Tag Archives: eating disorder specialist

Dietitian Advice, Eating Disorders, Intuitive Eating

What is Orthorexia Nervosa and what can I do?

Leave a comment

Orthorexia Nervosa is the newest eating disorder phrase on the block. It was devised by Steven Bratman in 1996, after he noticed a trend in his patients. Ortho means rich or correct.

Orthorexia = an unhealthy obsession with healthy eating. It can have elements of anxiety disorders and OCD with it.

Orthorexia Nervosa

Whilst there is an overlap here with anorexia nervosa and people with orthorexia may end up developing anorexia, there is also a big difference. Orthorexia is taking healthy eating to the extreme, it has an aspirational, wellness culture ideal associated with it. This means it is less about weight and more about purity and an ideal lifestyle. Social media has certainly heightened this and fuelled it. With role models who life perfect pure lifestyles of food, exercise and spirituality, it can seem as if that ideal is achievable and realistic. Striving to achieve it leads to feelings of failure and guilt.

The Bratman Orthorexia Self-Test

This is a test devised by Steven Bratman to help identify if you are at risk of orthorexia. If you answer YES to ANY of these questions you may be at risk.  I think it is useful test to read through and think to how much you identify with the statements.

(1) I spend so much of my life thinking about, choosing and preparing healthy food that it interferes with other dimensions of my life, such as love, creativity, family, friendship, work and school.

(2) When I eat any food I regard to be unhealthy, I feel anxious, guilty, impure, unclean and/or defiled; even to be near such foods disturbs me, and I feel judgmental of others who eat such foods.

(3) My personal sense of peace, happiness, joy, safety and self-esteem is excessively dependent on the purity and rightness of what I eat.

(4) Sometimes I would like to relax my self-imposed “good food” rules for a special occasion, such as a wedding or a meal with family or friends, but I find that I cannot. (Note: If you have a medical condition in which it is unsafe for you to make ANY exception to your diet, then this item does not apply.)

(5) Over time, I have steadily eliminated more foods and expanded my list of food rules in an attempt to maintain or enhance health benefits; sometimes, I may take an existing food theory and add to it with beliefs of my own.

(6) Following my theory of healthy eating has caused me to lose more weight than most people would say is good for me, or has caused other signs of malnutrition such as hair loss, loss of menstruation or skin problems.

If you identify with anything in this post then I highly recommend that you reach out to your medical team, GP, a friend, a parent, a dietitian who works in this field like myself. You can also contact B-Eat.

Top tips for Orthorexia:

Here are some steps you can take to help combat Orthorexia, I suggest these are done with the support of a therapist and dietitian.

  1. Unfollow anyone on social media who fuels the thoughts of having to eat a pure diet/lifestyle. Or try a social media detox for a week.
  2. Focus on eating a variety diet. There are no wrong or right foods it is all about the balance and variety that you eat. Nothing is off limits. Nothing is wrong to eat. 
  3. Work with someone qualified in this area to redefine healthy for you. This may include food, movement, quiet space, social time, family time.
  4. Develop alternative coping skills. Can you see how food helps you feel in control and also makes you anxious? Using distraction after a meal and journalling your thoughts can be a good initial step.
  5. Write out a list of your food rules/beliefs. These need to be challenged.
  6. Only allow yourself to get your nutrition knowledge from someone with a minimum of a degree in nutrition  –  a registered nutritionist or dietitian.
  7. Stop tracking your nutrition. This may take time to do so start with doing it at one meal at a time. 
Dietitian Advice, Eating Disorders

There is no perfect way to eat

Leave a comment
There is no perfect way to eat. The more I learn about nutrition the more I am convinced of this. The science of nutrition is continually evolving, growing and being researched. We are learning all the time and it’s a lot more complex than it looks on the surface, but also there are simple steps we can take to eat well.
 
Things are not always in your control. Our tastebuds, culture, finances and social circumstances are just somethings that can affect how we eat. The good news is there is no perfect way to eat. There are many, many ways to eat a nutritious diet. It’s not about striving to be perfect or have the best meals. It’s about eating as well as you can with what you have. No guilt. No shame. No judgment.
 
 
Our bodies change and need different things at different stages of life, often our bodies are able to adapt and help with this. As a baby, a mums breastmilk will change depending on what the baby needs.  Teenage bodies are able to absorb more calcium than at any other time of life. In pregnancy our bodies adapt and will absorb more of certain nutrients such as iron to provide for the baby and changes in the body. Isn’t the body amazing, it knows what we need better than we do. So one of my top tips is to focus on trusting your body, listening to your body and learning what your internal cues feel like. What does hunger feel like to you when you are very hungry, a little hungry and not hungry at all? What cues does your body give you about the foods it needs? Do you get cravings or suddenly feel you are drawn to certain foods? Sometimes this can be due to the nutrients in these. For example craving vegetables after a trip away when you have eaten differently, or craving salty foods when you haven’t had any salt for some time. 
 
