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Tuesday
Feb262013

Insidious Activity  

JillOW: Flickr.com

I have two half-finished blog posts that may or may not ever see the light of day.

In the meantime, I realized that apart from one relatively short post on exercise, I have not synthesized much of the scattered responses I have given to questions about activity and exercise in recovery.

Many of you have been directed to read my Replace and Distract post when it comes to attempting to stop exertion and exercise as part of recovery from a restrictive eating disorder. I get asked very often about the necessity of quitting all exercise and exertion while in recovery, so I will try to pull all the information together in this blog post as a one-stop location for future reference. 

Of the few science-based recovery programs out there, none support the continuance of exertion or exercise during recovery. 

Rob Helfman: Flickr.com

Anorexia Athletica/Exercise Bulimia

As a refresher, the restrictive eating disorder spectrum includes: anorexia nervosa, cycles of restriction/reactive eating, bulimia nervosa, orthorexia nervosa and anorexia athletica (also known as exercise bulimia). Other facets may include diabulimia and drunkorexia.

I have not addressed diabulimia to date and perhaps at some point in the future I will do a post on the topic. Diabulimia is something that may occur for those with Type I diabetes mellitus and a co-occurring restrictive eating disorder.  As I have mentioned in the past, whenever an eating disorder patient uses any maladaptive behavior to try to alleviate the anxiety that comes from needing to nourish herself, then those behaviors become facets of the condition itself.

Some facets are more socially reinforced than others and exercise is certainly perceived as a life-affirming, stress-relieving behavior that can have no down side. It is why anorexia athletica tends to sneak up on the patient and is easily overlooked by concerned friends and family for quite some time, until the injuries and damage start to pile up.

The risk of developing or reinforcing anorexia athletica is one of the most compelling reasons to cease exercise when you are attempting to recover from a restrictive eating disorder. However, it is not the only reason and I’ll get into more details on that as we go along in this post. 

As we are bombarded with messages of needing to exercise more and eat less, most who have a genetic predisposition to develop a restrictive eating disorder often begin that first diet with an accompanying focus to exercise hard as well.

However, there are also those who activate a restrictive eating disorder initially by either planned or unplanned restriction of food intake alone (dieting or illness). 

In both circumstances the increase in food intake needed to restore weight and repair damage tends to ratchet up anxiety. In response, it is very easy to apply the maladaptive anxiety-modulation of exercise. The cycle is quickly reinforced and soon the amount of food the eating disorder will “allow” you to consume is inextricably tied to how much you move around to burn off those calories.

Jonathan Cohen: Flickr.com

Non-Exercise Activity Thermogenesis (NEAT)

Do you prefer to stand when doing things that most people do while sitting? Do you try to avoid sitting? Do you fidget? Do others comment that you always seem to be on the go? If you answer “yes” to any of these questions, then these behaviors are non-exercise activity issues within the context of a restrictive eating disorder.

Non-exercise activity thermogenesis (NEAT) is basically all activity that is not exercise that “we undertake as vibrant, independent beings” [JA Levine, 2004]. NEAT dominates our entire metabolic homeodynamic ability to maintain weight, health and wellbeing. NEAT includes getting out of bed, brushing your teeth, standing, sitting, typing…you get the idea.

NEAT is known to drop precipitously for non-ED folks who are dieting and it increases just as significantly in trial studies where non-ED folk are overfed in laboratory settings  [GB Leyton, 1946; A Keys et al., 1950; JA Levine et al., 1999]. There is one particularly memorable photograph of the subjects of the Minnesota Starvation Experiment [A Keys et al., 1950] all lying down on the ground as they neared the end of the 3-month period of semi-starvation— too exhausted to sit up or do anything. How much NEAT drops or increases is variable from individual to individual, although fairly constant within each individual throughout a lifetime.

In Levine’s trial (n=16) the variation in the change in NEAT ranged from 700 calories down to -100 calories when the subjects were overfed 1000 calories above their normal baseline intake every day.

The higher the NEAT increased during the overfeeding period, the lower the weight increase that occurred. Remember, however, that in these purposeful overfeeding trials, subjects all return to their pre-trial weight within 2-4 weeks after the end of the trial [P Pasquet, M Apfelbaum, 1994]. Levine theorizes that we each have ingrained NEAT levels and that we also have significant seasonal variations as well.

So now you’re probably thinking, or perhaps more accurately some ED-powered elements of your brain are thinking: “So then if I move around more because I’m eating more, then that’s normal and why should I force myself to lie around and be a lazy slob all day? — That’s not normal when I have to eat so much in recovery!”  

Not so fast. Turns out that your NEAT is a bit messed up and it has failed to throttle back in the face of massive restriction of energy in the first place.

In fact, your NEAT is inextricably linked to the persistence of having a restrictive eating disorder.

Problematically NEAT appears to increase in those with restrictive eating disorders when they are actively restricting intake. The more you fail to provide your body with enough energy to function, the more you are compelled to keep moving, creating even greater energy deficits, driving more compulsion to move…(Dal Capo ad Infinitum, or repeat to infinity.)

I had a colleague who would regularly heap derision on the administrative cost-cutting mantra of “we’ll just have to do more with less”. His response was always, “and that inevitably leads to doing everything with nothing.” His retort is quite comparable to the spiral of a restrictive eating disorder.

Rebecca Lee: Flickr.com

Neuropeptide Y and Hyperactivity 

Neuropeptide Y (NPY) is “considered the most potent orexigenic neuropeptide known” [EJM Achterberg, 2009]. Essentially the presence of NPY generates increased appetite, hunger and feeding (orexigenesis).  When energy deprived, the levels of NPY increase in our central nervous system.

The investigation of NPY in anorexic and bulimic patients is one of several areas that Walter Kaye, a leading researcher in the field of eating disorders, has covered in numerous published papers. While it does appear that NPY and other central nervous system neuropeptides are altered in both anorexic and bulimic patients when compared to healthy controls, Kaye and colleagues have determined that the alterations are due to restriction and not causing restrictive behaviors [UF Bailer, WH Kaye, 2003].

Increased NPY levels in semi-starved animals and non-ED humans lead to lowered NEAT and increased food intake. For reasons not yet known, increased NPY in those with restrictive eating disorders leads to increased activity and decreased food intake [R Negård et al., 2007; EJM Achterberg, 2009].

In other words, NPY levels increase for all of us if we are semi-starved, but for those with a genetic predisposition for a restrictive eating disorder, the result is increased activity. In fact, the drive to be active decreases as an eating disordered individual re-feeds [UF Bailer, WH Kaye, 2003].

The most compelling theory as to why this altered NPY response may be present in those with restrictive eating disorders is the evolutionary benefits afforded a group of humans if some individuals are driven to forage for food in times of scarcity [S Guisinger, 2003].

ShortCHINESEguy: Flickr.com

Exercise Is Not As Great As You Tell Others It Is

I am usually told in no uncertain terms by many with restrictive eating disorders that they are not exercising to try to limit any weight gain. They assure me, and everyone else, that it has nothing to do with body image or food intake at all. They are merely exercising because they love it; it makes them feel strong and healthy; and it improves their mood.

