If Not Weight Loss, Then What?

If you read my last past, you know that weight gain during many phases of life is 100% normal for women. For example:

• Girls gain on average 21-26 kg between the ages of 10-16 (CDC Data)

• During pregnancy, the recommended/anticipated amount of weight gain varies, but is generally in the 9-15 kg range.

• During the menopause transition, women will likely gain anywhere from 5-15 kg.

These aren’t failures of control, errors of genetics, or other massive rips in the space/time continuum. It’s biology. Plain and simple.

Yet we fight it (or are taught to fight it) every single step of the way. And it’s exhausting! (And, a bit like pushing the boulder up the hill: pretty endless and defeating).

What if we used all this energy, anxiety, worry, focus, dare I say OBSESSION, with shrinking, controlling, trying to avoid the inevitable that is biology and just, I don’t know, STOP?!

Heresy, right? Unheard of. Because if you’re not trying to change your body, what is the alternative? Do you even care? Have you “given up” or “let yourself go”? Are you going to immediately die of diabetes? HELL NO! But this is what society wants women to think.

So let’s consider what other things we could do with all this energy, time, money. Here are a few ideas. I’d love to hear what YOU decide to do next.

• Move it! Take up weightlifting, masters swimming, hiphop dancing, open-water kayaking, surfing, or just hiking in the forest. Enjoying BEING in your body versus objectifying and shaming it.

• Learn to cook foods you REALLY enjoy! Take a cooking class. Travel to another country and take a local food tour. Learn how to make pain au chocolat, baguettes or eclairs. Have FUN with food!

• Do something creative! Learn to paint, draw, crochet, knit, macramé, sew, throw pottery, play a musical instrument or take voice lessons. Use your body and brain together in a way that lights you up!

• Connect with others. Dieting, restricting food and constantly worrying about what we eat isolates us, makes our lives smaller. Go have coffee (and a pastry!) with a friend. Meet your partner for lunch on a work day. Throw a pizza party with your friends. Make a sundae bar for your kids. Enjoy the heck out of Taco Tuesday. Make plans and see people. I promise, you wont regret this (even us introverts need this!).

• Travel, Explore, Learn. There is so much out there we miss when we’re so inwardly focused, self-monitoring and shaming ourselves. It can be easy to lose perspective and miss the wonder, beauty and energy the world has to offer. Getting out of your day to day and testing your own limits, going beyond your comfort zone - these will all give you more satisfaction and joy in the long-run than any diet can.

So what will you do with this one big beautiful life?

More About Menopause and Weight Gain (Let's normalize this shit!)

Let’s just get it all out there:

The majority of women (50-70%) will gain weight during perimenopause and menopause. Some research indicates that on average women gain approximately 1.5kg per year during the perimenopause transition, leading to an average weight gain of 10kg by the time menopause (12 months after the last menstrual period) is reached.*

There are many reasons that women tend to gain weight during this time of life, including:

• hormonal shifts

• metabolic changes

• eductions in muscle mass 

• changes in activity levels

• stress and life changes (cortisol!)

Some of these changes we can "manage" and strategize around. But some are going to be (far) less in our control. Let’s normalize staying strong and healthy during this time, instead of just trying to stay thin or lose weight. Especially because thin does NOT equal healthy. 

More specifically, here are some reasons why weight loss and a drive toward thinness may NOT be healthy at this time of life:

• Decreased bone mass —> increased risk for osteopenia/osteoporosis, falls, fractures

• Excessive muscle loss —> increased risk of insulin resistance & type 2 diabetes, falls, lack of mobility

• **Fat (in moderate amounts) is often considered cardio-protective. (Peri-)Menopausal women are at much higher risk of heart disease due to the loss of estrogen. Fat cells, especially those around the midsection, produce a (tiny) bit of estrogen, which can be protective.

• Increased risk of developing an eating disorder. (These can occur at any time, in any gender, but are increasingly common in women in their 40s and 50s).

• Diet cycling (frequently losing and regaining weight/constant dieting) itself can lead to increased inflammation; increased risk of insulin resistance, osteoporosis and muscle loss; decreased metabolic rate; and long-term weight gain. (In fact, the single biggest predictor of future weight gain is dieting!).

This doesn’t mean we need to just stop caring about our health or otherwise throw in the towel. It just means that weight loss isn’t necessarily the key to health, and may in fact be problematic.

My recommendations:

• Focus on habits versus the number on the scale. Aim for your 5 servings of fruit and veg daily, get 2 liters of fluid and 7 hours of sleep each day/evening, eat plenty of protein (1.2-1.5 g/kg body weight) and whole grains, move your body regularly (at least 30 minutes a day), add in some weekly strength training and high intensity interval or sprint training. For extra credit: add in plyometrics and jumping for bone health!

• Talk with your doctor and your dietitian for a customize healthcare and nutrition plan that fits your unique needs (one size definitely doesn’t fit all!).

• While body “love” at this age of life can be a struggle, aim for acceptance. We cannot turn back the clock nor should we want to. Try to find ways to feel good versus just focusing on outward appearances. This is your time to shine!

Good stuff to read:

*The British Menopause Society

* Adverse Changes in Body Composition During the Menopausal Transition and Relation to Cardiovascular Risk: A Contemporary Review

**Feisty Menopause, “The Health Benefits of Healthy Body Fat”

Menopause and Weight Gain: What the F*#k and What You Can Do.

ORIGINALLY POSTED FEBRUARY 2019, UPDATED AUGUST 2021

Ok, let’s be real. I’m 53 and most of my pants don’t fit. I am not thrilled with this turn of events. Not because I’m super body conscious per se, but because new wardrobes are expensive! Over the past 5+ years I’ve noticed a real change in my body, how my weight is distributed, my energy levels and my post-workout recovery time. These are not fun changes. And frankly, I’m a bit pissed off.

As a healthcare professional, you might reasonably think I would have all the answers, but I don’t. And that makes me even more cranky. But rather than just sulking and eating chocolate by the handful, I decided to do my research and try to get on top of all of this. So this is my little love letter to all of you ladies who are also going through the joys of perimenopause (“the menopause transition”) or are recently post-menopausal (e.g. you’ve not had a menstrual period for over a year). Because dammit, people don’t really talk about this enough!

Body Changes & Weight Gain : Seriously, what the hell?

Changes in hormonal levels cause a bunch of cascading reactions in our bodies starting anywhere around ages 45-50, and for some individuals, even earlier. Plummeting (though often, hormones rise higher than normal before making a cliff dive to super low levels) levels of sex hormones estrogen, progesterone, testosterone wreak havoc on myriad issues and tissues in our body.

As hormone levels fall, our body tries to compensate, because estrogen is critical to bone health, managing our cholesterol level and helping to regulate mood, body temperature and libido.

Thus, fat cells become an increasing source of circulating estrogen - especially abdominal fat cells. Yes therein lies part of our midlife, midbody weight gain. And, unfortunately these fat cells are not all that efficient at estrogen production, so fat accumulates in ongoing efforts to compensate and protect our bodies from bone loss, high cholesterol and increased risk for heart disease.

Metabolism also shifts during the menopause transition, though it’s not exclusively linked to hormonal shifts. As we get older, our metabolic rate slowly starts to wane. Our body muscle mass starts decreasing after age 30 (yes, you read that right!), where we lose anywhere between 3-5% of our total muscle mass each decade. Muscle requires a few more calories than fat to maintain, so as we lose muscle, our body’s calorie burning furnaces also slow down. (Note: For some mind blowing new science on the topic of metabolism and aging, check out Abby Langer RD’s August 2021 post on a recent study that sheds new light on the phases of life where our metabolism shifts. It’s not exactly as we once thought!).

It also turns out that in menopause, your body tends to burn less calories and less fat doing the same exercise it used to (truly unfair). And, our body’s rate of fat oxidation (where our body breaks down fat) is also reduced. Additionally, as we age, we often lose flexibility and our recovery time following hard workouts is a lot longer. We just don’t physically bounce back the way we once did. This can mean we exercise less or not vigorously enough to keep the metabolism stoked. This can contribute to body changes.

