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Rebroadcast: How Your Thinking Affects Your Health - Seven Health: Eating Disorder Recovery and Anti Diet Nutritionist

Episode 102: Welcome back to Real Health Radio. This week we’re looking at how thinking can affect health.


Nov 5.2020


Nov 5.2020

We discuss cognitive dietary restraint (aka dieting) and negative body image, and see if they can impact our physical health as a whole. We review several studies that have been done in this area and we chat about the importance of changing our mindsets around this issue.

Here’s what we talk about in this podcast episode:


00:00:00

Intro

Chris Sandel: Welcome to Episode 102 of Real Health Radio. You can find the links talked about as part of the episode at the show notes, which is www.seven-health.com/102.

Welcome to Real Health Radio, health advice that’s more than just about how you look. And here’s your host, Chris Sandel.

Welcome back, everyone, to another episode of Real Health Radio. Or if this is the first episode, I hope you are going to enjoy it and become a regular listener.

Before I jump into the show, I just want to make a quick announcement. A couple of weeks ago, I mentioned that I’d opened my practice to new clients, and I’m now nearing the end of that process. I have just three slots left, and this will be the last clients that I take on for this year. I work with clients for a period of 5 months, where we have a consult for an hour every 2 weeks.

Before working with anyone, I always have a free initial chat. This takes about 40-50 minutes and allows me to have a conversation with you, find out about your background, what’s going on, what you’re wanting help with, and for me to then explain the process of working together, etc. Basically, it’s just for us to see if we’re a good fit for one another, because I only want to work with people that I think I can genuinely help and people who are on the same page. This allows us to have a conversation and work out if that is the case.

I have clients all over the world, and consults are done via Skype or FaceTime or phone, so if you’re not based in the UK like I am, this isn’t a problem because the majority of my clients aren’t either. I regularly work with people in Australia, Canada, U.S., Dubai, France, Germany, and lots of other places around the world.

If you’re interested in finding out more, you can head over to www.seven-health.com/help. You’ll be able to see more details on that page, and at the bottom there is a link to apply for that free initial chat. If you do that, I’ll get back to you within 48 hours and we can then arrange a time that suits the both of us. If you are wanting help getting over dieting or with symptoms like sleep issues or hormonal issues or disordered eating or really any of the topics that I’ve covered on this podcast before, then head over to www.seven-health.com/help and get in contact.

With that out of the way, let’s get on with today’s show. This is another solo episode where I delve into a specific topic in detail. This one’s probably a bit less of a deep dive and more me wanting to speak about something that came up recently and added to my understanding of a particular topic.

In March of this year, I signed up to do the Precision Nutrition Level 2 training. Their Level 1 training is aimed at personal trainers and fitness pros and teaches them about physiology and nutrition. Given that I’m a nutritionist and I’ve been working in this field now for the last 7 or 8 or 9 years, something along those lines, I bypassed Level 1, as I just didn’t feel it was necessary. Undoubtedly, I would’ve still learned from that course, but I think it wasn’t what I needed right now.

With Level 2 training, this is about helping coaches to become better coaches. At the core, it’s really a psychology course. If I didn’t have bills to pay and a business to run, I would love to go back to university and study psychology. Just understanding how people think and why they do what they do and what influences motivation or willpower, all this kind of stuff really interests me.

The Level 2 course is then the perfect option for me in that it allows me to study this stuff while still doing my current job. Work in the area of health, the psychology that is then focused on is what is most relevant to that area. And it’s not just about psychology, but really getting you to understand how the body is a complex being, and there’s many things that influence it, and all of these things are interconnected.

I’m finding the course fascinating, and I’m able to use a lot of what I’m learning with clients. It’s definitely making me a better practitioner. It’s not just more book smart, but has a real practical sense to it.

00:05:00

Background on cognitive dietary restraint

How this then fits in with today’s podcast is because of one of the assignments as part of the course. There were a number of studies that we had to go through that were linked to cognitive dietary restraint. While there are many different questionnaires that could determine someone’s level of cognitive dietary restraint, in layman’s terms, it means someone using perceived ongoing effort to limit their dietary intake to manage body weight. So someone being on a diet where the diet takes some level of discipline and they are eating less than they ordinarily would like to be doing, or eating less of certain foods than they would ordinarily like to do, and this is done for the goal of losing weight.