Studies unfortunately suggest that you are desperately trying to believe your own advertising when you swear that the exercise you do is all good.

Turns out that those with eating disorders, through both self-reports and objectively assessed moderate-to-vigorous physical activity observation, are more likely to engage in exercise to regulate negative affect. Fitness and health are less important for ED patients than they are for non-ED controls [S Bratland-Sanda et al., 2010].

In another study, best predictors for identifying exercisers who also had an eating disorder were if they agreed with the following statements:

  • being annoyed if exercise interrupted
  • others feel you exercise a lot
  • feeling bad if unable to exercise a certain amount
  • feeling that you have/had problems with exercise.

 [C Boyd et al., 2006]

Ironically, high levels of depression were more likely with both AN and BN patients who exercised excessively, and levels of anxiety and somatization were particularly high but only with excessively exercising anorexics [E Peñas-Liedó et al., 2002]. The irony of those data is that exercise for non-eating disordered patients tends to ease depression and not exacerbate it.

A community-based study in Australia had the following outcome:

Exercising to improve appearance or body tone, and feelings of guilt following the postponement of exercise, were the exercise variables most strongly associated with elevated levels of eating disorder psychopathology and, in turn, reduced quality of life.”

[JM Mond et al., 2004]

Yet another comparative evaluation of how eating disordered patients engage in exercise when compared to healthy controls:

The anorexic group were significantly more hyperactive, exercised more frequently and engaged in a wider variety of exercise behaviours. They were also more likely to exercise in secret and were more compulsive about exercising. They displayed a ‘negative addiction’ to exercise, and gave control of their negative mood states as their major reason for undertaking it.”

[CG Long et al., 1993]

It also appears that a significant increase in patients’ activity levels at least a year prior to diagnosis with a restrictive eating disorder suggests that exercise alone may play a triggering role in the onset of restrictive eating disorders.

[C Davis et al., 2005]

That bears repeating because I have had many patients who have used the fact that their long-held active lifestyle predates their eating disorder and they use this fact as a reason to assume their exercise habits are not linked to the restrictive behaviors in their case.

I could go on, but the takeaway here is that while someone with a restrictive eating disorder is readily able to spout all the generally understood benefits of exercise, he or she is not experiencing any of those benefits.

You may find the Exercise for Restriction Quiz worth revisiting. I will address a bit later on in this post the ways in which you can help yourself stop being an apologist for exertion and start becoming an advocate for your own health and recovery.

Next we’ll revisit the logistics of why continuing exercise and pursuing an active lifestyle can sabotage your recovery effort… 

finishing-school: Flickr.com

Heart, Nerves and Safety

Those with restrictive eating disorders are most likely to die of either cardiac complication or suicide [M Misra et al., 2004; AH Crisp et al., 1994].

Exertion (exercise and/or moderate to intense activity) both during an active period of restriction and during the recovery effort, are dangerous and possibly life threatening. Also keep in mind that active restriction does include cycles of restriction/reactive eating, bulimia, orthorexia and not just anorexia.

The heart’s ability to function normally is hit hard on three fronts with restrictive behaviors: physical damage to the muscle, electrolytic imbalances and de-myelination of the nerves.

It is wise to be very, very conservative and assume that your medical care may or may not catch that you are in danger of having your heart fail during exertion.

I often use Harriet Brown’s article, She’s Not That Skinny. Is She? as a tragic but important example of how the risks can be overlooked even by eating disorder specialists.

Being of average or above-average weight does not automatically mean that the risks to your heart have resolved, especially if you are engaging in cycles of restriction/reactive eating, sub-clinical starvation, and/or purging, laxative and/or diuretic use.

Gabriela Camerotti: Flickr.com

Heart: The Muscle

When you restrict intake relative to your body’s actual energy needs, then it makes up the energy deficit by pilfering energy from everything in your body, not just your fat organ, but also muscles, bones, all other organs etc.

Our society believes that dieting is benign and is merely about trimming down ‘excess’ fat on our frames. The reality is that fat is not a storage compartment, but a critical hormone producing organ and the body also does not discriminate when it comes to trying to make up the energy deficits either.

In addition to the heart muscle being destroyed in the process of the body catabolizing energy from all the cells throughout the body, it is also possible that the volume of blood in your body is reduced such that the heart muscle has to work too hard to get the blood moving through the circulatory system.

Physical damage to your heart from a restrictive eating disorder will usually be identifiable by an experienced technician reviewing an echocardiogram.

Heart: The Electrolytes

Restriction, and in particular compensatory behaviors of purging, laxative and diuretic use all mess with the balance of electrolytes in your body.

Electrolytes support the electrical signal that causes the heart to contract strongly and rhythmically.

Electrolyte imbalances may or may not be apparent even in an electrocardiogram (ECG or EKG), as the fluctuations may not be present at the time you undergo the screening. The same holds true for blood screening as a way to isolate electrolyte imbalances as well. Somewhat more dependable is wearing a holter monitor and going about your usual daily life as the readout will capture any fleeting fluctuations that may occur at certain times and not at others.

Heart: The Arrhythmias

Arrhythmias can occur both as a result of heart muscle damage and/or electrolyte imbalances. The common arrhythmias that are present for those with restrictive eating disorders are tachycardia and bradycardia. The arrhythmias are the symptoms that you will notice and that will likely compel you to go investigate them further with your physician.

Bradycardia is a resting heart rate of below 60 beats per minute (bpm), although usually in practice physicians will use the marker of 55 bpm. There is a marked distinctive readout for bradycardia associated with restrictive eating disorders (on an ECG) that is distinct from a low resting heart rate for an energy-balanced non-ED athlete [I Swenne et al., 1999; GF Franzoni et al., 2002]. Unfortunately, because doctors themselves can sometimes be on the restrictive eating disorder spectrum [T Fidana et al., 2010] or they are unfamiliar with the dangers of bradycardia when it is present due to restriction, they can brush aside a low resting heart rate on the assumption that you are a healthy athlete.

As an aside, there is very little good trial data on the topic of eating disorders in medical professionals. If you are interested, Eating Disorders in Doctors: Out of the Shadows, by Betsy Bates Freed (article from Clinical Psychiatry, Vol. 40, No. 12) and an interview with Dr. Jennifer Gaudiani are some recent discussions on eating disorders within the medical community that may mean we’ll see some clinical research sometime in the future.

However, if you fail to let your doctor know that you are not eating enough to support your energy expenditure, then he or she cannot automatically be expected to investigate troubling bradycardia, especially when you reaffirm that you are just a very active person.

Tachycardia is a sensation of your heart speeding up even when you are at rest. You are most likely to notice this if you are lying down or seated quietly. It can also feel as if your heart skipped a beat, or it seems irregular in some way.

Orthostatic hypotension (feeling faint when going from lying to sitting or sitting to standing) is also a circulatory issue that will present with restrictive eating disorders.

Any one of these symptoms has to be taken very seriously. Take it easy. Stop exercising. See your doctor.

