Online Health Chat with Dr. Brenda Powell and Zivia Bairey, LISW-S, ACHT
September 14, 2010
Nutrition and weight loss are two highly visible topics in today’s society. With so many people attempting to eat better, shed extra pounds and become healthier overall, it is no wonder these topics occur in frequent healthcare conversations.
Are there alternatives to enhance the ‘traditional’ weight loss methods? Holistic Psychotherapy techniques such as traditional talk therapy, hypnosis, heart-centered hypnotherapy, creative art therapy, breath therapy, rebirthing breath-work and guided imagery – provide patients with the rare opportunity to discover a personal connection to their illness or condition and begin a powerful mental, emotional, spiritual and physical healing process. These techniques help patients identify how their body is manifesting emotional, mental or spiritual issues and develop a deeper understanding of the choices they can make to heal from within.
Brenda Powell, MD and Zivia Bairey, LISW-S, ACHT, from Cleveland Clinic’s Center for Integrative Medicine discuss alternative options for better nutrition and examining relationships with food. Both Dr. Powell and Ms. Bairey find these topics vital to their practices and welcome the opportunity to address these alternative options.
Brenda Powell, MD is a board certified physician in family medicine and currently practices at Cleveland Clinic’s Wellness Institute. She specializes in integrative medicine, preventive medicine, wilderness and travel Medicine, and women's health.
Dr. Powell graduated from Linfield College in McMinnville, OR and Duke University School of Medicine. She completed her residency in Family Medicine at Duke University Medical Center in Durham, NC. Dr. Powell is a member of American Academy of Family Physicians, International Society of Travel Medicine, Wilderness Medicine Society and ASCCP.
Zivia Bairey, LISW-S, ACHT is a practicing creative arts therapist, clinical social worker and advanced clinical hypnotherapist. She specializes in the treatment of psychiatric disorders, physical illness, sexual abuse, trauma and a variety of compulsive behaviors. Her experience includes agency-based as well as private consulting with individuals and their families. Prior to joining Cleveland Clinic Center for Integrative Medicine, Ms. Bairey provided consultation services for state-run and private programs serving both adults and children with a variety of disabilities. She directed a psychiatric facility, and served as an adjunct faculty member at the College of New Rochelle, NY. Ms. Bairey has also provided training to professionals, parents and teachers in the New York special education system.
To make an appointment with Dr. Brenda Powell, Zivia Bairey, LISW-S, ACHT or any of the other specialists in our Center for Integrative Medicine at Cleveland Clinic, please call 216.986.HEAL (4325). You can also visit us online at www.clevelandclinic.org/integrativemedicine .
Nutrition and Mindful Eating
soso: What are the most effective options for achieving and maintaining weight loss?
Speaker_-_Dr__Brenda_Powell: Slow and steady with the exercise and changing diet for a lifetime. Never stop monitoring. People without weight problems have a wax and wane eating pattern. If they eat more calories at a meal the next meal is reduced.
tryme: When I get stressed, I tend to binge on junk, mainly sugary and salty foods. What can I do to avoid those tendencies? Are there any healthier food options that will satisfy my cravings in these situations?
Speaker_-_Dr__Brenda_Powell: Mind body therapy helps with managing stress. Acupuncture may help with cravings. Are you someone that can take a small portion and then stop? Then get that taste. If not, then the substitutions are important. No oil popcorn with salt is good if you do not have high blood pressure. Sprinkle the popcorn with a little cocoa powder on it for the sweet, just not too much.
prettygirl: My husband and I both have very hectic schedules and wind up eating out (or getting carry out) 3-4 times a week. Since eating at home isn’t an option, how can we make sure we’re eating healthy while at restaurants?
Speaker_-_Dr__Brenda_Powell: First choose your restaurants wisely. Only eat where you can get low fat whole foods. Get your take out at the grocery store and choose carefully. Eat salads with the dressing on the side, have either just the meat or the cheese on the salad, but not both. Eat more stock based soup, no cream soups. NO FRIES !
jojob: I’m 5”6’ and weigh more than 220 pounds. I know I overeat at meals, but I can’t seem to avoid it. If I limit my portions, I’m hungry an hour later. How can I avoid overeating and have better control of my appetite?
