Rewiring Recovery: ADHD, Neurodivergence, and Healing Your Relationship with Food

Article written by our guest, Nikki DeRosa

 https://www.todaysdietitian.com/flexible-meal-planning-for-autism-and-adhd/ 

Most “healthy eating” advice is built for brains with steady energy, easy task initiation, and predictable appetite cues. If you live with ADHD, autism, or other forms of neurodivergence, that gap can turn food into a daily stressor and it can make eating disorder recovery even harder. We’re joined by registered dietitian Nikki DeRosa to unpack what neurodivergent-affirming nutrition actually looks like when you stop forcing one-size-fits-all rules and start designing support around real barriers.

We talk through the tricky clinical question: how do you tell the neurodivergent brain from the eating disorder brain without invalidating someone or letting the disorder “drive the bus”? Nikki shares how she looks for patterns over time, why she builds rapport before challenging, and how sensory needs, executive functioning, and interoceptive awareness can shape eating. You’ll also hear why shame is a short-lived motivator, how immediate benefits beat distant health promises, and why “convincing yourself” works better than bullying yourself.

Then we get practical with neurodivergent meal planning: lowering the number of steps, cutting decision fatigue, keeping six backup meals on hand, and even rolling a dice when your brain locks up. Nikki breaks down her simple framework for satisfaction and fullness: fat, fiber, protein, and a wow factor. We also connect spoon theory to food prep and explain why low-spoon dinners need low-spoon options.

If you find this helpful, subscribe, leave a rating and review, and share the episode with someone who needs neurodivergent-friendly nutrition support. What strategy are you going to try first?

Show notes:

Trigger warning: this show is not medical, nutrition, or mental health treatment and is not a replacement for meeting with a Registered Dietitian, Licensed Mental Health Provider, or any other medical provider. You can find resources for how to find a provider, as well as crisis resources, in the show notes. Listener discretion is advised.

Resource links:

Alliance for Eating Disorders: https://www.allianceforeatingdisorders.com/ 

ANAD: https://anad.org/

NEDA: https://www.nationaleatingdisorders.org/

NAMI: https://nami.org/home

Action Alliance: https://theactionalliance.org/

NIH: https://www.nimh.nih.gov/

How to find a provider: 

https://map.nationaleatingdisorders.org/

https://www.psychologytoday.com/us

https://www.healthprofs.com/us/nutritionists-dietitians?tr=Hdr_Brand

Suicide & crisis awareness hotline: call 988 (available 24/7)

Eating Disorder hotline: call or text 800-931-2237 (Phone line is available Monday-Thursday 11 am-9 pm ET and Friday 11 am-5 pm ET; text line is available Monday-Thursday 3-6 pm ET and Friday 1-5 pm ET)

If you are experiencing a psychiatric or medical emergency, please call 911 or go to your nearest emergency room.

Transcript

Mission, Trigger Warning, Sponsor

SPEAKER_01 0:00

Join us as we redefine, reclaim, and restore the true meaning of health.

SPEAKER_04 0:04

Let's dive into the tough conversations about mental health, nutrition, eating disorders, diet culture, and body image. This is Nourish and Empower. This episode is brought to you by Hilltop Behavioral Health, specializing in eating disorder treatment. Hilltop offers integrated therapy and nutrition care in one compassionate setting.

Introducing Nikki DeRosa

SPEAKER_01 0:38

Visit www.hilltopbehavioralhealth.com because healing happens here. Hi, everybody. Welcome to this week's episode of the Nourish and Empower Podcast. Today we have with us Nikki DeRosa. She's a registered dietitian with a BS in Psychology and Nutrition from Virginia Tech and an MS in nutrition from Bowling Green State University. She specializes in eating disorders, ADHD, and autism, creating individualized, compassionate nutrition plans that honor each client's needs. With a focus on intuitive eating, body positivity, and practical strategies, Nikki helps clients build a healthier relationship with food and their bodies while staying informed on the latest nutrition research. Trigger warning: we are identifying the following triggers that will be discussed but are not limited to eating disorders, ADHD, and autism. Listener discretion is advised. This show is not medical, nutrition, or mental health treatment and is not a replacement for meeting with the registered dietitian, licensed mental health provider, or any other medical provider. You can find resources for how to find a provider as well as crisis resources in the show notes. And I just want to add too, Nikki is also a published author on today's dietitian with an article entitled Flexible Meal Planning for Autism and ADHD, Supporting Neurodiverse Clients. So hi, welcome. Glad to be here. Thank you for having me.

SPEAKER_04 2:07

Yeah. Thanks for wanting to come on. It's a little jarring for some people. And you know, I have a lot of friends that I'm like, you need to come on. They're like, no, I'm okay. So thanks for giving us your all today.

SPEAKER_00 2:19

Anytime. I feel like I'm so used to it with teaching. Like it's just like teaching. You're just having a conversation. Yeah, that's a good thought about it.

Why Neurodivergence Shows Up In EDs

SPEAKER_01 2:27

I like it. Yeah. Well, thank you. This is so fun to get to see you and get to talk to you more. And I a few weeks ago, months ago, I don't remember when it was. I sent Jess your article. And we were both like, this is amazing. We need to have her on. So we are so lucky to get to pick your brain today. Yes. Yeah. Yeah. Awesome. So just to kind of start, you know, tell us a little bit of maybe like the background, right? Like why supporting neurodiverse clients, why that is such a big interest and specialty of yours.

unknown 3:02

Yeah.

SPEAKER_00 3:03

So I started with eating disorders, and that's why I have my bachelor's in psych as well, because I always knew I wanted to do eating disorders, mental health aspect. And in working with it and all of these patients, I noticed a pattern that like a high number of these individuals were neurodivergent. And I would argue that the like lasting eating disorders, the ones that are hard to meet recovery, I would even argue that that percentage of neurodivergent is even higher. And I firmly believe that in some cases, not all, the reason they have a hard time finding recovery is because the treatment and the care that they are getting was not neurodivergent focused. Then I found out my son had ADHD, which put me down a rabbit hole. And then I found out I had ADHD, which added additional rabbit holes. So it just kind of naturally progressed into specializing in this population, helping myself, my family, my friends, and my patients.

