Bone Health for Female Athletes Across the Lifespan

Good bone health affects your ability to stay active and healthy throughout life. However, when female athletes, especially those training for recreational or elite athletic competition, knowingly or unknowingly exercise too much and eat too little, they may be at risk for low bone mass and fractures.

Athletes across the lifespan are at risk for low bone density and bone stress injuries

The incidence of low bone density and stress fractures, is increasing among competitive and recreational female athletes of all ages, and leads to pain and lost time from training and competition. Osteoporosis, a bone disease caused by weakened, porous bone, occurs silently and progressively over time, often with no symptoms until a fracture occurs. It’s currently estimated that one in three women over the age of 50 will suffer from an osteoporotic fracture www.iofbonehealth.org.

Bone is a living tissue that is constantly changing. Nutrition, physical activity, and certain hormones all play a role in the development and maintenance of healthy bones. With adequate nutrients, in particular calcium, Vitamin D, and protein, as well as weight-bearing exercise, most people achieve a peak bone mineral density by their late 20’s. During the normal aging process, both bone mass and bone strength decrease, with increased declines related to the lack of estrogen, such as with menopause or in female athletes with amenorrhea. Therefore, bone disease prevention begins during childhood and adolescence, as well as lessening the extent of bone loss that occurs during the aging process.

Photo courtesy: Shutterstock.com

To optimize bone health, female athletes need to:

1. Consume foods that provide adequate calcium and vitamin D
2. Eat enough calories to support their training
3. Include high quality protein at meals and snacks
4. Participate in strength or resistance exercises that provide an mechanical force on the bone
5. Recognize that menstrual irregularity is a warning sign for low bone mass – and for postmenopausal women, consider having a DEXA bone density scan done to measure your bone density.

The Role of Calcium and Vitamin D

Calcium is an important mineral in the body for maintaining bone strength, regulating muscle contractions, maintaining blood pressure, and transmitting nerve impulses. Most of the body’s calcium is stored in our bones (and teeth); and, without enough calcium each day from the diet, the body will use what it needs from the bone to keep blood calcium levels normal. If more calcium is removed from the bones than is consumed in the diet, the bones may become fragile or weak.

The calcium recommendation for women ages 25 to 50 is 1,000 to 1,200 milligrams per day and 1,200 mg/day for women after age 50. Good sources of calcium include dairy products (milk, yogurt, kefir, and cheese), calcium-fortified juices or plant milks, some types of tofu, certain vegetables (collard greens, kale, broccoli, bok choy), oranges and almonds.

Vitamin D is also vital to bone health as it is needed for the absorption of calcium from the intestines and plays a key role in bone mineralization. The recommended daily allowance is 600 international units (IU) for those women under 70 years of age and 800 IU for those over 71 years of age. Vitamin D is present in only a few foods including fatty fish, egg yolks and fortified foods, like milk and cereal. It is also made in the skin when exposed to sunlight. For those unable to get sunlight or consume sufficient Vitamin D from foods, 2,000 units of Vitamin D daily may be recommended, but you should consult with your doctor before taking any supplement.

Photo courtesy: Adobestock.com

Other Key Nutrients for Bone Health

Consuming enough calories to fuel activity and other body functions is critical. Eating a variety of foods at three meals and two to three snacks throughout the day according to your hunger and fullness will generally meet the energy demands of your sport.

Including a source of protein (lean meat, fish, dairy products, soy foods, beans, legumes and nuts) at each of your meals and snacks will provide the building blocks necessary for building a strong matrix of protein fibers in bone. Achieving peak bone mass during childhood and adolescence, as well as preserving bone mass with aging, is dependent on the body having enough protein available for bone development.

Many other nutrients are needed for healthy bones. Although research is still evolving on their role and benefits, Vitamin K, magnesium, phosphorus, and zinc also have a role in bone health. 

I’m often asked if there is a way to reverse bone loss or if a supplement, like collagen, will help prevent bone loss. There are medications that can help slow bone loss, however these come with side effects. Osteoporosis is not reversable. At this time, there is no evidence to support taking a collagen powder to prevent bone loss. Collagen powders only provide three amino acids that are components of collagen in the body, but there is no way to direct those amino acids to specific tissues in your body (in this case bone) to aid in collagen synthesis. A better strategy would be to consume adequate amounts of high quality protein (such as those foods highlighted above) or include a protein powder that provides the body all of the amino acids (i.e. whey or soy protein).

Bottom line: A food first approach is a superior way to ensure your body is getting all the key nutrients needed for bone metabolism. For advice on customizing a fueling plan, consult a Registered Dietitian who specializes in sports, particularly a Board Certified Specialist in Sports Dietetics (CSSD).

