How to Eat on the Fertility Journey: Learning and Unlearning with Dr. Rebecca Berens

If you're like me, you have a complex relationship with food and body image. Back in the day, I even had a diagnosable eating disorder and received treatment for it. Thankfully, I've been in recovery for quite some time, but more stressful phases of life have challenged my ability to stay in recovery. 

Let's consider the fertility journey. Most of us gain some weight while undergoing treatments, and as female physicians we are taught that the lower the BMI, the better (in most cases). This is confounded by the fact that most REI's use the BMI to determine who may and may not receive certain treatments (usually for anesthesia reasons), and there are data about weight being a variable in fertility. 

How do we begin to unpack this and have a healthy relationship with food and body during this time? This episode is full of hidden gems. 

We discuss the following:

• why as female physicians we are wired to focus on weight, and how to unlearn this

• challenging the notion that a lower weight is better

• allowing for changes in body shapes and sizes throughout our lifespan

• embracing our current body as it is now 

• a new look at emotional eating and how our awareness of it may serve us

• permission to slow down and enjoy food

• the importance of teams in terms of teaching us how to eat well in all of the senses 

• how to allow this journey to make us more human (ie go from a dissociated state to a fully present and embodied experience of the fullness of life)

May we walk this journey together. Rooting for you always!

Guest Details: 

Dr. Rebecca Berens is a board-certified family physician and the founder of Vida Family Medicine in Houston, TX. She provides compassionate, weight-inclusive, trauma-informed healthcare with a special focus on supporting individuals with metabolic health concerns who are recovering from disordered eating. Dr. Berens is committed to reshaping healthcare into a more inclusive, respectful, and healing space for every body.

www.vidafamilymed.com

As always, please keep in mind that this is my perspective and nothing in this podcast is medical advice.

If you found this conversation valuable, book a consult call with me using this link:

https://calendly.com/loveandsciencefertility/discovery-call

Also, be sure to check out our website: loveandsciencefertility.com

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Please don’t let infertility have the final word. We are here to take the burden from you so that you can achieve your goal of building your family with confidence and compassion. I’m rooting for you always.

In Gratitude,

Dr. Erica Bove

Transcript:

Hello, my loves, and welcome back to the Love and Science podcast.

I have such an amazing guest today, Dr. Rebecca Berens.

She is a friend, she is a colleague.

We share so much in common in terms of how we approach people on this journey, people with a history of disordered eating.

It's just gonna be such a beautiful conversation.

So by way of introduction, Dr. Rebecca Berens is a board certified family medicine physician.

She's also the CEO and founder of Vida Family Medicine in Houston, Texas.

She provides compassionate, weight inclusive, trauma informed healthcare with a special focus on supporting individuals with metabolic health concerns who are recovering from disordered eating.

Dr. Berens is committed to reshaping healthcare into a more inclusive, respectful, and healing space for every body.

Which I'm so, so, so excited about the conversation we're about to have.

Welcome, Dr. Rebecca, it's so nice to have you.

>> Yeah, thanks so much for having me.

>> Yeah, absolutely.

So this conversation that we're about to have really is springing out of an actual conversation we had in real life around a dinner table about what can we do about this whole situation of female physicians who have infertility, who also have some sort of history of disordered eating, body image stuff, maybe even a full blown eating disorder.

Many of us were competitive athletes and so you can sprinkle a little healthy dose of that in there somewhere.

So I really wanted to talk today about, first I wanna know Dr.

Rebecca, how you decided to specialize in this particular area that you have.

But also what we can offer the listeners here who have that history, who just find it to be just this spider web that's hard to get out of in terms of navigating all these issues on the fertility journey.

>> Yeah, absolutely.

So when I was in college, had an eating disorder myself.

And so then when I was in medical school and residency, I was very aware of sort of the harms that can come from being very weight centric in the approach to healthcare.

And of course, much of our training is very weight centric.

And so I was constantly looking for ways to be more neutral about weight and not bring that into the conversation, recognizing how harmful that can be for some patients.

And so in the course of my training and then my own recovery, I came across the sort of like health at every size approach and weight neutral approaches from several dieticians and others in the eating disorder community that have focused their practices in that way.

And so I just kind of applied it to my own practice.

And then when I went into private practice, just seemed to get more and more of these patients, whether by them finding me naturally and just our vibes aligning, I don't know.

And then also just referrals from like minded therapists and dieticians that I referred my own patients to and then they would refer patients to me.

So it's kind of just grown into this is like almost all of the patients that I see now.

