Monday, December 31, 2012

It Doesn't Matter Why. Resolving to Change Your Eating Before the New Year.

We all want answers to what's unknown. Why did he have to die of cancer? Why did she get diabetes at such a young age? Why am I struggling with an eating disorder?

Forgive me for being harsh, but it doesn't matter.

Sure, it's great to understand what causes diseases so that we may find a cure and prevent them from targeting and harming more people. And if there were something we can do to protect ourselves from getting sick, wouldn't it be valuable to know. But on the personal level, it doesn't matter why or how you developed your unhealthy relationship with food. Practically speaking, it changes nothing. You still need to eat.

If a child is diagnosed with Type 1 diabetes, requiring regular insulin injections, it doesn't matter why. And it doesn't matter if they hate the treatment—the frequent injections to remedy the body's failing production of insulin. It's simply non-negotiable.

For nine years I had to self inject with a medication for my MS. Three times per week I administered those painful injections. I had no idea why I developed MS and there remains no cure but quite frankly, it didn't matter. What did matter is that I needed to do whatever I could to preserve my health. I could complain about it, and I could feel upset, but the fact remained the same—I just had to do it.

You know where I'm going, don't you.

If you're stuck ruminating about who caused your eating issues, it's time to move on. If the focus of your treatment is about simply understanding the why, it’s time to redirect. I’m not suggesting that these aren’t interesting questions to ponder. Being aware of how your disordered behaviors meet some needs may contribute to long-term changes in the way you use food to cope. For instance, it may be valuable to recognize that food restriction is your drug of choice—that it allows you to numb out and disconnect and avoid feeling those things you’d rather not feel— and then to learn more constructive ways to manage in challenging situations. Perhaps you identify that you never express yourself and share how you feel, so food restricting becomes the way you bottle up those feelings. There is certainly value is making connections between your thoughts and your feelings about food and your eating.

That said a poorly nourished brain fails to allow you meaningful insights. You look through your distorted lens, with rational thought left behind. Yes, it’s a bit of a catch 22; you need to eat to gain insight and understanding as to why you struggle to eat, which you struggle to do in the first place. This is where accountability is key—to your treatment team, family member or a close friend or partner. (And if you aren’t holding yourself accountable with this support, you may need a higher level of care.)

If you binge eat, following restricting, you can’t expect that you will be able to use much insight when you’re ravenous. And your belief in your ability to take charge of your eating will be quite low. You can’t blame yourself for your lack of willpower when you place yourself in unreasonable situations, such as expecting to eat mindfully when you are starving! Normalizing your eating needs to be the highest priority!

For binge eaters who don’t restrict, insight into how you’re using food is essential. And learning alternative strategies to manage in difficult situations and to endure challenging emotions will help you break out of your food fog.

But regardless of which group you fall into—restrictors, restrict/bingers, or binge eaters, you can start by recognizing how in the big picture, your eating disorder is quite ineffective in getting you to a better place in life; it has little positive impact—except in the moment to help you disconnect—managing your stress, anxiety, social issues, work and school trauma, to name a few. And that benefit is short-lived! In fact, I think it’s fair to say it only compromises your ability to cope! And if you were to make an honest list of the pros and cons of continuing with your eating disorder, you’d see that the cons far out weight the benefits of holding onto your disorder.

Even if you hate food records, consider recording just your thoughts, feelings and hunger level—along with the time that you ate. Yes, you can even omit what you ate in your record, because that’s really beside the point. But eating remains the key ingredient to recovery! Without eating adequate amounts of food, you will stay stuck.

Does this sound like a New Year’s approach you can live with? If so, make a point of starting today. Yes, if you’re really ready to move on, you can start on the December 31st!
But if it’s already 2013 when you read this, it’s still not too late!

Sunday, December 23, 2012

Measuring Progress with Gingerbread & Other Tales of Eating Disorder Recovery

But only if you do your part!
It was the shortest day of the year, the winter solstice, and it was a dark and rainy day here in the Boston area. And I was home sick with a bad head cold. It was enough to put me in a rather gloomy mood, if it weren’t for some bright spots from this past week that lightened my mood. Perhaps they’ll brighten yours, too.

Hannah had not had the easiest time these past several months. Besides her eating disorder, which ranges from anorexia to binge eating, she’s been struggling with depression. Yet after many months of working with her team her progress shined through.  No, I’m not talking about measuring her progress in pounds—her weight fails to reflect the recent progress that’s just starting to emerge. 

