Time for a Diaper Bag-A New Tool For Recovery

No more siblings for this fella!

No, no more babies in my future--unless I become a grandparent too early in my youth. "Two and through", I just overheard a woman say--I second that sentiment! And I've no need for carrying Depends--a diaper of sorts, for adults. This diaper bag is a bit different and it is as essential for me as for you, male and female alike. It knows no age limits--carry it if you're a teen or in your 60s, a single parent or a mom of little ones. It needs to be carried by you--for you--even if you've got no toddler in tow.

This diaper bag allows you to be in control. It holds the snacks you believe you don't need and don't feel you deserve--and it enables you to eat them whenever you need to. This helps you fuel your body any time, any where--whenever you need to. Intuitive eating becomes possible when you can recognize your hunger and are well-prepared to respond to it. It provides you with the essential pick me up to prevent you from dropping down to an unhealthy state physically--and psychologically. Simply placing your snacks into your sack is a very tangible reminder that you need to eat. But it's just the first step.

Choose a bag size that fits your needs!

"Why eat when I can put it off and wait until my next meal?", you might think. Because if you struggle with out of control eating, eating an adequate snack allows greater control at your next meal. It energizes you to help you think straight. It takes the edge off. It keeps you from dipping too low. It helps keep your thoughts straight and prevents major drops if blood sugar and the lightheadedness which follows.

Your diaper bag is a very visual reminder of  your needs. You tote it around as a reminder that you must eat. Yes, even you who are higher weight or BMI, or of normal weight but simply dissatisfied with your body; you, too, need to be burdened by the bag.

Your diaper bag validates that you need to nourish yourself. Would a mother of toddlers dare to leave the house without this tote? Would she leave behind the infant formula or the animal crackers to appease her child's hunger, to honor it, to respect it? Of course not. So why not consider your needs and provide for your own nourishment?

Yes, it's okay to include a portion of your favorites!

Your nourishment isn't limited to the snacks the bag contains. Your diaper bag may include a book or an ipod, or some other distraction from your own thoughts. Perhaps it even has a journal for you to express yourself and air your thoughts, your feeling, your fears.

Carrying your diaper bag is a way of saying you're important and that self care is a high priority, that your needs are as important as those of your children's or the parents you may care for, or your best friend.

Small, but holds the essentials for men or women.

But it's only as good as what you do with it. You've got to make the effort to dip into the bag and actually eat what you've carried. You've got to pull out the coping tools such as the music player or meditation download, and you need to listen to it. You need to change it's appearance and its contents from time to time, so it's harder to ignore it, to forget why you carry it.

Design your own bag or use a simple sack of your choice. But make it all about your needs with the tools to meet them. I know, I know, it's not going to be easy. You've never thought of yourself as number one on the priority list. But it's time for change, isn't it? And if you can't seem to get past doing it for yourself, consider starting by doing it for the sake of those loved ones you care about--your kids, your partner, your parents, your friends.

Please tell us what you've put in your bag. Or how you've created one and used it. See this post for inspiration http://keepcatebusy.blogspot.com/2012/08/i-made-something-messenger-bag.html

Thanks, in advance, for sharing.

“Do or Do Not. There Is No Try.” Think Again, Yoda.

I support mindfully eating these "black and whites" but not the
thinking by the same name.

She comforts with food, rewards herself with food, punishes herself with food. She eats what's served to her by her spouse—even when it's too much and she feels uncomfortably full. Nightly ice cream and dessert are the norm—on the couch, distractedly, while watching TV, simply to numb, barely tasted, never enjoyed. She's a self-described emotional overeater, also treated for depression. And she reports gaining over 20 pounds the past few months.
And then the work began.

Sharon is a 45 year old who first came to see me at the end of May, for weight and blood pressure management. She's had a range of medical issues including cancer, but her greatest distress was her weight and unhealthy eating habits. Her main goal was to lose weight from her high BMI, and to learn to eat healthier. She also suffered from diarrhea, the consequence of a medical procedure, making it more challenging to head outdoors to exercise; or, to even want to exercise at all, for that matter. 

