[DR. CRISTINA CASTAGNINI] Behind The Bite podcast is part of a network of podcasts that are good for the world. Check out podcasts like the Full of Shift podcast, After the First Marriage podcast and Eating Recovery Academy over at practiceofthepractice.com/network. Welcome to Behind The Bite podcast. This podcast is about the real-life struggles women face with food, body image and weight. We're here to help you inspire and create better healthier lives. Welcome. Well, hello everyone. For anyone who has listened to past podcasts of mine, you may have heard me say that the purpose of food simply is just fuel and nutrition. Just like cars cannot drive anywhere without gas, we cannot function or stay alive without food. But I know it has become so much more than that, so, so much more and I know I get it firsthand just how much more food means when you have an eating disorder, disordered eating or struggle with body image. I really wish food just remained simple for everyone, but it really just did just get so complicated, confusing, and it's really emotionally laden. Today that's what we're going to talk about. We're going to talk about food and your wonderful, amazing bodies, and hopefully by the end of the podcast, you're going to feel like things are a little bit more simplified and hopefully less confusing. So who is the we that will be discussing this? Well, me and someone who really knows all there is to know about food. Adrien Paczosa has more than 20 years of experience working in the dietetic field with a focus on eating disorders, neurochemistry nutrition, and business development. In 2007, Paczosa founded and opened her first private practice in Austin, Texas called iLiveWell Nutrition. She combined evidence-based nutrition science with a compassionate approach to counseling patients to deliver health outcomes and improve patients' day-to-day lives. She has personally counseled hundreds of patients ranging from severe eating disorder cases to diabetics to high performance athletes. A few years later, iLiveWell Nutrition has become Nourish, a nationwide virtual first, nutrition group focused on addressing America's healthcare crisis through greater access to nutrition care. She now serves as chief Clinical officer of Nourish and what started out as just an idea now serves thousands of patients, nearly all of whom use the service via telehealth and are completely covered by their health insurance. [DR. CRISTINA] All right, well, Adrien, welcome to the show. Very, very happy you're here. [ADRIEN PACZOSA] Oh, I am so excited to be here and talk to y'all. [DR. CRISTINA] Okay, so let's talk about how food impacts the brain, brain chemistry, mood, I mean, let's just get into this. I know people may not think it has such an impact, but fascinated to hear what you have to say about things. [ADRIEN] Oh, it's everything. Food affects every little molecule of your body, and of course, one of those molecules is part of your brain. I think when we think about it of like, oh yes, the food affects your heart and your internal organs and all that, we know that as like a deep seated part of it. But when we think about our emotions and our brain chemistry, we forget that part because it works and hopefully our brain is working. But I think that's sometimes that missed part of like how it all really worked together. Oh goodness, where do you even begin? I think we'll go, my favorite part is to talk about how food affects emotions, so when we think about happy, sad, all of those emotions, they all start in nutrition land. So if we think about it, happiness, serotonin, about 60% to almost 80% of your serotonin is made in your gut, your GI system and as we're using food, digesting food, it's creating that serotonin. And so if we're not getting enough nutrition in, there's absolutely no way that we could really get that serotonin functioning. Also fun fact about, about 60% to 80% of your immune system comes from your gut too. We could have a whole talk about gut health but as far as serotonin, that's a huge piece of it. Then if we look at the way all of these neurochemicals, so serotonin, dopamine, norepinephrine, gaba, all of these, they sound like really big crazy words but they're just how our brain processes emotions. They're chemical forms of them. They all travel through fat. So our nerve system looks like a wire, so the wire of my headphones is wrapped in plastic. Just like our neurons, they're wrapped in fat. It's called a [inaudible 00:05:25] and so if we don't have enough of that protective fat around our neurons, our synopsis, the way our brain talks to each other, it doesn't work as efficiently. So we're not able to have cognitive reasoning. As well our emotions can be all cattywampus and upside down. Then, I mean, I'll keep rambling, so please stop me if you need to. [DR. CRISTINA] Let's go back for a minute because some people might be listening saying, okay, you said a lot of things there about serotonin, dopamine, norepinephrine, gaba. Could we go through what all of those are because I know listening what serotonin, how that's different from dopamine or even what