Thursday, April 28, 2011

Eating a Vegetarian Diet. Not As Healthy As You May Believe.

You hear vegetarian and what comes to mind? A nutritious, disease preventing, high fiber diet? Wholesome meals full of whole grains, nuts and seeds, fruits and vegetables, chock full of vitamins and minerals? Slim and fit individuals living a healthy lifestyle, carefully meeting their nutritional needs?

If only it were so! Perhaps in its ideal form this diet is filled with all the protein, healthy fats and unprocessed carbohydrate you might need to stay healthy. It also provides a full range of antioxidants, including flavonoids, found in color-rich fruits and vegetables, as well as in nuts. These compounds are linked with prevention of many cancers, heart disease and aging related conditions. And if you include three low fat dairy servings per day, the model vegetarian diet satisfies the DASH diet for hypertension. This fruit and vegetable filled diet, together with the mineral-rich low fat dairy has been shown in studies to significantly improve blood pressure as effectively as medication.

But in practice, that’s just not how it is. Twenty-five years of counseling clients has shown me how real people live as vegetarians. And it’s not pretty. Here’s a look at what really happens to many vegetarians. Check out these pitfalls to healthy vegetarianism to be sure to avoid.

Vegetarians may set too many unnecessary rules.

Instead of eating the healthy diet described above, they may limit their fats, failing to meet their needs for essential fatty acids. Reduced fat soy milk or lower fat avocado—are they really necessary? Why choose such items?
Being fat phobic, they may omit valuable food sources such as nuts and nut butters, such as peanut butter and almond butter, eggs and even avocado. As a result of this extra layer of rules, it may be challenging to maintain their weight in a healthy range. With their limited selection, they also exclude valuable sources of protein-rich foods.
These vegetarians typically are not yet diagnosable as eating disordered. For them, vegetarianism is simply another way to limit their intake in a socially acceptable way. Vegetarianism is healthy, right?

They have no interest in exploring unfamiliar vegetarian food choices.

And so they limit their intake to vegetarian meals such as pasta, grilled cheese, and pizza, for instance. Now don’t get me wrong. There’s no problem with including these foods, as part of a balanced diet. But vegetarian choices tend to be limited, particularly when eating out. And if you don’t include much variety, the calorie density of your diet can become quite high. This becomes more exaggerated when you don’t care for many fruits and vegetables. And so your entrĂ©e portion needs to be larger to feel satisfied. Typically, these individuals end up gaining weight unexpectedly, in spite of their good intentions to eat a “healthy” vegetarian diet. As a result, they are left with a less than balanced diet and are struggling with their weight.

They are cooking challenged or have little time for food preparation.

As a result, they rely on mostly processed foods, generally quite high in sodium. Take a look at the labels on the canned beans or refried beans. Explore the sodium levels of the many soy-based and Quorn brand processed vegetarian products. To achieve the equivalent of three ounces of animal protein (a deck of cards size), you’d consume approximately 1200 mgs of sodium, from this single protein alternative, in a reasonable portion. If you are choosing vegetarianism for the prevention of heart disease, you may want to rethink this choice. If you have high blood pressure, the current recommendation is for a total of 1500 mgs. per day! You’d be better off allowing for lean protein sources such as white meat poultry, or fish, for the pescetarians.

If your nutrient needs are high (if you are still growing, quite active, very tall, pregnant or nursing, or underweight), vegetarianism can be challenging.  

A healthy vegetarian diet, high in whole grains, fruits, vegetables and legumes is high volume, high fiber with low caloric-density. As a result, it can be very filling. If you are someone with a high calorie requirement (like those described above), it takes more effort to meet your needs, while still feeling physically comfortable. It is certainly achievable, but requires a higher intake of fats and a bit more planning. Otherwise, you’ll frequently feel full and have a difficult time consuming all that your body requires.

Oh no! My daughter has decided to become a vegetarian!

Mrs. Katz called me earlier this week, seemingly alarmed, given the tone of her voice on the phone. She just discovered that her daughter has been limiting her eating to vegetarian choices for the past 3 weeks. Rebecca was well known to me from more than a year of regular visits for her eating disorder. Last time I saw her, 6 weeks ago, she had been doing great. She had been maintaining her weight in a health range, without symptoms, and appeared quite relaxed and comfortable about the changes she had made. She was allowing herself a full range of foods, including items formally considered junk foods. And she achieved all this while competing on her high school swim team. For many, many, months now, I could say she had fully recovered.

