200: Ask Me Anything

Chris Sandel: Welcome to Episode 200 of Real Health Radio. You can find the links talked about as part of this episode at the show notes, which is seven-health.com/200.

Seven Health is currently taking on new clients. We specialize in helping you overcome disordered eating and eating disorders, body dissatisfaction and negative body image, regaining your period and improving your hormones, and recovering from years of dieting. If you’re ready to put your struggles to bed and heal your relationship with food and your body once and for all, please get in contact. Head over to seven-health.com/help, and there you can read about how we work with clients and apply for a free initial chat. The address, again, is seven-health.com/help, and I’ll include that in the show notes.

Hey everyone. Welcome back to another episode of Real Health Radio. I’m your host, Chris Sandel.

Today is a special day on the podcast. We have reached 200 episodes. When I first thought of creating this show back in the midpoint of 2015, I had no idea this is how it would pan out. When the podcast reached 100 episodes, I did an AMA, or an Ask Me Anything episode, and the questions were mostly focused around my life, so I titled that episode “My Story.” We decided to do another AMA episode for this one, with some of the questions being personal and about me, but others being about recovery and Health at Every Size and many other topics. Drew, who is the Head of Operations and Marketing here, helped to facilitate this by asking me the questions.

But before we get started with that, I have two things I want to mention. The first is the book winner for this week, and it is Nathan W. Thank you for your review. You’ll be receiving a book of your choosing from our Resources page, and we’ll be in touch about this.

Reviews are a huge help to the podcast and they increase listenership, and they’re also a way for you to win a book. All you need to do is leave a review on iTunes, take a screenshot of it, and then email it over to info@seven-health.com, and you’ll then be permanently entered into the drawing. Thank you to everyone who’s already done this.

The second thing to say is just a big thank you for everyone who has listened to this show over the last 5 years. It has definitely been a big commitment to do a show like this every week, which we’ve mostly kept to – although some of these have been rebroadcast episodes. Thank you to everyone who has ever sent in feedback on the show, whether that was simply to say how much you enjoy it or to suggest a guest or because you’d left a review or, like on today’s episode, to submit a question. Thank you for giving me an outlet to have long-form conversations with people I respect and admire, and thank you for allowing me to do the solo episodes and actually wanting to listen to me talk about a topic for an hour or an hour and a half all on my own. I really do love doing the show, and I’m looking forward to many more episodes.

With that out of the way, let’s go on with today’s AMA show. Here is me and Drew answering your questions.

Drew Follette: Hey, Chris. Thanks for having me. I’m glad to be here. It feels weird to be on this side of the microphone for once.

Chris Sandel: Yes. You’re normally putting podcasts up and involved in all of the other processes except the being on a podcast.

Drew Follette: I’m the brains behind it, you’re the beauty. [laughs]

Chris Sandel: Yeah, exactly. [laughs] So yeah, 200 episodes.

Drew Follette: I know. I can’t believe it’s been this long. I think I’ve been with you since – gosh, I started before I moved to Bangkok. I moved in 2017, so I started with you probably in 2016 or maybe 2017.

Chris Sandel: I think it was 2017. I think it was before Ramsay was born, in the April or May time of 2017. You’ve been around for a while. And I think at that stage, we were just coming up on 100 episodes, thereabouts. You joined before the 100^th episode, but I know you were definitely there by that stage.

Drew Follette: Yeah, we were only in double digits at that point. Then I think we got a little bit sidetracked when Ramsay was born. Got a little bit behind schedule.

Chris Sandel: Yeah. I think the first 100 took just under 2 years, and then the next 100 has taken nearly 3 years.

Drew Follette: But you know, you had a baby.

Chris Sandel: There’s been more rebroadcast episodes, there’s been more weeks when something didn’t come out, but yeah, I have a child instead.

Drew Follette: You had a baby, there’s a global pandemic. Things have come up.

Chris Sandel: Exactly. It’s been busy.

Drew Follette: Definitely. I’m really excited to do this, and we put out a call for questions on social media, on Instagram, on Facebook, and we got a lot of really good questions, so I’m excited to dive into them and have you answer them.

Chris Sandel: Nice.

Drew Follette: You ready?

Chris Sandel: I’m ready.

00:05:30

Tips for dealing with negative body image

Drew Follette: All right, let’s do it. The first one is from Love Is Louder, and they want to know: “How do you deal with thoughts about restricting when you have a very bad body image?”

Chris Sandel: This question at its core is more about sitting with uncomfortable feelings. You say bad body image; I would say maybe bad body image days, because I think with this, things wax and wane. There’ll be times where it’s better and there’ll be times where it’s worse. I think that in and of itself is quite interesting in terms of one day you wake up and things are fine or are better, and then another day you wake up and they’re not so good. Normally in those situations, not much has changed, or often nothing has changed; it’s just a feeling that you have.

If you’re in that state of mind and the habit has been to restrict, then restricting feels like the smart thing to do or the thing that is most likely to help with that discomfort, but is very much a temporary fix and not really dealing with the root problem. From working with clients for a long time with this kind of thing, the restricting typically then feeds into the bad body image, and body image will typically get worse or become a lot more fragile and subtle and easier to rise up and become worse when that is the means which someone uses to deal with body image.

So from my perspective, it’s trying to look at the bigger picture or trying to look at it from a different angle. If you’re having a day where body image is worse, ponder, “Why could this be occurring if I’m trying to think of things outside of my actual body?” Because typically, that’s where it’s coming from. It could be that you’re under more stress at that point. There could’ve been an argument you had with someone. It could be that someone was talking about going on a diet. You could’ve had less sleep that night. You could be more bloated that day.

There can be lots of reasons why that’s more difficult on a particular day, and I would say as humans, we have off days. There’ll be times where there really isn’t a reason that you can figure out. You just don’t feel so good.

My thoughts about this are that restriction, even if it feels like it helps, is actually going to be making the situation worse. There’s more to this situation. It’s looking at how you feel and think about your body and doing more of that deeper work. The other thing that’s coming to mind is thinking about mindfulness and starting to be aware of the thoughts that naturally occur and naturally disappear on their own.

