Extreme food restrictions, abnormal eating behaviors, intense fear of gaining weight, but maintaining a normal or above-normal weight – could it really be an eating disorder?
Atypical Anorexia (AN) is an eating disorder included in (OSFED) Other Specific Feeding and Eating Disorder category. Its features are similar to typical anorexia without meeting low weight criteria, and those with AN are often living in a larger body or may have been living in a larger body and lost a significant amount of weight and received positive comments from family, friends, and physicians only to keep encouraging them to keep up what they are doing.
Was their weight loss it due to a change in lifestyle? Or surgery, cancer, depression, grief, or and eating disorder?
It’s important to look behind someones weight loss, don’t just assume it is healthy.
They may exhibit:
extreme fear of being fat
adding up all the numbers of the foods they eat,
forcing exercise to burn a certain amount of calories
cutting out foods and food groups,
avoiding social events with food,
anxiety over meeting a friend for lunch
deciding if they can eat dinner or not
distress over body image.
Those suffering from AN often do not show physical signs of suffering, therefore it is important to look beyond their weight. Eating disorders in someone living in a larger or normal size body can be a deadly psychiatric illness with physical and psychological complications. It may be accompanied by low blood pressure, amenorrhea (loss of menses), depression, OCD, self-harm, or suicidal thoughts.
AN in not a lesser diagnosis than anorexia, it is just a different manifestation. Many individuals who have atypical anorexia may not even realize that they are struggling with a severe and deadly eating disorder, simply due to the weight stigma that surrounds this disease. A person may think, “I am not sick enough to have an eating disorder”, because they may be within a normal or above weight range. There is a 3:1 ratio of females to males with the diagnosis of AN.
All eating disorders can be debilitating for an individual who is struggling. If you or a loved one may be dealing with an eating disorder, be sure to reach out to someone and talk about your struggles.
A treatment team consisting of an eating disorder dietitian and therapist will focus on evidence based treatment, Cognitive Behavioral Therapy, Exposure Based Therapy, Nutrition Rehabilitation and normalizing eating behavior.
Don’t let any type of eating disorder keep you from achieving health and happiness.
Suzanne Iovanni, RDN, CSSD, CLT
The Sunshine Vitamin – Although we refer to it as a vitamin, vitamin D is actually a hormone. Our body makes vitamin D from cholesterol when the skin is exposed to the sun. We can also get vitamin D through food; fatty fish, fortified dairy products, and egg yolks. But, it is very difficult to get it from food alone.
Vitamin D deficiency is very common, affecting about 50% of children and adults worldwide. Every tissue in the body has vitamin D receptors, including the brain, heart, muscles, and immune system. This means vitamin D is needed at every level for the body to function. Vitamin D deficiency has significant medical and psychological consequences. The signs usually start subtle and then become significant. Good news… it’s easy to fix!
Risk factors include
Dark-skinned individuals’ high level of melanin impairs absorption of vitamin D, which is made when skin is exposed to ultraviolet radiation found in natural sunlight.
As people age they lose some of their ability to synthesize vitamin D from sunlight. Also, elderly people who are homebound are less likely to spend time outdoors.
LOW CONSUMPTION OF FOOD FORTIFIED/CONTAINING VITAMIN D
People on a vegan diet are at high risk of suffering from vitamin D deficiency since most of the foods taken are not sources of vitamin D or just contain small amounts of it.
ALWAYS WEARING SUNSCREEN
We all know UVB radiation from the sun is the major cause of skin damage and cancer. But, we also know the sun is the most efficient way for us to make vitamin D. Sunscreens with a high SPF filter out the wavelengths that cause the production of vitamin D in the skin.
SPF of 15 or higher can reduce the body’s vitamin D production by 99 percent. To boost and maintain optimal vitamin D levels, researchers recommend spending about 10 to 30 minutes in midday sun twice each week, without the protection of sunscreen and exposing face, neck, arms, and legs.
LIVING FAR FROM THE EQUATOR
People living in areas farther away from the equator make less vitamin D in their skin. In these areas, more of the sun’s rays, especially UVB rays, are absorbed by the earth’s ozone layer. People who live farther away from the equator need to spend more time in the sun to produce enough. Which is further complicated in the long, cold winter months!
CERTAIN MEDICAL DISEASES
Celiac disease, cystic fibrosis, and chrohn’s disease can all affect your intestine’s ability to absorb vitamin D from the food you eat.
Common signs you may be deficient in Vitamin D
FREQUENT ILLNESSES AND INFECTIONS
Vitamin D plays a major role in our immune system, so if you are contracting things like the common cold, strep throat, the flu, or other infections and illnesses more frequently than you normally would and taking much longer to recover, it could mean you are low in Vitamin D.
