Healing Groups for People Living with Chronic Pain Nutrition in Aftercare

1. Healing Groups for People Living with Chronic PainNutrition in Aftercare Mind-Body Medicine at the Full Circle Center for Integrative Medicine

2. Stages of Change • Stages of Change: Big lifestyle changes like a change in the diet require preparation, emotional as well as logistical

3. Precontemplation • Not yet acknowledging that there is a problem behavior that needs to be changed

4. The Diet Affects: • Wound healing (raw materials) • Inflammation – allergies, fats, antioxidants • Neurotransmitter synthesis – amino acids, excitotoxins • Energy Production – muscles need energy to relax • Gut Flora – which affects all of the above • Obesity – Adipose tissue is inflammatory

5. The Basics The evidence-based diet to decrease chronic pain • Avoids: Alcohol Refined and/or hydrogenated oil (trans fat) Caffeine Refined flour Refined sugar Corn syrup Dairy Eggs Meat • Increases Fresh fruits Raw vegetables Salads Nuts & seeds Carrot juice Whole grain products Tubers Flax seed oil, extra virgin olive oil I also recommend 2 liters per day of water or liquids other than black tea, coffee, or soda

6. Contemplation • Acknowledging that there is a problem but not yet ready or sure of  wanting to make a change

7. Obstacles to Change • Cost • “Willpower” – Emotional decisions about what to eat, when, and how much • Digestive Problems • Knowledge • Knowing what to eat • Knowing how to prepare healthy food

8. Cost • Cost per calorie is lower for processed foods, foods high in sugar, however in this country few people are truly lacking in calories. • Beans and grains are low cost, however: • Black beans are 69-99 cents/lb dry(about 10 servings): • $0.16/serving 140 calories, 0 fat, 18g protein, 30 g fiber • Extra lean ground beef $2.49/lb, • $0.62/serving (4 oz) – 256 calories, 19g fat, 21 g protein, 0 fiber

9. Obstacles to Change • Cost • “Willpower” – Emotional decisions about what to eat, when, and how much • Digestive Problems • Knowledge • Knowing what to eat • Knowing how to prepare healthy food

10. Emotional Choices About What to Eat • There is a difference between wanting food and being hungry • Mindfulness when hungry/reaching for food can be very illustrative • Meet needs that are being met by food with other means (and first, figure out what those needs are) The Solution, by Laurel Mellin, is a great resource Deep Healing, by Emmett Miller, also addresses these issues

11. Obstacles to Change • Cost • “Willpower” – Emotional decisions about what to eat, when, and how much • Digestive Problems • Knowledge • Knowing what to eat • Knowing how to prepare healthy food

12. Digestion • Chewing – dental health and taking time • Digestion – stomach acid, enzymes • Elimination – constipation, related to medications or other issues, can be treated with magnesium or try our “flax pudding”: Soak 2 tablespoons of flax seeds overnight in water; in the morning, add an equal amount of yogurt (or Cool Whip, in the original recipe) and dried fruit (apricots, prunes, etc.) and mix in the blender. (Can make up for several days and keep in the fridge)

13. Obstacles to Change • Cost • “Willpower” – Emotional decisions about what to eat, when, and how much • Digestive Problems • Knowledge • Knowing what to eat • Knowing how to prepare healthy food

14. Preparation • Getting ready to change

15. Fruits and Veggies • 5-9 Servings per day decreases the risk of • Cancer • Heart disease • Degenerative Arthritis • There are more nutrients in a carrot than we can even name, and certainly more than you will find in a multivitamin – vitamin pills do not produce the above benefits

16. Carbohydrates and Fiber • Not all carbs are created alike – more on this later • Unrefined carbs come with fiber, which • Is Filling • replaces higher caloric density foods • Maintains normal colonic flora • Lowers Glycemic Index (more later) • Binds things • Enterohepatic Circulation of Cholesterol • Toxins produced by bacterial fermentation • Keeps the bowels moving regularly

17. Yogurt, lowfat, 14 unsweetened, plain Lentils 29 Apple 36 Spaghetti, ww 37 Tortilla, corn 38 All-bran cereal 42 Orange 43 Think Primitive! Resources: The Revised G.I.Diet The New Glucose Revolution Corn 49 Spaghetti, durum 55 Rice, white 59 Ice Cream 61 Macaroni and cheese 64 Grape-nuts cereal 67 French baguette 95 (High numbers are bad) www.mendosa.com/gi.htm www.glycemicindex.com Glycemic Index

18. Fats • “Good” Fats: • Nuts • Fish • Flax • Neutral Fats: • Olive Oil • Canola Oil • “Bad” Fats • Saturated Fat • Trans Fats

21. Action • Changing behavior

22. Logistics/Planning for Good Nutrition • It is generally easier to add “good” foods than to eliminate the “bad” ones we crave • Stock easy healthy foods, do not keep junk food in your home • Cook ahead • Use appliances • Make trades

23. Tips to Increase Fruits & Veggies • Pre-cut vegetables and salad mixes, even fruit • Add fresh fruit and vegetables to foods you already eat - like berries and bananas to yogurt and cereal; vegetables to pasta and pizza; and lettuce, tomato and onion to sandwiches • When it’s snack time, grab an apple or orange, or make a ready-to-eat bag of sweet cherries.

24. More Tips • Make a quick smoothie in the blender by puréeing peaches and/or nectarines, a touch of your favorite fruit juice, crushed ice, and a light sprinkling of nutmeg. • Use sauces to improve palatability for veggies you do not like • Make stews and stir-fries with lots of veggies and using meat “as a condiment”

25. Some Food Preparation Ideas • Sautés/Steams with varying flavors: Assorted veggies (onions, garlic, ginger, yams, broccoli, carrots, zucchini, snow peas, etc.) can be prepared with tofu or skinless chicken breasts using: • Soy sauce/sesame oil/ • Thai curry paste with low fat coconut milk • Diced tomatoes with Italian seasoning blend or rosemary (no ginger) • Soup recipes • Steamed Greens • Salads with low-fat dressing

26. Maintenance • Continuing the changed behavior and preventing relapse Make note of how your body feels when you eat more healthfully, and remind yourself of this when you feel drawn to other foods. Note the effects on your symptoms when you “fall off the wagon”.