Nutrition & Physical Activity
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.
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.
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.
Sporting sexy things for one's paramour is one of the many perks (no pun intended) of relationship life. And it is a great testament to your relationship that your boyfriend compliments you. Some wise person once said, however, that "reassurance never reassures." So it is possible that his compliments may not be fully sinking in. In order to accept kind words from others, some part of you must also believe the statement. Have you noticed how you react when he compliments you? Are you able to hear and believe positive comments about your appearance?
It is possible that your low self-esteem, or at least your negative evaluation of your appearance, may affect you beyond intimate situations. Do you think this is true? In the western world, the skinny image of feminine beauty is everywhere. Any young child can tell you what an "ideal woman" should look like and very, very few women fit that standard (which is not culturally universal). Many people have internalized negative beliefs about themselves. These messages did not originate with you: They are the voices of young peers, family members, TV, magazine and billboard ads, and other mass-produced images of a standardized and very specific idea of beauty. Once a person has internalized a negative belief about the self, it can be very difficult to unlearn it, especially if you have held the belief for a long time.
So what to do about it? Here are some strategies to address your self-consciousness:
Gaining more insight. Many psychologists believe that suffering can be alleviated through insight. There are many different kinds of insight: You can gain insight about the source of your pain, insight about how and when it operates currently, and insight about how tour low self–esteem may affect other people. Source insight can be helpful because it can help you understand how and when the view was established. Many believe that people experience a type of liberation when they are able to make connections between early experiences and current thinking. You are able to see that your view of self originated outside of you and may very well be distorted. Gaining more insight into how others view you, you may begin to wonder if your own negative view of self is distorted.
Changing thoughts. Even without gaining insight, people can change their belief systems. Cognitive behavioral therapy is one way in which a therapist can help address distorted thinking or false beliefs that you may have about yourself and about your appearance.
Changing emotions. What are the feelings that come up for you when you undress? Do you experience anxiety? Shame? Fear? What emotions come up when you imagine yourself wearing something sexy for your boyfriend? What emotions do you notice yourself feeling when he compliments you? Do you feel happy? Embarrassed? Doubtful? Another benefit of therapy is that it may help you uncover some these emotions and which may allow you to work on changing them. Sometimes, negative self–esteem can be as much about someone's emotional state as one's thought process.
Fake it 'til you make it. Some psychologists believe that changing behavior is what leads feeling better. If you do the things that you'd like to do, even if they cause anxiety, you may eventually become "de-sensitized," meaning that the negative feelings may become less powerful over time and may be replaced by more positive ones, especially if you have good experiences when you take such risks.
A great deal has been written on the subject of body image and self-confidence. If you're looking for some good reads, here's a list:
- Joan J. Brumberg's, The Body Project: An Intimate History of American Girls
- Rita Freedman's, Bodylove: Learning to Like Our Looks — and Ourselves and That Special You: FeelingGood about Yourself
- Marcia Hutchinson's, Transforming Body Image: Learning to Love the Body You Have
- Ophira Edut and Rebecca Walker’s Body Outlaws: Young Women Write About Body Image and Identity
- Susie Orbach's, Fat Is a Feminist Issue
- Kaz Cooke's, Real Gorgeous: The Truth about Body and Beauty
- Judith Rodin's, Body Traps: Breaking the Binds that Keep You from Feeling Good about Your Body
- Linda Sanford and Mary Donovan's, Women & Self-Esteem
- Charles R. Schroeder's, Fat Is Not a Four-Letter Word
- Eve Ensler's The Good Body
- Naomi Wolf's, The Beauty Myth: How Images of Beauty are Used Against Women
Whatever you decide to read, seeking support may be another good option. If you are a Columbia student, you can make an appointment to speak with a therapist at Counseling and Psychological Services (Morningside) or the Mental Health Service (CUMC). Best of luck on your journey to feeling more positively and confident about yourself.
March 19, 2012508812
"Apple cider vinegar a day keeps the doctor away" doesn't exactly roll off the tongue, does it? Even still, many people claim that this product of fermented crushed apples yields a variety of health benefits including those that you mentioned. Usually taken in liquid, powder, or pill form before meals, it's most often used to aid digestion since the high acetic acid content helps break down food. In addition to this, it has also been used for centuries to treat fungal infections and sunburn. Although this may spark a domino effect on other aspects of health, there is no scientific proof that it has any effect on weight, blood pressure, or acne.