those are, but what are those? [ADRIEN] Yeah, that's a great question and for your listeners, yeah, this is super sciencey and I don't expect you guys to like know it all at the top of your head. Actually, if you guys want, I do have a handout for all of this, and we broke it down into like mood issues like depression, what's going on with dopamine and serotonin and gaba and what should you do in nutrition land, same with like an anxiety and ADHD and memory loss. I'll share that link with you guys so that you can get that download. It's a fun little handout that we put together. So dopamine and norepinephrine are that beginning parts of our emotional brain and so it helps us to have those really high highs and emotions and go down, and I guess have that regulation of happiness and joy and pleasure. Same with serotonin, gamma, gaba gamma, aminobutyric acid lets us chill out. So we want to think of those, those are the big ones, oxytocin is love. So these are how our body produces some of these emotions that come out in these chemical reactions and then your brain does some magic and that's how they come out in other emotions. But they all start as chemicals and those chemicals come from food. Does that help? I'm not sure if I explained that really well. [DR. CRISTINA] So for instance, when you were talking about say, norepinephrine and dopamine, how would somebody lack, say if they're lacking in dopamine and so they're not feeling as much like pleasure what would they be lacking in terms of food and nutrition? [ADRIEN] That's a great question. So if we have a low end dopamine this sometimes presents in depression and ADHD. We would actually want to get more carbohydrates than I just, I'm so excited, because poor carbohydrates, they get the bums rush as far as like popularity and a lot of people are really scared of carbohydrates. But when we have those lows and we're not having those, that depression we really want to get our brain working and carbohydrates speed up that brain, may help us to be pulled out of that depression. Not complete 180, but it might help. So we want to be getting more carbohydrates in to really help speed up that brain, to help us really work. Also, we want to get in some good fats and dairy and for vegetarians we want to get in some beans and nuts and leafy greens and if you do eat eggs, some egg yolks fermented foods would be magical. As I say all this, when you air in that depression, it's one of those really hard things of like, I'm going to have some kimchi and salmon and have that over a bed of quinoa. Like that seems absolutely impossible when you are in a depression mindset or if we're really struggling to make peace with food. So that's what it's really nice when we get to work with patients to like, okay, what feels actually doable when we are needing some carbohydrates and we're scared of them, we don't like them, where do we even begin? So that's the fun parts that we get to do when we work with patients. [DR. CRISTINA] So I can imagine people listening thinking, now I'm on this regimen or I'm trying, or scare me. I hear that a lot from people. I try to talk to my patients and say like you need carbohydrates or your brain to function, for you to think. So what do you say to people, I'm sure you must hear it with your profession and people you're working with, people are so afraid of carbohydrates. Do you like, why is that? What do you hear? [ADRIEN] Oh, they're from everything that, carbs are just the meanest things in the whole entire world. They cause your body to change, all of these different things and it's sadly part of the diet culture mindset and the world we live in, that every food has gotten demonized at one point and it's carbs turn to get demonized right now. If you look back, I'm like, what is the carbohydrates function? It truly is your brain's number one fuel source. It is your body's number one fuel source. So if we understand, well why in the world do I need carbohydrates? So I actually need them? The answer is 1000010%, yes, you need them. We store carbohydrates in our muscles and in our liver as glucose, as glycogen. So when somebody says, oh, I'm not going to eat carbohydrates, blah, blah, blah, it's actually our body will go into its muscle to find carbohydrates. They're like, oh my gosh, we're not eating them. Let's go to the storage tank. They have to be there. If there isn't any there, our body will start to eat the muscle to make carbohydrates. That's where that whole stupid ketosis idea came from. It's not okay to eat our muscles. The body will not go after other tissues in the body. It goes after the storage tanks. So the easiest storage tank that has the best blood flow is your heart, unfortunately, so this causes a lot of heart issues and people are struggling with eating disorders. [DR. CRISTINA] Okay, so you brought up a big term. Some people might be going wait, so I've heard people debate with me saying, no, the keto diet works. It's the only thing that "has helped" me reach my goals, whatever. There's all this science behind it that says it's the best thing for your body. It's scientifically