Binge Eating Disorder: New Approaches to Appetite Control

On May 7, 2015May 8, 2015 By jodietitianIn Uncategorized1 Comment

Today I attended a conference presented by Walden Behavioral Care on the topic of Binge Eating Disorder (BED). Dr. James Greenblatt, Chief Medical Officer at Walden and author of the book “Answers to Appetite Control:New Hope for Binge Eating and Weight Management” spoke about the complicated interactions between our physiology and brain when it comes to binge eating. There are specific criteria that define a diagnosis of BED and just one of the criteria includes “recurrent episodes of binge eating characterized by both of the following: (1) consuming an abnormally large amount of food in a short period of time compared to what others might eat in the same amount of time and under the same or similar circumstances, and (2) experiencing a loss of control over eating during the episode. Additionally, in BED there is “significant distress” about the binge eating.

Dr. Greenblatt stressed that some binge eaters experience cravings that are physiologically based, in other words, the cravings are a result of your biology rather than just the environment or a social trigger. In fact, some research showed that brain scans of those who scored higher on a “food addiction” rating scale were similar to those of drug addicts. There was an elevated activation in the reward circuitry in response to food cues. Again, this does not mean that if you binge eat, you are “addicted” to food, but that everyone is different and some people have the physiology that makes it much harder (and it is not their fault).

In addition, disordered eating such as binge eating often co-exists with mood disorders such as bipolar disorder, anxiety disorders, depression and ADHD . In fact, ADHD has been linked to BED (apparently the act of chewing helps to decrease day dreaming brain waves and helps you pay attention). The odds of developing a binge eating disorder is 12 X greater in children with ADHD. Dr. Greenblatt stressed the importance of treating the mood disorder first before the binge eating could be addressed.

Another very important point was regarding the importance of protein. There are over 250 neurotransmitters that send impulses throughout our brains and affect our thoughts, feelings and behaviors, many of these directly affecting our appetite regulatory mechanisms. They are all derived from amino acids. Adequate protein intake is critical, often an issue for some. For example, vegetarians and vegans may not get enough protein (especially if they are not educated on nutrition) and chronic dieters often have inadequate intakes. And, even if a person does consume adequate protein, it may not always be available, such as in the case of insufficient digestive enzymes or excessive antacid use.

Finally, there was mention of how for a small percentage of people, certain foods substances may contribute to food addiction and binge eating, such as high fructose corn syrup and MSG (he also discussed the gluten craze as well as casein but I may save that for another post!) This does not mean we need to cut out any foods or that we should never eat them, it just is important to have balance in your life.

The importance of medication (such as mood stabilizers) in some cases was also mentioned, as well as how medication was not helpful in other cases. The bottom line is that everyone is different, and it is very important to get evaluated by a professional. BED is a serious and debilitating eating disorder, but there is help.

If you are interested in the book which contains a wealth of information from Dr. Greenblatt, check out: http://answerstoappetitecontrol.com/

Should You Have A “Cheat Day”?

On May 4, 2015May 4, 2015 By jodietitianIn UncategorizedLeave a comment

When I hear a person say “Saturday is my cheat day” I gotta be honest, it pushes my buttons. To most people it sounds like a harmless thing, but to me it is a red flag. An alarm goes off, triggering this irritating feeling throughout my body. I try not to react, it is a conscious decision on my part to ignore it if I am overhearing a conversation in the elevator of the hospital where I work part time, or somewhere else where there really is not time to get into it. Otherwise, such as a party or other informal gathering where women especially tend to chat about what they are doing to change their bodies…. I always take the opportunity to educate people about Health at Every Size, and how focusing on being healthy verses being thin is a much more sane goal. Then I may ask what they mean by”cheat day”. Inevitably, it means following some type of “healthy” eating plan or dieting throughout the week, then allowing themselves to overeat any of the foods they have denied themselves during the week on Friday or Saturday, and often again on Sunday.

