Reasons to believe in recovery? Take this simple, anonymous online questionnaire.

Perhaps you CAN rise above the clouds.

I don’t know the Harvard psychologist Dr. Sheila Reindl, but I have recommended her book Sensing the Self, many, many times over the years. It’s filled with wisdom about recovery from bulimia, honed from Reindl’s extensive interviews with 13 recovered women. (Not bulimic? Please read on! There’s something here for you too!)  Maybe I was attracted to it having learned that several of the pseudonym-ed women were actually past patients of mine, shared with a therapist who contributed these cases to the book. 

Or maybe that it meshed research with patient stories, extracting the essence of the recovery process into meaningful chapter themes. Personally, I hate reading books about recovery (but I read this at the insistence of a patient). That likely has mostly to do with the fact that I discuss recovery almost 40 hours a week. Do I really want to engage with strangers’ stories on my down time? I don’t think so.

Yet I likely suggest it because I believe it may help readers with recovery. Just as I recommend Schaefer’s fabulous Life Without Edand Arnold’s blog ED-Bites—long before it became chock full of valuable research interpreted into a language we can all understand.

I don’t know if reading recovery stories truly makes a difference in the recovery process—for better or for worse. But I’d like to find out! Because I’d like to have another tool available to help support recovery.

Can recovery stories show us the way?

Enter Lisa Dawson, an Aussie PhD candidate who has the very same goal and is doing the research to find the answers—and I reallyhope you will help! You may remember her name from previous research I referenced. Here’s the description of her research:

Researchers at the University of Sydney are interested in whether reading stories of recovery are helpful for current sufferers of anorexia nervosa. People aged 18 years or over who have anorexia nervosa or an eating disorder similar to anorexia nervosa are invited to participate. This study is conducted entirely online so anyone in the world can participate. Participation involves completing questionnaires on two or three occasions and reading five short stories about recovery. We are very interested in receiving your feedback about the helpfulness of the stories.

The study has been approved by the University of Sydney Ethics Committee and all aspects of the study, including results, are strictly confidential. We are hoping to have as many people as possible take part in the study. If you are interested in participating then please contact Lisa at lisa.dawson@sydney.edu.au.

So if you have a few moments, please email Lisa to learn more. And say hello for me!

Thanks for helping. Oh, and PLEASE share this any way you can!

Half full? What perspective has to do with recovery

It took me years to grasp this not-so-deep expression.  Rather than focusing on the full vs. empty, I'd get stuck with the half part. So while viewing a cup as half empty suggests looking at what's missing, and seeing it as half full connotes a positive outlook, I simply couldn't see it. The half empty description seemed rather positive to me. I mean, at least it's only 1/2 missing! I'm not sure I ever really contemplated half full—as in "it's just not good enough".

Take a look at the image to the right. What do you see?

And when you look at your body? 

Do you focus on all that's good about it, or get fixated on those parts that disgust you?

When you reflect on your eating yesterday do you highlight where you slipped, or acknowledge what was in place?

When you consider how you've eaten over the past week, do you recognize your mindfulness or your balance? Or can’t you get past where your eating, activity or behaviors were less than stellar?

Oh, and about that image above—did you note the black dot, a blemish of sorts? Or did you notice the full screen of white, of possibility?

Gratitude

Why would you take care of a body you despise—one you view as too fat, or weak, or unattractive? Why adequately nourish it, lovingly stretch it, gently exercise it? And why would you keep pushing for change if you can not appreciate the benefits of your efforts?

What if you woke up every morning with appreciation that you were still breathing, that you had the gift of another day? And what if you noted that, beyond the aches and pains, most systems functioned quite well? I know, I know—this maynot be the case for some of you. Persistent tinnitus (that high-pitched ringing in your ears), chronic hip pain, or knee or backaches, problems digesting or sleeping—these are nothing to be thankful for.

A patient of mine just told me about a buddy of his who's an avid hiker. He climbed all 48 4,000 footers in New Hampshire—an impressive feat, I'll tell you, as someone who knows those trails well; they're steep, rugged, filled with loose rock. It's certainly motivating, though, when rewarded with the stunning panoramas when we hit the peaks.

The only thing is, that successful hiker? He's blind, and hikes with a guide dog. Somehow I suspect he doesn't wake up and dwell on his lack of vision.