Right. That's so beautiful.

And I would imagine you have a population of people you see who also have fertility problems as well.

Like, oh, absolutely. Yeah.

And PCOS, for example, is a huge component.

Like many of many of my patients have PCOS.

And so, of course, there's fertility concerns that come come with that.

Yeah, absolutely.

So tell me about your approach to somebody when they come into your office, you know, fertility aside, how do you approach somebody?

Because we all know that weight is such a sensitive topic for those of us.

I also had an eating disorder.

So I totally understand this.

You know, when that has been the focus of the mental energy and all those thought pattern rabbit holes can be reactivated.

How do you approach somebody's health in a way that doesn't just focus on the number that that is a more inclusive, holistic approach?

Yeah. So when I see a new patient, I actually see them in my like office office, not the medical office.

So I do not check their weight until I'm done talking to them and hearing their whole story.

And I think that's a really huge just flip because I think for a lot of people, the first thing that happens when you walk into the doctor's office is they take you to the scale, they check your weight, they say it out loud in front of other people often, and then they go take you into this tiny room by yourself where you just like can sit and perseverate on that if that is something that is triggering to you in some way.

And so I don't do that at all.

I bring them into my office.

We have a conversation about the struggles they've had, things, symptoms they're having, their history, their family history, what they're concerned about.

You know, often a lot of patients I'm seeing have a family history of, you know, diabetes, heart disease, and they're very concerned about trying to avoid those issues for themselves if possible.

And so we get the whole story and then we go into the exam room and I do a blind weight as a standard for every patient.

I just don't find that most people want to know it's often more distressing or just, you know, adds a layer of complexity that's not necessary.

Some patients decline to be weighed at all.

That is also fine.

But I find that by flipping it, we really take that off of the focus.

And then it's just one more piece of information that I'm obtaining at the same time that I'm doing the rest of their vitals, I'm doing their exam, you know, and then we're talking about the labs that we're going to order.

So it's just one data point rather than being like the central thing that starts the entire visit, which I think unfortunately is often the case in most offices.

Yeah, it really is.

And especially as we think about fertility care and there's BMI cutoffs, I mean, usually we think about, you know, on the higher end in terms of anesthesia, not being able to do outpatient hyper-trivial and things, but also on the, you know, I wanted to mention that we do have at least in our practice, lower limit.

And, you know, we know that being significantly underweight is not great, you know, for fertility rates, but also a pregnancy.

And so trying to help people get to a fertile zone that works for them that is within certain parameters without focusing on those parameters too much, I think it can be really tricky.

So for yourself, how did you de-emphasize that number in order to be able, because I think it's like a mindset shift, right?

It's not just like, oh yeah, I'm just going to ignore it, but because if somebody's been so fixated on it, that's what they're going to want to judge themselves by.

So how did you do that for yourself?

And how do you help people do that for themselves?

Yeah.

So, I mean, I think being unaware of your weight, especially when, I mean, when you're recovering actively from an eating disorder, for a lot of people with eating disorders, I mean, this was true for myself and I think it's true for a lot of patients, like compulsively weighing yourself becomes a behavior.

And so not doing that behavior is very important for your recovery.

You not weighing yourself, if it's necessary medically for someone to weigh you, it's helpful to not know that number.

So I mean, personally for myself, I did not weigh myself from the time that I started recovering until I had my first child and I went to my OB visit and I was like over it ish by then, but I was a little like, Ooh, how is this going to feel, you know?

But I also have the privilege of like, I am genetically a thin person.

And I think this is very important to call out because I see this so many in my patients who, you know, naturally are genetically in a higher weight body and they have assumptions made about them before they even step on the scale often.

And if they try to decline being weighed or, you know, don't want to be weighed, it's like almost aggressively forced on them or like, it's just like taken as a negative that they're refusing that.

And that's like, fortunately, not something that I personally had to experience because I'm genetically a thin person.

But I think it's very important to call out.

Like that's a big issue that a lot of patients experience.

And so that's why like for me, again, like just having it as the standard that like, this is the least important thing about you, I'm getting all of your story first and hearing from you what you're experiencing first before I get that number, because so many people will tell me they go in and the first thing, like they go in for like a completely unrelated, like ear pain or something.

And the first thing is like, well, your BMI is XYZ.

You really need to lose some weight.

And it's like so unrelated to what the problem is, but it really colors the whole experience.

So I think that's for me, it's just like the emphasizing it.

If you don't need to know it, why bother?

Like why, why know it?

