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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I have a confession to make to you…

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2013 has been full of some serious body image blues.

You know how it goes:

  • not feeling comfortable your skin
  • feeling like none of your clothes fit well
  • not wanting to see your image in a mirror or a picture
  • struggling not to be tempted by the false promises and quick fixes of the diet and so-called “wellness” industry
  • feeling less then, ummm, hubba hubba with your spouse
  • not wanting to be very social
  • playing the compare game

A couple things crept in that started to take away from my New Year’s calm and clarity (my word for 2013): lack of sleep because of all things toddler (winter colds, potty training..) and my newly diagnosed asthma.  I was missing my time with my boot camp buddies – my one-two punch for social and active time.

I hit a wall. Right about the time I was doubling the staff at Potentia.  We just completed two successful cohorts of our 8 week Cultivating Courage workshop and put dates on the calendar for three Cultivating Courage Weekend Intensives.

All good stuff.

I was super pumped about all these happenings but was getting really depleted and disconnected from my social support.  My health was starting to suffer, too.

And in walked my body image blues right through the front door.

Shame said, “You hypocrite.  You are leading these men and women to heal their relationship with their bodies and you do not even feel good about your own.  You are a fraud.”

Ouch.

But here is where things took a different turn.  My discomfort in my skin did not necessarily dissipate but how I responded to these thoughts and feelings took a rather radical detour.

I practiced, practiced and continue to practice my shame resilience skills.  I dug in and wrote my daily gratitudes and read my daily devotions.

I got really clear on my needs and spoke them to my friends and family, not as demands but as requests.

I made my self-care – mind, body and soul – a priority and made sure my schedule reflected these values.

I practiced empathy with myself and others when judgements and crankiness reared their ugly heads.

I re-evaluated my boundaries and made sure I was not setting up walls which protect but also isolate.

I spoke my truth to my really, really safe people.

I now know I am enough even on days I do not feel enough.  I can hold that space while I feel yucky and not attack my core worth. Some days it is a bit of a knock down, drag out fight – but shame resilience has helped me run the marathon of living life reflective of my values and my true worth.

Wow.

Those who work in the eating disorder field are not immune to struggling with their own food and body issues.

And I am no exception.

It was pretty incredible to see how the ongoing practice of shame resilience kept me from dancing in the pit of self-loathing for very long.  It has helped me practice respecting my body even when I do not like it much.

Yeah, I am not immune to these thoughts or feelings.  But how I respond when they hit has truly been, well, awesome.

And as I say every day in my office, “Rarely are bad body image days about food, weight or the aesthetics of a certain body part.”

Negative body image is often the equivalent of that scratchy throat you get when feel you are starting to get sick. If you ignore the symptoms and do not take extra care to build up your immune system, you will get leveled and feel even worse, taking longer to recover.

And instead of going old-school and obsessing over weight, looks and what others think, my shame resilience skills are (almost) my default now and the obsessive tendencies to measure my worth by the number on the scale (if I had one) or how much I have worked out were not nearly as loud as they used to be.

This new response to shame has been so, so, so freeing and healing.  Instead of fearing vulnerability, I have grown to understand and respect its place in my life – though I do not like the feeling of it most of the time.

Reading Brené Brown’s books over the last few years have been so helpful in building my awareness about shame and normalizing the universal experience of shame.  I developed a whole new vocabulary.

But these last 9 months training with Brené, Robert Hilliker and the rest of the Connections team to complete my Certified Connections Facilitator Certification moved me from an intellectual insight of this work to a daily (well, mostly daily) practice.

I have seen the fruits of this practice in my marriage, my work as therapist and in my relationships with God, myself and others.

And this is why I can barely contain how excited I am to offer this work – Potentiafied for you in our Cultivating Courage Workshops and Weekend Intensives.

We have three Cultivating Courage Weekend Intensives scheduled for the remainder of this year: June 14-16, Aug 23-25 and Nov 1-3.  And my colleague, Molly LaCroix, and I will be launching our 8 week Weekly Cultivating Courage Workshop Series in January 2014.

For those who are local, we have some digging deeper workshops which will be launching this summer to give people a chance to freshen their Shame Resilience skills or have a toe-in-the water experience with this powerful work.

And plans are in the works to take this work online so our Potentia friends outside San Diego can have access to this material, too.  Make sure you are signed up to receive email updates so you can get the latest details on all of these happenings.

