EDAW 2019- A reminder ED's come in all sizes

It is Eating Disorder Awareness Week (EDAW) here in Canada, February 1st to February 7th, 2019. The National Eating Disorder Information Centre (NEDIC) is running a campaign stating that “1,000,000 Canadians struggle with an eating disorder- we can’t afford to wait”. The concept being that we need to squash the myths and stereotypes that surround eating disorders and get people the help that they need- and deserve! This stat should be concerning on a few different levels. First being- that is a huge number of individuals diagnosed however I suspect that there are many many more that are not being diagnosed because the medical community continues to have biases around body size and shape which means that people are not getting properly diagnosed and treated. This should be so upsetting to the human race yet I am not sure that it is. Our culture has taught us that our body sizes are our faults. That if we are not working to make ourselves smaller then we are not working hard enough. That if we live in larger bodies our bodies are not worth the same amount of care or treatment. There are so many more people walking around this earth with what could be a diagnosable eating disorder if anyone bothered to listen to their stories. And this is my plea. We need to listen. We need to put the body in front of us in context to their lives, not ours. We need to hear the trauma that their body has endured. We need to do all this without making the assumption that we can assess them just by looking at their body.

Deb Burgard once said “ we diagnose in smaller bodies what we prescribe in larger bodies.” Let that sink in. If you have an emaciated body with a list behaviours you could get an eating disorder diagnoses and access to treatment. If you have a larger body with the exact same list of behaviours you will either get a pat on the back if your weight has gone down or be told you need to work harder. Seriously. This is happening all around us. If you do not look like the Hollywood version of an ED it is harder for you to get a diagnosis. If you broke your leg and you went to the doctor for help and the doctor said “You are doing a great job, keep doing what you are doing as it is obviously working…” I am sure most of us would protest and demand to see another doctor. However we have been trained to have so much shame over our bodies that we do not. Diet culture has made us believe that we need to look a certain way to be normal- normal relationship with food be damned! I have sat with larger body clients that were told they needed to lose weight however are eating so few calories a day that they literally look at me and say “ I guess I am not supposed to eat anything because the doctor says I need to lose weight for my health”. But what is health? If the size of the body in front of me at that point were much smaller there would so much concern- a possible hospital admission, a run of blood work, a check of blood pressure and heart rate. But instead they are told to lose weight for health all the while I suspect that they are not believed when they say that they do not eat very much. This is completely unethical health care.

So what am I proposing?? Listening. Not listening to answer and move on. But really truly listening to the story of the body in front of me. Listen to their lived experience. Listen to how they relate to food and movement. Listen. Not to solve or fix. Not to criticize or deem unbelievable. But to be open minded enough to realize that eating disorders do not discriminate between genders, races, socio-economic status, sexual orientation or body size. They can affect any human that is walking this earth right now. We need to listen so that we can be the best health care providers or supporters we can be. We need to listen so that everyone who is struggling with their eating has a safe place to go to seek assistance. And we need to listen so that everyone can get the treatment and support that they all deserve.

If you are interested in following along for EDAW check the hashtag #EDAW2019 or go to nedic.ca for further information or links.

until next time be unapologetically you, while I be unapologetically me RD

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…

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..

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

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.

summer weather means...

Last Monday was the start of summer here in Canada...well kind of.  It was Victoria Day on Monday or as many call it May 2-4 the first long weekend of the summer.  Which is when I start to believe that we are done with snow and ready for some summer sun.  In fact my family spent Saturday swimming at my brothers house. Watching the kids jump happily in and out of the water brought my brain to the part I dislike the most about summer.  The onslaught of ads and discussions about "getting that beach body" or "get swimsuit ready". I firmly believe that you get a beach body by putting it on a beach and to be swimsuit ready you need to own a swimsuit and put it on.  But I am aware that is not the case for most.  In fact I had a vivid flashback to a picture of myself to a time that I didn't think I was "swimsuit ready"  

