Everyone has the right to enjoy cake, not just thin people

Yesterday one of my clients told me she was not doing to well with mindful eating. When I asked her to elaborate, she said how the day before, in a meeting, she had eaten two of the mini cakes on offer. I asked her what they were like and she said delicious, fresh and moist, just to her liking and that she felt satisfied and not too full afterwards. I then asked her why she felt this wasn’t mindful – it sounded like a perfect example of mindful eating to me – and her response was, “I didn’t need to eat two of them”.

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This is one of the commonest misperceptions with mindful eating, the idea that if you eat mindfully, you’ll eat less. While this may happen, it doesn’t need to and it certainly shouldn’t be the reason for practising mindful eating. If it is, it simply becomes another diet rule in an already saturated diet culture of food rules that dictate how or what we should or shouldn’t do with food. It is no surprise that mindful eating is being mixed up with dieting as diet companies such as weight watchers teach “mindful eating” as part of their program. If weight loss is your main focus, it becomes very difficult to not turn mindful eating into just another a diet – the mindful eating diet. Thanks weight watchers.

There is no one way, or correct way, to eat mindfully. Mindful eating involves some awareness of the sensory properties of the food (look, smell, taste, texture) and some awareness of appetite and how the food feels in your body, or leaves you feeling. Notice I used the word ‘some’ when talking about awareness. Awareness does not need to be 100%.

We then explored why my client felt she shouldn’t have eaten both cakes. She mentioned she didn’t feel too full afterward and actually ended up eating less than usual at lunch as she noticed she wasn’t as hungry. So what’s the issue I asked? My clients response was centered around “too much” sugar and calories and cake not being nutritious or “good” for health.

This lady is fit (she moves her body daily with swimming and walking) and she is healthy (she feels good in her body and bloods are all normal). The issue as my client sees it, is her body is larger than it “should” be. My client felt because of her weight, she didn’t really deserve to eat one of the cakes, let alone both. I then asked her if she felt it would be ok to eat the cakes if she was thinner and her response was emphatic – “Yes I would have both, I’d thoroughly enjoy them and not feel an ounce of guilt!”

We then discussed that if cake really was bad for health, surely it would be just as “bad” for thin people. Of course it’s not, thin people who eat cake are not automatically unhealthy. If thin people can enjoy both cake and health, and they can, then why on earth can’t bigger people? Now I am not saying we can all eat as much cake as we want without any regard for how we eat, that would be silly – I feel the need to say this as there will be people who choose to interpret my message as that.

The message I am aiming to get across here is that not only thin people have a right to enjoy whatever they hell they feel like eating without judgement or guilt. However, our culture is such that this is often what happens. People in larger bodies are often judged, not only by society, but also harshly by themselves, for their food choices. What we need to acknowledge is that this judgment usually has NOTHING (or little) to do with the nutrition aspect of health, but rather that they somehow don’t deserve to eat that food. This is a culture that needs to change, as not only is it misplaced concept, but it usually only serves to damage a person’s health. When people are made to feel shame about themselves, especially with regard to weight, they are LESS likely to engage in healthy behaviours. This paper on the impact of weight stigma clearly shows this.

Everyone has the right to enjoy all food, not just thin people. Enjoying cake does NOT mean you are disregarding health or that you don’t care about the health of your body. Health is not just a product of the food you eat and the nutritional aspect of health is something that occurs over many many food choices over many weeks, not just one food choice, be that an apple or a cake. So have your cake and enjoy it!

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Help! I am trying to practise intuitive eating but have been advised to avoid certain foods due to intolerances.

Over my 13+ years as a dietitian, my practice has forked into two clear areas of practice, food intolerance and non-diet approach (intuitive eating).

Food intolerance investigation involves periods of eliminating various foods, followed by food challenges in order to determine symptom triggers. The exception to this is Coeliac disease, where gluten needs to be avoided lifelong. I will talk about Coeliac disease separately.

Intuitive eating involves learning how to let go of food restriction and ultimately give yourself unconditional permission to eat whatever you feel like with attunement to appetite and other bodily sensations. 

The two may look antithetical, but they’re not and they can even work to help each other out. The more attuned you are to bodily sensations, a key aspect of intuitive eating, the more easily you may recognise if a food agrees with you or not. The more easily you can recognise a food reaction, the easier it can be to choose not to eat that food, or too much of that food. But to arrive at this point, you need to have a sound relationship with food.

