Obsessing about eating healthy is not healthy.

1. Beware of using...

This morning my beloved cousin and life-long friend, Lissa Rankin, sent me an email noting a post she wrote for Mind Body Green, titled 10 Signs a Juicing Habit is Hiding an Eating Disorder.  In it, she addressed an issue near and dear to all of us who work at Potentia: when eating healthy can mask the serious emotional and physical issues of an eating disorder.

I am so grateful for her post as it is important to continue the discussion around this often lightning-rod issue. A continued conversation helps push back on a common narrative in our culture that if you do not meet the criteria for an eating disorder and you are eating whole, fresh, organic food, you don’t have a problem. But when lifestyle change leads to obsession, it is this narrative that can keep people stuck in an emotionally paralyzing state.

Obsessions are connected to a multitude of factors: low sense of worth, traumas/distressing life events, family of origin, temperament, and even under-nourishment. And many people are genetically loaded to be more vulnerable to obsessive-compulsive traits, which are found on the anxiety spectrum.

The obsession with eating healthy is called orthorexia.  Orthorexia is a sub-clinical term coined by Steven Bratmen, MD who is also the author of Health Food Junkies: Orthorexia Nervosa – Overcoming the Obsession with Healthy Eating. I will explore orthorexia more deeply in an upcoming post, but for now,  it’s enough to know that the problem is not simply about the food (I say “simply,” since we need to eat to live), but mostly about the obsessions and related impact on your life based on how you respond to your food obsessions.

Any obsession, whether it be with food or otherwise, can be mentally and emotionally crippling. When the desire to make lifestyle changes and improve how you feed yourself is taken to an extreme, it can lead to orthorexia and eventually develop into more debilitating disordered eating and eating disorders.

In her post, Lissa noted key signs you may be using juicing as a mask to your disordered eating.  Below, I add some additional thoughts to unpack the important message of Lissa’s post. And thank you again, Lissa, for keeping this discussion going. It is a hot topic for sure, but I am so grateful for the conversation!

Here are Lissa’s 10 signs that you (or someone you love) is masking an eating disorder with juicing or cleansing:

1. Your BMI, or body mass index, reveals that you are underweight or normal weight, yet you replace meals with juice regularly.

Additional Thoughts: Yes, many people who are experiencing discomfort from negative body image want to lose weight or change their body. Restricting helps decrease the anxiety of this distress by the endorphins that are produced when their body is not getting enough nourishment. At Potentia, we use the BMI lightly. For most people, it is not an accurate indicator of ideal weight range. Plus, your worth is more than a number. Connect with Megan Holt for a consult to learn more about determining your ideal weight range.

2. You’re terrified of gaining weight, even if your BMI is normal or underweight.

Additional Thoughts: Regardless of your BMI, the fear of gaining weight needs to be addressed. Even if losing weight would be helpful to your overall wellness, a number of markers will be taken into account – not just your BMI. Your labs, your activity, physical pain, how you feed yourself, illnesses, medications, stress, social and emotional support and current life situation are all taken into account.

3. Other people think you’re skinny, but what you see in the mirror is a big fat slob.

Additional thoughts: Regardless of what other people think, if the image in the mirror triggers obsessive thoughts and behaviors, it is time to get help. And to those who are friends with someone struggling, be careful about compliments and encouragements around looks. If your loved one is in deep with this struggle, she will have a hard time trusting your words.  Validating her struggle and encouraging her to get help is a very loving support without feeding the obsessions.

4. For women, skipping periods or not menstruating at all can be a sign that you’re not getting enough calories. The body is genius. If it thinks you’re not at a healthy enough weight to have a healthy pregnancy, your periods will disappear.

Additional Thoughts: Yes – your body is genius! Osteopenia can lead to re-occurring injuries and is a sign your body is struggling. Getting your period back does not mean the recovery work is done. Until you do the deep soul work to manage your anxiety, this cycle of obsessions is likely to continue.

5. You binge on unhealthy foods and then either induce vomiting, exercise excessively, misuse laxatives, or use juicing as a sort of penance to undo the damage.

Additional Thoughts: Binging does not just have to involve food deemed unhealthy. It can be any kind of food, even healthy food. Many people attempt to mask their shame of binging by eating food that is not shamed by our culture and “junk food”.  And on that note, there is room for all food, even something that is not organic, processed or corn-fed – if the majority of your body’s needs are met with whole, fresh and organic when available and affordable.

6. You embark upon juice fasts that last more than a week. For example, a month of nothing but juice just isn’t healthy.

Additional Thoughts:  Lissa referenced our popular Q&A post on juice fasts.  This is an important resource as you think about the meaning and the motivation of your cleanse or fast. Even if you do not have a clinical eating disorder but are struggling with body image issues or eating issues, we caution against trying a fast to help manage your emotional distress. This choice could send you to a dark place that could take years of recovery.

7. You find yourself avoiding meals out with friends and family “because I’m cleansing.”

Additional Thoughts: This is such  a common struggle for those with orthorexia.  When eating fuels isolation, this is a red-flag.

8. Other people worry about how often you skip meals or cleanse.

Additional Thoughts: When those who care about you are concerned, it is not because they are working against your goals for health and wellness. Your disordered eating thoughts want to isolate you and be your only friend. In truth, eating disorders are toxic BFF’s.

9. Being away from your juicer or a juice bar triggers anxiety or even panic.

Additional Thoughts: If you lose flexibility in your lifestyle, it is a warning you are becoming a slave to your eating patterns. This is not how we are called to live.

10. You obsessively weigh yourself, and change your cleansing behavior as a way to diet yourself back to your target weight.

Additional Thoughts: Your worth is more than a number and dieting does not work. No matter what you call it, trying to lose weight by restrictive eating will only set you up to regaining the weight, even more than you lost, sending you on the dangerous weight-cycling path of disordered eating.

