I feel like Shepherd's Pie is so versatile. No matter what eating plan an individual follows, this dish can usually be modified to meet someone's needs. I also like that it is fairly quick to make and healthy. This is the recipe I made, but I will also throw out modifications as well.
-4-5 large potatoes (cut into large pieces)(Peel if you would like)
-1 head of broccoli (cut into pieces)
-1# ground turkey meat ( I like the mix of dark and white meat)
-1 zucchini squash (diced)(I do not peel mine)
-2 large carrots (cut into coins)(I do not peel mine)
-1 onion (Do not use if on elimination phase of low FODMAP diet)
-2 TBSP Olive Oil (made for sautéing or another oil of your choice)
-Salt, pepper and herbs
-Boil potatoes until soft, then add broccoli and cook until soft.
-Once potatoes and broccoli are cooked, mash together.
-While potatoes and broccoli are cooking, prepare meat mixture.
-Heat 3 TBSP of oil in a skillet.
-Brown turkey meat until no longer pink.
-Add carrots, onion and zucchini.
-I never measure herbs, salt or pepper. I usually throw in some salt, pepper, and herbs, such as parsley, thyme, oregano and basil.
-Cook vegetables until tender or to your liking.
-Once everything is cooked, place potato/broccoli mixture in a 9x13 dish. Evenly fill the base of the dish.
-Place meat mixture evenly on top of potato/broccoli mixture.
-If you want to add cheese (I did not), you will want to place it in the oven at 350 degrees for about 5 minutes to melt it.
For potato mixture:
-*If you do not eat potatoes, use a head of cauliflower instead. Can also mix cauliflower with a sweet potato to give it more bulk.
-Instead of mixing broccoli with the potatoes, chose any cooked green instead, such as kale or spinach. For the greens, instead of boiling with the potatoes, I would sauté them, and use a hand held mixer to mix them with the potatoes.
For meat mixture, the following could be mixed in:
-Celery (stick to 1 stalk if on elimination portion of FODMAP diet)
-Canned or fresh tomatoes
-Diced green beans
-Common green or red cabbage
*If you are following the elimination phase of the FODMAP diet, do not substitute cauliflower for potatoes.
If you are following a low histamine eating plan, modifications to some of these recommendations would have to be made per your tolerance.
The information in this blog is not a substitute for professional medical advice, examination, diagnosis and treatment. Always seek medical advice from your physician or other qualified healthcare provider before altering your diet, starting a new treatment or making changes to an existing treatment.
Over my years as a dietitian, I have seen many individuals struggle with various symptoms. Even while working at Johns Hopkins, there were some they just couldn't quite figure out what was going on. I was always under the impression that if you go to the doctor, you come out with answers. That is not always the case. Not because they don't understand, but because they can't know everything and there is so much we don't know. With a focus on GI nutrition, I try and learn everything I can about it, but I also keep my eyes and ears open for
other conditions, diseases, etc, that can have overlapping symptoms. I can't make a diagnosis for a client, but I can give advice to clients about what questions they can ask their doctors.
So, are you still on a search for your health journey? You have had every test done under the sun and still don't have a clue why you don't feel good? For many it can take years to get the correct diagnosis. For example, it has been shown that individuals with celiac disease see multiple physicians over an average of 11 years before receiving a definitive diagnosis. This was discovered in research studies conducted at Columbia University in New York and by the Canadian Celiac Association. It is estimated that only 5%-20% in the U.S. and Canada have been diagnosed. What about IBS? IBS generally takes a long time to diagnose. So much needs to be ruled out, such as celiac disease, inflammatory bowel disease, etc., before an IBS diagnosis is given.
I mostly see clients with gastrointestinal issues, but I also see many with outlying issues, such as joint pain, brain fog, body aches, etc. Yes, something like celiac disease and IBS can cause these symptoms, but what if you aren't feeling better after following all of the necessary recommendations?
I love the fact that we have so many options for healthcare right now. We have traditional doctors, functional medicine doctors and also many nurse practitioners that have their own practice. Functional medicine doctors are medical doctors that have just taken a different route in their studies. Some were traditional doctors, and at some point decided they wanted a different approach for their patients. I believe there is a fit for all doctors for different reasons. Many of my clients over time made a choice to go the functional medicine route because they needed a different focus on their symptoms.
