Nutrition

Talking Mental Health Self-Care with Laura Thomas PhD.

Many of you will have watched the moving and insightful BBC documentary Mind Over Marathon, which followed 10 volunteers, each with their on mental health concern. Part of the Heads Together mental health awareness campaign, the programme followed the volunteers as they used training for the London Marathon both as a personal challenge and treatment. I have written elsewhere about the value of exercise as a mental health intervention and it is great to see it receiving more recognition for its benefits.

Laura Thomas PhD was the nutrition consultant on the programme and on the latest episode of her podcast we talk about the five pillars of mental health self-care, the role of nutrition on brain health and dinosaurs. Enjoy!

 

Treating Depression with Diet: The 'SMILES' Trial

Regular readers of this blog or anyone who follows me on Twitter for even half a day will be familiar with some of the research on lifestyle interventions for mental health. While these include sleep, exercise and creative pursuits, one of the ones that I keep coming back to is diet. I have reported on epidemiological studies that show a relationship between a consistently healthy diet and depression in the general population and in women. This research has been correlational, it shows that there is a relationship but, technically, cannot say that what causes what. It could be that depressed people are more likely to eat a poor diet. All that changed recently with the publication of a randomised controlled trial of the use of diet as a treatment of depression; The ‘SMILES’ Trial. The research was led by Professor Felice Jacka, who, if you are interested, I recommend you follow on Twitter for updates and links to similar research.  

The 67 participants in this 12-week Australian study were adults who were depressed at the time and who had a clinically defined poor diet. A poor diet was one that was low in fibre, fruit and vegetables and lean protein, and high in sweets, salty snack foods and processed meats. Some participants were receiving treatment in the form of medication, talking therapy or both.

The participants were randomly assigned to either a nutritional intervention group or a befriending control group. In the intervention group the participants had seven one-hour sessions with a registered nutritionist who provided them with personalised nutritional advice including example recipes and meal plans, and coached them around goal setting and motivation to help them to stick to the nutritional recommendations. They were encouraged to eat (servings in brackets):

  • Whole grains (5–8 servings per day);
  • Vegetables (6 per day);
  • Fruit (3 per day); 
  • Legumes/beans (3–4 per week);
  • Low-fat and unsweetened dairy foods (2–3 per day);
  • Raw and unsalted nuts (1 per day);
  • Fish (at least 2 per week);
  • Lean red meats (3–4 per week);
  • Chicken (2–3 per week);
  • Eggs (up to 6 per week); and
  • Olive oil (3 tablespoons per day).

In addition, participants were encouraged to reduce their intake of “‘extras’ foods, such as sweets, refined cereals, fried food, fast-food, processed meats and sugary drinks (no more than 3 per week). Red or white wine consumption beyond 2 standard drinks per day and all other alcohol (e.g. spirits, beer) were included within the ‘extras’ food group. Individuals were advised to select red wine preferably and only drink with meals.” They were told to eat to their appetites and not worry about trying to lose weight, so it wasn’t a ‘diet’ in the colloquial sense. Those in the social support/befriending group had seven one-hour meetings with a trained professional who talked to them about neutral subjects (i.e. not nutrition, mood or anything that might be considered therapy). Anxiety, depression and general mood were assessed at the beginning and end of the study, along with biological data such as weight, waist circumference, fasting blood glucose and cholesterol.

People in the dietary intervention group were four times more likely to be in remission (not depressed) at the end of 12 weeks than those in the befriending group. They also had reduced severity of anxiety symptoms. There was no change in BMI, blood glucose, cholesterol or physical activity within or between the groups. People were not feeling better because they had lost weight but they were definitely feeling better.

What is also interesting is an analysis called the Number Needed to Treat (NNT). The NNT is a rating of a treatment’s efficacy and describes the number of people that need to be on the treatment in order for one unwanted outcome to be prevented or avoided. So, if a (miracle) drug worked for absolutely everyone then the NNT would be 1. If, for example, a migraine treatment had an NNT of 100 then 100 people would need to be on the treatment to prevent one person having a migraine. The NNT in the SMILES Trial was four. This compares favourably to common antidepressant medication which can vary from 5-16, which is still considered effective particularly in relation to the high global rates of depression. The authors also make the point that that this nutritional intervention would also have positive outcomes for other problems that are commonly associated with depression such as heart disease, type 2 diabetes and obesity.

Crucially, the researchers also looked at the affordability of the diet and found that, on average, people adhering to the diet spent $26 less per week on food and drink than they were at the start of the study.