What do you think about the obsession of eating healthy? Is it an important response to weight issues in our country? Have you or someone you cared about ever struggled with orthorexia?

Cheering you on as you (re) define your definition of health –

Rebecca

 

Weekend Wonderment – Better Late Than Never!

1. Your Health -

No surprise those with weight issues are more vulnerable to developing eating disorders. As long as we make weight a primary factor in determining health – and rewarding weight loss over overall wellness – we are contributing to the serious food and body issues in our culture.

Spread the word: You cannot be replaced!

A refreshingly honest, hilarious, and a little bit frenetic look inside the tension of being seen, authentic and vulnerable.

Love this blog on everything rustic and vintage on a budget. I just scored some of their amazing mini bread boards. I plan on getting more for gifts. You can even have each board engraved with up to 10 letters.  Sweet!

This is inspiring me to get my creative via my i-Phone photos. Who knew creativity and tech could be so fun and easy?

I am SO grateful for this website as I now have both kids in school and my oldest is needing lunches everyday.  The lists of recommended lunch gear saved me hours of research and the meal ideas and pics help with quick and easy planning.  Exhale.

This is an important post on bright girls, bright boys, and (re) defining perfectionism and being good enough.

Props to Matt Knisley for the heads up this new platform for books.  While I will always be a fan of old school books-in-hand, I am embracing technology and books. Netflix for books: count me in!

Donald Miller never disappoints with his powerful and convicting words. Read and be challenged to be brave and love without conditions.

In Awe and Wonder –

Rebecca

Weekend Wonderment: Inspiration from the Interweb

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Be the Gift.  Give yourself the gift of forgetting about yourself, the to-do lists, the plans, the appointments, the shoulds and have-tos. Thank you, Ann, for this heartfelt reminder. I needed it this weekend.

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Never, ever, ever forget: You are Loved. Thanks to Jeanne Oliver Designs for bringing this to my attention.  Blessed.

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Beautiful, grounding, convicting.  Read this and then take note where you feel your heart tugged to redirect how you spend your time today.

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Yes, let’s change the world for Greyson, my daughter, all kids.

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Darling is taking orders for their fall issue.  Order now and receive their latest print magazine full of beautiful photo shopped-free pictures, lovely words printed on gorgeous paper and receive the digital version as a free bonus.

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Here is more brilliance from Barn Owl Primitives (where I purchased the We Can Do Hard Things sign seen as you enter my therapy office). These are words that I want to flow out of my heart to my kids – especially during this season of preparation for and transition to school and the big, big world.  May we all live these words and not just say them. Actions indeed speak louder than words.

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No, juicing is not an eating disorder but for some it can be a disordered eating ritual masked in the spirit of healthful living. I appreciate this honest and humorous perspective of a world where the efforts to be healthy are sometimes a bridge to orthorexia (the obsession with eating healthy) and, well, deep hunger.  Now head over to Kayla’s Q&A with Megan on juice cleanses for some facts on this practice.

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A common area of struggle I see in my office is managing the in-betweens of life: relationships, jobs, school, physical health, and so on. Jeff Goins’ new book will encourage and challenge you to savor your in-betweens. The tension created in times of waiting can be the catalyst for our best art, so slow down and do not rush your in-betweens.

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In awe and wonder –

Rebecca

Stretch (and Breathe) Into Your Comfort Zone

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In three weeks, will host the third installment of our Seasons of Life Workshop series. I often joke and say once the month of September has finished the year is done! Time seems to go into warp speed with holidays, school activities, work, and celebrations. This lovely workshop led by our Yoga Coordinator, Kelly Schauermann, will help ground you as you kick off your fall season.

Who should register?

This workshop is for anyone who desires a couple of hours of peace, reflection, connection, and rest.

Why should you attend?

It is valuable to look back and reflect on what you have learned so far this year.  This workshop will help you focus on how you can harvest and implement this new knowledge as you turn the corner into a fast-paced fall season.

What makes this workshop unique?

The tools used in the Seasons of Life yoga workshop are gentle stretches and beginner yoga poses, small group and personally focused reflections, mindful breathing, and journal writing. Participants can enjoy a warm cup of tea or a refreshing glass of water and snacks after the workshop.  Those who attend will also receive personal support from Kelly, who is an incredibly experienced and skilled instructor passionate about ensuring every participant feels safe and comfortable.  She often adds special touches to each of her workshops, customized to those participating.

What should you bring?

Please bring your own mat, blankets and any supportive props you may use if you have a yoga or stretching practice. And if you do not have a mat or props, no problem! Just let Kelly know as she has a few extras for you to use.

Make sure to register soon since there are limited spots available. Also, the final installment in our Seasons Of Life Workshop in November is open for registration, so you can guarantee your space now by clicking here.

And for every workshop you register for in the month of August, you receive one entry to win a $100 gift card to Anthropologie.  Fun!

Questions?  Contact Kelly at kelly@potentiatherapy.com

Breathing Deeply and Exhaling Slowly (at least trying really hard to do this more often!) –

Rebecca

The Dark Side to Celebrating Eating Contests

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For the last several years, I have started writing posts about the mixed messages of celebrating eating contests and the dangerous impact reverberated by these mixed messages – but I have never finished them.  This year, I am pushing back on my unhealthy perfectionism and finishing a post I started earlier this month.  I hear the PR voice in my head saying it is too late and the peak for sharing this has passed. 
Well, so be it.

The fourth of July is one of my favorite holidays. I am a fireworks fanatic and this year we brought both of our kids to watch the glorious display of firework fun in the sky. This holiday is a lovely time to rest,  play, and celebrate.

But one tradition around this holiday frustrates and concerns me: Nathan’s Annual Hot Dog Eating Contest and the many iterations that have followed its popularity. Some of my friends and family think I am a bit of a buzzkill for not being a fan of this kind of eating. Such is my life as an eating disorder specialist – I cannot unlearn what I know about the physical and emotional dangers of binge eating and Binge Eating Disorder (BED).

