Eating Disorders and Nutrition News

Veganism Can Be a Cover for an Eating Disorder

I want to share one of the responses I received from the interview I did for writer Danielle Friedman on the connection between vegetarianism and veganism and eating disorders. In an email I was asked if I was misquoted (see Friedman's article below): did I really think parents should be discouraging if not outright prohibiting their pre-college aged children from becoming vegetarian or vegan? Here is my response:

I was not misquoted, but I think you missed an important point. I said: "Most families don't have the time to prepare vegetarian entrées." In fact both of my children (now young adults) were vegetarians as teenagers. As a parent, I made sure that we offered high protein vegetarian entrees at  every meal. In a lot of families, when one child goes vegetarian, all it  means is that they don't eat the meat, chicken or fish dishes, but no alternatives are provided. This is a child that could end up with a nutrient deficiency. Of note, my son is still a vegetarian, my daughter had to give it up when she had fainting spells due to low iron. Some people have no problem getting iron out of plant foods, others due to genetics need animal based iron to be healthy. I am the same way.

Let me add here that if parents have any concerns about their child being at risk for developing an eating disorder then this is a child who should not be allowed to experiment with vegetarianism until reaching adulthood.

 

When Veganism Is an Eating Disorder

by Danielle Friedman Info

 

Danielle Friedman has worked as a nonfiction book editor for Hudson Street Press and Plume, two imprints of Penguin Group. Her writing has been published in the Miami Herald, and on DoubleX and CNN.com. She is a graduate of the Columbia University Graduate School of Journalism.

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For people who refuse to consume any animal products, acceptable food can be hard to come by—which makes veganism a perfect cover for those hiding their anorexia.

When Jill Miller reflects on her long, painful dance with veganism, anorexia, and bulimia, she remembers standing alone in her kitchen, binge-eating a tofu-cream pie.

These episodes of stuffing herself with whipped soy—when what she really wanted was a pint of Ben & Jerry’s—stand out in her mind as a sign that her commitment to veganism was a cover for something darker. As do the many times that she turned down food with the seemingly innocent, even noble excuse that no one could argue with: Oh, sorry. I can’t eat that—I’m vegan.

“No prime rib and Yorkshire pudding at New Year’s with Grandpa,” says Miller. “This happened at every family event.”

“I seized on the food theory of veganism to justify my desire to restrict,” says one former vegan. “It was a convenient way to eliminate fat and calories.”

The shame, discomfort, and self-loathing represented by her eating habits defined much of her early life. When she was just 13, Miller became a vegetarian, in part for philosophical reasons, but mainly as an excuse to avoid her mom’s New Orleans-style chicken-fried steak and jambalaya. As she forged a career in yoga instruction, she further restricted her diet by going vegan, all the while struggling with an eating disorder that she kept under wraps.

“I seized on the food theory of veganism to justify my desire to restrict,” she told The Daily Beast. “It was a convenient way to eliminate fat and calories.”

A breakthrough came shortly after she turned 30. She realized that the only way to fight her illness—and be happy—was to stop saying “no” to so many foods, and begin saying “yes.” She’s now an omnivorous yoga guruhttp://www.jillmilleryoga.com/, starring in dozens of instructional DVDs, and she’s never felt better.

As veganism moves from the fringes to the mainstream of American culture, with A-listers like Natalie Portman and Jonathan Safran Foer loudly endorsing it, more Americans are giving it a whirl. Five percent of people in this country identify as vegan, according to a 2002 Time/CNN poll. And for most, becoming vegan can mark a healthy shift toward wholesome eating and concern for the welfare of animals. But for those at risk of developing an eating disorder, it can mask or trigger an illness, providing a socially conscious excuse not to partake in family barbeques or dinners out with friends.

According to Dr. Angela Guarda, director of the Johns Hopkins Eating Disorders Program, many vegans (and vegetarians) who enter her treatment center initially deny an underlying problem—only to later confess that their efforts to avoid animal products were really an effort to avoid food in general. “In most of our patients, the vegetarianism is in the service of the eating disorder,” she said.

For this reason, Guarda and her staff try to dissuade patients from observing any form of vegetarianism while undergoing treatment, encouraging them to broaden their food repertoire to include some meat. Other eating disorder and nutrition specialists report similar approaches.

