What Registered Dietitians Believe: AKA Don’t Trust Everything You Read

Processed, white bread, with sweet, unsalted butter. Yum!

Yes, that’s white bread—homemade by my bread machine, in fact (with my husband’s assistance)—and that indeed is real butter on top, added by yours truly. It was part of my lunch, together with my favorite lentil soup. And, a piece of salted almond dark chocolate, along with a cup of tea I’m still sipping on. A reality program of what RDs really eat?Not quite. Rather, I’m compelled to respond to an article that makes showing up at dinner parties with my real identity as a Registered Dietitian quite challenging!

I stumbled upon 9 Ingredients Nutritionists Won’t Touch as it was retweeted by some RDs on Twitter. Exaggerated statements about foods that dietitians wouldn’t dare eat plastered the article, so I thought I'd clear the air for the sake of people like Brian (not his real name), a blog follower struggling with an eating disorder. He saw this Dietitian's response, which read “An irresponsible piece overgeneralizing about RDs and what is healthy! No soy protein? Only 100% whole grain bread? Really?” He responded “I used to assume all nutrition 'experts' were this rigid - & triggering. Hence I've never consulted any”.

So let me set you straight. This article certainly doesn't represent all dietitians. The hype suggesting we should never eat these 9 ingredients is crazy. No single ingredient moderately consumed is poison. Although I will admit that eating a hotdog every day will greatly increase your risk of cancer. And certainly no one food or ingredient causes weight gain. (Or weight loss. Sorry to disappoint you.) The reason why I'm taking the time to address this is because the last thing you need is more food rules—especially senseless ones.

Since I honestly have never been concerned enough to avoid at all costs the ingredients purported to be avoided by nutritionists, I needed to do a bit of research on these food concerns. With a little bit of digging, here’s what I conclude:

Corn oil and omega 6 fatty acids (FAs)

Sure, I'd recommend an increase in omega three fats from fish such as salmon, sardines, tuna (in moderation if you are in your childbearing years), flax and walnuts, to benefit from their role in reducing inflammation and lowering cardiac risk. But to set a rule that products with ingredients such as corn oil should be banned is unwarranted. Omega 6 FAs also have their benefits, and a focus on the ratio of omega-6 to omega 3s is apparently misguided. Read the experts' review http://circ.ahajournals.org/content/119/6/902.long

The cancer causing additive potassium benzoate and benzene

Here’s an excerpt from the 2009 FDA paper addressing concerns about benzene levels found in beverages: How many and what products were found to have excessive levels of benzene?:

To date, FDA has tested almost 200 soft drink and other beverages in the CFSAN survey. Benzene above 5 ppb was found in a total of ten products. Benzene above 5 ppb was found in nine of the beverage products that contain both added benzoate salts and ascorbic acid. FDA also found benzene above 5 ppb in one cranberry juice beverage with added ascorbic acid but no added benzoates (cranberries contain natural benzoates). The manufacturers have reformulated products, if still manufactured, which were identified in the survey as containing greater than 5 ppb benzene. CFSAN tested samples of these reformulated products and found that benzene levels were less than 1.5 ppb. See also Data on Benzene in Soft Drinks and Other Beverages, including product names and benzene levels.

Don't trust the FDA? Here's a balanced, unbiased piece from Livestrong, June 2011 which references additional sources, too.

Even though benzene levels are not an issue, I’d vote for moderate intake, at best, of sodas.

Soy is poison? This one I had to look up because I was clueless!

In the article on the nine ingredients we supposedly avoid like the plague, Nunez, the  author quotes Valerie Berkowitz RD, saying "Soy protein, soy isolate, and soy oil are present in about 60 percent of the foods on the market and have been shown to impair fertility and affect estrogen in women, lower sex drive, and trigger puberty early in children," she says. "Soy can also add to the imbalance between omega-6 and omega-3 fatty acids."  Unfortunately, the evidence simply isn’t there to support Berkowitz’s claim.

For a balanced review of the pros and cons of soy, check out this Huff Post piece http://www.huffingtonpost.com/neal-barnard-md/settling-the-soy-controve_b_453966.html, which, rather than sensationalizing food ingredients, cites the research from peer-reviewed journals that are considered state-of-the-art.

If you are still concerned about the unproven risks of GMO soy, that shouldn't stop you from choosing organic which eliminates this possible risk. Apparently organic soy is stated to be free not only of pesticides but of genetic modification.

As for palm oil? And processed foods?

