Training on Empty: Chapter 32 (Possible TW)

Possible trigger warning with mention of behaviors

Chapter 32 – The End Result

"The day the child realizes that all adults are imperfect, he becomes an adolescent; the day he forgives them, he becomes an adult; the day he forgives himself, he becomes wise” – Alden Nowlan

The long-term effects of eating disorders are not pretty. Because of prolonged malnourishment, anorexics and bulimics are at risk for an inexhaustible list of related complications. I was fortunate in a way to have avoided becoming fully immersed in bulimia. During a few transitional phases of my life, I did binge and purge, but I was able to completely stop and I have not thrown up since 1998. Bulimia is a vicious illness that can cause esophageal damage, irritation or bleeding in the stomach lining, and erosion of the enamel on the teeth. I have known girls who have ruptured blood vessels in their eyes, passed out and developed ulcers. Other risks include dehydration, electrolyte and mineral imbalance, edema, fluid on the lungs, cancer of the esophagus or throat, high blood pressure and diabetes. Ketoacidosis, a condition in which acids build up in blood as a result of the body burning fat instead of sugar and carbohydrates to get energy, is also probable. In addition, it can lead to pancreatitis. Bulimia comes with a financial cost as well. At times, the craving to binge can cause those suffering from the disorder to spend huge amounts on food. When money runs out, some even resort to stealing. And to top it off, some bulimics report worsening bouts of acne during binge-purge cycles.

It’s a heartbreaking reality that anorexia is striking younger and younger victims today. It is not uncommon for children of eight or nine years old to be refusing food at dinner tables across the country. It’s exceptionally disturbing to know that these young kids are denying their bodies important nutrients at a critical growing phase in their lives. Although talking about anorexia has become more acceptable these days, this has not helped solve the problem, and the incidence of young children with anorexia has increased at such an alarming rate that treatment centers have had to add special units specifically for kids under the age of 12. Starvation at any age is a recipe for disaster, but denying the body food at a time when the body is growing can lead to permanent and irreversible damage and is more likely to lead to death.

In a world where high-powered superkids like Mary-Kate Olsen set the standard for hot pre-teen fashion, it’s all too easy for young children to follow the unhealthy Hollywood trend. However, society’s influence and insistence that it’s okay to be malnourished isn’t the only thing that leads a child to refuse food. There are many factors that contribute to any illness or addiction. In the case of anorexia, it was once thought the disease was entirely an emotional response to events outside the individual or the result of poor parenting. Many psychiatrists thought anorexia typically occurred just before puberty and that victims were afraid to grow up. It’s true that many people with addictions fear taking on adult responsibilities. The “Peter Pan syndrome” may play a small part in some cases of anorexia, but recently it has been discovered that there is a genetic predisposition which can lead to anorexia. Just like alcoholism, it’s a very complex illness and can have many triggers that may lead an individual to self-destruct. It’s true that many of the affected girls I knew had similar traits, such as being raped or abused in their pasts, but today similarities among sufferers of anorexia are becoming less apparent. Where once anorexia was thought to be a rich, white girl’s disease, it is now crossing the gender gap as well as knocking aside ethnic and economic barriers.

Despite all of my chronic pain and stiffness, I continued to run and work out up to three hours a day. On some level I was hoping for a late comeback, on another, I was using training as an excuse to feel okay about myself. I was aware this compulsiveness was also keeping me centered in some way. I still had a hard time allowing myself to eat normally if I didn’t work out. No matter how much I believed the body needs food at rest as well as when it’s at work, I experienced a tremendous amount of guilt on rest days. I have heard others with anorexia say that the illness is a way to say to the world, “I’m not okay.” Typically, anorexics display the traits of perfection. They are intelligent, hard working, successful, and loyal. Their frail outer appearance, however, is a reflection of their inner turmoil. They hold an underlying core belief they are ugly and worthless, not even deserving enough to take up space in the world. Although at this point in my life, I appeared to be recovering, I was continuing to bump up against these very issues. With the full intention of getting back into racing shape, I looked into hiring a local coach. I had several friends helping me with certain aspects of my training, but I was looking for someone who could deal with the emotional runner that I was; someone who could handle what had pushed most other people out of my life.

When I called Bobby, I knew immediately I had found the right coach. We met to discuss my goals and past training. I didn’t hide anything and told him I was extremely fearful of running and my own traumatic past. I still had periods where I would cry on runs, feeling overwhelmed and helpless against the demons in my head. I was still struggling with counting calories and obsessive-compulsive habits, but Bobby offered me some hope. We agreed to work together on a running program. In addition, I was lucky enough to find a chiropractor who was able to help ease some the stiffness and pain I was experiencing enough so I could run more normally again.

Running with Bobby brought some of the joy back into my training. It was obvious that I was very traumatized, not only by my own starvation but also by the lack of unconditional love and support from many people in my past. It took someone who was not attached to how fast I ran to make me see that. Bobby gave me unconditional support no matter how I performed and, as a result, I started running a bit faster again. Long gone were the days of running 5k's at 5:30 pace, but 6:45 wasn’t so bad given what I had been through. I understood this, but deep down I still deemed my slippage into mediocrity unacceptable. I was completely unsatisfied in my races and felt hindered and limited by my own body. Never before had I struggled on such a physical level with running. It felt as if I were a rusty car falling apart or a racehorse with a broken leg, limping to the finish line. I naturally had vivid memories of the runner I'd been in high school and couldn’t accept where I now was in comparison. Never did I imagine I could let go of running, so I held on and struggled through workouts and even easy runs, my body filled with pain and my mind brimming with disappointment.

