Ask Evelyn-Nutrition 411

Meta-analysis Reveals “Heart Healthy Omega-6 Fat” Increases Risk of Heart Disease

etribole@gmail.com (Evelyn Tribole MS RD) — Fri, 03 Dec 2010 18:12:00 GMT

Bottom Line: The research upon which the American Heart Association based their "eat-your-omega-6-fat" advisory, is fatally flawed, according to the results of a meta-analysis study, which showed that a steady diet of omega-6 polyunsaturated fatty acids increases the risk of heart disease and death, especially for women [1]. British J Nutr. Dec 2010.

Background: Omega-6 fats are the most commonly eaten polyunsaturated fatty acids (PUFA) in westernized countries. The top three sources are corn oil, soybean oil and cottonseed oil, which are the main ingredients in margarines, salad dressings, and mayonnaise. Many studies have shown that PUFA lower cholesterol.

Prior to industrialization, no population has been exposed to the current high levels of omega-6 polyunsaturated fats. We evolved on a diet with a balanced proportion of omega-6 to omega-3 fats of about 1:1. Today, that ratio in westernized countries is out of whack, near 20:1 of omega-6 to omega-3 fats. Different farming practices, new food processing and the urging by health authorities to use vegetable oils in place of animal fats for heart health, triggered an onslaught of omega-6 fats into the food we eat.

While it's true that PUFA lowers cholesterol, cholesterol is not they key culprit in heart disease. Inflammation is the "new cholesterol" in matters of eating to protect the heart (and other chronic diseases for that matter). Notably many inflammation medications work by blocking the effects of excess omega-6 fat, including statins, aspirin, and asthma inhalers.

In 1999, there was enough scientific evidence to prompt scientists to recommend an upper limit for omega-6 fats, to no more than 7 grams per day. This ceiling is based on eating a maximum of 3% fat calories from omega-6 fat on a 2000 calorie diet.

Yet, a decade later, the 2009 the American Heart Association (AHA) published a health advisory touting the benefits of eating a high omega-6 polyunsaturated fatty acids (PUFA), and warned that eating less than 5% of calories from omega-6 PUFA would be hazardous to heart health. [2-3].

The conclusion of AHA's advisory were seriously questioned in part, because of their failure to distinguish the types of PUFA used in studies, which also substantially increased omega-3 fats, which are also PUFAs. Notably, these studies did not provide the specific fat content of the experimental diets used to lower cholesterol. (Yet the AHA recommended to specifically increase omega-6 PUFA).
These flaws prompted a team of National Institutes of Health (NIH) scientists to re-evaluate the data, using techniques resembling a scholarly forensic investigation.

Design: Nine randomized controlled trials (the gold standard of study design), were identified, which met the criteria of having an intervention diet high in PUFA and reported clinical outcomes.

Next came the detective work, worthy of an Agatha Cristy who-done-it. Most of the studies did not provide omega-3 fat data--it was just lumped together in the PUFA category.

In order to track down the missing fatty acid data, (many of these studies were conducted over 40 years ago), they had to dig through newspaper archives, public records, scientific proceedings from national conferences and correspond with the study investigators (or their colleagues, if deceased).

Once the fatty acid data was collected, they were segregated into two categories:

Mixed Diet (containing both omega-6 and omega-3 polyunsaturated fatty acids.)
Omega-6 Specific Diet

Then the data was pooled to evaluate the effect of the Omega-6 Specific Diet, compared to the effect of the Mixed Diet, on clinical outcomes. They also evaluated the potential confounding role of trans fatty acids.

Results: Here's what they found when evaluating the composition of the intervention diets.
Diet Composition

Only three of the nine so-called PUFA studies were "pure" omega-6 intervention trials, which upped omega-6, without a concurrent rise in dietary omega-3. Combined, these three studies had 9,500 participants.

Four of the studies increased both the omega-3 PUFA (EPA and DHA) and omega-6 PUFA, which totaled over 1,700 participants. Notably, the researchers discovered that the Oslo Diet-Heart Study provided about 5 grams of EPA and DHA per day to the intervention group. (That's equivalent to about 16 fish oil capsules).

The control diets had a mean estimated trans fatty acid content of 3% (a significant confounding factor, which unquestionably increases risk of heart disease).