 

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What does a sound relationship with food look like? Food is more or less just food, you eat for the most part because you’re hungry, you eat food you enjoy and that leaves you feeling satisfied and you generally stop eating when you’re comfortably full. For some, food and eating offers joy and pleasure beyond fuel or nutrition, and for others it may be more a source of fuel or nutrition. There are times you eat simply for the taste, times you eat more than you need and times you choose to eat something you know might not sit so well. There is no right or wrong, no moral imperative and no need to compensate or make excuses. If you choose not to eat something, you are doing this out of self-care, not because you shouldn’t eat the food based on diet rules.

If you suspect you may have food intolerance, or perhaps you have been advised to try an elimination diet such as a low FODMAP diet, low food chemical diet or gluten free diet (not for diagnosed Coeliac), and your relationship with food is not sound, there are a few things you need to consider.

First up, seek help from a dietitian experienced with food intolerance and the non-diet/intuitive eating approach. There are a few crucial steps that must be considered before you start eliminating food, one of these is to rule out Coeliac disease. Depending on your age and family history, you may also need to be checked for other medical conditions that may be responsible for a change in gastrointestinal (GI), or other symptoms. A thorough assessment should also be carried out to see if food intolerance is indeed likely to be an issue and not some other factor, such as disordered eating, a current or past eating disorder or other psychological issue. If you have experienced psychological trauma at some time, or are highly anxious or stressed, this can trigger GI disturbances and other food intolerance related symptoms. If your pattern of eating is chaotic, you over-eat or binge at times, or you feel emotional distress with food, then this can be a trigger for GI symptoms independent of food intolerance. Sorting these issues out first may mean food is no longer, or much less of, a symptom trigger. I have seen this many times. 

A note on FODMAPs

In Australia, while the low FODMAP diet is a very effective form of managing GI symptoms, it is massively overused. This is partly due to the availability and misunderstanding of the breath testing and partly as FODMAPs were discovered here and the medical and dietetics professions have been educated in their existence and application. The breath tests available for FODMAPs are NOT a diagnosis, however, this is often not explained well to the general population. I have seen literally hundreds of people who thought their positive breath tests were a diagnosis for FODMAP intolerance. Regardless of your test results – and you do not actually need to undergo testing – you need to trial the low FODMAP diet. If your symptoms do settle, you then need to go through a process of food challenges to identify which, if any, FODMAPs are triggering your gut symptoms. The long-term aim is to free up your diet as much as possible whilst still managing symptoms; staying strictly low FODMAP long-term is unnecessary and not advisable.

Let’s assume you do have food intolerance, where a certain amount of a food in your diet triggers GI (or other) symptoms. If your relationship with food is a little dicey and this results in over-eating or anxiety around food, knowing which foods are an issue for you is not guaranteed protection against you over-eating those foods. In fact, you may find yourself craving the very food you’re trying to restrict and then over-eating it, which not only triggers symptoms, but also heightens your overall level of anxiety, further exacerbating symptoms. In this not uncommon scenario, eliminating food to try and identify food intolerance is often counterproductive and can worsen physical symptoms and psychological health. If this sounds like you, you would be better off to focus on improving your relationship with food before you start a food intolerance investigation. This is the approach I take in my practice with such clients. Once you are feeling more relaxed and neutral around food, eliminating or restricting food becomes less of a problem and any investigation you do will be more effective. You may also find that once you’re feeling more relaxed around food and no longer over-eating or bingeing on any one food, that your GI symptoms settle right down and you no longer need to do an elimination diet. This of course will not be the case for everyone, and some people will still need to investigate food intolerance and limit or avoid certain foods to manage symptoms. In my 13+ years of practice, I have seen many clients for whom this is true, but I have also seen many clients who found they did not need to restrict food once they healed their relationship with food and learned to eat intuitively.

For my clients who do need to manage food intolerances, understanding the principles of intuitive eating is of great help. Once you’re well attuned to your internal cues of hunger, fullness and how food leaves you feeling, the decision of whether or not to eat something that may trigger symptoms becomes less distressing. You may decide to eat a food with the knowledge you’ll get symptoms, but the decision is wholly yours and based on knowledge of how you’ll feel afterward. At times you may decide it’s worth it to enjoy the food or the social situation. Or you may choose not to eat the food, even though you enjoy the taste, because you know eating that food will leave you feeling unwell and therefore you’re not actually going to enjoy the experience of eating that food no matter how good it tastes. In this case, choosing not to eat something is in the name of self-care, not deprivation or restriction based on diet rules. 