Our bodies are intricate machines, so figuring them out takes many great minds. That is why we need all kinds of practitioners. No one is better than the other, but you need to find your fit and that can take time and money.
So many of these illnesses have overlapping symptoms. I am going to list many that I have learned about over the past years and what I have seen in my clients, learned at conferences, or have seen in my personal story.
-Irritable Bowel Syndrome (IBS)
-Inflammatory Bowel Disease (Crohn's and Colitis)
-Small Intestinal Bacterial Overgrowth (SIBO)
-Mast Cell Activation Syndrome (MCAS)
-Chronic Inflammatory Response Syndrome (CIRS)
I have written about a few of these on previous blogs. Kate Scarlata, dietitian from For A Digestive Peace of Mind recently wrote a 3 part blog on MCAS. She also has a great blog on SIBO. Go to her website at katescarlata.com or google search Kate Scarlata MCAS/SIBO blog. Dr. Carnahan is a functional medicine doctor and has blogs on many of the above illnesses. Some of these fit a traditional doctor diagnosis and others are more for a functional medicine doctor. It is your health and your life, so it is up to you to help navigate it. I tell my clients that their health journey is like a puzzle. It may take weeks, months or even years to get the pieces to fit together, but that is the ultimate goal. You have to decide how you are going to try and attain that goal, and where your comfort level is with varying health practitioners.
The information in this blog is not a substitute for professional medical advice, examination, diagnosis and treatment. Always seek advice from your physician or other qualified healthcare provider before altering your diet, starting a new treatment or making changes to an existing treatment.
Many individuals follow a gluten-free diet for various reasons. An individual could have a celiac diagnosis, wheat allergy, gluten sensitivity, leaky gut, or even IBD, such as Crohn’s or Colitis. Many of the diets for various disease states take gluten off the menu, such as Specific Carbohydrate or Paleo. Why someone has to follow one of these diets or chooses to is a personal story.
For this blog post I am going to focus on celiac disease with gluten exposure, not because others without celiac disease aren’t bothered by it, but with celiac disease a blood test can be run or another biopsy performed to see if someone is getting gluten. Sometimes an individual can be very sensitive to even a tiny amount of gluten exposure, and others do not even know they have had gluten.
The University of Chicago Celiac Disease Center recommends those with celiac disease receive follow-up testing on a yearly basis, with a blood draw to check their tTG and DGP.
Three million people in the United States have celiac disease. In a February 2018 study in the American Journal of Clinical Nutrition, they looked at gluten exposure detected by two tests. One was using urine and the other stool. These tests can detect the gluten peptides that make it through the digestive tract intact.
Just to give a reference range, the average woman (without avoiding gluten), consumes as high as 7,500mg gluten per day. The average man consumes 10,000mg gluten per day. For someone with celiac disease, the recommended limit for gluten consumption is no more than 10mg per day. That is a HUGE difference! If someone with celiac disease has more than 10mg of gluten on an ongoing basis, they can start to have symptoms and intestinal damage.
The study from the American Journal of Clinical Nutrition found that even though the participants were consuming a gluten-free diet, they were getting 244mg per day of gluten (by stool analysis), and 363mg per day (by urine analysis). That is a lot more than the 10mg recommended. These are individuals following a gluten-free diet! What is happening?
If someone is following a gluten-free diet, but they are still having symptoms, or their labs/biopsy indicate repeated exposure, where is it coming from? Here are some ideas!
1. The first place it can start is in the fields.
2. Processing, Packaging and Shipping.
The recommendation is to purchase certified gluten-free flour and oats, as they are at a higher risk of cross-contamination. If you are newly diagnosed, the recommendation is no oats for 6-12 months (depending on severity of biopsy), and after that no more than a ½ cup of dry oats/day as tolerated.
3. Medications (OTC/Prescription)
4. If there are still family members that eat gluten in your home, this is a way to get exposure. These are recommendations to decrease exposure in the kitchen.
