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Am I Ready to Work With a Registered Dietitian?

Investing in our health is just that; an investment. It takes commitment, dedication and perseverance. And in some situations, it is also a financial investment as some individuals may not have an extended health benefits plan that covers dietitian services and psychotherapy, two services that are essential to eating disorder recovery. 

When considering working with a Registered Dietitian, it’s essential to understand that it is not a quick-fix, one-and-done sort of thingfix. Dietitians offer so much more than a band-aid solution to a problem. They work with clients on an ongoing basis to help us live long, thriving lives. This is especially true when working with a dietitian to overcome an eating disorder. Diet culture has been ingrained in our brains for as long as we can remember, so naturally, it will take some time to reverse the damage and change our perceptions as we restructure our beliefs around food. It will take time to recognize that there are certain unhelpful behaviours clients may be using  that although may have once played a role,  are no longer needed in one’s life.

This is something that is rooted in the behaviour change model, which is based on ongoing interpersonal interactions with a trained professional whom may suggest small, attainable changes in behaviour as the individual becomes ready1. Making small changes is beneficial because if the goal seems achievable, we are more likely to be successful in accomplishing that goal. It also helps us to overcome barriers by planning how we will respond to situations before they arise so that we are better equipped to cope in the moment and can start to put planned actions into practice until they eventually become natural2. Implementing these behaviours is a gradual process and developing a trusting relationship with our healthcare team helps to create a collaborative environment where open discussion can occur regarding what is working and what needs to be adapted. 

According to the Transtheoretical Model of Change, there are five different stages of change; pre-contemplation, contemplation, preparation, action, and maintenance3. The pre-contemplation stage reflects a time before we even begin thinking about changing and may still be resistant to change or be in denial of needing help. The contemplation stage demonstrates the process of thinking about reaching out for help and support, followed by the preparation stage where we begin to feel ready to seek help. The action stage is the process of beginning to attempt to implement change, and then maintenance involves the prevention of relapse. Individuals can also move back and forth between these stages of change, which emphasizes the importance of seeking help individually. Meeting with a Registered Dietitian ensures that an individual  can receive the personalized support based on their needs in that moment,what they are ready for or what they need at a specific time. Here at change.creates.change, we often use motivational interviewing to assess how to best help our clients move through the different stages of change, and we focus on demonstrating acceptance and empathy4. Our dietitians are also able to adapt to resistance and take a different approach if needed, as well as supporting self-efficacy. We help our clients to feel empowered that they have the ability to be successful in the recovery process.  

Because we work exclusively with those looking to repair their relationship with food and their body, the change.creates.change team focuses on offering packages and not stand-alone sessions in the beginning of the nutrition counselling relationship. This is to allow time to establish a strong rapport and provides clients the opportunity to affect behaviour change. Furthermore, it is to ensure clients have adequate support and monitoring as they move through the stages of refeeding, which can have some uncomfortable physical and psychological effects for clients with disordered eating.


References

1Duffy, F.D. (2012) Counseling for behaviour change. Goldman’s Cecil Medicine (Twenty Fourth Edition). Retrieved from: https://www-sciencedirect-com.proxy1.lib.uwo.ca/topics/medicine-and-dentistry/behavior-change

2Hsieh, H., Kanda, Y., Fuji, S. (2019) Incorporation of coping planning to the behaviour change model that accounts for implementation intention. Transportation Research Part F: Traffic Psychology and Behaviour. Vol. 60. Retrieved from:https://www-sciencedirect-com.proxy1.lib.uwo.ca/science/article/pii/S136984781830086X?via%3Dihub

3Dawson, L., Mullan, B., Sainsbury, K. (2015) Using the theory of planned behaviour to measure motivation for recovery in anorexia nervosa. Appetite. Vol. 84. Retrieved from: https://www-sciencedirect-com.proxy1.lib.uwo.ca/science/article/pii/S0195666314005091?via%3Dihub

4Wilson, G.T., Schalm, T.R. (2004). The transtheoretical model and motivational interviewing in the treatment of eating and weight disorders. Clinical Pyschology Review. Vol. 24. Retrieved from: https://www-sciencedirect-com.proxy1.lib.uwo.ca/science/article/pii/S027273580400039X?via%3Dihub

Refeeding FAQs

Eating to nourish our bodies and help with nutritional healing is key to flourishing in eating disorder recovery. Some nutrition goals include repairing negative food relationships, incorporating foods that induce fear and develop a lifelong routine of normalized eating patterns.1 Weight restoration can also be a key factor in recovery if individuals present as weight suppressed.2 During this stage, the quantity and density of food types is especially important.1Like in other stages of the recovery process, there are no food rules or restrictions. 

Is it normal to feel anxious and overwhelmed in the beginning stages of mechanical eating?