Heart Disease and Death Outcomes
When the effects of the Omega-6 Specific Diet were compared to the Mixed Omega 6/omega-3 PUFA; the following health outcomes were discovered:

Omega-6 Specific Diet:

Increased risk of heart disease and death, compared to the Mixed Diet intervention studies.
The relative risk of cardiac death increased by 28%.
Increased the risks of all relevant cardiovascular outcomes.
There was only one study with women, which showed significant harm.

The Mixed Omega-6/Omega-3 Diet:

There was 8% risk reduction of death from all causes.
There was 22% risk reduction from heart disease death.

Conclusion: The scientists concluded, that not only is there no indication of health benefit, from increasing dietary omega-6 PUFA, but a possibility of harm. Therefore, they recommended that the public health advice to maintain or increase dietary omega-6 PUFA, should be reconsidered.
Study Quote: “The increased cardiovascular heart disease risks from omega-6 specific PUFA diets in our meta-analysis may be underestimated as omega-6 PUFA also replaced substantial quantities of trans fatty acids."

Conclusion: The scientists concluded, that not only is there no indication of health benefit, from increasing dietary omega-6 PUFA, but a possibility of harm. Therefore, they recommended that the public health advice to maintain or increase dietary omega-6 PUFA, should be reconsidered.

Study Quote: “The increased cardiovascular heart disease risks from omega-6 specific PUFA diets in our meta-analysis may be underestimated as omega-6 PUFA also replaced substantial quantities of trans fatty acids."

An accompanying editorial applauded the “extensive detective work” by the NIH research team, led by Christopher Ramsden [4].

Links to Sources
[1] Christopher E. Ramsden,Joseph R. Hibbeln,Sharon F. Majchrzak and John M. Davis (2010).Omega-6 Fatty acid-specific and mixed polyunsaturate dietary interventions have different effects on CHD risk: a meta-analysis of randomised controlled trials. British Journal Nutrition. Dec 2010; 104(11): pp 1586-1600.

[2] Harris WS et al. Omega-6 Fatty Acids and Risk for Cardiovascular Disease. A Science Advisory From the American Heart Association Nutrition Subcommittee of the Council on Nutrition, Physical Activity, and Metabolism; Council on Cardiovascular Nursing; and Council on Epidemiology and Prevention. Circulation published January 26, 2009. [Free Full Text.]

[3] American Heart Asssociation News Release. Omega-6 fatty acids: Make them a part of heart-healthy eating DALLAS, Jan. 27, 2009. [Free full Text]

[4] Philip C. Calder (2010).The American Heart Association advisory on n-6 fatty acids: evidence based or biased evidence? British Journal Nutrition. Dec 2010; 104(11): pp 1575-1576.[Abstact]

Copyright © 2010 by Evelyn Tribole, MS, RD Published at http://www.EvelynTribole.com Rights to Reproduce: As long as you leave it unchanged, you don’tcharge for it, and you include the entire copyright statement, you mayreproduce this article. Please le

Intuitive Eater's Holiday Bill of Rights

etribole@gmail.com (Evelyn Tribole MS RD) — Sun, 28 Nov 2010 06:20:00 GMT

What if peace on earth could begin at the dinner table? Imagine experiencing an inner peace, free from incessant worry about what to eat. It's hard to enjoy the holidays when you are preoccupied with eating or worried about what to say to relatives who have an annual tradition of telling you what and how to eat.

Consider your Intuitive Eating Bill of Rights, as we enter the holiday season, to help you foster inner peace with food, mind and body.

1. You have the right to savor your meal, without cajoling or judgment, and without discussion of calories eaten or the amount of exercise needed to burn off said calories.

2. You have the right to enjoy second servings without apology.

3. You have the right to honor your fullness, even if that means saying "no thank you" to dessert or a second helping of food.

4. It is not your responsibility to make someone happy by overeating, even if it took hours to prepare a specialty holiday dish.

5. You have the right to say, "No thank you," without explanation, when offered more food.

6. You have the right to stick to your original answer of "no", even if you are asked multiple times. Just calmly and politely repeat "No, thank you, really."

7. You have the right to eat pumpkin pie for breakfast.

Remember, no one, except for you, knows how you feel, both emotionally and physically. Only you can be the expert of your body, which requires inner attunement, rather than the external, well-meaning, suggestions from family.

Copyright © 2010 by Evelyn Tribole, MS, RD Published at http://www.EvelynTribole.com Rights to Reproduce: As long as you leave it unchanged, you don’tcharge for it, and you include the entire copyright statement, you mayreproduce this article. Please le

Is Intuitive Eating possible when you have a medical condition? (Part I)

etribole@gmail.com (Evelyn Tribole MS RD) — Thu, 26 Aug 2010 15:49:32 GMT

I often get asked by both consumers and health professionals, if Intuitive Eating can be used for people with medical conditions. Generally, yes!

