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?

The Google diet. No need to keep searching.

I've seen it first hand. And I'm certain that if you were to experience it first hand, that you'd be sold too. This is no testimonial for quick weight loss, nor for the latest cleanse. And I haven't lost my mind. And yes, I've already eaten my breakfast, and had my coffee--so my thinking is quite clear.

It's time to open our eyes to what Google already knows about being healthy and fit. And to apply those lesson plans to our schools--and to our selves. I'm talking about the Google diet: Google's approach to food and eating, to feeding it's many employees, that's super smart. It seems strikingly crafted, based on the research on keeping us healthy--and happy. I had no plans to blog on this, but after visiting a couple of Google offices I just had to share. Because we can all get some answers from Google.

So what's so impressive about the Google diet?

Snacking: from portions to placement

Google likes snacking. So yes, already I'm sold. There are snack stations at various sites throughout Google buildings, with several notable features: there are m & m's, and there are organic bars; there's dried fruit and fresh fruit (much of it local no doubt) and nuts and yogurts.  Take your pick. Yes, there are desirable snack options that encourage Googlers (employees) to snack. Because we all need to snack for energy, for clarity, for productivity. Or we get tired. And cranky. And impulsive when we finally get our hands on food. Or, we miss our opportunity to eat when hungry, and for some, interest in eating is lost.

There are very mini cups--the folded paper ones like what you get pills in at the hospital--and there are cereal size bowls, too. Need just a few peanut m & m's? Portion them into a mini cup and acknowledge you're eating them. And they'll look like much more, and appear more satisfying, than if served in a cereal bowl. (see Brian Wansink's work on this.) Googlers might even be encouraged to choose the more wholesome choices by placing them at eye level--just as supermarkets stock Fruit Loops at toddler height. 

And those snack areas? They are separate from work areas. We all need to have a time out for eating, separate from our other activities. And by keeping them separate, Googlers aren't prompted to eat them just because of the visual stimulus. Rather, they have to decide to go and get a snack because, I suspect, they're hungry. 

In contrast to Google,  our schools, specifically Middle and High schools, pretend that kids no longer need to eat between meals. They expect them to function well and not be irritable, in spite of drops in their blood sugar and falling energy levels. Yes, growing kids certainly need snacks between meals.

Yet teens are at the mercy of individual teachers to possibly break the rules to allow snacking in their classrooms; or, they must get permission when medically necessary to eat at the nurse's office. Sometimes kids need to sneak food in between classes--often the easiest option. Yup, nothing like encouraging our kids to start sneaking food.

Moderation

In schools, the curriculum speaks of good versus bad foods--although admittedly in slightly more opaque terms (see my last post). Fruits, vegetables and low fat foods--they're the good stuff, while fats and sugars--they're viewed as bad. It reminds me of the unsuccessful DARE drug education program taught in US schools, the program which had my middle schooler at the time appalled that I would dare to drink a glass of Cabernet with dinner. 

Not a Google dessert, but it could have been.

At Google it's about moderation. At the cafeteria, foods are labeled using the traffic signal approach: best choices get a green light, to be eaten freely; yellow, more caution with frequency and amounts, and red lights urge awareness that these shouldn't be eaten too often. (Think creamy clam chowder or fatty meat dishes.) But note that red light items are still served, and balance is the take home message. I can't say how effective the traffic light system actually is, but I surely like that they're not encouraging fat free or low calorie foods, nor displaying calorie counts in their cafeteria. Our schools, in contrast direct our kids to calorie count hoping that that awareness will solve the 'obesity epidemic'. 

I almost forgot to tell you about the desserts! They're served every day--but the portions seem rather reasonable. And they weren't placed at the start of the lunch line where diners are sure to grab it first thing--that's where the salad was displayed. Rather, it was somewhere in the center if I remember correctly--I had to search for it actually. And knowing there's no shortage of desserts being served each week surely must prevent Googlers from hoarding their desserts. No doubt they trust that it'll be there. And they can eat just as much as they need, because tomorrow will bring another dessert. (see Halloween post about this)

It's gotta taste good 

Ok. I realize that Google employs Michelin star chefs to prepare delicious food for their employees. But can't we even serve more desirable fruits and fruit salads in our schools? Can't we stir fry some tasty veggies to be more appealing for kids to want to eat? Can't we serve mini cookies with lunch--to teach balance and moderation? And can't we allow ourselves to eat foods we truly enjoy?