In the first stages of refeeding, individuals are working hard to transition from a negative relationship with food to a positive one. They are challenging their minds to ignore food rules and unrealistic ideals portrayed by the media, and instead, put faith in their bodies again. At this time, we want to focus on eating energy dense foods multiple times each day to meet the body’s nutritional needs while also keeping the volume load of the stomach manageable. This helps to reduce some of the uncomfortable digestive issues that can arise when first starting out 3 IT IS NORMAL TO FEEL ANXIOUS AND OVERWHELMED! You are asking a lot more out of your body than usual. You will be eating more than you’re used to and going against the eating disorder thoughts that constantly reside inside your mind. The good news is, our bodies are quite resilient and get used to the higher amounts of food quickly. The gas, bloating, constipation and/or diarrhea will be alleviated within a couple of months. 

How will I know when and I’m hungry? What if my body doesn’t tell me?

Once our bodies start to receive food on a regular basis, hormones begin to regulate and the body can revert back to its natural bodily processes. Cortisol levels decrease and the fight or flight response subsides in response to our bodies’  and being nourished adequately. Eating several meals throughout the day will eventually stimulate digestive processes to facilitate the response of hunger.3,4 When our bodies’ requires energy, there are a few things that happen. First there is a drop of blood suga, followed by a shift in hormones.  Signals are interpreted by the brain and sent to the body causing our stomachs to growl and the feeling of hunger to kick in.4 Our sensory and psychological cues also influence hunger and the desire to eat, which includes sight, smell, taste and emotions.4

It may take some time for hunger cues to be restored, and that’s why we use mechanical eating in the initial stages of refeeding. Working with a Registered Dietitian trained in the refeeding process can help you learn how to mechanically eat for your own body to help restore your hunger and fullness cues. 

How will I know if I’m eating too much or too little?

Energy consumption is increased gradually throughout the recovery process. Recommendations are individualized and based on the individual’s energy needs and stage of recovery. However, the basis of eating in recovery is relatively the same for everyone. Clients usually start off by repairing their nutritional deficits and increase their food intake. Over time, the amount of food consumed slowly increases to best meet the client’s needs. The important factors of a meal plan for standardized eating are the quantity and type of foods consumed as well as the timing of the meals being consumed.1 It is important to note that some individuals are more susceptible than others to gastrointestinal symptoms and may be vulnerable to bodily complications. A dietitian will work with individuals to help with refeeding syndrome by developing a plan that is tailored to the specific individual needs.1

Why can’t I follow Canada’s Food Guide for eating normally? 

One of the main goals in recovery is to get our clients’ bodies to a place where they can live a life they want to live. In order to accomplish this goal, our team helps clients take steps to repair their body with increased energy and specific nutrients. Canada’s Food Guide can be a useful resource for populations but is not tailored to the specialized needs of individuals living with eating disorders.3 Instead, Registered Dietitians create individualized nutrition care plans with their clients to help them make adequate nourishment a priority.  


References

  1. Garner, DM. Desai, JJ. Desmond, M. Good, A, Wohlers, J. (2017) Nutritional Rehabilitation for Eating Disorders: River Centre Clinic Program Description. In Ann Nutr Disord & Ther. Retrieved from https://www.austinpublishinggroup.com/nutritional-disorders/fulltext/andt-v4-id1044.php
  2. Marzola, E., Nasser, J. A., Hashim, S. A., Shih, P. B., & Kaye, W. H. (2013). Nutritional rehabilitation in anorexia nervosa: review of the literature and implications for treatment. In BMC Psychiatry,13(1), 290. https://doi.org/10.1186/1471-244X-13-290
  3. Waterhous, T. (2015) Normal Eating. Retrieved from https://www.mirror-mirror.org/noreat.htm
  4. Kornell, N. (2014) Hunger Comes From Your Mind, Not Just Your Stomach. Retrieved from http://www.psychologytoday.com/blog/everybody-is-stupid-except-you/201411/hunger-comes-your-mind-not-just-your-stomach

Animal-Assisted Therapy

Animal-assisted therapy can be used as a complementary practice in eating disorder recovery, providing a sense of calm and comfort in healthcare appointments. Animal-assisted therapy often involves a dog, cat, horse, or another animal, and is usually used in addition to other practices along the recovery journey. Animals show love and affection unconditionally , providing comfort and support that is readily accepted and trusted1. Having positive emotions associated with the animal can steer clients away from any negative thoughts that we may be having, as it is challenging to focus on both the positive and the negative ones at the same time. Additionally, the animal can act as a buffer during uncomfortable conversations, making it easier for clients to open up, and to cope with certain feelings1. It helps bring forth feelings of trust while providing a distraction, lessensingthe burden of a serious conversation and helping clients to feel more comfortable. Animals can provide a warm, comforting feeling that one doesn’t’ necessarily get from speaking with a healthcare professional alone.

