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 31^st!

But if it’s already 2013 when you read this, it’s still not too late!

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.

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.

Colonic Irrigation For Weight Loss?

Colonic irrigation may seem like a positive,
"relaxing"and necessary procedure but...

I’m okay with my weight, and with my body. Most days, that is. But what if I opened my email to find a Groupon that lured me with the promise of feeling better, of losing weight, of being cleaner, healthier? And what if I passed on it the first time, simply ignored it, but received it again, when I wasn’t in my best place? And what if I didn’t have the wisdom to know how I was being played with, manipulated, misinformed, for them to make a buck off me?

I ignored the promise of a cleaner colon and all of its wonders.

That was the first time. This time, particularly after inspiration from Carrie’s post at E-D Bites, I needed to post my rebuttal.

Won’t Colonic Irrigation (and laxatives, and diet pills) solve the obesity epidemic?

Here’s what the Groupon promised:

• Colon hydrotherapy gently purges digestive tract of debris & toxins to ease chronic pain & restore organ function
• May kick-start weight loss
• Noninvasive and relaxing treatment
• Purges body of impacted debris and toxins
• Can boost organ function and relieve pain

And the facts?

From Medicare:

“Colonic irrigation is a procedure to wash out or lavage material on the walls of the bowel to an unlimited distance without inducing defecation.  This procedure is distinguished from all types of enemas, which are primarily used to induce defecation. There are no conditions for which colonic irrigation is medically indicated and no evidence of therapeutic value.” Given its uselessness, it is nota covered service. Bummer.

From the Cleveland Clinic 

“While the idea of ridding one’s body of built-up toxins from sugar, alcohol, caffeine and meat is appealing, the truth is that the data supporting colonic cleansing and body “detoxification” have not been studied sufficiently in clinical trials.

Carol Burke, MD, Director of the Center for Colon Polyp and Cancer Prevention in Cleveland Clinic’s Digestive Disease Institute, warns of the hazards and lack of evidence to support these therapies. “There is no evidence to support their benefit; there is only evidence of their complications,” adding that complications may include rectal perforations from colonic irrigation and enema therapy, oftentimes requiring surgery.”

From Medial News Today: 

“Twenty past studies about colon cleansing published over the last decade were analyzed by researchers, and found little evidence that the procedure offers any benefits. Instead, a number of the studies noted side effects such as cramping, bloating, vomiting, electrolyte imbalance and kidney failure.”

And really, calling the procedure relaxing and noninvasive? Do we need a visual here to remind us of what the process is? (Sorry, no photos this time).

My reaction might seem targeted to colonic irrigation. But really it’s about being taken advantage of—by the media, by those who ought to know better, and by our own vulnerability. Because products promising weight loss, laxatives and colonic irrigation lying about cleansing our weight away, only cause us damage. We so desperately want to believe, to hope that something will fix our ills, will improve our weight, will help us feel better about ourselves.

We’re bombarded everywhere by media messages—as well as comments from friends and strangers, directly and in overheard conversations—about their latest, their best diet ever. Their solution, found at last, if only for this week.

It comes from people you trust—like your chiropractor, whose hands of gold and makes you feel physically better with his adjustments, perhaps. For a significant contribution to his monthly income, he encourages outrageous products such as 3 day cleanses. 

Yup, several of my patients, including those struggling with bulimia have been victim to the transfer of trust—the belief in the provider who has been trustworthy in some arena of care—but who is damaging in others.

Angie believed she had multiple allergies. What she had was the start of an eating disorder that snowballed into severe restrictive eating and reliance on products her chiropractor sold her. In spite of unhealthy behaviors and food avoidance, she was sold a line of products that contributed to her belief that cleansing was the answer. Her health deteriorated, and by the time she presented to me I knew she needed a higher level of care. Seeing her chiropractor ultimately kept her from following up with her doctor, who might have had the wisdom to see the harm she was doing to herself.

It doesn’t help that we are manipulated at every turn about what is normal and realistic, regarding our appearance. I am not saying that the media causes eating disorders—merely that it influences how we see and feel about ourselves. As we age, skin wrinkles, and hair may gray. Trust me, I know. Weight may fluctuate, as does our level of activity and eating. If we compare ourselves to our younger selves, we may yearn to change. If we look to the photos in magazines and online of individuals our age, we are misguided into believing they are real. 

Please view this amazing video, which lets you in on the secret:

http://www.youtube.com/watch?v=S_vVUIYOmJM

Your Challenge

In this post New Year’s period, have you been challenged, triggered by the pull of diets or diet aids? I’d love to see your responses to the crazy messages you’re enduring. How did you twist it to avoid the pull? What did you say to yourself to come to your senses? Please share via the comments on this post!

And if you need help knowing what something isn’t a wise choice, ask in comments as well! Again, check out E-D Bites post for examples.

Who or What Decides How Much You Eat? Taking Back Control of Your Eating.