Mrs. Katz had good reason to contact me. News of her daughter’s becoming vegetarian needed to be explored, to ensure it was not a slip into more eating disordered thinking and behavior.

When I met with Rebecca today, here’s what I concluded. That Mrs. Katz has no need for concern. That while a vegetarian diet could red flag unnecessary dietary restriction, for Rebecca I felt assured that limiting her intake was not the goal (or likely to result from her new found vegetarian identity). Yes, she would have to be mindful to maximize her iron intake, as well as her protein, calcium and Vitamin D, nutrients which often fall short when eating vegetarian. Not being a vegan, B12 deficiency was not going to be an issue. She was eating a varied diet providing enough calories to adequately fuel her body. And her weight continued to be maintained in a healthy range for her height. So it was easy to reassure Mrs. Katz.

Just because some vegetarians may be restrictive eaters, that’s not to say that you can’t be a healthy vegetarian and successfully meet your nutritional needs.

If you’re motivated to be a healthy vegetarian consider the following:
  •     A balanced vegetarian diet requires planning. Actually, you can say the same thing for balanced eating of any type. But it is easier to throw a steak on the grill than to cook rice and dry beans.
  •     Take advantage of vegetarian resources. Explore the many vegetarian cookbooks and websites for easy, delicious recipes. (Check out some of my favorites on this blog—lentil stew, lentil soup, vegetarian chili and corn bread, granola to name a few. As for cookbooks, my old favorites are Mollie Katzen’s updated Moosewood and The Enchanted Broccoli Forest, as well as the Vegetarian Epicure by Anna Thomas.
  •     Eating out? Consider Indian resturants, and other Asian cuisines (offering tofu based vegetable filled dishes), which typically offer a large selection of vegetarian options.
  •     Cook soups, stews, and casseroles and freeze them in small batches to provide quick and convenient vegetarian meals.

Being vegetarian clearly has its merits. It makes us more mindful of where our food comes from and its impact on the environment. (For true enlightenment, check out the movie Food, Inc. with Michael Pollan or his books including The Omnivore’s Dilemma). But choosing vegetarianism means not just being morally responsible. It requires being responsible for meeting your body’s needs. And that is equally important.

Do you have a favorite vegetarian cookbook or website? Have a thought to share on this post as a vegetarian or a soon-to-be vegetarian? Please share! I’d love to hear from you.

Thursday, April 21, 2011

Spring Cleaning for Your Thoughts. Ridding Yourself of Diets and Disorder.

I’ve never been a compulsive cleaner, and I know better than to say I wish I were. Many of my patients past and present struggle with this urge, which is not particularly pleasant. But I do tend to get into a bit of extra cleaning in this season.

In preparation for the Passover festival, those who observe are obligated to do some serious physical cleaning, throughout the house, and even of the car. The goal? To get rid of the residual leavening—you know, the crumbs—from eating while driving, eating in your bedroom and TV room, as well as the kitchen. Even if you appropriately and mindfully eat solely in the kitchen, no corner is to be left uncleaned, in this Passover preparation. Even closets, if they might contain some food remnants, and blankets, need to be dealt with.

But the deeper meaning of this preparation comes as I am mindlessly vacuuming out my minivan, a task last completed a full year ago. It’s a mess, and I must say I actually looked forward to this cleaning like I look forward to my daily Matzo Brai, a kind of French toast equivalent made with matzo. There’s something so pleasing about making things happen. You vacuum, and things look and feel better—immediately. Ah, if only changing our behaviors were this easy!

But what struck me most is the feeling as I tossed out the old wrappers and coffee cups, the used tissues and pre-GPS printed directions scattered on the dirty car mats. It felt good to get rid of things, useless things. Clearing out my physical trash and cleaning house, so to speak, somehow orients me, grounds me. Sound weird? Perhaps. But there have been plenty of studies about how our physical environment influences how we feel, and vice versa. It’s a scary thought, if you saw the inside of my van!

So I got to thinking about clearing out the internal crap. What chametz, or undesirable leaven, do I need to vacuum out of me? The answer isn’t a quick one. But I’ve decided to start with adding a filter, a cheese cloth of sorts. I’m working on more mindfully, and sensitively, letting out some of my less-than-thoughtful reactions to people and situations.

And what does this have to do with me, you ask? It seems that we would all benefit from examining which thoughts and beliefs we live by, or more specifically, eat by, and which are best sent on their way.

