Friday, June 29, 2012

Lessons from the Ride: Tales of Intuitive Eating, Anxiety and Mindlessness.

Tell me this isn't great?
Let me preface this post by saying that I’m no exercise fanatic. I like to work out—it makes me feel good—but if I don’t get the chance to, I’m not bent out of shape.  I’ve never been much of an athlete. No need for tears, but in elementary school I recall being one of the last ones chosen for teams. I’m over it now, though, really. It was not until my diagnosis of MS, Multiple Sclerosis that I began to regularly bike ride although I’d done my share of hiking. This past weekend marks my 10-year anniversary riding this 2-day fundraising ride, a total of 156 miles from Boston, Massachusetts to the tip of Cape Cod—Provincetown.

During the ride thoughts of blogging never entered my mind. But afterwards, I was struck by several observations that I just had to share.

Intuitive eating? Not quite

As you’re well aware, I’m a big advocate of intuitive eating. But the truth is, intuitive doesn’t always work. Case in point: I’d ridden 15 miles to the first rest stop, soaking wet from the rain, with an elevated heart rate. Was I hungry? Not at all. Did I need to eat? Perhaps. By the next rest stop, now more than a couple of hours from the start of the ride, I still wasn’t hungry. Perhaps it’s because of the volume of fluid I was drinking in an effort to stay well hydrated. Perhaps it was the adrenaline driving me, revving me forward, preventing me from being aware of my body’s need for fuel.

Just arrived at the lunch stop
Nonetheless, intellectually I knew I needed to eat. I knew that my body was using up energy and needed replenishing. And so I made myself eat. I had little interest in the sports bars nor in the cookies at the rest stops, but I ate them. And they successfully fueled me until the lunch stop just an hour later. Then I fed myself a sandwich and multiple bags of chips, along with assorted other snacks. Oh, and more Gatorade.

This is how it went for each of the two days. There were times I did get hungry—generally after I had cooled off and my heart rate had dropped. But for the most part, I had to just do it, to simply eat because I knew I needed to, to keep me safe while doing an activity that needed fueling. And even without exercise, we need to eat to fuel ourselves throughout the day.

Intuitive eating returns

By late Sunday night, I returned home, and at 9:30 PM, after consuming more complete meals and smaller snacks than I can even recall, I was starving! So what’s a girl to do? I ordered Chinese food—the sodium-rich cuisine was just what I felt like— and I enjoyed every bit. This was intuitive! Yet had I, like so many of you, been stuck with the misinformation that eating after a certain hour was bad, or that I had already eaten my umpteenth meal and shouldn’t be hungry, I would have failed to meet my body’s needs.

My husband, who also rode, was also quite intrigued by the regulation of his food intake. He asked me how much I thought we had each consumed and I did a very rough estimate of our intake—trying very hard to remember all we had eaten. Then he asked how much I thought we had burned. So I did some equally estimated calculations for our expenditure.

And what did I find? Each of us had consumed within 10-15 calories of our estimated need! It was astounding! This combination of eating at regular intervals—just because I knew I should—together with eating whenever I got hungry worked like a dream. Our high activity is really beside the point. The key thing is that you burn calories 24/7—and certainly more if you are moving or exercising. And it’s critical to both respect your hunger when it is present, and use your sensibility (or the wisdom of a professional who’s working to keep you on target)—because anxiety, exercise, distraction, fluids, fiber and volume of food can stand in your way from eating enough.

Other lessons from the ride

Anticipatory anxiety

Yes, it's raining!
I hate the thought of biking in the rain. It scares me. They threatened precipitation for Saturday, but that did little to reduce my fear of having to ride in bad weather. About 45 minutes before we started pedaling, the rain started. Steady rain. The ride was not called off. The teams were called, one by one, to head out to the road. And so I did. 

Yes, my eyes were stinging from my hair gel dripping into them, and I was getting covered with grit and spray from the bike in front of me, but you know what? The reality was much better than my fears. Would I choose to ride in pouring rain? No! But having had to do it, truth is, it’s really not too bad. I survived, as did everyone of the 2000 or so riders that rode. And after a couple of hours, the sun came out, and I dried off. And by the end of the 156 miles, I was so thrilled I didn’t allow my anxiety to stop me from achieving my goal. See where I’m going with this?