But yeah, this is something I work on a lot with clients, and it’s hard to give a really concrete answer because it really depends on the individual and what they can discover works for them through us looking at different aspects.

Drew Follette: Yeah, that makes sense. Do you have one or two favorite go-to resources for working on or improving body image?

Chris Sandel: I really like – and again, this depends on the individual and where things are coming from – there’s a book called The Body Image Workbook by Cash.

Drew Follette: Thomas Cash.

Chris Sandel: Thomas Cash, yeah. It can be really useful. I’m a big fan of Kristin Neff and Tara Brach and a lot of their acceptance and self-acceptance and self-compassion work. I’m also a fan of meditation. Sam Harris’s Waking Up is definitely my favorite with that and can be helpful. So those would be the things that come to mind.

Drew Follette: Those are all really good. Another one that comes to mind for me is a book called Beyond Beautiful. I know that I’m going to butcher her name, but I want to say it’s Anuschka Rees. Also a book about body image and all of those things – how do I feel good about myself when my culture and society basically tell me I shouldn’t based on how I look?

Chris Sandel: Yeah. There was a documentary called Embrace, which was Taryn Brumfitt. If you google “Embrace,” I really like that documentary. I think it was well done, and it’s something I often recommend with clients.

Drew Follette: Oh, I haven’t seen that. I’ll have to check that out.

Chris Sandel: Yeah, it’s good.

00:10:30

Thoughts on fasting

Drew Follette: All right, the next one is actually by the same listener, and they want to know what your thoughts are on fasting.

Chris Sandel: One of the things I’m always really big on is context. Context matters. For me, in terms of fasting, honestly, I haven’t looked into the literature around fasting to know when it might be applicable or where someone may see some health benefits from it.

The reason I haven’t done a lot of that is because within the population I work, I typically think it’s a bad idea because no matter what the upside could be of “this may help with longevity” or “this may help with X, Y, and Z health condition,” the downside is that it leads to disordered eating, eating disorders, and a pretty messy relationship with food, which are hugely detrimental to health.

Considering the population that I work in and the people who are normally coming to me, they already have a history of that stuff. Or even if it’s not disordered eating, they have a history of chronic dieting. So the idea of fasting within that population just makes no sense to me from a risk/reward perspective.

Can I completely throw out the idea of fasting? No. Maybe there are some benefits, and I’m open to that. But I would be really wary of it for the clients I work with. And even for me personally – I don’t have issues with food, I don’t have a history of an eating disorder – I’m not going to do fasting. Again, even if there are potential upsides with it, there are lots of other things that I think are much more important for me, which is having the healthy relationship with food, being able to listen to my body and respond accordingly. Fasting for me just feels like it’s not in alignment with that.

Drew Follette: I couldn’t agree more. I had all of these points in my head that I wanted to touch on and you just covered all of them. I agree. It just seems like the risk/reward balance – if you have any sort of eating disorder or history with disordered eating or you’re just doing it in the name of biohacking, it just seems not worth it. If you have some specific medical condition where your doctor really feels like it could be a good fit for you, that’s one thing. But to do it just because everybody on your Instagram is talking about it – meh. I’d rather have breakfast. [laughs]

Chris Sandel: Yeah. It’s been interesting when I look at how nutrition has changed over the last 10 or so years since I’ve been practicing, and longer than that, since I’ve been studying, and the normalization of more and more extreme practices. The idea that people would intermittently fast, if you go back 20 years ago, that’s going to appeal to like 0.0001% of the population. The fact that someone would want to do a carnivore diet, where all they eat is meat – you don’t have to go that far back for most people to think that is a really crazy idea. And yet these things are now hitting the mainstream.

And again, maybe there are times when these are appropriate. I can’t completely rule them out. But it’s not appropriate for the majority of the population, and it would be appropriate where it is in a specific setting as opposed to just “this is a good blanket panacea idea for everyday health.”

Drew Follette: Super agree. The carnivore diet is such a good example of that. I feel like even 5 years ago, if you had told somebody, “Literally all I eat is meat,” pretty much every person, including doctors, including nutritionists, pretty much everybody would’ve been like, “What’s the matter with you?” And now it’s the new cool thing to do.

I wonder how much of that, too, is due to the rise of the internet and social media and building a brand for yourself, and now you’re the “carnivore diet guy,” so you want to sell more things, so it makes sense for you to try and get everybody to do this diet whether or not it’s necessarily appropriate for you.

Chris Sandel: Yeah. I think you now have the ability to really rise up and speak to people in a way that you couldn’t do before and to build a following, and with all of that, it doesn’t have to be vetted. It doesn’t have to be that you have the proper qualifications, or it doesn’t have to be that what you’re saying has medical standing or anything along those lines. There are a lot of people who are making a really big splash because they’re really great at marketing or they’re really great in ways that help to build an audience, but that doesn’t necessarily mean that they know what they’re talking about.

I don’t want this to sound like I’m standing on some kind of soapbox and like I know the truth and all these other people are stupid, but I think there has been a real shift in the way that people can hit the mainstream that just wasn’t available before.

Let me also say I think that’s also a good thing in other ways. There have been moments that have now gotten traction and have become really powerful and done great things that also wouldn’t have been able to happen. So there’s good bits and bad bits of this. But I think that’s possibly why we’ve been able to see the rise of carnivore that you wouldn’t have been able to see 10 years ago.

Drew Follette: It’s true. I think also, things that are more about moderation or just eating regularly – that’s not sexy, right? No post about that is ever going to go viral.

Chris Sandel: No, exactly. That’s the whole point of Facebook and the whole point of social media, outrage or shock. Those kinds of messages will get more traction. They’re more likely to then be featured in a magazine or whatever. Especially over the last 5 or 10 years, but more the last 5 years, that has become a much bigger thing.

Drew Follette: Yeah. So I think where we came down on fasting was context is important. If you’re thinking about it, sit down and think about why. Is it because you have some sort of specific medical issue that could really benefit from it, or is it because you saw somebody talking about how great it was on the internet? Think about your context. Do you have a history with an eating disorder or disordered eating? Does it really seem worth it?

