Steve Tutty, Associate Director, Cognitive Behavioral Clinical Services:

A few days ago I decided to approach drinking alcohol in a mindful way. I thought about the steps our clinical team developed for mindful breathing and eating… and the process that unfolds when you observe, describe, and participate in each moment.

I opened a cold beer and followed those steps – gently pouring the beer into a pint size glass and observing its color, aroma, and carbonation. After a few moments, I took my first sip. I let it remain in my mouth and swished it from side to side before swallowing. I was struck by the amount of carbonation and acidity I could taste. After a few moments, I took another sip…and was fully present for the experience. By the time I had consumed half the beer, my stomach was full and I ended up pouring the remainder of the beer into the sink.

Like binge eating, binge drinking is an American pastime. We know that approximately one fifth of adults in the United States regularly engage in binge drinking. Binge drinking is defined as consuming more than five alcoholic drinks (including beer, wine, and liquor) for males, and four alcoholic drinks for females in one sitting – usually in two to three hours.  In young adult college populations, the rate of binge drinking is much higher – often between 40-50%.

People binge drink for many reasons. For one, alcohol is widely available unlike other substances. I remember when I lived in Arizona some of my friends would visit a beer and wine “drive in” after work. This “drive in” made drinking alcohol very convenient and accepting. My friends would view it like a fast food chain.
In addition, alcohol is very effective in helping one relax. It takes the edge off. When people drink their heart rate and breathing slows down, while the emotional tension and worry fade away…at least for a while. Not a bad combination. It’s no wonder alcohol has become our national lubricant, despite the known health and psychological consequences.

My experience drinking beer mindfully shifted a few things for me. For one, I realized that I don’t enjoy drinking beer as much as I thought I would. The taste and carbonation really wasn’t satisfying. In addition, this experience made me realize how old habits (i.e., mindless drinking) can mask the true nature of alcohol. There are plenty of other healthier ways to unwind.

Recently, yet another study was released supporting the health benefits of chocolate. This time, researchers reported in the Journal of Internal Medicine that, in people who had previously had a heart attack, eating chocolate at least twice per week was associated with lower risk of dying of heart disease. Earlier research has shown that eating chocolate is associated with lower blood pressure, decreased risk of blood clots, and lower cardiovascular mortality among people without a history of heart disease. The new study was the first time that protective effects of chocolate have been found in patients with established heart disease.

The benefits of chocolate on heart health are thought to be due to compounds called “flavonoids,” which are powerful antioxidants. However, chocolate also has a favorable profile of fatty acids and is rich in nutrients like zinc, selenium, magnesium, and vitamin E. In general, the darker the better for chocolate when it comes to health effects, since milk chocolate contains less of the flavonoid-rich cocoa solids and more of other ingredients that don’t have known health benefits. Although the recent study didn’t specify the type of chocolate the heart attack survivors were eating, the study was conducted in Sweden, where the even the milk chocolate is higher in cocoa solids (~30%) than many U.S.-made “dark chocolates” (~15%). In general, to get the most health benefits you want to look for a chocolate bar which is at least 60% cocoa. Many grocery stores now carry chocolate bars that are 85% cocoa or higher. Although some people find chocolate containing this much cocoa to be too bitter, for my tastes there is nothing more delicious. And the lower sugar content in very dark chocolate makes it less likely to trigger cravings or desire to overeat.

It is worth noting that, in addition to beneficial antioxidants, chocolate is also high in a number of natural compounds that may influence mood. Researchers have suggested that these compounds may be the basis for the chocolate cravings that some people experience, and may even create chemical conditions akin to “addiction,” although there are few well-controlled studies that demonstrate that eating chocolate actually influences mood. And, when it comes to healthful flavonoids and nutrients, you can get much higher quantities from vegetables and fruits than from chocolate without the sugar and fat.

If chocolate is a trigger food for you and you find it hard to eat a small amount, it’s probably best to avoid it. But, otherwise, as long as you are eating a healthy diet with plenty of fruits and vegetables, forget about feeling guilty and eat a small bite of dark chocolate a few times a week – your heart will be glad you did!