It's possible to integrate health recommendations for your condition, while being attuned to the experience of your body, which in a nutshell, is the ability to distinguish between emotional and physical hungers, and respond appropriately. It also includes:

Seeking pleasurable and satisfying eating experiences

Pursuing enjoyable physical activity, which rejuvenate the body and feels good, not to pay penance for eating or burn the most calories.

Coping with feelings without using food, respecting your body, and so forth.

One of the key challenges is to identify the factor(s) that might interfere with a person's ability to be attuned to his or her body. Common obstacles include: dieting, stress, chronic sleep deprivation, multi-tasking, and unrealistic expectations.

But when someone has a medical condition, there are other factors to consider:

Elevated blood sugars from diabetes and related syndromes, can cloud thinking and make it difficult to be attuned.
Polycystic Ovary Syndrome (PCOS), can interfere with satiety cues because of insulin resistance.
Anxiety, Chronic Pain, and Fatigue can distort satiety cues-from nausea to lack of appetite.

If your "satiety meter" is not working accurately, you might feel off-kilter. If you have trouble identifying hunger cues, you might have difficulty identifying low blood sugar (hypoglycemia), which is crucial if you are taking medication for diabetes and related conditions.

You will likely benefit from some type of self-care eating routine. This might mean working in conjunction with a health care team specializing in the particular medical condition and attuned eating. Check out this great example, from the Diabetes and Mindful Eating blog written by Michelle May, MD and Megrette Fletcher, M.Ed., R.D., C.D.E

In my next post (Part 2), we'll look at the issue of "unconditional permission to eat", which stumps many people when it comes to medical conditions. In essence, How do you Make Peace with Food, if you have celiac disease, diabetes or food allergies?

Rightsto Reproduce:As long as you leave it unchanged, you don’tcharge for it, and youinclude the entire copyright statement, you may reproduce this article.Please let us know you have used it by sending a website link or anelectronic copy to Etribole at gmail dot com.

Using “Mindful Distraction” to Help a Patient with an Eating Disorder

etribole@gmail.com (Evelyn Tribole MS RD) — Tue, 20 Jul 2010 04:27:00 GMT

I get a lot of questions about counseling strategies I use to help my patients eat. Sometimes, I call what I do "upside-down nutrition"--because on the surface it doesn't seem to make sense. I use different technques to help a patient feel safe and move forward in recovery. One of these techniques is "mindful distraction"--here's a recent example.

Just the other day, I asked my patient, “What could you do to distract yourself while eating?”   She looked at me with a wry smile and replied, “Evelyn , I just read an article, in which you were quoted as saying, how it is so important to eat without distraction.”

“You are correct, that is my general suggestion for people who want to become Intuitive Eaters —to eat without distraction, so they can connect with the nuances of eating—including hunger, fullness and satisfaction”.

What gives?   In this situation, my patient is struggling with an eating disorder and undergoing very stressful therapy, which makes eating seem intolerable.   (For those of you wondering, yes, I spoke with her therapist who validated her difficult therapy process.) My patient also has a general state of anxiety, which at best blunts her hunger cues, and at worse, results in nausea, which she is currently experiencing. Obviously, nausea and eating don’t go very well together. Yet she needs to eat—to nourish her body.

So, as a temporary measure, I encouraged my patient to create a mindful, soothing, distraction to enable her to eat. I realize this is an oxymoron—“mindful distraction”. My patient was willing and able to listen to relaxing music, via her mp3 player. This direct link of music-to-ears, seems to help drown out her anxious thoughts, while eating and prevents unnecessary distress.   My patient gets lost in the lyrics, rather than difficulty of eating.

Once my patient gets through this tough patch in therapy, we’ll move to mindful breathing, before meals, to help engage the parasympathetic nervous system for a calming effect.   But I can’t tell you when that will be--because the priority right now, is nourishing her body.   And it’s okay—you don’t have to eat perfectly to make progress in recovering from an eating disorder !

