting lifestyle changes in pursuit of better health as opposed to taking a weight-centered approach because the latter rarely turns out well.

Furthermore, weight in and of itself is generally not a good indicator of health (although there are some exceptions to this generality, such as for a patient who is recovering from anorexia nervosa).  About a decade ago, I had a weekly doubles game with three other guys.  One player was very lean and clearly had the lowest body mass index (BMI) of any of us.  Was he the healthiest in the group just because he was the lightest for his frame?  After we had been playing together for a few months, I got a call one afternoon saying he had had a heart attack.  I came to find out he was also diabetic.

So if not by weight then, by what should we measure our health?

First, we need to understand that just because a measuring tool is convenient and easy to use does not mean it is valid.  In other words, just because gaining access to a scale and stepping on it are actions that most people can perform does not mean that the resulting data are automatically useful.

You know from my biography that I have an undergraduate degree in mathematics.  For a statistics class project, I analyzed the November 6, 1997 trade between the Red Sox and Rangers that sent Aaron Sele, Mark Brandenburg, and Bill Haselman to Texas in exchange for Damon Buford and Jim Leyritz.  In an effort to determine which team got the better end of the deal, I analyzed the past performances of the trade’s cornerstones, Sele and Leyritz, and determined which metrics were the best predictors of the outcome that ultimately mattered most: team wins.  Some statistics, like strikeouts for a pitcher or home runs for a hitter, are easy to compute and understand, but it turned out that other metrics that were more complex to calculate and comprehend were better predictors of team wins.

While I was in the process of switching careers, I did a similar project in my nutrition assessment course in which I tried to determine which anthropometric measurement is the best predictor of cardiovascular disease.  The results were complex, but the conclusion that I reached is not the point of this blog entry.  The point is that just as I found with the baseball project, the ease of obtaining a particular measurement has nothing to do with the utility of said measurement.  In other words, just because it is easy to count the number of home runs a player accumulates or to step on a scale and find out our weight does not mean that these numbers are great indicators of team wins or our health, respectively.

With that in mind, let us now turn our attention to just some of the ways we can measure health.  This list is far from complete, but it gives a sense of all of the measurement tools healthcare practitioners have at their disposal.

We have anthropometric data, such as waist circumference, waist-to-hip ratio, body fat percentage, and BMI.  We have the numerous biochemical markers that doctors can examine through blood and urine tests, including blood glucose, insulin, total cholesterol , LDL (“bad cholesterol”), HDL (“good cholesterol”), triglycerides, red blood cells (RBC), white blood cells (WBC), and markers of liver health, protein stores, electrolytes, and inflammation.  Clinical indicators include hair and skin quality, finger nail appearance, and tests for hydration status.  Electrocardiograms and blood pressure readings comprise part of a cardiovascular system assessment.  Men and women can screen themselves for signs of testicular and breast cancer, respectively, through regular exams.

When I was a personal trainer, I used tests like the eight-repetition maximum bench press, Rockport walk, and sit-and-reach to assess my clients’ fitness and track their changes over time.  In my realm of nutrition, dietitians will sometimes use tools, such as a 24-hour recall or food frequency questionnaire, to assess the health of one’s food intake.  Aside from one’s intake of fruits and vegetables, for example, one can track other health-related behaviors themselves, such as physical activity duration and frequency as well as usage of tobacco, alcohol, and recreational drugs.

Health is not just about the physical; emotional and psychological health is also important.  This is not my area of expertise, but I am sure psychologists and psychiatrists have ways of screening for and assessing the magnitude of conditions ranging from depression to schizophrenia.

With all of these different tools we have for assessing and tracking health, the criteria that one uses has to be individualized, which is why it is important to talk with your healthcare team about how you should track your own health.  For example, diabetics may measure their health in part by monitoring their blood sugar at home and keeping their A1C under a benchmark value set by their doctors.  A patient with a family history of cardiovascular disease may monitor his health in part through periodic blood lipid level checks and self-monitoring of blood pressure at home.  A patient with celiac disease may monitor her health in part through bone density screenings and tTG blood tests.  A patient with a history of skin cancer may measure his health in part through routine screenings with the dermatologist.