5. Restaurants are an easy place to get gluten exposure.
6. There are varying opinions on toiletries and if they should be gluten-free, but here are a few things to think about.
Some would argue that the skin is the biggest organ in the body and it absorbs everything. So, it is a personal decision what you use, but be aware if your celiac antibody levels are still elevated, you are continuing to have symptoms or a follow-up biopsy reveals continued inflammation/damage, it could be something other than food.
This blog is intended for you to be aware of the many places gluten can be found, not to make you feel that you can’t eat or use anything! Some are very sensitive to gluten exposure, while others do fine just buying gluten-free food items.
The information in this blog is not a substitute for professional medical advice, examination, diagnosis and treatment. Always seek the advice of your physician or other qualified healthcare provider before altering your diet, starting a new treatment or making changes to an existing treatment.
When I attended the University of Michigan Conference this fall, one topic they presented on was Non-Alcoholic Fatty Liver Disease (NAFLD). This disorder is when there is an accumulation of fat in the liver of an individual, but they do not consume much alcohol.
There are two forms of NAFLD. One is fatty liver. It is not normal to have excess fat in the liver, but this in itself is thought to not damage the liver. The second is non-alcoholic steatohepatitis (NASH). With NASH, there is inflammation and scarring to the liver. NASH is more serious and can lead to cirrhosis, which means the liver may stop working efficiently and a transplant would be needed.
There is continued research on what is causing NAFLD, but many individuals with it have diabetes, pre-diabetes (insulin resistance), are overweight or obese and have high cholesterol, triglycerides and blood pressure. The typical American diet often lacks in fruits, vegetables, healthy fats and fiber.
NAFLD is very common, in fact it is thought that 1 in 3 to 1 in 5 adults have it, and about 1 in 10 children in the United States .
Based on information from the University of Michigan conference there are recommendations to work towards to help with fatty liver.
1. Weight loss (if needed).
2. Exercise 3-5 times/week at moderate intensity. This could include cardio, such as walking and light weights to help build muscle.
3. Follow the Mediterranean diet (there has been research on this diet in regards to helping treat fatty liver).
4. Decreasing industrial fructose, such as soda. Fructose is broken down in the liver.
5. Vitamin E 800IU can help with NASH per studies, but must be under doctor supervision.
6. Avoid alcohol.
7. Lipid lowering medications.
Remember to always consult with your physician before trying a new regimen, such as supplements, eating plans and exercise.
American College of Gastroenterology: Non-Alcoholic Fatty Liver Disease. Retrieved from patients.gi.org.
Naim Alkhouri, MD, and Marsha H. Kay, MD, FACG, The Cleveland Clinic, Cleveland, OH – Updated December 2012.
Ariel E. Feldstein, MD, and Marsha H. Kay, MD, FACG, Cleveland Clinic Foundation, Cleveland, OH – Published January 2006.
When you're tired, everything is more difficult, and that includes making good food choices. Sleep deprivation can interfere with your self control, appetite, metabolism, and cravings.
When you get enough sleep, it's easier to make good nutrition choices. You have more self control, and sleep helps keep hunger hormones regulated. You're less likely to crave foods that may not be a good nutrition choice.
Sleep Deprivation and Hormones
Insufficient sleep can interfere with the regulation of hormones that affect your metabolism and appetite. These hormones include ghrelin, leptin, cortisol, and insulin.
When you're sleep deprived, your ghrelin production increases, which tells your brain your hungry, even if that isn't necessarily the case. At the same time, your leptin production decreases. This hormone tells your brain that it's full. A lack of sleep can artificially increase your appetite, as these hormones signal to your brain that you're hungry and not full.
Sleep deprivation can also interfere with proper metabolism of carbohydrates, which can lead to increased production of cortisol, a stress hormone, and insulin. When your body grows resistance to insulin, it becomes more difficult to process fat and sugars and your body stores more of it as fat, which can lead to weight gain.
Sleep Deprivation and Self Control
When you're sleep deprived, your self control suffers. It's difficult to stick to a healthy diet, and you are more prone to seeking out junk food. People who are sleep deprived are more likely to consume more calories and more carbohydrates overall while drinking less water.
