Maggie’s 152 lb. Weight Loss—This Time, It’s Not Disordered

Eating Disorder Recovery is More than Achieving a Healthy Weight

At the MFA, Boston, MA

Just this Thursday yet another patient shared her beliefs, her fears about recovery. “If I’m at a normal weight then I won’t need to come in. And everyone will think I’m fine”, she stated. And that was one roadblock to her recovery. Wearing her eating disorder, just like, for a cutter, I suspect, wearing short sleeves, is a way of expressing that there’s a problem. It appears to be a way of passively asking for help, when words fall short. 

Some have been surprised when I described them as still having an eating disorder, complete with thoughts of restriction, denial of hunger, and food and weight preoccupation, in spite of having restored their weight.

A significant drop in weight could be a red flag for an eating disorder, or can be the result of healthy measures, in spite of an eating disorder history. And a normal weight can disguise the pain of your struggling with an eating disorder as well. All of the above apply to Maggie.

You’d think dropping 152 pounds would be a major accomplishment for someone close to 400 pounds. And it is, especially at the age of 67. But the more successful part of this story is the move away from reliance on eating disorder thoughts and behaviors, on both sides of the weight spectrum.

Also at the MFA, Boston

Maggie, at 130 pounds and 5’8” saw herself as a “big fat slob”. A low weight for her height by any medical standards, she was obese by her own. She reports never really feeling good about herself, and by her early 20’s had met criteria for anorexia, plummeting to 117 pounds with restrictive intake and bulimic exercise levels. By that I mean exercising excessively, typically to compensate for eating, in an obsessive way.

Like many I see, a motivation to conceive helped enable her to gain enough for normal menses to resume, and ultimately to carry and deliver a healthy daughter. She managed to maintain a healthy weight, although not a healthy relationship with food and her running shoes. And after some time, triggered by a traumatic event, Maggie’s eating disorder turned to binge eating, with a focus on night eating. (Let me assure you that with support from an eating disorder team, recovery from anorexia does not have to result in binge eating and subsequent obesity! But Maggie had not yet sought help.)

Fast forward to the summer of 2002, when at 388 lbs. Maggie presented to see me. Her goal? To lose weight and recover from her many years living with an unhealthy relationship with food. Basically, to learn how to eat and to listen to her body—something she had never really done.

Maggie still comes to see me, every 4-6 weeks. (She has also worked with a therapist, at my recommendation, but they have finished their work together.) Yes, it’s been a very long road, but her progress has been tremendous. It’s quite impressive that she is down 152 lbs. so far. But more impressive, is that it has been years since she has used behaviors to manage her eating and her weight. 

True, there have been slips where I have had to play the “tiger mom” role, insisting that she increase her food intake, when weight loss was getting a bit too rapid. But she heeded my firm warning, and stayed on course. 

And there were certainly frustrations, like when she went to see her primary care physician recently. In reviewing her history, the doctor asked what her weight had been before we began our work together. And when Maggie, somewhat shamefully, admitted it was 388 lbs., the doctor laughed and told her she had to be wrong, dismissing Maggie as exaggerating her weight loss. Could you imagine! This very same visit, the doctor denied her a referral for a therapeutic water program that I requested, to enable her to move more. Because after so many years, no matter how much weight she lost, her knees weren’t going to fix themselves and allow her to start walking. To her credit, the incredible anger and frustration she felt was verbalized, instead of buried with pastries.

Over these years of working together, Maggie has changed the rules. She allows herself to eat later at night—if she’s hungry, and she chooses foods she truly enjoys—but eats them mindfully. Sometimes I find her counting her carbs, but generally only when she’s concerned about her blood sugars, as she was diagnosed with Type 2 Diabetes several years ago.

Perhaps her next challenge will be learning to manage activity—after she has her knees replaced. And for the record, she also followed my most recent advice—she switched to a lovely new doctor, who gladly issued the prescription for the water exercise program!

A-ha! Another mystery solved.

With a title like that, there can be only one...


