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Sunday, April 3, 2016

Recovery from an eating disorder is still possible. Even after all these years.


Against all odds


She's not someone you'd expect to recovery. Decades living with an eating disorder, endless barriers to jump over.  But seeing the progress that my patient (I'll refer to as) Amy has made should provide hope to anyone who has long given up. Yes, recovery is possible. Not easy. Not quick. But possible. Please read through the end and share your thoughts with "Amy". 

In the last 50+ years, I cannot remember a time in which I was satisfied (even slightly) with my body.  As a matter of fact, I view it as disgusting and embarrassing.  Even at my sickest state, I was convinced I was the fattest one in the room.   In this point of my recovery, I deem it important to reflect on how far I’ve come.  Below is my life’s journey thus far.

It is uncertain to me why I have suffered from Eating Disorders for most of my life.   However, in my past, could lay the meaning for all of this.  My mom had EDs always.  My ED could be attributed to nature vs. nurture.  In other words, it was perhaps either a learned behavior or maybe it was genetically passed down to me.   It seemed important to my Mom that I should watch what I eat.  She was always suggesting that I should not have seconds at meals.  I remember my Dad taking us for ice cream when we were kids.  My mom would always get a diet soda so it seemed appropriate to me to follow her lead. When I was 8 years old I experienced a terrible trauma.  Even all these years later, I cannot reveal the details of this trauma.   All of these childhood memories are what, I believe, set the course for this ever-lasting emotional rollercoaster that is my life.

As I was preparing to graduate from high school, my ED became quite severe.  I was passing out on a daily basis.  My pediatrician told me that I was being “ridiculous”; I did not need to lose any weight and to just “eat more”.  It was at this time that I realized that if I ate just enough, it would not raise suspicions. It was also in my teen years that I started to self-harm.  I did this to the point of being certain it would kill me.  I didn’t care.  These behaviors even led into my adult life.

At the age of 23, I was married and eventually had 3 kids.  During this time, my behaviors somewhat subsided until my husband began drinking heavily.  This not only effected him, but it also effected me and our children.  What at first seemed like a “silver lining” was actually the calm before the storm.  I became engrossed in my ED once again.  All my behaviors emerged all at once.  I was unable to sit with my family at the kitchen table during dinners.  I would make my own “safe” foods and eat at the counter while doing chores while I ate.  Even as an adult, I was still following my Mom’s lead.

After 20+ years of marriage I finally somehow found the strength to separate from my husband.  As I began trying to pay our bills, it quickly became apparent that there was no money left in our joint accounts.  I had to begin again.  This stress increased the frequency of my ED behaviors.  I became quite sick again.  I refused to admit it.  My foggy brain kept me from the reality of my life.  Even when close friends and family claimed I needed help, I thought they were just trying to make me fat.  Kathy, my therapist, challenged me to attend an intake interview at an ED treatment center.  She even called them for me.  I went in order to prove my point – I do not need help!

Getting help--no quick fix


What I thought would be one hour out of my day, turned out to be four years of my life.  Since that day, I have been in residential 3 times, and PHP and IOP too many times to count.  After each stay, I felt like a failure.  I’m not sure if I felt this way because I couldn’t be cured from my ED or because I was letting my treatment team talk me into eating. Insurance was not a great help.  They would only approve 2 weeks max in resi for my first 2 stays. I would be discharged from residential and immediately make excuses for using just 1 or 2 behaviors.  “That’s better than all of them”, I would assure myself.  My outpatient treatment team were instrumental in convincing my insurance company to extend my treatment in my last resi stay to 6 weeks.  Upon discharge, I thought I was cured.  I felt great for a few weeks before the ED got into my head again.  I relapsed.

I overcame that relapse thanks to the support of my RD, Lori and the rest of my treatment team.  She could see through the ED lies.  She knew I was relapsing even before I did.  Yet I've turned it and I’ve had many accomplishments in the last few months:

I dug myself out of financial debt.
I eat my meal plan consistently
I’ve attempted to move away from “safe” foods.
I haven’t used ED behaviors in 3 weeks.
I’ve enrolled myself into a 16-week DBT group.

These are all accomplishments that I would not have believed possible even 3 months ago.  I will strive to add to this list within the next 3 months.  I feel more peace and contentment in my life now than I have ever before.

