Diet Plan

Thứ Sáu, 21 tháng 6, 2013

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.

Chủ Nhật, 9 tháng 6, 2013

The 'Life’s Too Short' Diet

Perhaps a little something with that coffee?

Do you fear you’ll be dealing with eating issues in your next decade—when you’re in your 30s, or 40s, 50s or beyond? Yearning to just be normal again? (Again—because at some point in time, perhaps way back when you were a child, you lived free of all these food concerns, never counting calories or giving a thought to when and how much you consumed). Wrestling to release your self from the hold of anorexia, binge eating or bulimia, and the preoccupation with your weight and the diet du jour? Ready to be free of carb and fat phobia?

Scared? No surprise. You don’t yet trust the next step, but know it’s time to change. Seemingly damned if you do, damned if you don’t change your relationship with food.

There comes a point, a tipping point, when you realize that the cost-benefit of staying stuck is not in your favor. Don’t be fooled into believing that you’ll be happier if only you weighed a few pounds less, because it’s simply a moving target. And the toll that restrictive eating and disordered behaviors takes on your body and your mind is a steep price to pay—even if you thought you’d be happy. It’s not worth the ruminating, the fatigue, the loss of social activities, the isolation, or simply the risk. It’s not worth living with your secrets.

While I no longer struggle with an eating disorder (although my past history of restriction and binge eating was shared in Food to Eat), my tipping point crystalized soon after my diagnosis with MS. It hit me that I didn’t know what tomorrow would bring. (Brilliant, huh? Nobody knows what tomorrow will bring! We could be hit by a car or by lightning, heaven forbid.) The awareness that I could lose my ability to walk, or bike or go up the stairs in my home at absolutely any time highlighted for me that the time was now. I needed to start acting like life is short—because it is. I needed to carve out time for me and for my needs and to seize the moment. Putting off travel was no longer an option. Taking care of my body—including minimizing my stress level—was essential. Continuing to eat well and stay healthy—to take charge of the variables I can control—was essential.

So to my readers who want to challenge their status quo, consider the following—life’s too short.

Life’s too short:

To count your calories, fearing you’ll run short while still hungry for more food;
To jump on the gluten or milk free, low carb, or fill-in-the-blank-freediet when you have neither celiac, gluten intolerance nor milk tolerance issues;
To live in your head, ruled by diet rules about when and how much you’re allowed to consume, disconnected from your body and its signals;
To view foods solely as nutrients, versus the tasty, pleasurable part of your intake they are;

Do you believe this?

To eliminate categories of foods—yes, even cupcakes and desserts—even if they have little nutritional value;
To spend the majority of your waking hours consumed by your weight, or size of your hips/thighs/butt/stomach or muscle mass;
To deny your hunger for the sake of dropping some weight;
To omit those foods necessary to support your health and any diseases you may live with;

Yes, another one of my weekend breakfasts...

To fail to attend to your body’s needs for fuel, for moderate activity (if you’re healthy enough to do so) and for kindness;
To ignore the needs of your soul, denying yourself time for you and embracing your needs for fulfillment;
To consistently override your fullness because you feel you’ve blown it and you don’t deserve to feel better;
To abuse your body through unhealthy behaviors, including food restriction, binging, purging, and excessive exercise.
To wait until you feel deserving to enjoy the food you eat with all your senses.
To wait until Monday, or January first for change, or until you’re taken through the emergency entrance.

The only thing missing is Enjoy.

So assess your thoughts and your actions. And ask yourself “What do I need to change to improve the quality of my life?” Truly somethingis in your hands to change.

Because life’s too short.

Thanks for reading—and for sharing your thoughts.

Thứ Sáu, 31 tháng 5, 2013

Name-calling Has Its Place: BED is Now Named as a Distinct Eating Disorder. So what’s in it for you?

What’s in a name?

Perhaps it sounds like an existential question, but if it doesn’t have a name, does it even exist? Labeling Binge Eating Disorder (BED) what it is—a painful struggle living with frequent overeating large amounts of food—makes real the impact on mood, thoughts, energy level, physical wellbeing and hopelessness, to name a few.
Living with Binge Eating Disorder when it was not yet recognized as a diagnosis, you might not have felt sick enough or eligible to be treated, because it just wasn’t taken seriously enough by those around you.

Being added as a condition all its own validates this not-uncommon eating disorder whose sufferers live with their secret relationship with food, silently and ashamed.

Like adulterers you may sneak around family members and friends consuming large quantities of food—rarely lean protein or vegetables, I’ll add—but typically those foods and nutrients deemed forbidden. Yes, adulterers, as you carry on a relationship you may fail to acknowledge, cheating only yourself.

