The Long-Term Effect Of Eating Disorders That Nobody Talks About

I found the following article really interesting and thought it may interest some of my readers as well. All of my organs became very weak when I was unwell (particularly my hear) and I often wonder about whether or not those organs have repaired fully yet or not.

This is why I think it so important to continuing nourishing your body, even after you become weight restored as a lot of the damage that you do to your body during starvation may not be reversed even when you are weight restored.

The Long-Term Effect Of Eating Disorders That Nobody Talks About                  

by Dr. Ashley SolomonMarch 2, 2017 5:22 AM         

With Healthy Heart Month in full swing, you might be hearing advice everywhere from your family doctor to your favorite newsletter about what to cut out of your diet to keep your heart strong. Ditch the soda! Cut the carbs! Skip the butter! Oh, wait, butter's back in! But maybe olive oil is better?!
While most of us can take this influx of diet advice in stride, those at risk for eating disorders are vulnerable to this deluge of information. In many cases, the eating patterns that eventually precipitated a full-blown eating disorder started with the intention to be healthier and feel better—both physically and emotionally. In a sadly ironic twist, those behaviors have likely contributed to the serious decline in health often associated with eating disorders.

Eating disorders are more than just a psychiatric illness.

In fact, eating disorders have the highest mortality rate of any psychiatric illness (or behavioral health disorder). So not only do they lead to a host of social, mental, and physical problems, but they actually put someone at increased risk for other health problems. Cardiovascular complications are one of the biggest risks for those struggling with eating disorders. The heart is made of muscle and basically functions as a pump that moves blood first to the lungs to pick up oxygen and then out to the extremities to bring oxygen and nutrients throughout the whole body. Our hearts are clearly key to our ability to live and function normally, and eating disorders put strain on the heart in a number of ways.

1. Weaker heart muscles

First, when one does not take in enough food to support our level of activity, the heart rate slows down as the body tries to conserve energy. Also, blood pressure will drop due to dehydration or because the muscles of the heart weaken. When blood pressure is low, it's harder for other organs—like the kidneys, the brain, or the liver—to receive the nutrients and oxygen that the heart usually pumps in their direction.
People with low-weight eating disorders actually lose cardiac muscle mass. All muscles of the body are subject to wasting away if we aren't nourishing them. Heart muscle is no exception. Underweight patients may develop mitral valve prolapse due to shrunken heart muscle cells, or they can develop heart failure due to a weakened heart that can't pump well.

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2. Shifts in the heart's chemical environment

A second concern is the development of abnormal heart rhythms, which happens frequently when someone is suffering from bulimia nervosa. The behaviors of binge eating and purging (which can involve not just vomiting but also laxative and diuretic use), can lead to dehydration and dangerous shifts in electrolytes in the body. When the chemical environment of the heart is abnormal, the heart is at risk for arrhythmias, which can cause heart palpitations, fainting, and even death.

3. Cardiac disturbances

And thirdly, there are a host of cardiac rhythm disturbances that are directly caused by weight loss and malnutrition. These are undoubtedly causal in the heightened risk for sudden death seen in people with anorexia nervosa.
Despite these very serious cardiac concerns, many people with eating disorders are reluctant to get help. The disorders themselves are marked by a brain-based type of denial that can make even seeing that there's a problem very difficult. As a clinician, I find that sometimes the presence of these heart issues can help someone see just how high the risk to their health really is.

Healing your body from an eating disorder

But even those who begin the process of recovery have to be very cautious about their heart health. For someone who has been eating very little, starting to eat more can cause its own dangerous shifts in electrolytes called refeeding syndrome, which again puts the person at risk for cardiac complications. Thus, some patients will need to be very closely monitored by a medical team during this process.
The heartening news is that most of physical complications of eating disorders are reversible with good nutrition. Once the body and mind are recovered and a knowledgeable support team is in place, the person has a great chance of living a long, healthy life.

