88 - Transforming Diabetes Management with Intuitive Eating

Can you imagine a world where you can enjoy a piece of cake without guilt or a salad without feeling virtuous? Well, our guest, Holly Paulson, a certified eating disorder dietitian, has done more than just imagine it.  Holly shares her story, debunking diet culture and shedding light on the difference between dietitians and nutritionists, offering a fresh perspective on how to eat intuitively, even with a chronic illness.

Navigating the turbulent waters of diabetes and food, we unpack the reality of living with this condition. With Holly's weight-neutral approach, we challenge the myth surrounding weight loss as the panacea for diabetes management. Busting the chains of restrictive diets, we advocate for intuitive eating, encouraging healthier behaviors that lead to a more balanced relationship with food, especially for those with type 2 diabetes.

As we wrap up, we delve into the logistics of seeking professional help, answering your burning questions about finding the right dietitian and the cost involved. Holly's wisdom emphasizes the importance of comfort and connection when choosing a practitioner. And to round off, we joyfully reclaim the inherent pleasure of food. Holly champions letting go of societal pressure, allowing us to embrace the satisfaction food brings. So join us, and let's start celebrating food again.

Transcript

Speaker 1: 0:51

Welcome back to the show. I am so excited for this episode. I had total fan girl going on with Holly, so this was just such a great experience for me.

Speaker 1: 1:03

Holly Paulson is a certified eating disorder registered dietitian in private practice. Her practice is focused on providing nutrition therapy for clients with eating disorders and disordered eating. As a certified intuitive eating counselor, holly loves to help her clients make peace with food and uses a health at every size approach to nutrition. She is a graduate of the University of Iowa and completed her dietetic internship at Iowa State University. In addition to her work with clients, holly provides professional case consultation and training to healthcare providers in the field of eating disorders. Holly and I talk about the differences between a dietitian and a nutritionist, how to eat intuitively with a chronic illness and some of the damages dieting can do. So enough of my blabbing, let's get to the good stuff. Welcome, holly. I am super excited about this episode. This is probably one of my most anticipated episodes, I think, both for me personally and listeners. So welcome to the Emotional Eating Therapist show.

Speaker 2: 2:05

Oh, thank you, Sabrina. I'm so glad to be here and talk with you.

Speaker 1: 2:08

Yeah, and I'm really bummed. So interesting little tidbit. Holly and I live in rural Iowa fairly I mean rural, you know, rural. Everything is fairly close together when we're rural. But we have a mutual friend who had been trying to connect us for probably the past four years and, for whatever reason, our paths just kept just like sliding by each other and I wouldn't call her and I don't know if Jennifer gave you my information, but I think I had it in my head that like you were this like celebrity. I know that sounds so funny, but I did because you're, you know, you're, you're this really well known in the eating disorder space in Iowa as this dietitian who, like everybody wants to get into, and I think I had it in my head that you know it was going to be like interviewing Oprah.

Speaker 2: 3:05

Well, that is very flattering and funny. Thank you.

Speaker 1: 3:09

Yeah. So now that I've got my fan girl out of the way, I always start interviews with guests of, just tell us a little bit about your experience with emotional eating.

Speaker 2: 3:21

Yeah, and emotional eating is such a loaded phrase too, isn't it? I can remember my whole life loving food. I mean food, it's the best right, and food gives us comfort, gives us joy, and I remember feeling that all through my childhood, really enjoying eating sweet foods, candy like all kids do, you know. I think it makes me think of Jerry Seinfeld as a stand up routine once, where he talks about kids and their. Their whole life is from one candy experience to the next. When's the next time I get candy? When's the next time I get candy? You know, because we withhold that kind of from kids. But I remember that in my childhood too, being very much loving candy, and as soon as I had my own money. I grew up in a small town where there was a grocery store down at about three blocks away I would walk down to get my candy. And that power and that enjoyment that came from that, that early experience with having my own opportunity to get foods I loved, is powerful.

Speaker 2: 4:23

But then, as I got older, like a lot of teenage girls, I started to notice changes, that I was gaining weight. I didn't like that. So I thought Well, you know one thing we're always told, and especially at that time. Well then, you do something about that, don't eat so much, or let's, let's try to change that. And I started as a teenager going on multiple diets, very restrictive diets, and then ending up binge eating. I probably spent six or seven years is a binge eater and I would say you know was would have been diagnosed with binge eating disorder if that was a diagnosis at that time. But really much stuck in a cycle of dieting, overeating in secret, starting again, feeling a lot of shame, a lot of embarrassment, weight cycling and really feeling out of control with food and not feeling like I knew how to eat, which really should be one of the most normal things, the most natural. We all are born knowing how to eat. We lose touch with that, so that's one of the reasons I decided to become a dietitian. I thought, Okay, well then, if I have all this trouble with food, I don't know how to eat, I'll become a dietitian, I'll fix that. Well, as you and I know, that's not the problem. It's not about having this perfect formula to be able to have the body we want or to be able to feel in control of food. It's about being able to let that go, but through learning more about food.