Your cravings may change when you're sleep deprived, causing you to crave foods that are rich in fat or carbohydrates. You may make poor snack choices at night and eat bigger portions.
Sleep deprivation increases fatigue. That makes it more difficult for you to say no to poor food choices, and you have less energy to live a healthy lifestyle including exercise.
Tips for Improving Sleep
With more restful sleep, you're in a better position to make good food choices. Use these tips to improve your sleep at night.
Selina Hall is an expert on sleep health and wellness for BestMattressReviews.com. She believes that sleep is one of the most important pillars of health. Selina lives in Portland, Oregon. She sleeps best under a handmade quilt passed down from her great-grandmother.
Is There Really Such Thing As Leaky Gut?
Sometime during 2015 I was told I had “leaky gut.” I had no idea what it meant or if it was an actual diagnosis. I had not heard the term in college or any of my time working at Johns Hopkins Hospital. In December 2016, I was accepted and attended the 3-day preceptorship program at the University of Chicago Celiac Disease Center. During a presentation, one of the gastroenterologists talked specifically about “leaky gut” or what is called intestinal permeability. Now, more doctors are seeing leaky gut as an issue. Dr. Alessio Fasano, a gastroenterologist and a world-renowned expert on intestinal permeability is doing much research on this topic.
What is intestinal permeability (leaky gut)?
The intestine is lined with a layer of cells. There are small gaps in the intestinal wall (tight junctions) that allow small molecules (such as water, electrolytes and other nutrients) into the bloodstream to be used by the body. This layer also helps keep harmful substances out of our bloodstream. In someone with “leaky gut” these tight junctions are not working properly. When these gaps become loose, food may not properly break down before they slip through. The gut is now more permeable. This can also allow bacteria and toxins to enter the bloodstream. The body looks at these as invaders and starts an immune and inflammatory response.
When harmful substances get through the intestinal lining into the bloodstream symptoms can include bloating, digestive issues, fatigue, muscle aches and pains, confusion, and skin issues. These invaders tend to target different areas in the body, making symptoms vary from one individual to another.
Link with autoimmune disease
It is thought that leaky gut is a precursor to autoimmune disease. The immune system reacts when the proteins, bacteria, and viruses slip through the junctions. This in turn can trigger an immune response in those that are genetically susceptible. Multiple diseases can arise or be exacerbated due to leaky gut, including Crohn’s disease, celiac disease, Type 1 diabetes, multiple sclerosis, irritable bowel syndrome (IBS), asthma, cancer, food allergies and intolerances, and rheumatoid arthritis.
What contributes to intestinal permeability?
A variety of internal and external irritants can contribute to leaky gut, such as chemicals in processed foods, alcohol, pollutants, radiation & chemotherapy, NSAID use (such as indomethacin, ibuprofen and naproxen), trauma and burns, and viral or parasitic infections.
Testing for leaky gut
The only test used to monitor intestinal permeability is the lactulose-mannitol challenge. This is used mostly in research, but available in some commercial labs.
Dr. Fasano and his colleagues have focused much of their research on zonulin, which is a human protein. Zonulin tends to widen the intestinal cell junctions, which is thought to cause leaky gut. Based on research, people with an autoimmune disease tend to release more zonulin than the average population, making them more prone to leaky gut. Bad gut bacteria and gluten (via gliadin) are two of the most powerful triggers of zonulin release.
Can leaky gut be treated?
This is an area with a large variety of opinions, but some points that are agreed on are:
Other suggestions for helping to treat leaky gut:
Larazotide acetate is being studied to help those with celiac disease that follow a gluten-free diet, but continue to have symptoms. This drug is a tight junction regulator, which can help restore the open junctions (“leaky gut”). In celiac disease, exposure to gluten causes these junctions to open, thus leading to an inflammatory reaction. This medication is also being looked at for others that have intestinal permeability for a variety of other reasons. This medication is still currently being studied.
The information in this blog is not a substitute for professional medical advice, examination, diagnosis and treatment. Always seek the advice of your physician or other qualified healthcare provider before altering your diet, starting a new treatment or making changes to an existing treatment.
