Amanda: Hey, this is Amanda, women’s health dietitian.
Emily: And I’m Emily, nutritional therapy practitioner.
Amanda: And this is the Are You Menstrual? podcast where we help you navigate the confusing world of women’s hormones and teach you how to have healthy periods.
Emily: Each week we will be diving into a different topic on women’s health and sharing our perspective using nutrition, female physiology, and metabolic health.
Amanda: Our goal is to help you wade through conflicting health information and empower you on your healing journey.
Emily: We hope you enjoy it.
Amanda: In this episode, I’m joined by Dana Monsees, and we are diving into some challenging but really important topics. A big one is around our relationship with food and how this can impact other areas of our health, which is something I definitely see a lot in practice. We’re also going to be talking about the problems with intuitive eating and how to use nutrition from a neutral non-diet approach.
Dana is a dietitian, nutritionist, and body image coach who specializes in helping women with gut issues and burnout from a HAES non-diet approach. Her philosophy combines neutral nutrition, weight- inclusive care, and her training and integrative and functional nutrition to help women heal their relationship with food in their bodies as a root cause of chronic health conditions. Dana hosts the Wholehearted Eating podcast—which I’ve been on before…definitely over 200 episodes now, so definitely go check it out—and has been running her recipe and nutrition blog, Real Food with Dana, since 2014.
So I’m really excited for this. I was chatting with Dana on Instagram, we were DMing and just talking and, like, we have to do an episode all about this. So we’re gonna dig into that. So thank you for being here with me, Dana.
Dana: Yeah, thanks for having me on. I’m so excited to be chatting again. I can’t even remember, I feel like the episode that you came on my podcast was like, over a year ago at this point.
Amanda: I think so, it’s so hard…
Dana: Time is just, like…who knows we’re in the vortex at this point. But yeah, I mean, I always love our chats. I love going deep into the, you know, evidence-based nutrition and everything like that, and physiology and stuff that I feel like is really missed in the intuitive eating space. So I’m excited to dive into that, too.
Amanda: Yeah, it’s gonna, we have quite a bit to cover. I told Dana, we’ll probably have her on again, we’ll do an Instagram Q&A with her too. The whole point is, like, Dana has a very unique approach. And we were talking before we started recording about how, like, we both get a lot of people from that Intuitive Eating space, because they’re not seeing success with whatever their main health concern is. I feel like it basically is just another diet. So that’s kind of what we’re trying to stay away from.
So Dana, can you share a little bit more about your background and how you came to this HAES, like, non-diet approach, but you also incorporate that integrative and functional nutrition, which I love.
Dana: Let’s be clear, I did not start out this way, right. Like a lot of the people that are coming out of dietetic school right now are like, I’m doing Health at Every Size, I’m doing, you know, body positivity, intuitive eating, all this stuff, like—this is definitely 100% not where I started. So if we want to go like way back, so I was an athlete growing up my whole life and was very, very body conscious. I was a swimmer growing up which then eventually developed into what I would call orthorexia—I was never diagnosed or anything—which then turned into an eating disorder. And so that really got me interested in nutrition, which I think is kind of like a lot of dietitians in our field. You know, that’s kind of how we get into it. Not necessarily from an eating disorder, but, you know, just this, like, overwhelming passion for nutrition. And for a lot of people like this desire to kind of look the part and, like, control your body size.
So I got into that. And then later I was having all these health issues in college, and it turned out that I had celiac disease. So I was trying to figure out like, okay, I dabbled in the, like, you know, food is medicine while I was in college. What even is this? You know, functional medicine was not really a thing back then. Luckily, I went to college in Vermont, so they’re very hippie dippie up there, and one naturopathic doctor, that was the first one that I ever heard of was like, well, why don’t you try cutting out gluten? I was like, wow, a whole new world, you know.
