Food Reward: a Dominant Factor in Obesity, Part VII

Now that I've explained the importance of food reward to obesity, and you're tired of reading about it, it's time to share my ideas on how to prevent and perhaps reverse fat gain.  First, I want to point out that although food reward is important, it's not the only factor.  Heritable factors (genetics and epigenetics), developmental factors (uterine environment, childhood diet), lifestyle factors (exercise, sleep, stress) and dietary factors besides reward also play a role.  That's why I called this series "a dominant factor in obesity", rather than "the dominant factor in obesity".
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Drug Cessation and Weight Gain

Commenter "mem", who has been practicing healthcare for 30+ years, made an interesting remark that I think is relevant to this discussion:

Recovering substance dependent people often put on lots of weight and it is not uncommon for them to become obese or morbidly obese.

This relates to the question that commenter "Gunther Gatherer" and I have been pondering in the comments: can stimulating reward pathways through non-food stimuli influence body fatness?  

It's clear that smoking cigarettes, taking cocaine and certain other pleasure drugs suppress appetite and can prevent weight gain.  These drugs all activate dopamine-dependent reward centers, which is why they're addictive.  Cocaine in particular directly inhibits dopamine clearance from the synapse (neuron-neuron junction), increasing its availability for signaling.
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Gluten-Free Frittata with Brown Rice Penne

Gluten-free pasta frittata made with brown rice penne.

Summer is officially upon us- allegedly. And by us I mean those of us calling the Northern hemisphere our home. See? I didn't forget you lovely readers from the topsy-turvy land Down Under, strapped to snowboards or skiing the snowy slopes of Victoria in need of steaming mugs of soup and plates of comfort food. I know it's winter for you. I get it. I do. I'm chilly, too. I've got Popsicle toes. And just so you know I'm not pulling your leg, Mate, I'll let you in on a little secret.

I'm not sporting a bikini these days, either.


Read more + get the recipe >>

30% Chance of Rain. 70% Chance of Recovery. Beating the odds.

I could get pretty focused on the weather this time of year, particularly on the weekends when I need to be outside biking, and especially the last weekend in June. For each of the past 9 years I've been doing a selfish fundraising bike ride to raise money for Multiple Sclerosis (MS). Why selfish? Because I was diagnosed with this condition 9 years ago. Now, back to the weather.

I'm struck by weather forecasts and how we interpret them. How do you hear “30% chance of rain”? Is it discouraging? For weather channels and websites, it’s represented by a visual image of threatening grey skies with rain. But what does “30% chance of rain” really mean? It means there’s a 70% chance of it not raining. Now doesn’t that sound better?

70% chance of no rain encourages me to get out and ride. I’m reassured there's a good chance I’ll stay dry. Even if there’s a very high likelihood of rain, let's say 90%, it's likely to rain for some time with a good deal of certainty, within a 12 hour period. That is, at least .01 inches. Now when I think rain, I think extremes, like being caught in the rain, not .01 inches of rain. So the weatherman could technically be correct and we might have a high likelihood of rain, but after it rains a bit, that may be it. The rest of the day may be bone dry!

What does the weather forecast have to do with you?

I've been told by many patients that I was the first person to give them hope, to believe that they could change. Yes, like the weather. Even when the odds were against them. And even when they didn't believe in themselves. The fact that someone else had the hope and expectation that they could shift and improve their eating and their sense of wellbeing, made all the difference. There's nothing worse than being given up on, whether you have a long standing eating disorder and your treater has given up, or your supports have tired of hearing that this time will be different. If you’ve struggled to control your weight and your relationship with food your whole life, it can feel like a bad forecast.

Similarly, when I was first diagnosed I remember reading websites about MS, including those reporting the abysmal statistics about disease progression. 85% start off with relapsing remitting MS, the type I'm labeled with, where symptoms can wax and wane. Within 10 yrs statistically more than half of us are doomed to progress to secondary progressive MS, characterized by worsening symptoms and more permanent disability. By 25 years, 90% of us are doomed to be there—or so the stats forecast.

