How does the non-diet approach meet competing as an athlete?

By Jen Pfeifler APD

In the world of sports nutrition and traditional dietetics, the first thing you might notice is how many times grams of carbs and protein or amount of calories need to be consumed each day. Tack on exercise at an intense level multiple times within your day, and you have now committed yourself to paying a WHOLE LOT of attention to food in order to 'get it right'. Now, this isn't to say that what you've been told to do is wrong, or won't work. In a lot of cases it does work. In fact, It works REALLY well.

However, what works really well for some, can be disastrous and/or dangerous for others. What I want to emphasise to athletes who are committed to performing at their very best, is that you DON'T have to obsess over food to 'get it right'. As a previous elite athlete myself, I totally understand there are SO many other things that need to be thought about like, oh I don't know, training schedule, planning competitions, entry fees, grocery shopping, and laundry (it's actually insane how many clothes we go through in a week), when to taper training, training in relation to performance and fine-tuning skills prior to game day, just to name a few. Adding in another HUGE component like timing of nutrition up to 6-7 times a day can start to wear on you. I acknowledge that there are people who are able and do actually enjoy having a detailed nutrition regime, however if placing your nutrition under a microscope daily sounds like it would impede on other areas of your life, there are alternative ways to fueling yourself well (perhaps even better) and performing that don't involve obsessing over food.

Developing and maintaining a healthy relationship with food is vital to your overall health and success. It may seem like eating perfectly and training intensely is the secret to winning and while nutrition and exercise are certainly important, they are just two of the components involved in overall success and fulfillment, and they certainly don't have to be perfect or intense all the time. The other key components involve sleep, mental health, confidence in your skills and your body to perform, and support networks. If these aren't in place, it might be time to put some of your eggs in these other baskets.

Research has suggested that athletes are at in increased risk of developing an eating disorder. Athletes who participate in sports that emphasise a certain body composition (gymnastics, dance, swimming, figure skating) or weight (running, triathlon, weightlifting and rowing) are particularly at risk (Beals, 2004). Eating disorders are only growing in prevalence due to diet culture and the traditional 'skinny equals healthy' mentality. There has been much shift in recent years, with the Health at Every Size (HAES) movement developed by Fiona Willer. In recent years, more and more high profile athletes are speaking out to raise awareness of disordered eating and the numerous pressures on athletes. For example, U.S. Olympic swimmers Amanda Beard, Misty Hyman and Maya DiRado, have outwardly spoken to USA Today about disordered eating among swimmers, stating their struggles and how prevalent they are among their own friends and teammates.

So where do sports nutrition and food freedom collide? This is where a non-diet dietitian who specialises in sports nutrition can help you improve your relationship with food and performance by working with you as an individual. Non-diet dietitians are useful to work with to develop strategies that are easy to implement, realistic for you, and don't involve counting each micro and macronutrient. Investing in this process can be valuable in gaining emotional freedom and the assurance you are hitting your requirements, despite not counting or calculating your intake. Athletes have so many things to think about, food doesn't and shouldn't be the main one.

References: Beals KA. Disordered eating among athletes: a comprehensive guide for health professionals. Champaign, III: Human Kinetics, 2004

The In-Between Ground

Published by Jen Pfeifler APD | Written by a client ready for recovery 24.10.18

The not so commonly discussed part of eating disorder recovery

I don’t want to write a story proclaiming ‘how I am now’ compared to the sick, undernourished girl forced into hospital and intravenously force-fed. That sentence alone gives enough of a background to display the stereotypical view of eating disorders that is all that is often seen through news stories and social media. Not to say this isn’t important – eating disorders can be life threatening and that fact cannot be emphasized enough for those with loves ones in imminent medical danger! The other end that is talked about is the after stories. How life has been reclaimed, and how worth it the struggle of recovery really is. But somewhere along the way, the middle stories are silenced. The journey’s that have are still going – that aren’t in the place of relapse or severity but also haven’t reached that wholly grail of ‘recovery’ (what is this anyway?) And let me say – this middle ground is probably the most interesting – as convoluted, painful, sometimes triumphant and very, very MESSY as it is.

When you first enter into the world of eating disorder treatment – whether you go my route (the road of ‘wholly crap what the hell is going on’ – not recommended), or come to the realization of needing to change (which needs to be acknowledged as an incredibly brave) it is inevitable that at some point the ‘stages of change’ shall come up on the agenda. In other words you go from the benign sounding pre-contemplation (i.e. nah guys I’m fine), to contemplation (i.e. I hear ya – but I’m good) to preparation (ughhhh nooo – do I have to?) to action (crap, crap, crap wth am I doing?) and then the magical maintenance phase (or in my ‘not quite there yet’ world – sitting juuusssttt recovered enough to not cause too much fuss). Nice and linear and structured – ED fairyland would love it!

But I don’t like it! In my experience, the first stage is just about right – denial, fighting and a bit more denial. But then - imagine one of those knotty cotton balls – the ones you have to unravel to do anything with. You can almost always find the ends – they sit there, tantalizingly ready to use… if only the rest of it wasn’t such a damn tangle.

The first part is hard – that’s the bit usually talked about. It’s different for everyone, but for me it was terrifying! I had been blackmailed into seeing a Dietitian for a few months before everything fell apart. She quite clearly knew something was wrong – I was defending every dietary choice I was making, and trying really hard to stick to her plan whilst also losing weight. So, I got told to see a psychologist – who told me to see an eating disorder specialist doctor. My first trip to Dr Barron’s office did not go so well – in fact, it ended up with an ambulance. Hospital, weight restoration, tears, and a belief that all was food bad and that all doctors were trying to make me fat followed. Luckily for me I have only had to go through this horrible ordeal once - trust me, one time being fed through a tube is enough.

