Your Relationship with Gravity

Amy Green: From Mamaya Health, this is It's Never Just Hormones. I'm Amy Green. I'm a therapist. I've spent two decades in the chairs sitting with women who had been told that it was stress or hormones or just what motherhood feels like, and watching them fall through the cracks of a system that kept answering a different question than the one that they were asking. Eventually, I stopped waiting for that system to fix itself. And built the one I wish I could have had to refer them to. This show works the same way that room did. Every episode starts with a woman's story told on her terms. Then someone who knows this territory helps me trace it back to what was actually happening in her body, in her mind, and in the system around her.

Before we start, this episode is about women's bodies and food, and it goes to some hard places: disordered eating and pregnancy loss, including stillbirth. If that's close to home today, the National Alliance for Eating Disorders helpline is 1-866-662-1235. And if you're in a crisis, call or text 988. I want to tell you a story about two women. Neither one has had a formal diagnosis. Both of them stopped trusting their own bodies, and it took them years to notice it had happened. The first one, she won a state pageant at 22. This meant that most of her adult life, her body was a tool. It was measured and disciplined and admired and judged, and in her own mind, always A little wrong.

And then she got pregnant. And that body, that tool, it just started doing whatever it wanted. She started to sit differently. She got up off the couch differently. And then she gave birth, and within about a week that whirled got real loud. Get your body back. Rack your stomach. Track it. Post it. Bounce back. She was breastfeeding. Which meant that she was hungrier and thirstier than she had ever been in her life, and she overrode it on purpose, because hunger had been the enemy since she was nineteen. She spent that whole first year postpartum just angry. Not at the baby, but at her body, for changing without asking, and then refusing to change back. The second woman had a different year.

She lost a pregnancy in the first trimester. Then another, and then later a placental abruption, and a beautiful, silent baby delivered still. She grieved her babies. Of course she did. But somewhere in all of it, she had come to believe her body was a place that could not be trusted. It was a body that had failed. It was supposed to know how to do this. In fact, everyone else's body was doing it so easily. Neither of these women is one woman. They are versions of stories I have heard many times with the details changed. Today, what happens when a woman starts trusting her own body? Why the doctor's office is where a lot of this gets worse instead of better.

And what it actually takes to come home to the body you're in. My guest today is a dietitian. Jen Fleischer practices nutrition therapy in Nashville. She was nervous before we recorded, which I mentioned because she then said the most clarifying thing anybody has ever said to me about bodies in 10 years. And it was in the first 90 seconds. I asked her the simple question, what does it actually mean to trust your body? Trusting your body, I think if we were to distill it down, it's Being able to hear the information that it's giving you and then make informed decisions in the best interests of your health. So our bodies are designed to give us information and none of what we think about our bodies is something that we were born with.

It's something that we've learned. Not one thing you believe about your body came with the body. So trusting it inherently is listening to it and believing that that is accurate information that it's giving you. The opposite of that, I wouldn't, I don't know if it's distrust, but I would say it's more like surveillance and control. So we might think that, I was hungry an hour ago, there's no way I'd be hungry again now. That's not necessarily like distrust, it's like disbelief. So much of what you're talking about is this language that my body speaks. So, how do I know when it's hungry? How do I know when it's full? It's not verbal language. It's in subtle sensations.

How do you see women come to you and understand sensations? And then how do you help them grow in their understanding of their body sensations or their body's language? Yeah. It's a great question. We get so many women who don't even know what those sensations. quote unquote sound like or feel like. ⁓ and we can take we take it back to baseline. If your bladder's full, you need to go to the bathroom. So you go to the bathroom. The consequence of not going to the bathroom can be very embarrassing and painful. so helping women reconnect with their intuitiveness is as simple as how can we slow down and notice what's going on? ⁓ there's so much coming in from the outside world that is confusing.

And especially when it comes to the seasons of a woman's life, each season is like a whole nother journey. It's like a whole nother chapter, a whole nother journey where everything changes. We're in perimenopause and we've got hormones going crazy, and you're now hungrier than you've ever been before in your life. But you didn't control your estrogen drop. Like that wasn't you. I see so many women try to ⁓ initially just attack and control. ⁓ well, I know I can do this. I can go and I can track my food and I can make sure that I'm eating X number of calories, da da da da. And then they're not getting the feedback they're looking for from their body.

And then their hands are up in the air, and that's usually when we see them. Yeah. So it's a lot of practice. It's a lot of mindfulness based strategies and slowing down enough to just hear what's going on. I remember years ago I kind of put this thread together because I was seen in supporting women who, to your point, Jim, like just didn't have the awareness. And, you know, I started trying to understand that deeper and went back to, you know, from the time that we start school, we are told to raise our hand to go to the bathroom. So if we have these body cues and our bladder feels full, it's We have to tell somebody.