Be positive. Really?

Do you emphasize the half or the full?

One of the recent goals we've been working on has been to identify some positive changes she has experienced between our visits. I must admit—this is where she really fails! Getting Sharon to credit herself for anything positive is like pulling teeth. 

She keeps my expectations low—she prepares me to expect little from her, with her self-deprecating words. And with her persistent focus on what's not in place, I’m forced to reality check and remind myself just how well she is progressing. Here’s a window into our session:

I praise her for beginning the process of contemplating exercise, by exploring the on demand cable exercise programs—first, just watching them, then moving to participate for the half hour session. But she replies, “yes, but I only did it once.”

I acknowledge that she got back to the gym after a long hiatus, and what does she respond? "I got there only three times”. “That’s three times more than last week!” I add. She rebuts "but I only did the bike", as if the 45 minutes on this piece of equipment didn’t even count, because, as she stated, "I planned to go more and I didn't". 

I remind her how she has been diligently recording her food, identifying her hunger and her eating triggers. But she replies “but I didn’t get to record for a couple of days”.

I noted how impressively she followed through with bringing lunches from home, but she admitted that she didn’t eat them every day—because it wasn’t always what she felt like eating.
“Wow, you’re paying attention to how things taste, to what you feel like eating—that is progress!” And she admitted defeat. She was being too hard on herself; it’s something she’s long struggled with. She began to describe how thirty plus years ago, when she was only a teen, she heard something she has never let go of. It was this: 

“Do or Do Not. There Is No Try.” The perfect philosophy

Precontemplation: Not even ready to consider thinking about
going for a walk.

—for a black and white thinker, that is. On or off, good or bad, dieting, or binging—hardly an approach I can endorse. Instead, I educated her about Prochaska’s Stages of Change Model, a theory about the process of changing behavior, which is much more nuanced than that of Yoda. This model acknowledges that behavior change is an ongoing process, and that there needs to be appropriate pairing of recommendations to one’s readiness to shift where they are at. So for Sharon, a non exerciser, her move to find an exercise program on TV, and then to choose to watch it to get more comfortable with the idea, was an absolutely appropriate shift—much more so than if I had instructed her to go from zero to 60 minutes per day of running several times per week. That would have set her up for absolute failure. Or if I had suggested she had to prepare a lunch from home every day—and eat it—when she hadn’t even made shopping a priority.

Prochaska’s Stages of Change model describes 6 stages that individuals go through—not necessarily in a straight line or in one direction. They may even hover in one stage for a while—until they are ready to move on. The stages include pre-contemplation, contemplation, preparation, action, maintenance, and relapse. Yes, there’s even a relapse. This guy knew what he was doing, didn’t he? He spent a great deal of time studying smokers and drinkers and others as they tried to shift toward healthier behaviors. And the resulting model has informed us about what works for clients dealing with changing their eating and activity—as well as their expectations for change.

See where this is going?

Contemplation stage: "I'm thinking about getting up
to eat my dinner, but I'm just not ready yet."

If Sharon keeps expecting to change by leaps and bounds when she is just contemplating action, she will continue to be disappointed. And if she thinks that slips don’t happen—that relapse has no place—then she is equally wrong. But if she can more compassionately acknowledge that there is a process going on and that action is only one visible step in that process—then she will have success. Setting unrealistic goals is a self-fulfilling prophecy. Yes, you will be a failure if you set yourself up for failure.

Back to Yoda.

I’ll admit it—I’ve never been a Star Wars fan. And this quote Sharon shared does nothing to endear me to Yoda. But then I watched this other movie clip that went beyond that short, all-or-nothing statement. 

Forget what you learned.

Yes, with all the misinformation and craziness out there, this one I can endorse! It’s funny that it’s stated in the same frame as the more well-known quote above. And, I suspect, it simply gets missed.

