I know that many people might not believe it, but sometimes I need to “sneak” vegetables into my diet.  Being a registered dietitian, I am sure this seems odd!  Sometimes I do find myself craving a big, crispy salad or string beans, but there are also many other times when I am not feeling like vegetables, no matter how healthy I know they are. We all know that veggies have so many wonderful vitamins and minerals and are important for overall health. So, what’s a dietitian to do when veggies do not seem so appealing?

Well, in times like these, I try to squeeze veggies into my meals and snacks as much as I can.  At breakfast, I will add spinach or broccoli to my omelet and have it with salsa.  For a post-workout snack, I have been making a green smoothie using baby spinach or kale, almond milk, yogurt, and banana.  It’s amazing how you cannot taste the spinach at all in the smoothie – it tastes just like a banana shake!  With dinner, I try to mix cooked veggies into at least one part of the meal.  If I am having mac and cheese, for example, I will mix in some frozen peas or broccoli florets.  If pizza is for dinner, I will add peppers and onions for toppings.  And of course, veggie-based soups, like zucchini bisque, are an easy way to increase one’s veggie quotient.

Many of my clients struggle with their vegetable intake, and I completely understand this.  However, it is easier to sneak these nutrient-packed superstars than you may think.  Get creative! 

Earlier this week, I posted a blog by Joan Salge Blake, a nutrition professor at Boston University, in which she discussed a research study that looked at the impact of calorie distribution on weight loss.  The researchers found that subjects who consumed a large breakfast and small dinner lost more weight than subjects who consumed the same number of calories, but flip flopped their breakfast and dinner intakes.

Those of you familiar with how we work might have been surprised to see me post an article that seemed to give weight loss advice.  Our treatment philosophy is in line with the reality that when people eat well and are physically active, weight tends to take care of itself.  On the other hand, when people make weight loss in and of itself too much of a priority, they are likely to take approaches that can be unsustainable, unhealthy, and sometimes dangerous.  Then they blame themselves and a supposed lack of willpower when the real problem was the approach.  Because I have held this stance for years, my decision to post what looks to be a weight loss advice article probably seems a bit contradictory.

But it really isn’t, and here’s why: Even though the blog does discuss weight loss, I see it as more about health than weight.  Professor Blake wrote, “Since the hormone ghrelin, which increases your appetite, was lower during the day in the breakfast group, these women also experienced higher levels of satiety, or that filling of fullness, throughout the day.  In addition, large breakfast eaters also had significantly lower levels of insulin, glucose, and fat in their blood, which may help lower the risk of diabetes and heart disease.”

In other words, the subject group that consumed the larger breakfast seemed to be healthier than the group that consumed more calories later in the day.  They had better blood markers, felt more satisfied, and were in a better position to make sound food choices later in the day.

And yes, they lost more weight than the other group too, but that only reinforces the point I made earlier: When we make lifestyle choices that make us healthier, weight usually takes care of itself.

The other night, I was watching the show 20/20 on ABC, and I was horrified to see a story they were doing on the “Tongue Patch Diet.”  The procedure entails having a piece of hard plastic mesh temporarily sewn onto one’s tongue, the purpose of which is to inflict pain if the individual tries to eat any solid food.  Apparently, this technique originated in Latin America and is all the rage, with 800 individuals undergoing the procedure at one Venezuelan clinic.  After the patch is put in place, the individual is then put on a strict, 800-calorie-per-day liquid diet or shakes and low-calorie beverages for one month.  In addition, the individual must exercise 45 minutes per day.  After all is said and done, the individual would be expected to lose between 18-20 pounds.

This bizarre intervention made me think back to the absolutely crazy “K-E Diet” aka “Feeding Tube Diet” featured on a number of news shows last year, which involves having a doctor place a nasogastric feeding tube into an individual for 10 days, preventing the person from being able to orally eat anything for that period of time.  The patient carries around a solution in a bag or purse, which delivers 800 calories per day of protein, fats, and water through the nasogastric tube directly into the stomach.  Given that the patient is not taking in any carbohydrates, he or she will be put into a state of ketosis, during which the body burns fat instead of carbohydrate.  In similar fashion to the “Tongue Patch Diet,” the individual can expect to lose up to 20 lbs in only 10 days.

There are many things that disturb me about the above procedures. Both are unrealistic and potentially life-threatening techniques to achieve weight loss.  Obviously, since both are basically very low-calorie diets, the individuals will lose weight quickly.  And as I have spoken about numerous times, using drastic measures to lose weight quickly almost always results in gaining the weight back and then some.  As for the “Feeding Tube Diet,” while being in ketosis might not be harmful in the very short-term, long-term ketosis can result in serious kidney and liver damage.  And since our brain almost exclusively uses glucose (the breakdown of carbohydrate) for energy, going low-carb leads to “brain fog,” where the individual feels groggy, fatigued, unable to concentrate, and irritable.

The “Tongue Patch Diet,” honestly makes me feel queasy. The thought of putting something into one’s body to inflict pain on oneself for eating solid food just seems barbaric.  Why don’t you just hire someone to hit you over the head with a hammer every time you pick up a French fry?!

What I think disturbs me the most about the above is that there are doctors out there who believe these procedures are totally legit and health promoting.  This sends a really hurtful and potentially dangerous message to millions of people who are desperate to lose weight.  If a patient came into my office and mentioned wanting to try out one of these procedures, I would recommend considering the following: Does this seem extreme?  Does he or she feel like this is something that will promote or hinder his or her health?  When the tongue patch/feeding tube comes out, how is he or she going to eat healthfully?  Hopefully after thinking things through, he or she will reconsider these dangerous methods and instead work on healthy, safe, and maintainable nutrition changes.