But what if I do this and I’m still battling the food police?

The food police is the voice in your head that says things like “don’t eat that” or “you’re not allowed to eat that.” This voice arises from diet rules where certain food is seen as fattening or “bad” based on rigid “health” ideas or weight control. If you feel you’re still battling the food police with your choice not to eat something due to food intolerance, you might like to change the dialogue. When the voice says, “you’re not allowed to eat that”, you could practice replacing that thought with “I can eat that if I really want to, but how will I feel afterwards?” You might allow yourself to eat the food in question a number of times to give yourself permission to enjoy the food and assess how it does leave you feeling. Even if the food does leave you feeling uncomfortable, the choice is still yours as to whether you truly want to eat it or not.

But I have Coeliac disease and have been told I must avoid the food completely…

If you have Coeliac disease, management does involve life-long avoidance of gluten. Again, if you choose not to eat a gluten containing food, this is based on self-care and not a diet rule. I have had a few clients with Coeliac who due to their troubled relationship with food would still find themselves eating gluten at times. In these instances, healing my client’s relationship with food and body was a vital step in reaching a point where they chose not to eat gluten based on self-care. While they were working through this, they gave themselves permission to eat gluten if they really wanted to. As their dietitian, I fully supported their choice and allowed them to come to their own decision when they were ready. For those of you reading this and thinking “but you can’t let them eat gluten”; remember, they already knew they needed to avoid gluten for a serious medical condition, initially this knowledge wasn’t enough to do so. In some cases, re-emphasising the need to avoid gluten at a time where a person is feeling “out of control” around food, would only be counterproductive. As clinicians, we must meet our patients where they are at for best outcomes for long-term self-care.

A note on food allergy

If you have a true food allergy with anaphylaxis or anaphylactoid reactions, then hopefully the potentially life threatening nature of your allergy is enough that you choose to avoid the food in question out of pure self-care (i.e. staying alive). I don’t work with food allergy as such – I have clients with food allergy but they manage it without my help – therefore, if you have true food allergy and you feel this hinders your ability to eat intuitively, please feel free to leave a comment on Facebook.

Final word

Eating intuitively is all about eating in a way that is in tune with your body’s internal regulation of appetite and how food leaves you feeling in the moment and longer-term. For some people this may involve limiting or avoiding particular food due to GI issues, headache/migraine, energy levels, skin rashes, respiratory issues or mood disturbances. Your decision of whether to eat or not eat a food is a decision you make because it’s what feels right for you. Remember, as an adult, you are the expert of your body and the ultimately the only person who knows what’s best for you.

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The diet mentality and why allowing yourself to eat what you really want might just be a better recipe for health.

The diet mentality in action…

You’re out to dinner. One of your favourite meals, lasagna served with garlic bread, is on the specials board. The voice in your head says “don’t eat that, it’ll be loaded with fat, carbs and calories!” So you order the warm chicken salad, it’s tasty and filling but leaves you feeling you want something else. The voice in your head says “go on, have dessert, after all you were good and chose the salad and you didn’t have any bread.” So you order dessert, feeling somewhat justified but also not without a touch of guilt. The dessert appears and it looks delicious. You take a bite and it’s incredibly rich and tastes divine! About half way through you notice you’re really quite full and have had enough. You overrule this observation as you rarely ever let yourself have dessert, you experience the “I’ll get it while I can” effect that comes with thoughts such as “this will be the last dessert I have for a while”.|

You leave the restaurant feeling overfull and slightly sick, you’re starting to regret ordering dessert and you think to your self, “no more sweets as of tomorrow!” An hour later at home, you find yourself thinking about the chocolate in the fridge. You have the thought “I may as well eat that too given I’ve already blown my new healthy eating regime and NO MORE SWEETS AS OF TOMORROW!”

Sound familiar?

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Now I want you to imagine ordering the lasagna and doing so with no judgement, you’re simply ordering because you like lasagne and you’re hungry for it. The lasagne arrives and it looks as good as it smells! Extra cheesy, just the way you like it. You’ve learnt about mindful eating and savouring your food and you do so, when you finish you’re truly satisfied. You consider dessert but you’re nicely full and the meal really did hit the spot. You thank your companion for a lovely evening and go home to bed.

This is an example of normal healthy eating.

As you learn how to loosen your grip and eventually let go of diet rules and diet mentality, this type of eating experience becomes possible.

