The freezer section contains some great options for healthy eating.  The standouts to me are the frozen vegetables and fruits, many of which contain neither added salt nor sugar.  Some of my patients use frozen produce either as a cheaper alternative to, or as a supplement to, fresh fruits and vegetables.  For example, if somebody does his weekly shopping on a Sunday in order to prepare for the work week, some of the produce may start to wilt, rot, or mold by late in the week if simply left on the counter or in the refrigerator.  Rather than make do with a small amount, or even zero, fruits or vegetables for the latter part of the week and weekend, he may use frozen fruits and vegetables until his next Sunday shopping trip.

A barrier some of my patients face when it comes to eating whole grains is the time it takes to cook them.  Products like frozen brown rice and frozen quinoa can cut down on cooking time immensely.  Brown rice, for example, might take somewhere in the ballpark of 45 minutes to make from scratch on a stove top, while frozen brown rice is ready after just a couple of minutes in the microwave or on the stove.  Similarly, frozen, pre-cooked steel cut oats can fill a need for somebody who wants a healthy, hot cereal for breakfast, but is too busy getting ready for work or school to do any significant cooking.

I cannot tell you how many new patients with celiac disease have come to me feeling discouraged that they could not find any gluten-free bread at their grocery store.  However, many gluten-free baked products reside in the freezer section, not the bread aisle where people understandably often look.  I found a wide range of gluten-free products in the freezer including not just breads, but also English muffins, waffles, frozen meals, and cupcakes.

Other products marketed towards those with food allergies or intolerances often reside in the freezer section too.  For example, I found a pizza made with a milk-free cheese substitute that I expected to taste, well, horrible.  But I bought it, tried it, and get this: I liked it.

Next installment, I will discuss the dairy section . . .

Body Mass Index (BMI), or the relationship of one’s height and weight, is most often used by the medical community to determine someone’s health risk.  BMI is really meant to assess the health of populations, not individuals.  If a researcher wanted to assess the health of adults in Massachusetts, for example, BMI could work quite well.  The problem is that it is inappropriately applied to individuals, partly because it is easy to do so as opposed to monitoring other markers that require more expensive testing and/or equipment.

There are a number of examples that call the BMI’s accuracy and usefulness into question.  For instance, Tom Brady’s BMI of 27.4 and Paul Pierce’s BMI of 26.5 put them squarely in the “overweight” BMI category, which is associated with increased risk for heart disease, diabetes, and a number of other health problems. Obviously, both of these athletes have a great deal of muscle mass and are in top physical shape. Would you call them “overweight?”  Of course not!

On the flip side, there are numerous people who fall into the “normal weight” BMI category that can’t even climb a flight of stairs without getting winded and have high cholesterol or high blood pressure.  In other words, lack of muscle mass can contribute to somebody being labeled as “normal weight” even though they are actually pretty unhealthy.  Some individuals with eating disorders also have “normal” BMIs, as do some formerly overweight patients who have lost weight due to diseases such as cancer or AIDS.  So clearly being healthy is about more than just one’s BMI.

Instead of just focusing on one number, there are so many other factors we need to take into consideration. Measuring blood pressure, cholesterol levels, and waist-to-hip ratio are just a few ways to get a better picture of someone’s health status. Other things to look at could be an individual’s physical fitness, mental and emotional health, as well as feelings of well-being. I think it’s important for all of us to remember that one number cannot tell us everything about a person’s health and that there are many ways to define what health is.

A young couple passed by me in the grocery store the other day.  I heard the woman remind her partner, “Remember, we are only shopping the perimeter.”  You may have heard the same advice that she was presumably referencing, that purchasing foods only from the store’s perimeter is somehow healthier than including the interior aisles.  Like much of pop culture’s nutritional advice, this tip is an overgeneralization that, if followed, can cause people to unnecessarily skip plenty of healthy foods.

The stick-to-the-perimeter advice has some merit in that it encourages people to load up on fruits, vegetables, dairy, seafood, and poultry, which are traditionally located on a store’s borders.  The advice also tends to reduce the temptations to which people are exposed.  In other words, somebody who might buy Oreos on impulse is spared that temptation by entirely avoiding the cookie aisle.

