Does this nutritionist count calories, track exercise on a Fit Bit, or limit her gluten, sugar or carb intake? You just might be surprised.

Time for lunch? Thinking about dinner?  I've gathered a bunch more pics to share from my recent meals. But first I need to respond to a couple of comments and questions you've voiced in person and on the last post.

Lean steak which I have infrequently with grilled farm-fresh
potatoes and watermelon.

Do you think about balancing your day's eating depending on what you ate earlier in the day?

Not at all.  I don't think "I shouldn't have bread again since I had some at breakfast" any more than I think "Oh, I had three fruits already so I'd better have something else for snack." I go with what I feel like, when I'm hungry. 

So you don't give any thought to your food choices?

Homemade pizza topped with artichoke and peaches.

That's not the case either. There's a balance between nutrition information and pleasure/preference that informs my decisions about what to eat. I might have lox at a meal but I wouldn't include olives, let's say, as the sodium would be quite high. And since I have high blood pressure I try to be moderate about my intake. Besides, I think it would be disgusting together. I might have pasta--white, low fiber pasta, but I don't eat a pound of it. I'll add veggies and perhaps a protein source such as chicken or tofu for some balance; the protein and fiber impact fullness which helps make the pasta meal more satisfying.  

Similarly, I'll routinely have a large salad with my pizza or I'm apt to eat a lot more pizza than I need, before recognizing that I've had enough. I happen to love fruit and vegetables so I eat them generously. But my favorite food just might be bread which I eat no less than twice a day. My latest favorite is homemade sourdough.

Do you calculate your calories? And if not, how do you know how much to eat?

I never calculate my calories. Okay. Not true. I did it once after a 2 day bike ride at my husband's request, as he was curious about how our constant eating (and cycling) measured up with our calculated need. In fact, it was strikingly right on--but calculated after the fact; I did not count my calories to limit my intake or determine my portions. When you allow your self to acknowledge hunger and not mask it with water or coffee or deny it until you 'deserve it', and respond to it with food for fuel, the system starts to work just fine.

This is a special meal I prepared from Gramercy Tavern cookbook
featuring halibut, zucchini in various forms and corn salsa.

But you also need to be eating regularly to prevent excessive hunger and impulsive eating. And it helps most of us to control the environment--removing food as a visual trigger to eat. Store food behind cabinet doors, in the fridge or freezer instead. And beware of the impact of other triggers such as alcohol, stress, and mood. Feeling a sense of hopelessness about your eating doesn't help either.

A veggie heavy pasta meal.

Do you think some people are born unable to do this and others aren't? Because I think I'm different, and this simply won't work for me.

No. I felt the same way many years ago when I struggled with a cycle of restrictive eating followed by binge eating. It feels like there's no way out. I don't buy into the addiction model for foods (http://dropitandeat.blogspot.com/2012/09/what-ive-learned-about-food-addiction.html) but I do see that behaviors can be addictive. So focusing on eating behaviors (which I address a great deal on this blog) is key. Search this blog for mindfulness, hunger and fullness to start.

Sure, you can do this because you must exercise a lot. 

Pasta with an indian flare-with some cashews and coconut.

Sometimes I exercise a lot, like when I'm training for my annual fund-raising bike ride. But I usually work out about 3-4 days/week (once is just a walk with you-know-who*), with an additional day of Pilates. In cycling season the rides may be long, but aside from then,  I don't spend more than an hour working out. 

And I don't intentionally adjust my food choices or portions on non-work-out days. I know my body burns calories at rest, even when I'm sitting at my desk for 8 hour days, 4 days a week. 

Hope this helps. Still thinking this is unhealthy? Let's discuss.
And by the way, all the meals above right were dinners, and those below were my lunches. Missing are the frequent PB and P (preserves of all kinds) sandwiches I bring for lunch but neglected to photograph.

A grilled cheese, arugula and tomato. Yes, on sourdough.

That's cheese hidden under the figs, and lox. Admittedly a weird 
mix, but I had little time to make a lunch when I was
running late.

Add caption

Bread and houmous, with yogurt and granola.

Lemony Lentil Stew with goat cheese, served on 2 corn
tortillas. From Drop the Diet www.food-2-eat.com

Yum!

*yes, you know who.

The very low sugar, low fat healthy diet—an oxymoron.

Kristen knew to avoid fats—except for those in nuts (which she included in very limited amounts) and certainly those in dairy and oils. Fats are bad. Period. She loves fat free yogurts, but those she omits because of the sugar. Same with milk, which she truly used to enjoy. Now she uses fortified water aka lite almond milk. Seasonal fruits, even the organic stuff—completely stricken from her diet, you know, because of the sugar.  Whole grains—well those have those god-awful carbs so those are out too. Yup, that leaves… lean poultry and fish and non starchy vegetables.