I asked the mother of one of my clients if she would like to write about her son's journey with IBS. Below is a very condensed version of his story. Some people are "fixed" quickly, while others, the pieces of the puzzle take a lot longer to fall into place. This client's mother was his biggest advocate and she deserves so much praise for getting her son where he is today.
Seeing my son in his first year of high school, enjoying the life of a typical teenager, I am grateful to Valerie Polley at Blue Tree Nutrition for helping him along his journey to better health.
For more than two years, digestive issues, headaches, dizziness and insomnia were making it impossible for my son to function normally. The problems began with a stomach virus, which ran a normal course with other family members, but persisted with my son. Because there were no physical signs the diagnosis became “school anxiety”. We felt that something else might be wrong, but experts were telling us otherwise.
Allergy testing came back negative. Counseling sessions didn’t seem to be helping. We homeschooled to avoid the pressure on all of us to get him to school no matter how he felt. We changed pediatricians when we realized that the first doctor wasn’t listening to our concerns.
After a while symptoms seemed to get better, so he returned to traditional school for junior high. Occasional symptoms occurred, but we told our son he had to tough it out and go to school as the medical professionals had told us to do. This worked until 8th grade when the GI issues and other symptoms began to occur daily. The new doctor had me keep a detailed record of symptoms and eating. He prescribed some medication which didn’t help.
The physician made a referral to a GI specialist. When we met the GI doctor in December 2016, she took time to get to know my son and to look at the records we had kept. She saw a pattern in the symptoms and told us that she thought that my son had IBS, a diagnosis that was confirmed with more testing.
It seemed that with a proper diagnosis and the right medication my son’s symptoms would go away, but that didn’t prove to be the case. We learned quickly that trial and error would be necessary, first to find a medication without troublesome side effects, and then to find the right diet. The third medication tried seemed to be the best, but symptoms were still occurring. The specialist had only provided us with clues about diet- “natural foods” and a note in a handout about something called, the Low FODMAP diet. The office scheduled an appointment for us with hospital dietician- in a month. I found the Low Fodmap App and began using it to find “safe” foods. We found that following the diet caused a decrease in symptoms, but my son was still having a lot of pain and not sleeping well at night.
I looked on the internet for dieticians specializing in the Low FODMAP diet and that is when I learned about Blue Tree Nutrition. Valerie was able to take more time with us and had a much better knowledge of how foods affect IBS than the doctors we had been working with. She gave me information on troublesome ingredients and ingredients hidden in food. She made many suggestions of appropriate products and recipes. After our meeting, she followed up with us several times to see how things were going and make suggestions for further changes. She is knowledgeable about the gastroenterologists in the area and helped us find a doctor that is more appropriate for my son.
Now taking the morning IBGard supplement suggested by the new doctor, medication at night, and avoiding the FODMAPs that cause reactions, my son is a healthy and happy 14 year old.
I attended a three day GI conference at the University of Michigan in September. It was an amazing conference packed full of presentations from some of the best GI doctors and dietitians. One presentation was on a topic I had never heard of, so I was intrigued and ready to learn more about it.
Congenital Sucrase-Isomaltase Deficiency (CSID) is a rare disorder that causes individuals the inability to digest certain sugars due to an absence or low levels of two digestive enzymes, sucrase and isomaltase. Both of these enzymes are involved in the digestion of sugar and starch. Table sugar is broken down into glucose and fructose with the help of the sucrase enzyme. Isomaltase is one of the several enzymes that help digest starches.
Both sucrose (found in fruits, and known as table sugar) and maltose (sugar found in grains) are disaccharides, which means they are made of two simple sugars. During digestion, intestinal enzymes break these down into simple sugars called monosaccharides. Sucrose=glucose + fructose and maltose=glucose + glucose. An individual with CSID has difficulty breaking down the disaccharides into monosaccharides that the body uses for fuel. These disaccharides are too large to be absorbed in the intestines by the microvilli (known as the brush border).
Starch can be a simple or complex carbohydrate. Simple carbohydrates have one or two sugar molecules, and complex carbohydrates have three or more sugars linked together.
