What are your NSV’s? (And a special invitation + year-in-review download)

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This is the time for resolutions, intentions, goals, and dreams. Research is clear that you have a higher chance of keeping your resolutions if you write them down and they are as detailed as possible.

The Potentia team is a fan of the Passion Planner and we have been busy personalizing our planners with our hopes and plans for 2017.

passionplanners

When it comes to resolutions, one of the most common goals for the new year is around weight loss. Carrying extra weight sure has been demonized to the point of many developing an unhealthy obsession with eating healthy (orthorexia). Because it is an easy measure, checking the number on the scale is common practice with the goal, though often misleading, for improving health.

As a result, our culture is very focused the scale. Because the brain gives a dopamine reward every time we check that number, we often feel compelled to check this number frequently. The scale is tricky as it is a common measure of health – yet not the most important one. Things like activity levels, how your labs are looking, and the quality of your relationships + connections are much better life-span indicators.

Whatever the number being chased, the results of the scale usually leave you feeling wanting: for more weight loss, fear of gaining weight or maybe thinking you can lose just a little more weight – even after you hit your “goal” weight. Often with the scale, it is never enough – scarcity mindset in all its glory.

And when scarcity mindset is running the show, your worth quickly gets tied into the number on the scale. Then you are living from the protective parts of you which are shame-based instead of leading from a place of calm, clarity, confidence and courage.

Goals which focus on true health contribute to a longer life-span and offer a more enjoyable life with increased sense of meaning and improved relationships. These are a few of the areas we encourage our clients to focus on as they detox from a diet-mentality and move to a (re) define health mentality.

Some more of our favorite “non scale victories” are around improving:

  • Mood
  • Energy levels
  • Mental clarity
  • Libido
  • Confidence
  • Lab results
  • Connectedness with self and others
  • Strength
  • Emotional Resilience

Which non scale victories would you add to the above list? And as you wrap up the year, we created this download to help you with some of you goals for the new year. We can’t wait to hear about some of your looking forward-looking back reflections.

Special Note to our San Diego/Southern California based friendsPlease join at us our upcoming I Choose Respect Open House + Fundraiser. We will have great food + community in addition to featuring local artists and makers + our I Choose Respect Photo Booth while raising funds for Project Heal Southern California and Feeding San Diego.

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Happy New Year + cheers to good health, deeper connections and more courage in 2017 –

Rebecca

 

2016-year-review

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7 Must-Read Quotes from Potentia’s Featured Book of the Month: Secrets from the Eating Lab by Traci Mann, PhD

Eatinglabbest

 

Hello!

Congratulations on completing week one of the 52 weeks of 2016!

If you are like most people in our country, some of your goals/resolutions/intentions for the new year are around your health: how you feed, move and rest your body.

It is absolutely important to make health a priority (though not an obsession) in your life.

Yet, breaking through the noise about what it really means to be healthy is quite the challenge these days.

There are so many differing views on how to eat, how to move your body, what food is “good” and “bad” for you.

As a result, the meaning of health has become so skewed and good marketing that speaks well to your struggles and desired goals can also add to the confusion of what it means to be well.

Secrets from the Eating Lab: The Science of Weight Loss, the Myth of Willpower, and Why You Should Never Diet by Traci Mann, PhD is a gem of a book that reads with ease while digging into some involved research around the science behind a lot of the narratives around health, obesity, food choices and more.

I really appreciate how she guides the reader:

  • through the history and evolution of dieting
  • how to better discern the quality of the research so many health “facts” are based on
  • figure out what the key factors are which impact and define health

Below are some of my favorite quotes from the book along with my additional thoughts and reflections. It was really hard to decide which nuggets to quote from this book as Dr. Mann has packed in so much wisdom. It is a worthy investment, for sure!

