Nutrition & Physical Activity

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Weightloss diets for vegetarians, and everybody

Dear Reader,

Fortunately for people who wish to lose weight, there are universal rules that apply, regardless of your typical diet — whether you're a vegetarian or omnivore. First, to lose weight a person has to use more energy (calories) than s/he takes in. To achieve this deficit you can either make dietary changes (so you're taking in less calories), get more physical activity (so you're using more calories in a day), or you can make changes in both areas. Experts recommend making both dietary changes and getting more physical activity for the best results.

It takes a deficit of about 3500 calories to lose one pound of body weight. This means if you are able to cut 500 calories per day from your regular diet you should be able to lose a pound a week (a healthy weight loss rate). It may be beneficial to consider finding the right balance of increasing your physical activity and decreasing caloric intake. You can check out the ChooseMyPlate.gov SuperTracker as a resource that can help you calculate how many calories you need per day, what nutrients are in the foods you eat, and how many calories you burn doing different exercises.

Some suggestions for dietary changes to reduce calories:

  • Steam, boil or bake foods instead of frying in butter or oil.
  • Sauté foods in vegetable broth, wine, or water instead of oil.
  • Limit of high-fat condiments (like mayonnaise, margarine, sour cream, cream cheese, salad dressing, etc.).
  • Try low-fat dairy products and nut- or peanut butter. Vegetarians sometimes begin to rely heavily on these foods as sources of protein, but low-fat dairy and nut products provide the same amount of protein as their full-fat counterparts.
  • Add beans and legumes to your diet as low-fat sources of protein.
  • Eat actual fruit or vegetables rather than drinking them in juice or smoothie form. The fiber in fresh produce works well to satisfy hunger.
  • Substitute water, tea, and diet beverages for regular soda, juices, and other high-sugar drinks.
  • Limit the amount of alcoholic beverages consumed (empty calories for everyone).
  • Begin lunch or dinner with a broth-based, vegetable filled soup or a large salad with a small amount of low-fat or fat-free dressing. These foods take longer to eat and can help curb your hunger so you don't overeat during the rest of the meal.
  • Be mindful of portion sizes — read nutrition fact labels to find out serving sizes. Some rules of thumb:
    • A medium apple or orange is the size of a tennis ball.
    • A medium potato is the size of a computer mouse.
    • An average bagel is the size of a hockey puck.
    • An ounce of cheese is size of four dice.

Some suggestions for incorporating more physical activity into your day:

  • Take the stairs as often as possible.
  • Park at the far end of the parking lot or get off the bus or subway a stop early.
  • Schedule your cardiovascular exercise (walking, jogging, swimming, biking, frantically cleaning your apartment before visitors come over, etc.) so you know you will be able to fit it in. If you're at Columbia, you can participate with CU Move to help stay motivated with your physical activity efforts and earn incentives.  Check out the site to learn more. 

Hopefully, you'll find some of these suggestions new and helpful. Good luck!

Alice

Eating soap — obsession

Dear Soap-Eater,

Kudos for thinking about how your behavior might affect your long-term health and writing in to ask about it. What you describe is called pica, an eating disorder where people frequently eat non-nutritive (non-food) substances. Depending on what a person eats, pica can be very dangerous. Ingesting dangerous substances or large amounts of some substances can lead to medical problems, including poisoning. There is also a risk of infection resulting from some substances, such as soil, and stomach problems including constipation, and other issues.

Fortunately, in your case soap is not a very dangerous substance, though in large amounts over time it could disrupt your health. Soap is generally non-toxic and should not lead to poisoning. However, it can cause diarrhea, vomiting or skin irritation.

The causes of pica are not known but some suggest that the following may contribute to the desire to eat non-food items:

  • Nutritional deficiencies. Some speculate that pica is your body's way of telling you that you are missing some important nutrient. Iron, calcium, zinc, and vitamins C & D deficiencies have been found in people with pica.
  • Culture and family influences. There is some suggestion that certain cultures and social groups accept eating non-food substances. Also, if your parents encouraged this as a child, you may still have the urge to eat these substances.
  • Stress. The desire to eat non-food substances may be a coping strategy for stress.
  • Underlying biochemical disorder. In some cases, pica may result from chemical imbalances in your brain.

You mentioned that eating soap makes you feel good when you're stressed. This could be a sign that your stress level is too high and your body is reacting by craving soap. You could consider finding alternative ways to deal with your stress. See Stress, anxiety and learning to cope and Number one cause of stress for some tips on other ways to combat stress.