Nutrition and Skin Health: Can You Eat Your Way to Healthier Skin?

The effect of diet on human health has become a source of debate, and perhaps even an obsession in the US. Many beg to know “what foods or diet is best” … to improve overall health, prevent disease, achieve a certain aesthetic look, or optimize athletic performance? But, how does your diet affect the body’s largest organ – your skin?

Numerous factors affect skin health, including genetics, hormones, aging, stress, sleep, and exposure to alcohol, smoking or the sun. Some of these you cannot influence, however, what you eat (or don’t eat) may be one of the most important factors you can influence in modulating the health of your skin.

Most well-known is the impact of malnutrition and nutrient deficiencies on disorders of the skin. For example, malnutrition due to an eating disorder, such as anorexia nervosa, is often observed by significant changes to the skin, i.e. dry, red, itchy and/or inflamed skin, lanugo-like body hair, acne, petechiae (tiny purple, red, or brown spots on the skin), and in some cases, a yellowish discoloration of palms and soles of feet referred to as carotenoderma. It’s well documented that certain vitamin and mineral deficiencies, due to under-eating or malabsorption, are also associated with various dermatological changes, such as the clinical manifestation of pellagra with niacin deficiency, or hyperpigmentation of the skin due to vitamin B₁₂ deficiency.

A more frequent, and perhaps controversial, question is whether there is a relationship between diet and relatively common skin conditions, such as acne. The link between frequent dairy or milk consumption and acne is often referenced, but to date there is insufficient evidence with no high-quality randomized controlled studies to recommend milk restriction as a treatment for patients with acne (Burris, et al. 2013). The evidence seems to be more convincing for a possible connection between the quality and quantity of carbohydrate consumption and acne. Still, by today’s standards, nutritional studies that isolate a food-triggered influence on acne are reportedly costly and difficult to control, thus making it challenging to develop well-defined, evidence based nutritional recommendations (Fiedler et al, 2017). 

Best Foods for Healthy Skin

Foods rich in antioxidants. Antioxidants are chemicals found in foods that fight unstable molecules, called free radicals, that can cause damage to cells in the body. A diet rich in antioxidants is important for the whole body, but antioxidants have an important role in skin health by protecting cells against UV-induced damage which may prevent or reduce dry, wrinkled skin. Beta-carotene, lycopene and vitamins A, C and E are specific nutrients that have antioxidant properties, while vitamin C also helps to make a protein, called collagen that keeps skin strong.

Good food sources include: A variety of colorful fruits and vegetables are rich in antioxidants. Specific foods sources of beta-carotene and vitamin A include carrots, sweet potatoes, red and yellow bell peppers. Foods rich in vitamin C include bell peppers, oranges, strawberries, and tomatoes (also a good source of lycopene); and, foods providing vitamin E include avocados, nuts, seeds, and spinach.

Foods high in Omega-3 Fatty Acids. Omega-3’s provide important building blocks for each cell membrane in the body. Our body is not able to make these essential fatty acids, so they need to be supplied to the body from the foods we eat. Flexible, healthy cells rich in omega-3 fatty acids enable nutrients to move easily into, and waste easily out of cells while helping to reduce inflammation in the body, reducing redness, maintaining skin moisture, and may also help improve the clinical symptoms of psoriasis.

Good food sources include: Fatty fish, such as salmon, mackerel, tuna, herring and sardines; nuts and seeds, such as flaxseed, chia seeds and walnuts; and, plant oils, such as flaxseed oil, soybean oil and canola oil.

Fluids and Hydration. Staying well-hydrated by drinking plenty of unsweetened beverages throughout the day is good for the entire body. So, will excessive water intake have an even better effect on hydration and skin health? The “more is better” philosophy, as it relates to skin and hydration, was explored by Wolf, at al. who concluded that in otherwise healthy individuals, there doesn’t appear to be an improved benefit. However, as often recommended, further research is needed to provide definitive evidence (Wolf et al, 2010).  

Final Thoughts. Although nutrition may be one of the most important factors involved in promoting healthy skin, the link between diet and disease is not always as simple as a single food or nutrient triggering a particular sign that disease is present. For example, dietary restriction or the stress/anxiety induced by worrying that a certain food is “causing” a skin problem may actually be more problematic than any single food item. An individual’s overall dietary pattern (i.e. adequate calories with plenty of fruits and vegetables, whole grains, lean protein and healthy fats) together with lifestyle (i.e., regular physical activity, stress management, not smoking, quality sleep, and low alcohol consumption) take advantage of the additive and synergistic nature of these behaviors to promote healthy outcomes, including healthier skin.

