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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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BODY IMAGE WORKSHOP FOR WOMEN- PRIMETIME: October 20th

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Friends in Singapore, I'll be leading a Body Image workshop with Primetime next Tuesday evening. It's a fantastic opportunity to learn, network, get to know yourself a bit better, begin improving your body image, and perhaps assist your daughters in doing the same. If you can make it, please join!

If you are unable to be a part of the evening, here are five quick tips to help yourself and each other beat the body image blues:

1. RETHINK COMPLIMENTS. Instead of complimenting someone on their physical appearance like we always do, acknowledge a positive attribute that's beyond skin deep. Like, "hey Adrienne, you're a truly awesome extrovert because you respect all sides of the coin," or "Roz, the weight room is a hundred times more sparkly and motivating when you're in it" or "Katheryn, if anyone ever teaches me how to do one of those wild & zany yoga headstands it's going to have to be you." Get it?

2. GET SPORTY. Studies suggest that girls and women involved in sports, as well as exercisers generally, have more favorable body image then those who are largely sedentary. So, get active and find out what your body is actually capable of.

3. MAKE A PACT AGAINST SELF-DEPRECATION. I know it's an easy way to bond and for many, it's also a habit, but your body really does hear what you're saying about yourself and it responds accordingly. Seriously. 

4. SPIRITUAL PRACTICE- GET INTO IT. Be it yoga, journalling, prayer, meditation, daily gratitude lists, communal worship, or getting up with the sunrise to contemplate life in solitude, learning how to base your life on wisdom, inner guidance and the larger picture will pull you further away from the stuff that doesn't really matter at the end of the day, whether that's zits, a roll of fat, wrinkles or anything else. 

5. LIMIT YOUR TIME ON SOCIAL MEDIA. I know- it's sort of ironic for me to post this on the blog- but the longer we spend on social media, the worse we tend to feel about our bodies and ourselves as a whole. Free yourself from the constant comparison trap that social media tends to encourage by being pointed and specific about your social media use.

Ok, I've got MUCH, MUCH more for you next Tuesday so hope to see you there but if not, perhaps this short list might be of use or make you smile. If you think someone might benefit from this workshop or list, please share.

Details and registration for the event are HERE--> http://www.primetime.org.sg/events.cfm?event_id=2CB81AAF-ECF5-EF60-C26B5EB20B167180&status=current

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You Are Worth the Work!

This morning I was reading about the work actor Matthew Perry is doing to help fellow addicts seek sobriety. One of the greatest gifts about the journey of recovery is having the opportunity to be a light for others who are new to the path of deeper living.

Many struggling with addiction- be it food, booze, sex, drugs, or anything else- believe that if they are "good" for a month or that if they go to enough meetings or abstain for a certain period of time, they'll be "cured,"- "all better" or that there was no issue to begin with. I certainly thought that way in the beginning, and then I ended up continuously falling into destructive patterns for nearly half my life!

It's not just about the BEHAVIOR, it's about the THINKING behind the behavior. If you've physically and mentally been operating a certain way for 10, 20, 30 years, why would you think that you can turn it around in a week or a month? Don't be so hard on yourself!

Recovery means learning a new way of living and being, AND doing the work to carry out that new way each and every day. You step into a daily ritual of gratefully rebuilding yourself until eventually, it becomes you, and even so, THE RITUAL CONTINUES BECAUSE IT HONORS THE BEAUTY AND THE PURPOSE OF YOUR LIFE.

Today, I'm thinking of all those who are new to the path. Yes, it is really tough stuff, but you are tougher, more resilient and YOU ARE WORTH THE WORK.

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The Conversation: What Does An Addict Look Like?

“I don’t think you are really an alcoholic,” someone close to me remarked quite unexpectedly as we shuffled past a neighborhood bar, making our way through the cool dark to a restaurant by the sea. It wasn’t a conversation I welcomed chewing into at that time. I was hungry and I didn’t have the patience to get into how the term “alcoholic” is both dated and inaccurate, or what “alcoholic” even means anymore.

“Why do you say that?” I asked. My throat tightened.

