Want to know how much I ate today? The pros and cons of comparing your eating to others’

Today's breakfast-crepes with sauteed fruit,
melted chocolate drizzle and vanilla yogurt.

When I was little, I mean, when I was young, (I was never particularly little compared to my peers), I recall a recurrent argument with my mother. “She can have it/eat it/do it—so why can’t I?”, I’d beg to know, to which she’d respond something like “If she jumps off the Empire State building does that make it okay for you too?” (Yes, I’m from NY and that was the tallest building back then.) Her point, of course, was that what’s good for one isn’t necessarily good for another. And if you’re going to compare, be careful.

Which gets me to you and your need to compare yourself to others; and more specifically, to compare your eating and your weight.  So what do you think—helpful to compare or harmful? Is it okay sometimes, or must you be consistent and never compare? Does it matter if you’re under eating, or if you’re overweight or is it simply dangerous?

Does it really matter what I eat (or anyone else, for that matter)?

Well, yes. To be honest, that’s why I include all the so-called food porn on this blog—beautiful images of delectable foods—all of which I am personally eating. Perhaps it shouldn’t matter. I mean I can give you sensible guidance regardless of how I choose to eat. But knowing that someone else is eating cookies or including carbs, or adding fats—things you just might fear—and is perfectly fine, reassures us. Viewing a peer’s eating as they’re comfortably eating ice cream can help motivate. Yes, normal, healthy people can and do eat ice cream. Seeing this can help increase your flexibility around foods and food categories—and that surely can help you change your relationship with food.

Yet it’s rather unprofessional to suggest that because something is fine for me that it’s fine for you. When I make my recommendations, they are based on my clinical experience—my 28 years in the nutrition field—and my knowledge of nutritional science and the limited research we have to work with.  What’s fine for me, isn’t necessarily right for you; I might include lots of veggies daily, but for you that added volume might be a challenge, making it difficult to meet your calorie needs. I might make most snacks rather calorie rich—when I’m out cycling or hiking for many hours and I’d rather eat smaller portions at each snack for convenience—this may be unnecessary for you; I’m almost 5’8 and my weight is just fine where it is, but your needs may be different—based on your height, your bone structure, your muscle mass, perhaps from years as an athlete, and your needs to normalize your weight to support your health.

Be careful!

My lunch. Looks big, right? Two pitas 'cause they were those too-light-be-
adequate 80-calorie ones. Certainly larger appearing than my husband's!*

When comparing to others, you might think—“She’s only eating a salad, why is that not okay for me?” or “Why do I need to work out when none of my coworkers do?” You may look at a friend and wonder how they can eat whatever they like when you have to be more mindful, or else your weight climbs out of your healthy range with no effort. Patients get frustrated when they report that their coworkers eat fast food and “junk food” and their weight is just fine, whereas they have to work hard and watch everything they eat. But they aren’t with these coworkers 24/7. Who knows what happens the rest of the time. What you see is a small slice of time, which may or may not reflect how any individual really eats.

Maybe they eat lighter when others are around—but make up for it in private. Perhaps they eat more only when they’re out with friends like you, but restrict when they are alone. Essentially, you have no idea what really goes on when you’re not with them. Unless I asked (and unless he were honest), I’d have no idea that my husband eats the leftover baked goods from work functions when he gets hungry and hasn’t brought enough to eat from home. Or even if he has, yet they are sitting so attractively frosted and displayed in work common areas for all to grab.

What you observe others eat may not be in their best interest—nor in yours. They may be struggling, denying their hunger and feeling fatigue, and preoccupied with food all the time.

He looks sedentary, but you should've seen him run today!

Are you comparing yourself to others for the wrong reasons? Do you let your eating disorder do the comparing as in “She’s having the fries, but I’m going to just order the side salad” or “He’s ordering the large ice cream, so I’ll just get the kiddie sized one.” Not what I’d recommend!

But I’m different

Do you ever think “that’s fine for you, but my body’s different”? You’re not alone! Somehow you may struggle to believe that what’s true for everyone else—that they can eat a range of nutrients including fats and protein and carbohydrate and no foods need be absolutely forbidden—just doesn’t apply to you. In fact, this basic truth does apply! Take a look at this older post: http://dropitandeat.blogspot.com/2012/04/youre-not-so-special-rethinking-your.html

My FAVorite cupcake place--located in NYC.

There are dangers in comparing your eating with others, as one size does not fit all. Just like food labels should not dictate how much we should be consuming—they merely identify nutrition info—you need to learn just what will meet your body’s individual needs.

And just because they decide to put themselves at risk and jump from the Empire State building doesn’t mean it’s okay for you.


* And for the record, I had a Napoleon pastry late afternoon and take out Japanese for dinner--with some nice Chardonnay. And if you asked, I'd tell you there were a few other items, too.

