Is the gut truly the first brain? 5 Daily tips for gut-brain health.

Authors: Katie Morra, MS, RD, LDN | Jen Unruh, MS, CNS, LDN

Do you want to be let in on a little secret?

Did you know that 90% of your serotonin and 50% of your dopamine is actually made in your gut and not your brain? That means that there is a 50-90% chance that you gut microbiome is controlling your mood. Wild, right?

Let’s break this down a little more so we are all on the same page.

• SEROTONIN is a neurotransmitter that helps to regulate mood and social behavior, appetite and digestion, sleep, memory, and sexual desire and function.

• DOPAMINE is a neurotransmitter that plays a major role in the motivational component of reward-motivated behaviors. We already know that imbalances in neurotransmitters can contribute to a higher prevalence of anxiety, depression and mood disorders. So, you may be asking, where am I headed with this?

The gut microbiome is constantly affected by your stress levels, dietary choices (your gut bugs eat what you eat), medications and supplements, digestive output and absorption, as well as infections (i.e.; parasites, candida, bacterial imbalances).

Get ready for the longest thought process in history (welcome to my brain):

If you are eating a Standard American Diet (high in carbs, sugars and low in nutrient dense foods and fiber), on medications such as antacids which set you up for a greater chance of being exposed to parasitic infections by lowering your stomach acid (which is responsible for digestion and absorption of protein and stimulating your digestive enzyme and bile output which are responsible for digestion and absorption of carbohydrates and fats), then your gut can no longer absorb the necessary nutrients for optimal brain function, increasing the likelihood that you may suffer from anxiety and/or depression. Second fun fact of this article, did you know that a majority of individuals (50-90% to be exact) that suffer from anxiety and depression also have a diagnosis of Irritable Bowel Syndrome (IBS)? Welcome to the vicious cycle and chaotic connection between your gut and brain.

OKAY (gasps for air..), let’s slow down, breathe and regroup. As you can see, the gut-brain connection is the ultimate chicken or the egg dilemma and you’re probably wondering, “where do I even start?”.

Here are our 5 tips for supporting your gut-brain connection daily:

• Focus on eating whole foods - choose minimally processed and pre-packaged foods, ideally organic, nutrient-dense foods that nourish the body.

• Practice mindful eating and chew more efficiently - simply chewing your food thoroughly can improve your body’s ability to absorb nutrients from your food, as well as prevent bacteria and yeast overgrowth from large food particles making it to the intestines undigested.

• Incorporate apple cider vinegar before meals - 1 tsp. of apple cider vinegar in 8 oz. of water before meals helps to stimulate stomach acid production, therefore improving your body’s ability to digest important amino acids, vitamins, and minerals.

• Choose foods daily that increase serotonin - these foods include: cage-free eggs (especially the whites), spirulina, wild-caught fish like cod and salmon, pasture-raised poultry, sesame seeds, cashews and walnuts, grass-fed beef or lamb, 100 percent whole grain oats, brown rice, corn or quinoa, beans/legumes, including chickpeas and green peas, potatoes, bananas.

• Choose foods daily that increase dopamine - these foods include: chocolate (dark chocolate, cacao), blueberries, healthy nuts and seeds, pasture raised animal products, cruciferous veggies and alliums (onion and garlic).

These daily tips may seem simple but if a root cause of most chronic illness is low stomach acid production and chronic stress, these tips above will add support to the cycle of proper digestive performance and optimal absorption to help support general brain health and gut health.

Is your gut really your first brain?
Breathe. Digest. Repeat...and you let us know!

iTunes Podcast: Gut Honest Truth
Instagram: @guthonesttruth
Facebook: https://www.facebook.com/guthonesttruth

Suicide - What to do

Worried that your child, friend, or family member is at risk for suicide?  Here are some steps you can take.

We often think that suicide is a terrible tragedy that only happens in other people’s families.  We want to think that it could never happen to us.  It is easy to fall into the thought that children or adults who think about suicide come from dysfunctional families with a history of violence or drug abuse, or must have severe depression.  While these are risk factors, suicide crosses all racial, economic, social, and ethnic lines, and only about half of suicide cases are linked to depression. 

Just how common is suicide? 

Each day, over a hundred Americans die from suicide.  That is 42,773 people per year.  Suicide is the 10th leading cause of death in the US, and firearms are accountable for almost 50% of all suicides.  Men die by suicide 3.5x more often than women.  Although the rate of suicide is highest in middle-aged men (particularly white men), children and teens of all ethnicities are also at risk.  Each day, over 4,800 children between the ages of 7-12 attempt suicide.  In fact, suicide is the second leading cause of death for ages 10-24.  That means that more teenagers die from suicide than from cancer, heart disease, AIDS, birth defects, stroke, pneumonia, influenza, and chronic lung disease combined.  

So what should you do if you are worried about someone you love?

Stay calm. 

Create a comfortable atmosphere for a person who is suicidal to open up to you and reach out for help.

Talk about it. 

There is myth out there that talking about suicide makes things worse, or that it will increase the likelihood of suicidal behavior.  In fact, an open discussion can help decrease the anxiety around the topic, and can feel like a relief.  Asking someone if they are suicidal makes it easier for them to open up.  Make it clear that you care, are willing to listen, and want to help.  Being direct is the best option.  You could say something like: “I’m worried about you, you seem really down lately. Have you thought about taking your life?”    

Act.

If someone is actively suicidal, they should not be left alone.  Try to get the person to seek immediate help from their doctor, or the nearest hospital emergency room, or call 911.  Another step is to limit the persons’ access to firearms, medications, or other lethal methods for suicide.  However – Don’t try to be a hero-never put yourself in danger by trying to take away a fire arm from someone against their will by yourself.  Which brings us to the next point…

Involve someone else.

It is important to act immediately, but it is also best not to act alone.  Is there a close friend, a parent, or family member that you can involve?  Calling a helpline to get support is also a great option.  For example, the National Suicide Prevention Lifeline at 1-800-273-TALK. 

