Category Archives: Eating Disorders

Restriction and Eating Disorders.

Having an eating disorder can make you feel invincible, it can sometimes be hard to see how being underweight and restricting your food intake can cause physical health issues, but there are so many knock on effects of being a low weight. When your body is not getting the nutrition that it needs it can lead to knock on consequences for your bone health as the minerals are take from yoour bones for use elsewhere in the body. Another big one is  muscle wasting throughout the body including your heart. Your brain will start to conserve energy and shut down some less vital functions, brain power, memory, reactions and concentrations can be impaired. The blood may not be pumped as well around the body leading to cold extremities. Mood swings and poor sleep are common. Skin, hair and nails will start to suffer. I’ve had some people who have lost their hair in large clumps.  Less of a physical symptom, as your body craves nutrition your mind becomes increasingly pre-occupied with food, recipes, the next meal, it can become all consuming. 

Dietitian UK: Restriction and eating disorders infographicIf you or someone you know is struggling with restricting their eating, it can be helpful to think through the physical affects on the body and use these as a motivation to focus on slowly eating more. If you need help with this, seek out an eating disorders therapist, dietitian or see your GP for signposting. 

I work with people with Skype, so get in touch if you need support.

Should we label a food as good or bad?

The label of good and bad foods annoys me. It is one of those labels that I find hard to get away from when I am talking to people as it comes up constantly. I spend a lot of time trying to break that idea down in people’s minds. Google it and there are over 71,800,000 links talking about what foods are good/bad, what bad foods are really good, the best good foods to eat and so on. But do good and bad foods really exist?

Bad foods seem to be ones that are high in sugar, fats and calories. Foods that are “not healthy” and that exert a “bad” affect on the body. They can range from fast food, processed food and high fat/high calorie snack items to carbohydrates and dried fruit.

Dietitian UK: Should we label foods as good and bad?

We have a complex relationship with food. Trying to make it fit into just one camp is tricky. Look at the major food groups – carbohydrates, protein, fat, dairy, fruit and veggies. Then look at lentils. They are put in the protein group but they contain carbs and are a portion of veggies too. 

Let’s take it to a more philosophical level. Can a person be labelled as good or bad? Take an object like a razor blade. Is it good or bad? One the one hand it can be used to shave and on the other hand it could be used as a weapon. 

So by trying to label foods as good or bad we are over-simplifying it. Foods are really neutral. Labelling them automatically places them into one category. Let’s take chocolate as an example. On the one hand this is a high calorie, high fat food that is often laden with sugar, so could be classed as a “bad food”. However dark chocolate contains iron, magnesium and fibre. It has antioxidants including polyphenols, catchins and flavanols and may help lower blood pressure plus reduce LDL cholesterol levels. Some research suggests it may help with cognitive function too making it sound like a pretty amazing food to be eating. Even fruit and vegetables can have their negatives, too many carrots can turn the skin orange due to excessive beta carotene!

No single food is to my knowledge nutritionally complete. We need a combination of foods in order to provide the body with all the nutrients it needs. This includes the full range of essential fatty acids and some sugar too.

The old phrase “All things in moderation” is actually very true. Instead of looking at a food in isolation we need to think about how often we eat a food, how much or it we eat, combined with what else we are eating and adding to a food. Limiting or not allowing yourself to eat certain foods can actually lead to you craving them more and then over-eating them. Food is something to be enjoyed rather than denied, so a small amount of the things you like really can be good. 

So instead of labelling foods as good and bad, or healthy and not healthy, how about we change the way we view it. I let my children eat all foods, including cake, sweets and chocolate. However they know that some foods are best to eat in small amounts as they can lead to their bodies getting sick. A good example of this is a weekend recently where we had multiple parties, leading to a lot of party food being consumed. Both children had tummy aches and were slightly constipated! An excellent time to highlight that they had eaten more biscuits and cakes, less fruit and veggies and their bodies were complaining. We talked about how these foods are delicious (the words of my toddler boy) but if you eat too much of them they can make you feel unwell. 

How do you label food in your mind? 

Dear health bloggers, please be responsible.

