The Miracle of Human Metabolism

The other topic of the radio show I mentioned a few posts ago is concerned with digestion and metabolism of processed foods. The doctor in that show speaks with authority about how digestion and metabolism are different with these foods as opposed to foods found or grown in the environment.

Specifically, he describes how processed foods are immediately available for digestion and absorption which leads to instant changes in blood energy levels. There is increasing evidence that the complex hormonal regulation of blood energy struggles to adapt to these new foods. More natural foods provide a buffer to delay and slow absorption, something our digestive system depends upon for normal regulation of blood energy. 

The doctor's step towards vilifying processed food and added sugars though is unrealistic. From his vaunted perch, it would be more helpful to discuss how to live in a world with our current food supply. Being able to eat processed foods in moderation is a cornerstone in modern life, but it's also crucial to understand why the majority of one's diet needs to be real food for our bodies to function normally. 

People generally think about metabolism in terms of burning energy. The goal in this rubric is to maintain a high metabolism to keep weight down; however, this is not the true definition. The pressures from the food and diet industry intend to place blame on the individual while hawking products that lead to weight gain. 

Metabolism is the bodily function that digests food, turns it into usable energy and transports the energy to parts of the body that need it. It is a complex interplay of the endocrine and gastrointestinal system which maintains healthy function throughout the body.

Our conscious part in this system is to eat regularly and eat predominantly a varied diet of real food. People like the NYU nutritionist Marion Nestle have written at length about what that means, but it's not about following the most recent fad, just following logical conclusions. 

The purpose of reflecting regularly in this blog about metabolism is for readers to understand and admire the way our bodies use food and energy in complex and amazing ways. With that knowledge, we can try to avoid the current trends and pressures about food and just do the basics each day. That's true for everyone, those with or without an eating disorder.


Putting Weight where it Belongs in Recovery

One main focus of eating disorder thoughts is weight. It feels like a huge success to seemingly master weight with disordered behaviors, restricting, binging, purging, laxatives, etc. The positive feedback weight loss elicits is often intoxicating and only fuels the eating disorder thoughts. Just when someone starts to question the symptoms, that person finds herself trapped between the possibility of recovery and the terror of gaining weight. 

Treatment programs and clinicians often focus too much energy on weight for many reasons. Insurance companies limit treatment after weight normalization as a way to keep down costs. The pressure of patients to focus on weight can be hard for treatment providers to resist. And weight provides a concrete, if limited, measure of improvement, something otherwise difficult to quantify. 

The focus on weight in treatment only strengthens the eating disorder because weight gain feels most terrifying to someone in recovery. Losing the false sense of security that the eating disorder provides with weight is an enormous change in identity. 

Recovery needs to put weight in context. The number on the scale is only one marker of improvement in health and quality of life. Medically, heart rate, blood pressure, improved organ function, normalized brain function and increased energy all are signs of improved health. Similarly, a broadened personal life through work, family and friends represents changes only possible with improved health. 

If weight becomes a battle between recovery and the illness, the illness always wins. Treatment needs to minimize the value of weight and refocus instead on health and living a full life. There is so much more to being in this world than the number on a scale.

The fact that women sick with a disease receive so many compliments for a core part of an eating disorder is a sad comment on modern day living.


Focusing on the Place of Weight and Metabolism in Eating Disorder Recovery

The radio show "Good Food" was a favorite of mine when I lived in Los Angeles. The show covered somewhat light topics such as the farmer's market and new restaurants, so it was a surprise to see the host use her platform to address issues around food politics and health in this episode. She interviews two people in particular who discuss central concerns for people with eating disorders. 

The first presents the struggle about how to define health with respect to weight, a topic critical in eating disorder recovery. Much of the treatment world focuses too much on weight normalization as the sign of improved health rather than the many other markers of recovery: energy, improved cognitive function, repair of organ damage and reengagement with the world.

This piece talks specifically about improving the health of people who are overweight without focusing on weight loss. It's a novel approach to treat the overweight medically and not hone in on the number on the scale. The eating disorder community could take a hard look hard at this research. 

The second piece is an interview of a doctor from UCSF. He focuses on the effect of processed food on body metabolism, namely that insulin production and the endocrine balance of digestion are dysregulated by processed foods.

Our bodies are designed to eat real food and function at their best when fed appropriately. This information is crucial for people with eating disorders, whose metabolism often stops working with abnormal eating patterns. 

Unfortunately, this incredibly useful research allows the doctor to get on his soapbox and vilify a new food, sugar. He may have a point but his standing is better used to counter food industry myths than waste his breath on a new food villain. It's too easy to ignore the important information about food and health when given the specter of a new horrible food to avoid at all costs. 

Here is the link to the radio show. 


I will write about more about the role of weight and metabolism, respectively, in eating disorder recovery in the next two posts. 


Kindness and Compassion: The First Step for Families

The central tenet families need to understand is that kindness, compassion and patience are necessary to help someone get better from an eating disorder. Firmness, criticism and judgment only harden the illness and isolate the loved one from support. 

Understanding why this is so important is linked with familiarity with the thought process of an eating disorder. 

The internal world of someone with an eating disorder is harsh, critical and judgmental. The standards are always too high. Any respite feels impossible.

Because reality never matches up with unreachable expectations, the person endures the endless shame of never being good enough. 

These thoughts are not always in the forefront of one's mind. Often they run as a loop in the background all day and influence every decision and interaction. It makes for a tortured existence. 