Chris Sandel: Yeah. I would say my inkling is if you’re listening to this podcast, especially if you’re a regular listener, there’s probably a lot within your history that means that it’s not the greatest idea.

00:17:55

Why people get anorexia vs bulimia

Drew Follette: A hundred percent. The next one is a great question from Madelon and Madelon wants to know: “If binging often follows restriction, what do you think causes some people to have an eating disorder that solely involves restriction versus restricting and then binging?” I think another way to ask that would basically be, why do some people get anorexia versus some people getting bulimia?

Chris Sandel: I don’t have a good explanation. I would say it’s most probably largely genetic or largely biological. When I see clients that end up where they are, just at that restriction end of the spectrum, versus someone who has been on and off diets for 20 years, versus someone who has restricted for quite a while and now they’ve ended up having periods of binge eating, pretty much all of them are the same. They all go into it with the same intentions. They’re all trying to do the same thing. They all have the same worries.

It’s just, for whatever reason, some people are able to maintain the restriction phase and some people just aren’t able to maintain that restriction phase. I don’t think it comes down to willpower; it’s more down to how someone is wired. That’s just because of something that is completely out of someone’s control and what happened because of birth.

Drew Follette: That makes sense. I saw that and I thought that was an interesting thing to think about as well, and I have no idea why that happens.

Chris Sandel: For me, it is interesting when I look through clients – as I said, there are just so many similarities with people despite the fact that it ends in different ways. Really, from my perspective, at the core of eating disorders is restriction. They just play out differently depending on how someone is wired.

Drew Follette: That makes sense. I hope that was helpful, Madelon.

00:20:20

Weight stigma in nutrition education

The next question is from Mary, and she wants to know if you have any resources for learning about basic nutrition without all the weight stigma.

Chris Sandel: We were actually talking about this before we hit record because the short answer is no. [laughs] It’s a really difficult thing to come across because most of the time, if you’re studying nutrition, if you do a nutrition course, if you do dietetics, the focus is going to be on weight and weight loss. That’s not going to be the only focus, but it’s going to be a big part of it, or it’s going to at least be included. Maybe some of the more up-to-date courses, while focusing on weight loss, will also include information about weight stigma, but it’s rare that it won’t include anything.

With a lot of dietitians or nutritionists who are more non-diet in their approach or Health at Every Size within their approach, it’s hard to do a nutrition-based course where the focus is solely on nutrition in that situation because you can’t really separate it out. There’s so many other bits that then go into that that are part of that model. You can’t talk about just nutrition without then talking about hunger or fullness, or talking about other components that come into it.

So I just don’t think that this is offered. It would be strange – strange maybe isn’t the right word, but I haven’t seen it offered where someone who has a real non-diet approach has a real strong nutrition course, because they seem – not in conflict to one another, but it seems like there would need to be a lot more context and there’d be a lot more things that would be included.

Drew Follette: Maybe it’s a new business idea for you. [laughs]

Chris Sandel: Yeah, maybe. Obviously, on the podcast I’ve done a show on carbohydrates, I’ve done one on protein, I’ve done one on fat; I did the update on the carbohydrates one, and I need to do it on the protein and fat. The feedback for those are always really positive, and I’m trying to approach it from lots of different angles, but even with all of that knowledge, it’s hard to apply that if you’re not applying all the other things because really, all you’re looking at is what’s good on paper, and individual experiences will differ. Understanding how to apply that understanding of differences and what to do in those situations really matters.

The other part of this is I’m good at being able to read or do a course where I don’t agree with a lot of the content, where I’m like, “There is all of this weight stigma, there is all of this weight loss focus, but actually I really like what they have to say about this thing of nutrition,” so I’m very happy to just watch that or consume that and take what I like and leave what I don’t like.

Drew Follette: Like with Precision Nutrition.

Chris Sandel: Like with Precision Nutrition. I have a real love/hate relationship with them. I think they do really wonderful work in lots of areas, and I’m eternally grateful for doing the Precision Nutrition Level 2 course. I think I’ve gotten a ton out of that course. Also, there’s a lot that I really disagree with. I disagree with a lot of their marketing.

It’s difficult because all the guests from there that I’ve had on the show – I think Krista is a super smart person, she’s done amazing things for them. Same with Kate Solo, same with Brian St. Pierre. All of them are really great speakers. They have a huge amount of integrity. They really believe in what they’re doing, and they’re doing mostly good things in the world. It’s just there’s a real weight loss focus that I can’t get on board with.

So yeah, it does make it really difficult to recommend some nutrition because of all that. This is a very longwinded way to say I don’t know. [laughs]

Drew Follette: It is tough because, as you were saying, you can take a course and filter out the things that are informed by weight stigma, but it’s probably a bit harder for somebody if they have a history of eating disorder or disordered eating or body dissatisfaction or any of those things. It’s probably a lot harder to take those things and filter out all the things that don’t apply to them or that are coming from a point of weight stigma or something without being triggered.

Chris Sandel: Yeah. It’s not even just me not having a history of that; it’s also me doing this for a lot longer, so I know what I’m listening to where I’m like, “That doesn’t match up with this other thing that I know about.” It’s easier for me, again, to have context with it. Whereas if you’re a complete newbie to this and this is your first course, you don’t know what you can and can’t disregard. I think that makes it much more difficult, and you’re more likely to take everything you see from that course as the truth, and it then takes a long time to work out the bits that actually aren’t correct.

Drew Follette: That’s so true. I remember when I was in nutrition school the first time, you take literally everything as gospel, right? That was before I had found Health at Every Size and learned about weight stigma and all of these things. Then going through Precision Nutrition Level 2 course, which I did as well, it was such a different experience going through and being like, “Oh wow, this is not true at all” and realizing that just because they’re teaching it to you and you’ve paid them to, doesn’t mean that it’s true. It’s definitely an interesting transition.