Dr. Marcia Herrin, founder of the Dartmouth College Eating Disorders Prevention, Education and Treatment Program and now a dietician in private practice, takes a stricter (if potentially problematic) approach: Herrin tells parents not to let their kids be vegetarian until they go to college, echoing that the diet can create a “ruse” that loved ones can’t see through. “Most families don’t have the time to prepare vegetarian entrées,” she said. “What’s at risk is the child’s growth and development, and potentially an eating disorder.”

Herrin may be onto something: A 2009 study in the Journal of the American Dietetic Association revealed that young adults ages 15 to 23 who reported being vegetarian were, at some point, more likely to have also engaged in unhealthy weight-loss behaviors like bingeing, purging, and using diet pills or laxatives. And surveys show that the prevalence of vegetarianism among eating-disorder patients is higher than in the general population.

It’s important to note that for most of the country’s roughly 3 million vegans, who don’t consume or wear any animal products, their eating habits never veer into mental illness. Many consider veganism a lifestyle, says Annie Hartnett, an animal-rights activist and blogger for Change.org, or a protest against cruel farming practices. And studies have found that the physical benefits of veganism, when observed in a healthy way, are extraordinary, including lowered risk of chronic disease, improved heart health, and increased energy.

Problems arise when individuals approach veganism primarily as a vehicle for weight loss, and indeed, more than ever, it’s being marketed by certain proponents as an extreme diet. Last month, actress Jessica Simpson tweeted that she’s going vegan, along with drinking a popular weight-loss tea. While she later claimed the veganism isn’t to shed pounds, tabloids have since treated it as if it were the next Atkins Diet. Then there’s the bestselling Skinny Bitch series, a vegan manifesto in diet-book packaging. Even PETA is guilty: This past May, the organization proposed placing an ad on the Great Wall of China, depicting an overweight American tourist, with the caption: “It’s the Wall That We Should See From Space, Not You. Go Vegan.”

At the most toxic end of the eating-disorder spectrum, “Pro-ana” websites pitch veganism as a trick of the trade, so to speak—as both a weight-loss plan and a front so no one will notice you’re anorexic. When Georgia Hollenbeck, 24, was in her early teens and spiraling into anorexia and bulimia, the veterinary worker decided to give veganism a try after reading about it on one of these sites. “I’m from Michigan, so we eat a lot of meat here,” she said. As such, becoming vegan allowed her to say “no, thanks” to meals much of the time, and allowed her eating disorders to flourish in secret.

Of course, some embark on vegan diets for all the seemingly right reasons, only to find themselves on a slippery slope to disordered eating. As with alcohol or cigarettes, exposure combined with biological predisposition can lead to abuse. “Going on any kind of diet where you’re paying a lot of attention to what you eat or don’t eat puts you at risk for an eating disorder,” says Herrin. “Especially when you label certain foods as ‘bad.’”

Recently, reports of “orthorexia” have captured headlines. Those who suffer from the controversial new disorder compulsively avoid foods thought to be unhealthy or unnatural, including products with trans fats, artificial colors, or flavors, high-fructose corn syrup, and preservatives. Often, orthorexics opt for a strict vegan diet. Some say orthorexia represents this dangerous slide from health to pathology.

To ensure both physical and psychological health, emerging vegans should educate themselves on how to maintain balanced nutrition and weight, says Keri Gans, a spokesman for the American Dietetic Association and a practicing dietician in Manhattan. Replacing meat and dairy with plant-based sources of protein and fat is crucial, as is taking certain vitamin supplements. If they’re not vigilant, vegans can become lethargic and malnourished; they’re particularly at risk for Vitamin B-12 deficiency, which can lead to deterioration of the spinal cord.

“A person who undertakes veganism as a lifestyle, not related to any kind of eating disorder, will know that they have to replace the foods they’ve eliminated with new foods,” says Gans. “If they’re saying to me, ‘Let’s talk about ways to add more foods into my diet, I’m not afraid of healthy fats,’ I’ll say to myself, ‘OK, this person gets it.’” If not, the veganism may be a red flag.

Perhaps counterintuitively, some who are in recovery from an eating disorder say adopting a vegan diet helped to nurse them back to health. After struggling with anorexia and drug use in her 20s, Mandi Babkes embarked on an all-raw, vegan diet. She now runs a holistic health practice and raw-food vegan catering business in Pittsburgh, explaining that while her eating disorders were about self-destruction, her veganism is about self-love. "Being a vegan and raw foodist really helped me to feel better, to feel cleaner, to feel more energized,” she said. “I sleep better, and I have a brighter outlook.”