Just because a food resides on the perimeter, however, does not mean it is one of the healthier foods in the store.  For example, guess what my neighborhood Whole Foods has on the perimeter: the bakery section!  Even on the perimeter, we are still subjected to temptations and less healthy foods mixed in with the rest.  In other words, the store’s perimeter is like the rest of life: we have to be able to make sensible and balanced food choices wherever we go.

As I considered what this woman said to her partner, I thought about some of the healthy foods they were missing, foods that not only would they never buy, but that they would never even see.  I went down the interior aisles a bit slower than usual, deliberately taking some time to explore the inventory and to consider some of the healthier options available and how one might choose to utilize them.

Following this entry will be a short blog series in which I am going to share some of my interior aisle reflections with you.  As I write, I will avoid singling out products by name, as I do not want anybody to mistake these musings as endorsements.  I invite you to post comments, including mentions of some of your favorite interior aisle foods and how you use them.

Next installment, we begin with the freezer aisle . . .

You may have read the blog entry that Joanne recently wrote in which she discusses the dangers of believing everything written about nutrition on the internet without considering the source.  One of the reliable sources of nutrition information online is the blog that Joan Salge Blake, MS, RD, LDN writes for boston.com.  In a recent post entitled “Do Sugar Substitutes Cause Cancer?” she discusses the widely-held belief that artificial sweeteners cause cancer, the historical roots of this belief, and the lack of any credible research whatsoever to support this belief.

Apologies to my former English professors who would frown at my decision to use “belief” three times in a single sentence, but I did so to emphasize my point: one of the main reasons that online nutrition information is often faulty is because the messages being conveyed are really just beliefs, theories, ideals, or hypotheses disguised as facts or well-supported conclusions.

Last month, I attended the Cardiometabolic Health Congress.  For four days, I sat in what might as well have been a series of statistics classes.  The presenters understood that the credibility of information rests on the quality and quantity of research supporting it.  Reliable information, like Joan Salge Blake writes about and Joanne and I use in our counseling, is founded on an evidence-based research approach.  The ethics of our profession demand it.

The authors of most website content, however, are bound to no such standards and are free to write whatever they please.  The result is that hypotheses are often misrepresented as conclusions despite the void of supporting data.  Remember this the next time you read about nutrition online.  Ask yourself who the author is, what his or her credentials are (if any), and be suspicious of claims that are not backed by reputable research.  If you get confused or have questions, ask one of us.  That’s what we are here for, and we are happy to help!

The internet is a wonderful tool.  I often wonder how in the world we were able to survive without it 20 odd years ago.  It provides a wealth of knowledge at our fingertips, and we can find the answer to almost any question with the stroke of a key.  Unfortunately, while the web has a lot of solid information about various topics, it also has a vast amount of bogus information.  This is markedly evident when looking for answers to nutrition questions.  I can’t tell you how many clients (as well as many of my friends and family), tell me about the latest diet or miracle food that they found out about online. Inevitably, there is very little truth to these food myths.

Here are some examples of the misinformation one can find online:

• Carbohydrates make you fat/gain weight.
• Bananas are not as nutritious as other fruits.
• Foods that are high in dietary cholesterol cause high blood cholesterol.
• Foods that contain fat will make you fat.

Given our thirst for immediate information, many of us turn to the web to help us figure out what is true and false.  The problem is that these diet myths are almost always written by individuals who are not nutrition professionals.  What is truly scary is that nutrition information is not policed on the internet.  Anyone can write almost anything and call it truth, and then millions of people can read it and be misinformed.

The moral of the story?  Don’t believe everything you read online about nutrition!  Unless the person writing it is a registered dietitian and has peer-reviewed, valid research to back it up, it is very likely that this nutrition information is false.  If you have questions about what foods will make you healthier, talk to your friendly registered dietitian, as he or she has been trained in nutrition and is qualified to answer your questions.  Be a savvy internet-user, and don’t believe the hype!

Earlier this week, I recorded a Podcast on cholesterol.  Stan Starsky, author of the snack cookbook “Peace, Love, and Snacks,” conducted the interview.  My apologies for the less than stellar sound quality; next time I will be sure to use a different phone.

If you have any questions about this topic, feel free to post them here or on our Facebook page.

