Thursday, September 30, 2010

Insanity or recovery?

Insanity is doing the same thing over and over and expecting a different result. Einstein

With mixed emotions I told Jamie not to schedule a follow up appointment. 

Yes, Jamie need not return to see me. It wasn’t that she was difficult or non-compliant. On the contrary. Jamie was done. She had truly recovered from her eating disorder. She not only knew what to do—how to eat to meet her needs, how to get back on track when she slipped, but she did it. Consistently. And she no longer needed me to guide her.

In May 2004, at the age of 18, a college freshman, Jamie presented after leaving her Ivy League university to move back home to work on recovery. She had struggled with bulimia for an entire year before seeking treatment with a therapist, and had now realized that it needed to be her full time job. She compulsively exercised. And vomited daily. She hated the purging, she “knew it was wrong”, but felt it was the only way. Her periods were irregular (not a major concern to her at the time), but she complained of feeling low energy and was frequently lightheaded. She binged and restricted her food intake. And binged again. And so the cycle went.

She chose the lowest calorie foods she could find and avoided “risk” foods. And the list of those were growing rapidly. On most days Jamie’s intake was way too low, particularly given her over-exercising. And yet her weight was higher than it needed to be, by about 15 pounds, a source of much frustration. As far as she was concerned, it could never be low enough to please her.

Fast forward to today.

Jamie has gone about four years without purging. And yes, she’s eating. Quite normally, I might add. Observing her you would never know she had had an eating disorder, as she chooses a range of foods and caloric beverages (although I think chocolate milk is her favorite!) She eats regularly, sometimes every 2-3 hours when she can grab a snack or sit down for a meal on her busy shifts. 

It took time, and trust in her providers to slowly break the cycle of nutritional self-denial through poor intake and over-exercise, which resulted in binge eating. And her weight has appropriately dropped to a very healthy place and has been stable within a pound or two for some time.

Now she occasionally exercises, but working many hours as a nurse is about as much exercise as she manages to find time for. And it doesn’t seem to faze her. Given the choice, I could see that Jamie would much prefer to spend time playing—with her almost 2 year-old daughter, that is. And she feels great about her modeling. Behavior, that is, for her lovely child who asked “Mommy snack too?” as the little girl fed her mother raisins in my office.

Jamie owes her success to “becoming comfortable with who I am as a person, the result of much therapy”, she acknowledged. And she knew that to do the work, to think clearly, to control her impulses, she needed to nourish herself. And over time she began to trust herself. And her body, and its signals. And it certainly helped when she knew she was responsible for another life when she was pregnant. And  in preventing a 2nd generation of eating disorders from developing.

There are times that body image issues reemerge, but Jamie can manage it. And she now periodically checks her weight, first assessing her situation, and then correcting any emerging patterns that need to be addressed. She knows the door is always open if she needs nutrition guidance and support. And she knows how to open it.

For those of you struggling, I write Jamie’s story to show you that recovery, full recovery is a reality. And not just for Jamie. Regardless of how different Jamie may seem from you, recovery is within your reach, regardless of where or if you went to college or what job you hold. If you think that Jamie had some advantages that enabled her to recover, or that this recovery was quick and easy, think again.

If you’re frustrated with your eating disorder progress, your weight management or your relationship with food, consider this. How many years have you been living with and maintaining your unhealthy behaviors? As Einstein said “Insanity is doing the same thing over and over and expecting a different result”. Maybe it’s time to try something different. Do you need to call on other supports? Family? A therapist? Nutritionist? A support group? A higher level of care, such as an eating disorder program?

And how long have you been working on change? If you’ve lived for 10 years struggling with your situation, but have only been addressing the issues and behaviors for 10 months, be patient! Just like a toddler may experience one developmental change at a time—walking or talking, but not both in the same week—you may similarly be making one shift at a time—changing your thinking versus changing your actions, for instance.

I hope this gives you the inspiration to spark your progress and to recognize the progress you are making. Please feel free to share a piece of your story with us!

Friday, September 24, 2010

Food Finds: Fig Jam

It feels like a little secret I need to share. And maybe I’ll discover from your responses that only I was the last to find out.  It’s about jam. Fig jam. Seem strange?