Sometimes the solution is right in front of you!

Ok, this brilliance I’ll share—just don’t think any less of me, please!

At the finish, not yet hungry, but quite tired!
I had a headache all Saturday morning, a painful, aching headache. I didn’t get it—I was drinking plenty and eating regularly, so go figure. Then lunchtime came, and I pulled off my bike gloves, and my helmet and ate. And the headache disappeared. Yet when I returned to the road, the pain returned.  Thoughts of stroke and aneurysm crossed my mind—really! But by the next rest stop I figured it out.

The indentation on my forehead told me that I had mindlessly secured the darn helmet way too tight!  Yes, sometime the solutions are really right in front of you. And sometimes, your symptoms have nothing to do with how much you had eaten! (Just being honest!)

Yes, that’s what I learned from my ride last weekend. Thoughts? Comments? I’d love to hear what you’re thinking (unless, of course, you respond to my inability to appropriately fasten a bike helmet!)

Monday, June 25, 2012

Putting a Squeeze on a Family Ritual: Starting Bad Habits Early

Sure, it was messy but it was so good!
How sweet! Cute little pouches of pureed food—not for infants but for toddlers to slurp up. Designed for eating on the run, they also help to appease the difficult feeder. You know, when you fear your picky eater might starve by not eating her peas. 

And, they’re convenient for the challenged parent, juggling work and the demands of raising kids. Perfect for soothing the fussy little one while watching TV or simply while riding in the car. Allows for hands-free feeding so you can easily be typing on your ipad or dealing with work issues by phone while productively feeding your little one, too!

Professor Brian Wansink, the fabulous researcher known for his work on environment and eating behaviors may be ambivalent about these, but my opinions are solid. I would never feed these newly popular foods in a pouch (described in the NY Times article Putting a Squeeze on a Family Ritual) to my kids. Never mind that my sons are in their twenties (years, not months, that is). Still, if I did have toddlers, these would be the last things I'd purchase to feed my children.

Now before you leave this page thinking this is irrelevant to you—that you, too, have no young kids to feed, nor care to learn about approaches to feeding toddlers—let me make a point: this has everything to do with you and with managing your weight. You’ll likely learn as much about feeding yourself and self-regulating your own intake as you might your kids.

So what’s my problem, you’re thinking? Let me highlight a few of my concerns.

Distracted eating

Yes, that's a grapefruit he's eating. With a spoon. Not pureed.
Mindful eating enables us to fully appreciate our food with all our senses. And it slows us down. In doing so, we can better appreciate when we’ve had enough, helping to prevent overeating. Distracted eating—eating while on the phone, while watching TV, or even while jumping on the trampoline (an example pulled from this NY Times article) is anything but mindful.  Eating while distracted may lead to overeating. (Although, for those anorexic patients I see, it may enable eating food that wasn’t intended—and that could be a good thing). It is challenging enough to change behaviors in adulthood that perhaps only started recently. I could only imagine what it would be like to shift these behaviors in adults raised mindlessly sucking down pureed food goo.

Regulation of juices, sodas and mush? Not so easy.

It’s well established that we don’t do a very good job regulating our intake of caloric beverages such as juices and sodas. It’s challenging for our body to recognize when it has had enough calories from such beverages, so we certainly need to be aware of our portions. Again, for some needing to increase their intake, this form of nourishment is quite helpful. Less has been explored about the impact on feeding a less-than-solid but greater than liquid calorie diet, such as the slush-from-a-pouch.

Mealtime a thing of the past? Are we really too busy to parent? To nourish our kids with attention, with positive interaction, and with calories and other nutrients?

Even when camping, there's time for meals.
Maybe I’m an idealist, but I cherished the family dinner with my young family. It was a time to connect, to hear about their day, to be present. Sure, when the little ones would toss their food off their tray it would come to an abrupt end. But it was good while it lasted. And it established a tradition that lasted throughout the years (the family eating, not the throwing of food!) It was a time we were all theirs—we were not blogging, texting or talking on the phone. We were simply present—if only just for the mealtime.

