Friday, April 18, 2014

Smoking good for your health? Making sense of the new fat and heart disease study.

It was like waking up in Sleeper, the Woody Allen movie, when the main character, asleep for umpteen years, wakes to find that cigarette smoking is good for your health. That’s how I felt some weeks ago after reading the half page article in the NY Times entitled “Study Questions Fat and Heart Disease Link”, based on the recent study by Dr. Chowdhury et al which reviewed more than 70 scientific studies and appears to turn our cholesterol lowering guidelines on its head.

No one is concluding you should be eating more of this.
You, my readers, may have little concern about your heart disease risk. Yet I urge you to keep reading—because unless this news splash is explained, you’ll be left feeling like health professionals just can’t get it right. I mean, one day they say saturated fats are bad, and next day they tell you they don’t impact your risk. Carbs are good, and then they’re bad. Hormone replacement therapy is recommended, and then it’s dangerous. Confronted with so much conflicting information, you, like me, might decide to trust none of it. And health professionals end up looking like a bunch of clowns.

After a deep breath, I poked through the research and sorted through the recommendations. And here’s how I’ve made sense of it so far:

  • Saturated fat increases blood cholesterol levels, including LDL, the so-called ‘bad’ cholesterol. Yes, that’s still true.
  • LDL does increase heart disease risk. Yup, still the case.
  • But reducing saturated fat doesn’t appear to lower heart disease.

So why doesn’t reducing saturated (sat) fat appear to improve risk? There are a few explanations:

Cornbread from Food to Eat and Drop the Diet
fits in a balanced diet!

  • Because most studies reducing sat fat reduced all fat. And when you reduce all fat something has to fill the void. Our food supply has three main building blocks—protein, carbohydrate and fats. Dramatically reduce one, something else fills the void, as a percentage of total calories. Generally, carbohydrate-rich foods replaced saturated fats in our diets. And the increased carbs tend to come from convenient, more processed, low fiber choices. Now let me clarify—those foods, themselves, as part of a balanced diet, don’t cause disease! But substituting saturated fat with a large intake of these items—rather than, let’s say foods rich in non-saturated fats (think nuts, avocado/guacamole, olive oil) raises another blood fat called triglycerides. And triglycerides increase heart disease risk. So in an effort to do something positive, namely reduce saturated fat to lower LDL/bad cholesterol, we’ve been increasing triglyceride levels. It’s like thinking that eating fat free Snackwell cookies instead of Oreos will make you healthier.
  • Harvard professors Willett, Sacks and Stampfer highlight several problems with Chodhury’s study. It fails to point out that substituting polyunsaturated fat for sat fat was associated with lower risk of heart disease. And the monounsaturated fats we usually think about as the healthy ones-those from avocado, nuts and olive oil, for instance—were not the sources referred to when concluding no health benefit from monounsaturated fats. 
  • When we combine lots of studies, the summary of the data may block out the small but critical findings. For instance, the authors conclude that  "Current evidence does not clearly support cardiovascular guidelines that encourage high consumption of polyunsaturated fatty acids and low consumption of total saturated fats." And that is surely what the media jumped on. But the truth is that certain unsaturated fats did result in benefits. Specifically, the active components in fatty fish, the omega 3s EPA and DHA were clearly shown to be protective. It's well established that these fatty acids lower triglyceride levels, decrease clot formation, decrease inflammation and act as a blood thinner, among other functions. 
Don't let fatty fish scare you!
Check out our curry salmon recipe in Food to Eat.
  • Supplementing with omega 3 fats had no benefit in Chodhury’s study. But here’s what I’d wonder: how consistent were supplementers with taking their supplements? Were doses at levels that really make a difference (most people mistake total omega 3s for the active EPA and DHA we’re looking to boost), and were those supplement takers already at higher risk—like maybe people who had already had heart attacks? Perhaps increasing food sources of omega 3 fatty acids (think salmon, tuna, bluefish, sardines, for instance), displaced saturated fat from other common protein sources, such as beef, pork and poultry, showing that food sources have more impact than simply supplements. Just a thought.
  • Lumping saturated fats as a single category misses the differences of various types of saturated fats. Saturated fat from dairy fat, for instance, was not viewed as a bad fat; it was associated with lower cardiovascular risk (perhaps it’s time to skip the low fat cheese and enjoy the good stuff!). So if you combine a bunch of studies with different sources of saturated fats with varying benefits and risks for heart disease, it waters down the results. As this study concludes, saturated fats (AS A WHOLE GROUP) may not be the issue, but certain types remain a concern.