Heart: The Nerves

While the arrhythmias will resolve fairly quickly in your recovery process, the nerves need more time and energy in. Of all the heart-related symptoms that put your life at risk, it is the nerves that require of you that you don’t just rush back to exercise the minute that your doctor gives you the all clear (see the article above by Harriet Brown).

The body is busily catabolizing all your cells when you create daily energy deficits and it strips the myelin from your nerves as part of this energy compensation. As I have often quoted before, researcher Janice Russell likens this process to throwing the antique furniture on the fire to keep the house warm.

Myelin is the fatty sheath that covers most nerves throughout your body and it is responsible for the speed and accuracy of electrical conductance along those nerves. And it is nerves that send the signal for the heart to regularly and predictably contract to keep your circulatory system in good working order.

So while your heart muscle may show no signs of damage, your electrolyte balance has been confirmed with blood work, and your ECG results have given you the “all clear”, the re-myelination of your nerves needs time, lots of energy intake (dietary fats in particular) and rest.

Safety

Because de-myelination occurs throughout the body, it also renders you more prone to injury: you don’t move as smoothly and are not as coordinated as you will be once you are in full remission and the nervous system has fully healed.

Furthermore, if you are dealing with functional hypothalamic amenorrhea (a lack of a menstrual cycle as a result of restriction and insufficient energy intake relative to expenditure), then exertion and exercise will also increase the risk of fracture.

Remember too that if you are on oral contraceptives (the pill) then you are not experiencing a menstrual cycle in a biological sense. Obviously do not come off of contraception if you are using it as birth control, but do keep in mind that you may be underweight for what is your body’s optimal weight set point and therefore you may develop osteoporosis (albeit at a slightly slower rate) while you continue to actively restrict and exercise. In other words you too might be prone to stress fractures.

And finally, being underweight is relative and not absolute. You could be BMI 23 and develop fatal heart fibrillation because you are underweight and physically damaged relative to what your body needs to be, to be optimally healthy.

You can also feel fairly confident that if it has crossed your mind that you are somehow not sick enough to need to rest and restore energy in your body then you already know that you are indeed “sick enough”. The term “sick enough” is only a concept that pops up for those with restrictive eating disorders.

Although I only have my own empirical evidence on that, maybe someday the “not sick enough” refrain will form the basis of a clinical survey that will unequivocally confirm that only those with restrictive eating disorders will identify with the phrase at all.

Right, a brief recap on why exertion is to be avoided during recovery from a restrictive eating disorder:

  1. Anorexia athletica is merely another facet of a restrictive eating disorder and will grab you by the throat and prevent your remission if you maintain exercise while attempting to recover.
  2. The NPY reception in your central nervous system robs you of a normal NEAT feedback loop such that the more you need energy in your body, the more you are compelled to expend it through heightened exertion. It means that exertion actually feeds the eating disorder.
  3. All the fun, enjoyable, relaxing, mood-modulating and overall health benefits of exercise are not available to you. While you may tell people that you love it, the scientific data say the opposite. The dominant motivators for exertion for you are trying to feel better when you feel bad and feeling worse when you fail to do enough.
  4. Exercise is dangerous to your health and life when you are in recovery.

Please remember you should never attempt a recovery effort without involving medical professionals.

where are the joneses: Flickr.com

Anorexia Athletica vs. Exercise Dependence

The scientific literature on exercise dependence, with or without the coexistence of an eating disorder, lacks solid consensus at this point. Often the delineation used is primary or secondary exercise dependence— secondary dependence referring to exercise being secondary to the eating disorder pathology.

In a study of 203 triathletes where all subjects completed both the Exercise Dependence Questionnaire (a comprehensive version of the Exercise Addiction Inventory) and the Eating Attitudes Test, 34% had eating disorders [MJ Blaydon et al., 2010]. Exercise dependence among the same group of triathletes was 52% [ibid.]. Interestingly amateur athletes are more likely to have primary or secondary exercise dependence when compared to their professional counterparts [ibid.; MJ Blaydon et al., 2002]. However, it could be that professionals are unable to maintain professional status when exercise dependence is present, as injury and ill health may remove them from competition far more quickly.

There is much fussing about in the literature using the DSM classifications for restrictive eating disorders while failing to include comparative healthy controls when attempting to identify prevalence of hyperactivity and excessive exercise in one facet of an eating disorder as opposed to another (i.e. AN vs. BN and their various purging/non-purging subtypes).

The prevalence, all facets and subtypes included, ranges between 54-84% [C Davis, 1994]. Of the few studies that exist where restrictive eating disorders are removed from the equation, it appears that primary exercise dependence may hit rates of 17% or less [DMW DeCoverley Veale et al., 1995; DJ Bamber et al., 2003; B Allegre et al., 2006].

One study of adult female exercisers (n=43) suggested that, in the absence of an eating disorder, primary exercise dependence lacked personality characteristics or levels of psychological distress that distinguished it at all from healthy controls. Although, the researchers did allow for the fact that menstrual abnormalities were present for primary exercise dependent subjects, which would warrant attention [D Bamber et al., 1999].

Bamber’s study in 2003 (n=56 female) did not isolate a single case of primary exercise dependence, as all had co-occurring eating disorder symptoms.  In 2000, Bamber and her colleagues also identified a priori female exercisers who were diagnosed with primary exercise dependence, secondary exercise dependence, eating disorder without exercise dependence and a healthy control. They were interviewed in depth and their taped interviews were subsequently analyzed from a social constructionist perspective.  Those who had been identified as primary exercise dependent either showed no evidence of exercise dependence at all, and if they did display facets of exercise dependence it was only in the presence of eating disorder traits as well [D Bamber et al., 2000].

So although a bit of arm waving is required right now to make sense of this, if you find postponing exercise generates distress and if you are driven to exercise to try to rectify food intake or ease anxiety, then your exercise behaviors are the result of a restrictive eating disorder.

eatmorechips: Flickr.com

Upping The Intake Doesn’t Work

Many ask me if they cannot just increase their food intake to somehow make up the difference of the expenditure associated with their exercise.

Our bodies do not work mechanistically. A better analogy is that a body has adaptive and quite sophisticated triage rules. Triage is a system used in emergency environments to try to maximize the number of survivors. The body also tries to maximize its ability to survive by prioritizing biological functions in times of energy depletion and deficit.

If an energy deficit exists in the body thanks to a period of restrictive eating or under eating relative to excessive energy expenditure, then replenishing the energy of daily exertion on top of the basal metabolic requirements (which are suppressed*) will take precedence over replenishing the overall energy deficit throughout all the cells in your body.

*Metabolic rate is suppressed when the body does not have enough energy (food) coming in to support all the biological functions in your body. The metabolism is not broken and is in fact performing its life-saving ability until such time as you are energy balanced when you reach remission.

Basically your body is saying to itself: “Well if she’s going to drag me out for a run every morning then there’s no way I’m going to be trying to figure out how to reverse bone mineral density loss, or repair the heart muscle and I’ll keep the biological functions suppressed so that there’s enough energy to handle the godforsaken run along with staying alive until tomorrow.”

