Vacation nutrition

    Sometimes my patients raise concerns about their nutrition over a vacation or another time when they are off their typical schedule. My instinctual response is to assure them that vacation represents a small minority of their life, and to not give it too much importance. But that answer does not really address the core fear. The bigger worry behind this is the fear of loss of control. When you are on your routine, it is easier to stay in control. You can set up your life to make sure you always have the specific food you need when you need it. You can avoid every triggering situation. You can avoid people who might have "forbidden" foods or talk about disallowed topics. It seems that the real work is to be open to all possible circumstances and the real human likelihood of imperfection. 

I was bad yesterday and ate pizza

    The ideals behind this statement bothers me. "Bad" should be reserved for things that are morally wrong. Maybe for insulting a friend or stealing. Eating food doesn't meet that criteria. I understand why people say this and I want to unpack it. There is a perception that pizza is unhealthy. There is a perceived rule that one is supposed to eat healthy foods. There is a feeling of guilt for violating that rule. Then comes the conclusion that eating pizza equates with being bad. Now we need to acknowledge why people eat pizza. A few potential reasons are: hunger--a basic human drive that we all experience and act on every day, desire for pleasure--another normal human drive, and anxiety--who would not use a coping mechanism for anxiety if they can reduce their anxiety with it? Do any of these reasons to eat meat our definition of bad? 

Reasons my patients want to make healthy lifestyle changes

• so I can be around to play with my grandchildren
• to lower my risk of a heart attack
• to improve my blood sugar
• so I can have an easier time climbing up the stairs
• to have more energy
• to improve my mood
• to have less nausea
• to have less bloating
• so I don't eat until I am uncomfortably overfull
• to feel better
• so I can walk further without getting out of breath
• to improve my blood lipid levels
• to feel stronger
• to feel good
• so I can take care of myself
• because only I can do this for myself

I want to lose weight!

     "I want to lose weight!" This is the most common goal of people who I speak to for a nutrition consult. If there is one thing I have learned through my years of being a dietitian, it is that I can't guarantee weight loss. My patients can tell you better than I can tell you that weight loss is really hard to achieve and even harder to maintain. Generally, in the best case scenario, diet alone will lead to 5-10% weight loss, which is often not enough to meet the patient's goal. Fortunately, nutrition changes, even with no weight loss, can lead to real improvements in health and health risk reduction. 

Fear of deprivation

     One of concerns that my patients have is that once they change their eating habits, certain foods will become forbidden, and they will constantly feel deprived of these foods. This fear leads to the "last supper" phenomenon that precedes a diet. The thought is, "I will never be allowed to eat donuts again, so I better get them all in now before they become banned in my next diet." In reality, the idea of prohibited foods is a concept we create ourselves. The extension of that thought, that deprivation is inevitable, is also self-created. 

    I would like to point out the fallacies in both statements. First, we do not have to outlaw foods. I am not even talking about promoting the "everything in moderation" theory. I am simply talking about the black and white/all or nothing thinking that goes into banning foods. The "never again" mindset. Regarding the fear feeling deprived, there are a few other possibilities. Some of that fear stems from the fact we decide foods are forbidden. It is human nature to want what is not allowed. Easing up on the rules can help us avoid the feeling of deprivation. Additionally, there are other helpful and more accurate thoughts we can have. Perhaps a more accurate thought might be, "Let's see what happens if I have oatmeal for breakfast today instead of a donut. I don't need to make plans for the rest of my life right now. I am just deciding about right now" Or the thought could be, "I want to eat a donut when I can really enjoy it, like on a relaxed Sunday morning when I can sit down and savor the taste. Now I am rushing to work and will scarf it down and barely taste it." Or the thought can be, "I would like to sit down and enjoy a donut now. Not because I earned it or because I was good. But because right now I am choosing to eat and enjoy a donut." 

    Remember, knowing these ideas does not immediately translate into feeling and living these ideas. It takes a lot of effort, practice, and reminding ourselves of the perspective we prefer to have. Bumps in the road towards this are just moments to notice what happened. Each new moment is a new opportunity that does not have to depend on the past. 

Non-hunger reasons we eat

• tiredness
• boredom
• anxiety
• restlessness
• pleasure-seeking desires
• habit
• social setting that encourages eating
• location
• eating customs
• "last supper" mentality
• rebound from food restriction

    Which of these have you experienced recently? 

Hunger and Satiety: When to eat and when to wait

     Many of us have grown out of touch with knowing when to eat. Babies tend to be good at crying for milk when they are hungry and stopping to eat when they are satisfied. As we get older, other influences encourage us to eat. We are coaxed to finish our dinners, offered sweets as rewards, and we start using pleasurable foods to calm our nerves. It takes a lot of relearning to get back to that "baby" state of eating when hungry and stopping when full.

    One way to reteach ourselves this skill is with the use of a hunger and satiety scale. With this scale, we can rate our current state and have prespecified points that correspond to "time to eat" and "time to stop eating." We will use a 10 point scale. Let's put "starving" at 1 and "uncomfortably full" at 10. If you at a 1, you have waited too long and allowed yourself to be too hungry. If you are at a 10, you might have stomach discomfort or pressure in your abdomen from the quantity of food eaten. At the midpoint, near 5-6, is where you are neither hungry or full. You could eat without making yourself uncomfortable, and you could wait longer and not be too hungry. Around 3 on this scale is where you feel hungry and ready to eat, but not ravenously hungry. This is a good time to seek out something to eat and begin a meal. The meal can continue until you reach about an 8 on the scale. At this point you are comfortably full, but not overstuffed. Based on this scale, we want to remain in the range of 3-8. This prevents us from getting too hungry or uncomfortably overfull. 

    At first, knowing when to eat out of hunger and stop when full will be a conscious effort. It will take effort to remember to check in with your inner hunger and satiety cues. You might sometimes forget, and then later notice that you allowed yourself to get ravenously hungry or uncomfortably full. With practice, you will remember more frequently to notice your inner hunger and satiety signals to help you remain in the 3-8 range. And with even more practice, it will become second nature.