Advice for Your Doctor for NEDAW

Call me crazy, but I’m tempted to respond to a doctor’s closed-ended questions in ways that would knock his socks off. When he asks me about alcohol, for instance, he frames it something like this “you don’t drink much, right?” Or perhaps to assess risk of STDs he suggests “just one partner—you’re married, right?” Well, yes, he’s right, but would I ever say anything other than what he’s led me to believe is the only acceptable answer possible?

Isn't it time to get the support you need?

This brings me to the important topic of educating your healthcare team, your doctor, in particular, about how to truly support you. In honor of National Eating Disorder Awareness Week (NEDAW) (here in the States) I thought that health care providers could use a bit of awareness, to hopefully make your visits, and your life, a bit less stressful. Please consider adding your own two cents to the comments—then pass it on to others—and your providers! While this is prompted by NEDAW, I’ve included recommendations that are worth sharing regardless of whether you struggle with an eating disorder, disordered eating, or simply are outside of what the BMI chart says you should be.

Unsolicited Advice From One Healthcare Provider To Another

On weighing your patient

Please weigh patients with their back to the scale. Have them remove all layers possible—most individuals, regardless of their weight, want the weight to reflect what’s real. Weighing with shoes, heavy belts, and jackets doesn’t contribute much valid information. Oh, and have them empty their pockets!

That said, some do want to misrepresent their weight—so less is always better—with regards to clothing. And have them empty their bladder first!

A poker face and restraint from commenting is wise. That is until you’ve gotten to assess their weight in context. Imagine if you said to an overweight patient—“great, you’ve dropped a ton of weight” only to realize that they had a rapidly growing cancer? 

Weight change must be evaluated relative to behavior. Someone who lost weight (regardless of how appropriate you thought it was for them to drop some pounds) may very well have gone about it the wrong way. 

Consider this—they may have been starving themselves, resulting in messing up their periods, their metabolic rate, their mood, their sleep, their thoughts, their relationships.  This is nothing to offer positive reinforcement for. There is nothing healthy about losing weight this way. Perhaps they are compulsively exercising, or dehydrated from purging or laxative abuse. No, weight would not be a good measure of health then.

Similarly, your patient with a high BMI might have simply maintained her weight. But she feels well, is active and fit, and is healthy by all measures. Maybe she has even turned things around, if her weight had previously been climbing. Sure, you can explore other risk factors, such as quality of her diet—as I hope you would do with your slim patients, too. But if all looks good, perhaps you can accept that her stable weight is just fine for her.

Perhaps if she’s been climbing in weight that might warrant some probing about recent lifestyle changes—stressors, activity, diet—to help with better self care and disease prevention.

And if your underweight anorexic patient has increased his weight, please similarly temper your response! While you may be delighted, he (or she) may not be. It’s a mixed bag, gaining weight, even for those who are trying to gain weight. There’s the healthy side of them that really wants to recover. And then there’s the eating disorder voice that sees weight gain as a failure, as a “you can’t do anything right”, pulling them back to restricting again. It’s more valuable to elicit a sense of what they are thinking and feeling about the change. How does it fit with what they expected? What are the benefits of the changes they’re making? Focusing on the behaviors that contributed to the weight shift is more valuable than discussing the weight itself.

If your patient isn’t doing well, rest assured that they are as frustrated—even more so, really—than you are. The impact is far greater on them than on you, that’s for certain.

Hooray! You got your period back!

It’s not healthy to lose one’s period due to such factors as anorexia, restrictive eating, or compulsive exercising. We all know that. But while getting a period back is a good sign, it is not always well-received by patients. For some, getting a period equals “I must be fat now”. For others, it means they are done with their efforts to change their eating and behaviors. And that may be the worse thing for them to conclude.

Periods may return before weight is restored and before behaviors are normalized. Or they may come back after 4-6 months after stabilizing in a healthy range. Or they may never have disappeared, as was the case of a patient of mine who conceived 5 children through her years living with anorexia. The point? Consider where your patient is at before you rejoice in their body’s normalizing their periods!

Don’t Ask, Don’t Tell? I Don’t Think So.