What bothers me about this approach to eating is that it ignores all of the principles of “mindful” eating, and about “listening to your body” . It gives food so much more power than it deserves. It makes me think of how back in the day (and actually still today unfortunately) food is used as a reward. For example, “if you finish your spinach, you can have the cookie”. What does that message send? It says “something is very wrong with spinach, and something is very special about cookies”. I wish food was never treated this way. If you are really honest with yourself, you have to admit, that sometimes fresh vegetables or a great salad or roasted garlic with asparagus is extremely yummy. And an Oreo cookie could never substitute for that taste. If however, one were to hold that Oreo up as a reward, then it might be different. Over time,we might become conditioned to look at that sweet in a different way, and want it even if we really didn’t want it! If we really were mindful and not conditioned to think some foods were good and some foods were bad (that we could only eat them on a “cheat” day) and REALLY listened to what our bodies wanted, then we would not even need a “cheat” day. We would eat in a mindful way, cooking meals that were healthy and that we enjoyed, because we want to feel good, have energy and live a long and healthy life. But that means enjoying the fun foods too, the ones that are important to us, in our culture, our family traditions or socially. Having a homemade blueberry muffin at Grandma’s house or sharing a favorite dessert when out with our old college roommate,or Grandma Harmon’s favorite cinnamon buns that you only get once in a blue moon. It may not be a Saturday or a “cheat” day, but it may be and should be just part of normal life. Monday, Tuesday, Wednesday, Thursday, Friday, Saturday, Sunday….I hope everyday you listen to your hunger, and fullness, and enjoy healthy eating, have energy, and never miss an opportunity to enjoy a serving of a special food that you enjoy. Heck with “cheat” days. Enjoying life is living, not cheating.

Are You in Diet Jail?

On May 1, 2015May 1, 2015 By jodietitianIn Uncategorized1 Comment

I first encountered the term “Diet Jail” in 1975. I was a biology major at Clark University in Worcester, Mass. I remember clearly working with the lab teacher who was doing his research on birds (he kind of looked like a cool woodpecker). He made me count bird chirps he had taped on a recorder. I decided I did not want to be a biology major because counting bird chirps was incredibly boring. So I met with my adviser who asked me what I was interested in. My best friend Joyce was a vegetarian and ate very interesting things such as yogurt with sunflower seeds and honey, and so I told him, I though vegetarianism was interesting. He told me I should be a dietitian. I did not know what that was, but anyway, I ended up transferring to the University of Connecticut to study nutrition. For my first nutrition class (Nutrition 101) I had to do a report about fad diets and at the time there were many books out there on the market, including the Atkins Diet. But I found one called “The Psychologist’s Eat Anything Diet” by two psychologists, Dr. Pearson and his wife, also Dr. Pearson. It changed my thinking in a way that lasted, well, forever. The authors were decades before their times in the strategies they were promoting, before we knew about mindful eating or how our bodies regulated themselves regarding calorie intake, fat, carbohydrate intake, etc. They described what they called “diet jail” where individuals who diet tend to “lock themselves up” in a jail where only the healthy foods exist. In other words, they tell themselves they are only going to eat healthy foods such as grilled chicken, vegetables, fruits, salad, etc until they lose the weight. So psychologically it is as if they “lock themselves up” in a world where only the healthy foods are available (or allowable). But outside the jail are all the other foods, the “bad” foods. The chips, cookies, ice cream, burgers, pizza, you get the picture. All the foods they have determined they are not allowed to eat (while they are on that diet). And so, most people can last a bit in Diet Jail. Yes, they get cravings, but they use their “willpower” and overcome them. Unfortunately, we now know our bodies send out very loud signals when we are not getting enough carbohydrate or fat (the foods that do not exist in Diet Jail!) and so eventually, our bodies drive our brains to give in. Add this physiological drive to an environmental trigger, such as walking into your friend’s home who just baked some homemade chocolate chip cookies, and things change. Your brain, which is triggered by the deficiency in your body, tells you to eat a cookie! It has just what you need, what you have been missing, that fat and carbohydrate! But you can’t have someone throw just one cookie into your jail cell, so you have to step out of the jail to get that one cookie…….the problem is, once you take that bite, your realize you are out there! Out of Diet Jail! And since you know you will go back in (you tell yourself that on Monday you will really start again!) you better eat while you are out here! So you decide to order pizza, and then have ice cream (a lot) because, heck, you are going to start again on Monday. Often a full blown binge results. Because you know this is just this one time. Soon you will be back on track. Back in Diet Jail. Until the next time.

As repetitive as this cycle is in so many people’s lives, they do not seem to stop. The next diet craze offers the next magic scheme. Weight is lost and then regained. Back then we did not know the physiological reasons people were driven to eat but now we do. We know if you restrict you will suffer from “disinhibition” or breaking out of Diet Jail.Often referred to as the “what the hell” effect. It is a very sad and draining cycle.