DISCLAIMER:Theinformation is intended to inform readers and isnot intended toreplace specific advice from a health care professional. Copyright 2010Evelyn Tribole, MS, RD

Copyright © 2010 by Evelyn Tribole, MS, RD Published at http://www.EvelynTribole.com Rights to Reproduce: As long as you leave it unchanged, you don’tcharge for it, and you include the entire copyright statement, you mayreproduce this article. Please le

Does Stress Cause Weight Gain?

etribole@gmail.com (Evelyn Tribole MS RD) — Tue, 08 Jun 2010 21:40:02 GMT

Q. Is it true that stress causes weight gain?

A. The price your body pays for chronic stress can be weight gain, not to mention a host of other health problems including diabetes, cancer, heart disease and high blood pressure.

A fascinating animal study showed a dose-response relationship between stress and weight gain. (And I can’t imagine animals worrying about paying their bills or getting their kids into college). So, the human stress factor might be even more profound, but there has yet to be a similar type of study on people.

Since the late 1980’s, stress has been associated with increased abdominal fat and insulin resistance [1]. Just last month, scientists discovered that the stress chemical, cortisol, is a critical step in growing a fat cell, into a fully mature fat cell [2].

Scientists recently discovered that counting calories also raises cortisol, which may be another reason diets not only don’t work, but also predict more weight gain [3, 4].

Note, that this "cortisol effect" is a biological mechanism, which may explain the stress-weight-gain connection. This is completely different from coping with stressful events by eating, which is a form of emotional eating.

So what’s a health-minded person supposed to do during stressful times? Obviously, you can’t control events such as the chaotic economy. Be sure to make your stress-reducing self-care, a non-negotiable priority, including: adequate sleep, engage in play time, and talk with supportive friends and family.

Links to Resources:

[1] McEwen BS. Protective and damaging effects of stress mediators. NEJM. 1998;338(3):171-179.

[2] A Fat Cell Grows Up.

[3] Tomiyama, A. Janet, Mann, Traci, Vinas, Danielle, Hunger, Jeffrey M., DeJager, Jill, Taylor, Shelley E. Low Calorie Dieting Increases Cortisol. Psychosom Med 2010;72: 357-364.

[4] Is it True that Dieting Makes You Gain Weight?

My Video Audition for Oprah's New Television Network...

I decided to take a risk and just submitted my audition video for a health show on Oprah's new television network. And I need your help. The top five audition videos will be finalists for getting their own television show!

Here's the link to my audition--if you like what hear--please cast your vote. You can vote as many times as you wish at http://bit.ly/bX5MUY Feel free to forward this to friends and post on social media site! Thanks for your support

_____

Rights to Reproduce: As long as you leave it unchanged, you don’tcharge for it, and you include the entire copyright statement, you mayreproduce this article. Please let us know you have used it by sending awebsite link or an electronic copy to Etribole@gmail.com.

Do Dietary Restrictions in the Absence of Disease Do More Harm Than Good?

etribole@gmail.com (Evelyn Tribole MS RD) — Wed, 12 May 2010 15:41:16 GMT

Q. I am a "complimentary" health care practitioner. It's very popular among my colleagues to recommend intense dietary restrictions to most of our patients (such as no sugar, no dairy, no wheat). After reading Intuitive Eating, I'm concerned that in the absence of a documented condition such as celiac disease, we may be doing more harm than good as we just add to the guilt and shame our patients already feel about food. What are your thoughts?

A. I agree with your inclination. Well-meaning diet restrictions may do more harm than good, especially when you factor in mental health and wellbeing. To achieve authentic health, a person needs to be attuned and responsive to inner satiety cues and basic needs. This includes the ability to eat in a manner that is satisfying and pleasurable.

Yet the pleasure of eating has become a lost art in the USA. Instead, eating is commonly viewed as something that will kill you, cure you, or make you fat. This is where we can take a lesson in the pleasure principle from France.

An international study found that Americans worry the most about their health and enjoy eating the least. In contrast, the French are the most food-pleasure-oriented and least food-health-oriented. [1] Notably, France has nearly half the obesity rate compared to the USA, for both adults and children [2].

When food restrictions are placed on a chronic dieter, or on a person who chronically feels guilty about eating, it increases the “forbidden food” burden. Consequently, rigid food rules interfere with the individual's ability to "hear" or be attuned to the eating experience of his or her body.

Instead, upon eating forbidden foods, there is usually a tremendous feeling of guilt, which becomes somaticized. For example, chronically dining on sugary, processed foods and meals doesn't usually feel good, physically—but this physical discomfort is equated to the emotional feeling of guilt. But when morality and judgment is removed from the eating experience, a person can truly ask, “If given the same set of circumstances, would I choose to feel this way again.” Usually, the answer, is no.