You know, and then, you know, when you have the ability to not have that information, I think it's helpful.

Yeah, that's, that's super, super helpful.

And I think I've sort of migrated there myself.

I find that, you know, my, my coaching practice is mostly female physicians with infertility.

Like I said, most of us have some history of this.

And as you mentioned before we started recording, like so many of us have been taught like to focus on the data, focus on this particular number, focus on weight, focus on BMI.

I have people say, but my fasting glucose, I mean, like, you know, I'm wearing a CGM, like my people are armed with the data.

And so how can we shift, you know, specifically thinking about female physicians with infertility?

How can we de-emphasize that data in a way that doesn't feel so scary that it's like, it's actually better to trust the body, trust the process.

So it's like, how can we uncouple our training and our history in a way that will allow us to live more fully in this process?

Yeah.

And I think this is like, I think a fallacy that we get so sucked into because it's, we love data.

Like we are data people as doctors.

Like I think we're all just sort of a little bit wired that way.

And we're all probably a little bit type A and just like, like to see numbers and trends and it feels very concrete and it feels controllable.

And I think that's the big thing is like, we are generally people who like to feel in control.

And so we feel like if we have numbers, we can make like predictions that are accurate.

But I think the really important thing is like that data is only as good as the quality of the data, right?

And like we, we hear about this in evidence based medicine.

Like if you're not, if it's not good quality data, the conclusions you're drawing from it are also not going to be good quality.

And I think that we are placing a lot of emphasis and giving the characteristic of high quality data to things that actually are not high quality.

Like CGM's, they're a tool, but those are not high quality data really.

And, you know, the quality of the conclusions that we're drawing based on trends in weight and blood pressure, like there's so much context and nuance to that.

It's not a black and white, like this number is good.

This number is bad.

This trend is good.

Like that's just not true.

And I don't know, when I was in medical school, I remember in the first two years learning, you know, the history and physical exam.

And what I remember being taught was if you let the patient talk and listen long enough, they will tell you the answer.

You don't need to do a whole bunch of expensive tests.

The physical exam is like supplementary to the history, but the history is the primary thing.

And I think culturally we've kind of shifted in this direction of like data and numbers and AI.

And it's like at the end of the day, medicine is art and science and it's much more art.

And I mean, that's like even your podcasting, right?

It's like, you know, it's this much, it's much more art because there's that humanity piece of it of like understanding this person as a human and all of the various complexities and nuance and and everything that goes into making them who they are and the life that they're having and their story and their, you know, their generational trauma and all these things like that is so much more important.

The data is supplementary to that.

And I think that's the reframe that that I found the most helpful.

And yeah, like you really will get the answer if you can listen long enough.

But as we both know, like we don't have a lot of time in traditional practices.

So I think that's why we then over rely on data as a way of compensating for the lack of time.

I think that is such a brilliant insight.

Thank you so much for sharing that.

I'm going to think about that for a while now.

So then so here we are.

We are a female physician.

We are now in the patient seat, right?

We yes, we get weighed once we go to the facility office, you know, and then there's this creep that happens.

I will think I will say, you know, this journey is usually not just months, but years, you know, with every cycle, it's like, don't exercise now.

Don't do this.

Don't do that.

And I would say most people, like we said, most people have a history of at least body image stuff.

And then there's this slow creep of weight gain that makes people feel inadequate and all the stories that we have associated with that.

And so what I find is when people are just like, I just don't feel like myself.

I just and is my weight contributing negatively to this not working?

And I think there's a lot of myths in all that, like a lot of things that we need to debunk.

But what would you say to somebody who is in, like I said, the spider web of like, you know, I'm a female physician.

I'm type A. I succeeded everything I do.

And yet I can't seem to control this weight that keeps creeping on.

I don't feel like myself.

You know, I don't even know how to handle it.

What would you say to somebody in that position?

Yeah, and that's so hard.

And I think there's many times in our lives where that happens.

Like, I think puberty is like, you know, obviously huge body change.

And that is also a huge time for development of disordered eating.

And it's because of the weight bias and, you know, fat phobia that exists in our society, like in puberty, you start gaining weight and you start worrying about gaining weight.

So then you start using behaviors to try to control your weight.

And in that cycle of constantly trying to control your weight, if you're artificially suppressing your weight and then you stop doing those behaviors, like say you're going through fertility treatment and someone has said, like, don't do this, don't do this, don't do this.

The things that you used to do to control your weight, it's appropriate and normal for your body to try to reset back to your normal set point.