Where I was once a confident racer, bold and a real risk-taker, I had become limited and timid and very afraid. My stride had completely changed, as if to verify my fears of continually being let down. Gone were the fierce steps carrying a heartfelt “I’ll show you” message. Instead, my feet were landing timidly, searching for the ground below as if it might just fall away, a definite “don’t hurt me” statement. It was during another injury, oddly enough, where I found some of my lost fierceness. Rather than drop me as an athlete when I developed a stress fracture in my foot, Bobby supported me and offered to give me bike workouts in replacement. With no worries about my performance and nobody watching, I was able to push some limits and get my heart rate up to racing levels. At times I rode with reckless abandon and it felt good to find some of the fire inside me that had been missing for so long.

Unfortunately, the stress fracture took a long time to heal. After two weeks of doing my best to stay off it, I went to a podiatrist in Longmont, Colorado to see if a cast might help the bone heal. The podiatrist insisted that I didn’t have a stress fracture. My coach, physical trainer and I all felt otherwise. I had even been to a bone specialist who said he felt sure it was a stress fracture as well. After a bit of arguing, the podiatrist took and x-ray which did not show any cracks in my bones. I knew from past experience that stress fractures don’t usually show up on an x-ray until they have started to heal, sometimes up to three or four weeks later, but this guy was convinced that I had a neuroma. He felt there was inflammation in my foot, so he gave me a shot of cortisone and told me I could run in three days. Two days later, my foot made an odd popping noise, and I collapsed to the floor in excruciating pain.

The podiatrist said he had no idea what was wrong. He suggested wrapping my foot in a soft cast or casting my entire leg from my knee to my toe in hard plaster. I knew there had to be another option, so after several days of limping around, my foot throbbing with intense pain, I went for a second opinion. “You have a stress fracture,” the second podiatrist said, immediately putting me in a removable walking cast. An x-ray confirmed this. The fracture took another six weeks to heal, but my left foot would never be the same again. I've had two surgeries to clean up the osteoarthritis in my joints that were badly damaged after the cortisone caused my tendons to atrophy severely. To this day, my foot still rolls out and I have a slight limp.

In spite of the fact I was dealing with yet another injury, I noticed that something was different. It’s hard to say what exactly changed in my life. Perhaps it was the unconditional acceptance from others that I was starting to feel or feeding myself the nutrients that by body craved. It happened gradually, but what I noticed was that despair no longer ruled my life. Before long I started to emerge as a new person. The changes were subtle at first, but I was laughing more and feeling more at ease in my body, calmer in my mind. I was even getting out and being social again. I often wondered if I was really the same little fat girl I was as a child, the standout runner I was in high school, or the scared woman who nearly died. Then it struck me that maybe I had left these all behind and become someone entirely new. For the first time in my life I felt like I could breathe a sigh of relief. I was beginning to show myself compassion and kindness instead of brutality and hatred. I realized that I was, in fact, the same person inside whether I was eighty pounds or one hundred and ten pounds, but I had grown and learned, expanded beyond my illness. In addition, I found that one hundred and ten pounds, give or take, allowed me to be more involved in the world. Somewhere inside me is the core of who I am. It doesn't change with outer appearance. Reclaiming this inner core has helped tremendously with recovery. It was important for me to rediscover likes, dislikes, passions and any opinions I had that I’d put aside to be an anorexic girl. As a child, I was unable to self-regulate under the tremendous stress of my home life. Anorexia was the addiction I chose to help me cope with my surroundings and anything beyond my control.

It wasn't until I was in my thirties that I began to rediscover my voice. I had just started to volunteer at a local radio station when I realized that I had something to say. I had an opinion about what music I like and disliked, and there were issues that interested me. While I had been quiet and shut-down for years, it seemed, I suddenly felt the urge to jump into debates and heated conversations. It amazed me that all of the years I spent focusing on weight and food had pushed me so far away from myself as well as others. It was time to reclaim myself, and that meant finding out who I am. I was ready to be heard, and I was finally ready to be alive. There was a feeling of safety being behind the mike without anyone looking at me. I was comfortable getting in touch with my wilder side, and it was fun. I didn't feel judged in any way.

Going through puberty is not easy. It’s even more difficult as an adult. At age 33 I had gone nearly 20 years without a period. From the time I was 14, I didn’t have a cycle. I did take hormones for a very brief time that were incredibly hard on my body and that induced one period when I was in college, but I quickly stopped when the PMS symptoms got to be too much. I experienced severe bloating, cramping and terrible headaches. In my early thirties when my first period did come, it was harsh. I could feel my body changing and noticed symptoms of PMS for months before the actual period came. I felt awkward and uncomfortable as my breast size increased and my body adjusted to the new level of hormones. With anorexia, hormone levels decrease, especially estrogen and testosterone. This was clearly a sign that my body, at least in one aspect, was becoming healthier. One day, I thought I had the flu. I was forced to stay in bed for two days. At that time I got my period. I thought it was a coincidence that I had the flu, but the next month there I was in bed again with the flu. It turned out that my body was having such a hard time adjusting to becoming a woman that I was thrown into fits of fevers and aches and other flu-like symptoms with every cycle. Over the course of a year, the periods started to become more regular and less traumatic.