No wonder meal planning is a challenge.

No wonder she struggles to not binge following a day of deprivation.

No wonder her energy level is low, and her thoughts are preoccupied with food and eating.

Why can’t I decide what to eat?

If you're like Kristen, you get so over-focused on what you shouldn't eat that you're challenged to figure out what to eat.  Your endless food rules about nutrition, weight and health leave few foods to eat—and enjoy. 

I've lost count of how many patients came into my office these last weeks, stating: "I have no idea what to eat anymore. I just can't decide." These are patients of all sizes and conditions—patients with anorexia, and those with binge eating disorder and bulimia; and those struggling with their climbing weight and obesity in spite of their attempts to eat healthy. And they’re all ruled by unnecessary food rules.

Wrong, wrong, wrong about fats!

Like Kristen you too may be fat phobic, in spite of the updated newest guidelines for Americans 2015, which have removed the notion that total fat should be avoided. Got that? There is no evidence to support a recommendation that total fat should be restricted—neither for weight management nor for health and disease prevention. 

Really? How can this be?

At the 2015 Scientific Sessions of the American Diabetes Association (ADA) there was a wealth of research showing that diets rich in fats from plants sources—with nutrients like mono unsaturated fats (think avocado, peanuts and olive oil)—and in omega 3s (think salmon, sword and tuna in addition to walnuts and flax) help reduce abdominal fat distribution which is the greater health concern than obesity.

And, wrong about carbs and weight gain!

Also at the ADA, extensive research was presented concluding that macronutrients—the protein, fat and carbohydrate balance of your diet—ultimately have no impact on your weight. That's right. Numerous large studies including a well-done Harvard study confirm this.

I know, I know, it’s hard to believe when you’ve already been sucked into the misinformation of carb and sugar toxic diets and fat phobia.

You’ve lost sight of the bigger picture. In spite of eating a diet full of healthy foods including protein sources, fruits and vegetables, grains and fats—your calorie intake can become reduced to the point of providing inadequate calories for your day to day need. You get fuzzy headed, feel fatigued and decision-making about food becomes challenging. Rules and restrictions consume you, so you're at a loss to figure out what you can eat. I mean if you know you can’t eat gluten or that carbs are toxic or fats will make you fat and sugar is poison than what's left? How can you choose what to eat when there's so little that allowed?

Remember when you used to simply eat?

Move from micromanaging your foods.

How can you loosen the reins? Start to shift your thinking from micromanaging your diet. Rather than hyper focusing on each individual food item, on every nutrient or component of your intake, consider the bigger picture.

Consider OJ.

I walk through the supermarket noting the orange juice selection. Remember orange juice, the juice of oranges naturally high in vitamin C (and lesser known for its high potassium and folic acid content)? Only now it’s available calcium fortified. And get it with pulp—it’ll make you think you’re getting more fiber, when in truth there’s no difference. Add omega 3s while you’re at it—just get it with fish oils (quite a disgusting thought, personally). My point? Why are we thinking that one food has to be everything to our diet? Can't oranges or orange juice just provide us with the nutrients it's known for?

Must our pasta be whole wheat and protein fortified or be banned from our diet? What if you started with white pasta—yup, no fiber, all carbs, delicious pasta? You don't need to have the whole 16 oz. of it. By itself it's hardly a balanced meal. But surely you can find a solution to that, right?

Yes, you can add vegetables—for vitamins, for volume and texture, for fiber and satiety. Feel the need for protein at that meal? Add a glass of milk, some cheese, some shrimp or chicken or smoked salmon.  See where I’m going? 

Maybe think even bigger picture. Perhaps some meals are higher carbohydrate, but your protein is met from other meals or snacks?  Maybe you had a Greek yogurt high in protein or some nuts, for instance.

It's time to aim for balanced meals and a balanced day of eating, rather than hyper focusing on some 'perfect', ideal foods and eating style. Imagine even including a baked good simply because you enjoy it, as a snack when you’re hungry—contributing to your energy needs for the day, in addition to the wholesome foods you strive to limit yourself to.

Now that’s healthy eating.

Thoughts? Questions? Does this resonate for you? Are you out there reading? Please share with anyone who might needs some reality checking! Thanks!

Why I’m worrying about Vyvanse and Binge Eating Disorder

Seeming quick fixes can be so tempting.

