The EALM Blog Shelf

While Laura Cipullo and the Laura Cipullo Whole Nutrition Team work on some new and exciting projects, you may notice less posts on the Eating and Living Moderately Blog. We have created a “blog shelf” below to keep you entertained and educated. Get caught up on the latest nutrition education by clicking on each year below. We will send you nutrition updates, but we will not be inundating your mailboxes on a weekly basis. If you want weekly “love” and inspiration, subscribe to our Mom Dishes It Out blog for weekly posts and recipes. Mom Dishes It Out provides expert advice from mom Registered Dietitians and mom Speech Pathologists on the “how to” of health promotion!

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The EALM Blog Shelf

Please feel free to peruse our posts organized by year below. Or take a look at the categories listed at the bottom of the page to find a post in the desired.







Diabulimia: Learning More about your Teen and their Type-1 Diabetes Diagnosis

Diabulimia: Learning More about your Teen and their Type-1 Diabetes Diagnosis
By Laura Cipullo and the Laura Cipullo Whole Nutrition Services Team


Diabulimia is an unofficial term, used by both the American Diabetes Association and the Juvenile Diabetes Research Foundation, to define a serious condition effecting, but not limited to, adolescent girls diagnosed with type 1 diabetes.

Photo Credit: via Compfight cc
Photo Credit: via Compfight cc

An adolescent diagnosed with diabulimia (known formally as ED-DMT1) is characterized by the intentional misuse and manipulation of insulin for the purposes of weight loss and control. By decreasing, or skipping the necessary dose of insulin, the individual’s body cannot absorb the carbohydrate, which affects weight and causes high blood sugar. This is very dangerous state as high blood sugar can cause Diabetic Ketoacidosis.


Did you know diabulimia’s prevalence is most widely recognized in adolescent girls? Studies conducted by the Academy of Nutrition and Dietetics: Pediatric Nutrition, report that an adolescent girl, with T1DM, is 2.4 times more likely to develop an eating disorder than her peers. While it is difficult to pinpoint the culprit behind diabulimia, the current assumption is the hyper focus on diet, control and weight. The strict diet associated with diabetes care and the pressures associated with women, eating, and body image could “exacerbate preexisting disordered eating tendencies.” (Childers)


If your tween or teen has diabetes, here are signs that may signify there is an element of disordered eating or an eating disorder:

  1. Frequent Diabetic Ketoacidosis
  2. Excessive Exercise
  3. Use of diet pills or laxatives to control weight
  4. Anxiety about or avoidance of being weighed
  5. Frequent and severe hypoglycemia
  6. Binging with alcohol
  7. Severe stress in family
  8. Frequent Insulin omission (Franz)

This is a relatively new branch to the field of nutrition, displayed by its mixture of symptoms and heath concerns.  It is important to remember the American Diabetes Association (ADA) continues to stress that there is no “one-size-fits-all” eating pattern for individuals with diabetes. When it comes to dietary recommendations, there is a strong emphasis on personal/cultural sensitivity and care. If your adolescent shows the above signs, it is highly recommended to seek a registered dietitian who specializes in both diabetes and eating disorders.


What do you think the prevalence of Diabulimia suggests about adolescent girls perception of health? How can we help to reframe this image?




  • Nancy, Childers, and Hansen-Petrik Melissa. “Diabulimia in Adolescent Females.” Pediatric Nutrition 37.3 (2014): 13-16. Print.
  • Franz, Marion J., and Kulkarni, Karmeen. Diabetes Education and Program Management. Chicago, IL: American Association of Diabetes Educators, 2001. 159. Print.

“Shattered Image”: An Interview with Brian Cuban

“Shattered Image”: An Interview with Brian Cuban
By Laura Cipullo, RD, CDE, CEDRD and the Laura Cipullo Whole Nutrition Services Team

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Weight Stigma Awareness week just passed and Laura joined her iaedp NY team at NEDA’s walk for eating disorder awareness this past Sunday. To continue raising awareness, here at EALM we are sharing a very honest and intimate interview with Brian Cuban, lawyer, author of Shattered Image, and brave individual who is sharing his own story of body dysmorphia.

1) How old were you when you realized that you suffered from BDD (Body Dysmorphic Disorder)? And could you describe what BDD is, from a patient’s perspective?

I was in my 40’s before I knew [BDD] had a name. While the disorder has been around for 100 years, BDD has really only been studied “mainstream” in the last decade. From my personal perspective, it was exaggerating the size of my stomach, love handles and the loss of hair on my head to the point where it affected my ability to function and caused me to engage in self-destructive behaviors.