Pica is rare in adolescents and adults, and can be the sign of other medical issues including nutrition deficiencies so you should consider contacting a health care professional to help figure out what might be causing this behavior. Columbia students on the Morningside campus can call 212-854-2284 to make an appointment or log on to Open Communicator. Students on the Medical Center campus can contact Student Health at 212-304-3400. You may also want to consider talking with a counselor about healthier strategies for coping. Columbia students can make an appointment with Counseling and Psychological Services (Morningside) or the Mental Health Service (Medical Center).

You took an important first step in asking about your behavior, but it's also important that you take the next step and talk to a health care professional who can help you figure out if there is some underlying cause. Taking care of your health is not silly — it's smart.

All the best,

Alice

December 19, 2014

594651
I've never eaten soap. However, once in a while (since I had my son 8 years ago), I get cravings for soap. I had a craving today and decided to google it. I'm so glad I'm not the only one. I really...
I've never eaten soap. However, once in a while (since I had my son 8 years ago), I get cravings for soap. I had a craving today and decided to google it. I'm so glad I'm not the only one. I really want to taste a piece one day, but idk if the logical part of me will allow me to try it.

February 26, 2014

553088
Believe it or not I have been eating soap for approximately 20yrs and here is some advise. If you can stop start doing so gradually and try not to go back. For me it has caused some skin irritations...
Believe it or not I have been eating soap for approximately 20yrs and here is some advise. If you can stop start doing so gradually and try not to go back. For me it has caused some skin irritations and recently some digestive problems. Although my mouth still waters at the thought, it is not worth it.

February 19, 2014

552436
I too crave soap. I like the taste of Irish Spring, Coast, Silk, Ivory, Jergens and others. I have discovered that it ruins your teeth and gums causing sensitivity and caries. It also creates long-...
I too crave soap. I like the taste of Irish Spring, Coast, Silk, Ivory, Jergens and others. I have discovered that it ruins your teeth and gums causing sensitivity and caries. It also creates long-term digestive issues such that my body is no longer absorbing nutrients as it should because ingesting soap changes the environment necessary for proper digestion. My guess is that the hydrochloric acid gets neutralized so it takes longer for the food to be broken down and pass through the system. Recently, I stopped eating soap because my teeth became so painful that I couldn't chew and was forced to really do something about it. Now, I try to buy brands of soap that I don't like and because iron supplements are too harsh for my stomach, I'm trying to boost my intake by using nettle and oat straw teas as well as spirulina and chlorella. My tooth sensitivity went away within a week of ending my soap eating habit and with intensive action to remineralize using the herbs mentioned along with black walnut tincture. I have stopped before for long periods, but went right back after a while. I can't afford to allow that this time, so I'm investigating tooth soaps to see if they have similar textures and nice tastes. Since these can be ingested, I'll try them if I fall off the bandwagon again and hope for the best. Best wishes everyone and I hope this really helps someone. Kindred Spirit

April 19, 2013

527515
Okay. I don't know what to say. I also thought I was alone. I'm also a soap-eater, and nobody knows this. At first, I thought I was just curious with it's taste, especially when it smells really good...
Okay. I don't know what to say. I also thought I was alone. I'm also a soap-eater, and nobody knows this. At first, I thought I was just curious with it's taste, especially when it smells really good...so it tried licking it, then it became a habit. Everytime I take my bath, I can't keep myself from tasting my bar soap, I became obsess with its taste and smell. I started craving for more. It seems like I can't stop myself from dong it. I'm really worried about this and I want to thank whoever is behind this website because I feel kinda relief knowing I'm not alone.

January 4, 2013

521132
I eat Irish Spring not proud of this behavior but I can't seem to stop :( It relaxes me as well for some reason.
I eat Irish Spring not proud of this behavior but I can't seem to stop :( It relaxes me as well for some reason.

December 10, 2012

519919
I'm also a soap eater,and I've been eating soap for over 5 years now and I just can't stop the cravings!
I'm also a soap eater,and I've been eating soap for over 5 years now and I just can't stop the cravings!

August 27, 2012

515527
I also am a soap eater and I thought I was alone. It's relieving to find out there are others out there that also have this problem. I am very health conscious and it disturbs me that I enjoy the...
I also am a soap eater and I thought I was alone. It's relieving to find out there are others out there that also have this problem. I am very health conscious and it disturbs me that I enjoy the taste of soap when the purpose is to wash your body or hands and not to eat. I guess you could say it started when I was a kid when my parents would punish me by making me stick a bar of soap in my mouth for an extended period of time. I just started washing my body with a bar of Irish Spring soap this past year and I would occasionally lick the moist bottom of the bar. It tasted funny at first but now it tastes delicious. I can't help but feel bad that I'm eating it because I know the bar is not meant to be eaten. I'm also stressed and find myself eating it more often then usual. I'm just glad it's not harmful to the body with small amounts and that I'm also not alone. Thanks soap eater!

