Ask Evelyn-Nutrition 411

Is It Okay for an Intuitive Eater to Eat at Night?

etribole@gmail.com (Nutrition Info 411) — 2010-03-13T18:39:41Z

Q. I’m trying to be an Intuitive Eater. But I’m not sure what to do when I get hungry at night. Around 9 p.m. or so, about an hour before I go to bed, I feel hungry. Should I listen to my body and eat? Or is it smarter not to eat something so late at night? Anonymous

A. Many people have the perception that eating past a certain time in the evening will cause weight gain. But that’s not true. Our bodies don’t punch time-clocks. For example, there is not a fat-making shift that begins at 7:00 p.m. Also, many cultures eat later in the evening, such as in Spain.

Mindless eating in the evening, while watching television or surfing the internet, however, could lead to overeating and weight gain. But the issue in this case, is the mindless eating, not the time of night.

Becoming an Intuitive Eater is about being attuned to your body—hearing and responding to its biological cues of hunger and fullness. Generally, if you are biologically hungry, it’s a good idea to eat. There are a couple of ways you could explore you evening hunger.

Biological —Are you eating enough food throughout the day? If you eat on the lighter side—it’s possible to feel hungry later in the evening. I’d consider eating a light, but satisfying, snack (since it can feel uncomfortable trying to sleep on a full stomach).
Habit—Is it possible you are in the habit of eating before bedtime? (I don’t get that impression from your email, but it’s a question worth exploring.) If eating a snack is part of your wind-down routine before going to bed, it seems that the night eating is more about desire and automatic habit, not biological hunger. If that’s the case, I’d suggest opting for a different relaxing routine—such as reading or taking a bath.

If you are not sure which approach to explore, you could also try eating a light snack and take note of its effect on your sleep and your energy level in the morning. Or, explore the impact of not eating. Do you find yourself having difficulty falling asleep or staying asleep (hunger can do that)?

Ultimately, every eating experience is an opportunity to learn something about your body.

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Obsessive Calorie Counter Wants to be an Intuitive Eater

etribole@gmail.com (Nutrition Info 411) — 2010-02-14T18:52:00Z

Q. I want to stop calorie counting ....for good. Since reading Intuitive Eating, I listen to my body more and not restricting what I eat, but I still count calories (consciously and subconsciously). I would really appreciate any tips or information you can provide me for overcoming my obsessive thoughts.

A. Keep in mind you’ve trained your mind to count calories, so even when you don’t want the information—it will still be there for awhile. It’s like when you’ve been shopping for a particular type of car.   Your awareness of car ads lingers after the purchase--even though you no longer need the information, but it eventually fades.

Similarly, as you rely more on your inner satiety cues, automatic calorie counting diminishes—it is no longer wanted or “needed”.   But it takes time, the duration of which, depends on how long you’ve been restricting and counting calories.   Here are the general stages to expect.

You will evolve into the first stage, which I call “calorie awareness." This is when you know the calorie content of a food or meal, but you don’t make eating decisions based on those numbers. Generally, as you begin trusting your body, the automatic calorie counting continues, but it doesn’t have the same power, it’s just annoying. Then it starts to fade into the background.

The background stage is akin to having several software programs open on your computer—they are there for you to use, but there’s only one active program.   In this case the “active program” is your inner satiety cues, and it gets more dominant the more you choose to use it.

My suggestion: Try to practice curious non-judgment every time your automatic calorie counter kicks in.   Just observe your thought about the calories—don’t react.   Remember that simply knowing the calories does not mean you are doing anything wrong.   The issue is how you react to the calorie information.   For example, if you decide to stop eating a meal-- is it because of the calorie information or because your are comfortably satisfied?

Every time you make a decision based on your inner cues, you become more attuned to your body.   It just takes practice--with compassionate patience.
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Can I Trust My Body to Send the Correct Hunger Signals?

etribole@gmail.com (Nutrition Info 411) — 2010-01-28T17:58:21Z

Q. I started obsessing over food and body image about 7 years ago—in which I Iost and gained the same 20-30 pounds. I’m familiar with Intuitive Eating and recently listened to your Intuitive Eating audio CDs.

I recently caved in and joined Weight Watchers. They claim they are not a diet, but they are. Now I feel like I’m really caught up in the dieting cycle trap. Now I feel like I'm not allowed to eat when I'm hungry. My question: Can I trust my body to send me the correct hunger signals if I have made it a habit of eating immediately feeling any tinge of hunger? Please help! --CS from Ketchikan, Alaska.