Keep in mind that looks aren’t everything. The fig, dried fig especially, would hardly draw you to it from its appearance. But the jam from this fruit truly enhances many foods, I’ve discovered. I’ve tried a few brands, but so far my favorite two are Bonne Maman (from France) and Organic Adriatic Fig Spread (a product of Croatia, it says). Both are easily found in US supermarkets (at least those in the suburbs in New England).  I even indulged at Williams-Sonoma (I had a gift certificate) and paid about $15 for a jar, but it didn’t compare to the other two brands which price at $4-5.

Why such affection for this product? It's a combination of its sweetness, which serves as a perfect and unexpected complement to a range of foods, and its texture, with its tiny seeds and chewy fruit pieces. And for a minimal addition of calories, it truly enhances the pleasure of eating so many foods!

So far, here are my favorite uses:

Spread on a sandwich with a strong cheese (an aged cheddar, goat cheese, or Manchego, a delicious Spanish cheese), topped with some baby spinach greens. Totally yum! I promise to add a photo of this soon, but today I had soup for lunch instead!

Dropped by teaspoonfuls onto homemade pizza. Yes, even with the tomato sauce, it works surprisingly well. Alternatively, buy some dried figs, slice them up and toss on the pizza instead.

As a topping on fish, especially salmon or other strong flavored fish. Spread it lightly when the fish is just about done cooking. Or, mix up a simple sauce, adding some balsamic vinegar to a few tablespoons of the fig jam to thin it out. A bit of Dijon mustard can be mixed in as well.

Mixed  into a cup of plain yogurt. A tablespoon will do. Delicious!

 Dried figs are quite high in fiber, probably the highest fiber fruit you'll find. From the estimates I've seen, they contain about 2 grams per single piece of dried fruit. About 3-4 pieces (that's 6-8 grams of fiber) would be the equivalent of eating a full size fresh fruit, such as an apple. But the jam, in the quantities you'll be using, won't make a dent in your fiber intake. Oh well. Guess you'll just have to include it in your diet because it tastes good!

Enjoy! And please share your creations with fig jam!

Wednesday, September 22, 2010


I didn’t eat, or drink for 25 hours, from 5:45 Friday night to 6:45 PM Saturday.  No, I haven’t lost my mind or my sensibility. And there’s no need to worry about me. I did it because it is my family’s tradition to fast, a complete fast, on this religious holiday, the Day of Atonement, which occurs once a year. And the experience raised some thoughts I’d like to share.
The purpose of this fast day is, in part to atone for one’s wrongdoing. But in general, it is intended to be a reflective, contemplative day, full of soul searching.

So here’s what I learned.

The act of fasting, or restricting my intake so severely, leads to anything but meaningful reflection and soul searching. Yes, it prevents us from doing other prohibited activities, including working and having sex (yes, that’s prohibited too). But meaningful contemplation? Clarity of thought and insights into our relationships and behavior?  What were those Rabbis thinking?!

It started harmlessly enough. I missed my evening snack, and in the morning I could only imagine the scent of dark roast coffee, freshly ground and brewed, as I do every morning in my French press (Melior), in addition to my breakfast, I might add. But I was fine. And then I sat through the temple services. As the morning hours passed and 1 PM was approaching, I noticed that it took me longer to read, and to comprehend the written passages.

And by 3:00 all I could think to do was to nap. And so I did. For almost 2 hours. No introspection. No making amends with friends and family. Just sleep. Quite the meaningful fast day!
As for my overall food consumption, let’s just say there was little thought or restraint to my “break-fast” meal that evening. Bagels, cream cheese spreads, smoked fish, cream cheese brownies, rich, whole-fat blintze soufflé, salad with nuts and goat cheese and of course walnut oil and dried fruit (yes, I made that one). And more brownies. Ah, and the coffee. Oh, and I had some bread with honey before going to my friend’s home for this meal (okay, so I broke the fast a bit early).

Many if not most of you, regardless of your size, have at times restricted your eating. And many of you still do. So I ask you to consider the following. Does the restricting ultimately work? Ok, I will agree, that in the short term, restrictive eating meets some needs. If it didn’t, you wouldn’t maintain the behavior. But the benefit is very short-lived. And not without consequence.

