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Friday, September 30, 2011

Hannah’s Story. The Tale of the First Reported Anorexic

Blogging should have been far from my thoughts, as I sat in Temple yesterday, the first day of our High Holidays. But food and eating and Judaism seem inseparable, and so my thoughts turned to Drop It and Eat. At this time of introspection, at the start of the Jewish New Year, a time of re-creating, what’s the chosen text we read each and every year? A tale of a woman named Hannah, who by my interpretation is clearly struggling with anorexia. Is it me and the lens I view life through?  Perhaps. But I don’t think so. 

Read the full, (translated) passage from 1 Samuel 1, dated from before 600 BCE. online if you‘d like. http://www.mechon-mamre.org/e/et/et08a01.htm
Here’s the synopsis, relevant to this blog topic, as I see it.

There was a man, who had two wives, one named Hannah, one named Peninah. Peninah had children, Hannah was childless. Hannah was his favorite, although God had closed her womb. Her rival, Peninah, to make her miserable, would taunt her that God had closed her womb. Year after year this happened. Every time she’d go up to the House of God, Peninah would taunt her, so that she wept and would not eat. Her husband would say “Hannah, why are you crying and why aren’t you eating? Why are you so sad? Am I not more devoted to you than ten sons?”

After they had eaten and drunk, Hannah rose. In her wretchedness, she prayed to God, weeping all the while. And she made this vow. (To paraphrase—look upon my suffering and remember me and if you give me what I want (a male child) I will dedicate him to your service.)

To make a long story short, she began praying silently,  “in her heart; only her lips moved, but her voice could not be heard”.  And the priest took her for a drunk, and told her to “sober up”. And what does she do? Does she shut her mouth in shame? And close her heart as well? No! She finds her voice in a big way. She replies, “I am a very unhappy woman. I have drunk no wine or other strong drink, but I have been pouring out my heart out to God. Do not take your maidservant for a worthless woman; I have only been speaking all this time out of my great anguish and distress.”

In response, she was apologized to, told to “go in peace” and “may God grant you what you have asked for”. Yes, an apology and a blessing. Pretty impressive, for a woman of those times. So she left, and she ate, and was no longer downcast.

After relations with her husband, Hannah conceived, and had a son and the story goes on. And for the record, Hannah became a model of prayer, with her silent but heart felt communication.
So I’ll reiterate the obvious. Here’s a woman, seemingly depressed, taunted, yearning year after year for a child. Her husband doesn’t seem to get it, or likely to understand her or her sorrow, as he naively asks her “isn’t my devotion as good as ten sons?” She manages to eat and drink something, then finds her voice. She takes control of the situation, by bargaining with God to get what she wants—take note and give me a son, and I’ll dedicate him to your service. She expresses her pain to the priest and makes herself understood after being accused of drunkenness. She leaves, eats, and is no longer downcast. And then she is able to conceive.

The text doesn’t tell us if she had amenorrhea. We don’t know if there is a genetic component to her fertility problems, or to her eating disorder. We know nothing of her thoughts about food and eating, about her preoccupation with anything other than conceiving. And I doubt she calorie counted. We certainly don’t know her weight, BMI or how medically stable she was. But we see a link made over and over in this text—She ate, she found her voice. She didn’t eat, she was infertile. And I have learned that when things are repeated in these texts, it is never accidental, but for emphasis. After expressing herself, pouring her heart out, she was able to eat and drink, resulting in her ability to conceive; a connection, causation even, suggested between not eating and infertility, between eating and conceiving.

Hmm. Seems like perhaps the earliest reported case of anorexia to me.

What’s the significance for you?

From my read, I see hope. You can be stuck year after year in the same bad place, but then something can change—YOU can make something change, and get to a better place. It takes nourishment to find your voice, to petition to get your needs met. But isn’t it worth it if you can finally be heard? And even if you don’t get blessed for your outspokenness, I suspect you’ll feel much better. Getting things off your chest—whether through personal expression (writing, journaling, silent prayer, meditation) or speaking up to your significant other or those who really don’t get it—is crucial. Yes, eating helps you find your voice, and expressing yourself helps you eat—but pregnancy will not necessarily result.

