The difference between you and me.

“How presumptuous”, you must be thinking, “to group all of your readers into one lump sum, overgeneralizing between us and you.”

Well, unless you are a member of my exclusive club, the one-in-750-in-the-US-living-with-Multiple Sclerosis, then I think you'll agree. As I'm sitting here awaiting the chemotherapy treatment to infuse into my veins, I'm painfully aware that I live with a chronic disease, a potentially debilitating one at that. But for now, I'm fortunately unaffected by this progressive neurological condition. 

Perhaps, like you, I'm on borrowed time. Borrowed time? Yes, because neither of us can predict just when the impact our conditions will hit us the worst. Or when the damage from our situation will lead to a fatal consequence.

A depressing shift in perspective from me? Not really. In fact, my intent is to show you just how fortunate you are. And to demonstrate that change is, in fact, in your hands.

I live with a healthy dose of denial. (Ok, so we really may not be all too different from each other.) That said, my denial allows me not to dwell on the ‘what ifs’. What if my condition progresses? What if a symptom hits me suddenly, like temporary blindness or double vision, my presenting symptom? And what if I become unable to work? Or walk? Or cycle and hike? Or leaves me unable to be present and functional? 

In spite of my denial, which I find quite beneficial, I am not denying my need for treatment. The stats are quite unimpressive—treatments don't cure MS, just like meds don't cure an eating disorder. But they might prevent my situation from progressing. Or they might not. MS is an unpredictable disease. And boy do I dislike uncertainty. But doing nothing ensures that nothing good can happen. 

Hmm, maybe I ought to change the title of this post to read "What you and I have in common"?

But here's where we differ. Besides the fact that you might be living with an eating disorder—bulimia, anorexia, binge eating disorder—or you might feel ruled by your rules (compelling you to deny yourself enough food or the pleasure of food)—the differences between us are vast.

Here's the biggest: You can do something to reverse your eating disorder or your disordered eating. You can use the tools of CBT or DBT or FBT to move you along. You can potentially utilize your resources—your friends, your family, a higher level of care, if needed. No, it won't be easy and it's not a quick fix. But these are strategies that can turn your condition around.

You can decide it's time to move on, to prevent your rules from ruling you, and eat enough to nourish your brain to soften those unhealthy voices. You can remove the triggers which result in purging and learn to move on after a slip from less than perfect eating and disordered behavior.

There's evidence that people recover, fully recover, from bulimia, binge eating disorder and anorexia, and that normal eating is a real possibility. Yes, you can take an active role in reversing your condition and prevent your eating disorder or disordered eating from robbing you of the life you so deserve.

I have no such option. Sure, I can choose to focus on the positives from living with such a condition as MS, but let's be real. Living constantly aware that any part of my brain or nerve pathway can be damaged and stop working is hardly something to see the positives in. 

In fairness, living with MS has had its benefits. It has made me much more sensitive to the fact that many individuals who look just fine—and act fine, even—may be harboring a condition that zaps them of their energy and steals their ability to life a full life. Living with MS reminds me that I can never look at someone and assume that they are just fine, when they may be living with a disability like MS or an eating disorder or disordered thoughts. Or depression. Or OCD…

Like those of you living with an eating disorder, we share a genetic predisposition to have the diseases we have—and we are not to blame! And our conditions might have been triggered by something in the environment. Stressing about it may only worsen our fate—high stress and anxiety—while not the cause of either of our conditions—may be obstacles to recovery and wellbeing. 

Based on statistics, I'd have mentally checked out of treatment, believing that chronic disability was my fate. But it's not. Not for me and not for you. 

You can live with some denial to get you through the days, but you still need to take your medicine—your food, your nourishment. And we need to put one food in front of the other and follow the recommendations of those in the know—our treatment team members—for without that commitment we fulfill a self-fulfilling prophecy that recovery can't happen. A positive outlook, and the belief that we can beat the statistics is essential to moving forward and making the most of what we’ve been dealt.

Personally, I cannot simply eat or take a medication to cure my MS. But you can certainly do just that. You can help your brain function fully, by eating enough, all the while improving your quality of life.

You can shift your thinking and ultimately your actions, and make change happen. I am at the mercy of MS research to be successful and find a cure for Multiple Sclerosis.

Neither of us is at fault for our conditions. But you are at fault if you take a back-seat approach to management of your eating disorder. Passively showing up for appointments fails to support recovery and well-being. Yet acting to change your course makes all the difference.

So as you move through the day, ask yourself if you are changing what's in your hands to change to move toward recovery. And if you answer no, then it's time to make a plan for moving forward. Not on Monday, nor on January first, but today.