Don’t promise confidentiality.

Although someone who is suicidal may ask you not to tell anyone, you must be prepared to break this promise, or not make it at all.  Keeping this promise is much less important than saving a life.  They may be initially angry, but try to remember that they are not thinking clearly, and that this is a time that they need to seek professional help.

American Foundation for Suicide Prevention:  www.afsp.org

Center for disease control: https://www.cdc.gov/injury/wisqars/

6 Myths About Suicide that Every Educator and Parent Should Know:

http://www.npr.org/sections/ed/2016/09/02/478835539

There are a ton of great resources out there to help us notice the signs and be as helpful as possible.  Some are listed below:

American Foundation for Suicide Prevention.  www.afsp.org

The American Association of Suicidology.  www.suicidology.org

National Suicide Prevention Lifeline.  www.suicidepreventionlifeline.org

The Jason Foundation.   www.jasonfoundation.com

Obsessive-Compulsive Disorder (OCD): Frequently Asked Questions

What is OCD?

Obsessive Compulsive Disorder (OCD) is a brain and behavior disorder that can be identified by uncontrollable, reoccurring thoughts (obsessions) and behaviors (compulsions) that a person feels the urge to repeat over and over.  OCD symptoms can interfere with all aspects of life including school, work, and social relationships.  People with OCD may have obsessions, compulsions or both.

What are the symptoms of OCD?

OCD causes severe anxiety in those affected by it and can have a major impact on a persons’ daily life.  Obsessions are persistent ideas, thoughts, urges or images that are experienced as intrusive and cause intense anxiety or distress.  The most common obsessions are repeated thoughts about contamination, repeated doubts, a need to have things in a particular order, aggressive impulses, and sexual imagery. Compulsions are the person’s attempt to suppress or neutralize such thoughts or impulses with some other thought or action.  These can include repetitive behaviors, such as hand washing, ordering or checking on things; or mental acts, such as praying, counting, or repeating words silently.

At what age does OCD begin?

OCD can affect children, adolescents, and adults.  Most people are diagnosed by the age of 19.  The age of onset is typically earlier in boys (between the ages of 6 and 15) than girls (between the ages of 20-29).

What causes OCD?

Although genes do play a role in the development of OCD (it tends to run in families), it is believed that the disorder is caused by a combination of genetic vulnerability and environmental influences.  Imaging studies have also shown differences in the frontal cortex and subcortical structures of people with OCD.  Researchers suggest that OCD may involve problems in communication between the front part of the brain and the brain’s deeper structures.  In terms of environment, people who have experienced trauma (such as physical or sexual abuse) during childhood, are more likely to develop OCD.  OCD symptoms have also been linked to a type of streptococcal infection - this is called Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infection (PANDAS).   

How is OCD diagnosed?

There are no laboratory or brain imaging tests to diagnose OCD.  The diagnosis is made based on the observation and assessment of the person’s symptoms by a psychologist, psychiatrist, or other mental health professional. 

How effective are treatments for OCD?

Typically, OCD is treated with medication (Serotonin Reuptake Inhibitors –SSRIs, or “tricyclic” antidepressants including clomipramine), psychotherapy (Cognitive Behavioral Therapy – CBT, or Exposure and Response Prevention – EX/RP), or a combination of both.  While some people with OCD continue to experience symptoms, the majority of people respond well to treatment.  Research has begun to show both medication and therapy can actually normalize the brain circuits involved in OCD. 

http://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml

https://bbrfoundation.org/frequently-asked-questions-about-obsessive-compulsive-disorder-ocd

PANDAS fact sheet:  http://www.nimh.nih.gov/health/publications/pandas/index.shtml

Teen Depression and Suicide Warning Signs

How to tell if your teen is depressed or suicidal 

It isn’t always easy to tell when a teen is struggling with depression or just normal teenage growing pains. Teenagers face many pressures (social, academic, family) and are often in the midst of figuring out who they are and where they fit in. When a teen begins to struggle with clinical depression, it impacts every aspect of their life, and goes well beyond “moodiness.” The good news: depression in teens is treatable, and parents can learn to identify when help is needed.

Here are some signs and symptoms to look out for:

• Sadness or hopelessness

• Irritability, anger, or hostility

• Tearfulness or frequent crying

• Withdrawal from friends and family

• Loss of interest in activities

• Poor school performance

• Changes in eating and sleeping habits

• Restlessness and agitation

• Feelings of worthlessness and guilt

• Lack of enthusiasm and motivation

• Fatigue or lack of energy

• Difficulty concentrating

• Unexplained aches and pains

• Thoughts of death or suicide

When trying to figure out if your teen is just “being a teenager” or whether they are depressed, consider how long the symptoms have been going on, how severe they are, and how different your child is acting from their usual self.

Teens struggling with serious depression often think about or talk about suicide.  These thoughts should always be taken very seriously, as increasing numbers of teenage suicide attempts are successful.

Suicide warning signs to watch for include:

• Talking or joking about committing suicide

• Saying things like: “I’d be better off dead,” “I wish I could disappear forever,” or “There’s no way out.”

• Speaking positively about death or romanticizing dying (“If I died, people might love me more or finally pay attention.”)

• Writing stories and poems about death, dying, or suicide

• Engaging in reckless behavior or having a lot of accidents resulting in injury

• Giving away prized possessions

• Saying goodbye to friends and family as if for the last time

• Seeking out weapons, pills, or other ways to kill themselves

If you suspect that your teen may be suicidal, take immediate action.  For 24-hour suicide prevention and support, call the National Suicide Prevention Lifeline at 1-800-273-TALK.

For more information about teen depression and suicide, visit the following resources:

https://www.helpguide.org/articles/depression/parents-guide-to-teen-depression.htm

https://www.helpguide.org/articles/suicide-prevention/suicide-prevention.htm

Talking to your teen about depression

If you suspect that your teen might be depressed, talk to them in a loving, non-judgmental way about how they are feeling. Let them know what specific signs of depression you have noticed and why you are worried.  In general, ask your teen to share what they are going through and be ready to really listen. Make it clear to them that you are willing to provide whatever support they need.

