be nice(er) to yourself

as my nutrition philosophy has evolved in the past couple of years, I’ve found myself naturally incorporating a more holistic approach into my practice. I’ll admit I’m a little wary about the term “holistic” – I feel like it’s been thrown around a lot in the wellness world to legitimize titles that lack actual credentials (“holistic nutritionist” or “holist health coach” come to mind) and it drives me crazy. But I can’t deny that the actual definition of holistic, or the treatment of the whole person, taking into account mental and social factors, rather than just the physical symptoms, is something I’m behind 100%. It’s like taking the person off the piece of paper, medical chart, set of lab values or arbitrary anthropometric measurements and instead taking into account that they are a human being with human feelings and experiences, and very likely someone’s mom, grandfather, sister, son, etc. That makes a huge difference, and I like that more and more healthcare practitioners have this type of mindset (and get really frustrated with the ones who don’t). So call me a holistic dietitian, if you will.

what a photo bomb ❤

these days it’s very rare for me not ask patients about their stress levels, sleep, exercise habits and relationships (with food and humans) because when it comes to overall health, these are just as important as nutrition. And they all affect each other. In fact, one phrase I’ve found myself repeating the most lately is a very simple, “be nice to yourself!” The first time I said this to a patient I myself was taken aback a bit as it just popped out. The patient was about “mom age” (so, around the age of my mom, or mid-60s), and beating herself up over not looking a certain way, choosing to eat XX for dinner the night before, etc. After I said it, I almost thought she was going to look at me like, “ok yeah sure, what do you know” or “how about we stick to nutrition here?” Instead, she visibly relaxed and agreed with me, and we spent most of the session talking about how she can do just that – be nicer to herself. It sounds so simple, but it’s something so many of us (myself included) can do better.

this doesn’t have to mean calling in sick to work and escaping to a luxurious beachfront resort for an extended vacation, buying yourself a crazy expensive handbag or getting a massage every other day. Being nicer to yourself can be way more simple (and affordable) by learning to recognize negative self-talk and redirect to a more positive mindset. Kind of like this:

  • instead of punishing yourself about a “bad” food choice by restricting the next meal or meals, try to remove labels from foods – there is no “good” or “bad”. Have what sounds good to you and know you’re nourishing your body with a variety of foods
  • instead of forcing yourself through an intense workout if something hurts or you’re super tired because of the “calorie burn,” think about how powerful rest can be for both the muscles and the brain, and how different exercise feels when you enjoy it
  • instead of comparing yourself to women on television/in the movies, on social media or magazines and feeling badly for not looking just like them, drop the comparison game – it won’t get you anywhere and can be an endless cycle of “she wore it better.” Plus, who knows if those people are truly happy or not, and isn’t that way more important?
  • instead of automatically saying yes to a date you know will go nowhere, another project at work or another engagement party for someone you sort of know, don’t. Know it’s ok to say no and make plans with yourself. This could be a solo dinner, netflix and a glass of wine or an early bedtime. Whatever YOU want
  • instead of following social media accounts that can trigger any and all negative thoughts and behaviors, unfollow them! If they don’t serve you in a positive way, they’re not useful

maybe this sounds too simple, but it can be surprisingly hard to break out of habitually negative thoughts and behaviors. It takes a little bit of work and some time, but asking the question “how can I be nicer to myself” in certain situations is a great way to start.

sometimes that means snuggling in your most comfy spot

think about how much brain space and time that could be freed up to focus on what is truly useful to you in a positive way.  I know I’ve personally found it hard to be present for the things that matter in life when I spend too much time beating myself up over the shit that doesn’t. So let’s all be nicer to ourselves. We totally deserve it.

nutrition · running

endurance sports and low carb/ketogenic diets

I almost don’t want to mention this for fear or “jinxing”, but my running has been feeling good lately. Even in the almost constant gross heat and humidity, the miles have flowed a lot better than they have in a while. I don’t think it’s real rocket science as to why – I’ve been taking it easier, running with no pressure, resting a bit more and doing other things like yoga, barre and nothing. I liken this to taking a running “chill pill” and I think it’s sort of working.

