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!

Avoidance isn't the answer. It's time to bear hunt.

Recovery is a tricky thing. You may be making progress with your eating—whether you are working to overcome binge eating, anorexia or bulimia—but may be fooled into believing that you’ve truly normalized  your relationship with food. It may feel like you’ve largely recovered; you’ve started to include ice cream (but only when you’re out, never keeping it in the house). And your binge frequency is close to zero. And surely you who’ve been restricting deserve credit for eating more than you used to—at least of the foods you deem good for you.

But consider this:

No, avoidance isn't the answer.

• Is it really recovery when the only way you feel in control is to fill your days with so much activity (no, not even physical activity) that you don't get to sit with your feelings? You work long hours waitressing, take on extra shifts or extend your work hours only to avoid being with yourself. You struggle to allow yourself to feel hungry—fearing you're not trustworthy to respond correctly. You equally fear fullness, that satisfying feeling of truly getting enough. Would you allow your best friend to carry on this way?

• Is it really recovery when you stop binging, only to restrict your food intake? You stick around family or friends because you know you'd never binge in their presence, but you also struggle to eat enough when they're around—and even when they’re not. If your child see-sawed between binge eating and restricting her food intake, would you say “that's just fine”?

It doesn't have to be so scary.

• Is it truly changing your relationship with food when your solution for managing chocolate cake—or your favorite flavor ice cream or bread or peanut butter—is to simply never have it around? You forbid yourself access—just for now, until you meet your weight goal, or maybe believing you’ll resist these for the rest of your life. Would you suggest this to your parent, or would you hope that life could be much better for them?

• Are you really recovering when the only way to nourish yourself (yes, I know some of you struggle with this loaded expression which implies self care in its fullest sense) is by keeping everything the same, limiting your food choices to just a few "safe" foods? Or, by weighing and measuring all of your food? No, not just for now, but forever? What would you say to your partner if he or she kept to the same restricted allowance, an even number of items to be comfortably ritually consumed, day after day after day?

Time to start living again.

• How normal is your eating if you rely on counting your calories, or your points a la weight watchers? Or if you can't release yourself from exercising when your intake exceeds your ideal or your self-prescribed amount?

Can you truly recover? Absolutely!

Full recovery requires feeling—not avoidance of hunger and fullness. Detaching yourself from these physical sensations, like avoidance of all feelings—sadness, disappointment, fear, hopelessness—only prolongs your suffering (while admittedly for a moment it seems like the only way to get through). Avoiding feeling by numbing out with your eating or your not eating, serves a purpose. But let’s not forget that you lose out on life’s positive emotions and experiences, too.

It requires “Going on a bear hunt” so to speak—a reference to Rosen and Oxenbury’s children’s book I loved to read when my kids were very young.

"We're going to catch a big one. / What a beautiful day! / We're not scared. / Oh-oh! Grass! / Long, wavy grass. / We can't go over it. / We can't go under it. / Oh, no! / We've got to go through it!" The family skids down a grassy slope, swishes across a river, sludges through mud and, of course, finally sees the bear…”

It takes trudging through all the uncomfortable challenges—with support, of course—in order to get past your fears. Like the very young kids, you might (at first) run away when you face the bear. But with some work (perhaps there needs to be a part 2 to this classic), you’ll be embracing it and feeling all the better for it.

There’s more to life than yearning for foods you enjoy yet avoid, or regretting the little you did eat. Or struggling after a binge—an inevitable consequence of days, weeks or a lifetime of rigid diet rules, of avoiding eating enough.

You deserve better. Really you do.  I don’t mean to minimize any progress you’ve made. I simply want to urge caution to be on guard for those sneaky eating disordered thoughts and actions. So please consider reaching out to take the next step to push through—to change your thoughts, your feelings and your eating. Push through the tall grasses and the mud. And conquer the bear.

Oh, and please share your thoughts with us!

Thanks.

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!

“Just Eat it”? Taking that leap of faith to let go of the diets and the rules.

Just Eat it. Designed by Olle Hemmendorff for Nike.

Just Do It has been a memorable Nike campaign, motivating and inspiring athletes and active wannabees for years now. But I really don’t want to talk about exercise and determination.