Through all these changes and the growth I experienced, Bobby was supportive. When my foot healed and I was back to running, I entered a cycle of continual set-backs. Bobby didn’t flinch; he stuck with me and offered an enormous amount of emotional support. It soon became apparent that my body was not reacting in a normal way to training. I was experiencing random muscle shutdown and chronic fatigue, and unrelenting stiffness lingered in my body. I was back on the trail of seeking out healers and therapists at a time when I felt all these issues should have resolved themselves. My body felt broken. I was tired, stressed and weak, and over the course of the next two years, it only got worse. The one thing that kept me going was hope. I was convinced there was a solution to my health problems, and I was determined to find it.

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Training on Empty: Chapter 31

Chapter 31 – Bobby

“Coaching is a profession of love. You can’t coach people unless you love them.” – Eddie Robinson

I met Bobby shortly after I had run my marathon. He agreed to be my coach despite the fact that I was still struggling with food and body issues. In addition, I was injured and could hardly walk at the time. Bobby was convinced that the two of us could create a healthier path to running again for me, and his passion and optimism rubbed off on me so much that I even thought for a brief moment I was ready to let go completely of the illness that I had clung to for the majority of my life. Though this freedom never quite occurred, Bobby did help me begin to express myself more and ultimately opened a door to a much happier life. His constant and unconditional support allowed me to begin to investigate my own self-worth, something that had been completely and totally torn apart by past traumas and the internalization of harsh comments by others. Though we no longer work together as coach and athlete, we remain closely bonded as friends. I'll let him tell our story:

Firstly let me say that it is both an honor and a privilege to have worked with Lize as her running coach and now to be her friend. This leads into what I feel is the most effective asset in the process of being a support to those unfortunate enough to suffer the horrors of anorexia – empathy. Remember, I am only a running coach with training in sport psychology, hardly the credentials I needed when it came about that I became someone known for having some insight and facility with anorexic distance runners.

I was fortunate enough to realize very early on in my work with these athletes that the running was often likely to be the compulsion that had replaced that abhorrence for food.

From a plain exercise physiological point of view, the lighter the runner the higher their Vo2Max. This is their ability (measured in milliliters) to utilize oxygen per kilogram of body weight. This is a key performance factor in endurance events. The lighter the athlete therefore, the better they perform – hence the warped “reward” that these athletes receive for losing so much weight. Of course this period of heightened performance is finite as the effects of the illness start to shut down the system with its all-too-often inevitable outcome – terrible, terrible illness, anguish and even death.

At the risk of sounding simplistic, let me lay out the loose process I follow when an athlete entrusted me with the truth of their condition:

Never view the illness as a simple case of misaligned thinking that can easily be corrected by a nice logical heart-to-heart conversation.

Gain permission from the athlete to be forthright – negotiate the space to be honest. When working with athletes who have clearly dealt with the illness since their youth, I often request to speak with the “adult,” when it is clear that the “child” is very much present in a trying/challenging situation.

Be wary of creating false hope as to the length of time or the possible linear course that the healing process may take.

Have a healthy take on the curability of the disease – I told myself that an athlete is either in remission (and working damn hard at it), or caught in the throes of the thing. Thinking that a runner (or any anorexic person for that matter), is fully and finally cured is a fallacy that can lull the supporters of the person into dropping their guard and miss crucial clues that could help prevent another acute phase.

Be utterly constant and unconditional in your love and support. Also be unwavering in the standards you set as acceptable; for example I refuse to offer coaching when the athlete is below a medically determined minimum weight. I never, however, dropped the athlete from my program when this occurred, only refused to allow them to train.

I would only coach such athletes with the existence of a team consisting of the coach, psychologist (or some effective type of psychotherapist) and a nutritionist. I would not move forward without the okay from these two persons. Of course, all these team members had to be totally trusted and accepted by the athlete. The athlete also has to be totally okay with open and clear communication between the three support members, other than the usual accepted confidences that these specialists must abide by.

Lastly, let me say that I coach by agreement and never more so than with the condition of anorexia. If an athlete trusts me, I honor that trust for the duration of the coaching relationship and beyond.

I hope that these thoughts are of some use to others who are part of the world of anorexia.

For many, there is a set belief that an anorexic can never fully overcome the illness. A coach must constantly keep an eye on anyone who has struggled with eating issues in the past. It's very easy for someone who has had an eating disorder to start sliding back into bad eating patterns when training or stepping back into competition. Most people who have had struggles with food and weight do better with a positive, one-on-one coaching style that avoids punishment or negative feedback based on performance. The focus with these kinds of athletes should clearly be more on motivation and personal achievements than on weight. Training and racing at the elite level can put an athlete at risk for developing an eating disorder. With good coaching and guidance, an athlete can remain healthy while reaching their athletic goals.