From a weight management standpoint, I’m certain it is ultimately most ineffective. As I experienced, I ate more both before the fast and after than I would usually consume. And my activity was impacted as well. I couldn’t even think of walking my dog. And I spent more hours sleeping than I ever would in a 24-hour period. And let’s say I were on a diet in which I intended to restrict types or amounts of various foods. The result? I would likely feel denied and deprived, and when I finally had a weak moment I would likely binge or overeat on the “forbidden” foods. Sound familiar?

But if the main goal, consciously or not, was avoidance—of feelings, of engaging in all life has to offer, in dealing with thoughts too challenging to contemplate—then restricting clearly works. But not without a price. It has a very short-lived benefit, and ultimately fails to fix the situations you might seek to avoid.
Perhaps the best part of this fast? It reminded me of how much better I feel when I eat to meet my needs. I appreciated that my mind and my body so depend on nourishment throughout the day. 

As for control, which many of you yearn for? My eating and your eating is far more in control when we can have delayed gratification and not eat impulsively. And when we can think clearly.

Susan recently broke up with her boyfriend of 3 years because of her eating disorder, her bulimia. She had been living with him and he had no idea of her daily, yes daily struggle with food and purging. But after working together for many months, together with her therapy work, Susan came to a realization. Several months had now passed since she had relied on purging. And she was eating regularly, and more adequately, with fewer restriction, although “healthier” foods still seemed safer. And she was feeling more grounded, more in touch with her feelings—and her self. And so Susan began to realize that she wasn’t happy in her relationship and hadn’t been for years. So she ended it. And moved into a new place of her own.

If it weren’t for her steps toward recovery Susan would not have been able to shift direction for better, to find her voice, to state her needs, to be true to herself, to have control over her life. So there’s control, let’s say over how little you choose to eat, and there’s control, over things that really matter.

Now I think I’ll need to revisit those cream cheese brownies, which I was in no position to truly savor on Saturday night.

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

Friday, September 17, 2010

I Hardly Know You!

A challenge to make your voice heard.

I’ve always loved to share my opinions, to argue, even. Really. Just ask my family and friends. And since starting this post in May, just 4 months ago, I realize how much I also enjoy writing. But writing with little response is a bit of a challenge for me. Don’t you like getting feedback? Fortunately, my patients, many of whom read this blog regularly, are not shy to speak up. I rely on the responses as a compass, to keep me directed, to know which topics need addressing, what misinformation out there in the media needs correcting. It helps me know which posts might be triggering and what to avoid stating, and to know what you’re struggling with. 

Yet so many of you are out there reading this so quietly, without a peep!

At the time of this post, you have visited over 3,200 times. Over 1,200 individuals have visited, and 62% of you have come more than once. You come from all over the map, from 46 countries so far, and increasing daily. After the US, the greatest number hails from Canada, the UK, and Australia. But you visit from Austria to New Zealand, Russia to Chile. The Americans that read in greatest numbers are from Massachusetts (no surprise here), New York (but interestingly my mother in Brooklyn hasn’t visited) and California. All US states have had visitors except for North Dakota and Delaware. Go figure!

But I don’t know why you came, what you hope to find, and if you’re finding what you were looking for. So don’t be shy! I want each of you to let me know you are out there, to tell me what you need from this sight. And let me know what you like best and what keeps you coming back. Please?

You already know a bit about me—my style, my philosophy about eating, my non-diet approach to eating well. You know by now I love the outdoors (perhaps because I was raised in the city), being active, and challenging myself. I do not have an eating disorder, though I have experienced disordered eating when in my teens and twenties. I do have MS, which I see as a great excuse for soaking up every bit that life has to offer, and not waiting until it is too late. And I love to travel and look for every excuse to do so. And to explore the cuisine.

So I challenge you to post a comment on this and other upcoming pages. Please don’t be a stranger! And let me know your thoughts about the blog content.

I don’t hope to get famous doing this or to make money. But I do intend to change people’s lives, one post at a time. Not too much to ask, is it?

