Redefining public health

I watched a documentary on the BBC this week which focused on women suffering from  Diabulimia. This is a type of eating disorder where someone with Type 1 Diabetes reduces the amount of insulin they take in order to control their weight. Without enough insulin, sugar builds up in a diabetics blood and urine. Chronically high blood sugar, known as hyperglycemia, can cause irreversible damage to the eyes, kidneys and nervous tissue. If the body is starved of glucose for long enough, it will start to beak down muscle and organ tissue in a process called diabetic ketoacidosis which can be fatal if untreated.

I had never heard of the condition before but straight away I could relate to the women as I am well acquainted with that deep sense of inadequacy that could cause you harm yourself in this way. It was so sad to see these beautiful women causing such harm to their body in order to stay slim. It made me angry that as a society we have created such a fear of weight gain that people are willing to risk their lives to achieve the “ideal body”.

The lack of support for this complex condition reminded me so much of my own visits to my GP. Admitting that you have a problem can be so challenging and reaching out for help is often a shameful experience. To  then be told that there is nothing available because you don’t fit into the standard boxes of anorexia or bulimia is ridiculous. It is time for us to open up the definition of disordered eating to include all of those whose preoccupation with food and weight is subtracting from their quality of life. I think we would be shocked at the number of people, especially women, who would come forward.

There is a need for a general education on the harmful effects of dieting and support for building a healthy body image. Children are growing up surrounded by diet products and perfect insta-filtered bodies and they need to be prepared to avoid a generation of damaged self esteem. The focus needs to shift from focusing on weight to teaching people to eat well and move their bodies to improve their health and internal sense of well being. There are some great programs emerging in the NHS which are encouraging healthy habits but for some reason the scale always takes centre stage.

The Health at Every Size movement focuses on encouraging positive lifestyle changes for people in all body shapes and sizes, reducing weight discrimination and improving bodily acceptance and self-confidence. This is an area that I am really interested in and going forward into a career in Public Health, I hope I can help raise awareness and be part of bringing these ideas into the mainstream. This change won’t happen overnight – diet culture is well established and we need a total reprogramming of our beliefs and values. But I do believe the shift has started and it is only a matter of time before people wake up and take back the power over their own health.

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Do you still believe in diets?

The fact that dieting works is one of the most widespread myths of the western world.

So many women are stuck in the constant cycle of calorie restriction, deprivation followed by rebound overeating and weight gain.

Diet cycle

The problem is that we don’t see it as a cycle. We see it as lots of separate, successful diets with periods of failure on our part in-between. We see the diets as being successful due to our initial weight loss and then blame ourselves for “falling off the wagon” and gaining back the weight. Then of course, we see the only solution as starting a new diet.

What we don’t realise is that with every cycle our body becomes better equipped to deal with the perceived famine.

  • Our digestive systems slow down in an attempt to squeeze every last calorie out of the food that we eat, leaving us feeling bloated and sluggish.
  • Our metabolism slows down so that we waste less energy as heat, resulting in a drop in our body temperature and symptoms such as cold hands and feet and sensitivity to cold.
  • Growth of our nails and hair slows down as our bodies try to conserve energy and we may experience disruption to our menstrual cycles.
  • Even we slow down as we start to feel the effects of being in a chronic energy deficit such as fatigue and muscle aches and pains.

Basically, everything slows down! Not only that, our bodies develop ways to persuade us to eat more, increasing our hunger signals and cravings for sweet and fatty foods making us feel like we just don’t have the willpower that we used to. Often, we feel like we have no control around food and start to think about it wayyyy too often.

Even though our society views dieting as the healthy and often even the moral thing to do, chronic calorie restriction and yoyo dieting are some of the most damaging habits for our bodies long term.

Really, calorie restriction can go one of two ways:

  1. Sustained weight loss / chronic calorie restriction

Yes there are people who lose weight and successfully keep it off. However, it is important to realise that those who lose weight through dieting need to eat less and less as they get older in order to maintain their weight. Sometimes this is referred to as “metabolic damage” but in reality it is actually our bodies getting super efficient!

Being in a calorie deficit is a stressor for our bodies, causing cortisol levels to sky rocket. Short term, this has the effect of raising our blood sugar and increases the breakdown of lean tissue for fuel. Long term, chronic stress affects all systems of the body causing digestive issues, a suppressed immune system and an increased risk of cardiovascular disease… and we thought going on a diet was healthy!