The years since have been painful, but also beautiful. If life in the depths of an eating disorder is a blank slate – numbing and cold and calculated as all feeling is numbed by rules, regulations and how many grams/calories are in that cup of raspberries – then the in between of recovery is one giant storm. Calm winds, followed by lighting striking at random intervals, thunder, and sudden downpours of rain.

After deferring my Engineering degree due to hospital I really did not know where I was going. So, I enrolled within my current Psychology degree – and I am so glad I did. But beginning University again whilst in recovery, and still very much stuck in an extremely rigid and perfectionistic headspace can get interesting. Especially when life outside of recovery generally doesn’t just sit there nice and pretty waiting for you to get well. I went the entire year determined to ‘live life’ and ‘move on’, but cannot even count the number of Doctors visits that year. I learnt so much over this time though, about what the body ACTUALLY needs, that maybe this process of trial and error is something that was necessary. Proofs and expertise were presented at every step– my doctor picking up on worsening ECG’s (miraculous machine’s measuring the heart’s structure and function), blood pressure drops and rapid increases in heart rate (postural tachycardia) when I decided to listen to what ‘I’ (ED) wanted to do. My Dietician informing me that ‘more exercise’ = ‘more food’ – and what this should look like. Cognitive supports – techniques to counter the thoughts that come up every day, every meal!

I thought that I would be completely recovered by the end of 2017 – this recovery journey is meant to be done in about a year right? So, I booked to climb Africa’s highest mountain – Mt Kilimanjaro. Unfortunately, life stepped in between in the second half of that year. I had been struggling to move forward medically throughout 2017, and stress has always been my Achilles heel when it comes to getting stuck in recovery. Although living out of home, family difficulties were still very much getting to me and despite being frantically busy I was determined to ace the academic year. It was an environment that my ED loved – it encouraged rules, and striving towards being ‘perfect’ in the crazy world I found myself in. Too bad the body doesn’t really work this way – and the behaviors that go along with this led to being medically compromised again. Three emergency visits in three weeks convinced me I needed more help – so I agreed to do an intensive outpatient program over summer. I did not even know if I had got in when I had a call – I wouldn’t even have the chance for a place unless I did not climb Mt Kilimanjaro – it was just too dangerous (I had been ignoring my doctor telling me not to for a month at this point).

I was devastated! But I agreed to defer my climb for 6 months, and ended up getting into the program. It was one of the hardest, and most painful experiences of my life! I had to stop dancing– one of my greatest emotional outlets through the turmoil and something I love! This was terrible for me (and according to those who know – I was one cranky person)– especially whilst being challenged emotionally every day, but it is something I know that my body needed and I went back when I was medically stable with more passion and motivation to than before.

The program has been one of the best things I have ever done. Through it I learnt so much about myself, and different ways to think and be. I appreciated that societies ideals of body and appearance are complete crap too – does it really matter that you look perfect if you are miserable and hate where you are in life? Nope! Does that make recovery any easier? Nope! Eating disorders are just a little bit more complicated than copying magazine articles stupid advice, but appreciating the disconnect between appearance and health is pretty important. More than anything though, I met the most amazing group of people – and I thank every moment that they have chosen the share their stories with me, and be such a big part of mine.

Since then, I have climbed Mt Kilimanjaro – and it was incredible! I got to the top and burst into floods of tears – all of the fight, and struggle and fear of not being ‘well enough’ and I was on top of the world (well, Africa). It was one of the most beautiful moments of my life – and it was full of pain. I was overcome by the struggle that had gotten me up that mountain. And with that came one of the greatest rushes of pride and joy that I have felt. I still have trouble accepting feelings – most people do, and eating disorders are just one way that develops to cope. But this moment helped me to see what it may be I am fighting for. Maybe feelings are not something that has to be pushed away.

The trip didn’t come without a cost. When you spend your life eating to a clock and not trusting bodily cues, such a schedule change means that things can go off quite quickly. More than ever I needed my team’s support when I got back – despite wanting to push them away.

At the same time, I have so much education and knowledge; it is much harder to slip back to where I have been before. Not saying things aren’t still hard– but I find it a lot harder to convince myself that what I am doing is ‘fine’ when I have every piece of information possible to tell me that it’s not. The ED digs it’s claws in, but it’s no longer a safety blanket – it’s just some sort of leech that I can’t shake. The thing is, eating disorders just get sneakier the more you know and change. Yes, I now know a lot about nutrition! My eating disorder also knows exactly how I can use this to sit on the fence without getting too medically unstable. I still have to think ‘is this too much food’ and deal with that – but also can calculate exactly how much of what is needed to keep my body well enough, and my eating disorder happy enough to straddle the middle ground.

With this I’m still numbing. We all do it – try to get rid feelings of inadequacy, and pain, and worthlessness. But at the same time I can’t be pushed out of the comfort zone by being in intense treatment because there are places I just don’t fit anymore. Don’t get me wrong –support is still there, and is still needed! But the step to jump – to make the decision to fight past what keeps me ‘just well enough’ has to be one that is made myself – and if that’s not terrifying I don’t know what is. I know I’m not writing as a person who has fully taken that leap and can tell you ‘how worth it’ it is. I’m still kind of dipping toes into the water and figuring it out. But no matter where the journey takes me –it shall be real. Life is hard, and it can have thorns the size of swords that like to cut you open if you turn the wrong way. But it’s also incredibly beautiful and can be amazing, and breathtaking – and I have no intention of missing out on that.

