Drop It and Eat: Drop the Diet, Manage Your Weight

Saying Goodbye to Your Jeans—A New Perspective on Progress

noreply@blogger.com (HikerRD) — Fri, 27 Jan 2012 18:09:00 +0000

I bought a new pair of jeans yesterday. For me, trying on jeans is right up there with going for a new bathing suit. No, not particularly positive. In fact, while I love fashion, shopping for clothes and shoes is never anything short of depressing. I can’t find my size shoes in stores (9 1/2 AAAA), and those in catalogues are often fashion failures. My shoulders are broad and my arms long, making well-fitting tops and jackets impossible to find. I’ll stop here; I think you get the idea.

I needed a new pair of jeans. Somehow, a few years ago, I had convinced myself to purchase a pricey pair of dressy jeans, and now I knew it was time to move on. Why? Because every time I put them on, while they looked fine, I was less than comfortable. Maybe knowing the phrase muffin topping had an impact—I just couldn’t get past that visual. And wearing them kept me from fully enjoying my dinners out and my socializing.

So I selected a new pair from a boutique with a limited but fabulous selection of clothes, and picked them (drum roll please) based on their fit and comfort. Yes, they were a size larger than my last designer-type jeans, in spite of my weight remaining the same over these years. And so I bought them.

Jeans were a topic raised in many patient sessions last week. (You thought I only talked about food, eating, calories, I suppose?) Marie, who has struggled with obesity and binge eating disorder for many years, reported her approach to moving on. She was ridding her closet of everything over size 20, as she now comfortably wears an 18, having lost, I forget exactly, but somewhere near 60 pounds (while enjoying such foods as cookies and bagels, I’ll add). The size 20s are really a just in case—I don’t think she truly trusts that her progress is for real, in spite of it being over a year and a half of consistent behavior change with resulting weight loss.

Even more notable was the message I received from Dana, describing the emotions of parting with her old jeans, her anorexic jeans, a remnant of her anorexic self. After discussing her decision to discard a stack of unhealthy-sized jeans, she followed up her session with this note, (excerpted with her permission, below):

“I must tell you that when I pulled down my street from my appt with you, the trash truck was at the house before mine... and as I pulled into my garage I watched in the car mirror the big claws grabbing the trash can to empty it into the truck. My jeans. I did it. Lori, I totally did it. I successfully threw them out. I'm feeling so mixed about this enormous sudden decision to get rid of those jeans. I'm so glad I told you I did this, as I originally wasn't going to tell anyone because to me it signifies weakness... I will never fit into those jeans again... I will never be as disciplined as I once was for so many years... I will FEEL now... there will be no more dismissing life... no living in a state of fog and numbing out... no more living passively...I must now be present in life.

I didn't want to tell you (or anyone) about throwing away the jeans because I feel like I'm a failure and I'm giving up. Logically I know this not to be true... but the emotional level is a whole other thing.

This feels a little overwhelming right now. Never did I imagine it would stir this much emotion. That pile of jeans symbolized so much - probably more than I can comprehend. All these years (I guess of progress and agonizing work) it took me to build that pile. The rejects. What does it mean for me now? The only descriptive phrase I can come up with is sink or swim. I made the decision to get rid of that pile of jeans that are unhealthy sizes for me. This means I forfeited the chance to fit back into them, ever again, because they are no longer in my possession.”

“Right this minute I am in the midst of surrendering to better health at a bigger size. I feel weak, but I also feel a pull to try. The challenge is to learn how to accept this larger size as a new way of life...”

“I don't like the size I am, but then I was never happy with the size of those jeans I just threw to the garbage...”

“Just a lot of feelings around this. You're right, maybe it is sort of like mourning…”

Wow. I am so impressed with her action, and her newfound ability to communicate her thoughts and feelings around this. In the past, these would have been masked with either binge eating or restriction. She couldn't have done it without the clarity that comes with nourishment, and, of course, with good counseling.

Clearly there’s much more to purging the jeans and buying a new pair. It’s about accepting change, and believing that it’s okay. It’s about trust, that you really have progressed, and you can continue to stay the course. And it’s about getting comfortable, physically—choosing sizes and styles that are appropriate, allowing your self to simply feel good. Maybe it's time to clear out your old jeans.

Your thoughts?

Colonic Irrigation For Weight Loss?

noreply@blogger.com (HikerRD) — Fri, 20 Jan 2012 03:39:00 +0000

Colonic irrigation may seem like a positive,
"relaxing"and necessary procedure but...

I’m okay with my weight, and with my body. Most days, that is. But what if I opened my email to find a Groupon that lured me with the promise of feeling better, of losing weight, of being cleaner, healthier? And what if I passed on it the first time, simply ignored it, but received it again, when I wasn’t in my best place? And what if I didn’t have the wisdom to know how I was being played with, manipulated, misinformed, for them to make a buck off me?

I ignored the promise of a cleaner colon and all of its wonders.

That was the first time. This time, particularly after inspiration from Carrie’s post at E-D Bites, I needed to post my rebuttal.

Won’t Colonic Irrigation (and laxatives, and diet pills) solve the obesity epidemic?

Here’s what the Groupon promised:

Colon hydrotherapy gently purges digestive tract of debris & toxins to ease chronic pain & restore organ function
May kick-start weight loss
Noninvasive and relaxing treatment
Purges body of impacted debris and toxins
Can boost organ function and relieve pain

And the facts?

From Medicare:

“Colonic irrigation is a procedure to wash out or lavage material on the walls of the bowel to an unlimited distance without inducing defecation. This procedure is distinguished from all types of enemas, which are primarily used to induce defecation. There are no conditions for which colonic irrigation is medically indicated and no evidence of therapeutic value.” Given its uselessness, it is not a covered service. Bummer.

From the Cleveland Clinic

“While the idea of ridding one’s body of built-up toxins from sugar, alcohol, caffeine and meat is appealing, the truth is that the data supporting colonic cleansing and body “detoxification” have not been studied sufficiently in clinical trials.

Carol Burke, MD, Director of the Center for Colon Polyp and Cancer Prevention in Cleveland Clinic’s Digestive Disease Institute, warns of the hazards and lack of evidence to support these therapies. “There is no evidence to support their benefit; there is only evidence of their complications,” adding that complications may include rectal perforations from colonic irrigation and enema therapy, oftentimes requiring surgery.”

From Medial News Today:

“Twenty past studies about colon cleansing published over the last decade were analyzed by researchers, and found little evidence that the procedure offers any benefits. Instead, a number of the studies noted side effects such as cramping, bloating, vomiting, electrolyte imbalance and kidney failure.”

And really, calling the procedure relaxing and noninvasive? Do we need a visual here to remind us of what the process is? (Sorry, no photos this time).

My reaction might seem targeted to colonic irrigation. But really it’s about being taken advantage of—by the media, by those who ought to know better, and by our own vulnerability. Because products promising weight loss, laxatives and colonic irrigation lying about cleansing our weight away, only cause us damage. We so desperately want to believe, to hope that something will fix our ills, will improve our weight, will help us feel better about ourselves.

We’re bombarded everywhere by media messages—as well as comments from friends and strangers, directly and in overheard conversations—about their latest, their best diet ever. Their solution, found at last, if only for this week.

It comes from people you trust—like your chiropractor, whose hands of gold and makes you feel physically better with his adjustments, perhaps. For a significant contribution to his monthly income, he encourages outrageous products such as 3 day cleanses.

Yup, several of my patients, including those struggling with bulimia have been victim to the transfer of trust—the belief in the provider who has been trustworthy in some arena of care—but who is damaging in others.

Angie believed she had multiple allergies. What she had was the start of an eating disorder that snowballed into severe restrictive eating and reliance on products her chiropractor sold her. In spite of unhealthy behaviors and food avoidance, she was sold a line of products that contributed to her belief that cleansing was the answer. Her health deteriorated, and by the time she presented to me I knew she needed a higher level of care. Seeing her chiropractor ultimately kept her from following up with her doctor, who might have had the wisdom to see the harm she was doing to herself.

It doesn’t help that we are manipulated at every turn about what is normal and realistic, regarding our appearance. I am not saying that the media causes eating disorders—merely that it influences how we see and feel about ourselves. As we age, skin wrinkles, and hair may gray. Trust me, I know. Weight may fluctuate, as does our level of activity and eating. If we compare ourselves to our younger selves, we may yearn to change. If we look to the photos in magazines and online of individuals our age, we are misguided into believing they are real.

Please view this amazing video, which lets you in on the secret:

http://www.youtube.com/watch?v=S_vVUIYOmJM

Your Challenge

In this post New Year’s period, have you been challenged, triggered by the pull of diets or diet aids? I’d love to see your responses to the crazy messages you’re enduring. How did you twist it to avoid the pull? What did you say to yourself to come to your senses? Please share via the comments on this post!

And if you need help knowing what something isn’t a wise choice, ask in comments as well! Again, check out E-D Bites post for examples.

The Hyperbole of Weight Gain—The Problem With Relying On How You Feel.

noreply@blogger.com (HikerRD) — Fri, 13 Jan 2012 03:57:00 +0000

Do you think she struggles with her size?

“We’ve got a big problem here”, she said, in a most unsettled way. “I’ve gained like 85 pounds”. I’m like a great heifer, no, a large female milking cow—whatever they are called”. I am F-ing fat, and I can’t fit into my pants, and it’s not good. I’m eating, and now I’m hungry when I wasn’t before, and it feels like I just can’t stop.” Kara was able to sarcastically acknowledge that no, it wasn’t 85 pounds, but certainly 35 or so added pounds gained this one-week period between our sessions. All while trying to increase her intake, to gain some weight gradually, following a period of weight loss from her already-too-low place.

Hyperbole, and then some, right? Yet this true story from the past week speaks to a feeling, one that was anything but exaggerated. And I write this to point out how feelings could lead us astray in our attempt to get healthy. Kara’s session was not unlike others I’ve had in my career—in this past few weeks, even—counseling patients struggling with eating disorders and disordered eating.

Following the outburst, I acknowledged that her feeling like she had gained a million (or 35) pounds was real. Yes, it feels different, eating more than her abysmally inadequate diet of past weeks. Her food choices—lots of high fiber whole grains, fruits and vegetables—make it all the more challenging. Their large volume and relatively few calories don’t fit with a need to increase calories. Yet she feels as if she’s eating a lot, too much, in fact. Oh, and the large coffees throughout the day didn’t help, either.

What’s worse is that once she started to eat more, she got hungrier. As is expected, metabolic rate, and along with it hunger, increases with an increase in food. So while metabolism slows with restriction, it picks back up with refueling. Research confirms it continues to increase (your metabolism, that is) until you hit a healthy weight range. (By the way, it’s also possible to be at a normal weight, eating pitifully little, resulting in a slowed metabolism. Increasing food, in this case, increases metabolic rate and weight may not increase, as calories increase along with metabolic rate.

But even if you know it, it feels scary having your hunger return. “What if it never stops increasing?” “Will I always be hungry, even though I’m trying to eat more?” “Will I ever be able to control my intake once I start eating more again?” The panic mounts.

Don't you just feel like staying this way sometimes?

If you respond to your hunger and honor it, it settles down—if you are eating enough. Sure, you’ll get hungry later—maybe 2 or 3 or 4 hours—and you’ll need to respond to that hunger as well. Otherwise, you may find yourself overeating, having restricted before. Until your signals start working for you, you may simply need to eat on a schedule—eating every few hours.

Back to Kara.

I weighed her. And she did gain weight. But it was only ¼ pound, to be exact. She assumed my scale was broken. I assumed she was serious, since that’s how she sounded. And what concerned me most, was my inability to reason with her in that moment; you can’t reason with someone who is irrational, who is simply responding to her feelings.

It’s just like trying to reason with a young, underfed child; a malnourished individual is incapable of sensible decision-making and rational thought.

Somehow Kara came to her senses. Perhaps it helped being heard. Maybe the increased eating this week was a boost, allowing her to move from her stuck place, to hear the wisdom of my recommendations. And, finally trusting that rationally, she wasn’t having enough to eat, enough calories, to support her body’s needs.

Perhaps having me acknowledge how difficult, and scary, this whole process is, helped ground her in reality, helped. Rarely do providers describe the negatives of recovery, but I was honest with Kara and acknowledged that it sucks to have to feel. Being numb—from restricting, binging, disconnecting, really works. It can be quite challenging to start to be present and to feel things you’d rather not be feeling.

Sometimes we really see ourselves
as distorted as this tape measure.

In past years, prior to more intensive treatment, there was no reasoning with her. It’s like a recent 24 year old male patient of mine who couldn’t get past his own food rules, and maintained his vigilance around raw foods, unprocessed foods low in fat, that never provided enough calories for his 6’2” frame. This bright young man was anything but reason-able, rational. That was all lost. It was all about how he felt. At that point, all I could do was recommend a higher level of care, to re-nourish him and restore his brain to allow him to think and act sensibly. Only then can we begin to successfully work together and move forward in recovery.

Last week a patient thanked me for letting her express her darkest, most disordered thoughts. After I listened, I rebutted. She had to hear my counter argument. She needed to see the pros and cons of her feelings—her feeling that she needed to drop some weight, in spite of being in the low end of a healthy weight range, in spite of the consequences on her body, her thinking, and her mood. She accepted my guidance, feeling liberated, and applied it in the days which followed. Because she was healthy enough, like Kara, she was able to come to her senses. Her thoughts helped change her feelings and subsequently her behaviors, and she is turning things around. Nice work!

If you are stuck on how bad your body feels, take a breath, and do a reality check. Is the change as major as it feels? And if so what are the benefits of eating more? Being numb may feel safe, and change can be overwhelming, but what are the consequences of staying where you’re at, in your unhealthy place? With a supportive team and the right level of care, it’s not too late to move forward.

Beyond Glycemic Index and Radical Diets This New Year.

noreply@blogger.com (HikerRD) — Wed, 04 Jan 2012 04:38:00 +0000

Besides amazing pastries, I do love their tag line!

"You guys eat a lot of pastries", she noted, commenting to my husband, her brother. Not a strange observation, I might add. After all, there were the baked goods from the gourmet shop, purchased Thursday, the croissants—chocolate, sweet-cheese topped with plum, and raspberry-filled, fresh from the St. Lawrence market, and finally the long awaited Dufflet Bakery Dacquoise. Oh, and as blogger NewMe can attest to, part of a slice of a disappointing layer cake on Friday afternoon, which my sister-in-law didn't even know about (until reading about it now, that is).

I think we were a bit of a puzzle to her. We appeared the same sizes we had been last we saw her, about 5 or 6 years ago. Well, I’m projecting now. We are the same sizes we were then, although I can’t exactly say that’s how we appeared.

Like the rest of the world, she gives a fair amount of thought to food, eating and weight. Expression of guilt regarding her carbohydrate consumption combined with questions about glycemic index of sweets engaged me in conversation, and got me going. I do wonder if I will be invited back!

An endless assortment of breads and croissants--
and happy customers!

I corrected the misinformation that carbohydrate is the culprit in weight gain. As for glycemic index (GI), I shared that a food’s GI has rather limited value in weight control. Defined as the impact of a carbohydrate-containing food on blood sugar, as compared to a standard food (typically sugar or white bread), this value was designed as a tool for helping with blood sugar control.