March 6, 2012

508112
ime so glad i looked this up.....i eat dove soap everyday now,i used 2 nibble imperial leather and knights castile as a child then again in my teens now started again at 41 !!!!!!!!,the cravings are...
ime so glad i looked this up.....i eat dove soap everyday now,i used 2 nibble imperial leather and knights castile as a child then again in my teens now started again at 41 !!!!!!!!,the cravings are so bad that i even brush my teeth with it aswell as bath in it and litterally bite chunks and chew it, i litterally crave it so much my mouth waters,all my friends etc think its disgusting but its like a drug addict needing their fix or an alcholic needing their drink! hopefully now ive looked into it i can get the right treatment and leave the dove alone :)

June 19, 2009

21546
To the reader:

Thank you, I thought that I was the only one and I searched high and low. I feel better knowing that there is a name for it. I opened up and told two relatives and I got scared when...

To the reader:

Thank you, I thought that I was the only one and I searched high and low. I feel better knowing that there is a name for it. I opened up and told two relatives and I got scared when they hinted that it may cause sterility. I also only eat bar soap and it relaxes me. I will take a chunk out of it and it's kinda like woosaa.

Thank you for this post and thank you for opening up soap eater.

Soap eater2

Will probiotic-enriched yogurt aid digestion?

Dear Reader,

It's wise to keep a healthy skepticism about the marketing efforts of some of these huge food corporations. Dannon's probiotic-fortified yogurt, Activia, is certainly an example of a highly promoted product. In recent years, the global market for "functional foods," has grown to billions of dollars annually, and since these supplement-food hybrids are appearing on the shelves ever more rapidly, the FDA doesn't have a chance to evaluate all of their claims. While there is evidence that probiotics do help to improve digestion and gastronomic health, it is hard to say that one brand over another is more effective at doing so.

Probiotics, beneficial bacteria that live in the small intestine, are believed to improve digestion. These gut-friendly bacteria actually help you to digest and eliminate your food, while crowding out the unhealthy gut-dwelling bacteria that cause gas, constipation, and bloating. Studies have shown that certain probiotics can help relieve irritable bowel syndrome, diarrhea, constipation, atopic eczema, and may also help protect against various infections and colon cancer. Researchers have found that stressed-out rats have benefited from a serving of water containing certain probiotics. Not a flattering comparison for us people, who might feel like stressed-out rats from time to time, but the findings of the study may be helpful. Probiotics are found in many types of fermented foods, like yogurt, sauerkraut, tempeh, and miso.

Regular yogurt is made using these live cultures, and serves up a healthy serving of them with each spoonful. But your question, is Dannon's Activia more effective in providing these results than regular good old-fashioned yogurt, is one that begs a good answer. Dannon (of course) says yes. Their Activia yogurt contains Bifidus regularis, a probiotic strain trademarked by Dannon that is not in other yogurts, and they claim that this particular strain speeds wastes through the digestive system and improves immunity in the intestines more effectively than other strains.

Dannon says that their Bifidus regularis, "survives passage through the digestive tract, arriving in the colon as a living culture," whereas other cultures can be destroyed by stomach acids and the natural process of digestion. The consumer reports lab has confirmed Dannon's claim, reporting that about three million of the original three billion probiotic organisms in a four-ounce serving of Activia made it through the stomach to the colon.

There is one other difference you mentioned between this yogurt and the others: the price. Activia typically costs more per ounce than regular Dannon yogurt. There are also other brands on the market that offer yogurts containing probiotics that are similar to those in Activia. If you're willing to spoon out the extra cash for yogurts with these particular probiotics and have noticed a decrease in stomach grumblings as a result, it seems like it working for you and might be worth it. However, now that you know that all yogurts contain healthy amounts of probiotics, it might be interesting to see if those regular yogurts feel just as good as the one with all the advertising. Eat up!

Alice

Food coma

Dear Reader,

The symptoms you describe sound like what many people call the "food coma." Sometimes, after eating a holiday meal, a big dinner or lunch, or even sometimes after meals that didn't seem that big, you may feel a bit drowsy. Some medical conditions can cause this feeling, including anemia, kidney dysfunction, sleep disorders, infections, or an electrolyte imbalance just to name a few. But even people who don't have any of these medical conditions may still feel tired after eating, because this symptom is also a consequence of normal digestion!