CHRONIC BONE AND LOWER BACK PAIN
Vitamin D helps your body absorb calcium, which is essential for bone health. Deficiency can negatively impact your nerves, muscles and your immune system. A common symptom of vitamin D deficiency is joint and lower back pain.
SLOW WOUND HEALING
Cuts taking along time to heal? Vitamin D impacts your body’s ability to heal its wounds. If you do not get enough vitamin D, you’re may experience impaired wound healing. This can be particularly problematic for people who are going through surgery or serious injuries.
Low levels of vitamin D can cause chronic fatigue despite how much sleep you get.
DEPRESSION AND ANXIETY
Vitamin D helps to regulate certain chemicals in your brain, including those that impact your mood. If you aren’t getting enough vitamin D, your mood could end up suffering.
Some studies show that by giving vitamin D to people who are deficient helps improve depression, including seasonal depression that occurs during the colder months and anxiety.
Vitamin D assists with the absorption of calcium, helping to build strong bones. It is imperative vitamin D levels are in optimal range to protect bone mass and reduce risk of fractures.
HAIR LOSS IN FEMALES
Štress is a common cause of hair loss. However, when hair loss is severe it may be due to an autoimmune disease called alopecia or nutrient deficiencies, including vitamin D.
Vitamin D receptors are present in nerve cells that sense pain and studies have shown a link between chronic pain and low blood levels of vitamin D.
TEST AND TREATMENT FOR VITAMIN D DEFICIENCY
The most accurate way to measure how much vitamin D is in your body is 25-hydroxy vitamin D blood test. A level less than 12 ng/mL indicates vitamin D deficiency, although a level less than 20 ng/mL is considered inadequate and often requires treatment.
Treatment for vitamin D deficiency involves getting more vitamin D through diet AND supplementation.
Guidelines from the Institute of Medicine increased the recommended dietary allowance (RDA) of vitamin D to 600 international units (IU) for everyone ages 1-70, and raised it to 800 IU for adults older than age 70 to optimize bone health. The safe upper limit was also raised to 4,000 IU. Therapeutic dosage may be prescribed containing more than 4,000 IU to correct a vitamin D deficiency, but blood levels must be monitored by your physician.
~Building Better Nutritiōn
The majority of athletes I consult with usually want to know what protein supplements are best and if they are necessary to their sport. I will help answer when and what protein supplements may be beneficial in an athletes nutrition plan. But, first let’s get this straight, no nutritional supplement will counter negative effects of a poor diet on physical performance! But, supplements can be a solution to filling a nutritional gap. There are some key bits of information to consider. The quality control of nutritional supplements does vary considerably, and a consumer may not always get everything they think they are paying for.
I get excited to talk about fueling with clients as for many it is just a guessing game, or worse, there is no fueling around the training session at all! I appreciate the science behind proper fueling and refueling for performance and recovery.
Adequate refueling (what to eat after a training session) post workout should be a 3:1 or 4:1 carb to protein ratio, consumed within 30-60 minutes of training completion. This is when your muscle and liver cells act like a sponge and soak up that nutrition to recover and repair! Depending on your size, you need 15-30 grams of protein after a hard workout to refuel and start to rebuild muscle. It’s not always possible to consume a meal right after a workout or maybe you just don’t have an appetite after intense exercise. Eating real food is ideal, but in a pinch it’s perfectly OK to grab something easy like a smoothie/shake with protein powder. Adding frozen fruit and fluid to a protein powder is a fabulous way to get in what you need post workout; carb, protein, and fluids – in a convenient and refreshing way.
But there are so many protein powders on the shelfs and online! How do you know what is the best or worst choice? I separate the choices into whey based and plant based protein powders.
Whey based protein is a complete source of protein with branch chain amino acids, which are the building blocks for muscle growth. It is high in Leucine (which we call the leucine trigger – some good science here). After consumption of whey protein, which is higher in leucine content than soy, casein, or plant protein, there is a rapid increase in blood concentration of leucine and this increase corresponds to the extent of stimulation of muscle protein synthesis. Therefore, whey protein has a superior increase in muscle protein synthesis compared to soy, casein, and plant protein.
Whey protein is the fast-digesting part of dairy protein. Different forms of whey protein supplements are available, with two of the most common being whey concentrate and whey isolate.
Whey concentrate is only 70-80% protein and has some fillers from lactose and fat. If you have problems digesting whey due to the lactose content, avoid the concentrate and go for isolate!
Whey isolate undergoes more processing, which results in a higher protein content 90%+ with less carbs, lactose and fat. Whey isolate is typically more expensive than whey concentrate.
Whichever you choose, whey is a high-quality protein that can help you reach your daily protein intake goals.
