Friday, January 27, 2012

Saying Goodbye to Your Jeans—A New Perspective on Progress

I bought a new pair of jeans yesterday. For me, trying on jeans is right up there with going for a new bathing suit. No, not particularly positive. In fact, while I love fashion, shopping for clothes and shoes is never anything short of depressing. I can’t find my size shoes in stores (9 1/2 AAAA), and those in catalogues are often fashion failures. My shoulders are broad and my arms long, making well-fitting tops and jackets impossible to find. I’ll stop here; I think you get the idea.

I needed a new pair of jeans. Somehow, a few years ago, I had convinced myself to purchase a pricey pair of dressy jeans, and now I knew it was time to move on. Why? Because every time I put them on, while they looked fine, I was less than comfortable. Maybe knowing the phrase muffin topping had an impact—I just couldn’t get past that visual. And wearing them kept me from fully enjoying my dinners out and my socializing.

So I selected a new pair from a boutique with a limited but fabulous selection of clothes, and picked them (drum roll please) based on their fit and comfort. Yes, they were a size larger than my last designer-type jeans, in spite of my weight remaining the same over these years. And so I bought them.

Jeans were a topic raised in many patient sessions last week. (You thought I only talked about food, eating, calories, I suppose?) Marie, who has struggled with obesity and binge eating disorder for many years, reported her approach to moving on. She was ridding her closet of everything over size 20, as she now comfortably wears an 18, having lost, I forget exactly, but somewhere near 60 pounds (while enjoying such foods as cookies and bagels, I’ll add). The size 20s are really a just in case—I don’t think she truly trusts that her progress is for real, in spite of it being over a year and a half of consistent behavior change with resulting weight loss.

Even more notable was the message I received from Dana, describing the emotions of parting with her old jeans, her anorexic jeans, a remnant of her anorexic self. After discussing her decision to discard a stack of unhealthy-sized jeans, she followed up her session with this note, (excerpted with her permission, below):

I must tell you that when I pulled down my street from my appt with you, the trash truck was at the house before mine... and as I pulled into my garage I watched in the car mirror the big claws grabbing the trash can to empty it into the truck.  My jeans.  I did it.  Lori, I totally did it.  I successfully threw them out.  I'm feeling so mixed about this enormous sudden decision to get rid of those jeans.  I'm so glad I told you I did this, as I originally wasn't going to tell anyone because to me it signifies weakness... I will never fit into those jeans again... I will never be as disciplined as I once was for so many years... I will FEEL now... there will be no more dismissing life... no living in a state of fog and numbing out... no more living passively...I must now be present in life. 
I didn't want to tell you (or anyone) about throwing away the jeans because I feel like I'm a failure and I'm giving up.  Logically I know this not to be true... but the emotional level is a whole other thing.

This feels a little overwhelming right now.  Never did I imagine it would stir this much emotion.  That pile of jeans symbolized so much - probably more than I can comprehend.  All these years (I guess of progress and agonizing work) it took me to build that pile.  The rejects.  What does it mean for me now? The only descriptive phrase I can come up with is sink or swim.  I made the decision to get rid of that pile of jeans that are unhealthy sizes for me.  This means I forfeited the chance to fit back into them, ever again, because they are no longer in my possession.”

“Right this minute I am in the midst of surrendering to better health at a bigger size.  I feel weak, but I also feel a pull to try.  The challenge is to learn how to accept this larger size as a new way of life...”

“I don't like the size I am, but then I was never happy with the size of those jeans I just threw to the garbage...”

“Just a lot of feelings around this.  You're right, maybe it is sort of like mourning…”

Wow. I am so impressed with her action, and her newfound ability to communicate her thoughts and feelings around this. In the past, these would have been masked with either binge eating or restriction. She couldn't have done it without the clarity that comes with nourishment, and, of course, with good counseling. 

 Clearly there’s much more to purging the jeans and buying a new pair. It’s about accepting change, and believing that it’s okay. It’s about trust, that you really have progressed, and you can continue to stay the course. And it’s about getting comfortable, physically—choosing sizes and styles that are appropriate, allowing your self to simply feel good. Maybe it's time to clear out your old jeans.

Your thoughts?

Thursday, January 19, 2012

Colonic Irrigation For Weight Loss?

Colonic irrigation may seem like a positive,
"relaxing"and necessary procedure but...

I’m okay with my weight, and with my body. Most days, that is. But what if I opened my email to find a Groupon that lured me with the promise of feeling better, of losing weight, of being cleaner, healthier? And what if I passed on it the first time, simply ignored it, but received it again, when I wasn’t in my best place? And what if I didn’t have the wisdom to know how I was being played with, manipulated, misinformed, for them to make a buck off me?