If you've suffered from an eating disorder, keep the following in mind:

1. Take any cardiac event very seriously. If you experience any chest pain, are getting dizzy when you stand, have a fainting episode, or notice your heart rhythm seems off, get to a medical provider as soon as you can.
2. Enlist the support of others. We know that eating disorders thrive in isolation, and recovery thrives in community with others you care about. Let someone close to you know that you're worried about your health.
3. Know that recovery is always possible. Even people who lived with an eating disorder for a very long time can expect a full and lasting recovery. It's not easy and can't be accomplished alone, but EVERYONE suffering from an eating disorder can be helped.

The recently deceased George Michael once said, "You'll never find peace of mind until you listen to your heart." Listen carefully to the messages your heart is sending you. And with the right treatment, you can find peace from the burden of eating disorders.
For additional information about the Eating Recovery Center, call 877-789-5758, email info@eatingrecoverycenter.com, or visit www.eatingrecoverycenter.com to speak with a master's-level clinician.

Why do I do Hebalife?

I get lots of people criticizing me for doing Herbalife. People have even accused me of being a part of a colt and have questioned whether it is healthy for me to follow a nutrition program at all, especially post anorexia. I don't blame these people one little bit as I know its just because they don't understand what Herbalife actually is and they have not had the privilege of experiencing our incredible and uplifting community. This is a post I wrote and posted to our Local Nutrition Hub this morning and I thought I would share it with you all too. I am not quite brave enough to share it with all of my family and friends yet on my facebook wall, as I still worry that they wont fully understand, but one day I would like to share my true Herbalife results with everyone and hopefully inspire everyone to do something that allows them to accept themselves as I am now able to do!

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For a while now I have been wanting to share my 'true' Herbalife results with others, but I haven't been quite brave enough to do that. Today however I am going to take the first step and share my results with all of you wonderful people.

Before Herbalife (bottom left picture) I had managed to restore a healthy weight after my eating disorder (top left picture) however I wasn't mentally recovered. I was still having to fight my anorexic thoughts daily and I didn't accept my body the way it was at all.

Now however I feel like a different person! It is only now that I have finally developed a healthy relationship with food, as well as with myself and that is only thanks to Herbalife and my wonderful coach Phoebe Outtram who not only introduced me to Herbalife, but also personal development, self love and self belief!

For the first time ever I now consider myself to be fully recovered from my eating disorder and that is something I never thought would happen . I am so much fitter, healthier and stronger now and my mental state is the best it has ever been!

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Recovery is uncomfortable....

Yes, Recovery is hard and uncomfortable.... But you should do it anyway, I promise its worth it!

Herbalife

Ever since starting my recovery I have really started to learn the importance of looking after your body. While I have done a much better job of this over the past 12 months then I had previously, I have decided that I would like to take that a step further and really start to nourish my body. I am hoping that this will improve my energy levels and get my body functioning optimally so that I can feel happier and healthier.

I have decided to start a Herbalife program which I hope will help me to feel more energetic and which I also hope will help me to fuel my body. Its by no means a weightloss program, but instead a wellness program which I may transition into a muscle building program if I decide to in the future. If you would like to find out more about Herbalife, follow this link. I have decided to start off with a protein plus starter pack as well as a herbal peach tea which is really supposed to help with your energy levels.

I have also joined a gym which I hope will allow me to grow fitter and stronger whilst taking the herbalife products and of course eating lots of good foods too. I am defintely not planning on taking the herbalife products instead of eating, I just plan to incorporate them into my diet. For example I might have a tea with my breakfast, and a shake with my lunch and add the protein powder to things I already eat ie. My morning oats or other snacks.