Where do we go from here?

Can't go wrong with my favorite wheatberry salad, made with 
whole grains,a bit of sweetness and heart healthy oil and nuts.
First, let's focus on foods, not just nutrients. To me what’s most practical is to learn from the diets of populations which have lower(ed their) risk of heart disease. This Circulation article demonstrates the benefits of a Mediterranean style diet on not just lowering cholesterol values, but significantly reducing heart disease risk—so much so, that the study had to be stopped early, given the 50-70% lower risk of recurrence. “These study subjects adopted a Mediterranean-type diet that contained more bread, more root vegetables and green vegetables, more fish, fruit at least once daily, less red meat (replaced with poultry), and margarine supplied by the study to replace butter and cream.”  Use of various oils were recommended, but not limited to olive oil, and moderate alcohol was also included.

And then there was the diet in Crete which is quite similar—full of fresh and dried fruits, grains and cereals, daily dairy, poultry and fish only weekly and red meat rarely. Oil was the predominant fat and oh, the Cretans ate desserts—and not just fruit, but pastry made with honey, too--a few times weekly!

Yes, balance.
Nope, the healthiest people were not eating low carb, nor gluten free. There was no almond milk nor fear of dairy. And fats and desserts still had a role in this most healthy way of life.

My conclusion? We should focus more on eating a balanced diet rich in a range of nutrients. Yes, back to the basics you may now fear—grains and cereals (whole grains are best), nuts and oils, fruits and vegetables and fish, including fatty types and lean meats and poultry to fill the void. Include dairy, not limited to the lowest fat ones you can stomach.

And remember there’s a place for wine and desserts, in moderation.

Friday, April 4, 2014

You? An eating disorder? Breaking the silence on binge eating disorder and OSFED.

I'm not posting this to brag nor, I'll add, to solicit more emails. 
We can't tell just looking at you who's living with an eating disorder.
And I certainly don't want those of you who are not in such a great place to feel worse about your apparent lack of recovery; I'm aware that's how some of you may think. Perhaps you, too, have come a long way on your journey toward recovery, in ways you rarely stop to acknowledge. (SHOUT OUT: identify what you have done well with today!)

Rather, I write because of what could have happened to Leah. And about what usually happens, to those with Binge Eating Disorder and other eating disorders. So please read on!

"I hope you are doing well and a Happy Belated Birthday!  I just read your latest blog post and it made me quite happy and blessed for our time together.I am happy and proud to say that I am doing great and haven't used food to deal with my emotions.  I am still in therapy and it is a big help but I have really come to the other side with my eating disorder.  I have my moments here and there but ultimately I consider my self in recovery.  I completely think a different way about food and to me that is huge.  I have an amazing relationship with food again and for that I thank you and all of your help.  It was just a year ago - March 18, 2013 that we had our first Skype session and I was in a pretty dark place and didn't know how I was going to get through it all....and then you came into my life.

To build on what Dana wrote....thank you thank you thank you for having the confidence in me when I didn't and for being there as a guide to help me get to this amazing place in my life that I can now say I am truly thankful and happy to live. Thank you!!"
I'm driven to post after an ICED (International Conference on Eating Disorders) session about the lack of treatment for eating disorders, particularly binge eating disorder and EDNOS—Eating Disorders Not Otherwise Specified (now renamed OSFED for Other Specific Feeding or Eating Disorder)—that catch all disorders not meeting the criteria for bulimia, anorexia, and binge eating disorder.

Anorexia and to a lesser extent, bulimia, are more likely to be treated—although admittedly so many more aren't in treatment and need to be. And truly, treatment is typically not long enough or intense enough or multi-faceted enough—my thoughts, not the presenter’s.