I ignored the promise of a cleaner colon and all of its wonders.
That was the first time. This time, particularly after inspiration from Carrie’s post at E-D Bites, I needed to post my rebuttal.

Won’t Colonic Irrigation (and laxatives, and diet pills) solve the obesity epidemic?

Here’s what the Groupon promised:

  • Colon hydrotherapy gently purges digestive tract of debris & toxins to ease chronic pain & restore organ function
  • May kick-start weight loss
  • Noninvasive and relaxing treatment
  • Purges body of impacted debris and toxins
  • Can boost organ function and relieve pain

And the facts?

From Medicare:

“Colonic irrigation is a procedure to wash out or lavage material on the walls of the bowel to an unlimited distance without inducing defecation.  This procedure is distinguished from all types of enemas, which are primarily used to induce defecation. There are no conditions for which colonic irrigation is medically indicated and no evidence of therapeutic value.” Given its uselessness, it is not a covered service. Bummer.

From the Cleveland Clinic 

“While the idea of ridding one’s body of built-up toxins from sugar, alcohol, caffeine and meat is appealing, the truth is that the data supporting colonic cleansing and body “detoxification” have not been studied sufficiently in clinical trials.

Carol Burke, MD, Director of the Center for Colon Polyp and Cancer Prevention in Cleveland Clinic’s Digestive Disease Institute, warns of the hazards and lack of evidence to support these therapies. “There is no evidence to support their benefit; there is only evidence of their complications,” adding that complications may include rectal perforations from colonic irrigation and enema therapy, oftentimes requiring surgery.”

“Twenty past studies about colon cleansing published over the last decade were analyzed by researchers, and found little evidence that the procedure offers any benefits. Instead, a number of the studies noted side effects such as cramping, bloating, vomiting, electrolyte imbalance and kidney failure.”

And really, calling the procedure relaxing and noninvasive? Do we need a visual here to remind us of what the process is? (Sorry, no photos this time).

My reaction might seem targeted to colonic irrigation. But really it’s about being taken advantage of—by the media, by those who ought to know better, and by our own vulnerability. Because products promising weight loss, laxatives and colonic irrigation lying about cleansing our weight away, only cause us damage. We so desperately want to believe, to hope that something will fix our ills, will improve our weight, will help us feel better about ourselves.

We’re bombarded everywhere by media messages—as well as comments from friends and strangers, directly and in overheard conversations—about their latest, their best diet ever. Their solution, found at last, if only for this week.

It comes from people you trust—like your chiropractor, whose hands of gold and makes you feel physically better with his adjustments, perhaps. For a significant contribution to his monthly income, he encourages outrageous products such as 3 day cleanses. 

Yup, several of my patients, including those struggling with bulimia have been victim to the transfer of trust—the belief in the provider who has been trustworthy in some arena of care—but who is damaging in others.

Angie believed she had multiple allergies. What she had was the start of an eating disorder that snowballed into severe restrictive eating and reliance on products her chiropractor sold her. In spite of unhealthy behaviors and food avoidance, she was sold a line of products that contributed to her belief that cleansing was the answer. Her health deteriorated, and by the time she presented to me I knew she needed a higher level of care. Seeing her chiropractor ultimately kept her from following up with her doctor, who might have had the wisdom to see the harm she was doing to herself.

It doesn’t help that we are manipulated at every turn about what is normal and realistic, regarding our appearance. I am not saying that the media causes eating disorders—merely that it influences how we see and feel about ourselves. As we age, skin wrinkles, and hair may gray. Trust me, I know. Weight may fluctuate, as does our level of activity and eating. If we compare ourselves to our younger selves, we may yearn to change. If we look to the photos in magazines and online of individuals our age, we are misguided into believing they are real. 

Please view this amazing video, which lets you in on the secret:

Your Challenge

In this post New Year’s period, have you been challenged, triggered by the pull of diets or diet aids? I’d love to see your responses to the crazy messages you’re enduring. How did you twist it to avoid the pull? What did you say to yourself to come to your senses? Please share via the comments on this post!
And if you need help knowing what something isn’t a wise choice, ask in comments as well! Again, check out E-D Bites post for examples.

Thursday, January 12, 2012

The Hyperbole of Weight Gain—The Problem With Relying On How You Feel.

Do you think she struggles with her size?

