Nutrition & Physical Activity

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Food coma

Dear Reader,

The symptoms you describe sound like what many people call the "food coma." Often times, 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

Complete and incomplete proteins in grains and vegetables?

Dear Perplexed by protein,

You're not alone — this can be a confusing subject. First some clarification — a complete protein is a protein that contains all nine essential amino acids (the building blocks of protein, which can only be obtained through eating food). Complete proteins come from animal-based products (meat, poultry, dairy, eggs, fish, etc), soy, and quinoa (a grain). An incomplete protein contains fewer than all nine essential amino acids, however incomplete proteins can be combined in meals to make a complete protein (for example by combining rice and beans or peanut butter and toast). These foods don't need to be eaten at the same time in order to be used by the body to build protein, as once was thought. We just need to eat these complementary proteins within 24 hours. Incomplete proteins come from plant-based foods, such as beans, rice, grains, legumes (other than soy), and vegetables.

Our bodies use amino acids from foods to make proteins. As a matter of fact, the amazing human body manufactures all types of substances — from hormones to muscle tissue, blood cells, enzymes, hair, nails, and many others — given the right proportions of amino acids.

All of the foods you mention contain amino acids, and therefore varying amounts of protein. Just because they don't contain all of the amino acids we need doesn't negate the fact that they contain some protein.

Although protein is a vital nutrient, our bodies don't require quite as much as you may think. The U.S. Recommended Dietary Allowance (RDA) of protein is 0.8 grams/kg per day for adults. This recommendation has been shown to meet the needs of 97.5 percent of the population. For a woman weighing 125 lbs (57 kg), her needs would be met with an intake of 46 grams of protein per day. For a man weighing 154 lbs. (70 kg), his needs would be met with 56 grams of protein a day. A person must be taking in sufficient calories to maintain their weight for these values. Dieters need larger amounts of protein, because some is burned for energy. Athletes require slightly more protein as well.

It's believed that people usually eat a variety of foods, thereby getting the amino acids needed to manufacture complete proteins. Granted, if a person only ate bread, s/he would be missing an essential amino acid. The same would be true if a person only ate vegetables. However, if these vegetarians added legumes to their diet, they would be able to obtain all of the essential amino acids needed to remain healthy. The Food and Nutrition Board of the National Academy of Sciences (which sets the RDAs) spell out the amount of each essential amino acid needed to form complete proteins. However, it isn't necessary to go that far, as long as you are covering your protein needs with a varied eating plan.

To determine your protein needs according to the RDA, divide your body weight in pounds by 2.2, which gives you your weight in kilograms, and then multiply that number by 0.8. Consult the following charts for protein content in various foods. Adjust for the serving size and the number of servings you actually eat.

Animal Sources of Protein Serving Size Protein (in grams)
Meat/Poultry/Fish 3 oz. 21
Cottage cheese ½ cup 14
Milk 1 cup 8
Yogurt 1 cup 8
Cheese 1 oz. 7
Egg 1 whole 6
Egg white only 1 3

 

Plant sources of Protein Serving Size Protein (in grams)
Tofu, raw, firm 3 oz. 13
Legumes: (Black beans, Kidney beans, Chickpeas, etc.) ½ cup 7 – 8
Peanut butter 2 T. 8
Nuts 1 oz. 5
Bread 1 oz. (1 slice) 3
Cereal 1 oz. 3
Vegetables ½ cup cooked or 1 cup raw 3
Pasta or rice ½ cup 3

So, as you can see, it's not difficult to reach your daily protein needs, as long as you include a variety of foods in your daily intake. Incomplete proteins needn't be too much of a concern. Vegetarians who consume complementary proteins are usually able to easily meet their protein requirements. Columbia students who would like more information can meet with a Registered Dietitian who can provide individual counseling and help students understand and meet their unique nutrition needs. If you're interested in learning more about healthy eating habits for yourself, please schedule an appointment. Students on the Morningside campus can contact Medical Services for an appointment and students on the CUMC campus can also schedule an appointment with a Registered Dietitian.

Alice

Breakfast: The first chance to fill your tank

Dear Reader,

Regardless of your activity level, breakfast is an essential part of a healthful lifestyle and is also important for maintaining energy all day long. The motto here is anything for breakfast is better than nothing at all. Think of your body as a car and food as gas. Without gas, your car cannot get from one place to another.