Chris Sandel: Yeah. The reality is, there is no perfect course. My understanding is based on doing lots and lots of different things and then creating a Frankenstein’s monster of an idea around all of this, where you’re just putting all of these disparate pieces together. It’s a constantly evolving process.

Undoubtedly, as I’m discovering with the podcast that I’m going back and doing second editions of, I’ve changed my mind on certain things and I’ve updated my stance based on new information or from working with clients for longer and seeing that certain things I thought were relevant aren’t so relevant anymore. I think we’re always going to be a work in progress, and there is no one course you can take that’s going to answer all your questions and is going to be 100% useful.

Drew Follette: Mary, we wish we had a better answer for you, but the short answer is we don’t know, but maybe we’ll get Chris to put out a course. [laughs]

Chris Sandel: Yeah.

00:28:05

Opinion on the anti-HAES community

Drew Follette: The next question is from Yamahatse, and they want to know what your opinion is on the anti-HAES community. (If you’re not familiar with that acronym, it’s Health at Every Size.)

Chris Sandel: Honestly, it’s not something I spend a huge amount of time thinking about. I think with pretty much every movement, things are on a spectrum. The people who are most vocal and most loud within the anti-HAES movement are pretty much trolls, and they have some fairly spurious and degrading and pretty horrible ideas, and there’s a real misunderstanding of the concepts.

Where it almost feels like they’re trying to create a straw man. There’s this concept of creating a straw man or creating a steel man. A straw man is you create someone’s argument that is not accurate of what they actually believe and you make it so it’s very easy for you to be able to pull that argument down. What you want to be doing is creating a steel man, which is really articulating the other side’s argument where they are happy with exactly how you’ve explained it and they’re like, “That is exactly my position” and then dealing with that.

That’s definitely not what I see happening. There’s this real misconception around Health at Every Size means that all you do is eat cake and chocolates and that you never move your body, and that’s just not what Health at Every Size is about. It’s about supporting health of all people without weight loss being the focus. It is about creating healthful habits, but understanding this in the context of different people’s lives and that one person’s way of being healthy is going to look different to someone else’s way of being healthy because we’re all individuals, we have different availability, we have different preferences. Health is not a moral obligation.

So I think in terms of the opinions of the anti-Health at Every Size community, it’s not something I spend a lot of time on, but I would say within all of this, it’s really complex. There are no simple solutions.

I remember when I had Alan Flanagan on the podcast. We had a really good conversation about this, and he’s a really great speaker on this topic, and we just talked about the complexity of trying to do health at a population level and just how many stakeholders are involved as part of that, how difficult it is because you’ve got so many people with so many various factors that are impacting on it – whether we’re talking about socioeconomics, whether we’re talking about location that people live in, whether we’re talking about the kinds of jobs people do. It’s just a really difficult thing to do.

While I would say I’m fairly Health at Every Size aligned, I’m also not fully on board with any movement because especially when you get into the extreme ends of it, it really becomes militant. It becomes draconian, and you just lose all the nuance.

So I would say check out the Alan Flanagan podcast to hear a little about that. I also released a podcast – I think I entitled it “Tribalism” – because I was invited as a guest on a podcast episode and then we had a great conversation, and then at the end of the conversation, I was having a chat with the host and talked about the fact that I wasn’t fully on board with Health at Every Size, the way I’m not fully on board with every movement because I think there is nuance and there’s complexity to things, and that episode then wasn’t broadcast.

The tribalism podcast was then talking about that and talking about why I want to be opening myself to various ideas and seeing things from different angles. Even with that, it doesn’t mean that I need to get into spending huge amounts of time on the Reddit anti-Health at Every Size forums, because I don’t see that as a useful use of my time. I’m happy to look at various logical arguments that are well-structured, that people have looked at evidence that there is support for. I’m happy to go into that, but not get into the weeds in some Reddit forum.

Drew Follette: Yeah, turns out nuance isn’t that sexy either. [laughs]

Chris Sandel: Yeah, and that’s really difficult, because people want simple answers. People want a principle that they know and works every time, “you just need to move more and eat less” and that kind of thing. But as soon as you say, “No, this is a lot more complex than that,” it often gets scoffed at or people just don’t want to listen.

Drew Follette: Hopefully that helped answer your question a little bit, Yamahatse.

00:34:00

Has Chris experienced issues with food?

The next one is from Alice and it’s a personal one for you, Chris. She wants to know: “Have you ever experienced any food or eating issues?”

Chris Sandel: Luckily, no. I think I’ve touched on this on other podcasts, but first off, I have to say I have a lot of privilege in this area. I grew up in a middle class household; I grew up in a body that has always been thin or lean, really irrespective of what I do. Undoubtedly that is a big part of why it didn’t affect me.

But even with people who live in my style of body, that is not to say that they can’t end up with issues around food or with an eating disorder. In combination with that, I was lucky to grow up in a household where I never remember my mom, or my dad for that matter, going on a diet. It just wasn’t something that they did. Again, part of that is because they lived in bodies where they were already thin – but again, that doesn’t stop a lot of people. So we never had that going on in the household.

There was never really a big focus on body. I don’t ever remember my mom or my dad commenting on their own body or any of our bodies as kids, so I was pretty naïve to all of this because it wasn’t something that I ever thought about.

When I got interested in nutrition and started studying it, I did play around with my eating. You’d read a book and it would be like “Grains are the worst thing you can eat. They’re why we’re all getting X, Y, and Z disease,” so for a while I wouldn’t eat grains. Or it was like “The paleo diet is the best thing you should be doing,” so I’d try that. I dabbled in different things, but it just never really took hold. It was never part of my identity. Even when I was playing around with things, it never got into me restricting. It never got into me being obsessive with food. I was always eating enough and allowing myself to eat.

I think part of that, after having that for all of my life, I think trying to give that up now would feel like a real challenge. I’ve had such a good relationship with food for so long that the temptation of doing a diet – and again, I’m not trying to lose weight, so maybe that makes it easier – but the temptation of doing a diet just isn’t there because I see all of the other things that I would have to give up as part of that.

