Blog | Bonnie Modugno, MS, RD

WHAT’S WITH WHEAT TODAY? Maybe it’s the gluten

May 21, 2013 by Bonnie

I notice when I eat bread I start to hiccup. So strange, but it’s been going on for years. I figured out the role of insulin resistance over twenty years ago and I eat mostly low glycemic starches. I grew up on pasta and bread, and learned in my 30′s that a high carbohydrate diet was packing on the pounds. I eat even less bread and fewer grains today, but I wonder if I can’t even handle that.

Monday I was feeling hungrier than usual, and knew I needed a bit more carbohydrate to be satisfied. I grabbed a few pretzels after a delicious Greek salad and headed out the door. I immediately started to hiccup. Ok, this is familiar. Then I started to burp and my belly felt tight and hard, like it was bloated. Yes, that happens sometimes, too. Minutes later my gut started churning. Soon I was hunched over in the car with a gripping kind of cramp. Nothing more, but I endured the distress for over an hour. What is happening?

There is evidence that since 1980 food sensitivities and food allergies are increasing. According to the Asthma and Allergy Foundation of America (AAFA) website 20% of all Americans today suffer from allergies and asthma:

Approximately 6% of allergy sufferers have food/drug allergies as their primary allergy.
Food allergy is more common among children than adults.
90% of all food allergy reactions are cause by 8 foods: milk, soy, eggs, wheat, peanuts, tree nuts, fish and shellfish.

WHAT IS CAUSING MORE FOOD ALLERGIES?

The AAFA website doesn’t address what may be causing the increasing incidence of food allergies. The Allergy Kids Foundation suggest environmental chemical contaminants could be to blame. This hypothesis is increasingly provocative when you realize that industry spews tens of thousands of chemicals into our environment. The compounds infiltrate the air, soil and water and eventually end up in the food supply. These compounds also bio-accumulate throughout the food chain. Those of us at the top bio-accumulate the most. We track only about 200 of these agents, and study even fewer. Who knows the role they play?

There is also much speculation regarding the role of genetically modified and engineered foods. There is no genetically modified wheat used commercially in the US, so I can rule that out in my case. Still, the jury is out on the role of genetically modified foods in the role of food allergies. In a 2007 review, the author concludes the paper by asking, “Where is the scientific evidence showing that GM plants/food are toxicologically safe, as assumed by the biotechnology companies involved in commercial GM foods?”

WHAT HAS HAPPENED TO WHEAT

Most of my symptoms surface when I eat wheat. The wheat we eat today is very different than the wheat families consumed decades ago. Today wheat doesn’t grow as tall and can easily be harvested with mechanical equipment. A recent USDA publication asserts that changes in wheat protein concentration are not significant, not likely the cause of increasing incidence of celiac disease, and suggests maybe it’s the imported wheat gluten. I’m not convinced.

In the NY Times best seller, Wheat Belly, Dr William Davis states two different protein fractions are probably causing harm, both gluten and gliadin. Both quantity of wheat and wheat protein content increased during the 21st century. The protein content of wheat allows bread to rise–a desirable quality. It is not much of a stretch to think farmers figured this out. In addition, the use of artificial fertilizers (which has been the norm especially since the 1950′s) is known to increase the protein content of wheat. What is behind the drive for greater protein content in wheat? In a word, profits.

A 2012 study of active duty US military showed a 400% increase in celiac disease ( a severe form of gluten intolerance) between 1999 and 2008. No one really knows what causes celiac disease, but it indicates that your gut experiences a dramatic inflammatory response to gluten that results in a damaged GI tract. The solution is to eliminate food sources of gluten. Of note, the greatest increases were seen in people in their 40′s and 50′s. Could this be happening to me?

Yesterday I purchased a bag of gluten free pretzels and a few other items. After a few handfuls, no hiccups, no burping, and no bloating or cramps. This should be interesting.

Filed Under: Blog Tagged With: carbohydrate, celiac disease, farming, GF, gliaden, gluten, gluten free, gmo, health, insulin resistance, profits, protein, USDA, weight, wheat, wheat belly, whole grains, William Davis

LIVING ON THE SPECTRUM: What autism can teach us about navigating the world

May 14, 2013 by Bonnie

I can’t wait to read Dr. Temple Grandin’s fourth book, The Autistic Brain, For years I read the experts and listened at conferences as they drew conclusions about autism that didn’t jive with my experience raising Noah. I am looking forward to learning what I have suspected for years. Yes, the autistic brain is different, but there is a continuum that links us all.