Some tips for communicating with your teen:

• Listen, but don’t lecture: Resist the urge to criticize or judge. Instead, just be there with them in the moment.

• Be gentle but persistent: Talking about depression can be difficult; don’t give up if they shut you out initially.

• Acknowledge their feelings: Don’t try to minimize or talk them out of their depression – even if it seems irrational or silly to you. Parents often mean well when they try to explain to their teen why things “aren’t that bad,” or to “look on the positive side,” but this may leave your teen feeling like they are not understood.

• Go with your gut: If your teen says that nothing is wrong or doesn’t open up, listen to your instincts. It can help to turn to a third party – a therapist, school counselor, favorite teacher or coach can often be helpful. The important thing is for your teen to start talking to someone.

If you suspect that your teen may be suicidal, take immediate action. For 24-hour suicide prevention and support, call the National Suicide Prevention Lifeline at 1-800-273-TALK.

For more information about teen depression and suicide, visit the following resources:  

https://www.helpguide.org/articles/depression/parents-guide-to-teen-depression.htm

https://www.helpguide.org/articles/suicide-prevention/suicide-prevention.htm

Steps to overcoming social anxiety

Those who struggle with social anxiety find themselves inhibited and anxious in many types of social situations, including public speaking, meeting new people, using public spaces, or eating around others. People with social anxiety fear that people will notice their anxiety, and that they will feel humiliated. One of the most common pitfalls, in terms of overcoming social anxiety, is that most people who struggle in this way choose to avoid social situations, or use alcohol or drugs to reduce anxiety before hand.  

The good news:

There is a way out of the social anxiety cycle. Here are some steps, as outlined by Robert Leahy, Ph.D. (author of Anxiety Free, The Worry Cure, and Beat the Blues) in Psychology Today.

1. Identify the situations you are avoiding.  Make a list of the types of situations that you feel anxious in or avoid.

2. Set up a hierarchy of fear.  Rage each situation that you fear from 0-10 in terms of how anxious it makes you.

3. Identify your safety behaviors and eliminate them.  Safety behaviors can include alcohol or drugs, holding yourself very stiffly, avoiding eye contact, constantly wiping your hands, or rehearsing exactly what you will say. The more you can give up these behaviors, the more powerful the feeling of facing your fears will be.

4. Challenge your anxious thoughts. People with anxiety often think about how badly things will go – and think of the worst-case scenarios. Challenge these thoughts by asking yourself: “Is it possible that people don’t notice you are sweating, because they are thinking about themselves? What is the evidence that people are talking about your anxiety? Would anyone even care if you are feeling anxious?”

5. Practice doing what makes you anxious. Once you have identified the situations that make you anxious, and have rated them from least to most anxiety provoking, you can start confronting your fears one by one.  You can begin by imagining yourself facing these situations, and move on to actually going through them.

6. Rather than practicing negative self-talk, practice self-reward. Socially anxious people often review and criticize how they do in social situations. Instead, congratulate yourself for facing your fears!

How to Overcome Your Social Anxiety
https://www.psychologytoday.com/blog/anxiety-files/201410/how-overcome-your-social-anxiety

 The American Institute for Cognitive Therapy
http://cognitivetherapynyc.com/presentations.aspx

5 simple (really!) yoga poses that help fight anxiety

Regular yoga practice can help us stay calm, grounded, and relaxed in our daily lives as well as give us strength and focus when facing stressful events.  Even when we don’t have time to implement a full yoga practice, just a few minutes in a carefully chosen yoga pose can be incredibly helpful during moments of anxiety.  So next time you are feeling overwhelmed panicked, try one of these to get you through the moment.     

Child’s Pose (Balasana)

An essential resting pose in any yoga practice.  This pose can help slow the mind and create a feeling of comfort and self-soothing.  It involves sitting on the shins with hips resting on heels, laying chest forward over the thighs and relaxing with the forehead to the floor.  Arms can extend forward or lay by your side. Hold for 8-10 breaths.

Final Resting Pose (Savasana)

This pose helps create a feeling of complete relaxation and is especially helpful for anxiety or panic.  Try lying down flat on your back, with arms at your sides and focus on taking smooth long breaths for 10 minutes.

Tree Pose (Vrksasana)

This basic standing balance pose can help calm a racing mind and increase concentration.  Stand tall, shift your weight to your right leg, and place the sole of the left foot into your inner right thigh or just below the knee with toes pointing towards the floor.  Press the left foot into the inner right thigh, while resisting that pressure with your outer right thigh.  Hands then come to prayer position with thumbs at the heart, eye gaze can face forward or up to the ceiling.  Hold for 5-10 breaths, then switch sides.  

Legs Up The Wall Pose (Viparita Karani)

This simple pose helps slow down racing thoughts and creates a sense of calm relaxation.  Lying down on your back, elevate and rest your feet against a wall with legs straight.  Try to get the hips as close to the wall as possible, close your eyes and relax for 10 minutes.  

Standing Forward Bend (Uttanasana)

A great pose for calming down the nervous system.  This pose releases tension in the upper body while being extremely soothing.  From a standing position, bend forward over the legs, relaxing the head neck and shoulders completely.  Hold for 5-10 breaths.    

Yoga For Anxiety: 10 Poses To Reduce Stress And Support Mental Health:
http://www.huffingtonpost.com/2013/05/19/yoga-for-anxiety-10-poses_n_3281986.html

5 Yoga Poses To Help Alleviate Anxiety:
http://www.mindbodygreen.com/0-16345/5-yoga-poses-to-help-alleviate-anxiety.html 

9 Yoga tips to overcome anxiety disorder:
http://www.artofliving.org/in-en/yoga/health-and-wellness/yoga-for-anxiety-disorder

Yoga: the new tool for therapists and parents?

