Category Archives: Nutrition, Diet, and Exercise

Cognitive-Behavioral Therapy

Cognitive-Behavioral Therapy techniques are a vital part of successful nutritional counseling. There are numerous techniques divided into three main categories: behavioral techniques, cognitive restructuring techniques, and psychoeducational techniques. Imagery and role-playing are forms of behavioral techniques. Both of these techniques are used to help clients imagine the possible outcomes of a difficult situation and their reactions to it while in the safe environment of the counselors office. Decatastrophizing is a cognitive restructuring technique counselors employ to reduce the anxiety a client experiences when confronted by their fears. Psychoeducational techniques include distraction, delay, and parroting which give the client the knowledge and skills to control their behavior.
A nutrition counselor may utilize imagery during a counseling session to help a client determine and understand their problematic eating habits at social gatherings. The counselor asks the client to close their eyes, relax, and picture themselves at a party. The counselor and client build the scene together and the client is allowed to explore their thoughts and feelings regarding this hypothetical situation. Role-playing takes imagery a step further by having the client act out the potential scenario with the counselor to explore their reactions and prepare for real-life performance based practice and situations.
Decatastrophizing can be used to help clients recognize their irrational thoughts and change the way they think about a specific situation. The counselor addresses the client’s misguided thought processes and gently questions the client in regards to these thoughts and emotions, helping the client become aware of their problem and make the necessary changes in behavior.
The psychoeducational techniques, distraction, delay, and parroting, work together to empower the client to be in control of their emotions and behaviors. These techniques are taught to clients in the counselor’s office and then used at home, making the client take control of their changes. Physical activities like going for a walk or bike ride as well as cognitive activities like reading or doing a crossword puzzle are all methods of distraction. These distraction techniques also help clients delay their response to a stimulus, allowing them to reassess their feelings before reacting. Parroting is often used in conjunction with distraction and delay techniques to help the client maintain control of their thoughts and behaviors. The nutrition counselor helps the client create statements that they can repeat to themselves when feeling overwhelmed by impulses and stimuli.

References:
King, K., & Klawitter, B. (2007). Nutrition therapy: Advanced counseling skills. (3rd ed.). Baltimore, MD: Lippincott Williams & Wilkins

Vitamin C and Bipolar Disorder

Oxidative stress to the cells of the human body has the potential for numerous, potentially deadly, consequences including cardiovascular disease, cancer, diabetes, renal disease, irritable bowel disease, and bipolar disorder (NIST, 2013). Antioxidants, such as copper, zinc, selenium, amino acids and vitamins A, C, and E, act to negate the harmful effects of free radical damage caused by oxidative stress. Recent research into the pathophysiology of bipolar disorder has discovered a connection between oxidative damage to the central nervous system and the severity of symptoms experienced in those diagnosed with bipolar disorder (Steckert et al, 2010). This new research suggests antioxidants could play a role in delaying the onset of bipolar disorder and reducing the frequency and severity of symptoms.
Oxidation is the process by which atoms lose electrons during metabolism and energy production (Thompson & Manore, 2009). This loss of electrons can cause the atoms to become unstable and form free radicals, which can damage tissues, cells, and DNA. Free radicals are volatile atoms with an uneven number of electrons orbiting the nucleus. In order to stabilize themselves, these atoms filch electrons from other atoms, creating more free radicals and starting a chain reaction of free radical formation (Thompson & Manore, 2009). The damage to other cells of the body through the formation of free radicals is known as oxidative damage or oxidative stress (Medeiros, 2012). The location of the free radical formation determines the effects oxidative stress can have on the body; bipolar disorder is believed to be caused by oxidative damage to the brain, particularly the areas involved in attention, emotion, and cognitive functions, as well as damage to the spinal cord and central nervous system (Wang et al, 2009).
Antioxidants work to reduce oxidative damage by donating electrons to free radicals and ending the chain reaction of free radical formation (Thompson & Manore, 2009). Antioxidant compounds include amino acids, vitamins, and minerals. Antioxidant action is just one of hundreds of possible functions of amino acids such as lutein and lycopene. Beta-carotene, vitamin C, and vitamin E all function as both vitamins and antioxidants within the body and selenium, copper, iron, and zinc all function as both minerals and antioxidants.

English: Sagittal MRI slice with highlighting ...