Do you hold on to crumbs of old diets, labeling foods good versus bad? Do you live by the clock, trying desperately to extend the interval to prevent eating until so many hours, all the while denying your hunger? Do you hold on to the crumbs of belief that you don’t deserve to eat well, to feel well, to indulge in foods you enjoy?
Regardless of religion, whether you follow one or not, we could all use a bit of spring cleaning, to sweep out the chametz. And to destroy those messages we replay that keep us stuck in unhealthy patterns.

Happy holidays to all.

Monday, April 18, 2011

A Slave to Diet Deprivation?

Pastry from French Memories, Sharon, MA

I just bought and ate a delicious Napoleon pastry—cream layered with flaky dough—and loved every bite. But was I hungry? No. Stressed? No. Mindlessly triggered by its appearance? No. I sought out a parking spot to purchase it at a favorite local French bakery and made a bee-line for the display, comforted that one remained. This was not the result of a fresh, enticing baked good on the kitchen counter luring me to eat it.

Being one to overanalyze things, I can tell you why I ate it. Deprivation. No, I’m not embarking on some weight loss diet (no need to panic) nor have I become diabetic, necessitating a controlled carb plan. This is anticipatory deprivation, knowing that I will soon be without the foods I love and cherish—if only for a week.

Just 8 more days!

Tonight starts the festival of Passover, which I observe. From a food perspective it is potentially a holiday of deprivation. That is, unless you are a lover of gluten-free style, bad-tasting baked goods. We give up a wide array of foods to help us remember, to feel as if we each personally experience that which our ancestors lived through as slaves in Egypt. Whether we believe the story as myth or historic truth, we follow these dietary rules quite rigidly.
We avoid anything leavened, for our hasty departure from Egypt left no time for our bread to rise. And so a week without is what follows. But it doesn’t stop here. There’s a very long list of foods to be avoided which includes most of my favorite starches—rice, pasta, legumes and of course, bread and most baked goods worth eating.

Friday I was food shopping and already feeling deprived. I found myself wanting to stock up, even hoard, the soon-to-be-forbidden starches. I recalled the many patients who reported binging the night before their first visit to the nutritionist’s office, fully expecting it would be their last supper, so to speak. And yes, they were pleasantly surprised by my message! And the many stories I hear from those who get anxious thinking about running out of food—not because of money—but because someone, perhaps even themselves, might restrict them from eating sometime soon. Trauma from a history of past diet experiences, perhaps. So now I really get it.

I do love these coconut macaroons! NOTHING like the canned ones in the market!

The remedy for my patients and for those of you still struggling with such deprivation is permission. Permission to eat whenever you need to, regardless of who you are with. Permission to eat whatever you feel like, in amounts appropriate for your body. Permission to eat any time you need to—yes, even at 11 pm, if you’re hungry.

Grandma Bea's sponge cake. Guaranteed to raise
your cholesterol level after only 8 days!
As for me? I had to remind myself of all that I love to eat that I can give myself permission to have. That includes the obvious fruits, vegetables, nuts, and all. And, my favorite baked goods, acceptable for Passover. So last night I baked 4 dozen coconut macaroons, 2 dozen almond ones, and a moist sponge cake. I packaged them up and removed them from the kitchen counter.

And I plan to enjoy them whenever I am hungry, to satisfy my need. On the positive side, at least I didn’t have to sacrifice use of my Kitchen Aid mixer and Cuisinart, although I don’t think the slaves had the benefit of these either.

Yummy almond macaroons.
Passover observant or not, these baked goods are delicious and so easy to prepare. The macaroons are high in sugar, but quite satisfying, requiring only a small dose to hit the spot. And perfect for those with celiac or others following a gluten-free diet.

If you are a follower and would like the recipe, please email me.

Friday, April 15, 2011

Over 30 or 40 and Struggling? You're Not Alone!

You carpool, cook and shop. You work at home without pay—childrearing, cleaning, managing the household—and perhaps at your job professionally. Universally bright, you are seemingly well-functioning to those who know you, at least superficially. Yet you’re ignorant about your own needs on so many levels. You’ve successfully gotten pregnant, and produced healthy children. Then proceed to ensure that everyone’s needs get met. That is, except your own. Most of you are in your 30’s, 40’s and 50’s. But some are still struggling into their 70’s. Yes, seventies.

You are my closest friends, from college and beyond, and my local acquaintances. You are my patients recently seeking care, and those struggling for a lifetime. And you are my blog followers from Australia to New Zealand.

And you have all managed to slip through the cracks for way too long, failing to get the help you so badly need, to acknowledge your eating struggle. You’ve successfully deceived family, denied concerns from friends, as well as the medical community, when they’ve had the occasional sense to ask.

