Chronic Illnesses do not take Holidays

As I flipped over the calendar to December I smiled thinking of the fun Christmas stuff ( we celebrate Christmas in our house) that was coming up, my tummy flipped thinking of all the stuff I had yet to do to prepare then my heart sank. December 25th is the day my next injection of medicine for my Chron’s disease, then December 27th is a scheduled colonoscopy- which means the 26th is prep day…(maybe good online sale shopping as I won’t be leaving the house). That is 3 days in a row where this disease gets to be front and centre. The 3 days my kids have been waiting for since last year. The 3 days where I am usually visiting family, eating foods that I enjoy and visiting places I want to see. 3 days that I am off work (hence the scope being scheduled) to spend time with my loved ones. And this disease, that has clung to my body like a heavy backpack, has decided to visit again this holiday. I will have to rearrange eating times and remove usual foods (I usually have to prep for 2 days by going to clear fluids 2 days before the scope…hey Dr. M can’t say that is going to happen!) and not do some of the things we might traditionally do. But this is life. This is my life. I am not the only one that will be carrying a backpack this holiday season and even if you can’t see a single backpack at your holiday functions I guarantee they are there, sometimes so well hidden, so that you do not have to “feel bad” for them during the festive season.

Food is such a staple of all holidays. Sometimes I think we can pick the holiday based on the smells coming from the kitchen. Every house has their holiday “favourites”. I have written in the past about how my mom would puree the same foods for me at Christmas when my stomach was really bad so that I could experience the usual tastes and smells. Now we make sure to have gluten free versions (although NOT AS GOOD!) of everything so that I can still eat. I am also really open about my chronic illnesses. However we should not expect this of others.

I have started spending the last 2 months of the year talking to clients about how to manage the holidays with whatever it is they are seeing me for- whether it be an eating disorder, trying to build a better relationship with food and their body or sports nutrition. The holidays can be very difficult for many, for various reasons and I think we need to acknowledge that those reasons do not take days off. A person with a restrictive eating disorder is going to struggle the same on the 25th as they do any other day and will need the same, if not more support. A person with diabetes might appear to be asking a lot of questions about the food on the buffet table about the carb amounts or serving sizes, don’t assume that they are worried about their weight- they are likely trying to figure out how to dose their insulin with a variety of food they are not used to without going sky high or bottoming out. A person who is trying to improve their relationship with food might leave conversations that are diet or body focused because they are trying to be social and setting boundaries at the same time. Any person that has a chronic illness does not get a pass that day. Their body does not transform from “the holiday magic”. So the struggle that they have everyday is still there: compounded with the attempt to not show everyone what they are going through.

So what can you do if your loved one has a chronic illness. Well to be honest I think it goes right along with what I say most days. One thing is to not comment on what they are eating- do not comment on what anyone is eating….ever…..like truly never ever. I will likely just eat mashed potatoes and turkey on Christmas Day for dinner. Too much fibre will make me cry the next day during prep- but I also do not really want to talk about the finer details of cleansing the colon at dinner either when I pass on the veg. So, it would be a great thing if nobody talked about what I put on my plate. A person with diabetes might pick and chose between the stuffing and the squash to account for the dessert they want because they want 1 injection of rapid acting insulin at dinner and they might not want to give a dose over a certain number of units. And that is their decision for choosing what makes them feel best. And really that is what it is going to boil down to, everyone should be choosing what is going to make their body and their minds feel the best. If it is December 25th or July 25th, eating the foods that make us feel the best and are nourishing our bodies is one of the most important things we can do. If you are following a meal plan in eating disorder recovery you need to still follow the meal plan- irregardless of whatever different eating patterns you had on that day in the past. (ummm….can I just ask WHY?? do people not eat all day to “save room” for dinner?? your body doesn’t work that way!! and people on the internet please stop saying it does!!)

So this holiday season, if you have a chronic illness (or acute) I see you, I hear you and I respect all the decisions you make to take care of you. And for everyone else remember, we can not throw tinsel on a body and make it holiday appropriate. So try something (possibly) new this holiday season- do not talk about the food (other than to say OMG THIS IS AMAZING (or terrible…you can say that…I think or maybe keep the do not talk about food rule there). Do not ask why someone is eating what they are eating. Do not comment on how bad (sinful, indulgent, guilty, other negative work) the food is or how “good” you were to skip dessert (random reminder you do not get medals for skipping a food you deem “bad”…nothing happens other than you miss out on the yummy food!). Just let everyone eat in the way that nourishes them.

So after all the gifts are opened, and I have tucked my overtired children into bed (they still wake up soooo early) I will come downstairs to the kitchen and give my injection, thankful that my body was here for another year, that is was strong enough to be with the ones I love and that it will make it through the next 2 days because I did what I needed to do to take care of it. That is the Christmas gift I give to myself- that I will do what I need to do to have my body continue to exist in a way that brings me joy.

Until next time be Unapologetically you while I be Unapologetically me…

Set your thermostat....

Wow…it has been so long since I last wrote anything. I am not going to lie, I tried but was stuck. I have way too many balls in the air at present and my brain just couldn’t write. And to be honest, I have been a little scared to write since I was a guest on The Mindful Dietitian Podcast with Fiona Sutherland (http://www.themindfuldietitian.com.au/lori-short-zamudio.html). I think my inner critic has been a too vocal since that episode aired…I mean… “what if everything I post is drivel (I love this word) now?? '“ What if everyone who listened and then considered reading wondered “ how the hell did she manage to get on at that podcast?” And possibly even more likely “what if more people read this and it’s not actually that good”. Interestingly, I have been critical of my work in the past but never to the point of avoiding to write. I love to write. I wanted to be a novelist when I was a kid, then a journalist as a teen, and now a blogger as an adult. I wanted to start with this because I think I wanted to acknowledge that we are continued works in progress. These last few months have been a reminder for me that I need to focus on self-care (Thank you Julie for that help) and joy. Writing brings me joy. So today I bring joy…

I went out for a walk today and was listening to a podcast about American Politics ( yes I know I am Canadian) and I was kind of half listening while I walked. Then a quote caught my attention- which I honestly can’t remember exactly but around it formed the whole point of this blog. It was about the differences between a thermostat and a thermometer. A thermostat sets the temperature and a thermometer tells the temperature. This really resonated with me in regards to diet culture and managing for the holidays. Stay with me… I think (read: hope) this will make sense.

The temperature in today’s society is screaming hot with body shaming, fat phobia, weight stigma and food policing. Pretty much every where we go we are doused with messaging about food and bodies. “Eat this for optimal health.” “Look like this (insert current socially acceptable look here) to be successful.” “Achieve enduring health by following these 10 ( or 5 or 50) steps.” Yet beware….if you do not eat this way, exercise this way, look this way or act this way, you will be less than, not good enough to be here or so society tells us. The process of changing this temperature will be slow. Much like the actual warming of the earth it will be slow but a few degrees can and will make a difference. We might be able to do this by looking at our thermostats.

Much like the homes I have lived in, we can set our own thermostat. Meaning that how we choose to talk about food and bodies in our homes, to our friends, family is our choice much like the temperature we set to stay warm in the winter. We can set boundaries in our lives that promote the type of talk we want to hear and engage in. We can curate our social media posts so that we see images that are in alignment with the values we place around bodies and food. We can set our thermostat to inclusive- all bodies regardless of size, shape, colour, gender or anything else is acceptable. We can set our thermostat to compassionate- acknowledge others lived experiences in their bodies and yours in yours. You can show compassion to your body by nourishing it with the foods that it needs to feel good and the movement it needs to feel joy. You can show compassion to your children by helping them learn their value in this world regardless of their bodies. And if their bodies do not meet the norms that society has placed on them you can continue to show compassion by not attempting to manipulate those bodies. We can set our thermostat to be free of diet talk. Diet talk is everywhere- we live in what I call Diet Stew. It is thick and sometimes difficult to move in. Yet you can banish it from your homes. You can set a boundary to everyone that comes across your threshold that diet talk is not permitted. There are so many other things that can be talked about with friends that do not include the words Macro, Keto, Paleo or inches. And when someone attempts to cross this boundary, or change the setting on the thermostat, it is ok to call them in and say “ We have decided that we do not want this type of talk happening in our home. I would be more than happy to sit down at another time so we can talk about why we feel this type of talk is harmful to ourselves but right now I would just love to sit and talk about other things”. You can set your thermostat to safety, meaning that you can create a space where you and your family feel safe from unwanted comments about bodies or food choices. And finally you can set your thermostat to peace. Peace with food, peace with bodies, peace with yourself.

And much like the fight over the thermostat when someone finds a room too hot or too cold, there will be people that attempt to bring the temperature from outside in. To that I say- you guard your thermostat because it is your space and you deserve to live in the temperature that you will thrive in- even if it doesn’t match the temperature of the world.

Until next time…be Unapologetically you, while I be Unapologetically Me…..

My body attacks its self but I refuse to attack my body

I recently read a really great blog post from Vincci Tsui (http://vinccitsui.com/blog/#.W7zQGS8ZN-U) during her series on Intuitive Eating with Chronic disease. This particular post was about Principle #8- Respect your Body. I replied to it on Twitter saying “My body may attack its self but I refuse to attack my body”. What was interesting to me was that I have never actually said that sentence before but it resonated within me. My body attacks its self….I have said that before but never acknowledged the trauma of that. If there was something/someone else attacking my body daily it would accepted for me to feel fear, hatred and anger towards that thing or person. Yet we are told often to love our bodies. Now don’t get me wrong. I think we need to work on our relationships with our bodies, for sure. But maybe at times love is too far away or doesn’t feel realistic. Maybe we need to respect. Maybe we need to refuse to attack our own bodies.

There are many ways we may see friends/love-ones/clients attack their bodies...and things we may do ourselves They may restrict food, overexercise, call names, pick and prod, shame or a host of other things. This daily attack will wear people down. Make them believe all that they say to be true. All of that, on top of living with a chronic disease that can be exhausting in of its self. Individuals with diabetes never get to walk away from having it, they need to test and administer insulin at all times of the day. People with GI diseases have to plan eating and bathroom breaks every single time they leave the house. And the list goes on. How do we start to respect the body that is not behaving in the way “it is meant to”.

For me (and this is me only so I am not sure if it would work for anyone else) it was finding joy. In Bréne Brown’s work on vulnerability she takes about joy coming from vulnerability. And she talks about how we are programmed to shut down joy. As humans we will often catastrophise our joy. I think with Chron’s disease it was really easy to do this. I was tired, in pain, feeling different, angry at the body and easily turned to shame. Shame is “ I am bad” talk vs “this was a bad choice”. I lived in a shame sprial with this disease for a long time. And then after major surgery I chose to find joy. It was not an easy task. It came in very tiny steps. There were big markers for me to find joy in this body that so easily attacks its self. I grew humans!! This was something that I so wanted to do but was told by medical professionals it was not likely. I won’t lie that it was easy but my body fought hard to give those tiny humans what they needed. I respected what my body was doing. I did not have control (I think this is when I realized I never had control of my body) of what my body would do but I needed to respect that it knew what was going on even if it didn’t the pregnancy blogs that I was kinda obsessively reading. I also had to respect that my body was not well after having both babies and I needed a lot of support. I also needed to bottle feed. I remember being angry for a brief moment that my body couldn’t feed my babies. It is always put on us that this is such an important part of development and bonding. It is natural and “breast is best”. But once again my body attacked its self. Did I need to go on attacking myself because I couldn’t do that or could I find the joy in the fact I had a tiny little life in front of me that still needed me to feed it. My little e’s needed food and I could still provide it. It is that simple. So I found joy in those quiet moments at 3am when the world is asleep and you really just want to be asleep but you have profound conversations with humans that can’t talk yet. And I found that joy even using a bottle.

