Dieting—Not Allowed!

It’s almost bathing suit season. Are you starting to panic because you’ll soon be shedding layers of winter clothing and exposing your body? Eeek!!!

When you have more flab than you want, fretting about excess body fat easily leads to plans to go on a diet, of which there are plenty of choices: Atkins, Paleo, Jenny Craig, the Cabbage Soup Diet, and the Banana Diet.  Unfortunately, none of these diets work in the long run. After all, if diets did work, then everyone who has ever been on a diet would be lean. Not the case. We are in the midst of an obesity epidemic.

Not only do fad diets not work, diets commonly backfire and contribute to weight gain in the long run.  A study with teens that were followed from middle school into high school indicates the students who were dieting at the time of the initial survey were worse off five years later. Many struggled with disordered eating or had an outright eating disorder and achieved no benefits from their attempts to lose undesired body fat. (1) Futile efforts.

Why eating is preferable to dieting 

Overweight teens commonly become adults who continue to struggle with food for the rest of their lives. That’s why, starting at an early age, we need to discourage dieting and instead focus on eating healthfully and appropriately. If you don’t go on a diet, you won’t “blow your diet,” gorge on cookies, and gain weight. Eating normally —enjoying appropriate amounts of wholesome foods when your body needs fuel during the day—leads to an appropriate weight.

Normal eating includes enjoying a good balance of wholesome foods, but not limiting yourself to only “healthy foods.” That is, you don’t have to have a perfect diet to have a good diet. A healthy food plan can include 85% to 90% “quality calories” and 10% to 15% “whatever.” Some days “whatever” is an apple; other days “whatever” is a cookie.

Striving to eat a perfect diet commonly results in deprivation of foods you truly like to eat. You will inevitably end up bingeing on those foods, sooner or later.  Think about it this way: If you put a little boy in a roomful of toys and tell him he can play with all the toys except for the green truck, what is the first toy he’ll reach for? Yup, the green truck. Hence, if you like chocolate cake, but tell yourself you shouldn’t eat it, what will you relentlessly hanker for? Yup. Chocolate cake.

How to take power away from food

The way to take power away from a “binge food” is to eat it more often, not stay away from it.  For example, if you like chocolate cake, you should eat it every day until you get sick of it. Don’t believe me? Do this experiment: For one week, eat your binge food every day instead of your normal breakfast, lunch, snack, and/or dinner. (You will not die of malnutrition in a week.) Observe what happens. The chances are that after three days of chocolate cake, you’ll hanker for shredded wheat again. And even if you want to continue to eat cake, a recent study indicates you can still lose weight on the Chocolate Cake Diet. In this study, the subjects who enjoyed chocolate cake for breakfast had better dietary compliance and ended up losing more weight than the people who were instructed to eat “diet foods.” (2)

Ideally, you want to learn to enjoy a daily food plan that includes a variety of mostly wholesome foods that are satiating, health promoting, and tasty. You want to eat heartily at breakfast and lunch, to prevent energy lags and cravings for sweets. You want to plan an enjoyable afternoon “second lunch” that helps energize the end of your work-day and curbs your appetite for dinner. Then, at night, you want to eat a little bit less—and lose undesired body fat when you are sleeping. The goal: To wake up ready for breakfast, and perpetuate the cycle of fueling by day, dieting by night.

While these suggestions to eat “normally” are seemingly simple, many dieters find the advice is hard to implement. They are afraid that once they start eating, they won’t stop. This over-compensation is “diet backlash,” strengthened by years of “last chance to eat cake so I’d better eat it all now before the diet starts again tomorrow.” There is a more peaceful way to manage weight.

What is “normal eating”? 

The following information offers tips for how to eat appropriately. Please trust that appropriate eating will lead you to an appropriate weight. Eating specialist Ellyn Satter RD, (www.EllynSatter.com), author of Secrets of Feeding a Healthy Family offers the following definition of normal eating.

• Normal eating is going to the table hungry and eating until you are satisfied. It is being able to choose food you like and eat it and truly get enough of it–not just stop eating because you think you should.

• Normal eating is being able to give some thought to your food selection so you get nutritious food, but not being so wary and restrictive that you miss out on enjoyable food.