I'm feeling disconnected and groggy right now. The Benadryl pretreatment has hit with a bang. I know no hunger, for now, and my thinking is compromised. My heart rate is slower than usual, and I have little control over much of anything—thank goodness for spellcheck. I'd be at risk if I dared to check out of here and attempt to drive my car or to exercise. I am compromised. Right now, you and I are truly quite similar. But my state is transitive. Yours can go either way, depending upon your actions.

Do not have pity for me, for I am fortunate enough to function 100% and I am living my life to the fullest. Have compassion for yourself, and may this post inspire you to get your butt in gear and turn your situation around.

Intuitive Eating is not for you—maybe not just yet, and maybe not ever.

“Have you lost your mind? You, the anti-calorie-counting dietitian, the believer in legalizing all things chocolate and trusting that everything will be okay? Are you suggesting I should start dieting now, or head to the nearest Weight Watchers meeting and start counting points? Or doing the Paleo thing?”

Nothing of the sort! I’m prompted to write this following two experiences I had at the MEDA conference, that wonderful eating disorder conference held in the Boston area this past weekend. And this pertains to those of you with anorexia as well as those struggling with overeating—compulsive or otherwise.

So I was casually walking in the hall after the keynote presentation by Dr. Roberto Olivardia just killing time until the next break when I’d be selling my book. And I overhear two women, representatives from two respectable eating disorder programs chatting up their programs. “We use an intuitive eating approach with our patients”, she stated. “We don’t use meal plans, but instead have them listen to their body…” Ok, anorexic readers and eating disorder professionals, anything strike you as a bit problematic here? Let’s start with a handy, wiki definition:

“Intuitive eating is a nutrition philosophy based on the premise that becoming more attuned to the body's natural hunger signals is a more effective way to attain a healthy weight, rather than keeping track of the amounts of energy and fats in foods. It's a process that is intended to create a healthy relationship with food, mind and body, making it a popular treatment for disordered eating and eating disorders…”

For starters, to learn to be more attuned to your hunger, to begin to trust it, you need to be able to sense it. Most individuals, by the time they make it to see me, no longer really notice their hunger—not if they’re restricting and not if they are frequently binge eating. With the metabolic slowdown characteristic of food restrictors, hunger gets suppressed, and so that handy cue to get you to eat, that signal you’re supposed to be trusting—it’s largely disappeared! And that “healthy relationship with food” which we all aspire to is just not going to happen with all those unhealthy and distorted thoughts about food and eating and your appearance. Further, if you’ve never had a healthy relationship with food—never trusted your hunger because you went from overeating to undereating, it’s mighty challenging to just start trusting yourself. And for good reason, given your past experience with food and self-regulating.

When I shared my opinions (you didn’t expect I’d just casually stroll past, did you?) the program rep agreed, acknowledging that intuitive eating is an approach they address much later in recovery. We both agreed that normalizing eating under someone else’s direction (a dietitian with eating disorder expertise, for instance), needs to happen first, much before an intuitive eating approach. You can’t expect to be an intuitive eater when you can’t discern hunger and fullness, or when the disordered or diet thoughts are so loud that you can’t trust your physical sensations.

But wait, there’s more.

There were two experiences I wanted to share, remember? The second involves the presentation by Dr. Olivardia, mentioned above, who spoke about ADHD and eating disorders. He highlighted that a very high percentage of obese individuals have undiagnosed ADHD, and identified characteristics of this condition that make it oh-so-challenging to just do it, to follow seemingly reasonable nutrition and behavior recommendations.

For instance, impulsivity. Perhaps if you don’t have ADHD it’s challenging, but manageable, to take a break and have an internal discussion about whether or not you really want to be eating the whole package of cookies, to not respond to your impulse to eat. But in those with impulse control, that discussion comes a bit late. If you struggle with this, you may find yourself eating mindlessly before you’ve even gotten to check in with your signals. And if you eat rather fast, as is typical, you’ll take in a lot of extra calories before the signal of fullness has hit.

Then there’s boredom. Are you still with me? Those with ADHD have a much harder time tolerating boredom. If you struggle with sitting with feeling bored, it may be more difficult to simply acknowledge that you’re not hungry and redirect. Eating to manage this boredom might be the action of choice. Not a very intuitive eating supportive choice!

And while we often think those with attention issues as struggling to stay focused, Dr. Olivardia points out that these very individuals also get hyper-focused on the things they are interested in. This can explain the failure to listen to their hunger, perhaps when they are over-focused on other things. By the time they do respond to their physical hunger they may be ravenous, contributing to overeating. Or maybe there’s an OCD component, with a focus on calories and calorie counting, which may stand in the way of responding to physical cues. Again, making intuitive eating quite a challenge.