ALL BEHAVIOR IS COMMUNICATION

Some of the miscue is based on assumptions experts made in the past about the nature of “autistic” traits. Temple Grandin begins the discussion by stating, “Contrary to long-held dogma, we should not mistake problems with social communication for lack of desire for social connection.” For decades too many experts assumed that an autistic child was merely content to be in their own world. When my son was newly diagnosed at 4, I witnessed Noah’s incredible frustration when he could not verbalize what he wanted or needed, and his incredible relief when I figured it out. In those early years I felt like an interpreter. I learned that all behavior is communication.

That experience led me to wonder how many other “autistic” traits are misinterpreted. Lack of effective self regulation and inadequate resilience are considered hallmark autistic traits. Repetitive behaviors known as perseveration are common. These behaviors are labeled as deviant, a sign of some disability when in fact most of the time they are purposeful. They serve to self soothe, to calm anxiety, or minimize fear. Sometimes they serve to distract, sometimes to insulate. But no matter how disconcerting, I always find that they serve a purpose.

REDEFINING THE SPECTRUM

My sense is that most of us struggle to some degree with similar challenges and exhibit some of these same traits, albeit often in a more socially acceptable form. Maybe it is time to reassess the nature of these traits that are used to diagnose autism. For starters, each of these traits could be plotted on a spectrum, from high to low expression, to more accurately assess the nature of each trait.

I’ll use socialization as an example. We already identify those who have social difficulties at one extreme. Maybe we could identify the hyper social types on the other end. That would give us an opportunity to identify those with functional and adequate social skills in the middle. This spectrum represents a far more honest assessment of socialization than the current model that fails to acknowledge when extreme social behavior is a problem. Too many hyper-social types can’t get anything done.

AMERICANS TEND TO CELEBRATE EXTREMES

Americans like the best, the worst, the most and the least. We celebrate the extremes. When someone doesn’t measure up, there is increasingly greater need to self sooth. Self soothing can be running for hours, it can be watching TV for hours. Society judges the behaviors differently, but both may be problematic when the behavior is more compulsion than choice.

When it comes to self regulation, we can draw a spectrum from extremely indulgent to extremely restrained behavior, and identify adequate self regulation in the middle. Today we often fail to acknowledge the harm of unwavering rigidity, whether from deprivation or excess. Effective self regulation isn’t absolute or rigid even though society often rewards the same as good discipline. Too often rigid discipline backfires, driving more and more polarized behavior. Ironically, the most effective self regulation is flexible and moderated to meet the needs of the situation.

I am not surprised to see more and more problematic behavior in families, at K-12 schools, on college campuses, and at the workplace. Our society is crippled as large numbers of people struggle to navigate a harsh and demanding world. Distorted relationships with food, alcohol, drugs, gambling, sex, and credit cards underscore the challenges of cultivating good enough self regulation and adequate resilience.

RETHINKING THE SPECTRUM

As we learn more about how our brains work, maybe we can begin a more honest assessment of what it takes to navigate our world successfully. My first suggestion is to stop being preoccupied with what is “normal” and be more attentive to what is functional. Let’s stop pretending that only those with a diagnosis need support to develop good enough social skills, effective self regulation and strong enough resilience. Only then we will be able to direct our energy to what really matters: helping each person cultivate the skills and resources to develop their potential and contribute as they can–even if I am just talking about what to eat.

Filed Under: Blog Tagged With: addiction, ASD, asperger's syndrome, autism, autism spectrum, autism spectrum disorders, compulsion, coping, diagnosis, eating disorders, experts, HALT, neurotypical, normal, OA, overeaters anonymous, overeating, PDD, perseveration, pervasive developmental delay, Race to Nowhere, relationships, resilience, self regulation, self soothing, social, socialization, Temple Grandin

Are You Treated Differently Because of Your Weight?

May 4, 2013 by Bonnie

What rational basis is there for people — any people — to be biased against other people because of adipose tissue?

Eating contests push all my buttons. In this picture there is one large contestant and one small. Which image challenges you the most?

Dr. David Katz asks this provocative question in his recent Huff Post Blog, Obesity, Bias and Bedrock. While the question is meant for everyone, doctors and other health professionals are the primary target. Dr. Katz takes his cue from Tara Parker-Pope’s piece in the New York Times, Are Doctors Nicer to Thinner Patients? The dark truth is that patients of size have faced medical bias and worse for decades, certainly longer than the 26 years I have been in private practice.

