Anorexia recovery and bulimia recovery don’t happen overnight.
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Even though it seems like once you decide to “get better,” you SHOULD be able to SNAP your fingers and “just eat,” stop overexercising, go to therapy, and stop binging and purging…statistics show, it doesn’t work like that.
ANOREXIA & BULIMIA RECOVERY STATISTICS
Of the 1 in 5 women who have an eating disorder, ONLY about 15% truly recover. (ANRED, 2018)
Moreover, 70% of those with eating disorders will NOT seek treatment at all out of fear of stigmas, stereotypes or lack of education and access to care (Eating Recovery Center, 2018)
Why are so many sufferers choosing to live with their eating disorder and NOT recover into a life of freedom?
Answer: There’s more to anorexia recovery and bulimia recovery than just “eating more,” stopping behaviors, taking medicine and going to therapy.
EATING DISORDER TREATMENT: SOMETHING’S MISSING
Standard eating disorder treatment (for anorexia, bulimia, binge eating, etc.) typically entails five things:
- Talk Therapy (Individual & Group Counseling)
- Medical Monitoring (blood pressure, heart rate, etc.)
- Medications (SSRI’s, birth control)
- Nutrition Counseling
- Weight restoration &/or Maintenance of a Healthy BMI
The idea behind these?
Just go to your weekly therapy appointments, gain some weight, maybe go to a treatment center, and follow a meal plan and EVENTUALLY you will get better.
Not quite. Unfortunately, if it was “that easy,” more people would recover.
BEEN THERE, DONE THAT
For 15 years, eating more, moving less and going to therapy was my own story too. My routine eating disorder treatment plan included:
- Weekly doctor check-ups, weight checks and vital monitoring
- Weekly therapy appointments and support groups
- Anti-depressants and anti-anxiety meds
- Weekly nutritionist check-ins and following a meal plan based on calories or exchanges
- And HOPING and WISHING the eating disorder would JUST GO AWAY
However, as compliant as I was with my eating disorder treatment plan…something was MISSING. For SOME REASON, no matter how much I talked, thought and tried to recover…I continued to struggle.
My own story all came to a head when, after 15 years of fighting the battle and “going through the motions,” I hit my “rock bottom,” through a near death experience at age 23. Looking back on my own 15-year eating disorder fight, I’ve often questioned:
Does anorexia recovery and bulimia recovery have to really come to a NEAR DEATH experience to fully recover?
Answer: NOPE.
Especially when you discover these 6 Things (Most) Doctors, Therapists & Nutritionists WON’T Tell You About Anorexia & Bulimia Recovery… (7 things that explain WHY anorexia recovery and bulimia recovery isn’t JUST ABOUT talk therapy, medications, a number on the scale or going through the motions).
6 THINGS (MANY) DOCTORS, THERAPISTS & NUTRITIONISTS WON’T TELL YOU ABOUT ANOREXIA & BULIMIA RECOVERY
- Medication is Often Not Effective for Mild/Moderate Depression & Anxiety
About 1 in 9 people are on an anti-anxiety or anti-depression medication (1, CDC, 2017). However, 30 to 40 percent of patients don’t respond to antidepressants at all (2, Oaklander, Time, 2017) (3 ). In addition, SSRI’s come with a host of side effects including: fatigue, insomnia, constipation, dizziness, irritability, agitation, anxiety (which is ironic because they’re often used to treat those conditions) weight gain, low libido, hormone imbalances, gastrointestinal bleeding, cortisol secretion impairment (i.e. stress response), movement disorders like rigidity or involuntary movements or restlessness.
