Episode 23: A Guide to Healthy Eating with Dr. Kara Nance

 

“I don’t think the fear of disease or the fear of adverse consequences is what gets anybody to make a long term change. I think it’s connecting with the positive aspect of whatever it is you’re choosing.”

In this episode of the Numinus podcast, Dr. Joe speaks with Dr. Kara Nance. Kara is a physician, double-board certified in Internal Medicine and Obesity Medicine. She is the founder of WellessenceMD, a medical practice in Chicago with an innovative, integrative approach to primary care and weight management. Kara is a certified Mindfulness-Based Stress Reduction teacher and uses mindfulness with her patients to address the cognitive, emotional, and behavioural components of diet.

Kara takes Dr. Joe on a fascinating tour of nutrition science, clinical best-practices, and the wisdom she has gained from many years of practice. Their conversation covered:

If you’d like to learn how to practice mindfulness to help with your diet, eating habits or any other unhelpful habits, please reach out to Numinus: numinus.com

Connect with Dr. Kara Nance on the Wellessence site and Facebook.

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Here are some highlights from their conversation:

What other approaches besides the ketogenic diet are you recommending to your patients?

The number one thing that I say is to all extents possible avoid processed foods. I think that anything that is not a whole food is a potential culprit.

There was actually a recent study done where people were fed a processed food diet versus a whole food diet. And they had the exact same number of calories and the exact same macronutrient distribution. But one was processed, and one was not.

And what we discovered was that the people who were eating the processed foods actually consumed more calories than the people who weren’t eating the processed foods. So I do think that’s pretty interesting. They consumed those calories over a similar period of time. It seems like they ate a little bit more quickly. So that’s the first thing that I say, try to get to a whole foods diet as best you can.

I also tell people to become mindful of how many carbohydrates they are eating. And then if people want to go through a detox and just get off sugar completely, there’s a variety of ways that we can support people in doing that. But even just saying, ‘I’m going to have 50 grams per day less than I do right now on average.’ And maybe the next month or week taking it down another 50. That’s another reasonable approach.

Although if people are addicted to these sugars and these carbs, it can sometimes be more difficult to do that than it is to go cold turkey because we have to remember that craving can be like a bonfire. Where the more you feed it, the stronger it becomes. So if you just stay away from the sugars, stay away from the carbs, the cravings will lessen over time for sure.

There’s no one food that I think all people are potentially addicted to. I think it’s a wide variety.

So back to the question about other diets. The paleo diet is another one that I think many people do well with. This is a diet that says, ‘Let’s try to mimic what our ancestors were eating a hundred thousand years ago.’ It’s a variety of animal based proteins, as well as naturally occurring animal and plant based fats as well as a wide variety of any fruit or vegetable that you can find.

Now some people will have trouble with fruit. We have to remember that our fruits have been genetically selected to be very sweet and have high levels of sugar. So I actually have some patients that identify as fruit addicts. And had taken everything else out of their diet and were still metabolically stuck until they took fruit out as well.

Can you speak to what the science says is the most healthy way to eat?

The interesting thing is that–there was a recent study done that looked at a wide variety of different diets. It looked at them in terms of weight loss. And it actually found that with all of these different dietary approaches similar amounts of weight loss were achieved.

They also saw that with all of these different dietary approaches after a year similar amounts of weight regain also occurred. So if you trust that data, there’s really not necessarily one diet that’s best for everyone.

Now with that being said, if you have certain metabolic diseases like diabetes, I think that a ketogenic diet may be a better strategy. But I think this whole idea around saturated fat and cholesterol and these kinds of foods leading to heart disease is only true if you’re also eating those foods with carbohydrates. In the absence of carbohydrates, the oxidizing effects of the cholesterol and the other inflammatory things that we know lead to disease processes really don’t seem to be happening with protein and fat, even from animal sources.

Well, that sounds kind of important. I’m not sure how many people are aware of that.

Yeah. Yeah. On the one hand, I want people to hear that a ketogenic diet is a healthy alternative, but if you decide to just increase the amount of protein and fat you’re eating, and you still have your toast, and your rice, and your cookies, you’re actually probably creating more harm than if you were following a more traditional mediterranean diet. That was one of the ones you mentioned that has more like 30% fat, instead of the 65% fat of the ketogenic diet.

So I think that it’s important to look at the overall diet and your overall compliance rate. And just figure out where it is that you think you can land.