The possibility of entering real treatment and recovery means lowering the bar from impossible to reasonable. The steps to get well can be slow and deliberate. Entering back into meaningful family relationships needs to be enveloped in kindness and caring. The key message, above all, is acceptance. 

Rather than searching for the best solution, families need to reconsider their efforts. Starting with a thoughtful, compassionate approach to the suffering of a loved one opens up the possibility for conversation and closeness.

There is no immediate concrete plan that will work. Through the door of compassion lies some of the answers to begin steps towards recovery.


Partial Recovery: Differing Views

I have written in this blog many times about the concept of having one foot in and one foot out of the eating disorder. The article linked below explains very clearly the risks of that state of living and why it inevitably leads to a small life followed by relapse. 

I also think it misses two key points. 

First, not everyone's path to recovery goes from two feet in to two feet out. For some, the perspective gained from having one foot out of the eating disorder is a significant step. Only recognizing the negative part of this state of recovery acts to take that progress away, which is not helpful.

It's crucial to understand that being only half out of the eating disorder is not an endpoint. Without continuing to press for recovery, the road from there is only towards relapse. 

The other concern about this article is that the message about weight restoration is somewhat heavy handed. It's clear through all the research that weight restoration increases the chance of full recovery significantly. But that research has limitations since the subjects are mainly at inpatient programs, thus ignoring a large part of the eating disorder population.

Rather than relegate these other people with eating disorders to chronic illness, I prefer to see their road as more complex. Their path will have to include improved nourishment and health, but immediate weight restoration without sufficient psychological progress also often leads to relapse, also shown through research. 

Preparing to step fully out of the eating disorder may need psychological and emotional attention first. Both parts of treatment are necessary for full recovery. 



Families must Start with Understanding, not Action

Someone savvier about blogs than me suggested I forgo a longer biweekly post for shorter, more frequent updates. That will start with today's post. 

The last post explored possible ways for powerless parents to approach an adult child with a chronic eating disorder. There is one central reason these approaches won't work that I will explain in this post. 

The logic families rely on to understand an eating disorder has one fatal misstep. It assumes that eating and health are the top priorities of the child. Either pulling back from the child or forcing her into treatment will not affect the underlying thought process, something crucial to start a path to recovery.

The driving force of the eating disorder is the use of symptoms to manage the trials of daily life. Starving, binging, overeating and any other symptom serve a powerful purpose as one's central coping mechanism. Any repercussions from the eating disorder pale in comparison. 

The first step for any family to understand the challenge of recovery lies with this crucial piece of knowledge. 

I often suggest that loved ones imagine what it would feel like if their most useful coping skill were suddenly ripped away. For those who can empathize even slightly with that scenario, the mental challenge of recovery becomes much clearer. 

The next post will start to review other options families can consider. 


The Plight of the Powerless Family: An Adult Child with a Chronic Eating Disorder

Families frequently reach an impasse when struggling to help an adult child with an eating disorder. Seeking treatment for a child is easier simply because the law is on the family's side. There is no barrier to stop a parent from ordering a child to get help.

However, an adult can make personal decisions and maintains that legal right even when sick. The parents' only recourse is to involve the court, a desperate and usually ineffective and destructive act for the family in this situation.

Unlike other psychiatric disorders, forced treatment does not restore the thought process that enables recovery. Physical wellness helps by mitigating starvation, but that is not enough to lead to full recovery. Even the sickest patient will struggle with the eating disorder thoughts once fully nourished. 

Parents will frequently contact me under these circumstances asking for guidance. Typically, these families have tried to help their daughter for many years, seen little progress and have gradually lost hope.

Lost in years of illness, often never nourished and well for more than a few months at any time, the child only knows the physical and psychological state of being very sick with the eating disorder. As a clinician, I can see that any path towards recovery is a long one, but that does not mean all hope is lost. 

The choices a family faces in these moments are not easy. The key point to remember is that any steps forward must include both physical and psychological healing--eating and compassion--in order to have any possible chance of success.

Eating without compassion or compassion without nourishment seem to almost always falter. Steps towards recovery even for the chronically ill must take into account all aspects of the disease to lead to real progress. 

The advice I give is general because each person and family is different, but I always emphasize the message that any positive step must include both parts of recovery to be of any value. The family must remember how much their child is suffering at the hand of a vicious illness. Blame and hopelessness reinforce the power of the disease. Compassion and care leave open the door towards healing. 

Families often end up stuck in a few similar situations without any sense of how to proceed. What ties these family struggles together is the powerlessness of the family to help the child take a step towards getting better. 

Sometimes the child ends up minimally functional and totally dependent but refuses any further treatment despite an incredibly limited life. Here the eating disorder has had a devastating effect on the child's life but has also built in the kind of powerlessness and fear that overwhelms any attempts for change. 

Some adult children with eating disorders can have a somewhat functional life, with financial support, but have cut off all personal and emotional ties. Many parents in these circumstances pull away and largely give up but may still, in moments of urgency, try to help in more dramatic ways. 

Some children end up with a highly functional professional life and an increasingly limited personal one. The severity of illness is often hidden from most people under the surface of work success. The family tends to be much more aware of the problem but has no recourse to help. 

The extremes of response tend to be the most common ideas a family with chronically ill adult children consider. These include completely giving up or creating an intervention to force treatment upon the adult child, including the threat of legal action.

The next post will address why these approaches won't work and how a family can take steps to help an adult child with an eating disorder.