So then after not working in nutrition, I worked in politics in D.C. for a couple of years, and I was like, wow, I hate this, went back to grad school, and really got deep into the functional medicine and functional nutrition field. When you’re trained in that field, it is kind of like…instead of in the medical field where you have this problem, and now here’s a pill to go with it to kind of fix you, in the functional medicine world it’s kind of, oh, if you have this issue—hypothyroidism, for example—here’s an autoimmune protocol, you know, like, here’s an elimination protocol. And we kind of hand these out like candy. I was really, really into that, right.
And so I was working with people on that one-on-one after I finished grad school and had my license and everything was like, yeah, this is working really well. And then after working with a lot of people on these protocols, I realized that they would come back to me and be like, Dana, my symptoms aren’t actually getting better. I was like, ooh, what is going on here? And then what happened next was kind of like a natural evolution, I find, of like, the more people that you see, the more that you realize how big of a role stress plays in chronic inflammation and symptoms and everything like that. And then when you take that further, it’s, okay, what are the different chronic stressors that are then playing into these health conditions. And the most common ones that I see are like, you know, what people call adrenal fatigue, and then burnout, and then also tons of gut issues, right. And so what I found was the constant, like, thoughts and just spiral that people have about what foods they should or shouldn’t be eating dependent for their chronic health condition or for symptom management, or to try and control their weight, or their body image, was one of the main stressors that was then contributing to all of these health issues.
Backing that up, I was like, oh, God, these elimination protocols, even though many of them are therapeutically designed, right, like, we know that. This isn’t just oh, try this diet for weight loss, which like a lot of people do, too. Now, this plays into it as well. But when you’ve tried to figure out your health for so long, which is a stressor in itself, and now you have all these different rules and shoulds and everything floating around in your head…especially if you have not only one set of chronic health symptoms but you’ve got a couple of different either organ systems or physiological symptoms that are, let’s say, going a little wonky here. You’re trying to incorporate all these different food rules and shoulds and stuff, there’s almost nothing left to eat. And then the stress of feeling like oh, my gosh, I shouldn’t be eating this food, or I was really bad for eating this food, or trying to control the foods that you’re eating for the sake of controlling your weight or your body image, is a huge stress that most women in particular, but also men and people of all genders, right, like really struggle with on not a day-to-day basis—we’re talking an hour-to-hour basis, right.
And so when you think about that everybody talks about from the conventional medicine field to the functional medicine field about how much chronic stress is inflammatory process that can create all sorts of short and long term health conditions. But what most people are not talking about is how this chronic stress of food and what I should and shouldn’t be eating to manage my chronic health conditions or to try and, you know, fix my body image or whatever it is, is really acting to a detriment to our health. And so that is where I come in.
Amanda: I love that. It really is one of those approaches where you don’t see it until you’ve seen a bunch of people. You’re 100% right. I was the same way, like, kind of traditionally trained in functional medicine and nutrition. And it is, it’s like conventional medicine with supplements. And that’s the issue is, that’s why I’m obsessed with minerals now and focusing on the foundations. Eating enough food, you know, so many women are undereating or going through, like, kind of those, like, restrict and binge scenarios that are so stressful for your body.
And so when you break all those layers back, like, yeah, are there short term therapeutic things you can try? Yes. But is it going to help you long term? Most likely no, it’s not. And it could kind of keep you on this hamster wheel of trying to figure out what’s going to solve your health issue. It’s like, usually, there’s something deeper and most of us know what it is. But we don’t want to address it because it’s, like, the hard stuff. So I love that.
And do you want to talk about a little bit more of, like, what HAES and, like, a non-diet approach mean and what they look like?
Dana: Yeah, so HAES is an acronym for Health at Every Size, which honestly, when I first heard HAES, I was like, what is that and how do you spell it? You know, HAES is Health at Every Size, which is really, on the one hand, a social justice movement that aims for, you know, equal treatment for all bodies, right. And it’s, there’s an important distinction, like, Health at Every Size is not saying that people are healthy at every size that they are, right? It is that health and healthy biomarkers and all of these things can exist at any size. And so it’s kind of an antithesis to the oh, health equals thin, right, and being in a larger body equals automatically unhealthy.
