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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Consider making this one thing a priority in 2017…

therapy-couch-at-potentia

“The opposite of belonging is to feel isolated and always (all ways) on the margin, an outsider. to belong is to know, even in the middle of the night, that I am among friends.”

Peter Block in Community – The Structure of Belonging. 

At Potentia, we understand the deep need for all of us to find a place to belong. We also know first hand hand how easy it is to let parts of your story hijack your present and your future.

Our culture’s mixed messages around what it means to be well can fuel fears of being misunderstood, keeping many scared while rumbling in secret with stories of struggle, afraid of losing what matters most – connection.

Addictions, betrayal, mental health struggles, grief, trauma, perfectionism and shame touch all of us directly and indirectly through those we love and lead. Attempting to try and think yourself out of your pain often exacerbates the pain fueled by the barriers of stigma + access to resources – keeping way too many people in isolation.

Though struggle can trigger feelings of:

  • fatigue from stagnated attempts to heal
  • overwhelm
  • frustration
  • being trapped by the belief that change is not possible

it is easy to forget that struggle is not failure but a place of growth, wisdom. And every rumble to heal has a timeline of its own – so caution against comparing your struggle to the journey of others.

I know we are biased on this matter but we believe one of the best gifts you can give yourself and your loved ones is to make healing emotionally something to respect and value.

Our hope is that you will make your mental health a priority now and in the new year. Leaving mental health issues unaddressed will make it harder to achieve your goals, desires, dreams, and to find that sense of deep belonging within and with those in your life. 

Yes… the time, resources and energy that is needed to heal is nothing but tidy and streamlined – any quick fix plan offered to heal deep soul pain will fall short of you showing up day in and day out to do the messy work to heal.

Slower is often faster when it comes to mental health healing. Making mental health a priority in your life will help you show up in your life with more clarity, connection and confidence.

All of us at Potentia continue to invest our own time and resources studying, training, consulting and collaborating – along with supporting our own mental health –  so we can offer our clients and their families the best support. We also believe you play a crucial role in the process of changing the stigma around mental health issues. By doing your own deep soul work, you are leading by example. Your courage in this process will be contagious and inspire others to take the brave leap to ask for help.

We would be honored to help you and those you care for find relief and more meaning in life. If you are looking for resources outside of the San Diego area, check out the following sites to find support near you:

Psychology Today

edreferral.com

EMDRIA.org

Center for Self Leadership

The Daring Way™

Cheers to (re) Defining Health in 2017! Keep us posted on how we can be a resource for you.

With gratitude –

Rebecca

 

PS – We would love for you to come to our I Choose Respect Open House + Fundraiser on January 14th, 2017 from 4-7PM. Local artists and makers will be featured along with great food + community plus our I Choose respect photo booth as we prepare for our 4th annual I Choose Respect effort. Click on the image below to register!

 

icr-2017-open-house

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


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

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

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

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

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

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

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

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

Examples of SFA’s include:

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

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

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

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

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

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

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

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

Results of the published study actually read as follows:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

In good health –

Megan


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

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Faith Fasting and Disordered Eating

photo
Post interview smiles with Amy Cyr

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

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

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

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

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

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

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

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

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

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

Cheering you on  –

Rebecca

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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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Q&A Series: Should We Care About BMI?

worthnotanumber

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.

——–

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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Do You Need a Prescription for Play?

 

Q_ The opposite of play is not work

Play is of one of Potentia’s core tenants of true health.

It is a crucial component to your well-being. I actually prescribe play to my clients on a regular basis because many need permission to play. In our culture, we have had the joy of play shamed, guilted, pained, busied, spent, devalued, and worked out of us.

Cutting play out of our awake time is killing us – turning us towards the zombie life: numbed out, detached, exhausted, sick, in pain, and stuck.

As you consider (re) defining health in your life, it is time to bring back play into your life in a way that is a sustained practice. At the Bass-Ching household, things have been full of a lot of life but not enough play. So to mix things up and to honor of my amazingly supportive husband, I declared Saturday “International Gavin Day”. I have not received all the details yet for his day but he hinted at a family adventure, good food and naps.  Count me in!

