Tag Archive | Intuitive Eating

Back to School: Recovery Focused!

For all of you who are going back to school – middle school, high school, college – there are some challenges that you may face. You want to be “armed” for these challenges and not let them hurt your recovery. For those of you who are parents of children, adolescents, or young adults with eating disorders, the following information will be helpful for you as well.

Summer, for many individuals, is a time of less structure, less pressure, and less exposure to the stress from peers. For students, it may involve a summer job, camp, vacation, a summer class or two, or just relaxing with friends and family.  Then, toward the end of August and the beginning of September, all that swiftly changes. Academic and social pressures begin again. Perhaps there is a change of school entirely, such as the change from middle school to high school, or high school to college. College students may leave home for the first time or begin living in an apartment, dorm, fraternity or sorority house.

Whichever the case is, transition back to school is a time of challenges for many students. It is especially challenging for those with eating disorders.

Structure, on the one hand, is very good for people with eating disorders. Getting back to the structure of a school day where there are specific times for specific academic and extracurricular activities, can be very comforting. The distractions that school provides, as well as the focus on new subjects, sports, and other skills, can also take the focus off the eating disorder and provide the sufferer with some relief.

On the other hand, going back to school can elicit some unforeseen stressors that can exacerbate an existing eating disorder. First and foremost, the anticipation of school (or leaving home to go away to college) will undoubtedly create anxiety. The fear of the unknown is a powerful source of anxiety. Social anxiety can also escalate. Anxiety can also relate to academics, lockers, teachers, making friends, and  living arrangements (at college). And, of course, there is tremendous anxiety related to body image, clothing, and food. I’ll highlight some of the specific stressors in my next few posts, and try to offer some solutions. Ultimately, it is important to be acutely aware that “back to school” time is a transition that individuals with eating disorders may struggle with. The issues are very real and must be handled with care and sensitivity.

The first topic I will discuss is “the lunch table” at school.

A number of my student clients are fearful of the lunch table. If you are a parent, you may be thinking “What types of stress could the lunch table create?”

Stressors that middle school and high school clients experience at the lunch table are:

  1. What should they put their lunch in – paper bag or lunch box (more typical in middle school)? Believe it or not, this decision causes an enormous amount of stress. They fear that if they put their lunch in the “wrong” container, they will get made fun of.
  2. Should they bring lunch, or buy lunch? This decision is stressful because they want to feel comfortable with what they eat for lunch, yet if their friends are buying lunch, they want to fit in. Also, there are usually lines of students waiting to buy lunch. Standing on line may be uncomfortable for the eating disordered student, as well as waiting on line creates a shorter amount of actual eating time. This can be challenging for the student who takes a bit longer to eat.
  3. If they bring lunch, what should it be and how much should they bring? Many individuals in recovery are on a meal plan that requires specific amounts of food that must be eaten at each meal. There is an enormous amount of conversation that occurs at the lunch table regarding what everyone eats. When a student eats anything that appears “different” in the eyes of anyone else at the lunch table, there is the potential for unwelcomed attention on the sufferer and their food choices. This is especially challenging when the sufferer is eating “more” than the others at the table.
  4. For female students especially, there is excessive “diet talk” at the lunch table. Comments such as “I am not eating carbs anymore.” Or “I only eat XX amount of calories a day.” Or “I have to lose XX pounds by Thanksgiving.” Or “I only eat pretzels at lunch.” This talk can trigger someone with an eating disorder, even when they are doing well.
  5. During the first few days of school, one of the biggest stressors my student clients experience regarding the lunch table is “where do I sit?” When an individual with an eating disorder has social anxiety and/or has only a few friends, and there is no comfortable person for him/her to sit with at lunch, he/she may experience an enormous amount of anxiety and may try to skip the lunch room altogether.

What are the ways to cope with these lunch table stressors?

  1. As far as the container you bring your food in, for the first few days, bring it in a paper bag (unless you know that the other students are using lunch boxes). Look around and see what everyone else brings their lunch in, and then you can re-assess whether the bag is the best choice or a lunch box. I’ve never heard of anyone getting teased about bringing lunch in a plain brown bag. Remember though, if you don’t have an ice pack in the bag, you shouldn’t bring anything that is perishable (lunch meats, fish, dairy, etc).
  2. Regarding bringing or buying lunch is concerned, keep your recovery at the top of your priority list when making this decision. If you feel most comfortable bringing lunch in order to meet your recovery goals, then bring lunch. As time goes by, and you can see what is on the school lunch menu, and you have seen how long it takes other students to get their lunch, then you can decide if you want to change your mind and buy lunch.
  3. You need to bring to lunch the amount of food that will carry you through until the next time you can eat (after school snack), or the amount of food that you and your treatment team have deemed necessary for your recovery. If you bring too little, you may struggle later, as you will be too hungry. This is true, no matter what type of eating disorder you have. In terms of what to bring for lunch, you want to bring the types of food that meet your nutritional requirements and foods that you like. If you need a supplement at lunch, you can bring it in a sports-type of bottle so that it appears like a sports drink. Try to bring foods that are “common” so as not to draw attention to your eating. I want to add here, that I understand this advice may cause some controversy. I’d love to say to my student clients to bring whatever they want to the lunch room regardless of what anyone might say, but I also want to protect them from any unwanted attention and comments. I had a male middle school client who brought tuna for lunch once and everyone at the table said “Ewww! That smells!” He threw his lunch away and ate none of it. A female high school client brought stuffed grape leaves to lunch and the others at the table commented on how “gross” they looked. She didn’t eat them and was too uncomfortable to sit at the lunch table again. Instead she ate in the nurse’s office.  You have to bring foods you like, but if there are foods that are pretty common looking, you will go unnoticed. These might be foods like peanut butter and jelly sandwiches or other sandwiches, yogurt, cheese sticks, pretzels, fruit, cookies, salads with chicken and cheese, granola bars, etc.
  4. When other girls start talking about their diets, you can try your best to ignore the conversation, start a separate conversation with the person sitting next to you, or change the topic altogether. Try to sit next to a “safe” person that you can rely on to help you out. If you are being too triggered, find an excuse to leave the lunch table (and take your remaining food with you). Unfortunately, diet talk is a pastime for so many people. You will likely not be able to escape it very easily. Also, many teens “talk” about their latest and greatest diets, but most of them don’t act on them. You must do your best to tune the “diet talk” out. Remember, in recovery, you have to stay focused on your needs, not the behaviors of others.
  5. Get as much information as possible in advance of the first day of school about who you know that will be in your lunch period. Ask them to meet you outside the lunch room before lunch starts so you can walk in together. Ask them to sit next to you as well. If you don’t know who will be in your lunch period, try to find a fairly empty table and bring a book with you. If you have a book to read, you might feel a bit more comfortable. While you are sitting there, try to look around for someone you know and then move to their table if there are empty seats. If there is someone else in the lunch room that seems like they are sitting by him/herself, you could try sitting at that table. He/she might be relieved to have someone sit with him/her. Or, if you are feeling courageous, you might try to use the lunch period to meet new people and sit with people you don’t know.