• Normal eating is giving yourself permission to eat sometimes because you are happy, sad, or bored–or just because it feels good. Normal eating is three meals a day, or four or five–or it can be choosing to munch along the way.

• Normal eating is leaving some cookies on the plate now because you know you can have some again tomorrow–or it is eating more now because they taste so wonderful.

• Normal eating is overeating at times; feeling stuffed and uncomfortable–or it can be under eating at times and wishing you had more. Normal eating trusts your body to make up for your mistakes in eating.

• Normal eating takes up some of your time and attention, but keeps its place as only one important area of your life.

• In short, normal eating is flexible. It varies in response to your hunger, your schedule, your proximity to food and your feelings.

Is it time to start learning how to eat normally?

Information provided by Nancy Clark, MS, RD CSSD (Board Certified Specialist in Sports Dietetics), Chairperson of the Nutrition Committee of the Female Athlete Triad Coalition.  Nancy Clark counsels active people at her private practice in Newton, MA (617-795-1875). For more information, read her popular Sports Nutrition Guidebook and food guides for new runners, marathoners, soccer players and cyclists, available via www.nancyclarkrd.com.

The Athlete’s Kitchen

Copyright: Nancy Clark MS RD CSSD March 2012

References 

1. D. Neumark-Sztainer D, M. Wall, J Gua, M Story, J Haines, M Eisenberg. Obesity, Disordered Eating, and Eating Disorders in a Longitudinal Study of Adolescents: How Do Dieters Fare 5 Years Later? J Amer Diet Assoc 2006 (4):559-568.

2. http://www.sciencedaily.com/releases/2012/02/120207133750.htm

Daniela Jakubowicz, Oren Froy, Julio Wainstein, Mona Boaz. Meal timing and composition influence ghrelin levels, appetite scores and weight loss maintenance in overweight and obese adults. Steroids, 2011; DOI: 10.1016/j.steroids.2011.12.006

World-renowned experts in sports medicine, sports psychology, nutrition and body image unite in support of knowledge dissemination regarding treatment and preventive strategies for physical and psychological sports health concerns for female athletes.

This two-day conference targets physicians, nurses, physician assistance, psychologists, neuropsychologists, athletic trainers, physical therapists, coaches, female athletes and their families and all others involved in the evaluation and management of female athletes.

Conference Dates: June 8 and 9, 2013

Conference Location:
Babson College Conference Center
231 Forest Street
Wellesley, MA

Please see the following materials for further information on the conference agenda and how to register:

View Brochure

Registration Poster

This conference is presented by the Female Athlete Program at the Division of Sports Medicine at Boston Children’s Hospital and the Eating for Life Alliance and sponsored by the Babson
College and Timberline Knolls Residential Treatment Center. A portion of proceeds will benefit Boston’s One Fund to support those affected by the tragic events at the 2013 Boston  Marathon.

bostonchildrens.org/femaleathleteconference

Breakfast makes me hungry…

“If I eat breakfast, I feel hungrier all day” complained a working mom who wanted to lose 10 pounds. She was a breakfast skipper. She believed skipping breakfast would save her some
calories and helps her shed a few pounds. Plus, when she ate breakfast, she reported she felt hungrier the rest of the day.

The reason she felt hungrier when she ate breakfast was because she did not eat enough breakfast. She’d have just an English muffin with a dab of jelly. That was only 200 calories. Her
body wanted at least 500 calories – English muffin plus a tablespoon of peanut butter on each muffin-half plus a banana and a ½ cup of milk in her coffee.

If skipping breakfast was truly an effective way to lose weight, she would have successfully lost weight. But that was not the case. She described her eating as being “so good during the day, but so bad at night.” That is, the minute she got home from work, she’d devour cheese and crackers and then a big dinner and then graze some more.

She thought that nighttime eating was the problem. It was actually the symptom and the result of her having dieted “too hard” during the day. Her dietitian suggested she experiment with eating MORE breakfast, to see if that would curb her evening appetite. Although she shuddered at the thought of eating more food, she completed the experiment and discovered that the heartier breakfast did satisfy her appetite and enabled her to curb her evening over-eating.