My body has taught me more lessons than I can count. It has taught me that it will signal when I need rest and that I need to listen. It will tell me when I am hungry and full. It will feel better when I provide the foods that it needs to stay strong- irregardless of whatever else some tells me will “cure” me. It reminds me when it wants to move in a joyful way and it signals when I am pushing too hard. And it will give me about a 4 minute warning when I need to desperately find a bathroom….( I do wish it would give a 40min warning as apparently my body has yet to understand rush hour traffic in Toronto)

Our bodies are amazing, AMAZING things. We need to respect them even if we can’t love them. This is why the banishment of diet culture is so important. How can we take care of something we hate. How can we listen to the stories it holds and the signals it gives if our internal brain dialogue is overriding it all. How can give our body what it needs if we are constantly listening to the noise outside telling us our bodies are not good enough. They are…..because let’s be honest, it is the only body you are going to have while you are here, you actually can not trade it in for a new model or upgrade to the next version. This is it…your longest relationship is with yourself and it can only improve if you stop attacking you.

Until next time be Unapologetically you while I be Unapologetically me…

Super Proud Non-Diet Dietitian...

Today is the day that my cat of 19 years is no longer with us. He was literally 3 months short of having spent half my life with me. This might not have been the opening sentence you were expecting but I promise I will explain…as well as it might explain if this post sounds sad, even when I am trying for it not to.

Watching a loved one pass, human or otherwise, is a strong reminder how fleeting life really is. And how at the end our bodies just can’t hold on otherwise. I have often said that BammBamm has lived this long as he is as stubborn as the humans he lives with, and loves with all of his being. It was when I was laying on the floor with him this past weekend reading through a few very long threads of diet vs non diet vs HAES vs diet culture on social media that I was struck with this gut punch. I did not care right then about whether he was eating or drinking or how much weight he was rapidly losing all I was caring about was giving him love. And then I had this weird flashback to a vet appointment when we were fat shamed for having an “obese” cat. Did I not know that I was essentially shortening his life by giving him diabetes?? (19yrs old and never had) he would need to go on cholesterol meds?? (nope no meds at all). Now I am not at all trying to compare this experience to a humans except to say that I felt like shit leaving that appointment and lets be clear…it was about my cat and not my child or myself. I couldn’t even begin to fathom the shame that is heaped on people. I will say however that experience was one of the reasons that I embraced the Non-diet and HAES approach. (thank you for letting me immortalize Bammbamm in my blog)

While reading many of the comments, within the HAES and/or Non-diet community, I was struck with how broad the learning spectrum is and how it appeared that there needed to be more conversations around this topic. We need to learn and grow. Once we say we have learned it all we are kidding ourselves into thinking that we have the learned experiences of all. This is impossible and will never happen. If you think you know all that there is to know about this type of work and how you fit in then that needs to be a red flag that you meed to learn more…do more….push out of that box. Listen, observe, ask questions! Why do some stop asking questions and assume that the answer is already known by them. I think we need more stories, more people of various lived experiences sharing. And we need to listen! It is our responsibility to do the work. So…I am going to tell you my story around intuitive eating…and why I would call myself an intuitive eater even if a black and white thinker I may not.

I have written before about having Crohn’s disease. For those of you that are not aware of what it is, it is a GI disease where my body attacks the lining of my intestinal tract causing ulcers to occur. There is inflammation in the intestinal tract as well as bleeding and sometimes infection. As one can guess this disease can also cause severe amount of pain. Couple with that I have to eat gluten free. I refused the biopsy for diagnosis of Celiac because I could not put myself through eating it for the month prior as the test was going to be months after blood work and a trial to see improvements. So I have not technically been diagnosed however I have been glutened 3 times without knowing and each time thought I was dying of a weird intestinal virus as the symptoms were so bad. So for all intents and purposes I do not eat gluten free because it is cool. Is it a choice? Well I think every food we eat is a choice so yes I choose not to be laying on a bathroom floor in tears for 24hrs after ingestion of gluten. So what does this have to do with intuitive eating? Some people say that intuitive eating is eating to your hunger and fullness cues and eating whatever your body tells you that you want. And yes, on a basic level this can be true but we need to look at the nuance. Over the years of having Crohns disease there have been long stretches of time where I couldn’t eat much fibre. All white flours, only vegetables that were cooked past the point of soft, blended fruit as long as it didn’t have seeds. I can honestly say that I didn’t enjoy eating like this. I made myself eat even when I felt too sick to eat because I knew my body needed nourishment. There was a period of at least a week once where the only thing that did not make me feel terrible were french fries. Yes this dietitian ate french fries for a week….and fyi I am still around to tell the tale. I was so sick one Christmas dinner that my mom had all the same veggies that were in the meal in pureed form for me so I could be part of dinner. Is this what some would say is eating whatever you want and listen to your cues? No maybe not but I will tell you I sure listened to what my body was saying.

Even now I eat what I want, with some planning. 16 years ago I had a bowel resection. I have a narrowing at the surgical site which needs to be dilated every year. I have obstructed on broccoli 3x in my life, each time leading to a few days in the hospital. So what did I learn from those experiences? I can’t eat a lot of fibre at a time (and broccoli is a vile weed!!). So even if my body really does want a salad for dinner I need to think about my meals and snacks earlier in the day. If I had a fruit and a raw veg in the afternoon I know that I can not handle a salad at dinner. If I am not particularly hungry at a meal time I know that I need to eat some but likely avoid fibre to see if it is that I am not hungry or if something is “stuck”. Couple this with making sure what I am eating is gluten free there is a lot of planning that goes into my daily eating plan. I have snacks in every bag in case I get stuck somewhere or am late (always!! late) because I can’t be spontaneous. But would I say I am intuitive eater? Yes. I would also say I am mindful and non diet. Yet I think that there are some that would argue. I eat the way I do with the patterns that I do and (lets be honest here) the rules that I do so that I can feel my best. If I eat gluten I do not absorb from the rest of my food. If I am not aware of my fibre or water intake I can get really sick. If I do not include the foods that have been restricted from me over the years I start to feel bad about my health. Example: I went years without much fresh fruit, so now I am in a place where I can get berries or something daily (Ontario peaches right now YUMMY!) and I will adjust a meal before or after depending on how well my gut is. And to me that is part of being in this community and being a non-diet dietitian. What works for me only works for me. And it will change. I might need another surgery. I might develop yet another autoimmune disease that will effect my eating. Or I might stay in this state for years. I don’t know. We can’t know.

Being a non-diet, HAES dietitian for me is, doing what is best for those around me. Listening to others experiences, and doing all the work…and when I say all the work I mean all the work. Learn about marginalized bodies and identities. Learn about oppression. Take time to evaluate yourself and your work. Have those hard conversations that need to be had. Don’t draw a line in the sand. Compassion- for yourself and others.

And for those of you that say “Intuitive eating is just another set of rules” look for the nuance in those situations, we can’t all eat the broccoli even when we want it.

Until next time be unapologetically you while I be unapologetically me….

Body Image work is life long work....

I have started writing this post multiple times.  I really wanted it to be about back to school and kids and talking about bodies but I keep getting stuck.  I haven't really had that happen before so I decided to check in and see what is up with my brain.  It's not that I am not passionate about what I was planning on writing about.  It's not that I don't think it is important because I really truly do.  And it's not that I don't think anyone would read it...because if I am going to be completely honest I think that with every post I write.  I think it is because I had an experience recently that has been eating at my brain a bit and maybe this is the place to dissect it.  I am going to be be completely honest...I have no idea how this is going to go.  And I really hope I find a point to what I am writing that someone else will find useful.

I am always reading books about body positive work, the politics of bodies and diets and pretty much anything I can get my hands on in this realm.  Recently I just finished "Landwhale" by Jes Baker (which if you have not ready you must!! So vulnerable, so amazing, so enraging) which is a memoir of living her life as a fat female.  So many components of this book were eye opening and having lived with thin privilege my whole life this book told stories that I needed to hear.  It was while I was reading this book that I had an appointment with my specialist for Crohn's disease.  I have recently started a new medication,  is a biological that I inject every 8 weeks and it treats both my Crohn's and Psoriasis.  At my appointment the doctor weighed me.  He does every 6 months and it is the only time I ever get weighed.  I don't decline because I know it is part of disease that my weight can fluctuate based on disease activity and he uses it dose my meds properly.   He made the comment that the meds must be working well as my weight has increased by 10% in 3 months.  Now as a person who spends her life wanting to eradicate fat phobia and make everyone comfortable in their bodies I was super pissed at myself for the reaction of "Seriously?!? Is that right??"  Here I am- a person that is supposed comfortable in their own body having a moment of "no..I did not gain that weight"  I- to be completely honest- don't remember much of the rest of the appointment as I was having an internal struggle with my gut reaction.  This is where I go back to "Landwhale" (READ IT!).  Jes talks about moving away from body love and body positivity to body autonomy.  Meaning that it is unrealistic to love our bodies every day, but we can work to accept that this is our only one.  We can be allowed to not like how they look  or how they are moving through the world- often times because the world is not built for all bodies- but we can learn to get through those moments.  Reinforcing that idea helped me, for a couple of different reasons.  First being that I was so pissed at myself for having any negative reaction to the comment that I was a grumpy ass for a few days.  I questioned all that I have written and said.  I noticed that my pants were tighter (noticed or projected I am not sure) and instead of telling myself to get new ones I had a couple hours (undershooting I think) of mental gymnastics of how to get my body back to what it was.  And I was disgusted with myself.  It was only when I was working on a lecture for school on self compassion that I seemed to snap out of it (not sure that is the right phrase).  My body is healing.  My body is absorbing food- all the food- for potentially the first time in years.  The psoriasis that covers 70-80% of my body is no longer visible or causing me pain.  And I was upset that my butt was bigger!  I sat here staring at my laptop wondering if I was only able to do the work I was doing because I was a "normal" clothing size.  Would or will I be brave enough to do it with a larger body- as the likelihood of my weight continue increase more is probable- or will I fall back into the depths of diet culture and rationalize my behaviour.  I can  honestly say I have never been more pissed off at myself nor have I ever questioned myself so much.  Both of which I think were good outcomes to be honest.  

I look at the work of fat activists, now these are amazing humans.  They not only put themselves out there to help others heal their relationships with their bodies they do it in a time where social media is rampant and trolls are everywhere.  The backlash they receive for merely existing is insane let alone that they live unapologetically in their bodies.  I realized that my message of "bodies need to be accepted at all sizes" is received in a different way because of my thin privilege(which is f'ed up)    This privilege has allowed me to have a voice that I am not sure I fully deserve to have.  (Yet I do believe that using my thin privilege to provide access to more marginalized voices is important and to this I will try to do more).  I want to showcase their work in a way that can bring more light to this topic and the amazing work that they do.  

The other thing that happened when I started working on this is that it became very apparent that this work is never, ever done.  Our bodies change all the time.  They age.  They get sick.  They heal.  And really as long as we have a body that means we are alive that in of itself is amazing!! Which means that one must always be doing the work on their bodies.  We must always be checking in to see what we are saying and thinking about ourselves.  And we must continue to challenge those thoughts and grow with our bodies.  My body didn't need food restriction or increased exercise.  My body needed me to say "heal from years of this disease", "do what you need to do so that I can continue to live my life".  My body needed me to say "thank you for continue to exist".  My body needed me to say "Who gives a flying fuck what you weigh!"

I am always learning, always changing.  I only know my own lived experiences and a bit about others from my learnings.  I feel that this experience opened me up to the realization that more work needs to be done in the world and in myself.  I am not even close to where I want or need to be.  I will continue to work on myself as I hopefully assist others on their body work.  

Until next time...be  unapologetically you while I be unapologetically me

ps....for those of you living in the GTA check out the Nourished Circle Retreat, link at top of page.

Mindful Eating is NOT a diet plan....and stop trying to make it one!