If you recall, in Keep 'em tight, I persuaded mum's GP to make recommendations to mum's care home re: Diet & Exercise. If you also recall, in Well, stone the (expletive deleted) crows!, agency carers were unaware of mum's GP's recommendations. Today, I had this for lunch:-


It's the same picture as in a post below, but it looked and tasted so good that I felt the need to post it again. After lunch, I asked the nurse in charge for mum's care plan.

There was no mention of mum's GP's recommendations in the care plan. I am awaiting a phone call from mum's GP tomorrow to find out what the **** is going on.

Update tomorrow.

EDIT: It's now Thursday 17th February. I received the call from mum's GP. He told the nurse who was in charge that day (Tuesday 1st Feb) to get specific information regarding exercise & diet from me. He doesn't know the name of the nurse who was in charge that day. I will be making enquiries. The book will be getting more entries, with fluorescent pink blobs to highlight them.

Some of mum's blood test results have come in. Her B12 is fine. Her calcium is on the high side, so she can stop taking two Adcal-D3 per day (which she hates as they're like chewing on sweetened chalk). Vitamin D result not in, yet. Two Adcal-D3 per day gave her only 800iu/day.

EDIT: It's now Friday 18th February. I saw a different nurse in charge today and asked her what was going on. She showed me mum's care folder and it contained the letter that I had written to mum's GP. On Wednesday, I was shown pages from the care folder but not the letter. A-ha! The nurse asked me to clarify mum's diet, so I got my green, orange & pink marker pens out and wrote a rough guide as to what mum could eat in unlimited amounts, in moderation and in very limited amounts. I photographed the guide and will be producing a tidy version on Word.

A carer said to me today "Whatever you're doing, keep doing it! Yesterday, your mum used her 3 wheeled walker unaided and found her own way to the dining room". Oh, wow!

Just wait until her Vitamin D status is improved. The last time I did that (in 2008), mum's MMSE score shot up from 14/30 to 26/30. Aricept also helped, but it usually gives only a 2 point increase.

Is there anybody out there?

'Cos there ain't mushroom in here (ouch!). Cue music video.


I've spotted a variety of fungi growing in my area. Here are some pictures. I think that I know which ones are poisonous, but I'm hoping that someone knowledgable will tell me for certain.

No.1 Found growing on a dead tree stump in my garden. I think non-poisonous.


No.2 Found growing at the base of a live tree in the woods. I think non-poisonous.


No.3 Found growing amongst dead leaves in the woods. I think poisonous.


In other news, mum got a mystery Valentine card on Monday. She managed to get it out of the envelope (despite having a bad tremor) after I got it started for her, and she also managed to read the words on the front of the card and inside. I videoed each event. The book got four green blobs (I use pink & green highlighters to highlight bad & good news) that day!

Where BMI Goes Wrong. Lessons From Cupid.

Yesterday was Valentine’s Day and no, I’m not going to flash more food porn involving chocolates. But with Cupid hovering around lately, I couldn’t help but address the subject of BMI, Body Mass Index.

What if Cupid and his parents showed up in my office concerned about obesity, what would I say? Let’s assume for a moment, from the various images of him these days that his BMI was in fact high. For the record, BMI is simply a calculation of weight divided by height squared, used as a marker for obesity. It is not, as you have been lead to believe, a measure of body fatness, or percent body fat.

If historically, as evidenced by Hallmark’s greeting cards, Cupid has always been husky from his youngest years, here’s what I’d say. Assuming he has paralleled the BMI chart, he is gaining as much annually as any other normal healthy child. It’s just that he started larger, simply genetics, most likely. I would still explore his intake and eating behaviors, recommending modifications to ensure health and prevent disease (just as I would do if an average weight individual presented for, let’s say, food allergies). But if all looked well, I would not create a problem where there was none.

If, however, I discovered he was hoarding the chocolates he planned to deliver, binge eating or emotionally overeating, perhaps because of unrequited love, these patterns would need to be addressed—with me, and with a therapist.