The permutations of how to measure health are endless and must be customized with the help of your doctor and any other healthcare practitioners who are on your treatment team.  Just because weight is easy to measure does not mean one should put much stock in the number or even track it at all.

The Lottery

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Ralph Francois, of Quincy, won $1,000,000 playing Mega Millions. Marjorie Teixeira, Frank DiMascio, and Christine Cummings, of Melrose, Watertown, and Dedham, respectively, all won lottery prizes on the same December day. Stanley Goryl of Smithfield, Francis McPherson of Somerville, Marque Scott of Fall River, Patricia Cannata of Attleboro, and Linh Dang of Dorchester are just a few of the 15 locals who won at least $1,000,000 through the lottery last month. Their pictures, smiling and holding up enlarged replicas of their winning tickets and prize checks, are both evidence of their victories as well as enticements to the rest of us suggesting that we can be winners too.

Despite these testimonials that fill us with hope, most people do not walk away a winner.  Massachusetts lottery players, on average, will only win back $0.72 for every $1.00 they spend on lottery tickets. According to a study by Bloomberg, state lotteries “have the worst odds of any form of legal gambling” in the country. To put things in perspective, one reportedly is 1,400 times more likely to die in an asteroid apocalypse than he or she is to win Powerball. As if the odds themselves were not concerning enough, playing the lottery can sometimes spiral out of control. A link on the Massachusetts State Lottery’s website directs people to where they can get help for compulsive gambling.

Some people enjoy gambling, including the lottery, and as one of my friends said to me recently, “You can’t win if you don’t play.” Going about it with a sporting attitude for the sake of entertainment and excitement is one thing, but nobody actually believes that playing the lottery will really net a profit, right? Wrong. According to a couple of 2005 surveys put out by the Consumer Federation of America and the Financial Planning Association, 21% of the surveyed Americans believe that winning the lottery represents the most practical way for them to accumulate several hundred thousand dollars. I imagine one would be hard pressed to find a legitimate financial adviser who would suggest that playing the lottery is a sound investment strategy.

Given the time of year with people around me making all sorts of resolutions, the clear parallel between playing the lottery and resolving to lose weight has been on my mind. Joanne and I have written extensively about the chronic failures of weight-centered dietary approaches. Although the exact outcome depends on the specific parameters of the given study in question, research across the board shows that the chances of keeping off lost weight are poor. According to one group of researchers, “Less than 20% of individuals that have attempted to lose weight are able to achieve and maintain a 10% reduction over a year. Over one-third of lost weight tends to return within the first year, and the majority is gained back within three to five years.”

Joanne and I advocate focusing on health rather than weight. In that sense, weight outcomes are only somewhat interesting to us. However, for programs and approaches that revolve around weight, shouldn’t the results at least be better than this?

However, just like people who play the lottery despite the terrible odds of making a profit, we get sucked in by glamorous testimonials, peer pressure, advertisements, and the like, all encouraging us to lose weight. We enter the weight-loss game with the expectation, whether by delusion, misunderstanding, or overconfidence, that we will be the rare exception who comes out on top. “You can’t win if you don’t play,” right?

The difference is that we are not playing a game; we are playing with our health. At best, the weight-loss-weight-regain cycle postpones behavior change that will actually improve our health. More likely, the cycle itself can leave us in a less healthy state, either physiologically, psychologically, or both. Furthermore, just as the lottery can lead to a gambling addiction, weight loss pursuits can lead to serious eating disorders which add a whole new layer of complexity to one’s health problems.

Instead of entering a game that you are likely to lose, leave weight-centered approaches behind and focus on making healthier choices. No, lifestyle change is neither sexy nor rapid. Lifestyle change does not make for good reality television. What it can do though is increase your chances of getting healthy and staying that way.

The Wrong Idea

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In addition to the many patients I see for eating disorders, I often have individuals come to see me for help with weight loss. This goal is completely understandable in the current context of our society. Most of us have been told by numerous sources that weight loss is essential for health, and only if we are at the “right” weight will we live long and healthy lives. And up until about five years ago, I would have agreed with this assumption.

