Untethered Eating: Exciting….or Terrifying?

Image may contain: people sitting and foodI love the word “untethered”….not sure why, probably because it makes me think of a dog escaping his leash and running free to smell the grass, jump around and finally, being able to be the creature he was supposed to be. Maybe that is why when I arrived at the airport way too early last month on my way to Florida, I ended up impulsively buying a paperback in the airport bookstore. I actually almost always end up buying a book at that bookstore because we are ALWAYS early. Anyway, I ended up purchasing The Untethered Soul by Michael A. Singer because I liked what it said on the back, it was not too long and like I said, I like the word “untethered”.

As I was reading the book, it struck me there were lots of parallels that could be made with the way we eat. I tend to be slanted in the way I look at eating because of my experience with working with individuals with eating disorders and with parents of children who have the dreaded unacceptable BMI. I often react to things very differently than others. When really smart and educated, even insightful and spiritual people fail to react to something that totally infuriates me, I know I am prejudiced against some of our culturally expected natural instincts. Anyway, I know this is why this book struck me so hard in the way it relates to eating, and especially dieting minds.

To see what the book is about check out this description on the Untethered Soul’s website. The bottom line, to me, was learning how to live in the moment verses constantly reliving and regretting the past, and/or spending way too much time planning, worrying about or dreading the future (hhmmmm… do you know anybody who does that with food?). It was about that voice that is continually and always in our heads, barking orders, belittling, shaming and stressing us out. And although it is somewhat different (the book refers to inner consciousness) I have talked about “self-talk” before. It is a common term in healing from disordered eating. We sometimes refer to this nasty voice as “ED” (eating disorder), the one telling us we are fat, we are stupid because we ate something, a cookie will make us gain weight, and on and on. The first step is to start to become aware of that voice.

And that is what struck me about the book message and how it can apply to the way we eat (or try not to eat). Becoming aware of that voice is the first step to a more peaceful relationship with food. Being non-judgmental of that voice, no matter what it says, is also critical. The important thing is to become more conscious of what is going on. Not running from it, not trying to change it, and definitely not judging it. Just sitting with it and accepting it.

After reading the book I started to think about what “tethered” eating looks like. All of the things patients have said to me came to mind. The sad thing is some of the culturally acceptable messages also came to mind (so you can imagine how hard it is to heal from disordered eating when cultural messages about bodies and eating are also disordered……how do you fight the world?).  Some of the thoughts stuck in our heads that keep us tethered might be:

  • You need to lose ______pounds
  • You need to get down to a size _____
  • You need to get rid of that tummy (thighs, butt, insert body part)
  • Carbs are bad
  • You need to be “good” (meaning don’t eat “bad” food)
  • Don’t eat fried foods
  • Sweets are bad
  • Don’t eat after 6 pm
  • Read the label and don’t eat anything with sugar
  • You ate __________ so now you need to burn it up by exercising more
  • Cheese is bad
  • Meat is bad
  • Eggs are bad
  • Cookies are bad
  • Pasta is bad
  • I can’t eat what everyone else is eating
  • I can’t order what I really want in a restaurant

And on and on, you get the message. We are so wrapped up in perfect eating and perfect bodies (whatever that means) that we end up feeling tied up when it comes to food. I actually have witnessed people looking almost like a cartoon when they are faced with food. Imagine a child in front of a bakery counter, drooling over whoopie pies or amazing looking desserts and the mom pulling the kid away, the child’s neck still stretched as far as it can toward that sweet display. Sometimes, that is how people strike me, but there is no leash, no adult pulling them back, they are just drooling and denying themselves something they really want because of the subconscious “tether”.  Then again, at other times when I see someone gobbling something up, it is because they have decided to cut the tie and go crazy (just like the puppy running free, they really let loose). It is a natural instinct I imagine, after feeling tied up for so long. But it has nothing to do with enjoying food in a healthy way (or a normal way). There is nothing intuitive or conscious about either extreme (of restricting or overeating).

If you are someone who is trying to lose weight (or simply trying to be a “healthy eater”), you may be thinking “of course I need to control myself, if I didn’t I would eat everything and gain weight (or be unhealthy)!”.

Probably not, if you stop and think first. Not if you tune in to your true hunger (or your true desire, craving or need). Not if you get to a place of knowing you are truly free, and believing it.

Remember, although I wish everyone with disordered eating could do this and be free, I know it is not that easy. Eating disorders are complex, and getting better is not this simple. Stopping binge eating or recovering from anorexia or bulimia takes lots of therapy , work and medical attention. And although leaning how to “tune in” to true hunger (verses using eating or not eating for something else) may be part of the process to recover, what I am talking about now is directed more toward the “typical dieter” who is simply falling into the trap of thinking eating needs to be perfect, or a certain way in order to affect weight. Those of you with eating disorders need to work with your specialists to do what you need to do for your individual situation. I know you will agree, though, that EVERYONE would be happier and mentally healthier if they got off this crazy perfect eating bandwagon.

With that said, my goal is to give you healthy-eating, dieting, weight watching people a little reality check. Thinking you need to be tied, tethered or whatever to eating a certain way either for a certain time period, or forever is actually preventing you from being the healthiest you can be. Keeping yourself leashed to a specific and narrow way of choosing foods based on Lord knows what not only may affect your physical health, it is likely a drain on your mental health, too. Thinking about every bite you put in your mouth is not only draining, it prevents you from living in the moment and enjoying all that life has to offer. And even worse, it actually keeps you disconnected and less in tune with what your body needs.

But what about our health, you might be thinking? Of course we need to think about what we eat! It is the only way to make healthy choices, right? OK, here is the clincher: it IS a balancing act. You DO need to care about your health (which means caring about your food choices) but, you also DO need to be happy and live life. You DO NOT need to be tethered to anything. How do you do both, eat healthy but be free? THAT is the balancing act.

Here are some tips:

  1. Reject any “all or nothing” thinking. Example (my pet peeve, this drives me crazy): sugar is bad, therefore I need to avoid any foods that have a lot of sugar. I need to pick the yogurt with the least amount of sugar (even though I really don’t like it).  I can’t get the one I like because it has 10 grams of sugar. Mine only has 5 grams. Really? FYI 5 grams of sugar is a teaspoon of sugar (15 calories people). So, for an extra 15 calories you are not going to get the yogurt you truly enjoy? NOT THAT CALORIES MATTER but, the point is, 15 calories is only a tiny fraction of your total intake for a day. It is basically meaningless. Eat the darn yogurt you like, would ya!?
  2. Be skeptical of the latest craze. For example, avoiding gluten. If you have celiac disease or a true intolerance, that is one thing. But most of us don’t have this problem, we have no digestive reaction to eating gluten containing foods and there is no reason to avoid it. On the other hand, it is perfectly smart to avoid things that we know are harmful (trans fat, for example), or, if you have a medical condition and need to limit something (such as saturated fat) that is different. But for those of us who don’t have medical conditions, there is no reason to scrutinize every label and every bit of food we eat. With that said, avoiding weird additives and artificial dyes, etc, and preferring natural whole foods is a personal preference and choice, not what I am referring to here (I like real food myself).
  3. Educate yourself about nutrition, but don’t be perfect. I have said it before, it is smart to make healthy choices, to learn how to cook in a healthier way, to plan ahead in order to avoid spending money eating out, bringing lunch to work or school, etc. But just because you know what makes a healthy meal does NOT mean every meal needs to fit some perfect pattern. Being a dietitian is sometimes irritating because I am totally aware of what I am missing in a meal. And I know how my choices may affect how I feel later. I still, though, really do try to practice what I preach. A good example is my recent craving for avocados. For some strange reason, I have been wanting avocados every single day for the past several weeks. Maybe it is the changing weather, with warm weather finally arriving, who knows. Anyway, there have been days where for lunch I just smash that avocado up with some salt on a roll or other bread item and skip the usual protein source (often leftovers) I typically have. I may have other things in my lunch, but they definitely don’t have protein. But guess what? I feel completely satisfied and happy. I know my hair is not going to fall out just because I got 20 less grams of protein for lunch. Yes, I may get hungry earlier in the afternoon than usual, but who cares, that’s what snacks are for. I would rather be happy with what I am eating and truly enjoy my lunch rather than force feed myself a few slices of turkey that I don’t want. So care about your nutrition, but please don’t try to make it perfect.
  4. Make a decision about what you want to eat BEFORE you start eating. Some people are so “out of tune” with what they like, and so accustomed to denying themselves foods that they tend to have an internal war with themselves when they have to pick something to eat. They may want to heat up a plate of that leftover lasagna for lunch, but noooooooooooooooo! That was a splurge on the weekend, and today they have to be “good”. They should have a salad (the last thing they really want). So, as they start to throw together their boring salad, they grab a few wheat thins (they have deemed that as healthy, so that’s ok), then maybe a few grapes (safe too). Maybe a bite or two of cheese as they grab the lettuce out of the fridge. Oh, there’s that lasagna….maybe a cold broken piece of noodle off the top. Finally, after NOT enjoying any of the bites of food they mindlessly nibbled on, they sit down to their bland salad, feeling deprived, but safe. What if, instead, this person stopped for a minute to think about what they really wanted to eat? Maybe they first had to case the fridge to see what was available (smart). They would have discovered the leftover lasagna and made the executive decision that this would be what would be truly satisfying. They get the plate, cut a piece the size they know would be satisfying but not make them uncomfortable, heat it up, and they sit and enjoy their lunch. They leave the table feeling satisfied, not deprived. There is no need to keep going back to nibble because they have actually satisfied their appetite and had a perfectly acceptable, normal lunch.
  5. Slow down. Put the phone down. Turn off the TV. Get a plate (or a bowl). Sit. There just is no way to start to tune in to enjoying your food when you are distracted. If you want to work on being free from restrictive eating and following rules, and you have taken the brave step to allow yourself to choose a meal you really want, then you also need to pay attention to how you feel. It sometimes takes time to learn how much is enough. It is ok to make mistakes (that lasagna person may be satisfied with half of the piece they took, or may find themselves hungry an hour later if the piece was too small). It is a learning process. If you don’t pay attention and tune in to your tummy and how you feel, you will miss it.
  6. Be wary of peer pressure. It is just weird to me how people care what other people are eating (or not eating). When you are truly in tune with your hunger and fullness, and when you start to really know what you like or don’t like it is a great, freeing thing. But sometimes, it does not make sense to others. I think most of the adults I know kind of think they should not eat sweets, so they avoid them like the plague. But when there is some occasion to celebrate, and sweets are available, they just don’t get it that someone may not want any. Something like desserts and sweets  really do lose some of their allure with both children AND adults when they are not made out to be so naughty. Friends or family probably will comment either way, if you eat it or if you don’t (you can’t win, I am telling you!).  If you don’t want something, they will say “oh, you are so good” and if you do take something they will say something else. Don’t let the stupid comments of others make you either eat something you don’t want, or skip something you really do want. The important thing is to eat what, and how much, makes you feel right.
  7. Don’t stop caring about eating healthy. The reality is that a good part of the time we are actually not too picky and don’t care what is available to eat. You may not be on an avocado jag. You may not care if you have the lasagna or a turkey sandwich if that is what is in the fridge. Maybe the blackened salmon on kale salad with goat cheese appeals to you just as much as the chicken wings with onion rings. Why not go with the healthy choice? That is the smart thing to do. But, if you are really wanting the choice that you have previously had rules about, why not take that risk and get what you truly want? The key is to take the time to tune it to how much is satisfying and enough. For example, if a gigantic basket of onion rings (which I love) is placed on your table in a restaurant, having some is satisfying, but eating the entire basket just because they are there leads to discomfort later for most of us. Taking a serving and passing it on is not restricting, it is knowing your body and what makes it feel right.

Untethered eating is not for everyone. For those who have eating issues such as emotional eating, binge eating disorder, or who have other eating disorders or disordered eating behavior, moving to intuitive eating may not be doable on your own (but, hopefully, you are under good professional care and working on it). And for those of you who are dieters, or just trying to eat healthy, but simply can’t imagine taking that step, I hope you at least take that first step: pay attention to that voice. Ask yourself: are you regretting what you ate yesterday? Are you stressing about what you are going to eat tomorrow? Why not at least take a moment to be in the present. Don’t miss out on the simple joy of even one meal or snack you could be enjoying today.

Just like the puppy who breaks off the leash and runs free…..don’t you want to be free when it comes to thinking about food and eating? Just like that puppy who runs around and around and goes wild for awhile, eventually, he plops down and relaxes…..

and so should you.

 

 

Two Cookies and a Yogurt

Image may contain: foodThe other day I was casually chatting with a young man about healthy eating. When someone finds out you are a dietitian they often have lots of questions. Anyway, this young man said something that really stuck in my head: “I feel like a war is going on in my head” he said when talking about trying to eat healthier. Apparently, he had been trying to lose weight and thought he should totally avoid eating junk food, and, just like everyone else who tries to “not eat” something, it creates a struggle.  But the way he described it as a “war” made me think. I actually could relate to having “wars” in my head with lots of things. We all have ideas of what the “right’ thing to do is, and struggle with decisions on a daily basis. Whether it be about what we should be accomplishing, if we should spend money on something, if we should have another drink, or visit a loved one, or make an appointment for a colonoscopy.

But when it comes to food and eating, what does this “war” mean? What is going on here? Where does it all stem from?

I have my opinion about that war, and where it originates when it comes to eating, and it is complicated. I don’t think we can ever totally come to a conclusion with this as everyone’s experience is different. I know people who grew up with health food nuts (sorry, don’t mean to offend anyone, but I am referring to those who are kind of obsessed with eating healthy foods only…..whatever you consider healthy food….you are talking to an Italian here, I have trouble thinking sausage is not ok). And then there are those who have a different food background with cultures dictating the foods they are exposed to. Or, think about someone who grew up with a weight watcher kind of mom who was always dieting and talking about her weight, jumping on a scale and degrading herself depending on the force of gravity that day. Another common scenario I have seen these days is the truly good and caring parents who have heard from the pediatrician about BMI concerns with their child. These parents unknowingly start thinking they need to restrict their children and scold them for wanting what everyone else is eating. Then of course there is the cultural influence, the final word of what we are supposed to look like. One year big breasts are the thing to have for women and the next year it is all about muscles. Abs always seem to be “in”. The bottom line is how we look at food can be complicated. God bless the untainted soul who somehow is resilient to all of it. Far and few between.

No matter what the contributing factors are as to why an individual may be so affected as to feel at war with themselves when it comes to food, it is helpful to know we are not alone. The experts have been looking into this for many years. There happens to be decades of research exploring this phenomenon of what is typically referred to as “restrained eating”. I have talked about this before as it is a theme that never seems to have disappeared. People don’t seem to stop and re-evaluate, even when they experience the same thing over and over (dieting, losing weight, gaining it back, dieting again). Not sure why, but guessing it has to do with the constant focus and pressure on being the right body size, something that women especially seem to distract themselves with. Although those suffering from eating disorders focus on eating, weight and food for other reasons, I am referring to the “typical” dieter, that person who just simply wants to lose weight. Even for these people, looking at food in a restrictive way eventually can become harmful. The person who starts out just wanting to lose a few pounds often starts to look at food in a different way (once they start dieting). For example, before the weight concerns and dieting/restrained eating started, maybe they were a bit picky about what kind of cookie they liked. They could easily refuse an oreo because they only liked their mom’s homemade oatmeal cookies. Nothing could hold a candle to those. But, suddenly, after 3 months of dieting and avoiding sweets altogether, even fake cookies look good. At a meeting at work, if cookies are on the table, they call out to dieters. The bigger the “war” in a person’s head, the louder that cookie’s voice. The non-dieter, on the other hand, may glance at those cookies and just not want one. Yes, any cookie takes on a different meaning depending on the war in someone’s head.

But is it not just about cookies. According to that young man I was talking to, any “bad” food was a food to be avoided. Once he realized he needed to lose weight he fell into the trap of thinking what everyone else in the world seems to think: certain foods make you fat and other (healthy) foods don’t. The good/bad  all-or-nothing thinking when it comes to food is the problem yet again. Giving any one food this particular power is a mistake. When it comes to health (or even weight for that matter) NO FOOD IN THE WORLD has the power to affect either (well, unless of course it is poisonous, but that is not what I am talking about and I think you know just what I mean).

What I told this young man is the same thing I will tell you. Yes, nutrition matters because eating a variety of healthy foods gives us everything we need to feel good, do what we want and prevent illness. But, it does not have to be that complicated. I believe in working on “mindful” and “intuitive” eating, and listening to one’s body, which is not easy for everyone (especially dieters or those with eating disorders). But, for the typical dieter who is at war with themselves, I have seen it work to free them. I have seen people actually learn to have just one slice of cake instead of half of the entire cake…..like they did when they told themselves they should not have any, ever. When people are able to tune out the “war” voice, and instead tune in to their true hunger and actually give themselves permission to have it, a funny thing happens. Your body really does not need or want more than a normal amount of anything. It is only when we deprive ourselves, when we restrict and unrealistically tell ourselves we can’t ever eat something that we break down and overeat it. And continue a war that we will never win.

