(00:01) Brett: Body modification is I think that even if something as simple as putting protein powder in a smoothie makes you feel gender euphoria, I'm like, fuck yeah, do it. I think that it's always about, so in this pursuit of building muscle mass, how much time and space is it taking up in your brain? Right?

(00:25) Jess: Welcome to the Gender IQ Podcast. My name is Jess Romeo and I'm a psychiatric nurse practitioner, psychotherapist, and just an endlessly curious soul. I'm also a trans guy who specializes in working with queer and trans folks every single day in my private practice.

This is part two of my conversation with Brett Ford, registered dietitian and founder of Bread and Salt Nutrition. For this conversation, we'll dig in a little bit more to what pursuing gender euphoria looks like for gender diverse folks and the ways in which our relationship to food, eating, and nourishment can work with, can work against, and work alongside pathways to gender embodiment and liberation.

Welcome back, let's get into it.

(01:05) Jess: So much of your story, especially in kind of coming back home, just reminds me of just what it is to be queer, too. There's something so queer, amazingly queer, about your story. And I think about that from the bell hooks kind of definition around queerness, needing to create creating something where it doesn't exist, instead of being able to neatly fit in with structures that have been given. So I just love how queer your journey is. But tell us a little bit about what should we know about gender diversity, queerness, and the way that disordered eating tends to show up in our folks?

(01:44) Brett: Yeah, think that, for instance, best part of me, so I love that it feels delightfully queer because that's very for me. Yeah. And so I think oftentimes we talked a little bit about kind of like the reasons why eating disorders show up for trans and gender expansive youth, particularly how that is often a response to a disenabling environment. Right?

So if we had access to hormone therapy and puberty blockers and community groups and to like gender affirming care in a way that feel incredibly complicated. A lot of, don't know this, but I would say that a lot of disordered eating symptomology would probably not cease to exist, but definitely become decreased. Right?

And so I think in terms of statistics, like there isn't a ton of research about trans folks and disordered eating. Not yet. And I was because there's a colleague scout Silverstein who actually just started this big newsletter for people who are doing research for gender and sexual minorities and eating issues and disordered eating. And there's a couple other researchers like Aaron Harrop is another researcher at the University of Denver, where like the research is happening, but we don't have a ton of like a quote unquote evidence base, right?

And so in terms of what that means nutritionally is oftentimes like from a nutrition care process. So like the first step of a nutrition care process is talking about how do we systemically approach to deliver nutrition care? And I would say this is true for my profession. There's a lot of type A dietitians. We talked about this a little where the first question is like, based on what calculation do I need to be using? And when it comes to estimating energy needs or looking at growth curves, how could I possibly know what adequacy is for this person.

(03:56) Jess: Yes. So a trans person maybe like, they, wait, what were they assigned at birth? Are they taking hormones right now? Which column should I be calculating my data in? Just give me the answer, please.

(04:06) Brett: For sure, for sure. That doesn't even account for like intersex people. Right? And so like there's like, I think it's funny because people always talk about like, pyagological sex is the thing that has the binary and I'm like, well, that's actually not true.

(04:19) Jess: By modal, not binary.

(04:21) Brett: Yes, exactly. Yeah. And I think that when it comes to nutrition assessment methodologies, there's a lot of gender specific values, right? And I think that some of that is helpful in terms of like what nutrients certain bodies need. And so I think about like people who are natal females who aren't on puberty blockers and like what that means in terms of like your iron needs when you're going through menarche, right? When you have disease and like your iron needs increase significantly. And if you were only getting the iron needs that were prescribed for somebody who is natally male, we would have a big deficit.

And so I think that so the kind of recommendation I give people is like, try to look at the whole person. It's not do the thing that I think a lot of trans people are very familiar with, they're like, what were you ever, you know?

(05:28) Jess: The question that... the strange... I don't know, I was just thinking about a metaphor for it because I think it just mimics what so many trans people experience just in the wild, which is I think folks are so used to being able to assume from looking at someone what all of their body parts are. They're just so used to being able to just quickly check, categorize that, and it's not like... these folks would also never say...