Drew Follette: When you were playing around with those other diets, like paleo or grain-free or whatever, did you end up stopping them because you were like “I just can’t take it anymore,” or you just didn’t feel that much different? Why’d you give those up?

Chris Sandel: Probably because I just didn’t feel that much different. It just didn’t really seem to be worth the effort. Also probably because I was so fickle with them and so new to nutrition that I would then read something else and I’d be like, “Oh, okay, let me try this other thing.” It wasn’t like, “Oh my God, I can’t do this anymore.”

The one exception to that was when Ali, my fiancée, was diagnosed with rheumatoid arthritis, we did the autoimmune paleo diet. She was the one that wanted to try it out – and again, she’s someone who doesn’t have a history of dieting, never wanted to do any diets, but was in a pretty bad way with her rheumatoid arthritis and was pretty open to trying anything. She found a lot of glowing testimonials online and how helpful this had been for people, so she said, “I want to try this out.” So I said, “I will be supportive and I will do this with you.”

After two weeks, she said, “You have to stop.”

Drew Follette: You were so cranky. [laughs]

Chris Sandel: She was like, “You are just angry. You are not fun to be around. You are not making this any easier for me. You are making it more difficult.” So I managed all of two weeks and I was like, “This is not useful.”

Ali lasted longer than that and then slowly started to bring more things in. The end with that is it did nothing for her. She’s now back to eating the way that we’ve always eaten, and the AIP diet did not solve her rheumatoid arthritis.

Drew Follette: I’m so glad that she was able to do that, because it feels like a lot of times people go on a diet to manage something – even if it’s not to lose weight, if it’s to manage rheumatoid arthritis or another condition – and they don’t get the results, instead of saying, “I’m going to go back to how I was eating before where I felt the exact same,” they say, “I should just do it harder. I should just do it more.” That’s when you end up getting into dangerous territory.

Chris Sandel: Yeah. I think she’s been primed because of what I do, and she has also studied nutrition as well, and she knew that going harder wasn’t the answer. She also knows how much better she feels when she’s eating food and eating regular food. The AIP diet was basically us losing all the things that we typically eat, so it was a real challenge, and with no benefit. So we were happy to sack it off.

Drew Follette: The AIP diet is pretty much “if you love it, you can’t have it.” [laughs]

Chris Sandel: Yeah. [laughs]

00:40:40

Why you might feel hungry soon after eating

Drew Follette: The next one is from Rachel, and Rachel wants to know what it means if you feel hungry within half an hour or less of eating, even if you ate until you were full. To give just a little bit of context, I believe it was asked after we posted the blog post from last week saying “you’re really just hungry,” talking about hunger in its different forms, why we lose touch with it, why we tend to ignore it, how to get in touch with it again, that sort of thing.

Chris Sandel: The simple answer is if that is the case, you need to eat again. You are still hungry. The reason that that can occur is many. It could be that the last meal that you ate, even though it left you feeling full, was high volume food but not enough calories, so that’s why you’re getting hungry again. It could be that the last meal was enough, but actually you haven’t eaten enough for the rest of the day or you’ve been more in a period of restriction, so that meal just isn’t enough to sustain you and that’s why you’re getting hungry again. Maybe you just haven’t eaten enough today.

So I would say that if that is occurring, yes, you can look at what you ate as part of that meal and think, “Maybe if I changed this or that, that wouldn’t have happened,” but it could also be coming from what happened earlier on.

Also, I think sometimes the thought process when someone is in an orthorexic type way of seeing food, there can be almost this feeling of like “How can I be eating the same amount of calories but keep that fullness feeling going longer?” Almost like “How do I trick my body into eating the same but just not noticing it as hunger?” That typically doesn’t really work. So I’d say if you’re getting hungry within half an hour of having a meal, then you need to be eating more food.

Drew Follette: When in doubt, eat more.

Chris Sandel: Yeah. When in doubt, eat more.

00:43:10

Can you fully recover from an eating disorder?

Drew Follette: The next one is from Jess, and Jess wants to know if you think that you can ever fully recover from an eating disorder – or do you think it’s like a substance use disorder, where you can get better, but it’s always something that you’ll have to manage?

Chris Sandel: I think, again, there is nuance to this. I think you can fully recover where you are living like someone who has never had an eating disorder. You’re able to experience life, have meals, do all of the things as a normal eater – with the caveat being that you will always have that susceptibility to having an eating disorder.

There are people who can go on a diet and will never develop an eating disorder. As I talked about earlier, I can go on a diet and then I stop that diet and – like when I did the AIP diet, it was two years ago; I’ve never even thought about it ever again. For someone who has a history of developing an eating disorder, that susceptibility is always going to be there. If you get yourself into an energy deficit, it’s likely that that is then going to come back.

It’s been interesting with the COVID pandemic over these last couple of months. When this all started, I reached out to the majority of clients that I’ve seen over the last couple years just to say, “Hey, how are you doing? What’s been going on?” What I found was there were a couple where some of their eating issues had come back, but what was interesting this time round was it had come back much more because of unintentional reasons. They weren’t intentionally trying to restrict; it was that things had become busy, they’d been overwhelmed, there had been anxiety, there had been things that happened because of this, and because of them entering into that energy deficit, all of the old thoughts started to come back up.

What was interesting is because this was now occurring after all the work that we’d done, they just had a different perspective on it. Yes, they now needed to go back to eating more regularly, they needed to stop doing exercise, they needed to do the things that are important as part of recovery and that had worked the first time round, but they weren’t buying into the thoughts that were coming up in the way that they had before. So even though there was a fear of weight that was coming up, they could see it as an illusion and that it wasn’t really about that.

It was just a good illustration for me of the fact that, yeah, this is something that you can get over, but there is always going to be that susceptibility. It means that if that’s in your history, then unfortunately you don’t get to go on diets, or you don’t get to do intense exercise over some threshold that you work out because the likelihood is that things will start up again. So yeah, I am on board with fully recovered, but that tendency never goes away.

