What is the Ketogenic diet? And why is this diet so popular?

What is the Ketogenic diet? And why is this diet so popular? | Potentia Therapy

 

By Megan Holt, DrPH, MPH, RD

The ketogenic diet is another iteration of a low-carbohydrate, high fat diet.  While the diet appears to have experienced a rise in popularity over the past couple of years, it was actually coined by a physician, Russel Wilder, from Mayo Clinic, back in 1921.

Carbohydrates from food are a primary substrate for glucose, but in this particular instance, the liver is forced to use fat for fuel, which is then converted to ketone bodies.

Dr. Wilder was aiming to induce ketosis through the diet, which is a metabolic state within which the body must rely on ketone bodies as a primary energy source in the absence of glucose.

A ketogenic diet has been used in pediatric populations for several decades, as there is evidence to support a subsequent reduction in seizure activity in children with epilepsy, though concerns around adequate calorie provision, stunted growth and development of effective medications for epilepsy resulted in a decline in its use. Evidence has been less compelling among adults with epilepsy, however.

Earlier versions of the diet also included a fluid restriction, though this feature fell by the wayside after reports of adverse events due to dehydration (namely constipation and kidney stones).

Most ketogenic diets are marked by an intake of carbohydrates under 20g/day, or rough macronutrient goals of 70% (or more) of calories from fat, 10% (or less) from carbohydrate and 15 – 20% from protein.

This translates to liberal intakes of meats, eggs, butter, oils, cream, nuts and seeds, and very restricted intakes of grains, starchy vegetables, beans/legumes, fruits and added sugars.

Think repurposed “Atkins Diet”, but more restricted (though the ketogenic diet technically preceded Atkins by several decades).  This has become particularly popular among those pursuing weight loss, as well as with athletes seeking performance gains and changes in body composition.

Part of the attraction here lies within the simplistic guidelines….it is easy for followers to understand.  The diet promises rapid weight loss and blood sugar stability, which in part is an accurate claim.

Any time we restrict large groups of readily available foods, we have potential for weight loss. When one loses weight rapidly, much of that initial weight loss is accounted for by fluid weight and muscle catabolism (breakdown). Further, rapid weight loss can be taxing on the gallbladder and heart, and we run the risk of suffering from nutrient deficiencies as a result of inadequate intake.

This is especially true given that many of the processed/refined foods are easy to access, and just as easy to passively over consume.

Elimination of these foods, in addition to any weight lost, will also give a person a reprieve from erratic changes in blood sugar and corresponding fluctuations in energy levels, though this differentially affects persons who are struggling with overeating carbohydrates (i.e. blood sugar changes are much less dramatic in persons consuming carbohydrate in appropriate proportions).  Simply put, we do not need to go on a diet in order to better manage blood sugar and energy levels.

Athletes are typically hit especially hard by the lack of available energy due to the carbohydrate restriction. Not only does performance and power output suffer, but injury risk increases, as carbohydrates play a vital role in buffering the inflammation and tissue damage that are inflicted by exercise.
 

What are the downsides?

When used for treatment of pediatric epilepsy, the ketogenic diet is typically prescribed in conjunction with close medical monitoring, and only for a short period of time.

With the diet’s surge in popularity among athletes and weight loss seekers, there’s been a deviation from safety guidelines and medical monitoring, and followers are often in ketotic states for extended periods of time without supervision. Given the risks associated with following such an extreme and limited diet, medical oversight is crucial in order to monitor vital signs, organ function (kidney, liver, gallbladder, etc.) as well as blood levels of vitamins, minerals, electrolytes and immune parameters.

Oh, and we can’t neglect to mention the evidence, which does not favor this, or any other fad diet, in terms of weight loss sustainability (nearly all dieters regain weight within 6 months of embarking on the diet). 

 Suggested macronutrient distributions for healthy persons are as follows. Roughly:

  • 50-60% calories from carbohydrate
  • 25-30% fat and 10-20% protein.

This may look like a typical dinner meal for many people: 4oz salmon, ¾ to 1 cup of brown rice and 1 cup of colorful veggies with liberal olive oil. Due to the severe restriction of carbohydrate on this diet, we face a number of concerns around vitamin, mineral and electrolyte deficiencies (and the corresponding deficiency symptoms, such as fatigue, depressed immune function, chest pain, nausea and confusion, to name a few).

