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.

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!

Look before you leap: Binge Eating Disorder, Vyvanse, and evidence-based psychotherapies

Binge Eating Disorder, Vyvanse, and evidence-based psychotherapiesGuest post by Elisha M. Carcieri, Ph.D. 

Binge eating disorder (BED) has been making headlines with the recent announcement that the FDA has approved lisdexamfetamine dimesylate (Vyvanse) for the treatment of BED.

So, what is BED, how is it treated, and what does this new treatment option mean for sufferers?

What is Binge Eating Disorder

BED is a condition in which a person engages in recurrent episodes of binge eating at least once a week for three months1. Binge eating episodes typically involve eating rapidly until uncomfortably full, and eating when one is not necessarily hungry. Some individuals with BED report feeling unable to stop the episode, and describe themselves as being out of control during a binge. Binge eaters often binge alone and make efforts to hide their behavior from friends, partners, or family members. Episodes of binge eating often end in feelings of guilt, shame, and depressed mood. Unlike other eating disorders, such as bulimia nervosa, people with BED do not vomit or use other methods of compensation (such as excessive exercise or fasting) to shed calories or lose weight after a binge. It should be clear that this is a very different experience than, say, overeating on Thanksgiving, having a second piece of birthday cake, or eating foods that are outside of your normal pattern while on vacation.

Until 2013, BED was not a diagnosable eating disorder. It was instead grouped in with other unspecified eating disorders that didn’t quite meet criteria to be formally diagnosed. After much research, the most recent iteration of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), has included BED as a specific eating disorder distinct from other diagnoses.

Despite only recently being formally acknowledged, BED is the most commonly occurring eating disorder. Prevalence estimates vary, ranging from 1.6-3.5% of women, 0.8-2% of men, and 1.6% of adolescents.1, 2, 3 BED occurs as commonly among women from racial or ethnic minority groups as for white women, 1 and is often seen in people with severe obesity.1, 4 Up to 30% of people seeking bariatric surgery or other interventions for weight loss are suffering from BED5. While it is more common for women to meet all of the criteria for BED, men tend to engage in binge eating as frequently as women2. Like all eating disorders, the causes of BED are complex. There is evidence for genetic, biological, and environmental risk factors. BED is associated with significant chronic health problems. It is also common for individuals with BED to struggle with other mental health disorders at the same time, including depression, anxiety, and substance use disorders.

The good news is that there are established treatments that work for BED. Unfortunately, effective psychological interventions for eating disorders don’t get as much press as pharmaceuticals. Nevertheless, those suffering from BED should be aware of what is available.

Treatment for Binge Eating Disorder

Evidence-based psychological treatments are first-line considerations for the treatment of BED. A psychologist or other mental health professional qualified to treat eating disorders usually conducts psychological treatment for BED on an outpatient basis. Cognitive behavioral therapy (CBT) is the most well studied and established treatment for BED with demonstrated effectiveness.6 The treatment involves reducing episodes of binge eating using tools such as establishing regular eating patterns and self-monitoring of food intake and patterns of eating. CBT also addresses concerns about shape and weight, and examines and challenges patterns of thinking that may be keeping a person stuck in a pattern of binge eating. CBT for BED involves discussion and planning of how to maintain progress, and how to recognize and respond to relapse. Studies have demonstrated improvements lasting up to 12 months post-treatment with CBT.7 Interpersonal therapy (IPT) has also been proven effective for BED with strong research support.8 IPT involves more of a focus on interpersonal (relationship) difficulties with an understanding of how these problems may have precipitated BED, or how they might be keeping the BED going. Finally, there is evidence that dialectical behavior therapy (DBT), which focuses on mindfulness, emotion regulation, and distress tolerance, is effective at treating BED.9

Pharmacological Treatments for Binge Eating Disorder

In addition to psychological treatments, some antidepressants and anticonvulsants have proven helpful at reducing the frequency of binge eating in patients with BED.6 The newest and only medication specifically approved by the FDA for BED is Vyvanse, a central nervous system stimulant that has been approved to treat ADHD in children and adults since 2007. The approval for BED came after clinical trials demonstrated that the average number of binge eating days per week among sufferers were decreased in those who took Vyvanse, compared to those who took a placebo.10 Sounds promising…but there are other considerations to keep in mind…side effects, long-term use, and the question of whether a medication can address the complex nature of a serious eating disorder such as BED.

The potential side effects of Vyvanse include decreased appetite, dry mouth, increased heart rate or blood pressure, difficulty sleeping, anxiety, gastrointestinal problems, feeling jittery, and even sudden death among people with heart problems. The drug is also particularly risky for individuals with a history of seizures or mania. Vyvanse may cause psychotic or manic symptoms in people with no history of mental illness, and has a high potential for abuse, dependence, tolerance, and overdose.

