For Many Rural Women, Finding Maternity Care Outweighs Concerns About Abortion Access
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BAKER CITY, Ore. — In what has become a routine event in rural America, a hospital maternity ward closed in 2023 in this small Oregon town about an hour from the Idaho border.
For Shyanne McCoy, 23, that meant the closest hospital with an obstetrician on staff when she was pregnant was a 45-mile drive away over a mountain pass.
When McCoy developed symptoms of preeclampsia last January, she felt she had the best chance of getting the care she needed at a larger hospital in Boise, Idaho, two hours away. She spent the final week of her pregnancy there, too far from home to risk leaving, before giving birth to her daughter.
Six months later, she said it seems clear to her that the health care needs of rural young women like her are largely ignored.
For McCoy and others, figuring out how to obtain adequate care to safely have a baby in Baker City has quickly eclipsed concerns about another medical service lacking in the area: abortion. But in Oregon and elsewhere in the country, progressive lawmakers’ attempts to expand abortion access sometimes clash with rural constituencies.
Oregon is considered one of the most protective states in the country when it comes to abortion. There are no legal limits on when someone can receive an abortion in the state, and the service is covered by its Medicaid system. Still, efforts to expand access in the rural, largely conservative areas that cover most of the state have encountered resistance and incredulity.
It’s a divide that has played out in elections in such states as Nevada, where voters passed a ballot measure in November that seeks to codify abortion protections in the state constitution. Residents in several rural counties opposed the measure.
In Oregon, during the months just before the Baker City closure was announced, Democratic state lawmakers were focused on a proposed pilot program that would launch two mobile reproductive health care clinics in rural areas. The bill specified that the van-based clinics would include abortion services.
State Rep. Christine Goodwin, a Republican from a southwestern Oregon district, called the proposal the “latest example” of urban legislators telling rural leaders what their communities need.
The mobile health clinic pilot was eventually removed from the bill that was under discussion. That means no new abortion options in Oregon’s Baker County — and no new state-funded maternity care either.
“I think if you expanded rural access in this community to abortions before you extended access to maternal health care, you would have an uprising on your hands,” said Paige Witham, 27, a member of the Baker County health care steering committee and the mother of two children, including an infant born in October.
A study published in JAMA in early December that examined nearly 5,000 acute care hospitals found that by 2022, 52% of rural hospitals lacked obstetrics care after more than a decade of unit closures. The health implications of those closures for young women, the population most likely to need pregnancy care, and their babies can be significant. Research has shown that added distance between a patient and obstetric care increases the likelihood the baby will be admitted to a neonatal intensive care unit, or NICU.
Witham said that while she does not support abortion, she believes the government should not “legislate it away completely.” She said that unless the government provides far more support for young families, like free child care and better mental health care, abortion should remain legal.
Conversations with a liberal school board member, a moderate owner of a timber company, members of Baker City’s Republican Party chapter, a local doula, several pregnant women, and the director of the Baker County Health Department — many of whom were not rigidly opposed to abortion — all turned up the same answer: No mobile clinics offering abortions here, please.
Kelle Osborn, a nurse supervisor for the Baker County Health Department, loved the idea of a mobile clinic that would provide education and birth control services to people in outlying areas. She was less thrilled about including abortion services in a clinic on wheels.
“It’s not something that should just be handed out from a mobile van,” she said of abortion services. She said people in her conservative rural county would probably avoid using the clinics for anything if they were understood to provide abortion services.
Both Osborn and Meghan Chancey, the health department’s director, said they would rank many health care priorities higher, including the need for a general surgeon, an ICU, and a dialysis clinic.
Nationally, reproductive health care services of all types tend to be limited for people in rural areas, even within states that protect abortion access. More than two-thirds of people in “maternity care deserts” — all of which are in rural counties — must drive more than a half-hour to get obstetric care, according to a 2024 March of Dimes report. For people in the Southern states where lawmakers installed abortion bans, abortion care can be up to 700 miles away, according to a data analysis by Axios.
Nathan Defrees grew up in Baker City and has practiced medicine here since 2017. He works for a family medicine clinic. If a patient asks about abortion, he provides information about where and how one can be obtained, but he doesn’t offer abortions himself.
