Thursday, July 25, 2013

Struggling to Manage Your Weight? Products, packaging and marketing leads to second guessing your eating.

This is a self-serving post. Really, I need to vent; because these things drive me crazy. They’re not directly harmful—except for the laxatives to be addressed in the next post—but they cause you to stumble. They mislead you. They impact your thoughts about what’s healthy and what’s allowed, and they add to your list of should and should nots.

They impact all of us, regardless of our weight. I’m just starting my list, in no special order, but I hope to inspire you to add to it—your comments, your own pet peeves. Because the more you're aware, the less you'll be mislead by the subtle, unreasonable nutrition messages. And the better you'll get at trusting your self and your body.

Almond milk: Forgive me if you are among the food allergic who can’t consume cow’s milk or soy milk. For you, almond milk is a reasonable option as a milk alternative to help meet your calcium need. But with the exception of its higher vitamin E content, it has little merit; it truly falls short as a milk alternative for those who do tolerate milk and soy. Here’s my issue: it short-changes you, because it looks like a glass of milk. But the calories don't compare, nor does the protein.

Sure, almonds, (as they proudly display on their website for Almond Breeze, one brand of almond milk) are high in protein and fiber and low in sugar. But this so-called almond milk? At 1 gram or less of protein, it is 6 or 7 grams less per cup compared to soy or cow’s milk, respectively. And a total of 1 gram of fiber. So please don’t assume that because it’s made from wholesome almonds that almond milk is anywhere near as nutritious.

Gatorade light: Why-oh-why would you choose light Gatorade? If you are consuming this sports drink for the reason it was developed—‘specifically formulated to help you perform your best’ during sports and training, then why have a reduced carbohydrate and low calorie beverage? Did I mention that calories=energy? The calories, from carbohydrate, are a convenient, easy to absorb fuel while exercising. But the light version is hardly worth it, providing minimal fuel to support physical activity.

And for the record, the electrolytes you get from Gatorade—the 160 mgs. sodium and 45 mgs. potassium from the recently increased serving size of 12 (vs. 8) ounces—is no greater than you’d get from a 12 ounce glass of milk (160 mgs. sodium and 560 mgs. potassium). 

Ok, I know you’re not about to drink milk on your run or bike ride. But unless you’re doing long duration exercise, generally more than 90 minutes, there’s little need for a sports drink anyway. You could easily replace your electrolytes when you get home, perhaps with a serving of pretzels and an orange or banana—a more generous replacement for both sodium and potassium losses. Just add any beverage to replace your fluid losses.

Sandwich thins: Made by Arnold and other companies, these seem innocuous, and are perhaps even viewed as a healthy alternative to sliced bread. And, they’re well liked, it seems. (I can't say personally—I've never tried them).

My problem? Eating one is like having just half a sandwich. And unless you are quite short in stature and quite sedentary, you likely need more than a half sandwich for a meal. Yet they look like they should be enough—there are 2 halves—but also half the calories. And, they provide little surface area to add your peanut butter or Vegemite (shout out to my Australian readers) or tuna or whatever. But if you love them and want to include them, have 2 for lunch! Or else when you get hungry later you’ll be beating yourself up thinking you’re not deserving of eating again!

Skinny Cow: I really love these ice cream sandwiches. But do you want to know a little secret? They’re no lighter than most traditional ice cream sandwiches you can buy (at perhaps a lower cost per bar!) But doesn’t Skinny Cow sound so light? All brands I looked at which are a similar size were within 20 calories (higher or lower)—and not promoted as a ‘skinny’ product. I do love their tag line, though: ‘who gives a lick about calories?’

The orange juice aisle: Maybe it’s just in US suburbs, but supermarket shopping is simply an overwhelming experience—even for me. A recent trip to the market revealed more choices than I could ever care to contemplate. Beyond the pulp options, there are orange juices fortified with calcium, and ones with fish oils (can you imagine?). It begs asking ‘Must one food item, this orange juice, meet all of my needs?’ Can’t we have orange juice for its naturally occurring vitamin C, folic acid and potassium? Must I get everything from this single item?

Similarly, must my pasta be protein fortified—or can’t I have chicken with it? Does it need to have added fiber, or won’t my eggplant, artichoke, peppers, etc. add that? Get the point?

Whey protein powder: Some of you who restrict your food intake and those vegans who plan poorly may truly benefit from boosting your protein intake. Why not use whey protein, the refuse, the left over liquid that remains when making cheese, conveniently packaged and sold at top dollar prices at health food stores, supplement sites and health clubs?

Whey protein boosts your calories—so this might be a positive for those of you trying to add some. But a whey protein shake mixed with water, in spite of it’s high protein content falls short as a meal replacement. And let me remind you about food halos. There’s nothing magical about protein. While your body requires protein to fuel your muscles and maximize recovery, from the looks of the label you might be thinking that you need whey more (sorry, couldn't resist) than you do. Even bodybuilders need little more than 1 gram of protein per kg body weight (or .45 gram per pound body weight). 

