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The Difference Between a Bad Habit and an Addiction

Is stopping by the bar after work every evening for two martinis a bad habit, or an addiction? Read on.

Is stopping by the bar after work every evening for two martinis a bad habit, or an addiction? Read on.

A new study suggests that drinking a bottle of wine a week increases the risk of cancer in women as much as smoking ten cigarettes, and that drinking three bottles of wine a week means that an extra thirty six women out of a thousand will develop cancer. Research over the past few years has turned the purported health benefits of alcohol on its head, particularly when it’s women who are drinking.

Nearly half of the clients I work with have a goal of cutting back on drinking, or quitting altogether. But, it can get tricky to discern between a bad habit and an addiction. Each require different paths of treatment, and impact the person in very unique ways. By the way, this does not only apply to alcohol, but to food, exercise, smoking, prescription drugs, and even sex and love. So, how are you supposed to know if you’ve got a bad habit or an addiction? Can someone who drinks “only” two glasses of wine every night be addicted?

A bad habit is an ingrained, learned pattern of behavior propelled by a stimulus and a response. It’s got a straightforward, routine quality to it, and a complete change can be made to break it within a period of a few months. An addiction is a complex and inflexible repeated behavior influenced by psychological, physiological and social factors. It’s often a coping mechanism for dealing with trauma or stressful emotions, and serves as both a distraction and a container that becomes increasingly necessary to function over time… until that coping mechanism caves in on itself. 

Whereas a bad habit can often be viewed as a nuisance or thoughtless behavioral pattern, an addiction is all-consuming, and will eventually erode your career, health, primary relationships, and self-esteem.

An addiction has an enticing quality, not unlike a secret lover—you’ll find yourself hiding, sneaking around, compromising, and making excuses over and over again.

Addictions and disorders — like an alcohol use disorder — trample over willpower and thrive on self-deception. As much as you say that you’re not going to drink for a week or a month, it may be all you can think about until finally, you rationalize caving in by telling yourself that you never really had a problem to begin with. Changing a habit can be hard work, but going to battle with an addiction often requires giving it everything you’ve got while altering your life constructs in the process.

So, to answer the question, “can someone who drinks only two glasses of wine every night be addicted?” YES. It is not the quantity that matters, but the consequences of that behavior and the difficulty in changing. 

For me, I knew that my relationship with alcohol had become an addiction when I could not stop drinking on my own, even though I’d given myself little challenges for years (Drynuary, “cleansing,” etc.). There were multiple consequences from my drinking which had started to impact my health, my relationships and my personal integrity. Alcohol had become my potion to suppress painful emotions and trauma. It took asking for help, and committing to addiction-focused treatment, to finally quit drinking (this year, I celebrate a decade of freedom from alcohol and cigarettes).

Action:

On the top of a sheet of paper, write down one behavior that is keeping you from living the life you desire. Fold it into two columns. In the first column, list all the consequences of that behavior. In the second column, write down all the potential positive aspects of changing that behavior. 

Power Question: 

In what ways is a bad habit or an addiction impacting your life? How might you be able to discern between whether it’s a habit or an addiction?

Thanks for reading! Have you struggled to discern between a bad habit or an addiction? Did something in this post resonate with you? Leave your thoughts in the comments section.

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A Few Notes on The Quantified Self

Technology is a double-edged sword. Lifelogging can help you use it to your advantage.

Technology is a double-edged sword. Lifelogging can help you use it to your advantage.

A friend recently took to calling me the “bionic woman,” but it has nothing to do with using superhuman powers in service of my government. 

On the back of my arm, you’ll spot a blood glucose monitor, which I use to keep an eye on blood sugar levels. On my pointer finger, there’s an Oura Ring, which tracks sleep quality and heart rate variability. On my wrist, you’ll spot a smart watch, which counts daily steps, heart rate, and daily exercise. My menstrual cycle is logged in an app, as well as a host of other factors related to my hormones. I often enter my food intake and macronutrients on my phone, and I take note of my daily mood and the quality of each day in a goals-oriented planner. Excel is a good friend; once in a while, I’ll make an account of every minute spent over a week to figure out where I’m leaking time. I’ve also journaled since the age of 8 or so, taking note of most important conversations and events. In my religious life, I try and take at least a once-weekly inventory of where I’m missing the mark. Oh, and progress on my goals has been color-coded since 2009 (red, yellow, green). Perhaps this is one reason I became a coach!

Ok, maybe you wouldn’t call me a bionic woman. Maybe you’d call me obsessive, fanatical, neurotic, an extreme naval gazer. Whatever label one may slap onto this behavior, I am part of a growing community that subscribes to the practice of lifelogging, otherwise known as The “Quantified Self.”

The Oura ring provides sleep data, heart rate variability, and tracks daily activity levels.

The Oura ring provides sleep data, heart rate variability, and tracks daily activity levels.

This movement focuses on self-experimentation and self-knowledge using numbers, with the goal of enhancing happiness, performance, and health through the collection and analysis of data. By taking ownership of one’s health information, one can also handle medical challenges in a more empowered and informed manner, and perhaps avoid energy derailments, unnecessary prescriptions and medical misdiagnoses. As a coach and an avid practitioner of lifelogging, I know that this practice can be a lifesaver.

As an example, a few years ago a doctor in Singapore diagnosed me with Chronic Fatigue Syndrome. “Take six months off and rest,” he advised. “There’s nothing else you can really do about it.” He said he saw this a lot in women “like me,” and that he had just diagnosed a lawyer and personal trainer with it as well. Admitting I was devastated by this news is an understatement. Based on my lifelogging data and research as well as a dose of intuition, however, I was able to conclude that his diagnosis was likely incorrect —there was something else going on. Taking the information I’d gathered to other specialists eventually led to the right diagnosis— a condition that has since been easily managed by keeping an eye on glucose levels and making a radical dietary shift.

