Dietitians: Are you Ready for the EDRDpro Symposium?

  • posted by Marci Evans
  • Wednesday, March 22, 2017

Yes, the EDRDpro Symposium is the only international, web-based eating disorder conference for nutritionists, therapists, and students.

Have you ever had the chance to participate in something that makes you giddy with excitement?? That’s exactly how I feel about the upcoming #EDRDpro Symposium - a 4 day online symposium with 15 eating disorder experts. How lucky am I to be included??

Whether you are a dietitian or not, I invite you to seriously consider registering for this event. There is an amazing lineup of experts on the topics of eating disorders and body image for this incredible 4-day event. The range of topics is multi-faceted and timely: building your brand, working with athletes, mastering the media, how to move away from a weight-centric treatment focus, exercise in recovery, raising healthy eaters, and so much more!

Many of you have asked for more information on my most recent venture - the complicated mix of digestive disorders and eating disorders. At the #EDRDpro Symposium I will be speaking on “The Gut Microbiome, Digestive Health, and the Eating Disorder Client.” I’ll be providing attendees with “my Top 10 Tips for Supporting Digestive Well-Being” in a user-friendly handout, along with an in-depth presentation which covers the most up to date research. I can’t wait to share it with you!

edrdpro symposiumYou may be wondering how I developed such a passion for speaking on digestive well-being, specifically for the eating disorder client. I can sum it up in a few bullet points:

  • Childhood gastrointestinal (GI) issues are among the top 10 risk factors for the development of an eating disorder
  • Up to 98% of clients with an eating disorder also struggle with some sort of GI issue. I care because it’s affecting so many people and very few know how to deal with both issues simultaneously.
  • Ongoing GI issues takes a toll on emotional well-being, body image, and the length of time it takes to recover from an eating disorder

The amazing thing is that there are so many solutions to improving gut health AND eating disorder recovery. And I want more people to know about it.

Here are more of the details on this event:

Early-Bird Registration is March 20th-27th and the cost is $299

Prices increase to $399 after March 27th (which is still a steal in my book!)

With registration you get:

  • 15 webinars available to you to watch at your own pace
  • 15 hours of CPE credits
  • Bonus videos and tips
  • Resources and tools to use in your practice
  • Expert insight
  • Private Facebook group just for participants to ask questions, build communities, and interact with the expert contributors during the symposium.

I hope to see you there! Remember to register early

 

Digestive Disorders and Eating Disorders: A Complicated Mix

  • posted by Marci Evans
  • Monday, March 06, 2017

Several years into my work as a nutrition therapist I found myself really grappling with a clinical dilemma. Many of my clients were not only suffering from an eating disorder but they were also suffering from pretty severe digestive issues. And these digestive issues were not only complicating their recovery but they were seriously impacting my clients’ quality of life. In fact, many clients who had made tremendous strides in their eating disorder recovery were suffering with digestive symptoms that other clinicians had promised would go away once they got better from their ED.

So I delved into the research, participated in a year long integrative nutrition therapy training, exchanged supervision with colleagues who specialize in digestive health, attended workshops, and I thought A LOT. In fact, I want to make a big shout out to my friend and colleague Lauren Dear who is an amazing digestive health dietitian and has taught me so much. (Sidebar: I have the honor to speak with Lauren at three upcoming conferences. See below!)

All of this study (and continued study!) led to a series of talks on the intersection of EDs and digestive disorders that I have and will be giving in 2017. And with enthusiasm, I’m writing to let you know that I am also in the process of developing an online self-study course on the topic. I will have it ready this spring and can’t wait to share it with you. I believe in my heart it will help you feel more capable in helping your clients heal. Below I’ll provide links with upcoming places I’ll be speaking on this important topic. But for now, I’d like to share some juicy tidbits!