 

Still, many dieticians and eating-disorder specialists hesitate to recommend a vegan diet as a path to recovery. “It’s like an alcoholic who likes to spend time in bars,” says Herrin. “It’s very risky to take on any system of eating that’s restrictive and passes judgment on food that’s not founded on health principles.”

Perhaps above all, clinicians and vegan advocates alike tend to emphasize one underlying message: At its most basic level, veganism is about practicing non-violence toward animals. And in keeping with this philosophy, its followers should look out for their own well-being, too.

Marcia

Marcia Herrin and Nancy Matsumoto, co-authors of The Parent’s Guide to Eating Disorders, Gūrze Books, (www.childhoodeatingdisorders.com).

 

Can we predict success in eating disorders treatment?

Our posts on motivation and readiness for change in eating disorders recovery seems to have touched a nerve, so why not keep the conversation going? Going through my files, I came across notes from an interesting eating disorders conference session that took place not too long ago. It was delivered by several of the most esteemed medical people in the field, Drs. Craig Johnson and Ovidio Bermudez of the Laureate Eating Disorders Program in Tulsa, Okla., along with social worker and mother of a former teen anorexic Robbie Munn. The title of their presentation was “Will That Boat Float?: Predictors of Success in Intensive Treatment.”

 

The doctors didn’t offer foolproof ways to predict whose treatment will succeed and whose won’t. Instead, they offered advice and hints on the kinds of things to keep in mind when your own loved one is in need of intensive treatment. Here are a few key points from the presentation:

 

· Why entering treatment can be so hard: Resistance to change is natural, it is a human adaptation for survival. Yet treatment means change.

· When it comes to adolescents, action needs to be taken swiftly and decisively. The longer an eating disorder continues untreated, the more entrenched and difficult to solve it becomes.

· In cases where an eating disorder endangers health, most people wait too long to go to the hospital.

· Change requires both the ability and the willingness to change.

· The more ready the patient is to change, the greater the chances of success.

· Once in treatment, don’t expect steady upward progress. Improvements in behavior will be followed by relapses. Aim for an overall upward trajectory and don’t be discouraged by inevitable backsliding.

· The malnutrition of a severe disorder can “hijack a patient’s ability to think clearly.” In some cases, an accompanying mental illness can be a barrier to treatment.

· A key factor to success is the ability to effectively treat these “co-morbid” or accompanying disorders, such as anxiety or depression, obsessive-compulsive behavior, drug and alcohol use, post-traumatic stress disorder or personality disorders. Once these conditions are under control the patient is better able to focus on recovery from the eating disorder.

 

Of course you are probably wondering,”but how do I get my child/friend/loved one to agree to entering treatment?” Drs. Johnson and Bermudez discussed Motivational Interviewing as an important technique to help patients arrive at the holy grail of “readiness to change.” For more on MI, please see our posts:  I am motivated to use Motivational Interviewing and Motivation: the first step to recovering from an eating disorder. They also discussed the “stages of readiness to change,” which Marcia and I will address in future posts. Stay tuned!

 

Nancy

Marcia Herrin and Nancy Matsumoto are co-authors of The Parent's Guide to Eating Disorders: Supporting Self-Esteem, Healthy Eating & Positive Body Image at Home (www.childhoodeatingdisorders.com).

The uneasy relationship between eating disorders prevention and obesity prevention

A recent article in The New York Times, Whether a Child Lights Up, or Chows Down, discussed the growing tension between the anti-smoking efforts directed at teens, and the anti-obesity movement. The first has been losing funding and public visibility, while the latter has become the cause du jour, attracting headlines and funds, especially in the wake of First Lady Michelle Obama’s Let’s Move program for the prevention of childhood obesity. In May, a White House Task Force on Childhood Obesity announced its goal of reducing the current 17 percent rate of childhood obesity to 5 percent by 2030.

No one can argue that smoking is deadly, or that rising obesity rates lead to increased health risks. It is also sad that in this age of shrinking federal and philanthropic funds, supporting one good public health campaign over another has become, as the Times noted, “a kind of weird zero-sum game.”