Last weekend I attended a diabetes conference in NYC (Yes, that explains the delayed post!). And although most of you don't have diabetes, there's so much valuable info to share with you.

First, I learned these experts know nothing about the feeding needs of the sedentary. Yes, sedentary program attendees, myself included, get hungry while simply sitting in a chair for a span of many hours. So with breakfast at 7:45, I was ravenous by the 10:15 coffee break. Now usually, when we say coffee break, we mean something more than simply a caffeinated beverage. Like, maybe we’d expect a mini pastry or muffin, or some fruit? Perhaps the Diabetes Association was using us like lab animals, exploring the impact of low blood sugar on us.

Yes, these are them! My sustenance 'til break time.

In any case, I was shocked, and unprepared, for the absence of adequate, calorie-containing snacks to accompany my coffee. And so I relied on the tiny hard candies to get me through until lunch. How ironic. My point? Just because someone else thinks it's okay to not stop and eat between meals, doesn't mean you have to go along with the plan!

Similarly, just because someone else tells you how much you should eat, doesn’t mean that’s right for you. What do I mean? Just because Quaker oats now says that the serving size is either ½ cup dry oats or ¾ cup for their “heart healthy portion” doesn’t mean that that is right for you. Several years ago, Quaker increased their portion from 1/3 cup dry oats, 2/3 cup cooked cereal. Maybe that amount worked just fine. Just because they’ve adjusted upwards doesn’t mean you have to!

Amazing sandwich from Eataly, NYC which I ate too
much of, having not had an adequate snack at break.

Have you ordered a sandwich out lately? Just half of many sandwiches (take Panera, for instance) more closely resemble a full sandwich most of us would prep at home. And eating only half of most burritos filled with rice and beans and guacamole would likely satisfy—except that once we’ve unwrapped it, we’re doomed to finish it.

And if your spouse or mother-in-law usually plates your food, take charge and plate your own food! Then you can’t blame anyone else for how much you’re eating.

Because we eat what’s put in front of us, without regard to how full we are in the moment, and without delaying to see if we really needed the full amount.

Brian Wansink, PhD, presented a fascinating session on his research findings at this conference (see www.MindlessEating.org for more info). This creative researcher developed a strategy to evaluate what factors regulate our food intake, telling us when we’ve had enough. He cleverly designed a feeding study where half the participants were served a bottomless bowl of soup. Yes, the soup was secretly pumped into their 22 oz. bowl, keeping it filled. And what did he find? That people just kept on eating! They ate 73% more soup than those with a finite portion. Yet they didn’t think they had eaten more.

He also interviewed Americans in Chicago, and Parisians, about when they know they’ve eaten enough. Parisians reportedly stopped when they felt full, and when their food no longer tasted good. The Chicagoans, however, made no reference to physical sensations, stating they stopped when their plate was empty, or when their TV show was over. Maybe that’s the answer to the French Paradox. They enjoy their food, including rich pastries and processed breads, but they stop when they’ve had enough.

It’s not that hunger sensations can’t work for us. It’s just that we don’t tend to give them a chance. Remember the titration example? (see  http://dropitandeat.blogspot.com/2010/08/size-matters-but-not-how-you-think.html ) We don’t allow our bodies enough time to take note and acknowledge fullness. Instead, we eat mindlessly, quickly, consuming more calories than we need before putting on the brakes. Then we blame it on the carbs, or the fats, setting rigid rules about what’s acceptable to eat.

The solution? Take charge of your environment, and of your body’s signals. Even if you need to gain weight, you’ll feel better if you are aware of what you eat. It’s not enough to gain weight, but to learn to regulate a healthy weight.

First, find your voice, and negotiate change, when necessary. If you’re out with others and feel hungry, eat a snack you’ve brought or stop for something. Yes, even if you’re the only one who needs to.

Plate your own food, and take responsibility for your own eating. If you're struggling with being overweight, start with a smaller portion than usual, giving yourself permission to have more after 45-60 minutes—if you’re hungry. If you are struggling to gain weight, consider having your grains on a separate plate, which some find less overwhelming.

Use a smaller plate. The size of bowls, glasses, plates, popcorn containers dictate how much we end up eating. Such a simple trick really works! And Wansink and others have the study results to prove it.

Eating out? Have them cut your sandwich or wrap in half, and package each half separately. If you need the second half later, it’s yours to eat then—if you need it! That’s where listening to your signals comes into play.

Limit eating to the kitchen or dining room. Then leave that room and use distraction to avoid the temptation to mindlessly eat.

Control your surroundings. Keep food off the kitchen counters. And keep fruits and vegetables in glass bowls in the fridge where you’ll see them and think to eat them.

And remember. Slips happen! This approach may be new to you, and other factors besides your awareness may impact your eating. Address your stressors and boredom, if they trigger you to overeat.

And set realistic goals. Work on one change at a time, before setting another goal.

As always, I look forward to hearing what you think!