Out with the old: Saying goodbye to 90’s nutrition advice

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In the spirit of New Year’s resolutions and goals, I thought I’d share this really great article I found recently on nutrition “myths.”  

Fitness Magazine interviewed registered dietitians on how their perspectives on healthy eating have changed over time.  These RD’s talk about some of the conventional wisdom regarding nutrition coming out of recent decades, how it influenced them, and how a lot of it turned out to be wrong.

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As a teenager struggling with body image issues in the late 90’s and early 2000’s, I encountered much of these same nutrition trends myself from magazines and books, as well as from the nutritionist I saw for help with my eating disorder.

I remember– I was terrified of fat.  When I went out to eat, I insisted that I found mayonnaise and salad dressing “gross,” because I had read that cutting those things out was the best way to cut calories.

Each day, I only ate a certain number of calories at set times, and carefully adjusting the amount depending on the number of calories I had burned through exercise.  My treat at the end of the day would be some kind of “low-fat” dessert or “snack pack” of cookies.  Most of the food I ate was low fat– Healthy Choice ham for my sandwich at lunch, with low fat cheese.  Lean Cuisines for dinner.

It is so strange, now, to realize that so many of the “rules” I based my life around were, in fact, actually all wrong.

One of the quotes I related to the most in the article came from Lauren Harris-Pincus, M.S., R.D.N., owner of Nutrition Starring You.  She says:

“When I became a dietitian in the mid 1990s, we were in the middle of the fat-free craze. Bagels, fat-free frozen yogurt, and Snackwell cookies were all the rage. Our hospital diet materials recommended limiting nuts because of their fat content and limiting shellfish because of their cholesterol. Now, we know much more about the health benefits of fats derived from nuts and seeds, and we’ve also learned that high-sugar, fat-free foods are not nutritious choices. Unfortunately, people have long memories and to this day, so many of my patients are afraid to eat shrimp if they have elevated cholesterol. It’s exciting to work in a field with ever-evolving research.”

Yes– it absolutely was a fat-free craze.  Fat-free dressing, fat-free cheese.  Sometimes I’d even come across bread that was labeled fat free.  I always thought I was doing something great for myself when I reached for that label, not understanding that my body actually needed fat in order to function.  

I also really related to this quote from Emily Cope, M.S., R.D.N., Owner & Consulting Dietitian at Emily Kyle Nutrition:

“When I was in college, I remember being obsessed with those ‘100-calorie packs’ of cookies and crackers. I thought they were a great option—less than 100 calories for all of those tiny wafers!! Little did I know those calories were being replaced with chemicals and unnatural ingredients. These days, now that I am older and wiser, I am less concerned with calories and more concerned with the quality of my food—whole fruit and nuts are my current go-to snacks!”

Yes.  Unfortunately, that was so me as well.  I felt comfortable with pre-packaged, processed foods because they were marketed for weight-loss, and it was easy to know how many calories were in them.

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These days, I have come so far in terms of my outlook to food that sometimes I almost forget that I ever had a problem.  (After all, I’ve had to deal with so much else with my body over the intervening years!).

I will talk more about how I overcame my eating and body image issues in future posts.  But for now, let me say that these days I think I live and eat pretty holistically.  I don’t get caught up on the idea of depriving myself of something if I really want it; I don’t count calories.  

And the funny thing is, now that I allow myself to eat whatever I want, I find that most of the time, I generally tend to crave pretty healthy choices.  Now that I’m actually well-nourished, I find myself more in touch with how my body responds to different foods, and I tend to gravitate towards the foods that make me feel best.

I’m sharing this with you for a few reasons:  

A) There’s some really good advice contained in this article, and

B) It serves as a reminder to me– and maybe to you– that things can get better.  Even if you have a problem that goes on for years; if you feel trapped and you truly seem stuck, things can change when you don’t expect it.

I truly hope this post was helpful to you.  Happy New Year!

Inflammation, Fibromyalgia, and Deceptive Marketing Tactics

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Ok, so I wish I could stop going on angry rants on this blog.  But, ironically, some of my rants have turned out to be among my most popular posts… so I’m going to keep going with this one.

One of the things that bothers me most about the majority of the online content regarding fibromyalgia is the idea that fibromyalgia sufferers must fight inflammation.