Recently I was shopping in a big box store looking for a birthday card.  For whatever reason at this store the magazine racks are right beside the birthday cards.  While there I noticed a magazine that was promoting itself as a mindfulness magazine and right on the cover I saw "The benefits of Intuitive Eating" as a title.  Excited I picked it up and flipped to the article on Intuitive Eating.   But there wasn't any article with that title- there was an article about mindful eating and the by-line even included it as a step to losing weight.   This bugged me because Intuitive Eating and Mindful Eating are actually 2 separate things (neither is a weight loss plan!) and neither one should ever be promoted as a weight loss plan.  Although similar, Intuitive Eating is an evidence based approach that follows 10 principles around eating (this is a very simplistic overview and not a thorough comparison of the two approaches).  It was created by the amazing (my words for them!) Elyse Resch RD and Evelyn Tribole RD in the 1990's and was revised more recently.  This approach to eating is a non diet approach that allows the person to follow their internal cues with regards to eating and movement.  Mindful Eating is different in the sense that it is used to bring awareness to the present moment.  How the body is feeling, what the mind is saying and how are you reacting.  This as well should follow a non diet approach as one of the tenets of mindfulness is non judgement.  Diets are full of rules and judgments so many rules and judgements.  So back to the article.

(The first draft of this blog had all the points in the article that I thought were diet-y, then I realized that I do not want to promote any diet-y rules as it might be triggering to some so I have removed them.) The article listed all kinds of "often-used-as-a-diet-rule-repackaged-as-a-mindfulness-thought" points.   These points make me angry.  Mindfulness is about being present.  Acknowledging how you are feeling whether that is positive or negative or even neutral.  Yes mindfulness is listening to your hunger and fullness cues but also being aware when you choose to eat more or less and not being judgmental of that.  It is allowing yourself to eat based on your emotions as you are aware of your emotions.  We all eat emotionally.  We have emotions everyday and we eat multiple times therefore we have emotions when we eat.  Mindfulness allows us to tune into ourselves.  Are we eating something that is comforting because we are upset?  Mindfulness allows us to be aware of the fact we are upset and can allow us to address those thoughts.  Mindfulness allows us to eat the ice cream (I know that ice cream is a stereotypical example here but there is a heat wave going on and I am planning on mindfully enjoying a bowl of vanilla ice cream with strawberry jam after I post this) and acknowledge that eating it is a coping mechanism not something that we should feel guilt about.  

Mindfulness allows us to check in and see what it is that will satisfy us.  Do we want something warm or salty, crunchy or smooth?  Do we want to have a variety of flavours or just a few?  Mindfulness is not premeasuring your food to what someone else has determined is an appropriate serving or choice for you.  Mindfulness allows you to be present with yourself and your food.  It is amazing how much more you taste your food when you are not watching a movie, scrolling through twitter and eating all at the same time.  It is not the new "weight loss" plan.  It is not the new plan that will change your life...oh...wait...it will change your life.  But not in the way diet culture tells you it will.  It will change your life by making you more aware of you.  Of your preferences, what makes you feel good and what makes you not feel good.  It will change your life by making you more present in all that you do, with your relationships with your self and others.  And ultimately it can change your life by helping you lose the judgement.  Lose the judgement you have around food, your body and your choices.  Now that is something I can get behind.

As a side note if you are wanting to learn more about Mindfulness and Mindful Eating I have found Fiona Sutherland APD at the Mindful Dietitian http://www.themindfuldietitian.com.au/ and Kori Kostka RD at Mindful Eating with Kori  http://www.mindfuleatingwithkori.com/ have both greatly helped me learn and grow in this area.  

Until next time be Unapologetically you while I be (mindfully) Unapologetically me

PS....any RDs in the GTA interested in attending a day long retreat on Body Image and Mindfulness check out the tab at the top of the page..Nourished Circle Retreat

The day I taught my 10 yr old about diets...

If you follow me on social media you would know that recently I posted a very excited statement that my child didn’t know what a diet was. (It was one of those "OMG look at what my kid did moments"...with her adding "that sentence is Insta worthy...you are weird," to crash me back to earth). After my fist pumping, jump screaming excitement dissipated I realized that I needed to ask a few follow up questions as well as figure out how to manage the next few years of her life now that I had essentially taught my 10 year old what a diet is (my version of diets which may or may not have included an “s” bomb in my description). 

To save the backspace button on my phone (typing this in the car as we drive to a rugby match-parental multitasking at its finest) I am going to refer to my child as E ( the younger is e- smart right?!?)   So this started a few months ago when E was learning about puberty in school, realizing I truly wanted to control the conversation about body sizes and abilities I decided to pick up Sonya Renee Taylor’s book “Celebrating your body! (And all it’s changes) (FYI E and I are going to write a review of the book when we are finished...maybe not so much a review but a gushing post about how you all need to read it.)   I chose this particular book for a few different reasons. I LOVE Taylor’s work-(have you read “The Body is not an Apology” yet?)- as well as loving the diversity of bodies depicted in the pages. So, we were reading it together, stopping anytime E had a question or wanted clarification or to say for the 100th time “ so you get hair where??” when all of a sudden she says “ we need to stop I just don’t understand” I guess my face asked “what?” because she then said “ the books says diets are not good for your body and I do not know what a diet is...so what is it anyways?”  I started to laugh. Which I can tell you that you should not laugh out loud while reading a book on puberty with your child. After dealing with her anger at me laughing (she thought it was at her) I explained that her not knowing what a diet is, is perhaps in the top 5 moments of my adult life.We proceeded to talk about diets, who might do them, has she heard anyone as school talk about diets or needing to lose weight (the answer to that was yes but she said she never wanted to talk about that so often left to go do something else hence missing the details). We had somehow managed to get through the first 10 years of life without learning anything about food manipulation. I reached over and kissed her saying “ you are perfection”. The reply “I know we all are”. In that moment. I had hope. I had hope that this generation might not be getting the same messaging about their bodies as I did. I had hope that people were becoming more aware of how they talk about their child’s body to them. E already talks about everyone’s body being different and embracing these differences. Or was this hope false because I work my ass off to be inclusive off all bodies, abilities, genders, races in all aspects of my work and personal life (and I make mistakes in this area all the time but am trying to learn and grow and show my kids that is ok)

After our talk I sat back and thought about it some more. Yes there is no body talk in the house but there has to be more.  There has to be more than that for her to not really understand what a diet is.  As I thought about it I realized that my stance on body talk has truly helped her be shielded from it.  Pretty much everyone in my life knows my views on bodies, diets and how we talk about these things.  I do think that most people in my life do not talk about their diets or body talk around me (and therefore my kids) because they know that it will end up being a conversation instead of a flippant remark.  I kinda feel like this has helped form a force field of sorts around my kids.  It's not a perfect field and I know that the dark side will likely be able to find a weak spot and weasel in at some point but for now it seems to be working to hold diet culture at bay.  It just goes to prove to me how important it is to talk about our own bodies in a neutral or positive way at home.  How important it is role model these behaviours.  

But diet culture is a shape shifting villain that rivals Thanos (my first Marvel reference??...hmmm) in strength and determination.  I know that it is every where and as they get older they will see it too.  I hope the base that we have been working to build around bodies and how we treat them will hold.  I hope that this base is safe and warm and is comfortable enough to come home to when needed.

In the meantime we have talked more about diets.  I told E what they mean and why people used them.  I talk to her about the culture and how people think that their lives will be better if they lose weight and so they pursue this dream without living their lives in the moment.  We even talked about how people use "health" to fat shame and encourage people to diet.  To which my almost 10 year old looked me straight in the eye and said...." you mean people think that you can determine someones health by looking at them??...That makes no SENSE!!"

And that is why I have hope in the future....

Until next time by Unapologetically you...while I be Unapologetically me..

Body Image starts at birth...

Yesterday I had the very cool opportunity to record a learning module with Kori Kostka on body image and how to bring it into your weight neutral practice (check out her program on "attracting clients to your weight neutral practice" online course...its amazing in my opinion).  I talked all about what I have learned by listening to clients talk about their bodies, my own personal experience of having a body and learning from other amazing practitioners (shout out to the amazing Body Image Workshop that Marci Evans and Fiona Sutherland held...if you are in London or the area please look up their workshop that they are having in fall 2018...I can't recommend more).  Yet after it I was pondering the turning point- the point in life in which our body story changes from one of neutrality or even positivity to one of negativity.  I realize that this point is different for everyone and I don't think it is necessarily a hard turn to the dark side but rather a twirly slide down that can travel at different speeds depending on the environment around it.  I love working with people to get back to that neutral spot of having their body but often times I wonder what can we do know to avoid the slide altogether or make it more like the baby slides at the park instead of the steep spiny metal ones that burn your butt (summer vacation here and lots of time at the park...sorry for lacking creativity in metaphors).

So what can we do in our lives-whether it be work, home. school or with friends to help change the culture around bodies and allow for more diversity without the negativity that I have often seen?  If you have read my posts before you are already thinking..."she is going to say language".  Yes!!  How we talk, the meaning behind words and how we present these words are so important.  Think about if you have even been around a baby.  Everyone (at least in my experience) comments on the "chubbiness" of the baby..."so cute, look at those chubby (insert legs, cheeks, arms).  So in reality-whether the child knows it or not- their body has been judged since they entered the world.  I had spindly babies, and was often asked what was wrong with them.  People assumed they were sick (they weren't) or even worse that as a dietitian I had them on a plan (I sure as hell did not) and even people I didn't know would comment.  This has always bothered me.  I will often question back "why do you feel it is ok to question the body of my child?"  To which my favourite response of all time was a woman who said "you are so rude".  But really...if we assume that it is ok to question bodies from birth then we are placing our child into the diet culture stew without their permission.  Next time you see baby or toddler find something else to comment on but also observe the comments of those around you.  You will start to be more aware of what I am saying here.  I personally find commenting on the giggle or the finger squeeze a great starting off point for many hours of conversation about all smiles, giggles and grip strength without ever once talking about leg size.  

As kids grow often body talk becomes more standard in life.  Great Aunt Gladys will say things like "wow, look how much you have grown!  you are huge now!"  With a big smile as she rushes to hug said child (random side thought- can we stop forcing kids to hug family members or friends?  We take away the right for them to choose what they are doing with their body when we do that.)  This can be a turn on that slide down.  Without intentionally harming, a child could internalize that word "huge".  In society today to "be huge" is not something that is seen as a positive trait.  In fact it is often one that is often stigmatizing.  It only takes a few twirls on that slide to have a downward trajectory.  I watch kids play at the beach or in the pool and they are not hiding or covering their bodies as they play.  They are running, jumping, laughing!  All without the commentary of how they look.  Yet depending on how many turns of that slide they have already done you can see diet culture swirling around them like a smoke.  This is very upsetting to me.  Bodies should be playing free of comments and critique.  If a child wants to put on a bikini do not suggest that a one piece would be better to cover the stomach.  Be a role model and this includes teaching your child to wear what they are comfortable with on their bodies.  Model carrying your body with pride.  Do the fun things. 

It take constant reinforcement not just from you but from others.  Talk to your kids coaches and teachers about how you do not want their bodies commented on- even in what they may perceive as positive.  If you say "you are perfect just as you are..." you are saying they are not if they change.  And they will change, we all change, all the time.  If you as a clinician say " your height and weight are in great proportion to each other" you are also saying that they need to remain on this trajectory to be ok.  Which if we know anything about growth and development we know that it is not linear.  And please for the love of M&Ms do not say "you will get rid of this baby chub when you get taller, just focus on growing up but not changing your weight".  What is that??  I have heard this said more times than I can count and I literally do not get it.  How do we "focus on getting taller??"  Never in all my years of education did I ever hear about the person that willed themselves to 7feet tall.  

Try something new at home to start this process.  This might be a big ask to do something different with yourself, your family, whomever you talk to in the evening but try asking "what amazing thing did YOUR BODY DO today?"  It's not "what did you do today?"  There is an emphasis on the body.  Every day get the little people in your life (and lets be honest it can only help the rest of us as well) to say something positive about their bodies.  EVERY DAMN DAY.  Make it as common as "what made you laugh at school today?"  Help wire those brains to combat against the body talk that surrounds them.  It might seem so small but it will make them think about themselves in a different way.  That their legs were strong enough to run the track at gym.  That their arms were able to swing them across the monkey bars. That their neck was able to support their head when they didn't want to listen to the teacher anymore (credit for that goes to my 6 year old).  Fingers can hold colouring pencils that make art.  Arms can hug those we love.  There are so many possibilities that really have nothing to do with outward appearance.  

Let's work on making this world a tiny bit easier for people and their bodies.  We can all do our part to make sure they get on the baby slide.  Let's start from birth to work on body image so that we don't have to spend so much time undoing the damage that society creates.

