Healing Through Gratitude

“As we express our gratitude, we must never forget that the highest appreciation is not to utter words, but to live by them.” — John F Kennedy

In a recovery environment, gratitude is used as a healing modality in itself.  According to Wikipedia, the definition of gratitude, thankfulness, or appreciation is a positive emotion or attitude in acknowledgment of a benefit that one has received or will receive. Gratitude is an emotion that occurs after people receive help, depending on how they interpret the situation. Specifically, gratitude is experienced if people perceive the help they receive as (a) valuable to them, (b) costly to their benefactor, and (c) given by the benefactor with benevolent intentions (rather than ulterior motives).


Leaders in the healing arena have indicated that people who are more grateful have higher levels of well-being. Grateful people are happier, less depressed, less stressed, and more satisfied with their lives and social relationships.  Grateful people also have higher levels of control of their environments, personal growth, purpose in life, and self-acceptance.

These leaders have also suggested that grateful individuals have more positive ways of coping with the difficulties they experience in life, being more likely to seek support from other people, reinterpret and grow from  experiences, and spend more time planning how to deal with problems.  Grateful people also have less negative coping strategies, being less likely to try and avoid the problem, deny there is a problem, blame themselves, or cope through substance use.  Grateful people sleep better, due to thinking less negative and more positive thoughts just before going to sleep.

So when you find yourself criticizing others or feeling/saying that, “It is never good enough,” look at how your thoughts parallel your relationship with your body, your perfectionism and perhaps your unrealistic expectations of others.  Coming back to a sense of gratitude can help put things in perspective.

“Gratitude unlocks the fullness of life. It turns what we have into enough, and more. It turns denial into acceptance, chaos into order, confusion into clarity…. It turns problems into gifts, failures into success, the unexpected into perfect timing, and mistakes into important events. Gratitude makes sense of our past, brings peace for today and creates a vision for tomorrow.“– Melodie Beattie

Written by Beverly Price RD, MA, E-RYT 200, CEDS and David Price MA, LPC, CAADC


Nutrition Musings from a Vagabond Dietitian

It felt like a daunting task to tackle a topic that seemed as broad as “nutrition philosophy,” especially speaking as a Registered Dietitian Nutritionist working in eating disorder recovery.  I began reflecting on my own journey in an effort to orient myself in this sea of vast opinions and differing experiences.  I have wandered through and tried a myriad of ideas on healthy eating, wellness, healing, cleansing, and detoxing all in an effort to “feel better.”  There came a point, though, when I was tired of living my life based around what I could, couldn’t, should, and shouldn’t eat for that elusive moment of final absolution from any physical, mental, and emotional ailment I might be trying to solve.

One day, I had an epiphany that all of the stress I might be incurring from trying to maintain whichever diet I was pinning my hope of salvation on and the guilt I experienced when I “transgressed” that said philosophy, was likely worse than any possible threat I might be experiencing from my food choices.


In his book, Nourishing Wisdom, Marc David explores the psychology of eating and notes a similar finding, “Ironically, any benefits of the diet are often outweighed by the tension and anxiety built up in maintaining it.  The guilt experienced when eating forbidden food creates more toxins in the system than the actual food.  Furthermore, the tension caused by resisting forbidden food can be equally toxic.”

We each inherently view life through the lens of our own ideas, experiences, goals, and vulnerabilities.  When we combine this with the constant barrage of various diet trends and fads, nutrition information, and misinformation, and marketed images of what is deemed “beautiful” for the moment, it is easy to see how one can feel like they are lost at sea when approaching their own nutrition philosophy.

Opinions on what “healthy eating” is varies greatly from one person to the next and are undoubtedly influenced by trendy diets and fads, societal body image pressures, and personal desires or even fears.  We strike out on each new diet journey made more buoyant by the promise or hope of health, happiness, love, acceptance, and whatever other word or idea one might attach to those things.

As a Registered Dietitian Nutritionist, most people think I’m supposed to teach them “how to eat healthy;” meaning their perception of what healthy foods are, and only these foods.  I have often been approached in a “won’t you please slap a meal plan on me and fix me” manner by friends, colleagues, and clients alike.  It’s no secret that the foods and beverages we choose to ingest influence us on every level – physical, mental, emotional, and spiritual.  In fact, that is one of the things that drew me to the field of nutrition.  It was the concept that Hippocrates elucidated near 500 B.C., “Let food be your medicine and medicine be your food.”