My favoured approach in my eating disorder work is to focus on reaching a healthy state and not a healthy weight. On reconnecting with your body and not ignoring it’s signals. This can be very hard to do and a long journey. It’s not all about the numbers on the scales. Sometimes shifting the focus away from weight can make a huge difference.  There is no perfect way to eat or perfect way to recover from an eating disorder, but we do have amazing bodies that can help us discover the right way for us. 

​

If you need any help with this then do get in touch. 

Other

Book a Consultation

5 Comments

Priya provides one to one consultations from her home consultation rooms in Southampton or online using video calls or phone consultations. See below for the types of issues Priya can help with. Skype/Zoom video calls provide a more flexible way to see Priya face to face but from the comfort of your own home. The software for this is free to use. The majority of Priya’s work is done this way as she works with clients all over the country and internationally too. She also offers dietary analysis via email where a thorough analysis is conducted on your food diary and a report emailed back to you.

As everyone is different and needs differing levels of support Priya does not have a set way of working. However she does work from a non-diet and intuitive eating background. This is based on the concepts that diets do not lead to long term change and that it is better to focus on changing health behaviours rather than just diet and a weight focus.  Retuning your body to listen to its hunger and fullness cues, learning to respect your body and listen to its needs can be a longer route but leads to lasting changes for life.

A initial consultation lasts up to 1 hour and includes an in-depth review of your current and previous diet and food related problems plus your weight and medical history. From this information Priya will give education, advice and help you set goals that are realistic and achievable. All advice is individualised and tailor-made for you. You will receive an email summarising the agreed goals set  along with any agreed information. This may include a meal plan, worksheets or educational literature.

Follow-up sessions can be booked and last for up to 30 minutes. The number of sessions you will need will totally depend on your needs. 

Prices: £95 for an initial consultation and £65 for follow ups.

Package: £260 for 1 x initial consultation and 3 x follow up sessions.

Email dietary analysis with report £65

Eating Disorders:

Priya is renown for her expertise in this subject and the majority of her clients will have an eating disorder. She takes a holistic approach, not just looking at nutrition in isolation but helps clients to look at the wider issues too. Many of Priya’s clients have worked with the NHS and need further support or have not met the criteria for NHS input. If you do not think you have an eating disorder but know your approach to food is not as it should be, then get in touch. Working as part of a team of specialists Priya can recommend a therapist for you to work with or can liase and work with your current therapy team as well as your GP. She works with the Wings Eating Disorders Unit in Romsey and also as part of the Marchwood Priory team. If you need help getting your eating back on track Priya is here to help with education, meal planning, practical help, support and an understanding ear.

Weaning Consultations

One of Priya’s specialist and much loved areas – book a weaning consultation for advice, recipes, top tips and support to help you get your baby off to a wonderful start with food. Having weaned 3 children herself Priya has first hand experience as well as the evidence case and the research to support her advice. If you are struggling with fussy eating Priya can also help with this. Family meal planning and suppoprt can also be supported.

IBS:

Priya can help with advice and support for those with IBS, this includes the low FODMAP diet which is a specialist diet that should be followed under dietetic supervision.

Other consultations topics Priya can help with include:  Chronic Fatigue, Learning Disabilities, Family Meals,  Anaemia, Osteoporosis, brain injury and achieving a healthy balanced diet. If you have another dietary issues please do contact Priya to discuss. If Priya is not able to help she can help point you to someone who can.

Some private medical insurance companies cover dietetic consultations, please check with your insurer. Priya is registered with AXA, AVIVA, WPA, BUPA, Exeter Family, Allianz and Pru Health.

Testimonial:

“The support Priya provided to help me gain weight and overcome an eating disorder was above and beyond what I would expect from a dietician. We met regularly and she never failed to surprise me with creative and interesting ideas to introduce variety into my diet and ensure that the weight gain process was as exciting and smooth as it could be. She encouraged me to face my eating disorder head on and used her incredibly extensive and detailed knowledge on nutrition to challenge disordered thinking. Her holistic approach has been so integral to my recovery that I cannot thank her more! I’d recommend working with Priya to anyone, as her caring, enthusiastic and creative approach is something you don’t find easily.” 
Dietitian Advice, Eating Disorders

Constant thoughts of food? It could be linked to your diet.

Leave a comment

One statement I hear regularly in my eating disorder clinics is “I feel like I’m going mad, all I think about is food”. Now whilst an eating disorder is a mental health illness it is not a sign of madness. However you can feel so consumed by your thoughts of food that it feel that way. Why? Well let’s have a look at some of the symptoms of being underweight….