Instead, I suggest you care about your health, make it a priority. Eat your vegetables (experiment with ways to prepare them to make them taste yummy such as roasting). Include protein sources with all your meals because it makes you feel better and last longer. Eat fruits you enjoy because they taste good and are healthy. Buy wheat bread instead of white. But, for heaven’s sake, don’t go to war over something as simple as a food choice. Your body knows what to do if you learn to listen to it. A normal serving of anything will never hurt you. But, if you deprive yourself, you definitely will be more obsessed with food and more likely to overeat and binge on it…..and not feel so good afterward.

Oh, you might be wondering what the heck “Two Cookies and a Yogurt” means. Well, I hate throwing away food, especially cookies. So on New Year’s Eve when my good friends Barbara and Fred had us over, there were gobs of Italian cookies leftover. She offered them to me, and well, you know, I couldn’t say no. They ended up in my freezer and I have been having them with my coffee for breakfast ever since (only 6 left I think!) No, cookies do not comprise a well balanced breakfast however, throw in a Greek yogurt and you are good to go. Well, I am. Everyone is different. Eat what is good for YOU for breakfast.

But don’t go to war over a cookie.

 

 

Nutrition 101: Eat Like a Kid

Dunkin Donuts 0006

When I was a kid, I loved Sundays. My family would all go to church and after the mass my older sister and I would walk over to the rectory (where the priests lived) and go down to the basement to open the  money envelopes. It was a job we got paid for in donuts. Yup, after all the envelopes were open and counted, Father Flower (his real name) would come in with a box of donuts for all of us (maybe a half dozen of us trustworthy young Catholics). I loved donuts back then because we rarely got them. They were a treat. But it didn’t end there.

My dad would pick us up and him and I would go together to Valley Acres. This was a small local store that had the best cold cuts in town. We would wait in line and get our ham and salami and provolone. Next stop, Lin Lou’s bakery for the poppy seed hard rolls and Italian bread, the best. Finally, home for lunch. Mom would have the peppers all fried up by now. We would make the most delicious sandwiches on those fresh rolls with provolone and ham and salami  and fried peppers (nobody thought about cholesterol back then). After that, I would help my mom make the meatballs (it was Sunday after all, which was always pasta day, sauce, meatballs, sausage, eggplant if mom was feeling like it). I loved grating the Italian cheese and mixing up the meatballs for my mom. She would do the cooking and then we would all go playing outside while the sauce simmered all day. No electronics back then, and only 3 channels on the TV so not worth it, unless of course it was football season. Then I would be on the couch with my dad, glued to the Green Bay Packers, his team. Anyway, dinner would be all together at the kitchen table, a big bowl of meatballs and Italian sausage, pasta with sauce and freshly grated cheese, great Italian bread from Lin Lou’s bakery, green salad with tomatoes and cucumbers and lots of oregano and olive oil. Maybe dad would have a glass of cheap Italian red wine, and we would eat and enjoy every bite. Then we did our jobs, clearing the table, doing the dishes, putting them away. And that was it.

Today, many years later, I think about how eating was back then. Nobody really thought about it much that I can remember. When it came to eating as a kid, all I remember was that I loved the food my mom cooked. I loved the Italian traditions. And I loved those donuts. I sometimes roll my eyes when I listen to adults talk about food and diets and nutrition, and I often think “TOO MUCH THINKING!!!” Somehow, we survived, even without knowing much about nutrition. We just ate. And, mostly, we ate what we liked. What happened? Why don’t people do that anymore? How did it get to where we need to analyze every morsel we put in our mouths?

Yes, since then, we have learned a lot about how to eat to be healthy. We have learned about antioxidants and phytochemicals and fiber. Funny thing, the old advice of “eat your vegetables” pretty much covers all that. Back then, fast food establishments were far and few between. We had one McDonald’s in the state of Connecticut when I was in grade school and when we went once or twice a year, it was a treat. Those discs of a burger were very different than my dad’s burgers on the grill, but french fries were something new. Yes, we enjoyed our McDonald’s and it did no damage. But then again, we went so infrequently, and there were only normal sized burgers and fries and one size of shake. These days our food environment is much different. I think it messes with our natural ability to eat the right amount. I have worked with lots of families who don’t have much money, so going to buffets is a big treat. Back when I was in high school we had to drive to a different state to get to a buffet. It was a once a year thing all teenagers did when they got their license…I think the place was called Custy’s and it was in Rhode Island and the big draw was the seafood…lobster, shrimp and all the kinds of things you really could not afford on a regular basis. I never went but I was fascinated by the stories of how much people ate…how many lobsters, pounds of shrimp, etc. I didn’t really get it because I did not eat fish back then.

Looking back at our attitudes and behavior around food as kids or even teenagers is interesting when you compare it to how we think about food as adults. Somehow, along the line we lose something. We seem to lose (from my experiences anyway) simple appreciation for yummy food without judgment. As adults, we just can’t seem to help adding our adjectives to food. “This is bad but I am not eating carbs tomorrow”. When we go to a party or out to dinner, instead of looking at the menu for your favorite food, or to see what sounds the most yummy (like you did when you were little), most people are weighing the calories or healthiness or carbs or trying to figure out the points.  All of these cognitive methods to figure out what to eat weigh in to help you make the “right” or “healthy”decision about what to get. But, what most people are unaware of is that all this thinking interferes with your natural ability to choose food you like and enjoy.

Sometimes, of course, people who are on a “diet” or restricting to lose weight tend to behave somewhat differently. If they are being “bad” they tune out their body altogether, order too much food, overeat and feel very uncomfortable after because tomorrow, they will be “good” again. This is not what I am referring to as far as natural eating and choosing what you like. This is almost the opposite extreme, a type of “force-feeding” borne out of food insecurity, or the feeling that you may never get it again. That is what tends to happen with people who diet.

It is not easy for most people to accept the idea that you “can eat whatever you want to” and still be ok. You might be thinking “if I did that, I would gain 20 pounds!” The key word is “whatever”. The biggest mistake I have seen people make is giving power to food. Not any food, only certain foods. Somehow, a 200 calorie candy bar has more power than a 200 calorie spinach salad. People mistakenly believe that lone candy bar will “make you fat” because it falls into that “bad” category. The spinach salad with the high protein boiled eggs however, despite providing the same amount of energy (calories) is never the bad guy. Nope, most people would agree, hard boiled eggs and spinach will never make you fat.

What I have seen most people do who have moved away from eating foods they love is a tendency to walk around almost never being satisfied. As a result, they may tend to nibble and pick on more and more “good” or “healthy” food…..only to eventually consume more calories than they would had they satisfied their appetite (both physically and sensory satisfaction) by eating exactly what they really wanted. The key is they are less likely to overeat when they are satisfied. Remember, however, everyone is very different. I am referring to those who do not suffer from Binge Eating Disorder (BED) and those who have typical brains and appetites that may only be off a bit because of normal dieting. There are those whose brain chemistries will lead them to eat beyond a typical amount if they allow themselves certain kinds of foods (usually sugar and fat). Most people (I hope) who have such an eating issue usually work with specialists who help them cope with their issues. The typical dieter or even the typical “healthy” eater however, is who I am reaching out to.

The bottom line is that it is NOT the “whatever” that matters, but the “how much”. If you eat just one candy bar (or burger and fries, or whatever the case may be when it comes to “bad” food) it is no different to your body than eating an equivalent of “healthy” food that may not satisfy you. The secret is to listen to your fullness. For those of you who are disconnected from this feeling, it may take time, but don’t give up. Do some experimenting. I often use the example of a college girl I worked with years ago. She had been eating very little during the day, restricting herself to a plain salad for lunch, but then began nibbling on “healthy” snacks throughout the night. She would have several fat free granola bars, rice cakes, sugar free jello and apples and by the time she went to bed, she did not feel so great. She also was frustrated with having to be thinking about food and eating all night. When I asked her what she really wanted at lunch if she could eat whatever she wanted, she said “a cheeseburger”. So she took the risk and agreed that just once she would get a burger for lunch and see how she felt. I will never forget her expression (and happiness) she had at her next visit when she shared her experience with me. “I felt so satisfied! And the best part was that I was not thinking about food all day! I actually ended up having just one snack instead of a dozen and felt much better!” She had to take that risk and try it once. But it literally changed her life.