A. It's not surprising that you find yourself caught in a dieting trap. Contrary to clever marketing, limiting foods by counting points is still a form of dieting!

In short, yes, you can cultivate the ability to hear and respond appropriately to your body's cues of hunger. But it can be rather confusing trying to attune to your biological cues, while counting points. (What do you do, if all your points are gone after lunch?)

I consider dieting a form of "nutritional trauma". It might sound a bit dramatic, but once your body experiences the biological and psychological deprivation from dieting, your body gets smarter. Consequently, it gets harder to stick with each new diet, because your cells know what to do. (See my earlier post, Is it True that Dieting Makes You Gain Weight?).

Your "habit of eating immediately feeling any tinge of hunger"--sounds like a reactive response from the dieting process, where hunger is a feared sensation, rather than a natural process that gears up and down, depending on when, and how much you ate.

While there is nothing wrong with eating this way, it tends to make hunger cues difficult to assess. And if you eat just until the hunger goes away, you will likely be hungry sooner, which sets up a cycle of constantly thinking about food and what to eat.

If you feed your body on a regular, consistent basis, by honoring your hunger, it will help build "body-trust". Here's what I suggest:

1. Ditch the diet.

2. Try sitting with your "tinge of hunger" sensation for a few minutes. Observe how hunger feels, physically. (Don't judge, just notice the sensations). During this time remind yourself, you will feed your body--you are merely checking in, just getting to know your body.

3. When you eat--take note of your hunger level (rate from 1-10) before, during and after eating.

4. Notice the experience of your food choice (whether it's a meal or snack). Did it sustain you? Was it satisfying?

5. You might want to consider aiming for "meal-based" eating--as it will provide stronger cues of hunger and fullness.

Lastly, be patient and compassionate with yourself--it takes time to learn how to become an Intuitive Eater, especially when you have been at war with your body.

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What Do You Think About Overeaters Anonymous?

etribole@gmail.com (Nutrition Info 411) — 2010-01-16T21:21:50Z

Q. What Do You Think About Overeaters Anonymous? Is their approach consistent with your Intuitive Eating philosophy?

A. Many years ago, I was fortunate to meet the president of the national Overeaters Anonymous (OA). She kindly took me through each of OA's 12 steps, which made it clear that OA can support Intuitive Eating. But group dynamics can really vary. Here are some things to consider:

Each OA group has it's own "personality"--some groups are wonderful, others not so much. I refer my interested clients to the OA website, which clearly does not promote any type of diet or restricting.
Abstinence is a personal choice--and it is usually the sticky issue, if there's going to be some sort of conflict. Nowhere in the 12 Steps, does it require you to abstain from a particular food or group of foods. Consider choosing abstinences that are nurturing, realistic and not punitive. For example, you could choose to refrain from dieting, abstain from skipping meals or from weighing yourself.
Your Sponsor has a tremendous impact. So, it's important to choose a sponsor that supports the Intuitive Eating process. (Over the years, I've had many sponsors refer clients to me, specifically to facilitate the Intuitive Eating process).

Lastly, a very encouraging study from the University of Notre Dame, showed that the Intuitive Eating is an effective approach for treating compulsive eating [1].

You can also check out the free online Intuitive Eating Support Groups and other resources listed below.

Resources:

[1] Smitham L, Evaluating Intuitive Eating for Binge Eating Disorder 2008 (Nov). Univ Notre Dame.

[2] Intuitive Eating Resources

[3] Overeaters Anonymous

Is it True that Dieting Makes You Gain Weight?

etribole@gmail.com (Nutrition Info 411) — 2009-11-08T23:32:38Z

Q. I know that dieting doesn't work in the long run, but is it true that dieting can make you gain weight?

A. In short, yes. There are compelling studies, which indicate that dieting predicts weight gain (and often binge eating). While most people know that diets don't work, not many are aware of the weight-gain hazard.

For example, a team of UCLA scientists reviewed 31 long term studies on dieting and concluded that [1]:

Dieting is a consisent predictor of weight gain.
Up to two-thirds of the people regained more weight than they lost.
Diets do not lead to sustained weight loss or health benefits for the majority of people.

A prospective study on nearly 17,000 kids ages 9-14 years old, found that dieting predicted binge eating behavior and concluded that, "...in the long term, dieting to control weight is not only ineffective, it may actually promote weight gain" [2].