The new flu outbreak has everyone concerned, but besides washing your hands a lot, the best way to stay healthy is to make sure your immune system is strong.  It’s well known that lifestyle choices have a big effect on immunity, so now is a good time to re-evaluate your current habits.

There are 3 key areas to look at:

1) Nutrition – If you are eating the Standard American Diet (“SAD”) full of white, processed foods and fats with few vegetables, fruits and whole grains, chances are your immune system is struggling.  This is partly because high-fat, highly-processed diets cause your body to be in a constant state of low-grade inflammation, which taxes the immune system.  Make sure your diet is full of fruits and vegetables with rainbow colors, which are not only high in vitamins and minerals but which also contain plant compounds that fight inflammation and boost immunity.  In addition, eat sources of anti-inflammatory omega-3 fats (salmon, sardines, tuna, walnuts or flax seeds) often and reduce your intake of pro-inflammatory omega-6 fats (soybean oil, sunflower or safflower oil).  Finally, vitamin D is critical for proper immune function. It’s estimated that up to 70% of Americans are vitamin D deficient, leaving us vulnerable to infection.  Talk to your doctor about getting a blood test to check your vitamin D level but, in the meantime, consider taking a daily dietary supplement with at least 1000 IU vitamin D.

2) Exercise – Moderate exercise, like brisk walking, has a powerful, beneficial effect on the immune system.  Our bodies were meant to move and they function better when we do so.  Now that spring is here and the weather is getting better, consider taking a daily walk for 20-30 minutes in the fresh air.  Not only will your immune system get stronger, but the exercise will help you shed any extra winter pounds you might have put on!  If you’re feeling a bit under the weather, consider foregoing the really intense workout, though, since research shows that vigorous exercise can actually suppress immune function temporarily.

3) Stress Management – Ironically, all the media hype about the swine flu is creating a lot of worry and stress, which can actually worsen our immunity and make us more vulnerable to the disease.  Stress hormones like cortisol are powerful immune suppressors.  So, make sure you are practicing regular stress-management techniques.  Take deep breaths, letting your belly expand as you breathe in (I do this frequently while watching the news!).  Do daily mindfulness-based meditation, which has been proven to lower cortisol levels, increase immune function, and decrease feelings of stress.  Reducing stress also helps you sleep better, which boosts immunity, too.

Talk of pandemics raises a lot of fears and makes us feel like we have no control, but in reality we have a great deal of control over our bodies and our health.  Take steps now to make sure that you are practicing healthy habits that keep your immune system strong. Be well!

“A cookie would go great with your beverage.” The sticker stares up at me from the lid of the soy latte I just purchased at the Barnes & Noble café.

This is added to the fact that the barista just asked me if I would like a warm chocolate chip cookie right out of the oven. It is 9:00pm on a Friday night and I already had a mini ice cream sandwich after dinner. In no way do I need a cookie. But the barista didn’t ask me if I needed a cookie. She asked me if I wanted a cookie. Well, of course I do, I thought. But I politely said “no thank you,” and went on my merrily smug way (I resisted temptation!), only to come face-to-face with the lid of my cup.

And as I sit here writing about this, staring at the blue sticker glaring back at me like the words on the tea cake in Alice in Wonderland, I still very much want that dang chocolate chip cookie. I can almost taste its sweet and salty chocolatey goodness.

Mindfully, I take a long sip of my soy latte.

I can’t blame my frustration on the barista, as much as I would like to. It’s her job to up-sell; I remember well the days I spent as catering manager of a restaurant convincing customers that our cookies and sweet tea were just going to make [them] so happy!  (I’m from Dallas, please excuse my palate.) Yet there is something to be said for the culture we have created and continue to nurture with marketing ploys like cookie-hawking stickers despite the ever-growing problem of obesity and overweight in our country.