If you don’t ask the right questions, you won’t get the real answers. So do ask open- ended questions—different than what my MD thought to ask—to obtain valuable information. If you’re discussing weight or body dissatisfaction, do ask if they’ve used laxatives, or diet pills, or vomiting or restricting—in the past, or currently. Suggest a frequency, in a non-judgmental way. If a patient says she purges daily, follow with a question like “how many times per day?” And when he says twice, follow with “And what’s the maximum?”  Just like if they say they have a couple of drinks, follow with what’s a couple—4? 5? 2? Per day? Per week? Suggest a range of possibilities, without raising an eyebrow.

 

We can only help our patients if we can accurately assess their situation. And, we can’t begin to do so if they feel they can’t trust us. So do your part. Ask your questions in open-ended ways, and be careful how you react. Ask how you can help, what they need from you. Are they connected with appropriate resources, or do they need guidance?

Encourage a follow-up sometime soon! 

Suggesting a 3 or 6-month follow-up visit certainly sends the message that their situation simply isn’t worth your taking too seriously. And as a result, they will undoubtedly convince themselves that really everything is fine, that nothing really needs to change.

And if you don’t believe me, read the comments from those in the know, below.

Thanks for taking the time to read this.

Taking Charge: Practical Strategies for Enjoying Holiday Eating and the Morning After

Ready to take control?

You, my readers, are a diverse bunch. Some of you are overweight, perhaps higher than your usual and healthy weight. You struggle to have balance in your eating—to eat what you’d like, and to learn to eat just enough. Others maintain their weight in a healthy range, yet grapple with these very same issues. Just because you may look fine, doesn’t mean you’re not challenging yourself to improve your relationship with food. You, too, may be working on legalizing foods, moving from a diet mentality.

Many of you are underweight, as evidenced not only by the scale, but by your body’s function—your low heart rate, body temperature, or hormone levels, resulting from inappropriate weight loss, food restriction or over-exercise. You too may be trying to release yourself from the grips of disordered thoughts and behaviors around food, whether or not it is visible to those around you.

Yet as diverse as you are, it seems most everyone gets challenged around holiday and social eating situations. Social anxiety may add flames to the fire. But I’ll leave that to the therapist bloggers to better address.

Last November, I did a post on recovering after slips, such as after Thanksgiving. Now I’m realizing I’d better address prevention. Perhaps I should have thought of this sooner? It’s not too late! (For those non-US residents, plug in Christmas, Hanukah, Kwanza or any other social eating situations not connected to a holiday celebration—the situation is the same.)

It may seem strange, but regardless of what end of the scale you’re on, or what your personal needs are— weight loss or gain or stabilization—these guidelines apply. Because we all want a sense of control over our situation—to eat what we’d like and eat enough of it—but not too much; to enjoy eating and feel entitled to eat, regardless of our size, in spite of the opinions of others; we’d like to free ourselves, discarding those useless rules around good food/bad food, appropriate times, and inappropriate times to consume food.

So here are my tips:

Maintain normalcy before the gathering.

Don’t skimp on your eating beforehand or you’ll be more vulnerable at the event. All too often I’m told of a client’s attempt to prevent overeating. What do they do? They eat less before the meal out or the function, figuring they’ll save some calories. Then they arrive more vulnerable than anticipated. As a result, their resolve to mindfully select their food, or to pace themselves through the afternoon of eating goes out the window.

The sensory stimulus doesn’t help.  The pleasant aromas and visual displays of appetizers through desserts calls to us. Their strategy backfires, and they feel a sense of hopelessness with getting their control back.

Using your head to maintain the necessary balance

Or like my patient, Shari, you restrict before the event, eat fine or over eat at the event, then restrict again afterwards. Hmm. Does this make sense? Somehow, when you hear it told about Shari, it’s clear how senseless this is. Yet my clients believe that somehow they are different, that the rules don’t apply. They are smart. They get it. I know they do. Yet I frequently have to remind them they are not special; lovely individuals, yes. But not so unique that the system doesn’t apply to them.

Get informed. Ask questions.

"What will you be serving?" "What time will we be eating?" It helps having a sense of what to expect. Going to a friend or family’s home? Ask what you can bring—not if you can bring something. Perhaps you'll contribute something you really enjoy and feel good about eating. A lighter dessert? A favorite vegetable dish? An appetizer you’re comfortable eating?