Saturday, September 24, 2011

How much should I eat? Using your head, trusting your body.

I just returned from two weeks abroad, 24-7 vacationing with my husband of 25 years (and yes, we still remain happily married). One week hiking in the Swiss alps, one week eating and drinking my way through Italy’s Piedmont and Tuscany regions have left me with so many thoughts to share. So enjoy the photos and commentary in the next several posts, and please share your thoughts and comments with me!

The lovely town center of Bagno Vignoni we pushed our bikes to.

I get it now.

This week I was struck by how much I utilize, maybe even rely on nutrition information to make my eating decisions. Sure, I eat intuitively, and I stand by absolutely everything I’ve told you throughout Drop It And Eat’s many posts. But I had an interesting revelation this week while in Tuscany. Until then, I hadn’t fully realized just how much nutrition info is a part of me, my food choices, my portioning. It came to light in a big way this Wednesday in Italy.

A lovely lunch, except for the 1/2 cup of oil!
Of course I’m aware that information impacts what I purchase. That includes higher fiber cereals, to keep things moving, as well as desserts with real butter, (because of the knowledge that I like the taste); white meat poultry, lower in saturated fats associated with cholesterol levels and cardiac risk, and whole grains for their mineral content, fiber as well as my awareness that I love their chewy texture. And while my awareness of the nutritional content of rich pastries doesn’t stop me from eating them, nor from thoroughly enjoying every bite, it makes me mindful to savor these items and to consume them in modest amounts.

18 euros, about $26 for these two fellas!
Twenty-five years as a nutritionist yet, I take knowledge for granted; I never really acknowledge its impact on my diet. No, I don’t calorie count, or tally my fat grams. And I don’t use a meal plan of any kind. Nor do I weigh my food. 

But at home, nutrition guidance surely impacts my life. When I buy fish, I ask for the amount based on an estimate of the number of ounces our family needs per person; ¾ pound for the two of us is not an unusual request. In contrast, most people I see approach the fish counter saying “I’ll have those two fillets” or “3 salmon steaks for the three of us”, without regard to the portion size.

I know how I like my food prepared; I enjoy good tasting meals with added fats—flavorful oils and butter—but I do add them sparingly, knowing they are calorically dense. Over time, I’ve learned how much rice I need at a meal, and just how much will serve my family, preparing accordingly. When I eat out, as you’d have guessed by now, I’m vocal, requesting foods the way I want it—light on the oil, or with extra basil or cilantro, or with added tofu or vegetables—whatever. Are you cringing just thinking about us dining out together?

Given the price of olive oil I considered getting this oil to go.
So imagine this. I’m in a country where I could barely order off the menu with minimal understanding of what I’m ordering. Culturally, I have virtually no awareness about regional preparation of the dishes. Imagine my surprise when I was served this veggie and cheese plate (right).

Earlier in the day, we ventured into the local fish market to plan for our home-cooked dinner in our apartment. Unlike what I am accustomed to, the fish are sold whole—then weighed, cleaned, and filleted—so we had no idea just how adequate a single fish would be. God forbid we should go hungry! So we ordered two whole fish. The price of 19 euros (approximately $26) should have been a red flag—a mighty expensive dinner for two! But what did we know?

Our home-cooked fish dinner, made with onion, peppers, fennel, capers,
garlic, white wine, and did I mention olive oil?
That evening, after cooking the meal—roasted branzino fish, risotto, cheese and figs—I realized that this meal was truly enough for four people, versus two. I had no knowledge of the food’s weight, the cheese was bought as a round single unit, and we just ate it. Slowly, we sat enjoying our delicious meal, together with a lovely white wine from the region.