Back in 1941 there was a landmark study conducted by Ancel Keys called the Minnesota experiment. The aim of this study was to get information on how to refeed those starving from famine conditions. 32 men completed the study, 12 of these were studied for 8 weeks to assess their baseline intake before the trial began. Then they were all starved for 24 weeks, with their intake reduced from 3,200kcals to just 1,600kcals/day served in 2 meals. which led to a 25% loss of body weight.  Now take a note of the number of calories, yes these men would have been more active and lived a different lifestyle but 1,600kcals led to them being starved. Many of the diets that are advertised today are much lower in calories that this, so are they really healthy for our bodies? 

Fascinatingly the men showed a lot of the symptoms we see in people suffered from an eating disorder. They become obsessed with food. Some read cookery book and stared at pictures of food. Cheating become a huge issue with them trying to find extra snacks. One man became psychotic, having vivid dreams of eating flesh and threatened to kill Keys, he was dismissed and after a few days these dreams and thoughts went away. This to me highlights the affect being a low weight can have on your thoughts and mental health. If you have an eating disorder and are a low weight that pre-occupation you have with food can totally be related to your body being undernourished. It is not you going loopy, it is the impact of being malnourished.

These men displayed a biological drive to eat, their hunger was increased and felt out of control. Keys ended up having to have each men chaperoned to stop them eating other snacks when not in the hospital. Our bodies are built to live and to live we need food. So they will do all they can to get us to eat. When you restrict your intake it makes perfect sense you will hungrier than before, stronger signals are being sent out and the body is going into amber alert. So that pre-occupation with food is actually a normal, biological sign that your body is working and doing it’s job.

The good news is, upon being re-fed, for most men, these symptoms disappeared. They were refer back to their usual weight and felt a lot better. Their thoughts, mood and emotional state improved alongside their physical healthy. Some of these men were interviewed in 2003 and they reported being glad they took part in the study, but there being some lingering after-effects. Some were worried about food deprivation for years afterwards. This can also be seen sometimes in recovery from an eating disorder, which is why  it is important to focus on recovery happening in stages and being a continual work in progress. 

If any of this has hit home to you and you feel like you need some support, do get in contact with me, see your GP for advice  or check out the B-eat website who have a helping and a list of eating disorder specialists. Taking that first step can be the hardest but with good support around you, recovery really is possible.

 

 

Dietitian Advice, Eating Disorders

5 tips for recovery from an eating disorder.

Leave a comment

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.  

IMG_2942

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. 

IMG_2943

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. 

image1

Dietitian Advice, Eating Disorders, Nutrition Education

Anxiety Techniques for Eating Disorders

Leave a comment

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.

Dietitian Advice, Eating Disorders

Having an Eating Disorder over Christmas.

1 Comment

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

Eating Disorders, Nutrition Education

How often should I weigh myself?

Leave a comment

In my role as an eating disorders specialist I come across a lot of people who weigh themselves daily or even several times a day. So this post is written from an eating disorders perspective. Now whilst regular weighing can seem like a sensible idea to help keep you on track here are my thoughts on why you want to step away from the scale at times. 

Dietitian UK: How often should I weigh myself?

1. You are not just measuring one change in your body. When you weigh yourself it is not just your body fat that you are looking at but also your muscle, bones, organs, body fluids, glycogen, cells, tissues and any water products that are being measured.  Plus we know that muscle weighs more than fat. If you have been working out more and building muscle then this can cause your weight to increase. So you can increasing your stores of glycogen from eating more carbohydrate. Or conversely using up your glycogen stores through exercise or not eating carbs will look like weight loss. 

2. Your weight fluctuates over the day and week. Whilst you may think this is to do with body fat, it isn’t! This is usually down to fluid, you will weigh less at the start of the day, before breakfast, after doing to the toilet. During the day you eat and drink which means you take in food and fluid, which increases your weight. By the end of the day you will weigh more than at the start but this is not necessarily true weight. Responding to daily changes in your weight will make you become fixated on your eating and weight.

3. Your hormones and your monthly cycle (for women) will affect your weight. You know how you often feel bloated and heavier around your period. Well that’s because you retain fluid and you do weigh a bit more. It’s perfectly normal and not something to worry about. Your weight will have a natural fluctuating cycle that happens over a month.

4. Constipation can have an impact on your weight too. So if you haven’t been for a few days then remember the waste in your body will weigh something. 

So you can see that weight is a complex issue. Within my clinical practise in eating disorders I don’t take a one off weight in isolation but always look for the trend. If you want to weigh yourself regularly then go for no more than weekly. Track your weights and look at the trend, you need at least 3 weights to do this. Do not freak out about a one off change in your weight but wait and see what the next reading does as it may not be a true reading. Look at the bigger picture – are you constipated, what have you been eating, are you dehydrated, where are you in your cycle? Weight needs interpretating with filters and googles. 

My last and biggest tip: Don’t use weight alone as your judge and guide. How you feel, your body shape, how your clothes fit and how happy can be better ways to focus on you. Step away from the scales once in a while.