Like chocolates, we come in all shapes and sizes. And if your size, like Cupid’s, has always leaned on the larger end of the spectrum, it is likely that is a healthy, and normal place—for you. If, however, you have never listened to your hunger and fullness, tending to regularly use food for comfort or to manage stress and emotions, there’s room for changing your relationship with food, and as a result, your weight.

Maybe as an adult your BMI is out of range, placing you in the “obese” category. That puts you in good company, with top paid professional athletes such as Vince Wilfork and Charles Barkley. BMI is hardly the best way to gauge your size, or your risk of disease. Many with high BMI’s are quite healthy and fit, often at the top of their game. BMI may be high simply from a high muscle mass. Remember, body mass index does not distinguish where that mass comes from—muscle or fat (or bone, for that matter).

Years ago a woman who did body building recreationally came in for assistance with weight loss. It was winter, and quite frankly, visually I could never have guessed what her risk was. By the charts, she was obese, with a high weight for her height. But when I assessed her eating, I could only conclude that she wasn’t eating enough, regardless of her weight concerns. Weeks later, following a half marathon, she reported that she was hospitalized with internal bleeding. Apparently, her percent body fat was so low that there was damage to her internal organs, resulting in the bleed. Yes, body fat does have a function, and cushioning our internal organs is just one example.

But if your weight has been climbing out of a healthy range, and you have not dramatically increased your muscle mass, it may be time to take a closer look—at your activity as well as your food intake and eating behaviors.

And we should be most focused on an individual’s pattern, as opposed to their absolute weight or BMI. I had a teen patient not long ago who presented at the 50^th percentile BMI for age. Great, no? His doctor thought so, and was quite pleased with his healthy place on the chart. But a look at his BMI chart revealed that he had plummeted in a very short period, from a high BMI to “normal”. Unfortunately, this drop resulted from anything but normal thoughts and behaviors around food, but rather the consequence of a full-blown anorexia. And reinforcing how “healthy” his recent BMI was only added flames to the fire.

As for the adult Cupid, waist circumference, or waist to hip ratio, would likely tell me more, suggestive of abdominal fat, and associated with chronic diseases including Type 2 diabetes. A waist circumference above 35 inches (women) and 40 inches (men) it is considered a predictor of increased risk. The waist-to-hip ratio—literally, your waist measurement divided by your widest hip measurement—is also a good predictor of risk. 1.0 or above is greater risk, and desirable is 0.8 for women, 0.9 for men. See http://www.cdc.gov/healthyweight/assessing/index.html

But perhaps the best measure to use would be percent body fat (most accurately determined by underwater weighing, but indirectly measured with calipers or more high tech devices).

And yet I rarely recommend it. Why? Because we really don’t need another measure, another number to fixate on. If your weight is climbing out of range, you’ll know it. Take a look at your eating patterns, and activity. Focus on eating mindfully and separating physical hunger from all the other reasons you eat. Reread some past posts on this blog for more guidance!

And if your weight is above a “desirable” BMI, but has been stable for years, and you have normal blood pressure, cholesterol and blood sugar, let it go. As long as you can comfortably engage in activity to keep you strong and fit for years to come.

Gluten-Free Chocolate Muffins Recipe

Sexy delicious gluten-free vegan chocolate muffins.

Today's post is short and sweet and all about muffins. Not just any old muffins, either. Gluten-free chocolate muffins. Because as any gluten-free goddess knows, chocolate makes breakfast better.

Gluten-free chocolate muffins for breakfast or tea time.

GFG Chocolate Muffins Recipe

I happen to love the taste of quinoa flour. It complements chocolate perfectly. But if you're not a fan of quinoa flour's taste, substitute your own higher protein flour. Buckwheat, almond, or brown rice flour should work.

Preheat the oven to 375ºF. Line a twelve muffin tin with paper liners.

