The Hidden Benefits of Full Fat Dairy by Katie Grubiak, RD

Galbani Whole Milk Mozzarella Cheese
full fat dairy
Galbani Whole Milk Ricotta Cheese
Greek Gods’ Greek Yogurt

History of the Low-Fat Movement

Since the 1980s, physicians, the federal government, the food industry, and popular media have championed the low-fat approach to dieting and weight control. The idea stemmed from a few studies published in the 1940s, which showed a correlation between high-fat diets and high-cholesterol levels. Because high-cholesterol levels were known to be a major risk factor for heart disease, low-fat diets were highly recommended as a preventive measure for at-risk individuals, and eventually for the entire nation. This advice became so widespread by the 1980s that reduced-fat and low-fat options dominated the diet-related product market.

The Argument for Low-Fat Dairy

Although this national preoccupation with low-fat products has waned since the 1990s, low-fat dairy products have sustained their popularity. Low-fat dairy products are lower in calories and saturated fat than their full-fat counterparts, while still boasting substantial amounts of protein and calcium. To experts worried about slowing the impending “obesity epidemic”, low-fat dairy at first seems an obvious choice – especially if choosing low-fat products can help prevent heart disease.

The Issue with the Low-Fat Dairy Argument

There’s just one problem with this logic – according to a review article recently published in the European Journal of Nutrition, there is no conclusive evidence to suggest that full-fat dairy consumption is associated with increased risk of obesity, heart disease, or diabetes. In fact, in 11 of the 16 studies reviewed, high-fat dairy intake was inversely associated with obesity risk. In a 12-year longitudinal study conducted in Sweden, researchers Dr. Sara Holmberg and Dr. Andres Thelin found that men who reported a low intake of dairy fat (skim milk, no butter, etc.) had a higher risk of developing obesity in the 12-year period than were men who reported a high intake of dairy fat.

Why Whole Dairy?

Much of this research may come as a surprise to those familiar with the calories-in, calories-out model of weight maintenance. How could eating dairy products that are significantly higher in calories help people avoid weight gain?

Researchers aren’t certain why full-fat dairy may aid in healthy weight maintenance, but there are a few ideas gaining traction in the field: 

  • Fullness 
    • To produce low-fat dairy products, “excess milk fat” is separated out of whole dairy. Much of this “excess milk fat” is made up of fatty acids found in milk, which are thought to make people feel full sooner and stay full longer. Thus, low-fat dairy products simply don’t keep you as full as whole dairy products do.
    • The fatty acids in whole milk also make whole dairy products richer, thicker, and more satisfying, which can add to the experience of fullness, and keep you full for longer.
  • Role in Gene Expression & Hormone Regulation.
    • The fatty acids found in whole milk may be involved with gene expression and hormone regulation in the body. Though these relationships are unclear, it is possible that fatty acids speed up metabolism or limit the body’s storage of fat.
  • Real Food, Not Just Nutrients.
    • Though macronutrient content can tell us a lot about the health benefits of food, whole fat dairy is more than just the sum of its (major) parts. Real food is a complex mix of macro (fat, carbohydrates, protein) and micro (vitamins and minerals) nutrients. Absorption of all of these macro and micronutrients is dependent upon several factors, so altering the macronutrient breakdown of dairy products (by removing fat) changes the way these products are metabolized by the body.For instance, Vitamins A, D, E, and K are fat soluble nutrients, which means that absorption of these nutrients is compromised when no fat is present.

When I have helped my clients with eating disorders to add full fat diary products back into their diet after a period of having avoided them, positive changes take place.  They often notice a decrease in food obsession and a reduction in volume of intake. Although most clients fear overeating whole full fat (and higher calorie) products, this does NOT happen. Instead, portion control often occurs more naturally since satiety comes from the taste, texture, & actual full fat macronutrient presence.  Clients recognize that they CAN feel in control but still go to their favorite real full fat foods which they previously feared and avoided. In reality, the low fat foods were the ones that they could not limit.   I have only seen satiety benefits as well as metabolic benefits of a diet higher in fat, 30-35% of total calories. To try it for yourself, I suggest:

