Loved one on a diet? What their shakes and weight loss mean for you.

Your spouse or partner (or best friend) goes to the doctor and is told to lose weight. And they do. You're pleased for them—on some small level that is—believing perhaps that weight loss is in their best interest. Maybe you’re concerned about how sedentary they've become or about their risk with climbing blood sugars or cholesterol levels. You know how sluggish they’ve been and surely you’d care to see them feel better both physically and mentally. But mostly you're not so pleased. Sound familiar?

Whether you're recovering from an eating disorder or trying to break from the diet mentality and release yourself from diet rules it has "triggering" written all over. To quote my dear friend in recovery from an eating disorder "why is that he's allowed to diet and I can't?" "Why must I be the one in the family who models appropriate eating behaviors, while he restricts his grains and sucks down liquid supplements?"

It's simply not fair. They can do crash diets but you can't. Or shouldn't. Right?

I mean, how well are they really doing?

Not quite. If your loved one is following a fad diet, resulting in rapid (albeit short term) weight loss, be careful what you're longing for. The result is subsequent weight gain that exceeds the loss in most cases. And in the meanwhile, they’ll be dealing with increased irritability, fatigue, and preoccupation with food, eating and weight. Is this really what you want? You've been there before I'm sure. The fantasy of slimming down (through unhealthy measures) and morphing into a new and improved happier being is simply fantasy. You know better. I know you do.

But what about those loved ones that are changing their habits for better, resulting in their losing weight? They’re moving from TV watching while eating and starting to taste their food. They’ve started to portion their food, better reflecting their need for fuel. And their knee-jerk reaction to stress and perceived failure and depressed mood is no longer to reach for food. These changes I certainly support.

Consider that you too can focus on your behaviors. Are you eating mindfully? Respecting your hunger and your fullness? Including physical activity that's enjoyable and not compulsive, that supports your mood and well-being?  Yes, those are actions you too can take, providing you nourish your body adequately (and are medically stable and cleared by your health care provider.) Shopping and preplanning meals and snacks might help, too.

What would you tell a child who says that it isn’t fair that their friend gets to eat a different amount than they do? No doubt you’d acknowledge that we each need to meet our individual needs—based on height, weight, muscle mass, physical activity and genetics, for instance.

For some that might mean eating less, while for others eating more. For some that means figuring out how to move more, while for others it demands respect for your need for fueling your body to enable the privilege of movement. Some of us are more vulnerable to restrictive eating, triggering more eating disorder thoughts and behaviors. While others can exercise modest restraint—delaying seconds and shifting the balance of foods on their plate, for instance.

Perhaps it's time to communicate to help support each other.

But would I endorse a fad diet that appears to promise great outcomes—even based on the short-term results you might find alluring—for anyone? No! I would have a heart-to-heart with your loved one to explain why that approach is not constructive. Not because you feel threatened by their weight loss, but because you sincerely care about their well-being and you know where restrictive diets lead. (And for the record, the macronutrient content—whether high protein or low fat or low are high carb—has no bearing on weight loss. Really. So do set the record straight!)

Their weight loss may not seem fair. But neither is the price of restrictive eating, of feeling like you're on a diet. You've been there. You know better. It's a short term high, and a terrible drop after that.

Remember how you enjoy your freedom, your right to eat the foods you love and give you pleasure. Remember that trusting your body to eat enough enables you to think clearly and decrease preoccupation with food. Remember how bad it feels when the rebound weight gain follows the severe food restriction, the dieting that’s looking so appealing.

You're an adult and you can do what you'd like. But do you really think another diet is going to make things better? Now please go talk with your loved one.

Don't wait for an earthquake to shake you into action.

I was talking to a guy from San Francisco this week, and the subject turned to earthquakes. This long-time SF resident and survivor of the big quake of 1989 offered some very practical advice for me to share with my son, a San Francisco newbie, fortunately naïve about the seriousness of going through an earthquake. His focus was not on what to do during the crisis—although that advice is critical as well—but rather what to do before hand. How to be prepared for this challenging situation, because being prepared, as he put it, is the surest way to increase survival.

Imagine that while sitting and discussing such matters my mind moved to you, my dear readers. No, there’s no need to worry about earthquakes for most of you. Rather, the subject of preparedness as a means to ensure survival and minimize damage struck me as most fitting—whether you struggle with an eating disorder or living free of diet rules.