I have mentioned in other posts how glucocorticoids (cortisol) impact how your body uses the energy you take in. Stress varies both the levels and pulse rates of glucocorticoids such that your body will preferentially move energy into storage while continuing to suppress biological functions. Exertion and activity are huge stressors for an energy-depleted body.

Even if you could eat enough to truly support regular exercise, on top of the energy needed to stay alive and the energy needed to restore weight and repair damage, the body is stressed by the exertion to the point where you are going to tread water and fail to reach a full remission.

Now let’s move on to the good news. Replacing exertion and exercise in your life while you are in active recovery will greatly improve the chance of a permanent and deeply fulfilling remission.

marcelo-moltedo: Flickr.com

Exercise Is Not the Be All and End All Anyhow

Living a healthy, fulfilling, generally disease-free and long life is not realized through exercise.

The problem with all the epidemiological data that suggest the more vigorously you exercise the longer you live, is they fail to integrate all the confounding factors that are involved. An epidemiological study simply follows a very large number of people over decades and then uses fancy pants statistical manipulations to attempt to extract correlates from extemporaneous life influences.

I have covered off some of the confusions that result in arbitrarily pulling out two correlates while overlooking other factors in several historical threads on the forums.

Exercise is specifically a forced, conscious and repetitive set of activities engaged in primarily for fitness or strength outcomes. Vigorous exercise correlates well with lower incidence of cardiac disease and death. However vigorous exercise is also correlated with lower cognitive performance later in life [MC Tierney et al., 2010]. Exercise positively correlates with a lower incidence of bowel cancer and yet also correlates equally well with gut ischemia causing cramping, bloating, nausea, and bloody diarrhea in athletes [EP de Olivieri, RC Burini, 2009].

And for all those who believe that strength training and toning is perhaps a reasonable choice in recovery because less demand is placed on the heart, that kind of training may be inversely correlated with longevity (meaning more muscle building equals shorter lifespan) [C Fry et al., 2010].

There is a complex interplay of many facets that will provide people with long and healthy lives: community, strong friendships, stability, resilience, a nice smattering of luck, some genetic input, most things within your locus of control throughout your life (higher socioeconomic status), regular activity (not exercise sessions), regular routine, and undying interest in learning and doing, and some kind of sense of purpose.

And that’s good news for those of you who now have to replace exercise and exertion in your life with other fulfilling and life affirming activities.

Before we get to that I will actually copy a couple of responses I made on forum threads with regards to extracting correlates such that causation is assumed, but is not confirmed. The first pertains to the French Paradox and the second to the longevity of Okinawans ostensibly being ascribed to hara hachi bu (eating to 80% fullness).

The French Paradox

“The root of the French paradox is supposedly that despite the fact the traditional French diet is very high in saturated fats, the rates of coronary heart disease (CHD) (and accompanying death rates from CHD) are lower than in other European countries or the US.

The rates of smoking in France are not much different from those in the States (35% to 25% respectively) and for women it is exactly the same in both countries.

Even if the French paradox exists (and there is reason to believe it does not— I’ll get to that in a moment) the possible source of the ability to eat a very high-fat diet and yet have lower CHD rates and mortality is most likely the protective effect of resveratrol in wine. If not the wine, then likely the lack of trans fat in the diet might account for lower CHD in France despite high-fat diets. Both the Women's Health Initiative and the Nurse's Study in the US were able to show that it is not a high-fat diet, but trans fat, that appears to correlate with CHD. (Note: read Food, Family and Fear to get a more accurate understanding of trans fat.)

"...in France, coronary causes can be considered as noninitial causes of death in a large proportion of cases, which is at variance with reporting habits in other countries. However that may be, strictly defined coronary death rates in French national statistics, both in the past and nowadays, should be considered as negatively biased estimates at the population level and cannot be used validly in ecological correlation studies." [P. Ducimetière; 2008]

And therein lies some of the concern regarding whether a paradox does indeed exist— if CHD death rates are underreported in France then "poof!" goes the paradox.

"…we can now say that CHD rates are not so low in France, animal fat intake not so high, and the diet-heart concept not so unique that the existence of a “French paradox” may be sustained any longer, except as cultural fantasy or a marketing ploy." [ibid.]

The French diet (which by the way is disappearing in the fast food/less sleep modern world in which we are all homogenized) is not just about food, or wine, or smoking. It is about human connection, about tradition, about food (not nutrients or nutraceuticals) and about a way of life.

Human beings are healthier and live longer if they concern themselves with their kin, their friends, their community and the enjoyment of food within those contexts.”

maryl kayoe: Flickr.com

Okinawan Hara Hachi Bu

Okinawan women are disproportionately long-lived and the population has a higher-than-average number of centenarians. Okinawa is the most southerly prefecture in Japan. The philosophy of eating to 80% full (hara hachi bu) is touted as being responsible for the longevity seen in this population…

In fact it is not 20% fewer calories. It is estimated to be between 10-15% lower than Americans however there is a big, big catch to this: the data are provided by self-estimated reports that are then rolled into the Japanese Public Health Center-based prospective study of which there is Cohort I and II data available.

In fact it is called the self-administered food frequency questionnaire.

Now, this is where we get into challenges when it comes to ways of life. A very interesting multi-center study was conducted on the prevalence of extremely restricted diets for pregnant women in South and Southeast Asian communities. The study set out to actually confirm whether such restrictions were occurring and whether it resulted in unhealthy outcomes for the fetus and newborn. Rather than relying on self-reports, the researchers monitored and weighed food. It turned out that none of the prescriptive restrictions (to which the women were supposed to adhere for cultural reasons), were closely held by the pregnant women at all. In fact, they ate as they always had. Keep in mind that the sociocultural concepts were that to eat these foods would endanger the child.

What the researchers were able to determine is that the concept of severe restriction (to support the developing fetus according to cultural dictates) also allowed for the pregnant woman to be removed from all obligations of physical labor that supported the larger family and community. They were essentially on complete rest. This to some extent minimized their energy requirements, but it also allowed for them to be excused precisely because they were supposedly not eating many forbidden foods (although they were eating them all as they normally would).

In another Indian caste where the women are the sole income earners doing incredibly physically demanding road work, the women all eat their lunches at cafes, spending about half of their income on these lunches. They could return home to eat and likely save significant money, but to do so would likely compromise their ability to take in sufficient energy to support their labor-intensive work because at home it is their obligation to place husband and family first for nutritional needs.

These complex sociocultural interplays of how women get sufficient nutrients despite the outward appearance that they do not, is especially common in rural communities and poor communities.

Interestingly in the Okinawan self-reports, it is the younger individuals who report calorie restriction of 10-15% below what their requirements would be. In a society where elders are revered and yet the back-breaking heavy labor (namely fishing) is managed by the younger individuals in the community, we cannot definitively confirm that the dietary restriction is in fact in place.

In other words, the need to appear to be deferential to cultural requirements is like a communal lie that everyone is in on to allow for nutritional requirements to be met but not in such a way that it would blatantly seem to undermine other values held dear within the culture.

There is no question that women in Okinawa disproportionately live to a great age. In Sardinia Italy, it is the men who disproportionately live to a great age. There are several "bluezones" (you can check out Blue Zones Cities) that have been identified where communities appear to have a higher proportion of their population living to their 100th decade.

