Eating Disorder Recovery Handbook (3)

Nourishment

“There are realities we all share, regardless of our nationality, language, or individual tastes. As we need food, so do we need emotional nourishment: love, kindness, appreciation, and support from others.” -- J. Donald Walters

As a note of caution: If you are at a point where refeeding syndrome might be a concern, please seek medical attention as soon as possible. Also, eating disorders can affect hormone and electrolyte levels. In general, stress can affect your entire endocrine system, so check in with your general physician or an endocrinologist to make sure you are not experiencing any symptoms related to hormone or endocrine imbalance. Be sure you are following the advice of your recovery team and doctors as you look into these and any other suggestions. Only use what you feel safe using.

Food is fundamental to life, yet many see eating as the most difficult aspect of treatment, however essential it is for recovery. Healing starts with giving your body, including the brain, all it needs to nourish and restore itself, so that it can operate at an optimum level. You have to give yourself permission to eat. Any guilt or shame around eating, no matter what your actual size, must be countered with a reminder that food is a basic right that you deserve and need. Food and nourishment are primarily for the body but also for the mind and the soul, so to speak. And nourishment can take many forms when it comes to how you manage your body.

Moving toward health takes seeing yourself and treating yourself as a whole being. This includes the physical, emotional, mental and even spiritual bodies. We can’t expect the cure of a complex illness to be found by focusing on only one aspect of the disorder, however, when it comes to eating disorders, refeeding and getting proper nutrition, no matter what your disorder, is essential. Unfortunately, getting the right nourishment can be one of the scariest steps in the healing process. It’s important to keep in mind, though, that the more the body is lacking nutrients, the more distorted thinking generally is. As an example, a person in the throes of an eating disorder such as anorexia will often feel fat. It seems counterintuitive, but this kind of distortion usually becomes less problematic as weight is restored and the right nutrients are included in the diet. In my own case, I constantly felt fat and uncomfortable in my body during my worst struggles, but when my weight returned to a stable level, I experienced fewer thought distortions and less negative thinking. In fact, the noisy, unhealthy chatter in my head went from being a constant annoyance to eventually slipping into the background to finally giving me peace as I continued to heal.

Whether your pattern includes restricting, binging and purging, or some combination, the ultimate goals in recovery are restoring health and experiencing life again. These are complementary goals: Progress in one eases the path toward the other. Refeeding can be a difficult step in recovery, and that’s why it’s safer to have support -- perhaps even in a hospital setting -- when you begin to eat after a long period of restricting or after eating inconsistently. Finding pleasure and enjoyment, even when it comes to eating meals, can happen. For those who believe they are eating too much and feel guilty, look at where these beliefs come from and how realistic they are. As Carmen Cool, MA, LPC says, “Your body, your rules,” so aim for both physical and emotional health as much as possible. Sometimes being healthy includes eating a chocolate ice cream cone in the middle of the afternoon with friends or having a second serving of potato chips with your sandwich.

It’s not uncommon to have an increased appetite as you begin to nourish your body. In fact, this is normal. Whatever kind of disorder you have, it’s so important to make sure you are getting enough protein, healthy fats and carbohydrates during this phase of recovery and that you have the emotional support you need. Cravings can feel scary, but the more you understand them and the more you listen to what the are saying, whether they are emotional or physical needs, the easier it will be to feel at ease when they appear.

I can’t stress this enough: The more support you have from family, friends, therapists, dietitians, nutritionists and/or members of support groups, the better. You don’t have to go through this alone. Knowing we are not alone is a comforting thought, and feeling supported can push us to make the changes we need.

The fear of not being able to stop or control the hunger once you begin eating regularly can be worrisome, but allow yourself time for your body to adjust to the changes and to the different foods you are now consuming. It can take a while for your body to heal and adjust to digesting food regularly again. Your metabolism will probably increase as you eat more and are no longer in a state of starvation. Even if you were not starving before starting your recovery, your body still needs time to get used to consistently receiving and processing the proper nutrients. Please trust me on this -- any uncomfortable feelings will subside. Have faith that the intense hunger will decrease once you get used to eating regular meals.

Honor your hunger, and don’t be afraid of it. Acknowledge it and learn that it’s OK to eat when you feel hungry. You don’t reach a moral high ground or display strength when you restrict and deny yourself what your body needs. On the contrary, it takes courage, conviction and strength to give your body what it desires when you are used to restricting or binging.