And then the other thing that I commonly see is like with weight cycling, if someone's like dieted and lost weight and then they've regained and like, we know that our set point does tend to creep up.

And that is, again, normal.

That's your body's way of saying, like, hey, I went through this like really stressful, undernourished period of time.

I don't want that to happen again.

So I'm going to keep these stores around to keep myself safe so that if I'm ever in that situation again, I will have what I need available.

And so your body is actually doing its job.

It's protecting you.

And I think the reason that it's a problem is because societally and particularly in like a very perfectionistic, like type A, you know, weight biased medical community, we have this experience of like gaining weight is always bad.

And if you're gaining weight, you didn't get an A, you know, it's not, you're not perfect.

Like all of these like thoughts that are coming in.

But I think if you can reframe it as like my body's doing what it's supposed to do, given the circumstances that I'm in, that can help a lot with that negative framing of it.

Absolutely. And I think that's so helpful.

You know, it's like, you know, my body is doing what it's supposed to do, because I think what I see is we resist it so much, you know, and then the resisting and then the fighting and the restricting and the severe behaviors and then it increases stress.

Like it just sets off this whole, whole very stressful, you know, sort of chain of events.

And so, you know, when I think of like when I do my egg retrievals, you know, people say, oh, should I lose weight before my egg retrieval?

And I mean, it takes energy to conceive.

It takes energy to have, you know, good quality eggs.

You know, if you think even back to like the, you know, paintings and the Renaissance period of all these like fertile women, like they're not small people.

You know, like, and not to say that people in small bodies aren't fertile as well as people in larger bodies, but I think there is something very concrete about saying that when we see who cycles, right.

And, you know, fertility rates and all that, there does seem to be a sweet spot where having some adipose, having some sort of signal to the brain and the rest of the body that like, yes, we have enough nutrients around to support a pregnancy, to breastfeed, to do all the things.

Like that is very biologically rooted.

And so I think instead of like you said, instead of resisting it to embrace this chapter of life and saying like, this is my fertile body, this is, hey, pregnancy is going to happen.

I'm going to gain my pregnancy anyway.

And so, and I know it's hard.

Many people are like, but what if I don't get pregnant?

Like just to stop fighting it, to listen to the body and trust the process, because I think our bodies do have this inner wisdom and that is the missing piece.

We're never taught how to listen to it.

We're not taught.

And even in medical school, how to access the body's internal wisdom.

And I think that's what we will help you do it.

We're told not to do it.

Right.

We're told like, don't eat, don't do anything.

Right.

All that jobs more.

Right.

Yeah.

No, you're so you're so right.

So so then let's take it one step further.

So then how how do we then start to trust our bodies?

How do we stop resisting and to say, OK, if this is my fertile chapter of life and my body will be changing, how can we embrace it and start to tune in and listen?

Yeah.

So it takes a while to learn how to perceive the signals that you have suppressed.

Because like we just said, like when you are in medical school residency, probably also college as a and probably high school, really, for talking about medical people.

Right.

Like you are working so hard to get through all of those steps and you were probably forgoing a lot of things to get there.

And some of those things were, you know, working long hours, studying long hours, you know, being in the hospital, long hours, doing a bunch of admissions, doing a surgery, doing a delivery, whatever it is, you probably held your pee.

You probably ignored your hunger.

You probably didn't drink any water.

You probably did a lot of things.

And so your body has naturally then stopped giving you some of those signals as a suppressive, like as a mechanism of helping you be able to get through your day without feeling like all this need constantly.

And so to be able to tune into it, you have to allow yourself to do the things that are required for life.

You have to eat meals.

You have to go to the bathroom.

You have to go to sleep and give yourself enough time to sleep.

Like all of those things that we, again, have restricted ourselves from.

We have to allow ourselves to do.

And I think what I always try to work with patients on is like focus on the behaviors first, like what are the behaviors that humans need to do to take care of themselves?

They need to eat.

They need to sleep.

They need to pee.

They need to poop.

All those things need to be happening and you need to give yourself the time and space to allow those things to happen and do them at appropriate, adequate intervals.

And the more that you're doing them, the more your body feels safe, but like, Oh, I'm allowed to do this now.

I'm allowed to feel the need for this.

Now you will start to get more back in tune with those signals, but it's really hard. And especially if you have struggled with disordered eating, you know, I think it is a team that you need.

This is not something you can necessarily just do by yourself.

Working with a therapist is super helpful.

I think working with a dietician is also super helpful.