Yoga practitioners around the world have long proclaimed the physical and emotional benefits of this practice. More recently, researchers have started to demonstrate evidence for these claims.

A growing body of research suggests that yoga may be an important ally in reducing symptoms of chronic stress, depression, anxiety, post-traumatic stress disorder (PTSD), and even attention deficit hyperactivity disorder (ADHD). Yoga has been shown to enhance social well-being, improve mood, behavior, and sleep, and increase mindfulness skills in children, teens, and adults.  For more information on these studies, please check out the links at the bottom of the page.  

How does yoga help?

Yoga, similarly to meditation, other forms of physical exercise, and even social interaction, is thought to impact stress, anxiety, and depression by improving mood and decreasing maladaptive nervous system arousal. Yoga causes an increase in endorphins (the “happy chemicals” in the brain), and gamma-aminobutyric acid, or GABA (a neurochemical that helps regulate nerve activity).  The deep breathing that accompanies yoga helps shift the brain from a state of biochemical arousal and tension to a state of calm and relaxation. This shift helps lower the brain’s response to threat (stress and anxiety), and decreases signs of physiological arousal such as heart rate, blood pressure, and respiration.

Through Yoga, which teaches self-awareness, children, teens, and adults with ADHD, can learn to connect with their mind and body, which can help build better self-control, and alleviate impulsivity.  Yoga’s focus on rhythmic breathing can also help children and adults learn to stay more focused, while the physical work of yoga can help decrease hyperactivity by providing a way for children to exert excess energy. 

So what does this all mean?

Practitioners in the fields of psychology, psychiatry, and education, are taking notice.  Researchers at Walter Reed Army Medical Center, are offering yoga-based treatments to our returning veterans suffering from Post-Traumatic Stress Disorder (PTSD).  Yoga has been incorporated into Eating Disorder and Substance Abuse treatment programs all over the country.   Yoga is also being incorporated in programs that help students and teens with Attention Deficit Hyperactivity Disorder (ADHD).  For example, in a recent post, “Yoga, Feel the Now,” Brad Hoffman, CEO and founder of My Learning Springboard, Inc., a multidisciplinary educational consulting firm, describes how his own yoga practice lead him to include private yoga coaching among the services that he provides for his clients.  He writes that the mental, physical, and emotional demands of a yoga practice can help students in a variety of ways.  Students with attention difficulties and anxiety may begin to feel more calm and grounded, while students who are impatient and impulsive may increase their patience and control. 

Mylearningspringboard.com

http://adhd.newlifeoutlook.com/yoga-adhd

http://www.health.harvard.edu/mind-and-mood/yoga-for-anxiety-and-depression

Yoga as a practice tool:
http://www.apa.org/monitor/2009/11/yoga.aspx

Yoga and the Therapy of Children with Attention Deficit Hyperactivity Disorder: 
http://epub.uni-regensburg.de/31378/1/yoga-and-the-therapy-of-children-with-attention-deficit-hyperactivity-disorder-2157-7595.1000168.pdf

Yoga shows psychological benefits for high-school students: http://www.sciencedaily.com/releases/2012/04/120404101824.htm

Study identifies genes, pathways altered during relaxation response practice:
http://www.sciencedaily.com/releases/2013/05/130501193204.htm

Kirkwood G, et al. “Yoga for Anxiety: A Systematic Review of the Research,” British Journal of Sports Medicine (Dec. 2005): Vol. 39, No. 12, pp. 884–91.

Pilkington K, et al. “Yoga for Depression: The Research Evidence,” Journal of Affective Disorders (Dec. 2005): Vol. 89, No. 1–3, pp. 13–24.

Yoga: my own path to mindfulness

There are many ways to learn mindfulness, from workshops and group classes, to home study programs and workbooks.  My own path to being more present in my life began nowhere other than in a yoga class. 

While I initially began practicing yoga with the hopes of improving my physical strength and flexibility, I gained much more than just a stronger core and more defined shoulders. 

With encouragement from instructors to “get out of my head and into my body,” I am better able to overcome self-doubt and push myself past my perceived physical and emotional limitations.  With frequent reminders that “the way out is through, not around,” I am slowly chiseling away at my tendency to respond to stress and anxiety by immediately pushing it out of my mind without actually “dealing” with it. 

Perhaps most importantly, despite all of my training as a psychologist, and my study of mindfulness as a “technique” to help my clients, my own “aha” moment, as far as mindfulness goes, came to me not in a book, but in a yoga class. 

It may have been the verbal reminders offered by my teachers, the quiet relaxing room, the soothing music (or no noise at all), or the presence of others on the same journey that finally helped me truly experience mindfulness for myself.  Or, maybe, it was the fact that I was “stuck” in a room for 75 minutes without my cell phone or computer, leaving me no choice but to focus on my internal experience (leaving class early, or god forbid, bringing your cell phone into the classroom are big yoga faux pas).  

Whatever it was, yoga helped me begin attending to the thoughts, emotions, and sensations in my mind and body in a more meaningful way.  And here’s the biggie – I’m learning to notice what I’m thinking and feeling without judgment or criticism (a major stipulation of mindfulness). 

All of these skills have carried over into my daily life in unexpected, or perhaps, for long-time “yogis,” expected ways.  Don’t get me wrong, I am not all of a sudden walking through life with the calm, centered, and peaceful energy that I so admire in my yoga teachers.  But moments of clarity, patience, and courage in my relationships, work, and home seem to be happening more often.

See below for some of my favorite local places to practice yoga:

Equinox Fitness, Bethesda and DC, www.equinox.com

Down Dog Yoga, Bethesda and DC, downdogyoga.com

Crunch Fitness, Chevy Chase, www.crunch.com

What is mindfulness and why is it important?

Mindfulness originated in ancient Buddhist meditation practices, but people of all ages and belief systems can enjoy it’s many benefits (there is no necessary religious component).  Mindfulness is a mental state achieved by focusing one's awareness on the present moment, while calmly acknowledging and accepting one's feelings, thoughts, and bodily sensations. 

