The “No Diet” Diet: Dispelling Diet Myths and Empowering Individuals

     The weight loss and diet industry is worth billions of dollars, annually. This may be of no surprise to you, given the widespread focus in our society on body size, “health” and nutrition. Needless to say, our society is saturated with dieting consumers, hopeful of losing weight. So the question begs to be asked: What are the results of all these dieting efforts? Are the billions of dollars spent on diets and weight-loss paying off? Or on the contrary, are our efforts actually proving to be more problematic than helpful?

     First of all, the reality: dieting has yet to reveal a sustainable solution for weight management. Although fad diets may facilitate quick weight loss, sustainable weight management is another story. The short story is: dieting doesn’t work. What's more, dieting can provoke metabolic disturbances and disordered eating patterns which can lead to destructive, and potentially dangerous health and emotional outcomes. I’d like to present an alternative approach, the “No Diet” Diet. This depicts a lifestyle free of dieting -- an experience defined not by rules, numbers or irrational beliefs. Instead, it invites instinct, trust, freedom and a true loving of self and body. For some, this experience with food is quite foreign, so much that the thought may sound intimidating, maybe even daunting. The truth is, however, that our ability to trust our body and restore a relationship with food, is possible.

     Imagine a young child that is being encouraged to eat past fullness. How much success is the parent going to have in encouraging the child to continue eating? Very little. Why is this the case? Because human beings are innately equipped with internal cues which signal to us: ‘it’s time to eat’ or ‘stop eating.’ So what happens as we get older? External factors can confuse our ability to listen to these internal cues. External factors such as stress, emotions, social norms, disordered eating behaviors, body image struggles, distrust in body (or self), to name a few. Thus, many feel they need dieting in order to monitor their food intake. When likely, it is the internal cues innate to our existence that have been quieted -- overshadowed by messages suggesting we “skip meals to lose weight” or invitations to religiously restrict calories under caloric needs, often to wreak havoc on our metabolism and our emotional well-being.

     So why hasn’t this “No Diet” Diet caught on? Maybe it’s because, as a society, we desire convenience. We desire “quick fixes.” And… if we’re being honest, we struggle with being patient. I mean, do we really want to take the scenic route when we can get there faster another way? I know I’ve thought that. The “No Diet” Diet is not a quick fix. Instead, it is a way of living. And like anything, relearning something that we haven’t done in a while…takes time. And the benefits? Freedom! Freedom to nourish our body and enjoy food. Freedom to empower our whole self – body, mind and soul. The scenic route is available to us all. The question you may be asking is: Do I want to take it? Oh and if you do, there’s just one thing you’ll have to give up. Dieting.

A Challenging Recipe: How Medical Nutrition Therapy Can Help in Substance Use Disorders and Diabetes-Sue McLaughlin, MOL, BS, RD, CDE,

 

Substance Use Disorders: Diagnosis, Causes, and Treatment

 

Substance use disorders (SUD) are categorized

with more than 300 other psychiatric 

diagnoses

 

 

 

1952 (DSM-I) by the American Psychiatric

Association, this was the first official

manual of mental disorders focusing on

clinical application. The need for such a

publication arose from growing recognition

by the United States Army and

Veterans Administration that World War

II veterans needed services addressing

what we now refer to as mental health

disorders (2). The most recent version of

 

 

the DSM, DSM-5, was released in May

 

 

 

2013 and continues to be viewed as the

“bible” by mental health professionals

who diagnose psychiatric illnesses in

adults and children. It uses a multidimensional

approach (i.e., consideration

of clinical syndromes, developmental

disorders and personality disorders,

physical conditions, severity of psychosocial

stressors, and highest level of

functioning) as the basis for diagnosing

mental health disorders because other

factors in a person’s life typically affect

mental health.

 

 

Compared to the DSM-IV, the DSM-5

 

 

 

does not differentiate between substance

abuse and dependence, but

instead, recognizes them as the same

disorder on a continuum within a new

category referred to as “addictions and

related disorders”(1). To diagnose substance

 

 

use disorder, the DSM-5 states

 

 

 

that two or more criteria must be

present within a 12 month period.

Severity of the SUD is based on the

number of criteria presented, ranging

from mild (2 – 3 criteria) to moderate (4-

5 criteria) to severe (6 or more criteria).

Genetic factors are recognized for

their role in causing substance use disorders.

Additional theories about the

causes of substance use disorder

include a desire to cover up or obtain

relief from an uncomfortable life situation

or chronic problem, (i.e. self-medicating

to address emotional or physical

pain) (1).

