Donut-licking is an Aberrant Eating Behavior

ariana keep outBefore this “news” story hits the briney deep, I have something to say about Ariana Grande. She is the 22-year old celebrity of Nickelodeon TV, theater, and music fame who was seen in July, on a surveillance video, licking glazed donuts on an uncovered tray in a donut shop. On the audio, she was overheard saying, “What the f*ck is that? I hate Americans. I hate America. That’s disgusting!” There were entertainment-news stories and hash tags galore: #ilickdonuts – #donutgate – #donutproblems – #arianadonuts –  #arianagrandelickingdonuts –  #ariwearewithyou – #arianahatesamerica. This week I read that Ariana Grande Is Now the 2nd Most Disliked Celebrity, Following Close Behind Bill Cosby. Can you believe that? 

But for me as a clinician, donut-licking raises a red flag. It is an aberrant eating behavior on par with eating in a ritualistic way, chewing food and spitting it out, mixing strange food combinations, eating the same foods over and over, skipping meals, taking tiny portions, cutting food in little pieces, and refusing to eat with others. They are all aberrant eating behaviors that may be seen in eating disordered patients.

Ariana also happens to be extraordinarily thin, which wasn’t the case last year when (according to the Internet), at 5’1” tall, she weighed 106 pounds (BMI 20), a perfect weight within the healthy weight range. But within the past year (according to the Internet), she lost twelve pounds by following a vegan diet. I figure that now Arianna is in the underweight range, weighing 90-94 pounds (BMI 17).

Ariana Before Vegan

Ariana Before Vegan

Ariana After Vegan

Ariana After Vegan

I’ve explained why vegan diets are a problem in Beyonce Promotes Vegan Diet. Tricked by Her Trainer. But that doesn’t stop the knuckleheads on YouTube from praising Ariana’s weight loss. (See Ariana Grande Vegan Weight Loss Transformation.) The photos are telling.

I understand why Ariana Grande might let it slip that, subconsciously, she hates America. After all, we made her into an object that must stay dangerously thin (and hungry) in order to survive. As a role model, she spreads the poison to young fans. How can she feel good about that? When all she wanted to do was sing and dance. I hope she gets help.

Hunger Signals Are Linked to Brown Fat

“Is it hot in here?”

That would be me asking, the day after I overate. I could literally feel the extra calories leaving my body as heat. My brown fat must be up to snuff, probably because I exercise and I don’t “weight cycle” (loose weight and regain.)

Brown fat (also called BAT, brown or beige adipose tissue) is a new critical determinant of energy expenditure. BAT seems to be an endocrine organ that influences metabolism. Aaron Cypess, M.D., a metabolic researcher from the Joslin Diabetes Center, explains that 54% of the variation in metabolic rate correlates with an individual’s activated brown fat. Wow! Maybe it’s time to retire the Harris–Benedict Equation and other formulas that predict basal metabolic rate.*

Last week, I wrote an article about new brown fat research for DietsInReview.com. In my opinion, the research links a healthy supply of brown fat to “intuitive eating” – in mice.
See my article, and the TIME magazine report, that got me thinking.

Your thoughts: Do you love brown fat as much as I do?

* Basal Metabolic Rate:  The rate at which energy is used by an organism at complete rest, measured in humans by the heat given off per unit time. It is expressed as the calories released per square meter of body surface per hour. 

Aglio e Olio, A Pasta Story

Aglio e OlioOn his blog, Ed Writes, Stories of the 40’s & 50s, my friend, Dr. Ed Iannuccilli, asks, “Do you have a pasta story to share?” Well, I can think of a pasta story that remotely involves him.

A long time ago, about seven years into my career, I worked as a dietitian in the medical office of Dr. I and his partners, where mostly everyone – professional and support staff alike and the patients too – were of Italian American heritage. I was not.

I had a patient with Anorexia nervosa, a psych condition characterized by a fixation on food and weight, although is really about deeper, difficult emotional issues. Nutrition therapy is an important part of treatment.

