So you think you're recovered from an eating disorder? Take this quiz to find out.

1) Recovery is about weight gain. Period.

The simple answer? 

It just might not be going the way you planned. 

False. Now don't let your eating disorder get all excited, saying "See! I told you so!"

Weight restoration is surely a must for those who have fallen from their usual weight or in the case of kids, their weight for age and BMI curves. That is, their expected pattern of gain based on their age and their weight history. For kids, falling off their usual growth curve suggests a problem. It shouldn't be praised or rewarded, but evaluated. (Pediatricians, did you read that?!) But if someone's weight was high due to unhealthy behaviors such as binging, emotional overeating, or general disregard for satiety, and weight dropped with improved eating and coping, weight gain is likely unnecessary.

Simply reaching a healthy range based on the charts also isn't enough. Perhaps your restrictive eating and suppressed weight began as a young teen, and you've lived for years with eating disordered behaviors. Did you rely on cigarette smoking or other substances? Was your appetite suppressed by ADHD meds? As you recover, weight gain may be essential regardless of what the BMI charts say. Focusing on the weight is misguided!

Your weight may be technically in the normal range, but your behaviors may indicate a problem. You know, like restricting, binging, purging, laxative abuse, compulsive exercise.

Weight is just one component of eating disorder recovery.

2) If I get a period (and I'm not a guy) then my body is healthy.

False

Surely losing your period when you're of age and sex to be getting a period is cause for concern. But getting your period is not evidence that all is well and you have recovered. You may get what seems like a period when you're on the pill, or start to get periods back without all the hormones being back to normal. Or maybe like one adult patient I used to see, in spite of her struggle with anorexia, she managed to conceive and deliver 5 children, never missing a cycle. Similarly, weight may be restored to the appropriate place, but it may take several months for menses to resume. For guys, low testosterone level is a more silent red flag that things are amiss; is resolves with adequate eating.

3) If I can take in enough calories, then I've recovered.

False

Can you eat foods you used to enjoy?

Sure, you will need enough calories to get your body bad to normal function--with a healthy heart rate and blood pressure, without major drops in pressure when you go from lying down to sitting or standing; with normal body temperature and energy level; with better sleep and mood. But full recovery means eating a range of foods and nutrients. It requires eating enough carbohydrates and fats-- not just protein. Recovery, true recovery, demands you include foods that seem scary, foods that you used to love, so that you aren't controlled by them. Like eating some pizza or an ice cream if the spirit moves you.  It means eating bread that may be whole wheat, or white, sourdough or french, without relying on ‘sandwich rounds’ or high fiber, low calorie flatbreads, or “Ezekiel” bread. If you’re truly recovered you can eat foods even if you can't justify them for their nutritional value, even if you don't think of them as "good for you".

4) I've stopped using laxatives, vomiting, and I'm eating better. I'm healthy now that I'm exercising every single day. So surely I'm recovered.

False. Replacing one behavior with another-- in this case, having to exercise to allow yourself to eat-- is also not healthy. Be careful that you aren't just swapping one behavior with another-- even a 'socially acceptable' behavior like exercise. If you feel you can't eat if you don't exercise you have work to do!

Ok. So I am doing fine with all that. But I need to be the one preparing the food. I'm still recovered, right?

I know. This is a scary idea. I will
settle for nourishing you
with words.

Not quite. Full recovery includes some flexibility and acceptance of what you can't control.

It means eating meals out without having to look up the calories before hand, and without having to modify the entire meal according to ED (that said, being vocal about your preferences doesn't have to be disordered. While Sally didn’t have an eating disorder in "When Harry Met Sally" this scene is worth viewing for some comic relief. Recovery is being able to eat a meal without watching the food be prepared, fearing the secret addition of ‘toxic’ ingredients.

