Tag: Food

Food Allergy Week: FPIES in focus
Navigating Food Protein-Induced Enterocolitis Syndrome (FPIES) can be complex, but dietitians have a crucial role in supporting families with clarity and care. In this episode, we’re joined by Ingrid Roche, APD and co-director of Advanced Dietitians Group, to explore the foundations of FPIES — from diagnosis to multidisciplinary care. Ingrid shares practical strategies for maintaining nutritional adequacy, managing feeding challenges, guiding safe food reintroductions, and supporting parents through the emotional journey. Whether you’re new to paediatric allergy or looking to deepen your expertise, this conversation is filled with evidence-based insights and practical takeaways to strengthen your practice.

Hosted by Rebecca Sparrowhawk

Biography

Ingrid Roche is an Accredited Practising Dietitian with many years’ experience in paediatric food allergy including a long stint at the Perth Children’s Hospital. She is co-director of Advanced Dietitians Group, a private dietetic practice in Perth, Western Australia, specialising in paediatrics and allergy. Ingrid also works for the National Allergy Council, leading the food service project, continuing her passion for training and education others in food allergy.
In this episode, we discuss:

What FPIES is and how it differs from other food allergies

Recognise the dietitian’s role in diagnosis, nutrition support and care planning

Explore approaches to feeding challenges and supporting parent confidence

Gain practical guidance for safe and structured food reintroduction
Additional resources
- Click here to find out more about Farmers Union Gut Good
- Click here to learn more about ASCIA Food Allergy and Adverse Food Reactions Course for Dietitians
- Click here to listen to our episode ‘Living with FPIES: From dietitian to allergy parent’ with Kristin Houts
- Connect with Ingrid Roche on LinkedIn
The content, products and/or services referred to in this podcast are intended for Health Care Professionals only and are not, and are not intended to be, medical advice, which should be tailored to your individual circumstances. The content is for your information only, and we advise that you exercise your own judgement before deciding to use the information provided. Professional medical advice should be obtained before taking action. The reference to particular products and/or services in this episode does not constitute any form of endorsement. Please see  here  for terms and conditions.
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May 23, 2025
Inhospitable Hospital Food

What do hospitals have to say for themselves about serving meals that appear to be designed to inspire repeat business?

“Hospital food needs a revolution.” I was surprised to learn that most inpatient meals served in hospitals are “not required to meet national nutrition standards for a healthy diet.” An analysis of the nutritional value of food served to patients in teaching hospitals found that many did not meet dietary recommendations. “Warning: Hospital food bad for health,” read the headline.

A registered dietitian wrote to defend hospitals and point out how stringent the guidelines are, saying that “over half the hospitals met or exceeded more than half the guidelines….It would not take more than choosing eggs for breakfast and 2 percent milk with meals to exceed the recommended intake of cholesterol and fat…The provocative conclusions of Singer et al. only lead the media and the public to conclude that we are a bunch of dunces who have no understanding of the relation between nutrition and disease prevention.”

Well, if the white coat fits…

“We spend a fortune on training doctors, but then don’t follow through on the simplest things, like food.” “Good diet is as necessary to recovery of health as good nursing, surgery, or medicine, and it is folly to pretend that it is beyond the power of our profession to change this reproach.” That was written 75 years ago, yet still there is pushback: “Perhaps we should question whether a ‘healthy diet’ given to a helpless patient during a 2- to 10-day hospital stay benefits anyone or anything other than the dietitian’s sense of ‘doing good,’” responded one doctor. He added, “I am always bothered when a healthy 75-year-old…is deprived of a desired morning egg because a ‘healthy’ low-cholesterol diet has been ordered.” I mean, what is a few days of a little heart-unfriendly diet in the scheme of things…

But it’s the message that’s being sent. “The presence of foods on the [hospital] tray sends a message to patients as to what is healthy and acceptable for them to eat,” responded the researchers who did the hospital foods analysis. “We still can think of no better place or opportunity to set an example of good nutrition than when patients are in hospitals.”

After all, public schools in California, for instance, have banned the sale of sodas for more than a decade. Why not children’s hospitals? In a study of California healthcare facilities serving children, 75 percent of beverages and 81 percent of foods sold in vending machines wouldn’t have been allowed to be sold in schools. We’re talking soda and candy. “Having unhealthy items in health care facilities and seeing staff consume these products…contradicts the nutrition and health messages children often receive from health care providers.”

On adult menus, nearly all meals contained excess salt, with 100 percent of daily menus exceeding the American Heart Association’s recommendation for staying under 1,500 mg of sodium a day. This means meals offered to patients may actually “contribute to the exacerbation or slow resolution of the very conditions that may have led to the hospitalization,” as I discuss in my video Just How Bad Is Hospital Food?.

But if hospitals adhered to the recommended limits of salt, the food wouldn’t taste as good, responded an executive from the Salt Institute, to which the researchers replied: Taste as good? “Hospital food is often criticized as having poor palatability, despite the fact that it likely already contains high levels of sodium.” It doesn’t taste good, no matter how much salt it has.

At the very least, we should “prepare all meals with low sodium content and make optional table salt available for those patients who do not have additional restrictions.” Then, if individuals want to add salt, it’s their choice. If they want to get someone to wheel them out into the parking lot and smoke, that’s their business, but we shouldn’t be blowing cigarette smoke into patients’ rooms three times a day, whether they want it or not. Interestingly, studies suggest that when people are allowed to salt food to taste, they rarely add as much sodium as may come in prepackaged foods.

As you can see below and at 3:55 in my video, when researchers switched study participants to a low-sodium diet, they used their saltshakers more, but, overall, their salt intake dipped way down. And they said their food tasted just as salty, because salt added to the surface of foods makes it taste saltier. But when a hospital meal is served pre-salted, “most inpatients may not actually have the option to consume healthy levels of sodium while they are hospitalized.”