Some recipes incorporating whole fats

  • *Maple Hill Creamery 100% Grass-Fed Organic Milk Creamline Yogurt-Lemon flavored with granola & banana for breakfast
  • *The Greek Gods Greek Yogurt-Honey Strawberry flavored with cut up pear for a snack
  • *Toasted Caprese Open Faced Sandwich-
    • French Sandwich Roll-cut in half
    • Expeller Pressed Extra Virgin Olive Oil
    • Fresh Basil Leaves
    • Heirloom Tomatoes Sliced
    • Galbani Fresh Whole Milk Mozzarella or Galbani Whole Milk Low-Moisture Mozzarella Cheese

    • Pink Himalayan Salt

  1. Drizzle the olive oil over each half of the sliced French roll
  2. Place sliced Whole Milk Mozzarella Cheese over the French roll with olive oil
  3. Lay Basil Leaves on top of the Mozzarella
  4. Lay sliced Heirloom Tomatoes over the Basil
  5. Grind & sprinkle Pink Himalayan Salt over the Tomatoes
  6. Opened faced-Toast in toaster oven for 3-5 minutes or heat in oven 350 degrees F for 5-8 minutes

Sources:

  • The full article from European Journal of Nutrition can be found here.
  • The full article from the Scandinavian Journal of Primary Health Care can be found here.
  • For a through and clear explanation of this topic, refer to this TIME Magazine article.
  • An additional study in the American Journal of Clinical Nutrition can be found here and is summarized here.
  • Another article is here.

Research Assistant, Erin Standen contributed to the writing and research of this post.

Eating Disorders in the Orthodox Jewish Community

eating disorders in the Orthodox Jewish communityHaving worked with several Orthodox clients and also having participated in a Chabad Orthodox congregation when my family lived in Shanghai, I was excited to join in on the Academy for Eating Disorders’ Tweetchat on Eating Disorders in the Orthodox Community last month. The chat was informative and the full transcript of the chat is available here. A summary of some of the information covered in the chat as well as from a review of other sources follows.  In addition, I received some feedback from Devorah Levinson of Relief Resources (a non-profit serving the Jewish community), which I’ve incorporated.

Eating disorders do not discriminate. They affect people of all genders, ages, races, ethnicities, body shapes and weights, sexual orientations, and socioeconomic statuses. As such, they are found in the Orthodox Jewish community as well as every other religious community.

Eating disorders are caused by a combination of genetic and environmental factors. Among the environmental factors implicated in the development of eating disorders among Orthodox females is a pressure among young Orthodox women to be thin. Some believe this pressure stems from the culture surrounding dating and matchmaking in the Orthodox community. For women of marrying age (frequently around 18 or 19 years old), thinness is greatly preferred, so women feel pressured to be thin in order to be matched with a desirable husband.  However, Devorah Levinson of Relief Resources wrote this in a response to my initial post: “Unfortunately I am not a big believer in the orthodox dating process being a cause or large contributor to the development of eating disorders. The dating process or variations of it have been in place for hundreds of years. The only thing that has changed is the beauty ideal. A beautiful wife has always been an important item on ‘the checklist.’ What’s important for us to note is that our vision of beauty has changed. Years ago in the Orthodox world it was actually the heavier woman that was sought after because she exuded health and financial stability. Just like how Marylyn Monroe was the ideal woman with her curvaceous figure and now would be considered overweight – it is the media and secular society that is so strong it has managed to change even the most insular communities’ visions of beauty. So I disagree with that being a large factor. I actually think the internet and easier access to outside media within our community has brought the thin ideal so close to home.”

Stigma surrounding eating disorders is pervasive in the Orthodox Jewish community, which can make getting help very difficult for individuals and their families. Moreover, in the case of the ultra-orthodox, the social disgrace surrounding an eating disorder could harm a woman’s prospects of marriage. Still, guest @JudyKrasna explained that Jewish law values health and life above all else, so despite the stigma that exists in the community, individuals are not prevented from getting treatment for religious reasons.  Devorah wrote, “stigma is a big challenge and it was one of the main reasons Relief was established. We wanted to be able to help our community access appropriate care for all mental health issues.”