proven to help you be healthier and do great things for your body and you just demonized it. But could you talk a little bit more about what happens to the body in that state because I know it to be a toxic state for the body, but --- [ADRIEN] Oh, keto, it's so interesting when you, anything can be proven in science just. Because it's been proven in a research article, please do not take it as fact. I think that's a rule of them. In like true evidence-based research, it takes about 15 years for something to be proven over and over and over again for it to be like long. So I always get questions when people are like, well, I feel better. Cool, what does feel better mean to you? So having somebody really explain that and then also like, okay, cool, you have like clarity in your mind and all that. Well, yeah, when you go into ketosis, your body's like, well this is awful. Let me just give you some dopamine so you don't notice that I'm eating myself. So it releases this dopamine, so it mimics that you're high dopamine, and so we feel euphoric, feel better, and it's not sustainable. So a lot of times if we aren't getting enough carbohydrates, it can only last so long. The keto diet people will want them to urinate on ketosis strips to see if you've hit ketosis. This is very, very dangerous for blood sugar controls, for hormone regulations. So this is not a good thing. It's awful. Lots of issues can occur with your heart, with muscle integrity, you can get sprains and strains easier. It's just the worst idea ever. [DR. CRISTINA] So if an aesthetic of ketosis when there's like, I guess ketones kind floating around, what actually does happen to the body? [ADRIEN] It's starting, we're starting to eat our muscles, so it'll go after the muscle first. So we're going into our muscle and it will take the muscle the protein molecules and "convert," and I'm using air quotes, convert them into carbohydrates. There's a chemical process for that in the body. The body knows how to do that to survive and it makes carbohydrates for the brain to stay alive. It is not sustainable. It is like emergency-only usage. Our body knows how to stay alive in starvation, but it's not, it's surviving. It's not a sustainable life. [DR. CRISTINA] So if someone continues down that path and does not stop, like ultimately what happens? [ADRIEN] We decrease our muscle integrity, which is, everyone's like, okay, cool, so what? I still hit my goal, so what? My gravitational pole earth is different, so what? What that actually does long-term is it adds to weight cycling big time. It adds to possible cardiac issues long time. It adds to the possible inability for you to breathe, our muscles that help to contract and breathe are affected. So every major muscle, your GI system, your gastrointestinal system, so your mouth all the way out is really affected, so how your body digests food as a muscle, so we're not able to digest food. So let's say that you decide to get off the keto diet and you're like, woohoo, carbohydrates are probably going to eat them again. Our body doesn't digest them as well because we've lost muscle integrity. So people will feel bloated, they'll feel constipated. Well, yeah, you've lost muscle in your gut, you've lost muscle in your whole entire body, so it's going to take a while to heal. [DR. CRISTINA] Okay. I hear that from people like, oh, I feel so bloated, I just want to go back to this, like, that was working. So to your point, the weight cycling, can we talk about that for a minute because I've heard, and I'm not in your field, so I don't want to overstep my bounds, but I've heard that that is actually much worse for the body than anything, this, the up and down with the weight. Can you speak to that a little bit? [ADRIEN] Yeah, so there's been studies, multiple studies, not just one study, multiple studies that show that when somebody is changing their body, losing, gaining, losing, gaining yo-yo dieting years and years and years, what that is showing is that it's causing so much damage to the body long-term. So people are having chronic conditions longer and it's putting people more at risk for a shorter life expectancy. So those that have gone through weight cycling are at higher risk for mortality, heart attacks, oh goodness, mental health issues, so many other things. There's actually out of the study showing that when somebody has this weight cycling over and over and over that is a higher indication for early onset of like heart attacks at a younger age, all of these other things. So being one that just ditches the diet, stops trying to focus on that silly little number on the scale and really starts to listen to their body and nourish it, ugh, we can actually really reverse a lot of that damage. [DR. CRISTINA] I love that you said that, instead of focusing on a certain number, instead of focusing on a size, really focusing on keeping the body nourished. I think that gets lost. [ADRIEN] It's not, it's not popular, it's not sexy. It's not what Instagram picks up. So no, that's hard thing for people to really wrap their brain around. [DR. CRISTINA] Right, because there's this, like