Why? Because our bodies spend a lot of energy digesting food. The stomach mechanically churns the food, produces acid to break the food into tiny pieces, and then controls the rate this broken down food can enter the intestines. In the intestines, enzymes use energy to further break down and absorb food particles into the body. For humans, it is normal for the rate of energy use to increase by 25 to 50 percent after a meal. This increased bodily activity could contribute to your feeling flushed after eating.

One explanation for your drowsiness lies in one of the hormones released during digestion — cholecystokinin. Commonly referred to as CCK, this hormone helps make you feel full, but also activates the areas in the brain associated with sleep. So after eating, when CCK levels rise to tell you you're full, you may also start to feel sleepy. Additionally, meals high in carbohydrates can increase the levels of tryptophan (an amino acid) in the blood. In the brain, tryptophan is converted into serotonin (a neurotransmitter that makes people feel both happy and sleepy). This boost in serotonin could also cause someone to feel tired.  

Since you don't feel tired after every meal, you may want to keep a food journal to see what types of food have you craving a post-lunch nap. If carbohydrate-rich or heavy foods like pizza, pasta, or panini slow you down, you could opt for a salad, soup, or sushi on days when you have a lot of work to do in the afternoon. You could also try eating several smaller meals throughout the day, rather than a big lunch, to avoid overwhelming your digestive system.  

Feeling tired after eating is a common experience, and not necessarily linked to a medical condition. However, if you feel your symptoms may be related to a medical problem, it's always a good idea to visit your health care provider, especially if your fatigue begins to seriously impair your ability to get your work done. Students at Columbia can contact Medical Services (Morningside campus) or the Student Health Services (CUMC).

Best of luck in staying alert during your post-meal endeavors,

Alice

Lactobacillus acidophilus for diarrhea?

Dear Reader,

Lactobacillus acidophilus is bacteria, not the pathogenic type that causes illness, but actually one of several kinds of beneficial bacteria called probiotics. These helpful bacteria are normally found in the intestine and the vagina. They are also naturally available in cultured or fermented dairy products, such as yogurt that contain live active cultures and acidophilus milk. Probiotics are also sold as nutritional supplements. Since the U.S. Food and Drug Administration (FDA) does not regulate dietary supplements, the presence and/or amount of live active cultures in supplements is not guaranteed.

Probiotics appear to offer various health benefits. They create a more acidic environment in the intestine and vagina, which helps keep harmful bacterial growth in check. This natural balance can be disrupted, however, by antibiotic use and illness. In these cases, the bad bacteria proliferate, usually causing conditions such as diarrhea or vaginal infections. Taking probiotics may help reduce the symptoms of diarrhea and treat vaginal infections.

Other possible benefits include enhancement of the immune system, helping the digestion process, production of antimicrobial substances, and protection against certain chronic illnesses, such as cancer, among other possibilities. However, more research is needed to definitively demonstrate that probiotics have these favorable actions.

To answer your question: There has been some research to suggest that L. acidophilus (commonly combined with another probiotic) may reduce the risk and/or duration of of some cases of diarrhea if used as a preventative measure. More specifically, a few studies have shown that the use of this probiotic has reduced the risk and incidence of diarrhea associated with antibiotic use and chemotherapy. In another study, a combination of probiotics that included L. acidophilus resulted in a shorter duration of acute diarrhea in children. While these findings are promising, there is currently no consensus on whether L. acidophilus alone or in combination with other probiotics would be effective for the prevention or treatment of traveler’s diarrhea.

Despite this research, if you are considering using L. acidophilus or other probiotics, consult your health care provider before doing so. Those who are pregnant or immune-compromised will need to determine whether or not it's medically safe to take probiotics. Adverse effects include gas and/or bloating, irritation, sensitivities or allergies, and interactions with over-the-counter or prescription drugs and/or other dietary supplements.

There are other remedies for diarrhea, including antidiarrheal and antimicrobial medicines, but these are not recommended in all cases. When the cause is food poisoning, it’s best to let the illness run its course. Antidiarrheals can delay the time it takes for food-borne microorganisms to leave the body.

Hope this helps!

Alice

Kickstart for getting healthy eating and exercise plan in gear?

Dear In dire need of a diet/workout routine,

While you may be low on motivation right now, don't fret; it's never too late to get back on track.