Foods & beverages to prioritize in your meals and snacks:

Vegetables: broccoli, spinach, kale, peppers, zucchini, cauliflower, carrots, beets, etc.

Fruit: berries, grapefruit, oranges, apples, cherries, bananas, pears, grapes, peaches, etc.

Whole grains and starchy vegetables: Sweet potato, quinoa, butternut squash, brown rice, oats, buckwheat, etc.

Healthy fats: whole eggs, olive oil, avocados, nuts, seeds, nut butters, coconut oil, etc.

Plant-based dairy alternatives: cashew milk, almond milk, coconut milk, coconut yogurt, etc.

High-quality protein: salmon, tofu, chicken, turkey, eggs, shellfish, etc.

Legumes: chickpeas, black beans, lentils, kidney beans, etc.

Anti-inflammatory herbs and spices: turmeric, cinnamon, black pepper, parsley, garlic, ginger, cayenne, etc.

Unsweetened beverages: water, sparkling water, green tea, hibiscus tea, lemon water, etc.

Hunger & Fullness: Honoring Our First Biological Instinct

“What are you hungry for?” 

This seems like it should be a simple, uncomplicated question. So, why do so many people struggle with a simple answer? You probably know how this goes! Whether you’re asking your kids, husband, guests, or yourself, we often get the response: “I don’t know!”

We are all hungry for something and there are different types of hunger. There is, of course, physical hunger for food, but too often people aren’t really hungry for food – or don’t know how to recognize their physical cues.

Some people – including kids – are hungry for comfort; others are hungry to fit in or belong; while some are hungry for feeling safe, secure, successful, or happy. Others crave to be the best, to win, or to be perfect. In fact, our tendency to overeat or constantly choose highly palatable treats over a simple piece of fruit (as the above image suggests) limits the opportunity to really figure what you’re hungry for.

Before we dive into this topic, it’s important to understand that there is nothing wrong with enjoying some of our favorite treats or goodies (unfortunately referred to by many as “junk food”). I don’t find this language helpful, nor descriptive of some of these favorite dishes that are often heirloom recipes reflective of time-honored traditions.

I do believe, from personal and professional experience, that it can be easy to get off track from recognizing and honoring our internal cues of hunger and fullness – which are really one of our first biological instincts that we are born with. So my hope is that with a little lesson in terminology, along with some simple nutrition interventions, your awareness of physical cues can be differentiated from other times when food is perhaps being used for another purpose.

What is the difference between hunger and appetite?

Hunger is a physiological need for food.  Appetite is a psychological desire or craving for food or drink, in other words, what sounds good?  Both hunger and appetite determine what, when and why we eat.  At times we are not hungry but have an appetite, such as seeing a dessert after eating a meal. Or, we may be hungry but not have an appetite, such as when we are sick.

Hunger:  “An uneasy sensation occasioned normally by the lack of food and resulting directly from stimulation of the sensory nerves of the stomach by the contraction and churning movement of the empty stomach.” ~ Webster’s Dictionary

What is the difference between fullness and satiety?

Fullness is usually associated with a satisfied feeling in the stomach or, if you overeat, an uncomfortable feeling. Therefore, fullness is a function of the amount of food you eat.  Satiety; however, is feeling satisfied, or not being hungry, that lasts after the initial feeling of fullness subsides.  Macronutrients in the food you eat can influence feelings of fullness and satiety.  For example, while fiber in food may promote a feeling of fullness in the short term; protein and fat have a lasting affect on satiety.

Satiety: “The quality or state of being fed or gratified.” ~ Webster’s Dictionary

How do you know if you are hungry or full?

The ability to use your internal cues to notice hunger and fullness may be difficult for some people and are only noticed until they are strong or intense.  For example, you may not notice the physical signals of hunger because of consumption of coffee or diet sodas. Eventually, you may become “famished”; and consequently overeat, not realizing how physically hungry your body really was.  On the flip side, you may not recognize the feeling of fullness until you feel uncomfortably stuffed.  The following scale is designed to help you become aware of your internal cues so you can manage your intake.

Why do I feel “full” but not “satisfied”?

Feeling full is a function of the amount of food you eat; for example, the amount of food on your plate also takes up room in your stomach.  However, sometimes it’s not just the amount of foods eaten, but the characteristics of that food that lead to fullness.  For example, the water and fiber content of the foods we eat can all influence fullness.

Satiety is a measure of many factors, most important being the macronutrients (such as protein and fat) in the meal that signal the brain you have had what the body needs.  For example, I could eat a whole plate of lettuce or drink a 20 ounce diet soda.  It will certainly take up a lot of room in my stomach, but shortly you will get urges to eat more because the proper nutrients weren’t supplied.