Ahh, the feeling of eating and trusting it's going to
be okay...
Rather, I heard her describe for one of the first times, her interest in food—in its taste, and in its texture. I heard her say that she realized that she actually didn’t like some of the things she had been eating, and I heard her talk about her food passions and preferences. Yes, Hannah is finally allowing herself to taste what she’s eating, and to select foods she enjoys the taste of. This is progress!

Then there was Sammie, who bought my book last week—Food to Eat, co-authored with Cate Sangster— and at her follow up visit on Tues. this 20-something-year-old came in all excited. She had prepared about 7 of the recipes, from Cate’s Muesli Bircher to the gingerbread. But more than that, she actually ate them all! (Not all at once, I’ll add!) And she reported loving each and every one of them.
Rye Pixels Copyright. 

She told me about her love of baking—something I knew nothing about—but confessed that she had not previously ever eaten the baked items she labored to prepare. No, not since she’s struggled with her eating disorder. But this week was different. And having broken the ice and done so once, she’s increased her confidence that she could do so again. She trusted, she told me; she felt like she knew what we were saying was true and that it was okay. And it worked.

Are you ready to challenge yourself and break with your routine? Bring a little light into these dark days by challenging yourself and trying something different. I’m attaching the gingerbread recipe—I baked it Friday with the lemon icing and it was divine! But with or without the glaze, you can’t go wrong.

It’s not too late to start to change. All it takes is the first step.

Let me know what you think.
From the recovery cookbook Food to Eat, one of 25 sensible and tasty recipes.

Saturday, December 15, 2012

Overeat, Restrict, Over-exercise—Just for now?

It may make you happy for now but...
Dana used to tell me she'd allow herself to eat "whatever", just until the holiday season was over, and then she'd buckle down and resume her restrictive approach to food management again. 

Rob cancelled his November appointments, preferring to wait until after January 1st to begin to improve his eating and his cholesterol level. And Stacy continued to restrict—in part because she knew that after her next doctor visit in a few weeks, she was going to be held accountable for her actions. Yes, she was going to need to turn her eating around or she'd be finding herself in a rather unhealthy predicament.

If you're like my patients and thinking you'll get by just for now, whether you'll continue to drop a few more pounds before you start normalizing your eating or you continue on your path of overeating, it's time to face the facts—you're not really planning to change. At least, not for long term.

I know, I know, you really do want to change. You may, like Dana, hate how challenging it is to do the simplest tasks, and how incompetent it makes you feel being foggy headed and spacey. Like Rob, you may be savoring what feels like your last supper, your last chance to get it all in before you take your diet seriously and have to give it all up. Or like Stacy, you may fear the consequences of eating enough—even if you know it's the right thing to do, for both your physical and mental well-being.

The truth is, this approach of just for now will do nothing to improve your relationship with food. If you continue to feel like it's your last chance to indulge, then plan to refrain from your favorite foods, you'll find yourself deprived. Sure, you'll do fine for a while—even a few weeks—until you're exposed again, or have a weak moment, a triggering situation. And then once your guard is down you'll overeat, again determined that it will never happen again.

And if you starve yourself or restrict your intake, fully intending to get your self back on track—once you drop the weight, that is—the behaviors that result will be anything but normal.

Putting off change-now that's a big mistake!
If you're serious about change, it can't wait until Monday—or for January 1st. And when you have a slip, you need to wrestle with it now and learn from it.  Ask yourself  "What happened here and what can I do next time to prevent this from happening again?"  But then you've gotta move on. (I say when not if you slip, because the truth is, slips do happen—so brace yourself.) You can't make it a slide until the first of the year, thinking you've already ruined it.

Please don’t wait until 2013 to resolve to change. Because if you're really serious, the change can and should start now.

I know it's hard, and I know you're struggling. But its not going to get any easier with the passage of time. So use your resources and start moving forward, won't you?

Thanks for reading.

Friday, December 7, 2012

Body Wraps, Toxin Removal and More: What I Learned at the Gym Today

I'd much rather be hiking...

It's hard enough starting at a new gym. Generally, I dislike going to gyms, preferring instead to enjoy a long bike ride, a hike or a cross-country ski or snow shoe when weather permits. But living in New England, there are times, like now, when conditions are simply not favorable for either of those activities.