We all have to fight for recognition of the causes we support or the fields in which we work. For professionals in the eating disorders world, the big concern now is the potential negative effect of the high-profile national anti-obesity campaign. Psychotherapist, social worker and body image expert Kathy J. Kater has put together an excellent summary of these concerns, which you can find posted on the NEDA (National Eating Disorders Association) web site. In “Why "Obesity Prevention is Making Us Fatter" Kater explains how the seemingly laudable goal of obesity prevention can produce unintended harmful consequences.

“Obesity is a measurement of size,” writes Kater. “Implicit in ‘size prevention’ is the anxiety-provoking notion that there is a ‘right’ and a ‘wrong’ size to be.” For those of you with any familiarity with how an eating disorder gets started this statement will set off alarm bells. You’ve probably seen a young girl or boy who starts on the path of dieting because of a careless or mean remark about size or who, by osmosis, picks up our society’s virulent fear of fat. I’ve had moms of 5-year-olds voice to me their shock when they hear their child utter the words, “Mommy, am I too fat?” You can see where this argument is going: Obesity prevention as a goal can increase weight stigma, fear of fatness and body dissatisfaction.

Other good points Kater makes are:

· Weight bias and body dissatisfaction in most people predict poorer and disordered eating and weight gain.

· “Size prevention” denies biological diversity, or the idea that different people have different “set points,” and may be naturally heavier without being overweight.

· People led to believe they are the “wrong size” will be tempted to follow diets for weight loss even though overwhelming evidence shows that 90 percent of weight lost through weight-reduction plans is regained, and over half of dieters who regain add more weight than they lost.

· When “size” is promoted as the reason for healthy eating and fitness habits, the value of health as a primary motive for these positive habits is diminished.

What we need instead of “obesity prevention” programs, Kater argues, is to shift the model to emphasize health as a value rather than size as a goal.” Focusing on “how we live rather than what we weigh” empowers people of every size and shape to be the best they can be, and fosters a tolerance of diversity of size and shape.

Let us know where on the obesity prevention vs. health-as-a-value issue you stand!

Nancy

Marcia Herrin and Nancy Matsumoto are the co-authors of The Parent's Guide to Eating Disorders, Supporting Self-Esteem, Healthy Eating & Positive Body Image at Home (www.childhoodeatingdisorders.com)

I am motivated to use Motivational Interviewing because it works!

Nancy blogged last month about my use of motivational interviewing (MI) in my counseling practice.  MI is so helpful that I want to talk more about how I use it my counseling.

MI challenges me to work to understand my patient’s motivation for change-- what is important and relevant to him or her. Another valuable aspect of MI is the assumption that the patient and the nutritionist are both experts.  In this “dual expertise,” I know I know how to help the patient but I keep in mind that the patient knows what he or she can do and what is important.  MI encourages me to remain collaborative rather than confrontational and to maintain an atmosphere of respect.

How I talk to the patient strongly influences the patient’s motivation to change.  MI advises the counselor to resist the urge to correct the patient or to tell the patient what her or she needs or tell the patient he or she is wrong. This kind of confrontation can lead to resistance and relapse.  Research suggests that creating a partnership with the patient offers the patient a sense of “hope”, which is an important part of successful recovery.  Here are some questions that I use in my counseling that may help parents and concerned friends have more productive interactions with a loved one with an eating disorder:

"If you had a day without your eating disorder, what would you do with it?"

"What are three things you want your grandchildren to remember about you?"

"How does your eating disorder fit into the rest of your life?"

Another helpful aspect of MI is that it is affirming. I may actually thank the patient for coming for his or her session. Here are examples of other MI-flavored affirmations that I have used with my patients:

Emphasize the person’s strength:“You are intelligent.”

Compliment on a positive behavior:“I appreciate your candor.”

Show support:“I hope things go well with you for you this weekend.”

Reinforce past successes:“You were able to stop bingeing for three months last summer.”

Marcia Marcia Herrin and Nancy Matsumoto, co-authors The Parent’s Guide to Eating Disorders, Gūrze Books, (www.childhoodeatingdisorders.com).