1. The use of the BMI is controversial because the formula for calculating it is not based on any understanding of how height and weight relate to each other, and because people who have high muscle mass tend to get categorized as overweight, despite having very little fat. (p.4)

  • At Potentia, we have educated our clients and community for years on the flaws of the BMI as a measure of health. It is more of a marketing tool and not an evidenced based measure of true health. Be wary of how you use this information to define your definition of health. It also can be very shaming and trigger behaviors that are unsafe.

2. If their (the weight loss industry) products were effective in leading to long-term weight loss, they would soon put themselves out of business. These businesses count on repeat customers. Richard Samber, the longtime financial chairman of Weight Watchers, likened dieting to playing the lottery. “If you don’t win, you play it again. Maybe you’ll win the second time. When asked how the business could be successful when only 16 percent of customers maintained their weight loss, he said “It’s successful because the other 84 percent have to come back and do it again. That’s where your business comes from. (p.9)

  • Caution against investing in businesses which profit from your failure. This is particularly concerning as weight-cycling (repeated gaining and losing weight) is shown to be more dangerous than carrying extra weight. This fact is cited extensively in this book, too!

3. Researchers have known for a long time that diets don’t work. Now you know it, too. (p. 15)

  • In this chapter, Dr. Mann shares how she and her students dug into all the studies often used to validate why a particular weight loss programs/diet will work. She found three major flaws in various health and weight related studies on weight. It is also noted why it is important for you to understand the gold standard of research and how to be a better consumer and questioner of the data being quoted. “The research says…” need not shut down the conversation but instead be a conversation starter.

4. Think of willpower as brute strength. The amount of you need is larger than the amount of it you have, and the amount you have is nearly depleted by nearly everything you do. (p. 48)

  • Unpacking the science behind willpower, Dr. Mann points out that willpower – when used as a tool to maintain health –  is not the best approach to lifestyle changes. She eloquently helps you understand the science of willpower so you can make better choices and decrease the physical, emotional and spiritual struggles around food + your health.

5. Shame is more painful than guilt, and to add injury to insult, shame has been shown to lead to a release of the stress hormone cortisol, and another kind of cell in the immune system (called a proinflammatory cytokine), which, among other things can promote the growth of disease. (p.62)

  • When shame is running your life around how you care for your body, diets – or some kind of restrictive or rigid rules around feeding and moving your body – are often a go-to response. Diet related behavior is one of shame’s bff’s.

6. But variables such as exercise, weight cycling, socieoeconomic status, fat distribution, and discrimination all factor into a person’s overall health…I hope you’re not still under the impression that you have to diet or obesity will kill you. If you exercise, eat nutritiously, avoid weight cycling, and get good quality medical care, you do not need to worry about obesity shortening your life. Especially if you shield yourself from weight stigma and the stress it causes… (p. 82+84-85)

  • Chapter 5 is powerful and provocative. It digs deep into the topic of obesity and myth-busting many narratives around carrying extra weight. The above words outline the complex factors which are a part of an accurate definition of health.

7. The benefits of exercise simply cannot be denied. Regular exercise can increase your life span, prevent disease, improve your mood, aid creativity, help you sleep better, and allow you to age more gracefully. These benefits are more easily attained than dramatic weight loss, and can be yours even if you do not lose a pound. (p.185)

  • Activity is a powerful indicator of your health. Finding an activity you will be motivated to do regularly is key. Now over-exercise, over-use injuries and complications related to hydrating and nutrition are flags that your activity has crossed over from being a positive positive part of your health into a negative one. At Potentia, we help our clients (re) define activity when this happens so moving their body can return to being a part of wellness and not the sole manager emotional pain.

There is so much good information packed into this book. I hope you check it out.

If you read the book, I would love to know what impacted you the most on how you view health.

All the best as you continue to challenge yourself to (re) define health in your life.

With gratitude –

Rebecca Bass-Ching, LMFT, Founder + Director of Potentia Family Therapy, Inc.