Does this mean you should throw nutrition caution to the wind? Not care about eating healthy ever again? Of course not! I believe in choosing healthy food, learning to cook healthy meals but educating yourself on how to make food yummy, too. However I also believe in living in reality. The fact is that you may really want the onion rings and not the side salad. And that’s ok. Plus, if you eat a few onion rings and feel satisfied I bet you are less likely to be seeking out food shortly after a restrictive meal.

So go ahead, take that step, even if it means just being honest with yourself (even if you can’t actually order that favorite food, at least you are considering it). Who knows, a fluffernutter may be in your near future yet.

PS A bit of advice: if you have been eating an extremely high fat diet such as visiting McDonald’s or other fast food joint on a daily basis, your body may actually be craving more fat than is typical. If you honestly don’t have a clue about nutrition, you may want to seek advice from a registered dietitian. Ask your doctor for a referral to a dietitian near you. Even one visit will give you direction.

 

 

 

 

Summertime Smorgasbords: How Do YOU Deal With Too Much Food?

Image may contain: foodChili Dip with Nacho chips, chicken cream cheese roll ups, guacamole layered dip with olives, cheeseburgers, hot dogs, grilled chicken, pulled pork, bean salad, corn salad, pasta salad, fruit salad, tortellini salad, cannoli dip with cinnamon chips, homemade macaroons dipped in chocolate, brownies, sugar cookies, chocolate chip cookies, rice krispy treats, cheese cake, Death by chocolate, peanut butter bars, every kind of chip imaginable…..oh, and wine, beer, sangria and water. What do you put on YOUR plate????

That was only part of the food that arrived at our pot luck picnic this weekend to kick off the summer season. Needless to say, the chatter regarding food and eating was unavoidable.  My own daughter was comically stressing about what to choose when the desserts were out. “I’m so full!!! But that looks so good!!” Since she is not a baker and is also very frugal, yummy desserts like these don’t often come her way. I think she felt like she should take advantage of the situation and eat a bit of everything. Yet, she was already full. I simply suggested taking a plate of everything home…..that way, tomorrow, when she was hungry again and eventually in the mood for something sweet, she would be very happy. She thought I was brilliant : ) Such a simple suggestion, yet I am guessing a lot of people might not do this, thinking it was maybe rude to ask to take something home? Yet, I do it all the time for the simple reason being that I am not a fan of tummy aches. Sometimes, you just have to be assertive to take care of yourself….

My daughter’s reaction to my simple suggestion of taking some dessert home made me realize that these summer celebrations, while mostly fun and something we all look forward to, can be stressful to many. That day the dieting/food chatter was impossible to avoid. Some comments my daughter and I overheard:

  • “I didn’t eat today so I can have this”
  • “I am going to do an extra workout at the gym tomorrow morning to burn this up”
  • “I have been good all week”
  • “This week already has been bad, I might as well enjoy it today because after Memorial Day I am starting my diet….again”
  • “I can’t make up my mind what I want to eat, there is too much!”
  • “Get this dip away from me!”

And I am guessing that some people were having their own private thoughts about food and eating they may not have spoken out loud. When I worked exclusively counseling individuals with eating disorders it made me much more aware of how food-filled celebrations like these were absolutely scary. Typical thoughts from my patients were: Will someone be pushing food on me? Will anyone make a comment about what I am eating (or not eating)? Will I gain 5 pounds if I eat something fattening? Yes, everyone is different when it comes to how they handle exposure to such an overwhelming amount of food choices, and it can be emotionally (and physically) draining depending on your relationship with food.

In general, in my career as well as in my daily life I have encountered a few different “types” of individuals when it comes to eating and health, and their reactions to something like my Memorial Day picnic would all be different. For example:

  1. The so-called “normal” eater: this person encompasses a wide variety of people. Picture the active young adult male (or female) who doesn’t know much about cooking, likes to eat and totally appreciates free food. This guy may not care much about how he looks as far as body size, but has the innate ability to listen to his body signals (or, really doesn’t think twice about overeating or feeling way too full). He tends to take exactly what he likes, enjoys his plate of food and may throw out what he can’t finish. He then runs off to play lawn games with friends. Or, picture the middle age or older person who no longer is as fit as they used to be, but never dieted and doesn’t know what a calorie is. They may talk more about their digestive habits than food and body size. They tend to grab food they enjoy but avoid the things they know give them digestive problems (as we age, for example, some of us can’t digest milk as well as we could before). Or maybe fried foods does not sit as well as before, so passing over the bacon chili dogs with cheese is not because of calories but because of the desire to avoid the uncomfortable repercussions.
  2. The “restrained eater”: this person does not have a clinical eating disorder (meaning they may not meet all of the criteria for a diagnosis) however they probably spend a lot of time thinking about food restriction, calories, etc. They are very weight-conscious and weigh themselves often to be sure they are not gaining weight, or because they are trying to lose weight. The way a restrained eater behaves at a picnic depends on which mind set they are in at the moment. If they are determined to be restrictive, they may choose only “safe” lower calorie foods (such as the grilled chicken and salad). They might be experiencing some inner turmoil because the food choices available are especially appealing to someone who tends to restrict them on a daily basis. They may actually break down and have something, but the guilt they feel after eating triggers a repetitive and negative, blaming message inside their heads. Or, they may overeat once they have “blown it”, knowing that days of restriction will follow. Yes, restricting intake and dieting is associated with binge eating. It may not make sense to a naturally intuitive eater why on earth someone would eat so much as to feel ill (sometimes referred to as a “food hangover”). The person who has never dieted won’t get it, but those who have put themselves in “diet jail” understand that you gotta eat while you can, because inevitably, the dieting days will start again. The bottom line for restrained eaters is picnics can be challenging.
  3. The eating disordered person: without going into detail, someone with an eating disorder (anorexia nervosa, bulimia or binge eating disorder) faces challenges beyond most people’s comprehension. They may have some great strategies to cope with these overwhelming situations if they have received treatment and this can help get them through it all. Sometimes, the hardest part for them is the scrutiny of others. That is why I make it a point to never comment on what someone else is eating (or not eating). It is none of my business. So please, do me a favor and keep your eyes on your own plate. Intentions may be good (they usually are from caring family and friends) but I promise you, unless your loved one personally asked you to be the food police, don’t do it.
  4. The “healthy eater”: this person may not be extremely restrained, but they prefer healthier types of foods. They may know little about calories and may not care about their weight at all. But they like good, wholesome and also delicious food. I know a lot of people like this (some may be referred to as “foodies”). They love to cook and discover interesting ways to make kale or beets. When you go to a party and there is that one unusual salad that you just can’t get enough of (and yet it’s main ingredient is vegetables), this is the person who likely brought it. Just this week I had a salad made of shredded broccoli, dried cranberries, walnuts (I think) and poppy seed dressing that was to die for. I also had a fresh corn salad with blueberries and cucumbers (go figure) that was also an unusually delicious combo. Besides enjoying cooking healthy type foods, these are the people who don’t eat much processed foods, not because they are worried about gaining weight but because they would rather make it themselves and know what is in it. I admit to being somewhat of a dessert snob in my old age (I can now taste the chemicals in a Twinkie). It needs to be homemade to taste good to me. Anyway, at a picnic these types of people may tend to be a bit selective but it is not the same as the “orthorexics” who will only eat super-healthy foods to the point of eliminating many fats, carbohydrate foods, etc. and who stress about eating perfectly. Normal, healthy eaters who prefer healthy food don’t waste a lot of time making their decisions about what they want to eat……they just may pick the more wholesome and homemade options (they really don’t miss the hot dog because they don’t enjoy them). But they won’t be passing up that homemade guacamole.
  5. The weight-conscious “healthy eaters”: these are people who have what is often referred to as “normative discontent”. They may be weight-conscious and try not to overeat, but they are going to enjoy themselves. As I may have written in another blog, in our culture it is difficult to not notice or care about body changes or weight gain as we age. Working on eating healthier and exercising but in a way that does not make you stressed out and does not affect your life in any big way is a different story than the restrained eater who feels guilt after eating. Still, focusing on weight in any extreme way (where it leads to meal skipping or restriction after a picnic or party day) may be a red flag. While it is reasonable to want to have a stable body weight as you get older, if too much energy has to be spent thinking about eating and food choices, or if guilt with eating enters the picture that is a different story.