Please share your thoughts and let me know you’re out there reading!

Exercise: Enough or too much? Knowing when to change gears.

Are you exercising enough or too much? Do you feel you need to be doing more? It’s often hard to judge for yourself. So take a look at these cases, modified from patients I encountered this past month, and see what you think:

Regardless of the activity, do be sure to listen to your body's needs!

• A competitive skier, who spends 5 hours/day skiing and 90 minutes/day hiking;
• A college student who runs 30 minutes, 4-5 times/week;
• A biker who biked 55 miles one day, 107 miles over 3 days;
• A coach who worked out at the gym 6 days/week, and spends 12 hour days physically active coaching.
• A woman with anorexia who runs 3-4 days/week for 40 minutes.

If you’re thinking: “It depends”, you’re right. So here are some more details:

• The skier came to see me wanting to gain weight to improve her strength and performance. She was fully on board with gaining weight and with eating more.
• The college runner? He pushes the intensity and distance when he’s overeaten or binged and then also overcompensates by eating less.
• The woman with anorexia? She has been successfully cutting down from her daily, injury-inducing hour-plus runs, while simultaneously increasing her food intake.
• The sports coach? His activity stays constant regardless of his intake. And his intake hovers between 300 and 400 calories per day. And his weight is stable.
• As for the biker? That’s me. I’m not making excuses but my husband got us lost on a ride last Sunday and we did way more than planned in our training for a 150 mile fundraising ride; but I did need to get the training in and was planning on a 40 miler. Along the route, after a full breakfast I had a delicious scone—and a generous lunch out. I acknowledged my poor planning when I petitioned my husband to part with one of his bars. He gave in and I ate it, and I was quite thankful.

Now what do you think? Is it becoming clearer?

It’s difficult to fairly evaluate activity levels simply by knowing the type of activity and the duration—whether or not you have an eating disorder or disordered eating. Without evaluating the bigger picture of thoughts and intentions, that is. The skier—with her very high activity but drive to eat enough for performance and health—is the least of my concerns—as long as her eating changes support her intentions. But the coach and the college runner? Activity is clearly used inappropriately in their cases.

But what if intentions are healthy—you want to maintain your healthy weight or even lose weight from your current higher than usual and healthy place, perhaps to include a moderate level of activity? Yes, I do support increased activity in these patients. With caution, though, in those with a history of eating disorders. And I support increased activity to help improve elevated blood sugars and cholesterol levels. But if you spend your waking hours premeditating how to work out to justify your eating, that’s a problem. If you perceive that it’s healthy to work out—for instance, you have intentions to be a healthy person—but your food intake falls short, resulting in low energy, irritability, early fatigue, inappropriate weight loss or slowed metabolic rate (with low body temp and heart rate)—then those good intentions clearly aren’t enough.

A healthy mind and body

Compelled to exercise at midnight because you can’t sit with the cookies you ate? It’s not enough that your vital signs are stable or that your weight is “better than it used to be”. No, there’s a problem here. Obsessed with the calorie displays on the treadmill, or the number of steps or miles on your pedometer or FitBit? Maybe it’s time to rethink your activity.

From my clinical experience, I’ve seen more previously sedentary people give up moderate activity when their sole goal was dropping pounds. Patients who exercise strictly to manage their weight are challenged to maintain their activity. If they didn’t drop weight in spite of exercising, they think: “why bother”; they ignore all the positives like the sense of achievement in having followed through with their goal, the improvement in mood and in sleep. They forget how nice it was to have time for themselves—or to connect with others around something other than eating. They fail to remind themselves about how their endurance or their strength has improved. So they drop the exercise.

Ok, I also ride to get to great places. Provence, France

I don’t ride to lose weight. I love the outdoors and love the feeling of the breeze on my face, like a dog with his snout poking through the car window. I like how it feels when I’ve accomplished a ride, but also how it feels while I’m riding; yes, I even like the journey. I enjoy the camaraderie of riding with company, but sometimes prefer to go off by myself. And my weight? It tends to remain within a couple of pounds throughout biking season. No doubt, because I am mindful to eat enough, stay strong while cycling—sometimes even when I don’t notice hunger. Sound crazy? There are times—like immediately after my ride or when we take a rest, that stomach hunger isn’t clear. Yet the fatigue might be stepping in, a sign of hunger gone too far, which can be resolved with nourishment. Sometimes the act of pushing fluids to stay well hydrated limits my perception of hunger. The high intake of water or Gatorade can buffer your hunger, making it more challenging to know that eating is necessary.

But if I did ride to support stabilizing a climbing weight, or to turn this trend around—would it be a problem? Perhaps not. Exercise, per se, is not the issue. But using it while denying adequate nourishment surely requires some help.

Back to my patients

Sure, the frequency and duration of activity might be a red flag, but we really need context to gauge its appropriateness.

