Archive for the ‘Controversial Nutrition Topics’ Category

Eating Problems: Get Answers…Today!

February 23, 2016
  • Do you worry constantly about what and how much you eat?

    The Struggle

    The Struggle

  • Are you afraid that eating “the wrong foods” will make you fat?
  • Does it seem like you spend too much time thinking about food and eating?
  • Do you fast, diet, use laxatives, diet pills or “cleanses” to make up for eating too much food (or the “wrong” kinds of foods)?
  • Do you eat in secret or feel like you don’t deserve to eat?
  • Do you feel out of control when you start eating or when you eat certain foods – as if you cannot stop until the food is gone or you feel physically sick?
  • Is figuring out what and how much to eat really stressful for you?
  • Do you ignore hunger and/or fullness cues? Or is it hard for you to tell if you are hungry or full?
  • Do you avoid entire food groups or specific foods out of fear they will make you fat or unhealthy?
  • Does stress lead you to either avoid food or overeat?
  • Do you exercise to “earn” your food?
  • Do you exercise even if you are sick or injured?
  • Is exercise mainly a way to burn calories and something you don’t otherwise enjoy?

Many of these statements are common thoughts, beliefs and behaviors that we don’t think are a problem. In fact we live in a culture that promotes many of these things. We don’t hear much about healthy eating or exercise that become problems when taken too far. For some people however, many of these statements can be clues to problem eating or even full-blown eating disorders.

Food is often used to comfort, numb or distract from uncomfortable feelings or problems that seem overwhelming. If this is a once-in-a-while thing you may be fine. But when this is the main way you cope (or don’t cope) it can be a serious problem.

How do you know if what you are experiencing related to food is “simply” emotional eating vs. a full-blown eating disorder? This year’s Eating Disorder Awareness Week promoted by the National Eating Disorder Association (NEDA) can help you explore this question. The theme this year is:

3 Minutes Can Save a Life. Get Screened. Get Help. Get Healthy.

 The NEDA website (http://www.nationaleatingdisorders.org) has a free, confidential screening tool and lots of information about eating disorders both for people who may be suffering with an eating disorder and for friends, family and others who are concerned about someone who may have an eating disorder.

Whether what you (or a loved one) are struggling with is an eating disorder or other eating issues that is causing physical or emotional distress, you are not alone. And, there is support and guidance available. Don’t wait – act right now.

 

 

 

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I Had No Idea: a “healthy” passion can become a problem

February 26, 2015

Passion drives many athletes and outdoor enthusiasts here in Jackson Hole, Wyoming. Surrounded by rugged mountain ranges and access to raging rivers, this recreational Mecca is a sort of proving ground for athletes who want to push their limits skiing, rock climbing, boating, biking, running and more. There is a strong subculture here that sets a high bar for “normal” exercise.

Passions Can Become Problems

Passions Can Become Problems

More than 20 years ago during my early years in Jackson a friend and I did a 24-mile day hike up in Grand Teton National Park, a major feat for us east coast transplants. We got an early start and crested the top of the divide feeling pretty good about our accomplishment until a couple of local friends came jogging up the trail and passed us wearing fanny packs with water. If you climb or ski something here someone has climbed or skied it faster, or as part of a multi-peak day, or they first biked from town, swam across a lake, and were heading down to reverse their route after passing you. Seriously.

This Uber-athlete mentality makes it difficult to define “excessive exercise.” Disordered eating patterns that often accompany problem exercise are also normalized here. Sometimes eating takes obvious disordered forms such as severely restricting all food intake or bingeing and purging food. Less obvious disordered eating can be adhering to rigid food rules such as “eating clean” or following any number of fad diets that are socially accepted. This does not mean anyone who is consciously eating well to improve health or athletic performance has an eating disorder but points to the difficulty in identifying problems in subcultures like ours where extreme behaviors are normalized.

A group of friends on a long backcountry ski tour together may have no idea one member of the group has not eaten for 12 hours because she “ate too much” yesterday. Or she needs to hike, skin and ski first to “earn” her next meal. Or she “feels too fat” to eat. Or the food available doesn’t meet her strict guidelines of acceptable food. And with the exercise itself, if someone works out despite illness or injury or never takes a rest day, she is badass, dedicated, someone to be admired.

Excessive exercise as a form of purging in Bulimia Nervosa was added to the DSM-5 (the manual that outlines criteria for a variety of mental illnesses including eating disorders) in June of 2013. Exercise has long been recognized as a problem in a variety of eating disorders but it was not previously defined as a form of purging in place of other purging behaviors such as self-induced vomiting.

Unfortunately, the general public health messages that encourage people to “move more and eat less” don’t acknowledge any downsides to either of these mandates. “Earning” meals or treat foods with exercise is commonly encouraged and the fine line between balancing calories and physical activity or obsessing about these habits is often blurred. Exercise habits can’t be adequately assessed based simply on the number of hours or days each week, the type of activity, or even the intensity, we must look at what drives the exercise.

Is it enjoyable?

