20 Low Carb Side Dishes To Steal The Spotlight This Easter

Just because you’ve decided to lower your carbs doesn’t mean you have to sacrifice taste this Easter. Surprise your family members with some flavorful low carb side dishes. I bet they wouldn’t even know they are eating low carb!


1. Low Carb Cauliflower Chicken Casserole via Drop The Sugar

Nothing reminds me more about Easter than a side dish of casserole to go with my meal.
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2. Cauliflower Au Gratin via Low Carb Yum

Make any meal special with this cheesy cauliflower au gratin with bacon.
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3. Grilled Cheesy Bacon Hassleback Zucchini via Sugar Free Mom

Grill or bake in the oven, 3 simple ingredients for an easy side for Easter!
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4. Broccoli Stem Noodles with Sesame Ginger Dressing via All Day I Dream About Food
Fresh low carb noodles made out of broccoli stalks! Paired with an Asian-inspired sesame-ginger dressing, it makes a wonderful healthy salad.
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5. Duchess Cauliflowers via Low Carb So Simple

These low-carb duchess cauliflowers are cousins of the classic duchess potatoes. Full of flavor and healthy ingredients, these morsels are also great for the finest dinner.
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6. Supreme Green Bean Casserole via Low Carb Maven
This Supreme Green Bean Casserole is everything the other one wishes it was: rich, creamy, flavorful and made from wholesome ingredients – OH! And, it’s low carb and gluten-free!
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7. Steakhouse Style Creamed Spinach via ItsYummy
This is a rich, creamy, low carb side dish that’s just like the kind you’d find at an expensive steak house.
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8. Hot Ham and Cheese Rolls with Dijon Butter Glaze via Peace Love and Low Carb
The Dijon butter glaze on these low carb and gluten free roll-ups really makes this dish stand out. So much flavor packed into a delicious little roll.
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9. Sesame Keto Buns via The Nourished Caveman
Do you miss bread with your food? These rolls are so fluffy and crunchy, they will make your mouth water…try them with butter!
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10. Buttery Bacon Brussels Sprouts via Ditch The Carbs
Hate Brussel’s Sprouts? This recipe might just be the one to convert the haters out there. Anything with butter and bacon in the title can’t be wrong.
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11. Low Carb & Gluten Free Blueberry Muffins via Drop The Sugar
Where I come from, muffins and buttered breads are part of my Easter side dish! You’ll love these blueberry muffins served warm before your main course.
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12. Garlic Cauliflower Celery Root Mash via Low Carb Yum
Adding celery root gives mashed cauliflower a consistency closer to potatoes. Roasted garlic steps up the flavor.
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13. Low Carb Antipasto Cauliflower Rice via Sugar Free Mom
All the Italian flavors of antipasto in this easy cauliflower salad! My Italian family had no idea it was cauliflower “rice” salad!
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14. Low Carb Cucumber Salad via ItsYummy
Crisp cucumbers and thinly sliced onions are the base of this favorite classic deli salad. No more worrying about what sugar might be hidden inside when you make it yourself, though!
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15. Parmesan Roasted Cherry Tomatoes via Low Carb Maven
Perfect, sweet, cheery tomatoes burst with tomatoey goodness when they are topped with garlic, parsley, and Parmesan cheese then roasted in the oven.
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16. Lemony Mascarpone Cauliflower Mac ‘N Cheese via All Day I Dream About Food
Creamy mascarpone takes the sauce for low carb cauliflower mac and cheese to a whole new level! Pair with some lemon and roasted asparagus and you have the perfect springtime dish.
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17. Eggs Benedict Casserole via Peace Love and Low Carb
This Eggs Benedict Casserole gives you all the amazing flavor of a regular eggs benedict without feeling like you are missing out on the muffins
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18. Easy Mashed Cauliflower via Ditch The Carbs
Have you tried mashed cauliflower but it went all soggy? See the top tips to never have that happened again.
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19. Chicken “Wild Rice” Soup via Maria Mind Body Health
This tasty soup recipe uses “chicken cracklings” in place of carby wild rice. Yum!
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20. Baked Eggplant Parmesan Boats with Sausage via Skinny Taste
A delicious twist on eggplant parmesan using eggplant “boats” that are hollowed out and stuffed with sweet Italian chicken sausage, tomato sauce, and then topped with melted mozzarella.
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Think you have a gluten allergy or stomach flu? Think again.

You might want to argue with Kate Ashford’s article in Prevention magazine, but it’s fun to read. Quoting three physicians, she points out “Five Health Conditions That Don’t Really Exist”:

● Stomach flu: If you suffer from vomiting and diarrhea, it’s not influenza, says Jill Swartz, an urgent-care doctor in New York. The flu virus causes fever, congestion and sore throat. The stomach issues are probably from gastroenteritis, which is a different virus.

● Walking pneumonia: Even though doctors use the term, it’s “something of a catch-all rather than an exact diagnosis,” Swartz says, trotted out when you have a chronic cough and doctors can’t figure out why.

● Gluten allergy: Yes, gluten can make some people feel sick, but what’s going on is not an allergy. “Celiac disease . . . is an immune response to gluten, not an allergy like we think about a peanut allergy,” says allergist Janna Tuck.And you might just have a sensitivity, meaning you get bloating or pain when you ingest gluten.

● Nervous breakdown: “When we get overwhelmed, we can feel like we are going to lose our minds, but we do not,” says Tamar Gur, a psychiatrist at Ohio State University. “People do not have mental breakdowns.” What they usually have, rather than a total meltdown, is an episode of a particular condition (anxiety, bipolar disorder, etc.) that is treatable, not apocalyptic.

