Sunday, August 29, 2010

Food Finds: Roasted Walnut Oil

I decided it was time to share my favorite food products with my blog followers. I will post them bit by bit (bite by bite?) as I can. Only food items I have tasted and really value will be listed. But this isn’t going to be an all-inclusive list. And I will share my thoughts about tips for fitting them into a balanced diet. Of course I will give you a few words about their nutritional value as well, although don’t expect to see a score! (see the last post for more on that subject).

To find all posts, see the label index on the blog home page. I will link them all to the label “food finds”. Let me know your thoughts on these products, as well as any others you’d like me to evaluate.

Walnut oil

Most people haven’t had much experience with walnut oil, unless you happen to live in or travel to southwest France. This brand, La Touranelle, (which sounds French, but is Californian) in particular is incredible—intense, rich, aromatic and nutty. I have tried other brands available locally, only to be disappointed. For the best price you can purchase it at Marshall’s or Homegoods, of all places! But it’s hit or miss. Whole Foods and Williams Sonoma carry it as well for a heftier price. 

Another brand available from a store called Fiore on Bar Harbor, Maine, is also terrific, and could be ordered on line.

Order direct at

Walnut oil is ideal in salads, although you can also drizzle some on steamed veggies. Because the flavor is so intense, a little goes a long way, so you don’t tend to need as much oil. Toss a couple of tablespoons onto your greens (enough for 2-3 people). Then add a mild vinegar, such as a balsamic or rice vinegar (I use the unseasoned, which does not have the added salt and sugar and tastes just fine).

Another benefit of walnut oil (besides the exceptional flavor) is that it is also quite high in omega 3 fatty acids.

Saturday, August 28, 2010

A Perfect Score: NuVal ranks unprocessed wheat bran number one. RD ranks NuVal a zero.

Wouldn’t it be great if we could easily assess a food, determine if it is good or bad, score it on its nutrition performance, using a single score? 

That’s just what Yale affiliated Dr. David Katz and his group of advisors decided to do, and have managed to convince Whole Foods and a range of other supermarkets to adopt. Sounds like a great idea, no?
NuVal, the Nutritional Scoring System scores ranks foods with a score from 1-100, the bigger the number the better (unlike the way many view larger numbers such as sizes and body weight). Perhaps with the exception of grade point average, SAT scores and salary, they would have done better to make the more desirable products associated with lower numbers.  But that’s a subject for another blog.
Here’s a description of how it works, taken from their website:
“The NuVal™ Nutritional Scoring System takes more than 30 different nutrients and nutrition factors into account when developing a Score. Nutrients with generally favorable effects on health are placed in the numerator: fiber, folate, Vitamins A, C, D, E, B12, and B6, potassium, calcium, zinc, omega-3 fatty acids, total bioflavanoids and carotenoids, magnesium, and iron. Higher values increase the NuVal™ Score. “
Nutrients with generally unfavorable effects on health decrease the NuVal™ Score and include: trans and saturated fats, sugar, sodium and cholesterol.
In addition to these two categories, “the NuVal™ System takes into account other key factors that measure the quality and density of nutrients, as well as the strength of their association with specific health conditions.”
And they recommend moving toward use of higher number foods to move to be healthier.

In many ways NuVal reminds me of the Rodale Press book, Eat This, Not That, a visually attractive glossy paperback of packaged food photos categorized as good and bad. The mere mention of it turns my stomach and makes me want to eat Twinkies (no, not the reduced fat ones). A top seller, no doubt, written by a non- nutrition professional who presents pairs of processed foods and declares one the winner. That is, based on some criteria he has decided (and doesn’t share) for each item. And, at least in his earliest books, the criteria appear to change. So one item may rank better given that it’s lower in saturated fat, but may be excessive in sodium. Yet on another page, the lower sodium food trumps the competitor, even if the calories are higher. Go figure.
The problem with NuVal
In this era of information overload—food rules and changing food science and recommendations that seemingly contradict, we get so much conflicting information that we no longer know what’s okay to eat. So in some ways this may seem like the perfect solution. Eat these, not those, good and healthy, versus bad and unhealthy. And move toward choosing the highest scored foods. What’s the problem, you ask?
These ratings basically do to foods what reputable organizations like the American Dietetic Association and the American Diabetes Association have worked for years to discourage. Namely, categorizing foods as good and bad, versus finding ways to have balance to our food eating. And there are a wealth of other concerns I have with it.
1) One size doesn’t fit all. You know that. So rating lite soy milk 82 and regular chocolate soy 68 might be fine for someone trying to reduce their caloric intake. But for the growing child? The athlete? The restrictive anorexic or bulimic? The elderly, struggling to get their needs met? See the problem? And to be penalized for higher calorie density?  We each have our individual health concerns and therefore need to personalize our approach to food selection. If I had kidney failure, a high potassium food, yielding a higher NuVal score would be undesirable. If I struggled with early satiety, fullness that comes quickly after eating, high fiber, low caloric density foods would not be appropriate. So the high scoring foods on NuVal’s list would be a problem for me.