Wednesday, September 15, 2010

The 4-Minute Nurture Diet

I’m riding the spin bike, alone, at the gym, in the spin room, and this song comes on my ipod. And it happens. Again. I get choked up, fighting tears. And I feel the need to share this song with you, not to make you cry, but because of its value. Ok, I’ll say no more. First listen, give yourself the 4 minutes. Here’s the link. Then read the lyrics below.
Lyrics by Noa


It’s 3:15
You have one minute.

Are you ready? 
Now think of all things created
Think of those that you care for
Think of what you've been blessed with
And everything that makes you afraid

Wish for anything
Let yourself dream
Wish for things to get better
Until 3:16

There's a stone in my garden that keeps me committed
And close to the ground when I feel I should run
There's a branch in my window that helps me remember
To reach out my arms and touch the sun..

There are two million ants that live in my sidewalk
Working together to nurture and feed
And the old TV set, with the sad evening news
So I never forget how much love we need

Home-made religion
(In my kitchen)
Home-made religion..

Think of how you've been feeling
And how you've made others feel
Think of what you've been given
And what you need to heal

Wish for anything..
Try to keep still
Wish for things to get better
And maybe they will

There’s a plant in the corner that helps me remember
All of the beauty that grows from a seed
And the old TV set, with the sad evening news
So I never forget how much love we need

Home-made religion
(In my kitchen)
Home-made religion..


It’s hard for me to clarify just why this song make such an impression on me. In just 4 minutes it says so much about how we can shift our perspective, which I think can be enormously helpful for any of us struggling—with eating issues and disorders, with losses, with chronic diseases. Directing us to take a moment, one minute literally, to ask for what we need. How often do we even give ourselves that? The time and space to think about our own needs? And concerns? To acknowledge our fears, instead of burying them with food? To confront our challenges, yet to remind ourselves of the positives around us?

I often direct my patients to start this ritual. Before bed, perhaps while brushing your teeth, identify 2 or 3 positives, things you truly feel good about. Simple, no? And yet most of us go through our days without ever acknowledging these things. 

We are skilled at identifying our failings, where we fell short. Someone will come into my office and I’ll ask about her week and she’ll tell me in great detail how badly Saturday night went, regarding her eating. “And the rest of the week?” I’ll inquire. “Oh, I did fine, really well, in fact” But had I not asked, I would only hear her skewed perspective about her shortcomings, about Saturday’s slips.

As to why this hits such an emotional spot for me? I think she really gets it. Noa, the singer, that is. And it speaks to what I do unknowingly, what keeps me focused and grounded. We all live with uncertainty, never knowing what tomorrow will bring. But some of us are more aware of that than others.

One year ago, Michael came to see me, newly diagnosed with Type 2 diabetes, in poor control. The most lovely guy, and highly driven, within weeks his sugars were in great control. But on October 29, 2009 our last visit, he told me that the previous week he was diagnosed with pancreatic cancer. Just yesterday, one year later, I spoke with him, now weak and limited to his bed. Feeling sorry for himself? Not a bit. He shared the value of our working together and told me proudly that he has continued to keep his blood sugars in good control! Imagine that perspective.

As for me, I am more fortunate. Diagnosed with multiple sclerosis (MS) 8 years ago I lead a normal life biking, hiking, enjoying good food. I am always aware that I can’t control the future. But I could do my part to control my outlook. And I take Noa’s words to heart, and think about what I have, what I need, and how to get it. Because we never know what tomorrow will bring.

How have you shifted your perspective and looked at things differently, to improve things? Has it improved your relationship with food? Have you been able to focus on your achievements, or is that an area you continue to work on? Please share your stories! Looking forward to hearing from you.

Monday, September 13, 2010

Food Finds: Cereals, Hot and Cold

I'm overwhelmed. As I move down the cereal aisle, hovering around the oatmeals I feel paralyzed. Where do I begin to decode the hidden information on these packages?  How can I guide you to navigate  the absurd abundance of food choices, in this single section of the cereal aisle, as well as in the many sections throughout the market?  There's the lower sugar, the high fiber, the weight control--the choices are endless. And if you read my NuVal blog entry you know I am not a believer in the "oversimplify" method, providing a single score or value to a product.

