Why weight loss experts fail their clients--Part 1

As a dietitian with somewhat of a reputation as having expertise in disordered eating/eating disorders, I have often found myself in the middle of debates about whether or not a structured "meal plan" approach or an "intuitive eating" approach is best. I don't really agree with either, alone, though I do think that restoring someone's ability to eat intuitively should be the ultimate goal.

A recent research project helps me to define why I say that.

Mood disorders are associated with changes of fatty acid content in the brain. A group of neuroscientists finally decided to use their technology to look at how blood flow in different brain regions differed in depression, and to look at how those differences correlated with essential fatty acid levels.

In neuro-ese, here are the results:

DHA% and AA% correlated positively with rCMRglu in temporoparietal cortex. In addition, DHA% correlated negatively with rCMRglu in prefrontal cortex and anterior cingulate. No correlations were seen with EPA%. Thus, under conditions of low plasma DHA, rCMRglu was higher in temporoparietal cortex and lower in anterior cingulate/prefrontal cortex.

Translated into English, what that means:

1. In depressed subjects, the lower the level of DHA and ARA in the tempoparietal cortex, the less blood circulation there appeared to be. This is the part of the brain that integrates and coordinates sensory information.

2. Blood circulation to the prefrontal cortex and the anterior cingulate were compromised when DHA levels were low.

The prefrontal cortex is thought to be important for memory retention and coordination of complex behaviors.

The anterior cingulate is important for carrying out executive, evaluative, cognitive, and emotional functions. It is also important for learning and problem solving, error detection, motivation, and emotional modulation.

I believe, and have written profusely about it on this blog, that imbalance in fatty acids not only causes depression, but it causes changes in brain chemistry that change eating behaviors. And those eating changes only make the brain chemistry worse. It becomes a vicious cycle that can become incredibly difficult to break out of.

Both diet approaches operate on the assumption that the brain is intact and functioning completely normally. If that were the case, I argue, the client wouldn't be asking for help with an activity that should be primarily intuitive and without thinking too much about it. My clients often demonstrate signs and symptoms that the above described imbalance exist, which sets them up to fail with commonly endorsed nutrition counseling approaches.

Wednesday I'll continue with how changes in these brain regions interfere with nutrition counseling. For now, suffice it to say that a fatal error nutrition and exercise counselors make is to assume that their clients have the brain power and function that allows them to make the changes we advise them to make. And in doing so, we work against their ability to change. If we understand what's going on in the brain, we can develop therapies that harness their potential to succeed!


Elizabeth Sublette M, Milak MS, Hibbeln JR, Freed PJ, Oquendo MA, Malone KM, Parsey RV, John Mann J. Plasma polyunsaturated fatty acids and regional cerebral glucose metabolism in major depression. Prostaglandins Leukot Essent Fatty Acids. 2009 Jan;80(1):57-64. Epub 2009 Jan 6.

Diet and Parkinson's disease

I've been studying nutrition and the brain for awhile now, and it's clear I'm a big fan of omega-3 fatty acids. It's only been recently that their role in Parkinson's disease prevention is becoming clear.

Oxidative stress, or aging, is to the brain what rust is to your car. In Parkinson's disease, oxidation appears to significantly affect the brain systems regulating dopamine.

In this study, rat brain tissue was exposed to several by-products of fatty acids found in the brain, docosahexaenoic acid and arachidonic acid. It turned out that the arachidonic acid--derived compound was the most toxic to brain cells.

Arachidonic acid is derived from two main sources, certain dietary oils, and meats. It's fairly easy to identify the oils that promote arachidonic acid production. They tend to be those, which in English, begin with the letters "S" and "C"; soybean, safflower, sunflower, sesame, corn, cottonseed...the only exception would be canola. These oils have been unloaded into the food supply in recent years and as they have, many diseases, not just Parkinson's, have been on the upswing. Start reading your labels!

Arachidonic acid is also found in meat. So if you are eating large portions of meat instead of balancing your protein with other types of food, your diet may be out of balance and promoting inflammation/oxidation/aging, particularly in the nervous system. Some rules to follow which you've heard before, for other reasons, include: eat more seafood and less red meat, eat more vegetarian meals, and limit your meat portions to the size of the palm of your hand without the fingers.

Parkinson's is not a problem to be taken lightly. If you have ever known someone who has had to deal with the tremors and deterioration in quality of life...you know what I mean. Some very simple dietary choices may help you to delay or prevent having to personally deal with this challenging diagnosis.

Liu X, Yamada N, Maruyama W, Osawa T. Formation of dopamine adducts derived from brain polyunsaturated fatty acids: mechanism for Parkinson disease. J Biol Chem. 2008 Dec 12;283(50):34887-95. Epub 2008 Oct 15.

Mania and free fatty acids

Plasma free fatty acids (primarily omega-3's) have gained much attention for their therapeutic potential in many psychiatric diagnoses--including depression, anxiety, obsessive-compulsive disorder, attention-deficit hyperactivity disorder, schizophrenia, post-traumatic stress disorder, and bipolar disorder. Now researchers are discovering that the level of these fatty acids in the blood may actually influence the symptom severity of these illnesses.

In this particular study, done in patients with bipolar disorder, medication-free patients who were seeking help for a manic episode had their blood tested for free fatty acid levels. These levels were compared to those in individuals who did not have bipolar disorder. In the manic individuals, the lower the levels of arachidonic acid (AA) or eicosapentaenoic acid (EPA), the worse the manic symptoms were. The greater the AA/EPA ratio, the worse the manic symptoms were.

In plain English? While the diets of these individuals were not analyzed, it is well-established that a diet high in fish and omega-3's promotes good EPA levels. A diet high in meat and pro-inflammatory oils (those "S" and "C" oils I like to refer to), the higher the AA levels.

So...eat a lot of meat and processed foods with the wrong kinds of fat, and your bipolar disorder stability might pay the price. Focus on fish, flax, and nuts...and you might not need as many emergency room visits.

It's kind of a catch-22. In working with bipolar disorder, it seems that the very foods that cause trouble are the very foods these individuals seem to crave. It can take a concerted effort to stay on track with nutrition. However...what I do notice is that if these individuals DO stick with the plan and pull their nervous systems back into balance, the cravings eventually lessen and appetites for healthier food begin to surface.

I've been in the presence of a client in the middle of her mania. At least from my shoes, on the outside looking in, knowing what danger her state put her in, I'd highly recommend making the effort and minimizing the manic episodes.


Sublette ME, Bosetti F, DeMar JC, Ma K, Bell JM, Fagin-Jones S, Russ MJ, Rapoport SI. Plasma free polyunsaturated fatty acid levels are associated with symptom severity in acute mania.Bipolar Disord. 2007 Nov;9(7):759-65.