Support movement

Biking or walking to work? You get rewarded! Yup, in Google's case, financially. Bike to school and you might be sent home. Seriously. It happened to a patient of mine in MA. And you'd be lucky if there were a place to store your bike! In US schools, the move has been to reduce physical education. At Google it has been to add spin classes and yoga. Something needs to change in our communities to support more movement.

Consider these Google diet lessons

• We all need opportunities to snack, when we're hungry. 
• Be strategic in your placement of food in your environment--we don't need it shouting to us, but it needs to be available for when we want it.
• Food should taste good, and we all need permission to eat what we like--in portions appropriate for our individual need.
• Dessert are not just for birthdays and holidays.
• Incentives for movement encourage movement. 
• Foods aren't simplistically good and bad nor are we good nor bad for eating them.

Thanks for reading! Comments welcome!

The consequences of weight bias: beyond making you feel bad.

Debra came to me frustrated about her climbing weight, now about 20 pounds out of her normal range. This is nothing unusual for me—plenty of women and many men reach this point, desperate for answers and guidance to help them take charge of their weight. Others present for help managing symptoms or medical outcomes—like high blood pressure or cholesterol or GERD that have more to do with the quality of their diet than with their weight.

Debra was an active woman in her 50s, a non-emotional eater—yes, they do exist—who felt like she was doing most things right. She ate regular meals and snacks; she had to, as she started to feel really low energy, and fuzzy headed if she didn’t. And she’d start to get the sweats, too. She had a history of very high cholesterol, and a family history of Type 2 diabetes as well. And the weight she had previously maintained, her normal weight, was nothing crazy, nor did it require heroic measures to achieve it. Her goals were quite realistic.

After reviewing Debra’s intake and activity, I made modest recommendations to ensure she was doing whatever was reasonable in terms of change. Was she still getting the workout that she thought she was, or does she need to evaluate her intensity or duration? Perhaps with better conditioning she could prevent further weight gain. Was she inadvertently influenced by the halo effect—having more of those foods she believed to be healthy, such as lean protein sources or nuts—without an awareness of just how much was enough? (http://dropitandeat.blogspot.com/2011/05/halo-effect-your-thoughts-about-healthy.html) Fullness was challenging to observe, she had stated. Perhaps she needed to evaluate just how much she needed as opposed to portioning her food on autopilot, without much attention to her need http://dropitandeat.blogspot.com/2010/08/size-matters-but-not-how-you-think.html or http://dropitandeat.blogspot.com/2011/02/who-or-what-decides-how-much-you-eat.html While these recommendations were helpful—and prevented further weight gain—it was clear to me that another explanation was responsible. She had many markers for polycystic ovarian syndrome (PCOS) or hyperinsulinemia, a condition where high circulating levels of insulin result in symptoms of low blood sugar (including the sweats, fuzzy headedness, irritability and immediate need for food). (For more on hyperinsulinemia http://www.diabetes.co.uk/hyperinsulinemia.html)

At my suggestion, she went to see an endocrinologist—an MD appropriate for evaluating such conditions. From Debra’s report she shared her sense of despair about her climbing weight and belly fat, yet the doctor began to dismiss her, like all the overweight women who presented before her, with a simplistic, patronizing “Eat less and exercise more”. Yes, judgment was decreed without even listening to how high her activity already was and how appropriate her eating has consistently been. 

But once she added the comment about the symptoms between eating—those low blood sugar-type symptoms—he got it. He finally recognized that it was unfair to put the blame on her—to simply tell her she needs to exercise more or eat less because after all, weight management is about energy balance. He put her on metformin, which addresses the underlying issue—it’s an insulin sensitizer, so it helps prevent excess levels of circulating insulin.

The outcome? Most importantly, her symptoms stopped and she felt so much better. No more shakiness in between meals, and the sweats ceased, too. And, her weight dropped about 9 pounds over the past year, in contrast to the weight climb the preceding year that felt so out of her hands.