And I, I get a lot of resistance to that from people who are like, I know what to do. I'm a doctor.

I know this.

And it's like, we really don't, you know, we are, we are taught some nutrition.

Like I hate when people say doctors are not taught anything about nutrition, cause that's not true, but we also learn a lot of bad habits.

Um, and of course of our training and we're also still influenced by diet culture messages.

And there's a lot of that, that gets wrapped up in interweave to where we think it's strong medical evidence and it's actually not.

So I think working with a dietician to say like, what are my baseline needs?

Am I meeting my needs right now?

Because you may not be, particularly when you're going through fertility treatment and trying to conceive your needs may be higher.

So are you even meeting your baseline needs?

Um, and working with a dietician is really a great way to like actually get some professional support with that.

Yeah.

It doesn't mean that there's any lack with us.

It's a different perspective.

It's like the same reason I might go and get acupuncture.

It's the same reason I might have a therapist.

It's the same reason I might, you know, I don't know, decide to have a massage because I can't give myself a massage.

Like there's, there's like these additional perspectives with the different additional lenses and sometimes we don't know what we don't know.

And we don't know even how a different vantage point might influence or add to what we already do now.

And, and some of it's unlearning.

I mean, I think the more I live on this earth, the more I realize like, you know, yes, I'm going to start doing X, Y, Z, but then I'm also going to stop doing X, Y, Z as well.

And so maybe there are things that we can let go of that would actually benefit us.

We just haven't even considered it yet.

So I think your point, Dr.

Rebecca, about like a team-based approach and like that it takes time.

Like, I mean, I'm sure you can tell your stories too.

Like I remember when I was learning how to eat again, I was like, I feel like I've been paralyzed and now learning how to walk, like it was that slow and painful of a process.

I remember working with my people and it was like, okay, you know, I think my hunger level is a four.

I think my hunger level is a seven and just like taking the time tuning in to like ask myself, what do I really need?

What am I hungry for?

What foods feel good in my body?

Like these are things that most of us have not learned, ignored all the things our whole lives.

And so how to even interpret those signals, like Dr.

Stump, I know she does a lot with satiety signals and patients, but like most people don't even have any reference point for that.

Right.

Yeah.

And that's true.

Absolutely.

I mean, I think I was around 19 in like the worst of my eating disorder.

And I did not feel like I was recovered until I was 29.

And that doesn't mean that I was like, you know, restricting or doing any behaviors necessarily all of that time.

Like the behaviors piece of it was like a short, intense time at the beginning, but the unlearning, like you said, and the reconnecting with your signals, especially because like I went through residency during that period.

So yeah, you're suppressing lots of signals.

There was like, I had to get out of residency.

I had to be able to take some time to like really focus on those things.

And it was a lot of unlearning and relearning and reconnecting with bodily signals. And I found like the mindful eating approaches really helpful just to like really understand and like mentally connect to physically what I was feeling, because there's, there's a lot of disembodiment in medical training.

Because again, like they just need you to be working and you have so much to learn.

And so it's like the bodily needs are not as important.

Those can take it backseat.

And so we really do get all up in our head and completely disconnected from our bodies. And so that just it's a process and it takes a long time.

It really does. Yeah.

I mean, that's it's just thank you for sharing.

It's really amazing to think about even 10 years.

And I will say like, I mean, now I'm in my 40s, like, and I think my like late high school, early college was the worst for me.

And it's still like sometimes like I'll have a situation in life where there are some body changes and I really just have to remind myself, like, you know, nothing has gone wrong here.

You can trust your body like, you know, a lot of us are going through peri-monopause, menopause, all that.

Like, you know, it's like, you know, we are here on this earth for a life, not just like one thing. And and maybe the body that we had at the age of 16 when we were doing XYZ is not the same body we have at the age of 40, 42, 44 as we're undergoing fertility treatments.

Like, I think sometimes we don't adjust our standards and expectations as our lives change. And it's okay.

It's okay to our bodies to change.

It's actually what's supposed to happen.

Yeah. So yeah.

So I actually am curious, like, what's your favorite mindful eating strategy that maybe our listeners could try as an exercise?

So there is a really great passage actually in the book, positive intelligence, which I don't know if you read that book, but we I read that maybe a couple of years ago and they had this exercise where you like eat a bite of food and you close your eyes and you really focus on like all of the flavors and textures that you're experiencing and like your enjoyment of them.

Because I mean, I still do this, like, you know, we will like inhale our lunch at our desk while we're like charting or calling people back or whatever, you know, you like don't even register the food that you've eaten.