In some ways, you are the riskiest ones. You see adult practitioners who are largely uneducated about eating disorders. And so they don’t know to ask the questions. And you certainly won’t volunteer the information. Instead, you get praised for your runner’s pulse and your low blood pressure, and for avoiding the middle age spread.
Usual signs of an eating disorder fall short in flagging you as at risk. Perimenopause or excessive exercise easily ”justify” a lack of menstruation. Low energy? Who wouldn’t be, with changes in sleep patterns associated with age. And besides, you function so well given the juggling that you do!

But let’s be real. We know each other too well. Please don’t minimize your disorder, attributing your eating issues simply to anxiety; selecting diet sodas and choosing a fat-free salad without the bread is a giveaway. And no, eating a breakfast or missing your exercise does not justify meal skipping.

Please don’t tell me it’s because you have a small frame, when you have never before maintained a size zero. And when XS-sized clothes slip off of you. No, there is nothing normal about being a zero.

Please don’t tell me “but I do eat!” when you know as well as I that it takes more than simply eating. Yes, it requires eating enough to support a healthy weight and a healthy body.

I’ve heard you say I’m just not hungry. And I know that’s honest and true. But you fill the voids with coffees and diet beverages. And with food restriction the hunger cues get lost. And so you really don’t feel hungry. And your anxiety, disordered thoughts and body image don’t make it any easier.

Please don’t suggest that you need your exercise to stay healthy and fit. You are only deceiving yourself. Physical activity supports health, but only when you fuel your body with adequate nourishment. Otherwise, you will slow your metabolic rate and suffer the many symptoms I’ve referred to above. And the very muscle you hope to build will be burned as fuel. It takes adequate calories from carbohydrate, protein and fat to fuel your body and maintain health.

Regardless of your absolute weight—even if it is in the normal range—if your thoughts and behaviors are disordered, there’s work to be done! You can be in the normal weight range or overweight while restricting and binging. That is no way to live.

And what impact is your eating having on those you care about, in particular, your children? Do you unintentionally, through your minimal food intake, convey what normal is? Do you role model denial using diet products or guzzling water when you are hungry, versus honoring your body’s cry for fuel? Do you send the message that food is the enemy? Do you set unrealistic goals for yourself as well as your children, suggesting avoidance of pleasurable foods, with lists of good versus bad foods to eat? Perhaps, simply passing on to another generation the very distorted messages you were raised on?

Loved ones read here

If you are a loved one wondering what the big fuss is, consider this. Restrictive eating consumes our thoughts and distorts our reality. It makes us irritable and contributes to depression and anxiety. It leads to social isolation, and contributes to losing one’s voice, so to speak. It’s numbing and protective, but impacts your loved one’s quality of life, and zaps her potential. It can lead to nutritional deficiencies, dehydration, muscle wasting, cardiac and renal issues. And ultimately, it can lead to death. And it impacts not only your loved one, but your children.

What do I do now?
It's not too late to change. I've seen it. It will be challenging, but it can be done. But don't put it off.

First, own it. Acknowledge that you are struggling with nourishing yourself.

Use your resources. Educate your spouse or significant other. Check out websites such as, and, as well as the many other online resources.

Enlighten your MD. She relies on you to share to appropriately guide you.

Seek out a therapist to help you understand why this pattern of eating and thinking is helping you meet some needs. Then learn alternative ways of coping to slowly let the eating disorder go.

See a Registered Dietitian experienced with eating disorders to help you reality check abut your needs compared to your perceptions. Get correct information to allay your fears of change, and the consequences of failing to do so. A good RD will let you work on baby steps, while ensuring you stay safe.

And if you are not yet in the age range I describe, consider the writing on the wall. Where do you want to be in five years? In ten? Please take this post as a wake up call for change.

Share this post with your supports. And pass it on to anyone you know who might benefit from this wake up call. Spread it on Twitter, Reddit, Facebook, Stumble upon or simply via email.

I do care what you have to say, so please leave a comment!

Friday, April 8, 2011

Lessons About Eating From the Big Apple Circus

Beyond popcorn and cotton candy.

Thanks, Ethan and Sherrie for tolerating my need to photograph!

Controlling popcorn portions? Canning the cotton candy? No, this post isn't going there. Rather, last Sunday's clowns, contortionists, jugglers and acrocrobats  at the Big Apple Circus unexpectedly provided great blog material. I had no plans to do a circus post. Really. But I did take my camera. 

Truly the greatest show on earth!