Having worked with hundreds of eating disorder (ED) patients and their families, the question I am most often asked by the patients’ parents is “How did I miss the signs?” EDs by nature are a very secretive disease, and those who suffer with them are pros at hiding them.  Despite this, there are some red flags that might signal that your daughter/son/sister/brother/friend could be struggling with an ED.

1. She is obsessed with watching the Food Network and/or cooking shows, finding recipes online, and with baking and/or cooking for others, but rarely partakes in her own creations.

This is a subtle, but clear sign that something is up.  People with EDs are preoccupied with thoughts about food – where to get it, how to prepare it, and what they can/cannot eat.  Therefore, it is natural that they would turn to TV shows about food, cooking magazines/books, and finding online recipes to fuel this obsession.  Of course there is nothing wrong with doing these things per se, but the key is that a person with an ED rarely, if ever, will eat any of the foods she creates.  Instead, she will bake an elaborate cake and offer it to her family and friends to eat while she has none.  In this way, the individual can vicariously enjoy the food without having to eat any of it.

2. He used to eat dinner with the family every night, but now he always says he ate dinner out or at a friend’s house.

Parents want to be able to trust their son or daughter.  If your child tells you that he already ate, you, like most parents, would believe him. But if your child has always eaten dinner with the family and this new behavior becomes a daily occurrence, then something could be up.

3. She used to love going out to eat and to the movies with her friends.  Now it seems like she finds any excuse to avoid these activities.

As mentioned above, one of the cornerstones of EDs is secrecy.  Most teens with EDs are not open about their disorders with their friends, so it would become pretty clear to her friends that something was wrong if she went out to eat with them and did not order any food.  For most individuals with EDs, simply avoiding these situations is the easiest way to keep their ED under wraps.

4. He used to love a wide variety of food, but lately he seems to only eat a few different foods.

There are plenty of kids who are picky eaters.  The red flag arises in the case of a child that formerly was an omnivore who has now started to cut out certain foods/food groups in an obsessive manner.  Usually this elimination happens in the context of a diet (e.g. “I want to lose some weight to be better at running track,”), so he might begin by limiting carbohydrates and fats, but soon the list of unacceptable foods starts to grow.  This could translate to no longer eating fruit because it has “too many carbs,” eating salad without dressing as it has “too much fat,” etc.  If your child will only eat certain “safe” foods and balks at the idea of increasing food variety, you might have a problem on your hands.

5. She all of a sudden wants to be a vegan, but is unclear about why.

Veganism (the omission of any and all animal products from the diet) is not inherently indicative of an ED.  The question to ask would be why the individual wants to become a vegan.  Is it because, for example, she feels that eating animals and their products is cruel or bad for the environment?  Or could it be another way for her to eliminate foods from a previously varied diet?  By declaring oneself vegan, that means that meat, fish, poultry, eggs, dairy, and a slew of other food groups will be off the table.  In a way, veganism can be used by ED individuals as way to legitimize their restriction.  Of course, this is not always the case, and there are plenty of vegans who are not disordered, but figuring out the motive behind this decision is paramount.

Now, am I saying that if your child exhibits one of these red flags that he/she definitely has an ED?  Of course not.  But I think it is important for parents, siblings, and friends to be aware of these subtle signs and to take action if necessary by talking to a professional such as a doctor, therapist, or dietitian who specializes in EDs.  Forewarned is forearmed.

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

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

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

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

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

How do you like your vegetables?

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

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

Is it just me, or does it feel like almost every celebrity out there has been talking about their latest and greatest cleanse?  You know, the one that helped them to lose 20 pounds in only two weeks, gave them abundant amounts of energy, and helped their bodies remove all of those pesky toxins. 

There are numerous cleanses and detox diets out there, but perhaps the most famous one is the Master Cleanse.  Championed by celebrities like Beyonce and Pink, the Master Cleanse is basically a modified juice fast which promises to detoxify the body while also helping you lose weight fast.  For 4-14 days, the individual must abstain from solid food and is only allowed to ingest a drink made with lemon, maple syrup, cayenne pepper, and water.  After the cleanse is over, the individual is instructed to slowly add solid food back into their diet, starting with things like vegetable soup, followed by fruits and vegetables and so on.

As you can probably guess by now, I am not a fan of the Master Cleanse or any cleanse or detox diet, for that matter.  First of all, yes, you will lose weight on a cleanse, but that is mainly just because you are creating a serious calorie deficit.  Most of that weight will likely be water and muscle tissue, not fat tissue, and your metabolism will slow down to a crawl.  Once you stop the cleanse and return to your old eating habits, you will gain the lost weight back and then some! 

Secondly, you will feel completely cruddy while on the cleanse; most people report nausea, headaches, sluggishness, fatigue, dizziness, and numerous gastrointestinal issues (usually diarrhea and/or constipation).  Thirdly, the lemon-maple syrup-cayenne concoction is almost completely devoid of any nutrition, save for the carbohydrates from the maple syrup and the vitamin C from the lemon.  Your body not only needs protein, fat, and carbohydrate to function, but also the myriad vitamins and minerals that a healthy diet provides.

Finally, your body does a perfectly good job of detoxification without the aid of a cleanse.  Your liver, spleen, lungs, and kidneys are already pros at keeping you healthy!

So, skip the cleanse. Your body will thank you.