Why Heart Healthy Eating isn't as Bad as You Think

February is Heart Month! 
If you're thinking this has something to do with chocolates or roses, think again! This national campaign has been going strong for more than half a century. The goal is to raise awareness (and donations) for the Heart and Stroke Foundation and highlight the risks of heart disease and stroke. 
Coming from a nutrition background, we used to talk about avoiding eggs and cutting down on fat to help reduce risk for heart disease. Oh, how the times have changed. The most recent recommendations released are the Dietary Guideline for Americans by the USA Government. Interestingly, these guidelines did not mention cutting out dietary cholesterol- the cholesterol that is found in food. It has been long known that eating less cholesterol does very little to actually lower cholesterol levels in our blood. This de-emphasis on dietary cholesterol is great news since it allows us to focus on food related changes that will be more effective in actually lowering cholesterol levels in our blood. 


The US guidelines, along with the 2012 Update of the Canadian Cardiovascular Society Guidelines for the Diagnosis and Treatment of Dyslipidemia for the Prevention of Cardiovascular Disease in the Adult suggest many of the things you'd expect: Eat a variety of vegetables (dark leafy green, red, orange), whole fruits, grain products (half of all grains should be whole grains), low fat dairy (such as milk, yogurt, cheese and fortified soy beverage) and protein rich foods (like seafood, lean meats, poultry, eggs, legumes, nuts and seeds and soy products). As well as recommendations to avoid too much added sugars, saturated fats, and sodium.

I have to admit, I hate talking about what not to eat. Not only is it boring, but it perpetuates the myth that dietitians take away food choices. Believing that there are foods you have to avoid completely to be healthy is a myth and doesn't give us perspective on all the things that should be enjoyed for a healthy body and mind.

If you are trying to lower your cholesterol levels, here are some interesting nutrients you'll want to consider including more often. Please note that these nutrients are more effective when blood levels of bad cholesterol and triglycerides are high (rather than normal): 

1. Plant sterols or phytosterols

-consuming 1-2 g per day of phytosterols can lower LDL cholesterol (the "bad cholesterol) by 5-8%.
-example*: some foods naturally contain plant sterols but in quantities that are too low to make an impact on blood cholesterol levels, so we have to look to fortified products. Practically all products fortified with plant sterol contain about 1g per serving. Choose 2 servings from this list and you'll get ~2g: 2 tsp /10ml plant sterol fortified margarine (example), 100g / 100ml plant sterol fortified yogurt, 1 plant sterol fortified drinkable yogurt, 1 cup plant sterol fortified juice (example).

2. Soy protein

-consuming 25g of soy protein per day can lower LDL cholesterol by 3-5%.
-example: 1/4 cup/1oz soynuts (12g) + 2/3 cup /3oz) edamame (6g) + 1 cup/8oz plain soymilk (~7g). 

3. High viscous fibres - or what we used to call soluble fibre

-consuming 10g of psyllium (a type of solutble fibre) per day can lowered LDL choelsterol by 7% if you have high cholesterol.
-example: 1 tbsp/15ml metamucil (3.5g) + 1/4 cup/1oz roasted soy nuts (3.5g) + 1 med orange (~2g) + 1 cup/250ml cooked broccoli (~3g).

4. Omega 3s

-consuming 2-4 g per day of EPA and DHA, under a physician’s care, can lower triglycerides levels by 25-30% if they are very high. 
-example: 75g / 2.5oz salmon (~1.5g) + 2 egg serving of omega plus liquid eggs (0.5g) + 75g/2.5oz canned sardines (1g).

5. Nuts 
-consuming 30-67g per day can reduce LDL cholesterol by up to 7% and triglycerides by 10%.
-example, 1/4 cup/60ml usually equals about 35g of nuts, regardless of the type of nut. 

*unfortunately, it was extremely difficult to find information on example products via the internet. The best bet is to read the package of the food that is fortified with plant sterols/phytosterols. Any food claiming to contain plant sterols must include the amount found in one serving. 

KEEP IN MIND: eating a diet that includes these cholesterol lowering nutrients may help you lower your cholesterol levels better than JUST eating a diet low in saturated fat (13.8% versus 3%). 