What these studies looked at was how this cognitive dietary restraint impacted on health – how it impacted on bone health or ovulation or longevity or cortisol levels or other markers of inflammation. Entangled as part of this is obviously body image. Typically if someone wants to restrict their eating below what their hunger would tell them to do, with a desired goal to lose weight, then body image is going to be involved. So as part of talking about cognitive dietary restraint, body image is part of this.

What I want to cover as part of the show is how cognitive dietary restraint and body image impact on health. Something I’ve said for a long time is that what someone eats is important, but what someone thinks about what they eat is equally important. How you think about the meal that you’ve just eaten or what you’ve eaten this week or what you’ve eaten over the holiday period or what your general beliefs are about your diet has a direct impact on your health. This is irrespective of what your actual diet looks like, solely based on your beliefs.

I would say the same thing about someone’s body. How someone thinks about their body directly impacts on how it functions. You could have two identical twins who eat the exact same identical diet and do the exact same exercise, and the only differences between these two identical twins is that one is very content with their body while the other thinks that they are a failure and unlovable because of how they look. These different thoughts lead to different health outcomes.

This is irrespective of someone’s actual body and how this matches up to society’s beliefs. You can have someone living in a body that society deems is fit or aesthetically pleasing, but if that person that inhabits that body doesn’t believe this, then these thoughts are going to affect their health.

Often when people mention this stuff, the focus is then on the actions that someone takes because of these beliefs. For example, if someone has orthorexic tendencies around food or has many fear foods, maybe they then start to restrict their eating. If they end up then with certain health problems, the focus is normally on the actual restriction. Because they restricted their calories or they restricted carbs, this is why those health problems are now occurring.

Or say someone has poor body image and they get really into exercise. They’re running 60 or 70 kilometres a week, or they’re going to boot camp or CrossFit and they’re doing this 4 or 5 or 6 days a week. If this person then starts to have health issues, the focus is then on the over-exercise, the overtraining. They are doing more exercise than is appropriate for the amount of rest and the amount of nourishment that they are giving themselves.

In both of these cases, I am not denying the action that someone is taking is then having a toll on their body. The restriction or the over-exercise is undoubtedly creating issues. But the point is that it is not just the actions alone that then account for the health problems. Someone’s thoughts and beliefs, irrespective of the actions they take, can directly impact on their health.

00:09:40

Physical restriction vs. mental restriction

This is something that I have been talking about for quite a while with clients. If we’re looking at it from the perspective of food, I typically talk about physical restriction versus mental restriction. Physical restriction is when someone actually restricts their food so that they have particular foods they don’t eat or they have particular amounts of calories that they don’t go above. They’re restricting their food.

But what I find is often a common situation is that people are no longer physically restricting. They’re eating more food or they’re eating cookies or ice cream or whatever their fear foods were, but while they are physically eating this stuff, mentally they are still restricting. While they’re consuming these foods, they are telling themselves that they shouldn’t be. They’re telling themselves that this is wrong, that starting tomorrow they won’t be eating this kind of food, or that they’ll eat it now, but if their weight goes up any further, then that’s it; this food’s back on the ban list.

And it might not be about a specific food. It can be about the amount of food. They’re allowing themselves to eat more, but this is conditional. If they go above some weight or some dress size, then the restriction will start again.

I should add that this doesn’t have to be specific where someone is actually hearing this dialogue going on in their head – although it often does happen – but if we were to then do some digging into someone’s beliefs, we would find a lot of those ideas there.

This kind of thing when someone is physically eating more, but still mentally restricting, can happen as part of the road to recovery. When someone decides to end dieting or get over their disordered eating or eating disorder, they normally start eating more or eating certain foods when they’re unsure and they aren’t completely convinced and there is still a level of mental restriction.