 

 

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Unpacking 5 Common Questions on Exercise and Wellness with Megan Holt, DrPH, MPH, RD

NoteRespect is looking at soreness

Note from Rebecca: The word “exercise” is often used in conjunction with the word “diet”. Exercise is indeed an important and necessary part of anyone’s wellness lifestyle. Yet the word itself is often misunderstood and loaded with expectations, shame and fear. Megan Hold, DrPH, MPH, RD unpacks some common questions and misunderstandings around exercise and how to care for our body when we are moving it and the importance of developing an intuitive relationship with exercise.

Q: Exercise is always a good thing, right?  I often read and hear that exercise makes our immune systems stronger.

A: Exercise is one of many stressors the body receives, and like other stressors, produces ill effects when introduced at a time when the body is overloaded.

Intermittent (spontaneous) very high intensity exercise and continuous over training (even if done at lower intensity) can compromise immune function.

For example, 90+ minutes of high intensity exercise may result in days of dampened immune function.  (“Intensity” can also look different from one person to the next, as we must consider baseline fitness levels).

During exercise, we experience an increase in cortisol ‘stress hormone’, which in turn increases blood pressure and cholesterol.  These effects are transient when exercise is balanced and appropriate, but over training can result in chronically high levels of cortisol, decreasing our immune function.

Other risk factors for infection include:

  • inadequate sleep,
  • weight loss,
  • poor quality of diet,
  • under nutrition/low calorie intake,
  • stress.

All of these things, including exercise, challenge homeostasis and therefore, can contribute to increasing susceptibility to illness.

On the flip side, exercise also attenuates stress, which bolsters our immune systems, though this occurs after the exercise but and in the scheme of a balanced training regimen.

Those who engage in moderate intensity exercise 4 days per week are nearly half as likely to use sick time relative to their sedentary and their ‘over trained’ counterparts.

Exercise stimulates phagocytosis, which can essentially be described as the gobbling up of illness producing bacteria by macrophages (the ‘big eaters’ of the immune system).

Immune parameters are enhanced for hours after exercise (and even longer if program is balanced and ongoing/continuous) but the benefits are compromised when one pushes too hard and denies themselves the rest that they need.

Q. What does research tell us about exercising when feeling under the weather?

A. Generally, if symptoms are ‘above the neck’ (i.e. the common cold) low intensity exercise is OK, such as walking or gentle yoga, though listen to your body and rest when symptoms are at their worst.

Wait at least 5-7 days before reintroducing moderate to high intensity exercise.  Cold weather does not increase risk of catching a cold…it simply results in close contact to a greater number of people, which increases transmission of bugs.

When symptoms are ‘below the neck’ or more involved, wait 1 ½ to 2 weeks before reengaging in workouts of moderate or high intensity.

Q. What are overuse injuries, and what are the primary risk factors for overuse injuries?

A. Overuse, in short, result from a culmination of ‘too much too fast’, repetitive movements, improper training techniques, inadequate rest and musculoskeletal system overload.

Half of kids 6-18 engaging in athletics will incur an overuse injury, with highest risk going to runners. Other major risk factors include lack of a period (being on birth control doesn’t ‘count’ if the period is absent without birth control), prior injury and inadequate calorie intake, which stimulates muscle catabolism and hinders muscle recovery.

Q. I am feeling pressured (from self and/or others) to overdo my exercise? What can I do?

A. Give yourself permission to decrease intensity when you need to, and kindly thank yourself for showing up!

Increase the intensity again when you feel like you have the energy to challenge yourself. Resist adding intensity/weight/incline speed because someone else is doing so, or the instructor of your fitness class insists upon it if you know that it’s too much for you.

You’re there for you, not for them, and it’s OK to modify.  Remember, they won’t be around to nurse your injury, so it’s up to you to know your limits.

Believe it or not, cardio is not the only component of fitness. Equally important are flexibility and muscular strength building exercise, particularly for the sake of preventing overuse injuries and building/maintaining bone mass.

