nutrition journal: thoughts on pleasure and joy, restrictive diets, eating disorder recovery, and intuitive eating

Do you have any rituals that make your weekends complete?


As a Taurus (sun sign), I most certainly do. As much as possible, I like my weekend mornings enveloped in ‘cozy’, wrapped in a blue fleece blanket, a high school graduation gift from my dressage instructor/mentor, comfortable with a pot of tea, pleasing music, time spent clearing my inbox, experimenting with creative kitchen projects, and choosing and planning recipes and meal ideas for the week ahead. Lately, I’ve also been researching and scheming ways to improve the coziness of our inside space and making it ‘even more me’ so when I walk in the door after a long day, it’s even more the space I want to come home to.

Even though we bought our house ‘done,’ and to my liking internally, I’ve been hesitant to invest in decorating the interior since we’ve never planned to stay long-term. But it also seems silly not to put my personal touches on the inside simply because we might move in a couple months or the very distant future.

Which brings me to my real topic today, a little weekend nutrition journal, which I’ll see about sharing more often in this space. Today is about denying ourselves pleasure because of an idea in our head or society’s messages. I follow several of my Facebook friends on Pinterest where I see much of what is pinned for meal ideas and I’m likewise part of a very large and active Facebook group here in Eugene for all the ‘foodies.’ These two groups are quite diverse, but if often breaks my heart to see the pins and posts go over the weeks and years from one diet ‘religion’ to the next. Right now, I see a lot of the sensational meat and dairy version of the keto diet, which seems to be all the rage and I’m sure is not contributing to long-term health.

As a clinical nutritionist, I have all sorts of thoughts and opinions about all the various dieting trends and their short and long-term effects on the body and mind. But when I speak to or think about individuals actually following these highly restrictive diets, I mostly I think about the (very Tauresian) pleasures of eating, dinner parties and eating in community, and eating what nature right outside our doors provides. And sticking to rigid dietary dogma or thinking all the time about what this or that particular food is doing to our bodies is simply not healthy. Anyone who’s ever had or is currently struggling with an eating disorder knows the havoc that rigid thinking can play on life satisfaction.

Sometimes I think about the food intolerances I do have, gluten and dairy, and the food preferences and avoidances I continue with (mostly meat, processed food, high sugar). I stick with the first two since I feel ill for days whenever I eat traces of them. I avoid the second list out of taste preference and because I generally feel better when they’re not consistently in my days.

But I periodically wonder if my subconscious didn’t help create my food intolerances and preferences out of my eating disorder as a way to not be pressured or to be automatically excused from the office pastries, co-workers’ baked goods, supermarket impulse buys, etc. In a way, I question whether my subconscious created a rigid rule to avoid certain mainstream ingredients as another way to control my food?

I consider myself to nearly always eat intuitively these days, meaning if I want to bake cookies or have dessert (which I often do), I will. And if pizza sounds good for dinner, if not today, then maybe sometime this week. I tend to be often training for a race, managing my autoimmune disorder, and eating to stay feeling healthy in those two regards, and that means my goal is to eat to feel good in my body. But I also highly value enjoying my meals and feeling good in the moment. And the way of eating that works for me largely does both.

One of my nutritionist peers shared a social media post recently that has had me reflecting on this topic in particular. It was a ‘Food for Thought’ on current caloric restriction and dieting patterns happening in mainstream culture, and their relation to a landmark nutrition study back in the 50’s called the Minnesota Starvation Experiment.

Here is what was written as a reflection to the post (not my words, but ones I highly agree with based on personal experience):

1200kcal per day is NOT enough to nourish any adult body.

There have been a lot of people I follow speaking out about how 1200kcal per day (as promoted by @myfitnesspal) is harmful and dangerous. I thought it might be perfect time to look back at one of the key (no pun intended) studies on the effects of human starvation.

The most interesting findings of this study (in my opinion) were not the physiological effects (which are somewhat expected), but the psychological effects. These previously healthy men became newly obsessed with food, looking at recipe books, and talking about food. They had strong urges to overeat, many chewing and drinking constantly up to 40 sticks of gum and 80+oz of coffee each day. Any opportunity to gain access to food, the men would binge consuming thousands of calories in a sitting. Interestingly enough, they also developed distorted self image and some men became preoccupied with their abdominal area.