● Head cold: No different from any common cold. (The same goes for “chest cold.”) You’re just describing where you happen to notice the symptoms.

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DEA Inflicts Harm on Chronic Pain Patients

HCPs

In an effort to curb opioid drug abuse and addiction, the Drug Enforcement Administration (DEA) has issued new rules that limit the accessibility of hydrocodone, putting chronic pain sufferers who rely on the drug in an impossible situation.

The DEA’s new restrictions come after the decision to relabel hydrocodone as a Schedule II drug, making it difficult for users with chronic pain to receive the medicine they need. The recent changes include the elimination of phone-in refills and a mandatory check-in with a doctor every 90 days for a refill.

Hydrocodone is one of the most widely used drugs to fight chronic pain in the United States, serving a consumer base of about 100 million people. Many who rely on hydrocodone suffer from debilitating chronic pain, which greatly disrupts and decreases their quality of life.

Pain advocates across the country were vocal when the DEA announced these changes: they would have unintended consequences that would hurt, rather than help, legitimate pain patients in need. I spoke with a former patient of mine to find out how she was affected by the up-schedule of hydrocodone. She lives two hours away from the doctor who currently helps manage her pain. For her, it’s a 4 hour round trip every 90-days to access the medication that has helped revive a semblance normalcy since her pain first surfaced when she was just 20 years old. What’s worse, she told me that now, more than ever, she has been made to feel like a criminal for seeking access to medicine that has been rightfully prescribed to her by her own doctor.

In attempting to decode how other patients have been affected by the DEA rule change, the National Fibromyalgia and Chronic Pain Association (NFMCPA) released a survey of assessing the first 100 days after the regulatory change. The results are scary:

·        88 percent of patients felt that the changes denied their rights to access pain medication

·        71 percent report being switched to less effective medications by their doctors, who are fearful of legal issues

·        52 percent felt an increase sense of stigma as a patient receiving hydrocodone

·        27 percent of patients even reported suicidal thoughts when unable to access their prescription.

Controlling the abuse and overuse of pain killing drugs is necessary to keep patients safe, but the importance of decreasing drug abuse does not outweigh the needs of millions of people who suffer from chronic and depleting pain. When patients who suffer from these excruciating conditions are denied access to medication, they often turn to alternative forms of relief such as black market drugs, creating a larger issue of abuse.

Solving the problem begins with communication among the medical community, to ensure patients have access to their necessary medicine and the ability to live the life they deserve.

The medical system’s purpose is to treat and work for the betterment of patients. When we work against the people we are set up to serve, we are doing a great disservice to our cause and the people who rely on us most.

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Morgan Freeman Wants Marijuana To Be Legal “Across The Board”

“How do I take it? However it comes! I’ll eat it, drink it, smoke it, snort it!” he says.

After a 1997 car crash left Morgan Freeman’s arm, shoulder, and elbow shattered, the actor admits that marijuana has been his medicine of choice to ease the pain.

After a 1997 car crash left Morgan Freeman's arm, shoulder, and elbow shattered, the actor admits that marijuana has been his medicine of choice to ease the pain.

Ben Gabbe / Via Getty Images

“They used to say, ‘You smoke that stuff, boy, you get hooked!” he told The Daily Beast. “My first wife got me into it many years ago.”

"They used to say, 'You smoke that stuff, boy, you get hooked!" he told The Daily Beast. "My first wife got me into it many years ago."

Jason Kempin / Via Getty Images

“Marijuana has many useful uses. I have fibromyalgia pain in this arm, and the only thing that offers any relief is marijuana,” he continued.

“Marijuana has many useful uses. I have fibromyalgia pain in this arm, and the only thing that offers any relief is marijuana," he continued.

Valerie Macon / Via Getty Images

“They’re talking about kids who have grand mal seizures, and they’ve discovered that marijuana eases that down to where these children can have a life. That right there, to me, says, ‘Legalize it across the board!’”

"They're talking about kids who have grand mal seizures, and they've discovered that marijuana eases that down to where these children can have a life. That right there, to me, says, 'Legalize it across the board!'"

Ian Gavan / Via Getty Images

“This movement is really a long time coming, and it’s getting legs—longer legs. Now, the thrust is understanding that alcohol has no real medicinal use. Maybe if you have one drink it’ll quiet you down, but two or three and you’re fucked.”

"This movement is really a long time coming, and it’s getting legs—longer legs. Now, the thrust is understanding that alcohol has no real medicinal use. Maybe if you have one drink it’ll quiet you down, but two or three and you’re fucked.”

Angela Weiss / Via Getty Images

And you thought his shades were for the sun…

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18 Charts That Will Help You Sleep Better ( Chronic pain relief )

Because good sleep is glorious.

1. Figure out exactly how many hours you should get.

Figure out exactly how many hours you should get.

2. Know your stages of sleep, and plan your sleep schedule around them.

Know your stages of sleep, and plan your sleep schedule around them.

You don’t want your alarm to go off when you’re smack in the middle of deep sleep. From Health Central.

3. Try to sleep in a position that minimizes your chronic pain, if you have any.

Try to sleep in a position that minimizes your chronic pain, if you have any.

Read more at SheKnows.

4. Pick a couple of these tricks to help yourself pass out.

Pick a couple of these tricks to help yourself pass out.

From Popsugar.

5. Like doing some yoga before tucking yourself in.

Like doing some yoga before tucking yourself in.