GI may impact one’s sense of fullness—generally less processed, higher fiber items have a lower GI and tend to help us feel more satisfied. Yet focusing on GI for weight management has its faults. If anything, taking into account the portion of carbohydrate, a calculation known as glycemic load (GL), would be a lot more useful. Otherwise, foods like carrots come out looking like items to be avoided—which would be quite idiotic, if you ask me.

But truthfully, the GI and GL are overrated for weight management. Why? Because we don’t eat foods the way they are evaluated in the lab, as single items, by themselves. Rather, we eat foods as part of mixed meals, which alters the impact on everything from blood sugar rise, to how quickly food empties from our gut, and our sense of fullness. Perhaps that's more than she, or you, cared to learn about glycemic index.

While staying with my sister-in-law and enjoying having her cook for me, I encouraged using less saturated fat than she would otherwise use. I recommended brushing the homemade blintzes with melted butter, then baking, as opposed to frying them in a pan with a more generous amount of fat. And she did. And everyone loved them. I suggested (only when prompted for my input) use of a non-stick pan for scrambling the eggs—topped with a quick shmear of butter for some flavor; combined with the sautéed onions, the reduced amount of fat in the pan was clearly not missed.

Among the many overwhelming sights at the
St. Lawrence Market, Toronto

I discouraged sweetening the fresh and ripe berry fruit salad—neither with sugar or Splenda—as it struck me as unnecessary.

As for those pastries I mentioned above? I had a sampling of the three croissants, amounting to one whole one, for my breakfast the next morning. Was I tempted to consume them, all three of them, while strolling around the market Saturday? Of course! But was I hungry then? Absolutely not! And I knew I’d enjoy them all the more when I was hungry, and not overwhelmed by the sights and distractions, so that I might savor them.

Our first night, when my sister-in-law served some pastries she selected for dessert, I just wasn’t hungry. After our fashionably late dinner, it was easy to pass them up. Of course I knew it wouldn’t be my last chance to enjoy such delectable items.

Am I treated like royalty or what?

Saturday night, however, I looked forward to, even longed for eating the hand-picked baked goods. Think macaron layers (meringue with ground nuts), filled with buttercream, flavored with hazelnut or cappuccino, covered with chocolate ganache, and topped with a French name I can't begin to appropriately pronounce. It met my expectation, as I vividly remembered these delights before their reincarnation from raspberry buttercream, 6 years back.

Admittedly, I worked out when visiting in Toronto, although I did less than my usual workouts, as we had other things on our agenda to accomplish. And Mica wasn’t there having to be walked.

And no, I don’t typically eat pastries with such frequency in the course of a week. But I can trust that it’s not my only chance to include these delights, so it’s easy to have just as much as I need, and only when I really care for them.

Remember that carrot cake? Believe it or not, there are still a few pieces remaining in the freezer. Really.

So don’t be pulled to extremes this time of year, lured by food rules, diets, and radical eating. The New Year shouldn’t mean the end of what you enjoy—be it high glycemic white breads, or great tasting pastries—but a new way of embracing what you truly desire, regardless of your weight. Just do so with respect for your hunger and your fullness, with the trust that it’s not your last chance to eat.

Struggling With Your Eating? Carrot Cake May Be The Answer.

noreply@blogger.com (HikerRD) — Tue, 27 Dec 2011 02:23:00 +0000

I ate too much. I kid you not. Eight days filled with fried foods is weighing me down. And while I don’t celebrate Christmas, it happens to be my husband’s birthday. So I made the obligatory carrot cake with cream cheese frosting—his favorite—a total yum— and probably ate a bit more than was necessary. And that was after the Indian food we had out—shared lentil soup, appetizers—the works.

Having my jeans fit rather tightly can be challenging even if I needed to gain some weight—which I don’t. Somehow, there’s just no positive reinforcement in our culture for having your waist band cut into your flesh—even if it’s truly a sign of progress, of necessary weight gain for recovery. Growing out of your clothes (unless you’re an adolescent, entitling you to indulge in the newest fashions) yields little benefit in our society. But in my case, that’s beside the point. My personal goal is maintenance, within my normal and healthy weight.

Yes, even nutritionists can, and do, overeat at times. Of course I know better, yet I found myself grazing on salted, roasted cashews rather mindlessly while mixing up the carrot cake batter. And serving the cake from the table? Big mistake. It called to me, a mere arms-distance away. Those skinny, knife thin slivers don’t really count, do they?

What did I resolve when I woke up this morning? First, I wouldn’t dare consider weighing myself—no need to see what I already knew. I might have considered a bowl of bran flakes or oatmeal. But I really felt like having the freshly baked bread I made the night before. (I was rather productive on Christmas, wasn’t I?)

Rather than have the cereal while yearning for the bread, I decided to have what I really wanted. And so I cut a thin slice of this rather dense, wholesome bread, chock full of oats and flax, figs and walnuts, seasoned with anise seed, and had a bowl of yogurt and fig jam to go with it. And, had my coffee, of course.

What I didn’t resolve was to make up for the extras consumed in the many days before. I did not resolve that I blew it, that I shouldn’t even bother, because it’s useless. Or, that the leftover carrot cake was to be trashed, so that I wouldn’t eat it again. I wouldn’t dream of such a thing (besides, my husband would probably fish it out of the trash barrel if I did). And if I did, it would only reinforce that cakes were something I wasn’t entitled to eat, so it was now or never when they were within my reach. This, of course, would only lead to overeating. I did, however, slice it up, wrapping each slice individually, and froze it.

I did not resolve to skip my usual workout, or my walks with Mica (you know who he is, by now, right?), because “why bother?” I love my treks through the woods by my home. It’s hard to know who gets more excited at the sight of a squirrel—me, or Mica.

Yes, it’s a process. We all need to remind ourselves of what is in place, rather than focusing on where we slipped. This morning’s Skype session with a client overseas addressed, in part, expectations. It came naturally to Anna to focus on the fact that her weight had not yet improved. But the positive changes she has been making were far less obvious to her, and certainly more difficult to measure. She needed to recall that having two chocolates, only two, was in fact, progress. Yes, there was a time, not too long ago, that she would have laughed when I suggested this was possible; chocolate was something to be avoided, when trying to manage weight, for fear that once she started she’d have no control over stopping.

Being able to distinguish her hunger—and her fullness—has also been a major recent achievement. Previously, without this awareness, she was left without the tools to self-regulate food intake. One night this week, she chose to have a snack, responding to this hunger, prior to dinner being ready. As a result, she was left with little hunger at mealtime. She gave herself permission to delay dinner—rather than eating it at the planned time—another step forward in listening to her body’s signals. She knew she could, and would, eat again later when she needed to. The fact is, as a result, she ended up being more in control of her eating, versus overeating.

But if the only goal is pounds lost, then she made no progress this past holiday week at all. Anna needed to revisit the house-building analogy, to shift her focus on what’s truly important at this stage of our work together. Building her foundation is a necessary first step to changing her relationship with food—and ultimately her weight.

As for me, I did have a lighter dinner this evening—a root vegetable soup, accompanied by the sliced homemade bread. And, I mindfully enjoyed every bite of the microwave-defrosted slice of carrot cake.

And I’m feeling quite good.

PS: Here's the recipe some of you requested!

Joel's Birthday Carrot Cake

Ingredients

2 cups flour

2 cups sugar

2 tsps baking soda

2 tsps cinnamon

1/2 cup oil

1/2 cup unsweetened applesauce

3 eggs

2 tsps vanilla extract

3 cups finely grated carrots

1 cup walnuts

1/2 cup shredded sweetened coconut

3/4 cup drained crushed pineapple

(See Cream Cheese Frosting Recipe below)

Preheat oven to 350 degrees F.
Line 2 round cake pans with wax paper, then grease or spray them. (a 13 X 9 inch pan works fine too, but doesn't look as awesome!)

Blend the dry ingredients in a mixer.

Add the next ingredients, through vanilla, beating thoroughly.

Then fold in remaining ingredients.

Pour batter evenly into the two pans.

Place in middle rack of oven.

Bake approximately 1 hour, or until the edges pull off the sides or a toothpick comes out clean when inserted into the center of the cakes.

Let cake cool 10 minutes in the pans. Then flip them over onto plates or cake platter. They should fall from the pans with ease.

Peel off the wax paper and let cool an hour.

Cream Cheese Frosting

12 oz reduced fat cream cheese or Neufchatel (brick form), room temperature

4 Tbsps (1/2 stick) unsalted butter, room temperature

1 1/2 cups confectionary sugar

1 tsp vanilla extract

2 Tbsps milk

Blend it all until smooth, without lumps, and it's ready to use.

Frost one whole cake. Then drop the second cake onto the first and frost top and sides.

Sit down with a slice, and enjoy every bite. Remove the rest from the counter, by slicing and removing the pieces from view (freezing is ideal!)

This Holiday Of Miracles—Ancient Wisdom About Managing Your Eating

noreply@blogger.com (HikerRD) — Mon, 19 Dec 2011 14:24:00 +0000

Taking back control. Rededication. Surviving persecution and abuse. Triumph after being restricted, forbidden from following your own path. Your prized possession, quality olive oil, gets you through, for much longer than you ever believed it could.

These phrases describe the festival of Hanukkah, yet I can’t help but repackage them as a recipe for moving forward with our eating—both, during this holiday season and beyond, for Jews and non-Jews alike.

First, here’s my very brief summary of the holiday (for a more complete story, check out Chabad and Wikipedia).

Hanukkah celebrates the rededication of the Second Temple in Jerusalem a long, long, time ago, more than 21 centuries ago. Following a rebellion against Hellenization, after being persecuted, denied following their own religion, a group of rebels fought back and regained control. They cleansed their temple, and wanted to light their 7-branched menorah, the candelabra, but there was only enough of the purified olive oil required for this ritual lighting to last one day. And yet, voila, it lasted all 8 days. This was great cause for celebration, and what better way than include a lot of fried food?

Some summarize our history more like this: They tried to kill us. They couldn’t. Let’s eat.

Thus, the tradition is to celebrate this triumph over oppression and the miracle of oil. And not just any foods, mind you. The Hanukkah mandate is eating oil rich foods, traditionally white carb types—it’s enough to cause panic among the health conscious and weight-focused. We eat fried latkes (aka potato pancakes), with sufganiyot for dessert (aka doughnuts). And did I mention this lasts for not one night but for 8?

Regardless of your particular culture or religion, we are all confronted by food challenges this season. And while I have addressed this subject in various posts previously, http://dropitandeat.blogspot.com/2011/11/taking-charge-practical-strategies-for.html, http://dropitandeat.blogspot.com/2010/12/recovering-from-slip-coping-with.html, I thought I’d give a bit more support to get you through this challenging (yet potentially joyous) season.

Balance

From my own experience, I’ll tell you that eating latkes or similarly fried foods, as the main entrée, isn’t going to work for me. I have no problem with including oil in my diet (see http://bit.ly/dOZNqH and http://bit.ly/uqnq92), but I need to have some balance. All too often, health-promoting types (nutritionists included) get stuck focusing on individual foods or nutrients, neglecting one important fact—we don’t eat single nutrients or food items.

And we don’t need to get all nutrients from a single food! No, we eat foods together, providing us the opportunity to balance our meals, and our day’s intake, to stay healthy.

Take control of portions

Yes, Hanukkah at my house will include latkes, on more than one night. There will be the traditional potato and onion ones, and my more recent favorite—a parsnip-potato pancake. Perhaps I’ll even try a cardamom leek fritter recipe I stumbled upon recently. But served as the whole meal? I don’t think so. So what will I do? I’ll serve them with a soup and a salad, some lighter fare. On one night, I’ll also serve my homemade sufganiyot, these two-bite delights that really satisfy; at least the portions are small. The bottle of oil, in my home, lasts way more than eight nights, I’ll add. While the sufganiyot are deep fried, I’m light handed pouring oil for my latkes preparation.

Choose what you enjoy. Enjoy what you choose.

Wondering how you’ll manage the Christmas bird or roast with all the fixings, with a yule log for dessert, too? You, too, can add some balance, picking and choosing the richer and the less dense items. But do include foods you enjoy! Otherwise, you may find yourself indulging when you aren’t hungry later, making up for your feeling of deprivation.

And please don’t forget to leave leftovers! Better to enjoy the extra food when you aren’t stuffed; won’t the cake and pie taste better when you’re hungrier? Perhaps for breakfast the next morning? Yes, it’s allowed!

If you are doing the preparing, shopping and cooking for the holiday feast, remember that you have the right and the ability to dictate the meal content. Substitute some applesauce instead of the full amount of butter in the cake. Offer a range of your favorite vegetables to accompany the meal. Strain the fat off before mixing the gravy. Determine the ratio of desserts to guests—must it be one pie for every two people?

Be prepared.

Feeling overwhelmed? Preplan as much as you can. Make a shopping list; then send someone else to retrieve the foods. Bake in advance, and then freeze cookies and cakes. Sure, you may end up eating them right from the freezer, but wouldn’t they taste better eaten mindfully at room temperature?

Plan for the holiday eating schedule—be sure to eat breakfast in the morning, rather than letting one meal slide into the next. And don’t even think of restricting early in the day to compensate for potential overeating later. That, my friends, is a recipe for disaster.

Consider your limits.

And do watch your alcohol intake if you are trying to stay in control of your eating. Sure, it might decrease your stress, but it will also decrease your inhibitions around food (and, perhaps around those difficult relatives). That may be fine, if you are comfortable with the outcome. But it seems to me that rarely is the case.

I hope this helps limit the holiday stress.

Do enjoy the holidays, including your favorite foods!

Happy Holidays!

The Gifts You Brought Me: Priceless Progress This Holiday Season

noreply@blogger.com (HikerRD) — Fri, 16 Dec 2011 19:56:00 +0000

Winter holidays are still several days away, but early gifts of gratitude have already shown up at my office. Yesterday’s were particularly sweet to me. Kay presented me with a lovely handcrafted pair of earrings, sold as a fundraiser for Project Have Hope. (Love that name!)

Guess who knew there were some yummy cookies to uncover?

But I was even more touched by the additional part of her packaged gift, which Mica (canine to the left) unwrapped for me last night. Kay apparently recalled my familiarity with and love of her favorite cookies—Petite Ecolier. Yes, Kay could openly discuss how many chocolate covered French biscuits she consumes, and the pleasure they bring her. Gone are the cookies eaten in the closet—and the car, and in front of the computer screen.

I earned silver yesterday, but felt like I was the recipient of a gold; I loved the sterling earrings crafted by an Israeli artist that my patient knew I’d appreciate. But the even greater gift was my experience of our session. 171.5 pounds she has lost since we began our work together, from her presenting weight until now.

No, that was not a typo. She started just below 400 pounds. There was no gastric bypass, in spite of the urging of her doctors. She has needed to decrease her diabetes medications as she has continued to progress. And after years of me patiently wearing her down, she is now exercising regularly. This was the most challenging piece to accomplish. Yes, she bought herself a new bathing suit for her water aerobics class she attends twice weekly. And she has been consistently walking a couple of time per week as well. It was quite the gift to behold all the progress she had made! You can read an old post on her: http://dropitandeat.blogspot.com/2011/02/maggies-152-lbs-weight-lossthis-time.html.

The other gifts were not intentionally timed with the holidays, nor were they intended for my benefit alone. There was Kate’s decision that life is worth fighting for, that her eating disorder needs to leave and that she needs to accept that a higher level of care is not a failure, but a move forward. Termination with some patients was also a gift—no, I wasn’t losing patience with them—it’s just that they were ready to move on—and I was so pleased to watch them fly.