Never mind. Enjoy it.

It's just like it just happened.

And it's sometimes without even your recognition that it happened.

So really just like focusing on the enjoyment of the flavors and textures in that food.

And again, like closing your eyes, shutting off all the other stimuli that you might be experiencing so that you can really connect to that.

And it's amazing how much more enjoyable food is when you actually pay attention to eating it.

And yeah, so I found that super, super helpful.

Yeah. Thank you for sharing.

And that is something I'm still learning to this day how to do is to eat slowly.

But I think when I can take in the food with my eyes, when I can really sit down, enjoy the people I'm with and not just, you know, maybe if I'm in the middle of my work day, that doesn't always happen. But to enjoy food as its own experience and not as some sort of just thing to get through or avoid.

Right.

Yeah. And I think there's a lot of like, food is just fuel, you know, that there's a lot of messaging and it comes from kind of a diety place of like food is just fuel.

You know, you just you just eat the food that you need.

You don't need this other stuff.

But it's like also humans are wired to enjoy food.

Like our brains are wired that way for a reason.

We are supposed to enjoy food.

And life is not just about eating like perfect macros or whatever it is.

Like you're a human.

You can enjoy the experience of eating delicious food, enjoying the company of other people when you're eating food.

Like all of that is very natural and very hardwired in our brains.

And when we don't get it, it does feed into some of these disordered thoughts and behaviors.

It's so true. And I think we have to remind ourselves that as doctors, we're humans too, because I think sometimes we're like, oh, wait, no, but I'm inhuman.

Like, I don't take a sick day.

I don't pee.

I don't like we have this like martyr complex about us and many of us.

And I think I'm one thing I'm unlearning.

Right. And so I think if we can just remind ourselves, like I am a human doctor, I'm a human person and, you know, I'm going to embrace this aspect of my humanity.

I think it's easier to give ourselves permission because if we're just mired in our doctor identity, I don't think it's ever going to happen.

That shift is just too hard to bridge.

Yeah. Yeah.

I was hoping we could talk a little bit about emotional eating and how you help your people with that, because that's something I hear a lot in terms of like, I just got really bad news. You know, I'm going to go do XYZ to like make myself feel better.

And there's so many ups and downs of the fertility journey.

And so what what do you think about emotional eating and how can we get get start just sort of I don't want to say get a handle on it because that's not like the right way to put it.

But how can we start to let that go?

Yeah. So, I mean, I think part of it is like this sort of negative feeling around emotionally like, oh, I didn't need to eat that.

I was just emotional.

Like, I'm emotionally eating. Right.

Like emotional eating is also normal and appropriate.

Right. Like throughout human history, in times of celebration, there are feasts and we eat and we enjoy it and it's emotional.

And that's like the point.

It's not just about hunger all the time.

So I think the first thing is just recognize, like, you're allowed to eat just for the pleasure of eating or for, you know, comfort in a difficult time.

Like that is OK.

I think the thing that people struggle with is like they're doing it in sort of like a dissociated way or they're doing it as like, this is my only coping mechanism.

I don't have any other way to cope with this.

And again, it's not that the eating behavior is bad.

It's just like you're struggling right now.

You're having a hard time accessing the support that you need or you don't have the support that you need to get through this difficult thing.

And so this is your only coping message.

So how can we develop some other coping mechanisms so that that you're not always falling back or just dissociating into this like, I don't want to be here right now.

I'm just like removing my brain from this process and doing something compulsively.

And so I think it's, you know, again, it's reconnecting with your needs.

And like when you when you're feeling that urge to eat something, it's like, what is it that I need right now?

Again, not in a way of like you shouldn't be eating, find something else to do.

But like, what do I need?

What am I feeling?

Really connecting to what you're feeling.

Do I need a hug?

Do I need to call a friend?

Do I need to like get some support because this is a really hard thing.

I need to see it there.

Like whatever it is, identifying that you do actually have other needs and you're allowed to have them met and you should have them met.

And then I think, you know, if it's if you are, again, getting into that sort of a very compulsive or dissociated type of eating like that is a type of eating disorder.

Right.

Like binge eating disorders, the most common eating disorder.

And it is often this sort of uncontrolled, compulsive, you know, just thing that's happening that we don't feel like we can stop.

And that's that is a real issue that a lot of people are struggling with and you deserve to have support and help with that.

And I think commonly sort of like the medical response is like, well, here's an appetite suppressant.