You can read more about how to do each of these positions over at Livestrong.

6. Or some basic meditation.

Or some basic meditation.

Read more about how to get started at Business Insider.

7. Figure out a routine that works for you.

Figure out a routine that works for you.

This routine is a good place to start. From the Huffington Post.

8. Make sure small things aren’t sabotaging your sleep time.

Make sure small things aren't sabotaging your sleep time.

From The Sleep Matters Club.

9. Cool off if your bed always makes you feel too warm.

Cool off if your bed always makes you feel too warm.

Particularly helpful in the summertime. From The Sleep Matters Club.

10. Make a warm shower part of your routine.

Make a warm shower part of your routine.

From Luna.

11. Learn how swapping out wall art or adding a few plants could make your bedroom a nicer place to doze.

Learn how swapping out wall art or adding a few plants could make your bedroom a nicer place to doze.

This is one that takes more investment, both time- and money-wise. But it’s something to keep in mind. From Made.

12. Consider supplementing your nightly rest with naps.

Consider supplementing your nightly rest with naps.

But if you have serious trouble falling asleep at bedtime, napping too late in the day may make it even harder to doze off at night. From TotalBeauty.

13. Seriously, napping can be great.

Seriously, napping can be great.

From Patio Productions.

14. Figure out a routine that will actually have you ~enjoying~ your mornings.

Figure out a routine that will actually have you ~enjoying~ your mornings.

Anything is possible. From Entrepreneur.

15. If you have kids, helping them sleep better will help you sleep better, too!

If you have kids, helping them sleep better will help you sleep better, too!

From Cleveland Clinic.

16. If you sleep with someone else who snores, talk to them about how they can fix it.

If you sleep with someone else who snores, talk to them about how they can fix it.

Or maybe you’re the one who snores. In which case: Do this for the sake of your partner. It might help you sleep more deeply, too! From The Sleep Matters Club.

17. Figure out a couple-friendly sleep position that doesn’t interfere with anyone’s comfort.

Figure out a couple-friendly sleep position that doesn't interfere with anyone's comfort.

Allison Pottasch for Swimmingly / Via swimmingly.com

From Swimmingly.

18. And one more time, because you’ve probably forgotten what the first chart said: GET ENOUGH SLEEP!

 And one more time, because you've probably forgotten what the first chart said: GET ENOUGH SLEEP!

 

Learn more about why you should sleep enough here.

 

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Centers to Treat Eating Disorders Are Growing, and Raising Concerns

Their websites show peaceful scenes — young women relaxing by the ocean or caring for horses in emerald pastures — and boast of their chefs and other amenities.

One center sends out invitations to a reception with cocktails and hors d’oeuvres. Another offers doctors and therapists all-expense-paid trips to visit and experience their offerings, including yoga classes. Several employ staff who call mental health professionals, saying they would love to have lunch.

The marketing efforts by these for-profit residential care centers are aimed at patients with eating disorders and the clinicians who treat them. The programs have proliferated in recent years, with some companies expanding across the country.

The rapid growth of the industry — there are more than 75 centers, compared with 22 a decade ago, according to one count — has been propelled by the Affordable Care Act and other changes in health insurancelaws that have increased coverage for mental disorders, as well as by investments from private equity firms.

The residential programs, their directors say, fill a dire need, serving patients from areas where no adequate treatment is available. “Only 15 to 30 percent of people have access to specialized care for eating disorders, which means there are a lot of people out there who have zippo,” said Doug Bunnell, the chief clinical officer for Monte Nido, a program that began in Malibu, Calif., and now operates centers in five states.

But the advertising and the profusion of centers, which typically cost $1,000 a day but can run much higher, is raising concerns among some eating disorders experts, who worry that some programs may be taking advantage of vulnerable patients and their families.

In the companies’ rush to expand, they argue, quality of treatment may be sacrificed for profit. And they question whether the spalike atmosphere of some programs is so comfortable that it fosters dependency.

“For the most part, the people who are running and working in these programs believe they’re doing the right thing,” said Dr. Angela Guarda, the director of the eating disorders program at the Johns Hopkins Hospitalin Baltimore.

“But it’s a slippery slope,” she said. “Money can cloud your view.”

Many eating disorders specialists agree that some patients require the supervision of residential programs and benefit from the treatment. But studies showing the programs’ effectiveness are scant, Dr. Guarda and other experts said. The methods of the handful of studies that exist have been criticized.

The quality and form of treatment varies widely across centers, and in some cases includes approaches — equine therapy, for example, or “faith-based” treatment — with little or no scientific evidence behind them. Some programs have full-time psychiatrists and medical doctors on staff, but others lack the expertise to handle emergencies or treat patients with coexisting medical or psychiatric problems.

The perks offered to outside clinicians who might refer patients, the experts say, include free trips, restaurant meals, educational seminars and small gifts like pens and key chains dispensed at professional meetings. Critics liken them to pharmaceutical industry tactics that led to laws and policies requiring financial disclosure, though on a smaller scale. Studies had shown that even small gifts from drug companies, like free medication samples, affected doctors’ prescription practices.

In an article to be published Monday in the journal Psychiatric Services, Dr. Evelyn Attia, a professor of psychiatry and director of theeating disorders program at Columbia University Medical Center, and four colleagues called for more transparency about the financial relationships between residential centers and the professionals who send them patients, and urged clinicians to be mindful of efforts to influence their recommended treatment.

“The effect of these clinician inducements, which are aimed at building a program’s patient referral base, may not be fully recognized by the professionals they target,” wrote Dr. Attia and her colleagues, who included Dr. Guarda.