  

Magnitude of the Problem

  

• In 2012, the Center for Behavioral

Health Statistics and Quality,

Substance Abuse and Mental Health

Services Administration, and the

United States Department of Health

and Human Services published a

162-page report of findings from the

2011 National Survey on Drug Use

and Health (NSDUH) (3). This survey

is conducted annually to gather

information about the use of illicit

drugs, alcohol, and tobacco, with

data collected during the month just

preceding the survey interview. The

2011 interviews involved approximately

67,500 nonmilitary, noninstitutionalized

individuals aged 12

years or older. The following is a

snapshot of the 2012 report. Survey

results have been extrapolated to

reflect trends applicable to the larger

United States population.’’

• An estimated 22.5 million people

(8.7% of the population) were currently

using illicit drugs, defined as

marijuana/hashish, cocaine (including

crack), heroin, hallucinogens,

inhalants, or prescription-type psychotherapeutics

(pain relievers, tranquilizers,

stimulants, and sedatives)

used nonmedically.

• Slightly more than 50% of respondents 

reportedly had consumed

alcohol, with slightly more than 58

million individuals (22.6% of the population)

having engaged in binge

drinking (defined as having 5 or

more drinks on the same occasion)

on at least 1 day during the 30 days

before the survey.

• Among young adults aged 18 to 25

years, binge drinking was reported

by nearly 40% of respondents, with

heavy drinking reported for more

than12%. Heavy drinking was

defined as binge drinking on at least

5 days during the past 30 days.

• Slightly more than 68 million

Americans (26.5%) reported using

tobacco products, with the majority

smoking cigarettes (22.1%), followed

by cigars (5%), smokeless tobacco

(3.2%), and pipes (<1%).

• Not quite 21 million individuals (8%

of the population) were estimated to

meet the criteria for substance

dependence or abuse, according to

the DSM-IV criteria.

• Treatment provided by medical facilities

specializing in substance abuse

(now categorized as SUD in DSM-5) is

severely lacking for those in need. Of

the nearly 22 million individuals aged

12 years or older in need of treatment

for illicit drug or alcohol abuse,

fewer than 11% received treatment.

  

Prevalence of Substance Use

Disorder in Individuals with

Diabetes

  

The NSDUH survey was conducted

among the general United States population

and did not identify participants

who had a coexisting diagnosis of diabetes.

Nonetheless, given the number 

of individuals known to have diabetes

in this country (25.8 million) (4), medical

nutrition professionals/diabetes educators

inevitably will work with a number

of patients who have both diabetes and

a substance use disorder diagnosis.

  

Tobacco Use

    

Recent data from the Centers for

Disease Control and Prevention found

that 20% of adults aged 18 years or

older with diabetes reportedly smoked

cigarettes (5). Several studies have

linked cigarette smoking to an increased

risk for microvascular complications of

diabetes (6) as well as insulin resistance,

elevated blood pressure, and impaired

endothelial function (7,8). Other investigators

have reported a dose-dependent

association between cigarette smoking

and the risk for type 2 diabetes (9). Early

smoking cessation has been shown to

reduce the risk for developing type 2

diabetes to a level comparable to that of

nonsmokers (10) and to mitigate the

increased risk for coronary heart disease

and mortality (11).

  

Alcohol

    

Based on data gathered from epidemiologic

surveys and reports of those

seeking treatment, 50% to 60% of individuals

with diabetes currently are estimated

to use alcohol (12,13). Binge

drinking has been shown to increase

the risk for diabetic ketoacidosis and is

an independent risk factor for peripheral

neuropathy and retinopathy (14).

This is particularly worrisome for adolescents

and young adults with type 1

diabetes because of the risk-taking

behaviors that are common in these

age groups and the prevalence of binge

drinking, as described previously.

Other studies have shown a higher

rate of adverse health outcomes linked

to alcohol (15) or other drug use substance

disorders among those with diabetes.

Leung and colleagues (16)

reported increased hospitalizations,

longer length of hospital stays, and

more frequent and severe healthrelated

complications for Medicare

and/or Medicaid beneficiaries with type

2 diabetes and a coexisting diagnosis of

an alcohol or substance use disorder.

Finally, individuals who have substance

use disorder diagnoses are less likely to

follow diabetes treatment guidelines,

including visits to the medical team for

routine diabetes care (17).