In situations where ketogenic diets are adequately supervised, followers are prescribed supplements on a daily basis. However, this becomes a bit of a guessing game in our typical ambulatory population, and the tendency is to either overdo supplementation or neglect supplements altogether.  Read more about supplements in our post “Tips on Becoming an Armed and Informed Consumer of Dietary Supplements”.

Other important concerns include risk of hyperlipidemia (the diet can raise ‘bad’ cholesterol while diminishing ‘good’ cholesterol levels).  Often, there is little attention given to the types or quality of fats consumed while on low carbohydrate diets, which exacerbates hyperlipidemia.

In children or adolescents who are actively growing, ketogenic diets have been shown to stunt growth, which is thought to be due to the fact that the diet can result in a reduction of growth factors and hormones.

Kidney stones, acidosis, loss of bone density, sluggish bowels/constipation (even with adequate fluids and fiber intake), reflux (due to high fat content) and nausea are other relatively common risks with a ketogenic diet. 

In closing, there are safer and more sustainable strategies for increasing energy levels and stabilizing blood sugar.  Not waiting too long to eat (eating every 3-4 hours), maintaining a diverse diet, comprised largely of whole foods with few, recognizable ingredients is a wonderful (and sustainable) place to start. However, if you are planning on adopting a ketogenic diet, please make sure you do so under the care of a registered dietitian and physician.

Click here to contact Dr. Megan Holt.

References

Bansal S, Cramp L, Blalock D, Zelleke T, Carpenter J, Kao A. (2014). The ketogenic diet: initiation at goal calories versus gradual caloric advancement. Pediatr Neurol, 50(1): 26-30.

Bergqvist AG.(2012).  Long-term monitoring of the ketogenic diet: do’s and don’ts. Epilepsy Res,100(3):261-266.

Freeman JM, Kossoff EH, Hartman AL. (2007.) “The ketogenic diet: One decade later”. Pediatrics, 119(3): 535–43.

Johnstone AM, Horgan GW, Murison SD, Bremner DM & Lobley GE. (2008). Effects of a high-protein ketogenic diet on hunger, appetite and weight loss of obese men feeding ad libitum.   Am J Clin Nutr, 87(1): 44-55.

Kossoff EH, Zupec-Kania BA, Amark PE, et al. (2009). Optimal clinical management of children receiving the ketogenic diet: recommendations of the International Ketogenic Diet Study Group. Epilepsia, 50(2):304-317.

Kossoff EH, Zupec-Kania BA, Rho JM. (2009). Ketogenic diets: An update for child neurologists. J Child Neurol, 24(8): 979–88.

Mann T. (2015). Secrets from the eating lab: The science of weight loss, the myth of willpower, and why you should never diet again. Harper Wave.

Sampath AE, Kossoff H, Furth SL, Pyzik PL, Vining EP. (2007). Kidney stones and the ketogenic diet: risk factors and prevention. J Child Neurol, 22(4):375-378.

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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.

icr-2017-open-house

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

Rebecca

 

2016-year-review

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How are you going to take action?

No Body Story Shame

Hello and happy first Friday in June!

The Potentia team has transitioned into our summer schedule which is full of vacations, sun, and fun while continuing to serve our community by treating the whole person and the whole spectrum of mental health and wellness issues.

As many of our long-time friends know, one of the areas we offer specialized support is in the treatment of the eating disorder spectrum.

Today I am adding to the voices talking about World Eating Disorder Action Day – which was yesterday but better late than never!

I know when I write or talk about eating disorders, many say this issue is not important to them because it does not impact their life.

I ever so gently want nudge that sentiment to say that this issue – the most deadly of all mental health struggles – is an issue for us all.

In fact, this is a leadership issue and your voice and action is needed.

It is time to take action and create space to have a different conversation about food, health, bodies, worthiness, strength and success.

Many are secretly struggling with self-loathing, anxiety, fear and shame around how you feed, move, dress, rest and talk to your body. This may not present as a clinical eating disorder though the distress is still significant.

We live in a culture where it is acceptable – and often encouraged – to critique how people look, eat, dress, and live. Our bodies, which are both personal and private, are often not respected in search of  control, status, belonging and relief.

Shaming self and others destroys souls and never leads to sustained change or healing.

And this is where you come in on this call to action.

Even if eating disorders do seem like they not impact you, taking some subtle yet powerful actions to help create more safe spaces to talk about what it means to be well, what it is like to struggle with depression, anxiety, obsessive thoughts, recovering from trauma, neglect, loneliness and hopelessness can make a profound difference.