In defense of their unhealthy food, one hospital food service provider explained that they’re just giving people what they want: “People are in the hospital and they are stressed and they need something that they consider comfort food, so I don’t want to deny that to people if that’s what makes them feel better.” That’s a reason one clinical director sends ice cream and candy bars to cancer patients: “We focus on familiar comfort foods, an approach that has enhanced patient satisfaction and improved intake.” You know what else might help? A nice, long drag on a cigarette. Hospitals used to sell cigarettes, “primarily…for ‘patient convenience.’” “‘I don’t think I can deny a paying patient the right to smoke a cigarette,’” said a medical center administrator. “‘As a service to the patient, I will have to insist we have cigarette machines in the hospital.” But others suggested that tobacco products shouldn’t be sold in hospitals at all. This wasn’t from the 1950s, but from the 1980s. Yet, at the time, the “irony of hospitals allowing the sale of cigarettes, which are the major cause of preventable illness and death in this country, has rarely been discussed in the literature…It is especially ironic that smoking is permitted in 89% of doctors’ lounges.”

To their credit, though, U.S. hospitals underwent “the first industry-wide ban on smoking in the workplace” by the mid-1990s. Now, “hospitals again have the opportunity to take the lead and to create food environments that are consistent with their mission to cure the sick and to promote health. Through the simple act of serving food that meets national nutritional standards, our hospitals will act in the best health interests of their patients, and their staff, and will undoubtedly again be leaders in our ongoing dialogue on how to improve our food supply, which in turn will improve the health of us all.”

“Strict antismoking regulations have frequently been criticized as too harsh or difficult to enforce, as if disease and premature death brought on by smoking were any easier to accept and control.” Think my smoking-diet parallel is hyperbole? Well, guess what? Today, the major cause of preventable illness and death in this country is no longer tobacco. The leading cause of death in America is now the American diet, as shown below and at 6:29 in my video. Hospitals in the United States serve “millions of patient meals each day and are optimally positioned to model a healthy diet through patient food.”

Doctor’s Note:

Have you seen my earlier video on junk food in hospitals? If not, check out Hospitals’ Profit on Junk Food.

For more on how the profit motive is degrading our health, see related posts below.

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May 4, 2025

Celebrating Food, Activism, and Black History Month with Jenné Claiborne

We had the pleasure of talking with Jenné Claiborne about her work, food, Black History Month, and her new cookbook. We hope you enjoy this interview and her recipe for her Amazing Edamame Salad.

Please tell us a little bit about yourself and your work.

I am the vegan chef, cookbook author, and content creator behind Sweet Potato Soul. Since 2010, I have been blogging and sharing delicious and nutritious vegan recipes with hungry readers. Committing to a vegan diet in 2011 set the course for my life and career in the best way, and I have never looked back.

How did you learn how to cook? What is your culinary story?

I learned how to cook by observing and assisting my grandmother and father in the kitchen. My dad was raised vegan, so I was familiar with plant-based cooking from a very young age. My grandmother is a classic soul food cook, but she made delicious and creative changes to her way of cooking when my family decided to stop eating red meat well before my birth. Growing up, I saw cooking as a way to creatively express love for family and friends, while also nourishing the body. My cuisine has always been inspired by my family, but also by the travels I’ve taken all over the world.

In your experience, how have you found food to tell a story and shape health, culture, and community?

Food is truly everything. You are what you eat. Food can tell a story about your origins and culture, your access, your knowledge, and your values. As a vegan who is inspired by soul food, global cuisine, and seasonality, I use food to tell a story of our abundantly beautiful world.

How do you educate people about whole food, plant-based nutrition, and what do you envision as the way forward to help expand whole food, plant-based options regionally?

I seek to educate people through setting an example of what a healthy vegan can be. My background is as a private chef in New York City, not a nutritionist or doctor. Without medical qualifications, I find that setting a good example and providing delicious recipes are the best ways I can educate those who are looking for inspiration and guidance.

As the author of the cookbook Sweet Potato Soul, how would you describe southern flavors and their history?

I’d describe southern flavors as seasonal, bold, colorful, and delicious. Like everywhere in the world, southern cuisine is very much influenced by what is available in the region seasonally. Traditionally, that meant a lot of leafy greens, whole grains, legumes/beans, and smoked foods.

What are some of your favorite ways to incorporate these flavors into plant-based dishes?

I adore classic southern foods and flavors, and they are all so easy to veganize. For example, I grew up eating smoky collard greens, cornbread, sweet potato pie, biscuits, and BBQ. I have found simple and nutritious ways to veganize them all by using wholesome ingredients like smoked paprika, flax egg, non-dairy milk, and mushrooms.

What does Black History Month mean to you?

BHM to me is a great time to learn about and celebrate the contributions of Black folks to American culture and institutions. Black people have made so many overlooked contributions, and BHM is a great time to recognize them, especially in the area of food. My favorite example is George Washington Carver, who revolutionized the production and use of peanuts, as well as sweet potatoes (my favorite vegetable).

AMAZING EDAMAME SALAD

Makes 2 to 4 servings

Originally published on Jenné’s website.

Ingredients

12 oz bag frozen and shelled edamame (also known as mukimame)
1 cup shredded red cabbage
2 shredded carrots (about 1 cup)
½ red bell pepper, diced
2 scallions
¼ cup fresh minced cilantro
¼ cup smooth almond butter, stirred well
2 tbsp freshly squeezed lime juice
2 tbsp Umami Sauce
2 tsp Date Syrup
1-inch piece fresh ginger, minced or grated
1 garlic clove, minced or grated
½ cup raw chopped almonds

Note: This recipe has been adapted to meet NutritionFacts.org standards.

Instructions

Bring a large saucepan of water to a boil over high heat. Add the edamame, then boil for 5 minutes or until tender. Drain and let cool at room temperature for 5 to 10 minutes, until the edamame are cool to the touch.
In a large mixing bowl, add the edamame, red cabbage, carrots, bell pepper, scallions, and cilantro.
In a small whisking bowl, combine the almond butter, lime juice, Umami Sauce, Date Syrup, ginger, and garlic. Whisk well until smooth and creamy.
Pour the almond dressing over the vegetables. Toss well to combine.
Cover and refrigerate the salad for an hour to marinate or serve immediately, garnished with chopped almonds.

You can find Jenné on her blog, Instagram, and Youtube. Her new cookbook is available wherever books are sold.

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February 28, 2025

Curex Is Making Food Allergy Care Easier Than Ever, Backed by Science

For many people, food allergies are a year-round problem. The fear of accidentally exposing themselves to foods they are allergic to, stomach pains, and even more severe reactions can make every meal feel like a gamble. Even small amounts of allergens in everyday meals can cause a lot of distress, turning something as simple as enjoying food into a stressful and cautious experience. Avoiding the food their entire life may be impossible, which causes significant distress for people with food allergies. Going to restaurants is like playing a game of Russian roulette, as very few kitchens are pure from cross-contamination.