Are you a non-body builder? Then .8 grams per kg (or .36 g/lb will meet your need. (For most, a daily total of 50 or so grams is adequate.) No doubt you'll see how over the top these whey protein supplements actually are, and not without their risks

Shrinking packages: Why has the portion of yogurt dropped from 8 oz (one cup) to 6 oz, to in some cases 5 plus ounces? And, for the same price? And why did my half-gallon of ice cream slim down in such a deceitful way, denying me the full number of portions it used to have? (It’s now 2 cups short of the old packaging, so if you feared you were plowing through it more rapidly, fear not!) Food manufacturers should not determine what an appropriate portion is, so be sure that you allow yourself to have as much as you truly need. And that's likely to be more than a 100-calorie pack, too!

Packaged nutrients, not foods: Must we be categorizing everything we eat based on nutrient content? Can't we just eat things because we enjoy them? Because they give us pleasure? 'Protein and Fiber'? Really? Looks like sweetened, cluster cereal to me.

I'm just scratching the surface. Gentle laxatives, gelato, bottled waters and other favorites of mine will be addressed in an upcoming post! Please send me your pet peeves, too!

Saturday, July 13, 2013

Not thin enough? Not sick enough? YOU—eating disordered?

I’ve done it. In just a few sessions I made my mark on a future generation of nutrition providers—an intern interested in eating disorder treatment, no less. She was, like most, biased by the sensationalized images and the media’s descriptions of emaciated anorexics; of teenage girls who ‘just wanted to be thin’; and of visibly unhealthy looking bulimics. Those were people with eating disorders, she believed.

Yet in the few days she has spent with me, she’s seen anorexic men, normal weight binge eaters, and women in their 40s, 50s and 60s struggling with eating disorders. Some developed their disorder recently, some only recently presented for treatment, having struggled with their relationship with food for decades. All are pained by their condition—no one chose to live with a disorder. Really, there are places they’d much rather be than in a medical office on a nice summer day.

Yet what they all have in common is that their appearance is not a give away. Most look just fine, I must say. (Although I’ll admit that without their layers of clothes some would be viewed as significantly underweight.)

Yet most carry their disorder on the inside.

It’s unfortunate, really, because as a result, they have suffered silently. Their doctors and health care providers never knew to direct them for the necessary expertise and failed to support recovery. And often they put their foot-in-their-mouths with inappropriate comments about weight or “healthy, runners’ blood pressures.” If only they could have seen it. If only it was as clear as the media portrays it. If only they knew that most people living with eating disorders don’t look like they have an eating disorder.

If you didn’t know to ask, you’d have no idea that perhaps 95% of their thoughts are spent perseverating about when they will eat next, and just how much; about whether their stomach is still flat, or whether they will have access to a bathroom after eating to purge; or whether they’ll have an opportunity to binge without anyone to witness it. If only medical providers thought to evaluate food intake and behaviors before the comprehensive, costly GI workups which fail to identify the cause of the chronic distress from hunger or slowed motility, or the reason behind the heartburn—namely, the chronic purging.

How helpful it would be for primary physicians or the referred-to neurologist seeking an answer to the puzzling chronic headaches. No, no one considers inquiring about the time between eating and the food restriction. Yes, migraines and other headaches occur more often with under eating.

Hope comes with new DSM

Fortunately, the new DSM-5 guidelines may help. They’ve changed the criteria for defining anorexia, removing some of the requirements that kept individuals from getting the help they needed. And, from misleading health providers about what eating disorders really look like. Now, rather than defining anorexia by using a specific weight change (such as the previous 85% of normal weight) it appropriately offers a broader definition. A low BMI is not a requirement for diagnosis!

The guideline states “the clinician should consider available numerical guidelines, as well as the individual's body build, weight history, and any physiological disturbances". In other words, an individual who is objectively overweight or high BMI can now, fortunately, be fairly labeled as anorexic if he/she has restricted intake resulting in significant weight loss together with physiological signs of starvation together with meeting all other criteria for the diagnosis. And, missing a period is no longer a requirement for diagnosing anorexia. That certainly may impact the many men out there struggling with feeling like an imposter with a ‘women’s disorder’!

No, you don’t have to fear that your weight isn’t low enough for your disorder to be acknowledged. And you don’t have to look like an adolescent poster child for anorexia.

No longer should you feel you need to lose weight to fit the anorexia definition to enable treatment or, for that matter, to validate your suffering. No longer does EDNOS—that vague ‘not otherwise specified’ diagnosis—need to be used for those restricting, nor for those suffering with Binge Eating Disorder (BED). Yes, you are sick enough.

Anorexics are 60 lbs. And individuals with anorexia are also 200 lbs. Dropping weight with severe food restriction is no less serious if your 30 lb. or 50 lb. weight loss brought you to 130 lbs. or to 90 lbs. Thank you, Deb Burgard, PhD, an AED member and blogger for HAES, for making this point loud and clear.

Having a BMI in the healthy range is hardly healthy if you are compulsively exercising, purging or restricting to maintain this place.

I’m so glad the intern gets it. It will make her a better provider when the time comes to practice, as she will now know to ask the questions to help identify and ultimately support recovery from an eating disorder.

But have I made my point strongly enough for you to hear? Please pass this along to increase awareness—to your friends and family members who you’d never know might be suffering—and to your medical providers who never thought to ask.