So why not take those bars down? Why not entertain the thought of changing what you have been doing that is not working? What if you were to start to believe that all foods are equal? No food is good, no food is bad, they all have a place in your life. Yes, we need certain nutrients to feel good, have energy, normal bowel movements, prevent disease, etc. So educate yourself (I will gladly help you!), experiment, enjoy your cultural traditions (yay. pasta fagioli!) but start paying attention to your body. Are you hungry? Are you full? Are you so confused that you might really want to get some help (such as from an eating disorder specialist?). Wherever you are, it is ok, just take some time to truly reflect on your patterns. My hope for you is to enjoy eating, be healthy, and take down those darn bars.

What is “HAES”?

On April 26, 2015April 28, 2015 By jodietitianIn Uncategorized4 Comments

I have a few simple questions to ask before I explain what HAES is:

1. How many people have you known who have “gone on a diet” specifically to lose weight?

2. Have you ever known someone who has gone on a diet and who has lost weight and kept it off? I am not talking about the person who took up a sport or quit smoking and adopted a healthier life style. I am talking about someone who followed a specific “diet plan” such as a low carb diet or meal replacement diet or counting calories or points kind of diet.

3. Have scientists discovered the one diet that works to help people lose weight and keep it off? Of course we know researchers have been looking into this, since people have been struggling with trying to lose weight for a long time. The “obesity epidemic”is always in the news. So have they found the one diet that works?

Not sure of your answer for question #1, but for #2, I am guessing the answer is NO, and for question #3, I will tell you the answer is NO. What most of the public does not know (because who would be interested in the research over the years regarding dieting except someone like a dietitian?) is that many researchers have been looking into dieting behavior for decades. In fact, when I went back to graduate school and did my research on “cognitive restraint” back in the ’90’s, I was angry! I could not believe the world did not know that the “experts” already knew many of the reasons dieting did not work! But then I realized, it is about the diet industry combined with desperate people wanting to lose weight.

I was not the only one who was angry. There now exists a split among health professionals working with people with weight issues (actually, the split has been there for many years but only recently gaining attention). Thanks to the more recent research and new groundbreaking books (see below) by Dr. Linda Bacon, the “Health at Every Size” Movement has now been brought into the public eye and the movement is gaining momentum.. Those of us who believe in promoting health instead of some perfect weight, are no longer alone. Yes, there are still doctors, nurses and dietitians who will put someone on a diet (boy could I tell you some horror stories). So it is important to ask any professional you are working with which side of the fence they are on. Are they familiar with the HAES Approach? If not, they may be a bit behind the times. Or, they may still be influenced by a society who values a certain physical appearance instead of health.

Here is an excerpt taken the HAES website at http://www.haescommunity.org/ :

“Health at Every Size” is based on the simple premise that the best way to improve health is to honor your body. It supports people in adopting health habits for the sake of health and well-being (rather than weight control). Health at Every Size encourages:

Accepting and respecting the natural diversity of body sizes and shapes.
Eating in a flexible manner that values pleasure and honors internal cues of hunger, satiety, and appetite.
Finding the joy in moving one’s body and becoming more physically vital.
and from Dr. Linda Bacon: “Health at Every Size is the new peace movement.”

“Very simply, it acknowledges that good health can best be realized independent from considerations of size. It supports people of all sizes in addressing health directly by adopting healthy behaviors.”

If you are tired of dieting and ready to focus on health instead of some magic number on the scale, check out Health at Every Size: The Surprising Truth About Your Weight by Linda Bacon, PhD and her most recently released book, Body Respect (http://thebodypolitic.biz/bodyrespect/), co-authored with Lucy Aphramor
And be sure to check out the HAES website at http://www.haescommunity.org/

The Truth About Drinks

On April 14, 2015April 15, 2015 By jodietitianIn UncategorizedLeave a comment

I remember many years ago going to a Sports Nutrition Conference and never forgetting the message. I heard a researcher named Richard Mattes speak about some cutting edge research he was conducting about how our bodies responded differently to liquid calories. I found the research fascinating. The bottom line message was that when we eat solid food, our brains get the message that we had enough calories and so we feel full and stop eating. His theory was that with liquid calories, we did not get the same message, and so our brain allowed us to keep drinking and take in excessive energy which eventually would result in weight gain.

Recently, I did a search and found that Dr. Mattes has not only been continuing this research, but has strengthened his earlier theory that liquid calories do not register in our brains. What is the important message here? If you fill up on drinks such as juice, soda, beer, wine or lemonade, it will be impossible to listen to your body as far as how much you need to eat. Instead, drink water to quench your thirst (free and healthy!) and limit juices and soda to once in a while instead of daily. Limit alcohol to social occasions and in moderation.