If you believe that breakfast makes you hungrier, think again and trust that eating a hearty breakfast is indeed the best way to start a day of dieting. Give it a try!

Be wise,
Nancy Clark MS RD
Sports nutritionist and author, Nancy Clark’s Sports Nutrition Guidebook
www.nancyclarkrd.com

Information provided by Nancy Clark, MS, RD CSSD (Board Certified Specialist in Sports Dietetics), Chairperson of the Nutrition Committee of the Female Athlete Triad Coalition.
Nancy Clark counsels active people at her private practice in Newton, MA (617-795-1875). For more information, read her popular Sports Nutrition Guidebook and food guides for new runners, marathoners, soccer players and cyclists, available via www.nancyclarkrd.com.

I should be pencil-thin for all the exercise I do.

I don’t keep cookies in the house. If they are there, I eat way too many of them.

I’m afraid if I start eating, I won’t stop…

Too many athletes are at war with food and their bodies. In their quest to attain the “perfect body” that is leaner, lighter and presumably faster and better, they have developed atypical eating patterns that are far from peaceful. As one client reported, “I’m trying so hard to lose five pounds but I’m getting nowhere. In fact, I’m even gaining weight. I’m “good” at breakfast and lunch, but after I get home from the gym at night, I end up devouring everything in sight. On weekends, my eating is even crazier.”   Sound familiar?

The problems with dieting

The first three letters of diet are D-I-E. Dieting conjures up feelings of deprivation and denial. Dieting is unsustainable, no fun. Few dieters win the war against hunger. Even 50% of people who had gastric bypass surgery regained weight within two years (1). 

Why does this happen? The body perceives a diet as a famine and strives to protect itself from starving to death by signaling hunger. Hunger leads to the overwhelming urge to binge-eat. Research with healthy, normal-weight men who cut their food intake in half (similar to what many dieting athletes try to do) reports most regained the weight they’d lost—plus 10% more—within three months (2). Another study with middle school kids who were followed through high school indicates all efforts to lose weight resulted in disordered eating patterns five years later—but not leaner bodies (3). Dieting tends to create more long-term problems than it solves.

How to find peace with food 

Let’s take a look at some ways to transform blown diets into appropriate fueling (while you chip away at losing undesired body fat). A first step is to remember food is fuel, not the fattening enemy. Food not only enhances athletic performance but also prevents hunger and out-of-control food binges.

As a human, you are supposed to eat, even if you are over fat. If you restrict your food intake, you also restrict protein, carbs, fats, vitamins, minerals and other bio-active food compounds that contribute to good health and high energy. Bad idea. Your body needs those nutrients.

Calories: Current research suggests a sustainable way to lose undesired body fat is to knock off about 200 calories a day (4), such as 10 ounces of wine, 20 tortilla chips or one roll with butter. By knocking off the calories at the end of the day, you can lose weight when you are sleeping (as opposed to when you are trying to train and function during the day).

Carbs: Bread, bagel, pasta, rice, crackers—all those dreaded carbs—are not fattening. Your body does not readily convert carbs into body fat. Rather, your body preferentially burns carbs to fuel your workouts. If your muscles become carb (glycogen) depleted, you will feel an incessant, niggling hunger that can lead to non-stop snacking. You may believe you are eating because you are just bored, but your muscles are telling you they want carbs to recover and refuel.

Do not try to “stay away from carbs.” Egg whites for breakfast, salad for lunch, and fish + broccoli for dinner leave muscles unfueled and your body unable to train and compete at its best. Oatmeal, whole grain breads, brown rice, and sweet potatoes are just a few wholesome suggestions. Enjoy them as the foundation of each sports meal.

Protein: Dieters need to consume a strong protein intake to help protect their muscles. That is, when you restrict calories, you burn not just body fat but also muscle tissue. Enjoy a protein-rich food (in combination with carbs) at each meal and snack.  

Protein is satiating; it helps keep you feeling fed and can curb your appetite. Dieters who eat protein (eggs) at breakfast stay full longer than those who eat just carbs (bagel, fruit, and granola bar). By eating a enjoying a satiating breakfast, you’ll be less likely to crave sweets and succumb to donuts or candy bars.

