Category Archives: Dietitian Advice

What makes it easier to recover from an eating disorder?

“Recovery is like riding a wild stallion. It is unpredictable, you will likely fall off many times. You will go through emotions ranging from fear to excitement, feeling out of control at times and clinging on to anything you can. Keep getting back on the horse, keep holding tight, sit up tall and go with the ride.”

There are many times in my working life that I just wish I had a magic wand to make recovery easier. The fact is, recovery is hard, damn hard and it takes a lot of guts, determination and hard work to even make a start on it. Once you start it can feel like it just gets harder at points, so you really need to plan and have support in place to help guide you and keep you going. Here are some things that can help the ride.

Have a social support structure in place

Deciding to make changes to your eating may sound simple, but once you plan it and then actually have to put it into place, it really gets harder. Having people around you who you are accountable to, people who will sit with you in the hard moments, challenge you to keep going and celebrate with you too. True friends and family who love you for you but want to see you healed up and able to live life to the full.

Have professional support

Yes you can do it on your own. However an eating disorder is an isolating illness, it can be a long and lonely path. So having a professional or a team of professionals who you trust is a good idea. People you can get the right information from and trust it, people who will challenge your thoughts, assumptions and beliefs and believe that you can do this. 

Being in the right place at the right point 

There is a cycle of change that I often use with people to talk through how you need to be in the right mindset and the right point of your life to begin recovery. This is especially key if you are in the community, recovering at home. In a eating disorders unit things are a little different and you have more support and encouragement. Take a look at the  phases below and see if you can identify where you are. Recovery can be a cyclical process where you move forward 5 spaces and then back 2 spaces, but do not give up, this is normal. 

Stages of ED recovery 

  1. I don’t think I have a problem
  2. I might have a problem but I’m ignoring it or I don’t care
  3. I don’t know how to change but I  want to
  4. I tried to change but it didn’t work
  5. I can stop some of the behaviours but not all of them
  6. I can stop the behaviours but not the thoughts
  7. I can be free from my eatind disorder some, but not all the time
  8. I am free from behaviours and thoughts = recovered

Have goals in mind

You need something to aim for. Why do you want to get better? What will life be like when you are free from your eating disorder? What do you want to do with your life that you cannot currently do. I recommend writing out or creating a vision board showing where you want to get to. Write out your dreams and dream big. Then use this as a motivational tool, put it up where you can see it. 

Surround yourself with the positive things

Part of recovery is about changing your mindset and the way you view life. It can be so easy to see the negatives about your life and yourself, then use food as a way to help with this. Or to get drawn into the negatives about weight gain. I challenge you to instead see the positives. Why is weight gain good? What does it mean for your body and your life? Grab hold of those negatives and turn them upside down. Having motivational phrases and images around you can be really helpful on those days that thinking is too tricky.

Go do it. I believe you can.

The golden toolbox of recovery

What’s in your toolbox?! I was recently at a meeting and friend turned to me and said “I have a strange picture that I’ve seen, it’s you with a golden toolbox. It’s like you have everything you need in that toolbox to deal with life”.

This spoke volumes to me as a person and as a health care professional. Having worked in a team which was predominantly psychological I was immersed in the language of the therapists and the word toolbox often came up. I sat in on plenty of group therapy sessions and got to experience a whole range of different therapies.  Also, in our team meetings we used these skills on ourselves as part of the debrief process. It showed me how important it is to look after not just your patients, but yourself. If you have a life with some stress in it (let’s face it that is probably everyone) then you need to have some skills to hand that help you deal with that stress. Stress and anxiety can be a huge factor in an eating disorder, in mental health conditions and also to physical digestive issues such as IBS. When you have a stressful event how do you respond? What does it trigger in you? When you know how you respond you can start to work on a more effective and helpful mechanism. 

 I will never forget my interview for my eating disorder post. I was asked such an eclectic mix of questions that I had no idea how I had done on leaving the room. When I received the call to say I had the job, I asked why I was chosen. The response “we could see you are robust and able to cope with the strains of this work”.  In the eating disorder field this robustness is certainly needed. I continually need to keep on top of my own anxiety and practise what I preach. 

I want to  highlight some skills or tools that we all, health professionals, patients, people, could include in our golden toolbox. Tools you can use regularly for moments of anxiety, tools you can pull out for those emergency moments.

I remember being on a train that got stuck in a tunnel and suddenly feeling trapped and my anxiety levels rising. It was not an experience I was prepared for and suddenly I knew I needed to use one of my tools. At that point visualisation of a calm beach with lapping waves and some square breathing helped immensley. I know if I had not practised these skills  previously, I wouldn’t have been able to use them there and then. So practise really is the key. 