Speaker 2: 5:50

I realized through my education that a lot of the ideas that I thought about food and a lot of things I thought about nutrition were really only things I learned from dieting and that there is a better way to eat and there's a way to enjoy food and to feel competent about it. And that was really my goal. And so as I figured that out for myself finally over the years and found a place where I was peaceful eating and able to eat really whatever I want, without thinking about it, without restricting, I realized that something I really appreciated being able to help other people with. So that's a lot of what my practice is.

Speaker 2: 6:28

I work with patients with disordered eating, wanting to give up dieting, and then a lot of clients with full blown eating disorders where that disordered eating is really tipped the scale and no pun intended, but biologically into something that starts to change the structure of the brain, and so we really untangle a lot of those messages. So one of my favorite things to do is to help people disconnect from diet culture, normalize food, enjoy food and feel competent about eating again. And it's not about dieting, it's not about good foods, bad foods. It's about connecting with yourself, knowing what you like to eat and really relaxing about it right, Because emotional eating is all about anxiety and soothing that and coping with emotions, and part of eating normally, intuitively, is letting that go and letting that be. So I love to help people with that. It's a very rewarding field to be in.

Speaker 1: 7:29

Thank you for sharing, and I think one of the questions that comes up a lot when I'm working with clients, whether in the counseling or coaching capacity, is what's the difference between a nutritionist and a dietitian and when do I need to enlist their help and who should I enlist?

Speaker 2: 7:50

Oh yeah, that's a great question. I'm glad you asked that because it is something that comes up a lot, that people aren't aware that there is a distinction. So a nutritionist that kind of broad term would be someone who. I don't know how you define a nutritionist If someone who works in giving nutrition advice, studies food and nutrition, maybe. But what is important to know is that anyone can call themselves a nutritionist. It doesn't have any credentialing behind it, it's just a word really that you can call yourself a nutritionist.

Speaker 2: 8:24

All dietitians are considered nutritionists because we all work in the field of nutrition dietitian, dietitian, nutrition, dietitian nutrition, nutrition, nutrition, dietitian. So the distinction of a dietitian is a registered dietitian, lead at a bachelor's degree in nutrition and dietetics, has had all that coursework in physiology, biochemistry, foods, health, and then they have passed a board exam that demonstrate that they are qualified to provide dietetic counseling, dietetic advice to people. And there's licensure in in Iowa. You have to have a license to actually practice as a dietitian, so dietitians provide what is called medical nutrition therapy. So if someone is looking for assistance with, let's say, diabetes, heart disease, chronic illness, kidney disease, where food is really part of the treatment or the regimen for managing the disease, it's really best to seek out the help of a registered dietitian. A registered dietitian would review lab work, would review medical history. Those were things that, if a person is a nutritionist, they would not necessarily have licensure and skills to evaluate.

Speaker 2: 9:38

If a person is looking for help with managing disordered eating, that can be done through a nutritionist If that nutritionist has the skills to evaluate disordered eating. It's very important, though, to see a registered dietitian in disordered eating care, because there's often that point where disordered eating is really an eating disorder and this is a medical condition. It's a psychological condition. It's something that needs more help than just reading a book. Yeah, a dietitian can work in all areas of eating, whether it's disordered eating, wanting to stop dieting or make peace with food, or a medical condition. I don't know if that distinction makes sense or yeah, it makes sense to me.

Speaker 1: 10:25

And as far as the mental health field, there's a distinction between. At this point, the coaching profession is not a regulated entity, and so anybody could put up a shingle and call themselves a coach, whereas in order to call yourself a counselor or a therapist, you have to have that master's degree and, again, board-certified some sort of exam, Right? So it sounds very, very similar. And as you were talking, you mentioned some more of those chronic diseases where maybe food is part of the treatment plan, whether that's diabetes, liver, other organ issues. Can you talk more about how food plays a role into that and maybe shed some light onto some of the myths that we don't need to completely restrict all sugars if we're?