In my coaching practice, these kinds of stories come up all the time. I also get to witness the many successes that arise from self-tracking. For people who have highly sensitive bodies or who lean toward being “feelers” more than “thinkers”, lifelogging can be particularly grounding, providing a kind of reality check. We’re in an age where industries that are supposed to support our well-being have become increasingly predatory. Our well being is thus hinged on taking more responsibility over our health by “knowing thyself” and doing our own research. Lifelogging has many benefits, and will only take about ten to fifteen minutes out of your day. We have little control over the things that may happen to us in life. Why not optimize the small sliver that we do have?

Action: Try out one form of lifelogging for a week. 

Power Question: How might lifelogging help you toward your goals?

As always, thanks for reading! Is Lifelogging a topic of interest to you? Let me know in the comments, as well as how you’re using it to improve your health!

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The Excuses of Thinkers and Feelers 

Do you lean toward thinking or feeling your way through the world?

Do you lean toward thinking or feeling your way through the world?

If you want to overcome your excuses, it’s helpful to understand the language they speak. In your daily life, what typically dictates most of your actions— your head or your heart? The Myers-Briggs Type Indicator is a self-reporting questionnaire exploring an individual’s psychological preferences, and can be an insightful tool in the journey of “knowing thyself.” This test will also help you figure out where you are on the thinker/feeler spectrum. 

Thinkers are experts in rationalizing their way out of change. Their minds are oriented to find the nearest escape route if “necessary”, and the messages they tell themselves can be pretty convincing. Here are some examples of “Thinker” excuses:

“Most people who lose weight end up gaining it back anyway. It’s not worth my time to put in the effort. I could use my focus for better things.”

“I only drink two or three glasses of wine a night, max. Gerry drinks nearly two bottles each day. He’s the one with the real problem, not me.” 

“Work’s really busy at the moment. I don’t think I’ll have time to get to the gym regularly and commit to a personal trainer.” 

Feelers may sometimes allow their emotions to dictate their lives. Consistency is particularly difficult for them because they’re easily swept away by the stirrings in their heart. “Feeler” excuses sound something like this:

“I’m feeling depressed today. There’s no point in writing because my mood is low and I won’t be able to produce anything worthwhile.” (I am personally acquainted with this excuse!)

“I can’t believe Harriet did that to me—it’s too upsetting to even think about. I know I said I wasn’t going to drink this month, but I deserve a martini just for putting up with her b.s.” 

“I promised myself that I was going to go running this evening, but there’s a party I want to check out and I’d rather do that.” 

By exploring our own natural tendencies, we become better equipped to recognize our traps as they arise. Self-knowledge fuels the power to make change.

Action: 

Take an abbreviated version of the Myers-Briggs test if you don’t know what your type is already or head to The Myers & Briggs Foundation for information on taking the MBTI assessment.

Read up on your type, and write down any insights that you find helpful from your research. 

Power Question:

What thinking or feeling excuses am I using that may be sabotaging my well-being? 

Thanks for reading! This is post #5 in a series on Habit Change. Have you taken the Myers-Briggs Type Indicator before? If so, how has it helped you? Can you recognize the thinking or feeling excuses that you usually tell yourself? Leave your comments below.

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The Stages of Change

The process of change isn’t linear.

The process of change isn’t linear.

Around the time Journey’s hit, Don’t Stop Believing, skyrocketed to the top of the charts, two researchers, James Prochaska and Carlo DiClemente, invented a new construct of behavior change that would dramatically influence their field. This theory, the Transtheoretical Model of Behavior Change (or TTM), is widely used today as a tool to assess whether or not a person is ready to adopt a healthier behavior. TTM has stuck around for nearly forty years as the dominant lens that behavior change specialists use when working with a new client, and it encompasses six stages that individuals will encounter during any health transformation, including addiction recovery.

These stages are:

Precontemplation (“I’m not ready!” Or, “No Interest!”) - People hanging out at this stage have no intention of taking action in the foreseeable future, and often don’t realize they’re engaged in a problematic behavior. The drunk driver forced by a court judge to attend AA might be examples of people who fall into the precontemplation stage.

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Contemplation (“I’ll think about it, but I’m still not ready!”) These folks have some inkling that their behavior is sabotaging their well-being, and will start to weigh the pros and cons. Negative consequences are on their mind, but change might feel a little too hard. 

Preparation (“Let’s do this!”) Individuals at the preparation stage are gearing up for action in the immediate future, and have begun taking small steps forward to address their self-sabotaging behavior. I generally meet people at the preparation stage. They’ve already read up on the issue they’re dealing with, and they’re trying to make manageable changes within the blueprint of their former life.

Action (“Check me out!”)  Superheroes in the action stage are fully engaged in reconfiguring their health and environment, and have made measurable modifications to their lifestyle in order to achieve their goals. They’re not afraid to ask for help, and they have probably enlisted a coach, therapist, personal trainer, doctor, or nutritionist for guidance and accountability.

Maintenance (“This IS Me!”) Here’s your butterfly. She’s been sustaining positive action for at least six months and works to prevent a relapse into old, nasty behaviors.

Termination (“What bad habit?”) A much debated category, termination represents people who are no longer tempted by their past and know they won’t again use their old habits as a coping strategy. This sixth stage has also been used for “Relapse,” where the individual has gone back to their old behavior. This stage was not included in the original version of TTM but was added as Termination to Prochaska’s updated model. 

While these stages are sometimes sequential, people can move in and out of a particular stage at any time— particularly in the first year of a health-related behavioral shake up.


Action: Give some thought to these stages of change in relation to your own habits. 

Power Question: Is there at least one health-related behavior that you’d like to change? Where do you currently sit on this model? 


Thanks for reading! Have you had any experience with using the Stages of Change to adopt a new habit or alter a behavior? I’d love to hear from you- leave your thoughts in the comments below. This is post #4 in an extended series on habit change.

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Go Tiny! Aim Big! 

