Nutrition & Physical Activity

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I'm worried my boyfriend has bulimia

Dear Reader,

It can be tricky to check in with a loved one about the concern that they may have an eating disorder. You may be afraid that you'll say something that might shut them down or hurt their feelings. You may be afraid that you're mistaken. This worry may be especially great for you since eating disorders are more prevalent in women (though eating disorders are more common among men than many people realize). Don't let these worries stop you from having an honest conversation about what you have observed and what your concerns are.

First, how might you recognize if a loved one has an eating disorder? There are a few different types of eating disorders, but you need not worry about making an "exact diagnosis." The following may be warning signs of bulimia, but a loved one need not exhibit all these signs in order to have it.

  • Frequent complaining or worrying about being overweight.
  • Use of "purging" tactics for weight loss, including excessive exercise, herbal weight loss supplements, weight loss medications, laxatives, or forced vomiting after eating.
  • Not wanting to eat in front of other people.
  • Eating large quantities of food in one sitting.

Warning signs of Anorexia can include:

  • Significant weight loss.
  • Enjoyment of cooking and preparing meals for others without eating much.
  • Significantly distorted body image — sees self as overweight, when he or she is likely significantly underweight.

Some people with eating disorders recognize that they have one, but are afraid to reach out for help. They may be afraid of being judged and/or losing loved ones if they open up about their eating disorder. Others may be in denial about having an eating disorder, while others may have such a low self-esteem that they feel, either consciously or unconsciously, that they do not deserve help. If you are afraid to check in with him about the possibility that he has an eating disorder, it may be helpful to know that eating disorders do not go away on their own and they can have severe health consequences. So the sooner he seeks help, the better his chances of recovery and the less damage that will be done.

But how to bring this up? There are a few good guidelines to cover that will help you convey a nonjudgmental attitude and also help ensure you are respecting your boyfriend's privacy:

  • Make the basis of the conversation about your worry. Try to remain positive while also explaining that you care about him and because of this, you are worried about his health and his emotional state.
  • Avoid comments about his appearance. Some people with eating disorders will not be affected, while others will be extremely affected by hearing your assessment of their weight (e.g. they may be flattered or they may be horrified. Either way, you may inadvertently reinforce their restricted eating or purging).
  • Do not demand that he eat or change his behavior.
  • Avoid placing blame or giving advice.
  • Watch out for accidental "fat phobic" remarks that you might make inadvertently (in other words, avoid making disparaging remarks about weight or overweight people). Avoid making remarks even about your own body weight.

Aside from offering you nonjudgmental support, the most important thing you can do for a person with an eating disorder is to encourage him or her to get treatment. The longer an eating disorder remains undiagnosed and untreated, the harder it is on the body and the more difficult to overcome, so urge your boyfriend to see a therapist or his health care provider right away. If your boyfriend is a Columbia student, he can make an appointment with Counseling and Psychotherapy Services (CPS) or with his primary care provider through Open Communicator.

It may also be worth checking out the following resources:

Recovering from an eating disorder usually takes time. Kudos to you for your patience and your willingness to support someone struggling with an eating disorder. This may at times be difficult for you, too, so make sure you are getting support, as well, whether it be through friends, family, and/or therapy.

Take care,

Alice

Raisin bran confusion — is it a good source of iron?

Dear Reader,

Props to you for wanting to donate blood! Alas, isn't it iron(ic) that one of the foods with higher iron content also may contain an iron absorption inhibitor? It's one thing to worry about getting enough iron through your food sources, but a whole other thing to worry about whether that iron is actually being absorbed. Boosting your hemoglobin by upping your iron intake shouldn't be too tricky, but know that there are a number of possible causes for low hemoglobin — being low on iron is only one cause (more on that later).  

Let's discuss the raisin bran question first. Phytic acid is often found in foods that contain whole grains, including some types of raisin bran. In large enough quantities, phytic acid can inhibit your body's iron absorption. This is annoying since these foods may also be high in iron. In addition to iron absorption inhibitors, there are also substances that aid in iron absorption. The primary is vitamin C, which is often also found in raisin bran. Your best bet is to check food labels so you know when you are consuming foods that contain phytic acid (and also whether it contains a substance such as vitamin C, which will help you absorb iron). If food products contain iron and phytic acid, chances are you'll still likely get at least some iron benefit from them (especially if that food contains vitamin C, too); however, it's wise to have additional sources or iron other than raisin bran. Another iron absorption inhibitor is tannic acid, which is often found in red wine, coffee, some teas, chocolate, and some sodas.