Speaker 2: 11:15

diabetic, oh my goodness, yes, yes. So people who are diagnosed with a chronic disease like diabetes or heart disease, kidney disease, any disease that we think of as being associated with food. Right there it sets up this relationship with food, that food has become the enemy of sorts, especially so, let's say, somebody who has diabetes. That's an example that most people are kind of familiar with. They know that or they believe that if someone has diabetes, oh, that means they can't eat sugar, and that's not true, but it's a common misbelief. But also for the person who is newly diagnosed with diabetes, or even someone who's had it for years, there's that conception that, okay, sugar is my enemy, food is what makes me sick. My relationship with food becomes anxiety-ridden and adversarial. And really that's not the case, because once we start putting those boundaries around food, it makes overeating, emotional eating, binge eating, more likely. As soon as we try to as I know you've talked about in your podcast before as soon as we start to put rules around food, food becomes more desirable. As soon as we don't eat enough, by restricting or by following some specific meal plan, the body biologically responds by making binge eating more likely, because it sends out all these signals to protect us and say you need more to eat. So for a person with diabetes, for example, if they are under the impression that they can't eat certain foods and they don't have them, so let's say they say, oh, you're not supposed to eat carbs if you have diabetes, right, first of all, that's not true.

Speaker 2: 12:54

Carbs are very important to someone with diabetes. They are life-sustaining for all of us, even people with diabetes. But if someone with diabetes has that impression or has been told that, even by a nutritionist is a good example of that. There are many nutritionists, so people who don't necessarily have background in nutrition, who provide coaching or advice or even write books for people with diabetes on no carbs or paleo diets, and that can cause damage, which is where I'm sure when you're talking about the distinction between a counselor and a coach in your profession, someone who does not have the training can cause damage in a situation that can cause harm to a patient.

Speaker 2: 13:35

So restrictive diets that say no carbs, no sugar for someone with diabetes can actually cause damage and can underfeed the person, create this biological cascade of events that happen that makes the person overeat and that's not a failure. But then the person feels like, well then I failed. And then they overeat, and then they restrict again and then it's stuck in the cycle and actually that cycle of binge eating and restriction is more harmful for our health than just eating, than just eating three meals and snacks whenever you need them. An interesting statistic or I find this interesting in my work with patients with diabetes is that in people with type 2 diabetes or what we used to call adult onset diabetes, but people with type 2 diabetes statistics say that 40% of people with type 2 diabetes have diagnosable binge eating disorder. 40% In the general population. It's more like 5% to 6%. So having diabetes puts a person at risk for binge eating disorder, makes it more likely, and I suspect that's because of the rules and restraints we put around eating.

Speaker 1: 14:50

I hadn't heard that statistic before, but wow.

Speaker 2: 14:55

Yeah, yeah. And so people might think, well then, maybe they had binge eating disorder and that's what gave them diabetes. No, it doesn't work like that. What we know is that the messaging around diabetes and the messaging around how a person is supposed to eat with diabetes or that a person has given themselves diabetes I mean that's part of common culture in movies and commercials that, oh, I'm going to give myself diabetes, I'm having a soda no, it's that messaging that drives people to move away from normal eating and to restrict their eating that leads to the binge eating and diabetes.

Speaker 2: 15:35

So people might say, well, you can't eat intuitively with diabetes, you have to have boundaries on what you eat. No, I would say that with diabetes it's even more important first to heal that relationship with food and then to address other things that we know make a difference in managing blood sugar. But I should impart the distinction here. If a person has type one diabetes, which is, that is, insulin dependent diabetes, the type of diabetes that starts in childhood often that's different. If a person is taking insulin, there are specific recommendations to be made and specific patterns that would have to be followed. So that's a little bit different.

Speaker 2: 16:18

But in type two diabetes, which is the more common form of diabetes. Managing eating by confidence in eating, intuitive eating, is the first step, and I kind of think of it as the umbrella over diabetes treatment, and that's one area I do work a lot in. This is working with clients with diabetes and what we would consider a weight neutral approach. For a long time, the management of diabetes has been well, you need to lose weight. No, there are many other ways.

Speaker 1: 16:47

My mom had diabetes for I can't remember how many years, but it was quite a few years before she passed away and that was one of the big messages back then and that was, you know, 20 years ago almost, was her doctors just kept telling her to lose weight and I didn't know what I know now. But she had to help her navigate any differently and there's a lot of shame wrapped up in that and the stigmatism that diabetes is a fat air. Quotes here fat disease.

Speaker 2: 17:24

Right and it's heartbreaking, and I'm sorry about your mom, and there were so many other people like her that spent a lifetime feeling guilty for their diagnosis of diabetes, for feeling deprived and then, naturally, a lot of them eating foods that they felt guilty about eating and feeling shame, yeah, and not knowing. What we know now is that you can eat sugar with diabetes. You can eat anything you want with diabetes. It's not about the food, but it is really important to be connected with how we're eating and how we feel about food.

Speaker 2: 18:06

And when they used to tell people lose weight with diabetes. That's how you control it, like it might have been like the first recommendation given by a healthcare provider be you need to lose weight, you have diabetes, you need to lose weight. We know, then, for people who lost weight and saw improvement in their diabetes, it wasn't the weight loss that improved the diabetes numbers. It was the behaviors the person employed to get there. So maybe they were exercising more, maybe they were paying attention to when they were hungry, maybe they were eating breakfast, maybe they were eating more fruits and vegetables. It's those type of things that do independently make a difference in managing blood sugar, not the weight. Not the weight.

Speaker 1: 18:49

No, it is not the weight, it is not no unfortunately, one of the things that I've noticed is sometimes it's really hard for especially people who have been stuck in that diet cycle or that restrict binge cycle, to make the shift into intuitive eating. What would you give as like a really a base level? Starting point of this is how you can start to be more intuitive and listen to your body.

Speaker 2: 19:23

That's a great question because sometimes you can't just jump into it. If someone has been dieting for years, or eating on the other end of the spectrum for a year, is going back and forth between restricting and feeling out of control with eating, those natural hormones that regulate hunger and fullness are probably not working real reliably. So what we start with is saying, okay, at first let's try just some structured eating. I can give you an example of most of the people that I would start working with not most of them, but it's very common for someone to come in and say well, I usually just have like a boiled egg for breakfast, I'll have a chicken breast and salad for lunch. And then it's late in the day when people have difficulty in their and again they're very hungry and their body responds with saying, okay, we need to eat, and they haven't had enough carbohydrates to the day and they end up overeating.

Speaker 2: 20:14

That can be a normal, typical cycle for someone who's restrictive eating. That person to go right to eating whatever they want whenever they want doesn't work well. So we start to recondition those hunger and fullness cues by some planned eating regularly. So what would it be like to have a full breakfast? Maybe you'll have something with some protein, like some eggs and some toast for carbohydrate, maybe some fruit alongside that. Then what would it be like to make sure that you have a full lunch with carbohydrate foods and a protein? What would it be like to have dinner on schedule and snacks when you're starting to feel hungry in between?

Speaker 2: 20:51

We usually start with the rule of let's try not to go longer than five hours without nourishing yourself with something, so reconditioning normal hunger and fullness cues. Once a person has started to feel less chaotic, what they're eating, less back and forth, once they start eating regularly, then it can be time to explore okay, what do I really want to eat, what do I like, and can I fit whatever I want to eat in that framework of just eating when it's time to eat? And that takes a lot of exploring what our thoughts are about foods and why some foods feel like good foods I'll use air quotes on that and bad foods A lot of unpacking of that.

Speaker 1: 21:34

And that's something that, yes, people can do kind of on their own just through some introspection, some journaling, some other stuff. But that's also where working with a provider like myself in the mental health field or Holly in the nutrition, dietetic field can really help guide you through some of that.

Speaker 1: 21:53

And I think if I had had somebody at the beginning of my journey, I don't think it would have taken me nearly as long to get to where I am. If I had kind of like a Yoda, a Jedi master, saying, no, that's totally normal, that's okay, that's exactly where you need to be great job.

Speaker 2: 22:13

Yeah, yeah, and it does make a difference to have somebody who already sees the whole big picture of it, to be able to help you with your journey through that and making peace with food, or however we wanna describe that. And I feel the same way. If I didn't have to figure it out on my own, I probably could have done a lot sooner. Somebody would have just said you don't need to diet. That's the problem, instead of feeling like a failed dieter. That was the problem. So emotional eating, disordered eating, exists on a continuum right. So there are some people that maybe feel like, oh, I eat when I'm stressed, or I eat too many cookies I'll use quotes for too many cookies, because there's not such a thing as too many cookies, or I eat too many cookies. That can just be a little bit of that beginning spectrum of needing to maybe reevaluate their relationship with food. Sometimes people can do that on their own, just by some awareness and some journal, and say, okay, why am I eating? How hungry am I? What do I wanna?

Speaker 1: 23:11

eat.

Speaker 2: 23:12

Am I putting rules around myself or am I holding myself back from eating, or am I not eating enough carbohydrates and really craving them later in the day? So that's kind of on the early end, and people can sometimes sort that out with listening to podcasts like yours, reading books maybe. And then as we move on, though, when it's disordered eating or dieting or whatever we wanna call it, starts to interfere with life and that guilt and that shame. Absolutely working with a counselor like yourself or an intuitive eating coach can be appropriate to help them untangle that and to guide them and to be able to point out some things that might be working to their disadvantage in their eating.