The impact of individual macronutrients on satiety is typically measured in experimental studies.  From this research, we know that sugar and fruit provide a quick source of energy, but are quickly digested and absorbed, so don’t stay in the stomach as long, compared to complex carbohydrates, fat and protein that take longer to digest.  A food that is reported to have high satiety tends to produce a longer “intermeal” period (a period of time between eating episodes during which an individual does not experience hunger).  Foods containing protein and fat tend to promote longer satiety between meals. There are many other factors, including food temperature, pleasure of food, individual issues such as blood sugar and hormonal response to food, or trying to use food to solve a problem (which it can’t do) that may continue to trigger the urge to eat or not feeling satisfied.

What can I do to better honor my internal cues of hunger and fullness?

Awareness of your internal cues of hunger and fullness is a great first step.  You can do this by using the sample hunger and fullness scale and noticing how you feel before and after meals and snacks.

Following are some additional strategies for helping you increase your awareness of your internal cues:

• Keep a journal. Record when and what you eat along with rating how hungry you are before and after a meal or snack.
• Awareness of emotional eating. Check in with how you are feeling (bored, happy, sad, angry, frustrated, etc.) before you eat.  Are you eating because you are hungry or to “fix” a feeling?
• Include a balance of macronutrients in meals and snacks. Include protein and fat in meals and snacks to promote satiety and decrease overeating between meal.
• Identify and challenge negative beliefs about fullness. A history of dieting often promotes the idea that “fullness” equals “fatness.”  Remind yourself that it is normal to feel “comfortably full.”
• If it seems you are out of touch with your internal cues (i.e. always hungry, never feel full, or never hungry), planning your meals ahead so they are well balanced, and include moderate portions, is vital to help you reconnect and relearn your hunger and fullness cues.

Dr. Susan Albers (www.eatq.com) has a number of resources and books to help individuals improve their relationship with food and eating. Following is an infographic that illustrates a decision tree for discerning the difference between physical and emotional hunger. Beginning to increase your awareness of these difference can be a great first step to reclaiming and honoring our first biological instinct!

Surviving Holiday Meals…Tips for Those with Eating Disorders

Special occasions or holidays often involve family rituals and traditions with food. However, holidays pose unique challenges for people with disordered eating or eating disorders that often disrupt the joyful part of their celebration. For an individual who is preoccupied with food, eating and weight, nearly 100% of the time every other day of the year, these events can feel especially overwhelming when food (especially “forbidden” food) is an integral part of the gathering.

At the same time, with the hectic schedules many people have today, these holiday meals may be one of the few times that a family comes together to eat and enjoy each other’s company.

Learning to manage these social situations involving food may be a critical part to an individual’s path to recovery and finding peace with food, eating and weight.

Following are some tips to help you or a loved one prepare…

Planning for the Meal

Planning ahead may be the key to helping you challenge the anxiety or potential struggles with holiday meals, so you can relax and enjoy good times with friends and family.

Consider how and when the meal will be served. Will the food be served family style or at a buffet? How will that affect your ability to follow through with your meal plan? To prevent overeating or restriction, you may want to ask what is on the menu and decide ahead of time what food fits in your meal plan.

Will the meal be served at your usual eating time, or will you need to adjust your food plan? For example, if the meal will be served later than you typically eat lunch, eating a balanced breakfast and snack prior to the meal event can help decrease overeating.  It’s okay to ask for something you need; and, it’s important to not allow yourself to get too hungry. Eating less all day to “save up” for the party is not helpful. Skipping meals/snacks usually affects productivity, causes poor concentration, more difficulty with problem solving, and increased fatigue. It can also lead to overeating at the next meal or snack.

What will you need for support to be successful at the event? If there are topics or conversations that are especially triggering, it may be helpful to rehearse ahead of time how you will manage these situations. What could you say in response, or would it be more helpful to quietly leave the room and join another conversation?

For some folks or situations, it may be important to have a plan before going home about what you will do for support after the gathering. Bringing home leftovers may not be helpful. Also, know who and where your support people are, and/or have a plan for distractions or non-food ways to comfort or soothe yourself, if necessary.

At the party or gathering 

• Try to sit or stand away from the food table and near supportive people.
• Bring along a dish or food that you enjoy and complements your meal plan.
• Try to eat mindfully and give yourself permission to savor the tasty holiday foods!
• Continue to follow your meal plan for the entire day, and stay well-hydrated by drinking water.
• Eat at an appropriate pace.
• Bring along an item such as an affirmation card, a picture, or a journal for some comfort throughout the day.
• Talk with loved ones about things unrelated to food, weight or the eating disorder.
• Enjoy your relationships and try to reflect on feelings of gratitude for blessings received – remember it’s not just about the food.