And if that person tells us, no, you can't go right now, then that discomfort that it causes, we're we're now taught to ignore. And the same thing is true about lunchtime. Lunchtime is scheduled. It is not something where I can just go and walk out of the classroom and go feed my body if it's hungry. But what you're also saying, and it's so powerful, and I hadn't thought about it till right now, is that like Then our sensations also change as our hormones and our seasons change. And so we have this constant reorientation and constant disorientation that requires us to have to pay attention over and over again. Exactly. And I I think another piece of that puzzle is not only is that a difficult journey, but then we also have the society that we live in, which values a certain look, a certain body.

And so then how could I possibly trust? my body if it's not fitting into that box. So I think that's another piece and layer on top of that through all these seasons. Most of the women Jen sees would pass every screening we have. So I asked her what she calls it, if it isn't an eating disorder. I tend to refer to it as disordered eating instead of an eating disorder. So it's like a disordered relationship ⁓ with food, with body. And outsourcing our ideal of what it is that we think we need. To fit into that box that I was talking about earlier, that's where we see the disorder start to happen, or that's where we see this poor relationship with food start to happen.

So ⁓ we start tracking food in apps. We think, I can do this calculation online and decide how much energy I need to consume. And I'm gonna then stick to that. But now I need to get deeper and meet these macronutrients. And then I'm also now exercising. And then so it just comp compiles over and over again until you get to a place where it feels like nothing's working, or we have we're injured, or we're so confused because now TikTok has told us that this is the right way to do this versus that's the right way to do this. I get a lot of clients who are just confused. They're like, I don't even know what to do anymore.

I'm so confused. And there's peptides. ⁓ don't even get me started on the peptides. It's yeah. Then then there's peptides. You know, oftentimes I think some of the women who are trying to figure this out again have always kind of experienced their body as a project or as something that they can either control to your point or to manipulate or it's going to perform how I want it to perform if I do these certain things. You can't discipline a first trimester. You can't control a first trimester as much as I as much as God, I wish I could. So tell me about her and how she experiences that. Yeah. So the woman that's already can trying to control these things and then gets pregnant.

In these moments, focusing on being fully nourished. And sometimes in this season, there is a little bit of Okay, this is what your body needs, as opposed to being like, just eat when you're hungry and stop when you're full. There, this is where like medical nutrition therapy comes into play. And being able to work with a woman and say, okay, here's what you've been doing, here's where your body is now, and here's how you need to nourish that body over time. and our body's gonna do what it's gonna do with that nutrition. How does she manage? Or adapt or adjust to the lack of control. Like, I can't control how my body is going to look right now.

It's doing its thing on purpose because it's growing a baby. And so there's even this like internal conflict about I wanna control this because this is very uncomfortable. And I also wanna do what's right for me and this baby. And those two things can sometimes come in conflict with each other. Well, I think this is it's important to have a full care team. Like having a dietitian alone is not ⁓ the answer in that. So if there is that conflict, then there is some sort of dysfunctional or disrupted relationship between that person and their earth suit or their body that they're in and the food that they're consuming. I think this is where you pull in mental health and therapy. ⁓ from the nutrition therapy perspective, we We work towards body neutrality.

We're not asking you to love it, but we can work on ⁓ respecting our body and making sure that we are meeting its needs. It's having this like neutral space where this is my body and this is what it is in this moment in time. So then moving to then like that postpartum season. So she gets home. Baby's home, they're thriving. And she goes online and she reads her books and they all tell her to get your body back, use a wrap, or come up with a workout plan, start tracking and again counting. Well, first of all, this scenario just makes me so sad. And also personally, I've been in this scenario. ⁓ and in this situation.

And you just birthed a whole human. into this world. And of course, the first thing that we want to do is make sure that all of our time and energy is given to that human. And what happens is we start to forget to eat, or we forget even forget just basic self-care, or it's just so difficult to do. There's negative self-talk likely going on in that, in that regard. ⁓ Your brain is being starved of nutrients if you're not eating enough. Your body is also repairing from an incredible trauma. Now we are nutrient depleted, we're iron depleted, ⁓ we're forgetting to eat. The comparison gets really loud too. It does. This idea that we go to our six-week checkup and we're supposed to be like right back to work and like just going back to normal before we had this baby.

From what I understand, it stems from like celebrity culture. I think it was in the early 2000s. Celebrities started to show up six weeks postpartum and they looked exactly like they looked before. And we didn't have the social media that we had n that we have now back then. And it was already pretty damning in our faces on People Magazine or whatever in the grocery store checkout, right there on the front cover of like so and so is back in six weeks. What it doesn't show is the trainers and the chef and the nannies, the night nurses, the the privilege and the access. And now there's such a show that we watch. Like there's this show that we watch other people.