So here are the facts. If you are lured to oatmeal for its fiber content, motivated to help with constipation, forget it. Wrong type of fiber to help move things along. For that, try All-Bran Bran Buds, high in insoluble fiber, from wheat bran. It contains an unusually high amount per serving, and it tastes good. Only 1/3 cup and you get 13 grams of total fiber, 10 grams insoluble. The other 3 grams come from psyllium and oats, sources of soluble fiber. This is the type that helps lower cholesterol (if you are able to take in 7-13 grams of it per day) and helps slow the rise in blood sugar (really only an issue for those with diabetes, not for the rest of you). No need for a whole bowl of Bran Buds, either. Try mixing cereals or add some Bran Buds as a crunchy topping to yogurt.

Ok, back to the oatmeal. If you have time on your hands, about 30 minutes, my favorite is steel cut oats. For Americans, this cereal will look quite different than the Quaker you are used to. Think whole grain rice or barley cut with a sharp knife, then cooked. It has a chewy texture and is quite satisfying. A quick version could be prepared as follows:

Soak the oats overnight. Before going to bed, boil four cups of water in a pot, add one cup of oatmeal. Simmer 1 minute. Cover pot and store overnight in refrigerator. The next morning cook the oatmeal on low heat for 9 – 12 minutes, stirring occasionally.

But beware of the serving sizes! On McCann's Irish oats, the steel cut type, 1/4 cup dry makes the equivalent of one serving, as compared to most cereal labels. For Quaker oats, AKA rolled oats, the package can be misleading regarding serving size. The heart symbol portion may seem like a wise choice, but for most of us, this portion would be excessively filling. Both varieties are healthy and tasty options, with zero sodium. Add a bit of brown sugar (or not, if you are diabetic and closely counting the carbs) and cinnamon for additional flavor. Dried fruit added during cooking is also a nice treat (dried cherries are my personal favorite). For either type of oats, you can cook multiple portions in advance and refrigerate, then microwave reheat. Or, you can have the convenience of microwaving the rolled oats. Just be sure to place in an extra large bowl and cover with plastic or a volcano will erupt in the microwave! Really! And if you must do the packages, you can mix and match, one plain and one flavored pack. With the exception of young kids, I don't know anyone who only needs one package.

Another hot cereal that ranks is Bob's Red Mill varieties--the 5, 7, and 10 grain versions (I think I've got that right). Grainier texture, it's a very satisfying hot cereal which, like most things, tastes even better with a bit of sweetener (and in this case, a splash of milk).

Given the cool temperatures these mornings, I should stop here. But cold cereals do give us a lot of options and are so convenient. So here are a few word about my favorites:

-Kashi Heart to Heart. Cheerios-like, but tastes sweeter, without them adding more sugar. Hmmm. I suspect they manage it by reducing the sodium, which is at a lower level than Cheerios. And you must try the warm cinnamon variety! Yum.

-Kashi Cinnamon Harvest. Think Shredded Wheat with flavor, but less sugar than frosted varieties. Quite good!

-Barbara's Shredded Spoonfuls. Bad name, I must admit, because it makes us think shredded wheat, which will turn lots of you away. But trust me--it's delicious and nothing like Shredded Wheat.
These three choices are modest in fiber (about 4-6 grams) and overall tasty, yet healthy options.

-Barbara's Puffins. A particularly good choice for kids, and several versions are gluten free.

-Nature's Path Flax Plus Flakes. More fiber (the constipation-curing type) in a simple flake. And stands up to milk better than regular bran flakes.

So start with these. And tell me what you think. Are there others that are your favorites that might be worth mentioning? There are plenty of others I didn't mention, but could have, if I had the time and the space on this page.

As a final note, I must confess. I was raised on Captain Crunch and Fruit Loops, and Tony the Tiger I thought was GRREAT! 

Wednesday, September 8, 2010

Ice cream for dinner. Just go with it.

Being flexible when things just don't go as planned.