Sleep issues that accompany perimenopause and menopause (hello nighttime hot flashes) can also affect nutrition and weight. Hormonal changes that result from lack of sleep (decreased leptin, increased ghrelin) can increase hunger and make it harder to make good food choices. Lack of sleep can also affect cortisol levels (which can have a direct affect on belly fat) and blood sugar regulation. Fluctuations in insulin and blood sugar can also cause stress in the body and increase potential for fat storage, and increase the risk for metabolic issues such as type 2 diabetes.

Finally, the hormonal shifts can also affect our emotional and psychological well-being. Anxiety and/or depression can be new issues for some of us at menopause as we fear being less “relevant” as a woman in a youth- and thinnness-oriented patriarchal society (and this is a topic for a whole other blog post!). Medications for these issues can also affect metabolism, appetite and hunger/fullness, which can influence further body changes. Food/eating can also be a very common and normal coping mechanism for many, and there is NO SHAME in this. In fact, certain foods (hello delicious carbs) are critical to mood and emotional well-being, as they help in the process of serotonin (a feel good neurotransmitter) production. So self-care to protect your SUPER IMPORTANT mental and emotional health, can also impact body weight in some cases. (AGAIN: THIS IS OK! “HEALTH” IS NOT HEALTHY WITHOUT GOOD MENTAL AND EMOTIONAL HEALTH).

So it’s not your imagination. Your body IS changing. And it’s not something that we can avoid, though we might some days wish to turn back the clock. Rather than running headlong into aggressively restrictive diets excessive exercise and self-hatred, let’s together take a collective deep breath and try to take care of this one amazing body we have. Because it’s gotta last us for a few more decades!

How to Cope With Menopausal Changes in Your Body

Besides just feeling cranky, there are a few things you can do to help maintain overall health as you grapple with some of these menopausal changes.

1. See your doctor for a complete physical. Check your cholesterol, blood sugar, blood pressure and hormone levels. Also check things like thyroid, iron and B12 levels, as these are also energy regulators in your body. Make sure there isn’t something that’s off and causing your body to struggle with energy regulation. Thyroid issues can be common during the menopausal transition, so even if you don’t have a history of thyroid disorder, get your levels checked!

2. Avoid restrictive diets. Calorie cutting, watching your macros, keto, paleo, intermittent fasting, WW, Whole 30, Noom, Dukan, South Beach, these are all restrictive diets (don’t be fooled by the “it’s a lifestyle” claims…) and can affect your overall bone health and further crash your metabolism. Studies have shown that severe calorie restriction can cause major deficits in lean body and bone mass in postmenopausal women (and honestly, cyclic dieting in general is a big negative on our bodies. More on this in a future post). We need this lean muscle mass and these strong bones now more than ever in this time of life - please don’t sacrifice them for a smaller pant size!

3. Eat regular meals versus snacking and grazing. Every time you eat something your body goes through a cycle of producing insulin to help shuttle newly-ingested glucose from your bloodstream into your cells. As we get older, sometimes the pancreas may struggle to properly match insulin release with incoming glucose from meals, leading to overproduction of insulin (and possibly, insulin resistance) and/or challenges with low blood sugar. Low blood sugar can then lead to increased hunger and cravings for sweet or high carb/high fat foods. Eating 3 squares per day can help keep this cycle from getting further out of whack. (For athletes and active women, a snack or two pre- or post-workout can also be important to ensuring sufficient energy levels).

4. Consider a lower carb diet. No, this doesn’t mean you need to cut out all carbs (especially NOT fruits and veggies and whole grains!) or go keto, but there is some scientific evidence that a lower carb diet can help with blood sugar and hormonal regulation that may get a bit out of whack with the arrival of menopause. Aiming for 30-45g of carbs per meal and 15-30g per snack is a good rule of thumb. *Note: If you are very athletic and exercise more than 30 minutes daily, you will likely need more carbs to feel and perform you best.

5. Make sleep a priority. Practice good sleep hygiene by keeping a cool bedroom at night, going to bed at the same time every night, keeping screens and smart phones out of the bedroom (or at the very least, off for an hour or more before bedtime), limiting alcohol intake and avoiding caffeinated beverages past noon. If you struggle with things like reflux/GERD, also make sure to eat your last meal no later than 3 hours before bedtime. Nighttime heartburn isn’t the key to good sleep.

6. Exercise regularly. 150 minutes per week is the minimum recommendation for good health, and more can definitely be helpful as our metabolism starts to lag. Aim for a variety of activity that includes cardiovascular exercise, strength or resistance training and flexibility training. I find I don’t recover well anymore after hard CrossFit or HIIT workouts, so I aim for 3 days per week of that, plus 2 days of yoga or cycling and 1-2 days of walking or running. And if I’m really tired and wrung out, I just walk. Elevated stress from working out too hard can lead to a high cortisol response and a trend toward fat accumulation. PRO TIP: If you’re not already doing strength training, now is a good time to start to help ward off aging-related loss of muscle or bone mass. Lift heavy s*it regularly! It’s great for your body, your bones and your mobility and it makes you feel like a badass!

7. Eat lots of fruits and veggies! Rather than focusing on a fad diet or a list of foods you need to cut out, I recommend tracking your daily fruit and vegetable intake. I find that by getting at least 6-7 servings of fruit and veg daily, plus my daily bowl of morning oats, I get my fiber intake in, which keeps me full, keeps my gut happy, and ensures I don’t have a lot of room for snacks and other not-so-healthy foods. Now don’t get me wrong, I still eat chocolate. Daily. But by aiming for high fiber intake, along with moderate fat and protein intake, I don’t have as many sweets cravings as I used to during times of low sleep or hormonal fluctuations.

8. Tune into your body and get curious. As our body changes, our nutritional needs and our ability to undertake certain types of activities may change. If you’ve always been doing a certain type of exercise or sport, and now you feel slow and sluggish, I hear you! But maybe now is a great time to explore something new that feels even better (and fun!). Fighting our body causes us angst and frustration. Get curious: What foods make you feel energetic and vital? Which ones make you feel cranky or slow? Try to notice and stay open to what your body is telling you.

9. Focus on TOTAL health. Dial in your exercise, sleep, nutrition, and stress management, get regular medical checks, supplement vitamins or minerals as appropriate, and live a full and happy life. While there can be health risks associated with too much weight gain during menopause, we also can’t set the clock backwards. We’re in the phase of life we’re in. And really, aren’t you glad you’re not 20 anymore? Also, as previously noted, stressing about weight is contrary to overall good health.

10. Talk with your doctor about hormone replacement therapy. It’s definitely not right for everyone, but it can make a world of difference, even at very low doses, for some individuals in terms of energy, better sleep and weight management. (p.s. Check out this great podcast on Menopause Hormone Therapy for some great research on this topic. It’s not as scary as we may have been led to believe by popular media).

11. Before taking any vitamin, mineral or herbal supplements, talk with your doctor. There are a lot of supplements out on the market that claim to help “balance hormones,” relieve hot flashes or increase metabolism, but there is very limited science to support this. The few that have some reasonable evidence include black cohosh, soy isoflavones and red clover extract (and of course, calcium and vitamin D for bone health), but some of these may cause interactions with other medications or medical conditions, so it’s important to chat with your healthcare provider first before taking them.

12. Enjoy life! This is another new phase of life, and one where there’s not a lot you can do to change how the body naturally functions. You are not your body. Your body is just the package that takes you along for this great adventure called life. Try to enjoy the ride! (Yes, I’m still working on this one too!). ❤️

Yours in good health and stretchy jeans,

Diana

p.s. Some awesome resources on menopause for you:

• The Menopause Manifesto by Dr Jen Gunter

• Intuitive Eating by Evelyn Tribole MS, RDN, CEDRD-S and Elyse Resch MS, RDN, CEDRD-S, FAND

• The Menopause Diet Plan by Hillary Wright M.ED., RDN and Elizabeth Ward MS, RDN

• Menopause Confidential, by Tara Allmen, MD

• Just When You’re Comfortable in Your Skin It Starts to Sag, by Amy Nobile and Trisha Ashworth

• Hit Play Not Pause, podcast by Feisty Media

Why Diets Suck!

Yes, my professional title is dietitian. And yes, I HATE diets. Wait, let me say that louder for those in the back:

I HATE DIETS!

Ok, now that I got that off my chest, let’s discuss why this is.