Ok so a bit of a rant. However I am getting increasingly annoyed and saddened in my line of work  by the impact that so-called health bloggers are having. I am seeing a definite impact upon young girls who are either following these social media gurus or are hearing about their nutritional messages through other channels.  Sadly there is no regulation for these new nutrition types and yet with thousands of followers, their advice is wide reaching.

Restricting your dietary intake under hear-say or because someone else tried it out and it worked, or due to social media advising it really isn’t the way to go. 

Firstly it can lead to your diet becoming overly restricted and make it hard to find enough foods to eat.

Secondly it can leave you lacking essential nutrients. 

Thirdly this can spiral downwards leading to weight loss and disordered eating.

Some phrases I often hear are: 

“Carbohydrates are not good to be eating”

“Gluten is toxic”

“Dairy is full of fat and hormones”

“I only want to eat healthy fats”

So I spend a fair amount of my time with these clients, dispelling the myths and explaining the science. Some of these clients  I manage to catch early on, before things have gotten too far. For others though the damage has already started. What started as healthy eating has spiralled downwards into overly restricted eating. They are too scared to eat certain food groups and have continued to lose weight, taking their bodies into an unsafe area. Many of these clients then realise what has happened and actually become quite angry. Angry at the incorrect advice they have believed and the influence of the health instagrammers. Angry that they have been drawn into this culture. Angry that they now have many months of hard work ahead of them to turn things around. Angry at the impact on their minds and bodies.

Now I’m not saying that health bloggers are the reason for eating disorders. But I am saying that for some, the instagram health blogging world shows a world they want to be part of. The perfect body, the perfect diet, the perfect workout, the perfect food pictures. In my mind there is no perfect. At least not in this world. Instead we aim for balance with a healthy does of reality. However I am a 3o something year old, wife with 3 children. In my teens I too had issues with body image, I know I would have been easily influenced by the perfect diet and have followed the clean eating trend. Now with 2 daughters, I want to ensure they, and many others do not fall under this spell. 

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So, if you give nutrition advice, please spare a thought for how it could affect people. How it could be miscontrued. Think about whether it is correct, evidence based and sound.

How about we have the rise of the evidence based, trustable health bloggers? 

Please.

Eating Disorders: Prevention is better than cure

Eating disorders are a mean, cruel illness. Once seen to be a disease of affluence, there are now so many reasons an eating disorder can begin. The roots can be due to trauma, family issues, relationship problems, low self esteem, bullying, loneliness and wanting to fit in, a desire to be healthy, a need to achieve. Often there seems to be this air of mystery surrounding them and they can even be seen as a status. However, once you are in the cycle of truly trying to recover you will wish you had never become drawn into the disorder in the first place. 

Healthy eating taken to the extreme can seem like a good idea, but for some it can rapidly become an obsession. Counting calories, measuring portions, having the right balance of food groups can be positive. But when it lead to these measures being down to the nth degree, becoming obsessed with what your next meal will be and anxious if you have to eat something out of your plan, then there is a problem. 

When I meet someone who is low weight and wants to weight restore I always emphasis that it will not be easy. Not because I want to put them off, but I always find it is important to be honest and forewarn them. Recovery from an eating disorder is a cruel business. Why do I say that? Well if you have an eating disorder you have issues around food, often you are restricting your intake and eating high calorie foods causes anxiety. You don’t like feeling full, bloated or heavy and putting on weight around your tummy is not something you want to happen. Guess what? When you weight restore all these things happen. It is like everything you are scared of you have to go through, a bit like one of those awful challenges where they put you in a box full of spiders to get you past your fear of them (yes I’m scared of spiders). Someone weight restoring will have to:

  1. Eat more.
  2. Eat more calorie dense foods. 
  3. Increase the variety of foods they eat.
  4. Eat more carbohydrates, fats and sugars.
  5. Will feel bloated after a meal.
  6. Will have to continue eating when full, pushing past that feeling of wanting to stop.
  7. Will have anxiety around mealtimes.
  8. Will gain weight and this may initially go to their tummy but will then redistribute.

So you can see some reasons why it is so hard. All the things you fear are the things you have to go through. I wish I had a magic wand or an easy solution. However recovery is definitely possible and so so worth it. 

What I do know is:

Dietitian UK: Prevention is better than cure

 

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Here is a quote from a  client talking about weight restoration to inspire you:

It seems like forever ago now and I can’t lie – I hated it at the time. I really struggled. I did the ISP after an admission and it was tough. I hated it at the time. I remember going through a folder of portion sizes with you and lying through my teeth. I couldn’t accept the help.  But I’ve been out of hospital for 3 years now. I’m small but not underweight. I had a lot of help and eventually knew how to use it. From there to now – I don’t think I could have got from there to where I am now without the support I received.

It hasn’t gone. It’s still there but I’ve got a lot to lose now (life, friends, family and definitely not weight) and I won’t give that up for anything. I never said thank you at the time because I couldn’t see that you were helping me. So I wanted to say thank you now. 

It is so good to be living again 😊

5 tips for recovery from an eating disorder.

1. Make recovery a priority:
This may mean taking a break from normal life. A year out. Recovery takes a lot more energy and effort than you may originally think. It needs to be right up your priority list. Time off work, school, certain friendships, travelling, exercise. Whatever it takes, this is important for this season.

Dietitian UK: Make recovery a priority

2. Find yourself again:
What do you like to do? It’s often hard to know what things make you, you. The busyness of life gets in the way of our identity. 
Book out some time to find you again. Try some activities you used to enjoy. Often creative projects can be a useful part of recovery. Maybe photography, baking, sewing, painting, collage, scrap booking, gardening,  I love the phrase “Find what makes you come alive, then go and do it”.

3. Mindfulness:
Sitting in silence and paying your full attention to your breath and body can help you bring an awareness of your thoughts and feelings. This practise helps you let go of the unhelpful thoughts and be more compassionate to yourself. Practising letting thoughts go in your mindfulness practice will enable you to take this into everyday life so when an unhelpful thought comes along you are in a better place to acknowledge it, but not to act on it.  

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4. Value yourself :
Take time to look after your body: nutritionally and physically. Some self care time in your week can make a real difference and can remind you that you are important and worth looking after. For some people an eating disorder can be a form of self neglect and may have some punishment aspects to it. Creating the emphasis on it being good to care for yourself and give yourself pamper occasions helps build self esteem and love for your body. 

Some ideas: A long bath, a manicure, pedicure, haircut, moisturising your body, shaving. Taking time to tidy your home, buy yourself flowers or something nice to look at each day, light candles in the evenings. 

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5. Fuel your body:
The right fuel at the right times of the day is vital. This may mean going against your feelings and thoughts, but with repetition a routine will evolve and habits will form. 
It is likely your have no idea what normal eating should be for you now. Plan out 3 meals and 3 snacks a day with general timings to stick to if you can. There will always be days things don’t fit into your plan, that is also part of normal eating! For more advice take a look at my healthy eating in Anorexia post.
Go for as much variety as you can. There is no perfect meal plan, it’s all about making small steps and challenging yourself as often as you can. 

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Anxiety Techniques for Eating Disorders

Anxiety is one of the biggies when you are working on recovery from an eating disorder. I’ve worked through this with many clients: either whilst they are eating, after a meal or whilst choosing a meal. It can feel totally overwhelming and be quite debilitating. So you need tools available to help you deal with those consuming anxious moments. One thing I alway like to remind people is that anxiety is a natural body response. It may feel like it will overtake you and spiral out of control, but it has to peak and then lessen. Give it 10-20 minutes to pass.

Dietitian UK: Anxiety Techniques For Eating Disorders

Distraction

Find something that can change your focus. If you are eating you may need someone to start a conversation, the radio may help or watching a candle burn.

If it is away from a mealtime then crafty activities, a good book, a bath or a phone call to a friend could help. Write out a list of things to try out.

Do a Body Scan

A Body Scan is a a great way to reconnect to your body. In moments of anxiety your parasympathetic nervous system can take over, dry mouth, heart beating faster, harder to swallow, feeling hot, a pounding head, tunnel vision – none of it will help when you are trying to eat or to relax after a meal. By working through your body from feet to head you cab bring your awareness back to your body and reduce the anxiety.  

Here is a free video version from Elisha Goldstein.

I particularly like progressive muscle relaxation, probably because it is a more active form or relaxation so I have something to do! It works by tensing the muscles in a body part, holding for 30 seconds and then releasing. This leads to a sense of relaxation in that area.. The whole process makes your think about your body and not that anxious event and helps you slow down your breathing too. 

Here is a useful script you can use.

Or you can just work from your toes through each muscle you can think of going up to your jaw. Or pick large muscle groups such as your fists, feet, legs, jaw and just do those for a few minutes. 

Being Barefoot

Walking barefoot can be a good exercise in thinking about movement, feelings and breathing. Slowly walk around on difference surfaces, working slowly through the foot and focusing on using as many of the small muscles in the foot as possible. Use deep breathing through the ribcage whilst you walk.

Try using a tennis ball to massage and release through your feet first to increase the amount of movement through your feet. 

Mindfulness

I often ask clients if they have tried mindfulness. Some people love it and others struggle with it. If you haven’t tried it then good apps include Headspace and Breathworks. It can take time to really get your focus and practise will improve it. Try and find a set time to practise each day, even if it is only 5 minutes. 

Breathing

I know this is something we all do, all of the time, but there are some good breathing techniques that can help reduce anxiety. Deep breathing reduces the fight/flight response that occurs when you are stressed. So simply focusing on your breath and slowing it down can help. When you are sat eating and the anxiety starts to mount up, threatening to overwhelm you, try refocusing on your breathing. 

In Pilates we use thoracic breathing, where you bring yourself into a neutral posture – stacking your ribcage over your pelvis, breath in deeply expanding through the chest and breath out letting the chest fall back. It always amazes me that just deep breathing uses the right muscles can make a difference. 

Another one I like is square breathing – think about or look at a square. Breathing in for 4, hold for 4, breath out for 4 and hold for 4. The counting can be helpful and you can do this without anyone noticing.

Orthorexia: when healthy eating is not healthy.

If you read my blog regularly you will know that healthy eating is definitely something that I promote. Sometimes, there can be point where healthy eating goes a step, or several steps too far. Can we be too healthy with our eating? 

The rise of healthy eating blogs, clean eating movements and instagram gurus has led to there being almost too much access to information, recipe and tips. As well as the not always qualified voicing their nutritional opinions. This can lead to confusion and information overload.

Dietitian UK: Orthorexia

What is Orthorexia?

Orthorexia Nervosa is a relatively new term meaning a “fixation of righteous eating”.  It was first used in 1996 by Steven Bratman, MD. It is not yet recognised as a fully fledged eating disorder in the diagnostic criteria, but is definitely something that is on the increase. 

People with orthorexia may not notice they have an issue with their eating, in face they may think the opposite. They can start out trying to eat a healthier diet but get drawn into the spiral of trying to eat a healthier and healthier meal plan. They become consumed with food, trying to eat right, being strict with their food intake and restricting the foods they are allowed to have. Purity, eating the healthiest foods they can and guilt if they stray off the plan are hallmarks. This can lead to an obsession with weight, shape and calories. Weighing food and adding in specific “health” foods can also creep in.

There are usually underlying issues that precipitate Orthorexia. This could be a need to escape, feeling out of control and needing to control an area of life, feeling a loss of identity. Suddenly finding an outlet in the form of control via eating can help fill that void. It starts out seeming like a healthy way to deal with your feelings, but then spirals out of control.

Why is it a problem?

Although on the surface a diet may sound healthy, when you dig down it is usual to find nutritional deficits in the diet. A lack of calcium for example, that can affect bone health. A lack of essential fatty acids, affecting brain function, skin and blood flow.

More noticeable is often the weight loss that ensues and the affects on socialisation. Physical side effects of weight loss can include: poor circulation, feeling cold, hair loss, poor concentration, memory and reactions times, low mood and mood swings, being unable to eat out, wanting to isolate yourself, fatigue and a general lack of lustre. People can feel consumed with the need to know what they are eating each day, needing to prepare it all themselves, planning meals and recipes far in advance and this becoming all-consuming. There can be a loss of hunger and fullness signals, with increased anxiety around meals. 