Ultimately, it feels better when you eat healthy, satisfying meals, most of the time. But this needs to be experienced, without judgment. If a person is truly inner-attuned, it’s possible to eat within any dietary framework such as “eating green” or eating “whole foods”, while paying attention to hunger, fullness, satisfaction and so forth.

[1]Rozin P et al (1999). Attitudes to food and the role of food in life: Comparisons of Flemish Belgium, France, Japan and the United States. Appetite,33, 163–180.

[2]International Obesity Task Force EU Platform Briefing Paper http://www.iotf.org/media/euobesity3.pdf [accessed May 12, 2010].

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

etribole@gmail.com (Evelyn Tribole MS RD) — Sat, 13 Mar 2010 18:39:41 GMT

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.

Rights to Reproduce: As long as you leave it unchanged, you don’tcharge for it, and you include the entire copyright statement, you mayreproduce this article. Please let us know you have used it by sending awebsite link or an electronic copy to Etribole@gmail.com.

Obsessive Calorie Counter Wants to be an Intuitive Eater

etribole@gmail.com (Evelyn Tribole MS RD) — Sun, 14 Feb 2010 18:52:00 GMT

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.
_____

Rights to Reproduce: As long as you leave it unchanged, you don’tcharge for it, and you include the entire copyright statement, you mayreproduce this article. Please let us know you have used it by sending awebsite link or an electronic copy to Etribole@gmail.com.

Can I Trust My Body to Send the Correct Hunger Signals?

etribole@gmail.com (Evelyn Tribole MS RD) — Thu, 28 Jan 2010 17:58:21 GMT

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.

_____

Rights to Reproduce: As long as you leave it unchanged, you don’tcharge for it, and you include the entire copyright statement, you mayreproduce this article. Please let us know you have used it by sending awebsite link or an electronic copy to Etribole@gmail.com.

What Do You Think About Overeaters Anonymous?

etribole@gmail.com (Evelyn Tribole MS RD) — Sat, 16 Jan 2010 21:21:50 GMT

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

Rights to Reproduce: As long as you leave it unchanged, you don’tcharge for it, and you include the entire copyright statement, you mayreproduce this article. Please let us know you have used it by sending awebsite link or an electronic copy to Etribole@gmail.com.

Is it True that Dieting Makes You Gain Weight?

etribole@gmail.com (Evelyn Tribole MS RD) — Sun, 08 Nov 2009 23:32:38 GMT

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.

_____

Rights to Reproduce: As long as you leave it unchanged, you don’tcharge for it, and you include the entire copyright statement, you mayreproduce this article. Please let us know you have used it by sending awebsite link or an electronic copy to Etribole@gmail.com.

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

etribole@gmail.com (Evelyn Tribole MS RD) — Mon, 26 Oct 2009 21:47:55 GMT

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

Rights to Reproduce: As long as you leave it unchanged, you don’t charge for it, and you include the entire copyright statement, you may reproduce this article. Please let us know you have used it by sending a website link or an electronic copy to Etribole@gmail.com.

Is there a test for eating disorders?

etribole@gmail.com (Evelyn Tribole MS RD) — Mon, 12 Oct 2009 14:22:10 GMT

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.

Rights to Reproduce: As long as you leave it unchanged, you don’t charge for it, and you include the entire copyright statement, you may reproduce this article. Please let us know you have used it by sending a website link or an electronic copy to Etribole@gmail.com.

DISCLAIMER: The information is intended to inform readers and is not intended to replace specific advice from a health care professional. Copyright 2010 Evelyn Tribole, MS, RD

Copyright © 2010 by Evelyn Tribole, MS, RD Published at http://www.EvelynTribole.com Rights to Reproduce: As long as you leave it unchanged, you don’tcharge for it, and you include the entire copyright statement, you mayreproduce this article. Please le

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

etribole@gmail.com (Evelyn Tribole MS RD) — Sun, 11 Oct 2009 03:29:17 GMT

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.

_____

Rights to Reproduce: As long as you leave it unchanged, you don’t charge for it, and you include the entire copyright statement, you may reproduce this article. Please let us know you have used it by sending a website link or an electronic copy to Etribole@gmail.com.