What happens if you miss a day of working out?

Has exercise replaced time you spend doing other things you enjoy or time you spend with friends and family?

Do you fuel and hydrate to support your activities?

Do you feel better afterwards or do you just feel relief that you exercised?

All of these questions must be considered in the context of the whole person. An elite or professional athlete may have to train on days conditions are less than ideal and training can appear compulsive to an outside observer and a recreational athlete who sometimes overdoes it may not have a problem. The point is we need to know that despite all of tNEDA - Exercisehe positive benefits associated with physical activity, exercise can have a dark side. People who exercise while malnourished and underweight can experience accelerated bone loss and exercising after food restriction or other forms of purging can cause dangerous electrolyte imbalances.

If you suspect someone you care about has no idea that their passion may have crossed a line into dangerous territory – seek support. NEDA has a free Coach and Athletic Trainer toolkit with ideas that may apply to recreational athletes who are not being coached. Also from the NEDA website are the following risk and protective factors for athletes that may be helpful to consider in the broader context of appropriate or “healthy” exercise.

Risk Factors for Athletes:

  • Sports that emphasize appearance, weight requirements or muscularity. For example: gymnastics, diving, bodybuilding or wrestling.
  • Sports that focus on the individual rather than the entire team. For example: gymnastics, running, figure skating, dance or diving, versus teams sports such as basketball or soccer.
  • Endurance sports such as track and field/running, swimming.
  • Overvalued belief that lower body weight will improve performance.
  • Training for a sport since childhood or being an elite athlete.
  • Low self-esteem; family dysfunction (including parents who live through the success of their child in sport); families with eating disorders; chronic dieting; history of physical or sexual abuse; peer, family and cultural pressures to be thin, and other traumatic life experiences.
  • Coaches who focus primarily on success and performance rather than on the athlete as a whole person.
  • Three risk factors are thought to particularly contribute to a female athlete’s vulnerability to developing an eating disorder: social influences emphasizing thinness, performance anxiety and negative self-appraisal of athletic achievement. A fourth factor is identity solely based on participation in athletics.

Protective Factors for Athletes:

  • Positive, person-oriented coaching style rather than negative, performance-oriented coaching style.
  • Social influence and support from teammates with healthy attitudes towards size and shape.
  • Coaches who emphasize factors that contribute to personal success such as motivation and enthusiasm rather than body weight or shape.
  • Coaches and parents who educate, talk about and support the changing female body.

 

Fire & Smoke: I Had No Idea

February 23, 2015

This year’s eating disorder awareness catch phrase put forth by the National Eating Disorder Association (NEDA) is “I Had No Idea.” The list of I Had No Idea moments I have experienced as an eating disorder professional is long. From my first client struggling with Anorexia, the inadequacy of my standard formal education as a Registered Dietitian, even with a Master of Science degree in Foods & Nutrition, was obvious. I immediately began reading, studying, and consulting with more experienced colleagues about eating disorders. I attended a workshop specific to CBT (Cognitive Behavioral Therapy) for eating disorders led by Christopher Fairburn and a national conference featuring several high profile experts in the eating disorder field back in 2008, and still I had much to learn. As most eating disorder professionals will admit (in candid moments at least), we learn the most from our clients and patients.

Eating disorders work is about more than learning for me – I am truly inspired by my clients. Their perseverance in the throes of incredibly difficult challenges humbles me. One of the best I Had No Idea professional moments for me was learning that eating disorder clients can fully recover. While not all clients do for a variety of reasons, knowing that full recovery is a possibility and believing each of my clients has this potential is an idea I am grateful to know now.

In addition to the important work I do with clients, one of the incredible aspects of being part of the eating disorder treatment community is just that – a sense of community. We work in an area of nutrition, mental health and medicine that requires us to incorporate what we have learned over the past few decades about good practice, and perhaps more importantly, to stay open to new developments. I feel honored to work among so many dedicated, intelligent, and passionate professionals doing this work.

I plan to write this week about some of the topics the National Eating Disorder Association (NEDA) has made a part of this year’s awareness campaign. [See the list and more info here.] Beyond busting myths and stereotypes, encouraging more people to recognize disordered eating and related issues (like problematic exercise), and advocating for people struggling with eating disorders everywhere, I also want to be open about some of what I have learned on my professional journey working with eating disorders.

Fire and Smoke

I begin with an analogy I learned from a colleague at the intensive outpatient clinic for eating disorders where I worked for two years in the Seattle area. Jeanne Wiccomb, Director of the Intensive Outpatient Program, described the outward behaviors we see in eating disorders as the smoke. Beneath the smoke is the fire, with a variety

Smoke

Smoke of the Eating Disorder

of “fuels” that can start the fire or keep it going.

Those of you who have attended one of my eating disorder presentations here in Jackson over the past year and half have probably seen the poster I made depicting this Fire and Smoke analogy for eating disorders. For those who have not I include pictures here of the newest rendition of my Fire & Smoke poster.