 

Best Wishes for Huge

“Huge” premiered on Monday June 28^th on ABC Family. Huge is the first TV show to feature a cast of all plus-size people.  The jury is still out on whether Huge promotes positive body image, addresses myths and stereotypes, or helps prevent eating disorders. One challenge is the setting—a weight loss camp for teens. I hope that adolescents who do not live in thin bodies will feel heard and represented. It is refreshing to see people of size starring on television. Besides the reality shows, practically everyone is on the thin side. Nikki Blonsky, the star of Huge, says

“…as you watch the show, you’re going to forget it’s about a weight-loss camp. You’re just going to get so invested in the characters. We deal with everything from eating disorders to body issues to sexual orientation to everything that every teenager is going through right now.”

Huge is already being criticized for its publicity photo which shows Nikki in a bathing suit looking scared, insecure, and uncomfortable with herself.  I join others who have commented that we wish Nikki was smiling and confident.

Marcia

Marcia Herrin and Nancy Matsumoto, co-authors The Parent’s Guide to Eating Disorders, Gūrze Books, (www.childhoodeatingdisorders.com).

Hi Everyone,

I've started a dedicated Twitter account for eating disorders- and nutrition-related tweets. Please follow me @ednutrition on www.twitter.com !

Nancy

Marcia Herrin and Nancy Matsumoto are co-authors of The Parent's Guide to Eating Disorders: Supporting Self-Esteem, Healthy Eating & Positive Body Image at Home (www.childhoodeatingdisorders.com).

Motivation: the first step in recovering from an eating disorder

One of the hardest parts of recovering from an eating disorder is finding and maintaining the desire, motivation and will to recover. In March when I blogged about a friend I called “Jane” (Knowing when to express concern about a friend’s eating disorder), her anorexia had taken a turn for the worse and she was scared. She was on the verge of seeking in-patient treatment, but was having a hard time committing to what she knew would be an extremely difficult and destabilizing process.

 

Today, almost three months later, Jane is still struggling with the decision. Last week, she admitted to me, “I kind of lost my way again.” A month before that, she wrote,

 

My doctor is going away for 2 weeks and he wants me to go to Renfrew [treatment center], but it is a very difficult decision to make. Even though I UNDERSTAND that if something/someone can help me, it is me - making a leap and just going there. Honestly, I do not see any other real way out for myself. And it is getting more and more difficult to deal with. I just have to push myself to Renfrew so they will give me a push to start my life all over again. As a different person. It is kind of scary, 'cause I do not know who this person will be. You know what I mean? Too much was invested into the person I am now, even though it was all negative.

 

Jane’s dilemma is wrenching but not uncommon. It got me thinking about motivation, and how we can help motivate family and loved ones to take the leap of faith required to enter treatment. Marcia uses a technique called Motivational Interviewing (MI). I thought that the basic techniques of MI might be of interest to many of you. The idea behind MI is that the impetus to change has to come from the eating-disorder sufferer herself. The best thing you can do is help move her toward positive change by helping resolve the ambivalence she feels about abandoning a behavior that has become who she is.

 

This site, Motivational Interviewing: resources for clinicians, researchers and trainers offers a lot of good information. The “interaction techniques” page offers a handy acronym that captures the fundamental techniques of MI: OARS: (1) Open-ended questions, (2) Affirmations, (3) Reflective listening and (4) Summaries. The rowboat oars image, the site explains, “gives us power to move, yet it is not a powerboat. We don't zip from one place to another, yet with sustained effort OARS can take us a long way.  

 

I like the way this introductory page differentiates between the MI techniques that therapists use and the spirit of MI, which you can absorb and try to keep in mind as you talk to your eating-disordered loved one. Here’s a very condensed version of the information on the site:

· Motivation has to come from the person himself, not from outside. There’s no room for coercion, bribing, cajoling or guilt-tripping. You want to mobilize your loved one’s values and goals to stimulate change.

· It’s your loved one’s task to voice and resolve his ambivalence. You may try to facilitate this process with open-ended questions.

· Your job is not one of direct persuasion. Usually this just leads to increased resistance.

· MI is a quiet asking and listening technique. Forget about aggressive confrontation or arguing: these are the opposite of motivational. This technique may seem slow and passive, but the change comes when your loved one is really ready, not because you’ve forced the issue.

· Your job is directive, meaning you are there to help your loved one zero in on the cause of her ambivalence about healing and resolve that deep divide over wanting and yet being afraid of the task of recovery

· Readiness to change is not always a permanent condition, it comes and goes with different interpersonal interactions. Your loved one’s resistance might be a sign that you’re assuming he’s ready when he’s not yet there. Be patient.