I really don't know. I am quite fortunate to have a body which functions at 100%, at least for now.

Do we need to experience the threat of loss of function to appreciate that our body works? Must we starve, or fast, to appreciate food? Can't we appreciate the power we have to change our reality, to shift our perspective?

Shift your thoughts

• Perhaps you purged this week, but only once or twice—per week, that is, versus per day.
• Perhaps you exercised, a goal you set for yourself, for 10-15 minutes per session—less than you intended, but more than you had managed to do in the recent months.
• Perhaps you overate, but stopped yourself much sooner than you usually do, preventing an all out binge.
• Perhaps you ate cookies, or cupcakes, but in reasonable portions, and perhaps you allowed yourself to finally taste them and thoroughly enjoy them. Imagine that!
• Perhaps you are beginning to give yourself credit for some positive actions you are taking—just not all the time. 
• Perhaps you can begin by identifying 2-3 positives each day, while getting ready for bed or when getting dressed in the morning.

Your intake, activity, or behaviors may be far from perfect, but perhaps you’re still moving forward. The work may not be done.

Maybe things aren’t so great. But have you lost the ability to create a positive shift, to see the white space?

Perhaps, it’s only half empty.

My gratitude to Rabbi Leslie Gordon and Rabbi Barry Starr for their recent words which inspired this post.

Consider these other posts on this topic:

http://dropitandeat.blogspot.com/2011/06/30-chance-of-rain-70-chance-of-recovery.html

http://dropitandeat.blogspot.com/2011/10/setting-record-straight-shifting-your.html

http://dropitandeat.blogspot.com/2012/01/saying-goodbye-to-your-jeansa-new.html

http://dropitandeat.blogspot.com/2011/07/losing-part-of-your-body-gaining-vision.html

The Door to Change is Open. Learning about eating disorder recovery from Let’s Make a Deal.

So you long to be at your old weight, the lower size, the place where everything was fabulous? Like the amnesia when recalling an old boy/girlfriend—you know, that selective memory that favors only the good times (not how miserable they made you feel or how unhealthy your relationship was with him/her)—you remember longingly how great it was to be thinner, and you strive unhealthily to get there. Remember how happy you were, how you loved your body then? Don’t you recall how great you felt—physically and mentally? No?

Was it as good as you recall or did you feel trapped?
The door is open for change!

Likely not! What was that disordered relationship with food really like? How great did/do you truly feel and function? Perhaps, as I hear from so many...

• Your mood was off. Depression crept in, as did anxiety. Thoughts might have become obsessive. As a result, you were not truly present. Rather, your thoughts were racing, removing you from engaging in conversation and interacting in a healthy way.
• You were emotionally removed—perhaps that was helpful—but not feeling the negative stuff also meant not enjoying the positive experiences either. Were you missing the connections with friends and family? Did you miss out on those early years of your children’s lives, or the later years as your parents were aging? Present, but in body only?
• You were dragging, deprived of energy from truly getting enough fuel throughout the day. Maybe you made up for it later, but that didn’t help you function throughout the day. Ok, so the coffees or diet Cokes gave you that caffeinated illusion that you were energized, but the headaches and preoccupation about your next meal surely told you otherwise.
• The lightheadedness and fatigue were bad enough. But the disturbed sleep during the night might have been more than you bargained for.
• You hated feeling cold all the time, especially when nobody else was.
• And having to attend all those appointments—with your doctor, your therapist, psychiatrist, and that darn nutritionist. Bad enough to have to take all that time, and copays, but having to be held accountable every visit? Uggh!

Yes, there is another way...

• The missed periods (for you women) were a bit worrisome, never mind the impact that would have on your bone density.
• It was so challenging and overwhelming planning meals and trying to be social, when so much centers around eating!
• Your thoughts became so distorted.
• And you felt so trapped and helpless.
• You were not even happy then, as you were still striving, against your body’s best interest, to lose more weight.
• It was like living two lives. The one everyone else saw. And then the real you, the you you struggled with.

