From eating disorder recovery & advocacy, to losing weight, to bread baking?

Got 30 minutes? Check out this podcast I was interviewed on yesterday on Heritage Radio's Feast Yr Ears. http://heritageradionetwork.org/podcast/lori-lieberman/



Topics discussed include:

• Why I love working with people with eating disorders--the most challenging of all my patients
• More nutrition pet peeves, what simple step pediatricians can take to catch an eating disorder
• What to say and not say to someone who has lost weight
• The me and Cate story of Food to Eat and Drop the Diet aka why I adore Cate Sangster
• My major food obsession. You mean you don't already know?

If you like it, please share it.

And thanks for your recent comments which I promise to respond to!

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.

Gluten Free or Gluten Freedom? You Decide. How a Gluten Free Diet Impacts Weight & Health

Do you really need to give this up?

Go ahead and eat how you’d like. Want to only buy organic produce? It’s your call—just don’t ask me to foot the bill. Into whole grains? Vegetarian or Vegan? Serious meat eater? Really it’s not for me to judge.

But you know I can’t just leave it at that. My concern is that if you choose to eat in a particular manner that it be without unnecessary rules that negatively impact your wellbeing—either physical or mental. And I’m concerned when you and others get caught up in the supposed health hype of the day, only to learn the hard way that it just wasn’t worth it.

Let’s talk gluten free

Yes, I even add gluten to my breads!

I hate pain and suffering. So if you have celiac disease and are suffering the effects of this autoimmune condition—this reaction to gluten that strangely results in self destruction of part of your small intestine, there is no diet I’d rather see you follow. Please follow it 100%. Period. Avoid cross contamination from wheat, rye, barley and its derivatives. Read labels and avoid it like the plague. And contact a Registered Dietitian who knows the ins and outs of following this diet to focus on what you can include, not just what you need to avoid.

And I hate deprivation. I mean, denying yourself great, fresh gluten-rich breads and hearty wheatberries and barley (see recipes from Food to Eat and Drop the Diet) to me is painful. I simply don’t see the why if you don’t have celiac disease. If you don’t have celiac choosing gluten free does nothing to enhance your wellbeing nor help you manage your weight. But you’re not alone for believing it will. At my 30^th college reunion recently, I confessed my profession to a classmate, a very bright MBA, Ivy educated attorney. This smart and sensible guy hopefully queried “Do you think I have to stick with this gluten free diet I’m on? Would I be okay if I just gave it up?” Yes, poor judgment knows no IQ limits! So LA classmate, this one goes out to you!

But aren’t there benefits of a gluten free diet?

What Gluten Free will do to your weight

Or these?

Start following a GF diet and no doubt you’ll be much more mindful of what goes in your mouth—because you have to be. You read labels and you think before you eat. And that’s a good thing from a weight management standpoint. It’s hard to be an impulse eater while following a GF diet. Besides, how many rice cakes or GF cookies can you really eat? But if you don’t cook much and you rely on ready-made GF products, the quality of your diet may suffer—along with your weight. GF breads are more calorie dense, as they are missing the scaffolding that gluten provides to assist leavening. And GF breads and other products are often (although not always) lower in fiber—there’s no whole wheat, or rye or barley. (Of course you can add quinoa and brown rice, but these you need to prepare.)

Or this?

If you are following a GF diet because of celiac disease, then your weight may very well increase; with poorly controlled celiac (think pre-GF diet), there is malabsorption. You eat, but much of what you eat passes through without being incorporated into your body. Resolve the underlying issue by avoiding the culprit—gluten—and you will restore normal absorption and get all that you eat. And yes, that may result in some (perhaps very appropriate) weight gain.

But if you’re like the majority of individuals following a gluten free diet, you haven’t tested positive for celiac (through a blood test or via an endoscopy and biopsy of your small intestine). Rather, you follow this diet for a range of other reasons.

A tale of 2 RDs

My favorite, homemade rugelach. Recipe on this blog! Not GF!

It’s amazing what desperation will do. When the medical community fails you—when they have no answer for your symptoms or no cure for your disease, alternative, non-evidence based practices look very appealing. And what’s to lose? Yes, even rational thinkers can be sucked into the hope that this may solve our problems. As I’ve written about previously, my diagnosis with MS 12 years ago lead me to the gluten free diet. Anecdotal evidence abounds and the theories seemed believable. So yes, I followed a gluten free diet—meticulously. Labels were read and dining out was largely avoided—except for at establishments that took gluten free seriously. I was cautious about cross contamination as well—I had my own jar of preserves and butter—no gluten rich crumbs were to enter my body.

And then I stopped. It wasn’t just that I thought about my favorite breads and baked goods I could no longer eat—that was a challenge— or the time it took to prepare everything from scratch—I do that largely anyway. But when my 3 month MRI showed more new damage to my spinal cord it was a done deal. The GF diet did nothing for my disease. Mind you, I’m not blaming it for the worsening of my condition during that time period; the disease progression coincided with the GF diet, but there was no evidence that it was caused by it! Anecdotes like mine are rarely posted. You generally just hear the success stories, leading you to believe only the positive.  