Instead of thinking about the negatives related to lack of exercise and poor diet (excess weight, feeling sluggish), thinking about the positive benefits of healthy exercise and eating patterns may help your motivation return. Exercise and a healthy eating plan can help promote long-term health, but they also have more immediate effects. Exercise helps relieve stress and causes the brain to release mood-improving compounds called endorphins. Time spent on exercise is time spent on you, time for you to consider the issues of the day or to simply clear your head. Working out improves sleep quality, so we have more energy to take on work, school, and the next workout. In the past, what positives have you experienced from exercising and eating well?

Having established some pros, you may want to consider the barriers that are keeping you from eating healthily and doing regular physical activity. One example might be that you don't see healthy lunch options at your workplace or school. Another could be that some fitness center memberships are too pricey. What are all the barriers you can think of? (Hint: start writing them down!) Once you know what you're up against, you can brainstorm solutions and take a step-by-step approach to implement your solutions. For example, with the lunch time conundrum, would it work to pack a healthy lunch two or three times per week? Or could you start to scour the menu and deli shelves for healthy options that may be hidden away? Some folks find that rewards are part of the solution. What are some non-calorie rewards that would give you the incentive you need to stay active and eat well?

Feeling sluggish can be related to giving your body more fat, sugar, and calories than it needs. An energy boosting, balanced diet includes plenty of fruit, veggies, low-fat dairy, lean proteins, and whole grains. Look at the Related Q&As listed below, or visit the Academy of Nutrition and Dietetics or Choosemyplate.gov web sites for tips and guidelines that will help you to put together a healthy and tasty eating plan. As you change your eating patterns, you may even chart your moods in a daily organizer, to see the foods that are making a difference.

Another great way to get back on track with exercise and healthy eating is to gain the support of an ally. Working out with a buddy will make it easier and more enjoyable, and will keep you accountable for those days when you want to skip your exercise. By varying the time of your workout and/or the activity you do, you can prevent getting bored with your same old routine. Sharing a home-cooked meal with a friend can be fun and healthy.

If you prefer, you could also get a professional perspective. Columbia students can schedule time with a trainer at Dodge Fitness Center. For healthy meal planning, Columbia students can set up an appointment with a registered dietitian by contacting Medical Services (Morningside) or the Student Health Service (CUMC). You can also participate in Columbia's physical activity initiative by joining CU Move. 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. If you are not part of the Columbia community, you likely have personal trainers at your university fitness center, local gym, or YM/YWCA.

Be realistic, have fun, take small steps toward your goals, and you'll be on your way to getting big rewards!

Alice

How do I slim down bulky, muscular thighs?

Dear Anonymous,

Many women athletes, once they end competitive play, work on reducing the size of their muscles in different parts of their bodies. As both a softball and soccer player, you are most likely performing power movements in order to train your legs. These power movements probably involve lifting very heavy loads for a few repetitions while weight training and performing explosive movements, such as pressing off of your pivot leg when sprinting.

The amount of muscle in your thighs can be reduced, but it may hamper your athletic performance if you are still active in softball and soccer. As a power athlete, you probably have a larger proportion of fast-twitch muscle fibers (Type II) than slow-twitch fibers (Type I), found predominantly in endurance athletes. Most of your muscle type will not change, as the type of muscle fibers do not predominantly change over the course of one's life. Basically, you are born with the primary type of muscle fiber that you will always have; however, a small amount may adapt to changes in your workout regimen. Resistance and endurance training enlarges Type I fibers, while inactivity causes them to atrophy. Likewise, training may alter Type II fibers, which come in two varieties: hybrid fibers (Type IIa) and glycolitic fibers (Type IIb). Weight training converts Type IIb fibers into larger Type IIa fibers. With disuse, Type IIa fibers revert back to leaner Type IIb fibers.

If you are no longer playing or simply have a strong desire to decrease the muscle size in your quadriceps and hamstrings that make up your thighs, consider cutting back on lifting heavy weights while strength training. As opposed to performing one to four sets for three to five repetitions at a very heavy weight (85 to 100 percent of your one-lift maximum, which is the most you can lift for only one repetition, after which, you cannot repeat the exercise), begin doing three sets for 15 to 20 repetitions at a low weight (approximately 50 to 70 percent of your one-lift maximum). Below are some leg exercises to include in your training:

  • Squats
  • Leg press
  • Leg curls
  • Leg extensions
  • Seated and standing calf raises
  • Adductor
  • Abductor

Another option to lessen the size of your thigh muscles is to introduce distance running into your training regimen, as long as you do not have or are not prone to any joint pain in your legs. This activity can transform the size and structure of your legs. This is because distance runners adapt to this form of endurance training by developing leaner muscular legs (even though the muscle type will predominantly remain the same). You may consider starting with one mile and then build up to five to ten miles during a training session.