Genetics, family of origin and difficult like experiences play a role in how we all navigate what it means to be well. The media we consume, our social, professional and faith communities all have a powerful influence on our lives, too.

Would you consider taking action on any of the following areas? These may seem like small gestures or actions. Do not underestimate the power of making a small change.

  • Discourage negative body talk or shaming at your home, school, place of worship and.or work.
  • Affirm people based on their character not their looks or physical accomplishments.
  • Edit your consumption of media (tv, social media, magazines, etc) or even consider taking a media fast for a week.
  • Learn about orthorexia and how the obsession to eat healthy is really masking serious disordered eating, anxiety and other serious struggles.
  • Read this series I wrote for Darling Magazine on the myths and meanings of eating disorders.
  • Make a commitment to learn more about what it means to feed well, move well, rest well and talk with your body well. Dr. Megan Holt is an excellence resource for in-person or online health + wellness consultations.
  • Stop dieting and extreme ways of feeding and pursue a practice of intuitive and mindful eating.
  • If there is someone in your circle of influence you think may be struggling on the disordered eating spectrum, dare to have a courageous conversation with him/her – stating your love, your concern and your suggested resources. 
  • Commit to making the dinner table and home a place where food is discussed neutrally and is a means for fuel and medicine and enjoyment – not to be a source of obsession or fear.

 

What would you add to this list? 

How do you plan to take action in your circle of influence? 

 

With gratitude –

Rebecca Bass-Ching

PS – Make sure to check out our Summer Mental Health Camp offerings throughout the summer!

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(re) Define: Resolutions

Happy New Year from Potentia 2015

This time of year is famous (or infamous) for resolutions.

Usually these resolutions involve language like:

  • more
  • less
  • start
  • stop
  • lose
  • change
  • balance
  • enough
  • no
  • yes

Goals are good. Intentions are important. Hope is crucial when we want to grow, heal and do life differently.

But sometimes we make some well-meaning errors in setting our goals, intentions, resolutions. They often are:

  • too rigid
  • unrealistic
  • not specific
  • too complicated
  • developed based what you think you need but not what you really need
  • leaning only on willpower instead of a collaborative community of support
  • not safe
  • not fun or enjoyable
  • developed out of impatience, fear or shame
  • not connected to your core values

Making desired changes in your life that are sustained need to be safe, practiced regularly and fueled by meaning and motivation.  (Click to Tweet)

Your goals, resolutions and intentions need to be inspired by your core values – not on an ideal identity you desire to hide behind as protection.

Yes, dream big.

Then scaffold your dreams into small actionable practices that will fuel more change, growth, fruits of your labors and healing.

It starts with showing up and asking for support from people you can trust.

Pacing desired change is also important when seeking sustained change.

The pain of loneliness, discomfort in your body, fear of rejection or failure can influence the resolutions you choose.

Turn away from numbing, hurting self or others and begin to build the emotional muscle to tolerate vulnerability.

Sometimes people numb out with the wrong resolutions thinking they will get sustained relief from pain if ______ happens.

What you desire to change is a very personal decision.

Desiring sustained change – not numbing out – involves leaning into vulnerability: risk, uncertainty and emotional exposure – as defined by Brené Brown.

And to be clear – there is nothing comfortable about being in the space of vulnerability.

At Potentia, we offer (re) Define Courage workshops to help people build a life long shame resilience practice so shame and non-protective fear do not run the choices you make in your life.

Our team also offers specialized support for those who desire change in their relationships with food, their body, their story and their relationships with God, self and others.

(In addition to offering individual, couples and family therapy, our team is launching several workshops this month. Make sure to save your spot soon!)

When distressing life events occur, your brain is made to move towards healing.

And when your brain gets stuck in working through the tough stuff of life, it is easy to get confused on how to deal with pain, fear, desire, hope and meaningful connection.

The psychotherapists at Potentia incorporate EMDR therapy into our work with clients so the process of getting unstuck has an evidenced-based road map customized to each client.

As you kick off 2015 with your goals, resolutions and intentions, make sure they are connected to your core values and can be regularly practiced.

If you have health or wellness related goals, contact Dr. Megan Holt for an in-person or Skype non-diet wellness assessment so you can cut through the marketing noise of the diet industry and develop goals that are best suited for your unique body and lifestyle.

