Jonny gets Punked: Does Lindsay have an eating disorder?

Ever wonder how those tabloid articles exposing some star's latest plastic surgery or eating disorder get written?

Well, funny you should ask.

A writer working on the story calls up a plastic surgeon and shows him two pictures. The star a year ago and the star today. The most infamous of these was the Michael Douglas pics shown all over the tabloids a few months ago. Then the writer asks the plastic surgeon — who, by the way, has never treated the star — to comment on whether he thinks the star had surgery.

Most plastic surgeons love to get their name in the paper, particularly when framed by "Top Beverly Hills plastic surgeon (Insert Name Here) says...", so they venture a guess.

Thing is, if someone has a completely different nose or lips or has miraculously lost significant amount of wrinkles, it's a pretty easy guess.

Not so easy when it comes to bodyweight.

I, who love to see my name in the Enquirer as much as the next guy, have commented on both Oprah's lipo / non-lipo and one of the Olsen twins' eating disorder / non-eating disorder for the National Star.

So I know the drill well. It's a variation of the plastic surgery routine.

The writer calls up a nutritionist (for example, me) and shows them pics of a star at two distinctly different weights. Then they ask one of two stock questions: Do you think she had lipo? Or, do you think she has an eating disorder?

Problem is, unlike a new face, you really could get a new body the old fashioned way, without surgery or pathology.

So the truthful answer to the question ought to be: "I have no friggin idea."

If I — or any of the dozen other nutritionists/doctors/trainers they routinely go to to ask this question — were really honest this is what we'd say: Get a life. There's simply no way to tell what someone's private life is like from looking at a publicity pic. Ms. Celebrity d'Jour could have gotten her fat sucked out at Dr. Feelgood's on Robertson Blvd or they could have worked it off in the gym. You'll never know. And people with eating disorders are remarkably adept at hiding them, often even from loved ones. Sorry, cholly, but no can tell. It would be like me showing you a picture of someone having fun at the poker table in Vegas and asking you to comment on whether they have a gambling problem. They might, but you sure couldn't tell from looking at a snapshot.

But I'm a sucker for media, so when a new mag called last week and asked me if Lindsay Lohan had an eating disorder, I (sigh) said, "send the pics over."

They sent me a posed shot of a really nice looking, healthy looking freckled faced teenager in a black dress that obscured her body. I scanned her face and for the life of me she looked perfectly OK, if maybe a little "caught in the headlights" typical of any teenager these days. I told them that as far as I could tell, she looked fine.

Two days later, I saw the cover of two other tabloids — US and the Star — with pics of Lindsay and her pal Nicole Ritchie. Both looked like death warmed over. Now Nicole Ritchie is hardly a sympathetic case, being known around these parts the quintessential poster girl for obnoxious entitlement and self-absorption of the "Do you know who I am?" variety, but the poor thing looked like Diana Ross on crack. Lindsay didn't look much better. I haven't seen anyone in Hollywood look this sickly since Portia De Rossi was on Ally McBeal.

So now, some hot tabloid is going to come out next week with an article on Lindsay Lohan that quotes "Top LA nutritionist Jonny Bowden" as saying that Lindsay looks perfectly healthy at a weight of... what, 80 pounds? (I’m guessing.)

And you know what? I still don't know for a fact if Lindsay has an eating disorder. How in the world could I?

But I do know that there's something really screwed up about a system that tells a slightly plump teenager that she needs to look like an Auswich survivor in order to be attractive.

And something even weirder about a system that produces kids who actually believe that.

Good articles!

How many of us have heard a zillion times over that yo-yo dieting "screws up" your metabolism and makes weight gain easier? Worse, how many of us have used that excuse not to try to lose weight? While there might be many reasons that someone who alternates crazy starvation routines with out and out binging regains quickly (increased activation of lipoprotein lipase for example), overall there really is no evidence to back up the myth that a history of yo-yo dieting condemns you to a life of being overweight. Even if you have yo-yo dieted, you can still lose weight and keep it off permanently. You may have to do a bit of "metabolic healing" and "balancing"-- bringing hormones into balance and eating in a way that corrects high blood sugar and the tendency towards high levels of insulin (the fat storage hormone), but you can definitely do it. A new article in the New York Times today confirmed that the idea of yo-yo dieting permanently screwing up your metabolism is indeed a myth.