The journey isn't over. But recovery is in site


Even though I reached so many incredible accomplishments, that is only the beginning of the end of my recovery. Today, there a different challenges to face. Being closer to recovery than ever before, I am now terrified of losing my ED.  It’s been my stress control, my safety net, my numbing against my life.  How do I let go of it when I may need it again?  What if I can’t get it back? Even though I know that it is in my best interest to continue to move forward with my recovery, part of me does not want to let go of my ED forever.   My goal going forward will be to use my “wise” mind to conquer these thoughts.  I want to be able to look in the mirror and think, “I am who I am; I’ve done the best I could, given my circumstances, and I am proud of what I’ve accomplished”.  I WILL continue to fight and learn to love myself, whoever that may be, “Against All Odds”

Here's another recovery story you might like:

Thursday, March 17, 2016

From eating disorder recovery & advocacy, to losing weight, to bread baking?

Got 30 minutes? Check out this podcast I was interviewed on yesterday on Heritage Radio's Feast Yr Ears. http://heritageradionetwork.org/podcast/lori-lieberman/



Topics discussed include:


  • Why I love working with people with eating disorders--the most challenging of all my patients
  • More nutrition pet peeves, what simple step pediatricians can take to catch an eating disorder
  • What to say and not say to someone who has lost weight
  • The me and Cate story of Food to Eat and Drop the Diet aka why I adore Cate Sangster
  • My major food obsession. You mean you don't already know?


If you like it, please share it.

And thanks for your recent comments which I promise to respond to!

Sunday, February 21, 2016

Pet Peeves. Just in Time for Eating Disorder Awareness Week.

We will all rest more easily if we air
these 'pet' peeves.
Radio show host, Brooklyn Kitchen store owner and foodie Harry Rosenblum wants to know my food related pet peeves. He'll be interviewing me on March 16th on Feast Yr Ears about eating disorders and recovery with a particular interest in Cate and my book, Food to Eat: guided, hopeful & trusted recipes for eating disorder recovery. Pet peeves. Funny he should have asked; 'Thursday's patient' was just suggesting this for a blog post.

We all have them. Pet peeves are those things that drive us crazy that people and companies say and do that make us want to scream. But most of you don't scream, or even express your outrage. You might be annoyed, infuriated even, but you just keep it quiet and say nothing. Maybe you ruminate about it, or binge eat or don't eat at all. "I'll show them" may be your thinking. So readers, here's your prompt to share those things that piss you off. Ok, ok, not so fast. Let's narrow the focus to food and eating disorder related topics, okay?

I'll start us off with a few.



  • People who ought to know better, that assume weight loss is a good thing. Think doctors and nurses. Just 2 days ago a pre surgical nurse interviewing a family member asked if there was weight loss of more than 10 pounds in the past month. Yes, was the reply. "That's great!" she  moronically responded, naive to any underlying vomiting, pain, growing cancer, or depression that might have contributed. Brilliant. Or the pediatrician who praised the boy's weight drop from his high BMI, failing to ask the critical questions that would have diagnosed his eating disorder.
  • Food companies that sneakily shrink their packaging, thinking we just won't notice. 1/2 gallon of ice cream? Nope. Now it's just 1.5 quarts (vs 2 quarts). Kashi cereal boxes--same height, just a fraction of the content, with skinnier boxes. Call a spade a spade. Increase the darn price but keep the package size the same. Don't insult my intelligence, please! I'm waiting for them to fill my dozen eggs with just 10. Just you wait. 
Stop insulting my bread.
And please call it bread, not carbs!
  • Nutrition misinformation that people can't let go of--belief that gluten, or carbs make you fat. Not so my friends! There's no evidence to support this. It's like global warming for a particular US political party. They hold on to these beliefs in spite of all the science to the contrary. Ughh!
  • Food labels that shout out "high protein" or "low fat" or "gluten free" as if we should care. (If you  need to watch your gluten since you have celiac you'd better look for more that the shout out gluten text; you'll need a legitimate stamp identifying foods that have a measured low gluten level through careful factory testing).
  • People that think their food choices or diet type raises them to a higher moral ground. Choose to be vegan if you are concerned about the planet or animals or both. But don't wear it like a designer label because quite simply, I'm not impressed.
This is steak. It contains protein.
And fat. And other nutrients.
  • Calling food by its nutrient. As in "I'll have some protein with that" referring to meats or fish, for instance. Can't we appreciate and select foods for their other characteristics, too? For their flavor, or texture, their smoothness or crunch? The simple pleasure they give us?