  

Treatment

  

Research is ongoing to identify the

most effective treatment approaches

for individuals dealing with substance

use disorders and diabetes, individually

and as comorbid chronic diseases.

Several studies have documented

improved coordination of care and positive

outcomes with a team-based care

approach, as in the patient-centered

medical home (18). Some investigators

found reductions in nicotine dependence

and the negative consequences of

alcohol use with an integrated care

model (18,19). A report by Ghitza and

associates (20) found implementation

of this care model resulted in lower

total medical costs and improved

health outcomes in a variety of settings.

Ongoing social support in a one-on-one

or group setting, coupled with an open

and non-judgmental approach have

been recognized as critical components

of treatment for both diabetes and substance

use disorders. However, the

effectiveness of participation in

Alcoholics Anonymous (AA) has

revealed mixed results, as described in a

review by Kastakas (21).. The number of

people with diabetes in this review was

not identified.

As reported by McLellan and colleagues

in 2000 (22), part of the challenge

in treating substance use

disorders is fueled by a longstanding

belief held by the public and some

medical care providers that dependence

is an acute condition, rather than a

chronic illness. The researchers conducted

a literature review comparing

drug dependence to several other

chronic diseases: type 2 diabetes,

hypertension and asthma. Comparators

included diagnosis, heritability, genetic

and environmental factors, pathophysiology,

adherence to treatment, and

relapse rates. Results of the review led

the researchers to conclude that drug

dependence must be viewed as a

chronic illness, and that long term

strategies of medication management 

prepare and the accompanying nutritional

concepts/benefits, which sets

the intention, putting the lesson into

a larger framework. Before the first

cooking class, a session on kitchen

sanitation and safety is very helpful

(we use a video and quiz). Obviously,

everyone must understand that they

must wash their hands before beginning

to work.

• Establish an overall learning goal of

demystifying the process of putting

food on the table. This can be accomplished

by imparting general kitchen

skills (e.g., measuring ingredients, use

of knives); techniques and shortcuts;

use of equipment; sanitation and

safety; following and modifying

recipes; preparing food from scratch

for control of nutrient content;

preparing lower fat and sodium,

higher fiber, less processed, less

expensive, better-tasting food; overcoming

fear of trying new foods; and

reducing the carbon footprint.

Specific aspects are predicated by

participants’ interests and nutrition

goals.

• Introduce new “weird” foods (e.g.,

tofu, quinoa) by weaving the familiar

with the less familiar. For example,

we make changes in traditional

southern recipes, such as preparing

collards seasoned with lemon juice

or sesame oil instead of fatback, creating

barbeque tempeh with a

homemade low-sodium sauce, crafting

a glorified version of macaroni

and cheese by sneaking in some tofu,

and developing an oriental stir fry

with gluten (affectionately dubbed

“Chinese Chitlins”). Presenting nutrient

dense foods and their role in

disease prevention and treatment

along with discussion of additional

health-related topics specific to the

audience can pique interest and

increase acceptability.

• Consider other hands-on nutrition

education activities, such as field

trips to farmers’ markets, “health

food” stores, supermarkets, restaurants,

and farms.

• Gather outcomes data with simple

pre- and posttests of objective knowledge,

food habits, attitudes, and/or

self-efficacy. Do the participants still 

think of tofu as a four-letter word?

Share your results with institution

administrators to gain support for

expanding the program.

Incorporating hands-on nutrition

education into your RD toolbox can

enhance customer success while broadening

your skills, job satisfaction, and

fun quotient.

  

“Cook for Life” Program

    

“Cook for Life” was launched in

August 2011, and is the Gainesville, FL,

version of the Veterans’ Administration

Nutrition and Food Services’ “Healthy

Teaching Kitchen” project. Conducted

by two RDs, the format includes 5

weeks of 2-hour sessions. Four of the

sessions are hands-on cooking classes

(very roughly themed breakfast, lunch,

dinner, and snacks) and one session is a

“consumer savvy” field trip to a local

food market. Veterans are referred from

the MOVE weight management

program and outpatient nutrition

clinics, most commonly due to one or

more health concerns of overweight,

hypertension, or diabetes. Our mission

is to give participants the tools and

motivation to prepare healthy, tasty,

affordable meals to meet their dietary

needs. The class is usually limited to

four to eight people, and Veterans are

encouraged to bring their significant

others or family members.

Before the first class, students complete

an interest/needs survey (so we

can tailor the menu items and topics to

each cohort) and a preprogram questionnaire.