It would have been easy to give in to probability, to feel like my health was not in my hands. Feeling that the odds are against us, can make us give up, to stop trying to take care of ourselves. You may see patterns of eating behaviors in your family, and feel that living with disordered eating is inevitable. Perhaps recognizing that eating disorders are truly diseases may make you feel you have less of a role in recovery. But attitude is everything, combined with a great team you can trust! Personally, I need to focus on the less than 50% chance that I will not progress with a worsening prognosis, the 70% chance of not-rain, versus the 30% chance of storminess.

I believe you can do the same. If you give up it is 100% guaranteed that things won't go well with your eating and ultimately with your health. If you decide that you are a failure at changing your behaviors and your thoughts and feelings, then it will be so—a self-fulfilling prophecy. So I ask you to skip the forecasts and make your own, brighter predictions for your future.

Just one thing I ask—please hope for at least 30% chance of non-rain for most of this weekend, June 25^th and 26^th, as I bike from Boston to the tip of Cape Cod.

Unfortunately the ride does not bring me back to Provence!

PS: And if you feel inspired by this post and want to contribute to my fundraising effort, every dollar or euro will bring me to a greater percent of my goal! http://bit.ly/jNqx09

Thanks for reading.

As always, I am eager to here 100% of what you have to say!

Food Reward: a Dominant Factor in Obesity, Part VI

Reward Centers can Modify the Body Fat Setpoint

Dopamine is a neurotransmitter (chemical that signals between neurons) that is a central mediator of reward and motivation in the brain.  It has been known for decades that dopamine injections into the brain suppress food intake, and that this is due primarily to its action in the hypothalamus, which is the main region that regulates body fatness (1).  Dopamine-producing neurons from reward centers contact neurons in the hypothalamus that regulate body fatness (2).  I recently came across a paper by a researcher named Dr. Hanno Pijl, from Leiden University in the Netherlands (3).  The paper is a nice overview of the evidence linking dopamine signaling with body fatness via its effects on the hypothalamus, and I recommend it to any scientists out there who want to read more about the concept.
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Knowing When to Change Direction. A Case Study.

Laura wasn’t gaining weight, and I was puzzled. Now most practitioners who have been working with eating disorder patients might laugh at me and call me naïve. She has anorexia, after all! How odd is it for her not to be gaining weight, when you think she’s eating all that she tells you? You can’t trust the eating disorder!

Here’s the backdrop.

Laura, a woman in her early thirties, had struggled with anorexia for years before first seeing me. She was painfully honest about her unsuccessful attempts to eat amounts we had agreed upon, to follow a plan we had negotiated. At times she made some progress with eating a bit more but it was never sustained enough to change her weight or her health. And in between she cycled through numerous hospitalizations and eating disorder programs.

Several months had gone by and Laura was now in a very different place. She had shifted her will, in favor of recovery, of change. She asked great questions in our sessions and strategized about practical changes to boost her food intake. There was a notable change in her food records, which supported what I was hearing in my office. I was impressed by both her determination and the significant increase in food she had reported eating.

Yet Laura wasn’t gaining weight.

So I called her doctor, the best MD around for eating disorders. I told her it just wasn’t adding up. Yes, she reminded me that Laura has a long history with this eating disorder, and that I shouldn’t forget this. But, she trusted me and accepted, albeit reluctantly, my recommendation for a GI consult. If there were no clinical explanations for the lack of weight gain in spite of her reported intake, than I’d accept my foolishness in believing, in having some faith in this patient.

Following the procedure, the gastroenterologist report read like none I had ever seen. As head of a GI department, with a specialty in celiac disease, he stated that never before had he seen such a progressed case of celiac disease. Celiac disease is an intolerance to a protein called gluten found in many grains and foods, including wheat, barley, and rye. Gluten is also found to contaminate grains, showing up where it shouldn’t occur. For those with celiac, taking in gluten causes damage to the intestine’s ability to absorb nutrients, and results in discomfort and often weight loss and other consequences.)

Despite eating all she was eating, her body was unable to use most of these calories.  Her reports of eating were likely not exaggerated. And so for many months Laura followed the prescribed celiac diet, a gluten free plan, and finally began to gain weight as expected.

But it's going to take some work!