because I was feeling all the feels about running this past weekend, I decided to go on a longer run down the West Side Highway and Hudson River Park. I love running down there, but usually only do so when marathon training because it’s an out and back run and takes a long time. The solution? Take my metro card and subway back home when I felt like it and was near a subway. I’ve actually never done that before because I don’t really like being soaked with sweat far away from home and always end up getting cold. But! YOLO, right? So I headed out for what I thought would be 10 or so miles without any fluids (there are tons of fountains) or nutrition (usually don’t use this for runs under 12-13 miles).

happy place. but from the winter/spring of 2016 as I usually don’t like taking my phone out mid-run

it was such a beautiful morning and I loved being out there without any sort of pacing plan or route. After about 8 or 9 miles my energy started getting a bit low, which is pretty normal for me these days since I take Peanut for a walk before my runs now and haven’t really nailed a new pre-run fueling plan. My usual half a banana doesn’t really cut it so much anymore. So, ok. Low energy, no fuel, but I had a credit card and an idea of where I could get the subway and a snack. The only thing is that it was a bit far away – I was downtown near Battery Park and the WTC and I wanted to be in Union Square. Those three or so miles uptown were tough, and as I neared my destination my legs felt more and more like heavy bricks. I felt so depleted, and I probably used my last glycogen store as I triumphantly pulled up to the Juice Generation on 18th street. All I could think about was slurping down something cold and sweet, and decided on an acai bowl because I’ve been wanting to try one for a while.

hit the spot in a major way.

and all this got me thinking of another nutrition trend I just can’t get down with, and that is endurance athletes going on “ketogenic” diets. One principle of the diet is basically running on the depleted state that I unintentionally ended my run on Sunday. It’s miserable. And I’d hate for anyone to purposefully do that to themselves under the false belief that it’s going to help them get that PR.

what exactly is a ketogenic diet?
these are diets very low in carbohydrate, low in protein and very high in fat, with the goal of putting the body into ketosis. This is when there is a build-up of acids called ketones in the body, as a result of burning fat stores in the absence of glucose. A true ketogenic diet is something like 5 percent carbohydrate, which is very hard to do unless you’re eating butter and cheese all day and have some direction from a dietitian. In fact, most athletes who say they are on a ketogenic diet are often just on a low carbohydrate, high fat diet because they are consuming too many carbohydrates to achieve ketosis. That said, though, they are still consuming far too little carbohydrates to fuel their activity!

so what is the point?
there has been some recent hype touting performance enhancements achieved by drastically cutting carbohydrates and increasing fats, with the idea being the body will burn more fat as fuel. We don’t necessarily need to achieve ketosis to do this. The body has limitless stores of fat and very limited stores of glycogen, so this is thought to be a much more efficient fuel source and one that can help us go longer, faster. It sounds good on paper, at least.

but that’s really all it is, and it’s not for lack of research. If an individual begins consuming a low carbohydrate, high fat diet, the body will physiologically adapt by increasing fat oxidation and reducing carbohydrate utilization. But while our capacity to use fat for energy enhances when we have consistently limited carbohydrate stores, this does not translate to a better performance in endurance events. There is a lot of recent research to back this up. If we train our body to use a less-preferred source of fuel (fat), it will also do so during an endurance event like a marathon. The problem is that all it really wants is carbohydrates, which it has adapted to use less of. Even if you carbohydrate load in the few days before said event, the body remains less efficient at using glycogen stores once it adapts to using more fat.

one of my fave carbohydrate forms – toast!

more research
this study is the most recent and thorough I’ve read, and I had the pleasure of listening to one of the study investigators – Dr. Hawley – speak at FNCE last year. He talked about the study a bit (it had yet to be published) and gave such compelling evidence as to how and why low carbohydrate, high fat and/or ketogenic diets just don’t work for endurance athletes. His study used elite race walkers who were all put on the same intense training program, but one group followed a low carbohydrate, high fat diet, another a high carbohydrate diet and another a periodized carbohydrate diet (still high in carb, just spread out differently during the day). At the end of the training program, all athletes had improved aerobic capacity, but only the high carb and periodized groups experienced an improvement in race performance (a timed 10K). This is because, as I mentioned above, when we adapt to a high fat diet by increasing fat oxidation, we also adapt by using less carbohydrates and reduce carbohydrate oxidation. It’s this adaptation that limits performance capacity.