It could also happen when physiology starts to overrule someone’s ability to restrict. For many of the clients that I deal with who come to me, they do so because they now feel uncontrollable around food and they’ve started to binge. What preceded this current pattern of binging was restriction. For years, they’re on diets, and maybe in the beginning they found that it was quite easy, but over time things had started to change. At some point, their body said, “Enough is enough,” and it revolts in an attempt to keep this person alive.

So they find themselves having binges, and they’re eating more against their will, and this is typically when people contact me. In their mind, when they were restricting, there was no problem. Restriction was normal to them. It was just what they did. But now that the binges have started and they feel uncomfortable and uncontrollable around food, now they see it as a problem.

In this instance, there may be a lot less physical restriction – or at least, in comparison to what was going on before – but for the mental restriction, really nothing has changed on that front. There is the same thoughts and the same beliefs going on, and possibly it could be even worse because they now feel like they’re failing. They’re having these binges and they can’t control themselves.

As I said, this is something that I’ve talked about a lot with clients before. From my experience of working with clients, I noticed that this kind of thinking has an impact on someone’s health – and not just because of the actions that they take, but the thinking all by itself can be damaging to health.

00:13:30

The research backing this up

What was nice as part of doing this assignment and these studies was to find research that actually backs this up. This isn’t just something that I’ve learnt anecdotally from client experience, but actually something that has scientific studies that look into it.

What I want to do is go through each of these studies – there were four studies. I’m not going to go into huge amounts of detail with each of them, but I just want to explain what they show from a health perspective and how someone’s cognitive dietary restraint and body image impacts on this. I will link to each of the studies in the show notes, so if you want to check them out for yourself, you can have a look.

00:14:00

Dietary restraint and telomere length

The first study looked at cognitive dietary restraint and telomere length. A telomere is a region at the end of a chromosome, and your telomeres become shorter as we biologically age. Their shortening is then associated with morbidity and mortality, so associated with disease and with death.

In the study, they used leukocyte telomeres and leukocyte telomere length as a biomarker for aging and for health. Leukocyte telomeres are more specific to the immune system, and they’re associated with cardiovascular disease and predicting overall mortality. They wanted to see how cognitive dietary restraint impacted on the leukocyte telomere length.

For this study, they define dietary restraint as a ‘chronic preoccupation with weight and attempts at restricting food intake’. What they pointed out is that dietary restraint is about the intention to restrict, irrespective of whether this actually happened in reality. So just because someone had cognitive dietary restraint, doesn’t mean that they were losing weight or that they were actually restricting their eating. It was just about the preoccupation with these things and the desire to restrict.

As part of the study, they identified other factors that could also impact on telomere length. It could be things like age, BMI, smoking status, that person’s general perceived stress levels, emotional eating. But what they found was that even if they controlled for all these other factors, cognitive dietary restraint led to shorter telomere length. So the simple act of thinking about restricting had an impact on their telomere length, and because of the connections that had, could then point towards issues in terms of aging or issues in terms of other diseases that are associated with that.

There are two things that I should highlight. The first is that there was a nonlinear relationship with someone’s level of cognitive dietary restraint. To measure the level of cognitive dietary restraint, the participants filled out a questionnaire. It was a shortened version of the Dutch Eating Behaviour Questionnaire. As part of it, the questions also looked at the influence of things like external cues impacting on eating or emotional eating.

Form the questionnaire, they could then give that participant a score. What they found was that while dietary restraint impacted on telomere length, it wasn’t proportional to the score. The person who had the highest cognitive dietary restraint score didn’t have the shortest telomeres – which actually isn’t that surprising considering that dietary restraint is just one factor, and it’s probably a smaller factor than a lot of other things. So it shouldn’t be the overwhelming thing that was going to cause shorter telomere length. So it’s not that surprising that there was a nonlinear connection.

The other thing to mention is that the researchers indicate that they believe that cognitive dietary restraint has an indirect relationship with telomere length and health in general. It is a proxy. What this means is that they believe it’s not the thinking or the beliefs, but that it’s linked to some other unmeasured or unaccounted for variable. While they controlled for things like smoking or age or perceived stress, there’s probably some other variable they didn’t control for that would explain the change in telomere rate rather than it being directly linked to cognitive dietary restraint.