Recovery acknowledges that people you know diet or overexercise or are losing weight, and it is what it is. (see husband triggering) And that you stay the course with eating and avoiding behaviors because it simply has to be; because you can be a great dieter-- but it didn't serve you very well being in that place before. And because you simply deserve to feel better.

Not as far along as you hoped? 

Then move your frustration to action. If you've just started on this path, hooray for improving your intake and taking steps toward recovery! Perhaps you're finding other ways to cope, so you're freeing yourself from unhealthy disordered behavior. Maybe reading this post helps you realize that more recovery pieces are in place than when you started. Progress! The point of this piece is to raise your awareness to help you keep going and reach fuller recovery. And to shake up some denial that stands in your way.

Yes, there's hope. See some of the links below.

Any changes to your thinking or eating you still need to make? Perhaps the post below will help to motivate.

Please share your thoughts!

And thanks for reading.

http://dropitandeat.blogspot.com/2011/09/beyond-calories-learning-to-embrace.html

http://dropitandeat.blogspot.com/2012/09/lessons-from-my-final-day.html

http://dropitandeat.blogspot.com/2013/05/do-you-believe-recovery-just-isnt.html

http://dropitandeat.blogspot.com/2012/03/normalizing-eating-and-hiking.html

I'm Sorry. Blame the Bread.

You are owed an apology and an explanation. After receiving a reader's most thoughtful, concerned email I decided I needed to post. I stopped putting out blog posts and virtually disappeared (pun intended), with no warning or explanation. Admittedly, it happened gradually, from blogging 1-2 times per week to monthly to, well whenever the spirit moved me. Why, you ask? For lots of reasons.

Bread

You could say I've replaced one passion with another. Or that I've been compensating for the deprivation of the masses who have chosen a low carb or gluten free lifestyle. Defiantly making and eating bread? Maybe. I've been baking (and eating) sourdough breads and I'm thoroughly enjoying the process, the art, the texture and the taste. And no, in spite of all the carbs and gluten I've neither ballooned in size nor suffered inflammatory attacks (other than from my friends when I don't share these highly desired loaves.)

The vacuum

It's not easy to continue to write posts and get minimal feedback from readers. I know you're out there--my stats prove it--but the feedback is so minimal. And I'm no different than the rest of you; I also care what others think about what I have to say--even if you don't agree. If you've tried to respond but Blogger isn't letting you, than please let me know at info (at) LoriLiebermanAndassociates.com. 

Recirculating misinformation

Writing about nutrition fallacies falls flat. When misinformation gets out, it's most impossible to reverse. I wish we learned from our mistakes--that diets ultimately result in weight gain not loss, that deprivation ultimately will drive you nuts, and that no nutrient group is toxic. And most importantly, that you deserve to eat what you like--in public--and truly enjoy it with all your senses. I started shifting this blog to leading by example--showing real foods and meals, and practical recipes (as in www.food-2-eat.com) which I'm hoping was useful. Like you, I'm challenged every time I hear the craziness from public figures and common folk. It's simply overwhelming and perhaps counterproductive to keep spreading their lies.

The end of DropItAndEat?

I doubt it. But maybe you can offer me some guidance. What would you like to see? And how can you get more engaged, dialoging in the comments?

Again, I'm sorry if my absence worried any you. It's nice to know you missed me.

Does this nutritionist count calories, track exercise on a Fit Bit, or limit her gluten, sugar or carb intake? You just might be surprised.

Time for lunch? Thinking about dinner?  I've gathered a bunch more pics to share from my recent meals. But first I need to respond to a couple of comments and questions you've voiced in person and on the last post.

Lean steak which I have infrequently with grilled farm-fresh
potatoes and watermelon.

Do you think about balancing your day's eating depending on what you ate earlier in the day?

Not at all.  I don't think "I shouldn't have bread again since I had some at breakfast" any more than I think "Oh, I had three fruits already so I'd better have something else for snack." I go with what I feel like, when I'm hungry. 

So you don't give any thought to your food choices?

Homemade pizza topped with artichoke and peaches.

