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Saturday, October 29, 2011

Setting the Record Straight. Shifting Your Perspective Toward Recording.

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


8:30-9:00

Bread and jam, 2 slices
Freshly juiced red grape and berry juice, ~8 oz.
Coffee with whole milk
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Vanilla yogurt with fresh peaches
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Semolina cake with plum topping
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1 fried egg
Bread and jam

12:30 PM
Medium gelato,

~2:00 PM

Wine samples and bread sticks

3:30 PM

½ a thick cheese and tomato sandwich, on white Italian bread
½ a thick pesto and roasted veggie sandwich, same bread
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Wine tasting, approximately 6 oz, and a few bread sticks

7:45 PM

Cheese samples, approximately 1-2 oz.

8:00 PM

Bread, 2 slices
Large vegetable salad (enough for 2 or 3 people) with olive oil and vinegar
Wine, approximately 5 oz.
Gnocchi and sauce

~9:30 PM
A couple of cheese bites from around the world.


Nectarine with hazelnut chocolate sauce--day two's breakfast!
So what did you think? And have you figured it out yet? The she is me, and you are seeing an entire day of my eating while vacationing in Italy, unadulterated.

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

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

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

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

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

The egg course--day 2!
More about record keeping in a bit. But first, I want to say a few words about this day's eating, a real day last month in Tuscany.

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

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

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

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

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

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



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


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

Dinner reservations were secured for 8 PM, so we decided to start our cheese tasting before the meal. As for dinner? There was nothing I yearned for more than vegetables! After the preceding week in Switzerland where I ate much less of them than I am accustomed to, I was thrilled to find a large salad as a starter to the meal. It was truly the best part of this meal for me. Then I ate a portion of the gnocchi— although I found them a bit too rich—but had enough room for some more varieties of cheese bites, as we strolled around the lovely town of Bra late night. And did I mention these cheese samples were not low fat?
Bra during the cheese festival 
By the way, my activity for the day was largely eating and wine tasting. There was minimal walking around some quaint medieval towns, but this was not a high output day, by any means. No biking and drinking for me.

What can you take from this?

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

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

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

Client: Nutritionally, this day was way too high in saturated fat, as well as in alcohol calories.
Me: This is quite atypical for your eating. You rarely graze on cheese with such frequency, and you never drink in the afternoon, never mind multiple times in one day. Given the frequency of this type of eating, then, nothing to worry about.

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

Client: I shouldn't have had the gelato; I should have chosen something healthier.
Me: No, you chose what you felt like eating, and that's appropriate.  And you had as much as you needed. You started to share when you were feeling you had had enough. Perhaps the small gelato dish might have done the trick. Maybe next time you’ll try the small. (Wow, a next time? What a thought!) You never do know how much will be enough, until you explore the options and learn to titrate.

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

Client: I should have limited my dessert to once a week, not twice a day!
Me: Once you set arbitrary limits on your "indulgences" you'll set yourself up for trouble. If cake can only be eaten on birthdays or special occasions, you will certainly find yourself eating more of it on the one and only day you allow yourself to have it. If you are only allowed to eat before 8 PM, you'll find yourself eating a lot more before the time is up. Ultimately, these rules fail you.

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

Benefits of Recording

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

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

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

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

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

What Should I Include When Recording?

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

Don't go by this clock, though!
·         The time you ate
o   This helps you see your eating pattern and understand why you ate as you did. Too long between eating? That will lead to trouble. Eating every hour? Is there something other than hunger driving your eating?
·         Your hunger rating
o   I’ve come to like the scale 1-7 best, with 1 meaning starving and 7 meaning stuffed. But use whatever works best for you, including word descriptions.
·         Your thoughts and feelings
o   This helps you see your obstacles to eating, and to then work with strategies such as CBT (cognitive behavioral therapy) to change them. Food rules and misinformation may come to light, best addressed with your nutritionist.
·         The location food was consumed
o   Does the location support mindless eating? Are you eating in bed for comfort? Would you sleep on your kitchen table?
·         Any other diversions while eating?
o   Distracted eating is mindless eating. For those trying to get their needs met and not know it, this can be useful initially. But ultimately, we all want to be in control of our eating and our weight regulation. So try to separate eating from distractions.