Until next time be Unapologetically you while I be Unapologetically me

PS...check back to some updates over the summer....there is a Podcast in the works with an awesome colleague....eekkkk...if you are digging this blog you might like to hear me too... 

Diabulimia

Welcome to the 3rd and final post in my 3 part series on Type 1 diabetes. I am going to put a trigger warning on this article, which is something I have not done in the past but I think I should here.  I will be talking about some of the techniques I have seen in the past to omit insulin as well as other eating disorder type behaviours.  I do think it is important to mention these in this article however please stop reading here if it could bring up too much for you.

In this series started off talking about language at diagnosis and how that could be internalized to create body image issues.  This was followed up by an article about carbohydrate counting and the focus this puts on food.  Finally I am going to write about Diabulimia.  To be honest this is the most difficult one for me to write about as I do not think that are any straight answers with regards to prevention or treatment.  There are however many questions that I think need to be asked and thought about as we see more people struggling with an eating disorder while living with Type 1 diabetes.

Diabulimia is a term that has been used often in the diabetes world to describe someone who is omitting insulin to purge calories.  It is not a term that is found in the DSM IV (Diagnostical and Statistical Manual of Mental Health Disorders) however it is found all over the internet and in books when talking about eating disorders in combination with Type 1 diabetes. 

I have read in the past that women with Type 1 diabetes are 2.4 times more likely to have an eating disorder than woman without Type 1.  They are also 1.9 times more likely to show chaotic eating behaviours.  This stat alone should make us concerned about how we work with individuals with Type 1 with regards to their bodies and eating behaviours.  

 To put it simply Diabulimia means to purge calories by omitting insulin.  This term in of itself is tricky, not everyone who omits insulin has an eating disorder nor does everyone, who has type 1 and eating disorder behaviours, omit insulin.   It takes a fairly detailed assessment by someone who has a strong background in both to determine if a person is experiencing diabulimia and this is where the first issue shows up.  There are not a lot of clinicians that have any experience in both let alone a strong background.  So what are we supposed to do?  Hope they figure it out?? Refer to a new team?? Hire me?? (well if your centre is on a beach today I think that would be a fabulous idea!!)

Let’s start with the omission of insulin.  There are so many reasons for missed doses of insulin that are not related to weight loss, people really truly do forget.  Honestly.  Have you ever left the house and questioned whether you remembered to turn off the stove or brush your teeth?  Life is busy and the brain is going in a million different directions and in my clinical experience insulin is often not the top priority for teens- no matter what the adults in their lives say.  So you would need to determine whether the omission of insulin is to manage weight or if it is one of the million other reasons for missing doses. 

Manipulation of insulin for weight loss is likely one of the very first things a person learns at diagnosis.  No or little insulin means weight loss hence why they lost weight prior to being diagnosed.  Starting insulin meant weight gain.  It is not a very huge step from seeing this at diagnosis and using it later in life.  I have sat across from clients that have outright told me that they manipulate the doses for weight loss.  I have seen HgA1c's (a test that shows what average blood sugars for a 3 month period) skyrocket in the months leading up to prom or a wedding. (A whole other post on sizing in the fashion industry could be written here)  Insulin omission is also a very simple way to purge (meaning eliminating calories by excessive means,  Insulin takes glucose from the blood stream into the cells for energy.  Without insulin glucose gets stuck in the bloodstream or a small portion eliminated in urine)  People are able to eat fairly normally in front of family and friends.  There is not the tell-tail going to the bathroom after eating to vomit or the excessive exercising that can be viewed.  An individual could simply skip the dose of rapid acting insulin that should be given for the meal, pretend to give the dose by shooting it in the sink, push the buttons on their insulin pump but not deliver the insulin or even decrease the dose.   I have found that most parents or loved ones would ever check the dosing because there are no bright red flags for them to.  I have even learned from clients over the years how to use other liquids to "trick" the meter to showing good blood sugar numbers.  All this to say that an individual could be doing this for years before it is picked up.  By then the behaviours are very normalized and entrenched.

Not only will individuals have the effects of eating disorder behaviour (potential for restrict/binge cycles, depression, negative body image, increased isolation...), they will have the side effects of high blood sugars (increased urination, increased thirst, fatigue, irritability...). This is not a combo that makes treatment easy.  Do you start with the eating behaviours themselves, the omission of insulin and adjusting of insulin or do you dive right in with both.  This is where I have no definite answer and I think you need to follow the lead of the client.  As I find myself saying over and over, we need to bring the body into the room.  There is likely a significant amount of body hate in this particular group of clients.  Their bodies have "let them down" by having a pancreas that does not function as it should.  The have endured (sometimes years) of appointments where they are weighed and their insulin sites assessed.  There is a strong probability that they have not found joy in being in their bodies.  As clinicians we need to be aware of that.  Aware of the story.  Sit with them and let them tell you the story of their body, their experience with diabetes, their history.  It is only after that do I think that you can work as a team (the individual, you and any other members you can get involved) to figure out where to start.  Sometimes its having someone else figure out all insulin doses so that the individual does not have to count their food. (Imagine trying to quit "dieting" or being obsessed with what you eat and needing to count the carbohydrates of everything you put in your mouth!) Sometimes its just getting them to give a smaller dose at each meal to start the habit of injecting again then working their way up to the appropriate doses.  (FYI I think most, if not all, Endo's will hate me for saying that....#sorrynotsorry....as in the end I think it will have better long term results). Sometimes it is fighting the rest of the team like hell to realize that this is a slow process and threatening future amputation does not help (I have never found threatening someone helpful and I have seen many many professionals try.  When you tell someone not to touch the red button that says "BOMB"...they usually touch the button..well I would).  

So if treatment is hard and tricky is there any way to avoid it?  Not likely as eating disorders are seen in most populations, i all genders and all ages.  But can we decrease the risk or spot it sooner? I think so.  (Read post 1 and 2 of this series..lol) End body shaming and diet talk at your clinic and in your home.  Talk to others about what they are feeling and thinking about themselves.  Notice if the rapid acting insulin is not running out as much as it used to.  Be aware if someone is losing weight-even if it appears to be intentional.  In reality a kid/teen should not be losing weight they should be growing!  Talk to your diabetes team about weigh in's for appointments and how is makes you or your child feel.  Be aware of....well be aware of everything.  Diabetes demands attention all the time.  24hrs a day 7 days a week.  I think this is part of the reason that the little changes that can lead to diabulimia type behaviours can go unnoticed.    

I have said before and I will say it again.  We live in the stew of diet culture.  It is thick and hard to move around in.  For a person with diabetes its like they are stuck between a potato and a carrot in this stew(not my best metaphor I know but follow me) which makes it even harder to move around.  They have the added stress of a chronic disease that is not entirely visible but never gives them a break and makes them focus on their bodies and their food much more than the average person.  It is hard.  

There are no gold standards for treatment in diabulimia.  There are not a lot of studies on it either.  But I think if we take the stance of body neutrality at diagnosis and assist in developing a positive relationship with all foods the rates of diabulimia may lessen or the behaviours may be caught sooner and therefore less ingrained before helped.

I hope you enjoyed this little series of posts.  I may try this again sometime...

Until next time be Unapologetically you, while I be Unapologetically Me...

 

  

Type 1 Diabetes continuing the conversation with Carbohydrate Counting

Part 2 of 3 in my series of Type 1 diabetes, body image and language.  Today we are going to talk carbohydrate counting...

Over the years in my role as a Registered Dietitian in an exclusively Type 1 diabetes facility I heard many stories from clients regarding their diagnosis and their lived experience with Type 1.  I always felt it was important for them to share their stories with me, if they chose to, because their lived experience with diabetes was different from that of another person’s and very different from what I read in textbooks.(Truly isn't every client different from the textbooks!?!?)  After a while I started to notice that I could almost pinpoint the decade that they were originally diagnosed by the way they talked about food.  Seriously, I could have had a carnival booth for this skill.  The foods they avoided, the way they timed their meals it all told a story of their lived experience with food.  Over the years there has been much change with how food was discussed in the diabetes world but overall I would say it has been very black and white, good and bad.  I would listen to clients say that they had never eaten cake (or cookies, or candy or a freezie) because they had diabetes.  Or that they knew fruit was bad for them (spikes blood sugars!) but that they just loved it.  I would sit there and listen to these stories and my heart would break.  Truly to have never eaten cake on their birthdays….all “because of diabetes”.    We would set goals such as “try a piece (or 2 or 3) of cheesecake”, “go out for ice cream”, “buy myself a birthday cake...and eat it”.  An interesting story that has stuck with me… a person discovered that they didn’t like cheesecake after finally trying it and realized they had spent 20 years being jealous of people eating cheesecake for no reason.

Usually this was where I ask if they would like to be introduced carbohydrate counting.  The idea being that you could count your carbohydrates and do a little math to determine the correct rapid acting insulin dose for that food.  What was most interesting to me was how these clients continued to skip the cake (or whatever foods were deemed bad) because they had spent so many years believing they could never eat that food.  It proved to me over and over again how ingrained these beliefs become.  Shame and fear when used as a motivator to monitor blood sugars and food intake creates negative relationships with food. Full stop...Regardless of disease of state- so why would it be different here.   Even though shame is not as common a motivator now (Or at least I am hopeful that others were at least similar to my experience) I often wonder how we can improve the way we talk and teach carb counting so that in 20 years another dietitian is not sitting there wonder "what the actual F*%^k where they doing in the 2010's?

Carbohydrate counting is currently the gold standard of matching food to rapid insulin.  There are many things wrong with this(in my opinion) but I am not going to address that today.  What I want to talk about is how we can teach carb counting in a way that might help keep a positive relationship with food.

For me this comes back to language (are you shocked..?).  If you read this first article in this series (please do if you haven't...kinda proud of it)  you would have seen how I talked about the language we use around bodies.  Carbohydrates are vilified in popular media. The poor carbohydrate has been tried in the court system of diet culture and is currently living out a life sentence in fad diet hell.   We blame it for weight gain, for acne, for mood, for the weather (I am sure that will come soon) and when you get diabetes it is the macronutrient we talk about the most.  We take all that diet stew you live in and talk about it even more.  And now you have to give your self an injection when you eat it so it physically can hurt you as well.  To top it all off an individual gets reinforcement that carbohydrates cause weight gain because they will gain weight after diagnosis and insulin is started.

If we take a step back, look at what we know about starvation and try to apply it to this conversation.  We know that when a body is starving it will do everything in its power to survive.  A great example is how the body will increase the drive to eat after restrictive eating.  Think of onset of diabetes as the restrictive time and then initiation of insulin as the time when being allowed to eat- on a cellular level not necessarily due to the clients own drive.  When we initiate insulin, and they start to feel better, there is often a dramatic increase in hunger as the body is trying to get all the energy it needs.  I have heard parents say of their children “I have never seem them eat this much”.  *Can we pause here just to reinforce the ideas that this is not the best statement to be saying to your child, teen, any other human...let them listen to their bodies and feed them!*  So back to my point-This can bring fear to the parents or clients themselves as there is a feeling of being out of control around food.  It is during this stage that carbohydrate counting if often taught.  So imagine.  We are teaching how to meticulously focus on food at a time when the body is still in survival mode.   This should come with warning bells.  This should be the time that we pull parents, guardians, partners to the side and explain how they will not help the build a positive relationship with food and carbohydrate counting if they become fixated too.  We need everyone on board with nourishing the body not obsessing over the body.

There are many different methods that are taught to carbohydrate count, I have never seen anyone teach it the same to be honest.  Due to the ability to be more precise with insulin doses now than in the past, I think that many decided it was best to get super precise with carb counting.  (please note I wasn't one of them) Lists of foods with carbohydrate amounts, scales that measure your food and tell you the carb amount- along with all the other macro and micornutrient as if you weren't overwhelmed enough, apps that can be used (for the forces of evil as well), labels to be read.  Often times I would hear that the first grocery shop after diagnosis took 2 hours because they read every label.  Image the stress at picking out cereal.  Instead of thinking "do I want the marshmallow one this week or not you have to read all the labels and to math to estimate a carb amount in serving sizes! All this fixation on carbs- sometimes forgetting that there are other macronutrients our bodies need- at a time when the body is recovering from starvation and parents (if diagnosis is in child or teen) are wanting to gain control.  I think as professionals at this time we need to talk about the micromanagement of food.  We need to be clear that there are many factors that will influence the absorption of food and in turn carbohydrates.  You can do the exact same thing 2 days in a row with diabetes and the outcomes will be different.  The body is so much smarter than the brain and it will do what it needs to do every day regardless of your plan.