• Diets simply don’t work. I know, you’re saying to yourself, “But that last diet I did was great and I lost all this weight. But then it stopped working. And I gained weight. But then that other diet I did a few years ago was so awesome. Until it wasn’t. And I stopped. And then I gained the weight back. And a bit more. But wait, what about that one crazy diet I did 5 years ago? That was so effective and I lost all this weight.. Hmmm, why did I stop that one? Oh yeah, because life got busy and the food wasn’t so great. And then I gained the weight back again. “

  DO YOU SEE THE TREND HERE? Research shows that most diets fail and dieters gain the weight back within 2 years. In fact, there’s very little evidence that shows that more than maybe a couple % of people who diet ever keep the weight off long-term.

• Diets are the primary predictors of future weight gain. See #1 above. What often happens is that people get in the diet cycle and can’t get off.

  When we diet, our body doesn’t know that we are purposefully trying to starve it; it justs knows it’s starving. So, myriad physiological and psychological responses to this starvation lead us to want to eat, to obsess about eating, and to eventually eat. And, the ongoing bursts of “famine” over the years cause our metabolism to slow, as the body seeks to protect itself and conserve energy, meaning two things: 1) A starving body burns a lot less calories than a well-fed body. 2) When we do start eating again, our metabolism has a hard time cranking back up again. Bingo —> weight gain.

• Diets make us feel crappy about ourselves. Sure, the first few weeks of a new diet are like a honeymoon. We have energy, focus, excitement about what might be “possible” with this new and super cool plan we found. And then, the fatigue sets in. The frustration with limited food choices. The stress about eating with others or what to do when we can’t find our “proper” food for our diet plan. We’re hungry and cranky. We feel depressed or isolated because everyone else is eating delicious things, and we, well, broccoli and chicken. So we go off the plan a little. And then a lot. And then we feel mad at ourselves. Why weren’t we stronger? Why couldn’t we resist? Now we start over with being strict again… and the cycle continues. We deprive ourselves, and when we can’t take it anymore, we rebound back to eating anything and everything. There’s no middle ground, and we feel physically and emotionally like garbage. And worst of all, we feel like it is US who FAILED. But it’s not:

  IT’S THE DIET THAT FAILED YOU!

• Diets can also adversely affect our health. I hear from lots of my clients that they want to “lose weight to be healthier,” and I understand this statement. Society, and even healthcare professionals, have advocated for weight loss for decades (ok, centuries) that weight loss is the magical key to good health. But the problem is, many of the ways people go about trying to lose weight are SUPER UNHEALTHY! Eliminating entire food groups from your diet = UNHEALTHY. Starving yourself so that your metabolism slows down and your hair starts thinning = UNHEALTHY. Avoiding friends and family because you can’t eat with them = UNHEALTHY. Exercising daily until you are so fatigued you can’t do much else = UNHEALTHY. Drinking only weird herbs and lemonade so you can “detox” and avoiding any solid foods = UNHEALTHY.

  Need more evidence of the tremendous ill-effects of dieting? Studies have shown that dieting often leads to:

  • Slowed metabolism

  • Loss of muscle mass

  • Body and food preoccupation

  • Body dissatisfaction

  • Increased stress

  • Disordered eating or full-blown eating disorders

  • Lowered self-esteem

  • Depression

  Your body was made for a variety of foods. It thrives on diversity, variety, abundance. Starving it and cutting off its supply of nutrient rich foods will not make you healthier. It will make you sick, stressed, depressed and cranky.

I could keep going, but I think I’ve made my thoughts pretty (probably annoyingly) clear.

You are not a bad person because you want to lose weight. You are not a bad person because you live in a body that isn’t “movie star thin.” You are not a bad person because food seems to rule your waking thoughts. Society puts us in this place and it’s hard to see another way of living.

But there is another way of living and living with (and even, dare I say ENJOYING?) food. You can work with your healthcare team (doctor, dietitian, therapist, coach) to find a way to be healthy on your own terms. To revel in your body (or at least stop hating it), and choose foods that both taste good and feel good to your body.

I know this might sound like a Fairy Tale, but it’s real. And it’s possible. And it’s way more real than the load of crap that diets are trying to sell you.

❤️YOU ARE WORTH MORE THAN YOUR WEIGHT. ❤️

xoxo,

Diana

p.s. For more good stuff on the research around diets and long-term weight gain, check out Fiona Willer’s Unpacking Weight Science podcast here: https://unpackingweightscience.podbean.com/.

p.p.s. Laura Thomas PhD’s book Just Eat It is a fantastic resource for frankly assessing diet culture’s hold on us, and finding ways to break these bonds.

p.p.s. See my blog post on Body Kindness Resources for some other great reading on this topic.

Nutrition During a Pandemic: There's no right or wrong way

There’s a meme going around social media right now about “the quarantine 15,” and how everyone is gaining weight because we’re all confined at home due to the COVID-19 pandemic. On the surface, this seems kind of funny, and is analogous to the “freshman 15” that is often discussed when someone goes to university and lives away from home for the first time, gaining 15 pounds their freshmen year due to lots of parties, beer and pizza. But in reality, it’s all pretty shame-inducing. The implication is that we should feel bad about ourselves if our habits have changed or our body has changed. Which is something we don’t need any more of when it comes to nutrition and health.

I say this often, but it bears repeating: No one successfully changes their habits for the long-term based on shame and self-loathing. Long-term change comes from self-compassion, self-acceptance and a healthy dose of motivation and ability. But I digress….

During a situation like our world is facing currently, nothing in our life is “normal.” Our eating habits, work hours, sleeping patterns, exercise options and ability to get to the store to get food have ALL CHANGED DRAMATICALLY. And then there’s the stress of what we are facing in the world right now: A massive pandemic that has affected millions of lives and killed several hundred thousand people in just a few months.

We are not robots. We feel. We grieve. We fear for our jobs, our kids, our families, our own lives. So yes, things will change, and sometimes we will not stick to our healthy eating habits because we are stressed, we are tired, we can’t get fresh food. We may not exercise, because we can’t go outside, to the gym and we live in a tiny apartment with many others. Or we may just be so exhausted we can’t even contemplate it. Regardless of the situation, it is OK. It is OK not to be perfect right now. It is OK to eat less than healthy foods. It is OK if your body changes. You are human.

So please, scroll past those memes. You don’t need that in your life right now. Take care of yourself in whatever way you can. Take care of your family, check in on others and take some deep breaths. We will all get through this. And once we do, we can start to re-emerge and find our healthy equilibrium once again.

Menopause and Weight Gain: What the F and What You Can Do.

ORIGINALLY POSTED FEBRUARY 2019, UPDATED AUGUST 2021

Ok, let’s be real. I’m about to turn 51 and most of my pants don’t fit. I am not thrilled with this turn of events. Not because I’m super body conscious per se, but because new wardrobes are expensive! Over the past 5-6 years I’ve noticed a real change in my body, how my weight is distributed, my energy levels and my post-workout recovery time. These are not fun changes. And frankly, I’m a bit pissed off.

As a healthcare professional, you might reasonably think I would have all the answers, but I don’t. And that makes me even more cranky. But rather than just sulking and eating chocolate by the handful, I decided to do my research and try to get on top of all of this. So this is my little love letter to all of you ladies who are also going through the joys of perimenopause (“the menopause transition”) or are recently post-menopausal (e.g. you’ve not had a menstrual period for over a year). Because dammit, people don’t really talk about this enough!

Body Changes & Weight Gain : Seriously, what the hell?

Changes in hormonal levels cause a bunch of cascading reactions in our bodies starting anywhere around ages 45-50, and for some individuals, even earlier. Plummeting (though often, hormones rise higher than normal before making a cliff dive to super low levels) levels of sex hormones estrogen, progesterone, testosterone wreak havoc on myriad issues and tissues in our body.

As hormone levels fall, our body tries to compensate, because estrogen is critical to bone health, managing our cholesterol level and helping to regulate mood, body temperature and libido.

Thus, fat cells become an increasing source of circulating estrogen - especially abdominal fat cells. Yes therein lies part of our midlife, midbody weight gain. And, unfortunately these fat cells are not all that efficient at estrogen production, so fat accumulates in ongoing efforts to compensate and protect our bodies from bone loss, high cholesterol and increased risk for heart disease.