Anorexics usually have strange food rituals, such as eating the same food over and over because it feels safe. This patient’s “safe food” was Aglio e Olio [pronounced AH-lyoh ay AW-lyoh], a simple pasta dish that was unknown to me at the time. The patient shared an intimate history. It wouldn’t be right to interrupt. “Aglio e Olio Aglio e Olio Aglio e Olio Aglio e Olio Aglio e Olio….” Follow the bouncing ball. It was all the patient ate. 

When the appointment finally ended, I burst out of my office into the common area where my coworkers sat. “Help!” I said, “What the hell is Aglio e Olio??!!”

Here’s a recipe for Spaghetti Aglio E Olio. Eat it with other foods as part of a balanced diet

Ingredients:

  • 1 pound dried spaghetti
  • salt
  • 1/3 cup good olive oil
  • 8 large garlic cloves, cut into thin slivers
  • 1/2 cup minced fresh parsley
  • 1/2 teaspoon crushed red pepper flakes
  • 1 cup freshly grated Parmesan cheese

Directions:

  • Heat the olive oil over medium heat in a pot large enough to hold the pasta. Add the garlic and cook for 2 minutes, stirring frequently. Do not overcook. Add the red pepper flakes and cook for 30 seconds more.
  • Boil and drain the pasta.
  • Carefully add the reserved pasta-cooking water to the garlic and oil and bring to a boil. Lower the heat, add 1 teaspoon of salt, and simmer for about 5 minutes, until the liquid is reduced by about a third.
  • Add the drained pasta to the garlic sauce and toss. Off the heat, add the parsley and Parmesan and toss well. Rest the pasta for a few minutes. Serve warm.

Your thoughts: Do you have a pasta story to share?

@MaryHartleyRD in the Word Cloud

Check out the word cloud of my recent Tweets generated by MyTweetCloud. Riveting content, right? That’s why you might want to follow me on Twitter (and Facebook too) at MaryHartleyRD.

Up in the Cloud

Algae appetizers AskMaryRD baby back pain beer bicycles BL14 bloat body image boomers breakfast brew Brooklyn calories cereal facts chocolate city living Congress craft beer Denmark detox diet dietitian diets doctor donteatit draconian duh eating disorders eco evoo exercise faceit family farmers market farming fermentation Fitbloggin fitness FNCE food foodie fuel gardeners gut HAES health healthy food heart health heatwave homebrew hydrate icecream intuitive eating itscomplicated japan july4 junk food justsayin keepitreal kidney kids kidshealth lift lorcaserin madeitup MassHealth MeatlessMonday microbes mindfulness mommy MyFitnessPal MyPlate nodiet nutrients nutrition NYC ObamaCare opportunity organic OWS patient pizza poison ivy pool poster preschool RDchat recipe recipes respect restaurants RI road trip savings sleep snack snacks sugar summer tea TheBiggestLoser thoughtsbecomethings toddler toomuchsitting truthiness vacation walking weekend weight loss

You thoughts: What else should I Tweet about?

How I Use Calories on the Menu

Yesterday, at a rest stop in New Jersey, standing in the combined line for Cinnabon, Popeyes and others, waiting to pay for the blueberry-granola-and (un)real yogurt that I always get, I spied a “MiniBon” roll and mentioned that, calorie-wise, it was better than the classic. (The Cinnabon Classic has 880 calories, while the Minibon has 350 calories per roll.)  My daughter and the woman standing ahead of me, both in their 20s and of slim/normal weight, admitted they had no idea of the number of calories they need. Neither one seemed the worse for the lack of information, but I gave them a tiny lesson on calories (and told them never to “diet.”)

Later that night, I read this on the Intuitive Eaters Professionals Group on Linked-In:
“The other day I went to a restaurant for lunch with friends and was surprised to see calorie counts next to each menu item. My friends, both fairly health conscious “normal” eaters, didn’t seem to mind, but did remark on the counts. I was bothered because I found that the counts drew me away from eating intuitively and back to my days, half a lifetime ago, of dieting. I had to force myself not to look at them and then was okay. My question is: Are menu item calorie counts helpful or not? Might they be useful for different populations, i.e., okay for “normal” eaters who want to eat more nutritiously but not so much for anyone who leans toward dis-regulated eating?”