Have a plan, he said. In San Francisco that might mean knowing which are the secure places to hover—the solid doorways and tables to stay under. But before it strikes, he emphasized that it’s critical to have an action plan: to keep cash on hand—because you never know when you’ll need it and ATM machines simply don’t work in these situations. Have a plan for communicating with those you’re close with—because electric doorbells to apartment buildings will fail and telephone lines other than landlines will fail. A transistor radio helps you connect with the world—to reality check what’s going on outside of your own limited space. You’ll need light of course—so batteries and flashlights need to be stashed to access easily.  And of course a supply of non-perishable food as well as water. Decision-making when undernourished will surely be compromised.

Time to come out of hiding and ask for what you need.

You can guess where I’m going with this. Yes, the analogy applies to you who are metaphorically on no greater solid ground. Communication is key to survival, and planning for opening these channels is critical. Can you tell your partner you’re struggling? Can you ask for help shopping and cooking to ensure your health and nourishment? Can you simply say “I need a place to eat dinner tonight?” Can you ask them to keep the pastries off the counter when you are trying to avoid impulse eating? Can you ask for a referral to a therapist or a behaviorally oriented dietician?

Where’s your transistor radio, so to speak, your exposure to the world outside of your own thoughts? Admittedly the cultural media may not be the most fitting reality check for sane thoughts, for diet-free messages, unfortunately. What I mean is that you need exposure outside of your own disorder thoughts—someone that can ground you when you are limited inside your own space. Were you really happier when you were so much thinner? Did staying on that crazy diet truly improve your quality of life? Your mental health? Or are you using magical thinking like the way we recall old boyfriends/relationships, fantasizing about how awesome it all was--when really it was nothing of the sort? Do you think you’ll restrict just for now and then be able to simply normalize your eating? Think again!

Do you have a grounding place to run to—your doctor, therapist, dietician, perhaps even a higher level of care—if your foundation is shaking? Do you have ready to eat food for when resources are tough to come by? A reserve for when, due to all the stress, your ability to organize and think through what’s best to eat may be impaired?

Where will your light come from when the power goes out? Do you recharge with talk therapy, or maybe yoga or meditation? Do you get spiritual support or guidance from wise friends or loved ones?

You may get no warning before the quake, before the shake up to your healthy behaviors and thoughts. So have a plan. Be prepared.

What steps will you take? Please share—we can all use to hear some ideas!

Read more about slips and relapses:

http://dropitandeat.blogspot.com/2011/08/so-you-really-think-i-can-keep-this-up.html

http://dropitandeat.blogspot.com/2011/08/hope-or-despair-only-you-can-decide-but.html

http://dropitandeat.blogspot.com/2011/11/quick-fix-for-your-struggle-with-eating.html

http://dropitandeat.blogspot.com/2010/12/new-years-resolutions.html

Declare Your Freedom: Gaining independence from diets and disorders.

This stormy day, oppressed by the weather and the limits on my freedom to enjoy the outside, I find myself home, contemplating your freedom. It’s July 4, a national holiday in these united states.  Fortunate to have been born in the US, never oppressed by my government, I take for granted the freedoms that some yearn for. Yet through my day to day interaction with patients, I’m painfully aware of how enslaved many are by their own thoughts and actions—though admittedly not by their choosing. Most wish not to suffer, but feel entrapped; they are overwhelmed by the rules which dictate what’s acceptable to eat and the intrusive thoughts and judgments about their eating and activity. They irrationally fear anything from white flour and sugar to fats. Sometimes the type of foods is not the issue, but the portions are. At first glance, a food record may look impressively normal—until I probe about quantities consumed—the limited bites here and pieces there that are actually consumed.

“We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness…”

While this preamble to the Declaration paves the way to addressing national independence, it’s predicated on individual rights.  Yet how many of you acknowledge these basic entitlements?

Equality. Do you feel that your needs should be considered equally with those around you? Do you consider your needs—for time for yourself, for eating when you need to and what you feel like? Do you feel deserving of pleasurable dining experiences? Or is such pleasure only for other people to experience?

Life. A full and satisfying life. Yes, you are deserving of this too. A healthy life, allowing you to engage in whatever you enjoy. A life not eaten up by self criticism.

Liberty. Freedom from food rules (barring medically critical ones, like avoidance of an allergen that causes a reaction). And liberation from mental hoops you jump through whenever you consider food and eating. Must you feel guilty if something tastes ‘too good’?