But, as I have written about in many other blogs, I’ve had a paradigm shift. There is more and more scientific evidence out there that weight and health are not inextricably linked. In fact, it is completely feasible for someone to weigh considerably more than the BMI and weight charts tell her to and to be perfectly healthy. In contrast, I have seen countless patients in my office who are at their “ideal” weights, yet are using extremely unhealthy measures to stay there and have numerous health issues as a result.

Therefore, I am concerned when the New Year comes around, as I know that our office will become busier than ever with people wanting to lose weight. I’m afraid that prospective patients will have the wrong idea about what I will and will not do. As a registered dietitian, I am knowledgeable about nutrition for health promotion. This means I can provide nutrition education for my patients and help them figure out ways to establish some healthier eating habits.  While these healthier eating habits may lead to some weight loss, weight loss will not be the inherent goal of our work together. If any weight loss occurs, it is just the byproduct of the lifestyle changes one instills. It isn’t the primary goal.

Maybe 2014 will be the year that we can all start taking our eyes off of the scale and instead focusing on making healthy lifestyle changes instead.

Be Your Own Best Friend

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It’s the holiday season, a time to spread joy and love to those around you.  Many times this takes place in the form of buying gifts, baking, and cooking for those we care about.  It often involves telling our friends and family how much they mean to us, how loved they are.  This is the time of the year when we show our appreciation and care for others.

So, in the midst of spreading all of this happiness to others, who often gets neglected?  You guessed it – you!  Not only do we often forget or put off taking care of ourselves, many of us are pros at talking especially harshly to ourselves.  Many of my clients have an inner monologue that goes on a continuous loop.  These thoughts include things like, “I can’t believe you missed that workout today – you are so lazy!” or “You have to stop eating like such a pig” or “You are a disgusting, fat person who has no self-control.”

Now, would any of us talk to our best friends the way we talk to ourselves?  Of course not!  Pretty soon, we wouldn’t have any more friends!  Then why do we think it’s okay to talk this way to ourselves?  Whenever a client tells me about her latest bout of self-hate talk, I ask her to think about what she would say to her best friend if the friend was saying these hateful things about herself.  Common answers to the above hate talk include, “You’ve been so tired and run-down lately, it’s probably a good thing you skipped that workout.  You need the rest!” and “You are not a pig!  We all overeat sometimes, and it’s not the end of the world,” and “You are a beautiful, smart, and loving person – self control has nothing to do with how wonderful you are!”

Let’s break the cycle of negative self-talk and start talking to ourselves in a more positive way.  When we are kind and gentle to ourselves, we are more likely to take better care of ourselves, too.  Imagine what a difference that would make!

He Said, She Said: Weight Management

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Weight concerns are one of the main opportunities for improvement that bring people to our practice. Our approach may ring true for you or elicit skepticism.  Either way, we invite you to share your reactions and questions on our Facebook page.  Also feel free to contact us directly if you prefer to voice your questions in private.

He Said

“Weight Management.”  According to my business cards, that’s what I do.  Because weight is such a loaded term that quickly brings to mind so many thoughts, feelings, and expectations, coming up with concise language that accurately reflects my approach is a challenge that I am still trying to settle.

Indeed I do help with weight management, but not in the direct fashion that some people might expect.  We know from working with patients, collaborating with our colleagues, and reading the research that weight-centered approaches to losing weight almost always fail.  That’s the irony: The more we emphasize and focus on weight, the harder it tends to be to keep weight off.

This fact is hardly a secret.  In October, I wrote about a conference I attended where presenters showed that over 20 diets resulted in the same pattern of weight change: sharp initial weight loss followed by gradual and steady weight regain.  A few years back, I had a telephone interview with a commercial weight-loss program that was interested in hiring me.  A study they had posted on their own website showed that approximately 85% (I forget the exact number.) of their clients regained their lost weight after one year, so I asked the interviewer what strategies they had developed since that study to help prevent this rebound.  She said they realized that clients are unable to successfully transition off of the commercial meal replacements and must stay on them for life.  This is very similar to the diet drugs on the market, which also must be taken for life or else the weight will come back, as well as commercial weight-loss programs where leaders tell clients they should be prepared to be lifetime members if they want to keep the weight off.  Sounds like a great business strategy.  As you can imagine, I did not get the job, which was fine by me.  Philosophically, we were not a good fit.