So the way that I put that into practice in my clinical practice is unlike at a regular doctor’s office. I don’t ask anyone for their weight ever. And also, the way that I measure health is not by the weight on the scale or someone’s body size. So I’m never going to give someone a set of recommendations based on their body size. For example, if you go to the doctor, and they’re like, oh, you have PCOS. The doctor’s like, oh, you know, you should probably lose weight, you know, to manage this and the person’s like, wow, I’ve never thought of that or tried that before. Like no way, you know.
So in my practice, instead of being like, oh, well, let’s just you know, like, go for weight loss and just hoping that that’s going to fix everything, because it’s not. Like if you need to do that, sure. You could cut a limb off and lose some weight that’s not going to fix your PCOS, you know. What is actually going to fix, whether it’s hormonal issues or gut issues or anything are working on the lifestyle, behavior, nutrition, movement modifications, and shifts that actually create changes, if we’re using the case of PCOS, in your blood sugar and in your hormones, right.
So when I say a non-diet approach to nutrition, what I’m focusing on is, again, those long term health promoting behaviors from an add-in, non-perfectionistic approach. Because a lot of nutrition, at least from what we see, is very all or nothing—it’s either you have to do this protocol perfectly or your symptoms are going to come back and it’s basically your fault. Which then can lead people to a lot of, like you said, Amanda, these, like, restrict binge cycles of people feel like they’re being really, you know, “good” and they’re sticking to their protocols and everything. And then, you know, we just had the holidays when this episode comes out, if people have, you know, pumpkin pie or cookies or whatever, they then feel like they’re a failure. And if they’re having a flare they think it’s their fault, because they kind of strayed from the protocol.
So instead of using this kind of perfectionistic all or nothing approach, what I do is try and add in those things that we know are supportive to different health conditions or to health in general, right. Like everybody knows that movement is beneficial for your health. But setting a goal of I’m going to go to a CrossFit class seven days a week, and if you only go four then you’re getting mad at yourself. What if we celebrated that you’re doing something, that you’re moving—and hopefully you’re enjoying—and there’s no, you know, shame or guilt or anything involved with it.
But then with like nutrition, for example, if we use PCOS, if we use hypothyroidism, whatever, we know that there are minerals, that there are nutrients, that there are other things that have been shown in the research to be beneficial for these health conditions in therapeutic doses. Why don’t we work on adding those in via food, via potentially supplements if there are deficiencies in your bloodwork. Rather than you need to do this very specific protocol, you need to cut out all of these foods, you need to cut out all potentially inflammatory foods, you have to be drinking X amount of water per day, you have to be meditating this many minutes a day. And it’s a whole, like, wellness productivity checklist that is realistically completely unattainable for someone who has a job, who has a family, who has other things going on, you know, so, yes.
Amanda: …fatigue, everyone’s dealing with, like whatever symptoms if you have PCOS you’re probably tired, you might not have, like, great sleep, you know, you might have really poor appetite so you have a hard time eating enough during the day. Like, there’s so many things that are going to make it harder for you to apply all those things at once anyway,
Dana: Right. So if you, in that example, if you go to a nutritionist, a dietitian, whatever, and they’re like, okay, here’s your meal plan for PCOS. And you have to meal prep on the weekends, and you have to blah, blah, blah…that person is probably already getting so overwhelmed, because they’re like, I came to you because I am so tired that I can’t make meals, I don’t know what to eat, and I just need some help to start feeling better as soon as possible. And then that person is giving you a recommendation that is completely unattainable for you. And now you feel like a failure because you haven’t been able to do it. So instead of that, it’s really trying to meet my clients and my patients where they are and working on adding things in. So an abundance-based mindset rather than an elimination, restriction, all or nothing mindset.