And then it struck me. I had felt, at first, handicapped, yearning for my usual knowledge-based cues to assist me that day. How much oil is in this dish at lunch? How many ounces of cheese am I eating? How many people should this fish dinner serve? But I let it go.

Dinner included delicious goat cheese with black truffles. Lunch featured
the regional specialty of Pecorino, a sheep's milk cheese.
While I didn’t have the concrete information I usually rely on, I still had my experience—my knowledge of just how much I usually eat, which allows me to maintain a healthy weight. And I retained my internal knowledge—the physical signals that told me when I had had enough food and was satisfied.

When I reflected on this day, consuming ½ an Italian bread (no, I am not exaggerating), cheese, and god-knows-how-much olive oil in my lunch, I realized that I hadn’t gotten hungry throughout the afternoon; in fact, I seemed to have skipped my usual afternoon snack, inadvertently.

Trust

So it still comes down to trust. If you’re maintaining a healthy weight, your usual portions will suffice. Need to gain or lose? Modify your portions accordingly. Eventually your physical signals will resume, so you can finally distinguish physical hunger from all the other reasons you do or don’t eat.

If you speak the language, then speak up! Ask for foods the way you’d like them, and request a doggie bag for leftovers. And trust that all is not lost (gained?) if a meal is different from your norm. I personally would never choose to use half a cup of oil on my veggies, even good tasting extra virgin olive oil, but as I told my husband at lunch, “at least it’s good for my coat!”

I got more of an upper body workout than I bargained for.























In the end, in the two weeks I had had much more wine than I ever consume, significantly more fats of all types, more meals out, and more frequent desserts. Swiss chocolate is divine, and there were times we had some with breakfast. I biked less than planned, walked more than expected (including walking the bikes in terrain I couldn’t manage), and was generally more active than usual, especially given the length of our hikes. 
Sometimes, all we can do is to laugh at the situations
we encounter!




And for the record, my weight is exactly the same, as it should be, as I’d expect. But most importantly, I enjoyed it all, even playing with the leftover oil-soaked food at lunch. Because life’s too short to diet.



Wednesday, September 14, 2011

The Wedding Diet. Guaranteed to Change Your Weight.

Hard to tell, but it really was pink!


I lost a bit of weight then, but it was unintentional. It’s hard to recall the details—it was 25 years ago—but I certainly recall my pre-wedding jitters, my perseveration over details of this NY Wedding’s menus and seating and flowers, and the stress of commuting to work 3 hours daily. And then there was the wedding gown hype (Imagine Say Yes To the Dress; I bought it at the same Kleinfeld’s of TV fame).


But as PJ points out in her guest post below I was not typical—I did not try to lose weight before the big day. And who buys a pink wedding gown, like I did, anyway?


Who Is PJ Anyway?


First and foremost, she’s a bright, sweet, thoughtful, determined Follower of this blog, who I adore. She’s an Aussie, a mother of three young children and an adult new to acknowledging and tackling her own long-standing eating disorder. And she’s approaching her recovery with gusto, true to her nature. She’s using her resources 100%, while painfully honest about her struggles and her slips.
Welcome PJ, who miraculously knew I’d be in a bind this week, unable to write a timely post.

Read her fabulous blog, Recovery, PJ Style, for more honest writing, incredible wisdom, and support.

The Truth about the Wedding Diet

Ever planned to lose weight for a big event? How did you get on? And, probably more importantly, what happened after? Well, let’s start by seeing what Lori has to say on the topic. In her post the Graduation Diet, Lori describes a woman named Amy determined to lose 15 pounds in the 6 weeks leading up to her son’s graduation. But despite Lori’s warning/prediction:

“Dramatic changes in eating and activity are rarely sustainable. And they never occur without a cost”

We never did find out how Amy fared. What do you think?