And be careful to not compare your goals for change to the goals and resolutions of others.

Comparison is a general buzz kill to change.

You are the expert on you. Never forget that.

As you seek collaborative support and sustained change, the Potentia Team is here as a support and resource for you. It would be an honor to help you make 2015 a year of living in clarity and purpose.

____

What are you resolutions, goals, intentions for 2015?

What support do you need to meet your goals?

Cheering you on in 2015 –

Rebecca Bass-Ching, LMFT

 

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America’s Love/Hate Relationship with Saturated Fats By Dr. Megan Holt, DrPH, MPH, RD


Let’s start off with an overview of saturated fatty acids, and how they differ from poly or monounsaturated fatty acids.

Saturated fatty acids (SFA’s) have the following characteristics distinguishing them from other fatty acids (trans, monounsaturated & polyunsaturated):

  • solid at room temperature
  • occur naturally in foods
  • referred to as ‘saturated’ due to their having no double bonds along the carbon chains that comprise these saturated fatty acids

Unsaturated oils, on the other hand, are liquid at room temperature, primarily found in higher concentrations in plant sources (with the exception of fatty fish) and have one (mono) or multiple (poly) double bonds along the carbon chain.

Contrary to popular belief, foods do not consist of one type of fatty acid. Rather, foods are composed of varying percentages of unsaturated and saturated fatty acids.

For example, SFA’s comprise roughly 13% of the fatty acids in olive oil, and 65% of the SFA’s in butter.

SFA’s are found in higher amounts in dairy products (ex: cream, butter, milk, cheese) as well as in meats (bacon, sausage, chicken fat, mutton), ghee, suet and lard.

Palm oil, palm kernal, coconut and cottonseed oils contain a larger percentage of SFA’s (relative to the other plant based fats), though they lack the cholesterol contained in animal sources.

Examples of SFA’s include:

  • lauric (palm kernal oil, coconut oil, vegetable shortening and is also used in )
  • palmitic (palm oil, tallow, processed foods to enhance texture)
  • myristic (palm kernal oil, coconut oil, butter)
  • stearic acids (cheese, sausage, bacon, ribs, beef/ground beef, candy, cocoa butter)

These fatty acids are also commonly used in conjunction with sodium hydroxide, creating a product commonly found in soaps, shampoos and cosmetics (ex: sodium laurate and sodium palmitate).

For several decades, foods high in SFA’s were demonized by public health and nutrition experts, citing numerous studies suggesting that SFA’s were disease promoting.

Saturated fats were linked to increased LDL (‘bad’ cholesterol), a primary risk factor for heart disease.

Current American Heart Association guidelines suggest limiting calories from saturated fat to less than 7% per day (or roughly 16g or 140 calories).

SFA’s were somewhat vindicated when evidence emerged several years ago suggesting that trans fatty acids (partially hydrogenated oil) were more offensive, as they not only raise LDL, but decrease HDL (or ‘good’ cholesterol).

Recently, however, results of a meta-analysis of 72 studies (including both observational studies and randomized controlled trials) on saturated fat intake and heart disease published in the Annals of Internal Medicine found no association with SFA intake and risk of heart disease – basically stating saturated fats were found to have no influence, positively or negatively, on heart disease.

The results were highly publicized, and largely misconstrued by media.

Results of the published study actually read as follows:

“Current evidence does not clearly support cardiovascular guidelines that encourage high consumption of polyunsaturated fatty acids and low consumption of total saturated fats.”

Critics of the study, including nutrition experts from the Harvard School of Public Health (one of whom actually authored the study) are calling for a retraction or revision of the paper.

Critics have pointed to the limitations of meta-analyses as one potential problem, as numerous studies are combined and summarized, despite vast differences in methodologies (particularly across nutrition literature).

They also cite conflicting findings from numerous large scale population studies that link plant based/vegetarian diets (and lower intake of animal products) with health and longevity (Framingham, Adventist Health Study, China Study).

Another author (there were fourteen) has stood by the study’s findings, but insists that the conclusion of the meta analysis only suggested that we need further research to better understand the relationship between SFA’s and heart disease.

She has also supported continued adherence to American Heart Association’s parameters for SFA intake, stating that relaxing the guidelines would be premature at this point.

There are a number of studies in progress looking at the influence of particular saturated fatty acids on health outcomes, inspired by recent findings that suggest that all fatty acids are created equally.