Calories on the Menu

Expect to see calories on the menu in restaurants with 20 or more outlets as part of the Affordable Care Act upheld by the Supreme Court last week. Restaurants and movie theaters must post calorie information on menus, menu boards, and drive through displays, and provide written information about total fat, saturated fat, cholesterol, sodium, carbohydrates, sugars, dietary fiber, and protein upon request.

For people like my daughter and the woman in line, the information will be meaningless, but for others, it may be extremely informative or downright disconcerting. As a longtime registered dietitian, intuitive eating practitioner, and former dieter over thirty years ago, I think a “calorie information free menu” should be available to anyone upon request, no questions asked. (Heaven forbid the Affordable Care Act returns to the Supreme Court for alleged “actual harm” coming from calories on the menu!) Anyway, I live in New York City where calories have been on the menu since 2008. Real-world studies show that, as a public health intervention, it has only a modest reduction or no effect in the calories purchased by customers. In time, the issue could be a moot point.

For what it’s worth, this is what I told my daughter and the woman in line about how I approach calories on the menu:

  • Women need about 2,000 calories a day and men need around 2,400.*
  • When the calorie count is high – say greater than 20% of the daily total or 400 calories – look askance
  • Decide if the extra calories are from too much wholesome food or from “empty calories” full of added sugar and/or animal fats but with negligible nutrients.
  • For wholesome food, I split the serving with my companion or carry away half, and for empty calories, I decide if I love it enough and have to have it right then. (Luckily, I’m not impulsive.) If yes, then I have it; if no, then I skip it. But if I were to feel guilty or otherwise, awful, I’d ask why and think of it as a growth opportunity.

Righteous indignation seems to fuels me. You can’t get me to eat most of the crap sold in American chain restaurants. I don’t value filling my body with junkie food. I am attracted to fresh food well prepared, mostly by me. Usually, I’m sated at don’t care about dessert. If I really want dessert, then I eat it only a little at the meal.

Your thoughts: What do you think about calories on the menu?

*To find your calorie requirements, use this chart from the government or use a calculator fromany one of the online diet websites.

Helping Cassey Ho

Cassey Ho is a Pilates instructor, YouTube fitness guru, blogger and online community leader, and designer of yoga bags. When you count her blog subscribers and social networking fans, she has around 185,000 followers. Cassey is an exceptionally hard-working young woman who will probably go far in the fitness world. I met Cassey online a few weeks ago when I helped her with a dilemma.

Cassey wrote: Lately, some of my fans have attacked me for “triggering” their eating disorder and body image disorder tendencies because I’ve been talking extra about weight loss and dieting because it’s bikini season. The blog that started it is Best Celebrity Bikini Bodies…thanks to PILATES!  Some have said that I may have an eating disorder or body image disorder myself! They’ve even gone as far as to say that I should have my posts looked over by a psychologist to analyze the potential messages I am sending out. As a professional, what do you think?

I wrote back:  I think “triggers” are everywhere for people with psychological disorders. I believe that anyone who feels vulnerable should beware of potentially triggering experiences that they can control (e.g. don’t buy fashion magazines, don’t visit certain websites or watch certain TV shows, etc.) The really difficult triggers are those stressful life situations, including trauma and loss, that they can’t control. Ideally, a trigger will start a conversation. It is rich material for mental health therapy.

As to whether celebrities like Miley Cyrus and Cassey Ho have disordered eating patterns, I cannot say without a proper assessment. But Americans, and the world for that matter, like their celebrities to be thin. Most celebrities exercise an lot and are very careful not to over-eat. How else could they look that way? They have millions of dollars resting on it.

But when does self-care – a desire to exercise and eat right – turn into a disorder? When a person’s “love for diet and exercise” precludes enjoying a variety of wholesome foods in the amount needed to maintain a healthy weight, and when someone’s exercise program is so intense that it leads to injuries, exhaustion, and irritability, then that’s a problem. But, if not, then go girl! Cassey’s readers, and anyone, should take The Eating Attitudes Test (EAT-26), the most widely used, standardized self-report measure of concerns and symptoms of eating and exercise disorders. It is a screening test that indicates a need for professional evaluation.

