National Eating Disorder Awareness Week

This week marks National Eating Disorder Awareness Week.  That's what the presentation I mentioned in my last blog post is for actually (well the RD's role at least).  So I'm still stressing about my presentation, but I also believe that it's important to promote education about and awareness of eating disorders since they can be such devastating diseases, so below are a couple of eating disorder facts and tips. If you or someone you know may be struggling with an eating disorder, now is a better time than ever to reach out for support.

Eating Disorder Fact #1: The peak onset of eating disorders occurs during puberty and the late teen/early adult years, but symptoms can occur as early as kindergarten.

Why? Partially because puberty is a difficult time, especially for girls.  It's normal for girls to gain a significant amount of weight in a fairly short period of time as their bodies mature and this can be extremely uncomfortable both physically and emotionally.  How do we help young girls deal with this? First by normalizing the experience.  Sometimes just validating that, yes, puberty and becoming a woman is awkward and it's normal to feel uncomfortable in your own skin, is helpful. Also, modeling normal eating and promoting self-love and body acceptance.  If a mother is constantly dieting or complaining about her body that can send negative messages to her daughter about physical beauty and worthiness.  Mothers need to practice what they preach and focus on health, balanced eating and exercise, and taking care of and loving (or at least accepting) ones body regardless of it's size. 

The late teen and early adult years are often a time of transition.  Many people are leaving home, going off to college, or living on their own for the first time and this can be stressful.  Eating disorders are often a way to cope with stress or deal with an otherwise tumultuous time in life.  Some college students even struggle with the concept of feeding themselves and cooking on their own if they've never had to do so before.  What to do? Encourage teens to take an active part in preparing meals at home so they have the skills they need to cook for themselves when they are on their own.

If you notice a child or adolescent seems overly preoccupied with food or weight don't be afraid to ask them how they are feeling. They may be wanting someone to notice!

Eating Disorder Fact #2: An eating disorder can develop at any age.

While the late teens/early 20s may be the peak onset time, don't think that someone is in the clear because they are middle age.  An eating disorder can develop at any age and stage in life.  I've seen women with eating disorders in their 60s and even 80s.  Major life changes such as a divorce or death may onset an eating disorder, so be especially careful to seek support during these difficult times.  Dieting can also be a trigger for someone susceptible to developing an eating disorder. Please don't diet! If you need to lose weight for health reasons do so slowly by eating a balanced diet full of whole grains, fruits, veggies, lean meats, fish, dairy, nuts, legumes, and healthy fats etc and by exercising moderately.  Don't deny yourself the occasional treat and don't force yourself to log hours a day at the gym. That's not sustainable for most people anyway. Find activities you enjoy and can do with friends and families. Make exercise enjoyable, not a chore.

For more information or help check out these websites:
http://www.nationaleatingdisorders.org/who-we-are
http://www.eatingrecoverycenter.com/about-us/

The Pitfalls of the Quest for Perfect Nutrition

I once overheard a personal trainer at my gym say to another trainer “I was so bad today, I had a white bagel!”   The other trainer gasped in horror as I cringed to myself and debated whether or not it was worth telling the trainer how silly she sounded.  I don’t like when people refer to themselves as bad because of something they ate. That’s classic eating disorder talk and it’s sad to think that some people genuinely feel so guilty about something they ate.  Sometimes I think things like the trainer said are said as an exaggeration or for effect, but it’s still not a good habit.  Eating a less than healthy food does not make one a bad person! Lying, cheating, stealing…those things make you a bad person, but not your nutrition choices.

The problem I see with striving for perfect nutrition is that it doesn’t exist.  Think about it: two of the most popular ways of eating out there currently, vegetarianism and Paleo, are just about as opposite as you can get.  So how do you even begin to define what “perfect” would look like?  There is no consensus on what the best diet is, even amongst nutrition professionals.  Another problem with trying to attain perfect nutrition is that there is almost always a next step that could be taken.  Eating lean meats isn’t good enough; you have to marinate them to help reduce development of carcinogenic compounds during cooking.  Oh and make sure it’s grass fed and free range. And local.  Maybe it starts with decreasing sweets, then it’s decreasing refined grains, then it’s all grains, then it’s an eating disorder.  Okay, now I’m exaggerating but you know what I mean.  Where do you draw the line?  To me, this means that trying to reach nutrition perfection will result in inevitable failure, and you’ll end up feeling bad about yourself and possibly set yourself up for disordered eating.

So what do you do if health is important to you but you don’t want to feel bad about your nutrition choices?

• Eliminate food rules.  If you have rules, you’re more likely to want to break them and then feel guilty about it afterwards.

• Practice mindful eating. Pay attention to what you are eating and enjoy it.

• Find balance.  A white bagel isn’t going to ruin your health as long as it’s not the main staple.  Set more realistic goals, like choosing whole grains more often than not, that way you don’t have to shame yourself for the occasional appearance of a white bread product.

• Practice moderation.  Allow yourself less nutrient dense foods, such as dessert, on occasion. Totally denying yourself of it will just make you want it more. 

• Don’t stress about the occasional indulgence. That’s normal and that’s part of what makes life enjoyable.  One brownie will not change the course of your life (okay maybe if it has an engagement ring in it or something!)

• Reward with food in moderation.  But also try to find other forms of reward, like getting a massage or buying yourself that new gadget you’ve been wanting.

• Never punish with food (yourself or your kids).  Even taking away dessert can backfire. I once worked with a patient whose parents locked up all the candy in the house when she was a kid. Years later when she got a car she started driving to the store daily to buy her own candy to binge on.

• Focus on the positive. Instead of thinking about what you “shouldn’t” eat, focus on getting plenty of nutritious foods.  If you’re getting enough of them you just might find you don’t even want the less nutrient dense stuff.

