Tag Archives: eating disorder specialist

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

20 March, 2018 Priya 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.

7 July, 2016 Priya 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.

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.

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.

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.

Dietitian Advice, Eating Disorders, Nutrition Education

Anxiety Techniques for Eating Disorders

13 February, 2016 Priya 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.

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.

24 December, 2015 Priya 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.

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.

Here are my top tips:

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.
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.
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.
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.
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.
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.
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.
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.

Eating Disorders, Nutrition Education

How often should I weigh myself?

3 July, 2015 Priya 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.

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.

Dietitian UK