The Fear of Spring and Warm Weather

The approach of spring is generally a time of hope and excitement. After months of hibernation combined with the dark and cold, the long days and warming sun tend to inspire a sense of good things to come. 

But for people with eating disorders, the warm weather only evokes anxiety and dread. The insistent thoughts to lose weight grow in strength, and the fear of summer clothes escalates. It's a time of year when the eating disorder thoughts feel even more justified and the inclination to restrict food or do what it takes to lose weight feels most important. 

Body image thoughts, often the most rigid and inflexible of all eating disorder thoughts, feel even more true in the spring. The absolute necessity to create any sense of comfort through weight loss often seems like the only escape. The warm weather gives rise to the foreboding sense of exposure and vulnerability. 

I find that it is very difficult to break through all of these thoughts and feelings of someone with an eating disorder. The most effective way to help someone is to find perspective from the experience.

Each person will have had to face the spring before. Each spring elicits the same feelings and fears. The key is to recognize that the rounds of torture through restricting, binging, purging and any other symptoms do not actually help in the end.

Any short term comfort from hiding in the eating disorder is an attempt to stave off the fear that the warm weather brings. But the symptoms provide no real relief. 

Sometimes the panic about the coming summer is so great that it is very difficult to find that perspective. But even reiterating the fact that allowing the eating disorder symptoms to ramp up will not make this time of year any easier can helpful. 

The purpose of leaning on perspective is to bring back compassion into one's thought process. The eating disorder thoughts are punishing and cruel. Perspective brings with it distance, and through distance one can find compassion again. Kindness towards oneself is always the best first step away from the eating disorder.

Vyvanse Approved for Binge Eating Disorder

A medication, Vyvanse, approved in the last few weeks for Binge Eating Disorder (BED), ought to be cause for celebration. There just are not many options to treat binging. Yet my first reaction is concern and trepidation. 

This medication is a stimulant initially marketed and approved for Attention Deficit Disorder. It is effective and safe for this disorder. A once daily, long-acting alternative to Adderall and Ritalin, Vyvanse was a welcome addition to this class of psychiatric drugs. 

One of the most common side effects of stimulants is appetite suppression, the purported effectiveness of Vyvanse in BED. Since children often take stimulants, decreased appetite can lead to weight loss, malnutrition and medical issues. Adults often see this side effect as an added bonus, which only increases the appeal and risk of stimulant usage. 

My first concern is that the side effect of appetite suppression is now touted as a potential cure for binge eating, which is patently untrue. These medications can be used to stop binging that is particularly dangerous in the short-term but no more.

Like most side effects, loss of appetite tends to wear off as someone takes Vyvanse regularly.  The binging returns soon enough as appetite returns to normal, unless the patient receives alternative treatment. Vyvanse is a bandaid in this instance, not a cure. 

My other concern is that Vyvanse is an addictive medication. In other words, people develop a tolerance to the drug so that they will experience withdrawal if it is stopped abruptly. Also the initial effect tends to wear off and necessitates an increased dose for the same effect. 

When used for ADD, the doctor can increase the dose until it is effective. Since Vyvanse actually treats the symptoms, the effects will usually be long-lasting. When used for BED, Vyvanse diminishes appetite only as a temporary side effect, so increasing the dose is inevitable when appetite returns to normal.

Continually searching for an effective dose will lead some people to seek higher doses, increasing the chance of taking too much medication. There is no benefit to replacing binging with prescription medication abuse. 

The shortage of effective medications for BED is clear to patients and physicians. However, a government agency cannot justify approving an addictive medication with extremely limited use for binge eating as a viable treatment alternative.

It's better to increase awareness and develop more treatment options than propagate false hope. 

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.