SPEAKER_01 4:11

So yeah, that's thank you for sharing that. That's great to hear too. Like that you have a personal connection to it as well as, yeah, I mean, it's so common in eating disorder treatment that we typically see some current co-occurring diagnoses. So it makes sense, like professionally, you probably have worked with a lot of people, but then also to have like a personal tie to it as well. Yeah.

unknown 4:32

Yeah.

SPEAKER_00 4:33

It's always interesting because I feel like a lot of dietitians in the ED world, obviously not all, but a lot of them had their own issues with, I'm not gonna say a full-blown eating disorder or disordered eating. And that was never the case for me. Never had those issues. I was always an intuitive eater. So I always found it interesting that I gravitated towards this, but I feel like it makes sense now, knowing the neurodivergent link in that aspect, what kind of brought me to this area of nutrition.

SPEAKER_04 5:04

I was gonna ask you, because I feel like at such a young age, right? Of like that 17, 18, 19, going into college, knowing you wanted to do eating disorders, I feel like that's so specific. Like I knew I always wanted to be a therapist, but like what brought you at such a young age to know like eating disorders was the path you wanted to go down?

SPEAKER_00 5:24

I was debating between therapy and nutrition for a really long time. So I think it felt like kind of like the meeting point for both. And I would argue that that is very true. Um dietitians in the eating disorder world have to have more of that psychology background and understanding of it. So it just kind of naturally worked in that range. So it is very specific. And if I can't even like think of the moment where I was like, this is what I want to do, like yeah, it's just always what the plan was, and I don't remember necessarily how the plan was made.

SPEAKER_04 6:06

I love that though.

SPEAKER_00 6:10

I love psychology and that is a big part of it. Yeah.

SPEAKER_01 6:17

How do you feel like you include in elements of psychology when working with neurodivergent clients?

SPEAKER_00 6:26

I feel like at this point, and obviously I have to stay within my lane and I'm always within my scope, but I feel like half the time my job is more of like a neurodivergent coach, like an ADHD coach, right? Where even if we're talking about food stuff, a lot of what we're talking about can be applied in other areas of their life. So it'll come into those discussions. But it's a lot of talking about executive functioning and sensory issues and just being understanding of what their barriers are and being able to address them.

SPEAKER_02 7:06

How do I want to ask this question?

Executive Functioning Meets Food

SPEAKER_04 7:10

Because I feel like with like we know with eating disorder recovery, right? Everything is so individualized. How does the level of individuality when you have eating disorders and then also ADHD or autism, like what does that typically look like? And does it bring in a what does that extra layer kind of do to the treatment process? Have you seen?

SPEAKER_00 7:32

It is even more individualized. So in the eating disorder world, the issues, like some of the specific ones, is like they won't allow distractions at meals, right? So even though they're individualized, they still have some like overarching policies at times, especially in higher levels of care. Obviously, more in outpatient, it becomes more flexible. But in like higher levels of care, they'll have specific rules that I feel like don't reflect the life of a neurodivergent individual. Like the no distractions. They have like the no weird food combinations, which I understand. Like I understand why the rules exist, but when it comes to neurodivergent people, I feel like they just don't always work the way they intend them to, right? Like they will also like really push for condiments and flavor. And some neurodivergent people just really want bland food. They'll also say things like no food rules. And I agree with that. However, a lot of neurodivergent people can't make decisions if they don't have guideposts to help them make those decisions. Right. So there has to be rules, but they have to be framed in a flexible manner, right? So it's not saying you can't have this, but like a rule for me is you could only divide one meal into two snacks, right? So in ED treatment, they talk a lot about how like three meals per day is like the bare minimum and what everybody has to be doing. I don't think that works a lot for neurodivergent people in the outpatient world. In higher levels of care, yes. But in the outpatient world, it doesn't always work. So they'll end up grazing throughout the day, which we know can be just as problematic in many ways. So I'll give them the rule of you can split one meal into two snacks. So my bare minimum is either three meals or two meals and two snacks, which gives them a rule while maintaining that flexibility and allowing them to adjust day to day. Does that make sense?

SPEAKER_04 9:50

Yes, I have so many questions. Oh my God, I'm so excited we're having this conversation. Okay, because how do you know the difference between the neurodivergent brain and the eating disorder brain? Because everything you said, I was like, oh my God, that makes so much sense. And then I was like, the manipulation that can happen for someone to be like, oh my god, no, it's my neurodivergence, and it's like, Miss ma'am, sir, no, it's not. You're trying to one up me and like do a little dance. So how I just can't imagine. Okay, oh my god, okay, okay, take it in, Jessica. Like, how do you know the difference? And how on it do you have to be as the clinician? Like, uh you can't have any distractions. Like, I'm bomb brain that can't exist in the room, like, absolutely not. Like, how I'm gonna take a sin. Please explain.

When ED Rules Do Not Fit

SPEAKER_00 10:40

So, Maggie will probably understand this a little bit more, but you know, Maggie, how some people will come into ED treatment and they'll say, I'm a vegetarian, right? And they say, I'm a vegetarian because of ethical concerns. But you know, like from talking to them, you know, is this actually ethical or are they using this as an eating disorder? Right. And usually in the beginning, you're not just gonna say, you can't be vegetarian anymore, right? You're gonna start challenging those thoughts, asking questions and doing that. And I feel like it's much the same way with this, right? Is asking those questions, challenging those, and then also paying attention for patterns, right? So if they say, I don't like this texture and that's why I can't have that, but then they're eating something else that's a similar texture. I'll call them on that. I might not say, You said you'll eat this, why won't you eat this? But I'll say, Well, what's the difference between this and this? And kind of back them into a corner to like say it themselves in a way. But it's a lot like that, where yes, there is often where it might be them using that, but you have to challenge that slowly. So I will always in the beginning be like, okay, I'm not gonna argue it in the beginning because we need to build rapport. We need to build that trust. And then once that is built, I will slowly start like checking on those things. And I might purposely recommend something similar to see what their thoughts are on that and then see how they respond to that and then bring it back. So I would say it's just a lot more on the provider. You have to be keeping that in mind a lot, but I also will never find it in the beginning ever. And I won't challenge it in the beginning ever. I'm just going to, in the very beginning, say, okay, like that's what you feel, like that's what it is. And then I will slowly build on that later.

SPEAKER_04 12:50

Takes a lot of effort. Yeah. Like we as providers really do feel the mental gymnastics, but just like a different form of it that our clients do. Because they're doing mental gymnastics to stay in their disorder, but we're doing mental gymnastics to understand their disorder and to challenge it. And I don't think people realize how much mental we my entire job is tricking their brains, I swear.

SPEAKER_00 13:16

For like my neurodivergent people who don't have an eating disorder, where like the issues are really just the neurodivergence, the executive functioning, PDA, those aspects are like the primary issue. It is literally like tricking their brain. Like, yeah, I will talk about well, okay, so what benefits do you get? Because they'll hear I have to eat fruits and vegetables, right? And because they have hear that, they just think of it as a chore, something they have to do. And I will have to go in and think, okay, let's identify what improvements you have when you eat fruits and vegetables. So that way they can better argue it in the moment, right? Instead of just saying, I have to eat fruits and vegetables, they can say, all right, if I eat my fruits and vegetables, I'm gonna be fuller longer. I'm gonna go to the bathroom more regular. I'm, you know, and kind of go through all of those things to actually understand why and convince themselves. But so much is tricking the brain. So much of it with neurodivergence is how to trick the brain. There's the psychology, right? Yes, a lot of values-based, right? Um, and really looking in at what they prioritize day to day because a lot of things with nutrition, I feel like is focused more on in the future, right? Like you're going to have less of a chance of GI cancer. You're going to have less bone loss when you're older. Like all of it is kind of in the future. And with neurodivergent people, they can't use that as motivation. Like that's not motivating to them. So you have to actually look at like the day-to-day. So one that I always use is exercise for myself, right? Before even going into eating disorder, there was still a point where I had diet culture, right? So for a long time, exercise was weight loss. Then, you know, I moved into the that realm and exercise became health benefits. Neither of those things were motivating to me. But when I was able to say, okay, on the days I exercise, my anxiety is a lot lower, right? I sleep so much better those nights. Those things are an immediate benefit and therefore more motivating and able to convince, right? And for me, my health in the future, yes, that's a value. I'm a dietitian. Obviously, I value those things, but I value my anxiety levels and getting sleep so much more in the moment. So using that as an argument is going to better convince me to do the thing, right? So it's identifying what is important to them and then using that. Like I always say I'm really good at manipulating people, but I use my powers for good, right? Like I could be evil and mean, but I instead use my manipulation to look at what motivates people and then change their thought process to work with it to help them make better decisions. Does that make sense?

SPEAKER_04 16:17

Oh, absolutely. And where do I sign up? Thank you so much. Number one. Number two, I say that similar, I say that to clients all the time, like especially my really stubborn ones. I'm like, you could be so good at recovery if you used your stubbornness and your like the pride that you have to say, screw all of this, I'm going to recover. Like you like, it is your superpower. Let's use it for good. It takes some people a little bit of time to get there, but like I say that all the time. Like, you have your strengths and they can be used for good if you allow yourself to see them as good. I also love the reframe, right? Like psychology. I love the reframe that you have on values, right? Because or like, what are you getting out of it? Because I even have clients that are like, well, it doesn't give me anything. And I'm like, but it does, right? Even if we're talking about the maladaptive of what the eating disorder gives you, right? Like there's always something you're receiving. Everything exists for a reason. Exactly, right? Like if we didn't feel, you know, numb or better in like air quotes or whatever have you, you wouldn't be engaging in your eating disorder. Therefore, you wouldn't have an entire treatment team and we wouldn't have to go through this, you know, treatment if it wasn't providing you something, because then you wouldn't do it, right? We're not all skipping, we're all walking because skipping is weird as like a typical way to move, or walking is typical, right? I don't know why that's the example that came to my head, but that's fine. But you know, and I just love the way that you reframed it because even when you brought in exercise and when you're thinking about the future, and I also have ADHD and I'm anxiety girly, but like I felt so called out and like in such a good way, but I was like, damn, you're like reading me to filth right about now. But like when you were like, you know, like you have to think about what actually works for you and where your values are, right? And when it comes to like finances, working out, whatever have you, you can't put me in the future. I'm gonna be like, okay, sick. Like I am a reactive, not a proactive individual. And I love that you were like, you have to find what it gives you and what matters to you in the day-to-day. And I think that just makes somebody feel and see and want to do so differently. It's like Maggie and I telling clients, it's bite by bite, it's meal by meal. It's not what are we doing for the week? It's like, what can we do in that moment? And I just love the way that you worded that and that you did that. Helped me. So thanks so much.

Neuro Traits Versus ED Avoidance

SPEAKER_00 18:45

So welcome. And the way I see it, right, is that when you have that, then you're able to convince yourself to do something versus bully yourself into it. Right. Because so often we're just like, why can't especially ADHD with like executive functioning, right? Because the big issue is like getting yourself started, right? Like the task initiation. And often you're sitting there and people are like, oh, they're just sitting there doing nothing. No, in their head, they're like, I need to get up, I need to do this, why can't you do this? You're so lazy. Other people can do this. Like, why can't you? You are literally bullying yourself. So I'll ask people, okay, if you wanted your partner to go somewhere with you that had to do with your interests, but not theirs, are you gonna say you're a bad boyfriend, partner, you're a bad person, horrible, I won't love you anymore if you don't go with me? No, most people are not gonna do that, right? They're actually going to convince them. I'm like, you deserve that just as much as they do. Like you need to convince yourself, right? If your partner came up to you and talked to you the way you talk to yourself, you would probably respond very poorly. And you are responding poorly in your head as well. Like you need to convince yourself. So having those values, understanding those benefits, and identifying them gives you the opportunity in the moment to actually convince yourself.