Yes, Sharon, it’s time to forget the diet rules and the self-destructive thinking. It’s time to forget the failures you’ve come to expect and to hold on to the hope.

And I do expect to see a list of positives from you—at least when you are ready to accept that you are truly doing well.

Thinking It's All Your Fault?

That’s what they’re thinking, isn’t it? And likely you believe it too. Whether you’re fat or thin, healthy or unhealthy, fit or not, we need to place blame. It’s too hard for us to accept what’s not in our hands to control. We blame your weight on your eating and your diseases—even when there may be no link; we unfairly blame the parents for their child’s eating disorder; and we yearn to believe that it was your actions that caused your disease. Here are just a few examples of this I’ve recently encountered:

• "You’re too fat and of course you must eat poorly. And you’re lazy, too. Shouldn’t you be moving that 350 plus pound body around better—faster, longer, more gracefully? Your knee problems, your reflux, your high blood pressure—they’re all caused by you, don’t you think?" It doesn’t matter that you were an overweight baby and a chunky child—cute then, but not for the adult you. No, it bothers us to see people outside the “perfect” range. 
• The first question they ask is “Was he a smoker?” And the answer is no. Not a smoker nor a drinker yet my father died from primary lung cancer which spread to his liver. And no, there were not even asbestos or environmental factors. And my relative’s recent diagnosis of stomach cancer—rarely seen in the US but common in Japan—where they tend to be slimmer, I might add—was not caused by her weight nor her diet—those pickled, fermented and smoked foods associated with this cancer are not in her repertoire of foods regularly consumed.
• I was sent many an internet, urban legend article on diet soda and multiple sclerosis after my diagnosis of MS. They were well-intentioned senders. They just wanted to find the answer, to find a cure. Never mind that the best research facilities still don’t have a cure, and that I can count on one finger how often I drank a diet beverage over the past months. But they thought they were being helpful. Wouldn’t it be great if I had caused my MS, and then I can equally easily undo it?
• It’s the families, isn’t it? You know, that cause the anorexia? Wasn’t her mother always dieting? What about the home environment? Didn’t her sister also have an eating disorder?

Randomness is difficult to accept. If there’s no cause and effect, it means we can’t do anything to protect ourselves from all the bad things that may befall us. It means we have no control over the future of our health, of our survival, and of the risk to those that we care about. It leaves us feeling way too vulnerable.

We want to place blame. If her cancer was caused by her weight or her gastric bypass surgery, then it won’t happen to me. If his cancer was due to smoking or asbestos, then I am safe. Cut out the diet sodas and I’ll be free from risk of neurological disorders. If mothers cause anorexia, then I can change how I parent and prevent my child from getting it.

If only life were this simple. An eating disorder is complex, and can’t easily be caused from environmental influences. It likely involves a genetic predisposition, some triggering event, and environmental support to maintain it. Yet that doesn’t mean that parents are helpless. They may help prevent an eating disorder in a high risk individual by keeping eating on track and preventing the dieting that all too often results in an eating disorder. And they can certainly actively support their child’s recovery!

My MS and the ALS of a dear relative will not be cured with nutrition or weight change. But we can take control of our stress and maintain the health of the functioning bodies we do have. We can eat well to feel well—and yes, that includes cupcakes in addition to whole grains!

As for the myth that your weight is responsible for all evils? Reread this old post!

All hope is not lost. Even conditions we didn’t cause, we have a role in repairing. Yes, even the cancer. Getting the best treatment team and following the recommendations of your medical team is key. Reducing stress and keeping a positive attitude are critical remedies as well.

So when the conversation goes down that path of placing blame, politely educate the naïve inquisitor. And when you’re thinking it’s all your fault, think again.

On my list of "to dos"!

But don’t free yourself from the responsibility of taking action, of taking control of your health in all the ways that you can. And whether you have a terminal illness or a progressive condition or are 100% healthy, start living like you don’t know what tomorrow will bring. Because the truth is—you don’t. 