I would love to know what your questions are about shame and Brené Brown’s shame resilience theory.  Please email me directly at rbass@potentiatherapy.com or post your questions below.  If I feature your question in a future blog post, you will receive a copy of Brené’s most recent book, Daring Greatly.  So don’t hold back, I really want to hear from you.

Working on being my own cheerleader while cheering you on, too!

Rebecca

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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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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

 

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Seeking True Health in a Health Obsessed Culture

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True Health

Is your definition of health keeping you unhealthy?

Maybe. Maybe not. But I recommend taking a critical look at how you define health in your life and to reflect on how your definition of health is impacting your overall wellness.

When you say something or someone is healthy, what drives your sentiment?

I usually hear the following impacting this statement the most:

  • Looks
  • Weight
  • Fashion
  • Food choices
  • Fitness routines

And by the frenzy of advertisements everywhere about all of the above, the definition of health in our culture has been skewed to meet the needs of for-profit industries while also fueling disconnection and shame about the food we eat, our bodies, and our stories.

It is time to start thinking critically about the messages we are integrating into our definition of health.

Any person, book, or program that touts drastic weight loss, cutting out major food groups, or specific results is a wolf in sheep’s clothing. None of these diets or “lifestyle choices” are sustaining after 1-2 years. The facts show weight cycling from dieting, disordered eating, and serious eating disorders are continuing to wreak havoc on our health.

I respect and totally get the desire to look good and feel good. Yet, there is a dark side to these pursuits when the meaning and motivations are based on fear, obsession, and untruths.

I am troubled by the loud chorus of people in the medical and wellness fields that are getting on the bandwagon of fear of fat and an over-focus on the number on the scale as a measure of true health.

And I am even hearing health preached from the pulpit. Yet when people in faith communities are equating virtue with the number on the scale or whether you eat certain foods, it only results in more anxiety, confusion, and discontent. Shaming people to lose weight or eat well in the name of God hits below the belt and increases psychological and spiritual wounds.

I am surprised how many people are still using the archaic BMI (Body Mass Index) as an indicator of health. It is simplistic, formulaic, and reductive. The BMI does not take into account your genetics, unique physical makeup, and lifestyle. Yet it is still used as the gold standard for whether someone needs to lose or gain weight.

And I am still skeptical of the FDA standards of the BMI knowing that many of the people on the board have or have had connections to the diet industry. If the BMI is a part of your definition of health, I encourage you to take a step back and reconsider its role.

We do have some serious issues to address regarding wellness in our country, but the myopic focus on weight + good food/bad food is missing so many other factors that contribute towards true health. And until we have a multidimensional view of health, we will keep spinning.

I talk a lot about what health is NOT.

I believe health is not:

  • determined only by the number on the scale;
  • achieving the “perfect” body or striving for unhealthy perfection;
  • eating food restrictively or based on a “good” food or “bad” food mentality;
  • unsafe relationships;
  • an obsession with eating healthy where there is no room for flexibility;
  • dieting and demonizing foods and food groups;
  • shaming, blaming, or judging self or others.

I also talk a lot about how I define health.

I believe true health is:

  • finding something you are passionate about and striving to spend most of your waking hours in this space. When people are bored or feel trapped in jobs or situations that drain them of their creativity, their motivation, and ability to sit in vulnerability, this has a negative impact on mental and spiritual health which in turn can develop into physical ailments.
  • having a relationship with money where you are living within in your means and have enough to give and save. Leaning too heavily on finances as a means of control or comfort gives money way too much power over your peace of mind. And using money as a means to medicate can create chaos and a cycle of stress that negatively impacts mental, physical, and spiritual health.
  • involvement in your local community. So many people are disconnected from the places they live, but emotional wellness comes when we feel safe, have purpose, and community.
  • having a faith + regular spiritual practice. Understanding we are loved beyond measure and there is a greater purpose for your life gives perspective and meaning in all circumstances.
  • having a deep soul connection with a special few individuals who you can be real with, share your fears, mistakes, dreams, and hopes. Feeling heard and understood creates connection. Connection breeds empathy and gratitude. Gratitude impacts how our brains fires and improves our well-being, body, and soul.
  • living in a body that has energy, its needs met, is rested, moves well, and is free from pain. And when many are living in chronic pain or have chronic illness, practicing the previous five points can actually help improve their physical health. The only numbers of real concern are on your labs checking your bloodwork and other internal functions.