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Training on Empty: Chapter 30

Chapter 30 – Living to Die

“[W]e now know that the human animal is characterized by two great fears that other animals are protected from: the fear of life and the fear of death... Heidegger brought these fears to the center of his existential philosophy. He argued that the basic anxiety of [humanity] is anxiety about being-in-the-world, as well as anxiety of being-in-the-world. That is, both fear of death and fear of life, of experience and individuation.” – Ernest Becker

It seems a bizarre irony that someone so afraid of death would have taken her life right up to the edge for a possible glimpse of the other side. Perhaps I thought I was facing my fear. Regardless, confronting the reality that I might soon die – which I had to do more than once – never actually eased my intense phobia. If anything, it only made it worse. When I was in the throes of anorexia, I would often consider that any given moment could be my last. However, I was never able to let go of all the limitations and restrictions I had placed on myself. I had a bad case of the what-might-bes. I would think of all the foods I had missed tasting, all the life I had missed living, and all the people I had missed meeting. My life had become so narrow, uneventful and gloomy. I needed to know how the story would end, and I didn't want it to end like it was threatening to. It took years for me to reach any kind of balance and start sampling life again. Just as I was beginning to emerge from the ugly black pit of my past, I was struck with the intense feeling I was going to die.

There have been several times in my life when I have come face-to-face with death. The first incident was in grade school. I was at home playing with a friend and suddenly felt a terrible headache coming on. The headache was so bad that I had to ask my friend to leave so I could go lie down. The pain intensified quickly. Before I could even attempt to call out to my mom down the hallway in the other room, I became paralyzed from the severe throbbing pressure growing in my skull. It was as if my brain was going to explode. Any slight movement was far too painful to tolerate, so I stayed as still as possible for over an hour until my mom finally came looking for me. When she entered the room, I saw her panicked face as she leaned over me. My eyes had glazed over and we both thought I would be dead shortly. “My head,” I managed to whisper. She called the hospital, but the nurse told her there was an epidemic of viral meningitis going around. Chances were I was another case. The hospital was swamped. My mom was told to call back only if I didn’t improve over the next three hours and an ambulance would be sent. Viral meningitis is described as a swelling of the outer layer of the brain. It is extremely painful and can cause brain damage, deafness, blindness, and in some instances, death. Fortunately, the pain lessened over the course of the night, and it was indeed, as the ER operator had expected, viral meningitis and not a related – but often lethal – disease, bacterial meningitis. I recovered fully over the next few days and was back to my normal activity in less than a week. Many years later, when I was in my early forties, I would be struck down again with this illness in a much more severe case. Miraculously, in the latter case, after nine days in the hospital with my life hanging in the balance, I was released and started a slow recovery. As a friend of the family put it, "You have bad luck." However, I have to recognize that living in a state of malnutrition for so long probably didn't help me have good luck when it comes to health.

Another brush with death I experienced was in college, when I went river-rafting with a few friends. It was my first experience in a raft. I had grand images of sunning myself on a spacious raft on the calm waters. When the river guide started pumping up the tiny inflatable vessels by hand, my daydream came to a disappointing halt.

I should have figured out that the trip was cursed when, as we were waiting to shove off into the mild waters, a big spider crawled over my hand. We split up into two teams, and just as my team was beginning to get the hang of maneuvering the tiny little raft, the guide yelled out for us to paddle as hard as we could. I heard a loud roar of rushing water before us, and as I lifted my oar out of the water fully intending to plunge it back in as hard as I possibly could, the raft flipped and I was sucked under. My first instinct was to fight to reach the surface, but I was being pulled under with such force, I knew that any effort would be futile. A strange calm took over me as I looked up and saw the raft getting farther and farther away. I convinced myself that the force pulling me down had to stop at some point. I was right. The moment I felt the eddy release me, I swam for the surface with a fury that I had never known before. I could see the sun on the water above me. It seemed so incredibly far away though. I was completely out of breath with a good three feet left to swim. Time stood still and all was quiet just before I broke into the air and sputtered and coughed as the guide quickly maneuvered the raft to me and pulled me aboard.

As traumatic as this was, it was my most serene confrontation with death to date. Somehow the thought of nature being in control had, at that moment, eased my worries about death. The force of nature was something I realized then that I couldn’t fight. If the eddy had continued to pull me under, it was beyond my control to fight. This sense of serenity in the hands of some universal force did not, however, transfer to the relatively microscopic environment of my own body. Once I became anorexic, the seizures and near-death experiences were filled with terror and fear, and just when I thought it was all behind me, I once again came face-to-face with my own mortality.

After I ran my first marathon, I started to experience severe stiffness in my pelvis, hamstrings, lower back and hips. It was such an accomplishment to have finished the marathon, regardless of my time. Despite running much more slowly than I had in the past, I felt satisfied and even a little bit emotional crossing the finish line. Unfortunately, shortly after the race, everything started to hurt, and I could hardly step up a single stair riser normally, let alone jog. It didn’t make sense that I would be this sore when I hadn’t truly raced the marathon and even stopped twice. I saw over 11 practitioners, from chiropractors to medical doctors, none of whom could offer any help or provide a clue as to what was going on in my body. In addition to the chronic stiffness, I was beginning to experience panic attacks. I was worried the seizures were coming back, but I couldn’t figure out why they would occur since my weight and electrolytes were stable. The attacks started fairly mildly; I would get a funny sensation in my back and experience a sense of worry and fear. I tried in vain to reassure myself everything was okay, that I was going to be fine, but the attacks got progressively worse. Eventually I was getting full-blown fight-or-flight responses for no apparent reason.

At this time I was working as a nanny for two fun, outgoing kids in addition to working part-time at a local health-food store. I had to miss a few days of work when the panic became severe, and I noticed both chest pain and shortness of breath. Convinced I had wrecked my body and was paying for my anorexic past, I assumed I was about to have a heart attack. I went to the emergency room in tears with the distinct feeling I was going to die. I was very scared. The fear seemed beyond my control; no amount of positive self-talk could ease my worries and physical symptoms.

