Bulimia

Nutrition Experts Podcast Episode 49 The Diet Culture Says That Something Is Wrong With You with Aileen Birkitt, RD, LD

April 8, 2019 by matheaford Leave a Comment

Became a registered dietitian in 2002 as a second career
Owned a private practice nutrition counseling office in Basking Ridge, NJ 3/09-11/18
Moved to Rhode Island and opened up a private practice 1/19
Experienced former Dietitian for 5 years in the Eating Disorders Unit at Robert Wood Johnson-Somerset Medical Center in New Jersey. This facility has inpatient and outpatient (PHP, IOP) eating disorders programs
Specializes in Eating Disorders, also counsels many individuals and families on how to eat and live a healthier life; utlilizing evidence based guidelines.
Independent contractor for ComPsych Corporation and Excel Body Fitness, where she presents workshops on healthy eating to corporate employees as part of their employee assistance program.
Member of The Academy of Nutrition and Dietetics
Member of IAEDP- International Association of Eating Disorders Professionals
practices HAES (Health at Every Size) counseling, LGBTQ friendly

Mathea Ford: [00:00:28] Hi there! It’s Mathea. Welcome back to the Nutrition Experts Podcast. The podcast featuring nutrition experts who are leading the way using food starts today right now with our next guest. It’s great to have Ailleen Birkitt on the show today. Ailleen, welcome to the Nutrition Experts.

Ailleen Birkitt: [00:00:46] Hi. Thank you so much for having me here. I’m very excited to be here today.

Mathea Ford: [00:00:50] I’m excited to have you on the show and share your expertise with my tribe. Let’s start by letting you tell my listeners a little more about you and what you do.

Ailleen Birkitt: [00:01:00] Sure. I’m a Registered Dietitian and licensed dietitian currently in the state of Rhode Island where I have my own private practice called Nutrition 4 You LLC. I did become a registered dietitian in 2002. Opened up my own private practice in New Jersey in Basking Ridge, New Jersey in March of 2009. I was there until November of 2018 where we had a family move for my husband’s job relocation and I’m now in Rhode Island and I have an office in North Kingstown, Rhode Island where I see a bunch of different patients. I do specialize in eating disorders. I’ll see people with diabetes, pre-diabetes, high cholesterol, high triglycerides, weight management and like I said all the picky eating, the whole span of also the whole span of eating disorders.

Mathea Ford: [00:01:54] You mentioned that you specialize in eating disorders. Have you worked a lot with people with eating disorders?

Ailleen Birkitt: [00:02:00] Yes I have. I worked as a per diem dietitian at Robert Wood Johnson Barnabas Hospital in Somerville, New Jersey which is an excellent program for people with eating disorders and there they have inpatients, outpatient so there is a partial hospitalization program and IOP. So, I have seen the whole realm of eating disorders starting from inpatient and the cool thing about that program is that you do get to see people progressed. It’s the same therapist, same dietitian, psychiatrist every step of the program.

Mathea Ford: [00:02:39] What is your experience working with young adults? Because I I guess I associate eating disorders with younger people and body image.

Ailleen Birkitt: [00:02:49] A lot of people think that it is only something that afflicts adolescents but also we did see people that were much older. You know it’s definitely more prevalent with adolescents. I’d say like 1 percent are female adolescents suffer from this but honestly like 30 million people suffer from anorexia, bulimia and binge eating disorder. So it kind of all different lifespans. Another interesting thing too is there are males that have eating disorders that doesn’t always get noticed or mentioned a lot. It does typically get to be considered like an adolescent female disease.

Mathea Ford: [00:03:32] So, what’s your experience kind of with young adults and how they view body image and how it gets distorted and I guess in an eating disorder?

Ailleen Birkitt: [00:03:41] What I find a lot with young adults is they are like a lot of us very prone to images with social media. And in today’s day and age they’re on all sorts of social media all the time seeing a lot of images and other people you know just saying this is the way you’re supposed to look. Unfortunately, there’s a lot of misinformation out there too about how to get there. So, yeah. And I say misinformation because a lot of it is not healthy. And so a lot of times I feel like they’re kind of seeing maybe not the right things. I try to work with them and always have an eating disorder should also be working with a therapist in conjunction for treatment and you know we work together to try to make sure that they are kind of staying away from some of that negative information and kind of going to more body positive information. And I do find a lot of times that adolescents will be who come in say that they’re comparing themselves to others a lot it seems to be a common thing.

Mathea Ford: [00:04:42] But is it an eating disorder they kind of have a difference? I don’t know that called dysmorphia like they don’t see themselves the same way in the mirror that we see them as a physical person. Can you talk a little bit about that?

Ailleen Birkitt: [00:04:57] Sure absolutely. That is very common where they will you know see something completely different than in themselves and what we see. So, there’s a lot of tactics we can use you know just really trying to work with them on kind of self-worth, giving them affirmations does kind of start to feel better about their body. Some things that have been done are putting a lot of times a lot of things happen when they look in the mirror too. I’ve come to find where sometimes a recommendation is just put some post it notes on the mirror saying “you’re awesome! You rock! You’re not being judged by just what they see in the mirror.” We also try to educate them that there is this kind of like an eating disorder voice. A lot of people with these orders know it as Ed as soon as we give it a name which seems to help to say well if Ed’s saying that you look a certain way in the mirror just talk back to Ed and that can help sometimes too. Talking back to that negative voice.

Mathea Ford: [00:05:59] So, the voice you’re talking about is basically the voice that saying “you’re fat! Your hips are too big!” You’re not whatever else it would say. So, when they hear those messages you encourage them to just talk back and what kind of things would they say back to that voice just “that’s not true” or?

Ailleen Birkitt: [00:06:15] Yeah! Yeah! Something like you know “Be quiet.!” They can yell at it if they want. Yeah, whatever works for the person. Another cool thing sometimes they can do is take an index card and say “well, what are all these thoughts that come up in your head?” And they’ll write it down and I’ll say take on the back of it. Write a better response. Like for instance, “you’re fat and ugly.” I will say “No, you’re beautiful the way you are.” You know it’s just something to you know because if you do over time you can train the brain to start to talk back you know it’s work it’s definitely a lot of work and it does take a lot of time and that’s why they should also be working with a therapist on some of these issues.