Dr Katz mentions biology, suggests a role for anthropology, but fails to ask his colleagues to look in the mirror. From my perspective one of the biggest reasons patients experience weight bias is because medicine pretends weight has much more to do with health and disease than it actually does.

WEIGHT IS A POOR SURROGATE MEASURE FOR HEALTH

Measuring weight and calculating BMI scores is fast, easy, and inaccurate. Metabolic health is the critical indicator, but more time consuming and expensive to assess. So, doctors continue to measure weight, remark about weight and lament when patients don’t lose weight despite evidence that says weight doesn’t accurately assess health status. In addition, preoccupation with a number on the scale completely ignores the fact that how you lose weight matters.

Patients lose weight but cholesterol doesn’t drop, blood sugars don’t get better, blood pressure doesn’t decrease. It is a myth that a 10 pound weight loss improves health. The truth is that lifestyle changes help the body to use fat more effectively for fuel. A healthier metabolism improves health status and weight loss is the result of better metabolic health, not the cause.

FOCUS ON WHAT REALLY MATTERS

Maybe medicine needs to stop pretending that weight is an indicator of health. It isn’t. If health care professionals are serious about decreasing weight bias, they can focus on what really matters:

Ask your patient if anything about their metabolism is of concern or keeping them from living the life they would like to enjoy. Keep the focus on metabolic health and resist using weight as short hand.
Discuss what kind of activity patients enjoy, or if they have time to be active. What holds them back? Give them an opportunity to consider what they could do. The more patients own the plan, the more likely they will make an earnest effort to follow through. If they can’t, there is more to be discussed.
Ask patients about their diet. Resist leaning on one or two soundbites of advice. Be ready to listen without judgment. Give your patients a safe place to discuss what is not working. Ask them if they are interested in getting some help with that. Then if you don’t have the time or expertise to take it further, refer them to a registered dietitian or qualified nutritionist.
Consider what else could be getting in the way of effective energy metabolism. Stress plays a powerful role, so does lack of sleep. Medications often interfere with energy metabolism; some cause dramatic weight gain and even diabetes.
Stay open to the concept of healthy at every size. (HAES) There are many people who are living large– and are metabolically healthy.
Scrutinize your own beliefs and values. We are fast evolving from the simplistic notion that a larger body just eats too much. A sympathetic and non-judgmental ear is far more encouraging than even the slightest hint of shame or blame.

It is clear to me that weight bias exists because too much value is given to the number on the scale. If doctors are serious about eradicating weight bias, they need to figure out a more accurate and honest way to assess health. Have you been treated differently because of your weight?

Filed Under: Blog Tagged With: activity, David Katz, Dr. Katz, eating, eating contest, fat, fat bias, HAES, health at every size, health care, judgment, metabolic health, NY Times, obesity, scale, shame, Tara Parker-Pope, weight, weight bias, weight discrimination

Its All About Growing Grass

April 10, 2013 by Bonnie

I remember picking up Joel Salatin’s book, Everything I Want To Do Is Illegal soon after I finished The Omnivore’s Dilemma by Michael Pollan. I wanted to learn more. Joel’s reverence for growing grass captured my imagination. His explanation of bio-dynamic farming confirmed my suspicions. Animals and plants are meant to be cultivated together.

It’s all about the grass. Look closely at the hill behind the trees. That land is conventionally farmed, while the foreground is bio-dynamically farmed at Polyface.

Our visit to Polyface Farms, located in Virginia’s Shenandoah Valley, fit perfectly into our spring break excursion– but was a little too early in the season to see the farm in full production. No chickens pecking around the chicken mobile or cows grazing on pasture. Still, Brie Aronson walked us through the property and answered all our questions. The picture that sticks in my mind is the early greening of the Polyface pastures compared to the distinct brown of his neighbor’s land. Bio-dynamic farming feeds the land, the animals and the farmer in a way that conventional farming just can’t.

We saw chicks pecking in the brooding house, and were told how pigs contribute by disturbing the land. The thrashing of the pasture and paddocks allows seed to be spread, nutrients to till, and the rich ecosystem of the soil to thrive. Resting the pastures allows them to regenerate and grow the grass that feeds the cows far longer than conventional farms. Polyface relies on hay feed for a mere 40 days of the year while more conventional local operations feed hay an average of 120 days.