See below if you are interested in the dirty details!

Beverage vs. solid fruits and vegetables: effects on energy intake and body weight.

Obesity

Volume 20, Issue 9, pages 1844–1850, September 2012

According to Elizabeth Garrison in “A summary of Richard Mattes’ research since 2005: Effects of food form, feeding patterns, and specific nutrients on appetite, satiety, and metabolic responses in humans”:

Differences in food form, beverage versus solid, elicit different appetitive, satiety, and hormonal responses. Solid foods, matched on energy content and macronutrient composition elicited lower levels of hunger and desire to eat. Additionally, solid and liquid meal replacements caused different ghrelin, insulin, and CCK responses, all hormones involved with regulation of food intake and body weight. Specifically and most importantly, beverages cause greater levels of ghrelin, a hormone that initiates hunger and desire to eat, after a meal than solids. Therefore beverage and solid meal replacements should not be used interchangeably for weight control or energy balance.

Can I eat after 6 pm?

On April 13, 2015April 14, 2015 By jodietitianIn UncategorizedLeave a comment

People ask me the same question over and over: “is it bad to eat at night? I shouldn’t eat after 6 pm, then it all turns to fat, right?” WRONG!

The fact is our bodies are constantly burning energy, even while we sit. It really doesn’t matter if you eat something before bed (such as a small snack if you are hungry). Researchers, however have been investigating the difference between meal frequency as well as when you consume the majority of your calories. In other words, does it matter if you eat the same number of calories in ONE meal verses several? Does it matter if you eat very little during the day and then MOST of your calories in the evening?

That is a different story! The Journal of the Academy of Nutrition and Dietetics recently published a study discussing this very topic. In the April, 2015 issue, “The Impact of Eating Frequency and Time of Intake on Nutrient Quality and Body Mass Index: The INTERMAP Study” the eating pattern of 2,385 participants were evaluated (1,232 men and 1,153 women). The principal findings demonstrated that more frequent eating (eating 6 times per day) as well as a higher energy intake during the day verses during the evening resulted in a lower BMI as well as an improvement in nutrition quality. In other words, those who tended to avoid eating that often (<3 eating occasions during the day instead of 3 meals and 2-3 snacks) tended to eat most of their calories at night, and their diets weren’t as healthy. The frequent eaters (6x daily) still ate at night, however they tended to spread it out (they did not miss meals during the day).

What does this mean for you? If you want to have a healthier diet, and be the weight your body is supposed to be, you need to fuel your body all through the day. This study strengthens the evidence that skipping meals during the day requires that you will need to make up for it in the evening. A snack is fine, and a late meal is fine, too. But when you do not eat enough during the day, you will be starving and tend to overeat.

So go ahead and have that snack if you are hungry!! Just be sure to give your body what it needs during the day too!!

Is Pizza bad?

On March 21, 2015April 13, 2015 By jodietitianIn UncategorizedLeave a comment

I find it somewhat funny when patients often ask me about a food such as pizza. “Is it bad?” Or maybe pasta, or bagels or potatoes. Why is it that some foods are so confusing to people? Why is there a need to classify foods as “good” or “bad”?

My simple answer is always “if you like it, it is good!”.

I think what people really want to know is “is this food good for me?”. The truth is there is a place for ALL foods in our lives. We all need to have a variety of healthy foods to feel good, stay healthy, and have energy. Yes, we need protein foods, fruits, vegetables, etc. But food plays a much more important role in our lives than just keeping us healthy. I am not a big fan of the slogan “eat to live”, because most of us have wonderful connections to certain foods and great memories around meal time.

For instance, being from an Italian family, holidays always came with specific foods. Easter breakfast had sausage and peppers, fried dough and ricotta pie. Christmas Eve had an assortment of fish dishes and Christmas day was always several gigantic pans of lasagna and eggplant parm. And sometimes, it is just simply wonderful to order a pizza delivered to your door on a Friday night after a long week at work when you are just too exhausted to even think about cooking.

Unfortunately we have been brainwashed to avoid carbs, avoid fat, avoid sugar, and that is why so many people are so confused. The diet industry relies on us to have these concerns, or how else would they be able to sell their products?

So instead of trying to judge if a food is “good” or “bad” why not try to eat healthy most of the time, but enjoy the foods you love, in moderation, listening to your hunger and fullness, eating so that you enjoy it and feel good afterwards;

In the end, you will be both healthy AND happy!