Mathea Ford: [00:06:55] Yeah I had a guest recently that we were talking about brain changing those thoughts and those processes and how reality. Yes but your brain you know you do have these inner commentary going on so identifying that is important whether you have an eating disorder or not if you have some sort of negative inner voice that’s going to hold you back a little I would think. So, can we talk a little bit about what since I’m sure you work a lot of with people with eating disorders on healthy body image versus an unhealthy one can you talk about what is the difference?

Ailleen Birkitt: [00:07:31] There’s something called Health At Every Size. It’s a movement going on right now. It’s kind of accepting where you are right now which is extremely hard to do vs. an unhealthy body image is that really giving into that inner voice “you’re fat! You’re ugly! You shouldn’t eat.” I mean it’s amazing the things that this voice will say. It’s just unfortunate. So, that you know try tried to tell people that that these voices are these thoughts are not truths seems to be kind of sometimes those phrases can really help people. And that’s a big one that I like that not every thought that goes through your head is a truth.

Mathea Ford: [00:08:10] Just like everything on the Internet is not true right?

Ailleen Birkitt: [00:08:12] Right! Right. And sometimes people will just you know say “I feel bloated today. So, I must be fat” and I say “wait a second. Do you hear what you just said? ‘I feel’ is that truth? You know what I mean?” So kind of working a lot with that. And a lot of things you know just telling them too about the media how altered. It’s so amazing how altered so many of the images are to look a certain way.

Mathea Ford: [00:08:38] What was kind of an eye opener to me I guess is when we went out to Vegas one time and they have the costumes for the performers and stuff. Even in a hard rock cafe they have the costumes that these performers wear and they’re so small like their size 4, size 2, whatever. But looking at them on TV or whatever you know I wouldn’t necessarily think they were that small. But you’re right kind of visually what you see and having that process is just really made me realize that the size that I thought they were that I you know they may be shorter than I thought they were they may be taller than I thought they were but just kind of that reality of “oh wow!” That’s actually the costume that they wore so that’s just kind of reminds me a little bit of what you were just saying.

Ailleen Birkitt: [00:09:30] Coz Marilyn Monroe was a size 10 and that was acceptable at the time and and just how things have changed over the years where with you know people just you know in the media just keep wanting you to get smaller and smaller. It’s just not right. And I think now I feel like things are changing a lot. I feel like some people are kind of calling that out. I know there’s I think of the which there there’s a magazine that just kind of said they’re not going to alter all the images anymore as a women’s magazine. I don’t want to say the wrong one I can’t think of which one it is but so certain things are beginning to happen. I think you know people are starting to call it out a little bit more so I’m happy about that.

Mathea Ford: [00:10:15] Yeah and then on the opposite side you have all these Instagram filters and waves of apps that can shrink your waist and make your eyes look bigger and your head kind of rearranged in that altered image that then is presented as factual. I can see how it can mess with your mind a little bit. What types of things do you use with your clients to implement the Health at Every Size mentality?

Ailleen Birkitt: [00:10:42] I always tell people not to… I don’t I don’t think people should be weighing themselves because that instantly makes people not happy about their size. Like right away. I mean you wake up and you get on the scale it’s like I’ll just say it’s just a number. But what a downer like for because of that one thing like the whole day is shot. Do you don’t I mean. Yeah. And so if I do need to weigh somebody I tried to focus on weight except if somebody had been suffering with anorexia nervosa they’re an outpatient treatment they really need to be monitored. Of course they’re going to need to see what their weight is fairly frequently but I’ll do a like a blitz a blind weight like they will turn the other way and they won’t see it. So, I try to keep the focus just in general off of the number on the scale. And when people come in you know we just talk about things that we can just make you feel better. “How are you eating right now? I’ll kind of have them give me like a dietary recall and just tell me what they had to eat yesterday. What’s a typical day?” And then I try to just kind of see where there might be gaps and talk about how to eat and then you know with a focus on feeling better and if anybody exercises you know is it just because “oh! I got to exercise, I’ve got a burn” or is you know trying to focus on something enjoyable for the body. I think those are all kind of things that go along with the Health at Every Size.

Mathea Ford: [00:12:10] So, back to like eating disorders. How common are they? I know you mentioned you said 1 percent of females. Did you mention in an age range or?

Ailleen Birkitt: [00:12:22] It was adolescence.

Mathea Ford: [00:12:24] Okay. Is there a group that is more inclined to that diagnosis outside of teenage girls or women, young women?

Ailleen Birkitt: [00:12:32] Point five to three point seven percent of women suffer from eating disorders. There are 30 million people which is a huge number that suffer from anorexia nervosa, bulimia or binge eating disorder. So, I think that’s pretty alarming number and that’s just the reported numbers that we know about. You know what I mean? There’s some that probably aren’t even reported in that.

Mathea Ford: [00:12:56] So, can you talk about what each of those is anorexia and bulimia and binge eating disorder?

Ailleen Birkitt: [00:13:02] Sure doesn’t. There’s a whole bunch of criteria for each one but anorexia nervosa is people are restricting and they’re usually you know usually end up being very underweight their ideal body. They’re way below their ideal body weight. So, kind of to work a lot with them on very slowly at first re-incorporating food. For it to really be a binge and binge eating disorder it’s going to be a unusually large amount of the food item that somebody eats like more than just a normal serving and then there’s a lot of guilt after eating that. So, three point five percent are women that have this and 2 percent are men. So, that is one of the higher eating disorders that men would have would be the binge eating disorder it’s much you know fairly more common in men and some of the other eating disorders.

Mathea Ford: [00:13:53] So, they don’t necessarily with the binge eating they don’t necessarily do anything to throw up or over exercise or anything it’s more just the eating and the feeling and the guilty?

Ailleen Birkitt: [00:14:03] Right for the criteria. Now though it’s the bulimia where there’s a purging aspect. So, there’s the binge you know the binge eating and then also the purging or vomiting sometimes purging. You know we always assume it means vomiting but sometimes it can mean exercising to compensate for calories eaten.