As the initial dietitian in a newly diagnosed client you can help shape the relationship your client has with food-FOREVER. I am not trying to over emphasize this but it is true.  Ask any person who has type 1 diabetes and they can likely name the first nurse and dietitian they met or the one that changed their lives.   By using words that do not stigmatize foods such as free foods vs counted foods or saying “this food is bad for your blood sugars” can help.  By taking parents aside and discussing the need to not battle at the table over foods, have a backup plan for when a child refuses the potatoes at dinner that you already gave insulin for, and realize you cannot gain control of what you are going through by controlling the food.  Also to get parents to realize that this child is no different from their other children.  Everyone gets the ice cream or cake or the 2nd scoop of pasta. Type 1 diabetes is a difficult disease to live with (understatement I know).  There are so many factors that influence blood sugars that it is very easy to grasp onto the one that you think you can control the most.  That is why it is so important to create a positive experience with carb counting because it will continue to be the recommended method of dosing insulin until technology figures out how to do it for us.  Which may not be far off....

Until next time be Unapologetically you and I will be Unapologetically me

Type 1 Diabetes, Body Image and Language.

One thing that became very apparent to me when I was at the Body Image Workshop in Chicago with Marci Evans and Fiona Sutherland, was just how much we (RD’s, Therapists, Humans in general) need to work body image into the discussion with clients.  This got me thinking.  Not only does it need to be part of the discussion when working with clients with eating disorders, it needs to be part of the discussion when we are talking to clients in any context.  I think body image work needs to start being considered and perhaps even implemented in various settings.  I think about how diet or wellness culture is so pervasive.  We hear body talk almost constantly everyday- whether in direct conversations, on television shows (do we even call them that anymore if they are made for Netflix random thought), on the radio, in print ads and all over every platform of social media.  That constant inundation of diet or negative body talk can only be highlighted when they get diagnosed with a disease where the body become front and centre. 

Today I want to talk about type 1 diabetes and body image.  I worked in an exclusively type 1 facility for 8 years.  I watched these amazing families work with a disease that is highly unpredictable and very scary.  I also spent those 8 years wondering if what I was teaching to help each child diagnosed survive and grow would harm their body image.  Carbohydrate counting is very important for matching insulin doses to food however this puts a huge focus on carbs.  Kids and teens (my area) could easily link the need to take an insulin shot with the intake of carbs.  No carbs-No shot.  No matter how inclusive of all foods you are as a practitioner or a parent there is still an incredible emphasis on foods.  An individual with type 1 diabetes is recommended to give their rapid acting insulin approximately 15 minutes prior to eating.  This may not seem like such a big deal to some but what we are asking this individual to do is decide how many carbohydrates they are going to eat at that meal- no more no less- (unless they want to give a second shot to cover a second plate or they are on an insulin pump which is a bit different)  In doing this we are eliminating the ability to listen to internal cues- because there could be very dire outcomes if you give insulin for carbohydrates you decide not eat.  It is just another way we are teaching them not to trust their bodies.  And if you look at it from the lens that they probably already feel that way due to having a disease where their bodies “attacked” their pancreas. 

All this and we haven’t even scratched the surface on bodies.  So this topic is going to be a mini series of blog posts that can be read individually or together-this post will be on language around bodies, followed by eating and insulin and lastly diabulimia.  There are many things I wish I could have done better or changed more for my clients in my time at the diabetes centre.  I was still navigating my way around HAES™ in an environment that was not an eating disorder facility and in retrospect wish I had done more to change the diabetes universe (realizing just recently that I still could do this)  however I do think I made some changes or planted some seeds that were helpful and I want to share them with you.  Even if you do not work in diabetes I think that this might trigger some thoughts about your own work.

Language.  If you have read this blog before you know that I am very interested in language and how it lands on the receiver.  Especially how we talk about bodies.  At diagnosis, a kid or teenager will likely lose a fairly significant amount of body weight.  This is due to the physiological effect of starvation.  The body has stopped or is not making enough insulin and therefore the individual’s glucose is not getting to the cells for energy.  This will cause the body to breakdown muscle and fat for energy and will put the body into ketosis.  Due to not having enough insulin in the body to rid the body of the ketones many people will be diagnosed with Type 1 Diabetes when they are in or close to Diabetic Ketoacidosis.  These individuals are also often dehydrated as their bodies have been working to get the glucose out of the bloodstream via urine.  Therefore increased thirst and increased urine output.  All this to say that most bodies are much smaller at diagnosis then they were even a few months ago.  And it is at this point we need to be very aware of what we are saying.

Insulin needs to be injected subcutaneously, meaning into the fat tissue.  Imagine being newly diagnosed with a disease that you do not understand but learning your medicine needs to go into fat and often times these individuals will be told that they are so tiny right now(at diagnosis) that is it hard to find a spot to give the insulin.  In a culture that praises thinness this can be viewed as the best compliment.  Being so thin that it is hard to find a spot to inject.  If a child has been living in a larger body for a while this could be seen as ultimate accomplishment.  This is where I think the language around injections needs to be considered.  I do not think that practionners should be saying “ you can put this injection anywhere you can pinch an inch” or “we will use your butt as it has some good padding” or “ see this chub right here this is a perfect spot to inject”.  I wonder if we actually teach the kids (or parents depending on the age of the kid) what the layer under their skin actually is and why it is there.  What if we got really radical and called it your adipose tissue or the layer of fat under the skin.  By using cutsey names for fat we are again increasing the power of the actual word “fat”. 

The other talking point at diagnosis is weight.  As I mentioned there is often a decrease in adipose and muscle tissue prior to diagnosis which is then followed by an increase once insulin is initiated.  Clients are then often weighed every few days to assess that the insulin is working.  This is where I think education could happen such as talk about set point theory or even something as simple as what is actually being weighed on the scale.  I have personally found many kids and teens surprised to hear that when they are being weighed after diagnosis it helps the educators see that they are becoming more hydrated and getting more muscles.  That the scale tells you nothing about you or your health most times but in this instance it tells me water and glucose are staying in your body.  For whatever reason (DIET CULTURE!!) many kids think that the only thing a scale tells you is how fat you are.  Not how much your bones weigh, or how much the poop in your colon ways (a huge hit with the 6-10yr old crowd) In full honesty, I “forgot” to weigh people quite often but if a doctor demanded a weight I was sure to educate while doing it.  And I do think this helped.  Because as I will talk about in the third part of this series people learn very quickly at diagnosis no insulin=decrease of weight.  Which can then lead to purging by omitting insulin or Diabulimia as it is often referred to. 

Just imagine all this then you now have to live with a chronic disease that requires you to inject yourself daily-often in your abdomen, buttocks or possibly legs.  Well aren’t these every teenagers favourite body parts (yes, even boys the often forgotten group when speaking about body image).  In a social media world where these body parts are glorified when thin and smooth, it can be very difficult to constantly “pinch an inch” to give insulin.  Every 3 months (standard appointment spacing where I live) the diabetes team will ask to see these “sites” and check that they are not “lumpy”.  Again, imagine how this feels.  Imagine having multiple eyes on your midsection when you are already self-conscious.  I think this is why the continued dialogue around body image is so important.  Educators should be asking how clients feel about having so much focus on certain body parts.  We should be asking how this factoring into their self-talk about their bodies.  We should be asking how their bodies are being perceived at home.  I have often wondered if because of the nature of diabetes and the fear parents have, if those living with diabetes feel like their body is never truly their own.  I wonder this because there can be so many people involved in their management. 

Finally, gold standard care for a child living with Type 1 diabetes in Canada is that they see their specialist doctor every 3 months and as part of this routine checkup they are weighed.  I have seen parents standing at the scale ready to record the weight.  I have seen doctors comment on how much a kid is up over the course of the last 3 months.  I have seen kids panic before stepping on the scale. Again to be honest I always did blind weights.  I got very good at measuring a height and a weight at the same time.  Now I wish I had pushed back a bit more and questioned why.  We as a clinic stopped weighing teenage girls as frequently but I think it should have been for all ages and all genders.  My thought behind this is, why make weight such a key thing every 3 months.  Why should it be as important as HgBA1c or a meter download.  Because it’s not.  The weight tells me nothing of kids health.  What taking a scale weight did tell me however, is how much of a focus is on weight in a particular house, but I am not sure that most people will pick up on that information.  When you see a parent panic about the weight on a scale please take that as a sign that there will likely be diet talk (or healthy lifestyle change dressed up in diet talk) in the house. 

Watching how we phrase things regarding diabetes management can go a long way to helping protect our clients from poor body image.  And if you still struggle with these ideas try it yourself.  Be a client in a clinic appointment.  Get weighed in front of the team.  Show everyone your abdomen.  Show everyone your blood sugars and let them guess on your food intake and exercise (next post!) and then rate your body image.  How do you feel?  Now image being a teenager with a changing body and a disease you struggle with.  How do you feel about yourself now?

Until next time be unapologetically you, while I be unapologetically me

Food rules vs curiosity

Last Sunday May 8th, 2018, was International No Diet Day(and Marci Evans birthday How friggen perfect is that!!).  This is a day where we encourage others to let go of dieting and just live.  I have always loved the idea of this day but often wonder how to get the message out the other 364 days of the year.  So instead of writing a post on that particular day I waited until today- only 2 days later- to try to keep the conversation going.  

What if we let go of the rules around eating and just ate with curiosity.  It is amazing how many rules a person can have around eating-without even thinking about what the rules are.  Eating rules can be introduced at a very early age.  Did you ever have to finish all your dinner before you got dessert?  Or were you told at school that your morning snack had to be the "healthy choice".  Even something as innocuous as cereal and toast are breakfast foods only.  The internalization of these food rules only grows when entering the school system.  My experience with my own children in school (presently grade 1 and grade 4) is that foods are taught to be "good" or "bad".  That they should be choosing "healthy choices" instead of "junk foods"  They are being taught a language around food and eating that is very moralistic and can create some very strong food rules going further.  These rules continue to solidify as kids are exposed to more and more adults living in diet culture that are outside their own families.  Rules are reinforced at family gatherings when Aunt such-and-such says "I am so bad for eating this cake" or cousin says " I am not eating that burger because it is summer and I have to wear a bathing suit".  These statements can further create rules that get internalized as "but I like burgers, maybe my body isn't good enough for a swimsuit". Or even "cake is bad therefore I am bad when eating it".  And before too long these kids are teens or young adults with a complex web of food rules that dictate what they eat and how much.

So if we take all those rules then add all the rules about dieting...and really what is a person supposed to eat after all that?  Each diet, wellness plan, lifestyle change all has rules.  They are all about external forces saying when, what and how much you should be eating.  Stand in line at the grocery store and read all the headlines on 3 different magazines- you get enough food rules from those to confuse you for at least a year. You might start drinking green juice, eliminate a food group, don't eat after 7pm but never eat before 6am and that's from just reading the headlines.   And all the rules we learn leads us to the exact same spot.  That you can not trust your body.  You can not trust it when it tells you it wants to eat.  That you can not trust it when it settles at a weight or size you don't want it to.  All of these food rules tell you that you are wrong and they are right and if you follow them you will "live your best life".  Or whatever saying is the diet industry tag line for now.

So what do we do without rules?  Wouldn't there be anarchy?  Wouldn't there be a worldwide shortage on white bread and candy if we just ate what we wanted??  Ummmmm...no.  Trust me when I say I am the last person on earth that would do anything to put m&m's into a shortage.   So instead of rules we could try curiosity.  We could eat what we choose and then ask ourselves "do I actually like the taste of this food", "how do I feel after eating it" or even "did I enjoy this eating experience??".  Food is joy.  Food is pleasure.  Food nourishes us and gets us through this crazy thing we call life.  