These feelings of trust, love, feeling calm, and positive emotions are beneficial in the recovery process. Clients can sometimes feel reserved or guarded, and an animal helps them to feel more at ease. Often the presence of an eating disorder can lead to a negative impact on one’s relationships with others as loved ones tend to be shut out. With the addition of animal-assisted therapy, clients can start to experience those feelings of love, acceptance, affection, and support again, which can potentially have a positive impact on healing other relationships in their lives. Petting a dog while talking to a healthcare team member can help clients to feel more protected and less stressed or overwhelmed. It also gives clients something to look forward to that brings them joy and adds fun to an otherwise potentially stressful situation or uncomfortable task, helping to motivate them to continue attending sessions. 

Just as petting a dog can be a positive distraction during a conversation, it can also be beneficial after a meal to distract clients from eating disorder behaviours or feelings. A therapy dog can help to keep clients in the present moment and help them to step away from restrictive thoughts that may be going through their minds1. Animals do not hold a false sense of what beauty should look like, and are a great reminder that everyone is deserving of love and compassion. Having therapy animals around to help support clients is a beautiful addition to the many aspects of recovery and brings forth many positive benefits for one’s emotional well-being. 

Longbottom, our therapy dog-in-training, accompanies our Lead Dietitian Jillian in all her sessions with clients. In November, Longbottom will be evaluated and officially become certified as a therapy dog! Until then, Longbottom stays close to Jillian and gives everyone a high five on their way out of the office (as seen in the photo).


References

  1. Patricia Flaherty Fischette (2017). Animal-assisted therapy (AAT) as an adjunctive treatment for eating disorders: exploration of AAT through the lens of attachment and affection regulation. Retrieved from: https://search-proquest-com.proxy1.lib.uwo.ca/psycinfo/docview/1957279631/477AF25A9BE04DC9PQ/1?accountid=15115

What to Expect During the Refeeding Process

Eating disorder recovery usually involves several treatment interventions. Refeeding, or the refeeding process, is used in treatments with other effective strategies to treat patients who are recovering from disordered eating. Nutrition rehabilitation and weight restoration are the first components of the refeeding process and is taken very seriously to avoid symptoms of refeeding syndrome1. Clinicians and the multidisciplinary team work alongside one another to ensure that the refeeding plan is easy to understand, safe and individualized. During the refeeding process, an individual may experience the usual symptoms of mechanical eating, those being gastrointestinal discomfort, increased satiation, body fluid fluctuations and re-established hunger cues. An individual may also experience feelings of psychological discomfort and may regress by engaging in self-defeating behaviours throughout the process of mechanical eating1. The refeeding process will teach individuals in recovery about normalized eating, restore hunger cues, improve their relationship with food and adopt new eating patterns. 

The refeeding process is used in collaboration with other treatments and therapy programs. It is important that the individual manages their stress throughout the varying metabolic changes and weight restoration processes. The goal for an individual in recovery is to achieve their setpoint body weight through mechanical eating and nutrition therapy. This process involves consuming a surplus of energy that the body is not used to and during this change, physiological changes can occur. The body may endure a shift in fluid balances, electrolytes and hormones as the body is working to repair itself and moving away from a state of starvation. The body also shifts from being in a catabolic state to an anabolic state, now using energy and nutrients to build and repair tissues and vital organs2. Weight gain will occur as the body moves from a dehydrated and malnourished state to a hydrated and nourished state. Changes in lean body mass, water retention and body fat are normal and need to occur in order for someone recovering from an eating disorder to reach their setpoint body weight3.  Uncertainty is something that individuals may face as they can experience a fluctuation in weight in result of the extra energy and nutrients that they are now consuming. This is a normal part of the process. Some symptoms reported pertain to the gastrointestinal tract which include bloating, diarrhea and abdominal discomfort4. This is due to the expansion of the abdomen and digestive processes that are being repaired. Digestion remains slow in the first stages of the refeeding process, which is why most patients experience bloating and/or gas4.  The bloating sensation will be reduced as our body gets used to normal eating. Some patients also report constipation while refeeding. Eating more fibre and water can improve this symptom over time4.

Mechanical eating is a way of eating to normalize eating behaviours and restore hunger cues. This integrated eating strategy is used to treat most eating disorders, including anorexia nervosa, bulimia nervosa and binge eating disorder5. It is a structured way of eating three meals and two ot six snacks daily according to an individualized timely schedule5. The idea is to eat every few hours to keep your body engaged, channel hunger cues and adopt normalized eating behaviours. Throughout eating disorder recovery, working with a Registered Dietitian can help individuals to establish a mechanical eating plan that is tailored to their lifestyle, levels of comfort and readiness for change1.

The refeeding process may also trigger psychological discomfort. This can due to the fact that individuals recovering from an eating disorder are undergoing cognitive restructuring and learning how to adopt normalized eating behaviours and cope with the many changes in their body. Eating disorder thoughts may increase as mechanical eating goes against unrealistic health ideologies and food rules that were once followed. Individuals usually experience anxiety in many form such as stress, nervousness and varying emotions of uncertainty and unpredictability3. If the individual has begun to engage in self-defeating behaviours, it is important to remember to be kind to their future selves and to not allow feelings of guilt or shame cloud their thoughts and goals for recovery.  Regression is a normal part in recovery and can be treated by remembering why one started on the path to recovery in the first place.  Don’t allow oneself to get stuck in the past; move on, find self-acceptance and work towards progression. 