Wishing you a peaceful road ahead.

Emails with thanks and appreciation for this blog arrived throughout the year— comments from Australia and British Columbia to France and Switzerland, from patients and fellow professionals as well as strangers—tales of a post, or a sentence, even, that made a difference, providing a sense of hope that wasn’t there before, a new perspective on their situation, a motivation to reach for something better than they have. Not all were positive and upbeat, that’s for certain. But having someone reach out for help, and appreciate that support I have given, is quite a gift.

These have been the greatest gifts I could ask for.

Coming up: More management strategies for this challenging, food-focused time of year. Look for it within the next couple of days.

Following a Vegan Diet. And, a Gluten Free Diet. And, and, and…

noreply@blogger.com (HikerRD) — Fri, 09 Dec 2011 16:47:00 +0000

Couldn't Resist This Photo Op In Switzerland!

It’s time for some praise for doctors. Surprised? I know you are used to my airing my complaints here, for inappropriate, unconstructive assumptions some doctors make. And, for their misinformation not infrequently conveyed to patients, when it comes to diet and disease management. Just last week, a patient with type 2 diabetes shared her experience about her follow up MD visit. Jane has been eating well, resulting in a significant and appropriate weight loss. She’s moving more, and watching her carbohydrate intake, improving her post meal blood sugars. But given that her morning numbers remained quite high, in spite of her fabulous lifestyle changes, I encouraged her to address this with her doctor, hoping for a shake up in her diabetes medications.

Can you guess what he told her?

You guessed it. Just lose weight. Yes, he wanted her to continue to stay with sugars almost 100 points too high, potentially causing damage to her blood vessels and her organs. Perhaps continued weight change will improve her sugars—but that takes time, and with the 50 or so pounds she has already lost, the numbers haven’t changed significantly. But it’s easier to pin the responsibility on the patient to change.

Oops! I was planning on praising a doctor today!

The wisdom of Dr. Mars

His patient was not an obvious referral for nutrition counseling. She did not present with any complaints about her health, and her rudimentary labs did not flag any concerns of disease in the works—normal cholesterol, blood sugar, thyroid, to name few. Other, more detailed nutrient assessment is pending. Her blood pressure is fine, low in fact, with that “healthy runner’s pulse”. And her weight? It had dropped from her usual place many years ago, from the normal range, when she had been diagnosed with cancer, now in remission; but it had increased somewhat since then.

“What brings you here?” I asked, as it was not so clear, at first glance. “Dr. Mars suggested I get in to see you”, she replied. “His concerns?” I continued. “He’d like you to assess my diet and be sure it’s adequate.” Fair enough, I thought.

At least she's left with these--if they're uncooked!

And here’s what I heard. Di moved from a vegetarian diet to a vegan diet some years ago, presumably to be healthier. She then cut out soy products because of inconclusive evidence of a link between soy and some cancer. Only she did not have the type of cancer that might have even been impacted by soy. She then decided that she should cut out gluten, because she thought she might be allergic. She didn’t notice any change, but had heard (from reliable sources, no doubt) that it helps. So she stuck with it. Rumor had it (Hollywood tabloids, perhaps?) that the raw food diet was a means to extend life and stay fit, so she tacked on those rules too.

I’m not sure I could have created such a patient from my imagination. The only thing she hadn’t reportedly restricted was fats. But judging by her food selection her intake of fat was quite low, unhealthily low. Oh, how wise of Dr. Mars to send her my way!

My confession

We do the craziest things for our cause.

I get it, at least to some extent. If you’ve been handed a diagnosis for which there is no cure, or one which can easily take your life, you feel quite vulnerable. So anything you can do to potentially help your situation makes perfect sense. And so early in my diagnosis with Multiple Sclerosis I embarked on my own gluten free adventure. Armed with anecdotes spread across the Internet, I was determined to take charge of my condition in any way I could. I knew that the science was sketchy, at best, in its infancy in fact. Much had been written about other auto-immune conditions and the benefits of a gluten free diet, but little to no research existed for MS. I had my MD check my labs, which revealed some abnormal levels—so maybe there was a link, I thought. Celiac experts (those that address the autoimmune disease truly caused by consuming gluten) dismissed these labs as inconclusive, but I was determined.

Three months of strict adherence to a gluten-free diet cured my MS!

Don’t I wish! Rather, meticulously following a gluten-free diet was a constant reminder that I lived with this medical condition; kind of like following a meal plan with an eating disorder. But if it worked, I would follow it forever. Only it didn’t work. Sure, I felt I was taking charge, doing my part to control my disease. But in those three months I had more new lesions on my brain and spinal column than perhaps at any other time in my 9 years with MS.

There’s a point you have to ask yourself “Is this strategy working for me?” Is it really meeting the need I intended it to meet?

Gluten-free failed. But fundraising and riding with my team of friends and
family (almost half of whom are MDs) has helped me enormously.

Did Di’s strategy improve her health with her myriad of diets rules? Hardly! She now had irregular periods (potentially due to a low percent body fat), and she likely will be experiencing muscle wasting, as her total calories and total protein are insufficient for her need. Osteoporosis or osteopenia , its precursor, is inevitable, with her low calcium intake and vitamin D, and with her questionable estrogen levels, given erratic periods. I could go on listing the pitfalls of her diet, but I think you get the point.

Focusing on her food rules may very well work for Di—on some level. But if she allows herself to be honest, she’ll realize that this is not a healthy diet at all.

And you?

Is it time to reexamine your own patterns of eating or food rules? Are your eating behaviors really working for you? And is it in your hands to change?

I’d love to hear from you.

Thanks for reading and for giving me your invaluable feedback!

What Your Healthcare Team Needs to Know About Your Non Compliance.

noreply@blogger.com (HikerRD) — Sat, 03 Dec 2011 16:44:00 +0000

Compliant |kəmˈplīənt|

Adjective

1. inclined to agree with others or obey rules, esp. to an excessive degree; acquiescent : good-humored, eagerly compliant girls. See note at obedient. (From the New Oxford American Dictionary)

A picture of NON-Compliance. Only a biscuit will
motivate him for action.

It’s rare that I have the opportunity to chat with a medical student, a soon to be doctor. But this past weekend I was fortunate. Mike, a bright, articulate, and lovely guy of 28, is nearing the end of his fourth year of his medical education, currently doing his internal medicine rotation. He attends a top medical school in New York City. And you know me. I just had to ask him, this soon to be practicing doctor, a few pressing questions, while strolling along the brownstone lined streets of NYC. Here’s how it went.

LL: “So how much nutrition education do you get throughout your training?”

Mike: “About 5 hours total, in my four years.”

LL: “And what kinds of nutrition topics do you cover?”

Mike: “The greatest focus is on all the vitamins and minerals and their deficiencies—scurvy, beriberi, Wernicke-Korsakoff, to name a few.”

LL: “Wow, so the bulk of your nutrition education is spent studying conditions that we rarely see in our country.” (scurvy is a vitamin C deficiency, beriberi a thiamin deficiency rather uncommon in these parts), with the exception of Wernicke’s which we do see in severe alcoholics (also from a thiamin deficiency).

Further along in our conversation Mike shared his frustrations regarding nutrition-related illness:

“Patients tend to be non-compliant. You know, they don’t do what we tell them, what they need to do to help themselves.”

What does your doctor need to hear from you in
this limited time?

And with that comment, I had to hold back my biting tongue. (He really was a lovely fella, and a friend of my son, so I took a breath and went for the patient response.) Yes, it is frustrating to feel that people could help themselves if only they would follow what you tell them to do, if they would just do it. We discussed the fact that the average length of a typical doctor’s visit is maybe 17 minutes, start to finish; during the length of three songs on your iPod, your doctor needs to assess your medical situation, answer your questions, figure out how best to convey information to you about your condition, educate you and direct you to resources. Sounds easy, no?

Clearly something gets missed in these limited length visits. How can providers expect patients to change when they haven’t even probed to see what obstacles are keeping them stuck?

For better “compliance”, doctors need to better assess patients’ readiness for change. And then provide them with correct information and useful resources to go forward.

Laziness Keeping Her From Exercise?

Maybe there's another reason she (he?) stays where he's at?
And no, I didn't pose them when I too this picture.

You can’t tell someone, like my patient Ellen, who might benefit medically from an increase in physical activity for her blood sugar, cholesterol and blood pressure management, as well as her escalating weight, that she needs to exercise four days per week, 30-40 minutes. Why? Because she associates an increase in heart rate with anxiety, and fears it’ll result in a heart attack. Instead, I had to work on getting her to see that exercise is safe, first and foremost. So I discussed with her doctor getting a stress test done, followed by a doctor’s approval for exercise, to allay her fears. After that, she was able to slowly increase her activity. Now she exercises regularly.

Time To Change The Strategy

Stubborn and non-compiant--
but who knows what's going on inside his head?

More than one woman I have worked with has shared that her husband has made it clear in no uncertain terms that she shouldn’t be eating what she eats, or weighing the weight she weighs. The result? An “I’ll show you” response—she eats beyond her need, when he’s not around, in part to spite him. Acting like her husband, telling her what to do, judging her by her size, will ensure that her weight continues to climb. Instead, directing such patients to work with a therapist to better communicate with their spouse (and others) and speak up for them selves can help. And enlist their suggestions, their ideas for practical change. That’s a way for providers to successfully problem solve.

And such patients need to be given permission, with practical strategies, to bring food out of the closet. I often recommend that they tell their spouse what to expect—that they will see them eating foods the spouse deems unacceptable for weight management—and they shouldn’t be surprised. And their spouse should withhold comment and judgment, thank you very much. Only then can we expect “compliance”.

Information Can Cause Slips

Health care providers need to check their facts, before being quick to disseminate information. Telling patients “cut out your carbs” is simplistic and unnecessary, including for diabetics. And you can bet it’ll lead to non-compliance. And confusion, as they get bombarded with nutritional misinformation from all ends. It is unrealistic, and not a practical change.

They need to get educated, too, in communicating information with teenage and adult, anorexic girls and young men. Statements like “great job! Your weight’s heading right up there!” or “You need to gain weight or you won’t get your period” can be traumatizing. Or “You’re perfect—don’t gain another pound!” And how many girls couldn’t care less about getting their periods? Telling a 12 year old that not getting a period will lead to osteoporosis? Who cares? They envision old, bent over, great-grandmothers—not something they believe can happen to them in their teen years. But tell them amenorrhea could cause fractures when running or engaging in their favorite sports, requiring them to end participating in sports with their friends—now that may make a difference.

What’s In It For You?

Listening to what patients really do care about, about where their concerns lie, will help motivate change. For some, it’s about hair loss in clumps, or lanugo, hair growth on their arms or face, as their weight has dropped, that concerns them. Or it’s being freezing all the time, as their body temperature has dropped. Or the fear they will not be able to return to soccer, or dance, or field hockey, to name a few.

Sure, doctors and health care providers get frustrated by non-compliance. But our patients are no less frustrated—and they’re angry, and hurt—too. Because they are not understood; because there are good reasons they stay stuck in their unhealthy behaviors. And it is rarely due to ignorance.

Advice For Fellow Healthcare Providers

Compliance shouldn’t be the goal we shoot for. Patients need to be more than puppets nodding and acting according to our commands. (See definition of compliance.)

They need to be engaged in the process of change, participating in charting their course. We all need supports, guidance, and compassion, not just rules, to begin making change. Oh, and did I mention the need for hope? Certainly, if I don’t believe in my patients, they won’t believe in their own potential for change.

The health system isn’t going to get over-hauled any time soon. Seventeen minutes may seem like a luxury in the future. But if only doctors and other providers would take the time to ask a few key questions. And then? Give up a few minutes of the 17 to truly listen.

Then they can refer to appropriate providers—the nutritionists and therapists experienced in a behavioral approach to change. Only then can they assist their patients in making change, helping us all feel a lot less frustrated.

Why Bother? Patient Lessons.

noreply@blogger.com (HikerRD) — Sun, 27 Nov 2011 19:50:00 +0000

Tuesday With Marla

Gotta love her attitude!

Why bother? That’s what I thought. I worked hard on making changes, and in spite of my efforts, here’s the bland response I got from my doctor in this letter: “Your A1c is fine. Your lipids are high. LDL 105, HDL 46, Triglycerides 167. Stay on the statin. Continue to work on your diet and exercise.” If we hadn’t already discussed these results together, you and I, I would have just blown it, food wise.”

What’s this all about, you’re wondering? Let me fill you in. Marla has been working with me for about 8 months. She presented to me with high cholesterol, high blood pressure, and obesity. And her A1c, the blood test that gives a picture of blood sugar control over a three-month period, was just about out of range when she first came to see me. But most distressing to her, was her relationship with food, her struggle with binge eating disorder. Her emotional triggers were real, and life continues to have its share of stressors.

So what happened to Marla?

Here’s the quick summary, based on the concrete facts, the numbers, first. Her A1c dropped into the normal range, several points below where it started. And several points, on the A1c scale, is a pretty huge change. Her ratio of total cholesterol to HDL—the good cholesterol—improved significantly; it is now well within the healthy range, below 4.3. And it started at 6.1. Her good cholesterol is higher than ever, about 40% higher, likely the result of the significant improvement in her activity level. Of course I shared this great news with her at our recent session, expressing how pleased I was that she achieved this dramatic improvement while simultaneously reducing her dose of statins, the cholesterol medication she had been on from the start.

And while her BMI remains high, she is down 43 pounds. And get this—her food record today revealed proudly inclusion of Pay Days, the mini Halloween sized candy bars she gets on sale after Halloween. One or two at snack were consumed when she needed to eat, when she got hungry. And she ate them for many days, I’ll add.

Why so proud to be consuming these chocolate peanut candy bars? I’ll tell you.

Keeping dessert in balance, Marla now can enjoy her favorites.
These, though, are mine-homemade French macarons.

Because, as Marla stated, “Just last year, I thought that once I started I couldn’t stop—because that was what would happen—in the past. I’d find a trail of Pay Day wrappers strewn about my apartment, unaware of just how many I had eaten throughout the evening. Now, I’m not in deprivation mode. And I can record (and acknowledge) that I ate them. And I can eat them in moderation, and enjoy every bite.”

But when Marla saw the doctor’s letter, she had to work hard to remind herself that she really had done well, regardless of how his summary distorted things. “Lipids are high”? They are not only significantly improved, but almost all the values are now in the normal range. “A1c is fine”? How about “Job well done! You are now in the normal range as a result of your hard work! ? Marla had gone from a fatalistic approach about her health—she shared that she never expected she might outlive her relatives, many of whom passed on in their 50s of heart disease. And when she first saw the doctor’s letter she assumed, once again, why bother? I guess I can’t change the situation. She assumed that genetics tell all—her high levels were just meant to be, and there was little she could do about them. But now she knows that is not so.

Why bother?

Even if her levels hadn’t improved (which of course they had), was it really a “why bother” situation? Certainly not! She felt more in control of her food, was able to include whatever she liked now, in reasonable amounts, and was more fit than ever, with her increased activity. She felt physically better having lost weight, and mentally, was in a better place. And she was taking an active role in her health, rather than assume her fate was sealed because of genetics.