Pre-plan.

It starts with inquiring about what’s being served. For some, it’s necessary to think through your options in advance. If you are dining out, consider checking the menu online, to be less overwhelmed with the decision making during the gathering. Going to family for a holiday meal? Hmmm, they’re serving 6 different starch choices, including mashed potatoes, stuffing, winter squash, sweet potato casserole, biscuits, and pumpkin bread. Which ones can I get at any time? Which ones are my favorites? Which ones should I just pass on, without regret?

Remember, it’s not your last chance to eat.  So if cranberry sauce is a favorite, plan to buy it and keep some at home. Add it to turkey sandwiches or make a turkey with the fixings, even when it’s not Thanksgiving or Christmas.

You don’t need a dog for a doggie bag. Plan to bring a piece of pie, or a package of leftovers for a later time. Perhaps you’ll get hungry again later that evening. You’ll better appreciate the leftovers when you are less full anyway.

Plate the appys.

Enjoy the appetizers. But know how much you are eating. Select what you’d like, and place them on a plate, together. This allows you to take note of what you are consuming. When we are simply grazing on them, without really seeing or acknowledging them, it is much easier to over eat.

Watch the alcohol.

Painting by Russell D'alessio, Bar Harbor, ME
I hope these women had eaten before their martinis!

Nothing decreases our awareness and inhibitions like alcohol. If you can drink responsibly, that’s fine. Best to delay your drinks until after you’ve had some solid food, though.

Be flexible*.

Maybe you decide you’d like something other than what you intended to eat. Or you ate more than you anticipated, even though you tried to be well prepared. The worst thing you can do is to beat your self up. Best to work on moving on. (Yes, it takes 3,500 surplus calories to gain a single pound.)

We may not be able to control senseless comments from those around us at family and social gatherings. And unless we are hosting, we can’t eliminate temptations. But we can certainly take charge of our own thoughts and actions. And in the worst-case scenario, remember it’s only one meal, or one day. So if you ate more than you needed and are sitting with regret, re-visit that old post on the morning after.

* Did you, like me, wish this subheading was left-justified, instead of over here on the right? It's the start of being flexible!

As always, I'd love to hear your thoughts!

Fuller-bodied, Strong and Intense.

Truly the only way.

I like my coffee roasted medium-dark, French press or espresso-machine made. Dunkin Donuts will never do, not even when traveling. I’ll take tea instead, if coffee at friends’ is sub par. Just don’t microwave the water. Yuck!

I like my red wine fruity and flavorful. Full bodied, from any region. Just don’t serve it with fish! For that, a selection of whites will satisfy, thank you.

Dark and intense is my passion for chocolate. Milk and white varieties will get left behind, Lindt or otherwise. Checkout-line varieties will never do, although in my past I loved Peppermint Patties, (although those hardly count as chocolates).

Okay, call me a food snob. I’m the first to admit it.

But it’s like this. If I’m going to eat something, and eat it mindfully, I’m going to taste it. And if I taste my food, I surely want to love what I’m eating. I want to savor the flavors and the textures. 

Every bite should be a pleasure.

A quick fix for dark chocolate, Petit Ecolier, LU France

For me, there is no compromising. I’d rather not eat out, unless the food is superb. Superb generally comes at a price, so I don’t eat out all that often. My husband and I tend to enjoy our own cooking more than the food at most places.

That said, my all time favorite restaurant in the Boston area is Oleana and I would gladly accept an invitation or a gift certificate there any day of the week! Their food is aromatic, texturally interesting, and full of flavorful blends of spices.  The experience is so satisfying, that even if the meals are more substantial (calorie-wise) than I usually prepare, a little goes a long way. Yes, in spite of a multi course meal there Sunday (including a shared Baked Alaska to die for), I was able to comfortably walk out, feeling quite good, I might add.

I believe we have a right to have foods taste the way we want them to. Trying to lose weight? Assuming you need to, ask for modifications to meet your goals—but only if they will also please your palate. If the resulting dish is bland, it will fail to satisfy. And if you only order what you think you should eat, you’ll do fine while out. But once you return home, you’ll be seeking out what you truly yearn for. At a local Chinese food restaurant our family orders everything “light on the oil”. Such cuisines don’t suffer with lower fat modification, given their rich flavor from ginger, garlic, soy sauce, to name a few.