Metabolism also shifts during the menopause transition, though it’s not exclusively linked to hormonal shifts. As we get older, our metabolic rate slowly starts to wane. Our body muscle mass starts decreasing after age 30 (yes, you read that right!), where we lose anywhere between 3-5% of our total muscle mass each decade. Muscle requires a few more calories than fat to maintain, so as we lose muscle, our body’s calorie burning furnaces also slow down. (Note: For some mind blowing new science on the topic of metabolism and aging, check out Abby Langer RD’s August 2021 post on a recent study that sheds new light on the phases of life where our metabolism shifts. It’s not exactly as we once thought!).

It also turns out that in menopause, your body tends to burn less calories and less fat doing the same exercise it used to (truly unfair). And, our body’s rate of fat oxidation (where our body breaks down fat) is also reduced. Additionally, as we age, we often lose flexibility and our recovery time following hard workouts is a lot longer. We just don’t physically bounce back the way we once did. This can mean we exercise less or not vigorously enough to keep the metabolism stoked. This can contribute to body changes.

Sleep issues that accompany perimenopause and menopause (hello nighttime hot flashes) can also affect nutrition and weight. Hormonal changes that result from lack of sleep (decreased leptin, increased ghrelin) can increase hunger and make it harder to make good food choices. Lack of sleep can also affect cortisol levels (which can have a direct affect on belly fat) and blood sugar regulation. Fluctuations in insulin and blood sugar can also cause stress in the body and increase potential for fat storage, and increase the risk for metabolic issues such as type 2 diabetes.

Finally, the hormonal shifts can also affect our emotional and psychological well-being. Anxiety and/or depression can be new issues for some of us at menopause as we fear being less “relevant” as a woman in a youth- and thinnness-oriented patriarchal society (and this is a topic for a whole other blog post!). Medications for these issues can also affect metabolism, appetite and hunger/fullness, which can influence further body changes. Food/eating can also be a very common and normal coping mechanism for many, and there is NO SHAME in this. In fact, certain foods (hello delicious carbs) are critical to mood and emotional well-being, as they help in the process of serotonin (a feel good neurotransmitter) production. So self-care to protect your SUPER IMPORTANT mental and emotional health, can also impact body weight in some cases. (AGAIN: THIS IS OK! “HEALTH” IS NOT HEALTHY WITHOUT GOOD MENTAL AND EMOTIONAL HEALTH).

So it’s not your imagination. Your body IS changing. And it’s not something that we can avoid, though we might some days wish to turn back the clock. Rather than running headlong into aggressively restrictive diets excessive exercise and self-hatred, let’s together take a collective deep breath and try to take care of this one amazing body we have. Because it’s gotta last us for a few more decades!

How to Cope With Menopausal Changes in Your Body

Besides just feeling cranky, there are a few things you can do to help maintain overall health as you grapple with some of these menopausal changes.

1. See your doctor for a complete physical. Check your cholesterol, blood sugar, blood pressure and hormone levels. Also check things like thyroid, iron and B12 levels, as these are also energy regulators in your body. Make sure there isn’t something that’s off and causing your body to struggle with energy regulation. Thyroid issues can be common during the menopausal transition, so even if you don’t have a history of thyroid disorder, get your levels checked!

2. Avoid restrictive diets. Calorie cutting, watching your macros, keto, paleo, intermittent fasting, WW, Whole 30, Noom, Dukan, South Beach, these are all restrictive diets (don’t be fooled by the “it’s a lifestyle” claims…) and can affect your overall bone health and further crash your metabolism. Studies have shown that severe calorie restriction can cause major deficits in lean body and bone mass in postmenopausal women (and honestly, cyclic dieting in general is a big negative on our bodies. More on this in a future post). We need this lean muscle mass and these strong bones now more than ever in this time of life - please don’t sacrifice them for a smaller pant size!

3. Eat regular meals versus snacking and grazing. Every time you eat something your body goes through a cycle of producing insulin to help shuttle newly-ingested glucose from your bloodstream into your cells. As we get older, sometimes the pancreas may struggle to properly match insulin release with incoming glucose from meals, leading to overproduction of insulin (and possibly, insulin resistance) and/or challenges with low blood sugar. Low blood sugar can then lead to increased hunger and cravings for sweet or high carb/high fat foods. Eating 3 squares per day can help keep this cycle from getting further out of whack. (For athletes and active women, a snack or two pre- or post-workout can also be important to ensuring sufficient energy levels).

4. Consider a lower carb diet. No, this doesn’t mean you need to cut out all carbs (especially NOT fruits and veggies and whole grains!) or go keto, but there is some scientific evidence that a lower carb diet can help with blood sugar and hormonal regulation that may get a bit out of whack with the arrival of menopause. Aiming for 30-45g of carbs per meal and 15-30g per snack is a good rule of thumb. *Note: If you are very athletic and exercise more than 30 minutes daily, you will likely need more carbs to feel and perform you best.

5. Make sleep a priority. Practice good sleep hygiene by keeping a cool bedroom at night, going to bed at the same time every night, keeping screens and smart phones out of the bedroom (or at the very least, off for an hour or more before bedtime), limiting alcohol intake and avoiding caffeinated beverages past noon. If you struggle with things like reflux/GERD, also make sure to eat your last meal no later than 3 hours before bedtime. Nighttime heartburn isn’t the key to good sleep.

6. Exercise regularly. 150 minutes per week is the minimum recommendation for good health, and more can definitely be helpful as our metabolism starts to lag. Aim for a variety of activity that includes cardiovascular exercise, strength or resistance training and flexibility training. I find I don’t recover well anymore after hard CrossFit or HIIT workouts, so I aim for 3 days per week of that, plus 2 days of yoga or cycling and 1-2 days of walking or running. And if I’m really tired and wrung out, I just walk. Elevated stress from working out too hard can lead to a high cortisol response and a trend toward fat accumulation. PRO TIP: If you’re not already doing strength training, now is a good time to start to help ward off aging-related loss of muscle or bone mass. Lift heavy s*it regularly! It’s great for your body, your bones and your mobility and it makes you feel like a badass!

7. Eat lots of fruits and veggies! Rather than focusing on a fad diet or a list of foods you need to cut out, I recommend tracking your daily fruit and vegetable intake. I find that by getting at least 6-7 servings of fruit and veg daily, plus my daily bowl of morning oats, I get my fiber intake in, which keeps me full, keeps my gut happy, and ensures I don’t have a lot of room for snacks and other not-so-healthy foods. Now don’t get me wrong, I still eat chocolate. Daily. But by aiming for high fiber intake, along with moderate fat and protein intake, I don’t have as many sweets cravings as I used to during times of low sleep or hormonal fluctuations.

8. Tune into your body and get curious. As our body changes, our nutritional needs and our ability to undertake certain types of activities may change. If you’ve always been doing a certain type of exercise or sport, and now you feel slow and sluggish, I hear you! But maybe now is a great time to explore something new that feels even better (and fun!). Fighting our body causes us angst and frustration. Get curious: What foods make you feel energetic and vital? Which ones make you feel cranky or slow? Try to notice and stay open to what your body is telling you.

9. Focus on TOTAL health. Dial in your exercise, sleep, nutrition, and stress management, get regular medical checks, supplement vitamins or minerals as appropriate, and live a full and happy life. While there can be health risks associated with too much weight gain during menopause, we also can’t set the clock backwards. We’re in the phase of life we’re in. And really, aren’t you glad you’re not 20 anymore? Also, as previously noted, stressing about weight is contrary to overall good health.

10. Talk with your doctor about hormone replacement therapy. It’s definitely not right for everyone, but it can make a world of difference, even at very low doses, for some individuals in terms of energy, better sleep and weight management. (p.s. Check out this great podcast on Menopause Hormone Therapy for some great research on this topic. It’s not as scary as we may have been led to believe by popular media).

11. Before taking any vitamin, mineral or herbal supplements, talk with your doctor. There are a lot of supplements out on the market that claim to help “balance hormones,” relieve hot flashes or increase metabolism, but there is very limited science to support this. The few that have some reasonable evidence include black cohosh, soy isoflavones and red clover extract (and of course, calcium and vitamin D for bone health), but some of these may cause interactions with other medications or medical conditions, so it’s important to chat with your healthcare provider first before taking them.