There are three objectives to my annual pilgrimage to Tiverton, Rhode Island: indulging in the amazing bakery and ice cream shops, hitting a favorite, funky clothing store, and taking in the beautiful surroundings by bicycle. The terrain is bucolic, perfect for riding with its gentle rolling hills lined with farms and old stone walls, classic and unpretentious New England homes and stunning views of the ocean. The clothing store, Abigail and Marigolds, never disappoints (except for my husband who patiently waits in the “husband chair” as I try on and ultimately purchase more comfy, fun and colorful garments).

We arrived just in time for lunch—what a coincidence—and headed right for Provender, the bakery café. We were sensible enough to share a sandwich, leaving room for what we really came for—the baked goods. We split a carrot cake cupcake (quite small, I might add, except for the mound of cream cheese frosting), a chocolate orange cookie and one oatmeal raisin. Then off for the ride! We covered a good number of miles over the crisp fall-like late afternoon before returning to our parking spot. Yes, we were conveniently parked near Gray’s ice cream, an establishment known to us for their exceptional homemade quality ice cream.

But it was dinner, real food we were seeking, and so we sought out a fish restaurant that was recommended. Twenty minutes later we arrived back at Gray’s. The restaurant was closed on Sundays, and it was already getting late and we were now quite hungry and ready desperate for some fuel.

What’s a girl to do? Stuck with ice cream. So I attempted to order a “kiddie” size, typically a small, ½ cup size intentionally omitted from the menu so that you’ll spend more money for a larger portion. But to no avail. No kiddie size possible. Sure, I could have said “then just a very small scoop, please” but no, I just couldn’t bring myself to, not at $3.50 for a small. And so I order a “single scoop”, the small (coffee chip, I might add). And it was good. Delicious, in fact. But enormous. What was supposed to be a single scoop had to be about 1 ½ or 2 cups of rich, premium, high fat ice cream. And yes, I finished every creamy bit.

At that point, fantasies of fish fillet were put on the back burner. I had no interested in dinner now, as my hunger was well taken care of. But an hour and a half later I felt like I needed a little something. So I made a light dinner, a salad with a bit of feta and croutons and felt quite satisfied.

What can you take from my Tiverton experience? Certainly, that it's a lovely place to visit. But also that sometimes we need to just go with the flow. Food wise, things didn't quite go as I had planned. Ice cream for dinner? Much as I love ice cream, it wasn't what I had in mind. But feeling quite satiated after a portion that exceeded my needs, the best thing was to wait until I was hungry and delay dinner. And if needed, eat a light dinner. But not because I had consumed too many calories and I had decided that I needed to reduce my intake. But because quite frankly, I didn't need any more food at that time. And pushing to eat what you believe you should eat--whether to satisfy other people's needs, or to get in some protein or other nutrients you believe you need at a meal after consuming more than you needed, is a mistake.

The other point I hope you'll take from this is that there's a place for baked goods. And ice cream. Not only when you are active, but even when that's what you are yearning for, simply because it tastes good. And eaten in reasonable amounts that fit with your need, it is 100% appropriate!
Now one disclaimer-I don't recommend daily, large portions of premium ice cream and baked goods particularly if you care about disease prevention, like keeping cholesterol levels in range. But is there a place for these items in the context of a healthy balance diet? Absolutely.

Monday, September 6, 2010

Start Cooking! Moroccan Chicken With Chickpeas

The first must have ingredient is plastic. Whether you plan to cook to eat healthier and better quality food, or for the convenience of coming home and having dinner ready, or simply to save some money, you’ll need to get yourself some plastic. Containers, that is. Cooking for one? It takes as much effort to make four dinners as it does one, so you may as well make multiples and store them. Cooking for two or more? Consider doubling the recipes posted and freeze in meal size batches.
It’s a strange time. Most teens and twenty and thirty something’s simply don’t know how to cook. Many were raised in homes where there simply wasn’t much cooking. That is, if you don’t consider microwaving frozen pizza or chicken nuggets as cooking. Others had the convenience of fast food and family restaurants at their doorstep, with little time to invest in shopping and cooking. Want to start a great business? Open a “teach the newlyweds to cook” center. It’s the perfect wedding gift, if the couple cares to wait that long!