The small boulder and the mighty mountain peak share a few things in common…

The small boulder and the mighty mountain peak share a few things in common…

“If you want to change your life, you’ve got to have a goal that’s big enough to inspire you. Go big, or go home!”

“Change only happens incrementally. The tinier the shift, the easier it is to modify a behavior. Tiny habits rule!”

I’m betting that a lot of you reading this right now have come across both schools of thought. However, despite being treated as dueling approaches, micro-habits and big goals hang out together on the same curb.

Tiny Habits, an approach developed by Stanford behavioral researcher, BJ Fogg, is based on the premise that if we adopt a new habit that’s super easy to stick with, we’ll eventually make our way to the bigger goal by encouraging a snowball effect. From his research, Fogg concluded that only three things will change behavior in the long term: a) an epiphany b) a new environment and c) taking baby steps.

Since most of us won’t be able to uproot ourselves and epiphanies tend to be sort of rare, we’re left with learning from our earliest self. 

Fogg’s outlined three steps to implementing a tiny habit: 

1) You need to GET SPECIFIC. What behavior do you want to change? What outcome would you like to have?

2)  You’ve got to KEEP IT SIMPLE. How can you make the behavior easy to do? 

3).  You’ll want to TRIGGER THE BEHAVIOR. For example, you might say, “every morning after I brush my teeth, I’ll do ten pushups.” The trigger is brushing your teeth, and the Tiny Habit is ten pushups. 

What will prompt you to engage in the behavior? Does your trigger already exist, or will you need to create it from scratch? 

Finally, Fogg emphasizes that after you complete the Tiny Habit, you’ve got to celebrate. That could be as small as yodeling “Woohoo!” or giving yourself a pat on the back.

I’m a big fan of Tiny Habits and have shared Fogg’s principles in many corporate wellness talks. Visualizing big goals, like quitting smoking and running a marathon, coupled with beginning your journey to that goal by implementing a Tiny Habit, like lacing up your running shoes each morning after you finish breakfast, is a sure path to celebration. 

Action: 

Check out BJ Fogg’s TED talk on Tiny Habits, and then try it out for yourself! (https://www.youtube.com/watch?v=AdKUJxjn-R8)

Power Question: 

What Tiny Habit could you cultivate in working toward a bigger goal? What’s the trigger for that Tiny Habit? 

This is post #3 in a long series on habit change. Do you have any thoughts on big goals and Tiny Habits? Have you tried the Tiny Habits method before? Leave your comments below! Thanks for reading!

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  Creating a Morning Practice

Rise and shine!

Rise and shine!

Yesterday’s post addressed the power of a daily morning visualization. Nesting this practice into a set morning routine will strengthen its potency considerably. Countless articles have already been written on the morning habits of highly successful people. Generally, they advise one to get up early, exercise first thing, engage in some type of motivational mental practice like prayer or mindfulness, and do the hardest tasks first. There’s even a bestselling book, “My Morning Routine,” detailing what famous people do as soon as they wake up!

In my years as a coach, I’ve found that there’s really no one winning formula for a morning routine — everybody’s different. One person might gain energy and focus by getting up at 8am, reading the Bible and walking their dogs as exercise. Someone else might find their daily golden ticket in a morning visualization, 5km run and cold shower before sunrise.

We all have unique goals, motivations, preferences and constraints. What matters is that a consistent morning practice has been established— something that you can rely on to weather bad moods, low energy, and challenging times. A morning routine is an insurance policy against the motivation extinction everyone experiences at least once in a while.

Setting up a sustainable, consistent morning routine requires some experimentation. I have yet to meet a single person who sets one up and sticks to it right out of the gate. Play around with all the “first thing” activities that might improve your life. Make a list of them. Can you imagine doing three of those activities within a block of thirty minutes to an hour? What combinations might work for you? For instance, you might consider:

Morning Routine #1:

6am: Wake up
Hot shower 
Morning Visualization 
45 minute workout at the gym

Or 

Morning Routine #2:

6:30 am: Wake Up
Morning Visualization
30 minute run outside
Cold shower 

Try each of your potential morning practice out for a week. Take note of any changes or ideas during this time. Which one feels most beneficial to you?

Action: Design a morning practice that will power each day. Write it out in detail. 

Power Questions: What three actions can you take in the morning to set you up for success? What would motivate you to stick with this morning practice?

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  Minding Your Mind in the Morning

How will you frame your mindset in the morning?  Photo: Penang, Malaysia

How will you frame your mindset in the morning?

Photo: Penang, Malaysia

Each morning, most of us have the ability to direct the mood of our day. We can either carry our subconscious fears, nightmares and anxieties into breakfast and beyond. Or, we can redecorate the rooms of our mind to create a more pleasant atmosphere. Consider Austrian psychiatrist, Viktor Frankl. During his imprisonment in a Nazi concentration camp where he witnessed catastrophic loss and death firsthand, Frankl immersed himself in positive memory and the imagery of hope, which he credits for his survival. After his release, he developed logotherapy, a therapeutic method that focuses on increasing one’s will by locating a sense of meaning through the mind’s creation. Closer to home, it can safely be said that Singapore’s founder, Lee Kuan Yew, was able to see beyond the malarial swamp that is now a glittering global success story. And, a highly cited study conducted by The Cleveland Clinic Foundation found that simply visualizing exercise led to greater muscle activation levels and improved overall outcomes. In other words, participants gained significant strength through mental training. There are countless examples to support the real power of visualization. 

Morning visualization—“seeing” our day in our minds when we first wake up—has three distinct benefits. First, it gives you the opportunity to reprogram your subconscious mind on a daily basis. Studies on neuroplasticity provide ample evidence that we can indeed rewire our brains. But, in order to fill in those old negative grooves, we’ve got to create new mental images. Second, visualization in the morning will better prepare you to actually do the things that you’d like to do. If I can imagine enjoying and completing a thirty minute run before the sun rises, I’ll be a lot more motivated to lace up those running shoes instead of staying in bed. Third, morning visualization enhances what’s within your control. We encounter so many circumstances each day that are beyond our making: traffic jams, a grumpy boss, an after-work party with lots of alcohol and unhealthy food. Visualization prepares you to focus on what you can change instead of orienting your mind toward frustration. 