Remember also to talk to your family, friends, and/or treatment team about the anxiety you might feel about “back to school”. They will surely understand and might offer some great support.

Stay tuned for more posts regarding “back to school.”

 

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Well-Intentioned Mothers and Fathers

Several conversations I have had lately with mothers prompted me to write this post regarding parenting around food. There is an extensive amount of controversy over how to handle food and weight with children. The following opinions are based on the extensive experience I have had with parents, children, adolescents, and older teens. Since I am a nutrition therapist specializing in eating disorders, I see those individuals who have had a multitude of negative experiences around the issues of food and weight.

I’ll begin by recounting a story from the first mom I spoke with this past week. Her 13 year old daughter, “Abby”, came to her and said she was unhappy with her weight and wanted to lose a few pounds. Abby would be described as a normal weight girl by “normal” standards, but as a slightly overweight girl by the media’s unrealistic standards. Her mother said she approved of Abby’s plan to lose weight and would help Abby accomplish her goals. She told Abby to write down everything she ate so Abby could assess her portions sizes, and also recommended that she cut out “junk food”. This all seems innocent enough…except for a couple problems.

  1. Abby is 13 years old, which is right in the middle of growth and development. During growth and development, a girl’s body often gets a little larger prior to a growth period. It also gets larger prior to the onset of menstruation. This is normal and should not be interrupted.
  2. Abby is influenced by an array of negative, misguided and often inaccurate influences such as dieting peers, magazines and other forms of media that present a constant unrealistic source for body and weight comparison and dissatisfaction, and a constant barrage of internet sources that tout all types of unhealthy forms of dieting.  All these sources of misinformation may cause Abby to take her innocent diet too far or in a direction that could be harmful.
  3. Abby is not going to be under the supervision of a qualified nutrition professional that can help her through the process, therefore all her decisions will be made by herself and as a result of all the “outside influences”. This is a breeding ground for arbitrary, unhealthy rule-making.
  4. Dieting at any age is the number one behavior that leads to an eating disorder. Dieting at age 13 is tremendously risky.

The second mother I encountered this past week did some research on a particular method of eating that has been shown to have value in certain populations such as those with learning and developmental disabilities such as autism-spectrum disorders. As far as I know (I do not have all the information regarding her children), none of her four children have any type of learning or developmental issue. The reason I tell this story is because I have encountered many mothers who change their children’s diets drastically for one “good” reason or another and many (not all) children react in a very negative, adaptive way.   This mother restricted all breads and other wheat products, as well as all other grains from her children’s diets. I reiterate that I am not writing this post to discuss the pros and cons of any type of eating plan, just to illustrate the effect on children of drastic eating changes. These children frequently come over to my house to visit, and the family dines with ours a couple times a month.  The mother made me aware of the changes she was making to her children’s diet so I prepared meals that included a number of options that they were permitted by their mother to eat. I also included grains and breads for my family to eat, if they desired. On every single occasion the children have been at my house, they have “snuck” some type of bread or other grain while their mother wasn’t looking. I hadn’t been paying much attention at first, but my children pointed it out to me because they were worried the other children would get reprimanded by their mother and wanted to let me know that they were not encouraging nor discouraging the other children to eat any of the “forbidden” foods. They would sneak bread at meal time and would “raid” the cabinets for cookies and other snack foods. Whenever my children would notice, the other children would say “shhhh…don’t tell my mom.”

This mother’s intentions are to help her children but unknowingly, she is helping create a disordered relationship between her children and food. It would be my assumption that they are “sneaking” food in other places as well as my house. They may be feeling deprived of the foods they are not permitted to have in their home. The mother thinks her children are eating in one way when in fact they are eating in another.

I see another phenomenon over and over in my practice. Parents call me to tell me that their child is sneaking food. They find wrappers and all sorts of food paraphernalia hidden in couch cushions, dresser drawers, backpacks, garbage cans, etc. Their solution is to make the food environment even more restrictive, their child becomes even more creative in finding ways to get food, and the disordered relationship between the child and food worsens. If the child has the tendency to appear to the parents as “overweight”, the parents often become overly restrictive with food, reprimand the child for eating “too much”, criticize the child for his/her weight, and create unfair food rules for the child that the other children in the family don’t have to follow (if they are perceived to be of normal weight). An enormous amount of energy is spent by the parents trying to “control” the child’s eating, creating a stressful environment for all, especially for the child. The child ends up feeling deprived and becomes obsessed with food leading to a non-intuitive dysregulated relationship with food.

A (well intentioned) dad once said to me that he was demanding  his 9 year old daughter spend at least 45 minutes on the treadmill each day because she was developing a “stomach”. He was so concerned that she would become an overweight teen and then an overweight adult. He insisted that if he didn’t “help” her, she would be bullied and have no friends.   I met this little girl. She looked like a beautiful 9 year old girl. She had a little roundness to her stomach, as many little pre-pubescent girls do. There was nothing noteworthy about her appearance. I later found out that the dad had been bullied as a child and became an avid exerciser to cope with his negative experiences.  I expressed my concerns to the dad. I explained to him that it was my opinion that his daughter was just fine and did not need to be on the treadmill  to “get rid of her stomach”. I explained that she was perfectly normal. She was probably going to get a little wider before she grew taller and experienced puberty. If allowed to eat a wide variety of foods and experience movement in a way that she enjoyed, she would not be doomed to a life of being bullied and having no friends. She would hopefully develop a healthy relationship with herself and food and he would be better off supporting her in all ways, instead of worrying excessively about her physical appearance.