The skier I have little concern about—in spite of her very high and frequent exercise—because it appears that her head is in the right place. And I was met with no resistance when encouraging practical calorie boosting recommendation to increase her energy and her weight.

For the coach with a very low calorie intake, his weight might be stable, but his intake is very restrictive. And he has a history of losing significant amounts of weight combined with unhealthy thoughts and behaviors—that’s a major problem. There should be no physical activity for him—at least until his intake increases significantly. Exercising, in his case, will only break down the muscle he has long worked to develop.

What are you hoping to achieve by working out?

The 30-minute college runner’s activity concerns me a great deal. Clearly it’s not the amount of exercise, but the way in which it’s used when he is uncomfortable sitting with the distress of eating, when he perceives he’s eaten too much. Yet I’m less worried about my patient running with anorexia—as long as she continues her progress with eating enough and maintaining her weight and medical stability—which she has done beautiful well with.

In some instances it’s quite clear that the exercise prescription needs be refined. If your weight or vital signs are falling out of range—something has to change, starting with reduction or elimination of activity; and if your eating becomes more restrictive, even if your weight is stable (due to slowed metabolic rate with undereating + exercising), activity needs to go. Really.

Many individuals can include exercise and be healthy—even if the exercise supports weight loss (in someone for whom weight loss is deemed appropriate by their medical team).

Talk to a therapist, your doctor, or your dietitian about your activity level. But don’t forget to share your thoughts—not just the details of duration, frequency and intensity of your activity.

Body Wraps, Toxin Removal and More: What I Learned at the Gym Today

I'd much rather be hiking...

It's hard enough starting at a new gym. Generally, I dislike going to gyms, preferring instead to enjoy a long bike ride, a hike or a cross-country ski or snow shoe when weather permits. But living in New England, there are times, like now, when conditions are simply not favorable for either of those activities.

So off to the gym I went, attending my first spin class of the season, at a new gym with a new instructor. And I could barely get through it. No, I am not that out of spin shape—although those cycling muscles certainly needed a workout. Rather, I was feeling my blood pressure rise as I sat through the marketing pitch and endless misinformation by this supposed promoter of health—the spin instructor.

I'm still headachy from it, so in truth, I am blogging to air my annoyance and frustration.

You know me be now—I am not shy to share my opinions, particularly those I feel strongly about. But this was a challenging setting. Jane, I'll call her—no, Barbie better suits her—stood before the class of about 35 cyclists confidently spewing her crap. Misinformation spilled from her mouth with no objection from the group, until I, a newcomer there, just had to speak up. But it was hardly the forum to debate in, and my rebuttals could be endless if I countered every outrageously false claim about weight loss.

No, neither body wraps nor green
powders will remove body fat.
Sorry!

She endorsed a powder she was selling with her personal testimonial about how she believed it really helped her, as it releases the toxins from the body, those horrible things which fester and cause disease. (Toxins, by the way, are released from our bodies every day, with no need for a product to make it happen.) And it gave her natural energy and promotes weight loss. (For the record, calories are the form of energy we get from foods; a product with no calories has no energy, although you may get a short-term boost from stimulants such as caffeine.) Then I heard her endorsement of the body wraps for sale, which essentially shrink your body a size or so overnight! All without dehydrating you! And finally I learned that you should be drinking half your body weight in ounces of water each day. 300 lbs? That's 150 ounces each day of water, about 5 liters or quarts per day.

So why am I all upset, you ask? Where shall I begin?!

• because while for me it was simply an irritation (and a big one at that), I know how others will be lured by this misinformation, sold products with false claims, sucked into unhealthy thinking and potentially dangerous supplements; more misinformation makes sensible thoughts a challenge;
• because she was speaking to a group of completely normal weight individuals, none of whom could afford to lose weight;
• because no one should be sucking down water or non-caloric beverages instead of eating when they need fuel, simply to mask their hunger;
• because she's setting people up for failure and unrealistic goals, luring them for her personal financial gain, to buy a product, in the case of the wrap, that at best may contribute to a decrease in hydration for a temporary appearance or short-lived sensation of lightness;
• because if we each spoke up every time we heard something we know to be false or inaccurate, then maybe we could make a difference!

Yet another gym promotion. Uggh!

There, I feel so much better now. I think I'll go have dinner, now that I can more calmly and peacefully enjoy it.

Thanks for letting me rant!

Obsessive Workouts and Protein Powders: How Concerned Should We Be?

Reactions to the NY Times article and the Pediatrics study on teens and muscle-enhancing behaviors.

I'm bothered by something I read. "Compared with a sedentary lifestyle of video games and TV, an obsession with working out may not quite qualify as a health hazard", as stated in last week's NY Times article. While the article brought to light the silent struggle many boys deal with—or rather, don't deal with—their obsession with weight training, dietary modification and steroid use to achieve the 'perfect' body—it failed big time in educating readers about when to be concerned, and what we can do to prevent this unhealthy trend. But this is not just about boys—the Pediatrics article identified that girls, too, are taking steroids and more frequently protein shakes to increase muscle mass while pushing activity.