Recipe for the greatest carrot and spice appetizer inside!

But at Oleana, I’d rather have a richer prep of an exotic entrée, eat it mindfully, and stop when I’ve had just enough. Then I get to enjoy the leftovers another day. (This does require asking for a second plate when ordering your food. Otherwise, the delicious meal before you will be consumed in no time, before you’ve thought to put some aside.)

If you are struggling with anorexia, just eating out may be a great accomplishment. Order foods however you need to, to be able to enjoy the meal and not be anxious. Regardless of what others may think. Just be sure to meet your nutritional needs when you get home, if necessary. Ultimately, though, wouldn’t it be nice to be flexible and have foods without analyzing their content?

Look closely. It's made of roses! MFA, Boston, MA.

The message here? Be assertive. Ask for what you need, and what you want. Not just regarding dining, but in life, I might add. And work on choosing foods you really enjoy, not simply foods you think you should be eating. You can't simply cross your fingers and hope all will go well.

I’d love to hear your thoughts!

Hope you enjoy whatever you’re eating tonight.

Note: if you are following a special diet for medical reasons follow the recommendations of your medical team. 

Weight Watchers Beware!

Ecstatic to freely eat bananas, for the first time in years—this was the sentiment at Thursday’s meeting. Finally able to select salmon—previously too pricey by their point system—this made them rejoice.

Most of my readers care little about Weight Watchers. But I’m writing this post because whether we realize it or not, whether we are “Weight Watchers” or not, their messages infuse into our culture and into our beliefs. They impact our thoughts about what’s acceptable to eat for health and weight management, whether they are myths or truths. Hearing some myth-information recently, I decided I needed to cut it short, before it spreads. I also wanted to point out a side of diets that most lose sight of—the damage they do.

Unlike those in attendance at their meetings, their cheerleaders who are pleased with their program and their successes, I get to see another perspective.

No Lifetime Membership for Sharon

Sharon came to see me for the first time this week, having never struggled with her weight. That is, until the past few years when it began to slowly climb.  That led this smart, level-headed woman to Weight Watchers. She followed their plan 100%, yet still gained weight. Encouraged by their new program, she figured maybe the old program just wasn’t for her. Two weeks into the new Points Plus system, she arrived frustrated and distraught in my office, and for good reason.

Sharon’s climbing weight made perfect sense to me, and with the recommendations we discussed I am confident she will turn things around. But I mention her because of how she changed as a result of the Weight Watcher’s diet.

Her whole life, she ate what she wanted, in moderate portions. She’d have ice cream at night—when she felt like it—but only as much as she needed. She had wine with dinner some nights, but just a glass, and she listened to and trusted her body. And it worked for all of her 38 years. Only recently, the balance wasn’t there.

Enter Weight Watchers. Her weight continues climbing, and now she is thinking about food all the time. She avoids the normal foods she always had, the moderate portions of foods she truly enjoyed, opting instead for lots of fruit (free on the new program). She moved from trusting her body, which had always worked for her, to trusting the program. And even if it had worked, it has totally impacted her relationship with food, and her ability to be normal. And this can happen with any diet, not just Weight Watchers.

So I went to a meeting. Yes, I decided to put on my journalist’s hat and collect information. I wanted to be fair and not misrepresent their program, to hear it from the horse’s mouth, so to speak.

Lori goes incognito

They were prepared to sign me right up, on line, and at the meeting. It didn’t matter that my BMI was in the normal range (I do have issues with using BMI, but we’ll take that up at another post). No one questioned the appropriateness of my joining, in spite of my normal weight. I could only imagine the damage done, if an eating disordered individual, also in the normal weight range, showed up. The messages, in my estimation, run counter to those supporting a healthy relationship with food.

Here’s what I saw and heard. Upon checking in, your progress is assessed. Behaviors? Thoughts? No, no, simply weight. Progress is measured solely in pounds. It doesn’t much matter how your weight changed.  No, the group leader isn’t inquiring whether you binged, then restricted all week, or if you purged before the meeting. You are praised simply for the weight change.