Bipolar disorder is a chronic and debilitating mental illness characterized by severe mood swings and alternating episodes of mania and depression (NIMH, 2013, Russo, 2010). Scientists are still researching the causes of bipolar disorder, but abnormal neural activity in the brain and spinal cord is believed to be responsible for the changes in cognition and behavior (Wang et al, 2009, NIMH, 2013). Recent research utilizing brain-imaging and post-mortem brain tissue samples suggests oxidative damage to cells of the brain and spinal cord plays a strong role in the development and progression of bipolar disorder (Wang et al, 2009). Brain-imaging is used to study the brain’s structure and neural activity in patients with bipolar disorder. These studies have indicated changes in size, shape, and function of several areas of the brain including the anterior cingulate cortex and the prefrontal cortex (NIMH, 2013). Wang et al (2009), went on to test post-mortem tissue samples from the anterior cingulate cortex to determine the level of oxidative stress experienced in this region in patients with bipolar disorder. The results of this study showed a significant increase in oxidative damage in this region of the brain in patients with bipolar disorder, as well as patients with schizophrenia (Wang et al, 2009). Oxidative damage is believed to cause damage to cell membranes and DNA in the brain and neurotropic pathways, disrupting energy metabolism and neural signal transduction (Steckert et al, 2010, Wang et al, 2009).

The structure of the antioxidant vitamin ascor...

Vitamin C serves numerous functions in the body, including antioxidant activity. Vitamin C scavenges for free radicals and donates electrons to stabilize these molecules and prevent further damage to tissues and cellular organelles (Thompson & Manore, 2009). Vitamin C works within the extracellular fluid to stabilize cellular membranes and regenerates vitamin E, another antioxidant, in the process. Vitamin C also works to synthesize DNA and neurotransmitters that may have been damaged by oxidation, further helping the bipolar patient (Thompson & Manore, 2009).
The RDA for vitamin C is 75mg for adult women and 90mg for adult men. Deficiency is uncommon in developed nations, but only a month-long deficiency of vitamin C can result in scurvy. Scurvy causes bleeding, swelling, and bone and joint pain. Untreated cases of scurvy lead to death due to infection and hemorrhaging (Medeiros, 2012). Because water-soluble vitamins are not stored in the body, toxicity from vitamin C is rare and is not considered fatal. However, megadoses of vitamin C can actually function as prooxidants, promoting oxidative damage rather than stabilizing the free radicals (Thompson & Manore, 2009). Therefore, it is important to consider all sources of vitamin C in the diet before deciding if supplementation is appropriate for an individual, with or without bipolar disorder.
Researchers agree that there is no one cause of bipolar disorder, but the new research into the role of oxidative damage offers patients new treatment options and the potential for an improved quality of life (NIMH, 2013).

References

Medeiros, D.M. & Wildman, R.E.C.. (2012). Advanced Human Nutrition. Jones & Bartlett Publishers. ISBN: 9780763780395.
National Institute of Mental Health. (2013). What is Bipolar Disorder?. Retrieved from http://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml
National Institute of Standards and Technology. (2013). Online Resources for Disorders Caused by Oxidative Stress. Retrieved from http://www.oxidativestressresource.org/
Russo, A. J. (2010). Decreased Serum Hepatocyte Growth Factor (HGF) in Individuals with Bipolar Disorder Normalizes after Zinc and Anti-oxidant Therapy. Nutrition & Metabolic Insights, (3), 49-55. doi:10.4137/NMI.S5528
Steckert, A., Valvassori, S., Moretti, M., Dal-Pizzol, F., & Quevedo, J. (2010). Role of oxidative stress in the pathophysiology of bipolar disorder. Neurochemical Research, 35(9), 1295-1301. doi:10.1007/s11064-010-0195-2
Thompson, J. and Manore, M. (2009). Nutrition: An Applied Approach 2nd Edition. NY, New York: Pearson Education Inc.
Wang, JF., Shao, Li., Sun, X., and Young, L.T.. (2009). Increased oxidative stress in the anterior cingulate cortex of subjects with bipolar disorder and schizophrenia. Bipolar Disorders, 11(5), 523-529. doi:10.1111/j.1399-5618.2009.00717.x

It won’t zip!!