- Gut Inflammation Triggers Mental Health Disorders
Ever wonder WHY you just can’t get those thoughts out of your head? The answer may be in your gut. (a.k.a. “The Brain-Gut Connection”). The gut has been referred to as the “second brain:”-95% of your serotonin is produced in your gut (your “feel good” brain chemicals)
-We have 400-500 times more melatonin in the gut than in the brain (chemical that helps you relax)
-The vagus nerve (the nerve that governs how you THINK), is connected from the top of your gut to your brainYour gut and the brain are part of a unified central nervous system. In fact, most of the output of the brain signals travels through the vagus nerve, which ALSO innervates the entire gut. Hence: The brain controls the gut, and the gut controls the brain.Research (Schirmer et al, 2016) suggests that mental health struggles, like anorexia, bulimia, anxiety and depression are caused, in part, by low-grade chronic inflammation in the gut, which in turn, affects the brain! (also known as the “inflammatory cytokine model of depression” theory).This theory basically states that inflammation in your brain most often occurs as the result of gut issues (like too much “bad” bacteria, a leaky gut or low stomach acid) that produce inflammatory cytokines. These inflammatory cytokines then escape into the bloodstream, and travel through your bloodstream, up to your brain, crossing the blood-brain barrier, where they then suppress your frontal cortex (the part of your brain that is responsible for a lot of our higher brain function). In short: when the action of your brain’s frontal cortex is suppressed, you get symptoms that you see in eating disorders (obsessive thoughts, negative thoughts, depression, anxiety, etc.).
- Artificial Sweeteners & Excess Sugar Feed Gut Bacteria
No food is innately bad AND making peace with food is ESSENTIAL for eating disorder recovery and food freedom. However, there is also freedom in moderation, and when it comes to sweeteners and sugar this is particularly true.Often times, in eating disorders, many people turn to “safe foods” or low-calorie and low-sugar diet foods, composed of artificial sweeteners that help keep you full, satisfied or “quench” your sweet tooth.On the flip side, treatment center plates and hospital cafeteria trays can seemingly also take food freedom to the other extreme—ditching the artificial sweeteners, in place of desserts with many meals; sugar-rich packaged and processed snacks; high-sugar tube feeding formulas; and frequent ice cream or candy bar snack challenges.Again, while NO FOOD is innately bad, the human body can only take so much sugar (about 25 grams), and when we consume sweeteners or sugars on a regular, we don’t do our brains and recovery process the full justice they deserve. Excess sugar AND artificial sweeteners (even stevia) contributes to an inflammatory gut microbiota (which affect your brain health). (Lam et al, 2016)In addition, artificial sweetener and/or sugar consumption can also lead to impaired glucose tolerance, blood sugar swings and hypoglycemia that trigger cause anxiety-like symptoms when changes in blood sugar occur (Aucoin & Bhardwaj, 2016).(The Bottom Line: Have your cake and eat it too! Eat dessert in moderation, minimize artificial sweetener consumption, and focus on building your plate around a balance of proteins, fats and veggies as the base of meals).
- Processed & Packaged Foods Make Your Brain Mushy
Many grain-based foods and omega-6 fats found in highly processed industrial seed oils (canola oil, grapeseed oil, vegetable oil), also contribute to a systemic inflammatory mental health condition, like eating disorders andIt’s a catch-22, because in one sense, you want to MENTALLY be OK with all foods in moderation, however when the pendulum swings to either extreme (i.e. not eating at all or eating only diet foods, to eating processed foods, restaurant foods and sugar in treatment), therein problems arise.We can all acknowledge that, generally speaking, the eating disorder’s food rules are NOT healthy nor in your best interest. However, some treatment methods seemingly swing the pendulum in the complete opposite direction and base a “recovery diet” on the Standard American Diet, consisting of many Omega-6 fats and cereal grains.Omega-6 oils are found mostly in processed and refined foods, foods that come in a bag or a box, restaurant foods (even DIET FOODS, like bars, shakes and frozen dinners). Omega-6 oils are fragile and susceptible to oxidative damage when heat is applied, so if they’re used in cooking and frying, they can become easily rancid and oxidized. The result? Inflammation in your gut and brain. Similarly, refined cereal grains, found in bread, pizza crust, flour-based desserts, cereals, and pastas are rapidly absorbed in the upper part of the digestive tract, which can provoke an inflammatory gut microbiota. Most grains also lack fermentable fibers and contain gluten, which feed the beneficial bacteria in the colon, and that also contributes to an inflammatory gut microbiota. In addition, some of the pesticides used on industrially grown grains may contribute to intestinal permeability (leaky gut) and more impairment to the brain-gut axis.