The first treatment that has emerged to combat food allergies has been oral immunotherapy, or OIT. It is administered in the office by an allergist, who, after conducting testing, creates a cocktail of allergens and asks the patient to drink it. Most doctors mix their own cocktails from ingredients they buy in a store, which is not a precise process and frequently causes significant side effects and even anaphylaxis. While OIT is effective for those who persevere and complete the treatment, few do because of painful side effects.

Fortunately, a new treatment for food allergies, sublingual immunotherapy (SLIT), has become a popular and practical solution for many. Through drops applied under the tongue, the treatment exposes the immune system to small, regulated amounts of common food allergens like peanuts, dairy, or shellfish. Unlike OIT, SLIT is created by specialized pharmacies like Allergychoices. They mix clinical-grade allergenic extracts to create a highly precise dosage of immunotherapy mix. The medication is taken under the tongue—where a smaller dose is effective—instead of being drunk like OIT. The immune system becomes desensitized over time, which reduces the extremity of allergic reactions. Allergy drops like these treat the root cause of food allergies, offering a long-term solution compared to short-term fixes like avoiding trigger foods and constantly carrying an EpiPen for emergencies.

SLIT allergy drops have been used widely for environmental allergies. Studies have shown that allergy drops work just as well as traditional allergy shots for treating conditions like pet allergies, dust allergies, and hay fever. With SLIT, patients can handle their treatment from their own homes without having to deal with needles or numerous clinic appointments, making it easier to stay consistent and add it to their busy schedules.

Recent studies have also shown that sublingual allergy drops are effective for food allergies. They rarely produce side effects—owing to much lower controlled dosage—which in turn results in a high completion rate. Patients who complete treatment can tolerate accidental exposure to a few peanuts or similar quantities of other foods in question, leading some to introduce the food into their diet or getting a peace of mind.

Fewer severe reactions and the ability to enjoy meals without fear are two key benefits of using SLIT drops for food allergies. Many patients report getting confidence in dining out, better energy levels, and improved peace of mind when managing their allergies. Allergy drops don’t just reduce symptoms—they address the root cause, giving patients the freedom to live their lives without constantly having to worry about accidental exposure. For many, it represents a transformation in how they approach food allergies—from a constant source of stress to a manageable part of their daily lives.

Making Allergy Care More Accessible

Curex has been leading in the effort to increase the number of people who can benefit from SLIT drops. Curex’s patient-focused approach and scientific innovation have made at-home allergy therapy easier than ever. A telemedicine consultation is the first step in the process, in which certified allergists evaluate the individual needs of each patient. Curex customizes each treatment plan to target specific allergy triggers—whether food-based, seasonal, or pet-related—and changes in the seasons using AI-driven data analysis, guaranteeing optimal effectiveness.

Curex sends tailored allergy drops directly to 50,000 patients’ homes when the treatment plan is finalized by its clinical team. Regular usage of allergy drops under the tongue is meant to raise tolerance to allergens like specific foods, dust, pollen, or pet dander. “We want to make allergy care less complicated and give patients a solution that works for them,” says Curex’s founder, Gene Kakaulin. Curex gives patients the ability to manage their allergies without the inconvenience and time commitment associated with traditional treatments thanks to this simpler process.

Curex patients often describe their experience as life-changing. Besides the ease of at-home care, many people report noticeable changes in as little as a few months, such as increased energy, fewer symptoms, and the ability to completely and continuously enjoy life’s moments, including dining and eating out without fear. Curex provides a customized, scientifically supported method of managing allergies for those who are prepared to go beyond band-aid solutions.

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January 27, 2025
How to stop tracking macros and trust yourself around food
“I worried that if I stopped tracking macros, I would lose my physique.”

After years of careful macro tracking, Dr. Fundaro finally admitted to herself that the method no longer worked for her. Yet she was afraid to give it up.

If anyone should feel confident in their food choices, it would be Dr. Gabrielle Fundaro. After all, Dr. Fundaro has a PhD in Human Nutrition, a decade-plus of nutrition coaching experience, and six powerlifting competitions under her belt.

Yet, when she was really honest with herself, Dr. Fundaro realized that she felt far from confident around food. For years, she’d used macro counting as a way to stay “on track” with her eating.

And it worked… until it didn’t.

After years of macro tracking, Dr. Fundaro was tired of the whole thing. She was tired of making sure her macros were perfectly in balance. She was sick of not being able to just pick whatever she wanted off a menu and enjoy the meal, trusting that her health and physique wouldn’t go sideways as a result.

Yet the idea of not tracking freaked her out. Every time she quit tracking, she worried:

“What if I don’t eat enough protein, and lose all my muscle?”

“What if I overeat and gain fat?”

“What if I have no idea how to fuel myself without tracking macros? And what does that say about me as an expert in the field of nutrition?”

The more Dr. Fundaro wrestled with macro tracking, the more she wanted to find an alternative.

Something that would support her nutritional goals while also giving her a sense of freedom and peace around food.

Calorie counting wouldn’t do it. That was just as restrictive as counting macros—maybe more.

Intuitive eating didn’t seem like a good fit either. Intuitive eating relies heavily on a person’s ability to tune into internal hunger and fullness cues to guide food choices and amounts. After years of relying on external cues (like her macro targets), Dr. Fundaro didn’t feel trusting enough of her own instincts; she wanted more structure.

Meanwhile, at the gym, Dr. Fundaro began lifting based on the Rate of Perceived Exertion (RPE) scale—a framework that helps individuals quantify the amount of effort they’re putting into a given movement or activity. It’s considered a valuable tool to help people train safely and effectively according to their ability and goals. (More on that soon.)

While using the RPE scale in her training, Dr. Fundaro found she was both getting stronger and recovering better. There was something to this combination of structure and intuition that just worked.

And then, it dawned on Dr. Fundaro like the apple hit Sir Isaac Newton on the head:

If Rate of Perceived Exertion could help her train better, couldn’t a similar framework help her eat better?

With that, the RPE-Eating Scale was born.