I'm constantly, thinking about people's genitals and I'm uncomfortable when I don't know what their genitals are. Like they would never think that. But I think when you're used to having information or thinking that information is like on an end cap of a grocery store aisle and suddenly they've put it in a different place and you can't find it. You're like, wait, where is it? I don't know how to find it. And realizing that actually it's not that important.

Like it's. It's not not important, it kind of depends on what you're asking, but there's a lot of other interesting things to explore about this person along the way, other than that information.

(06:32) Brett: Yeah. And if you're not their healthcare provider, it's probably not. You know, yeah, I think I think that's it's kind of for me. And again, this is like probably where I've been really, really lucky just to be in a lot of queer community. I'm like, again, like my mind doesn't naturally try to go out.

(06:37) Jess: Yeah, exactly. Yeah.

(07:01) Brett: I like the fact that people that can't make assumptions about anybody based on how they look. think that that means that like, I get to learn who they are over time and they get to reveal themselves to me and I get to reveal themselves to them. Yeah, but I think that in terms of like, what, like what this means for like, a body, right? So like we have these things in nutrition that are called kind of dietary reference intakes, right?

And those are the kind of requirements or suggested amounts for people to have. And I think developmentally, especially during teenagerhood, young adulthood, that's where things, especially I'm always thinking about bone health, right? And so it's really important in terms of like calcium, vitamin D, iron, these things that are micronutrients for those to be held and to, to be had in sufficient qualities in a diet.

The other thing I think about a lot is the macronutrients. And so like, we also need to make sure that people are getting enough calories, enough carbohydrates, enough protein, enough fat. And I think that what is so fascinating to me for a lot of my clients is that they do have a lot of, I'd say some of them actually like incredibly sophisticated nutritional knowledge.

But a lot of it is coming from a diet culture framework, right? And I think that when you don't have relationships that are trusting with your healthcare providers, a lot of my clients end up going online, which makes a lot of sense, right? Like Reddit forums. And I think that there's actually a lot of wisdom in some of those peer spaces.

And I think there's also some misinformation, certainly say that there's a lot of misinformation when it comes to the things that traditional, I would say diets tell people that they need, trans folks. So I would say for people who are interested, like the kind of energy, estimated energy requirements, often if someone is taking hormone therapy, we would want to see them on like six months of hormone therapy to then change the reference that we're using, whether it's for their dietary reference intakes or their estimated energy intakes. And that's just because of metabolic changes within that though. I like to think about like, okay, I'm like, what is your client, how is your client doing? Right?

And so like maybe they've only been on estrogen for three months and they're feeling like really lethargic and having trouble focusing. Okay, so for me, then I'd be like, okay, so like, maybe let's talk about, are we getting enough carbohydrates? Like, is there adequacy? I think there are a couple of things that people are always like, okay, but like, what are the biological risks of going on hormone therapy?

And I think that there are some metabolic changes, right? And so for estrogen therapy, we think about the fact that you are going to have some change in your lipids, right? And so heart health is often really important for people taking estrogen and bone health is really important so that bone sensitivity doesn't decrease over time. And I think with testosterone therapy, we're thinking about like adipose tissue redistribution and potentially increased muscle mass, which sometimes leads to higher protein needs. I think there is often a little bit of an obsession with protein intake for some of my folks who are taking testosterone and not everybody-

(11:00) Jess: I don't relate to that at all. have no idea what you're talking about. I've never don't have protein powder in the kitchen. Yeah. I know what you mean. Yeah. Well, there's a reason which the like, where is the line to right between something that's gender affirming? I think it's hard when you have a culture that is very eating disordered that when you were talking earlier about people going online to find information, I start to get a little concerned like the more someone knows about nutrition, the more concerned I get unless they are a professional. I think that says a lot about our culture. But I think there is a way in which I just sought out that information just because I wanted to be able to feel that gender affirmation of, this is possible for my body now in a way that I thought that was over for me. I didn't think I could ever get this kind of muscle mass before. So that's really exciting.

(11:58) Brett: And I think it should be exciting. Like body modification is life-saving, you know? And I think that even if something as simple as like putting protein powder in a smoothie makes you feel like gender euphoria, I'm like, fuck yeah, do it. you know? But for some of my clients and like, I think that it's always about like, okay, so in this pursuit maybe of like-

(12:14) Jess: Less so now, but it used to.