The problem with these epidemiological studies is that there is no way to identify correlations from causes. These communities have many facets that ensure a lifetime of activity, an integral and revered role within the culture well into old age, close familial and social interactions that are solid throughout life, diets that are distinct based on the region but generally high in local, nutrient-rich vegetables and plants, and some likely relevant genetic mutations as well.

So far, calorie restriction has shown to have no value in humans and this may have something to do with our size, relatively slower metabolism and existing length of life. CR has real positive impact for longevity for mice and rats but has not been transferrable as a technique for extending life in humans.

So essentially, there is no confirmation that Okinawans do in fact eat as per their guidelines of Hara Hachi Bu, however it may be an inherent philosophy that ties the community together in a way that has tremendous health benefits even though there may not be any calorie restriction actually happening at all.”

Replace and Distract

I received a Lego® kit that you see on the left here as a gift just recently. To prove that I have successfully assembled the above kit you can check out a much better set of images on the official Lego Site.

I know. It’s pretty exciting to have waded through thousands of words in this post to get to a high point of seeing proof that my Lego skill equals that of most six year olds.

There’s a point to this exposition beyond showing off actually. When my son was young I used to help him assemble various Lego kits but of course my role was relegated to pointing out the piece in question and sitting on my hands to resist the urge to snatch it away with the eager/have-no-patience cry of “Here, let me do it!”

The masterpiece above is my first start-to-finish Lego success. But the best part was how much fun I had putting the thing together. Really.

I haven’t had a chance to read it yet, but plan to after I get this post up on Your Eatopia, but Carrie Arnold has recently posted Knitting My Life Back Together (or the power of yarn in ED Recovery on her site edbites.com.

There is some evidence that the reduced use of our hands in modern life has had a hand (pun intended) in increased rates of mental illness such as anxiety and major depressive disorders. Kelly Lambert addresses the research pertaining to this theory in her book Lifting Depression: A Neuroscientist’s Hands-On Approach to Activating Your Brain’s Healing Power. I have not read this book, and the reviews suggest it may have a bit of a pop-neurology feel to it, but the references attached to her work will likely stand up under scrutiny.

Because the use of arts and crafts in occupational therapy has gone in phases and is currently half-embraced and half-shunned, it has never received thorough scientific assessment. Sinikka Pollanen synthesizes what data exist in her published report: Craft as context in therapeutic change [S Pollanen, 2009]. Canadian Karen Ribeiro previously covered off a similar review in Occupation-as-means to mental health: A review of the literature, and a call for research. [K Ribeiro, 1998]

The best way to describe occupational therapy is the practice of applying daily life activities in a guided way that supports healing and a return to full participation in interdependent (communal) and independent (self-directed) living.

Knit, sew, collage, paper-toll, scrapbook, paint, sculpt, photograph, draw, sketch, embroider, quilt, decorate, crochet, weave, spin, thread, glue, paste, embellish, carve, bind, emboss, fold, marble, mâché, cobble, felt, concoct…build things with Lego®!

Arts and crafts will successfully replace exercise sessions and also distract you from the pent up anxiety that not exercising will generate in the initial phases of recovery. It also will allow you to modulate negative affect (bad mood) upwards and broaden a sense of yourself and an innate sense of accomplishment.

Stopping exercise sessions with nothing but yourself and your thoughts to keep you company will inevitably make you want to crawl out of your skin in short order. Researchers in the exercise dependence field recommend replacing the exertion with other non-exertion-based activities and distracting yourself from the times in the day when you are likely to want to indulge in exertion-based activities [K Linder, M Blaydon, 2007].

The first thing I always suggest as a great replacement is sleep. That would of course be second in line to the best of all replacements: food! If you happen to be an early morning exerciser, then simply sleep in.

For some, the usual morning wakeup is needed and provides some grounding. In that case, still set the alarm, but do 30 minutes of slow yoga stretching, or mindfulness exercises, breathing exercises, or just sitting quietly in the kitchen with a nice mug of something hot (and ideally full of calories too).

Distraction can help alleviate the negative mood, irritability and anxiety that you feel because you are not exercising. Have family breakfasts. Set up a mid-morning get together with a friend for a coffee and a muffin. Have a strategy for busyness at the times when you are most likely to want to exercise.

Enroll in activities (non-exertion) that you may have had some interest in in the past. Crafts, languages, learning new software packages: flip through what's on offer at a local community center to get inspired.

Getting out in the nature is mentally valuable. In fact there is now a whole sub-section of study on green activity. There are three kinds of green activities: appreciative, consumptive and motorized. Not surprisingly appreciative green activities improve environmental behaviors [MA Tarrant, GT Green, 1999].

Access to a garden or a green area a short distance from home is associated with less stress [TS Nielsen, B Hansen, 2007]. All green spaces improve mood, with the greatest self-esteem improvements realized for those who are mentally ill. Water in the green space generated greater positive effects in both self-esteem and improved mood, and mood improved within 5 minutes of being outside [J Barton, J Pretty, 2010].

My favorite study on this topic is Elizabeth Nisbet and John Zelenski’s ingenious trial of getting subjects to forecast the benefits they might experience by crossing the campus via the outdoor pathways, or an indoor tunnel-based path to get to classes:

“…we found that although outdoor walks in nearby nature made participants much happier than indoor walks did, participants made affective forecasting errors, such that they systematically underestimated nature’s hedonic benefit.”

[EK Nisbet, JM Zelenski, 2011]

It is not about exercise and it’s not even about sunlight helping you to manufacture vitamin D. In fact the positive effect sunlight has on mood has been shown to be regulated through the eye [LN Rosen et al., 1991]. Just get outside without breaking a sweat.

How slowly can you go around the block? Make that your task. See if you can get it to 15-20 minutes for one block. Take in absolutely everything in your surroundings. Note every change. Bring a camera and take a picture of the same view each day so you can then compare after your walk whether you actually missed a detail from one day to the next or not.

Consider gardening on a patio or deck— allowing you to be outside and connected to some of the benefits of gardening without the more strenuous aspects of hauling mounds of dirt etc. Set up a bird feeder. Sit out and admire your handiwork growing in the pots and watch the birds.

For those who have followed the MinnieMaud Guidelines to a full remission, no one has returned to rigorous, planned and repetitive exercise and most have expressed surprise that they feel no drive to do so. While a broad array of rewarding activities will be a regular part of your life in remission, exercise will cease to have any hold on you.

If one kind of replacement strategy doesn't work, then try another. Basically enter the process with curiosity about what things you could include in your life to broaden your horizons, rather than entering the process with trepidation assuming you will simply be pacing the floors with nothing better to do.

Identity is not what you do, or don’t do. It is who you are. Find out who you are through the process of recovery.

Visit the Tools for Recovery Shop Tools for Recovery are available in the youreatopia.com Shop

Reader Comments (51)

Hi Gywn! I was just curious if exercise is out of the question forever for those on the REDs, even when fully recovered? I was just curious as I enjoyed tennis pre-ed and would like to think that I could maybe get back to playing a few times a week when I'm fully recovered. Thanks!