Dr. Fundaro has since used this alternative method to help herself and her clients regain confidence and self-trust around food; improve nutritional awareness and competence; and free themselves from food tracking.

(Yup, Dr. Fundaro finally trusts her eating choices—no macro tracker in sight.)

In this article, you’ll learn how she did it, plus:
- What the RPE-Eating scale is
- How to practice RPE-Eating
- How to use RPE-Eating for weight loss or gain
- Whether RPE-Eating is right for you or your clients
- What to keep in mind if you’re skeptical of the concept
What is RPE-Eating?

Invented by Gunnar Borg in the 1960’s, Rate of Perceived Exertion (RPE) is a scale that’s used to measure an individual’s perceived level of effort or exertion during exercise.

Though Borg’s RPE uses a scale that goes from 6 to 20, many modern scales use a 0 to 10 range (which is the range that Dr. Fundaro adapted for her RPE-Eating scale).

Here’s the RPE scale used in fitness.

Rating Perceived Exertion Level

0 No exertion, at rest

1 Very light

2-3 Light

4-5 Moderate, somewhat hard

6-7 High, vigorous

8-9 Very hard

10 Maximum effort, highest possible

Originally used in physiotherapy settings, the scale is now frequently used in fitness training.

For example, powerlifters might use it to choose how heavy they want to go during a training session. Or, pregnant women might use it to ensure they aren’t over-exerting themselves during a fitness class or strength training session.

Because human experience is highly subjective and individual, the scale allows the exerciser to judge how hard they’re working for themselves. A coach can provide a general guideline, such as “aim for a 7/10 this set,” but it’s up to the client to determine exactly what that means for them.

Dr. Fundaro had used the scale many times with herself, and clients. She always appreciated the sense of autonomy it gave her clients, while still providing some structure.

So, she decided to take the same 1-10 scale and its principles, and apply it to eating.

Here’s what the RPE-Eating Scale looks like:

The goal with RPE-Eating is similar to RPE when training: Develop the skills to determine what is sufficient for you, without having to rely on other external metrics (such as apps or trackers).

How to practice RPE-Eating

If you’ve ever practiced RPE-training, you’ll know it takes some time to get used to. RPE-Eating is the same.

Don’t expect to be in lockstep with all of your body’s internal cues at first, especially if you’ve been ignoring them for a long time.

With this in mind, apply the steps below to practice the RPE-Eating process.

Step #1: Get clear on your goals.

RPE-Eating is not just another diet.

“It’s not about aiming to change your body,” Dr. Fundaro explains. “It’s not about feeling more control over your diet. Nor is it about feeling like you’re eating the ‘optimal’ diet.”

If your priority is maintaining a specific physique (such as staying ultra lean) or changing your body (building muscle or losing fat), this method can be adapted for that, though it isn’t the most efficient one to use.

Instead, RPE-Eating is about sensing into what your body needs and giving yourself appropriate nourishment—while building inner trust and confidence along the way.

“You have to trust that you’ll be able to nourish your body, and that you’ll be okay even though things may change in your body,” says Dr. Fundaro.

Admittedly, this can be challenging to do. It can also be difficult to let go of the expectation that you’ll hit the “right” macros at every meal—which RPE-Eating isn’t specifically designed to do.

However, if your goal is to build more self-trust, RPE-Eating can be a great tool to help you do that.

Step #2: Practice identifying your hunger cues

Before we explore this step, let’s distinguish between two motivators for eating.

First, there’s hunger. Hunger occurs when physical cues in your body (like a general sense of emptiness or rumbling in your stomach, or lightheadedness) tells you that you require energy—known to us mortals as food.

Then, there’s appetite. Appetite is our desire or interest in eating. It can stay peaked even after hunger is quelled, especially if something looks or tastes especially delicious—like a warm, gooey cookie offered after dinner that you feel you have to try, even though you’re technically full.

While it’s normal to eat for both hunger and appetite drives, the two can become mixed up. Especially if we have a history of dieting and tracking food.

The RPE-Eating scale helps you tap back into those true physical hunger cues, and learn the difference between hunger and appetite.

To put this in practice, try this before your next meal:

Using the RPE-Eating scale mentioned above, identify your current level of hunger. Record the number on paper or the notes app on your phone.

Then, eat your meal with as much presence as possible. (Note: This in itself takes practice. It can help to limit distractions, such as eating at the table rather than in front of the TV, and focusing on the flavors and textures of the food you’re eating, and how you feel eating it.)

About halfway through the meal, check in again. Based on the scale, how hungry are you now? As before, record the number.

If you’re still hungry, finish your meal. When you’re finished, repeat the same process, writing down where you are on the scale.

Once you’re done, take a minute and tune into what your body feels like. What does it feel like to be full? “Download” that feeling into your mind and internalize it in your body, as if you’re updating your phone with the latest software.

Repeat this for as many meals as you can. Aim to do it for one meal a day for a week or so, or for as long as feels good to you. Don’t worry if you forget: simply repeat the practice when you can.

The more you practice this, the better you’ll become at being attuned with your actual hunger cues. With time, you’ll likely find you develop more trust in your internal compass than what the latest diet tracker says for your needs.

(For more on fully-tuned-in, mindful eating, read: The benefits of slow eating.)

Step #3: Get to know your non-hunger triggers

Have you ever come home after a super stressful day and you’ve basically thrown yourself onto a bag of chips or a carton of ice cream?

We might like to imagine ourselves eating every meal mindfully, using the RPE- Eating system to a tee, but life rarely works like that.

Chances are, there are certain situations that trigger you to eat more quickly, mindlessly, and beyond the point of hunger.

That’s okay.

Dr. Fundaro’s suggestion? Aim to become more aware of the situations that cause you to overeat in the first place.

To do this, you can practice something we use in PN Coaching: Notice and name.

When you find yourself scarfing down food faster than you can blink, simply try to notice what’s going on.

Can you name a feeling—such as anxiety, or sadness?

Can you identify a situation or moment that happened before you started eating—say, an argument with your teenager, or a nasty email from your boss?

Once you’ve identified the feeling, event, or person that’s triggered you to eat compulsively, see if you can also identify what you might really be needing or desiring.

Eating for comfort is normal. However, if it’s the only coping method we have, it can cause more problems than it solves in the long run.