Amanda: And I feel like this mindset can also go for anyone listening to this podcast, right? I think a lot of people…I get a lot of people inside my Master Your Minerals course, they sometimes get frustrated because they’re like, okay, well, I have this kind of stuff going on, my hair test shows me this, I’m like super stressed, my minerals are very depleted. But with the lower minerals I’m, like, really focused on food and stress is the big thing because you’re depleted. And so you’re probably going to react not amazingly to different protocols and supplements and things. So food is really powerful. But it can be hard for people to go slow or to, like, work on one thing at a time. Because most of us, we have this history of restriction with food, of dieting, of trying many different health protocols, whether it’s for weight loss or just for like our wellness in general. And it, we, we almost, like, want that, because we think oh, this is going to be the next best thing that is actually going to help me solve my problems.
Dana: And we’re always told, especially from the functional medicine space, that food is going to fix everything, which it’s funny hearing this from two dietitians, right, and we’re like food is not, you know, it’s not everything right. But I think I like to always lead with a lot of, like, compassion and understanding. Like, I understand why people think that food is going to fix everything. Because first, let’s say patient one has a health condition and they go to a conventional medicine doctor and their, kind of, their health conditions are dismissed or maybe their labs are you know “normal”—which we know what that means—but they’re not getting the help that they need there.
So then they go to functional medicine. Makes sense, right? They’re looking for another avenue. Then in functional medicine, you get the, you know, here’s all the supplements to fix your problems and here’s this elimination diet. And we’re really, functional medicine is a very, like, kind of libertarian approach to health, right? It’s kind of, like, take your health in your own hands, like, conventional medicine failed you, like, here’s the tools that you can use to, you know, fix yourself, basically. But then there’s also this, like, underlying current from, not everybody, but like some people in the leading paradigm in the functional medicine space that’s like: well, if you’re not feeling better, then it’s because you didn’t do the food stuff right Or you didn’t do the supplement stuff, right. Or you didn’t fulfill this, like, laundry list of productivity wellness checklist of whatever, you know. So then a lot of people are left in the middle of feeling like, well, what…I’m lost, you know, like, what do I even do? And that’s a really frustrating place to be.
And then again, that leads us back to the physiology of stress and that conversation. You feel like you’ve exhausted a lot of different avenues here, and now you’re like, well, what do I do now? And the stress of that in addition to body image stress, food stress, trying to figure out your health, everything else that’s going on in your life, is going to be negative…impacting…negatively impacting your symptoms. And I want to mention one thing, too, right, is like, I don’t want anyone to think that I’m saying that the only reason you have these symptoms is because you have a negative relationship with food or body image, right? This is just a big missing piece of the puzzle that a lot of people are not talking about, right. So of course, there’s going to be things like underlying hormonal imbalances, maybe there’s a genetic component, there’s probably an environmental component, your gut bacteria are all over the place, you know, whatever is going on.
But what we want to emphasize here is, like, all of those things can exist. And all of these other stressors, which are contributing to the severity of all of those other factors and why your symptoms are continually getting worse if you feel like you’re trying all these other things. And let’s say you have, like, a chronic dieting history or you’ve just got, you know, a little bit of a rocky relationship with food—it doesn’t have to be a diagnosed eating disorder for your relationship with food to impact your physiological stress response and the severity of your symptoms.
Amanda: I still think that the majority of people listening will probably…it, maybe not now, they might not currently have, maybe they’ve like worked on their relationship with food. But in the past, I feel like most women can relate to that. And even honestly, men as well. I think that’s just not like as talked about. One thing I just, I love that you emphasize is this idea of, like, your, kind of, environment. And I think that can be our physical environment, but I think it can also be like our mental and emotional environment. And I think we have to remember that we can’t heal in the same environment that made us sick. And mental and emotional stress is, it’s, it’s like your body is experiencing this chronic stress every single day, all day. So I would say we can’t negate how powerful that can be on your health.
And I think that’s why when we look at our body image, when we look at our relationship with food, and the approach that we’re taking to our food, and our health in general…that’s why it can be so stressful, right? If you are in that, like, type A mindset, or all or nothing mindset, although that can be detrimental. And then you’re doing all the right things, but you’re still saying bad things to yourself all day long that you would never say to another person. You’re still in that same mindset where you’re picking apart your body despite it trying to do all these amazing things for you. So I do think that that whole mindset piece has such a big impact as well.
