Reasons This Dietitian Refuses to Cut Out Sugar

On the heels of the anti-carb movement is the notion that sugar is bad and to feel good, look good, lose weight, and be healthy, you just need to cut out sugar! Advocates of a sugar-free diet proclaim that people need to remove table sugar, sweeteners such as honey and maple syrup, condiments, dressing, refined flour, soft drinks, sweets, dairy products, and often fruits such as bananas and apples.

I don’t agree! Here’s some reasons why…

#1. I love food. All food.  And…”cutting out” a particular food “for the sake of health” would actually compromise health.

Health is more than just a physical state of being or defined by the mass of your body tissue. For any individual – especially a health provider – who believes otherwise, consider spending some time working with individuals struggling with all types of eating disorders. I have worked with plenty of people who have a healthy weight and BMI, and are far from “healthy” or able to enjoy life.

Mental and psychological well-being matters for overall health too and enjoying a variety of nutritious and enjoyable food supports this important aspect of health.

Yes, it’s true. Food is fuel and what we eat matters! As such, I’m a huge proponent of cooking at home (most of the time), and enjoying a variety of wholesome and nutrient-dense foods.

…But, there’s more to food and eating, such as food memories; heirloom recipes; favorite foods; celebrations; holidays; social events – many of which happen to include sugar. I prefer not to minimize the fact that there’s something special about food and how it brings us together. Whether it’s religious, ethnic, holiday or family traditions, food has a meaningful role.

Christmas hors d’oeuvres…my mom and daughter (making her famous fried pickles!)

For those who play the “I just enjoy these foods occasionally-card,” but you still believe the forbidden food is “bad”, or that your health will suffer because of eating these foods, that’s just a recipe for shame, guilt, stress, and anxiety. Research, Research, and more research demonstrate that people who worry about food are more likely to get caught in a cycle of restrict, eat, overeat, guilt, repent, and repeat; and, consequently gain more weight in the long run.

Most important is that some of my everyday “favorite foods,” that I’d rather not give up, contain natural or added sugar (yogurt, milk, fruit, bread, crackers), and happen to provide important nutrients (calcium, vitamin D, B vitamins, fiber, etc). Consumed in moderation, these foods make it easy to combine nutrition with convenience, affordability – and pleasure.

#2. I love to cook and bake – and sugar happens to be important ingredient for a quality food product.

One of my favorite recipes for Pecan Lassies…clearly it’s been used a bit!

I learned the hard way when fat was the “evil dietary villain”, that removing fat from cooking (i.e. replacing oil in muffins with applesauce; cream cheese in cheesecake with strained yogurt, or half-and-half with nonfat evaporated skim milk) resulted in poor food quality. At the time,  somehow I “believed” that the food was “good”. But, when I was really honest with myself, the truth was that the food and these cooking methods sucked!

The sugar-free diet explosion and food substitutions are no different. When boredom sets in after removing all the offending foods, efforts to replace sugar in recipes with Stevia or artificial sweeteners, sugar alcohols; or, the example of making a pancake with nothing more than an egg, some banana and a little cinnamon is, well, just history repeating itself.

Yes, sugar is valued (or demonized) for it’s sweet taste, but it also performs many other essential functions in cookies, cakes, and other baked goods. In addition to adding flavor, sugar affects the texture of food by creating tenderness and keeping baking goods soft and moist, while adding color and crunch in a recipe.

I’ve worked with folks who’ve tried to bake a so-called “healthy” dessert, i.e. leaving out sugar, and what resulted was a poor quality product that triggered a binge. No, this doesn’t happen to everyone, but the point is that when your experience with a particular food (taste, mouthfeel, aroma) is less than your expectations (or what your brain remembers), there can be an impulsion to keep eating hoping that eating more will provide the satisfaction you desired.

#3. I’ve been doing this “nutrition thing” for more than a couple decades and have helped many people over this time achieve their weight and health goals without needing to follow this particular “rule” and become worried or obsessed about sugar in food. I’m sensitive to the fact that we all have a unique relationship with food, so perhaps “cutting out sugar” seems like the right thing for some folks. It just seems a bit extreme and with a disrespect for the potential long term consequences of restricting or forbidding sugar – or any particular food.

I do not subscribe to the “eat like me, look like me” style of nutrition counseling, so I suppose my habits and relationship with food shouldn’t matter. Perhaps my clients, family, and myself are just “an anomaly.” I’ve actually heard that before. On the other hand, there’s a chance that all these folks, including myself, share many of the the same busy and stressful life and food challenges that everyone else does, and are evidence that it is possible to trust your body, trust your instincts with food, use non-food ways to manage stress and emotions and ultimately find balance with all foods so that you can enjoy pleasurable foods, and still “be healthy.”