This week’s inbox held the following message from an old patient:

“I was watching Good Morning America and they had Monica Seles on, admitting she's suffered from binge eating disorder (BED). They announced a medication they are now using to treat BED, Vyvanse, also used for ADHD. I looked it up and side effects include weight loss. Have you ever recommended this drug for BED? Do you feel it is effective for BED? Can people with BED take this med to lose weight? Do they think if you have BED you must be overweight and this medication can cause weight loss? Which would perhaps (in their minds) solve the bingeing?

That small ED voice that lurks deep from within is screaming 'get me that drug! Get me that drug!' so I can lose weight. WTH?!"

I’m glad she was brave enough to share what she was wondering, as I’m sure she’s not alone in her curiosity. Aren’t you wondering what this means for you?

Let's start by clarifying a few things about binge eating disorder. Most notable about BED is the recurring episodes of binge eating, feeling out of control while binging, and feeling guilt and shame afterward. People of all sizes live with BED, and the experience of a binge may vary. You might eat large amounts of one item—such as a whole package of cookies—or large amounts from a combination of foods. For some, even eating a single bite beyond what they intended may feel like a binge.

There's a way off the roller coaster--appropriately
named the Cyclone.

The common features among sufferers, though, is the guilt, shame and lack of control accompanying the eating. According to the Binge Eating Disorder Association,  "Binge Eating Disorder (BED) is the most common eating disorder in the United States. An estimated 3.5% of women, 2% of men, and 30% to 40% of those seeking weight loss treatments can be clinically diagnosed with binge eating disorder. The disorder impacts people of all races, levels of education and income — including adults, children and adolescents."

Given the shame associated with BED, however, there are likely many more living with the condition than we know.

Medication to the rescue?

Two recent studies were done using Vyvanse—a stimulant used to treat ADHD—for the treatment of moderate to severe binge eating disorder. They were well-done studies— randomized, double-blind and placebo-controlled—with promising outcomes. 

In one study, participants who binged three or more times per week were treated with either a placebo—a dummy pill—or 30, 50 or 70 mgs/day. Researchers saw a significantly better response to the 50 and 70 mgs/day doses compared to placebo in a study of over 250 subjects with a roughly equal number of controls. Improvements included reduction in binge frequency/week, a higher percent of subjects binge free for 4 weeks, and a change from baseline in the Yale-Brown Obsessive Compulsive Scale Modified for Binge Eating—compared to placebo treatment.

Notable, however were a couple of other outcomes. The placebo group also improved, by 21.3 percent (versus 42% in the 50 mgs/day and 50% in the 70 mgs/day treated groups). Meaning, the belief that taking something could help your binge eating was enough to improve binge frequency.

And then there were the side effects. More than 5% of those treated with Vyvanse reported symptoms including “dry mouth, insomnia, headache, decreased appetite, nausea, irritability, heart rate increased, anxiety, feeling jittery, constipation, hyperhidrosis [excessive sweating].” Twelve patients (5%) on Vyvanse reported treatment-related adverse events that led them to stop the study; 5 patients in the placebo-treated group had such negative effects. 

And then there’s this: “CNS stimulants (amphetamines and methylphenidate-containing products) have a high potential for abuse and dependence.” 

If you struggle with Binge Eating Disorder and are tempted by the positive research results, consider the following before you request a prescription. While medications might improve binge eating, so does addressing some underlying eating patterns and thoughts—without the risks of medication. In fact, since the placebo also improved binge frequency by over 21%, it suggests that the power of believing you could change—with some help—is quite strong with BED.

Yes, there's hope without meds for BED!

Need I say more? http://www.annetaintor.com/

Do any of the following scenarios apply to you? If so, medications for BED may be unnecessary.

1. You restrict your calories throughout the day, trying to be “good”. You deny your body the fuel it needs and by later in the day—often late afternoon or at night—you start eating, intending to eat in control. But then it feels like the flood gates open and you just can’t stop. Perhaps you feel like you’ve already blown it, so feeling defeated, you decide to continue to binge. You’re determined to get back on track tomorrow—with restricting. And so the cycle continues.
2. You eat enough calories throughout the day, but your food choices are very limited—including only foods you "should" be eating based on rules you follow; they may be only high protein, or unprocessed or not very palatable. They are foods that you’re okay with, but that don’t necessarily give you much pleasure. Then, when at a friend’s or out to eat and you eat something to appear ‘normal’ or because you really want it, you have serious regret. Later you continue eating because you’ve already "ruined it", but are determined to get back to your very restrictive, healthy food choices.
3. You truly get enough to eat—enough calories and enough of foods you really enjoy. But most of your eating is quite mindless—you eat standing up in the kitchen, while multitasking—while driving, on the computer or on the phone. So you never truly feel satisfied. And it’s worse when food is kept in sight.
4. You eat enough, you get what you want to eat, AND you pay attention to eat mindfully. But when stress if high, or you struggle with an emotion that’s hard to sit with, your knee-jerk reaction is to reach for food for comfort or to numb out. You may even be completely aware of what you’re doing, but the pull is so strong, because in the short run, it helps. But later, you are left with regret.