And if you do want to try to follow something that is a lot stricter like a ketogenic approach and you do fall off the wagon, recognizing that the sooner that you can get back into your ketogenic habits, the easier it will probably be.

The yo-yo diet effect actually can be somewhat detrimental. There are some studies that suggest each time people regain their weight, they regain a little bit more than what they had lost. And that’s not the result of fad dieting or the ketogenic or any specific dietary approach. It’s just when the set of habits is abandoned that enabled the person to lose the weight, the body goes back to this fat-mass set point. And it seems like each time the set point rises a little bit higher. So it’s a little bit harder to get back down there the next time.

So if something is too restrictive and is resulting in a lot of yo-yoing in regards to weight, then I recommend that people get rid of the processed foods to the best of their ability and just really to pick whatever approach that they sustain with more ease, with less suffering. Because at the end of the day, we want eating to bring joy. Eating is a wonderful thing. And we really don’t want to overcomplicate it or make ourselves too stressed. But I think it’s important to have these intentions around what do I think is going to be best for me.

Mindful Habits

Let’s face it: almost everything we do in life is tied to a habit. Life is simply too complex to think everything through. Could you imagine having to lay out explicit instructions on how to drive a car? Or cook a meal? Or walk? Or even breath? Thankfully, our brains automate these sequences, by creating habits, which free up numinus for more interesting concerns like how to deal with a sticky problem at work or make our own lives happier or more meaningful.

All of this automation comes at a cost though. Whether we like it or not, habits are continually shaped by all the positive and negative reinforcements we encounter over the course of each day and we are not entirely in control of this process. As a result, we sometimes develop bad habits like eating too much sugar or spending too much time on facebook, or in the extreme, addictions to thing like drugs and alcohol. The science of habit formation is beginning to show us how exactly this works and even point to some cool ways to take back control.

The Habit Loop is an incredibly important model for understanding habits. The loop includes 3 components: cues, routines, and rewards. A cue is anything that triggers the habit. It can include something in the environment that we see or hear or something internal like a state of mind or sensation in the body; a routine is the actual behaviour associated with the habit, like eating chips or checking facebook; and a reward is the positive experience we have following the behaviour. Rewards typically trigger the release of a brain chemical called dopamine, which feels really good and makes our brains more likely to remember and reproduce the behaviour in the future.

Let’s look at a few examples to help clarify the habit loop. You’re driving down the highway around noon and you’re hungry. In the distance you begin to see McDonald’s golden arches on the side of the road. That’s the (visual) cue. Your brain calls up the McDonald’s restaurant script and next thing you know, you’re parking, ordering, paying, and eating. That’s the routine. The salt, sugar, and fat in the Big Mac trio you just consumed fills you with a sense of pleasure and satiation and you feel happy (for now). That’s the reward. Going through that loop reinforces the habit and makes you that much more likely to do it again the next time you see the cue.

A similar loop applies to your morning caffeine ritual. You wake up and notice groggy state of mind (internal cue), make and drink coffee (routine), and groggy feeling is replaced by sharp alertness (reward). Habit loops can shape helpful routines as well. If you’re having trouble staying motivated to go to the gym, keep your running shoes or gym bag somewhere clearly visible in your environment. So next time you’re walking in your home and you see your running shoes (cue), you’ll be reminded of the going to the gym routine, and be more likely to enjoy the relaxed, energized feeling you get after a workout (reward).

Habit loops are playing out all the time in our use of technology. See the notification of 13 unread emails on your mobile device (cue), open email app and scan new messages (routine), experience release of stress if there is nothing urgent to deal with (reward) or burst of excitement if you get some good news (reward). The habit loop is partly what makes email and social media addictive. The constant reinforcement we get from these apps strengthens the association between the cue and the reward and the habit gets stronger and more automatic. If we’re not careful, our lives can get overrun by a series of unhelpful habit loops.

So how do we take back control? The trick is to be mindful habit loops so that we can deconstruct the unhelpful ones and shape the development of helpful ones. Once the virtuous habit loops are in place, we can let go and let them run on autopilot. Here’s how.

When you come across a cue, you can usually observe subtle changes in your experience that indicate you are warming up to engage in a routine. For example, you might notice salivation when you see the golden arches, a sense of urgency when you see an email notification, or feeling of impatience when you feel tired in the morning. Bring mindful awareness to all of these sensations, by pausing and observing them with interest and curiosity, rather than jumping right into the routine mindlessly. This pause and change in perspective creates space to make a skillful choice about what you do next. You may choose to proceed with the routine anyway, if that’s what is called for in the situation. Or you may choose to pursue a different course of action, thereby establishing the foundation of a different habit loop. The important thing is that it becomes a choice, rather than something you do reactively.