Here are some of my favourite toolbox tools that I use myself and recommend. 

Journaling –

I’m a seasoned journalling fan. This is something I have always done since my teenage years, I now have a lot of full notebooks with a collection of my teen angst, my working life, my spiritual life and my family life in them. Looking back it shows me how I have evolved and where my stress triggers are. I can see the patterns that I fall into and work on improving my reactions. I dig out my journal when I have a moment I need to work through, when my mind feels cluttered or when something erupts! I also love to journal the good and positive, so any life events or just when I get the urge.

If you are on a recovery journey then I recommend that you journal daily  or at least 4 times a week. It needs to become a discipline and a part of your coping mechanism. A good way to start is to write down 3 things that went no so well in your day and how you could have dealt with these better. Then always finish on a positive, so 3 things that have gone well or that you coped with well. You can also take a single scenario and write out alternative endings. Using an eating disorder example: You had an argument with a friend, this increased your stress and you responded by missing your snack. Thinking through why this was not a useful response – restriction of food does not help your emotional well being, it is a quite fix but not a long term cure. Now you have missed out on some nutrition for the day and your body is hungry. Your body needs regular food right now as you work towards recovery. So take a think through how you could have responded instead…. maybe you could have gone for a walk, taken a bath or done some mindfulness to help you reduce your anxiety after the argument instead of turning to food.

Mindfulness and Breathing –

Such a buzz word at the moment, but this is not a fad. I’ve been using mindfulness with eating disorder clients for over 10 years and I’m sure it has been used for far, far longer than this. Just 10 minutes before a meal or after a meal can make a huge difference. It is all about calming your thoughts and body. I personally love just deep breathing, there are so many variations on this so try a few out. For me, the breathing  is something that spills over from Pilates practise and so I get a double benefit from Pilates of exercise and mindfulness. There are some great free resources to help here. 

Exercise –

This is something to decide upon according to your recovery stage. Exercise can be amazing as a mood booster and a de-stresser. However if you are working on weight gain then it will also have an affect on this. If your BMI is less than 17.5 then you will want to modify your exercise so that it is physically safe. 

Distraction – 

I often suggest that people put together a list of distraction techniques that they can use. For example, after a meal,  or when a the urge to binge strikes, at times when anxiety levels are rising it can be useful to have an activity planned. Things like craft, having a friend to call, painting your nails, reading a book, cleaning out a cupboard – something that immerses your mind and changes your thoughts. Puzzles, crosswords, knitting, collage are all great things to have on your list.

Positive thoughts –

Those anxious, negative thoughts are something that we all get. It is how we deal with them that is key. I love the thought of noticing the thought, and finding the opposite reaction. So turn that negative into a positive. If you practise this regularly it can turn into a habit that you hardly notice you are doing. I’m now working on this one with my children too, teaching then that there is always a positive side to things. It is a great skill to learn at a young age but one that you can learn at any age.

I’d love to know what tools you find useful. 

SaveSave

IBS and the Microbiome

Priya regularly writes for Network Health Digest (NHD Magazine), here is her latest article.  The microbiome is such an up and coming area with so much we are still to research and find out.

Click the link below for the article.

Issue 126 fermented foods IBS and microbiome

Eating Disorders: Why can’t I recover?

Working in eating disorders as a dietitian is the very hardest part of my job. As a freelancer I cover a huge variety of roles. In my other world as a Pilates teacher and studio owner I have an altogether more energetic and flowing role. Yet it is working with eating disorder clients that uses the most of me, pushes me hardest, and pulls on my mind, spirit and emotions. 

 Some of my hardest work is with the “stuck” clients. Those who really want to change, really want to break free, really want help…. and yet they just can’t do it. It is so very hard for them as you can see they do want to get better. Imagine this – knowing how you are living is ultimately going to shorten your life, make your life difficult and lead to you not being able to do a lot of things and yet not being able to change it. Life with an eating disorder is a very hard life.

Often there is a specific weight that they cannot push past. 

Sometimes there are behaviours such as exercising or purging that they cannot give up.

Change can be made, but only to a point.

 

So what causes this “stuckness”?

An association with a certain weight.  

It is not uncommon for me to being working with someone who 100% agrees that they need to get their weight to xx kg. We put a plan in place, they are working towards it really well, everything seems to be on target and then the “stuckness” hits just before our weight goal. Why? It could be that when they were last at this weight they didn’t like their bodies/themselves, someone said something negative about them or that something traumatic happened at this weight. It could be they have never been that weight before, it is the highest weight they will have reached.

I like to work this through with people. 