The results of Annals of Internal Medicine study are intriguing indeed, and warrant further attention.

But until we have more evidence, the large majority of experts recommend continuing to keep SFA intake to a minimum and acquiring dietary fat from plant based sources (examples include olive oil, avocado, nuts and seeds). We must also consider the steep environmental cost of meat consumption (10-15 pounds of grain is required to produce 1 pound of meat).

Bottom line: It’s a bit too soon to begin piling meat and cheese on your plate, but the results do suggest that more work needs to be done before we fully understand the relationship between SFA’s and heart disease.

And please be cautious when relying on media to interpret results of complex studies.

What can we conclude from the referenced study and other similar studies on SFA’s and health?

  • It seems that not all SFA’s are ‘equal’, and the way that they influence disease risk is not well understood and deserves further attention, so avoid dogmatic teachings around good food/bad food.
  • While we seek to better understand the SFA/health relationship and await further study results, please still proceed with caution when adding SFA’s to your intake.
  • Foods that are high in SFA’s (meats, dairy) are also often high in preservatives (and other artificial fillers) and sodium. Quality of meat/dairy DOES have a meaningful effect on the nutrient density, so going organic/grass fed IS worthwhile if you’re able.
  • Good nutrition is a complex picture with many shifting parts, and research is moving away from studying the influence of single nutrients on health outcomes, so be wary of these kinds of studies.
  • Lean on a plant based diet for necessary fats and proteins such as beans, lentils, nuts, seeds and whole grains (budget friendly AND protective), and supplementing with high quality (organic/grass fed) meat and dairy products when you do want to include animal fats.

Questions, thoughts and reflections? Please post them below. I look forward to continuing this important discussion with you.

In good health –

Megan


Study Reference:
Rajiv Chowdhury, Samantha Warnakula, Setor Kunutsor, Francesca Crowe, Heather A. Ward, Laura Johnson, Oscar H. Franco, Adam S. Butterworth, Nita G. Forouhi, Simon G. Thompson, Kay-Tee Khaw, Dariush Mozaffarian, John Danesh, Emanuele Di Angelantonio; Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk: A Systematic Review and Meta-analysis. Annals of Internal Medicine. 2014 Mar; 160(6):398-406.

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Faith Fasting and Disordered Eating

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Post interview smiles with Amy Cyr

Last week I had the pleasure of doing an on-camera interview for undergraduate PLNU communications student, Amy Cyr.

Inspired after reading this article, Amy focused her story on faith fasting and explored how fasting in your faith community may be a trigger to develop disordered eating patterns or engage deeper in an already existing eating disorder.

After interviewing leaders from various faiths who practice fasting as a spiritual discipline, Amy shared concern about the lack of awareness around eating disorders and how community or individual faith fasting may be an unintentional trigger to engage in unhealthy/unsafe practices around food and body issues.

I was touched by Amy’s savvy insights and desire to discuss an issue that is complex and important. Since eating disorders are so misunderstood and also the most deadly of all mental illnesses, it has become a passion to educate leaders of faith communities about eating disorders and how faith fasting may become an unintentional pitfall for the communities they are serving, leading and supporting.

In honor of this season of Lent and fasting for other faith communities, I have posted the information from Potentia’s Fasting and Eating Disorder flier below.

Spiritual fasting is an important discipline that can have many benefits. Please keep the following in mind when considering a spiritual fast:
• When fasting from food, daily hydration is essential for sustaining LIFE.
• Fasting can trigger eating disorder symptoms in persons, especially those who have recovered or are in recovery for these issues.
• If at any time the goal of a fast shifts to primarily losing weight, it is no longer a fast but a crash diet. Fasting should not be used as a tool to promote weight loss. It’s ineffective, and it also lowers metabolism.
• Many who struggle with food and body issues will engage in a fast as a mask for their disordered eating. Given the prevalence of eating disorders, disordered eating, dieting, and body shame in our culture, regularly focusing your community on the priorities of the fast is crucial.
• Food restriction tends to intensify food related obsessions and talk, and this can persist for some time even after the fast.  This kind of talk can also be very triggering for someone struggling with food and body issues.  Encouraging a “no negative food or body talk “ pledge during a fast is wonderful to include at the start of a fast.
• Validating and encouraging other non-food options for fasting can help people struggling with eating disorders and disordered eating have the freedom to participate in a fast with their community.
• Many report feeling like a bad or not good enough person of faith if they choose to not participate in a fast “perfectly” ie: fasting from food. Helping individuals in your community to make the best decision for their mind, body, and soul is respectful and empowering.
• Fasting is not recommended for active persons that wish to continue with exercise during the fast.  Our bodies need the fuel (and electrolytes) before and after exercise, and throughout the day!
• Certain groups should never participate in fasting, and these include: children, elderly, pregnant women, persons with a history of disordered eating (or currently struggling) or are undernourished, persons who have problems with blood pressure (or are on medication for blood pressure), kidney disease, diabetes or are prone to hypoglycemia, persons with unique nutritional needs or nutrient deficiencies (just to name a few).
 