another important point is that our brain and central nervous system also depend on glucose (what carbohydrates are broken down into) to function. And if we are in a state of depletion, we also may not be thinking clearly. This can effect things like pacing, perceived effort and even simple decision making during a race. Not really a recipe for success, right?

in conclusion…
still, the anecdotal evidence persists and with the help of social media, one or two “success” stories can and has snowballed into a real trend. I don’t think this one will last forever, though, with science firmly rooted against it. And because even anecdotally, if you look at the plates of most top endurance athletes, they are more often than not generous on the carbohydrate front. And that is for good reason.




becoming a non-diet dietitian

while my core nutrition philosophy is not something I’ve wavered on too much since becoming a dietitian, it is still evolving somewhat as I gain more experience and sift through fun new research, as it should. One big thing that has changed is that I rarely weigh patients or clients and I very rarely put them on diets (this of course excludes those with more severe medical issues, etc.). Ok technically that was two things, but work with me here as I have a story.

such a hearty and delicious breakfast – quinoa/oats with almond milk, cacao powder, sweet local berries, banana, chia/hemp seeds, coconut and lots of almond butter

when I was first starting out as a clinical dietitian, I did some extra work helping run a medically supervised weight loss program. I needed the money and wanted any and every experience possible, but thinking of this now I absolutely cringe. The program was extremely strict in that participating patients had to have a particularly high BMI, were put on a VERY low calorie diet and had to eat meals provided by the program that were packed with sodium and a laundry list of junky chemicals. I would have to hold sessions every week with a pre-planned lesson (courtesy of the program), mostly with tips on how to only eat these awful, prepackaged foods and manage crazy hunger levels. Every single patient who was on the program had tried dozens of diets already, lost and gained hundreds of pounds and were ready and motivated to give it another go. This would be THE diet that would help them lose weight and keep it off for good. Only, it didn’t. They all lost a lot of weight initially, which is common in super restrictive diets, but it was impossible to maintain over any longer than a few months. Bingeing or being “bad” was common, and much of the lessons were all about getting “back on track” or being “good.” I’ve never been a fan of those terms, but I really thought I could help these patients who so badly wanted to change. Each week I’d add more of my own ideas into the lessons and less of the programs, but at the end of the day realized it wasn’t something I could ethically do anymore. Patients would get so upset when their weight loss slowed or the numbers on the scale varied slightly, the episodes of bingeing would be followed by severe shame and depression, and they were almost always beating themselves up over something related to the “diet.” This was something I wasn’t very prepared for. Working with patients on their relationships with food wasn’t a topic I learned much, if anything, about during my dietetic internship but is so crucially important. Not to mention the fact that what crazy restrictive diets actually do is make weight loss harder by seriously messing with hormones and metabolism.

diets don’t work.

not only do diets fail to address the dieters relationship with food, which is very often THE most important issue, but they impart unsustainable restrictions on foods, food groups, calories and often put foods into “good” and “bad” categories. There may or may not be consistent “weigh ins”  or assigned crazy amounts of exercise. Plans like this are almost always sustainable for a week or two, when motivation is high and the initial weight loss may occur. But after that, not so much. We as humans can only deprive and restrict ourselves so long until we physiologically and mentally reach a breaking point. This could be manifest in an hour-long binge on everything in the pantry followed by severe shame, quitting the “plan” entirely or on the other side of the spectrum, lead to an even more restrictive eating pattern and diagnosable eating disorder. Because diets also wreak havoc on our hormones, our bodies become more resistant to weight loss every time we enter into a new restrictive and stressful eating pattern.

lovely wild salmon with greens, roasted chickpeas, sauerkraut, avocado, side of sweet potato fries and peanut

There’s a statistic from a past research survey that estimates as many as 75% of women report having unhealthy thoughts, feelings or behaviors related to food and their bodies. This is the diet industry’s vulnerable and impressionable target audience. What diets essentially do is fuel these unhealthy thoughts further and fool us into thinking we need some gimmicky eating plan to make us “better.” They don’t help us work on our relationship with food or why these thoughts are occurring in the first place, making it nearly impossible to change.