I have to take personal responsibility – I admittedly spend too much time in cafés, where I know I will be surrounded by baked goods. This is a type of environment that I choose because I enjoy what it provides: the sounds, the people, the smell of coffee brewing and, yes--cookies baking. I make a choice to enter and to linger, so I shouldn’t be surprised to find myself confronted with such temptations.

The other morning I was in line at Starbucks (since moving to Seattle I have swapped sweet tea for coffee), staring down the cinnamon scones in their case. I wasn’t planning on purchasing a cinnamon scone; I was going to buy a banana to accompany my coffee. But when the cashier called out “banana,” the woman behind the snack case shouted back, “cinnamon scone?” I kid you not. She read my mind. Well, either that or she had seen me salivating on the snack case.

We all shared a laugh when I admitted that the cinnamon scone was indeed what I really wanted. But I stuck to my healthy-behavior-toting guns and bought my banana. It satisfied my hunger very well, thank you very much.

Certainly a lot better than the cinnamon scone that I consumed the next morning after caving to my craving.

But today was another day. I’ve finished my soy latte and I am satisfied. I’ve spent the last hour engaged in writing – my favorite pastime – and now, as I hear the barista ask yet another customer “would you like a cookie, fresh from the oven?” I can honestly say that I would not. I’m fine, thanks.

Annie Short, Marketing Intern:

I have been practicing yoga for about 6 years. As a runner and a skier, yoga is the perfect balance to both of those sports and many more. I often ask my friends to try yoga; I typically get the same response: “Why would I waste my time with stretching?” Well, the 5,000-year-old practice of yoga is so much more than stretching.

Yoga has a multitude of health benefits, such as flexibility, balance, strength, mood and stress management. There are many types of yoga, so if you are new to exercise, recovering from an injury or just wanting to try something different, there is a yoga practice that is right for you.

Flexibility:

Many people believe that you have to be flexible like a gymnast to practice yoga. The beauty of yoga is that you can modify any position or asana to your level. In fact, the flow of yoga positions allows you to stretch your muscles, which release lactic acid buildup to gain flexibility. Build up of lactic acid causes tension, stiffness, pain and fatigue.

Strength:

Yoga is known for stretching, but there are many styles of yoga that help improve muscle tone and core strength. Positions such as Plank, Chatarunga (bent arm plank), Downward facing dog and Upward facing dog work on upper body strength, while standing positions such as Warrior I and Awkward Chair pose work on your leg strength, especially if you hold each pose for a couple of breaths. Most yoga poses, including the ones mentioned above, work on your core strength.

Posture and Body Awareness: 

A combination of increased strength and flexibility creates better posture. Yoga gives you a heightened awareness of how your body feels and allows you to recognize when you are slouching and how to correct your body to stand up straight. Body awareness can also lead to mindfulness when eating and knowing when to rest, which are great weight management strategies.

Stress Management and Mood:

One of the most important properties of yoga is the practice of breathing or pranayama. An article on Web MD states that, “Most forms of yoga emphasize deepening and lengthening your breath. This stimulates the relaxation response -- the opposite of the fight-or-flight adrenaline boost of the stress response.” Deep breathing sends a message to your brain to relax and calm down. This practice can be transferred off your mat and into everyday life.

Although investigation into the effects of yoga on depression is still in its beginning stages, people who do yoga often note that they feel happier after they take a class. This may be due to the boost in oxygen levels to your brain that help you feel more content and gives you the ability to concentrate and focus better.

So get on a mat and see how yoga can start making you feel stronger, less stressed, more flexible and happier today.

Yesterday I learned that if I download the “Whopper Sacrifice” Facebook application and delete 10 friends from my account, I will receive a free Burger King Whopper.

Salivating, I mentally reviewed my friend list: who will I ax first? Do I sacrifice the outliers and use the promotion as a reason to trim my inflated friend count? Do I sacrifice friends who need a good laugh? The Facebook-obsessed? The vegetarians?