Let's make a deal

Remember that old TV show, Let’s Make a Deal? I guess it still airs, but decades ago when I last watched it here’s what I remember. There were three curtains, and behind each one there were items—some desirable and some, so-called zonks. Contestants would have to make a decision to trade what they were shown behind one curtain with the unknown contents hidden behind

Have you read all the posts this cup mug is on? Just checking!

another curtain. They had a chance to reneg on their decision—offered money to trade back, still site unseen— restoring the hope and promise of possibilities behind the alluring curtain—which of course could turn out to be a worthless dud.

This show somehow seems like eating disorder recovery itself. In spite of knowing that we are living with a zonk, which in the grand scheme of things has so little value, it is challenging to trade for the virtually unknown. Virtually, because we have all but forgotten how much better, how much more value that former non-disordered self had.

If you’re stuck in a pattern that you know isn’t working, why not take the risk, so to speak, and try what’s behind a different curtain? Could it really be much worse that what you are living with now? You knew what the other curtain held—the benefits of listening to your body, of nourishing yourself, body and soul. So why not make a deal and trade up?

Maybe you won’t like all the offerings behind a curtain. So toss or trade back the parts you could do without. Perhaps you'll need to learn to tolerate some parts of the package that aren’t your favorites—you’ll learn how to make due. Yes, with support and experience you can become more accepting of the full package.

"How do I start?"

Ready to trade up? Make a list of what you dislike about your current situation—physically and emotionally. What is it stopping you from doing? What harm is it doing? What would you be able to do if you didn’t have this disorder? What was it like without it?

And what positives do you get from your disorder? A strange question, perhaps. But on some level you must be getting something positive from your current situation. It may be your drug of choice, or allow you to not have to make decisions about your future. There may be all sorts of positives you attribute to your disordered lifestyle.

Now put them together. Bring them in to discuss with your health professionals—your therapist, dietitian, or MD.

Do the math, adding the pros and the cons. Then make your voice heard and make a deal. Yes, it’s time to peak behind the next curtain.

Struggling to Manage Your Weight? Products, packaging and marketing leads to second guessing your eating.

This is a self-serving post. Really, I need to vent; because these things drive me crazy. They’re not directly harmful—except for the laxatives to be addressed in the next post—but they cause you to stumble. They mislead you. They impact your thoughts about what’s healthy and what’s allowed, and they add to your list of should and should nots.

They impact all of us, regardless of our weight. I’m just starting my list, in no special order, but I hope to inspire you to add to it—your comments, your own pet peeves. Because the more you're aware, the less you'll be mislead by the subtle, unreasonable nutrition messages. And the better you'll get at trusting your self and your body.

Almond milk: Forgive me if you are among the food allergic who can’t consume cow’s milk or soy milk. For you, almond milk is a reasonable option as a milk alternative to help meet your calcium need. But with the exception of its higher vitamin E content, it has little merit; it truly falls short as a milk alternative for those who do tolerate milk and soy. Here’s my issue: it short-changes you, because it looks like a glass of milk. But the calories don't compare, nor does the protein.

Sure, almonds, (as they proudly display on their website for Almond Breeze, one brand of almond milk) are high in protein and fiber and low in sugar. But this so-called almond milk? At 1 gram or less of protein, it is 6 or 7 grams less per cup compared to soy or cow’s milk, respectively. And a total of 1 gram of fiber. So please don’t assume that because it’s made from wholesome almonds that almond milk is anywhere near as nutritious.

Gatorade light: Why-oh-why would you choose light Gatorade? If you are consuming this sports drink for the reason it was developed—‘specifically formulatedto help you perform your best’ during sports and training, then why have a reduced carbohydrate and low calorie beverage? Did I mention that calories=energy? The calories, from carbohydrate, are a convenient, easy to absorb fuel while exercising. But the light version is hardly worth it, providing minimal fuel to support physical activity.

And for the record, the electrolytes you get from Gatorade—the 160 mgs. sodium and 45 mgs. potassium from the recently increased serving size of 12 (vs. 8) ounces—is no greater than you’d get from a 12 ounce glass of milk (160 mgs. sodium and 560 mgs. potassium). 

Ok, I know you’re not about to drink milk on your run or bike ride. But unless you’re doing long duration exercise, generally more than 90 minutes, there’s little need for a sports drink anyway. You could easily replace your electrolytes when you get home, perhaps with a serving of pretzels and an orange or banana—a more generous replacement for both sodium and potassium losses. Just add any beverage to replace your fluid losses.