As you can see the smoke consists of the various behaviors we often use to define an eating disorder. Food restriction, binge eating, various forms of purgeing (including dysfunctional exercise), and the “other” category with additional forms of self-harm such as cutting that we see commonly with eating disorders.

Many people, including health and medical professionals, have no idea that these behaviors (the smoke) are not the eating disorder itself. This smoke is how the eating disorder presents itself but is only part of the whole picture.

The fire that produces the smoke can be caused by a number of “fuel” sources. Sometimes the fuel that starts the fire differs from fuel that keeps the fire going. Potential eating disorder fuel sources include:

Depression

Anxiety

Stress

Fire & Fuel

Fuel for the Eating Disorder Fire

Chemical dependency

Addictions (drugs, smoking, shopping, sex, exercise, gambling)

History of Trauma or other abuse (physical, sexual, emotional, psychological)

Poor body image

Low self-esteem

Personality characteristics & temperament (perfectionist, rigid, compulsive traits, obsessional, harm avoidant, sensitivity to rejection, reward dependent, anxious)

Feeling of Powerlessness

Life Transitions – life cycle, lifestyle changes, loss (death, divorce, move)

Troubled Personal Relationships

Sensitivity to rejection

Peer pressure

History of Bullying or Teasing Related to Weight/Size

Media Messages and Images (Unrealistic Thin or Muscular “Ideals”)

Cultural Ideals of Beauty – emphasis on outward appearance

Prejudice Against Obesity – Body Shaming

Inability to express emotion in healthy or appropriate way (emotional dysregulation)

Genetics?

Brain chemical imbalance?

 

There are many things I love about this analogy (in addition to the opportunity to do a really fun art project making this poster!). The treatment process and recovery journey is often long and complicated. Conceptualizing the eating disorder as a fire with many possible fuel sources helps us “see” why it can take so long to recover, why simply getting rid of the outward behaviors (or clearing smoke) is not enough, and why relapse is common or considered part of the process.

I have worked with eating disorder clients for nearly 15 years and I have yet to meet a client with only a single fuel source. When I show this poster to clients and their families they often immediately identify several possible contributors. This helps families, especially parents to feel less guilt, and clients to feel validated in the difficulty of their struggles. This also helps all of us see that socio-cultural factors such as the media portrayal of the “Thin Ideal” for females and the “Muscular Ideal” for males or problematic relationships may not cause eating disorders, though these can be significant contributors.

If you know someone who has no idea what eating disorders really “look like” I invite you to share this analogy and graphic with them.

Beyond Broccoli’s Response to Article: “6 Things I Don’t Understand About the Fat Acceptance Movement”

December 29, 2014

This morning I read a blog post by Carolyn Hall entitled “6 Things I Don’t Understand About the Fat Acceptance Movement.” I realize that as with so many contentious current issues, people on all sides are so entrenched in their own views they struggle to step back and look at the whole picture. We all do this – we judge what we see and hear based upon our own life experiences. The bigger problem occurs when we are not open to changing our preconceived notions. As I tell my university students – if we want to be part of the solution to our current problems we must learn to communicate with people who don’t think like we do. This post is an attempt to do just that.

frozen creek

Though I felt frustrated reading this article I recognize Hall’s questions are shared by many who are unfamiliar with the nuances of the HAES (Health at Every Size) approach and provide an opportunity to respond with my take on these questions. I assume this author genuinely wants to hear a different view point and respond to her 6 points accordingly. Each response is based on my 14 years of work as a Registered Dietitian with a major focus on a non-diet approach to health, and a specialty working with problem eating all along the continuum, including eating disorders.

1. America is extremely accepting of fat.

Only someone who has not lived in America in a fat body could make this statement. To be clear, despite feeling fat most of my life starting in preadolescence, and going through periods of being 20-25 pounds or so above what is considered “healthy” for my height, my work with clients in larger bodies has shown me that I do not really know what it is like to be fat in our culture. I am haunted by their life stories however, and I can assure you this statement is not accurate.

I do agree with Hall that our culture accepts and even encourages many of the factors that contribute to unhealthy lifestyles, including excess weight and inadequate physical movement. As a whole (with some very vocal exceptions) we accept a food system that produces and promotes a plethora of unhealthy foods and makes them cheap, convenient, and accessible 24/7 for most of us. We accept that our “busy lives” don’t include time to prepare and eat health-promoting food at regular intervals and without distractions. We don’t encourage people to connect with their internal cues of hunger and fullness or with how their physical and mental health is linked to their eating habits. We accept a fear-based approach to education about virtually everything, including nutrition, and then blame people who don’t make sustainable changes based on fear (a topic for another post).

2. “Body positivity” should include health.

I cannot speak for every member of the Fat Acceptance or Health At Every Size Movements but I can tell you as a longtime advocate of a non-diet approach to health, and an eating disorder professional, my motivation to do this work is a focus on health. As with all social “movements” I suspect there are advocates with extreme and more rigid views than mine but having read many books by HAES proponents, any suggestion that health is not a key part of this movement is a misinterpretation.