That's not the case either. There's a balance between nutrition information and pleasure/preference that informs my decisions about what to eat. I might have lox at a meal but I wouldn't include olives, let's say, as the sodium would be quite high. And since I have high blood pressure I try to be moderate about my intake. Besides, I think it would be disgusting together. I might have pasta--white, low fiber pasta, but I don't eat a pound of it. I'll add veggies and perhaps a protein source such as chicken or tofu for some balance; the protein and fiber impact fullness which helps make the pasta meal more satisfying.  

Similarly, I'll routinely have a large salad with my pizza or I'm apt to eat a lot more pizza than I need, before recognizing that I've had enough. I happen to love fruit and vegetables so I eat them generously. But my favorite food just might be bread which I eat no less than twice a day. My latest favorite is homemade sourdough.

Do you calculate your calories? And if not, how do you know how much to eat?

I never calculate my calories. Okay. Not true. I did it once after a 2 day bike ride at my husband's request, as he was curious about how our constant eating (and cycling) measured up with our calculated need. In fact, it was strikingly right on--but calculated after the fact; I did not count my calories to limit my intake or determine my portions. When you allow your self to acknowledge hunger and not mask it with water or coffee or deny it until you 'deserve it', and respond to it with food for fuel, the system starts to work just fine.

This is a special meal I prepared from Gramercy Tavern cookbook
featuring halibut, zucchini in various forms and corn salsa.

But you also need to be eating regularly to prevent excessive hunger and impulsive eating. And it helps most of us to control the environment--removing food as a visual trigger to eat. Store food behind cabinet doors, in the fridge or freezer instead. And beware of the impact of other triggers such as alcohol, stress, and mood. Feeling a sense of hopelessness about your eating doesn't help either.

A veggie heavy pasta meal.

Do you think some people are born unable to do this and others aren't? Because I think I'm different, and this simply won't work for me.

No. I felt the same way many years ago when I struggled with a cycle of restrictive eating followed by binge eating. It feels like there's no way out. I don't buy into the addiction model for foods (http://dropitandeat.blogspot.com/2012/09/what-ive-learned-about-food-addiction.html) but I do see that behaviors can be addictive. So focusing on eating behaviors (which I address a great deal on this blog) is key. Search this blog for mindfulness, hunger and fullness to start.

Sure, you can do this because you must exercise a lot. 

Pasta with an indian flare-with some cashews and coconut.

Sometimes I exercise a lot, like when I'm training for my annual fund-raising bike ride. But I usually work out about 3-4 days/week (once is just a walk with you-know-who*), with an additional day of Pilates. In cycling season the rides may be long, but aside from then,  I don't spend more than an hour working out. 

And I don't intentionally adjust my food choices or portions on non-work-out days. I know my body burns calories at rest, even when I'm sitting at my desk for 8 hour days, 4 days a week. 

Hope this helps. Still thinking this is unhealthy? Let's discuss.
And by the way, all the meals above right were dinners, and those below were my lunches. Missing are the frequent PB and P (preserves of all kinds) sandwiches I bring for lunch but neglected to photograph.

A grilled cheese, arugula and tomato. Yes, on sourdough.

That's cheese hidden under the figs, and lox. Admittedly a weird 
mix, but I had little time to make a lunch when I was
running late.

Add caption

Bread and houmous, with yogurt and granola.

Lemony Lentil Stew with goat cheese, served on 2 corn
tortillas. From Drop the Diet www.food-2-eat.com

Yum!

*yes, you know who.

The very low sugar, low fat healthy diet—an oxymoron.

Kristen knew to avoid fats—except for those in nuts (which she included in very limited amounts) and certainly those in dairy and oils. Fats are bad. Period. She loves fat free yogurts, but those she omits because of the sugar. Same with milk, which she truly used to enjoy. Now she uses fortified water aka lite almond milk. Seasonal fruits, even the organic stuff—completely stricken from her diet, you know, because of the sugar.  Whole grains—well those have those god-awful carbs so those are out too. Yup, that leaves… lean poultry and fish and non starchy vegetables.