But I write about these other conditions, these seemingly lessor eating disorders because their impact is so great; of those with eating disorders, approximately 60% of women and 83% of men have BED/EDNOS combined. And while the need for hospitalization or risk of sudden death might be lower, the impact on quality of life, mood, self-esteem, body image, control over eating is tremendous. And let's not forget GI distress, heartburn, constipation, fatigue, high cholesterol, blood sugar management issues—I could go on.

You? Living with an eating disorder?

No, it's not about size!
Sufferers are rarely identified nor have their eating behaviors addressed, contributing to minimizing their own struggle. I mean, if your doctor doesn't ask the questions why would you volunteer about your struggle? More likely, attention is paid to your BMI or 'weight issue' instead. If your loved ones don't sense your struggle with food, but rather just see your weight as a concern, maybe you're the one with the distortion. If you look good and your weight is more or less fine, what's the big deal? They have no idea how you struggle. And if everyone around you is focused in how fat their thighs are or how much weight they're gaining, then you’re certainly not the one needing treatment, right?


Back to Leah. I received her note coincidently while at the ICED conference, and invited her to stop by, as we had never met in person. She would have surely agreed to meet for lunch—as she had come a long way from relying on froyo as lunch/dinner—but time was tight for me, so chai lattes would have to do. And our meeting got me thinking about her history. She long struggled with dieting and food rules, consuming way too much of her mental energy.  That was the norm in both her family and in her peer group.

But Leah knew that this was no way to live.

As she recalls it, it took a tweet of mine that she came across, which lead her to my blog, and then my website and then my book, food to eat, to move her from knowing to doing, to taking action on making her life around food better. We skyped, and I encouraged therapy as well. And as you can see by her note, she did it.
But what if she didn't stumble upon that tweet? Would she, or you, or your friends take the step and initiate change, to move from being ruled by food? Apparently not. The stigma and shame around binge eating and EDNOS is great,as described by Stephanie Bauer, PhD, a researcher in Heidelberg, Germany, making the barrier to change hard to get over. And I learned in a session by Federico Girosi, PhD, from the University of Western Sydney, Australia, that it's hard for those with eating disorders to consider the long term consequences of their disorder, when the short term risk of seeking treatment seems great.

I'm doing my small part. You can do yours too!

Let me tell you, you are not alone. More of you struggle with binge eating disorder and other eating disorders that don't meet the criteria for anorexia or bulimia but which need to be treated!!! You are no less deserving of being freed from the burden of your disease as the person living with cancer.

Please speak up. Halt the fat talk that you hear in your home and with your friends. Start living now, regardless of your size. Ask yourself if the cost of treatment--your fear of what you might hear and how you might feel--is really greater than the cost of not seeking treatment. Do you want to live your whole life concerned about food labels and the calories you consume? Do you want to spend time at meals preoccupied with food and it's nutritional value, rather than enjoying the company of your loved ones? And do you want to carry this sentiment to your children as well? For Leah, that might've been just the tipping point she need, as she was approaching age 30. It felt like enough was enough.

Yet there was no action until perhaps she felt like somebody got it, that she'd be understood, that the risk of shame and stigma might be lower seeking help from someone whose messages she was already comfortable with.

Or in a blog?
Please share this with your friends, whether they have an eating disorder or not. If they start a conversation about dieting or body image, turn it on it's head. share the messages you're reading here and challenge them to have a better life. Check out our new book drop the diet: guided recipes for overcoming your food rules, a modified version of food to eat, rewritten with chronic dieters and binge eaters in mind—coming VERY soon!

Work on giving yourself permission to eat, and enjoying food, all foods, regardless of their fat or carb content. And seek out the services of providers who specialize in eating disorders to help guide you along the way.

Really it's not too late.
Please share on FB, Twitter, Pinterest, email or in conversation with your community! Thanks for reading. More to come from the ICED conference soon!

Wednesday, March 26, 2014

There's no gift like recovery. And spreading some hope.