Ingredients:

1/2 cup organic quinoa flour

1 cup sorghum flour

1/4 cup GF millet flour

1/4 cup potato starch (not potato flour)

1/2 cup unsweetened cocoa powder

1 1/2 teaspoons baking powder

1/2 teaspoon baking soda

1/2 teaspoon fine sea salt

1 teaspoon xanthan gum

1/2 teaspoon nutmeg

1 cup organic light brown sugar

1/4 cup light olive oil

3/4 cup to 1 cup rice milk- start with less

1 tablespoon Ener-G Foods Egg Replacer whisked with 1/4 cup warm water till frothy*

1/4 teaspoon lemon juice or light tasting rice vinegar

Instructions:

Whisk the dry ingredients in a bowl. Add the wet ingredients. Mix until the batter is smooth- it will be slightly sticky. If it climbs the beaters use a figure eight motion to control the batter better.

If the batter is too thick, add in a little rice milk at a time until it becomes smooth- like a thick version of cake batter.

Stir in:

1/2 cup chopped pecans or walnuts (omit for nut-free)

Heaping 1/2 cup of vegan chocolate chips

Spoon the batter into twelve lined muffin cups. Swirl and smooth the tops with a wet finger if you need to. Top each muffin with a pecan, chopped walnuts, or a couple of chocolate chips, as you prefer.

Bake in the center of a hot oven until domed and firm, but springy. About 17-20 minutes. Remove the baked muffins from the pan as soon as possible and cool on a wire rack (this keeps the bottoms from steaming).

Fabulous, fabulous, fabulous warm from the oven, when the chocolate chips are melty. When cooled, I recommend wrapping each muffin in foil and freezing in a freezer bag for optimum freshness. Thaw to room temperature.

Cook time: 20 min

Yield: One dozen muffins

*Or use two large free-range organic eggs and omit the vinegar.

Recipe Source: glutenfreegoddess.blogspot.com

All images & content are copyright protected, all rights reserved. Please do not use our images or content without prior permission. Thank you. 

Weekend link lurve.

Today, I built a bird table. Ta-da!


My sister bought this in kit form about a year ago, but couldn't find anyone to assemble it for her. I live about 40 miles away and, having been a bit occupied with mum's illness & (lack of) care, didn't get around to visiting her until today. I also fault-found her Hitachi TV (which uses a cathode ray tube) and inadvertently fixed her digi-box by accidentally rebooting it!

Before I drove there, I noticed that the YouTube videos in my blog weren't playing. I don't know what went wrong, but I've had to change the embed code on all of them from the new "iframe src=" style to the older "embed src=" style and they appear to be working again.

Polyphenols, Hormesis and Disease: Part I

What are Polyphenols?
Polyphenols are a diverse class of molecules containing multiple phenol rings. They are synthesized in large amounts by plants, certain fungi and a few animals, and serve many purposes, including defense against predators/infections, defense against sunlight damage and chemical oxidation, and coloration. The color of many fruits and vegetables, such as blueberries, eggplants, red potatoes and apples comes from polyphenols. Some familiar classes of polyphenols in the diet-health literature are flavonoids, isoflavonoids, anthocyanidins, and lignins.

The Case Against Polyphenols

Many diet-health authorities seem pretty well convinced that dietary polyphenols are an important part of good health, due to their supposed antioxidant properties. In the past, I've been critical of the hypothesis. There are several reasons for it:

1. Polyphenols are often, but not always, defensive compounds that interfere with digestive processes, which is why they often taste bitter and/or astringent. Plant-eating animals including humans have evolved defensive strategies against polyphenol-rich foods, such as polyphenol-binding proteins in saliva (1).
2. Ingested polyphenols are poorly absorbed (2). The concentration in blood is low, and the concentration inside cells is probably considerably lower*. In contrast, essential antioxidant nutrients such as vitamins E and C are efficiently absorbed and retained rather than excluded from the circulation.
3. Polyphenols that manage to cross the gut barrier are rapidly degraded by the liver, just like a variety of other foreign molecules, again suggesting that the body doesn't want them hanging around (2).
4. The most visible hypothesis of how polyphenols influence health is the idea that they are antioxidants, protecting against the ravages of reactive oxygen species. While many polyphenols are effective antioxidants at high concentrations in a test tube, I don't find it very plausible that the low and transient blood concentration of polyphenols achieved by eating polyphenol-rich foods makes a meaningful contribution to that person's overall antioxidant status, when compared to the relatively high concentrations of other antioxidants in blood* (uric acid; vitamins C, E; ubiquinone) and particularly inside cells (SOD1/2, catalase, glutathione reductase, thioredoxin reductase, paraoxonase 1, etc.).
5. There are a number of studies showing that the antioxidant capacity of the blood increases after eating polyphenol-rich foods. These are often confounded by the fact that fructose (in fruit and some vegetables) and caffeine (in tea and coffee) can increase the blood level of uric acid, the blood's main water-soluble antioxidant. Drinking sugar water has the same effect (2).
6. Rodent studies showing that polyphenols improve health typically use massive doses that exceed what a person could consume eating food, and do not account for the possibility that the rodents may have been calorie restricted because their food tastes awful.