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Before I go any further, let’s talk about inflammation for a little while.  In general, I think it makes sense to break inflammation down into two categories: localized inflammation and systemic inflammation.  Localized inflammation occurs in one specific part of your body: you have a wound that’s healing, or you have tendinitis in your elbow.

Systemic inflammation, on the other hand, is a whole-body thing, and usually takes place as some sort of disease process.  For example, lupus is “an autoimmune disease characterized by acute and chronic inflammation of various tissues of the body.

Decades ago, when researchers first began to look at fibromyalgia, they suspected that some sort of systemic inflammation might be involved.  They questioned whether fibromyalgia might be an auto-immune condition, such as lupus or rheumatoid arthritis.  They were looking for some sort of obvious physical changes in the body; looking for inflammation in the joints, and focusing on on the idea of “tender points.”

Yet none of this research really revealed any of the physical signs they were looking for.  Basically, doctors couldn’t find anything “wrong” with fibromyalgia sufferers.  For a while, doctors measured the number of “tender points” on a patient’s body, but as this 2010 American College of Rheumatology briefing asserts, the tender point test has been shown to not be a reliable means of diagnosing fibromyalgia.

As researchers began to rule out the idea of fibromyalgia being some sort of autoimmune or inflammatory condition, they began to pick up on the idea of central sensitization.   Proposed by scientist Clifford Woolf in 1983, the idea of central sensitization is that people’s nerves can be altered by an extremely painful physical experience.  The way these nerves function can change in response to this experience and leave the person with a heightened sensitivity to pain.  This heightened sensitivity persists, even after the initial injury has healed.

Now most scientists believe central sensitization to be the cause of fibromyalgia.  While there are a lot of things we don’t yet know about it, what we do know is that it is not caused by an abnormal inflammatory response, like rheumatoid arthritis or lupus.  This is why fibromyalgia sufferers have historically been dismissed by doctors—by all objective diagnostic tests, we appear normal.

The fact that so many fibromyalgia sufferers have been dismissed by doctors is what makes us so susceptible to frauds, fads, and bad information.

I can’t even count the number of times I’ve been reading an article on the Huffington Post or ABC news and seen a “Suggested Article” at the bottom screen that reads something along the lines of “Problem with inflammation? You might have Fibromyalgia.”

I’m here to tell you that no, you don’t.  Chronic systemic inflammation is not a symptom of fibromyalgia.

There are simple blood tests which doctors use to determine whether or not a patient has a problem with systemic inflammation.   C-reactive protein and erythrocyte sedimentation rate are two of the most basic measures of inflammation.

If you are concerned about your health, go to your doctor and ask for these blood tests.  If this is a problem that’s been going on for a long time, chances are he or she has probably already ordered them.  You can always ask for them again– I don’t remember ever having to pay some sort of huge copay for them, as they’re pretty basic– but if they come back normal, you do not have a problem with inflammation.

For the first few years after I developed chronic pain, I spent a lot of time wondering if I had a problem with inflammation, thanks mainly to the erroneous information I found in the Internet.  None of the doctors I saw ever seemed to take me seriously.  After I took an anatomy class and learned about the tests that can measure inflammation, I realized why.  I had had these blood tests performed several times a year, and the results were always normal.

This is why I get so angry about these articles and websites that just seem to prey on people’s fears.  I spent years worrying if I was on the road to developing lupus or arthritis or any number of autoimmune conditions, thanks in large part to the misinformation these people spread.

Let’s not be victims of unethical marketing tactics.  If you have a problem with chronic, persistent pain, ask your doctor for the blood tests I mentioned.  If they come back normal, you are going to be okay.  If they come back abnormal, it is time to see a specialist.  The thing to remember is that there are treatments for autoimmune and inflammatory conditions.  If your inflammatory response is so messed up that you need treatment, it will show up on a blood test.  Otherwise, thank your lucky stars and start reading up about how to work with a sensitized nervous system.

**The picture above is actually of a blood sample taken from a dog. How cool is that?  Thank you to Nottingham Vet School for putting it on Flickr.

Beware the Red Herring

One of the reasons I sometimes take a critical tone towards alternative medicine on my blog is not always that I think these approaches have no merit.  But I do think that, too often, people are drawn to and waste their time treatments that are simply “fads.”