Food can be wonderfully healing, nourishing, pleasurable, and supportive.  However, there is another aspect to eating that tends to go often unaddressed in this country and especially for those in the grip of an eating disorder, and that is how we relate to our food.  It is the concept that what we bring to the table – physically, mentally, emotionally, and spiritually – matters just as much, if not more than, the foods we choose to eat.

Marc David further expands this concept in Nourishing Wisdom: “Many of us are concerned about health and search for ways to prevent disease through diet and supplements, yet we often overlook the importance of an ingredient consumed at each meal – attitude.  If you eat something ‘bad’ for you with an attitude of guilt and self-punishment, the experience of the food will certainly be unnourishing – any toxins in the meal are made doubly potent simply by adding fear.  Yet the same food eaten with an attitude of celebration may have a very different reaction in the body.  Likewise, the healthiest foods may prove unhealthy if the motivation for eating them is based on a fear of disease rather than a love of life.”

As a Registered Dietitian Nutritionist working in the field of eating disorder recovery, I begin by meeting my clients where they are at.  We start to build a healing plan together by first learning what a meal plan looks like to acclimatize their bodies and minds to regular nourishment.  Next, we start to explore their fears and usual pitfalls and learn how to bravely approach the uncomfortable for the sake of their recovery.  On the journey from an eating disorder to healing we will redefine what healthy is for each client.  Along their journey, we will likely talk about Intuitive Eating, what it means to be an intuitive eater, and how they can move toward being one.

Evelyn Tribole and Elyse Resch, Dietitians and nutrition therapists, wrote a book about Intuitive Eating.  They have been able to define and scientifically support certain traits that characterize people who are able to eat intuitively.  On Tribole’s website it is stated, “Intuitive eating is an approach that teaches you how to create a healthy relationship with your food, mind, and body – where you ultimately become the expert of your own body…It’s also a process of making peace with food.”  When struggling with an eating disorder, you may not have some or even any of these traits or skills, but the good news is that you can gain these skills by practicing them.

Client can begin to work toward being an intuitive eater through these concepts: moving toward unconditional permission to eat – eating whatever your body is desiring with attunement, eating for physical rather than emotional reasons – learning to cope with emotions in ways other than with food or the lack thereof, reliance on internal cues of hunger and satiety – learning to trust themselves, and body-food choice congruence – meaning that the desire for nutritious food is present along with permission to eat the fun stuff.

I have personally found that healthy eating isn’t so much about the should’s or shouldn’t, rather, it is about permission with attunement and mindfulness.  I have also professionally witnessed clients who have bravely dismantled their previous definitions of “healthy” and learned to embrace a more expansive and inclusive definition of what “healthy” means to them.  Though the path isn’t as clear-cut, it certainly brings more freedom from food and weight obsession to the things in life that truly matter to them – they begin to live their lives again and more fully.

If you are struggling with an eating disorder and would like more information on how we can help you, please reach out to Inner Door Center at www.innerdoorcenter.com or by phone (248) 336-2868.  We offer many levels of care as well as some free support groups.  We would love to partner with you on your journey toward healing and freedom.

Written by Erika Schwan, RDN, LMT, RYT-200

Sports & Eating Disorders

Participation in organized sports has many benefits including: accountability, and determination. Improved self-esteem and body image for many is also common.  The environment often fosters a sense of community, and increases communication and teambuilding skills. However, there are many factors of a team sport environment which can contribute to an increased risk for developing an eating disorder. A 2004 study[1] found that eating disorder symptoms are more prevalent in elite athletes than the general population (13.5% compared with 4.6%). Competitive team sports and pressure to perform increases the risk for eating disorders among athletes. This intense drive to achieve paired with a culture that glorifies thinness, puts female athletes in particular at an even greater risk. Though eating disorders are more common in female athletes, males are also susceptible.  Sports which focusing on an athlete’s diet, appearance, size, and weight requirements, such as wrestling, bodybuilding, crew, and running are risk factors for both male and female athletes.


