How to improve insulin resistance when you have PCOS

If you have polycystic ovarian syndrome (PCOS), then you know just how frustrating it can be if you’ve been trying to gain control of your weight. I have quite a few friends, clients, and patients that deal with this condition that digs deeper than infertility, as devastating as that can be on its own.

First let’s define what it is and why it matters for your weight. PCOS is characterized by overproduction of the androgen testosterone, menstrual abnormalities when ovulation does not occur and enlarged ovaries containing multiple small follicles (hence, polycystic ovaries). Women with severe PCOS have greater menstrual irregularity, androgen excess, total and abdominal fat and resistance to insulin; higher degrees of obesity are associated with worsening symptoms. This means their risk is increased for metabolic comorbidities such as diabetes. Since insulin is a known fat storage hormone, the greater the insulin resistance, the harder it usually is to control weight gain. It’s a double whammy.

Did I just described you or someone you know personally? Whether your insulin resistance is caused by PCOS or something else, some of these principles will apply. Insulin resistance otherwise known as “pre-diabetes” or “glucose intolerance” often leads to diabetes later in life and can really wreak havoc on your weight loss efforts. If you have received a diagnosis of insulin resistance, it means your insulin receptors are not very sensitive to the “lock and key” fit that insulin creates to move glucose (sugar) into their cells for energy. As a result, your pancreas produces more insulin to try and keep up. But like anything, our bodies become tolerant when it gets too much of something. Same thing happens when you take antibiotics over and over- your body recognizes it and you become antibiotic resistant over time. Consider someone who has become addicted to a drug and requires more over time to attain the same effect they did when they first tried it. Same concept.

When you have an abundance of insulin circulating in your blood stream, it’s constantly promoting fat storage in your body making it extremely difficult for you to succeed at any weight loss attempts. A common treatment in PCOS specifically is to prescribe metformin. However this isn’t really correcting the problem – it’s just telling your liver to produce less glucose but not directly addressing the fact that your body is producing too much insulin.

My expertise is in natural health and what to eat. So I’m not recommending you stop any current medical treatments without speaking to your physician. But I do want to help you with what you can safely control, starting today.

Begin with these simple (but maybe not so easy) steps:

  1. You gotta cut out fake food – meaning processed, refined, simple carbohydrates and sugars. These foods do nothing for you. Well, nutritionally they do nothing. I know emotionally they are “feel good” foods and literally turn on the pleasure centers in our brain by increasing dopamine levels and offer a great distraction to our negative emotions. But they spike insulin levels quickly and when consumed persistently (as part of frequent snacking let’s say), they worsen insulin resistance eventually leading to type 2 diabetes. Don’t misread this, those with a normal functioning pancreas cannot give themselves diabetes by eating these foods alone. Many other factors are running behind the scene including weight and genetics.
  2. Reduce your total carbohydrate intake. Key word here is REDUCE not eliminate. I’m really not a proponent of consuming under 10% of your calories from carbohydrates because I haven’t seen anyone sustain it for long term and there are very healthy foods that truly don’t deserve that kind of neglect. Why would you eliminate an apple from your diet that contains fiber and vital nutrients? It doesn’t make any sense. But it IS a good idea to cut back to 100 to 130 grams of total carbohydrate per day. If that sounds like a lot to you, consider that most people consume anywhere from 300 to 600 grams of carbohydrate per day in the standard american diet. Restricting down to 100 or so is enough to put you into a very mild ketosis so that you are depleting your glycogen stores (in simple terms, energy from sugar stores) while dipping into some of your fat stores. The effect of ketosis is to reduce hunger and successfully lose weight while not feeling terrible. *Note if you are a diabetic taking insulin you will need to discuss this with your doctor before lowering your carbohydrates this much as your regimen is likely designed for you to eat more than this.
  3. Consider a 30 day cleanse to reset your system and begin to bring your hormones into balance. This will not be an overnight fix. But, essential oils are natural, aromatic compounds that when coming from pure sources, have therapeutic properties that can have amazing benefits for bringing body systems that are out of balance, into balance. A good cleanse eliminates processed food and sugars, includes a high quality multivitamin, whole food enzymes, essential oils, probiotics and others that I outline specifically on a recent post here that you can read about if interested. If you experience symptoms like fatigue, irritability, headaches, stomach distress, bloating, recurrent sinus infections, lack of focus, or other vague symptoms not otherwise diagnosed as anything definitive, a cleanse could be exactly what you need. These could be signs of a weakened immune system caused by increased levels of stress, poor diet, increased candida overgrowth in your gut, and/or sleep deprivation.
  4. Incorporate essential oils into your daily maintenance plan to bring and keep your hormones in balance. Oils like clary sage and geranium when used daily regulate the hormones responsible for the female reproductive system. Clove, cinnamon, and rosemary support the pancreas to balance healthy blood sugars. Grapefruit, cinnamon and ginger regulate appetite and reduce cravings, particularly for sweets. Making teas using these can help along with increasing your fluids. And lastly but just as important, oils like cilantro, lemon and tangerine regularly cleanse and assist the liver to keep it functioning at it’s best. I recommend adding lemon to all of your water for this purpose. Just one drop of essential oil per eight ounces.
  5. Manage sleep and stress. This isn’t easy, I realize. However, you can do all of the above and if you don’t take care of these two, it won’t do you any good. Stress and sleep deprivation increase the hormone, cortisol, which inhibits the production of progesterone, a main marker of PCOS. Grapefruit essential oil can also prevent cortisol from doing this, so adding it to some of your water is a good idea. But more importantly, taking measures to get at least seven hours of sleep each night is key. Refer to this post I did a while back on taking simple measures to achieve this.

I’ve only scratched the surface on this. As you know, PCOS affects many areas of your life from causing unwanted facial hair, to thinning hair, and infertility. This post was meant to focus primarily on the weight and insulin resistant aspects as that is what I do best. However, I do believe that by addressing diet and hormonal issues that naturally, each of the symptoms can be improved greatly over time. If you’d like to know more about my cleanse and diet program, please feel free to contact me.