It raised smany valuable and truly essential lessons about eating and eating disorder recovery, I simply had to share. Yes, much more critical than guidance on high sugar, high salt snack control!

Sticking to your plan 100% versus being flexible depends on your situation.
I'm not into extremes. I'm sure you've guessed that by now. But if you're the trapezist or high wire act, there is no grey area. You've got to get it right, or else there are serious consequences. If the risk of a hospitalization is looming near, there's little wiggle room regarding staying on track. But if you're the juggler and you drop the cones or batons, life goes on, with less impact. The sooner you pick them up and move on, the less damage will be done. The longer you wallow in your disappointments, the harder it is to get your act together.

And after you slip, remember to pick your self up, with grace.  Slips happen!

And, you'll still get applause. Yes, even metaphorically, in real life.
The sooner you get back on track, the easier, both physically and psychologically. If you see your slip as an irreversible failure and give up, it becomes a self-fulfilling prophecy. The acrobat who repeatedly messed up throughout the first half was clearly losing faith in himself. And as a result, I had come to expect him to fail. But he started the second half with a restored confidence and was amazing. Believing in himself allowed him to turn things 180 degrees. And rather than dwelling on his slips, the audience praised him with the loudest applause at the end.

Be flexible, within your limits. 
Simply awesome!

If you are new to being flexible, don't start with a split! It may be enough of a struggle to take in all that you need to eat, even if you need to stick with only foods that feel safe. As long as you are medically safe, try one small change at a time. For some, flexibility comes more naturally, like for contortionists. Truthfully, no amount of practice and stretching will enable me to put my torso between my legs. But be patient. Learning to eat, sometimes for the first time, really takes time. Even breastfeeding has a learning curve you realize! 

Use your supports

Hooray! I got to chat with Grandma, aka Barry Lubin, my favorite clown
who in spite of all he's gone through continues to make us all smile!
There was such a clever, yet simple, most touching act. One of the clowns, seemingly lacking confidence, pulled out a small box which fit in his hand, with a hinged cover. Whenever there was enthusiastic applause, he'd quickly pull out the box and open it. Through his pantomime, he'd encourage more applause, and when it reached its peak, he'd abruptly close the cover. He had stored the applause, the positive reinforcement of cheers of support in his little box to carry with him. I loved the concept. 

How can we carry the positive messages, the counter to our negative feelings and discouragement when we are away from our treatment team, or our friends and supports? Maybe we could find our own symbolic hinged box.

Set realistic goals
Think tortoise. Sometimes progress is being stable or very slow moving. Sometimes you have to accept that it was enough to give yourself permission to respond to your hunger. But perhaps including new foods will take awhile. Goals will vary with where you are in recovery, how long you've been working at this, and if you've got a tiger mom on your team!

It's ok to be real

Reason to be pleased with himself!
Less sad about his mess-up then his fnger!
Not only is it okay, but to me it seems essential to cry when you're hurting and beam when you're proud of your accomplishments. And sometimes it's necessary to laugh at your self and the absurdity of your thoughts. We need to do a lot more of that.

Expect the unexpected 

A goat riding a horse was a new one for me. Shouldn't rock anyone's boat, so to speak, but neither should adding a serving of carbs or fat, when you come right down to it. Sometimes you'll need to make changes that you never expected to have to make. Like giving yourself permission to enjoy (yes, enjoy) a piece of cake!

Personally, I'm glad I allowed myself to to go to the circus for my own pleasure, even at 48 years old without a toddler in tow! (although I did feel compelled to bring along my baby, now almost 20 years). And the Big Apple Circus is just as fun and meaningful as when you're very young.

Tuesday, April 5, 2011

The Lies They're Feeding You About Your Weight and Health

 And, what you can do about it

Blatant misinformation comes from perhaps the least likely sources, including well-intentioned doctors and the media. Unaware, you continue to be misinformed about your weight, your eating and their impact on your health. Let's take my patient Dave. A pleasant, driven man in his late 60s, Dave takes medical advice to heart. He has a history of high blood pressure, for which he takes medication, religiously. Yet his pressure remains too high. So his doctor told him "You gotta lose weight, Dave, and your pressure will get under control." Reasonable enough, right?

I think not.  Now only 8 or 10 pounds above his college weight (pretty good, I'd say, given his age), here's a little secret about Dave’s blood pressure--it was elevated even when his weight was at its lowest, back in his early 20's, when his weight was just fine. Oh, and did I mention Joe's fitness level? Despite being in his seventh decade of life, Dave runs 6-8 miles, 5-6 days per week, and he's been doing so for years.
Great art. Terribly high sodium content.