A ‘balanced’ regimen may include:

  • yoga,
  • strength training (‘sculpt’ classes)
  • swimming or running/hiking
  • bike riding (moderate to high intensity)

Try to engage other people in your workout regimen, even if this ‘compromises’ intensity just a little bit. Friends who move for fun and wellness can help to keep you from engaging in the craziness of calorie counting or compensatory exercise. Healthy relationships and interactions are also great for your health. =)

If you find that you’re worrying throughout the day about how you’ll fit in your workout, take a breather until you have time to make it a priority without adding to your already overfilled plate.

This is especially true if you’re active a few days/week, but feel inclined to stick to a rigid 5,6,7 days at any cost. If you’re exercising for health benefits, but obsessing daily about how to make it happen ‘perfectly’, the impact of the stress defeats the purpose.

Q. I missed my class and now I’ve blown it. I missed yesterday’s as well, and now I am in a real bind because I am going out to dinner, and I don’t feel like I have ‘earned’ the calories.

A. This is the picture of a not-so-healthy relationship with food and exercise.  Take a walk instead, even if it’s not what you had in mind, and thank yourself for being flexible.

Carbohydrate and protein are a MUST after exercise, as they serve to decrease muscle and joint tissue damage (and no, a low carb protein shake does not suffice, even if it has, like, fifty grams of protein).

This includes an adequate intake of grains. And grains are not the devil. We have decades of research supporting the health benefits of whole grains in the diet, including, but not limited to, their being a great source of antioxidants, fiber, and essential anti-inflammatory fats.

Finally, don’t neglect dietary fat. The anti-inflammatory benefits are tremendous (which means inflammation is buffered by protective qualities of fats, primarily the plant-based fats, which means lower risk of injury).

Don’t wait until you have an overuse injury and are stuck with a bandaid approach to ‘fixing’ it and explore the benefits of a few choice lifestyle modifications, which can prevent, delay onset or aid in healing. Aim for your intake to be at least 30% of calories consumed from fat sources.

How do you define your relationship with exercise?

Do your trust your body to tell you when you need to rest?

Thanks for reading and please post your questions below in the comments section regarding all things exercise and wellness.

In good health –

Megan

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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

 

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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

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Weekend Wonderment 8.24.13

This was a week where the topic of loneliness went viral. Check out this incredible 3-D perspective on loneliness in our very “connected” world.

And here is a spot on article noting how loneliness is a bigger threat to our health than weight issues.  Truth.

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Raw, real and gloriously authentic, Dr. Brené Brown talks church.

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Interesting, informative insights on anxiety, eating disorders and schizophrenia.  Increased understanding about the spectrum of mental illness will ensure more people get the help they need.

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Swoon over this mash up of “Brave” by Sara Bareilles (a personal favorite) and Katy Perry’s new song, “Roar”.  Watch, be awed and left with a big smile on your face.

http://www.youtube.com/watch?v=c-wa1_y6uZQ

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An apology letter from a former weight loss consultant stirred up a lot of chatter on the interweb. Provocative, sincere, honest, this letter offers a unique perspective from the heart of the diet industry.

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Back to school must haves: These adorable “gentle reminders” pencils would be a wonderful gift to a student you know heading back to school or for anyone needing some fun encouragement.  And I am loving this sweater that screams fall in my favorite color.  How cool that you can have it custom made to fit you.  I am in line to order mine this week.

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Busy is the new “fine” but we are living at a pace that is unsustainable.  It is time to (re) define success and make wellness a priority as we follow our dreams and passions.

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My husband and I have been having so. much. fun with this cookbook.  I love Deb Perelmen’s blog, too.  Her latest post is full of peaches, glorious peaches which is appropriate for National Peace Month. She always uses real food that never sacrifices flavor with simple techniques = pure palette joy.

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Just because.  🙂

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In awe and wonder –

Rebecca

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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.

 _____

In awe and wonder –

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

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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

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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

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