March 2022 - Embody Health London

How to manage Ramadan with an eating disorder

Eating disorder recovery: To fast or not to fast?

Throughout the month of Ramadan, Muslims fast as a reminder of the human duty to help those in need. This entails not eating or drinking anything, including water, from dawn to sunset.

Ramadan can be considered the utmost expression of religious dedication for many Muslims. However, for those struggling with a past or present eating disorder it can be a triggering and even harmful period.

As Ramadan is approaching, in this article we will explain how you can cope during this time, whether you choose to fast or not, as ultimately, it is up to YOU and we hope to facilitate empowered choices.

How Can Ramadan affect my Eating Disorder?

Validating fasting for religious purposes can be an opportunity for your eating disorder to obscure your food restriction with the veil of devotion to Islam. Even if you are medically cleared to participate in Ramadan, the fasting practice can still make you poorly.

Ask yourself, “Who am I fasting for,

Allah, or my eating disorder?”

Fasting can strengthen your eating disorder voice, put a strain on your improvements, or even elicit a relapse. For example, if you are prone to overeating, there are chances you will overindulge at Sehri or Iftar, which can make you feel distressed and uncomfortable. On the other hand, if you engage in restrictive eating behaviours, fasting can be damaging to your recovery and health.

To Fast or not to fast?

For all believers, fasting during Ramadan can be an extremely challenging practice not only physically, but mentally too. Even though it is one of the five pillars of Islam, there are exceptions to Ramadan as per the Surat-Baqarah of the Quran¹. Allah ‘does not intent hardship’ for those who are ill, as it would be detrimental to their health.

Like any other illness, withholding nutrition

and hydration can be harmful to eating disorder recovery.

It’s painfully true that for some people, eating disorders and other mental health conditions do not fall under the category of “illness”. We want to remind you that your eating disorder, visible or not, IS AN ILLNESS. You have valid reasons to not abstain from food and drink and suffer in silence this time of the year.

Remember, not taking part is NOT a weakness in faith, and you shouldn’t feel guilt or shame for not fasting.

After all, religion shouldn’t stand

in the way of treatment, it should aid it.

What else can I do instead of fasting to participate in Ramadan?

Ramadan is so much more than fasting. True spirituality always comes from within. If you are not fasting, you can focus on other ways to participate that have nothing to do with when or how you feed yourself.

I am NOT fasting during Ramadan; how else can I participate?

Recite Quran
- ‘Feed’ less fortunate people, cook for someone who is sick (even yourself) or donate food to charity.
Focus on good deeds within your community
- Offer used clothes to charity, volunteer, teach, foster animals, pay a visit to a nursing home, hold the door for people behind you, tip generously or babysit.
Use this as an opportunity for self-reflection, growth, and discovery
- Avoid bad behaviour, apologise to an old friend, help those in need.

If I am choosing to fast during Ramadan; how can I help keep myself safe?

Be mindful of your triggers. List them all down and formulate a plan of how to avoid them but also what to do if they come up.
Create a plan with a Dietitian or a family member.
Do not skip Sehri or Iftar to reduce risk of bingeing and/ or purging.
For your non-fasting period, have meals regularly. You can start with a starter, then have a main meal, and finish off with a pudding and/ or snack later.
Have balanced meals including carbohydrates, protein, fat, fruit, and vegetables.
Aim to eat complex carbohydrates (whole wheat bread, pasta, brown rice) that will keep you fuelled for longer.
Pace your water intake slowly after your meals so you don’t feel overly full.

Where can I find additional support during Ramadan if I have an eating disorder?

Websites

https://waragainsteatingdisorder.com/
https://naseeha.org
https://myh.org.uk
https://www.meeda.me

Instagram accounts

@islamandeatingdisorders
@1866naseeha
@muslimyouthhelpline
@meedassociation
@muslims_eds

Be kind and compassionate towards yourself. You are not the only one with this struggle and internal conflict. You do not need to fast because of family or peer pressure, and do not let anyone question your faith. You are no less Muslim than someone who decides to observe Ramadan. If you choose not to fast, you are making the right choice for yourself. Remember, Allah does not want to make things difficult for you.