When I look back on everything that led up to my losing an ovary, I can’t help but feel my digestive problems are to blame.  I wasn’t sure I wanted to talk about my digestive issues on this blog, but what the heck.  I have issues with IBS and chronic constipation, made worse by the fact that I have a pelvic floor disorder.

I am so used to feeling discomfort in my abdomen that I didn’t rush to the hospital the moment things began to hurt.  In retrospect, that was critical time in which my ovary was being deprived of blood supply, and although the doctors and nurses I talked to didn’t want to come right out and say it, there is a chance I could have kept my ovary had I gone to the hospital sooner.

When I look back, I can see that some of the symptoms I associated with my twisted ovary were actually building for months.  I had this weird feeling in my right side, a feeling that something was where it shouldn’t be, for almost a year.

It’s so infuriating to realize this, because I talked to two gastroenterologists about the feeling that something new was wrong on my right side, that somehow things were getting worse.  I told my most recent doctor– who actually published a book on digestive issues in women– that I felt as though the right side of my abdomen always seemed to be a bit swollen (for lack of a better word). That my right side was always aching a little bit, that it was simply bigger than my left side.

This doctor basically told me not to try too hard to diagnose myself; that I shouldn’t go by how things felt from the outside.  I tried to explain that I wasn’t, but our appointment time was over and she had mentally checked out.

I am so frustrated now, because I wish she could have pointed just out that ovarian cysts can have many of the same symptoms of IBS.  Perhaps she could have said something like “Gee, I have no idea why that area is bothering you, perhaps you should try seeing someone in a different specialty.”

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I also wish I’d tried harder to get an answer.  It’s funny because, a few days before the pain really started up in earnest, I knew things were getting worse.  I didn’t have the horrible pain in my right side yet, but the feeling that something was there, that something was stuck, was really getting on my nerves more than usual.  I remember saying to my mom “I have to deal with this problem.  I can’t keep taking no for an answer.  I have to find a new gastroenterologist.”

Almost a year had gone by since I had seen a new doctor.  The last time I saw my doctor, which was almost a year ago now, she had offered to put me on Amitiza, a medication for chronic constipation.  I was reluctant to start a medication without exhausting every other possible option, so we decided that I would try going gluten-free first to see if it helped.

My doctor had said that sometimes it can take a long time for the gluten free diet to help.  She also said that it won’t necessarily work to just reduce gluten; you might have to eliminate it completely to really see an improvement.  So I spent the past year waiting to see if this would help.  At some point over the course of that year, my right ovary began to twist, and I did not aggressively pursue answers for the new pain I was feeling.

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Now, I am sure that a gluten-free diet has helped many people.  But at the same time, gluten-free diets for non-celiac sufferers is not something that has actually been proven to have any scientific merit (as far as I’m aware).

I think it was a mistake for me to have endured so much discomfort, for so long, waiting for something with so little evidence to help me.

When I look back over the years, I can actually see how sometimes, being stoic and just enduring the pain and discomfort has not served me well.  I’m sure certain family members of mine will get a good laugh out of this statement, but I wish I had complained more, not less.

Being stoic is not always good.  And neither is being too open to new ideas.  I had a very real, very diagnosable problem in my abdomen.  But I was content with no answers, for too long, because I was waiting to see if something that is basically a fad was going to help me.

Of course, I don’t mean this in any way to be a criticism of those who are on gluten-free diets.  If it helps you, that’s great.  I might even try it again in the future if my digestive symptoms don’t improve.

But it’s about proportionality.  When I look back, it just doesn’t seem logical; the idea that I could fix extreme discomfort by no longer eating something I had eaten comfortably for most of my life.  I can see why my doctor would have recommended a gluten-free diet for a more subtle condition.  A subtle treatment for a subtle condition.

But there was no proportionality between the persistent, nagging feeling that something was stuck in my abdomen, which bothered me day in and day out, that kept me awake when I tried to fall asleep at night… and gluten.  If gluten-free diets could clear up this kind of discomfort, I’m pretty sure they would be in medical textbooks by now.

So, these were my mistakes.  The first: a lack of proportionality.