I love these takeaways of this study from an article on @projectheal:

“1) The restriction of nutrition leads to a heightened interest in food and eating. So there is an “explanation” for why you may be overwhelmingly preoccupied with food. 2) Overeating may be a direct result of undereating. 3) Many features of anorexia are actually symptoms of starvation and resolve with refeeding. 4) Prolonged restriction of food negatively impacts mood. Restriction and weight loss may lead to an increase in anxiety symptoms and obsessive thinking. 5) Inability to stick to strict diets is not because of a lack of willpower. There is a biological pull to maintain a consistent body weight.”

Sources:

1) Keys, A., Brozek, J., Henshel, A., Mickelson, O., & Taylor, H.L. (1950). The biology of human starvation, (Vols. 1–2). Minneapolis, MN: University of Minnesota Press. (Full study)
2) The psychology of hunger. The American Psychological Association: https://www.apa.org/monitor/2013/10/hunger
3) What we can learn from the Minnesota starvation study about the impacts of restriction in behaviour: https://www.theprojectheal.org/healblog/impact-of-starvation-on-behavior

I formally struggled with orthorexia which quickly became anorexia, which became an incredibly shameful binge/restrict season (which lasted the longest), until my weight was restored and I allowed healthy relationships and less control over food into my days. Learning to eat intuitively also helped me to reach the weight and size that feels best for my body, which interestingly happens to be the weight and size I sought to achieve when I first began controlling my body as a sixteen or seventeen year-old. This is just my experience and one I expect will vary by individual.

Learning about the Minnesota Starvation Experiment a few years ago helped me in not only understanding, but finally working through the shame I harbored for many years about the bingeing phase of my weight restoration, which was more or less part of the physiological consequence of severe caloric restriction and malnutrition.

This is all to say, I’m not a big fan of food patterns that feel rigid or overly forced, and eating in a way to reach or maintain optimal health for one’s condition (as is often the way of functional medicine) has to be balanced with eating in a way that feels good, is intuitive, and doesn’t lead or contribute to disordered behaviors, obsessions, or control-mentality around food. It’s a fine balance and I’m not sure I’ve yet met a nutritionist, dietician, doctor, or otherwise nutrition professional that’s got the balance quite right in practice.

But one thing I do know. We all need to ask more questions of ourselves in the everyday process. Questions such as:

– Am I eating this to feel good in the moment or to feel good long-term? (To which there’s no right or wrong answer but simply knowing is a first step).
– Am I avoiding this food because of fear, or because I want to control my body?
– What makes me feel good (food or otherwise)?
– What do I need right now? (A meal, a snack, a hug, a kiss, quiet, noise, love, sleep, connection, etc.)
– What does hunger look like for me? How do I know I’m hungry?
– What way of eating makes me truly feel my best? If you’re not sure, think back to a time when you felt particularly healthy, happy, and satisfied for more than just the short-term.
– And, what brings me joy?

This last one is particularly important.

One of the major things that brings me joy is baking. I have vivid memories of learning to bake, and doing so has been a lifelong love that I feel absolutely no need to give up. Back to being that earthy, sensual, comfortable Taurus, baking is a way to indulge all my senses in delight and to enjoy the end result.

If any of this resonates with you, I encourage you to take some time for reflection, journal your responses to the questions above, or free-write your personal takeaways. Reach out to me if you’d like to chat. And overall, be well in this season.

Stay tuned for a recipe treat coming later this week.


Gingered Sweet Potato Dal + tips for better digestion

Every few months or when I notice a trend in increased GI upset, not digesting foods or absorbing nutrients properly, I strip my meals way back to simplicity so most of the hard work is done for me (in the cooking process). With the turn from late summer into fall, I noticed an uptick in the above symptoms, and since this tends to fall in a pattern each year, I decided to make the last last few weeks about eating primarily very simple, easy to digest meals. Conveniently, and also not so conveniently, these simple meals tend to be needed more as running mileage goes up – which also means less cooking time, planning and prep! If you’re busy and having trouble with digestion — or just enjoy easy, dreamy meals this time of year, the recipe below is one to add to your rotation.

Taking from Ayurvedic medicine, which has much to offer in terms of treating and preventing just the type of malabsorption and upset I tend to experience, I chose to make meal-in-a-pot dishes such as kitchari and lots of dal. Kitchari is a rice and lentil or split mung bean combination that’s perfect for these occasions. Dal, in my opinion may even be more so, as it often eliminates the grain component for even easier food break-down and assimilation.