12. Enjoy life! This is another new phase of life, and one where there’s not a lot you can do to change how the body naturally functions. You are not your body. Your body is just the package that takes you along for this great adventure called life. Try to enjoy the ride! (Yes, I’m still working on this one too!). ❤️

Yours in good health and stretchy jeans,

Diana

Travel tips for the Low FODMAP Diet

It’s almost holiday season and many people will be traveling to share the special occasions with their loved ones. But, if you have IBS and are following the low FODMAP diet, this can mean added stress about what to eat. Here’s a few quick tips to keep in mind so you can enjoy the festive season without worrying about gut issues.

1. Pack lots of “safe” snacks for travel. Just in case you aren’t near a good source of low FODMAP foods, you’ll want to have options. Safe crackers, cheese, nut butter, trail mix, muesli bars, fruit or cookies/biscuits can make a satisfying meal in a pinch.

2. Research local markets and grocery stores where you’ll be staying. Often times, you may find websites in certain countries that highlight low FODMAP, gluten free or other specialized restaurants and stores. You can also seek out local Facebook groups that offer information on low FODMAP products and restaurants in the region and get advice from area folks in-the-know.

3. Consider shipping food to your location. Amazon carries a ton of low FODMAP products, as do FODShop (Australia), and FODMarket (UK). FODY Foods also offers delivery of FODMAP-friendly foods in the US and internationally.

4. Choose simple meals when dining out. Look for or request basic meals that include plain protein (chicken, fish, meat, eggs) and safe sides, such as plain potatoes, rice or quinoa, along with plain low FODMAP vegetables, and order sauces and dressings on the side. For breakfast, stick with eggs and oatmeal, or a safe bread with butter or nut butter and low FODMAP fruit. And, be sure to keep the Monash University Low FODMAP app with you at all times to check items for safety and/or proper portion sizes.

5. Print out low FODMAP cards in the local language, if traveling overseas. These can be lifesavers when trying to communicate with restaurant staff in different countries. Kate Scarlata and Casa die Santé offer cards you can share with chefs and servers, or you can also use Google Translate and make your own. The Google Translate app also has a great feature that allows you to translate menus from one language to the next “on the fly” by holding your smart phone over the menu.

Most of all, enjoy your time with family and friends! Do some advance planning and then try not to let worries about your gut interfere with your holiday season. Health is about the WHOLE you, including your own happiness and joy. Find the balance that works best for you. xo

Body Kindness Resources

My previous blog post was about kicking Diet Culture to the curb. I think we all know we need this to happen, but making it a reality is a lot harder. 

If you are struggling with disordered eating or body image issues, you're not alone. There are tons of resources that can help you see your own light shine. You're amazing. Truly.

Take a look at some of these books, podcasts or organizations below and pick a few to sample or experiment with. Feel free to reach out with questions, comments or ask for support.

You are perfect, just the way you are! xoxo

Body Kindness Resources

Books:

·      Body Kindness, by Rebecca Scritchfield

·      Nourish: How to Heal Your Relationship with Food, Body, and Self, by Heidi Schauster

·      If Not Dieting, Then What? By Rick Kaussman

·      Beautiful You: A Daily Guide to Radical Self-Acceptance, by Rosie Molinary

·      Women, Food & God, by Geneen Roth

·      The Rules of “Normal” Eating: A Commonsense Approach for Dieters, by Karen Koenig

·      The Food and Feelings Workbook, A Full Course Meal on Emotional Health, by Karen Koenig

·      Weight Wisdom: Affirmations to Free You from Food & Body Concerns, by Kathleen Burns Kingsbury

Podcasts:

·      Body Kindness by Rebecca Scritchfield

·      Food Psych, by Christy Harrison

·      Fearless Rebelle Radio by Summer Innanen

·      Bodylove Project, by Jessi Haggerty

·      Dietitians Unplugged, by Aaron Flores and Glenys Oyston

·      Love, Food podcast, by Julie Duffy Dillon

·      All Fired Up, by Louise Adams

Other Good Stuff:

·      Body Positive Fitness Alliance

·      Evelyn Tribole and Intuitive Eating (books, workbook, workshops)

·      Geneen Roth (books, podcast, workshops, online courses, retreats)

·      Anti-Diet Revolution

·      Body Positive Australia

·      TedX Talk with Victoria Welsby

·      Food Peace Syllabus by Julie Duffy Dillon

Bye Felicia: F-CK YOU DIET CULTURE!

I work with a lot of clients who suffer from gut issues, but today I'm not writing about that. What I really want to write - or rant - about is Diet Culture. 

So many people in our modern society, especially women, feel compelled to change their body. Regardless of their current shape, size or health status. They are bombarded daily with messages about how "thinner is better" and even our environment often forces individuals to think about "how much space they take up."  You're supposed to be a certain size to sit on a bus, in a car or an airplane. Mainstream clothing is made in a specific number of sizes. Start thinking about the number of places a "proper" body size means you can enter or participate in something (and an "improper" size means you can't). Society puts us in a box. 

Restrictive weight loss diets are promoted everywhere: in magazines, websites, blogs, tv shows, billboards, and especially social media. We cannot turn around without being told what to eat and why what we're currently eating is wrong. Just look at any morning tv show or women's fitness magazine. The Diet du Jour is endless. And relentless.

So what does this do to us? Well, for starters, if your body doesn't look like the ones promoted in mainstream culture, you may feel shame. You may be confused about what to eat (keto, paleo, low carb, organic, vegetarian, vegan... the varieties of diets are endless). And you may feel unhappy in your own skin. You may not know what to eat. You may feel completely frozen and overwhelmed when it comes to food. 

THIS IS NOT OK.  (Also F-ck You DIET CULTURE)

We are not carbon copies of each other. We are individuals. We have different genetics, different lifestyles, different health issues, different family situations, different everything. WE ARE NOT THE SAME. 

When did we decide to let someone else choose what we should look like? Sadly, this culture is decades, if not centuries in the making. But WE CAN CHANGE THIS. 

* We can choose to be happy with our body, no matter what shape it is in or what it looks like.

* We can choose to pursue health without having it always be about weight. 

* We can learn to trust our bodies and ourselves. 

* We can be supportive, empathetic and open to diversity of all types. 

It starts with us.  

Let's give Diet Culture the Finger, and find a better way. 

/rant

p.s. I love you and you are perfect. Just the way you are. 

Getting Started on the Low FODMAP Diet

Ok, so you've been diagnosed with irritable bowel syndrome (IBS). Your doctor has suggested you try the low FODMAP diet, and you left his or her office with a huge stack of information and some food lists.

You're feeling overwhelmed at the thought of a complete dietary overhaul, and maybe anxious about how to shop, plan meals and cook to support this big change. And your gut symptoms are getting even worse as a result. 

NOW WHAT?!! Don't panic. I've got you covered.

Here's a few important steps to get yourself on the right path, and soon you'll be feeling better. 

1. Find a Low FODMAP Trained Dietitian.

Yes, you can go it alone, but having a skilled partner who has navigated these waters for dozens upon dozens of individuals before you can help ensure you avoid pitfalls, unnecessary errors and over-thinking. This diet is complicated and the reintroduction phase can require some nuanced assessment of symptoms, as well as some skilled sleuthing to track down troublesome hidden FODMAPs in your diet. Good FODMAP trained dietitians are worth their weight in gold. And they can help you feel better as fast as possible. To find one near you, contact your doctor or gastroenterologist. If you aren't having any luck with that route, or perhaps you live in a rural area, there are many RDs (registered dietitians) who also offer online consultations.

Finally, click here, here or here to access lists of trained FODMAP dietitians in the US and Europe. You can also email me for a free 15-minute consult. I am a Monash University Certified Low FODMAP Dietitian, and have also completed Advanced FODMAP Training from Kings College of London.