If you resonate strongly with the diet mentality scenario, suddenly switching this off is not as easy as flicking a light switch. You most likely have many years of programming and it takes time and patience to rewire your brain, but it is possible. Don’t be afraid to ask for help from a HAES/non-diet dietitian or therapist.

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The ability to be so selective with what we eat is a Western world privilege.

In terms of the Western world, I strongly suspect an over-abundance of food, our desire for convenience and of course the food industry, are reasons we have so much highly processed food in our diets. The proliferation of such processed food is, I believe, a large part of why so many people are turning to different forms of eating, be it ‘paleo’, ‘clean’, gluten free, quitting sugar, vegan etc. After all, if we only had fresh whole food available to us, the term ‘clean eating’ most likely would not have arisen. I also suspect that if we only had fresh whole food available to us, and this includes whole-grains and legumes, the paleo diet also would not have come about. There is no doubt the over-use of refined sugar in processed food is a why people have started quitting sugar.

The one thing all these new styles of eating have in common is the elimination of highly processed food. Well at least that’s what the idea was, the food industry has responded with plenty of packaged paleo food (there’s paleo chips, paleo chocolate, paleo protein bars, paleo muesli) and highly processed sugar-free (insert anything free) food, which ironically is exactly how we got into this “food fight” in the first place. Watch this space, in a few years there will another style of eating to combat all the new processed food that has infiltrated paleo, clean eating and quitting sugar – at some point I’m sure the halo will fall from rice malt syrup and it too will be seen as “evil”.

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While all this goes on, there are millions of people in the world who are just happy to have whatever food is available. They have no interest in whether the food is sugar free, clean, paleo, alkaline or Calathumpian and most likely they don’t even know theses terms exist – except maybe Calathumpian.

Rice, maize (corn) and wheat provide 60 percent of the world’s food energy intake (see source below). Of the top 10 crops in the world, all are carbohydrate rich food. I am not suggesting that this is the way it should be, but it is the current situation. The overwhelming majority of people in the world cannot afford (and I don’t just mean financially) to adhere to these Western world food trends. Luckily for them, they don’t need to, and nor do we. I’m not saying eating clean, paleo or sugar free is wrong, I’m just pointing out it’s not necessary in order to eat well and looking at some of the reasons these styles of eating have come about. Dietitians and nutritionists have been banging for years about reducing sugar – for some reason our collective voice is not really heard, it seems you need to be a celebrity, or have the message SUGAR EQUALS DEATH to be really heard. The power of the food industry might just be playing a part in our voices being drowned out, and this is probably happening to quitting sugar too.

However you choose to eat, try to keep things simple, ensure the bulk of your diet is whole fresh food (veggies, fruit, nuts, legumes, whole-grains, eggs, meat, fish, dairy, oils etc), consider how much highly processed food you consume, from an environmental and nutritional stand point, and be thankful you have access to so much nourishing food. Try to avoid placing a moral value – I’m being so good, let’s be naughty – on how you eat, or following a style of eating that doesn’t fit in easily with work, family, social events or travel, or where you don’t receive pleasure from food and eating.

Why? Aside from the practical difficulties and having to restrict food you might actually enjoy eating, restrictive eating can foster an unhealthy relationship with food and can lead to disordered eating or eating disorders. If one of your reasons for following a specific style of eating is weight loss or your appearance, then you may be increasing your risk of body image dissatisfaction, weight cycling and ultimately, weight gain. If you have ever dieted, you will know what I mean.

Note: if you have been properly diagnosed with Coeliac disease or a gluten intolerance by a health professional, then of eating gluten free is necessary for you. Vegan is also an ethical choice for which a person has every right to.

Source: What the world eats

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Fish & Chips – No, they’re not fattening…

Pictured here is a meal of fish and chips. Many people will look at this picture and think; “fish and chips are loaded with calories and fattening” or “fish and chips are bad for you.”

The wonderful thing about enjoying all food in moderation is that no one type of food will result in you consuming excess calories or will adversely affect your health.

What is moderation?

Moderation is the avoidance of extremes, a place where you don’t completely restrict yourself, or go completely nuts, around food you want to be able to enjoy. Moderation is not a line in the sand that you draw, it looks different to different people and will even vary for the same person depending on factors such as appetite, mood, environment, current circumstances and even the weather! Ultimately, once you find what moderation means to you, you will be able to enjoy your desires without it being excess to the point of regret. But, as Oscar Wild famously said – “everything in moderation, including moderation” – meaning that sometimes going to excess is ok too.