The problem I see is that weight and health are so intertwined we overlook the fact that many lifestyle changes related to food, exercise, stress resilience, and more, can improve health with little or no change in body weight. Even if weight loss can increase health benefits, which is likely to be true in the extreme cases of morbid obesity the author refers to throughout her article, as long as positive lifestyle changes are tethered to weight loss, we encourage yo-yo dieting and unsustainable changes linked to metabolic mayhem that are not likely to yield long-term health benefits.

Body positivity does not mean you love being fat or want everyone to be fat. Accepting that you are a human being with worth that extends beyond your appearance is body positivity. In my experience working with people who struggle with food, weight and body image, the preoccupation with body weight, shape and size occurs in underweight, overweight and healthy weight individuals, male, female and transgendered. Shifting the focus toward what Connie Sobczak calls “intuitive living” in her excellent book Embody, is about self-care in every aspect of our lives. As long as we are only focused on a number on the scale we are not truly engaged in sustainable self-care.

3. “Health at every size” seems physically impossible.

Again, Hall is hung up here on the extremes – as many critics of the HAES approach are. As stated above, the main idea is that we need to shift the focus from weight to health, for everyone. Weight gain, or loss, may be part of the bigger health picture for people at the extremes of anorexia and morbid obesity. However, I see clients on a regular basis who are within a “healthy” weight range and routinely engage in unhealthy behaviors in an attempt to change (or maintain) the way they look.

I cannot count the number of times clients report compliments about how “good” they look or how much weight they’ve lost after days of erratic eating, purging, starving themselves, or exercising in dangerous ways. They not only hear this positive feedback from friends and co-workers but health professionals – doctors, personal trainers, and yes, sadly, nutritionists. All of us can be blind to the physical and emotional health consequences of a weight-focused vs. health-focused culture.

4. People are allowed to not be attracted to certain body types.

I have no issue with this statement. Attraction is thankfully diverse and individualized. My issue is that the fat shaming prevalent in our culture is an accepted form of discrimination and prejudice. Though I don’t believe we are anywhere near “post-racial” or beyond any other form of discrimination widely accepted earlier in my lifetime, I see examples on a regular basis of serious discrimination based on weight that is totally accepted in mainstream culture. Even people who still believe race, ethnic background, sex, gender, or religious preferences are undesirable, don’t express such views widely (except of course on the internet). Yet somehow there is a general acceptance of negative comments made about someone’s weight. As a society we allow fat to be a code word for lazy, stupid, weak, and other harmful judgments.

Promoting the idea that people come in different shapes and sizes does not mean we all suddenly have to be attracted to fat people. This is more of a social justice issue than a personal attraction or general health issue.

5. Food addiction is a real medical problem.

A complete response to this point is easily an entire blog post unto itself. In brief however, the concept of “food addiction” is controversial, particularly if we attempt to address this “diagnosis” as we do addictions to other substances. There are many issues that contribute to both what and how much we eat on a regular basis. While biochemistry and neuroscience can explain pieces of this complex puzzle, any attempt to reduce problem eating to “simple addiction” is not helpful.

Foods that are highly processed and bypass our internal cues of hunger and fullness are a problem. As stated previously these foods are cheap, convenient, and accessible. They are also heavily promoted using results from billions of dollars of food psychology research. I fully agree we need to address these issues.

To understand eating problems more completely however, we need to include the biochemical aspects of our response to food, along with our long-established neural pathways or habits, various influences in our food environments, and other aspects of human behavior. Evolutionary psychology can also help us better understand our currently maladaptive tendencies with the curiosity and compassion we need to make significant and sustainable changes to our behavior.

Like it or not, eating habits are complicated and reductionist “solutions” must be recognized as such. The HAES movement may not focus on all of the points I mention here but it does recognize the “answers” to the “obesity crisis” are not simple.

6. Childhood obesity is something we can’t be accepting of.

I could not agree more on this point. I know many health professionals who endorse non-diet and HAES approaches and none of them are “pro-obesity” of any sort, especially among children. Raising children to eat based on fear – don’t eat this or that because you will get sick, or worse, get fat, is not helpful. Continuing to advocate a weight-focused vs. overall health-focused paradigm will not help our children. They need to know that eating nutritious foods and moving their bodies daily is good for their brains, bodies, mood, energy levels, and overall health. But they also deserve to know that thin does not equal healthy; that as they transition from childhood to adolescence and then into adulthood, their bodies will grow and change, and these changes don’t mean they are unacceptable when they don’t fit narrowly defined ideals of beauty.

Our children need to know there is no “perfect body” or “perfect diet.” In fact it would be great if they abandoned the notion of perfection altogether. Striving to do the best they can is awesome. Chasing the illusion of perfection can be dangerous.