Monday was my birthday, celebrated with my favorite buttercream cake (which I'm still enjoying), lovely get togethers with friends and family, and a gift to myself of a new bike.

But the best gift is one I must share with you. It was one sent unknowingly--she had no idea it was my birthday-- and I share it with Dana's approval. It was, coincidently, one of a couple of emails I received that day, updates on progress from patients I no longer see. I'm posting Dana's letter because I think many of you need to see it. Because I could not have crafted such a beautiful and inspiring myself.

Perhaps you recall reading about her before? In summary, she had anorexia from her early teens and first presented for treatment in her late 30s. She survived too many traumas to count, and in spite of having many close friends and family members around, did not utilize them for eating disorder support. She had a family history of anorexia, and struggled later with bulimia and depression as well. Statistically, Dana had little promise of recovery. But you know I don't always care much for statistics (I am the 1 in 1000 to get MS, and I am perhaps more fortunate than most with this disease. So I believe that we shouldn't get bogged down with recovery rates!)

I post this for you who believe there is no hope. I share this because recovery truly is possible, not just for those early in their disease, or with fabulous supports, but for all. But it doesn't come easy, nor does it happen fast. And as I've written before, it's not without discomfort--emotional and physical--along the way.

My birthday greeting from Dana

So Lori, I thought this was an important email to send to you.

Why? Bc it's officially been one year since I last engaged in an eating disorder behavior!  I have not purged in one year!  This was my last behavior to "let go of" and I did it!

Happy One Year to me!

I think of you at this one year mark.  We endured quite the journey, didn't we?!
I truly wanted you to know this important milestone bc I could not have done it without all the help and patience you provided. I wanted to share it with you bc of all the work we did together... all the frustrations, setbacks, etc paid off and got me to this point.

I thought I was a lost cause.  I thought why bother so often.  Why try.  I thought I'll always need this ed bc it's helped me survive and cope and without it, I won't be able to live.

I thought I was going to be the case where you work so hard for so long and I STILL fall through the cracks and will die from this.  I felt too broken and damaged and I got tired of flailing and struggling. All too often I just wanted to give in/give up. I was going to be your patient that would not survive this eating disorder.  Me!

Hardly ever did I imagine I could push through and see it to the other side.  Especially being fully aware that I'd been suffering for so many years and it was just, simply, part of me.

I did it though, Lori - I'm one of your "success stories"!
Not sure just how many kick and scream their way out of their ed, but I succeeded!  Rough and very bumpy ride, but I buckled up and made it.
And maybe it's not really too big a deal to anyone else - maybe even you, but inside I feel like it's a really big deal.  A victory I could never have seen myself achieving.  But here we are!

I think you deserve acknowledgement as well.  And maybe I just wanted someone to cheer with.  But we were partners in this lengthy, anything but linear recovery process, so I wanted to share and allow you some recognition at this one year mark as well, and I hope you don't mind  :)

Silly, huh? I'm doing all right.  I am back working and I have also begun taking violin lessons, which is interesting.

Anyhow... thank you for your huge role in my healing and recovering so I could celebrate this one year completely eating disorder free. Thank you for letting me quietly share.  I really wanted to share with you.

One whole year.  Can you ever imagine?!
I guess people CAN recover?!!


Please don't tell me that you are different. You too can recover. Really.
PS: pictures to be added soon! I am enroute to an eating disorder conference and simply couldn't wait to post! Please share with anyone who needs a bit of hope. Thanks.

Saturday, March 15, 2014

How yogurts and ‘milks’ mess with your head.

The big news in Olympic history before the games even started was the yogurt embargo. Yogurt, specifically US shipments of Chobani Greek (style) yogurt, was banned from Russia because of paperwork issues. If Americans were outraged about the politics of this ban on yogurt-eating liberty, fair enough. But trust me, the impact on athletes’ nutritional status and performance was non-existent. Did Gold miss medaling for figure skating due to it? Hardly. Did Ligety capture two golds in spite of his yogurt free diet? Absolutely.

Yogurt's impact on you.