People may be genetically predisposed to have strong leg muscles in their thighs. This might not only apply to you, but also may be a reason for your athletic success. Although your legs may not look traditionally feminine, it's important to recognize their beauty in performing strong, powerful moves when scoring a goal or running to home. Since it sounds as if you're still active in softball and soccer, you might come to terms with your priority — to stay competitive in these sports, to play at a more leisurely level, or to stop for the time being. Your choice will determine whether, how much, and for how long you can transform the muscle mass in your thighs.

The bottom line will be deciding whether it's more important to you to have strong muscles that serve you athletically, or smaller muscles and less athletic prowess (or power). If you desire both, and you cannot change what is in your genes, then you may be able to change how you view your powerful, capable body.

Alice

I'm worried about my friend who may have bulimia

Dear Reader,

Your friend is lucky to have a friend like you, who observed a change that concerned you enough to ask for help and learn more about what could be going on. A twenty-five pound weight loss in one month is definitely cause for concern. Losing that much weight in such a short period of time could indicate a medical problem. Has your friend seen a health care provider recently? If not, you may consider urging her to schedule an appointment with a medical provider for a physical exam to make sure she is okay. This may or may not be an easy thing for you to do. Strategies to consider when encouraging a friend to see a health care provider include:

Validating your friendship
Convey that you care for her and that your concern is genuine. You can say, "I value our friendship, and I hope you know that I care about you."
 
Thinking about your approach
Plan what you will say. Be direct with your concern, and focus on your friend's health rather than on her weight. Sometimes it's easier to identify an aspect of someone's health or behavior. For example, "I've noticed that you seem tired all the time"; or, "I've noticed that you seem kind of blue lately." If she's an athlete, you might be able to comment on her decreased performance. Whatever you choose to say, keep the emphasis away from weight, appearance, and food, because sometimes the most seemingly innocent statement can be misinterpreted and unwittingly close a door you had planned to open.
 
Offering a plan with options
Sometimes it's not enough to express concern. Follow up your observation with action-oriented ideas. For instance, "Is there a health care provider you feel comfortable scheduling an appointment with? If not, I'd be happy to help you find one." Or, "I can go with you to your appointment with the health care provider, if you like, or perhaps there is someone closer to you whom you might like to go with instead."
 
Recognizing your own limitations
Perhaps going to a health care provider with your friend is outside of your comfort zone. That's okay. It's important to know what you feel comfortable with so you avoid overextending yourself. Maintain whatever boundaries you need to so as not to get stressed out. Choosing to stay within your limits doesn't mean you're not supporting your friend.

It is not clear whether or not your friend has bulimia; however, you have noticed that she is in a serious situation and needs to be seen medically, since her health may be at risk. If you think your friend has an eating disorder, consider the following:

  • Individuals with bulimia nervosa tend to be of normal to slightly overweight range. Bulimia typically involves regular and repeated, often secretive binge eating bouts followed by purging, or other compensatory behaviors, to prevent weight gain. In general, purging is accomplished by self-induced vomiting and/or misuse of laxatives, diuretics, or enemas (purging type). People with bulimia may resort to other extreme behaviors, such as excessive physical activity or self-induced starvation (non-purging type) to avoid weight gain. Bulimia is highly correlated with substance abuse. People with bulimia often have a history of misusing alcohol and/or other substances.
     
  • Anorexia nervosa is characterized by an unwillingness and inability to maintain a healthy body weight. Typically, someone with anorexia is at 85 percent or less of her/his healthy body weight. S/he has a severe fear of fat and weight gain, and has a distorted body image. The seriousness of the significant weight loss is often denied by someone with anorexia.
     
  • Binge eating disorder is similar to bulimia nervosa in that it is typically characterized by regular and repeated binge eating episodes. An episode of binge eating involves rapidly and uncontrollably eating a large amount of food in a single time period at one sitting until uncomfortably full. Unlike bulimia nervosa, binge eating disorder does not include purging or other compensatory behaviors. Affected individuals are usually obese and have had problems with fluctuations in their body weight. For a majority of these individuals, binge eating begins during a diet.
     
  • Eating Disorders Not Otherwise Specified (EDNOS) describes individuals who show signs of anorexia and/or bulimia, but do not fully exhibit the behaviors necessary to be clinically diagnosed with anorexia or bulimia. Someone with EDNOS may purge but not binge eat, or binge eat less than twice per week. So someone with disordered eating may not fit into the category of anorexia or bulimia, but still have an eating disorder that requires treatment.