When you find yourself with an urge to eat mindlessly, consider what non-food coping mechanisms might help you feel better. That could be 10 minutes away from your computer to close your eyes and breathe, a walk outside, or a quick call to a friend to rant—or just talk about something completely unrelated.

Getting to know your non-hunger eating triggers—plus widening your repertoire of self-soothing methods—is just as valuable as getting to know your hunger cues. Over time, this awareness will allow you to eat with more intention.

Step #4: Eat for satiety AND satisfaction

Even when you’re “adequately fueled” from a physical perspective, you might still feel unsatisfied from an emotional perspective.

That’s because, according to the RPE-Eating framework, eating should fulfill two criteria:

Satiety describes the physical sensation of being full; your calorie or fuel needs are met.

Satisfaction describes a more holistic feeling of being nourished; your calorie needs are met, but your meal also felt pleasurable.

If you ate to satiety only, your calorie needs might be met and your physical hunger quelled, but you might still feel unsatisfied—maybe because chocolate is on your “don’t” list, and even though you’ve eaten everything else in your kitchen that isn’t chocolate, nothing quite “hit the spot.”

In other words, you can eat to satiety at every meal, yet still be “restricting” foods.

You may not be restricting calories per se, but you may have banned entire food groups—baked goods, pizza, or whatever else curls your toes. This can lead to a feeling of constantly needing to police yourself, and doesn’t leave much room for the flexibility and spontaneity that real-life (enjoyable) eating requires.

(Plus, avoiding particular foods tends to work like a pendulum: restrict now; binge later. If you want to learn how to stop those wild swings, read: How to eat junk food: A guide for conflicted humans)

Satisfaction is a key part of eating.

After all, humans don’t just eat for adequate nutrients and energy. We eat for other reasons too: pleasure, novelty, tradition, community, enjoyment.

So, to take your RPE-Eating to the next level, Dr. Fundaro recommends trying it with meals and foods you genuinely enjoy.

If any foods or meals have been “off-limits,” try eating them using the RPE technique. (Macaroni and cheese, anyone?)

Practice using the scale with a variety of meals (including those you may have restricted previously), and notice how you feel over time.

With experience, you’ll get to know what it feels like to adequately fuel yourself with a variety of foods—including those you genuinely enjoy.

How do I know if RPE-Eating is right for me or my clients?

RPE-Eating isn’t for everyone, but might be a good fit for you (or your clients) if:

You feel dependent on food tracking, but you don’t want to be.

Every time you stop tracking, the loss of perceived control freaks you out and drives you right back to tracking.

You want to stop tracking, but you want to have some type of system or guidance in place.

You’re currently tracking (or considering tracking) your food intake, and you have elevated risk factors for developing an eating disorder such as high body dissatisfaction; a history of yo-yo dieting; a history of disordered eating patterns; and/or participation in weight class sports.

If you’re a coach looking to use this tool with a client, check out Dr. Fundaro’s resources. Remember this tool may not be for everyone, and how you apply it needs to be flexible.

Note: If you or your client struggles with disordered eating, this tool does not replace working with a health professional who specializes in eating disorders, such as a therapist, doctor, or registered dietician.

How to use RPE- Eating for weight loss or weight gain

According to Dr. Fundaro, the best way to use RPE-Eating is in a weight-neutral setting.

While it could be used for weight modification, she doesn’t recommend treating it as another way to hit your macros or “goal weight.”

“I’m not anti-weight modification,” Dr. Fundaro explains. “I’m pro safe weight modification. I compare weight loss to contact sports. There are inherent risks but they can be mitigated through best practices.”

Dr. Fundaro elaborates: “Since RPE-Eating removes macro-tracking, which can increase risk of disordered eating in some people, and relies on biofeedback and non-hunger triggers, RPE-Eating provides a safety net that macro-tracking alone doesn’t provide.”

But if you do want to use RPE-Eating for intentional weight change, what should you do?

Dr. Fundaro recommends aiming to hover around the ranges that support your goal.

(As a reminder, a 1 to 3 on the RPE-Eating scale is categorized as “inadequate fuel; a 4 to 7 is categorized as “adequate fuel”; and a 8 to 10 is categorized as “excess fuel.”)

If the goal is weight gain, you’ll likely aim to eat within the 7 to 8 range for most of your meals.

If the goal is weight loss, you’ll likely aim to eat within the 4 to 5 range for most of your meals.

A key thing to remember is that you would never use RPE-Eating for extreme weight-modification such as for a bodybuilding competition. “That would be like using physio exercises to prepare for a powerlifting competition.” In other words, it’s not the right tool for the job.

Hold up, bro: Isn’t this just feelings over facts?

If you’re skeptical and think this is just eating “based on your feelings,” keep in mind that RPE was once laughed at by lifters, too.

These days, RPE and autoregulation are widely accepted in gym culture and have been studied as a valid method for managing and guiding your training. ¹

RPE isn’t perfect, but it’s pretty accurate and incredibly convenient. A lot more convenient than, say, using a velocity loss tracker for every set. ^{2 3}

And while it might seem like it’s all feelings-based, the RPE scale is actually built around practicing the skill of interoceptive awareness—the awareness of internal sensations in your body.

The better you get at the skill of interoceptive awareness, the more you’ll be able to use that awareness to make informed decisions about your training.

RPE-Eating is similar: It builds the skill of sensing into your own body, and lets your internal sensations guide your decisions.

Similar to how the bar slowing down on a squat would indicate you’re getting closer to failure, experiencing the absence of hunger at the end of your meal would indicate you’re closer to being full.

Instead of tracking your glucose levels to validate your perceived hunger, you use internal cues that correlate with lowered blood sugar and coincide with hunger.

And, let’s be real: Being mindful of stomach grumbling or general hunger pangs is much more convenient and accessible than tracking glucose readings.

This process will not be perfect. You may undereat or overeat at first. But over time, with practice, you’ll build the core skills of RPE-Eating.

Are there downsides to RPE-Eating?

While this tool can be helpful, it’s just a tool. A screwdriver is great, but it isn’t useful when you need a hammer.

RPE-Eating can be great for helping you become more aware of your internal hunger cues and build a better relationship with food along the way.

It can also be more laborious. It requires paying real attention to your feelings (physical and emotional), and reflecting on them.

This can be difficult for anyone—but especially people who aren’t able to sit at the table and have a leisurely meal, like parents with small kids, or people with work schedules that require eating on-the-go.