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 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.

My passion for play was rekindled when I learned about Gary Landreth, PhD.  His work taught me play is the primary language for kids and therefore an important means for doing therapy with children. In his landmark textbook Play Therapy: The Art of the Relationship he defines child-centered play therapy (his unique theoretical approach) as:

  • A dynamic interpersonal relationship between a child (or person of any age) and a therapist trained in play therapy procedures who provides selected play materials and facilitates the development of a safe relationship for the child (or person of any age) to fully express and explore self (feelings, thoughts, experiences, and behaviors) through play, the child’s natural medium of communication, for optimal growth and development. (p. 16)

It was Dr. Landreth’s approach that inspired how I wanted to use play with my kids. When I began to get on their level to understand them through their primary language of play, I discovered parts of my soul that had been tucked away during my workaholic years. As my play passion was rekindled, my desire for nature, creativity, music, books came rushing to me like a glorious – and a bit overwhelming – wave.

So what is the importance of play for all ages? Reading Stuart Brown, MD‘s book Play:How it Shapes the Brain, Opens the Imagination, and Invigorates the Soul, where he uncovers the biology of play, the importance of play and how we are making ourselves sick by eliminating play from our lives, inspired me even further to step up my own play time so I could sustain all the passions I am juggling in my life right now.

“The opposite of play is not work. It is depression.”- Stuart Brown, MD  Tweet this

Dr. Brown defines play as:

  • Apparently purposeless (done for it’s own sake) – Who does anything purposeless these days?
  • Voluntary – Do you allow enough margin in your lives to have space to do something you choose to do verses feel like you have to do?
  • Inherently attractive – Boredom is squashed and our brain chemistry is supported when we do something that is fun, elicits laughter and excitement.
  • Free of time constraints – When you are in the zone of play, you lose track of time. Sometimes this may even involve your work – when you are in the zone of your passion.
  • Causing diminished consciousness of self – Play is a super power against the comparison game and worrying what other people think. You are able to be fully present and in the moment. Amazing. Play takes away feeling self-conscious. But these days, I see so many people not playing for fear of not being cool or of not doing it “right”.
  • Improvisational – Rigidity melts away and we sink into a free space of chance and spontaneity verses following the rules. There is no room for unhealthy perfection in this space! Play is also the space I see my kids work through issues in their own time and way. Instead of just being told, they play it out. Play is a crucial part of the healing and problem solving process for all ages.
  • Desired for continuation – Fun wants to be continued.  Who does not want to continue times of laughter, creating, dreaming, connecting, making, moving, competing (for those who enjoy competition) and dancing?

Play is not a luxury. It is a necessity to your well-being.  Tweet this

Dr. Brown further notes in his book the best way to rekindle your sense of play is to go back and reflect on times in your life when something you did led to totally consuming enjoyment,  involvement where you are totally present, and a desire to doing it again and again.

Play:

  • heals;
  • inspires;
  • clarifies;
  • connects;
  • innovates;
  • creates;
  • changes.

Cutting out play is cutting out a major support to your immune system for your mind, body, and soul. But be warned: checking in with your play story can be triggering and/or lead to major life-shifts that may stretch and strain your personal and professional relationships. Reach out for some specialized support as needed to help you bench play in your life.

“Remember the feeling of true play, and let that be your guiding star. You do not have to become irresponsible or walk away from your job and your family to find that feeling again. If you make the emotion of play your north star, you will find a true and successful course through life, in in which work and play are bound together.” Stuart Brown, MD

Play is where my most creative ideas occur; my mental blocks get unstuck, and I get clarity and purpose. Play is a now non-negotiable for me to live out my calling and for my own physical and emotional well-being. I just have to recalibrate this value regularly as the trap of busyness can be slick and seductive.