 Recovery is a slow process that is not linear; it is very common for people to take steps backward before moving forwards. By trusting the process and working towards a goal with your family and healthcare team, the process can be much more manageable and comfortable. It is important that the individual in recovery is comforted by their support system and is actively talking about their emotions, fears and concerns with their healthcare team.  At this time, a sense of security and reassurance will help the individual to progress and reach further stages in recovery. 

Eating intuitively can be the ultimate goal in the recovery process but this can not be reached without first tackling refeeding. 


References

1) Mehler, P. S., Winkelman, A. B., Andersen, D. M., & Gaudiani, J. L. (2010). Nutritional rehabilitation: practical guidelines for refeeding the anorectic patient. Journal of nutrition and metabolism,625782. doi:10.1155/2010/625782

2) Mascolo, M. (2018) Refeeding Patients with Anorexia Nervosa: What Does Research Show? In Eating Disorder Hope. Retrieved from https://www.eatingdisorderhope.com/information/anorexia/refeeding-patients-with-anorexia-nervosa-what-does-research-show

3) Winkler, J., Alperovitz, D. (2015). The body’s response to adequate fuel in anorexia. In Eating Disorders Catalogue. Retrieved website: https://www.edcatalogue.com/the-bodys-response-to-adequate-fuel-in-response-to-anorexia/

4) Nutrition in Eating Disorders. (n.d.). 2016. In Nova Scotia Health Authority. Retrieved from http://www.nshealth.ca/sites/nshealth.ca/files/patientinformation/0308.pdf

5) Grave, R. D. (2005). A multi-step cognitive behaviour therapy for eating disorders. In European Eating Disorders Review, 13, 373–382. doiI: 10.1002/erv.671

Starvation Syndrome

Starvation syndrome can occur in individuals of all weights when the body is denied energy through food restriction for a prolonged period of time. It is common in individuals with eating disorders because they often restrict food, eat irregularly, and try to compensate ingested calories through overexercising or forcing the body to eliminate food quickly. The symptoms that are commonly associated with eating disorders are often symptoms of starvation syndrome. This blog post discusses several of these symptoms as well as common ways to help combat these uncomfortable symptoms. Remember that it is important to seek help from a Registered Dietitian or doctor if you are struggling with an eating disorder. 

Starvation impairs physiological, emotional, cognitive, and social functions. The physical changes that may take place can affect several different organs and body systems. Less visible physical changes that can occur are: reduced heart muscle mass, decreased heart rate, decreased blood pressure, slower basal metabolic rate, extreme fatigue, weakness, dizziness, feeling cold all the time, and decreased hormone levels.1More visible physical changes that can occur are: hair loss, blackouts, fluid retention, lack of sexual desire, and dry skin.1Emotional changes often take place as well and can manifest themselves as depression, anxiety, irritability, or loss of interest in life.1Brain function can also be impaired, resulting in impaired concentration, impaired comprehension, impaired judgement and ability to make decisions, obsessional thoughts, and decreased alertness.1Starvation syndrome can also affect friends and family as starving individuals can lose their sense of humour, withdraw from relationships, neglect personal hygiene, and/or isolate themselves.1Additional possible behaviour changes include: frequent thoughts about food, strict meal planning, very fast or slow eating, increased hunger, binge-eating, hoarding, and increasing the use of spices or condiments.1

Although starvation syndrome has a long list of potential side effects, it can be reversed. Treatments to reverse starvation syndrome comprise of physical re-nourishment, weight restoration, and psychological therapy to address negative feelings about food and body-image. Physical re-nourishment, also known as the initial refeeding process,is the foundation for other positive changes. It involves establishing regular eating habits and consuming nourishing meals. The symptoms of starvation may persist in the beginning of re-nourishment, but they will disappear eventually.  

Regular eating is important as it brings the body back into balance. Humans function best when they eat about every 3 hours throughout the day.2When recovering from starvation syndrome, it may be helpful to “eat by the clock” at the beginning to get your body use to consuming food regularly. Try to aim for 3 meals and 2-4 snacks each day. Preparing your meals in advance may also be helpful with staying on schedule. At first, it may feel uncomfortable to eat every 3 hours, but your digestive system will adapt overtime. Once you have a regular eating routine in place, you can begin to increase your portion sizes and broaden your food choices. It may also be helpful to drink fluids between meals so that you have more space for actual food. 

Recovering from starvation syndrome is a long process. You will probably hit a few bumps along the way, but remember that recovery is possible and you CAN do it. Try to make use of some of the resources that you may available to you such as a trusted Registered Dietitian, doctor, friend, and/or family member. You can fight starvation syndrome and take back your life. 


References

  1. What is starvation syndrome? (2018). In Centre for clinical interventions. Retrieved from: https://www.cci.health.wa.gov.au/~/media/CCI/Mental%20Health%20Professionals/Eating%20Disorders/Eating%20Disorders%20-%20Information%20Sheets/Eating%20Disorders%20Information%20Sheet%20-%2033%20-%20What%20is%20Starvation%20Syndrome.pdf.
  2. Flemming, K. (2018). Regular Eating for Recovery. In Centre for clinical interventions. Retrieved from: https://www.cci.health.wa.gov.au/Resources/~/media/95F9A1FC3F1C4D0A92CD31B09166FDDB.ashx.

Relapse Prevention

Recovering from an eating disorder is a huge achievement, but it often involves a few setbacks along the way. Relapse occurs when an individual who has recovered from an eating disorder reverts back to some of their old disordered cognitions and behaviours, such as negative thoughts about food or their body. Relapses are completely normal, but there are some things a person can do to prevent them or make them less destructive to their overall recovery. This blog post discuses common signs of a relapse as well as some prevention strategies that can help facilitate a smoother recovery.

It is important to be able to recognize a relapse budding in order to make use of some of the strategies below. Some possible warnings signs are: frequent weigh checks, skipping meals, avoiding certain foods, an increase in exercise, looking in the mirror often, social isolation, wearing loose-fitting clothes, difficulty coping with stress, avoiding situations that involve food, desiring more control, and/or striving to be perfect.

Strategy 1: Develop a Strong Support System: Find people who support you and encourage your recovery in a way that makes you feel comfortable. These people can be professionals, family members, or friends. Once you find a good support system, be sure to use it when you need to. Reaching out for the very first time may be difficult, but it will get easier. Remember that these people want to help you! It may also be helpful to generate a contact list that includes everyone on your support system so that if you feel yourself slipping, you can reach for the list and connect with someone. 

Strategy 2: Identify Your Triggers & Develop A Coping Plan: Identify all of the triggers that bring you negative emotions or thoughts and lead you towards your old disordered eating habits. Planning to avoid any of the triggers is not a realistic and sustainable plan. Instead, identify a coping mechanism that will work to combat each of the triggers. Some examples of coping mechanisms include: reaching out to your support system, finding a peer support group, using positive affirmations, or distracting yourself with an activity you enjoy. Making a list of coping mechanisms that you can quickly access when you feel triggered can also help keep you on track with your recovery. Most importantly, be honest with yourself if you feel any eating disorder symptoms returning as the faster you address them, the easier you will find your way back towards recovery.

Strategy 3: Identify & Reduce Negative Influences: A negative influence is anything that is not helpful to your recovery. It may bring about negative and unsupportive comments, thoughts, comparisons, or emotions. Some examples of potential negative influences are people, social media, television, certain websites, magazines, a scale, mirrors, old clothes, and certain social settings. If the negative influence is a loved one, try to talk to them about the situation. If the negative influence is electronic, get rid of it. It may be useful to unfollow accounts on social media that stir up negative emotions and replace them with inspirational and motivating accounts. In addition, stop watching shows or movies that are triggering; instead, replace them with entertainment that makes you smile and laugh. You are able to choose your surroundings to a certain extent. Take care of yourself and do what is right for you.

Strategy 4: Eat Regularly: When trying to prevent a relapse, it may be useful to develop a meal and snack plan that helps you to eat regularly. Sometimes, returning to mechanical eating is very helpful in relapse prevention and involves planning what you will eat and when you will eat it. Be sure to choose meals and snacks that you enjoy so that you can look forward to eating. Alternatively, In addition, it may be helpful to prepare some meals and snacks in advance incase life gets busy or you find yourself reverting back to old habits. 

Strategy 5: Do What Makes You Happy: It may be difficult to find the motivation and strength for recovery if one does not take care of themselves. It is helpful to engage in activities that promote physical and mental well-being. Try to fill your life with joy and happiness by spending more time with loved ones or participating in activities/clubs that you enjoy. It is also important make time for yourself to relax and unwind when you need it. This can mean taking a bath, painting your nails, putting on a face mask, getting a massage, meditating, doing yoga, listening to music, reading, writing, drawing, or anything else that brings you serenity. 

When recovering from an eating disorder and trying to prevent a relapse, believe in yourself and try to find your inner strength and courage. Recognize how far you have come already! Relapses may feel like a step in the wrong direction, but they can just be a minor slip if you are determined to find your way back towards recovery. Each relapse can teach you something new about your triggers and strengthen your coping skills. Recognize that your journey will not be perfect, but the slips along the way will guide you towards a full recovery. 


References

  1. Relapse Prevention. (2019). In Kelty eating disorders. Retrieved from: https://keltyeatingdisorders.ca/recovery/relapse-prevention/.