Fat: Fat (preferably healthful fat such as in nuts, olive oil, salmon, and peanut butter) is an essential part of a sports diet. It’s required to absorb vitamins A, D, E and K. A little fat gets stored right within the muscle cells and gets used during long workouts. It enhances endurance. Runners who switched from a low (16%) fat diet to a moderate (30%) fat diet improved their performance by 14% (5). That’s a lot! And, they did not gain body fat.

The mantra “Eat fat, get fat” is false. Overeat calories and you will get fat, particularly if you over eat calories from fatty foods. Excess dietary fat easily converts into body fat.

Vitamins: The less fuel you ingest, the fewer vitamins you consume. Taking a vitamin pill might replace some of those losses, but a pill does not provide other bio-active compounds in foods that protect your good health. Strive to enjoy colorful vegetables and/or fruits at each meal.

By satisfying your hunger with wholesome sports foods at daytime meals, you will ruin your appetite for the evening “junk food” that contributes to fat-gain. You feel better during the day, have better workouts, be in a better mood—and be able to knock off 200+ calories of evening snacks so you can lose weight easily when you are sleeping. Experiment for just one day with front-loading your calories; the benefits will be obvious!

Easier said than done?

While food-binges can simply be the backlash from unrealistic efforts to lose a few pounds, they sometimes also serve the important job of distracting people from thinking about painful relationships and feelings of inadequacy. That is, if you incessantly think about food, you are not thinking about how sad, depressed or lonely you might be feeling. You’d rather focus on losing five pounds, believing weight loss will make you happy. Doubtful.

Instead of trying to find happiness from a number on the scale, the better bet is to appreciate your body for all the good it does. Do not compare your body to others. To compare is to despair. Practice eating mindfully and ask yourself before you eat “Does my body need this fuel?” Eat mechanically, on a time schedule, with even-sized meals that truly satisfy you, so you don’t just stop eating because you think you should.

Rather than struggle with food and weight issues on your own, consult with a sports dietitian who can help you create a positive food plan. Use the referral network at SCANdpg.org to find your local RD CSSD (Board Certified Specialist in Sports

Dietetics). Life is too short to spend it fighting with food.

Information provided by Nancy Clark, MS, RD CSSD (Board Certified Specialist in Sports Dietetics), Chairperson of the Nutrition Committee of the Female Athlete Triad Coalition.  Nancy Clark counsels active people at her private practice in Newton, MA (617-795-1875). For more information, read her popular Sports Nutrition Guidebook and food guides for new runners, marathoners, soccer players and cyclists, available via www.nancyclarkrd.com.

The Athlete’s Kitchen
Copyright: Nancy Clark MS RD CSSD 

References 

1. Magro D, Geloneze B, Delfini R, Pareja B, Callejas F, Pareja J. Long-term weight regain after gastric bypass: a 5-year prospective study. Obes Surg. 2008 Jun;18(6):648-51.

2. Keys A, Brozek J, Henschel A. et al. The Biology of Human Starvation. Vols 1 and 2. Minneapolis:University of Minnesota Press, 1950

3. Neumark-Sztainer D, Wall M, Guo J, Story M, Haines J, Eisenberg M.  Obesity, disordered eating, and eating disorders in a longitudinal study of adolescents: how do dieters fare 5 years later? J Am Diet Assoc. 2006 Apr;106(4):559-68.

4. Stroebele N, de Castro J, Stuht J, Catenacci V, Wyatt H, Hill J.   A small-changes approach reduces energy intake in free-living humans. J Am Coll Nutr. 2009 Feb;28(1):63-8.

5. Horvath PJ, Eagen CK, Fisher NM, Leddy JJ, Pendergast DR.  The effects of varying dietary fat on performance and metabolism in trained male and female runners. J Am Coll Nutr. 2000 Feb;19(1):52-60.

Body Image and Athletes

Question 1: What are two things dogs and athletes have in common?

Answer: One, both dogs and athletes love to exercise. Two, they both come in different sizes and shapes.

Question: What is one thing dogs and athletes do NOT have in common?

