10/23/14

Why People with Eating Disorders are Experts on Nutrition

A common misconception about people with eating disorders is that they don't understand basic nutrition.  This confusion leads not only to misunderstandings but to mistreatment and even condescension to people with these illnesses. 

The crux of an eating disorder is the inability to eat food through the day and to allow one's body to digest food regularly. Feeding oneself is an automatic activity for everyone else, as basic as taking a shower or going to sleep, but that mechanism is broken for someone with an eating disorder. 

When people who eat without difficulty try to understand what has gone awry in an eating disorder, it's very difficult to wrap their mind around the basic concept of the illness. Accordingly, they assume that the problem lies in concerns they themselves struggle with, such as the health benefit of food choices or portion sizes of meals.

It's more apparent to people in general that education about nutrition might solve the problem rather than realize the issue is something much more profound. 

The reality is that people who struggle with eating disorders actually know more than almost everyone else about nutrition. In fact, nutritionists who specialize in treating people with eating disorders know that education is not their primary role in treatment. Their goal is to help someone in recovery relearn how to eat meals and snacks throughout the day while avoiding the pitfalls of eating disorder behavior patterns. 

People with eating disorders, desperate to find a path out of their illness, often obsessively research nutrition. Many of them end up studying nutrition and become excellent clinicians because of their depth of knowledge. Their hope is that a vast amount of knowledge might counteract the eating disorder enough to help speed up recovery. 

Sadly, this information may be useful but does not contribute much to recovery from an eating disorder. 

The rules and behaviors of an eating disorder don't follow logic or reason. It will never be reasonable to starve oneself through the day, eat an enormous amount of food at once, regularly purge one's food or overdose on laxatives to lose weight. The driving force for these behaviors is the illogical but powerful thought pattern of the illness.

Combatting the thoughts of an eating disorder with reason and education will never work. 

I have written many times that compassion, kindness and understanding are the centerpieces of treatment for an eating disorder and for the support one needs from family and friends. This is a far cry from nutrition education, and for good reason. 

People with eating disorders suffer from a punitive, strong internal thought process that makes them feel horrible about themselves. The origin of these thoughts is different for each individual, but once the person is trapped in a cycle of starvation and illness, the thoughts intensify and dominate their lives. 

It's much more logical to combat a punishing thought process with kindness and compassion rather than with nutrition facts. After one understands the facts of these illnesses, the best way to help becomes much more clear.


Recovery is not a matter education about nutrition. It's a combination of learning new ways to manage food in one's life in an environment of kindness and compassion.

10/10/14

The Hard-Line in Eating Disorder Recovery

A common question from families, parents and loved ones about how to support someone in recovery from an eating disorder is about the type of support that is best to offer. After extended periods of illness, many people believe a hard-line approach will be helpful, one that emphasizes eating at all costs. They hope that standing their ground will enable the person to make the harder choices needed to get well. 

But often this kind of support represents frustration more than the compassion the person in recovery desperately needs. 

Given the choice between this type of support and the eating disorder, most people don't feel like they have a choice. The eating disorder is a way of life and has dominated every decision of every day for a long time. It provides comfort as much as it does misery. In the absence of other comfort, it feels like the only option. Just standing firm won't change an illness. It will just alienate the person who is unwell. 

Plus, families typically understand their loved one very well but don't understand the intricacies of the eating disorder thought process quite as well. The emotional bond of a close relationship remains important despite the illness but is not enough to lead to a magic cure. Instead, the person feels worse about the personal relationships but no more empowered to get well. 

The best support remains boundless love and compassion. This is not easy for even the most patient person to maintain through years of illness and recovery, but no one battling an eating disorder ever tires of that kind of support.

It inevitably creates a level of connection that sustains a person struggling to get well. Moreover, love and compassion send a clear message of believing the person can get well. That is invaluable. 

However, standing firm does have its place in the recovery process. The treatment team has a responsibility to assess the person at each step of the way. After a period of learning about recovery and learning how to face the eating disorder thoughts, most people get stuck. They can see the steps of recovery ahead of them but often back down out of fear of many things. 

It can be fear of getting well and the expectations that might come when the illness is no longer a crutch. It can be fear of losing the eating disorder, something that has defined identity for many years. Or it can be fear of gaining weight and looking healthy so that people stop worrying about their well being. Although these fears are the most common, there are many more. 

At this point, the treatment team has a responsibility to stand firm that it is necessary to take those steps forward in recovery. All these fears are present, but they cannot halt the steps towards getting well.

Years of illness have proven that life with an eating disorder is only a shell of a life. That is not enough. 


What the family needs to do is trust the treatment team, their loved one and the process of recovery. Taking recovery into their hands inevitably backfires, but family can provide love and support in ways no one else can. Love and compassion will be sustaining after recovery is finished and present the building blocks to life after recovery. That support plays a crucial role in treatment and allows the team to play its role as well.

9/26/14

Conclusions about Artificial Sweeteners

On the heels of the media coverage of the possible health benefits of a diet low in carbohydrates comes new research into the biological effects of artificial sweeteners. It's hard to resist the urge to magnify a study that supports one's beliefs into gospel, but an eye on any research needs objectivity. Whether or not you agree with the results of a study, all research has utility and limitations. 

Artificial sweeteners are chemicals manufactured and used for two reasons. The first is that they are very sweet, many times sweeter than sugar, meaning they have a much more powerful effect on human sweet taste buds. Second, they are chemicals humans cannot digest and absorb. Thus, they have no calories.

In essence, artificial sweeteners trick the body into perceiving sweet taste without providing any energy or nutrition, an apparent boon for a society bent on losing weight but maintaining pleasure. 

In this study, newborn mice either drank water with various artificial sweeteners or with sugar. Simply put, the results revealed that baby mice exposed to sweeteners showed signs of glucose intolerance while the mice which drank sugar water did not. 

Glucose intolerance is a metabolic precursor to diabetes. The hallmark of Type II diabetes is an inability to maintain normal blood glucose levels. The body has to manage an intricate balance between absorbing food from the stomach while releasing energy to organs all while keeping blood glucose levels within a narrow range. When this system malfunctions, diabetes ensues with the initial sign of elevated blood sugar followed by the many medical repercussions that come with the illness. 

With no other interfering factors, it appears that the exposure to artificial sweeteners had a part in causing glucose intolerance in these baby mice. This is the first study to convincingly show any possible linkage between diabetes and artificial sweeteners. 

The theory behind this result reinforces the idea that tricking our bodies to eat processed food is replete with dangers. Stimulating our taste buds begins a process of synchronized reactions in the body: preparation in the stomach and intestines for food, secretion of digestive enzymes, shunting of blood to the gastrointestinal system to absorb food and many more.

If this reaction is triggered routinely but then leads to no actual needed digestion, the theory suggests it would have an impact on our biological function. In this case, that means management of blood glucose levels goes awry. 

The study then continues to try to suggest these findings apply to people as well. This part of the study was less conclusive and in many ways secondary to the initial study. 

The most significant limitation of this study is how it applies to people. Mice may be mammals, but a study like this only makes it clear similar research needs to be performed on humans rather than proof we should all stop using artificial sweeteners.

Developing research to show long-term harm from these chemicals in people will be much more challenging. One cannot use human babies as experimental subjects as one can use baby mice. 


As with all research, the conclusions are interesting and thought-provoking but still leaves each of us with personal decisions about how to use artificial sweeteners.

9/12/14

A New Study about Low Carbohydrate Diets: A Study in Irresponsible Journalism

An article in the New York Times recently reported the health benefits of a low carbohydrate diet. The article attempted to explain the importance of such a finding and balance it within the current medical knowledge about nutrition and health.
Instead, this article reinforced that journalists need to better understand the influence of such a piece on the public at large. Many people will use this study to justify disordered eating and strict decision-making around food and health. Influential media need to heed their own power and adjust their reporting accordingly.

The article summarized the findings of a study in a respectable medical journal as follows: a diet comprised of low carbohydrates and high unsaturated fats appears to have improved health outcomes, especially cardiovascular health.

On the surface, a few simple conclusions seem harmless and perhaps even useful for a population eager for guidance on nutrition, but newspapers, desperate for an uptick in unique views and ad revenue, need to understand the way the public will interpret these conclusions.

The article surprisingly suggests that few people will heed this information, but that is clearly untrue. A stamp of approval by this newspaper immediately turns reasoned, balanced conclusions into fact for the public.

For a readership already plagued by confusing nutrition information and a terror of obesity and eating disorders, new, far reaching conclusions from a study the public is not educated to interpret only worsen the fear for the normal eater, who now will believe carbohydrates to be an evil food.

The newspaper needed to expound on the significant limitations of such a study. On first glance, the research has four glaring concerns which limit the utility of the conclusions. I imagine a more indepth analysis of this research would reveal many more.

The first is that the researchers have no way of proving that each subject followed the prescribed diet, and, in fact, research into dietary studies has repeatedly shown that people do not report diets faithfully. They tend to alter food diaries to reflect what they want the researchers to see rather than the truth. This is a common issue with studies about nutrition but must also be acknowledged.

Second, it is almost impossible to factor out all possible reasons for improved health and single out a change in diet as the cause. Making broad medical conclusions from a dietary change is hard to prove in subjects of a study and thus risky to propose, especially for information so desperately sought after, and then followed, by the public.