For so many years, I had been living in limbo. It seemed unfair that death would squeeze its icy fingers around my heart just at the time I was deciding I wanted to live and not merely exist. In the past, I had lived by default: too afraid to actually kill myself, but equally afraid to really be in the world. I had fallen to a certain level of mediocrity, no longer a heroic athlete or super student. I felt I had failed Life 101. I was thin though, and that meant something. It seemed it was the only thing over which I had any control. Here I was, finally stepping up to experience all I had been missing, and there was death staring at me once again. For the first time in over five years, I was starting to feel again. I even had a slight crush on one of the guys at the health-food store and had gone on my first date in what felt like an eternity. I remember our first kiss like it was my first ever. Suddenly a door that had been closed was thrown open, and I was aware of my own sexuality. The thought of a heart attack sickened me and made me realize my own fate was out of my hands. Eating more or eating less would not solve this problem. I realized how little control one actually does have in life.

The doctor who saw me that day reassured me that my heart was beating fine. She did detect a clicking sound and ordered an ultrasound, which revealed a heart-valve leak. She called it mitral valve prolapse and told me the condition itself actually causes panic attacks. What occurs is a physical response, not a mental or emotional episode. I was instructed to give up chocolate, caffeine, teas and any stimulants and watch my blood-sugar levels. Homeostasis was best for keeping the panic attacks and other symptoms at bay.

With the panic attacks resolved, I was left to once again deal with the pain and stiffness issue. I had started running again in order to train for another marathon or perhaps a half-marathon, but I suffered on my long runs. I shuffled and limped along with my running partners and had trouble keeping up. Running with my new circle of friends had previously allowed me to open up and feel more at ease with myself. However, the pain was forcing me to shut down a bit. Once the chatterbox of the group, I had become quiet and would often fall so far back that my training buddies had to circle around to pick me up again. After a failed attempt to run a half-marathon, I decided to get a coach and see another chiropractor. These would be two of the best moves I ever made in my life.

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Training on Empty: Chapter 29 (Possible TW)

Possible trigger warning with mention of behaviors and numbers.

Chapter 29 – Leap of Faith

“God comes to the hungry in the form of food.” – Mahatma Gandhi Quotes, Mahatma Gandhi  

As with any other addiction, anorexia is a means for someone whose life may feel out of control to establish a false sense of security. Unable to control events outside themselves, addicts control their immediate environment. There is considerable irony in that the addiction ultimately ends up controlling the individual, but there is comfort in knowing that the situation, as bad as it may become, won’t change. Sometimes pain when one expects it is easier to handle than when outcomes are left up to fate. An extreme example of this is when victims of physically or verbally abusive perpetrators start an argument. Knowing when the slap or verbal attack is coming allows them to prepare for the blow and move on more quickly after the fact. Most often, a sense of the world being unpredictable stems from continually being let down by the universe; a parent failing to show love, a relationship ending abruptly, a lost job, a friend’s death. Although addiction temporarily offers a sense of control, everyone knows life is something that can’t really be driven and directed like some Hollywood movie. Going with the natural ebb and flow of nature is the best scenario, but is often a difficult exercise.

After a full day of crying and making calls to various counselors in the Phoenix area, I was told I could not receive financial assistance for any emotional or physical support or treatment until I was a resident. That meant I would have to stay there eight more months before I could afford care. I called my sister. I did not expect her to be so honest and forthright about how she felt. For the first time, she let me know that while she loved me and supported me, she was convinced that getting over an eating disorder was going to have to come from within. She was right; after all, I had spent thousands of dollars on hospitals, alternative medicine, books and therapists with no tangible results. I was like a chronic drunk who attends many Alcoholics Anonymous meetings without actually working the steps, assuming that something outside her could be the cure. While many of these avenues had given me greater insight into the disorder, none helped me overcome the problem. I understood my illness on an intellectual level, but I couldn't put it together in a way that allowed me to heal from it. I needed to take a leap of faith and allow myself to trust myself and trust that letting go didn't have to be such a struggle. There was a part of me that knew a healthier way to live, even if I couldn’t visualize it perfectly. I had just never nurtured that part of me, because I was too caught up in punishing myself. I believed fully in Geneen Roth’s method of living – listening to your body’s inner wisdom and trusting that deep down, you know what your body needs. I knew in my heart everyone could learn to feel what hunger was and know when fullness occurred. What I didn’t realize at the time, though, was the physiology behind eating and fullness and how much that changes with prolonged food issues.

In normal people, when blood sugar drops, the liver sends signals to the hypothalamus alerting the brain that the body needs glucose, the sugar the body breaks down from food. At this point, physical hunger is often experienced when the stomach contracts and the urge to find food and eat is experienced. The hypothalamus also identifies particular foods your body needs and is thought to be responsible for cravings. After food has been consumed, hormones are released and again find their way to the hypothalamus as the food begins to move from the stomach into the intestines. These hormones tell the body it’s time to stop eating. One hormone, called leptin, is released from the fat cells themselves. Satiety occurs after all these hormones have traveled to the hypothalamus. Unfortunately, with both starvation and purging, it’s as if these hormones become downright confused and are hesitant to be released. It takes a much longer time for leptin to be released in a bulimic than in a normal person. This can often trigger another binge because the bulimic actually still feels hungry, despite having just eaten a normal meal. Since anorexics constantly override these hunger signals, hormonal chaos results and delayed hormone release is likely. It takes many weeks of regular meals to establish the hormonal connection that allows one to begin to read and recognize both hunger and fullness. It has been reported that some of the concentration-camp victims in World War II experienced a warped sense of body image. It is also known that some who survived starvation and the harsh conditions of the camps ate so much upon their release their stomachs burst. Clearly, the body this far out of balance is not able to regulate its own needs for survival.