The pursuit of happiness. Can you even imagine what this is? Do you remember what you were passionate about before food and diets snatched it all away? What do you dream about when you free yourself from the bitterness of your diets, of your restrictions, of your unrealistic expectations for size?

Freedom can be scary. But independence from both diets and disorders is the sure way to support life, liberty and the pursuit of happiness. I don’t think it’s simple. But taking a stand for change is a valuable first step.Seek out supports--an experienced therapist, dietitian and medical provider can help. But also use your close connections--don't be afraid to ask loved ones for help. Become informed--there's a wealth of posts on this blog on nutrition realities and great links to other reputable bloggers and websites, as well as my books, drop the diet and food to eat, coauthored with ASPIRE's founder, Cate Sangster.

What steps will you take to declare your independence?

More on this topic:

• http://dropitandeat.blogspot.com/2011/04/slave-to-diet-deprivation.html
• http://dropitandeat.blogspot.com/2011/04/over-30-or-40-and-struggling-youre-not.html
• http://dropitandeat.blogspot.com/2012/04/0-false-18-pt-18-pt-0-0-false-false.html
• http://dropitandeat.blogspot.com/2012/03/youre-invited-to-celebrate.html

Smoking good for your health? Making sense of the new fat and heart disease study.

It was like waking up in Sleeper, the Woody Allen movie, when the main character, asleep for umpteen years, wakes to find that cigarette smoking is good for your health. That’s how I felt some weeks ago after reading the half page article in the NY Times entitled “Study Questions Fat and Heart Disease Link”, based on the recent study by Dr. Chowdhury et al which reviewed more than 70 scientific studies and appears to turn our cholesterol lowering guidelines on its head.

No one is concluding you should be eating more of this.

You, my readers, may have little concern about your heart disease risk. Yet I urge you to keep reading—because unless this news splash is explained, you’ll be left feeling like health professionals just can’t get it right. I mean, one day they say saturated fats are bad, and next day they tell you they don’t impact your risk. Carbs are good, and then they’re bad. Hormone replacement therapy is recommended, and then it’s dangerous. Confronted with so much conflicting information, you, like me, might decide to trust none of it. And health professionals end up looking like a bunch of clowns.

After a deep breath, I poked through the research and sorted through the recommendations. And here’s how I’ve made sense of it so far:

• Saturated fat increases blood cholesterol levels, including LDL, the so-called ‘bad’ cholesterol. Yes, that’s still true.
• LDL does increase heart disease risk. Yup, still the case.
• But reducing saturated fat doesn’t appear to lower heart disease.

So why doesn’t reducing saturated (sat) fat appear to improve risk? There are a few explanations:

Cornbread from Food to Eat and Drop the Diet, 
fits in a balanced diet!

• Because most studies reducing sat fat reduced all fat. And when you reduce all fat something has to fill the void. Our food supply has three main building blocks—protein, carbohydrate and fats. Dramatically reduce one, something else fills the void, as a percentage of total calories. Generally, carbohydrate-rich foods replaced saturated fats in our diets. And the increased carbs tend to come from convenient, more processed, low fiber choices. Now let me clarify—those foods, themselves, as part of a balanced diet, don’t cause disease! But substituting saturated fat with a large intake of these items—rather than, let’s say foods rich in non-saturated fats (think nuts, avocado/guacamole, olive oil) raises another blood fat called triglycerides. And triglycerides increase heart disease risk. So in an effort to do something positive, namely reduce saturated fat to lower LDL/bad cholesterol, we’ve been increasing triglyceride levels. It’s like thinking that eating fat free Snackwell cookies instead of Oreos will make you healthier.

• Harvard professors Willett, Sacks and Stampfer highlight several problems with Chodhury’s study. It fails to point out that substituting polyunsaturated fat for sat fat was associated with lower risk of heart disease. And the monounsaturated fats we usually think about as the healthy ones-those from avocado, nuts and olive oil, for instance—were not the sources referred to when concluding no health benefit from monounsaturated fats. 
• When we combine lots of studies, the summary of the data may block out the small but critical findings. For instance, the authors conclude that  "Current evidence does not clearly support cardiovascular guidelines that encourage high consumption of polyunsaturated fatty acids and low consumption of total saturated fats." And that is surely what the media jumped on. But the truth is that certain unsaturated fats did result in benefits. Specifically, the active components in fatty fish, the omega 3s EPA and DHA were clearly shown to be protective. It's well established that these fatty acids lower triglyceride levels, decrease clot formation, decrease inflammation and act as a blood thinner, among other functions. 

