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Keeping on track: a dietician from our Assistance Program shares her travel advice

March 12, 2018

Whether we're on the road or overseas, it can be difficult to eat a healthy diet while travelling.

But that doesn't have to be the case, Dina Daniello-Santiago says. A Registered Dietician with Manitoba Blue Cross's Assistance Program, Dina works with clients to assess their needs, set goals and help improve their health. Clients often approach Dina to facilitate healthy weight management, increase their literacy around food labels, control diabetes or heart health and improve their overall nutrition.

March is Nutrition Month, and with many people planning their summer trips, Dina has some tips to eat healthy while on the go.

Plan ahead

When working on your itinerary, you'll want to keep meals in mind, Dina says.

"Depending on where you're going, you can always book ahead," she says. Some restaurants have their menu on their website, so it's relatively easy to pick something healthy in advance, she adds.

Between meals, "Pack healthy snacks," Dina says. If you're prepared, you can avoid the gas station snack raid that often ends with chips and chocolates. Fruit, whole grain crackers, trail mix and even certain granola bars offer good nutritional value and are easy to pack, she says.

"Convenience doesn't have to be in a package," Dina says. "Convenience can be a banana and an apple. But we usually don't think of it that way," she adds. In some countries, fruits and vegetables are widely available in stands, markets or stores, making a nutritious snack even more convenient.

Getting a room with a mini-fridge or a kitchenette will grant you even more options. Being able to store healthy snacks like yogurt, fruit or hardboiled eggs can keep you from making that late-night run to the bodega or greasy taco stand down the block.

Go for the greens

Preparation is important, but it's also easier said than done. Your dinner plans might fall through, or a scheduling change might take you to a restaurant you hadn't anticipated.

Depending on where you're going, it might be impossible to plan ahead. A restaurant in a small town or village might not have a website, and nutrition information might not be available. And even if it is, language barriers can make it harder to understand.

In that case, try to avoid deep fried foods and aim for the greens, Dina says.

"Fill up on vegetables," she says. Salads can be a great choice, because many of them include fruit or nuts that turn them into a full meal.

Control your portions

When we order a heaping plate of food, it's all too easy to devour it – often with negative effects. And even when we plan on taking some of it home, it doesn't always go as expected, Dina says.

"If we have in our head that we're going to take half of it home, but we ask for the full size, we end up eating the whole thing," she says. If you want to save some for later, Dina recommends asking your server to box half of it before he or she serves it to you.

If you're trying to avoid oversized meals in general, share with a friend or get a lunch-sized portion, which is usually smaller and cheaper than a dinner portion, Dina says. Appetizers are also a good choice – in some countries, sharing small plates (like tapas) is a cultural activity, which can make portion control even easier.

Drink smart

"Don't drink your calories," Dina says. We often don't notice, but the calories in juice, soda or alcoholic drinks can add up quickly. For instance, many beers contain over 100 calories, while a glass of wine has a similar amount.

But it's not just the alcohol that may cause an issue. "When you drink alcohol, food usually goes along with it, and it's not usually celery sticks and carrots," Dina says.

Be careful about how much you drink: not only is excess alcohol harmful, but it also lowers your inhibitions, meaning you'll be more likely to reach for those extra snacks when you've already had plenty, she says.

Keep your routine

Keeping things routine is most important, Dina says. "Try to stick to your regular routine as much as possible with a little bit of flexibility," she says. If you normally stay active, try to build that into your trip. Whether you're hiking through the jungle, reaching your tour sites on foot or just booking a hotel with a gym, incorporating activity into your travels will help keep you on the right path.

An illness, not a choice
February 1-7 is Eating Disorder Awareness Week

January 29, 2018

Eating disorders can affect anyone.

That's the main message of this year's Eating Disorder Awareness Week, which is organized by the National Eating Disorder Information Centre (NEDIC). Eating Disorder Awareness Week aims to educate Canadians about these dangerous and sometimes misunderstood conditions.

Eating disorders can be deadly

According to NEDIC, eating disorders are deadlier than any other mental illness.

"One of the reasons is because of the impact it has to all organs of the body," says Lucille Meisner, an eating disorder specialist at Manitoba Blue Cross's Employee Assistance Centre.

Our bodies use stored fat for energy when we restrict calories, which is why we lose weight when dieting, she says. But when we are starving and fat is depleted, our bodies use muscle to survive. The heart is a muscular organ – if blood chemistry is imbalanced, it can cause abnormal heart function, she adds.