For years I've been saying that health, healing and losing weight aren't just about finding the "perfect diet" (information) or the "perfect drug" . They're about the whole person. In a really moving, terrific article today, Dr. Thomas Gross talks about the healing benefits of simple human interaction. In this case, the person's immune system got stronger and their sleep improved. It's a beautiful example of the healing powers of simple connection. And think about it- when's the last time you ever did anything life-changing simply because you got good "information"? If it were that simple, no one would smoke. We change our behavior when we're inspired, when we're optimistic, when we're connected and when we feel "gotten". All those set in motion a huge pharmacology in the brain that takes us on the path of health and healing.

Is Being Overweight Healthy? The New JAMA Study

Is being overweight healthy?

I actually spoke with Dr. Katherine Flegal yesterday. She's the lead researcher on the JAMA study that got so much media attention; the one that made it seem like fat people are healthier than normal weight people and that they live longer. Seems the media didn't get the whole story.

What a surprise.

Here's what Dr. Flegal and her colleagues did find. Number one: Compared to the number of deaths in a control population of "normal" weight people (BMI 18.5-25), being underweight (less than 18.5) was associated with about 33,000 more deaths than would be expected in the "normal" weight group. Number two: Being obese (BMI >30) was associated with about 111,000 more deaths. So being in either one of these categories is a risk factor.

It was the "middle" category that was puzzling. The federal gov't definition of obesity begins at a BMI of 30 and defines "overweight" as 25 through 29. And, yes, the people in this category actually had somewhat fewer deaths than those of normal weight.

This did not in any way mean they were healthier. Dr. Flegal was very clear that no one should draw that conclusion from her study — in fact, she and her team didn't even look at measures of health. They just looked at one outcome: dying.

So people who were moderately overweight could be expected to die at a slightly lower rate than "normal" weight people. There are lots of possible explanations for this. One of them is what I call the "Arnold Phenomena." Remember, the BMI does not, repeat not, take into account body composition. Any bodybuilder or athlete who has single digit bodyfat and a ton of muscle will fall into the "overweight" BMI classification. So there's an awful lot of highly conditioned people in that classification. Maybe they skewed the results.

Or maybe people in that category — which is about 40% of America — are just smarter about getting good medical care.

Another possibility — one that Dr. Flegal suggested — is that maybe that extra fat or weight serves as a kind of nutritional or strength reserve in times of stress. Maybe it serves as a kind of "cushion" to help survive the stress of something like cancer or cancer treatement. Who knows?

Point is, we really don't know why those folks die at a slightly reduced rate from normal folks.

It's important to remember that any association study never tells us anything about cause and effect. It only tells us that two things are found together. Sometimes one causes the other, but just as often it doesn't. It's human nature to think that when things happen at the same time, one causes the other (like thunder and rain, or a wearing a lucky shirt when you pitch the winning game.) DVD sales and diabetes both went up during the same time period and therefore there's a statistical correlation between them, but there's no cause and effect relationship.

I know that an awful lot of columnists were celebrating this study with undisguised glee (David Brooks of the NY Times, for example.) I'm just not at all sure that the take home message from this study should be to stop worrying about weight because fat people are healthier.

That's certainly not what the author of the study said, and it's probably not the best message to walk away with.

Consumer Reports Rates the Diets

Every time Consumer Reports writes about something I don't know anything about — like cars or mattresses — I figure they’re giving really good advice. They sure sound like they know what they're talking about. Yet my brother, who is a true expert on cars, thinks they're idiots. My friend — who is in the mattress business — thinks the same thing.

Now that they've written about something I actually know something about, I can understand why.

Consumer Reports rated the diets based on how well they conformed to the 2005 U.S. Dietary Guidelines, which, according to them "represent the current best advice on long-term healthful nutrition." That would be a decent idea if in fact the US Dietary Guidelines were any good. They're not.

