Clean

Out of the Mouths of Babes

Just before Christmas I was at an artisan food market in my other guise as a food producer. To my left and juxtaposed against Glamorous Jam was a friend and baker who specialises in ‘clean cakes’; free from refined sugar, wheat flour and with lots of raw, ‘plant-based’ ingredients. She has developed something of a cult following with people returning from a local yoga class looking for a ‘guilt-free treat’. That morning the baker was engaged in a conversation with a fan; a mother who was telling her about her ethos on food. Sugar is poison and verboten in her home. She spoke with pride about how her husband used to cook a lot of the meals when they first dated but how she refused to let him cook now; from the moment that she became pregnant with their daughter she had taken total control of the kitchen.

As she spoke her daughter wandered off and approached me. Bright and inquisitive she asked,

‘What’s that?’

‘It’s jam.’

‘Does it have gluten in?’

‘No, it doesn’t. Why do you ask?’

‘I’m not allowed to eat gluten.’

‘Why is that?’

‘I don’t know I just know that it is bad.’ She paused and then asked, ‘How do you make it?’

‘Well, you put some fruit and some sugar in pan and….’

She interrupted with a gasp and her tiny face pinched into an expression mixed of disgust and dismay. ‘It’s got a lot of sugar in it!’

‘Well, yes, it has.’

‘Oh.’

‘How old are you?’

‘Six.’

She turned and walked back towards her mother who was preparing to leave when the girl pointed to a small dial operated vending machine, the kind that sells only one product. There were two machines side by side. One selling Pringles and the other Skittles. The girl pointed, could she try some of those?

‘NO!’ This was from both her mother and the baker.

‘You don’t want those. Those are disgusting!’ the baker told her.

‘No, you must never eat those,’ her mother added, ‘Listen to what she says. She is a master chef so she knows.’

This conversation left me disturbed for a number of reasons, all related to my work as a psychologist working with people struggling with disordered eating and eating disorders. With the caveat that I know nothing about this woman – I don’t know whether it was difficult for the couple to conceive or whether her daughter was a sickly infant. I know nothing about the mother’s own history with food. My thoughts are solely a synthesis of my clinical experience and my observation of both this mother and child.

My fear is that it will be impossible for this young girl to grow up without a conflicted relationship with food, for the following reasons:

1. This girl is explicitly being taught to fear food. She doesn’t know why but she knows that gluten is ‘bad’. Maybe she is gluten intolerant. Maybe. I got the sense that she was bright enough to say if she had been diagnosed with Coeliac Disease. That did not seem to be the case. Rather she had a vague sense of the ability of gluten to harm her. Others have written at length about the lack of plausible evidence behind this assertion, but often, in online wellness blogs and books, gluten is demonised as an anti-nutrient. In truth it is employed as a specious reason to restrict carbohydrate intake for weight loss reasons. But the largely unfounded warnings about its dangers persist.

2. What is implicit in this ‘How to Fear Food: 101’ is what this young girl is being taught about her body. The human body is incredibly resourceful and robust and childhood is a time of rapid cell growth, development and repair. It is a time of exploration and discovery of what the body is capable of and the carefree joy of movement. Yet, already at the age of six, this girl is being taught that her body is fragile and that a handful of crisps present a significant danger to it.

3. She will come to understand that her mother’s approval of her is linked to the types of food that she chooses to eat. To put it another way she will learn that, at least in this aspect, her mother’s acceptance of her is conditional; she can please or displease her mother based on the food she chooses to put in her own body. This is particularly harmful in a society where girls are taught to be good, sweet and obedient. This kind of conditioning prevents her from learning to make food choices based on her own appetite and wants. As a consequence, it will, I believe, be much harder for this young girl as she grows up to drown out the external rules about food and the voices – from magazines, untrained bloggers, peers etc. – telling her what she should eat.

4. Clearly this young girl is curious about these forbidden foods. We know that making a food off-limits, whether we are dieting or under instruction, tends to make that food more attractive and encourages food rumination (excessive food thoughts). Caught between her innate curiosity and the restrictions imposed by her mother I worry that the scene is set for later binge and/or secret eating. It is easy to imagine: as an adolescent with greater control over her diet she perhaps sees her friends eating foods that have been denied her and suffering no obvious ill effects. Knowing that her mother would not approve, and, on some level, having internalised this contempt for sugar-sweetened or ‘unclean’ foods, she can only allow herself to eat them furtively, in secret. Perhaps she must have as many of them at once. Afterwards, knowing that she has transgressed, she experiences a deep sense of guilt and ‘weakness’ for not having been able to resist these foods. To get rid of this feeling and in order to feel ‘clean’ again she purges and returns to the clean, ‘safe’ foods, until the next time.