No wonder meal planning is a challenge.

No wonder she struggles to not binge following a day of deprivation.

No wonder her energy level is low, and her thoughts are preoccupied with food and eating.

Why can’t I decide what to eat?

If you're like Kristen, you get so over-focused on what you shouldn't eat that you're challenged to figure out what to eat.  Your endless food rules about nutrition, weight and health leave few foods to eat—and enjoy. 

I've lost count of how many patients came into my office these last weeks, stating: "I have no idea what to eat anymore. I just can't decide." These are patients of all sizes and conditions—patients with anorexia, and those with binge eating disorder and bulimia; and those struggling with their climbing weight and obesity in spite of their attempts to eat healthy. And they’re all ruled by unnecessary food rules.

Wrong, wrong, wrong about fats!

Like Kristen you too may be fat phobic, in spite of the updated newest guidelines for Americans 2015, which have removed the notion that total fat should be avoided. Got that? There is no evidence to support a recommendation that total fat should be restricted—neither for weight management nor for health and disease prevention. 

Really? How can this be?

At the 2015 Scientific Sessions of the American Diabetes Association (ADA) there was a wealth of research showing that diets rich in fats from plants sources—with nutrients like mono unsaturated fats (think avocado, peanuts and olive oil)—and in omega 3s (think salmon, sword and tuna in addition to walnuts and flax) help reduce abdominal fat distribution which is the greater health concern than obesity.

And, wrong about carbs and weight gain!

Also at the ADA, extensive research was presented concluding that macronutrients—the protein, fat and carbohydrate balance of your diet—ultimately have no impact on your weight. That's right. Numerous large studies including a well-done Harvard study confirm this.

I know, I know, it’s hard to believe when you’ve already been sucked into the misinformation of carb and sugar toxic diets and fat phobia.

You’ve lost sight of the bigger picture. In spite of eating a diet full of healthy foods including protein sources, fruits and vegetables, grains and fats—your calorie intake can become reduced to the point of providing inadequate calories for your day to day need. You get fuzzy headed, feel fatigued and decision-making about food becomes challenging. Rules and restrictions consume you, so you're at a loss to figure out what you can eat. I mean if you know you can’t eat gluten or that carbs are toxic or fats will make you fat and sugar is poison than what's left? How can you choose what to eat when there's so little that allowed?

Remember when you used to simply eat?

Move from micromanaging your foods.

How can you loosen the reins? Start to shift your thinking from micromanaging your diet. Rather than hyper focusing on each individual food item, on every nutrient or component of your intake, consider the bigger picture.

Consider OJ.

I walk through the supermarket noting the orange juice selection. Remember orange juice, the juice of oranges naturally high in vitamin C (and lesser known for its high potassium and folic acid content)? Only now it’s available calcium fortified. And get it with pulp—it’ll make you think you’re getting more fiber, when in truth there’s no difference. Add omega 3s while you’re at it—just get it with fish oils (quite a disgusting thought, personally). My point? Why are we thinking that one food has to be everything to our diet? Can't oranges or orange juice just provide us with the nutrients it's known for?

Must our pasta be whole wheat and protein fortified or be banned from our diet? What if you started with white pasta—yup, no fiber, all carbs, delicious pasta? You don't need to have the whole 16 oz. of it. By itself it's hardly a balanced meal. But surely you can find a solution to that, right?

Yes, you can add vegetables—for vitamins, for volume and texture, for fiber and satiety. Feel the need for protein at that meal? Add a glass of milk, some cheese, some shrimp or chicken or smoked salmon.  See where I’m going? 

Maybe think even bigger picture. Perhaps some meals are higher carbohydrate, but your protein is met from other meals or snacks?  Maybe you had a Greek yogurt high in protein or some nuts, for instance.