Answer: Dogs are content with their natural physiques, while too many athletes try very hard to change the way they look. These athletes might be better off being like dogs. That is, does that bulky St. Bernard yearn to look like a lanky Greyhound? Heavens, no! Does the barrel-chested Labrador want to look like a sleek Setter? Doubtful. Each dog is very proud to represent his breed. Wouldn’t life be easier if each active person could be just as proud of his or her “breed”?

As a sports dietitian, I spend too many hours helping my clients find peace with their bodies. Most of these active people take the outside-in approach. They think if they change their body from the outside by losing undesired body fat or by adding some muscular bulk, they will be happier on the inside. Unfortunately, not true!

No weight will ever be good enough to do the enormous job of creating happiness. This story, told to me by a cyclist, proves that point: “I once weighed 124 pounds and was unhappy with that weight. I started exercising and dieting rigidly. I lost to 99 pounds but I still wasn’t happy. I ended up binge-eating; I gained to 160 pounds, where I was miserable. I sought help from a counselor, stopped eating emotionally, and with time, got my weight back to 124—and I felt happy there! Why couldn’t I have been happy at 124 pounds in the first place? Because happiness has nothing to do with weight…”

Granted, some people do have excess body fat they can appropriately lose to be healthier as a person and lighter as an athlete. They can rightfully feel pleased when they accomplish the goal of attaining an appropriate weight. But other athletes just think they have excess fat to lose; they have distorted body images. A survey of 425 collegiate female athletes reports the women wanted to lose 5 pounds, on average. (1) Another survey of the top women runners in the country found the same results. (2) Even elite athletes wistfully believe they will perform better if they are leaner. Unfortunately, the struggle to attain that “perfect weight” can cost them their health and happiness. Restrictive diets with inadequate protein, iron, zinc, calcium and a myriad of other health-protective nutrients—to say nothing of carbs for fuel—often contribute to injuries and poorer performance.

So what can you do if you are discontent with your body? First of all, you should get your body fat measured to determine if you actually have excess fat to lose. Data can be helpful. (Find a local sports dietitian to measure your body fat via the referral network at SCANdpg.org.) You may discover you have less body fat than expected!

Feeling fat

It’s easy to understand why so many athletes have distorted body images. When you put on skimpy running shorts that expose your “flabby things”, or a bathing suit that shows every bump and bulge, you can very easily “feel fat.” Sound familiar?

One solution to the “I feel fat syndrome” is to remember “fat” is not a feeling. That is, you don’t feel “blond hair” or “freckled.” You also do not feel “fat.” Yes, you may be feeling uncomfortable with your body. But you are really feeling imperfect, inadequate, insecure, and anxious—and any number of other feelings that get described as “feeling fat.”

I encourage you to explore those real feelings, and figure out where you got the message that something is wrong with your body. The media is a good start, but it could also be a parent who lovingly said at a tender age “That outfit looks nice, honey, but if only you’d lose a few pounds…” What you hear is “I’m not good enough” and this can create a downward spiral of self-esteem. Weight issues are rarely about weight. They tend to be about feeling inadequate and imperfect.

What to do

So how can a discontent athlete feel better about his or her body? One tactic is to stop comparing yourself to your peers. To compare is to despair. Rather, pretend you live on an island where your body is “good enough” the way it is. (You are unlikely to ever have a “perfect” body, so the second best option is to enjoy a body that is “good enough.”) If you step off your island and start comparing yourself to your peers, please notice: Do you end up being too fat, too slow, too ugly, too dumb? Do you ever let yourself rise to the top and be better than others? Doubtful. You are better off staying on your island, and calling yourself a Gorgeous Goddess or Handsome Hulk. With time and practice, you can change the way you see yourself and come to believe perhaps you are, indeed, good enough the way you are!

Granted, changing the way you feel about your body is a complex process. The following resources can help you in this journey to find peace with your body:

www.nourishingconnections.com (free e-newsletter)
www.findingbalance.com (has videos about resolving weight issues)
www.adiosBarbie.com (offers resources and insights into the media)

For a plethora of books, visit the online bookshelf at www.gurze.com. Some of my favorites include The Body Image Workbook and The Don’t Diet, Live-It Workbook.

Life is more enjoyable when you can love your body and appreciate it for all it does and stop hating it for what it is not. When the drive for thinness comes with a high price, that price may not be worth the cost.