“There’s not a lot of anonymity in small towns for physicians who provide that care,” he said. “Many of us aren’t willing to sacrifice the rest of our career for that.”
He also pointed to the small number of patients requesting the service locally. Just six people living in Baker County had an abortion in 2023, according to data from the Oregon Department of Public Health. Meanwhile, 125 residents had a baby that year.
A doctor with obstetric training living in another rural part of the state has chosen to quietly provide early-stage abortions when asked. The doctor, concerned for their family’s safety in the small, conservative town where they live, asked not to be identified.
The idea that better access to abortion is not needed in rural areas seems naive, the doctor said. People most in need of abortion often don’t have access to any medical service not already available in town, the doctor pointed out. The first patient the doctor provided an abortion for at the clinic was a meth user with no resources to travel or to manage an at-home medication abortion.
“It seemed entirely inappropriate for me to turn her away for care I had the training and the tools to do,” the doctor said.
Defrees said it has been easier for Baker County residents to get an abortion since the U.S. Supreme Court overturned Roe v. Wade.
A new Planned Parenthood clinic in Ontario, Oregon, 70 miles away in neighboring Malheur County, was built primarily to provide services to people from the Boise metro area, but it also created an option for many living in rural eastern Oregon.
Idaho is one of the 16 states with near-total bans on abortion. Like many states with bans, Idaho has struggled to maintain its already small fleet of fetal medicine doctors. The loss of regional expertise touches Baker City, too, Defrees said.
For example, he said, the treatment plan for women who have a desired pregnancy but need a termination for medical reasons is now far less clear. “It used to be those folks could go to Boise,” he said. “Now they can’t. That does put us in a bind.”
Portland is the next closest option for that type of care, and that means a 300-mile drive along a set of highways that can be treacherous in winter.
“It’s a lot scarier to be pregnant now in Baker City than it ever has been,” Defrees said.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Subscribe to KFF Health News’ free Morning Briefing.
This article first appeared on KFF Health News and is republished here under a Creative Commons license.
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Women Living Deliciously – by Florence Given
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“Wouldst thou like to live deliciously?” as the line goes, and this book answers that, and how.
While roundly aimed at women, as per the title, this book will be of benefit to anyone who finds that society has wanted to keep you small and contained, and that perhaps you were meant for better.
The book is divided into three sections:
- Excavating
- Planting
- Blooming
…which broadly describes the process the author takes us through, of:
- Digging up what is wrong
- Putting better things in place
- Enjoying life
This is important, because otherwise a lot of people will understandably exhort us to step 3 (enjoying life), without really thinking about steps 1 and 2.
Her wording of it is important too, it wasn’t just being flowery for floweriness’ sake—rather, it highlights the nature of the process: while “enjoy life” seems like a thing-in-itself (as Kant might say), in reality, there’s another necessary thing (or series of things) behind it. In contrast, the gardening metaphor renders it clear: how will your flowers bloom if you do not plant them? And what good will planting them do if the soil is not right for them?
So, she gives us a “ground upwards” therapeutic approach.
The style throughout is casual but sincere and heartfelt, and while this is a book of personal change rather than social change, it does reference feminism throughout so if that’s not for you, then neither is this book.
Bottom line: this is a lot more than just a pep talk or a book of platitudes; it’s a lot of concrete, applicable stuff to markedly live life better.
Click here to check out Women Living Deliciously, and live deliciously!
PS: we notice a one-star review on Amazon expressed disappointment upon discovering that this is not a recipe book. So please be aware, the only recipe in this book is the recipe for a fulfilling and vibrant life 😎
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Beyond Supplements: The Real Immune-Boosters!
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The Real Immune-Boosters
What comes to your mind when we say “immune support”? Vitamin C and maybe zinc? Those have their place, but there are things we can do that are a lot more important!
It’s just, these things are not talked about as much, because stores can’t sell them to you
Sleep
One of the biggest difference-makers. Get good sleep! Getting at least 7 hours decent sleep (not lying in bed, not counting interruptions to sleep as part of the sleep duration) can improve your immune system by three or four times.
Put another way, people are 3–4 times more likely to get sick if they get less sleep than that on average.
Check it out: Behaviorally Assessed Sleep and Susceptibility to the Common Cold
Eat an anti-inflammatory diet
In short, for most of us this means lots of whole plant foods (lots of fiber), and limited sugar, flour, alcohol.
