Don't wait for an earthquake to shake you into action.

I was talking to a guy from San Francisco this week, and the subject turned to earthquakes. This long-time SF resident and survivor of the big quake of 1989 offered some very practical advice for me to share with my son, a San Francisco newbie, fortunately naïve about the seriousness of going through an earthquake. His focus was not on what to do during the crisis—although that advice is critical as well—but rather what to do before hand. How to be prepared for this challenging situation, because being prepared, as he put it, is the surest way to increase survival.

Imagine that while sitting and discussing such matters my mind moved to you, my dear readers. No, there’s no need to worry about earthquakes for most of you. Rather, the subject of preparedness as a means to ensure survival and minimize damage struck me as most fitting—whether you struggle with an eating disorder or living free of diet rules.

Have a plan, he said. In San Francisco that might mean knowing which are the secure places to hover—the solid doorways and tables to stay under. But before it strikes, he emphasized that it’s critical to have an action plan: to keep cash on hand—because you never know when you’ll need it and ATM machines simply don’t work in these situations. Have a plan for communicating with those you’re close with—because electric doorbells to apartment buildings will fail and telephone lines other than landlines will fail. A transistor radio helps you connect with the world—to reality check what’s going on outside of your own limited space. You’ll need light of course—so batteries and flashlights need to be stashed to access easily.  And of course a supply of non-perishable food as well as water. Decision-making when undernourished will surely be compromised.

Time to come out of hiding and ask for what you need.

You can guess where I’m going with this. Yes, the analogy applies to you who are metaphorically on no greater solid ground. Communication is key to survival, and planning for opening these channels is critical. Can you tell your partner you’re struggling? Can you ask for help shopping and cooking to ensure your health and nourishment? Can you simply say “I need a place to eat dinner tonight?” Can you ask them to keep the pastries off the counter when you are trying to avoid impulse eating? Can you ask for a referral to a therapist or a behaviorally oriented dietician?

Where’s your transistor radio, so to speak, your exposure to the world outside of your own thoughts? Admittedly the cultural media may not be the most fitting reality check for sane thoughts, for diet-free messages, unfortunately. What I mean is that you need exposure outside of your own disorder thoughts—someone that can ground you when you are limited inside your own space. Were you really happier when you were so much thinner? Did staying on that crazy diet truly improve your quality of life? Your mental health? Or are you using magical thinking like the way we recall old boyfriends/relationships, fantasizing about how awesome it all was--when really it was nothing of the sort? Do you think you’ll restrict just for now and then be able to simply normalize your eating? Think again!

Do you have a grounding place to run to—your doctor, therapist, dietician, perhaps even a higher level of care—if your foundation is shaking? Do you have ready to eat food for when resources are tough to come by? A reserve for when, due to all the stress, your ability to organize and think through what’s best to eat may be impaired?

Where will your light come from when the power goes out? Do you recharge with talk therapy, or maybe yoga or meditation? Do you get spiritual support or guidance from wise friends or loved ones?

You may get no warning before the quake, before the shake up to your healthy behaviors and thoughts. So have a plan. Be prepared.

What steps will you take? Please share—we can all use to hear some ideas!

Read more about slips and relapses:

http://dropitandeat.blogspot.com/2011/08/so-you-really-think-i-can-keep-this-up.html

http://dropitandeat.blogspot.com/2011/08/hope-or-despair-only-you-can-decide-but.html

http://dropitandeat.blogspot.com/2011/11/quick-fix-for-your-struggle-with-eating.html

http://dropitandeat.blogspot.com/2010/12/new-years-resolutions.html

Want to know how much I ate today? The pros and cons of comparing your eating to others’

Today's breakfast-crepes with sauteed fruit,
melted chocolate drizzle and vanilla yogurt.

When I was little, I mean, when I was young, (I was never particularly little compared to my peers), I recall a recurrent argument with my mother. “She can have it/eat it/do it—so why can’t I?”, I’d beg to know, to which she’d respond something like “If she jumps off the Empire State building does that make it okay for you too?” (Yes, I’m from NY and that was the tallest building back then.) Her point, of course, was that what’s good for one isn’t necessarily good for another. And if you’re going to compare, be careful.

Which gets me to you and your need to compare yourself to others; and more specifically, to compare your eating and your weight.  So what do you think—helpful to compare or harmful? Is it okay sometimes, or must you be consistent and never compare? Does it matter if you’re under eating, or if you’re overweight or is it simply dangerous?

Does it really matter what I eat (or anyone else, for that matter)?