It's time to aim for balanced meals and a balanced day of eating, rather than hyper focusing on some 'perfect', ideal foods and eating style. Imagine even including a baked good simply because you enjoy it, as a snack when you’re hungry—contributing to your energy needs for the day, in addition to the wholesome foods you strive to limit yourself to.

Now that’s healthy eating.

Thoughts? Questions? Does this resonate for you? Are you out there reading? Please share with anyone who might needs some reality checking! Thanks!

Why I’m worrying about Vyvanse and Binge Eating Disorder

Seeming quick fixes can be so tempting.

This week’s inbox held the following message from an old patient:

“I was watching Good Morning America and they had Monica Seles on, admitting she's suffered from binge eating disorder (BED). They announced a medication they are now using to treat BED, Vyvanse, also used for ADHD. I looked it up and side effects include weight loss. Have you ever recommended this drug for BED? Do you feel it is effective for BED? Can people with BED take this med to lose weight? Do they think if you have BED you must be overweight and this medication can cause weight loss? Which would perhaps (in their minds) solve the bingeing?

That small ED voice that lurks deep from within is screaming 'get me that drug! Get me that drug!' so I can lose weight. WTH?!"

I’m glad she was brave enough to share what she was wondering, as I’m sure she’s not alone in her curiosity. Aren’t you wondering what this means for you?

Let's start by clarifying a few things about binge eating disorder. Most notable about BED is the recurring episodes of binge eating, feeling out of control while binging, and feeling guilt and shame afterward. People of all sizes live with BED, and the experience of a binge may vary. You might eat large amounts of one item—such as a whole package of cookies—or large amounts from a combination of foods. For some, even eating a single bite beyond what they intended may feel like a binge.

There's a way off the roller coaster--appropriately
named the Cyclone.

The common features among sufferers, though, is the guilt, shame and lack of control accompanying the eating. According to the Binge Eating Disorder Association,  "Binge Eating Disorder (BED) is the most common eating disorder in the United States. An estimated 3.5% of women, 2% of men, and 30% to 40% of those seeking weight loss treatments can be clinically diagnosed with binge eating disorder. The disorder impacts people of all races, levels of education and income — including adults, children and adolescents."

Given the shame associated with BED, however, there are likely many more living with the condition than we know.

Medication to the rescue?

Two recent studies were done using Vyvanse—a stimulant used to treat ADHD—for the treatment of moderate to severe binge eating disorder. They were well-done studies— randomized, double-blind and placebo-controlled—with promising outcomes. 

In one study, participants who binged three or more times per week were treated with either a placebo—a dummy pill—or 30, 50 or 70 mgs/day. Researchers saw a significantly better response to the 50 and 70 mgs/day doses compared to placebo in a study of over 250 subjects with a roughly equal number of controls. Improvements included reduction in binge frequency/week, a higher percent of subjects binge free for 4 weeks, and a change from baseline in the Yale-Brown Obsessive Compulsive Scale Modified for Binge Eating—compared to placebo treatment.

Notable, however were a couple of other outcomes. The placebo group also improved, by 21.3 percent (versus 42% in the 50 mgs/day and 50% in the 70 mgs/day treated groups). Meaning, the belief that taking something could help your binge eating was enough to improve binge frequency.

And then there were the side effects. More than 5% of those treated with Vyvanse reported symptoms including “dry mouth, insomnia, headache, decreased appetite, nausea, irritability, heart rate increased, anxiety, feeling jittery, constipation, hyperhidrosis [excessive sweating].” Twelve patients (5%) on Vyvanse reported treatment-related adverse events that led them to stop the study; 5 patients in the placebo-treated group had such negative effects. 

And then there’s this: “CNS stimulants (amphetamines and methylphenidate-containing products) have a high potential for abuse and dependence.” 