Mathea Ford: [00:14:23] All of this kind of you know talking about Health at Every Size and body image. I know that there may be 30 million people out there with eating disorders but there’s a whole lot of more people a whole lot more people who are dieting so to speak or you know doing this where they eat right for a little while and then they go back to a normal whatever they go back to eating carbs or whatever happened. So, what part of the diet culture is troubling for you as a dietitian?

Ailleen Birkitt: [00:14:57] The thing is it’s not just the diet culture too just the beauty products culture. People are if they feel like they’re always trying to make us feel like something’s wrong because otherwise how would they make money. I think it’s huge for people to just gain an awareness of this because it’s been around for so long. And I think a lot of us just take it for granted that’s there. But if you really stop and think like when you turn on the TV there’s a commercial, infomercial as well you know there’s something wrong with your face so you need this product. Well, same thing happens with food and dieting supplement industry is huge I mean if you take this year to perform better. They’re always trying to make us feel bad with what we have rather than you know it wouldn’t make money if everybody was just kind of celebrating how we are as we are. But it’s just so rampant. It’s everywhere. You can’t go. I mean you know the grocery store aisle you’re looking at a magazine like the captions and headlines this diet, that diet, anti aging you know we we can’t even it’s not even okay to age you know.

Mathea Ford: [00:16:07] Yeah it’s not okay age and to get wrinkles. You’ve got to start using Vitamin C and vitamin A on your face.

Ailleen Birkitt: [00:16:13] Right! Right. So, it’s just I think just really having that awareness that a lot of you know most of it is really a moneymaking thing. And you know if we can just be a little bit more aware that that’s what’s going on I think it would help. I guess it doesn’t sell the cover to say you know celebrate your aging naturally and don’t go on a diet. Right?

Mathea Ford: [00:16:36] Obviously, there are health problems with some with being overweight and stuff. So, yes there may be a little bit but I understand what you’re saying about you know people who are 20 pounds overweight they’re giving this impression that you need to still just lose this weight to be this perfect size or like you said when you’re in your 40s you need to start using anti aging creams so you don’t look like you’re 60 when you’re 60 with wrinkles.

Ailleen Birkitt: [00:17:04] Right.

Mathea Ford: [00:17:05] I guess I never really thought much about it but that is the way they sell that something wrong with you so you need to change. So, how do you combat that in your clients or even just in regular people hard. How do you mean how do you combat that besides just being aware of it?

Ailleen Birkitt: [00:17:21] Well, I do have like a little checklist like I’m a big handouts person all the time so when I see you in my office always like “here’s a handout about X. I think it really helps like little reminders.” I do have a thing to kind of decipher like what’s junk media that can be called and you know it doesn’t sound too good to be true. “Is it telling you you have to have this product and everything will be better? Are there a lot of should or shouldnt’s?” Those are big things. So, just so that when somebody has that and they see things they can maybe look at that paper and say “oh! Wait this person. I don’t even know who they are and they’re saying I should go on this diet and I should only eat carrots or I shouldn’t eat carrots.” I mean it’s all sorts of things out there.

Mathea Ford: [00:18:02] A lot of this diet culture is promoting fad diets or what dietitians call fad diets. You know eat like you said eat only carrots or eat only cabbage soup or do these certain things. Are there any good things about fad diets?

Ailleen Birkitt: [00:18:18] I don’t think there are any good things about fad diets. I I believe more in working with someone to eat in a way that they can do for their lifestyle. The thing that the fad diets is yes, a lot of people will lose weight in six months and sometimes it’s rapid. Some of this just water weight but as far as research and things we there’s not a lot of research saying beyond that that’s six months at this weight stays off in most cases people gain it back and then even gain back more. When you have these fad diets, usually there’s something that’s restricted. For instance, a big one takes carbs. Okay. So, yes if you cut things out you know the weight does go down but the problem with fad diets is people are going to go off them probably if they’re not sustainable. And then when you go off it’s like “oh my oh my gosh! I haven’t had carbs in so long” and then next thing you know these things that were forbidden are suddenly very appealing. And then there comes a weight gain I believe more in sustainable eating and just kind of showing people what does a what is a healthy plate look like? What should be on your plate for meals? You know in about three to four hours after your meal. It’s a good idea to have a snack. So, just ways to eat that they can take with them for the lifetime. It’s not just a quickly come lose weight and then you’re on your way.

Mathea Ford: [00:19:35] I think sometimes that people don’t understand it’s not just a weight loss. You know there are health components to carbs, fiber, vitamins especially in whole grains. And sometimes you know missing out on those things even though we may take a supplement to replace it it’s just not the same as the whole food is and allowing that may have consequences later. So, and the yoyo thing too. It’s just really hard on your body.

Ailleen Birkitt: [00:20:08] Just to kind of talk that a little more. There are certain things kind of. They have the diet name but they’re not really a fad diet. There’s been a lot of research showing that the Mediterranean they say diet but I still think of it as a way I’d rather clip Mediterranean way of eating. I like that term better. You know focusing on you know fish and olive oil and nuts and whole grains like is it really. There’s research. That’s a great way for heart health to eat. And there’s another thing called the DASH diet which is for lowering blood pressure. It’s dietary approaches to stop hypertension which focuses alone lots of fruits and vegetables and then lower sodium. And that has been shown to reduce blood pressure and improve heart health in some people. But those are not really a diet in the sense that they’re excluding you know “oh you can never have this! You can never have that!” They’re just kind of incorporating healthy things in the eating.

Mathea Ford: [00:21:03] So, thinking about overall just the diet culture, eating disorders that type of stuff. What’s the solution to improving how we eat?

Ailleen Birkitt: [00:21:11] Make sure of all the components in a meal. You know some carbohydrates and protein, some fat, fruits, vegetables, dairy, eating every three to four hours is really important. So, you never go to long. When you go too long without eating then you end up ravenous and probably not eating like a regular portion size that you would want. And then sometimes that creates the old guilt cycle or binge cycle. So, there’s a lot to that. So, it’s really regular eating, incorporating these components. I talked about three meals a day plus one to two snacks a day.