So off to the gym I went, attending my first spin class of the season, at a new gym with a new instructor. And I could barely get through it. No, I am not that out of spin shape—although those cycling muscles certainly needed a workout. Rather, I was feeling my blood pressure rise as I sat through the marketing pitch and endless misinformation by this supposed promoter of health—the spin instructor.

I'm still headachy from it, so in truth, I am blogging to air my annoyance and frustration.

You know me be now—I am not shy to share my opinions, particularly those I feel strongly about. But this was a challenging setting. Jane, I'll call her—no, Barbie better suits her—stood before the class of about 35 cyclists confidently spewing her crap. Misinformation spilled from her mouth with no objection from the group, until I, a newcomer there, just had to speak up. But it was hardly the forum to debate in, and my rebuttals could be endless if I countered every outrageously false claim about weight loss.

No, neither body wraps nor green
powders will remove body fat.
She endorsed a powder she was selling with her personal testimonial about how she believed it really helped her, as it releases the toxins from the body, those horrible things which fester and cause disease. (Toxins, by the way, are released from our bodies every day, with no need for a product to make it happen.) And it gave her natural energy and promotes weight loss. (For the record, calories are the form of energy we get from foods; a product with no calories has no energy, although you may get a short-term boost from stimulants such as caffeine.) Then I heard her endorsement of the body wraps for sale, which essentially shrink your body a size or so overnight! All without dehydrating you! And finally I learned that you should be drinking half your body weight in ounces of water each day. 300 lbs? That's 150 ounces each day of water, about 5 liters or quarts per day.

So why am I all upset, you ask? Where shall I begin?!

  • because while for me it was simply an irritation (and a big one at that), I know how others will be lured by this misinformation, sold products with false claims, sucked into unhealthy thinking and potentially dangerous supplements; more misinformation makes sensible thoughts a challenge;
  • because she was speaking to a group of completely normal weight individuals, none of whom could afford to lose weight;
  • because no one should be sucking down water or non-caloric beverages instead of eating when they need fuel, simply to mask their hunger;
  • because she's setting people up for failure and unrealistic goals, luring them for her personal financial gain, to buy a product, in the case of the wrap, that at best may contribute to a decrease in hydration for a temporary appearance or short-lived sensation of lightness;
  • because if we each spoke up every time we heard something we know to be false or inaccurate, then maybe we could make a difference!

Yet another gym promotion. Uggh!

There, I feel so much better now. I think I'll go have dinner, now that I can more calmly and peacefully enjoy it.

Thanks for letting me rant!

Sunday, December 2, 2012

Thinking the Work is Complete Now That Your Weight Has Changed?

Lessons from co-writing Food to Eat: guided, hopeful & trusted recipes for eating disorder recovery.

Last week I saw a new patient, a 50 something year-old overweight woman who presented with the stated goal of improving her health—and taking control of her escalating weight. Her body language and her attitude shouted ambivalence—or more accurately, defensiveness—and within the first quarter hour she had me on the defensive, too. Not too much rocks my boat, given 26 years seeing patients, including those who'd rather not be there. But the accusatory tone in which she asked about my weight history startled me. While not speechless (imagine what it would take for that to happen!) I was certainly at a loss to articulate my credentials to help her in a way I thought she could hear. Perhaps even expecting that she would hear was setting an unrealistic goal.

Can I ever REALLY know how difficult his life is? Or what he's thinking?
What could I possibly know about her weight struggle, was what she implied. How could I—a slim appearing, seemingly confident person  know about her challenges? Who am I to be giving advice? Well it wasn't the first time I had heard such questions, but for some reason her's threw me off guard. How do I begin to explain that my weight has nothing to do with my knowing, and with my ability to help? (Do I need to share my personal struggle with weight—which I openly discuss in my new book, Food to Eat, coauthored with Cate Sangster—which should have no place in our session about her?)  

What does weight have to do with it?

And if I had been a fat nutritionist, would that have validated my skills in guiding her on her recovery path? I suspect not, as I have heard many a criticism of dietitians' weights that has made me cringe over the years. That is, unless they were able to look past size and weight bias and hear the value of my words, as the Fat Nutritionist proves worth doing.