Thanks for reading. As always, I’d love you to share this if you liked it. Now there’s some action you can take!

Forgetting to Remember: The Key Obstacle to Eating Disorder Recovery

In Memory of a Lost Patient.

Maybe it’s because I was taught never to forget. I was instructed to mark days for the sole purpose of remembering—the anniversary of a loved one’s passing, a date of destruction of a holy site, or the attempted annihilation of my people throughout history. Recalling a negative occurrence, as I’ve learned, has much value. 

I’m not suggesting dwelling on it, as a kind of “woe is me” way of existing, thinking catastrophe may strike at any time! But remembering negative events reminds us of our good fortune to be where we’re at, to appreciate all we have, all we have survived. And it reminds us we need to be anything but passive to ensure that we do our part to prevent future damage and disaster.

And what does this have to do with you, my dear readers? Everything! If you read Drop It And Eat for support with your eating and your health, for the sake of changing your relationship with food, then forgetting to remember is a key obstacle to your progress. Are you a dieter or a restrictive eater? A binge eater or someone stuck in a purge mode? Your memory is essential to breaking out of the trap you’re in.

Here’s why.

When you are restricting you may focus on the high you get, how empowered you feel—yet forget that it is but a fleeting feeling. Rather, the restricting has landed you with rebound overeating or disappointment with subsequent weight regain.

Alternatively, you achieve your “success”, and the restriction continues, only to result in symptoms, health risks and hospitalizations.  You forget the lightheadedness, the risk when driving alone or with those in your charge. You fail to acknowledge that fuzzy headedness and the fact that slowed thinking is not your norm.

Maybe if you remembered that weight loss didn’t itself bring you happiness, that goal weights were a moving target. That no weight was ever low enough, and that it never made you feel good enough.

You’ve forgotten that the isolation from friends and detachment from those you love was a hefty price.

You’ve forgotten how scary it is to vomit blood, to see the veins pop in your eyes—but instead you simply focus on the risk of keeping those extra calories in.

You get so used to living in a substandard way, not functioning at full capacity, that you forget what life could be like—the potential you truly have to make a difference, to even one person you care about.

Before the memory is gone, recall it. When you are considering rigid dieting or the need to purge, think about what you know. When you are thinking you already blew it, that it hardly matters what you do at this point, consider where that has gotten you. Was the action worth it? Did it really achieve your intended goal? Is this how you want your life to be?

Do not forget that your thoughts used to be spent on passions and hobbies, on family and on learning—not singularly on calories and carbs, and pounds and numbers, on shoulds and shouldn’ts.

Remember that you are worth it, that you have made a difference and that it is not too late to change your eating behaviors.

This post is written in memory of my one patient who left this world too soon, well on her way to recovery from her bulimia, but struggling with her bipolar disorder. Her memory inspires me to do my part in eating disorder recovery.

Who’s Telling You What to Eat?

RDs? Nutritionists? Trainers? Finding healthy, sensible advice to change your relationship with food.

Don't let me teach you to juggle! And don't let some
clown pretend to be a nutrition expert!

I thought about doing a spinal adjustment on my overweight patient with back pain, but then I realized “Hey, I’m a dietitian, what am I thinking? I have no expertise in this!”

Ok, I’m kidding. I wouldn’t dream of guiding clients in areas I am not qualified (although I have made suggestions about stress reduction I would never consider myself a replacement for a therapist). Educating clients on target heart rate and setting realistic exercise goals based on their current health is one thing, but I wouldn’t instruct them on bench presses. Subtle mistakes and misinformation could lead to major problems.

So why don’t other provider types feel the same way when it comes to doling out nutrition information? Take chiropractors for instance. What extensive training qualifies them to tell you how to eat? Or to sell “toxin cleansing systems”, aka serious laxatives, to bulimic patients (I kid you not), all for the sake of a giant profit? Yes, I really had to coach a patient to return a product to her chiropractor who had convinced her that this was the answer to her woes. Thankfully, I was successful.