But the story doesn’t end here. When you have a medical condition, everyone, perhaps including you, assumes that everything you experience is the result of your condition. It took some convincing that Laura was seemingly eating what she said, and that there could be something else going on. As a person living with MS, I have to remind myself this all the time. I could have pain or numbness because I did something in my workout, not just because I live with a neurological disease. Similarly, Laura had two conditions—one of which managed to get missed, because we were all so focused on the other one.

The reverse is also true. Just because we knew Laura had celiac disease, didn’t mean that her lapses in progress with weight restoration were directly linked to her celiac disease. Sometimes they were, the direct result of restrictive eating.  And sometimes the two diseases were linked, like when her eating disorder side sabotaged her recovery and chose to eat gluten-containing foods, leading to more malabsorption and poor weight gain.

Laura’s case is rather atypical. But there’s a lot we can learn from it. We, all of us, need to watch our assumptions. We are quick to attribute everything to a single condition—and that includes obesity, as well as eating disorders. Remember that post where I shared I have high blood pressure http://dropitandeat.blogspot.com/2011/04/lies-theyre-feeding-you-about-your.html? Yes, in spite of my normal weight and active lifestyle, I take meds for hypertension, as did my slim father.

Not giving up, just respecting his limits, acknowledging when
it's time to slow down.

That being said, even medical conditions, including eating disorders, can be changed, so don't give up! No, there’s no medication to resolve it, but even individuals like Laura, and like Jamie http://dropitandeat.blogspot.com/2010/09/insanity-or-recovery.html dealing with anorexia and bulimia and Maggie http://dropitandeat.blogspot.com/2011/02/maggies-152-lbs-weight-lossthis-time.html and Erin http://dropitandeat.blogspot.com/2010/09/meg-hit-300-pounds-wednesday-and-was.html dealing with binge eating disorder, with significant obesity for most of their lives before changing it, can recover. 

It takes some faith in your self and some good supports, including a treatment team that believes you can move on. And a willingness to change course when you need to—to learn how to manage obstacles, to explore additional therapies and levels of care that might get you over a hurdle.

I wouldn't have married him if he couldn't find a better solution!

And now?

Laura has had her share of ups and downs over the many years I have worked with her. But she is the best I have ever seen her. And she wanted me to share her story with my readers. I continue to try to support her as she balances her newfound interest in food and eating (including foods such as lasagna) with guidance for preparing such foods gluten free.

Friday Eye Candy: Farmers' Market, Strawberries, and a Peek at My Beach Path

Organic strawberries make gluten-free luscious and beautiful.

I have been sitting here in my chair, as bone quiet still as a nun in a pew at midnight, with nary a poetic turn of phrase in sight. I am trying to conjure words for strawberries. And summer. And the newly minted sensation of actually, finally, living by the sea. I keep thinking about breathing- because the ionized ocean air is so sexy gorgeous you could eat it with a spoon. And because for the first time in a long, long time I can feel myself uncoil a bit and allow a long, soft exhale to trail into the stream of salty wind that whistles through the crack of an open window above my bed as I blink awake to the whoop of a sunrise surfer ripping his way down a foamy curl. His joy is infectious. And I smile. And yawn.

The word gratitude comes to mind.

Not to mention, abundance. This week's farmers market was indeed abundant, tumbling wild with the jewels of summer. Boxes and boxes of fragrant strawberries. Buckets of cherries. Crates of plums. Potted herbs and June blooms- peonies and Japanese iris. So I offer you eye candy today. The gift of color. And ten gluten-free strawberry recipes to inspire your weekend and get you in the mood to whoop.

It's summer. Live a little. Get juicy.


Read more + get the recipe >>

Day 70 - shooting Backwater!

A screen shot of co-star Justin Tully and I in "Backwater" :)

Here is a blog journal of the 70th Day on my Customized Health Programs put together by some of The Earth Diet team.

The programs I am currently taking are for Eating and Exercise!

This is what my week (Saturday 4th - today Thursday 9th) has looked like for the past week while shooting Backwater!

Director of "Backwater" Christopher Schrack!