Information provided by Nancy Clark, MS, RD CSSD (Board Certified Specialist in Sports Dietetics), Chairperson of the Nutrition Committee of the Female Athlete Triad Coalition. Nancy Clark counsels active people at her private practice in Newton, MA (617-795-1875). For more information, read her popular Sports Nutrition Guidebook and food guides for new runners, marathoners, soccer players and cyclists, available via www.nancyclarkrd.com.

References:
1. Beals K and M Manore. Disorders of the female athlete triad among collegiate athletes. Int’l J Sport Nutrition and Exercise Metabolism. 2002. 12:281-293

2. Clark N, M Nelson, W Evans. Nutrition educational for elite female runners. Physician and Sports Medicine. 1988. 16:124-135

The Athlete’s Kitchen
Copyright: Nancy Clark MS RD CSSD

Protein tips for vegetarians

“Since I’ve given up meat, I’ve been eating lots of nuts and peanut butter for protein” reported my client. She thought she was eating TONS of protein, but the reality is, nuts and peanut butter are not as protein-dense as many people think. While nuts do offer protein, only about 5 to 10% of their calories come from protein and about 70% of their calories come from fat. (The good news is, the fat in nuts is health-protective so is a positive addition to a sports diet.)

Most athletes need at least 60 grams of protein. Two tablespoons of peanut butter offers only 8 grams of protein for 180 calories. You could get three times more protein—26 grams of protein—in the same amount of calories of Greek yogurt!

Beans (as in kidney beans or hummus) are also lower in protein than many vegetarians realize. Beans offer about 6 grams of protein in a half-cup. While they are a smart choice for athletes because they offer a hefty does of carbs and can both fuel the muscles and heal/build muscles, they only offer about 12 grams of protein per 180 calories.

You also have to eat big portions of tofu and garden burgers… read the food labels for protein information!

The trick to getting enough protein as a vegetarian is to consume generous amounts of plant proteins at each meal and snack. You can successfully consume a balanced vegetarian diet as long as you educate yourself about the protein content of the foods you choose.

Be wise,
Nancy Clark MS RD
Sports nutritionist and author, Nancy Clark’s Sports Nutrition Guidebook
www.nancyclarkrd.com

Information provided by Nancy Clark, MS, RD CSSD (Board Certified Specialist in Sports Dietetics), Chairperson of the Nutrition Committee of the Female Athlete Triad Coalition. Nancy Clark counsels active people at her private practice in Newton, MA (617-795-1875). For more information, read her popular Sports Nutrition Guidebook and food guides for new runners, marathoners, soccer players and cyclists, available via www.nancyclarkrd.com.

For Athletes Who Struggle with Food and Weight

Too many athletes (males and females alike) struggle with food and weight. Their common belief is “the lighter I am, the better I’ll perform.” This is not true if the cost of attaining the perfect body is poorly fueled muscles, overuse injuries, and a dysfunctional relationship with food.

If you are an athlete who struggles with losing those last few pounds, take note. Weight issues may have little to do with body fat and more to do with “I’m not good enough.” Haven’t we all, as athletes, had that thought? And certainly, some athletes struggle with the “I’m not good enough” belief far more than others. They are the ones who can easily cross the line into having an eating disorder.

An eating disorder distracts the athlete from the feelings that come with being “not good enough.” After all, if you are always thinking about whether or not to eat, and how much to exercise, you are avoiding feelings of imperfection or inadequacy. Unfortunately, using food to distract from those feelings can end up hurting your performance.

The following information, presented at a conference in Boston organized by the Multiservice Eating Disorders Association (MEDA), offers food for thought for athletes who struggle with finding the right balance of food, weight, and exercise. For additional information, check out MEDA’s website, www. MEDAinc.org. It’s filled with helpful resources for teammates, friends and family members, as well as athletes with anorexia, bulimia, and food obsessions.