If this is you, just use RPE-Eating when it does work for you—or simply pick and choose specific steps to use in isolation. For example, maybe you try RPE-Eating on the occasional quiet lunch break. Or, maybe you focus solely on developing your awareness of hunger and fullness cues, without trying to change anything else.

If you’ve been tracking macros for a long time, it can be hard to stop.

Tracking macros isn’t inherently bad. It can actually be a helpful tool to teach you more about nutrition. But it’s also not something most people want to do for the rest of their lives.

The problem is, if you’ve depended on tracking your food intake, stopping can feel scary.

In these cases, RPE-Eating can be used as a kind of off-ramp to help transition away from rigid and restrictive macro tracking.

(It can also help loosen the compulsion to “always finish your plate.” Though macros tracking and habitual plate-cleaning may sound different, they’re actually similar: both rely on external cues—such as macro targets or what’s served on your plate—to determine when you’re “done.”)

RPE-Eating won’t take away all the scary feelings that may come with changing ingrained ways of eating.

However, it can provide some structure and language to help you, or your clients, eat with less fear, less stress, and a bit more confidence.

“The goal,” says Dr. Fundaro, “is to know that you’re nourishing yourself—and you don’t need a food tracker to do that.”

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References

Click here to view the information sources referenced in this article.

1. Helms, Eric R., Kedric Kwan, Colby A. Sousa, John B. Cronin, Adam G. Storey, and Michael C. Zourdos. 2020. Methods for Regulating and Monitoring Resistance Training. Journal of Human Kinetics 74 (1): 23–42.

2. Hackett, Daniel A., Nathan A. Johnson, Mark Halaki, and Chin-Moi Chow. 2012. A Novel Scale to Assess Resistance-Exercise Effort. Journal of Sports Sciences 30 (13): 1405–13.

3. Zourdos, Michael C., Alex Klemp, Chad Dolan, Justin M. Quiles, Kyle A. Schau, Edward Jo, Eric Helms, et al. 2016. Novel Resistance Training-Specific Rating of Perceived Exertion Scale Measuring Repetitions in Reserve. Journal of Strength and Conditioning Research 30 (1): 267–75.

The post How to stop tracking macros and trust yourself around food appeared first on Precision Nutrition.

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December 27, 2024
Junk Food in Hospitals

Why is hospital food so unhealthy?

“Put in stark terms, CVD [cardiovascular disease] claims 1 American life every 39 seconds and is responsible for more deaths annually than cancer, chronic lower respiratory disease, and accidents combined.” For most heart attack deaths, you just keel over. Sudden cardiac death “is the first manifestation of CHD [coronary heart disease] for the majority of individuals, particularly among women.” So, “for many of these sudden death victims, their demise was the ﬁrst indication of the presence of coronary heart disease.” They didn’t even know they had heart disease. That’s why an ounce of prevention is worth way more than a pound of cure—because there is no cure for death.

That’s also why the prevention of sudden cardiac death “remains a major public health challenge” because most people don’t even know they’re at risk. However, we’ve known for more than half a century, when we first started autopsying young servicemen who died during the Korean War, that coronary artery disease begins in our youth, even among young children. So, “business as usual…simply is not going to yield the improvements necessary to radically improve the CV [cardiovascular] health of the United States” and around the world.

There is good news, though. A “low-risk lifestyle (not smoking, exercising regularly, having a prudent diet, and maintaining a healthy weight)” may be able to eliminate the vast majority of the risk for sudden cardiac death. “The time is now long overdue to start aggressive preventive cardiovascular disease programs in our schools, our homes, and our worksites.” How about starting in our hospitals?

As I discuss in my video Hospitals Profit on Junk Food, a significant percentage of hospitals surveyed had fast-food restaurants inside them, with Krispy Kreme topping the list. Brilliant marketing, given that “families surveyed at the hospital with McDonald’s were…twice as likely to think McDonald’s was healthy, as compared to families at the hospitals without McDonald’s.” After all, McDonald’s was in the hospital.

What about food served in hospital cafeterias? Any better? Researchers analyzed 384 entrees from 14 children’s hospitals in California, and only 7 percent “were classified as healthy.” And, just in case someone chose the rare healthy option, 81 percent of eating venues in children’s hospitals had junky “high-calorie impulse items, such as ice cream freezers, cookies, and candy, at or near the checkout register” and 38 percent “had signs encouraging unhealthy eating.” Why would they do that?

If you ask hospital cafeteria managers, “less than a quarter (4 of 17) of respondents reported that the hospital followed nutrition standards for food offered in the cafeteria.” “Nutrition is not a top priority.” It’s the same reason unhealthy food is sold anywhere else: “pressure on food service departments for cafeterias to generate proﬁt.”

“Increased emphasis…[is] placed on running a hospital foodservice department as a profit center”—a bigger and “bigger profit center,” that is. It’s such a metaphor for our sickness-care system in general, where healthy, treat-the-cause approaches are eclipsed by the pills and procedures that bring in the most money.

What do you expect from the private sector? Public hospitals don’t seem to be much better. A 2019 analysis of veterans’ hospitals found that “all VA Hospitals contain vending machines providing a majority of soda, candy, and junk foods that directly conﬂict with healthy food choice recommendations from US governing health bodies,” such that, ironically, “hospital visits could theoretically promote worse health….An important question that should be posed is why are any soda or candy machines available at our VA hospitals? Are we trading the health of our veterans for proﬁts?”

Maybe it’s time to ban junk food on hospital premises. “On daily rounds, it is appalling to see patients…gorging on crisps [potato chips], confectionery [candy], sports drinks, and cola—the very food items that may have contributed to their admission in the first place…It is obscene that many hospitals continue to have…fast food franchises on site, as well as corridors littered with vending machines selling junk food. Such practice legitimizes the acceptability and consumption of such foods in the daily diet…The obesity epidemic represents a public health crisis, but it is a public health scandal that by legitimizing junk food hospitals have themselves become a risk factor for diet-related disease by perpetuating the revolving door of healthcare…It’s time to stop selling sickness on the hospital grounds.”

What message do residents receive when they are fed pizza and soda at grand rounds? We need a healthcare system with “more Hippocrates, less hypocrisy.”

For more on how the profit motive is degrading our health, see related posts below.