Plus it’s incredibly delicious on a cold, blustery fall or winter day. And with the addition of sweet potato or other root vegetables, it’s still hearty and fulfilling like kitchari.

The classic dal that I make features red lentils, which I find to be the most digestible bean/legume there is, other than split mung beans, which can be difficult to track down. Red lentils break down and cook quickly, and they don’t usually need soaking or planning ahead. However, if one is already having tummy troubles, soaking is still a good idea. Here are a few more tips to help make lentils and beans more digestible:

– Soak and rinse in a big bowl of water, ideally for a few hours. Discard the soaking water before using the lentils in your recipe.

– If there is foam that rises to the top of the pot while cooking, skim it off. The foam contains a type of protein that is hard on our digestive system. When in nutrition school, my cooking instructor Eleonora constantly repeated, ‘skim your beans’ so often that that’s the one line I associate most with her!

– Make sure the lentils – or other beans – are cooked thoroughly. This means they are soft, not al dente. One of the biggest problems with canned beans, in my opinion, is that most of them are not actually cooked as well as they should be for proper digestion. Cooking until the lentils or beans begin to break apart, or in the case of red lentils, turn into mush completely, is the best way to know they’re done.

– Add spices! Carminative spices, meaning they boost the digestive capacity, is a long-held way in traditional cooking to make meals more digestible. This is why a big soup pot with beans and meat often contains a bay leaf. Other carminative spices include ginger, cumin, coriander, fennel seed, thyme, rosemary, oregano, basil, allspice, black pepper, cardamom, cloves, and more. Virtually every cuisine of the world is ripe with carminatives in the traditional recipes for the exact purpose of not only adding flavor, but also boosting digestion!

– Add a squeeze of lemon, lime juice, or vinegar. Ideally every meal contains a slightly sour flavor addition, since sour helps to activate digestive enzymes. Most meals don’t need to taste outright sour, however. A little addition at the end of cooking goes a long way and often balances the recipe that’s missing ‘just a little something.’

– Lastly, eat your foods warm, especially this time of year. If you think of an ideal digestive scenario as a nice little cozy fire in the digestive system, eating cold foods is like throwing cold water on it. Not so great for turning food into nutrients and energy! In the summer months when we can be overheated, eating cold and raw meals makes much more sense and is seasonally appropriate. But this is rarely the case as we turn into fall and winter.


One other little tip that I find incredibly helpful is to reduce stimulus, particularly around meal time, but perhaps throughout the day too to help rebalance digestion. Constantly checking our phones and computers, keeping up with what everyone else is doing while they’re avoiding being present themselves, and eating in a loud, overstimulated environment or while upset or anxious is a recipe for continued GI problems. Our gut and brain are incredibly closely linked. We can go a long way to improve tolerance to the foods we eat just by eating slowly, chewing each bite upwards of 30 times (yes, really!), and not doing anything else while eating, other than eating. If you try these tips, you might also find you enjoy your food more, which is always an added bonus.

Now, onto the dal!


Gingered Sweet Potato Dal, serves 3-4
adapted from Everyday Ayurveda Cooking for a Calm, Clear Mind by Kate O’Donnell

Use the larger amount of coconut oil if you tend to have dry skin, variable hunger, feel often bloated, gassy, or constipated, and less if you tend to accumulate extra congestion, have oily skin, and slow metabolism.

1-2 Tbs. coconut oil
1 tsp. ground coriander
½ tsp. ground cumin
½ tsp. ground turmeric
½ tsp. cinnamon, optional but delicious
1/8 tsp. fennel seeds
1 3-inch piece of ginger, finely grated
1 cup red lentils
4-5 cups water
1 large sweet potato, peeled and diced small
salt and freshly ground black pepper to taste
a squeeze or two of fresh lemon or lime juice

  • Warm the coconut oil in a large pot over medium heat. Add the spices including fresh grated ginger, and stir just until they start to smell.
  • Add the lentils and sauté for 1-2 minutes, making sure they’re nicely coated. Then add the water and diced sweet potato. Bring to a boil, then turn down and simmer until the mixture is creamy and soupy, about 20 to 30 minutes. Stir occasionally. The lentils will be broken down, making a nice porridge-like consistency. Add more water if you need to.
  • Near the end of the cooking time, add the salt and pepper, and a squeeze of citrus. Remove from heat and enjoy!