If we don’t have time for what may be our most important job—parenting—it’s really a sad state we’re in. An acquaintance recently stated that he had no time to deal with exploring college options for his daughter with special needs—he had some very important business deals that needed his full-time attention! Seems like parents choosing feeding pouches may feel similarly.

Gone is the motivation for change.

Feeding our kids is often what motivates parents to shape up their own diet and eating behaviors. They want their children’s experiences to be positive—to feel good about their body, to be healthy and fit. They care about their little ones’ intake, but had previously not given much thought to their own eating. Having kids can change that, unless of course, family meals are eliminated. Gone is the need for role modeling and healthier eating for parents.

What’s normal and appropriate anyway?

Perhaps because we view smoothies and meal replacement shakes as eating, pouches fit the bill for our little ones. But what about the experience of eating? It’s enough that movies go with popcorn, and we need hot dogs at baseball games. Must we solidify the link from the youngest age, between eating and other activities? Must riding in a car be accompanied by fueling your body? Will they not expect to be eating, mindlessly, once they start to drive? I mean, isn’t that what they’ll have learned to associate with doing whenever they’re in the car?

Neil Grimmer, chief executive of Plum Organics, sees it as empowering children. “It’s on-the-go snacking, on-the-go nourishment,” he said. “It moves with kids and puts the control in their hands.” Seems to me that these days kids have more control in their hands than they need or want—perhaps limit setting would be a more appropriate parenting approach.

He further endorses feeding in response to hunger, and I’m all for that! In my mind, that necessitates parents connecting with their children and being aware of their cues. You know, taking note of when they start pushing their food away, when they have had enough. Or providing them with an additional few bites of cheese when they have finished what you served—just to see how much they truly need.  When they’re done, they will make it clear! This is quite different than serving a predetermined 100-calorie portioned food pouch. But the convenience of these foods and their inappropriate use in so many situations far from tunes in to a child’s hunger. See how this might be relevant for you, too?

Grimmer also states “Regular mealtimes just add one more item to the schedule”. Bummer. Now you have to deal with those kids you decided to have! Hain Celestial Group, the company that makes Earth’s Best baby food, sees it as the solution for the child who wants to be independent and self-feed. How about teaching them to use a fork or starting them on finger foods? Toddlers are developmentally ready for more than slush from a pouch!

This old momma thinks it’s time to shift our thoughts about feeding—our kids, and ourselves.

Thursday, June 14, 2012

Smart. Easy-to-handle. Attractive.

And practical minded too. Will do it all but cook for you.

I'm talking about my new book, “Food to Eat, guided, hopeful, and trusted recipes for eating disorder recovery”.

Lori Lieberman, RD, CDE, MPH, LDN, and Cate Sangster may seem like unlikely coauthors. Lori, a 26-year veteran of eating disorder counseling and a blog author in the Boston, Massachusetts area and Cate, a soon-to-be-published coauthor (with eating disorder author June Alexander), and recovering adult anorexic in Melbourne, Australia created a novel recovery tool. Part cookbook, part CBT-styled guidance and support, this book gently and thoughtfully assists readers, allaying their fears and misconceptions they may be ruminating over when contemplating eating.

It addresses head on the barriers to change, including perception and fear of nutrient content, GI issues and the consequences of change. Nutrition myths are broken down and justification and support for renourishing is provided.  It builds on a transference of trust like that which propelled Cate forward in her own recovery—from connecting with Lori's writing and learning, for the first time, that recovery is possible, to moving to increasing her own range of foods consumed beginning with this project collaboration.

No, it's not out yet, but it's coming soon, and Cate and I are so excited to share it with you. “Food To Eat” will be available as an ebook and in print—details to follow.

We've gotten enthusiastic thumbs up from eating disorder professionals, and valuable input from those struggling with eating disorders and disordered eating to help us perfect it.

We'll keep you posted when it's ready for release!