To be a successful intuitive eater, you need to be mindful of what you are consuming. Not so easy of you have ADHD and your norm is to multitask! My typical recommendations to separate eating from distractions may not be realistic for those living with ADHD, those for whom multitasking is simply the norm.

What now?

For the record, I am a big advocate of intuitive eating and for years have recommended a fabulous book on the subject by RDs Evelyn Tribole and Elyse Resch. Do take a look for more guidance on learning to be an intuitive eater.

Surely it’s not hopeless if you fit the descriptions above. To become a more intuitive eater requires more organization to your eating, including preplanning eating times and even meals. Organizational skills may not come so easy, so use tools like alarm reminders, such as on your phone or computer, and make shopping lists. Arrange eating times with friends or family for greater accountability, too. Utilize simple, easy-to-follow cookbooks, where close-to-immediate gratification occurs (with recipes taking 20 minutes or less, for instance.) Yes, Food to Eat fits the bill! And seek the guidance of an ADHD expert like Olivardia, along with an RD with a behavioral focus.

And please be realistic—and less harsh—if you’re prone to berate yourself for being lazy. There may be good reasons why you’re falling short with your follow-through with intuitive eating.

Thoughts? Comments? I’d love to hear what you’re thinking.

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:

http://dropitandeat.blogspot.com/2010/07/daily-exercise-is-must-or-so-you-think.html

http://dropitandeat.blogspot.com/2012/03/protein-new-black.html

Thinking It's All Your Fault?

That’s what they’re thinking, isn’t it? And likely you believe it too. Whether you’re fat or thin, healthy or unhealthy, fit or not, we need to place blame. It’s too hard for us to accept what’s not in our hands to control. We blame your weight on your eating and your diseases—even when there may be no link; we unfairly blame the parents for their child’s eating disorder; and we yearn to believe that it was your actions that caused your disease. Here are just a few examples of this I’ve recently encountered:

• "You’re too fat and of course you must eat poorly. And you’re lazy, too. Shouldn’t you be moving that 350 plus pound body around better—faster, longer, more gracefully? Your knee problems, your reflux, your high blood pressure—they’re all caused by you, don’t you think?" It doesn’t matter that you were an overweight baby and a chunky child—cute then, but not for the adult you. No, it bothers us to see people outside the “perfect” range. 
• The first question they ask is “Was he a smoker?” And the answer is no. Not a smoker nor a drinker yet my father died from primary lung cancer which spread to his liver. And no, there were not even asbestos or environmental factors. And my relative’s recent diagnosis of stomach cancer—rarely seen in the US but common in Japan—where they tend to be slimmer, I might add—was not caused by her weight nor her diet—those pickled, fermented and smoked foods associated with this cancer are not in her repertoire of foods regularly consumed.
• I was sent many an internet, urban legend article on diet soda and multiple sclerosis after my diagnosis of MS. They were well-intentioned senders. They just wanted to find the answer, to find a cure. Never mind that the best research facilities still don’t have a cure, and that I can count on one finger how often I drank a diet beverage over the past months. But they thought they were being helpful. Wouldn’t it be great if I had caused my MS, and then I can equally easily undo it?
• It’s the families, isn’t it? You know, that cause the anorexia? Wasn’t her mother always dieting? What about the home environment? Didn’t her sister also have an eating disorder?

Randomness is difficult to accept. If there’s no cause and effect, it means we can’t do anything to protect ourselves from all the bad things that may befall us. It means we have no control over the future of our health, of our survival, and of the risk to those that we care about. It leaves us feeling way too vulnerable.

We want to place blame. If her cancer was caused by her weight or her gastric bypass surgery, then it won’t happen to me. If his cancer was due to smoking or asbestos, then I am safe. Cut out the diet sodas and I’ll be free from risk of neurological disorders. If mothers cause anorexia, then I can change how I parent and prevent my child from getting it.

If only life were this simple. An eating disorder is complex, and can’t easily be caused from environmental influences. It likely involves a genetic predisposition, some triggering event, and environmental support to maintain it. Yet that doesn’t mean that parents are helpless. They may help prevent an eating disorder in a high risk individual by keeping eating on track and preventing the dieting that all too often results in an eating disorder. And they can certainly actively support their child’s recovery!

My MS and the ALS of a dear relative will not be cured with nutrition or weight change. But we can take control of our stress and maintain the health of the functioning bodies we do have. We can eat well to feel well—and yes, that includes cupcakes in addition to whole grains!

As for the myth that your weight is responsible for all evils? Reread this old post!