Then I stopped mid-review: why on earth would I want a free Whopper? The last Whopper I consumed was probably 5 years ago, in an airport, out of necessity rather than choice (or so I justified at the time). Yet Burger King’s brilliant ploy had me dreaming of charbroiled tastiness (perhaps topped off with a chocolate milkshake?).

Burger King’s Crispin Porter & Bogusky has always gotten my attention with previous ad campaigns such as the Subservient Chicken and Whopper Virgins; and honestly, who doesn’t think the king is creepy? But despite the laughs these ads have brought me, this is the first time I’ve been lured into actually considering entering a store and making a purchase (the more I thought about the milkshake, the better the whole deal sounded).

Yet there is something to be said for recognizing that (blessed) moment of mindfulness when it hit me that:

1) I don’t actually like the way Whoppers taste
2) I really don’t like the way I feel after eating fast food
3) I am lactose intolerant (milkshakes are always a no-no) 

Now, I’m not going to lie and say I never eat fast food hamburgers, but I am going to tell you that I try to take a moment and pay attention to what my body actually needs and evaluate my reasoning for making such a choice (most of the time I realize I’m craving protein). To be honest, it’s usually the times when I’m not paying attention to what my body needs or how it feels when I make such a decision.

It is so easy to get caught up in the influences of our modern environment – and now we have the added pressure of keeping up with the status updates and tweets of friends and strangers alike. Right after I first read about the application, I updated my Facebook status to say: “Erin may be sacrificing your friendship for a Whopper.” Within the hour one of my so-called “friends” commented, “I’ll sacrifice you first. Mmm…Whopper.”

And he did.

For the sake of his health and his sanity I am happy to report that after deleting 10 of his friends he was directed to a site that asked for his contact information and told him that it would take up to 4 weeks to receive his coupon. If his disappointment was any indication, I’d say it’s pretty safe to assume he won’t be walking into a Burger King anytime soon.

I’m currently deliberating whether to accept his latest friendship request. After all, he did choose a hamburger over me.

With daily reports about the economic crisis and other urgent national issues grabbing our attention, the fact that our national nutrition crisis can make headlines is noteworthy.

The current obesity epidemic is one symptom of the national nutrition crisis.  Research has implicated the environment we live in as a major predictor of obesity and poor health.  Factors like the availability of neighborhood sidewalks and parks, access to grocery stores with fresh fruits and vegetables, and junk food ads on children’s television programs have all been shown to influence obesity.

These factors can be addressed through state and federal nutrition policy; however, as public health expert and dietitian Suzanne Havala Hobbs notes, much of our nutrition policy is set up to fail.  Failure is, in fact, almost guaranteed due to conflicts of interest within our government (public officials and scientists commonly receive funding from the food industry and processed food manufacturers) and strong fiscal policies that support junk food production. One oft mentioned example of food policy gone awry is the heavy government subsidies of corn production, which drive the availability of massive quantities of cheap high-fructose corn syrup in our food supply.

However, the issue goes beyond the challenges of implementing effective policies to improve American’s health and waistlines.  Michael Pollan, author of In Defense of Food, has laid out a series of food and nutrition related challenges facing our next administration in an open letter to the President-Elect. Pollan documents the inter-relationship between our current food policy, which supports the production of cheap commodity crops, and the energy crisis, climate change, and the global economy.

He notes, for example, that the current way we produce food uses more fossil fuel than any other sector of the economy other than cars, and contributes to greenhouse gases more than anything else we do.  It is well documented that the dramatic increase in healthcare costs in the past few decades is due to an increase in diet-related chronic diseases like Type 2 diabetes, heart disease, stroke and cancer.  And, in recent months, global food shortages due to high prices have led to violence in many countries and will certainly impact future trade policies, while the risk of terrorism involving food supplies is increasingly a national security concern.