A medical problem can trigger such significant weight loss in a short period of time, and so can depriving and/or ridding one's body of calories. Body weight remains stable when people eat just enough food to give their bodies the energy (calories) that they need for daily activity — calories taken in or ingested need to equal calories out or expended for weight maintenance. People gain weight if they consume more calories than their bodies need and use. If people eat fewer calories than they need and use, their bodies will take the energy from their storage, body fat, and will lose weight. Significant weight loss indicates that there may be multiple factors involved.

Based on your observations, the sooner you take action, the better. If you're comfortable, consider your approach if/when you talk with your friend. Timing is important, so choose when you two can sit in a relaxed environment that allows enough time to talk. Think about what you will say without coming across in a threatening or accusatory manner. Use "I" statements to express your feelings about what you've noticed that seems to be happening with her: "I'm worried that something is going on with your health." Try not to let the discussion turn into an argument or power struggle. If the conversation becomes hostile, back off and resume after you both have had time to calm down and think. Be prepared for rejection the first, fifth, or tenth time you express your concern with her. Persistence could pay off at some point, as the road to recovery is a process. If your friend denies she has a problem, a common reaction, don't take it personally; at least your friend now knows that she can come to you if/when she's ready to ask for or to get help.

If you're a college student, you can get help and support for your friend and even for you in dealing with your friend, from your resident adviser (RA) or residence hall director (RD), dean, advisor, or from someone in the Counseling Department. If you are at Columbia, you can reach out to the Health Services' Eating Disorders Team, Counseling and Psychological Services (CPS) at x4-2878, or a nutritionist or medical provider at Medical Services at x4-2284. As you can see, there are many opportunities to begin to get the help you need to be able to help your friend. It is important to remember that she needs medical care, and that you alone cannot fix her. She's lucky to have someone like you who cares enough to reach out.

In an emergency situation, however, you need to involve your friend's RA, RD, and/or dean to make sure she gets appropriate help immediately. Signs that indicate an urgent situation include sleeping all day, blacking out, suicidal thoughts or attempts, or significant weight loss, such as in this case. You may feel reluctant to blow the whistle on your friend, but you will be a better friend by helping her get the assistance she needs than by respecting her privacy in this specific situation.

Alice

Does warm milk really lull us to dreamland?

Dear Reader,

A cup of warm milk is no magic sleep potion, yet it is probably the most common food associated with bedtime. Milk contains two substances that are known to be related to sleep and relaxation, the hormone melatonin and the amino acid tryptophan. The amount of melatonin in a glass of milk is minute, much less than what would be taken in a supplement. The amount of tryptophan in milk is also small. In addition, our digestive process is complex. Considering these factors, it is unlikely that a glass of warm — or cold — milk would shorten the length of time that it takes to fall asleep.

Though milk components and serving temperature are not likely to influence the onset of sleep through physiological means, warm milk might have psychological significance. The routine of consuming a glass of warm milk may elicit memories of mom, home, and comforts of childhood that help us to relax. This is part of the natural transition from wakefulness to sleep. Recommendations include practicing stress reduction techniques, sticking to a regular sleep schedule, creating a relaxing bedroom environment, and avoiding caffeine or heavy meals close to bedtime.

For some individuals, particularly those with lactose intolerance or milk allergies, a glass of milk can be followed by uncomfortable digestive consequences. Lactose reduced, soy, almond, and rice milk are options that are more likely to be tolerated. If you have no allergy or intolerance, and warm milk simply grosses you out, you could try flavoring it with a bit of honey, vanilla, or cinnamon, but there is no reason that you need to continue attempting to use it as a sleep aid. Keep drinking your cold milk, to meet your daily calcium needs, and try other sleep improvement techniques.

Alice
P.S.: As a side note, putting your finger into a liquid that has just boiled, whether it is water, tea, or milk, is not advisable. Boiling milk reaches a temperature of approximately 100ºC. Ouch!

February 27, 2012

507786
I have used warm milk for almost fifty years as a sleep aid and it works wonderful. i believe in it fully... better than taking pills.
I have used warm milk for almost fifty years as a sleep aid and it works wonderful. i believe in it fully... better than taking pills.

November 12, 2008

21491

Hi Alice,

I am a lover of milk and love it cold or warm. I have always had success w/ warm milk lulling me to sleep. I have even had occasions when I've had a decaf coffee drink w/ steamed...