Need some inspiration to play?  Here is some via my son…

SONY DSC

and also from the ever hilarious and play master, Jimmy Fallon:

http://www.youtube.com/watch?v=R4ajQ-foj2Q

——–

What is written on your prescription for play? What memories do you have as a child of play as defined by Dr. Brown? Does play excite you or repel you?
 

Cheering you on from the playground-

Rebecca

 

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Q&A Series: Yoga Therapy

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In our Q&A series we’ve unpacked the paleo diet, the gluten-free diet, and cleanses. This week, Kayla Walker, MFT Intern, spoke with Kelly Schauermann, CPRYT & Yoga Intructor, to learn about yoga therapy and Kelly’s upcoming “Seasons of Life, Reaping + Harvesting: Acknowledging Growth” workshop.

Kayla: You are a Certified Phoenix Rising Yoga Therapist. What exactly is yoga therapy?

Kelly: It’s a way to experience how the mind and the body work together through assisted stretches and client centered dialogue. In short, I move you through stretches, ask you, “what’s happening now?” and you respond with whatever comes up. I may reflect back to you your OWN words, so that you have the opportunity to really hear what’s happening when you’re in postures. Each session begins with a centering time to connect with your breath, body, mind and spirit, and ends with a time to integrate everything you noticed from your session by creating some tangible steps to take your newfound wisdom off the mat and into your daily life.

My intention with yoga therapy is to create a safe space for people to listen to their bodies and notice what they feel, to explore their stories, and to listen to themselves without judgement, and to be heard without judgement. Creating a safe space free of judgement is important because it’s not often you have that space to be witnessed. It’s key to have that safety and to connect it with body movement, especially for those who have felt unsafe in the past, or experienced trauma. In that way, it’s an extension of talk therapy—there is so much that someone can explore and experience when they engage their bodies.

Kayla: Who can benefit from yoga therapy?

Kelly: Anyone who feels physically and emotionally ready to experience bodywork can benefit. Working with your body can be a very vulnerable space, especially for someone who has experienced trauma or has food and body issues. Usually, if someone is referred to me by a therapist, I trust that they are ready, but if someone isn’t sure if they’re ready to receive a session, then I encourage them to contact me and/or their current therapist to discuss if they are ready to try yoga and/or yoga therapy. You don’t need any exercise or yoga experience to practice with me.

Kayla: What is “Phoenix Rising?”

Kelly: “Phoenix Rising” refers to my training facility. There are different styles of yoga therapy, some are more prescriptive and specifically address physical ailments, along the lines of physical therapy but emphasizing yoga postures. My training with Phoenix Rising focuses more on a psychological level.

Instead of being prescriptive, I am trained to meet people where they are at, to listen to them, to watch their breath and the way they move, then guide the session from there. It’s a very organic process.I never assume I know how someone feels physically or emotionally. I use the dialogue piece to get an idea of what THEY are thinking and feeling, not just what I think they are feeling. Dialogue is one of the main differences between Phoenix Rising and other forms of bodywork and yoga. By giving a client space to speak freely about their experience, they can feel empowered and known.

Kayla: That sounds very different from a yoga class…

Kelly: It’s not like a class where I would have a set routine or flow of postures. Each session is different. I have no plan going in, instead each session is influenced by the dialogue and where the client is. If the person feels safe with physical touch, I incorporate light, safe touch to assist with movements and stretches, but if not, that’s okay, I can work without touch. I use a large futon mat instead of a yoga mat and many props like blankets, bolsters and blocks, to better support the clients body in longer held stretches.

Kayla: Your “Seasons of Life” yoga workshop is coming up this Saturday. Would you tell me a little bit about that?

Kelly: I’ve been working on a series of workshops this year in which I use the seasons as a reflection of our own life journeys. I think our bodies and our whole disposition can reflect the same thing the seasons do. For example, spring is a time of a lot of movement, change, growth and rebirth, so I designed a workshop around stretches and postures that help participants feel the movement and changes in their own body, as well as notice what’s emerging and growing in their own
lives.