Recently, a five-year study on teens, found that dieters had twice the risk of becoming overweight, compared to non-dieting teens [3]. Notably, at baseline, the dieters did not weigh more than their non-dieting peers. This is an important detail, because if the dieters weighed more--it would be a confounding factor, (which would implicate other factors, rather than dieting, such as genetics).

Lastly, a critical editorial on the efficacy of dieting, published in the New England Journal of Medicine, concluded, "We do not need another diet trial, we need a change of paradigm" [4]. Indeed, let us begin with this caution, "Warning: dieting increases your risk of gaining more weight."

[1] Mann, T. Medicare’s search for effective obesity treatments: Diets are not the answer. Am. Psychologist, 2007; 62(3): 220-233.

[2] Field AE et al. Relation Between Dieting and Weight Change Among Preadolescents and Adolescents. Pediatrics, 2003 112:900-906.

[3] Neumark-Sztainer D. et al. Obesity, disordered eating,and eating disorders in a longitudinal study of adolescents: how do dieters fare five years later?J Am Diet Assoc. 2006;106(4):559-568.

[4] Katan, Martijn B. Weight-Loss Diets for the Prevention and Treatment of Obesity NEJM 2009 360:923-925.

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What is Krill Oil and is it the Best Omega-3 Source?

etribole@gmail.com (Nutrition Info 411) — 2009-10-26T21:47:55Z

Q. What is Krill oil--and is it better than fish oil for omega-3 fats?

A. Krill are the tiny shrimp-like crustaceans eaten by whales and other marine animals. Wild salmon get their rich color from the krill they eat [1]. And like all seafood, krill contains the vital omega-3 fatty acids, EPA and DHA.

Here's what you need to know. There's no clear advantage of taking krill oil over other fish oil supplements. The vast health benefits of fish oil, specifically its bioactive components, EPA and DHA, have been documented in studies using: fish oil, EPA concentrates, DHA concentrates and not to mention, eating fish, itself.

Most fish oil is produced from sardines and anchovies, which are in abundant supply. Krill however, are a critical link in the marine food chain and is becoming endangered [2]

While there is no harm from taking krill supplements [3], it is best to choose a supplement that provides the right kinds of omega-3 and in the right amount.

For more information on fish oil supplements and omega-3s, see: Choosing an Omega-3 Supplement: Dose & Cost Effectiveness.

[1] 10 Catchy Salmon Facts

[2] Feds Look to Ban Fishing of Krill

[3] Krill Oil Safe, Well Tolerated

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Is there a test for eating disorders?

etribole@gmail.com (Nutrition Info 411) — 2009-10-12T14:22:10Z

Q. Is there some sort of easy evaluation test for eating disorders?

A. The simplest (and valid) test for eating disorders has only five questions, which goes by the acronym SCOFF, (each letter represents one of five questions). Simply answer yes or no:

1. Do you make yourself Sick because you feel uncomfortably full?
2. Do you worry you have lost Control over how much you eat?
3. Have you recently lost Over fourteen pounds in a 3 month period?*
4. Do you believe yourself to be Fat when others say you are too thin?
5. Would you say that Food dominates your life?

Answering "yes" to any two or more of these questions indicates a likely case of an eating disorder.

The SCOFF screening tool was developed by researchers at St. George’s Hospital Medical School in London. Here's the link to the free full text of this study [1]:

*Note: The original question reads, "Have you recently lost more than One stone in a 3 month period?" Therefore, the original "O", stands for "One-stone", which is the British equivalent of 14 pounds. I "translated" the "O" to, "Over 14 pounds."

[1] Morgan JF, Reid F, and Lacey JH.
The SCOFF questionnaire: assessment of a new screening tool for eating disorders. BMJ 1999;319:1467-1468.

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I Need Advice for My Patient--an Emotional Eater, Determined to Lose Weight

etribole@gmail.com (Nutrition Info 411) — 2009-10-11T03:29:17Z

Q: I have a patient who lost about 100-pounds over a two-year period, and kept it off for 9-years, at a stable 120 pounds. The reason she consulted me, is because she recently gained 25-lbs from emotional eating. (Consequently, she tried extreme dieting to lose the weight, but without success.)

I'm having her read your book, Intuitive Eating. But she is scared and really focused on losing weight. I'm not sure where to go with this (her current weight is considered "overweight"). Any thoughts from your experiences?