The rate at which your body uses calories for energy is known as metabolism. Think of metabolism as the motor of your car. Metabolism is directly related to energy levels, so the higher your metabolism, the more energy you have throughout the day. When you are sleeping, your body naturally decreases its metabolism. When you wake up, there is an increase in metabolism, which peaks by noon. How much energy you have during this time is contingent on how much food calories your body has to use for energy. Breakfast becomes the first stop to the gas station before your road trip. So basically, eating breakfast actually helps maintain high energy levels throughout the day. In fact, the more hearty a breakfast you have, the more your metabolism motor will roar!

You do have to stick to some guidelines, of course, to promote optimal energy.

Calories

The best range of calories for breakfast is between 350 to 500. Below 350, your body will not fulfill the requirements for morning energy usage; above 500, your body may store unneeded calories as fat.

Balance

Plan and eat a balanced breakfast meal including complex carbohydrate, protein, fat, and a fruit or vegetable.

Quantity to Aim for

  • 1 to 2 servings of complex carbohydrates. One serving equals 1 piece of bread, ½ cup of cooked oatmeal, 1 cup of dry cereal, 1 English muffin, ½ bagel, ¼ cup of granola, 1 small muffin.
  • 1 serving of protein. For example, 1 cup of yogurt, ½ cup of cottage cheese, 1 ounce of cheese, 1 large egg, 2 ounces of smoked salmon, 1 cup of milk or soy milk, 2 tablespoons (T) of peanut butter, or ¼ cup of nuts or seeds.
  • 1 serving of fat. E.g., 1 teaspoon (t) of butter, 1 t of oil, 1 tablespoon (T) of cream cheese. But check your protein and carbohydrates for fat, there's no need to add extra if you have a serving of fat in your granola or omelet.
  • 1 serving of a fruit or vegetable. That is, 1 medium piece of fruit, 1 cup of cut fruit, ¼ cup dried fruit, 6 ounces of fruit juice, 1 cup of raw or ½ cup of cooked vegetables, 1 cup of vegetable juice.

Some examples of energizing breakfast meals include:

Meal Equal to
2 pieces of toast
2 T of peanut butter
1 medium banana
2 servings of complex carbohydrates
1 serving of protein
1 serving of fat
1 serving of fruit

½ bagel
1 T of cream cheese
2 ounces of smoked salmon
½ cup of sliced tomatoes

1 serving of complex carbohydrates
1 serving of fat
1 serving of protein
1 serving of vegetables

1 cup of cooked oatmeal with
1 cup of 2 percent fat milk
¼ cup of raisins
2 servings of complex carbohydrates
1 serving of protein
1 serving of fat
1 serving of fruit
1 small muffin
1 cup of plain low fat yogurt
1 cup of orange juice

1 serving of complex carbohydrates
1 serving of fat
1 serving of protein
1 serving of fruit

As you see, there are many delicious ways to get from point A to point B every morning. Imagine your surprise when you see the results with more energy!

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

Does caffeine affect athletic performance?

Dear Reader,

Your coach and captains may not be correct. Several studies, under various conditions, suggest that consuming caffeine prior to physical activity has no additional effect on sweat rates, total body water loss, or negative effect on athletic performance as compared to non-caffeinated products — and it may provide a boost for you out on the soccer field!

Caffeine has been considered an ergogenic aid — a drug that increases performance as a result of the physiological effects it has on the body. While the exact mechanism isn't known for sure, some researchers believe that caffeine stimulates earlier and greater fat burning during exercise. This would help preserve the body's store of glycogen (the fuel muscles use) so that a person could exercise longer before feeling exhausted. This theory supports findings that caffeine improves performance in endurance events, such as long distance running and/or cycling. A review of literature on the effects of caffeine in short-term and high-intensity exercise concludes that the substance may also aid athletes’ performance in team sport activities that requires repetitive sprinting (like soccer) if ingested before the activity. Others believe that the stimulant effect of caffeine may help with alertness, mental clarity, and overall mood, all of which could help during a workout. For more information, check out Energy drinks and weight loss from the Go Ask Alice! archives.

However, caffeine can affect people in different ways. While some people might notice a performance boost, others might suffer from dizziness, headaches, loss of coordination, abdominal cramps, or nausea — definitely not desirable on game day. Caffeine can also interfere with sleep patterns; overuse might mean that you're not well-rested enough when it comes time to play.

Do you notice that you experience some of these issues when you add caffeine to your diet? If so, you might want to opt out and focus your efforts on proper training, rest, and nutrition for optimal performance. If you don’t, you can rest assured that caffeine does not seem to cause excessive dehydration (though make sure to drink plenty of water and other non-caffeinated drinks, too) and may actually be of benefit when you’re on the field!

