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Hint: It is about adding and not subtracting!
by Kate Sweeney
When I tell people I’m a dietitian, they often ask me something like: ‘How do I eat healthy?’
There is a lot I would want to ask someone to learn more about them, what their definition of healthy is and much, much more. But, let’s say I’m short on time and they really want some response.
My short answer is: add instead of subtract.
How to shift your mindset of what healthy eating is
What does 'adding' food mean?
If you want to improve cholesterol levels, decrease gas and bloating, have more energy, build physical strength or recover from disordered eating, one thing that may be helpful is shifting both mindset and behavior to be about what you can add to your diet - versus what you ‘should’ take out.
(Just FYI: ‘Diet’ in this newsletter means eating pattern, no restrictive connotation.)
A common narrative in our everyday lives is that we need to eat less. The push for optimization found on social media and even the information from some nutrition “experts” all focus on limiting or completely avoiding certain foods, particularly added sugar, ultra processed foods and foods high in saturated fat.
There may also be an emphasis on some foods or ways of eating as being ideal and superior to all others. This advice is dizzying. You could read something on emphasizing meat in the diet (or even going full carnivore) and the next minute watch a video about the benefits of eating vegetarian.
This being said, certainly some influencers encourage eating more. However, from what I can see, it tends to be more of protein and less of everything else. The message is still in some way limiting.
This way of thinking about food is very confusing, restrictive, not individualized and often black and white.
Nutrition and eating are grey and nuanced.
Plus, healthfulness isn't just what we eat at a meal; it is also our eating experience like who we eat with that affects our health.
Cognitive Restraint and Eating Behavior
Some of us struggle with fearing we will eat ‘too much food’, that we cannot trust ourselves.
Some of us struggle with binge eating or chronic overeating.
Others struggle with thoughts around what we ‘should’ or ‘shouldn’t’ be eating. Anything from energy dense foods like brownies to specific foods like onions can be anxiety provoking - out of concerns these foods will create negative short or long-term effects.
As a result of our fears and concerns, we may think about reducing or taking out certain foods from our diet. This can cause us to experience cognitive restraint.
Cognitive restraint is defined in the literature as “control over food intake in order to influence body weight and body shape”.
While some studies show cognitive restraint is associated with a greater intake of fruits, vegetables, whole grains and lean proteins and eating less calories overall (not that that is a good thing in and of itself!) there are also studies showing cognitive restraint to be associated with a decrease in diet quality and an increase in weight gain (again, not itself a bad thing!).
In individuals who struggle with eating disorders, the research available shows cognitive restraint is associated with increased frequency in binge episodes for people with binge eating disorder.
This makes sense to me. If you struggle with BED and try to restrict exposure to food, it may not work long term. Instead, focusing on what you can eat during the day (not during a binge) may help.
The research is mixed, and there are limitations to it. Food Frequency Questionnaires (FFQ) are often used as ways to measure dietary intake and quality, and we know that people struggle to capture their intake accurately on an FFQ. Outcomes often are based on BMI or weight gain, which are not a good indicator of health.
There is still a lot to learn about cognitive restraint and eating behaviors, and the factors that impact both as well as how they impact each other.
How may focusing on taking food out of our diet be problematic?
Sometimes we think so much about what we should not eat, and what scares us about food that we do not consider what we can eat and what foods make us feel nourished.
We may get distracted from functional planning of meals and getting food ahead of time at the grocery store, actually resulting in a more erratic eating pattern.
Taking food out of the diet can also create unrealistic expectations (cue: social media) and spur disordered eating.
Taking out foods can also lead to negative health effects.
For instance, subtracting foods can potentially mess with the gut microbiome and sometimes, cause more digestive issues. For instance, the 4-6 week low FODMAP diet has been shown to be helpful in people with Irritable Bowel Syndrome. However, when followed for longer periods of time, it can result in nutrient deficiencies and a lack of short chain fatty acids like butyrate that protects against colon cancer.
Taking food out of our diets can also mean missing out on important nutrients or not getting enough to eat. This can lead to a whole host of problems.
Practically, subtracting foods can be tough if you live with someone or have a family you cook for. It can be stressful, expensive and also affect the eating patterns or mindset of those around you, especially kids.
So, does the subtractive approach to food work? My feeling is that it does not.
How can you shift your mindset to an additive one?
Some questions to ask yourself when considering what to add to your diet are:
What meal or snack is the least satisfying or filling? Do I want to try something to make it more appealing?
How do I want to feel physically after eating? Am I eating foods that support this?
What foods do I like and nourish me? Am I eating them and if not, how can I incorporate them more?
What are my health concerns and what foods can I eat to support my physical and mental health? For instance, if you have high cholesterol, you may be advised to add in poly- and monounsaturated fats like those found in olive oil, sardines, nuts, seeds.