Some of the areas they suggested investigating and for other researchers and studies to be investigating on is looking at people’s responsiveness to food cues, to dietary habits, to early life influences on nutrition, and personality and lifestyle variables. So while this study did find a link between cognitive dietary restraint and shorter telomere rate, the authors suggest further studies to determine whether this is a causal relationship.

Part of the reason why I want to mention this is I don’t want to oversell these studies and what these studies show. It’s too easy to pick studies that support your beliefs and overstate what they’re actually pointing out, but I don’t want to do that. I just want to demonstrate through this collection of studies that there is evidence pointing in a certain direction with this stuff, but not really hype up the results of individual studies because of what I want them to show or because it would make my argument look better.

00:19:15

How ovulation, bone density and cortisol in women are impacted by dietary restraint

The next study was looking at ovulation, bone density and cortisol levels in women and how this was impacted on by cognitive dietary restraint. To preface this one, let me briefly explain how ovulation, bone density, and cortisol levels can be interrelated.

While we think of women’s menstrual cycles as being about procreation, reproduction, it actually has many functions in the body. This is because a number of the hormones that are released and used as part of reproduction – hormones like oestrogen or progesterone, for example – have body-wide effects.

One of these effects is to do with building bone. We often think of bone as this solid, inert substance, but it actually is something that is constantly being built up and broken down. While you may think of say calcium for building strong bones because that’s the message we so often hear, bone health is impacted on by lots of substances, whether we’re talking about vitamins and minerals or hormones. A woman’s monthly cycle not only gives her the chance to conceive, it also helps to build up bones, amongst other important factors.

You can then test bone density by doing what is known as a DEXA scan. This looks specifically at the lumbar spine and the hips as well as looking at the bones of the whole body.

One extra bit that I want to add in is that the bone building ability that is linked to a woman’s cycle, that is driven by these hormones, has much more of an impact if ovulation occurs. The reason for that is these hormones are an important part of ovulation. You can have a situation where a woman isn’t on the pill or any other form of birth control and she is having a monthly period, but despite having that period, she doesn’t actually ovulate. This is known as anovulatory cycle.

As part of this study, they weren’t just looking at whether a woman was getting a period, but what they were looking at was whether or not she actually ovulated and the timings around that.

The third factor after ovulation and bone density is cortisol levels. Cortisol is a stress hormone. It has many normal, everyday functions and follows a pattern during the day of being highest when you wake up and in the morning time and then being lowest in the evening time. But on top of these normal, everyday functions, it also then rises in response to stress.

Stress can obviously come from many different sources. It could be from cognitive dietary restraint, but it also can happen for a plethora of reasons. As stress increases, typically the chance of ovulation goes down. There’s obviously individual variation around this, but typically, the more the body feels that it is not safe and secure because of real or perceived stress, the less likely it’s going to want to bring another human being into the world, so ovulation either stops completely or it becomes less regular.

What this study wanted to do was look at how all these pieces fit together through the lens of cognitive dietary restraint. Does cognitive dietary restraint have an impact on ovulation, on bone density, and on cortisol levels?

What the study found was that in otherwise healthy premenopausal women, the higher the cognitive dietary restraint, the more likely they were to have subclinical issues with their cycle. These subclinical issues were having anovulatory cycles, so getting a period but not actually ovulating, or it could also be having a short second half of the cycle, which the researchers classified as less than 10 days. For that cycle, the participant would’ve ovulated, but they then had their period start less than 10 days after ovulation.

Combined with this, when someone had higher incidences of subclinical ovulatory disturbances, over the space of two years their bone mineral density became less positive.

On the cortisol front, this seemed to have less of an impact. Maybe if it was at higher amounts they would’ve had a connection, but what they found was that even though cortisol was higher in women who had greater cognitive dietary restraint, the researchers didn’t confirm that cortisol played a role in mediating the bone mineral density or the ovulation issues.