But I think that's really unhelpful because now you're just taking away another coping mechanism from a person who's struggling.

What we need to say, like you're allowed to use this coping mechanism that you have because this is the one that you have right now.

But let's find you some other ones and let's get you that help that you actually need so that you're not just only relying on this one thing because you need more than that.

That's not the only thing that you need as a human.

That is, again, so brilliant.

Like I can't wait for the listeners to hear this because I think there's just so many kernels of wisdom here.

What I'm hearing you say is that there is nothing wrong with emotional eating.

We are wired to eat emotionally throughout time.

It's the fact that we feel that we lose our agency and we're completely disembodied when this is happening.

And so if you know that if emotional eating is a sign that we're actually suffering and having a hard time expressing that in a different way or figuring out what we really do need and reaching out and asking for that support, that's really where the opportunity is to say, OK, you know, this is a behavior that's happening over and over again.

Nothing inherently bad in and of itself.

And maybe sometimes if I choose to did like last night, I went out and had a beautiful ice cream like, you know, that's like that's that's a choice.

But like I say to my clients, like when they're waiting to find out if they're pregnant, that's a really long nine or 10 days.

Right. And so I say, have intentional distractions way better than being like, oh, my gosh, I just did Netflix for six hours.

What is wrong with me?

I'm such a bad person.

But it's like even to say ahead of time, I'm going to binge Netflix because this is how I'm passing the time.

Like those two things are so different.

Like one's a decision.

One's like, oh, my gosh, I just was totally hijacked by my monkey brain and look at look at me.

So I think the same thing is true with eating is like, you know, not that we're like sort of like planning and executing every single moment, but like what is my intention as I think about the food that I'm putting in my mouth and how is the rest of me doing?

And are there feelings that are needing to be expressed that I don't have language for and how can I get support around those things?

Yeah. And I think like like you said, like removing the guilt and shame for it, like if it happens, you don't need to like sit and beat yourself up about like, I can't believe I did that again.

Like I'm so I feel so bad.

I'm so ashamed.

You know, like it happened.

It happened because you were struggling.

So like giving yourself some compassion like that happened because I was having a really hard time, not because I'm a terrible person.

You know, it's like that happened because I needed something and like how can I meet that need?

And I think the other thing that I just want to distinguish too, because I think this is a really common thing is like a lot of people will call it emotional eating when they like binge sweet carby foods at the end of the day while they're watching TV.

And I think it's really important to recognize like sometimes when that happens, it's actually because you didn't eat enough all day.

Like you were trying to eat all the perfect meals.

And I see this all the time.

They're like, I'm trying to like reduce my carbs.

I'm trying to.

And so I didn't eat.

You know, I had a perfect breakfast and I had a perfect lunch and I had a perfect dinner.

And then at the end of the day, I just binge.

I don't know what's wrong with me.

It's like, well, you were probably hungry because your perfect meals didn't include any carbs all day long and your brain needs carbs.

Like we all know this, your brain prefers glucose as its preferred energy source.

And if you've done no carbs all day because you were trying to be good or perfect or whatever it is in that at the end of the day, your brain's like, I need carbs.

That's going to happen.

So I think it's also really important to distinguish that.

Like I see a lot of people calling it emotional eating when it's actually just I was hungry and I was right.

Right.

Myself all day.

Right.

It's like actually intuitive eating.

Yes.

This is my intuitive eating because my body knows I need XYZ.

That's amazing.

And that really does reduce the shape.

Like I know I, you know, people who know me know I train for half marathons regularly.

And on my long run days, it's amazing.

Like I finished my long run and then all of a sudden I'm like salt, salt, where is the salt?

Like I just like, I have to have tortilla chips.

That's like the fastest way.

And yes, I have electrolytes, stuff, whatever.

But like it is like the most interesting phenomenon to me that like my like animal body nature is like, where are those chips?

Like it is like this craving that and that's the one thing that makes it better.

And I think, you know, we can extend that to all sorts of food groups, protein and carbs and all sorts of things like our bodies know what we need.

I think it's just that we're taught that those cravings are bad and to like deny those cravings.

But I think if we can pause, have that awareness, ask ourselves like what we actually need and also making sure that we're getting what we need throughout the day, including hydration, including sleep.

I mean, it's like what I'm a female physician.

Like, you know, what are you telling me to do?

Like we do our best.

It's not a perfect world, but like really trying to get the sleep we need, trying to get the hydration we need, trying to get the healthy exercise that we need.