I have done some extensive research to find a great tasting protein powder without unnecessary additives (artificial sweeteners/flavors, carrageen, corn syrup solids) and the one that has stuck for my family and I, is Klean Athlete. All their products are NSF Certified for Sport, which means they go through rigorous testing and are free from banned substances and contaminants. This is especially important for athletes who play at a level where drug testing is involved as it provides athletes the peace of mind they need in order to perform at their best—safely and effectively. I also believe non-drug tested athletes and casual competitors alike should also have access to supplements free of banned substances!
Because I am a regular consumer of Klean Athlete and this is my number 1 choice of supplements to recommend to my clients, I am able to offer you an affiliate discount of 15% off any Klean Athlete Product. To receive the discount simply copy and paste the link below to order, set up your account and you are good to order with 15% off.
Plant based protein powders are easily digestible and have been proven to fight inflammation and reduce muscle soreness, which makes them a good alternative for any athlete or active person who follow a vegan diet or suffer from dairy allergies. These often include soy, brown rice, pea, chia, and or hemp protein. Although whey based protein has been scientifically proven as the superior protein powder choice for it’s muscle-building benefits, there are alternatives for you!
Suzanne Iovanni, RDN, CSSD
*Sports Nutrition plans should be individualized as nutrient requirements are not static and energy availability is the foundation for health and performance.
**Consult with a sports dietitian for an individualized nutrition and fueling plan.
The weight loss industry knows we have caught on to them, especially commercial weight loss programs such as Weight Watchers and Jenny Craig, often thought of as your mother’s and grandma’s diet which they have become lifelong members with- why is that? Because they do NOT work! And gone are the days of fat free foods and 100 calorie pack snacks, those just leave us feeling hangry (hungry and angry).
Restrictive diets in effort to lose weight and quick, results in increased cravings and urges for food. 90-95% of people who lose weight on diets, regain the weight back and many result with weight higher than they started at! We have the before diet, after diet, then there is the after, after diet! And it is not because you failed! Restrictive diet’s cause you to gain weight in the end!
Diets cause many biological and health damage including; teaching the body to retain more fat, slows rate of weight loss with each attempt of dieting, lowers metabolism, and increases binges and cravings.
Dieting also provides psychological and emotional damage; eating disorders, increased stress, social anxiety. Dieting gradually erodes confidence and self-trust.
Since the diet industry knows that millennials have caught on, they are coming at us from a different angle. They are reinventing themselves as Wellness. They are coming at us from a sneaky way to continue the dieting rollercoaster, but presenting it as health and wellness (and sustaining the multi billion $$ diet industry). These are in the form of clean eating, cleanses, Whole30, detoxes, Paleo, Ketogenic Diet, Intermittent Fasting. Again, giving you more food rules and pushing you further away from intuitive eating, which really hones in on your hunger and satiety cues. Resulting in not eating when we are hungry and then eating past satiety.
I admit it is so hard to go against the grain and start trusting your body to tell you what, when, and how much to eat. Especially when you are constantly inundated with social media posts regarding diets. The only thing you should detox are the social media accounts that make you feel not good enough! It’s time to retrain our minds on nourishing our bodies for physical and mental satisfaction as well as balancing our appetite and weight regulating hormones after dieting has disrupted the balance. Diets that consistently have us taking in too few calories than we expend through our resting metabolic rate (RMR) and activity, result in our bodies responding by increasing or decreasing certain appetite stimulating and satiety hormones. Let’s take a look at hormones that effect our appetites and weight – Leptin, Ghrelin, Cortisol, and Insulin.
Leptin is the ‘master’ hormone that regulates weight and is produced by fat cells. It tells us when we have enough food and can burn energy. It also influences our fertility and immunity. Its primary goal is energy balance and it influences how much we eat, expend, and store. Weight loss decreases leptin, then the brain tries to gain weight back. We can have leptin resistance! This is when the brain isn’t listening. No drop in appetite, no increased metabolism. Your brain can even think you’re starving, because it doesn’t think that there’s not enough leptin. So it makes you even hungrier!
So the vicious cycle starts:
- increased body fat = more leptin
- too much body fat = leptin signal disrupted
- brain thinks you are starving, so you eat more
- and it repeats
Ghrelin is the ‘hunger’ hormone, which is produced in the stomach and tells the brain to eat! It’s primary role is to increase appetite, increase food intake, and store fat. Ghrelin rises during dieting and increases hunger. The more restrictive you eat, the higher the ghrelin. Yikes!! So, how do we decrease ghrelin? Avoid restrictive dieting, ensure adequate sleep, increase muscle mass, and increase protein intake throughout the day
Cortisol is increased with STRESS! I know, we all have stress in our lives, but, if we have chronic high stress resulting in high cortisol levels for long periods of time, this can result in high blood pressure, weight gain, fatigue, disrupted sleep, impaired memory (brain fog), and suppress immunity.