A dad came to see me to discuss his picky eater. This dad was one of the most intelligent men I have ever met. He had numerous degrees and was very well respected among his peers. He said his daughter ate only a few foods and he was desperate to improve her variety of choices and help her develop a more “sophisticated palate”. I asked him what methods he had already tried to help his daughter. He had only tried two…force feeding and bribery. For every new food she tried and liked, he would give her money. If she tried it and didn’t like it, she’d get no money. If she didn’t try it, she’d get no money. If it was put in front of her and she didn’t want to try it, he would force her to eat a bite by actually forcing it in her mouth. My first thought was “Oh my goodness. This poor child is in a bad situation.” My second thought was “Intelligence sure doesn’t equate to good parenting with food.” He was shocked that I disagreed with his methods.  I gave him some helpful suggestions, mostly regarding giving his daughter the power to make her own choices, not making them for her. I also told him not to pressure her in any way. She would not develop a “sophisticated palate” via any of his methods. The only things that these methods would create would be disordered feelings about food, and food aversions. I informed him that the worst thing that might happen if he gave her more freedom and less pressure would be that she would continue to be a picky eater. I also suggested that he invest some of the “bribe money” in a good full-spectrum multivitamin for her so that she wouldn’t develop any vitamin/mineral deficiencies.

None of these parents are bad people. They clearly love their children and want them to be healthy and happy. They are possibly misguided or ill-advised. Perhaps their own issues have clouded their judgment regarding parenting around food.

It is always important, as a parent, to put extensive thought into the actions you take regarding your children’s diet. Bear in mind that a child’s perception is his/her reality. If the child feels deprived or hungry, he/she will take strong measures to meet his/her needs.  If a child is receiving negative or mixed messages at home and in his/her outside environment, he/she may not have the skills to decipher between what is healthy and what is unhealthy. Messages may be internalized and create distorted thoughts and feelings about his/herself.

Force feeding creates long term food aversions. Deprivation creates powerful cravings and rebound overeating.  Try to remove your own food/weight issues from the decisions you impose upon your children. If you are on any type of diet, be careful how you speak about food around your children. Be especially careful about the language you use about your own body and the bodies of others. I treated a 5 year old girl once who was convinced that her thighs were fat because she heard her mother repeatedly say that her thighs were fat. If you are constantly popping on the bathroom scale and commenting negatively about your weight, you are teaching your child that it is normal to base his/her self-worth on the number on the scale.

A great resource for parents is http://www.ellynsatter.com/. Ellyn Satter is a pioneer in the topic of parenting with food. She has written several books that are very informative and helpful. On her website are informative handouts for all types of issues around parenting with food.

Ultimately, when parents lay the groundwork  for their children’s  relationship with food and relationship with themselves, they need to use extreme caution, insight and sensitivity.

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Why Can’t I Just Stop?

 

“When I’m having a bad day at work, I fantasize about the food I have at home.”

“When I’m making dinner for my kids after a long day of doing a million things for them, I can’t wait till I put them to bed so I can be by myself and eat all the leftovers.”

“I look forward to the times my husband goes away on business so I can do whatever I want with food.”

“The split second I am upset, I race into the kitchen and eat, eat, eat, as though my life depends on it.”

“As I feel the anger start to bubble up, I race to the box of xxx and crunch until I feel calm.”

“On Sundays, I feel so lonely I can’t wait to dive into the xxx to feel better. Then afterwards, I feel even worse. I also feel defeated, like I will never get better.”

“I feel so overwhelmed at times, I just can’t stop eating. I’m not sure whether I am overwhelmed and then can’t stop eating or if I can’t stop eating which causes me to feel overwhelmed, or both.”

“As I am jamming my hand into the package for another mouthful, I am promising myself that this will be the last bite but I can’t stop until it’s all gone.”

The above quotes from some of my clients illustrate that an eating disorder is not about the food. It is about the “state of mind” or “state of being” that the food and food behavior accomplishes. These quotes also illustrate the urgency these clients experience when thinking about getting to use the food behavior, as well as the helplessness that they feel.

I consistently try to help my clients see the relationship between their food behavior and what they are trying to “accomplish” by engaging in that behavior. Look at the words highlighted in the quotes above:

Bad day>>>fantasize

Doing a million things>>>be by myself

Look forward>>>do whatever I want

Upset>>>my life depends on it

Anger>>>feel calm

Lonely>>>feel better>>>defeated

Overwhelmed>>>can’t stop eating

Can’t stop until it’s gone

 

If an eating disorder were just about food, these clients would be able to “just stop” doing these types of behaviors and eat without all the urgency and subsequent remorse. But, an eating disorder is a complex combination of brain “hardwiring” and chemistry, environmental and familial issues and traumas, inability to communicate and feel authentically and effectively, etc. These food behaviors are an adaptation to many things.

If you are suffering from the type of eating disorder that causes any circumstances similar to the types of scenarios mentioned above, you personally know how hard you have tried to “just stop”. It doesn’t work that way. It’s not that simple.

But, there is hope.

First off, you have to try to understand that you have a complex history of underlying issues, combined with a brain that is genuinely trying to make you feel better.  It’s not your fault that you have found a food behavior that “works” in the moment to calm you down, numb you out, or wash away the thoughts and feelings that are painful to you. If it weren’t such an “effective solution”, you wouldn’t be so urgently seeking it out. You wouldn’t obsess or fantasize about it. You would be able to “just stop.”

Second, you must be willing and able to be kinder to yourself. If a loved one were going through the same pain and suffering you were going through, you would have compassion for them. Give yourself the same compassion. Tough love or self-criticism is not only ineffective; it worsens the behaviors every single time.

Third, without judgment, you have to be willing to self-reflect about what the food behaviors are trying to “tell you”. What are they accomplishing? Insight is essential. Without it, you will continue to beat yourself up and try to “fix” the problem behaviorally. It never works.