A. Focusing on an external number (weight) undermines the Intuitive Eating process, which is a process of inner attunement.

Given the history you describe, (a stable weight for 9 years with a recent increase from emotional eating)-- it would be likely that your patient will normalize to a lower weight with Intuitive Eating.

Here's what I do with my patients in this type of situation. First, I ask these series of questions.

What do you think would happen to your body if you:

Consistently took care of yourself (adequate sleep, et.)?
Stopped binge eating?
Managed your stress?
Participated in physical activities that you enjoy?
Nourished it consistently?

In general, the response to those questions, is "my weight would be less". Yes, likely.

Then comes the tricky, tough part. It's important to have realistic expectations. So, I tell my patients the following:

"You don't get to pick when this will all come together. Your body needs to trust you--that it will be adequately and consistently fed (but every time you diet, this trust is broken and you need to start anew).

Lastly, you don't really get to pick exactly what weight your body will settle.

Instead, it's better to focus on how this process of taking care of your body feels (as it will help temper the urgency about weight loss)."

Keep in mind that it was your patient's reactive dieting, (in response to her binge eating and weight gain), that in part, created this problem. I say this not to blame, but rather to foster compassion and the patience, she will need, to achieve authentic health.

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What is Considered Too Much Exercise?

etribole@gmail.com (Nutrition Info 411) — 2009-09-05T21:22:00Z

Q. My friends are worried that I exercise too much, but I think exercising keeps you healthy. Is there such a thing as exercising too much?

A. There are indeed many health benefits from exercising regularly. But there is a dark side to exercise, which is often missed because it’s so revered in our culture. Excessive exercise can lead to injuries or be a component of an eating disorder.

Many people believe that exercise helps the body burn more calories by speeding up metabolism. But that’s not the case if you are not eating adequately. Excessive exercise can lower your body’s metabolic rate when you are not eating enough food to fuel your activity. It can be tricky to figure out when you’ve crossed the line from healthy pursuit of physical activity to compulsive exercise. Here are some warning signs to consider. Do you _______?:

•Continue to work out, even when you are sick?
•Feel guilty if you skip a day of exercise?
•Eat enough to fuel your physical activity?
•Decline activities with friends, such as biking or going for a walk because it seems like a waste of time (it doesn’t “count” as exercise).
•Increase the amount of your exercise if you think that you ate “too much food or too high in calories”

Emerging research is helping define what constitutes a healthy relationship with exercise, which is called mindful exercise. There are four components to mindful exercise [1]—it is physical activity that:

1.    Rejuvenates, rather than exhausts or depletes.
2.    Enhances the mind-body connection.
3.    Alleviates stress, rather than amplifying stress.
4.    Provides genuine enjoyment and pleasure.

Mindful exercise builds attunement, by placing value on paying attention to how your body feels during and after movement

Resource:
[1] Calogero R and Pedrotty.Daily Practices for Mindful Exercise. pp.141-160 in Handbook of low-cost preventive interventions for physical and mental health: Theory, research, andpractice; L'Abate L., D. Embry, & M. Baggett, Ed. Springer-Verlag. 2007

Resource:

[1] Calogero R and Pedrotty.Daily Practices for Mindful Exercise. pp.141-160 in Handbook of low-cost preventive interventions for physical and mental health: Theory, research, and practice; L'Abate L., D. Embry, & M. Baggett, Ed. Springer-Verlag. 2007

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Mindful Eating versus Intuitive Eating--What's the Difference?

etribole@gmail.com (Nutrition Info 411) — 2009-08-23T18:17:00Z

Q. The phrases "intuitive eating," "mindful eating," and"normal eating" seem to be used interchangeably on the internet. I know that you and Elyse cameup with the concept of intuitive eating. What is your take on all of thedifferent phrases? Do they all represent the same thing?

A. In 1990, Jon Kabat-Zinn published his best-selling Full Castrophe Living, which describeshow to live mindfully. He included a couple of pages on mindful eating, with anactivity on how to eat a raisin using a mindfulness approach. To my knowledge, that was the first timethe concept of mindful eating was introduced to the public. (I am a big fan of his work, but I was not introducedto it until about 7 years ago!)

Mindful eating is compatible with Intuitive Eating, and it is a process of paying attention (on purpose), to your actual eating experience,without judgment. While thissounds straightforward, the process can be quite complex, especially for those inclined to multi-tasking.