Between efforts to juggle the demands of our work, home, marriages, and children, we are often “not present” in our own lives.  Our minds are easily distracted, constantly examining past events or attempting to anticipate what will happen in the future.  Becoming more aware of our thoughts, feelings, and sensations, without judgment or criticism, can have a major positive impact on our lives.  The idea is, that mindfulness helps us step away from our automatic, often unconscious emotional and physiological reactions to everyday events, so that we can see situations more clearly, and respond in more thoughtful and effective ways.  Not surprisingly, there is a strong body of research that supports the role of mindfulness in reducing stress, improving quality of life, and even helping to reduce mental health symptoms.  

How is mindfulness learned?

There are many different approaches to learning mindfulness that are effective.  The most widely recognized and researched modern forms of mindfulness are Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT), both of with are taught using a standard curriculum.  Both MBSR and MBCT are taught as 8 week programs with participants meeting for 2-3 hours per week as a group and practicing individually at home between sessions.  Most training includes a body scan exercise, two sitting meditations, a walking meditation, gentle stretching/body awareness exercises, and a three-minute mindfulness meditation. 

Mindfulness Based Stress Reduction (MBSR):
http://www.umassmed.edu/cfm/stress-reduction/

Your Guide to Mindfulness-Based Cognitive Therapy:
http://mbct.com

Mindfulnet.org

Nine Tips for Overcoming an Eating Disorder

One of my favorite websites focused on Eating Disorder resources (eatingdisorderhope.com) recently published a list of tips for successful Eating Disorder recovery. 

Here are the top tips from the list with my thoughts on each one.

1. Work with an eating disorder specialist treatment team if at all possible.
   I can’t overstate the importance of finding a team that has a lot of experience working with people struggling with Eating Disorders. How well you connect with your treatment team is also incredibly important – if you don’t feel comfortable, safe, and connected to your therapist, how can treatment be helpful? 

2. Develop self-acceptance through practicing compassion toward yourself. 
   This is a big one, and often, after years of struggling, self-compassion goes out the window. In fact, many times, a lack of self-acceptance and kindness towards one’s self is at the root of the Eating Disorder itself.

3. Develop a positive and self-nurturing internal dialogue.
   Again, a critical inner voice only exacerbates the shame, embarrassment, and self-hatred that accompanies Eating Disorders.

4. Get treatment for co-occurring disorders such as anxiety and depression. 
   People struggling with Eating Disorders often suffer from anxiety and depression.  Make sure you find a therapist who is experienced in treating all three, and focus on exploring how other symptoms play a role in your Eating Disorder and vice versa.

5. Practice mindfulness and living in the moment.
   Eating Disorder symptoms often serve to distract us from whatever we are actually feeling in the moment (sadness, shame, fear, hopelessness). Learning to attend to our experiences and emotions in the moment, so we can better manage them, is the first step to overcoming symptoms such as emotional eating or extreme calorie restriction.

6. Listen to and honor your feelings.
   Our emotions are usually telling us something (often important). Learning to notice, listen to, and actually use our emotions to take a course of action is necessary in overcoming not just Eating Disorders, but many other mental health difficulties.

7. Eat well and listen to your body’s hunger and fullness signs.
   After ignoring our body’s hunger/fullness experiences for a length of time, it becomes very difficult to re-learn what it actually feels like to be full or hungry.

8. Accept your genetic makeup and appreciate your body.
   Your body is the only one you have, and not treating it with kindness, acceptance, and compassion only leads to a never- ending cycle of shame and self-hatred. 

9. Have a relapse prevention or correction plan.
   It’s important to know that most people have set backs – and plenty of them. The goal is to learn from each set back (What was my trigger? What helped me over come it?), and work towards bouncing back more and more quickly instead of continuing on a downward spiral.

For more information, visit:

eatingdisorderhope.com

http://www.ednmaryland.org/Family--Parents---Friends.html

The human-animal bond: an important factor in healing mental illness?

People impacted by mental illness often struggle with feelings of isolation and disconnection from others.  But new research is finding that, many people with mental health issues feel deep emotional connections with their pet that are not always available from friends and family.

In a study recently published in the journal BMC Psychiatry, Helen Brooks (a mental health researcher at the University of Manchester in the UK) and her colleagues found that pets can provide more than just emotional support and companionship, but also a distraction from mental illness. 

Brooks and her colleagues interviewed 54 people with serious mental illnesses.  The participants were asked who they went to for help or advice, where the gained support an encouragement, and how they spent their time. The participants were also given a diagram with three consecutive circles radiating out from a square representing themselves. They were asked to write the people, places and things that gave them support into the circles, with the circles closest to the center being the most important.

Sixty percent of the people who considered pets to be a part of their social networks placed them in the central, most important circle — the same place many people put close family and social workers, while twenty percent placed their pets in the second circle.

Participants in the study described that their pets helped them get out of the house to be around people, helped prevent them from withdrawing from the world.  Keeping a routine while caring for their pets (waking up in the morning to feed, groom, and walk them) provided a sense of structure and purpose in their lives.  When left jobless, having a well taken care of pet was described as a source of pride. 

Although there is much work examining the positive impact of service animals in mental health treatment, more research (such this study done by Brooks and her colleagues) is needed to better understand the potential positive impact of everyday family pets on mental health functioning.

https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-016-1111-3

http://www.npr.org/sections/health-shots/2016/12/09/504971146/pets-help-people-manage-life-with-serious-mental-illness

Orthorexia: the eating disorder you may not have heard about

The concept of Orthorexia has been gaining attention in the media and is widely used by eating disorder professionals. Although Orthorexia Nervosa is not a formal psychological diagnosis, symptoms associated with it can have a significant impact on a person’s daily functioning. In a recent article published in the journal of Eating Behaviors (Dunn & Bratman, 2016), a set of criteria was proposed to help identify the symptoms of Orthorexia Nervosa.   

What is Orthorexia Nervosa?