Hunger and Food Insecurity

On March 16, 2015April 13, 2015 By jodietitianIn UncategorizedLeave a comment

One topic I discuss often is the concept of hunger. It may sound like a simple thing. Either you are hungry or you are not, right? Well, unfortunately, for those who diet and restrict, or binge eat as a result of this, hunger is much more complicated.

Today I was fortunate to have the opportunity to volunteer at a soup kitchen. It was quite interesting to see the different kinds of people come in. Kids and elderly and families. What struck me was how some people came up a few times and took second and third plates, and I am talking full plates. I wondered how they could fit that much food in their tummy in one meal! Then it struck me. “Food Insecurity” was what I was seeing. The feeling that you will not get enough food. It is a scary feeling many of us have never experienced.

Unless you have dieted. Then, maybe, that feeling is there. With a self-imposed diet, restricting many foods, you get the same mind set that those who truly do not have enough food have. And so the answer is, to eat as much as you can when you have the opportunity. When you break your diet (and know that you will start again tomorrow). Very similar to the person who gets to have a good meal once per week when the other days of the week are not so good. It makes sense.

But the reality is, for those of use fortunate enough to be able to buy the foods we need, we never have to experience this feeling. You can always have what you want. So why overeat when you break your diet? If you don’t diet in the first place, and instead try to listen to your “true” hunger (typically a meal time or snack time when you have not eaten for a few hours) you are more likely to avoid getting into this mind-set. Listen to your body! Easier said than done, but keep trying!!

Having a “Goal Weight”

On March 13, 2015April 13, 2015 By jodietitianIn UncategorizedLeave a comment

Throughout my years as a dietitian working with people with eating and weight issues, it seems that a majority of people have a set “goal weight” in their heads. It is if there is some perfect number they need to reach, and then they will be happy with their bodies. Even parents of young children ask me “what should he weigh?” as if at 8 years old his body needs to be at the perfect weight (despite needing to grow a few feet by the time he is 18…), so does it really matter if his weight is “perfect” right now?

Let me ask, do you really think our heads can determine what our physical bodies need to weigh? and is a body ever really stagnant, stable, the same day to day? No, it is not. And I have learned a few things throughout the years (research of course demonstrates that our bodies are all different and have a genetic “set-point” weight range) but watching what happens to people’s bodies has taught me more than books or research.

Here is what I have learned:

1. An individual’s weight NEVER stays at one number. It is normal to fluctuate a few pounds up or down.

2. Goal weights are typically unrealistic. And when people manage to reach them, either they can’t stay there for long (and give up whatever rigid lifestyle they used to get there often going the other way to the extreme) or they live with having to constantly focus on eating (usually leading to an eating disorder or depression).

3. If and when people reach their “goal weight” they change it. Because their need is to focus on that number instead of the other scary and uncomfortable things in their lives. It serves a purpose (not a healthy one, but for some people, it distracts them and this is easier for awhile than addressing real issues).

So what should you focus on if not your weight? How about looking at your lifestyle and deciding to make healthy changes you can live with! And giving your body what it deserves, healthy food, good sleep, fun movement, joy, and the permission to be what it was born to be…healthy AND happy! Many years ago one patient of mine said it best, and I will never forget: “It finally dawned on me. Why do I care about the force of gravity on my body???” I wish you the same freedom!

Fast Food

On February 28, 2015April 12, 2015 By jodietitianIn Uncategorized1 Comment

Have you ever come home after a long day dreading the thought of having to prepare dinner? This is the time many of us resort to fast food. How much easier to go to the drive through and grab a quick meal!

Although this is fine to do once in awhile, if you neglect to plan ahead, it can become a daily habit! Something that works for me is “Sunday Cooking”! It is the one day of the week I actually have time to cook the way I love to. The beauty of it is that if you make a large amount of whatever it is you are cooking, you can freeze and save for use during the week. Turkey Chili (pictured above) is one of my favorites! There is no recipe that I use, and I make it differently every time. I tend to use whatever is in the fridge in addition to frozen ground turkey that I almost always have on hand. Just brown and drain your turkey, add in a large can of diced tomatoes, fresh ones, salsa if you have it, diced peppers (green, red, yello), onions, garlic, corn, grated carrots, any kind of bean such as kidney, cannelini, chick peas, and then your seasoning (chili powder, pepper, cumin, etc) or you can use one of those packets that come with all the chili spices mixed together. Either way, this is just one ideal meal you can cook ahead of time, freeze and just heat up after a long day at work! No drive through, healthier meal and money saved!!

Joanne Arena MS, RD

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