Speaker 2: 23:54

On that other end of the spectrum, though, there is where eating becomes again full blown eating disorders, disordered eating. Even that is interfering with life. If a person can't go to a restaurant because they're afraid of what's in the food or they're afraid they can't prepare it themselves, those are things that really benefit from both a counselor and a dietitian registered dietitian to sort out those things. So it's really kind of where they are in that continuum and an emotional eating for some of us who fall in that real far end of the spectrum with binge eating disorder and emotional eating. That's almost like a punishment right. People use it as a punishment and therapy counseling is really important in that Most of the clients I work with I always require that they have established with a therapist as well If we're working on an eating disorder diagnosis, because it's a huge part of it.

Speaker 1: 24:47

It's amazing how much food and mind and body are all connected and we don't. Unless we're in this realm, we don't think about it that way. We think food over here, and then my body over here and my mind over here, and they're all mixed together.

Speaker 2: 25:03

They are. They're all connected and I think science really only knows the tip of the iceberg with that. We don't even know how the gut microbiome or our digestive tract is tied into neuro function or to our brain and how we think just the tip of the iceberg of how that's connected. But when you think, when you mentioned brain and eating and all that being and our emotions being connected, I mean that's like from the very time that we're born there's such a connection between emotions and eating. I mean babies are nurtured and fed from the moment they're born and when everything is in a good environment, of course the privilege of that food is comforting, food is emotional. There's connection there and it's supposed to be that way. It's nurturing and then we start at some point look at that as a bad thing if we enjoy food, it's supposed to be enjoyable.

Speaker 1: 25:56

It is supposed to be, and you're completely right that somewhere along the journey of life we learned that there are good foods and there are bad foods, and I think a lot of that bless our parents because they're doing the best that they can given what they know and where they're at at the time. A lot of that comes from our caregivers, and if you are caregiver, especially your primary caregiver doesn't have a good relationship with food or their body. Chances are that's gonna be passed on to you and I always like to normalize that with clients of like this isn't your fault. One, we're a product of our environment. You can't go through any grocery store and go through the checkout line without seeing some sort of magazine that says who wore it better or lose X amount of pounds and X amount of days, like we're constantly being bombarded with that message.

Speaker 2: 26:53

Right, Constantly. We all live in that diet culture soup, if we wanna use that metaphor that we're just all existing in there and we start to think it's true, right, that there's this perfect way of eating and if I just eat this way, everything will be fine, my body will be the way I want it to be and my health will be perfect. And it just doesn't work that way. And then when we say being at the tip of the iceberg for what we know about the science of eating, even as far as nutrition, what most people know about nutrition, as I mentioned before, we get from dieting or from diet culture and that's the list of the good foods and the bad foods. It doesn't work that way.

Speaker 2: 27:36

Nutrition is not all that minutia of every little good food, bad food detail.

Speaker 2: 27:42

I tend, when I start to work with people, I say let's put all the food in one basket because it is really all the same and that's part of how we can teach nutrition in a way that doesn't trigger that messaging of disordered eating. So what we really know about food and this is one of the things that helped me untangle my own disordered eating and binge eating was knowing that you know what All foods get broken down into their three macronutrients carbohydrate, protein and fat. No matter what it is, no matter whether it's a Twinkie or whether it is chicken and brown rice and broccoli, it all gets broken down into carbohydrate, protein and fat and, at its basic elements, our body doesn't know the difference. Okay, so our body knows it gets some antioxidants and good fiber from the chicken and broccoli and rice. But it's not that the Twinkie is bad, it's that the Twinkie didn't give the good stuff. See, not everything we eat has to have all the micronutrients, and there's room for Twinkies and the other food.

Speaker 1: 28:47

Put it all together and then we listen to our body and how we feel, and it's fun it is and food is meant to be fun, like that's why people like to go out to eat, that's why chefs like to cook is is there so many different combinations of food that you can put together and have fun with it? Add some play back into your life anywhere you can, and food's a great place to do that when it doesn't hold all of that power.

Speaker 2: 29:17

Right, right, when it is not the enemy, too, and it is just the enjoyment of it. And you know, feeding yourself foods you enjoy is an act of self-care. Right, it's taking care of yourself. But we think about, when people think about taking care of themselves and they think about food. They think about, well, depriving myself If I'm gonna take care of myself and I'm not gonna eat this or not gonna eat that, and really it's about nurturing yourself. And when people start to reconnect with, okay, when am I hungry? Okay, I'm thinking about, okay, how hungry am I? What do I want to eat? That's that next step. What do I really want?