This is why I’m such a fan of intuitive eating, because it’s not a diet, and it focuses on changing our thought process when it comes to eating and our relationship with food. It takes something that was once so easy for most of us, even if we have to go back to our toddler days, and that’s eating intuitively what we want when we’re hungry and stopping when we feel satisfied. There’s definitely more to it than that, and the book Intuitive Eating is an awesome resource.

being a “non-diet” dietitian and totally entrenched in this ideology, I often forget that having a non-diet mentality is still not very common. At least once every day I have a patient who comes in expecting to be put on a scary “diet” in some form and is shocked when I explain to them what we are actually going to do. I love seeing their reactions and I love even more how happy, fulfilled and hopeful they seem after our appointments. There is no fear of failing or vows to stick to something super strict or else. It’s awesome. And that’s the way it should be.


what the hell(th)

I’ve had a few patients and dietitian friends ask me if I’d see the documentary “What the Health,” and while I knew the basic premise promoting a plant-based, vegan diet, I finally had some time to watch it this weekend.  And I watched it while eating eggs, somewhat defiantly. When I didn’t have a mouthful of eggs chances were pretty good I was shouting expletives at my laptop and explaining to Peanut what the research the filmmaker was attempting to interpret actually meant. She was confused, much like most of the public, probably, after watching this film.

egg and cheese… friend or foe?

so let’s talk about the research
the filmmaker was big on citing research studies, which is a great way to sound like you know what you’re talking about, even if you don’t. The studies he talked about were cherry -picked to be easily manipulated into what he wanted them to say. Maybe because I’m used to reading and interpreting research, but it was so clear to me he didn’t actually read the studies and didn’t know how to interpret the data. He basically took key words – like “dairy” and “death” or “saturated fat” and “plaque” – and ran with them. The study on breast cancer and dairy, for example, is one I am very familiar with. This is an epidemiological study on a little less than 2,000 women with breast cancer who answered food frequency questionnaires, which is not the most reliable study design. What the data actually says is that high intake of high fat dairy products was potentially linked to a higher risk of mortality after breast cancer diagnosis. Not intake of all dairy, period. And the study also failed to account for dietary patterns and lifestyle factors of the high fat dairy intake group. This is HUGELY important. To date, the majority of the literature has found no overall association between dairy intake and breast cancer recurrence or survival, and this is an actual fact.

not done yet
it should also be noted that NONE of the studies cited in the entire film are randomized, controlled trials (RCTs), and these are the GOLD standard in the research world. Oversight much? It’s also extremely hard to draw definitive conclusions from nutrition-related studies in general because of inaccurate methodologies (the food frequency questionnaires or 24 hour diet recalls), self-report bias and confounding variables like other lifestyle factors. There is no mention of this in the documentary, of course.

fear mongering at its finest
I’m pretty sure at one point, the filmmaker compared eating eggs to smoking cigarettes. Um, what? He also claimed that meat directly causes diabetes (not really) and proceeded to ask why the ADA had recipes with animal-based products on their websites. The recipes also contained a lot of vegetables, but that doesn’t make for good discussion. Plus, any diabetes specialist or dietitian would logically conclude that the recipes on the ADA website are geared toward people who already have diabetes, and therefore a bit lower in carbohydrates to help them manage their blood sugar. The fear mongering continued for most chronic diseases, likening the intake of chicken to a death sentence or milk to a guaranteed cancer diagnosis. That. Is. Not. A. Thing. No chronic disease is caused by any one food. Period.

