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.

Smart. Easy-to-handle. Attractive.

And practical minded too. Will do it all but cook for you.

I'm talking about my new book, “Food to Eat, guided, hopeful, and trusted recipes for eating disorder recovery”.

Lori Lieberman, RD, CDE, MPH, LDN, and Cate Sangster may seem like unlikely coauthors. Lori, a 26-year veteran of eating disorder counseling and a blog author in the Boston, Massachusetts area and Cate, a soon-to-be-published coauthor (with eating disorder author June Alexander), and recovering adult anorexic in Melbourne, Australia created a novel recovery tool. Part cookbook, part CBT-styled guidance and support, this book gently and thoughtfully assists readers, allaying their fears and misconceptions they may be ruminating over when contemplating eating.

It addresses head on the barriers to change, including perception and fear of nutrient content, GI issues and the consequences of change. Nutrition myths are broken down and justification and support for renourishing is provided.  It builds on a transference of trust like that which propelled Cate forward in her own recovery—from connecting with Lori's writing and learning, for the first time, that recovery is possible, to moving to increasing her own range of foods consumed beginning with this project collaboration.

No, it's not out yet, but it's coming soon, and Cate and I are so excited to share it with you. “Food To Eat” will be available as an ebook and in print—details to follow.

We've gotten enthusiastic thumbs up from eating disorder professionals, and valuable input from those struggling with eating disorders and disordered eating to help us perfect it.

We'll keep you posted when it's ready for release!

My Mother’s Day Advice.

From the MFA, Boston, MA

I’m not your mother. But the mother in me wants to share some motherly thoughts. Won’t you indulge me in this on my annual holiday? 

Yes, I yearn to do motherly things like feed you—knowing full well that moving past your eating issues and your eating disorders takes way more than my cooking. I fantasize that I can have you all over for a meal and you can eat it and enjoy it without compensation, without unhealthy thoughts and behaviors. That you can see how safe it is to eat. If only it were this simple.

So instead I’m sharing some nurturing guidance, whether you are 20-something or in your 50s.

Indulging at a favorite cafe with my
mom and my son.

Words from your non-mother (when not acting as the Tiger Mom)

• Give yourself permission.
• Be forgiving.
• Treat your body as you would expect your child or your sister should treat herself. Respect its limits—don’t exercise when your body isn’t up for it. And please fuel it.
• Be realistic. Setting the bar too high with unrealistic expectations is a recipe for disaster. You will never be able to healthily sustain such changes.
• Slip. Then pick yourself up.  Yes, it’s unrealistic to believe that slips don’t happen, that they shouldn’t happen, that you should know and do better. So move on. The real test of a slip is your ability to stand back up and move forward. Real progress is having fewer slips that are less severe. Real progress is being able to learn from your slips and work on prevention for next time—without beating yourself up.

• Find a Mom. No, it doesn’t have to be your mom (don’t forget—I said be realistic!) Rather, explore your resources, your supports, and ask for help. Yes, you can do it.

Are you my mother?

• Hope, even if you don’t yet believe, that recovery is possible. Because this old Mom knowsthat it is.
• Trust that things can and will get better. Gotta love Ingrid Michaelson’s song Gonna Be OK for the inspiration.
• Appreciate what you do have—what’s in place in your life, as well as with your eating. Check out Noa’s Homemade Religion which truly moves me to appreciate.

Enjoy, dear readers! And please let me know you're reading!

The Halo Effect. Your Thoughts About Healthy Foods Can Make or Break Your Weight Struggle.

Convinced of the health merits of such calorie-dense items as almonds, peanut butter and olive oil? You may feel more relaxed, more permissive about eating them as they’re nutrient rich and heart-healthy. After all, they’re good for you, right? So what’s the harm of eating them freely?

But then there’s the frustrated cry I hear most days, by seemingly educated dieters.

"But I eat so well, so healthily, I don't understand why I'm not able to lose weight”.

Thank you Jenny Wan-Chen Lee, a graduate student at Cornell University and her mentor Dr. Wansink for clarifying what’s going on here, confirming and quantifying what I’ve long experienced with my patients the past 25 years in practice. It’s called the halo effect.

What’s the Halo Effect?

Beautiful people are often attributed other positive features, simply because of their beauty. Their beauty radiates a sort of halo, influencing us to see them as smarter, more competent, and more likely to make a better president, for instance.

I enjoyed every morsel of this lavender flavored chocolate, and no,
it was not organic!