If any of the above statements apply, then working with an eating disorder dietitian—together with a therapist can really help. Cognitive Behavioral Therapy (CBT) is a valuable, well-studied treatment for BED, and you can purchase self-help workbooks specifically for this condition as well. 

Learn to normalize  your eating!

Yes, binge eating can be resolved without medication. But it requires dropping the diet and rigidity around eating. Really, dieting simply isn't helping.

For those with ADHD who also binge eat, the medication may be helpful to manage impulsivity—which can lead to binge eating. Delayed gratification—redirecting and waiting to notice fullness—can be too challenging, as is moving away from multitasking.

But using Vyvanse is not without consequences. Decreased appetite may sound appealing but if you don’t know when you’re hungry, it's hard to trust when and how much to eat — making intuitive eating impossible. It may contribute to inadequate intake and food restriction—something those struggling with binge eating may already struggle with. 

Do we need to swap one problem with another?

Further, will doctors inappropriately start prescribing Vyvanse for those who are overweight but not living with moderate to severe BED? Will prescribing seem like the medical quick fix, while failing to address restrictive eating, or deprivation or over-exercising that truly need treatment? 

So, dear readers, please don’t be tempted. But don’t give up hope. Seek out providers that work with binge eating disorder patients because it is in your hands to change.

Other related links you might find helpful:

http://dropitandeat.blogspot.com/2013/05/name-calling-has-its-place-bed-is-now.html

http://dropitandeat.blogspot.com/2013/03/weight-loss-and-recoverycan-they.html

http://dropitandeat.blogspot.com/2013/04/intuitive-eating-is-not-for-youmaybe.html

http://dropitandeat.blogspot.com/2013/03/heres-to-speedy-recovery-maybe-not.html

http://dropitandeat.blogspot.com/2013/04/eating-disorder-recovery-reflections.html

http://dropitandeat.blogspot.com/2012/08/do-or-do-not-there-is-no-try-think.html



http://dropitandeat.blogspot.com/2012/07/forgetting-to-remember-key-obstacle-to.html

Chocolate for fat people?!

Since I’ve last posted, I’ve had a troubling, food related conflict. Can I dump on you, dear readers? Can I model what I suggest you should do—to express yourselves and reach out for support?

Colleague conflict

I love good chocolate. So it follows that at holiday time I’d want to share the joy as holiday gifts to some providers that refer to my practice. (Remember, this dietitian has a cupcake as the mainpage image on her website. What harm in that, I thought?

Yet in sharing my intentions with a nutritionist colleague, I heard a very different perspective. Namely, that many office employees are trying to lose weight—so chocolates are the last thing they need. Those who are obese hardly need the box of chocolate sitting around the office. And since many are so anti-sugar these days, giving chocolates is simply a bad idea.

Once I moved from my totally speechless state (a rarity with me), I tried to be open-minded. Is it diet sabotage to give a box of chocolates to be eaten in an office with many employees—i.e. with little opportunity to squirrel them away, in the season of New Year’s weight loss goals? Was I sending the wrong message as a promoter of health, that chocolate—ok, they weren’t even exclusively heart-healthy 70% cacao-dark chocolates but simply great tasting Belgian chocolates—are an acceptable snack?

Further, can those of high BMIs be given chocolate (or cakes/cookies/highly-palatable foods)? Are they entitled to enjoy the pleasure of great tasting desserts? Should anyone, regardless of their size or percent body fat be given chocolates as gifts? I mean, should we even be allowed to eat foods we truly enjoy?

Must we live an ascetic life of food deprivation and denial—whether for short-term weight change or for life? Is that a healthy lifestyle? Are we doomed to live secret lives—the model kale-salad-protein-smoothie-ingester in public and guilt-laden, binge eater by night or by car ride?

Still on the fence?

Perhaps Jamie’s Christmas surprise will do the trick. This patient’s sorrow and shame was revisited in my office post holiday, as she described her Christmas disappointment. Her three siblings dug into their chocolate-filled stockings, while she rummaged through hers. Only hers was filled not with her favorite candies but with plastic items.  No chocolate indulgence for this overweight young woman. A helpful, healthy holiday message? I don’t think so. A supportive gesture? Hardly.