Is going vegetarian as healthy as it's made out to be?

By Jen Pfeifler APD

3 reasons why it may not be right for you

In recent years, there has been a big shift in eating more plant based. This shift in thinking can be contributed to a few reasons- health, animal rights, and environmental sustainability. These are reasonable reasons to decrease the amount of animal meats being consumed, however let's take a look at 3 reasons why you may not want to completely forgo animal based foods all together.

No. 1: MENTAL HEALTH

As a dietitian working in eating disorders across clinical diagnoses, subjective disordered eating, and amongst athletes of all levels, I see first hand what can develop when a simple new year's resolution diet starts, or a 2 week detox is underway, or trying to shed a few kg's to enhance performance in their sport.

The thing is, dieting is THE #1 RISK FACTOR for developing an eating disorder. You also don't get to choose whether you will develop one. In the past few months, new research has suggested the metabolism gene to be a huge factor in developing an eating disorder. You can read the article here. This is a huge movement to breaking stigma and is a step forward for health professionals in learning how to recover people quicker. If you are thinking about going vegetarian, ask yourself why? Removing food groups comes at a cost, and will always mean there will be an increased focus on food. If your 'why' is to lose weight, or become healthier, this may not be the answer. Talking to your dietitian can be a really great way to help you navigate through this.

No 2: SOCIAL ISOLATION

Becoming vegetarian, unfortunately will close some doors for you. Social situations will now become much more challenging. Christmases, birthdays, summer BBQ's, dinner parties now have a chance of becoming more stressful. Celebrations of all kinds, are meant to bring people together as food is part of our culture as human beings. Relationships, memories and emotions are all apart of these experiences. Being a vegetarian can hinder your relationship with food, and actually make you resist going to social gatherings due to the inflexibility it promotes. Human connection is vital for our health and well-being. If you find yourself becoming stressed with what foods will be at a party, or start to resent social gatherings, being vegetarian may not be for you.

No. 3: NUTRIENT DEFICIENCY

Ironically, while decreasing your intake of red meat has been headlined as being healthful due to the increased risk of developing some cancers, it can also cause some nutritional deficiencies which WILL NOT be healthful. These deficiencies are iron, B12 and the latest evidence now on choline. These nutrients each play an important role in the body. Iron is needed for binding oxygen to your red blood cells to be carried throughout the body, ultimately giving you energy, B12 is a co-factor for metabolising carbohydrates and is needed to produce these energy molecules and choline is vital for brain and liver function. The recent trend in going plant-based, now means these nutrients will be sacrificed to varying levels. I will state that it is not impossible to get these nutrients as a vegetarian, it just means you will have to pay more attention to the foods you eat and/or supplement. As easy as supplementing is, it isn't always the most healthful thing. Supplementing can be fairly expensive and more importantly, means you aren't meeting your nutritional requirements just on eating foods alone. If the reason for going vegetarian is to become healthier, this may not be the answer.

What do I recommend? The phrase that I like to keep reminding people is the old saying "Everything in moderation, including moderation." As boring as this lifestyle is, every fad diet that has popped up and trialed, is seen to fail time after time. Whether it's due to being unsustainable, results in nutrient deficiency, or just simply drives you crazy, eating a variety of food, at regular intervals, with the ability to be flexible and social is a really positive behaviour to adapt to encompass all baskets of health and well-being.

Lastly, I would like to say this article is written with an average, healthy adult in mind. If you have chronic conditions or have been told by a health professional to alter your diet for medical reasons, this article may not apply to you. As always, if you are unsure, please talk to your dietitian before altering food groups!

Recovery vs. The ED

Published by Jennifer Pfeifler APD | Written by her sensational client going through recovery

Which one do you choose?

The fact that many aspects of recovery mirrors the everyday ED dialogue strikes me as kind of ironic. I have often found the critical voice that I have found through this process mirrors the critical voice of my ED so closely that I sometimes get confused which one is shouting at me. Typical dialogue of recovery can sound like this:

Me: “I’ve added nutrition – it was a really hard thing for me to do and I struggled, but I did it because I’m dedicated to this process and want to be well.”

Recovery: “This isn’t good enough – your heart is being incredibly tachycardic, and your blood results are bad. Have you been exercising more? Going to have to stop right now if you want to avoid more intensive treatment”

Me: “But it’s is something I really love and need! Please don’t take it away – and I tried really hard to please you and do the right thing”

Recovery: “It’s not good enough – stop exercising, and we need to add more food”

Me: “So, I am restricting my activities (something I love), and forcing myself to do something that I know is going to make me feel like crap about myself? All for the promise that it shall all be better one day?”

Recovery: “It’s all part of the process”

When juxtaposed with the dialogue of an ED, there are way too many similarities to ignore.

Me: “I’ve tried really hard to cut down on food. And I’ve started doing extra exercise and compensating for more – this must be making a big difference”

ED: “Honestly, this is not good enough! You have only lost X amount – going to have to step up the effort here and stop resting during the day to burn more or you are going to get lazy and fat”

Me: “But I really need to let myself go for two seconds here and there. Please – I tried really hard to please you and do the right thing”

ED: “It’s not good enough, in order to be better you need to cut down more and work harder”

Me: “So, I’m pushing myself to eat less for a hope that I may make these bad feelings go away and feel ok about myself for a bit? Despite the fact I’m exhausted right now?”