P.S. If you’re looking for online support with like minded women striving to live a healthier lifestyle, you may be interested in joining my free support group here.

 

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Jillian McMullen, RDN, CSOWM, LDN

Surviving holiday weight gain without driving yourself crazy

Thanksgiving has come and gone with the holidays in full effect now. I’ll admit, I’m one of those people that really love this time of year. There are lots of special things we get to enjoy right now- Christmas music, holiday decorations and lights, winter clothes, and of course seasonal food. I know some of you may be feeling a bit anxious about holiday weight gain though. Especially if you’ve experienced it in previous years past. To give you a better handle on it, I’ve put together some simple tips that I believe will help you out. This year, I want you to think about making it easier for yourself without making it the center of your life. The holidays are about family, friends, gratitude, and should be an exciting time. Frankly, it’s not a great time to go on a new diet. I’m a huge fan of mindlessly losing or maintaining your weight, especially during a time of year when many are mindlessly (and effortlessly!) gaining weight.

  1. How much weight do you normally gain this time of year? Do you actually gain any? According to a study published in 2000 on 195 people in the U.S., the average weight a person actually gains between Thanksgiving and New Years is only about a pound. Although many of us perceive it to be more like five to ten or more. The real problem, however, is that it doesn’t typically come off, whatever you gain. So it just ends up being an additional pound each year compounding on top of the previous year. Now if you know you put on more, say eight to ten pounds….is it realistic to say that this year you are going to actually lose five pounds? What would be different? I’m going to challenge you to think differently and set an unconventional goal that you will gain only a fraction of what you normally gain. For example, if your typical M.O. is to put on ten pounds over the holidays, how about make it a goal this go around to only put on four pounds? If you fall in the average one or two pound weight gainers population, then maybe you can focus on maintaining your weight. Does that make sense? I hope so.
  2. When you are at a holiday party, stand at least slightly more than arms length from the buffet or food table. Ever notice where people like to socialize? People want to stand around the food because it’s where the action is. The problem is you’re going to mindlessly eat for possibly hours if you do that, consuming hundreds of extra calories that you didn’t mean to. This seems like a very simple concept because it is.
  3. Choose wisely on the first trip to the buffet. In a Cornell study, it was found that we tend to serve ourselves the most on that first plate. So, if you know that, choose the lowest calorie foods to put on your plate first. You can always go for a second round to get the richer foods such as dips, cheesy casseroles, and desserts. This way, you are filling up on salads, fruit and veggie platters, and lean proteins while saving yourself up to thousands of calories simply by switching up the order in which you served yourself. Think of it in terms of volume – a creamy pasta dish will have hundreds more calories per cup than a cup of salad with low fat vinaigrette dressing.
  4. Take smaller sips and bites. On a normal everyday basis you may eat like you’re trying to win a race. But at holiday parties, it’s about socializing and enjoying those moments spent with loved ones. I get it, sometimes it’s more stressful than enjoyable during holidays with family. But the foods we eat are also meant to be savored and enjoyed this time of year. They’re special around the holidays, are they not? You will feel more satisfied on less if you choose to eat and drink slower.
  5. Manage your emotions. I would be remiss if I didn’t acknowledge the fact that this time of year can bring up unwelcome emotions such as depression, anxiety, and even anger. If you have a tendency to stress eat this is particularly troublesome for you to manage your weight effectively. I have many past posts addressing this topic that work just as well during the holiday season as they do throughout the year. Remember that if hunger is not the problem, food is not going to solve it. This time of year especially is when we have to be intentional about separating food and our emotions:

Make food about food and emotion about emotion.

Here’s a few quick questions for you though: Why are you sad? Is there someone you can talk to? Are you just stressed because you’ve over-scheduled yourself? Has Christmas shopping overstretched your budget? What things can you address and actually do something about? And what things do you need to let go of?  Most importantly, what are your priorities? I learned a few years ago that when I am clear on my key priorities, it becomes easier to filter my decisions through them. For example, I may be asked to participate in three different “secret santa” gift exchanges, but if one of my key priorities is to manage my budget so that I am able to pay off past debts, the decision to decline the invitations becomes very clear. If I’m asked to volunteer to help with a holiday event but it’s during a time I’ve set aside to spend quality time with my children and they are a key priority for me, the decision to say no is not as difficult and the potential stress of broken promises to anyone is avoided.

Even if you choose just to use one of these, I think it will really change your outcome when you get to January 1. Imagine how it will feel making that resolution and not feeling like you are starting ten steps behind!

P.S. If you’re looking for online support with like minded moms striving to live a healthier lifestyle, you may be interested in joining my free support group here.

 

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Jillian McMullen, RDN, CSOWM, LDN

4 ways to conquer binge eating

Many people struggle with this and it ruins the best of intentions to lose weight or even just maintain your weight. You could be going along happily in your life and then boom, it hits. You know, that hard to ignore urge to binge until you’ve overdone it that ultimately ends in regret, guilt, and food restriction and/or self punishment. What if you could stop yourself before it even happens? It’s possible.

But first, let’s define what a binge truly is. Technically it’s when you are eating something that elicits the feeling of loss of control until you’ve eaten more than is a desired reasonable amount. The quantity and food varies from person to person. Person A could define a personal binge as eating 3 doughnuts while person B could define their personal binge as not until they’ve consumed the whole dozen of doughnuts. Person A could define a personal binge as consuming two servings of potato chips while person B could define their binge as eating the entire family size bag. Make sense? We all have different thresholds in this. No judgement for any quantity, it’s more about when you feel like you’ve lost your sense of self control that leads to feelings of guilt and self punishment. That’s no good for anyone.

