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:

Saturday, November 17, 2012

Cupcakes for control—A healthy strategy for weight management

No need to wait until the holidays for a slice of pie.
What if you ate what you liked? No, not just ate what you liked but accepted it as ok, too? And what if you allowed yourself to eat enough of it? What if you ate as much as you needed to satisfy your hunger?

Imagine you actually notice your hunger. The signal becomes clear to you as your stomach begins to growl. Then you get annoyed, angry with yourself for feeling. You want to deny the hunger.  You start counting down until the right hour has arrived to eat, to justify the fuel your body begs for. You're angry that your body is fighting with you, telling you that you should eat, that you need to eat, while your thoughts fight back. I shouldn't need to eat—I ate yesterday! I ate too much earlier today! I didn't exercise! I don’t want to gain more weight. I don't deserve to eat.

Well I'll tell you what I argued back, in a session earlier this week: "Don’t expect that you can have it both ways; that you can easily stop eating when you've had enough, while not eating when you haven't had enough! Don't expect that you can deny yourself food and still feel well fueled over time. No, that's just not going to work for you." Ultimately, we need to respect our hunger and to get enough.

"But I should choose healthy foods, right?"

If you only eat what you think you should eat, omitting what you'd truly love to eat, you will keep yearning. You'll have the popcorn, then the fruit, then a yogurt and ultimately the cookies. And not just one cookie. And not just a comfortable amount of cookies. Because even though you're eating them, you're thinking and believing you're not supposed to be. So you shovel them down. You neither taste them nor enjoy them. You'd rather not even feel them. Then you set the unrealistic goal that tomorrow (and the day after, and the day after that) you will not eat sweets, or carbs, or white flour, or fill-in-the blank.

It looked beautiful—the low-fat chocolate soufflé that my husband decided to make, prompted by the professionally photographed image on the cover of my nutrition magazine on our kitchen table. But the taste? Yuck. So after one or two bites, I left it. It made me yearn for the rich, satisfying, molten chocolate desserts my friend Amy makes. What a disappointment. (Now that's not to say there aren't great, satisfying yet reduced calorie desserts, mind you. I've got some really good ones in a soon-to-be-released recovery cook book, in fact).

A patient of mine recently said, "No spray paint supermarket cupcakes for me—if I'm gonna have them, they're going to be good ones from a great bakery." Yes, even full fat desserts can be a let down at times. Last Thursday I was served some of those tasteless, mass-produced brownies at a function, and I couldn't get past a single bite. I came home, still hungry after the yummy vegetarian entrée I had there, and ate a small bowl of dark chocolate chips, peanuts, and raisins—my go-to when there's no fabulous baked items available. And that hit the spot. I sat at the table, and I enjoyed them.

I'm bragging a bit; I want you to know that it's ok to eat what you like, and to taste it, and truly enjoy it. And that you can leave what you don't like—as long as you're still meeting your needs. (And that doesn't mean leaving what's not 'safe'—that's a very different story. You know who you are.) When I hear patients describing how fabulous something tasted—how much they enjoyed a particular dish or meal—I know they've made progress. That is, if they allowed themselves more that just a bite in a pathological restrictive way that's far from healthy.

Waiting patiently for a satisfying dinner.
When I came home from that 'brownie-evening' out, I noticed that Mica, my dog, had not touched his food. And then I realized. I had placed dry chow in his bowl earlier that afternoon, but had not mixed in his usual and preferred wet food. He was hungry for sure—but you know, dry food alone just doesn't cut it. So he waited patiently for me to return and feed him what he really wanted. And you know what? He even left some food over when he had had enough!

Sometimes when we're hungry we eat for the pleasure, while sometimes it's just for the fuel. When my son was a nursing infant I experienced for the first time eating to live. I often ate simply for the fuel. I got hungry frequently as a new mom juggling my infant's needs and my own and I needed to eat whatever was convenient. I got hungry and I ate anything. Similarly, when I'm hiking or biking I eat to fuel. I'm just looking to get enough, and it's not for the pleasure of eating, but strictly for function. While most other times I eat, in part, for the experience.

Moving forward.

Visions of cupcake vans? Time to allow yourself to eat some!
Does this post resonate? Start noting when you get hungry, and how you respond. Do you honor your hunger and eat? Do you count up your calories to see if you're allowed to eat? Do you check the clock to see if it's acceptable? Put aside those rules and work on responding to your hunger before it gets extreme or you miss your 'window of opportunity'.

