EALM reviews: "PCOS: The Dietitian’s Guide"

In honor of National Nutrition Month, EALM reviews: “PCOS: The Dietitian’s Guide

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Specializing in both eating disorders and endocrine disorders, I often encounter women with an ambiguous diagnosis of PCOS (polycystic ovary syndrome). Some of these clients have struggled with weight issues for years and doctors have mentioned PCOS, but they do not have an official or clear diagnosis. When looking for resources to help these clients, I came across Angela Grassi’s The PCOS- Workbook and PCOS- The Dietitian’s Guide. Whether you are a woman with a potential diagnosis of PCOS or a dietitian looking to brush up on the condition, these books are much needed additions to your bookshelf.

 

Having been diagnosed with PCOS herself, Angela Grassi understands just how difficult it is to receive the correct diagnosis, as well as the complexities of living with the syndrome. Her first-hand experiences and knowledge as a registered dietitian help to offer a mind, body, and soul perspective to her readers.

 

It is estimated that PCOS affects between 6-10% of women worldwide, but getting diagnosed may be difficult. Many more women may be living without a diagnosis. A diagnosis typically requires two of the following criteria: Irregular or absent menstrual cycles, clinical or biochemical signs of increased androgen production, and polycystic ovaries (Rotterdam, 2003). Women may struggle for years before these symptoms are recognized. As dietitians, a client may present with weight struggles, disordered eating, or glucose abnormalities even before she knows she has PCOS.

 

What most women don’t know is that a lot of the symptoms of PCOS, such as hunger and weight gain are a result of their condition.  For example, did you know “women with PCOS have pre- and post-meal ghrelin impairments” (Page 31)? Ghrelin is a hormone that stimulates appetite. Complications of PCOS, such as infertility, diabetes, and cardiovascular disease, can be reduced with lifestyle changes, making nutrition critical to the treatment of PCOS. However, “despite the benefits of weight loss, losing weight and maintaining weight loss is difficult in the general population and especially for women with PCOS (Page 31).”

 

Grassi reviews common diet trends and offers information on supplements that may be useful in this population. Did you know 1 tsp (3g) of cinnamon has been shown to reduce fasting blood glucose and improve long-term glycemic control (Page 52)? Pick up a copy of Grassi’s book to find more information about supplements that may help with the insulin resistance commonly found in women with PCOS.
The book goes on to describe challenges women may face throughout their lifetime.  It also touches on the psychological aspects of PCOS, including eating disorders. Because individuals with PCOS are at a higher risk for disordered eating and body image disturbances, dietitians must be aware of the signs and symptoms of disordered eating. Grassi offers dietitians and professionals various ways to screen for eating disturbances and tips for working with these clients.

 

This book summarizes current research, making it a great tool for any one looking to learn more about PCOS. It provides context to the disorder, offers practical advice, and reviews evidenced-based nutrition therapy in order to address treatment for the “entire” person. This particular book is intended for dietitians and health care professionals, but Grassi also offers a workbook for women with PCOS.

Screen shot 2014-03-03 at 2.25.44 PM For more information on both Angela Grassi and her books click here.

Is food always on your mind?

 

 

5 Signs You May Be Eating When You Don’t Need To

  1. You sneak food.
  2. You eat every time you come home regardless of your hunger level.
  3. You eat in bed.
  4. You always eat when you are sad or angry.
  5. You eat food just because it is there.
If you answer yes to any of the questions above, read the article below. 

ENDING THE INTERNAL FOOD FIGHT

By Laura Cipullo, RD, CDE, CEDS

You’ve finished eating dinner. You’re satisfied and feel good. But coming from the other room is a voice. It whispers, “Eat me. You’re tired, and I will make you feel better. You gorged last night. . . and every night the week before—why not tonight?” So you get off the couch and sink, bite by blissful bite, to the bottom of a pint of your favorite ice cream.