This one is kind of a trick question, and the answer actually depends on your age, life stage, and state of development.
If you thought the answer was A, please seek common sense immediately; bonus points though if you know the reference. (I jest, but on the serious side, this kind of thinking and behavior is extremely dangerous, and I urge anyone who believes this to be a good idea to seek medical assistance in their weight management goals). Option B is also a bad idea; fad diets, like the grapefruit diet, Atkins diet, and so many more, are both dangerous and counter-productive. They are written and sold with the intent of making money, not helping you lose weight and live a healthy lifestyle. They are generally based on hypothetical data and evidence and focus on “quick fixes” and “miracle foods/herbs/pills” that can solve all your problems. I’m sorry to tell you, these do not exist. There’s only one healthy way to lose and maintain weight; but we’ll get to that in a minute.
Option C is actually an appropriate answer for many girls and young women in this situation. If the size change has come from normal growth and development, your clothes should grow with you. When trying to determine if your size change has been a healthy, natural one it is important to consider the difference between excess fat tissue and new muscle growth, in addition to girls’ normal growth and development. If you’ve been working out, especially doing weight training, your muscle growth will increase your overall size, a healthy change that you should be proud of!
When I was getting married I had a final fitting about a month before the wedding and the dress fit beautifully; a week before the wedding I tried it on for my mom, who hadn’t seen it yet, and the top inch wouldn’t zip. I was in tears. How did my chest get so much bigger without any increase in my bra size? Worse yet: how was I going to get into this dress in a week?? In the months preceding my wedding I was working as a gymnastics coach at a children’s gym; working on the bars and demonstrating handstands 8 hours a day 6-7 days a week had increased my upper body strength, and size, considerably. After accepting my natural size increase, I was able to find a tailor that could fix the dress and long story short, the dress fit perfectly and I felt amazing in it! In a world where small frame size and low body weight are praised as beautiful, it is important to recognize healthy increases to body size.
However, if the growth has occurred due to weight gain from an unhealthy lifestyle, it is important to take steps towards maintaining a healthy weight, and slimming down to fit into your gorgeous new gown could be the perfect motivation to get you going.
So, how do you do that? There is only one answer to that question: burn more calories than you consume. It’s a simple answer; but, putting it into action isn’t as easy. No matter how driven you are or how much will power you have, you can’t achieve and maintain a healthy weight without the facts. You need to know exactly what you are putting into your body, including calorie count, fat, carbohydrate, and protein intake.

What’s eating you?

Eating disorders are overwhelmingly misunderstood by the general population, and even many medical professionals.  The American Psychiatric Association has established criteria for three separate eating disorders as of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders: Anorexia Nervosa, Bulimia Nervosa, and Eating Disorders Not Otherwise Specified (EDNOS) (DSM-IV-TR, 2000).  Each disease is characterized by specific behaviors, but they all include an intense desire for thinness and a fear of becoming fat (Hinton & Chapman, 2009).  The media is often blamed for the recent rise in patients diagnosed with eating disorders; however, media influence only plays a very small role in the development of most eating disorders (MacDonald, 2001).  There are numerous factors behind complicated mental illnesses like eating disorders, and underweight, emaciated females certainly are not the only victims.

Many people are quick to dismiss these deadly diseases as sheer vanity, and blame superficial sources like celebrities and advertising campaigns for behaviors and thoughts that are actually rooted in very deep issues of self-concept and identity (Hinton & Chapman, 2009).  Although the media may play a role in some patients’ eating disorders and advertisers have capitalized on society’s obsession with body image, they cannot be blamed as the cause of eating disorders (MacDonald, 2001).  Melanie Katzman, a consultant psychologist from New York, argued that the media was to blame for eating disorders and stated, “You don’t get eating disorders without dissatisfaction” (as cited in MacDonald, 2001, p. 1002).  Although she was not entirely incorrect in that statement, dissatisfaction can come from several external factors, as well as from within, without any influence from the media.  Family environment, social circle and peers, and negative life events are just a few of the external factors that can influence eating behaviors.  Genetic factors, personality traits, and unsuccessful resolution of developmental milestones are often triggers for disordered eating, and comorbid psychiatric conditions significantly quantify the severity, development, and course of eating disorders (Hinton & Chapman, 2009).

It has been theorized that personality traits such as perfectionism, compliance, and self-sacrifice and an inability to achieve autonomy may predispose an individual to developing an eating disorder (Wechselblatt, Gurnick, & Simon, 2000).  Feelings of powerlessness and lack of control in one’s life are also correlated to disordered eating (Hinton & Chapman, 2009); patients often measure their feelings of self-worth and esteem by their ability to control their eating behaviors, not by the actual amount of weight lost, although weight loss may be used as a measure of this ability.  Control over one’s thoughts and behaviors related to food become central to the patient’s self-concept and loss of this control results in feelings of shame, disgust, and guilt (Hinton & Chapman, 2009).

Although the APA only recognizes eating disorders that lead to or endeavor for abnormally low body weight, many overweight and obese individuals also suffer from disordered eating.  Binge eating and chronic overeating leading to above average BMI are both disordered eating behaviors that are currently being researched for possible inclusion as eating disorders in future revisions of the DSM (DSM-IV-TR, 2000, Hinton & Chapman, 2009).  The current criteria for eating disorders elude to a stark contrast between obesity and eating disorders, however the concomitant rise at both ends of the BMI scale suggest that these diseases may not be as different as is currently believed.