For those of you struggling with an eating disorder, you may feel similarly. Just because you are weight restored or nearly so, doesn't mean your disordered thoughts have abated. My co-author Cate, even when in a physically healthy place, is no stranger to these intrusive thoughts. And she shares them so openly with raw emotion—exposing her fears and her wishes relating to food and eating. But what does the public know when they see Cate or you on the outside? No, it's not just the stereotypical 60-pound-anorexics that suffer from eating disorders.

And what assumptions, what projections do you make, about what they are thinking about you? Do we have any idea what anyone struggles with unless their appearance is extreme? Would people know I live with MS when I am not wheelchair bound nor walking with assistance? Do they know about your closet eating? Your food hoarding? Your bulimia? Your obsessive calorie counting and weighing and body checking?

Being exposed.

In a similar way, completing the book leaves us both vulnerable. How will it be received? Will it look good? Will it be criticized and viewed as flawed? Will it be taken seriously? Will it have been worth the struggle to do the work? Will readers, like last week's patient, wonder what we could possibly know about the struggle to improve your relationship with food?

Can you even see the distortions?
I think not. Cate and I have been painfully honest, sharing—perhaps for the first time—about our own histories and relationship with food. We are not naïve enough to believe that this one book will solve your eating disorder—your bulimia, anorexia or compulsive overeating.  But we believe deeply that it is immensely valuable in changing your thinking and getting yourself eating with more peace. In spite of our fears, we've put ourselves out there and have taken the risk of exposing ourselves.

Quite frankly, I never dreamed that experts in the eating disorder community would take the time to thoroughly review our book. And then to provide valuable criticism that would really enhance it. I certainly didn't expect to receive the praise we got. Really, I am humbled and flattered beyond words.

I owe thanks to Laura Collins, author of Eating With Your Anorexic and a leader in supporting families living with eating disorders, for pointing out our blatant omission of families—both as a target audience for the book, and in their role supporting those struggling to prepare food and to eat.

And to Dr. Lydia Shrier of Boston Children's Hospital Adolescent Clinic and Harvard University, for highlighting our need to think more broadly about genders and partners and spouses in the book.
To have virtual strangers and mere professional and cyber acquaintances—Dr.Cynthia Bulik, the well-published researcher, author and public speaker; CarrieArnold, author of Decoding Anorexia, known to me from her ED Bites blog; Dr. Suzanne Gleysteen, with whom I've shared so may eating disorder patients; Dr.Therese Waterhous, a dietitian at the forefront of the eating disorder field; Dr. Wendy Oliver-Pyatt, from Oliver Pyatt Centers; and MEDA, the Multi-service Eating Disorder Association—think enough of Food to Eat to write fabulous, glowing reviews, exceeded all of my expectations.

Getting exposure?

Flying high, but feeling rather vulnerable.
Won't you provide the safety net?
I believe in Food to Eat and its value like I believe that recovery is possible. I regret that, due to its beautiful printing is full color, it needed to be priced to cover the large costs of production and distribution to Amazon and bookstores. (Purchases of the print version outside of Create Space and Amazon yield a shared profit of $.04, for the record!). We do not expect to get rich on this project, which has taken the two of us almost a year to complete. But we do hope to make a difference.

Can you help? If you buy a copy via Kindle or Amazon, will you kindly write a review? And if you buy it through Create Space please add your review to our comments page on
Can you demonstrate the power of social media, and share a link or a comment on Facebook, or Twitter, Pinterest or Google Plus? Or even on your blog if you write one?

And please contact me or Cate with feedback on the book, any feedback. Yes, we all need to be prepared for criticism!

Thanks for listening!

Sunday, November 25, 2012

Obsessive Workouts and Protein Powders: How Concerned Should We Be?

Reactions to the NY Times article and the Pediatrics study on teens and muscle-enhancing behaviors.

I'm bothered by something I read. "Compared with a sedentary lifestyle of video games and TV, an obsession with working out may not quite qualify as a health hazard", as stated in last week's NY Times article. While the article brought to light the silent struggle many boys deal with—or rather, don't deal with—their obsession with weight training, dietary modification and steroid use to achieve the 'perfect' body—it failed big time in educating readers about when to be concerned, and what we can do to prevent this unhealthy trend. But this is not just about boys—the Pediatrics article identified that girls, too, are taking steroids and more frequently protein shakes to increase muscle mass while pushing activity.