Moments later, your feeling of bliss is gone. Guilt, remorse, shame and loss set in. You just ate an entire pint of ice cream when you weren’t even hungry. You feel that food is controlling you and that you just can’t win.

Well, you can win. Food needs to be balanced with your physical needs and sometimes your emotional needs. You can break the cycle of behavioral eating by giving yourself time and working in phases. This article outlines six phases to end the internal food fight and gain a neutral relationship with eating. Each step focuses on a small behavioral change designed to prevent the feeling of deprivation. The continuation and accumulation of the new habits can lead to big health and lifestyle changes for your future. Give yourself a week or two to move through each phase.

This article addresses night eating of previously restricted foods and builds off the ice cream example above, but these phases can be applied to many other eating habits. Other non-hunger reasons for eating include eating to comfort yourself, eating something after a meal because you grew up eating dessert, and eating socially because your friends are eating. Using the steps below as a guide can help you break these too. Before you begin, however, you have to first identify and accept your counterproductive habit. Only then can you begin the journey toward freedom from your internal struggle.

Phase 1 (Weeks 1 & 2): Once you’ve identified your behavior, embrace your habit or forbidden food. Give yourself permission to eat ice cream past your point of fullness. Allowing yourself the food or behavior removes the guilt and releases you from the internal struggle. Enjoy the food/habit, recognizing how your body feels as you are indulging. In our example here, remember how good that first bite of ice cream tastes (it’s often what your body remembers most, because as you continue to eat, your senses are dulled).

Phase 2 (Weeks 2 & 3): It’s time for another small change. Start by reducing your portion to three quarters of its original size. While you’re modifying your behavior in a healthy way, you’ll still be allowing yourself to enjoy the food. You aren’t depriving yourself, and you’re beginning to be mindful of your physical needs.

Phase 3 (Weeks 4 & 5): Decrease your portion to half the original size over the next two weeks. While slowly reducing the portion, you shouldn’t feel restricted or deprived. Savor your food; notice the color, the texture, the taste, and how it makes you feel during and after eating it.

Phase 4 (Weeks 5 & 6): You have experienced your food fully and have probably realized that a smaller portion satisfies you. Now change the food you are eating. Using our example, try a creamy sorbet. If nuts are your night food of choice, try switching to another salty finger food, like popcorn.

Think about why you are eating. Do you want to keep this habit? While you’re continuing to eat at night, you’re now doing so with a neutral food (one that was not formerly restricted), which is less numbing. Your relationship with food should feel more balanced.

Phase 5 (Weeks 6 & 7): Get ready to reintroduce your original food. Alternate eating the halved portion of regular ice cream with one of sorbet. When you crave the ice cream, eat it. And when you want the sorbet, dig right in. Try to alternate your snack every other night and eat your food at the kitchen table with no other stimuli (watching TV, talking on the phone). This creates an environment that allows you to be mindful, and intuitive. Hopefully you feel freer and are better able to enjoy both foods.

Phase 6 (Weeks 7 & 8): Incorporate your night foods in moderation. Enjoy the food while paying close attention to your body’s needs. Remember that your night eating should be stimulus-free and at the kitchen table. Alternate your foods, follow your cravings and, most important, if you aren’t hungry, find something else to do.

Follow this proactive plan, and after 12 weeks of gradual changes, you will be eating less and feeling more empowered and less controlled by food. Don’t be tempted to race through phases. There’s no reward for finishing first, so remember to take your time. Doing so will help make your new habit a permanent one, and you’ll be more in tune with your body’s needs.

Moving forward, you can repeat the phases if you feel the need to further reduce your portions or if your old habit recurs. Finally, remember that you can always receive additional support from trusted friends, family, self-help books or a registered dietitian.

Phases 1 through 6, in Brief

Phase 1: Allow yourself your chosen food or behavior for the first one to two weeks.

Phase 2: Reduce your portion size to ¾ its original size.

Phase 3: Decrease your portion further to ½ its original size.

Phase 4: Choose a different food. Change the food you are eating.