“Because you’re not that weak,” he replied. The weight of those five words sunk to the pit of my gut and anchored there as carelessness and ignorance. This, from someone so intelligent, someone who knew me so well. “Well, that’s your opinion,” I said, having nothing more to offer on the matter and sensing that any further explanation would just be wood chips for the fire. I have since realized that those many cutting statements delivered to people in recovery are not only sprung from 
naiveté, but also from a desire for control. It is “Human Nature 3.0”- we like things to be predictable and we want to have the upper hand (more on this in a future “Conversation”).

"Because you're not that weak." 

Stereotypes imprison the addicted and block our collective consciousness from seeing that this crisis is perhaps the largest societal challenge we face today. After all, the vast majority of us are addicts in action; our poisons are the differentiator. Food. Sex. Gambling. Money. Shopping. Booze. Drugs. Pills. Work. “Perfection.” Love. Prestige. Exercise. Religion. Facebook. Beauty. Power. And yet, when people conceptualize the image of an “addict” in their minds, their own reflection is rarely conjured.

"Getting sober just exploded my life. Now I have a much clearer sense of myself and what I can and can't do. I am more successful than I have ever been. I feel positive where I never did before, and I think that's all a direct result of getting sober." - Jamie Lee Curtis

"Getting sober just exploded my life. Now I have a much clearer sense of myself and what I can and can't do. I am more successful than I have ever been. I feel positive where I never did before, and I think that's all a direct result of getting sober." - Jamie Lee Curtis

Imagined instead are: 

  • A drink upon waking
  • Homelessness and squalor 
  • Trembling hands, “the shakes”
  • Messy hair, body odor, bad teeth
  • Joblessness & living on the dole
  • School dropouts, lack of education
  • Marital and financial trouble
  • Piercings & tattoos
  • Drink or use every day 
  • Foolishness, weak-willed  

Maybe so many people have chosen to frame addicts this way because it’s easier, because the reality is far too close and unearths unacceptably discomforting levels of fear. Consider that over 7% of the US population and just under 4% of Singapore’s population fit the criteria for having an alcohol use disorder, according to population-based surveys (estimates should be considered extremely conservative, given self-reporting methods and the shame associated with admission). Millions of these people are educated, hold down jobs, and have family and friends to answer to. In fact, around 20 percent of individuals with an alcohol use disorder are considered “high functioning”- in other words, highly intelligent achievers who are able to maintain the façade of an accomplished and even enviable life despite their dependence on alcohol. Gabrielle Glaser, author of “Her Best Kept Secret: Why Women Drink,” writes that the more educated and well off a woman is, the more likely she is to consume booze, and that white women are more likely to drink than women of other ethnicities. And, according to a new survey by Protecting.co.uk, a third of workers in the UK have admitted to using drugs at work while nearly every respondent said they had gone to work drunk at least once.

                                                                                    "What made me stop [drinking]? I realized it was not going to end well." - Kristin Davis 

                                                                                    "What made me stop [drinking]? I realized it was not going to end well." - Kristin Davis 

In an age where nearly everything seems to revolve around cocktails- from bonding with friends to making important business decisions and even having sex (yes, many people admit that drinking is often a prerequisite requirement to doing the deed), what does addiction actually mean and how can someone tell whether or not they’ve crossed the line? Perhaps it is first crucial to accept that no one definition of addiction exists, as it is viewed from diverse perspectives.

Many scholars and doctors define addiction as a “brain disease,” which in my view is a simplistic and even dangerous way to categorize a many-tentacled beast that sucks its existence from complex social, cultural, biological, psychological and spiritual forces. Other addiction experts say that addiction is a chronic neurobiological disease characterized by impaired control, compulsion, continued use or behavior despite harm, and craving. This perspective to some extent minimizes the outcomes while focusing on the actions. Is an addict still an addict if she is no longer engaged in her addiction? SMART Recovery describes “addiction as an impulse disorder, favoring momentary satisfaction over the long term view,” while other programs consider addiction a “spiritual bankruptcy.” The origin of the word “addiction” perhaps gives us a clearer meaning; it is derived from a Latin term that means “bound to,” or “enslaved by.” This notion, “an enslavement,” resonates most with me; when you have an alcohol use disorder- or any kind of addiction- you must tie yourself to some external actor in order to feel ok; that desired sense of belonging or normalcy exists at the other end of the craving. Addicts without their fix- be it cocktails, cakes or cocaine- find it impossible to inhabit themselves.