Visualization is a superpower that all of us possess.

What’s happening around us can have less of an impact on our reality than what’s happening within us. When you consistently seed your mind with life generating thoughts, the world around you flourishes and you’ll begin to see yourself bloom, too. 

Now, here’s something for you to try…

Action:

You’ve just awoken. Set a timer for 60 seconds and visualize your desired day ahead. Then, plan the day out based on that visualization, focusing on what’s within your control. 

Power Question:  

What does my ideal day look like? Write it out!

Thanks for reading! Any thoughts on this post? Leave them in the comments section below. This is post #1 in an extended series on habit change that will help you reflect on your health behaviors and take positive action. More on that later!

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Four Common Nutrition-Related Health Conditions That Can Mimic Depression & Anxiety – and What To Do About Them

How you feel often has a lot to do with what you eat.

How you feel often has a lot to do with what you eat.

Mental health conditions, particularly depression and anxiety, are extremely common today and yet complex to treat because they’re often caused by a combination of psychological, biological and social factors. An estimated one in seven people in Singapore have experienced a mental health disorder. In the US, approximately one in four women are prescribed at least one psychiatric medication to treat anxiety, depression, ADHD and other mental health disorders. This is truly the global public health crisis of our generation. Yet, a significant number of people in treatment are unresponsive to medication-based solutions.

I was one of those individuals, cycling through countless psychiatric drug interventions in my teens and twenties before finally discovering that if I changed the way I ate and moved, my thought processes and energy levels radically shifted. What I did not know at the time was that I had two common health conditions, endometriosis and non-diabetic reactive hypoglycemia, both of which I’d probably been living with for decades. Looking back on my days of bulimia, I’d binge on tubs of Betty Crocker frosting to chase away feelings of anxiety and dread, dousing my fears with sugar until my body could hold no more. In my twenties, I’d nurse on a bottle of wine most nights to keep the heart palpitations, sadness and physical pain from driving me mad.  What I did not know was that I was dealing, in a sense, with a physiological Sisyphus, one that medication or psychotherapy was not meant to fix.

Since getting to the bottom of these health issues, I’ve had to reconsider not only my personal history, but also the entire narrative that currently defines mental illness, one that I had long suspected was off the mark. Yes, millions struggle with psychological conditions which respond well to medication, particularly in tandem with talk therapy. However, there are countless others who would be better served by lifestyle and nutrition interventions rather than by prescriptions for psychiatric drugs.

At a time when suicide rates are rising and increasing numbers of people are incapacitated by symptoms resembling psychiatric illness, it’s critical that mental health professionals, physicians, dietitians, physiologists, personal trainers, and health coaches begin working together as a team rather than approaching behavioral health from opposing and competing camps.

Numerous physical health issues are often misdiagnosed as psychiatric illness — hypothyroidism, diabetes, Ehlers-Danlos Syndrome, endometriosis, PCOS and arthritis are just a few. People waste years and even decades trying to fix the wrong problem, bouncing from one specialist to the next as they collect misdiagnoses. Compellingly, many nutrition-related conditions can also cause symptoms resembling bipolar disorder, major depression, anxiety, schizophrenia and even psychosis. Here are four of the most common:


Iron-deficiency anemia (IDA) impacts an estimated six percent of the population, with higher numbers in women who are menstruating, pregnant or nursing, and in people following a vegan, vegetarian or raw food diet. Worldwide, an estimated two billion people are anemic; iron deficiency is a top ten risk factor for chronic disease. Numerous studies show that iron deficiency anemia increases the risk of psychiatric disorders in both children and adults, and researchers have urged the medical community to consider iron intake in assessing the underlying causes and treatments for mental illness. Symptoms of IDA include fatigue, decreased stamina, insomnia, rapid heartbeat and depression. In other words, they are nearly the same as the symptoms listed on some popular pharmaceutical commercials for depression and anxiety.

So, what can you do if you suspect you may have iron-deficiency anemia?  

First, get a complete blood test (CBC) from your doctor and ask to see your results for your red cell count, haemoglobin, hemocrit volumes and mean corpuscular volume (MCV). Compare these numbers to the “normal” range that the blood test includes, and keep in mind that a result which is borderline low but not abnormal may still result in symptoms. Every body is different, and results must be put into context. A subclinical or borderline normal result can still make you feel awful!

Treatment for iron-deficiency anemia is pretty straightforward. An oral iron supplement or IV iron treatment can do wonders, but for long-term relief, changing one’s diet is crucial. Adding foods like red meat and poultry, dark leafy greens, beans, nuts and seeds, seafood and organ meats like liver to your daily diet will boost iron levels over time. Vitamin C and beta-carotene rich foods will also help your body absorb non-heme iron, while substances like caffeine and soy protein can inhibit it. Many people are often shocked by how dramatically their mood and energy levels improve after increasing iron intake over two to three months. One big reason new mothers experience postnatal depression and crippling fatigue during baby’s first year? Iron deficiency!

 

Gluten Sensitivity and Celiac Disease are two different yet related issues that present with similar symptoms. Celiac Disease is an autoimmune reaction to gluten and can be easily tested and confirmed by a doctor. Non-celiac gluten sensitivity is more nebulous and therefore, there are no specific biomarkers to diagnose it. Celiac disease is rare — an estimated one percent of the population has it. Gluten intolerance appears to be more common, and may affect up to thirteen percent of people, although estimates widely differ. Symptoms of both include bloating, gas, fatigue, depression, constipation, iron-deficiency anemia (see above!), delusional thinking, and even psychosis. Some fascinating research on the connection between schizophrenia and gluten has been published recently, although results are not yet consistent enough to conclude a causal relationship.