In the days and weeks to come, I will dig even deeper into these components of true health.

I am curious: How do you define health in your life? What do you think of my definition of health?  I look forward to and value your thoughts and feedback on this important and controversial topic.

Rebecca

 

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Getting Comfortable in Your Skin: Action Steps to Take Now

 

1. Respect your body, even if you do not like it.  You have people in your life that you don’t like but you still treat with respect.  Give your body the same respect even if you are not a fan of it at the moment.  Everyone has a bad body image day (week, month…); it is normal.  Your body can serve you better when you treat it with respect instead of constantly trash talking it.

2. Shift to saying “I feel…” vs “I am…”  The difference between saying “I am…”  vs “I feel…” has a ginormous impact on how our brain fires.  Saying “I feel” is respectful honesty so you can assess how to care for yourself.  Saying “I am…” is a judgement, shaming and disrespectful.

3. Stop the compare game.  Nobody wins.  This is tricky as our brains like to assess threats, and these days the threat is not just looking for life + death dangers but also assessing who is prettier, stronger, thinner, smarter, funnier, etc. Doing your work to bench negative emotion helps you manage vulnerability and keep the compare game from wreaking havoc on your self-worth while staying connected.

4. Take a break from the scale.  If your mood + self worth are negatively impacted after you weigh yourself, take a break from the scale.  I dare you.

5. Stop the negative body talk.  Similar to #1 but a slightly different take.. Talking negatively about your own body and the bodies of others can add to the toxic noise in between your ears and in your community.  Negative body talk increases anxiety, depression, and disconnection.  Let words that are life-giving and that build up be a priority in your discourse.  This is a quick way to turn down the volume on your inner drill sergeant.  You have a powerful voice, whether you believe it or not, so use it with caution+respect.

6. (re) define how you give compliments.  Instead of telling someone she looks amazing after she lost weight or how good she looks in her jeans, talk about her smile, the color of her shirt, her generous spirit, her faithfulness.  Do not underestimate the negative effect a well-intentioned compliment about looks, food, etc. can have on those around you.  You just do not know how it will be taken, so why risk hurting someone?  Start a compliment revolution and notice the awesome ripple effect.

7.  Wear clothes that fit YOUR body and that you love wearing.  Feeling comfortable in your skin requires wearing clothes that fit you well and you enjoy wearing. Note: You have just been encouraged to shop.  Go! (But stay within your budget+do not let this be an excuse to spend money you do not have in your account.)

8.  Move.  Mild to moderate activity five days a week can have a marked impact on your mood, wellness, and sense of worth.  Be safe.  Check with your MD before starting anything new.  Stretch. Walk. Skip. Sweat.  Just move.

9.  Re-evaluate your social support.  Spend your time with safe people who build you up, support you, and bring out the best in you.  Connection with safe people is medicine for the soul.  The act of being seen and understood is a love bomb that quickly shifts your focus from your perceived body flaws to positive engagement.

10. Take a media fast.  See #3. Try it for a week.  I double dare you.

11.  Start a gratitude practice.  I have to confess, I was very cynical about this whole  gratitude practice thing and thought it was trendy, surface, and not effective.  Then I read the research, felt the call on my heart, and started my own gratitude practice. I was completely convicted + convinced.  My faith + my mentors challenged me in my practice and now I am challenging you.  When you are intentional about what you are grateful for, your brain fires differently, your mood lifts, your priorities + purpose stay clear, and you are able to bench joy without waiting for the other shoe to drop. A gratitude practice is a flu shot for shame storms.

12. Fill your awake time with play + creativity.  Your soul is dulled by monotony, fear, shoulds, and have tos. Push back at unhealthy perfectionism which is a buzz-kill on your desire to play and create.  Start without worrying about finishing or how you look. Get silly.  Paint. Draw. Craft. Write. Play catch. Swing. Your soul craves it and your well-being needs it.

