Friday, February 26, 2010

Building a Bridge from ED to Intuitive Eating, Part 1


“Most patients who are in the throes of anorexia nervosa, bulimia nervosa, or compulsive overeating have lost touch with their innate signals of hunger and fullness and taste preference. The physical starvation is often so grave in those who are suffering from anorexia nervosa that an attempt to listen to the signals of hunger or fullness can only lead to confusion and maintenance of the underfed state. If even the smallest amount of food is ingested, the slowed stomach emptying that occurs in anorexia pushes away signs of hunger and creates a false sense of fullness.”

“In the treatment of bingeing disorders, including bulimia, patients have become so accustomed to eating quantities of food that are larger than one’s normal needs that their interpretation of fullness is highly skewed. They so often have ignored hunger by eating for many other reasons, such as boredom, loneliness, anger, etc., that asking them to listen to hunger signals feels alien and frustrating. We begin, instead, by putting on our nutritionist caps and teaching them about normal body functioning, including the concept of blood sugar fluctuations and the body’s reaction to meals that are imbalanced or inadequate in terms of energy intake.”

“So, intuitive eating is best seen as the model of eating that will ultimately become one’s own. This happens after there has been a period of time for healing the body physically and shifting the cognitive distortions that rule the mind of someone who has developed an eating disorder as a coping mechanism.” – Excerpt from, “Intuitive Eating: A Revolutionary Program That Works”, By, Evelyn Tribole, M.S., R.D. and Elyse Resch, M.S., R.D., F.A.D.A.

“Hello… I’d like you to meet my frenemy, ED”

For a long time now I have felt like there was a piece of the puzzle missing in the ultimate design of intuitive eating. Something about the process felt off. Working as an intuitive eating counselor, I have seen far more people struggle to embrace the path of intuitive eating, than I have seen readily take to it. I have experienced difficulty myself and this is after four years of believing I was an intuitive eater. In order to paint a clear picture, it’s necessary to share the story of my struggles and those of the many people all over the globe who have crossed my path on this journey.

In October of 2009 I experienced a relapse of my eating disorder issues. I have a long history of eating disorder with the first signs emerging that something was wrong when I was 10 years old. By the time I was 12, ED had me firmly in it’s grasp. I battled anorexia and purging behavior off and on over a period of 12 years. I never received any kind of professional support for my eating disorder even in my most desperate state of crisis. At that point, I was 24 years old. My weight had plummeted to a dangerously low level. At a height of 5’7”, I was a slip of a woman, somewhere in the mid 80 lb. range. I have to guesstimate my low point because I had not stepped on a scale for about three weeks and at last weigh-in I registered a mere 92 lbs. My body continued to waste away after that step on the scale, so I think it is fair to say that I was well into the mid-80 lb. range. I was vomiting blood on a daily basis. I was isolated and alone, without the necessary support I needed. Many of my friends, feeling fearful and not understanding the gravity of the situation, turned their backs on me. The abandonment and rejection was almost more than I could bear. The intensity of the shame and humiliation I felt is beyond words. Somehow, in the darkness of that bleak space I was able to strike a match. That inner light, however small, illuminated the possibility of hope burning brightly in the distance. I reached for it with both hands like a moth drawn to a flame. I clawed my way out of that dark tunnel and nurtured myself back to some semblance of health. It would be many years before I would notice that ED was still hanging out in the background, lurking in the shadows of my consciousness.

I had a brief period of stabilization. Life felt good for awhile. I was out of the danger zone health-wise and things were looking up in my life. I finally found the courage to stand up for myself and leave behind abusive situations. I left a dead-end job in the dust and moved on to a new career as a therapeutic massage therapist, working alongside doctors, providing physical therapy for their patients. It felt deeply rewarding to be earning a right livelihood by helping others find healing. In restoring others, I felt renewal in my own soul. Call it karma yoga. I took a leap of faith and manifested a lifelong dream, opening up my own practice and business was booming. I found instant success. Within my first month of opening doors I recovered all my starting costs plus found myself securely in the black with a handsome profit. It only continued up from there. I was working hard, but for the first time in my life I had financial security and was able to treat myself to the finer things. Within a few months, everything I had worked so hard for was reduced to nothing more than ash when a practitioner who shared space with me left a hot plate burning that set a fire, quickly consuming the building. I’ll never forget standing in the charred remains of what used to be my treatment room. How quickly life can completely change on the drop of a dime and leave you reeling senseless. I was not able to salvage a single thing except for a large statue of a fairy that I had sitting in the corner who somehow managed to survive the fire, her face glowing pearly white against a backdrop of blacken ash. I kept her as a reminder that even within darkness, there is light.

After this event, I hit the wall. Truth be told, the fire was a rather symbolic moment in my life. I was burned out. The field of rehabilitative massage is a taxing one. I didn’t do what therapists have dubbed ‘club rubs’. You know, those massages you get at the frou-frou spas where they pet you into submission. I did deep tissue, neuromuscular retraining, Heller work, sports massage and action release/trigger point therapy. This kind of work exacts a major toll on the body. I was in high demand and often found myself grinding through 60 hour work weeks. I was spent. My body depleted, I collapsed. I struggled for many years and saw a reactivation of my eating disorder issues, but this time it took a different form… non-purging bulimia. I used excessive exercise and tight eating as my compensatory behavior for the binges that were becoming ever more frequent. My weight escalated and I quickly became morbidly obese at over 300 lbs. I never really discovered my highest point because it got too depressing to see the rising numbers after awhile. I felt completely powerless against my body which only made my anxiety rise. This was a new experience for me. I had never been a large woman. I had gone through periods of being softer, fleshier, but never to the extent that it was difficult for me to function.