Several industry representatives said that while they had not seen the journal article, they agreed that more data on patient outcomes and stricter standards were needed. But, they said, the trips and seminars offered to clinicians were primarily educational. “I don’t think anyone in the eating disorders world is giving out swimming pools and trips to Europe and things like that,” Dr. Bunnell said.

Jillian Lampert, president of the Residential Eating Disorders Consortium, a group that represents about 85 percent of the centers, said, “Health care’s always been a business,” adding that quality and profit were not mutually exclusive. If there are concerns, she said, “we are incredibly open to having those conversations.”

A Deadly Mental Illness

Eating disorders are among the most difficult mental illnesses to treat.

Anorexia, in particular, has stymied many of psychiatry’s best treatment efforts. The illness has the highest mortality rate of any mental disorder, with patients dying from the medical complications of starvation or from suicide. And patients often resist treatments that make them feel uncomfortable.

The most severely ill patients — the prognosis is grimmer the longer someone has anorexia, studies suggest — require hospital treatment just to stay alive. But even after being stabilized, many patients need continual supervision for a time to regain weight and learn new behavior. The length of stay in residential centers ranges from two weeks to a year. A 2006 study found that the average stay was 83 days.

In the past, health insurance companies placed strict limits on coverage for eating disorders, treating them differently from other medical illnesses. Few insurers were willing to pay for 24-hour care after a patient was out of immediate danger.

But the passage of the Mental Health Parity and Addiction Equity Act in 2008 and the Affordable Care Act two years later mandated equal treatment. Lawsuits brought by the families of patients who were denied coverage added to the pressure on insurers. In 2012, a federal appeals court ruled that health plans must cover residential treatment for anorexia under California’s parity law. The higher reimbursement rates offered some relief to families, who had often mortgaged their houses or drained their savings to pay for critically needed care.

They also attracted the attention of Wall Street investors, who saw profits in providing treatment for so-called behavioral health problems like eating disorders, alcoholism and drug abuse. “The number of covered lives is growing faster than the availability of services to treat them, creating compelling investment opportunities,” the accounting and consulting firm BDO noted last year in an article on its website, referring to the effects of the legal changes.

As the industry has expanded, larger centers have acquired smaller ones and some programs, flush with private equity investments, have expanded across the country.

For example, Monte Nido, a treatment program founded by Carolyn Costin, a former teacher who recovered from an eating disorder, began with a center in Malibu.

But in 2012, with financing from Centre Partners, a middle-market equity firm, Monte Nido began opening new residential centers and day-treatment programs. The company now has centers in Oregon, Massachusetts, Pennsylvania and New York, including one in a renovated mansion in Westchester County.

Last year, noting that the investment had “tripled the company’s facility footprint during our ownership period,” Centre Partners sold Monte Nido to another investment firm, Levine Leichtman Capital Partners, for an undisclosed sum.

“I believe that the Monte Nido’s [sic] approach to eating disorder treatment is what you and others like you have been waiting for,” Ms. Costin wrote in a letter to potential patients on the company’s website, which includes images of beaches, mountains and the Boston skyline on its home page.

With a need to fill more beds, marketers for some centers make cold calls to psychiatrists, psychotherapists, medical doctors and others who treat eating disorders, offering to inform them about a program’s advantages and inviting them to visit.

The Denver-based Eating Recovery Center has a call center and employs 20 “professional relations liaisons” who contact clinicians across the country. The author and motivational speaker Jenni Schaefer, who recovered from an eating disorder, recently joined the program’s outreach team. On its website, the company, which began with a single center, bills itself as “the only national health care system devoted to serious eating disorders at all levels of care.”

Craig Johnson, a well-known eating disorders specialist, joined the company in 2010 and has seen it through its expansion to 24 treatment programs in seven states, including three residential centers. He said when therapists visit, the focus is education, not entertainment. “We’re delivering lectures,” Dr. Johnson said.

Some therapists see the offer of free trips as a chance to view the facilities that they might recommend to patients.

Ann Jacob Smith, a family therapist in Chevy Chase, Md., said that last year, she accepted an invitation to visit the Oliver-Pyatt eating disorders center in Miami. (The center is now part of Monte Nido).

“It was absolutely promotional,” she said, “But it was actually really educational. They took us in depth into what they did.”

Her later referrals were not influenced by the visit, she added. “I’m not impressed by being romanced.”

But Adrian Brown, a psychiatrist in Virginia, said that therapists who had not gone through the “battle phase” with drug companies might not even realize they were being swayed by financial interests.

Dr. Brown recalled being offered a “V.I.P.” trip to a treatment center, with the representative telling her, “We will pay your way, put you up in a really nice hotel, all expenses paid, yoga and whatever.”

Dr. Brown responded, “No, that’s not ethical.”

The representative replied, “What do you mean?” Another invitation arrived the next year.

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Jillian Lampert heads a group representing eating disorder centers that is seeking to establish standards for accreditation. Below, some centers’ promotional images. CreditJenn Ackerman for The New York Times

Mixed Results

Prospective patients or family members searching for a treatment program sometimes turn to edtreatmentreview.com, where former patients describe their experiences at different centers, evaluating the staff, critiquing the food and noting whether cellphones are allowed.

Many reviewers have spent time in more than one residential center and the opinions on any particular program vary widely, a range reflected in interviews with former patients over the last several months.

Tina Klaus, a 51-year-old artist who has struggled with bulimia since she was 10, said residential care was initially useful.