“What will it be like being this weight”

“How will it change your relationships and how you see yourself”

“What will be better and what will be worse?”

I also remind them that you really cannot predict how it will feel and be until you get there. Using the analogy of a night in a hotel. You can guess how it will be, you can imagine how you may spend the time with your partner, you can predict the layout of the room, the hotel and the menu. However you cannot really be sure what it will be like until you get there. Even if you have stayed there before, things change, things feel different at different stages of life.

2. Not wanting to move on.

Having an eating disorder can for some be a way of escaping. Escaping growing up, escaping emotions, escaping reality. So getting better means that you have to deal with all those tricky issues. You cannot run away any longer. You have to put on those big pants and be a grown up. It isn’t necessarily going to be fun, but in the long term it will be worth it. 

I find using some motivational work can be beneficial here. Looking at the pros/cons of change. Planning out a vision board of where they want to be in 1 year, 5 years time. Talking through the real reasons they need to get better. For most people there is something driving the desire to make change. Examples are wanting to have a certain career that you can’t do at a low weight (nursing, law), wanting to have children, wanting to be able to go travelling.

3. Invested in the Eating Disorder.

This may seem like a strange one. If you have had an eating disorder for a long time it can be hard to imagine not have one. It becomes part of who you are. It becomes part of the way that other people see you, relate to you and care for you. If you no longer have an eating disorder there is an uncertainty, how will others see you, will they still care for you, will they still take time over you? If you no longer have an eating disorder who will you be? A huge part of this is all around knowing your identity. Spending time journalling can help with this. Thinking about who you used to be, who you would like to be. What are the things that make you come alive inside? Spend time doing those. What are your dreams and aspirations? What things are you good at? Asking someone close to you the question “What are my giftings or what are I good at?” can be very revealing and helpful.  Once you have an idea of who you could be outside of your eating disorder you can push yourself to move past it.

Working on your relationship can also be helpful. If these are strong then you know that people will care for you always, with an eating disorder or not. Being in a sick role means you are seen in a very different way. Being recovered and healthy can expand and move your friendships and relationships to new levels. 

Being stuck in your eating disorder recovery can be a very natural part of the recovery process. If you are in this place do seek some help. Do spend time journalling, talking, being creative and finding who YOU are. To look for a good therapist and dietitian near you in the UK the B-eat website is a good starting place. Or drop me an email as I work with people around the UK by video call.

SaveSave

Eating out with young children.

Eating out is meant to be a relaxing, delicious event, yes? Well, when you have young children it isn’t always the case. My husband loves to eat out, I find that I need to be in the right mood. Eating out with my tribe of kids (Miss K age 6.5, J-boy aged 3 and Etty just 1 yr) requires a military operation of packing bags, finding shoes, brushing hair, finding toys and by the time everyone is in the car I’m ready for a nap. I am the one that has the noisy kids that will not sit still and talk politely, the one everyone looks at, I like to think they are looking over and thinking how adorable my children are, but I’m probably deluded!

So here are my top tips for eating out with small people:

    •  

    • Leave them behind! I’m only half joking. If you want a calm, relaxing meal where you can hold an adult conversation then having a child-free meal could be the answer.
    • Choose somewhere that is family friendly. Somewhere that it is ok to make noise, to make a mess and to get down from the table. My kids do not sit still and they need something to look at, somewhere they can talk noisily and somewhere they can walk/jump/dance around. For us Sainsburys cafe, community cafe’s and Wagamama’s are a hit.

 

    •  

    • Check the menu before you go. Is there food suitable for the whole family? This doesn’t have to mean a children’s menu as such, just a balanced meal option your child will enjoy. There is no satisfaction over ordering a meal and your child refusing to eat it. A starter, a selection of side dishes or sharing an adults meal between a couple of children can work well. In fact, my children are not fans of the standard nugget and chips children’s fare. When the adult meal arrives and looks yummier they are not impressed and just eat mine. There go my prawns. 
    • Set the expectations. I tend to explain before we set out where we are going, how I expect them to behave and what type of food we will be ordering. I then repeat it when we get there.
       
       

 

  • Pack a bag. Toys that you can play with at the table, colouring bits, stickers, a book and snacks. I always have something to tide them over until the meal
    arrives in case it is a long time. You know you don’t want a grouchy, tired child on your hands.
  • Do not expect them to be perfectly behaved. They are children, they are meant to be noisy, they are meant to be active, they are meant to have fun. If you are ready for them to be this way then it is a nice surprise if they do sit quietly!
  • Breath and remember they are only young for a short, short time. Enjoy the moment and relish not having to wash up and leaving the mess behind. 