AND…Remember to Breathe! Taking slow, deep breaths may help produce a state of calmness and relaxation.

Gather Support!

• Talk to family and friends about what is helpful and what isn’t, i.e. no diet, “fat”, or weight talk.
• Consider choosing a loved one to be your “reality check” with food, to either remind you of food portions or check in with about your meal plan.
• Choose someone to reach out to or call if you are struggling with negative thoughts, eating disorder behaviors, or difficult emotions. Talking to a supportive person ahead of time and letting them know about your concerns and needs may help assure you they are open and willing to receiving your call, when needed.
• Stay active with any therapy appointments or groups you may be attending.
• Discuss your anxiety or anticipations of the holidays with a professional, such as a therapist or dietitian, so they can help you predict, prepare for, and get through any uncomfortable family interactions without self-destructive coping attempts.
• Talk with loved ones about important issues: decisions, victories, challenges, fears, concerns, dreams, special moments, spirituality, and relationships. Allow meaningful themes to be present and allow yourself to have fun (rather than rigidly focusing on food or body thoughts).

Enjoy (and Give Back) with These Non-Food Activities:

• Relax and watch your favorite holiday movie with a close friend or family member.
• Seek out a few holiday craft fairs.
• Go out and look at lights and holiday decorations.
• Attend holiday concerts and plays.
• Baby-sit for someone so they can shop.
• Participate in local charity events to celebrate giving back to the community.
• Find out what’s going on around town. Look in the local newspaper to get fun holiday ideas.
• Purchase or make a gift for someone who is less fortunate than you.
• Enjoy the winter season. Go ice skating, have snowball fights, or make a snow sculpture in your yard.
• Challenge yourself to find activities that don’t focus on food, but instead are about relaxing and enjoying the season.

General Ideas to Keep in Mind:

• Get enough sleep and rest.
• Don’t forget about other coping mechanisms (yoga, deep breathing, relaxation imagery, journal, etc.).
• Choose to move in mindful ways. This might be a good time for a peaceful leisure walk under the stars with a loved one instead of a busy or intense exercise class.
• Flexibility in your thoughts is what you’re striving for. Learn to be less critical in guidelines for yourself and in expectations for others.
• Overbooking and over-stressing yourself will only lead to unhelpful coping strategies. Cut down on unnecessary events and obligations and leave time for relaxation, contemplation, reflection, and enjoying the small but important things in life.
• The holidays come and go every year. You can and will survive!

5 Tips for Managing Emotional Eating

Emotional eating is when an emotion triggers a person to eat, instead of the physical symptom of hunger.

There are many misconceptions about emotional eating.  One of the biggest myths is that all emotional eating leads to overeating and weight gain.  In fact, it is natural to eat for emotional reasons and still maintain your weight.  For example, celebrations with family and friends often include special foods that we have an emotional relationship with.  Having birthday cake with friends, not because you are hungry, but because it feels good isn’t necessarily a prescription for overeating or weight gain.   In fact, a recent study investigated how an individual’s perceptions about eating a food, like chocolate cake, influenced their motivation to maintain a healthy eating plan.  Researchers discovered that those who felt “guilty” after eating a piece of cake were more likely to sabotage their weight loss efforts than those who associated the cake with “celebration.”

So then, what’s the problem with emotional eating?  Emotional eating is a problem when you abuse it.  When a person is out of touch with their feelings and eats to comfort themselves or stuff their feelings down, it can result in overeating.  When an individual engages in this behavior day after day, it is likely to result in weight gain.

Diets and forbidden foods often make the problem worse.  Dieters, or individuals with restricted eating patterns, are typically eating less than they need; less of the foods they enjoy; and, are chronically hungry.  When faced with stress or other emotions, the ability to maintain control of the restrained eating becomes intolerable for the individual who “gives in” and overeats.  In these situations, the individual eats quickly; is distracted; and, is disconnected from his or her internal cues.  Feeling guilty and remorseful, the dieter tries harder to restrict the eating and the cycle continues.

How to stop abusing emotional eating.