Fourth, you have to be willing to discover and tolerate the feelings you are attempting to numb out from, without the fear that you can’t do it. This is an area where clients often ask me “how do I feel my feelings? I don’t know how to do that.” The answer is simple and complex at the same time. We know that the food behavior is designed to numb out the feelings, so by delaying using the food behavior, you will feel something. You most likely won’t be able to do this for more than a few minutes at a time. During the few minutes you are trying to be abstinent from using the behavior, you may only feel anxious and obsessed about wanting to use the food behavior, but use the time wisely to gain information about the function of the food behavior. You may want to say to yourself, “I want to eat xxx so badly right now, but I’m going to hold off for 15 minutes to try to learn something about myself. During these 15 minutes, I’m going to journal whatever I am thinking or feeling. Then after 15 minutes, if I want to eat xxx food, I will.” By doing this through repetition over time, you may get some answers and may elongate the time during which you can be abstinent from the behavior.

Fifth, take the information you have gathered and try to make some life changes with it. For example, the woman who found that she fantasized about being by herself with food, after a long day with her children, used the information she gathered to try to make more time for herself  during the day. This way, she wasn’t in such need for it at night. The client who experienced loneliness every Sunday, decided to plan an activity with a friend or at least reach out and talk to one or two people every Sunday to feel connected. By realizing what the food behavior is “telling” you, you can work on improving the quality of your life.

Lastly, seek support. Both professional and personal support will help you make the changes you are seeking. You truly cannot do this work alone.

By no means does this process change your food behaviors in a day, or week, or month. You didn’t get to where you are in a day and it will take some time to make lasting changes. It can be done though…one baby step at a time.

Through (1) understanding, (2) kindness, (3) insight and self-reflection, (4) taking time to feel, (5) making slow life changes, and (6) getting support, you will heal…

 

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Can I Recover?

Many clients have been asking me lately:

“Do you think I can fully recover?”

“What does recovery look like?”

“Is recovery worth it?”

It is normal to be asking these types of questions. In my experience treating numerous people who have been and are continuing to go through the process, these questions come up often.

So, I’d like to answer them to the best of my ability in three separate posts. The answers are my professional opinions, based on my experiences.

Question one: Do you think I can recover?

Answer: I wouldn’t be working in the field of eating disorders if I didn’t think it was possible for everyone who has these illnesses to recover. But, what many people don’t often realize is that recovery takes an enormous amount of fortitude, time, insight, skill-building, and hope.

Fortitude during the good times is easier to attain. Fortitude when things are rough is much harder. It is during the roughest times that your fortitude will be tested, but will need to be an essential ingredient in the recovery process so that you don’t regress or relapse.

The time recovery takes varies person to person. I have never seen any individual recover in a short period of time though. You need to change your expectations if you thought recovery was going to be a “quick-fix.” Most estimates are between 4 and 7 years for the process. Some people make a quicker recovery and some take much longer.

Having insight into the origins of the illness as well as insight regarding it’s ongoing purposes is not only a gift, it is a necessity. If you know what your eating disorder’s functions are, you will be able to find better solutions for those issues.

Skill-building is the process during which you will need to practice using healthy coping mechanisms and communication skills in place of using eating disordered behavior. This new way of living is very challenging. It is uncomfortable. Resorting to comfortable eating disordered behaviors instead of healthy coping mechanisms is, in part, what causes the process to take time.

Recovery also takes support – in various ways – professional support, support groups, support of loved ones, friends, family, and peers. That doesn’t mean that you need to have full disclosure to everyone in your life, but seeking support in various ways from others is key.  Financially speaking, seeking the right type of professional support can be challenging, sometimes impossible. There are services that are free (some support groups and other group meetings). Finances may necessitate you being more creative in the types of support you can receive. There are also organizations like NEDA that have mentoring programs and group support via the internet. Project Heal offers treatment scholarships for people through an application process.

Resources are available. Support is available.

The question I often ask my clients when they ask me if they can recover is “Do you think you can recover? I believe in you, but you have to believe in you!” Often when people are in the throes of these illnesses, they truly don’t know the answer to this question.  They are unsure, scared, and haven’t build the confidence necessary to truly know. If you don’t know the answer to the question for yourself, you need to trust that others have gotten better and with time, strength, and practice, you can too.

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Q&A with Donna

Tiffany Asks: I’m doing well in recovery, but I was wondering how much involvement with food is ok. Is it ok to work a food / nutrition related job? Is it ok to watch Food Network? Or are these signs of obsession?

Great question! As a person who has a lot of experience in the world of food, I can tell you that many of my clients have been very involved in food-related jobs, interests, and hobbies while in the throws of their eating disorders, only to find out that when they get better, they lose many of these interests. Some of them have actually studied it in college but then switched majors when they realized they really didn’t enjoy it as much as they had thought they would. Others have continued to study it and enjoy it, long after they had been doing well in recovery. It’s very hard to know whether it is a true pleasure or if it is an obsession as a result of your eating disorder until you are very far into the process of recovery, or dare I say, recovered.

If you are currently doing well in recovery, try to ask yourself “will this food involvement trigger me to get worse, help me get better or have no effect on my recovery?” If you think it is triggering you or contributing to making you worse, it is not a good idea to invest energy into it. If is not triggering you to get worse or actually feels like it is helping you get better, then it’s probably just fine. Many of my clients have found that working in a food environment is the most challenging and triggering.

Anonymous Asks: Ever heard of on-demand eating? What is it?

On-demand eating is intuitive eating, which means eating what you want to eat when you are hungry and stopping when you are full. It is the kind of eating that many non-disordered people do with ease. It does not involve counting calories, fat grams, carbohydrate grams, or exchanges. It does not include weighing or measuring food, or rigid food rules. It absolutely does not involve dieting. If you have suffered from an eating disorder, it requires a significant amount of mindfulness, being very attuned to your emotions and trust in the process. It is imperfect. Mistakes are made when you may overeat or undereat. It has quite a learning curve so you need to be patient and hopeful!

Maria asks: How am I supposed to know if a craving that I am experiencing is based on nutritional needs or emotional needs?

It’s often extremely difficult to determine whether a craving is nutritional or emotional. You have to practice being in tune with your hunger, fullness, appetite and emotions to really gain a full understanding of your cravings.

Many people have cravings. Most “normal” cravings vary. They may be one type of food on one day and a completely different type of food on another day. One day you might crave ice cream, the next day, steak, and salad on another day.