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

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

6 comments:

  1. Great post.

    I have kept a food diary off and on for ten years, while struggling with issues like obesity, binge eating disorder, and general messed up thinking about food and weight. I rely on my food diary very heavily. Generally the times when I have been faithful about recording are the times when I have been moving in a healthy direction. My food diary provides me with objective information, and if I use it properly I can counteract any unhealthy tendencies. For example, I have a tendency to binge in response to eating something "bad" that I didn't plan for. But if I look at my food diary I can see that my "bad" episode is not really that major and anyway I have generally been doing so well lately. Don't freak out. I also make use of the times I record, trying not to go longer than 3-4 hours without eating. I also check whether I binge or overeat in response to not eating enough protein. I also check that I am eating enough food period, in order to not binge/overeat out of excessive hunger.

    Any chance of another post with more detail on how to get the best use out of the information collected in the food diary? My nutritionist is great when it comes to nutrients and stuff, not so great when it comes to emotional/psychological factors.

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  2. I haven't found keeping a food diary helpful so far. I find I use it the wrong way. But I am getting to a point where I could see the value in it as an objective measure of where things are going well or not-so-well. But I still don't trust myself enough yet.

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  3. I have to keep a food diary everyday for my dietitian and therpist to look over each session at the ED Clinic. I have had to do this for them since day one there.

    I record the food and portion size, the time, whether I BP or used lax, and my feelings about the meal, choices and thoughts whilst and after eating. And NOT writing the calorific values down EVER

    At first I was going crazy obbsessed with it and not being fully honest with my team because I was not writing down the calories on my 'official' diary, but I was keeping a sepertate note book of my food intake, and writing down the EXACT calories in there. Until my ttherapist and dietician both pointed out that this was Ana's book, its her fail safe way of hooking me in aand allowing my to fall back to the lowest calorie meals in an instant, mindlessly. The day I binned those diaries, I moved a little further from making ED led choices at meal times.

    My food diaries are changing shape again from yesterday though. I am now working from a meal plan set weekly, so my food diary, if I have had a successful week will reflect my plan, so it is more of direct comparison from which I can discuses with my dietician as to whether I have had a good or bad week regarding intake and restoration.

    It also means to 'feelings' part and be more 'i chouldn't choose, so i had the smaller portion or the salad' and I'll be able to talk about the way 'Ana' felt or how good Sarah felt.

    I do find problems in the obsession with writing EVERYTHING down, and it does make me less able to 'pick' at foods work out where they 'fit' in my plan or diary - this is something that is a massive issue for me - grazing - so as time goes on and I move towards intuitive eating, I am hoping the structure of my plans and diaries loosens!

    I wrote about the meal plan introduction on my blog yesterday too http://dream-recover-live.blogspot.com

    Thanks for a great post.

    Sarah.

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  4. by -grazing - I mean my absolute hatred to doing it and avoidance of 'picking' at foods etc. which means that I have (for years) restricted food if it's not at 'meal' - So i need to relax about this and my food diaries need to reflect this, so I see relaxing about writing certain things down equals positive steps.

    Hope that makes sense?

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  5. Lori, I just came across your blog yesterday while searching for answers. I have struggled with overexercise and undereating for decades, and though I am much better now than I was as a teenager I still harbor many of my old habits. Your blog gives me just the right words and perspective on what is really important- loving life, loving myself, and not spending the rest of my days obsessing over my body. The travel writing especially has been a joy to read because you are having invaluable experiences involving food and culture that people like me might find too scary to ever try. Thank you...I will look forward to all of your posts.

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  6. @ Anonymous: SO glad you found me, and that the site provides some inspiration!

    In response to the other insightful reflections: Yes, the use of the food record evolves. Sometimes it helps us feel reassured and safe, sometimes it may allow up to maintain disordered or compulsive tendencies. Even recognizing this is helpful. At the minimum, it helps hold you accountable and is useful to the RD whom you might be working with (which ultimately helps you, of course).

    If you struggle to get yourself to record, consider taking on only one aspect--such as just the hunger rating or thoughts and feelings, leaving the concrete food list out of it.

    ReplyDelete