Often neglected in discussions about refeeding (or simply changing your diet) is the fact that troubling digestive issues may arise. Digestive enzymes, such as pancreatin and hydrochloric acid, can ease bloating, gas, and that uncomfortable full feeling while they help your body absorb more nutrients. Other symptoms, such as acid reflux, constipation, nausea, excessive hunger, or diarrhea, might require that you seek medical attention. With severe malnourishment, intravenous vitamin drips can be most beneficial. A high-quality multivitamin and mineral tablet – especially one that contains an adequate amount of zinc, a mineral that has been shown to decrease the symptoms of anorexia – is crucial when adequate daily nutrients are missing from the diet. Ultimately, the body is resilient and is able to repair itself when given the chance. Healing is possible. With proper nutrients and an improved mental outlook, complete healing can occur more quickly.

Keep in mind that no single diet will work for everyone. There is no perfect diet, and what is optimal for one person might not be for another. In addition, the diet you settle on now may evolve, and you may find that it changes as your comfort level around eating improves during recovery. Aim for a nutrient-dense diet, but move away from too many rules, especially ones that are too strict. Your diet should be something you create that includes a variety of foods. If you are unsure about what you should be eating, try seeing a nutritionist or dietitian to get you started in the right direction.

Food should nourish both the body and the soul, so to speak. Some people like the idea of intuitive eating, while others like to have a meal plan to use as a guideline. Be sure, though, that meal plans are suggestions only. You should be able to allow any rules around food to be broken when it means you are honoring your physical needs. It’s also OK to break rules just because you feel like it, but try to be aware and don’t beat yourself up about it afterward. It’s your body, and you are allowed to have a say in how and what you eat. This will become more second nature the more you get used to eating a healthy amount. During meal times, try to make your environment as calm and comfortable as possible with few distractions. Turn off the television, set the table, put your cell phone in the other room, and sit down, so that you can concentrate and be aware of the food you are eating and also be in touch with how you are feeling. Make sure you are addressing any issues that can make meals more stressful and cause an increase in anxiety. Try to make mealtimes stress-free. After meals, use either journaling or distraction to keep from feeling any anxiety related to eating.

Eating out and eating with others can be challenging when you are also dealing with an eating disorder. Not being able to control what you eat and eating in front of others might cause anxiety. Do your best to stay as calm and relaxed as you can. Part of eating with others is the social aspect, so do what you can do focus on enjoying the company you are with. For some, eating with others can actually help them feel more relaxed. Being with others can allow a person to feel safer with trusting that portion sizes are acceptable and with eating in general. Whatever the case, whether you see eating with others as a challenge or an advantage, push yourself to go outside of your comfort zone from time to time.

Fad diets, even those based on scientific findings, do not typically address the emotional aspect of eating. Whether you restricted, binged or purged, make sure you are addressing the underlying emotional issues related to your particular disorder. Always remind yourself that you are deserving and need food to survive. There should be no shame or guilt around eating. Fad diets might give you quick weight-loss results, but they don’t teach you how to listen to and trust your body and its needs.

There is nothing wrong with enjoying your food. Many cultures celebrate and use food as a way to socialize. Food can be a way to create warm memories when we learn to get past any disordered thinking around it.

Online Advice

Sometimes I read "advice" online that makes me cringe. Please, if you are struggling with an eating disorder, be careful with the advice you take. Not everyone is qualified to be counseling others, especially when it comes to nutrition, psychology and recovery.

Recently, I read a blog post that the author mistakenly called an article, and I was shocked by the amount of incorrect information she was pushing. This is a person who supposedly has a Ph.D. and supposedly gives out advice to the many people who supposedly email her both on Instagram and by way of her blog. In reality, she takes a ton of photos of herself, and that's her main focus. I didn't look to see where she earned her degree, but I'm surprised anyone who has that much of a difficult time writing in coherent sentences can receive one. While wading through her post, it was difficult to decide if she didn't understand the topics she was discussing or if she simply can't write in intelligible sentences. I decided it's a little bit of both.

Let me make this more clear. I can't believe the complete garbage some people put out there. It makes me so angry when people like the lady mentioned above promote warped and potentially damaging ideas around nutrition and recovery. I assume they do so not because they are necessarily bad people but because they have their own unresolved issues around food.


The blogger made an effort to address hormonal imbalance resulting from severe dieting and mistakenly said that hormone levels are low in these dieters, but there are several hormones that play a role in the hunger and satiety feedback loop, most of them not low in those on restrictive diets. Leptin in both obese people and in anorexics is usually high, but it's lower in bulimics. A higher Ghrelin/obstein ratio in anorexics is thought to be related to an increased expression of the preproghrelin gene. In other words, this is also higher in people who restrict, not lower. Stress hormones also tend to be higher in anorexics and people dieting, but reproductive hormones tend to be lower. You can't make these big generalizations when it comes to hormone levels and eating disorders or any condition, really, and you definitely shouldn't be giving out incorrect information in general. If you don't know about hormone levels in people with eating disorders, you're not required to write about them in a blog post. If you choose to, don't just make shit up.