Of course, we have to bear in mind that this was a small study of people from a particular part of the world and it will both interesting and exciting to see the trial replicated with more participants from different ethnic backgrounds. However, it is also, I think, hugely important. It is the first study (as far as I can see) that demonstrates a direct influence of diet on depression. Depressed people who improved their diet felt better. This trial doesn’t tell us how the diet had this beneficial effect; the results were unrelated to any of the other measurements they took. My guess is that future replications will find a link to systemic inflammation and perhaps to action of the gut microbiome, but time will tell. The upshot is that improving diet in line with general guidelines (no extreme diets) had a significantly positive effect on depression. The benefit of this kind of intervention is that there are no waiting lists or side-effects, and it doesn’t have to be expensive. We eat several times a day and this research shows us that each meal provides us with a valuable opportunity to make a difference to how we feel.

Reference

Jacka, F. N., O’Neil, A., Opie, R., Itsiopoulos, C., Cotton, S., Mohebbi, M., Castle, D., Dash, S., Mihalopoulos, C., Chatterton, M. L., Brazionis, M., Dean, O.M. Hodge, A. M. & Berk, M. (2017). A randomised controlled trial of dietary improvement for adults with major depression (the “SMILES” trial). BMC Medicine15, 23. http://doi.org/10.1186/s12916-017-0791-y

New Year's Resolutions Worth Making: Week 2 - Food

At this time of year the word ‘diet’ is exclusively used to refer to the new 4, 8 or 12 week plan that will help you ‘drop a dress size’ or ‘blast belly fat’. In fact, when people think about the functions of food they will usually think about its role in fuelling or reshaping the body; it’s unusual for us to think about the influence of diet on brain structure and function. Even though we have an understanding that nutrients from food are important for the health of our organs, e.g. ‘eat carrots for better night vision’ and might even go as far as taking supplements to improve the condition of our skin or hair, we neglect the brain, forgetting that it too is an organ and relies on nutrients from the diet for optimal function. In fact, though your brain makes up only about 2% of your total body weight it accounts for nearly 25% of the body’s energy requirements; it has a huge nutritional demand. So, this January how about making a resolution to take better care of your brain?

A Quick Note on Omega 3s

If we took your brain out of your head, removed all the water, 60% of what was left would be fats, and especially omega 3s. Omega 3 fats are essential fats, ‘essential’ meaning they are crucial to brain function but the body is unable to synthesise them; they must be taken in through the diet. These fats are critical for the normal development of the brain.

There are three forms of omega-3: ALA, EPA and DHA. ALA is the version found in plants, things like chia seed (although they are also relative high in phytates that can reduce the absorption of important minerals) and flaxseeds. EPA and DHA are found in marine sources; oily fish and other seafood. The NHS recommends that we eat two portions of fish per week, of which one should be oily but barely anyone is achieving that intake. DHA is the most abundant essential fat in the brain and is understood to be particularly important for brain development so it is critical during pregnancy, infancy and childhood. As we age EPA comes in to its own providing a protective, anti-inflammatory action as well as supporting neurochemical synthesis and transmission. It’s actually very difficult for the body to make use of ALA; it can use it to synthesis EPA and DHA but not very efficiently and only in tiny amounts so people who avoid animal products and are unwilling to take a fish oil supplement are likely to be deficient.

Supplementation with EPA + DHA has been shown to improve memory performance(2), vocabulary and non-verbal reasoning (3) and may prevent age-related brain shrinkage (4). It may also play a preventative role in the disease course of Alzheimer’s Disease, now the leading cause of death in England and Wales (5). Older people with mild cognitive impairment who were supplemented with DHA and EPA improved their depression scores (6). Omega 3s may also play a preventative role in post-partum depression (7).

General Diet

A number of studies have shown a positive effect of a healthy diet on brain health and mood. Polyphenols are the anti-oxidant compounds found in berries, green tea, vegetables, spices and cocoa and they have been shown to have a protective effect on brain cells and can even promote the growth of new ones. Flavanols (a type of polyphenol) in cocoa can increase the flow of blood to the brain and as a result may improve cognitive functions such as attention, learning and memory (8). Consuming polyphenols can promote the production of BDNF, a protein that stimulates the growth of new brain cells (9). Low levels of BDNF in the brain have also be implicated in the development of brain disorders such as Alzheimer’s Disease, Parkinson’s, depression, bipolar disorder and schizophrenia (10). Though there is some question about exactly how polyphenols themselves may act on the brain it is a consistent and robust finding that people who consume diets high in polyphenol rich foods (leafy green and brightly coloured vegetables, berries, spices) are less likely to develop depression and age-related decline in brain function. In 2008 a plant- and omega-3-rich diet was suggested as a preventative strategy for Alzheimer’s Disease (11). More recently a large American trial tested a modified Mediterranean Diet and found that it was linked to a lowered likelihood of developing Alzheimer’s (12). A large Spanish studied that followed 15,000 people over 10 years found that, after controlling for other factors such as smoking, activity levels and BMI, those who ate the healthiest diets were up to 30% less likely to become depressed (13).