And then there was Sarah.

from the MOMA, NYC

Sarah, in her mid twenties, presented yet another “Why bother?” to me last week. (Was it a full moon, or just one of those weeks?) She has been working on recovery from anorexia and bulimia. Medically stable, she has been out of an eating disorder program for several months, since we began our work together. And she’s doing quite well, I might add. There’s no crisis now, no flames to put out, no imminent need to push her self. Yet she still needs to continue her work to gain weight, to move into an appropriate weight range.

In our last session it struck me (us?)— getting healthier has its risks. It means she can’t blame any failures (such as not getting into grad school, or moving forward in a career, or in life) on her eating disorder. And recovery has another downside. When you peel away the eating disorder—the restrictive eating and thoughts or the binge eating—you are left having to feel. And quite frankly, feeling doesn’t always feel so great.

So why bother?

No, this is not me! But I did capture this amazing sight in Switzerland.

Because once you get to this better place with food and your health, and get support for managing those painful feelings, life is more fulfilling. You can rediscover your passions, and get more out of living. You can feel that what you do in the world makes a difference. And you can be more present to enjoy the people around you whom you care about.

Marla could have accepted her assumptions that there’s nothing she could do to change her course—but she didn’t. And the results, on all levels, speak to the benefit of her bothering.

In Sarah’s case, it’s possible that in spite of her eating disorder recovery, she may not get into the grad school of her choice. But without recovery, it is a guarantee for ultimate failure.

Life’s too short to not live it to the fullest.

Taking Charge: Practical Strategies for Enjoying Holiday Eating and the Morning After

noreply@blogger.com (HikerRD) — Mon, 21 Nov 2011 00:54:00 +0000

Ready to take control?

You, my readers, are a diverse bunch. Some of you are overweight, perhaps higher than your usual and healthy weight. You struggle to have balance in your eating—to eat what you’d like, and to learn to eat just enough. Others maintain their weight in a healthy range, yet grapple with these very same issues. Just because you may look fine, doesn’t mean you’re not challenging yourself to improve your relationship with food. You, too, may be working on legalizing foods, moving from a diet mentality.

Many of you are underweight, as evidenced not only by the scale, but by your body’s function—your low heart rate, body temperature, or hormone levels, resulting from inappropriate weight loss, food restriction or over-exercise. You too may be trying to release yourself from the grips of disordered thoughts and behaviors around food, whether or not it is visible to those around you.

Yet as diverse as you are, it seems most everyone gets challenged around holiday and social eating situations. Social anxiety may add flames to the fire. But I’ll leave that to the therapist bloggers to better address.

Last November, I did a post on recovering after slips, such as after Thanksgiving. Now I’m realizing I’d better address prevention. Perhaps I should have thought of this sooner? It’s not too late! (For those non-US residents, plug in Christmas, Hanukah, Kwanza or any other social eating situations not connected to a holiday celebration—the situation is the same.)

It may seem strange, but regardless of what end of the scale you’re on, or what your personal needs are— weight loss or gain or stabilization—these guidelines apply. Because we all want a sense of control over our situation—to eat what we’d like and eat enough of it—but not too much; to enjoy eating and feel entitled to eat, regardless of our size, in spite of the opinions of others; we’d like to free ourselves, discarding those useless rules around good food/bad food, appropriate times, and inappropriate times to consume food.

So here are my tips:

Maintain normalcy before the gathering.

Don’t skimp on your eating beforehand or you’ll be more vulnerable at the event. All too often I’m told of a client’s attempt to prevent overeating. What do they do? They eat less before the meal out or the function, figuring they’ll save some calories. Then they arrive more vulnerable than anticipated. As a result, their resolve to mindfully select their food, or to pace themselves through the afternoon of eating goes out the window.

The sensory stimulus doesn’t help. The pleasant aromas and visual displays of appetizers through desserts calls to us. Their strategy backfires, and they feel a sense of hopelessness with getting their control back.

Using your head to maintain the necessary balance

Or like my patient, Shari, you restrict before the event, eat fine or over eat at the event, then restrict again afterwards. Hmm. Does this make sense? Somehow, when you hear it told about Shari, it’s clear how senseless this is. Yet my clients believe that somehow they are different, that the rules don’t apply. They are smart. They get it. I know they do. Yet I frequently have to remind them they are not special; lovely individuals, yes. But not so unique that the system doesn’t apply to them.

Get informed. Ask questions.

"What will you be serving?" "What time will we be eating?" It helps having a sense of what to expect. Going to a friend or family’s home? Ask what you can bring—not if you can bring something. Perhaps you'll contribute something you really enjoy and feel good about eating. A lighter dessert? A favorite vegetable dish? An appetizer you’re comfortable eating?

Pre-plan.

It starts with inquiring about what’s being served. For some, it’s necessary to think through your options in advance. If you are dining out, consider checking the menu online, to be less overwhelmed with the decision making during the gathering. Going to family for a holiday meal? Hmmm, they’re serving 6 different starch choices, including mashed potatoes, stuffing, winter squash, sweet potato casserole, biscuits, and pumpkin bread. Which ones can I get at any time? Which ones are my favorites? Which ones should I just pass on, without regret?

Remember, it’s not your last chance to eat. So if cranberry sauce is a favorite, plan to buy it and keep some at home. Add it to turkey sandwiches or make a turkey with the fixings, even when it’s not Thanksgiving or Christmas.

You don’t need a dog for a doggie bag. Plan to bring a piece of pie, or a package of leftovers for a later time. Perhaps you’ll get hungry again later that evening. You’ll better appreciate the leftovers when you are less full anyway.

Plate the appys.

Enjoy the appetizers. But know how much you are eating. Select what you’d like, and place them on a plate, together. This allows you to take note of what you are consuming. When we are simply grazing on them, without really seeing or acknowledging them, it is much easier to over eat.

Watch the alcohol.

Painting by Russell D'alessio, Bar Harbor, ME
I hope these women had eaten before their martinis!

Nothing decreases our awareness and inhibitions like alcohol. If you can drink responsibly, that’s fine. Best to delay your drinks until after you’ve had some solid food, though.

Be flexible*.

Maybe you decide you’d like something other than what you intended to eat. Or you ate more than you anticipated, even though you tried to be well prepared. The worst thing you can do is to beat your self up. Best to work on moving on. (Yes, it takes 3,500 surplus calories to gain a single pound.)

We may not be able to control senseless comments from those around us at family and social gatherings. And unless we are hosting, we can’t eliminate temptations. But we can certainly take charge of our own thoughts and actions. And in the worst-case scenario, remember it’s only one meal, or one day. So if you ate more than you needed and are sitting with regret, re-visit that old post on the morning after.

* Did you, like me, wish this subheading was left-justified, instead of over here on the right? It's the start of being flexible!

As always, I'd love to hear your thoughts!

Healthy Food = A Healthy Diet? Not Necessarily.

noreply@blogger.com (HikerRD) — Sun, 13 Nov 2011 17:48:00 +0000

My lunch on a hike in Switzerland

Organic, whole grain, natural, unprocessed. These words carry visions of ideal diets, of pure and clean eating, of good health. US News and World Report’s recent article summarized the healthiest diets, from The DASH diet at the top of the list to The Paleo near the bottom. A panel of experts reviewed each plan for safety and nutritional value—then ranked the best down to the worst plans for health and weight control.

Here’s a brief summary of a few of their findings—with my interpretation added. You didn’t think I’d let this pass without putting in my two cents, did you?

DASH diet

Never heard of it? Not surprising, unless you, like me, have high blood pressure. DASH, an acronym for Dietary Approaches to Stop Hypertension is shown to be as effective against hypertension as medication, when compared side by side in studies. Its key elements are large quantities of fruits and vegetables, and inclusion of three low fat dairy products daily. It also includes lots of grains, and adequate amounts of lean protein sources. It recommends limiting sodium intake and being physically active as well.

What does this expert think? While it hasn’t normalized my blood pressure, the studies on DASH are quite impressive in demonstrating an improvement in blood pressure. And that’s what it was designed for. And it’s one step you can take to be healthier, if you have high blood pressure. I like its positive focus—on eating more fruits and more vegetables than most individuals consume, and on inclusion of three low fat dairy servings daily. Watching sodium generally necessitates eating less processed foods, which may lead to greater fullness—think apple versus juice.

Paleo diet

The theory, according to US News, is as follows:

Our highly processed, carb-obsessed eating pattern is the culprit behind many of our biggest health ills, so why not go back—way back—to the Paleolithic period of more than 10,000 years ago, when our diet wasn’t full of junk food and pasta? Paleo advocates say we should eat the way we ate when we were hunting and gathering: animal protein and plants.

The diet includes meat, fish, and other protein sources, as well as fruits and veggies, but omits dairy, grains and starchy vegetables, and several oils. Yes, even protein-rich, high fiber, satisfying legumes (think beans and lentils) are out of the question. As are root vegetables, such as sweet potato. (Imagine Thanksgiving at the Paleo family’s home!) Apparently these are omitted because they needed to be cooked. And say goodbye not only to milk, but also to those gut-beneficial probiotics we consume from yogurts with active culture. Never mind the lack of evidence that supports eliminating these foods.

If I have to give something up, there darn well better be a good reason for it. Unless there were some life altering evidence in favor of a Paleo, I say let’s be thankful we’ve evolved since then. And how fortunate we are to be able to consume legumes and grains—those carbohydrate rich foods, full of minerals and energy, as well as rich in fiber—given that we can cook them. Most of you, I suspect have a stovetop?

If you are not living in a year-round warm climate—rich in sunshine used to produce vitamin D, or you choose to prevent skin cancer by using sunscreen—you’ll be missing out on the foods necessary to obtain all the Vitamin D that you need following the Paleo diet. By the way, why use a Paleolithic period diet as some ideal, anyway? Their lifestyle was a bit different, I believe (I haven’t had to chase my dinner), and our lifespan has only increased over the years.

As for Atkins?

The lack of carbohydrate through many stages of this diet, and the saturated fat-rich intake flies in the face of all that we know about disease prevention. Review the 2010 Dietary Guidelines For Americans for an evidence-based review of these recommendations. Is anyone really taking this diet seriously anymore?

And Ornish?

Generally pretty extreme in it’s limitation of fats, which research confirms is not the cause of us getting fat; weight loss at the 12-month mark was no greater with a low fat diet, compared with many other popular diets. And any differences in weight loss between various diets (containing the same calorie level) was obliterated at the later follow up date. No, fats don’t make you fat. And a super low fat diet does not appear to be necessary to improve your lipid profile; very low fat diets may increase triglyceride level, an independent risk factor for heart disease. In the Ornish diet, meat, poultry and fish are not recommended, as well as all oils, nuts, seeds, and refined carbohydrate. It has its merits for reversing heart disease, but his studies showing this reversal focused not solely on dietary changes, but included a comprehensive stress reduction and exercise component.

Mediterranean Diet

My only beef with it is not its lack of meat, but its limited dairy. There’s no support for restricting dairy, particularly low fat varieties, for good health and weight management. I do like their inclusion of moderate amounts of wine, with meals, for those who are able to limit their alcohol. This diet is much higher in fats and carbohydrate than most, but includes, for the most part, less processed varieties. That said, they do not urge extremes, such as no bread or white potatoes.

The U Diet: The best diet you've never heard of

What was unfortunately left off the list of healthy diets was the U diet. Missing is consideration for the individual, because what’s healthy for one person is not necessarily healthy for another. Eating healthy, for many of you, should mean not trying to beat the system and eat less (like the Volumetrics Diet, for instance). Even those 2010 Guidelines for Americans act as if we are all obese and unhealthy and needing to eat less. It’s a challenge, for sure, when the rest of the universe is struggling to drop a few pounds or kilos and you are working, somewhat reluctantly, to gain them, or even to maintain them!

The U diet is truly the answer. It means, first and foremost, including an appropriate intake of calories. Ideally, if you are healthy enough to do so, this is done through better self-regulating (read the 100 or so posts in which I’ve addressed this already. Then re-read them!). It involves more mindful eating, and distinguishing hunger from other eating triggers. You know what I mean.

But it also means releasing yourself from the rules which prevent you from eating when you are hungry, regardless of whether its only been two hours, or if it’s after 8 PM.

As I’ve mentioned previously, for many of my readers it requires the “just do it approach”—eating in spite of not thinking or feeling you need to eat. It may defy all the healthy recommendations you’ve read above. Yes, you may be among those that need to decrease your vegetable intake, if they are displacing the calories and nutrients your body desperately needs to function.

Let's take Brian, whose diet was chock full of such wholesome ingredients, as recommended by DASH, Volumetrics, Mediterranean, and some dieticians' model diet.

Breakfast

Old Fashioned rolled oats with soy milk

Snacks

Fresh fruits and vegetables, both orange and green ones

Lunch

Brown rice and veggies

Dinner

Beans and a vegetable soup

Pretty good? Not at all. At 6'1" Brian struggles to function. His determination to select what he considers healthy foods has made him anything but healthy. His energy level is low, as is his testosterone level, impacting a range of quality of life activities. Let's just say, it impacts more than just the frequency of his shaving. His weight, while I will omit mention of numbers, is unhealthily low.

Or let me tell you about Sarah's recent diet. Her move away from "junk" food to a more wholesome diet landed her with a low heart rate and a plummeting weight, now below the 5th percentile. Never one to struggle with her weight in either direction, she now teeters on the need for a hospitalization. Her diet is low sodium, making it more challenging to keep her blood pressure in a healthy range given her unhealthy weight, contributing to her lightheadedness with posture change, from lying, to sitting, to standing.

And then there was Amy, who never intended to lose weight. Really. She gradually moved toward less processed foods, leaving her favorite items behind. Who needs Pop Tarts anyway? Her biggest concern, besides her hair loss, is that she is constantly freezing, even with the record warm temperatures we have had this fall in New England. This is what is motivating her to break from her "healthy" diet.

Diane was also concerned that her daughter wasn't eating healthy enough. Review of her intake revealed the following—she consumed a variety of foods, but would benefit from additional sources of dairy or an alternative. She included meals, but was somewhat picky about what she liked to eat -- pasta was high on her list, as well as several other choices. And for snacks, she responded to her hunger with what appeared to be reasonable quantities of items like Chips Ahoy cookies -- or fruit, or cereal. She certainly could use to increase her intake of fruit or vegetables, for the variety of nutrients they provide, and for the fiber. But she eats enough to maintain a healthy weight with healthy body function. Her diet supports her need for energy, for fuel, to engage in the activities she enjoys.

Ahh, all butter pump cookies!

The Chips Ahoy? Those processed, refined carbohydrate and sugar containing cookies fit just fine, in the context of her diet. As long as she is getting all the nutrients she needs from a variety of foods, and she needed the calories from the amount of food she consumed, if Chips Ahoy was here snack of choice, why should I try to make it "healthier"?

Healthy eating, to me, is not just about healthy foods. It is about getting enough of what you need--enough calories--from protein, fat and carbohydrate to fuel your body and allow for repair and normal function. It includes a range of vitamins and minerals, as well as all the nutrients, such as phytochemicals, that we are learning contribute to disease prevention (think about selecting colors -- deep orange and yellows as well as deep green, and reds and blues in vegetables and fruits). It includes whole grains, and refined, low fiber foods as well (think French bread or my much photographed challah—white flour and delicious!)—because in our world we also need to balance our need for convenience with our busy lives. And, our interest in eating foods we enjoy.

Follow the U diet, and you, too will rest
peacefully!