So, when does drinking become a problem; how do you know if you have an alcohol use disorder? Well, you can take a handy "Almost is Too Close to Always" quiz from Harvard, although I’m not sure its results are definitive, particularly since, again, the criteria varies. Or, you can go with a more traditional screening method like CAGE:
C
 Have you ever felt you should cut down on your drinking?
A Have people annoyed you by criticizing your drinking?
G Have you ever felt bad or guilty about your drinking?
E Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover? 
According to a CAGE screening, two positive answers warrant further assessment. 

Be warned however, that most people severely underestimate how much they drink and count, on average, only one quarter to one half of the drinks they actually consume. I think, with many of these types of issues, we already hold the answers within. I knew years before I quit drinking that it was hollowing me out and stealing my spirit. But, if someone asked me about it, I wouldn't hesitate denying that knowledge.  

It is alcohol after all... cunning, baffling, powerful. 

So, if you suspect that your drinking may not be serving you well anymore, why not begin your exploration of that relationship by reflecting on these questions?

  • Is my alcohol use holding me back from my dreams?
  • Is my drinking negatively impacting my relationships or my health?
  • Do I actually enjoy drinking or has it just become something to do?
  • Am I drinking away boredom?
  • Would my life be better if I quit drinking? In what ways?

I quit booze when I realized that it was beginning to steal the life I was meant to lead- one with a sense of peace and confidence, a creative existence, a good marriage, a rewarding career, a spiritual belonging, the ability to accept myself as is. A few people might argue that I hit the bottom several times, while most others standing on the outside looking in could only see a woman who had it mostly together- top student, secure job at a great company, solid friends and marriage, and a rather exciting life in a "city so nice they named it twice." What I knew for sure was that I was deeply unhappy with who I’d become, and that if I chose sobriety, I’d at least have a chance to turn it around.

Best. Decision. Ever.

 Perhaps it will be the same for a few of you reading this today.

If you missed the first two installments of The Conversation, you can check them out here and here. Blogger EJ Austin-Jones also had some thought provoking things to write about this series, so check out her take here. I'd love to hear your thoughts, so please share them in the comments section. If you liked this post or think it might be interesting to someone else, please share! Stay tuned for next week's installment and if you have a question on addiction or would like me to cover a particular aspect, just send me a message. 

 

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The Conversation: "Total Alcoholic"- Is Our Language a Problem?


“The Conversation” is a weekly series on women and drinking. If you missed the introductory post, you can read it here. I am a health and addiction recovery coach and researcher who has firsthand experience with this topic; I am not a medical doctor, counselor or psychologist. All ideas proposed are up for discussion and debate- it's one of the best ways we can find new solutions and evolve. 

Tina* was the kind of girl you could always count on for a fun time. We met when we were both waitresses at the landmark Coffee Shop in Manhattan’s Union Square, and we immediately discovered that we had something else in common- we both relished getting blitzed toward the close of our work shift and were always smooth about not getting caught. After we'd punch out the clock, we’d race over to the East Village together and spend the rest of our evening drinking at a handful of dive bars until closing time- ones that would serve underage charmers like us. Our party came to an abrupt end when, after barely a few months at Coffee Shop, we were both dismissed. I didn’t see Tina again until a few years later, when I ran into her at the 24-hour diner where she worked as I was brunching with a friend. I surveyed her face- sunken cheeks spotted with acne, circles under her drowsy eyes, collar popped on a grubby shirt- while we exchanged an awkward acknowledgment, and I remember thinking to myself,

“Total alcoholic.”

What were our differences? She was a young black woman from the Bronx, I was a Connecticut-born WASP without the usual privileges attached. She was serving up eggs at a rundown greasy spoon, while I was racking up student loan debt at a fancy university. She was relatively honest in her presentation to the world, while I was a liar in a Betsey Johnson frock who spent money I didn’t have on dresses and martinis that I certainly didn’t need. She’d always been “balls to the wall.” I was measured, careful, rehearsed. And yet, we were both heading in a similar direction. 

“Total alcoholic.”