more delicious eggs from stone barns, and a cookie made with plenty of butter

the film was entirely one-sided
not a second was spared to discuss the “con” side of the filmmaker’s argument, and every MD he interviewed was drinking his kool-aid 100 percent. That’s convenient and again, makes for good TV, but is not reality. Had he asked, I’m sure experts would have lined up around the block to dispute the claims he was trying to make, myself included. Another pet peeve of mine is that he interviewed a “certified nutritionist,” which is such a BS term and I believe only requires you to have taken a handful of nutrition classes and pass a very general exam.  No advanced degree, clinical training, research applications, counseling experience, internship/field work (etc.) required. THESE THINGS ARE IMPORTANT. The “nutritionist” of course adamantly agreed with what he had to say and sounded like she found her main talking points on Google minutes before her interview.*

Also, I should mention that Steve-O (the stoner dude from that old show Jackass) was interviewed in this documentary in support of the filmmaker’s claims. Because that’s legit?

plant-based diets
while I’m not a fan of this documentary, I am a fan of plant-based diets and there is a reason they are so popular these days. There are a few different definitions of the actual term, vegan being one of them. I’m not against veganism, but I am against promoting it for completely unresearched reasons. My definition of a plant-based diet, and the one I teach to patients, is not exclusive and I don’t think it has to be. Yes, the majority of the foods you eat should ideally come from plants. But there is absolutely room for animal products too, if you enjoy eating them. With every meal, even! Remember, it’s dietary patterns as a whole that are going to affect our overall health in the long-term, not eating eggs instead of tofu at brunch this past Sunday.

final thoughts
there is always going to be a new book, movie, news article, ridiculous wellness summit and the like promoting new life-changing foods or diets, many of which were vilified just a few years ago or vice versa. That’s what sells. The problem is that people not knee deep in nutrition research are easily influenced by things like this, which often leads to unnecessary dietary restrictions and a whole lot of fear. Remember, fear + dietary restrictions = stress. And stress will hurt you long before your full fat Greek yogurt will.


*I really don’t like to dis on those in the health and wellness field, but things like this really make my blood boil.

dogs · nutrition · running

day in the life

in thinking about the blog posts I like to read the most, the more personal ones usually come up. I really admire people who just put it all out there in the internets, and while I don’t think I’ll ever quite get there (consider yourselves lucky…), a “day in the life” kind of post seemed like a fun idea. I picked last Thursday because it contained a little bit of everything work-wise and was non-stop busy until around 8:00 p.m., which is pretty typical lately. Here we gooooo.

5:30 a.m. wake up right before my alarm and Peanut staring at me from her “spot” in my/our bed above my pillows. I like this spot because she is comfy and there is little chance I can roll over on her. She sneezes and it’s too cute, and we snuggle for a few minutes before getting up. I’m reading Rebecca Scritchfield’s new book Body Kindness, and the chapter I read before bed the night before was all about sleep. So naturally, I think too much about how important sleep is and couldn’t fall or stay asleep. Oh well.

she woke up like this

6:15 a.m. we are back from our walk around the neighborhood and I feed Peanut her breakfast before heading out for my run. She is excited for breakfast and then not excited that I am leaving, but Mommy wants to run. I have about half a banana with some peanut butter and head out. This was a cool-ish morning and I felt pretty good. As I come out of my sleepy haze about 2 miles in, I remember that I have an interview with Runner’s World about marathon fueling (!!) and think of things I want to say. And also pinch myself because, #livingthedream. I see my friend Baker just after I get pooped on by a bird. That’s good luck, right? I ran for a little more than an hour, which is my current happy place.

7:30 a.m. get home and say hi to Peanut, quickly shower and make breakfast.

sprouted grain toast, greek yogurt, berries, nuts butter, more berries and coffeeeeeee

8:45 a.m. after getting ready, practicing Peanut’s new commands (we are learning the simple stuff like sit and stay during our weekly training class), checking emails and watching a little Today, we head out to daycare.