If you struggle with Binge Eating Disorder and are tempted by the positive research results, consider the following before you request a prescription. While medications might improve binge eating, so does addressing some underlying eating patterns and thoughts—without the risks of medication. In fact, since the placebo also improved binge frequency by over 21%, it suggests that the power of believing you could change—with some help—is quite strong with BED.

Yes, there's hope without meds for BED!

Need I say more? http://www.annetaintor.com/

Do any of the following scenarios apply to you? If so, medications for BED may be unnecessary.

1. You restrict your calories throughout the day, trying to be “good”. You deny your body the fuel it needs and by later in the day—often late afternoon or at night—you start eating, intending to eat in control. But then it feels like the flood gates open and you just can’t stop. Perhaps you feel like you’ve already blown it, so feeling defeated, you decide to continue to binge. You’re determined to get back on track tomorrow—with restricting. And so the cycle continues.
2. You eat enough calories throughout the day, but your food choices are very limited—including only foods you "should" be eating based on rules you follow; they may be only high protein, or unprocessed or not very palatable. They are foods that you’re okay with, but that don’t necessarily give you much pleasure. Then, when at a friend’s or out to eat and you eat something to appear ‘normal’ or because you really want it, you have serious regret. Later you continue eating because you’ve already "ruined it", but are determined to get back to your very restrictive, healthy food choices.
3. You truly get enough to eat—enough calories and enough of foods you really enjoy. But most of your eating is quite mindless—you eat standing up in the kitchen, while multitasking—while driving, on the computer or on the phone. So you never truly feel satisfied. And it’s worse when food is kept in sight.
4. You eat enough, you get what you want to eat, AND you pay attention to eat mindfully. But when stress if high, or you struggle with an emotion that’s hard to sit with, your knee-jerk reaction is to reach for food for comfort or to numb out. You may even be completely aware of what you’re doing, but the pull is so strong, because in the short run, it helps. But later, you are left with regret.

If any of the above statements apply, then working with an eating disorder dietitian—together with a therapist can really help. Cognitive Behavioral Therapy (CBT) is a valuable, well-studied treatment for BED, and you can purchase self-help workbooks specifically for this condition as well. 

Learn to normalize  your eating!

Yes, binge eating can be resolved without medication. But it requires dropping the diet and rigidity around eating. Really, dieting simply isn't helping.

For those with ADHD who also binge eat, the medication may be helpful to manage impulsivity—which can lead to binge eating. Delayed gratification—redirecting and waiting to notice fullness—can be too challenging, as is moving away from multitasking.

But using Vyvanse is not without consequences. Decreased appetite may sound appealing but if you don’t know when you’re hungry, it's hard to trust when and how much to eat — making intuitive eating impossible. It may contribute to inadequate intake and food restriction—something those struggling with binge eating may already struggle with. 

Do we need to swap one problem with another?

Further, will doctors inappropriately start prescribing Vyvanse for those who are overweight but not living with moderate to severe BED? Will prescribing seem like the medical quick fix, while failing to address restrictive eating, or deprivation or over-exercising that truly need treatment? 

So, dear readers, please don’t be tempted. But don’t give up hope. Seek out providers that work with binge eating disorder patients because it is in your hands to change.

Other related links you might find helpful:

http://dropitandeat.blogspot.com/2013/05/name-calling-has-its-place-bed-is-now.html

http://dropitandeat.blogspot.com/2013/03/weight-loss-and-recoverycan-they.html

http://dropitandeat.blogspot.com/2013/04/intuitive-eating-is-not-for-youmaybe.html

http://dropitandeat.blogspot.com/2013/03/heres-to-speedy-recovery-maybe-not.html

http://dropitandeat.blogspot.com/2013/04/eating-disorder-recovery-reflections.html

http://dropitandeat.blogspot.com/2012/08/do-or-do-not-there-is-no-try-think.html



http://dropitandeat.blogspot.com/2012/07/forgetting-to-remember-key-obstacle-to.html