Speaker 2: 29:53

I think of it like a pegboard. Really, I was visualizing okay, you've got this pegboard. Each day you need to fill up. You need to get enough to eat first, right, everybody that's the main foundation of eating is getting enough, whatever it is. Human body is really resilient. We can eat a whole mixture of foods. Doesn't have to be perfect, but then you need to get, you know, carbohydrates, protein and fat, but also the other pegs in that pegboard. We need to fill up.

Speaker 2: 30:17

Is the enjoyment of food? Right, because you can be hungry, you can be full, but if you're not satisfied and enjoying what you're eating, you're not gonna be done eating. Sometimes I'll use the example of, you know I could be really starving, hungry, and then if I have a great big bowl of boiled potatoes to me, it was not very satisfying, I really wouldn't like that. But if I ate that big bowl of boiled potatoes I'd be full. But I wouldn't be done looking for food. I would not be satisfied because those pegs in the pegboard for what I really wanted to eat was not fulfilled.

Speaker 2: 30:51

So people getting into that switch to say what really makes me happy, what do I want to eat. And it can become like almost like a dance throughout the day between okay, am I hungry, yeah, I'm hungry, what do I want to eat? Going something sweet, salty, crunchy. And if you get to choose each time you're hungry based on what sounds good, then it's kind of fun. Well then, okay, if all foods are available to me, then what do I want next? And then, when I'm full, stop. Then next time I get hungry, what sounds good now, and that being able to tune into that is really. It's rewarding, rewarding for people.

Speaker 1: 31:23

The other question that kind of comes up a lot with that intuitive eating piece and just honoring what your body wants and needs in the moment is well, how do I plan for that? And I don't think you give meal plans but also, how do you make a grocery list so that we're only going to the grocery store once a week, so that we're not going every single day and still have things on hand that we like to eat?

Speaker 2: 31:51

Right, and I think it's about being flexible too, knowing that not everything we eat is going to fill all the pegs, peg holes. It's okay sometimes we eat something and we're like, oh, that was okay, but it wasn't really what I wanted. But then, if I'm allowing myself that next time, well, maybe I will choose something. Maybe then I want some chips or something later. I don't know. But to plan for that, as in feeding your family or as in having foods on hand, it may be meaning keeping a variety of things. What if we want something crunchy and savory and maybe we want pizza? So we keep things on hand to make pizza, maybe it's. Sometimes we want something soothing, like pasta. Well, maybe we have some of that on hand. And then maybe there's other things, like light things, like salads.

Speaker 2: 32:39

And also I want to impart when I'm even saying that that that's a privilege too to be able to purchase things that are variety and are helpful, and that many of us don't have that option. It's only what our budget will allow, and then we just do the best we can. And again, that first level of healthy eating is eating enough. So I use the example a lot that sometimes you'll see a sale for Jack's pizzas, five for $10. If that's where your budget allows, then that's what you buy, because the first thing is getting enough and then adding in things as you can canned fruit, frozen vegetables, if you like those. It doesn't have to be perfect, right. The first thing is getting enough to eat.

Speaker 1: 33:32

I think that's really good advice. I hope a listener, if not more listeners, can kind of find some relief in that of like, oh, I don't have to be perfect. No I don't have to have everything fresh. Holly said it's okay to eat Jack's pizzas if that's what I can afford and that's what I like Right and if you like that, yes, yes.

Speaker 2: 33:48

I like Jack's pizza. Me too I used to be a big fan of Chotino's.

Speaker 1: 33:53

That's what got me through undergrad. Yeah, I think they changed the recipe. Either that, or I'm just eating more mindfully. They don't taste as good now, ah.

Speaker 2: 34:05

And it was a totally different experience at that time too. Like you said, they got you through undergrad. They were a comfort and a friend, they were reliable, they were a comfort and a friend.

Speaker 1: 34:14

And they also were dirt cheap, cause back in those days you know that was like 20 years ago they were less than a dollar Right, so I would go and I would go to the grocery store when they were on sale. So they were even cheaper than less than a dollar and I could have one of those and it would fill me up for the rest of the night and it was good.

Speaker 2: 34:31

Right, right, and that's perfectly fine. There's nothing wrong with that right. We so much judge food choices and our worth based on what we eat, and that's wrong on so many levels. Wrong in that there's nothing moral about food, there's nothing moral about it and that it's a privilege to be able to have access to lean meats, fresh produce and whole grains, as nutrition information would lead us to believe is the only way to eat. That's a privilege and that's not a necessity. There's many ways of eating, many paths of healthy eating.