This handy graphic outlines all you need to know about the powerful nutrients you should include in your diet to help lower high cholesterol:

Mindful Eating Series with The Grounded Therapist (#1)

This time of year you can't glance at any social media feed without being bombarded with (bad) advice on how to lose weight/be healthy/shape up. There IS an alternative to all that diet & clean eating crazy speak: Mindful Eating. I understand that it can be a hard to understand concept- so I have embarked on a project to help you understand what it is and how it can help you and (perhaps more importantly) how you can start practicing it today. This is a collaboration between myself and The Grounded Therapist. 

I met Rachel Dougherty, The Grounded Therapist, through a bloggers group. Since I write & talk a lot about the psychology behind eating, I am always eager to collaborate (and learn from) psychologists who are experts in mindfulness. After some exciting exchanges, we decided to collaborate on a Mindful Eating series! 

Here is what Rachel had to say about Mindful Eating: 

"This is the time of year when people try to make healthy goals for themselves. Diets and weight loss tricks are everywhere. It’s unavoidable. However, there are few real sustainable plans out there. Since we know most diets fail, what can you do if you want to lose weight, be more healthy or set a new fitness/wellness goal? What about starting to eat more mindfully? I know mindful eating is something I consider each new year after eating way too many cookies and cake. My birthday is on thanksgiving. It’s just cake and sweets from November to January 2nd. When you eat well and get some exercise you body and mind feel great. You will have more energy which means you will do good work, be able to accomplish more goals which make you want to continue to eat better. It’s an amazing cycle which I still manage to derail at times. I ... consider mindful eating a self care priority. "

Without further ado, here is our first post:

You’ve probably heard that mindful eating can help you manage your weight, reduce any disordered eating and help repair your relationship with food. Understanding what mindful eating is and how to practice it is the challenging part. This is mainly because it requires inner reflection, paying attention and lots of practice.

Being a mindful eater means much more than just eating when you are hungry and stopping when you are full. Most people have heard the advice to “stop when you are full” and roll their eyes because, let’s be honest, you’ve probably tried it, and without the proper support, it may not have worked for you. For a greater chance of actually stopping when you are full, there are many things to practice and that is what this series is all about! In fact, the goal for many people is to use mindful eating as a way to reduce emotional and mindless eating. This means practicing being able to recognize when you are full, estimating how much food you need, letting go of judgement about your body & food and learning to trust your instincts.

Going beyond the “eat when hungry and stop when full”, mindful eating includes noticing the colors, smells, flavors, and textures of your food; eating more slowly; getting rid of distractions like TV or reading; hearing hunger and fullness cues and learning to eliminate guilt and anxiety about food. Noticing these things means deliberately paying attention and being fully aware of what is happening both inside and outside yourself.

Inside yourself includes what is going through your mind such as any emotions or thoughts you may be having- "I am stressed" or "I feel fat". Mindfulness includes paying attention to the experience in our body. Where in the body do we feel hunger? (in the head or in the stomach?) What does half-full feel like, or three quarters full?

Outside yourself means your surroundings:

• Where are you physically?
• sitting or standing? 
• at your desk with emails coming in every 2 minutes? 
• or alone in the kitchen with everyone gone to bed?

• Who are you with? 
• Compassionate people who make you feel confident?
• Or people who judge your eating and weight. 

The idea is to eventually learn in what way these thoughts, emotions and environment affects what, how and how much we eat. But, before we get ahead of ourselves, lets stick to practicing observing.

Eating mindfully can sound a bit abstract and practicing concrete activities to increase mindfulness can help you get started. To start becoming more mindful of when, how and what you eat as well as what influences you to eat, there are hands on exercises you can practice. Let’s start with this exercise:

Before eating, take a minute to observe your environment (outside your body) and your thoughts, emotions and how you physically feel (inside your body):

• are you stressed? Anxious? Happy? Sad? Tired?

• at the table and discussing stressful news? Standing up at the counter? Sitting in front of the tv?

• are you at your desk? In a stressful meeting? Rushing around in the car and feel you have no time to eat?

The goal is only to observe. Take notice. Pay attention more to your surrounding and your body and mind. This is invaluable for later, when trying to find patterns or barriers to eating mindfully. 

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Superfoods Swap

Wording carries a lot of weight!