Chronically low blood sugar can cause seizures, and purging or vomiting can cause internal bleeding, Lucille says. Ongoing and persistent malnourishment can even stop a woman's menstrual cycle, and the decrease in estrogen can impact bone density.

"I'm counselling women who have been diagnosed with osteoporosis, and they're 30 years old," Lucille says, noting that osteoporosis usually occurs in seniors.

Narrow views lead to treatment barriers

Eating disorders affect people of all ages, genders, sizes and cultures, Lucille says.

"Sometimes, there's a very narrow view and belief about what an eating disorder looks like and who gets them," says Lucille. "And that's often one of the barriers to seeking help."

When people think of eating disorders, they usually think of anorexia and bulimia – and believe if they don't have either, they don't have an eating disorder, she says. Anorexia is typically characterized by a fear of gaining weight, which causes people to exercise excessively or avoid food. Bulimia is characterized by binge eating and then "purging" the food through vomiting or laxatives.

Often, we fail to consider other ways in which food, weight and body preoccupation cause severe emotional distress and impair day-to-day functioning, Lucille says.

Some people struggle with compulsive overeating – periods of bingeing followed by periods of starvation, Lucille says. Others have binge-eating disorder, which is characterized by bingeing but is not followed by compensating behaviours (purging, vomiting or restricted eating).

On the other hand, there's purging disorder, where a person consistently engages in purging behaviours (vomiting, using laxatives), but doesn't binge.

There are also other disorders such as pica (the eating of non-food items like soap or hair) and night eating syndrome (excessive eating after an evening meal or in the middle of the night).

An illness, not a choice

In a 2014 Ipsos Reid poll, 40 per cent of Canadians surveyed thought eating disorders were a personal choice.

"It is not uncommon for those who don't understand eating disorders to think that it's a choice rather than a serious and dangerous illness," Lucille says. "The common misconception with any addictive or compulsive disorder is, 'Why don't you just stop?'"

"It prevents people from asking for help," Lucille says.

The "ideal" body can take its toll

"We live in a society that worships a certain body type," Lucille says. While she's worked with eating disorders since the 1980s, it's a concept that has stayed the same throughout the decades, she says.

In the '80s, the "ideal" female body type was thin and tubular, while today, it's more of an hourglass shape, Lucille says. But she still sees the same desire to fit in with the ideal.

"The pressures never change," she says.

It's that need and drive to be "perfect," to fit in at all costs, that often leads to eating disorders, specifically anorexia or bulimia, Lucille says.

"It's a bit of a no-win," she says. "If you dance that line of being the ideal stereotype and the perfect flawless body, you risk mental illness."

That no-win scenario can create challenges in treatment, she adds.

"If the person fits the ideal for the perfect body, it makes it hard to be motivated to change," she says. "Because on the outside, they're getting positive reinforcement for their appearance. What goes on behind closed doors is a secret.

"Body shaming is a serious problem in our society," she says. "It begins during childhood and for many, it becomes internalized as adults. We become our harshest critics when we believe we don't 'measure up.' We live in a society that worships thinness and a youthful look – at all costs.

"It becomes a vicious cycle," she says. "I see all ages and genders. Sometimes my client is an athlete who has to achieve a certain weight, sometimes it's a man or woman who feels like perfecting their body will perfect their life, and sometimes it's an adolescent who feels their body is the only thing they can control."

Seeking assistance often means giving up the ritual that provides relief, helps us fit in or gives us a sense of control, she says. It can also mean giving up a shame-filled secret that consumes someone's entire life.

Getting help

When a person with an eating disorder does seek help, counselling focuses primarily on reconciling emotions that drive the disorder, she says.

"When you're struggling with an eating disorder, your feelings underneath it are most often avoided," she says.

"There is often fear and insecurity, loneliness, rejection and shame," she says. "Preoccupation with the body and the feelings related to starving, bingeing and purging are the primary feelings the person knows, and those are often self-deprecating and self-defeating. The satisfaction that comes with fitting into society's ideal image is fleeting at best. It is a no-win.

"People with eating disorders often feel helpless and hopeless and have low self-esteem. One of the goals of counselling is becoming more connected with our true self," she says.