Other risk factors to keep in mind include sports that focus on the individual rather than a team. These include sports like figure skating, diving, gymnastics, and running versus team sports like baseball or soccer. Sports emphasizing appearance or a weight requirement also may contribute to disordered eating beliefs and behaviors including: wrestling, and body building. Low self-esteem, family discord, and pressure to be thin from others in and outside of the sport are just a few of the many warning signs to look out for. Social influences emphasizing a thin ideal, performance anxiety, and negative self-appraisal of athletic achievement are three top risk factors noted by the National Eating Disorder Association, [2] and are thought to predominantly contribute to a female athlete’s vulnerability to developing an eating disorder.

The Female Athlete Triad

When engaged in competitive sports ignoring the needs of our bodies in the service of our sport can have severe consequences. The female athlete triad [3] is a dangerous combination of three conditions including: amenorrhea (loss of one’s menstrual cycle), chronic insufficient fueling one’s body to meet the intense needs of athletic training, and osteoporosis (weakening of the bones due to loss of bone density). The consequences of just one of these factors can be severe ranging from increased irritability and anxiety to stress fractures and “overuse injuries” which interfere with success in your sport as well as your life.

The above mentioned symptoms can be treated by medical professionals. To avoid long standing health issues seek medical attention quickly, even if only one component of the triad is present.  Warning signs or symptoms to look out for include: the presence of a stress fracture, shin splints that do not heal, or decreased interest in your sport due to a preoccupation with food and weight.

How to prevent the triad:

  1. Keep track of your periods by writing the number of days between cycles, discussing them with your physician if there is significant fluctuation.
  2. Eat every three to four hours. Plan ahead to adequately fuel your workouts and help you recover afterwards.
  3. Account for the amount of exercise you get in a day. More food/fuel is needed with increased exercise.

Protective Factors

In addition to warning signs and risk factors, protective factors for athletes are equally important. Having friends, family, and coaches who support and influence healthy attitudes towards shape and size can be very beneficial. Emphasizing factors that contribute to personal success such as motivation and enthusiasm can be much more beneficial than body weight or shape to promote healthy body image and self-esteem. Finally, having access to coaches or trainers who educate and discuss the negative effects of chronic malnutrition on performance reduce the risk of developing an eating disorder or eating disorder symptoms.

Treatment of Athletes With Eating Disorders

When treating competitive athletes with eating disorders it is important to take into account the length and time the eating disorder has been present, one’s physical health at the start of treatment, and what their exercise level will look like after treatment. Collaboration with a medical professional is essential to address the long terms effects of amenorrhea and osteoporosis. Overarching goals include: learning appropriate types of training and implementing healthy and individualized meal plans with a registered dietitian. In therapy continual focus on the function or motivation for excessive exercise and calorie restriction/monitoring is essential. Learning skills to increase psychological flexibility and gaining the tools to challenge long held beliefs and internal rules created around how much to exercise or consume at a time are imperative.

In summary, participation in sports and general exercise has many psychological and physiological benefits including increased energy and self-esteem. Unfortunately, it can also increase one’s risk to develop an eating disorder, particularly when emphasis is placed on an individual’s performance versus that of a team. Healthy social support, medical consultation, and education are preventive/protective factors to counteract much of the negative messaging consumed through the media. Regular consultation is recommended with medical professionals and registered dieticians concerning irregular menstrual cycles, excessive/lingering injuries, and questions surrounding proper nutrition. This is true especially when engaging in competitive sports and activities.

Inner Door Center is a JCAHO accredited eating disorder treatment center that offers multiple levels of care to fit your specific needs. If you, a loved one, or someone you know are suffering from an eating disorder, or any other mental health concern, please contact Inner Door Center at (248) 336-2868.

  1. Sundgot-Borgen, J., & Torstveit, M. K. (2004). Prevalence of eating disorders in elite athletes is higher than in the general population. Clinical Journal of Sports Medicine, 14(1), 25-32.
  2. https://www.nationaleatingdisorders.org/athletes-and-eating-disorders
  3. http://www.olympic.org/hbi

Please call Inner Door Center for any inquiries you may have at (248) 336-2868 or check out our website at www.innerdoorcenter.com.