Trainers and coaches, perhaps well educated in their field getting people exercising, seem to misinform their clients more than most practitioners, requiring a great deal of my time to correct. They propagate fitness magazines’ and supplement manufacturers’ myths about carbs, and protein (they see a major halo around this nutrient) and base their guidance on their own unhealthy beliefs. Not all providers, of course—but many. They share what they believe has worked for them—which has little to do with what is healthy or appropriate for you! Even the Pilates studio I go to is now selling purgatives in pretty packaging suggestive of clean, fresh and natural health. If only they were aware of the damage of these senna filled disguises. Uggh!

I can at least support the "celebrate recovery"!

Then there are those that proudly call themselves nutritionists, which is actually quite a meaningless term. A nutritionist could be a steroid-infused guy pushing supplements at the local vitamin store, with no qualifications for this position other that his availability from 9-5. Or it could be the produce manager at the local Whole Foods or other market. Yes, anyone can call himself a nutritionist.

Admittedly, I too, have referred to myself as a nutritionist—a nutrition consultant my business card still reads. Like others, I began to use this term as a way of differentiating myself from the stereotype of food service dietitians of days gone by. It was a way, perhaps of putting a more updated spin on who we are. The difference, though, between me and those other nutritionists is that I also have very valid credentials in my field—RD, MPH, CDE, LDN (see below for definition of these credentials).

Why should you care about the initials?

Credentials are not just for bragging rights. Rather, they help to separate providers based on their qualifications. There are many bright and well-educated nutritionists—faculty members, PhDs often, who are not Registered Dietitians but rather academics with post docs in nutrition. But while they may have a wealth of wisdom about nutrition research and science, they often lack the clinical and likely the behavioral expertise of someone with an RD with years of experience working with patients. As a result, their recommendations may be less than realistic.

That said, credentials are just a starting point. There are many RDs with good qualifications that I would never refer to—they are too inexperienced or rigid in their approach.  So if you are looking to work with someone, it’s critical that you learn about their experience, their philosophy and their approach to shifting your relationship with food.

Potential for danger

A sign I came upon in Zermatt, Switzerland

A family member living in another state recently contacted me about the guidance he received from a nutritionist. He was instructed on a Paleo Diet—apparently what this nutritionist puts everyone on, regardless of their symptoms. When his symptoms worsened, she said to switch to gluten free and lactose free. But she also suspects heavy metal toxicity. Or, she added, maybe a parasite. Or something. But in the meanwhile, she prescribed her diet  “remedy”, with absolutely no evidence to support it. Oh, and she strongly encouraged a paycheck's worth of supplements which she could conveniently sell him.

And in the meanwhile, this relative is wasting away from his already underweight place. He’s feeling weaker and is nutrient deficient. But he clings to the very personal guidance he’s getting from the nutritionist. MDs have not yet identified his diagnosis nor cure, but this nutritionist is giving him hope. The problem is, this hope comes with a price; namely reducing his energy level and his muscle mass, imposing restrictive (and unnecessary diet rules) and dangling more hope that there is more this quack can do for him.

Perhaps it seems harmless enough. After all, he wasn't getting anywhere with his regular practitioner.

But it absolutely is harmful! Restrictive diets that result in weight loss in those in no position to be losing weight are irresponsible. They may stall constructive, valuable follow up with appropriate specialists. They add confusion to an already overwhelming treatment course. And they provide a false sense of trust—and hope.

Finding the right dietitian

Sometimes, it's hard to know what advice to take!