The cultural significance of food and fasting in the Orthodox Jewish community is also important to consider. Dietary laws for Orthodox Jews require that they keep to a kosher diet, which can limit food options for individuals in treatment. Moreover, certain celebrations and holy days involve fasting and/or feasting, which can be additional obstacles for those struggling with eating disorders.

Eating disorders are the same across races and religions. Therefore, members of the Orthodox community do not necessarily need to use Orthodox providers for treatment. Instead, members of the Orthodox Jewish community should seek the best treatment options available. When selecting a residential treatment center, however, it is important to consider a provider’s availability of kosher options. When faced with a lack of residential centers that provide kosher options, Family Based Treatment (FBT) may be an effective treatment strategy.

Devorah adds, “Regarding kosher food, I have tried very hard to encourage parents to not let that be a stumbling block or deciding factor in making a treatment decision. I try and help families find the best and most effective treatment facilities and then we work out the kosher food situation. Most facilities will accommodate to some extent. After that, because of the medical issues involved many Rabbis understand the severity of the situation and will give families dispensations to not be as meticulous with their observance of these laws for the time the patient is in the program. In general I have unfortunately not seen success with programs that were either created for Orthodox patients or even had an ‘orthodox track’.  My goal has always been to find the most effective evidence based treatment and then promote cultural sensitivity amongst the clinicians. I have traveled to several facilities and have always been welcomed with warmth and openness.”

For providers working with members of the Orthodox Jewish community, cultural competency is key. To build this competency, treatment centers and providers should familiarize themselves with available resources (see below), and should also ask patients directly about how to better address their specific needs. In addition, treatment centers should work to provide kosher options for Orthodox individuals. Even with these improved treatment options, the issue of stigma within the Orthodox Jewish community remains an obstacle. For this reason, it is especially important that we reach out to others outside the eating disorder field, especially rabbis and educators, to raise attention to the problem, and ultimately, to reduce the stigma surrounding eating disorders in the community.

Resources:

  • Relief Resources is a non-profit organization that provides services for individuals who suffer from mental health disorders and caters to the needs of the Jewish community.
    • Relief Resources also has an Eating Disorder Hotline at (718)-431-9501 ext. 103.
    • Devorah Levinson, the referral specialist and Director of the Eating Disorder Division at Relief Resources, wrote this article for the parents of Jewish Orthodox Children with eating disorders.
  • Suggestions for kosher dietary recovery is available in this article.
  • To learn more about eating disorders in Orthodox Jewish communities, thorough articles are available from NEDA Psychology Today The Jerusalem Post, Gurze-Salucore, and The New York Times.
  • Eating Disorders Recovery Today and TreatingEatingDisorders.com offer extensive background information about some of the vulnerabilities to eating disorders that exist in Orthodox Jewish communities.
  • Orthodox Union recently released a short documentary, “Hungry to be Heard” covering the topic, which can be found at their website and it was designed to be presented to parents in schools and synagogues to raise awareness. 
  • Temimah Zucker, a blogger for The Times of Israel, is a survivor of Anorexia and runs support groups geared towards the Jewish community. Her blogs cover a variety of topics related to Judaism and eating disorders, which can be found here.
  • The Renfrew Center offers specialized programs and groups for observant Jewish individuals, and their residential programs offer kosher options for all meals.

Research Assistant, Erin Standen contributed to the preparation of this post.

July LACPA Eating Disorder SIG Meeting

I am so excited to confirm the next speaker for the Eating Disorder SIG who will be joining us from Washington, DC.

Wednesday, July 22 at 7:15 pm  headshot from Lobby Day Kathleen

Presenter:  Kathleen MacDonald

Title:   Advocacy and the Eating Disorder World:  Why Clinicians Matter

Location:  The office of Dr. Lauren Muhlheim (4929 Wilshire Boulevard, Suite 245, Los Angeles) – free parking in the lot (enter on Highland)

Description:  Capitol Hill, Advocacy and Eating Disorders –what possible connection do all three of these things have and why should you care about how they intersect?  Together we’ll discuss the answer to this question and discover how clinicians have a major role to play in eating disorder advocacy.  You will learn concrete ways to advocate for eating disorder legislation –ways that will not take up too much of your precious time, but ways that WILL make a difference.  You will also learn how to empower your clients, when they’re ready, to advocate for eating disorder legislation –a process that can be cathartic, empowering and life-changing.  And perhaps most of all, you will learn how one voice can make a difference on Capitol Hill –how the impact of one voice has the capacity to send ripples out beyond the halls of Congress, and into the lives of millions who suffer the insidious diseases we call eating disorders.  