What are your thoughts about the intersection of fasting with food and disordered eating?

What do you think about faith communities encouraging fasts from non-food items so everyone can participate in a community fast, regardless of their health?

Have you ever seen someone take a fast too far and turn it into a weight loss strategy?

I look forward to hearing from you on this complex and important topic.

Cheering you on  –

Rebecca

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A Not So Celebration of the History of Popular Diets

I Choose Respect Over Body Shame
I Choose Respect Over Body Shame

“Insanity: Doing the same thing over and over and expecting different results” – Albert Einstein

In honor of Respect Your Body Month, Potentia’s Coordinator of Nutrition and Wellness – Megan Holt, DrPH, MPH, RD – compiled a timeline and unpacked the history of  fad diets and their many claims. Somewhat humorous and ridiculous at times, this list is not an endorsement of any of these trends but is intended to reflect the the constant ebb and flow of claims on what is true health. We support a non-diet, intuitive eating approach to feeding – when appropriate – and are passionate about educating the community on the dangers of fad diets and the diet mentality. – Rebecca

1863 Banting’s Diet: One of the first documented low carbohydrate diets. William Banting was a carpenter and undertaker. “Bad” foods included sugar/starch, butter, milk and beer.

1830 Graham’s Diet: A Presbyterian Minister, Sylvester Graham, touted a ‘bland’, vegetarian diet free of milk, meat, alcohol, white bread and ‘excitatory’ spices (which, upon intake, cause a person to become ‘lustful’).

1920 Inuit Diet: Vilhjalmur Stefannson, an Arctic explorer, noted improved health and quality of life among persons living in Arctic regions by eating a diet consisting predominantly of whale blubber, raw fish and caribou, with minimal fruit and vegetables.  Thus, the Inuit Diet was born.

1930 Dr. Stoll’s Diet Aid: One of the first liquid supplement diets, shakes were given out as meal substitutes in local beauty parlors in efforts to popularize this diet.

1930 Hay’s Diet: Dr.Hay warned of ‘digestive explosion’ from consumption of fruit, meat and dairy at the same meal. He urged separation of foods into alkaline, acidic and neutral meal/snack categories.

1950 Grapefruit Diet: Consists of having ½ grapefruit daily, and minimal caffeine. Fatty meats, particularly bacon, may be consumed liberally, as the combination of grapefruit and saturated fat is “claimed” to accelerate the burning of body fat.

1980 Cabbage Soup Diet: This plan advises the consumer to consume cabbage soup at meal times for seven consecutive days, with the stepwise addition of beef, fruit, vegetables, brown rice and skim milk.

1980: Fat free/very low fat: Emphasized elimination of fat in the diet, given its caloric density and link to development of cardiovascular disease. Manufacturers quickly adapted by producing fat reduced versions of our favorite foods, using sugar to enhance palatability.

1990 Atkins Diet: Popularized by Dr.Robert Atkins, initial phases demand a carbohydrate intake not greater than 20g/day, and exclusion of fruit, starches/grains, added sugar, starchy vegetables and beans/legumes. Caffeine and alcohol are forbidden, but meat, eggs and oils may be consumed liberally.

2000 South Beach Diet: Essentially a tamer version of Atkin’s, partakers are allowed to include a greater percentage of calories from carbohydrates in the form of fruits, vegetables and whole grains in later stages, and are discouraged from over consumption of fatty meats/foods rich in saturated fats.

2000 Master Cleanse: Users are ‘detoxified’ by adhering to a strict regimen that includes a mixture of water, lemon juice, maple syrup and salt. The diet was originally publicized in the 1940’s by an alternative healer by the name of Stanley Burroughs.