1. Identify your triggers.  Keep a mood food diary and track information about your meals and snacks (including unplanned eating), Write down what you are eating, when you are eating, where you are eating, whom you are eating with, and how you are feeling at the time.  Many of my clients strongly object to keeping a journal for various reasons.  Taking time with a nutritionist or other health professional to discuss strategies to overcome  those barriers may be key for you to take the first step in getting control of your emotional eating.
2. Don’t skip meals.  Feed yourself regularly while being mindful of balance, variety and moderation in your meal planning.
3. Eat whole foods.   Eating whole foods that you enjoy, on a regular basis, can help to balance out your mood and provide consistent energy during the day.
4. Develop alternative coping skills to manage your emotions. Take a moment to create a list of activities you can use when emotions run high.  Things like calling a friend, gardening, being outside, reading, and taking a bath are all examples.  Many activities result in the release of the chemicals in the brain that help us feel better.  I suggest that individuals have their list visible and easily available.  When you notice a trigger to use food for comfort, try one of the items from your list.  After 10 minutes, if the food is still beckoning you, try the 2^nd activity for 10 minutes, and so on.  Usually if you make it to the 3^rd activity, you will notice that the urge to eat is less.
5. Try Individual or group counseling. Talking about your triggers and getting support for planning healthy meals and snacks may be the key to making the behavior changes that are needed.

Battling Midlife Weight Gain: The “Perfect” Problem

“Life, Liberty and the Pursuit of Happiness” is an unalienable right we Americans have. For many women experiencing midlife weight gain, the pursuit of happiness seems to have been replaced by the “prison of perfection.”

I’m often asked by women who are experiencing symptoms of the menopause transition what’s the secret to the “battle of the bulge” – you know that increasing waistline that never used to be a problem? My answer is that the key to success is about making appropriate lifestyle changes that manage the effects of aging and declining hormones (keep reading to learn more about those). I know, I know! Not a very sexy answer, especially for the woman who is desperate and has already made significant attempts at “eating well” and “exercising regularly.”

The problem, I learn after more questions, is not just about what she needs to do to stay healthy through her midlife transition, but really this: “what’s the perfect diet to get thin/stay thin (you know like I was in my 20’s)… and remain ageless?” After all, we’ve been bombarded by messages from media, marketers and society that have seemingly convinced us that “healthy and happy” is found in perfection – the perfect body, job, husband, house, kids, food, skin…

Consider the fact that the number of cosmetic procedures using Botox (botulinum toxin which is a neurotoxic protein produced by the bacterium Clostridium botulinum) have increased a whopping 750% from 2000 to 2014, according to a report from the American Society of Plastic Surgeons. Somehow, cosmetic surgery and these types of procedures have become “normalized” for remaining ageless. We’ve become convinced that challenging the imperfection of aging is the key to happiness.

In fact, the battle with midlife weight gain may actually be a “perfect” problem, as well. The struggle many midlife women have over gaining a few pounds during the menopause transition can become quite intense; resulting in restrictive eating, diet cycling, disordered eating and excessive, compulsive exercise…if not a pathological eating disorder.

“The perfect problem,” according to Margo Maine, PhD, in her book Pursuing Perfection: Eating Disorders, Body Myths and Women at Midlife and Beyond, “promotes the myth that we can find life’s meaning and the answer to every challenge in the shape of our bodies.” Dr. Maine’s book eloquently points out that midlife women are not immune to the cultural pressure to attain a perfect body and may mistakenly underestimate the power of dabbling in pathological behaviors like these. She challenges the reader to many questions, but this one stood out to me:

“When was the last time we were part of an all-woman conversation where no one brought up weight, food, or personal appearance?”

Okay, time out. I’m a born and raised perfectionist, so I’m not here to throw any stones. In fact, my perfectionism has been a gift in many ways – pushing me to academic achievement, career success, and fiscal and financial stability. But, sadly it also got me into a lot of trouble (a prison as Dr. Maine refers to in her book), especially in my 20’s and 30’s as I sought out to have the perfect body, house…you know the list. I was desperate. Desperate to fit in at a time when I didn’t really know who I was. Without going into the gory details, the point is that no matter how hard I tried, it never felt “good enough”.  Someone else always had “it” better. Let’s just say my 30’s didn’t end well.

I’ve come a long way since those days (with a lot of hard work, therapy, faith, and good family and friends), thus the reason I am passionate about helping women of all ages feel confident and at peace with food, exercise and weight – no matter what their size. I want women to know it’s okay to age imperfectly! You are not your body. Wrinkles are normal. Skin will sag. Fat prefers to be stored in the belly after menopause… and, this: “There is no greater power in the world today than the zest of a postmenopausal woman.” ~ Margaret Mead.

So, do we just need to surrender to mediocrity?  Absolutely NOT!

Don’t get me wrong. I want to age as healthfully and gracefully as I can. I want to be strong, energetic and healthy enough to bike the country, travel the world, and chase grandchildren around. The difference is that the pursuit of health is different that the pursuit of perfection. Getting sucked into following the latest trends with food, exercise, skincare, surgery, etc. actually contributes to more stress and anxiety. There will always be something better. Something more “right” and the cycle just continues. Ultimately, none of these behaviors will help you achieve those important life-long goals.