What is Binge Eating Disorder?

I like this write up by the Mayo Clinic staff on BED:

You may have no obvious physical signs or symptoms when you have binge-eating disorder. You may be overweight or obese, or you may be at a normal weight. However, you likely have numerous behavioral and emotional signs and symptoms, such as:

  • Eating unusually large amounts of food
  • Eating even when you’re full or not hungry
  • Eating rapidly during binge episodes
  • Eating until you’re uncomfortably full
  • Frequently eating alone
  • Feeling that your eating behavior is out of control
  • Feeling depressed, disgusted, ashamed, guilty or upset about your eating
  • Experiencing depression and anxiety
  • Feeling isolated and having difficulty talking about your feelings
  • Frequently dieting, possibly without weight loss
  • Losing and gaining weight repeatedly, also called yo-yo dieting

After a binge, you may try to diet or eat normal meals. But restricting your eating may simply lead to more binge eating, creating a vicious cycle.

(Notation from Rebecca: Many fall somewhere along the spectrum of BED. You do not need to have all of these symptoms to struggle with the issue. Denial, minimizing, and rationalizing often keep people from getting the help they need because they do not feel like it is that serious.)

5 reasons eating contests hurt our collective psyche around food

1. Eating contests give the impression that binge eating is always a choice. As of May, Binge Eating Disorder is now a clinical diagnosis in the new DSM-V. This is a huge victory for those who struggle with these issues along with those who are passionate about treatment and advocacy. Prior to BED officially being placed in the DSM -V, there was a lot of controversy around whether this diagnosis should be included; many thought this diagnosis was making excuses for those making bad choices. If this struggle was simply fixed by a choice, there would not be millions of people struggling with this serious issue. Addressing core issues such as attachment wounds, anxiety, depression, distressing life events and traumas, perfectionism, shame, and identity issues are at the heart of this struggle, not a simple choice. The choice available to those with BED is reaching out and asking for helping instead of staying stuck in the cycle of shame, pain, isolation, and physical distress.

2. Eating contests make BED and related behaviors a joke and sport to many. We laugh. We cringe. We build up the hype. It is a business and we are buying into it. This recent Forbes post on whether eating contests should be considered a sport noted:

“While spectators question the validity of such a label, its organizers say there is no confusion – competitive eating is a serious business in the world of sport.”

Man Vs. Food with Adam Richman (I confess, I adore Adam — he is so endearing!) is a perfect example of eating as sport. Adam travels to a new town each episode to discover a city’s best sandwich or meal and then engages in a restaurant’s food challenge by eating an insane amount of food in a designated time period. People are around him cheering him on as he takes his body on a dangerous episode of binge eating — for all the world to watch.

But my work with people on the disordered eating spectrum has taught me food competitions do great harm to our collective understanding of eating disorders and related health issues. This double standard keeps people struggling with BED spectrum in silence, fear of reaching out for help and making binge eating behaviors a joke. A sport.
Binge Eating Disorder is not a sport. Though many who participate in these eating contests may not fit the clinical diagnosis of BED, many of the behaviors mirror this serious illness. When we make binge eating cool to watch, we decrease the seriousness of this issue. It is time to stop the jokes and change the dialogue around this issue.

As long as we are watching, cheering on, and participating, eating contests will be good for business. And bad for health – mind, body, and soul.

3. Binge eating is very hard on your body. If you have ever seen the line-up at Nathan’s Hot Dog Eating Contest, you can see a representation of different ages, genders, and sizes of those who down dozens of hot dogs in a matter of minutes. Physically, binge eaters are at risk for developing: type 2 diabetes, gallbladder disease, high cholesterol, high blood pressure, heart disease, certain types of cancer, osteoarthritis, joint and muscle pain, gastrointestinal problems, sleep apnea, and other related health concerns. Professional binge eaters have the same health risks as those who are clinically struggling with BED. This is not something to be celebrated or perpetuated.

4. We have become obsessed with talking about food and eating contests just add to this unhealthy obsession. Food is personal and how we choose to feed ourselves is a very vulnerable topic. How we eat, what we eat, when we eat, and where we eat are all hot topics that can breed food shame and discord instead the joy of breaking bread with family and friends. Eating contests (and most reality shows for that matter) encourage us to become professional judgers and blamers. We talk about “good food vs. bad food” as if we are talking about sinning or staying pure; we Instagram our meals with a sense of awe and worship; the latest trends in eating, dieting, health dominate the majority of our conversations. We are obsessed with food. This obsession masks core issues of identity, worth, shame while fueling anxiety and depression. And the resistance to looking deeper is intense – understandably as it is much easier to talk about food than the messy, vulnerable, deep soul stuff.

5. Eating contests are a waste of food when so many are food insecure in our country and our world. In our country alone, food insecurity impacts about 15% of households. I often wonder about the positive impact companies and businesses that promote eating contents could make if they took their resources of time and money and fought hunger instead. We can change this demand by choosing not to watch and not to participate – which will shift how companies spend their advertising dollars.
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Post your feedback below and let me know what you think about eating contests? Do you think binge eating is just a choice?  I look forward to your thoughts on this controversial subject.

Happy belated 4th of July (take that perfectionism!)  –

Rebecca

Five Year Celebration and a Giveaway

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Potentia Celebration and Summer Giveaway!

5 years ago today, Potentia Family Therapy, Inc. was officially incorporated in the state of California. After writing a (big) check to the state, I was given a fancy binder with some very official paperwork. I had a notebook full of ideas and dreams. My first child was a little over two months old, my husband was moving to a new school, and life as I knew it was very different.  Blessed, full, and amazingly different.