Mathea Ford: [00:21:46] We all know kind of that’s the right thing to do and I think even the word is out in the media as well. It’s just not a fast solution. It’s a time it’s over time. So, why aren’t people doing you know the eating that right way?

Ailleen Birkitt: [00:22:03] Kind of like what you just said there’s all these fast what seem to be fast solutions that keep coming out. And I think people just kind of grab on to that because you know a lot of times I think it’s because the maybe the person telling it looks so great and “oh! I did this look at me” and so I think a lot of it is media perpetuated. You know if more people could focus. I like to teach a lot about intuitive and mindful eating which is kind of eat when you’re hungry stop when you’re full. We get really away from that with all the diets. It takes us away from our natural hunger and fullness and then we’re following kind of this other plan. So, trying to get back in touch with that. And then really paying attention to what and when we’re eating I think is huge.

Mathea Ford: [00:22:47] Yeah. They just go ahead.

Ailleen Birkitt: [00:22:49] Oh I just think a lot of the stuff we’re told to do you know may not be or to follow might not be working. And I think focusing on some of these other things. Yeah I see. It’s just tremendous. And it gets people more in touch with their body and were kind of at peace with food.

Mathea Ford: [00:23:06] You know this morning just this morning at breakfast my daughter she ate her we had some sausage and chips and applesauce and she ate about half for applesauce and then she said she ate or sausage in the applesauce and she said “oh! I’m done.” And so my son says “if that was ice cream would you finish it?” You could have two stomachs like a regular stomach and then an ice cream stomach. And she said “no, I wouldn’t.” And the truth is is that she does whenever we have like ice cream she gets a smaller bowl. She doesn’t eat as much. Just you know not out of any sort of desire to lose weight but more of a desire to just eat what she has in her bowl and not throw it away. But I said “okay, fine. You don’t have to eat the rest of your applesauce if you’re full you’re not hungry we’ll stick it in the fridge for a snack later whatever.” That just what you’re talking about just reminds me that it starts at a young age. That message that I got the message when I was growing up that I needed to clean off my plate because there wasn’t that much food. We were low income and we didn’t have a lot of money and so if you didn’t need all your food you may not get food later. So, it’s a little different for my kids because it’s always been like not about you have to clean your plate. It’s about don’t come back five minutes later for the Cheetos thing. So, you a little help here but listening to the messages your body gives you. How would you recommend like dietitians when they’re counseling their patients or people who are listening to this podcast. How could they implement kind of what we talked about today as far as eating healthier diet culture all that type of stuff?

Ailleen Birkitt: [00:24:51] Okay. I think by educating their patients on some of the things I talked about about where look at the message who’s saying it? Where’s it coming from? What is their degree? You know is it a dietitian or you know? Because it could be MSRD which is a dietitian with a master’s you know that the RD there would be a great source for nutrition information. Checking where they’re finding their information. Well, people kind of come in and say “oh! I found this out on the web. Should I be doing it?” Well, where did you find it out? You know is it a reputable source the information? So, kind of deciphering that and then also I think working with people to get in touch with their more mindful eating like “well, are you pay attention to when you’re eating? What times a day eating?” Certain things like that. That makes sense.

Mathea Ford: [00:25:46] Yeah. I always when I thought a lot about patients. I would always pay attention in the supermarket to what the fad diets were that were on the magazines just because I knew I was going to get asked about that kind of knowing a little bit.

Ailleen Birkitt: [00:25:59] Yeah! Yeah sure. It just kind of having that knowledge. Also one other thing I want to bring up is with the you know educating patients for dietitians out there with the fad diets and things, just recognizing that you know it’s a fad diet if there’s a list of good foods and bad foods like I said the should and shouldn’t just really being aware of that because I believe it’s very important to teach patients that all foods fit and you hear that a lot from dietitians. But I do think it’s really important because once you label it as bad there comes the guilt and there comes the food that you want to eat. Kind of like what you were saying with your daughter you’re offering I can this slick small portion size bowl you’re offering ice cream. You know you’re these things are around. They’re not like completely prohibited. I think it’s important to teach you to learn to work with all the things that are out there and how do you incorporate them into your daily eating.

Mathea Ford: [00:26:54] So, are there any signs for a parent if they have a teenage boy or girl but like you mentioned it’s more common in teenage girls that they might notice in their daughters or sons that might trigger them to think that they’re starting to have some of these issues with food?

Ailleen Birkitt: [00:27:12] Yeah! Certainly, and of course if they notice any weight loss hopefully they’re going to their physicians you know for for checkups. Sometimes, if you find like hidden food around like in the bedroom that you know that’s another kind of thing just to be aware of. The problem is too low though sometimes these are hidden so well it’s hard to know. I think just having a dialogue too with the kids keep checking in on them and having family dinners and talking together is going to be extremely helpful.

Mathea Ford: [00:27:47] Yeah! I had a cousin when I was growing up that had anorexia and I mean by the time it was clear to everybody in the family that she had it and it was pretty significant. But yeah it’s the signs like the good foods, bad foods like I can’t eat certain things you know are being like you said a picky eater but there’s something between a picky eater and I want to eat it but I can’t eat it.

Ailleen Birkitt: [00:28:11] Sometimes when someone starts to restrict and restrict and then restricts meat you know it can be a sign. And it is something that we as dietitians who focus on eating disorders look out for we ask why. Well, you know is a for ethical reasons or sometimes it is eating disorder just saying “hey! Its another thing that you can restrict to help you lose weight.” I’m not and I’m not saying that that that is a weight loss mechanism it’s not but that’s sometimes with the eating disorder mind will think. When you start to see someone who all of a sudden starts to avoid a lot of foods gradually that’s another sign of a potential eating disorder. Like we’re talking and not someone who’s always been picky there is a difference where you just suddenly start to see these changes where they were eating that always enjoyed it and suddenly “now, I don’t want that.” You know you’ve got to kind of find out. And you can and I’d say referring them to a therapist, a dietitian are you know excellent ways to work on on those issues.

Mathea Ford: [00:29:11] Yes, speaking of foods I always ask my guests “What is your favorite foods?” So, tell us what your favorite food is.

Ailleen Birkitt: [00:29:20] Its definitely eggplant parmesan.