Food for thought

• Anorexia has the highest mortality rate of any mental illness. Whether death is from heart arrhythmias or suicide, we need to pay attention when athletes struggle with food.
• Just as athletes with anorexia lose arm and leg muscle that helps them be strong athletes, they simultaneously lose heart muscle. The heart gets smaller and cannot respond to stress. The resulting arrhythmias can be a cause of death.
• The purging associated with bulimia takes its toll in terms of not only electrolyte imbalance associated with vomiting, but also gray teeth (due to erosion of tooth enamel on the inside of the mouth), and dental caries. The person may also suffer from acid reflux, difficulty swallowing, and chronic constipation (if purging includes laxative abuse).
• Thankfully, many medical issues are reversible but two “biggies” can remain problematic: 1) cognitive dysfunction due to the brain shrinking and 2) bone health. The bones (particularly in the spine, hip, and wrist) lose density. This increases the risk of stress fractures today and osteoporosis in later years. A shocking one-fourth of young women (<20 years) who suffer from anorexia have early osteoporosis. Some end up in severe pain for their lifetime, others in wheelchairs. Teens need to be fully aware they are not only losing bone density but also are not gaining it, as should happen during teenage years. Surprisingly, men with anorexia end up with worse osteoporosis than women.
•Any female athlete with amenorrhea (loss of her menstrual period for more than 3 months) should get her bone density measured for a baseline. Should she also take a birth control pill to force the return of menses? Current research suggests not. The pill offers a false sense of recovery, plus does not enhance bone density. The better path is to eat enough food to restore the body to an appropriate weight.
• Beware that eating a very high fiber can interfere with calcium absorption. No need for more than 25 to 35 grams of fiber per day!
• People with eating disorders commonly have high cholesterol levels. The solution is not to limit red meat and eggs; rather, the athletes need to normalize their entire diet.
• Medical symptoms that raise red flags include: heart rate less than 40 beats per minute, body temperature less than 95°F (35°C), blood pressure less than 70/40, and low blood glucose (<60 mg/dL) between meals. These numbers are sometimes seen in highly trained athletes; hence to identify those with eating disorders can be tricky. Other red flags include noticeable “fur” on arms and face (lanugo hair, for warmth), brittle fingernails, blue fingertips, itchy dry skin, and a yellow skin tone due to overindulging in carrots and orange vegetables.
• Athletes with anorexia may complain about “feeling full” despite a small food intake, and food that just “sits in the stomach.” The solution is to force them to gradually increase their intake. Even though they may not feel hungry, their body is starving and needs fuel.

Do people recover?

Yes, usually with help from a therapist, registered dietitian (RD), and medical team. Some people get tired of the eating disorder and learn to accept their perceived body flaws. Others get scared when they vomit blood. Some find hope in a new personal relationship —Maybe I am good enough to be loved!—or choose to eat better so they can get pregnant.

One pathway for recovery is to see the eating disorder as being just one part of you. It is the part that tries to protect your other parts that don’t like feeling lonely, rejected, or imperfect. For example, perhaps you had traumatic experiences in middle school. Your eating disordered part can distract and numb feelings of pain, terror, and fear. It keeps you feeling more in control of life.

Try talking to your eating disorder and ask, “Please tell me why you are here? What are you trying to do for me?” The eating disordered part might answer “I’m trying to distract you and protect you from painful feelings—you know, the shame you felt as a kid in middle school…” Yet, we all know that starving one’s body does not solve any problems. Hence, a probing question is, “How effective on a scale of 1 to 10 (with 10 being 100% effective) is the eating disorder in making you happy in your core?” Most athletes with eating disorders are miserable.

Using a model of recovery such as Internal Family Systems (www.selfleadership.org), athletes can discover their core that is centered, competent, secure, self-assured, relaxed, and able to both listen to and respond to feedback. These core values can displace the eating disordered voices and lead to a happier, healthier life and improved performance. Is it time for you to stop struggling and start living and performing better?

Information provided by Nancy Clark, MS, RD CSSD (Board Certified Specialist in Sports Dietetics), Chairperson of the Nutrition Committee of the Female Athlete Triad Coalition. Nancy Clark counsels active people at her private practice in Newton, MA (617-795-1875). For more information, read her popular Sports Nutrition Guidebook and food guides for new runners, marathoners, soccer players and cyclists, available via www.nancyclarkrd.com.

The Athlete’s Kitchen
Copyright: Nancy Clark MS RD CSSD June 2012