Do not be afraid to ask for support and speak up. Whether this is professional help or speaking with a community that shares the same interests and struggles.

Dimitra Theodoraki, BSc, RD

Team EHL x

Reference

https://corpus.quran.com/translation.jsp?chapter=2&verse=185

Why weight gain happens during menopause and tips to help avoid it

Menopause Weight Gain: Is It Inevitable?

Menopause is a natural part of aging, and typically occurs between the ages of 45 to 55. However, we are humans, not robots, and it can occur outside of this age range for many women too, with early-onset menopause happening before age 40 and late-onset menopause happening after age 60.

People with a uterus often notice changes in their bodies such as hot flushes, sleep disturbances, mood swings, vaginal dryness, and a decreased libido. Weight gain is also quite common during this period. All these changes can make menopause a difficult experience and understandably lead you to feeling uncomfortable within your body.

When folks start menstruating, and throughout child-bearing age, they tend to store fat around their hips and thighs as subcutaneous fat, which doesn’t increase the risk of disease as much as visceral fat, which is the fat that builds up around internal organs. However, during menopause, low oestrogen levels can promote fat storage around the stomach areas in the form of visceral fat, which is linked to various health conditions, such as diabetes and cardiovascular disease (Abildgaard et al., 2021; Mauvaise-Jarvis et al., 2013).

To prevent weight gain, it is important to know the root cause of it. This article will discuss menopause and weight gain, how it might affect you, and what you can do about it from a non-diet approach.

Why does weight gain happen during menopause?

Weight gain is caused when the calories consumed through food exceeds the calories being burned by our body through basic functions and activity. However, we know that it is not always that simple as our hormones, health status and so many other factors play a massive role too.

Weight gain during menopause is multi-factorial, meaning it is not attributed to one thing but a combination of changes. Hormone imbalances and sleep disturbances can lead to poor nutrition intake, lack of exercise or a change in lifestyle habits such as drinking more alcohol or being more sedentary, and these factors can contribute to weight gain during this period.

How does menopause lead to weight gain?

Reduced caloric needs:

Our reproductive system requires energy to function, which is why in severe calorie deficits, women may lose their period and their fertility can be affected as the body shuts down this system to conserve energy.

With this system shutting off during menopause, you may naturally require less energy, and therefore you may notice some weight gain during menopause if your intake remains the same.

Hormonal changes:

Menopause is associated with significant drops in oestrogen levels, which can affect body fat distribution, but also lead to water retention and bloating, which may look like weight gain.

There is also an increase in cortisol levels, which is ‘the stress hormone’, and this encourages the body to store fat as opposed to using it. This can be increased due to mental stress, but also physical stress such as lack of sleep and not eating enough (Nedeltcheva & Scheer, 2014).

Reduced activity levels:

Sleep disturbances are common during menopause, and this may lead to tiredness throughout the day, which might make you feel less like exercising. Exercise and general activity increase calorie output, and if your intake is higher than your output, it can result in weight gain.

Changes in nutrition:

Due to a lack of sleep, or changes in hormone levels, you may find that you are eating more food to give you a sense of energy or pleasure. Various studies have concluded that people who do not get enough sleep are more likely to have a higher calorie intake without an increase in energy output (Grander et al., 2014).

Tips to help fight menopausal weight gain

Rest and respect your body

Sleep deprivation is a common cause of weight gain (Wu et al., 2014). When you are tired, you may find that you reach for more fast-acting carbohydrates, which give you instant energy, but this energy is not sustained, so it means you seek more food to feel energised. This is an example of how sleep can lead to eating more, and thus lead to weight gain.

If you don’t get enough sleep, cortisol levels increase, which makes the body resistant to weight loss. Lack of sleep can also lead to decreased energy output due to lack of exercise.