For more details, you can see our main feature on this: Keep Inflammation At Bay!
You may wonder why eating to reduce inflammation (inflammation is a form of immune response) will help improve immune response. Put it this way:
If your town’s fire service is called out eleventy-two times per day to deal with things that are not, in fact, fires, then when there is a fire, they will be already exhausted, and will not do their job so well.
Look after your gut microbiota
Additionally, healthy gut microbiota (fostered by the same diet we just described) help keep your body pathogen-free, by avoiding “leaky gut syndrome” that occurs when, for example, C. albicans (you do not want this in your gut, and it thrives on the things we just told you to avoid) puts its roots through your intestinal walls, making holes in them. And through those holes? You definitely do not want bacteria from your intestines going into the rest of your body.
See also: Gut Health 101
Actually get that moderate exercise
There’s definitely a sweet-spot here, because too much exercise will also exhaust you and deplete your body’s resources. However, the famous “150 minutes per week” (so, a little over 20 minutes per day, or 25 minutes per day with one day off) will make a big difference.
See: Exercise and the Regulation of Immune Functions
Manage your stress levels (good and bad!)
This one swings both ways:
- Acute stress (like a cold shower) is good for immune response. Think of it like a fire drill for your body.
- Chronic stress (“the general everything” persistently stressful in life) is bad for immune response. This is the fire drill that never ends. Your body’s going to know what to do really well, but it’s going to be exhausted already by the time an actual threat hits.
Read more: Effects of Stress on Immune Function: the Good, the Bad, and the Beautiful
Supplement, yes.
These are far less critical than the above things, but are also helpful. Good things to take include:
Enjoy, and stay well!
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What Harm Can One Sleepless Night Do?
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We’ll not bury the lede: a study found that just one night of 24-hour sleep deprivation can alter immune cell profiles in young, lean, healthy people to resemble those of people with obesity and chronic inflammation.
Chronic inflammation, in turn, causes very many other chronic diseases, and worsens most of the ones it doesn’t outright cause.
The reason this happens is because in principle, inflammation is supposed to be good for us—it’s our body’s defenses coming to the rescue. However, if we imagine our immune cells as firefighters, then compare:
- A team of firefighters who are in great shape and ready to deploy at a moment’s notice, are mostly allowed to rest, sometimes get training, and get called out to a fire from time time, just enough to keep them on their toes. Today, something in your house caught fire, and they showed up in 5 minutes and put it out safely.
- A team of firefighters who have been pulling 24-hour shifts every day for the past 20 years, getting called out constantly for lost cats, burned toast, wrong numbers, the neighbor’s music, a broken fridge, and even the occasional fire. Today, your printer got jammed so they broke down your door and also your windows just for good measure, and blasted your general desk area with a fire hose, which did not resolve the problem but now your computer itself is broken.
Which team would you rather have?
The former team is a healthy immune system; the latter is the immune system of someone with chronic inflammation.
But if it’s one night, it’s not chronic, right?
Contingently true. However, the problem is that because the immune profile was made to be like the bad team we described (imagine that chaos in your house, now remember that for this metaphor, it’s your body that that’s happening to), the immediate strong negative health impact will already have knock-on effects, which in turn make it more likely that you’ll struggle to get your sleep back on track quickly.
For example, the next night you may oversleep “to compensate”, but then the following day your sleep schedule is now slid back considerably; one thing leads to another, and a month later you’re thinking “I really must sort my sleep out”.
See also: How Regularity Of Sleep Can Be Even More Important Than Duration ← A recent, large (n=72,269) 8-year prospective* observational study of adults aged 40-79 found a strong association between irregular sleep and major cardiovascular events, to such an extent that it was worse than undersleeping.
*this means they started the study at a given point, and measured what happened for the next eight years—as opposed to a retrospective study, which would look at what had happened during the previous 8 years.
What about sleep fragmentation?
In other words: getting sleep, but heavily disrupted sleep.
The answer is: basically the same deal as with missed sleep.
Specifically, elevated proinflammatory cytokines (in this context, that’s bad) and an increase in nonclassical monocytes—as are typically seen in people with obesity and chronic inflammation.