Yes, teens, both boys and girls, have become more focused on increasing their muscle mass. "Strong is the new skinny" is a current sentiment; neither being healthy nor slim is good enough. The bar has been raised necessitating increased muscle mass to change one's appearance. And the price they pay is far greater than suggested in the Times' quote above.

Lean and muscular, yes, but nor much of a sex drive!

But how big a deal is it if a teen—or an adult—takes a supplement or pushes their training to change their appearance? The actual study, in my humble opinion, did little to differentiate unhealthy disordered behaviors from more innocuous ones. What's the issue with weight training to increase muscle mass, any way? What's the harm in your taking a protein shake to bulk up your muscle a bit? (Steroid use is another story, and that is well addressed in the Times article.)

If you're like twenty-three year old Nathan, it's quite a big deal. He relied on the gym-endorsed protein powders, "to promote muscle growth". All things high in protein were considered safe—if they were also very low fat. Despite my urging to reduce his exceedingly high protein intake, and to liberalize his intake of fats and carbohydrate, his kidneys began to fail, struggling to filter the extraordinarily large load of protein waste products. His thoughts were all consumed with when he'd be able to get to the gym and when and what he'd be eating next.

But this is not solely a male thing, as the Pediatrics study shows. Girls, though, are more likely to modify their diet, while boys will increase their gym training to 'meet their needs'.

And what if it were high in carbs?

Like Karen, you may be spending more and more time at the gym while restricting your intake, ultimately finding it too stressful to live life with school and work demands, along with your rigid workout regimen.

Certainly, drinking protein supplements is not itself a cause for alarm. But relying on shakes in lieu of real food is. It impacts our ability to socialize, to be flexible in eating situations and to get all that we need nutritionally. A diet devoid of fats and carbohydrate will be deficient in much-needed nutrients, and typically in calories. A sense of deprivation often results, accompanied by obsessive thinking about food and eating and weight.

As for the workouts, where do we draw the line about what is healthy and safe, and what is excessive? If you're in a community of triathaloners, marathon runners or iron men/women, a few hours at the gym will seem inconsequential. 

But is it driven by a preoccupation and distortion that anything short of a few hours will leave you fat or unfit? Many of my patients believe falsely that working out is always a good thing. Nothing can be further from the truth. When intake is inadequate, working out not only won't build muscle mass, it will help break down muscle to convert it to fuel! And when net intake is substantially less than need (either because of very high activity or low intake) metabolic rate slows down, so you burn fewer calories 24/7. Certainly not what you intended!

Surprisingly, there was no mention of the low testosterone levels that result in males, similar to the drop in hormones seen in females with anorexia. Tell this to those boys and it might motivate for change. Sex drive drops, facial hair diminishes and risks to bone density increase as well. For boys in their growing years—which might last until 18 or 19 years—the consequence may be stunted growth. And the opportunity for catch up is lost once the bone growth plates have closed. Most boys and girls do care about their height, but do they realize this may result?

And what messages are we conveying to our kids with their school BMI screenings? Are we faulting them for their high BMI (which will remain high as muscle mass increases and height fails to increase)? Or are we fairly looking at an increasing BMI percentile for that individual as a possible marker for unhealthy behaviors—be it steroid use resulting in rapidly increasing muscle mass or binge eating? Are we presenting being obese as so horrific that even if their behaviors are healthy, we tell them they need to lose weight? Is a drop in BMI in an overweight child healthy if they starved themselves or compulsively exercised to get there? 

Shouldn't we be screening with questions about thoughts and behaviors, not just BMI?

Are we reinforcing their interest in fitness because we perceive it as healthy—no matter what? Do we share the same distorted views about all things protein-rich being "good" while villainizing carbohydrate-rich grains and fat-rich foods, too? Are we contributing to the misinformation they hold fast to? Why don't we recognize that there is sometimes pathological thinking and behaviors that drive extended workouts and dietary changes?

I don't have the answers.  But I do know that we are influenced by cultural standards of beauty, and that these images have become more and more unattainable. Yes, without steroids, you can't possibly bulk up like many of your weight-lifting role models, nor can you be both healthy and low weight as the air-brushed magazine pics would lead you to believe.

Something has to change. And it can start with you. Add your comment. Share this piece. Counter misinformation and acknowledge unhealthy behaviors—even when society fails to.

Consider these older posts for more information on topics covered in this post:

http://dropitandeat.blogspot.com/2010/07/daily-exercise-is-must-or-so-you-think.html

http://dropitandeat.blogspot.com/2012/03/protein-new-black.html

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!)