SPEAKER_05 20:16

So good.

unknown 20:17

Thank you.

SPEAKER_00 20:18

So good because it's true. This is how I ended up getting into a whole TikTok comment section thing with the Gillian Michaels talking about shame as motivation. I did so good. I scrolled past like 10 TikToks and didn't comment. And then there was one about shame and motivation, and I was like, I can't. And then I got into a whole war with people in the comment section. But I got somebody in a TikTok comment section to be like, okay, I see your point. I think you're right. Love.

SPEAKER_04 20:52

I deserve an award. You good for you. Like, how did I do that? That's not easy. That is not easy.

SPEAKER_00 21:00

But I got them to admit it. Because shame just doesn't work. And you know, if we are focusing on that shame, it's gonna wear off, right? And that's kind of the idea of like weight loss with the exercise, right? It takes time, effort, and a lot of work for your health to change and your weight to change. Nothing happens quickly in the body. And if it is happening quickly, it's bad. Like I tell clients all the time, nothing is supposed to happen fast. If it is happening fast, there is a problem. Like nothing happens fast unless it's a problem, right? And because of that, the shame is gonna wear off before the benefits occur, which is just going to end up being in that binge restrict cycle, right? Where you're restricting because you feel the shame, then nothing happens. So you get frustrated, you're not losing weight, the benefits didn't happen. So you say, screw this, you do it again until the shame comes back, and it just puts you into that. That binge restrict cycle in so many ways. So it's about really focusing on how do I convince myself? Like, what are the benefits? How am I going to do that? And pay attention to those things, right? Because a lot of the time, especially with ADHD, they experience a lot of object permits, right? And in babies, we see like, oh, here's the bear, bear's gone, it doesn't exist. But in adults, we experience it must much differently. For example, if somebody says, if I go to a doctor's office and they're like, Have you been feeling? Oh no. I can only tell them how I feel right now. However, I'm feeling is how I've always felt and it's how I'm always going to feel. Right. That is that object permanence is that what you are experiencing is always it, right? So then you have a hard time being like, oh, my pain level for that was this, because you don't know you're not in it. It doesn't exist anymore. Right? That permanence is gone. So that plays a huge role in a lot of these aspects because they're not going to be able to feel that motivation. They can't see that because that doesn't exist.

SPEAKER_01 23:13

Do you see my eyes?

SPEAKER_04 23:17

I'm like, well, it's also like I'm having I'm having like such a moment. Oh God. Because you're not only blowing my mind and you're teaching me like clinically, but you're also explaining a lot of what I experienced that I never realized I experienced.

SPEAKER_00 23:39

Yeah. It's hard. ADHD is hard. Like I like to remind people, like I have to all the time be like, you are disabled. Like ADHD is a disability. And a lot of my clients are a hundred percent like, no, I'm not. I'm not. You can't compare that. And I'm like, listen, my sister has one leg, right? She is disabled because she has one leg, right? And I respect the fact that she needs a wheelchair and all of those things, but it doesn't change the fact that I am still disabled because I have ADHD. Right? Like you are still disabled. And people be like, Well, I don't feel it. I'm like, yeah, you don't feel it until it's disabling you. And then you're all shocked that you're disabled. Like, yeah, it disables you. It's not going to be disabling all the time. My sister with one leg was the the athlete of the family, right? Like she was the basketball star, volleyball. She did every sport, right? Made me and my other sister with two legs look real bad. She made us look horrible with how athletic she was, right? But she was still disabled. She was an athlete. Like she, if she had two legs, would have had a college, like scholarship. That's how good she was. But she was still disabled, right? We can be all of these things, but it is still disabling. Yeah.

SPEAKER_04 25:03

I didn't realize this is gonna be a therapy session, Maggie. She's gonna need it to give me a heads up here.

unknown 25:09

Sorry.

SPEAKER_04 25:11

No, I'm always here for it. Let me tell you. I mean, it's not easy being on like the client side of the chair. I always say that to my clients. I'm like, I'd rather be in my seat than your seat. But like, wow.

SPEAKER_00 25:24

I have learned so much about myself from my clients.

SPEAKER_04 25:28

Like so much about that is something nobody talks about is the parallel processing that occurs between a clinician and their client and things that happen between them when we're helping clients. Because, like, agreed, the amount of times that I've either felt seen or I've been like, you get me, but like internally, and like the amount of times you see, like you feel healed during their healing journey because you go through something so similarly, like that's such a non-spoken connection.

Motivation Without Shame

SPEAKER_00 26:03

Because people always want to make it seem like if you're doing that or benefiting from the sessions, then it's like, what's that word? Like transference or counter-transference. Thank you. Yeah, that it's like that. And I don't think that's the case, right? Like you can still grow from it, and it can even be something as silly as I remember. I always said that I don't get thirst cues, right? I don't feel thirsty. And then in a session one day, like me and a client are just talking about thirst, and like we mutually realized in session that your mouth feeling weird is a thirst cue. And we had no idea that that was a thirst cue. So like we were responding by like chewing gum or like you know, doing doing something to like get that weird feeling out of your mouth. And the whole time that is a thirst cue that we just didn't even know existed. Like, just mind, I I will never forget that. Because I just remember being like, we literally just looked at each other for a few minutes, like, huh? Wow. We do experience thirst, we just didn't know what it was.

unknown 27:12

Like, wow.

