A gradual increase in fibre intake should be recommended. This will minimise possible side effects which include flatulence and possibly diarrhoea. When increasing fibre intake, also check fluid intake. If fluid intake is inadequate, constipation may result due to absorption of water by fibre in the large bowel.

It is also wise to caution clients against an excessive fibre intake. Besides the obvious gaseous effects, large quantities of insoluble fibre—particularly wheat bran—can interfere with the absorption of iron by the body.

Assessing dietary fibre intake. A ‘fibre count’ can be performed to identify sources of fibre and opportunities for increased intake. A greater fibre intake will result from increased consumption of fruits, vegetables, wholegrain cereals, legumes and other unprocessed plant foods. Client education should promote an eating style which includes these foods. As this list is limited to major fibre-containing foods, it can only provide a rough estimate of dietary fibre eting habits.

Reading food labels for carbohydrates. Nutrition information panels indicate carbohydrate content by showing the ‘total carbohydrate’ and the quantity of ‘sugars’ per 100g. The starch content can be calculated by subtracting sugars from the total. This is a comparison between white and wholemeal bread. Both breads contain a relatively large amount of starch—44.4g and 40.7g respectively. Although technically carbohydrate, fibre content is shown separately. As you would expect, wholemeal bread contains more fibre.

In the absence of a nutrition information panel, an ingredient list can give an indication of the fibre content of a food. Names such as wholewheat, bran, wheatbran, wholegrain, wheatgerm, wheatmeal and oatbran appearing near the front of an ingredient list may indicate a generous fibre content.

An ingredient list can also provide an indication of sugar content. Sugar can be identified by numerous other names: sucrose, maltose, lactose, dextrose, fructose, glucose, sorbitol, mannitol, glucose syrup, com syrup, golden syrup, disaccharides, monosaccharides, polysaccharides, modified carbohydrate, raw sugar, brown sugar, molasses, honey and treacle.

Nutritional claims about carbohydrates. Like fat, there are requirements for manufacturers’ claims about fibre in food.

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A normal person who feels the urge to eat something sweet might be satisfied with a couple of cookies or a candy bar. In contrast, a carbohydrate craver continues to eat beyond the point of satisfaction. As we learned earlier, serotonin usually acts to suppress eating. The Wurtmans believe that carbohydrate-craving behavior suggests something has gone wrong with the feedback loop that signals the brain when enough food has been taken in.

There’s another level to the problem as well. When asked why they succumbed to such dangerous eating practices, carbohydrate-craving people reported that they weren’t interested in the taste of the food. Instead they ate as a means of fending off tension, anxiety, or mental fatigue. In other words, carbohydrate cravers seem to use food as a kind of self-prescribed regimen of antidepressant therapy. Earlier we saw how carbohydrates lead to increased serotonin levels. Could a defect in the serotonin system be a common link between these disorders?

Knowing that a faulty serotonin system may underlie certain kinds of abnormal eating has led to the use of medications to correct the problem. A chemical called d-fenfluramine, for example, acts as a kind of biological boxing coach. It calls on serotonin to get out there and fight by triggering its release from nerve cells. Then d-fenfluramine prolongs the bout by blocking reabsorption of serotonin back into the cell-in a sense, keeping the boxer from returning to his corner before the fight is over. The popular antidepressant Prozac (fluoxetine) also increases serotonin levels by blocking the reabsorption of serotonin by the nerve cells.

Through this one-two punch, d-fenfluramine helps serotonin do the job it was designed for: control appetite. Use of this and other similar compounds can help some carbohydrate-craving patients enjoy more normal moods and in some cases lose weight. There has also been some success in using these medications for PMS and SAD. Recent research in patients with PMS has also shown that consumption of high-carbohydrate meals (which increases serotonin) can help improve premenstrual depression, tension, and fatigue.

Eating is not just a simple process. A complex network of signals exists between the brain and the rest of the body. Some of these signals arise from within. Others- anything from the amount of daylight outside to a friend’s invitation to go and grab a burger-come from the outside world.

These signals trigger the release of biochemicals that stimulate appetite. The digestive organs respond to what we eat by releasing still more chemical messengers that report to the brain. The brain processes the information and issues orders to stop, continue, or eat something different next time.

Although social cues play a role, eating is largely a self-sustaining physical process. Disruptions can occur at any point in the system. There may be insufficient supplies of a certain brain chemical or a defect in an organ’s ability to respond to a neurotransmitter’s message. Fortunately, our growing knowledge of how physical problems contribute to eating disorders points the way to new and effective biological treatments.

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He started by giving up meats and fried foods, then eliminated cheese, ice cream, and other high-fat fare. In their place, he learned to prepare low-fat meals, using a cookbook that his mom gave him. The pounds started coming off almost immediately.

Inspired by his progress, Mitch started plotting his next strategy: exercise. At first, he tried walking around the block. But because his job as a newspaper reporter had him working odd hours, he had to find an activity that better fit into his crazy schedule. So he invested in a stationary bike, which he rode when he got home from work. “I’d set little goals for myself,” he recalls.

“I’d ride for 5 minutes the first five sessions, then 7 minutes the next five sessions, and so on.”

Of course, some nights Mitch could hardly bear to look at his bike, much less ride it. That’s when his diversionary tactic came into play. He’d throw a towel or a T-shirt over the timer, then concentrate on something else. He’d get so lost in thought that before he knew it, his time was up.

After 2 years of his diet-and-exercise regimen, Mitch had lost 200 pounds. Five years later, at age 34, he’s still fit and feeling good about himself.

WINNING ACTION

Let your imagination go. Boredom can put a crimp in even the best-laid exercise plans. If you’re not enjoying what you’re doing, chances are, you won’t stick with it. So find ways to make your workout interesting. Mitch hides the timer and thinks about something else. If you’re using a stationary bike or other fitness equipment, try watching TV, flipping through a magazine, or cranking up some Tina Turner, Madonna, or your favorite uptempo tunes. Personally, as dull as it seems, I’m a fan of nothingness, like Mitch. I like quiet time when I’m on my treadmill. My mind wanders everywhere!

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