So what does all this mean? Diversified food sources of iron will be your best bet in ensuring that you meet your recommended daily allowance, but there's no harm in making raisin bran one of those sources. Check out the Q&A's below for more information on iron, how much you need, and getting enough of it through your diet.

Now, are you sure low iron is the cause of your low hemoglobin? There are several other possible causes. Cirrhosis (scarring) of the liver is one cause. Some common causes of cirrhosis include alcohol abuse, hepatitis B or C, cystic fibrosis, and some parasites caused by chronic liver damage. These conditions, as well as the cirrhosis itself, would likely be accompanied by additional symptoms, such as fatigue, nausea, weight loss, and/or easy bruising.

Other causes can include certain cancers of the blood (e.g. leukemia, multiple Myeloma) or of the lymphatic system (e.g. Hodgkin's and non-Hodgkin's lymphoma), enlarged spleen (splenomeglamy), or vasculitis (inflammation of blood vessels caused by an autoimmune response of various origins). Though anemia and iron deficiency are common causes of low hemoglobin, it may be worth a trip to your health care provider to rule out these other causes.

Happy hemoglobin boosting!

Alice

Relaxation drinks

Dear A Sip of Calm,

Can we actually find relaxation in a can? Seems like it could be a great idea, unfortunately, at this point in time, it's just too good to be true. Just like herbal supplements, the FDA does not require companies manufacturing the "relaxation beverages" to prove their claims or standardize their ingredients. As such, there is no conclusive scientific evidence that any of these products are safe and effective. What little research has been done has shown that many compounds in these drinks, such as 5-HTP and melatonin, degrade in water. Other ingredients  such as GABA, cannot cross the blood-brain barrier so are completely ineffective. One study even tested five popular brands and found that many of the ingredients listed were barely even present in the drinks themselves!

Two popular ingredients in relaxation beverages that have been studied are valerian and kava and the news is not good. Valerian can cause dependency if taken regularly while kava has been shown to cause liver damage. These types of ingredients can also interact with medications such as Allegra or benzodiazepines (Xanax, Valium, Atvian, etc.) or even with Tylenol and cause serious health problems.

What's your best bet for relaxation? For starters, maintaining a proper diet, exercising, and trying to keep a regular sleep schedule can contribute to feelings of relaxation. You may also want to try meditation and/or yoga.  

In the end, it seems as if nothing beats a glass of warm milk or hot (decaf) tea to unwind in the evening.

Alice
Assigned researcher

What's the difference between ionic and colloidal minerals?

Dear D2,

Trying to make sense of all the vitamin and mineral supplements on the pharmacy shelves may make you feel stuck between a rock and a hard place! Before you swallow any information, it is important to know that both ionic minerals and colloidal minerals have a lot of dubious marketing and advertising surrounding them. Manufacturers of colloidal and ionic supplements may make a variety of claims about their products — many of which are not confirmed by scientific research. Moreover, the body doesn’t need a whole lot of minerals; fewer than 20 have been judged to be essential to your health.

A colloid is a mixture in which particles are suspended in a liquid or a gas. Colloidal minerals come from humic shale deposits, primarily from Emery County, Utah. After collection, the shale is crushed and placed in water so that the minerals can enter the solution. Colloidal mineral distributors stress the “naturalness” of their product and have made claims about improving conditions associated with certain diseases, a practice judged to be illegal by the FDA. In addition, some advertisements state that colloidal supplements contain 75 minerals, many of which have not been proven to be beneficial to health (such as platinum, gold, and silver).

Ionic mineral distributors state that colloidal minerals have too large of a particle size to be absorbed by the body. Therefore, ionic minerals (named after their supposed positively and negatively charged molecules) were created to have the “correct electrical charge” and therefore lead to higher levels of absorption by the body. Although these supplements may actually lead to greater absorption, it is important to remember that there are various other conditions that must be present in the body in order for this to happen.