You can try to improve sleep by improving your sleep hygiene or pre-bed routine. This might look like creating a sleeping environment that is conducive to sleep i.e., dimmed lighting, cool room, clean bed sheets, or implementing some strategies to help you wind down such as putting away your phone an hour before going to bed, doing some meditation, reading a book, or having a bath.

It can be difficult to accept the decline in energy and changes in your body during menopause, and you may find having a lack of energy frustrating. Fighting against your body will not get you the results you desire, so instead of increasing your levels of cortisol more by perhaps exercising when you’re tired, try to listen to what your body needs a bit more and be gentle during this adaption i.e., perhaps try a gentle walk if you didn’t sleep well or try some other low-intensity form of movement such as yoga.

Focus on gentle nutrition

Weight gain may feel uncomfortable, and you may feel compelled to restrict your intake or to go on a diet. Menopause aside, we know that crash diets can lead to weight gain in the long run due to the increased likelihood to overeat when the diet ends, and the effects of dieting on the body’s natural hunger and fullness cues.

Prioritising a balanced diet can help to keep blood sugar and energy levels balanced, which can mean you are less likely to overeat or to rely on processed food for energy. Ensure that you include foods you enjoy regularly, so that you don’t feel restricted and crave them, as this can lead to binging or overeating when you are next presented with that food.

Choosing carbohydrates which are rich in fibre can help to keep us to feel fuller for longer. Fibre-rich carbohydrates, such as whole grains, legumes and fruits and vegetables, release energy slowly, keeping us energised for longer and our blood sugar levels stable; to minimise urgent cravings.

Eating plenty of protein and including some dietary fat can help keep you satiated and provide essential nutrients to nourish your body.

Manage stress levels effectively

As mentioned above, cortisol increases when we feel stressed. By actively trying to reduce or manage stress better, you can reduce the likelihood of weight gain due to stress.

Also, eating is a common coping mechanism for stress, and whilst it is not necessarily a bad thing to eat when stressed, it can become an issue if it is your only coping mechanism.

If you experience high levels of stress in your work or personal life, it’s important to recognise how this may be negatively impacting your relationship with food. Our top tips are to set healthy boundaries, schedule breaks in your day and make it a priority to include activities you love. Mindful movement can be useful to help you to get out of your head and into your body. Check in with yourself, practice a gentle yoga flow or challenge yourself to go for a walk without anything in your ears. Take a breath and reconnect with nature.

If you feel as though you are struggling with the changes during menopause and it is having a detrimental effect on your relationship with food and your body, book your free discovery call with us and it will be our pleasure to guide you on this journey.

Elle, R.D, BSc, MSc

Team EHL x

References

Abildgaard, J., Ploug, T., Al-Saoudi, E. et al.Changes in abdominal subcutaneous adipose tissue phenotype following menopause is associated with increased visceral fat mass. Sci Rep 11, 14750 (2021). https://doi.org/10.1038/s41598-021-94189-2
Grandner, M. A., Jackson, N., Gerstner, J. R., & Knutson, K. L. (2014). Sleep symptoms associated with intake of specific dietary nutrients. Journal of sleep research, 23(1), 22–34. https://doi.org/10.1111/jsr.12084
Mauvais-Jarvis, F., Clegg, D. J., & Hevener, A. L. (2013). The role of estrogens in control of energy balance and glucose homeostasis. Endocrine reviews, 34(3), 309–338. https://doi.org/10.1210/er.2012-1055
Nedeltcheva, A. V., & Scheer, F. A. (2014). Metabolic effects of sleep disruption, links to obesity and diabetes. Current opinion in endocrinology, diabetes, and obesity, 21(4), 293–298. https://doi.org/10.1097/MED.0000000000000082
Wu, Y., Zhai, L., & Zhang, D. (2014). Sleep duration and obesity among adults: a meta-analysis of prospective studies. Sleep medicine, 15(12), 1456–1462. https://doi.org/10.1016/j.sleep.2014.07.018

Four tips to get back on track after a binge

So you binged… now what? Post-binge strategies

When living with an eating disorder or whilst in recovery from one, binge eating can be something that may happen at an impulse. Although binge eating is a normal part of recovery, it may throw us off our path, sometimes drastically.