So, the point is this: Do we need to give in to the multi-billion dollar diet, supplement and cosmetic industries – who are working hard to convince women we aren’t good enough the way we are, by the way – to be happy?

No, we don’t! But, what can we do?

Most people I know and work with want to feel in control. Life often feels out of control, so, it’s helpful to know what we CAN control and know it  will make a difference. Spoiler alert: The following list is not “sexy.” You’ve probably heard all this before. But, here’s the deal. These behaviors DO matter. When done consistently, you can be and feel strong, healthy, confident and energetic.

Stay active. Find things you enjoy doing and participate in those activities daily – hiking, gardening, biking, running, golfing, playing volleyball, and lifting something heavier than a soup can!

Cook at home. As we get older, have more money or even more time, eating out can become an all-too-frequent pastime. Change it up. Invite your friends over, explore new recipes, cook with new foods, or just learn to cook if you need to. We know that eating more nutrient dense (versus calorie dense foods) provides more vitamins, minerals, antioxidants, etc. and helps with weight management and overall health. Eating at home provides more control over what you are eating – saves money and can be a lot of fun too!

Eat more fruits and vegetables. I know this point may sound cliche, but the reality is that over 80% of Americans do NOT get the recommended five servings a day of fruits and vegetables, while 60 to 75% of Americans eat more than the recommended servings of grains and protein. So, it wouldn’t hurt to work on eating more of these wholesome nutrient dense foods which will naturally replace over-consumption of other foods. (What We Eat in America, NHANES 2007-2010.)

Eliminate restrictive eating and diet cycling. I can’t say enough about this. But whether intentional or unintentional, restrictive eating sends a powerful message to the body to become very efficient with metabolic processes; use less energy; and, store more fat to protect the body from a state of famine. Thus, although weight loss may happen initially, anything you can’t sustain will backfire with weight regain and likely even more weight stored as fat – in the abdomen! Thus the feeling midlife women have that “their old tricks don’t work anymore.”

Drink less alcohol. Any of the reported benefits associated with alcohol intake are based on drinking in moderation or less than one serving of wine or beer per day and less than three servings at a time. Research demonstrates that women who drink heavily are more prone to central obesity while increasing the risk of breast cancer and cardiovascular disease. Additionally, women at menopause are especially vulnerable to depression, and heavy drinking can just make that worse.

Get good quality sleep. This can be tough for midlife women experiencing shifting hormones that may interfere with sleep. Maintaining a regular bedtime routine and practicing good sleep hygiene (i.e. turn off electronics one hour before bed) may be helpful.

And, let us not forget:

• Don’t smoke – ever. Enough said.
• Brush and floss your teeth regularly.
• Wear sunscreen daily

There is a strong psychological association between taking important steps to take care of yourself and improving body image. For many women, just a week of eating well and regular exercise promotes positive thoughts about their body – even if they didn’t lose weight. There are many reasons for this, but the challenge is to remember that behavior change takes time. Getting support from friends or even a professional, such as a Licensed Psychologist or Registered Dietitian, may be critical to declaring your freedom.

You have a “right” to life, liberty and the pursuit of happiness. Don’t let the “prison of perfection” take that away!

Do Fear-Based Nutrition Messages Really Work?

An old Chinese proverb suggests “It is better to light a candle than to curse the darkness”. The meaning behind this proverb is that in bad times or hopelessness, it’s better to do something – no matter how small – than to curse your plight or misery. Lately, I’m wondering if we need to do both.

I don’t know about you, but although fear-based messages about food and nutrition in media and advertising may be “something” aimed at improving health and wellness, they drive me nuts because of the negative effect these messages have on a significant number of people.

Consider the following statements I’ve read recently: “cow’s milk is toxic”; “sugar and carbohydrate-based foods are the underlying cause of all disease”; “GMO’s cause cancer”; “animal products cause heart disease and death.” Really? We know that for sure?  Of course each of these proclamations is from “an expert” that has something to sell – a book, a diet program, supplements, a blog, endorsements, an industry. So perhaps I feel the need to “curse the darkness.”

Recently, I listened to a highly credentialed food and nutrition expert discuss an important topic related to food, mood and the brain. Initially, I was captivated by the research and science related to what we are learning in the field of neuroscience.

And then it started…the preaching or “nutrition evangelism” (as I like to call it). That idea that it is her “duty” to question and convince everyone – at parties, in the grocery store, wherever – that what they are eating is making them sick; will cause a horrible disease; and will likely result in a pain-filled and shortened life. This is where the “expert” lost me.