Dana: Oh, yeah, it’s huge. And it’s so hard too, because health is so complicated, right? And if we think that if we are in the mindset—which many people are, and I was there so I get it, right—if that, like, supplements are going to fix it and food is going to fix it, then we feel like, especially if we have this type A kind of perfectionist personality, which I think functional medicine leads really well to, right. Like if you have a type A personality and you’re perfectionist, like, those kinds of protocols are like, ooh, I’m sticking to this thing, and I’m going to be great. But if that’s not working for you, because all or nothing doesn’t work, or you just, you know, as many people say, like, “fall off the wagon” or whatever it is, you then again feel like it’s your fault, and then we’re kind of back to square one.
And there’s also the component of: how much stress is trying to follow this protocol to the tee impacting your mental and emotional health? Because I know for me and for a lot of my clients who have come to me who have tried to do these really restrictive protocols, and if they’ve tried to combine protocols because they have multiple, you know, things that are going on—thyroid, gut, adrenals, you know, those are, like, that’s kind of the triad that I will typically see—if you try and combine a thyroid protocol with an adrenal protocol and you’ve got SIBO, or you’ve got you know, any of these other things…you’re left to eat with almost nothing. And then it’s like, I can’t go out and be social, I can’t eat with other people, I’m starting to feel more and more restrictive.
I’ve seen this happen so many times to people who, even who people, even people who have never identified as having like a, you know, a rocky relationship with food or identify as chronic dieters or anything like that. And then they feel so restricted that they physically can feel the stress in your body. I can tell you 100% of the time, that is contributing to your symptoms, especially if they are gut symptoms, and especially if they are adrenal or burnout type symptoms. So it’s really this, really tough kind of Catch-22 of, like, where do I go from here, you know. Like I tried, I went on this protocol, because I wanted to make my symptoms feel better. But now I’m doing the protocol and my symptoms aren’t actually getting better.
And the thing I always go back to with my clients is, if that is the case, it’s not about the food. Because if you were eating, you know, whatever it was you were eating before, and now you’re eating this super strict protocol… And maybe you got better for, you know, like, the honeymoon phase of the beginning of the protocol, but then you’re kind of in it, and you’re really not feeling much better. We’ve got to look deeper than the food. You know, it’s not that food is not a powerful healing agent. But we can’t rely on food as the only thing that we are looking to. Because unless you have something like an IgE food allergy—peanuts, seafood, your throat is closing up, we’re going to the hospital—or you have something like celiac disease—just removing that food is not going to fix everything. And even in that case, especially with celiac disease, speaking as someone who has celiac, you can’t just remove the gluten and then everything is fine and dandy. You’ve got to do some serious healing after that, because of the massive amounts of damage that that is done to your body.
So again, food is a powerful component of this. But if you’re stopping after looking at food, and you’re not really diving into anything else as a potential cause or, like, healing agent, it’s time to go a little bit further. And give yourself permission to do that and be like, it’s okay if I wasn’t perfect on this protocol, right? Because food is not the only thing that is contributing to my symptoms.
Amanda: Or supplements. You know, guys, we don’t have to be perfectly… some people will be like, oh, I forgot to take this, like, especially with gut protocols. And like, you can’t mess up a protocol in my opinion. I don’t think it’s possible. Yes, we, we do certain things if you have something really big going on. Or, like, for example, that celiac health history, it’s like, of course, you might do specific things when the person is ready, and it’s appropriate time in their life, like stress wise. But even so I’m like, it’s okay, like, it’s really not a big deal, we’re just gonna continue and pick up where you left off, your body’s gonna figure it out. Also, your body doesn’t just stop working hard when you stop a protocol. So that’s a good thing to keep in mind, too.
And so the way that you approach this and work with people on this whole idea of, okay, let’s optimize your nutrition, but in a less, like, prescriptive way is, you call neutral nutrition, which I love. Can you tell us more about, like, what’s your definition of neutral nutrition and then some ways that we can all kind of start practicing this approach?