Besides needing to meet our physical need, we cannot dismiss food's other benefits. There's the pleasure factor, the enjoyment of the taste and texture, the sensory experience of eating. I'm not saying we should simply eat for pleasure. Rather, that we need to consider these aspects of eating when we are hungry and seeking food. What do we feel like eating? What would we enjoy eating? Not simply what should we be choosing.

Consider the U diet. It may not be a best seller, but it’s a sensible, and healthy diet for your body and your mind.

The Quick Fix For Your Struggle With Eating? Patience.

noreply@blogger.com (HikerRD) — Sat, 05 Nov 2011 16:25:00 +0000

20 years to construct Chateau de Chambord,
Loire Valley, France

I know you’re impatient. Everyone’s impatient—you are not alone. We want change to have already happened. And we want to be done with the struggle of eating—eating enough, not eating too much, eating just right. We want to be free of the rules and the thoughts, but are reluctant to invest the effort and time to enable it to happen. We make change, but it never seems good enough, and when it seems to be going along just fine, we fear we’ll slip up—and maybe we do. Quick fixes allure us, offering such promise. But this is not about quick fixes.

I’d like to wave my magic wand and make it all better. I do have a magic wand, but I’m saving it for when all hope is lost. And really we haven’t reached that place.

I’ve never built a house, but this analogy has crossed my mind many times. And you know once something is in my thoughts it’s challenging for me not to share!

Railroad house, Swiss Alps

Consider building your house

It starts with the foundation, which needs to be rock solid, firmly planted. Poured concrete, perhaps, definitely strong—at least after it has had some time to cure, to dry and set. And you’ve got to wait for that.

You could slap together some shoddy construction and it could look just fine on the outside—at least for some time. It may appear attractive at first, but with the first storm the siding may fall off, and the paint may begin to chip. The damage begins.

Restorations may take even longer. There’s some necessary destruction of the existing structure, which precedes the new construction, the rebuilding. And you have to pick and choose what you want to keep and what you’d like to discard in this new dwelling.

Such is the case of building a healthy relationship with food.

It takes time. After all, it took a long time to get into the mess you’re in now. And it takes a solid conviction that change needs to happen—because you believe in the need for change, not just your doctor, or your husband or your mother.

Return to trusting your hunger and your body’s ability to self regulate, if that was a part of your history, if you had once had a normal relationship with food. Remember how charming the old wallpaper looked and how comfortable it felt being in that space? Wasn’t it nice to be able to eat a couple of cookies or a piece of cake, without the negative self talk?

Or, was there never a normal relationship with food? Was it always a relationship of shoulds and rules? Did you never feel safe listening to your internal cues? No feng shui when looking at the wall colors of the past rooms? Sure, it’s more challenging restoring, having never followed your internal compass—getting rid of the old thoughts and habits, and redirecting toward healthier behaviors.

Discarding old beliefs and unhealthy views requires some trust that your house will still be able to stand, without the supports of unhealthy rituals and black and white thoughts. The new pieces of information get tried on, sampled, then permanently attached, as you see their value and beauty.

You need to be able to weather challenges. Stressors, like strong winds and snow, can knock you down. But the more solidly you have set your foundation, the less damage will occur. For instance, keep structure to your day’s eating versus skipping meals. You’ll feel less vulnerable and therefore better able to handle the stressors. And remain fixed in the belief that yes, you are worth it, you do deserve to feel well, to take care of yourself, to eat. These are your cement.

It may take some time for these foundational principles to set, but adding supports can help.

Actually, he's a Swiss Alps goat farmer, but whatever!

Who are your craftsmen? Those who you select to labor on this building with you, whom you rely on to direct your project and provide a vision?

Select a team of with experience—your MD, therapist, RD. And surround yourself with laborers that have the same vision and can support your project, not pro-Ana sites, or diet programs failing to address your behaviors and thoughts. Contract with friends and bloggers who can assist you in getting the building done, and can support your repairs as soon as they need to happen.

Building this chateau (Chenonceau) over water
must have required great vision.

Quick fixes, like sloppy construction are destructive. I’ll just restrict now (and deny my hunger), just for this week, she told me, or just until the holidays, he stated. It’s like leaving off the insulation and expecting you’ll still stay warm. Okay, perhaps not so bad at first. But then the pipes freeze, and then burst, and now you’re left with major water damage and repairs to be done. After restricting, you may eat more than you intended, and then purge, or continue to restrict. Now your signals get confused, and distinguishing hunger and fullness is a challenge. Trust is lost, and your ability to self regulate. Never mind the damage to your body, your emotional state, and your belief in yourself. The thermostat stops working.

But it can be repaired

This medieval castle in Carcassonne, France was partially
reconstructed. Turned out well, no?

Repairs? Yes! Because slips happen (a new bumper sticker, perhaps?) Over time, damage may occur—a tree may come crashing into your house, a window may need replacing. Slips are a normal part of maintenance. But wait too long to work on quality repairs and soon the wiring will also be affected, or the cost of getting the work done will be too great. I can’t miss work to do an eating disorder program, can I? Or I don’t have time to see my nutritionist and my therapist regularly!

Don't hike up Peyrepretuse, in France, unless
your house is solid.

Remember, it gets way more costly putting off construction and renovation of your house. Consider starting now, from the ground up. Gather your team, and start pouring your foundation. And take the first steps to drafting your blueprints for a better relationship with food.

Setting the Record Straight. Shifting Your Perspective Toward Recording.

noreply@blogger.com (HikerRD) — Sat, 29 Oct 2011 16:54:00 +0000

Here's what she had to eat. Take a look. Then write down your assessment and tell me what you think. You know, as if you were the nutritionist working on helping her improve her diet and her relationship with food.

8:30-9:00

Bread and jam, 2 slices

Freshly juiced red grape and berry juice, ~8 oz.

Coffee with whole milk

------------------------------------------------

Vanilla yogurt with fresh peaches

------------------------------------------------

Semolina cake with plum topping

------------------------------------------------

1 fried egg

Bread and jam

12:30 PM

Medium gelato,

~2:00 PM

Wine samples and bread sticks

3:30 PM

½ a thick cheese and tomato sandwich, on white Italian bread

½ a thick pesto and roasted veggie sandwich, same bread

----------------------------------------------------

Wine tasting, approximately 6 oz, and a few bread sticks

7:45 PM

Cheese samples, approximately 1-2 oz.

8:00 PM

Bread, 2 slices

Large vegetable salad (enough for 2 or 3 people) with olive oil and vinegar

Wine, approximately 5 oz.

Gnocchi and sauce

~9:30 PM

A couple of cheese bites from around the world.

Nectarine with hazelnut chocolate sauce--day two's breakfast!

So what did you think? And have you figured it out yet? The she is me, and you are seeing an entire day of my eating while vacationing in Italy, unadulterated.

I'm not in the habit of sharing my food intake in such detail, in part because what's fine for me is not necessarily right for you. And I don't have a ton of personal experience with recording—the last time I tracked my dietary intake was for a grad school project, a good 25 years ago. But I decided I needed to address the topic of recording because it can have great value.

For most clients, recording is the bane of their existence. I say for most, because I have seen that rare person who loves recording. It suits their need to do things perfectly, completely, meticulously, so they follow the recording recommendation to the "nth" degree, including every sip of water and every bite of food they eat.

Do you know how many times I heard "I left my food records in the car" this week? No, you are not alone. They’ve been eaten by dogs, whirled away by hurricanes, and inadvertently used for fireplace kindling. Yes, I have heard it all, the most creative excuses. It reminds me of a NY Times article on North Korean doping (July 17, 2011). Following evidence revealing their soccer team’s use of steroids,

“A North Korean delegation told FIFA (the world governing body of soccer) that the steroids had accidentally been taken with traditional Chinese medicines based on musk deer glands to treat players struck by lightening on June 8 during training.”

You can do better than that, I'm sure.

The egg course--day 2!

More about record keeping in a bit. But first, I want to say a few words about this day's eating, a real day last month in Tuscany.

This is 100% honest. I neither overestimated nor underrepresented my food intake. It is a description of a day we spent in the town of Bra (no, not a typo), the home of the Slow Food Movement and the international, biennial cheese festival which we attended. I don't usually eat quite like this. And I certainly don't drink like this. But we were in one of the most amazing regions for red wines, home of Barolo, Barbaresco and Barbera, and so we did a good deal of tasting.

When you evaluate your intake, please ask yourself "is this typical?" Perhaps you need to view the day in the context of your usual intake, recognizing that there are always exceptions to the norm.

Here's my take on my day's eating:

The evening before the breakfast at Villa La Favorita

The breakfast meal was crazy. Crazy good. And endless. We stayed at a bed and breakfast called Villa La Favorita where the breakfast was served in courses. Multiple courses. The broken lines show the breaks between items served.

Unfortunately, I did not have the benefit of knowing what was coming next, nor how much was coming my way. And the food was wonderful. By the second of our two days there, I knew enough to leave the bread and await the more exciting baked item, to skip the items I cared less for, and to pace myself.

Not knowing what awaits you is most difficult. If you struggle in such situations, obtain as much information about what will be served as you can, so you can prepare yourself. But let's say you didn't, as occurred on day one at the B and B, and you, too, ate more than you needed. What's the worst thing that will happen?

Have you seen enough gelato yet in these posts?

In my case, I didn't get hungry until later than usual. But by 12:30 I needed to eat something. Imagine my pleasure at finding a gelato shop en route to the car! And so I had my second gelato of the trip (see post gelato diet). And it was good. I thought about ordering the small, but had the medium instead. My husband got the small (he is so well trained), but then I shared mine when he was done. So, I think that counts as a smedium?

After a wine tasting in a lovely castle!

The additional "snack" of some wine (quite little, truly—we paid for these tastings by the sample) and some bread stick pieces resulted in a rather late lunch. It wasn't until late afternoon that we got hungry, quite hungry, in fact. That gelato and wine tasting just didn't cut it. By then I couldn't decide what to eat, and so we ordered two different sandwiches, sharing them both evenly. (It was, perhaps, the best food per euro we had anywhere, in a nothing special seeming little spot.) Thankfully, my husband is accommodating and enjoys similar foods.

Dinner reservations were secured for 8 PM, so we decided to start our cheese tasting before the meal. As for dinner? There was nothing I yearned for more than vegetables! After the preceding week in Switzerland where I ate much less of them than I am accustomed to, I was thrilled to find a large salad as a starter to the meal. It was truly the best part of this meal for me. Then I ate a portion of the gnocchi— although I found them a bit too rich—but had enough room for some more varieties of cheese bites, as we strolled around the lovely town of Bra late night. And did I mention these cheese samples were not low fat?

Bra during the cheese festival

By the way, my activity for the day was largely eating and wine tasting. There was minimal walking around some quaint medieval towns, but this was not a high output day, by any means. No biking and drinking for me.

What can you take from this?

Get as much information as you need to feel comfortable, and where appropriate, ask for foods to be prepared how you need them. But when the situation prevents that, trust it will be okay—because it will be. And work on being flexible. In the situation above, perhaps I could have asked about the breakfast menu. But it honestly didn't cross my mind. And so in spite of the breakfast being excessive for me, I had what I wanted, and left part of the foods that I was indifferent to, like the egg. It likely was more than enough; I could have had less, perhaps, and felt just satisfied. But I didn't.

The fuller breakfast meal sustained me, removing the need for an AM snack. (If you are someone following a meal plan at this point, don’t get any ideas about skipping meals or snacks because you don’t “need” them. When your body and your mind are working to keep you healthy and safe, of course you can and will use these cues. But for now, stick with the program and use your meal plan.) Really the gelato met that need—just a bit later than I'd usually need a snack. The source of my calories at 12:30 was hardly relevant, as long as I had enough, and I ate what I wanted to eat. And I enjoyed every creamy bite.

Gotta expect the unexpected! Sculpture from a wine
tasting town in Piedmont

If a struggling client had recorded this day, and was self assessing his intake, here's what they'd likely say, and what I would have countered with:

Client: Nutritionally, this day was way too high in saturated fat, as well as in alcohol calories.

Me: This is quite atypical for your eating. You rarely graze on cheese with such frequency, and you never drink in the afternoon, never mind multiple times in one day. Given the frequency of this type of eating, then, nothing to worry about.

Client: Breakfast is too big.

Me: It may have been more ideal to distribute your food better, spreading this enormous breakfast through the morning. But you couldn't. And so it was. Radical acceptance.

Client: I shouldn't have had the gelato; I should have chosen something healthier.

Me: No, you chose what you felt like eating, and that's appropriate. And you had as much as you needed. You started to share when you were feeling you had had enough. Perhaps the small gelato dish might have done the trick. Maybe next time you’ll try the small. (Wow, a next time? What a thought!) You never do know how much will be enough, until you explore the options and learn to titrate.

Client: I consumed a lot of calories from beverages, including alcohol.

Me: If you are working to increase your calories, the benefit of beverages (non-alcoholic, I mean) is that they move quickly through your gut, and the feeling of fullness passes fast. But if you’re looking to feel more satisfied from your intake, I'd vote for fruit over juices. Again, it really depends on your need. As for alcohol, it's important to identify the impact drinking has on your awareness and mindfulness of your eating. Some can manage modest amounts, others simply cannot.

Client: I should have limited my dessert to once a week, not twice a day!

Me: Once you set arbitrary limits on your "indulgences" you'll set yourself up for trouble. If cake can only be eaten on birthdays or special occasions, you will certainly find yourself eating more of it on the one and only day you allow yourself to have it. If you are only allowed to eat before 8 PM, you'll find yourself eating a lot more before the time is up. Ultimately, these rules fail you.

Client: I ate so much and should have exercised.

Me: The food doesn't turn to fat because you didn't exercise. While I absolutely do recommend exercise for health and disease prevention, it is essential that you consume enough food to support it. Your body is quite forgiving. A larger intake on some days doesn't result in weight increases that day or that meal. Of course over time, if you exceed your need for maintenance, whether you exercise or not, you will gain weight. And for many of you that really is a good thing! You know who you are.

Benefits of Recording

Recording gives you the opportunity to view things differently, to gain insight, while letting go of the self-criticism and self-loathing. Inevitably my view of my clients' eating is way more compassionate than their perspective. So writing things down and debriefing about it with a knowledgeable provider may truly help shift your opinion of yourself and your eating.

Rather than seeing this as a report card, or a confession, consider yourself a detective, with the goal of uncovering some answers, solving the puzzle of your eating struggle. This helps you break down the barriers to implementing dietary change. Including information such as your hunger rating and other eating triggers, along with the location food is eaten, is enormously useful.

Recording avoidance is common, for individuals dealing with all kinds of eating, regardless of their weight. Record keeping makes us more aware of our eating, which ultimately helps us make change. It's an in your face reality check. And that benefit may be the very reason you may flee from writing down what you eat. It is easier to not confront it. If you don't see it, you don't have to acknowledge it.

But if you don't acknowledge what you are doing, you don’t have to make peace with it. Hence, eating while on the computer, while watching TV, reading, driving, multi-tasking really do the trick to keep you stuck.

If you no longer record, but still consider what you eat, whether you are hungry, or simply satisfying a range of other needs, than putting it down on paper may not be necessary anymore. If that awareness starts to fade, you may want to resume recording.

What Should I Include When Recording?

Let’s start with what you shouldn’t be recording—calories, fat grams, fiber, and any specific nutrient content. Why? Because that leads to relying on external information, versus internal cues. Internal cues? Hunger and emotions, for instance. Here’s a list of what you ‘d benefit from including:

Don't go by this clock, though!