I have made my consultant aware of my history of anorexia and she is really excited for me as she believes Herbalife will really help me. She too was once really underweight and Herbalife has really helped her to transform her body and life. She asked me to write 20 goals and also do some before shots so that we can use them to see any progress I make. Here they are :)

1. Increase my confidence

2. Learn to eat more intuitively 

3. Cut back on sugary processed foods 

4. give my body the nutritious food it deserves

5. Get stronger

6. Gain some weight (in the form of muscle)

7. Become more energized 

8. Tone my muscles

9. Get fitter

10. Do a fun run for charity

11. Have a well balanced life 

12. Develop a healthier relationship with food

13. Stop counting calories

14. Learn to listen to my body

15. let myself rest when I need to

16. Develop a more positive body image

17. Prove to other sufferers that full recovery from anorexia is possible 

18. Increase my positivity and enthusiasm 

19. Run 10 kilometers

20. Visit the gym regularly  (atleast 3-5 times a week)

Knowing when you are physically recovered

It can be hard to tell when you are physically recovered or getting close to being fully recovered physically. It is really difficult to know when you should start to cut down on your calorie intake during recovery, especially if you are trying to recover on your own. I used the following indicators to help me decide when to reduce my intake slightly...

1. I reached a healthy bmi as well as the goal weight that my doctor set for me

2. My bones no longer stuck out unaturally as they used to do

3. I could fit nicely into normal sized clothes once again

4. I no longer felt the cold or suffered from poor circulation like I once dd

5. My pulse rate is normal

6. My figure has returned to the same shape it was before I got anorexia

7. My energy levels increased significantly, as did my strength

8. People no longer stared at me or commented on me being thin

10. My family all told me how fantastic I was looking and told me how proud they were of me

There are still a few indicators that I am not completely physically recovered however which is why I am still eating a recovery intake (more than 2500 calories). These include...

1. I still havent had a natural period

2. My stomach still bloats sometimes and I have a few digestion issues

I am really glad that I have reached a healthy weight and I am even happier that I am able to accept my body at this weight. It is really important that you do not reduce your intake as soon as you reach a minimally acceptable bmi as this does not indicate you have reached a healthy and recovered body state. If you reduce your intake too soon, while you may be an acceptable weight, your internal organs will not be fully repaired and your metabolism and bodily functions may not work efficiently. 

July 2013

July 2015

I think you can even see a huge difference in my face between these two photos. I think my face looks much healthier now. In the first photo my face even looks much thinner then Amy's and Amy is 8 years younger then me.

Making recovery choices

As I said in my post this morning, I am starting to feel self conscious at times because of my weight gain and I have felt as though I need to start eating less. Today I decided, with the help of some of my readers, that it is probably not a good idea for me to cut my intake back yet as I know that I still have not reached my natural set point weight and my bmi is only just within the 'healthy range'. Instead I have decided to stop restricting my exercise and to just try and have a normal relationship with exercise.

I am hoping that if I no longer restrict my exercise, I will start to rebuild some of the muscle I lost because of my anorexia and this will get me closer to reaching my set point weight. I will most likely continue to gain some weight from what I am eating regardless of the fact that I will be exercising more sometimes because I am still eating the same large recovery amount. Somedays I still wont get a chance to exercise more then I currrently am anyway as I simply dont have the time but this just means that I can go for runs or longer walks sometimes, if I ever feel like it.

Since exercise is still a bit of an issue for me, I realise that I still need to have some exercise free days and other days when I dont exercise as much because I do not want to get addicted to exercise or feel as though exercise is a way for me to compensate for eating. I only want to exercise because it makes me happy and becaus I want to be fit and healthy. If I ever feel as though I am exercising for the wrong reasons, I will try my hardest to stop myself from exercising as I do not want to give into my anorexia. I want to fight it, every chance I get.