DISCLAIMER: The information is intended to inform readers and is not intended to replace specific advice from a health care professional. Copyright 2010 Evelyn Tribole, MS, RD

Copyright © 2010 by Evelyn Tribole, MS, RD Published at http://www.EvelynTribole.com Rights to Reproduce: As long as you leave it unchanged, you don’tcharge for it, and you include the entire copyright statement, you mayreproduce this article. Please le

What is Considered Too Much Exercise?

etribole@gmail.com (Evelyn Tribole MS RD) — Sat, 05 Sep 2009 21:22:00 GMT

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

________

Rights to Reproduce: As long as you leave it unchanged, you don’t charge for it, and you include the entire copyright statement, you may reproduce this article. Please let us know you have used it by sending a website link or an electronic copy to Etribole@gmail.com.

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

etribole@gmail.com (Evelyn Tribole MS RD) — Sun, 23 Aug 2009 18:17:00 GMT

Rights to Reproduce: As long as you leave it unchanged, you don’tcharge for it, and you include the entire copyright statement, you mayreproduce this article. Please let us know you have used it by sending awebsite link or an electronic copy to Etribole@gmail.com.

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

_____

Rights to Reproduce: As long as you leave it unchanged, you don’tcharge for it, and you include the entire copyright statement, you mayreproduce this article. Please let us know you have used it by sending awebsite link or an electronic copy to Etribole@gmail.com.

DISCLAIMER: The information is intended to inform readers and isnot intended to replace specific advice from a health care professional.Copyright 2010 Evelyn Tribole, MS, RD

Copyright © 2010 by Evelyn Tribole, MS, RD Published at http://www.EvelynTribole.com Rights to Reproduce: As long as you leave it unchanged, you don’tcharge for it, and you include the entire copyright statement, you mayreproduce this article. Please le

Is it Okay to Eat Dessert for Dinner?

etribole@gmail.com (Evelyn Tribole MS RD) — Thu, 13 Aug 2009 22:45:00 GMT

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!

Copyright © 2010 by Evelyn Tribole, MS, RD Published at http://www.EvelynTribole.com Rights to Reproduce: As long as you leave it unchanged, you don’tcharge for it, and you include the entire copyright statement, you mayreproduce this article. Please le

What's Your Take on Tropical Oils?

etribole@gmail.com (Evelyn Tribole MS RD) — Mon, 10 Aug 2009 17:36:00 GMT

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.
_____

Rights to Reproduce: As long as you leave it unchanged, you don’tcharge for it, and you include the entire copyright statement, you mayreproduce this article. Please let us know you have used it by sending awebsite link or an electronic copy to Etribole@gmail.com.

DISCLAIMER: The information is intended to inform readers and isnot intended to replace specific advice from a health care professional.Copyright 2010 Evelyn Tribole, MS, RD

Copyright © 2010 by Evelyn Tribole, MS, RD Published at http://www.EvelynTribole.com Rights to Reproduce: As long as you leave it unchanged, you don’tcharge for it, and you include the entire copyright statement, you mayreproduce this article. Please le

Are You Paying Too Much for Your Omega-3 Supplements?

etribole@gmail.com (Evelyn Tribole MS RD) — Wed, 29 Jul 2009 23:31:00 GMT

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.

_____

Rights to Reproduce: As long as you leave it unchanged, you don’t charge for it, and you include the entire copyright statement, you may reproduce this article. Please let us know you have used it by sending a website link or an electronic copy to Etribole@gmail.com.

DISCLAIMER: The information is intended to inform readers and is not intended to replace specific advice from a health care professional. Copyright 2010 Evelyn Tribole, MS, RD

Copyright © 2010 by Evelyn Tribole, MS, RD Published at http://www.EvelynTribole.com Rights to Reproduce: As long as you leave it unchanged, you don’tcharge for it, and you include the entire copyright statement, you mayreproduce this article. Please le

Can Intuitive Eating Be Used to Treat Diabetes and Bulimia?

etribole@gmail.com (Evelyn Tribole MS RD) — Sat, 18 Jul 2009 00:42:00 GMT

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.
_____

Rights to Reproduce: As long as you leave it unchanged, you don’tcharge for it, and you include the entire copyright statement, you mayreproduce this article. Please let us know you have used it by sending awebsite link or an electronic copy to Etribole@gmail.com.

DISCLAIMER: The information is intended to inform readers and isnot intended to replace specific advice from a health care professional.Copyright 2010 Evelyn Tribole, MS, RD

Copyright © 2010 by Evelyn Tribole, MS, RD Published at http://www.EvelynTribole.com Rights to Reproduce: As long as you leave it unchanged, you don’tcharge for it, and you include the entire copyright statement, you mayreproduce this article. Please le