I spend a lot of my time directing patients on how to get healthy, great tasting, balanced meals on the table. And I finally compiled a list of these menu ideas that met the criteria when my son moved into an apartment when studying abroad, ready to start cooking on his own for the first time.
The recipes and cooking tips are not designed for people with special dietary needs, yet all the recipes can be easily modified to accommodate your particular nutrition requirements. I know that many of you won’t approach a recipe unless you have clear instructions and know exactly what and how much is in it. So I have attempted to measure things as I’ve made them, and even photographed the process, since many of you may be more visual learners.

Please give me feedback! How was the recipe? How did it taste? Was it challenging or manageable? And do you like having this feature on the blog?

Thanks, and bon appétit!

Morrocan Chicken with Chickpeas

(Serves 5-6)*
Ingredients (in order of appearance):

Oil, canola, vegetable or olive, approx. 2-3 Tbsps. (just enough to help saute the onions)
Onion, 2 medium
Boneless chicken breast, 1.5 lbs.
Cumin, 2 Tbsps.
Cinnamon, 1 Tbsp., optional
Chickpeas, 2 cans, rinsed
Raisins, 1/2 cup
Prunes and/or dried cherries, 1/2 cup total
Frozen orange juice, 1/3 to 1/2 cup
Water (1 - 1.5 cups, depending on amount of OJ used)
Salt, to taste

What You'll Need:
Approximately 15 minutes of prep time
Approximately 50 mins or hanging around time while the food is cooking
A large skillet with sides
A sharp knife

So here goes!

1) Chop or slice the onion (take the skin off first, of course!). It doesn't matter the size of the pieces. Put the onion aside for a minute.

2) Cut up the chicken in largish bite size pieces. Trim off any fat or undesirable things.

3) Heat the pan with the oil--medium temperature should work. When it appears hot (you'll see some lines in the oil).

4) Add the onion, cooking until translucent (it looks like cooked, not raw onion, and it is not yet browned.) Should take a few minutes.

5) Add the chicken spreading it around the pan. Let it start to cook before trying to mix it (or it will stick). Then stir it to more evenly cook it. But don't worry about cooking it completely. You are just partially cooking it now, then simmering it in the pan after.

6) Sprinkle the cumin and cinnamon. Then mix.

7) Add chick peas, dried fruit and orange juice concentrate. Add the water and mix. Cover and simmer at a low to medium temperature. Cook for about 50 minutes.

8) Stir occasionally. Add salt to taste.

Yum! I love this served on Israeli couscous (takes only 10 minutes and adds great texture) along with a green vegetable. Leftovers freeze well. Please share your thoughts on the taste and the process. Was it manageable? Is this your first time cooking?

*For those of you using a meal plan--portioned to serve 6, this will count as 4 protein servings, 1 fat, 2 fruit and one grain.

Saturday, September 4, 2010

Erin hit 300 pounds Wednesday. And was she happy?

Ecstatic! She hit the 300lb. mark for the first time in more than two decades, and she was delighted. Her total weight loss came to 91 ¼ pounds since we started our work together. How did she do it, you ask?

Well, I could give you that simplistic response that many medical experts reply—“she just took in fewer calories than she was burning”. Oh, that answers it! That’s a statement of the obvious. But how did she really do it? I mean she presented to my office at almost 400 lbs. and at 5 ft. 1inch that’s a lot of extra weight to carry around.

First, she ignored her doctor. That is, when her doctor repeatedly hounded her that she should resolve her weight problem by getting gastric bypass or lap band surgery. Doctors love to recommend these treatments. Faced with a patient like Erin they are likely feeling quite useless and ineffective. No quick and easy solutions, as in “take these antibiotics and the infection will be gone in 48 hours.” They seem to see surgery as a quick fix, failing to see the challenges that patients face even afterward. No, bypass surgery doesn’t cure the problem, although it does help get some weight off in the very overweight and can improve some medical conditions including diabetes and hypertension. And for certain individuals it is something I would and do support.