Anyway, I just wanted to let everyone know what I had decided to do. Thanks to everyone who helped me to make this decision. I really value the opinions of all of my readers and you all give me the strength I need to keep fighting every single day. There have been various occasions throughout my recovery so far that I know I would have given into my anorexia if I didnt have my blog and all of the beautiful people who read my blog belieing in me. So thanks again everyone <3 xx

Starting Yoga

I have decided that I am going to start doing yoga which is held each Wednesday night in the school gym. It only started last week and I was talkinng to the lady that takes it and she said that she would be more than happy for me to come. I told her that I have ligamentous laxity (so I am super flexible) but she seems to think that it is ok for me to do yoga as long as I don't over stretch my body and as long as I focus on holding poses and controlling my movements carefully.

In fact it should help me alot as it will help me to build up the muscles around my joints so that they can support my joints in the ways that my ligaments fail to. I think that yoga is also a fantastic sport to start participating in as it can help me rebuild all of the muscle that I lost through my anorexia, without exerting myself too much. Afterall, I want to reach a healthy weight by gaining back some of my muscle as well as just fat. I know that I need to have some fat on my body too but I obviously don't want to just have all fat.

So I am going to ring the yoga instructor and let her know that I am going to be there Wednesday night. I work at the supermarket Wednesdays anyway and finish work at 5:45 so it will be perfect as Yoga starts at 6pm. I am excited to be doing this as I do not only think it will be good for my body but also for my mind too. And it will be a great way to get out in the community and meet new people and spend time with those I already know.

I found the following article online which talks about how yoga can help a person to
recover from anorexia.

Research shows yoga helps eating disorder recovery

Interestingly, despite the growing numbers in terms of eating disorders in our nation, very little is actually known in regards to how they form, and what causes relapses in sufferers. Researchers led by Lourdes P. Dale from the University of Hartford determined to discover alternate healing for eating disorder recovery as it was noted that many of the traditional healing techniques failed at focusing on the emotional and body awareness aspects of eating disorders. 

The study involved a 6-week yoga workshop incorporating women with a history of eating disorders. The results were reported that the women who attended the workshop were better at identifying their emotional states, being aware of their emotional states, and found themselves more capable of handling their mood fluctuations. There was also a significant drop in the level of eating concerns for this particular group of women, and these positive outcomes carried on even after the workshop was complete.

Yoga practice focuses on deep breathing, mindfulness, and attention to how the body is working. It literally allows you to take your attention off of the matters surrounding you, and forces you to only think of the matters at hand, the person struggling with an disorder is thus allowed to redirect all their pain, and energy into the mat itself. Peaceful meditation allows for the re-centering of the thought processes, and the poses provide the strength of the body and redirection in the flow of the bodies energy. All positive, and necessary benefits in terms of eating disorder healing. 

The biggest challenge in any form of recovery, is taking the first step. It is literally mind over matter and a clarity will suddenly strike the sufferer that says, “I will no longer let this control my life. I am in control.” And when that clarity finally hits them, they will be ready to begin the healing process. Yoga can be there to guide them through to full, and lasting recovery.

http://www.evolationyoga.com/yoga-eating-disorder-recovery/

Here is also a video which I found from someone who strongly believes that yoga can make a wonderful difference to a person recovering from anorexia.

https://youtu.be/khB79zfC0hU

So if you think yoga might help you to recover, give it a go. I will let you know how it goes for me on Wednesday night. :)

Food is our medicine

I know I have talked about this on my blog before but I think that it is an incredibely important message to get out there as realilsing it really is esseential to recovery, so I am going to talk about it again. In the years I spent losing weight and also mantaining my weight, people tried to tell me that food was my medicine and that through eating, would come recovery but I didn't believe them. I could not see how eating food would change the way I felt towards my weight and food and I was convinced that I would never be able too eat proper recovery amounts.

I just couldn't see how gaining weight would make any difference to what was going on inside my head and gaining weght just seemed far to difficult.  The best decision I ever made was when I committed fully to my recovery and decided to give eating real recovery amounts a go. Since then I have been able to develop a whole new attitude towards recovery.