Well, yes. To be honest, that’s why I include all the so-called food porn on this blog—beautiful images of delectable foods—all of which I am personally eating. Perhaps it shouldn’t matter. I mean I can give you sensible guidance regardless of how I choose to eat. But knowing that someone else is eating cookies or including carbs, or adding fats—things you just might fear—and is perfectly fine, reassures us. Viewing a peer’s eating as they’re comfortably eating ice cream can help motivate. Yes, normal, healthy people can and do eat ice cream. Seeing this can help increase your flexibility around foods and food categories—and that surely can help you change your relationship with food.

Yet it’s rather unprofessional to suggest that because something is fine for me that it’s fine for you. When I make my recommendations, they are based on my clinical experience—my 28 years in the nutrition field—and my knowledge of nutritional science and the limited research we have to work with.  What’s fine for me, isn’t necessarily right for you; I might include lots of veggies daily, but for you that added volume might be a challenge, making it difficult to meet your calorie needs. I might make most snacks rather calorie rich—when I’m out cycling or hiking for many hours and I’d rather eat smaller portions at each snack for convenience—this may be unnecessary for you; I’m almost 5’8 and my weight is just fine where it is, but your needs may be different—based on your height, your bone structure, your muscle mass, perhaps from years as an athlete, and your needs to normalize your weight to support your health.

Be careful!

My lunch. Looks big, right? Two pitas 'cause they were those too-light-be-
adequate 80-calorie ones. Certainly larger appearing than my husband's!*

When comparing to others, you might think—“She’s only eating a salad, why is that not okay for me?” or “Why do I need to work out when none of my coworkers do?” You may look at a friend and wonder how they can eat whatever they like when you have to be more mindful, or else your weight climbs out of your healthy range with no effort. Patients get frustrated when they report that their coworkers eat fast food and “junk food” and their weight is just fine, whereas they have to work hard and watch everything they eat. But they aren’t with these coworkers 24/7. Who knows what happens the rest of the time. What you see is a small slice of time, which may or may not reflect how any individual really eats.

Maybe they eat lighter when others are around—but make up for it in private. Perhaps they eat more only when they’re out with friends like you, but restrict when they are alone. Essentially, you have no idea what really goes on when you’re not with them. Unless I asked (and unless he were honest), I’d have no idea that my husband eats the leftover baked goods from work functions when he gets hungry and hasn’t brought enough to eat from home. Or even if he has, yet they are sitting so attractively frosted and displayed in work common areas for all to grab.

What you observe others eat may not be in their best interest—nor in yours. They may be struggling, denying their hunger and feeling fatigue, and preoccupied with food all the time.

He looks sedentary, but you should've seen him run today!

Are you comparing yourself to others for the wrong reasons? Do you let your eating disorder do the comparing as in “She’s having the fries, but I’m going to just order the side salad” or “He’s ordering the large ice cream, so I’ll just get the kiddie sized one.” Not what I’d recommend!

But I’m different

Do you ever think “that’s fine for you, but my body’s different”? You’re not alone! Somehow you may struggle to believe that what’s true for everyone else—that they can eat a range of nutrients including fats and protein and carbohydrate and no foods need be absolutely forbidden—just doesn’t apply to you. In fact, this basic truth does apply! Take a look at this older post: http://dropitandeat.blogspot.com/2012/04/youre-not-so-special-rethinking-your.html

My FAVorite cupcake place--located in NYC.

There are dangers in comparing your eating with others, as one size does not fit all. Just like food labels should not dictate how much we should be consuming—they merely identify nutrition info—you need to learn just what will meet your body’s individual needs.

And just because they decide to put themselves at risk and jump from the Empire State building doesn’t mean it’s okay for you.


* And for the record, I had a Napoleon pastry late afternoon and take out Japanese for dinner--with some nice Chardonnay. And if you asked, I'd tell you there were a few other items, too.

Please share your thoughts and let me know you’re out there reading!

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.
Sorry!

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!

What’s the Point? I’ve Already Blown It. Breaking the Cycle of Restrictive & Binge Eating.

What bothered Stacey most was the binging. Sure, the restrictive eating made her feel lightheaded and made it difficult to function. And yes, she was tired—but that was to be expected—it was what she was used to. The preoccupation with her weight, her eating, her food rules—that was all she knew. But then the binges soon followed, along with the need to purge and as this increased in frequency, she began to panic. Which brought her to seek my help.

We began with a behavior chain—a mapping of the sequence of events that Stacey experiences, the link between her thoughts, feelings and actions, which keep her stuck in her disorder. It shows how one link in the chain leads to the next, then the next, to keep the cycle going.

They have no idea how she's suffering.