After much consideration, I decided to move back to Boulder where I could at least find support from family and friends. In the meantime, I was determined to allow my body to rule my appetite. I figured I had already hit rock bottom, so anything, even gaining weight, could not be as bad as living the way I had been living. To celebrate my faith that I would survive and live to see a better life, I went out for ice cream, something I had not done in over 10 years. I had sometimes eaten frozen yogurt at home, but to actually go out and allow someone else to serve me was something I had not experienced since my days in college.

I remembered from my stay in the hospital that once my metabolism started working again, I would be hungry. I didn’t realize I would experience an almost frantic need for food. I would eventually have to address both the emotional deprivation and the extreme physical deprivation the years and years of anorexia had caused. At times I would become panicky at the thought of having to wait to eat. I was consuming food every few hours. When I packed my belongings and headed home, I was on a mission to eat exactly what I craved. On my drive to Colorado, I stopped at five different stores in search of a bran muffin. It took an extra hour to find one, but after such severe restriction, I was allowing myself some indulgences. My fear of gaining weight was definitely still right in my face, but it was as if my body had taken over. I didn’t fight my intense cravings, only the thoughts in my head that insisted I was already getting fat.

Unfortunately, after too many sugary meals and far too little protein, I set myself up for another short bout of bulimia. It seemed that no matter how much I ate, it wasn’t enough. Also, for some reason, I couldn’t exercise without crying. It was as if all my fears were coming back to haunt me. I buckled under the past trauma of performing and overtraining, starving and living compulsively. My self-esteem was shot to hell and I was desperate for reassurance that I was going to be okay. I followed my mom around like a little puppy dog in order to feel safe. I felt vulnerable and shy and was having a terrible time trying to regulate my food intake. It seemed that the pendulum had swung in the complete opposite direction and stayed there after being held so tightly on one side. I finally saw a psychiatrist who put me on an antipsychotic drug called clozapine and some antidepressants, including a low dose of Prozac. Eventually I started to reach some balance. I felt obese at just around 95 pounds, only 15 pounds heavier than my low point. This was still very thin, but my weight was creeping ever higher and my fear was that it wouldn’t stop increasing. My psychiatrist told me that one of two things would happen: Either I’d continue to be anorexic or I’d get healthy and end up hating my body. This was a Sophie's choice, and I didn’t believe him. I also couldn’t believe he would say something like that. I knew there were women out there who were healthy and tolerated their bodies. I had even heard of people who actually loved their bodies. I refused to accept those as my only two choices. I quit seeing him and attempted to take responsibility for my own wellness.

Since I was still struggling with a horrible self-image, despite my belief that others could overcome this issue, I decided that in addition to starting to run again, I was going to stop weighing myself. I could not deal with the numbers any longer. They made me crazy no matter what objective story they told, and I obsessed about being a certain weight when the scale was involved. It's terrible to consider how a number could determine how I felt about myself. I knew this then, yet I still couldn’t stand the thought of my weight going above that 100-pound mark. I tried hard to stick to some sort of regular eating pattern: breakfast, lunch, dinner, and one snack. It wasn’t long before I couldn’t stand the sight of myself, though, and I started restricting again.

The next few months were a roller coaster of eating what I felt was too much and then reverting back to sharply restricting calories. I was running again and back to working out several hours a day, mixing the running with biking, walking and calisthenics. It wasn’t long before I was struck down with another stress fracture in my pubic bone. A later diagnosis would show that, over the years, I had suffered several small fractures in addition to the larger one in that area. I took to biking and lifting. I was very shocked at how weak I was. I had no core strength despite all the running and compulsive aerobic exercise, which only burned what little muscle tissue I'd retained. My muscles did not seem to respond to weight training by getting bigger or stronger. Instead, they broke down. It was as if my body no longer knew how to synthesize muscle. I experienced chronic soreness in addition to a general feeling of not moving forward and feeling stuck, yet I continued to work out like a hamster trapped on a wheel.  

A therapist friend of mine and I decided that since I had a tendency toward bipolar disorder, I should stop the antidepressants. She suggested lithium, but I was too afraid of the possible weight gain. I already felt such self-loathing at just over 100 pounds. I couldn’t imagine gaining more weight and living with myself. I had stopped purging, but was still having difficulty finding balance. On a whim, I tried a product called SAM-e. I didn’t notice any great change at first, so I stopped taking it, but a month or so later I realized it had actually been easing the depression I had felt throughout my life.

As for my eating, a combination of what I thought was sensible and what my body was craving seemed the best approach, so I used a variation of the Zone Diet to achieve at least some sort of regularity in my life. I found that eating smaller meals throughout the day kept me from feeling panicky or overly worried. The smaller, more frequent meals kept me from getting overly hungry or weak and also helped keep metabolism going. The smaller meals were also much easier to digest and didn’t leave me feeling as bloated or full. To help keep my blood-sugar levels from fluctuating too much, I made sure not to eliminate entire food groups from my diet. Basically, instead of following any diet in particular, I learned to balance what I was craving with a sensible meal plan. I aimed for a bit of protein, carbohydrate and fat at each meal. Still, I relied heavily on calorie-counting strictly out of fear of gaining too much weight, and letting go completely seemed out of the question.