Eating Program: 

Mornings: Usually water with lemon or mint tea. Fresh berries; Strawberries, blueberries and raspberries. Organic Granola ingredients: oats, quinoa, spelt, kamut, almonds and vanilla.
Snacks throughout the day: Berries, cherries, granola bar with organic peanut butter (ingredients roasted peanuts), almond butter, raw chocolate.
Dinner: We have been eating wild salmon, vegetables, fruits, rice, lentils, turkey, shrimp/prawns, salads mmm divine nourishment :) !!!

Today we went to THE Bagel place (mandatory hehe) and I had an 'everything bagel' with avocado and egg.

*My program was created to be majority raw, some cooked foods, incorporating meats and vegan meals, juices, cleansing teas/meals/drinks and desserts. All meals use only ingredients that are provided by the earth naturally. When you complete the questionnaire online you can also create it how you want it to be. 

Exercise Program by Patrick:
Being on set is a workout in it's self ;) In the mornings I stretch and do some breathing and yoga :) Today Justin and I went for a run in the glorious heat hehe :)

Whats NEW:

• The Earth Diet line is now available at Organic Corner in Massepequa in Long Island, New York! Everything is raw, organic and vegan including the epic Chocolate Peanut Butter Cups made from cacao, cacao butter, agave, almonds and peanuts!!!
• Have you checked out Sarah Mae's latest video diaries of her experience on The Earth Diet? See here if you like... 

http://www.youtube.com/user/TheEarthdiet

• The next class I'm teaching at OC will be on Saturday 25th June 9am-10:30am. We are doing Sweet & Spicy Wraps and Cheesecake.
• The next RAW food class I'm leading in Huntington at The Water Well will be on Tuesday the 28th of June 7-9pm, we are doing Lasagana then Ice Cream :)

Sarah Mae - check out the blog AND video diaries of her experience on TED!

Inspiration:  Loving these this week:

• 'He who has a why to live can deal with almost any how'. My trainer Patrick (Check out his new website www.2thin2fat.com) told me this one ;) Not sure who it's by... 
• The discipline that we would like you to exercise is to make a decision that nothing is more important than that you feel good, and that you are going to find thoughts that feel better. Your cork floating is the only thing that is worthy of discipline. --- Abraham
• A classic by Grabielle 'Dreams Can Come True'

With love, Liana :)

For free recipes visit:  

http://www.theearthdiet.org/all-recipes.html

To create your own Customized Health Programs with one of our team members visit: 

http://www.theearthdiet.org/all-customized-programs.html

www.TheEarthDiet.org

Summer Wheatberry Salad. My Favorite!

The finished product!

It’s hard to say what I like best about this wheatberry salad. I love the chewiness of the wheat berries and dried fruit, combined with the crunch of the celery and the pecans. There’s the sweetness from the orange juice, dried cranberries and drizzle of honey, that’s just sweet enough, countered by the vinaigrette and zing of the orange zest.

And then there’s the fact that it’s easy to make, and can serve as a side dish with dinner, or stand alone as the main dish at lunch. And did I mention that everyone loves it? It’s also a great source of fiber (about 6 grams per serving).

This is one of my favorite salads for the warm weather season. And yes, I realize it’s still springtime, but this recipe so reminds me of summer!

Enjoy!

Summer Wheatberry Salad Recipe

Serves approximately 12 (just about 1 cup per serving)

This is more scallion than you'll need!

Ingredients

2 cups dry wheatberries (also called hard red wheat berries) (will make 6 cups cooked wheat berries)
3 Tbsps. olive oil
1 cup orange juice
1 large tart apple, chopped, skin on (such as Granny Smith)
1 cup fresh mint (spearmint), chopped
4 celery sticks, diced
4 scallions (green onion), green and white parts, chopped
¾ cup pecans
1 cup craisins (sweetened dried cranberries)
¼ cup vinegar (red wine or apple cider)
1 tsp salt
1- 1 1/2 Tbsp honey (to taste)
orange zest from one whole orange

Fresh mint from my garden. The only thing I manage to grow well!

Consider adding chopped red peppers, red onion or additional celery for more crunch and larger volume per serving.

1. Cook the wheatberries. Place the wheatberries into 6 cups of boiling water. Cook, uncovered, over low heat for 45 minutes, until soft and chewy. Drain.
2. Place drained wheatberries in a large bowl. 
3. Add all ingredients and mix thoroughly.
4. Refrigerate. Serve cold or at room temperature.