So let’s talk about some ways to combat it:

  1. Know your triggers. Understand what sets you off in the first place and then avoid it or prepare for it when necessary. Does going to a party trigger you to binge on the chip bowl? Plan ahead of time and know that you simply can’t hang out around the food table. Does having a giant tub of ice cream in your freezer trigger you to indulge in the entire thing as soon as you’re home alone? Don’t buy it! Does having an argument with your spouse trigger you to run to the pantry and dive into the chocolate chip cookies? Put a post-it note on your pantry door that reminds you to stop and take a few deep breathes before you’re so quick to start eating when food is not what you really need at that moment.
    • Understand this, every habit we have is part of a chain that has multiple links. Each link is attached to the next that produces a result. The key is for you to break the link that results in a binge. It only takes one alteration, like a post-it note, to put a kink in that chain and direct you to a different activity.
  2. Exercise regularly. When we exercise on a regular basis, it keeps a steady stream of endorphins going in our system and helps keep our mood stabilized. It also helps us sleep better and thus, make better decisions throughout the day. Ever been sleep deprived for a few days? Remember how emotional and irrational you were? This is a high risk time for binging. In general, those who exercise just feel better about their health and body and have an easier time maintaining their weight overall.
  3. Start the day with a healthy breakfast. If you are going to skip any meal of the day, don’t let it be this one! Really work hard to eat within 2 hours of waking up and strive for 25-30 grams of protein at that meal. This helps stabilize blood sugars, control hunger later in the day, and thus keeps your mood more even making it less likely for a binge later on. Also, usually when we start our day off healthy, we are more likely to keep it going than when we started our day off not so great (say, with a sugary, high calorie breakfast).
  4. Avoid going more than 3-5 hours without eating. This one just makes sense. If you let yourself get too hungry and the setting is right, a binge is inevitable. Plan for high protein snacks such as cheese sticks, yogurt, deli meat, nuts or high fiber foods such as fresh fruits and veggies to fill in the gaps when meals are spread far apart. Find some other options here.

Lastly, this will be a work in progress for you if you have struggled with binge eating for a long time. The tips I’ve given you will help the person who struggles with occasional episodes of binge eating that they relate to either unhealthy emotions or certain situations that act as triggers for them. I am not referring to someone who has a recognized binge eating disorder which is characterized by behaviors far beyond what is described in this blog post. If you find yourself preplanning binge episodes, eating large quantities of food (in the multiple thousand calorie range) in very short periods of time, purposely eating alone out of embarrassment over the quantity of food eaten, and feelings of “zoning out” and even forgetting what food was consumed during these episodes, you may have an eating disorder and I encourage you to seek professional help from a licensed counselor.

P.S. If you’re looking for online support with like minded moms striving to live a healthier lifestyle, you may be interested in joining my free support group here.

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Jillian McMullen, RDN, CSOWM, LDN

How do I fit alcohol in during the holidays?

Can you believe it? It’s November and the holidays are just around the corner again. I am confident that many of you will have a plan this year and will stick to that plan well. But have you given any thought to alcohol?

Alcohol does a few things – of course it adds a gazillion calories, often unaccounted for. But more importantly, it lowers your inhibitions. So you know those Christmas cookies you swore you would limit to just one? Yeah, you need some self control to stick to that plan and alcohol is going to lower your ability to do that. Double whammy.

I get it. The holidays are a stressful time for a lot of us. Let’s face it, alcohol may be present at just the right time – that work party you didn’t really want to go to in the first place. Or that family gathering that usually ends up in some sort of nonsense argument that you’d rather not be a part of. Or yet again, you go home after a shopping trip you spent way too much money on and now you’re not sure how the electric bill is gonna get paid. Stress. Alcohol, like food, is a quick fix. But only temporary and ineffective long term.

Here are some tips to keep it real and sane this season:

  1. Incorporate alcohol into your plan if you usually indulge. One or two drinks max and then switch to a calorie free seltzer water. Social drinking can also get the best of us. If you continue to drink in a wine glass, but keep it alcohol free, you may surprise yourself how you really don’t notice. And if you don’t usually drink, well don’t start now!
  2. Be aware of calories. Light beer, non-dessert white wines, and liquor in calorie free or low calorie mixers are the lowest options. Dark beers, dessert wines, and fancy drinks can contain up to 800 calories a pop (mudslides, egg nog and rum, margaritas, etc). Know your serving sizes too. Once drink = 12 ounces beer, 4-6 ounces wine, 1 ounce liquor = 100 calories roughly
  3. Destress in other ways. Start with the source of your stress.
    • Lack of time? Find time weekly to do something fun or enjoyable. This may be off your normal routine since the holidays generally keep us busy. Whatever that is for you, just ten minutes of meditation, a few minutes set aside for daily devotions, reading a book, or getting your nails done can make a huge difference mentally.
    • Lack money? Trying a secret santa gift exchange among your extended family, cutting down on the amount of presents you normally buy your friends/family, and simply following a gift budget can all help. Try shopping ahead of time to space it out. It’s only early November and if we’d all start our gift shopping now, it would cut down on a lot of financial stress and keep us from battling the crowds later on. As Dave Ramsey says, Christmas is the same day every year, yet we all act like it’s a surprise emergency!
    • Exercise. We all know this helps with stress yet this will be the first to go when time is slim. Make it a priority this year to walk even if only 20-30 minutes a day. It will help you sleep better and handle any unknowns that come your way better. If you normally do your exercise in the evening, you may have to switch it up and do it in the morning during the holidays with a busier schedule. If you normally take the weekends off, you may need to go ahead and walk on the weekends to make up for missed time on the weekdays. Bottom line, be flexible when your schedule calls for it.
    • In the moment, try aromatherapy. When we are stuck in traffic or at the family dinner and a fight breaks out, it’s tempting to handle stress poorly. But don’t underestimate the power of aromatherapy from essential oils. Personal favorites include wild orange, lavender, and grounding blend. A drop or two can be worn on a diffuser necklace or rubbed between the palms of your hands and inhaled for a quick shot to the limbic brain – the center that controls our emotions.

Let me know what your strategy is going to be this holiday season. Do you have something to add or do you plan do use one of these tips?

P.S. If you’re looking for online support with like minded moms striving to live a healthier lifestyle, you may be interested in joining my free support group here.