Did you know? That individual yogurt you’ve been buying isn’t what you thought it was. Yes, you too have had limitations placed on your yogurt.  Same price, with even greater costs, as you’ll see, so keep reading.

I was rushing down the aisles of Stop and Shop last week, hitting the perimeter for the essentials. Produce, bread, eggs and yogurt, to name a few— were on the list. Not a regular ‘Stop and Shop shopper’, I was struck by the relatively low prices on the yogurt, the Greek yogurt, the Chobani Greek yogurt, specifically. So I grabbed some arms’ full and dropped them into my cart. But before moving on, I took a double take. The packaging was subtly different, though not strikingly so. Same shape, ever so slightly different label design. They were slightly cuter, even.

And then I realized. The container was once again downsized, this time from 6 ounces to 5.3. And the calories were similarly reduced. Yes, yogurt has slimmed down once again. The tag line should read “now with less calcium (only 15%!), fewer calories, and other nutrients you were expecting—all for the same price!”

What yogurts used to be.

When I was an elementary school kid, I remember buying individual containers of yogurt—Dannon at that time. They were 8 ounces, and they certainly weren’t lite—these were the olden days, where the only diet product with artificial sweeteners was an awful tasting cola called Tab. It’s possible they were low fat, but not fat free—that also didn’t exist back then, to my knowledge. And they were in the mid to upper 200 calorie range. At that time, it wasn’t odd to have a yogurt—along with a fruit or a muffin, let’s say, for a quick lunch or breakfast. And that might have been just fine.

That was then. But now?

While I hate to talk calories, I think it’s important here: prepackaged yogurts these days are the caloric equivalent of an 8 old glass of skim or low fat milk. That’s right. We're talking a standard paper cup size,  the equivalent of 2/3 of a 12 oz soda can portion. Would you expect a small glass of low fat milk, by itself, to be an adequate meal? How about for someone you really care about? Do you have a double standard here—okay for you, not for them? I consistently see patients consuming it with the expectation that it ought to be enough.

You and the Olympians.

The consequence on the yogurt-deprived American athletes may have been on their psyche—they may be accustomed to doing things the same way perceiving that if they change, they won’t get the same results. But truly, unless they are vegetarians dependent on the high protein content of Greek-style yogurts, protein malnutrition would not threaten a medal.

This one's 8 oz still!
But the impact of the manufactures’ sneakily shrinking serving size is much greater for you. You eat one and expect it to satisfy like it used to. Or if you, like me, grew up in the era of fuller fat yogurts, you may still be in the mode of considering a yogurt a meal or a significant part of one. No, we simply can’t rely on portion sizes to dictate our needs! (Read more on this topic: and

Milking it

While we’re on the subject of dairy, let’s talk about milk, or rather, beverages mistakenly referred to as milk. Think rice, coconut, hemp, and almond beverages. Beverages, because referring to them as milk misleads us. There is nothing milk like about them, except, perhaps, the shade of grey/off white. Sure, they may be fortified with calcium or vitamin D (although not all are, in fact), but when you pour a glass of milk-beverage you expect that it’s going to satisfy like a glass of milk. Yet many of these beverages are little more than fortified water or fail to match milk nutritionally.

You’ve already heard my rant about almond beverage.

Some almond milks have as few as 30 calories--I'm not recommended these, and all have only about 1 gram of protein—that’s 7 grams less than a glass of cow’s milk. Soy milk is consistently better matched with cow’s milk for protein (usually at 6 or 7 grams) but may be much lower calorie as well. Coconut water is neither high in protein nor calcium or D, but at least they call if ‘water!’. Hemp milk (yes, really) comes in at 2-3 grams of protein and calorically is a match for 2% or whole milk. Rice milk also matches calorically, but has only 1 gram of protein.

Who cares?

Why address this topic? Because I want you to not be fooled into thinking that these yogurts and milk beverages are adequate. When you get hungry after a pseudo milk drink, I don’t want you to blame yourself. When you are feeling less than satisfied with what you thought was your usual yogurt, think again.