Researchers at John’s Hopkins University’s School of Public Health found that people with celiac disease are three times more likely to develop schizophrenia than those without it. A literature review of studies published between 1900 and 2014 found that anxiety, depression and fatigue are all common complaints in patients with celiac disease that has been untreated.

So, what can you do? Simple serology tests, the Tissue Transglutaminase IgA antibody and the IgA antibody, will look for antibodies in the blood to determine whether or not you have a negative reaction to gluten. If this test is negative but you still suspect you have celiac disease, you may want to ask your doctor for an IgA Endomysial antibody test, although this is more expensive and less accurate. Genetic testing can be helpful in determining if you might be a candidate for celiac or gluten sensitivity, but only about five percent of people who carry the genes will actually develop Celiac Disease. You may also want to rule out a straightforward wheat allergy, which often presents differently, by taking an allergy panel like RAST or skin prick testing.

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Celiac disease and gluten sensitivity are treated through dietary shifts— but that doesn’t mean that the process is easy! Many foods in restaurants contain hidden gluten (one-third of gluten free dishes in US restaurants have been found to contain gluten) and package labels in the grocery store are not always accurate. Cross-contamination in manufacturing plants is common, so it’s rarely safe to rely on an ingredient list unless the packaged food is certified “gluten-free.” And, many people who are aware that gluten trashes their health still cannot resist the siren song of pizza and freshly baked bread, which is where enlisting the help of a health coach may be extremely helpful. Going gluten free is definitely a lifestyle shift, but if you have celiac disease or gluten sensitivity, it’s the only way to heal. Give your body and mind three months to adjust to the change, and be patient with yourself as you navigate living in a gluten-free world. It’s not easy, but the boost to your wellbeing may be considerable!

 

Reactive Hypoglycemia, also known as the great mimicker of depression and anxiety, is a little known yet increasingly common condition where blood glucose levels become dangerously low three to four hours after eating a meal. There are a few different types of hypoglycemia and while some are associated with pre-diabetes, non-diabetic reactive hypoglycemia is simply caused by low blood sugar without the highs. Symptoms include weakness, shakiness, dizziness, headache, sweating, anxiety, irritability, heart palpitations, insomnia, a sense of doom, hallucinations, extreme fatigue and loss of consciousness.  Studies conducted on the prison population found that reactive hypoglycemia was linked to violence among inmates, and it is often misdiagnosed as chronic fatigue, subclinical hypothyroidism, depression, bipolar disorder, alcoholism, anxiety, and others.

Hypoglycemia can also drive alcohol use disorders and eating disorders because temporary relief from symptoms is usually dependent on the ingestion of sugar, creating a vicious cycle. This may be why Alcoholics Anonymous often pushes donuts and juice on the newly sober to counteract the terrible effects of decreased glucose in the body!

Testing for reactive hypoglycemia is straightforward, although few doctors look for it. If you suspect you may have reactive hypoglycemia, you will need to ask an experienced endocrinologist for a Mixed Meal Tolerance Test, which involves swallowing a sweet drink containing fat, protein and sugar. This will raise your blood glucose and force your body to pump out more insulin. Then, you’ll be given several blood tests over the five hours following ingestion to see how your body reacts.

If you test positive during this test for reactive hypoglycemia, your endocrinologist will likely implant a blood glucose monitor into your arm and ask you to eat a wide variety of foods over a period of a few weeks, taking note of when your blood glucose drops and symptoms appear. He will then analyze this data and work with you to create a nutrition plan of action, as well as discussing medication options. You can usually treat non-diabetic reactive hypoglycemia through dietary changes alone, but patience and persistence is key. While some do well on a nutrition plan that incorporates moderate complex carbohydrates ingested every few hours, others cannot tolerate any carbs and may find relief on a Paleo approach to eating, the “keto diet” or a “zero carb” meal plan, which stabilizes insulin levels and trains the body to turn fat into ketones for energy production, rather than relying on glucose. Regular exercise and daily glucose monitoring are also important! Nutritional changes and lifestyle adjustments can completely reverse this frustrating condition.
 

Not Eating Enough is a surprisingly common reason for why people experience symptoms of decreased mental wellness.

The dieting industry and weight loss culture that has predominated over the past thirty years taught millions of women that if they wanted to shed pounds, they’d need to eat somewhere between 900 to 1200 calories per day. This ludicrous suggestion has given rise to an increase in eating disorders, slowed metabolism, suboptimal health and self-loathing.

When we do not eat enough to support bodily functioning, we rob our organs of the macro- and micronutrients they require, which can lead to a host of pretty scary symptoms, including severe depression, anxiety, fatigue, and insomnia. In my coaching practice, about thirty to forty percent of the women I work with are not eating enough, and have been living that way for years and even decades. There is so much confusion over how many calories we actually need to perform at our best. A simple way to figure this out is to use something called the Mifflin St. Jeor equation:

For women, the equation is: 10 x weight (kg) + 6.25 x height (cm) – 5 x age (y) – 161.

For men, the equation is: 10 x weight (kg) + 6.25 x height (cm) – 5 x age (y) +5

 Your result will give you the amount of calories you a recommended to ingest in order to support your Basal Metabolic Rate (or BMR, your metabolism at complete rest).

 From there, you’ll want to multiply that number depending on your daily activity level, which is called your basic activity factor, as follows:

1.2 if you are sedentary (little or no exercise = BMR x 1.2

1.375 if you are lightly active (exercise 1-3 days/week) = BMR x 1.375

1.55 if you are moderately active (exercise 3-5 days week) = BMR x 1.55

1.75 if you are very active (hard exercise 6-7 days week) = BMR x 1.725

1.9 if you do very hard exercise on a daily basis and work a physical job BMR = 1.9

Using this formula will give you a pretty good idea of how many calories you need to consume daily in order to keep your body functioning optimally, assuming that you do not wish to lose weight and that there are no serious underlying health problems. If you are trying to shed some body fat, a certified and experienced health coach can help you figure out how to adjust your caloric intake and still keep your body in a happy place.