Bio:  Kathleen MacDonald is Director of Social Media & Advocate Relations for the Eating Disorders Coalition for Research, Policy & Action (“EDC”) and a Health Insurance Advocate at Kantor & Kantor, LLP.   She believes that eating disorders education, along with early intervention and identification of symptoms and behaviors that can lead to the development of eating disorders is central helping to prevent people from suffering these deadliest of all mental illnesses.  Some of Kathleen’s professional experience includes: Patient Advocate for those impacted by eating disorders; FREED Foundation College Speaking Tour; assisting in the EDC’s creation and drafting of the Anna Westin Act of 2015 and the FREED Act (the Federal Response to Eliminate Eating Disorders Act), the first comprehensive bill in the history of Congress to address eating disorders research, education, prevention, and treatment; and writing appeals against the denial of insurance benefits for eating disorder treatment.  Kathleen has been involved in eating disorder advocacy since 2002.  She currently lives in the Washington, DC., area with a few English Setters, a few cats and a loved one of the two-legged variety.

RSVP to:  drmuhlheim@gmail.com

SIG meetings are open to all LACPA members.  Nonmembers wishing to attend may join LACPA by visiting our website www.lapsych.org

This is a really unique opportunity to hear from someone who has worked on eating disorder policy.  New members can join LACPA in July and get 14 months of membership so encourage your nonmember friends to join now and take advantage of this amazing speaker!

FBT Insights from the Neonatal Kitten Nursery

Parents feed children in FBT Kitten CollageI recently began volunteering at the Best Friends Neonatal Kitten Nursery. Best Friends Los Angeles opened its neonatal kitten nursery in February 2013.  The nursery is staffed with a dedicated coordinator and supported by volunteers who sign up for two hour feeding shifts 24 hours a day to help the kittens grow and thrive.

If you were an abandoned kitten in the Los Angeles area, or even a kitten with a mother, you’d be lucky to make your way to the Best Friends Neonatal Kitten Nursery.

The most vulnerable animals in the Los Angeles shelters are newborn kittens, often abandoned at birth, or turned into shelters from accidental litters. Because the kittens cannot feed themselves, they will die without someone to bottle feed them.

In the mommy and me section of the nursery, mothers nurse their kittens. In the other sections, kittens are bottle-fed, tube-fed, or syringe-fed until they are able to eat gruel on their own. Kittens are weighed before and after each feeding. If their weights are not steadily going up, the interventions increase. They are very fragile at this age.

The other night, the nursery coordinator, Nicole, was tube-feeding some kittens who were ill. As she explained, they were feeling too sick to eat on their own. Although acknowledging that her tube feeding was making them angry, Nicole was resolute. No kitten would starve to death on her watch. Of course, I connected this back to my families working to re-feed their children with anorexia.

In the neonatal nursery, we don’t spend time thinking about why the kitten is not nursing or eating in the expected fashion. If they are sick, they are treated for that, but in the meantime, every kitten is fed around the clock and those who don’t have mothers are bottle fed, those who won’t nurse from their mothers (often when they are too congested) are tube-fed, and those who won’t eat gruel independently are syringe-fed.

How does this relate to parents doing Family Based Treatment (FBT) for Eating Disorders with children who have Anorexia?

Of course, parents do not literally force food down human children’s throats, but they do set up contingencies to require eating even if the child doesn’t feel well and even if they rail and resist and are angry about it.

This is the heart of FBT Phase 1. When children are not able to eat on their own (due to an eating disorder) parents are instructed to nourish their starving child back to health. Parents need to step in and help their children make steady weight gains until they are able to eat on their own. Parents need to be resolute and not worry about their children being angry at them. They also should not spend time exploring why their child is not eating.

For further information on parental direction over eating in FBT, check out this prior blog post.