Five years later, my family has grown from one to two kids, my husband has expanded the AP History program at his school (and is moving to a new AP prep this fall) and Potentia is now in a gorgeous space –  home to a team of incredible professionals dedicated to helping people heal their relationships with food, their bodies, and their stories.

At Potentia, our team has high standards of care. We believe our clients deserve:

  • the best in clinical, legal, and ethical practice
  • respect
  • dignity
  • hope
  • healing (in their own time)
  • safe community
  • authentic connection

Words cannot do justice to the courage, the sacrifice, the character, the growth, and the miracles we get to witness at Potentia. Thank you to my friends, family, colleagues, mentors, contractors, and all those who have helped shaped Potentia from dream to thriving practice. You all simply amaze me. (You rock!) I am also grateful for this calling God has put on my heart which daily strengthens my faith.

As we launch several new groups and workshops for the fall, we are also continuing our behind-the-scenes plans to make Potentia’s approach to (re) defining health available to people outside the San Diego area. Stay tuned…

But for now, we want to celebrate Potentia’s birthday! And what is a birthday without gifts?

Head over to Potentia’s Facebook Page and leave your birthday wishes to Potentia under the birthday post to enter into our birthday giveaway. Three winners will be chosen at random to receive a special mid-summer gift bag including a copy of Darling Magazine’s summer issue (which contains an article I was honored to contribute), sunscreen, lip gloss, a towel, and some other cool Potentia schwag.

Comments received up until 11:59PM today  – July 16th, 2013  – will be eligible for an entry.  UPDATE: We are extending this one more day until 11:59PM July17th.  Yay!

On behalf of the Potentia team (me, Megan, Molly, Kayla, Nicole, Kelly, Alyson), thank you for being a part of the Potentia Community.

Cheers, confetti, and hugs galore!

Rebecca
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Q&A Series: Cleanses

Q&A Series: Cleanses

Kayla Waler, MFT Intern at Potentia: So, we’ve recently tackled pertinent topics such as Paleo and gluten-free diets. My friends have expressed interest in a Q&A about juice fasts and cleanses. I know juice fasts and cleanses are popular, especially around certain times of the year…what can you tell me about this practice?

Megan Holt, RD, MPH, Ph(c) and Coordnator of Nutrition and Wellness at Potentia: In my experience, people tend to be interested in cleansing for one of four reasons: 1) weight loss, 2) detoxification, or 3) as a means of hitting a ‘reset’ button when they’re feeling particularly bad about their current diet or 4) for an energy boost. Cleanses usually involve one or more of these components: 1) a fast 2) some sort of product or regimen purported to remove toxins from the body, or 3) a colon cleanse.

Kayla: Let’s start by talking about fasting…

Megan: I tend to discourage fasting because it can reactivate disordered eating behaviors–whether that’s restriction or feeling out of control with food or feeling disconnected from hunger and fullness cues when one does start to eat again. I generally recommend against it for anyone who has suffered from disordered eating in the past. But for someone without a history of disordered eating, there’s really no harm in doing a juice fast or any fast for one or two days, as long as the person is hydrating appropriately. Beyond a few days, there’s no way one can really meet his/her micro and macronutrient needs for vitamins, minerals, fat, fiber, and protein through a fast (including a juice fast). So, if the fast is prolonged, say for two weeks, he/she will start to break down muscle tissue, resulting in a weight loss (muscle tissue is heavy and dense, about 1.7 or 2 times the weight of fat mass). This can’t be sustained without becoming malnourished, nor is it ideal to waste muscle tissue and lose strength. In such a state a person can expect to be in ketosis, a state characterized by elevated levels of ketones in one’s urine or a fruity or acetone-like smell in one’s breath. Ketosis is one of the hallmarks of starvation/malnutrition.

Kayla: I know detoxification is a trendy concept. What are the toxins people are trying to rid from their bodies?

Megan: Usually the claims about detoxification on these products are overstated and generalized/non-specific. Most refer to PCBs, lead, heavy metals, or environmental toxins like food additives, food coloring, pesticide residue, etc.

Kayla: And would a cleanse rid the body of these toxins?

Megan: Actually, there’s no evidence that a cleanse or fast would (although, as long as one is fasting, one is likely taking in less of these compounds, though they’re reintroduced once the fast ends). There seems to be nothing about a cleanse that is as beneficial as adopting a good quality of diet consisting primarily of plants and whole foods. But there isn’t much research out there; there haven’t been many high quality studies on cleanses because higher preliminary studies show no benefit. Cleanses are typically promoted by testimonials given by celebrities or people who have no training/educational background (major red flag).

One problem with cleanses/detox diets is that if someone had a poor diet before doing on a cleanse, they usually revert back to that diet afterward, as they often don’t build skills to enable sustainable changes. So, unless he/she makes a concerted effort to change diet and lifestyle, he/she will return to feeling just as poorly as prior to the cleanse.

Kayla: …because he/she is just reintroducing all the old stuff…?

Megan: Right. The benefits are not sustained and not sustainable. So if you wish to feel better, or are seeking the reported benefits of something like a cleanse or detox diet, the best bet is really working on changing quality of diet and increasing activity, both of which sustainably promote feelings of well being (without undesirable side effects).

And it’s most important to note that not everyone reports feeling better during or after a cleanse. Most people report feeling disorientated or lethargic, dizzy, weak, a little confused or groggy because they’re malnourished and not getting enough glucose to the brain to fuel proper cognitive processes and physical functioning. Some people often report feeling lighter, and I can see that because one may lose weight in the form of fluid and stool bulk primarily (and perhaps a smaller proportion of fat mass and muscle mass depending on how the cleanse or fast lasts). But most often, participants complain of weakness, confusion, or just feeling “out of it.”

Kayla: Then why do people believe a cleanse is beneficial?