While eating disorders can resemble alcohol or drug addiction, they present special challenges in treatment, Lucille says. "We have to find a way to incorporate healthy eating," she says. "Abstinence is not an option."

Lucille often has to help people introduce food into their lives, she says.

"I often refer clients to nutritionists and dietitians so that they may learn to enjoy food again," Lucille says. "For many, it has been decades of a conflicted relationship."

"If you starve yourself, you have to discover a way to be with food," she says. "If you're a binge eater, the goal is to be with food and stay present and avoid the binge trance. If you purge, the goal is to become comfortable again with food that is digesting in the stomach."

Getting well involves developing self-compassion and learning to care for our bodies and ourselves, Lucille says. A healthy body image and a relaxed relationship with food is the goal.

"To change the number on the scale only temporarily changes how we feel inside," she says. "To change what we say to ourselves when we look in the mirror... that is an inside job and a very personal journey."

Manitoba Blue Cross members with Employee Assistance as part of their employer health plan can contact the Employee Assistance Centre directly to inquire about counselling services or to schedule an appointment:

Directly: 204.768.8880
Toll Free: 1.800.590.5553
TTY: 204.775.0586

If you are unsure as to what benefits are available to you and your family, check with your Human Resources representative.

Other resources:

Eating Disorders Manitoba

National Eating Disorder Information Centre

National Eating Disorder Information Centre helpline: 1-866-633-4220 (toll free)

5 tips to make your resolutions stick

January 15, 2018

If you're like many others, you've resolved to improve yourself in 2018. Maybe you've committed to doing nightly push-ups; perhaps you've sworn off sweets. Making resolutions is commonplace this time of year – but unfortunately, so is breaking them.

So, how do you keep your resolution? Here's what experts from around Manitoba recommend.

1: Make a plan

Blindly stumbling into your resolution typically doesn't end well. One way to prevent that is to create a personal action plan, says Jim Evanchuk of the Winnipeg Regional Health Authority.

"Your personal action plan is a thoughtful and honest conversation with yourself," he writes. "It helps you identify an action or behaviour that is highly important to you, one that you can envision yourself doing and feeling good about achieving."

Making a plan involves acknowledging the change you want to make, creating your goals, noting the difficulties you may experience and knowing the resources you can rely on.

2: Narrow it down

Maybe you're trying to eat healthier, so your goal is to eat more vegetables. That isn't clear enough, says the Sport Medicine & Science Council of Manitoba (SMSCM). "What does more mean?" the organization writes. "Is more eating a few peas on your plate? You need to be specific."

Rather than "more," you might aim for four servings a day, the SMSCM suggests. Being specific also makes your success easier to measure, because you'll know for sure if you've hit your four-serving minimum (rather than guessing whether you've eaten "more").

3: Be realistic

"One reason why I expect that resolutions tend to fail is that people try to accomplish too much, too quickly and precisely when they are still in recovery from the holiday season," writes Jason Leboe-McGowan, a psychologist at the University of Manitoba.

The SMSCM agrees. "Look at your goal and ask yourself if this is something that you can achieve based on your workload and schedule," the organization writes.

It's easy (and fun) to be ambitious, but consider whether you can see yourself succeeding in your goal months down the line, when your post-holiday excitement has faded and life is back to normal.

4: Plan around life obstacles

"I suspect that many resolutions ultimately fail because the structure of a person's life makes fulfilling the resolution impossible," writes Leboe-McGowan. For instance, if you're trying to get in more exercise, you'll need to look at the reasons you haven't exercised in the past. Does your work schedule conflict with your workout schedule? Do financial constraints prevent you from buying equipment or a gym membership?

"Adjustments to many other aspects of our lives may well be necessary if we are going to succeed at implementing even a modest New Year resolution over a practical timeline," Leboe-McGowan writes.

Unfortunately, making substantial life changes isn't easy. You'll have to create your resolutions with your situation in mind and see what changes you can reasonably make.

5: Forgive yourself

Sooner or later, you'll probably hit a setback. Maybe you'll miss an exercise day, or maybe you'll eat more sweets than you planned.

"Don't beat yourself up over your failure," writes Jim Evanchuk. "Instead, believe that you can get back on track. It's also important to not compare yourself to others. Your personal goals are just that."

It's important to realize that simply attempting change is a great first step. "At the very least, trying to improve ourselves will steal time away from doing things that are bad for us," says Leboe-McGowan.

Here's to a happy and healthy 2018!