(12:25) Brett: - you know, a certain kind of like building muscle mass, like what, how much time and space is it taking up in your brain? Yeah. Right. And so I think that to your point of like, the more that you know nutrition, probably like the more like my alarm bells start to ring as well, because most of us know so much about nutrition, but we don't know a lot about eating and food, right? To kind of circle back or harken back to some of our conversations earlier.

And I think there is like this really like there's a lot of language that kind of just tends to fly about in terms of like, oh, like the word metabolism, like micronutrients. And I think that oftentimes they're weaponized, kind of almost always. I think when I look at like where the path leads, I'm like, oh, you're somebody's trying to make my clients buy something.

So that doesn't mean that like thinking about nutritional adequacy is wrong. It's actually really, really important. But the way that we think about nutritional adequacy is often very disordered. And so I would say that even a lot of well-intentioned other care providers that I work with and see clients with, there's a lot of the selectivity bias or confirmation bias of, well, this works for me.

And so I've had a lot of clients be like, "well, my doctor said like, should try intermittent fasting and things like that." And I'm like, like this is, and it's not with any mal intent, but I would say that a thought that I'm having and I, and I don't mean this to like discredit people's wisdom or their life experiences, but like, if you aren't like a trained nutrition professional, then I would say that like giving guidance around what people should be eating and the amounts of foods they should be eating is probably not something I would suggest because like we talked about, there's just like so much junk that unfortunately like tends to linger or lurk underneath people's understandings of food and nourishment.

(14:35) Jess: It's a strange paradox though, isn't it? That it's something that people must do every day to be able to meet needs to survive. But it can be so easy to step on a landmine of misinformation if you don't have quite enough training. Like I find part of myself wanting to push back a little bit on that, but also you're the trained person that I don't want to push back on you because I agree with you at the same time.

I think that can just be hard for providers to navigate if there's not ready access to a licensed nutrition provider. You know what mean?

(15:14) Brett: Yeah. And I'm not saying that people shouldn't like explore these topics with their clients. I think, I think you should, you know, like I think that often I think about a lot is that oftentimes people don't realize that their clients have issues with like food, especially it's because clinicians are never asking. So I'm not saying that there should be any sort of conversation around food and like the way in which nourishment is showing up. think that, yeah.

I think that it's really interesting because eating is something that we all do. And it's also something that I find that a lot of us feel like we're the experts of, right? Because we figured out patterns and strategies that tend to work for us. And so like, I think that people are the expert of their own experience, right?

But I think that the issue is that often then that's getting offered as a suggestion. And that's where I'm kind of like, that I think is something that I might discourage the practice of. But in terms of like talking about nourishment and feeding practices with your clients, that's definitely something I would encourage.

I just think that even for dieticians, to be perfectly honest, sometimes I get really curious about like, there's, there's an institute, called the Ellen Satter Institute. And it's this woman, Ellen Satter, who's like a dietician and a therapist. And they do a lot of incredible work around eating competence. And eating competence is kind of this model that looks at your kind of your eating attitudes, - the way that you're - kind of like food making capacity. And it's this kind of like, I think it's a little bit more of a holistic model than just looking at your like bio-metabolic markers, like what are your, what's your purpose doing? And I find it to be like a little bit refreshing in terms of the way that they're assessing people.

And I think the thing that I think about a lot is they have this whole methodology, which I use with some clients that is actually talking about how to eat, not what to eat. Because I think that we have been drilled, like hammered over the head with like, what should we be eating, whether it's like through like the food pyramid or the my plate or whatever. So I think that actually thinking about how is your client eating can be a little bit of a pathway in that might not need as much nutritional training.

(17:49) Jess: That's a really good point because I think the entire time we've been sitting here talking about this, I've kind of unconsciously been thinking about the what and not thinking about the how exactly. Does some of that get back to finding some sort of balance in the ritual and the culture and the community around food?