Megan: In part due to the power of testimonials—some people do report feeling better. Certainly people can report feeling better after adhering to a really nutrient-dense juice cleanse for several days in a row. But when someone is coming from a place where their diet is poor, of course they are going to feel better when diet improves. The problem is that it’s short term. We know that fad diets don’t work in terms of sustaining weight loss, and cleanses/detox diets are not exceptions.

Some people notice that a one or two-day cleanse or fast helps them to break habits of mindless eating and get back to a cleaner quality of diet. For example, someone who takes a one or two-day fast or cleanse after the holidays. Having said that, if you’re someone who is willing to stick to a juice fast or cleanse for just a few days as a means of hitting a ‘reset’ button, then you’re probably also apt to resume your pre-holiday eating style without doing the cleanse/fast.

Kayla: I know fasting can be dangerous because of the risk of malnourishment. Are there other risks? Can a cleanse regimen be dangerous?

Megan: Cleansing and fasting can be especially difficult and contraindicated for people with altered nutrient needs due to illness (diabetes, kidney disease, etc.). So, prior to participating in a cleanse or fast, I’d suggest consulting first with your physician.

Kayla: Earlier, you mentioned colon cleansing. Will you explain what a colon cleanse is? Why do people do it, and what are the pros and cons?

Megan: A colon cleanse is usually performed with an enema, commonly salt water or purified water injected into the colon. The idea is to remove any metabolic waste that the colon hasn’t removed on its own. Conventional physicians usually don’t support colon cleanses because there isn’t evidence to support the reported benefits. The colon is self-cleaning… it does a really good job of getting rid of metabolic waste on its own. So, we don’t need a procedure to cleanse the colon. In fact, introducing a foreign object into the colon can actually be pretty risky. Perforation of the bowel is another big risk with colon cleansing, as are infections and electrolyte disturbances.

Proponents of the colon cleanse will say they are introducing higher levels of good bacteria and getting rid of “bad” bacteria in the intestines, but there is really no evidence of that being the case, and the introduction of good bacteria is something you can get from eating probiotic-containing foods and a primarily whole-food plant based diet.

Also, we have a liver and other important organs that perform that function for us without prompting. Environmental toxins can not be metabolized or cleared by a cleanse or fast, unfortunately. If you are looking to make a change to feel better, my advice is to follow something that is sustainable for you, preferably a nutrient-dense, plant-based diet—though not necessarily vegetarian—with a high intake of whole foods: fruits, vegetables, whole grains, legumes and plant based fats.

What are your experiences with cleanses and fasts?  Have they been helpful or triggering of disordered eating thoughts and behaviors?

And thanks so much for your interest in this Q&A series.  Please keep us posted on future topics you would like us to cover in future Q&A posts.  Thanks for reading!

In good health – Megan and Kayla

Q&A Series: Gluten-Free Diet Unpacked

Unpacking Gluten-Free Diet
Unpacking Gluten-Free Diet

After getting the scoop on the Paleo Diet, I sat down with Megan Holt, DrPh(c), MPH and Registered Dietitian, to get more information about another popular diet craze–the gluten-free diet.  –Kayla

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Kayla: So, what exactly is gluten, and what is the gluten-free diet?

Megan: Gluten is a protein found in wheat and other grains, but it has been incorporated into a lot of different food products.  Rye, barley, bulgur, triticale, some oats (due to cross contamination), and wheat products, of course, contain gluten, as do many sauces and meat tenderizers or seasonings.  Gluten tends to slip its way into many products because of its elastic structure and ability to act as a thickener. A gluten-free diet is simply an exclusion of gluten, which means the diet rules out all of the pastas, breads, pastries, and cookies that are gluten-containing, but also many other sauces and seasonings.

Kayla: I know that I’ve heard a lot about gluten-free products and the gluten-free diet within the last year or two, but how long has this diet been around?

Megan: The idea of a gluten-free diet gained popularity about 5 years ago, but it really exploded about two years ago in conjunction with the Paleo diet.  A number of studies have supported benefits of a gluten-free diet for certain subsets of the population, and largely as a result of the popularity, we have an increased awareness (and an increase in the number of people being tested).  We are now more aware of the symptoms of gluten sensitivity, and, given the availability of gluten-free products on menus in stores, sticking to a gluten-free diet is far less stigmatizing and isolating than it was in the past.  These are real benefits for people who are genuinely gluten-sensitive.

Kayla: What are the benefits of gluten?

Megan: There are decades of research that supports the use of whole grains in our diet.  High intake of whole grains are protective in terms of lowering risk of major causes of death in the United States:  cardiovascular disease, type II diabetes, metabolic syndrome (in part due to the fact that low intake of whole grains is associated with higher abdominal fat and obesity).  Breads, grains, and pastas make up the bulk of the western diet (for better or worse), so one benefit of gluten intake in the US is that many of our grain products (which are gluten containing) are vitamin-fortified.  So, we tend to get a lot of vitamins and minerals, like folate, fiber, iron, and zinc, from gluten-containing products.  Of course, there are other, sometimes better sources for these vitamins, but gluten-containing products are a really common accessible source in the US.  Finally, whole grains themselves are very satiating, and they contribute to sustaining normal levels of blood sugar, even more so than a lot of the gluten-free counterparts.  One example would be whole wheat pasta versus (gluten-free) brown rice pasta.  Whole wheat pasta is a little more stabilizing and has more fiber and protein than brown rice pasta.  That’s just one example of a not-necessarily-healthier gluten alternative.

Kayla: Can you explain gluten sensitivity? What is the difference between that and celiac disease?

Megan: So, with the explosion of the gluten-free fad, we’ve become better at recognizing the symptoms of gluten sensitivity, which is milder than celiac disease and usually characterized by physical symptoms, with no damage to the small intestine.  Symptoms can include: diarrhea, bloating, abdominal pain, rashes, joint pain, and other inflammatory symptoms.  Celiac disease is characterized by an immune response to gluten, which can lead to the destruction of the villi in the small intestine, which can be severe and debilitating.  Many of these folks suffer from serious nutrient deficiencies just because they can’t absorb what they’re eating, so the removal of gluten from their diets is imperative.  But true celiac disease affects less than 1% of the population.

