When fat things happen to good people. On being thin, fat, and your false assumptions.

"Such crazy thoughts in that Aussie article!"

Do you think that if only you do the right thing—eat a healthy diet, exercise, get enough sleep—then you will achieve your dreamed of weight, live free of disease and live happily ever after? This, dear readers, is a fairy tale. 

If you believe that eating nutrient packed, low calorie foods is solely responsible for whether or not you get cancer, or arthritis or MS, think again. And don’t be fooled by the preaching of Dr. Fuhrman in his book, Eat for Health, that health equals nutrition divided by calories, period. Health is not such a simple equation. And no, eating whole grain, veggie packed meals won’t protect you from an eating disorder either. 

If you think that eating 'right' ensures thinness, as was recently emphatically suggested in a popular newspaper article in Australia, it is yet another fantasy.

And if you torture your overweight self with the belief that you must lose weight--at all costs, and that your inability to reach target goals based on BMI charts is your personal failure, you’re wrong again.

“What is she thinking?” you’re thinking? Let’s start from the top. 

Eating healthy equals health

Yes, diet can impact many, many health measures. And I certainly encourage a balanced, varied diet filled with a complement of vitamins, minerals, antioxidants, and an appropriate level of fiber, to name a few. Yes, there are correlations in populations that have higher intakes of alcohol and saturated fat, for instance, with increased rates of cancer and high cholesterol, respectively. And a nutrient-rich diet chock full of antioxidants and lycopenes, like those found in tomato-based products, may help stave off such conditions as Alzheimer’s, cancer, and other diseases. But eating a proscribed diet will not guarantee your health. Nor will it ensure happiness, which is not to say I don’t encourage making healthy choices—I surely do. But do not, for a moment, think that if you are fortunate enough to stay healthy (or unfortunate enough to become ill) that it is solely by your hand. Credit your parents for their genes, to start.

Fallacies about thin

And do you know what? Eating well does not ensure thinness either. I see my share of patients who choose the most wholesome foods, but eat in excess—even those nutrient rich, heart healthy foods, like avocado and almonds, lean protein and kale. By excess I mean frequently eating without regard for hunger, and eating past a point of comfortable fullness. And eating well—high quality, nutrient-rich foods—even eaten mindfully and intuitively—may not keep you slim. Yup, it’s a sad truth that many of you don’t want to hear. And in fact, the very act of pushing your body to be a weight it is not meant to be, may put you in worse shape—both physically and psychologically. Just wait until you hear about these studies!

Stay tuned. That’s my next post, based on fascinating research presented at the Renfrew Conference I attended last weekend.

And those who are thin do not necessarily eat well and are often hardly fit by any standard. Do be careful about equating weight with health because they do not always pair up as you’d expect. Individuals may be thin because they are genetically predisposed to be, or they may be thin because, in contrast to what journalist and dietitian Susie Burrell believes—that they “know what to do to control their weight”—they may fall quite short in controlling it appropriately. They may be no better than someone who binge eats for emotional reasons at knowing “how to cope when things are tough”. Don’t be fooled into assuming that thinness is simply a lifestyle choice, a moral higher ground.

And I’d caution her, and you, not to overgeneralize about thin people’s skill at “assuming responsibility for self”. Just spend a few hours in my office; even those without eating disorders may allow anxiety or depression to stand in their way of eating enough. How responsible for self is the person who denies herself nourishment when low energy or headachy—hunger gone too far—or pushes herself to exercise even when she reports constant fatigue, or pain? 

Eat when they are hungry, stop when they are full? Some thin people may. But overgeneralizing about a segment of the population isn’t too intelligent. 

No, I didn't leave the rest over, for the record.

Thin people may self-regulate just fine. Or they may deny their hunger and fluid load or rely on high volume low calorie foods. They may eat nourishing foods, or a diet of junk—just not excessive in calories. Or they may compulsively exercise, hardly resulting in mental health, potentially leading to loss in muscle mass, heart problems and a range of symptoms if accompanied by undernourishment. Really, the only thing you can generalize about thin people is… that they are THIN. You can’t assume they are healthy, or happy, or good at self-care or self-regulation.

And of course the reverse is also true. The only thing you can tell by looking at a fat person is….? Yup. It’s that they are fat. You cannot predict their lipid levels or their blood pressure. You can’t tell whether they’ve never exercised or they exercise too much. And you can’t determine the quality of their diet.

My own parents are perfect examples of this, as I’ve written about previously. 

The mere suggestion that health is 100% in our hands I take offense to, as would the rest of the population which struggles with MS, and cancer, and ALS, and type 1 diabetes and arthritis and, and and… And I can say the same thing about a target weight or size. I hate to break it to you, but even if you do all the ‘right things’, you may not achieve your desirable, fantasized-about weight. And you know what? It’s not your fault.

Stay tuned for part two, (which I hope to get out within the week), which will address obesity, weight loss, and the risks and benefits of change.

Did this post push your buttons? Did it challenge your thinking? Did it offer some relief? Do let me know what you’re thinking! 

Thanks for reading, and if you liked this post, please share!

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.

Who’s Telling You What to Eat?

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

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

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

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

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

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

I can at least support the "celebrate recovery"!

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

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

Why should you care about the initials?

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

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

Potential for danger

A sign I came upon in Zermatt, Switzerland

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

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

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

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

Finding the right dietitian

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

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

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

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

As for my philosophy?

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

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

The credentials:

RD: Registered Dietitian

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

CDE: Certified Diabetes Educator

LDN: Licensed in the state of MA

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