Friday Q&A: balance and aging; adding dietary fiber; GLP-1s and disordered eating; & retraining hunger cues
Answering your great questions!
ICYMI 👉
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💊 No live podcast for the next two weeks, but join me again on Tues 7/15 at 5 pm ET for our regularly scheduled live conversation!
In this week’s reader-submitted Q&A, we’re tackling these questions:
When should healthy older adults worry about balance changes and falls?
What are easy ways to increase fiber beyond just eating more vegetables?
How do you weigh GLP-1 medications for someone with eating disorder history?
How do you shift from skipping breakfast to better meal timing throughout the day?
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The following subscriber questions have been lightly edited for length and clarity.
QUESTION #1: BALANCE & AGING
I’m 66 and healthy, but lately I’ve noticed my balance is a little off and I’ve fallen a few times. Nothing major—but it spooked me. I’ve always been active. Is this just aging, or something I should get ahead of now?
-Anna
Dear Anna,
Great question. It’s important to discuss the subtle but concerning changes in balance that many people experience as they age. While it's true that our balance systems naturally become less sharp over time, I wouldn’t necessarily attribute your issues to aging alone.
Balance relies on three integrated systems: your inner ear, vision, and proprioception—the sensors in your muscles and joints that tell your brain where your body is in space. Age affects all three, but significantly, strength training and balance exercises can dramatically improve function.
Falls are a leading cause of serious injury in older adults, and they're often preventable. The fear of falling can become almost as limiting as falling itself, causing people to restrict activities and lose even more strength and confidence. I've seen patients who stopped hiking, dancing, or even walking their dogs because of balance concerns, only to become more frail and at higher risk.
Your active lifestyle is your greatest asset here. Rather than scaling back activities, this is the time to add targeted interventions. Balance training—simple exercises like standing on one foot or walking heel-to-toe—can create remarkable improvements within weeks. Strength training, particularly for your legs and core, provides the foundation that supports good balance. Even twice-weekly sessions focusing on squats, lunges, and standing exercises can transform your stability.
I'd recommend seeing your doctor to rule out any medical causes like medication side effects, vision changes, or inner ear issues. But don't wait for that appointment to start gentle balance exercises. Many community centers offer balance classes specifically for older adults, and physical therapists can design personalized programs.
The spooked feeling you mentioned tells me your body is sending you important information. At 66 and healthy, you have tremendous capacity to improve your balance and reduce fall risk.
QUESTION #2: ADDING IN MORE FIBER
My doctor said to eat more fiber, but I already eat vegetables every day. I’m not sure what else I’m supposed to add. Are there “sneaky” ways to boost fiber without overhauling my entire diet?
-Cheryl
Hi Cheryl,
Eating vegetables daily is great—and it’s probably what you’ve been told to do since you were a kid!—but veggies are only one piece of the fiber puzzle. Even dedicated vegetable eaters often fall short of the recommended 25-30 grams of fiber daily because we tend to focus on leafy greens and forget about the fiber powerhouses hiding in plain sight.
The easiest fiber boost comes from switching to whole grain versions of foods you already eat. If you typically have toast for breakfast, choosing whole grain bread instantly adds 3-4 grams of fiber per slice. Swapping white rice for brown rice or regular pasta for whole grain pasta can double or triple the fiber content of those meals without changing what you're actually eating.
Beans and lentils are your secret weapons here. Adding half a cup of beans to soup, salad, or even pasta sauce contributes about 8 grams of fiber—more than most people get in an entire day. Canned varieties work perfectly and take minimal preparation. I tell patients to think of beans as fiber delivery vehicles that happen to taste good.
Seeds and nuts offer another sneaky approach. Sprinkling ground flaxseed or chia seeds on yogurt, oatmeal, or even salads adds fiber without changing flavors significantly. An ounce of almonds provides 4 grams of fiber along with healthy fats and protein.
Don't overlook fruit with edible skins—apples, pears, and berries are fiber goldmines that many people underestimate. Keeping the skin on potatoes when cooking also provides a surprising fiber boost.