Have you ever found yourself wanting something you can't have- seemingly only because you can't have it? Have you ever found yourself eating more food than you wanted after being denied it - maybe because you wanted to take back control over your own decisions? If so, then you are not alone.

People want to see themselves as being in charge of their own decisions and behavior. Threats to their freedom of choice can motivate them to restore their sense of freedom and self-determination by acting against the rule as soon as possible. This is why having a coach or spouse be the food rule enforcer can lead to eating in secret. This may seem innocuous or silly to some, but for the person who is secretly rebelling it can be quite a guilt trip and feel shameful.

This is a phenomenon called "psychological reactance"- reacting to a rule (that infringes on your freedom of choice) by breaking the rule to feel back in control of making decisions. One obvious problem with this phenomenon is that setting restrictions or rules can backfire and actually increase the unhealthy habit. So what are health professionals and campaigns to do when advocating for healthy lifestyle changes!?

Due to reactance, dietitians and other health professionals have had to change their tone and way in which they give advice in order to connect with clients and better meet their needs. Long gone are the days when clients needed information on the topic at hand and many of them are coming to sessions having already researched what they want to know. Our role had morphed into more of a facilitator or coach to help keep the client motivated to make the changes they want to make. Recent research suggests that this more "gentle" approach is not only what the client may want but what they need to make changes.

The reactance phenomenon was recently studied and you can read the article here. The researchers looked at the difference between making eating-related rules as suggestions versus restrictions.
So, for example, stating 'you should not eat unhealthy food' versus stating 'it is best not to eat unhealthy food, but ultimately the decision is up to you'. See the graphic to the left for more examples.

Results of this study indicate that "ironically enough, a restrictive rule may actually increase intake of food in situations where the rule is no longer in place or cannot be enforced". The explanation they gave was that a restrictive rule evoked psychological reactance and participants ate more of the unhealthy food once the rule was no longer enforced.

They also examined if both ways of giving advice are effective in discouraging unhealthy behavior. Some professionals believe that a more flexible and gentle approach won't push the client enough to make changes and follow rules. This study showed that both kinds of statements were equally able to discourage the unhealthy behavior. Therefore a suggested, more gentle rule does not minimize the problem behavior and may ultimately be a more practical alternative to a restrictive rule.

A great summary was written by the researchers: "a suggested rule still discourages consumption of a certain food, but it leaves the ultimate decision about eating the food up to the individual".

SO next time you feel yourself rebelling against a rule- you may be catching yourself in the act of psychological reactance. Take a step backwards and try rephrasing the advice you were given to be more of a suggestion than a rule.

Stop emotional eating (for your sake and your children's)

The more I speak with people about dieting or weight loss, the more I realize that emotional eating plays a huge role. In my defense, I am not the instigator of this topic (and have a hard time talking about it with people outside of the consult room) but it does sometimes feel like an inevitable topic, especially with strangers.

There's the tired cliché about women who are sad, reaching for chocolates to sooth but emotional eating goes much more deep than this. Eating to spite someone (or go against their "helpful" diet advice), eating due to happiness or celebration and eating due to loneliness are all examples.

Stress is perhaps the biggest culprit. Stress from work, home or social life has been a huge influence for many of my clients. It's not always obvious to them but most evening snacking sessions can be due to stress from the day. Making time to reduce stress and have a few moments to breath during the day can help reduce relying on food's ability to calm you down at night. Things like "I deserve this snack because I worked so hard all day" or "because I skipped lunch" or "taxied everyone around this evening" are not uncommon reasons we give ourselves to eat when we are not hungry. It is important to eat foods you love, to eat when you are hungry and to sometimes eat for pleasure rather than necessity. However, eating to reduce stress is a vicious circle, Especially if you are doing it on a regular basis. Most people who are not mindful eaters tend to increase feelings of guilt and anxiety, rather than feel comforted, when eating comfort foods.


Focusing on eating when you are hungry and asking yourself "why do I want to eat" before reaching for food when you are not, is just one way to start being more aware of emotional eating. Of course, the biggest issue with emotionally driven eating is possible weight gain and not being hungry at meals.


Another reason for reducing emotional eating was recently highlighted in a study involving children and parents. It found that offering food to children to soothe their "negative emotions (i.e. sadness, anxiety, etc) was the number one thing parents can do to encourage emotional eating by the child. Unfortunately, the impact of the parents doesn't stop there. The study also suggested that the parent's "emotional feeding practices" (i.e. emotional eating) can influence their children's emotional eating. So it is suggested that there are two ways to reduce emotional eating in children- stop using food to ease their negative emotions (i.e. ice cream to ease sadness or to cheer up the child) and take a look at (and stop) the parent's own emotional eating.

You can read more about this study (Associations between child emotional eating and general parenting style, feeding practices, and parent psychopathology) here.

Are my eating habits normal? Use this tool to know when to reach out for help

There are a few ways to screen for an eating disorder. One short and easy questionnaire is called the SCOFF. SCOFF is an acronym that is used to help people & professionals remember the specific questions. It is touted as being simple, memorable, easy to apply and score. It is designed to raise suspicion of the presence of disordered eating rather than to diagnose. It is mostly used by health professionals but since it is easy to understand, it can be used by anyone. 

The SCOFF questions

Do you make yourself Sick because you feel uncomfortably full?
Do you worry you have lost Control over how much you eat?
Have you recently lost more than One stone in a 3 month period? (or about 6kg or 15lbs)
Do you believe yourself to be Fat when others say you are too thin?
Would you say that Food dominates your life?

To score the questionnaire, give one point for every “yes”. A score of 2 or more indicates that there are symptoms present similar to those in anorexia nervosa or bulimia. In other words, if you (or who ever took the test) scored 2 or higher, you may need help in re-establishing a healthy relationship with food and your body. 

There are other more in-depth questionnaires for helping to determine whether you have symptoms commonly associated with an eating disorder. One very popular one is called the Eating Attitudes Test-26 (or the EAT-26). You can take the test anonymously here.

Thinking that your disordered eating is not "bad enough" to seek help or the idea that you aren't sick enough to merit the help of a professional is one of the main reasons people suffer from eating disorders. Getting help sooner rather than later helps to speed recovery and lift the burden off your shoulders. 

So called "healthy" habits

Nothing gets my goat like pseudo nutrition advice - and unfortunately the most damage is caused by people who are believed to be "experts" with no actual knowledge. Case in point: bodybuilding and workout "gurus".

In the past, I have been involved in the "workout" or "bodybuilding" world. I have since decided to focus on other domains of nutrition partly because somethings just never sat right for me with this area of "nutrition". 

Firstly, there is not much of an opening for dietitians. Too many trainers take over the role of dietitians, psychologist and even doctors. Unfortunately, they do not have actual knowledge to back up their advice. And no, anecdotal or single case studies do not count as science based facts. Because dietitians believe in balanced meals, the consumption of all 3 macronutrients and that all foods can fit into a healthy diet- we are less dazzling. We are less "interesting" than people who taut amazing, too good to be true, miracle, quick results and this is because dietitians are regulated by an Order that helps to ensure that we are qualified to give nutrition advice and that our knowledge is based on science. 

Secondly, for people who claim to love their bodies and want to be super healthy, its a mystery to me why they rely on so many powders (i.e. protein powders and so called "vegetable" greens), processed foods (meal replacement bars, protein bars, fibre bars), and unnatural "natural" supplements (garlic capsules and plant enzymes). Of course, not all weightlifters or bodybuilders use these products but many do and many more are being encouraged/pressured everyday. The money spent on these products is unbelievable. The worst part is, they are not regulated and often come with a bunch of untested health claims. It's beyond my comprehension why dietitian's suggestions to eat high fibre foods, add real garlic and food fats to recipes and to include lean protein rich foods daily is not taken more often. I can tell you that a glass of chocolate milk tastes better and is much cheaper than a protein powder drink.

Lastly, the lack of variety of the types of foods eaten continues to astonish me. Every book or diet warns of a different "bad" food and promises the superpowers of a different food. None of the diets admit to how crazy their recommendations really are and they all apparently have "proof" of how and why they "work". I compare this lack of insight to someone who believes in fairies finding the idea that Santa Claus exists ridiculous. In other words, with these diets you are merely trading one food myth/misconception for another. From a dietitians point of view, a healthy diet includes a variety of food from all the food groups. Boiled chicken, eggs, sweet potatoes and oatmeal are only a few of the many healthy choices. Anything otherwise is just untrue.