Behavioral health issues like depression and anxiety can be tricky to treat, and their underlying causes are not always straightforward. I know that if my nutrition is on point and I’m exercising regularly, I generally do not experience any symptoms of depression and anxiety, but if I consume sugar or carbohydrates, skip my workouts, and surround myself with negative people, I’m in for trouble. For many of us who have faced mental health issues, a cure does not exist in a pill, but rather in the way we eat, move and live. If you’re struggling with a drug resistant mental health condition, consider consulting an endocrinologist and a registered dietitian to investigate potential physical underlying causes. A skilled, experienced health coach or nutritionist can also be helpful in crafting a plan of action while providing support and accountability as you move into a more peaceful and contented frame of mind—and body!

 

As always, thanks for reading! I have not posted in a long while - between mamahood, health coaching, consulting, school, long-form writing and self-care, my priorities have changed. Social media/blogging doesn’t happen often these days! I do, however, continue to work with a small number of health and behavior change coaching clients, so if you’re curious about how coaching may help to improve your energy levels and overall well-being, email me at aimee@tangramwellness.com. Please be aware that I am only taking clients in Singapore at this time.

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Stressed and Depressed in Midlife? Five Reasons Why- And What You Can Do About It

Photo credit: Chris Barbalis

Photo credit: Chris Barbalis

Heart palpitations, panic attacks, fear of the future, psychosomatic illness, body dissatisfaction, anxiety and clinical depression are plaguing women in their 30s, 40s and 50s, contributing significantly to the astounding rise of the wellness and functional medicine industries as millions seek out alternative routes to improve their well-being. I should know— as a health and life coach in Singapore, the majority of my clients are women in this age bracket who wrestle with personal dissatisfaction, low energy, baffling physical symptoms, and self-sabotaging habits.

From changing physiologies, increasing stress loads, existential crises, and maladaptive cultural coping strategies, midlife packs a wallop and women, more than ever, are feeling it.

In fact, studies consistently show that the midlife crisis is a real phenomenon, with women experiencing their lowest point of happiness somewhere between the ages of 40 and 53 (peak happiness is reached at age 34, according to international research). Combined with inevitable hormonal changes during this period that radically change the circuitry in both brain and body, women are struggling.

Today in the US and the UK, an estimated one in four women are taking at least one mental health medication, making up the majority of those prescribed an antidepressant, and that number appears to be climbing in Singapore as well. In many parts of the world, middle-aged women are one of the primary groups seeking treatment for substance abuse, particularly problem drinking. And, measures of subjective well-being indicate that women’s happiness has declined in relation to men’s across industrialized countries and demographic groups.[1]

So, what the heck is going on? Here are five reasons I’ve observed that underpin stress and depression for women in midlife, as well as some initial tips on how to turn things around.

1. Your Hormones Are Dramatically Changing During the Menopause Transition:

Although menstruation doesn’t completely stop until around age 51, women generally enter the perimenopausal phase sometime between their late thirties and mid-forties, propelling a cascade of changes to hormone levels as the body gradually produces less progesterone and estrogen while ovarian function declines. During the transition into menopause, cortisol levels rise and adrenal function may be compromised, contributing to stubborn weight gain around the abdomen typically experienced by women in their forties.

The roller coaster of perimenopause generally lasts for three to four years although it can stretch on for a decade or more, bringing with it extreme fatigue, hot flashes, vaginal dryness, heavy periods, sexual dysfunction and erratic moods. This drastic shift, coupled with popular culture’s shame-based attitudes etched upon aging women as well as changes in appearance and sexual functioning contribute heavily to increased stress, generalized anxiety disorder and depression. Fascinatingly, North American and European women tend to have far more extreme symptoms than women in societies which revere older women as wise matriarchs and honor the seasons of life as well as those which subsist primarily on plant based diets, including Southeast Asia, Japan and Mexico’s Yucatan peninsula.[2]

Balancing your hormones during this time without the intervention of hormone replacement therapy is typically a challenge, but there are a few things you can do on your own to reduce anxiety and depression during this phase:

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  •  Change up your exercise routine. Perimenopausal women often hire health and fitness professionals to help them tackle unwanted weight gain after finding that, despite exercising themselves into the ground, the weight still isn’t budging. A cyclical problem arises, particularly when personal trainers and health coaches aren’t knowledgeable about the impact these hormonal changes have on the body. HIIT (high intensity interval training) is generally the protocol for torching body fat through exercise, but can work against women in the menopause transition by further increasing their cortisol levels, fatigue and muscle and joint soreness. Instead of high intensity interval training and running, adopt low to medium intensity modalities with adequate rest periods. Breath-focused Pilates and strength training, which can help stave off osteopenia, are good options during this time. Additionally, “while guidelines have advocated an accumulation of at least thirty minutes a day of moderate-intensity exercise most days of the week (150 minutes per week), a major study (the DREW study) found that a lower amount of activity was associated with a significant improvement in fitness for women in their mid- to late-fifties,” just after menopause. [3] Lower amounts of exercise can also benefit clients in the perimenopause phase, particularly if they’re not getting enough restful sleep.
     
  • Make sleep a priority, and aim to get at least 8 to 9 hours of shuteye a night. Sleep length and quality plummets during this time as melatonin levels decrease, cortisol rises, and everyday life takes on a frantic quality.

When women don’t sleep, restorative DHEA and growth hormone cease production, which in turn compromises the immune system and contributes to inflammation in the body. This reaction has a tendency to set off clinical depression.

In this age, sleepless warriors are touted as demi-gods, celebrated for their ability to subsist on 4 or 5 hours a night. In Singapore, most people are clocking just over 6 hours per night— not nearly enough for restoration and rejuvenation. Ignore the hype and commit to some serious rest. Turning your bedroom into a peaceful, device-free and cocoon-like sanctuary, practicing a bedtime ritual such as prayer or mindfulness, and taking melatonin and ZMA (zinc+magnesium+B6) supplements half an hour before lights off can all help contribute to better quality sleep. If you’re bolting up in the middle of the night— common for perimenopausal women— don’t just lie there! Get out of bed, make a cup of relaxing tea such as kava tea and read a boring book. Whatever you do, avoid looking at your phone or laptop screens- exposure to blue light is a primary culprit of insomnia.