The Dilemma

Heck, I owe my bikini (or one piece swimsuit) body to Pilates. I go to Pilates three times a week and try never to miss. But for non-celebrities like me, after a certain point, say 60 minutes of exercise 5-6 times a week and healthy eating 85 percent of the time, chasing the perfect body has diminishing returns. After health habits are in check, time is better spent working on inner qualities and making the world a better place. How about helping the SPARK Movement, a girl-fueled activist movement, to demand an end to the sexualization of women and girls in media. They are collaborating with hundreds of girls ages 13 to 22. And, for heaven’s sake, don’t take diet advice from a celebrity! As I told Diets In Review, Miley Cyrus Stays Trim Following a Gluten-Free Diet is not a good idea. Every modified diet, including vegan and raw food diets, carries a nutritional risk because so many foods are omitted.

Cassey had many more questions, and you can read my answers at Bringing it to Light: Eating Disorders on Bloglates.com. I thank Cassey for trusting my professional advice, and I wish her smooth sailing in her work to bring health to the masses.

Your thoughts: Have you ever wondered if you have an eating or body image disorder?

My Intuitive Eating “Aha” Moment

On LinkedIn, I am a member of the Intuitive Eating Professionals Group, where Evelyn Tribole, MS, RD, group founder, asks us to “share something…that is not included in your profile, perhaps an “aha” moment in your career.”  I am inspired to share my “aha” moment after attending the BEDA (Binge Eating Disorder Association) national conference on Saturday, where I learned that, treatment-wise, not much has changed over the years.

In 1985, I worked in a large gastroenterology practice affiliated with a teaching hospital. I saw lots of eating disordered patients because one of the docs did medical evaluations of patients with bulimia and AN. At the same time, another gastroenterologist performed a procedure with a device called the Garren-Edwards Gastric Bubble. A deflated ‘bubble’ made of stretchable plastic (like a pool toy) was placed by endoscopy in the stomach of a severely overweight patient.  With the pull of a cannula, the bubble was inflated and left in place to fill the stomach while the patient followed a low-calorie diet. That’s where I came in. The bubble was developed by a team at Johns Hopkins. It was all above the board. The hospital asked us to do the procedure, but we stopped after a patient got a small bowel obstruction from the bubble. Those were interesting days. My patients’ eating patterns were all over the map.

But my “aha’ moment came by way of a patient referred by an internist for a simple weight loss diet.  She was a favorite patient, a young woman of my age, overweight but far from obese, with my mother’s maiden name. We were doing the balanced, flexible diet thing with a focus on behaviors when one day, she looked at me and said, “Mary, you don’t understand. I peek behind the curtain, and when my husband drives away, I make a batch of scalloped potatoes, and I eat the whole thing.” Aha! I thought, “they didn’t teach us this in school.” And then I thought, “this is really real.”

I was lucky because psychologists who specialized in EDs would stop into  the office. They turned me on to Susie Orbach, Fat Is a Feminist Issue (1978); Geneen Roth, Feeding the Hungry Heart (1982) and Breaking Free from Compulsive Eating (1986) and, of course, Hilde Bruch. Evelyn’s book, Intuitive Eating (1995), wasn’t published yet and there was no Gurze catalogue. But, I read and read and saw lots of patients, and attended Geneen’s workshops,  consulted with therapists, and taught others how to do it. And now it’s wonderful to see so many dietitians espouse the non-diet approach. But, after all those years, the pills, shakes, meals, stomach stapling (but not swallowing pool toys) are all still here.

Your thoughts: Why don’t more people give up dieting and follow a non-diet approach?

Bless Your Throat. Bless Your Food.