Now hopefully, those of you dealing with eating disorders or even weight management, in another setting, have experienced a different approach. When you see your team, progress should be measured not only by weight change, but by improvement in your thinking and preoccupation with eating and weight, by changes in your vital signs, and your energy level and sense of well-being.  Weight may not change one week, but we may see breakthroughs in how you cope with challenging situations without relying on food and disordered behaviors.

Those of you who really know me would have been so proud! I work hard to filter my thoughts, when they’re inappropriate, and to think before I speak. I could be sharp tongued, at times, when something really pushes my buttons. But at this 7:30 meeting I asked some naïve-sounding questions, and truly tried to listen to the answers. And I bit my tongue really hard.

It’s not about the calories? It’s about eating for health? Really?

“Can you tell me about the new point system?” I asked. “We’ve learned so much about weight loss,” the meeting leader replied. “It’s not just the calories, it’s the macronutrients,” she tells me, “the protein, fat and the carbs, besides the fiber, that determine your points.” Hmm. Has anyone taken basic biochemistry? Or maybe just high school biology?  Those calories in foods come from (drum roll please) those very macronutrients—protein, fat and carbohydrate.

Let me remind you that energy balance and weight regulation is about the calories. In a large Harvard study, they again showed us that weight change is the same whether following a low carbohydrate or low fat diet, by one year’s time, calories being equal. And similarly, for those on the other side, the weight gain is no worse regardless of which component of your diet you increase, calories being equal. And then there’s my favorite Dr. Haub study (see previous post).

What is true, is that certain food choices may make us more full in the short term. But this is not the wisest choice. We may find ourselves in situations getting too hungry, when that volume from liquid and fiber they promote, passes. That doesn’t help us sustain our bodies and our energy. And if we are struggling to recognize hunger and fullness, lots of water and water-filled foods will only mask your ability to listen to your body and its needs.

“It’s about promoting choices based on what we know about eating for health, so we encourage whole grains and less processed foods”, I was told. “It’s not about calories.” And yet, the unprocessed, whole grain brown rice has the very same point value as white rice. To me that would send a message that they are equal, no? And why is a glass of wine so high in points? Science does, in fact, support a glass of wine. And dark chocolate, I might add. Have they not seen that science?

Cocoa and chocolate, concentrated sources of polyphenols, have received much scientific interest and study. In fact, health benefit evidence regarding cocoa and chocolate were reviewed by the Dietary Guidelines for Americans Committee (2010). This session will review the cocoa bean's composition as well as the population-based and dietary intervention studies supporting the cardiovascular health benefits of consuming cocoa and chocolate. (from the American Dietetic Association 2010 conference guide).

Yet Karen, the leader, said “have the fruit first and that may satisfy. Then if you really need it, have the crap.” No, she didn’t use those words exactly, but that was what was implied. You know, “good food” first. In other words, don’t have what you really feel like.  Yet ultimately, after yearning for what you really want, you’ll eventually end up eating it having consumed both the calories from the fruit and the calories from the other item.

Not a diet?

Their materials work hard to convince us that it’s not a diet, but a lifestyle. They’ve got to be joking!  You’re given a plan, a number of points, and ways to count foods. And you’re encouraged to have all your points. There is little focus on self -regulation, eating what you need, as just as much as you need, based on your hunger and fullness. How can they not call this a diet?

They do, apparently have a plan that has you listening to your body, but that plan was largely dismissed at this meeting. And to truly be supported in that approach, an approach I completely support, it takes time, and exploration of eating triggers, and stress management tools, and one-on-one guidance.

So here’s the thing. There’s a place for sensible guidelines. These just weren’t so sensible. Adding structure to our day’s intake helps us not get too hungry, and I certainly support regular meals and snacks. And if you are at a place where you mask your hunger (with anything form large volume, low caloric-density items to coffee and diet sodas) than listening to your hunger with be a challenge—for now.

For those of you who don’t listen to your body’s hunger and deny your needs, a meal plan may have its place—for now. You should re-learn the tools to self manage, to listen to your hunger and your fullness, and trust them. Move out of your head, away from all the rules and information you’ve picked up. Work on becoming mindful—of what you eat and how it tastes. And tune in to what is making you eat—or stopping you from eating, in spite of hunger awareness.

That’s the work we have before us. And counting points isn’t going to resolve it, or improve your relationship with food.