A common misconception about apple cider vinegar is that it curbs appetite and promotes fat burning, but physiologically, even though acetic acid intake may temporarily facilitate loss of water weight, it doesn't appear to affect fat. In fact, the high acidity of the vinegar may cause erosion of tooth enamel, throat irritation, and drug/supplement interactions (particularly with insulin and diuretics). It also acts as a blood thinner, so people who are on blood-thinning medications may want to reconsider its use.
Because the confirmed health benefits of apple cider vinegar are often a result of its high nutrient content (including iron, calcium, copper, and potassium), the choice between organic and non-organic is one to consider carefully. Non-organic apple cider vinegar has undergone pasteurization, the process of heating the liquid to a very high temperature to kill bacteria. As a result, the vinegar is much clearer and more attractive to consumers but in the process has lost the bulk of its nutrient content. Depending on what the consumer is aiming to gain from apple cider vinegar, this could affect the health benefits they experience. Then again, the potential bacteria content in organic (unpasteurized) apple cider vinegar could be problematic. Regardless of the nutritional supplement, a health care provider could be consulted before starting any alternative treatment.
Overall, if the reason for using apple cider vinegar is to lose weight, reduce blood pressure, or prevent acne, there are other treatments whose effects have been scientifically confirmed. In terms of weight loss, the key is to consume fewer calories than you burn on a daily basis. Routine physical exercise and a diet of fruits, vegetables, whole grains, and lean protein are your best bet. For more guidance on addressing these health concerns, see the Q&As below. You may also want to consider speaking with a health care provider or registered dietitian. Columbia students can make an appointment with Medical Services (Morningside campus) or the Student Health Service (CUMC).
In the end, an apple a day is more likely to keep the doctor away!
When it comes to weight, the two factors to pay attention to are calories consumed and calories burned. If you consume more calories than you burn, you will gain weight and vice versa. The problem here is either that you are not consuming enough calories or your body is somehow not making the best use of them. Before we get into the biological possibilities, try a quick dietetic experiment.
With all the media surrounding diets and obesity, it may be easy to get the wrong idea about what constitutes "healthy." Eating a lot of vegetables as you do is great (and a vital component of a healthy diet) but vegetables are low in calories and many don't contain fat or protein, both nutrients your body needs. When you feel those hunger pains, consider grabbing a snack or a meal that combines all of these, such as a salad with chicken (lean protein), avocado (healthy fat and a fruit!), and low-fat ranch dressing. Including more healthy fats (limit trans and saturated fats) and lean proteins (also found in seafood, dairy, and nuts) in your diet may help you feel fuller longer and will also add more healthy calories into your diet.
If this doesn't curb your appetite, there may be other factors affecting your hunger sensors, which a health care provider may help identify. Some questions to ask yourself are whether you've been feeling increased anxiety, if you've recently started or changed medications, or if you've experienced increased thirst, heart palpitations, or a need to urinate. These may be signs of hunger-causing conditions such as:
- Anxiety and other mental conditions
- The use of drugs such as corticosteroids and anti-depressants
- An overactive thyroid gland (hyperthyroidism)
- Grave's Disease
List adapted from The National Institutes of Health.
If you experience nausea or vomiting along with your insatiable hunger, that may be a sign that you have a parasite (such as tapeworm) in your digestive track. That possibility brings a whole new meaning to "eating for two." In the related Q&A's below, you may want to read more about parasites as well as other conditions that could explain your hunger. Regardless of the cause of your insatiability, though, if you lose more than ten pounds or five percent of your bodyweight unexpectedly or if weight loss persists, consider contacting a health care provider to get to the bottom of the issue…and your bottomless stomach. Columbia students may do this by contacting Medical Services or logging on to Open Communicator.
Whatever the cause of your endless appetite, hopefully this has sated your hunger for an answer. Eat up!
February 3, 2012506179
Dear Overactive eater,
Generally, a case of the munchies is your body's way of signaling that it's time to refuel. If snacks and even full meals don't fill you up, there may be another cause for your ongoing hunger. If diet changes don't do the trick, a visit to a health care provider may ease your mind and your appetite.
Based on your description, it sounds like you can rule out the possibility of a digestive parasite. Rather than fueling your hunger, most stomach bugs cause digestive troubles like nausea, vomiting, and diarrhea that can kill your appetite. There is one infamous bug, the Taeniasis parasite (aka tapeworm), that is often blamed for insatiable appetites or unintended weight loss. However, Taeniasis is acquired by eating infected pork or beef so it's not likely that you have a tapeworm since you've been vegetarian for years.