People with Orthorexia Nervosa have an obsessive focus on “healthy” eating and feel intense emotional distress about food choices seen as “unhealthy.”  This obsession is evidenced by compulsive behaviors and/or preoccupation with healthy eating (which is thought to promote optimum health) and feelings of anxiety and shame upon violation of self-imposed dietary rules.  Often, these dietary restrictions escalate over time and lead to elimination of entire food groups, or more frequent “cleanses.” 

It’s not all about being thin…

People with Orthorexia Nervosa often lose weight, but unlike in other eating disorders (such as bulimia or anorexia), this is not the primary goal.  The desire to lose weight is typically hidden or secondary to the desire to achieve ideal health.

What’s the big deal?

We all know someone who seems to eat “healthier” than the rest of us, but a hyper-focus on being healthy becomes problematic when it begins to impair physical/emotional health, or social functioning.  People with Orthorexia Nervosa may experience malnutrition, severe weight loss, or other medical complications.  They may lose the ability to eat intuitively and become unable to identify their body’s cues for hunger or fullness.  They may begin to have problems in their relationships with others and often withdraw from their social life.  If one’s life revolves around healthy eating choices, there may be little room for other activities and interests.  Lastly, the difference between a healthy focus on eating right and Orthorexia Nervosa is that one’s food choices become all consuming of their identity.  In Orthorexia Nervosa, a person’s body image, self-worth, or life satisfaction becomes excessively dependent on their compliance with healthy eating behaviors.  They begin to define themselves as “the person that eats healthy food,” and lose sight of other aspects of who they are – funny, smart, a mother, a colleague, a sister, a professional.    

For more information about Orthorexia Nervosa, head to:

Dunn, T.M & Bratman, S. (2016). On orthorexia nervosa: A review of the literature and proposed diagnostic criteria. Eating Behaviors, 21, 11 -17.

www.orthorexia.com

www.nationaleatingdisorders.org/orthorexia-nervosa

Losing A Pet. How To Help Your Kids And Family Through The Grieving Process.

What does grief look like in children?

Many children grieve the death of a pet very deeply, but often do not talk about their feelings. They may hold back their feelings because they are so overwhelming, and therefore, appear as though they are not affected by the death. Other times, children may express how they feel through behavior and play, rather than words. Similarly to adults, children’s reactions to death, or impending death, are varied.  However, some common reactions to look for include:

Shock:

the child may not believe it really happened and proceeds with normal activities. This is usually because the thought of death or impending death is too overwhelming.

Physical symptoms:

The child may have various complaints such as headache or stomachache and fear that this means they, too will die.

Anger:

Being mostly concerned with personal needs, the child may be angry to be “left all alone” or that God didn’t “make the pet well.” 

Guilt:

The child may think that they caused the death by having been angry, or not spending enough time with the pet who died or feel responsible for not being “better” in some way. Or they may have wished at some time that the pet would die.

Anxiety and fear:

The child may wonder who will be their “best friend” now or fear someone else in their family will die. They may cling to their parents or ask other significant persons repeatedly if they love them.

Regression:

The child may go back to behavior they had previously outgrown.

How do I talk to my children about the loss or impending loss of our family pet?

The death of a family pet is often a child’s first experience with loss.  This can also be an opportunity to teach your child about coping with the grief that inevitably comes with loving another living creature.  Importantly, although losing a pet can be a traumatic experience for a child, they may feel and show it differently than adults.   How parents handle the loss, or impending loss of the pet, and how they talk to their children about it, can have a lasting impact on the child.  Many parents may try to protect their child by leaving them out of discussions about the pet’s impending death.  This can leave children felling anxious, confused, and alone during a time when they most need the help and reassurance of those around them. 

For parents who need extra support through this process, Georgetown-Psychology-Associates offers phone and in-person consultations to help you talk to your children about the loss, or chronic illness of your family pet.

Some general tips also include:

Be as honest as possible from the start

Do not use expressions such as “getting put to sleep” as they can be confusing for younger children

Let your child see you express your own grief at the loss of the pet

Encourage your child to express their feelings openly

Reassure your child that they were not responsible for the pet’s death (children often mistakenly think that they are somehow responsible)

Involve your child in decisions related to the pet’s illness or death if possible

Understand that the emotional response of each child may vary based on age, developmental level, and relationship with the pet 

Recognize the pet’s death as a significant loss; do not trivialize or minimize your child’s feelings

Talk to each child about what they are thinking and feeling

Be open and receptive to your child’s questions

Do not rush to get a “replacement pet”

Involve your child in a good-bye ceremony and in memorializing the pet

When should I seek professional help?

For some children, coping with the loss, or impending loss of a pet, can be very overwhelming. If your child’s feelings of sorrow or guilt have not lessened after several weeks, or if they are getting in the way of their ability to engage in family, social, academic, or extracurricular activities, you may wish to seek professional support.  Reaching out to a counselor for one-on-one, group, or family grief counseling sessions can help a child get through this very touch time in a healthy way. Learning how to process difficult feelings surrounding their pets death can also help prepare the child to deal with future loses in adaptive ways.

Some signs to watch for in grieving children:

An extended period of depression - the child may lose interest in daily activities and events, be more irritable, exhibit behavior problems, or isolating from others

Inability to sleep, loss of appetite, prolonged fear of being alone

Acting much younger than their age for an extended period

Excessively talking about the pet’s death or impending death, continued crying, repeated statements of wanting to join the pet in death

Withdrawal from friends

Sharp drop in school performance or refusal to attend school

Helpful websites:

Ken Pope, Ph.D., ABPP; Pet Bereavement Resources                                                                      

List of resources in Maryland (including DC/VA)

Humane Society on coping with the death of a pet

helpguide.org on coping with pet loss

Association for Pet Loss and Bereavement

Association for Pet Loss and Bereavement - Children and Pet Loss

Penn Vet Grief Support And Social Services Facebook page

University of Pennsylvania School of Veterinary Medicine, Grief Support Resources

Argus Institute for Families and Veterinary Medicine, Colorado State University Veterinary Teaching Hospital

Hotlines:

Virginia-Maryland Regional college of Veterinary Medicine
540-231-8038

The PAL Pet Loss Comfort Line, Washington DC
202-966-2171

Losing A Pet: How To Deal And Heal In A Healthy Way

How can I take care of myself after losing my pet?