(18:09) Brett: Yeah, I think so. And I think the other thing that it often invites with a lot of my clients is maybe a decreased obsession with food morality of like, okay, so if I'm thinking about how I'm eating, whether that's like, and I think that there is a lot of perversion of what I would say is like mindful eating in the guise of dieting.

And I find that for some of my clients havingkind of mindfulness informed practices while eating can be super helpful, especially for some of my clients who tend to maybe be on a more dissociative spectrum. I think it can also be not helpful for other clients, right? So I think a lot of my clients who have ARFID or my autistic folks, like that can actually be incredibly dysregulating.

And so I think when I'm thinking about patterns around how to eat. The other thing that I think about a lot is about accommodations. so again, I feel like I'm just like shouting at all these people, but there's Noreen Hunani is the person who runs RDs for neurodiversity. And she has like an incredible framework where she kind of walks through that model.

But I think how to eat also kind of gets away from, "how am I how am I supposed to do this?" And being like, "how can I make this possible for myself and maybe even my family?" Right, so like, "what is the strategy that I need?" And for some people that doesn't look the way that maybe they want it to look, A, and B, in the way that has been maybe modeled in terms of what is healthy eating.

And so I do think that sometimes thinking about how we're eating can be a little bit of like a pressure release valve in terms of a lot of my clients. The question is like, okay, but like, are you going to give me a food plan? Like, yeah, it's helpful, but not - not often. It's more about the practice of eating and like, what are the systems and strategies and like what supports whether it's community or like getting groceries delivered if that's economically viable, like that you need in order to make this happen.

(20:36) Jess: It's really, that makes a lot of sense to me and I can see how it really apply to a lot of the folks that I see. I don't know, something in this, you know, when we first started talking connecting and you talked about food being political, you know, I'm certainly a provider who - I am not apolitical in the work that I do. Right. We can't divorce it. Um, you know, I work with some colleagues who might have to be a little bit more convinced of that. But there's just something throughout this whole story I've been reflecting around how so much of this is about meeting some standard that someone else has set. Like someone else has said, "I'm supposed to be X way. So let me try to organize my life, my body, my preferences, my needs, my wants to be able to fit into that mold."

And that's why I think your work is so queer. And I think it's amazing because it's really about, how about we just step away from that for a second and think about what could we create that feels right?

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(22:49) Brett: Yeah. Well, I love that reflection as you're talking. My heart is just, you know, expanding and I'm thinking a little bit about like, there's a queering of it. And there's also for a lot of my clients, which is almost feels contradictory, but I don't think so. There's also like a return to something like we were talking about this, like coming home. And this is where I feel like actually sometimes the professionals that you need in your life are like grandmothers, right? In terms of like passing on practices and recipes and things like that.

And so I think a big part of my work too is like, okay, so like stepping away from the nutrition experts, like maybe checking in with your own experience, maybe thinking about things from like a disability rights kind of framework of like, okay, so it actually like takes too much spoons for me to like chop up these vegetables. And so I'm actually just like get a veggie tray that I eat off of and like, that's good enough.

And then I think that there is a lot of kind of like what I would say is like this balance of like, kind of creating some wisdom within yourself of like what works for you. And also having some sort of like, potentially like biomedical nutrition information can be helpful for certain health conditions certainly. And then this really beautiful kind of maybe reconnection with ancestral practices, right, if those are available.

And like, I think that something you said that has been kind of reverberating around in my mind of like this connection between food and attachment, right? And I think about the fact that like the very first time we're being held is often the same time we're being fed and how deeply interwoven kind of those neural frameworks are in our minds and how in this time, especially for trans and gender expansive people, where our needs are essentially being like, like they're too much and we're not interested in meeting them. How having like a consistent and resilient and persistent nutrition practice, feeding practice can be such a self in terms of like just working with activation and also feeling like, you know, like the mutual aid part of me is like, yeah.

And feeling into these like mutual aid supports, whether they're, you know, something as simple as like getting together with a couple friends and like meal prepping for the week because everyone's like so overwhelmed because the world is on fire. Right. And fascist dystopian hell. I think the other thing that you said around bell hooks, I think I'm obsessed with speculative fiction. And so I think that there is something here, too, of like, yeah, like and what what is possible in terms of being queer bodies and families and communities. And I don't think that it should be stagnant. And I hope that people are going to iterate and find ways to really get fed biologically and also spiritually in ways that are going to blow my mind.