Ailleen Birkitt: [00:29:23] Oh really!

Ailleen Birkitt: [00:29:23] Over pasta. Yes.

Mathea Ford: [00:29:27] So, I was looking at some eggplant parmesan recipes the other day and they mentioned slicing up the eggplant and then salting it to get the extra moisture out. Is that something that you do or?

Ailleen Birkitt: [00:29:39] Yeah absolutely. I try to slice it really thin and get the moisture out. Yep.

Mathea Ford: [00:29:44] Yes it does.

Ailleen Birkitt: [00:29:45] So, typically if I go to an Italian restaurant that is if that’s on the menu that’s what I’m getting.

Mathea Ford: [00:29:53] Ailleen, I’ve loved talking to you today. Thank you so much for being on the podcast. It’s a pleasure having you on the show. I know my listeners learned a lot about this diet culture eating disorders. And if listeners want to connect with you what’s the best way to do that?

Ailleen Birkitt: [00:30:08] Well I have a website. It’s www.nutrition4uLLC.com. I’m also on Facebook. Same thing nutrition4uLLC and also on Instagram as @nutrition4uLLC. So, there are lots of ways and I encourage you to check it out.

Mathea Ford: [00:30:31] Well guys this has been another great episode of the Nutrition Experts Podcast. The podcast that it’s all about learning more so you can do more with nutrition in your life.

I give credit to the The National Eating Disorder Association, where I got all my data (%s, #s etc. ) That is also a great resource for information about Eating Disorders. www.nationaleatingdisorders.org

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Nutrition Experts Podcast Episode 38 Eating Disorders and Sports Nutrition with Amy Goldsmith, RDN, LDN

January 21, 2019 by matheaford Leave a Comment

Amy Goldsmith RDN, LDN (Founder and CEO)Founded Kindred Nutrition in 2010. She became a dietitian in 1999 and although she has worked with many realms of Medical Nutrition Therapy, specializes in Eating Disorders, Digestive Health, and Sports Nutrition. Amy’s specialty in Eating Disorders initiated the HOPE Consortium, helping people with Eating Disorders, which she co-founded with Dr. Albertson. Amy focuses on meeting all her clients where they currently are and focusing on education, re-framing the mind, and using food as fuel for your brain and body. She believes there is a strong connection between the gut and brain and focuses on both with all clients. In addition, as a sports nutritionist and dietitian Amy assists with getting the client to peak performance by incorporating optimal nutrition before, during training, race time, and recovery. Amy also enjoys speaking to many teams in the community such as FOX Swim Club, MAC Swim Club, Hood College Athletics, Mount Saint Mary’s Athletic Teams, Odin Crossfit, and more.

Amy has been featured in multiple media outlets and works directly with Frederick County Schools, Montgomery County Schools, Run Farther and Faster, The Frederick Steeplechasers, Odin Crossfit, Anytime Fitness, Multiple Swim Clubs & Division 1 Collegiate Athletes throughout the United States.

Amy is routinely quoted in the Frederick News Post, has been quoted in SHAPE Magazine and My Fitness Pal forums, and written articles for Frederick Child’s Magazine. She has been interviewed live through Frederick Advice Givers and WUSA-TV.

In her spare time Amy enjoys spending time with her husband, two children, and Portuguese Water Dog and Crossfitting, hiking, cooking, and just plain relaxing.

Mathea Ford: [00:00:26] Hi there! It’s Mathea. Welcome back to the Nutrition Experts Podcast. The podcast featuring nutrition experts who are leading the way using food starts today right now with our next guest. It’s great to have Amy Goldsmith on the show today. Amy, welcome to Nutrition Experts.

Amy Goldsmith: [00:00:54] Thanks so much for having me.

Mathea Ford: [00:00:26] I’m excited to have you on the show and share your expertise with my tribe. So, tell my listeners a little bit more about your expertise what you do.

Amy Goldsmith: [00:00:54] Okay. I have been a dietitian for 20 years and about 10 years ago I open to Kindred Nutrition which is a private practice. We specialize in eating disorders treatments, sports nutrition and G.I. health. We also focus on community outreach. And recently I accepted a position on the board of directors with the Maryland American Nutrition and Dietetics as a Consumer Protection Coordinator.

Mathea Ford [00:01:22] Wow! So, that is a lot of stuff. So, you mentioned that you help with eating disorders, sports nutrition, kind of what’s the biggest issue you you usually find your patients need you to help them work on?

Amy Goldsmith [00:01:33] Lots of times, unfortunately, I feel like patients are coming to my practice as a last resort. There’s lots of information out on the website or some quick fixes that are sold. And after trying and not getting the results that they want, clients will come to me for some evidence based help. I really start working with them on the acceptance of their current state of mind putting appropriate goal setting in place providing education and then focusing on accountability.

Mathea Ford [00:02:09] So, regardless of what their problem is you kind of help them get a better understanding of their issues and then like a path that you help them walk down?

Amy Goldsmith [00:02:18] Yes. I feel like it’s really important to help my patients have the right mindset. So, we work on that first and then we focus on the education and then the goal setting.

Mathea Ford [00:02:30] So, you also mentioned eating disorders and their treatment. Can you talk about maybe our audience doesn’t necessarily know exactly what an eating disorder is or what might cause them. Can you talk a little bit about what those are? what you see in your practice and where they come from?

Amy Goldsmith [00:02:47] Sure! There is not a lot of research that can pinpoint exactly what an eating disorder is from but there’s some research that shows there is a genetic predisposition to mental health such as anxiety or depression or OCD and the eating disorder can concur with that and be used as a need to cope or find a way to believe they can control something. I see in my practice too that there’s environmental triggers that can kind of lead to a eating disorder as well. Sometimes depending on the environment my clients feel so out of control. When they start to focus on the black and white it’s a little bit easier for them to distract themselves from that emotion and really say “Okay, let’s make some rules I’m going to eat this amount of calories. I’m good today, I’m bad today” and etc.

Mathea Ford [00:03:36] So, what typical eating disorders do you see?