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Jillian McMullen, RDN, CSOWM, LDN

Food safety tips during and after a power outage

Many of us in Florida are dealing with power outages this hurricane season and that means our refrigerated and freezer items are at risk for developing bacteria.  The question that immediately comes up is, is it safe to eat? Perhaps it’s time for a refresher on a few food safety tips:

  1. Cold (refrigerated) foods should be kept at or below 40ºF. Your appliance will have a temperature setting to tell you where it’s at, but try to avoid opening it as much as possible so you don’t let the cool air out. A closed refrigerator that is full should keep the food cold enough for about four hours.  Once the temp drops below 40ºF, you have a two hour window before the food becomes an ideal environment to grow bacteria.
    • Hopefully you’ve stocked up on ice and coolers to start putting your important items in. Personally, I suggest consuming high risk items prior to reaching above 40º such as eggs, mayonnaise and mayonnaise based products such as tuna/potato/chicken salad and any leftovers.
    • Fruits and vegetables will last much longer than two hours and many are shelf stable, so don’t worry too much about these. An exception would be berries and grapes that tend to spoil quickly. Eat those first.
  2. Frozen items should be kept at or below 0ºF. Again, your freezer should tell you this, but don’t open it more than you have to. A full freezer will keep the temperature for approximately 48 hours (24 hours if it is half full).
    • It is best to keep the items close together so they keep each other cold. Once it rises above 0ºF, watch it as many of those items will be okay if cooked before reaching above 40ºF. Unfortunately if they go over that 40ºF past two hours, especially frozen meats, it’s time to throw them out. It’s just not worth the risk of getting sick.
    • Remember, you can put some of your refrigerated items in the freezer to keep them under their 40ºF for a longer period of time and you may be able to save them.
    • Having extra ice packs, even dry ice if you can get some, full tupperware of frozen water, and full frozen ice trays stocked in your freezer can help keep the food at ideal temperatures for as long as possible.
  3. Hopefully you stocked up on nonperishables. If you didn’t, there will likely be a next time and might as well plan sooner than later. These are some of my favorites:
    • Quest protein bars
    • Starbucks light double shots (gotta have coffee)
    • Trail mix or mixed nuts or any kind of nuts are great
    • Peanut butter or any kind of nut butter
    • Triscuits (for spreading nut butter on – better than just plain ol’ bread to me)
    • Bananas
    • Tangerines
    • Tomatoes (I could eat these like apples!)
    • Apples
    • Beef jerky
    • Pre-seasoned tuna pouches
    • 3 ounce chicken cans
    • Cracklin oat bran cereal (or granola is good too!)
    • Animal crackers (okay, not most nutritional, but gotta have a crunchy snack!)
    • Dried fruit (I got mini raisin boxes, mangos, and apricots this go around)
    • Pita bread
    • Avocados
    • 1 gallon water per person per day
  4. A sample menu for you using only shelf stable food:
    • Breakfast:
      • Quest bar + tangerine
      • Pita bread with peanut butter and banana sandwich
      • Cracklin oat bran + 1/4 cup dried fruit
      • All to include Starbucks light double shot of course!
    • Lunch/Dinner:
      • Tuna pouch + sliced tomato + 8 triscuits
      • Pita bread + sliced avocado + canned chicken + 10 animal crackers
      • Peanut butter spread on 8 triscuits + mini raisin box
      • Pita bread with peanut butter and banana sandwich + 1/4 cup trail mix
    • Snack tips:
      • No stress eating! This is a stressful time, but it’s not going to make you feel better. I’ve written lots of posts on this in the past explaining why.
      • Stick to the rule of eating every three hours as much as you can. Your meals are possibly going to be smaller, however, so eat to hunger if necessary. High protein, shelf stable snacks include: nuts, trail mix, beef jerky, canned chicken, and tuna pouches. When the power goes out, cheese sticks and yogurt are great to eat up first. I also recommend hard boiling your eggs beforehand so you have snacks and breakfast items to eat while they are still in the correct temperature zones. Remember, you are probably going to have to throw out these highly perishable items anyway- cook them while you can!
  5. What do you do when the power comes back on?
    • Do not, I repeat, do not rely on odor and appearance to determine if a food is safe to eat. You gotta rely on temperatures. Trust me when I say, a food borne illness in the aftermath of a hurricane is not something you want to be dealing with.
    • Throw anything out that has reached above 40ºF for longer than two hours. Period. Especially meats that started to defrost and any frozen items that no longer have ice crystals.
    • If a food has been determined safe to eat and is perishable, such as eggs, meat, etc – be sure to cook it all the way. No rare steak or sunny side up eggs just to be sure.
    • Lastly, when in doubt, just throw it out. You can always replace the food later. Be safe!

P.S. If you’re looking for online support with like minded moms striving to live a healthier lifestyle, you may be interested in joining my free online support group here.

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Jillian McMullen, RDN, CSOWM, LDN

Is weight loss surgery the easy way out?

No, no it isn’t. If you opted for weight loss surgery, don’t ever let anyone tell you that you took the easy way out. If you know someone who opted for it, realize that the decision was most likely made after hours and hours of intense thought and discussion amongst family members and key medical providers. It involves drastic lifestyle changes with a serious commitment to habit alterations. But it’s lifesaving and as I said in my recent post, it is often the best decision that person has ever made for their health.

My goal for this post is to explain the options in the simplest way possible and drive home the fact that, although weight loss surgery may be the most successful end point for weight loss known to date, it certainly is not the easy way out. It’s only a tool, but a damn good one at that.