· The time you ate

o This helps you see your eating pattern and understand why you ate as you did. Too long between eating? That will lead to trouble. Eating every hour? Is there something other than hunger driving your eating?

· Your hunger rating

o I’ve come to like the scale 1-7 best, with 1 meaning starving and 7 meaning stuffed. But use whatever works best for you, including word descriptions.

· Your thoughts and feelings

o This helps you see your obstacles to eating, and to then work with strategies such as CBT (cognitive behavioral therapy) to change them. Food rules and misinformation may come to light, best addressed with your nutritionist.

· The location food was consumed

o Does the location support mindless eating? Are you eating in bed for comfort? Would you sleep on your kitchen table?

· Any other diversions while eating?

o Distracted eating is mindless eating. For those trying to get their needs met and not know it, this can be useful initially. But ultimately, we all want to be in control of our eating and our weight regulation. So try to separate eating from distractions.

So if you choose to stay stuck, skip the recording. If you want support, and a new perspective, record and share with your providers. Or, self assess as if it were your sister’s or your best friend’s recall; this will likely give you a more compassion perspective. If the only result of recording is more preoccupation with food and eating, and changing your perspective isn’t helping, than please do yourself a favor and don’t record your food. But even assessing these other components, minus the actual food items, can be quite useful. So give it a try.

And please let me know if it was helpful. As always, I welcome your thoughts, comments, reactions, and corrections to my assumptions!

Healthy At Every Size?

noreply@blogger.com (HikerRD) — Mon, 24 Oct 2011 02:03:00 +0000

Read first, then decide.

Today I saw a 12 yr old girl, I’ll call Gabrielle, whose weight was off the charts. She was referred by her doctor, supported by her concerned parents. And here's what I told her, because I believe it to be true.

Her place on the weight chart is likely the right place—for her. Since the age of 2 yrs she has paralleled this curve at just above the 95^th percentile, (in spite of being only 5 ft tall, much shorter than average), resulting in a very high BMI. She is an active, healthy girl—more active than most thin girls and boys I see, with no apparent suggestion of health issues. She eats well—appropriate portions, as I'd expect for her need, a healthy balance of foods, including those I'd call "junk" food, and she eats the same when she is alone and when with others. In other words, she’s got a healthy relationship with food. Most importantly, she feels good about herself, and the last thing I wanted to do was add mental health issues to any perceived, but non-existent risk of physical health issues.

Gabrielle is one of several patients I’ve seen recently, fitting this description. Some individuals are larger than average size, some smaller, kids and adults, males and females. And we should not assume that’s a problem, as several bloggers are sharp to point out. Health At Every Size, The Fat Nutritionist and others enlighten those who don’t know better, who don’t ever question their assumptions, that large people can be healthy, fit, and in fact happy.

End of story?

Not quite. The key word is can be. While we cannot and should not assume that an individual’s weight is causing them medical or emotional problems, there are overweight individuals who are not healthy or comfortable at their size, for whom weight loss may help. I question the belief that striving to lose weight, in all cases, is bad. And I am not talking fad diets, mind you.

I am not simply projecting here. I speak on behalf of the patients I have seen over my 25 years of practice. Just as we cannot assume that they’re distressed at their current weight, we cannot assume they are very comfortable or healthy at their state of health and size either.

There are kids, and adults, like Gabrielle described above—always large, but healthy and fit. Many are self-accepting, many self-loathing, perhaps due to society’s discrimination and learned messages they need to unlearn. And I do my best in my sessions to convey this very message, that they are just fine as they are—their eating, their activity and their weight. I am not addressing these “Gabrielles” in the remainder of this post.

Rather, I am speaking about those for whom obesity, or the degree of obesity they are living with, is not their norm, the men and women who have gained weight outside of their comfortable and usual weight range. This includes individuals struggling with compulsive overeating, as well as those without any emotional baggage. It applies to those who no longer take time to meet their needs for exercise, or who might have suffered an injury, which forced a decrease in activity, without adjusting their food intake. I’m describing those who don’t know how to prepare a healthy meal as well as those who eat many meals out, juggling the modern life of working and parenting, soccer practices and carpooling. And those who minimally eat throughout the day, only to eat excessively at the end of the day.

I am not judging them, merely conveying what I hear from them day in and day out. They put off travel because airplane seats feel too tight, and European cars fail to accommodate their size. They want to be off the medications they now take daily, for hypertension, high cholesterol and joint pain. They want to be free of their sleep apnea and their heartburn.

Sure, there are plenty of normal weight people, thin even, who also develop such conditions (count me in—thin with high blood pressure). But as a population, increased weight increases the odds of developing such conditions. The damage to their knees may be already done, but it is easier to move a body with a lower mass versus carrying surplus weight, particularly when you’ve got pain.

I’m not picking on the obese. If you read any of my posts you’d clearly see my philosophy. Similarly, I do not believe there can be health at every size at the low end of the spectrum. While not all slim individuals have eating disorders, (some are naturally thin, always were and always will be) I can tell you that a low body weight that contributes to loss of menstrual periods, low body temperature, a very low pulse, distorted thoughts and preoccupation with food similarly would benefit from a change in weight.

And if you think these individuals are immune to society’s judgment, think again. There is equally little sensitivity to those struggling with weight issues on this side of the spectrum. Yes, sometimes the very people who preach size acceptance are all too quick to dismiss, insult and disregard the opinions and insights of someone who is thin, simply because they are thin.

A rabbi friend once said jokingly “Anyone who is more religious than me, is a fanatic. Anyone less religious, a heretic.” Sometimes that’s how I think we all behave around the issue of weight. It’s fine if you are my size, but thinner or fatter we accuse of needing to change and have a difficult time accepting.

Ultimately, the primary focus should not be on losing weight. Yes, even for those who truly care to lose weight, for whom a high BMI was not the norm. Rather, they need to address their behaviors and experience tangible benefits—a sense of accomplishment, having set a realistic goal and achieved it; better sleep; better endurance; better concentration; less irritability by honoring their body’s need for fuel; and a better relationship with food. As these changes occur, weight loss also follows.

Where do you fit in all of this?

Does your activity need to be addressed? Are you even at a healthy enough place to be exercising? What modest goal can you set that you’ll be able to achieve?

Do you allow yourself to eat when you need to? Or do you push this to the limits, thinking you are too fat to be eating? Everyone,

regardless of her size, needs and deserves to eat throughout the day.

Do you give yourself permission to eat foods you enjoy? Do you even remember what those foods are? Or are you so stuck following everyone else’s rules (including your own), absorbed from years of dieting and denying yourself?

Yes, allow yourself to eat whatever you’d like—no single food makes a person fat. And have it when your body needs it—when you are hungry, any time you are hungry. But learn to have just as much as you need (do read through the many older posts that address this topic).

In fairness, the palpable anger I feel from those who blog about fat acceptance is understandable. They have been mistreated by our society, including those that should know better, such as the medical community. They include those, like Gabrielle, for whom weight loss may be inappropriate. They are repeatedly told to change, when change is truly not necessary.

But let’s not over generalize. There are also those overweight individuals who would like nothing more than to be accepted for who they are but have medical conditions that may be assisted with weight loss. And they deserve to be supported on their journey to a healthier place.

Weight Management Gelato Style

noreply@blogger.com (HikerRD) — Wed, 19 Oct 2011 02:58:00 +0000

The first time I traveled to Italy I was 19. I recall marveling at marble fountains, being seduced by sculpture and impressed by massive stone architectural creations while touring through Rome and Florence. But perhaps as memorable as Michelangelo’s larger than life David (http://bit.ly/nyY9rx), with which I fell in love, was the smooth and creamy gelato. Twice daily I would indulge in such intense flavors as nicciolo (hazlenut) and espresso, midday and late evening.

In fact, I would purchase a scoop regardless of the hour, whenever I had an excuse to pass through the famous square the gelateria occupied. I had purchased it fearing I’d never, ever, see gelato again. It was now or never, as gelato doesn’t travel well in luggage. This, by the way, was the early 1980’s.

During my recent trip, however, I was older and (somewhat) wiser. I had gelato only twice in 7 days. (Okay, I did share some bites of my husband’s on a third occasion, I admit, but does tasting just a bite on those tiny plastic spoons really count?). It was not because I was watching my weight (I was not), but because I trusted this time; I knew it wasn’t my last chance to get this fabulous Italian ice cream. Boston has great gelato, as does NYC, which I visit not infrequently. In fact, you can even purchase some good stuff from the supermarket these days—at least where I live (check out Whole Foods). Or, as I’ve done, you could make it at home with an ice cream maker.

But back then, I harbored many a diet thought. As a teen, I had dabbled in the Scarsdale Diet, and wasted my time at Weight Watchers (Now you understand my vengeful post! (http://bit.ly/gY2653)

My thoughts about food and eating and my body have changed enormously over these years. At the age of 19 and by the end of college, my BMI was out of range and it was not okay—I was sedentary and hardly fit—and I was rather disconnected from my body’s signals and needs. And I was not a large-size person from early childhood, genetically predetermined to exceed the BMI charts, justifying this above average size.

I’m older and wiser now at 48. On my return trip to Italy, I savored the rich and flavorful, slow cooked meals of the Piedmont, filled with mushrooms and truffle oil—but I didn’t fear it was my last supper; I lingered over multicourse meals, filled with flavors I adore. And I stopped when I had had enough—even though it was delicious.

I skipped desserts when they seemed unnecessary, but took advantage of the aforementioned gelato when I needed a snack. I sampled many a local Pecorino cheese in Tuscany and savored the hearty Tuscan Ribollita soup filled with beans, bread and vegetables. We enjoyed divine meals artfully prepared with local ingredients, served by Italians passionate about their culinary art.

Among the very best meals was at La Coccinella, located in the small town of Serravalle DiLonga in the Piedmont. Fabulously prepared fish, as you can see from this photo. But like the gelato of old, I will never forget the dessert lovingly prepared with local hazelnuts, a delight of textures and flavors I can never duplicate.

I write this not on behalf of the Italian tourism department—no one is advertising for your clicks here. Nor, to brag about my travels I feel fortunate to have taken, along with my husband who enjoys great tasting food as much as I. Rather, it is my hope that this will inspire you.

You may never care about great olive or truffle oils, perhaps. And traveling may be the furthest thing from a reality for you right now. But enjoying food can start at home, wherever you live. Sure, it may require some prep time (although good gelato, like fine chocolate, could easily be obtained and consumed). It requires you to start asking yourself “what do I feel like eating?”, when you are hungry, not just “what am I supposed to be eating?”, yearning later for the very items you’ve prohibited yourself from having. It necessitates giving yourself permission to eat now, and again later—even if what you choose to eat later is ice cream. Because when you know you have permission to eat it again, you can stop when you’ve had enough. You’ll begin to trust this is not your last chance.

And after doing this for some time, and really trusting your body, you’ll note something strange. Sometimes, there may be times when you’ve truly had enough gelato, and there’s nothing more desirable than a fresh, juicy piece of fruit. And that’s ok to eat too.

Making Enemies 101: Tips From the Blogosphere

noreply@blogger.com (HikerRD) — Tue, 11 Oct 2011 02:46:00 +0000

Anger. All I could feel was their anger. Their perhaps valuable messages got muffled, but I was left with my tail between my legs. That was my experience of reading a couple of blogs I respect and frequent often, one with a focus on eating disorder recovery, one on size acceptance of the obese. No doubt this post of mine may provoke more anger—that is not my intent. And while these two topics may seem vastly different, I hope to show that they have many commonalities.

Laura's Soap Box

I have learned a lot from Laura’s Soap Box: http://www.laurassoapbox.net

It has, more than anything, strengthened my stance that we have no time to waste, when it comes to recovery; that the ever-hopeful practitioners that patiently wait while engaging in therapy often do so for way too long. And especially for the young anorexics and those new to their eating disorder behaviors and thoughts, those with a narrow window of time for weight restoration for growth and development, for preventing hard-wiring of their approach to eating. The parenting style, more loving tiger mom than most of us like to approach, has its merits. Yes, for survival and health, it takes a tough parental stand.

Yet when I read the post http://www.laurassoapbox.net/2011/10/why-words-matter-and-whose-job-it-is-to.html I was struck not by this very appropriate message, but by the anger and frustration at parents and practitioners who haven’t mastered the art of (eek) Maudsley? Family-Based Therapy? Modified? I’ll refer to it as Maudsley-style from this point forward, so as not to incite more anger.

I’m guilty.

It's a long way to travel to get to where we need to be.

I admit it. In my 25 years practicing as a dietitian, I have never formally been taught this approach. (Nor, for that matter, was I formally trained in an academic setting on eating disorders; they were only minimally covered in my graduate studies). I have learned what I know by educating myself through eating disorder conferences, literature, as well as more recently through blogs like hers. And, through seeing vast numbers of eating disordered individuals over my career. From my understanding, in this approach, nutritionists/RD have no place. But that’s another story. In my version, RDs play a very valuable role.

Anorexia recovery is not one-size-fits all.

Many families I see are not candidates for this approach. Some are quite dysfunctional, frequently making supervision at mealtimes disastrous; it would take years to educate them about their inappropriate messages, to correct their nutrition misinformation—I could go on. And we just don’t have that kind of time. Caution: I am in no way suggesting that these dysfunctional families caused their child’s eating disorder, merely that they are in no position to take charge of the recovery.

Some families aren’t candidates, as I see it, as they have too many other demands, such as caring for another family member—a parent, a child with special needs, a newborn, working multiple jobs, etc.

Some families certainly could learn to use a Maudsley-style approach—if they were prepared to take the time. Yet I find many parents want their kids fixed—they bring them for care with an unrealistic perspective on what recovery entails, how it is measured and how long it might take. And most importantly, they have no idea how important a role they play as parents, Maudsley-style or non-Maudsley-style.

I say some intentionally. Many parents couldn’t be further from this description. They are present, physically, and emotionally for their kids; they are anxious to know just what they could do to help their child, and how best to do it, and they adjust their schedules to make treatment appointments a priority. They are scared, but they work on accepting that treatment is a process and takes time.

In such families, some of the kids with anorexia may be supported by their parents, without the parents having the level of supervision and involvement I understand a Maudsley-type approach to have. They set appropriate safety limits, from a health standpoint (ie—they respect and enforce the outpatient team’s recommendation that there is to be no physical activity, for now). But their children are able to make progress, measurable progress with weight restoration and vital sign changes, that enable them to continue in this setting, without their parents taking charge of their food plating or supervising their snacks. And they are able to engage in therapy, both mental health counseling as well as nutritional counseling in the process.

But then there are those for whom the Maudsley-style approach is perfect. A willing family, with the time it takes to be an active player, to be intimately involved in refeeding. Parents willing to shift the relationship to that of supportive team members, fighting the anorexia along side their child, taking charge the way their unhealthy child can’t, at this time. And I have seen recovery with both these approaches.

Treatment for eating disorders needs to be as varied as the individuals with the eating disorders. As health care providers, we too are not a homogeneous group, not by specialty, not by style and approach. We also get frustrated and angry, when we encounter patients and families, as well as other medical providers who fail to support our stand, to set appropriate limits to ensure recovery. We too recognize that it takes a nourished mind to engage in the process of recovery and decision-making, a role many starving anorexics simply cannot do.