Multiple enzymes are needed to properly digest starch. Digestion begins in the mouth with an enzyme in the saliva called amylase. Digestion continues in the stomach by further breaking down the food. In the small intestine, starch is processed by an enzyme called pancreatic amylase and converted into maltose and sucrose. The brush border contains numerous enzymes (sucrase, lactase, maltase) to continue the breakdown of digested food into smaller particles that can be better absorbed. The isomaltase enzyme breaks the bonds linking sugars into glucose, which can't be broken down by amylase or maltase. This is one of the final steps in the digestion of starch to glucose.
To sum it up, those with CSID lack the sucrase and isomaltase enzymes to properly break down the food to a simpler form, so the body can absorb it.
Without the proper enzymes, digestion can't take place correctly and individuals can have symptoms, such as:
So, what do you do if you suspect you have CSID?
Visit sucroseintolerance.com to take their quiz. On that site there is also an "ask your doctor" form to take to your physician. A sucrose breath test can help with the diagnosis. This can be ordered by your doctor or I can order a complimentary sucrose breath test to be sent to your home.
What if you have a positive breath test?
You will do a two-week elimination diet of sucrose and starch, followed by a gradual reintroduction of both. The reintroduction will help identify how much of these foods you can tolerate. Many like the guidance of a dietitian familiar with this deficiency to help them navigate through the elimination and reintroduction phases. Others also do the diet along with a test of the sucrase enzyme, Sucraid® (sacrosidase) Oral Solution. The sucrase enzyme can be purchased through One Patient Services, a subsidiary of QOL, Medical, LLC, the manufacturer of Sucraid® Oral Solution, at SucraidASSIST.com.
Please consult with your doctor regarding your symptoms and for a final diagnosis.
If you have any questions regarding Congenital Sucrase-Isomaltase Deficiency, please feel free to call or text me at 410-963-4782 or email at firstname.lastname@example.org.
I promise I won't just post muffin recipes. They are just one of my favorite quick foods for breakfast or a snack.
-1/2 cup sugar
-1/2 cup oil (your choice what type)
-2 cups spinach
-1 1/4 cup almond flour**
-1 cup gluten-free oats***
-1/2 tsp salt
-1 tsp baking soda
-1/4 cup chia seeds**
-1/4 cup ground flax seed**
-1/4 to 1/2 cup chocolate chips (dark or milk chocolate)**
-In a blender mix sugar, bananas, eggs, oil, and spinach.
-In a separate bowl, mix together almond flour, gluten-free oats, salt and baking soda.
-Remove banana mixture from blender and stir with dry mixture.
-Stir in chia seeds, flax seeds and chocolate.
Spray and fill muffin trays 1/2 full with batter. Bake at 350 degrees for 20 minutes. Makes 12-15 muffins.
*Those following a low FODMAP eating plan often times tolerate the less ripe banana over a very ripe banana. Either one can be used in this recipe, depending on your toleration.
**Based on the Monash App the green light is given for:
-Almond flour at (1/4 cup)
-Gluten-free rolled oats (1/2 cup)
-Ground flax seeds (1 TBSP)
-Chia seeds (2 TSBP)
-Milk chocolate (1 fun size bar)
-Dark chocolate (5 squares)
Since this makes over a dozen muffins, these green light servings are safe. Just remember not to eat too many muffins each day!!! These can be refrigerated or frozen.
***Caution using oats for the first 6 months if you are a newly diagnosed celiac. If you are past the 6 months or have a gluten sensitivity please purchase certified gluten-free oats.
Many of my clients comment that co-workers, friends and even sometimes family are not understanding of their diagnosis or why they are eating a certain way. It is difficult to be in social settings with food and feel like you aren't eating like everyone else, or able to eat anything at all. I reached out to a licensed mental health counselor, Denise Cutshaw to get her opinion on how individuals can deal with outside pressure when given a diagnosis that effects the foods they can eat. Enjoy! And at the end of her blog are a few extra questions I had for her.