Hi Alice,

I am a lover of milk and love it cold or warm. I have always had success w/ warm milk lulling me to sleep. I have even had occasions when I've had a decaf coffee drink w/ steamed milk and it did me in for the rest of the work day. It really has worked for me in all the years that I have been doing it. As a matter of fact, it's a cool night where I am tonight and I'm going to have a nice warm mug of milk and maybe add a little honey and vanilla, curl up in my bed, and read until I'm done partaking... yum, what a treat! Sweet dreams, ya'll...

January 10, 2007

21178
Dear Alice,

I have been having trouble falling asleep and do not wish to use pills. I have found that 1 measuring cup of warm milk does put me to sleep. There is very little time between the...

Dear Alice,

I have been having trouble falling asleep and do not wish to use pills. I have found that 1 measuring cup of warm milk does put me to sleep. There is very little time between the actual drinking of the warm milk and my being asleep. This is not usual for me to fall asleep so fast, so it must be the warm milk.

— Jerry

March 3, 2006

21030

Alice,

Just wanted to add that in most microwaves a minute is all you need to get it hot. 3 minutes is like cooking!!

Alice,

Just wanted to add that in most microwaves a minute is all you need to get it hot. 3 minutes is like cooking!!

What's a healthy weight?

Dear Confused,

It is courageous of you to write in about your situation, an important first step in getting to a healthy weight (and body image, for that matter). For most women, a healthy weight is one that allows regular menstruation and is sustainable when following a healthy, balanced eating plan. If the only way to attain a certain weight is by severely restricting your eating, that weight is not the healthiest, most natural weight for your body.

As far as a healthy weight for you is concerned, pinpointing a number, or even a range, without having a thorough medical assessment would be difficult, because different people can be healthy even if they have vastly different body weights. Unfortunately, media images and celebrities often aren't great role models when it comes to having a healthy weight. Some celebrities may be thinner than you, as you note, however they may achieve their weight through unhealthy means, such as over exercising, using drugs or diet supplements, or severely restricting their diets. In reality, they may owe their good looks more to teams of stylists and make-up artists than to good health.

It sounds as though you still have concerns about your health, even though the purging has stopped. You're right to realize that not getting your period is a huge red flag indicating something is not right with your body. Amenorrhea (loss of your period) can happen if your weight is very low, especially if your body fat is too low, or if your diet is too low in fat. Other factors, such as excessive exercise, may also play a role in amenorrhea. Your reluctance to see a health care provider is natural and understandable, many people who have disordered eating feel the same way, however amenorrhea is a condition that needs medical attention. If you are a student at Columbia, you can meet with a member of the Eating Disorders Team (Morningside) or with any provider at Medical Services (Morningside) or the Student Health Service (CUMC).

As for your diet, based on the plan you describe, your body is probably lacking many nutrients, including calcium, vitamins D, K, B-6, and B-12. In addition, you may be getting too little zinc, magnesium, iron, essential fatty acids, and protein. Some vitamin and mineral deficiencies take time to develop, but you are starting to see the effects of inadequate nutrition by not getting your period. Many people make the mistake of severely limit their dietary fat; however, our bodies must have some fat to absorb vitamins A, D, E and K, assimilate calcium into our bones, and manufacture sex hormones such as estrogen. Women need estrogen to keep their bones strong and get their period. The amenorrhea is a clue that your body isn't making sufficient estrogen, which, if continued, can put you at risk for developing osteoporosis — even as a young person.

When you're thinking about improving your diet, remember that your body needs healthy forms of carbohydrates, fats, and protein to function well and stay healthy. Balancing these "macronutrients" may sound like a daunting process, but if you break it down to small, manageable goals, even small bites, you could have a better chance for success. You can check out ChooseMyPlate.gov to find more information about balanced eating. Here are some tips to get started:

  • Try adding one new food at a time to your daily regimen.
  • You might start with a good source of protein: tofu, fish, poultry, meat, or eggs.
  • Next, you can add milk (soy or dairy) or yogurt to your cereal. It will help to satisfy your hunger, and provide much needed calcium in your eating plan.
  • Add in some vegetables, one at a time.
  • Finally, try switching to some whole grains; for example, whole wheat bread or brown rice (instead of the white varieties of each).
  • If you feel more comfortable snacking or having several small meals during the day instead of having full meals, that's fine, as long as you have well-balanced food choices.

Although you don't want to tell anyone about your situation, it might just help you feel better about your situation. Perhaps there is a parent, religious leader, guidance counselor, teacher, doctor, nurse, friend, or relative with whom you could speak to help put your body image in perspective. Maybe starting the conversation seems like the most difficult part. If you are nervous about how to start, you can simply write down your symptoms and show someone, like you have here. You may find that talking to someone is less difficult than you expect, and also worthwhile.

Alice

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