Dana: Yeah. So when I think of neutral nutrition, I think of an evidence-based approach to nutrition, but in a non-perfectionistic way. And again, going back to that, like, adding in rather than focusing on taking away. Because for so much of health what we hear, especially going back to the functional medicine world, is, like, you have to eliminate in order to get better, right. Which in the research is not actually true. Like, there’s plenty of research that supports adding in, for example, minerals, like, Amanda’s specialty, you know, and all this other stuff to help with chronic health conditions or just health and wellness in general.
So when I’m thinking about neutral nutrition, one I have heard is the most helpful things that I do with clients is neutralizing everything that they think they know about nutrition, right? So not only starting with like, oh, this is a good food and this is a bad food. It’s thinking about no, no, there’s no food that’s inherently good or bad. There are foods that have different nutrient values in them. This is neutral, right? Oranges have more vitamin C than KitKat bars do, right? But that doesn’t mean that KitKat is a bad food, right? So if we can start to think about it in that way. And he way I teach this to little kids because I teach Girl Scouts sometimes is each food has different superpowers to it. And I’ll talk about, you know, the colors of a rainbow and this is why foods exist in different colors or nature and everything like that. We can start to think about that with different foods is there’s no moral hierarchy of foods. If you’re not, you’re not a good or bad person if you eat certain foods. If you have a chronic health condition or if health is one of your, you know, primary things that you go for, yeah, it would be great to add in more nutrient dense foods, depending on the thing that you’re working on—thyroid health, PCOS, gut health, whatever it is. But we don’t have to eliminate 100% of the time all these, you know, “bad foods” just because they don’t have as high of a nutrient value as these other foods.
And so part of neutral nutrition is really deconstructing what you think you know about different nutritional properties. And like, for example, carbohydrates is a big one that I go through with people, right? Because when we think about like, colloquially, carbs are bad, carbs make you fat, they are going to, if I eat this doughnut it’s going straight to my thighs, right? So when I take a neutral nutrition approach that I’ve kind of, therapists would call this like re-parenting, right, but like neutralizing those terms. Depending on how science-y your clients like to get, we can go to the, you know, molecular backbone of carbohydrates and really break it down. Because what I find is, if people do have this kind of complicated relationship with food, or we have a lot of shoulds around what foods we should and shouldn’t be eating?
Well, let’s break it down. What are the body’s needs? The body needs carbohydrates for energy. There are different sources of energy. There are different ways that carbohydrates break down in the body based on if it’s a starch, based on if it’s glucose, based on whatever it is, right. And so to whatever level is the most helpful for them, going back to really the science, like, and the evidence-based research and everything, like, that can help neutralize things for people. So we’re no longer looking at things in like a good or bad way, or kind of like a hierarchy of foods. It’s just realizing, okay, well, you know, I’ve been really tired today, you know, I’m really tired around this time in the afternoon, and then I get to the end of the day and I’m starving, and I feel so bad about it because then I binge on all of these things. Okay, well, let’s rewind here. What were the things that you were craving during the day? What are the things that you typically binge on? Like, when do you typically get hungry? What are the things that you’re eating during the day?
And so all of that can give us information. Instead of saying, like, oh, I’m such a bad person for having, you know, chocolate cake or something after dinner today. It’s, well, if you were craving chocolate cake, it sounds to me like you were craving iron and magnesium. It sounds to me like you’re craving carbohydrates. It sounds to me…you know, and breaking those things down. And then saying, well, it makes a lot of sense that you’re craving these things, because you’re on your period. We’re actively losing iron and magnesium, and shedding your uterine lining is exhausting, right. So it makes sense that your body’s asking you for more energy, more iron, more magnesium, you know, all these different things.
And my clients will have these light bulb moments and they’re, like, that makes so much sense. And I feel like I’ve been just, no wonder I was beating myself up about it. Because we receive all of this negative messaging, especially around any food that has the potential to make us gain weight, right? So just, carbohydrates are one example. Because I find those are just generally the, the scariest foods to work through, right. But it takes awhile. And so if you fin