Dr. Walt Willett, arguably the most respected nutrition researcher in the country, and Professor of Nutrition and Epidemiology at the Harvard School of Public Health called the new USDA Dietary Pyramid "a lost opportunity to help Americans make informed choices about diet and long-term health." I call it a triumph of politics and food industry lobbying. I'm sure the American Dietetic Association thinks it's just peachy. (They’re the same folks who think supplements just make expensive urine.)

So Consumer Reports doesn't like Atkins because it doesn't have enough bread and grains. It likes Weight Watchers because it's low fat. It calls the Zone a "high protein" diet, even though the majority of its calories come from carbs. And it actually likes and recommends Slim Fast because... well, you'd have to ask them. Slim Fast was rated the "number 2" diet in the land. I suppose a diet of chemical goo in a can that contains 17 grams of sugar meets the requirements of the USDA Nutritional Guidelines for being low in fat. Who knows?

I'm going to be a little more skeptical the next time I read the Consumer Reports ratings on digital cameras.

Expensive to Eat Healthy?

A reporter called me today to interview me about the cost of doing low carb. She told me she wanted to talk about the fact that it costs more money to follow South Beach or Atkins than it does to eat macaroni and cheese.

I told her I'd be happy to talk to her about that, but that the discussion wasn't really a nutrition issue, it was an issue of politics and economics.

She said she wasn't really interested in politics or economics, she just wanted to talk about why it cost more to go on Atkins.

I found that amusing. Kind of like saying, "I'd like to interview you on the subject of the conflicts in the Middle East, but I'm not really interested in discussing fundamentalist Islam."

The fact is that we live in a country that subsidizes wheat and corn. The products that are made from them – high fructose corn syrup, Sugar Pops, sliced bread- are cheap and plentiful. We also happen to live, more for better than for worse, in an economic system called capitalism that allows companies to market their products — including their junk — aggressively, and price it accordingly. This goes for "Grand Theft Auto" and "Die Hard 2" as well as the Happy Meal. There's no farm subsidy for broccoli and there's no multi-million dollar PR budget for apples.

I'm not saying I'd rather live under a different system, I'm just saying that it's pretty stupid to ignore these facts when you're talking about why it's more expensive to eat healthy food than it is to fill up at Taco Bell. Healthier food doesn't stay on the shelf as long. Healthier food is more expensive to produce. Organic food spoils. Apples that haven’t been on steroids aren't huge and red and uniform and shiny — people look at them and go "ugh." It costs a lot more to raise cattle that roam around grazing on their natural diet of grass and not eating growth hormone and antibiotics than it does to stick them in cages on a factory farm and feed them grain and steroids till they're fat enough to go to market. Sorry. That's just the way it is.

So is it a national disgrace that you can't get vegetables in certain parts of big urban areas (like the ghetto or the barrio)? You bet. Or that the school system has to depend on the "donations" of companies like Pepsi who pay for "pouring rights" in the school cafeteria? You bet. Am I unhappy about the fact that the average kid sees 10,000 commercials a year mostly for fast junk food? Sure am. And would I vote for any politician who promised to get junk food out of the school cafeteria? Yup. Is that gonna happen? Don’t bet on it. They have far more important things to do, like protecting me from the dangers of a Howard Stern fart joke.

Meanwhile, the system we have is the system we have. And I'm still not convinced that people eat crap just because it’s cheap. There are powerful lifestyle issues at play here, as well as social, economic and commercial ones.

By the way, in case you haven’t noticed, many of those same people who say it costs too much to eat healthy think nothing of dropping $4.50 for a daily mocca frappacino.

So I'm not 100 percent convinced that if we somehow could wave a magic wand and make healthier food cheaper, everyone would eat it, any more than I'm convinced that if you made crap more expensive, people would stop buying it. We made cigarettes twenty times more expensive than they were when I was a kid, and last time I noticed, people still smoke.

I would have been happy to discuss all this with the reporter, but she wasn't particularly interested. Who can blame her? Discussing the complex social, psychological, economic and marketing influences on our eating behavior is hard stuff. Plus you actually have to think. Better to just file a story on how we'd all be lean and healthy if only good food were cheaper.