2) Our perception of a food’s value can also have a negative effect on our eating. Remember when Snackwell’s came out in the 1980’s as one of the first fat fee cookies? Patients would come into my office and declare proudly that they had 5 Snackwell sandwich cookies.  They were drawn into the marketing message labeling them as a healthy, fat free item, and felt license to eat them, without regard to quantity. In fact, they contained about as many calories as the equivalent number of Oreos.
Similarly, score an item low and it becomes labeled as bad, or not good for you. You may start to see it as forbidden or “to be avoided”. You may end up eating the food, let’s say cupcakes for example, but without truly giving yourself permission. So you have a cupcake, but you don’t feel good about it. You may see it as having slipped from your healthy and desirable eating style. Perhaps you’ll start eating cupcakes when no one else is around, and leave no trace. And you’ll typically find yourself overeating in a “now or never” opportunistic way, overeating those forbidden, low-scoring cupcakes when you finally get the chance.

3) We don’t typically eat foods as single items. So the nutrition value of a single is less valuable, in fact useless, unless it is viewed as part of a whole. Let’s take today’s breakfast. While I couldn’t find an on line score for French toast, and since homemade versions are sure to vary, I will extrapolate the principles NuVal uses to rate it myself. I prepared it with my delicious homemade, low fiber challah bread, surely a low-ranking NuVal score. (Let me know if you’d like the recipe!) Then I added eggs—high in cholesterol, a NuVal negative.  So far it would hardly rank high as a healthy recommended breakfast food.
Yet the eggs are a valuable source of high quality protein, containing all 9 essential amino acids, the building blocks of protein, which NuVal gives no credit for.  And carotenoids, and vitamin D, two nutrients they do value. And add to this some berries, high in fiber, vitamin C and antioxidents, and a dollop of low fat yogurt. Maybe even a glass of low fat milk for some additional calcium and vitamin D.

And did I mention the pleasure factor? I so enjoyed my French toast this morning! It was delectable—the texture, the flavor and the sweetness from the drizzle of real maple syrup (high calorie density with little redeeming value)—a NuVal disaster I’m sure. (Quick tip—heat a small amount of syrup in a mini pitcher in the microwave for 10-12 seconds and it will both enhance the flavor and thin out the syrup, allowing you to use a smaller portion.)

And I suspect given how satisfied I felt eating this meal that I won’t be drooling over the muffins and pastries at the farmer’s market later. And I know I’ll be better fueled on my bike ride this afternoon, as opposed to if I had that perfect scoring unprocessed wheat bran! Ugghh!  So how useful was it to discredit my low fiber, non-fortified, white flour bread and French toast?

4) Even nutrients should be considered as part of the whole, not simply as their contribution to a single food. You may be hypertensive and trying to control your sodium intake. But that doesn’t mean that all items have to be low sodium. And then there’s the portion to consider. An ounce of pretzels (depending on the brand and the form) may fit just fine in a reduced sodium diet, for instance. But several ounces just wouldn’t work.