Weight bias in reverse

Another active woman—at a normal and stable weight, recently had a physical. She’s a 51 year old who enjoys food and eats a healthy diet. By healthy, I mean rich in healthy fats, whole grains, fruits and vegetables, with a reasonable intake of desserts and chocolate and wine. She’s not vegetarian—but her intake of meat is minimal—nor gluten free, nor dairy free, nor carb free. She’s a reliable reporter.  I know, because she is me! For the first time in her/my history, my cholesterol was high! The good cholesterol was high too—likely the result of my activity (I’d attribute it to genetics except neither parent had a high HDL)—but the bad, the LDL was out of any lab’s range of acceptable. Add that to my high blood pressure and that places me at further risk.

And what did my doctor do? Nothing. Other than telling me to continue to ‘watch my diet’ and maintain my activity (about which he knew little), that is. Yet the variables that I can control are already in order. My diet and exercise aren’t going to change for better so I don’t suspect there will be any astounding improvement. Most likely, my hormone status was likely the greatest factor increasing my levels—LDL can increase 15-25% with menopause! But heart disease risk similarly increases with postmenopausal elevations in cholesterol. 

Me (in Robin's hand-me-downs) and my slim father who had type 2 DM,
high blood pressure and high cholesterol.

In spite of my high cholesterol, my doctor didn’t suggest that I have it rechecked in 3 months or that I start a statin to lower the levels. He didn't explore my exercise frequency, intensity or duration. While the updated 2014 cardiac risk calculator concludes statins for cholesterol lowering aren't necessary for me, (and doesn't include weight in the assessment) he didn't plug the numbers into this risk analyzer (I did later though.) No, I did not look like a high cholesterol patient so my cardiac risk was minimized.

I share this for those of you still blaming yourself—for your health, and for your weight. That is not to say that there aren’t things you can do to take charge of your health. Physical activity in moderate levels can improve insulin sensitivity, lower cholesterol, improve blood sugar and assist in energy balance. Oh, and it certainly may help mood and sleep, too. And eating portions appropriate for your need can help everything from reflux to fatigue to your weight climbing out of your normal, healthy range. Eating more home prepped meals can give you more control of portions and meal content. Even for you non-cooks, there are plenty of easy-to-prepare, yummy dishes you can make, with practical strategies for pulling it all together. And avoiding long periods without food certainly will improve your energy level and your control of eating when you finally take the time to eat.

But if you’re already doing what’s in your hands to do, don’t let others burden you with blame. And start to advocate for the care you deserve.

When I see my new doctor, you can bet I’ll be discussing my labs and inquiring about any treatments that might lower my risk. Because truly, my high cholesterol is not my fault.

thanks for reading!

I’ve Gained Weight. Now What Am I Gonna Do?

Perspectives for those with bulimia, anorexia and those with no eating disorders at all.

"How much weight have I gained since we started working together?", “I want to know." That was the pressing question.

Ellie has been seeing me for several years, for periods at a time. She presented with severe bulimia, purging 3 times per day, every day, after each of the three times per day she allowed herself to eat. Back then, eating and keeping food in was simply not an option. Over time, her purge frequency decreased and she normalized her food intake, ultimately giving up her bulimia. 

Beyond her initial and modest weight increase, her weight has remained stable within a 2-3 pound range over the past many years. And that initial increase can be attributed to two things—no longer living in a dehydrated state and better nourishment.

To me, the better question for Ellie to ask would have been " how much better off am I since I’ve changed my eating?" In spite of the modest weight increase that she had no interest in, what did Ellie get in return?

When confronted with this question, she appropriately retreats from her disordered thoughts which periodically reemerge and readily acknowledges just how far she has come, how much better she feels. She remembers that there's no way she could've taken care of her newborn grandchildren in the state she was in then, or be trusted driving back and forth to their home. No, the price she paid, the few pounds gained, is nothing given what she's getting in return.

Gaining weight is rarely seen as a positive in our culture. Advertisements fail to praise us for outgrowing our jeans.