In the FAQ section, I touch on why the “just tell me what to eat” approach to counseling is often unproductive.  In fact, many of my clients are people who previously tried this technique with other dietitians and came away dissatisfied.  Oftentimes the patient blames the practitioner when really neither one of them, but rather the approach, is at fault.

Yesterday, a new patient and I fell into the “just tell me what to eat” trap together.  After she told me about her issues and goals, we discussed different options for moving forward.  I suggested a collaborative approach, but she felt she could benefit from starting from scratch and having me create a meal plan for her.  In other words, she wanted the “just tell me what to eat” approach.  We discussed the pros and cons of this method and eventually went ahead with it.

As soon as she looked at the menu I created for her, I could see the disappointment and frustration on her face.  “Do you have kids? she asked me.  She continued on that the meal plan I created would not work for a mother of young children like herself.  The irony is that I created her plan using meals and snacks that I know from experience have worked for other busy parents, but the point is not whether or not they work for other people but rather that they did not work for her

I take the blame for this.  While I agreed to the “just tell me what to eat” approach because I wanted to respect the client’s wishes and because I wanted to give her the benefit of the doubt that she might be the rare exception of a patient who responds well to it, in hindsight perhaps I should have tried to be more persuasive about taking a different approach.

The problem with the “just tell me what to eat” technique is that everybody is indeed different and what works for one person is not automatically going to work for another.  After all, we are dealing with real people, not homework case studies in some nutrition textbook.  Real people have likes and dislikes, time constraints, children and spouses with their own food preferences, etc.

The client is the expert in his or her own life, not the practitioner.  Therefore, a much more effective approach is for both the client and the practitioner to bring their expertise to the table and figure out together how to create change.  I would welcome the opportunity to sit down with this woman again and this time collaborate on a plan that will not only help her towards her nutritional goals, but also work in her life instead of just on paper.

One of my patients recently told me the story of when she began yelling at her pregnant friend, “You are killing your baby!”  What had the friend done that was deemed so horrible that it warranted such a harsh reaction?  She had ordered a smoothie in the mall food court.

Dr. Steven Bratman coined the term “orthorexia” to mean an unhealthy obsession with healthy eating.  While orthorexia is not an official medical diagnosis, a movement exists among practitioners that perhaps it should be.  Being a dietitian and not a doctor, I have no business diagnosing anybody with anything, let alone with a condition that does not officially exist.  Having said that, I do occasionally get concerned that a patient’s well-intentioned pursuit of healthy eating has crossed the line from constructive to destructive.

In such cases, the patient usually recognizes, on some level at least, that something is amiss.  Consider the woman in the preceding example.  She used terms like “fear” and “obsession” to describe her relationship with food and admitted that her attitude towards food was negatively affecting her friendships.  Because she was so forthcoming about her concerns, we were able to have an honest talk about the matter and discuss what she wants to do about it.

Unfortunately, not all “orthorexic” patients realize they might have a problem.  I find that these patients tend to have an expectation that I share their black-and-white views regarding nutrition, and when they discover that I do not they are stunned.

The way I look at it, humans often risk their health for the pursuit of pleasure.  Smoking is a blatant example, but plenty of more subtle examples exist.  Consider somebody who drives to the movies, thereby risking a debilitating or even fatal car accident for the sake of enjoying a film.  Consider those who love the bustle of urban life so much that they forgo the better air quality and lower crime rates of the countryside in order to live in the city.  Countless other examples abound.

Why, then, is it so hard to understand that the vast majority of us choose to sometimes eat less healthy foods for cultural, social, or financial reasons, or simply because we like the taste?  If I took the stance that these factors should have no bearing on food choices, then I would be out of touch with the vast majority of my patients and therefore an ineffective dietitian.

When the pursuit of healthy eating becomes so all-consuming that the pleasurable aspects of eating are shunned as second-class citizens, other areas of the patient’s life can suffer.  Whether orthorexia is ever adopted as an official diagnosis or not does not change the fact that this phenomenon exists.

The good news is that help exists too.  If you are reading this blog and saying to yourself, “I can relate to this,” consider speaking with your doctor about it and asking to see a dietitian who can help you to find a better balance in your relationship with food.