Celiac Disease, Gluten Sensitivity and Wheat Allergy: what’s the difference and what are the concerns?

I remember the beginning nearly exactly. Lower GI pain that began in the afternoon, dull enough at first I tried to ignore it, and would only go away after eating dinner, coming back at nearly the same time the next day without any apparent linkage to what I had eaten. I was in the first month of my one-year graduate program for teaching at the time, age 22. I was otherwise healthy and relatively stress-free. Over the next two and a half years, without doing anything about it, the pain intensified and some days was nearly constant.

And I developed more symptoms, many of them far beyond my GI system.

After the first couple hour-long meeting with my doctor, a naturopath, she told me she highly suspected what was going on, but we’d confirm with further testing. It was nearly Thanksgiving then and some of my symptoms were overwhelming anxiety, daily headaches, acne that was far worse than I ever had as a teen, and a nearly complete inability to concentrate. Having formerly struggled with an eating disorder, I was weary of having restrictions in what I ate. Plus, I was making incredibly delicious homemade bread and pastries regularly and I didn’t enjoy the idea of changing that. So I pushed the testing off, dug in my heels, and waited to confirm or change anything until after the holidays. What we confirmed was that I was significantly depleted in nutrients despite eating normally, and highly reacting to gluten. In addition to those other symptoms above, test results also showed a bunch of the wrong type of bacteria hanging out in my system, further contributing to my complete sense of not-at-all-wellbeing. At the time I had many other life events happening with tight finances, job/career uncertainty, and an upcoming wedding halfway planned–so I didn’t push for further testing or a celiac disease biopsy like I should have. Instead, I grudgingly and not altogether stringently, took out gluten from my diet with the knowledge I had.

I felt better very very slowly, but after six months, I was only better enough to know I was still reacting to more than gluten. So we tested again and found more problem foods.

Celiac Disease

Celiac Disease is an autoimmune condition characterized by damage or destruction of the villi in the small intestine resulting in malabsorption of nutrients and widespread pathophysiological symptoms throughout the digestive tract and often in other areas of the body (1, 2)

The only current long-term treatment to successfully stop the autoimmune response that occurs in celiac disease is to strictly adhere to a life-long gluten free diet. This includes avoiding wheat and its relatives (spelt, kamut, emmer, einkorn, triticale, etc.), barley, rye, and in some individuals, oats (3). In celiac disease, the inflammatory response invoked by the gluten proteins leads to destruction of enterocytes, the cells in the small intestine, then atrophy of the intestinal villi, the tiny, fingerlike projections along the small intestine lining that enable nutrient absorption to occur.

The lining of the small intestine is one cell thick, and these cells are semi-permeable, which allows for tiny molecules of nutrients to pass through into the bloodstream. The cells of the gut lining are also joined together by what are known as tight junctions, which are supposed to be tight, but damage can cause larger particles to slip through. When the body negatively reacts to gluten proteins, chemicals that are released in their presence causes the lining of the small intestine to become much more permeable, and substances that normally would not be allowed to pass through now can, causing even more inflammation.

When the area of the body that is responsible for nutrient absorption is so critically damaged, decreased nutrient absorption quickly follows. Likewise, the immune complexes attacking the small intestine don’t just stay there. They travel throughout the body and can damage other organ systems, which is why it is common to see symptoms that are far beyond the gut in those negatively responding to gluten, such as depression or anxiety, headaches or migraines, joint and muscle pain or weakness, skin conditions, fatigue, infertility or repeat miscarriages, frequent bruising, brain fog or difficulty concentrating, osteoporosis, tooth enamel damage, canker sores, and many more associated with lack of adequate nutrients. Lastly, if not diagnosed, or one does not adhere to a strict gluten-free diet, those with celiac disease are at much more risk for developing secondary autoimmune and other diseases, such as cancer.  

When gluten is no longer triggering the immune system, the enterocytes and then villi can begin to heal (3). The goal in implementing a strict gluten free diet is to heal the gut lining so nutrient depletion and widespread symptoms stop occurring. After just one meal containing gluten, symptoms can appear for up to six months in those with celiac disease, which makes paying close attention to cross contamination, and educating friends and family who prepare meals a primary concern. So too is being particularly careful about eating out at restaurants that pay strict attention to cross contamination, or that don’t prepare any food with gluten, which is rare but a real haven for those that need to avoid it.