It may come as a surprise to learn that the healthcare community is still uncertain to what degree weight in and of itself matters in terms of health.  The folks who officially declared obesity a disease state this past summer can cite research supporting their view.  The “Health at Every Size”® supporters, who argue that health and body weight are independent, have supportive research as well.  Personally, I have been talking about the concept of “Health at Every Size” for a decade, long before it even had that label.  As a guy whose BMI labeled me as overweight despite a very low body fat percentage, excellent labs, and solid athletic capabilities, I could see firsthand that weight was not necessarily a good indicator of health.  Lest you think that the unimportance of body weight is a fringe theory or an excuse that overweight individuals use to stay that way, my energy metabolism professor, a lean and athletic guy himself, taught us the same concept back when I was studying nutrition at a large state university.

Clearly, there is still much that we need to understand about how important weight is when it comes to our health, but how much does this question even matter?  On one hand, determining the importance of weight is of course important from a public health standpoint.  In order to best help people be healthy, we need to understand the factors at play as well as their roles.

Speaking pragmatically, however, the importance of weight is largely irrelevant.  We know from epidemiological data that overweight and obesity have become more prevalent, not more scarce, over the years.  Closer to home, even if you have not tried to lose weight and keep it off through various permutations of food restriction and/or overexercise without long-term success, you at least know several people who have.  When Joanne and I listen to our new patients share their histories, tales of weight lost and regained are par for the course.  Society as a whole has been acting under the assumption for decades that weight matters, yet this assumption has not helped us to get any thinner.  In fact, quite the opposite is true.

If we remember that weight-centered approaches almost always fail, the only alternative is lifestyle change.  Even more radical approaches, such as bariatric surgery and lifetime medications, have to be coupled with lifestyle change in order to be effective.  There is just no getting away from it.  Whether weight matters or not, or whether somebody wants to undergo a radical approach or not, the bottom line is that lifestyle change is still necessary in order to improve health.

What constitutes healthy lifestyle change is based more upon one’s baseline than it is on some idealistic vision of what one should be doing in theory.  The efforts and constructs of lifestyle change are usually limited by other factors (e.g. time, finances, personal preferences, etc.) rather than by guidelines, so in a sense guidelines do not even matter all that much when it comes to helping people in real life.  The idea is just to start wherever you are and move towards better health one small step at a time. 

More specifically, instead of gravitating towards a particular mode of exercise because it burns the most calories per unit of time, find ways of being physically active that are fun and agree with your body.  You will be happier and more likely to make the activities long-term habits.  Instead of counting grams and calories, restricting your intake, and cutting out whatever food group is being scapegoated this week, learn to eat mindfully and listen to your body’s hunger/fullness cues.

As a result of these changes, weight loss does oftentimes occur, and when it does, it tends to stay off, but it may or may not be the magnitude that you, your friends, your parents, your partner, a BMI chart, society as a whole, etc. would like.  Therefore, part of establishing a healthy lifestyle means learning to love and accept yourself the way that you are and severing any link you may have between weight and self-worth.

It is really about putting forth your best effort to be healthy while still maintaining balance in your life.  This is what I help people to do; that is what I mean by “Weight Management.”

She Said

Well, we are closing in on the end of 2013. Inevitably, after the ball has dropped and the New Year’s celebration has ended, many people start to think about their New Year’s resolutions.  What’s at the top of the list for most people?  Weight loss.  Every January we become inundated with new patients looking to us for help with their weight goals. Most of them have tried every diet and eating program in the book (losing and regaining many pounds in the process), but they are certain that this time things will be different. This time I will find the perfect diet, most people think to themselves.  This time I will have more willpower, and I will lose the weight for good!

I truly understand why so many people want to lose weight.  Every day we are bombarded by messages about our weight. Whether it is from doctors, the media, family, friends or partners, the message seems to be that it is desirable to be thin and it is bad to be fat.  Those who try to lose weight through dieting are to be admired, while those who are fed up with diets are viewed as weak-willed and lazy.  Fat is not only disliked but also feared.  According to a 2006 study by the Rudd Center for Food Policy and Obesity at Yale University, nearly 50% of the 4,000 people surveyed said they would rather give up a year of their life than be fat.  The same study found that 15-30% of the respondents would rather become unable to conceive, be depressed or become alcoholic than be obese. 5% would rather lose a limb. 4% would rather be blind.