Have you ever seen a baby eat?  The way they play with their food?  They mash it with their hands.  They smell it.  They put it in their mouths and let it sit there a bit before they either spit it out or scoop up more.  They are curious.  They are mindful.  They are perhaps more what we should be like as adults than we actually are.  Now before you close off this page thinking I am being silly by saying you should play with your food-think about this.  You do not have to play with it by smooshing it on your face.  Play with it in other ways.  What if you added some spice to a dish.  Or change up an ingredient.  What if you try a totally different entree the next time you went to your favourite restaurant.  What if you did all this without any rules.  Or consequences.  Because when we throw out the rules we also throw out the consequences.  Eating the dessert without mentally calculating how long you need to workout the next day means you get to free up your brain to actually take in the tastes and textures of the cake.  

Try being curious.  Try being mindful.  Try letting go of your food rules-even if you have had them for your whole life.  Try something new.  Try being free

Until next time be Unapologetically you while I be Unapologetically me

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When I met some Body Image Super Heroes

Have you ever heard the saying that you should never meet your heroes as they will just let you down?  Well I met 2 of mine recently- and they did not let me down in any way, in fact they filled me with so much inspiration that I presently feel like I can take on the diet industry and kick it's weight bias, calorie-restricted ass.  

Last fall Marci Evans and Fiona Sutherland announced that they were offering a body image workshop in New York in November.  I madly tried to rearrange my life and finances to attend but in the end it did not work out.  I guess they had such amazing feedback (no surprise really) that they decided to go on a "North American" tour April 2018.  Unfortunately there was not a date in Toronto but there was one in Chicago and one in Boston- both of which are not crazy long flights so I looked up flights and registered. I was going to Chicago.  Little did I know that it would alter me more than I could ever have imagined.  

 I have known for a long time that this area is where my passion lives.  That I want to be a warrior when it comes to bodies- learning to accept on both the personal level as well as reducing weight stigma and bias on the larger scale.  I have been arguing about BMI scales at work, trying my best to make people aware of the language they use and how it affects bodies, adopting a HAES™ framework in my teaching and practices as well following a non-diet approach.  Yet now I feel more prepared to face the world in this space.  Not only was I blown away with Marci and Fiona, I was equally blown away by the other attendees.  I learned so much from the wisdom in that room on those 2 days that I feel like I might burst.

So why is this work important?  Simply put we all have bodies.  Irregardless of how they work, how they look or how they feel- we all have a body.  How we view this body can be informed by so many things: culture, trauma, biological factors, privilege and weight stigma to just name a few.  We all internalize these messages differently and therefore have different experiences.  I have realized that so many people have shame about their bodies.  Shame is felt and it is personal.  It can affect the decisions that are made around our bodies.  Whether we nourish it or move it or take care of it.  Shame can be a driving force to how we see ourselves.  We as clinicians, parents or even just humans living on this earth need to bring shame into the room and acknowledge it as a human experience.  As a parent I need to check in with my kids as to what the internal dialogue of their bodies sounds to them.  What random (perhaps even well meaning) comments about their bodies have made them think differently about their bodies.  I have worked really hard on myself in this area but also work hard with those around us.  I realize as they get older and are exposed to different people in different situations they are going to be exposed to this toxic culture.  I am not sure anyone can go unscathed but I think that we can help build some resilience.  We can start with ourselves and how we talk and treat bodies.  When we say "OMG you look great, have you lost weight?".  That can be heard as " Wow, you looked like shit before good thing you lost weight."  Or "You are perfect as you are right now." However bodies change over time and this sentence basically says that they body is only perfect right now...not when you grow or change or age.  When you say "I can't eat this or I will have to go for a run tomorrow", you are saying that this food can only be eaten if you compensate for the calories later.  This can be internalized by someone as this is a "bad" food.  When medical professionals label bodies as "obese", "overweight" or "normal" we are not taking into account each bodies individual history or genetics.  We all need to be doing this work.  Not just clinicians who are dealing with clients with eating issues for instance.  We all need to do our own work.  Start to acknowledge your own weight bias.  What is it you say about your body and how does that inform the choices you make.  How could this be affecting those around you?  Are you accepting of your body or do you want to change it to something else?  How do you treat your body in this world and how do you view others. 

Now I am not going to lie.  These are huge complex questions that have no simple answer.  We live in this diet culture stew and its messaging surrounds us everywhere we go.  Even the terms "Body Positivity" and "Body Love" have been co-opted by the diet industry (UGH Weight Watchers) leading people to believe that they can "love themselves thinner".  I am not at all saying we need to wake up every day and be in love with our bodies.  I am not sure that is humanly possible.  But what if you woke up everyday and just accepted this was your body without trying to "fix it".  What if you did the behaviours that made your body and your heart and your mind feel good.  The community of practitioners working in this space is growing. I am hoping that it continues to grow so that everyone can have access to someone that can help them work on their body image and self care.    

I am going to be writing a little series on this and some of what I learned.  I want to relate it to Type 1 diabetes as I have worked a great deal in that area and have seen how the language of bodies can really harm how people view their bodies in this world.  I will also relate it to my experiences teaching students who self select into nutrition and fitness industries and therefore I have noticed really struggling with their bodies.

So I am not disillusioned after meeting 2 of my superheroes.  In fact I am even more in awe of the work they and many others due.  I only hope to live up to standard they have sent.  I am posting the pic with Fiona so that it is eternally on the internet (OMG I fan-girled so hard I lacked words).  And I didn't get one with Marci which means I will need to find her in real life again...ummmm can we get a level 2 of this workshop??????

Until next time be Unapologetically you while I be Unapologetically me...

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When teaching BMI...

I was recently asked by a colleague at the college that I teach at, how I thought we should we be teaching Body Mass Index (BMI) so not to harm our students.  First off, I wanted to fly out of my chair and hug her for asking this question.  Second, I thought how do we teach nutrition and health and wellness and weights without harming.  Especially in this day and age.  When everyone in the room has a different story and a different relationship with food and their body.  When I look out at a classroom full of students that have self selected into studying nutrition I know that there are likely many different internalized views on what it means to be healthy and how to achieve this.  We do not know the struggles anyone in our classes are having with food or body.  And we can't assume that nobody in class is struggling.  

I was even more reminded about the diet stew we swim in when giving a class an assignment on diets.  They needed to find a fad diet- (I used to say fad diet but have switched it to diet because they need to realize that anything that has rules or restricts is a diet, fad or not), they research where the diet can be found (in a book, online, in a shop), state the claims, find scientific research to back up the claims- or research at the disputes the claims and compare it to Canada's Food Guide (not perfect but a comparison). Every year -this is the 4th  year I have taught this class with this assignment- I get emails from students pointing out that Whole30 or paleo are not diets- they are lifestyle changes and I should remove them from the list of diets.  Or that they can't find any journal articles to support (insert any restrictive diet here) so they would like permission to quote off the website as it sounds scientific (??).   And every year I am reminded of how strong the pull of the diet industry is.  I try to surround myself with like minded people (or nobody I am friends with talks to me about diets anymore because they were worried about my head with all the eye rolling and forehead slapping). My social media feeds are very carefully curated to include images of all body sizes and non diet inclusive minded feeds, even my podcast selection are mostly the same HAES, non-diet, inclusive podcasts.  I think I really do forget what the "other side" looks like.  I think I forget how radical I sound to these students.  I think I forget that some of them really do think that Whole30 or the diet du jour will make life better and their bodies smaller. 

Which is what brings me back to the beginning of this post.  How do we teach BMI in a way that will not be harmful especially when they are swimming in the diet stew?  We never know the lived experiences of all the people we come into contact with especially when teaching.  When I teach I am considered the expert in the room (I cringed at writing that if you are interested...I do not think I am expert at anything expect myself).  If I stand up there and say this is the BMI, this is how you calculate it, this is what your category is...and leave it at that...what I am leaving there?  Did I just trigger a student into thinking they need to lose weight because they see their BMI in the overweight category?  Did I just put my whole class into a defined box that doesn't account for anything except their height relative to their weight?  So, do I even teach BMI?  Yes, I do.  And here is why.  Even if I do not use it in practice or find it relevant, they will see it in the world.  They will come across it in their work and their lives.  They will be told what their BMI is at doctors appointments or while getting a fitness assessment at a gym.  They will see the chart in magazines or in weighting rooms.  And I want to teach them what that number really means.  I want to make sure they know how the BMI was created, where the categories came from and all the limitations.  I want to teach them that they are so much more than a number on a scale or a point on a chart. ( I would like to take this point to thank Fiona Willer AvdAPD for her podcast "Unpacking Weight Science" (you can find it here https://www.patreon.com/UnpackingWeightScience/posts) and her online course of the same name as Fiona is now giving me even more tools and the proper language to use when teaching about weight. She is on the SheRo list for sure )  I want to teach my students to look at diets critically and use this critical thinking when assessing weights and bodies.  If I can even reach one student in each class then we will continue to ripple out this effect.

So in short- Yes I think we can teach BMI in a way that is less harming but we need to teach where it came from, how we got to using it the way that we do and be very clear about all the things it does not measure.  I need to acknowledge that even though I would erase BMI from the world- I can't. But I can arm the future with enough knowledge to challenge its uses and slowly over time I hope we will not have to be having conversations about how do we teach BMI in a non harmful way, we will be teaching about the archaic why we used to think weight was related to health and this ancient index that makes no sense. 

Until next time be unapologetically you while I continue to be Unapologetically me

 

My spin on Nutrition Month

Happy Nutrition Month (March 2018 for reference)!  It is Nutrition Month here in Canada and I do think other places in the world as well.  Each National Dietetics Association makes a theme for the month to promote a particular nutrition topic.  This year Dietitians of Canada has set the theme of "Unlock the Potential of Food".  There are various handouts you can give out and there are events all over the country to promote this.  (www.dietitians.ca) I would like to put my spin on it for you.

When I think of unlocking the potential of food the thing that comes to my mind is not how can particular foods improve or change me but how can food give me pleasure or even neutrality.  What would it be like if we unlocked the potential pleasure in food?  How does food enrich my life, my relationships with others and myself?  I know that food does not bring pleasure to many.  It is a source of guilt and shame, a source of fear, a source of pain, a source of confusion.  I would like to spend a month (or a lifetime) on that.  Putting food back in its place of nourishing the body, sustaining our lives so we can live our lives.  A thing we need to interact with multiple times a day but doesn't cause us to overthink or over plan.  I want to spend the month talking about those moments when you laugh over a plate of nachos with friends or learn about your kids day over dinner or simply being alone with your food and enjoying it.   

Every morning I sit quietly and drink my first mouthful of coffee and savour it.  I let the warmth fill my body as I let the aromas surround me.  It may be the only mouthful of coffee I enjoy in quiet and alone for my whole day but I make sure it happens most days.  I try to make it more about the enjoyment of the flavours than a device I need to get through my busy often sleep deprived days.  This is where mindfulness comes in.  The smells, the textures, the tastes.  Every meal has an explosion of each- even the most simple meals. 

Finding the pleasure in the foods can be hard for many as we live in a culture that does not necessarily allow us to find pleasure in things.  We use terms such as "I am so bad", " this is devilish", "sinfully delicious" "I only eat clean"(this terms bugs me soooo much)....we put such morality on foods.  Have you ever caught yourself saying " I am so bad for eating this...(insert food here) but I will just (insert whatever you say you will do to compensate for said food)".  Nobody has ever gone to (your version) of Hell or jail or anything for eating a food you enjoy.  If I was sent to jail for every time I enjoyed a "sinful" food unapologetically I would likely be living there by now.  The jail we send ourselves to is in our brains.  We don't let ourselves find pleasure instead we find shame.  Some count calories or macros.  Some workout however much exercise is needed to "burn off" this food.  Some feel like they failed for eating a particular food or way and then this seeps into other aspects of life.  I think that if we find a way to just eat the damn chocolate because you love the chocolate instead of all the negative self talk we do you might actually find the pleasure in the chocolate.  