“Residential treatment is vital when you are at your ultimate rock bottom” she said. But once home, her illness worsened because “you’re going back into your life, you’re going back into all the emotions you used your eating disorder to hide from.”

Melissa R., 28, who asked that her last name not be used for reasons of privacy, said after several hospitalizations for anorexia, beginning when she was 21, she found a residential center in the Southwest on the Internet and spent six weeks there. The center, which she described as “more like a resort,” was “somewhat helpful,” she said, but not worth the time and money.

“People were nice, and the food was really good,” she said. “I had fun, I enjoyed rock climbing and stuff, but that’s not why I was there. I’m paying a lot of money to get well, not to rock climb.”

Last year, she spent two months at Eating Recovery Center in Denver, moving from residential care to day treatment, and began to gain control of her illness. “E.R.C. was the best place I’ve been,” she said about the center. “They were very individualized.”

Ashley Bilkie, 29, had a different experience with E.R.C. When she returned home in February 2015 after about six months in the Denver program — her fourth stay in an inpatient program for treatment of anorexia and her second at E.R.C. — “I was getting sicker and sicker,” she said. She lost the weight she had gained back at the center. “I had to buy children’s clothing,” she said.

She was evasive with her parents. At the recovery center, she said, “It was kind of like they set up a battle between myself and my parents.” For their part, Ms. Bilkie’s parents, who for years had watched their daughter’s health decline, grew frantic. Ms. Bilkie would disappear, her father, Robert Bilkie, said, and he would find her wandering the aisles at Kroger or Target. Driving through the neighborhood, he half-expected to see her hanging from a tree.

“It’s a parent’s worst nightmare,” he said.

It was also expensive. Mr. Bilkie, a financial adviser in Michigan, calculated that over three years, he paid at least $350,000 for unreimbursed inpatient care for his daughter. The Eating Recovery Center, he said, sent him bills for $30,000 each month. Mr. Bilkie paid willingly — he was desperate to see Ashley get well, he said — but no program seemed to produce lasting results.

“We spent an outrageous amount of money for what really amounted to ineffectual treatment,” Mr. Bilkie said.

Last fall, Ms. Bilkie entered the eating disorder center at the Johns Hopkins Medical Center, a university affiliated program.

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Ms. Bilkie is studying to be a nurse. CreditLaura McDermott for The New York Times

The staff there gradually weaned her off some drugs she had been taking taking at the center in Denver, including high doses of Xanax, a tranquilizer, and Adderall, an attention deficit drug and a stimulant.

In group therapy, other patients put pressure on her to change her behavior. It was a switch, she said, from previous groups, where patients talked about their problems. With the program’s stress on weight restoration — studies show that it is the best predictor of how anorexic patients will do once they leave, rather than, say, elevated mood — her weight returned to normal.

She was discharged in November and continues to do well.

“I hated every single solitary second of it,” she said of the experience. “But that’s a good thing, because I was not comfortable, and it meant that something was working.”

Dr. Ovidio Bermudez, the chief clinical officer of Eating Recovery Center, said that other patients have fared poorly at academic centers and then done well at E.R.C. Despite Ms. Bilkie’s perception, he said, therapists at the program did not try to divide patients from their families. (Ms. Bilkie gave Eating Recovery Center permission to discuss her case.)

“We would have to filter this through 20/20 hindsight,” Dr. Bermudez said. “It’s really hard to know what somebody’s frame of mind is and the degree of fragility they bring to any treatment experience.”

Dr. Anne Marie O’Melia, a psychiatrist at the recovery center, said Ms. Bilkie was on Xanax when she arrived and was fearful of reducing the drug’s dosage, though the center tried. She was switched to Adderall from another stimulant at E.R.C., Dr. O’Melia said, to treat “significant impulsivity.”

Seeking Standards

Ms. Bilkie’s history of ups and downs is not unusual for patients with eating disorders.

“In many cases, you see one step forward, two steps back,” said Dr. Mark Friedlander, the chief medical officer for Aetna Behavioral Health.

His company, Dr. Friedlander said, considers residential care essential for treatment of some patients. But, he said, a lack of outcome studies, an absence of industry standards and a patchwork licensing system across states make it difficult for Aetna or other insurers to evaluate care.

“We would love to see greater consistency and higher standards,” he said.

To that end, a group of eating disorder specialists from treatment centers, including Eating Recovery Center and Monte Nido, have developed a list of minimum requirements for accreditation of residential programs. The Joint Commission, an independent company that accredits health care facilities, has adopted the requirements, which go into effect July 1.

Dr. Lampert, president of the consortium, said the centers in the organization were also collecting data on patient outcomes, lengths of stay and other variables, with each center collecting data on 15 consecutive admissions of adults and adolescents.

In the meantime, many patients and families will continue to rely on word of mouth and any information they can find online.

“These are black boxes,” Dr. Scott Hadland, an adolescent medicine specialist at Harvard Medical School, said of the residential centers. “People get the idea that these are places that can heal just based on what they see on a website or in the photos.”

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Daily Marijuana Use for Chronic Pain is Safe, Effective

Chronic pain patients who use herbal cannabis daily for one-year report reduced discomfort and increased quality of life compared to controls, and do not experience an increased risk of serious side effects, according to clinical data published online ahead of print in theJournal of Pain.

Researchers at McGill University in Montreal assessed the long-term health of 216 medicinal cannabis users with chronic non-cancer pain who consumed a daily standardized dose (12.5 percent THC) of herbal cannabis compared to 215 controls (chronic pain suffers who did not use cannabis). Subjects in study were approved by Health Canada to legally use medicinal cannabis and consumed, on average, 2.5 grams of herb per day, typically via inhalation or vaporization.