Which brings me to another RD

Kay struggled with many of the classic symptoms you hear about, attributed to gluten intolerance—GI cramping, low back pain, diarrhea, fatigue, to name a few. And regrettably, her doctors failed to screen her with the simple blood test that picks up the majority of sufferers with celiac, nor suggested an endoscopy to take a look at what was going on. Rather than delay, Kay began a gluten free diet and by her report started to get relief from her symptoms within days—not fully, but significantly.

In Kay’s situation, this was likely celiac—just never diagnosed. I often see patients, though, who believe they have a gluten problem who likely don’t. One recent patient had been avoiding all gluten for many months, yet continues to have diarrhea 3 times/day. If it were a gluten issue, symptoms would certainly be improving. Another patient believes she fails to tolerate gluten and reports following a GF diet and feeling great. But a closer look revealed lots of hidden gluten sources—like on a daily basis. No, avoiding gluten wasn’t what was helping her—because surely she only perceived she was avoiding it. Rather, the placebo effect just might have been working its magic.

Dessert, not bread, from Tartine, San Francisco. Yum.

So why share all this? Because there is so much misinformation out there that it’s easy to get sucked into the craze of the days. And I believe that you should be educated about the impact of your diet choices—both physically and mentally—so you may make informed decisions.

And no, I have no financial interest in gluten-rich products, but I do love my favorites including Tartine (San Francisco), Seven Stars (Providence, RI), Guillaume (Montreal, Canada), and Clear Flour (Boston, MA). And of course Kings Highway Bagel in Brooklyn, NY, where I grew up. What are your favorites?

And for those who follow GF, what are your favorite, certified GF baked goods? Please share!

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.

Role modeling with the Lean Cuisine diet. Who needs the reality check?

Adorable, yet strikingly painful. 

                              (If a video doesn't appear above, click here)

Young, school age children, sharing their observations about their moms’ and their dads’ eating. These are strictly their observations, without judgement— except for the stink of some of the cleansing pepper drinks they refer to. The contrast made by Lean Cuisine is that eating their frozen dinners as a strategy for weight loss—that is normal!

Well isn't it? Not unless you are a 4'8 woman, non-competitive athlete. To have one of your main meals of the day, your lunch or dinner, coming in under 300 calories is hardly adequate for most anyone. Yes, even though it does contain some carbs. And the suggestion that it, in itself, is a meal, an adequate meal, is quite problematic. Who do you blame when you are left feeling hungry after this meager intake? No one but yourself, no doubt. Calling it an appropriate meal replacement is misleading, unless you add a glass of milk, a fruit, a salad with some oil and vinegar or nuts, for instance.

We know all the Lean Cuisine eaters in this YouTube video have families, including kids—young, impressionable, school age kids. So let's think for a moment about dinner time in these homes. "Here, sweetie, you can eat the chicken dinner I made for the family, I'll just eat my (inadequate, 300 calorie) frozen meal. You know, because I need to lose weight." Or "You deserve to eat this great tasting meal I've made, but not me—I'm too fat!" Or maybe, "Why don't we all live on Lean Cuisines, so you can have control over your portions too; because I don't really trust that I or you can manage when there is more than a limited amount of food in front of me!"

Fast-forward several years and let’s imagine these innocent kids as adolescents. Do they feel entitled to eat an adequate plate of food? Or do they, like many a patient I've heard from, feel limited by the messages they heard from their parents (yes, parents, because dads put forth much of the same diet shtick so to speak). Like Dana, she may struggle to ever eat more than half a sandwich—that's how much her mother allowed herself. And like Allie, she might be counting her calories, limiting them to the boxed frozen dinner amount that her mom thought was right.

What do these kids end up taking from this? That their frozen-diet-dinner-dependent moms are the sane ones, as the video implies? Or that their moms and dads (and maybe them, too, when they’re grown ups) dislike their bodies, and certainly can't trust themselves, their ability to eat enough, their body's signals, their ability for their body to be forgiving if they ate a bit too much one day. They learn that normal family dinners are things other people can have, but not them. This is just the price they have to pay to lose weight.

Are you stuck in this place? 

Are you the adult child of such a dieter, who never learned to trust her own eating? Or simply struggling as of late, desperately dieting, relying on prepackaged foods and calorie-restricted meals? Consider cooking--see the recommendations made by "Thursday's patient" to ease the process, or check out Food to Eat for more support, with its 25 recipes in an easy to manage format, justifying the merits of each dish and its nutrient content. Serving sizes are suggested, but are by no means restrictive. Suggestions to enhance the meals are provided, along with sections to help you get out of your own way--to change your perspective about food and respond to your needs. And check out the links below, including sample recipes.

Kudos to Lean Cuisine for pointing out how crazy our culture is, with moms and dads filled with body loathing following all sorts of nonsensical diets. If only they can see that their video stopped short of pointing out the irony of their own product.

http://dropitandeat.blogspot.com/2010/08/size-matters-but-not-how-you-think.html

http://dropitandeat.blogspot.com/2011/03/normal-eating-taken-too-far.html

http://dropitandeat.blogspot.com/2011/02/who-or-what-decides-how-much-you-eat.html

http://dropitandeat.blogspot.com/2010/11/honor-thy-hunger-and-thy-fullness.html

And from Food to Eat: 

http://dropitandeat.blogspot.com/2010/11/pecan-pumpkin-pancakes-you-can-feel.html

http://dropitandeat.blogspot.com/2010/10/how-to-cook-healthy-meal-before-eating.html