you said, in diet culture, there's this external idea, what people look "healthy." I'm putting that in quote, what "healthy" people look like versus I think a lot of times people "look healthy" and they are so the opposite. [ADRIEN] Yes. Oh, a hundred percent. I always encourage our patients to really think of like health personal, how do you define health? Because how I define it for me is going to be way different than you. So that's one of our beginning conversations we have with our patients is how do you define health without a number, without using weight, without using any other numbers? How do you define that for you? That's what we're going to work towards. [DR. CRISTINA] So I mean, if you turned the body inside out, and didn't look at like the external, how would you help somebody who's coming to you saying like, I am lethargic, my moods are all over the place, but I'm eating "so healthy," like, what am I doing wrong? [ADRIEN] Oh, I would ask how's your sleep? How's your stress? How's your water intake? How's your energy level? Like, just because you're eating healthy, that's like 25% of the puzzle. It's also how do you feel in this human suit? So are you actually getting enough sleep? How is your stress level? Stress is insane. How is your mental health? All of those things play a big piece into it. I think if we've been taught in society to only judge nutrition land, but we got to look at all the other puzzle pieces. [DR. CRISTINA] To that point too, there's so much emphasis on like, what, I'll read one article and it demonizes certain categories of food or even certain foods and I'll read something else and it's so the opposite. I've been around long enough that back in the eighties, carbs were king and everyone loved them. It goes through cycles. So I'm of the mind that eat what you want that feels good for you, that you enjoy and all these labels of what I think is when I hear people say, oh, good foods, healthy foods, really what they're talking about are diet foods that they're not, they feel like if I eat these, I won't wait. And when they're talking about bad foods, unhealthy foods, I really find most people say, oh, I feel bad. I feel guilty if I eat these. I really like these foods. These are the foods I really enjoy, but I am so afraid I'm going to gain weight if I eat these things that they're no-nos. I don't know, what do you hear? [ADRIEN] Oh, I hear it. We hear the same thing. So I always tell people there's no such thing as good, bad, right, wrong in nutrition land. So if certain foods feel really good in your body, rock stars, then that is what you need to be eating. And if it doesn't feel good in the sense that it causes diarrhea as soon as you eat something, let's spin, maybe we don't eat that because your body doesn't enjoy that. Or maybe you have an allergic reaction, an anaphylactic shock, like, please do not eat that. That would be something that would not be good. But if it's, when I always tell people when food gets stuck to an emotion like guilt or shame or blame, that's disordered eating, just eating disorder and that's that roller coaster. So the dietician's job is to slowly separate and like, let's talk about food. Let's understand the reason, the why, the science behind it then you and your therapist, you guys figure out the emotion. I don't know what to do with happy, sad, mad, I know how to make it but how that affects you, that's for you guys to figure out. So food shouldn't cause an emotion in the sense of guilt or shame. I can help you to emphasize some of those serotonin and dopamine. But guilt and shame, those are, that's a therapy land. [DR. CRISTINA] Something you just said brought up to mind, for people listening maybe who are just tuning in, I do this because I had my own eating disorder. I often say that one of the biggest things that helped me get to recovery was meeting with somebody much like yourself. I had all these fear foods and really what I realized was my whole way of choosing foods to eat was based on, again, those categories of good food, bad food. However, I thought they were going to impact how I looked on the outside versus I didn't really take any time to think about what I was actually eating or was doing for my body or not for my body. But it was very helpful to sit with a dietician and have them explain, oh, when you eat pizza, say, all the different parts of the pizza and what it actually does for the body and where it goes and how it helps and what it prevents, I don't think people think about that. I think they're just so focused on like, what's this going to do to the scale or my size or [ADRIEN] Oh, a hundred percent. I even asked like, do you like it? People are like, oh, well I don't eat cheeseburgers. I'm like, cool. Well, do you like it? They're like, oh my god, yeah, I love them. They're like, well, why are we eating a cheeseburger? It's delicious. Or the other side it's like, well, did you even just taste that? Do you know what those, that tastes like? I'm like, I don't know. I just, I went right through it when I was in a different phase and I was like, okay, well let's taste it