I should note that stress isn’t just about cortisol. Cortisol is just one of many hormones. So while this study didn’t show that cortisol on its own had an effect with these participants, that doesn’t mean that when it’s combined with other hormones or when it’s looked at in its entirety, say under the bracket of the whole stress response, that it’s not having a causal impact.

In the last study we saw that higher cognitive dietary restraint was linked to shorter telomere rate, and in this study we see that it’s related to subclinical ovulatory disturbances and worse bone health.

One thing I want to add, because I do think it’s highly relevant, is that for the women in this study, those with the higher cognitive dietary restraint had higher baseline weight, higher BMI, higher fat mass, higher body fat percentage, higher BMI adjusted energy intake. So if someone is using cognitive dietary restraint as tool to help them to eat less and a tool to help them to lose weight, this study shows that it really doesn’t work.

But even when they adjusted for age and for BMI, the results mentioned earlier were still the same. The more ovulatory issues and the worse bone density issues that someone had, the higher cognitive dietary restraint was going on.

I think these findings are also important for another reason. It’s often talked about that women who have issues with their cycles, especially if they’re not getting their cycle or they’re having anovulatory cycles where they’re not ovulating, and/or where they are losing bone, it’s because of actual restriction. When body fat percentage and body weight is so low, the body starts to catabolise itself, and that’s reducing the bone mineral density, and it then reduces its reproductive function to save on energy.

Undoubtedly that does happen in a lot of cases, and it happens in a lot of the clients that I work with, but with this study, this wasn’t what they found. Cognitive dietary restraint was still a factor irrespective of someone’s weight.

00:27:00

The impact body image has on C-Reactive protein

The next study looked at the link between C-Reactive protein and body image in adolescents. C-Reactive protein is a substance that is produced by the liver, and it increases in the presence of inflammation. C-Reactive protein, which is shortened to CRP, is used as a marker for body-wide inflammation, it’s used as a marker for cardiometabolic risk, and it’s really linked into the immune system.

Inflammation is part of normal physiology, and on its own it’s not inherently bad. But as inflammation increases, especially if this is chronic inflammation – so not in response to some injury or acute situation, but general inflammation levels are higher, and they’re higher on an ongoing basis – this can be a problem.

I’ve seen it argued that inflammation isn’t actually the problem; it’s just a proxy, and it indicates that other issues are going on. But whether it’s the inflammation causing the issue or it’s just associated with the problems, having higher amounts of CRP is typically not a good thing outside of acute situations.

CRP is often higher in children and in adults with higher BMI, and this is often blamed on the weight itself. But what the study wanted to do was to see if some of these changes were actually linked to psychological factors like body image. Could poor body image on its own be impacting on the immune system and on CRP?

As part of the study, body image was defined as an individual’s thoughts and feelings about his or her weight and body shape. This was determined by asking questions relating to someone’s desire to lose weight, and that could be either their own desire or others’ desire for them to lose weight, and questions about how much their current body matched up to what would like it to look like. As part of the study, it included both boys and girls, and they were 13 year olds and 16 year olds.

What the study found was that poor body image did raise CRP levels, even when they controlled for BMI and for age. Body dissatisfaction had the biggest impact, followed by being encouraged to diet by others, and then lastly receiving negative comments about their weight from someone.

Interestingly, this impact was more noticeable on boys over the girls in terms of its impact on CRP levels. The boys that had body dissatisfaction or the boys who were encouraged to diet had the impact on their CRP levels more than the girls. Studies on these types of topics are pretty scant, and most of the stuff that is done is done almost exclusively with females. So it’s interesting to see that males were included here and to see that they are not immune to these things. They, too, can be affected.

So poor body image outside of age or BMI affects the immune system, or at least specifically the CRP levels.

00:30:25

Whether negative eating and body attitudes are associated with increased blood pressure

The final study I want to cover looked at whether negative eating and body attitudes are associated with increased daytime ambulatory blood pressure in otherwise healthy young women.