2. You’ve Lost Sight of a Life Purpose or Worthwhile Goals:

Around one’s mid-thirties, some people begin to wake up to the fact that they’ve designed a life and chosen a career path that they thought would please others— usually their parents, a peer group, or some nebulous societal definition of success. However, many of us find that as we stabilize financially in our thirties and forties through careers that are personally unfulfilling, regret and energy depletion eventually catch up, particularly for women who have tucked their artistic or altruistic ambitions into the cobwebbed corners of their hearts.

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At this point, one is faced with the decision to remain shackled to proverbial golden handcuffs, or to take a radical dive into the unknown, doing battle with the prevailing (and idiotic) notion that when one hits her forties, it is too late to make a successful career change (hello- you’ve got a good twenty-five to thirty productive years ahead. You’re just getting warmed up!)

Other women who have taken years off to stay at home with their children may discover in their forties or fifties that they're itching to rejoin the workforce, but have lost their sense of professional identity in the process of attentive motherhood. While I am not a career coach, I do a lot of work with clients to explore their purpose and goals through an investigation of their values and life narrative. In this coaching work, I’ve discovered numerous ways to craft a new purpose beyond fashioning it from the insights garnered by personality tests like the Enneagram and Myers-Briggs. Here are three helpful tips:

  • Become an apprentice. Rather than diving in to what you think might satisfy your purpose, seek out opportunities to volunteer or intern in roles that appeal to you, or audit diverse courses to get a taste of your options. Apprenticeships are not just for twenty-somethings. Increasingly, midlife adults are seeking internship opportunities as a way to hone new skills and explore what might be most pleasing to the child within.   
     
  • In uncovering one’s true vocation—  a summons to an occupation that a person is specifically designed for— world-renowned spiritual guide and counselor Henri Nouwen suggested taking a piece of paper and drawing a foundation stone at the base of the page, filling it in with one’s birth date and life circumstances during the time. From there, “build on the stone, adding all the major events of your life, whether joyful or sorrowful. When you’ve finished, go back and add notations about cultural or world events happening during those times: political changes, natural disasters, war, etc. When you have finished, look at the whole picture and reflect on this question: what might God be doing in my life and in the world?”[4]
     
  • Honor your subconscious and body wisdom by ceasing to overthink. In his book, “How To Be An Adult,” psychotherapist David Richo writes that “in matters of the heart, thinking (ironically) leads only to more confusion. What works best is simply noticing a) what your body feels, b) what your actions are, and c) what your intuition keeps coming back to.” We have a tendency to overanalyze our options. Free journaling, body scan meditations, and centering prayer are all tools you can use to get out of your head and into your heart.

3. You Are Drinking or Otherwise Self-Medicating to Cope, Rather Than Making Space to Resolve the Real Issue:

It’s no wonder that levels of happiness and satisfaction begin to dip in midlife. During this time divorce rates increase, kids begin to cling to their independence, more women find themselves sandwiched between elder care and child duties, and a lack of self-realization sets in (see #2!)

While the “midlife crisis” has typically been seen as the domain of forty-something men who trade their responsibilities in for a flashy car or a fling, women also contend with a shifting sense of self. 

But they usually deal with it differently. In Australia, the US and Europe, as well as in expat communities around the world, women in midlife are becoming increasingly dependent on alcohol, engaging in high risk drinking that has been normalized by celebrities and on social media threads. A recent report from the OECD indicates that college-educated women in Australia should now be considered a high-risk category for binge drinking.[5] And in the US, studies show that problem drinking is on the rise across all age groups while “drunkorexia” is the new trend for middle-aged women who replace usual food calories with booze in an effort to remain trim…and blitzed. Deaths among middle-aged women from prescription painkillers and anti-anxiety tranquilizers like Xanax are also climbing as women take far more than the recommended dosage while washing the pills down with wine— a lethal cocktail. I will be bold enough to assert that alcohol abuse is one of the greatest public health crises women face today, contributing to hospitalization rates for anxiety, depression and suicide attempts; increasing the risk of breast cancer and cardiac disease; disintegrating relationships; and generally eroding one’s overall quality of life. Untangling yourself from a reliance on substances to get through the day is tricky, but millions of people each year prove that it can be done. Here are some options for mapping out a path to sobriety:

  • Enlisting a qualified psychologist or psychotherapist to help you uncover, work through and process any trauma or present life circumstances contributing to substance use is paramount in obtaining an awakened, clear-eyed life. Some coaches, including myself, are trained and experienced in supporting individuals battling a reliance on alcohol or prescription drugs, and in helping to change self-sabotaging habits and behaviors. Ceasing to self-medicate generally requires some professional support, at least in the beginning. Don’t be afraid to ask for help!
     
  • Fellowship-based support groups like Moderation Management, SMART Recovery and AA are available around the world, and many have women-only options. Find what works for you… and you may also find many other women that you can relate to.
Photo credit: Ben White

Photo credit: Ben White

4. A Spiritual Framework Has Not Been Fully Developed:

The culture of wellness has morphed into a religion of sorts, replacing ancient teachings and rituals with the shiny promises of green juices, colonics, westernized yoga, app-led meditation and “clean eating.”

As more women identify as “spiritual but not religious,” discontent with life has also seemed to escalate, evidenced by increases in antidepressant and anti-anxiety prescriptions, heavy drinking, eating disorders in midlife... and a wellness industry that’s now estimated to bring in $4 trillion dollars globally at last count, with no signs of stopping.[6]

In fact, according to a study published in the British Journal of Psychiatry, people who are spiritual but not religious are more likely to suffer from poor mental health, including a dependence on drugs, eating disorders, anxiety, phobias and other neuroses— findings that support other similar studies.[7] Surprisingly, atheists tend to fare better than the “spiritual but not religious” group, while those who identify as “religious” have the highest rates of life satisfaction as well as lower rates of depression and suicide.