Amy Goldsmith [00:03:40] So, I would say the typical eating disorders that we see here is Anorexia Nervosa which is more restriction over exercise, we see Binge Eating Disorder and Bulimia Nervosa. We are also starting to see a rise in Orthorexia as well.

Mathea Ford [00:03:57] What is Orthorexia?

Amy Goldsmith [00:03:59] So, Orthorexia is obsession with wanting to eat specific types of food. So, it’s similar to anorexia with restriction and maybe over exercising. But it is that particular individual wants to be very aware of everything that goes in their mouth. I don’t like to pinpoint any. The cause of eating disorders of anything specific. But I would say it’s similar to the person that you might know who will only eat clean or will not have any added sugar or you know they make rules and if they can’t follow that it completely disrupts their day.

Mathea Ford [00:04:40] What are some signs that someone might have an eating disorder or that a professional… Well, we have some dietitians, doctors, nurses that listen to the podcast. What signs would a professional see to indicate that that might be an eating disorder?

Amy Goldsmith [00:04:57] That’s a great question. It’s hard because I think a lot of the colleagues that I work with we’re lucky from a dietitian end because we get 45 minutes to an hour to spend with our clients and we’re trained to motivational interview. So, I think that’s an obstacle sometimes for some of our colleagues since we are really in and out you know in 10 to 15 minutes. So, unfortunately one of the only signs that physicians may see is a change in weight or a change in labs. But you are motivationally interviewing someone you can kind of determine if they are skipping dinner, if they are focusing on healthy eating like in an excessive way, if they are isolating themselves from family and maybe starting to make their own meals, not eating with others or leaving during meals to use the bathroom for example. So, I feel like it’s hard to determine if somebody has a eating disorder if you’re not trained to take the time to really be investigative of that relationship with food.

Mathea Ford [00:06:04] Yeah and I think by the time the weight loss shows or those signs that would be more evident it’s gone on for a while because I think people tend to be able to hide these fairly for a while.

Amy Goldsmith [00:06:18] Absolutely and I would say you know with some of the eating disorders we don’t see weight loss. And so if you’re trained in kind of that black and white thinking it’s easy to say well they’re stable so it’s tricky.

Mathea Ford [00:06:31] Do you usually see eating disorders for women because I know that’s a pretty typical thought that I’ve heard or is it equal men and women? What about athletes or young or old? What type of person is most likely you think?

Amy Goldsmith [00:06:42] I first actually started to train more with eating disorders because I work so much with athletes and I was absolutely in my younger years and early on in training I was absolutely shocked at how many athletes had disordered eating. But as I worked with athletes you know it kind of made sense to me because there’s such pressure on performance. And if you think about it even in the media you hear people say you know that you have to be a certain race weight. Runners have to be a certain race weight or wrestlers have to be a certain weight. I mean we have football players weighing in before season and high jumpers have to weigh in so they’re using the correct pole. So, it surrounds that athletic field. But I would say you know when it comes to my practice, there is a higher percentage of women but I see both males and females and all ages. Matter of fact, one of the things that’s been a little bit troubling is that I’m starting to see disorders at a very young age. So, I have lots of eight, nine year olds and that’s really been a change that I’ve had to get used to.

Mathea Ford [00:07:54] So, would you say with the younger crowd, does it kind of seem to start with picky eating and then go from there? Or is it the athletic stuff they’re trying to do better with that?

Amy Goldsmith [00:08:05] I feel like it’s a perfect storm with the younger kids which is…

Mathea Ford [00:08:10] Social media.

Amy Goldsmith [00:08:13] Right. Social media. You know my clients of eating disorders are very very smart, high achievers and it could be one little trigger that starts a eating disorder. So, maybe it’s maybe that child was bullied believe it or not and they weren’t able to talk to anybody about it and they felt so out of control because of the way that’s making them feel. They start to focus on what they’re putting in their mouths subconsciously but then they lose weight and people are giving them positive feedback. It could be believe it or not this is something that I’ve really tried to get a grasp on but health class believe it or not. If you have a child who is type A and maybe a little bit obsessive compulsive. Imagine what they process when they hear in their health class “if you eat sugar or you’re going to get cancer.” It’s very very scary to the individual and it may make them want to really change their eating patterns. And the picky eater as well, I think the longer picky eating goes on I think it really creates a lot of fear with trying new foods. It’s not necessarily that they have a issue with body image but they just become so fearful from food they can’t move forward.

Mathea Ford [00:09:28] So, I was kind of surprised the first time when I went with my daughter she’s 13 and we went to the doctor and she was mentioning her height and weight chart because it was her annual exam and she was telling her she’s gaining a little too much weight. I was just like “let’s not focus on the weight, let’s focus on activity. We’ve decreased activity so we need to do a little more activity and obviously the eating choices can be better.” I also know that weight her weight fluctuates. I mean so I was kind of disappointed to hear the doctor says like “uh! You just put weight into your her head as an issue.”

Amy Goldsmith [00:10:07] I know and I feel like there’s been such a high intensity training for physicians as you have to identify childhood obesity and we need to squash this. So, you know when there’s pressure like that I think it does kind of create this checklist right.? So, they do the weight, they do the height, they check the BMI. Oh! BMI is too high. But BMI is not the best indicator. It doesn’t take muscle mass into consideration. They didn’t really o enough to really look at children from you know as far as a BMI standard. So, there needs to be a little bit more questions that are asked when they look at weight. Plus lots of times as our kids grow in height. We expect the weight to follow. And I think sometimes that’s forgotten.

Mathea Ford [00:10:54] Yeah. Yeah it’s still very. At 13 still very transitional weight, height time. So, is there any tips or thoughts that you might give other dietitians to help someone who they were just in the way we talk to people to help with addressing kind of that issue if that makes any sense?