2. Download the Monash University Low FODMAP App.

A team of researchers at Monash University created the low FODMAP diet and they are still the main go-to for updated research and information on the diet. The app is available for the Apple and Android platforms and can be downloaded from the appropriate app stores. It offers a wealth information about IBS, getting started with the diet, which foods contain FODMAPs, how to ensure a balanced diet and proper nutrition, and perhaps most importantly, a massive database of foods that have been tested for FODMAPs content. The app uses a "traffic light" system to identify which foods are low in FODMAPs (green), which have some FODMAPs but can be enjoyed in small quantities on occasion (yellow) and those which contain high amounts of FODMAPs and should be avoided (red). 

The app contains specific portion sizes (in both imperial and metric measurements), so you know which foods you can eat and in which amounts. This is important because eating too much of even low FODMAP foods can accidentally become a high FODMAP situation (I'll talk about FODMAP "stacking" in a future post). For more information on the app, go to your app store or the Monash University website. 

3. Pick a Start Date.

It doesn't have to be tomorrow, but you do want to get started on the path to feeling better, fast. Try to find a time period where you won't be traveling a lot and can take some extra time to plan meals and eat at home most days. This may not be 100% possible and that's ok. There are plenty of tips for eating out or with others! However, when you start the Elimination phase you're in learning mode, and it can be helpful to be able to focus on this without juggling restaurants, unfamiliar kitchens and social demands. Look at your calendar and pick a week that you'll get started, knowing that Elimination is a 2-8 week process* whereby you'll be eliminating all high FODMAP foods from your diet temporarily, to try to get good control of your GI symptoms. 

*Now is also a good time to remind you (and emphasize) that the Elimination phase is intended to be temporary. Once you're feeling better, it's important to work more foods back into your diet, so you can be symptom free (or as close to it as possible!) AND have a diverse and nutritious diet. (See this article I wrote for FODMAP Everyday for a bit more on this topic). 

4. Keep a Food & Symptom Journal.

The low FODMAP diet is a bit like being a detective: you're constantly trying to "sniff out" what food or combinations of food are the culprits behind your own specific gut issues. And sometimes it feels like no matter how carefully you follow the elimination instructions, you still get tripped up. This can happen for many reasons. Perhaps you ate out in a restaurant and there were hidden ingredients that weren't listed on the menu.  Maybe you tried a new food product and didn't read the label closely and lo and behold there was a high FODMAP ingredient you didn't initially notice. Or, you're going through a really stressful period of life and your anxiety levels are through the roof, and this is also affecting your IBS. Still others may find that they feel pretty terrible after a hard or extended workout. How do you know what the actual culprit is?

Keeping track of your food intake, stress levels, physical activity and symptoms can be an important part of starting to once and for all assess your triggers for GI upset. There are a lot of ways to do this, from a paper diary to websites to mobile apps. Choose the method that works best for you and your lifestyle, and try to track during the entire elimination phase. Here's a couple links that might help get you started: 

• Bowelle app: https://itunes.apple.com/app/id1002889997
• Cara: https://cara-app.com/
• IBS Diet Tracker: https://itunes.apple.com/gb/app/ibs-diet-tracker/id1053516418?mt=8
• mySymptoms: http://skygazerlabs.com/wp/ 

5. Create a Low FODMAP Shopping List. Start with your regular grocery list and use the Monash app (or one of the lists below, which are frequently updated) to find low FODMAP options for other foods you normally purchase and eat. Going into the grocery store well-prepared will reduce stress and ensure you have a pantry full of tasty and nutritious options, so you don't feel deprived. There are also a number of food manufacturers who have created low FODMAP products that you can seek out. Many of these are certified Low FODMAP by Monash or FODMAP Friendly (the other product testing and certifying body), so you know that you are in good hands if you purchase a certified product. 

Shopping Lists:

• Diet vs Disease Low FODMAP Shopping List: https://www.dietvsdisease.org/diy-low-fodmap-diet/
• FODMAP Everyday Trader Joe's Shopping List: https://www.fodmapeveryday.com/trader-joes-low-fodmap-shopping-list/
• FODY Foods Shopping List: https://www.fodyfoods.com/pages/low-fodmap-food-list

Food Brands & Products

• FODMAP Friendly: http://fodmapfriendly.com/certified-products/
• Monash Certified: https://www.monashfodmap.com/i-have-ibs/certified-products/
• FODY Foods: https://www.fodyfoods.com/
• Casa de Sante: https://casadesante.com/
• Stellar Labs Nutrition: https://www.stellarlabsnutrition.com/
• Bays Kitchen: https://bayskitchen.co.uk/

So what are you waiting for? You can do it! Get started on the low FODMAP diet. You (and your gut) will be glad you did!

Exercise and IBS: Should You and How Much?

Many individuals with IBS have questions about exercise, especially when they are going through a “flare,” or a particularly difficult set of symptoms. It is understandable that the idea of exercising while in pain would not be the first thing someone is inclined to do, but exercise can be incredibly helpful for IBS sufferers. Read on for more tips on this topic.

Benefits of Exercise

IBS symptoms are heavily influenced by stress; stress can cause increased symptoms, and then the anxiety or reduced quality of life that results from painful, uncomfortable or embarrassing symptoms can create further stress. It’s a vicious cycle, and our brains and our bodies sometimes feel at war. Exercise can help reduce this stress by stimulating the release of endorphins (feel good hormones) and lead to a greater sense of calm and/or well-being.

Exercise can also help increase your level of fitness and strengthen your body, which is good for overall health and longevity, and it can also leave you feeling stronger and more capable of handling your tough symptoms. And, as we know from years of research, exercise can help moderate blood sugar levels, reduce blood pressure, regulate sleep and help individuals manage their weight.

Finally, studies have shown that exercise can improve overall IBS symptom severity. A recent study compared two groups of IBS patients. The group of individuals who increased their exercise levels experienced a significant decrease in IBS symptoms, while the control group (those who did not increase their exercise levels) saw increased symptom severity/worsening of symptoms.

What Type of Exercise is Most Helpful?

The type, duration and intensity of exercise you decide to do will depend on your symptoms. If you’re feeling good, and you are generally healthy and your doctor says that exercise is safe for you, there are generally no limitations. Choose an activity that you enjoy and that you can comfortably do 3-5 days per week for 30-45 minutes at a time. For best health, 150 minutes of weekly physical activity are recommended. Vary your choices and have fun with it!

During a period of intense pain or abdominal discomfort, exercises that are very fast-paced and jarring, such as running, soccer, cross fit or other high-intensity activity, may cause greater discomfort. They will not harm you, but they certainly will not likely feel very comfortable. This again, will depend on your symptoms and IBS subtype. For example, individuals with IBS-C may benefit from more intense or endurance exercise, as it can speed up intestinal transit time and relieve constipation. However, individuals with IBS-D may find that some of these same gut changes (see below) can be more problematic.

Running, especially longer distances, can cause increased GI distress due to increases in gut permeability that results from reduced gut blood flow (while you exercise, your body is busy pushing blood to working muscles and away from the gut). Changes in nutrient absorption and gastric emptying time can also result, which can make runners more susceptible to cramping and diarrhea. In fact, it’s estimated that 30-83% of runners (even those without IBS) suffer from GI disturbances during longer runs. This doesn’t mean you shouldn’t run, but it does mean you may want to avoid it during a flare of IBS symptoms. You should also be careful of the foods you eat before and during a long run, as many have concentrated sugars (including fructose, a high FODMAP sugar) or caffeine, which may exacerbate symptoms. Kate Scarlata has a great booklet on this on her site, if you’d like more information. Dr. Dana Lis also has published research in this area, regarding utilizing the low FODMAPs diet for endurance athletes who suffer from exercise-induced GI distress.

So, what types of exercise should you try when you’re not feeling good? Gentle or low-impact activities such as walking, yoga, light cycling, tai chi or swimming can all be amazing stress reducers, while also being really good for your body. Getting outdoors to exercise is also encouraged, as the effects of daylight and external environmental cues (e.g. being in nature!) have been shown to improve mood and reduce anxiety.