5. Alternatively, she simply rebels. A part of her, angry and frustrated by the intense dietary scrutiny and control that has been exercised over her, just chooses to disobey. Susie Orbach’s (1978) seminal work on women’s struggles with food and their bodies poses the argument that, for many women, obesity is the physical manifestation of a psychological rebellion against the familial and societal mores placed on women.

I recently saw this mother and child again. The mother came to find the clean cakes but, discovering them unavailable, she was not interested in anything else. As the mother asked about the absent vendor her daughter wandered towards another stall. There stood two talented patissiers, the pastry chefs for a renowned middle-eastern chef and food writer, displaying their handmade cakes. Caramelised brownies concealing a clever layer of crisp feuilletine; a perfectly straight-edged all-butter sablé tart filled with fragrant passion fruit curd and topped with a fan of spiced, marinated fresh pineapple. Delicious foods made with excellent quality ingredients by skilled and passionate chefs. Before the girl could ask about them her mother called her away. There was nothing here for her.

I hope this does not read as a castigation of a mother who I understand is trying to do the very best for her child. Evidently, she and her partner are doing a good job: they are raising an inquisitive, confidant daughter. I will be joyous with relief to, in 10 years’ time, be proved undisputedly wrong. But when I work with young women (the majority of my work with eating disordered clients has been with women, both individually and in groups) who have so lost connection with their own bodies that they cannot tell whether they are hungry or full. When they describe how they ‘know’ their value to their parents is contingent on their appearance. When their own opinions have been so degraded that they don’t even bother to disagree anymore, not at least with words, instead their rage is expressed through their aggression towards their own bodies. When you sit with someone who is in despair about whether they deserve dinner, you become less hopeful. Not hopeless, never hopeless, but the path between what I saw in the market and what I see in clinic is well-trodden, and it makes me sad for the loss of freedom and vibrancy in these beautiful young people.

And that’s why I am angry. Because I worry about the lost hours, months and years of discovery, pleasure and productivity that lie ahead for children and adolescents raised in environments of harmful restriction and food fear. When children are taught to ignore their appetites, deny their curiosity, and distrust their own bodies. When, at the same time that they are being taught that it is morally wrong to hit, kick or be unkind, children are receiving messages about the ‘goodness and badness’ of certain foods, their own appetites inappropriately become part of a moral dilemma. Am I a bad person for wanting to eat crisps? Will my mother be hurt if she finds out I ate those biscuits? Somewhere down the line these questions mutate into a deeply held doubt as to whether their bodies are truly their own or whether other people will always have the right to tell them what to do with them. Of course, we need to raise our children with an appreciation of healthy and delicious foods and a caring respect for their bodies, but this must be done free from emotional conditions, nameless fear and moralising or else their physical health will be the least of our worries.

 

 

References

Hart, K. E. & Chiovari, P. (1998). Inhibition of eating behaviour: Negative cognitive effects of dieting. Journal of Clinical Psychology, 54, 427-430.

Herman, C. P., & Mack, D. (1975). Restrained and unrestrained eating. Journal of Personality, 43, 647–660.

Orbach, S. (1978). Fat is Feminist Issue. London: Paddington Press.

Sumithran, P., Predergast, L., Delbridge, E., Purcell, K. Shulkes, A., Kriketos, A., & Proietto, J. (2011). Long-Term Persistence of Hormonal Adaptations to Weight Loss. New England Journal of Medicine, 365, 1597-1604. http://www.nejm.org/doi/full/10.1056/NEJMoa1105816#t=articleMethods

What’s wrong with the New Year Detox? Well, pretty much everything.

 

First published 31 Dec 2015

It’s coming to the end of the Dead Zone, those few structureless days between Christmas and New Year’s where there are no rules. Nobody knows what day it is or what to do (is it still okay to eat mince pies?) We’re off work but there’s nowhere to go because we’re all broke from festive fiscal excess. And that’s not the only extravagance we are left to contemplate. Three solid weeks of unabashed eating, drinking and being merry have left most of us with a little more abdominal insulation than seems fair – we were having such a good time. Now we have a few long days to rub our bellies in forlorn resignation, lamenting our gustatory largesse and making heartfelt, if vague, promises to put it right on the first Monday in January. So, it’s less of a ‘Dead Zone’ and more a kind of alimentary purgatory where the already devoured sins are weighed up against the promises to repent.

Repentance comes in the most puritanical of forms, the January Detox, a month of mass mania and ritual self-flagellation. Bodies are pounded on pavements and vile-tasting shots of medicinal herbs are downed in order for the body to be cleansed. This annual penance for the sins of December results in maybe a few pounds temporarily lost but comes at the cost of a month of your life spent in constant self-loathing, misery and deprivation. This is clearly no way to live but it has become a Hunger Game that we play with ourselves, goaded on by the innumerable media outlets and self-styled gurus looking to cash in on this most harmful annual custom. And it certainly is harmful, both physically and psychologically, and it’s about time that we stopped.

There are so many fundamental problems with the January Detox that, like a chocolate orange, it is better to break it down into chunks.

The Science Problem

The first of many problems with the January Detox is the one that is the easiest to expose: it has absolutely no scientific basis. Unless you are addicted to heroin or have been licking lead pipes and require medical intervention detoxing is not a thing. Year after year doctors and science writers valiantly debunk the myth that your body needs the assistance of juices, gels, patches, enemas, or celebrity endorsed magic water to eliminate waste products. They say things like this:

“Let’s be clear,” says Edzard Ernst, emeritus professor of complementary medicine at Exeter University, “there are two types of detox: one is respectable and the other isn’t.” The respectable one, he says, is the medical treatment of people with life-threatening drug addictions. “The other is the word being hijacked by entrepreneurs, quacks and charlatans to sell a bogus treatment that allegedly detoxifies your body of toxins you’re supposed to have accumulated.”– The Guardian, December 2014 (1)

They present reviews of the available literature and conclude: “To the best of our knowledge, no randomised controlled trials have been conducted to assess the effectiveness of commercial detox diets in humans.” (2) That is to say that there is no good quality evidence that any of this stuff works. Or just ‘no evidence’.

We are reminded that no two manufacturers of detox products or purveyors of detox diets can agree on what a toxin is but we blithely trundle on in the pursuit of purity presumably because the idea of a ‘detox’ performs a wholly different function to the reality of it. I’ll get to that in a bit.

As with many other illusions that we like to keep hold of in the face of objective scrutiny (and we all do at times) the wealth of contradictory evidence is casually dismissed in favour of specious subjective experience. During the annual purge detoxers report experiencing symptoms such as bodily aches, brain fog, cravings, acne, poor sleep and digestive problems all of which are referenced on health and weight loss websites as being signs that you are detoxifying (hoorah!). All of which can be more credibly attributed to inadequate caloric intake and a sudden change in diet (oh, wait…).

But, no big deal, right? So maybe it doesn’t technically do anything, there’s no harm done and maybe it will kick-start some healthy changes, yeah? Um..no.

The Sustainability Problem

This is where it gets a bit technical (*dusts off A-level biology textbook*). The reason that diets of this kind are indicated for short periods of time is because they are inherently unsustainable. When you drastically reduce your caloric intake below basal metabolic rate (the amount needed to keep the organ systems ticking over) it doesn’t take long for the body to glean that there is something drastically wrong. After about 2-3 days the body’s glycogen (sugar) stores are depleted and metabolism switches to using fat as fuel and the production of ketones that the brain can use for energy. There is still, though, a small sugar requirement. In the absence of dietary carbohydrates these missing sugars are synthesised from the body’s own proteins. The body will begin to break down lean tissue (muscle and organs) because ‘the first priority of metabolism in starvation is to provide sufficient glucose to the brain…Initial sources of protein are those that turn over rapidly, such as proteins of the intestinal epithelium. (3) It is worth knowing then that the cells that line the intestine create a barrier between the contents of the gut (including pathogens) and the rest of the body. Damage to this lining impairs the immune system and exacerbates digestive disorders such as IBS and Ulcerative Colitis (4). In the long term very low calorie diets can cause serious damage to the organs and this is the reason that Anorexia Nervosa is the most deadly psychiatric condition, with death often caused by heart or kidney failure.

Of course I’m not talking here about chronic psychiatric conditions. A detox is only a month, maybe six weeks so the risks of long term damage are low. Except they’re not. A study published in 2011 (5) looked at the long-term effects of short term ‘very-low-energy’ (500-550 calories per day) diets. A year after completing the 8 week diet:

  • Levels of leptin, the hormone responsible for feelings of satiety, were significantly lower than at the start of the study

  • Levels of ghrelin, the ‘hunger hormone’ were significantly higher

  • Peptide YY, an appetite suppressor, was lower

  • Self-reported ratings of hunger, desire for food and urge to eat were higher as were preoccupations with food thoughts

  • Participants expended less energy and felt less full.