Phase 5: Alternate eating the halved portion of original food with its healthier counterpart. Remember to eat in a stimulus-free environment at the kitchen table.

Phase 6: Incorporate all foods, in moderation. Choose ice cream one night, sorbet one night and perhaps nothing another night (if you are not hungry), maintaining your new healthy habit.

 

The above is not intended for those suffering from eating disorders.

 

 


The Epidemic of Diabetes

Hydrate with water, not soda

Regardless of weight and age, America is heading towards a Diabetes epidemic. Americans must change their lifestyles by moving more, and eating less.

Diabetes does not discriminate based on overall weight. America needs to focus on decreasing belly fat, specifically, eating less processed food and moving more.

 

Based on the study reported in the Journal of Pediatrics, Diabetes is increasing in our teen population. There was a 14% increase in prediabetes and diabetes in a ten year period. In 1999 – 2000, there was a 9% incidence of prediabetes and diabetes in teenagers between ages 12- 19. In 2007- 2008, there was a 23 % incidence of prediabetes and diabetes. This is more than two fold. However, the study also revealed this was regardless of weight. Across the weight spectrum, all teens had an increase in the incidence of Diabetes. In my mind, this is a Diabetes Epidemic not an obesity epidemic.

Obesity did not increase in our youth during this ten year period from 1999 – to 2008. One study from the NHANES reports an actual decrease in teen obesity, despite an increase in prediabetes and diabetes. Also, half of the participants in the study had at least one risk factor for cardiovascular disease, which means everyone needs intervention.

So what is the intervention? It depends on who you ask but the many agree America must move more, eat less processed food, and practice stress relief. America is eating too much and not moving enough. We are a culture of convenience. People need to eat because they are hungry rather than bored. We need to eliminate highly processed food such as chips and soda. We need to feel full with fiber and drink for hydration. Simple solutions are to replace chips with fiber rich berries and soda with bubbly water like Perrier. Ideally, we need to decrease insulin resistance and belly bulge (aka abdominal obesity).

The study admits to flaws. One of the flaws is the tool BMI – Body Mass Index. This measurement tool uses overall weight and height, not accounting for muscle mass and frame. Football players are considered obese when using BMI. A better tool to assess for obesity, belly fat, insulin resistance and or risk for diabetes would be the waist to height ratio. This tool would not qualify the typical football player as obese.

On Tuesday, I had the opportunity to share some of these thoughts with the HLN audience. Click here to see the clip.

 

May AL, Kuklina EV, Yoon PW. Prevalence of cardiovascular disease risk factors among US adolescents, 1999−2008. Pediatrics. 2012;peds.2011-1082.

Leaving Perfectionism Out of Your Diet

By Katherine Kaczor, Nutrition Assistant and Intern

We all want to eat right, but no one can (or should) have a perfect diet. This perfectionist mentality limits our enjoyment of food and ultimately out of life. Perfectionism does not belong at the table. Follow these tips to have a healthier relationship with food.

  1. Make foods morally neutral– Labeling foods “good” or “bad” gives them way more power than they deserve. Foods are meant to provide energy, nutrients, and enjoyment. Each food has its unique set of nutrients that can find its place in a healthy diet. Following a diet that restricts certain foods takes away from this enjoyment and can ultimately lead to feelings of deprivation and ultimately overindulgence.
  2. Live in the present– Don’t put your life on hold while you attempt to meet your dietary goals. Start living today! The positive experiences you go through will help motivate you to make healthier choices.
  3. Take a mindful approach- Take the time to truly savor your food. Experience all the flavors, textures, and aromas of the food. Listen to your body’s hunger signals and honor them. Try not to eat on the run or while distracted by television or reading material. This can inhibit your ability to enjoy the meal and reach a point of satiation and consequently, lead to over or under eating. Eating in a mindful manner will allow you to consume the appropriate number of calories and obtain the proper nutrients you need.
  4. Don’t listen to critics– These days it seems like everyone wants to be the food police. Do not allow people in your life or the promotion of fad diets steer you away from a wholesome lifestyle. Just because Dr. Oz or your mother-in-law scrutinizes you for eating a bagel, do not allow them to upset you or perpetuate you into restriction or overeating. Everyone has his or her own nutrition needs. Talk to your RD about your individualized needs and stand up for yourself when critics arise.
  5. Make SMART goals- Trying to change all of your eating and exercise habits at once is unrealistic and unsustainable. Accomplishing small goals over a period of time leads to greater success and helps ensure the changes become permanent. To make your goals smart, make sure they are specific, measurable, attainable, realistic, and provide a time frame for yourself.  An example of a SMART goal would be: I will eat 5 servings of fruits and vegetables daily for at least 4 days per week by the start of next month. Work with your RD to help find the SMARTest goals for you.