As you suggested, people who follow a vegetarian diet sometimes don't get enough protein. These power nutrients give your body energy and also help you feel full, more so than carbs or fruits and vegetables. Vegetarians also need to consider the kind of proteins they eat. Unlike meats, individual plant foods don't supply all the amino acids that your body needs. To make sure you're getting a complete protein package, try combing two complementary foods that offer different amino acids from these four protein groups: grains, legumes or beans, seeds and nuts, and eggs and dairy. For example, a PBJ sandwich combines grains (go for whole wheat bread!) and legumes (peanuts) for a complete protein. Similarly, a yogurt parfait with fruit and almonds complements dairy with nuts. Newer research has indicated that protein pairings need not be consumed at the same time. That is, it should be sufficient to combine the complementary foods within the same day. For more tasty protein pairings, check out the related Q&As below about protein sources.
Another source of satisfaction comes from eating enough fat. Depending on your level of physical activity and other factors your fat needs will vary. However recent research shows that eating moderate amounts of healthy fats can really help satisfy. In addition to nuts, think avocado and healthy oils (canola, olive, safflower, trans-fat free spreads). Check out ChoseMyPlate.gov to calculate your calorie, protein, fat, and carb needs and determine whether what you're eating should be filling you up.
To make sure you're eating enough of the right proteins and fats as part of a balanced diet, it may also be helpful for you to keep a food journal. You can use the journal to plan out meals, make grocery lists that include healthy and filling snacks, and record when and what you eat throughout the day (and night). The food journal may help you answer some key questions to explain the uptick in your appetite. For example, are you eating enough calories throughout the day to make you feel full? Do your tummy rumblings coincide with any particular emotions like stress, sadness, or happiness? If you do end up seeing a health care provider, the journal will help them understand your diet and what might be causing your excess hunger.
If diet changes don't seem to satisfy your hunger, there may be an underlying health condition that's giving you the munchies. According to the National Institute of Health, causes of increased appetite may include:
- Certain medications (such as corticosteroids and some antidepressants)
- Grave's disease
Premenstrual syndrome (PMS)
List adapted from the article Appetite - increased at MedlinePlus
Since there are a variety of explanations for your hunger pangs, if adding a healthy balance of proteins and fats to your plate won't satiate your appetite, your best bet is to see a health care provider. Getting medical attention is a good idea especially if you have any other unexplained symptoms like frequent urination, increased heart rate, or feeling very thirsty. Students at Columbia on the Morningside campus can call 212-854-7426 or log on to Open Communicator to make an appointment with a health care provider or nutritionist at Medical Services. If you are a student on the CUMC campus, give the Student Health Center a call at 212-305-3400 to make an appointment with a health care provider or nutritionist.
Fueling up with more complete proteins and healthy fats may help you feel full and keep your body running strong. If your hunger still hangs around, visit a health care provider to find out what your body needs to fill up and feel good. Take care,
It's great that you want to stay active and try new sports or activities, both at Columbia and beyond. There are lots of resources for adult sports education in New York City, and with so much online information it's sometimes hard know where to look.
If you like exercising in the great outdoors, check out Central Park's list of activities and resources. This site has information on a wide range of activities, from road running to wall climbing, and much more. Some of the activities do have fees, so be sure to read the fine print. Also, many of these are not instructional, so if you're looking to try something new and want to take a class, you might look a little further downtown at Chelsea Piers.
Although you will have to spend a bit more money, Chelsea Piers just might be worth the extra cash. This place has just about everything you're looking for, including a wide range of sports, and all levels of instruction from beginner to advanced. The field house has basketball, gymnastics, soccer and rock climbing, or check out golf lessons and ice hockey. If Chelsea is a bit too far from Columbia for you, the 92nd Street YMCA (on the East side) also has classes in basketball, racquetball and volleyball.
If hitting the roads is more your thing (and you have a bike or are thinking of getting one) you can take advantage of the organized bike rides from the New York Cycle Club that are inclusive of all types of riders. If you prefer running over cycling, check out the classes offered through New York Road Runners. You can also check out Zog Sports and MeetUp.com for groups, often organized by neighborhood, that meet up to play a range of informal and formal team sports, from soccer to softball to ultimate Frisbee. Again, some groups have fees, so check out the details.
It's great that you're revved up to try something new. If you want a great way to stay motivated and connected, you can participate with Columbia's CU Move initiative. CU Move encourages members of the Columbia community to engage in active lives that include regular physical activity. The program provides participants with motivation, incentives to be active throughout the year, and event calendars with access to plenty of free and low-cost physical activity options on campus and around NYC.