P.s. do you know roughly when the forums will be reopened? ~ I can't wait! :) Thanks again!

February 26, 2013 | Registered Commenteraoifefa

Ahh I loved reading this, the last section made me feel all warm and fuzzy inside :) so happy to hear from you again G!

February 26, 2013 | Registered Commenterprttyinnpnk2

SO Happy to have read this! Amazing and totally 100% explains everything and now I know for a fact that exercise was the onset of my restrictive eating pattern. Exercise is what started it all for me. I can 100% relate to "It also appears that a significant increase in patients’ activity levels at least a year prior to diagnosis with a restrictive eating disorder suggests that exercise alone may play a triggering role in the onset of restrictive eating disorders." and that is what happened with me.

It is so sad that I can also so closely relate with "being annoyed if exercise interrupted
others feel you exercise a lot
feeling bad if unable to exercise a certain amount
feeling that you have/had problems with exercise."
"Ironically, high levels of depression were more likely with both AN and BN patients who exercised excessively, and levels of anxiety and somatization were particularly high but only with excessively exercising anorexics [E Peñas-Liedó et al., 2002]. The irony of those data is that exercise for non-eating disordered patients tends to ease depression and not exacerbate it."

Just wanted to say thank you so much for this so helpful article :)
And also, thank you for pointing out about the doctors and how they just assume we are healthy because we are highly active ad that is the reason for our low resting heart rate and that gets brushed under the rugs for most of us. Thats why doctors often misjudge our sickness....they see us as highly trained athletes...which is not right....

Thank you!

February 26, 2013 | Registered Commenterstateofgrace

Thanks so much for this information! For me, too, the anorexia started because of exercise. Weird how I didn't realize this before..
Thanks!!

February 26, 2013 | Registered Commenterclausjuhh

Is that Gollum?! So cool!

Very interesting and helpful reading, as always! Makes a lotttt of sense. 8+ months in, 2 periods (and interestingly they didn't come back until after the holidays, when I happened to be forced to be more sedentary than usual!), weight restored and some, sometimes I still struggle with the thought of "justifying it", yet I know that for me exercise is a totally ED-driven urge, because I used to literally dread it pre-ED. I was very "active" as a child (always playing around) and I've always loved walks and other activities, but not exercise "regimens", gyms, (almost all) sports etc. It would be too strange (read: disordered) if I magically started to like it or enjoy it now, given that in my life it has been either something I hated with all my heart, or something I developed to "punish" myself, to "compensate" and as a form of coping during the worst of my ED. Also, I can relate with underweight being relative and not absolute... I'm not "underweight" anymore by any means (I'm most likely over-, u--uuuh!) but I still have episodes of tachycardia sometimes, apparently out of nowhere, although it's definitely much better and more sporadic than it used to be. Numbers and classifications really don't mean much, if anything at all... I'd rather listen to my own body, because I know I can trust it (while my mind... not so sure)!

OKAYYY, I've rambled a lot again, but it was just an introduction to the most important part of my comment, that is- I've missed you! <3

P.S. I desperately want to buy a giant jigsaw puzzle now...

February 26, 2013 | Registered Commenterellevu

This was an interesting post!! I wonder though why "sports" or team exertion activities did not trigger the ED full fledged but my "personal sessions" did. Hmmmm

February 26, 2013 | Registered Commenterbauersgirl

Thank you for this post, I feel better knowing that I'm doing the right thing for my body by being sedentary. I used to do intense Crossfit workouts after purging repeatedly- the thought of the damage I was doing to my body makes me sad and scared. Like ellevu stated above, pre-ED I hated exercise. My family often went to the gym together and I'd stay home because I just never enjoyed it. I loved swimming, walking outside, etc, and these were never things I did to be more 'fit.' But I am having a hard time finding a hobby to distract me from thinking ED thoughts. Any suggestions?

Gwyn, this is probably a silly question, but can you be TOO sedentary? I was financially able to take the month of February off work and I feel like all I do is lay around and sleep, with some house chores like laundry, dishes, etc. It's hard when family and friends ask what I've done with my month off, which is really not much. If I were underweight my lack of activity would probably be understood, but I'm not. Even my boyfriend mentioned that I might be 'sleeping too much.'

February 26, 2013 | Registered Commentersmiller088

Thank you for this post. I massively needed to read it at the moment. After weeks and weeks f increasing exercise, I realised yesterday things were utterly out if control. I started to exercise obsessively when I started to gain weight from being underweight. I thought because I was a "healthy" bmi I couldn't put weight on so continued to restrict, though not very much, but exercised. At first I felt good and got a lot from it. But now, after last week exercising every single day, obsessively 'watching my weight', I'm utterly exhausted.I'm just done. My eating disorder has ruled for such a long time and I'm so tired. I plan to cut my exercise and rest. I firstly want to use the time to sleep, I know I'll need distractions too. This post has given me a lot of inspiration and ideas to help me, so thank you so so much.

February 26, 2013 | Registered Commenterfairy-wings

Bauersgirl -- Although the studies are inconclusive, there is some evidence that suggest lean-focused sports and individual sports (running etc.) are more likely to correlate with the onset of an eating disorder than non-lean sports (often basketball and volleyball are used as examples) [Sungot-Borden 1993; Petrie 1996]. Lean-ficused sports, as examples, might be beach volleyball, swimming, gymnastics, dancing. It is not surprising that you found individual sport endeavours greatly ratcheted up your eating disorder focus as the modulating influences of non-ED team-mates are not available to you.

Smiller088 -- Not really. Sleeping too much is not actually a concept in the absence of something like a sleep disorder or possibly major depressive disorder or seasonal affective disorder. If you are dealing with depression, then there are many more symptoms that will be present besides just sleep issues (sleeping too much, or insomnia). However, the most common reason for sleeping a lot is cumulative sleep deprivation. We are a massively sleep-deprived society.

You don't need to do anything in recovery save rest and eat. Underweight is a relative term. Trust your body. If you need to rest, then you don't have to account for a mere month that you have taken off to support that need. Both sleep and energy deficits are cumulative. It takes time to catch up on all those deficits.

As you become more energy and sleep balanced you will naturally find yourself wanting to do things and investigate new hobbies. As I mention in the blog post, consider investigating the great wide world of arts and crafts.

Best wishes to all and thank you for your comments on this most recent post. G.

February 26, 2013 | Registered CommenterGwyneth

And yes, that's Gollum with a fish. :-)

February 26, 2013 | Registered CommenterGwyneth

I just discovered this site a few days ago & have been eating the requirements for only about 2 days, but then I saw this post and it worried me because I joined the school track team(which is 5 days a week for 1 hour and a half) before I decided to start recovering, Ive also been doing kickboxing for almost s year and I just recieved my belt & I really dont want to quit both because its alot of fun & alot of my friends do it but I still want to gain the weight and return to a healthy lifestyle! I've been eating the minimum for my requirements (3000+ cals) but is there anyway I dont have to quit track & kickboxing?? PLEASE HELP!