So brief exposure to a very low calorie diet resulted in long-term hormonal changes that left the dieters hungrier and more obsessed with food than they had been at the start, increased the likelihood of subsequent weight gain and made it harder to lose the next time. The particular cruelty of this situation is that dieters who regain weight (and 90% of all dieters do) will believe – or worse, be told – that it was their lack of control or the failure of their willpower that is to blame, not the powerful biological adaptations to starvation that were set in motion by the diet/detox in the first place. It is a pernicious lie and it makes me angry. Throw the sense of total failure in to the pot with the misery of feeling hungry and deprived the whole time and the fact that this is no long-term solution becomes self-evident.

The irony is that not only does the body resist restriction but the brain does too. In a paper published in 1975(6) restrained eaters - people who tried to rigidly control what they ate and avoided unhealthy foods – tended to overeat when their guard was down. Unrestrained/relaxed eaters ate to their appetites; they stopped when they were full. Making a food forbidden makes us much more likely to overeat when the opportunity arises.

The Psychological Problems

Perhaps longer lasting than the physical effects are those on the mind and these are the ones that I encounter most frequently, in my consulting room. They are multitudinous but I’ll just hit up the main ones.

The social norms around detoxing - its associations with health, celebrity and ‘instaglamour’ - help to cement the denial and perpetuate the essential illusion: that you are doing something healthy for benevolent reasons. In truth you are not ‘detoxing’ you are ‘crash dieting’. It is not because you want to feel good but because you feel guilty and angry with yourself for overindulging during the festive season. It is a kind of open conspiracy; we all know that ‘detox’ is a code word for ‘crash diet’ but we all nod in silent permissiveness of what could more honestly be called ‘elective starvation’. Somehow the word ‘detox’ seems to soften the edges of extreme dieting. If at any other time of the year (except perhaps before a summer holiday) a friend told you that they were restricting themselves to 450 calories per day you’d worry, think these were desperate measures, tell them it was a bad idea, but in January it’s all good, you wish them well and make a date for drinks in a month’s time. In many ways I would be happier for people to call it what it really is, at least that would be honest. It would be real. And we could address it. As it is ‘detoxing’, ‘cleansing’ and elimination diets are a too often a socially sanctioned cover for disordered eating and eating disorders as is attested by the number of high-profile healthy food bloggers who have admitted to having serious eating disorders (7) and those who haven’t…

Also problematic is that this cycle of binging in December and purging in January (sounding disordered yet?) promotes polarised thinking and behaviour. In CBT this is referred to as ‘all or nothing’ or ‘black and white’ thinking, in psychoanalytic theory it’s known as splitting; the setting up of dichotomous states of mind with no room for moderation or shades of grey. It’s absolute triumph vs total worthlessness, virtue vs sin. It’s the two biscuits that ‘ruin everything’ or the additional pound on the scales that means it is going to be a ‘bad day’. Whilst different therapies use different terms for this phenomenon all are agreed that these kinds of extremes are unhealthy. These harsh attitudes make it impossible to experience self-compassion, a trait that is associated with positive mental health outcomes. People who are self-compassionate are happier, more optimistic and emotionally resilient and less likely to be depressed or anxious (8). Self-compassion isn’t about self-pity or lack of discipline and, interestingly, it can support attempts to eat healthily. A recent study suggests that rigid diets tend to result in overeating and that self-compassion can reduce this tendency.(9)

Another facet of this particular brand of splitting is that detoxes tend to be based on the consumption of foods that either don’t taste good (I’m looking at you, wheatgrass) or don’t taste of anything (two words: Rice. Cakes) strengthening the association between ‘pain and piety’ and pleasure as ‘sin’. Coming so soon after the dietary abandon of December the implication is that eating for pleasure is a bad thing and that one should suffer for health. This is both utterly wrong and incredibly unhelpful, particularly when trying to encourage individuals to eat more healthfully in our currently failing attempts to stem the tsunami of obesity.

Rather than helping dieters to understand their personal relationships with food – including the attitudes to food, weight and body shape in their families, schools, society etc. – the January Detox reinforces the two-headed dietary monster of the ‘one-size-fits-all’ and the ‘quick fix’. It should be common sense that genetically (including the gut microbiome) unique individuals with different food histories would benefit from personalised dietary approaches, and that your relationship with your own body is a life-long partnership requiring ongoing investment. But it’s not, and that’s because the diet industry, media outlets and some lifestyle bloggers (a few well-intentioned, others not so much (10)) continue to perpetuate the myth that if you just try hard enough with this short-term intervention everything will be perfect. This is oversimplification to the point of ridiculousness and aspiration to the point of sadism.