Tomorrow morning, February 3rd , I’m heading over to the Catholic Church to celebrate the feast of Saint Blaise. Back in St. Patrick’s School, that was the day we lined up to get our throats blessed. The priest came to classroom (while the nuns went teeheehee), carrying a cross of two large candles tied with red ribbon. The priest held the candle cross up to each of our throats and, in Latin, said, “Through the intercession of St. Blaise, may God preserve you from throat troubles and every other evil.”  I loved the quaint the little ceremony and the story of St. Blaise who saved a boy with a fish bone stuck in his throat.  A kid just like me!  Nowadays, I like being saved from “every other evil” thing.

Keep on Blessing

Forever, I’ve believed that blessing food is the way to go. It’s especially important when practicing a new way of eating. Blessings confer holiness and strong wishes for happiness; they are inherently good. I just don’t think you’re likely to lose control on blessed food. When done sincerely, the blessing brings in a state of mindfulness, gratitude and peace. And so it stands to reason (to me anyway) that blessed food will be eaten with intention and joy.  A lit candle is also nice for casting out dark confusing thoughts. I mean, why not give it a try?  Bless your food.

A penny for your thoughts…

 

A Reading List for Yo-Yo Dieters and Emotional Eaters

I am happy to report that my online nutrition counseling practice is taking off. And the best part is that I get to work with my favorite patients/clients/customers: yo-yo dieters and emotional eaters. They are the folks that don’t feel good about their weight and the way they eat. A history of traditional diets knocked them off their natural course and, for many, childhood trauma had a role. Their weights cycle up and down because, unfortunately, diets make you fat. My job is to help them get off the wobbly track and back into the groove. It doesn’t matter if they have a medical condition; everyone has a personal best. When they stop dieting and their weight no longer cycles, better health always returns.

My Favorite “How To” Books for Intuitive Eating

Evelyn Tribole and Elyse Resch, two registered dietitians, wrote the 1995 classic, Intuitive Eating, that gave a useful name to the “non-diet” approach. The approach uses physical and emotional feelings (and knowledge) to guide intake and rebuild pleasure in eating. The mindset can be learned, especially with the help of a skillful teacher, and so to understand the ins-and-outs of intuitive eating, I always ask my yo-yo dieters to read at least one of these excellent books:

When I asked the LinkedIn Group of Intuitive Eating Professionals to recommend their favorite books, they also suggested books that address self-acceptance, self-care and spirituality, essential issues of breaking free. Here are some of the books for emotional eaters that they recommend:

Your thoughts: Which books help you to a healthy life and eat with joy?

Orthorexia Nervosa, Cleaner Than Need Be

One of the hardest parts about wanting to clean up your diet is learning where to draw the line. At one end of the spectrum is a careless diet of non-nutritive, highly processed foods and at the other end is ‘clean eating’ to the point of malnutrition and social isolation. Some people have orthorexia nervosa, an extreme obsession with eating healthy food.  Their righteous eating patterns are mixed up with low self-esteem, OCD tendencies and other anxiety disorders.

I wrote about the unofficial eating disorder, orthorexia nervosa, for Calorie Count. See  my article, Orthorexia: Obsessed with Healthy Food. What I like most about that article is the 7-item (non-validated) tool from the book, Health Food Junkies: Orthorexia Nervosa: Overcoming the Obsession with Healthful Eating, by Steven Bratman, MD.  Here are the questions; if you answer “yes” to two or three, then you’d better loosen your grip on food – and get some help from a psychotherapist and registered dietitian who specialize in  eating disorders.

1.    Are you spending more than three hours a day thinking about healthy food?
2.    Do you always skip foods you once enjoyed in order to only eat the “right” food?
3.    Does your diet make it difficult for you to eat anywhere but at home, distancing you from friends and family?
4.    Do you look down on others who don’t eat your way?
5.    Does your self-esteem get a boost from eating healthy?
6.    When you eat the way you’re supposed to, do you feel in total control?
7.    Do you feel guilt or self-loathing when you stray from your diet?
8.    Is the virtue you feel about what you eat more important than the pleasure you receive from eating it?
9.    Has the quality of your life decreased as the quality of your diet increased?

Your thoughts: Do you know someone who might have orthorexia nervosa?  What makes you think so?