Our bodies are such a reflection of what we feel and need on an emotional level, and these workshops help bring awareness to how we can awaken those deeper parts of ourselves. Following time of safe movement, participants have had an opportunity to journal about what they learned and even do some creative drawing or light crafting to express what it is they wanted for the 2013 year.

For the upcoming workshop, we’ll be focusing on the transition from summer to fall. Fall is also full of energy, with school starting and the big shift from warm weather to cool weather, harvesting plants and falling leaves. It’s a time to prepare for the more inward nature of Winter. So we’ll be doing a mix of stretches, postures and movements that reflect those transitions, and focus on bringing together what they’ve learned through the year thus far.

Kayla: What would you like people to know about your work as a yoga therapist?

Kelly: I want people to understand that my work isn’t about religion or pushing beliefs or philosophy on anyone. I think the idea of yoga can send up red flags in the faith community—some people are okay with it, but others seem uncomfortable with the idea of yoga practice. Yoga doesn’t have to be a spiritual practice, but it can be depending on the person doing it and if he/she wants to incorporate his/her beliefs. It’s personal.

I’m not about preaching or telling people how they should be or should think. I want people to feel safe to explore that for themselves regardless of their faith background. What’s most important is that people are learning to connect with themselves on all levels, not just physical, not just mental, not just spiritual. It’s a whole practice, and one that can be so rich with wisdom.

Thanks for reading our Q&A on Yoga!  What additional questions do you have about yoga as a support to healing and wellness?  Have you found yoga helpful in your own healing process?  We would love to hear from you and let us know any additional questions you have about yoga for future a furture Q&A post. 

Warmly – Kayla and Kelly

PS – We still have some space at this Saturday’s workshop.  You can register here.  We hope to see you soon!

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The Dark Side to Celebrating Eating Contests

http://lazygastronome.files.wordpress.com/2012/01/adam-richman-diet.jpg
 
For the last several years, I have started writing posts about the mixed messages of celebrating eating contests and the dangerous impact reverberated by these mixed messages – but I have never finished them.  This year, I am pushing back on my unhealthy perfectionism and finishing a post I started earlier this month.  I hear the PR voice in my head saying it is too late and the peak for sharing this has passed. 
Well, so be it.

The fourth of July is one of my favorite holidays. I am a fireworks fanatic and this year we brought both of our kids to watch the glorious display of firework fun in the sky. This holiday is a lovely time to rest,  play, and celebrate.

But one tradition around this holiday frustrates and concerns me: Nathan’s Annual Hot Dog Eating Contest and the many iterations that have followed its popularity. Some of my friends and family think I am a bit of a buzzkill for not being a fan of this kind of eating. Such is my life as an eating disorder specialist – I cannot unlearn what I know about the physical and emotional dangers of binge eating and Binge Eating Disorder (BED).

What is Binge Eating Disorder?

I like this write up by the Mayo Clinic staff on BED:

You may have no obvious physical signs or symptoms when you have binge-eating disorder. You may be overweight or obese, or you may be at a normal weight. However, you likely have numerous behavioral and emotional signs and symptoms, such as:

  • Eating unusually large amounts of food
  • Eating even when you’re full or not hungry
  • Eating rapidly during binge episodes
  • Eating until you’re uncomfortably full
  • Frequently eating alone
  • Feeling that your eating behavior is out of control
  • Feeling depressed, disgusted, ashamed, guilty or upset about your eating
  • Experiencing depression and anxiety
  • Feeling isolated and having difficulty talking about your feelings
  • Frequently dieting, possibly without weight loss
  • Losing and gaining weight repeatedly, also called yo-yo dieting

After a binge, you may try to diet or eat normal meals. But restricting your eating may simply lead to more binge eating, creating a vicious cycle.

(Notation from Rebecca: Many fall somewhere along the spectrum of BED. You do not need to have all of these symptoms to struggle with the issue. Denial, minimizing, and rationalizing often keep people from getting the help they need because they do not feel like it is that serious.)