Laura shares with Fox Business on how to save money by buying healthy.

Save Money With These 5 New Year’s Resolutions

By Dana Dratch

Some New Year’s resolutions can help you save cash. Put the savings in the bank and use it for practical things, such as retirement, groceries or the power bill. Or reward yourself with a night on the town, a much-needed getaway or a new toy.

While you’re ruminating on how you’ll spend your well-gotten gains, here’s a look at just how much keeping five popular resolutions could save you, along with the items that money could buy.

Read more to get the Laura’s latest scoop on food and savings: http://www.foxbusiness.com/personal-finance/2012/01/04/save-money-with-these-5-new-years-resolutions/#ixzz1j4mCBe5S.

Tips to Avoid Mindless Eating

In 2009, I attended a seminar Turning Mindless Eating tm Into Mindless Weight Loss taught by Brian Wansink, PhD Food Psychologist at the Cornell Food and Brand Lab. Here are the tips I learned:

Tips to Avoid Mindless Eating

  1. Repackage snacks into individual sized bags to prevent overconsumption. Larger containers make us more likely to over-indulge.
  2. Store foods in cupboards or the pantry rather than on the counter or other open area. You’ll be less likely to mindless munch on foods if you have to go out of your way to get them.
  3. Eat on smaller dinner plates. Using larger plates leads us to overfill our plate unintentionally and consequently eat more.
  4. Be cautious of food labels claiming “low-fat,” “low-sugar,” or “low-calorie.” These foods can cause people to overeat because they don’t feel as “guilty” about consuming them in comparison to the regular versions.
  5. If you are feeling sad, don’t use food to try to improve your mood.  Instead, try going for a walk, watching a movie, or talking to a friend.
If you like these tips, show your appreciation by subscribing to
www.EatingandLivingModerately.com, like Laura Cipullo Whole Nutrition Services on Facebook and by checking out our latest blogging adventure www.MomDishesItOut.com. Thanks!

The All Inclusive APP

My new and most favorite iPhone app is dLife Diabetic Companion. Not only can you easily log your blood sugar, carbs and insulin units, but you can easily click on added notes. Examples of the notes include but are not limited to the following: skipped a meal, drank alcohol, missed exercise, changed infusion site, and feel hypo. You just click/tap, no typing needed. This makes logging and multitasking easy. 5 Stars!!

In addition, the dLife app includes 25, 000 foods and their facts. You can access 9,000 recipes easily categorized for most nutritional needs. This app may be beneficial for anyone in need of free nutrition education and healthy recipes. You don’t have to have diabetes to benefit from this app. Take a look for yourself because it is free. http://www.dlife.com/dlife_media/mobile

 

Move over TV dinners and say hi to this microwave meal.

It’s the end of August and we are all scrambling to get everything ready for the new school year. Sometimes meals become second priority. If you are lacking time and want something tasty, try Kashi’s Pesto Pasta Primavera. Add one half cup of beans (rec. no added salt) to this microwave meal and you have a balanced vegetarian lunch option with 18 grams of vegetarian protein and 14 grams of fiber.