Speaker 1: 35:09

Yeah, and there's no right way. No, there is no right way, demonstrated by all the cultures in the world that all eat differently, and I just want to apologize to all the other perfectionists or recovering perfectionists out there. Sorry, there's no right way. You just gotta figure out what's good enough for you.

Speaker 2: 35:27

Right and that's a hard, hard thing to accept sometimes because, especially with people who are very heavily into disordered eating, it does scratch an itch in our brain. You know that. Okay, this is right, I'm doing this the way I've been told by someone is perfection or is right and moral again, that judgment and there's so many other ways to feel safe and to feel confident besides what we eat and because when we start to mess with what we eat, it creates a lot of other problems Deletion and that cycle, yeah.

Speaker 1: 36:05

Yeah, let's shift gears and go into more of like a lightning question round, sure, and then I'll see if that triggers anything else or there's anything else that you want to make sure that the listeners know we're here before we can completely wrap up. So, and these are all coming from questions that have been emailed to me from listeners from the show, people on my Facebook group, social media so, sure, the mess. They are Okay. So how can someone find dietitians for referrals, whether it's in Iowa or across the States?

Speaker 2: 36:41

So if you're looking to work with a registered dietitian which I would recommend, if you have, you know, any medical conditions or suspect you might have an eating disorder working with a registered dietitian, you can go to eatrightorg which is ironic that that is the name of the organization that credentials dietitians, eatrightorg and you can find access to dietitians in Iowa. If you're looking for help with disordered eating, the eating disorder coalition of Iowa has a provider's list for both therapists, counselors and dietitians, and there may be some healthcare practitioners that work with eating disorders, so that's a good resource as well.

Speaker 1: 37:26

Yeah, I will put links for both of those in the show notes so that you don't have to write them down real quick if you're walking or driving right now. So this is a good question on so many levels. How do we pick a dietitian that will be the right fit for us?

Speaker 2: 37:39

Oh, that is a good question and I think it just depends on most dietitians if they're working in private practice or for a clinic or anything will allow you to have a phone call first to and I do that with all new clients. We'll do like a 15 minute if you'd like phone or video chat just to talk a little bit about what your goals are, what you're hoping to work on. Most dietitians and I would share what my philosophy is, how we would work to achieve your goals and then I think you just know whether it feels like a comfortable situation to you and definitely if it's uncomfortable, then that's not a good fit and that's a good sign.

Speaker 1: 38:19

Let's find somebody else. Right, exactly, find somebody else.

Speaker 2: 38:23

And not all dietitians are the right fit for all clients.

Speaker 1: 38:27

And same in the counseling therapy world. We can know it and finding that practitioner, whether it's a dietitian or a counselor or a primary care physician, who, personality wise, you click with, is instrumental in healing.

Speaker 2: 38:44

And that is the same with healing relationship with food and competence in eating. Yeah, there has to be somebody that you feel connected to, because that therapeutic relationship of somebody's going to guide you in making changes in something so normal yet personal, which is eating. You know you want to have a good connection.

Speaker 1: 39:03

What are the typical costs and can insurance be built?

Speaker 2: 39:08

They vary from dietitian to dietitian. I don't take insurance. My business is private pay. Most dietitians in private practice to my knowledge are private pay because insurance doesn't typically reimburse dietitian services and that is a whole another advocacy and legislative issue. However, some insurance companies do cover dietitian services, so probably a third of my clients do have benefits through their insurance. I provide them with a super bill, they turn that into their insurance and they do receive reimbursement for their sessions.

Speaker 1: 39:43

So if you're listening to this and you want to work with a dietitian, would you recommend calling your insurance plan and asking if they cover dietitian services.

Speaker 2: 39:54

I would recommend calling and asking what my benefits are for registered dietitian services and it may make a difference. If a person has a diagnosed eating disorder, then coverage is better. Right that your company may say if you have a diagnosed eating disorder, if your doctor has referred you because it's medically necessary, then that service is covered. A lot of insurances will cover for diabetes Medicare. Does so many insurances follow that?

Speaker 1: 40:23

Do they ever go to people's houses or to the stores with them to help them the word is clean their food supply and teach them more about food selection?