So maybe next time you find yourself eating try to unlock the potential pleasure of the food.  Slow down and notice the tastes, the textures, the smells.  If you are eating with others maybe you could be so brave as to talk about the wonderful flavours you are eating.  Maybe encourage others to describe what tastes or feelings come of up with that food.  Take deep breaths, relax and enjoy.  Eating can become a pleasurable experience that does not need to be "fixed" later.  Noticing what you are telling yourself while eating can be a first step towards Unlocking this Potential in food.  

Until next time be Unapologetically you while I be Unapologetically Me.

Mindfulness and me

January was mindful eating month as hosted by The Centre for Mindful Eating (https://thecenterformindfuleating.org/ if you are interested).  The theme for that month was compassionate self care.  I had full intent of writing many posts on this topic over the course of the month culminating in a post on January 25th which was mindful eating day.  Well as you can see that didn't happen.  It is now March!  (ummm...so really time really does go faster as you get older!) So now I am revisiting compassion- not just in how we eat but in everyday life.  I have to be compassionate with myself that life got very busy and I had to prioritize.  Compassionate self care is essential when we are looking at our lives- to decrease judgement and shame regarding our decisions-whether it is what we ate or whether we decided that a blog post could go unwritten at present.  When I sit back and look at January and February I can see how work got exponentially busier at a time when it generally doesn't. I can see how unexpected life situations came up and smacked me in the face.   I can see how things got hectic but I made more time for self-care to get through it all.  Not going to lie- I didn't really realize this until I reflected on the last 2 months. 

I have decided to become more mindful this year by incorporating a mindfulness practice into my life (and my kids have joined- 6yr old now asks for his "breathing app" daily... so fun).  Whether it is actually getting back on my yoga mat, a 2 minute mindful breathing exercise or sitting quietly for 5mins in the morning before my day starts I have been doing this most days.  So I was practicing compassionate self care- I just wasn't telling anyone about it...and in today's society if I didn't selfie it did it truly happen?? (A thought for another day)

I have even been incorporating mindfulness into one of the classes I teach.  We have done a couple meditations with heads down and breathing.  But last week I did a mindful eating exercise.  You might have done this in the past with a raisin.  I, however, provided my students with 3 pieces of chocolate (or they could bring food of their own choice to class for this) and walked them through a guided mindful eating exercise.  To be honest I went a bit faster than I find I do in smaller groups (not sure if it was the restless energy they started with or my feeling of being overwhelmed at the moment I started this not knowing the outcome).  This class has 34 students which even though not a large class is the largest group I have ever done guided mindful eating with.  After they went through the exercise I had them sit silently and write a reflection of the experience.  These reflections were an amazing experience for me to read.  Students commented on how they had never really smelled their food before eating.  Many students commented on how  the chocolate tasted different than any chocolate they had every eaten- one even asked if I had it shipped from Europe.  But the most interesting comment I heard, that was written more than a dozen times, was that they did not feel self conscious to eat the chocolate because everyone else was doing it because they had to do it for class.  Many of these comments were followed by something like- "I didn't realize I thought like that".  

This really hammered home for me that mindful eating can help us slow down, enjoy the tastes and pleasures that come with food but it can also make us more aware of all the negative self talk that comes of up when we eat certain foods.  The judgement that we put on ourselves by not "following the plan" or eating a "bad" food.  If we eat anywhere from 3 to 9 times a day that means we have 3 to 9 times a day at least where we could be engaging in negative self talk about our food choices.  That's 3 to 9 times a day that we may be unconsciously doing damage to our mental health and physical health.  

I have been dabbling, for lack of a better word, with a mindful practice for about 12 years now.  I have known how to explain it and even help guide but I have never embodied it.   I am now working on that.  And by working on my mindful practice I can see how much it could benefit everyone.  I have been devouring everything that The Mindful Dietitian, Fiona Sutherland, has to offer.  I am learning from my colleagues at work. I am taking the Motivational Interviewing and Mindfulness course by Nourished Body (Woohoo Kori Kostka!) I have been reading and listening and learning and experimenting.  (I have been doing an exercise with my coffee in the morning before I take my first sip and HOLY SHIT the amazing coffee tastes even better and will always make this grumpy not a morning person smile).  I am trying to be a pebble in a lake with regards to this topic.  I am only one person.  Yet, if I can ripple out the message of mindfulness to my students and my own children, then they ripple out to their families and clients, then they ripple out to whomever they chose- it may take a generation but I believe that this is a key to healing our societies relationship with food and bodies.  

Today I stood in a space that has just been renovated in the office where I do my private practice sessions and I was struck with an almost fully formed idea of a body image/mindfulness based group for kids aged 10-14.  This is my tiny fight back to WW (#wakeupweightwatchers) and it might just be another ripple in the lake that could be part of a movement of change.

So you be unapologetically you, while I mindfully be Unapologetically me....

#wakeupweightwatchers

If you were on Twitter the last week (for reference 2nd wk of February 2018) you might have seen the hashtag #wakeupweightwatchers.  Many of the individuals that work in the eating disorder realm, body positivity/acceptance and HAES™ areas or people who realize that marketing dieting to teenagers is a repulsive idea were trying to put pressure on Weight Watchers ™ to stop their new program.  This program offers teens free memberships this summer to start "the development of healthy habits at this critical life stage" or as I would like to reframe it - "the development of an unhealthy relationship with food that will carry on with them in this critical life stage and beyond".  To be honest the first time I saw a headline on Twitter about it, I stared at it for a while wondering if my brain was officially so tired it couldn't read words any longer.  I mean really....WHO thought this was a good idea?!?!?  And then I thought about it.  Moneymakers thought it was a good idea.  And really, I guess if you take the fact that WW (I am boycotting even writing their name for the rest of this post) has been around for decades and keeps having to change their program to make it "better" (if it really worked long term do you think they would need to keep changing it?) then it makes sense that they want a person signing up at 13 because imagine...the amount of money they will pay over their lifetime in fees (I am guessing there are fees to be treated like you are not good enough as you are).  I mean really...why wait until they are in their 20's and 30's...get them now!!  This means more money (Well they do have to pay the mighty O and I am guessing that's not cheap).  

WW is going after a very vulnerable section of the population.  Teens bodies are changing, growing, developing.  Often they do not have the best relationship with it during this time.  Sometimes they are being raised in houses with grownups that do not have a good relationship with their bodies or food.  So lets make this a family event!  (side note: I am writing this in a coffee shop and I am sighing and pounding my keys and the people beside me keep looking with concerned looks...I kinda just want to say "DIET CULTURE SUCKS!!"...I will let you know if it comes out..)

To be completely transparent I have never been to a WW meeting or whatever they do online.  However it is my understanding- from having clients that have tried this in the past- that there are weigh-in meetings where everyone stands around while you get weighed.  Then you have to discuss why your weight is down or up or nothing changed.  It is also my understanding the the meeting leaders are people that have been "successful" (what does that even mean?!?!) on this plan and want to "help" (eye roll) others.  Let's just think about that for a minute.  Let's put a bunch of self conscious teens in a room and weigh them-in front of everyone.  This makes me want to take a big scale with big flashing digital numbers and go to a WW board meeting.  I would like to have them each stand on the scale that would be in the middle of the boardroom table (my fantasy don't judge..lol) so they have to climb up for everyone to see.  Then the number will be recorded in a little book so that they can compare it at the next meeting.  I wonder if attendance at these meetings would be good.  I wonder if even more chaotic eating behaviours would start the week before the weigh in.  I wonder how many of them would protest that their weight is their business and nobody else's. 

And then after we get judged on our relation to gravity on earth- we no longer call food its proper names.  Let's assign some points to foods so people can work on their math skills???  Why can't an apple be an apple?  Or chocolate cake be chocolate cake??  And call it a "healthy habit"?!?!?!?!  This is where I can't even more annoyed.  This is not a health habit- it is a diet- plan and simple.  If you make your food decisions based on an arbitrary point system instead of what you actually want to eat- it is a diet.  If you restrict foods, or whole food group to follow a plan- it is a diet.  If you have to consult your app to assess whether you are allowed to eat what is on your plate for dinner- IT IS A DIET!   Plan and simple.  This company is marking to the 13-19 year old age group because they know that diets don't work and that they will now get consumers into the diet cycle sooner and therefore make more money.  And they do this by continuing to push diet culture.

What if there were programs that were free and backed by celebrities that helped teens in this age group to trust their bodies.  Listen to their hunger and fullness cues.  Teach them that food is pleasurable and nourishes our bodies and our souls.  What if we had a free campaign that taught teens that their bodies were perfect JUST THE WAY THEY ARE!  What if there were millions of dollars poured into advertising to show that a body size does not equate health.   I realize that it might not be as sexy as changing but if we were able to raise a generation that didn't buy into the diet culture machine.  I truly do not believe in the depths of my soul that a program like this will actually help.  It breaks my heart to think of the path that it puts individuals on.  

If you have any time to do a quick look at #wakeupweightwatchers on twitter please do.  So many great minds have been dropping truth bombs about diets and eating disorders and the effects they have long term.  And if you are feel brave and more eloquent with words than I am please consider @ this company to voice your concerns.  This issue needs voices.  It needs loud amazing voices to get them to reconsider what they are doing. 

Until next time be unapologetically you while I be unapologetically (and angrily) me

Diet Culture makes me angry...

Today is the last day of Eating Disorder Awareness Week- #EDAW2018 here in Canada. The National Eating Disorder Information Centre (www.nedic.ca) and other organizations across Canada have been running awareness building and educational activities to try to educated the public that eating disorders are a serious mental health issue that can affect anyone regardless race, gender, class or body size.  The theme for this campaign was "Was Size Does NOT fit all" and it has been working to dispel the myth that there is only one specific looking body that has an eating disorder.

I really like this campaign- in fact I have loved all of their campaigns since I became aware of the organization in 2001.  (Check out their website..its a great resource) One of the reasons that I have gravitated to this message is because I suspect that many individuals in our society are not diagnosed with an eating disorder because of how they appear on the outside.  I personally have worked with individuals struggling with a restrictive eating disorder but lived in a larger body therefore many medical professionals thought they were lying about their restrictive behaviours.  I also believe that when we allow for personal bias or societies own eating disorder to interfere with diagnosing we can affect treatment or even miss diagnosis.  I was referred a male client once who had finally been referred to a clinic after years of struggling with his eating disorder because his doctor didn't really believe a male could have "eating issues" so spent over a year running tests for other disease states.  I have worked with teenagers who struggled in recovery because intuitive eating in the home conflicted with the parents dieting mentality.  I believe this circles back to societies ingrained fat phobia and diet mentality.  DIET CULTURE. And that is where I think we need to start targeting campaigns.  

What would our culture look like if it was no longer on a diet?  Seriously- think about it.  What would happen if people made food choices strictly based on what made their bodies feel good and what tasted good not what the app on their smartphone told them they should eat today because they didn't balance their "macros" properly at breakfast. Or what some random person told them was "the best way to eat".  What if everyone moving their bodies was strictly doing it for enjoyment and not to compensate for said unbalanced macros at breakfast or as punishment for eating something that brought them joy.  What if peoples bodies were just fine the way they were? OMFG!!  I think I would love this world but if I am being honest I can't picture it clearly.  Diet culture is so pervasive, so insidious that I can't imagine fully what this type of world would look like. And that truly pisses me off.   Diet culture affects everyone, everywhere.  There is not one place I was today that was totally free of it (exclude my house as it is a DIET FREE ZONE 24/7 and if you bring your diet shit in I will politely-the first time- ask it to leave!!)...except maybe my car...no radio today-therefore no "lose xx amount of weight by Valentines Day" just 3 awesome body liberation podcasts...nope I was wrong...I drove by a car that was wrapped in an ad for a fad diet company.  It's EVERYWHERE!  