Let us not for a moment believe that we are not entitled to enjoy life’s simple food pleasures. Yes, you. Yes, regardless of your size.

For me, the conflict’s resolved.

And for you?

Burning through the calories: where the carbs fit for weight management

Are you hyper focusing on the nutrients that are 'safe' to eat?

Processed foods are bad, toxic even. Breads, even so-called wheat breads, must be avoided. Other starches aren’t great for you either—but those whole grains seem a little better. And forget sugar, because you know all the horror stories about what sugar does.  Best to avoid it all; it’s much safer that way.

That’s what Dave thinks, and he’s not alone. He's an underweight young man, unhealthily thin. Yes, most sources of carbs are a problem for him. In fact, most fats are also a problem for him. He selects only foods he perceives as super-foods—super healthy choices chock full of nutrients; he’s not contaminating his body with any of that other junk. He reads a lot, but never the full research paper, because, I mean, who does? Anyway, if it’s in print, then it must be true, right?

Start to look at the big picture.

No, not correct. Even all the hype about sugar and its negative impact on health pulls from studies showing high intakes—25% of total calories, to be specific. That’s a lot of sugar. And that’s quite different than including a couple of mint Milanos or Lindt chocolates for instance, in the midst of a healthy, balanced diet. But why all the fuss, you ask? Who needs processed carbs anyway?

An RDA for chocolates?

It’s like this. There’s no daily requirement for processed foods—that’s for certain. But creating long lists of foods to avoid creates another set of health issues, both mental and physical. Deprivation, for one, creates rebound overeating, so setting rigid rules about all the foods you can’t eat becomes an issue. Further, avoiding large categories of foods as Dave does leaves fewer fuel sources and nutrients to meet your needs. A diet of vegetables and lean protein and a bit of fruit will likely leave you low energy—carbohydrate stores are our go-to for fuel; yes there’s a reason why Marathoners have a pasta dinner before their event.  Food rules are challenging to adhere to and lead to increased preoccupation with food and eating.

It’s worse if your needs are high, like if you are in the process of restoring weight from a low place. Truly, metabolic rate dramatically increases to well above what others of the same height (but who weren’t restricting and now re-feeding) experience. So the feeling of fatigue may result, and if you’re wondering why your strength is lost, this could be why. Or if you are a growing teen, restricting what you can eat may add to your problems—it’s challenging to meet your needs to restore normal growth when there’s lots you choose not to eat.

Burn, baby burn

Take a step back and try to look at your
assumptions a bit differently.

It's hard to negotiate with irrational thoughts. And the media's messages villainizing most anything that tastes good hardly help. So I’ll turn to my fireplace analogy to help him (and you) see carbs as just another fuel.

Let's say you have a fireplace. You could burn logs of pine or oak or maple. Burning each log type generates heat, turns to ashes in the end, regardless of which you started with.

Should it matter to you which type of log or fuel you use? Well you might have a preference for the scent of pine or maple, let's say. But from a fuel standpoint, it doesn't much matter. That is, as long as the total amount of wood is equivalent. It's just like food and its building blocks. You could burn carbs or protein or fats that you eat and yield energy—our heat equivalent here. And as long as the total amount of fuel or calories is the same, your body hardly cares where the fuel source came from—from a weight standpoint. You may have a preference for the taste of chicken or of nuts, and some foods may be more satiating (think whole grains or balanced meals including protein); and a varied diet will help meet your nutrient needs over time. But if the calories are the same, they will generate about the same amount of energy.

That's sweetened chai tea with real milk to go with our
carb-based snack.

But substitute some twigs and the fire dies down fast. Rice cakes, for instance, just won't sustain the energy. You could swap newspaper for the logs. But you'd need a ton of it to heat your house in winter. Yes, just like if you chose only light products or large volume but low calorie dense foods like broths or salads with little substance to them.

So what can I do now?

Stoke your fire with items that are pleasant. I love the scent of burning pine, personally, and I enjoy a good piece of pastry when I need the fuel. There are times those whole grains are just what I'm yearning, and they'll likely take a bit more time to process, and thus burn, than just white rice. But brown sushi just doesn't seem right.  And favoring protein and eating lots of it simply because you heard it’s good for you is no advantage for long-term weight management.

A healthy body requires getting enough. Not just total calories, but satisfaction, from a wide range of foods and nutrients. Isn’t it time you free yourself from the unnecessary food rules?