It is our responsibility as adults to provide an environment for our children that supports good health and a sense of well-being. In our current culture this is no easy feat. It is clear however, that what we have been doing for the past few decades is not working. Focusing on short-term fad diets, succumbing to the trappings of modern society that support unhealthy lifestyles and then blaming people who gain weight or don’t exercise enough, using fear-based tactics in an attempt to change people’s habits, are not helpful strategies to produce the changes we want to see.

I don’t like the phrase “fat acceptance.” I prefer “human acceptance” which gets more to the core of our various health problems linked to weight. In fact we know that the statistics related to weight and health also apply to socioeconomic status and health. This doesn’t mean we don’t pay attention to these relationships but hopefully it means we try harder to understand the complexity of the issues beyond what we see on the scale.

There is no single way out of the mess we are in related to poor health as a society. Blame, shame, fear, anger, and a lack of compassion for ourselves and others are not working to make us healthier physically or mentally. What I am drawn to in alternate paradigms such as Health at Every Size (HAES) is the refusal to reduce our current health problems to weight alone, nor to continue clinging to approaches that don’t work. It is time for a fresh perspective and frankly I don’t care what we call it as long as it takes us in a more positive direction.

Overweight and in Recovery from an Eating Disorder

November 17, 2014
Photo from a client in recovery

Photo from a client in recovery

Last week following a presentation about eating disorders to a group of mental health professionals a participant stood up and shared that a relative of hers had just returned from eating disorder treatment and was overweight. What should she (the relative in recovery) do?

Each time I hear this question my heart sinks. We live in a culture where the primary metric for health is weight. If someone does not meet clinical criteria for a “healthy” weight range she is encouraged by everyone around her, often including her health providers, to “diet.” It astounds me that even when a person has struggled with a full-blown eating disorder the focus remains on weight, and too often “dieting” is the recommendation. Keep in mind that a “diet” for someone with an eating disorder is like a drink for someone addicted to alcohol.

Responding to the question about what to do next is difficult for many reasons. First, I know nothing about this person’s eating disorder journey – how it began, the form it took, the treatment she received, current support, etc. What I do know is that no matter what her journey looks like, working with a combination of outpatient therapist and dietitian with training and experience in eating disorders is the ideal next step. I’d like to say this type of follow up care is essential based on the many stories I’ve heard from my eating disorder clients about working with professionals not experienced with eating disorders. Unfortunately the reality of living in areas where specialized services are not available makes this an ideal scenario rather than an essential one.

The long term nutrition goal is to create a positive relationship with food (body and emotions too but these are more in the psychotherapy realm). Here are my top 3 next steps for nutrition in eating disorder recovery after some type of residential or inpatient treatment:

  • Seek support related to a more intuitive and mindful approach to eating. There are several books and websites on these topics. For Intuitive Eating resources Evelyn Tribole’s website is great http://www.evelyntribole.com/resources/intuitive-eating-articles-studies-support-groups/10-principles-of-intuitive-eating and for Mindful Eating guidance Michelle May, MD has some really good resources http://amihungry.com/resources/about-the-mindful-eating-cycle/
  • Be aware of any type of food restriction – especially if your eating disorder includes binge eating. This is one of the most counter-intuitive aspects of eating disorder recovery for those who struggle with binge eating. This is also commonly ignored among dietitians and other health professionals not experienced in eating disorder treatment. The focus is too often on the binge rather than the food restriction that can begin a cycle of disordered eating. Skipping meals and snacks, avoiding certain foods or food groups, only allowing yourself to eat at certain times, or arbitrarily determining portions sizes rather than relying on your body to tell you what and how much you need, are all forms of food restriction that can be harmful in eating disorder recovery.
  • Watch for “always” and “never” thoughts and statements. These words are red flags for “black-and-white” “all-or-nothing” types of thinking that support disordered eating behaviors of all kinds. These words are rarely true when it comes to food and can help you identify struggles that lurk beneath the surface during your recovery journey.

There are many more issues to address in support of long-term, sustainable eating disorder recovery and a positive relationship with food. If you are overweight as you face the next stage of your recovery these steps can help you stay focused on health and well-being while you support your body’s return to a healthy weight range tailored to your individual needs.

“The Jungle Effect” as Antidote to Fad Diets

February 14, 2014

Many of you have heard me rant about various fad diets. I lament how easily these temporary promises of a better, thinner, healthier version of ourselves take hold in our often anxious and preoccupied minds. I know humans innately crave a mix of new experiences (and foods) as well as the comfort of familiar routines (and foods), so I get why at least some of these fads are appealing. We know at some level we will never look like the celebrity du jour touting this fad as the secret to her success. We understand that no matter how much we long for simple solutions to our problems, it is unlikely the complex layers of our issues will be unraveled simply and with minimal effort.

Yet we can’t help ourselves. The power of our imagination is so great that we enter each new fad wide-eyed with possibility. Maybe this time we will lose weight, gain health and self-confidence, and all of the problems we think are tied to our weight and appearance will magically melt away.

I am reminded of my favorite nickname of a hockey teammate in Seattle – “Dream Crusher.” Though I understand very well the myriad reasons all of us are attracted to different fads at some point or another (this extends beyond fad diets for those who think this post doesn’t apply to you), I am here to crush that dream. There are no quick fixes to solve complex problems related to weight and health.