Chicks are raised on a special non GMO feed until they are old enough to take to pasture

The exquisite execution and overall efficiency of each farming operation impressed us the most. Every season allows work to be done that prepares for the next. We saw how the cows feeding in the barn were actually busy building the layers of manure, fermented corn and hay that the pigs next door churned into rich compost and fertilizer. (Boy, are they rambunctious. I remember seeing docile pigs in crates at the LA County Fair and cringe. I have a new appreciation for Joel Salatin’s intent to honor the “pigness of a pig”. ) We saw the chicken mobiles that allow the chickens to range and peck on the fly larvae maturing in cow pies that ultimately creates the delicious omega three rich eggs. The cycle of life hard at work.

Pigs root for the fermented corn and churn the layers of manure and hay to form rich compost on the farm

CONVENTIONAL FARMING IS UNSUSTAINABLE

The current industrialized model for farming and raising animals is unsustainable. Conventional farming doesn’t optimize the synergy between the grass, animals and plant foods. Waste in the conventional model is considered a resource in the bio-dynamic model.

Conventional farming depends on cheap energy and subsidized products, horribly distorting food costs in the marketplace. The cheap stuff at our local markets is subsidized by our taxes, so we do pay more for this food, just not directly. Ironically all this cheap food is more than we can afford. Treating diabetes, heart disease, cancer, and the myriad of other diseases linked to our abundant and highly adulterated food supply only continues to cost all of us–individually and collectively. There is another way to produce the food we need. Thanks to Joel Salatin and sustainable farmers everywhere, more and more of us have a choice. What do you do to eat closer to the earth?

Filed Under: Blog Tagged With: biodynamic farming, chicken, farm, farm bill, food subsidies, grass, grass fed beef, Joel Salatin, Michael Pollan, omega three, Omnivore's Dilemma, pigs, Polyface, rethink food, soil ecology

Two Food Worlds: Navigating the great divide on the road

April 6, 2013 by Bonnie

At lunch I savored raw local oysters and my first taste of fried green tomatoes. We visited Charleston, South Carolina yesterday–graceful and elegant even in pouring rain. After braving the ferry ride to Fort Sumter and maxing out on Civil War history, we returned to the visitor center and headed across the peninsula. We gaped through beaded windows at the stately mansions, and then turned our attention to lunch. Amen Street Fish and Raw Bar caught my attention, especially since I knew we had a date for ‘cue later that day. I wanted a light meal, suspecting I would be crossing the entire spectrum of dining within a mere six hours.

EATING LIKE THE LOCALS

Amen Street charmed me all at once. The cozy brick walls dressed up with fashionable decor. The wait staff moved briskly about their business in white shirts and ties. A casual but refined energy permeated the room. I was ready to enjoy and I did. The menu opened to a full page of raw oyster options. When questioned, our server quickly explained that patrons in Charleston scrutinize a menu of oysters pretty much like a fine wine list. Knowing so little, I immediately asked for help.

Not every oyster selection was in season or available, helping narrow the options. I still had no idea what I was doing, so I opted for a half dozen order with three different local varieties. My favorite? The Otter Island, but I enjoyed the Carolina Cups and Capers Blades as well. A chilled glass of prosecco perfectly complimented my adventure.

Frank ordered a She Crab Soup that was tasty and rich enough that one spoonful was enough. I know why he likes my chowders better–you can eat a decent bowl without feeling completely overwhelmed. Our guts are just not used to cream based soups.

Next up another unknown, but local favorite: fried green tomatoes served with pickled okra and peppers. Everything in my body savored each bite. This is one dish I will try to emulate at home. The savory fried tomatoes complimented the crisp and tangy okra to perfection. Every bite sublime, I barely offered a taste to Frank or Noah. I took so long eating that we had to run out at the last minute to feed the meter–so much for a brief little repast.

Afterwards we took a few minutes to walk alongside Bay Park just as the sun tried to peek through the clouds. It was the first opportunity to walk the graceful paths and view the architecture without the blur of a rainstorm. More charm. We will return

ALL YOU CAN EAT ISN’T ALWAYS ENOUGH

Three hours later we arrived back in Columbia and picked up our cousins for dinner. Off to Little Pigs BBQ–an all you can buffet. I had been warned, and found the classic fixings to be just as advertised. The buffet seemed more like a trough with an incredible variety of barbecue with all the fixings. The locals reminded me that in South Carolina macaroni and cheese is a vegetable, but I still found it easy to fill half my plate with plant food. I enjoyed a tasty meal of collards, stewed tomatoes and okra and sweet potatoes along with all three varieties of pulled pork, two different ribs. a fried chicken gizzard and a couple of morsels of fried catfish. A balance of food filled the plate, but that comes from practice. It’s what I eat–mostly protein and produce.