So if you struggle to manage the information overload and food selection, take this advice: pick the one or two nutrients truly relevant to you for your health and needs. High cholesterol your concern? Focus on the saturated and trans fat content of your food. But don't impose a strict rule that all foods must be low in saturated fat. Instead, consider your daily allowance to allow for some balance to your food selection. And some pleasure! And if a higher calorie intake is in order, then defy the masses and focus on your nutritional needs! Even if that means a lower NuVal score. And if you are struggling to break free from rigid rules resulting in a pattern of restricting and  overeating, than focus on getting what you really want to eat. Because ultimately, you'll be physically healthier by eating without extremes and psychologically better off as well.

Monday, August 23, 2010

Drink, Eat, Pray?

What I learned about drinking this summer.

This post is dedicated to my college-age patients, many of whom will be heading off to school over the next weeks. I will miss you all and hope that you will stay in touch through your insightful comments on these posts!
I’m great at justifying my indulgences—medium-dark roast coffee, freshly ground and French pressed, luscious dark chocolate, and fine wine, be it an “oaky” Chardonnay or a full-bodied red on a cool autumn day. So finding me rationalizing alcohol consumption should come as little surprise.  
In spite of its high calorie content, moderate drinking has its benefits. Really? This sounds as good as the news that dark chocolate is good for your heart! Yes, moderate drinking, defined as 1-2 alcoholic beverages per day may be good for your health. And one drink or alcohol equivalent is defined as 12-ounces of beer, 5-ounces of wine, or 1.25-ounces or a large “shot” of 80-proof distilled spirits or liquor (gin, rum, vodka, or whiskey).
This summer a new study revealed that normal-weight women (in the 39+ age category) who drink a light to moderate amount of alcohol gain less weight and are less likely to become overweight or obese than non-drinkers. Strange but true. And this is consistent with other studies showing that women tend to substitute alcohol for other beverages, without increasing total calorie intake (while men simply tack it on to their total intake).
Women consuming about one or two alcoholic drinks a day had the lowest risk of overweight or obesity, almost 30% lower, with the strongest link for wine. And from numerous other studies there is strong evidence to support a reduced risk of heart disease, gallbladder disease and prevention of diabetes, through improvement in insulin resistance.
But please read on. My experiences over the past several months leave me unsettled. While my client population may not be representative of the general public, I am struck by what they tell me about the amounts of alcohol being consumed. I have been enlightened about beer funnels, vodka as the mixed drink of choice and the inability to even know how much was consumed each night. And the drinking isn’t limited to a Friday or Saturday night. So the total alcohol intake is a far cry from the moderate description referred to above.
According to the National Institute on Alcohol Abuse and Alcoholism binge drinking is defined as a pattern of alcohol consumption that brings the blood alcohol concentration level to 0.08% or more. This usually corresponds to 5 or more drinks on a single occasion for men or 4 or more drinks on a single occasion for women, generally within about 2 hours. By that definition more than 1 in 3 college students are binge drinking (I haven’t dared to explore the rates among middle and high schoolers).
And the calorie cost for this drinking? Each alcohol equivalent described above provides between 100 and 150 calories, not counting mixers, depending on your beverage choice. And keep in mind that unless you’re at a bar and they are measuring it, your drink may have significantly more than the amount stated. Your vodka and crystal light may be providing a couple of hundred calories per glass, and a much greater alcohol impact. Most glasses of wine filled just halfway, will provide 6-8 ounces minimum. So two glasses provide more than just 2 alcohol equivalents.
While alcohol may be cardio-protective in moderate amounts, drinking even 1-2 drinks per day increases a woman’s risk of developing breast cancer. In one study, women who drank 27 or more drinks per week increased their risk of breast cancer 3 ½ times! And heavy alcohol drinking is linked with many undesirable conditions, including liver cirrhosis, cancers of the mouth, throat and esophagus, breast cancer, and traffic accidents, to name a few. Alcohol poisoning, from too high a blood alcohol level has the most immediate consequences, and may result in death.
The long-term risks may seem inconsequential. They are far off in the future. But what most people ask me about is this—How do I fit in alcohol while managing my eating and weight? So let’s do the math. If you are consuming a couple of large shots per glass, and drink 7-8 drinks in a night, that’s an average of 1500 calories for the evening, just from alcohol. So compensating with less food is hardly an option; you’d be starving yourself all day to allow for your night out drinking. And that recent study about the benefits of moderate drinking on weight control? It doesn’t apply to binge drinking. In fact, consuming larger amounts of alcohol is associated with decreased inhibitions around eating (forget mindful eating), and correlates with an increase in eating disorder behaviors and higher BMI.
So I fear I have failed you. Much as I can support fitting light or moderate alcohol into a healthy diet, I am at a loss to assist with fitting in the high levels you might be used to. The high alcohol intake, besides providing significant calories from the alcohol itself, leads to overeating. And a more sedentary activity level. So “Drink, Eat, Pray” might be the only option. And I don’t put a lot of faith in that as a treatment option. So please consider your options. And do drink responsibly, and not when driving. There is a middle ground (moderate drinking of a couple of drinks/day). And maybe even a health benefit to doing so.