But for some, that is exactly what needs to happen. Staying at the weight you were at when you were 12  is hardly appropriate when you are 16, 20, or 40 years old. And even if your weight is objectively 'within the normal range' for the population, it may not be in range for you. It drives me crazy when doctors tell their patients that their weight—a  weight that has never been maintainable without an eating disorder because it's too low—is fine, because they are basing it on the charts for populations. Why the double standard? Because if you've always been a healthy larger size and you've lost weight through unhealthy measures, that 'normal range weight' may be anything but normal. Perhaps given your build, your genetics, your muscle mass, your history of athleticism, your body needs to be at a higher-than-average weight. And fighting it to be at a place you've never been will only contribute to unhealthy ways of eating and thinking. For your mental and physical well-being, weight gain may be just what's needed.

Gaining weight without an eating disorder?

Not long ago—a couple of months, maybe—I noticed that snugness around the middle. No, my jeans hadn't just been dried at high heat for too long. And really it was not in my head. Everything was fitting a bit too tightly. (Yes, even the bras.) Not one to weigh myself with any regularity, I suddenly jumped on the scale. I felt the need to reality check, to verify what I was feeling.

Yup. My weight was up.

Save your rush to judgement, please--it has nothing to do with the cupcakes, the chocolates and my homemade, full fat lavendar ice cream. Ok, let me clarify. No "I told you so's" necessary, because I ate all those foods before. But over the months of summer, the balance wasn't perfect, and so my weight crept up. 

Could it be that I was super active through the end of June, training for my fundraising ride, only to reduce my activity precipitously with the heat wave and awful humidity? Perhaps. Could it be that I've been socializing more, sipping on wine with dinner more nights than previously. Perhaps.  Could I have possibly joined my husband for an after dinner snack—just because it looked good and I thought I'd keep him company—more often than I really needed from a nourishment standpoint? Likely. Like you, I'm not perfect.

But the bigger question is what to do about it. If you were me, would you:

1. exercise a couple of hours each day to make up for the previous reduction in activity?
2. reduce your food intake to compensate for the extra calories consumed?
3. seek the guidance of a Registered Dietitian?

Ok. So I'm the RD so  I'd better come up with a fix.

But if you don't fall into the categories described above--those truly needing to gain weight, or those who've gained appropriately as a result of releasing yourself from disordered behaviors--and you find you've gained some unnecessary weight, here's what I'd suggest. Intuitively, it may seem appropriate to make up for any overeating in the days or weeks which follow. But don't do it! Instead, refocus. Get back to the basics, particularly if you've found yourself slipping into old patterns. Have you forgotten the basics? For starters,

Sit. No eating as you walk around the kitchen emptying the dishwasher. No eating standing at the fridge. And no, don't sit at the fridge; seat yourself at a kitchen or dining room table.

Separate. Eating and distractions,  (other than your family which you can't get rid of) should be separate activities. TV watching, texting, reading--these should be separate from eating. (Unless, I'll add, you are struggling to get food in and find that being less mindful is actually helpful--which it often is!)

Eat with your senses. Are you seeing your food and acknowledging what you're eating? Are you experiencing the textures of what you're eating? Are you tasting your food? Doing so will allow you to slow the pace and to feel more satisfied with what you're eating. You'll enjoy the food so much more!

Choose what you enjoy. Are you giving yourself permission to eat what you like, or holding on to rules about what's allowed vs forbidden, in your mind?

Tune in to  your hunger. Don't wait  until you are at the extremes of hunger--if you're starving you are more likely to struggle to eat as described above, and overeat.

Re-explore fullness. Are you eating until you are stuffed? Might a modest adjustment in portions be appropriate? That said, if you start with smaller portions, do give yourself permission to eat again later--after about an hour--regardless of what you you ate before.

Don't panic! And don't take radical steps to 'fix' the problem. Restrictive eating, denying your body's signals and needs, does nothing positive in the long run. It will only perpetuate an unhealthy cycle and make you feel like c!*P!

Breathe. It won't take long to get yourself back on track. But be realistic--if your eating was off course for some time it will certainly take some time for you to be back to your former, healthy self. Radical dietary changes can have radically negative consequences, so do be patient and appreciate the modest improvements as they happen.