#4. It’s called “Balance, Variety and Moderation.”
I know. Not a popular (nor sexy) headline. The idea that the sugar industry is out to kill us (per the reputable Dr. Oz) and headlines claiming that “Sugar is as addictive as cocaine and heroine” gets more views, followers and sells more.

For those readers who believe any of that, you may want to read “No, Sugar isn’t the new heroin” by Traci Mann, researcher from the University of Minnesota.

With respect and without judgement, the truth is that some people struggle with over-consumption – for many different reasons. Some unknowingly, while others recognize an intense and persistent draw to highly palatable foods for reward, comfort, etc. The reality is that some folks really do struggle with over-consuming sugar/food; alcohol (and I’m not referring to those with a known alcohol addiction); they may also overspend; over-commit; over-exercise – hopefully you get the idea.

In the case of over-eating – or when sugar feels like an “addiction,” making healthy and sustainable behavior change is possible. When a particular food (i.e. highly palatable foods such as sugar-laden goodies) take up residency as the go-to for nutrition, then we need to work on changing the “mental channel.”

This may mean “taking a break” from a trigger food or foods to create a safe and healthy eating environment that focuses on nutrient-dense foods. But, this is NOT
…a 10, 20, or 30- day detox.
…the idea that XYZ food (that contains sugar) is fatal and should be forbidden
…believing fear based messages about XYZ food.
…giving into the idea that “you are a flawed person” and someone else can “eat whatever they want.”

Finally…

#5. Plain and simple, it’s disordered eating to have forbidden foods.
Disordered eating has become normalized in our culture – but that doesn’t make it right or healthy. It is well established that restrictive eating, eliminating foods/food groups, and dieting is an environmental trigger for pathological eating problems and all types of eating disorders.

Not everyone has an eating disorder and eating disorders are a complex mental illness, but restriction and worrying about food is certainly an important risk factor that shouldn’t be disregarded or minimized when making or receiving nutrition recommendations.

The statistics speak for themselves. The National Eating Disorders Association (NEDA) reports that 35% of “normal dieters” progress to pathological dieting and that 20-25% of those individuals develop eating disorders. Furthermore, hospitalizations involving eating disorders have increased for all age groups, but hospitalizations for patients aged 45-65 have increased the most, by 88 percent, from 1999 to 2009.

When one considers the common emotional and behavioral symptoms of an eating disorder, it’s worth questioning the “normalization” of dieting or food restricting – “for the sake of health”.

Common Emotional and Behavioral Symptoms of an Eating Disorder:

– In general, behaviors and attitudes that indicate that weight loss, dieting, and control of food are becoming primary concerns
– Preoccupation with weight, food, calories, carbohydrates, fat grams, and dieting
– Refusal to eat certain foods, progressing to restrictions against whole categories of food (e.g., no carbohydrates, etc.)
– Appears uncomfortable eating around others
– Food rituals (e.g. eats only a particular food or food group [e.g. condiments], excessive chewing, doesn’t allow foods to touch)
– Skipping meals or taking small portions of food at regular meals
– Any new practices with food or fad diets, including cutting out entire food groups (no sugar, no carbs, no dairy, vegetarianism/veganism)
– Withdrawal from usual friends and activities
– Frequent dieting
– Extreme concern with body size and shape
– Frequent checking in the mirror for perceived flaws in appearance
– Extreme mood swings

Source: National Eating Disorders Association

Finally, an individual’s relationship with food, eating and weight is a very personal and even intimate topic.

Nutrition is a science that interprets the interaction of nutrients in food in relation to growth, development, health and disease in an organism. But, overall health is more than just how nutrients function in our body.

Enjoying a variety of pleasurable foods and understanding how the “joy of eating” feeds our soul and makes life interesting, adventuresome and fun is something I would encourage anyone to not miss out on!

Let’s Get Real: #NEDAwareness

Let’s get real – eating disorders can affect anyone, anywhere. This week is National Eating Disorders Awareness Week and we’re working on changing the conversation around food, body image, and eating disorders! This year’s theme is “Let’s Get Real.” The goal is to promote more conversation about the reality of eating disorders and the impact this illness has on more than 30 million people in the U.S. alone.