Vyvanse appears to decrease symptoms over a short period of time (about three months) while taking the medication. However, it is unlikely that the medication will result in long-term changes in complex binge eating behavior once the drug is stopped, meaning that one might expect to take Vyvanse for the rest of their lives in order to keep BED at bay. This is problematic considering the chronic nature of BED, 2 and the fact that the negative emotion, distress, shame, and weight or shape concerns that are often related to BED would almost certainly remain unaddressed.

While there are no identified side effects to engaging in psychological treatment of BED, these treatments do take time (often around 20 weeks), and not every person will respond to an intervention the same way. It may take some trial and error to find the right therapist or treatment. However, psychological treatments are more equipped than medication alone to address the binge eating behavior itself, and the different ways binge eating relates to other areas of a person’s life and functioning. Rather than simply masking and reducing symptoms in the short term with a medication, completing a course of evidence-based therapy can provide the insight and tools needed for managing the patterns of disordered eating that are characteristic of BED for life. Many people with BED may benefit from trying a psychological approach before initiating treatment with a serious medication like Vyvanse.

Implications for Patients

All of these factors should be carefully considered when making a decision about treatment for BED. With all eating disorders including BED, it is important to get help sooner rather than later. For many people, turning to their primary care doctor is the first step. Patients should keep in mind that these conversations can be sensitive and difficult, and many providers may not be familiar with BED. Other providers may be familiar with the recent approval of a new drug, and will be eager to explore prescription medication options for treatment.

If you aren’t getting anywhere with your doctor, it is always appropriate to ask for a referral to a medical provider who is more familiar with eating disorders. Your doctor may also be able to provide you with a referral to a mental health provider, such as a psychologist, who can provide one of the therapies discussed above, and to a nutritionist or dietician who specializes in eating disorders for even more comprehensive support. Remember that it is important to seek help from professionals qualified to treat eating disorders, and treatment decisions should be tailored to the unique needs of each person.

If you do see a psychiatrist regarding any medication, we have some recommendations.

References

1. American Psychiatric Association. (2013). The Diagnostic and Statistical Manual of Mental Disorders: DSM 5. bookpointUS.

2. Hudson, J. I., Hiripi, E., Pope Jr, H. G., & Kessler, R. C. (2007). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological psychiatry, 61(3), 348-358.

3. Swanson, S. A., Crow, S. J., Le Grange, D., Swendsen, J., & Merikangas, K. R. (2011). Prevalence and correlates of eating disorders in adolescents: Results from the national comorbidity survey replication adolescent supplement. Archives of General Psychiatry, 68(7), 714-723.

4. Marcus, M. D., & Levine, M. D. (2005). Obese patients with binge-eating disorder. In The management of eating disorders and obesity (pp. 143-160). Humana Press.

5. Kalarchian, M. A., Marcus, M. D., Levine, M. D., Courcoulas, A. P., Pilkonis, P. A., Ringham, R. M., … & Rofey, D. L. (2007). Psychiatric disorders among bariatric surgery candidates: relationship to obesity and functional health status. The American journal of psychiatry, 164(2), 328-334.

6. Brownley, K. A., Berkman, N. D., Sedway, J. A., Lohr, K. N., & Bulik, C. M. (2007). Binge eating disorder treatment: a systematic review of randomized controlled trials. International Journal of Eating Disorders, 40(4), 337-348.

7. Wilson, G. T., Grilo, C. M., & Vitousek, K. M. (2007). Psychological treatment of eating disorders. American Psychologist, 62(3), 199.

8. Wilfley, D. E., Welch, R. R., Stein, R. I., Spurrell, E. B., Cohen, L. R., Saelens, B. E., … & Matt, G. E. (2002). A randomized comparison of group cognitive-behavioral therapy and group interpersonal psychotherapy for the treatment of overweight individuals with binge-eating disorder. Archives of general psychiatry, 59(8), 713-721.

9. Telch, C. F., Agras, W. S., & Linehan, M. M. (2001). Dialectical behavior therapy for binge eating disorder. Journal of consulting and clinical psychology, 69(6), 1061.

10. McElroy S. L., Hudson, J. I., Mitchell, J. E., et al. (2014) Efficacy and Safety of Lisdexamfetamine for Treatment of Adults With Moderate to Severe Binge-Eating Disorder: A Randomized Clinical Trial. JAMA Psychiatry.

Elisha Carcieri, Ph.D., is a licensed clinical psychologist (PSY #26716) practicing in the Los Angeles area. Dr. Carcieri earned her bachelors degree in psychology from The University of New Mexico and completed her doctoral degree in clinical psychology at Saint Louis University. During her graduate training, she conducted research focused on eating disorders and obesity, and was trained in using cognitive behavioral therapy (CBT) for eating disorders and other mental health disorders such as anxiety and depression. Dr. Carcieri completed her postdoctoral fellowship at the Long Beach VA Medical Center, where she worked with Veterans coping with mental illness, disability, significant acute or chronic health concerns, and chronic pain. In addition to cognitive behavioral strategies, she also incorporates alternative evidence-based approaches such as mindfulness, and acceptance and commitment-based strategies, depending on the needs of each client. Dr. Carcieri has experience working with culturally diverse clients representing various aspects of diversity including race/ethnicity, gender, age, disability, and size, and welcomes new clients from all backgrounds. She is a member of the American Psychological Association (APA), the Academy for Eating Disorders (AED), and the Los Angeles County Psychological Association (LACPA). 