ED: “It’s all part of the process”

See the similarities? The constant roadblocks, frustrations and proofs that your body is ‘struggling’, or your behaviors are ‘worrying’ in recovery leads to just as much of a dialogue as does the constant roadblocks and frustrations in the fruitless attempts to get ‘thinner’. Only this time, you are also meant to deal with the emotions that hit like a truck in recovery due to no longer being able to numb them out. Maybe this makes it a little bit more understanding why there are so many bouts of ‘I just can’t do this anymore’ and ‘screw it, this doesn’t make things any better I’m going to do what I want’. But then the whole cyclic and never ending cycle starts up again when you finally seek relief through behaviors only to find that medical problems can get worse, and health professionals are pushing to get you back onto the recovery road (either through reasoned argument or hospital).

This never ending and exhausting cycle has led me on many occasions to pull my hair out and want to run away screaming that I will never see another health professional or worried friend ever again. The very act of being in recovery, though, usually means that as soon as you try to turn your back for a few minutes on the process you realize how much you actually can’t do it alone.

You now have all these crazy emotions – what on earth is that all about? Your still a newborn child when it comes to coping with it – may need someone to help you through hey? Or, I know that what I am doing to my body is wrong but I’m also exhausted and can’t do this eating thing anymore. The internal shouting match and anxiety attack every mealtime is getting too much to deal with, so can’t make those decisions for myself right now! Sigh – guess I am going to have to listen to that doctor and dietitian because I just need that safety net for my own exhausted brain to not completely break down into despair and return to the ED land, letting my body to slowly disappear.

As time has gone on I have begun to appreciate, rather than resent, the fact that there are people around me who care enough to pick me up when I am struggling. It is incredibly frustrating and sometimes painful when all that is wanted is to numb out whatever is going on in life, but it keeps me safe and well enough to live life when things start to improve again. I think that’s something that relapse or reverting completely back to the blank world of restriction would not allow. Yes, it would help me through that tough time – and I may begin to feel better for a bit. But what about when suddenly, a new job crops up, or I want to try something new or have the hope that things may be changing for the better? Instead of just being able to say ‘hey, that was a pretty crap time – this may turn out to turn it around and be pretty cool’ I would be stuck with a brain that goes ‘nnnnnnn (*static noise*), no food allowed – this feeling of floating and numbness is fine the feelings that come with food would be too overwhelming.... nnnnnnn”. And I would also probably be in hospital. Fun! (Not).

Also, being picked up again, and again has allowed me to slowly begin to see that maybe the ‘recovery’ voice is so similar to the ‘ED’ voice because it has been warped to be the same. Every person has some sort of an internal critic – and just because suddenly you are now in recovery does not magically change the way that you talk to yourself. This makes it incredibly easy to not see why getting exhausted and losing motivation in recovery is so easy. What are we working towards? We don’t understand how this shall ‘make everything better’ - the voices still yell, the emotions are worse and recovery is something that is being failed just as much as the goals of ED were failed.

I am master at convincing myself I am doing everything recovery is asking of me – eating that damn food, trying to do what the team asks, and then getting frustrated and demotivated when things never seem to move. Then, when something happens in life that seems difficult to deal with it’s just a little bit too easy to revert to what works.

I hate to admit it considering how blooming hard it is, but instead what else could be said? “I’ve had a really hard day today, and food has been difficult, but just because this is difficult for me does not mean that I am a bad person or not good at recovery”. My favorite at the moment is “shut up critic I’m having a really bad day and you are not making it any better – get stuffed!”.

The problem I have found, though, is that often restriction (sometimes for safety’s sake) has got to be met with restriction. Instead of telling myself that I wasn’t allowed to rest, or eat then I often found myself in a situation where I was being told I wasn’t allowed to exert myself too much – needed to be checked in with, and treated with suspicion. I get it – I really do! There really is no other way sometimes, and this was done all in the name of safety and care. But at the same time – for those with this freedom taken away, then there has to be an appreciation that it is a process of deprivation, whether it is required or not. And through this understanding, appreciate that in some ways, treatment itself may actually be reinforcing these negative restrictive patterns for some time. I don’t know a way around this yet – if someone needs that support then it can be the only available route – but it is my belief that acknowledging that this IS a flaw in the process is important in continuing to improve our outcomes.

Long term – freedom is needed! It is the only way to break that restrictive and punishing pattern. Mistakes probably will be made – and support is needed when inevitably this happens to help catch it, put in healthy boundaries - and put up with the tantrums. I hate to liken this journey to being a child with it simply because I don’t want to reinforce the idea of being ‘sick’ or needing ‘handling’ - but the process of letting go, but being a stable base is a good metaphor for those who have people in recovery in their lives so I’m rolling. I have never had to worry about judgment with the incredible people I have been lucky enough to have help me anyway. It is so incredibly important to have those people – treating team, friends, or family – doesn't matter. Non-judgmentally allowing life in recovery to be experimented with, and lived – but there to help when falling is so important. Not just for those in recovery either – every person has hard times, and needs help sometimes – and giving help often facilitates care and support in return. I hope that I have the opportunity to give as much back to my friends and supports as they have given me. If an eating disorder is lonely and cold and calculated, then allowing this to happen is colorful and bright and raw – and in such is the complete opposite. And makes it just that bit easier to fight back against that dialogue!

Carbs and Your Mood

By Jen Pfeifler APD

Can the amount of carbs you eat influence your behaviour?