Written by Sydney Walsh, PhD

Staff Spotlight: Ja’Lynn Randall

Need your vitals done, have a question about Inner Door Center® or need help with anything? Ja’Lynn Randall is your go-to person! Ja’Lynn, or Jay, has been here since 2013 andjalynn_randall_sm knows this company inside and out.

After getting her Medical Assistant degree from Sanford Brown College in 2013, Jay immediately came to work for Inner Door Center®. She really wanted to work closely with the patients and was intrigued by how unique the center was.

Although she’s a licensed Medical Assistant, that’s only the beginning of the work she does here. Along with doing vitals on clients, Jay calls insurances to check on benefits, looks up medical records and performs front office duties such as scheduling clients and conducting intakes over the phone.

“My favorite part of my job is drawing blood and helping patients with their medical records and letters,” said Jay.

When she has free time, Jay likes to watch Anime with her husband and sing in her church choir.

If you would like to learn more about our staff at the Inner Door Center, please visit our website at http://www.innerdoorcenter.com. For more information on Inner Door Center and our treatment programs, please contact us at 248-336-2868.

Managing Your Eating Disorder During The Holidays

We’re well into the holiday season as we’ve already experienced Thanksgiving and move expectantly toward Christmas and the New Year.  This time of year evokes a lot of thoughts and feelings for people – some easier and pleasant and some not so easy and not as pleasant.  For many, the holidays evoke warm thoughts and memories, anticipation of familiar holiday meals, and traditions that give their lives a rhythm and sense of meaning.  While for others, this can be a stressful and anxiety provoking time – whether it’s about the abundance of food, challenging family relationships, or the loss and grief experienced from missing a loved one.  They may struggle to experience a rhythm and sense of meaning in their limages (7)ives in the wake of these stresses and heartaches.  For anyone struggling with an eating disorder, these feelings can be amplified.   Eating disorders are a multi-faceted disease that takes hard work, commitment, and courage to overcome.  If you are struggling with an eating disorder, preparation and planning ahead can be helpful to combat the anxiety and concerns you may have during this holiday season.  Here are some tips that may help to safely guide you through the holidays.

  • If you are currently working with an eating disorder recovery team, be sure to discuss any concerns you are anticipating – problem solving together can help ease some of that tension
  • If you are working with a registered dietitian and following a meal plan, try to stick to it over the holidays – unusual schedules and traveling can interrupt a regular eating pattern that is meant to keep you healthy and on track to recovery
  • If you are traveling any great distance, it is wise to pack snacks that you are familiar and comfortable with for ease of following your meal plan
  • Tell the food police to go away! and allow yourself to enjoy that special food item (or items) that you may not see again for another year – practice giving yourself permission
  • If you have a family member or a friend involved in your recovery already, enlist their support to be a reality check with food portions and to share in eating with you
  • Identify a support person ahead of time – someone you can call or to talk to if you are struggling with your eating disorder, addictive behaviors, negative thoughts, or difficult emotions
  • Take advantage of support groups or join one if you are not currently involved – just knowing you are not alone in your struggle can help ease the burden you bear
  • Make a list of coping skills that you can utilize when faced a difficult thought, emotion, or circumstance – take a break and some time away when you need it, without over-isolating
  • Give yourself the gift of a vacation from the scale – this is often very triggering and fans the flame of eating disorder thoughts instead of being recovery-minded
  • Don’t overload your schedule – set boundaries when you need to and enjoy the things you decide to engage in
  • Take time for self-care – this never gets old and never loses its importance in recovery or life
  • Shift the focus away from food when you can – celebrate and enjoy the relationships that surround you, tell someone how much they mean to you
  • Make time to serve others – whether it’s the homeless, toys for children, or a neighbor in need
  • Have a vision for where you would like your mind and heart to be during this holiday season – take time to recalibrate and attune to your vision whenever needed

For family and friends of those struggling with an eating disorder:

  • Express that you care about your loved one and want to support them
  • Be patient and ask them what they think would be most helpful for them
  • Acknowledge any progress or hard-work you see your loved one doing
  • Avoid making comments on appearance, body image, and size
  • Avoid indulging in conversation about the richness of food and “having to work it off”
  • Help to curb any unhealthy talk that arises in conversation surrounding food and body image
  • Compliment qualities that you appreciate about your loved one – personality, character, etc.
  • Recognize and support when your loved one may need a break for a few moments
  • Remember that they are not their eating disorder – find other ways to engage with your loved one by catching up, playing games, watching a good movie, or enlisting them to help out in some way