  1. Weight cycling / Yo-yo dieting

Cycling between extreme calorie restriction and rebound overeating is a trap that many dieters fall into. One of the issues with this is that we can end up depriving our bodies of essential nutrients. In the dieting phase, we might be eating healthy food (or not!) but if we are not consuming enough calories then it is unlikely we are getting the nutrients we need. In the rebound phase, our bodies are desperate for energy so we are much more likely to reach for calorie dense, processed foods that provide that quick surge of energy but still don’t provide the nutrients our bodies need. Of course, this is another survival mechanism as if we were in a true famine it is much better to survive with a slight nutrient deficiency than to waste away from lack of energy. But when we are practicing this pattern again and again throughout our lives we can get into trouble.

In addition, each weight cycle results in loss of muscle as well as fat which can change our body composition significantly over time. Reduced lean mass leaves us with a lower resting metabolic rate, meaning that each time we fall of the wagon we seem to regain weight quicker and each time we diet it gets harder and harder to lose weight.

So if dieting is off the cards, what is the solution?

Jumping off the diet wagon and learning to eat intuitively is one of the healthiest things you can do for your long-term health. I really recommend the book Intuitive Eating by Evelyn Tribole as a guide to escaping the diet cycle and tuning into your body’s needs. It is definitely a journey rather than a quick fix as it take time to unpick old habits and form new ones but one that is so worth it!

Right now, I am in the healthiest place I ever have been with food. I probably weigh 15lbs more than my old “ideal weight” but in time I am realising how warped my view of ideal actually was. Plus, I am maintaining that weight on twice as many calories than I used to eat which is so liberating. I eat food that I love and that I know is nourishing for my body and eat A LOT of it. And when I want to treat myself I do. I go out to eat knowing that I can have whatever I want with no guilt and I eat until I am satisfied (sometimes more and that is ok too!).

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If you are currently stuck in the dieting cycle, please please please take a moment to write down a timeline of your dieting history and look at the patterns. I know for me it really helped to see on paper how long I had been chasing my tail – just how many times I had lost and gained the same 5lbs and just how many “fresh starts” I had had. Sit and really think about the emotions that you feel during each phase of the cycle and ask yourself whether it is worth it. And if not, know that there is a way to step out of all of that and into food and body freedom 😊

Calling all health freaks on birth control

Are you taking the contraceptive pill?

Are you into “health and fitness”?

Do you exercise a lot?

Do you watch what you eat?

Are you underweight or at the lower end of an average BMI?

Are you under a lot of emotional stress?

If the answer to any of the above questions is yes, then listen up.

Your hormonal health may be suffering and be masked by taking the pill.

In my HA Recovery Diaries series I wrote about my struggles with Hypothalamic Amenorrhea. This is when women stop having their natural menstrual cycle due to physical or emotional stress on the body, including over-exercise, under-eating and being at a low body weight (and by low body weight I mean below our bodies’ happy point, not what is defined by the media or fitness industry).

The hypothalamus is like the control centre of our brain. It sends out hormonal signals which regulate all our important bodily functions, including metabolism, body temperature and reproduction. When the hypothalamus detects a stressful situation, in particular an “energy crisis” which can arise from exercising too much and moving too little, it shuts down any unnecessary functions. This can result in symptoms such as feeling cold, brittle hair and nails and, of course, loss of our menstrual cycle.

For women who are on the pill, this huge sign that something is wrong can easily be missed. The pill introduces synthetic hormones into the body in order to trick the body into thinking it is pregnant, thereby preventing ovulation. In order to induce a monthly bleed, 7 days of sugar pills replace these hormones every 4 weeks. The “period” that we get when on the pill is in fact a withdrawal bleed from the sudden drop in hormones. This means that we assume everything is fine with our hormonal system when actually things could be going very wrong!

In today’s body conscious society, I think this is a much more common problem than we realise. It has become fashionable to hang out at the gym, living in leggings and sports bras, striving to achieve the perfect, toned body. We are told that exercise is important to maintain a healthy body, which is true to a certain extent, however it is not the full story. Moving our body is of course good for our health, however exercising too intensely or frequently is perceived by the body as a physical stress and can cause our metabolic and reproductive systems to shut down.

I was lucky that I came off birth control after only 12 months and after a few years of being fobbed off my doctors that my “post-pill amenorrhea” was normal I realised that something else was going on. However, it still took me another 6 years to actually get to the bottom of the issue and to regain my cycles. During my recovery process, I have met so many women who have come off birth control to try and get pregnant and found that their cycles just didn’t come back. I can only imagine the disappointment and frustration at wanting a child and your body simply not being ready.

And the recovery process is not always quick or easy. Depending on the extent of the damage done, not so much in terms of physical damage to your body but more in how ingrained the thought patterns have become, it can take months or even years to recover. For many who have built their life around nutrition and exercise and may be known by their friends and family as “the fit one” or “the skinny one”, habits can be extremely hard to break. Even once you start treating your body right, it may be months before it feels safe enough to grow a child. I am not saying all of this to scare you, I am just being honest.