Paleo. Low-carb. Keto. Clean Eating. No sugar. Carb free. These words are everywhere in today's culture. You've probably dreamt at least one of them this month. They are so common, they play into our subconscious. What are they and why do they exist? In essence they are another term for a diet- a way of eating that lasts for a little while until you can't take it anymore and your body rebels and before you know it, you've taken over the buffet table at Aunt Barbara's birthday party. Although you curse yourself for having such poor will power, you actually just behaved in a way that's perfectly normal. You listened to your body screaming for you to give it the nutrients and energy it needed. These diets exist because businesses advocate for them. Our diet culture embraces them. People make money- industries thrive off of them. How? We let them. Our diet culture feeds on our vulnerability to be better, to look better, as if we aren't good enough the way we are.

Let's take a step back to the part where you were on one of these idolised diets. Did you happen to notice your energy level? What about your patience? How many times did you lash out at a friend, family member or stranger during this time? Perhaps you felt sadder than normal. Did you notice any changes in you sleep pattern or increases in restlessness? What about the number of times you thought about food, cooking or your weight? If these questions triggered something within you, you aren't alone.

Much research has gone into solving this dilemma. Old and new research still demonstrates that carbohydrates are pivotal molecules of energy for our wellbeing. Pederson and colleagues highlighted that adequate carbohydrates are needed for immunity, particularly if exercising frequently. Mood disturbance was also seen in dieters, resulting in a dysphoric mood, increasing the risk of eating disorders (Leon and Chamberlain, 1973).

I get the whole concept of "strive to be the best version of yourself" philosophy, but his shouldn't have to mean that we need to change our looks or our weight to achieve that. To be the best version of yourself involves ALL the food groups. Time after time again, dieters end up bouncing right back (about 95% of the time, in fact) to including all five nutritious and functional food groups plus what I like to call your 'pleasure food group'. This food group exists because we are human beings who have thoughts, feelings and emotions. Science is fundamental, and it's led us to what we currently know, however science doesn't encompass everything involved with being an individual human with drastically varying personalities, stressors, and genetics. There are times where you just NEED to have that food that makes you happy. If you stress over eating that chocolate bar at your best friend's graduation, wedding or birthday, chances are that stress has a larger negative impact on your health than just eating it would. After all, chocolate is food. It is made up of carbs, protein, and fat and even some other vitamins, like magnesium. I could go into what each of those macronutrients are used for, but my sense is you already have a pretty good idea of what I'm getting at.

Just to make my point even clearer, more and more research has come out identifying a lot of cofounding factors have been ignored. For example, numerous studies (13 if you want to get specific) from a very highly acclaimed researcher and professor at Cornell University, have been revoked from the literature due to inconsistent methods, and cherry picking of results (Resnick & Belluz, 2018). This means some of the reporting and data collected have been tampered with in a way that favours the wanted outcome. NO GOOD. Other studies have been identified that disordered eating and eating disorders have not been accounted for when conducting studies dependent on assessing energy consumption and blood testing. This would significantly impact results if some of the participants were engaging in regular bingeing, purging and restricting behaviours. Does this make you question if health really is all about obsessing about each and every macro and micro nutrient you put in your mouth? Because it should.

Resnick, B., & Belluz, J. (2018, September 21). A top Cornell food researcher has had 13 studies retracted. That's a lot. Retrieved from https://www.vox.com/science-and-health/2018/9/19/17879102/brian-wansink-cornell-food-brand-lab-retractions-jama

Why you should focus on timing of nutrients over calories and grams

By Jen Pfeifler APD

It's pretty common as a dietitian to get asked "what is my upper calorie limit? Tell me how much food I am allowed to have with the amount of exercise I am doing." The answer to this seems like a simple calculation. Traditionally, it has been. I want to detract a little from numbers and precision, and get back to the big picture. Let's have a chat about carbohydrates, protein and fat in a whole day's context including a 45 minute resistance training session, and why this matters more than getting the numbers right.

It's really easy to get caught up in fat, protein and carbs, the ratios of all of them and how much is too much or not enough. And to be honest, the majority of people I see aren't eating enough carbohydrates, and are eating way too much protein, despite the perception that carbs are the devil and 'the more protein I eat, the more fat I'll lose and more muscle i'll gain', kind of mentality. If this resonates with you, then keep reading. Better yet, come in for a nutrition chat, and let's get you on the track to improving fitness and strength.

If I've said it 10 times, I'll say it 100 more, just counting your macros and having them fit in your day is not the answer. Do I want you to eat all three macros? Yes. Yes I do. But it's less about making sure they all add up and more about having those nutrients fuel your body for what you are going to put it through during the day. Just to be clear, I still want you to eat during your off days, holidays, rainy days, moving house days, and work days. Restricting your calories based on the previous day's meals or because of what's about to happen later on tonight is not a behaviour that will end up getting you results in the long term. If this is something you find yourself getting caught up in frequently and finding it affects your mood and thoughts, let's talk about it.

Ok, so let's look at why timing is more important than tracking the amount. Our muscles go through a constant cycle of anabolism and catabolism. That's a fancy way of saying our muscles are in periods of building up and breaking down. With each meal that we eat, there will be a spike of anabolism or building up. This is good, because it gives us a chance to replenish, restore, and refuel are muscles, and cells. Our body also releases insulin in response to carbohydrates. This is not a bad thing, like it's sometimes made out to be. The goal is to have a combination of the macro-nutrients throughout the day to aid in keeping blood sugars steady throughout the day, and maintain muscle maintenance and ideally promote muscle growth. Fat is also necessary because it helps carry other nutrients in the body. It's also responsible for hormone production, organ protection and keeps us warm. When we consider resistance training, which is a major stimulus that would make the muscles break down, this is a prime and necessary opportunity to give them protein AND carbs to prevent any muscle breakdown further than intended when you walked into the gym in the first place. The amount of protein for muscle growth in one hit isn't your 40g protein shake that are promoted without any evidence to support it.