Don't let fatty fish scare you!
Check out our curry salmon recipe in Food to Eat.

• Supplementing with omega 3 fats had no benefit in Chodhury’s study. But here’s what I’d wonder: how consistent were supplementers with taking their supplements? Were doses at levels that really make a difference (most people mistake total omega 3s for the active EPA and DHA we’re looking to boost), and were those supplement takers already at higher risk—like maybe people who had already had heart attacks? Perhaps increasing food sources of omega 3 fatty acids (think salmon, tuna, bluefish, sardines, for instance), displaced saturated fat from other common protein sources, such as beef, pork and poultry, showing that food sources have more impact than simply supplements. Just a thought.

• Lumping saturated fats as a single category misses the differences of various types of saturated fats. Saturated fat from dairy fat, for instance, was not viewed as a bad fat; it was associated with lower cardiovascular risk (perhaps it’s time to skip the low fat cheese and enjoy the good stuff!). So if you combine a bunch of studies with different sources of saturated fats with varying benefits and risks for heart disease, it waters down the results. As this study concludes, saturated fats (AS A WHOLE GROUP) may not be the issue, but certain types remain a concern.

Where do we go from here?

Can't go wrong with my favorite wheatberry salad, made with 
whole grains,a bit of sweetness and heart healthy oil and nuts.

First, let's focus on foods, not just nutrients. To me what’s most practical is to learn from the diets of populations which have lower(ed their) risk of heart disease. This Circulation article demonstrates the benefits of a Mediterranean style diet on not just lowering cholesterol values, but significantly reducing heart disease risk—so much so, that the study had to be stopped early, given the 50-70% lower risk of recurrence. “These study subjects adopted a Mediterranean-type diet that contained more bread, more root vegetables and green vegetables, more fish, fruit at least once daily, less red meat (replaced with poultry), and margarine supplied by the study to replace butter and cream.”  Use of various oils were recommended, but not limited to olive oil, and moderate alcohol was also included.

And then there was the diet in Crete which is quite similar—full of fresh and dried fruits, grains and cereals, daily dairy, poultry and fish only weekly and red meat rarely. Oil was the predominant fat and oh, the Cretans ate desserts—and not just fruit, but pastry made with honey, too--a few times weekly!

Yes, balance.

Nope, the healthiest people were not eating low carb, nor gluten free. There was no almond milk nor fear of dairy. And fats and desserts still had a role in this most healthy way of life.

My conclusion? We should focus more on eating a balanced diet rich in a range of nutrients. Yes, back to the basics you may now fear—grains and cereals (whole grains are best), nuts and oils, fruits and vegetables and fish, including fatty types and lean meats and poultry to fill the void. Include dairy, not limited to the lowest fat ones you can stomach.

And remember there’s a place for wine and desserts, in moderation.

You? An eating disorder? Breaking the silence on binge eating disorder and OSFED.

I'm not posting this to brag nor, I'll add, to solicit more emails. 

We can't tell just looking at you who's living with an eating disorder.

And I certainly don't want those of you who are not in such a great place to feel worse about your apparent lack of recovery; I'm aware that's how some of you may think. Perhaps you, too, have come a long way on your journey toward recovery, in ways you rarely stop to acknowledge. (SHOUT OUT: identify what you have done well with today!)

Rather, I write because of what could have happened to Leah. And about what usually happens, to those with Binge Eating Disorder and other eating disorders. So please read on!

"I hope you are doing well and a Happy Belated Birthday!  I just read your latest blog post and it made me quite happy and blessed for our time together.I am happy and proud to say that I am doing great and haven't used food to deal with my emotions.  I am still in therapy and it is a big help but I have really come to the other side with my eating disorder.  I have my moments here and there but ultimately I consider my self in recovery.  I completely think a different way about food and to me that is huge.  I have an amazing relationship with food again and for that I thank you and all of your help.  It was just a year ago - March 18, 2013 that we had our first Skype session and I was in a pretty dark place and didn't know how I was going to get through it all....and then you came into my life.

To build on what Dana wrote....thank you thank you thank you for having the confidence in me when I didn't and for being there as a guide to help me get to this amazing place in my life that I can now say I am truly thankful and happy to live. Thank you!!"