Remember: these were young, lean, healthy participants going into the study, who signed up for a controlled sleep deprivation experiment.
This is important, because the unhealthy inflammatory profile means that people with such are a lot more likely to develop diabetes, heart disease, Alzheimer’s, and many more things besides. And, famously, most people in the industrialized world are not sleeping that well.
Even amongst 10almonds readers, a health-conscious demographic by nature, 62% of 10almonds readers do not regularly get the prescribed 7–9 hours sleep (i.e. they get under 7 hours).
You can see the data on this one, here: Why You Probably Need More Sleep ← yes, including if you are in the older age range; we bust that myth in the article too!*
*Unless you have a (rare!) mutated ADRB1 gene, which reduces that. But we also cover that in the article, and how to know whether you have it.
With regard to “most people in the industrialized world are not sleeping that well”, this means that most people in the industrialized world are subject to an unseen epidemic of sleep-deprivation-induced inflammation that is creating vulnerability to many other diseases. In short, the lifestyle of the industrialized world (especially: having to work certain hours) is making most of the working population sick.
Dr. Fatema Al-Rashed, lead researcher, concluded:
❝In the long term, we aim for this research to drive policies and strategies that recognize the critical role of sleep in public health.
We envision workplace reforms and educational campaigns promoting better sleep practices, particularly for populations at risk of sleep disruption due to technological and occupational demands.
Ultimately, this could help mitigate the burden of inflammatory diseases like obesity, diabetes, and cardiovascular diseases.❞
You can read the paper in full here: Impact of sleep deprivation on monocyte subclasses and function
What can we do about it?
With regard to sleep, we’ve written so much about this, but here are three key articles that contain a lot of valuable information:
- Get Better Sleep: Beyond The Basics
- Calculate (And Enjoy) The Perfect Night’s Sleep
- Safe Effective Sleep Aids For Seniors
…and with regard to inflammation, a good concise overview of how to dial it down is:
How To Prevent Or Reduce Inflammation
Take care!
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7 Essential Devices For Hand Arthritis: Regain Control of Your Life
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Dr. Diana Girnita is a double board-certified physician in rheumatology and internal medicine. With a PhD in immunology (on top of her MD), and training at Harvard and top universities, she founded Rheumatologist OnCall, offering integrative medicine to broaden rheumatology access. Here’s what she has to say about things that make life easier:
Get your hands on these…
The seven devices that Dr. Girnita recommends are:
- Hand grip strengthener: helps build grip strength with a spring-loaded mechanism. Regular use can improve strength and reduce pain.
- Finger exerciser: different device; similar principle: it strengthens hand and finger muscles using resistance, enhancing hand function.
- Moisturizing paraffin bath: a heated paraffin wax bath that soothes hands, providing heat therapy and moisturizing the skin.
- Weighted silverware: weighted utensils (knives, forks, spoons) make gripping easier and provide stability for eating.
- Foam tubing grips: foam covers to make kitchen tools, toothbrushes, and hairbrushes easier to grip.
- Electric can-opener: reduces strain in opening cans, making meal preparation more accessible.
- Compression gloves: provide gentle compression to reduce swelling and pain, improving hand flexibility and circulation.
- Door knob cover grips: make it easier to turn doorknobs by providing a larger surface to grip.
- Wider-grip pens: ergonomically designed pens with a larger diameter and softer grip reduce hand strain while writing.
This writer, who does not have arthritis but also does not have anything like the grip strength she used to, also recommends a jar opener like this one.
As a bonus, if you spend a lot of time writing at a computer, an ergonomic split keyboard like this one goes a long way to avoiding carpal tunnel syndrome, and logically must be better for arthritis than a regular keyboard; another excellent thing to have (that again this writer uses and swears by) is an ergonomic vertical mouse like this one (aligns the wrist bones correctly; the “normal” horizontal version is woeful for the carpal bones). These things are both also excellent to help avoid worsening peripheral neuropathy (something that troubles this writer’s wrists if she’s not careful, due to old injuries there).
For more on the seven things otherwise listed above, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
- Avoiding/Managing Rheumatoid Arthritis
- Avoiding/Managing Osteoarthritis
- Managing Chronic Pain (Realistically!)
Take care!