The second: being too stoic.  I waited far too long for something with very little scientific credibility to help me, instead of insisting that a doctor understand exactly how miserable I am.

Let’s not be strong all the time, people.  Sometimes, it’s really important to just let yourself complain.

Arsenic levels in rice… too high for comfort.

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This was all over the news a few months ago, but in case you missed it, Consumer Reports published a report in November 2012 showing surprisingly high levels of arsenic in dozens of brands of rice and rice products.  This is not good news for people who eat a gluten-free diet, or for people who just plain eat a lot of rice.

Arsenic is a chemical element that exists naturally in the earth’s crust.  It is toxic to humans, affecting the nerves, heart, and blood vessels, and is a known carcinogen.  Arsenic is nothing new– it has been around for the duration of our evolutionary history.  But all of the human activities of the past few centuries– farming, mining, construction– have disturbed the ground and allowed higher levels of arsenic to seep into our soil and water.  Arsenic is also found in many pesticides, which is why it ends up in even higher concentrations on rice farms.

The Food and Drug Administration currently does not have any restrictions on arsenic levels in food, however there is a limit for the maximum allowable amount of arsenic in drinking water.  This is currently set at 10 parts per billion (ppb), although the Environmental Protection Agency originally requested it be set at 5 ppb.  Consumer Reports says,

“Using the 5-ppb standard in our study, we found that a single serving of some rices could give an average adult almost one and a half times the inorganic arsenic he or she would get from a whole day’s consumption of water, about 1 liter.”

This is scary, especially when you consider that people on a gluten-free diet and those who eat traditional cultural diets which rely heavily upon rice are going to have way more than one serving of rice a day.

Now, all of the articles I’ve read on this subject have been quick to point out that there haven’t yet been any studies published proving that higher levels of rice consumption leads to health drawbacks.  But it’s pretty obvious that’s because no one knew about the high levels of arsenic until now.  It’s not as if there have been any studies proving that high levels of rice consumption doesn’t have any health consequences.  I would bet money that there are researchers submitting grant proposals right now for funding to examine this very issue.

Until those studies start to be published, I think it’s best that people don’t make rice a cornerstone of their diet.  Here are some of the best pieces of advice that I’ve gathered from various articles on how to deal with this issue.

  • Limit Rice Consumpion.  Consumer Reports suggests that adults eat no more than 1.5 cups of cooked rice per week, and kids no more than 1 cup.  Honestly, if I had kids of my own, they wouldn’t be getting any rice until at least the age of 10.  Even small amounts of a toxin are a big deal when they’re in a smaller body.
  • Eat a variety of foods.  FDA Commissioner Margaret Hamburg said in a statement, “Our advice right now is that consumers should continue to eat a balanced diet that includes a wide variety of grains – not only for good nutrition, but also to minimize any potential consequences from consuming any one particular food.”  While I think Ms. Hamburg may have been downplaying the potential risks of rice, she is right that the best approach is to eat a variety of foods, and that includes where those foods are grown.  We never really know what gets into our food, even when it is grown on an organic farm (acid rain, anyone?) so it can’t hurt to switch up which company you buy your food from.  In case there are contamination issues at a particular farm, shipping truck, or warehouse, you’re just kind of lowering your odds of being exposed to more chemicals over time by switching up what you eat.  Not only should we be eating a variety of different foods, but we should be buying a variety of brands and switching it up.  In other words, you shouldn’t just buy one brand of pasta that you’ve decided you like and eat it for your entire life.  Better to rotate brands.
  • Choose white rice over brown.   Unfortunately, Consumer Reports found that brown rice contained higher levels of arsenic than white rice.  This was true for every brand they tested.  This is because much of the arsenic collects in the outer shell of the rice grain.  This outer shell contains the extra nutrients and fiber that generally make brown rice a healthier choice than white rice.  When you remove the shell from brown rice to make white rice, you are removing a lot of the arsenic.  (Unfortunately, you are also removing a lot of the nutrients and fiber that generally make brown rice a healthier choice than white rice).
  • Avoid rice grown in the US South.  According to Consumer Reports, rice grown in different areas is likely to have different levels of arsenic.  In general, rice grown in the US South tends to have higher levels of the toxin because the rice is grown in a lot of areas that were once cotton farms.  Those areas were heavily sprayed with arsenic-containing pesticides to combat the boll-weevil.
  • Choose aromatic rice.  According to the Chicago Tribune, “Imported basmati and jasmine rices showed about half to one-eighth the level of arsenic as regular rices grown in the Southern U.S.”
  • Aromatic rice grown in Bangladesh has been shown to have markedly low levels of arsenic.  Of course, it’s not so simple as walking into a supermarket and finding “low arsenic Bangladeshi rice” on the shelf, but maybe it will be in the future.
  • Wash rice thoroughly.  Several of the articles I found mentioned this.  Apparently, the FDA has found that washing rice thoroughly can reduce arsenic levels by 50-60%.  The Chigago Tribune quotes Michael Hansen, senior staff scientist at Consumer Reports, who explains that he cooks and drains rice similar to pasta. “‘We say to use about 6 parts water to 1 part rice… And then drain off the water after it’s done.'”
  • Remember the other gluten-free grains.  There are lots of other yummy grains out there… at least, they’re yummy when you cook them right.  Some good choices are potatoes, corn, oats (the ones that are specifically labelled gluten-free) and buckwheat.  Yes, buckwheat is gluten-free.  Next time you’re in a Thai restaurant, order buckwheat pad thai (aka pad thai soba)… it’s so amazing.