Doctor Knows Best

If you've ever read the fine print on any book or website that offers nutritional advice, you've probably seen the standard disclaimer, "Be sure to check with your doctor first."

I always find that advice amusing.

Now let me be the first to say that what I'm about to tell you is not a hard and fast rule. So let's get the exceptions out of the way first: There are doctors who know a lot about nutrition. I see them at the seminars and workshops that I participate in around the country. They are my friends and colleagues. They are really bright, integrative, edgy practitioners who aren't afraid to take a stand, and who combine conventional western medicine with a cornucopia of techniques and information from all sorts of conventions — acupuncture, chiropractic, TOM (Traditional Oriental Medicine), Ayruvedic, herbal medicine, and nutritional medicine.

That said...

Most doctors are nutritional illiterates.

Let me repeat: there are exceptions. And to a man (and woman) they will be the first to tell you that everything they learned about nutrition they learned on their own, through the very seminars and workshops and certifications where I run into them. Ask them how much of what they know about nutrition they learned in med school and every single one of them will tell you the exact same thing: Absolutely nothing. And if you think I'm hard on doctors when it comes to what they know (and don't know) about nutrition, you should hear these guys: They're positively vicious.

Checking with your doctor about nutritional recommendations is like checking with your accountant about your golf game. Now, obviously, there are accountants out there who play great golf. They take lessons, they play in club tournaments, they're really masterful. But none of them learned their golf games in accounting school.

You can find a doc who will speak up for nutritional interventions, but it's about as common as a Republican congressman who is going to actively campaign to remove Tom DeLay. They exist — but they're rare, and they're completely bucking the party line.

Up till the mid-nineties, no med school even had nutrition in their curriculum. Most med schools still have zero nutrition in their curriculum, but a few have a single course, usually equivalent to high school home economics. The relationship of the pharmaceutical companies to doctors begins right when the docs are struggling students, and continues through internship and practice, from free lunches to Zoloft note pads to honorariums to paid vacations at "research seminars." This is not just my opinion — it's been lovingly documented all over the place (nofreelunch.)

Most docs barely have time to keep up with the New England Journal of Medicine and JAMA. The majority has never seen an issue of The American Journal of Clinical Nutrition, let alone the dozens of other journals in specialties other than their own. Please remember this the next time a conventional doc tells you there's "no research" on vitamins. Better yet, go to the National Library of Medicine, and put in the name of your favorite vitamin in the search engine.

Get back to me after you've checked out the first couple thousand entries.

But God forbid, let me go on a TV show and recommend a change in diet and perhaps some chromium and omega 3 fats to some poor diabetic whose doc has him on a diet of 70% carbs and before you know it, you've got a potential lawsuit on your hands. No wonder the lawyers get nervous.

My mother recently spent some time in a hospital and was diagnosed with congestive heart failure. The cardiologist had "heard" of Coenzyme Q10 but wasn't sure what it did and wouldn't recommend it because the hospital pharmacy didn't carry it. I asked a nurse in passing if she had ever heard of COQ10 and she said — I'm not making this up — "Yeah, that's some enzyme that the heart makes when it's failing, right?"

Well, anyway, I'd love to stay and chat, but I have to go file my tax return.

Before I do, I'm going to check it for accuracy with my tennis pro.

"Eat a Balanced Diet" and Other Useless Advice

"Eat a balanced diet."

"Everything in moderation."

"Eat less junk food."

"Eat more fruits and vegetables."

What comes to mind when you hear these phrases again, and again, and again? I'll tell you what comes to my mind: Ka-ka. These overused homilies are about as useful and meaningful as a politician's speech that says "Poverty is bad and should be wiped out." Which is to say, it tells us exactly nothing of any use. It is safe, predictable, and virtually meaningless.

What is a balanced diet? What elements should be balanced? Everything in moderation? Does that include sugar for sugar addicts, or alcohol for alcoholics? What is junk food? Is it synonomous with fast food? All fast food, or just some of it? You mean "slow food" can’t be junk? And which fruits and vegetables should we eat "more of?" How much more? Are they all created equal? Are fruits and vegetables even equivalent on the nutritional pantheon?