Ambulatory blood pressure is where blood pressure is measured at regular intervals throughout the day. There is a phenomenon known as ‘white coat hypertension’, which is the sheer act of sitting in a doctor’s office and having your blood pressure taken can cause your blood pressure to increase due to nervousness or anxiety. Ambulatory blood pressure checking gets around this and helps to give a more accurate reading of what is going on normally because it’s doing these readings throughout the day, not when you’re sitting in a doctor’s office.

Blood pressure is often used as a gauge for stress levels. As part of the stress response, when stress hormones are released blood pressure is increased. If you’re about to be in a life and death situation – say you turn a corner and you come face to face with a lion – you want your blood to start pulsing through your body to get nutrients to your heart, your muscles, your brain so that you can run or fight. While most people aren’t fighting lions on a regular basis, this mechanism is what is turned on as part of the stress response.

One thing I should mention is that while chronic stress is associated with higher blood pressure, the opposite can also be true. I’ve seen many clients, especially those who are dieting or those who are under a lot of stress, who have very low blood pressure. But that is just a little bit of a side note.

What has been noticed is that those who have higher blood pressure, or hypertension, as it is known, are more likely to have atherosclerosis, which is the thickening of the arteries, and in particular, thickening of the carotid artery in the neck. These are both risk factors associated with cardiovascular disease. They’ve also found that young adults with prehypertension numbers – that’s numbers that are not quite at hypertensive levels but are on their way – are more likely to end up with atherosclerosis 15 or 20 years later.

Stress, as I mentioned, is often associated with all of these negative markers, and what this study wanted to try and do is tease out the stress from the negative eating and body attitudes from the rest of the stressors and see if it alone had an impact on blood pressure.

What were the results as part of this study? Let me quote directly from the study, as they sum it up pretty well. They said: “We found that women with negative eating / body attitudes had higher 12-hour average diastolic blood pressure and mean arterial pressure than women with more positive attitudes. Several of our findings suggest that the difference in ambulatory blood pressure may be related to the cognitive aspects of eating / body attitudes rather than the behaviours or relative weight status.

“First, BMI, energy intakes, and physical activity did not differ by eating / body attitude levels, indicating differences in blood pressure were not related to physiological stress due to energy deprivation or conversely due to excess body weight. Secondly, although women with more negative attitudes were more likely to report current weight loss attempts, blood pressure did not differ by weight loss effort. Thirdly, there were no interactive effects between eating / body attitudes and weight loss efforts for any variables measured in this study.”

This study, amongst its participants, showed that negative eating / body attitudes can have an increasing effect on blood pressure. Interestingly, the negative eating and body attitudes were not associated with higher cortisol levels. Like I mentioned in the study related to ovulation and bone density, stress can be having an impact on the body despite little shift in cortisol levels, and these changes could be linked to catecholamines like adrenaline or noradrenaline, or really a long list of other hormones.

But despite not knowing the biochemical mechanism for why this is happening, we can see that negative eating / body attitudes can increase blood pressure, which in turn could lead to risk factors that are associated with cardiovascular disease.

So those are the studies. Despite the fact that this is an area where there isn’t a huge body of knowledge and this really is just dipping the toe in the pool, it seems to indicate that cognitive dietary restraint and body image thoughts outside of someone’s actual behaviours can impact on our physical health.

00:35:45

Suggestions on where to go from here

What I want to do to close out this podcast is give some thoughts and ideas based on this information. In the world of nutrition, there is a huge focus on food that people eat, like working out what has the highest nutrients in it or what has the most problematic substances in it that people should be encouraged to avoid or to minimise.

While this stuff definitely has its place, so do someone’s thoughts about what they’re eating. In a sense, we have to work out how these two ideas can sit together because the supposed health benefits of a food or a way of eating can be increased or diminished simply by someone’s thought process and how they think about those foods.

I think this is where the problem lies, in the fact that cognitive dietary restraint is completely subjective. It doesn’t necessarily match up with what someone is eating. You can have two people eating the exact same diet, same foods, same frequency, same amounts – one person really enjoys this way of eating and it feels very easy; they don’t feel restricted. It doesn’t feel like they’re on a diet. If they were to eat like this for the rest of their life, they would be very happy.