Yoga has been studied quite a bit by GI researchers, and a recent study showed that individuals with IBD (inflammatory bowel disease) found improved quality of life and an improved state of their disease (e.g. fewer symptoms) with weekly yoga sessions. Another recent study, which compared yoga to the low FODMAPS diet, found that twice weekly yoga was nearly as effective in reducing IBS symptom severity as the low FODMAPS diet. Yoga was also found to be very helpful in regard to reducing patients’ levels of anxiety and increasing body awareness and responsiveness. In a scientific review of a number of studies that evaluated yoga practice for IBS sufferers, it was also noted that the improvements in symptoms and quality of life gained from yoga practice may also lead to reduced need for medications, fiber supplements and probiotics.  Thus, a combination of yoga and the low FODMAPS diet should be quite helpful for many IBS sufferers!

The Bottom Line

When starting a new exercise program, or if you are feeling pretty uncomfortable, start slow and listen to your body. And, be sure to fuel up for activity with nutritious foods and hydrate well. But stick with it. Your overall health and quality of life can benefit tremendously!

And, as always, please check with your doctor before starting a new exercise program to make sure it is appropriate for your age, lifestyle and current health status.

---

If you’d like to read more on this topic, here are a few studies not previously linked to above:

https://www.ncbi.nlm.nih.gov/pubmed/29274540

https://www.ncbi.nlm.nih.gov/pubmed/26086986

https://www.ncbi.nlm.nih.gov/pubmed/21206488

http://www.cghjournal.org/article/S1542-3565(16)30088-X/fulltext

FOD-What? The low FODMAPs diet: An important tool for gut health.

In my previous post, I discussed irritable bowel syndrome (IBS) and some of the challenges many individuals face with getting an appropriate diagnosis and/or living their life with chronic pain and GI upset.  In this post, I will discuss the low FODMAPs diet, one of the most promising treatments for IBS. 

The Search for a Cause of GI Issues

It's long been recognized that certain foods can cause uncomfortable GI symptoms, such as bloating, gas and/or pain. Many people have successfully narrowed down their own individual triggers by eliminating (temporarily or permanently) these suspected foods or ingredients from their diets in a trial and error fashion - e.g. maybe they cut out milk and dairy, or perhaps they don't eat sugar-free foods that cause uncomfortable bloating. The problem with this strategy is that there can be unintended consequences, such as eliminating something that isn't actually the cause of the problem and thus, possibly adversely affecting overall nutrition, or masking another important health issue.

An example of the second scenario is when individuals think gluten might be causing a problem for them, so they cut it out of their diet, at least some of the time, but they don't get tested for celiac disease. Now they don't eat gluten-containing foods very often, but they still enjoy their weekend pancakes or pizza or cookies. The problem with this is that someone with celiac disease really must eliminate ALL gluten. Otherwise they risk malnutrition, permanent damage to their small intestine, and myriad other issues. And if, as a(n undiagnosed) celiac sufferer, they are still eating gluten occasionally, eventually they will face serious health issues in the future. So, the bottom line is, we want to really know what is at the root of GI symptoms to ensure the most diverse and healthy diet possible. Trial and error just isn't enough. We need a systematic approach. In this example, we'd want the individual to be tested first for celiac disease, and if that was negative, then they might pursue a different strategy, such as the low FODMAPs diet. 

The History of the low FODMAPS Diet

Nutrition researchers have long been studying IBS and food intolerances, and seeking to gain insights into what dietary changes can be made to help individuals with painful gut symptoms feel better. Some of the research focused on specific foods or food ingredients, while other research has looked at overall digestive processes and GI physiology. The low FODMAPs diet arose from both of these.

The Low FODMAPS diet was developed by researchers at Monash University in Australia and originally introduced in 2006. The diet is centered around the premise that certain types of carbohydrates found in foods (short-chain carbohydrates) are not well absorbed by certain individuals, leading to the uncomfortable symptoms of IBS. These poorly absorbed carbs can: be fermented in the gut (gas, pain and bloating), draw water into the gut (causing distention and pain), affect changes in gut motility (e.g. how fast or slow a food is digested, leading to diarrhea or constipation), and cause changes to overall gut bacteria (which can be related to a host of other issues). Often, there are also some "chicken and egg" scenarios as well, where individuals with IBS have extra sensitive GI systems and are hypersensitive to pain and discomfort, or they are rapid digesters of certain foods. Thus, the combination of both carbohydrates and anatomy can lead to extremely painful GI symptoms. (Note: environmental issues such as stress can also affect IBS symptoms, and I'll discuss that in a future blog post). 

What are FODMAPs?

FODMAP is an acronym for the following short-chain carbohydrates (based on either their structure or their action in the gut):

F = fermentable

O = oligosaccharides (fructans and galaco-oligosaccharides)

D = disaccharides (lactose)

M = monosaccharides (excess fructose)

A = and

P = polyols (sugar alcohols such as sorbitol, maltitol, mannitol, xylitol, isomalt)

Each of these different types of carbohydrates may be found alone or in combinations in various types of foods, including fruits, vegetables, seeds, nuts, grains and sweeteners. Some foods may have just a small amount of one of these carbs, while others may have high amounts.  It is the high amounts that tend to cause the biggest issues for most individuals (however, each individual may also have a different tolerance to specific FODMAP carbs. I will discuss this further in another future blog post).

You can find lists of foods that contain high amounts of FODMAPs in the Monash University app (which is regularly updated and the "bible" for FODMAP content of foods) or at Kate Scarlata, RD's website. Kate was one of the first dietitians in the US (along with Patsy Catsos) to be trained in this diet and she is a wealth of information on this topic. 

How it Works: The Low FODMAP Diet Process

The low FODMAPs diet is undertaken in several phases, including: Elimination, Reintroduction and Modified/Personalized phases, with each phase building on the one previous.

1. In the Elimination phase, the individual eliminates all high FODMAP foods according to the guidelines provided by Monash University, which are based on years of research that has tested the FODMAP content of thousands of foods. The goal of this phase is to eliminate foods that may be causing GI symptoms and achieve good symptom control (e.g. get you feeling better!). This is a temporary, 2-8 week phase. 

2. Reintroduction: Now that (ideally) symptoms have been reduced significantly, in this phase, each of the individual FODMAPs groups (e.g. fermentable, oligosaccharides, and so on) are reintroduced to the diet one by one, in small doses. This allows the IBS sufferer to reintroduce or test each FODMAP group separately and to see which ones tend to cause the most symptoms when they are eaten. This is a rather complex and time-consuming phase, and individuals strongly benefit from working with a dietitian who is certified in implementing this diet. This phase can last from 8-12 weeks, depending on how many food challenges one undergoes.

3. Modified/Personalized Low FODMAPs Diet: This is the long-term goal, where an individual is now able to eat a diverse range of nutritious foods. They will avoid the FODMAPs (or eat in very small amounts) that cause them GI distress, but they might also be able to add back in other foods they might not have previously tolerated. This phase is very individual and will be based on the results of the challenges from phase 2. As an example, some people may find that lactose is a huge problem for them, so they need to avoid most dairy products (or seek lactose free options), but fructose is just fine and they can now enjoy things like cherries, mangos and honey. Other individuals may find that polyols and excess fructose really bother them, but small amounts of oligosaccharides are ok. 

This systematic elimination and reintroduction process allows individuals to develop a diet that is best for them and ideally, eliminates the fewest amount of foods possible (while also ensuring they feel better!). The problem with many other elimination diets is that they are too broad and often permanent, which can lead to nutritional deficiencies and/or health problems. The personalized nature of the low FODMAPs diet is designed to ensure that only the problem foods are eliminated, and that we don't "throw the baby out with the bathwater."

If it sounds complicated, it's true that it can be. But it can absolutely be worth it for individuals who are struggling to manage day-to-day life because of constant GI pain and upset. 

If you have IBS and think a low FODMAPs diet might be useful for you, feel free to contact me for more information. I am a Monash University Certified Low FODMAPs Dietitian. 

When Eating Hurts: Irritable Bowel Syndrome and Its Treatments

Have you experienced chronic problems with gastrointestinal (GI) pain, gas and bloating, diarrhea and/or constipation? I know, it's not proper to discuss this in polite company, but ignoring symptoms won't make them go away! 

Individuals who suffer from chronic GI and related symptoms may have Irritable Bowel Syndrome. This is a functional gut disorder (more on that below) clinically defined by the Rome IV criteria as recurrent abdominal pain, on average, at least 1 day/week in the last 3 months, associated with two or more of the following criteria: 1) related to defecation/bowel movements, 2) associated with a change in frequency of stool, and 3) associated with a change in form/appearance of stool. For a clear IBS diagnosis, these criteria should have been fulfilled for at least 3 months, and onset of symptoms at least 6 months before diagnosis. So if this sounds like you, it may be time to get checked out by your primary care provider or a GI specialist.