• Philosophies may vary, but I’d suggest avoiding anyone suggesting you eliminate whole categories of foods or nutrients, such as carbs, grains, dairy, etc.
• Avoid those whose recommendations are based solely on their personal experience and lack evidence-based recommendations. It’s no better than a LICSW who starts her session using Tarot cards (this, too, I’ve heard about). Fun, maybe, but not a sanctioned, proven therapy!
• Learn about their experience treating those struggling with your particular issues. More experience is best, of course.
• Do they come recommended from other health care providers or peers you can trust? Do they work in collaboration with your other practitioners? This, too, is critical.
• Do they believe you can change? If they view you as unfixable, damaged goods, discard them and move on to another provider, please!

We are bombarded with nutrition information and much of it is conflicting and inconclusive, some of it downright wrong. And the more confused we get, the less likely we are to take action, to make the necessary changes to support our health.

So choose your providers cautiously. Select those that can intelligently sort through the overwhelming overload of food rules you’re hearing. And be on guard for quacks and those simply stepping out of bounds, dispensing information out of their field. Or even worse, selling you useless and often harmful products for their personal gain.

As for my philosophy?

How great is this?!
You can purchase it from their website: http://bit.ly/Mr4gmv

• Maybe it’s because I’ve got 26 years of experience behind me. Or perhaps it’s the effect of being diagnosed with a chronic progressive disease (I’ve got Multiple Sclerosis). But personally and professionally I’ve come to believe that life is too short to deny ourselves what we truly enjoy eating. Of course, if you’ve got a severe food allergy (or other such condition) and your survival depends on dietary changes, that’s obviously quite different!
• You need to weigh the costs and benefits of dietary and lifestyle changes. Sure, weight loss may be appealing, but at what price? Is it really worth the deprivation, the denial, the decreased energy, and the obsessive thoughts to achieve an unrealistic rate of weight change or even an unhealthy weight?
• Food should be enjoyed with all your senses—regardless of your weight. Everyone deserves to nourish himself and to enjoy eating.
• Change is challenging, but worth making to improve the quality of your life. And it’s not too late to make it now with the help of a qualified RD.

The credentials:

RD: Registered Dietitian

MPH: Masters in Public Health, in Nutrition (UNC Chapel Hill)

CDE: Certified Diabetes Educator

LDN: Licensed in the state of MA

Not listed: BA in Biology, Brown University, Providence RI.

Carbs Still Don't Make You Fat. But Taubes' Words May Make You Crazy

Don’t do it! Don’t dump your carb-rich foods because of yet another Gary Taubes’ article, which hand picks research to make for sensational headlines that successfully get propagated in the NY Times (albeit just in the Opinion section, not the Science one, thank God!) Yes, yet another news piece inappropriately attacks carbohydrate, failing to note the study’s limitations and the risks of jumping to irrational conclusions.  I’m no researcher but I’m a critical reader of research. And I find Taubes’ (and other such articles drawing false conclusions) simply appalling.

Serve with a Greek yogurt and include the nuts and the
glycemic load is lowered. Better than given this favorite up!

Taubes pulls from a recent study by Ludwig and colleagues at two well-respected Boston hospitals. The objective was to examine the effects of 3 diets with different composition of protein, fat, and carbohydrate and glycemic load, on metabolism. This was done on overweight and obese 18-40 year olds following a weight loss of 10-15%. Glycemic load refers to how much a food will raise blood sugar compared with a standard. It takes into account the amount of carbohydrate in a food, as well as the impact of that food on blood sugar.

Here are a few facts to consider. Taubes' carb-bashing article ignores some critical points, many highlighted by the study authors themselves:

• Total sample size of this ground-breaking study? 21—an embarrassingly small size to be drawing such global conclusions! Perhaps even more striking is that the study began with 32 participants--that's a 34% drop out, in spite of a $2500 financial reward for full participation. I am left wondering why such a high drop out rate? These were self-selected participants, in response to an ad. Were the results not as satisfactory in those that dropped out? We'll never know, but I could only guess that if they were satisfied with the weight loss and maintenance results they might have been inclined to stick with the study. If we had all 32 starting participants perhaps the results would be quite different.