Look, I get it. We live in a sedentary and toxic food environment with a lot of choices that aren’t so helpful for achieving optimal wellness – and other choices that are.  And, the reality is that many individuals are truly struggling to navigate this “toxic” environment. But, for the “experts” out there – describe a time you sat with an individual, or group of people, struggling with binge eating, disordered eating, or just their relationship with food, eating and weight?  Have you heard about the pain and trauma people experience when you follow through on your “duty” to proclaim what they have in their grocery cart is “bad”; “will make them fat” and “cause horrible disease?”

Or, how about the latest viral video (interestingly sponsored by Chipotle) that so dramatically describes how horrible the food industry is? So, it’s okay to eat the Chipotle burrito that has the nutritional equivalent of more than 2 meals because their food is from some non-GMO, organic farm? Sadly, this was distributed through a news feed to folks who already struggle with disordered eating.

The reality is that this dramatic, fear-based strategy doesn’t work, as evidenced by most victims of this experience reporting more anxiety and stress; increased cycles of restricting and overeating; more shame, guilt and clinical depression. The truth is that some people may benefit from lowering their carbohydrate intake, replacing cow’s milk, or more carefully considering their selection of foods. It’s likely we all need to move more and “eat more real food.” But, a one-size-fits-all approach is not the answer and catastrophizing the situation doesn’t help anyone and likely causes more damage.

Instead, consider asking yourself the following questions when reviewing health and nutrition information for “something” that may help YOU feel more hopeful with your health goals:

What are they trying to sell me?

Does it sound too good to be true?

Is the message informative or make me feel worried, bad, guilty?

Is the information based on un-biased scientific research?

There are a LOT of different opinions about what is “healthy” and “what is not.” What I’ve heard from my clients is that people need more positive messages based on credible evidence about food and nutrition and how to make realistic lifestyle change, i.e. when choosing fast food, consider wholesome food choices such as a burrito bowl, with tortillas on the side, and make your own reasonable-sized burrito (with leftovers to spare). Only then will people be able to experience the freedom to choose what will work for them; rather than coerced or “bullied” into something that benefits the seller – not optimal wellness.

True or False: It’s Not Good to Eat Carbs After Dark

This question comes up a lot from my clients and from individuals attending my workshops. It seems to have morphed from another myth or food rule that states, “it’s not okay to eat after 7 pm”.

The short answer for both of these statements is False! There are many interesting theories and anecdotal evidence about this idea for weight loss. But, let’s understand where these myths come from and why they seem to work (at least at first).

The “real” problem often begins with over-eating at night when an individual is tired, bored, stressed, or overly hungry. This is especially true for the person who “diets at breakfast, diets at lunch and blows it at night.” By this time, cravings (usually for carbohydrate-containing foods) become very intense and they “give in” to eating, and often overeating, highly palatable, convenient, serotonin-producing, processed snack foods. Food rules, like “don’t eat after 7 pm” provide structure and and a sense of control when the person feels “out of control.”

So, what are food rules? Food rules often develop along with sincere efforts at eating healthy. Having a list of foods that state “eat this and don’t eat that” or labeling foods “good” vs “bad”, healthy/unhealthy, fattening/nonfattening, etc. provide very clear structure for an individual who is trying to lose weight. Basically, when a person can’t trust themselves with their eating and weight, they turn to something or someone else, like a “diet” or an “expert” with a list of “do’s” and “don’ts” that they believe they can trust.

Although food rules are meant to be helpful, they often backfire. When an individual follows a rule like “stop eating carbs at night” or “don’t eat after 7 pm”, and they lose weight, it’s easy to believe that the real culprit to their excess weight was because “carbs are bad” or that “late-night eating leads to weight gain.” Unfortunately, when the real problem of under-eating or emotional eating hasn’t been addressed, the individual will likely “give in” and break the rule. Since deprivation can increase desire, this may also contribute to overeating the forbidden food or eating at the forbidden time.

Subsequently, feelings of guilt or shame result because they weren’t able to “follow the rules” which again leads to more overeating…and more self-doubt. Sadly, the cycle continues when the person tries to regain control with even more “structure” – a stricter diet, more food rules, another “expert”, etc etc.

Most would proclaim they want to stop this food fight, but having unconditional permission to eat (at any time of the day) feels very scary. The only way to reduce fears of food is to discover the root cause of behaviors that may be leading to excess weight gain and develop strategies that address those behaviors. For some, that may be giving themselves permission to eat enough earlier in the day or it may be legalizing food and trusting that a healthy balance is achievable.

In either case, this usually means getting the appropriate support for positive behavior change with food, eating and weight. It may also mean setting aside unrealistic “rules” about weight and weight loss. Learning to trust yourself (and your body) with food and eating, rather than a diet, a food rule or a so-called “expert”, may be the real answer to a nourishing and healthy relationship with food, eating and weight.