Have you ever had this thought cross your mind about a person you don’t truly understand while out at a friend’s party or a wedding or a company meeting? I know I have, at several points in my life. The colleague at work who’s always hungover, who’s always calling out sick. The melodramatic, co-dependent buddy who just can’t seem to keep it together. That Facebook friend who posts photos of cocktails several times a week, with hashtags like #roughday and #thirsty. The lover who stumbles home well past midnight after yet another business outing, who wakes you up by vomiting. It’s the easiest way to dismiss a behavior that unsettles us because that behavior hits too close to home, or because it looks like us, or because it confronts us with something that seems incomprehensible, alien, uncouth.

So, what’s an “alcoholic?” This often misused and outdated term came into our lexicon way back in 1852 to describe a person who was addicted to alcohol and who could no longer control their consumption, nor the harmful outcomes resulting from it. Much like the designations  “lunatic asylum” or “mentally retarded,” “alcoholic” was retired quite a while ago and is no longer found in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which sets the standard for criteria and language to be used by mental health professionals, researchers, insurance providers and pharmaceutical companies. “Alcoholism” has been replaced instead with “Alcohol Use Disorder,” a phrase implying an issue that flows along a spectrum (your experience and mileage may vary), rather than a disease (you either have it or you don’t). Unfortunately, journalists, recovery programs, and the general public have not received the memo- labeling someone an “alcoholic” may be as inaccurate, inappropriate and backwards as placing the “R” word on a child with dyslexia or ADHD- or any other challenge, for that matter.  Compounding this issue in our language and, of course, our thinking- as one shapes the other- is the fact that the primary method of treatment prescribed by hospitals, doctors and courts is Alcoholics Anonymous, which more or less encourages its participants to pat a label on themselves like a gold-foil badge: “my name is so-and-so and I’m an alcoholic.” 

I know the drill well because I’ve said that sentence myself at least a few hundred times over the years, which has created just as much peace within me as it has turmoil. When we are labeled, that mark initially makes it a lot easier to find our place in the world, even if that place costs us, over time, our ability to flourish, transform and grow. Sadly, I still use the word on occasion- about myself and in describing the experiences of others- if only because it makes it so much easier to carry on with a conversation or get to the point, rather than delving into its history and myriad offenses. “Alcoholic” is what most people know. It’s what we’ve learned to get comfortable with. And, I owe a great deal to AA, just as millions of others do. In its context, saying, "I'm an alcoholic," becomes nearly as easy as, "my name's Aimee and I'm a Taurus." 

But, what would happen to the way we view, treat and discuss excessive or problem drinking if we changed the language we use in describing it, and in describing all the millions who are impacted by it? How would treatment for those with an ALCOHOL USE DISORDER evolve and improve if we honored the spectrum as well as each individual's unique experience, rather than framing it in black and white? By alleviating sufferers from the yoke of stigma- and I cannot help but think of Hester Prynne's scarlet red patch embroidered in gold with the big letter "A"- are we then finally encouraging them to heal and become healers themselves? Or, must we brand them in order to keep them humbled and in line? I don't have the answer, but what I do know is that I'm doing my absolute best to adopt this more progressive terminology as a way to acknowledge the dignity and POTENTIAL of those who are wishing to change their relationship with alcohol, those who have already changed it, and to also respect my own growth.

I stopped fully identifying with the term "alcoholic" a few years ago- a divorce that was actually quite conflicted. I remember saying it aloud following my name, and feeling my throat constrict. This constriction had happened again and again- it felt as though I was no longer telling the truth about who I was, and I had a lot more to discover about who I was to become. I needed to make room for that. In this shift- one that isn't yet complete and may never be- I've discovered a world of difference in living as a thriver, in comparison to existing as a survivor. 

So, I'll pose the question once again- what would happen if we released the term "alcoholic" from our world and all the ideas that go along with it, and instead began to work with and through the knowledge, language and discoveries of more recent times? Estimates show that only around 15 percent of people with an alcohol use disorder receive treatment and that most people who drink too much are not alcohol dependent. If we went about discussing it in a more accurate and progressive manner, how many more would finally get the help they need? 

Thank you for reading. I'd love to hear your thoughts on this topic, and as I mentioned earlier, all points are up for discussion or debate. I do not propose to have or offer all the answers, so if you disagree with me or feel that something needs more explanation, please say so. I'm here to learn as well! In the next installment of "The Conversation," I'll be exploring how one can identify an addiction or alcohol use disorder. What's the difference between someone who likes to party and someone who drinks too much? How and when does drinking become a problem?

*Names have been changed.






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