Other Signs of Hunger

When we think of hunger signs we commonly imagine the classic sign of a growling stomach. Yet, there are a variety of hunger sings, some more subtle than others.

1. Headache or Mental “Fog”

   1. When you haven’t eaten in 3+ hours your body will experience a gradual dip in blood sugar levels. This can lead to a headache or lack of mental clarity. You might find it difficult to focus on a task or notice yourself continually zoning out.

2. Tiredness

   1. If the body is running low on energy, then we will likely feel tired. This can be one sign that it’s time to eat again.

3. Food Thoughts

   1. Are you constantly thinking about food or drawn to pictures of food? We are biologically wired to seek food when our body is hungry. This might show up as obsession with cooking, food pictures, grocery stores, or planning food.

4. Anxiety or Fidgeting

   1. While anxiety can have many origins and influencers, one of those can be related to hunger. When the brain is malnourished or hungry, it can produce an anxious state. Scientists suspect the anxiety might be a biological drive to make us more alert for food sources.

5. Irritation or Hangry

   1. Hangry is the mix of hunger and anger. When you notice your irritated (especially if its for no reason) check in with yourself. When was the last time you ate? Was it enough? Perhaps try eating something.

6. Feeling shaky or weak

   1. When the body is running low on energy, you might feel physically shaky or weak. Physical exertion, such as lifting weights, running, etc. may become more difficult than usual. This is a sign that your body doesn’t have enough energy.

7. Nausea or Stomach Pains

   1. This one may seem counterintuitive, however, nausea can sometimes be a symptom of hunger. This can occur due to the acidity of stomach acid, in addition to taking certain medications (ex. NASIDS) or supplements (ex. multivitamin) without food.

While this isn’t an exhaustive list of hunger signs, it hopefully provides you some guidance on navigating your less obvious hunger cues. Questions or want more? Contact us to meet with our nutritionist!

Diets Don't Work

FACT: Research shows that diets are proven to fail long term (~5-10 years post start of the diet). The research that shows weight loss diets “working” is all conducted within the 5 years time or less.

Why do diets not work?

Well, first of all, your body is WAYYY smarter than any diet program. Your body recognizes “oh crap, I’m not getting enough energy; there is a limited amount of food…guess I should slow things down.”

You’re body doesn’t know the different between purposeful restriction and unintentional /environmental restrictions. And let’s be real, it all has the same outcome of reducing the body’s ability to repair, move, think, grow, and heal.

Now you’re probably thinking “okay, great, what do I do now?”

Eat like you did as a young child. Eat in a way that respects your physical and emotional needs. Become attuned with your body, listen to it, and nourish it.

If you feel really detached from with body’s needs, that okay. You’re not alone.

Working with an ED-informed or intuitive eating specialist can be really helpful in rebuilding a healthy relationship with food.

Note: this post is not meant to replace individualized healthcare recommends. Information has been simplified for the purpose of making a brief post.

New Upcoming Event: Family-Based ED Caregiver Skills Group

Family-Based ED Caregiver Skills Group starting on September 13th!

Will be held VIRTUALLY Monday 6-7pm for 10 weeks.

Lead by Eva-Molly Dunbar, MA

Co-lead by Rebecca Hardin, PsyD

This group is for caregivers of individuals with eating disorders, that are receiving FBT treatment at PBS.

In this group you will be able to:

• share experiences on caring for your loved one with an eating disorder

• receive peer support and professional guidance

• and build coping skills to prevent burnout

Interested? -> contact us!

571-257-3378

info@pbshealthcare.com

Clothing Sizes and Body Image

THESE JEANS ARE ALL THE SAME “SIZE” ACCORDING TO THE TAGS.

Now visually we can tell that of course these jeans are not physically the same size as each other.

So even though you may be a size [something] in one brand, doesn’t mean there’s anything wrong with your body when the size doesn’t fit right elsewhere. Using arbitrary sizes to judge your body will likely lead you feeling upset and frustrated. Our bodys change from day to day, hour to hour. This is natural, normal, and healthy! We are dynamic and organic beings, rather than static machines.

With that being said, we recognize it can be hard to accept your body, or to accept that your body will change. We recognize that from a young age, many of us have been taught to feel a certain way about our bodies - such as it “needs” fixing. Therefore, it can be difficult to accept that your body doesn’t need to fixing. Instead, it likely needs compassion. So…

REMEMBER.... the clothes are meant to fit YOU. And not the other way around!