All hope is not lost. Even conditions we didn’t cause, we have a role in repairing. Yes, even the cancer. Getting the best treatment team and following the recommendations of your medical team is key. Reducing stress and keeping a positive attitude are critical remedies as well.

So when the conversation goes down that path of placing blame, politely educate the naïve inquisitor. And when you’re thinking it’s all your fault, think again.

On my list of "to dos"!

But don’t free yourself from the responsibility of taking action, of taking control of your health in all the ways that you can. And whether you have a terminal illness or a progressive condition or are 100% healthy, start living like you don’t know what tomorrow will bring. Because the truth is—you don’t. 

Thanks for reading. As always, I’d love you to share this if you liked it. Now there’s some action you can take!

Which One Really Needs Help? Call the Doctor!

Even Mica was disturbed by this!

I know, I know—I’ve got another 5 days before my expected post is due, but I just can’t wait. I can’t let Laura’s painful experience go unaddressed. If you haven’t read it, please do so now. But brace yourself—you’re gonna get angry.

It’s not unusual for me to hear and read about inappropriate statements and suggestions that medical providers make. Actually, we all can manage to say stupid things—I know I’m no exception.  (Really, no need for those that know me personally to comment on this statement!) But today I heard two doozies—Laura’s tale and a patient’s story.

I don’t know Laura—except, that is, from her blog comments. What I do know about her is that she has made extraordinary progress in her recovery from anorexia. That she can now enjoy pizza! That she gets it—and she follows through with healthy, normal, eating behaviors. That’s she’s worked hard to put all the disordered thoughts aside and use her wise mind to justify doing the right thing. That she, like many others, have needed to use self-talk to move from the myths, the misinformation, about nutrients and foods and weight. Ahh, she’s done so well. I don’t even know her, but I am so proud of the work she’s done, of how far she’s come!

And then someone she respects, her MD, albeit inexperienced with eating disorder, totally sideswipes her. The respectable doctor projects, I suspect, her own mishugaas—about weight control, about carbs, about fats. Our wise Laura knows better—but of course when the white coat-clad MD begins her critique of Laura’s intake it’s simply devastating.

Yes, you can eat the whole panini if you're hungry!

What I read in this comment is not that it triggered her eating disorder; she concludes by stating that this doctor just didn’t work out. (Hooray for Laura! Time to change doctors—or get her to close her mouth and withhold absurd and inaccurate assessments of Laura’s intake!) 

But, I suspect, it’s the profound sense of disappointment in her doctor, and perhaps in our crazy food-and-weight obsessed society, as a whole. Laura appropriately acknowledges that there are absolutely no grounds for this doctor’s comments—she has zero evidence to conclude that Laura is struggling with her weight, or unhappy with her intake or struggling with eating disorder behaviors. 

Perhaps if she had asked more open ended questions—you know, like “How’ve you been feeling about your eating these past weeks?” or “What concerns would you like to address about your recovery?”, she could have prevented this damage. It would make a lot more sense than projecting that there’s a problem, simply because Dr. Dieter has perhaps struggled with her own weight and her eating!

Hats off to you, Laura, for having the sense to air your feelings and get support—and for sharing your reaction with the doctor. Hopefully, she’ll learn from her mistakes. And hopefully, you’ll find an MD that really gets it!

As for the patient story? Nothing too unusual that you haven’t heard before. It’s a case of an MD who looks at a 20-ish patient and tells her that her weight should be about 50 pounds less than it is—which would bring her to a place she has never seen on her growth curve. It would bring her BMI to a percentile lower than ever before, even since grade school! Fortunately, this young woman appeared to have a good sense of self, knowing darn well that this MD’s goal was crazy.

If she is appropriately nourished and growing
along her curve, must we make her weight
an issue?

But what if she took the doctor’s orders to heart and began to fight her body on what was normal? To push activity to an obsessive level and to restrict her intake to a point that was neither healthy nor maintainable? What if she had the genetic predisposition for an eating disorder and all it took was the encouragement of a doctor to set the ball rolling—given her own frustration with her recent weight increase and being told her BMI was in the obese category? This woman was more fit than most people I know and had no health issues. She ate healthily and exercised. And there likely was an underlying medical explanation for her recent unexplained weight gain, yet to be determined.

See the problem? Do they even realize the power of their words?

Do you even realize the power of yours? If you are on the receiving end of poor advice, do share your concerns. Consider another opinion from someone you trust. Or do like Laura did—contact the MD and respond. And if you need to, move on—and reach out for support.

Feel free to share your own horror stories, or simply to express your opinions.

Thanks for reading.