Anyway, that’s it for now.  Hope this article was helpful!

Rice photo courtesy of sweetbeatandgreenbean on Flickr.

I’m going to start eating more “bad” fat

I read this article last night on my phone while pretending to listen to some loveable relatives butcher some Christmas music, and it made me sad.

http://phys.org/news/2012-12-fat-decisions-brain-cells-production.html

Like pretty much every other girl who was unhappy in school in the late 1990’s/early 2000’s, I used to starve myself.  I mean, I ate, but if I ever get brave enough to post pictures of myself from that time period, you’ll see what I mean.  It was not good.

The one thing I absolutely avoided was fat because, of course, everything around me said that it was bad.  I had low-fat cheese on my sandwich (gross) at lunch.  I even had fat-free, cholesterol-free salad dressing in our refrigerator at home.  I had problems.

I get sad when I see people still trapped in that mindset, especially when they’re also engaging in extreme exercise. These are the people who pay more attention to their health than anyone else, but are in fact the ones doing the most damage.  It’s only a matter of time before their bodies break down (I know, because mine did).

We need fat, and we need cholesterol.  The article I linked to includes a quote from Ernest Arenas, a professor of stem cell neurobiology, on the role cholesterol plays in the body:

“‘We are familiar with the idea of cholesterol as a fuel for cells, and we know that it is harmful for humans to consume too much cholesterol.  What we have shown now is that cholesterol has several functions, and that it is involved in extremely important decisions for neurons. Derivatives of cholesterol control the production of new neurons in the developing brain. When such a decision has been taken, cholesterol aids in the construction of these new cells, and in their survival. Thus cholesterol is extremely important for the body, and in particular for the development and function of the brain.'”

You literally need cholesterol to form new brain cells.  Though we are conditioned to think of this substance as bad, it actually plays a vital role in the body.

There is also new research coming out that says there might not be as much of a risk from saturated fat consumption as previously thought.  Like cholesterol, you need saturated fat to perform certain functions in your body.

While the jury is still out on this, I personally am going to stop being so strict about avoiding saturated fat.  Our ancestors didn’t know anything about the different types of fat– to them, fat was fuel.  The fact that fat and cholesterol play so many vital roles in the body says to me that these nutrients played a significant role in our evolutionary history, and my body is tired of missing out.

This is not to say that I’m going to drop everything and head to McDonald’s (there’s plenty of other bad stuff in fast food!).  I’m not going to start eating bacon every single day.  But maybe I’ll actually let myself eat it when someone else offers it to me.  I think that if I can do this, it will be letting go of the last piece of me that’s still afraid of the things I eat.

I will be writing more on the saturated fat controversy.  Like anything, it’s important to be well-informed and do research from a variety of reliable sources, and it’s important to me that I don’t write a health-oriented blog based on opinion.  But this is how I’m feeling this morning.  If you enjoyed this post, eat a big hunk of cheese for me today.