But patients are left without the skills to manage their feelings and thoughts contributing to their pattern of overeating. That part doesn’t simply get rebooted or surgically removed. If you’ve always relied on food to self-sooth, to comfort, to numb out or simply to enjoy—to excess, you’ll continue to struggle with the very same issues, even after bypass surgery. And you’ll learn to work the system, so to speak. You’ll find ways to get your food “needs” met, with or without feeling ill—perhaps with milkshakes or other liquids spread throughout the day, perhaps enduring the “dumping syndrome” resulting in diarrhea, that follows.

Confronted with a problem that is complex and requires much time and patience, the wise doctors refer to me and others with my experience. And that’s how I came to meet Erin.
Erin could write a book on losing weight. She had been on all the conventional diets—the Weight Watchers, Jenny Craig, Diet Center types. And she had done the less conventional treatments as well, including the physician supervised protein sparing modified fast, under the direction of a leading obesity researcher at a Harvard teaching hospital. She had even attempted a more holistic approach at the highly regarded Mind Body Institute in the Boston area. These strategies were not without success. Erin would lose some weight, learn some skills, but fail to sustain the changes. Until now.
How do I know that this time is different? Because it’s been 19 years. No, she hadn’t seen me continuously for 19 years. Erin first came to see me in 1991 and has worked with me over long intervals, returning periodically as needed. And, it’s different this time because Erin has made some major changes that she hadn’t made in the past.

Like cooking. And shopping. As Erin found out, liquid diets and frozen meal plans are effective for weight loss. That is, if you’re looking for short-term weight loss. 

But nobody sticks to protein shakes or prepackaged food long term. Who can? Even if you love the taste, they don’t allow for living a normal life, for living in the real world. So what do you do when you are invited to someone’s home to eat? Or want to be social and eat out? Or take part in a celebration? Or not feel deprived? Ultimately, you have to learn to prepare foods, even if, like Erin, you didn’t even know how to boil rice. Or had never had a vegetable other than potato. And even if it’s “just you” at home.

So we started small. And basic. But Erin increased her confidence in cooking. Slowly. And she dramatically expanded the variety of foods she purchases and consumes. She now looks at her shopping cart with amazement. From asparagus, peppers, and broccoli slaw salads to brown rice and chicken soup ingredients. Her shopping cart does not look like what you might assume you’d see a 300-pound woman purchasing!

But Erin has not been without setbacks. Imagine experiencing this one. She has just gone shopping, at Trader Joe’s in fact, and has loaded the groceries in her car. She is now quite hungry, as things took longer than expected while she was out. Erin takes my recommendations to heart. So she realizes that the best thing to do is to honor her hunger, to have a snack to tide her over until she could get back home for lunch. She rummages through her paper bags and pulls out an individually portioned snack. And then proceeds to eat it, mindfully, while parked, in the Trader Joe’s parking lot in Hanover, Massachusetts. Until a woman approaches her car. Yes, a total stranger comes up to Erin's car and starts to lay into her about her eating. “Should you be eating that?” she demands. “You should really watch what you eat at your weight, it’s not good for your health”, she continues.

Could you even imagine how Erin felt? I was in tears listening to the abuse she endured, feeling the shame she experienced. And here she was doing all the right things—listening to her needs, her hunger, making wise choices (no, she didn’t manage her hunger at the drive through), eating mindfully, versus driving and eating as she had done so many times before. And yet in spite of all the good she was doing for herself some arrogant, unenlightened soul had the nerve to open her mouth and utter what she did. So yes, Erin had a slip that week.

But she also had a recovery. Her binge didn’t last as long as it had in the past and she was able to get back on her feet sooner than she had in the past. She didn’t get into the all or nothing thinking about her eating, thinking that she ruined it and may as well keep going. And she didn’t bury her feelings in her food late at night. Rather, she came in to talk about them in sessions with me and with her therapist. And as a result, the damage was kept to a minimum.

The struggle is far from over, and Erin has lots more weight to lose. Her latest goal? She wants to lose 8 ¾ pounds. Yes, just 8 ¾ pounds to bring her total weight loss to 100 pounds. That’s her short-term goal. Yes, Erin has learned something else through all this. She has learned to set realistic goals, goals she can achieve and maintain. And with her new pedometer, she plans to increase her activity one step at time.

Yes, Erin is thrilled to have hit 300!