So here we go, let’s start with the laparoscopic banding procedure. Nothing is changed from your inside anatomy. So you still have your full stomach and intestines intact. The band is purely a restrictive procedure and is just what it sounds like, a band (think of it like a bracelet even) that is placed around the top portion of the stomach. At first, it’s just a fancy expensive bracelet. Shortly after surgery, it can be filled with a salt solution, called saline, to tighten its grip around the stomach, by injecting the fluid through a port that runs from the band to just under your skin. Think of it as blowing up a doughnut ring….that hole in the middle is gonna get tighter when it’s blown up. Problem is, this procedure doesn’t work. I know, that’s a bold statement for me to say, but in the ten years I’ve worked with bariatric surgery candidates, I only saw maybe three patients (out of hundreds) lose the expected 20-25% of their initial starting weight and maintain it off for more than one year. And guess what? All of them eventually had to have their bands removed due to complications and/or weight regain. Luckily, their bands were converted to the sleeve gastrectomy and they were able to continue their lives with a more permanent option.

People see the band as the “noninvasive, less risky” choice. However, that’s just not true. When you have a foreign object placed in your body, it doesn’t like it. The band can slip out of place, corrode, grow into the stomach, get infected, flip over and out of place, the port tubing can get a hole in it and leak, and the possibilities go on and on. Most often, one of two things would happen. I either saw people throw up over and over because food just wouldn’t go down where the band was and eventually their esophagus above the band placement would dilate, or get bigger, and they would end up with essentially two stomachs to fill. Think of it like an hour glass, one on top and one on the bottom….endless hunger. Or I saw them give up and live on liquid, soft foods that slid through the band into the stomach easier…..so milkshakes, pudding, ice cream, jello, mashed potatoes, and even fried foods. It’s not uncommon for someone to even gain weight after this procedure, as you could imagine. Some facilities have smartened up and don’t offer the band anymore. In my opinion, if a surgeon recommends the band to you, run the other way.

The sleeve gastrectomy has gotten lots of attention over the past five years or so for those who have a lot of weight to lose but may or may not have any major health problems. It is a purely restrictive procedure as the surgeon removes around 75-80% of the stomach in a vertical fashion, leaving a banana shape left. Don’t be mistaken, though, your stomach ends up smaller than a banana. Think “man’s index finger” size. It is very restrictive, but what I think helps people out the most is that the part of the stomach that gets removed is also the part that produces the hunger hormone, ghrelin.

So, yea, you may fill up on the same amount of food your two year old niece just ate, but you weren’t really hungry to begin with. And if you have read or listened to any of my content before, you may have heard me talk about how ghrelin increases in production in response to massive weight loss. It can’t with the sleeve gastrectomy. That’s a big plus. I do caution people against choosing this procedure if they have problems with stress or emotional eating or what I call “grazing.” If you don’t eat because of excessive hunger and you have a habit of nitpicking all day long out of boredom or stress, this procedure doesn’t do anything to stop that….you can still eat a small amount of food every couple of hours or so. You can’t, however, sit down to a large meal and finish it in your normal ten minutes. It’s going to take at least twenty minutes to finish off a 1/3 cup of ground turkey. Talk about eating to live! Expected weight loss is anywhere from 25 to 35% of your starting weight. This is life changing for the vast majority of those that are are successful at it.

The last procedure I’m going to talk about here is the roux en y gastric bypass. This one has gotten a bad rep for years which is why I believe there are so many new procedures constantly up and coming, like the stomach stapling at one time, then the lap band, now the sleeve, and the up and coming “balloon” (that’s for another post). But this one has stood the test of time for the last forty years now and remains the gold standard of weight loss surgery. Is it drastic? Yes. Does it involve a huge lifestyle change? Oh yes. Does it work? Yes. I’ve seen lives absolutely change for the better and people leave the hospital off their diabetes medications after having this surgery. There was no waiting period for weight loss, it was immediate. When we talk about this surgery, we are talking about a metabolic operation that changes the body’s hormones with some major rerouting of your digestive system. So, like the sleeve gastrectomy, hunger is no longer an issue. Nothing is actually removed, like in the sleeve, but the part of the stomach that produces the hunger hormone, ghrelin, no longer comes into contact with food. The major difference is that a large portion of the small intestines is rerouted to create a “Y” shape with the new, smaller, egg-shaped stomach and connected lower down the digestive tract which results in calorie malabsorption. Not only are you not hungry and restricted in how much you can eat in one sitting, but you also don’t absorb all the calories you eat at one time. Lastly, high sugar and high fat foods are a no go. You run a high risk of getting sick with the shakes, diarrhea, and breaking out in sweats if you eat even just one small bite of the wrong thing. Interestingly enough, lots of people who have had this surgery experience a change in their taste preferences anyway.

Since expected weight loss is closer to 35% starting weight, I recommend this procedure for the stress eater, person with a slow metabolism, chronic yo yo dieter, and most importantly, anyone with a serious health condition who requires massive weight loss to improve. This would include cardiovascular disease, obstructive sleep apnea, or diabetes.

This is your life, and if someone told you there was a cure for a known disease that you have, would you take it? In 2013, the American Medical Association recognized obesity as a chronic disease. At that point, health insurance companies began expanding their coverage for weight loss surgeries. A chronic disease is something that never really goes away. If you have been struggling with your weight, you know what I’m talking about. You succeed at a weight loss attempt temporarily, but the weight always finds its way back, somehow. I know that this is not for everybody and you may note even qualify.

If it is something you are considering or if you are in a place where you don’t quite qualify, but you’d like some help with your weight, feel free to reach out to me at the below links.

P.S. If you’re looking for online support with like minded moms striving to live a healthier lifestyle, you may be interested in joining my free online support group here.

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Jillian McMullen, RDN, CSOWM, LDN

Why it’s not risky to have weight loss surgery

Although I have never personally been overweight, I am an advocate for those who are. It’s not because I watched a family member struggle or have some heart wrenching personal story to share with you. Circumstances ten years ago just lead me to a position working with people who do struggle with weight.

Through that time, I have gotten to know hundreds, if not thousands, of individuals and their personal stories, and why there is so much more to weight loss than “eat less, exercise more.” I’ve helped a lot of people make the scary decision to pursue weight loss surgery, get their habits (and their mind) right on the way there, and I’ve been there that amazing day when they became a literal new person. So much so, I couldn’t even recognize them standing right next to me as I called them into my office for that two month post surgery check up.