If you have consistently deprived yourself of a particular food or food category (like bread, for example), you most definitely will crave this food. You may be able to suppress it for a period of time, but it will most likely unleash itself at some point. It will be powerful and difficult to fight, the more you avoid this food. This would not necessarily be a nutritional craving, but a deprivation-driven craving.

If you give yourself a variety of foods on a regular basis so that you are not depriving yourself, and you find yourself craving something, ask yourself first “when was the last time I ate?” If the last time you ate was a while ago (let’s say 3 or 4 hours), then your craving may just be hunger-driven. Your brain will picture a food that gives you pleasure and you will want to eat it.
If, on the other hand, you have eaten recently and it was a good amount for you, then you can most likely rule out a nutritional or deprivation-driven craving. You then need to ask yourself “where is this craving coming from?” Your craving may definitely be emotional. You can be fairly certain that you are craving something other than food. The food is what your brain is making you think of and obsess over so that you don’t have to think about what’s really going on inside your head. The food becomes an emotional salve or a temporary means of distraction.

Sometimes there is more than one type of craving at work. The most powerful cravings are those that combine hunger, deprivation-driven and emotional cravings. So if you restrict amounts and types of food, go long periods without food and you are going through a stressful time, be aware that these types of cravings will be stronger.

Stephanie asks:How do you find treatment that is affordable??

Great resources for services and other information on eating disorders are the NEDA website http://www.nationaleatingdisorders.org/ and the something fishy website http://www.something-fishy.org/.
You can locate services in the area where you live on both of these websites. NEDA sponsors web chats and can put you in contact with a NEDA Navigator.
There are also free support groups in many areas for people in recovery.

Elizabeth asks:Should I tell my nutritionist I used to chew/spit if I havent done it in years? Now i just restrict.

It is not essential to tell your nutritionist about a past eating disordered behavior, but I believe that it is important for you to be as honest with your treatment professionals as possible. If you had a past eating disordered behavior like chewing and spitting, it might be helpful to discuss the circumstances surrounding the behavior, the triggers, emotions etc. Remember that eating disordered behaviors are all symptoms/clues of underlying issues. The more your treatment professionals know, the better equipped they are to help you get to the root of the illness and help you get better.

Brooke asks: I am ready to recover from bulimia, I don’t want to tell others can I do this on my own?

Bulimia is an illness and as such, in order to recover, it is important to receive treatment from professionals that are experts in eating disorders and will treat you with the compassion and respect you deserve. You don’t have to tell other people unless you can seek their support as well. Most importantly, you need to be medically stable and gain the tools you will need to recover from your illness. Good luck, Brooke!

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Intuitive Eating

This topic is so broad it would take an entire book to cover all the characteristics. I just want to discuss appropriateness of this type of eating in recovery. I feel like so many of you want to try it but get worried because it is a concept that is foreign. So, first and foremost, when you are ready, you will hopefully know. Or, you and your treatment team will know. If you are not ready, there isn’t a “race” to get there. I think some people look at it as the end point of their recovery, a point of no return, and that alone brings up fear. Some people have asked me, “what if I go out of control because I can’t do it? What if I gain too much weight because I can’t trust my inner cues or they are wrong? What if I choose all the ‘wrong’ foods and then I can’t turn back? ” and the most common question is “What if my intuitive eating makes me gets me to my natural weight and it is higher than I like?”

What if, what if, what if????? All these “what if’s” are a huge obstacle but they sometimes also demonstrate a lack of readiness and fear. If you have a bunch of “what if’s” about intuitive eating, DON’T discuss it with the eating disordered part of your mind. Your eating disorder will turn it into a “fear fest”. Discuss it with your treatment team, especially your nutritionist.

If you have had an eating disorder for any length of time, your eating has been “from the neck up”. What do I mean by this? Your eating has been guided by your head only – your thoughts, your rules, your emotions, your past experiences, your disordered fears…not by your normal natural physiological mind-body cues. If you have restricted, binged, compulsively overeaten, purged, taken any appetite-suppressing substances or laxatives, overexercised, or a combination of these, you have “short-circuited” your natural means of detecting hunger, fullness and appetite. So, as a result of this short-circuiting, you will need to learn the skill that non-disordered people exhibit normally, until it actually becomes intuitive.

When are you supposed to do this and how are you supposed to do this??? It varies person to person but you can only expect to start the process when you are well-supported by your team. You cannot begin if you are at an extremely low weight or are using eating disordered behaviors regularly. You must be medically stable for a good stretch of time and should be eating consistently (perhaps on a meal plan). Also, you have to do this when you are confident that you have the ability to separate your emotions from your eating. You must also realize that you will make mistakes along the way. Sometimes you will eat too much and feel too full (scary) and sometimes you will undereat and want more (clearly a risk if you are not ready). This is an essential part of the process. No one learns how to intuitively eat “perfectly” without making mistakes.

Also, I like to look at the parallels between what you do with your food and where you are in developing your life skills as an indication of your readiness. So, as far as intuitive eating is concerned, when you are being more intuitive (guided by your gut instincts) in other areas of your life and trusting yourself with decisions regarding relationships, feelings, self-care, boundaries, etc, you will be more equipped to develop your intuitive skills regarding your eating. Overall, you will be living a more trusting relationship with yourself.

Please remember that recovery is a process (I feel like I say this so often!) and you need to know where you are in the process. I want you all to be able to trust your process and unquestionably get to the point where you can trust your true self! Just try to stay focused on where you currently are in your recovery and take the baby steps that are in front of you.