I could have easily filled up with mac and cheese, grits, mashed potato, potato salad, macaroni salad, rice, pasta, and other heavy and starchy sides. I could have topped all of that with mounds of chocolate or banana pudding, along with all the soda I could swallow. In sum, it is possible to consume an enormous amount highly refined starch and sugar coupled with plenty of fat for $9.95 at Little Pig’s BBQ.

Thankfully, I can navigate abundance without feeling over full or uncomfortable. But not everyone has the skill or the capacity to self regulate in an environment of abundance. The seduction of all you can is too much for too many. I am not a small woman, but I felt positively petite at this establishment. Ironically, the meal didn’t come close to satisfying me the way a much more modest portion of incredibly delicious food did earlier in the day. Barbeque at Little Pigs quieted my belly, but didn’t begin to satisfy my soul.

Ultimately, two things are abundantly clear and reinforced every time I travel. First, I see evidence of two food worlds in every corner of this country. Secondly, delicious food usually costs more money– a lot more considering how many calories you are served. My exquisite, but relatively light lunch totaled just over $35.00. Little Pig’s all-you-can-eat buffet was priced at $9.95.

Filed Under: Blog Tagged With: abundance, all you can eat, Amen Street Fish and Raw Bar, carbohydrates, Charleston, cheap food, enough, local food, protein and produce, rethink food, satiety, self regulation, self regulation Little Pigs Barbeque, starch, too much to eat

IS WORK-LIFE BALANCE AN OXYMORON?

March 20, 2013 by Bonnie

Years ago I learned of a company CEO who stopped all overtime except if it was approved by his office. Within in three months absenteeism, sick leave and tardiness declined by 30% across the board. Just this last year I was asked to speak about nutrition and health to employees of a media company, but advised that I shouldn’t address the 14-16 hours days they usually worked. Most employees know when they are being toyed with, and I declined the invitation. Today stress and the cost to business is getting prime time exposure.

Ariana Huffington reports that corporate CEO’s are finally connecting the dots between stress and the bottom line. I found myself both cheering and jeering at the same time. It seems that mindfulness and yoga are the hot buzz words in corporate culture with studies showing reduced absenteeism, sick leave and other indirect costs, costs that are 200-300% higher than actual health care bills. It’s time the business minds paid attention–but I don’t trust that their attention is what it needs to be.

It is too easy to encourage workers to take a few yoga classes or meditate for a few minutes on company time–and then have them return to unreasonable work loads and a corporate culture that encourages excessively long work days, working after hours and plugging in on vacation. Where is the time for preparing healthful meals, engaging in regular physical exercise and other core ingredients of good health when everyone is working 10-12 hours days on top of a 1-2 hour commute?

And then there is that issue with outsourcing and job insecurity all the while corporate practices hold cash in foreign subsidiaries to avoid paying taxes for the very services their communities need. Most Americans experience considerable stress as their quality of life continues to deteriorate–just as the executive office continues to reap the rewards of reigning in costs and driving profits. The disconnect is obscene and more so all the time. Yoga and mindfulness can’t fix that. So, if corporations are serious about reducing both the direct and indirect costs of health care, I have a few questions to ask each CEO, their board of advisers, and anyone looking for greater and greater returns on their investments:

1. Are efforts to address stress in the workplace serious or just paying lip service?

2. Can yoga and mindfulness really trump low wages, obscene workloads, job insecurity, and the incessant drive for profits over people ?

3. When will CEO’s and their boards stop sucking more and more of the profits into their own pockets and support their workers in materially meaningful ways?

4. Is “Work/life balance” a misnomer?

While you ponder these questions, you may want to read this article and watch this video and consider what it means for every one of your employees, everyone who lives in your community, and the overall health of this nation when corporate policies continue to drive inequality. We have only one life. It doesn’t matter how much CEO’s talk about mindfulness or a work/life balance. Employees won’t have a balanced life when work–and the effort to hang on to one’s standard of living–saps most of their space, time and energy.

Filed Under: Blog Tagged With: absenteeism, corporate policies, cost of healthcare, energy, exercise, fitness, health, inequality, mindfulness, nutrition, overtime, stress, tardiness, time, work life balance, yoga

Can You Lose Weight with Green Coffee Beans?

March 5, 2013 by Bonnie

I got another call today asking about Green Coffee Bean extract (GCE) and weight loss. Time to look at the evidence.