My breakfast of smoked fish (with nitrites), enriched white
bread, and saturated-fat containing foods--in moderation, of course.

Sure, I'm not big on palm oil, a saturated fat, but again, it's about the bigger picture. How much are you consuming? Too much saturated fat will increase your LDL or “bad” cholesterol, as it's commonly known. But even those needing to follow a diet low in saturated fat to lower their high blood cholesterol levels can consume up to 7% of their total calories from saturated fat. Certainly that leaves room for the occasional product that has a bit of palm oil as an ingredient.

Nitrates and nitriteshave long been acknowledged to be carcinogenic, leading to cancer. So no, I wouldn't recommend frequent intake of hot dogs and bacon. But an occasional dog at a picnic? Be my guest.

The statement about avoiding enriched flour? That one tops the list as the most absurd recommendation, and the mere suggestion that this represents what dietitian's believe would certainly keep me from seeing one! So I'm with you, Brian. What they are suggesting is that enriched is code for refined—because the only foods that need enrichment are those that have been stripped of their original nutrients. That said, all foods do not need to be nutrient powerhouses; refined (unenriched bread) isn't poison, as part of a balanced diet. And of course enrichedbread would only bring additional B vitamins to the meal. So what's the problem? Must we always choose the most fiber filled, nutrient-rich food items? Can't we include vegetables for some of the fiber and vitamins and minerals, and simply enjoy the French bread—enriched or otherwise?

Articles like 9 Ingredientsperpetuate misinformation about food and nutrition and about dietitians. While it does refer to the nutrition professional as a nutritionist, a general term having no qualifications attached to it, they quoted from many a Registered Dietitian throughout the article.

If you're trying to improve your relationship with food and you visit with a Registered Dietitian whose messages match up with the 9 Ingredients hyped article, do run the other way! But please don't assume that we are all like that. I know I'm not alone in my approach to eating. Registered Dietitians with a focus on behavior change and those with extensive experience treating individuals with eating disorders are most likely to share my approach.

So Brian, hopefully now you’ll reconsider a visit to a dietitian—just find one with a sensible, balanced approach to eating.

Thanks for reading.

Measuring Progress with Gingerbread & Other Tales of Eating Disorder Recovery

But only if you do your part!

It was the shortest day of the year, the winter solstice, and it was a dark and rainy day here in the Boston area. And I was home sick with a bad head cold. It was enough to put me in a rather gloomy mood, if it weren’t for some bright spots from this past week that lightened my mood. Perhaps they’ll brighten yours, too.

Hannah had not had the easiest time these past several months. Besides her eating disorder, which ranges from anorexia to binge eating, she’s been struggling with depression. Yet after many months of working with her team her progress shined through.  No, I’m not talking about measuring her progress in pounds—her weight fails to reflect the recent progress that’s just starting to emerge. 

Ahh, the feeling of eating and trusting it's going to
be okay...

Rather, I heard her describe for one of the first times, her interest in food—in its taste, and in its texture. I heard her say that she realized that she actually didn’t like some of the things she had been eating, and I heard her talk about her food passions and preferences. Yes, Hannah is finally allowing herself to taste what she’s eating, and to select foods she enjoys the taste of. This is progress!

Then there was Sammie, who bought my book last week—Food to Eat, co-authored with Cate Sangster— and at her follow up visit on Tues. this 20-something-year-old came in all excited. She had prepared about 7 of the recipes, from Cate’s Muesli Bircher to the gingerbread. But more than that, she actually ate them all! (Not all at once, I’ll add!) And she reported loving each and every one of them.

Rye Pixels Copyright. 

She told me about her love of baking—something I knew nothing about—but confessed that she had not previously ever eaten the baked items she labored to prepare. No, not since she’s struggled with her eating disorder. But this week was different. And having broken the ice and done so once, she’s increased her confidence that she could do so again. She trusted, she told me; she felt like she knew what we were saying was true and that it was okay. And it worked.

Are you ready to challenge yourself and break with your routine? Bring a little light into these dark days by challenging yourself and trying something different. I’m attaching the gingerbread recipe—I baked it Friday with the lemon icing and it was divine! But with or without the glaze, you can’t go wrong.

It’s not too late to start to change. All it takes is the first step.

Let me know what you think.

From the recovery cookbook Food to Eat, one of 25 sensible and tasty recipes.

Overeat, Restrict, Over-exercise—Just for now?

It may make you happy for now but...

