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Dietitian Advice, Eating Disorders, Nutrition Education

What makes it easier to recover from an eating disorder?

19 September, 2017 Priya Leave a comment

“Recovery is like riding a wild stallion. It is unpredictable, you will likely fall off many times. You will go through emotions ranging from fear to excitement, feeling out of control at times and clinging on to anything you can. Keep getting back on the horse, keep holding tight, sit up tall and go with the ride.”

There are many times in my working life that I just wish I had a magic wand to make recovery easier. The fact is, recovery is hard, damn hard and it takes a lot of guts, determination and hard work to even make a start on it. Once you start it can feel like it just gets harder at points, so you really need to plan and have support in place to help guide you and keep you going. Here are some things that can help the ride.

Have a social support structure in place

Deciding to make changes to your eating may sound simple, but once you plan it and then actually have to put it into place, it really gets harder. Having people around you who you are accountable to, people who will sit with you in the hard moments, challenge you to keep going and celebrate with you too. True friends and family who love you for you but want to see you healed up and able to live life to the full.

Have professional support

Yes you can do it on your own. However an eating disorder is an isolating illness, it can be a long and lonely path. So having a professional or a team of professionals who you trust is a good idea. People you can get the right information from and trust it, people who will challenge your thoughts, assumptions and beliefs and believe that you can do this.

Being in the right place at the right point

There is a cycle of change that I often use with people to talk through how you need to be in the right mindset and the right point of your life to begin recovery. This is especially key if you are in the community, recovering at home. In a eating disorders unit things are a little different and you have more support and encouragement. Take a look at the phases below and see if you can identify where you are. Recovery can be a cyclical process where you move forward 5 spaces and then back 2 spaces, but do not give up, this is normal.

Stages of ED recovery

I don’t think I have a problem
I might have a problem but I’m ignoring it or I don’t care
I don’t know how to change but I want to
I tried to change but it didn’t work
I can stop some of the behaviours but not all of them
I can stop the behaviours but not the thoughts
I can be free from my eatind disorder some, but not all the time
I am free from behaviours and thoughts = recovered

Have goals in mind

You need something to aim for. Why do you want to get better? What will life be like when you are free from your eating disorder? What do you want to do with your life that you cannot currently do. I recommend writing out or creating a vision board showing where you want to get to. Write out your dreams and dream big. Then use this as a motivational tool, put it up where you can see it.

Surround yourself with the positive things

Part of recovery is about changing your mindset and the way you view life. It can be so easy to see the negatives about your life and yourself, then use food as a way to help with this. Or to get drawn into the negatives about weight gain. I challenge you to instead see the positives. Why is weight gain good? What does it mean for your body and your life? Grab hold of those negatives and turn them upside down. Having motivational phrases and images around you can be really helpful on those days that thinking is too tricky.

Go do it. I believe you can.

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Dietitian Advice, Eating Disorders

The golden toolbox of recovery

15 August, 2017 Priya Leave a comment

What’s in your toolbox?! I was recently at a meeting and friend turned to me and said “I have a strange picture that I’ve seen, it’s you with a golden toolbox. It’s like you have everything you need in that toolbox to deal with life”.

This spoke volumes to me as a person and as a health care professional. Having worked in a team which was predominantly psychological I was immersed in the language of the therapists and the word toolbox often came up. I sat in on plenty of group therapy sessions and got to experience a whole range of different therapies. Also, in our team meetings we used these skills on ourselves as part of the debrief process. It showed me how important it is to look after not just your patients, but yourself. If you have a life with some stress in it (let’s face it that is probably everyone) then you need to have some skills to hand that help you deal with that stress. Stress and anxiety can be a huge factor in an eating disorder, in mental health conditions and also to physical digestive issues such as IBS. When you have a stressful event how do you respond? What does it trigger in you? When you know how you respond you can start to work on a more effective and helpful mechanism.

I will never forget my interview for my eating disorder post. I was asked such an eclectic mix of questions that I had no idea how I had done on leaving the room. When I received the call to say I had the job, I asked why I was chosen. The response “we could see you are robust and able to cope with the strains of this work”. In the eating disorder field this robustness is certainly needed. I continually need to keep on top of my own anxiety and practise what I preach.

I want to highlight some skills or tools that we all, health professionals, patients, people, could include in our golden toolbox. Tools you can use regularly for moments of anxiety, tools you can pull out for those emergency moments.

I remember being on a train that got stuck in a tunnel and suddenly feeling trapped and my anxiety levels rising. It was not an experience I was prepared for and suddenly I knew I needed to use one of my tools. At that point visualisation of a calm beach with lapping waves and some square breathing helped immensley. I know if I had not practised these skills previously, I wouldn’t have been able to use them there and then. So practise really is the key.

Here are some of my favourite toolbox tools that I use myself and recommend.

Journaling –

I’m a seasoned journalling fan. This is something I have always done since my teenage years, I now have a lot of full notebooks with a collection of my teen angst, my working life, my spiritual life and my family life in them. Looking back it shows me how I have evolved and where my stress triggers are. I can see the patterns that I fall into and work on improving my reactions. I dig out my journal when I have a moment I need to work through, when my mind feels cluttered or when something erupts! I also love to journal the good and positive, so any life events or just when I get the urge.

If you are on a recovery journey then I recommend that you journal daily or at least 4 times a week. It needs to become a discipline and a part of your coping mechanism. A good way to start is to write down 3 things that went no so well in your day and how you could have dealt with these better. Then always finish on a positive, so 3 things that have gone well or that you coped with well. You can also take a single scenario and write out alternative endings. Using an eating disorder example: You had an argument with a friend, this increased your stress and you responded by missing your snack. Thinking through why this was not a useful response – restriction of food does not help your emotional well being, it is a quite fix but not a long term cure. Now you have missed out on some nutrition for the day and your body is hungry. Your body needs regular food right now as you work towards recovery. So take a think through how you could have responded instead…. maybe you could have gone for a walk, taken a bath or done some mindfulness to help you reduce your anxiety after the argument instead of turning to food.

Mindfulness and Breathing –

Such a buzz word at the moment, but this is not a fad. I’ve been using mindfulness with eating disorder clients for over 10 years and I’m sure it has been used for far, far longer than this. Just 10 minutes before a meal or after a meal can make a huge difference. It is all about calming your thoughts and body. I personally love just deep breathing, there are so many variations on this so try a few out. For me, the breathing is something that spills over from Pilates practise and so I get a double benefit from Pilates of exercise and mindfulness. There are some great free resources to help here.

Exercise –

This is something to decide upon according to your recovery stage. Exercise can be amazing as a mood booster and a de-stresser. However if you are working on weight gain then it will also have an affect on this. If your BMI is less than 17.5 then you will want to modify your exercise so that it is physically safe.

Distraction –

I often suggest that people put together a list of distraction techniques that they can use. For example, after a meal, or when a the urge to binge strikes, at times when anxiety levels are rising it can be useful to have an activity planned. Things like craft, having a friend to call, painting your nails, reading a book, cleaning out a cupboard – something that immerses your mind and changes your thoughts. Puzzles, crosswords, knitting, collage are all great things to have on your list.

Positive thoughts –

Those anxious, negative thoughts are something that we all get. It is how we deal with them that is key. I love the thought of noticing the thought, and finding the opposite reaction. So turn that negative into a positive. If you practise this regularly it can turn into a habit that you hardly notice you are doing. I’m now working on this one with my children too, teaching then that there is always a positive side to things. It is a great skill to learn at a young age but one that you can learn at any age.

I’d love to know what tools you find useful.

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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