Remember to take the holiday season one day at a time and remind yourself that “this too shall pass” when you find yourself experiencing a challenging moment.  Practicing an attitude of gratitude can also be helpful to saturate your mind, body, and spirit in the richness that already surrounds you in your daily life.  “The purpose of life, after all, is to live it, to taste experience to the utmost, to reach out eagerly and without fear for newer and richer experiences.” –Eleanor Roosevelt.

Inner Door Center is here to support you on your journey to wholeness and offers support groups as well as different levels of care for your individualized needs:

  • Weekly on Tuesdays from 7-8 pm we offer a free and open support group to anyone struggling with an eating disorder – discussions will be recovery focused & led by a licensed therapist.
  • Reconnect with Recovery is a free support group on the 3rd Saturdays of each month from 11 am – 1 pm; connect with those in the recovery community as you are led through an hour of yoga followed by an hour of discussion and support.
  • For a limited time, we are offering a Holiday Partial Hospitalization Program (PHP) for college students who are on winter break. If you are needing extra support while home from college, you can participate in our PHP program for a shorter time period.

Please call Inner Door Center for any inquiries you may have at (248) 336-2868 or check out our website at www.innerdoorcenter.com.  May you each find peace, love, and support throughout your holiday season.

Written by: Erika Schwan RDN, LMT, RYT 200

Staff Spotlight: Noura Kejbo

Here at the Inner Door Center, our medical assistants are a vital role to our team. They take care of all the patients as well as help run the front office. Having such a busy office, we rely on our medical assistants heavily and we appreciate all of their hard work!

Noura9375Noura Kejbo, one of our hard-working medical assistants, is a dynamic part of our team. In the mix of doing vitals and tests for patients, she checks in clients, calls insurances and assists our Physician Assistant.

Noura came to the United States in 2011 and started her schooling to become a medical assistant at Dorsey School in 2013. She has an interest in helping people and wanted to be in the medical field in some way. After she graduated, she immediately applied for a position at Inner Door Center.

Inner Door Center is so unique in the programs and services we provide Noura wanted to be a part of that. Eating disorders are becoming more prevalent in the community and she wanted to be a part of that treatment process.

“I love working directly with the patients. Getting to know them and helping them through treatment is very rewarding,” Noura stated. “Also doing vitals, drawing blood and doing EKGs is a fun part of my job.”

After a long day at work, Noura goes home and spends time with her husband and two kids. One of her favorite things to do is to spend time with her family.

If you would like to learn more about our staff at the Inner Door Center, please visit our website at http://www.innerdoorcenter.com. For more information on Inner Door Center and our treatment programs, please contact us at 248-336-2868.

Eating Disorders and Healthy Sports Nutrition for Adolescents

It is estimated that nearly 38 million children and adolescents in the United States participate in organized sports each year and it is widely recognized that participating in sports can be beneficial for healthy growth and development.1, 2 Sport helps to build self-esteem, improve physical conditioning, allow space to practice unique skill sets, teach the value of teamwork, build healthy bones and muscles, control weight, and potentially improve blood pressure and cholesterol levels. 1, 2 However, for adolescents who struggle with anxiety, depression and perfectionism, the pressure of athletic competition can cause severe mental and physical stress. When paired with the cultural ideals for thinness and achieving an ideal body type, adolescent athletes can be at a higher risk for developing disordered eating.111542033_984826828203847_5447071866058583464_n

In recent years, it has become more known that body image problems and eating disorders are common among young athletes. As discovered in a study of Division 1 NCAA athletes, more than one-third of female athletes reported attitudes and symptoms that placed them at risk for the development of an eating disorder.1 Most times these disordered behaviors and symptoms are related to misinformation, preoccupation or restriction of food in the hopes of improving athletic performance or controlling body type. For this reason, screening, early diagnosis, aggressive management and most importantly prevention of eating disorders in adolescent athletes is very important.2

One group of people that have close contact with adolescent athletes, are their coaches. According to literature by Bonnie Spear, as many as 90% of coaches have no formal training on the nutritional needs of athletes. She writes, “misinformation, as well as heavy marketing by supplement manufacturers often cause coaches and parents to recommend unhealthy and potentially dangerous nutritional practices.”2 Given that the development of disordered eating in adolescents can be influenced by the messaging that they are surrounded by, it is important for the athletes themselves, their coaches and their parents to have basic knowledge of proper needs for active adolescents.