Insulin is the ‘storage’ hormone. High spikes in insulin from peaks of blood sugar tells our body to store fat. The goal is to control blood sugar peaks to prevent high spikes in insulin. Which results in decreased cravings, increased energy, and better mood : )
The end goal with all my clients is Intuitive Eating. Intuitive – using or based on what one feels to be true even without conscious reasoning; instinctive. BUT, for many, we need to reverse the damage that restrictive dieting has done to their metabolism, hormones, mental thoughts regarding food, and depleted energy levels. So, how do we get these hormones regulated?! First off, ensuring you are not eating BELOW your RMR! Then begin eating balance meals based on macronutrients – PFC (protein, fat, carbs) and make sure you are ‘pairing’ your foods to contain all 3. To begin regulating your hormones, you need to trust nutrient dense foods and forgo the fear of calories. Remember, limiting calories ultimately increases cravings by increasing ghrelin, resulting in overeating in the later part of the day, and then the guilt sets in. One should never feel guilty or bad about eating!
Here are the 5 Keys to Health to focus on to help regulate your hormones;
1. REST (Lack of sleep leads to more ghrelin, less leptin, and disrupted glucose and insulin metabolism)
2. NUTRITION (eating PFC throughout the day)
3. MOVEMENT (find ways to enjoy movement throughout the day)
4. MINDFULNESS (calmly accept your feeling’s and thoughts and aware of eating)
5. SELF CARE – decrease stress!
The health and fitness world can be a confusing place. A Registered Dietitian can help cut out the noise and guide you to the best eating and lifestyle strategies that are individualized to you and your personal goals. Visits with a Registered Dietitian are often covered by your medical insurance.
Building Better Nutrition
Building Better Nutrition is now partnering with fitness centers, Crossfit, and athletic teams. Let’s work together to create a strong nutrition presence with proven results for your members and athletes!
Built on your core values, we’ll design resources, programs, messages, and metabolic testing. By combining your effective programming with my effective nutrition strategies, your members and athletes will improve their health, body composition and athletic performance!
Let’s discuss providing a robust nutrition presence in your facility or with your team!
COLLABORATION OPPORTUNITIES INCLUDE: SEMINARS, INDIVIDUALIZED NUTRITION COACHING FOR YOUR MEMBERS/ATHLETES, METABOLIC TESTING & BODY COMPOSITION ANALYSIS, AND A SOCIAL MEDIA PRESENCE
Ever wonder how a restricted diet affects your body long term? All too often I see clients that have jumped from one fad diet to the next, trying to find that perfect plan that will give them the results they desire. In the meantime, not only are they sliding down a slippery slope of a lifetime of diets, because we all know, diets fail us. Yes, that’s right! Diets fail us!
Restrictive diets in effort to lose weight, result in increased cravings and urges for food. 90-95% of people who lose weight on restrictive diets, regain the weight back and many result with weight higher than they started at. That’s right! Diets cause you to gain weight! They cause many biological and health damage including; teaching the body to retain more fat, slow rate of weight loss with each attempt of dieting, decrease metabolism, increase binges and cravings.
Dieting also provides psychological and emotional damage; eating disorders, increased stress, social anxiety, lowered self-esteem. Dieting gradually erodes confidence and self-trust.
So how does dieting affect my gut?
Here’s one more way diets leave us hurting. Eliminating whole food groups or foods containing gluten effects your gut microbiome. There’s a lot of recent research showing how our gut microbiome can affect our overall health. Research has shown the relationship between the gluten-free diet and the gut microbiota. Complete elimination of gluten, unnecessarily, (without celiac disease or gluten sensitivity), leads to worsened immune function by increasing pathogenic bacteria (E.Coli!) and decreasing beneficial gut bacteria. Our gut ecosystem is greatly influenced by our diet. When the growth of beneficial bacteria is not supported due to reduced supply of their main energy sources, other non-beneficial bacteria begin to grow and lead to intestinal microbial imbalance (dysbiosis). This can lead to irritable bowel syndrome, colitis, yeast infections, leaky gut syndrome, skin conditions (eczema/acne), brain fog, infections, and colon cancer.
Dietary counseling by a Registered Dietitian Nutritionist (RDN) will help guide you to achieve your individual health and fitness goals, while including interventions to eliminate potential health risks of restricted diets. When needing to eliminate gluten, good planning with the guidance of an RDN will allow you to feed the beneficial gut microbiome largely through resistant starch, providing pre and probiotics.
Here’s to good gut health!