Drew Follette: I wouldn’t say it’s that unfortunate that you couldn’t go on a diet. [laughs] But yeah, I think that makes a lot of sense. If any of that is sounding familiar about the relapse stuff, we actually have a really great blog post on our website called “The Unintentional Relapse” that addresses a lot of the points that you brought up here and goes into some more detail.

Chris Sandel: Yeah, definitely.

00:47:05

How to eat to support mental health

Drew Follette: The next question is from Liz, and Liz wants to know if you have any advice for how to eat to support mental health, particularly anxiety, without feeling too much restriction.

Chris Sandel: I wouldn’t think of just eating in terms of dealing with anxiety. I think there are lots of components that would go into this.

If I’m thinking from a food or an eating standpoint, it would be making sure that you’re eating frequently enough, and that will differ depending on person to person and what their preferences are with that. It would be making sure that you’re eating enough calories so that you are able to support all the functions that are going on. It would be eating food that you get satisfaction from, so that there is enjoyment from your meals, and alongside that enjoyment is supporting your health. You’re eating in a way that supports energy and supports your ability to focus and concentrate.

I know I’m talking really broadly here, but that will differ from person to person. In a basic sense, it’s having carbohydrates and proteins and fats come in. What makes up those different macronutrients will depend on personal preference, will depend on what works best for you from a digestion perspective, from an energy longevity perspective. There are definitely things you can do from an eating perspective to help with anxiety, but that’s going to be person-specific.

But I would think also, alongside that, there’s so many other things that can be supporting this. One of the big ones would be sleep and getting good, quality sleep and having good consistency with your sleep. I recently did a double episode on sleep. That would be one of the first things I would be thinking about with anxiety.

Having time outdoors, getting sunshine, meditation or mindfulness, connection with people, preferably in real life when a pandemic’s not going on. Looking at your internal critic or your internal dialogue or the constant thoughts that are coming up and where you then go with those thoughts – are you just seeing them as thoughts, or do you get hooked in and go down the rabbit hole with them?

And then other practical parts of life in terms of life stress and finances and someone’s actual life circumstances, because there can be real, legitimate reasons why someone can be feeling anxiety because of particulars within their life.

All of those things, and I would say lots of others I haven’t thought of in this moment, would be things I’d be thinking about in terms of anxiety. For me, yes, food is important, but food is important to give you the foundation of like “Are you eating enough? Are you eating regularly enough? Are you eating the foods that are helpful for supporting your body?” but without having to really get into the nitty-gritty of getting enough magnesium or getting enough thiamine or that kind of detail. I think there are other things that are going to make much more of a move of the needle for you.

Drew Follette: I love that. Basically, the breakdown on the question specifically about how to eat for it is to not look at it from a perspective of restriction, which is “Don’t eat any of this, don’t eat sugar,” and more think of a perspective of the things you can include that have nothing to do with restriction that will be supportive. Make sure you’re eating often enough to keep your blood sugar steady, make sure you’re eating enough quantity in general, make sure you’re eating all of the macronutrients, things like that.

Chris Sandel: Exactly. Was it the person who wrote “I quit sugar, then did a whole book on anxiety and how quitting sugar helped with anxiety” – that kind of stuff I really just don’t get into. Yes, if you’re eating nothing but sugar, that could make your anxiety worse because you’re probably not getting enough protein. There’s going to be lots of other reasons why. It’s not the sugar per se. But yeah, any real big push of “this is the anti-anxiety diet,” I don’t get on board with.

Drew Follette: Yeah, because also, restriction increases anxiety.

Chris Sandel: Totally. That is not going to help.

00:52:30

Reasons that triglycerides/LDL could be high

Drew Follette: Sounds good. Our next one is from Tasha, and Tasha wants to know why triglycerides and LDL would be high despite eating a diet low in animal products and high in fats like chia seeds, nuts, and avocado.

Chris Sandel: For a question like this, there is not enough information to be able to answer properly. The answer is there are many, many, many possible explanations for why triglycerides or LDL could be high. You would need much more information, whether that be more information in terms of different markers, but also information in terms of diet and lifestyle and history and all of that, to be able to answer that question.

If I just list off why you could potentially have high triglycerides or LDL, it could be hypothyroidism, it could be familial hypercholesterolemia, it could be anorexia or restriction, metabolic syndrome, insulin resistance, oxidative stress, renal/kidney issues, liver issues, it could be because of medication – estrogen and progestins and the pill in general, beta blockers, diazepam, corticosteroids – all of these could be possible explanations as to why it’s going on.

As part of the question, you chose to include “but I don’t eat animal products and I eat these other foods that are higher in other types of fats”; that is one tiny part of the equation. There are so many other factors that could go into this. So the simple answer to this question is there’s not enough information to be able to answer that question.

00:54:35

What Chris will do when the pandemic's over

Drew Follette: Sounds good. I think you nailed it. Next question is from Nina, and it is a personal one. They ask: “What’s the first thing you’ll do when COVID is over?”

Chris Sandel: This depends. It depends how far out we’re going.

Drew Follette: Will it be over? Doesn’t feel like it. [laughs]

Chris Sandel: Last week I played golf, and that was the first time that that’s happened in a long while. That was because they recently opened the golf courses again, so that felt like a big change and was something I was looking forward to.

But in terms of things opening up more, just seeing friends in real life and being able to give them a hug and being able to have a meal with them and being able to have a drink and just connecting with people not over Zoom. That’s the thing that comes to mind more in the near term.

Further out from that, I would love to go to a music festival or a club or something like that. I think one of the things that has happened a lot over this time – I’ve got a real passion for electronic music. I worked in that industry a while ago. It’s something I’ve listened to for a really long time. I listen to music in general, but within electronic music, so many DJs now have not been able to play for a long time. They’ve been doing livestreams, so I’ve been listening to a lot of club music at home while working and definitely feel like I would like to be going out and experiencing that in a club or festival setting. But that feels like a long way off. I don’t know when that will be.

So they’re the things that instantly come to mind. What about you, Drew?

Drew Follette: Oh, jeez. For me, right before all of this happened and the bottom fell out of everything, I had a 6-week trip booked to Bali and other parts of Indonesia. I had been looking forward to it. We’d planned it like a year out, and we were going to spend time in Bali and then go to several other parts of Indonesia and go surfing and scuba diving and all of the outside things that we love to do, and we were so excited about it. Unfortunately, it didn’t happen.