Given most people’s dislike and, in some cases, fear of fat, it makes sense that weight loss is on the forefront of many of our patients’ minds.  But as much as I understand our patients’ feelings, focusing all of our energy on losing weight and fighting obesity by dieting restrictively and exercising excessively hasn’t helped anyone reach and maintain their goals.  I mean, if these methods really worked, would we still have a billion dollar weight-loss industry?  Of course not.

It is time to take the focus off of weight and put it on health.  As I’ve blogged about many times before, health and weight are not synonymous.  Numerous studies have shown that when talking about health, it is lifestyle behaviors that make the difference, not just weight loss.  When patients come into my office with the sole goal of losing weight, I try to help them shift their view to one that is health-focused rather than weight-focused.  By implementing healthy lifestyle changes such as eating intuitively, being more physically active, and dealing with stress appropriately, one’s weight will often settle into a “healthy weight range.”  This weight range might not be what the media or the BMI chart says is desirable, but it is one that is sustainable and will result in the best health outcomes.

To a large extent, our individual genes determine where our weight will settle.  There really is not much we can do about that.  But what we can do is work on becoming the healthiest person we can be, regardless of what we weigh.  By honoring our body’s hunger and fullness cues, being active in a way that is enjoyable to our body, and accepting and appreciating our body where it is now (not 20 pounds less than now), we will truly reach our health goals.  Now that’s a resolution worth keeping.

 

Noms: Zaftigs, Brookline

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Zaftigs

Zaftigs Delicatessen is hardly a new kid on the block when it comes to affordable, addictive Jewish- and American-style food.  Since opening up in Brookline’s Coolidge Corner in 1997, the restaurant has received numerous awards and recognition for its impressive menu of comfort food favorites.  Since Zaftigs is merely a five-minute drive from our home, we often go there for breakfast, lunch, or dinner at least once a month!

The menu at Zaftigs is large but not too overwhelming, separated into Starters, Salads, Sandwiches, Entrees, and Breakfast sections.  We often find ourselves ordering the same things over and over, but we occasionally will go out on a limb and try something new.

This past Friday evening, we were in the mood for sandwiches.  Joanne ordered her usual Nanny Fanny sandwich, which typically is made with corned beef, coleslaw, Russian dressing, and Swiss cheese on marble rye.  This time, however, she swapped out the beef and had roasted turkey instead and asked for a small salad as her side.  Jonah went for his favorite grilled cheese on challah bread (pictured above), asked them to throw some tomato slices in there, and also had a side salad.

The turkey Nanny Fanny was a really nice change from the usual corned beef version.  The turkey was tender and juicy, and the coleslaw in the sandwich added a wonderful amount of sweetness and crunch.  Zaftigs is known for its generous portions, and this overflowing sandwich was no exception. Jonah’s grilled cheese was ooey gooey and delicious, definitely a warm and comforting choice for a chilly December evening.

Given the size of Joanne’s sandwich, she was fully satisfied with eating half for dinner that night and saving the other half for lunch the next day.  And since the whole meal came out to only about $27, it was a real deal, as we basically got three meals out of it!

Zaftigs is truly a gem in Coolidge Corner (A new one opened up in Natick recently and is equally delicious.) and we will continue to go there for breakfast, lunch, dinner and everything in between!

Extreme Disappointment

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In general, I don’t watch reality weight-loss shows. I used to. Biggest Loser was one of my favorites. I was always in awe of how many pounds the contestants would lose each season, many of them shrinking to half of their starting size. But, ever since I became a dietitian, I view these shows in a much different light. Shows like My Big Fat Revenge, Biggest Loser, and Extreme Weight Loss promote dangerous messages about weight management – namely, that fat people are inherently unhealthy and that the only way to be healthy is to lose copious amounts of weight quickly by drastically restricting one’s calories and exercising like a maniac.