Sandwich thins: Made by Arnold and other companies, these seem innocuous, and are perhaps even viewed as a healthy alternative to sliced bread. And, they’re well liked, it seems. (I can't say personally—I've never tried them).

My problem? Eating one is like having just half a sandwich. And unless you are quite short in stature and quite sedentary, you likely need more than a half sandwich for a meal. Yet they look like they should be enough—there are 2 halves—but also half the calories. And, they provide little surface area to add your peanut butter or Vegemite (shout out to my Australian readers) or tuna or whatever. But if you love them and want to include them, have 2 for lunch! Or else when you get hungry later you’ll be beating yourself up thinking you’re not deserving of eating again!

Skinny Cow: I really love these ice cream sandwiches. But do you want to know a little secret? They’re no lighter than most traditional ice cream sandwiches you can buy (at perhaps a lower cost per bar!) But doesn’t Skinny Cow sound so light? All brands I looked at which are a similar size were within 20 calories (higher or lower)—and not promoted as a ‘skinny’ product. I do love their tag line, though: ‘who gives a lick about calories?’

The orange juice aisle: Maybe it’s just in US suburbs, but supermarket shopping is simply an overwhelming experience—even for me. A recent trip to the market revealed more choices than I could ever care to contemplate. Beyond the pulp options, there are orange juices fortified with calcium, and ones with fish oils (can you imagine?). It begs asking ‘Must one food item, this orange juice, meet all of my needs?’ Can’t we have orange juice for its naturally occurring vitamin C, folic acid and potassium? Must I get everything from this single item?

Similarly, must my pasta be protein fortified—or can’t I have chicken with it? Does it need to have added fiber, or won’t my eggplant, artichoke, peppers, etc. add that? Get the point?

Whey protein powder: Some of you who restrict your food intake and those vegans who plan poorly may truly benefit from boosting your protein intake. Why not use whey protein, the refuse, the left over liquid that remains when making cheese, conveniently packaged and sold at top dollar prices at healthfood stores, supplement sites and health clubs?

Whey protein boosts your calories—so this might be a positive for those of you trying to add some. But a whey protein shake mixed with water, in spite of it’s high protein content falls short as a meal replacement. And let me remind you about food halos. There’s nothing magical about protein. While your body requires protein to fuel your muscles and maximize recovery, from the looks of the label you might be thinking that you need whey more (sorry, couldn't resist) than you do. Even bodybuilders need little more than 1 gram of protein per kg body weight (or .45 gram per pound body weight). 

Are you a non-body builder? Then .8 grams per kg (or .36 g/lb will meet your need. (For most, a daily total of 50 or so grams is adequate.) No doubt you'll see how over the top these whey protein supplements actually are, and not without their risks. 

Shrinking packages: Why has the portion of yogurt dropped from 8 oz (one cup) to 6 oz, to in some cases 5 plus ounces? And, for the same price? And why did my half-gallon of ice cream slim down in such a deceitful way, denying me the full number of portions it used to have? (It’s now 2 cups short of the old packaging, so if you feared you were plowing through it more rapidly, fear not!) Food manufacturers should not determine what an appropriate portion is, so be sure that you allow yourself to have as much as you truly need. And that's likely to be more than a 100-calorie pack, too!

Packaged nutrients, not foods: Must we be categorizing everything we eat based on nutrient content? Can't we just eat things because we enjoy them? Because they give us pleasure? 'Protein and Fiber'? Really? Looks like sweetened, cluster cereal to me.

I'm just scratching the surface. Gentle laxatives, gelato, bottled waters and other favorites of mine will be addressed in an upcoming post! Please send me your pet peeves, too!

Lying And Eating Disorder Recovery. What Do You Do Now?

First, myconfession: I lied to a patient yesterday, and I feel the need to come clean; it’s not my norm to lie. I told this new client struggling with an eating disorder that I have never lost a patient—and that I am determined to do all I’m able to keep my patients safe.

The truth is a bit different. I’ve lost one patient in the 26 years supporting patients with anorexia, bulimia and binge eating disorder. And while statistically one patient is a tiny percent of the thousands of individuals I’ve seen over the quarter century, one lost patient is one too many.