Dana used to tell me she'd allow herself to eat "whatever", just until the holiday season was over, and then she'd buckle down and resume her restrictive approach to food management again. 

Rob cancelled his November appointments, preferring to wait until after January 1^st to begin to improve his eating and his cholesterol level. And Stacy continued to restrict—in part because she knew that after her next doctor visit in a few weeks, she was going to be held accountable for her actions. Yes, she was going to need to turn her eating around or she'd be finding herself in a rather unhealthy predicament.

If you're like my patients and thinking you'll get by just for now, whether you'll continue to drop a few more pounds before you start normalizingyour eating or you continue on your path of overeating, it's time to face the facts—you're not really planning to change. At least, not for long term.

I know, I know, you really do want to change. You may, like Dana, hate how challenging it is to do the simplest tasks, and how incompetent it makes you feel being foggy headed and spacey. Like Rob, you may be savoring what feels like your last supper, your last chance to get it all in before you take your diet seriously and have to give it all up. Or like Stacy, you may fear the consequences of eating enough—even if you know it's the right thing to do, for both your physical and mental well-being.

The truth is, this approach of just for now will do nothing to improve your relationship with food. If you continue to feel like it's your last chance to indulge, then plan to refrain from your favorite foods, you'll find yourself deprived. Sure, you'll do fine for a while—even a few weeks—until you're exposed again, or have a weak moment, a triggering situation. And then once your guard is down you'll overeat, again determined that it will neverhappen again.

And if you starve yourself or restrict your intake, fully intending to get your self back on track—once you drop the weight, that is—the behaviors that result will be anything butnormal.

Putting off change-now that's a big mistake!

If you're serious about change, it can't wait until Monday—or for January 1^st. And when you have a slip, you need to wrestle with it now and learn from it.  Ask yourself  "What happened here and what can I do next time to prevent this from happening again?"  But then you've gotta move on. (I say when not if you slip, because the truth is, slips do happen—so brace yourself.) You can't make it a slide until the first of the year, thinking you've already ruined it.

Please don’t wait until 2013 to resolve to change. Because if you're really serious, the change can and should start now.

I know it's hard, and I know you're struggling. But its not going to get any easier with the passage of time. So use your resources and start moving forward, won't you?

Thanks for reading.

Record Keeping to Change Your Perspective--And Your Eating

I'd LOVE to eat your food record, but I'm really not that hungry!

“My dog ate my food record.” “Oh, I left it at work.” “I know what I eat, I don’t need to write it down.” And finally, the very honest and most insightful comment I’ve heard, “I just couldn’t bring myself to do it. Because if I don't write it down, then maybe it didn't happen." This, perhaps, sums up why, in spite of knowing that food record keeping is recommended, it is often not done. But of course you know I can't just let it go at that! 

First, let me clarify. A food record, generally speaking, is a journal of what you ate including the quantity of food, and when you ate it. A valuable food record also includes some other critical information—your perceived hunger when you begin eating, your thoughts and your feelings—both physical and emotional. Noting where you ate is also quite useful, as we’ll discuss in a bit. Oh, and if food was consumed but eating disorder behaviors followed, that should be noted as well.

And calories? In my view, these have no place in your food record. “But don’t they count and impact my weight?” Absolutely. Yet counting them is not my idea of a healthy way to change your relationship with food and normalize your weight. We are trying to get out of your head—away from your over-analyzing what's acceptable to eat—and into your body, aware of its signals to eat and to stop eating. A goal of record keeping is to help you learn to rely on these signals so you can trust your body—I know you're not there yet—but this is a great way to start.

Why all the fuss about keeping a food record? Why do Dietitians like me recommend it and why do so many struggle against doing it? 

Accountability, compassion and shifting perspective

If you know that someone is going to be looking, you certainly think twice about what you eat. Now you may think that you already are painfully aware of what others think about your eating. And that recording only makes you obsess more about what you're eating. But writing it down in the way described below does something different. It allows you not to hyper focus on the meal you overate or the fact that you ate when you think you didn't need to. Rather it allows you to look at the bigger picture. Truthfully, this is where having another set of experienced eyes makes all the difference. 

Just saw this in NYC--can you imagine?!

Most of my clients find that my perspective on their eating  helps them to be less critical of their eating. They see that their overeating followed too long a span of time, or that their recurring hunger makes perfect sense, given the large volume of food devoid of adequate calories they were consuming.

Recording allows you to distinguish between physical hunger vs other eating triggers. Recognizing that you weren't hungry helps you to realize that something else contributed to your eating. Seeing that you were hungry but didn't eat, forces you to ask yourself what your intentions of restricting were.