No wonder people are getting sick of "expert" advice. Most of it is useless.

Nutrition advice is a lot like politics. The safer you play it, the more meaningless it is. So let's break away from these stupid little platitudes and see if we can begin to make some sense out of this stuff.

"Eat a balanced diet."  OK, that's fine, but what's the definition of balance? If you've got a hundred bucks and you want to give a "balanced" and equal distribution to each of three people, each would get one third. That's balanced, right? Well, food comes in three flavors — protein, carbs, and fat. So why, when these establishment dietitians talk about a "balanced diet," do they "distribute" it as 65% carbs, 25-30% fat, and 10-15% protein? A "balanced" distribution would look a lot more like one third, one third and one third, wouldn’t it?

"Everything in moderation."  Great. How about poison? One man's meat is another's potassium cyanide. Moderation (assuming you could define it, which is not unlike defining the meaning of "is") might be fine for some people, but some foods and substances (like alcohol) are time bomb triggers for certain people. For those people, moderate amounts of the trigger food is not the best strategy — abstinence is. "Everything in moderation" does not work for everyone.

"Eat less junk food."  Great advice, this. Much like the old Lenny Bruce joke about the "expert" advice on swimming in shark-infested waters ("Get out of the water as soon as possible"). Yeah, thanks doc. Of course we should eat less junk, but the problem is that the food industry has done a magnificent job of concealing the "junkiness" of many foods, and has even managed to pass them off as healthy. In this category: most commercial breads, bagels, pastas and cereals, "whole wheat" crackers, "cheese foods," refined vegetable oils which loudly proclaim that they have "no cholesterol," and virtually everything in a snack machine. Ironically, you're probably better off with a breakfast burrito or a salad and bunless mystery meat from McDonalds! (Not much better off, but still...)

"Eat more fruits and vegetables."  Ironically, this is the only platitude that's true, but it's so vague as to be meaningless. Fruits and vegetables are not created equal. Vegetables have the definite edge. Overeating fruits can be a disaster for sugar sensitive people. And if the vegetables you're eating are overcooked slop from a salad bar or a can, don't bother. Vegetables should be eaten as often as possible — lightly cooked, steamed, or raw. Yup, you should eat more vegetables, even though "more" is a relative term. It's virtually impossible to eat too many vegetables, and most people could also stand to eat "more" (and better) protein.

If "experts" stopped looking over their shoulders to see what the party line was, stopped worrying about giving advice that was so politically correct, and started being willing to take a stand, they might actually start making a difference to the people that look to them for guidance.

Weight Loss Not Fast Enough: The Bowden Equation

I just got another letter from someone who doesn't think they're losing weight fast enough for all the "work" they're doing. This gal lost two pounds in a month; which is only disappointing if you were expecting 10. If you were expecting 2, you'd be happy, right? Which exactly proves my formula — The Bowden Equation: Unhappiness is only equal to the the difference between Expectation and Reality.

Suppose I get in my car in New York City and drive to LA. And somehow, on the way, I find myself in Biloxi, Missisippi. Which I'm sure is a perfectly nice place to be, but it's not LA, which is where I want to go. So what do I do? I'll tell you what I don't do... I don't turn around and throw up my hands and drive back to New York! I figure out a course correction and continue on. And maybe it's not Biloxi where I find myself, but Las Vegas. Which, even tho it's not LA, happens to be on the way to LA, so in that case, I just take a bathroom break, pick up a Starbucks, hit the Eagles Playlist on the iPod, and carry on for another five hours of driving.

My point is that if weight loss (or for that matter, any goal) is not coming fast enough to suit you, change your expectations. Your choice is to go back to the way you were doing things before — which is going to guarantee that you wind up where you were to start with — or to carry on and enjoy the journey. Sure, make a course correction here and there if needed, unless you like hanging out in Biloxi for a while (not that there's anything wrong with that), but for goodness sake, what's the point in turning around and going back to New York?