This may cause your self-confidence and stamina to fall, even with the best of intentions and ‘willpower’.

There is nothing more frustrating than feeling further away from your recovery goals, which is why we bring you this article: top tips to help you stay on track after a binge-eating episode. Read on for more!

ONE: Practice self-compassion and start afresh

The urge to binge might be a signal that you are feeling physically or emotionally hungry, lonely, bored, or it may be a signal that you are seeking comfort, soothing, connection and stimulation. These ‘symptoms’ point to how you are really feeling and this feedback from the body can be acknowledged in a compassionate way.

It can be incredibly valuable to remind ourselves that every day is a new start and not to pressure ourselves if things don’t go to ‘plan’ early on in our day – feeling like we have already failed after a minor slip-up. The symptoms of binge eating are often coded with deep meaning, and if we can meet ourselves with curiosity and compassion, we can begin the journey back home to our true self.

However, it’s important not to beat ourselves up when we face obstacles in recovery. The post-binge period can bring about challenging and destructive feelings – of shame, guilt, failure, and hopelessness. We may feel anger within ourselves, as though we can’t get anything right – a perfectly human response that many of us can probably relate to.

Instead of this fixed mindset, how can we meet ourselves with tenderness, kindness, and compassion? Binge eating happens and that’s ok.

Holding and committing to the unconditional effort to try, and try again, and show up for your mind and body daily is what holds the most value on your recovery journey.

TWO: Enjoy some gentle movement or dedicate time to a hobby or interest

Whilst we may feel guilty for bingeing and want to combat any excess food consumed through exercise, it may be more beneficial and sustainable to go on a mindful walk, join a yoga session, get out in nature, or explore any gentle movement that feels good for your body.

This way, we can feel the benefits of movement without overdoing it or falling into the cycle of ‘compensating’ for our food intake. Remember – you do not need to earn your food!

Allowing yourself the unconditional permission to eat without harbouring feelings of guilt, alongside incorporating some modest activity into your day, will enable you to occupy your day with other activities and hobbies, and ultimately coming back home to your body.

THREE: Assess, experiment, and shift your focus towards mindful eating

Think about what might have caused your recent binge episode. Can you dare to look below the surface to identify any potential triggers or factors that led to the binge? Were you hungry or restricting yourself beforehand? Did you experience a negative encounter or event in your day? Were you feeling bored, lonely, or unpleasant?

Then, consider how hunger manifests in your body – in the stomach, in the mind, in the mouth, or anywhere else. This can be quite individual – really take the time to become mindful of these signals to increase your interoceptive awareness.

Habits begin with consistency, so do whatever you can to make it easier for you to feel more comfortable and in control around food. Do you need to eat more throughout the day? Plan in snacks between meals? Create a pleasant and calm eating environment? Again, this varies between individuals and so putting in the time you need to assess what that might look like is recommended.

FOUR: Ask for help when you feel you need it

One of the bravest things we can do in times of living with an eating disorder is to reach out to the people closest to us, be vulnerable and let them know we are struggling.

Whether this is through friends, family, support groups or even a healthcare professional, it’s important to speak up when intrusive thoughts about food and your body creep in.

A meal out with a close companion may be a great way to reset – a wholesome catch up with food in a public setting can prevent a further binge – as they most often occur in isolation. Read more in our article on how to confidently eat in restaurants for more tips with this.

Wherever you are on your journey, remember that you inherently possess the wisdom and knowledge to recover from your eating disorder, for good. Before you continue on with your day, we want you to take a moment now to reflect on your progress so far. Baby steps still move forward.

Our evidence-based programmes and compassionate team of dietitians here at EHL will be able to help you on your recovery journey back to your true Self. Get in touch with us here to book your free discovery call to see how we could best work together.

Priya Chotai, BSc, ANutr

EHL Team x

The role of the dietitian in eating disorder treatment

Dietitians are a vital part of your eating disorder care team

Dieting is not the sole feature of eating disorders, but it is indeed a principal one according to Fairburn’s transdiagnostic model of eating disorders. So, it comes to no surprise that dietitians would play an integral role in their treatment.