Growing evidence suggests that this halo effect may also apply to foods, ultimately influencing our eating. Research has shown that people tend to eat more calories at fast-food establishments claiming to serve "healthier" foods, versus the amount they’d have at a standard fast-food restaurant. Perceiving a food to be more nutritious, they’re less cautious and tend to overindulge. New research by Lee explored the halo effect around organic food, to see if people’s positive notions of organic items would lead them to perceive them as tastier or lower calorie.

“She tested this question by conducting a double-blind, controlled trial in which she asked 144 subjects at the local mall to compare what they thought were conventionally and organically produced chocolate sandwich cookies, plain yogurt, and potato chips. All of the products, however, were actually of the organic variety -- they were just labeled as being "regular" or "organic." Participants were then asked to rate each food for 10 different attributes (e.g., overall taste, perception of fat content) using a scale from 1 to 9. She also asked them to estimate the number of calories in each food item and how much they would be willing to pay.”

“Confirming Lee's health halo hypothesis, the subjects reported preferring almost all of the taste characteristics of the organically-labeled foods, even though they were actually identical to their conventionally-labeled counterparts. The foods labeled "organic" were also perceived to be significantly lower in calories and evoked a higher price tag. In addition, foods with the "organic" label were perceived as being lower in fat and higher in fiber. Overall, organically-labeled chips and cookies were considered to be more nutritious than their "non-organic" counterparts.”

http://www.sciencedaily.com/releases/2011/04/110410130831.htm

From my experience, this halo effect can have a positive or a negative impact on eating, depending on your eating issue.

For those struggling with overeating, the halo effect contributes to eating in

excess. Here's how it happens. If you perceive a food as healthy or good for you, and therefore acceptable to eat, you tend to be less mindful of portions of these foods. So consider that cry I hear frequently from new patients presenting for weight management. Assessing their intake makes it crystal clear—they are simply eating too much of a good thing!

And the Atkins and Zone Diets have made the situation worse, as I see it. If you were indoctrinated with the false information that protein at any cost is the answer and that carbohydrate is the culprit for your weight problems, it’s not so easy to let it go.

 And so excessive portions of protein rich foods are eaten, leading to excessive calories and therefore worsening weight struggles.

It may look attractive in the display, but... 

Trainers at the gym, are also frequently at fault, for propagating nutrition bubbe meises, or old wive’s tales. “Eat more protein to lose weight”, they convince their clients, who return to my office frustrated by their escalating weight (not, I might add, the result of increasing muscle mass).

When I started practice in the 1980s, I remember patients proudly sharing their progress. They'd declare that they had moved from Oreos to Snackwell's fat free cookies, consuming 6 or 8 at a time because they were fat free. But they missed the part that they were not calorie free. These patients were sold on the merits of Snackwells having no fat, which in that era was considered a good thing.

This very same halo effect has its benefits for those dealing with

restrictive eating disorders. It is often easier to include foods seen as healthy, even if only because of their organic label. Yes, for some people, certified organic chocolate feels safer as a means to increase calories than many other items might be. Similarly, a food attribute such as fiber content often allows people to select that food even if it is higher in calories. It's an effect I encourage taking advantage of, as it allows clients to become more comfortable with a wider range of foods.

What does this halo effect mean for you?

If you struggle with restrictive eating, you may find it easier to incorporate foods with some perceived health benefit, something you can justify as good for you. This often makes change easier. This will also lead to greater variety with less deprivation. It can then lead to transference of trust—allowing you to change items, to swap them—recognizing they are equivalent in nutritional value for weight and energy balance. Ultimately, you’ll be more likely to manage your nutritional needs, expanding your food selection and increasing your intake.

For those who believe that simply eating healthy foods without regard to physical need shouldn't result in weight gain, think again. Excessive calories relative to need is what impacts weight. Organic, high fiber, whole grain, omega 3-containing foods may all have their merits. But weight management comes down to calories in versus calories out.

The Lies They're Feeding You About Your Weight and Health

 And, what you can do about it

Blatant misinformation comes from perhaps the least likely sources, including well-intentioned doctors and the media. Unaware, you continue to be misinformed about your weight, your eating and their impact on your health. Let's take my patient Dave. A pleasant, driven man in his late 60s, Dave takes medical advice to heart. He has a history of high blood pressure, for which he takes medication, religiously. Yet his pressure remains too high. So his doctor told him "You gotta lose weight, Dave, and your pressure will get under control." Reasonable enough, right?