Speaker_-_Dr__Brenda_Powell: Consume more whole foods and fiber. Make sure you have low fat protein and a small amount of olive oil at the meal. If you can not self regulate portions, then measure and weigh everything. Come to the table with a measuring cup and spoon.
Alexandra: What advice can you give the business traveler who is forced to eat at restaurants all week?
Speaker_-_Dr__Brenda_Powell: Have instant oatmeal in the room for breakfast or a protein and fiber bar. If there is a fridge make a quick grocery run for yogurt and fruit. At lunch have the salad dressing on the side, choose non-cream based soups for lunch and a salad. Choose your restaurants wisely to be able to eat healthy foods. Of the various parts of dinner - bread, appetizer, main meal and dessert - give up dessert and just choose 2 of the other selections. Never have calories in anything you drink. Watch the alcohol and fruity drinks.
Carolyn: I am trying to watch my portion sizes and exercise - but does it have to be aerobic exercise? What about just walking long distances like a couple of miles a day?
Speaker_-_Dr__Brenda_Powell: Doing those 10,000 steps daily is beneficial. The aerobic exercise just needs to be moderate in intensity, no need to overdo it. I encourage you to keep up the walking.
Debb: I am always hungry in the evenings while watching TV. Any suggestions on ways to control my late night eating patterns?
Speaker_-_Dr__Brenda_Powell: Always have breakfast, eat high fiber and low calorie vegetables, no high fat dips, drink more water, walk after dinner or even eat dinner slightly later. Are you really hungry after a healthy dinner? Maybe it is more thirst and boredom and learned behavior.
danielle: What can be eaten when stress arrives for comfort food?
Speaker_-_Dr__Brenda_Powell: Try healthy choices such as celery with almond butter or cottage cheese and fruit. A small portion of 70% cocoa chocolate gets you the satisfying taste.
Cuddler: I definitely have 'negative' thinking going on whenever I am starved and want to eat something totally wrong - like a big piece of chocolate cake. I just don't know how to stop my brain from telling me that it is okay and I will begin tomorrow. I do the same negative self-talk when it comes to exercise. Help!
Zivia_Bairey_LISW-S_ACHT: It is important that you have this awareness as that is the first step to recovery. It may be helpful down the road to take a closer look at the motives behind your eating. It may also be helpful to begin to look at other ways to take care of yourself.
Holistic Psychotherapy & Weight Loss
pigwig: What is holistic psychotherapy? Can you explain how it works, and what conditions and/or symptoms it can help treat?
Zivia_Bairey_LISW-S_ACHT: Holistic psychotherapy utilizes traditional methods of psychotherapy as well as non-traditional therapies of holistic healing with the purpose of creating a fuller integration between the mind, body and the spirit and the deepest level of healing possible. These services are currently delivered by a clinician with a license in clinical social work and marriage counseling, certification in advanced clinical hypnotherapy and a Master’s degree in creative art therapy.
The traditional approach includes elements of traditional psychotherapy such as psychoanalytic/psychodynamic, cognitive/behavioral, developmental, educational, family systems and humanistic therapies that utilize a ‘strengths’ perspective to match the individual needs of the patient.
Non-traditional therapies are based on a variety of traditions, which tap into different levels of mind-body-spirit healing. The holistic methods are taken from a broad range of traditions: transpersonal psychology, humanistic psychology, shamanic healing, subtle energy medicine, hypnosis of different types, hypnotherapy, creative arts therapies, regression therapy, conscious breathing therapies, and guided imagery. All therapies have a strong spiritual component, which utilizes different levels of consciousness and spiritual awareness.
plos_tra: How can holistic treatment options help with weight loss?
Speaker_-_Dr__Brenda_Powell: Metabolism can be improved by addition of omega 3 in the diet, magnesium, zinc and green tea. Acupuncture can ease cravings. Good sleep helps with weight loss. Mind-body therapy can help you see why you undermine your good intentions.
sarah72724: How successful is hypnosis in treating those with binge eating disorders and compulsive overeating?