Interoception And Intuitive Eating Tools

SPEAKER_00 27:15

And that's another issue, right, with neurodivergence is that lack of interoceptive awareness that struggled to identify the body. And a lot of the time, I feel like people who aren't specializing in neurodivergence, like this happened at a previous practice where somebody said neurodivergent people could not eat intuitively, that it was impossible. And that's not true, right? It's harder. Everything's harder when you're neurodivergent, right? But it's not impossible, right? One of the things I say is we lack that awareness because we live in here, right? I explain it as you know, those movies where there's like the big robot monster and like the villain is sitting in the head controlling the big robot monster. Yeah, that's what I feel like. Like I live up here. This is just like a weird extension. Like, this is where I am, right? And because of that, we get lost in our thoughts and in our brain, and then we are just not checking in with the body, right? So I'll tell them, okay, I want you to set random alarms throughout the day, just random. When they go off, you don't have to get up, you don't have to do anything. What I want you to do is close your eyes, start from the top of your head, go down to your toes and do a body scan. Right. Body scans. And I just teach them to identify it. They're not going to be able to just feel the body. They have to intentionally check in to identify those things. It is possible, it just takes that extra step that nobody teaches them. Right. But it's definitely possible. Some people are going to struggle no matter what. There are definitely still times where I forget that my mouth feeling weird is thirst cue, right? But it is possible it just takes a bit of a little bit more of intentional work to achieve it.

SPEAKER_04 29:12

And to understand it, right? Because even you talking about the body scan, like sometimes clients get in their head too of like, well, what's the body scan supposed to feel like? What am I supposed to feel here? Right. Like, so them even getting inside their heads of like, am I doing? And I feel like people with anxiety, you know, also do this, not just like ADHD of like, am I doing this right? What is it supposed to feel like? But if I feel this, is that what other people feel like, or is it supposed to feel like something? And then, like, oh, it's hard to do the body scan because then you're like, I don't even know what my body's supposed to feel like to do a body scan.

Training Clinicians To Individualize Care

SPEAKER_00 29:41

And it's very I've literally made a worksheet with one of my clients that I was like, I cannot help you with a worksheet identify exactly where you are on a zero to ten on the hunger phone skills. Like, that's not gonna happen. I'm like, but we could like identify what section you're in, right? Like, are you zero to three? Are you three to five? Are you five to seven? And we made like a questionnaire where like when you counted it up, it would give you what section you were in to help them kind of guide. And of course, when I'm doing that, I'm making sure that I'm like, this is not a Bible. This is not like this is a tool to help you. There are going to be times where you know exactly where you're at and you don't need any help. And that's okay. This is a tool. You use it when you need it, right? You don't always need it. I've made like one I had one client who has an eating disorder and has autism, and we made a flow chart about whether or not they should eat, where it's like yes or no questions and brings them to different areas where we have it where like if he on the the first question is like, where are you on the hunger scale? And if it's zero to three, I'm like, eat. That is the answer, right? And if you are here, it brings you to other questions. And it even does things like, oh, you're above a seven, but this is a food that you don't get a lot, right? Like, is this a food that you don't have access to on a regular basis? Yes or no. Is this like, are you eating because you're feeling emotional? Yes or no? And like kind of go through all of those. And then the answer is never not eat. That is never what my answer says on the flow chart. My answer is like, wait an hour and do it again. It's never don't eat. It's wait an hour, do it again. Or I even have one like do a coping skill, wait an hour and try again. Right. So no the answer is never don't eat. You have to be very specific when making these things because they can take that and run with it in some ways, right? So I have to be very intentional about how I'm creating it and building it to make sure that I'm thinking of what their brain will take it as and then apply it. Does that make sense?

SPEAKER_04 32:02

Yeah.

SPEAKER_00 32:02

That's why I say it's like tricking their brain. I have to think how does their brain work? How can I make this work within that?

SPEAKER_01 32:11

So I have like a two-part question for you based off that, because something I've always admired about you is like you truly embody individualized work with clients. And so part one is if a client feels like their dietitian is not individualizing their work, how might they be able to bring that up to them? And part two is if a clinician is listening to this and is feeling inspired of like, I need to be more individualized and I need to have more flexibility, especially with working with neurodivergent people. What would you recommend to them?