So how do we break up with diet culture? (middle fingers up??....well thats how I started) But maybe we start with the realization that one size  really does not fit all.  There is not one perfect size of body.  There is not one perfect way to eat.  There is not one perfect way to move.  We all come in various shapes, sizes, colours, abilities and so should our lives.  We can read blogs by amazing humans doing amazing work in this area...(random thought- Maybe I should post a list of the ones I love...ohhhh...yes...that's coming soon).  We can shut down diet talk in the office- "no thank you, I am not interested in hearing about why you think eating like a Whole#CaveManOnAPointSystem is the best thing ever".  We can advocate for spaces that have chairs that actually fit human butts in all their various sized glory(I'm looking at you doctor office waiting rooms...well any waiting rooms and movie theaters and restaurants and anywhere that has a chair).  For those of us that live with some privilege in this life we can use our voices to get the voices of those are that are marginalized heard-trust me they have amazing things to say.  Put on our damn crowns and take down diet culture. (see post called "crown on..."to understand what I mean or visualize any type of crown that makes you happy).  Christy Harrison host of Food Pysch podcast (https://christyharrison.com/foodpsych/)calls diet culture the life thief and I couldn't agree more.  Let's arrest this thief and lock them up for eternity.

Until next time but Unapologetically you while I be Unapologically Me.

Body Betrayal

I have started off 2018 pretty much the same way I finished...trying to catch up.  And one of the things that I have prioritized in my catch up world are podcasts.  I love listening to them as I commute to work and if you have read this blog in the past you have heard me randomly discuss some.  I actually listen to the them at 1.5x speed so I can through them faster...(honestly I was listening at 1.5x forever before I realized I was doing that..I thought it was odd that people talked so fast but got used to it). And it was pounding through all the Body Kindness Podcasts from November 1 until now that I got inspired to write this.  

Body Kindness Podcast is hosted by Rebecca Scritchfield, RDN(she's awesome sauce!) who is also the author of "The Body Kindness Book", which I can't recommend enough for people looking to build a more positive relationship with food and their bodies.  Anyways I have been listening to this podcast for about a year now- I really enjoy it- and starting in August (I think it was) she started having theme months.  I listened to all of "Body Betrayal" theme month in a row and the collection resonated with me more than any collection of podcasts ever had.  So I decided to be brave (continuing this bravery thing from last year....so much more to be brave about I think) and write about my own body betrayal and how it shaped my life in such a profound way that I would never wish my life without it.  

I have written about having Crohn's disease in the past yet I don't think I have ever written about how I viewed my body, my relationship with food and my life with a chronic illness that people can't see. So here it is...how I got angry with my body but found a peace and a fire that I am not sure I would have ever found otherwise.

 I was diagnosed at the age of 20yrs old.  At the time I was finally diagnosed I had been symptomatic for about 5 years.  Even though I knew about Crohn's disease- my Granma Kay had it as well- nobody really thought that is what was wrong with me.  As an anxious teenager my stomach issues were put down to a nervous stomach or avoiding helping with the dishes after dinner.  I didn't realize that most people didn't need to have a bowel movement after each time they ate anything or that my tummy filling up with air to the point of stabbing pain was that odd.   When I was finally diagnosed there was an inflammatory mass in my small intestine so large I was having difficulty bending over to put on my socks.  It was so bad that the tech that was doing by very first barium x-ray said "Dear you need to take your Chron's meds everyday, its not looking good" when my response was "huh...I don't have that"  I was marched directly down the hall by the tech through the waiting room and presented to my new Gastroenterologist who I had yet to meet because I was just doing the initial workup for him.  I remember asking why did I have to get to this point before anyone looked at this...my doctors response "You haven't lost weight".  He went on to explain that many doctors wouldn't investigate this because dramatic weight loss is often seen and I didn't have that.  My weight had been pretty stable for the last couple years hence why the medical community thought it was my mental health not my GI health.  I remember being angry.  Nobody believed me because I didn't look "sick".  This is when the roots for Health at Every Size started for me even when I didn't know it existed....but it still took time.  I was too angry.  I was angry that I had a body that attacked itself.  I had an immune system that couldn't tell invaders from normal healthy cells.  How the hell did that even happen.  That winter everyone kept talking about boasting their immune system and I was thinking how do I kill mine???  My body let me down.  I was just 20.  I was young.  I still had so many things I wanted to do and none of them included waiting in doctors waiting rooms for more tests or appointments or contemplating having parts of my intestines removed or a colostomy!  I wanted to do stupid stuff like get drunk at a club or buy stupid expensive shoes or stay in bed and read all day.  But my body hated itself and in turn I hated it.  I was self conscious to go out because I often needed to go the bathroom- I used to joke that I knew every public bathroom in a 100km radius.  Slowly though something changed.  My "f' you" attitude moved to my body.  Two years after diagnosis I started university for nutrition (which I always feel the need to say I never wanted to do it because of my disease I had wanted to become an RD long before) even though my doctor said they stress would not help me be well.  I pushed on.  During 2nd semester of 2nd year I had 3 feet of my small intestine removed, didn't drop out of school and managed 2 courses through this time.  I was starting to rebuild my relationship with myself.  If I did what I needed to do to stay well (my version of well) then I could pursue all the things I wanted.  It was after my surgery that I was again struck by peoples odd perception of bodies.  About 6 weeks after my surgery- which left me with 36 staples down the front of my abdomen right down to my pubic bone and 30lbs less that my admission weight I was out shopping for new pants.  Waistbands hurt so I was looking for overalls (It was 2002 so lets pretend they were cool then) when the woman helping me in the store made a comment that she would "kill to be thin like me"  My body had just had organs removed but hey lets have that body!  It was there...in the GAP...that I realized size does not equate health, happiness or anything else I had been sold. Fast forward a few more years, many ups and downs (almost 15 colonoscopies, 3 endoscopies, 6 CT scans, 3 MRI's and 3 dilations of my intestinal tract), my body had healed a huge incision but left a "beautifully healed scar" (every doctor tells me this...) and it had gotten me though university and internship...

As a dietitian I struggled with not eating the foods that I thought I was supposed to be recommending.  I felt like a fraud working in an eating disorder program and needing to drink ensure because solid food caused too much pain to eat.  My mom served me pureed versions of Christmas dinner because the fibre in the vegetables hurt.  I ate white...white bread, white rice, white potatoes, french fries, boiled chicken breast.  This was my life.  I missed fruit!  I dreamed of ceasar salad.  And broccoli..let me tell you about broccoli...3x it has sent me to hospital with an obstruction because I ate it then ate more of it...and it got stuck.  Who would ever want to work with a dietitian that lived on a steady stream of peanut butter sandwiches on white bread and pudding?!?!  Yet again my body taught me.  It taught me to enjoy food.  I enjoyed the times of remission when I could eat an orange.  It taught me to listen to my body.  I learned that I could tolerate cooked vegetables and still eat a fruit at the same meal without pain.  It taught me to slow down and taste my food and enjoy the sweet juice in a mango.  It also taught me that my food choices, the ones that I made to make me feel good did not dictate how good I was as a human or a dietitian because I made these decisions to keep me well.

My body taught me empathy during this time, perseverance, strength and resilience.  My body taught me to listen to the stories of others because we don't carry our stories on the outside they are inside sometimes buried very deep.  My body taught me to show my scars- they are part of my story not something to be hidden but something to be proud of.  My body grew 2 humans after being told it never would.  It has run multiple half marathons after it was told it was too weak.  It has gotten to through almost 40 years on this earth.  My body taught me that everyone deserves to have a positive relationship with their bodies because it truly makes life worth living. It is the only body we get.  

But my body decided I needed another lesson.  The second body betrayal I felt was 3 years ago.  I had worked on body positivity in my life and that of my clients.  I was an anti-diet dietitian.  I thought I would never hate my body again...but I did.   It started with a few red rash like dots on my thighs, then spread up to my abdomen then down to my ankles, then up to my shoulders.   I saw multiple doctors before I was diagnosed with auto-immune psoriasis.  Yet again my body attacked itself.  But this time it did it in a way the whole world could see...in August...when it was hot...and I was wearing shorts and tank tops.  I had psoriasis covering almost 80% of my body.  My face was spared but that was it.  It was during this time that I experienced something that I had never experience in my life as a white thin female- people pointed at my body in disgust.  Strangers made comments.  I was asked if I should be in the park with my kids as I may infect others with my skin disease. It was at the high point of my body being covered that I took my kids to an indoor waterpark for a weekend.  I overheard a woman say to another person while in line for a waterslide "does she not realize how gross her skin is, she should not wear a bikini".  At first I looked around to see who she was talking about because I wanted to stand up for this person but then I realized it was me.  People had been moving away from me all day.  Moving chairs, stepping away in line, giving me a wide berth in the wave people.  My kids who were 3 and 6 at the time actually noticed too!  The sad part was is that I didn't stand up for me.  I wasn't sure what to say.  I wasn't sure what to do.  I did nothing.  But it was there. Surrounded by strangers that I moved into my next phase of work.  I do not know what it is like to live in a larger body but my body taught me what it was like to live in a body that people thought was unclean, unhealthy and not good enough to be looked at.  My body showed me what it is like to question whether your mental health can handle taking your body out in public.  My body made me think about times when I didn't go in the pool at a pool party because I was embarrassed to expose my skin.  My body gave me a tiny tiny glimpse into what it must be like to live in a marginalized body.  Please do not misunderstand- I am very aware of my experience is not that of those that face shame and ridicule for just being born a certain colour or size or gender or ability- but it opened the blinds.  It was this that has made me work on how we talk about bodies and present those bodies to others.  It made me a fat advocate.  It made me look at diet culture as a social justice issue.  

My body didn't betray me...my body taught me.  It has given me lessons that I am not sure I would have gotten anywhere else.  It opened my eyes to biases that I had too much privilege to realize were there.  It made me who I am.  And for that I can only be grateful.  Thank you body, my earth suit, for getting me through this world each and every day.  

until next time be unapologetically you while I be unapologetically me.  

A different kind of resolution

As 2017 comes to a close I feel that I have been smacked over the head with "new you" "lose weight and take control of your life!" and " be a better you this year" ads. (Side note we are currently in the south western United States and I feel that this is even more prevalent than at home)  Its everywhere.  Radio ads, billboards, Facebook posts, Instagram stories...everywhere I turn!!  I have heard a few name January "international diet month" and nothing could be more true.  Diet culture goes all in at the start of the year.  Playing up on peoples desire to make this year better than the last- as if losing some (or a lot) of weight will somehow change finances or your family situation or improve your work life balance.  I hate to tell you this- no actually I love to tell you this- it doesn't work.  Studies show that up to 95% of all diets fail long term and that those that do lose the weight have to continue restriction to maintain this weight loss long term.  Most regain all the weight they lost plus some- then comes the guilt and shame. But what if this year instead of a resolution that includes x number of hours at the gym or x number of kilos lost what if this year the only resolution you made was to find some joy.  Find joy in food, joy in movement, joy in quiet, joy in the loud....Just find joy...or whatever your word for that is.  If yoga makes you feel joy try to carve out 5 mins a day (or whatever you can do) to find that joy.  If drinking your morning coffee while it is still warm in peace and quiet (OMG this is the awesomest thing in my world!!) maybe try setting your alarm a bit earlier to get up and enjoy this time.  If you find joy in freshly baked chocolate chip cookies- eat the damn cookie- and instead of saying "I shouldn't eat this" say "I really truly love this".  

I find joy in being outdoors.  I love feeling free with my body, that I am not tied to anyone or anything.  Walking, running or hiking outside fill me up with a peace and grounding that I need.  I need to get outside each day, this is self care for me.  Drinking my coffee while its still hot, snuggling with my kids, eating food that makes me feel nourished and satisfied.  Standing in front of my students and seeing in their faces that they are getting what I am trying to teach.  These are all things that I find joy in.  And there are many more.  I am telling you this to say we do not need to change to find our joy.  

In a world that is constantly telling us we need to change, that we are not good enough, strong enough, smart enough, thin enough- that we are just not enough- it is a radical act to find joy in what truly makes you happy.  So when the clock hits midnight and January 2018 kicks off maybe take a moment to not think of "this is the year I become what society says I am supposed to be" but say " this is the year I listen to myself and just find the joy"

I wish you all the best as we start 2018.  May you find your joy while being unapolegtically you and I will continue to be unapologetically me....