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November 26, 2024
Fast Fat Burning Meals Cookbook – Paleo, Vegan, Real Food Recipes

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October 6, 2024
Are Food Ads Making Us Obese?

We all like to think we make important life decisions, like what to eat, consciously and rationally, but if that were the case, we wouldn’t be in the midst of an obesity epidemic.

The opening words of the Institute of Medicine’s report on the potential threat posed by food ads were: “Marketing works.” Certainly, there is a “large number of well-conducted randomized experiments” I could go through with you that “have shown that exposure to marketing—especially, but not only, advertising—changes people’s eating behavior. Marketing causes people to choose to eat more.” But, what do you need to know beyond the fact that the industry spends tens of billions of dollars a year on it? To get people to drink its brown sugar water, do you think Coca-Cola would spend a penny more than it thought it had to? It’s like when my medical colleagues accept “drug lunches” from pharmaceutical representatives and take offense that I would suggest it might affect their prescribing practices. Do they really think drug companies are in the business of giving away free money for nothing? They wouldn’t do it if it didn’t work.

To give you a sense of marketing’s insidious nature, let me share an interesting piece of research published in the world’s leading scientific journal: “In-Store Music Affects Product Choice” documented an experiment in which French accordion music or German Bierkeller music was played on alternate days in the wine section of a grocery store. As you can see below and at 1:27 in my video The Role of Food Advertisements in the Obesity Epidemic, on the days the French music played in the background, people were three times more likely to buy French wine, and on German music days, shoppers were about three times more likely to buy German wine. And it wasn’t a difference of just a few percent; it was a complete three-fold reversal. Despite the dramatic effect, when shoppers were approached afterward, the vast majority of them denied the music had influence on their choice.

Most of our day-to-day behavior does not appear to be dictated by careful, considered deliberations, even if we’d like to think that were the case. Rather, we tend to make more automatic, impulsive decisions triggered by unconscious cues or habitual patterns, especially when we are “under stress, tired, or preoccupied. This unconscious part of our brain is estimated to function and guide our behaviors at least 95% of the time.” This is the arena where marketing manipulations do most of their dirty work.

The part of our brain that governs conscious awareness may only be able to process about 50 bits of information per second, which is roughly equivalent to a short tweet. Our entire cognitive capacity, on the other hand, is estimated to process more than 10 million bits per second. Because we’re only able to purposefully process a limited amount of information at a time, if we’re distracted or otherwise unable to concentrate, our decisions can become even more impulsive. An elegant illustration of this “cognitive overload” effect was provided from an experiment involving fruit salad and chocolate cake.

Before calls could be made at the touch of a button or the sound of our voice, the seven-digit span of phone numbers in the United States was based in part on the longest sequence most people can recall on the fly. We only seem to be able to hold about seven chunks of information (plus or minus two) in our immediate short-term memory. The study’s setup: Randomize people to memorize either a seven-digit number or a two-digit number to be recalled in another room down the hall. On the way, offer them the choice of a fruit salad or a piece of chocolate cake. Memorizing a two-digit number is easy and presumably takes few cognitive resources. As you can see in the graph below and at 3:52 in my video, under the two-digit condition, most study participants chose fruit salad. Faced with the same decision, most of those trying to keep seven digits in their heads just went for the cake.

This can play out in the real world by potentiating the effect of advertising. Have people watch a TV show with commercials for unhealthy snacks, and, no surprise, they eat more unhealthy snacks compared to those exposed to non-food ads. Or maybe that is a surprise. We all like to think we’re in control and not so easily manipulated. The kicker, though, is that we may be even more susceptible the less we pay attention. Randomize people to the same two-digit or seven-digit memorization task during the TV show, and the snack-attack effect was magnified among those who were more preoccupied. How many of us have the TV on in the background or multi-task during commercial breaks? Research suggests that may make us even more impressionable to the subversion of our better judgment.

There’s an irony in all of this. Calls for restrictions on marketing are often resisted by invoking the banner of freedom. What does that even mean in this context, when research shows how easily our free choices can be influenced without our conscious control? A senior policy researcher at the RAND Corporation even went as far as to suggest that, given the dire health consequences of our unhealthy eating habits, “the marketing techniques of which we are unaware should be considered in the same light as the invisible carcinogens and toxins in the air and water that can poison us without our awareness.”

Given the role marketing can play even when we least suspect it, what is the role of personal responsibility in the obesity epidemic? That’s the subject of my next video.

We are winding down this series on obesity, with three videos remaining:

If you missed any of the previous videos, see the related posts below.

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September 22, 2024
Obesity and a Toxic Food Environment

Implausible explanations for the obesity epidemic serve the needs of food manufacturers and marketers more than public health and an interest in truth.

When it comes to uncovering the root causes of the obesity epidemic, there appears to be manufactured confusion, “with major studies reasserting that the causes of obesity are ‘extremely complex’ and ‘fiendishly hard to untangle,’” but having just reviewed the literature, it doesn’t seem like much of a mystery to me.

It’s the food.

Attempts at obfuscation—rolling out hosts of “implausible explanations,” like sedentary lifestyles or lack of self-discipline—cater to food manufacturers and marketers more than the public’s health and our interest in the truth. “When asked about the role of restaurants in contributing to the obesity problem, Steven Anderson, president of the National Restaurant Association stated, “Just because we have electricity doesn’t mean you have to electrocute yourself.” Yes, but Big Food is effectively attaching electrodes to shock and awe the reward centers in our brains to undermine our self-control.

It is hard to eat healthfully against the headwind of such strong evolutionary forces. No matter what our level of nutrition knowledge, in the face of pepperoni pizza, “our genes scream, ‘Eat it now!’” Anyone who doubts the power of basic biological drives should see how long they can go without blinking or breathing. Any conscious decision to hold your breath is soon overcome by the compulsion to breathe. In medicine, shortness of breath is sometimes even referred to as “air hunger.” The battle of the bulge is a battle against biology, so obesity is not some moral failing. It’s not gluttony or sloth. It is a natural, “normal response, by normal people, to an abnormal situation”—the unnatural ubiquity of calorie-dense, sugary, and fatty foods.