Gluten Intolerance

Beyond celiac disease, there is the slightly more common gluten sensitivity (also called gluten intolerance), which often displays the same or similar symptoms as celiac disease, but does not cause intestinal damage, often will not take as long for healing and symptom remission to occur, and is not always lifelong. Gluten sensitivity also is not autoimmune, and does not appear to have a genetic linkage. When enough healing has occurred in one that is gluten sensitive but does not have celiac, the individual can often reintroduce gluten in small amounts and/or return to eating it normally.

The one caveat in determining between lifelong strict avoidance of gluten for those with celiac disease, and perhaps less stringency with those with gluten sensitivity, is that the only way to definitely diagnose those with celiac disease is with an intestinal biopsy, and damage will only be ‘complete’ enough to diagnose with daily consumption of gluten for at least six months. I had an unfortunate episode a couple years after I removed gluten in which I unknowingly was eating contaminated oatmeal every day for a month. After realizing and removing it, it still took me over six months to be symptom-free, and that very small amount of gluten daily for about 30 days was nowhere near enough gluten to be able to diagnose. So if one suspects gluten is a problem, I always recommend ruling out celiac disease before completely removing gluten from the diet.

Wheat Allergy

Now, for a slightly different but similar condition—wheat allergy.
Those with wheat allergy have developed an antibody to a particular structure in wheat. Similar to a peanut allergy, symptoms can occur immediately after eating, up to within two hours later, and include swelling, itching or irritation of the mouth or throat, itching, hives, or skin rash, itchy watery eyes, GI concerns such as diarrhea, cramps, nausea, vomiting, difficulty breathing, chronic hay fever, heart palpitations, etc. Like other food allergies that cause similar reactions, even a trace of the food allergen can trigger a severe reaction, and the way your body reacts to a food allergen one time does not predict how it will react the next time. So a mild response in the past does not mean the response will always be mild, and vice versa for severe reactions.

Gluten-Free Diet for other Autoimmune Conditions

A question and/or concern that comes up routinely in those that have been diagnosed with other autoimmune conditions is why is a gluten-free diet commonly suggested if one has something like Hashimotos thyroiditis, Lupus, or others?
The answer here is slightly complicated—but the simplest way to describe it is that it is commonly believed that the gluten proteins are highly complex and difficult molecules to break down, and they are mildly inflammatory in most individuals, but highly inflammatory in others. For those individuals that already have an autoimmune response occurring in the body, an immune system that is “on alert” does not need more inflammatory molecules entering the system. That is why many feel better when removing gluten and other inflammatory foods, such as refined sugar, dairy, processed meat, etc., and load up on anti-inflammatory foods to help heal the whole system.

Sourcing Gluten-Free Products

If one does need to avoid gluten and/or wheat, pay particular attention to sourcing, packaging, and labeling of all foods, and in particular grains that might be processed in the same facilities as wheat and other gluten-containing grains. Flours that are certified gluten-free, or that at least say on the label they are not processed on a line that also processes gluten-containing grains is essential –that’s how I got into trouble with the oats! This means purchasing flours and grains from bulk bins needs to be done with care, as well as knowing the source and details of the processors so as to avoid cross-contamination. Edison Grainery (my favorite source currently), Arrowhead Mills, Bob’s Red Mill (which has two lines so pay attention to whether food is from the gluten-free line!), and One Degree Organics are great companies, but there are many more to be found as long as you read the ingredient list, look for a gluten-free certification, and read the small print about allergen cross-contamination.

I hope this informational article clarifies some of the myths and misconceptions about these challenging dietary conditions. Feel free to comment below or contact me with your further questions or for more information on working with me if you or a loved one are concerned about gluten and/or wheat. In addition to my own experience mentioned above, I studied gluten-associated pathophysiologies extensively while in graduate school for clinical nutrition.

References:
1: Lipski, L. (2012). Digestive Wellness (4th ed.). New York, NY: McGraw Hill.
2: Hardy, M.Y. and Tye-Din, J.A. (2016). Coeliac disease: a unique model for investigating broken tolerance in autoimmunity. Clinical and Translational Immunology, 5(11): e112. doi: 10.1038/ct.2016.58.  
3: Barker, J. M., & Liu, E. (2008). Celiac Disease: Pathophysiology, Clinical Manifestations and Associated Autoimmune Conditions. Advances in Pediatrics55, 349–365. http://doi.org/10.1016/j.yapd.2008.07.001.