Make a list of what you like to eat. And make a list of what you allow yourself to eat. Then start moving things over from one list to the other.

But don't just eat it. Eat it mindfully. Eat it peacefully. Eat it with all your senses. See it. Feel it—the creaminess in your mouth, the granular sugar on the surface. Smell it and hear it. Yes, note the crunch of the chips, the chewy sound of the chocolate caramels. 

And of course taste it. Really taste it and enjoy it. Because honestly? It's going to be fine.

Wednesday, November 7, 2012

You Can Pull It Off--But It Won't Be Pain Free

What Nobody Tells You About Eating Disorder Recovery

Ever have a bad wound that you covered protectively with a large Band-Aid? Then you decide to just pull it off and ouch it hurts! There's that darn adhesive that clings tenaciously to your skin and mini hairs. And there's the sensation of being exposed; the injury is fresh and even small bangs or temperature changes impact it—it’s just so sensitive—and the sensation of clothes brushing against it feels awful. And don’t you hate the way the wound can look?
Well, in many ways, this analogy applies to removing your eating disorder behaviors.

Perhaps with the Band-Aid, you've come to expect that there's some discomfort, and you know at some point the bandage no longer works and has to be forcibly removed. Peeling off this layer may leave your injury exposed, but over time it allows you to heal. But your eating disorder? Did anyone warn you that it might not feel so good to remove it, to move in a healthy direction?

It's time to come clean. Yes, pulling away the protective layer of eating disorder behaviors doesn't necessarily feel so great. In fact, it can feel like crap. In part, because you start to feel—emotions, positive and negative—as well as physical sensations. 

And feeling things you'd rather not experience is no picnic. If you've been restricting and now begin nourishing your body, you'll start to be more present. You'll notice your hunger again, and that increased hunger may be rather scary. You may feel that you have no ability to manage this hunger, that it will simply spiral out of control, getting stronger and stronger. And starting to eat again after a restrictive mode can cause physical discomfort, as food takes longer to move through your digestive tract compared to when you were eating normally.

But it gets better. Really it does.

You may be surprised to find yourself feeling sad, or even more depressed than you’d been when actively engaging in eating disorder behaviors. No surprise. It’ll take some work with a good therapist to learn to sit with those feelings, and to discover that they too shall pass.

But it gets better. Really it does.

Why bother recovering, then, if it’s a painful process? How do you get yourself to do something that may feel so bad—at least at the start?

It may help to remember that it also feels terrible on many levels to maintain the unhealthy place you’re at, and that the risks are quite high. Need a reminder?

The physical ones include risk of sudden death, regardless of where your weight is at. You can be bulimic and have a shift in your electrolyte balance causing sudden heart problems and death. (I kid you not). If you’re the restricting type, it may be a longer, slower move toward permanent damage, with a decrease in your immune function, making you more susceptible to infections, a slowed heart rate, low body temperature and decreased kidney function, to name a few. It may take a great deal of effort to move through your day, although you likely have forgotten just how much better you can feel—since this is what you’ve come to view as normal.

The cognitive changes include the challenges of processing information and difficulty working, studying, and parenting. Your thinking becomes distorted with food restriction and you’re more likely to start ruminating with obsessive thoughts.

Need I describe the mood changes? Ask any loved one and they’ll describe the irritability, self-loathing and isolation that result from your tortured relationship with food. Depression and anxiety may have preexisted, but they worsen. And of course hopelessness overcomes you.

Is it really better to stay where you're at, patched with your Band-Aid, out of fear of feeling, or fear of failing at recovery?; to live life as an out of body experience?; to not fully enjoy the company of loved ones and close friends?; to not be there for your beloved pet?

Eating enough, and moving from binging is neither painless nor easy. But improving your quality of life, and realizing that there’s more to you than your eating disorder is something worth doing. And if you need help pulling off the Band-Aid, reach out for a hand. If things have gone too far, it just might be time to allow others to start lifting up the corners.

This post is dedicated to an old patient of mine who recently resurfaced and asked for help. At her first visit, she pulled out a quote she had typed up and attached to her recovery binder—a statement I made to her several years back when she was struggling. “I’m still not giving up on you”, it said. And I’ll say the same to you. It’s not yet too late to turn things around, unless you refuse to reach out and ask for help.

Let me know how it goes.