Investigators reported that daily cannabis consumers possessed no greater risk than non-users to experience “serious adverse events.” Specifically, researchers identified no significant adverse changes in consumers’ cognitive skills, pulmonary function, or blood work following one-year of daily cannabis consumption. Medical cannabis consumers did report elevated risk of experiencing “non-serious adverse events” (e.g., cough, dizziness, paranoia) compared to controls; however, authors classified these to be “mild to moderate.”

Pain patients who used cannabis reported a reduced sense of pain compared to controls, as well as reduced anxiety, depression, and fatigue.

“Quality-controlled herbal cannabis, when used by cannabis-experienced patients as part of a monitored treatment program over one year, appears to have a reasonable safety profile,” authors concluded.

The study is one of the first to ever assess the long-term safety and efficacy of medicinal cannabis. A prior health review of patients receiving medical cannabis monthly from the US federal government as part of the Compassionate Investigational New Drug program similarly reported that cannabis possesses therapeutic efficacy and an acceptable side-effect profile.

Full text of the study, “Cannabis for the Management of Pain: Assessment of Safety Study,” appears online here.

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24 Things No One Talks About When It Comes to Having Fibromyalgia

A lot of information comes up when you Google “fibromyalgia” — associated symptoms, treatment options and the like. It’s probably similar to what a doctor might tell someone recently diagnosed. But a lot goes unmentioned — things you might not know unless you have fibromyalgia or love someone who does. And even then, as is true with many chronic illnesses, there are things people who have it just don’t talk about.

We asked people with fibromyalgia in our community to share one thing not often talked about when it comes to having this disease. Every answer offers more insight into this misunderstood illness — and hopefully increases awareness and advocacy in the process.

1. “There’s a lack of knowledge about fibromyalgia in the medical community.” — Kayleigh May Meek

Blurred photo of stethoscope with the text: "There is a lack of knowledge about fibromyalgia in the medical community."

2. “It can negatively effect a person’s sex life and relationship issues may arise because of this. I have found this to be the most isolating part of the diagnosis.” — Alison Taylor

3. “It is so much more than having to accept not feeling good or having to take medication. Regardless of interest or motivation, it cuts down on your life and what you can do, and what goals you can set and ultimately changes how you see yourself.” — Mary Lynne Mountjoy

4. “It is a real chronic illness. It is not something doctors tell patients just because they do not know what the true problem is.” — Lexi Potter

Hands holding clouds with the text: “It is a real chronic illness. It is not something doctors tell patients just because they do not know what the true problem is."

5. “There will be pain even after treatment and lifestyle changes. It is chronic pain. It can be managed but not cured. Flare-ups will occur like a surprise smack in the face.” — Nikki Albert

6. “It impacts your ability to follow your career dreams, to interact the way you want to with your children.” — Stacy Schofield Adkins

7. “Fibromyalgia doesn’t play fair. The physically stronger people don’t overcome, unfortunately. You have to become smarter and learn your limits.” — Julie Garver

8. “It is a progressive illness and seems to get worse every year for me. Plus so much gets blamed on it once you get a diagnosis that other problems that actually aren’t the fibromyalgia get missed.” — Janet Secord

9. “Fibromyalgia is different for different people. My fibro means my feet often feel like they’re burning and I have to use ice-packs on them, but my friend with fibro always has freezing cold feet and has to wear thick, warm socks and use warm foot baths. The only similarity is that neither of us regulate or own body temperature very well. This isn’t a one-size-fits-all diagnosis, and there isn’t a one-size-fits-all treatment.” — Joanne Purewal

Four figs on a wooden table with the text: "This isn't a one-size-fits-all diagnosis, and there isn't a one-size-fits-all treatment."

10. “No one talks about the stress it puts on relationships. The inability to be able to do the things you love, as well as keeping the house clean.” — Echo Shifley

11. “The fear. It is incredibly scary to be diagnosed with a disease that half the medical profession doesn’t believe in, doesn’t know what causes it and doesn’t know how to fix it. It’s really scary not to be in control of your own body. I have no idea why it does half the things it does. The scariest thing is I never know if my symptoms are fibro or something more sinister. I’m very scared that one day they will discover something terrible that has been explained away by fibro.” — Kathleen Hughes

12. “Pain and fatigue is just the tip of the iceberg. It affects literally everything!” — Winifred Kakouris

13. “It is so unpredictable. One day I can be feeling pretty OK and actually get a few things done, and the next day I’ll wake up feeling like I got hit by a truck. Some days I need a cane, some days I need a walker, some days I can’t even get out of bed.” — Vanessa Blevins

14. “Family and friends don’t seem to understand the emotional impact fibro has on my life… how much depression and anxiety being in constant pain brings. I can’t just snap out of it. I literally mourn the loss of my former self.” — Terri Brown-Watson

15. “It takes energy to move through the pain and fog to be productive. So many compromises all through the day. If I shovel the walk will I be able to prepare dinner? Will my children manage if a play with them for two hours then need to sleep four hours?” — Judith Brain

16. “It can be isolating and utterly devastating to have everyone not believe you. It’s soul crushing to be told, ‘It’s all in your head’ and that your pain is not valid. — Katie Andersen

17. “Having fibro is a roller coaster ride. I don’t ever know what’s coming next, and the emotions that come with it — well, that’s just overwhelming at times.” — Amy Reilly