Despite my dislike of these shows, I do (rarely) catch an odd episode from time to time. Many of my clients watch these shows and take what the “experts” say as gospel, so it helps if I am in the know about the latest and greatest gimmicks these shows use, so I can help re-educate my clients.  

Last night, I stumbled across an episode of Extreme Weight Loss that truly disturbed me. In this episode, a 23-year-old woman named Alyssa was the individual who was chosen to undergo a year of restrictive eating and over-exercising courtesy of trainer Chris Powell.  The episode started predictably enough: initial weigh-in tears, a loss of 100+ pounds over the first 3 months (Phase 1), and the inevitable struggles to lose weight during Phase 2 (months 3-6).  

This is where things take a serious turn. After Phase 1, Alyssa found that the weight just wasn’t coming off like it had been before. No matter how much she tried to follow the meal and exercise plan, her weight was at a plateau. So, in order to reach her goal of losing another 60 pounds during Phase 2, she decided to drastically reduce her calories even more, at times eating close to nothing. This resulted in rebound binges and subsequent purging. Alyssa developed an eating disorder (ED).

At this point, the show’s producers should have stopped the program for Alyssa, insisted she get treatment for her ED, and take all of the focus off of her losing weight. Instead, Alyssa had a heartfelt talk with Chris and his wife Heidi (who herself struggled with an ED for eight years), and despite the fact that clearly Alyssa needed help dealing with her ED, they continued to encourage her to lose weight and restrict her calories. She was instructed to eat 1500 calories per day while exercising for at least three hours per day to achieve “healthy” weight loss.

At the very end of the program (and after she had completed the program, losing a total of 200 pounds), Chris offered Alyssa a two-month stay at Shades of Hope, an ED treatment center. While at first she rejected the offer, Alyssa ended up going to the program two weeks later, as it was clear that her eating issues were continuing. Why wasn’t this offer made immediately after Alyssa admitted her ED to Chris? Why did they wait until the end of the year to offer her help?

When someone is struggling with an ED, there should be no talk of trying to lose weight, whether it is in a “healthy way” or not. In a sense, the show itself taught Alyssa how to eat in a disordered (re: restrictive) way, priming her for developing an ED. By letting her continue on in her weight loss program, the show did Alyssa a real disservice and gave the message that EDs are no big deal and are just a “phase” that can be dealt with easily. Unfortunately, EDs are not only extremely damaging (and potentially fatal), but they also often turn out to be a life-long struggle, not something to be glossed over.

These shows are not only doing damage to the contestants, but also doing an enormous amount of damage to their viewers. I am hopeful that one day these shows will run out of steam and stop reinforcing the idea that losing weight and the number on the scale are the end all, be all. Maybe someday shows will promote healthy behavior change, without focusing on the numbers. But, I guess that wouldn’t make for scintillating TV.

Noms: Cook, Newton

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Last weekend, we decided to branch out and try a new restaurant.  Cook, located on Washington Street in Newtonville, opened its doors this past September.  This New American Bistro serves a wide variety of dishes, including snacks such as bacon-caramel popcorn, wood-fired flatbreads, appetizers like shrimp tacos, and a number of entrees for vegetarians and omnivores alike.

We went to Cook on the early side, as we had gleaned from the numerous Yelp reviews that the restaurant can get very busy very quickly.  When we arrived, we were surprised to see a number of television cameras and bright lights – Chronicle, Boston’s daily TV news journal, was shooting there!  We saw Anthony Everett, the host of the show, talking with the head chef, and the cameramen were taking footage of the restaurant patrons, too.  You might just see us on that episode of Chronicle, so keep an eye out!

While there were a number of items on the menu that looked delicious, Joanne ended up going the rather unadventurous route of having the roasted chicken.  It came with a parmesan polenta cake and sautéed broccoli rabe.  The chicken was juicy and tender, the polenta cake was creamy and delicious, and the broccoli rabe was cooked to perfection.  Jonah got the grilled cheese sandwich which was accompanied by a small side salad.  We decided to also share an order of French fries that came with three dipping sauces: a sriracha ketchup, a curry honey mustard, and a creamy bacon dip.  The grilled cheese was excellent, right up there with Rox Diner.  We both enjoyed the French fries with the various dips, although at the end of the meal, we felt like we could have skipped them because we had no room for dessert.