Present day fad: The Paleo Diet, also referred to by some as the ‘Caveman’ diet, advocates a diet mimicking that of our Paleolithic ancestors. The Paleo diet features exclusion of processed grains/oils, legumes and dairy.  This sort of an eating style is not new, as it was initially popularized in the 1970’s, though it’s made a comeback in recent years.

Despite their obvious differences, many of these diets all share a few common features (aside from the lack of credentials or expertise of behalf their wealthy creators): They erroneously suggest that we can manage health/weight through black and white thinking, they don’t ‘work’, they aren’t sustainable and they lack supporting evidence.

What do you think about this list? Would you add to it?

How do you respect your body through how you feed yourself?

Please join the conversation over on Potentia’s Facebook page on Choosing Respect Over Body shame.

In good health –

Megan

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I choose respect over body shame – will you join me?

I choose respect (over body shame)

 

February is often a month dedicated to bringing awareness to food and body issues, with the last week of the month specifically focused on Eating Disorder Awareness.

I have been a big supporter of this time of year for the last decade. There is such a need for more understanding, awareness and education on eating disorders and related issues. They are deadly, misunderstood and too often unintentionally perpetuated by many who mean to help those struggling with these issues.

Whether you have a history of struggling with disordered eating, negative body image or are really passionate about wellness, sometimes you may have a bad body image day, week, month or more.

In a culture where a good portion of the few thousand messages coming at us a day are focused on our body, health, and image, it is hard to not internalize some of the scarcity, comparison and shame hurled at us.

So, even if you are at a place where you can generally say, “I am ok as I am — mind, body and soul” it seems completely understandable to me that there are seasons, bumps in the road per se, where your relationship with your body is not always full of love.

Many in recovery are ashamed and fearful of having a season where their old ways of thinking and being make a comeback. So the masks of “everything is perfect” go up and the fear of showing vulnerability spikes.

I started seeing some masks pop up in my clients and friends hiding the fear of being seen struggling; not having it all together; not being seen as holy enough…

We can’t force a love relationship with our body. Building or rebuilding trust with your body takes time. Eating disorders, chronic illness, abuse, depression, anxiety, and shame induced by cultural ideals of beauty all can rob you of your ability to trust your body.

So many people have a hard time loving their body, let alone liking it. Sometimes you have to start from a place of respect before you move to love.  

I hear many share their frustration with how body-focused they are and offer a lot of self-judgement because their brain is stuck obsessing about what the scale says, what the mirror reflects, and what is eaten.

Food and body issues are real. Call it what you want — I think it is time to redirect the judgements that pop up about these struggles and try to really understand what is at the root of the pain.

From my perspective, when someone’s sense of comfort, peace and wellness is attacked, it impacts all other areas of their life. These are not trivial, self-indulgent, self-absorbed issues.

In an effort to debunk the stigma around body image struggles and normalize these common struggles, I gathered colleagues, teachers, parents, pastors, students, and business owners for an “I choose respect” photo shoot at Potentia.

We are posting an “I choose respect” feature photo every day this month on the Facebook page and the response has been so encouraging.

And here is a special gift for you inspired by I choose respect over body shame month: our Respect Your Body Creed.

(click to download)
(click to download)

What is your respect your body creed or mantra?

Share in the comments below and, if you feel bold, post a picture here or on our Facebook page letting me how you choose respect over body shame.

Cheering you on —

Rebecca

 

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Q&A Series: Should We Care About BMI?

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In our Q&A series we’ve unpacked the paleo diet, the gluten-free dietcleanses, and yoga therapy. This week, Kayla Walker, MFT Intern, spoke with Megan Holt, MPH, RD, Potentia’s Coordinator of Nutrition and Wellness to learn about using BMI as an indicator of health.

Note from Rebecca: The following post may be triggering for some who are early in their recovery or struggling with their recovery, so please pause here if this information will not be helpful for you right now. There is some frank talk about numbers in this post because we want to offer some accurate information about the BMI, what it is, why it is not an accurate or helpful indicator of health and how its use is fueling the disordered eating spectrum.

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Kayla: What is BMI?

Megan: BMI stands for body mass index. It’s an equation commonly used in healthcare venues to estimate risk of developing chronic diseases that often accompany increases in body fat, such as diabetes, heart disease, and many forms of cancer.

Kayla: How do you calculate BMI? How do you know whether your BMI is in a healthy range?