“This too will pass, so enjoy the moment”

 

 

Messy Home, but Top Nutrition Tips.

When the BBC ask if they can come and film you in your home what do you do? 

Firstly –  Say Yes.

Secondly  – Flap about in panic at the state of your house and kitchen. People who know me well will know that my kitchen is rarely tidy and usually full of our home life. Pictures from the kids, plates ready to go in the dishwasher, toys on the floor. ARGH. 

Thirdly – Wonder what on earth they are going to ask your to talk about. Oh well, that can wait, I have a house to tidy.

So, when the crew turned up, their first statement was “Wow lovely kitchen, it’s very lived in” which I read as “It’s certainly not pristine and clean”. SIGH. I did tidy, I promise. 

Then when they ask to look in your freezer…. OH MY GOODNESS. Really? I can’t say No, but I didn’t see that coming. My freezer is outside the house and definitely NOT TIDY or video viewing. 

So you have been warned, this is a “lived in”, mum with 3 kids, messy life video. Or maybe I should say it is REAL LIFE.

Love to know your thoughts. 

 

 

Reduce your risk of breast cancer.

Today, a report entitled “Diet, nutrition, physical activity and breast cancer” came out from the World Cancer Research Fund. When you are a dietitian, this kind of thing excites you – why? Well it included a good review and analysis of the research on breast cancer. Looking at 119 studies worldwide and over 250,000 women, the evidence has been categorised into strong and limited evidence. 

Here is a little summary and a vlog I did as a Facebook Live.

 

Diet:

There is strong evidence for alcohol increasing the risk of breast cancer. The report states that a glass of wine or small beer a day (equivalent to 10g alcohol content) is linked to a 5% increase in breast cancer risk in pre-menopausal ladies and a 9% increase in post-menopausal ladies. We all know alcohol is a toxin for the body, I’m not sure I’m ready to give it up entirely though. Other evidence from the Mediterranean diet tells us that red wine can be good for heart health. So I think the take home message here is to stick to small amounts and to have plenty of alcohol free days too.

Limited evidence was found for

  1. Eating non starchy vegetables (broccoli, mushrooms, peppers, beans, green leafy veg etc).
  2. Eating catotenoids – orange and red fruit  (orange peppers, sweet potatoes, tomatoes, carrots) and veggies plus dark leafy greens.
  3. Having a high  intake of dairy foods. Increasing these by 200g led to a 5% decreased risk. 

Exercise:

We all know we should be getting active. The research supports this showing exercise that increases your heart rate was helpful in reducing the risk of breast cancer. Swimming, running, fast walking, cycling – anything that gets you a bit out of breath.

A strong link was found with weight. Being a healthy weight could prevent 16% of cases in the UK. 

Having Children:

Pre-conception and pregnancy are key times for getting on top of your eating as what you eat will help lay the foundation for baby. Your diet at this point can influence your baby as an adult, Birthweight was found to be a predictor or later growth and being a healthy weight is linked to reducing the risk of so many chronic diseases including breast cancer.

Having children reduces your risk as does having a pregnancy before you are aged 30 yrs. 

Finally breastfeeding was found to reduce the risk for you as a mummy.

Lots of great take home tips that centre around eating well and being active. We already knew that waa a good idea, now there is more proof. 

Coeliac Disease: The Facts and Frustrations.

Coeliac Disease is often referred to as a gluten intolerance or allergy. Which makes sense as the treament for it is to follow a strict gluten free diet. However it is actually an autoimmune disease, which means it is a disease in which the body produces antibodies and  attacks it own tissues. In the case of coeliac disease there are 3 antibodies produced in response to gluten and these can be tested for: 

  • anti-tissue transglutaminase (tTG) antibodies
  • endomysial antibodies (EMA)
  • deamidated gliadin peptide (DGP) antibodies

The immune response leads to damage to the villi in the intestinal linings. The villi are where nutrient absorption occurs, they produce enzymes that help digest carbohydrates and proteins, they absorb nutrients into the capillaries around them so the nutrients can then go to the blood stream. Destruction of the villi means that there is firstly less surface area available, so less absorption of nutrients occurs. Secondly the enzymes are not there to digest the food. This may mean that you eat food but just don’t absorb it, instead you excrete it, leaving you lacking nutrients and suffering with digestive symptoms such as abdominal pain and diarhoea. Over time this can have a major impact on your body and be very confusing. If you know you are eating a well balanced diet but you are showing symptoms of nutritional deficiencies or digestive problems this is definitely the moment to see your GP and get advice.  