Carb-rich wheatberry salad--a summer favorite!
One of 25 recipes at food-2-eat.com

• The study looked at the impact of three different diets after weight loss, which might be quite different than the impact on those whose weight has been stable. The body does act differently after being starved!

• 1 month per diet type only! That’s how long the study evaluated these various diets.

• Even if this were all valid, would the subjects actually gain weight? It is unclear, given these were not free-living conditions and resulting weight changes were apparently not explored. In fact, we have no evidence of how closely these diets were actually followed, given this was an outpatient setting. The study mentions likely predictors of future weight change (such as changes in metabolic rate), but no actual weight change data on each of the diets is described. Yet Taubes certain jumps to this conclusion.

• Even if they did gain more on a higher carbohydrate diet, there were 2 very negative effects of the lowest carb diet, that may result in long term serious consequences.  Both urinary cortisol levels (a hormonal measure of stress) and C-reactive protein (a marker for chronic inflammation) increased. And both of these are associated with increase risk of cardiovascular disease.

• With the most minimal effort on Pub Med, I found another study on the pediatric population exploring high and low glycemic load meals on energy intake, satiety and hunger. Guess what this study concluded? That there is no evidence for this population (of Hispanic youth) that changing the glycemic load effects short term hunger, fullness, satiety or energy intake. BTW, this one was also by Ludwig and colleagues. In fact, even in the study Taubes reports on, there is no advantage in terms of subjects sense of hunger on the three different diets.

• The authors of the study (not Taubes) state: 

Low carb? absolutely! But not without its risks.

"These findings suggest that a strategy to reduce glycemic load rather than dietary fat may be advantageous for weight-loss maintenance and cardiovascular disease prevention."  

Yes, reducing your intake of fat to very low levels is quite senseless. But no one is advocating for a diet rich in saturated fats, like those found in the meat above. Yes, fats are a welcome addition to diets, even for those watching their weight! And key words to note here are "glycemic load". In other words, think balance. Meals with a combination of protein, fat and carbohydrate will have only a moderate glycemic load, and that is what may be key--both for metabolic health, psychological well-being (think avoiding deprivation) and long term adherence. Yes, the study authors have the wisdom to add:

"Ultimately, successful weight-loss maintenance will require behavioral and environmental interventions to facilitate long-term dietary adherence." And they acknowledge that the study diets were not designed for long-term practicality, and that the very low carb plan would be difficult to follow long term.

Having worked with many thousands of individuals to manage their weight, I stand 100% behind including carbohydrate to do so. Carbohydrate-rich foods are a necessary, satisfying, and energizing part of a healthy diet. I urge caution to the public, which may be less experienced at reading such strong-stated opinions as Taubes' as if they were fact.

Lessons from the Ride: Tales of Intuitive Eating, Anxiety and Mindlessness.

Tell me this isn't great?

Let me preface this post by saying that I’m no exercise fanatic. I like to work out—it makes me feel good—but if I don’t get the chance to, I’m not bent out of shape.  I’ve never been much of an athlete. No need for tears, but in elementary school I recall being one of the last ones chosen for teams. I’m over it now, though, really. It was not until my diagnosis of MS, Multiple Sclerosis that I began to regularly bike ride although I’d done my share of hiking. This past weekend marks my 10-year anniversary riding this 2-day fundraising ride, a total of 156 miles from Boston, Massachusetts to the tip of Cape Cod—Provincetown.

During the ride thoughts of blogging never entered my mind. But afterwards, I was struck by several observations that I just had to share.

Intuitive eating? Not quite

As you’re well aware, I’m a big advocate of intuitive eating. But the truth is, intuitive doesn’t always work. Case in point: I’d ridden 15 miles to the first rest stop, soaking wet from the rain, with an elevated heart rate. Was I hungry? Not at all. Did I need to eat? Perhaps. By the next rest stop, now more than a couple of hours from the start of the ride, I still wasn’t hungry. Perhaps it’s because of the volume of fluid I was drinking in an effort to stay well hydrated. Perhaps it was the adrenaline driving me, revving me forward, preventing me from being aware of my body’s need for fuel.