- Low-Fat Diets & Low Protein Weaken Your Brain Too
Eating disorder diets—even treatment diets—are often low in fat and sometimes even proteins, particularly low in saturated fats and cholesterol, and/or animal proteins (if vegetarian or vegan).For starters: Fats. Contrary to popular belief, saturated fats actually do a body good. Your brain is made up of at least 60 percent fat— mostly saturated fat and cholesterol. Inadequate fat intake affects brain health, and in turn, a low-fat diet or low cholesterol may not provide adequate fat for optimal brain function. Cholesterol is a component of the brain’s myelin sheath, the insulation around its neurons, and studies show that both inadequate or very low levels of cholesterol and very high levels of cholesterol can cause neurological impairments (Harvard Health, 2007). A balance of all fats—saturated (butter, ghee, egg yolks, animal meats, coconut), monounsaturated (avocado, olive oil, olives) and some polyunsaturated (nuts and seeds)—is ideal for mental health and recovery (beyond just focusing on weight or BMI alone). (And: FAT DOES NOT MAKE YOU FAT).As for proteins, most people get enough of it in the typical US diet, but for those who are vegetarian or vegan, they may not get enough. Neurotransmitters (chemical messengers to your brain) are created from amino acids found in protein Too little protein can exacerbate mood disorders, and especially if the diet is not containing all of the essential amino acids. Hence, the ideal intake for someone with eating disorders should be one-half to one gram per pound of body weight. This is often overlooked, again, specifically for those who have a vegetarian or vegan diet, and while you CAN recover on these diets if that is an honest conviction for you, it’s vital you’re aware of not only your risk of amino acid deficiencies, but low B-12, low zinc and high risk for leaky gut.
- Sleep & Movement Are Medicine
Sleep and movement are often overlooked as part of the BASE of a treatment plan. However, with eating disorders and mental health disorders, sleep and movement may be two of the most important factors.Thirty percent of people report less than six hours of sleep a night, and more than 40-million Americans suffer from sleep disorders (CDC, 2017). Sleep is when our brain gets much needed rest and if we’re not getting enough of that, all kinds of things happen in our brain that perpetuate the eating disorder (i.e. treatment from eating disorders should also focus in on getting enough sleep).
Number two: Movement (read: NOT excessive overexercise) is also, like sleep, an often (less talked about) component to recovery. In part, this is greatly because many people abuse exercise in their eating disorders, but movement, as part of a healthy recovery plan does NOT have to mean running on treadmills or tracking calories in Orange Theory Fitness class. Movement, such as walking, yoga, strength training, stretching and outdoor activities is essential to establish, early on, once over the “hump” of a malnourished state. Instead of viewing movement as “good” or “bad,” or as a privilege, it should instead be upheld (and talked about) as an act of self-care. Not only is this important from a recovery standpoint, but also a mental health and anti-inflammatory standpoint.Less than 5 percent of people get 30 minutes of activity a day, and only 1 in 3 get the recommended amount of physical activity per week (CDC, 2017). Moreover, the average person spends 50 to 70 percent of the day sitting (BLS, 2017), putting them at higher risk of disease, including depression and mental health disorders (Nam et al, 2017 ). Movement improves cognitive function and boosts mood, and when addressed early on in treatment and recovery, movement CAN be an asset (not a detriment) to enhanced, balanced healing (Kilpatrick et al, 2013 )
The Bottom Line: There is more to anorexia recovery and bulimia recovery than just goin through the motions of therapy, treatment and medications.
Stay tuned for Part 2: Mental Health Nutrition for Anxiety, Depression & Eating Disorders.
Want guidance in navigating your own recovery? Connect with Dr. Lauryn today.