13. Rest.  We are one tired nation with pretty crappy sleep hygiene.  When your brain is robbed of rest, you compromise all aspects of your well-being.  Set a regular bed time + wind down ritual and stop drinking caffeine after noon.  Activity, nourishment, and social support all play a role in your quality of sleep, so take an inventory of these areas if you are struggling with getting the quality sleep you need.  If you have sleep issues, get a physical and assess how your body is functioning.  Yoga, massage, acupuncture, and prayer are important calming skills to help your nervous system recalibrate.

What action step are you going to take to help you feel more comfortable in your skin?

What would you add to this list?

Cheering you on –

Rebecca

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Holding the Numbers Lightly

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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

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New Year’s Eve Soap Box (and good tidings, too)

 

I am a big fan of this time of year.  There is something about the beginning of a new year that brings with it rejuvenated hope, a fresh start, space to dream.

This time of year is also when everything media is saturated with promises to help you with your resolutions about exercise, weight loss, nutrition + wellness, relationships and more.

In particular, the diet industry along with fitness, health and personal improvement gurus are promoting the heck out of their various programs to help you make 2013 your best. year. ever.

So much of this hype genuinely speaks to many of you who are uncomfortable in your skin.  Food, family, fat, and other f-bombs get thrown around out of frustration a lot at this time of year.

And for those of you who have be on the diet, weight cycling, body hatred, I am not enough, scale-obsessed train for some time now, promises of quick relief to real pain are seductive and haunting.

Clicking “buy now” brings promise of solutions to real concerns and serious pain points in your life.

But this incessant talk about weight, body and food is like adding fuel to a dangerous fire burning in the hearts and minds of many who are crushing against the emotional pain of serious food+body issues, anxiety, depression, unhealthy perfectionism, loneliness+disconnection.

To be honest, there are some quality people and quality programs out there that can help you on your way to true health. And then here are some that frustrate the heck out of me as they exploit, are unsafe and make promises that are not based on sound research or true health.

While I believe there is room for a variety of definitions of health, I am fed up with definitions of health being reduced to the number on the scale and the fear of everything fat. Good intentions to help improve wellness are creating more anxiety+depression around food+body issues.  This deeply concerns me.

Restricting, denying, punishing, shaming are not sustaining change agents.

There is a whole host of struggles we have to tackle as we seek to improve the quality of life for all. We do need to move more and strive to make whole, fresh, organic food affordable + accessible to all.  We need to play more, laugh more, rest more. And improving our support of those with mental illness is a non-negotiable.

Seeking change is important.  It is a natural part of growth.  But when desired change is motivated by a numbers on scales, fear, people pleasing or performance – it will wreak havoc on your mind and soul.

Change is hard, change is messy; change is an ebb and flow.
Change is often needed, demanded.
Change is uncomfortable; change is frustrating; change is important.
Change is about showing up, fighting through fear and shame.
Change involves trusting like you have never trusted before.  Once step at a time.

Never forgot, homeostasis will fight to the death to maintain status quo.  That is why change is so difficult.  Especially when we avoid doing our own deep soul work.

I love Donald Miller’s recent post on resolutions.  He states they do not work when:

  • Our resolutions are not meaningful
  • We failed to make a plan
  • We forget our resolutions.
  • They just were not for us.

Donald Miller went on to say when resolutions do end up working is when we:

  • Choose a meaningful ambition
  • Create a plan for our meaningful ambition
  • Engage in conflict
  • Share our story with the world

If we are seeking changes that fuel deep soul meaning in our lives; if we have the emotional muscle to handle conflict internally and externally and own our story instead of shrink from it, well, look out 2013.

Suddenly obsessing about numbers+other people’s opinions do not have as much power with this new lens.

What do you desire to change this year?  How are you going to go about making these changes?

Are you trying to do it all at once or can you tolerate a step, a shift in direction, a phone call or email to start the process?

Are in this alone?  You may feel that way but my faith informs me differently.

Get clear on the changes you are seeking. Be specific.

  • Check your motivations for change. Are your desired changes life-giving or fear-based?
  • Check your expectations and desired results. Are they realistic for you, your body, your current life situation?
  • Check your beliefs about change. Do you have hope you can change?
  • Check the source of doubt, fear and shame against your faith.

And then turn towards lasting change and away from diets + shame-based expectations.

Happy 2013!

Rebecca

PS – And for those of you in the San Diego area who want to work on creating sustaining change in your life, check out our Cultivating Courage Workshop series launching in a few weeks.

 

 

 

 

 

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