“We’ve got a big problem here”, she said, in a most unsettled way. “I’ve gained like 85 pounds”. I’m like a great heifer, no, a large female milking cow—whatever they are called”.  I am F-ing fat, and I can’t fit into my pants, and it’s not good. I’m eating, and now I’m hungry when I wasn’t before, and it feels like I just can’t stop.” Kara was able to sarcastically acknowledge that no, it wasn’t 85 pounds, but certainly 35 or so added pounds gained this one-week period between our sessions.  All while trying to increase her intake, to gain some weight gradually, following a period of weight loss from her already-too-low place.

Hyperbole, and then some, right?  Yet this true story from the past week speaks to a feeling, one that was anything but exaggerated. And I write this to point out how feelings could lead us astray in our attempt to get healthy. Kara’s session was not unlike others I’ve had in my career—in this past few weeks, even—counseling patients struggling with eating disorders and disordered eating.

Following the outburst, I acknowledged that her feeling like she had gained a million (or 35) pounds was real. Yes, it feels different, eating more than her abysmally inadequate diet of past weeks. Her food choices—lots of high fiber whole grains, fruits and vegetables—make it all the more challenging. Their large volume and relatively few calories don’t fit with a need to increase calories. Yet she feels as if she’s eating a lot, too much, in fact.  Oh, and the large coffees throughout the day didn’t help, either.

What’s worse is that once she started to eat more, she got hungrier. As is expected, metabolic rate, and along with it hunger, increases with an increase in food. So while metabolism slows with restriction, it picks back up with refueling. Research confirms it continues to increase (your metabolism, that is) until you hit a healthy weight range. (By the way, it’s also possible to be at a normal weight, eating pitifully little, resulting in a slowed metabolism. Increasing food, in this case, increases metabolic rate and weight may not increase, as calories increase along with metabolic rate.

But even if you know it, it feels scary having your hunger return. “What if it never stops increasing?” “Will I always be hungry, even though I’m trying to eat more?” “Will I ever be able to control my intake once I start eating more again?” The panic mounts.
Don't you just feel like staying this way sometimes?
If you respond to your hunger and honor it, it settles down—if you are eating enough. Sure, you’ll get hungry later—maybe 2 or 3 or 4 hours—and you’ll need to respond to that hunger as well. Otherwise, you may find yourself overeating, having restricted before. Until your signals start working for you, you may simply need to eat on a schedule—eating every few hours.

Back to Kara.

I weighed her. And she did gain weight. But it was only ¼ pound, to be exact. She assumed my scale was broken. I assumed she was serious, since that’s how she sounded. And what concerned me most, was my inability to reason with her in that moment; you can’t reason with someone who is irrational, who is simply responding to her feelings.

 It’s just like trying to reason with a young, underfed child; a malnourished individual is incapable of sensible decision-making and rational thought.

Somehow Kara came to her senses. Perhaps it helped being heard. Maybe the increased eating this week was a boost, allowing her to move from her stuck place, to hear the wisdom of my recommendations. And, finally trusting that rationally, she wasn’t having enough to eat, enough calories, to support her body’s needs.

Perhaps having me acknowledge how difficult, and scary, this whole process is, helped ground her in reality, helped. Rarely do providers describe the negatives of recovery, but I was honest with Kara and acknowledged that it sucks to have to feel.  Being numb—from restricting, binging, disconnecting, really works. It can be quite challenging to start to be present and to feel things you’d rather not be feeling.

Sometimes we really see ourselves
as distorted as this tape measure.
In past years, prior to more intensive treatment, there was no reasoning with her. It’s like a recent 24 year old male patient of mine who couldn’t get past his own food rules, and maintained his vigilance around raw foods, unprocessed foods low in fat, that never provided enough calories for his 6’2” frame. This bright young man was anything but reason-able, rational. That was all lost. It was all about how he felt. At that point, all I could do was recommend a higher level of care, to re-nourish him and restore his brain to allow him to think and act sensibly. Only then can we begin to successfully work together and move forward in recovery.

Last week a patient thanked me for letting her express her darkest, most disordered thoughts. After I listened, I rebutted. She had to hear my counter argument. She needed to see the pros and cons of her feelings—her feeling that she needed to drop some weight, in spite of being in the low end of a healthy weight range, in spite of the consequences on her body, her thinking, and her mood. She accepted my guidance, feeling liberated, and applied it in the days which followed. Because she was healthy enough, like Kara, she was able to come to her senses. Her thoughts helped change her feelings and subsequently her behaviors, and she is turning things around. Nice work!

If you are stuck on how bad your body feels, take a breath, and do a reality check. Is the change as major as it feels? And if so what are the benefits of eating more?  Being numb may feel safe, and change can be overwhelming, but what are the consequences of staying where you’re at, in your unhealthy place? With a supportive team and the right level of care, it’s not too late to move forward.

