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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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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How is Your Sleep Hygiene?

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Note from Rebecca: Just days before Day Light Savings ends, we thought it would be good to address one of the most important tenants of health: our sleep hygiene. We are a tired nation with a high threshold for pushing through our exhaustion. But not meeting our sleep needs while trying to maintain a high level of function in all areas of our life is unsustainable over the long term. Making a commitment to change or start a new sleep hygiene habit can shift your trajectory of health and wellness for the better. Thank you, Megan, for sharing your wisdom!

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Humans sleep approximately 1/3 of their lives away, which equates to 27 years of life for an 82 year old.

Proper sleep has been proven to enhance mood and immune function, IQ, concentration and memory.

It also reduces risk of a long list of ailments and accidents: Heart disease, depression, obesity, diabetes, substance abuse, suicide and car accidents.

But 80% of people will have some sleep disorder during their lifetime, and persons with lower socioeconomic status are particularly disadvantaged. This makes sense as nutrition, exercise and stress all effect quality of sleep (all of which are compromised in individuals of lower SES).

So how much sleep do we need?

Everyone differs in terms of their ideal range, but 7-8 hours is a good general range. Individuals sleeping less than 5 hours/night carry a higher risk of diabetes, heart disease, and all-cause mortality (death).

Among the 5 stages of sleep, adequate time in REM (dream) stage is most crucial for mental tasks and memory function.

What can you do to protect your sleep?

Actions that are helpful include:

  • Having exposure to daylight/sunlight during waking hours
  • Regular exercise (promotes REM sleep)
  • Keeping room temperature cooler
  • Using the bed only for sleep and sex
  • Having a ‘wind down’ routine that may include caffeine free teas, a warm bath or a TV show

On the other hand, the following tend to interrupt sleep:

  • Nicotine
  • Caffeine
  • Sharing the bed with partners that toss, turn or snore
  • Stimulating the brain prior to bed (with reading material, work, intense/mysterious or thought provoking TV shows)
  • Alcohol (even one drink before bed for some individuals will do it, and this is especially true for females, who lose more sleep from drinking alcohol than men)
  • Perspiring/overheating
  • Having large meals within 2-3 hours of bed time (a small snack is fine)
  • Excess weight can also be associated with sleep deprivation. Not only are cortisol levels typically higher in obese persons, but the extra weight can result in snoring and sleep apnea.

For those of you more concerned about the cosmetic consequences of sleep deprivation, here are a few additional reasons to prioritize your beauty rest and improve your sleep hygiene:

  • Puffiness under the eyes, due to fluid and sodium retention
  • Skin wrinkling, as the balance between cortisol (promotes wrinkles/aging of skin) and growth hormone (protective/regenerative) is disrupted
  • Acne, also due to the increase in cortisol production
  • Reddening of eyes and dark under eye circles due to dilation of the blood vessels

How is your sleep hygiene practice?

What one change are you going to focus on to improve your sleep hygiene?

In good health –

Megan Holt, DrPH, MPH, RD

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Potentia is 6!

Potentia is turning 6

Several years ago, I had this picture in my head of a beautiful space where people could receive collaborative and specialized care all under the same roof. Six years ago this month, Potentia’s incorporation papers were filed and the dream started to take fruition.

I can laugh now but looking back six years ago, things were a little nutty. My first born was just a little over 2 months and I was clumsily learning how to integrate all of my new loves and passions on very little sleep.

Today, I am a little more rested. And my family has grown along with Potentia.

I am in awe and filled with gratitude looking at how the seed of a vision planted in my heart + mind has turned into something so much more.

As we celebrate our six year milestone, we are in the process of expanding: more office space, new clinical team members – including two male therapists – and new service offerings such as individual and group consultations on EMDR and Eating Disorders (CEDS) along with Child Centered Play Therapy.

Even our website is in the process of getting freshened up.

Whew!

And I am pleased to introduce you to five therapists who are a part of this season of Potentia’s growth: Moe Perdomo, Hannah Branch, Brian Resiwg, Kayla Walker and Roxanne Strauss.

Look at them all spiffy here…

Interns formal 2014

And here they are showing their brave and getting a little silly. Silly is so good for the soul!

Interns silly 2014

These new interns are joining me and our veteran Potentia team members:

The Potentia team is equipped with an understanding of:

  • the brain
  • non-diet approaches to wellness
  • the power of your story (owning, respecting and telling it)
  • the influences of shame and vulnerability

so we can be the best support to people seeking meaning in their struggles and desiring sustained relief from their pain.

All of our psychotherapy clinicians are trained in EMDR, which is an approach that helps people who are stuck because of tough life events, anxiety, depression, compulsive behaviors, loss, blocking beliefs, perfectionism and more. We also have therapists who offer specialized support with:

  • Shame Resilience and The Daring Way TM method
  • Food and Body Issues
  • Couples Issues and Premarital Counseling
  • Teen and Family Issues
  • Transition
  • Pastors Kids and Missionary Kids

I am excited to see where this now collective dream takes all of us as we continue to trust, pray, learn, grow and serve.

And to those of you who have a dream on your heart, respect it. Sketch or write it out. Share it with someone who will not talk about all the barriers to your dream but instead be a support to it.

Be careful to not compare it, minimize it or let the desire for certainty squelch your hope. Your dream is precious and it is placed on your heart for a purpose. It may not be logical or make sense. It may be painful to be in the inbetween of it being unfulfilled.