From Dave’s perspective, his referral to me was a blessing in disguise. He's learned that his sodium intake was way too high—3-4 times the recommended level for those with hypertension. Reducing his sodium intake may have much more of an impact than simply losing weight. To focus on his weight was simply foolish, as his weight, historically has had no bearing on his blood pressure. If he put his energy into losing weight and then his blood pressure remained high (as I'd expect given his history) he would feel like a failure. Changing his food choices, however, reducing his very high sodium intake would increase his odds of normalizing his pressure.

Thinking it's all about sodium? Not so fast. Here's a bit more personal story. My father, when he was in his 20s developed high blood pressure, as well as pre-diabetes. He was a normal (actual rather slim) weight, and was active, as he walked everywhere. His father and grandfather before him had Type 2 Diabetes, although I am unsure about their blood pressure. When I was in my 20s I had my first bout of hypertension, which I blamed on the crazy level of stress at my first job. But in fairness, even years later, I still have high blood pressure.
My Dad, 26 who survived his diabetes
and high blood pressure and died of lung
cancer (no, he didn't smoke)

Managed with diet? Exercise? Isn't that what you'd expect from a dietitian? Not so! For the record, I am in a normal weight range, and I watch my sodium. My eating (besides the cake you so often hear about) tends towards freshly prepared food, with lots of fruit, vegetables, grains, and nuts, and my fair share of my favorite oils (olive, walnut and truffle). And yes, I am active. So basically, my healthy diet, normal weight and exercise have done nothing for managing my blood pressure. Thank goodness for meds! But perhaps my healthy lifestyle, in spite of my genetics, may be helping to prevent diabetes.

Me & Mom in NYC
And then there's my mother. I won't mention the dreaded O word, but let's just say that her current BMI qualifies her for gastric bypass. Oh, and that's even after the procedure was done some years ago. And even at her highest weight, prior to her surgery, her blood pressure and cholesterol were always perfect. She actually eats rather well, but does no regular exercise. She does have knee problems, perhaps due to years of carrying the extra weight, perhaps not. Did I mention I also have knee problems?

Now don't get me wrong. I am not suggesting that obesity has no impact on your health, physical and emotional. That is simply false. It increases the risk of Type 2 diabetes, high blood pressure, and cardiac risk. It also contributes to knee and joint problems and has been associated with breast cancer. It presents challenges when people are trying to travel--renting small European cars, for instance, sitting on airplane seats—and in dealing with social stigma and job discrimination. I certainly support making practical, realistic changes to feel better on all levels—eating healthier, being more fit, lowering your stress, getting more sleep. But the focus should be on the impact of those lifestyle changes on your quality of life now, today. If you're motivated simply to lower your blood pressure, you may be disappointed if the outcome isn't as expected.
Not fitting for everyone.

It's like the many clients I see who report a history of starting to exercise. After a short time, they fail to see the weight loss they were expecting for any number of reasons. And so they stop exercising. They forget that there were clear benefits they experienced from exercise—lower stress, better sleep, better mood, greater energy, to name a few. But with a singular focus on exercise to drop pounds fast, they had failed. And so they stopped exercising, giving up all the benefits they were getting from it. How quickly they forget.

Try to change what's in your hands to change, to feel better and to potentially lower your risk of and from chronic disease. And it helps to focus on the imminent changes—those immediate benefits you can see, and feel and experience—not just the benefits far in the future. Those, too, are important, but it’s much harder to motivate for those off-in-the-distance benefits that you can’t even feel.

But if in the end you need to add a medication to keep you healthy, accept (without guilt) that you have done your part, and continue your healthy lifestyle changes because of all the benefits it brings you. This applies to those who are overweight, as well as those with restrictive eating disorders. You need to do your part, in addition to using all available resources as well.

Biking and fundraising for MS with a little help from my friends.
While perhaps unrelated to the weight struggle, I will share one more personal piece. Nine years ago this month I experienced my first symptom that led to my diagnosis of MS (multiple sclerosis). This unpredictable disease is not caused by lifestyle changes, and does not run in my family. Yet while diet and exercise neither cause nor cure MS, they can certainly allow me to stay healthy on all fronts. I don't live with the illusion that my actions will cure my disease, but I can appreciate that I feel well doing what I am doing, and taking control, in a healthy way, of those aspects of my health I can control.

Thanks to Quincy Carole for a past comment, prompting this post!

Thanks for reading.