I’ve cried with clients, done happy dances with them when the scale hit a certain number, and held the trash can when they needed to vomit because they ate something they shouldn’t have (yea, sucks to do that in your dietitian’s office.) I’ve been the first person to weigh someone after years and years of avoiding the scale. I’ve been the last person to see someone drink a soda before they chucked it in the trash can for good (carbonation isn’t allowed after weight loss surgery if you were wondering.) I’ve also been the first person to find out they’re going for it, for realz. It’s scary, it’s exciting, it’s terrifying, and it’s truly life changing.

Here’s the deal though, I don’t want to hear that “bariatric surgery is high risk” from people who know nothing about it other than that their brother’s coworker’s aunt’s mother in law had that “stomach stapling” procedure back in the 80s and died. Don’t ever take the excitement away from someone by telling them it’s too risky. 

I do get it. I’ve worked with two or three people out of hundreds that had the surgery and it went terribly wrong. They can’t eat food anymore because they had a rare complication. They get to live on a feeding tube for the rest of their life. I’ve gotten to know a couple of individuals who died months later because their health problems before surgery were against them and weight loss surgery didn’t fix it. It sucked. But they were exceptions, more on this later.

But I’ve also seen people get out of wheelchairs, off their diabetes medications, go on vacations again, and live life out of the house again because of this surgery. And that “stomach stapling” or “risky gastro procedure” everyone is so scared of, was actually life saving to someone that used to spend their entire life dieting without success, counting pills, administering injections, and going to doctor visits because their body became a prison.

If you think it’s about eating less and exercising more, think again. Obesity is not a lifestyle choice. If it was, there would be zero obese people in this world trying to lose weight. Everyone would wake up, cherry pick their dream weight and get to it. But if you’re reading this, you probably know that’s not true.

Here are 5 well meaning reasons why I’ve heard weight loss surgery is an unsafe choice and why they are false. If it’s something you’ve been considering but have been convinced it’s a “last ditch effort,” I want to give you some peace of mind to make a rationale choice. I’m not here to tell you to go do it, but I don’t want you to not go do it out of fear, either.

  1. You could die. Obesity itself is the number 2 cause of preventable death (aside from smoking) in the United States today. In this analysis of 13,871 morbidly obese patients from a national registry between January 1996 and January 2006, the risk of death within 60 days following any weight loss procedure was 0.25%, making it a rare event. A main reason for this is because modern day procedures are typically done laparoscopically, meaning only 5 small incisions about one inch in length each are made to perform the procedure rather than a long vertical incision as used to be made. Medicine is always evolving!
  2. It’s a cop out. And you could die. Okay, this is kind of a continuation of the first, but I felt needed more clarification. Bariatric surgery is emerging as a powerful weapon against severe obesity and type 2 diabetes mellitus (T2DM). Numerous studies confirm that weight loss surgery, particularly Roux en y gastric bypass surgery is more effective at bringing those with T2DM into disease remission than those who were undergoing conventional medical therapy. Some studies that back this up include this one, this one, this one, and this one. But there are several more available in case you need more proof. As a reminder, complications of long term, uncontrolled diabetes include: kidney failure, often requiring dialysis, neuropathy leading to toe and/or foot amputations, and heart disease. Not one of these are known complications of weight loss surgery.
  3. You’re going to throw up a lot. Well, yes, if you don’t follow strict dietary guidelines. I get it, this is not a lifestyle for everyone. It requires consuming adequate amounts of nutrition, 5-6 times/day, when you’re barely hungry. It also means you will be preplanning your meals every day, for the rest of your life, including the small details like quantities, calories, and protein grams. You will also need to be picky about what restaurants you choose when and if you decide to eat out in restaurants. Be prepared to eat slower. A lot slower. And chew well. Choose your food wisely. No room for fillers here when your stomach is the size of an egg. So no air swallowing habits either, like chewing gum or soda. Eat the wrong food item and you may be sorry for hours or days following.
  4. You’ll have no energy. Actually, if you’re frame has been carrying an extra 50-100 pounds it’s not supposed to be carrying and all of the sudden, in a very short person of time (say, 4-6 months?), you lose it 50 plus pounds, just like that? Wouldn’t ya think the opposite would be true? Think of it more like this: you’ve been carrying a 75 pounds back pack for a few years and I just took it off. How would that feel? This doesn’t really matter what your starting weight is, either. 75 pounds is 75 pounds.  You will also be forced to eat better with surgery, that’s part of what the surgery is for. Run through the drive through with some friends and a cheeseburger real quick and you’ll be running to puke. It’s just what happens when you’re digestive system is rearranged and shortened. Better diet = more energy.
  5. You’ll just gain it all back, so why bother going through that? Not true. Statically, 20% or 1 in 5 individuals who have weight loss surgery will regain all of the weight lost following surgery. But that also means 80% or 4 in 5 will maintain that loss. Those who do not have surgery? If your body mass index is above 30, the sad and terrible truth is, statistically <1% of individuals will maintain any weight off. I know….

In case you haven’t figured it out by now, I’m a pretty big proponent of weight loss surgery. This may surprise you, but like I said, I’ve worked with lots of people and I know their struggle. I’m also a big proponent of taking control of your own life, whatever that may mean for you…and I’m here to help you on that journey. I’ve got a ton of posts for the non-surgery folk too, so look around!

There are various types of surgeries, but the two most effective and common choices available today are the laparoscopic roux-en-y gastric bypass and the laparoscopic sleeve gastrectomy. If you want to know more about them, I encourage you to talk with your doctor. This post would go on forever if I described them here, but certainly feel free to reach out to me for resources if you want to know what they are.

P.S. If you’re looking for online support with like minded moms striving to live a healthier lifestyle, you may be interested in joining my free online support group here.

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Email: contact@jillianmcmullen.com

Jillian McMullen, RDN, CSOWM, LDN

Diet hacks for eating less and feeling full

Portion control. Do you cringe when you hear that? It’s more like portion distortion. The bigger is better mentality has surfaced everywhere – smart phones, television screens, computer monitors, boobs (yea, I said it), muscles, tires, cars, houses, and on and on.