In reality, the body only needs minerals in trace amounts. Excessive dosages of minerals can actually be toxic. Therefore, before you experiment with any vitamin or mineral supplements, you may want to speak with your health care provider. A provider can help you sort out fact from fiction, so you can make an informed decision and avoid products that may be harmful or simply ineffective. In certain cases, you may be better off wearing these minerals than ingesting them!

Alice

December 11, 2012

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Dear Alice. I think people who are in tune to their body are able to judge very quickly if something helps, whereas health care providers know next to nothing about nutrition. It is amazing to me...
Dear Alice. I think people who are in tune to their body are able to judge very quickly if something helps, whereas health care providers know next to nothing about nutrition. It is amazing to me that those same health care providers are so quick to say you may harm yourself by using supplements, but in a heart beat will prescribe a drug they Know is toxic, habit forming, and with such a list of side effects it boggles the mind. I felt like a different person in just one week after starting Ionic Minerals. I had strange small muscle tics, anxiety and poor sleep and from reading and knowing my body, I decided to try a liquid and happened onto the Ionics. It's a miracle. I hate that the medical, pharmaceutical industry are so quick to label something dangerous.

Are low carb diets safe?

Dear Reader #1 and Marianne in Mesquite, Tx,

The Atkins Diet is a popular low-carb diet, which restricts certain types and amounts of carbohydrates (such as grains, starchy veggies and fruit) and emphasizes protein and fat. The idea behind the diet is that eating too many carbohydrates leads to blood sugar imbalances, weight gain, and cardiovascular problems. The Atkins Diet, in particular, has varying phases of strictness, at first limiting carbs drastically and then gradually increasing your range of foods over time. 

So why have you both heard that a low-carb diet might be bad for you? Drastically cutting carbs can result in some not-so-fun side effects such as headache, dizziness, weakness, fatigue, and constipation. You may even experience nutritional deficiencies. Eating a green salad each day might not cut your risk entirely. Carbohydrates are your body’s main fuel source, and digestion breaks down carbs into glucose (blood sugar). Severe restriction of carbohydrates (less than 20 grams a day) can result in a condition known as ketosis. Ketosis happens when your body doesn’t have enough glucose for energy, which leads to your body breaking down stored fat, causing ketones to build up in your body. The side effects of ketosis include nausea, headache, mental fatigue, and bad breath. Low-carb diets may be dangerous for people with severe kidney disease, or for pregnant or breastfeeding women. It’s best to consult your health care provider before starting a low-carb diet, especially if you have diabetes or gout, or take diuretics, insulin, or oral diabetes medications.

Some studies suggest weight loss with the Atkins Diet is not due to cutting carbs, but taking in fewer calories because your food choices are limited and protein and fat may keep you feeling full longer. The key to low-carb diets, or really any diet, is to find a way to balance being healthy (getting the nutrients and exercise that you need) while watching your food intake. Shedding the pounds can mean shedding disease risk! Almost any diet that helps you lose excess weight can improve your HDL cholesterol and triglyceride levels and can reverse risk factors for heart disease, type 2 diabetes, high blood pressure, bone loss, and some cancers.

When considering a diet for weight loss, there’s no famine of options. Check out the Alice’s archives on weight gain and loss for more information on different types of diets and the healthy eating category for more ideas on what to eat. Consider your personal preferences, budget, and health and look for a safe and effective weight loss plan. It can be hard to stick to a restrictive diet in the long term, making it difficult to reach a weight goal. Just because a diet is popular or your friends are trying it, doesn’t mean it’s the best approach for you. Besides speaking with your health care provider, you could also consider weight-loss support groups or speaking with a registered dietitian.

Under the 2010 Affordable Care Act, diet counseling is covered for people at higher risk for chronic diseases like type 2 diabetes and high blood pressure. Depending on your insurance, you may be able to get diet counseling at no cost to you. Check with your insurance provider to find out what’s included in your plan.

You can check out our get balanced! Guide for Healthier Eating. Columbia students on the Morningside campus can make an appointment with Medical Services. Columbia students at the Medical Center can make an appointment with Student Health or the Center for Student Wellness.