Kayla: How does one confirm gluten sensitivity or celiac disease?

Megan: Well, the gold standard to check for celiac disease is a biopsy of the small intestine to look for flattening of the villi.  Some doctors will perform an endoscopy to actually look for damage to the small intestine, but some look to blood tests that reveal the level of antibodies that have developed.  If these antibodies are outside a normal range (high), it may indicate a gluten intolerance or celiac disease.  But usually people will just try an elimination diet–eliminating gluten and then reintroducing it and looking for symptoms.

Kayla: But that only works if you’re only eliminating gluten, not adding in other things, or completely changing your diet…

Megan: Exactly.  Most of the people I see are just starting to pay attention to quality of diet or trying to improve their quality of diet and may feel like one the markers of improving their diet would be excluding gluten.  When I see people who want to follow a gluten-free diet, what I typically ask them to do is see their physician to check if they can get a test to confirm non-celiac gluten sensitivity or celiac disease if that’s what they suspect.  If there’s no confirmation, we work for a few weeks to clean up the overall quality of diet and I ask them to pay attention to the appreciable benefits they experience from simply improving the quality of diet.  Then, we can exclude the gluten-containing foods, substituting them for something comparable for a month or so before reintroducing gluten and noting any symptoms.  Changing the overall diet while excluding gluten is not ideal.

Kayla: Are there any benefits of a gluten-free diet for people without gluten sensitivity?

Megan: None that are evidence-based.  If we’re just excluding gluten or substituting whole grains for gluten-free grains, then no, there’s no benefit.  Moving away from genetically-modified foods and toward organic foods is beneficial, and this is a shift that is often made at the same time as one decides to go gluten-free.  But generally, gluten-free products tend to be more highly processed and are not fortified, compared to many gluten-containing grains, so you actually get less fiber and have a higher intake of processed foods when you’re just swapping out whole grains for gluten-free grains–unless you have legitimate gluten sensitivity.  That’s always the exception to the rule.  For most of the clients I see, those who don’t have gluten sensitivity, reintroducing gluten after elimination brings on no symptoms, other than perhaps a bit of an adjustment to a higher intake of fiber.

Kayla: So how can someone going gluten-free for a legitimate reason do so in a healthy way?

Megan: There are ways to be gluten-free more healthfully, that are more than just swapping out the gluten-containing grains for gluten-free ones.  For example, someone can get a lot of nutrients from beans, lentils, and other whole grains that are gluten-free like brown rice, amaranth, quinoa, and gluten free oats, or from fruits and vegetables.  Using these foods as staples is very healthy.  I’m a firm believer that you can have a balanced diet that excludes things you don’t want to eat or things that don’t make you feel well, but you have to be intentional about adding other food sources to make up for what you’re losing.  You have to take a balanced approach.

Kayla: How can I tell if someone going gluten-free is really struggling with disordered eating?

Megan: Unfortunately, I often see people using the gluten-free diet in the service of disordered eating, that is, as a reason for restricting their eating.  Then, if weight loss happens, it’s because of the restriction, not because their diet is gluten-free.  If you’re concerned about someone going gluten-free, you can always suggest that they see their physician for confirmatory testing.  Other red flags:  Is he/she restricting food /calories outside of those that are gluten containing? Has there been an undue or unnecessary weight loss? Is he/she unable to enjoy food or participate in activities involving food?

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We would love your thoughts on our conversation about the gluten-free diet. Post your thoughts and any additional questions for us in the comments section below. Also, let us know if there are any other diet or wellness trends you would like unpacked in future Q&A blog posts.

In good health –Megan and Kayla

Q&A Series: Paleo Unpacked

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Lately, I’ve noticed a lot of chatter amongst my friends about the Paleo diet. Naturally, I’ve been a little curious about it, so I thought I’d talk with my fabulous colleague, Megan Holt, Ph(c), MPH and Registered Dietician, to get the scoop on the science behind the Paleo diet and her thoughts on how to eat right and stay safe in our diet-obsessed culture. – Kayla

Kayla: Thanks for taking time to talk with me today, Megan! I have some questions about the Paleo diet.  It seems like half the people I know are on it. Can you talk a little about what the Paleo diet is?

Megan:  So there have been versions of the Paleo diet around for 30-40 years–the idea of eating like our ancestors first surfaced in the 1970’s. Today’s Paleo Diet was coined and popularized by a professor, Dr. Loren Cordain. The idea behind it is that our bodies can’t process some of the foods–grains, for example–that have become staples in our diets since the industrial revolution. So, we are better off eating like our ancestors, the cavemen, with a diet that consists primarily of meat & vegetables with no dairy, grains, or processed foods.

Kayla: Well, that sounds pretty good, in theory.

Megan:  With this diet, as with any of the other fad-type diets, like Zone or South Beach or Atkins, there are always a few really positive and helpful features. A favorable aspect of the Paleo diet, for example, is the suggestion that you take an 85/15 approach to food…that is, you should follow Paleo principles 85% of time and the other 15% of the time non-Paleo foods are allowed. I like the idea of that sort of flexibility, rather than having certain foods be “off limits.”

Kayla:  So, what are the drawbacks?

Megan:  Many of the Paleo principles are far from evidence-based. The cavemen, for example, didn’t suffer from the diseases that we suffer from in the western society like stroke, heart disease, or cancers, but their lifespans were very short. They didn’t tend to live long enough to experience these chronic diseases…so we’re unable to draw strong conclusions or make a fair comparison. Also, the emphasis on animal products like meat, beef, is problematic.