I believe we all share the very same goal—to foster recovery and normalize life for the individual as well as the family dealing with anorexia. And we need to stand united in this goal. There is no single best treatment for all individuals. But educating with a consistent message about the seriousness of eating disorders of all types and the need for treatment and support is essential.

We put our heart and soul into doing the work we do. But few will respond well when faced with angry rants—by me, by parents, or by Maudsely-style bloggers. We, too, are works in progress.

And yes, I will soon address the other angry blog in an upcoming post.

This Time It’s Simply About The Calories

noreply@blogger.com (HikerRD) — Wed, 05 Oct 2011 02:14:00 +0000

Piedmont: Great Wine, Great Challenges

I’m a snob. I admit it. When it comes to food, it’s got to taste good. Because I intend to really taste it. To enjoy it. To savor it. Every bite of it.

But Thursday, after many long, hot hours biking the grueling hills of the Piedmont region of Italy, we were hungry. Really hungry. The hills took us much longer than expected; we had no idea what it really means to be in shape for riding hills! And the snacks we carried? We downed those within the first couple of hours.

So we rolled into a tiny town, known for its hazelnut production. Now give me a dessert with hazelnuts and chocolate and I would’ve been just fine. But that didn’t happen—no bakeries in sight. But it didn’t take us long to identify the only eating establishment around. Think retro, stale, cigarette-smoke-filled air luncheonette before it turned quaint and chic.

In our broken Italian we ordered the only Panini that sounded acceptable. Oh, and a salad. What comes to your mind when you think salad? Fresh, crisp vegetables? A brilliant assortment of colors, flavors, and shapes? Think again. They offered what is known as Russian salad—a heaping mass of mayonnaise, containing diced potatoes, peas and a speck of carrot. We had it along with the white bread sandwich packed generously with cheese. And I neglected to mention (how could I forget?)—that there were two rolled up sardines with olives. At least they added some color.

Well, I ate at least 90% of this lovely meal. And I hated every bite. (Although given my sweating from the unseasonable heat, the sodium rich sardines and olives were much appreciated.) This was so far from the fabulous cuisine I had heard so much about and had begun to enjoy my first day in the Piedmont (more posts about those meals to follow). The Piedmont, after all, is know for the Slow Food movement http://www.slowfood.com/international/6/faqs, amazing wines (Barolo, Barbaresco and Barbera) and white truffles (these are intense mushroom like fungus, not chocolates, my friends), with their distinctive flavor which embellishes foods with a mere drop of a truffle infused oil.

At this point, exhausted and overheated, depleted of energy, it was strictly about the calories, the fuel. I wasn’t going anywhere without eating this awful meal. I had no other options. I couldn’t find my voice in this language I barely spoke, and I suspect there were no other options, given the appearance of this place. Yes, mayonnaise-laden salad with a bland cheese sandwich was the only answer. Simply non-negotiable. There was nothing else to do but eat it.

Provence, not Piedmont!

What’s the meaning of this post? It’s not about my disappointment, of things not going as planned—that could be a whole other post. It’s not about adjusting expectations, because who could have expected this? Never mind that the biking was a total drag, nothing like our fantasy rides through Provence with climbs we could manage and stunning varied vistas to distract along the way.

No, the meaning is much more literal. Sometimes it comes down to Nike’s message—Just Do It.

For those of you who undereat—I know there are times when you are not hungry, and eating seems totally unnecessary. And when a fat-containing food may overwhelm. Or you question why you have to eat more than everyone else around you. Or the uncertainty of a meal’s content leads you to want to choose the safest route—food aversion. Or the allure of not eating, or restricting, promises a pleasant disconnect which might be so welcomed at this moment.

As for the overeaters and binge eaters (and anorexics, too)—skipping meals or snacks certainly sounds promising. Why take in those extra calories when a coffee will suffice? Because sometimes, you need to just do it. And when you’re feeling hungry even if no one else is, you need to just eat—because you need to begin to listen, to trust your body and its signals. Because you so deserve to be well nourished. Because your size has nothing to do with your need for nourishment in the moment. Yes, you too, need to trust it’s okay, it’s necessary to eat. And that you deserve to eat, regardless of what others’ glances may suggest, in spite of the messages from family members you hear or replay in your head, regarding your need to lose weight. Be in the moment, and trust that you should eat.

A cool drink after a long day of unmanageable hills and bad food!

I won’t be heading back for another Russian salad-filled lunch in the Piedmont. But I’m pleased I was able to fuel up for the challenging ride back. In the end, we enjoyed a lovely meal at dinner, and a refreshing drink just after unclipping from our pedals.

Hannah’s Story. The Tale of the First Reported Anorexic

noreply@blogger.com (HikerRD) — Sat, 01 Oct 2011 01:34:00 +0000

Blogging should have been far from my thoughts, as I sat in Temple yesterday, the first day of our High Holidays. But food and eating and Judaism seem inseparable, and so my thoughts turned to Drop It and Eat. At this time of introspection, at the start of the Jewish New Year, a time of re-creating, what’s the chosen text we read each and every year? A tale of a woman named Hannah, who by my interpretation is clearly struggling with anorexia. Is it me and the lens I view life through? Perhaps. But I don’t think so.

Read the full, (translated) passage from 1 Samuel 1, dated from before 600 BCE. online if you‘d like. http://www.mechon-mamre.org/e/et/et08a01.htm

Here’s the synopsis, relevant to this blog topic, as I see it.

There was a man, who had two wives, one named Hannah, one named Peninah. Peninah had children, Hannah was childless. Hannah was his favorite, although God had closed her womb. Her rival, Peninah, to make her miserable, would taunt her that God had closed her womb. Year after year this happened. Every time she’d go up to the House of God, Peninah would taunt her, so that she wept and would not eat. Her husband would say “Hannah, why are you crying and why aren’t you eating? Why are you so sad? Am I not more devoted to you than ten sons?”

After they had eaten and drunk, Hannah rose. In her wretchedness, she prayed to God, weeping all the while. And she made this vow. (To paraphrase—look upon my suffering and remember me and if you give me what I want (a male child) I will dedicate him to your service.)

To make a long story short, she began praying silently, “in her heart; only her lips moved, but her voice could not be heard”. And the priest took her for a drunk, and told her to “sober up”. And what does she do? Does she shut her mouth in shame? And close her heart as well? No! She finds her voice in a big way. She replies, “I am a very unhappy woman. I have drunk no wine or other strong drink, but I have been pouring out my heart out to God. Do not take your maidservant for a worthless woman; I have only been speaking all this time out of my great anguish and distress.”

In response, she was apologized to, told to “go in peace” and “may God grant you what you have asked for”. Yes, an apology and a blessing. Pretty impressive, for a woman of those times. So she left, and she ate, and was no longer downcast.

After relations with her husband, Hannah conceived, and had a son and the story goes on. And for the record, Hannah became a model of prayer, with her silent but heart felt communication.

So I’ll reiterate the obvious. Here’s a woman, seemingly depressed, taunted, yearning year after year for a child. Her husband doesn’t seem to get it, or likely to understand her or her sorrow, as he naively asks her “isn’t my devotion as good as ten sons?” She manages to eat and drink something, then finds her voice. She takes control of the situation, by bargaining with God to get what she wants—take note and give me a son, and I’ll dedicate him to your service. She expresses her pain to the priest and makes herself understood after being accused of drunkenness. She leaves, eats, and is no longer downcast. And then she is able to conceive.

The text doesn’t tell us if she had amenorrhea. We don’t know if there is a genetic component to her fertility problems, or to her eating disorder. We know nothing of her thoughts about food and eating, about her preoccupation with anything other than conceiving. And I doubt she calorie counted. We certainly don’t know her weight, BMI or how medically stable she was. But we see a link made over and over in this text—She ate, she found her voice. She didn’t eat, she was infertile. And I have learned that when things are repeated in these texts, it is never accidental, but for emphasis. After expressing herself, pouring her heart out, she was able to eat and drink, resulting in her ability to conceive; a connection, causation even, suggested between not eating and infertility, between eating and conceiving.

Hmm. Seems like perhaps the earliest reported case of anorexia to me.

What’s the significance for you?

From my read, I see hope. You can be stuck year after year in the same bad place, but then something can change—YOU can make something change, and get to a better place. It takes nourishment to find your voice, to petition to get your needs met. But isn’t it worth it if you can finally be heard? And even if you don’t get blessed for your outspokenness, I suspect you’ll feel much better. Getting things off your chest—whether through personal expression (writing, journaling, silent prayer, meditation) or speaking up to your significant other or those who really don’t get it—is crucial. Yes, eating helps you find your voice, and expressing yourself helps you eat—but pregnancy will not necessarily result.

How much should I eat? Using your head, trusting your body.

noreply@blogger.com (HikerRD) — Sat, 24 Sep 2011 16:28:00 +0000

I just returned from two weeks abroad, 24-7 vacationing with my husband of 25 years (and yes, we still remain happily married). One week hiking in the Swiss alps, one week eating and drinking my way through Italy’s Piedmont and Tuscany regions have left me with so many thoughts to share. So enjoy the photos and commentary in the next several posts, and please share your thoughts and comments with me!

The lovely town center of Bagno Vignoni we pushed our bikes to.

I get it now.

This week I was struck by how much I utilize, maybe even rely on nutrition information to make my eating decisions. Sure, I eat intuitively, and I stand by absolutely everything I’ve told you throughout Drop It And Eat’s many posts. But I had an interesting revelation this week while in Tuscany. Until then, I hadn’t fully realized just how much nutrition info is a part of me, my food choices, my portioning. It came to light in a big way this Wednesday in Italy.

A lovely lunch, except for the 1/2 cup of oil!

Of course I’m aware that information impacts what I purchase. That includes higher fiber cereals, to keep things moving, as well as desserts with real butter, (because of the knowledge that I like the taste); white meat poultry, lower in saturated fats associated with cholesterol levels and cardiac risk, and whole grains for their mineral content, fiber as well as my awareness that I love their chewy texture. And while my awareness of the nutritional content of rich pastries doesn’t stop me from eating them, nor from thoroughly enjoying every bite, it makes me mindful to savor these items and to consume them in modest amounts.

18 euros, about $26 for these two fellas!

Twenty-five years as a nutritionist yet, I take knowledge for granted; I never really acknowledge its impact on my diet. No, I don’t calorie count, or tally my fat grams. And I don’t use a meal plan of any kind. Nor do I weigh my food.

But at home, nutrition guidance surely impacts my life. When I buy fish, I ask for the amount based on an estimate of the number of ounces our family needs per person; ¾ pound for the two of us is not an unusual request. In contrast, most people I see approach the fish counter saying “I’ll have those two fillets” or “3 salmon steaks for the three of us”, without regard to the portion size.

I know how I like my food prepared; I enjoy good tasting meals with added fats—flavorful oils and butter—but I do add them sparingly, knowing they are calorically dense. Over time, I’ve learned how much rice I need at a meal, and just how much will serve my family, preparing accordingly. When I eat out, as you’d have guessed by now, I’m vocal, requesting foods the way I want it—light on the oil, or with extra basil or cilantro, or with added tofu or vegetables—whatever. Are you cringing just thinking about us dining out together?

Given the price of olive oil I considered getting this oil to go.

So imagine this. I’m in a country where I could barely order off the menu with minimal understanding of what I’m ordering. Culturally, I have virtually no awareness about regional preparation of the dishes. Imagine my surprise when I was served this veggie and cheese plate (right).

Earlier in the day, we ventured into the local fish market to plan for our home-cooked dinner in our apartment. Unlike what I am accustomed to, the fish are sold whole—then weighed, cleaned, and filleted—so we had no idea just how adequate a single fish would be. God forbid we should go hungry! So we ordered two whole fish. The price of 19 euros (approximately $26) should have been a red flag—a mighty expensive dinner for two! But what did we know?

Our home-cooked fish dinner, made with onion, peppers, fennel, capers,
garlic, white wine, and did I mention olive oil?

That evening, after cooking the meal—roasted branzino fish, risotto, cheese and figs—I realized that this meal was truly enough for four people, versus two. I had no knowledge of the food’s weight, the cheese was bought as a round single unit, and we just ate it. Slowly, we sat enjoying our delicious meal, together with a lovely white wine from the region.

And then it struck me. I had felt, at first, handicapped, yearning for my usual knowledge-based cues to assist me that day. How much oil is in this dish at lunch? How many ounces of cheese am I eating? How many people should this fish dinner serve? But I let it go.

Dinner included delicious goat cheese with black truffles. Lunch featured
the regional specialty of Pecorino, a sheep's milk cheese.

While I didn’t have the concrete information I usually rely on, I still had my experience—my knowledge of just how much I usually eat, which allows me to maintain a healthy weight. And I retained my internal knowledge—the physical signals that told me when I had had enough food and was satisfied.

When I reflected on this day, consuming ½ an Italian bread (no, I am not exaggerating), cheese, and god-knows-how-much olive oil in my lunch, I realized that I hadn’t gotten hungry throughout the afternoon; in fact, I seemed to have skipped my usual afternoon snack, inadvertently.

Trust

So it still comes down to trust. If you’re maintaining a healthy weight, your usual portions will suffice. Need to gain or lose? Modify your portions accordingly. Eventually your physical signals will resume, so you can finally distinguish physical hunger from all the other reasons you do or don’t eat.

If you speak the language, then speak up! Ask for foods the way you’d like them, and request a doggie bag for leftovers. And trust that all is not lost (gained?) if a meal is different from your norm. I personally would never choose to use half a cup of oil on my veggies, even good tasting extra virgin olive oil, but as I told my husband at lunch, “at least it’s good for my coat!”

I got more of an upper body workout than I bargained for.

In the end, in the two weeks I had had much more wine than I ever consume, significantly more fats of all types, more meals out, and more frequent desserts. Swiss chocolate is divine, and there were times we had some with breakfast. I biked less than planned, walked more than expected (including walking the bikes in terrain I couldn’t manage), and was generally more active than usual, especially given the length of our hikes.

Sometimes, all we can do is to laugh at the situations
we encounter!

And for the record, my weight is exactly the same, as it should be, as I’d expect. But most importantly, I enjoyed it all, even playing with the leftover oil-soaked food at lunch. Because life’s too short to diet.

The Wedding Diet. Guaranteed to Change Your Weight.

noreply@blogger.com (HikerRD) — Wed, 14 Sep 2011 22:15:00 +0000

Hard to tell, but it really was pink!

I lost a bit of weight then, but it was unintentional. It’s hard to recall the details—it was 25 years ago—but I certainly recall my pre-wedding jitters, my perseveration over details of this NY Wedding’s menus and seating and flowers, and the stress of commuting to work 3 hours daily. And then there was the wedding gown hype (Imagine Say Yes To the Dress; I bought it at the same Kleinfeld’s of TV fame).

But as PJ points out in her guest post below I was not typical—I did not try to lose weight before the big day. And who buys a pink wedding gown, like I did, anyway?

Who Is PJ Anyway?

First and foremost, she’s a bright, sweet, thoughtful, determined Follower of this blog, who I adore. She’s an Aussie, a mother of three young children and an adult new to acknowledging and tackling her own long-standing eating disorder. And she’s approaching her recovery with gusto, true to her nature. She’s using her resources 100%, while painfully honest about her struggles and her slips.

Welcome PJ, who miraculously knew I’d be in a bind this week, unable to write a timely post.