Amy Goldsmith [00:11:17] Yeah. That makes a lot of sense. One of my best friends is a dietitian. We met at our first job and cracks me up because she says “Amy, my gosh I see more eating disorders in my practice than I would like to. Right?” And she says “but lots of times it’s confusing because they come to me for weight loss or you know something like constipation or something” and she really will dig down and ask lots of questions but she really doesn’t feel comfortable working with eating disorders. And I try to normalize that and say “yeah. That’s you know I’m not the best with diabetes. Right? Like I’m not up to date on the newest insulin pumps and glucose testing and that sort of thing.” So, she’s gotten to a place where she assesses for the eating disorder. She normalizes it you know and has a pretty good try where she is. So, she says “you know I don’t really think that you have the best relationship with food. I have a great colleague that I think you may be able to work with and you know I am not abandoning you but this would be somebody else I could work on our team.” So she’s not afraid to refer that patient out. And I think sometimes when dietitians are younger and you know they kind of would see that as failure you know if they were. But we all have a specialty. That’s why there’s so many of us. And it’s okay to say “I hear where you are. I hear what you’re saying to me. I’m not the most comfortable with it. It’s my job to get you the help you need. Here’s my recommendation. ”

Mathea Ford [00:12:51] Yeah. I love that because like I’m a specialist in kidney disease, renal nutrition. So, I don’t know a lot about cancer and I have friends who get cancer and they’ll say “What should I eat?” And I say “you should find a cancer dietitian at the cancer center because I have general knowledge” but so I think that’s an excellent point that it’s not a problem to refer somebody especially if you’re helping them. And we have in Oklahoma we have a little group on Facebook that’s just our RDs in the state. And we kind of go in there and I’ll see things people Pediatric dietitian who takes our state sooner care you know for a failure to thrive in Tulsa for example. So they’re trying to find someone to help those people. So, if you have that resource in your area you don’t have it and you want to start building one. I would recommend that because it is the new. Like you said you know somebody and you know that they’re going to help. So they have a specialty. So, talking about consumers a little bit you mentioned you’re going to be the Consumer Protection person for the Maryland… Is it you’re having an Academy of Nutrition and Dietetics?

Amy Goldsmith [00:14:04] Yes I am.

Mathea Ford [00:14:04] Yeah. So, talk about being a better consumer, what does that mean?

Amy Goldsmith [00:14:10] We live in such a different time. I’ve been a dietitian for 20 years. So, it was very very different when I became a dietitian and I feel like nowadays you can go on just the computer and Yahoo and Google or you know they have ads running based off of your search engines. Joyce cracks me up because I’m a dietitian and don’t try to sell me you know your magic pill.

Mathea Ford [00:14:32] We have fake Dr. Google.

Amy Goldsmith [00:14:37] Right. But you know we also I would say obesity has risen and there’s a lot of attention paid to health but the nutrition or the pharmaceutical business is a multi-billion dollar business. Their goal is to make profits. And I hate to simplify it like that but it’s true. And they market to the consumer who is desperate or frustrated or sad and they make it a little bit more affordable price because they can get the volume. So, that’s one of the things that I hear a lot is if I don’t take someone’s insurance yes it is a discretionary fund to spend to see a dietitian. And it’s not going to be as cheap as someone’s shakes or some of the you know even the medication that some of the physicians are prescribing. But that’s because there’s a lot of investigative work and it’s individualized. Right? So, these numerous pharmaceuticals they can they can sell something for $19.99 because they’re going to sell it to millions of people. Also I feel like we’re in this new era which I’m really trying to calm myself down a little bit. There are a lot of people who really do get into nutrition. Athletes, you know they really do notice that they have a change of performance when they eat right. Women who have lost a certain amount of weight doing something specific. We’ve even got some pyramid schemes that go on that boast their individual experience. That experience does not give somebody the credentialing to be able to really determine what an individual needs to lose weight. And I know that lots of times people say calories in versus calories out that equals weight loss. I’m here to tell you that’s not necessarily the truth. There’s a lot that goes into weight loss which is why dietitians have to take biochemistry, organic chemistry, anatomy and physiology on and on.

Mathea Ford [00:16:42] So, how can people be a little bit better consumers related to food?

Amy Goldsmith [00:16:47] I feel like if they have an understanding of marketing. If there’s a particular food that’s marketing success, see if there’s a research behind it. And if there’s any research behind it, see who paid for that research to make sure that it’s not biased. I also think that if you’re going to someone who is going to be your nutrition coach or your life coach or nutritionist, even do a little bit more research to see what experience they have. I feel like I’m a great mom but I’m not going to start a business telling everybody how to be a parent. I just think it’s really important to see where that person got their education.

Mathea Ford [00:17:26] How can people be harmed by or not helped by talking to someone who is not necessarily trained but just kind of have this experience of either being part of a multi-level nutrition marketing scheme or even have gone to some some training but not or lost weight. And like you said you’re a great mom but you’re not going to necessarily write books and coach people of being mom, how to be a mom. So, how can how does that affect people what’s the harm in that?

Amy Goldsmith [00:18:01] Well, lots of times some of the programs will have people restrict a completely… A complete group of food so either restrict grains completely I’m just using as an example or cut them and we know as dietitians that there is a better affects the biochemistry within the body and also affects your lean muscle tissue versus your fat muscle tissue which affects your metabolism so you may see the quick fix and the weight loss but long term you may be increasing your fat mass which is more dangerous to your heart health. You may be decreasing your muscle mass which will affect your metabolism in a negative way. You might be you’re removing an entire food group. So, if you’re not checking your labs and that sort of thing you may be creating a deficiency within your body. So, it’s not a one size fits all. You know it’s the same thing with lots of times I work with vegetarians. Vegetarians who are athletes and I’m not against it and I meet all my clients where they are. But every vegetarian should be checked to see if they have an iron deficiency. And they have to go to the right person who knows how to assess that to improve their quality of life and their health.

Mathea Ford [00:19:16] So, I know it’s dietitians were often trained to do some physical exam assessment to look for those nutrition deficiencies. And I think that’s something that when we look at somebody we’re taking into account all their whatever you’d call it comorbid conditions. Maybe they have diabetes and they’re taking insulin and all of a sudden you tell him to not eat grain or flour products. You know that’s a pretty significant change that someone who may have lost weight and doesn’t have those issues may not recognize that the diabetes, the insulin is going to get them too low and they could potentially have a little blood sugar which hypoglycemia which could be very bad.

Amy Goldsmith [00:20:01] Absolutely! We’re trained to look at the whole body. I always tell my clients we’re trained to look at the body from the moment something hits your tongue until it comes out of your body and everything that goes along with that. Which I think is unique.