How Our Dietitians Can Help You in Eating Disorder Recovery

A Registered Dietitian (RD) is an integral part of the multidisciplinary healthcare team that should be involved in eating disorder recovery. An eating disorder is a mental health diagnosis and therefore requires the involvement of healthcare professionals from various disciplines, including a General Physician (GP), a therapist (a psychologist, psychotherapist or social work) and a dietitian. RDs are regulated health professionals who have gone through years of school and training and are qualified to provide evidence-based recommendations to help clients meet their nutritional needs. Dietitians who specialize in eating disorders have undergone further specialized training related to eating disorders to qualify them to work with this high-risk population.

The dietitians at change.creates.change Nutrition Counselling are here to support the client throughout the eating disorder recovery process. As this is intended to be a long term counselling relationship, it is extremely important that time is given to build trust and a strong rapport between the RD and the client. This means that our dietitians will spend time getting to know the client so they feel comfortable discussing their food behaviours, as well and their thoughts and emotions related to eating. This will build the foundation for the dietitian-client relationship so the client feels they can disclose personal information without fear of being judged. Additionally, there is no pressure for the client to set goals right away. It may take time for the client to feel that they are ready to begin changing their eating behaviours and that is completely okay Our dietitians are here to support our clients throughout the entire process, even when the client is not yet ready to change.

Over the first one or two sessions, our dietitians will conduct an in-depth nutritional assessment with the client to determine their usual eating patterns, food intake, feelings and fears surrounding food, supplement use and goals the client wishes to achieve1. Our dietitians will not only explore the factors which influence what the client eats, but also where, how and whether the client eats as well. This aspect of the dietitian-client relationship can be emotionally draining as the questions may stir up some strong thoughts and feelings in our clients. We encourage that our clients take fresh-air breaks during sessions when needed and that they are gentle with themselves following appointments. Oftentimes, our clients report experiencing a “vulnerability hangover” and we ask that our clients use self-soothing skills and reach out to their supports while they process their experience. 

One of the main roles of a dietitan in eating disorder recovery is helping the client normalize their eating behaviours. Since an eating disorder is a mental health diagnosis, those suffering from an eating disorder will most often have a distorted view of food, exercise and/or their own body. Our dietitians help clients to work through these distortions and help overcome their fear surrounding food. Normalizing eating behaviours is also important for recovery because the brain must be adequately nourished to function properly and do the hard work that is required in their therapy sessions. One of the ways this may be achieved is through the development of a mechanical eating plan. This eating plan will help the clients’ bodies get used to eating regularly again and help them relearn hunger and satiety cues which may have been diminished by their eating disorder. Eventually, the client will ease off of the eating plan as they relearn these cues and get more comfortable and skilled in eating normally2. This eating plan will be individualized to include a recommended number of meals and snacks per day and examples of food categories that should be included at each meal time to best meet the client’s nutritional needs and reduce the negative physical symptoms of refeeding their body. 

Those struggling with eating disorders tend to have misconceptions about nutrition and what foods they should be eating. An RD understands the vital role food plays in the body and why it is essential for health. They have studied the effects of food in the body and why many nutrients are needed each and every day. Our dietitians can also help the client view food in a more positive way. For example, a client may have the misconception that eating foods containing fat will make them gain weight. An RD would explore this food belief in detail with the client while also providing education around why fat is essential for the absorption of fat-soluble vitamins, production of hormones, and maintenance of the reproductive system, among many other functions3

Our dietitians will also assess the client’s current food skills. This includes their efficacy in meal planning, grocery shopping, food preparation, and general knowledge of food4. In addition to improving the client’s knowledge of food, there may also be the option to work on further developing such skills like meal planning and grocery shopping. Furthermore, our dietitians can provide meal support therapy to provide encouragement and guidance to clients during meal times and reinforce normalized eating through social modeling. Clients may also be invited to go on restaurant outings in order to practice their learned skills in a real-world setting. 

Ultimately, our dietitians at change.creates.change Nutrition Counselling are here to support clients during their eating disorder recovery. They play an integral role in helping to normalize eating behaviours and repair client’s relationship with food, ultimately supporting individuals throughout eating disorder recovery. 


References

  1. Gurze- Salucore Eating Disorder Resource Catalogue. (2014). The Role of the Registered Dietitian/Nutritionist on the Eating Disorder Team. Retrieved fromhttps://www.edcatalogue.com/role-registered-dietitian-nutritionist-eating-disorder-team-2/
  2. Mirror Mirror. (2015). Normal Eating. Retrieved from https://www.mirror-mirror.org/noreat.htm
  3. Centre for Clinical Interventions. (2018). The Facts on Fat [PDF file]. Retrieved from https://www.cci.health.wa.gov.au/~/media/CCI/Mental%20Health%20Professionals/Eating%20Disorders/Eating%20Disorders%20%20Information%20Sheets/Eating%20Disorders%20Information%20Sheet%20-%2025%20-%20The%20Facts%20on%20Fat.pdf
  4. Practice-based Evidence in Nutrition. (2014). Food Skills. Retrieved from http://www.pennutrition.com.proxy1.lib.uwo.ca/KnowledgePathway.aspx?kpid=22933&trid=22982&trcatid=38

Pregnancy and Eating Disorders

Growing a baby and becoming a parent requires a lot of physical, psychological, and emotional strength. The journey before, during, and after pregnancy can be difficult at times, especially for individuals struggling with an eating disorder as pregnancy can magnify negative feelings towards one’s body and towards food. Other the other hand, pregnancy can also be a healing experience for some as it gives a woman responsibility for another life. Either way, becoming pregnant with an eating disorder may be associated with morecomplications for both mom and baby if mom’s body is not adequately prepared and nourished before, during and after pregnancy1.