Read her fabulous blog, Recovery, PJ Style, for more honest writing, incredible wisdom, and support.

The Truth about the Wedding Diet

Ever planned to lose weight for a big event? How did you get on? And, probably more importantly, what happened after? Well, let’s start by seeing what Lori has to say on the topic. In her post the Graduation Diet, Lori describes a woman named Amy determined to lose 15 pounds in the 6 weeks leading up to her son’s graduation. But despite Lori’s warning/prediction:

“Dramatic changes in eating and activity are rarely sustainable. And they never occur without a cost”

We never did find out how Amy fared. What do you think?

At the recent conference for the Australian and New Zealand Academy for Eating Disorders, a researcher named Ivanka Pritchard from Flinders University, gave us the answer. Pritchard recruited 343 brides-to-be from a bridal expo and asked them a series of questions; including whether or not they planned to lose weight before the wedding and whether or not they had been told to lose weight (this pressure came from a variety of sources such as family, friends and even the wedding dress saleswoman!). Pritchard reported that over 50% of brides-to-be wanted to lose weight before the wedding (approx 8kg) and around 13% had been told to lose weight.

Pritchard also collected data on starting weights and then followed up at 1-month pre-wedding and 6-months post-wedding.

Of the first group (those that wanted to lose weight), what do you think the average weight loss was? Nothing. That’s right, at 1-month pre-wedding there had been no change in the weight of this group. However at the 6-month post-wedding follow-up there most certainly had been a change. This group had gained an average of about 2kg. Pritchard called this the ‘oh-thank-god-that’s-over-now-I-can-eat-what-ever-I-want’ effect.

The second group (those that were told to lose weight) did show some slight weight loss pre-wedding but gained significantly more post-wedding than the first group.

Pritchard concluded her presentation by highlighting the need for awareness campaigns to reduce the pressure on these woman to fit some societal ideal for the perfect bride – especially in the face of the competition they are up against: both Jenny Craig and Weight Watchers, as well as a selection of health clubs all had stalls at this expo.

So there’s your answer. And although in the scientific world we don’t call it proof, merely evidence, you’d have to agree it’s pretty compelling evidence to say the least.

The Wedding Diet will NOT result in weight loss. But it will result in weight GAIN. Darn. Oh well, at least we still have Drop it and Eat.

Beyond Calories. Learning To Embrace Food For Pleasure

noreply@blogger.com (HikerRD) — Thu, 08 Sep 2011 12:11:00 +0000

From my seat in the kitchen I could only see his butt. But I could hear the probing of his snout, which piqued my curiosity. Then his head emerged, his eyes beaming at mine. After catching my glance he guided me with the movement of his head, pointing toward the 25-pound bag of kibble.

Waiting patiently for his favorite biscuits.

What could he want, I wondered. He has food in his bowl. He repeated this gesture talking to me without my comprehending. But then my husband got it (he speaks dog better than I do). He wants the fresh, new dog food, he realized. The stuff in the bowl was from the end of the last large bag and it’s just not what he wants.

So my husband opened the new bag, a new variety in fact, replacing the previous batch. And he chowed down (my dog, I mean, not my husband).

Yes, even my dog Mica has absorbed the lessons living in this household. Maybe the quality of the older food was sub-par, or perhaps it was the allure of something new. But for some reason, he was triggered to sniff out something more desirable, and make his needs known to us.

Milanos, one of my favorite cookies.
But I prefer the mint variety to the orange!

There’s meeting your needs for fuel, the most basic in the hierarchy of eating needs. But then there’s eating to satisfy on other levels— to have what you really desire, to enjoy the flavor and textures of great tasting food, to avoid limiting food choices to shoulds.

Admittedly, it is challenging at first.

It requires:

Taking a leap of faith, a bit of risk taking. Ask yourself “What’s the worst thing that can really happen?” When you realize that the risk is quite miniscule, you’ll likely find it’s easier.
Taking baby steps. Maybe a single component of the meal (or of your day) may change at first. It may be varying the portion of your dinner entrée or finally ordering a favorite sauce—perhaps on the side, to begin with.
It may mean choosing to step out only with people who know and understand your struggle, who you know will be supportive.
It involves asking for things the way you want them, when eating out. Trust me, you are not the first to assert yourself when dining out! And with the exception of buffets, the food isn’t prepared until you order. So no great hassle to accommodate you.
It requires feeling entitled, deserving of the pleasure of eating. This allows you to find your voice to vocalize what you’d like and how you want it.

When my mother comes to visit from out of state we often dine out for a dinner. Time after time, this is how it goes:

Me: “So what do you feel like eating tonight?”

Mom: “Oh, anything. I don’t care. Whatever you guys feel like. I’ll do anything”

Me: “Really? Anything? You’d be equally happy with Thai food as with Indian? Seafood or salad would satisfy as well as steak and fries? Gooey cheesy Mexican will work for you as easily as sushi and miso soup?”

No, it’s not easy being my mom. I long to hear a passion for food, an interest in truly enjoying a meal, not simply a need to ingest food and limit her calories until she’s full. Like you, I need to be patient.

You'll rest better once you start enjoying what you eat.

At this point, perhaps you’ve progressed to listening to your hunger and honoring it, to noting your fullness, and trusting there will always be a chance to eat again—when you should need to. Now consider this next level, beyond simply meeting your needs for fuel. Challenge yourself to step out of your safe place, slowly moving to truly enjoy what you eat. And release yourself of the guilt of not following rigid diet rules, set either by others or by your irrational self.

Because life is too short to diet.

My Eulogy

noreply@blogger.com (HikerRD) — Fri, 02 Sep 2011 15:04:00 +0000

Don’t be thrown by the title—there’s no need for concern. I’m not at any risk (that is if you exclude the Swiss Alps hike to the Hornli Hut at the base of the Matterhorn that I’ll be leaving for shortly). And let me confess—I’m afraid of heights and precipitous drops.

Curious? Check out this link http://www.youtube.com/watch?v=PcoU0dlep6s from ~2mins.

But really. I’ve often thought about what I’d want my eulogy to read, when my time has come. I see it as a kind of blueprint, a how I want to live my life and be remembered. What will my legacy be? What messages will I have conveyed to the people I care about? And yes, that includes you, readers.

I can’t help but think of this as I’m sitting with patients who are struggling with their eating disorder or an unhealthy relationship with food. I think, Is this the focus that you want to define you?

Accomplished?

Beth was an accomplished dieter. She was proud of her ability to keep her weight to XYZ pounds. (I’m trying not to make this triggering). It made her feel she was successful, limiting her foods to six safe items, and controlling her appetite for temptation. It was what she felt she did best.

Beth leaves 3 daughters whom she has endowed with a love of dieting. They are preoccupied with their appearance and are following in the footsteps of their mother. Excessive exercise consumes them, as does a keen determination to choose good and healthy foods. Their eating issues may have had their start in genetics, but their beliefs about foods and their effect on their body, and their behaviors around eating and exercise have, in part, been learned.

Beth could be any one of my many patients wrestling with their eating, before they’ve turned the corner and took control of their disordered eating. They’ve lost perspective about what’s important in life. They’ve forgotten who they really are—their interests, their passions, their dreams. They’re stuck, limited in part by fear—What else am I capable of succeeding with? How else will I be able to manage without my best friend, Food or ED? What would my day and life be like if I had to really live and experience disappointment and pain, as well as pleasure?

Life’s too short to be stuck in this place. If you’re like Beth, it’s not too late to turn your situation around. “Where do I start?” you’re thinking?

Isn't this WOW? Posters can be ordered from their site
http://shop.holstee.com/pages/about

Get your supports lined up to allow you to better nourish yourself. This includes a team of experienced providers—a physician, therapist and Registered Dietitian, as well as friends and/or family members. Keeping your struggle a secret helps you maintain the status quo.

Consider the consequences on those that you love, on those that model your behavior. Yes, I’m thinking about your children, and the children you might plan to have. It’s never too early to shift your thinking and your behaviors.

Ask yourself “Is this really how I want to be remembered?”

Be fair to yourself. Change takes time. How long did it take to develop your current eating issues? You can’t expect it will change overnight. Patience and compassion, my friends!

View from the top of the Matterhorn where I won't be going. I do know my limits!

As for me, I’m planning to push past my anxiety about heights and attempt to reach the Hut. Because I know that the vistas will be stunning and awe inspiring. And because each time I have pushed myself through such challenges in the past, I’ve emerged with an amazing sense of accomplishment and incredible pride. And perhaps, I put this out here to you to be certain I follow through with my plan.

Powerless?

noreply@blogger.com (HikerRD) — Wed, 31 Aug 2011 00:48:00 +0000

I’m typing this from my office computer, where I still retain power after Hurricane Irene.

But last night I dreamed that I lost the power to speak. I could hear and listen, I could see, ‘though I have no knowledge of taste (as I didn’t eat anything during this brief period). I was in unidentifiable, unfamiliar surroundings, but somehow did not feel uneasy. Even experiencing this loss felt familiar, like when I temporarily lost sensation in my left arm, due to MS, and was unable to dress myself. Powerless.

In the morning, the windows were open, and I felt the cool, dry air across my skin. I saw the beam of dust particles shimmering in the morning sunlight. And I heard my voice as I said goodbye to my husband, as he departed for work. Ahhh, all was well—my body was fully functioning.

The electric and telephone, however, remained non-functional. But all was not lost. I could drive to work, and get in touch with the world from there.

Even in the absence of modern life’s distractions—cut off from the Twitter tweets, the endless email, and the more pleasant indulgences of good music and movies, I had had to simply be. I had to give serious thought about what to grab from the fridge (I needed to act quickly to prevent the cold air from exiting). And I needed to sit and eat mindfully, by daylight or by candle.

My mind was freed for creative thought. Yes, 3 posts were written (by hand, I’ll add) yesterday.

Don’t get me wrong. Losing power has its downsides. I was hoping to bake those rugelach (http://dropitandeat.blogspot.com/2010/12/minding-your-eating-managing-your.html) to send to my son, but couldn’t without a working oven. And when the hot water that remained in the water tank was all gone, I wouldn’t be rejoicing in the cold shower. And for some, the consequences, no doubt were more dire.

But sometimes these little reminders are so valuable to remind us of what power we really do have. My body still functioned, even though the electric was dead. My brain filled the void, when it had free reign to create. There was much I could do, and enjoy, in spite of the temporary loss of power. And just doing nothing, an option I never consider, was now possible; imagine giving yourself permission to do absolutely nothing!

Some things are out of our hands, like the electrical service into my home. But sometimes we simply need to take charge of our situation—to find creative solutions, to appreciate what we do have that works, and to shift perspective.

And, we need to appreciate that we always have the power to speak and advocate for ourselves.

No, we’re not powerless at all.

So You REALLY Think I Can Keep This Up?

noreply@blogger.com (HikerRD) — Fri, 26 Aug 2011 02:15:00 +0000

The verdict is still out, but I’d bet on Sally’s success. Over the past 12 months, this formerly mid-200-pound woman has lost 54 pounds, since we began our work together. But she’s done that before, without my help. In fact, she’s lost weight faster in the past, each of the past three times, even. These previous diets yielded a weight loss of 70 pounds, I’m told. Yes, in each of her decades of life, she managed to lose, and then to regain, approximately 70 pounds.

Back then, after about a year, she’d slip into old habits. She’d get bored with her eating routine, overeat, and then feel like a failure, letting the “What the heck effect” take over. So I probed Sally, given her one-year anniversary working with me, to summarize what has changed, why this time is different. And here’s what I heard.

Clothes

Of course you’d expect her clothing size to change, with a more than 50-pound weight loss. But this time, she discarded her “fat clothes”. No sense holding on to things you hope never to need. But equally important, she tossed her unrealistically small sized garments. Sure, they were outdated. But she also recognized the importance of setting realistic goals, and living in the present, and appreciating her self and her body where it’s at, even as she continues to make changes. Sally has purchased a few new outfits that she feels good wearing. But she hopes to purchase some new items as she continues her progress. One step at a time.

Guilt

It’s hard to release yourself from feeling guilty after eating “treats”, particularly if you lived most of your years believing that you were not entitled to eat them. Overweight? You might believe you don’t deserve to eat ice cream; the stares alone, from strangers even, might convince you of that. Even if your weight were never out of range, you might have absorbed messages of caution around foods you’d love to indulge in. So perhaps indulgences occurred when your watchful parents or spouse or siblings weren’t around.

Sally stated that while she did have sweets before, while losing weight, she would always be thinking that she should be having a carrot instead. Hmmm, cake or carrot, cake, or carrot. Which would you choose? Now, she includes sweets, as part of a healthy diet, and with a lot less guilt. She doesn’t limit them to when she is alone, or driving, or eating mindlessly. Now she can put a dessert on a plate, sit down with it, with or without others present, and enjoy it. Really enjoy it. Now she bakes, sometimes modifying a recipe, while still allowing for a satisfying and delicious product. She no longer awaits vacations to include the foods she enjoys. Instead, she chooses what she likes—but eats in portions more appropriate for her body’s need.

Doing it for Sally

Sally always had to be accountable when in a diet program. But this time, while she may still care to be a good student and do well at our visits, something major has shifted. “I’m doing it for myself now”, she shared. More than needing to show me a weight loss, Sally is determined to maintain her progress, which impacts how she feels—her ability to move her body, to feel comfortable after a meal, to go clothes shopping.

Thoughts and Actions

With past weight loss there was the before and the after, weigh in periods. Hours prior to that stressful moment, you know how it goes. Those struggling with overweight restrict more, to save face at their weigh in; and those of you struggling to gain, may push out of your comfort zone for those few remaining hours or days before the weigh in. And unfortunately, the weigh in lady would reward you simply for the loss of weight (think Weight Watchers); and similarly, those nurses or doctors inexperienced with eating disorders would reward you for your gain.

No one explored how the weight change occurred, whether through healthy or unhealthy measures; few bothered to ask. Rarely did anyone inquire whether you were struggling with the recent changes, and whether they were sustainable. Progress was measured strictly in pounds lost or gained. Some things, regrettably, never change. You might have changed your actions, but not your thoughts, making the eating behaviors less likely to be lasting changes.

Unlike many medical professionals and weight loss program leaders, Sally now does know better. She can appreciate that her weight is only one small part of who she is, and how she is doing. She knows that her thoughts and eating behaviors are what’s most important. They built the foundation to support her progress.

In the past, losing weight required pain and suffering—at least as I heard it described by Sally and many others. “Isn’t going to bed hungry a good thing?” a teen patient recently inquired. That’s what she was taught. That was the gold standard. So why should she think otherwise?

At our most recent visit, I heard something I don’t always hear; Sally described how proud she was of how she handled a recent slip. Rather than focusing on what she failed to do, I got to hear the other side, the side that I am usually working hard to get patients to acknowledge. And without any prompting, Sally shared her accomplishment, pulling herself back up after a recent slip. Instead of dwelling on her excessive dinner portion when socializing with friends, and the seemingly unnecessary dessert which followed, in spite of not being hungry, she didn’t beat herself up, as she had for decades past. She described how she was able to put this eating in perspective, realizing she is only human, and move on, which she did just beautifully.

Slipping is not the problem, when it comes to changes in eating behaviors. It’s the ability to shift gears, to see the positive, and to appreciate your ability to continue to move forward. And to learn from our mistakes.

Yes, that’s why I’ll put money on Sally’s success.