Here’s the deal….most of us don’t even know what a portion of any food actually is. And when we do find out, it’s laughable. Why is that? Well, because we have become conditioned to super-sized servings. Now, a portion is an actual MEASURED amount. A serving is whatever you put on your plate. They are two very different things. So here’s a little education for you:

1 portion of carbohydrate = 1/2 cup (cooked, plain cereal like oatmeal/grits, potatoes, pasta corn, peas, beans) (80 calories) *rice is an exception at only 1/3 cup per serving

1 portion non starchy vegetable = 1 cup raw or 1/2 cup cooked, but really – unlimited (25 calories)

1 portion fresh fruit = 1 cup raw, 1 cup frozen or 1/2 cup canned (60 calories)

1 portion added fat = 1 teaspoon (oil, butter) (100 calories)

1 portion nut butter or avocado, sour cream = 1 tablespoon (90 calories)

1 portion nuts = 1/4 cup (170 calories)

1 portion dairy (milk, plain yogurt, cottage cheese) = 1 cup (110 calories)

1 portion of lean meat (chicken, fish, pork tenderloin, egg) = 3 ounces  or 1 egg (110 calories)

1 portion of high fat meat (beef, ribs, fatty fish) = 1 1/2 ounces (110 calories)

Note these are all estimates and foods vary A LOT depending on added sugars and fats or lack thereof. So reading labels is important too. But the key here is to understand that you are probably over-eating. For example, in a restaurant, the smallest sirloin is 9 ounces, that’s SIX TIMES as much as a “portion size”. I’m not saying you can only eat 1 1/2 ounces, but calories count and they add up fast if you aren’t paying attention. It’s really no wonder how people gain weight easily when they are eating out frequently.

But it’s not just restaurants to blame. It’s how we cook at home, too. For instance, when you make pasta – do you cook the entire box? Have you ever looked at the label? A pound of pasta is enough to feed sixteen people if you are sticking to the 1/2 cup serving. If you go with the box’s suggested serving of two ounces or 1 cup each, then you are cooking for eight people. I’m guessing you aren’t feeding that many people for dinner on a regular basis though. So how do you deal without feeling hungry all the time?

Here are some tried and true tricks:

  1. Realize this is not willpower. I repeat – NOT willpower. It’s skill-power. So first of all, STOP cooking for an army and start cooking for the number of people having the actual dinner. I once counseled a couple that did this and each lost forty pounds without changing what they were eating. If you really don’t want to do this, then plan for leftovers, but make two pans/pots/casseroles and immediately put one in the freezer or whatever you need to do BEFORE you start eating. Remove that temptation.
  2. Use smaller plates – as in six to eight inch plates. You know those salad plates you have that came with your ten inch dinner plates. Yeah, those ones. In a study done by food scientist and researcher, Brian Wansink, he explored how an optical illusion leads us to make inaccurate estimates of serving size, depending on what size plate they are presented on. The more “white space” around the circle, the smaller it appears and thus, we feel the need to fill the plate to the edges. Same goes with bowls, in another study he conducted at a health and fitness camp, campers who were given larger bowls served and consumed 16% more cereal than those given smaller bowls. Despite the fact that those campers were eating more, they estimated eating 7% less than the group eating from the smaller bowls. Interesting, huh?
  3. Allow a good twenty minutes to finish your first plate before getting seconds. It takes your brain that long to register that you have eaten. Now I do understand that it can be quite annoying to eat slow if you are a naturally fast eater. So I suggest if you zip through your meal in five to ten minutes, then wait for the next ten minutes to pass before you decide if you truly need a second helping. And if you do, go for veggies first since they are the lowest in calories.
  4. Use the plate method and shift the calorie make up on your plate. This goes with the concept of a volumetrics type diet. Notice how vegetables only have twenty-five calories per portion? But the starchy carbohydrates have eighty? And that’s assuming you didn’t load them up with gravy, butter, or other fats. Same with meats, 110 calories per one to two ounces? Fill up half of your plate with non-starchy vegetables (so NOT corn/peas/potatoes), a third with high fiber carbohydrates, and the rest with a meat, preferably a lean meat. If it’s breakfast time, fill that half with fruits. Make sense? You are eating more low calorie foods and less high calorie foods, but not sacrificing volume. Another way of looking at is like this: one cup of salad dressing is around 1440 calories, one cup of nuts is 680 calories, one cup of fat free milk is 90 calories and one cup of raw vegetables is 25 calories. In other words, a large plate of pasta is going to be a ton more calories than a plate of salad. Here’s the issue with most of us: usually our plates are half meat (often high fat), half starch, and vegetables as an afterthought or something starchy like corn (at least here in the south!) Personally, I prefer the plate method over measuring my food. I got kids and if I don’t inhale my food, I don’t eat before there’s an explosion of a hot mess in my house. Like many of you I’m sure, I don’t get the luxury of measuring, weighing, and taking my time to eat dinner – so I’m thankful for these hacks that still make it possible to eat well.

Lastly, remember that the above will not work if you arrive to the dinner table starving. The day starts with a healthy breakfast, planned out high protein snacks and a healthy lunch. If you didn’t eat high protein, healthy foods every three to five hours earlier in the day, you can forget about the rest because you will want to eat the refrigerator door by the time you sit down for dinner and a six inch plate will just piss you off. For tips on preplanning meals – head over to this previous post on how to do that.

P.S. Love to eat out but not sure how to fit it in with your health and wellness goals? Get these tips  sent to your inbox and hopefully they will help you out.

P.P.S. If you’re looking for online support with like minded moms striving to live a healthier lifestyle, you may be interested in joining my free support group here.

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Email: contact@jillianmcmullen.com

Jillian McMullen, RDN, CSOWM, LDN

Anxious eating & why it’s the worst!