18. “You may have guilt over not being able to do all the things you need and want to do every day. It’s crushing and one of the main reasons I feel so depressed.” — Jennifer Leigh Brown

19. “No matter how hard you try to relax, sometimes your muscles just won’t.” — Brandy Bowie Fallon

Feet hanging over the side of a couch with the text: “No matter how hard you try to relax, sometimes your muscles just won’t.” — Brandy Bowie Fallon

20. “Of those living with fibro, approximately 90 percent are women. There absolutely should be the deliberate and scientific presence of a gender bias that brings new insight into women’s health and treatment, while confronting this disease. Instead, there is often a sexist cultural gender bias at work in confronting, and undermining, the women who live with it.” — Arria Deepwater

21. “No one talks about how often we force ourselves to do things we really don’t want to do, only because we get tired of seeing the look of disappointment in the eyes of others.” — Lin WallBonn

22. “It’s hard to balance earning a living, what friends expect of you, your own expectations, and your family responsibilities without triggering a flare.” — Karen Glorsky Epstein

23. “No one talks about how many times you’ll hear that ‘it’s all in your head.’ That ‘no one can be that sick.’ No one tells you how people will leave your life because they can’t handle it.” — Katherine Herrmann

24. “It affects your family. My mom suffers from fibro. I can recall many instances when I was younger thinking to myself, ‘Why can’t my mom just be like other moms and do cool, fun stuff.’ Now 12 years later I’m married and have kids, and I am just now realizing she did everything she could to store up energy for one good day out of every 15 to 20 days just for her kids. I can’t sit back and say I didn’t notice a difference in my childhood because of fibro because I did. What I can say is I’ve learned the meaning of loving sacrifice from it.” — Ana Tomson

*Some answers have been shortened for brevity and clarity.

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15 Things To Remember If You Love A Person With Bipolar Disorder

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Bipolar disorder can be a challenge to navigate. The disorder is fundamentally characterized by dramatic mood swings and can lead to struggles in personal relationships. The National Institute of Health estimates that nearly 2.6 million Americans are currently effected by the disorder. This means that many loved ones are faced with the challenges involved in supporting individuals with this disorder. In order to provide the best support network possible, there are several things to keep in mind when working with an individual with bipolar disorder.

1. They experience emotions on extra loud when in a state of mania

Although we usually explain mood swings in terms of highs and lows, it is not the case that bipolar individuals feel all great happy things when in a state of mania. Instead, all the emotions one normally experiences are on a more intense setting. Everything comes through louder and it can be very difficult to navigate everyday life with such an intensity.

2. They have to navigate a lot of complex medications

Currently, medications for bipolar disorder do not effect everyone equally. As a result, each individual has to work through a complicated web of proper medications in order to find the best balance. This takes time and energy from the individual and can lead to higher levels of stress.

3. They miss perceiving the world as they did prior to the disorder

Depression and mania can cause one’s perception of the world to change dramatically. This can be both exhausting and frustrating. When the medications start to balance out and things begin to stabilize, the individual may again see things through a more normal lens. This can be a great feeling, but it can also be frightening because its unclear if this will last.

4. They enjoy parts of mania, but ultimately feel exhausted by them

There are parts of mania which are exciting and fun. Colors are more vibrant and individuals often feel incredibly empowered; however, every episode of mania comes with a deep slide into depression. The obsession and highs of mania take incredible amounts of energy and ultimately wear the individual out.

5. They sometimes consider going off their medication

This is not true for all individuals with bipolar disorder, but when the medications begin to work and stabilize the everyday experiences of the individual, it can take some time to adjust. The life of an individual with bipolar disorder is filled with extremes. When medications begin to remove some of those extremes, it may feel somewhat boring. This sensation typically passes as the individual realizes this is a healthier way of life, but before that realization can come, he or she may be tempted to return to the extremes.

6. They often struggle to be open about their disorder

Revealing one’s struggles with bipolar disorder can lead to feeling vulnerable. It takes a lot of guts to trust another individual with this information, even though he or she may really want to help their loved ones understand the explanation behind their sometimes unusual behavior.

7. They experience more than the normal ups and downs of life

Everyone feels highs and lows, but individuals with bipolar disorder are experiencing much more. It is important to respect this difference and not put unreasonable expectations on the individual as a result.

8. They are not alone in their struggles with mental health

Millions of Americans struggle with mental health issues. Although bipolar disorder has its own unique characteristics, many people are trying to navigate the complexities of mental health. That means those trying to support such individuals are also not alone. Seek support if you need it.

9. They don’t necessarily want your sympathy

Of course we all need a bit of sympathy here and there, but you shouldn’t assume right off the bat that sympathy is required. It is best to listen and try to understand as much as you can. Avoid saying you understand more than you do, and be weary of giving out too much advice. Just be a friend that listens and you will be great.

10. They will never “cure” their disorder, but can learn to manage it

Bipolar disorder is with the individual for a lifetime. There is no medical solution to curing the condition. Through medication and often therapy the disorder can be managed so the individual may live a healthier life, but there currently is no “cure.”

11. They may or may not be more creative than the average person

There has been some research indicating a connection between bipolar disorder and creativity; however, creative abilities are not necessarily part of the package. For some, such as Stephen Fry and Demi Lovato, their disorder does seem to contribute to their creativity.

12. They were not diagnosed via a specific test

Bipolar disorder is complex and currently there is no single test one can take to determine if he or she has the disorder. As a result, it often takes some time and careful analysis from a professional to receive the diagnosis. As a loved one, you are probably not in the best position to diagnose someone or seriously challenge the diagnosis, so take concerns directly to the doctors if necessary.