The questionnaire is designed

to discern each participant’s baseline in

terms of dietary knowledge, attitudes,

and self-efficacy. At the end of the final

session, we ask them to complete the

questionnaire again as well as a participant

evaluation of the program. Using

this material, we can generate quantitative

data to document any changes in

the dietary indices and qualitative data

about the program to help us modify

and improve it.

As of September 2012, data has been

collected from 22 of 31 participants

(several participants did not attend the 

final meeting). The knowledge and attitudinal

sections of the questionnaires

produced less useful results. This may

be due to confusing wording of the

items, such as “Write the number that

best reflects how you feel right now (1 –

5 from strongly disagree to strongly

agree): Unsalted foods always taste terrible.”

There were only four or five items

in those sections. In contrast, the selfefficacy

questions revealed definitive

changes. Participants were asked to rate

their degree of confidence by recording

a number from 0 – 100 using a scale

ranging from 0 = cannot do at all to 100

= highly certain can do. One example

that they were asked to rate was: “How

certain are you that you can…..shop for

healthy food?” By tracking general

trends (grouping results: 0 to 49%, 50%

to 79%, 80% to 100% ) rather than

smaller incremental changes, the selfefficacy

data indicated a clear trend

from “clueless” to “confident” in all ten

items. These results are particularly

gratifying because the adherence literature

reveals self-efficacy to be the only

consistent indicator of behavioral

change. In other words, people who

perceive themselves as capable of

doing something are much more likely

to attempt the task and to succeed.

The program evaluation form poses

questions such as “What was the most

helpful part of this program?” and asks

for favorite and least favorite parts as

well as suggestions for improving the

program. In response to “Do you feel

that your participation in this program

will help you in achieving your health

goals?”, 19 of 22 participants answered

“yes” (plus 1 neutral and 2 “somewhat”).

Favorite and helpful parts of the

program included linking food to

health, how to prepare various foods,

new ways of cooking, exposure to new

foods, spices, ideas, group discussion

and input, gaining confidence by

hands-on cooking, getting copies of

recipes, and especially eating. Other

  

comments included “delightful surprise,”

“look forward to the class each week,”

and “enjoyed learning how to use a pressure

cooker.” Suggestions for future

classes included more meat, more

menu planning, more liquids, and most

commonly, more and longer sessions.

A larger data set (n=86, ) was also 

collected May 2011 to May 2013 from

the SARRTP nutrition education

program, where cooking classes have

been conducted for more than 15 years.

  

Of 69 residents who were asked “Do you

feel that the nutrition knowledge and

skills you gained will help you in sustaining

   

your recovery?”, 64 wrote in “yes”, 3

“no”, and 2 “somewhat”. Although

SARRTP is voluntary, residents are often

surprised by the mandatory “Nourishing

Recovery” didactic and hands-on

cooking classes, which often lead to

some initially reluctant and even hostile

participants. Their feedback frequently

notes that they had negative impressions

initially, but then found they

actually enjoyed the classes.

Serendipitous positive outcomes

included socializing with peers, staff,

and volunteers as a means to practice

social skills; discovering an interest in

nutrition; realizing the joy of cooking in

community; and working through other

life issues via food and cooking.

Overall, “Cook for Life” participants

from both groups have found hands-on

cooking classes to be informative, motivating,

and simply fun. The dietetic

practitioners have verified that the

program is extremely gratifying for

them. Our goal as RDs is to teach and

promote healthy food preparation and

cooking habits, for a greater understanding

of how diet modulates health,

and the acquisition of practical experience

and skills to be implemented in

the home. “Cook for Life” provides this

in a patient-centered, nonjudgmental,

supportive atmosphere where RDs can

inspire creativity and confidence,

empowering our Veterans to optimum

nutritional wellness.

As the Native American proverb

states, “Tell me and I’ll forget. Show me

and I may not remember. Involve me

and I’ll understand.”

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

How common are eating disorders in the Latino population? Mae Lynn Reyes-Rodriguez Ph.D.