Speaker 2: 40:36

Some dietitians do and that has been an area of dietetics that would be more like. It's not the type of dietetics work I do, because I don't think any foods are a bad choice. So I would not be asking you to clean out your cupboard. But it used to be that and some dietitians still do, especially if they're focused on weight loss, which I did not work on intentional weight loss. I work on normalizing weight through improving your relationship with food right, naturalizing your body's weight.

Speaker 2: 41:08

But some will go into your house clean out your cupboards with you say get rid of this. All the bad food, air quotes again, and so you can't have chips in your house, no cookies. Well then, what is the first thing that you're going to want tonight? Or install the chips and the cookies are gone. Normally it's going to be chips and cookies, so that can be a short-term fix. There are dietitians who do that and I'm not impugning with their work. That's another way of practicing. So, yes, you can. At some grocery stores there are dietitians on staff that will take you through the store and help you shop and find foods that fit what you're looking for Dietitians who are helping clients make peace with food or improve their relationship with food. Don't do that.

Speaker 1: 41:52

The last one for this lightning, which isn't very lightning, but that's what we're going to call it. What role do dietitians play in helping a client with meal prep and?

Speaker 2: 42:00

again, it would depend on the type of work you're doing with the dietitian. Okay, so I can tell you, with my work with clients, we would talk about meal prep from how it would help you in achieving your overall relationship with food. If, when you get home from work, you're starving and nothing is ready and you're stressed until you grab a bag of chips and sit down and because you don't have anything ready, then that's a step in that chain of events, right To go from being starving, feeling deprived, to eating a bag of chips. That's a step we can intervene on. Say, okay, what would it have been like if I would have had a couple of meals already in the refrigerator? Would I have eaten one of those and nourished myself with that, and would I feel better?

Speaker 2: 42:40

Okay, we would talk about meal prep from. What does it do for me? Not that, oh, you must meal prep, because that's what so-and-so on Instagram shows is meal prepping so that you can be the size. That's a little different, but how can it help you with being prepared to eat, with nourishing yourself and feeling better? So we will talk about then. Sometimes people are starting really at square one with eating and don't know what am I gonna make, and so we would talk about some simple things. To get started, what are some protein foods that you like, what are some carbohydrate foods you could have with it, and it could even be something as simple as Jack's pizza and a can of peaches, it just depends.

Speaker 1: 43:19

I love that philosophy of looking at meal prep as more from a place of self-care rather than a meal plan that I need to follow to make sure that I get all of my calories and all of my macronutrients Right and check all the boxes and do it right.

Speaker 2: 43:37

Yeah, that is a box to be put in right To say that this is how I have to eat, that this is what I need to do, and that just does not work and is not necessary and is not what we consider healthy eating.

Speaker 1: 43:49

There anything that's either come up that you wanna touch a little bit more on, or is there anything that we didn't touch on that you wanna make sure the listeners know before we leave?

Speaker 2: 43:59

Well, that's a good question.

Speaker 2: 44:01

We talked about so many things and I really appreciate your podcast and the issues that you're bringing forth and the conversation today.

Speaker 2: 44:07

I would just say that a lot of times I start to work with people who had a really adversarial relationship with food in their bodies for years and they feel like this is me, this is my failing and this is never gonna be able to change.

Speaker 2: 44:22

And that's not necessarily true. I wanted to say that's not true. I believe that's not true in all the cases. I have worked with people who have had severe eating disorders for over 20 years and they're able to make peace with both their body and food again and to be able to eat all foods. And that with that, as you mentioned before, looking for advice and information in places that are credible and not taking all of our information about nutrition and how to eat from anyone else other than knowing that you're the only expert of your body and what you need, but also knowing that you may need some guidance in reconnecting to that. And what does that look like? And I think about work with eating as really reducing the chaos around eating, the noise in your head, the negative thoughts and then putting back the pleasure of eating as a form of self-care and really just peace and confidence again. So it's possible for everyone.

Speaker 1: 45:22

When life's too short and tastes too good. Do not enjoy it for the time that we're here, Absolutely.

Speaker 2: 45:31

And then it's supposed to taste good. It's supposed to be good and the feelings that we get from eating and enjoying food, which can be connected to shame now are really supposed to be connected to pleasure and the chemicals in your brain that are soothing and that make you happy.

Speaker 1: 45:48

Yeah, it's supposed to yeah. Biologically it's meant to yeah.

Speaker 2: 45:54

From the moment of birth. Food is supposed to make you happy, calm and comforted.

Speaker 1: 45:59

And I think that is just a beautiful way to end it. So, holly, thank you so much for coming on. It has been a pleasure and I really hope that the listeners get a lot from this episode.

Speaker 2: 46:10

Thank you, sabrina, thanks for having me. I really enjoyed it.