Recent clinical practice guidelines capture well the need for specialist dietetic intervention in eating disorder treatment. Dietitians are key members in the multidisciplinary team, alongside Doctors, and mental health professionals.

Dietitians are highly educated at university in human physiology, biochemistry, pharmacology, pathology and eating behaviour. Thus, dietitians are in a uniquely advantageous role, as they integrate their nutrition knowledge with counselling skills to support behavioral change. They help optimise their clients’ nutritional status whilst supporting them in healing their relationship with food and their bodies.

In this article, we will break down the various roles a dietitian has when supporting someone with an eating disorder.

Nutrition Rehabilitation

When a person is experiencing an eating disorder, it is very likely that they also suffer from clinically significant malnutrition. It is one of the main roles of the dietitian to identify this and help the patient bring their nutritional status back to an optimal level.

A Dietitian’s Nutritional Care ‘Plan’ Steps

The dietitian completes a comprehensive nutritional assessment: This includes assessing the client’s clinical status, weight history, dietary intake, eating pattern, beliefs around food, and their lifestyle.
The dietitian subsequently provides a nutritional diagnosis: Identifying the severity of undernutrition, what is missing and what potential health risks exist.
The dietitian develops and offer a nutritional intervention, which includes implementing gentle nutrition guidelines (not rigid rules!) personalised to each client to ensure dietary adequacy, variety, and balance (the three pillars of nutrition). Exploring the timing of meals, and gaps in nutritional knowledge or skills that hinder adequate nutrition are also addressed in this step.
The dietitian monitors your progress: An ongoing evaluation process in accordance to the client’s goals and of course they work WITH you.

Dietitians do this all with being mindful of any other common comorbid conditions, such as diabetes mellitus, food allergies and intolerances, gastrointestinal conditions, and osteoporosis. They are also trained to identify those at risk of refeeding syndrome, and to produce meal plans to safely renourish.

Nutritional Psychoeducation

The nutrition care process has much to offer than just simply creating an energy surplus or equilibrium. Those struggling with an eating disorder may have irrational thoughts about their body and food. Dietitians work closely with the client to re-educate them on nutrition topics, myth bust and challenge any limiting beliefs around food and unhelpful behaviours.

The core topics of their discussions are on exploring food belief systems, eating patterns, nutrition misinformation, and weight stigma. They also cover themes such as self-care, body image work, which goes hand in hand with, but is not limited to, nutrition rehabilitation.

The Values of an Eating Disorder Dietitian

Person Centred/ Collaborative

We consider the person as a whole, taking into account their clinical background, identity, preferences, dietary patterns, priorities, past experiences, and trauma. Together with the client we focus on what’s important to their physical and mental health, and we help them set their goals. We are adaptable and set aside our agenda so that we work with the client rather than on the client. From listening their concerns, we notice patterns, and offer ideas that they will find useful to meet their goals.

Empowerment

Our greatest goal is to enable our clients to be autonomous by the end of their treatment. We teach them how to attune with their needs and be well equipped to work independently by following their wise mind and intuition.

Honesty/ Clarity

We share information that is accurate, and evidence based to help our clients cut through the noise of misleading headlines that are cluttered in the diet culture we live in.

Compassion

We show understanding and kindness toward our clients’ suffering by integrating our interpersonal skills with our nutrition expertise.

Respect

This is an integral part of our standards of proficiency of our dietetic code of practice. We employ a non-discriminatory manner, by honouring the needs and preferences of our patients, celebrating the diversity in their bodies, upholding their rights, dignity, values, and autonomy, and their central role in decisions about their health.

Social Responsibility

We are advocates in increasing the awareness of eating disorders. We are committed to resolve weight stigma, and we always strive toward a fairer, more inclusive health care.

If you or a loved one need support and believe you could benefit from working with a specialist dietitian, we are here for you. Book your free discovery call today to learn more about how we can help.