At times, the experience of grief after losing a pet can feel difficult to manage.  It is important to express and acknowledge emotions instead of bottling them up, which can increase stress levels and actually prolong and complicate the healing process.  The purpose of healthy grieving is to integrate the experience of a pet’s death into your life in a meaningful way.  There are many strategies that can be helpful when coping with the loss a beloved pet.  Some people find comfort in calling a pet loss support hotline, joining a pet loss support group, reading books about coping with a pet’s death, or talking with a counselor.  Here are some helpful tips:

• Try to remember the happy, fun, loving moments with your pet, instead of focusing only on your sorrow and grief

• Share stories of your pet with loved ones and friends; talk to them about your loss

• Celebrate your pet’s life by:

Journaling about your pet’s story (how you met, their personality, nicknames, what you love the most and what you will miss the most about them)

Writing a poem, song, or obituary for your pet

Good-bye ceremony: have a funeral or memorial service

If you chose cremation, you can keep the ashes in an urn or scatter them in a place that was special to your pet

Create a scrapbook or photo album of our pet

Keep your pet’s tag on a key chain

Ask your vet to make clay paw-prints of your pet

Keep a lock of fur in a locket or holiday ornament

Plant flowers that bloom every year for your pet

Light a candle in your pet’s memory

Donate time, money, or talent in your pet’s honor to a local rescue group (WORL, Lucky Dog, DCHS), Humane Society, or SPCA 

When should I seek professional help?

For some of us, coping with the loss of a pet, or helping children through their own grief can feel overwhelming. If your feelings of sorrow or guilt have not lessened after several weeks, or if they get in the way of your ability to engage in family, social, work, or other activities, you may wish to seek professional support.  Reaching out to a counselor for one-on-one, group, or family grief counseling sessions can be helpful in getting through this very tough time in a healthy way. 

People seek counseling after losing their pet for a variety of reasons including: 

Not having a strong support network of people to turn to

Not feeling comfortable speaking to friends and family about this loss

Experiencing grief for a prolonged period of time

Feeling unable to manage the emotions associated with grief in a healthy way

Feelings of grief that are getting in the way of performance at school or work

Feelings of grief that are negatively impacting relationships

Persistent flashbacks, nightmares, or intrusive memories about a pet’s death

Continued yearning for the lost pet

“Feeling stuck” in the grief

At times, people can experience more serious difficulties after the loss of a pet.  If you are experiencing any of the symptoms described below, you should seek professional help as soon as possible:

Thinking about hurting or killing yourself

Thinking about hurting or killing another person

Using drugs or alcohol to help you cope with your grief

Symptoms of depression such as difficulty with basic daily activities like getting out of bed, eating, bathing, or going to work, isolating yourself from friends or family, feelings of hopelessness

Helpful websites:

Ken Pope, Ph.D., ABPP; Pet Bereavement Resources                                                                      

List of resources in Maryland (including DC/VA)

Humane Society on coping with the death of a pet

helpguide.org on coping with pet loss

Association for Pet Loss and Bereavement

Association for Pet Loss and Bereavement - Children and Pet Loss

Penn Vet Grief Support And Social Services Facebook page

University of Pennsylvania School of Veterinary Medicine, Grief Support Resources

Argus Institute for Families and Veterinary Medicine, Colorado State University Veterinary Teaching Hospital

 

Hotlines:

Virginia-Maryland Regional college of Veterinary Medicine
540-231-8038

The PAL Pet Loss Comfort Line, Washington DC
202-966-2171

Losing A Pet. What Does Grief After Pet Loss Look Like?

For many of us, our pets are our best friends, companions, and family members.  Our pets are often a source of social support and unconditional love, while expecting very little in return.  Many people form very strong relationships with their pets, and losing these pets may lead to feelings of grief similar to those experienced after any other significant loss.  

When grieving the loss of a beloved pet, you may feel a wide range and depth of emotions such as anger, pain, guilt, despair, regret, relief, loneliness and shame.  Although these emotions are a normal and healthy part of the grieving process, they can affect many areas of our lives: physical, intellectual, emotional, social, and spiritual.

What does grief look like and how long will it last?

Although there is no “normal” timetable for grieving, the pain of losing your pet usually eases with time.  Some people feel better in a matter of weeks or months, while for others, the grieving process can last years.  It is not unusual, overtime, for certain memories of your pet to become blurred, or for grief to come in “waves,” changing from day to day. This does not mean that you are forgetting about your pet, or that you love them any less.  They will always remain in your heart as a special part of your family.  While each person may experience grief differently, some common reactions are:

Physical:

crying, shock, numbness, dry mouth, lump in throat, shortness of breath, stomachache, nausea, tightness in chest, restlessness, fatigue, exhaustion, difficulty sleeping, change in appetite, body aches, stiff muscles/joints, dizziness, fainting

Emotional:

sadness, anger, guilt, anxiety, relief, loneliness, irritability, desire to blame others for loss, resentment, embarrassment, self-doubt, lowered self-esteem, feelings of being overwhelmed or out of control, feelings of hopelessness and helplessness, feelings of victimization, affect that may seem out of sync for the situation (e.g., smiling/laughing when nervous)

Intellectual: 

denial, sense of unreality, confusion, inability to concentrate, preoccupation with loss, hallucinations related to loss (visual, auditory, olfactory), need to reminisce about the pet and talk about the circumstances of the loss, sense of time passing very slowly, rationalizing or intellectualizing feelings about the loss, thoughts or fantasies about suicide (not accompanied by concrete plans or behaviors)