Today’s “spiritualish” approach lacks the very definition of integrity— a wholeness or completeness— as diverse practices and traditions are taken piecemeal and appropriated, usually without some well-defined life guidelines or ethical foundation, which leaves many feeling hungry or confused. The explosion of corporatized yoga is a perfect example of this, with some of India’s yogis sounding the alarm on its commoditization, fitness-oriented focus and Instagrammable lifestyle. Without a strong spiritual framework, a close-knit community is also missing as modern forms of spiritual practice seem to be more about self-improvement (and arguably, self-absorption), and less about helping your fellow woman, furthering social justice or drawing closer to (God, a higher power, universal life force, the divine, the ineffable, etc.) Developing strong spiritual roots requires openness and faith, which is premised by a yearning to seek out the truth with eyes wide open, and to accept suffering as intrinsic to the human experience. This challenge is an extremely personal one, and more people are finding that the religious options available to them are at odds with our current culture, as well as their original teachings— hence new movements like emergent Christianity and a resurgence of mystical practices. As you endeavor to build a framework that is rooted deeply into solid ground, here are two things to consider doing:

  • Seek out true spiritual leaders who have devoted their lives to their faith or belief system and have a conversation with them about your questions and struggles. Come armed with questions and a healthy curiosity about how they’ve come to know what they do, as well as their routines and overall outlook. This can seem extremely intimidating, but many will be willing to talk with you.
     
  • Spend time regularly in nature, open to the silence and the wonder surrounding you. Book a walk with your friends through jungle or forest, basking in each other’s company while staying present to the sounds and sights of the natural environment. It’s no coincidence that many mystics, monks and saints found their connection to the divine while on a mountaintop or deep in the woods.

5. You’ve Got Way Too Much Going On for One Person to Handle:

In Singapore, wealth and status are doggedly pursued, fueling the rise of moneylenders, pawnshops, plastic surgery and marital strife. Social media compounds this insatiable need for prestige, providing a virtual platform to “keep up with the Joneses”. Between the duties of family and career, as well as social responsibilities and the pervasive need to live a double life— the one based in reality and the one shared on social media— women play professional juggler while striving to look the part of perfection, people-pleasing in the process. No wonder they’re drained!

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Philosopher and writer Jiddu Krishnamurti remarked over seventy years ago, “it is no measure of health to be well-adjusted to a profoundly sick society,” which certainly applies today. We are, as a collective of people in urban areas all over the world, driving ourselves into the ground by subscribing to an unsustainable lifestyle that is better designed for soulless robots than for human beings. A large part of the problem exists in the rising cost to stay afloat, as evidenced by the widening income gap in Singapore and the subsequent outcry from its citizens. In the midst of writing this, a taxi driver lamented to me, “I work twelve hours a day to support my family. I barely get in 1,000 steps a day. What can I do?”

On the other side of the issue are our expectations of what it means to have a comfortable life, and how much is actually enough. Two common sights in Singapore are the luxury sports cars parked outside HDBs (public housing) and the administrative assistant carrying a new Louis Vuitton handbag. Privileged expats are also stretching themselves to the limit in an effort to keep up with appearances.

In response to runaway consumerism and the stress of modern life, movements in minimalism and essentialism are spreading beyond a niche group of millennials and into the mainstream.

While these movements emphasize simplicity and conscious consumerism, they are primarily tools for obtaining freedom and peace of mind. Greg McKeown, author of the bestselling book, Essentialism, writes that it’s “not about how to get more things done; it’s about how to get the right things done. It doesn’t mean just doing less for the sake of less either. It is about making the wisest possible investment of your life and energy in order to operate at the highest point of contribution by doing only what is essential.”

Here’s an initial exercise to launch a life that embraces the essentials:

  • Fold a paper lengthwise down the middle, creating two separate columns. In one column, write down every single thing that takes up your time and energy in a one week period. Be specific! Now, in the second column, write down no more than half of the things that you really and truly need to do each week. Finally, highlight or underline the top three things that matter. Can you envision what your life would be like if you lived by the second column, paying particular focus to the three things you underlined?

Suffering is an inevitable part of life woven into the human experience. But, accepting suffering as one of the many waves we’ll each face does not have to equate to a life of stress and depression.

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Cultivating purpose, self-respect, and a strong spiritual foundation along with a focus on the essential and an acceptance of the seasons that each of our bodies will endure invites peace and vitality back into our lives, no matter what our age or circumstances.

I wish you good health, and thanks for reading!

Wow- you got to the end- it was a long one! Did this post help you in some way? If so, share the love on social media or in an email to someone who could use the read.

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References:

[1] (2009) Stevenson, Betsey and Justin Wolfers. “The Paradox of Declining Female Happiness” http://www.nber.org/papers/w14969

[2] (2017) “Perimenopause: Rocky Road to Menopause.” Harvard Women’s Health Watch, Harvard Medical School.

[3] Sweet, Wendy PhD, (2018). “The Connection Between Exercise and Menopause.” ACE Fitness, https://www.acefitness.org/education-and-resources/professional/certified/january-2018/6882/the-connection-between-exercise-and-menopause

[4] Nouwen, Henri.  (2013) Discernment. Harper Collins.

[5] (2015). “Women and Children First: Tackling Harmful Drinking.” OECD http://oecdinsights.org/2015/05/12/women-and-children-first-tackling-harmful-drinking/

[6]  (2017). “The Big, Booming Business of Wellness” Self Magazine. https://www.self.com/story/the-big-booming-business-of-wellness

[7] (2013) King, Michael, Louise Marston, et al. “Religion, Spirituality and Mental Health: Results from a National Study of English Households” The British Journal of Psychiatry.

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© Tangram Fitness 2013