Contact us via our website or phone number if interested in services regarding body image.

When is your child's picky eating TOO picky?

“My kid is such a picky eater! I’m afraid they arent getting enough.”

Ever heard or said this phrase? Or perhaps you’ve said it before. It’s common for kids to go through a picky eating phase when they’re young. But….

How do you know when it becomes TOO PICKY?

• they become emotionally distressed when told to have a food they dislike (e.g. crying, screaming, running away from table, etc)

• they’re gagging on foods they don’t like

• they will only eat VERY specific foods

• their variety is severally limited

• they aren’t growing sufficiently

This isn’t a diagnostic list but it gives an idea of the difference between simple food preferences and a type of disorder eating, called Avoidant Restrictive Food Intake Disorder (ARFID).

ARFID is typically first noticed in young children and can persist into adulthood if not addressed.

It frequently includes severe texture, taste, smell, and temperature preferences, resulting in a very limited diet and anxiety around food.

How to approach treatment?

• Work with a trained ED-informed dietitian or therapist that provide in-person sessions

• they will likely have your child do controlled food exposures with feared / disliked foods

• these food exposures will likely need to be replicated and repeated at home

• understand that these feared / disliked food may be very distressing for your child… AND that don’t mean they can’t grow distress tolerance to them

Interested in treatment? Message us through our website portal!

Acceptance First

In order to change something we must first accept it as it is. Acceptance does not equate to condoning or agreeing with the situation. But rather, acceptance is acknowledgement without judgement that this is the situation. Once we can accept this is our situation, then we can move forward with changing the situation.

Mindfulness in Meals

By: Julia Yuskavage, MS, RDN

Can you relate to the experience of feeling like you are on “autopilot” in life at times, such as going through the motions of an activity without putting much intentional thought into it? Some might describe this state of being as “mindless”. I would venture to say that almost everyone has felt like this at some point in time. For example, at times mindlessness may be related to a pursuit of busyness and productivity; other times, it may be for protective reasons. I have heard patients describe some eating experiences as mindless, in that they may complete a meal before they really notice that they have even begun. Perhaps you have experienced eating until feeling uncomfortably full due to being unaware. On the other hand, perhaps you have experienced the opposite and have neglected to eat at times.

Let’s look at one definition of the word mindful:

1. attentive, aware, or careful: mindful of one's responsibilities.

2. noting or relating to the psychological technique of mindfulness: mindful observation of one's experiences. (1)

Some describe mindfulness as noticing, observing, or simply paying attention on purpose, doing so in the present moment, and doing so without judgement. At first glance, mindfulness might seem like a fairly simple concept to grasp and put into practice. However, mindfulness is a skill that requires practice to master, like many other things in life. Mindfulness can be applied to just about anything in life, and if applied to eating processes, one may gain more awareness and insight into one’s eating habits than ever thought possible.

You might be wondering what some of the benefits of mindful eating are. Mindfulness can increase your awareness of thoughts, feelings, and physical sensations related to food and eating. Over time, increased awareness can lead to the opportunity to form new experiences regarding eating, rather than automatically reacting out of habit and/or impulse.

How can someone apply aspects of mindfulness to eating? 

• Observe your internal and external experiences while eating, without automatically reacting to them. For example, you might observe that your environment while eating entails a television that has its volume turned up high or that you eat more quickly and your heart beats more rapidly when watching the news on television at a loud volume. You might also notice that the pace of your eating changes if the television is off and soft music is playing in the background instead; perhaps you feel more relaxed and less anxious with this change in environment. Changes in your surroundings can influence your eating experience, and having awareness of this can lead to a more satisfying and pleasant experience.

• Notice what it is about a meal that speaks to each of your five senses. Is the meal hot? Has the food been sitting out and cooling off? Does the temperature outside seem to influence your desire to eat a hot or cold meal? Does the meal contain crunchy or smooth textured foods? Does the food require a lot of chewing or is it soft in nature? What smells do you notice wafting from the food? Are the foods brightly colored and varied in color, or are they similar colors? Do you taste sweetness, saltiness, tanginess, sourness, or a combination? Noticing what appeals and what does not appeal to each of your senses can help you tune in to what really satisfies you, rather than making food choices based on what you hear that you “should” or “should not” eat from external sources. 