Coffee is one of those substances that is often in the news. Sometimes the news is good, sometimes it’s bad and it all depends om what the researchers are looking for. Pharmaceutically speaking, coffee is a complex substance. Today Green Coffee Bean extract is getting lots of attention due to a chemical called cholorgenic acid. Cholorgenic acid is linked with improvement in blood sugar (glucose) and serum lipids, like cholesterol and triglycerides. The acids are thought to work by decreasing glucose absorption from the intestine. If true these are changes that could improve metabolic health overall and specifically help individuals lose desired fat weight.

ASSESSING THE STUDIES
One study out of Finland published in 2007 shows just that. Of the 30 volunteers, the 15 who consumed a coffee beverage spiked with extra cholorgenic acid showed markedly more fat loss over the 12 week study. The test subjects lost an average of 8 pounds of weight (80% fat weight) when using the spiked beverage versus the 1.5 pounds of weight loss observed in the control group drinking regular instant coffee. The daily dose of cholorgenic acid (Coffee Slender in this study) was not stated, but the standard dose of Coffee Slender was noted as 11 g. News like this get everyone’s attention, but one study is just one study. As I read the results my first question was what happened to the volunteer’s diets during the study? There is no documentation, but the subjects were told “don’t change anything”.

In 2011 a larger review study of green coffee bean extract was published. This study was what is called a “meta-analysis”, which is an attempt by researchers to get some statistical weight by combining the results of several smaller studies together. After reviewing their findings, the authors concluded, “The results from these trials are promising, but the studies are all of poor methodological quality. That means the researchers didn’t think much of the study designs. Their position is that more rigorous trials are needed to assess the usefulness of GCE as a weight loss tool.”

Changes in body weight during three phases of green coffee bean extract supplementation

More recently, another study was published, this one a randomized, double-blind, placebo-controlled, linear dose, crossover study to evaluate the efficacy and safety of a green coffee bean extract in 16 overweight subjects. This is the language scientists use to tell you that neither the subjects nor the researchers knew who was getting the extra cholorgenic acid in their beverage. The study was also designed to rule out the placebo effect, and each test group was assessed using each modality: a high dose of cholorgenic acid (1050 mg) , a low dose (700 mg), and the placebo. Dietary intake was assessed, and seems to remain rather consistent through each phase of the study—or at least the pooled data from each phase looked the same. You can’t really tell from the graph.

INTERPRETING THE RESULTS

The results are curious and somewhat confusing. If you look at the graph to the right, significant weight loss happened during the placebo phase [PL] for the open triangle group, fairly similar to the high dose supplement group [HD] (but less dramatically in the low dose supplement group[LD]). Later in the study, supplementation seems to be associated with more weight loss, and the placebo phases don’t show as much loss and even some regain. It looks like the “placebo effect” was much stronger in the first few weeks of the study.

In the three groups studied, the results between placebo, low dose and high dose are rather variable. It is important to note that only 5-6 subjects were in each group. This is a very small study so there is lots of room for statistical error. The supplement may be somewhat effective at helping people lose fat weight, but the nature of the results makes it difficult to tell just how much. Maybe the idea of taking a supplement gets some of the credit.

Filed Under: Blog Tagged With: blood sugar, body composition, cholorgenic acid, coffee, Coffee Slender, diet, fat, GCA, GCE, glucose, glucose tolerance, glucose uptake, green coffee bean extract, lipids, placebo, weight loss

Attitude Counts: What Does Exercise Mean To You?

February 24, 2013 by Bonnie

Some people live to exercise, others embrace their couch. Many know they should exercise, but they struggle with ambivalence. I remember bribing myself to run in college. I really didn’t like it, but I thought it was the best exercise to manage my weight. Today I wake up wondering what I will do to be active almost every day. Recent research reported in the Wall Street Journal begins to explain why people have such different experiences moving their bodies.

BEYOND MOTIVATION AND DISCIPLINE: WHY ISN’T EVERYONE ACTIVE?