A few months later, when my stress fracture had healed, I began running again, and I decided I wanted to run a marathon. I knew it was risky, but I wanted to prove to myself that I had the ability to give my body what it needed to run that far. I wanted to prove to myself I could adapt. I needed to show the people around me I had courage, so I started training by running longer runs on the weekends. I knew that on some level I was a bit over the edge but considering where I had been, I was indeed healthier, at least emotionally.

During the time I trained for the marathon I met some amazing new people, people who showed me the meaning of true friends. Unaware I was continually complaining about how fat I felt, I was confronted by my running partners. They said that while they loved me, they didn’t want to hear me say “I feel fat” anymore. This led to a change in my conversational habits that ultimately helped ease the actual feeling. The more I moved away from saying that I felt fat, the more I moved away from actually feeling fat. Eventually, I even thought about it less. The noise of these obsessive thoughts was decreasing over time. When I began to have panic attacks, another friend, Misty, suggested I wasn’t eating enough. She pointed out the pattern of my panic attacks and suggested I try eating a bit more each day. She said, “Look, you know that what you’re doing isn’t working, so just change.” I laughed, “What?” I couldn’t “just change.” Or could I? I had never thought about it, but she was right. “Just try something different for a week, and if it doesn’t work, you can always go back to what you were doing before,” Misty said. “Chances are, though, you won’t want to. If all else fails, try something completely different” And all of a sudden, I saw not one way out, but many. Infinite options were before me.

Change is hard for most people. It’s even more of a challenge for anorexics. They tend to set rules in concrete and develop rituals that may appear meaningless to others but are as essential as a life-sustaining breath of air to them. In addition, they are some of the best game-players in the world. No matter the extent to which rules around food, deprivation, and exercise threaten their lives, they will do what it takes to stay the course. It’s easy for an outsider to suggest that they just eat something, simply change the rules, but this is nearly impossible for someone trapped in the grip of such an illness. The desire to be well may be there, but the means to becoming well is missing. The thought of simply eating something outside the rules set is just not an option. There is no going cold turkey with anorexia. Unlike stopping other addictions, it’s impossible to have an all-or-nothing avenue for recovery. Instead, it’s more a matter of gradual change, baby steps. Although the analogy of a smoker having to smoke only half a cigarette is not quite accurate because cigarettes are not ultimately healthy for the body, in terms of addiction, the difficulty of this scenario would compare to what an anorexic has to do in order to recover.

When it comes to eating disorders, it often takes someone outside to allow for the permission of a change in the rule book. At times when exhaustion from dealing with the disorder and all that it brings sets in, an anorexic will welcome outside help and agree that someone other than herself needs to step in and take control. It takes an enormous amount of strength for this change to come from within. Whether the initial change happens as the result of allowing someone else to take control or from allowing the body’s needs to finally be heard, it is the only thing that will ultimately lead to recovery. Finding self-worth and discovering self-love are integral parts of reclaiming health. Simply gaining weight is not the cure to anorexia, and it's essential to feel worthy in order to heal. Listening to the inner self – the self that longs to live and be free and play by rules that are not so strict – is the real cure.

Anorexics have a tendency to see the world in black and white. It’s either-or; there’s no living in the grey. It occurred to me in the middle of my conversation with Misty that eating didn’t have to be a matter of starving or being fat; it could possibly be something in between. With this broad new view of my once-limited world, I was able to occasionally add snacks to my daily diet as needed. The panic attacks were fairly manageable and seemed to lessen with proper nutrition and by avoiding caffeine. The panic attacks would eventually get worse, but at the time they were not overly worrisome. I finished the marathon almost completely anonymously in an unimpressive time of 3:49 that included two stops – one to talk to a friend on the sidelines and one to use the portable toilet – but I found that I had accomplished a great feat. I had discovered my ability to listen to my body.

I would find out later that listening to my body could be disrupted and would become nearly impossible with so much damage already done to it. For some unknown reason, my body was continuing to break down despite an improved diet and a strict “no purging” policy; it was as if I had passed some physical point of no return, like a former smoker who quits too late to keep her emphysema from gradually worsening in spite of having given up cigarettes. And so it was that just when I thought I was getting on my feet, I faced the fact that despite not yet being 35 years old, I might have already caused irreversible damage to my body.

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Training on Empty: Chapter 28 (Possible TW)

Possible trigger warning with mention of behaviors.

Chapter 28 – The Long Road

“Courage consists of the power of self-recovery.” – Julie Arabi

Anyone who has suffered an eating disorder can tell you how increasingly distorted life becomes the longer the illness progresses. It’s hard to imagine being so lost and so stuck that hope disappears. There was a point in my illness where I had crossed over to what I truly believed was a point of no return.

When I was younger, I was at least somewhat well-rounded. I painted and drew, cooked, read books and watched movies. I don’t recall doing much of anything once my weight became so abnormally low. I also don’t recall exactly when it was that I stopped being in the world. I was isolated, except for a few select friends who could tolerate the sight of me, and I had dropped all hobbies and interests from my life. Days on end were spent exercising, though it’s hard to imagine exercising with no real strength. I also spent my time waiting for my two small meals: one in the evening, one late at night. Occasionally, there were days I would eat more normally and even some days on which I would binge, but the guilt was extreme and often very hard to handle. At the time I couldn’t see that those days of eating normally were what my body, mind and spirit craved.