You eat quickly, masking the empty packages for fear of the response. “Who finished the cookies?” you dread hearing. You may eat salads or nothing at all in the workplace or with others, then stop at the convenience store or the fast food drive in and eat more than a day’s worth of calories, before even getting home. And then perhaps eat dinner as if nothing had ever happened. There may be a short-lived thrill preceding the binge, but a lingering guilt-filled regret to follow.

I should be mindfully eating?

Binge eaters rarely taste their food, nor do they enjoy it mindfully—from the accounts of my patients over the past 26 years. They eat cakes and cookies and ice cream, but they don’t consume them with permission—their own permission, that is. They may be quite unaware of what and how much they have eaten. And although there are exceptions, they rarely truly enjoy what they are binging on—although the experience may be quite pleasurable—in the short-term. Friday’s new patient diagnosed with BED would never come in for a follow up—that much was certain—if I dared to suggest he’d have to give up his nightly, longed for ritual of binge eating. Yes, making change takes time—and hard work.

Why oh why do I do this?

You may find yourself eating impulsively, wondering why, even though you know better, you can’t follow through with your intended control over food.

Let’s start with one basic fact. You are not stupid. It is not for lack of knowledge that you maintain your binge eating pattern, but likely because it meets some needs. It may temporarily numb you, a drug of choice for some, or may help manage your anxiety. Or it may be triggered by impulsivity, even greater in those who get too hungry and those who struggle with impulse control—like those with ADHD. Now don’t get me wrong. I’m not endorsing binge eating to meet your needs. Rather, hopefully providing some insight so you can begin to move from the place you are stuck.

Binge eating typically, although not always, follows deprivation and food restriction. Ever notice that your binging is worse after dieting or fearing you will be without food?

Thoughts like “I’ve already blown it so I may as well keep going”, what I call the what the heck effect, adds flames to the fire, contributing to continued overeating. Or you may preplan a binge—a very much-controlled binge, counter to the uncontrolled binges often described.

“What’s your point?”

I just sent a family member a link to a popular press article about a parallel situation- trichotillomania (compulsive hair pulling) is also now added to the new DSM-5, the mental health manual of diagnoses. In response to the link, the trich sufferer responded, “So what’s your point?” So let me clarify for all. The point is, if you are described in these posts, then you deserve to have your condition acknowledged and treated. And that includes getting support from a mental health professional (one who’s trained in CBT, Cognitive Behavioral Therapy). And for BED sufferers, adding a Registered Dietitian who specializes in eating disorders is essential as well.
It takes time to shift your eating pattern and your thoughts, and to find alternative ways to manage things that cause distress, but recovery is possible.

How do you change and move from being a binge eater? Five areas tend to need to be addressed. You’ll need to:

Eat enough calories throughout the day. Guidance from an RD can be quite helpful here.
Watch your eating pattern to avoid long periods without eating. Excessive hunger leads to excessive intake. Think about a pendulum; swinging to one extreme results in an equal swing in the opposite direction. We are looking to be swinging in a much more narrow range!
Move toward mindful eating. Start by separating eating from distractions, such as TV, reading, computer, driving, phone use. Keep food in the kitchen or dining room only. And try to use your senses when eating. Yes, you deserve to experience and taste what you eat.
Once you are preventing excessive hunger and mindfully eating, it’s time to reintroduce foods you view as ‘forbidden’. Remember that if you are listening to your hunger and eating when you need the fuel, you are no worse off for choosing something you really enjoy eating—be it ice cream or chocolate chip cookies. But keep in mind that while you’re working on liberalizing your ‘forbidden’ foods, work on…
Distinguishing physical hunger from emotional eating triggers, such as stress, reward, depression, anxiety, the need for self-punishment.

Now that it is a recognized condition, it’s my hope that MDs will no longer direct their overweight patients for lap band or gastric bypass surgery, never inquiring about or addressing the underlying problem behaviors. Perhaps the medical community will also begin to distinguish those who are overweight yet healthy—yes, they do co-exist—from those that are struggling with their thoughts and behaviors.

What I like most about this new diagnosis it that it puts the focus on your behavior, not your body weight. Now let’s hope that the medical community begins to ask the questions to open discussion about eating behaviors so that you and others can get the support and direction you need to recover.

Check out these older posts on binge eating and related themes:

Many more posts on the subject can be found by clicking on the relevant labels on the right of the blog.

I'd love to hear from you! Thanks for reading.

Chủ Nhật, 19 tháng 5, 2013

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.