It’s my hope that none of you need a lifetime membership. Let’s work on making changes that can change our relationship with food and our trust in ourselves, to help us for a lifetime.

---

Forty-eight food-filled hours. And yes, my jeans still fit.

I love eating. I value being fit and feeling good. And I reject rigid rules about how and what to eat. Strange combo, perhaps, but it works. And there’s truly nothing special about me. Yes, it is possible to manage your weight in a healthy range while enjoying food of all kinds. 

So let me give you a window into my 48-hour food fest this past weekend, in Madison, Wisconsin. It’s a lovely town, Madison, with the best of restaurants. But the draw was a last chance to catch the outdoor farmer’s market before snow falls in the Midwest, and to experience the Madison Food and Wine show. Oh, and did I mention that my son lives there too? Yes, that was the main draw to Madison!

The eating began with a delectable dinner at The Coopers Tavern, where I had, among other dishes, an amazing farro salad (see recipe adaptation below). What is farro salad, you ask? A mix of whole wheat grain tossed with greens in a truffle vinaigrette, roasted wild mushrooms, cauliflower, red peppers and croutons. I learned that truffle oil is now a must have ingredient, even if it means working extra hours to pay for it. And it reinforces that even foods that are quite good for you (whole grain, high fiber, etc.) can taste great.

Next morning after a boring hotel continental breakfast—you know, bran flakes, yogurt, fruit—we headed to the Capitol square to the weekly farmer’s market. Even the cauliflower and parsnips were beautiful to view, but the tasting included no vegetables at all. No, cheeses, including the local specialty, fried cheese curds, were the focus, along with honey and jams. I didn’t eat much, given how tiny the samples were, so by early afternoon I was ready for my next feeding. 


Off to another favorite spot, newly renamed Graze. What a great name for a restaurant! My last visit there enlightened me that their French pastries were second only to those I’d eaten in Paris. 

So my afternoon graze began with a flaky apple cinnamon filled croissant. I’ll let the photo speak for itself! Although it was just a single item, I can assure you it was quite calorie dense and satisfying, and certainly enough to hold me over until my next eating venue—the Madison Food and Wine Show.

If you’re into drinking lots in the afternoon (and are over 21) this might be the event for you. I did get to try a range of beverages, the best being a non-alcoholic chardonnay, and confirmed that Wisconsin is not known for its wines although from those in the know, the local beers are quite good. The cheeses were amazing, as were some local chocolates.

There was a short workout somewhere in the day, I might add. And by dinner I was well in control of my appetite, which was a good thing, because the restaurant we dined in was like none I had eaten in before. Yes, I can say definitively L’Etoile was my best eating experience to date. Also, I might add, perhaps the most expensive, although those two don’t necessarily go hand in hand. 


Highlights of the meal may seem strange—a radish salad, outstanding for its taste, texture and appearance (sorry, too embarrassed to pull out the camera again), the chèvre gnocchi with apples, buttermilk blue cheese, toasted hickory nuts, apple cider reduction and the Farm-raised daurade ( a fish special ordered from Greece), scallion-potato cakes, bok choy, pea vine salad and a truffle vinaigrette. You just can’t eat this food mindlessly. Ever bite was savored and thoroughly delighted in.

Pumpkin pancakes were a must the next morning at Marigolds, my favorite breakfast spot. The final food highlight was the beverage on State street, Café miel latte, created with 2 shots of expresso, skim milk, honey and cinnamon. Total yum!

I recently heard the expression food porn, referring to food writers’ description of food and eating in a decadently passionate way, to arouse desire. That wasn’t my 

intent here. Rather, I wanted you to see that while this weekend was a bit extreme, and no, I don’t eat this way every 48 hours, we can and should thoroughly enjoy our food whether it’s a simple home-cooked meal or a fancy meal out. And if you choose what you truly enjoy, you will feel so much more satisfied than if you only choose what you think you should eat.

As for weight management? I, and you, don’t need to compulsively exercise to make up for our food intake. We need to listen to our body, to it’s signals and respond appropriately. Managing your weight is more about the how much you eat, and less about the what you eat. It’s about trusting when you are hungry, and recognizing when eating is driven by other factors—like boredom, stress, feeling like you blew it. And it’s about truly giving yourself permission to eat what you really want, and using all your senses to fully experience it.