Lucky for you I am not particularly comfortable with the moniker “Dream Crusher,” as appealing as it is for a defensive partner on the ice in the context of a hockey game. I prefer to inspire hope and to support the process of change that leads my clients toward their goals and whatever it takes for them to live in harmony with their values. So I have put together a class called “The Jungle Effect” to appeal to your sense of adventure while honoring your need for comfort and the familiar.

“The Jungle Effect” is a phrase coined by integrative physician Daphne Miller. Miller observed several patients who experienced health problems when they transitioned away from their traditional way of eating and adopted the ways of our modern, industrialized society. One client in particular spent time in a traditional community in the jungle as a child and when she returned to this place for an extended visit years later, many health issues she developed as an adult resolved.

Intrigued by this idea that returning to a simpler way of eating and living could reclaim health, Miller explores five areas in the world where populations still follow a mainly traditional way of life, including eating habits, and enjoy an unusually low incidence of various chronic diseases and conditions that plague much of the developed world.

There are many aspects of Miller’s approach that appeal to me. First, she uses stories of real people to introduce us to these exotic places and to give us ideas about how we can integrate traditional ways into our modern lives.

Next, there is a lot of nutrition myth-busting that occurs throughout the book, especially related to our annoying tendency to reduce nutrition to specific nutrients as a guide to a “healthy diet.” While she does introduce information about components in foods that have powerful health benefits like the omega-3 fats found in fish, she presents a broader picture of nutritional benefits. Popular ideas such as simply eating “too many carbs” is a general problem vanish as we learn that the people of Copper Canyon, Mexico eat a traditional diet that is composed of roughly 80% carbohydrates and enjoy one of the lowest rates of diabetes in the world.

Perhaps the best part of the book for me though, is that Miller provides a picture of each culture that extends beyond what they eat. There is no doubt the “what” is important, yet through Miller’s presentation of cultures as diverse as Crete and Iceland we are encouraged to look beyond what is eaten and contemplate how food is produced, prepared and shared, along with many other aspects of daily life in these communities that benefit their health.

“The Jungle Effect,” and more specifically the idea of pursuing more traditional ways of eating, is the closest thing I think we will find to a “simple solution.” By definition a culture that continues its way of life, including eating habits, over centuries is going to have a more simple approach than our post-industrial modern society.  The challenge then becomes reclaiming simplicity in a complex society, no small feat as many of you know.

Next week’s class through our local branch of Central Wyoming College is based on some of the important concepts from Miller’s book, complete with foods that represent these special places – Copper Canyon, Mexico, the islands of Crete and Okinawa, Cameroon, West Africa, and Iceland. We will explore some of the key concepts common to this diverse collection of cultures that contribute to good health and longevity.  Best of all, we will embrace the excitement that comes with trying something new while uncovering the comfortable, familiar aspects of this simple approach that require no special talents beyond our own inner wisdom.

What Do You Mean “It’s Not About the Food?”

January 29, 2014

Next week I begin a new series of Beyond Broccoli classes called Food & You: Exploring Beyond the “What.” I am excited about this unique option for nutrition education and support for the many people in our community who struggle with food, weight, and body image, using a behavioral nutrition approach that recognizes in many cases – “it’s not about the food.”

Not long after I started Beyond Broccoli back in 2001 I remember thinking that so much of my formal training and education in nutrition focused on what to eat (or not eat) for a variety of outcomes, and yet the most important work I did with individual clients came down to something we spent relatively little time studying: behavior change.

I remember learning about the “Stages of Change” model that describes the process most people go through to make changes. I was fascinated by this process, though I had no idea at the time this would be some of the most important information to my practice with individual clients. It didn’t take long for me to realize that struggles with food, weight and body image add layers of complexity to changing habits. If I want my clients to be successful in making sustainable changes, together we need to explore well beyond the “what” of their eating habits. So I have devoted much time and energy over the past dozen years to learning more about this whole process.

I suspect some find this idea of a nutritionist not focusing on the “what” confusing. Aren’t nutritionists supposed to be the experts on what to eat (or not eat)? Isn’t that why we consult with them?

As a Registered Dietitian it is important that I know about Medical Nutrition Therapy, or how nutrients can prevent or manage disease and illness. Here in Jackson it also helps me to know about sports nutrition to help my clients optimize food as fuel. Educating clients about the links between food and mood is important for both long-term health and how they feel on a daily basis, often a much more compelling reason to make changes. So yes, what we eat, and don’t eat, is definitely important and a major focus of my ongoing work (and continuing education requirements).

I am also passionate about the need for nutrition education to go beyond just spewing information. I enjoy helping clients acquire tools and build skills to actually apply this information in the context of their individual life situations – or more simply, the “how” related to eating habits.

