Several years into my work as a nutrition therapist I found myself really grappling with a clinical dilemma. Many of my clients were not only suffering
from an eating disorder but they were also suffering from pretty severe digestive issues. And these digestive issues were not only complicating their
recovery but they were seriously impacting my clients’ quality of life. In fact, many clients who had made tremendous strides in their eating disorder
recovery were suffering with digestive symptoms that other clinicians had promised would go away once they got better from their ED.
So I delved into the research, participated in a year long integrative nutrition therapy training, exchanged supervision with colleagues who specialize
in digestive health, attended workshops, and I thought A LOT. In fact, I want to make a big shout out to my friend and colleague Lauren Dear who
is an amazing digestive health dietitian and has taught me so much. (Sidebar: I have the honor to speak with Lauren at three upcoming conferences. See below!)
All of this study (and continued study!) led to a series of talks on the intersection of EDs and digestive disorders that I have and will be giving in
2017. And with enthusiasm, I’m writing to let you know that I am also in the process of developing an online self-study course on the topic. I will
have it ready this spring and can’t wait to share it with you. I believe in my heart it will help you feel more capable in helping your clients heal.
Below I’ll provide links with upcoming places I’ll be speaking on this important topic. But for now, I’d like to share some juicy tidbits!
- Up to 98% of clients with eating disorders have a functional gut disorder (FGD) (Note: FGDs are things like Irritable Bowel Syndrome, gatric reflux, bloating, constipation, and diarrhea (to name a few).
- People who suffer from FGDs and EDs share the same underlying mental health challenges- namely anxiety and depressive disorders
- These mental health challenges can lead to digestive symptoms that can perpetuate long after the ED symptoms have resolved
- EDs can actually cause FGDs and FGDs can make a person vulnerable to the development of an ED. This means it is BOTH the chicken and the egg.
- Childhood GI issues are a key risk factor for the later development of an ED
- Both EDs and FGDs negatively impact body image. A person who suffers from both has a double whammy to contend with!
- Anorexia Nervosa changes the gut microbiome by deceasing bacterial diversity. Lower numbers of bacterial diversity are associated with greater levels of eating disorder psychopathology.
Key Take Home Messaging
There are many non-harmful interventions to try with clients.
- Most if not all behavioral interventions that support ED recovery will also support digestive health. Root out remaining ED behaviors as most will
reinforce negative GI symptoms.
- Sensitive systems require CONSISTENCY & BALANCE.
- A stressed out person will likely have a stressed out gut. Help clients embrace hypnotherapy, meditation, deep breathing, guided relaxation. The relationship
between head brain and gut brain is REAL!
- Food variety improves the gut microbiome and is a key ingredient to ED recovery.
- The goal is to include as many foods as possible for mental, emotional, and psychological well-being.
- Integrate the use of digestive enzymes, probiotics, and well-researched supplements to help manage symptoms.
- Fuel healthy bacteria by integrating fermented foods and drinks.
- Incorporate a stool or squatty potty for more anatomically supported elimination (ie the squat position makes it way easier to poop!).
- Eliminate “diet foods” as they contain a lot of additives that worsen digestive symptoms and are often a culprit in the ED
- Play with changing the texture of foods rather than eliminating them all together
In today's vlog I give a roundup up 2 products I love and 1 product I hate. It's my Fall special of showcases and no case that I think you'll love. I'm talking my favorite cures for the common cold, simple and delicious frozen food, and taking yoga challenges to task. Tune in and then let me know some of your favorite (or not so favorite) products for the Fall season!
I was recently asked to give an interview on essential fatty acids. I was actually thrilled to talk about this because getting enough essential fatty acids (omega-3) in your diet is essential to brain health, mental health, and satiety! Through the 90's dietary fat got a very bad rap. But slowly people seem to be coming around to the idea that fats are crucial to eating well.
In fact, did you know that inadequate dietary fat is association with increased levels of anxiety and depression! Seriously.
So what's your biggest obstacle to getting more omega-3s into your diet?
Yesterday, I received several emails with a link to this article on a condition called "Orthorexia." Most people read the article and wondered if it was serious, wondered if it wasn't some sort of exaggeration or joke.
And while I admit, reading about it online may seem strange or even ridiculous, it is a true disorder that affects both the physical and emotional health of a lot of people. Just read my recent client spotlight. What began as "healthy eating" and exercising for her, quickly became orthorexia, which then became a much more severe eating disorder that required residential treatment and intensive outpatient care.
Now of course I believe in healthy eating and exercise- my life is committed to supporting it in myself and others! BUT, the distinction between healthy living and orthorexia are two important words: unhealthy obsession. You can read more on the Orthorexia home page, written by Dr. Steven Bratman who coined the term and wrote the book "Health Food Junkies."
<Ironically, I just loaned my copy to a client who has suffered mental, emotional, and physical distress FOR YEARS due to an unhealthy obsession with "healthy" eating and exercise.> My clients who suffer from orthorexia share a single characteristic- the obsession diminishes rather than enhances their quality of life. Relationships suffer, social isolation ensues, they have often feel paralyzed, depression/anxiety is worse, sleep patterns are affected, etc.
My philosophy is that moderation with food, exercise, and in life- is the key! And I also believe that we are meant to find enjoyment, satisfaction, and fulfillment from the food we eat. Anything taken to an extreme is unhealthy. If you have always been interested in "healthy" living and are curious as to whether or not you are taking a bit too far, the assessment below may be helpful to you. This is taken from Dr. Bratman's book.
Dr. Bratman suggests that you may be orthorexic, or on your way there, if you:
o Spend more than three hours a day thinking about healthy food.
o Plan your day’s menu more than 24 hour ahead of time.
o Take more pleasure from the “virtuous” aspect of your food than from actually eating it.
o Find your quality of life decreasing as the “quality” of your food increases.
o Are increasingly rigid and self-critical about your eating.
o Base your self-esteem on eating “healthy” foods, and have a lower opinion of people who do not.
o Eat “correct” foods to the avoidance of all those that you’ve always enjoyed.
o So limit what you can eat that you can dine “correctly” only at home, spending less and less time with friends and family.
o Feel guilt or self-loathing when you eat “incorrect” foods.
o Derive a sense of self-control from eating “properly.”
Bratman suggests that if more than four of these descriptions applies to you, it may be time to take a step back and reassess your attitude toward what you eat. If they all apply, you’re in the grip of an obsession.
This seems to be a controversial topic. I'd love to hear your thoughts.
Striving to live a balanced life in hectic Harvard Square,