Mathea Ford [00:20:15] Yeah. I just think people want that quick fix and it can be more expensive to see a dietitian. It can take longer to see results. So, I think that’s what’s hard for consumers because they’re so used to that quick fix and they see these beautiful sculpted bodies on Instagram and they say “I took the supplement. You can too.” So, I was watching this past December the Heisman Trophy win by Kyler Murray who is from Oklahoma and he mentioned the nutrition staff as being part of the reason why he was so successful. And I’m not I was so appreciative of that because I know they have a dietitian and I am so excited that a lot of the colleges are starting to utilize dietitians and realize that like you mentioned they can get eating disorders, they can get other issues, they have dietitians teaching them in all the sports not just football. I’ve talked to the Oklahoma dietitian and she helps with golf. She helps with women’s softball, she helps with baseball. She makes sure they’re hydrated. You know she gets kind of ready and and she also manages their training table you know what they eat. I think that’s great that colleges are starting to recognize that it’s a performance improvement when you have a dietitian helping you with sports nutrition. So, can you talk about kind of what you do with athletes besides the eating disorders that help them with sports nutrition?

Amy Goldsmith [00:21:47] Yes. So, sports interest and they’re really fun because they’re so motivated and they have pretty specific goals usually and you know I think by the time people are athletic. The goals aren’t completely unattainable so they’re pretty realistic which is me. I think a lot of people are surprised with how much nutrition can help performance or recovery because I often think about you know I’m in my 40s and we don’t really talk about nutrition at all as it’s related to performance. So, I assess people’s needs based off of you know their general and the metrics I get but then also really really dig down to their activity which is fun for me I love to do that. And then even break it down even more into “Okay. This is what your needs are. But we can even focus on timing of the meals so you know if you eat this particular food half an hour before you start this activity you’re going to get energy for this long and then within 30 minutes after your activity let’s recover and we look at really key things. So, how do you feel 10 minutes into the workout, 20 minutes into the workout, 45 minutes into the work out, how do your muscles feel? Like are you seeing a decrease in your delayed onset of muscle pain and that sort of thing. So and then I always tell my athletes you know you train for an event so we don’t expect nutrition to be 100 percent correct. Like the prescription that we’re putting in place, you have to train for your nutrition.” But I would say I mean all of my clients are always shocked once they hit that right nutrition kind of prescription and it’s so fun like the Marine Corps Marathon is here every year and my phone is going off like you want to believe with text messages from my clients “Oh my gosh! I got a PR! I felt great! I was hydrated and what’s better than that?” So full!

Mathea Ford [00:23:53] It’s towards the end of January when this is airing. Most people have new year’s resolutions and may have given them up by now but any ideas or tips related to exercise and nutrition to keep from overdoing it and kind of staying the course if you’re like “Okay, I gave up but maybe I could start back in a more reasonable manner?”

Amy Goldsmith [00:24:12] One of the phrases that I always say that I think initially might turn people off is “you can’t exercise a bad diet. You can’t out exercise a bad diet.” So, you know oddly enough people always say to me “are you gearing up for January? You must be really busy.” It’s our slowest month at Kindred Nutrition. I mean everybody’s joining in their gyms and starting their shakes and that sort of thing. April’s our busiest month because by then everybody’s kind of decide that they want to take a new route. You know your goals have to be realistic. I do think there’s something about starting a new year and being positive and I’m going to make this this year great but you don’t have to make the year great by telling yourself you’re going to get up at 5:00 in the morning five days a week to exercise for 45 minutes. If it’s not something that fits in your lifestyle. And also I’m a huge promoter of physical activity but I look at physical activity more as a endorphin producer, stress reducer. You know 45 minutes working out is great but if you’re not eating the right way it’s not enough to help you lose weight and get to that magic number that you’re looking for if that makes sense. So, I’m a fan of SMART Goal I know that’s really really helped with our clients here and we actually even have a sheet. SMART Goal stands for a specific goal that’s measurable that’s attainable and realistic. And then it has a time expectation.

Mathea Ford [00:25:46] Thinking about setting goals and just being reasonable. I also know that we just mentioned people want quick fix. Exercise does take time to kind of see the change. So, does a diet a little bit. But I think you can see it a little quicker with a diet. Maybe you got burned out because you were sore after two weeks of working out every day for 45 minutes and be a little more reasonable find that good place. I know a lot of times we can’t see the benefit of exercise till all of a sudden we stop for like a week on vacation and we’re like “oh my gosh!”

Amy Goldsmith [00:26:19] That’s so true! Coming back to being active after being on vacation. You’re right. That’s a good way to positively reframe it like “wow! I wasn’t in a better shape.” Well, the positive thing about that is you do have muscle memory and you can build a back up.

Mathea Ford [00:26:38] I think that’s absolutely true. You don’t have to give up and fall off the wagon and not get back on it. So, Amy my favorite question to ask everybody is what’s your favorite food? Since we didn’t talk a ton about food but I’d love to hear what you love to eat.

Amy Goldsmith [00:26:51] Okay. So, even though I’m a dietitian my favorite food believe it or not is chicken wings with really good blue cheese and spicy hot and spicy.

Mathea Ford [00:27:03] Yeah! It doesn’t matter that your dietitian. I used to when I was in the army I would be in the grocery store in the commissary on post and I’d be shopping and people come into my cart. “What are you buying?”

Amy Goldsmith [00:27:22] Oh Frederick is a small town that happens to me sometimes in the grocery store it’s funny.

Mathea Ford [00:27:23] Yeah. So, Amy thank you so much for being on the podcast today. It was a pleasure to have you on the show. I know my listeners learned a lot about just eating disorders and sports nutrition kind of dealing with that. So, if listeners want to connect with you what’s the best way to do that?

Amy Goldsmith [00:27:38] We have a website www.kindrednutrition.com and we also are on social media and Instagram we’re @kindrednutritionreel and Facebook Kindred Nutrition.

Mathea Ford [00:27:54] Great! Well, guys this has been another great episode of the Nutrition Experts Podcast. The podcast that it’s all about learning more so you can do more with nutrition in your life.

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