The message I wanted to send today is that the summer fun has only begun, and my hope is that you will find a way to truly enjoy it at the same time as you honor your health, both physical and mental. That means accepting the person who YOU are and reflecting on your relationship with food. Do you find yourself feeling excessive guilt after eating at picnics? Do you starve or restrict before a party, then overeat and feel awful? Or, do you embrace and enjoy the great variety of foods you don’t ever get to have (because, honestly, who has the time to scrape corn off a cob for a blueberry corn cucumber salad?) If you find you really don’t enjoy these fun summertime food-centered events, try to figure out why….are you trying to be too healthy? are you afraid of gaining weight? Do a reality check. One meal or one day honestly has little affect on health or body weight. If you work on intuitive eating and listening to your fullness, you truly can eventually figure out a way to enjoy the entire event, food and all.

And, remember, you can always take home a doggie bag : )

 

The Military Diet: 5 Reasons Why You Should March in a Different Direction

marchingWith spring here and all the fun yard work and garden planning going on in my life right now, I was struggling to come up with a good idea to write about. Starting my zinnias, cosmos, bachelor buttons and nasturtium and scaring away chipmunks has overtaken my life. But then I saw a client whose goal was to lose some weight she had gained (just about 10 pounds over a few years) and I knew I had to do some investigating after she told me what she was doing. I was aware of the Military Diet after reading about it briefly in a review article on the latest fads, but I had never really encountered anyone who had tried it. Apparently, she had started this diet about 6 months ago and “it worked”….but….she has since gained the weight back and was starting it again. After making it clear that I was not going to help her “lose weight” but would help her try to figure out how to ease into a happier and healthier way to eat, she shared what she was doing. Apparently, she was restricting her calories pretty severely for a few days of the week only. She explained the diet called for following this restricted plan for part of the week and the rest of the week you could “eat whatever you wanted”.

When I pried a bit further into her diet eventually she admitted to an increased obsession with eating. She had started to binge eat on her “off” days and these were not “subjective” binges . A subjective binge is when a person may feel as if they had a binge when in reality, it was a normal amount of food, such as a large piece of cake for dessert, or 3 slices of pizza and dessert. They feel guilty and out of control after eating which is still very disturbing and upsetting for that person. But this young lady assured me it was a real binge (which can be referred to as an “objective” binge). She actually consumed an amount of food that anyone would consider much more than normal eating. On the days she was not following her diet she was consuming boxes of cookies and half gallons of ice cream. And she was not happy about this, yet, it was hard for her to make the connection to the trigger for this behavior, the diet itself. I explained in detail how our body responds to being deprived of carbohydrates and fat and how our brain then reacts to drive us to make up for the lack. Thank goodness it all made sense to her, and she did realize her entire life this binge behavior never occurred…..until she started the Military Diet.

We came up with some ideas she agreed to regarding what she needed to add to her meals to prevent these extreme cravings, and also how to fit in the foods she loved in amounts that she would feel ok with her, both physically and emotionally. But, I realized I needed more facts about this new craze of starving your body part of the week.

I found  a recent scientific review that helped explain this approach and its repercussions, January 2017 Review Article on Intermittent Fasting. This type of dieting is referred to as Intermittent Energy Restriction (IER) as opposed to a typical diet referred to as Continuous Energy Restriction (CER). Much of the research on this type if energy restriction is done with mice, and there are very limited studies of the effect on humans. The bottom line from the review is that as far as weight loss, there is no difference between IER approaches and CER diets. The same failure over time happens. The review makes it pretty clear that we need many more studies that are longer term with larger sample sizes to be able to determine the negative physical, metabolic, and psychological effects of these types of diets on humans.

So, the Military Diet is no miracle diet (no diet is). And you should march in a different direction because:

  1. We don’t know the effects of intermittent fasting and starvation on our metabolism (which is what restricting calories this low is considered: starvation). In other words, it is possible that doing intermittent type of restricting may shift your body to burn less calories, lower your metabolism, and it might be permanent. So, if research over time discovers this to be true, a person who used to burn 2000 calories a day may only be able to consume 1500 calories after doing this diet over time. But, weight would stay the same despite eating less. We know that extreme dieting burns muscle mass and lowers metabolism, and weight regain is usually body fat, resulting in a lower overall metabolism. I have seen patients totally mess up their metabolisms for life with repetitive diets. This diet is different and we still just don’t know. The repercussions could be even worse.
  2. Dieting usually increases obsession with food and eating. Although everyone is different, my client who was never a binge eater, became one. According to the review article, this may not happen to everyone however we need more research with larger samples over a longer period of time. I can tell you from experience (decades of working with dieters) that nothing good comes of this type of starvation in the end. Inevitably, weight is regained and even worse, disordered eating behaviors result.
  3.  There is no way to meet nutritional needs or to feel good on this type of diet. Even a few days of starvation wreaks havoc on our body systems. Bone loss, decrease in muscle mass, dehydration, strain on our kidneys from fluid loss and breakdown of muscle mass may affect those at risk. With such a low energy intake, performance at a job or in school certainly suffers as hunger interferes with thinking. Feeling crappy affects your daily life.
  4. This type of dieting promotes a truly unhealthy view of food and eating. To me, meal preparation, cooking, socializing with meals and entertaining is a part of the joy of life. Just yesterday, which happened to be a beautiful warm sunny spring day when we had a chance to do some yard work, our friends stopped in to drop off some kindling wood for our large fire pit. We ended up having our first cook-out of the season. I picked up some bratwurst (which I never had before and by the way, was really good), Swiss cheese burgers and an arugula spinach blue cheese and balsamic salad thrown together, chips on the side and a good red wine served in a glass pitcher, Italy style. I threw a colorful tablecloth on the picnic table and we had a roaring fire as the sun was setting. It was lovely. Imagine not being able to participate in the joy of a simple evening like this because you were on a restricted diet. Or, just as bad, imagine feeling like you better eat as much as you could because this was an “off” day and tomorrow (or the next day) you would not be allowed to have this food. This is just not a normal way of looking at food and it certainly can’t be enjoyable. It is a total tuning out of your natural body signals that are trying to communicate to you: “you need more”, or “you are full”.
  5. Every day that you try to follow a diet such as this translates into one less day of working on the solution to your eating habits. In the end, what we have learned through research is that most people fall back into old habits once they go off of their “diet” or meal plan. That is because eating is a very complex behavior for those who are struggling with weight issues. The reasons we gain weight or lose weight, or are not at our natural body weights are varied. Lifestyle changes, stress, age, genetics all affect our bodies in different ways. Some people eat more, some less with stress. Our metabolisms change with age and lifestyle changes. Our weights fluctuate. But following a diet is a temporary and not permanent solution. Instead, identifying non-hunger eating triggers (such as stress) and working on strategies to deal with stress evolves into a permanent solution. Figuring out how to incorporate healthy and fun movement promotes strength, endurance and joy into life. Learning about nutrition and healthy cooking and eating carries over into a healthier lifestyle. All of these are a movement into long-term health and a stable body weight that you don’t have to stress about on a daily basis.

The bottom line is the Military Diet is just that, another diet. It could work in the short term if the goal is temporary weight loss. Although I am adamantly against diets because of the repercussions I have seen throughout my professional life, I always like to share that I respect the decision of people who say they need the structure of a diet to help them at first. There are some individuals who actually can safely learn to eat healthier by first starting a “diet”. The problem is that you never know if you are at risk for becoming more obsessed with food and eating or more prone to binge eating or disordered eating when you start a diet. So if you are one of those people who feels immune to these disordered eating behaviors, then I suggest you just reflect on your past experiences so you can learn about yourself. Maybe you never dieted before, and you just need to be aware of the dangers. Or maybe you have, and you regained your weight, but you learned some good healthy recipes your family loves and you can keep making. Maybe your “diet” helped you learn a bit about nutrition or label reading. Just remember, anything you go “on” means eventually going “off”……and back to real life. Do you know how to deal with that? real life, real eating, reality.

The funny thing is that my client who told me about this diet said”it lets you have ice cream every day!” as if that made it better. Yes, the diet called for a half cup of ice cream with the low calorie dinner. But if that made it better for some reason, then why, I wondered, did she still feel compelled to eat a half gallon on her “off” day? In time, after much research, we may learn the answers, but in the meantime, I am going to bet we find out the same thing with IER that we know about CER…..it is not the long term answer.

Weight Wars: What Really Happens When You “Try to Help” Your Partner Lose Weight

Every morning was the same. Margaret would sit at the table for breakfast with her husband before he left for work. She would have her measured cup of Special K with 8 ounces of skim milk and a cup of black coffee. Her husband, on the other hand, would have his usual 2 large pancakes dripping with butter and thick maple syrup and several links of his favorite breakfast sausage. His coffee was sweetened and lightened with cream. He would read his newspaper as usual, and then when they were done, she would clear the table. On his way out the door she would bid him to “have a good day” and out he went. After she closed the door behind him she would go to the window and peer through the blinds as he left the driveway, made his way around the corner, and then out of sight.