• Watch your thoughts related to food choices as they come and go, as if they were clouds passing through the sky. For instance, perhaps you encounter a thought such as “this food is bad and unhealthy”. Try to acknowledge your responses to food without applying labels to them, accepting them for what they are and nothing more. You might think to yourself, “I am having a thought that this food is bad”, and visualize the thought floating on a puffy, white cloud through a blue sky. This can help to create space between your perception of a food and the food itself, and lessen judgments and moral convictions that are attached to the food.

• Pay attention to physical sensations, such as signs of hunger and fullness, or notice the absence of such sensations. Maybe you sense emptiness in your stomach or low energy levels throughout your body. Perhaps you notice that you do not eat until late at night and think of eating only when you are feeling very hungry. This practice can help deepen your mind-body connection as it relates to listening to and nourishing your body.

• Notice your feelings that arise before, during, and after eating, as if they were leaves floating down a stream. Perhaps you experience a feeling of joy when eating a particular dessert that your grandmother made for you as a child. Maybe you notice feelings of guilt and fear after eating a bacon cheeseburger. You might say to yourself, “there is guilt” or “there is fear” and watch as it floats by on a crisp autumn leaf. Doing so can help take away power and negative associations that certain foods have for you.

Taking a mindful approach to eating can be very different from the approach that many people currently have. If you would like to shift your awareness and perspective on your current eating processes, mindful eating practices can open that door for you.

References:

1. http://www.dictionary.com/browse/mindful

Complications of Anorexia Nervosa: Why medical evaluation and monitoring is critical

By: Andrew Hopkins, PA-C

In life, food is our friend and starvation is our enemy

The human body is very effective in energy conversion. It breaks down food into the necessary nutrients our cells needs to function. Without food, the body transitions into starvation. As the body starves, it begins to break itself down and converts fat and protein into energy. This is a temporary strategy for the body if you miss lunch or are unable to eat for a few hours. But what if your body can’t count on food? What if your body is being permanently starved?

Missing a meal v. Anorexia nervosa

Individuals with Anorexia intentionally restrict food intake leading to starvation, weight-loss, and a low body weight. There is a fear of weight-gain or a fear of “becoming fat”, despite being profoundly underweight. Individuals with anorexia also demonstrate a distorted perception of body weight and image, and may often deny the medical seriousness of a low body weight.

Starvation is deadly

The rate of death in Anorexia is a staggering 10-12 times higher than the general population.1,2,3 In addition, the rate of suicide in Anorexia is nearly 5 times higher than the general population.4,5,6 Medical complications, including heart attacks and heart failure, account for more than half of all deaths in patients with Anorexia. The two biggest risk factors leading to medical complications include the degree of weight loss and how long food restriction has been present for.

Fats, proteins, and changes within the body

In starvation, the body begins to break itself down to create cellular energy in a process known as catabolism. In Anorexia, where there is long-term starvation, the body turns to a more substantial supply of fat and protein: the vital organs. The body breaks down proteins and fats in the heart, brain, liver, kidneys, and muscle leading to atrophy, or tissue wasting. Atrophy results in poorly functioning organ systems and ultimately, organ failure.

Symptoms and signs

While considerable changes to the body and organs are occuring, symptoms may be vague, misleading, or non-existent. Fatigue, low motivation, and changes in mood are common in the course of Anorexia. More concerning signs may be objectively measured, such as low blood pressure, reduced heart rate and reduced core body temperature. Some organ failure can occur without any warning signs or symptoms. Many patients who experience medical complications due to Anorexia require hospitalization due to severity. This makes medical evaluation and screening critical immediately following the diagnosis of Anorexia.   

Comprehensive evaluation and medical monitoring

Immediately following the diagnosis of Anorexia nervosa, one should have a comprehensive medical evaluation. This should include an extensive physical exam to evaluate for any objective manifestations of weight-loss and low body weight. Blood work is critical to identify for any nutrient deficiencies, abnormal hormone levels, or early signs internal organ failure. An Electrocardiogram (EKG) is needed to evaluate heart health and rule-out any functional changes related to heart atrophy. In females who have not menstruated for over 9 months, it is common to have a Bone Density Study (or DEXA scan) performed to rule-out early-onset Osteoporosis. Any abnormalities during this initial medical evaluation may require hospitalization to stabilize and correct.

Reversing Complications and Restoring Health

The treatment of Anorexia always involves weight restoration. While medical complications may necessitate urgent medical care, nearly all medical complications of Anorexia nervosa can be effectively reversed with adequate weight-gain. However, weight is not the only marker of recovery. It is appropriate to perform continual medical screenings throughout treatment. In order to vigilantly monitor for medical complications during recovery, frequent screenings involving blood work, vital signs, and a review of systems are routinely incorporated.