And it's exhausting. We get so many women. I see women who come and they are so tired that like all their creativity around food is gone. I don't even know what to feed myself. So I'm just picking off my kids' plate. They're drained emotionally, they're drained mentally, and they're drained physically. And when you get into that cycle, that cycle just feeds itself. If you don't have the the mindset ⁓ or the access in your mind to be able to do this thing, and you're not able to feed yourself, then you're definitely emotional and hormones are all over the place. And it just feeds itself. The mother who feeds everyone then and is eating, standing over the sink, what's really happening there?

And what does she say to you when she points that out to you? Ooh, I think so I think what she says to me, let's start there, is I don't have time. I'm taking care of everyone else. I can't remember the last time I showered or washed my hair. and the thing I say to her is girl, I feel you. Like that is been there. Done that. and this is a classic like oxygen mask scenario. You know, they teach you get on the plane, you're like, Assemble your oxygen mask first before you put it on anybody else, because if you're not there and okay, anybody else that's with you is not going to get the help they need.

And women have never been taught how to properly put on their oxygen mask. And I think in our culture, especially in America, that is seen as selfish or like putting myself before everyone else. there's this like martyr culture. We should do it all and break ourselves, but yet we helped so many other people. So the woman that comes to me and says that will work on how can we make sure that you have some semblance of an oxygen mask on when it comes to food, put maybe even some gentle movement, if depending on what else is going on, in order for you to really fully show up, because they're only getting a a half empty version of yourself.

And it isn't only the culture, it's the schedule. In 2018, the American College Of obstetricians and gynecologists rewrote postpartum care. And it was a real improvement. Contact in the first three weeks, a full visit by twelve, the whole thing reframed as a fourth trimester. Talk to me about the doctor office scale. What would you change about how medicine talks to women about their bodies? And how should she ask for space around weight at her medical appointments if that's something that's going to be a trigger? Yeah, yeah. Okay. So it's a two-parter. What can she change? And then what would I change? ⁓ I would change so much. The sequence at a doctor's office, we show up.

Whether you're going to triage at a walk-in clinic, the ER, or your regular doctor's office, the first thing you do is they do your height, they do your blood pressure, they get you on a scale. And the person is literally not even looking at you. They're looking at their clipboard and they're going, okay, or they make a comment about one of those numbers that they just received about your body. And that is informing how you feel about yourself in that moment. So just going in, I think, sets the precedence that weight is a determinant of health, and it's not. We know that it's not now, that weight does not equal health. It's one data point.

It's one data point. And also, if we're being honest, weight on a scale is your relationship with gravity in that moment. And it changes. It's literally all it is. ⁓ it doesn't tell us anything else about your lived experience, your medical history, your stress. That your mom just passed, like it doesn't tell us anything else about what's going on in your body. The not getting to wait until it's necessary. Well, when is weight necessary? So a lot of prescriptions are prescribed based on body weight. So yes, we do need that number, but it doesn't need to be a number of judgment on a person when they're at the office. ⁓ So if I were to change the sequence, what I would do is I would go in, I would have the person come in, ask them why they're here, ⁓ what their goals are, what they're experiencing, what are their chief complaints.

And then if I'm like, ⁓ let's get these tests and when it's time to prescribe a medication, we can go do a weight. Would you like to see your weight? Do you do you have a history with that? Like we would ask them those questions. So if we get to the second part of this question, which is what can we do? As women, when we go into the doctor's office and advocate for ourselves. And I think that's exactly what it is. It's it's advocating to protect ourselves from what we know about our relationship with that number and with our body. ⁓ you can ask for a blind weight at a doctor's office. You can say, I have a poor relationship with my weight, and I would rather not see it.

So I'm gonna turn around. Like we we will help someone come up with a script based on their relationship with their doctor. So that they can advocate for themselves when they're in the office. I'd rather not see it. I'm going to turn around. That is the whole medical appointment. Rescued in 11 words. One caveat. If you're in treatment for an eating disorder, this is a conversation with your team. The evidence-based protocols there actually lean the other way. And it's genuinely unsettled. What I'm talking about is your regular appointments. That's consent. Which already applies to everything else they do to your body in that room. What have you experienced in working with women when a woman has experienced a loss and how she experiences her relationship with her body after a loss?

Grief is so hard. Grief can shut systems down. It can throw us into needing to control something because the loss that you had was out of your control that you might have falsely thought you had control over. What I see come across is either like a super lack of appetite, just like apathy towards food, apathy towards body, deep depression, or I'm gonna control this to the nth degree. And at least I have control over something. How do you help someone nourish a body that she's angry at or feels like has betrayed her? I think this goes back to body neutrality. And just getting to a place where I have a hand and this hand feeds me. ⁓ it don't even have to have gratitude for it.