What are your pet peeves? Let's put them out there and circulate them. And maybe we will raise awareness and create change.

Friday, February 5, 2016

So you think you're recovered from an eating disorder? Take this quiz to find out.

1) Recovery is about weight gain. Period.


The simple answer? 
It just might not be going the way you planned. 
False. Now don't let your eating disorder get all excited, saying "See! I told you so!"

Weight restoration is surely a must for those who have fallen from their usual weight or in the case of kids, their weight for age and BMI curves. That is, their expected pattern of gain based on their age and their weight history. For kids, falling off their usual growth curve suggests a problem. It shouldn't be praised or rewarded, but evaluated. (Pediatricians, did you read that?!) But if someone's weight was high due to unhealthy behaviors such as binging, emotional overeating, or general disregard for satiety, and weight dropped with improved eating and coping, weight gain is likely unnecessary.

Simply reaching a healthy range based on the charts also isn't enough. Perhaps your restrictive eating and suppressed weight began as a young teen, and you've lived for years with eating disordered behaviors. Did you rely on cigarette smoking or other substances? Was your appetite suppressed by ADHD meds? As you recover, weight gain may be essential regardless of what the BMI charts say. Focusing on the weight is misguided!

Your weight may be technically in the normal range, but your behaviors may indicate a problem. You know, like restricting, binging, purging, laxative abuse, compulsive exercise.

Weight is just one component of eating disorder recovery.

2) If I get a period (and I'm not a guy) then my body is healthy.

False

Surely losing your period when you're of age and sex to be getting a period is cause for concern. But getting your period is not evidence that all is well and you have recovered. You may get what seems like a period when you're on the pill, or start to get periods back without all the hormones being back to normal. Or maybe like one adult patient I used to see, in spite of her struggle with anorexia, she managed to conceive and deliver 5 children, never missing a cycle. Similarly, weight may be restored to the appropriate place, but it may take several months for menses to resume. For guys, low testosterone level is a more silent red flag that things are amiss; is resolves with adequate eating.

3) If I can take in enough calories, then I've recovered.

False

Can you eat foods you used to enjoy?
Sure, you will need enough calories to get your body bad to normal function--with a healthy heart rate and blood pressure, without major drops in pressure when you go from lying down to sitting or standing; with normal body temperature and energy level; with better sleep and mood. But full recovery means eating a range of foods and nutrients. It requires eating enough carbohydrates and fats-- not just protein. Recovery, true recovery, demands you include foods that seem scary, foods that you used to love, so that you aren't controlled by them. Like eating some pizza or an ice cream if the spirit moves you.  It means eating bread that may be whole wheat, or white, sourdough or french, without relying on ‘sandwich roundsor high fiber, low calorie flatbreads, or “Ezekiel” bread. If you’re truly recovered you can eat foods even if you can't justify them for their nutritional value, even if you don't think of them as "good for you".

4) I've stopped using laxatives, vomiting, and I'm eating better. I'm healthy now that I'm exercising every single day. So surely I'm recovered.


False. Replacing one behavior with another-- in this case, having to exercise to allow yourself to eat-- is also not healthy. Be careful that you aren't just swapping one behavior with another-- even a 'socially acceptable' behavior like exercise. If you feel you can't eat if you don't exercise you have work to do!

Ok. So I am doing fine with all that. But I need to be the one preparing the food. I'm still recovered, right?

I know. This is a scary idea. I will
settle for nourishing you
with words.
Not quite. Full recovery includes some flexibility and acceptance of what you can't control.
It means eating meals out without having to look up the calories before hand, and without having to modify the entire meal according to ED (that said, being vocal about your preferences doesn't have to be disordered. While Sally didn’t have an eating disorder in "When Harry Met Sally" this scene is worth viewing for some comic relief. Recovery is being able to eat a meal without watching the food be prepared, fearing the secret addition of ‘toxic’ ingredients.