Just arrived at the lunch stop

Nonetheless, intellectually I knew I needed to eat. I knew that my body was using up energy and needed replenishing. And so I made myself eat. I had little interest in the sports bars nor in the cookies at the rest stops, but I ate them. And they successfully fueled me until the lunch stop just an hour later. Then I fed myself a sandwich and multiple bags of chips, along with assorted other snacks. Oh, and more Gatorade.

This is how it went for each of the two days. There were times I did get hungry—generally after I had cooled off and my heart rate had dropped. But for the most part, I had to just do it, to simply eat because I knew I needed to, to keep me safe while doing an activity that needed fueling. And even without exercise, we need to eat to fuel ourselves throughout the day.

Intuitive eating returns

By late Sunday night, I returned home, and at 9:30 PM, after consuming more complete meals and smaller snacks than I can even recall, I was starving! So what’s a girl to do? I ordered Chinese food—the sodium-rich cuisine was just what I felt like— and I enjoyed every bit. This was intuitive! Yet had I, like so many of you, been stuck with the misinformation that eating after a certain hour was bad, or that I had already eaten my umpteenth meal and shouldn’t be hungry, I would have failed to meet my body’s needs.

My husband, who also rode, was also quite intrigued by the regulation of his food intake. He asked me how much I thought we had each consumed and I did a very rough estimate of our intake—trying very hard to remember all we had eaten. Then he asked how much I thought we had burned. So I did some equally estimated calculations for our expenditure.

And what did I find? Each of us had consumed within 10-15 calories of our estimated need! It was astounding! This combination of eating at regular intervals—just because I knew I should—together with eating whenever I got hungry worked like a dream. Our high activity is really beside the point. The key thing is that you burn calories 24/7—and certainly more if you are moving or exercising. And it’s critical to both respect your hunger when it is present, and use your sensibility (or the wisdom of a professional who’s working to keep you on target)—because anxiety, exercise, distraction, fluids, fiber and volume of food can stand in your way from eating enough.

Other lessons from the ride

Anticipatory anxiety

Yes, it's raining!

I hate the thought of biking in the rain. It scares me. They threatened precipitation for Saturday, but that did little to reduce my fear of having to ride in bad weather. About 45 minutes before we started pedaling, the rain started. Steady rain. The ride was not called off. The teams were called, one by one, to head out to the road. And so I did. 


Yes, my eyes were stinging from my hair gel dripping into them, and I was getting covered with grit and spray from the bike in front of me, but you know what? The reality was much better than my fears. Would I choose to ride in pouring rain? No! But having had to do it, truth is, it’s really not too bad. I survived, as did everyone of the 2000 or so riders that rode. And after a couple of hours, the sun came out, and I dried off. And by the end of the 156 miles, I was so thrilled I didn’t allow my anxiety to stop me from achieving my goal. See where I’m going with this?

Sometimes the solution is right in front of you!

Ok, this brilliance I’ll share—just don’t think any less of me, please!

At the finish, not yet hungry, but quite tired!

I had a headache all Saturday morning, a painful, aching headache. I didn’t get it—I was drinking plenty and eating regularly, so go figure. Then lunchtime came, and I pulled off my bike gloves, and my helmet and ate. And the headache disappeared. Yet when I returned to the road, the pain returned.  Thoughts of stroke and aneurysm crossed my mind—really! But by the next rest stop I figured it out.

The indentation on my forehead told me that I had mindlessly secured the darn helmet way too tight!  Yes, sometime the solutions are really right in front of you. And sometimes, your symptoms have nothing to do with how much you had eaten! (Just being honest!)

Yes, that’s what I learned from my ride last weekend. Thoughts? Comments? I’d love to hear what you’re thinking (unless, of course, you respond to my inability to appropriately fasten a bike helmet!)