February 26, 2013 | Registered Commentermarie0203

Marie 0203 - The minimum intake of 3000 is for someone who is just going to school and walking to classes. Your athletic schedule you have planned is extreme and will get in the way of your recovery.

It might be a really good idea to have your parents read this post on exercise and then for you all to discuss what might be the best way for you to take care of yourself and put your recovery first.

Restrictive eating disorders are pretty deadly. And I know you don't want to hear this, but there are plenty of ways you can have fun and be with your friends without it just being about track and kickboxing.

It's a bad idea to think you can bargain with an eating disorder -- it always wins and it plays for keeps. If you take the time out now to get really well, then your chances of having a permanent remission are really good. If don't put your recovery first now, then you have a 1 in 5 chance of dying in the next 20 years from complications and damage from a restrictive eating disorder.

You are right to be worried about the exercise you are about to take on. It's dangerous. So I think I am probably already just repeating what you know is the answer in your heart in any case.

Put your health and your life first and you won't regret it. G.

February 26, 2013 | Registered CommenterGwyneth

Hey Gwyneth,

What advice do you have for someone who is totally sick of food? The first weeks of recovery, I was loving all the high calorie meals that I got to eat, but now I'm really sick of food and don't have much of an appetite for eating a lot...however, I'm making sure to get the minimum 3500 (I'm a 20 y/o male)...still I don't feel like I have any cravings...

In fact, I'm worried that I might be eating too much of the same foods? I have an issue with orthorexia mostly...so I cut out bread for about a year, and now I'm eating tons of bready foods...two months in, I'm worried that I might just be eating too much of the same thing. Bread doesn't really cause me the problems that I thought it would, so it's not too much that there's a health issue.

Is this just part of the path to complete remission? Will I feel a genuine desire to eat again? I experience extreme hunger, but then i'll still feel really tired of eating foods.
I know it's only been two months for me, but are there times where it feels like there is no progress being made? Just wondering. Would love to hear back from you, thanks!

February 28, 2013 | Registered Commenterkamran

Yes part of the path. There is the initial honeymoon of "I can eat everything again" and then the eating disorder tends to ratchet up anxiety (BTW not everyone has the honeymoon phase).

It is a bit of a full time job eating in recovery and so not all of it is going to be a joy -- then add the fact that eating disorder starts to get more antsy the more you are refeeding.

I would suggest you read (or re-read) Phases of Recovery from a restrictive eating disorder as I cover off all these aspects of the challenges of feeling "bored" or "full" as you get beyond the first 6-8 weeks.

Congratulations on your progress thus far. Keep going. G.

February 28, 2013 | Registered CommenterGwyneth

Gwyn, I wasn't sure where to post this because the forums are still down. Today I found out that I'm pregnant. It was completely unplanned and a surprise. I'm only 6 months into recovery- how will being pregnant affect recovery? This should be a happy time but my ED is scared of how much weight I'm going to gain when I'm already overweight. I want to enjoy this without being worried about my weight, but I'm scared that the pregnancy will 'use up' nutrients that my body needs. Help?

March 1, 2013 | Registered Commentersmiller088

Thanks for the post. I've been stuck lately and I really wish the forums were up and running..I could really use some inspiration =\

March 1, 2013 | Registered Commentercoffeebean

Everything mentioned in this post seems true, when I was deep in my ED I literally couldn't stop moving, I'd feel tired and weak but I'd still get up to jog almost without thinking about it. Now that I'm a little healthier than I was (still not considered "recovered," yet) I have no desire to do "boring" exercise (for weight loss i mean). I've always been wondering this: How good of a marker is blood pressure and pulse for reaching a healthy weight? I find when I get back to my optimal weight (bmi 23-25) my blood pressure is considered borderline high as is my pulse but right now (dunno..? I'd guess around bmi 20.. 21 at the highest) it's considered perfect.. I really don't get that..

March 1, 2013 | Registered Commenterkashieee

Gwyneth, so good to hear from you! What an appropriate topic.

I so wish we still had your input regularly but just this post was so exciting to find today.

This morning I am sitting here, flipping through the channels to my favorite local PBS station and what do I find but that my usual program is not on and instead they are in fund-drive mode, and are featuring JJ VIRGIN talking about how I ought cut soy out of my diet because it is making me fat. All I can think is, if only youreatopia was still up surely someone on there would have a proactive solution to get out the message that this woman's quackery has no place on public television. But alas.

March 2, 2013 | Registered Commentert-mac

smiler088. Congratulations! You may want to read Restrictive Eating Disorder Spectrum: Fertility and Pregnancy Of course the fertility aspects won't be quite so riveting for you now :-) Nonetheless I talk about the fact that pregnancy itself and post-partum are high-risk times for relapse.

One of the best things you could do at this point is find a counsellor or therapist to develop cognitive behavioural techniques to handle the anxiety that your changing body and shape may trigger for you. If you and your partner are intending to raise the child together (sorry, I don't know your relationship status), then consider also entering couples therapy well in advance of the baby's arrival. Having some sense of how you will address the workload and share responsibilities for feedings, changings etc. can lessen the risk you face of post-partum anxiety and/or post-partum depression.

As you are 6 months in hopefully you feel somewhat connected to a steady level of hunger and that should increase as the demands for keeping you and baby healthy continue along over the following couple of years (assuming breast feeding post-delivery as well).

If you feel your eating disorder still tends to lock down on your hunger, then it might be a good idea to work with a dietician who has experience with expectant mothers who are addressing a recovery at the same time. You should expect to be hungry for 3000-3500 and you may still hit times of extreme hunger that are to do with continued repairs and recovery needs as well.

Best wishes! Gwyneth.

March 2, 2013 | Registered CommenterGwyneth

Thank you so much for the response. I have a very supportive boyfriend so I'm very lucky in that respect. I think I'll have him read that article as well. One positive I've noticed is that I don't think about my size as much- I think about how eating plenty is so good for my baby, and I'm less focused on how I look. I've been extra hungry lately so it's hard to keep up, but I think I'm doing pretty well. Thanks again :)

March 2, 2013 | Registered Commentersmiller088

Hey Gwyn! Thanks always for the time and care you put into these posts. They're so incredibly informative.

This post is especially timely for me. I'm about 9.5 months into recovery. I've been really wanting to get back to running, at least a little bit. I haven't worked out once in recovery so far. The problem is, I'm nervous that the "desire to run" voice is ED-generated. Thing is, people who know me (very well) tell me that they can hear a difference when I speak of running for the love of running, and when I speak of it from an ED-generated anxiety, and to try to listen to that genuine voice if it tells me I want to run. Other people who know me more casually (who know about my recovery) encourage me to take it up again if I want.

Another factor is that while I'm weight-restored, I'm pretty sure I've overshot somewhat, and the state of my figure does leave me wanting. I'm worried that my dissatisfaction with myself physically will worm its way into any exercise endeavors, regardless of how genuine they might be. I'm just really conflicted.

Anyway, thanks again for the post! It's a great read ^_^

March 3, 2013 | Registered Commenternmmumaw

Hi everyone,

Hope I am allowed to post a long one here. Seems like this is the only place that people can give comments.