Psychologically speaking health lies elsewhere. Somewhere between nutritionism (just nutrients on a plate) and hedonism (I think I ate the plate) is a place where food choices are a result of self-respect, self-awareness and self-compassion. Not aggression, external rules or desperation. For many of us it is not an easy place to get to; there are many outlets competing over the right to tell you what to eat and how you should feel about yourself and it’s been happening for a long time. I sit with patients who were put on diets in infancy because their mothers didn’t want a ‘fat baby’ or whose fathers mocked their adolescent body shape. These children then went in to competitive school environments where the aesthetic was king. Somewhere in the midst of these interpersonal challenges the media intervenes to let us know what the standard is and just how far short of it we are all falling. It can be an enormous task to clear through the layers of extraneous commandments and the years of social training to get back to a place of trust in one’s own body. Anyone who has fed a young child will have a sense of this. A spoonful of food can be mid-flight to the mouth when the child stops. No, I’m done. There might be pathetic half of a fish finger on the plate and, unless they are encouraged to ‘clear the plate’, it will remain abandoned because s/he knows that they don’t need it and what the body doesn’t need it doesn’t want. Children trust their bodies because they haven’t yet been taught not to. Sadly this state doesn’t last long and for many adults the external noise is so powerfully intrusive that the assistance of a therapist is essential in helping to create the quiet and the confidence to hear themselves again.

For a lot of those embarking on it the January Detox has nothing to do with food. Instead it symbolises a different kind of panic; not about the waistline but about the timeline. The closing of another year and the start of a new one inevitably evokes reflection on how the time was spent and, unconsciously for some, how much we might have left. If in this retrospection we feel we have not done enough, not succeeded enough, we can feel a need for a quick win. We cannot change our careers/improve our relationships/get out of debt in a month but we can lose a stone! Drastically changing the body becomes a substitute for feeling powerless to change other areas of our lives. But whilst our energy is focused on just making it through this juice fast the real challenges remain unchanged and neglected. It’s that reality issue again.

Being aware of what we are eating and, crucially, why is the key to regaining a compassionate relationship with the body and a non-anxious attitude to food and eating. Being mindful of what we are really hungry for (food, comfort, sleep, affection) enables us to make more honest food and life choices. If we ate mindfully throughout the year, including allowing room for the occasional overeating, we would negate the need for radical ‘cleansing’ in January.

The January Detox encapsulates everything that is wrong with the way we think about our bodies, food and eating. It is no way to live and no way to treat someone as important as you.

Kx

 

  1. http://www.theguardian.com/lifeandstyle/2014/dec/05/detox-myth-health-diet-science-ignorance

  2. Klein A. V. & Kiat, H. (2015). Detox diets for toxin elimination and weight management: a critical review of the evidence. Journal of Human Nutrition and Dietetics, 28, 675-686. http://onlinelibrary.wiley.com/doi/10.1111/jhn.12286/abstract

  3. Berg JM, Tymoczko JL, & Stryer L. (2002) Biochemistry. 5th edition. New York: W H Freeman.

  4. Coskun, M. (2014). Intestinal Epithelium in Inflammatory Bowel Disease. Frontiers in Medicine, 1, 24. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4292184/

  5. Sumithran, P., Predergast, L., Delbridge, E., Purcell, K. Shulkes, A., Kriketos, A., & Proietto, J. (2011). Long-Term Persistence of Hormonal Adaptations to Weight Loss. New England Journal of Medicine, 365, 1597-1604. http://www.nejm.org/doi/full/10.1056/NEJMoa1105816#t=articleMethods

  6. Herman, C. P., & Mack, D. (1975). Restrained and unrestrained eating. Journal of Personality, 43, 647–660.

  7. Refinery 29 – My Life with Orthorexia. http://www.refinery29.com/jordan-younger-vegan-orthorexia

  8. Neff, K. D., Rude, S. S. & Kirkpatrick, K. L. (2007). An examination of self-compassion in relation to positive psychological functioning and personality traits. Journal of Research in Personality, 41, 908-916.

  9. Adams, C. E. & Leary, M. R. (2007). Promoting self-compassionate attitudes towards eating among restrictive and guilty eaters. Journal of Social and Clinical Psychology, 26, 1120-1144. http://self-compassion.org/wp-content/uploads/publications/AdamsLearyeating_attitudes.pdf

  10. Jezebel – Belle Gibson, blogger who lied about having cancer, just keeps lying. http://jezebel.com/belle-gibson-blogger-who-lied-about-having-cancer-jus-1715566234