The sea of excess calories we are now floating in (and some of us are drowning in) has been referred to as a “toxic food environment.” This helps direct focus away from the individual and towards the societal forces at work, such as the fact that the average child is blasted with 10,000 commercials for food a year. Or maybe I should say ads for pseudo food, as 95 percent are for “candy, fast food, soft drinks [aka liquid candy], and sugared cereals [aka breakfast candy].”

Wait a second, though. If weight gain is just a natural reaction to the easy availability of mountains of cheap, yummy calories, then why isn’t everyone fat? As you can see below and at 2:41 in my video The Role of the Toxic Food Environment in the Obesity Epidemic, in a certain sense, most everyone is. It’s been estimated that more than 90 percent of American adults are “overfat,” defined as having “excess body fat sufficient to impair health.” This can occur even “in those who are normal-weight and non-obese, often due to excess abdominal fat.

However, even if you look just at the numbers on the scale, being overweight is the norm. If you look at the bell curve and input the latest data, more than 70 percent of us are overweight. A little less than one-third of us is normal weight, on one side of the curve, and more than a third is on the other side, so overweight that we’re obese. You can see in the graph below and at 3:20 in my video.

If the food is to blame, though, why doesn’t everyone get fat? That’s like asking if cigarettes are really to blame, why don’t all smokers get lung cancer? This is where genetic predispositions and other exposures can weigh in to tip the scales. Different people are born with a different susceptibility to cancer, but that doesn’t mean smoking doesn’t play a critical role in exploding whatever inherent risk you have. It’s the same with obesity and our toxic food environment. It’s like the firearm analogy: Genes may load the gun, but diet pulls the trigger. We can try to switch the safety back on with smoking cessation and a healthier diet.

What happened when two dozen study participants were given the same number of excess calories? They all gained weight, but some gained more than others. Overfeeding the same 1,000 calories a day, 6 days a week for 100 days, caused weight gains ranging from about 9 pounds up to 29 pounds. The same 84,000 extra calories caused different amounts of weight gain. Some people are just more genetically susceptible. The reason we suspect genetics is that the 24 people in the study were 12 sets of identical twins, and the variation in weight gain between each of them was about a third less. As you can see in the graph below and at 4:41 in my video, a similar study with weight loss from exercise found a similar result. So, yes, genetics play a role, but that just means some people have to work harder than others. Ideally, inheriting a predisposition for extra weight gain shouldn’t give a reason for resignation, but rather motivation to put in the extra effort to unseal your fate.

Advances in processing and packaging, combined with government policies and food subsidy handouts that fostered cheap inputs for the “food industrial complex,” led to a glut of ready-to-eat, ready-to-heat, ready-to-drink hyperpalatable, hyperprofitable products. To help assuage impatient investors, marketing became even more pervasive and persuasive. All these factors conspired to create unfettered access to copious, convenient, low-cost, high-calorie foods often willfully engineered with chemical additives to make them hyperstimulatingly sweet or savory, yet only weakly satiating.

As we all sink deeper into a quicksand of calories, more and more mental energy is required to swim upstream against the constant “bombardment of advertising” and 24/7 panopticons of tempting treats. There’s so much food flooding the market now that much of it ends up in the trash. Food waste has progressively increased by about 50 percent since the 1970s. Perhaps better in the landfills, though, than filling up our stomachs. Too many of these cheap, fattening foods prioritize shelf life over human life.

But dead people don’t eat. Don’t food companies have a vested interest in keeping their consumers healthy? Such naiveté reveals a fundamental misunderstanding of the system. A public company’s primary responsibility is to reap returns for its investors. “How else could we have tobacco companies, who are consummate marketers, continuing to produce products that kill one in two of their most loyal customers?” It’s not about customer satisfaction, but shareholder satisfaction. The customer always comes second.

Just as weight gain may be a perfectly natural reaction to an obesogenic food environment, governments and businesses are simply responding normally to the political and economic realities of our system. Can you think of a single major industry that would benefit from people eating more healthfully? “Certainly not the agriculture, food product, grocery, restaurant, diet, or drug industries,” wrote emeritus professor Marion Nestle in a Science editorial when she was chair of nutrition at New York University. “All flourish when people eat more, and all employ armies of lobbyists to discourage governments from doing anything to inhibit overeating.”

If part of the problem is cheap tasty convenience, is hard-to-find food that’s gross and expensive the solution? Or might there be a way to get the best of all worlds—easy, healthy, delicious, satisfying meals that help you lose weight? That’s the central question of my book How Not to Diet. Check it out for free at your local library.

This is it—the final video in this 11-part series. If you missed any of the others, see the related posts below.

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September 16, 2024
Your food allergy questions answered
Join us for a fascinating Q&A with food allergy expert Sherry Coleman Collins, MS, RDN, LD– a follow-up to our popular webinar, “Advancing food allergy care: The latest innovations and insights.” Find out more about the unique way food allergies impact adults, the transient nature of food allergies, and why we even bother with skin and blood testing when the false positive rate is so high.

Hosted by Kristin Houts

Biography

Sherry Coleman Collins, MS, RDN, LD, is a Marietta, GA-based Registered Dietitian Nutritionist with more than 15 years of experience in food allergies, pediatric nutrition, school food service and nutrition communications. She is a nutrition educator, speaker and writer, and serves as an expert to the media. Sherry spearheaded the development of the Academy of Nutrition and Dietetics’ Certificate of Training in Food Allergies, authored the Academy’s Practice Paper on the Role of the RDN in Food Allergy Diagnosis and Management, and has completed the FARE Pediatric Food Allergy Certificate of Training. She’s a fellow with the Academy of Nutrition and Dietetics Foundation.
In this episode, we discuss:

Sherry’s framework for thinking about food allergy prevention, diagnosis, and management

The ins and outs of the oral challenge

How the gut microbiome may play a role in food allergies

The dietitian’s opportunity to provide positive education and support for patients
Additional resources

In case you missed it, you can watch Sherry’s webinar “Advancing food allergy care: The latest innovations and insights” here.

The content, products and/or services referred to in this podcast are intended for Health Care Professionals only and are not, and are not intended to be, medical advice, which should be tailored to your individual circumstances. The content is for your information only, and we advise that you exercise your own judgement before deciding to use the information provided. Professional medical advice should be obtained before taking action. The reference to particular products and/or services in this episode does not constitute any form of endorsement. Please see  here  for terms and conditions.
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September 15, 2024