So, when we’re talking about a diet that protects the brain the evidence suggests that 500g of vegetables and fruit, 10g of dark chocolate, a small glass of red wine and four cups of green tea per day is effective, and supplemental omega-3s may also be beneficial.

Next week I’ll be talking about how exercise can change the structure and function of your brain. Until then, eat your greens!

Kx

References

1. Hamazaki, K., Harauma, A., Otaka, Y., Moriguchi, T. & Inadera, H. (2016). Serum n-3 polyunsaturated fatty acids and psychological distress in early pregnancy: Adjunct Study of Japan Environment and Children Study. Translational Psychiatry, 6, e737. doi: 10.1038/tp.2016.2

2. Yurko-Mauro K., Alexander D.D., van Elswyk M.E. (2015). Docosahexaenoic acid and adult memory: A systematic review and meta-analysis. PLoS ONE. 10:99

3. Muldoon M.F., Ryan C.M., Sheu L., Yao J.K., Conklin S.M., Manuck S.B. (2010). Serum phospholipid docosahexaenonic acid is associated with cognitive functioning during middle adulthood. Journal of Nutrition,140, 848–853. doi: 10.3945/jn.109.119578

4. Conklin S.M., Gianaros P.J., Brown S.M., Yao J.K., Hariri A.R., Manuck S.B., Muldoon M.F. Long-chain omega-3 fatty acid intake is associated positively with corticolimbic gray matter volume in healthy adults. Neurosci. Lett. 2007;421:209–212. doi: 10.1016/j.neulet.2007.04.086.

5. https://www.theguardian.com/society/2016/nov/14/dementia-and-alzheimers-leading-cause-of-death-england-and-wales

6. Sinn, N., Milte, CM., Street, S. J., Buckley, J. D., Coates, A. M., Petkov, J. & Howe, P. R. (2012). Effects of n-3 fatty acid, EPA and DHA, on depressive symptoms, quality of life, memory and executive function in older adults with mild cognitive impairment: a 6 month randomised control trial. British Journal of Nutrition, 107, 1682-1693.

7. De Vriese, S. R., Christope, A. B. & Maes, M. (2003). Lowered serum n-3 polyunsaturated fatty acid (PUFA) levels predict the occurance of post-partum depression: further evidence that lowered n-PUFAs are related to major depression. Life Science, 73, 3181-3187.

8. Lamport, D., Pal, D., Moutsiana, C., Field, D., Williams, C., Spencer, J. and Butler, L. (2015) The effect of flavanol-rich cocoa on cerebral perfusion in healthy older adults during conscious resting state: a placebo controlled, crossover, acute trial. Psychopharmacology, 232, 3227-3234.

9. Murphy, T., Dias, G. P. & Thuret, S. (2014). Effects of diet on brain plasticity in animal and human studies: Mind the gap. Neural Plasticity,  doi:  10.1155/2014/563160

10. Gomez-Pinilla, F. & Nguyen, T. T. J. (2012). Natural mood foods: The actions of polyphenols against psychiatric and cognitive disorders. Nutritional Neuroscience, 15, 127-133.

11. Kidd, P. M. (2008). Alzheimer's disease, amnestic mild cognitive impairment, and age-associated memory impairment: current understanding and progress toward integrative prevention. Alternative Medicine Review, 13, 85-115.

12. Morris, M. C., Tangney, C. C., Wang, Y., Sacks, F. M., Bennett, D. A. & Aggarwal, N. T. (2015). MIND diet associated with reduced incidence of Alzheimer’s Disease. Alzheimer’s & Dementia, 11, 1007-1014.

13. Sánchez-Villegas, A., Henríquez-Sánchez, P., Ruiz-Canela, M., Lahortiga, F., Molero, P., Toledo, E., & Martínez-González, M. (2015). A longitudinal analysis of diet quality scores and the risk of incident depression in the SUN Project. BMC Medicine, 13, 197-197.

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