Winters had always been hard on me, but when I weighed so little they became downright dreadful. I shivered in the top-of-the-line winter gear my mom had bought, freezing while others around me enjoyed the brisk air. Rather than risk another winter of extreme cold, I decided to seek warmer climates. Just a few months after being released from the hospital, I found a job at a Montessori school in Phoenix and left Boulder, hoping the new environment would not only ease the trauma of surviving harsh winters, but also allow me to escape my past. Yes, I was running away from my problems or at least attempting to escape. I wanted to get well, pay my parents back for all the money they spent on me and participate in the world again, but I couldn’t face the possible comments from other people about any weight gain. My thinness was what defined me, and I knew from past experience how hard it would be to change. Understandably, well-meaning people who would say, “You look healthy” or “you’ve gained weight” did not know that for me, those words translated to “you’re fat.” Those were the words I knew would devastate me. I was hoping that if nobody knew me as an anorexic, I might be able to change. Instead, the new environment and added stress of living on my own caused me to revert back to my most compulsive regime in terms of both exercise and eating.

Instead of getting better, I got worse. My weight was just below 80 pounds at times, and I was constantly sick. Though the seizures had stopped, my immune system could not fight off colds, the flu, or any illness floating in the warm desert air. I missed many days of work at a time. During times of illness, my fevers would spike so high I worried for my life. I would shiver and sweat the nights away and wait for morning to come, hoping I would wake to see one more day yet tired of facing these days.

When I wasn’t sick and merely trying to survive, I was compulsive, dragging myself through the days. I often called my sister or my friend, Heidi, in tears. I had no idea how selfish I was being at the time; all I could see was my own pain. I was miserable, living a marginal life. It took years before I could see the strain I put on others and how very much my friends and family suffered with my disorder. I had no idea of the sadness and anger my sister felt over losing her little sister who was, in fact, alive but not living. She felt cheated, not having a relative she could do things with, and admitted that she was tired of having to walk on eggshells around me, afraid that anything she said could upset me and potentially worsen or trigger my bad eating habits. She missed having someone she could do things with and talk to about things other than food and body image. It had been years since I had gone clothes shopping or gone out to eat with anyone. These were things my sister did with friends, because I wasn’t able to be a part of her life with my distorted thinking.

People at work were concerned about me and often tried to encourage me to eat. I refused. I was good with the kids and I loved what I was doing, but at times I felt terribly weak. I was unable to lift or carry most of the children, and I remember disappointing one heavier boy when I couldn’t lift him up onto the playground jungle gym. My heart went out to him, knowing exactly how he must have felt, but I was in no condition to be lifting the youngsters.

The kids where I worked were exceptional. They seemed wise beyond their years and had no problem making me feel welcome and wanted. To them it didn’t matter what my weight was; they just wanted someone to listen to them, play with them and teach them. While basically getting paid to play with these kids, it occurred to me that I had really missed out as a child. Although I had played with the other kids in the neighborhood, I always felt like an outcast, not accepted. It was the first time other children wanted me to be a part of the group, even though I was an adult. I longed to have their innate wisdom regarding wants and needs and their sense of joy about life. Mostly, I longed to have their carefree attitude toward food.

One day, not long after settling into a regular routine of workouts and work, I noticed that one of my teeth was hurting. I made an appointment with a local dentist and he discovered a sinus infection. He also discovered that I had an infection on both sides of my upper jaw. Apparently, after all four of my wisdom teeth were removed many years earlier, an infection eventually developed in two of the empty tooth sockets. The dentist had to go back into the socket to clean out the infection. I was scheduled for surgery just a few days later. The surgery was long and draining. I was supposed to return to work the following week, but my face was so bruised and swollen on my already too-tiny body that the director of the school where I worked was afraid I would scare the children. I sat home for a few more days until the swelling subsided and returned only to have the kids comment on my terribly pale, slightly yellow complexion. It was becoming all too obvious that my anorexia was affecting my liver and I was jaundiced.

Not long after the surgery, I developed another injury. My diet continued to be incredibly unbalanced and I was still compulsively exercising, running on a sore leg and doing calisthenics. Eventually the pain got to be too much, so rather than fight it, I stopped running. In order to reduce the fear of gaining weight, I decided to try a few days of a modified juice fast. My daily intake consisted of vegetable juice plus a little brown rice and vegetables. No other solid foods were allowed. After a few days I was starving. I binged and purged and called in sick to work. I was a complete mess emotionally and physically. When I went into the bathroom to wash away the tears, I stared darkly at myself in the mirror, my self-hatred growing. My eyes penetrated the image in the mirror, looking deeply and critically at my reflection.

That’s when it happened.

I had an epiphany. For the first time ever, and the last time since, I saw myself exactly as I was. I saw the bones on my face, my ribs sticking out, my thinning hair, my sharp hip bones protruding and my bony knees sticking out over my tiny calves. I could even see the bones between my almost nonexistent breasts where my ribs met. My arms were frail and so, so small. I was shocked, horrified. I was amazed I was still alive and finally understood all the stares and odd looks I received. I had no idea how things had gotten this bad, and I certainly had no idea how things could possibly get better. I knew I was stuck. I also knew I needed help.

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