Below are the 10 Intuitive Eating Principles, by Evelyn Tribole & Elyse Resch, authors of Intuitive Eating

1. Reject the Diet Mentality Throw out the diet books and magazine articles that offer you false hope of losing weight quickly, easily, and permanently. Get angry at the lies that have led you to feel as if you were a failure every time a new diet stopped working and you gained back all of the weight. If you allow even one small hope to linger that a new and better diet might be lurking around the corner, it will prevent you from being free to rediscover Intuitive Eating.
2. Honor Your Hunger Keep your body biologically fed with adequate energy and carbohydrates. Otherwise you can trigger a primal drive to overeat. Once you reach the moment of excessive hunger, all intentions of moderate, conscious eating are fleeting and irrelevant. Learning to honor this first biological signal sets the stage for re-building trust with yourself and food.
3. Make Peace with Food Call a truce, stop the food fight! Give yourself unconditional permission to eat. If you tell yourself that you can’t or shouldn’t have a particular food, it can lead to intense feelings of deprivation that build into uncontrollable cravings and, often, bingeing When you finally “give-in” to your forbidden food, eating will be experienced with such intensity, it usually results in Last Supper overeating, and overwhelming guilt.
4. Challenge the Food Police Scream a loud “NO” to thoughts in your head that declare you’re “good” for eating under 1000 calories or “bad” because you ate a piece of chocolate cake. The Food Police monitor the unreasonable rules that dieting has created. The police station is housed deep in your psyche, and its loud speaker shouts negative barbs, hopeless phrases, and guilt-provoking indictments. Chasing the Food Police away is a critical step in returning to Intuitive Eating.
5. Respect Your Fullness Listen for the body signals that tell you that you are no longer hungry. Observe the signs that show that you’re comfortably full. Pause in the middle of a meal or food and ask yourself how the food tastes, and what is your current fullness level?
6. Discover the Satisfaction Factor The Japanese have the wisdom to promote pleasure as one of their goals of healthy living In our fury to be thin and healthy, we often overlook one of the most basic gifts of existence–the pleasure and satisfaction that can be found in the eating experience. When you eat what you really want, in an environment that is inviting and conducive, the pleasure you derive will be a powerful force in helping you feel satisfied and content. By providing this experience for yourself, you will find that it takes much less food to decide you’ve had “enough”.
7. Honor Your Feelings Without Using Food Find ways to comfort, nurture, distract, and resolve your issues without using food. Anxiety, loneliness, boredom, anger are emotions we all experience throughout life. Each has its own trigger, and each has its own appeasement. Food won’t fix any of these feelings. It may comfort for the short term, distract from the pain, or even numb you into a food hangover. But food won’t solve the problem. If anything, eating for an emotional hunger will only make you feel worse in the long run. You’ll ultimately have to deal with the source of the emotion, as well as the discomfort of overeating.
8. Respect Your Body Accept your genetic blueprint. Just as a person with a shoe size of eight would not expect to realistically squeeze into a size six, it is equally as futile (and uncomfortable) to have the same expectation with body size. But mostly, respect your body, so you can feel better about who you are. It’s hard to reject the diet mentality if you are unrealistic and overly critical about your body shape.
9. Exercise–Feel the Difference Forget militant exercise. Just get active and feel the difference. Shift your focus to how it feels to move your body, rather than the calorie burning effect of exercise. If you focus on how you feel from working out, such as energized, it can make the difference between rolling out of bed for a brisk morning walk or hitting the snooze alarm. If when you wake up, your only goal is to lose weight, it’s usually not a motivating factor in that moment of time.
10. Honor Your Health–Gentle Nutrition Make food choices that honor your health and taste buds while making you feel well. Remember that you don’t have to eat a perfect diet to be healthy. You will not suddenly get a nutrient deficiency or gain weight from one snack, one meal, or one day of eating. It’s what you eat consistently over time that matters; progress not perfection is what counts.

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Top Ten Ways To Eat Pretzels

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Obsessed with Food!

People have sometimes asked me “Are you obsessed with food?” to which I answer with a resounding ”Yes, of course I am! It’s my business to be obsessed with food.”

For as long as I can remember, I was obsessed with food and the way it worked in the human body. I loved going to the grocery store with my mother in grammar school. When other little girls wanted to do ballet and play with dolls, I loved clipping coupons, reading food boxes and packages, looking at food ads in magazines, and of course cooking. I made up my own flash cards with names of parts of the body and what they did. I made up word games and crossword puzzles with food names.

Then, during the time I had my eating disorder, I thought it was “all wrong” to love food the way I did. My eating disorder told me that enjoying food was wrong and I was a bad person to be excited about eating. When my weight was up, my eating disorder said that if I enjoyed food I was weak. When my weight was down, my eating disorder told me if I enjoyed food I was weak. I couldn’t win against the impossible rules and the critical voice that told me to loathe food and to avoid all aspects of it. I was a slave to the rules and therefore gave up all my “healthy obsessions”. In their place, I developed unhealthy obsessions like going to the grocery store and hating anyone who bought the foods I loved, or buying all my favorite foods and using unhealthy behaviors with them. My love for food turned into a form of self-punishment that lasted for years. I’d see my favorite foods and immediately hate myself for loving them. I’d read a label and beat myself up for enjoying the words and images. The grocery store became a battle zone. My magazine and nutrition books became enemy #1.

Then, slowly…I got better!!!!!  I fought back and regained my healthy obsession with food! I went to the grocery store and bought those wonderful foods I loved so much! I began enjoying foods with breathtaking colors and flavors and textures. I poured over new food packages. I bought fresh ground coffee and put half and half and sugar in it, just as I loved to have it before my eating disorder. I relearned all the ways food benefits my body and helps fuel me and give me energy! I turned my healthy food obsession into a career devoted to helping people challenge their unhealthy obsessions with food and their body and developing healthy relationships with food and their body.

Currently, one of my favorite things to do is to find a gourmet food store and just walk around looking at all the beautiful colors, aromas and packages. Sometimes I find it hard to believe the brilliant reds, yellows, oranges and greens of peppers. And, I love the smell of fresh ground coffee, right out of the coffee grinder. The combination of ingredients I find at salad bars amazes me and gives me great ideas for meals at home. Fresh breads and cheeses make me so excited! Learning all the ways foods can help heal people is astounding to me still!

So…yes, I am obsessed with food, and nutrition, and helping people in their recovery!!! I hope you can some day be as healthfully obsessed as I am…or at least not “unhealthfully obsessed”!!! Reclaiming a healthy relationship with food and your body and taking the power of choice and decision-making away from your eating disorder is a healthy obsession worth fighting for!

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Lessons and Learning

Every day I learn something new about life and about myself. The lessons aren’t always positive but lessons, nonetheless. I learn about my relationship with food, myself, and the world. The lessons aren’t earth shattering either. Just lessons…

Today, one of the things I learned is that I truly love to make people happy with food. My kids were home from college and my daughter brought some friends home with her for a mini “vacation”.