At the recent conference for the Australian and New Zealand Academy for Eating Disorders, a researcher named Ivanka Pritchard from Flinders University, gave us the answer. Pritchard recruited 343 brides-to-be from a bridal expo and asked them a series of questions; including whether or not they planned to lose weight before the wedding and whether or not they had been told to lose weight (this pressure came from a variety of sources such as family, friends and even the wedding dress saleswoman!). Pritchard reported that over 50% of brides-to-be wanted to lose weight before the wedding (approx 8kg) and around 13% had been told to lose weight.

Pritchard also collected data on starting weights and then followed up at 1-month pre-wedding and 6-months post-wedding.

Of the first group (those that wanted to lose weight), what do you think the average weight loss was? Nothing. That’s right, at 1-month pre-wedding there had been no change in the weight of this group. However at the 6-month post-wedding follow-up there most certainly had been a change. This group had gained an average of about 2kg. Pritchard called this the ‘oh-thank-god-that’s-over-now-I-can-eat-what-ever-I-want’ effect.

The second group (those that were told to lose weight) did show some slight weight loss pre-wedding but gained significantly more post-wedding than the first group.

Pritchard concluded her presentation by highlighting the need for awareness campaigns to reduce the pressure on these woman to fit some societal ideal for the perfect bride – especially in the face of the competition they are up against: both Jenny Craig and Weight Watchers, as well as a selection of health clubs all had stalls at this expo.

So there’s your answer. And although in the scientific world we don’t call it proof, merely evidence, you’d have to agree it’s pretty compelling evidence to say the least.

The Wedding Diet will NOT result in weight loss. But it will result in weight GAIN. Darn. Oh well, at least we still have Drop it and Eat.


Thursday, September 8, 2011

Beyond Calories. Learning To Embrace Food For Pleasure



From my seat in the kitchen I could only see his butt. But I could hear the probing of his snout, which piqued my curiosity. Then his head emerged, his eyes beaming at mine. After catching my glance he guided me with the movement of his head, pointing toward the 25-pound bag of kibble.
Waiting patiently for his favorite biscuits.

What could he want, I wondered. He has food in his bowl. He repeated this gesture talking to me without my comprehending. But then my husband got it (he speaks dog better than I do). He wants the fresh, new dog food, he realized. The  stuff in the bowl was from the end of the last large bag and it’s just not what he wants.

So my husband opened the new bag, a new variety in fact, replacing the previous batch. And he chowed down (my dog, I mean, not my husband).

Yes, even my dog Mica has absorbed the lessons living in this household. Maybe the quality of the older food was sub-par, or perhaps it was the allure of something new. But for some reason, he was triggered to sniff out something more desirable, and make his needs known to us.

Milanos, one of my favorite cookies.
But I prefer the mint variety to the orange!


There’s meeting your needs for fuel, the most basic in the hierarchy of eating needs. But then there’s eating to satisfy on other levels— to have what you really desire, to enjoy the flavor and textures of great tasting food, to avoid limiting food choices to shoulds.


Admittedly, it is challenging at first. 


It requires:

  • Taking a leap of faith, a bit of risk taking. Ask yourself “What’s the worst thing that can really happen?” When you realize that the risk is quite miniscule, you’ll likely find it’s easier.
  • Taking baby steps. Maybe a single component of the meal (or of your day) may change at first. It may be varying the portion of your dinner entrĂ©e or finally ordering a favorite sauce—perhaps on the side, to begin with.
  • It may mean choosing to step out only with people who know and understand your struggle, who you know will be supportive.
  • It involves asking for things the way you want them, when eating out. Trust me, you are not the first to assert yourself when dining out! And with the exception of buffets, the food isn’t prepared until you order. So no great hassle to accommodate you.
  • It requires feeling entitled, deserving of the pleasure of eating. This allows you to find your voice to vocalize what you’d like and how you want it.