So I think we are going to definitely put that on the top of our list as soon as travel seems safe again. We were pretty bummed to miss out on that. And then also hugging my friends and all that other stuff, but mostly Bali. [laughs]

Chris Sandel: [laughs] Yeah. The thought of travel seems – after not getting close to someone for a really long time apart from the two people who live in my household, the thought of sitting on a plane in that confined area with everyone feels so strange.

Drew Follette: It’s interesting, because I think the vibe is a little bit different in America. You see pictures online all the time of planes basically full right now. So many people are traveling like normal. Planes will try and block out some seats, but they’re pretty darn full. And I feel the same way; it definitely feels unnecessarily risky at this point.

Chris Sandel: Yeah. I don’t know what’s going to change between now and the point at which I’m going to get on a plane. I don’t know if there’s going to be a vaccine anytime soon, I don’t know if there’s going to be an antiviral anytime soon. I think it’s going to have to have, in a sense, petered out on its own or petered out because of lots of testing and tracking. It’s just a weird one to try and get my head around.

00:58:50

Unique recovery challenges for perimenopausal women

Drew Follette: Before we get overwhelmed with existential dread, let’s move on to the next question [laughs], which is from Julie. Julie wants to know if you have worked with women going through anorexia recovery while in late perimenopause.

Chris Sandel: Yes, I have worked with women, and I’m currently working with women in that. I work with lots of women who fall into that category. My assumption is part of asking that question – Julie didn’t want me to just stop there – is what I think is maybe unique about that client population that would make it more challenging or different as part of going through anorexia recovery.

There can be things that are going on from a symptoms perspective where you’re like, is this to do with anorexia or is this to do with hormones and the stage of life that is going on? Things like night sweats or lower sex drive or fatigue or trouble sleeping or low mood or low energy could all be connected to perimenopause, it could all be connected to eating disorder, so there is some of that where it can be a little bit difficult to differentiate.

It could be the case that if someone is dealing with an eating disorder at that stage, this is then going to be something that is really longstanding. If they developed an eating disorder in their teenage years or in their early twenties and they’re now into perimenopause, we’re talking 20-30 years that that could’ve been ongoing. That can make it more challenging just because there’s been a much longer period for habits to have been formed and for neural pathways to become more entrenched. So it can be more challenging as part of that.

But in lots of ways, age doesn’t matter. When I’m working with someone, I’m dealing with the person who’s in front of me. I could have 10 perimenopausal clients who are all uniquely different. So yeah, there are some things that might be more unique to that category, but I would say there are going to be lots of differences for all the people that fall into that category.

Drew Follette: I know that a lot of the symptoms of the two do overlap, but have you found with the women that you’ve worked with to overcome their eating disorders that some of their perimenopausal symptoms have cleared up as well?

Chris Sandel: Definitely, yeah. There’s often a lot that is chalked up to “This is because I’m perimenopausal,” and then later on it’s like, “Oh, okay, maybe that wasn’t the case.” Women who are like, “I think I’m definitely perimenopausal because I’m not getting my period or I’m getting my period really irregularly,” then it’s like, “Oh, my period has now come back.” I think sometimes there can be a tendency to think it’s down to life stage as opposed to the habits that have been kept up.

I would say, though, that I have had clients at times where by going and getting hormones checked, that has been really helpful. There have been times where their hormones are really low and they have gone on some medication as part of that, like HRT, and that has done really good things for their mood and has been really helpful. So I don’t want to say that because there’s an eating disorder, you then ignore all of those symptoms and say it’s just because of the eating disorder.

I think my general approach is to work on the assumption that the majority of these things are, if not coming from the eating disorder, at least being made worse by the eating disorder, so let’s see what we can change and see how these symptoms improve. They might not improve to the point where they aren’t occurring, but they’re improving to the point where this feels more normal for what’s expected for perimenopause as opposed to where it was before.

01:03:40

What are Chris's favorite foods?

Drew Follette: That makes sense. The next question is from Kyle, and Kyle wants to know: “What is a food that you just can’t say ‘no’ to?”

Chris Sandel: There really isn’t a food that I can’t say ‘no’ to in the sense that if I’m full, food is not appealing. There is no magic food that has some hold over me. That’s not to say that I don’t eat food when I’m really full or that I haven’t ended a meal being overly stuffed or anything along those lines, but I don’t really think of foods in a way of like “I can’t say ‘no’ to that food.”

If I go shopping, there is no food that I would ever think we can’t have that in the house because I don’t want to have that – or where we can have that in the house, but I’m only buying one packet of that because if I buy any more of it, I’m just going to eat all of them on Day 1, or anything along those lines. There just isn’t. I don’t have that compulsion around food, and that’s because everything is on the menu, and if I feel like something, I’m happy to allow myself to eat that something.

But if I take the question a little more broadly and say what foods I really enjoy eating or what are some of my favorite foods – having a barbecue – and maybe this is recency bias because I’ve been doing it more because the weather’s gotten nicer, but I just love doing a barbecue. I think that’s partly also being Australian. It’s a pastime.

But where we are here, there’s an amazing butcher that does really great meat, like rack of ribs, they do lamb steaks, they do amazing sausages. Just really, really good meat. I will always do lots of meat and then also lots of vegetables, like cutting up potatoes and sweet potatoes and aubergine and peppers and courgettes and doing them on the barbecue. They are just amazing. Having that with some tzatziki or some hummus and then lots of bread and butter and everything is a really good meal.

Drew Follette: I want to come to dinner at your house.

Chris Sandel: [laughs] Definitely. Barbecuing chicken, I do a lot, like spatchcock a chicken and put that on the barbecue. Takes about an hour to cook, and it is amazing.

Drew Follette: Oh, I’ve never tried that.

Chris Sandel: Yeah. Super simple, but it’s really nice and juicy. So barbecuing in general, and then lasagna, pizza would be things that I really like. Dessert wise, banoffee pie, crème brûlée. They’re the kind of things –

Drew Follette: Fancy.