Zivia_Bairey_LISW-S_ACHT: Eating disorders are generally difficult to treat and take a long time. The kind of treatment that I practice does not just involve inserting commands into the brain, but is really taking a close look at what is underneath the behavior from the standpoint of an addiction.
We look at co-dependency issues, the habit forming component and the physical component. The treatment involves on one hand, re-programming the brain under deep relaxation. For this to work, the client must be also willing to do a lot of healing on the emotional and spiritual levels. This is not a quick fix solution.
crannies: Are there any precautions to consider with holistic psychotherapy treatments?
Zivia_Bairey_LISW-S_ACHT: Each patient responds differently to holistic psychotherapy. The Center for Integrative Medicine recommends that patients attend sessions with an open mind to receive the full benefits of this process. Patients currently prescribed psychotropic medications for mental health or who are under psychiatric treatment may still benefit from holistic psychotherapy. Patients who present with active psychotic processes or that pose a danger to themselves or others will be referred to an appropriate facility until they are more able to benefit from this process.
lovelyte: Can you say more about mind-body therapy. What is it?
Zivia_Bairey_LISW-S_ACHT: Mind-body therapy assumes that every ailment and everything presenting in our body is an accumulation of negative energy, emotions, conclusions and agreements that have not been expressed in a healthy way. Every event in our life is stored in our "cellular memory" and has a body counter-part. This means that our body is manifesting all of our past experiences whether we are consciously aware of this or not. Our body is actually telling us about our emotional pain.
The mind-body therapeutic process involves "communicating with our body" and listening to its messages. This may involve going back in our unconscious to events in our life that require resolution.
Once the event is processed, emotions released and the client 'getting' the message, the client can be an active participant in retraining the body and the mind to respond in more adaptive ways to stress around us.
It is crucial to treat the spiritual and emotional patterns that have contributed to the formation of the illness. It is best to treat the disease on the physical, emotional and spiritual levels.
Meditation, Yoga & Weight Loss
sparkhill: How does meditation help with weight loss?
Zivia_Bairey_LISW-S_ACHT: Meditation allows us to develop the ability to be fully present with ourselves, which in turn gives us invaluable tools to deal with our emotions in a healthy way.
We often eat to numb emotions and when we meditate and be able to be present with those emotions, they seem to magically dissolve. This takes willingness and practice.
There are many types of meditation that are worth researching.
helping: Can practicing yoga help with weight loss?
Speaker_-_Dr__Brenda_Powell: Yes, it builds muscle and burns calories
Disease and Weight
Frances: Are there co-existing diseases (co-morbidities) that influence whether or not you are able to lose weight?
Speaker_-_Dr__Brenda_Powell: Weight loss can be more difficult in the patient with diabetes, metabolic syndrome and hypothyroidism. Also some medications for these illnesses and depression and high blood pressure can make weight loss more difficult. Even chronic use of antihistamines can interfere with weight loss.
Sherri: What are the risk factors for conditions and diseases associated with obesity?
Speaker_-_Dr__Brenda_Powell: Where you carry the weight is important. Having all your weight around the abdomen with trim arms and legs is deadly. This central fat is what puts you at risk of diabetes, high blood pressure, heart attack, stroke and cancer. A woman with her weight in her buttocks and thighs and maintains her hourglass figure is less at risk for chronic disease.
JackT: My wife suffers from cardiovascular disease and isn’t entirely confident that she’s eating the right foods. What alternative options would you recommend for improving her diet and overall nutrition to help combat her illness?
Speaker_-_Dr__Brenda_Powell: Use only olive oil or Benacol in cooking. Olive oil helps HDL levels and Benacol lowers LDL. Whole foods and less animal fats are important. Try more vegan or vegetarian meals.
sarah72724: Are there any foods or vitamins you would suggest to help children with focus and teens with hormone changes?
Speaker_-_Dr__Brenda_Powell: Look at moving away from processed foods and starches with high fat. Children need more whole grains, vegetables and fruit. Stable, fixed meals are important. Everyone should have breakfast daily. Each meal needs to contain some type of protein, health mono unsaturated fat and high fiber foods for stable blood sugar levels.
Tutaloo: If you have digestive disorders (GERD, IBS), is it harder to lose weight, especially in the abdomen?
Speaker_-_Dr__Brenda_Powell: Only by influencing what you eat. If these health issues make you pick highly refined carbs and sugars it will be hard to lose weight. Make sure these health issues are fully evaluated and treated to be able to eat whole foods and a high fiber diet.
carrot_top: I was recently diagnosed with IBS. Can you give me any nutritional recommendations to help me better control my symptoms?
Speaker_-_Dr__Brenda_Powell: The addition of probiotics can be helpful. Also, add whole foods with more fiber and avoid artificial sweeteners.
Mama: How can you help a person who is on steroids for medical conditions (such as asthma) lose weight? Help please!
Speaker_-_Dr__Brenda_Powell: Eating to keep insulin levels down will help. This means eating as if you have diabetes. Focus on lean protein, vegetables, 2 fruit servings and whole grains with olive oil as your only fat source. Processed carbs and sugars are off the menu.
lmoran: Can you give any nutritional recommendations to help with hypothyroidism?
Speaker_-_Dr__Brenda_Powell: Outside of the 5 recommended, there is currently no other supplement recommendation that improves thyroid function.
drsue: What about causes of weight gain such as lack of sleep, and perhaps low magnesium leading to that? And electromagnetic radiation?
Speaker_-_Dr__Brenda_Powell: Weight gain is basically the amount of calories IN versus OUT. Some individuals have additional issues such as chronic illness, medications that cause weight gain. Metabolic syndrome, hypothyroidism can lead to weight gain. Can you clarify the question?
tommy1: If you place garlic, olive oil, or onions on your feet with socks, will you then sneeze out olive oil, garlic and cough out same? Sweat?
Zivia_Bairey_LISW-S_ACHT: You are supposed to sweat it out during the night. This topical therapy is popular with flu symptoms.
Good Food: Bad Food
sarah72724: I've received conflicting information relating to sugar and if it is better to completely rid yourself of any, or allow it in moderation (which seems to bring on more cravings). What are your thoughts?
Speaker_-_Dr__Brenda_Powell: Sugar can be an addictive substance and it is better to eliminate it entirely. Very few people can eat small amounts and walk away from eating sugar.
Whole foods such as fruit that may have a naturally sweet taste will help with this. Strive to move away from processed sugars.
carverp_1: What is a good coffee substitute?
Speaker_-_Dr__Brenda_Powell: If you choose to drink coffee it should be filtered with a paper filter. Otherwise drink green tea or black tea. Herbal teas are an alternative to caffeinated drinks.
drsue: What about artificial sweeteners. There has been some research indicating that they make people eat more calories overall. Do you agree?
Speaker_-_Dr__Brenda_Powell: I agree - artificial sweeteners have been shown to increase the desire for more sweet foods.
choochoo: My cravings are not for sweets, but for salty, crunchy things, like chips, pretzels, etc. Biting into a soft piece of cake, for example, is not at all satisfying, even though it may taste good. Do these types of cravings mean something different? Are they easy to control, with help?
Zivia_Bairey_LISW-S_ACHT: Try having a little bag of veggies with a bag of salt and paprika to satisfy the crunch and salt craving. Also try something crunchy like carrot sticks, celery, cucumber and balsamic vinegar.
mytree: With all the dietary supplements on the market, which are most effective?
Speaker_-_Dr__Brenda_Powell: Vit D, omega-3, magnesium and probiotics are a healthy base.
drsue: How does one navigate the 'sea' of nutritional supplements that are out there for weight loss and be able to assess what works and what does not? All the claims look reasonable and as they are not FDA regulated it is so hard!
Speaker_-_Dr__Brenda_Powell: You should be able to access PubMed.gov to search for 'weight loss supplements' to review evidence-based studies. Other web sites are ClevelandClinicWellness.com or nih.gov; Consumerlabs.com or do a general search for natural medicine database. These sites have papers that review whether the supplements work or not.
lmoran: What is the recommended daily amount of supplements we should take? Should we take these in addition to a multivitamin?