Critical Research Nuggets:
  • Up to 98% of clients with eating disorders have a functional gut disorder (FGD) (Note: FGDs are things like Irritable Bowel Syndrome, gatric reflux, bloating, constipation, and diarrhea (to name a few).
  • People who suffer from FGDs and EDs share the same underlying mental health challenges- namely anxiety and depressive disorders
  • These mental health challenges can lead to digestive symptoms that can perpetuate long after the ED symptoms have resolved
  • EDs can actually cause FGDs and FGDs can make a person vulnerable to the development of an ED. This means it is BOTH the chicken and the egg.
  • Childhood GI issues are a key risk factor for the later development of an ED
  • Both EDs and FGDs negatively impact body image. A person who suffers from both has a double whammy to contend with!
  • Anorexia Nervosa changes the gut microbiome by deceasing bacterial diversity. Lower numbers of bacterial diversity are associated with greater levels of eating disorder psychopathology.
Specific Concerns for the ED Population
Traditionally, medical providers and dietitians have encouraged an elimination diet of some kind to treat these enduring and often puzzling symptoms. However, eliminating foods is really the opposite of the goal of nutrition therapy for EDs. Restriction, even if medically indicated, complicates ED recovery. In my personal experience, I have seen well-intended clients/practitioners advocate for an elimination protocol that has led to full blown relapse. So what are we to do as clinicians who feel desperate to help our clients fully recover and treat any concomitant digestive health concerns? I have a few take home points for you to consider.

Key Take Home Messaging

 There are many non-harmful interventions to try with clients.

  1. Most if not all behavioral interventions that support ED recovery will also support digestive health. Root out remaining ED behaviors as most will reinforce negative GI symptoms.
  2. Sensitive systems require CONSISTENCY & BALANCE.
  3. A stressed out person will likely have a stressed out gut. Help clients embrace hypnotherapy, meditation, deep breathing, guided relaxation. The relationship between head brain and gut brain is REAL!
  4. Food variety improves the gut microbiome and is a key ingredient to ED recovery.
  5. The goal is to include as many foods as possible for mental, emotional, and psychological well-being.
  6. Integrate the use of digestive enzymes, probiotics, and well-researched supplements to help manage symptoms.
  7. Fuel healthy bacteria by integrating fermented foods and drinks.
  8. Incorporate a stool or squatty potty for more anatomically supported elimination (ie the squat position makes it way easier to poop!).
  9. Eliminate “diet foods” as they contain a lot of additives that worsen digestive symptoms and are often a culprit in the ED
  10. Play with changing the texture of foods rather than eliminating them all together
One Last Request
Clinicians, please stop telling your clients that all of their GI problems will resolve by eliminating ED behaviors and enduring the refeeding process. While this may be true for some clients and for some symptoms, the research is quite clear that this is often not the case! But the good news is that with a varied and creative toolbox, it’s possible to support ED recovery and improve your client’s digestive well-being.

Upcoming Talks

MEDA’s National Conference- March 11th, co-presenting with Lauren Dear
ANCE- The Massachusetts Dietetic Association’s Annual Conference- March 31st, co-presenting with Lauren Dear
EDPRO Online Symposium- April 28th-May 2nd (early bird registration opens March 20th!)
iaedp Online Live Webinar- August 10th, co-presenting with Lauren Dear

 

Selected Citations
Abraham, S., & Kellow, J. (2011). Exploring eating disorder quality of life and functional gastrointestinal disorders among eating disorder patients. Journal of Psychosomatic Research, 70(4), 372–377.
Boyd, C., Abraham, S., & Kellow, J. (2010). Appearance and disappearance of functional gastrointestinal disorders in patients with eating disorders. Neurogastroenterology and Motility, 22(12), 1279–1283.
Janssen, P. (2010). Can eating disorders cause functional gastrointestinal disorders? P. Janssen Eating and functional gastrointestinal disorders. Neurogastroenterology & Motility, 22(12), 1267–1269.
Kleiman, S. C., Watson, H. J., Bulik-Sullivan, E. C., Huh, E. Y., Tarantino, L. M., Bulik, C. M., & Carroll, I. M. (2015). The Intestinal Microbiota in Acute Anorexia Nervosa and During Renourishment: Relationship to Depression, Anxiety, and Eating Disorder Psychopathology. Psychosomatic Medicine, 77(9), 969–981.
Peters, SL. (2016). Randomised clinical trial: the efficacy of gut-directed hypnotherapy is similar to that of the low FODMAP diet for the treatment of irritable bowel syndrome. Aliment Pharmacol Ther. Sep;44(5):447-59.
Sato, Y., & Fukuco S. (2015). Gastrointestinal symptoms and disorders in patients with eating disorders. Clin J Gastroenterol, Oct;8(5):255-63.
Surdea-Blaga, T., Baban, A., Nedelcu, L., Dumitrascu, D. (2016). Psychological interventions for irritable bowel syndrome. Journal of Gastrointestinal and Liver Diseases, 25(3).
Voci, S. C., & Cramer, K. M. (2009). Gender-related traits, quality of life, and psychological adjustment among women with irritable bowel syndrome. Quality of Life Research, 18(9), 1169–1176.