Too many people looking to improve their fitness get hurt or demoralized when they push themselves (or someone else pushes them) too hard. What you can do may not meet expectations of what you think you should be doing. In the Wall Street Journal article I was especially taken by the examples mentioned by Iowa State University researchers. There isn’t one right way to exercise, just as there is no single right way to eat. Interestingly I have personal experience with each of the scientist’s observations:

WORK WITH YOUR BODY: Stories in the popular press seduce readers. People don’t realize how often the stories aren’t true, and the pictures are photo shopped. Years ago I remember our local paper featuring one young actress with her secret diet plan detailed in a sidebar. My jaw dropped. I had been seeing that same actress for months as she struggled with a raging eating disorder. Her food intake didn’t look anything like what she (or the journalist) claimed she was eating. When I asked her about the piece she started crying, knowing that she had lied to protect her privacy. What works for someone else may grab your attention, but what really counts is what works for you.
CONSIDER WILLINGNESS, READINESS AND ABILITY: Changing any behavior requires all three factors working in concert– and sometimes it is complex. I once worked with a client who wanted to lose weight and take care of his health, but he said exercise gave him the same feeling as a panic attack. He worked with a therapist to tease apart the physical experience of panic and the physical sensation of exertion, hoping to gain some insight–and cultivate a skill set to manage his experience. He stopped working with the trainer because he felt he could never meet her expectations.
EXERCISE WITH MUSIC TO INCREASE EFFORT: My son is a strong and able cyclist, but that wasn’t always the case. Those early years he struggled to ride with any measure of intensity, as if he was stuck in slow motion. My husband and I are avid cyclists, and we often worried that Noah would never get up to speed. Then he started to listen to music. He’s a drummer and responded readily to the rhythms. We gave him access to i tunes and the rest is history. Today he leaves me in the dust.
MOVE WITH JOY: I bribed myself to exercise right through my 20′s. I was 31 and teaching four classes, seeing private clients and planning a wedding in six weeks. And I was running–until one day I just stopped. I was exhausted and tired of pushing myself every minute of the day. I remember stopping on the boardwalk in Venice Beach and walking the rest of the way home. Instead of glancing at my watch every few seconds wondering when it would be over, I noticed how invigorated I felt as I gazed at the ocean and the blue sky. I haven’t run for exercise since. But I bike everywhere, enjoy yoga twice a week with friends, swim when I can, hike the local mountains and walk the beach, along with other more recreational “play”.

NO PAIN, NO GAIN IS NOT TRUE

Too many experts identify the best exercise as one that gets heart rate up or burns the most calories or creates great definition. Many trainers still drive clients to “go as long as you can, as hard as you can.” I believe this thinking is exactly why so many people don’t enjoy physical activity. I remind my clients that ever increasing goals work for some, but not for others. You don’t have to keep getting more and more fit to be fit. At some point all that intensity can blur the line between fitness and compulsion.

Too often we celebrate the biggest, the strongest, the fastest and the leanest. We also assume that the most accomplished athlete or the person with the “best body” is ideally suited to helping others get with the program. Maybe we need to stop making such superficial assumptions in fitness, diet, and weight loss arenas. It is easy to tell someone to do what works for yourself. It takes real skill and education to help someone figure out an approach to diet or physical activity that works for them and can be incorporated into their life.

Physical activity allows the body to use both glucose and fat better for fuel. With better metabolic health comes less risk of disease no matter your body size. Exercise allows us to release tension in our muscles and truly restore ourselves. People often sleep better and enjoy better digestive health when they integrate physical activity into their day. It is critical that everyone figures out how to integrate physical activity in their life, not just people who can’t live without it.

Filed Under: Blog Tagged With: coach potato, competition, discipline, exercise, expectations, fitness, metabolism, motivation, music, pain, slow metabolism, weight

An Open Letter to Mark Hyman, MD

February 21, 2013 by Bonnie

I received an invitation today from Mark Hyman, MD, author of The Blood Sugar Solution to help him “change the future of food” . On February 26 he is publishing The Blood Sugar Solution Cookbook, version 2013. (There is a 2006 version of The Blood Sugar Solution Cookbook I found on Amazon, and I don’t quite know the difference) He shares that:

“The consumption of industrial fast and processed foods is driving our
epidemic of obesity, diabetes, and chronic disease that now affects EVERY other American.
We need a food and cooking revolution to change this!”

His answer is simple enough: we all need to cook more. I think that is mostly true, but there is much more to this story and I told him so in a return email. Here is my response:

Prepping for Albondigas Soup

Dear Dr. Hyman,

I admire your efforts, but there is something disingenuous in asking people to cook more when so much is already asked of their time and historically we have never valued the time and energy to purchase, prepare and eat food as daily sustenance. Cooking and shopping have been mostly considered women’s work, something that is supposed to just happen despite the radical changes in how women live their lives since the 1900′s when only 2% of food was eaten outside of the home (Dr. Hyman’s quote, not mine).