2) The documented number of men with eating disorders is increasing. Why do you think this is? Do you think our society and the field is offering more resources for men to seek support?

I think it’s because more men are coming forward and being diagnosed because of increased awareness. The increase in awareness makes it easier for a guy to not be consumed by gender stereotypes and stigma and be honest with his treatment provider or other trusted person. There are absolutely more resources. When I first started going through it in the early eighties there was virtually no awareness nor were there resources. I didn’t even know the words anorexia or bulimia existed.

3) Where does bullying fit in the “eating disorder and BDD spectrum”? Would you say bullying was a trigger for your EDO and BDD? Or is there a way to describe to readers how all of these: EDO, BDD, and Poly-substance abuse are all likely to fall in the same bucket?

Bullying is definitely one of the things that played a major role in the development of my eating disorder, especially when that bullying was related to appearance.  It was certainly that way for me. Can I say it was the only reason? No. There was also fat shaming at home. I was also a very shy and withdrawn child genetically. It is possible there was a pre-disposition to such behavior for me.

I started with a distorted image in the mirror. In my mind, if I could change that image to what, I equated, as something that would cause me to be accepted, then everything would be ok. For me, that was being thin at first. When eating behaviors did not work to change the image, I cycled into alcohol and drug abuse, and, eventually, steroid addiction.  I call it a “BDD Behavior Wheel” -constantly spinning with no end game until I addressed the core issues of the fat shaming and bullying I experienced as a child.

4) As a man who has suffered from an eating disorder, in what ways could an eating disorder impact a man’s life that may differ from a woman? (If any).

Gender specific health issues aside, I think the impact is probably the same from a social and day-to-day standpoint. Shame, isolation, health, and impaired achievement affect both men and women with eating disorders. It is society that views them differently. From a male’s “going through it’ standpoint, I suspect much is the same for both sexes.

5) Do you have any advice for moms and dads raising boys or what to look for in terms of signs that their son may be developing a negative relationship with food and body?

I try not to take the role of a treatment provider since I am not one. I can only speak for my behaviors. These are the behaviors I engaged in: trips to the bathroom with water and/or the shower turned on to hide purging, evidence of purging in the bathroom, scraped/bruised finger joints from purging, and eating tiny portions. I was eating less, staying below a specific number of calories per day. Depression, isolation and social withdrawal are big ones. Children don’t isolate themselves without a reason, something is wrong.

6) In addition to genetics and other environmental stimuli, what role do you think nutrition played in the development of your eating disorder and BDD? Was there a message of health versus thin in your house and if so how do you think this affected the ED/BDD?

Nutrition played a role in that it was something I had no context for. Healthy eating was not really something that was a huge topic of discussion in the early 1970’s. I honestly can’t remember whether it was a topic of discussion in my home. I think my parents did the best they could to provide a healthy food environment within the constraints of awareness of that era. I can say that I tended to not eat healthy because it soothed my loneliness and depression in the moment. This typically occurred during lunch and during the day.

7) In terms of eating – do you now practice intuitive eating, mindful eating and/or how would you generally describe your nutrition intake?

Currently I would say that I practice intuitive eating but, I have to admit, I go through yo-yo phases like many others. I actually consulted a nutritionist about a year or so ago and did pretty well with it, but I have gotten away from healthy/balanced eating more than I would like recently. It’s nothing that ties into my disorder in itself, its just life although when I gain weight because of it that can have an effect on how my BDD thoughts play out.

8) Do you have any words of wisdom to share with adolescents who may be struggling with similar issues?

You are not alone and you are loved.  Find a trusted person you can confide in. There is an end game of recovery and a great life if you can drop the wall of shame and self protection for one second and take one tiny step forward by confiding in those who love and care about you.  Don’t wait 27 years like I did. Do it now.

Shattered Image - BCuban

One of our lucky subscribers will receive a free copy of Brian’s book, Shattered Image!

First be sure you have subscribed to EALM and then you can submit more than one entry by doing any of the following.  Be sure to leave an additional comment letting us know you subscribed and liked us! Good luck!

  • Leave a comment here and  “Like us” on our Facebook page
  • Follow @MomDishesItOut and tweet “@MomDishesItOut is having a #Giveaway”

Giveaway ends on Sunday, October 20th, 2013 at 6:00PM EST.