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Dr. Greger’s Anti-Aging Eight
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Dr. Greger’s Anti-Aging Eight
This is Dr. Michael Greger. We’ve featured him before: Brain Food? The Eyes Have It!
This time, we’re working from his latest book, the excellent “How Not To Age”, which we reviewed all so recently. It is very information-dense, but we’re going to be focussing on one part, his “anti-aging eight”, that is to say, eight interventions he rates the most highly to slow aging in general (other parts of the book pertained to slowing eleven specific pathways of aging, or preserving specific bodily functions against aging, for example).
Without further ado, his “anti-aging eight” are…
- Nuts
- Greens
- Berries
- Xenohormesis & microRNA manipulation
- Prebiotics & postbiotics
- Caloric restriction / IF
- Protein restriction
- NAD+
As you may have noticed, some of these are things might appear already on your grocery shopping list; others don’t seem so “household”. Let’s break them down:
Nuts, greens, berries
These are amongst the most nutrient-dense and phytochemical-useful parts of the diet that Dr. Greger advocates for in his already-famous “Dr. Greger’s Daily Dozen”.
For brevity, we’ll not go into the science of these here, but will advise you: eat a daily portion of nuts, a daily portion of berries, and a couple of daily portions of greens.
Xenohormesis & microRNA manipulation
You might, actually, have these on your grocery shopping list too!
Hormesis, you may recall from previous editions of 10almonds, is about engaging in a small amount of eustress to trigger the body’s self-strengthening response, for example:
Xenohormesis is about getting similar benefits, second-hand.
For example, plants that have been grown to “organic” standards (i.e. without artificial pesticides, herbicides, fertilizers) have had to adapt to their relatively harsher environment by upping their levels of protective polyphenols and other phytochemicals that, as it turns out, are as beneficial to us as they are to the plants:
Hormetic Effects of Phytochemicals on Health and Longevity
Additionally, the flip side of xenohormesis is that some plant compounds can themselves act as a source of hormetic stress that end up bolstering us. For example:
In essence, it’s not just that it has anti-oxidant effect; it also provides a tiny oxidative-stress immunization against serious sources of oxidative stress—and thus, aging.
MicroRNA manipulation is, alas, too complex to truly summarize an entire chapter in a line or two, but it has to do with genetic information from the food that we eat having a beneficial or deleterious effect to our own health:
Diet-derived microRNAs: unicorn or silver bullet?
A couple of quick takeaways (out of very many) from Dr. Greger’s chapter on this is to spring for the better quality olive oil, and skip the cow’s milk:
- Impact of Phenol-Enriched Virgin Olive Oils on the Postprandial Levels of Circulating microRNAs Related to Cardiovascular Disease
- MicroRNA exosomes of pasteurized milk: potential pathogens of Western diseases
Prebiotics & Postbiotics
We’re short on space, so we’ll link you to a previous article, and tell you that it’s important against aging too:
Making Friends With Your Gut (You Can Thank Us Later)
An example of how one of Dr. Greger’s most-recommended postbiotics helps against aging, by the way:
- The mitophagy activator urolithin A is safe and induces a molecular signature of improved mitochondrial and cellular health in humans
- Urolithin A improves muscle strength, exercise performance, and biomarkers of mitochondrial health in a randomized trial in middle-aged adults
(Urolithin can be found in many plants, and especially those containing tannins)
See also: How to Make Urolithin Postbiotics from Tannins
Caloric restriction / Intermittent fasting
This is about lowering metabolic load and promoting cellular apoptosis (programmed cell death; sounds bad; is good) and autophagy (self-consumption; again, sounds bad; is good).
For example, he cites the intermittent fasters’ 46% lower risk of dying in the subsequent years of follow-up in this longitudinal study:
For brevity we’ll link to our previous IF article, but we’ll revisit caloric restriction in a main feature on of these days:
Fasting Without Crashing? We sort the science from the hype!
Dr. Greger favours caloric restriction over intermittent fasting, arguing that it is easier to adhere to and harder to get wrong if one has some confounding factor (e.g. diabetes, or a medication that requires food at certain times, etc). If adhered to healthily, the benefits appear to be comparable for each, though.