What foods have I never tried and want to? Have I ever had…Injera…Pomelo…Eggplant… Millet…Tofu…Sardines…etc?
If I’m struggling with disordered eating, which foods does my ED part not want me to have? (Having those may be a good exposure!)
What recipes have I not made in a while? Is there a possibility of reincorporating those?
What cooking skills do I need to learn to be able to try certain foods?
Who do I want to eat with when I try new foods?
Where do I want to try the new foods? Out at a restaurant or at home?
Considering these questions may give you some ideas on what to try in regards of increasing meal/snack frequency, eating more food at meals/snacks, trying new foods, bringing back foods or recipes you ate in the past or finding new food experiences.
If we come at nutrition for an additive lens, think of all the possibilities!
The Positive Effects of an Additive Approach to Food
Thinking about nutrition from an additive lens can help you get foods that:
Allow connection with others (i.e. cake at a birthday party)
Bring you satisfaction and pleasure
Help you practice more flexibility (I.e. if you go on a trip or get sick, you aren’t feeling so restricted from what you can eat)
Are tied to your cultural or religious background (i.e. eating Challah bread on Shabbat)
Improve your health for functional benefit. For instance, having peanut butter on toast for snack to get in polyunsaturated fats for heart health or trying some sardines with pasta to get in calcium from the fish bones for your bone health.
Fit into a sustainable dietary pattern. When we have a variety of foods available to us, we are much more likely to continue this way of eating.
Of course, recovery from disordered eating is always on my mind. When we add in food versus take it out during recovery, we may reduce our restrictive mindset and shift to a more flexible, spontaneous and satisfying one.
Closing Thought
I want to be clear that some people may need to avoid certain foods. Think, gluten for someone with Celiac disease or a high histamine food for someone with MCAS.
Others may benefit from a certain dietary pattern to help their diabetes or their digestive issues.
Even in all of these cases, it is possible to consider what to ADD to the diet.
Adding food, versus taking it out can create more fun and pleasure, be health-promoting and be way more sustainable than a restrictive mindset.
Works Cited:
de Lauzon-Guillain B, Basdevant A, Romon M, Karlsson J, Borys JM, Charles MA; FLVS Study Group. Is restrained eating a risk factor for weight gain in a general population? Am J Clin Nutr. 2006 Jan;83(1):132-8. doi: 10.1093/ajcn/83.1.132. PMID: 16400061.
Filippone L, Shankland R, Hallez Q. The relationships between social media exposure, food craving, cognitive impulsivity and cognitive restraint. J Eat Disord. 2022 Nov 25;10(1):184. doi: 10.1186/s40337-022-00698-4. PMID: 36434703; PMCID: PMC9701005.
Giudici KV, Baudry J, Méjean C, Lairon D, Bénard M, Hercberg S, Bellisle F, Kesse-Guyot E, Péneau S. Cognitive Restraint and History of Dieting Are Negatively Associated with Organic Food Consumption in a Large Population-Based Sample of Organic Food Consumers. Nutrients. 2019 Oct 15;11(10):2468. doi: 10.3390/nu11102468. PMID: 31618887; PMCID: PMC6836016.
Michael ML, Juarascio A. Elevated cognitive dietary restraint mediates the relationship between greater impulsivity and more frequent binge eating in individuals with binge-spectrum eating disorders. Eat Weight Disord. 2021 Dec;26(8):2795-2800. doi: 10.1007/s40519-021-01153-0. Epub 2021 Mar 3. PMID: 33660165.
Nogay NH. The role of psychological eating styles in obesity among Turkish adolescents: A cross-sectional study. J Pak Med Assoc. 2017 Apr;67(4):573-576. PMID: 28420918.
Richardson AS, Arsenault JE, Cates SC, Muth MK. Perceived stress, unhealthy eating behaviors, and severe obesity in low-income women. Nutr J. 2015 Dec 3;14:122. doi: 10.1186/s12937-015-0110-4. PMID: 26630944; PMCID: PMC4668704.
S. L. Peters, C. K. Yao, H. Philpott, G. W. Yelland, J. G. Muir, P. R. Gibson. Randomised clinical trial: the efficacy of gut-directed hypnotherapy is similar to that of the low FODMAP diet for the treatment of irritable bowel syndrome. Alimentary Pharmacology and Therapeutics. 2016; 44(5) 447-459. https://doi.org/10.1111/apt.13706.
Stunkard AJ, Messick S. The three-factor eating questionnaire to measure dietary restraint, disinhibition and hunger. J Psychosom Res. 1985;29(1):71-83. doi: 10.1016/0022-3999(85)90010-8. PMID: 3981480.
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