9:00 a.m. drop Peanut off at daycare. We just started going this week and I was so nervous that she wouldn’t make dog friends or there would be a mean dog or she would hate it. But, so far so good. I say goodbye to her and get a little too emotional when leaving. I am an unapologetically crazy dog mom and I’m ok with it.

9:15 a.m. stop at Whole Foods to buy the perishable ingredients for my meal prep class at work that night, like veggies, shrimp and tempeh. I do one of these classes every month or so for my patients and it’s super fun. I’m not allowed to use heat because it’s a fire hazard, so thinking of things to make requires some creativity. Tonight we’re making Vietnamese spring rolls with a peanut dipping sauce and I’m pumped.

9:45 a.m. arrive at work. Check my patient schedule and the treatment schedule of ladies receiving chemo that day to see if there is anyone I need to follow up with. I don’t have anyone until noon so I prep for my Runner’s World interview at 10:30.

11:10 a.m. the interview went well (I think, stay tuned for the October issue!). I head to the hospital cafeteria for lunch because I’m usually always starving by 11:00 a.m. and that’s when they switch over to lunch. Get my usual and head back to my office.

greens, tuna, avocado (brought from home), broccoli, chickpeas, quinoa salad and baked sweet potato

12:00 p.m. after having lunch at my desk reading some articles, I head down to our chemo suites to see a few patients. A lot of my work is with women who have already undergone treatment for breast cancer and who are doing very well. They are survivors and they are all amazing. Another good chunk of my work is with ladies currently undergoing treatment (i.e., chemotherapy), and while the day to day mix changes, today was a mostly treatment day.

1:00 p.m. run upstairs to meet a dietetic intern who will be with me for the afternoon. I love having interns and always find myself talking non-stop about all things nutrition and breast cancer I want them to learn. It’s also interesting to hear what they’re doing during their internship, since most of them that come to the hospital were in the same internship I did. Still not nearly enough talk on intuitive eating and embracing a non-diet practice, but hopefully we’ll get there.

2:30 p.m. we see another patient after picking her up some fruit ice from the cafeteria, and then get to work on some meal prep class prep. Ha. Today this was basically chopping a lot of vegetables, putting down table cloths, that kind of stuff.

3:30 p.m. leave work to pick Peanut up at daycare, take her for a little walk and feed her dinner before heading back into work for my class. I live about 25 minute walk away and am usually too stubborn to take a cab or even Uber, so walking wins. Before heading back, I inhale some whole milk Greek yogurt and Purely Elizabeth granola (my fave, so good) straight from the 32 ounce yogurt container and remember that I forgot to have a snack in the afternoon.

5:00 p.m. get back to work and finish prepping, check some emails and do some other admin things.

6:00 p.m. my class starts and I’ve got about 15 ladies participating. They are skeptical at the preparation of rice paper for the rolls, but they go with it and it actually works! I am relieved. I usually talk a bit about nutrition as we’re preparing our meals, so we touch on things like cruciferous veggies (we had some cabbage) and healthy fats (in the peanut sauce!). We also have shrimp for the rolls and I ensure them that although shrimp does contain cholesterol, it’s absolutely fine to eat and won’t affect blood cholesterol. Ditto for eggs. I love telling people they can eat eggs. We chat, we eat, and start to clean up.


7:30 p.m. I save the cutting boards and knives to clean the next day and make sure the conference room (where I have my classes) is clean. Head out into the gloriously lovely summer evening and walk home with my intern, who was a huge help.

8:00 p.m. try not to think about how tired I am and take Peanut for her last walk of the day. I wish she could tell me about the friends she is making at daycare and if she likes it or not, and then think that I worry too much about her having human feelings. She tries to say hi to another dog on the walk and I think daycare is making her more brave and social. Hooray! When we get home, I have more yogurt and granola because I was talking too much to eat enough during the class. Typical. Peanut looks at me with her little puppy dog eyes and I give her some yogurt.

impossible to resist

9:00 p.m. we wind down and get ready for bed. I remember to do some journaling, and then we get into bed while I read a bit more Body Kindness before shutting the lights off. Thankfully, this chapter was not on sleep and I drift off instantly.