Sunday, June 3, 2012

Supersized Disaster

Yes, that's a 44 oz individual serving of soda!
I never recommend soda to my patients or my family members. And I cringe when I walk into fast food restaurants (only to use the bathroom, of course) or a movie theater and see single serving cups in the range of 32-44 ounces. It’s obscene. That volume of sugar devoid of other nutrients, consumed at a single sitting is crazy. Our society has a distorted sense of what normal portions are—not just for beverages, but for food as well. The only place I’ve been able to find a true juice glass, a 4 or 6-ounce size, has been at antique stores. Really. So I support NYC’s Mayor Bloomberg’s recent ban on the sale of supersized sodas, right?

Not at all. While the mayor is desperately trying to change a growing trend of overconsumption and obesity, his new policy restricting the sale of sodas larger than 16 oz is absurd on so many levels.

While I take my freedom for granted, having never lived anywhere that restricted my personal choices, including what I eat, the thought of a law limiting the size of my portions feels, well, un-American. Mark my word; if they try to restrict my purchase of cupcakes after 8 PM, for instance, I’ll start hoarding them at 7. I mean it.

Who decides what you're allowed to eat and how much?

It’s quite a slippery slope. Who decides that Sprite is out, but grape juice is fine? Or that 24 oz smoothies are ok, but soda is not?  Maybe they should halt the sale of those cardiac-inducing hot dogs sold on food carts throughout NY, instead? Sure, there’s nutritional value in the smoothy, but if the driving force behind this policy is obesity and health—why would 24 or more caloric ounces of anything accompanying a meal be appropriate?

Next, will NYC next set limits on who can buy these large caloric beverages? Will we need to weigh-in at the food carts on 5th Avenue—high BMI? You get the under 16 oz regular soda or the diet one; low BMI? You may choose the supersized drinks—but ONLY those drinks with calories—no diet beverages for you

Should we perhaps ban the sale of large portions of diet beverages, given that they displace the calories and nutrients desperately needed by those with eating disorders and those simply underweight?

And what about cost? Can we not buy a bottle of soda at the deli to share with others, resulting in a smaller portion and less cost per person? Bloomberg’s ruling prohibits this.

The unforseen consequences

What message does it send if 16-ounce beverage portions—regular or diet—are considered the norm? Our caloric needs vary; for some, 16 oz of juice is absolutely appropriate. For others, it’s excessive for their need. But a law stating that 16 ounces is fine or distinguishing between soda and juice as healthy versus unhealthy creates a hierarchy people will believe is valid—when it’s not. If we are talking about weight management it's about calories, and a Coke is no different than a bottle of 100% juice. 

Should those with high blood pressure be forbidden
 this heavily salted popcorn?
I understand that simply educating the public to improve health is at best challenging. We are impacted by visual stimuli and sensory prompts to eat, as well as our perception--not just information about what and how much is healthy to consume. Prompted by the suggestion that you can size up for only 75 cents more (which I overheard at the movies yesterday), most of us will go for it. If you perceive that you haven’t eaten much you will continue eating, regardless of your fullness. And if you believe that 16 ounces is appropriate--because the Mayor believes it's fine for your health-- you may be more inclined to select the 16 oz size than something smaller.

If they’re going to set rules…

Perhaps there are better alternatives than Bloomberg’s to reduce our excessive intake—if or when it is unhealthy for the individual. How about a pricing policy removing the financial incentive to size up? If ordering the 32 oz soda vs the 16 oz adds $1.20 vs 20 cents, I suspect there’d be more thought before supersizing.

Yes, this is for real. And financially more sensible that the 32 oz
 which was more expensive per ounce!
Or what about a rule allowing individuals to bring their own snacks into a movie—maybe healthier popcorn from home? Or limiting movie-theater food to a specific eating area as opposed to in front of the screen? Can we not go 90 minutes without a feeding? Why are we encouraging distracted eating, when all evidence supports mindful eating helps us better regulate our intake and our weight?

Yes, something needs to be done to improve the health of our nation. But setting arbitrary boundaries on portions, about good beverages and bad, is hardly the answer. And the fallout from this perhaps well-intended policy may only result in more problems.

And I thought I lived in the liberal Northeast...