The next thing that happened was predictable because it had become somewhat of a habit, or maybe it was something different (an act of rebellion?) As soon as she felt safe, Margaret would head to the fridge. The leftover sausage was thankfully still warm. She would pop a few in her mouth and gobble them down fast while standing in front of the open fridge. What else could she have? Leftover meatloaf, some pie from a party, cold french fries from a restaurant (her husband’s leftovers, not hers, she never ordered fries). Then, one after the other she would eat these random foods in a manner that was not enjoyable. No, she was not savoring some good food because she was hungry. There was little enjoyment here, and she really didn’t know what was going on. But I had a feeling because I had seen it one too many times before.

You see, Margaret’s husband was trying to help her lose weight. Over the years her weight creeped up and she often complained about it. Whether he also had an issue with it, or was only trying to help her I don’t recall, but the affect was the same. He became the food police and she became the prisoner. But she got to break free when he wasn’t around. Deep down, she was also angry and resentful that he was trying to control her, yet she didn’t have the awareness or strength to speak up. I ended up referring her to a therapist to help her with these issues and we worked on ways to stop her binge eating. Margaret’s story is not unique, and trying to help a partner with weight concerns and dieting is not unusual. Being partners together working on healthy eating and exercise can be a great thing. Understanding when it spells trouble, however, is critical.

Whether you relate to either side of this scenario, I have some suggestions from having witnessed so many situations where good and loving intentions backfire. Are you the person who is adamant about eating healthy and feel your partner should too? Have you listened to your wife or husband complain about his or her weight for years and so you feel compelled to say something when you see them taking 2nds? Are you worried about your husband’s newly diagnosed hypertension and now your fear for his health causes you to point out the sodium content of everything he puts in his mouth?

Or, maybe you are the person under the microscope (at least that may be how you feel). Do you find yourself choosing what to eat in a restaurant because it won’t cause your partner’s eyes to roll? Do you quickly hide the snack in your hand when your husband or wife enters the kitchen (because you are sneaking something and don’t want to be found out?). Do you feel sad inside because the person who is supposed to love you seems to be focused on your body size and shape instead of the real you?

When we care about those we love rarely do we do or say things to hurt them on purpose, yet when it comes to weight, dieting and eating, it happens all the time. If you have someone you care about or who complains about weight and you want to help, or, if you feel like the victim in this dynamic, here are some suggestions I have learned are helpful to restore peace and hopefully, happiness.

  1. Have a conversation. Stop pretending. If you are feeling hurt by the fact that you feel like you are being watched when you are eating, say something. Wait until you are not feeling angry and think about what you really need for support. Since every situation and every relationship is different, you may or may not feel comfortable with this. If you don’t feel like you can have a peaceful and productive conversation, and you truly are finding yourself eating out of resentment or if you are binge eating in secret, consider getting some support from a professional therapist who specializes in eating issues. Life is too short and if you can’t have a conversation it is likely the situation will get worse.
  2. If you are the one who has taken on the “watch dog” or food police role, but sense that your partner does not appreciate, or even gets angry at your diligence, why not ask them? Even if your partner asked you for support initially, you need to find out what that means. It may not mean they need comments from you, or maybe they thought they did need that kind of policing, but now it is not helpful anymore. The best thing you can do when you want to help someone is to ask: what can I do to help?
  3. Take a chance. Eat it in public. Eat it in front of your partner. Don’t hide when you eat. When you go to grab that snack and find yourself gobbling it down while standing in front of the fridge before you get caught, stop and ask “is this really enjoyable?” Eating food you enjoy is one of the blessings of life. Instead, walk over to where you normally have a meal, get a plate or napkin, and sit down. Enjoy your snack. Being aware of what you are eating, how it tastes, how your tummy feels, how hungry you are (or aren’t) is the first step to getting more in tune with your body and intuitive eating.
  4. Do some self-reflection. Do you recognize a pattern in your life when it comes to dieting and weight? Does your weight fluctuate depending on if you are dieting or not? Sometimes, we get into patterns in our relationships involving dieting and this can affect our relationships. The non-dieting partner may not know how to help and just assume they are being supportive when they become the food police after the big dieting announcement. If you recognize a pattern, my suggestion (of course!) is to consider getting off of the dieting band wagon. There are lots of resources and support for ways of living that are focused on intuitive eating and health (instead of weight). Check out Health at Every Size as well as a great non-dieting blog Dare Not To Diet

In this world focused on dieting, eating fads, weight, fitness and all that, changing your ways in not easy. I always have believed that caring about your health is way different than obsessing about your weight (which is not exactly in your control). There IS a way for us to work together toward a sane goal, but it has nothing to do with the scale and no food police needed. Instead, it involves partnering with each other to agree to make time for meals together. To agree to take a walk together or do yoga together, or turn off the TV during dinner time. It may be to learn to cook together, to try new vegetable recipes, to learn about special diets together (if one spouse needs to follow a low sodium diet for hypertension, for example). In this case, working on keeping giant bags of chips out of the house for the person who does not have the issue (they can buy a bag for lunch at work, instead). Creating a healthier eating environment at home to be supportive of each other’s health goals is way different than watching and commenting on what we eat. At the same time, deciding to go out for pizza and enjoying every minute (no comments about “breaking the diet” please!) does not mean you gave up on health. No, it means you are learning to incorporate normal balance in your life, and enjoying pizza on occasion does not mean you don’t care about your health.

With spring around the corner, I can almost smell that feeling of hope in the air when I walk outside in my garden and see some new life emerging (among the finally diminishing layer of dirty snow). I hope you consider a new life with no food police, no guard dog, just complete freedom and peace. Wherever you live, with whomever, that is the way it should be.

“Listening to Your Body”: not always easy

Christmas Cookies 2

In the midst of the holiday season the effort to “listen to your body” as far as eating is concerned is not an easy task for many. This article by a fellow dietitian (one of the most sane nutritionists I have ever encountered) is really insightful as far as feeling full and what it means. If you struggle with being in tune with your hunger, read on for some good advice: How Full Should I Be? by Glenys Oyston

 

Feeling Stuck and Corn Stalks: Visualizing Change

Clouds and corn“I chopped down a corn stalk yesterday!” my patient (I will call Susie) said as she sat down for our session. She had binge eating disorder, and was in the habit of restricting her intake severely during the day, then after work she would pull into the drive-through of several different fast food establishments on her way home. First for several double burgers, fries and giant milkshake. Then, Dunkin Donuts for a bagful of donuts and large coffee drink. She would gobble this down with predictable feelings of guilt and remorse afterwards. No matter how much resolve she had the next morning (“that’s it! I am starving myself today, I don’t deserve to eat. I will make up for it. And today, I won’t do it” ) by the time 5 pm rolled around, her starving body screamed at her and her conditioned brain went into automatic pilot. Her car just seemed to turn automatically into that darn entrance with the sign that said “Drive-Thru Entrance Here”along with the giant yellow arrow to be sure you do not miss it.

Maybe you can’t relate to this behavior, maybe there is some other behavior that you do that you wish you could stop. Bad habits are complicated and more difficult to change than one would imagine. Sometimes, we look at others and think “how could they do that? why don’t they stop ______” Fill in the blank. Smoking, drinking too much, watching too much TV, not sleeping, starving themselves, binge eating, purging……all detrimental to our health. Why can’t we have more willpower? When my patients start bashing themselves (don’t we all feel kind of bad when we just can’t do what we thought we could do?), it typically is a pattern. We get into what you might consider “automatic pilot” mode, both with our thinking and with our behavior. You may have heard of “behavior chains” . Susie’s might look something like this:

Skip Breakfast and Lunch->Leave Work->Drive by McDonald’s->Turn in Drive Thru->Order Food->Eat in Car->Feel Guilty->Drive by Dunkin Donuts->Turn in Drive Thru-> Order Donuts->Eat in Car->Feel Guilty->Go Home->Eat More, go to bed->Wake up, Skip Breakfast, Skip Lunch, Leave Work and REPEAT CYCLE

My patient Susie wanted desperately to change this behavior, but her expectations of stopping totally and miraculously going home to eat a healthier dinner was not reasonable. Part of the reason is NOT lack of will power, but the reality that our brains are not always under our control when it comes to bad habits. To help patients understand this, and also because I am a visual learner, meaning, I need pictures to learn things, I use a “corn stalk” analogy to explain this phenomenon. First, identify a behavior you want to stop (for Susie, she wanted to stop binge eating fast food after work). Next, imagine what healthy behavior you wish you could do instead (Susie really wanted to be able to drive straight home and prepare a healthier and normal sized meal and not feel guilty).  Now imagine your brain as a very thick field of corn stalks. You have to get to the other side to your “behavior” or outcome. You see a beautifully paved path leading somewhere. It is shiny, made out of beautiful marble, glistening in the sun. So of course, you head down this path because it is so easy, and it is actually somewhat enjoyable.