How do I count this on an exchange plan? For a full cup this satisfies 2 grains and 2 fats. Toss in some grilled chicken to help round off the meal.

Time to Clear My Plate. Before You Get Triggered by My Plate, Read This.

Oh, Michelle, I so appreciate your honest and passionate concern for improving the health of our nation, particularly our kids. Really I do! But quite frankly, the subtle messages conveyed through the new USDA My Plate set us way back in our progress.

That’s not to say that I find nothing favorable about it. I do like the bright colors (they make me feel like a kid again), and the concept of half the plate as fruits and vegetables is truly a helpful, and reasonable teaching visual. And, a message I can support. But here’s where we part.

Where are the fats?

Ok, I realize that in the written food group description fats get mentioned, but not encouraged. And let’s face it—it’s the visual image that makes the biggest impact. And in that regard, fats are absent. Yes, in spite of the latest Dietary Guidelines for Americans summarizing the enormous body of research and declaring that increasing (unsaturated) fats should be a goal, comprising up to 30% of all our calories, this message is lost in My Plate.

In fact, in the description accompanying the image, it even sheds a negative light, saying “oils are not a food group”. And by oils they really mean fats, because avocado, for instance is not oil. Funny, in past pyramids, such as 2005, fats were a distinct part of the pyramid and were scattered around as a component of the other food groups. And if fats are not a food group, why is protein? If I remember my basic nutrition way back the three macronutritent groups making up all foods are protein, fats and carbohydrate. Yet My Plate places the nutrient protein on the plate, a component of foods, as if it’s a food, yet states that fats have no place? I don’t get it.

Where’s my favorite food group?

But perhaps the biggest problem I have is the omission of those “empty calorie” villains, the “sweets”. Past health messages from the American Dietetics Association and the recent aforementioned Dietary Guidelines for Americans 2010 instructs us to “find balance between food and physical activity.” At no point do they suggest we should eliminate sweets to prevent obesity.

And speaking of those additional calories, why make such an overreaching statement like “Enjoy your food, but eat less”? Should I suggest this to my normal weight sons? To the healthy growing kids I see? To the many I work with struggling with trusting their hunger, many of whom are working hard to increase their calories by appropriately eating more? Should I be eating less as I’m training for a biking event this month? Such an unnecessary and detrimental generalization! Would it take an eating disordered child for Michelle to be more sensitive to such absurd health recommendations?

This dietitian endorses a health-promoting message to include junk food!

Here’s the scoop. Black and white messages about good foods to eat and bad foods to avoid are damaging. They contribute to society being misinformed about weight management, and about eating in a healthy, balanced and pleasurable way. In life kids and adults are going to eat cupcakes and chocolate and ice cream in all flavors. The problem won’t be that we’re eating these foods. It’s that we view them as bad, feel guilty, and end up overeating them, because we have been convinced that we have done wrong by consuming them—in any amount. Rigid rules and clear omissions teach us nothing. They reinforce the wrong messages. It’s time to get with the times.

Why the beef about dairy?

And to the critics of inclusion of a dairy serving, like Walter Willet at Harvard (who says there’s no evidence to support including a dairy requirement), I’d like to ask you this—are you thinking we’re going to meet our requirement for calcium and Vitamin D from sardines, canned salmon, almonds and broccoli? I don’t think so. Perhaps the USDA could have done better by broadening that category to say “milk and fortified soy milk”; no other non-dairy alternative provides as much protein as well as calcium and Vit D. Yes, there is evidence that we need an adequate intake of these two nutrients, and practical, economical, acceptable sources are few and far between outside of dairy products.

As for the interactive resources, I would love to share my thoughts. But after signing in, the program failed to work when I tried to explore the physical activity section.

Time to go eat. 

My plate will include some homemade waffles this morning, fruit, yogurt, and real Vermont, full sugar maple syrup. And I just might decide to include a piece of pastry for my afternoon snack. And in spite of what My Plate urges, I have no intentions of reducing my portions from their usual level!

Thanks for reading! Enjoy your sweets today.