We started the day with subs for lunch, and then went into hot chocolate with an assortment of cookies. Later we rolled into a dinner of chicken, three types of pasta, garlic bread, fruit and veggies. We ended the night with “make your own sundaes”.  I think, for me, food is an integral part of creating good memories. I have had so many bad memories of food; I am trying to replace old bad memories with new, happy ones.

During the days of my eating disorder, I would want to see people eat because I would get pleasure from watching them, but it wasn’t a “healthy” pleasure. Nowadays, I love to think of what people would like to eat and then go “all out”. I think it is partly a nurturing thing. I have to admit, I also like the “thank you’s” because it makes me feel like I’ve accomplished something positive that brings people enjoyment.  I also realized though, that I don’t like to prepare food for friends who are connoisseurs of food. I have had dinner parties in the past where my anxiety was high due to the fear of the expectations of my guests. Now, my audience has to be easy to please, like my kids and their friends, or my family. I feel like part of my character is wrapped around being a good hostess. My kids, their friends, and family are easy to please. Plus, I like the simple foods too!

I also experienced a variety of feelings today…”good” ones and “bad” ones. Joy, happiness, and pleasure, but also worry, overwhelm and fear. It never ceases to amaze me that life is a mixed bag of everything.  I already knew, but certainly experienced today, the ups and downs of life. I will strive though, to hang on to the positive experiences and feelings, understand and allow the negative experiences and feelings. When the day is over, I will accept it all.

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Why Is This Food So Misunderstood???

How can a simple wheat product that naturally contains protein and carbohydrate, and is fortified with iron and B vitamins, (and sometimes omega-3 fats) get such a bad reputation that people avoid it like it is a toxic substance, a drug, the devil?

Pasta is such a fabulous and versatile food. I cannot understand why so many people eliminate it out of their diet. I have heard countless times that pasta is “fattening”. If I had a dollar for every time I heard a negative comment about pasta, I’d be rich.

Let’s clear up some misinformation about pasta.

  1. PASTA IS NOT FATTENING.
  2. CARBOHYDRATES (FOUND IN PASTA) ARE NOT FATTENING.
  3. PASTA IS NOT BAD FOR YOU.
  4. PASTA HAS NO “POWER”.

So why then do so many people avoid pasta? Why are they afraid of pasta?

People who don’t have the accurate information about the nutritional value of pasta “buy into” what they hear in the media and from other people who perpetuate myths and misconceptions.

Truth:

  1. Pasta is a carbohydrate containing food that also contains protein, B vitamins, and iron.
  2. Pasta has approximately 100 calories per ½ cup (cooked), similar to other grains and starches, including starchy vegetables.  

End of story.

So…why do people fear this food??? I don’t want to upset or trigger anyone reading this post, but I want to present the facts and my professional opinion, instead of perpetuating the misconceptions.

In my opinion, when “most” people eat pasta, they are eating probably upwards of 2 cups (cooked), which seems like a reasonable entree amount when you see it in a bowl or on a plate. 2 cups cooked is approximately 400 calories. Unless you eat it plain, you are probably adding some type of sauce and protein (like meatballs), which will also contribute to the caloric value of the meal. Then, you might add bread with butter or dipping oil, salad with dressing, and other components to the meal. Your meal could therefore be naturally higher in calories than the original 400 for the pasta.  So perhaps the total meal is of higher nutritional value, and then all the “blame” gets placed on this wonderful “harmless” grain.

Pasta is a versatile food. It can be combined with all sorts of proteins, cheeses, sauces and veggies. It can be added to salads. It can be eaten hot or cold. It can be an entrée or a side dish. It comes in all different shapes and sizes. There are even whole grain versions, high protein versions, and non-wheat (gluten-free) versions. If you haven’t had it in a while, you could first have it as a side dish. Or, you could sample a few bites of someone else’s.  If you are “afraid” of pasta because of all the myths you have heard or because you have had a “bad” experience with it, remember, it is just a grain. It is worth trying it again. You might actually surprise yourself and have a positive experience! Bon appetit!!

 http://www.ilovepasta.org/

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Oh, the Places You’ll Go!

Thank you Dina, for a great post!

Congratulations!
Today is your day.
You’re off to Great Places!
You’re off and away!

You have brains in your head.
You have feet in your shoes
You can steer yourself
any direction you choose.
You’re on your own. And you know what you know.
And YOU are the guy who’ll decide where to go.

These are the first few lines of “Oh, the Places You’ll Go!” by Dr. Seuss. If you are not familiar with this wonderful book about life’s challenges, please do yourself a favor and read it! (You can find the complete text online, but I really recommend reading the book.)  While the message of this book is relevant at any stage in life, it is especially appropriate for someone setting out in a new direction. To a special client who has just taken a very brave step toward recovery, and to all of you who carry on courageously each day – YOU’LL MOVE MOUNTAINS!

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What is Normal Eating?

The following is a great definition of  “normal eating” written by a pioneer in the field of  “eating competence” , Ellyn Satter.

Normal eating is being able to eat when you are hungry and continue to eat until you are satisfied.  It is being able to choose food you like and eat it and truly get enough of it – not just stop eating because you think you should.  Normal eating is being able use some moderate constraint on your food selection to get the right food, but not being so restrictive that you miss out on pleasurable foods.  Normal eating is giving yourself permission to eat sometimes because you are happy, sad, bored, or just because it feels good.  Normal eating is three meals a day, or it can be choosing to munch along.  It is leaving some cookies on the plate because you know you can have some tomorrow, or it is eating more now because they taste so wonderful when they are fresh.  Normal eating is overeating at times:  feeling stuffed and uncomfortable.  It is also undereating at times and wishing you had more.  Normal eating is trusting your body to make up for your mistakes in eating.  Normal eating takes up some of your time and attention, but keeps its place as only one important area of your life.

 In short, normal eating is flexible.  It varies in response to your emotions, your schedule, your hunger and your proximity to food.

 Source:  How To Get Your Kid To Eat…But Not Too Much by Ellyn Satter

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The Holidays are Coming!

As November gets into full swing, I brace myself for the onslaught of stress that the upcoming holiday season brings. I love the holidays but they are a time of increased exposure to family issues, excessive spending, depleted bank account, shopping during every free minute, pressure of getting the “right” gift, decorating the house, making the “perfect” holiday meals etc. But, alas, I try to focus on the things I love about the season so I don’t get buried by the stressors.