Social: 

feelings of withdrawal, isolation, greater dependency on others, rejection of others, reluctance to ask others for help, change in friends or living arrangements, desire to re-locate or move, need to find distractions from feelings of grief (stay busy or overcommit to activities)

Spiritual:

bargaining with God in attempt to prevent loss, feeling angry at God when loss occurs, renewed or shaken religious beliefs, feelings of being blessed or punished, searching for meaning in the loss, questioning whether souls exist and what happens to loved ones after death, need for closure or purposeful ending (e.g., funeral, memorial service, good-bye ritual) 

 

Helpful websites:

Ken Pope, Ph.D., ABPP; Pet Bereavement Resources                                                                      

List of resources in Maryland (including DC/VA)

Humane Society on coping with the death of a pet

helpguide.org on coping with pet loss

Association for Pet Loss and Bereavement

Association for Pet Loss and Bereavement- Children and Pet Loss

Penn Vet Grief Support And Social Services Facebook page

University of Pennsylvania School of Veterinary Medicine, Grief Support Resources

Argus Institute for Families and Veterinary Medicine, Colorado State University Veterinary Teaching Hospital

Hotlines:

Virginia-Maryland Regional college of Veterinary Medicine
540-231-8038

The PAL Pet Loss Comfort Line, Washington DC
202-966-2171 

B.E.D. – the eating disorder that’s way more common than you think

What is Binge Eating Disorder (B.E.D)?

B.E.D. is an eating disorder in which a person experiences recurrent episodes of binge eating (on average, at least once per week for for three months) that are marked by consuming abnormally large amounts of food, more food than a person would normally eat in a similar period of time. Binge-eating episodes are often accompanied by a feeling of being “out of control” and followed by feelings of guilt and shame. Binge eating may also be characterized by eating extremely fast, eating beyond feeling full, eating a lot when not hungry, eating in secret to hide how much is being eaten. Unlike people with other types of eating disorders, people with B.E.D. don’t routinely try to “undo” their excessive eating with extreme actions like throwing up or over-exercising. 

How common is B.E.D?

B.E.D. affects an estimated 2.8 million US adults, making it 3x more common among adults in the United States than anorexia and bulimia combined.  It can be seen in children, teens, and adults and can affect both women and men. Although the exact cause of Binge Eating Disorder is unknown, it is believed that certain chemicals in the brain, family history, and certain life experiences play an important role. The judgment, shaming, blaming, and discriminating that takes place around body weight in today’s society is also thought to be a key contributor.   

How is B.E.D. managed?

Recovery from B.E.D. is typically an ongoing process of growth and insight, and change happens by working through the ups and downs. Over time, those with B.E.D can develop a much more peaceful relationship with food, their bodies, and themselves. Compassionate self-care and self-awareness are key for long lasting recovery. Treatment may include individual therapy, support groups, family therapy, family member support/education, specialized nutrition counseling, or medication. Various types of therapeutic modalities have been found to be helpful including Cognitive Behavioral Therapy (CBT), Interpersonal Therapy (IPT), and Dialectical Behavior Therapy (DBT). Other types of therapy may also be available and effective, but have not been thoroughly studied yet.

Helpful Websites:

National Eating Disorder Association (NEDA)

The National Association for Males with Eating Disorders (N.A.M.E.D.)

www.bingeeatingdisorder.com

Binge Eating Disorder Association

Recommended Books:

The Bing Eating and Compulsive Overeating Workbook

Intuitive Eating

Healthy Bodies: Teaching Kids What They Need to Know

 

Three things you can do to stop a binge in its tracks

Binge Eating Disorder B.E.D. is the most common eating disorder in the United States. It affects 3x the number of people diagnosed with anorexia and bulimia combined. An estimated 3.5% of women, 2% of men, and 30%-40% of those seeking weight loss treatments meet criteria for a B.E.D diagnosis. An even higher number of people may not meet full diagnostic criteria for the disorder, but still suffer from the emotional effects of binge eating.

Being mindful and present is key to overcoming binge eating behavior and coming to a place of self-compassion and love. Although recovery is a complex process, here are some strategies that can help you gain control:

 

Set yourself up for success

For many, a binge is, in large part, a reaction to restrictive dieting. When your body is deprived of nutrients and calories, it is in “starvation mode” - making it incredibly difficult not to engage in a binge once your body finally has access to food (especially food that is considered “off limits”). The key here is to eat a healthy, well-balanced meal or snack every 3-4 hours (a combination of protein and fiber is best). 

Practice Mindfulness

STOP:

As soon as you notice the urge to binge – STOP in your tracks and take a few minutes to really listen to yourself. Find a quiet place, sit down, and tune in…

NOTICE & NAME your emotion:

NOTICE what your heart and body are experiencing. Ask yourself: “What am I feeling and thinking, right now in this moment?” Once you can identify a thought or emotion, NAME it. Is it Anxiety? Fear? Loneliness? Anger? Sadness? By giving your emotions a name, you can create some space for yourself to step away, observe your experience in a new light, and chose a different, more effective behavior. 

Chose an ACTION:

The goal here is to listen to your needs and care for yourself in a healthy way. Ask you yourself: “What am I needing right now and how can I take care of this need?” For example, if what you are really feeling is loneliness, instead of engaging in a binge to numb this feeling, call a friend or family member to re-connect. If you are feeling anxious, perhaps taking a walk around the block or engaging in a deep breathing exercise can help you feel more calm.

Get Help

Recovering from binge-eating behaviors takes time and often requires engaging in treatment with a professional therapist or counselor. For those experiencing binge-eating episodes on a more frequent basis (at least once per week for three months), it’s important to make self-care a major priority, and reach out for help.

Recommended Books:

The Bing Eating and Compulsive Overeating Workbook

Intuitive Eating

Healthy Bodies: Teaching Kids What They Need to Know

Helpful Websites:

National Eating Disorder Association (NEDA)

The National Association for Males with Eating Disorders (N.A.M.E.D.)

http://www.bingeeatingdisorder.com/

Binge Eating Disorder Association