Unfortunately, at the end of the path lies the exact behavior you have been trying to stop. For Susie, at the end of her nice shiny easy path is McDonald’s. And Dunkin Donuts. And binge eating, followed by guilt. What Susie really wants at the end of her path is a nice healthy meal, and feeling good. But there is no path to that scenario. She needs to make one.

Do you think it is easy to make a paved path through a giant field of corn stalks? No, it is not. Neither is changing behavior. Neither can be done overnight. For Susie to forge a different path, she needs to get herself a hatchet and knock down one cornstalk at a time. After lots of hard work, sweat and tears, eventually a path, albeit bumpy and conducive to tripping…well a path will slowly appear. Susie will actually be able to get down that path to the place she wants to be. Her old smooth beautiful path will still be there. But eventually, that old smooth path will start to be less smooth and easy as new baby corn stalks begin to grow. She will still be able to get by, but it won’t feel as easy or right. Eventually, over time, that old pathway will be covered and pretty much gone. The new path will start to be nice and smooth and very easy to walk down. Maybe not made of marble, maybe some smooth sand, but walking down it will feel pleasant and good, not like in the beginning.

How does this look in Susie’s “real” world? Take a look at her “behavior chain”. What Susie did was pick a place in the chain where she felt she could do something different. She told me “I don’t need to go by Dunkin Donuts. That is actually the long way home”. So the first hard work she did, that first corn stalk chopped down was taking a different road home and skipping Dunkin Donuts. She still went to McDonald’s, still ate too much, still was starving during the day, but she was able to make this change. She felt pretty proud of herself and had some hope. The next step was at the beginning of the chain, the skipping of breakfast and lunch. She did not want to eat breakfast, but agreed to starting to eat something at lunch. This helped her be less starving on the way home and eventually she was ordering a smaller amount of food at McDonalds. Another corn stalk down.

I have had many patients like Susie, all with different issues and behaviors they wanted to change. Those who accepted that change did not happen overnight often went on to change their brains by changing one little thing at a time. Most of us are not that patient, it seems, and so we try to change all at once. When we fail, we blame ourselves. Instead, if we stop and think about the corn stalk field in our brains, maybe we can accept that chopping down one corn stalk, changing even one little thing at a time will eventually get us where we want to go.

So can you think of any unhealthy behaviors you want to change? Then pick up that hatchet, it’s time to chop.

 

 

3 Steps to Eating Mindfully:Which One Are You Neglecting?

My hungry husband at Faneuil Hall, Boston

The other day I found myself standing at the kitchen counter, wolfing down some leftovers. I was in a rush to finish packing for a weekend trip, and I was in one of those “multi-tasking” modes. You know, if you can figure out how to do two things at once, try doing three. So there I stood, with the small TV that is stuck in our kitchen wall closely watching the path of Ermine (or was it Hermine?), the hurricane that was maybe going to hit us as we had our yearly outing with good friends in their boat down the Connecticut River. A hurricane would be bad. So I was standing there shoveling this yummy salad down my throat,and it suddenly struck me that I was not even tasting it. And I LOVED this creation, which was a random modification of a kale goat cheese salad I make often (if you ever go to Bricco’s Restaurant, their kale salad is the one I tried to copy…..I got pretty close!). It is a delicious blend of chopped kale, fried chick peas, garlic, red onion, olive oil, balsamic glaze and crispy bacon bits. Anyway, I kind of combined this salad with another bean salad recipe I make with black beans, corn, carrots, etc. and boy, was it good. I should have enjoyed it, but instead, I was just rushing it into my belly so I could move on.

 

Ye, I was in a rush, but promised myself when I got back from the weekend trip, I needed to write about this. If felt important to me because mindful eating, and working on having a healthy relationship with food is one of the messages I hope to send. This means enjoying eating. Shoving food down to get it over with is the opposite of mindfulness. I understand not everyone looks at food and eating as something to be enjoyed, and I chat with people every single day who look at food as “the enemy”. It kind of makes me sad, as cooking and creating healthy but yummy dishes is something I greatly enjoy. I just love sharing what I cook with family and friends, and maybe that is part of my Italian heritage, but being a dietitian definitely affects my cooking, too (“how can I make my mom’s sausage and eggplant but not give my husband heartburn?”).

Ermine missed us, and we sailed down the river easily, and as I joyfully floated one day on a gigantic blow up duck (don’t knock it till you try it) I had time to reflect on how I would describe this eating experience and what bothered me by it. It dawned on me that eating involves three simple (yet not always easy) steps. Each step is important to understand if your goal is to eat somewhat healthy and feel good. Especially if you want to have a healthy-ish relationship to food and eating, and most importantly if you are an emotional or binge eater.

Here is what I came up with:

Step 1. You need to have food available to eat. Now before you say “duh…”, let me ask you this: what are you making for dinner tonight? What are you having for lunch at work this week? What snacks can you have, right now, this minute if you get hungry? Like I said, I love to cook, I know a bit about nutrition, and yet, it is after 12:00 noon and I have yet to figure out dinner, although I have successfully defrosted what looks like 2 gigantic boneless chicken breasts. As for lunches for work, it will have to be leftovers. I am not at all in the mood for grocery shopping. Snacks, well, shriveled grapes and frozen fudge….and the bottom of a chip bag.

The point is, having food available is pretty important because it really does affect what you are going to eat. For those with binge eating issues it can be critical. FYI there are 2 kinds of “binge” eaters. The first kind is the “subjective” binge eater who thinks eating a full sandwich and a cookie is a binge (these are the dieters or even those with disordered eating who don’t allow themselves to eat what most of us might consider a normal meal). The second type is an “objective” binge eater which is someone who truly eats an amount of food most people would consider a large amount, such as the whole box of cookies on top of several sandwiches. Lots of guilt follows an eating episode no matter which type. Many binge eaters have certain “trigger” foods, in other words, when these foods are in the house they can’t resist eating “the whole thing”. Not consuming enough food also can trigger binge eating. It is pretty smart to know yourself, and creating a food “environment” that works best for you.

Besides triggering binge eating, eating healthy and feeling good is next to impossible if you don’t have access to healthy food. I know of some people who just would rather not bother. Maybe they are single or live alone, or maybe the kids moved out and so they don’t cook. Eating macaroni and cheese every night with Pop Tarts for breakfast and take out for lunch eventually will affect your health. Having a bowl of jelly beans on your desk may not be the best idea if you are a mindless nibbler, especially if the dentist is not your favorite person. Yes, paying attention to your food environment definitely affects what you eat and your health. What foods do YOU have available….at home and at work?

Step 2. The act of taking a bite, a forkful, a spoonful or otherwise putting that food into your mouth, chewing and swallowing. The first question is, where are you when you eat and what are you doing? Standing in the kitchen like I was while watching the weather is pretty much the exact opposite of how to eat in a mindful way. Digestion actually does begin in your mouth, so chewing fast and swallowing foods whole will interfere with this. Did you know that savoring your food (really seeing it, tasting it, enjoying it, feeling it in your mouth and chewing it thoroughly) actually has been shown to lead to “sensual satisfaction” and helps you to know you are full? In other words, taking the time to look at your food (not the TV or a book), pay attention to the flavor and texture (is it good? need to add something?) and really enjoying it helps you to be more in tune with your body. Savoring your meal or snack instead of rushing through it makes it more likely that you will eat the amount that you need. Even more important, truly taking the time (more than 2 minutes) to enjoy your food can be a part of the joy of life.