I think not.  Now only 8 or 10 pounds above his college weight (pretty good, I'd say, given his age), here's a little secret about Dave’s blood pressure--it was elevated even when his weight was at its lowest, back in his early 20's, when his weight was just fine. Oh, and did I mention Joe's fitness level? Despite being in his seventh decade of life, Dave runs 6-8 miles, 5-6 days per week, and he's been doing so for years.

Great art. Terribly high sodium content.

From Dave’s perspective, his referral to me was a blessing in disguise. He's learned that his sodium intake was way too high—3-4 times the recommended level for those with hypertension. Reducing his sodium intake may have much more of an impact than simply losing weight. To focus on his weight was simply foolish, as his weight, historically has had no bearing on his blood pressure. If he put his energy into losing weight and then his blood pressure remained high (as I'd expect given his history) he would feel like a failure. Changing his food choices, however, reducing his very high sodium intake would increase his odds of normalizing his pressure.

Thinking it's all about sodium? Not so fast. Here's a bit more personal story. My father, when he was in his 20s developed high blood pressure, as well as pre-diabetes. He was a normal (actual rather slim) weight, and was active, as he walked everywhere. His father and grandfather before him had Type 2 Diabetes, although I am unsure about their blood pressure. When I was in my 20s I had my first bout of hypertension, which I blamed on the crazy level of stress at my first job. But in fairness, even years later, I still have high blood pressure.

My Dad, 26 who survived his diabetes
and high blood pressure and died of lung
cancer (no, he didn't smoke)

Managed with diet? Exercise? Isn't that what you'd expect from a dietitian? Not so! For the record, I am in a normal weight range, and I watch my sodium. My eating (besides the cake you so often hear about) tends towards freshly prepared food, with lots of fruit, vegetables, grains, and nuts, and my fair share of my favorite oils (olive, walnut and truffle). And yes, I am active. So basically, my healthy diet, normal weight and exercise have done nothing for managing my blood pressure. Thank goodness for meds! But perhaps my healthy lifestyle, in spite of my genetics, may be helping to prevent diabetes.

Me & Mom in NYC

And then there's my mother. I won't mention the dreaded O word, but let's just say that her current BMI qualifies her for gastric bypass. Oh, and that's even after the procedure was done some years ago. And even at her highest weight, prior to her surgery, her blood pressure and cholesterol were always perfect. She actually eats rather well, but does no regular exercise. She does have knee problems, perhaps due to years of carrying the extra weight, perhaps not. Did I mention I also have knee problems?

Now don't get me wrong. I am not suggesting that obesity has no impact on your health, physical and emotional. That is simply false. It increases the risk of Type 2 diabetes, high blood pressure, and cardiac risk. It also contributes to knee and joint problems and has been associated with breast cancer. It presents challenges when people are trying to travel--renting small European cars, for instance, sitting on airplane seats—and in dealing with social stigma and job discrimination. I certainly support making practical, realistic changes to feel better on all levels—eating healthier, being more fit, lowering your stress, getting more sleep. But the focus should be on the impact of those lifestyle changes on your quality of life now, today. If you're motivated simply to lower your blood pressure, you may be disappointed if the outcome isn't as expected.

Not fitting for everyone.

It's like the many clients I see who report a history of starting to exercise. After a short time, they fail to see the weight loss they were expecting for any number of reasons. And so they stop exercising. They forget that there were clear benefits they experienced from exercise—lower stress, better sleep, better mood, greater energy, to name a few. But with a singular focus on exercise to drop pounds fast, they had failed. And so they stopped exercising, giving up all the benefits they were getting from it. How quickly they forget.

Try to change what's in your hands to change, to feel better and to potentially lower your risk of and from chronic disease. And it helps to focus on the imminent changes—those immediate benefits you can see, and feel and experience—not just the benefits far in the future. Those, too, are important, but it’s much harder to motivate for those off-in-the-distance benefits that you can’t even feel.

But if in the end you need to add a medication to keep you healthy, accept (without guilt) that you have done your part, and continue your healthy lifestyle changes because of all the benefits it brings you. This applies to those who are overweight, as well as those with restrictive eating disorders. You need to do your part, in addition to using all available resources as well.

Biking and fundraising for MS with a little help from my friends.