Contrary to Popular Belief – Men, Also Suffer From Eating Disorders

Contrary to Popular Belief – Men, Also Suffer From Eating Disorders
By: Laura Cipullo and the Laura Cipullo Whole Nutrition Services Team

Many people believe that the majority of individuals with eating disorders are female. However, recent studies are showing that this is not the case. Males, also, suffer from eating disorders. In fact, the amount of men facing an eating disorder may surprise you.

The National Institute of Mental Health has determined that an estimated 1 million men struggle with eating disorders or roughly 1 in 10 eating disorder patients is a male1. Researchers believe this suggests, not only that the incidence of male eating disorders is increasing, but the amount of men seeking treatment is also rising2.

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A recent report featured in the Journal of Men’s Health and Gender found that a frequent behavior among males with eating disorders is a term called “Anorexia Athleticism,” or extreme and frequent exercise3. It is typical to see male eating disorder patients use excessive exercise to make up for their eating habits or on the other hand, exercising without enough food intake, resulting in possible starvation or Anorexia. Andrew Walen, LCSW-C, a psychotherapist specializing in male eating disorders, states that eating disorders can also stem from childhood bullying (A. Walen, LCSW-C, phone communication, September 2013). For example, a young boy who is bullied because of his weight may be prone to dieting to feel accepted by his peers. This can be a slippery slope that could potentially lead to an eating disorder.

According to NEDA, boys’ and men’s body images are formed by the “attitudes and beliefs that culture attributes to the meaning of masculinity, including the traits of independence, competitiveness,
strength, and aggressiveness. Those who do not conform to the culture’s ideal image tend to have a
lower self-esteem than those who do conform. When males fail to live up to these masculine expectations,
they feel emotionally isolated, and this leads to problem behaviors. These problem behaviors may take
the form of eating disordered beliefs and behaviors”4.

John F. Morgan, the author of The Invisible Man: A Self Help Guide for Men with Eating Disorders, Compulsive Exercise, and Bigorexia, states that if left untreated, male eating disorders can affect aspects of the man’s life, such as “interference with their work, social activities, or just meeting day-to-day responsibilities”5. “While the effects of an eating disorder don’t differ dramatically between males and females,” Andrew Walen explains, “males typically experience a deeper feeling of shame.” The male psyche has an “I can handle it” mentality and admitting the need for help can be difficult for men. There is often a sense of isolation for men, even in recovery (phone communication, September 2013).The good news is that the amount of resources for males with eating disorders is beginning to change with the increasing level of awareness.

Study authors, Kearney-Cooke and Steichen-Asch, state that in our modern day culture “muscular build, overt physical aggression, competence at athletics, competitiveness, and independence” are desirable traits for males, while, “dependency passivity, inhibition of physical aggression, smallness, and neatness” are often viewed as more appropriate for females6. Here at EALM, we encourage families to be very cautious and not fall prey to furthering this type of categorizing and or stereotyping of boys and girls. We ask parents to educate yourselves on eating disorder warning signs that your sons may exhibit.

Possible Warning Signs of EDO Young Boys:

  • Experienced a negative reaction to their bodies from their peers at a young age6.
  • Tendency to share a closer relationship with their mothers, in comparison to their fathers.
  • Dieting in response to being overweight, (whereas females begin to diet because they may “feel” overweight).
  • Likely to manage their weight through exercise and calorie restriction.
  • Fixated on building a muscular “shape,” or a certain look. They are less likely to be fixated on their actual weight on the scale.
  • Participate in the following sports: gymnasts, runners, body builders, rowers, wrestlers, jockeys, dancers, and swimmers. Are particularly vulnerable to eating disorders because their sports necessitate weight restriction. It is important to note that weight loss in an attempt to improve athletic ability differs from an eating disorder when the central psychopathology is absent4.

 In addition to the above signs, there are psychological and biological factors that may also be associated with eating disorders including, but not limited to the following:

  • A lack of coping skills or a lack of control over one’s life
  • Experiencing anxiety, depression, anger, stress, or loneliness
  • Having a family member with an eating disorder

If you feel that you, or a family member, may be suffering from an eating disorder, we’ve provided some suggestions from Andrew Walen:

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  • Visit The National Association for Males with Eating Disorders, Inc.
  • Find a male therapist or find a program that understands the male perspective.
  • Get help wherever you can, educate yourself, and be sure to include your family.
  • Lastly, don’t let shame or your eating disorder voice tell you that you aren’t worth it, because you are.