Tuesday, January 3, 2012

Beyond Glycemic Index and Radical Diets This New Year.

Besides amazing pastries, I do love their tag line!
"You guys eat a lot of pastries", she noted, commenting to my husband, her brother. Not a strange observation, I might add. After all, there were the baked goods from the gourmet shop, purchased Thursday, the croissants—chocolate, sweet-cheese topped with plum, and raspberry-filled, fresh from the St. Lawrence market, and finally the long awaited Dufflet Bakery Dacquoise. Oh, and as blogger NewMe can attest to, part of a slice of a disappointing layer cake on Friday afternoon, which my sister-in-law didn't even know about (until reading about it now, that is). 

I think we were a bit of a puzzle to her. We appeared the same sizes we had been last we saw her, about 5 or 6 years ago. Well, I’m projecting now. We are the same sizes we were then, although I can’t exactly say that’s how we appeared.

Like the rest of the world, she gives a fair amount of thought to food, eating and weight. Expression of guilt regarding her carbohydrate consumption combined with questions about glycemic index of sweets engaged me in conversation, and got me going. I do wonder if I will be invited back!

An endless assortment of breads and croissants--
and happy customers!
I corrected the misinformation that carbohydrate is the culprit in weight gain. As for glycemic index (GI), I shared that a food’s GI has rather limited value in weight control. Defined as the impact of a carbohydrate-containing food on blood sugar, as compared to a standard food (typically sugar or white bread), this value was designed as a tool for helping with blood sugar control. 

GI may impact one’s sense of fullness—generally less processed, higher fiber items have a lower GI and tend to help us feel more satisfied. Yet focusing on GI for weight management has its faults. If anything, taking into account the portion of carbohydrate, a calculation known as glycemic load (GL), would be a lot more useful. Otherwise, foods like carrots come out looking like items to be avoided—which would be quite idiotic, if you ask me.

But truthfully, the GI and GL are overrated for weight management. Why? Because we don’t eat foods the way they are evaluated in the lab, as single items, by themselves. Rather, we eat foods as part of mixed meals, which alters the impact on everything from blood sugar rise, to how quickly food empties from our gut, and our sense of fullness. Perhaps that's more than she, or you, cared to learn about glycemic index.

While staying with my sister-in-law and enjoying having her cook for me, I encouraged using less saturated fat than she would otherwise use. I recommended brushing the homemade blintzes with melted butter, then baking, as opposed to frying them in a pan with a more generous amount of fat. And she did. And everyone loved them. I suggested (only when prompted for my input) use of a non-stick pan for scrambling the eggs—topped with a quick shmear of butter for some flavor; combined with the sautéed onions, the reduced amount of fat in the pan was clearly not missed.

Among the many overwhelming sights at the
St. Lawrence Market, Toronto
I discouraged sweetening the fresh and ripe berry fruit salad—neither with sugar or Splenda—as it struck me as unnecessary.

As for those pastries I mentioned above? I had a sampling of the three croissants, amounting to one whole one, for my breakfast the next morning. Was I tempted to consume them, all three of them, while strolling around the market Saturday? Of course! But was I hungry then? Absolutely not! And I knew I’d enjoy them all the more when I was hungry, and not overwhelmed by the sights and distractions, so that I might savor them.

Our first night, when my sister-in-law served some pastries she selected for dessert, I just wasn’t hungry. After our fashionably late dinner, it was easy to pass them up. Of course I knew it wouldn’t be my last chance to enjoy such delectable items.

Am I treated like royalty or what?
Saturday night, however, I looked forward to, even longed for eating the hand-picked baked goods. Think macaron layers (meringue with ground nuts), filled with buttercream, flavored with hazelnut or cappuccino, covered with chocolate ganache, and topped with a French name I can't begin to appropriately pronounce. It met my expectation, as I vividly remembered these delights before their reincarnation from raspberry buttercream, 6 years back.

Admittedly, I worked out when visiting in Toronto, although I did less than my usual workouts, as we had other things on our agenda to accomplish. And Mica wasn’t there having to be walked.
And no, I don’t typically eat pastries with such frequency in the course of a week. But I can trust that it’s not my only chance to include these delights, so it’s easy to have just as much as I need, and only when I really care for them. 

Remember that carrot cake? Believe it or not, there are still a few pieces remaining in the freezer. Really.

 So don’t be pulled to extremes this time of year, lured by food rules, diets, and radical eating. The New Year shouldn’t mean the end of what you enjoy—be it high glycemic white breads, or great tasting pastries—but a new way of embracing what you truly desire, regardless of your weight. Just do so with respect for your hunger and your fullness, with the trust that it’s not your last chance to eat.