Like I think when we have all those things that are contributing to our self care, then, you know, healthy eating is a component of those things.

But I think we do need we really do need guides if we've not learned this already.

And we've even like learned the wrong things in our training.

Like we really do need guides to bring us back to like what is going to be helpful to us because so many of us, you know, probably both of us are like self taught, but like there are people like you who can help bring you back to what is actually an enjoyable, wonderful part of life.

Yeah, absolutely.

Yeah.

Oh, that was so interesting.

Is there anything else on your mind that you want to share with the listeners about your wisdom, your perspective on this?

I mean, it's so complex.

Like it is really, really complex.

And you I mean, I'm so grateful for your patience that you focus on this.

I could have used you like this.

We'll probably struggling on the same time.

But like I think that, you know, like so many people need what you have to offer.

And it's just not very common to to have somebody who understands the whole picture.

Is there anything else with your fun of knowledge, wisdom, experience?

Is there anything else you'd like to share with our people?

Yeah, I mean, I think I think the fundamental thing is just like self compassion.

And like you kind of hit it on the head just then you were just saying, you know, like we think we're in human and we don't have these human needs like we think we are so much more in control of our behaviors and ourselves than we actually are.

And especially right now, there's all this like longevity medicine and all this stuff like we can control everything we really cannot.

There's like this tiny little fraction of our health that we can control with our behaviors.

But so much more of it is predetermined by genetics, by environment, by socioeconomic factors.

And we I think we cognitively do know this as physicians like we are taught this.

But we feel like we are somehow above it because we are doctors and we know everything and we should be able to change it.

And like you really just can't.

So I think having some compassion with yourself that you're a human animal and you're going to have animal tendencies that are going to make you do things and you have to reconnect with the fact that like you are not in control.

And that's so hard, especially for people going through infertility that that you're seeing, you know, there's so much loss of control that person feels in that situation.

So really having some compassion with yourself that like you are doing the best you can.

Your body is doing what it's supposed to do.

You have to just treat it with the respect and care that it needs and not shame your you can't shame yourself healthier.

You can't shame yourself pregnant.

You just have to take care of yourself and have some compassion.

Yeah, that makes total sense.

And compassion is also a skill like we do a lot with my self compassion.

And I think that is usually the right answer as it as it tends to how do we live this human experience?

How do we live most authentically?

How do we have the best relationships possible?

Even like, you know, there's so much and I could talk about self compassion for hours, but like, you know, we're like, oh, but it's going to make me soft.

Oh, but it's going to make I'm going to lose my edge.

The data actually suggests just the opposite.

The data suggests that we have our highest performance because our brains are online.

Right.

When we when we don't have that harsh inner critic, when we have that that inner coach.

And I think that's what you help people with is like, so many people come to you with that harsh inner critic, and it's just not serving them.

And so how can we unlearn that, let that go and have that like loving, compassionate voice from inside showing us what to do and sharing a song?

Yeah, yeah.

Well, Dr.

Rebecca, thank you so much for joining us today.

I cannot wait for our listeners to hear all of this.

I you know, this is going to give me fodder to do my own journaling.

And I reflect on some of the wisdom that you shared because I think when we've gone through this ourselves, like it really does, you know, it's helpful to think about the progress.

It's also helpful to think like, you know, I'm reading the book, you know, we can do hard things right now.

And it's like, why are we the way we are, you know, and I think when we can understand ourselves better, we can have more compassion for ourselves as a starting point.

And that's when we can really start to say, OK, well, what do I need to let go of these things I still hold on to?

What do I need to embrace my body as it is right now?

And, you know, just let go of all that energy that is spent resisting and and move on forward with the journey.

Yeah. So where can people find you?

Because I know people are going to hear this and be like, oh, my gosh, I need her to be my doctor.

So I'm in I'm just outside of Houston in Sugarland, Texas, is where my office is.

I practice is called Vida Family Medicine and I can see patients in all of Texas.

So we do offer off of virtual care as well.

So, yeah, love to see anyone that I can help.

Absolutely. And we'll put like your websites and everything in the show notes and and make sure people can click on the link.

But yes, go find her, go work with her, especially if you're on the journey.

And, you know, this part of your life is a struggle right now.

And I know how many of you are in Texas.

I do. Please do seek her out because in on a personal level, she's just an absolutely amazing human. So thank you, Dr.

Rebecca. Such an honor to have you.

I cannot wait to hear some of the wisdom that comes out of this out of this conversation.

Thank you so much for having me.

Yeah, you're welcome. Until the next time.