I get it. I wrestled with all of this over the years. Still do. The waiting, the tests of faith, the investment of time and resources, the trust are the refining part of the dream. Pace yourself and stay the course.

Cheering you and your dream on –

Rebecca

PS – Please make sure you are on our email list so you can stay up to date on our offerings, events, blog posts and receive an invitation to our upcoming  fall open house.

 

 

 

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

NoteRespect is looking at soreness

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

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

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

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

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

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

Other risk factors for infection include:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A ‘balanced’ regimen may include:

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

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

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

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

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

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

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

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

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

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

How do you define your relationship with exercise?

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

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

In good health –

Megan

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2013 in Review: Top 10 Potentia Blog Posts

top 10 blue

2013 has been quite a year! We celebrated Potentia’s 5th birthday, launched our signature workshop, (re) Define Courage: Dare to Show up+Be Seen, and added three therapists to our team to meet the clinical demand. I’m grateful to have had you along for the journey – I value your support and encouragement. In today’s year in review, I put together a list of the most-read blog posts of 2013.

This year we started a Q&A Series with Potenita’s  Megan Holt, DrPH, MPH, RD and Kayla Walker, MFT Intern that proved to be most popular – you can look forward to seeing more of these posts in 2014! Here are some of the favorites:

Q&A Series: Paleo Unpacked 

“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.”

Read the full blog post https://potentiatherapy.com/health-in-the-media/qa-series-paleo-unpacked/

Q&A Series: Cleanses

“Actually, there’s no evidence that a cleanse or fast would [cleanse the body of toxins]… 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).”

Read the full blog post: https://potentiatherapy.com/health-in-the-media/qa-series-cleanses/

Q&A Series: Gluten-Free Diet Unpacked

“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.”

Read the full blog post: https://potentiatherapy.com/health-in-the-media/qa-series-gluten-free-diet-unpacked/

Another popular series in 2013 was our Fat Talk Free Week series:

Fat Talk Free Week 2013: Interview with Natalie Lynn Borton

“For me, fashion has provided so much freedom for me in terms of embracing and loving the body that I have. Style has become my personal creative expression, and a way for me to be more authentically myself, rather than try to fit a mold. It’s counterintuitive, I suppose, but that’s just how it’s played out in my life. I don’t worship high end brands and expensive products, but rather let style be something that is playful, fun, authentic and enjoyable.”

Read the full blog post: https://potentiatherapy.com/health-in-the-media/fat-talk-free-week-interview-with-natalie-lynn-borton/

Fat Talk Free Week 2013: Interview with Rebecca Bass-Ching, LMFT

 “’Fitspiration’ is a wolf in sheep’s clothing and triggers fat talk big time. It can be like cocaine to the brain and can deplete your self-worth when you come down from the high. These images are most often photoshopped and they only fuel comparing, dissatisfaction, and feeling not enough. Yuck.”

Read the full blog post: https://potentiatherapy.com/health-in-the-media/fat-talk-free-week-2013-interview-with-rebecca-bass-ching-lmft/

No surprise, posts on the body – how we move it, talk to it and care for it, rounded out the most popular posts of the year:

Getting More Comfortable in Your Skin: Action Steps to Take Now

 “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.”

Read full blog post: https://potentiatherapy.com/redefining-health/actions-steps-to-getting-more-comfortable-in-your-skin/

Do You Need a Prescription for Play?

 “Play has not always come easy for me. For so long, play felt to me like a luxury or a sign of slacking. Play often seemed uncool and not put together. Perfectionism beat the heck out of my desire for spontaneous or planned play. Making space to play is often still vulnerable because I have to walk away from my to-do lists and internal shoulds that can get loud when I am working too much.”

Read the full blog post: https://potentiatherapy.com/redefining-health/play-is-not-a-luxury/

I Have a Confession to Make to You

“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.”

Read the full blog post: https://potentiatherapy.com/redefining-health/i-have-a-confession-to-make-to-you/

Holding the Numbers Lightly

 “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.”

Read the full blog post: https://potentiatherapy.com/redefining-health/holding-the-numbers-lightly/

Potentia’s 5 Year Celebration Giveaway also drew a lot of attention – which was especially fun for me, since Potentia and I have the same birthday!  Stay tuned for more Potentia giveaways in 2014 that are both fun and meaningful – including another birthday celebration in July!

Five Year Celebration and a Giveaway

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

Read full blog post: https://potentiatherapy.com/redefining-health/five-year-celebration-and-a-giveaway/

What were your favorite Potentia blog posts of 2013? What would you like to see more of in 2014? What kinds of questions should be address? Who would you like to hear from?

Stat tuned for my new Skype Interview series with writers, leaders, artists and others who are daring to show up + be seen in their work, family, art, faith and community.

Thanks for following with us on our journey.

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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Q&A Series: Cleanses

Q&A Series: Cleanses

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

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

Kayla: Let’s start by talking about fasting…

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

In good health – Megan and Kayla

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Q&A Series: Gluten-Free Diet Unpacked

Unpacking Gluten-Free Diet
Unpacking Gluten-Free Diet

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

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

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

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

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

Kayla: What are the benefits of gluten?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

In good health –Megan and Kayla

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Q&A Series: Paleo Unpacked

IMG_2448

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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