and see if you really, really like it. So I think that's another experiment, is we're really in that mental space of good, bad, right, wrong or we're in a rush situation. I encourage everybody just to like be curious and like, do you like it? That's where we start. Just be curious. [DR. CRISTINA] I'd to go back to even that. I hear that too, because I love the hamburgers and French fries. I haven't had them in years because why. So if we could just even start with a cheeseburger, like what does eating a cheeseburger, how does, what does that do in your body? What it provide for a body once it's eaten? [ADRIEN] It's amazing. There's so many good parts. There's carbohydrates, there's protein, there's fat. Like it's complete, it's awesome. It's also one of the things as it's just a cheeseburger, it's not the end of the world. If everything is working on the inside, like your body is so amazing and knows how to do this and knows how to digest it, we're digesting food. But right now, and I didn't have to tell that, I didn't have to tell like this part of my body to like secrete this enzyme to digest this and all that, everything's working and it knows what to do. So what's the other piece of the puzzle is we got to trust our body where most people can do really cool things, digesting food. So I think that's a whole other conversation that I encourage patients to have with their therapist is like, how do we start to trust our body and food. [DR. CRISTINA] So yeah, like is that part of what you do though too, is help people get over maybe ideas about certain foods that are part of diet culture? [ADRIEN] Oh, a hundred percent. So I'm always curious to like, oh cool, where did we learn that this food is a bad food or like, oh, you shouldn't eat that. I think it's one of those, I'm curious of like, I'm just curious where that thought came from or that belief. So like, okay, well if they're open to it, like let's understand the science behind it. Like why do we need a carbohydrate? Why do we need protein? Why do we need that? Awesome. So if we sometimes can understand the whys, maybe we can try it. Maybe not, maybe we're not there yet, but it's slowly starting to make some peace with food. Maybe if somebody's never had a hamburger in five years, we wouldn't jump straight to hamburger. We might start slowly. That would be another source of trauma. We don't want to do that. But we'd start someplace slowly and understand, okay, well, if it's a no way, I'm never eating that, I haven't done that in five years, I'm like, ok, well, what's something that would be not terrifying, but like, it's a little nerve-wracking, would slowly start there and slowly like, okay, we had whole wheat bread. Okay cool. Did anything happen? Did you catch on fire? No? Cool. Your body knows how to do this. It's gotcha. It's gotcha. So we slowly start to like test it out and make sure that we're okay. [DR. CRISTINA] So, I mean, and I think that that's great but I'm wondering too, I've heard much more about the impact of social media, all these "experts" that are on there promoting, like what do they eat in a day and like promoting all their plans. They scare me because obviously you are licensed and you've been doing this a long time, actually what you're talking about. But I think most people are listening to people out there in the universe who are touting all these things and giving a lot of misinformation or people coming in with these ideas that are inaccurate. [ADRIEN] Yes, just say the least. Oh, it's hard. It really is. Because they might have a louder voice, they might have a prettier Instagram. Dieticians, were not that great at Instagram. Some of them are, some dieticians are really great and so I think it's fortunate that influencers have a larger voice in nutrition land. I hope to have a bigger voice someday and I hope to, but I think that's, I encourage our listeners to find an inclusive health at every size dietician. Just like in any professions, there's dieticians that have training in disordered eating disorders and then there's some that don't. So I encourage people to really do your due diligence and try to really listen to people that have that background in it. [DR. CRISTINA] So let's say there's somebody out there who's promoting like, oh, you can eat all this and then they're, what are the telltale signs? I mean, I have some ideas about there, but what would be some telltale signs of somebody listening going, oh, maybe that's not somebody who's well versed in this that should have some caution following or listening to. [ADRIEN] I would say they start to cut out things. Like if they're starting to demonize, oh, well don't eat X, Y, and Z or eat this, don't eat that, if they're starting put certain foods on a pedestal, oh, you'll only be healthy if you eat blah, blah blahs. So that would be my first warning sign of like, that might not be a good person to watch, or if the portions look like what a toddler should eat. I think that's the other crazy thing is some of these portions are just ridiculous. Also findings that follow your lifestyle, so if you, I'm just speaking from my