Nutrition & Physical Activity
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!
Dear The Wondering Diabetic,
As you've experienced, weight gain can be a common side effect of insulin therapy. Some diabetics do resort to skipping their insulin shots in order to lose weight, a disorder known as "diabulimia." Doing this can be dangerous to your health, but the good news is that diabetics and non-diabetics alike can safely control their weight through regular exercise and a healthy diet.
Normally, insulin allows body cells to absorb sugar from the food we eat. Cells burn the sugar as energy and any leftovers are stored as fat. Before being diagnosed, type 1 diabetics are often under-weight since their bodies are unable to use sugar properly. Insulin therapy enables type 1 diabetics to process sugar, and to convert excess sugar into fat, which then causes weight gain. Skipping insulin shots may seem like an easy way to lose weight, but denying the body insulin has harmful effects.
Without insulin to metabolize sugar, body cells are deprived of necessary fuel. To survive, the body breaks down fat and protein (instead of sugar) for energy, which releases toxic acids called ketones. This leads to a potentially deadly condition called ketoacidosis. According to the Mayo Clinic, signs of diabulimia and/or ketoacidosis include weight loss, excessive thirst, frequent urination, low energy, nausea, fruity-scented breath, neglecting blood sugar monitoring or insulin dosage, and uncontrolled blood sugar. Diabulimia and lack of insulin also cause sugar to build up in the bloodstream. Over time, high blood sugar can cause heart and blood vessel disease, nerve damage, and kidney damage.
Safe weight management strategies for diabetics (and people recovering from diabulimia) include a healthy diet, frequent exercise, and proper insulin therapy. Nutrition recommendations are similar for diabetics and folks without insulin disorders, and include eating mainly fresh fruits and veggies, whole grains, and a daily breakfast to keep your metabolism steady. The American Diabetes Association has several good resources for diabetics who are looking for healthy ways to keep off excess pounds and stay in shape. Take a look at their exercise plan and meal plan for diabetics. You might also want to check out Meal planning for people with diabetes on Go Ask Alice!
Before making diet or exercise changes, diabetics should talk with a health care provider.
Although it may be tempting to skimp on your insulin shots to lose a few pounds, diabulimia has serious health consequences so you're right to be wary of this weight loss strategy. Healthy diet and exercise are safe ways to manage your weight that will keep you healthy in the long run.
Congratulations on getting a handle on a difficult situation. Anorexia can be life-threatening, so you've essentially saved your own life — something that hopefully makes you proud. As you point out, a side effect of anorexia can be secondary amenorrhea (loss of period for six months of longer). Typically, women in recovery find their periods come back once they get their weight up to what it was before they stopped getting their period. Some women, who aren't underweight, but who stop getting their periods during times of extreme exercise and erratic eating, regain their period once they get back into a routine of healthy eating and exercise habits. So, your concern is warranted. And, yes, it would be a great idea to seek a medical work-up at this point. Before you head to your health care provider, it might help you to get more information.
There are several possible explanations for secondary amenorrhea. Given your history of living with anorexia you may be experiencing functional hypothalamic amenorrhea (FHA). While FHA seems to occur most frequently in women with low amounts of body fat, it can happen in women of various body shapes. The common denominator seems to be erratic eating patterns and/or excessive exercise. These behaviors disturb the thyroid gland and hypothalamus-pituitary-adrenal gland in ways that lead to increased production and release of steroid hormones, called glucocorticoids (including cortisol, a major stress hormone). Also, low body weight is associated with lower levels of leptin, a necessary chemical that helps to regulate ovulation. In combination, these chemical changes in the body can affect periods and stop them altogether until the chemical balance is restored through changes in behavior and/or hormone therapy.
While your amenorrhea might be related to your history of anorexia, there are other health-related factors to secondary amenorrhea that you might want to consider:
- Hormonal contraceptives (e.g., some birth control pills, implanted or injected methods, intrauterine devices)
- Pregnancy or breast-feeding
- Extreme mental stress
- Certain medications (e.g., some antidepressants, chemotherapy drugs for cancer, oral corticosteroids)
- Chronic illness
- Thyroid problems
- Hormonal imbalance
- Benign pituitary tumor
- Uterine scarring
- Premature menopause
You can see there are many possible reasons for secondary amenorrhea. It's also good to know that women with secondary amenorrhea can be at increased risk for some pretty serious health conditions like: osteoporosis, bone fractures, cardiovascular disease, and metabolic problems.
You can contact your health care provider or women's health specialist. If you don't have a trusted women's health care provider, you might consider finding one soon. If money's a concern, you can check out Planned Parenthood's website to find a local health center. Some Planned Parenthood health centers offer sliding-fee services and other programs to cover the cost of care for people who qualify financially.
There's no doubt that secondary amenorrhea is a complex issue with many possible causes and consequences. And, everyone woman's situation is different. If investigating the absence of your period is the next step for you, working with a women's health specialist could help you get the answers you need.
To your continuing good health,
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,
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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...
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.
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!
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,
Fish can be an important part of a healthy diet; it's loaded with high-quality protein and omega-3 fatty acids and low in saturated fat and cholesterol. It’s also true that nearly all fish have at least trace amounts of methylmercury. The good news is that many of the commonly purchased fish in the United States, including several varieties of tuna, typically have lower levels of mercury and are safe to eat if the amount you consume doesn't exceed the weekly recommended serving size.
To answer your question specifically, Albacore (white) tuna and light tuna are the two most common kinds of canned tuna. Due to its larger size, white tuna contains significantly more mercury — up to three times more — than light tuna. The EPA guidelines state that it's safe to eat up to twelve ounces of light tuna (or any fish low in mercury) a week or six ounces of white tuna a week. Considering that the standard weight of a can of tuna is six ounces, you may be putting yourself at a risk for mercury poisoning if you're eating two to five cans per day.
So why worry about mercury? It's considered a pollutant and is released into the environment, largely from factories and other industrial settings. It eventually travels to streams and oceans where microorganisms present in the water turn it into methylmercury. Fish then absorb this chemical into their bodies from the water. Mercury levels in the fish depend on what they eat, how long they tend to live, and where they are in the underwater food chain. Larger fish typically contain higher levels of mercury not only because they're heavier and have more surface area to absorb mercury, but also because they eat smaller mercury-containing fish, which increases the larger fish's mercury content. Because of this, the Environmental Protection Agency (EPA) recommends staying away from shark, swordfish, king mackerel, and tilefish from the Gulf of Mexico, since on average they have higher levels of mercury.
Most of the warnings about mercury poisoning are targeted to young children and pregnant women because exposure to mercury during development can cause neurological defects, including impairments in cognition, memory, attention, language, and fine motor skills. This is especially of concern because infants born with these impairments have been observed even when the mother showed no symptoms of poisoning. Mercury poisoning in adults can cause numbness in fingers and toes, muscle weakness, and speech, hearing, and walking impairments. And so far, research has not found that mercury exposure in humans is associated with cancer, but human studies are limited. If you find yourself experiencing any of these symptoms, it’s best to visit your health care provider as soon as possible. If you feel fine but are scared of prematurely swimming with the fishes, you might want to switch up your fish or seafood meals to include a variety of low-mercury choices, such as salmon, shrimp, pollock, catfish, cod, or tilapia.
The National Resources Defense Council's Mercury Contamination in Fish - Consumer Guide to Mercury in Fish provides tools that can help make this transition proceed swimmingly. It contains a list that informs consumers of the frequency that a certain fish can be eaten safely, as well as a mercury calculator that generates a safe value for fish intake based on a person's weight and type of fish. Lastly, if cost is of concern, there are many additional options for protein and nutrients on the cheap. You could also try substituting the tasty and affordable tuna with non-fish sources of protein, such as chopped canned chicken, lean deli meats, or beans; these can also be part of a healthy diet without breaking the bank.
It's often said that the more (naturally) colorful your plate is, the healthier that meal is for you. This saying holds true in the corn arena: Blue corn does contain more of the amino acid lysine and the antioxidant anthocyanin than "regular" yellow corn; however, it loses much of these nutrients when it's processed into a chip. Blue corn chips may be slightly more nutritious in this sense, but if you're trying to increase the amounts of lysine or antioxidants in your diet, fresh and whole fruits, vegetables, and lean proteins are much better sources.
Research has also found that blue corn tortillas (fresh, not fried into chips) contain more protein than their yellow or white corn counterparts. In addition, blue corn tortillas have a lower starch content and lower glycemic index (GI) than regular corn tortillas. Both of these factors may be helpful to people on low GI diets, such as diabetics, because food with a lower starch and low GI breaks down more slowly into sugars absorbed by the blood stream and can help people avoid spikes in blood sugar levels.
Keep in mind that chips of any color are often fried and can be high in fat and calories, so it's probably best to not make them a regular snack. Baked chips or crackers may be a healthier alternative, especially if they're made with whole grains. Look for the words "whole grain" or "whole" before the grain's name on the ingredients label to make sure it falls into this category. Fiber is another important consideration in a healthy snack, and not all whole grain products are high in fiber, so be sure to look at fiber content on the nutrition label. For more information on whole grains and fiber, check out some of the Related Q&As below.
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!
Kudos for taking the first step and reaching out to ask about your feelings and behaviors. The symptoms you describe, including going long periods of time without eating, may be dangerous and could have long-term effects on your health. Feeling down once in a while is common but the depression you mention, and the fear of becoming more depressed if you begin eating more regularly, may be a serious clinical depression (and could be what is affecting your eating habits).
Skipping meals and intentionally not eating for periods of time (sometimes called fasting) can become addictive. Many people who fast experience euphoric feelings of well-being, feelings that are likely harmless when fasting in moderation. However, this "high" may mask feelings of being down or depressed and could explain why you feel better when you avoid eating (and why you continue to go long periods of time without food). Fasting too often can be detrimental to your health because your body is denied nutrients and energy it needs.
Avoiding food could also be a sign of a serious eating disorder: anorexia nervosa. See Eating disorders vs. normal eating for more information about the signs and symptoms of eating disorders. People with anorexia sometimes describe a feeling of control when they don't eat; a feeling that may be very powerful. You mention that you feel like you can't change anything in your life; controlling what you eat and skipping meals may be a way of feeling in control. Talking with a counselor or other mental health care provider about your feelings and eating habits may help you to understand your behaviors and feel more in control of your life.
Talking with a mental health care provider may be a good way to begin to think about other factors in your life that may be contributing to your desire to skip meals, especially when you are around your friends. If you aren't sure how to begin a conversation with a counselor, you could simply tell her or him what you have written here, or you could ask one of your concerned friends to go along and help explain what s/he has noticed about your eating habits. Gaining an understanding of why you are feeling this way is an important step to overcoming these feelings and being able to eat normally without fear of becoming depressed.
It may take some work to find the right counselor and confront your fear of becoming depressed, but you already took an important (and difficult!) first step to seeking help. It also sounds like you have good friends who want to support you. Best of luck as you take the next steps to living a healthier, happier life.