The next step is to bring that same mindful awareness to the reward. Sometimes the dopamine hit following the routine is not as wonderful as we anticipated. Really tuning into the experience and aftermath of eating junk food or staring at a little screen sometimes exposes the unpleasant aspects of those routines, which can in itself help weaken the habit. Sometimes, the reward for other routines like exercise are more reinforcing than we anticipated and that awareness can strengthen the habit. And sometimes, simply choosing not to engage in an unhelpful routine feels empowering, which is rewarding in itself. Regardless, we need to actually bring awareness to our experience to see the impact of our habits clearly.

Now that you know the mechanics of habit formation, see if you can bring your mindfulness practice into the picture to take back control of your life!

Eat, Drink, and Be Mindful

Hanukkah starts this week and Christmas is right around the corner. While the holidays can be exciting time of year, they can also be stressful for people who tend to overeat, binge eat, or eat mindlessly. Almost every holiday party and event offers an abundance of delicious sweet and savoury goodies, and the holidays tend to create a joyful and permissive environment that promotes overindulgence.

There’s nothing wrong with enjoying the holiday season with a little pleasurable overindulgence, but overeating that leaves us feeling sick or upset can be avoided by practicing mindful eating.

Mindless Eating

Many of us eat mindlessly much of the time. Examples include eating on the go, eating too quickly, eating everything that’s put before us, eating even when we’re full, and snacking simply because food is available. Even when we’re eating food that’s good for us and aren’t overeating, we often fail to be present when we eat.

Mindful Eating

Eating mindfully simply means bringing mindful awareness to the table whenever you eat. It’s not a rule or a diet, rather, it means becoming more aware of our eating habits, particularly those that sabotage eating well. In so doing, we learn to make better decisions surrounding food–and to have compassion for ourselves when we make less helpful choices.

Mindful eating author Susan Albers outlines three steps to mindful eating using the mind and the body. Together, these steps direct our attention and awareness directly toward our food and toward our thoughts and feelings about our food.

1) Tune in to the physical characteristics of food and to physical feedback about satiety. Use your senses to pay attention to how your food smells and tastes, and to how it feels in your mouth. Is it hot, cold, or lukewarm? What are the different textures? Can you identify distinct notes of spicy, salty, sweet, and tangy? Notice whether or not the food you’re eating satisfies your taste buds, whether it’s something your body really wants to take in. At the same time, keep track of the feedback from your body about fullness. Are you 50% full? 80% full? How do you know?

2) Tune in to repetitive habits and eating on autopilot. Notice how you eat by tuning in when you’re eating on autopilot. This includes things like having a snack at the same time every day; eating something every time you walk into the kitchen, even if you were simply intending to pour yourself a glass of water; or eating the same foods every day. You might notice autopilot habits like always eating if others are eating, stopping only when your plate is empty, or multitasking while you eat.

3) Tune in to emotional triggers for mindless eating. Become an expert on the emotional triggers that prompt mindless eating. Do you head to the vending machines when you’re frustrated with a problem at work? Do you always overeat when you’re with a certain friend, or when you visit your childhood home? Does a bad day trigger the desire for comfort food or do do you head to the buffet table when you’re feeling uncomfortable at a party? When you eat, ask yourself “What am I feeling? Am I emotionally or physically hungry?”

Getting in touch with the sensory experience of eating can help us take pleasure in foods we eat so frequently we don’t taste them anymore (e.g., our morning toast, cereal, coffee). Furthermore, paying close attention to the experience of eating often helps us slow down, giving us the chance to notice often-ignored internal feedback about hunger and fullness.

Identifying our autopilot habits can trigger reflection and help us make different choices based on awareness. Getting to know the emotional triggers that push us to eat when we aren’t hungry can help us anticipate and understand the urge to eat. Knowing that the urge doesn’t necessarily correspond with physical hunger can help us respond more effectively to our emotional needs.

The practice of mindful eating can transform food from a source of stress into a source of nourishment and pleasure, allowing us to be fully present to enjoy the holidays.

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This article is based on Dr. Susan Albers’ Eat, Drink, and be Mindful.