Speaker_-_Dr__Brenda_Powell: Vitamin D 2000 iu; Omega-3 Essential Fatty Acids 4000mg/day ; Magnesium 250-500 mg; Zinc 10-15 mg; Probiotic supplement twice a day.
sarah72724: What are your feelings on taking a hoodia supplement?
Speaker_-_Dr__Brenda_Powell: Again - we do not recommend 'quick fixes'. Hoodia is a way to get more fiber into the diet and making you feel fuller.
Monicaalexx: What about the Acai Berry supplements or colonic cleansers? Do they help make you stomach go down?
Speaker_-_Dr__Brenda_Powell: These have not been shown to reduce abdominal fat. By reducing colonic contents you will feel flatter in the abdomen, but it is temporary.
Gretel: Once I get to my ideal weight - how can I stay there? Do I have to swear off fattening foods (like cake & ice cream) forever?
Speaker_-_Dr__Brenda_Powell: Long term weight maintenance has been studied. Successful dieters are always monitoring their caloric intake. They learn to modify intake around celebrations. Eat less prior to and after the celebratory meal. They never stop exercising and attempt to always make wise choices in eating. “Sinful” foods are never eaten in the quantities prior to weight loss or as often.
Fisher: Do scales matter? My home scale weighs me 8 lbs less than any of the scales at the medical office. I like my scale better of course. Is it okay to monitor weight gain/loss using just my scale? It seems to fluctuate similar to the MD office one.
Speaker_-_Dr__Brenda_Powell: Monitoring weight on your home scale is fine for the feedback of gain or loss. However, accuracy is important for the calculation of BMI.
Weight Loss Programs & Second Opinions
di564: I’m not sure how alternative therapies would help me achieve my weight loss goals. Can you provide examples of how these techniques have helped other patients in the past?
Speaker_-_Dr__Brenda_Powell: During the first session, the clinician will go through a comprehensive assessment with the patient, which includes elements of a traditional bio-psycho-social assessment along with questions about one’s spirituality. This session lasts between 80 to 90 minutes and allows for the patient and clinician to set goals for treatment.
The clinician assesses the patient from a traditional perspective, as well as from one that includes mind-body as well as spiritual issues. Subsequent sessions are usually 45 to 50 minutes. During all sessions, the clinician will best address the patient’s specific needs, allowing for greater flexibility between the different therapies as treatment progresses.
laura970: Do you expect to have a class for weight loss that will include hypnosis or other techniques to reduce cravings?
Zivia_Bairey_LISW-S_ACHT: We are in the process of making the necessary provisions from the standpoint of insurance companies to be able to provide this class.
Weezer: If obesity is such a serious disease, what can be done or offered (excluding surgery) regarding weight loss programs at little or no cost to those on a limited income?
Speaker_-_Dr__Brenda_Powell: As simple as it sounds, it is that calories in have to be less than calories burned up for weight loss. Monitoring calories, portions and food choices are free. Walking, dancing around the house and limiting TV are inexpensive. There are many free websites that help one count calories and record exercise.
Westchester: Can anything be done to pressure insurance companies to consider paying for weight loss help programs? It is ridiculous that they won't pay for programs that prevent disease, but will pay lots of money for the disease once it is acquired.
Speaker_-_Dr__Brenda_Powell: Maybe congress can add this as a covered preventive medicine benefit in the healthcare overhaul? Lobby your representatives
drsue: Is it possible to have a phone consultation if one doesn't live near the Cleveland Clinic
Speaker_-_Dr__Brenda_Powell: For a second opinion, you may reference www.eclevelandclinic.org/myconsult
Cleveland_Clinic_Host: I'm sorry to say that our time with Dr. Brenda Powell and Zivia Bairey, LISW-S, ACHT is now over. Thank you again Dr. Powell and Ms Bairey for taking the time to answer our questions about Integrative Medicine Options for Nutrition and Mindful Eating.
Speaker_-_Dr__Brenda_Powell: Thank you for your participation.
- To make an appointment with Dr. Brenda Powell, Zivia Bairey, LISW-S, ACHT or any of the other specialists in our Center for Integrative Medicine at Cleveland Clinic, please call 216.986.HEAL (4325). You can also visit us online at www.clevelandclinic.org/integrativemedicine .
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