Alice

Conflicting nutrient values charts

Dear Reader,

There is so much nutrition information available from a host of different sources and it’s not hard to see why confusion can arise. You may have access to information published in scientific journals, which are studies that have been critiqued by nutrition experts. At the other end of the spectrum, some sources such as websites and corporate advertisements are created with the intention of boosting sales of the latest diet book or food product. In order to increase the chances of finding valid nutrition information, it's important to identify, use, and refer back to sources you trust. Additionally, when comparing information from multiple sources it is very important to make sure you are comparing exactly the same thing (same serving size, same source, etc).

When gathering information online, it is important to determine who sponsors the site, how often it is updated, the sources for information, and if advertising is involved (or influences content). As an example; Go Ask Alice! is sponsored by Columbia University, content is updated daily (all pages have an update date listed), the sources are described (see below), and the site is advertising free (learn about our no ad policy).

The U.S. Department of Agriculture (USDA) is generally the most reliable source of nutrition and food-related information for the general public in the United States. The dietary guidelines can be found at their MyPlate website where you can also find sample menus and recipes, a food tracker, BMI calculator, as well as several other useful health and food-related tools.

The USDA also has a National Nutrient Database, which is a reliable source for nutrient values for foods. Frequently, this site is accessed by nutrition researchers and developers of nutrient analysis programs. The National Nutrient Database site is user friendly enough that even regular people will be able to do a food search during her/his first visit to the site. Even the National Nutrient Database site, however, can be confusing. For example, it will generate conflicting numbers for nutrients in products such as milk, which comes in a number of varieties. For example, cow's milk provides 8 grams of protein per 8 ounces, evaporated skim milk provides 19 grams, and soy milk, 3 grams. The lesson learned here is to check the details of the food you searched for if the results seem different. For example, a search for milk could yield information on both coconut milk and cow's milk.

The MyPlate SuperTracker and the Nutrient Analysis Tool (NAT) are comprehensive online programs that can be used to analyze not just one food, but an entire day of food intake. They show a comparison of the analysis to your daily nutrient needs. The food lists in these programs come from the USDA National Nutrient Database, and nutrient needs are based on the Recommended Dietary Allowance (RDA).

RDAs are amounts of nutrients that, if consumed on a daily basis, would meet the needs of approximately 97 percent of the population, and are amounts that have been established after years of intensive research studies. The RDA of protein for adult males is 56 grams per day, and for women it is 46 grams per day. This general recommendation is based on 0.8 grams of protein per kilogram of body weight, for individuals in good general health. Protein needs can vary depending on a person's health status and exercise regimen.

For a personalized assessment of your nutrient needs Columbia studnets can make an appointment with a Registered Dietitian. Columbia University students can call x4-2284 or log into Open Communicator to schedule an appointment. Non-students may have access to a nutritionist through her/his primary health care provider or search for a dietitian in your area through the Academy of Nutrition and Dietetics web site. You might also want to check out the resources listed on the Columbia Health Get Balanced nutrition page.

For additional information regarding finding quality health information online, check out Health information on-line: Whom can you trust? Hopefully these new resources will help to clear up your nutrient value confusion, making it easier for you to make healthier eating choices.

Alice

Does exercising on an empty stomach maximize fat burning?

Dear Reader,

First things first: Great job staying active! Now, on to your very interesting (and slightly complicated) question. As you have already noticed, there are many schools of thought on the issue of maximizing fat loss. Do you exercise on an empty stomach or do you make sure and eat a little something before your morning run? Sifting through all this information can indeed be confusing. Let’s get to the bottom of the issue.

The latest research seems to indicate the following: If you will be exercising longer than 30 minutes, eat a light snack in the morning before you run. It’s a good idea if that snack contains some carbohydrates and some protein (i.e. a banana with peanut butter). This allows your body to use the carbohydrates to help burn fat in your body and the protein will keep you going past that 30 minute mark. However, if your aerobic workouts are less than 30 minutes, exercising on an empty stomach may indeed be the most beneficial for fat-burning.

Carbohydrates are the easiest for your body to burn — they require the least amount of oxygen. Fat, the body’s long–term energy storage mechanism, takes more oxygen. If no carbohydrate is present (i.e. an empty stomach), your body will burn fat for energy. But your body will also start burning protein. Herein lies the catch to performing aerobic exercise on an empty stomach: You may experience some muscle loss, especially if your work out is 30 minutes or longer. Here are a few more things to consider:

  • Not eating before a workout may cause you to fatigue faster, thereby shortening or lowering the intensity of your workout.
  • Exercising on an empty stomach can decrease blood sugar levels, which may make you hungrier and more prone to overeat at your next meal.