• Get to the bottom of the bad feeling.  Chances are it’s not really about the food, so if you are feeling really guilty about your food or eating habits or your body enlist the help of a dietitian or even a therapist to explore your relationship with food and your body.

Exercise and Eating Disorders

It's not always easy being an eating disorder professional and an athlete.  As I started thinking about writing a blog about my half marathon training (coming soon!) I had the thought that it's a bummer I have to keep that part of myself somewhat hidden at work. The patients I work with are very sick and compulsive exercise is a common struggle for them, so personal exercise talk is pretty taboo, and understandably so.  When my patients ask what I do on the weekends I tend to play things down.  I say I went for a short hike when in reality I climbed a 14er.  A training run becomes a walk in the park.  A bike ride up Vail Pass a casual cruiser ride.  It's not that I like lying, it's pretty awkward actually, but it doesn't seem appropriate to delve into my athletic adventures.  Exercise and eating disorders is a complicated subject.  While I fully believe my exercise is healthy, I understand how it would be difficult for patients to understand. But I do it because I love it, not because I am trying to change my body or because I feel like I have to.  I live for the adventure. I fuel myself properly before, during, and after my activities. Heck, the sports nutrition is sometimes the most fun part for me!  And I don't stress too much if I miss a workout or if it doesn't go as planned.

Why is exercise such a tricky topic with eating disorders?  I think it's because it's a healthy thing taken too far.  Sure exercise has health benefits, and it can be a great stress relief, but when it's compulsive it can actually be detrimental to your physical and mental health.  And when it gets to that point it's hard to cut back, so sometimes total abstinence is the way to recovery.  There is actually research about running and eating disorders that basically says it's nearly impossible to recover from an eating disorder if you refuse to stop logging miles.  This all seems quite contrary to what we hear in the media about how most Americans don't get enough exercise and this lack of activity is causing health problems.  I always have to reality check my eating disorder patients-are you more likely to suffer health problems from lack of exercise or the eating disorder?  I guarantee it's the eating disorder.

So how do you know if your exercise is a problem?  Ask these questions:
- Is my day ruined if I don't get in a workout?
- Am I working out because I feel guilty about food I've eaten?
- Am I eating enough to fuel my workouts?
- Am I avoiding spending time with friends and family in order to exercise?
- Is my workout routine interfering with my work, school, or other obligations?

A "yes" (or 4) doesn't mean you have an eating disorder but it might be an indicator that you should further evaluate your exercise habits.  Remember, exercise should be enjoyable! If you're forcing yourself to run on the treadmill but you hate it, not only are you creating an unhealthy attitude around exercise, but you're probably not going to stick with it long enough to reap any health benefits.  Remember- balance and moderation are key.  Exercise is great if you are doing it for the right reasons and properly fueling yourself, but it's also okay to cancel a workout in order to grab dinner with a friend, or because you are tired, sick, or injured. Be kind to your body.


Below is a link to a blog I was quoted in awhile ago about one woman's recovery from an eating disorder and the role exercise played.  She has some good insight and is doing well with her recovery, but keep in mind this was just one woman's journey.

http://blisstree.com/look/eating-disorder-recovery-exercise-personal-trainer-227/

Coconut Water is Not a Real Snack

I recently read a line in a famous fashion magazine from a certain waif-like starlet who claimed “I love to snack”. As a professional in the eating disorder field, this was so refreshing to hear! Except that she followed this comment by saying that she “is constantly reaching for coconut water and fruit”. * Sigh* Seriously? Coconut water and fruit?! That’s not a real snack!
It’s not that I have anything against coconut water. I actually find it a quite refreshing way to rehydrate after some of my longer runs. And obviously fruit has health benefits. It’s the message the statement sends that concerns me. I worry that women and girls who struggle with their body image will think that if they just have coconut water and fruit all day they will look like her, when in reality they will miss out on the real nutrition their bodies need, and potentially set themselves up for problems with disordered eating.

A small (11 oz) container of coconut juice has about 60 calories in it, roughly the same as a small piece of fruit. That’s not nearly as much as the average person needs for a snack and it’s certainly not going to keep anyone satisfied until the next meal or snack. No wonder she is “constantly” reaching for that snack! I for one would be hungry again in less than 5 minutes if that’s all I ate. Even for those trying to lose weight healthfully I wouldn’t recommend a 60 calorie snack. That being said, I am a fan of having snacks in between meals, but it’s important to snack effectively.

Here is what I recommend for snacks:

• Space meals and snacks out as evenly as possible throughout the day, typically every 2-4 hours. Don’t wait until you are starving for your next meal or snack, but don’t feel you have to eat a snack 2 hours after a meal if you are still full. Listen to your hunger and fullness cues.

• Be sure to include a source of protein at all snacks. This will help keep blood sugars and energy levels steady until your next meal or snack. It will also help ensure that you meet your protein needs for the day.

• Try to include fruits and veggies whenever possible. It’s not easy to get the recommended 5-9 servings of fruits and vegetables in every day so if you rely solely on meals, you’re not gonna hit the quota. Try carrots or other cut up veggies with hummus, an apple or banana with peanut or almond butter, greek yogurt with fruit, or blend a smoothie with the milk of your choice (dairy, soy, almond), some frozen berries and a handful of spinach or kale. Add protein powder to make it a little more satisfying. Oh, and by the way, you are never too old for “ants on a log”- celery sticks with peanut butter and raisins.

• Plan ahead. If know you’ll be on the go, throw a protein bar or a bag of mixed nuts into your purse or bag so that you don’t have to rely of fast food or a vending machine.

Happy (and healthy) Snacking!