It is very possible to enjoy fried food, such as fish and chips, without needing to worry about excess calories/fat or the meal being “unhealthy”. Provided you are physically hungry for the meal, eat in a mindful manner so as to truly enjoy the food, and you are able to make a choice to stop eating when you’re satisfied (a sense of comfortable fullness and pleasure from the meal), you really do not need to worry about how many calories you are consuming or whether or not the meal is nutritious enough. I might point out here that potatoes and fish are actually very nutritious, even when deep fried.

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Worrying about calories can take much of the pleasure out of eating and you may find you’re less likely to feel satisfied at the end of the meal. Thinking you have eaten too many calories may also leave you feeling guilty and saying to yourself “oh well, I’ve blown it now, I may as well just keep eating!” While you may have been slightly past comfortably full after your first round of fish and chips, chances are you will feel uncomfortably full (eaten too much) if you keep eating.

I love this quote by William Shakespeare: “There is nothing either good or bad, but thinking makes it so.”

You can see from this scenario that by thinking you had eaten more calories than “allowed” and “blown it”, you then end up eating excess calories. This type of situation is much more likely to happen if you are following a prescriptive diet or meal plan, or counting calories.

Now some people will think, “but if I followed this philosophy, I’d fish and chips all the time!” Would you? Read the following sentence first and then I want you to close your eyes and imagine. Imagine choosing to eat fish and chips every day, or even 3 times a week, week in week out. What do you think might happen after a few days or weeks? The common response I hear from people is they’d get sick of the food and never want to see that meal again, at least for a time. You can do this same imaginary exercise with any meal, say grilled salmon and a Greek salad, would you really want to eat the same meal day in day out? 

Next time you have a meal out (or even at home), try to put aside any thoughts about calories or nutrition. Instead, appreciate how the food looks, how it smells, how it tastes and think about how you feel in terms of your hunger and fullness, before, during and after the meal. Also consider how the food taste changes as you progress through the meal. For many people, this is not as easy at it sounds, and for some people it takes time to be able to reconnect with food, appetite cues and sensations in the body. This is a key part of what the intuitive eating process is about.

If you do choose to avoid a certain food, don’t make that choice because it’s high in calories or because you’re trying to lo lose weight; but because it’s not what you feel like eating right at that moment or because you’re not actually hungry for the food.

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What moderation is really all about.

An article titled “Moderation is a terrible rule to eat by” was recently brought to my attention. It is clear the author does not appreciate or understand the context within which the concept of moderation is applied by dietitians or nutritionists. She states “Nutrition professionals have a specific meaning for the word: moderation means small portions, especially when talking about food that we should eat little to none of.”

I’d be interested to know where she found this “definition”. It’s certainly not what I know it to mean. The concept of moderation does not dictate the size of portions, not does it consider there are foods we should eat little or none of. The dictionary definition is the avoidance of excess or extremes.

The philosophy behind the concept of moderation is much more than just eat “everything in moderation”.

I highly doubt (and sincerely hope not) there are any dietitians or nutritionists who just advise to eat everything in moderation and you’ll be fine.

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To enable people to practice moderation, many of us use the concept of intuitive eating.

Intuitive eating is about nourishing your body when you’re hungry and recognising how much food is enough for you at any given point in time. It is about eating mindfully and really appreciating how food looks, smells and tastes. It is knowing what food truly satisfies you both physically and mentally, what food leaves you feeling good inside. See this blog or visit The Non-Diet Approach page for more about what intuitive eating is.

Here is are two examples of how intuitive eating can guide moderation.

  1. Pictured below is the dinner I enjoyed yesterday evening. Given I was hungry before ordering the food and then comfortably full after finishing the meal, this is an example of enjoying food in moderation. It has nothing to do with only eating a small amount of pate or only a few chips (not pictured), I ate what I wanted and thoroughly enjoyed it! Some may argue that if they did this, they would always eat pate and chips (or their favourite food) for dinner. I would challenge them, that if they were truly in tune with their body and appetite, they would not want to eat the same food all the time, that their body would crave a variety of foods. Many people can relate to having been away, eating out more and often with not much vegetables and after a time, starting to crave vegetables, salad and fruit.
  2. Sometimes you eat 2 squares of chocolate as that is all you feel like, sometimes you eat more as that’s what you feel like at that moment and sometimes you choose not to have any.

If you have a positive attitude to eating, are nurturing a healthy relationship with food and your body, then moderation is a wonderful concept to practice and live by.

Thanks for reading and as always, I am happy to take your comments on Facebook! This blog was posted on The Moderation Movement

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