I think about her every time I open my dresser drawer—she gave me a gift just two weeks before she left this world—following my compliment of the shirt she was wearing. She knew I’d get a kick; she wore it to amuse me, for sure. I don’t think it was a parting gift; her death was rather impulsive.

And I think about her whenever I bike ride past the train station upon whose tracks she ended her life. She was being treated by a qualified eating disorder team and by all accounts she was doing quite well—based on what she shared with us, at least. 

Objectively, her eating had normalized and medically she was stable. I can’t recall now just how long it had been since she had purged, but she was doing well enough that we were spreading visits out a bit.

I’m not quite sure why I lied. Perhaps I wanted yesterday’s patient to know how determined I am to keep her safe and to know that one way or another I’ll support her and work with her to recovery. Maybe it has to do with my sense that Dahlia’s death was not because of her eating disorder, but her depression. Was it even a lie when her cause of death was not directly due to her eating disorder? Regardless, it made me think about this topic of lying, particularly as it pertains to recovery.

Years ago I had a new patient who, after introducing herself, immediately shared that she is a pathological liar. And that she steals. It’s a bit of a conundrum, then, to know if I should believe her. And should I hide my purse when I head out to retrieve some materials from the next room? Do I trust her—ever?

But more typically, I encounter patients whose lying is slowly revealed and we both need to make sense of it. And we both need to learn to move on after they’ve lied or mislead.

Daniel found himself in a bind several months ago when I proposed he increase his intake given his inappropriate weight loss. He looked me right in the eyes and emphatically swore he’d stuck with the recommendations from the preceding week—every single one of them. Yet he was well aware why he had lost weight. And he didn’t want to admit that he was struggling with following through with my recommendations. He silently hoped that his method of skimping on his intake would still hold his weight steady—even though I advised him otherwise. And now, if he agreed to my new add-ons, he’d have to lie again—because he had no intentions of eating more. Now he regretted lying as things had gotten quite complicated.

When this happened againsome weeks ago, I knew that his eating disorder was at work and could not be trusted. Yes, Dan wanted to recovery, to head off to college, but his eating disorder had a voice all its own. I made sure that he was returning for medical assessments to help verify his progress—as his eating disorder was not tolerating his being honest with me. Surely he didn’t like not feeling trusted. Yet this was the only way I could begin to trust him again and keep him safe.

Sometimes lies aren’t so apparent. You know, like the lies of omission. “So you had the sandwich and the glass of milk?”, I’d confirm. “Yes, and the fruit”, she’d add. But only when I probed further with “And how much of the sandwich did you manage to get through?” did I hear “less than the half”. Or, when I asked about how the exercise limits were adhered to and told that she stuck with the agreed upon 30 minutes, for example. But when I asked “And what was the maximum time spent exercising?” I heard “Well, 40-45 minutes—on most days”.

And then there’s the lying to your self. You look at the cereal and you think surely that’s about the right amount, when truly you know that your portioning falls short. Or you ignore the fact that gardening and compulsively cleaning count as exercise too. You underestimate the number of planned binges or your need to throw out food so no one knows you even bought it and ate it, and you eat mindlessly so you can even fool yourself about your eating.

Your therapist can better explain the role lying plays for you and why you rely on it. But from my perspective, your feelings of shame about eating, of not being deserving, and of needing to be in control are just a few of the contributors. You want to please us providers so we won’t abandon you and truly you’d like to believe you’re doing as well as you state you are.

But like the boy who cried wolf, you leave us struggling with trusting your word. It makes it hard to know just when we need to offer more guidance and support if things always sound great.  I worry when you say that things are always going perfectly—really I do. How will you learn to pick yourself up when you slip if you never share your struggles?

I know this is hard. Nobody talks about it. But as a provider who is determined not to lose another patient to an eating disorder and its comorbidities, I urge you to push yourself to be honest—on your food records, in your sessions, about your difficulties. Volunteer the answers—even if your doctor or your other providers don’t know enough to ask. Tell your supports when your struggling. Hiding beneath your binging, your restricting, or your purging with vomiting or exercise or laxatives is only lying to your self.

I came clean. Now it’s your turn.

Thanks for your honesty. And thanks for reading and commenting.