personal experience, if you are a mom with little humans, there's absolutely no way I can make all these beautiful things that I see on Instagram. I'm like, yeah. So I think also following people that are part of your life in reality, like Instagram is made to look beautiful and some of the food images are beautiful, but not real life. [DR. CRISTINA] Right. Something I also see is a lot of people showing off their bodies and I always find that very interesting because, again, the focus is almost like this, oh, if you eat like me, if I you hire me then I eat like this. I'll look like this. But again, everybody is different. So even if you eat the same exact thing and do exactly what they say and do, their body's different than yours. So the promise almost of, oh, you're going to look like me if you do this. That's always so interesting to me. It's like, no, that's awful. [ADRIEN] Yeah, I always think it's funny. I'm very short and so it's always, I always use height as something like, oh yeah, if maybe I'll be 5"1, 5"2. Sounds absolutely silly to say out loud is like, oh, if I eat more marshmallow, maybe I'll grow two more inches in height. I'm just like, that seems crazy. So why would it ever be the same in eating something else to change your body? Every human is so different from genetics, from lived experiences, so no, no, no, no. [DR. CRISTINA] So, and I don't like to bring up what I'm going to say next because I think it can be triggering, but I know it is out there very prevalent. It's the norm because I'm hearing it from patients and people out there. There's this unfortunate thing where people are saying, you only eat 1200 calories a day. That's like the norm. I've talked about this on previous podcasts of the past. It's been a while, but that scares me. I think people think that that's normal. So when I say that it's not, it's like what are you talking about? [ADRIEN] Oh, that, for an grown adult, no, just like, no, no, no. Like that's the, yeah, that would barely keep like your brain alive. So if we look at it from like, I love that your analogy of like turn the body inside out. Each organ requires a certain amount of fuel, aka calories to survive. So each kidney requires so many hundreds of calories. Each lung requires so much each. This is just for you to lay like broccoli and do nothing. So that is, 400 calories is not even enough to keep your internal organs alive, let alone enough fuel for you to brush your teeth, wash your face, talk on the phone. So 400 hundred is not enough for sustainable life as a human to lay and do nothing. I was in the hospital and somebody was on a ventilator and we were breathing for them the amount of nutrition that they would have just to stay lay and breathe and not move was insane amounts of nutrition. So yeah, even people that are not moving need a ton of nutrition. [DR. CRISTINA] It's interesting, a lot of the people who come and tell me this are also working out an enormous amount during, not even just the week during a day. I'm like, what are you doing? [ADRIEN] How are they functioning? The sad part is if we flip them inside out, I'm going to be using that all the time now. Thank you. They would be just, the body's just chewing on their muscle, not on the fat tissue, not what on social media tells you. It's chewing on your muscle because your body goes for the easy thing to break down fat tissue, which we need. You have to have it. We all need a good amount. It's really hard to break down and because it, we need it, protein muscle is really easy to break down so your body goes the easiest route first. [DR. CRISTINA] Okay, so a lot of people listening might be like, wait a minute, I thought it went right. If I decrease the amount I'm eating and I exercise more, I'm going to be burning off that. Again, might be triggering for people with disordered eating or eating disorders. I know I was there, but I want to bring this up for a reason because I want to break some of the myths out there that maybe get you thinking like maybe what I'm doing is actually not what I'm thinking I'm doing [ADRIEN] Oh hundred percent. So I always present this idea to patients, so if I had a plate of butter or you're a meat eater, a beautiful cooked steak. Or if you're a vegetarian, like wonderful Tempe roasted or something, which would you choose first, a plate of butter or protein? You'd be like, yeah, I'm going to eat the plate protein. I don't want to eat a plate butter. That's exactly what your body does. It's like, I'm going to do something that tastes good and easy. I don't want to eat a plate of butter. So it's the exact same thing that your body does. Yes, your body will, it runs off of a mixed energy source. It does that easily and that's what it's supposed to, but it doesn't go like, hmm, I'm just going to eat some fat right now. No, it doesn't do that. [DR. CRISTINA] I know we're getting to time, but I know that the age old fear and I don't know if you get people actually working with you on this, but once they have people in treatment with me, they're so scared to start treatment. They ask me the question of doc, I'm fine having