Her pattern began, like it does for many of you, with deprivation—or simply not eating enough. She often fools herself into thinking that she is having enough—eating regularly, yet consuming insubstantial amounts or very low cal items; or limiting her intake because of not feeling hungry—perhaps because of the large volume of water and coffee she relied on to take the edge off. 

Maybe it seems justified—I mean, she did binge the night before—so it seemed reasonable to her to "get back on track" with her diet mentality. And sometimes even her anxiety makes it challenging to notice her hunger and rely on it. At this point, she simply doesn’t trust her body or herself.

Next, she tends to get quite hungry. Sometimes she actually allows herself to eat enough—knowing she needs the fuel—while other times she overeats. But when she does eat a reasonable amount, she feels so guilty and not entitled to it that she later attempts to restrict.

Patterns can be nice, but not this pattern she's
stuck in.

But once Stacey crosses the line, guess what? She figures “why bother?” and so initially she decides to continue to overeat, thinking she’d already blown it. This leads her to feel disgusted with herself and to lose hope. She continues this cycle for a while until much damage is done—to her intake, to her mood, and to her sense of self-worth. Eventually this leads her, once again, to restricting her intake—to make up for the damage from the day before, to punish herself, to “get on track and take control”.

The scale compounds the problem. Focusing on the number prevents her (and you) from really looking at the problem behaviors. Your weight's climbing? This only increases your panic and impulse behavior to try to seize control--without thinking rationally about what your body truly needs. Your weight’s stable? Perhaps you minimize how damaging your thoughts and behaviors have become, and simply accept them as normal. No, it is not acceptable to spend 90% of your thoughts on food, and eating, and weight. 

And your drop in weight? It may reinforce your unhealthy behaviors, as weight loss can be seen as a positive—even if it is anything but healthy—especially in the manner it is achieved. To me, weighing is generally a lose-lose situation (and I’m not talking about weight) in this situation, before you have learned to trust your body and its ability to self regulate; until you have learned to view your weight as just one variable in the big picture of your health. (So please stop weighing yourself if this applies to you!)

See the problem? In Stacey’s case, as she's eaten less, even with the periodic binging, her weight has been stable. So of course she fears what might happen if she does eat more. In her mind, more food must equal more weight. Yet in reality, there are a couple of explanations for this stable weight despite lower daytime intake. She may be making up the calorie difference when binging (although in her case this did not appear to be happening). 

Or more likely, her metabolic rate decreased to accommodate her low intake. So now she eats less, her body slows the rate at which it burns calories—she feels tired, preoccupied with dieting and sometimes out of control when she overeats—and she fears changing this situation will result in her doubling in size. But this is wrong, wrong, wrong! Because her metabolism will in fact increase again as she normalizes her food intake!

It seems we have a selective memory regarding eating. We focus on the fact that we overate—but we ignore that there was restriction that preceded it; we simply blame ourselves for our "lack of control", or failure to have “willpower”. If we binge and then purge, our memory stays fixed on how much we binged on, so we get annoyed when later on we get hungry and need to eat. How quickly we forget that we have gotten rid of a large part of our food intake, and that feeling hunger makes total sense.

Stacey has a long way to go. But here’s what she is working on. Rather than blaming herself for her seeming inability to take control, she's working on acknowledging that restricting keeps her stuck in the vicious cycle. And now she is beginning to liberalize her daytime intake, to prevent this unhealthy chain of events from continuing.

She further needs to join the “Clean Slate Club”. Yes, that's the Clean Slate, not clean plate, club. Overate? Binged? What's done is done. Trying to compensate with restricting will ensure you (and she) stay stuck—and that needs to change.  Starting with a clean slate mentality can help. It is more damaging to keep going on the destructive eating path, than to stop now and lessen your losses. It is worse to purge then to sit with the discomfort of overeating. And it is senseless to begin again with restricting, because it is quite clear where that will lead.

A typical breakfast prepared and eaten on my vacation:
fruit, yogurt, honey, baguette and butter and pastries. 

Perhaps you identify with Stacey—who is actually a composite of several patients I have seen this week.  Or maybe you haven't (yet) experienced the rebound binging—and purging—that may result from continued restrictive eating. It is not too late to change, to prevent the potential rebound overeating that deprivation can cause.

Why not start to break the cycle now?

Lessons from the Ride: Tales of Intuitive Eating, Anxiety and Mindlessness.

Tell me this isn't great?

Let me preface this post by saying that I’m no exercise fanatic. I like to work out—it makes me feel good—but if I don’t get the chance to, I’m not bent out of shape.  I’ve never been much of an athlete. No need for tears, but in elementary school I recall being one of the last ones chosen for teams. I’m over it now, though, really. It was not until my diagnosis of MS, Multiple Sclerosis that I began to regularly bike ride although I’d done my share of hiking. This past weekend marks my 10-year anniversary riding this 2-day fundraising ride, a total of 156 miles from Boston, Massachusetts to the tip of Cape Cod—Provincetown.