 

The treament for Coeliac disease is a lifelong strict gluten free diet. This is not a fad diet, or a “choose to be gluten free for a while diet” but a gluten free diet that has to be followed to the letter. I’m not a coeliac but I can’t eat wheat, it won’t harm my villi but it can cause me to be unwell for a few days and is linked to a some digestive issues I have. When I eat out I have to double check and often I find things on my plate than I can’t eat! This can be very dangerous for a coeliac. Even a few crumbs of gluten can cause problems. When on a gluten free diet the villi should recover and nutrients should start be be better absorbed. 

What can be frustrating is that Coeliac disease is under-diagnosed and so there are people with it who have no idea. The rise in gluten free diets also means that there are more gluten free options around, but sometimes it can take aware from the severity and the need for a strict gluten free diet. I’ve seen quite a few places advertising gluten free foods with statement such as “we cannot guarantee these foods are made in  an area free from gluten”. So gluten free food that is not suitable for a coeliac! 

Coeliac Awareness Week is a great time to spread the word and to get people knowing more about these issues so please share and get talking.

Is having a cuppa soon to be history?

Britain has historically had a love affair with tea. In fact it was the British who introduced it to India in order to compete with the Chinese production of it.  According to the recent Cost of Tomorrow report, people between the age of 50 and 64 spend £31.20 on tea annually, but for millennials this drops to £10.40. So are we drinking less tea? If so what are we drinking instead?

© Tatjana Grinberg | Dreamstime Stock Photos
© Tatjana Grinberg | Dreamstime Stock Photos

Currently, the average household spends £1,475 on tea over a lifetime and  £2,585 on coffee over the course of their lives, so coffee has definitely overtake in the hot drink department. Soft drinks have definitely increased with smoothies, fruit juices, fizzy drinks and milk shakes being more popular now. All of these contain more calories and sugar than your average cuppa. 

Sadly, coffee shop culture means we spend a lot on the treats that go with that cuppa. The Cost of Tomorrow report suggested we spend £11,520 on cakes, buns and biscuits to complement our favourite hot drinks; 4.2% more than we spend on fresh fruit (£11,034) over a lifetime. 

So the take home message on National Tea Day 2017? 

  1. It is perfectly safe to drink 2-3 standard caffeinated cups (400mg) of tea or coffee a day. If you are concerned about the caffeine then try herbal/fruit tea or decaff versions.
  2. Tea contains polyphenols and there are health benefits stated for dental health, diabetes, heart disease and cognitive function. 
  3. Tea is a natural sources of fluoride so has benefits for dental health.
  4. The polyphenols in black tea are thought to be responsible for the links between tea and reduced risk of cardivascular disease. 
  5. Soem studies show a reduced risk of diabetes with 2-3 cups of tea a day (presumably tea without sugar).
  6. With less calories and sugar (if you don’t add it by the spoonful) tea is a good option to be drinking, better than a fizzy drink. 
  7. Tea does hydrate you. Studies have shown it to be equivalent to water!
  8. Tea provides calcium (from the milk), manganese and potassium as well as flavanoids which are potent antioxidants. 

Now who is for a cuppa?

Chocolate: the good, the bad and the portion. 

Chocolate originates from cocoa beans from the Theobroma cocoa tree. The beans are fermented, ground and separated to cocoa butter and powder. 

Cocoa has been used for many used as a medical aid. It is rich in flavonoids which have potent antioxidant functions. These include being :

  1. Anti-inflammatory 
  2. Helping blood vessels to dilate so helping reduce blood pressure. 
  3. Increasing insulin sensitivity 
  4. Decreasing the risk of atherosclerosis. 
  5. Positive affect on cholesterol: increase HDL (the good guys) and decrease LDL oxidation. 
  6. A reduction in cardiovascular risk factors. 

However we don’t eat cocoa on its own. Milk chocolate has a variety of other ingredients added in. It is high in energy, free sugars and saturated fat. One point to note here is that not all chocolate is equal. The darker the chocolate (higher % cocoa) the higher the flavanol content and the less sugar. White chocolate is not actually chocolate as it doesn’t contain any cocoa powder or cocoa solids but cocoa butter mixed with milk and sugar. The chocolate in eggs can be of a lower quality with lower flavanols and mineral content so watch out! Check the cocoa solids. 

An easy way to remember a portion of chocolate is “the size of your index finger”. That is about 2 squares for a child and 4 squares for an adult. 

© Magdalena Żurawska | Dreamstime Stock Photos

So chocolate is something that can definitely be enjoyed as part of a balanced diet. The key is thinking about the quality of the chocolate you are having and the portion size. Space that chocolate out and enjoy it, rather than gorging on it all in one go.  Savour it and eat it mindfully,