However, I now know that actually making changes often goes way beyond needing to change, wanting to change, and knowing what to do. I can put together the best meal plan ever for someone, based on all the current research and my clinical experience, but if she isn’t engaged in the process of making the plan and it doesn’t fit into her lifestyle, isn’t compatible with her life goals and values, or doesn’t take into account where she is in the readiness for change process, this “ideal plan” is likely to fail. This leads me to the real crux of changing habits – the “why.”

As I see it, my area of expertise is food and nutrition while my clients and patients are the experts on themselves, even if they are not conscious of this fact. They know why they want to change, or think they want to change, and more importantly what they are willing to do. Sometimes it takes a bit of effort to uncover the layers of “why” and sometimes for clients who struggle with food, weight and body image (which is many of my clients) this process works better with the with additional guidance and support from a skilled therapist using a team approach.

This idea of enlisting additional support for the often challenging process of changing habits is why a group situation can be really helpful. The “Food & You” classes are a way to apply some of what I do with individual clients in a group setting. I offer nutrition education and support using this behavioral nutrition approach rather than dictating “eat this” or “don’t eat that.” Together we explore the myriad factors that influence what we eat, as well as how, when, where, and why. Each class includes a different relaxation or mindfulness technique to get things started, creative and interactive class activities to spur discussion, and a host of ideas, tools and a chance to practice building skills that can help participants move forward in their journey toward a better relationship with food.

I Resolve to Wait Until Spring for New Year’s Resolutions!

December 27, 2013

“We spend January 1st walking through our lives, room by room, drawing up a list of work to be done, cracks to be patched. Maybe this year, to balance the list, we ought to walk through the rooms of our lives… not looking for flaws, but for potential.”
–Ellen Goodman

A quick search on New Year’s Resolutions reveals roughly half of Americans bother to make them annually, some do it once in a while, and less than half of those resolutions are kept past the sixth month mark. Clearly even people who don’t make yearly resolutions at least think about them, and many write about them. So what is it that compels all the hoopla every year at this time?

Starting the New Year with some fresh habits that better support our life goals or our health is reasonable on the surface. But I suppose many years of living in places where January is cold, dark, snowy or wet, and not a time when I feel particularly bursting with excess energy has jaded my view of this practice. I also balk at the idea of forcing a change at this arbitrary point in the year, especially when the more natural time for making changes for me is springtime.

I think winter is a great time to contemplate change and perhaps to make sure I get back to any changes I made last year that may have reverted to old ways during the holidays amidst stress and all kinds of distractions. Habits I already worked to change but just weren’t quite my go-to during the busy holiday season are much easier to tackle in January than a completely new thing. For me, the long, dark evenings (and early mornings) are perfect for introspection and planning. As it turns out, planning is also pretty important for sustainable changes.

For me Spring is a natural season for changes, full of renewal and rebirth in the natural world, snow and ice melt here in the valley, buds appear on the trees, baby Bison wander the northern meadows. More hours of daylight and warmer temperatures lighten my mood and I feel more energized. By springtime I have also given thought to meaningful changes and perhaps even taken a few preliminary steps to get the ball rolling.

You may prefer summer or autumn to make changes – maybe you need lots of sunshine or impending winter to nudge you toward change. And sometimes we don’t get to choose when to change. A medical diagnosis or life event may motivate or necessitate change with no luxury of waiting until the time is just right.

As the New Year approaches if you do decide to make a change, here are some key basics to set yourself up for success – and to me that means a change that is sustainable.

  •  Understand your motivation to change. Is the change something you want to do or what someone else wants you to do (a spouse, doctor, friend, etc.). Are you clear about the benefits involved and will the change be a reward by itself? If not you may want to set up rewards along the path to change to keep you going.
  •  Consider all possible barriers to change. Know what you are up against then you can plan accordingly. We are all part of different groups – families, friends, co-workers, church, community, etc. and any changes in our everyday habits can be supported or sabotaged by those around us.
  •  Make a plan and be specific about how you will move forward. Vague statements like “eat more vegetables” are difficult to plan for, implement and measure – all ways we determine our success or failure. Planning will help you assess any skills, tools, knowledge, and support that will help you be successful.
  •  Seek or at least allow support from others for your change. The idea of being a solo badass is alluring to many of us. “Just Do It.” We subconsciously or outwardly buy into the myth that asking for any kind of help means we are weak. The reality is that we all need help sometimes and asking for it is hard. Really hard sometimes. People who care about you want to support you, so let them and increase the chance of successful change.

Beyond Broccoli Holiday Nutrition Tips:

December 10, 2013

Tired of the same old holiday nutrition tips that promote a focus on calories, fat grams, weight gain, and other negative consequences of dietary indiscretion, here are some ideas that fit more with the Beyond Broccoli nutrition philosophy and approach.