(26:05) Jess: Yeah, that's really beautiful. Well, it kind of makes me want to sort of get closer to the wrap up by asking you what I've wanted to ask, which is your practice is called bread and salt nutrition. And tell me a little bit about that name itself and how that represents some of your work.

(26:25) Brett: Yeah, it's a - it's very - it's a sweet question. So, my practice has gone through like a couple of different iterations around like, what is this going to be called? Like some of them, if people have worked with me, they'd be like, well, some of the first ones were not very good - and they were correct. I think the thing that I really wanted to convey with bread and salt was I wanted it to feel like a homecoming, right?

And so, bread and salt, I think in many traditions is something that you might present a traveler after a long journey. Right? And so somebody comes into the home and you're greeted with bread and salt. And so that was, I think the original kind of origin seed of why I wanted to, to call my practice this. And on top of that, there are lots of other layers on top of that.

Bread and salt are also things that people with disorder eating often are very afraid of. So I think explicitly trying to talk about almost using my company name as a little bit of exposure therapy of like, yeah, like this thing that can feel so scary, that's actually like really, really essential, right? In terms of your physiological functioning. like carbohydrates and salts as electrolyte, these are things we need actually at much higher levels. It's all this one that people always push back on, but then oftentimes we think - so, bread and salt nutrition therapy is a way for me to articulate that oftentimes, especially now there are going to be so many forces that are trying to force us away from our bodies. Right? And to really make us feel like the expertise is elsewhere, right? It's not in our community. It's not in our own body. It's not in the way that we're relating with hopefully care professionals that feel really affirming. It's this person on the internet or this politician.

And I think that what I really find heartening about the name is that it's - for me, it really is about sustenance, right? So it's about like after a long journey, come home, sustain yourself and also sustain yourself maybe in ways that might feel scary.

(29:01) Jess: Yeah, just I remember looking at your website and you referenced a sign in the movie. It's A Wonderful Life like "bread that this house may never know hunger, salt that life may always have flavor."

(29:10) Brett: Yeah. Yes. Yeah. I actually, that was a client after I named my business that was like, this reminds me of it's a wonderful life. I was like, that is perfect.

(29:29) Jess: Love when those things happen. I know. It's so great.

(29:33) Brett: And I'm going to say that all of my best stuff comes from my clients.

(29:36) Jess: Always, always. They really are the best. Well, I like to end these conversations by asking, know, tell me if there's a moment or something in your life right now that represents queer or trans joy. Like, what's giving you some queer joy right now?

(29:57) Brett: Well, I would say my life is surrounded. I'm grateful to be surrounded by lots of queer and trans people who constantly are providing me with joy.

I think in this exact moment, in this exact moment, actually, the thing that I'm going to say is I have a lot of friends and beloveds who are thinking really intentionally about survival strategies. And so I think the thing that is bringing me a lot of joy is I have friends who are being like, okay, so like, when are we gonna take that tourniquet class? And I have friends who are talking about maybe starting a boxing club.

And I think that the reason that that feels really joyful to me is that it doesn't feel like fear and anxiety is an isolation. It feels like there is a real intentional shift into being like, okay, I'm like, how are we going to take care of each other and ourselves because we are living under state abandonment and now we are living under something even scarier, which is to be targeted, right? And to be - and our identities be weaponized.

And so I think the thing that's bringing me a lot of joy is just seeing how queer and trans people are continuing to show up for ourselves and to continue to show up for the movement and to be really creative in what that looks like. So I would say I'm thinking a little bit about Audre Lorde in like survival is a promise, you know? And I think that I see that really clearly in my life.

(31:56) Jess: Yeah, that's really beautiful. You know, and I think all the talk about food, end up whenever I'm writing, if that's like marketing copy or anything for gender IQ or just sort of writing about the state of the world, food metaphors very often come up. Like I kind of try to describe my trainings as not a recipe book, but it's a little bit more like salt, fat, acid, heat. Like you'll sort of learn how to put all these things together.