During the ride thoughts of blogging never entered my mind. But afterwards, I was struck by several observations that I just had to share.

Intuitive eating? Not quite

As you’re well aware, I’m a big advocate of intuitive eating. But the truth is, intuitive doesn’t always work. Case in point: I’d ridden 15 miles to the first rest stop, soaking wet from the rain, with an elevated heart rate. Was I hungry? Not at all. Did I need to eat? Perhaps. By the next rest stop, now more than a couple of hours from the start of the ride, I still wasn’t hungry. Perhaps it’s because of the volume of fluid I was drinking in an effort to stay well hydrated. Perhaps it was the adrenaline driving me, revving me forward, preventing me from being aware of my body’s need for fuel.

Just arrived at the lunch stop

Nonetheless, intellectually I knew I needed to eat. I knew that my body was using up energy and needed replenishing. And so I made myself eat. I had little interest in the sports bars nor in the cookies at the rest stops, but I ate them. And they successfully fueled me until the lunch stop just an hour later. Then I fed myself a sandwich and multiple bags of chips, along with assorted other snacks. Oh, and more Gatorade.

This is how it went for each of the two days. There were times I did get hungry—generally after I had cooled off and my heart rate had dropped. But for the most part, I had to just do it, to simply eat because I knew I needed to, to keep me safe while doing an activity that needed fueling. And even without exercise, we need to eat to fuel ourselves throughout the day.

Intuitive eating returns

By late Sunday night, I returned home, and at 9:30 PM, after consuming more complete meals and smaller snacks than I can even recall, I was starving! So what’s a girl to do? I ordered Chinese food—the sodium-rich cuisine was just what I felt like— and I enjoyed every bit. This was intuitive! Yet had I, like so many of you, been stuck with the misinformation that eating after a certain hour was bad, or that I had already eaten my umpteenth meal and shouldn’t be hungry, I would have failed to meet my body’s needs.

My husband, who also rode, was also quite intrigued by the regulation of his food intake. He asked me how much I thought we had each consumed and I did a very rough estimate of our intake—trying very hard to remember all we had eaten. Then he asked how much I thought we had burned. So I did some equally estimated calculations for our expenditure.

And what did I find? Each of us had consumed within 10-15 calories of our estimated need! It was astounding! This combination of eating at regular intervals—just because I knew I should—together with eating whenever I got hungry worked like a dream. Our high activity is really beside the point. The key thing is that you burn calories 24/7—and certainly more if you are moving or exercising. And it’s critical to both respect your hunger when it is present, and use your sensibility (or the wisdom of a professional who’s working to keep you on target)—because anxiety, exercise, distraction, fluids, fiber and volume of food can stand in your way from eating enough.

Other lessons from the ride

Anticipatory anxiety

Yes, it's raining!

I hate the thought of biking in the rain. It scares me. They threatened precipitation for Saturday, but that did little to reduce my fear of having to ride in bad weather. About 45 minutes before we started pedaling, the rain started. Steady rain. The ride was not called off. The teams were called, one by one, to head out to the road. And so I did. 


Yes, my eyes were stinging from my hair gel dripping into them, and I was getting covered with grit and spray from the bike in front of me, but you know what? The reality was much better than my fears. Would I choose to ride in pouring rain? No! But having had to do it, truth is, it’s really not too bad. I survived, as did everyone of the 2000 or so riders that rode. And after a couple of hours, the sun came out, and I dried off. And by the end of the 156 miles, I was so thrilled I didn’t allow my anxiety to stop me from achieving my goal. See where I’m going with this?

Sometimes the solution is right in front of you!

Ok, this brilliance I’ll share—just don’t think any less of me, please!

At the finish, not yet hungry, but quite tired!

I had a headache all Saturday morning, a painful, aching headache. I didn’t get it—I was drinking plenty and eating regularly, so go figure. Then lunchtime came, and I pulled off my bike gloves, and my helmet and ate. And the headache disappeared. Yet when I returned to the road, the pain returned.  Thoughts of stroke and aneurysm crossed my mind—really! But by the next rest stop I figured it out.

The indentation on my forehead told me that I had mindlessly secured the darn helmet way too tight!  Yes, sometime the solutions are really right in front of you. And sometimes, your symptoms have nothing to do with how much you had eaten! (Just being honest!)

Yes, that’s what I learned from my ride last weekend. Thoughts? Comments? I’d love to hear what you’re thinking (unless, of course, you respond to my inability to appropriately fasten a bike helmet!)