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

A Twist on Dealing with Negative Body Image

Negative Body Image.

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

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

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

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

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

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

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

Ugh.

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

And this is where things often spiral.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Consider this strategy in your relationship with your body.

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

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

All the while administering generous doses of respect and gratitude.

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

With respect and gratitude –

Rebecca

 

Holding the Numbers Lightly

lifetooshort

 

Numbers.

I have a lot of conversations about numbers in my line of work. And not the numbers that my accountant or financial planner talk with me about (ugh) but the numbers that are used to help us measure our physical health.

My clients over the last decade have taught me that these numbers can be destructive, shaming, and spike their inner drill sergeant to start screaming awful things about their worth + value.

Working with those who struggle with eating disorders, negative body image, and disordered eating has taught me a lot about some numbers and how they can be draining and all-consuming.

I am referring to the number:

on your scale
of the size of your pants
of calories or points of a food item
on your labs (I like these numbers but they can often be used incorrectly)
of calories burned

While I believe our emotional, relational, and spiritual health are deeply enmeshed with our physical health, I want to address these numbers — particularly the number on your scale — and how you use them as you seek to make changes in your physical well-being.

When it becomes clear to me that these numbers are toxic to my clients and are preventing any real change from happening, I often ask them to take a big risk and leap of faith.

I ask them to get rid of their scale.

Sometimes they are not ready to get rid of it, so I hold it at my office (you should see the space under my couch) or they put it in the trunk of their car or have a trusted friend hold it or hide it.

Afraid of losing control without their scale, my clients ask:

What if I gain a ton of weight?
How will I know if I am making progress?
What will motivate me for change without the scale?

I always respect this resistance. I get it.

It’s a frightening idea to let go of this measure that helps them manage their anxiety + fear and has been serving as an emotional container for some time. But if they are in my office, I suspect this means of containing has reached capacity.

The scale simply does not serve as an effective means of control and in fact spikes obsessive thoughts about weight, food, numbers, and what other people think.

Stepping on the scale fuels the “never enough” crazy-making because:

  • If it is higher than you would like, you feel anxious, depressed, ashamed.
  • If it is right where you want it to be, you are excited but also paralyzed by fear of doing anything that will change that number in the wrong direction.
  • Even If you have achieved a weight in the range that is best for your body, sometimes the desire to go even lower gives a rush that is hard to resist.

Contrary to the many messages we are inundated with in our culture, weight is not a direct correlation to our health.  Last week, the results of a meta-analysis study of weight and mortality revealed those deemed overweight were associated with significantly lower all-cause mortality.

This study is more indication of the need to rethink how we define overweight and obese. I want to be clear, the results of this study are not a pass for those who need to make changes in how they care for their body. But shaming people to make changes to better their well-being is not effective and is destructive.

Determining our well-being is way more complex than a number on a scale or an antiquated formula or chart. These faulty formulas are pervasive in our culture and prey on those who are feeling pretty crappy about themselves, who are desperate for change and relief.

When the number on the scale is the primary measure of your success in achieving your goals, you are vulnerable to a shame spiral.

When this number has power over your worth and value, it is time to get off the scale until you can recalibrate that way of thinking and learn how to bench negative emotion so you respond to your pain in ways that are not harmful to yourself and others.

Many clients report a positive emotional benefit after taking a break from the scale. They report less anxiety and that their inner drill sergeant has dialed back the volume.

Let me be clear: I think it is important to own all of these numbers…

…at the right time in your healing journey.

At the wrong time, shame, perfectionism, impatience, and fear can take these numbers and wreak havoc on your sense of worth, your mood, your focus.

Megan Holt, Potentia’s Coordinator of Nutrition + Wellness, often monitors the numbers on the scale for our clients while working with them on strategies towards true health that are customized for each individual. (Note: We all need a Megan in this culture!)

When our worth gets tied up in numbers, we make changes — often needed changes — for reasons that do not support sustaining change.

Our goal is to help people really discover where their bodies have the most energy and function the best. We support people discovering their food preferences and moving away from calling food good or bad. It is so amazing to see people find a way to enjoy food while still nourishing well.

When we use eating, restricting, or eliminating food in unsafe ways to take away the pain or to numb, dull, and repel, we do not allow ourselves to develop the emotional muscle to bench the hard stuff in life.

Food — eating it or restricting it — is powerful. It can be fun + enjoyable, too.

But for many, tolerating joy is very triggering and even less tolerable than shame and fear. Going back to the dark space, albeit uncomfortable, is known. And our brains like known.

So, if you are starting off this new year and food + body issues are one of your primary goals to tackle this year, awesome.

But please hold the numbers lightly.

And if you notice the numbers on your scale or on food items you are eating or the size of clothes giving fuel to your inner drill sergeant, then take a pause.

Ask your dietician, your nurse, or doctor to do blind weigh-ins for a while and not to talk about numbers for a bit as you seek to recalibrate your thinking.

These numbers are one of many factors that measure your progress on the journey towards true health, but they are not the sole indicator of progress as they may fluctuate for a variety of reasons.

Hold the numbers lightly as you seek true health in your life, and fiercely guard your heart from believing your worth is tied into a number.

Cheering you on —

Rebecca

Faith Fast or Crash Diet?

Source: google.com via Rebecca on Pinterest

 

I was recently asked to put together a handout for an organization getting ready to start a community-wide faith-based fast and I want to share this important information with you, too.

Spiritual fasts are a powerful and important discipline which can bring about some truly meaningful experiences and growth.

But in today’s culture riddled with the extremely high incidence of eating disorders and disordered eating, I encourage individuals and leaders to please consider the following when engaging in 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 Christian” or “not a good enough Christian” 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 on this hot topic?

I would love to hear about your experiences with spiritual fasting in the comments below.

Rebecca

Five Reasons to Ditch Dieting

Source: google.com via Rebecca on Pinterest

 

By Megan Handley, MPH, RD and Nutrition+Wellness Coordinator at Potentia

  • For the last time, diets don’t work! A group of researchers out of UCLA analyzed studies that followed dieters for 2-5 years, and found that the vast majority of participants gained back the weight, and then some, by the end of the follow up period.

  • Diets rely on external cues to guide our eating, rather than teaching us to listen to our body’s hunger and fullness cues.  Food is fuel for our bodies and should be enjoyed, savored and appreciated!

  • Diets are often based on testimonials, rather than on sound scientific studies.  The suggested eating plan is often rigid, and does not translate to real-world living.

  • Diets often require that we severely restricts calories or entire food groups, putting us at risk for nutrient deficiencies, and robbing our bodies of the energy that we need to be active.

  • Intense feelings of deprivation and hunger set the dieter up for binge eating patterns, which are then followed by feelings of guilt and dissatisfaction.

The following links are wonderful resources for you as you seek to (re) define health in your life:

Academy of Eating Disorders
American Dietetic Association
Finding Balance
Health at Every Size  
Health at Every Size: The Surprising Truth About Your Weight by Linda Bacon
Intuitive Eating
The Center for Mindful Eating
The National Eating Disorders Association 

Diets can be a polarizing topic of discussion these days as many seek relief from real physical and emotional pain.  What do you think about diets? Have you had positive or negative experience with a diet?  Do you agree that diets do not work?