During pregnancy, there are many important nutrition and energy requirements that must be met in order to grow a healthy baby and maintain mom’s wellbeing. Nutrition and energy requirements become greater at each trimester and they continue to be elevated up to one year post-birth, especially if mom is breastfeeding. In the first trimester, the most important nutrients that the baby needs for proper growth and development are adequate energy, folate, vitamin A, vitamin B6, and iron.2This is when the heart, brain, bones, and placenta are developing.1During this time, there are also several critical periods of development that require a sufficient amount of specific nutrients. If these needs are not met, the baby may miss an important developmental stage and the damage will be difficult to be reversed. An example of this is a baby born with an open neural tube due to insufficient folate intake. In the second and third trimesters, energy needs increase along with protein, carbohydrate, vitamin C, and vitamin D.2This is when the brain, nervous system, muscles, tissues, fat storage, and facial features are developing.2Mothers who breastfeed continue to have increased energy and nutrient requirements in order to maintain breastmilk quantity.

Weight gain during pregnancy is a natural biological process that signifies a healthy pregnancy. Individuals with eating disorders may find this weight gain distressing, however it is important to remember that maintaining a stable weight or losing weight during pregnancy can have detrimental effects on the fetus. Even people who have recovered from an eating disorder may feel triggered during pregnancy. It may be helpful to know that not all of this weight gain is due to increasing fat stores; a lot of it comes from the baby, breast tissue, increased blood volume, uterine muscles, fluid retention, the placenta, and amniotic fluid2. It is common for disordered eating behaviours to emerge after the baby is born.During this time, try to focus on the health and development of your baby, while keeping in mind that breastmilk quantity suffers with inadequate nourishment. Further, celebrate the amazing process of creating and nourishing a child with your strong and powerful body!

There are several potential health risks associated with pregnancy when a woman is living with with an eating disorder. Poor nourishment during pregnancy can cause a woman to experience malnutrition, dehydration, cardiac irregularities, premature birth, labour complications, difficult recovery, difficulties nursing, preeclampsia, increased risk for cesarean birth, and pre/post birth depression.3,4Mothers who do not gain adequate weight during pregnancy can also experience low blood pressure, weakness, fainting episodes, anemia, miscarriage, and/or a complicated delivery.2,5Binge-eating during pregnancy can cause high blood pressure and/or gestational diabetes.2Babies who do not receive adequate nutrition have an increased risk to be born with a low birth weight and have long-term developmental delays.2They can also experience feeding difficulties and respiratory distress.4However, it is possible to have a healthy pregnancy if proper treatment and care is taken prior to and during pregnancy. 

Women who struggle with an eating disorder during pregnancy may display some of the following symptoms: food restriction, little to no weight gain, extreme exercise, purging, chronic fatigue, headaches, dizziness, difficulty concentrating, social isolation, depression, and/or anxiety.4Please seek professional help if you or someone you know is experiencing some of these symptoms. Corrective action must be taken immediately to avoid negative consequences for the developing fetus and for the mom.

If you or someone you know is struggling with an eating disorder and wants to become pregnant, it is very important to see a doctor and a registered dietitian in order to properly prepare the body for pregnancy. Furthermore, being informed about all the expected body changes, possible complications, and common struggles associated with pregnancy is essential for adequate mental preparation. It is also imperative that mom finds a strong support system that can help her when times get tough. Strengthening the body, mind, and environment can help set a woman up for success. Most importantly, mom should try to embrace the natural changes that her body is programmed to go through in order to enjoy the experience and grow a healthy baby.


References

  1. Brown, E. J. (2016). Nutrition through the lifecycle: Boston, MA: Cengage Learning. 
  2. Fleming, K. (2018). Eating Disorders & Pregnancy. In Centre for Clinical Interventions. Retrieved from: https://www.cci.health.wa.gov.au/~/media/CCI/Mental%20Health%20Professionals/Eating%20Disorders/Eating%20Disorders%20-%20Information%20Sheets/Eating%20Disorders%20Information%20Sheet%20-%2011%20-%20Eating%20Disorders%20and%20Pregnancy.pdf.
  3. Pregnancy and eating disorders. (2018). In National eating disorders. Retrieved from: https://www.nationaleatingdisorders.org/pregnancy-and-eating-disorders.
  4. Eating disorders and pregnancy. (2013). In Eating disorder hope.Retrieved from: https://www.eatingdisorderhope.com/treatment-for-eating-disorders/special-issues/pregnancy.
  5. Eating disorders & hormones. (2018). In Centre for clinical interventions. Retrieved from: https://www.cci.health.wa.gov.au/Resources/~/media E8EFAD2E7A224E708BDDA78998ABC8F0.ashx.