Yes, teens, both boys and girls, have become more focused on increasing their muscle mass. "Strong is the new skinny" is a current sentiment; neither being healthy nor slim is good enough. The bar has been raised necessitating increased muscle mass to change one's appearance. And the price they pay is far greater than suggested in the Times' quote above.

Lean and muscular, yes, but nor much of a sex drive!
But how big a deal is it if a teen—or an adult—takes a supplement or pushes their training to change their appearance? The actual study, in my humble opinion, did little to differentiate unhealthy disordered behaviors from more innocuous ones. What's the issue with weight training to increase muscle mass, any way? What's the harm in your taking a protein shake to bulk up your muscle a bit? (Steroid use is another story, and that is well addressed in the Times article.)

If you're like twenty-three year old Nathan, it's quite a big deal. He relied on the gym-endorsed protein powders, "to promote muscle growth". All things high in protein were considered safe—if they were also very low fat. Despite my urging to reduce his exceedingly high protein intake, and to liberalize his intake of fats and carbohydrate, his kidneys began to fail, struggling to filter the extraordinarily large load of protein waste products. His thoughts were all consumed with when he'd be able to get to the gym and when and what he'd be eating next.

But this is not solely a male thing, as the Pediatrics study shows. Girls, though, are more likely to modify their diet, while boys will increase their gym training to 'meet their needs'.

And what if it were high in carbs?
Like Karen, you may be spending more and more time at the gym while restricting your intake, ultimately finding it too stressful to live life with school and work demands, along with your rigid workout regimen.

Certainly, drinking protein supplements is not itself a cause for alarm. But relying on shakes in lieu of real food is. It impacts our ability to socialize, to be flexible in eating situations and to get all that we need nutritionally. A diet devoid of fats and carbohydrate will be deficient in much-needed nutrients, and typically in calories. A sense of deprivation often results, accompanied by obsessive thinking about food and eating and weight.

As for the workouts, where do we draw the line about what is healthy and safe, and what is excessive? If you're in a community of triathaloners, marathon runners or iron men/women, a few hours at the gym will seem inconsequential. 

But is it driven by a preoccupation and distortion that anything short of a few hours will leave you fat or unfit? Many of my patients believe falsely that working out is always a good thing. Nothing can be further from the truth. When intake is inadequate, working out not only won't build muscle mass, it will help break down muscle to convert it to fuel! And when net intake is substantially less than need (either because of very high activity or low intake) metabolic rate slows down, so you burn fewer calories 24/7. Certainly not what you intended!

Surprisingly, there was no mention of the low testosterone levels that result in males, similar to the drop in hormones seen in females with anorexia. Tell this to those boys and it might motivate for change. Sex drive drops, facial hair diminishes and risks to bone density increase as well. For boys in their growing years—which might last until 18 or 19 years—the consequence may be stunted growth. And the opportunity for catch up is lost once the bone growth plates have closed. Most boys and girls do care about their height, but do they realize this may result?

And what messages are we conveying to our kids with their school BMI screenings? Are we faulting them for their high BMI (which will remain high as muscle mass increases and height fails to increase)? Or are we fairly looking at an increasing BMI percentile for that individual as a possible marker for unhealthy behaviors—be it steroid use resulting in rapidly increasing muscle mass or binge eating? Are we presenting being obese as so horrific that even if their behaviors are healthy, we tell them they need to lose weight? Is a drop in BMI in an overweight child healthy if they starved themselves or compulsively exercised to get there? 

Shouldn't we be screening with questions about thoughts and behaviors, not just BMI?

Are we reinforcing their interest in fitness because we perceive it as healthy—no matter what? Do we share the same distorted views about all things protein-rich being "good" while villainizing carbohydrate-rich grains and fat-rich foods, too? Are we contributing to the misinformation they hold fast to? Why don't we recognize that there is sometimes pathological thinking and behaviors that drive extended workouts and dietary changes?

I don't have the answers.  But I do know that we are influenced by cultural standards of beauty, and that these images have become more and more unattainable. Yes, without steroids, you can't possibly bulk up like many of your weight-lifting role models, nor can you be both healthy and low weight as the air-brushed magazine pics would lead you to believe.

Something has to change. And it can start with you. Add your comment. Share this piece. Counter misinformation and acknowledge unhealthy behaviors—even when society fails to.

Consider these older posts for more information on topics covered in this post: