Thoughts about Recovery during the Holiday Season

This season is meant to be one of joy and celebration, and for many there are moments that match the hopes with true sentiment. Even so, a time of year with so much riding on it can lead to disappointment or disagreement, argument or worse. It's a time of year when people come together and families or groups cope with a host of mixed, often intense feelings. 

For people in recovery from an eating disorder, this season brings a mixture of regret about the past and time lost and also hope for change in the future. Often surpassing the celebratory moments can be the extra pressure on recovery to somehow take a giant leap forward or even magically leave the struggle of the eating disorder thoughts and behaviors behind. 

Clearly, the nature of recovery is neither kind nor forgiving. Progress comes from hard and steady work. Changing ingrained thoughts and patterns around food, a necessary component of survival, involves refashioning behaviors deeply imprinted in our most basic brain function. It's almost like learning how to walk again when every ounce of your body wants to sit forever. No holiday or new year will speed the process. 

What this time can bring is the peace to find steady ground around those people closest to us. The antidote to an eating disorder is not strict rules or tough love but about connection, meaning and forgiving love. The way to find peace from an unrelenting eating disorder is to create a foundation of true connection and bonds. Those pillars limit the space for an eating disorder in one's life. 

Although there may be a desire to push people away, the real benefit comes from knowing people are on your side. Feeling as if there are people supporting the cause can galvanize recovery and strengthen the sense of a healthy future more than anything else.

Why Compulsory Eating Disorder Treatment Almost Always Backfires

A topic I have visited several times in this blog is forced treatment of adults with eating disorders. I have seen patients taken to treatment against their will improve their medical health many times, but rarely if ever does this approach lead to psychological and emotional wellness and recovery. 

It feels incomprehensible for families to watch a loved one suffer, become ill or even come close to death from any illness, let alone an eating disorder. And watching this process is excruciating. There is a point when severe medical compromise leads a family to take their loved one to the ER for emergency care in order to avoid permanent damage or death, and that step is as valid for an eating disorder patient as for anyone. 

However, compulsory residential treatment for months is another consideration. At this juncture, forcing someone into treatment involves confining them against their will and forcing them to eat and follow rules they never agreed to. The result is such a loss of autonomy and enormous fear of doing things that feel impossible and indeed traumatizing. From the patient's point of view, enforced eating doesn't feel kind or compassionate in any way but instead incomprehensibly cruel. 

This is hard for people with little knowledge of eating disorders to understand. Eating for most people is as simple as breathing and sleeping. It is one of the basic daily tasks we must do to survive. Even for people who ruminate about what to eat, they must eat. For people with eating disorders though, nothing could be more terrifying. 

But forcing people to eat is not the crux of eating disorder recovery. Successful treatment entails regular eating and health to be sure, but love and compassion combined with the growth of the individual outside the pervasive and punitive eating disorder thoughts create true health. 

The circumstances necessary for treatment must be voluntary. A patient needs to realize the need for help while also recognizes the limitations the eating disorder imposes on daily life. From that point of view, there is a purpose to the scary step of starting treatment. There is a reason to seek out extraordinary circumstances and to start down the path to creating a full and healthy life.

Overexercise, an Undertreated Part of Eating Disorders

Exercise is a relatively new concept in health. Only in recent decades, as a significant number of jobs have become sedentary, has the medical world realized the detriment of the lack of exercise to health. 

The health news media spread the word about the need for exercise and helped create a new part of the virtuous life. The well-rounded, healthy individual must incorporate exercise into any daily regimen, so the message goes. 

Although the concept has merit, the individual's well-being, in today's age, is always secondary to the power of the marketplace and money. Accordingly, business interests now dominate the exercise world, exploiting a medical recommendation into a guilt-inducing profit machine.

From over-priced gyms to exercise classes to communities proselytizing a new way of life, smart individuals created companies to manipulate people to spend money on exercise and to translate the modern need for an idealized version of health into monetary gain. 

For people with eating disorders, the effect of a powerful exercise industry is more nefarious. Since exercise remains an unquestioned positive in today's society, there is still no room for the message about overexercise. The gyms and classes have no way to manage the person who spends seven hours per day in the gym or goes to four, five or six classes per day. 

The medical effects of overexercise are cardiovascular problems, chronic dehydration, muscle breakdown and even kidney failure. Even for those whose symptoms aren't as severe, exercise dominates one's life and leaves no room for any other personal growth or relationships. 

The first step towards addressing overexercise is to call it a problem. Exercise is necessary for our bodies to function, but that can mean walking each day as much as going to a gym or class. The idea is that our bodies are not made to sit exclusively. Moreover, the human body needs food to function every day, no matter the amount of exercise. The industry has coopted the concept of calorie burning to mean one deserves food only after burning energy. Separating food from exercise is a crucial part of discounting eating disorder myths. 

Limiting exercise to a certain number of times per week and amount of time per day is also a way to recognize the potential detriment of overexercise. Without a way to acknowledge excess, the pervasive message that exercise is always good will triumph. 

Taking these initial steps will also open the eyes to the eating disorder community that exercise must play as large a role in the eating disorder symptomatology as starving, purging or laxative use. When we as clinicians take overexercise seriously and devise treatment aimed directly at these symptoms, people seeking treatment will hear the message much more clearly.

It's Time to Treat Eating Disorders as Both Psychological and Physical Diseases

What makes eating disorders unique in the scope of psychiatric illness is the fundamental medical nature of treatment. As such, the complete approach to recovery needs to include a medical sensibility as well as psychological one. 

However, artificially separating the psychological and physical tends to limit the effectiveness of care. The best plan must incorporate and weave together these two parts of eating disorder for truly comprehensive care. 

The clinical world tracks eating disorder providers into specialities: food, therapy and medical. Each provider is a crucial member of the treatment team but usually focuses their specific treatment on only one component of recovery. However, the individual's experience is a cohesive one, and separating out the different aspects of an eating disorder doesn't reflect the reality of having one. 

This problem begs for creativity on the part of the treatment team, something always called for in eating disorder treatment. The wisest clinicians have gleaned enough knowledge and experience to know that blending information from other parts of recovery, even when it's not one's specialty, makes for more complete care and an increased chance for recovery. 

For the therapist, this means referring regularly to the medical complications from an eating disorder and heeding the severity of the illness. For the physician, respecting the power of the eating disorder thought process rather than implying recovery is the same as willpower. For the nutritionist, recognizing food and nutrition education isn't really the cornerstone to treating someone with an eating disorder: the treatment is really food therapy. 

Each clinician may have a specialty; however, the team overall must focus on the psychological and physical components of an eating disorder as well. Each appointment is a way to call into question the dominant eating disorder thoughts and point out the fallacy of continuing the symptoms. A cohesive approach of each member of the team can acknowledge the realities of recovery and help the patient recognize how physical and psychological impairment limits their lives.

The Role of Family and Friends in Recovery

People in recovery from an eating disorder need the kind of help most people would need when healing from a chronic, severe illness. Family members and friends can offer love and care while showing expressing their concern with time and attention. Most loved ones wouldn't interfere with the medical and clinical plan other than to be sure that care is adequate and proficient. 

However, it is hard for families and friends to resist meddling in treatment for eating disorders. In general people have very strong personal opinions and feelings about food and weight. Despite every intention of following clinical care, loved ones have ideas about what recovery ought to look like. 

More often than not, those opinions come from a place of love. Adding seemingly useful advice to a treatment plan can seem helpful and constructive. 

However, the person with the eating disorder almost universally experiences the guidance as intrusive and judgmental. The advice comes across as harshly critical and detrimental and is counterproductive in ways that won't make much sense to the family member or friend. 

Clinical guidelines and meal plans come from an objective caregiver with experience and knowledge about how to approach eating disorder recovery in a caring but non-judgmental way. There is no way for a loved person in the patient's life to express opinions about food that are purely supportive. 

The easiest way to explain this paradox is that for a person with an eating disorder, discussing food and meals is the most  personal, exposing and potentially shameful thing to open up to others. Nothing else compares. For people without eating disorders, food is largely impersonal, but people with eating disorders would discuss anything else first. So offering love and support can help the loved one use her own strength for recovery. Objective opinions about food only leads to a feeling of exposure and shame which only strengthens the eating disorder. 

The basic premise is that support for someone in recovery needs to involve love and care. Advice, like with any other illness, belongs to the clinical treatment team, not with loved ones.

Body Size and Shame in Recovery

The markers of success in our society are fairly clear: money, power and education all rank high on the list. But to a large degree, the people who are successful are most often born into that world. Realistically, movement into and out of that world is very limited. 

The powerlessness of daily life has reinforced a new marker of success: thinness. For people without any indication that life can change, dieting and creating an enviable body has become a way to mark accomplishment and then display it to the world. 

Although the eating disorder epidemic began in a wealthier, more successful class, all indicators show that these illnesses no longer discriminate. The generalization of dieting throughout all first world communities opens the genetic door for all people to develop eating disorders.

One consequence of the drive for thinness, ironically, is the increase in obesity, in part from binge eating disorders. Chronic dieting triggers overeating and binge eating for many people. Being overweight is seen as the antithesis of thinness, not only in terms of body size but as a sign of success or failure. 

Meanwhile, the reality of dieting and overeating is that they are flip sides of the same coin. As I have written many times in this blog, longstanding restriction triggers a very powerful hunger response which often leads to binging. In addition, slowed metabolism from restriction triggers the body to react by storing energy as fat to preserve against future limited food intake. In other words, thinness and being overweight are two of the body's reaction to not feeding oneself properly. The opposite to both of these is normalized eating. 

This thought process confirms a crucial part of recovery from binge eating disorders, eliminating the shame. Society may impose harsh criticisms about weight, and a necessary step in treatment is to quiet those voices. The reality is that one's body will handle the effects of disordered eating to survive, whatever that means about weight.

Facing any source of shame or negative feelings needs to be a cornerstone to therapy while also trying to separate the personal feelings from the societal sense of blame. Inevitably, recovery includes finding a sense of personal peace irrespective of body size. Health and wellness means both normal eating and psychological well being. A strong focus on body size will only reinforce the illness. 

Disorders of Overeating and the Place of Blame

I have written many times about Binge Eating Disorder, compulsive overeating and obesity in this blog, and the central message about these illnesses is that these compulsive behaviors are not a matter of willpower. This false belief perpetuates a feeling of shame and responsibility and a pervasive sense of blame, secrecy and, most sadly, a long delay in seeking help. 

Almost always, eating disorders or disordered eating stems from a combination of a genetic predisposition to the eating symptoms combined with a powerful emotional and chemical response to the behaviors. All disorders comprised primarily of overeating are the exact same way. 

In fact, the symptoms and treatment for people with these illnesses are essentially identical to the treatment for bulimia. The exact expression of the eating disorder symptoms relate mostly to physiology and biological response to eating disorder behaviors, not to a difference in willpower or personal responsibility. 

Not only are eating disorder symptoms an attempt to manage hunger and weight, they also have powerful effects on mood and thought processes. Starving, binging, purging and compulsive overeating all change someone's mood very quickly and decrease anxiety significantly. The positive effect is brief, however, and the long term result inevitably is worsening mood and anxiety. But, like anyone who uses a behavior or substance to change their immediate state of mind, the urge to use that symptom overrides any logical conclusion that it won't work. 

People with eating disorders of overeating have the added societal bias that their behaviors are primarily from a personal flaw and that the world around them judges their symptoms more harshly as failure. In addition, the bias about weight often leads to being overlooked in both personal and professional parts of their lives.

Accordingly, recovery from these disorders needs to incorporate ways to challenge or circumvent this bias, to assert self-confidence and to refute the assumptions around them. Accepting judgment only reinforces the illness and extends the period of being unwell. The next post will address how treatment can focus on this component of recovery.

Doctors and Nutrition

The science behind nutrition, if it can be called that, is extremely limited. Here is what we know: eat a variety of food, more plants and minimal processed food. That's it. 

If you read the unlimited literature on dieting and its supposed link to health, you would be led to believe that nutritional science is incredibly advanced, but the diet industry has a vested interest in propagating this lie. 

What's more surprising is the similarly unlimited diet advice from doctors. It has become commonplace for doctors to blame a substantial number of medical illness on diet and weight, with minimal evidence. On the heels of such a statement, medical professionals often launch into their own beliefs around food and diet, again without any way to substantiate their claims. 

Medical training includes very little nutritional education. Since there is basically no science to review, nutritional guidelines tend to only reference vitamin or mineral deficiencies. Precious else in medical education has merit. 

This fact means doctors' diet advice is based solely on their own opinion. They use their position of authority to trumpet their own personal thoughts about diet, exercise and weight, as if these opinions are fact. In a world where we are inundated by diet and exercise propaganda, mostly to line the pocket of big industries, this component of the machine is disturbing. 

Doctors tend to be naive about their influence on common societal beliefs. Each doctor lives in a bubble with their patients or cohort and often forgets the power of authority vested by the white coat. Pharmaceutical companies have used that sway for years to drum up business for new drugs. The exercise and diet industry has, perhaps less overtly, used that sway with less than savvy doctors to promote their beliefs and brand.

Without any way to combat the plague of striving for thinness, endless dieting and overvaluing exercise, doctors often support whatever company has the newest and greatest product and are just as suggestible as everyone else. 

The solution is less obvious than the problem. Nutrition education is a start for doctors, but the problem runs deeper. Weight and diet have become such a facile way to explain medical issues. Medical education needs to explain the true place diet has in our lives. The lack of scientific knowledge about food choice translates into a realm doctors need to avoid. Our job is diagnose and treat illness and to promote health. Treading lightly on topics we know very little about is advisable. Stick with medicine instead.

Exercise in Our Lives

Much of our learning about health and exercise has stemmed from large changes in lifestyle since the industrial revolution and especially in the last fifty years. Job opportunities in the first world have become increasingly sedentary. The human experiment of life with minimal movement and exercise has forced the medical world to explore the ways in which moving our bodies improves overall health and well being. 

However, clinical understanding of the health benefits of exercise has lagged behind the powerful food, diet and exercise industries. Capitalizing on the lack of information, big business took advantage of an opening to create a new narrative, and that storyline is much more compelling and powerful. 

Rather than explore how activity can enhance our daily routine in today's world, these for-profit businesses have used another convincing but ultimately cynical tack. The bottom line is a subtle attempt to place blame and responsibility for the lack of exercise on the individual.

Using guilt as the ultimate subtext for a business model has been very successful. Education about the type of useful exercise and the many ways to create opportunities to be active is much less profitable than convincing the public that exercise is essential and that the level of exercise can only be attained in classes or at a gym, in other words by spending money.

The effect of this misinformation is to create a cohort of young adults addicted to exercise and who feel they are not ok, and even cannot eat, without it.

Similarly for those at risk for an eating disorder, exercise has become a gateway to illness. The exercise industry encourages the urge to obsess about body and shape and as a means to justify the intake of any food. More and more, exercise is a cornerstone for young people to develop eating disorders. Instead of exploring the place for activity and movement in our lives, exercise is a personal responsibility and a source of self-assessment, almost always one that leads to negative thoughts about oneself. 

Prior to the sedentary lifestyle of many career choices today, exercise was not an activity but part of daily life. Just the act of standing, walking and taking care of life events helped keep our bodies fit and capable. The goal today is to fit time into our day for that movement, not to create an opening for industry to exploit our own insecurities and fears.

Eating Disorders in the Presidential Campaign

Fat shaming sadly has become a central part of the presidential campaign this week, a place this form of bias clearly doesn't belong. However, the high profile publicity of ridiculing women forces our society to face a hidden and malicious prejudice. 

Just as eye opening as the comment was the presidential candidate's shocking capacity to defend his statement as if it were completely acceptable. Needless to say, some media outlets exposed the callousness of the remarks, but it also became clear that fat shaming is not only an accepted form of attacking women but one accepted by a significant segment of the public. 

Outing this hidden bias exposed a dynamic women must struggle against every day. Just as important, these expectations of thinness, and the general acceptance of shaming women who don't fit into this image, encourages women, including young women and girls, to look into dieting at increasingly younger ages. 

The last few posts make clear the dangers of dieting: it is the most important risk factor for developing an eating disorder. And so the effects of fat shaming run much deeper than a mere insult. 

The overall effect of condoning this kind of behavior is an increased risk and even likelihood that girls and young women will develop eating disorders. Messages about body shape and weight are destructive in their immediate psychological effect and insidious in sustaining the high incidence of eating disorders in our community. 

As harmful as elements of the presidential campaign have been, fat shaming takes the misogyny on display to a new level. Using the largest political platform in the world to indirectly encourage severe, life threatening illnesses is despicable and represents a form of bias that must be fully exposed.

Disempowering the Diet Industry

The diet industry has become a strong, large and incredibly lucrative business due in large part to the insatiable desire for thinness in our society. A new diet is like a new beginning. It's a virtuous way to find a path towards health and wellness. All our daily ills supposedly wash away from the newest diet. 

Just as importantly diets never work. Any one person can choose to start string of diets that end and start anew. The industry has a revolving door of repeat customers ready for the newest health fad. And the fact that diets never work is something the public refuses to acknowledge despite easily accessible and conclusive proof. 

Instead food choice and the ultimate goal of weight loss remain the holy grail of adult life. The diet industry plays off of this desire and encourages us all to conflate diets with self-care. It's an insidious way to capitalize on the general human ennui and create meaning out of nothing, for food in the end is just sustenance and choosing one meal over another on any given day creates no more virtue or success in anyone's life. 

The first step in avoiding diets is to recognize this reality. We are not defined by what we eat, and changing a diet temporarily signifies nothing. That's a difficult step for many people so two other steps are often more realistic to be able to shift away from overvaluing dieting. 

First, the goal of eating needs to change from dieting to eating a variety of real food. Our current world offers a mixture of processed and real foods, and realistically we will all eat what we find tasty and easy to prepare or buy. The ability to be flexible when eating while allowing pleasure, convenience and reason to dictate daily decisions is the key to normal eating. 

The second step is to resist the urge to look for meaning in food. It's very tempting based on the power of the diet industry and the large number of people who ascribe to this philosophy, but meaning in life is largely centered on other facets of the human existence: relationships, career, family or kindness to others. Food and diet contribute nothing to our well being other than the nourishment and pleasure that comes from daily meals. 

It takes energy to resist the pull of the diet culture. Attention to the details of what we eat won't change our lives. It's within our grasp to disempower the choice of food and instead look for real value in other parts of our lives.

The Painful Truth about Dieting

The term diet originally meant the different types of food a person ate each day. The concept described a factual list of foods rather than a prescribed or limited one. 

A diet has clearly become something different in our current world. Today dieting implies intentional food restriction in order to lose weight. The act of going on a diet means one needs to lose weight and will make a concerted effort to do so. It means judgment about one's body and weight. It means someone is taking a supposed virtuous and health-minded step towards wellness. It means something is wrong and a diet will somehow fix the problem. 

Although dieting originates with concerns about weight, by and large the result of dieting is to attempt to fix the ills in one's life. 

The result of any temporarily successful diet is widespread praise. Others comment on changes in weight and compliment on a regular basis. Dieting is a public act that warrants public attention. This is often the main reason people diet. 

Paradoxically, hard data about dieting shows that 98% of them fail. In fact, the large majority of people end up gaining weight after a diet. Despite a plethora of evidence against the benefit, people regularly attempt to diet. There is nothing else to replace the collective desire for the praise that attends short-term weight loss. 

With this background, it's clear to see why adolescents, who are constantly searching for an identity and praise, easily latch onto dieting and weight loss as a marker of personal success. No wonder dieting has become a rite of passage in high school. But exposing most teenagers to dieting looks more like a horrible experiment in the effects of widespread starvation than an introduction to adulthood. 

Chronic food deprivation triggers the biological survival mechanism of starvation. Humans are genetically programmed to respond to food restriction in very specific ways to survive. Symptoms include obsession with food, all consuming hunger, the desire to overeat and focus on all things related to food, to name a few. Specifically, these symptoms look suspiciously like eating disorder symptoms.

In other words, most eating disorder symptoms are the biological response to starvation gone awry. Our diet culture has in large part caused the sharp spike in the incidence of eating disorders. 

As long as dieting is a central part of our general ethos, eating disorders are here to stay. I'll write about some thoughts on how to combat dieting in the next post.

Dieting is the Most Important Risk Factor for Developing an Eating Disorder

Clinical literature, academic research and personal memoirs about eating disorders all ignore one crucial and salient fact about these illnesses: they all start with a diet. 

This seems like an obvious point. The inception of an eating disorder is right in front of us. Dieting is an integral part of our culture, a rite of passage for all adolescents. Weight loss and the compliments that ensue are a sign of the ultimate gold star of success. 

What is lost on the communities that condone dieting is the inherent risk of this ritualized practice. For most people, dieting is one of a few things: a short-term lark, a series of new beginnings which always fail or a misstep in how to eat healthily. But for a small percentage of people, it is the start of a chronic, severe illness. 

Dieting is essentially self-inflicted starvation. The goal is to eat a limited amount of food, significantly less than one's body needs, in order to lose weight. Dieting is somehow considered safe and healthy, largely due to the influences of the cultural norm of thinness and a powerful diet industry. The consequences are almost completely ignored. 

To state the dangers of dieting as clearly as possible, the number one risk factor for developing an eating disorder is dieting and restricting calories over a significant period of time. If people didn't diet, there would be no public health problem of eating disorders in this country. Prior to the late 1960's, eating disorders were a very rare phenomenon. The increase in dieting has in large part spurred the skyrocketing incidence of eating disorders. 

This fact remains unheralded and ignored despite the explosion of public information about eating disorders. Parents will follow a doctor's or nutritionist's advice to put a child on a diet. Most parents won't bat an eye when a teenager diets and loses weight. The willful collective ignorance about dieting continues to leave children unprotected from this growing problem. 

The next post will address more clearly why dieting causes eating disorders.

Why is Coaching a Viable Part of Eating Disorder Treatment

The last post explored the role of coaching in eating disorder treatment but left one question unanswered: how can untrained paraprofessionals safely participate in treating a severe mental illness?

There are parallels in other fields where less extensively trained people treat illness: optometrists vs. ophthalmologists or chiropractors vs. orthopedists, to name a few. These options generally reflect a cheaper form of care when the patient seeks help for more basic problems. But the increase in coaching as a viable alternative or addition to traditional eating disorder treatment reflects something different.

Eating disorder treatment is often successful, but the underlying reason for improvement is elusive. Although different types of therapy can give a patient the choice to find the right fit for them, even seeking the supposed best care doesn't guarantee full recovery. Finding the motivation or reason why one person can take steps in recovery is typically very individualized. Progress depends less on education or training and more on the nature of the therapeutic relationship and the ability to tap into a desire for wellness otherwise unknown to a patient. If successful treatment depends largely on the relationship, then it's possible that the best person for someone may not be a professional. 

Coaching offers a new way for people who have experienced their own struggle with food and body, or even their own eating disorder, to help others without seeking formal training. The risks of seeing someone less trained are clear: a lack of complete understanding of the power of the therapeutic relationship and the nature of recovery can be damaging. However, exposure to the right person can be exactly what someone needs to find their own path to recovery. 

Due to the risks of seeing someone less trained, I would suggest a patient see an experienced therapist as the foundation of treatment, but seeking guidance from a coach whose writing and messages are meaningful can augment recovery in significant ways. In the end, the goal is recovery in any way one can find it.

The Role of Coaching in Eating Disorder Treatment

A relatively new but growing component of the eating disorder treatment community is coaching. Although this industry is generally becoming more popular, helping people with eating disorders is its most significant foray into mental health. 

In general, coaching provides many more options and much more flexibility than traditional clinical treatment. Not bound by the same professional and ethical constraints, coaches can provide not only one-on-one meetings but group online chats or discussions, weeks or months long courses, an assortment of blogs and podcasts and more flexible meetings and hours. 

As I have written many times in this blog, successfully treating someone with an eating disorder demands flexibility. The eating disorder thoughts are present 24 hours per day. An appointment a few times per week may be helpful in the moment but is often insufficient to stave off the power of the eating disorder meal after meal after meal. 

The inherent flexibility in the coaches schema allows for much more accessibility to counter the relentless eating disorder thoughts. 

The rise in coaching people with eating disorders also reflects two facts about these illnesses in our society. 

First, there is still a conflict between the concept of disordered eating/food obsession and an actual eating disorder. The internal struggle with food and weight that is pervasive in our current ethos masks the severity of full-blown eating disorders. Coaching spans all these issues, and many people with eating disorders many not be aware how severe their problem is. That leaves room to research and seek help from non-clinical care. 

Second, the limitations of clinical and often overly medicalized treatment for eating disorders leaves a lot to be desired. Many people are frustrated after seeking out help and are turning to coaching for another avenue for recovery. Coaches are more free to individualize treatment and forge new theories of practice. They also aren't as well regulated and certainly aren't trained to diagnose an eating disorder or identify concurrent problems. But the desperation of struggling with an eating disorder certainly makes another option worth pursuing when clinical treatment has been a bust. 

It would behoove the eating disorder treatment community to embrace the coaching movement. The flexibility of support, positive, creative messages and alternative approaches to countering the eating disorder thoughts can all help someone in the throws of recovery. Since there is no clear path to wellness, any support that is useful to someone struggling to get well can have real benefit. 

The Realities of Nutrition Science

A recent article about nutrition studies by a renowned but at times misleading health writer cast a spotlight on an often hidden reality. Research into nutrition science is almost completely useless. 

The article points out that these studies cannot possibly take into account the myriad effects of many other external causes into various diseases or health concerns. The complexity of singling out any direct link between a diet change and a medical or health outcome is almost impossible. 

The omnipresent diet and exercise industries would have us all believe otherwise. They insist that any number of decisions about food choice is essential for long-term health and weight loss. These supposed experts have no guidelines and regulations about their advice and can continue to spread misinformation to build business. As long as the media covers nutrition studies as if it is science, most people will attempt to follow these often contradictory suggestions and remain adrift about any dietary decisions they make. 

The real experts have provided guidance about how to interpret nutrition information for years. However, their thoughts are so basic and obvious that they tend to drift quickly into oblivion. No one wants to hear that diet advice is completely unfounded. It's not interesting copy to report that the best diet is a variety of foods in a moderate amount with as much real food as possible. 

The limited amount if knowledge we do have about food and nutrition doesn't come close to satisfying our collective appetite for a magical way to approach eating. Everyone wants a quick fix that is proven to promote health, longevity and weight loss. Since nothing of the sort exists, American ingenuity creates an endless assortment of fabricated solutions to food, and the public gobbles them all ignoring the obvious fact that no approach is proven to be effective. 

The first step to find a peaceful and knowledgeable way to approach food is by accepting the clear evidence that nutrition science is extremely limited. Any desire to find a quick fix represents an emotional attachment to food and a need to manage those emotions through manipulation of one's diet. Acknowledging this reality is the first big step forward for anyone with a difficult relationship with food.

Common medical problems associated with Chronic Bulimia

The medical problems associated with Bulimia are largely due to the process of compensating for binges most commonly with purging or laxative abuse. Both behaviors are very traumatic to the body. Most people will be able to adapt temporarily but the long term consequences are severe. 

When we vomit in any way, the body loses a large amount of potassium at one time. Just being sick over a period of several hours or a day is a state we can overcome quite easily after a day or two of rest and replenishment. Regular purging over months and years leads to a constant norm of low blood potassium concentration. This electrolyte is necessary for normal human function, so the medical consequences of low potassium are great. The two organs most affected are the heart and kidneys.

The heart conduction system initiates each and every beat and is very sensitive to low potassium which can cause irregular beats or even lead to cardiac arrest. Although the body can adjust to chronically low potassium, this new state leads to a continued risk of cardiac abnormalities or even death. 

Constant low potassium also causes chronic kidney damage over time. At first this leads to kidney dysfunction, but since we can all survive with one kidney, the damage doesn't lead to a change in lifestyle. However, a decade of this new steady state can lead to kidney failure and the need for a transplant, something that is a real possibility for someone with chronic bulimia. 

Laxative abuse is another common form of compensation for binging for people with Bulimia. Laxatives draw water into the colon, the second main part of the gastrointestinal system, and cause the muscles of the colon to contract powerfully and thus evacuate the bowels. Overuse leads to addiction so that the GI system slows down and eventually cannot function without laxatives. Withdrawal then forces the colon to relearn how to function normally again. 

Laxative abuse causes damage to the GI system by slowing down normal functioning leading to symptoms of constipation and bloating. Short-term laxative abuse can be overcome fairly easily, but long-term abuse can cause permanent damage. The colon sometimes cannot resume normal function and is damaged by the constant trauma of these medications. The effect is colonic inertia or very slowed processing of foods and waste, constipation and constant bloating. 

After years of laxative abuse, the body becomes used to losing significant amount of fluid through multiple episodes of diarrhea per day. The human body is constantly working towards a way to survive any change in circumstances. Thus, it will adapt to the daily loss of fluid by retaining fluid in another ways. Once laxative use is stopped, people often experience fluid retention since the adaptation of holding onto fluid continues. Most often, the body adapts back to its typical way of managing fluid, but years of abuse can damage the system of maintaining normal fluid levels and it can take months or years to adapt back again. In this situation, fluid retention and swelling are common symptoms until the body resumes normal fluid management.

These last two posts highlight how anorexia and bulimia are medical as well as psychiatric diseases. Sufferers need to understand that medical evaluation and care are important parts of treatment and clinicians need to be sure all patients have regular medical follow-up.

Common medical problems associated with Chronic Anorexia

As a medical doctor treating almost exclusively people with eating disorders, I see a cross section of complex conditions in almost every medical field. This experience leads me to often have a very narrow band of knowledge to diagnose and treat unusual situations. This post will highlight some common medical problems with anorexia and the next post with bulimia. 

Anorexia frequently causes severe gastrointestinal issues. This system is essentially one long tube lined by muscles that moves food and then stool through the body. Like other muscles, disuse leads to atrophy. Anorexic patients experience a GI system that stops working, namely gastroparesis (slowed digestion) and colonic inertia (chronic constipation). The symptoms people experience are bloating, gas and often painful constipation, all of which makes it even more difficult to eat. Treatment has limited benefit and only eating truly heals the problem, a conundrum for someone with anorexia. 

Poor circulation is another common chronic problem, especially to the fingers and toes. It's not uncommon for people with anorexia to have blue or even white fingers and toes in the winter. Often it can take an hour to restore full circulation once someone comes inside from the cold. There are medications that improve these symptoms and stop worsening of the circulation. Malnutrition limits the body's ability to maintain distal circulation to parts of the body furthest from the heart and prioritizes the functioning of the most important organs. 

For many complex and not fully understood medical reasons, patients with anorexia have trouble managing fluids. What this means practically is that people can often get swelling in their legs and sometimes through their entire body. The body cannot manage where the excess fluid goes and so it can build up in various places, some of which are medically worrisome. At its worst, people can gain up to 20 lbs of fluid overnight only to lose it in a few days. The best way to manage this medical problem is to monitor symptoms carefully and not rush to any medical treatment. Typical treatment for swelling can be dangerous for someone with anorexia because the balance of health is precarious. It's best to let the body handle the fluid and just to watch the basic vital signs. 

These three medical effects of anorexia are relatively common although very different from healthy people of the same age. Knowing the best way to manage the symptoms is critical for someone sick with this illness to keep them safe. Following standard protocol may be dangerous because an anorexic body survives and functions very differently from a healthy one. 

The Most Important Part of Eating Disorder Treatment

Recent exposure to non-clinical blogs and videos has led me to review my own blog and reflect on the overall message of my writing. I was surprised to see only a limited number of posts specifying treatment differences between anorexia and bulimia. However, there are a lot of posts about obesity and binge eating disorder, two increasingly recognizable eating disorders only now getting attention from the mental health community. 

But the majority of the posts concern the psychological experience of having an eating disorder and the treatment approaches necessary to counteract and heal that suffering. 

The nature of treating people with eating disorders has clearly inspired me to focus primarily on what leads to the difficult changes in the thought processes central to the eating disorder. My experience treating adults with eating disorders led me to realize that finding ways to fight the thoughts is necessary for recovery. 

The eating disorder treatment community has now created treatment centers, both inpatient and outpatient, that help people with eating disorders find immediate stability with food and nutrition. Depending on the severity of malnutrition and behaviors, almost every person can find appropriate care, often even covered by health insurance, to accomplish short-term medical stability. 

These patients leave treatment after a month or two and almost always quickly relapse within a few months. The gains of medical stabilization do nothing to change the eating disorder thought processes which inevitably consume the person's mind and restart the behavioral cycle. 

The path from seeking treatment options, attending a program followed by relapse is exhausting and demoralizing. The process of recovery really starts after discharge and involves help from an experienced team and the daily struggle of identifying the eating disorder mindset, questioning it while adjusting behaviors around food and body. That process, day in day out, is the work of recovery that leads to becoming fully well. It's painstaking work.

I have come to know the intimate details of what true recovery looks like. I have seen people suffer with relapse and struggle to apply everything they know for the purpose of getting well. This experience is both heartwarming and excruciating and has led me to want to share my experience two ways.

First, I want to help people in recovery understand they are not alone: there are crucial parts of recovery that are universal. Second, I want people in recovery to understand the key mental and relational components of what makes treatment more effective.

The urgency to share these two things has inspired the majority of posts to this blog. In my mind, these key points reflect the needed parts of a treatment plan that lead to full recovery and to open the door to personal discovery.