Protein restriction
In contrast to our recent main feature Protein vs Sarcopenia, in which that week’s featured expert argued for high protein consumption levels, protein restriction can, on the other hand, have anti-aging effects. A reminder that our body is a complex organism, and sometimes what’s good for one thing is bad for another!
Dr. Greger offers protein restriction as a way to get many of the benefits of caloric restriction, without caloric restriction. He further notes that caloric restriction without protein restriction doesn’t decrease IGF-1 levels (a marker of aging).
However, for FGF21 levels (these are good and we want them higher to stay younger), what matters more than lowering proteins in general is lowering levels of the amino acid methionine—found mostly in animal products, not plants—so the source of the protein matters:
For example, legumes deliver only 5–10% of the methionine that meat does, for the same amount of protein, so that’s a factor to bear in mind.
NAD+
This is about nicotinamide adenine dinucleotide, or NAD+ to its friends.
NAD+ levels decline with age, and that decline is a causal factor in aging, and boosting the levels can slow aging:
Therapeutic Potential of NAD-Boosting Molecules: The In Vivo Evidence
Can we get NAD+ from food? We can, but not in useful quantities or with sufficient bioavailability.
Supplements, then? Dr. Greger finds the evidence for their usefulness lacking, in interventional trials.
How to boost NAD+, then? Dr. Greger prescribes…
Exercise! It boosts levels by 127% (i.e., it more than doubles the levels), based on a modest three-week exercise bike regimen:
Skeletal muscle NAMPT is induced by exercise in humans
Another study on resistance training found the same 127% boost:
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Beat Food Addictions!
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When It’s More Than “Just” Cravings
This is Dr. Nicole Avena. She’s a research neuroscientist who also teaches at Mount Sinai School of Medicine, as well as at Princeton. She’s done a lot of groundbreaking research in the field of nutrition, diet, and addition, with a special focus on women’s health and sugar intake specifically.
What does she want us to know?
Firstly, that food addictions are real addictions.
We know it can sound silly, like the famous line from Mad Max:
❝Do not, my friends, become addicted to water. It will take hold of you and you will resent its absence!❞
As an aside, it is actually possible to become addicted to water; if one drinks it excessively (we are talking gallons every day) it does change the structure of the brain (no surprise; the brain is not supposed to have that much water!) causing structural damage that then results in dependency, and headaches upon withdrawal. It’s called psychogenic polydipsia:
But back onto today’s more specific topic, and by a different mechanism of addiction…
Food addictions are dopaminergic addictions (as is cocaine)
If you are addicted to a certain food (often sugar, but other refined carbs such as potato products, and also especially refined flour products, are also potential addictive substances), then when you think about the food in question, your brain lights up with more dopamine than it should, and you are strongly motivated to seek and consume the substance in question.
Remember, dopamine functions by expectation, not by result. So until your brain’s dopamine-gremlin is sated, it will keep flooding you with motivational dopamine; that’s why the first bite tastes best, then you wolf down the rest before your brain can change its mind, and afterwards you may be left thinking/feeling “was that worth it?”.
Much like with other addictions (especially alcohol), shame and regret often feature strongly afterwards, even accompanied by notions of “never again”.
But, binge-eating is as difficult to escape as binge-drinking.
You can break free, but you will probably have to take it seriously
Dr. Avena recommends treating a food addiction like any other addiction, which means:
- Know why you want to quit (make a list of the reasons, and this will help you stay on track later!)
- Make a conscious decision to genuinely quit
- Learn about the nature of the specific addiction (know thy enemy!)
- Choose a strategy (e.g. wean off vs cold turkey, and decide what replacements, if any, you will use)
- Get support (especially from those around you, and/but the support of others facing, or who have successfully faced, the same challenge is very helpful too)
- Keep track of your success (build and maintain a streak!)
- Lean into how you will better enjoy life without addiction to the substance (it never really made you happy anyway, so enjoy your newfound freedom and good health!)
Want more from Dr. Avena?
You can check out her column at Psychology Today here:
Psychology Today | Food Junkie ← it has a lot of posts about sugar addiction in particular, and gives a lot of information and practical advice
You can also read her book, which could be a great help if you are thinking of quitting a sugar addiction:
Sugarless: A 7-Step Plan to Uncover Hidden Sugars, Curb Your Cravings, and Conquer Your Addiction
Enjoy!
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