13. They want to know you love them, no matter what their current state

Whether its a moment of mania, or a time slice in the depths of depression, stability and love are critical. The world is an extreme place for someone with this disorder, and whatever pieces of stability they can latch onto are critical to their sense of well being. You can help by being consistent and finding ways to communicate your love to the individual.

14. They might need you to wait until they are ready

Sometimes the best you can do for someone with bipolar disorder is give them the time they need. Although your friend may want to come out with you or call you on the phone, sometimes they truly need some time to process through their current experience. Sometimes the gift of time is truly the greatest a friend can give.

15. They want to be treated like everybody else

Bipolar disorder comes with a lot of unusual experiences, but deep down each person longs to live a normal life. Its important that those supporting such individuals strive to provide the space needed for this individual’s health, but whenever possible, he or she should be treated like everybody else.

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5 Things You Need to Know About Gluten

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Unless you’ve been on a media-free diet, you probably saw Jimmy Kimmel Live’s hilarious ‘What is Gluten?’ video, in which none of the gluten avoiders interviewed could explain exactly what gluten is. The truth is, most of my gluten-free clients don’t really know what it is either (check out my previous post Your 5 Worst Gluten-Free Mistakes), but they do know that they feel better when they avoid it.

But there’s a problem: I noticed that some of the things people said in Kimmel’s video, like where they think gluten is found, were just plain incorrect. The video has more than 2 million views, so I thought it would be helpful to provide a primer. Here are five things you should know before starting a gluten-free diet, in order to reap the benefits and avoid the pitfalls.

Gluten is a protein

Yup, gluten is a type of protein naturally found in wheat (including spelt, kamut, farro, and bulgur) and other grains, like barley and rye. But gluten also lurks in many products, like salad dressings, seasoning mixes, vitamins, and even lip balm, so eliminating it completely is a big commitment. I’ve met many people who say they are gluten-free, but in reality they’ve just eliminated wheat-based foods like bread, pasta, and bagels, because they think wheat is the only source. If you truly need to banish gluten altogether, you need to become a gluten sleuth.

Gluten isn’t in every type of grain

I’ve heard many people say that gluten is found in grains period, but that’s not the case. There are several grains that are naturally gluten-free, including rice, corn and popcorn, quinoa, amaranth, buckwheat, millet, sorghum, teff, and oats (as long as they haven’t been contaminated with wheat during processing). In other words, gluten-free and grain-free aren’t synonymous, and I don’t recommend the latter. Gluten-free whole grainsare chock full of vitamins, minerals, antioxidants, and fiber, and as long as you don’t overdo it portion-wise, including them in your diet can help you lose weight, and protect your health. Unfortunately the gluten-free craze has given all grains a bit of a black eye, but refined white pasta and quinoa aren’t even close to being in the same category from a nutrition perspective.

Gluten-free foods can be processed, too

Some people are under the assumption that all processed foods contain gluten and no gluten-free foods are refined or processed, but that’s not accurate. Because gluten-free has exploded in popularity, there are more gluten-free products than ever, and many are highly processed, or made with refined versions of gluten-free grains, such as white rice. For the best nutritional bang for your buck, look beyond the words “gluten-free” on a package and read the ingredient list—it should read like a recipe you could recreate in your own kitchen. And if grains are included (some gluten-free products are made with other starches, like potatoes or beans), they should be whole, which means they haven’t been stripped of their fiber and nutrients.

Avoiding gluten may help you feel better, even if you don’t have Celiac disease

People who have Celiac disease must completely eliminate gluten, because consuming even small amounts triggers symptoms, including belly pain and bloating. This happens because in people with Celiac, gluten causes the immune system to damage or destroy villi, the tiny, finger-like outgrowths that line the small intestine like a microscopic plush carpet. Healthy villi absorb nutrients through the intestinal wall into the bloodstream, so when they become damaged, chronic malnutrition occurs, which is typically accompanied by weight loss and exhaustion. In people with this diagnosis, avoiding gluten is the only way to reverse the damage.

However, people who test negative for Celiac may also benefit from going gluten-free if they’re experiencing a condition called gluten intolerance, or gluten sensitivity. While it’s not the same as Celiac disease, consuming gluten can cause bothersome side effects in many people, including flu-like feelings, bloating and other gastrointestinal problems, mental fogginess, and fatigue. Unfortunately at this time, there is no widely accepted test for gluten sensitivity, and the symptoms may be related to other issues, including stress, so it’s not black and white. If you think you may have a gluten sensitivity, avoid gluten and monitor how you feel.

What you eat when going gluten-free is as important as what you don’t

A lot of people who go gluten-free focus on getting rid of foods, but to balance your diet and ensure that you’re taking in a broad spectrum of nutrients, it’s also important to emphasize what you do eat. As I noted, there are several nutrient-packed whole grains that are naturally gluten-free. So if your old standby side dish was pasta, replace it with something like whole grain rice (brown, red, black, or wild), quinoa, or roasted organic corn.

Fresh veggies and fruits, beans, lentils, and nuts are also gluten-free, so if you used to nibble on crackers, pretzels, or cookies, trade them for wholesome snacks, like veggies with hummus, berries with nuts, or roasted chickpeas. One of the key benefits of adopting a gluten-free diet is that it’s an opportunity to reinvent the way you eat. Take it on it by seeking out superfoods, so in addition to getting rid of gluten, you’ll also be embracing a wide variety of nutrients that will help you look and feel your best.

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