Chris Sandel: Yeah. But I don’t know. Very much the point of just food is food. It’s not that I don’t enjoy food, but it’s not this massive thing in my life that I’m constantly searching after.

The one thing I would say about moving out to the countryside is I miss restaurants in London. The countryside where we are has amazing ye olde pubs where you go in and there’s a plaque in there that says “This building was built in 1560 or 1492” or something along those lines, and there’s wonky bits of the ceiling and low beams and everything. They do amazing pub food. But in terms of restaurants and finding something that does really good Thai food or more interesting food, it doesn’t have it so much in the countryside. So that I miss.

But again, food is enjoyable, but it’s just not my be-all and end-all. What about you? What are your food preferences?

Drew Follette: Well, I could say ‘no’ to a taco, but I don’t think I ever have. [laughs] Tacos are definitely top of the list for me. I’d even eat one if I’m full. They’re delicious and they are small and they are the perfect couple of bites, and I don’t think that you could find something better. So I’m a taco person through and through.

Chris Sandel: Nice. We don’t have a lot – that’s something I need to come out and eat with you, because we don’t have a lot of good Mexican food. Definitely not in the countryside. Someone will probably point out where really good Mexican is in London, but it wasn’t something I used to eat a lot of.

Drew Follette: Yeah, I get that. The worst part of living in Thailand is that there’s literally no good Mexican restaurants there, so it was a long time to go with no good Mexican food. It was tough.

Chris Sandel: But now back in Seattle, you still haven’t been able to get good Mexican food because everything’s closed.

Drew Follette: Yeah. Really, the good Mexican food is – well, it’s in Mexico, but down in California and Texas and places like that. Seattle is not amazing, but it’s head and shoulders above anything that you would find in Thailand.

Chris Sandel: Yeah.

01:09:40

What is Chris afraid of?

Drew Follette: We have time for one more question. It’s from Chelsea, and it is another personal question. Chelsea wants to know: “What’s something that you’re afraid of?”

Chris Sandel: I don’t have a lot of fears. I think the obvious one that comes to mind is I’m afraid of the people that I love dying or being injured or becoming ill, like Ali or Ramsay or my parents or my brother or sister or friends, them passing away or getting sick. That would be the thing that I would be afraid of.

But it feels weird to say ‘afraid of’ because it’s not something that is front and center that I’m constantly thinking about. I mean, obviously with the pandemic, there’s been a little bit more of that, but touch wood, no one that I know within my family has become ill. So there hasn’t been that realization of that. I think that there’s probably a lot of things that I would discover I’m afraid of because they then started to occur, and I’m just not aware of them because they are out of mind, out of sight, and they don’t feel like they’re a possibility at this point.

I’m generally a pretty optimistic person. I’m generally pretty content. I’m fairly – blasé is not the right word, but I definitely have a stance of “things will be fine, things will pan out.” Me going to what I’m afraid of is not my norm.

Drew Follette: What about more practical things, like are you afraid of heights? Are you claustrophobic? Any of those sort of things?

Chris Sandel: I’m afraid of heights. I mean, I’ve done rock climbing, so probably only when I get quite high up and I’m on the edge of a wall. That kind of feels like it makes a little bit of sense. But in those moments, I’m still able to keep climbing and do that.

Claustrophobic – I don’t want to be put in a really tiny space. The thought of being put in a coffin and someone sitting on it does not fill me with joy. But in terms of being in an elevator or being in a small staircase, that doesn’t fill me with claustrophobic fear. It has to get really small for me to have the fear come up. If I was to play rugby and I was at the bottom of a pile of people, that would not be enjoyable and I think I would have a fear around that. But that’s not happening in my regular day to day life. [laughs]

Drew Follette: Fair enough. So generally, not too afraid of a person.

Chris Sandel: No. That’s not my general demeanor.

Drew Follette: For me it’s bugs.

Chris Sandel: Oh really?

Drew Follette: Oh yeah. Mostly spiders, but just bugs in general. They’re creepy and crawly, and they’re not even that small in Thailand, to be honest. But there’s so many of them. One time I googled how many bugs there are on the planet, and I can’t even remember what it is, but I instantly regretted googling it. I don’t know, it’s like 35 million bugs for every person on the planet. It’s something bizarre. There’s something about it where if I see a bug anywhere, I have to have somebody else come kill it. I just can’t handle it.

Chris Sandel: I’m fine with, if there’s a spider in the house, putting it outside. Maybe there is a size of spider where I’m like, “Okay, I don’t want to do this.” [laughs] But no, regularly, it’s fine for me to put a spider or – I can’t remember the last time I saw a cockroach, but if that was to occur and I needed to put it outside or whatever, that would be fine.

Drew Follette: All right. Well, if we’re having barbecue at your house and I see a bug, I’ll just call you.

Chris Sandel: Yeah, it’ll be fine.

Drew Follette: That sounds good. Well, that is all the questions that we’re going to do today. That is the end. I’m so glad that we did this. I feel like we got through a lot and we answered some really good questions that people sent in.

Chris Sandel: Yeah, this was good. I know we’ve chatted about doing AMAs more on a regular basis before and it just hasn’t happened, but I’ve actually really enjoyed doing this today, so I think maybe we can start to make this a more regular thing.

Drew Follette: Yeah, I think that’s a good idea. If you’re listening and if you have some questions that come up anytime, you can email them in to info@seven-health.com, and we’ll add them to the list for our next podcast.

Chris Sandel: Perfect. Thank you for asking the questions and for getting involved.

Drew Follette: Thank you.

Chris Sandel: That is it for this week’s show. Thank you for everyone who submitted questions.

As I mentioned at the top, Seven Health is currently taking on new clients. If you’re struggling with dieting, with disordered eating or an eating disorder, you have body image issues, or really any topic that we cover as part of the show, then please get in contact. You can go over to seven-health.com/help.

I’ll be back with another episode next week, so until then, take care, stay safe, and I’ll catch you then.

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