Whether you, or a loved one such as your spouse, child or other family member has been recently diagnosed with any type of gastrointestinal issue, food allergy or intolerance, it can feel very overwhelming. You start with educating yourself on the types of foods that are “safe” and may even reach out to a registered dietitian to help you with a food plan (highly recommended!).
Then…the feelings set in as you begin to navigate through get togethers, parties, celebrations, holidays, office breakfasts/lunches, and traveling. Common feelings that may arise are loneliness, isolation, feeling misunderstood, frustration, anger, defeat, anxiety or even depression. If these feelings are persistent for you, it may be beneficial to talk with a counselor. Counseling can help someone with a recent food allergy/intolerance or autoimmune diagnosis, such as celiac, better cope with these feelings and how to ask for help and support from loved ones and friends. Children can especially find benefit in talking with a counselor and seeking out support groups to help normalize their feelings by being exposed to others with similar circumstances.
Counseling can help an individual process and work through some of these feelings through different modalities of treatment. Cognitive Behavioral Therapy is extremely beneficial in identifying one’s thoughts, feelings, and behaviors as it relates to food and outings with food. Assertiveness skills can be taught and reviewed as a means of making sure you build a safety net around your core people that are aware of restrictions and are sensitive to your needs or the needs of your child. Thirdly, psychoeducation can be provided through the counseling relationship as well as with your dietitian on acquiring knowledge and education on your limitations/diagnosis.
Life transitions and events can certainly contribute to an onset of depression and/or anxiety. When to be concerned or seek out help for depression and/or anxiety symptoms depend on a multitude of factors. Consider these presenting factors for depression and seek counseling to help address these:
Questions for Denise:
Question: How should patients/clients deal with co-workers, friends, etc. that continue to make comments about what they are or aren't eating? Even adults can somewhat "bully" another adult and make them uncomfortable in social situations with food. Often times these individuals avoid situations that involve food because it is uncomfortable, especially around those that don't understand. This comes up with a handful of clients and it is easy for me to tell them to tell their co-workers it is a doctor's order, but this doesn't always make the situation better.
Answer: It's hard to deal with people that don't understand and make comments about food whether they are rude comments or bringing attention to it. Some ways to manage that is to be as educated as you can be on what foods are "ok" for you and why so you can respond with "I've learned so much about what works for me" or "it was a little difficult for me too at first to understand, but I've really educated myself and found what works and it is helping tremendously".
When loved ones that we are very close to continue to make comments, using "I feel" language is also helpful. For example. "When you make comments about my food, it makes me feel anxious and on edge. I need for you to be understanding of my food choices and not make those comments". That type of language allows an openness about how the comments make you feel and if the person is still unable to honor your needs, you can then decide to restrict your time with them, especially around food. You can also invite close loved ones with you to a dietitian or doctor appt. to assist in education on the matter so they have a better understanding.
Question: Do you encourage a significant other (if the person with the diagnosis is an adult) to join them for these professional visits, such as with the dietitian or yourself? Some family members are not supportive, so do you think it helps to have them present or hurt? I see this with individuals that have been dealing with these GI issues for a long time.
Answer: As a counselor, I truly feel that getting as many people involved in your care is so very important. It can assist in the person's support network with education but also insight into the feelings of the person affected and how these food issues impact them on a daily basis. For children, any caregiver that will be caring for the child and feeding them meals or snacks would benefit from attending any appointments as well. Even the parents of friends of your child can be educated and provided a "safe list" of snacks and foods okay to eat while your child is over at their home playing. This helps reduce any potential anxiety for the parent or child and the child doesn't feel "singled out" having to sit out for snacks during play times.
Overall, being assertive and open is always best in the care for yourself or your loved ones who struggle with food issues. If you're finding you're avoiding situations around food either yourself or your child, it could be an indication you may need to be more open and assertive about your needs or the need of your child as well as your feelings so people can better understand and be educated.
Denise Cumshaw, LMHC is on leave at this time and not accepting new patients, but if you need more information or feel like you may benefit from counseling services please contact her at email@example.com.
Valerie is the dietitian and owner of Blue Tree Nutrition. I will be blogging a variety of topics, recipes and will also have guest bloggers from time to time.
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