Maybe there's a reason you're scavenging for food!
Start looking around, because these aren’t the only items shrinking. Did you think you plowed through the whole 1/2 gallon of ice cream? Well for the record, most brands (at least here in the US) have shrunk, too. Breyer’s, one of my favorites, now has 6 not 8 cups per container. In fact, it has fewer calories per cup, too—but interestingly, they’ve not advertised that! They have substituted guar or tara gum as a filler, displacing some of the cream and whole milk.

I realize that we all don’t need more saturated fat from cream, and some might benefit from an adjustment in portions. But if you’re noticing you’re hungrier these days with your same products, take a second look. You just may not be getting what you thought. Maybe your body is just trying to tell you something. Perhaps it’s time to start trusting your signals—and taking a second look at the package sizes.

Have you had this experience? Wondering why you’ve been hungrier? Seen other products that have shrunk without telling us? Please share!

Thanks for reading and passing this on!

Saturday, March 8, 2014

Do you ASPIRE to recover from your eating disorder?

Is your eating disorder your own little secret? Do you hesitate to confide in others, fearing they just wouldn't get it? Do you wish you had support from someone knowledgable about the struggle to recover, yet safe to share with?

Introducing the desperately needed ASPIRE, created by Cate Sangster, who knows a lot about these struggles, as you'll read. We connected through this blog as she embarked on her journey to recover, created a book together and are now dear friends. So read on and then visit ASPIRE!

"Ask someone off the street about eating disorders and they’ll probably tell you about skinny young girls with too much vanity and not enough substance to their lives. But those of us in the know, understand that the true landscape of eating disorders looks very different to this. 

Firstly we understand that eating disorders are not a lifestyle choice. They are not about vanity or attention seeking, but rather they are a severe mental illness that cannot be cured by guilt and ridicule. 

Secondly eating disorders are not just about anorexia. Bulimia and BED are far more prevalent and equally as devastating to the sufferer, both in terms of mental and physical health. 

And thirdly, we also recognise that this is not an illness that strikes only young girls. Increasingly it is being seen in older women as well as men. However little exists in the way of exclusive treatment centres or support networks for older adults.

ASPIRE, or Adults Supporting Peers In Recovery from Eating Disorders is group I started recently to fill the gap I felt existed for adults with an eating disorder. During my own recovery from anorexia I found that one of the places I felt most at home was on the FEAST facebook page, and Laura’s Soap Box (the FEAST founder’s personal blog) as the people on these sites were not only adults, but also parents like me. However these sites were set up to support carers – the parents of young ED sufferers – so was not really my place. As much as I enjoy Laura’s perspective on things, as well as the information shared by the parents, it is not set up to support sufferers.

This is where ASPIRE fits. Adults need information and support – we are often in the treacherous position of being in charge of our own recovery, as well as, in some cases, needing to raise a family at the same time. We have unique problems, but also unique skills and insights that we can use to help each other through the minefield of recovery. Being in charge of our own recovery means we have to make the decision to attend appointments, make and eat appropriate meals, take medication, hold down jobs, pay bills etc, all while our eating disorder is in control of our minds. Not impossible, but very difficult, especially when you are not accountable to anyone but yourself (and your eating disorder).

So where can you find ASPIRE?

-        blog – adult recovery tips and answers to questions from readers
-        facebookgroup - *new* a space for members to ask questions, reach out for support and provide advice to other adults sufferers
-        twitter – random thoughts on recovery, RTs from other ED tweeters and respected researchers, as well as inspirational quotes to get you through the week
-        pinterest – boards for recovery motivation

How can ASPIRE help me?

  •        providing you with information about recent ED research
  •        providing you with motivational advice and information
  •       providing you with support  - talk to other adults in recovery, ask questions about the things that are on your mind
  •        and you can provide others with support when you are in a good place – helping others gives great purpose to our lives. We have a wealth of experience we can use to help others just starting out on the recovery journey.

The value of ASPIRE will increase with every member that joins. The more members we have to support each other and provide advice on the myriad of complicated situations that arise during recovery, the better!! Start by visiting the blog to find out more.

Look forward to meeting you soon."