Megan: The formula for BMI is:

BMI = weight in pounds/(height in inches x height in inches) x 703
or
BMI = weight in kilograms/height in meters squared

CDC recommendations categorize BMI in ranges of underweight, ideal weight, overweight, and obese, as follows:

Below 18.5 = Underweight
18.5 to 24.9 = Ideal
25.0 to 29.9 = Overweight
30.0 and above = Obese

Note from Rebecca: In 1998, the FDA changed the ranges for the BMI and overnight millions of people became “overweight” and “obese.” In his movie America the Beautiful, Darryl Roberts noted this changed was approved by a board that was directly connected to the dieting industry. Given the annual 50+ billion dollars which are spent on diets and diet related products, the BMI is regularly used as a marketing tool to support the use of various products in this industry. And since diets do not work – and in fact set you up to regain the weight and often more within 1-2 years – it seems the BMI is more of a marketing tool than a predictor of true health.

Kayla: Where did the idea of using BMI as a marker of health originate?

Megan: A mathematician (not a clinician) from Belgium by the name of Lambert Adolphe Jacques Quetelet came up with the BMI in the early 1800’s. His aim was to come up with an inexpensive proxy for measuring degree of obesity. Named the Quetelet index (and later BMI), it was used as a means of assessing “appropriateness” of weight for height.

Kayla: Why is BMI used?

Megan: After WWII it was noted that obese and overweight life insurance policy holders were at higher risk for morbidity and mortality were getting increasingly fatter.

It’s easy to understand and compute, it’s inexpensive, and gives us some helpful feedback in terms of anthropometric assessment, though this holds true mainly in the extremes (very underweight and very overweight/obese).

Note from Rebecca: Recent studies are showing a lower death risk for those who are considered “overweight” according to the BMI  furthering doubt the BMI ranges are not helpful in indicating true health.

Kayla: What are the limitations of using BMI as a marker of health?

Megan: BMI does not account for differences in bone mass/structure, fat mass and lean body (muscle) mass, nor where fat is stored (visceral vs. subcutaneous).

Visceral fat (fat around the abdomen/vital organs) is much more inflammatory and problematic in terms of health risks than subcutaneous fat (under the skin).

It implies that thin or normal weight individuals are healthy and have lower risk of developing preventable disease relative to their overweight (according to BMI) counterparts, and this just isn’t the case.

Athletes are an excellent example of persons who tend to have higher BMI’s but carry lower disease risk. Similarly, body fat is underestimated in the elderly, as they typically carry very little lean body (muscle) mass. Remember, one can be thin and simultaneously unfit and/or unhealthy.

Kayla: What should we be using instead, or at least in conjunction with BMI, to predict health risks? What are other markers of health?

Megan: Waist to hip ratio, for one, needs only a measuring tape, and has more predictive power than BMI. Women should have a waist-to-hip ratio of 0.8 or less, and men 0.95 or less. Women are advantageously pear shaped, and thus carry lower risk for preventable diseases. Think of this next time you’re cursing your curves, and please STOP hating on your body!

Other methods exist that are quite costly and/or intrusive, but may be more accurate, such as requesting a lipid panel (which requires blood work) from your physician, or assessing body fat through use of skin fold calipers, underwater weighing, or bioelectrical impedance. However, assessment of percent body fat alone still does not account for ‘location’ of fat-visceral versus subcutaneous.

Kayla: How do you assess your clients? Do you use BMI as a health indicator?

Megan: I rarely, if ever, calculate BMI when working with clients, whether they are athletes or people struggling with disordered eating.

Rather, I use an assessment of their current diet and lifestyle behaviors and blood work results from their physician to measure risk.

When working with individuals who do fall in the extremely obese category, I find that they are well aware of where they fall in terms of BMI categories, and that calling attention to this is not helpful.In fact, it often deters these individuals from wanting to make changes to lifestyle, as they likely will remain in the ‘obese’ category even with a fairly significant weight loss.

We know that even mild weight loss, 5-10%, for example, is enough to significantly decrease risk of “Western” diseases, such as diabetes, heart disease, and numerous cancers.

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Thanks for reading our Q&A on BMI!

What are your thoughts about using BMI as an indicator of health? Has it been helpful or harmful in your journey to health? What additional questions do you have about health, weight, or body image?

We would love to hear from you and address your questions on health and wellness in a future Q&A blog post.

In good health –

Kayla & Megan

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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

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