Step 3. Stopping eating. You might find it interesting to know that scientists are fascinated in studying what makes us stop eating. How and why do we “feel full”? What factors contribute to satiety? Everybody knows that eating fast usually contributes to overeating (and by this I mean getting too full, not feeling good physically because you ate too much, I don’t mean the guilt and judgement some people put on themselves because they did not follow their “diet”). We now know there are several chemical messengers that our body sends to our brain to tell us we are full and can stop. We are all different, and some people may feel full faster, but most people need time (about 20 minutes or so) for that messenger to get to the brain to signal fullness. Many factors affect this of course, such as the food we eat, how much fat, protein, fiber, etc. But one of the most fascinating things to me is the “sensory satisfaction”, or how much we actually enjoy the particular food that may affect how satisfied and full we are. Yes, some researchers have found connections. This is just one abstract about how  the sensory aspect of food and how it contributes to feelings of satisfaction and makes us stop eating. Yes, other studies have connected good tasting food with overeating, and we all know that when excessive yummy food is available most of us may eat more than we usually do. The key is finding the balance. Do you expect yourself to live on dry toast, cottage cheese and salad? Are you absolutely bored by the food you make? I have seen people become kind of obsessed with foods they normally deny themselves especially when they try to be “good” all the time…I hate that word, but people use it when they define their eating, so I want to be sure you know what I mean. Eating only and I mean only healthy food. Boring, especially if you aren’t into cooking. Instead, jazzing up your meals, even a little bit can greatly add to your satisfaction. Can you throw some avocado onto that grilled chicken wrap? add some crunchy granola to that morning yogurt? How about a little olive oil dressing in that salad? Make it taste good, and you are bound to feel more satisfied, less obsessed with food, and maybe you even may develop a new hobby…..collecting cookbooks?

Besides being sensually satisfied, tuning in to the ole tummy is also a part of learning to be an intuitive eater. I sometimes use a “hunger scale” (many dietitians do) to help people judge how full they are. It typically goes from 1 (starving) to 10 (stuffed to the gills, extremely uncomfortable). Check out a typical hunger scale HERE.  If you are a mindless eater who gobbles down meals too fast, you may find yourself with indigestion or an upset tummy after the fact. That is one sign that you could benefit from taking the time to slow down and tune in. Practice sitting quietly somewhere, or at least trying to pay attention to what your stomach has to say about a half hour after eating. Are you barely satisfied or are you feeling sick? Both extremes teach you something.

So there you have it. The thoughts I had while floating down the Connecticut river on a duck. I hope you take the time to “digest” some of this, and realize this is not a skill we learn overnight. If you have trouble, just give yourself time. The important thing is doing the reflecting. The rest comes with trial and error. There is no right or wrong, and if you want to live on mac and cheese and Pop Tarts, who knows, you may live a long and healthy life without the fiber….but if you truly do want to feel your best then do your best to work on creating a healthy but enjoyable food environment. Slow down. Tune in.

By the way, we named the duck…Ermine.

Does Your Teenager Have an Eating Disorder? Signs and Symptoms You Should Not Ignore

scaleThey came to their visit together. Jessica (not her real name) did not want t be there. I let her stay in the waiting area fixated on her cell phone (she made up her mind she hated me, at least that is what her facial expression conveyed). Instead, I took her mother into my individual counseling room to get the story before I met with Jessica. It was one I have heard before. In fact, the entire scenario became predictable. Mom was all over the place, at first angry that her teenager was being so rebellious, she was driving them all crazy. She refused to go anywhere with the family, she hid out in her room, refusing to sit at the family dinner table. Vacations were a night mare. “She used to be such a sweet girl, so happy and care free, she LOVED helping me in the kitchen and really enjoyed going out for pizza with the family, but now she is like someone else. We don’t know what to do”. Next, after the anger, comes the crying. “She looks horrible. She passed out the other day and it was so scary. Yet, she won’t stop this. It does not make sense!”Jessica took to wearing very loose and baggy clothes, and it wasn’t until her mother walked in on her changing that she noticed her protruding ribs and the obvious weight loss. After lots of threatening, Jessica agreed to go to her pediatrician’s and was then referred to us. How did it get to this point, and how did this family miss it?

Eating disorders can happen at anytime, but transitions are especially tough. Back to school, back to college, back to normal life. Simple, predictable, or is it? Not for everyone. Times of transition and change, such as starting a new school, going away to college, new teachers, different friends, all of it can be a challenge for some kids. Times like these can be risky when it comes to falling into the grip of an eating disorder. Couple that with society’s obsession with losing weight and it is pretty easy to understand why lots of eating disorders often go unnoticed until it is almost too late. As a parent, what signs or symptoms should you look for? Some things that you should not ignore:

  • Weight loss. Sounds obvious, but actually, especially in teenagers who are larger or fatter, parents mistakenly tend too think the weight loss is a “good” thing. Even doctors make the mistake of automatically praising weight loss, especially if it brings a child closer to a “healthy” BMI (gag).  That meaningless number does it again…….clouds the judgement of otherwise smart and well-meaning people (parents and professionals alike). The great news is the American Academy of Pediatrics came out with a new report in August highlighting the risk of treating obesity in adolescents with disordered eating as well as the importance of focusing on health verses weight. See this article in American Academy of Pediatrics for the specifics. The bottom line is that we need to get off the losing weight bandwagon, fight the cultural message that everyone needs to be thin, or a certain BMI, and NEVER EVER praise weight loss in a teenager. Yes, there are times when a kid may lose weight. A teenager who is very sedentary who goes away to college and finds themselves having to walk 9 miles a day just to get to all their classes may indeed lose some weight. This is not what I am talking about. But even then, making a big deal about weight loss is never good. Even this kid, if they get lots of attention for losing weight may decide they like the attention, and start doing things to purposefully lose weight (I have seen this happen many times). Don’t do it. Don’t compliment weight loss in a kid. Instead, compliment growing up and being successful.
  • Food refusal. When your teenager has always loved your home-made macaroni and cheese, and even begged you to make it, but now refuses to eat it, NOT GOOD. Unless there is a really good reason for refusing a favorite (recent stomach bug, stomach ache, cramps, etc) don’t ignore this red flag. Should you try to force your kid to eat it, or pressure them to answer you as to why they don’t want it? Like I said, one refusal because they don’t feel good is normal, but a few times in a row is just not normal, however responding with anger is not helpful. Instead, I have found those parents who are able to open up a caring dialogue with their teen have a better chance at getting to the bottom of it. It is important to pay attention to all signs and symptoms so you can then make a plan to address it. Forcing food or anger does not help.
  • Decreased socialization. For a teenager with an eating disorder, any situation that involves food and eating is threatening. You will start to notice they don’t want to go to their friends houses, or to birthday parties, and they especially will try to get out of family functions (those typically aren’t a teen favorite anyway, but they are doubly horrifying because of the food involved). They may lose interest in going to what once was a favorite restaurant and a big treat. They will refuse to eat the family’s favorite pizza on “pizza night”. Red Flag.
  • Loss of menstrual period. Not that you need to keep track of your teenage daughter’s cycle, but if you notice she does not ask you to buy feminine hygiene products the way she usually does, ask. Don’t ignore it as this can be a sign of weight loss and inadequate calorie intake.
  • Obsession with exercise. If you notice your teen going out for long runs, or running both morning and night, or if you notice the bedroom door is always closed and when you walk in she just so happens to be exercising, this could be a sign that something is not right. Yes, being active is good for all of us, but if doing calisthenics is something new and different, and especially if your teenager seems to be hiding it, then this is also a red flag.
  • Going to use the bathroom after every meal. If this has always been normal for your child that is one thing, but if it is a new behavior, it could mean they are purging or throwing up their food. You can check the bathroom for evidenced or you may hear it, but don’t ignore this. Vomiting on a regular basis is an eating disorder behavior and could leads to electrolyte imbalances that can be deadly.
  • Body checking. Do you notice your teenager looking at her body, especially her stomach obsessively? Does she tend to squeeze her arms as if to check for fat? This is a common behavior for people with body image issues and should not be ignored, especially if other signs are present.
  • Obsession with food labels, writing food in a journal, or counting calories. I can’t tell you how many food journals complete with calorie counts I have seen in my life. It is NOT normal. It is NOT a good thing. Yes, there are apps and websites and even the My Plate site has trackers for this. I hate them.This is as far away as normal, intuitive eating as you can get.

So what should you do if you notice any of these symptoms? Remember, your teenager is not doing this on purpose. They can’t stop. It is a very complicated disease and the triggers and causes are different for each person. It is important to be empathetic, kind and loving and to avoid blaming as this will not help. The first step might be to call your pediatrician and share your concerns. They will probably want to see and evaluate your child and may recommend therapy and a visit to a dietitian. Be sure that both specialize in treating eating disorders. Your teenager probably won’t be happy, but you can also get support from the therapist as far as how to handle resistance. The sooner you address the issue, the better chances for recovery. Remember, it does not matter what size your kid is, if they are fat or thin. It is very easy to ignore some of these red flags, like I said, some are so socially acceptable and desirable that it is sometimes hard to see what is going on. Don’t ignore these signs. They won’t go away on their own, and the longer you put off getting help the harder it will be.

There is hope. You can get your old teenager back.But you gotta move fast.

For more information and for great resources, check out the website: Eating Disorders Awareness and Prevention.