What’s next?

Treatment of Anorexia often involves a team of providers. At Potomac Behavioral Solutions, our treatment team will work collaboratively to ensure to the best outcomes. We offer dietitian services, family-based therapy (FBT), and medical monitoring during treatment to improve outcomes. Please contact our intake coordinators for further information on how to get started with our treatment team today!

Work Cited:

1. Löwe B, Zipfel S, Buchholz C, Dupont Y, Reas DL, Herzog W. Long-term outcome of anorexia nervosa in a prospective 21-year follow-up study. Psychol Med. 2001;31(5):881-90.

2. Keel PK, Dorer DJ, Eddy KT, Franko D, Charatan DL, Herzog DB. Predictors of mortality in eating disorders. Arch Gen Psychiatry. 2003;60(2):179-83.

3. Herzog W, Deter HC, Fiehn W, Petzold E. Medical findings and predictors of long-term physical outcome in anorexia nervosa: a prospective, 12-year follow-up study. Psychol Med. 1997;27(2):269-79.

4. Hoang U, Goldacre M, James A. Mortality following hospital discharge with a diagnosis of eating disorder: national record linkage study, England, 2001-2009. Int J Eat Disord. 2014;47(5):507-15.

5. Suokas JT, Suvisaari JM, Gissler M, et al. Mortality in eating disorders: a follow-up study of adult eating disorder patients treated in tertiary care, 1995-2010. Psychiatry Res. 2013;210(3):1101-6.

6. Crow SJ, Peterson CB, Swanson SA, et al. Increased mortality in bulimia nervosa and other eating disorders. Am J Psychiatry. 2009;166(12):1342-6.

Dieting: Much More Harm Than Good

By: Julia Yuskavage, MS, RDN

I think most people can agree that the last few months of 2018 have been filled with weight loss television commercials, radio ads for diet programs, and coupons for herbal products that promise a quick fix for “losing that stubborn body fat”. There is a reason for all of this - the dieting industry continues to profit big time from selling these kinds of products. Many times, people believe that if they were able to lose weight or fit into a smaller clothing size, then they might feel happier about themselves and their lives. However, I wonder how much truth there is in this belief.

What many people don’t know, or don’t want to believe, is that the companies that bombard you with these advertisements have a common goal: to sell you something.

Some of the questionable ideas hidden in these messages might sound like…

• Lose those last 10 pounds and you will be happier!

• Stop eating carbs and people will notice you!

• Reduce your belly fat and your dating life will improve!

• Give up “bad” foods and you will feel better about yourself!

• Drop 3 dress sizes and you will have finally accomplished something worthwhile!

In fact, a leader of a weight loss corporation has been quoted as saying that their product is great for business because people who use it will inevitably fail, thus returning for more of it (i.e.: buying it) again and again and again. That makes me feel frustrated for people who are using these systems and working hard to meet their nutritional goals/needs.

The reality is that there is no magical number on the scale or measuring tape that will make you feel whole. What diets often lead to are vicious cycles of food restriction, low energy levels, moodiness, overeating, and feelings of guilt, shame, and failure – that then leads to food restriction all over again.

“If you just tried hard enough and did a better job at dieting, you wouldn’t be a failure” is the message that the diet industry is trying to sell. It’s no wonder that the temptation is so high to try a different diet approach each time you feel like a “failure”. Diets often do not lead to long-term health and happiness; instead, they often lead to disordered eating and even early mortality associated with eating disorders.

We’re here to remind you that it’s okay to love yourself JUST the way you are. Accepting yourself and working through the underlying emotions that fuel your desire to diet and lose weight can be a path to freedom.

So often we see clients who are torn between wanting to end dieting once and for all, yet also wanting to lose weight because they believe doing so will lead to happiness. It can be tough to feel like you are stuck between wanting to follow a non-diet approach, yet also wanting to lose weight. If one is willing, there can be a sense of freedom that comes with giving up self-imposed dietary rules, learning to listen to your body’s hunger and fullness cues (or eating intuitively), and accepting yourself for the unique individual that you are. Intuitive eating is referenced as a “dynamic process – integrating attunement of mind, body, and food”(1). The great news is that you have the skills to eat intuitively inside you already – you were born with them; they just got pushed way down, buried under all the societal pressures and norms that have tried for so long to convince you otherwise. If this is how you are feeling/what you are noticing, it might be time to work on letting that skill resurface and start walking the path towards healing your relationship with food and your body. If you would like to learn more about intuitive eating, or if you have concerns about your current eating habits, we are here to help.