 

Defining Self-Acceptance... Or At Least My Definition

  • posted by Marci Evans
  • Saturday, February 18, 2017

My client, whom we'll call Sally, was telling me how she's been reading up on all sorts of positive body image blogs. You know, blogs that encourage you to love yourself and accept yourself as you are right now. And that was just all too far from reality for her to be able to swallow. She told me "I can't love my body. I can't stand living in it. I don't feel good physically in my body. Why would I accept something that makes me so miserable?" 

And I understood what Sally was saying. Often, people confuse self-acceptance with stagnation. Staying miserable, learning to put up with something you hate. Many people wrongly assume that they'll never change if they accept themselves (not to mention love themselves!) as they are right now. But it turns out that isn't true.

ACCEPTING SOMETHING DOESN'T MEAN YOU HAVE TO LIKE IT. The reality is that self-acceptance FACILITATES CHANGE. Acceptance can be defined as "the act of assenting or believing." Once we come to truly accept where we are at in life, what works for us, and what doesn't, we are then able to make decisions based on that reality. Here are a couple of diagrams to show what I mean.

Cycle of Non-Acceptance

Cycle of Acceptance

I share this message with you as a new year is about to begin because it's a time that you might be thinking about setting goals and contemplating how you'd like to improve upon this past year. So  you just might want to consider adding self-love and self-acceptance to the top of your list. Ironically, it just might help you accomplish everything else you had in mind.

I'm going to leave you with a quote from a fabulous book that I stumbled upon while researching this blog post. The quote relates to accepting your body as it is right now.

How can you begin to learn the lesson of acceptance? By recognizing that what is, just is, and that the key to unlocking the prison of self-judgment lies in your own mind. You can either continue to fight against your body's reality by complaining bitterly and immersing yourself in self-deprecation, or you can make the very subtle but powerful  mental shift into acceptance. Either way, the reality remains the same. Acceptance or rejection of your body only carries weight in your mind; your perception has no bearing on how your body actually looks, so why not choose the ease of acceptance rather than the pain of rejection? The choice is yours. "

Found in "If Life is a Game, These are the Rules" by Cherie Carter-Scott PhD

Have you had an experience with self-acceptance? Please share it!

Practice Taking a Pause

  • posted by Marci Evans
  • Wednesday, February 15, 2017

By Sarah Patten, RD LDN


One of my favorite routines after getting out of bed in the morning involves making a steaming hot cup of coffee and taking a moment before taking my first sip to pause, gaze out my kitchen window, and set an intention for my day ahead. This ritual started a couple of years ago as I began to realize how busy the days can be and how easy it is to fill the waking hours to the brim without taking the time to slow down and check in. I found myself talking with clients and friends about the importance of mindfulness, self inquiry, and pausing, but realized that I too needed to hear that message and bring focused attention to sloooowwwwwwwwwingggg down.

Sometimes setting an intention to set an intention is the hardest part

At first, I had to remind myself to take that moment or would chide myself with self-criticism if I'd rushed around after waking up too late/hitting snooze and had forgotten about the intention to set an intention altogether. Just like any type of habit change, however, with enough practice and repetition, the new ritual stuck and now it's the part of my morning I look forward to most. This “mindfulness moment” allows me the opportunity to assess how I'm feeling, what I'm grateful for, what I'm worried about, and what I'd like to practice for the day ahead. Solidifying this habit in the morning has also helped to make it much more natural to return to this practice throughout the day.

Even the fullest days can hold mindful moments

Maybe it's taking a moment to check in while waiting in line at the grocery store, sitting down to eat lunch, or washing dishes at the end of a long day – wherever it may be, the realization that there IS time to take time throughout a busy day has been a huge change for me. We all have the ability to slow down and check in with ourselves, no matter how full our time may seem.