Dr. Bratman, who recovered from orthorexia, states “I pursued wellness through healthy eating for years, but gradually I began to sense that something was going wrong. The poetry of my life was disappearing. My ability to carry on normal conversations was hindered by intrusive thoughts of food. The need to obtain meals free of meat, fat, and artificial chemicals had put nearly all social forms of eating beyond my reach. I was lonely and obsessed…I found it terribly difficult to free myself. I had been seduced by righteous eating. The problem of my life’s meaning had been transferred inexorably to food, and I could not reclaim it.” (Source: www.orthorexia.com)

So a healthy diet is bad for me?

Well it can be, if it takes over your life, your thinking, your time and leaves you with feelings of anxiety, guilt and self-loathing. If you are not able to relax and eat cake now and again then that is not normal eating.

How to get help?

  1. Recognise the problem. This is a huge step.
  2. Talk to your GP and ask for advice. They may be able to refer you to a local eating disorders team.
  3. Look for an eating disorders specialist who can work through your food beliefs and give you the confidence to make changes.

Having an Eating Disorder over Christmas.

I love Christmas and all the build up that goes with it, I’m like a small child with the excitment of it. For me it is special celebration. However through my work in eating disorders I know what a hard time it can be for some. 

Christmas brings with it a lot of socialising, which can mean a lot of different meals. Eating in restaurants, buffet events, and more alcohol than usual. Then we have all the delicious, but high calorie festive foods: mince pies, christmas cake and pudding, stollen, pannetone, yule log, pastry items, cheese, nuts and those tubs of chocolates. All of this can cause someone with an eating disorder a lot of anxiety and that is before we get to the Christmas meal itself.

Dietitian UK: Surviving christmas with an eating disorder

I know I will freak out over buffet food but I really want to go, what can I do?

How can I eat in front of other people?

Should I cut my intake down the rest of the day if I am eating out?

How much can I drink and how does it affect my calories?

The 25th December. A special day, spent eating, drinking and being around people you may not see all the time. In our family we end up having 2-3 Christmas days as we visit my side of the family and hubby’s side to celebrate with them too. So it could end up being 3 Christmas meals. Suddenly you are in an environment where you may eat at different times, have higher calorie foods at meals that you haven’t eaten for a while and are eating with different people. 

Will everyone be looking at me and watching what I eat?

If the Christmas meal is late what do I do about sticking to my usual meal plan?

How much should I have at that meal, will it be more calories than  I am used to?

What will this do to my weight?

I don’t want to spoil the meal/day for everyone but how what do I do if I am not coping?

Should I have dessert?

This year, I have spent time with each of my clients talking through their plans for the build up to Christmas. It’s been a real challenge for some with meals out with work colleagues and planning the Christmas Day itself. However everyone has a plan in place and I hope everyone will be able to relax a little and enjoy the moment.

Dietitian UK: Surviving Christmas with an eating disorder 2

Here are my top tips:

  1. Preparation is key. Try to get as much information about what is going to be happening in advance. If you take some of that element of surprise out of the equation you will reduce  the anxiety somewhat.
  2. Ask others around you for support. Let someone know that you may find this meal/event tricky and if so this will be your signal and give them ideas of what they can do to help. Maybe they can distract you with conversation or use a few motivational phrases to boost your confidence. 
  3. If people do not know about your eating disorder then they are unlikely to be watching you. If they are watching you then it is probably out of sheer intrigue. You could try smiling at them to show things are ok (even if they are not). Remember that this is a moment for you to enjoy and you don’t want to let little things get in the way of your recovery.
  4. Plan out which days you will be eating differently over the festive time. Then also plan out a list of foods you want to allow yourself to eat. When are you going to do this? Can you swap a normal snack for a mince pie? One of my clients worked out a mini mince pie was not that different to her usual cereal bar so that was an easy way to build a mince pie into her meal plan. Try not to let yourself miss out.
  5. The meal itself can be overwhelming. It is one meal out of 21 in a week. It is 1 day out of a week. If you eat an extra 700kcals that day, it only equates to an extra 100kcals every day that week – not enough to cause any effect on your weight. You need to eat an extra 250-500kcals everyday for your weight to increase, and even that is not enough for some people.
  6. The 80/20 rule – stick to your meal plan 80% of the time and you can come off your meal plan and relax more around food 20% of the time. It is a normal and healthful way of eating – for example think how people eat in a more structured way during the week but eat differently at weekends.
  7. Keep some meals on that big day safe and normal. It may be you can have a normal breakfast and morning snack but then you have a large lunch with dessert. Listen to your body and your wise thoughts. Check out those feelings of fullness – are they related to your emotional fullness, your anxiety or your physical fullness? Use your knowledge and common sense to decide what else you need to eat for the rest of the day. 
  8. Restricting, purging or exercising after a big meal is not the answer. It may help you feel better initially but it won’t help your recovery in the long term. Find ways to distract yourself – crafty things can be good, get a mindfulness colouring book (all the rage right now it seems!), phone a friend, hang out with that family member you haven’t seen in ages, suggest a gentle post-meal walk with people. 