While Intuitive Eating, includes mindfulness (we call it conscious eating)-- I consider Intuitive Eating a broader philosophy, which includes physical activity for the sake of feeling good, using nutrition information without judgment, and respecting your body, regardless of how youfeel about its shape. In short,Intuitive Eating is a form of attunement of mind, body and food. It's exciting that scientists have started to research and validate Intuitive Eating as a healthful way to live and use in the treatment of eating disorders (see resources).

In a nutshell, normal eating means eating is flexible—it’sa way of eating that varies according to your hunger, schedule andsatisfaction. Ultimately, normaleating is enjoyable. My favorite definition comes from Ellyn Satter, which youcan read in its entirety here:

https://ellynsatter.com/showArticle.jsp?id=268

For those who struggle with their eating, both mindfuleating and Intuitive Eating can help facilitate normal eating.

Resources:

1. The Center for Mindful Eating website:http://www.tcme.org/

2. Intuitive Eating website: www.IntuitiveEating.org

3. Jon Kabat-Zinn. Full Catastrophe Living.(1990). Delta:NY,NY.

4. Tylka, T. Intuitive Eating Assessment Scale. J CounselingPsychology 2006(53):226-240.

5. General Intuitive Eating Resources

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Is it Okay to Eat Dessert for Dinner?

etribole@gmail.com (Nutrition Info 411) — 2009-08-13T22:45:00Z

Q. First off, I have read and re-read Intuitive Eating 3 times! I was chronic dieter for roughly 10 yrs, so your book continues to help me on my road to freedom. I was wondering if it is acceptable to eat dessert for dinner, if that is what I truly want? Such as a brownie sundae...I'm not talking every day, but as a once in a while thing. Thanks in advance for your help!

A. The journey of Intuitive Eating is about creating a healthy relationship with food mind and body—where you truly become attuned to your inner self. Ultimately, you become the expert of you! Only you know: your experiences, feelings, thoughts and how your body feels (these are all examples of inner attunement).

Dieting is often a choice to eat based on external expectations of others, which can include family, friends and culture. Often, a client will say to me, “I don’t even know how to eat anymore.” This is a common consequence when you lack inner attunement—it’s a big disconnect between your mind and body, where you don’t even trust yourself.

I find that when people feel guilty about their eating—they are so overwhelmed by the guilt, they really don’t experience how that particular food or meal feels physically in his or her body. It is another form of disconnect. That's why Making Peace with Food (Principle 3 of Intuitive Eating) is an important part of the healing process.

So yes, it is acceptable to eat dessert for dinner, especially when healing your relationship with food. (Keep in mind that one food, one meal, or one day of eating, does not make or break your health).

To make the most of this experience, I suggest eating without distraction so you can stay attuned to your dessert experience. Also, here are some questions you might want to explore in the process (take care to ask these questions from a place of neutral curiosity, no judgment).

Does this dessert meet your expectations?
Do you like the way it tastes?
Is the taste similar or different from the last bite? (Keep checking in with each bite).
How is the texture?

When you finish eating, explore these questions:

Was this dessert-meal is truly satisfying?
How do you feel physically right now---Pleasant, unpleasant, or neutral?
Did anything surprise you about this experience?
Did it sustain you?
Given the same set of circumstances, would you choose to eat this way again?

Enjoy!

What's Your Take on Tropical Oils?

etribole@gmail.com (Nutrition Info 411) — 2009-08-10T17:36:00Z

Q. I have noticed that food companies are using more palm and palm kernel oils. Aren’t these saturated fats unhealthy too? What’s your take on tropical oils?

A. Many food companies have made a quick switch to tropical oils, in order to reduce or eliminate the trans fatty acids in food. (Trans fatty acids are created when food processors add hydrogen to oils. These oils are called hydrogenated oils.)

It’s important to keep in mind that classifying fats as merely "saturated" or "polyunsaturated” does not accurately indicate their impact on the body. Rather, it's important to look at the specific fatty acids. There are several different saturated fatty acids.

In the earlier days, studies indicated that saturated fats raise cholesterol, which was the basis for health guidelines advocating a reduction in eating this type of fat.   But a growing body of research shows that individual saturated fatty acids are much more diverse in their actions.

In the Pacific Island of Tokelau, the indigenous diet contains 40% saturated fat. Yet, these islanders have an apparently low heart disease rate. Nearly all of the saturated fat in their diet is from coconut oil, which is high in lauric acid. This saturated fatty acid is associated with elevating the beneficial HDL-cholesterol.