But you then have someone else who is following the exact same eating pattern, but to them it feels very different. It feels very restrictive, and it feels like they’re eating less than they would like or they’re avoiding certain foods that they would like to be eating. On paper, this way that this person is eating could look great. Maybe it is ticking the nutritional boxes, so from this perspective you’d think this person is on to some kind of winning formula. But to them it doesn’t feel this way.

As a practitioner, when I’m looking at someone’s eating, not only am I thinking about the actual contents of what they’re eating and what foods are making it up, but also how they feel about what they’re eating.

00:37:45

Separating health and weight

We also need to change the way that so much of the focus from health is about weight loss. Alternatively, we should be finding ways that get people to be eating healthier food and moving their body that aren’t linked to cognitive dietary restraint and poor body image. Eating healthier food here can mean many different things depending on the situation. If someone is eating more fast food, then it’s shifting to having more whole foods, which can be done at a pace that is right for that person where it doesn’t feel restrictive.

But eating healthier could also mean having less of a ‘clean eating’ or orthorexic thinking around food. It can mean more food, it can mean more hearty foods or more comfort foods, and generally just having more allowance around foods. Our overfocus on healthy foods but without the context of how someone feels about this eating can really affect people across the whole spectrum and all different types of eaters.

One of the studies mentioned earlier looked at cognitive dietary restraint and ovulation and bone density. I work with so many women who suffer with hypothalamic amenorrhea or HA, so women who aren’t ovulating and not getting their period. One of the guests I’ve had on this show before is Nicola Rinaldi, and she’s done a ton of amazing work in this area. She has a book called No Period. Now What? that goes through this in a very in-depth way and explains how women can get their periods back.

With HA, it’s often come about by a combination of things – definitely undereating and over-exercising, intertwined with a lot of body image issues. So really classic cases of cognitive dietary restraint that are then followed through with actual dietary restraint and then with a large helping of exercise thrown in on top.

00:40:00

Going all in

As part of the recovery process that Nicola suggests is the idea that people need to go all in. What she means by being all in is not just increasing food and decreasing exercise, but mentally being all in and getting on board.

I’ve been a big proponent of this idea for a long time, and it does really make a big difference. I’ve had many clients who’ve made changes to exercise and their food, but their period hasn’t come back. But when they finally make that mental shift, when they do mentally go all in and get on board, this is when changes actually happen.

It’s nice to then be able to show studies about this mental/emotional side of things and to have studies that validate why being all in can have a real positive impact on health in general, but in these situations in terms of ovulation and bone density, etc.

While I haven’t linked to any studies here about fat shaming, there is just a mountain of evidence to show that it doesn’t work. And not only does it not work in terms of actually getting people to lose weight, if people then feel worse about their body, this leads to cognitive dietary restraint, and as we see in these studies, this isn’t great for health. For people who are always wanting to fat shame people with the idea of “I’m trying to do it for their health; this is going to help them in terms of their health,” this would demonstrate that this doesn’t do things for their health. In fact, it makes health outcomes worse.

I should add that this is an incredibly complex issue. While in this episode I’m focusing on body image and cognitive dietary restraint, there are so many different variables that come into play with this stuff. I think just honour that complexity and know that there’s really no hard rules on this stuff, and that there will be fluidity and that we need to start to incorporate all of these different factors.

That is it for this episode. As I said at the beginning, these were studies that really caught my attention and supported what I’d noticed in clients through practice. It is still early days for this stuff, and I don’t want to overstate the results, but it does give us a starting point of understanding that our thoughts and our beliefs about our food and our body can have an impact on our health markers, and that’s irrespective of our actual choices.

As I said earlier, with all the studies, they will be in the show notes, so you can access them at www.seven-health.com/102. That’s it. I’m going to be back next week with another guest. I hope to catch you then.

Thanks for listening to Real Health Radio. If you are interested in more details, you can find them at the Seven Health website. That’s www.seven-health.com.

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