Fortunately, Pollan doesn’t just give us the bad news.  He provides a number of suggestions for ways the new administration could improve food policy to address all these inter-linked concerns.  I encourage you to read his article in full, but in the meantime here are some suggestions for your own personal “food policy”:

1. Eat whole foods and avoid processed foods. Refining foods not only removes a lot of nutritional value, the industrial processing and packaging is destructive to the environment. 
2. Buy organic when feasible. Using your food dollars to buy organic foods not only gives you higher levels of nutrients but supports farming practices that are sustainable and healthier for the planet.
3. Buy local. Whenever possible, shop at farmer’s markets, produce stands, or get community-supported agriculture produce delivered to your door.  Start a garden.  Do what you can to minimize the environmental impact of transporting food long-distances (which also minimizes risks of food contamination, purposeful or not).
4. Enjoy your food. OK, I’m not sure whether enjoying your food will help the economy or reduce global warming. However, I do know that when I take the time to really savor my food, eating only when I’m hungry and appreciating the labor that went into producing what I’m eating, I naturally start to eat healthier, eat less, and cultivate gratitude, which I suspect is healthy in lots of ways.

With the holidays upon us, it’s easy to get caught up in the frenzy– of shopping, celebrating, and enjoying special treats. New Year’s resolutions may be just around the corner, but for now, we just want to eat, drink, and be merry.

Setting goals is a powerful way for individuals to take charge of their health no matter what the season. At Free & Clear we encourage our participants to think of goals as their roadmap – goals help them find the most direct route to where they want to go. Without goals, they may end up taking the scenic route – nice for a road trip, but frustrating when it comes to becoming more active, losing weight, or quitting tobacco.

No matter what health behaviors a person is ready to change, she can boost the odds of success by developing written S.M.A.R.T. goals:

• Specific – detailed, not broad
• Measurable – can be assessed by pre-determined criteria
• Achievable – can be accomplished, given an individual’s life circumstances
• Realistic – practical and recommended by most experts
• Timed – has an endpoint in order to ensure accountability

I’d like to lose 5 pounds - a reasonable goal, but it’s not a S.M.A.R.T. goal.  S.M.A.R.T. goals focus on actions – in this example, the behaviors that will lead to weight loss.

My S.M.A.R.T. goals could look like this, depending on what behaviors I need to change:

1. I will increase my daily fruit & veggie servings from 4 a day to 5 a day on 4 days this week.
2. I will walk for 30 minutes, at a moderate pace, 4 times this week.
3. This week, each time I feel stressed, I will take a walking or stretching break instead of reaching for holiday cookies.

When a participant develops S.M.A.R.T. goals, she is creating an action plan to achieve a better level of health. It’s a way to prepare for the journey ahead - like making sure her tires are properly inflated and she’s got plenty of radiator fluid for holiday travel.

Before heading down the road of behavior change, participants need to set themselves up for success. And so should you. Do you have a roadmap this holiday season? Remember – you don’t have to wait until New Year’s to take action and enjoy the benefits of a healthier lifestyle. As they say, there’s no time like the present.

This is a wonderful time of year to celebrate with family and friends. But for many, the holidays also bring extra pounds as we indulge in the sweets, treats, big meals, parties and family traditions of the season. Don’t let the eggnog get you down, or the scale moving up! Here are 10 proven strategies to let you enjoy all the warmth of the season while keeping you healthy and happy.

1. Use exercise to help balance extra calories. Make regular, daily exercise a priority; don’t let the busy season derail your plans. Add extra sessions or keep at it a little longer if you feel you are indulging more than usual.

2. Decide ahead of time what and how much you will eat and drink before going to social functions or holiday meals. If you have thought through your choices and visualized what you will eat and drink, you are much more likely to follow that plan.

3. Don’t go to a social function hungry!  Eat a small amount of protein such as string cheese, hard boiled egg, turkey, or ½ oz of nuts, or an apple or carrots before you go. This will be especially helpful if alcoholic beverages are served.  The effects of alcohol are felt much more quickly on an empty stomach and can lead to overeating & overdrinking.