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!!

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

Cooking veggies and vitamin loss?

Dear Reader,

Vegetables can be a wonderful source of vitamins, minerals, and other nutrients that people need to stay healthy. The problem is that preparation can put a damper on the benefits that vegetables provide. In fact, according to the American Dietetic Association (ADA), improper preparation can cut the nutrient content of certain fruits and vegetables in half.

When cooking vegetables in water, some of the nutrient content, especially water-soluble vitamins including vitamins B and C, may leach into the surrounding water. But, as you suggest, using that water (or broth) in a soup or a gravy can, in fact, be a way of saving those nutrients and putting them to good use.

Still, high temperatures and long cooking times can degrade vitamins that are more sensitive to heat. While this is hard to avoid with soups, it is much less of a concern than leached and wasted vitamins. 

If you're planning on preparing vegetables to eat alone, you may want to try steaming them briefly until they are crisp and tender.  It's almost always best to keep cooking times low: microwaving, steaming, blanching, and stir-frying take the cake when it comes to speed.  Also, you may want to eat your veggies raw; salads and crudité are a great way to enjoy fresh vegetables and their full range of nutrients. Generally, the less cooked the better — overcooked vegetables don't only lose nutritional content, they also lose much of their flavor and color. This doesn't mean you should stop adding vegetables to your soup. The ADA recommends that you consume at least 3 to 5 servings of vegetables every day, so it may be a good idea to vary your preparation on a daily basis. Bon apetite!

Alice

Allergic to peanuts = allergic to pecans?

Dear Reader,

Being allergic to peanuts doesn't necessarily mean being allergic to tree nuts (and vice- versa). Being allergic to peanuts also doesn't automatically mean being allergic to other members of the legume family, such as lentils and soybeans. Similarly, being allergic to one kind of tree nut doesn't automatically result in being allergic to other tree nuts. However, most health experts recommend that people with peanut and/or tree nut allergies avoid all peanuts and tree nuts, just in case. A little introduction to peanuts and tree nuts might clarify this.

Peanuts are not actually nuts, but legumes, which are beans and peas. Peanuts, peanut products, and peanut by-products are found in many foods and in many variations, such as peanut flour, peanut oil, and peanut butter. The presence of peanuts in foods is tricky to identify; they can even be a hidden, unlabelled ingredient, such as hydrolyzed plant or vegetable protein. Also, cross contamination during manufacture of food products is another source of exposure to peanuts that can elicit allergic reactions, so some non-nut items are labeled as "may contain nuts."

Unlike peanuts, pecans are part of the tree nut family, which also includes almonds, walnuts, cashews, hazelnuts, pistachios, macadamia, chestnuts, and brazil nuts. Tree nuts are also present in a variety of foods and even in some bath and beauty products.

Allergy to peanuts and tree nuts, usually life-long, are two of the most common food allergies. Fortunately, many people with these allergies experience mild responses to the proteins found in peanuts and tree nuts, such as sneezing and/or itching. However, what is worrisome about these allergies is that some people experience severe enough reactions from miniscule amounts that can be life-threatening (e.g., difficulty breathing, loss of consciousness). In fact, about 100 people in the United States die each year from their peanut allergy. The most intense responses tend to be from ingesting food containing peanuts, tree nuts, or their derivatives, but inhaling air contaminated with peanut or tree nut dust, having skin or eye contact with something containing these items, and even kissing someone who recently consumed peanuts or tree nuts also can produce allergic responses. In particular, the sensitivity of peanut allergies and the prevalence of peanuts in our food supply and elsewhere have made peanuts a source of heated controversy for schools, camps, airlines, and restaurants concerning whether or not to ban them in these places.

What is in your control to prevent peanut and tree nut allergies is avoiding all peanuts and tree nuts (though accidental exposure could still happen no matter how vigilantly you avoid nuts). Educating oneself about the allergy (i.e., always asking about ingredients and reading food labels carefully) and preparing oneself for accidental exposure (i.e., always keeping epinephrine nearby) are other keys to managing a peanut or tree nut allergy. If you are uncertain about whether or not you can eat pecans safely, your health care provider may be able to refer you to an allergist. S/he can administer a skin prick, blood, and/or medically supervised food challenge test.

For more information about peanut, tree nut, and other food allergies, check out the Food Allergy and Anaphylaxis Network web site.

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

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