Third, changing one's diet for one year is nowhere near long enough to make any overall conclusions. The relationship between diet and a lifetime of health is broad and the information available is inconclusive. In order to have real value, a study will need to track health over a much longer period of time and will need to attempt to factor out the many other causes of health problems. However, that is a long and expensive endeavor that this study did not attempt.

Last, over 95% of people who change their diet end the changes within two years, so the likelihood subjects will continue this diet once they are no longer tracked by the researchers is extremely low. Making any reasonable connection between the general public and a dietary change needs to take into account the current, accepted knowledge about how hard it is to maintain changes in one's eating habits over an extended period of time.

The desire for a quick-fix diet and for definitive data to choose a philosophy of eating as healthful is overwhelming. Confusion around endless food choice and unlimited, delectable eating options leaves most people unsure of how to eat each day. Instead, the latest diet craze, research conclusions or evil nutrient lead to the endless string of nutrition fads in recent decades.

With a plethora of knowledgeable, balanced journalists, this reputable paper needed balance the conclusions of one study with the irrefutable evidence that scientific knowledge of nutrition is limited and that a balanced diet is the best alternative. As many of their esteemed reporters have said, we are omnivores who survive best on a varied diet with more real food and less processed food eaten regularly through the day. Any other information presented as fact is, at this point in time, purely conjecture that needs much more extensive research to have medical value.

The media needs to understand its responsibility in presenting new nutritional information and translate the findings into valuable information for the general public.

8/22/14

Raising a Child in a World of Dieting Part II

It rails against everything parents know to say less is more in raising children.

The time and energy spent managing the success and future of a child leaves little room for the child's personal growth and exploration. Forget any concept of small successes and failures: these kids are praised moment to moment as if they invent electricity every other day.

No measure of success truly matters because it is the norm. In fact, many communities just create endless rounds of success for kids these days--trophies for everyone--and not a whit of criticism or room for improvement.

Perfectionism has become the expected way of life. Difficulty translates into difference. No one, parents included, can tolerate failure. Ever. 

For readers of this blog and, for that matter, any literature about eating disorders, this mindset will be very familiar. It describes to a tee one central personality trait for people with eating disorders. Motivation gone awry turns into overwhelmingly impossible standards.  Internal drive without reason or purpose makes people need a way to opt out of completely unrealistic goals. Life is too hard when the expectations are so unreasonable.

Instead kids find perfection another way, namely through manipulating food and weight. 

Parents also struggle to accept imperfections in their children. Just because each kid gets a trophy doesn't mean they're all equally good at the sport. Adults, even those taken by fantasies of wildly successful prodigy, see the writing on the wall sooner or later. Accepting that reality and realizing their child is just another imperfect person are not easy pills to swallow. 

When faced with this reality, parents can turn to food and weight just as much as children. The illusion of creating a perfect child because of correct eating and weight maintenance becomes very alluring. Part of that can be positive reinforcement by adults who approve of a child's body type, but an overweight child can cause concern in adults and lead parents to use weight loss as a goal with their child, as a way to perfect their offspring. 

Establishing food restriction and weight loss as central to a child's identity severely limits their personal growth and development as well. At a time when a child is learning about their place in the world, focusing on something so limiting and narrow as weight can quickly derail their maturing selves. 

In this realm, the goal of parents is to reinforce the personal qualities of that child, psychological, emotional and physical, while protecting the child from the collective forces trying to focus family energy on food and weight. A consistent message from parents can balance those outside pressures and ensure the child knows the alternatives that exist in understanding oneself. 

It can be very difficult for parents to brush off outside comments about their child's physical appearance, especially when critical. Aggressively defending one's child against those adults who make comments only gives their thoughts more credence. The key is to discredit their thoughts while always presenting another way to see the world. 

Consistency, clarity and balance can, over time, allow the child to learn different ways to balance food and weight in a different world philosophy. The idea is not to eliminate those messages that reflect body and weight obsession since parents don't have that kind of power. It's rather to provide an alternative that so that the child  knows there are more important things to life.

8/12/14

Raising a Child in a World of Dieting Part I

In the next two posts, I will switch gears to talk about parenting children about food and weight. Adult attitudes towards these topics are central to a child's understanding of self-perception and of her place in the world. It is one thing for adults to struggle with the role of weight in determining self-worth, but it's something entirely different to saddle a child with those thoughts from the get-go. 

It has become fully accepted that weight is one of the primary means to judge others and oneself. The bias against those who are overweight--and the similar overestimation of those who are underweight--runs rampant in our society. The less discussed caveat to the prejudice is that being overweight or underweight always reflects overeating or dieting, respectively.