· Think of your relationship to the loved one you are helping not as a parent-child or other hierarchical relationship, but as a partner or companion relationship. Respect your loved one’s freedom of choice. Until she decides she wants to change, it is not going to happen.

Nancy

Marcia Herrin and Nancy Matsumoto, co-authors of The Parent’s Guide to Eating Disorders: Supporting Self-Esteem, Healthy Eating & Positive Body Image at Home, Gūrze Books,www.childhoodeatingdisorders.com.

 

Delayed bulimia diagnosis and why you can’t afford to lose precious time

Eating disorders are one of those diseases that can sneak up on a child or adolescent. You may notice a few odd behaviors and not get around to delving deeper into them (after all, isn’t adolescence full of odd behaviors, most of them age appropriate?). Then suddenly you’ve got a very sick person on your hands. This is true of both anorexia and bulimia. While understandable, a delayed bulimia diagnosis can be dangerous—and in cases where purging causes electrolyte imbalances and affects the heart—even life threatening

 

There are many reasons why it can be hard to diagnose bulimia, but one frequent cause is that the patient herself is not forthcoming with information. Lacking access to the whole picture, a doctor may be forced to eliminate a long list of possible other causes for the troubling symptoms.

 

Be alert if your child:

· Complains of more than expected gastrointestinal distress, sore throats, or flu

· Spends a lot of time in the bathroom, especially after meals

· Chooses to shower after meals

· Displays red knuckles or irregular eating patterns (e.g. sometimes overeating, sometimes undereating)

Other signs to watch for are missing food that no one in the family can explain and finding evidence of your child eating in bedroom.

 

Marcia has seen many patients who have been worked up for all sorts of hypothetical diseases and conditions by doctors because the patient cannot or will not admit he is bulimic. “The doctor may say, ‘This looks like x, y, or possibly an eating disorder.’ But if the patient doesn’t come forth and say anything, the doctor is a little bit stuck,” Marcia explains.

 

Often, the patient will keep quiet because she is in denial. Sometimes it is part of a cat-and-mouse game. “This kind of thrill of pulling the wool over a doctor’s eyes is a scary and dangerous one,” says Marcia. “Precious days and weeks can be lost, and the child’s health seriously endangered.” Marcia suggests that you as parents share your concerns and observations in advance of your visit to the doctor with your child.

 

Marcia Herrin and Nancy Matsumoto are the co-authors of The Parent's Guide to Eating Disorders, Supporting Self-Esteem, Healthy Eating & Positive Body Image at Home (www.childhoodeatingdisorders.com)

 

Anorexia: Addicted to Starvation?

Recently, a colleague shared an interesting article by science writer Trisha Gura, PhD (http://www.trishagura.com), author of Lying in Weight, published in 2008 in Scientific American Mind entitled, Addicted to Starvation. A free full-text version of the Scientific American article is at http://www.trishagura.com/articles/samgurastarve.pdf. Gura looked at the science of how the lack of food may be like an addictive drug for people with anorexia. She cites the research of French scientist Valerie Compan who found using animal studies that a refusal to eat arises from abnormal activity in the brain’s reward system. Well known American eating disorder researcher Walter Kaye found that anorexic subjects, like drug addicts, are incapable of feeling pleasure from food. Brain scans of Kaye’s subjects suggest that these women are physically unable to appreciate pleasant taste sensations. Another study that supports this hypothesis is the famous 1944 Ancel Keys study. Keys semi-starved 36 young men for 24 weeks. When the study was over and the men were allowed to eat normally, some became classically anorexic—dieting, feeling fat, etc. Gura concluded that “when a person with anorexia diets, he or she actually feels better—more alert and energetic—when starving.” Basically anorexic patients get hooked on undereating. This could explain why anorexia requires intensive treatment to overcome.

 

Marcia

Marcia Herrin and Nancy Matsumoto, co-authors of The Parent’s Guide to Eating Disorders, Gūrze Books, (www.childhoodeatingdisorders.com).

Great news! In about a month, our book, The Parent’s Guide to Eating Disorders: Supporting Self-Esteem, Healthy Eating and Positive Body Image at Home, will be available as an ebook! For those of you with new iPads who don’t know what to do with them, here’s your chance to learn a lot about an important subject while playing with your new toy. Our book will also be available for the Kindle and other electronic readers. We’ll let you know when the e-version is online.