Asking Providers For Better Support

SPEAKER_00 32:48

Okay, I'm gonna start with clinicians first. So one thing I want to say is don't just go with your immediate reaction, right? When talking about like those the food combinations or things like that, like our first thought is, oh, that's disordered. No, right? We need to pause and we really need to dig in deeper with that and not make those assumptions. I had a client who was on tube feeding because of how severe her RFID was, where she just wasn't eating. And when we were reintroducing food for the first time in a year, I'll never forget where she had like applesauce and she was like, I didn't like the texture. And I was like, Oh, well, could we blend it? And she like cried because she's like, nobody has ever just been like, oh, that's an issue, let's address it, versus like they're like, that's not an issue, you need to get over it, kind of thing, right? It's like really listening to them and identifying those barriers and actually looking for strategies that will address what those barriers are for them. But it's very much just taking the client. We are experts, and I'm never gonna pretend I'm not the expert in nutrition in these sessions, but I'm not the expert in that client. They're the expert. And if they're telling me I can't tolerate this texture, who the heck am I to be like, yes, you can? No, that's on my body, right? Like we all have things we don't want to eat. And if we were told we have to eat it, like we're not gonna be happy. So it's really recognizing that autonomy, questioning what your gut instinct is and instead diving deeper with them. And remember that just because that the best choice is not always a choice, right? I always say it's not about picking the best choice, it's looking at what your available options are and picking the better one, right? We often really want to push for diversity of intake, and that is important, and I know that. But for clients who struggle with fruits and vegetables, if we could at least get one fruit or vegetable from every color family, that's enough diversity, right? But we'll push them to want more. And if they want that, I'm all for it. I'm gonna help them. But there are many times where they don't care, they don't want that, but we think they should have it. So we push that on them in some ways. Diversity is important, I know that. And I'm going to educate them and talk to them about it, but I'm also going to allow them to have the knowledge base to be able to make that decision. Like I'm going to give them the full background of it and let them make their own decisions, right? And if they think having one from each color family is enough, then that's enough diversity. We don't have to keep pushing them to do more. I think it's a lot about re-looking at what you have been defining it, thinking more about what they need, pay attention to those values and just be flexible where you can while also holding boundaries, right? And something I also think is important is active communication, right? So a lot of the times we're building up to good behaviors, right? Like this is a let's say level 10 toxic behavior, and we want to get them to zero, right? But I'll say, okay, this is still a little toxic, but it's less toxic, right? So we want to make sure I'm gonna still tell them this is still a little toxic, right? Because I think sometimes they'll be like, yeah, you could do that. And then later they're like, Well, you let me do it before. And you're like, Well, yeah, I did let you do it before, but that was before and this is now. And they're like, Well, why didn't you say anything? So I'm very clear in that. I'll say this is still toxic, but we fight toxicity with less toxicity and we grow on that, and that's okay. And then actually explaining things as well, right? Everyone knows we're supposed to eat fruits and vegetables, right? Everybody knows. But if we actually say these are the reasons why, this is what we get out of it, that can help them to make different decisions, right? Like I say, we eat fruits and vegetables for volume to be full, for hydration, because they have good water in them, for our micronutrients and for fiber, right? But we could get all four of those things from other foods too, right? And actually talking about that versus just being like, this is what you're supposed to do. Explain it, go deep dive. A lot of neurodivergent people do not like to just be told what to do. They want to know why. Yes, they want to know why. Like they want it to be explained to them. And unfortunately, I would say this is a biggest issue, not in dietitians necessarily, but in doctors, maybe, where they're the doctor, they went to med school, they know what's best. How dare you ask me to explain it to you? Like, just take my word for it, right? Kind of like that bad complex we see at times. And they we don't respond well to that at all. So it's about just really explaining things as well, like actually diving into the explanation of why you're making the recommendations you're making. And then they might then be able to be like, oh, I see why you want me to do this, but what if I did this instead? And they'll be able to identify what the actual benefit is and maybe look for alternatives that are actually alternatives, right? Instead of like people think, oh, I'm supposed to eat fruits and vegetables. So then they take like those green powder, you know? And they're like, that makes up for it. That's only that's only one part of why we eat fruits and vegetables. So actually explaining it all helps them to look at that and then be like, okay, and make better decisions and work together better as like a clinician client team to actually be able to make those changes. So, in terms of clinicians, those are my best advice is just listen to your client, explain, go into detail, especially neurodivergent. They want to, they want to know. They want to understand, I would even say it's not even just know, they want to understand the process behind it and why. And they aren't going to make a change unless they do understand the process and why, because that's just how their brain works. So it's really not getting frustrated. I've had to explain things to clients five million times and five million different ways until it clicks as well, because you have to find it that just works for their brain. And just be flexible, kind, patient, and understanding. And just don't make assumptions. For you said for clients, right? The first part.

SPEAKER_01 39:47

Yeah, like if a client feels like they're not getting an individualized approach, how can they kind of initiate bringing that up?

SPEAKER_00 39:57

So hard in that because I feel like there's the like power imbalance of feeling like you can't say that to somebody. But I would say just being direct and straightforward, but doing it in a kind way. Like I feel like I have been experiencing X, Y, and Z barriers. And I don't feel that your interventions have been helping me to address these barriers, right? And it's not saying your information is bad or it's wrong. It's just saying these, this information is great, but I don't know how to apply it, considering X, Y, and C and really explaining it. And then if your provider isn't willing to do that, then it's time to find a new provider, right? Ideally, I would love to believe that every provider will be like, okay, let me grow and do better, because that's who I am. Like I tell all my clients there's no ego in my sessions. If it's not working, I will be 10 times more annoyed if you let me just keep talking about something you know isn't going to work. Like you're wasting both our time. Like we have valuable time. Tell me, I'll I'll divert, and that's fine. So I would like to believe that if they could say that to a provider, like, these are my barriers, this is what I feel like isn't being addressed. How can we incorporate that into the recommendation?

SPEAKER_04 41:15

There's this TikTok account that I follow. Actually, I don't know if I follow her, but her stuff pops up all the time. And she teaches people, or like her videos are like comedy of like teaching people how to say things corporately, but of like saying you see the girl, and she's always like to-do looo with her mom. And how you just worded that reminded me of her because it's so good of being like, I'm gonna say this very respectfully, but in my head, this is what I really want to say. And I just loved, I loved that.

Saying Things So They Land

SPEAKER_00 41:47

It was very nice, and that to me is very important, right? I often think about it that it's not just what you're saying, but you want the person to hear it the way you want them to hear it. Like you want it to be received the way you want it to be received. So I am always very intentional with the way I talk because I understand that being direct, I'm neurodivergent. I'm often very direct. There are some people you can't be that direct with because they won't hear it. And I will adjust because it is just as important for them to hear it as for me to say it. So, like that was the Gillian Michaels. I got so irritated with watching the debaters with her because they were not good debaters in that sense. Like they weren't communicating in a language that was going to be heard by Gillian Michaels, right? She is, if she hears you say obesity is derogatory word, I'm not going to use that. Do I agree with that on a personal level? I 100% do. Would I use, would I have said that in front of Gillian Michaels? No, she's not going to hear me, right? As soon as you say something like that, they're no longer going to hear you. And that is what's important is thinking like, I want this message, but I also want them to take the message the way I want them to. So you have to frame it in that way. Does that make sense?

SPEAKER_02 43:20

Yeah. Yeah.

SPEAKER_01 43:23

We haven't watched the Gillian Michaels thing yet. Just just really wants me to, so we can do an episode on it. And I I in some ways I want to, and in some ways I don't, because I know that I'm just gonna have such a reaction to it.

SPEAKER_00 43:36

It was very painful. However, from what I heard, none of the people knew it was going to be Gillian Michaels. They don't find out until they walk into the room and she is the one sitting there. So wow. I'm trying to remember that when I get so upset by how poorly I feel like a lot. There were some good ones, don't get me wrong, but a lot of them I feel like didn't. Do a great job, but I'm thinking it's because they were likely really activated. Because if I had to say, like the epitome of diet culture, it would be Jillian Michaels. So if I walked in and it was her, like you're going, especially for body positivity, people in our profession, that's going to be triggering as hell. So I'm choosing to believe that that's why they didn't debate well.