New member here but have been spending time here many hours almost everyday. Not sure if I can bug you with stupid questions that lots of people had asked and posted here but I am really really scared to death and need reassurance. Could anyone please help?!

Overweight all my life after 10-year-old, (big bone frame and BMI around 30,5 for many years before i started to loose weight for 4 years ago). Lost period for 3 years ago, averagely lost 2 kg of body weight per month. Everything was good and done for good health in the beginning and by the time I lost period, i got wild and started to calculate calories and had experienced unconsciousness binge for recovery process. By that I mean my body simply push me to eat more and I listened to it only on weekends, I did not realize that is body tried to fix itself until now.

I am on my way to recover, I can manage to eat a lot since I was obese before, big amount of food is not a problem. Problem is the sick ED brain.

How do you know your extreme hunger comes from your body wants to fix the health, or you simply are greedy? (especially for someone like me who knew she ate too much before. All she tries to do now is not to let that greedy emotional stupid overeater come back)

For me who had BMI 30+ before, do I have to go back to 30+ BMI then I shall be able to fulfill the repair?

I still have BMI 19,5 now but all doctors want me to gain weight. I was put in a big machine to measure body fat and it turned out I only have 12% body fat which is too low for women and I am not even a person who likes to exercise. Have no extra energy to exercise for this moment either, sadly. I am soon 35 years old and have a lovely husband who wants me to put on weight for 3 years ago, families and friends all want me to put on weight but my ED is always in control.

I am stuck in the thought of I will restore BMI 30+ since that was where I was for many years before all this restriction to loose weight thing. I was a happy and loving person, now I barely have feelings. I still smile and be nice everyday, but I know I am faking it to remain a normal person.

I really tried my best to read and find whatever information that is beneficial to me from this blog and the internet. I just somehow cannot completely let go. I envy you guys who are able to eat whatever you want, cuz i dare bit, even though I do have a sound inside my body that is shouting for go! let go! eat crazy!

What is really wrong with me? I want to recover but I keep worrying and doing the opposite. I have no reason nor need to keep this weight, I know it and I hate it when it hurts to sit and lean against the wall. I even give up my favourite thing "bathing" cuz it hurts to lie down in the bathtub.

I know my brain is not functioning well, otherwise I wouldn't be so stuck by my own worries and thoughts. Could anyone be nice and give stupid me some experience and advise? Why I keep doing the opposite thing? Why I keep putting myself back in the hole while I scream and cry for recovery all the time?

and what I really need help the most is: How to let go completely? I don´t really count calories, just refuse to eat food that contains more salt or calories. Have also night eating syndrome. I have already put on weight even though I am not sure how much more calories I have been eating.

All I want for now is full recovery and any opinion is appreciated.

March 3, 2013 | Registered CommenterBobi

Nmmumaw -- What happens when something we love could possibly harm us?

Let's imagine instead of running you were a pianist. You practiced 6-8 hours a day. You have lived your music since almost before you could walk and talk. When you talk about your music your entire face lights up and there is such passion in your voice that all who know you simply know that you are destined to play the piano and it is your ultimate calling in life.

Then you develop a neuralgia of some sort. Playing the piano is doable, but you have been told that it will only hasten not merely the inability to play the piano but likely damage you to a point where you will render your hands completely unusable for even day-to-day things and you will be in constant pain as well. If you stop playing the piano immediately and enter physiotherapy it is quite likely that you will be able to maintain your ability to manage day-to-day things for the rest of your life quite comfortably and without pain.

What do you do?

Therein lies your issue with returning to running. I cannot tell you which path is right, but I can tell you that some will play the piano until they can play no more and lose everything as a result, and others will find it in them to source other ways in which to connect with their passion while maintaining their ability to use their hands. I can also tell you that those who play until they can play no more inherently also assume that when they cannot use their hands any longer someone is there both willing and able to do everything for them from then on.

Should a restrictive eating disorder be treated as such a similar kind of life sentence? Yes, actually. But there is no misery in that. While we tend to revere in our society the romantic concept of "no compromise" and riding off into the sunset with guns blazing, the reality is that life is very meaningful, sweet and rewarding if we shun the movie ending and instead become deeply curious about what else life might hold for us beyond the thing we thought was our passion.

G.

March 3, 2013 | Registered CommenterGwyneth

Bobi:

At age 35, looking to recover and struggling to move forward in that endeavour, you might really benefit from finding a cognitive behavioural therapist, ideally one who is also trained in motivational interviewing, to work with.

Just so you know, you probably don't have night eating syndrome as that is a distinct condition that is really a sleep disorder usually highly responsive to full spectrum light therapies. Rather you are eating at night because your body is so horrifically undernourished and thankfully the exhaustion you feel at those times actually helps the body to take over more readily and get some much needed (although not nearly enough) energy into you.

BMI 30 at age 10 has no bearing on what your optimal adult weight might be, however the eating disorder will find anything to latch onto as a reason to avoid food because food has been misidentified as a threat in your neural patterns at the moment. CBT can help you rewire that anxiety-avoidance response so you can move forward with weight restoration and physical repair.

If you would like to have me provide more detailed response, you could consider (if finances allow) the Question and Answer service that I provide. You can also look out other forums for first-person responses from others in recovery:

uzilu.com
edsafehaven.com
webiteback.com

While you may have scoured a lot of the posts on the forums that are on hiatus right now on this site, I encourage you to read the following blog posts (or re-read them) as they provide my direct input with research to back it up:

Rebounding to Calm Part I and Part II
Little Miss or Mr. Perfect: Is There An Eating Disorder Personality?
Food, Family and Fear
I Need How Many Calories?!!
Bingeing Is Not Bingeing
Weekly Forum Roundup -- read from the subheading Bon Appetit! onward in that post.

Hope this helps, G.

March 4, 2013 | Registered CommenterGwyneth

Thanks a lot, Gwyneth. Wasn´t expecting to get an answer since it was so full of bla bla bla post. Really appreciated. I have been seeing ED expert, nutritionist and endocrinology specialist. I also told them about the theory and minnesota starvation experiment. just like all the doctors in the world, one calorie is one calorie, they do not believe body stop gaining with excessive calorie intake nor support the idea that you can eat whatever you want in recovery. That is probably why I got so confused with the LET GO and ENJOY FOOD part. They all suggest me to put on weight with stable 2500 calorie intake + healthy smart food choice. oh I do eat very healthy and do I end up healthy now? not really...

I will possibly try your one on one Question and Answer, I am just way too terrified/confused and need help. How ironic, I do have received help from all experts.

I read many success stories here, I read people eat 8,000 calories daily but i somehow cannot believe this magic will work on my body. Have been overweight all my life - have been overeating almost all my life except these 4 recent years. I no longer can trust my body voice when it screams "food! more food! who cares if you just eat 4 slices of bread, give me more", I don´t know it comes from real needs or just the OLD me, the emotional over-eater is ready to come back and I will end up BMI 30+ again.

Enough of this boring thing, thanks again for the reply. Was really happy to get one. :)

March 4, 2013 | Registered CommenterBobi
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