I used to think I wasn’t an emotional eater. That I couldn’t understand the concept of eating when you’re sad, lonely, angry, overly stressed, or even bored. Until I found myself devouring a bag of m&ms down into my anxious stomach.

Anxiety. Most of us feel it at some time or another. It’s our body’s healthy response to imminent danger. Except when there is none. And then we’re just sitting there fearing the world around us but we really don’t know what is making us want to jump out of our own skin. So why food? It’s a distraction. And a damn good one at that.

Anxiety is really uncomfortable. Our world gives us so many reasons to feel it more often than not. The symptoms range from a flipping stomach, mild or severe headache, pounding heart, shaky hands, sweating, inability to focus, crying, irrational fear. None of these symptoms are easy to sit in. And multiply them by ten during an anxiety attack. The most common reason for ER visits in the U.S. is due to chest pain, which is often caused by anxiety attacks. Anxiety attacks from unsuspecting individuals that think they are having a heart attack. I believe this is why many people fall into drug and alcohol addiction or otherwise. Escaping it consumes the thoughts of an anxious person.

And then there’s food. High carbohydrate, high fat, sugary food to be exact. Why? Because it triggers a dopamine response similar to narcotic-like drugs that lessens the anxiety. But, exactly like a drug, over time the brain becomes less stimulated by the food and needs more to experience the same effect. This is why people can feel like they’re addicted to sugar. In a sense, they are.

How can you get rid of it without becoming addicted to an unhealthy habit? I was taught by a psychologist that the best way was to ride it out. Sounds crazy right? But in reality, an anxiety attack isn’t going to kill you like a heart attack and it WILL eventually end. The fear that leads to the unhealthy habit to make it end NOW is that it will NEVER end. But rest assured, most anxiety attacks end in an average of 10 minutes.

What about that nagging, everyday anxiety that many of us feel until we’re elbow deep into a bag of potato chips? Personally, I’ve found listening to music, prayer, and deep breaths with citrus essential oils to be most helpful. If you don’t have citrus essential oils, a fresh cut orange, lemon, or grapefruit will do. Studies have indicated that most adults take shallow breathes from our sternum. However, as children, we start out taking deep, slow breathes from our abdomens – about six per minute. This is how we are naturally built. But as we age and life happens, we take quicker, shorter breaths that feed less oxygen into our nervous systems. No wonder stress has such a damaging physical effect on our bodies!

For other types of emotions I’ve recommended journaling. For the anxious person this isn’t always realistic due to the inability to focus. So try simpler tasks like coloring, painting, and going for a short walk. Thing is, as I’ve said in my previous posts on the subject of emotional eating, you won’t know what works until you give it a shot. We all know eating works. But if you’re reading my posts, I’m guessing you want to get away from that.

Let me know in the comments what you discover works for you, whether in this post or not and let’s help each other!

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How to fail at weight loss in 4 easy steps

“I’ve been working really hard at this! Why I haven’t I lost weight?!”

I hear this question all the time. There isn’t just one answer to this seemingly simple question. But I’m going to attempt to offer some insight here that may help many of you out.

Here we go, how to fail at weight loss:

  1. Go the the gym. And nothing else. You’re burning more calories right? Wrong. Going to the gym doesn’t give you a license to sit the rest of the day. And definitely not one to continue eating as usual. Losing weight is 80% diet and 20% physical activity. You simply can not lose weight and continue with your afternoon sweet fix, sweet tea at dinner, Friday night pizza and wings, and coffee with extra whip cream every morning. At best, you can expect to burn an extra 200-300  calories at the gym, the equivalent of one slice of pizza, a small McDonalds fry, or 1-2 cookies. Depressing, I know.
  2. Skip meals. Sounds counterintuitive. Skipping meals means eating less calories, right? Wrong. Think of your body as a car that needs fuel to keep going. What fuel is to a car, calories are to the human body. Without it, we are like a car that has run out of gas or otherwise, a metabolism that simply cannot move. When you go more than five hours without eating, this signals the body’s metabolism to slow the heck down and conserve, rather than use, energy. You’re like a parked car. And guess what? Next time you eat, not only are you ready to eat the table, your body is in storage mode and now is going to store MORE calories at the meal than it would have if you were eating more frequently. You know “those skinny people” that seem to be eating all. day. long. And you probably hate them for it? This is why. They keep their metabolisms going 100 miles per hour. You can do the same, just not with junk food, ok?
  3. Continue to use food for comfort. This one sounds like a no brainer, but it is the number one reason I see people struggle to see ANY results at all in their weight loss goals. If this is your M.O. you gotta address it before you even think about anything else. Sure, food is readily available and as I mentioned in my previous post, create a fantastic dopamine response (aka feel good) in the brain, but it’s never going to help you lose weight if used as comfort. I’ve written lots around this topic and suggestions for overcoming it in previous posts. But remember this: let food be about food and your emotions be about emotions. Food was never supposed to be centered around your emotions.
  4. Don’t go grocery shopping. When working with a new client, one of the first questions I ask is “how often do you go to the grocery store?” And the second one is “do you make a list?” That can tell me a lot about their meal planning habits. News flash: fresh fruit, vegetables, greek yogurt, and grilled chicken won’t magically appear in your refrigerator. The old cliche “when you fail to plan, you plan to fail” applies here. Someone has to purchase this heathy food, prepare it, and get it in front of you, preferably on a kitchen table. Not on a coffee table in front of the television or on a desk in front of the computer. Again, food is about food – to be eaten in the setting of a meal at a table, not eaten all over the place.

There are lots more reasons why people fail like expecting massive results too quickly, trying to change their whole lives overnight, refusal to make important changes, genetics or just a history of significant dieting in general. I will plan to address these in future posts. But for now, I implore you to take an honest review of your own habits and decide to change what’s holding you back.

If you need some help and are interested in a free 30 minute telephone wellness consult, contact me here and I will get back to you in the next 48 hours to schedule an appointment with you.

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Email: contact@jillianmcmullen.com

Jillian McMullen, CSOWM, RDN, LD