SPEAKER_04 44:23

Especially because the whole that like three episode on the biggest loser just came out. And she like, I don't even think she was a part of it.

unknown 44:32

No.

SPEAKER_00 44:32

And I, if I was there, I would have loved to have talked about the studies that have found that like their metabolism is stunted by 40% 10 years later. But nobody talked about that. One person said recommending weight loss is unethical. I agree with that entirely. I have said that to people before. But let me tell you, usually, if I were to say that to a client, it would have been on like our 10th appointment. Because if you say that at the first appointment, they're gonna be like, you're crazy. Yeah, you're crazy. Like, how can you be crazy? Like, how are you that crazy? Yeah, like so. I just wouldn't say that until they're in a position where they could hear it.

SPEAKER_04 45:10

Where did you find it to watch it?

SPEAKER_00 45:13

TikTok. I just saw like the clips.

SPEAKER_04 45:17

I did not actively look it up. I know I want to like find the whole thing. I think it's on YouTube. That's what I thought. Okay, okay, fine. It's on YouTube.

SPEAKER_00 45:25

But I just saw the clips, and I remember the first one I saw it was her. I was like, oh god. And I just kept scrolling and it just kept coming.

SPEAKER_04 45:33

My husband sent it to me, and he was like, You have to watch this. And I was like, You want to fight, is what I'm hearing, but okay, that's fine. And then I sent it to Matt. And then immediately after I was like, Why do I want to watch this? Immediately I sent it to Maggie and I go, You want to watch this? I had like such, I know my brain wouldn't have. That's why I was like, maybe I mean, I'll probably I'll record myself watching it. I'll be throwing popcorn at the screen and screaming at her. We could make a comedic relief out of it.

SPEAKER_00 46:00

Oh, and she was so condescending. Wait, to hear her tone. I would I'm ready to I would have been like, dude, you need to talk to me like I'm an adult and not a five-year-old, please. I just uh maybe we'll she I will tell you that, and you know that it kills me to say she won that debate. She won that debate, and that kills me to say, yeah, like it ruins me to say that, but she a hundred percent won. And I don't think it's fair because imagine, like, there are people in bigger bodies who have been like post-eating disorder and seeing her.

SPEAKER_04 46:35

That is that's a lot. I was gonna ask, well, the the panel, if you could, I don't know if that's the right word. What was their background? Like, were they providers?

SPEAKER_00 46:46

There were some dietitians, there were some therapists, and the big ones were body positivity, like influencers, like people big in that movement, like policy. Essentially, the big topic of the debate was that. Oh my god, it kits kills me to even say it. That body positivity movement is destroying healthcare in America. Okay. So it was, and they did talk about neurodivergence in it too, and how that plays a role and things like that. But even that I feel like wasn't well done. So it was it was hard. It was a hard watch, especially for like providers like us who know the information where we're like, you should have said this, but like we aren't there, and like it's hard. But it's it's a painful watch. But it would be a good topic, I think, for a podcast, but it's rough, yeah. It's rough.

Meal Planning With Fewer Steps

SPEAKER_01 47:47

All right, more to come. We'll watch it. I've been I've been procrastinating it, but we we will do it. But Nikki, let me ask you one more question before we wrap up. So when it comes to meal planning for neurodivergent people, what would be like kind of your best tips to make meal planning feel like less overwhelming, more accessible day to day?

SPEAKER_00 48:12

So one is you want to reduce executive functioning as much as you can. Okay. So reducing the steps as much as possible. You want it to be as easy to get a balanced meal as it is to stop for fast food. They need to be equally easy. Right? So it's finding ways of doing that. Now, one is like decision fatigue, is a part of it, right? So something I'll talk about is choosing six backup meals that are always like shelf stable or that you will always have in stock. So like they could be in the freezer, shelf stable, but like something that's not gonna go bad if you haven't eaten it in a few days, kind of thing. Choose six, have a list. And if you can't decide, you roll a dice for decision. And whatever that dice lands on, one through six, that's what you keep, right? And just kind of letting fate decide. Additionally, it is finding like re helping them re-establish what normal could be. So a lot of the times, like I'll never forget a client who was finally meeting their fruit and vegetable goals because of that's it fruit bars. Like I got them onto that's it fruit bars. And he was like, it feels like I'm cheating. Right. That is literally that brain process where like they're not going to think about like applesauce or that's it fruit bars or things along those lines as a serving of fruit or vegetables. Right. They're not going to think about that. So, like reminding them that they're allowed to make food fun, that like the way we talk about fruits and vegetables for kids, we are allowed to talk about them for adults, right? So finding ways of sneaking them in, finding ways of making it exciting, like that is all really important. I'll often talk about like finding like all or nothing, right? Challenging that mindset where maybe you have a fruit or veggie tray in your fridge, right? And on the way home from work, you stop at McDonald's and get a burger, but instead of getting a meal, you just get the burger and then you have the veggie tray at home with it. Right? Like finding little things that can just make things a little bit easier. I also will tell them that in my head, unless they have diabetes or blood sugar issues, fruit and vegetables are the exact same. Right? Fruit gets such a bad rap because of the sugar controversy that they'll just eat nothing because they don't like vegetables. But they like fruit, but their fruit is bad. So then they don't eat it. So I will tell them that fruit is equal to vegetables unless they have blood sugar issues. And then of course I'll go into the talks about that. But generally speaking, they're equal. So I'm like, I don't care if you have an apple with your dinner versus having broccoli. Like, I don't care. Right. So when I do my meal planning, my way is fat, fiber, protein, and wow factor. Right. And I say that because fat, fiber, and protein are physically satisfying. And so often they're grazing and typically grabbing carby snacks, right? Because dopamine. So they end up then hungry again an hour later and they're irritated. They're like, it took me so much work to get myself to eat and just to be hungry an hour later. Like that was a waste of my effort and time. So I always don't frame it as like, this is what's healthiest. I frame it as you want fat, fiber, and protein because that will help you feel physically full.