This past Christmas, I received the perfect gift to accompany this morning ritual - “Journey to the Heart” by Melody Beattie. This book has a daily reading for each day of the year and always seems to deliver just the message I need to hear. There was a reading a few weeks ago that gave me pause for thought and it felt important to share. It's entitled “Look at What's Right” - a reflection about how we can spend so much time looking for flaws in ourselves, even in the name of self improvement,”that we often forget to stop and take stock of what is going well or what we value within ourselves. Here's the reading:

“Take time to notice what's right in ourselves, in others, and in the world around us. We may become so concerned with correcting ourselves we become habituated to seeing what's wrong. Not just seeing it – constantly looking for it. The question itself – What's wrong? – is enough to keep us on edge.

"There are times to take stock, do an inventory. Times to learn and grow. But spirituality and joy do not stem from trudging around in the muck of what's wrong with others, ourselves, and life. We do not have to seek out mistakes and errors, poking and picking at ourselves to continue our growth. Poking and picking hurts. Our lessons will be revealed to us, and they will present themselves naturally. Growth will occur.

"Give yourself a break. Ask yourself what's right, what's good, what's true, what's beautiful. Sometimes the lesson isn't in discovering what's wrong. Sometimes the lesson is discovering that the world is all right – and so are you.”

So, with that, I'd challenge all of you to practice taking a pause today (and maybe eventually every day) to acknowledge what's right. Give yourself the gift of self compassion, give yourself some space from that internal critic, and call out a strength you possess – even if it seems tiny or insignificant. With practice and persistence, everything gets easier.

 

BED and The Well-Trained Clinician: Are You Helping Without Harming?

  • posted by Marci Evans
  • Monday, February 06, 2017

The Need for Well-Trained Clinicians


This blog post was originally posted on the Binge Eating Disorder Awareness Blog. I've reposted it here to spread the word! 

Binge eating disorder (BED) may seem new since it was just added to the official list of mental health diagnoses. But the truth is that using food to manage difficult internal experiences and emotions has been around a long time! While it’s official status is “young” in the eating disorder (ED) world, well-trained clinicians are desperately needed! The problem being that many clinicians haven’t been properly trained on how to treat BED, which is distinctly different than treating weight. Often, clinicians conflate the two and unintentionally create a whole host of problems!

While the ED field has a long way to go in developing substantive research to guide our treatment protocols for BED, we must borrow from related fields of research to guide our way.

The first area of research ED clinicians need to become familiar with is weight stigma. Similar to other oppressive forces in our culture, weight stigma infiltrates all of our lives in sneaky and insidious ways. And sadly, even ED clinicians are top offenders when it comes to bias and stigma relating to weight.

What is Weight Stigma?
Check out this succinct PDF on weight stigma developed by BEDA. In short, weight stigma is negative judgment, bias, assumptions, attitudes, and treatment based on a person’s size. Most importantly, when a person experiences weight stigma it makes them vulnerable for WORSE health outcomes. This means that when people are stigmatized they are less likely to get proper care and are less likely to improve in any health parameters. This is why a weight neutral approach to improving health of people suffering with BED.

Why A Weight Neutral Approach
A weight neutral approach makes no assumptions about a person’s health or habits based on appearance. And it deems every individual deserving of health enhancing interventions regardless of whether it produces a change on the scale. Two important philosophies, Health at Every Size (HAES) and Intuitive Eating (IE), provide the scaffolding and guidance for clinicians to generate interventions that will improve the health of clients without interjecting harmful weight stigma. Integrating these philosophies into the backbone of BED treatment is critical to helping without harming.

Seeking Additional Treatment
It is imperative that ED clinicians seek additional training in weight stigma, HAES, and IE. I have developed an online training for ED clinicians that is focused on how to provide nutrition specific counseling that is HAES informed, weight neutral, and grounded in research. I developed it because I am passionate about reducing weight stigma and improving treatment for people with EDs. There are relatively few resources for clinicians so I created am online training that is affordable and accessible from your own home. You can learn more about my online training for dietitians interested in eating disorder work here

Additionally, here are some other resources I recommend:

Let’s elevate the field of ED treatment and provide our clients with BED with the best possible care.