When my mother comes to visit from out of state we often dine out for a dinner. Time after time, this is how it goes:

Me: “So what do you feel like eating tonight?”
Mom: “Oh, anything. I don’t care. Whatever you guys feel like. I’ll do anything”
Me: “Really? Anything? You’d be equally happy with Thai food as with Indian? Seafood or salad would satisfy as well as steak and fries? Gooey cheesy Mexican will work for you as easily as sushi and miso soup?”

No, it’s not easy being my mom. I long to hear a passion for food, an interest in truly enjoying a meal, not simply a need to ingest food and limit her calories until she’s full. Like you, I need to be patient.

You'll rest better once you start enjoying what you eat.
At this point, perhaps you’ve progressed to listening to your hunger and honoring it, to noting your fullness, and trusting there will always be a chance to eat again—when you should need to. Now consider this next level, beyond simply meeting your needs for fuel. Challenge yourself to step out of your safe place, slowly moving to truly enjoy what you eat. And release yourself of the guilt of not following rigid diet rules, set either by others or by your irrational self.

Because life is too short to diet.


Friday, September 2, 2011

My Eulogy

Don’t be thrown by the title—there’s no need for concern. I’m not at any risk (that is if you exclude the Swiss Alps hike to the Hornli Hut at the base of the Matterhorn that I’ll be leaving for shortly). And let me confess—I’m afraid of heights and precipitous drops. 

Curious? Check out this link http://www.youtube.com/watch?v=PcoU0dlep6s from ~2mins.

But really. I’ve often thought about what I’d want my eulogy to read, when my time has come. I see it as a kind of blueprint, a how I want to live my life and be remembered. What will my legacy be? What messages will I have conveyed to the people I care about? And yes, that includes you, readers.
I can’t help but think of this as I’m sitting with patients who are struggling with their eating disorder or an unhealthy relationship with food. I think, Is this the focus that you want to define you?

Accomplished?

Beth was an accomplished dieter. She was proud of her ability to keep her weight to XYZ pounds. (I’m trying not to make this triggering). It made her feel she was successful, limiting her foods to six safe items, and controlling her appetite for temptation. It was what she felt she did best.

Beth leaves 3 daughters whom she has endowed with a love of dieting. They are preoccupied with their appearance and are following in the footsteps of their mother. Excessive exercise consumes them, as does a keen determination to choose good and healthy foods. Their eating issues may have had their start in genetics, but their beliefs about foods and their effect on their body, and their behaviors around eating and exercise have, in part, been learned.

Beth could be any one of my many patients wrestling with their eating, before they’ve turned the corner and took control of their disordered eating. They’ve lost perspective about what’s important in life. They’ve forgotten who they really are—their interests, their passions, their dreams. They’re stuck, limited in part by fear—What else am I capable of succeeding with? How else will I be able to manage without my best friend, Food or ED? What would my day and life be like if I had to really live and experience disappointment and pain, as well as pleasure?

Life’s too short to be stuck in this place. If you’re like Beth, it’s not too late to turn your situation around. “Where do I start?” you’re thinking?

Isn't this WOW? Posters can be ordered from their site
http://shop.holstee.com/pages/about

Get your supports lined up to allow you to better nourish yourself. This includes a team of experienced providers—a physician, therapist and Registered Dietitian, as well as friends and/or family members. Keeping your struggle a secret helps you maintain the status quo.

Consider the consequences on those that you love, on those that model your behavior. Yes, I’m thinking about your children, and the children you might plan to have. It’s never too early to shift your thinking and your behaviors.

Ask yourself “Is this really how I want to be remembered?”

Be fair to yourself. Change takes time. How long did it take to develop your current eating issues? You can’t expect it will change overnight. Patience and compassion, my friends!

View from the top of the Matterhorn where I won't be going. I do know my limits!




As for me, I’m planning to push past my anxiety about heights and attempt to reach the Hut. Because I know that the vistas will be stunning and awe inspiring. And because each time I have pushed myself through such challenges in the past, I’ve emerged with an amazing sense of accomplishment and incredible pride. And perhaps, I put this out here to you to be certain I follow through with my plan.