As a dietitian who has worked in this field for over a decade, it continues to amaze me that in our “wellness-focused” culture, we remain fixated on certain measures (weight, BMI, clothing size), one’s appearance (“lean”, “fit”, anti-aging, anti-wrinkle, etc.) or whether you eat the “right” foods (as defined by a celebrity, Dr. Oz, or what’s trending on social media) to define health and wellness. Sadly, for many people, what’s going on “under the hood” is far beyond well. What’s even more frightening to me is the number of young people and children that are falling victim to disordered eating and eating disorders. Perhaps growing up in a small town in Nebraska sheltered me a bit, but I don’t recall such a fixation on food, eating and weight as what we are experiencing today.

Take a moment to consider the following facts:

• At least 30 million individuals of all ages and genders in the United States are diagnosed with an eating disorder at some point in their lives
• The majority of these individuals do not seek treatment because they feel embarrassed, are in denial, do not have the financial means or social support, or simply do not know where to start 
• Eating disorders have the highest mortality rate of any mental health disorder
• Approx. 30% of individuals who engage in binge and purge behaviors also engage in self-harm behaviors such as cutting
• Approx. every 60 seconds, an individual dies as a direct result of an eating disorder
• 13% of women over the age of 50 engage in some sort of eating disorder behavior
• Approx. 10% of female college students suffer from a clinical eating disorder
• Only one in 10 individuals with an eating disorder will receive treatment
• 42% of 1st-3rd grade girls want to be thinner
• 81% of 10 year olds are afraid of being fat
• Binge eating disorder is the most common eating disorder in the United States 
• Approx. 50% of the risk for binge eating disorder is genetic 

What about women over age 50?  At a time in a woman’s life when we deserve to be happiest and most fulfilled, age doesn’t seem to make us immune to the reality of disordered eating, eating disorders and negative body image.

 

In a survey of 1,849 women, ages 50 and over, 71% of women responded that they were currently trying to lose weight! More than 3/4 of the women responded that weight or shape plays a “moderate” to “the most important” role in their self-perception (so more important than being a great mom or honest and hard-working woman?) AND more than half (62%) responded that weight or shape negatively affected their lives.

 

Eating disorders do not discriminate. Men of all ages are also affected!

What Can We Do?

Examine AND CHALLENGE mixed messages about what is “healthy” vs achieving a “certain size or look.” For example, does it really make sense to cut out fruit, legumes, and whole grains (as dictated by some popular diet trends)? You can read my thoughts about some of this “science” and diet trends HERE.

Respect EveryBODY. We all have a unique size and shape that doesn’t fit perfectly in the middle of the “BMI curve”. Yes, it’s important to encourage “health-promoting” behaviors, such as regular activity, eating a balanced diet, good sleep habits, not smoking, etc, but remember – you really can’t tell if someone is healthy by looking at them. Think of it this way. Should every dog strive to look like a poodle? Take a look at this “Poodle Science” video.

Prevent these behaviors or offer support. If you are a Parent, Teacher, Coach, Trainer, Health Provider, Educator, or Friend, get educated about disordered eating and eating disorders. The National Eating Disorders Association has some fabulous resources and tool kits to help prevent this illness or offer appropriate support.

Seek out appropriate help. If you or someone you know is struggling, work with a licensed professional who specializes in eating disorders. It’s painful to me when I learn about someone who is suffering from any type of eating disorder who is being treated by a health coach, personal trainer or “nutritionist”. Please forgive me for being so blunt – but would you take your child to a health coach or chiropractor if he or she had cancer? Many of these folks do a fabulous job at what they are trained to do. However, it’s unlikely they have been trained to work specifically with a diagnosed, or even un-diagnosed condition of anorexia, bulimia, binge eating disorder, AFRID, or orthorexia. In the Atlanta area, providers who specialize in eating disorder treatment is available HERE.

Image source: http://www.beautyredefined.net

Surviving Holiday Meals…Tips for Those with Eating Disorders

Special occasions or holidays often involve family rituals and traditions with food. However, holidays pose unique challenges for people with disordered eating or eating disorders that often disrupt the joyful part of their celebration. For an individual who is preoccupied with food, eating and weight, nearly 100% of the time every other day of the year, these events can feel especially overwhelming when food (especially “forbidden” food) is an integral part of the gathering.

At the same time, with the hectic schedules many people have today, these holiday meals may be one of the few times that a family comes together to eat and enjoy each other’s company.

Learning to manage these social situations involving food may be a critical part to an individual’s path to recovery and finding peace with food, eating and weight.