Palm oil and palm kernel oil are both high in saturated fats, but with very different fatty acid profiles.

    * Palm oil is 43.5% Palmitate, which is the dominate saturated fat in the USA diet, (most of which is from eating grain-fed meats and dairy). This fatty acid raises LDL (bad cholesterol).

    * Palm Kernel oil is 47% Lauric acid, which is a saturated fatty acid associated with reducing the total cholesterol to HDL ratio (mostly by elevating the beneficial HDL-cholesterol).

If I was on a deserted island and you were to ask me to pick the best of the three tropical oils, I'd say coconut oil, but I would not go out of my way to seek it out.

Here's a great review for more information:
Ramsden et al. Dietary fat quality and coronary heart disease prevention: a unified theory based on evolutionary, historical, global and modern perspectives. Curr Treatment Op in Cardiovascular Medicine 2009,11:289-301.
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Are You Paying Too Much for Your Omega-3 Supplements?

etribole@gmail.com (Nutrition Info 411) — 2009-07-29T23:31:00Z

Q. As a big fan of your O-3 book, I'm wondering what your thoughts are about a fish oil supplementthat I recently purchased, which consist of 100% Norwegian fish oils. Two capsules contain 1600 milligrams of omega-3s: (700 mg of DHA, 700 mg of EPA, & 200 of other omega-3s).

A. Here's my bottom line on fish oil/omega-3 supplements: Aim to get the right dose for the best price. Here's the caveat--the supplement needs to be one you tolerate. For kids, that might mean choosing a more expensive supplement, if it's one they will take, such as the Coromega, which is a kid-friendly pudding-like supplement (I do not consult for, nor profit, from this company).

Your new supplement contains a nice dose of the key omega-3s (700 milligrams each of DHA and EPA, for a total of 1400 milligrams of these long chain omega-3 fatty acids). To put the dose into perspective, consider the following:

For healthy people, International guidelines [1] recommend aiming for at least 650 milligrams a day, from a combination of EPA + DHA. If you have heart disease, the American Heart Association recommends [2] getting at least 1000 milligrams/day. And the American Psychiatric Association recommends [3] at least 1000 milligrams/day if you have a mood or impulse disorder.

Lastly, I created a cost analysis of some popular fish oil supplements, and turned it into this interactive widget, which allows you to sort the columns. I chose 800 milligrams as the comparison dose, because it's about what you get in one prescription capsule of Lovaza. To get an idea of the cost effectiveness of yoursupplement, compare the price you paid to the brands listed below.

[1]Simopoulos, AP, Leaf A, and Salem N. Workshop on the Essentiality of and Recommended Dietary Intakes for Omega-6 and Omega-3 Fatty Acids.J Am Coll Nutr 1999 18: 487-489. (free full text)

[2] Kris-Etherton.Circulation. Circulation. 2002 Nov 19;106(21):2747-572002 Nov 19;106(21):2747-57.

[3]Freeman MP et al.Omega-3 fatty acids: evidence basis for treatment and future research in psychiatry. J Clin Psychiatry. 2006 Dec;67(12):1954-67.

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Can Intuitive Eating Be Used to Treat Diabetes and Bulimia?

etribole@gmail.com (Nutrition Info 411) — 2009-07-18T00:42:00Z

Q. Can Intuitive Eating be used if you have both diabetes and bulimia.Could you please tell me whether you've had patients with these two problems at the same time and how did they respond to Intuitive Eating?

A. When you have an eating disorder, Intuitive Eating is ultimately a goal, but you'll need guidance from anexperienced team that specializes in eating disorders (physician, therapist and dietitian). Hunger and fullness cues are not accurate when you are in the midst of an eating disorder. Diabetes can make it even more complicated. For example, elevated blood sugars can cloud thinking and make it difficult to beattuned to your body.

Yes, I have worked with patients who have both bulimia and diabetes, but Intuitive Eating was not implemented until both the bulimia and the blood sugars were stabilized, and it was a gradual process. If you need some referrals in your area please feel free to contact me.
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Is lipstick gluten-free and does it matter?

etribole@gmail.com (Nutrition Info 411) — 2009-07-07T23:51:00Z

Q. I'm doing a good job eating gluten-free (I have celiac disease), but I'm confused about lipsticks--do I need to look for gluten-free lipsticks and cosmetics?