(32:25) Brett: Yeah.

(32:27) Jess: But I really love, you know, this idea that for cis and straight allies, that, you the work of allyship, at least for me, I really want to build longer tables because I do think that divisiveness is too easy. I think that asking purity is too easy. And it's important that we build longer tables and that we have many people over at those longer tables.

But it is a potluck. And you can maybe not bring a dish once, but it's a potluck. So after a while, if you're not bringing something to the table, you're not going to get invited back. But you're welcome to come and join. And you just got to bring something too.

(33:14) Brett: Yeah, I love that. And I think there's, I think a thing that I do often is I'm literally looking at it. It's like the food and travel writing, the best essays of 2024. I, there is a Booker poet, Ben Okree, who has this really, really beautiful short story about the importance of extending a table. I'll send it to you.

I think that what you're saying is really important. And I think it's also a time in which our bodies are not meant to be vessels of terror for prolonged periods of time. And I think that what you're talking about in terms of coming together, they're gonna be inconvenient and imperfect people. I might be.

(33:44) Jess: I definitely am.

(34:11) Brett: I'm sure I said something in this. guess some people are gonna be like, girl. And like, I'm welcome. I welcome that feedback. But I think to your point is just like, yeah, and like, how do we show up with each other and create space for very human foibles? And I think that food metaphors are such a beautiful way to do that. But also literally food is really, really good.

(34:39) Jess: It is. Yeah, it is. Might burn the toast, because you can still get invited back though. This is lovely. And I think that actually is probably a nice little like, I could just imagine a podcast where like, still getting invited back and it like fades out and then the music comes. I think that's going to be a good one. I've never done this before, but I can like see it. Is there anything that you feel like you really were kind of burning to say that we never quite got to?

(35:06) Brett: I think that a lot of the lineages of thought that have deeply informed the way that I practice are from Black and Brown, queer and trans, fat people. And I think that the liberation that those teachings and those people have given me in this body and continue to kind of ripple out into the way that I work is something that can't be understated. It's something I feel like forever grateful for. And I have like, if people are interested in learning more, like I definitely have lots of sources that have like deeply, deeply impacted the way that I think about bodies, the way that I think about food.

And I would say that a lot of times people are really hesitant to work with dietitians because I think historically dietitians have been quite harmful and some still are, but not all. And so I would just say that definitely be choosy about who you work with. Again, like there are lots of people who are giving nutrition advice and not in a gatekeeping way. Like if there's somebody who's not a dietitian who you really vibe with and feel safe with, then like do that too.

But make sure that - for me, it's like, okay, and if this is getting in the way of me getting enough, can I let it go? Right? So whatever thing that I'm working with, whether it's advice from an allergist or advice from a dietician or advice from a friend, if it's getting in the way of me getting enough, like "can I put this down?"

But outside of that, like I feel like, preparation for this, made a little mind map and I feel like we've gotten to touch on all these little spaces. And so just have been really, really enjoying the conversation and feel really grateful.

(37:07) Jess: Thank you so much for the first, probably more conversations about this because it was too much fun.

(37:13) Brett: Good. Thank you.

(37:17) Jess: That was just such a lovely conversation. I felt nourished by that conversation. Really, it really got me thinking about how many structures I've tried to meet in my own life and how I might approach the question of, "can I let go of this?" Each conversation I have here feels like another layer of the matrix being pulled away in some ways. Systems that I thought I had intellectually questioned 10, 20 years ago to satisfaction are now coming up again in these really quiet but insidious ways. And it's, and it feels very freeing to take the space to ask, in what ways am I approaching my day-to-day life from a place of not enough or from a place of needing to live up to a standard that someone else set. I think it takes time for information to travel from the head and that cerebral place and then to get integrated into our bones. And I feel like this conversation was just one more step toward feeling some of that freedom, that liberation, and all the beauty and joy that is queerness in my bones.

So thanks again to Brett and to y'all out there listening.

You can find Brett's info at brettinsaltnutritiontherapy.com.

We will be back soon with more enlightening, empowering and disarming conversations at the Gender IQ Podcast.