It's also important to rule out other possible GI concerns, such as ulcerative colitis or crohn's disease (these are collectively called Inflammatory Bowel Disease), food allergies or chemical intolerances, autoimmune disorders such as celiac disease, or cancer (and in women, endometriosis), before a diagnosis of IBS can be safely made. This is when a gatroenteroloigist and a registered dietitian can be especially useful to help you navigate the range of issues and ensure you're on the right track to feeling better. 

What makes IBS a "functional gut disorder" is that it is a series of symptoms based on the overall functioning of the gut and the interaction between the brain and gut (they do a lot of talking!), versus an inflammatory or infectious disease. (However, there are some times when these can overlap - this is for a future blog post). For individuals with IBS, this means that their GI tract may have motility issues (food can digest much faster or much slower than in non-IBS individuals, causing discomfort or abnormal bowel habits), normal gut bacteria may be altered (which can change your gut from a happy, healthy place to one that's cranky and unsettled), there can be increased sensitivity to and intense pain (called visceral hypersensitivity) with normal digestive processes such as gas or bloating, changes in the gut's immune function, and changes in how the brain sends and receives messages from the gut. So while your gut may not be infected with anything, there is a LOT going on. 

The problem with IBS is often that it is a diagnosis of "last resort" for some individuals. After suffering painful, anxiety producing or embarrassing symptoms for months to years, many IBS sufferers begin to lose hope for relief or start to self diagnose and self treat, which can mask more serious issues and/or lead to insufficient relief. There are no specific diagnostic tests for IBS, (though a few are used in the diagnostic process, such as breath tests) and it's largely a diagnosis of exclusion of other issues or diseases via various other lab tests and scans, such as blood tests for celiac, stool tests to rule out bacterial or parasitic infections, endoscopies and/or colonoscopies. This lack of clarity can lead people to feel frustrated and hopeless, or like they're alone and a bit crazy. 

If this is you, know this: It is not hopeless and you are not crazy.  There are some great diet and lifestyle treatments that can dramatically reduce IBS symptoms and improve quality of life. Future blog posts will discuss the low FODMAPs diet and other complementary treatments that can help IBS sufferers get their lives back. If you have any questions in the mean time, please feel free to get in touch via the contact page. 

You can also read more about IBS here: 

• https://www.aboutibs.org/diagnosis-of-ibs.html
• https://www.mayoclinic.org/diseases-conditions/irritable-bowel-syndrome/diagnosis-treatment/drc-20360064,m
• https://www.niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome/diagnosis

Here's to happy eating. And happy pooping.  :)

The Best Diet in the World

Now that I have your attention, let's talk diet!

But first, let's talk about what "diet" means. To many people, diet means a way to lose weight. In reality, "diet" simply means the kind of food a person habitually eats.  The latter is the definition I wish we'd all focus more on, and then we might not have to focus on the former. In fact, the focus on losing weight is actually making a lot of people even heavier (See below for a few links to studies on this). The ongoing cycle of weight loss and regain can also leave individuals prone to increased risk of high blood pressure, elevated cholesterol, metabolic syndrome or gallbladder disease. But of course, being overweight or obese also increases the risk for many of these same issues. So what's a health-conscious person to do?

1. Focus on overall health (see my previous post titled What is Good Health). A narrow focus on weight or BMI can be counter-productive to our overall health. Look at the bigger picture and take into account your habitual diet, exercise, sleep, stress, cardiovascular health, recent lab values, etc. If you're taking good care of all the aspects of your health and getting regular medical check-ups, your weight isn't as important. Really.

2. Find a way of eating that meets your goals AND your lifestyle. An overly restrictive diet plan that requires tons of meal prep, the purchase of hard to find or prepare foods, or isolates you from your friends and family is not one that you're likely to sustain for a lifetime. Think about what you can imagine eating for YEARS AND DECADES, not days or months. Also, consider your goals. Are you training for a marathon or just trying to find more energy to chase your kids around all day? Do you want to lose weight or are you trying to develop better blood sugar control? Each of these will require a different way of eating.

3. What way of eating actually makes you feel good? Everyone is different. Some people are "grazers" and prefer to eat 5-6 small meals per day, while others find that something like intermittent fasting works well for them (e.g. 16 hours of no food, an 8 hour eating "window" daily). Some people function really well on a very low carbohydrate diet, while others can't make it through the day without a regular influx of carbs. The point is, there is NO ONE SINGLE WAY OF EATING THAT WORKS FOR EVERYONE. (Did I sound like I was shouting? Yes, kind of). This is incredibly important. There is so much hype and so much crazy "diet evangelism" (e.g. the "I lost some weight, I published a book and my diet is the best.") in this world. It can get confusing and hard to decipher all the conflicting information. But you don't need to worry about everyone else. Pay attention to how *you* feel. YOU DO YOU!

4. What does your doctor or healthcare team recommend for you and your specific body, health status, age and lifestyle? Notice I said *your* doctor. Not your mom, your aunt, your co-worker, your friend's cousin's daughter's best friend, Dr. Oz...  If you have diabetes or insulin resistance, you should follow a specific plan that makes sense, is based in science and will meet your needs. Or, if you have GI issues or food allergies, work with your dietitian on identifying trigger issues and develop a plan to avoid those. Heart disease? Look towards a lower fat plan and talk with your team about what works best in this case. Don't go it alone and don't self-diagnose. Your health is yours alone, and it's precious.

So what is the best diet in the world? The one that works for YOU.

-DR

p.s. If you want a list of good dietary plans that are well-balanced and sustainable, check out this review from US News and World Reports, http://health.usnews.com/best-diet/best-diets-overall.

References:

https://www.ncbi.nlm.nih.gov/pubmed/21677272

http://onlinelibrary.wiley.com/doi/10.1111/obr.12255/full

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4241770/

Eat what you enjoy.

And enjoy what you eat.

What is Good Health?

The phrase "good health" or "healthy" are thrown around a lot in modern media and every day conversation. But what does this really mean? For (perhaps too) many, it's about being the "correct" weight or constantly striving to lose weight. For other people, "healthy" might mean lack of illness, which certainly sounds like a good thing. Or, healthy can mean that someone eats a very careful diet and buys only organic or non-GMO foods and never touches refined sugar. This sounds pretty good too. But is it a sign of good health? Not necessarily.

Let's unpack some of these concepts. Can health be boiled down to a single indicator like weight or BMI (body mass index)? Often, popular media and even medical professionals will focus on these metrics and then make recommendations based on the "need" to increase or decrease weight. Is this the right choice? Well, maybe. But not in isolation. Someone with a higher than normal BMI might also be very athletic and carrying a lot of muscle, so their weight and BMI aren't indicative of excessive fat mass or some of the health risks that go along with that. Someone with a very low weight or BMI may be suffering from a serious disease or malnutrition. One single number just doesn't tell us enough.

What about the person that eats "clean" (one of my least favorite terms)? Are they in great health? Maybe, and maybe not. Do we know what their blood sugar levels are? Is their cholesterol high? Do they have a family history of heart disease? Do they sit for hours and hours at a time or have very little physical activity?  Eating a diverse and balanced diet IS really important to good health, but food/diet alone also doesn't tell a particularly rich story.

Similarly, the person that exercises daily and takes a multivitamin and drinks 2 gallons of water each day sounds pretty healthy, right? And they might well be. But is their life filled with extreme stress? Are they hitting the fast food drive-through daily and not getting much sleep? That certainly isn't goin to lead to long-term good health.

The bottom line is that good health (and maintaining it) isn't a single number. It's not a diet plan. You can't outrun bad health or an over-stressed lifestyle. A true healthy lifestyle includes a focus on eating well, exercise and activity, stress reduction, regular medical care/assessments and proper sleep. Sometimes we'll have to sacrifice one or the other, because let's face it life gets crazy. But we should always remember that good health isn't defined or created by a single action or metric. It's integrative. It's cumulative. And it's important.