For years my mom had a photo in her kitchen window of my brother and I on a family trip to Florida.  I was about 10 or 11- not much older than my daughter is presently- and I was in my favourite blue and pink bikini.  My brother was shirtless in his swimsuit and aviators (everything makes a comeback!) and flexing his arms-likely imitating some wrestler.  He looked calm and relaxed and clearly comfortable hamming it up for the camera.  I however have this weird look on my face as I am clearly sucking in my stomach for the picture.  My arms were at an odd angle as I tried to pull my belly button closer to my spine (thanks Cosmo for that tip).  WTF!! When did I learn to suck it in for the camera.  I honestly do not remember.  I do remember lying to a friend in high school when she asked me why I was sucking in my stomach for that picture.  My response " I wasn't I was just thin"  and the stupid part is that I was thin.  My body was perfectly fine as it was and I was supposed to be enjoying this amazing trip that I got to miss a whole week of school from but instead I worried about what I looked like on the beach.  This is something I do not want for my daughter or son for that matter.  I watch her now, carefree running around in her bathing suit, and I think "how do I protect her from this" (now she is a gymnast-which will be a whole other post someday I am sure)  But I know what I can do at home.  Talk about bodies in a positive way (which we do), not diet (there are no good or bad foods here, just food) and show her that I love my body and I am not ashamed of it (this is likely the hardest one as we all have days this is hard).  So I wear my bikini's- they fit me the best as I am long in the torso and they are way more comfortable than one piece suits(thought why did I feel the need to justify why I wear bikinis?)- without a T-shirt.  Stretch marks from 2 pregnancies, an 8 inch scar down my stomach from a bowel resection surgery 10 years ago, and skin covered in auto immune psoriasis (scars and active ones) be damned.  I need to show my kids (both not just the girl) that my body is fine just the way it is.  And if anyone has a problem with that then that is their problem and societies problem.  Not mine.  And especially not the problems kids need to be facing.

So yesterday to further push myself even further into presenting my body as is, I joined (figuratively as I don't think there is an actual thing to join) the #SportsBraSquad by running in my sports bra.  (Sports Bra Squad was created by Kelly Roberts and documented on her blog RunSelfieRepeat.com)  I am attaching a photo for proof.  Please see that there was no sucking in of stomach.  So to the 10 year old me...nothing you have accomplished in life was because you sucked in your stomach on the beach that day, you accomplished it because you are determined, smart and caring.  And none of that has to do with how you look in a swimsuit

And one final note on my sports bra run.  An elderly lady was walking towards me as I ran on the sidewalk of a busy street.  She signaled for me to stop and I worried something was wrong with her.  She said "You are amazing for dressing appropriately in this heat!! Good job"  and off she went.  Sometimes it just takes a little comment to make you brave enough to take a selfie of your stomach and put it on twitter....and always remember the reverse is true. 

Until next time be unapologetically you while I be unapologetically me....in my sports bra!

International No Diet Day...why not everyday??

On Saturday May 6th it was "International No Diet Day".  This is the day we are to eat without fear and rules.  This is a day to push back against the diet industry when it tells us we are not good enough as we are.  This is a day to eat for pleasure and enjoy our foods.  But why do this only one day a year?  What happened to the other 364 days??

Have you ever watch a baby eat?  They cry when they are hungry and push the bottle or nipple away when they are full.  They do not measure the amount of food they are consuming, they do not say "I've had enough carbs today" or "I was bad-I had the breastmilk"...  They just eat until they are full then they stop.  There are no rules, there is no shaming, there is just eating for nourishment and growth. Interestingly we as a society love a "chubby" baby but also as a society we condemn those that continue to be this size as they age.   There are stats that show that children as young as 5 have established food rules that are for the purpose of weight loss.  I remember the first time I saw that I thought "how does that even happen?"  But then I realized.  Children idolize the adults in their lives, they model their behaviour.  They go to schools where the teachers talk about their weight watchers points openly, they watch TV that has commercials for weight loss programs, they have adults in their lives that go on and off diets regularly- I once had a 6 year old client say to me she was on the "Disney Diet" because they were going to Disney in the spring and needed to be healthier before they left.  We are raising a generation of children that are self conscious of their bodies before they even understand what that means.  And I think this is why we need to stop the diet talk every day.  I want to raise children to realize the amazing things their bodies can do.  Their bodies are their earth suits.  These bodies will take them through everything thing they will do while on this earth and that truly is amazing.

So lets try to make International No Diet Day every day.  That may seem scary and daunting for some but imagine the freedom.  Imagine the freedom of letting go of your rules about foods.  Imagine a world where our children spend their time and energy on projects that bring joy to them instead of fighting with their bodies... Imagine.

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