I'm driven to post after an ICED (International Conference on Eating Disorders) session about the lack of treatment for eating disorders, particularly binge eating disorder and EDNOS—Eating Disorders Not Otherwise Specified (now renamed OSFED for Other Specific Feeding or Eating Disorder)—that catch all disorders not meeting the criteria for bulimia, anorexia, and binge eating disorder.

Anorexia and to a lesser extent, bulimia, are more likely to be treated—although admittedly so many more aren't in treatment and need to be. And truly, treatment is typically not long enough or intense enough or multi-faceted enough—my thoughts, not the presenter’s.

But I write about these other conditions, these seemingly lessor eating disorders because their impact is so great; of those with eating disorders, approximately 60% of women and 83% of men have BED/EDNOS combined. And while the need for hospitalization or risk of sudden death might be lower, the impact on quality of life, mood, self-esteem, body image, control over eating is tremendous. And let's not forget GI distress, heartburn, constipation, fatigue, high cholesterol, blood sugar management issues—I could go on.

You? Living with an eating disorder?

No, it's not about size!

Sufferers are rarely identified nor have their eating behaviors addressed, contributing to minimizing their own struggle. I mean, if your doctor doesn't ask the questions why would you volunteer about your struggle? More likely, attention is paid to your BMI or 'weight issue' instead. If your loved ones don't sense your struggle with food, but rather just see your weight as a concern, maybe you're the one with the distortion. If you look good and your weight is more or less fine, what's the big deal? They have no idea how you struggle. And if everyone around you is focused in how fat their thighs are or how much weight they're gaining, then you’re certainly not the one needing treatment, right?

Wrong.

Back to Leah. I received her note coincidently while at the ICED conference, and invited her to stop by, as we had never met in person. She would have surely agreed to meet for lunch—as she had come a long way from relying on froyo as lunch/dinner—but time was tight for me, so chai lattes would have to do. And our meeting got me thinking about her history. She long struggled with dieting and food rules, consuming way too much of her mental energy.  That was the norm in both her family and in her peer group.

But Leah knew that this was no way to live.

As she recalls it, it took a tweet of mine that she came across, which lead her to my blog, and then my website and then my book, food to eat, to move her from knowing to doing, to taking action on making her life around food better. We skyped, and I encouraged therapy as well. And as you can see by her note, she did it.

But what if she didn't stumble upon that tweet? Would she, or you, or your friends take the step and initiate change, to move from being ruled by food? Apparently not. The stigma and shame around binge eating and EDNOS is great,as described by Stephanie Bauer, PhD, a researcher in Heidelberg, Germany, making the barrier to change hard to get over. And I learned in a session by Federico Girosi, PhD, from the University of Western Sydney, Australia, that it's hard for those with eating disorders to consider the long term consequences of their disorder, when the short term risk of seeking treatment seems great.

I'm doing my small part. You can do yours too!

Let me tell you, you are not alone. More of you struggle with binge eating disorder and other eating disorders that don't meet the criteria for anorexia or bulimia but which need to be treated!!! You are no less deserving of being freed from the burden of your disease as the person living with cancer.

Please speak up. Halt the fat talk that you hear in your home and with your friends. Start living now, regardless of your size. Ask yourself if the cost of treatment--your fear of what you might hear and how you might feel--is really greater than the cost of not seeking treatment. Do you want to live your whole life concerned about food labels and the calories you consume? Do you want to spend time at meals preoccupied with food and it's nutritional value, rather than enjoying the company of your loved ones? And do you want to carry this sentiment to your children as well? For Leah, that might've been just the tipping point she need, as she was approaching age 30. It felt like enough was enough.

Yet there was no action until perhaps she felt like somebody got it, that she'd be understood, that the risk of shame and stigma might be lower seeking help from someone whose messages she was already comfortable with.

Or in a blog?

Please share this with your friends, whether they have an eating disorder or not. If they start a conversation about dieting or body image, turn it on it's head. share the messages you're reading here and challenge them to have a better life. Check out our new book drop the diet: guided recipes for overcoming your food rules, a modified version of food to eat, rewritten with chronic dieters and binge eaters in mind—coming VERY soon!

Work on giving yourself permission to eat, and enjoying food, all foods, regardless of their fat or carb content. And seek out the services of providers who specialize in eating disorders to help guide you along the way.

Really it's not too late.

Please share on FB, Twitter, Pinterest, email or in conversation with your community! Thanks for reading. More to come from the ICED conference soon!