There are a number of dishes we would like to try upon our return, including some of the sumptuous- looking desserts, so we will definitely be going back to Cook sometime in the near future!

He Said, She Said: The Paleo Diet

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Even if you have not tried to “go Paleo” yourself, you at least know someone who has.  Running neck and neck with gluten-free, the Paleo Diet seems to be one of the most popular diets these days.

The idea is to eat how some of our ancestors supposedly ate: inclusion of meat and seafood, fruits, vegetables, eggs, nuts, seeds, and some oils, and exclusion of grains, legumes, dairy, potatoes, refined sugar, salt, certain oils deemed unhealthy, and anything processed.

Should you go Paleo?  Here is what we think.

He Said

Last month while I was at a wedding, I asked a child psychiatrist seated next to me if any experiences from her own childhood inspired her choice of profession.  She smiled, leaned in, and asked me, “Oh, Jonah, do you have a week?”  Both the scope and depth of the topic were much too large to cover in the few minutes before the bride was due to walk down the aisle.  Similarly, how can I possibly do justice to all of my concerns with the Paleo Diet in this small space?  I can’t, so here are just a few of them.

  • No Legumes: Legumes are a staple of the Mediterranean diet, which has been shown in research to reduce the risk of strokes, heart attacks, and cardiovascular disease deaths.  One such study published this summer in the New England Journal of Medicine found the Mediterranean diet’s benefits to be so significant that the study was stopped early because it would have been unethical to delay publishing the findings.  Legumes are a great source of cost-effective and environmentally-friendly lean protein.  Their fiber keeps us satiated, regulates our bowel function, stabilizes our blood sugar, and lowers our cholesterol.
  • No Dairy: One can live perfectly fine without dairy, and many people around the world do just that.  We can get dairy’s nutrients, including calcium and vitamin D, from other sources.  However, anytime we cut out a food group, we have to pay that much more attention to making up for the nutrients it provides, or else we face the possibility of deficiencies.  Such deficiencies are real and do happen, even in our community.  A doctor recently referred an otherwise healthy young athlete to me because it took the woman nearly a year to heal from a simple fracture.  Her body was so deficient in nutrients after going gluten-free and dairy-free that her body was unable to heal itself until the deficiency was corrected.  When we include a wide variety of food groups, such deficiencies are less likely to occur, and we do not need to pay such close attention to the minutiae of our day-to-day eating.
  • Saturated Fat: The Paleo Diet is not necessarily high in saturated fat, as one could choose fat sources that are higher in polyunsaturated and monounsaturated fats, such as fish, nuts, seeds, and certain oils.  However, the potential for excess saturated fat exists if one overconsumes red meat or coconut oil.  One point that really bothers me though is the Paleo Diet’s notion that saturated fat is not actually detrimental to our health.  As I explained in one of my blog entries, it could come to pass that saturated fat is found not to be the concern that we currently think it is, but as of now, the overall body of research does not support that conclusion.  Experts around the world (literally) agree that we should keep our saturated fat intake low in order to protect our cardiovascular health.  To expose our bodies to high levels of saturated fat while banking on the hope that doing so is not detrimental to our health is to take a heck of a risk with our cardiovascular health.
  • Environmental Impact: Even if we were best off consuming animals as our only significant protein source, the planet cannot sustain it.  The United Nations tells us that we as a global society need to move towards a more plant-based dietary pattern for environmental reasons.  Recently, one of my colleagues attended a lecture given by a pro-Paleo author, and she asked him about the environmental impact of the diet.  “Not my problem,” was reportedly his answer.  But it is his problem.  It is all of our problem.  If the earth cannot handle its inhabitants eating a certain way, we have to adjust our ways.
  • Sustainability: As with any diet, the results are only as good as the changes are sustainable.  There are thousands of life events that can bring a diet to its end: the diet worked great, but then the holidays came around, or I started a new job, or someone brought leftover Halloween candy into the office, or I got sick, or I went on vacation, or I didn’t have the willpower to keep it up, and so on.  For reasons I can only hypothesize, when a diet is working, people praise the diet, but when the diet stops working, people blame themselves or some exterior event.  For a nutritional approach to be successful, it has to work for the long term, not just at first, and it has to be flexible enough to weather the challenges that life brings our way.  Ask yourself honestly whether the Paleo Diet meets these criteria.
  • Accuracy: According to archaeologists, the Paleo Diet does not even accurately reflect how our ancestors ate.  Not only did the diets of paleolithic man vary greatly depending on geography and season, but archaeologists also have evidence that their diets did include legumes and grains, two food groups excluded from the Paleo Diet.  Furthermore, virtually all (if not literally all) of our food supply has changed with agriculture, so our blueberries, carrots, lettuce, tomatoes, and bananas, for examples, barely resemble those that our ancestors ate.