There's plenty out there to choose from, so what will it be? Ice hockey? Wall climbing? Golf? Something else entirely? The choice is yours; whatever you choose, be sure to have fun!
Dear Needing Antioxidants,
Microwave ovens may be a common and convenient fixture in many kitchens, but they have long been accused of causing cancer, radiation poisoning, and, as you mentioned, being weapons of mass destruction (of nutrients in foods, that is). No matter how you slice it, the act of cooking fruits and vegetables will destroy some of their nutrients because certain minerals, vitamins, and antioxidants cannot withstand the heat. The good news is that there are many ways to reduce the amount of nutrients lost. Additionally, microwave cooking generally does not cause any more damage to food than other cooking methods such as baking, boiling, or sautéing.
The study you mentioned noted that the broccoli was immersed in a large amount of water when it was cooked, which may have been responsible for such a high proportion of the antioxidants being destroyed; the nutrients likely leaked out into the water during cooking. Other studies have shown that when broccoli was cooked in the microwave with no water, the degree of antioxidant loss was much lower. The key ingredients to preserving antioxidants and other nutrients seem to be a shorter exposure time to heat while using as little water as possible. In that case, microwave cooking can actually be better than other methods of cooking, because it cooks food quickly and therefore reduces the time the food is heated. Other tips to keep the nutrients intact during cooking include:
- Leaving vegetables in big pieces so less surface area, and therefore less nutrients, are exposed.
- Cover your container to hold in heat and steam, which will reduce the cooking time.
- Avoid peeling the vegetable if possible; many nutrients are actually in the peel itself or just below its surface.
- Make sure you don't overcook your vegetables; take them out when they are crisp and tender.
If you are really concerned about getting enough antioxidants, you can also stick to choosing fruits and vegetables that you can eat raw, such as carrots, tomatoes, or cucumbers, or simply eating more of them. If an apple a day keeps the doctor away, think of what doubling or tripling that can do! Just keep in mind that not only is variety the spice of life, but it's also the best way to make sure you get all the antioxidants you need.
Getting the recommended amount of fiber can be a challenge, especially if you are limited in your food choices. Eating healthy foods other than whole grains is certainly one option, but with a bit of planning ahead, there are some other ways to make sure you are fulfilling your fiber and carbohydrate requirements.
If fiber is your main concern, then getting a lot of fruits and vegetables and taking a fiber supplement can help to "bridge the gap" on days where you must avoid grains. However, whole grains have a lot more to offer than just fiber. They may contain many other healthy components such as complex carbohydrates, antioxidants, vitamins, and minerals. Whole grain consumption has been linked to a reduced risk of heart disease, diabetes, and obesity.
Eating out is a challenge for anyone who has dietary restrictions, but thankfully some restaurants are adapting their menus to cater to clients that cannot eat certain foods, including wheat, dairy, gluten (a compound found in wheat and some other grains) and other common allergens. Consider talking with your server about your food allergies so they can notify the chef. They may also have some recommendations for you from the menu. If this is embarrassing for you to do in front of a client, consider calling or emailing ahead to ask about what items on the menu are free of wheat, corn, and sugar or how other dishes can be adapted to fit your needs. You might also consider ordering foods you can eat, such as salads, potato- or rice-based dishes, lean meats and seafood, and soups while out with clients, and snacking on complex carbohydrate- and fiber-rich foods before or after your business meals.
Checking out menus and calling ahead is useful because common food allergens can "hide" in places you may not expect to find them, such as salad dressings and some sauces. One resource to consider for finding a friendly restaurant is the Gluten-Free Restaurant Awareness Program website, which lists restaurants with gluten-free options throughout the US.
Since there are many benefits to eating a variety of whole grains, perhaps you can start taking some food with you when you travel, or shopping for food once you reach your destination. Since food packages must list all ingredients you can be sure you're getting what you need, avoiding what you can't eat, and you might save yourself some money in the process. Who doesn't like saving money?!
Finally, it might be useful for you to spend a little time with a dietician. A consultation could trigger many new ideas for getting the right amount of fiber. S/he is likely to present some creative and tasty options you may not have expected. If you are a Columbia Student, you can contact Medical Services (Morninside) or the Student Health Service (CUMC) to schedule an appointment with a registered dietitian on campus.
With creative planning and a visit with a professional you can be sure you're getting what your body needs to stay healthy. It might take some extra time and effort, but your health is worth it!