While perhaps unrelated to the weight struggle, I will share one more personal piece. Nine years ago this month I experienced my first symptom that led to my diagnosis of MS (multiple sclerosis). This unpredictable disease is not caused by lifestyle changes, and does not run in my family. Yet while diet and exercise neither cause nor cure MS, they can certainly allow me to stay healthy on all fronts. I don't live with the illusion that my actions will cure my disease, but I can appreciate that I feel well doing what I am doing, and taking control, in a healthy way, of those aspects of my health I can control.

Thanks to Quincy Carole for a past comment, prompting this post!

Thanks for reading.

Black And White--Great For An Outfit, Not For An Outlook

“You don’t understand—I can’t have just one or two pieces. Once I start eating sweets I can’t stop. It’s like the floodgates open and there’s no stopping it. I’m out of control. I’m addicted to junk food and I simply can’t have them around. Maybe it’s a fine approach for others, but I’m different.”

It’s all or nothing, black or white, good food, bad food. It seems simple, clear cut, easy to follow.  Strict rules about what is acceptable to eat and what is forbidden. And does this approach to eating and managing your weight work? Absolutely not. And yet you may find yourself clinging to it for safety, hoping that maybe this time you’ll have the willpower to get some control.


No one believes it at first when I tell them that this black and white way of classifying food and eating behavior is what fails them. It begins with an approach to eating that is too rigid, too “diet-y”. Sure, you choose foods that are healthy, and nutritious food choices may have plenty of benefits. Perhaps they are heart healthy, being low in saturated fat. And maybe even high in fiber. But the problem is that you deny yourself on several levels; you deny yourself adequate fuel, in the form of calories, throughout the daytime. And you forbid yourself the satisfaction of eating what you truly yearn for.

Several patterns can result. Your body can rebel and you’ll find yourself waking at night and eating somewhat unconsciously—the only time your body can get what it is forbidden (see Jenna’s Story below). Or you may have a slip from your acceptable way of eating, triggering you to think you blew it and to feel defeated. This could lead to the What the Heck Effect, a term I’ve coined to describe what follows this “slip”. 


You feel that you’ve ruined it and decide in your all or nothing thinking that you may as well keep going. So you don’t stop at a couple of cookies or chocolates, but decide to give up—until tomorrow, or Monday, or January first. Then, you compensate perhaps, deciding to make up for the damage from the day or days before. Which only sets you up for the cycle to continue.

Jenna’s Story

Jenna was the “perfect dieter”. She had a small bowl of high fiber cereal for breakfast, salad for lunch, and a balanced dinner consisting of a small portion of chicken, minimal grains and some vegetables. Friends would typically comment how well she ate, how amazing she was with her will power. It was a bit of a puzzle to them why she struggled with her weight, given how they saw she ate. But when she showed up in my office several months ago quite distressed, she presented a very different portrait.

Jenna struggled with nocturnal binge eating disorder; she would wake multiple times nightly, unconsciously proceed to eat, and return to bed. She often had no memory of what she had consumed, but was left with the evidence—the wrappers and pieces that remained, the chocolate smudges left behind. It disturbed her sleep, contributed to her weight struggle, and left her with feeling a great deal of shame.

The source of Jenna’s problem with night binging? Food restriction, both of total calories and of food type. Jenna lived her waking hours eating in a way that she expected others to see as acceptable. She would never allow herself to eat sweets or ‘junk food’. Foods were categorized as ‘good’ and ‘bad’, and she would never allow herself to eat ‘bad’ foods. She exercised aggressively, and set her body up for feeling starved.

The solution? I worked with Jenna to move foods from the forbidden or ‘bad food’ list to being acceptable. It was a challenge, but she realized that sticking with her current approach was failing her. So she accepted the challenge. In addition, I encouraged her to increase her daytime food intake, to better match her need for fuel. This required her to better listen to her hunger, as opposed to masking it with water, coffee and diet beverages. Over the weeks, the frequency of night waking decreased, and when she did wake, she found herself eating more moderately than she had before. She had also begun to be more open about her eating issues with her boyfriend. It helped her feel more comfortable when she explained her approach, the prescription to include ‘risk’ foods, and worked to remove the shame she felt about her eating pattern.

Jenna is now recovered from her night eating disorder, enjoys a range of foods of all types, and has lost weight as a result.

Please visit the next blog post for “how-to’s” on moving toward the grey from the black and white. But in the meanwhile, make a list of the foods you consider “good” or “safe” and those that you feel no dieter ought to be eating. And start to ask yourself what you feel like eating (as opposed to what you should be eating). And if you have your own story to share about moving toward the grey, please share with us!