A. As you know celiac disease is an autoimmune disorder, which is treated by eating a gluten-free diet. The core issue is ingestion--making sure that no gluten enters your body via your mouth (and GI tract). Eating tiny amounts of gluten are significant (such as accidental gluten ingestion from a shared peanut butter jar or licking stamps). In short, anything that touches your lips needs to be gluten-free.

So in the realm of cosmetics, the answer lies in knowing which of your cosmetics you might ingest. (Think incidental ingestion here, such as lipstick or lip gloss rubbing against your teeth). As for which lip products are gluten, it varies from brand to brand. Here's a list of gluten-free cosmetics that are updated routinely at the Gluten Free Hub, in particular, check out the gluten-free lipsticks and lip balms:

http://www.glutenfreehub.com/resources/gluten-free-cosmetics/
http://www.glutenfreehub.com/reviews/cliniques-gluten-free-lipstick-and-lip-gloss/

I Just Switched to Intuitive Eating--How Many Calories Should A Teenage Girl Eat?

etribole@gmail.com (Nutrition Info 411) — 2009-07-05T20:19:00Z

Q. I am 16 years old and trying to follow your Intuitive Eating principles. (I've been a big time calorie-counter.) While I am able to eat when I'm hungry and stop when I'm full--I'm eating more calories now and I'm worried that I'm doing something wrong. Actually, I'm scared that I might gain weight (I was eating 1500 calories/day). I also run on the girls cross-country team.

A. While you didn't say that you were dieting, limiting your food to 1500 calories/day is a form of dieting, especially for your activity level. Restricting your eating/dieting can lead to bigger problems, especially for teenagers. Studies show that teenagers who diet are more likely to gain weight (yes, gain) and have an increased risk for binge eating and developing an eating disorder [1, 2].

To give you some perspective, the typical 16 year-old-teenage girl, who is moderately active, needs nearly 2400 calories/per day, according to the Institute of Medicine's 2005 report, which is below [3]. Generally, when your body is not getting adequate calories on a regular basis, your metabolism slows down to compensate. That's why it is possible to eat more food and not gain weight--because your metabolism starts to normalize to its higher level.

1.Field AE, et al.
Relation Between Dieting and Weight Change Among Preadolescents and Adolescents
Pediatrics 2003 112: 900-906. (Free Full Text)

2. Neumark-Sztainer D. et al.
Why Does Dieting Predict Weight Gain in Adolescents? Findings from Project EAT-II: A 5-Year Longitudinal Study Journal of the American Dietetic Association March 2007. 1073):448-455.

3.
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What are good sources of Vegetarian Omega-3s?

etribole@gmail.com (Nutrition Info 411) — 2009-07-02T16:24:00Z

Q. I am vegan, (which means I don't eat any fish, dairy, eggs, meats or poultry). I keep hearing how omega-3s are important for health. What are good sources of omega-3?

A. There are many different types of omega-3 fatty acids with different functions (just like there are many different B-vitamins that have different actions in the body).

The plant-based omega-3 , ALA, is rather easy to get in the diet (flax meal, flax oil, walnuts, green leafy vegetables). The marine-based omega-3 fatty acids, EPA and DHA, are the key omega-3s associated with health benefits ranging from mood, inflammation and heart disease. International guidelines recommend getting an average of 650 milligrams, daily, of a combination of EPA + DHA.

While ALA can technically be converted to EPA in the body, it's very, very low--so you can't rely on it to meet all of your omega-3 needs

[1]. For example, if you eat 1000 milligrams of ALA, it will only make about 27 milligrams of EPA. This means it's important to get direct sources of both EPA and DHA, which for vegans means an algae-based supplement. There are many excellent brands of vegan DHA, but I only know of one brand that contains both EPA and DHA (I don't consult for this company):

V-Pure is one of the few brands that contains vegan/algae EPA. Two caps provide:
Eicosapentaenoic Acid (EPA) – 50 milligrams
Docosahexaenoic Acid (DHA) – 350 milligrams

Also, steer clear from supplements that add Omega-6 and/or Omega-9 fats. Too much omega-6 fats interfere with the benefits of omega-3 fats. The typical western diet, (including vegetarian diets) are already high in omega-6s--found in vegetable oils, especially soybean oil, cottonseed oil and corn oil. There's nothing wrong with omega-9 fats--it's just an unnecessary expense. Olive oil is high in omega-9 fatty acids.