treatment but I don't want to gain weight. As long as I don't gain weight, I'm fine. Like I can go through treatment. Or I've heard that if I start eating more this is going to happen. Like how long is it going to be, that, this whole process? Like do you get people in that are working on this and are scared? [ADRIEN] Oh yes, everybody, everybody's terrified. I think that it's normal and all of it is scary because this eating disorder, disorder eating pattern, it's kept you safe from lots of different things and that's what therapy does, is help you to build in those other structures. But yeah, I get it. So it's not one of those things that I can't say that if we start eating more, your body's going to gain weight. I can't say that if we control, not control, but get a handle on our binge cycle that we're going to lose weight. I have absolutely no idea what your body's going to do, but I do know that what you're doing right now is not okay. So how long is it going to take? I have no idea. It has a lot to do with how long we've been in this disordered pattern. It has a lot to do with what your body wants to do. So I don't know is the hardest thing to sit with but that's the part about having a care team is each person is there to walk next to you during that whole recovery journey. [DR. CRISTINA] Again, I don't bring this up to try to keep perpetuating that all of this is about weight, but I'm bringing it up because I think that is the biggest hurdle to people going into treatment, seeking treatment and staying in treatment. Because ultimately my hope at least is that weight becomes a moot point and we get way past that and if we could just focus in on what treatment actually is for this to not be something you're so focused on. Because that is the illness in and of itself, is it's so focused on the external being what's important to your point. But I do think that that needs to be discussed is like okay, is that really what's keeping you from seeking help in treatment because you're so afraid? [ADRIEN] Yeah, oh it's a huge piece and I think that's the other part is it's normal to be having really conversation, for patients have that really big conversation and they're terrified and they don't want to get help because of that weight. I get that, I get that. I wish I could have like a great answer for patients because I know that that fear is there and I know that that's a big piece and that's the hard part is nobody knows. There's not one provider that can tell you like, oh yeah, this is hundred percent happen to your body because we just don't know. [DR. CRISTINA] Yeah, but again, to your point, I love that you said finding somebody who's weight inclusive, health at every size, really focusing on what the purpose of treatment is to get healthy, not just look "a certain way." But really what is the focus is to treat the illness and to nourish, as you said, nourish your body so it's functioning properly. [ADRIEN] That's hard in the beginning. I think that's why recovery and this whole journey is a hard journey is because it takes a while. I always tell people like, you might have been doing this for 20, 30 years, we're not going to fix it in six months. [DR. CRISTINA] Again, to that point too, people ask how long? [ADRIEN] Don't know, but we got this. Like, I think that's the other piece is it's a scary thing and you're going to want to quit and you're going to want to run away and that's also normal and it's going to just going to be a hard one. [DR. CRISTINA] And acknowledging that. I love that you're bringing all this up to the surface to discuss and not sugarcoating it. So thank you. [ADRIEN] There's no sugarcoating in the journey of recovery. It's hard and I think that's the other piece that I wish more and more providers would talk about is this, thing's have to do this multiple times. Is maybe that we weren't ready in that moment, or maybe we hit a really big roadblock, maybe something in life triggered us. So recovery is not linear at all. [DR. CRISTINA] But I love that you're out there helping people. You're an expert in your field, you are well versed in this, you get it. Love that you like the team approach. If people do want to work with you, they want information, I know you have some great information out there, thank you for sharing the links, how can they find you? How can they work with you? [ADRIEN] Yeah, so if you head on over to usenourish.com, that's our website. All of our providers, dieticians are weight inclusive trained. Some are more eating disorder based. Others might be pediatric based. So that's easiest way to. All our socials, it's just to Use Nourish. [DR. CRISTINA] Fantastic. Adrien, you've been such a pleasure. Thank you for all this great information and really appreciate it. [ADRIEN] Thank you. [DR. CRISTINA] This podcast is designed to provide accurate and authoritative information in regards to the subject matter covered. It is given with the understanding that neither the host, the publisher or the guests are rendering legal, accounting, clinical, or any other professional information. If you want a professional, you should find one.