“Off with her head!”

Physically, this was a scary place to be. I was constantly getting winded and could barely make it around the block without having to stop to catch my breath. I was scared to sleep. When I laid down for bed I could feel this crushing weight on my chest. It felt suffocating. The worst part was that my ED tricks were no longer working. No amount of compensation could unravel the cascade of biological events that were happening in my body. This is the part of eating disorders that many people don’t talk about and I think it’s time we did. Eating disorders do serious physical damage to your body. They wreak havoc on your digestive system and once that damage has been done, it takes a long time and much effort to repair your internal terrain. When your digestion heads south, watch out! You become vulnerable to a whole slew of physical health complications. Unable to assimilate the nutrients from food, your state of well-being quickly deteriorates. It may seem like ED is helping you obtain the coveted prize of a thinner body but you can rest assured, there will come a time when you have to pay the piper and the price exacted will be your heavy head. Take it from someone who knows. It’s not worth it.

My body was in constant pain because of depleting bone mass. I had a bone density screening and the nurse practitioner was highly disturbed by my results. She informed me that I was only 3 points away from being like an 80 year old woman with osteoporosis. She had never seen a woman in her twenties with these results in all her years of practice. I found myself having to visit my dentist frequently for dental caries. My immune system was shot. I seemed to get every cold and flu that would come around the bend. It was very common during those days for me to be laid out sick for weeks on end. Every time I tried to exercise to address my escalating weight it was like throwing a match into a barrel of kerosene. My body was on fire and it was screaming at me, “Stop! Please stop! Be gentle with me. Be kind. I can’t take this abuse anymore!” My body was in the trenches of eating disorder, raising the white flag of surrender, but sadly, for many more years the battle raged on. Ultimately, my energy was completely snuffed out. I blew out my thyroid.

Many people are unaware that a major contributor to hypothyroid conditions is a history of chronic dieting. It’s no wonder that thyroid disease has reached almost epidemic proportions in the United States with our cultural diet obsession. The irony is, the longer you restrict, yo-yoing back and forth between feast and famine, the more your body will put up a fight for self-preservation. This is why many people find that despite the small amount of food they eat and the more strenuously they exercise their body only holds onto fat stores for dear life. This is because in a very real sense biologically, it is a life or death struggle. After years of abuse and self-neglect of basic needs, our bodies remain in a state of high-alert, never knowing when the next meal will come. Despite being fed, this uncertainty will linger. How long will this food be available? When will the next famine arrive? To the average person trying to live up to societies’ one-note beauty ideal this pursuit may seem harmless. Intellectually, you may understand that you are choosing to forgo food in favor of thinness, but this is completely irrational to your body. The body adapts in these situations and will slow everything to a grinding halt, including metabolism. This is why it is very common for restrictive eaters, chronic dieters and those who have battled anorexia to deal with overweight/obesity conditions later in life. We can’t blame our bodies. They are responding accurately to a lack of food security. We have to stop working against our bodies and instead work with our natural biological drives if we ever hope to have lasting healing.

There’s a Light in My Attic

After 9 more years of struggle with bulimia, beaten down and spent, I finally made the decision to give up the fight. I made a commitment to never diet again. I wanted to reconnect with my body. Even though I was a very large woman, I couldn’t be concerned about my body size. I was just so tired of the constant struggle. The fight that came every morning when first opening my eyes and wondering if today was going to be a good day or a bad day. Most were bad days. I couldn’t take the sheer disappointment… the numbness and apathy… of living that way a moment longer.

I decided to embrace intuitive eating. The first year was challenging. I continued to exhibit bulimic behavior, but I was seeing slow and steady improvement. My second year into intuitive eating, my binges fell away. However, an air of restrictiveness remained. I couldn’t see this at the time, but looking back now, it is very clear to me. I will share how this restrictiveness stayed in place in hopes that it may help others to recognize destructive patterns within themselves. I was very conscious about eating just to the point of satiation. This is something that is recommended in the book, “Intuitive Eating”. Unfortunately, since I never received any help for my eating disorder I had certain distorted perceptions about food, hunger and satiety imbedded in my brain. Adhering to this guideline kept me in a state of perpetual underfeeding. Additionally, I continued to over-exercise. Not to the extent that I once did at the most exacerbated points in my ED history, but imbalanced nonetheless. I frequently hit periods of over-training and injury. I summed this up to being the end result of trying to exercise as a heavy woman and something I just needed to push through.

After two and a half years binge-free, I felt better than I had in 10 years. A doctor’s appointment confirmed that I had released 70 lbs. effortlessly. My energy was improving. My health was on the mend. I had a new respect for my body and felt a peace around food that I never had at any point in my life. During this period of time I became certified as an intuitive eating counselor by going through the training program designed by, Evelyn Tribole and Elyse Resch, the authors of, “Intuitive Eating”. I was listed on the national directory and made the decision to pay it forward by founding, “Through Thick and Thin”. My vision was to establish a sacred space in the format of an online community where the support would be free and all who entered could feel welcome, accepted as they are, and be gifted with tools that could help them in their recovery. It was a lofty vision because that level of integrity is rarely seen on the internet, but we have somehow managed to hit the mark. Every time I hear a member express that the, “Through Thick and Thin” community is one of the only places they feel free to be themselves, accepted and safe, it reminds me of the importance and value of the work we are doing collectively as a community. I felt like I had mastered recovery.

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