Lastly, individual bodies with different metabolisms do this sugar-protein-fat dance slightly differently. For example, certain types of health conditions, such as diabetes and low blood pressure, necessitate eating before exercising, as a cardio workout on an empty stomach could cause other health problems. Medical conditions aside, some people are more prone to muscle loss than others, and some will burn fat more quickly or easily than others. Additionally, the altitude at which you work out makes a difference. People exercising at higher altitudes have less oxygen at their disposal, so running at a slower pace, which will lower your heart rate, will help you burn more fat. Many trainers say that to maximize fat burning, you should do your cardio workout at a level that allows you just enough breath to hold a conversation.

Columbia students interested in more physical activity information can by sign up for Columbia's CU Move motivational emails. You can also visit the CU Move webpage for other physical activity related information. Best of luck to you on your morning workouts!

Alice

Anorexia and successful hospitalization?

Dear Future-In-Question,

First of all, the fact that you are reaching out for help takes lots of strength and is incredibly brave. It is also a very good sign for recovery. Your willingness to attend the eating disorders group at Columbia, visit Barnard Health Services, talk openly with your therapist and your parents, and write here, shows a lot of determination and courage, qualities which have probably gotten you through other challenges previously in your life.

Your questions about various forms of treatment are good ones. Most studies put the recovery rate for outpatient treatment (what you are currently receiving) at about 60 to 70%. Studies indicate that the vast majority of hospitalized patients respond favorably to treatment. However, (and this is what your therapist may be referring to), there are high relapse rates following hospitalization (30 to 50%) so what happens after hospitalization is crucial to maintaining the benefits. Relapse rates for outpatient treatment aren’t available because it’s often so unsuccessful in the first place, that it’s too tricky to accurately measure relapse rates. The fact that the data is skewed in this way may make hospitalization look less effective than it is. If your gut is telling you that it’s time for hospitalization, keep fighting for it. Tell your parents and therapist that you think it is best for you right now. They need to understand that you have a potentially life threatening condition. It is not your fault. It’s not a character flaw. You deserve treatment.

Hospitals that treat eating disorders do so holistically. Anorexia needs to be addressed from a nutritional, bio-chemical, psychological, and social perspective. They have you work with psychiatrists, psychologists, dieticians, gastro-enterologists, endocrinologists, and other health care providers. Any co-occurring issues such as substance use, depression, body distortions, etc. need to also be addressed, and hospitals that treat eating disorders understand this. When people are released from the hospital, it can feel like a significant loss of structure and support. Therefore, it is important that you, the hospital, your parents, and therapist plan for this and have such structures in place.

Research indicates that a combination of individual therapy, group therapy, and family therapy (if you’re living with your family), plus visits with a dietician and medication (often antidepressants) can prevent relapse. Individual therapy should specifically be cognitive behavioral therapy, preferably with a clinician that has had specific training in treatment of eating disorders. And it’s important to know that even in cases of relapse, you can bounce back. When people learn new behaviors and new ways of thinking about themselves, mistakes are almost inevitable and should be expected, because you are changing patterns that are firmly etched into your way of being. As a Barnard student, you have many rich resources around you. For instance, Barnard students can make an appointment to see a professional counselor at the Rosemary Furman Counseling Center.

As far as insurance goes, it may be a good time to have a heart-to-heart with your parents. Let them know how you feel and share any information or research that you have found. The National Eating Disorders Association has specific information on insurance coverage and how you and your parents can discuss what is and is not covered with your insurance company. Your willingness to seek out help is a real strength and will likely inspire other readers. So thank you. For more resources on eating disorders, see these resources and the related Q&As below.

Helpguide.org

National Association of Anorexia Nervosa and Associated Disorders

Eating Disorder HOPE

Take care,

Alice

Overcooked pasta and beans — Still nutritious?