After a stimulus from resistance training is achieved, you are burning fuel up to 3x longer after your session than doing cardio, This means we want to support muscle growth hours after your session. This is why I always recommend dairy before bed. The composition of dairy (carbs + protein + fat) is superior in MPS (muscle protein synthesis) and will help keep you muscles from breaking down while you sleep, and in fact will contribute to greater muscle mass in the long term.

So rather than thinking about how much, think about when. Eat regularly throughout the day, more carbs before training, and carbs and protein after training and again at the following meals following training to support muscle growth, and prevent any binge eating that can occur if you aren't eating enough at other times of the day.

Need help with what that looks like? Book a dietitian appointment by calling 0481857362.

Is recovered life better than ED life?

By Jen Pfeifler APD

An attempt to give inspiration and hope to those struggling.

I recently asked a client this question "What do you struggle with the most on this recovery journey?" The response was immediate. "How is recovered life better than shitty ED life. I'm just struggling to know how it could be better."

Even though people with eating disorders refer to the 'ED life' as being horrible and..well 'shitty', it still has a very strong hold on their actions and mind set. NO ONE chooses this illness, I can promise you that, but the thought of getting across the line to the other side is incomprehensible, impossible, and scary AF.

I want to take this time to write my thoughts down in an attempt for you to see what your life could be like. It won't happen over night, nor will it be easy to get to this mindset. I KNOW this. I'm also a dietitian who has dedicated my time and energy into working with those struggling. Why? Because i've lived a bloody good life so far (with pain, heartache, struggles, and stress-but who hasn't) and I want people to experience what I had the opportunity to experience- but with your own passions and day dreams in mind. I believe you should be able to sit back with a cuppa or a bevy any day of the week and smile to yourself when you think back at all you've achieved, and experienced. Everyone's story is different, interesting and BEAUTIFUL. If you can't do that at this stage of your life. That's okay. It's NEVER too late to work towards that point.

So what does living and thriving on the other side look like? Imagine waking up and looking forward to breakfast. Looking forward to enjoying the taste, texture and feeling of fullness come over you. Imagine being excited to go on a date, or brunch with family, or catch ups with friends at a cafe or your favourite restaurant- even better a NEW restaurant. You don't feel the need to look up the menu to calm your anxiety, or feel guilty that you are going to splurge on a potentially higher caloric meal. The idea of trying new foods or a cappuccino makes you so happy (because its the small things in life that bring the greatest pleasure). Imagine being 'present' for conversations and interested in what your best friend has to say because you aren't secretly feeling paranoid that she/he is judging the shit out of you. Imagine feeling the anticipation of summer, in a good way though. The images that come to your mind are pool parties, drinks, and unicorn flotation devices that we all know and love. Imagine laughing, and singing all day long to your favourite songs while trotting around in a bathing suit- and not in a pretend kind of way.

Now think about all the Christmas's, birthdays, Thanksgivings for you North Americans, weddings, Uni or work functions. These occasions are actually really exciting and bring you so much joy and excitement. Having difficulty imagine that one? Yes. It's possible. Year after year. Imagine being comfortable in your body. Yess. Now this one is bound to bring up some emotions. I'll be honest, You will never ALWAYS love your body every single minute of every day, and if someone tells you that's possible, they are lying. We are human beings. We will have weaknesses, insecurities, and WON'T particularly enjoy looking at our bodies some days. That's also okay. Really. It's okay.

Now for the boys and girls graduating high school this year. If i've said it 100 times i'll say it 100 more, you are about to embark on THE time of your life. Youth is not a right. It's a privilege. It's a privilege that is taken from you in a blink of an eye. I want you to soak in this time of your life, because this is when you find yourself. You have these years to make mistakes, party too hard, play sports, (young muscles, strong bones and undamaged joints-praise!) love with all your heart, travel, find your passion, and explore what this world is all about free from rules and restriction. These moments along the way are completely overshadowed when you are living with an ED or disordered eating.

My wish for you is to live the glorious life you were given. To dance with everyone watching, to wake up ambitious to follow your heart. If you still are not convinced, let me ask you "What do you have to lose in attempting the recovered life? You know what your current life is about. What if there could be something far, far greater? Perspective, my darling, is a powerful thing.

ANA and I aren't working out anymore, so I think it's time I dump her.

By Jen Pfeifler APD

Eating Disorders aren’t just a ‘girl thing’!

During conversations at dinner parties, social functions, or in professional meetings, it seems that a lot of people think that the clients I see with eating disorders are females. In fact, nearly everyone is surprised when I say I have male clients too. Why is this the case? I like to think of it as a conditioned response. For so many years, eating disorders have been linked to females, particularly dancers, gymnasts and swimmers due to the high aesthetic concentration of their sport. Because of this, anorexia nervosa has been coined as 'the most common eating disorder'. It may be the most well known, but it certainly isn't the most common. In reality, people with anorexia nervosa make up a small percentage of my case load. The majority of people I see are individuals like you and me who struggle to maintain good relationships with food- INCLUDING men!