Recording the food you've eaten also takes it out of the closet, so to speak. It legalizes eating. And hearing someone like a Dietitian react not in the way you'd expect—rather, acknowledging how delicious the brownie might have been, or that you only had 3 versus the whole package of cookies, or that you seemed to have needed to eat when you did and it was great that you entitled yourself to do so—get the idea? These messages help to counter the negative assumptions you have about your eating, and may help you feel more justified to eat in a balanced way. No, not the way you think you should be eating—full of restrictions and deprivation, but a more human way of enjoying food.

Would you sleep or do other things on your kitchen table?
(Ok, you don't need to answer that.)

Identifying the location you eat in is also quite important. Do you only eat when driving—where no one can see—not even you? Do you do a lot of eating in your bedroom late at night? Must you eat your food alone, out of the watchful eye of family members?

And what do you choose to eat? Do you limited your selection to diet foods, light in calories and in satisfaction? Do you include a range of nutrients including fats, carbohydrate and protein—or tend to shy away from one or more of these groups? Do you allow yourself to really eat what you like—not just to eat it, but to see it and take it in with all your senses?

Sure, there are some of you that feel so overwhelmed that recording feels like just another chore—which it is. And some of you feel you just can't get organized to remember to write things down. But largely most readers may prefer not to know—not to see it, not to acknowledge what you've eaten—at least on the days you didn't think you ate as you should have—and so you don't record.

If you're serious about shifting your relationship with food, get yourself a notebook you can keep in the kitchen. Or do you live with your smart phone at your side? Check out a fabulous free app, Recovery Record, which leaves off the nutrition details common to so many apps, but appropriately includes the thoughts, feelings and behaviors that so influence your eating, and how you feel about yourself. Then get started. And be sure to share this info with a professional experienced in this area—not the gym trainer who may have a slightly different way of seeing things.

And do start by moving your scale out of site. It is much more challenging to begin to trust yourself when you are being jerked around by that object on your bathroom or bedroom floor constantly.

Thoughts? Comments? I'd love to hear from you.

What I've Learned About Food Addiction

This post applies to all so read on.

I'm addicted to desserts and I can't keep them in the house. They just call to me. I can't simply eat a piece or a small portion—no, not me.  Once I start I can't stop and I have to eat them until their gone or I need to throw them in the trash—although sometimes, I’m embarrassed to say, I dig them out of the trash because I just can't let them slip away. And I never know when I'll get to eat them again. Avoidance—total avoidance seems like the only way—yet it never seems to work. I just have no willpower.

No, that's not me speaking—although these statements were certainly true for me at some point in my life. Yes, that time in my early twenties when my eating was emotionally driven and I had no idea what hunger and comfortable fullness felt like.  Rather, the comments above were spoken by many patients that walk into my offices—by the overweight who have unsuccessfully struggled to lose some weight with rigid diets and deprivation, and by those of average weight and below who now approach food in a black and white way, seeing food as the enemy. 

And why wouldn’t they, and you, feel that there is no hope, that you must be addicted to food in the way others are addicted to drugs? The debate about food addiction has again emerged, with media distortions and outrageous researcher conclusions on rat studies and MRI findings. And it will leave you feeling hopeless—unless you see how you are being manipulated and left to believe you are powerless.

Yum! Salted caramel.

The Wall Street Journal put out a rather balanced piece on food addiction. Yet the NY Times article on this subject is an embarrassment.  "Can Food Be Addictive?" makes reference to several studies suggesting that overeating is an addiction, perhaps not much different than addictions to drugs and alcohol. The examples cited?

"...Princeton University and University of Florida researchers have found that sugar-binging rats show signs of opiate like withdrawal when their sugar is taken away — including chattering teeth, tremoring forepaws and the shakes. When the rats were allowed to resume eating sugar two weeks later, they pressed the food lever so frantically that they consumed 23 percent more than before", they tell us. 

Well, I’ve never had my paws shake and my canines never chattered, but this sounds like sugar dependency is a serious culprit! That’s what they’re leading us to believe. But a more detailed review of this 2011 study sheds a whole different light on things. We learn that rats were first deprived, going 12 hours without food to eat, prior to being given the sugar solution. And, this binging was dependent upon the timing of the feeding. One blog describes how "... rats who had received only the food chow on this intermittent schedule, or had unrestricted access to food and sucrose, did not show these effects." That's right—not depriving the rats and actually allowing them access to food including sugar prevented binge eating. The blog reporting on this study appropriately summarizes:

I don't wait for special occasions to eat these!