Relax a little.

Enjoy the moment so you can look back and be proud of you.

Keep recovery in mind and keep going one meal at a time.

If you need any support get in touch and we can set up a face to face or Skype consultation.

Dietitian UK: Surviving Christmas with an eating disorder 3

Feelings of Fullness

“I feel full after eating a small amount”

“When I eat more than usual my stomach feels uncomfortable and bloated”

“I feel like I have a food baby”

These are phrases I often hear from clients with eating disorders as we work on increasing their meal plan. Unfortunately there is no magic cure here and it is a stage that has to be worked through. What can help is understanding what is happening.

Dietitian UK: Feelings of Fullness

The Science:

In someone who has been under-eating for some time, the digestive track slows down. As a result food moves slower through the system. That feeling of the food remaining in the stomach for a long time can be true and is known as “delayed gastric emptying”. This can also lead to a heightened sensitivity to feelings of fullness and bloatedness. It is not necessarily that you are fuller than anyone else, but you may feel that way.

If you have an eating disorder you are likely to have been blocking out those feelings of hunger and of fullness too, there is a disconnection and a loss of sensitivity to them. Fullness is regulated by the hypothalmus in the brain. 20 minutes after you eat a signal is sent to the brain. This is an easy system to overide so it needs your sensitivity. This connection has to be rebuilt and relearnt which takes time. It may feel like you cannot trust the signals the body is sending. Actually it is your reading of these signals that is the issue, sticking to a balanced, regular intake of meals and snacks will help to realign your thinking with your feelings and food.

Thoughts are powerful. If you think you should be full or are full then this can trigger anxiety leading to feelings of fullness. Try to keep mealtimes relaxed and have a period of time afterwards where you distract yourself with something like art, craft activities, phoning a friend, reading a book. It takes 20-40 minutes for the feelings of fullness to subside. 

Number 1 tip for staying on track with your eating.

Whatever changes you have decided to make to your eating there is something that can really make a difference to making or breaking that habit. 

It’s a commonly known fact that it can take 6-8 weeks to form a new habit, so if you have set yourself a healthy habit to form you need to stick with it. 

Whether you are gaining weight because you are underweight, losing weight or maintaining your weight, this applies across the board. 

I know because it is something I personally do and it is something that makes a real difference to the clients I work with. 

So here it is.

MEAL PLANNING. It isn’t rocket science I know, but it is everyday common sense science.

Dietitian UK: Meal Planning.

If you want to make a healthy change to your eating, you need to plan it into your day and week. Just deciding on a change will not make you stick to it. To give yourself the best chance to suceed you need to have the right mindset, the right food in stock, have the right time to prepare it and have the right recipe to hand.

Here is an example. If you need to increase your diet in order to gain weight, you could just say to yourself “I will eat more at each meal”. When it comes to that meal 1. Will you remember? 2. Will you have extra food to hand? 3. Will you panic and decide not to do it? Using a meal plan is a useful tool as it make you plan out exactly how you will meet your goal. So where you will increase your current meal plan and exactly what extra foods you will add in. This means you can now prepare practically by making sure you have the foods available at the right times and prepare mentally so you are focused.

If you make a plan you are more likely to stick to it than if you have no plan.

There are several ways of meal planning. Some people like to use a whiteboard in the kitchen (this is what I do), others like a notebook they carry around with them and others like a printout stuck up in the kitchen. Think about keeping your meal plan visible and available at meal times as a reminder.

Make meal planning a regular part of your week and it will really help you hit your goals.