[1] J. Thomas J.T. Brenna, Norman Salem, Andrew J. Sinclair, Stephen C. Cunnane, for the International Society for the Study of Fatty Acids and Lipids, ISSFAL. Alpha-Linolenic acid supplementation and conversion to n-3 long-chain polyunsaturated fatty acids in humans. Prostaglandins, Leukotrienes and Essential Fatty Acids - February 2009 (Feb): 85-91. DOI: 10.1016/j.plefa.2009.01.004)

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Nutrition Headline News

etribole@gmail.com (Nutrition Info 411) — 2008-10-22T22:24:00Z

Nutrition Headline News is re-located in the sidebar.

How do I Help My 18-yo Daugher Adjust to Celiac Disease?

etribole@gmail.com (Nutrition Info 411) — 2008-10-22T20:22:00Z

Q. I am a Registered Dietitian working in a Burbank hospital. My daughter just got diagnosed with Celiac Disease. She is 18. We originally biopsied her 5 years ago and she tested negative. A recent biopsy was positive. We are adjusting to the diet change and fortunately she has a dietitan Mom who is able to navigate thru all of the conflicting information available. I know you mentioned your son was diagnosed years ago. Any advice on helping my daughter adjust? She is in college and lives at home. She doesn't want to eat at restaurants because of the embarrassment of having to question the waiters. It's only been a month, but I want her to start taking ownership of her condition and not relying on Mom so much. Also, can you recommend a gastroenterolist in Los Angeles specializing in Celiac? Thanks so much.

A. Here's what I'd suggest:

Make an appointment with a dietitian who specializes in celiac disease, so that your daughter really hears the information without relying on you to filter the information. (I readily admit that when my son was diagnosed with celiac disease over 10 years, I was completely overwhelmed with learning the details of the gluten-free diet, even though I was a dietitian at the time!). It was one of my motivations to get educated in celiac disease and treatment. (Check out this link to find a dietitian specialist in your area Finding Dietitians that Specializes in Celiac Disease)

Re-assure your daughter that it is normal to feel overwhelmed in the beginning and that she will be feeling better eating a gluten-free diet.

Restaurant Strategies: Since your daughter is inexperienced at ordering gluten-free from a standard menu, it's understandable that she feels awkward. Have her call the restauarant a head of time and ask the necessary questions. I'd also suggest dining during non-rush hours so she will have the wait-staff's attention. Many restaurants have gluten-free options (See Gluten-Free Restaurants). Also, to simplify the ordering process, I tell the wait staff, my son has an "allergy to wheat, rye, oats and barely and any of their derivatives such as soy sauce". While celiac disease is an autoimmune disorder, not an allergy, this request has really cut down on errors from the restaurants. (It was advice given to me by an executive in the restaurant industry, because "allergy" has a legal conotation and gets the needed attention to details).

Join Teen/Young Adult Celiac Support Groups: Since you are in the LA area, I'd join the Celiac Disease Foundation, they have a wealth of information including support groups.

LA Gastroenterologist: I highly recommend Michelle Pietzak, MD or Richard Mathes, MD. There are many more qualified physicians, but I have worked with these particular doctors over the years. Here is a resource of recommended physicians provided by celiac.com.

Gluten-Free Restaurants

etribole@gmail.com (Nutrition Info 411) — 2008-10-13T23:42:00Z

Q. I have been eating a gluten-free diet ever since I was diagnosed with celiac disease over a year ago. I really miss eating out, do you know of any restaurants that serve gluten-free meals?

A. The options for gluten-free dining out are starting to improve. My favorite recommendation is PF Chang's as they have a dedicated gluten-free menu and their food tastes wonderful. Their web site lists their gluten free menu, which you can also download.

Here are some helpful resources:

Gluten-Free Restaurant Awareness Program's is an exciting new program provided by the Gluten Intolerance Group of North American. You just enter your zip code to locate participating restaurants in your area.

Gluten Free Registry, lists restaurants by state and city. They also have customer ratings, which is a nice feature.

The Essential Gluten-Free Restaurant Guide, is book listing over 4700 restaurants. It's a great resource, but unlike the above sites, there's a fee.

One of the trickiest issues when eating out is being sure that there is no cross-contamination of gluten. For example, if you ordered scrambled eggs, you need to be sure they are not cooked on grill area where they make pancakes. Or if you order french fries, you need to be sure they are not fried with breaded onion rings, or other breaded foods. For specific tips on eating out click on this link: Gluten-Free Dining.

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