The main point is that the body does not seem to "want" polyphenols in the circulation at any appreciable level, and therefore it gets rid of them pronto. Why? I think it's because the diversity and chemical structure of polyphenols makes them potentially bioactive-- they have a high probability of altering signaling pathways and enzyme activity, in the same manner as pharmaceutical drugs. It would not be a very smart evolutionary strategy to let plants (that often don't want you eating them) take the reins on your biochemistry. Also, at high enough concentrations polyphenols can be pro-oxidants, promoting excess production of free radicals, although the biological relevance of that may be questionable due to the concentrations required.

A Reappraisal

After reading more about polyphenols, and coming to understand that the prevailing hypothesis of why they work makes no sense, I decided that the whole thing is probably bunk: at best, specific polyphenols are protective in rodents at unnaturally high doses due to some drug-like effect. But-- I kept my finger on the pulse of the field just in case, and I began to notice that more sophisticated studies were emerging almost weekly that seemed to confirm that realistic amounts of certain polyphenol-rich foods (not just massive quantities of polyphenol extract) have protective effects against a variety of health problems. There are many such studies, and I won't attempt to review them comprehensively, but here are a few I've come across:

• Dr. David Grassi and colleagues showed that polyphenol-rich chocolate lowers blood pressure, improves insulin sensitivity and lowers LDL cholesterol in hypertensive and insulin resistant volunteers when compared with white chocolate (3). Although dark chocolate is also probably richer in magnesium, copper and other nutrients than white chocolate, the study is still intriguing.
• Dr. Christine Morand and colleagues showed that drinking orange juice every day lowers blood pressure and increases vascular reactivity in overweight volunteers, an effect that they were able to specifically attribute to the polyphenol hesperidin (4).
• Dr. F. Natella and colleagues showed that red wine prevents the increase in oxidized blood lipids (fats) that occurs after consuming a meal high in oxidized and potentially oxidizable fats (5).
• Several studies have shown that hibiscus tea lowers blood pressure in people with hypertension when consumed regularly (6, 7, 8). It also happens to be delicious.
• Dr. Arpita Basu and colleagues showed that blueberries lower blood pressure and oxidized LDL in men and women with metabolic syndrome (9).
• Animal studies have generally shown similar results. Dr. Xianli Wu and colleagues showed that whole blueberries potently inhibit atherosclerosis (hardening and thickening of the arteries that can lead to a heart attack) in a susceptible strain of mice (10). This effect was associated with a higher expression level of antioxidant enzymes in the vessel walls and other tissues.

Wait a minute... let's rewind. Eating blueberries causes mice to increase the expression level of their own antioxidant enzymes?? Why would that happen if blueberry polyphenols were protecting against oxidative stress? One would expect the opposite reaction if they were. What's going on here?

In the face of this accumulating evidence, I've had to reconsider my position on polyphenols. In the process, and through conversations with knowledgeable researchers in the polyphenol field, I encountered a different hypothesis that puts the puzzle pieces together nicely.  I'll discuss that in the next post.


* Serum levels of polyphenols briefly enter the mid nM to low uM range, depending on the food (2). Compare that with the main serum antioxidants: ~200 uM for uric acid, ~100 uM for vitamin C, ~30 uM for vitamin E.