Oops, she did it again when she brought up insulin. I think she was conflating insulin sensitivity with blood sugar levels, but she was vague with what she wrote. It's hard to tell exactly what she meant. Sometimes people toss out terms without knowing or fully understanding what they mean. She did this several times in her post. When she suggests that insulin sensitivity increases during phases of extreme dieting, the information is inaccurate. Really, insulin sensitivity varies from person to person. Fasting (not eating a low-carb diet or dieting in general) typically decreases insulin levels, and this appears to increase sensitivity over time. Low-carb diets are also effective in reducing insulin levels but less effective in improving insulin sensitivity. In other words, when a normal person diets, insulin levels decrease, but there's rarely any immediate effect on insulin sensitivity. However, some studies suggest that fasting at regular intervals for diabetics does exactly this. It can increase insulin sensitivity for those who are insulin resistant.



If you're a diabetic, this kind of information might be important, but since fasting can potentially negatively affect your immune system and organs, cause dizziness, fatigue, and even cause more severe conditions, most doctors don't recommend it. Also, most people don't have insulin resistance (low sensitivity). This blogger seems to be suggesting that normal people would experience some type of insulin resistant hunger if they diet and then allow themselves to eat, which is not accurate, but, again, because the post was poorly written, it was hard to tell.


Yet another mistake she makes is suggesting or implying refeeding syndrome involves dangerous variations in electrolytes. I will give her some credit here because this is partly true, but refeeding syndrome involves much more than electrolyte imbalance. The main concerns with refeeding syndrome are edema and severe metabolic changes, taxing the body when systems that were not functioning or not functioning well begin working again and require nutrients that are not generally found in a starving body. Yes, the syndrome can include electrolyte imbalance, but you can't really describe a syndrome by focusing on one symptom and ignoring the more prevalent ones.

Mistakes are one thing. Everyone makes them. I can forgive her for these errors, but putting yourself in a position where you are giving others advice and then reinforcing complete myths about eating disorders is criminal. It's bad enough that she can't get her facts straight, but she steps over the line when she tries to convince others that people can't control themselves when they resort to intuitive eating after "extreme dieting," because....she can't? It's pure bullshit. 

How the fuck do people like this sleep at night? Mistakes, yeah, the body and its systems are complex and often confusing. I understand that. I've made mistakes or misunderstood various aspects of human biology, too. I hope if I make mistakes in my blog, people will call me out on it. What really pisses me off is someone basically suggesting that a person should continue harming herself, because she might not be emotionally prepared to handle change. In other words, this blogger thinks that if you are under-prepared to address the underlying psychological issues that are often associated with an eating disorder, you should just continue to engage in behaviors that might kill you. Absurd. 

Additionally, she seems to think that, because she is obsessed with food and hasn't resolved her own issues, anyone else who tries to eat intuitively after restricting will suddenly become overwhelmed with choices and want to eat and eat and eat. In my book, I write about a phase I went through in which I did eat a lot of junk, but I didn't have any idea what a sensible diet looked like at that point. Plus, my body desperately needed food. If your body needs calories and a lot of them, of course you are going to want to eat once you allow yourself, but you have to have some faith that you will be able to find balance once your health is more stable. It takes time. And if you are aiming for a nutrient-dense, well-balanced, varied diet, chances are less likely that you will swing to any extremes. 

There's no doubt that if you are struggling with an eating disorder, it's best to work with professionals. It's true that you can get some useful advice online, but you really have to be careful not to take advice from people who try to inflict their issues and insecurities onto others. Take everything you read with a grain, or in some cases a shaker, of salt. It's so important to consider your own beliefs and recognize when others are stuck in theirs. Seeing reality clearly can be difficult when you're struggling with an eating disorder, but do your best to trust that you can and eventually will figure it all out. Rather than reading random blogs, a safer bet when it comes to reaching out for advice and online support is to look into some of the eating disorder recovery forums on Facebook.  

In the end, the one good thing about this woman's post is that she admits that she is ill prepared to address questions related to severe eating disorders and that people who are struggling should go to a professional. Yes, thank you. Finally a bit of rational thought in an otherwise large pile of crap.   

Obviously, it takes working on the physical, emotional, mental and even spiritual aspects of the disorder, but the first and often the scariest step is refeeding, eating consistently and enough. Of course, if you are at a point where actual refeeding syndrome is a concern, this stage should definitely be supervised by someone in the medical field. I think it would be rare for someone in that state to be hanging out online asking bloggers who aren't specifically addressing recovery questions about diet, though it might happen. Anyway, what I did was risky, dangerous given where I was, but I also knew I would die if I continued restricting the way I had been. I wasn't prepared mentally or emotionally to handle eating again, but I had to do something to save my life. I at least knew that much. Is anyone ever really ready for change? There probably are some who can go into recovery more prepared. There's no real right or wrong when it comes to saving yourself.