Please share with us how you enjoyed a recent meal. 

And enjoy the recipe, provided by the new and sure to be a favorite Coopers Tavern!


Coopers Tavern Farro Salad


• Prepare vinaigrette
1/3 c white wine vinegar
2/3 c canola oil (or other mild oil)
2 tsp truffle mustard (available on line from KL Keller, $15/bottle) or be creative and use 2 tsps. dijon mustard and several drops of a good black truffle oil (pricy, but you really only use a few drops at a time).
Salt and pepper to taste
• Roast cauliflower and wild mushrooms in garlic olive oil (400 degrees, 40 mins should do it).
• Mix together salad: mixed baby greens, wild mushrooms (cremini, oyster and shiitake were used at the restaurant--divine!), roasted red peppers (the jarred kind, drained and rinsed will work)
• Cook farro (see this link for a good visual http://chefinyou.com/2009/06/how-to-cook-farro/). It will close to triple in volume, so don't make too much!
• Add about 1/2 cup cooked farro to the salad and toss with about 4 Tbsps. of the vinaigrette.
• Add croutons, if desired. (Personally, I'd rather skip them and eat more farro!)


I realize this is way more labor intensive than many might dare to attempt. But the flavor is truly phenomenal. And you could be flexible about the amount of vegetables and farro you use, as well as the dressing. Maybe it will simply inspire you to try some new ingredients or experience truffle oil or other intensely flavorful food products. Or more simply, take a trip to Madison and have Tim Larsen, the chef at Coopers Tavern make it for you!  
Either way, enjoy!

Drink, Eat, Pray?

What I learned about drinking this summer.

This post is dedicated to my college-age patients, many of whom will be heading off to school over the next weeks. I will miss you all and hope that you will stay in touch through your insightful comments on these posts!

I’m great at justifying my indulgences—medium-dark roast coffee, freshly ground and French pressed, luscious dark chocolate, and fine wine, be it an “oaky” Chardonnay or a full-bodied red on a cool autumn day. So finding me rationalizing alcohol consumption should come as little surprise.  

In spite of its high calorie content, moderate drinking has its benefits. Really? This sounds as good as the news that dark chocolate is good for your heart! Yes, moderate drinking, defined as 1-2 alcoholic beverages per day may be good for your health. And one drink or alcohol equivalent is defined as 12-ounces of beer, 5-ounces of wine, or 1.25-ounces or a large “shot” of 80-proof distilled spirits or liquor (gin, rum, vodka, or whiskey).

This summer a new study revealed that normal-weight women (in the 39+ age category) who drink a light to moderate amount of alcohol gain less weight and are less likely to become overweight or obese than non-drinkers. Strange but true. And this is consistent with other studies showing that women tend to substitute alcohol for other beverages, without increasing total calorie intake (while men simply tack it on to their total intake).

Women consuming about one or two alcoholic drinks a day had the lowest risk of overweight or obesity, almost 30% lower, with the strongest link for wine. And from numerous other studies there is strong evidence to support a reduced risk of heart disease, gallbladder disease and prevention of diabetes, through improvement in insulin resistance.

But please read on. My experiences over the past several months leave me unsettled. While my client population may not be representative of the general public, I am struck by what they tell me about the amounts of alcohol being consumed. I have been enlightened about beer funnels, vodka as the mixed drink of choice and the inability to even know how much was consumed each night. And the drinking isn’t limited to a Friday or Saturday night. So the total alcohol intake is a far cry from the moderate description referred to above.

According to the National Institute on Alcohol Abuse and Alcoholism binge drinking is defined as a pattern of alcohol consumption that brings the blood alcohol concentration level to 0.08% or more. This usually corresponds to 5 or more drinks on a single occasion for men or 4 or more drinks on a single occasion for women, generally within about 2 hours. By that definition more than 1 in 3 college students are binge drinking (I haven’t dared to explore the rates among middle and high schoolers).