  1. Be kind to yourself. This does not replace the giving to others we emphasize during the holiday season – compassion for others is linked to self-compassion. You cannot give what you don’t have and you take the best care of what you love. You do the best you can and that is enough.
  2. Check in with why you are eating. The holiday season presents endless opportunities to graze mindlessly. Sometimes the simple question “what do I really need/want right now?” can stop or at least make you aware of eating for non-hunger reasons (emotions, environment, peer pressure).
  3. Eat slowly and intentionally. Identify pleasing flavors and textures in the food you eat and give your brain the 20 minutes it needs to identify fullness. It helps to eat sitting down with minimal distractions (not an easy task for many of us!).
  4. Notice how your body feels after you eat. This primitive instinct once let us know which foods (or amounts of food) caused digestive discomfort so we could avoid (or eat less of) the food the next time. Understanding which foods nourish our bodies best can empower us to make better choices.
  5. Eat regularly throughout the day. When we go too long without eating we set ourselves up to overeat. This is basic biology – part of our hard-wired survival instincts, now mismatched with our abundant food supply. If you are going to a holiday dinner or party in the evening you can make healthier food choices during the day, but skipping meals and arriving at your special occasion ravenous is not a good idea.
  6.  Stay hydrated. Our need for fluid increases with many environmental extremes including hot, cold, dry and high altitude. Many of us are conscious about drinking more water when it’s hot but forget we need more when it’s cold and/or dry too. Soups and hot tea are great ways to increase fluid on cold days.
  7. Strive to include joyful movement in your busy holiday schedule. Physical activity can take many forms – find ways to move that you enjoy and you are more likely to keep this as part of your holiday self-care regimen. Forcing yourself to squeeze in a gym session can create more stress than it relieves. Dance at holiday parties, acknowledge that holiday shopping and cleaning are opportunities to be active and “count” as physical activity.
  8. Savor food you perceive as special treats. Choose your special treat foods, knowing that in our modern world most foods are available any time of year so identify the truly special foods for you. Notice that when you give yourself permission to eat and savor these foods you may “need” less of them to feel satisfied.
  9. Shared meals provide benefits beyond physical nourishment. Food connects us as humans – we all must eat to live. There is research that supports many benefits of family meals. Taking time to share meals during the holiday season can help us feel grounded, connected to each other, and in charge of our lives vs. stressed out about how out-of-control this season can get.
  10. Remember to breathe. Deep breathing has many benefits, especially related to stress resilience. Stress is an inevitable part of life and our ability to work through stressful moments or events is important for many reasons, including the ability to not use food as an antidote. Just 3 deep “belly breaths” can change the blood flow in your brain from your “fight or flight” response to your more “rational” thinking.

Salt, Sugar, Fat – How the Food Giants Hooked Us

November 15, 2013

I am no stranger to the genre of Food Industry Horror Stories, both in book and film forms. Eric Schlosser’s Fast Food Nation was my first plunge into the seamy underside of our industrialized food system and its myriad cultural implications. Sadly many others have expanded on Schlosser’s work, including the latest contribution from investigative journalist Michael Moss called Salt, Sugar, Fat – How the Food Giants Hooked Us.

Moss shares what he learned from food industry researchers and executives themselves about how foods are specifically designed to entice people to eat past the point of normal fullness; calculated “bliss points” are used for added sugars, just the right texture and amount of salt for a “flavor burst” to maximize the rush to the brain’s pleasure centers upon hitting the tongue, and fats that add both flavor and a quality called “mouthfeel” – a powerful combination that does not seem to trigger messages to stop eating.

For those of us who encourage our clients to work towards normal or “intuitive eating” rather than restrained eating, Moss’ reminder about the many foods engineered to derail this internal system is both frustrating and important. People who struggle with compulsive overeating, binge eating, or restricted eating that stems from fear they will not be able to stop eating once they begin, at some point need to know that their behaviors are not entirely emotionally based or a sign they are somehow bereft of willpower. This is exactly what food manufacturers want all of us to do – eat what they produce, in excessive amounts, and often. These so-called Food Giants also spend billions of dollars to market highly processed, ultra-palatable foods, and to make sure they are available nearly everywhere we go.

My hope is that the information in Moss’ book will help us be more aware when we eat processed foods, knowing they are deliberately hard to resist overeating. If this deeper understanding about how processed foods are made and marketed so we will eat more helps us let go of the guilt that often comes with eating these foods, particularly if we eat more than we planned to, then I am all for this type of consumer education.

I am concerned however, that yet another of these dire warnings about our food system will reinforce rigid all-or-nothing thinking about what we eat (or don’t eat) based on fear. It is one thing to strive for more whole or minimally processed foods that support good health and another to be so fearful of processed foods that when our options are limited and that is the only food available, we either don’t eat at all, or we are overly anxious while eating (not good for digestion or absorption of nutrients not to mention the increased release of damaging stress hormones).

I guess I’m a bit of an idealist in that I prefer to inspire change rather than jam it down people’s throats with a heavy dose of fear. But I have to admit, I like the idea that when we eat more whole foods and prepare more of our meals at home rather than outsourcing this important work to big food companies (restaurants, ready-prepared or frozen meals in grocery stores, etc.) we are effectively rebelling against a modern food system in dire need of repair.