Dear Long Cooker,

Whether you’re an avid chef or a microwave maven, it is important to know that overcooking can deplete the amount of vitamins and minerals in foods. If you are cooking your pasta and beans for as long as you say, you are most likely losing some of their nutritional value. Overcooking destroys bonds between molecules, significantly depleting the nutritional value. For example, overcooking can destroy amino acids and many of the B vitamins, such as Vitamins B-1 and B-5. These vitamins are important for metabolism and energy production.

Generally, shorter cooking time retains more nutrition in a food. Here are a few basic cooking guidelines for your pasta and beans:

Beans, peas, and lentils (members of the legume family) are low in fat and high in fiber, making them a healthy part of your diet. Cooking your beans properly can make them a nutritious and delicious addition to a meal. Dried beans should be soaked overnight in fresh water. They are then cooked for 1-3 hours, depending on the variety of bean. This is standard preparation, and beans cooked in this manner are full of nutrients.

Pasta is a complex carbohydrate, with more fiber and a lower glycemic index than simple sugars. Overcooking pasta can strip it of its fiber content. Most pasta only needs to be boiled between 5 and 15 minutes, depending on the cut of the noodle. Overcooking pasta will only add to the loss of vitamins (especially water-soluble B vitamins) and minerals that occurs when you cook it. Another tip: try not to rinse cooked grains and pasta, as this causes further loss of nutrients.

The style of cooking plays an important role in the overall nutrition of food as well. Whether fresh, steamed, baked, grilled, boiled, or fried, how food is prepared can modify the nutritional content. For instance, boiling leeches more nutrients out of vegetables and beans than baking, as many of the vitamins in vegetables are water-soluble. Steaming and microwaving your food can help maintain the most nutrients.

Bon appétit!

Alice

Androstenedione — is it safe?

Dear Reader,

While it appears that androstenedione has helped some people (a few prominent athletes included) increase their muscle mass and recover more quickly from injury, there is no scientific research supporting these results. In order to help you decide whether such nutritional supplements are right for you, let’s first take a look at androstenedione.

Androstenedione is a direct precursor hormone to testosterone and other hormones including one type of estrogen. It is converted from cholesterol, as are all other steroid hormones. Specific enzymes and hormones, among other things, must be present and ready to work for these conversions to take place. For instance, luteinizing hormone, produced and released by the pituitary gland, plays a pivotal role in converting androstenedione to testosterone. Simply introducing extra androstenedione to your system does not automatically indicate that all of the necessary players will be there to produce testosterone or improve the productivity of your workout.

About sixty years ago, when androstenedione was first synthesized, it was shown to have both androgenic (male hormone-like) and anabolic steroid-like properties. The anabolic effects were considerably less than those of testosterone. Subsequent research found that testosterone levels rose after inhalation of androstenedione, but remained elevated for only a couple of hours, with peak levels lasting a few short minutes.

Beyond these cursory early studies, rigorous studies have come to two broad conclusions about androstenedione. First, despite increasing testosterone levels for those with low baseline testosterone levels such as women and older men, androstenedione has not been shown to increase the testosterone levels of young men or to improve the effectiveness of their exercise regiments aimed at building muscle.

What side effects can you expect from androstenedione? No one knows for sure. Androstenedione  falls under the category of steroid hormones, which are known  to have androgenic and anabolic properties. Therefore, androstenedione may produce side effects similar to those of testosterone-based anabolic steroids. The most dangerous of these side effects is the increased risk for cardiovascular disease, certain cancers, depression, psychoses, and even extreme aggression. There are also gender-specific effects. For men, these include shrinking testes, increased hair loss, enlarged breasts, and possible sterility. Women may experience side effects such as shrinking breasts and uterus, enlarged clitoris, irregular menstruation, increased facial and body hair growth, and a deepening voice. In fact, due to many  potential negative health hazards, the Food and Drug Administration (FDA) has prohibited the sale of over-the-counter androstenedione and similar steroid-like dietary substances.

Is it safe? Safety can be difficult to determine when you don't really know what you're dealing with. Is it worth the risk? That's for you to decide. Before you begin taking any dietary supplements you may want to speak with your healthcare provider. S/he can answer your questions and give you more detailed information. Columbia students might want to consider making an appointment at Medical Services by calling x4-2284 or online using Open Communicator. Students on the Medical Center campus can contact the Student Health Service.

Alice

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