You just be like, this hand picks up my fork. ⁓ it brushes my teeth. Body neutrality is it is the it's the place to start when you are at at war and at odds with yourself. and again, I think there's like the food piece of it, and then there's the mental piece of it, and they are Consistently going head to head. ⁓ how we think and feel informs the behaviors that we have around that food. And ⁓ yeah, I think what was the question again? How do you help someone nourish their body? I love you so much. It's so real. I love you too. It's so real. Yeah, no. So how do we nourish them?

I think first it starts with body neutrality. Absolutely. ⁓ secondly, If we can just get consistent meals in. And if a person is not eating enough, ⁓ then they don't have a foundation for anything else. So you have a food and mood cascade. ⁓ when you don't have enough to eat, the rest of that cascade can't happen. So the glucose can't cross the blood-brain barrier in order to get into your brain for you to even think correctly. So in that case, you're stuck. So our goal is to just get consistent meals in. And we look at like what does that look like for each individual person? Feeding yourself is a form of self-care. I remember you had told me years ago, Jen, ⁓ that you named that loud voice in your head.

What did that do for you and how is that helpful? I should I should all over myself is what I used to say. Like I would should all you should be doing this and you should be doing that. ⁓ So I call it naming your inner critic. And I have a fun little worksheet that I do with clients. ⁓ but I did it with myself and I learned this in therapy. There are at least four traditions that arrive at this same move. Narrative therapy calls it externalizing. Acceptance and commitment therapy calls it diffusion. Internal family system calls it part works. That's where Jen's worksheet comes from. But you give this this this thing that is not you, it's a part.

It's a part of you. That is likely scared of something, has been told they're not enough, ⁓ and is trying to protect you. I really do believe it's in the spirit of love that it is trying to get you to a place where you're okay. And it is not. It's it's not doing the right job. And I ended up naming my inner critic, Miranda Priestley from The Devil Wears Prada, because she is very much like, no, no, that is not okay. Here's what you should be doing. and For me, it it allowed me to separate it from my identity. And I was able to separate the voice, that part of me, from actually who I am.

And that a lot of times those voices, like that the one activity that's great is you can like write down the literal dialogue, like what did it just say to you? And then who taught you that earlier in your life? Because that's not your voice. It's somebody else's. And it came from either a person or an experience that just didn't land well, and now your brain is trying to protect you in these really terrible ways. Thank you for sharing that. You're welcome. So as we wrap up, we're gonna talk straight to the woman who got dressed this morning, who doesn't recognize herself in the mirror, and she hasn't eaten lunch yet. What would you say to her?

Hmm. I would say I see you, I hear you, I feel you. And you're not alone. ⁓ also that you're loved and you're enough and you deserve food. You deserve to eat. I think it's unrealistic to have a hundred percent love for our body all the time. I think this is where we veer into what people mistake for like body positivity. It doesn't mean you don't have to be positive about it all the time. This back to body neutrality. Can we get to a place where like, whoo, I'm having a day with my body? And I know I still need to eat because if I don't, this important thing that I have later, my brain's not gonna work for.

Or when I pick my kids up at the end of the day, I am gonna have zero nerves left to deal with the one that didn't eat lunch that day and is now in the fetal position in my car, not wanting any of the snacks that I brought. And then I'm gonna lose myself. I would say that it's so real. I would say that neutrality oftenti it leads to respect. And then that respect leads to trust. So it's like body neutrality. Now can we respect it, respect our bodies by making sure it's fed. And then we can start to trust it. And that just really leads to a better relationship with ourselves over time. Thanks, Jen.

You're welcome. If it's your season for this, here's the whole first step. Eat at roughly the same times. Whether you're hungry or not, whether or not yesterday went good or bad, three meals, a couple of snacks. That's the first move in every evidence-based protocol that we have. And if your relationship with food or with your body has been quietly hard for some time, the National Alliance for Eating Disorders helpline is 1-866-662-1235. If something in this found you where you live, here's what I want you to know. What you're carrying is real, it has a name, and it is more treatable than anyone has told you. At Mamaya, we measure every woman's progress, every single session, because the only way to know care is working is to actually check.

Most women who come to us in the clinical range finish below it, and most of that change lands inside 12 weeks. Finding care built for your season takes one step. Visit us today at memayahealth.com or visit the resources in our show notes. If you're in a crisis, call or text 988. If you're pregnant or postpartum, postpartum Support International is a great resource. And if there's a story you've never told about this season or any season nobody warns you about, the form is in our show notes. Anonymous is fine. Nothing airs without your okay. I confirm it with you first, every time. It's never just hormones is from Amaya Health. Our senior producer is Emily Seiner.

New episodes twice a month. I'm Amy Green.