LACPA Eating Disorder SIG upcoming events (Fall 2014)

I am excited to announce the next 3 upcoming meetings of the Los Angeles County Psychological Association Eating Disorder Special Interest Group (LACPA ED SIG).  We have amazing speakers lined up.  The LACPA membership year begins in September, so now is the time to join or renew to maximize your benefits.  SIG events are open only to LACPA members, but are FREE.  For information on membership, see the LACPA website. www.lapsych.org.  One does not need to be a psychologist to join LACPA; other professionals may join as well.

Dr. Stacey Rosenfeld
Dr. Stacey Rosenfeld

Date: Thursday, August 28th

Time: 7-8:30

Title: Does Every Woman Have an Eating Disorder? Challenging Our Nation’s Fixation with Food and Weight

Presenter: Stacey Rosenfeld, Ph.D.

Location: The office of Stacey Rosenfeld, PhD (2001 S. Barrington Avenue, Suite 114, Los Angeles)

BIO: Stacey Rosenfeld, PhD, is a clinical psychologist, licensed to practice in New York and California, who treats patients with eating disorders, anxiety/depression, substance use issues, and relationship difficulties. A certified group psychotherapist, she has worked at Columbia University Medical Center in NYC and at UCLA in Los Angeles and is a member of three eating disorder associations. The author of the highly-praised Does Every Woman Have an Eating Disorder? Challenging Our Nation’s Fixation with Food and Weight, inspired by her award-winning blog of the same name, she is often interviewed by media outlets as an expert in the field.

Dr. Rosenfeld is also the founder of the LACPA ED SIG but will be leaving the group in the fall due to relocation.  This will be a unique opportunity to hear her speak and also to acknowledge the contributions she has made to the Los Angeles community during her fruitful three years here.

Maggie Baumann, MFT, CEDS
Maggie Baumann, MFT, CEDS

Date: Tuesday, September 16th

Time: 7-8:30pm

Title: Pregnancy & Eating Disorders: Journey Through the Facts and Recovery

Presenter: Maggie Baumann, MFT, CEDS

Location: The office of Stacey Rosenfeld, PhD (2001 S. Barrington Avenue, Suite 114, Los Angeles)

Bio:  Maggie Baumann is a psychotherapist in Newport Beach who specializes in treating people struggling with eating disorders, including pregnant women and moms with eating disorders. She is a former board member for the Orange County Chapter of the International Association of Eating Disorder Professionals (IAEDP) and serves as a committee member on the national IAEDP certification board.

Maggie has been a featured guest on nationwide talk shows and TV segment profiling pregorexia and moms with eating disorders. She was a mental health blogger for Momlogic.com, where she shared her own story of suffering from pregorexia over twenty-five years ago. Additionally, Maggie serves as a guest eating disorder expert for KidsinTheHouse.com, a video parenting resource. She is also authoring a chapter on eating disorders and pregnancy for an upcoming book on Eating Disorders in Special Populations (publication date: 2015). Now, Maggie has partnered with Chicago-based residential treatment center, Timberline Knolls, in hosting their Lift the Shame eating disorder support group the first web-based support group for pregnant women and moms with eating disorders. Lift the Shame, is a free group and has members from across the US and abroad.

T-FFED
T-Ffed: Trans Folx Fighting Eating Disorders

Date:  Thursday, October 23

Time:  7- 8:30 pm

Title: TRANSforming Eating Disorder Recovery: Deconstructing the Overrepresentation of Eating Disorders in Trans and Gender Diverse Individuals, and How Healthcare Professionals Can Better Serve Our Communities

Presenter:  Dagan VanDemark

Location:  The office of Dr. Lauren Muhlheim (4929 Wilshire Boulevard, Suite 245, Los Angeles)

Bio:  Dagan VanDemark is the Founder and Executive Director of the pending non-profit T-FFED: Trans Folx Fighting Eating Disorders, based in LA but quickly gaining national reach. Dagan, a genderqueer trans boi, battled bulimia/EDNOS for fifteen years. They have a B.A. in Gender Studies from CSULB, a certificate in Grant Writing and Administration from CSUDH, and they are enrolled in both the Non-Profit Management certificate program at UCLA and a transgender leadership initiative through Gender Justice LA. They speak on university panels about gender variance and sexual diversity, and write/blog extensively about transgender communities’ experiences with eating disorders.

Please RSVP for any or all of the 3 events to drmuhlheim@gmail.com