What does proper nutrition look like for an adolescent athlete? Overall, if adolescents are well hydrated and properly fueled, they will be able to get more out of their practice and daily physical activity than if they are not nutritionally prepared. Below are couple of nutrition categories that contribute to the proper fueling of an active adolescent.

Energy – In order to meet the nutritional needs for physical activity, health, growth and development, the diet of a training adolescent should consist of 55% of the total energy coming from carbohydrates, 12-15% from protein and 25-35% coming from fat.2

Carbohydrates – Energy from carbohydrates can be released into exercising muscles up to three times as fast as energy from fat, and therefore carbohydrates are the preferred fuel for working muscles. 2 As we are active, our bodies convert carbohydrates into glucose for immediate usage, yet only a limited amount of carbohydrates can be stored as glycogen in the liver and muscles. When we engage in brief, intense exercise (for example sprinting or jumping in basketball, football or volleyball) our bodies use glycogen (glucose stores) to provide energy.2 Sports that require more endurance, such as long-distance running, use glycogen stores initially and then turn to body fat for energy.2 Eating or drinking carbohydrates immediately following the event, and then at 2-hour intervals afterwards help to replenish the glycogen stores in our muscles.2 On the other hand, our bodies store glycogen up to 48 hours before an event. The main goal of a pre-event meal is to provide the body with foods high in carbohydrates (especially complex carbohydrates), with moderate amounts of protein and fat.2

Protein – Protein is a very important part of an adolescent athlete’s diet. Protein functions to build, maintain and repair muscles, produce hemoglobin, and form antibodies, enzymes and hormones – all of which are things that young athletes need to be healthy. On average, the protein recommendation for adolescents is 0.9g of protein for every 1 kg body weight per day.2 It is important to note that eating significantly more than the recommended amount of protein per day does not improve the bodies’ functions nor work to make the body stronger.2 Rather, excess protein is stored as fat, not muscle.2 For that reason, protein supplements have not been shown to enhance muscle development, strength or endurance.

Fat – Fat is an important fuel for light to moderate intensity exercise and for muscle activity during longer periods of exercise. Severe fat restriction may limit an adolescent’s performance by not allowing the body to retain adequate stores of fat triglycerides for energy.2

Fluids – One of the most important functions of fluids is to cool the body while it is working hard. Working muscles generate heat, which raise the temperature of the entire body. The goal of drinking water before, during and after physical activity is to prevent dehydration. It is recommended that active athletes drink 10-14 ounces of water 1-2 hours before the event, 4-6 ounces of water every 15-20 minutes during activity, and about 10-14 ounces of water after the sport.2

Dietary supplements – Given that there is no scientific data that supports that dietary supplements can improve performance, their use can be dangerous.2 As Spear reports, “supplements can give young athletes a false sense of security and any performance improvement will be credited to the supplement, and not the hard work and practice.”

With this information, coaches, parents and athletes can have a better understanding of what a balanced and healthy diet looks like for active adolescent athletes. It is important to keep in mind that eating a diet to support athletic performance is not about perfection, but rather about understanding what works best for each individual athlete.

Written by Beth Cotter, MPH, RDN – Registered Dietitian at the Inner Door Center in Royal Oak, Michigan

  1. “NEDA TOOLKIT for coaches and trainers” <http://www.nationaleatingdisorders.org/sites/default/files/Toolkits/CoachandTrainerToolkit.pdf&gt;
  2. Stang J, Story M. eds. Guidelines for adolescent nutrition services. Minneapolis, MN: Center for Leadership, Education and Training in Maternal and Child Nutrition, Division of Epidemiology and Community Health, School of Public Health, University of Minnesota; Chapter 16: Sports Nutrition, 2005.

Photo: Exposure Skate