“This means that after being deprived of the food or drug the rat will self-administer extremely large quantities of the substance once it is available again. This behavior tapers off once the animals are sated, but these binges will consistently occur after each period of deprivation.”

Ok, so they binged when given sugar. But more importantly the research actually confirms the very problem with food deprivation and the resulting out of control eating that we see in our clients who feel trapped in this cycle. No, there was no problem when they could freely feed on food and sugar as desired. Rather, the problem with binging resulted from the withholding of food for long periods, which set the rats and sets my rat-like readers up for trouble.

Might I add that we are not rats in our ability to step in and change our situation. We are not limited to our cages—we can choose to step out of our environment and to control our triggers. And we can certainly avoid deprivation—the biggest trigger for binge eating. You didn’t need a rat study to tell you that, though!

Another study referenced by the NY Times article to support the food addiction theory drew equally absurd conclusions. Researchers at Oregon Research Institute surveyed 151 teens who were in a healthy weight range about their eating habits and food cravings. Then they did brain-scan studies on them while the kids looked at pictures of chocolate milkshakes—more activity in the brain was considered to be linked with greater cravings. Next, they gave them a milkshake to drink while they were having an MRI scan. The kids who'd reported eating the most ice cream over the past few weeks prior to the MRI scans registered lower activity in their reward centers from the milkshake—in other words, less craving for the milkshakes. To me that’s a good thing. Those very kids who had access and consumed these items regularly did not have their brains light up as if they were getting some big reward when offered a milkshake—no, it was no big deal to them.

Yet the NY Times states that these findings "suggest that just as drug abusers and alcoholics need increasingly larger doses over time, children who are regular ice-cream eaters may require more and more ice cream for the reward centers of their brains to indicate that they are satisfied."   One study author similarly concludes that not having as great a response to eating the food (based on MRI) is problematic—that “over consumption of these foods down regulates reward processes. That may, in turn, make you eat more." Really? That's quite a strange conclusion to draw, in my opinion, especially as these kids were not overweight. (in spite of their more frequent ice cream consumption.

Further, this study attributes possible addictive-like qualities of ice cream shakes, made with Haagen Daz ice cream, to the high fat content.  But if it is about the fat, why don’t we have addictions to such high fat items as prime rib or deep fried chicken? Or whole milk, even? No, this just isn’t seen. 

High fat and satisfying!

So maybe it's not the nutrient, the fat or sugar (as implicated above) content at all but the conditions under which we eat. Is it any surprise that those reward centers of the brain would light up in MRIs, similar to what occurs with other addictions, when these very food items are used in our culture as rewards? You know, you had a hard day, so you indulge yourself with an ice cream, ironically just as the old Haagen Daz ads suggested? Or as a young child, you scrape your knee and your mom gives you some cookies to feel better. If we could only allow ourselves to enjoy such pleasurable foods as ice cream without the value judgment we add to it!

The take home message.

What's not in question is how you feel. Clearly, when you experience out of control eating you feel as if your are addicted to food—that you have no control over certain food items or types and that it therefore must be out of your hands to seize control. And with the recent studies I referenced, you might be convinced this is true. But the only clear link with what feels like food addiction is food deprivation. 

This is not a meal!

Continuing to use food as a reward for a hard day or for eating healthy all week is a huge mistake. 

If you’re feeling like you’re addicted to food, consider changing your relationship with food and move from black and white thinking, giving yourself permission to eat those foods you enjoy but think are forbidden. 

Eat in a balanced way--and I don't mean by following the My Plate way. Rather, make the foods you eat enjoyable. Sure, include satisfying less processed foods, too--but not at the exclusion of other foods. 

And take charge of your environment—focus on mindfully eating and truly enjoying your food so you know when you have eaten just enough.

Read more about this approach in some older posts below: 

http://www.dropitandeat.blogspot.com/2012/04/0-false-18-pt-18-pt-0-0-false-false.html

http://www.dropitandeat.blogspot.com/2010/06/you-dont-understandi-cant-have-just-one.html

http://dropitandeat.blogspot.com/2011/12/following-vegan-diet-and-gluten-free.html

http://dropitandeat.blogspot.com/2010/12/recovering-from-slip-coping-with.html

http://dropitandeat.blogspot.com/2010/11/twinkies-for-weight-control.html