Ten things I love about the holidays:

  1. I can eat leftover turkey sandwiches and pumpkin pie for a few days after Thanksgiving.
  2. Clients bring me Christmas cookies.
  3. I have a month off from teaching my college class.
  4. I can wear the coziest sweaters and there is a chance of snow.
  5. There are Christmas carols on every radio station.
  6. Starbucks has red cups.
  7. Williams Sonoma has free samples of peppermint bark.
  8. My kids are home from college for a month.
  9. I make the best Christmas buffet dinner.
  10. I can enjoy the scents of our Christmas tree and holiday candles.

I will post a “survival guide” for the holidays in a few days, but meantime, since I am trying to focus on the positive aspects of the upcoming season, I’d love to hear your ideas on how  you plan to make your holiday season a recovery-focused happy one!

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Carbs, Carbs, Wonderful Carbs!

You are a human. You are not a plant. Therefore you cannot photosynthesize to get energy to live. You must get your fuel/energy from food. The “essential” nutrients in foods – carbohydrates, proteins, fats, vitamins, minerals and water, provide the “raw material” to give your body life! The reason these nutrients are called “essential” is because life ceases without them!

Today’s post is on the topic of carbohydrates. Bashing carbohydrates is OLD NEWS. In fact, it never should have been news in the first place. Carbohydrates are your body’s NUMBER ONE source of energy. There are between 75 and 100 trillion cells in the adult human body. All those trillions of cells need carbohydrates to thrive.

Carbohydrates are essentially carbon (C), hydrogen (H) and oxygen (O) organized in teeny little carbon rings, either by themselves or bound together with another similar ring or in longer chains of rings. They are found mostly in foods of non-animal origin.

This is glucose. It is the only carbohydrate your cells can use. All other carbohydrates you eat have to eventually convert into this cute little molecule in your body. So no matter what food your carbohydrates come from, they ultimately will become glucose to give your cells energy.


Carbohydrates are the PREFERRED source of fuel for most of your body’s trillions of cells but they are the ONLY type of fuel that your brain and central nervous system can use. They cannot use any other type of nutrient as their energy source. They need carbohydrates to survive. Have you ever felt a lack of concentration, brain fog, from eating too little carbohydrate? After going long hours without carbohydrates, have you gotten weak and shaky, your muscles begin to tremble and your heart begins to race? Ever wonder why that happens? When your brain is “starved” of carbohydrates, it senses that it has no energy to survive. It sends messages to your muscles to tremble to release any stored fuel (carbohydrate) to send to the brain and it makes your heart beat faster to get the blood quickly to the brain to prevent the brain cells from “dying”. This isn’t a pleasant scenario and your brain is obviously showing you it is in danger.  Your brain is telling you it is desperate and has no fuel to work!

You need carbohydrates all day, every day for sustained energy for your brain and body. So, every time you eat something, whether it is a meal or a snack, it would be ideal to include a carbohydrate source with your other nutrients.

Also, contrary to some peoples’ beliefs, carbohydrates are NOT “fattening”. This concept is misleading and incorrect! Remember, from another post on this blog that a calorie is a calorie is a calorie. Calories coming from carbohydrate-containing foods are no more or less able to change an individual’s weight than calories coming from other foods. That is a MYTH!  The more you avoid them though, the more you will set yourself up to crave them. If that has happened to you, the more consistently you are able to include them into your daily meals and snacks in a “safe” way, the more comfortable you will become.

In addition to the energy you will give your body and brain by eating carbohydrate- containing foods, you will also give it other fabulous nutrients, depending on which foods you choose. For example, if you choose to eat whole wheat bread you will also be giving yourself fiber and B vitamins. If you eat yogurt, you are also getting calcium, protein and vitamin D.  If you eat fruit, you are getting fiber and antioxidant vitamins. Or you could have a fun food like a candy bar and you will benefit from the energy from carbohydrate and a side benefit of pleasure (an essential ingredient in my opinion)!!

So, the next time you are considering what to eat, remember that carbohydrates are essential!  Your trillions of cells will thank you!

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Pizza!

As you all know, I am a nutrition therapist who specializes in the treatment of individuals with eating disorders. And as a nutrition therapist, I don’t spend a considerable amount of time “educating” my clients on nutrition. What I do is more like “therapy” around eating, food and weight. Very often however, my clients’ food choices are based on fears, diet propaganda, misinformation, myths and misconceptions.  It’s during conversations revolving around these topics that the “nutrition educator” in me comes out!

Since I have a strong background in nutrition and physiology, I thought I’d add some posts to the blog discussing specific foods, providing nutrition tidbits and dispelling some myths and misconceptions about certain foods and diets. Many of you may avoid certain foods or nutrients that you truly like but have been “brainwashed” into believing they are “poisonous”! I hope you enjoy these posts.

The first food I want to discuss is pizza. Pizza is an emotionally charged food. I can’t tell you how many discussions I’ve had over the years about this controversial “delicacy”. Most of my discussions have involved listening to and understanding people’s aversions to pizza and helping them challenge and overcome their fears of this very simple food.

Pizza is basically four ingredients – dough, shredded mozzarella cheese, tomato sauce, and herbs. Yet, people describe it as “greasy, fattening, bad for you, etc”.  How could these basic four ingredients get such a bad rap? Would you feel the same if I suggested you eat a pita with 1 ounce of cheese, and a few slices of tomato? Probably not. It’s basically the same thing, just heated up! One slice of pizza is 2 ounces of dough, ¼ cup of shredded cheese and probably a tablespoon or two of sauce. That’s it. The reason it looks a bit shiny is because when cheese melts in a hot pizza oven, the small amount of oil inherent in the cheese rises to the top. 1/8 of a large pie is only about 250 calories! Pizza is a “social food” that is served at parties, at restaurants. It is a fun food!

The next time you are thinking “I can’t eat pizza. It’s so bad!” remember that it is actually good for you. It’s got protein, calcium, vitamin C, and other healthy nutrients! You can even have it topped with your favorite veggies for added flavor, nutritional value and excitement! If you are nervous about ordering a whole pie, just start off with ordering an amount you feel “safe” with and prove to yourself that you can do it!

I’d love to hear some stories from you about positive experiences you’ve had with pizza!

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