And the calorie cost for this drinking? Each alcohol equivalent described above provides between 100 and 150 calories, not counting mixers, depending on your beverage choice. And keep in mind that unless you’re at a bar and they are measuring it, your drink may have significantly more than the amount stated. Your vodka and crystal light may be providing a couple of hundred calories per glass, and a much greater alcohol impact. Most glasses of wine filled just halfway, will provide 6-8 ounces minimum. So two glasses provide more than just 2 alcohol equivalents.

While alcohol may be cardio-protective in moderate amounts, drinking even 1-2 drinks per day increases a woman’s risk of developing breast cancer. In one study, women who drank 27 or more drinks per week increased their risk of breast cancer 3 ½ times! And heavy alcohol drinking is linked with many undesirable conditions, including liver cirrhosis, cancers of the mouth, throat and esophagus, breast cancer, and traffic accidents, to name a few. Alcohol poisoning, from too high a blood alcohol level has the most immediate consequences, and may result in death.

The long-term risks may seem inconsequential. They are far off in the future. But what most people ask me about is this—How do I fit in alcohol while managing my eating and weight? So let’s do the math. If you are consuming a couple of large shots per glass, and drink 7-8 drinks in a night, that’s an average of 1500 calories for the evening, just from alcohol. So compensating with less food is hardly an option; you’d be starving yourself all day to allow for your night out drinking. And that recent study about the benefits of moderate drinking on weight control? It doesn’t apply to binge drinking. In fact, consuming larger amounts of alcohol is associated with decreased inhibitions around eating (forget mindful eating), and correlates with an increase in eating disorder behaviors and higher BMI.

So I fear I have failed you. Much as I can support fitting light or moderate alcohol into a healthy diet, I am at a loss to assist with fitting in the high levels you might be used to. The high alcohol intake, besides providing significant calories from the alcohol itself, leads to overeating. And a more sedentary activity level. So “Drink, Eat, Pray” might be the only option. And I don’t put a lot of faith in that as a treatment option. So please consider your options. And do drink responsibly, and not when driving. There is a middle ground (moderate drinking of a couple of drinks/day). And maybe even a health benefit to doing so.

Forget the Fats? Cut Out the Carbs? Maybe...NOT!

Let’s say you need 2000 calories per day to maintain your weight (actual needs vary based on height, weight, muscle mass and physical activity—this is only an example!)  And suppose you ate 2000 calories each day, but, the calories all came from carbohydrate (“carbs”).  What would happen?

How about if you instead managed to take in 100% of your calories from fat—shall we say, for instance, 16-17 Tablespoons of oil or the equivalent?  I know, I know, it’s a gross concept.
But what would happen to your weight, assuming again that your body needed 2000 calories per day?

It’s kind of like that old, not funny riddle “Which weighs more, a pound of feathers or a pound of gold?” From a weight standpoint, your body couldn’t care less whether the calories come from carbs, fat or protein.  The foods you eat get digested, and those chemical bonds that make up carbohydrate, fat, protein and alcohol molecules get broken and energy is released.  And your body only cares that it is getting the energy it needs.  It is true, that per gram, protein, fat, carbs and alcohol each provide different amounts of energy. Fats provided the greatest energy, followed by alcohol, and finally by protein and carbohydrate which tie for the lowest calories per gram.

So should you be worried about taking in carbs? Or fats, for instance?  Not at all.  If the total intake matches your need, regardless of the source of those calories, you’re safe, from a weight standpoint.  (And in later posts I will address just how to find that balance.)

Now let me clarify a few points.  You certainly still need all three nutrients (alcohol excluded). You need adequate protein, fat and carbohydrate for your body to be healthy, in addition to vitamins and minerals to prevent disease. So I’m not suggesting you eat only carbs, for instance.  But tomorrow morning when you are contemplating eating some cereal or pancakes or a bagel, rest assured that it doesn’t go right to your hips (or butt, or waist). And having a modest intake of fat may also contribute to your eating pleasure and satisfaction.  And perhaps prevent you from feeling denied and deprived.

If you don’t believe me, try it out.  And keep in mind, it takes 3,500 surplus calories (beyond what your body needs for maintenance) to gain a single pound (or 3,500 calories less to lose it).

The only way to really trust is to experience it. So go ahead and step out of your comfort zone tomorrow.  And when you find that nothing bad happens, please post a comment on the blog and let me know! (By the way, the top photo is of my lunch on a trip to Provence, France.)