Prebiotics & Probiotics

Probiotics and prebiotics are growing in popularity as research is discovering their relationship with the microbiome and human health. The microbiome is a term used to describe the dynamic collection of microbes (eg. Bacteria) found in the human intestines. Many of these microbes have a symbiotic relationship with humans; this means that both species benefit from one another. For example, bacteria can produce vitamins, aid with digestion, and destroy disease-causing microorganisms.1However, harmful microbes also exist and may contribute to some health problems. The reason why probiotics and prebiotics are becoming popular is because they have been shown to support the growth of beneficial microorganisms in the intestines, which may in turn improve our digestion.

Prebiotics and probiotics work together to foster a healthy digestive system in the human body. Prebiotics are non-digestible parts of carbohydrate foods that feed beneficial microorganisms in the large intestines. Probiotics are live beneficial microorganisms that are also naturally present in the large intestine. You may be thinking, if they are naturally present, then why do people consume them? Probiotics are consumed because the microbiome is a dynamic system, meaning that different factors such as stress, certain foods/beverages (eg. alcohol), and some medications (eg. antibiotics) can decrease the presence of beneficial microbes. Probiotics simply help bring the microbiome back into balance. The positive effects of probiotics will vary between individuals and they will depend on the quantity eaten and the type of probiotic; however, more does not necessarily mean better.2It is still unknown how many probiotics are needed in order to reap any health benefits, however, it is suggested that they should be consumed regularly as part of a balanced diet for a long period of time to support the microbiome.2Although probiotics are safe for most individuals, they may cause gas, bloating, and diarrhea in some people.

Prebiotics and probiotics are naturally found in many foods. Some food sources of prebiotics include: garlic, leek, onion, psyllium husk, wheat bran, bananas, whole grains, tomatoes, and potatoes. Food sources of probiotics include: yogurt, cheese, kefir, and fermented vegetables such as sauerkraut. Foods such as juice, cereal, chocolate, and ice cream may also be fortified with probiotics.2It is important to read food labels to make sure that these foods contain live bacteria, otherwise the pasteurization process destroys them and they are not added back in. The types of probiotics that are often added to food products are Lactobacillusand Bifidobacterium.2  Both prebiotics and probiotics can also be found in a supplement form, but they are not necessary for good health and there is no guarantee that they are effective.2Consult a doctor or dietitian if you would like to take such supplements. 

Research shows that the consumption of probiotics may support the gastrointestinal tract. Probiotics may improve the symptoms of both irritable bowel syndrome and inflammatory bowel disease.2They may also help lessen diarrhea associated with antibiotic consumption.2Furthermore, probiotics may help some individuals with their lactose intolerance, but more research must be done to confirm this.2

Multiple direct and indirect pathways have been discovered between the gut and brain, which has led to a new phenomenon referred to as the gut-brain axis.3The gut-brain axis is a term used to acknowledge the relationship between the health of the intestinal microbiome and the health of the brain. For example, an unfavourable microbiome composition may be associated with anxiety and depression.3Therefore, it is suspected that probiotics may potentially benefit mental health as they can rebalance the microbiome by reducing the number harmful microbes and increasing the number of beneficial microbes.4The microbiome also appears to have an effect on immune function, behaviour, and stress response.3,4

More research is needed to fully understand all of the health benefits associated with consuming probiotics and to determine appropriate dosages but we can assume that probiotic-containing foods are safe for most people.2These foods also contain other micronutrients that are needed for good health. The bottom line is that it is not necessary to consume probiotics to be nourished, but they are not harmful in moderation and they may be even be helpful in certain situations. Here at change.creates.change, our dietitians often recommend a probiotic to help with the digestive issues that arise with the refeeding process!


References

  1. Hibberd, P., Duffy, L., & Shurtleff, D. (2018). Probiotics: in depth. In National centre for complementary and integrative health. Retrieved from: https://nccih.nih.gov/health/probiotics/introduction.htm.
  2. Dietitians of Canada. (2018). The Pros of Probiotics. In Unlockfood. Retrieved from: http://www.unlockfood.ca/en/Articles/Digestion/The-Pros-of-Probiotics.aspx.
  3. Rieder, R., Wisniewski, P. J., Alderman, B. L., & Campbell, S. C. (2017). Microbes and mental health: A review.Brain, Behavior, and Immunity, 66, 9-17. doi:10.1016/j.bbi.2017.01.016
  4. Dinan, T. G., Stilling, R. M., Stanton, C., & Cryan, J. F. (2015). Collective unconscious: How gut microbes shape human behavior.Journal of Psychiatric Research, 63, 1-9. doi:10.1016/j.jpsychires.2015.02.021