Here are our recommended resources:

National Eating Disorder Association, NEDA

The International Association of Eating Disorder Professionals Foundation, iaedp Foundation

The International Association of Eating Disorder Professionals Foundation of NY, iaedpNY Foundation

The Eating Disorder Referral and Information Center

Diet, Detox, or Disorder – An article featuring Laura Cipullo

Screen shot 2013-09-25 at 1.19.21 PMIf you live in the NYC area, come join us on Sunday, October 6th in a walk to raise awareness of eating disorders at the NYC NEDA Walk. Click here to learn more.



1. Strother, E., Lemberg, R., Stanford, S. C., & Turberville, D. 2012. Eating Disorders in men: Underdiagnosed, undertreated, and Misunderstood. Eating Disorders, 20(5), 346-355.
2. Striegel R.H., Rosselli F., Perrin N., DeBar L., Wilson G.T., May A., and Kraemer, H.C. Gender Difference in the Prevalence of Eating Disorder Symptoms. Intnl J of Eat Dis. 2009; 42.5: 471-474. Available at:
3. Weltzin, T. 2005. Eating disorders in men: Update. Journal of Men’s Health & Gender, 2: 186–193.
4. Shiltz T. Research on Males and Eating Disorders. NEDA. undefined. Available at Accessed September 20, 2013
5. Morgan, J. 2008. The invisible man: A self-help guide for men with eating disorders, compulsive exercise, and bigorexia, New York, NY: Routledge.
6. Kearney-Cooke, A., Steichen-Asch, E. 1990. Men, body image, and eating disorders. Males and Eating Disorders. 54-74.

Healthy in the Mind and the Body

You want to be healthy in the mind as well as the body, right? So do you think a gym is a place of healthy attitudes and positive role models? Unfortunately, it’s not always the best place for our mind or bodies especially when we are moving for the wrong reasons. Many times, I encourage my clients to move but fear they will get caught up in over-working their bodies, or triggered when their trainer or instructor give unsolicited diet advice or encourages more than one spin class a day. Well my colleague had the brilliant idea to create a training program to educate fitness specialists/trainers at the gym how to work with health seekers in a way that honors both the mind and body. This amazing training helps the gym employees to identify individuals with eating disorders and gives them tools to work with clients in a healthy way rather than encouraging the disorder. Read on to learn about Jodi’s Destructively Fit and perhaps think about whether or not your health club needs a little bit of Jodi’s energy.

By Guest Blogger, Jodi Rubin

Eating disorders have always been my passion. They have been my specialty since I began my LCSW private practice more than a decade ago. Over the years, I’ve directed a program for eating disorders, currently teach a curriculum I created on eating disorders at NYU’s Graduate School of Social Work, and have done a few other things. Yet, I have not found a way to connect my love of healthy fitness and honoring one’s body with my passion for helping those struggling with eating disorders.

The issue of eating disorders within fitness centers is a ubiquitous one. I’ve seen people spending hours on the treadmill, heard countless patients recounting their obsessiveness with the gym, and others seeming as though their self-esteem became immediately deflated if they couldn’t work out hard enough, fast enough or long enough. The research I have done has revealed that the presence of eating disorders within fitness centers is “sticky” and “complicated” and gets very little attention. Through no fault of anyone in particular, if people aren’t given the education and tools, then how can anyone feel knowledgable and confident enough to address this sensitive issue?

I went directly to fitness professionals to see what they thought about eating disorders within the fitness industry. As I suspected, it was clear that there was not a lack of interest in this issue. Quite the contrary. Most, if not all, of those with whom I spoke were eager and excited to finally have a forum in which they could learn about eating disorders and how to approach the issue. That’s when DESTRUCTIVELY FIT™: demystifying eating disorders for fitness professionals™ was born. I created this 3-hour training with the goal of educating those within the fitness industry about what eating disorders are and what to do if they notice that someone may be struggling. It has since been endorsed for continuing education by both the National Academy of Sports Medicine (NASM) and The American Council on Exercise (ACE) and has sparked the interest of variety of fitness clubs. Check out Destructively Fit™ in the news here!

Some stats for you…
• 25 million American women are struggling with eating disorders
• 7 million American men are struggling with eating disorders
• 81% of 10 year old girls are afraid of being fat
• 51% of 9-10 year old girls feel better about themselves when they are dieting
• 45% of boys are unhappy with their bodies
• 67% of women 15-64 withdraw from life-engaging activities, like giving an opinion and going to the doctor, because they feel badly about their looks
• An estimated 90-95% of those diagnosed with eating disorders are members of fitness centers


Read more about Destructively Fit™ on You can also follow Destructively Fit™ on Facebook and Twitter. Help spread the word and be a part of affecting change!