There is the idea that saturated fats aren’t inflammatory or linked with preventable diseases as we once thought they were. The large majority of research suggests otherwise–that saturated fat still is a risk factor for several chronic diseases. There have been some studies that suggest a more mild relationship, but we still have lots of research to support keeping saturated fat to a minimum in our diet. Additionally, quality of animal products and production methods are drastically different in today’s society, and can’t be fairly compared with meat that was consumed by our ancestors.

And the problem with eliminating grains is just that it’s not evidence-based.  There are loads of high quality studies that suggest that whole grains play a supportive role in our health. Paleo diet proponents have been able to cash in on other popular diet trends in our society, such low-carbohydrate diets, gluten-free diets and emphasis on foods with low glycemic index.

Kayla:  So, what’s the rationale for limiting carbohydrates and high-glycemic foods?

Megan:  Blood sugar control. The idea is that if we ingest foods on the lower end of the glycemic index, it helps us maintain energy levels and stabilize blood sugar. Some of that is evidence based–there’s some good in that. Limiting processed foods, added sugars, and high-fat dairy and encouraging vegetable intake is also helpful.

But a high intake of animal fats from meats, beef, sausage, bacon is absolutely not protective, nor is it environmentally responsible. Roughly 10-15 calories of grain is required to produce 1 calorie of meat, and ten times the amount of fossil fuel/energy is required to produce 1 calorie of meat versus 1 calorie of grains.

Kayla:  And what about limiting grains?

Megan:  We have decades of evidence in support of whole grains, unless someone has a legitimate gluten allergy or intolerance. Some really good things have come out from exploring the relationship between gluten intake and inflammation, but it is way overrepresented in our population. When we cut out a lot of processed foods and dairy and peanuts (not allowed on the Paleo diet), we have to remember that these are the most likely culprits of food allergies/intolerances.

So, it makes sense that when someone with an undiagnosed intolerance or allergy removes these foods from the diet, they will tend to feel remarkably better. And when someone without allergies cuts down intake of processed foods and added sugars, and increases intake of fruits and vegetables, they will naturally feel better.

This is nothing new, and it is not unique to the Palo diet. Anytime we improve quality of diet and move away from foods with poor nutrient density, particularly those which are easy to passively over-consume (think milkshakes, frappuccinos, pastries), we will experience improvements in terms of health.

But with nutrition research, it’s hard to tease out which aspects of a diet are resulting in the change…Are we benefiting from the foods we’ve removed or from the foods we’ve reintroduced in place of them? For example, when we cut out gluten, we cut out all the processed grains and many grain-based desserts/pastries.

When we cut out these foods, we’re going to notice some sort of benefit or resulting weight loss. We may substitute our Cocoa Puffs for something much more protective and energizing, such as a greens smoothie.  Of course we’d feel better, but this doesn’t warrant demonizing grains.

There are many factors to consider. If we feel better after cutting out a food, what are we replacing the food with? What other lifestyle factors have changed? Has there been a shift in our activity level? Are we sure we can attribute feeling better to the elimination of a food, like gluten? More often than not, it’s unclear. Roughly 20-30% of people who identify themselves as sensitive to gluten actually are.

Kayla:  Those are good points. So, what is your advice for someone who wants to be healthy, to eat cleanly, and/or to lose weight in a healthy way? How would you advise her to go about making food choices?

Megan:  I support eating styles that are evidence-based and sustainable in terms of how well they support health and lower risk of preventable diseases. What that tends to look like is roughly half, if not 60%, of food intake coming from carbohydrates, mainly whole grains, whole fruits and vegetables. About 15% should derive from lean protein and fatty fish.

We get a lot more protein from plant-based sources than we think (whole, minimally processed grains, legumes, nuts, seeds), so we don’t need to rely on meat. The rest–roughly 30-35% of our calories should come from plant-based fats like olive oil, canola oil, avocado, or grapeseed oil, versus saturated or trans fats like butter/dairy fat or lard. A small amount of saturated/trans fats are OK, but they shouldn’t represent the bulk of our intake.

Many of my clients have a long history of dieting and weight cycling, and benefit from a more flexible approach to eating and meal planning. In such cases, we try to identify foods that they enjoy and are drawn to that will also be energizing and health-promoting.

If your morning ritual includes coffee and a donut, then we talk about breakfast staples that appeal that offer more in terms of nutrient density. Surely we can find something that is more energizing, such as oatmeal with almonds and fresh berries. We’re not demonizing donuts here, but we have to acknowledge them as the less supportive choice.  Enjoy them as treats, but perhaps not as a breakfast staple.

Kayla: When I am with my friends who are talking about their Paleo diet, or going gluten-free, how can I tell if what they’re talking about is just normative, fad diet stuff, or if it has crossed the line toward disordered eating?

Megan:  I tend to look for improvements in quality of life when one is following a particular diet.  If they’re feeling better, maintaining weight that is right for their body and showing signs of improved energy levels, then great.  However, if they have to take unreasonable measures to comply with the diet, such as isolating themselves from social engagements that involve food, that might raise a bit of concern. Excess weight loss, even if the person does not appear “underweight” by current standards, is also a red flag.

Kayla:  And for someone in recovery from disordered eating, how can she keep herself safe in the midst of this cultural obsession with dieting?

Megan:  I’d suggest she just voice her concerns as they apply to her and her friends openly & non-judgmentally. If she’s meeting friends for some purpose that doesn’t relate to dieting or exercise, consider setting a limit around food- and weight-related talk (so ask friends to refrain from revolving conversation around dieting/weight loss). Supportive friends will understand and will be able to respect this.

Living in Southern California makes it nearly impossible to avoid diet talk altogether, as at least 2/3 of peer groups, especially female, are going to be dieting or interested in dieting or preoccupied with thoughts of wanting to lose weight. Surrounding oneself with a safe and supportive group of peers is crucial. There are women out there who have a healthy relationship with food and their bodies. 🙂

Avoid giving into the pressure of having to identify yourself by the dietary trend you follow (i.e. “vegan, paleo, etc”) as this often results in our feeling badly about our choices when we stray from the diet”s tenants.  Take a more flexible (and sustainable) approach and choose foods that you truly enjoy and make you feel well.