Statistics show that 90% of patients with Anorexia Nervosa, Bulimia Nervosa, and Eating Disorders Not Otherwise Specified are female, however the incidence of eating disorders in young males has been increasing over the past few decades.  This statistical increase may be partially due to more males now seeking treatment than in previous generations; however, males are just as susceptible to societal demands as females and may develop disordered eating or exercise behaviors in response to society’s current focus on the benefits of nutrition and fitness.  Males are also at risk for the same feelings of powerlessness and lack of control as females and may use disordered behaviors to compensate for feelings of inadequacy in the same manner as females.

Eating disorders are highly complex illnesses that are vastly misunderstood by the majority of society.  The numerous and various contributing factors, and resulting thoughts and behaviors, complicate not only the treatment and recovery of individuals afflicted, but also the education of the general public, and medical community alike, about these life-threatening illnesses.  As further research is conducted on the incidence and causes of currently recognized eating disorders, new information is likely to clarify some of what is already known about these disorders while simultaneously raising many new questions such as, should there be a classification within the eating disorders for overweight and obese individuals?

References

American Psychiatric Association.  (2000).  Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR).  Retrieved from http://behavenet.com/apa-diagnostic-classification-dsm-iv-tr

Hinton, P.S., & Chapman-Novakofski, K.. (2009).  Special topics in preadolescence and adolescent nutrition: dietary guidelines for athletes, pediatric diabetes, and disordered eating. In S. Edelstein & J. Sharlin (Eds.), Life cycle nutrition: An evidence-based approach (83-102). Sudbury, MA: Jones and Bartlett.

MacDonald, R.. (2001).  To Diet For.  British Medical Journal, 322(21 April), 1002.

Wechselblatt, T., Gurnick, G., & Simon, R. (2000). Autonomy and relatedness in the development of anorexia nervosa: a clinical case series using grounded theory. Bulletin Of The Menninger Clinic, 64(1), 91-123.

Hack Away the Pounds

When it comes to losing weight there are many fads, gimmicks, and “miracle cures” available on the market to “help” you lose weight. Unfortunately, there is no quick fix to managing one’s weight; the only way to achieve and maintain a healthful weight is by taking personal responsibility and making permanent lifestyle changes. Expecting a pill, drink, or grapefruit to magically melt off the pounds is unrealistic. Even if short term results are seen, in the long run, maintaining that diet could have dangerous health consequences and most often the weight that has been lost returns, commonly adding additional weight gain as well.

The Hacker’s Diet, developed in 1991 by John Walker, an engineer and computer programmer, is unlike most other diet programs on the market. There are no gimmicks, no quick fixes, no promises of success without hard work or dedication. Walker’s “The Hacker’s Diet: How to lose weight and hair through stress and poor nutrition” focuses on long-term goals, the important balance between calorie intake and energy output, and modifying lifestyle behaviors, including exercising for the health of it, not just to reach weight loss goals. His approach to weight loss doesn’t focus on eating or eliminating any type of food, and while supplements are recommended for those who are not reaching their daily recommended intake for certain nutrients, they are not considered essential, or even necessary, for success with the program.

Although his unique mechanical approach to weight loss may seem intimidating at first, the concepts, such as the “eat watch” and the “rubber bag,” are thoroughly explained using real life scenarios, experiences, and humor, making Walker’s book an easy and enjoyable read. He also offers many tools to help promote progress and increase motivation including: calorie intake records, energy expenditure records, weight loss and gain records, analytic reports, and a diet calculator. He includes strategies for all technologic comfort zones: those who are experienced with computers will find many helpful online tools and Excel spreadsheets, and those who prefer paper and pencil will learn valuable record keeping skills including how to keep a food journal and how to draw a graph and plot your progress.

The Hacker’s Diet doesn’t simply offer weight loss strategies, there are no exercise plans or recipes, but it is unique in its thorough education on how the body controls the intake and usage of energy and how it functions in different states of malnutrition. Walker provides an easy to understand foundation for developing healthy habits that will last a lifetime, not just a bikini season.

Achieving and maintaining a healthful weight is not a short-term goal, it is a life-long process that requires education on how the body functions, behavior modifications, and lifestyle changes and implementations that promote a lifetime of health and wellness. A weight loss program should not be something to be started and ended; it is a process that once started can lead to success in maintaining a healthful weight and achieving optimal physical fitness and health, extending life expectancy as well as quality of life.

 

References

The Hacker’s Diet. Walker, John. (2011). Retrieved May 3, 2012 from

http://www.fourmilab.ch/hackdiet/e4/. 

Thompson, Janice and Manore, Melinda. Nutrition: An Applied Approach 2nd edition. (2009).

Pearson Publishing.