Friday, August 13, 2010

The Oxygen Diet-Try it on yourself first!

I’m not a frequent flier but each time I have been on a plane I’ve been struck by the following flight attendant speech: “In the event of a loss of cabin pressure, an oxygen mask will drop down from above you.  If you are traveling with young children, secure the mask on yourself first. Then place it on your children.”

What? Place the oxygen mask on myself first, not on my kids? What are they thinking? As a mother, it seems so counterintuitive to meet my needs before my children’s. How could my safety and wellness come before theirs?

Well I finally get it. It’s not that my needs or my survival is more important than theirs.  On the contrary. It’s just that in order for me to be of any use to them I need to have my oxygen. I would be in no position to care for my children and make the decisions necessary for their care and wellbeing if I am without oxygen.
Now let’s substitute food for oxygen. Unless you are well fueled you are not in the best position for taking care of others—your kids, needy family members or even close friends. Maybe no one relies on you in this way. But perhaps you babysit, or work in a service profession, where others are dependent on you and your good judgment. If you are restricting your intake it becomes a challenge to make wise decisions and to be successful in whatever you do.

Sounds like I’m just speaking to my eating disordered readers? Think again. Even those of you who do not fit that category can set yourself up in the same way. Perhaps you’re overweight and struggling to move to a healthier place. You may find yourself restricting your food intake, going long periods without eating. You may feel low energy, even a bit foggy headed as a result. And certainly we have all experienced the irritability of the restrictive dieter.

There are two key messages to leave you with.

1) Struggling to motivate, to get healthy for your own sake? While making change for you is ideal, you may find it challenging. Consider finding the strength to make change for the sake of those you care about and may even care for!

2) Changing your weight, even if it is appropriate and necessary for health reasons, doesn’t require suffering. Change, yes. But not suffering. And it shouldn’t compromise your wellbeing. You should not be feeling cranky, lethargic or starving. And if that’s what you’re experiencing, you need to be tuning into your hunger, trusting it and responding to it better!

Friday, August 6, 2010

Size matters. But not how you think.

The facts about serving size and portions.

What do a quarterback, toddler, 90 year old woman and you have in common? Very little, I suspect. And yet each will glance at the nutrition label on packaged foods and observe the serving size. Some may measure it, others might strive to meet it, and many will ignore it. But most of you will expect that you should be sticking to the stated portion. At least most of my blog readers.
So what is the serving size declared on the label really for? It is simply a way to define nutrition information, required by the FDA. And most serving sizes are standardized by product. For instance, approximately 1 ounce of cereal or ½ cup of ice cream, regardless of the brand, are considered the serving sizes. This way consumers know that the information (the protein, calcium, etc.) are based on that serving size listed on the label. And the calorie content for that same serving can vary significantly!
Yet most people I’ve discussed this with believe that the serving size is the amount they are supposed to be eating. And not a morsel more! You measure out 1 oz of cereal for breakfast, the right amount according to the label, and you are left feeling that the problem lies with you. “Why isn’t this enough?” you may ask yourself.  Well, does it make sense that the football player, the growing child and the sedentary woman would all need exactly the same amount of calories, of fuel? And that that amount is also appropriate for you? Clearly not!
If you don’t follow the rules, the amount you were supposed to limit to, you may feel that you have slipped. Yet neither Kellogg nor the FDA knows how much you actually need to eat for breakfast. And neither do I. The only one who can truly judge is you.
I often use the analogy of titration. For those of you who have long forgotten chemistry, it is the process of figuring out just how much of a substance is necessary to cause a reaction. Take a look at this for a quick visual:
One clear liquid is added to another, drop by drop, until the point when a reaction happens. In this titration, the solution turns pink. Could they dump all of one substance into the other and have the reaction occur? Sure. But they are looking for the point where it is just enough of the added substance to turn pink.
Continuing with the food analogy, we could eat a lot at once, and have the “fullness reaction” happen, just like you could combine these two clear liquids all at once and have it turn deep pink. But with eating, we are looking to identify just the start of “pink”, so to speak. And it takes a while for us to master our own food and eating titration. So you may be disappointed if you are expecting a quick reaction.
The point? The nutrition label isn’t the answer to knowing how much you need—to knowing how much will put you “in the pink”.  It is a process to figure out just how much your body needs to eat at any time. It takes time after eating your meal to sense fullness (see the Tylenol reference in previous blog entry). And it takes time to identify your eating patterns.
If eating the portion size stated on the label leaves you hungry an hour later then clearly that amount is not enough. So in addition to eating a snack then, be sure to increase your portions next time you eat breakfast and assess how that feels.
And if you can’t tell if your portions are excessive resulting in “deep pink”, consider reducing your portion by 25% and see how you feel. Perhaps that will still get you in the pink, closer matching your need for fuel and energy balance.