The latest statistics from the National Eating Disorders Association (NEDA) illustrates some trends- trends that are favouring an increase in eating disorders in both males and females of all ages. Did you know males represent 25% of individuals with anorexia nervosa, and are at a higher risk of dying, mainly because they are often diagnosed too late due to the common misconception males don’t get eating disorders? In fact, the prevalence of eating disorder admissions increased from 235 to 466 from 2010 to 2018 in England, Wales, and Scotland alone. Hopefully I'm not alone in saying that these increased admissions in the UK are absolutely astonishing and reflects how dominant our diet culture really is in all countries. Essentially, what i'm trying to say is eating disorders are not just a girl THING. It's a people THING. And it's OUR responsibility to acknowledge this condition and make it a well known THING. The more males and females that slip through the cracks, the harder it is to change. Eating disorders don't discriminate, but unlike other chronic conditions, those affected CAN ALWAYS recover with the right support.

This increase in diagnosed eating disorders is likely 1, due to the stigmatism beginning to break down, enabling males to be more open about what they are going through, and 2, the heavy use of social media and diet culture messages seeping into our subconscious. The newest non-diagnostic eating disorder now termed by some experts is called 'bigorexia'. Bigorexia is the most recent disordered eating condition in which young men and boys are obsessed with muscle definition and body shape. Just like anything there's a fine line between wanting to be fit and healthy with more lean muscle mass than fat mass, and being fixated on it. If excessive thoughts about food, exercise and body image are preventing individuals from going to social functions/activities, acting spontaneously and living their life according to their inherent values, than the sooner they can talk to someone can be the difference in going down a rabbit hole, and reorienting behaviours in a healthier, less stressed and rigid manner to prevent deficiencies, delays in development, and other compromises in health.

I think it's now time I tell you the story behind the title of this blog. I have been seeing a man in his early 60's weekly for some time now for treatment of severe anorexia nervosa (I'll keep this brief as to not trigger any readers). Through several weeks of listening to his story, and slowly piecing the parts of his life together (along with identifying his associated health complications) and numerous attempts of motivational interviewing, (I am far from an expert!) he walked in after a few sessions looking calmer than usual and stated he had some news for me. I asked him how "ANA" had been treating him this past week, which he proudly took a big breath in and exhaled as he firmly stated "ANA and I aren't working out anymore, so I think it's time I dump her". I'll preface this by saying I've been known to be quite enthusiastic and outgoing during my sessions. I jumped out of my chair with my hands high over my head and shrieked with happiness. I told him how proud I was of him as I reviewed his diet intake and compensatory behaviours, all which improved drastically. I was so speechless I couldn't believe the hard work he put in, in such a short time of working together. The following week, his nutrition intake doubled, and weight gain was consistent with recovery. Although we still have a long way to go, his story and perseverance filled me with pride and joy and confirmed that even though anyone can be a victim, there is always a chance to recover and reclaim your life.

This story is just one of many from the non-diet dietitians at River Oak Health who work specifically in the area of eating disorder/disorders. Hopefully I've at least planted a seed that may grow into changing your perception of eating disorders among males young and old. If you know of someone who might be struggling, it is OK to ask them if they are okay and raise your concerns. It is an emotionally exhausting and isolating condition. Your support goes a long way even if it doesn't seem like it at the time.

Feel free to contact us to talk through strategies to help your loved one, or dicuss which treatment option is right for you.

Disordered eating... Or not?

By Jen Pfeifler APD

Challenging situational eating vs eating with rules and rigidity.

There's some new kids on the block, and FIT is their middle name. Chobani yoghurt has released a new yoghurt range called Chobani FIT. Since I began working as a dietitian within the eating disorder community, plain Chobani greek yoghurt is usually what I see my clients choosing. Now that I think of it, it's the ONLY type of yoghurt my clients chose from the start. I identify it by the 'light blue one' description they gave me when discussing their daily diet. Some choose it because it's the 'healthiest' and some because it's the only type they think they are allowed to eat defined by our diet culture and the rules they have placed on themselves.

Now that Chobani is upping its game with a new type- actually labeling it "FIT", I have no doubt next year I will be hearing the phrase 'I've been having the kind that says FIT on it' instead. This particular yoghurt is labeled FIT because it is slightly higher in protein (15.5g) and has no added sugar- a selling point because for the first time you don't have to buy plain yoghurt to get the protein boost with no extra carbs. For those familiar with the YoPro brand- this is the Chobani version.

Now I have to admit, they are delicious. I LOVE yoghurt and certainly do not discriminate. In fact, I am eating one of the original Chobani yoghurts as I type (the lemon flavoured one with less than 2% fat to be precise). I had never tried this flavour before so I thought I would give it a crack while writing this blog today. What can I say, welcome to a dietitian's life!

If we take a closer look at these 2 kinds, the plain low-fat, greek yoghurt actually has more protein at 16.5g than any of the FIT pots at 15.5g and has pretty much the same amount of total carbohydrates. The real selling point Chobani offers is now you can give your taste buds something to dance about with flavoured yoghurt.

Chobani Yoghurt Brings out new selection of yoghurts, increasing protein amount from ~13.5g to ~15.5g compared to original pot flavours and decreasing added sugar from ~15g to ~5g- equaling about a 10g difference in total carbs.

So let's talk about why this topic is worth a whole blog. The fact that there's a yoghurt with 15g of protein and no added sugar is great. It's also great that there are other yoghurts that have added sugar, are higher in fat, have mixed pureed fruit, and some that have no fruit. Choosing a yoghurt that has higher protein and no added sugar is not a bad thing. It becomes a problem when this choice becomes the ONLY choice or is based on rules or the mindset that the other yoghurts are 'bad' for you. The point I want to make is that the situation in which you choose a particular yoghurt is key. There are no good or bad kinds of yoghurt. There is only variety, and maintaining variety in your food choices (across all food groups) is very important in living a healthy and balanced life.