Following are some tips to help you or a loved one prepare…

Planning for the Meal

Planning ahead may be the key to helping you challenge the anxiety or potential struggles with holiday meals, so you can relax and enjoy good times with friends and family.

Consider how and when the meal will be served. Will the food be served family style or at a buffet? How will that affect your ability to follow through with your meal plan? To prevent overeating or restriction, you may want to ask what is on the menu and decide ahead of time what food fits in your meal plan.

Will the meal be served at your usual eating time, or will you need to adjust your food plan? For example, if the meal will be served later than you typically eat lunch, eating a balanced breakfast and snack prior to the meal event can help decrease overeating.  It’s okay to ask for something you need; and, it’s important to not allow yourself to get too hungry. Eating less all day to “save up” for the party is not helpful. Skipping meals/snacks usually affects productivity, causes poor concentration, more difficulty with problem solving, and increased fatigue. It can also lead to overeating at the next meal or snack.

What will you need for support to be successful at the event? If there are topics or conversations that are especially triggering, it may be helpful to rehearse ahead of time how you will manage these situations. What could you say in response, or would it be more helpful to quietly leave the room and join another conversation?

For some folks or situations, it may be important to have a plan before going home about what you will do for support after the gathering. Bringing home leftovers may not be helpful. Also, know who and where your support people are, and/or have a plan for distractions or non-food ways to comfort or soothe yourself, if necessary.

At the party or gathering 

• Try to sit or stand away from the food table and near supportive people.
• Bring along a dish or food that you enjoy and complements your meal plan.
• Try to eat mindfully and give yourself permission to savor the tasty holiday foods!
• Continue to follow your meal plan for the entire day, and stay well-hydrated by drinking water.
• Eat at an appropriate pace.
• Bring along an item such as an affirmation card, a picture, or a journal for some comfort throughout the day.
• Talk with loved ones about things unrelated to food, weight or the eating disorder.
• Enjoy your relationships and try to reflect on feelings of gratitude for blessings received – remember it’s not just about the food.

AND…Remember to Breathe! Taking slow, deep breaths may help produce a state of calmness and relaxation.

Gather Support!

• Talk to family and friends about what is helpful and what isn’t, i.e. no diet, “fat”, or weight talk.
• Consider choosing a loved one to be your “reality check” with food, to either remind you of food portions or check in with about your meal plan.
• Choose someone to reach out to or call if you are struggling with negative thoughts, eating disorder behaviors, or difficult emotions. Talking to a supportive person ahead of time and letting them know about your concerns and needs may help assure you they are open and willing to receiving your call, when needed.
• Stay active with any therapy appointments or groups you may be attending.
• Discuss your anxiety or anticipations of the holidays with a professional, such as a therapist or dietitian, so they can help you predict, prepare for, and get through any uncomfortable family interactions without self-destructive coping attempts.
• Talk with loved ones about important issues: decisions, victories, challenges, fears, concerns, dreams, special moments, spirituality, and relationships. Allow meaningful themes to be present and allow yourself to have fun (rather than rigidly focusing on food or body thoughts).

Enjoy (and Give Back) with These Non-Food Activities:

• Relax and watch your favorite holiday movie with a close friend or family member.
• Seek out a few holiday craft fairs.
• Go out and look at lights and holiday decorations.
• Attend holiday concerts and plays.
• Baby-sit for someone so they can shop.
• Participate in local charity events to celebrate giving back to the community.
• Find out what’s going on around town. Look in the local newspaper to get fun holiday ideas.
• Purchase or make a gift for someone who is less fortunate than you.
• Enjoy the winter season. Go ice skating, have snowball fights, or make a snow sculpture in your yard.
• Challenge yourself to find activities that don’t focus on food, but instead are about relaxing and enjoying the season.

General Ideas to Keep in Mind:

• Get enough sleep and rest.
• Don’t forget about other coping mechanisms (yoga, deep breathing, relaxation imagery, journal, etc.).
• Choose to move in mindful ways. This might be a good time for a peaceful leisure walk under the stars with a loved one instead of a busy or intense exercise class.
• Flexibility in your thoughts is what you’re striving for. Learn to be less critical in guidelines for yourself and in expectations for others.
• Overbooking and over-stressing yourself will only lead to unhelpful coping strategies. Cut down on unnecessary events and obligations and leave time for relaxation, contemplation, reflection, and enjoying the small but important things in life.
• The holidays come and go every year. You can and will survive!

Food Rules: What are the Costs?