You might think that because you are not trying to get pregnant, then it isn’t all that important to have a period. Certainly the whole point of the birth control pill is to shut it down. But like I said earlier, not having a period is a clear signal from your body that it is not happy and that things need to change. Think of it like your monthly report, indicating how well your body is functioning. Menstrual cycle disruptions, including PMS as well as amenorrhea, indicate the health of your bones, thyroid and metabolism. This beautiful, complex hormonal cycle also regulates our emotions, sex drive and even how much we enjoy sex. These days everyone is using fitbits and health and fitness apps, but we have our own built in tool to inform our health decisions and we are simply not using it!

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So to summarise, if you are on the contraceptive pill and there is a chance you fall into the category of “health freak”, “fitness fanatic” or “stress head” then I strongly advise you to do some research on Hypothalamic Amenorrhea. Read my HA Recovery Diaries series, check out this link and see what you think. If you think you are someone who could be affected by this then it may be a good idea to come off the pill for a while and see what happens. The first stage of solving any problem is awareness and you now have that after reading this post so you are already on the journey to recovery. Next comes acceptance and hopefully it won’t take you 6 years to get to this stage like it did for me.

Finally comes action! And if you get to this point you are in great company. I have met so many amazing women online going through this healing journey. I have discovered Intuitive Eating, Health at Every Size and Life Unrestricted communities which have helped to totally reprogram my brain. So for that I am thankful!

If you have any questions please contact me and I will be happy to help 🙂

 

HA Recovery Diaries #7 Progress Update

It has been two months since my last post so I thought it was time for an update on my recovery process.

I had my first period at the beginning of March and my next cycle came right on time after 28 days. I was amazed and thought it was too good to be true!

And it was.

On day 17 of my third cycle, just a few days past when I should have ovulated I had a random two day bleed.  And nothing since..

It was quite disappointing as it had felt like a miracle had occurred and things had just fallen back into place but looking back, it was actually a great thing. A big STOP sign which led me to pause and reflect on my life and recovery process. I felt like things hadn’t changed so I went back to the book (Nicola Rinaldi’s No Period Now What book that is for those who haven’t been following my posts) and reminded myself of what can send our cycles out of whack.

Cycle

The first point is a tough one. I definitely have not been eating as much lately as during my peak HA recovery efforts. This hasn’t been on purpose but more because my focus has shifted towards other things and I simply don’t feel like sitting around eating biscuits and chocolate in the evenings.  I have gravitated back towards a whole foods plant based diet simply because this is what makes me feel good! I am still eating a ton of food and I am definitely not in a calorie deficit but maybe I do need to think about introducing some more “fun foods” back into my life.

I am still keeping away from the gym and all cardio activity. Since the weather is getting warmer I am probably walking more than I was but nothing extreme. I am still focusing on yoga and trying to slowly build my strength back. I don’t feel like my current activity level is enough to stress out my body but if I am not seeing any positive signs in the next few weeks I may have to rethink things and give my body more time to rest and heal. This is pretty frustrating as I love cycling and I was hoping that I would be able to spend the summer exploring on my bike but maybe this is not a good idea for me right now.

My weight has stopped increasing and has remained pretty stable since my period returned. How do I know that you might ask? Well if I am honest, I have got back into the habit of weighing myself every once in a while “just to check up on things”. This is something that absolutely needs to stop. I am so past the point of feeling that my weight defines my health, happiness or value as a human being but old habits die hard. So from now on, I am enforcing a scale ban for a minimum of 30 days.

Now to the big one: stress! I have had a lot of stress in my life this month. I have decided to leave the safety of my job and venture into the unknown. I will write more about this in another post but to summarise, my anxiety levels sky-rocketed when I had to make that decision and again when I had to actually make it happen and tell people at work that I am leaving. Now that stress is over I have the dull, underlying worry of wondering what I am going to do next, when I will find another job and whether I will be able to pursue my passions and find a new career that I love.

So really, looking at the bigger picture, it is no surprise that my cycle went a bit wonky this month. Recovery is not a linear path and I expect the future to be full of ups and downs in the road. But this is ok. Even being aware of this is all amazing progress. My advice for those who are still working towards recovery is to be patient  with yourself. Treat yourself with kindness and compassion and celebrate the small victories. Don’t dwell on the setbacks, learn from them and move on. Never stay stuck in your comfort zone, keep trying, keep challenging yourself and facing your fears. I promise it will be worth it!