If you are an athlete, a gym junkie or someone who exercises regularly, this Chobani FIT yoghurt would be a great choice. Since dairy is optimal for muscle maintenance and growth, a higher protein yoghurt is a great option. Depending on your level of intensity and duration, you may need to think about adding in some additional carbs, as 7.7g of carbs isn't going to do the job in aiding muscle recovery. Even if you aren't an athlete or do minimal exercise, Chobani FIT is still a great choice. It will provide a solid protein rich snack for mid meals, or complement to main meals, especially if you are a vegetarian and struggle getting enough protein in your diet. On the other hand, the non FIT yoghurt pots are also a great snack, particularly if you're on the go and don't have a muesli bar or some fruit (for energy) to pair it with.

I can sit here and break down the different kinds of flavours and types apart based on their nutritional value, but at the end of the day will 1-2 grams of protein make much difference if you are eating adequately? If you are an active person, would you be better off having the normal flavoured yoghurt to better meet your carbohydrate demands? Branding is incredibly influential, and just because something says FIT on it, doesn't mean it's always going to be the best choice for you to stay fit. Above all, if you genuinely dislike a particular yoghurt flavour, don't buy it!

If you find yourself questioning your motives, or are ready to change your thinking, it is ALWAYS worth playing it safe and double checking with a dietitian. There ARE dietitians who specialise in eating disorders and disordered eating who will help guide you to increasing your flexibility in food choices allowing you to eat socially, spontaneously and enjoyably all in a non-judgmental manner.

Carbohydrates and Competing

By Jen Pfeifler APD

Why carbohydrates are a must for an athlete

First of all, I totally understand how appealing the keto, or low carb-high protein lifestyle is. We all have that one friend who raves about how much weight they lost when the cut out the carbs, but it isn't all what it's cracked up to be. There are many health risks associated with a lower carb diet such as vitamin deficiency, restlessness, and mood disturbances (Burke & Deakin 2010, pp. 132-133). Athletes have even more to add to that list, such as lower immunity, decreased iron status (performance iron health status is different to normal iron health status) and issues gaining or maintaining muscle mass. For an athlete's sake, it certainly doesn't enhance performance in a multi-faceted race like the triathlon. Here's a brief insight into optimising performance without compromising health or body composition.

Let's talk about why carbohydrates should be on the menu. Ideally, carbs should be eaten throughout the day and especially before and after training or competing. So what's so special about these little molecules of energy? I'm glad you asked!

If we break down the word, we get carbo and hydrate. The carb part refers to energy. This is utilised by cells, muscles and the brain for fuel prior to exercise. It fact, it's the brain's preferred fuel source! After strenuous exercise, the body craves more fuel or carbs to help replenish the energy lost. If this doesn't happen, the body will look for other sources of energy. Since fat isn't as easily broken down and utilised, the body will also take part of the energy it needs from it's protein stores. Unfortunately, these stores are in the muscles, thereby breaking them down in effort to produce energy, resulting in muscle loss, zero training progression, and little to no chance at a PB (eating protein alongside carbs is the ultimate goal, but that's a whole other article)!

The hydrate part is the important bit. For every 1 part carb, we also get 3 parts water when carbs are absorbed by the cells, tissue and muscles (this may be why you feel heavier and therefore blame carbs for the sudden weight gain-it's not fat, just water). The water absorption is a great bonus. Since water is lost in sweat, carbs indirectly help to keep the body's cells hydrated to keep you performing at your best.

We've discussed the backbone of carbohydrates, now let's talk about where they fit on the menu. For an everyday individual, we recommend eating 5-6x a day or in some cases 3x a day, with carbs added to main meals at minimum. For triathletes, however, that pattern of eating just isn't going to cut it! Triathletes need to be eating 6x a day at minimum, plus a pre and post carb rich snack around training. The AMOUNT and KIND of carbs is the tricky part. This is where it's important to understand your body and gut sensitivity. Trialling this in training leading up to competition is key. Your sports dietitian/nutritionist can play a huge role in this process and assist in which supplements such as caffeine, creatine, nitrates, etc. (if any) may be right for you.

If you've taken the time to read to this point, I'll let you in on a fantastic product that has been tested and raved about by fellow triathletes for its taste and ease on the gut, and supported by dietitians for its nutrition profile. With many different flavours to suit your fancy, and different products to choose from such as pre and during event energy or post event recovery products, Tailwind Nutrition delivers all the way from Colorado U.S.A and is available here.

Tailwind supplies products containing enough energy and electrolytes for pre or during competition and products with enough energy and protein to replenish the body after competition deeming a dietitian's mark of approval.

Before supplements can have a positive and noticeable improvement in your performance, your nutrition foundation should already be in tip-top shape. If you're unsure, new to triathlete competing or just wanting to make sure, a sports nutrition consult could be the difference between a PB and getting a ripper calf cramp on the home stretch.

Finally, I want to emphasise that having a healthy relationship with food is the most important and first step toward performing at your best and finding fulfilment in competing and succeeding. It is possible to be flexible with your eating to match your lifestyle while at the same time fueling your body for performance. Talk to your sports dietitian/nutritionist for more information!

Burke, L., & Deakin, V. (2010). Clinical sports nutrition (Fourth ed.). North Ryde, N.S.W., Australia: McGraw-Hill Education (Australia) Pty.