Start gradually, adding about 5 grams of fiber weekly to avoid digestive discomfort, and increase your water intake accordingly. The goal isn't to overhaul your entire diet but to make strategic swaps and additions to foods you already enjoy. Your digestive system, blood sugar, and overall energy will thank you for these small but meaningful changes.
QUESTION #3: GLP-1S & EATING DISORDERS
My doctor suggested a GLP-1 but I’m in recovery from an eating disorder. I’m afraid it could trigger old habits. How do you decide when these medications are helpful—and when they might cause more harm than good?
-Rebecca
Thanks for your question, Rebecca. Your concern is valid and shows great self-awareness about your recovery. This tension between potential medical benefits and eating disorder triggers is something I navigate carefully with patients, and there's no universal right answer—only what's right for you at this stage of your recovery.
GLP-1 medications work by affecting appetite, satiety, and food thoughts—mechanisms that can be genuinely helpful for some people but potentially dangerous for others with eating disorder histories. The medication's ability to suppress appetite and reduce food preoccupation could theoretically support recovery by quieting obsessive food thoughts. However, it could also reinforce restrictive patterns or create a new dependence on external appetite control rather than trusting internal cues you've worked hard to rebuild.
The decision framework I use involves several key considerations. First, how solid is your recovery foundation? If you're still working actively on intuitive eating, rebuilding hunger and fullness cues, or struggling with food fears, this likely isn't the right time. However, if you've been stable in recovery for years and are dealing with separate medical concerns like diabetes or metabolic issues, the calculation changes.
Your treatment team's input is crucial here. Your therapist and any eating disorder specialists know your patterns and triggers better than anyone. They can help assess whether you have the psychological tools to use this medication safely or if it might undermine recovery work.
We also need to examine why the medication is being suggested. Is it for diabetes management, where the benefits might outweigh risks? Or primarily for weight loss, which could be more problematic given your history? The underlying medical necessity matters significantly in this risk-benefit analysis.
If you do consider trying it, having robust safeguards is essential—frequent check-ins with your eating disorder team, clear criteria for discontinuation, and honest monitoring of any returning eating disorder thoughts or behaviors.
Recovery is precious, and protecting it should be the primary consideration. Sometimes the wisest choice is saying no to potentially helpful medications when they threaten something more valuable—your peace with food and your body.
QUESTION #4: RETRAINING HUNGER CUES
I used to skip breakfast and snack all day. Now I’m trying to eat a bigger morning meal to reduce cravings later—but honestly, I’m not that hungry in the morning. Do you have tips for easing into a bigger breakfast without feeling stuffed?
-Kathy
Hello Kathy,
Your instinct to shift toward a more substantial breakfast is spot-on, but you're absolutely right that forcing yourself to feel stuffed isn't the answer. Your body's current lack of morning hunger is actually telling you something important—after months or years of skipping breakfast, your natural hunger hormones have adapted to expect no food until later in the day.
The key is retraining your hunger cues gradually rather than dramatically overhauling your morning routine overnight. Think of this as gently waking up your digestive system rather than shocking it into action. Start smaller than you think you need to—even just a piece of toast with peanut butter or a small yogurt with berries can begin signaling to your body that morning fuel is coming.
Protein is your secret weapon here because it provides lasting satiety without the heavy feeling that carbohydrates alone might create. A hard-boiled egg, Greek yogurt, or even a small protein smoothie can feel manageable while starting to stabilize your blood sugar early in the day. This early protein intake helps reduce those afternoon and evening cravings you're trying to address.
Consider timing as well. You don't need to eat the moment you wake up. If you're genuinely not hungry until an hour or two after waking, respect that natural rhythm while gradually increasing what you eat during that window. Some people find that having something very light immediately upon waking—like a few nuts or half a banana—can stimulate appetite for a more substantial meal later in the morning.
Pay attention to your evening eating patterns too. If you're eating late or having large dinners, your body may still be digesting overnight, which naturally suppresses morning hunger. Eating your last meal earlier in the evening can help restore natural morning appetite within a few weeks.
Be patient with this process. It typically takes two to three weeks for hunger hormones to readjust to new eating patterns. Your goal isn't immediate perfection but sustainable progress toward more balanced daily nutrition values.
Disclaimer: The views expressed here are entirely my own. They are not a substitute for advice from your personal physician.
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