Monday, August 2, 2010

Moving your thoughts, moving your body.

Maybe the last post just doesn’t apply to you. The compulsion to exercise is far from the problem. Rather, it’s a struggle to even think about moving more. I mean, why bother when perhaps you feel it’s hopeless? Here are some obstacles to exercising that I frequently hear from my clients:

   -“Last time I started exercising I didn’t see results, so I stopped.”
   -“I’m supposed to be doing one hour or more of exercise per day, and that’s just not gonna happen. So if I can’t do that, no sense doing any.”
   -“I’ve already failed at meeting my goal—I didn’t exercise the past few days, so I may as well skip it altogether.”
See any flaws in this thinking? Perhaps you’re not exercising because you just didn’t “see results”. But were there really no benefits of your increased activity? Did you not notice any improvements in your energy level? Stress? Feelings of accomplishment? Was there no impact on your appetite and your motivation to take care of yourself and eat well? Or perhaps on your sleep? Is weight change the only measure of success, of getting results?

It certainly shouldn’t be! Managing your weight is only one of many benefits of exercise. And I choose the word managing intentionally. Regardless of your personal need in terms of weight—to stabilize it, lose it if you are overweight or increase it if you are underweight, exercise can be quite valuable. That is, if you fuel your body appropriately.

Maybe your past experiences with exercise helped to stabilize your weight, in contrast to the unintentional climbing you struggled with. Exercise may have helped to prevent future weight gain but you failed to recognize its value. Or perhaps you improved your activity, without addressing your eating.

And who on earth begins to be active with 60 minutes per day?  While an hour daily might be a great target, setting the bar too high is likely to set you up for failure. Just today a patient was relating the experience of a recent visit with her physician. Here’s the backdrop. Struggling with binge eating, pre-diabetes, overweight and high cholesterol, Kay presented to me for guidance. Over the past several weeks she reports that her binging has stopped, completely. Still overweight, yes. But her weight is gradually dropping as her eating behaviors and activity have improved. And she feels so much better. And no, she did not begin with an hour a day. In fact, I believe we started with a modest goal of walking 15-20 minutes, a few times per week, appropriate given her sedentary activity level.

So about the physician visit. He apparently told her that her walking isn’t good enough. And that yup, she ought to be doing an hour a day! And that he exercises daily! So instead of acknowledging that she’s made remarkable progress, for the first time in years, he makes these absurd recommendations that were nothing short of devastating.

Rather than viewing your progress as half empty, as just not good enough, try to focus on what you have achieved, even if it falls short of your (or the doctor’s) ideal level of exercise. And please acknowledge the many benefits you're getting from exercise on many levels—physically as well as psychologically. And set realistic, achievable goals and reevaluate them from time to time. And finally, try to choose activities  you enjoy so you’ll be more likely to want to stick with them.

Please send in your comments and let me know how you’re doing!