References:

1. Tribole E, Resch E. Intuitive Eating. A Revolutionary Program That Works; 2012:1-344.

The Downside of Missed Periods

Sam Tryon, MS, RD

For some, the idea of not having their period might be cause for celebration.  No cramps, bloating or having to worry about keeping tampons or pads on hand; awesome right?! Unfortunately, not getting your period could be cause for concern.*

If you are 16 years old and have not yet started your period or if you have missed at least 3, you could be diagnosed with amenorrhea.1 Amenorrhea can be caused by a variety of factors including genetic abnormalities, gland problems, and certain gynecological conditions.1  Amenorrhea may also be due to what you eat and how active you are.

The roles of nutrition and activity

Low energy availability is one cause of amenorrhea.  Energy availability is a measure of the energy left for bodily functions (i.e. heart beating, digestion, breathing) after subtracting for energy used during exercise and other activities of daily living (i.e. vacuuming, walking to work, gardening).  Low energy availability means that there is not enough energy for body functions and exercise.

Low energy availability can be a result of not taking in enough fuel (A.K.A. not eating enough) and/or using too much energy for exercise.  Among other effects, the lack of energy left for bodily functions leads to decreased production of gonadotropin-releasing hormone, a hormone important in reproduction, which causes decreased production of estrogen and progesterone and disruption of the menstrual cycle.2

Amenorrhea and Bone Health

Both low energy availability and reproductive hormone changes have negative impacts on bone density.  In addition to not having the available energy and nutrients to maintain bone mass, lack of estrogen is associated with bone loss.  In a healthy body, our bones are constantly being broken down to release minerals like calcium and then rebuilt.  Without estrogen, there is increased breakdown without rebuilding which leads to decreased bone density.  This can progress to osteopenia and osteoporosis, putting a person at risk for fractures.  

Studies have found that up to 95% of people with Anorexia Nervosa have osteopenia and as many as 40% have the more severe osteoporosis.3 Weight gain is associated with return of menstruation and possible reversal of at least some bone loss.

Amenorrhea and bone loss are especially concerning in adolescents as peak bone mass is reached during this time. Bone loss from low energy availability during this stage of life may prevent patients from reaching a normal peak bone mass. This can put them at increased risk for fractures later in life.

Next Steps

If you have missed 3 or more periods, an appointment with your general physician can help to determine the cause of amenorrhea.  They may recommend a bone density test to look for possible bone loss.  

If the cause is found to be nutrition related, a dietitian can help you change your diet to make sure you are taking in enough energy to fuel your body. Amenorrhea can occur with or without disordered eating and a dietitian can also help assess for any disordered eating behaviors.  If disordered eating is a problem, a therapist may be added to the team to best tackle these concerns and get you back to the activities you love.  

*The content of this article is for informational purposes only and does not constitute medical advice, professional diagnosis, or treatment.  See your healthcare provider before making any healthcare decisions or with any questions you have regarding a medical condition.  

References:

1. Amenorrhea. Eunice Kennedy Shriver National Institute for Child Health and Human Development; [accessed 2017 May 31]. https://www.nichd.nih.gov/health/topics/amenorrhea/Pages/default.aspx

2. Mallinson, R and De Souza, M. Current perspectives on the etiology and manifestation of the “silent” component of the Female Athlete Triad. Int J Womens Health. 2014; 6: 451–467

3. Mehler, P and MacKenzie, T. Treatment of Osteopenia and Osteoporosis in Anorexia Nervosa: A Systematic Review of the Literature. Int J Eat Disord. 2009; 42: 195-201

NEDA Walk, Washington, DC: April 2, 2017

Alexa, Charlie (with Daria!), Joanna, and Rebecca 

Alexa, Charlie (with Daria!), Joanna, and Rebecca

Evelyn and Alexa- Our WONDERFUL intake staff! 

Rebecca and Alexa

Evelyn and Joanna

Joanna Marino, PhD giving a keynote speech at the DC NEDA walk!

Alexa ;)

Our booth at the walk

Joanna Marino, PhD giving a keynote speech at the NEDA walk

Ellyn Satter's Hierarchy of Food Needs

Below is a description of how our nutritionists view food needs