Recovery acknowledges that people you know diet or overexercise or are losing weight, and it is what it is. (see husband triggering) And that you stay the course with eating and avoiding behaviors because it simply has to be; because you can be a great dieter-- but it didn't serve you very well being in that place before. And because you simply deserve to feel better.

Not as far along as you hoped? 


Then move your frustration to action. If you've just started on this path, hooray for improving your intake and taking steps toward recovery! Perhaps you're finding other ways to cope, so you're freeing yourself from unhealthy disordered behavior. Maybe reading this post helps you realize that more recovery pieces are in place than when you started. Progress! The point of this piece is to raise your awareness to help you keep going and reach fuller recovery. And to shake up some denial that stands in your way.
Yes, there's hope. See some of the links below.

Any changes to your thinking or eating you still need to make? Perhaps the post below will help to motivate.


Please share your thoughts!

And thanks for reading.

Friday, January 15, 2016

I'm Sorry. Blame the Bread.

You are owed an apology and an explanation. After receiving a reader's most thoughtful, concerned email I decided I needed to post. I stopped putting out blog posts and virtually disappeared (pun intended), with no warning or explanation. Admittedly, it happened gradually, from blogging 1-2 times per week to monthly to, well whenever the spirit moved me. Why, you ask? For lots of reasons.

Bread


You could say I've replaced one passion with another. Or that I've been compensating for the deprivation of the masses who have chosen a low carb or gluten free lifestyle. Defiantly making and eating bread? Maybe. I've been baking (and eating) sourdough breads and I'm thoroughly enjoying the process, the art, the texture and the taste. And no, in spite of all the carbs and gluten I've neither ballooned in size nor suffered inflammatory attacks (other than from my friends when I don't share these highly desired loaves.)




The vacuum


It's not easy to continue to write posts and get minimal feedback from readers. I know you're out there--my stats prove it--but the feedback is so minimal. And I'm no different than the rest of you; I also care what others think about what I have to say--even if you don't agree. If you've tried to respond but Blogger isn't letting you, than please let me know at info (at) LoriLiebermanAndassociates.com. 

Recirculating misinformation


Writing about nutrition fallacies falls flat. When misinformation gets out, it's most impossible to reverse. I wish we learned from our mistakes--that diets ultimately result in weight gain not loss, that deprivation ultimately will drive you nuts, and that no nutrient group is toxic. And most importantly, that you deserve to eat what you like--in public--and truly enjoy it with all your senses. I started shifting this blog to leading by example--showing real foods and meals, and practical recipes (as in www.food-2-eat.com) which I'm hoping was useful. Like you, I'm challenged every time I hear the craziness from public figures and common folk. It's simply overwhelming and perhaps counterproductive to keep spreading their lies.

The end of DropItAndEat?


I doubt it. But maybe you can offer me some guidance. What would you like to see? And how can you get more engaged, dialoging in the comments?

Again, I'm sorry if my absence worried any you. It's nice to know you missed me.

Monday, October 12, 2015

Spouses, partners, parents of loved ones with eating disorders--I need you to keep reading. Really.

You may have no idea how they're suffering. Your wife, or mother, or partner or son. It's about shame. And fear. That's why they can't tell you. That's why it's so hard for her to ask for help. I'm not placing blame, but I'm asking you to start to listen like you never have before. Because it's hard for those living with anorexia, bulimia and binge eating disorder to say what needs to be said.

Don't be fooled by his size or his weight. People with eating disorders come in all sizes. And don't be fooled by how well she had been doing. Slips happen. That's normal. But recovery requires acknowledgement that things are amiss, and that support is available. Right there. In person. Not just virtually through this blog, or a virtual support group or a friend across the world.

Yes, they need to know that you are there for them, unconditionally. Even if you really don't understand. Even though you wish they'd just 'get over it'. Struggling with an eating disorder is something they simply did not choose.

She may not discuss it with you, seeming as if all is well. And he may deny that he's restricting or over exercising. Besides. It's so much easier to see what we'd like to see.

So if you suspect that there's something not quite right, please start a discussion. And use open ended questions, ones that can't be dead-ended with a simple yes or no response.

You just might have your blinders on to
what's really going on--right before your eyes.



Do you know how trapped she's feeling?
Like there's no way out of her misery?
Sometimes we're a bit too close to the situation to
see the whole picture.