Historically, these disorders have been associated with white upper middle class females. The fact that most of the research, assessment measures, and diagnostic criteria have been developed for the Caucasian population has contributed to the misperception that EDs do not occur in diverse populations. However, EDs occur among all races/ethnicities, ages, sexes, and socioeconomic backgrounds (2,3). Specifically, in the Latino population, our knowledge about EDs comes

from studies conducted in Latin America, but less is known about these disorders in Latinos/as living in the United States. Some studies propose that the prevalence of disordered eating behaviors in Latina women is similar to or higher than those in non-Latina white women (4,5,6). The estimated lifetime prevalence in the United States of anorexia nervosa among Latinos is .08% in women and .03% in men, of bulimia nervosa 1.9% in women and 1.3 in
men, and of binge eating disorder 2.3% in women and 1.6% in men (4). In a study conducted in a large college sample in
Puerto Rico, 3.26% of females and 4.40% of males reported symptoms congruent with the DSM-IV criteria for bulimia nervosa (7). Surprisingly, in this sample, the frequency and severity of symptoms related to bulimia nervosa were more common in males, pointing out the need to explore EDs in males and to develop male-friendly detection and referral programs at college campuses (8).   

What's New for Eating Disorders in the DSM-5? by Mae Lynn Reyes-Rodriguez, Ph.D.

The new category in the DSM-5 is now called Feeding and Eating Disorders and includes presentations that occur both in children and adults, namely pica and rumination disorders, avoidant/restrictive food intake disorder (ARFID), anorexia nervosa, bulimia nervosa, binge eating disorder, and other specified feeding and eating disorders (OSFED) (1). The most relevant changes between the DSM-IV and DSM-5 for anorexia nervosa are the elimination of amenorrhea and the phrasing of the criterion related to fear of weight gain to include a  behavioral component. For bulimia nervosa, the reduction of the frequency of binges from twice to once per week over a 3-month period was the most significant change.
Finally, binge eating disorder was recognized as a distinct eating disorder (ED) marked by the same frequency of binge eating as described for bulimia nervosa.

Maybe Food is Love - Rachel Myhre, MS, RD, CD

Food, Relationships and Love

 

At the core of the human heart -- indicative of an innate longing -- is a desire for connection. Connection with people. The words and life of Christopher McCandless capture this notion well. The24-year old hiker -- who ventured into the Alaskan wilderness, desiring a time in solitude – stated these words near the end of his life: “Happiness is only real when shared.” [Italics mine]The very wildness that would take his life, exposed his profound realization. A realization that rings true for so many.

Although unique to each individual, the desire for genuine relationships, connection and love is safe to assert. And may we pause to reflect on the fact that human connection is unattainable separate from the building blocks of life which sustain it.

“Everyone runs on food. Every hug, every kiss, every page ever written is because of food. Without food there is no life. Everyone has to eat! I was so disconnected from the real purpose of food as nutrition and so focused on the emotional uses of food that I forgot that we all run on food. This was an important realization in my recovery and still strikes me as important.” –TA ¹

How often do we become disconnected from the primary purpose of food and nutrition that we overlook the fact that food is fundamental to life? And thus fundamental to connection. This is not breaking news to anyone I am sure. And yet, how often do we neglect the role of food as nourishment? And letexpectations, diets, fears or destructive habits pertaining to foodbecame our focus? How often do we trust our innate ability tolovingly fuel our body?

In the midst of this appreciation, we acknowledge thatconnection can be stirred by a candlelit dinner. We acknowledge that memorable holidays and celebrations would not be the same without the food traditions that enrich them.

Food nourishes our body in a way that is vital to life.Connection nourishes our soul in a way that breathesrelationship, meaning and love into our existence. Our experience with food can never replace the genuine connection we experience with people. And connection with people, alone,cannot sustain our lives. So let us embrace the relationships and love that are beside us. And may the nourishment of your bodyset the stage for the nourishment of your soul.

 

1.

8 Keys to Recovery from an Eating Disorder. Carolyn Costin &Gwen Schubert Grabb

No Weigh! Support Group Starting January 9, 2014

No Weigh! Support Group

Emotions and Food. How do these interact? What is emotional eating? Emotional eating can be described as eating, without the presence of hunger, to distract from emotions. For many, even eating a slice of birthday cake can elicit feelings of guilt, shame or regret. If you struggle with emotional eating, feel that your relationship with food disrupts your attempts to live your life, or are continually frustrated by weight issues, you are not alone. No Weigh! Support Group was specifically designed to address the unique needs of those struggling with binge eating disorder and emotional eating. This group is a safe, non-judgmental place for participants to explore their true selves, and learn to fill up on life, not food.

*Please call (206) 909-8022 or e-mail Estevan@rameynutrition.com to learn more or sign up!*

Our weekly group begins:

January 9^th, 2014

@5:30-7pm

Ramey Nutrition, 4241 11^th Ave. NE Ste. B, Seattle, WA  98105

Check out our new Team Page!! http://rameynutrition.com/team