Labeling food as good/bad or healthy/unhealthy is an example of a food rule. Food rules have seemingly become “normalized” in our culture as being helpful.  They are often suggested for dieters to use because they provide “limits” that often help the eater feel more in control.

Labeling Food:   Categorizing foods as unhealthy/healthy, bad/good, legal/illegal, fattening/nonfattening, safe/dangerous usually backfires.  The intent of labeling foods is to help people get control of their eating for the sake of losing weight, for example, and thus categorizing foods as either fattening or nonfattening provides a sense of control.  However, deprivation often increases desire.

Some possible benefits from food rules include:

• Focusing on the “rules” is a great distraction from focusing on more distressing issues
• Helps you feel safe or in control.
• Produces a “high” when you are successful at following the “rules” which in turn,  perpetuates the eating behaviors while feeling self-righteous or disapproving of your previous eating behaviors.

The downside is that these behaviors often promote rigidity and limits and individual’s choices with food, eating, health, exercise and weight. Simple, healthful guidelines become complex, demanding and powerful.

Another problem is that deprivation often increases desire. When the individual gives in to this desire and eats the “forbidden” food, feelings of guilt or shame are the result often leading to overeating or other compensatory behaviors, such as increased restriction or excessive exercise.

And the cycle continues… Eventually, a person begins to feel as if they cannot live without the strict rules and eating continues to become more rigid and disordered.

Therefore, following are some of the costs an individual suffers by relying on food rules:

• Food rules prevent the development of confidence in your own body, skills and judgment
• Rules exacerbate dieting behaviors and rigidity with food, exercise and weight
• Rules increase your sense of guilt if a rule is violated

Negative thoughts and perceptions about food, weight and eating patterns make it difficult to successfully change certain behaviors.  You may be overly critical of yourself, have a low self-esteem, or view foods as being either bad or good – which can all sabotage your efforts of achieving peace with food and your body.

Following are some examples of food rules: I can only eat one meal per day It’s not okay to eat after 7 pm Labeling foods as “Good” and “Bad” It’s never okay to eat between meals, i.e. snacks I can’t eat in restaurants because… No fried food I can’t eat red meat It’s not okay to feel full Never eat more than ______ calories If you eat a “bad” food, or break another rule, then …. I have to exercise at least 60 minutes every day, or …

Most would proclaim they want to stop this fight with food and their body, but having unconditional permission to eat feels very scary.  One of the most effective solutions for eating problems of all types is to begin to return all foods to a neutral status – to stop and give yourself permission to eat all foods, trusting you will find a healthy balance.

Legalizing food and eating requires action.  There are 3 things you will need to do:

1. Have a plan. Make a plan to bring forbidden foods into your home; (with support), you want to begin to expose yourself to foods you crave.

When you begin to expose yourself to foods you enjoy, it’s helpful to have a plan that includes: where to start, how to challenge negative thoughts, who can support you, etc.  Remember your goal is to stop the food fight and find a peaceful relationship with food and your body.  You cannot do that if you continue to evaluate food in terms of “good” vs “bad” or in terms of “fat” and “calories.”

2. Replenish supplies of favorite foods. When it feels safer, begin to have your favorite foods around, so you don’t feel deprived.

One suggestion is to make a list of food or foods you would like to reclaim.  Then, you may want to start with the least feared item on your list.  Then, I guide my clients through a “step-by-step” plan for experimenting with reclaiming this food. In this plan, we identify what are the irrational thoughts about the food, i.e. carbs will make me fat or sugar is toxic. Then, we identify what you will do to try the food. For example, if ice cream is forbidden and there’s a risk you will binge on a half gallon of ice cream if it is brought into the house, then plan to go out for a small dish of ice cream with a supportive friend. We discuss a plan for dealing with the irrational thoughts, i.e. education on how your body uses carbs for energy and finally evaluate how the plan went. Finally, we evaluate why your plan worked or didn’t work and what to do different next time.

3. Create a pleasant food atmosphere in your home.  This step is critical for setting you up for ongoing success.

Examples of changes you may need to make include: promising not to “yell” at yourself for eating foods you enjoy; eating slowly and mindfully at a table so you can truly savor your food; and/or use a realistic meal plan that helps you see the big picture of how these foods can fit while helping you achieve your goals with food, wellness and weight.  Journaling your food intake along with thoughts and feelings can be helpful at recognizing that you didn’t “blow it” when you enjoyed a small piece of dessert.

The point of all this is re-learning to trust yourself and your body with food and eating again. Food does not need to have all the power and deserves to be on the plate – not on a pedestal.