Laden with judgment, this reflection represents the implied battle between gluttony vs. restraint and the basis for judgment on our moral character. 

The sad truth of our culture today is that changing this prejudice doesn't seem to be on our radar. Much of the writing about the general increase in obesity and eating disorders reflects changes in accessible food, the plague of dieting, acceptable body type and the drive for thinness, but these cultural changes don't stop us from fully believing the overarching bias. 

This attitude has now seeped its way into judging a parent's ability to raise a child. The increased interest in parenting techniques and the concept that children are a reflection of parents' success make weight an easy target for judgment. Parents of thin children gloat while hose of overweight children shrink away in shame. These tendencies all seem to ignore the general well being of the child. 

Parents heed the fear of an overweight child by focusing on the child's eating right away. Starting with parents' obsession with a baby's feeding patterns, they monitor food intake throughout childhood, first for health and wellness but gradually, with the communal bias in mind, for weight maintenance. The end result is that parents know they will be held responsible for any change in their child's weight. 

It's easy to see how the collective judgment can let a child's psychological development go awry. Childrens' bodies change constantly. As expert pediatricians explain, growth comes in fits and spurts, ups and downs. The message for a parent is to be ready for anything without expectations and certainly without judgment.

Varying growth will undoubtedly include changes in weight. At several stages of development, it is common for children to gain more weight: babies until they start walking and pre-puberty, for example.

Interestingly, some children can be underweight at those ages as well; however, others are likely to praise an underweight child rather than worry about adequate nutrition. Educating ourselves about a child's development--information easily at our fingertips--seems more valuable than judging a child and her parents based on a number on a scale. 

Falling into the trap of judgment sends a message to that child: there is something wrong with you. It isn't necessary to praise everything a child does, but it is imperative to allow her to believe she is capable, that she is not battling against an indelible mark against her. 

The clear step for parents is to figure out how to manage food, weight and health in a child's formative years based on the child's wellness, not the arbitrary worries of a community. Although the ill effects of outside judgment may be hard to bear, heeding those warnings is essential so as not to confuse or derail a child's psychological growth. 


The next post will address these concerns and give practical advice about how to monitor a child's well being.

7/28/14

Dieting, Metabolism and the Toll on our Lives

The central, common symptom of most eating disorders is chronic starvation. This is obvious for people with anorexia, but most patients who binge also feel like they must compensate regularly between binges by trying to restrict food as much as possible.

But even broader than eating disorders, it has become all too common for people to consider an inadequate intake of food to be the norm, if not superior to regular eating. And people often find praise in eating less and showing what is considered restraint, no matter how insufficient their meals. 

Extended periods of limited food intake affect how the body works. Without adequate energy to maintain and support healthy organ systems, the body sacrifices necessary function on many levels to compensate for the lack of energy. These sacrifices can span any organ, depending on the person, and can even become irreversible over an extended period of time. 

To much surprise, the metabolic effects of food restriction apply to overweight people as well. When people gain weight, their body becomes accustomed to a new normal weight range over time, so severely restricted food intake might lead to initial weight loss but then triggers the same metabolic reaction as it would for anyone. That sacrifice of organ function combined with shunting energy to basic needs are survival mechanisms. Ultimately, survival trumps the number on the scale every day for the human body. 

The combination of an endless supply of treats, all intended to increase food and economic consumption and the falsehoods of a diet industry leave much of he population at a loss as to how to eat. A significant percentage of the population is trying to diet every single day. Our metabolic reaction to these mixed messages render all extended food restriction pointless. The only real effect of dieting is a constant sense of failure. 

There's another insidious way chronic dieting invades our way of life, societal norms and pop culture. The expectation of many social communities is thinness at all costs. Much of the information from celebrities reinforces these same messages, as does any promotional photos that are photoshopped to reveal impossible looking bodies. 

Through my work to help people eat regularly again, I find myself fighting an uphill battle against constant and much more powerful messages outside my office from industry to celebrity to general norms. The ways to normalize food by returning to our roots of culture, meals and pleasure are typically drowned out by the endless ways society approaches food and weight. 

What is even more astonishing is realizing the extent of sacrifice in our lives and world. All the people who are chronically underfed cannot function at their top level. Hunger quickly turns off the most potent and creative parts of our mind and leaves us unproductive and unable to perform at our expected ability. 

It certainly appears that body and weight are more important than healthy bodies and highly functioning minds in our society, but I don't know if that is clear to the general public. 


I wonder if this message would have more impact than the current attempts to change how we eat. It feels like competing with the dieting maxims and convincing people to rest at their body's normal weight are ineffective. People need a clearer reason to see how we are constantly duped by a society bent on pushing us all to limit our lives because of a number on the scale.