SPEAKER_03 51:55

Right.

SPEAKER_00 51:56

And then you want the wow factor for that mental satisfaction, right? They talk about that in intuitive eating. It's important even for neurotypical people. But I would argue it's more important for neurodivergent individuals because of the dopamine regulation and the impulsivity, right? If you don't feel confident that you can have something you enjoy every time you eat, you're more likely to then have like those cravings in between meals when you're not even hungry and impulsively eat them because you're like, you're not gonna let me have this unless I have it right now, kind of thing, right? So that's how I do it. Another way is I will, depending on the client and if they have an eating disorder or not, right? Is I will give them a list of different definitions of a meal, right? So I'll say a meal is typically 400 to 700 calories, right? It's gonna have this much protein, this much fat, this much carbs, this much fiber, right? Kind of like a checklist. I'll say you want to have three different food items. You want to fill up a plate, right? And then I one of those things on that checklist will be the fat, fiber, protein, and wow factor. And I'll say, at a meal, you just want to check off as many as you can. Right. And some days the only thing you could check off is like getting enough calories. Like maybe you just make mac and cheese for your meal, and all you can do is get enough calories, right? But maybe other days you're like, okay, maybe I could get goodles, and then that has fiber and protein in my mac and cheese, right? But saying it's just about checking off as many as you can. And then the way I frame it is the more you check off, the more satisfied you're going to be after that meal. So if you only check one, that doesn't mean you did anything wrong. It's just to say, I only checked one, so I'm going to be hungry sooner. Right. Or I didn't check protein, like I didn't get enough protein in this meal. I didn't check that off. So I know that in my next meal, I need to prioritize that as one of the check boxes. Right. But essentially saying, like, these are all the different ways of defining it and see which ones you can do in that meal. Now, obviously, if they have an eating disorder, I may not give them the number aspects of like the calories or like the protein and stuff like that. But it just gives them that way of saying, like, I don't have the capacity today to even get the fat, fiber, and protein. So I don't know what to do, right? Because if they don't, again, have a way of making a decision, that's how I make my decisions. I can't do that, then I can't make a decision. So doing this gives them different ways of being like what your energy levels are, what your capacity are, and be able to understand like how to prioritize that. Does that all make sense?

SPEAKER_01 54:52

Yeah. Thank you. It's great. So if people listening want to learn more, they want to work with you, where can they find you?

SPEAKER_00 55:02

So I am accepting clients through a private practice. I work at with Luna Nutrition Therapy, lunanutrition therapy.com. I am accepting clients, but only at specific times. But my practice all are neurodivergent affirming. Everyone in the practice is neurodivergent themselves. And I do trainings as well as our the owner of the practice does trainings, and we talk about it in detail. So anyone within the practice would be able to use these skills and be able to do that with any client.

SPEAKER_01 55:37

Awesome. Thank you. This was so great. Thank you so much. I mean, it's so informative. It's just like so lovely to get to see you again, too. And I I knew you and Jess would would hit it off and she'd be wowed by you. So I'm glad that we got that reaction.

Spoon Theory And Final Wrap

SPEAKER_04 55:51

Anytime. I and even in the last part that you just said of like, or that whole last bit, you really just like read my life. Like, so I'll call you. We'll chat. We should talk about spoon theory. So many people try to explain this to me, and it goes right over my head.

SPEAKER_00 56:09

Okay, I can explain that. Hold on. I got the time. If you guys don't mind, I'm gonna explain it. So the reason you have to think of spoons as a currency. Okay. Maybe that's the best way. It's money. It's money, right? Neurotypical people essentially wake up every day with what feels like unlimited money. Essentially, they have more money than they're gonna spend in that day. So it feels unlimited. Does that make sense? Yeah. Now, neurodivergent people, we wake up every day with a different amount of money. And while we can predict it, like forecasting like the weather, we we're not always gonna be accurate, right? So one day we might wake up with 10 spoons, while the next day we only have five, right? And the idea is if you wake up with 10 and you use all 10, you put in a hundred percent. If you wake up with four and you used all four, you put in a hundred percent, right? Yeah. And it's recognizing that some days you have that high energy and you're able to do all of those things, but on some days you're low energy and you're not able to do all of those things, right? Yes. And adjusting that, right? So that's kind of what those check boxes are, where sometimes you only have enough spoons to be like, I'm gonna have this and this is enough calories, and that's it. And other days you might have enough spoons to cook a whole meal, right? And it's also, you know, dinner is when the end of the day where we've used up a lot of spoons, you have no idea how that's gonna be, which is why a lot of people then struggle to like cook dinner because they used up all of their spoons and now don't have any. I'm tired. Yeah. Exactly. So that's why you always those when I say those backup meals, right? For like the dice for decision, those are always going to be like one spoon meals, right? Like an uncrustable with a banana and a chompstick, right? Ramen made with bone broth and broccoli, right? Like it's going to be incredibly easy things so that even if you are low energy, you can make those things. I'll always be willing to talk more about this. I love talking about it. So if you guys ever want more, I am happy to do it. Like, this is my favorite thing to talk about. And I don't have a lot of people in my day-to-day life to talk about it with, except for my clients. Okay, great. We'll put you on the calendar again. We'll send you another example. Like you think. I love it. Like I genuinely love talking about it. That's why I love teaching, is because I literally just get to talk about nutrition and make it fun. And I love it.

SPEAKER_01 58:57

Yeah. Awesome. Well, thank you so much, Nikki. Thank you to everybody listening. And we will post where to find Nikki as well as her article. So that way you can check that out. And we'll catch you all on the next episode.

SPEAKER_02 59:14

Thanks, everybody.

SPEAKER_04 59:16

Bye. Thank you so much for listening to this episode of Nourish and Empower Podcast.

SPEAKER_01 59:23

We hope this episode helps you redefine, reclaim, and restore what health means to you.

SPEAKER_04 59:30

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