Given the buzz around Paleo, my clients in recovery are naturally curious about the diet:

  • What is with the Paleo diet?
  • Is it safe?
  • Why are so many people talking about it?
  • Would this be good for me?

I tell them, especially those who have been through proper treatment, that they know what foods are going to make them feel well and what their body needs in order to perform well in terms of sleep, hydration, nutrition–and they have to trust that.  I ask them to try to refrain from taking nutrient/diet advice from their peers, most of whom acquire knowledge from media sources without scientific merit.

I remind them, “Refer back to your own experience. You’ve been through numerous diets; you know where that’s taken you. Trust that you know how to meet your body’s needs.”

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We would love your thoughts on our conversation about the Paleo diet.  Post your thoughts and any additional questions for us in the comments section below. Also, let us know if there are any other diet or wellness trends you would like unpacked in future Q&A blog posts.
In good health – Megan and Kayla

A Twist on Dealing with Negative Body Image

Negative Body Image.

In my tribe of Eating Disorder Treatment Specialists, we often say negative body image is the first to come and the last to leave in the treatment of food and body issues.

And that is a pretty constant truth from the many recovery journeys I have witnessed over the years.

My clients have taught me some more nuanced facts about body image, regardless of whether they have had a full blown eating disorder or not.

Everyone has (at least) a bad body image day.

Depending on where you fall, if at all, on the disordered eating spectrum, dealing with dark, obsessive, and/or negative thoughts and compulsions regarding your body is a part of the gig when dealing with disordered eating.

You may recognize all too well some of these reccurring negative thoughts used to bully and shame yourself – just fill in the blanks with your own words to customize these statements to your experience:

My ____ is so ____.
I feel so ______.
I am so ______.
My _____ looks so ____.
I just need to___.
When I _____ I will be _____.
I hate my_____.
My _____ will always/never be_____.

Ugh.

So many try to manage these thoughts and feelings by stuffing them and putting on their “I love my body” and “It’s all good” masks of virtue, hiding the truth that they are living at war with their body. Others externalize these thoughts and add to the cacophony of negative body talk and diet talk.

And this is where things often spiral.

Many try to manage the pain of being in their skin and their body shame by:

  • over exercising
  • restrictive eating
  • dieting
  • mindless, emotional eating
  • comparing
  • competing
  • shaming
  • all of the above

And this can lead to a dark journey into the world of eating disorders and disordered eating.  Yet, many hover in this place of emotional ickiness where they cannot shake the uneasiness of living in their skin and make genuine, though harmful, attempts to get relief.

For many of you, this battle really is not about your body.

If my client is stable emotionally and physically, and her needs are met nutritionally, then I often look at negative body image as a sign of something bigger.

Like when you get that scratchy throat feeling.  It is a sign you are on the verge of getting really sick; it is not just about the sore throat.  You know you need to rest, to take some extra Vitamin C, drink some tea, ask for help with projects, cut back on your social calendar.

When the yuck of a bad body image moment comes up, it is often a sign of something else going on in your life.  I move my clients away from the laser focus obsessions on what needs to change with their body and pull back the blinders to look at what else is going on in their life.

If you are feeling this way, it is important to asses:

  • if you are you getting enough rest,
  • how you are adjusting to weight restoration or weight loss (yes, weight loss can be very triggering)
  • stressors
  • social support — safe, sustainable, available social support
  • if you daily activities are life giving or draining
  • dieting behaviors
  • traumatic or distressing life events that have gone untreated
  • if your temperament is perfectionistic, obsessive-compulsive, cares big, and feels emotions intensely
  • labs taken within the last month and making sure all physical systems are operating well and your body’s needs are being met

I have learned that setting the expectation to always be comfortable in your skin is a set up for continual frustration and feelings of hopelessness.  (Not helpful…)

The key is not to focus on the goal of eradicating negative body image days (though the parallel process is to decrease the frequency and intensity of those days, for sure)  but instead to respond on those days, weeks, months when you are feeling crappy in your skin DIFFERENTLY.

Instead of defaulting to negative food and body obsessions and action, I work with my clients on how to acknowledge what they are really feeling and what they are really thinking in that moment. 

Then we focus on respecting those thoughts and feelings in the moment.  I also emphasize the truth in how my clients feel.  What they feel is always real but rarely is it ever fact.

Finally, we focus on how to respond differently when body hatred arises.  Instead of stuffing, minimizing or denying — which only fuel the negative thoughts and coping tools — I work with my clients on accessing new tools and strategies when the dreaded body yuck surfaces.

When there is too much focus on feeling better in your body and not looking at the correlation with bad body image to other factors — physical, emotional, social, and spiritual — then I think we are limiting the potential of experiencing true health and true healing.

And it is ok not to love your body all the time.

But I think it is imperative to focus on respecting your body and being grateful for your body — even when you do not like it.

You can actually dislike your body while also showing your body respect and gratitude.  Eventually, respect and gratitude will win if you hang in there.

For example, there are a good handful of people I know that I do not care for but I respect them, treat them with dignity and kindness, and find space for being genuinely grateful for the challenging relationship.

Consider this strategy in your relationship with your body.

With heavy doses of respect and gratitude in addition to responding differently to your bad body image days, the feeling of your body never being enough may dissipate, and an eventual truce with your body may be declared.

And if one of those days surfaces again, the hope is you do not shame yourself for backsliding in your recovery but see your body image woes as a clue, a hint to investigate what is out of sorts in your life.

All the while administering generous doses of respect and gratitude.

How do you deal with your bad body image days?
Do you agree that it is not realistic to achieve a space where you never have a bad body image day?

With respect and gratitude –

Rebecca