The shift from cooking to “assembling” is a result of the pressures and expectations of our society, not just a cause of poor health. I prepare most of my family meals from scratch and shop primarily at farmer’s markets. It is an enormous task, taking hours every day. My family prepares food to take to school and the office from whole foods purchased and prepared at home. I feel lucky to have the time and flexibility to make this happen. I’m not sure the infrastructure is in place for everyone to access the time and energy it takes to eat this close to the earth.

WHAT SUPPORT IS NEEDED FOR PEOPLE START COOKING MORE?

People need support to cook more. That means employers need to honor a reasonable work day. People need to limit themselves to reasonable commutes. Schools need to limit students to reasonable homework and families need to push back on the ridiculous expectations of extracurricular activities that mean no one is home for dinner– and rarely home to enjoy family meals on the weekend. There needs to be a way for people to have the time and energy to engage with their families while still being valued in the workplace. No one should have to fear losing a job because they attempt to live a balanced life. Too many people need to learn how to cook because their parents were too busy or unable to teach them.

While I am all for cooking more, I’m not sure what your answer is for all those folks who don’t like to cook in the first place. It is likely that restaurants–even fast food establishments– serve more whole food, wonderfully prepared, than what people throw together for their “meal” at home when they are not ready, willing or able to cook for themselves. But that is another letter….

SURVEY YOUR COLLEAGUES

Check out the status of your colleagues. People working in the medical field are known for long hours with the same challenges eating well as people working in other demanding careers. But health care providers are supposed to know better. How many shop for their own food and prepare their breakfasts, lunches and dinners from scratch working typical 40+ hour work weeks?

On the other end of the spectrum, how many people work two jobs just to pay rent and get food on the table? Too many people in this country live below the poverty level despite working long hours. And what about all the working middle class and single parents who don’t enjoy the privilege of help at home and juggle everything on their own? The challenge of cooking more is a much bigger issue than just cooking more.

You have a strong platform. Start the conversation, raise awareness. Cooking is an honorable goal, but it is the back end of the conversation. I am hoping for a bit of honesty and candid conversation about what we are really asking people to do—and then ask all stakeholders to step up and support the effort. Let’s encourage everyone to cook more. More importantly, let’s push for a cultural environment that values food–and everything it takes to purchase, prepare and eat food– in its rightful place.

Warm Regards,

Bonnie Y. Modugno, MS, RD

www.muchmorethanfood.com

Filed Under: Blog Tagged With: commutes, cooking, diabetes, disease, farmer's markets, fast food, food, groceries, health, industrial food, jobs, life balance, Mark Hyman, obesity, poverty, processed food, smfms, stress, work

THE COST OF FOOD

February 9, 2013 by Bonnie

Hotel catering departments and meeting planners are challenged to manage costs and deliver food under trying circumstances, but the impact of a highly subsidized food supply trumps their efforts when it comes to nutrition. You can tell what food is cheap by what is served…even at conferences for health professionals.

I am working at another conference this week, this one with the California State Nurse’s Organization (CSNO). When you walk into the exhibit hall the Continental Breakfast is laid out before you: muffins, danishes, and bagels. I caught the eye of one of the event managers who knows me and the words tumbled out of her mouth, “You would think they want to put everyone to sleep”

She escorted me to the back of the table, where she proudly pointed to her handiwork: the hard boiled eggs and light yogurt. I know she had to fight to get the protein on the table. What a statement.

The food options at conferences has only improved slightly over the thirty years I have been attending professional conferences and the number one reason is cost. I helped arrange the breakfast options at a conference in Las Vegas last fall. The continental breakfast was priced at $29.00 per person for the privilege of a hot beverage service and the usual carb fest. The hot breakfast with typical scrambled eggs, potatoes and choice of carbs was priced at #39.00 per person. For $49.00 per person you get something I might cook at home: a “farm to table” version with vegetable fritatas, an assortment of breakfast meats, fresh fruit, and hot steel cut oats instead of highly processed and refined carbohydrates parading as breakfast.

Today’s boxed lunches posed a whole different realm of the Omnivore’s Dilemma. I’m sure the costs of the protein trumped the costs of vegetables, but the labor for prepping the vegetables trump the labor of preparing a sandwich and brownie. The attendees were asked their preference. I would have been bummed no matter what. I eat mostly protein and produce and I would want to know, “Why do only the vegetarians get that delicious salad?”

Omnivore’s box lunch

Vegetarian lunch option

Filed Under: Blog Tagged With: box lunch, catering, conferences, continental breakfast, cost of food, CSNO, farm to table, health professionals, hotel, meal planning, meeting planners, omnivore, protein, rethink food, school nurse, Vegetarian