4. Volunteer to bring a dish to the party so that you know there will be something healthful there that you can enjoy.

5. Fill your plate ¾ full with fruit and vegetable dishes. This will help to make sure you are filling up on healthy foods and will also help to minimize total calories consumed. Look over the food and choose a couple of higher calorie items you want to try; add just those to your plate. Portion control is the key to success: think moderation.

6. Exercise prior to a high calorie meal, and before going to social functions where there will be food. You will be more apt to make healthier choices following an exercise session.

7. Don’t skip breakfast.  Studies show those who skip breakfast eat more calories later in the day and may burn less calories overall by not getting their metabolism revved in the morning. 

8. Focus on friends & family. Try a new tradition of playing a game, recalling a favorite holiday memory or singing some carols. Form holiday traditions that don’t include eating or cooking.

9. Manage the stress! Exercise helps keep you energized & ready to handle the stress this time of the year can bring. Maintaining your physical activity routine during the holiday is critical to overall health. If time is an issue, walk an extra lap or two around the mall before you shop, park farther from the door, or walk around your office on breaks. It really helps!

10. When cooking holiday meals at home, keep the menu simple & cook smaller amounts; you don’t need multiple desserts or leftovers.

Staying focused on your eating and exercise goals. Even writing your goals down will let you feel in control and ensure you start 2009 on the road to health!

In recent years, considerable research has focused on the health benefits of mindfulness.  Not to be confused with any kind of religious practice, “mindfulness” is simply the process of becoming aware of and attentive to the present moment.  In mindfulness meditation, you focus on your breathing while being aware of thoughts and emotions that arise without attachment.  Most people find it initially very challenging to stay in the present, without automatically drifting into thoughts of the past or the future.  The benefits of persevering are significant, though.  Research has shown that, in addition to psychological benefits, mindfulness meditation improves immune function, helps the skin clear faster in psoriasis patients, and reduces chronic pain.

Mindful eating is of particular interest in weight-related issues.  Like mindfulness in general, mindful eating involves bringing your full attention to the sensations of eating in the present moment.  Most of us are not very mindful when we eat.  Particularly in these days of fast food drive-throughs and eating on the run, we are more likely to be unconsciously shoving food in our mouth than mindfully noticing what we are eating.

Mindful eating can be a wonderful experience.  It starts with noticing how your body feels before you even put the food near your mouth.  Are you actually hungry?  Do you feel tired, energetic, rushed?  Then as you get ready to eat, you engage all your senses in appreciating the food – how it looks, how it smells, and how it tastes and feels in your mouth.  Finally, you notice how you feel after you’ve eaten the food.

Although I try to eat mindfully as often as I can, one of my favorite ways to practice (and teach) mindful eating is with a piece of really good-quality dark chocolate.  (Note: Since dark chocolate is rich in antioxidants, relatively low in fat, and studies have shown that it reduces blood pressure, insulin resistance and inflammation, I consider it a “health food”!)  Recently, one of my coworkers brought back some dark chocolate from a trip, so several of us decided to do a mindfulness experiment.  It took us several minutes to really appreciate the chocolate with all our senses, and then let a small piece melt in our mouths before swallowing.  It was amazing how you could detect the various flavors – sweet, bitter, even tangy – when you really stopped and focused on the experience of eating a piece of chocolate.

A big advantage of this approach is that when you mindfully enjoy a small piece of a food like chocolate you rarely want to eat any more.  You are satisfied and nourished on many levels and the desire to keep eating more than you need just melts away.

Another advantage of mindful eating when you are eating something that maybe isn’t so tasty (a greasy fast food burger that’s been sitting under a warming lamp for 10-15 minutes, perhaps?) is that you may realize that you don’t actually want to eat it.  Not surprisingly, studies at Duke University and Indiana University have shown that mindful eating reduces binge eating in overweight women.  Further research is ongoing at a number of other universities (including, now, UCSF) to see what benefits this approach has on weight loss.

So, the next time you eat, take a few moments to become aware of your experience in the present moment.  You’ll be amazed not only at what you learn about your food and your body, but how much more satisfying and pleasurable food can be.