5 reasons eating contests hurt our collective psyche around food

1. Eating contests give the impression that binge eating is always a choice. As of May, Binge Eating Disorder is now a clinical diagnosis in the new DSM-V. This is a huge victory for those who struggle with these issues along with those who are passionate about treatment and advocacy. Prior to BED officially being placed in the DSM -V, there was a lot of controversy around whether this diagnosis should be included; many thought this diagnosis was making excuses for those making bad choices. If this struggle was simply fixed by a choice, there would not be millions of people struggling with this serious issue. Addressing core issues such as attachment wounds, anxiety, depression, distressing life events and traumas, perfectionism, shame, and identity issues are at the heart of this struggle, not a simple choice. The choice available to those with BED is reaching out and asking for helping instead of staying stuck in the cycle of shame, pain, isolation, and physical distress.

2. Eating contests make BED and related behaviors a joke and sport to many. We laugh. We cringe. We build up the hype. It is a business and we are buying into it. This recent Forbes post on whether eating contests should be considered a sport noted:

“While spectators question the validity of such a label, its organizers say there is no confusion – competitive eating is a serious business in the world of sport.”

Man Vs. Food with Adam Richman (I confess, I adore Adam — he is so endearing!) is a perfect example of eating as sport. Adam travels to a new town each episode to discover a city’s best sandwich or meal and then engages in a restaurant’s food challenge by eating an insane amount of food in a designated time period. People are around him cheering him on as he takes his body on a dangerous episode of binge eating — for all the world to watch.

But my work with people on the disordered eating spectrum has taught me food competitions do great harm to our collective understanding of eating disorders and related health issues. This double standard keeps people struggling with BED spectrum in silence, fear of reaching out for help and making binge eating behaviors a joke. A sport.
Binge Eating Disorder is not a sport. Though many who participate in these eating contests may not fit the clinical diagnosis of BED, many of the behaviors mirror this serious illness. When we make binge eating cool to watch, we decrease the seriousness of this issue. It is time to stop the jokes and change the dialogue around this issue.

As long as we are watching, cheering on, and participating, eating contests will be good for business. And bad for health – mind, body, and soul.

3. Binge eating is very hard on your body. If you have ever seen the line-up at Nathan’s Hot Dog Eating Contest, you can see a representation of different ages, genders, and sizes of those who down dozens of hot dogs in a matter of minutes. Physically, binge eaters are at risk for developing: type 2 diabetes, gallbladder disease, high cholesterol, high blood pressure, heart disease, certain types of cancer, osteoarthritis, joint and muscle pain, gastrointestinal problems, sleep apnea, and other related health concerns. Professional binge eaters have the same health risks as those who are clinically struggling with BED. This is not something to be celebrated or perpetuated.

4. We have become obsessed with talking about food and eating contests just add to this unhealthy obsession. Food is personal and how we choose to feed ourselves is a very vulnerable topic. How we eat, what we eat, when we eat, and where we eat are all hot topics that can breed food shame and discord instead the joy of breaking bread with family and friends. Eating contests (and most reality shows for that matter) encourage us to become professional judgers and blamers. We talk about “good food vs. bad food” as if we are talking about sinning or staying pure; we Instagram our meals with a sense of awe and worship; the latest trends in eating, dieting, health dominate the majority of our conversations. We are obsessed with food. This obsession masks core issues of identity, worth, shame while fueling anxiety and depression. And the resistance to looking deeper is intense – understandably as it is much easier to talk about food than the messy, vulnerable, deep soul stuff.

5. Eating contests are a waste of food when so many are food insecure in our country and our world. In our country alone, food insecurity impacts about 15% of households. I often wonder about the positive impact companies and businesses that promote eating contents could make if they took their resources of time and money and fought hunger instead. We can change this demand by choosing not to watch and not to participate – which will shift how companies spend their advertising dollars.
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Post your feedback below and let me know what you think about eating contests? Do you think binge eating is just a choice?  I look forward to your thoughts on this controversial subject.

Happy belated 4th of July (take that perfectionism!)  –

Rebecca

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