Realize that people are much more likely to be vocal about their dietary successes than their disappointments.  For example, if a given diet works for 5% (which is actually a pretty typical success rate for most diets) of the 10,000 people who try it, 9,500 disappointed people will stay relatively silent about their experiences while 500 individuals rave about it online, at the gym, in the grocery store, at the office, over Thanksgiving dinner, etc.   Therefore, the impression we get of a given diet’s success is skewed and not reflective of reality.  If you have gone Paleo yourself and you feel great, it works in your life, and you are enjoying it, great, more power to you.  For most people though, the Paleo Diet is much too strict to integrate with their lifestyles in any sort of sustainable way. 

She Said

While the Paleo Diet might seem to be a relatively new eating style to many people, it has actually been around in one form or another for almost 40 years.  In 1975, a gastroenterologist named Walter L. Voegtlin published The Stone Age Diet: Based on In-Depth Studies of Human Ecology and the Diet of Man, in which he suggested that following a diet similar to that of our caveman ancestors from the Paleolithic Era would improve one’s health.  The diet, which consists of a higher protein, fiber, and fat intake and a lower carbohydrate intake, is said to minimize one’s risk of chronic disease as well as result in weight loss.

The diet recommends a high intake of fruits and vegetables, which in addition to supplying a plethora of vitamins and minerals, also provides fiber (which helps with GI function and blood sugar levels) and antioxidants (which help fight the trouble-causing free radicals that try to wreak havoc on our cells).  Fruits and veggies are also an excellent source of potassium, which helps regulate blood pressure.

There is some evidence that a Paleolithic diet can be beneficial for those with type 2 diabetes at risk for cardiovascular disease.  A 2009 study compared the Paleo Diet and the diabetes diet to see which was more successful at managing patients’ blood sugar, weight, cholesterol levels and other health factors.  Overall, the patients that followed the Paleo Diet for 3 months had better blood sugar management levels, increased levels of “good” HDL cholesterol, lower blood pressure measurements, and greater weight loss than those who followed the diabetes diet.  After looking at the patients’ food recalls, the investigators found that the patients who followed the Paleo Diet had a higher intake of fruits, vegetables, meat and eggs compared to the patients who followed the diabetes diet.  In addition, the Paleo group took in fewer total calories, carbohydrates, and saturated fat while having a higher intake of unsaturated fat and several vitamins than the diabetes diet group.  All of these results point to the Paleo Diet being a viable option for those looking to better control their type 2 diabetes and manage cardiovascular risk factors.

I am a fan of decreasing one’s intake of processed foods in general.  These foods are often made with large amounts of sugar and sodium, and some even contain trans fats to improve the food’s taste and/or make it more shelf-stable.  According to the Academy of Nutrition and Dietetics, about three-quarters of our sodium intake comes from processed foods.  High sodium intake is linked with high blood pressure, which is associated with a higher risk for stroke and heart attack.  Aside from increasing our calorie intake and possibly leading to weight gain, high sugar intake has been linked with the development of type 2 diabetes.  Trans fats, or manmade fats, raise our “bad” or LDL cholesterol while lowering our “good” or HDL cholesterol.

In general, I am not a fan of “diets,” that is, any eating plans that lay out a set of diet rules that one should follow in order to reach his or her health goals.  But, the Paleo Diet has some interesting principles and could be advantageous for certain individuals.