Rather, let’s talk about Just Eat It, the image circulating on social media with that very phrase. This expression has crossed my mind—but not my lips—during many a patient session way before the creative graphic emerged. Yes, sometimes I’d like to shout out JUST EAT IT! (or even JUST EAT!), at times when rational discussion seems to get us nowhere. But that’s my emotional—and occasionally frustrated—response.

Personally, I struggle with the just part of the statement. Does it feel like a just to you, as an only? Or merely eat? To the person living with disordered eating, I bet just is the worst possible adverb imaginable. To me, it minimizes the struggle. Just eat it? As in, “it’s no big deal, what’s all the fuss about anyway”. EAT it?! If you could just eat, wouldn’t you?

The hike toward the Hornli Hut, heading toward
the Matterhorn. 

My editor was reviewing this piece—by editor I mean husband—and he likened this minimizing to a personal experience he and I have had. You see, I have a fear of heights, and I swear it’s worsened as I’ve gotten older. So now, when we go hiking where the path has narrowed and I can vividly imagine the drop off to my death, I get a bit stuck—think deer-in-headlights kind of stuck. No, not just a bit stuck. There’ve been times when he’s had to talk me through, or physically be there to support me. At those times, he’s clearly communicated the message of “just do it, just get over it”, as in “what’s your problem?” failing to understand that my concern just might be irrational.

No, others really may not get it; fear is often irrational. But somehow reading a draft of this post he did get it. I don’t choose to get anxious at precipitous drops at high elevations. And sometimes the dangers are real. But the risk of stepping outside of your comfort zone to eat (as opposed to the risk of not eating enough), is not life threatening.

I suspect that if you really think about it, you’d realize that you used to eat the very foods you fear will make you fat, or will trigger overeating, with no ill effect. Think back to the time before the rigid rules and diets began, before your eating disorder or disordered relationship with food developed. Sure, you may associate carb restriction with something positive—weight loss perhaps (strictly because it resulted in reduced calories, and not because there’s anything magical about reducing carbs, or fats, or any food or nutrient in particular). 

But you fail to acknowledge that your struggle with binge eating only began with this restriction, with the deprivation. Or, that starting to restrict set you on your path to being unable to nourish your body, to respond to its needs. You hold on to all the ‘good’ you associate with dieting, yet minimize the consequences of your disordered eating on your health—on your mood, on your ability to be social, on your energy level, on your thinking.

There’s a bit of a conundrum we face; by we I mean providers and parents and loved ones alike. I can present all kinds of justification for nourishment—for including carbs, for increasing necessary calories, for adding snacks, whatever—but sometimes that’s not enough. Evidence that food restriction is slowing metabolism may help—such as pointing out that a slowed heart rate or lowered body temperature is a consequence of starvation. Showing evidence that you had previously been both healthy and a normal weight when eating your now feared foods may help, but it doesn’t seal the deal. 

Do you know which are the least read of all these blog posts? They are the ones describing research—the clearest evidence—in favor of normalizing your eating. Few tend to care about the evidence.

No, you can’t always negotiate with an eating disorder.

Sure, it’s easier if you know you can trust me—that I’m not going to mislead you; that it’ll really be okay if you make the dietary changes I suggest. But where’s the proof? Until you actually do it, and see that it really is okay, it’s challenging to trust. You believe that you’re different, that the rules simply don’t apply. And so we’re stuck.

At that point, you need a leap of faith. You need to go on blind faith that it will be okay. It helps to acknowledge that where you’re currently at is clearly not alright—in fact, that you’re quite miserable, if you allow yourself to be honest about how you feel. And it helps if you consider ‘what’s the worst that can happen?’ acknowledging that fear of rapid weight change is a distortion of your thinking; progress on so many levels can start here. Recognize that you don’t have to commit to continuing with this change forever—take it one day at a time, and give yourself the opportunity to back out.

It can be scary getting to the top, but it's worth the effort.
Capu Rosso, Corsica

Sometimes we do need to “Eat it!” or “Do it” giving yourself no option but to not go running, or to cease all purge behaviors, for instance. Sometimes giving your self no option makes the recovery process much easier.

But if you can’t bring yourself to take that leap of faith, or to “Do it”, then eating disorder programs may be the next best thing. Or, for those living at home with family, FBT (family based treatment for eating disorders) may be a great alternative.

Over time, you’ll realize that there’s really no other option for living a healthy life than to maintain the changes you’ve started.

Just saying.

What are your thoughts? Is anyone reading out there?