Through giving my body the energy it needs through food, my mind has started to repair which means that I can think a lot more clearly and can fight my anorexia much more successfully. Now I have the ability to think for rationally and clearly and I know that this is only because my brain is repairing.

I know how scary the prospect of increasing your intake to a proper recoevry amount may seem, but unfortunateely the only way you can overcome this fear is by doing it. Try not to think about the weight gain or any of the other things that eating more may bring. Just think about the fact that food is your medicine and that you WILL NOT be able to successfully recover unless you increases your intake to proper recovery amounts.

Please trust me when I say that the weight gain really does get easier as it continues as your mind is also getting better from the extra food and you can therefore handle it more than you would have otherwise. Some people regain their weight while eating lower amounts (i.e. 2000 calories) and I honestly think that the weight gan would be a lot harder for them, as their minds are not repairing at the same time so their anorexic thoughts are still as strong as ever.

Through repairing your mind with food, you are able to better accept your body and learn to accept it the way it is supposed to be. Ihave gained 10 kg throughout my recovery so far and I can honestly say that I like my body just as much now as I did when I was 10kg lighter. I think that this is because as my mind repairs (due to eating the extra food) my body dismorphia has also improved so I am starting to see my body more accutrately.

Also whenever I do feel self conscious about my body, the non anorexic part of my mind is strong enough to tell me that there is nothing wrong wrong with my body and that they are only anorexic thoughts I was having. Eating recovery amounts does not only let your mind repair but the rest of your body too.

Your heart and other organs are all damaged whilst you are starving yourself and the only way they can repair themselves is if they have the energy neccessary to do so. The body truly is a wonderful thing if you think about it. The way that it is able to undo a lot of the damage we have done to it is truly remarkable so I think the least we can do is provide our bodies with the energy they need in order to do this.

The Food Intake Guidelines

Here are the guidelines for when 2500 calories applies as a minimum daily intake for recovery:

1. You are a 25+ year old female between 5’0” and 5’8” (152.4 to 173 cm) and,
2. The regular menstrual cycle has stopped and/or,
3. You have other symptoms of starvation: feeling the cold, fatigued, foggy headed, hair loss, brittle nails, dull skin and/or,
4. Even if you were only underweight/dieted for a very short space of time (a few months) these guidelines apply. And remember “underweight” is relative to your body’s optimal weight and is not a clinical measurement.

Here are the guidelines for when 3000 calories applies as a minimum daily intake for recovery:

1. You are an under 25 year old female between 5’0” and 5’8” (152.4 to 173 cm) or an over 25 year old male between 5’4” and 6’0” (162.5 and 183 cm) and,
2. The regular menstrual cycle has stopped and/or,
3. You have other symptoms of starvation: feeling the cold, fatigued, foggy headed, hair loss, brittle nails, dull skin and/or,
4. Even if you were only underweight/dieted for a very short space of time (a few months) these guidelines apply. And remember “underweight” is relative to your body’s optimal weight and is not a clinical measurement.

Here are the guidelines for when 3500 calories applies as a minimum daily intake for recovery:

1. You are an under 25 year old male between 5’4” and 6’0” (162.5 and 183 cm) or female with young children or an equivalent and unavoidable level of activity.
2. The regular menstrual cycle has stopped and/or,
3. You have other symptoms of starvation: feeling the cold, fatigued, foggy headed, hair loss, brittle nails, dull skin and/or,
4. Even if you were only underweight/dieted for a very short space of time (a few months) these guidelines apply. And remember “underweight” is relative to your body’s optimal weight and is not a clinical measurement.

If you are taller than the guidelines listed above, then add 200 calories to the guidelines that match your age and sex. If you are shorter than the guidelines listed above, then you may eat 200 calories less than what is suggested for your age and sex, however these are all minimum guidelines and everyone is expected to eat well above them for a good portion of the recovery process in any case. Please see this this blog post for more details: Extreme Hunger I: What Is It?

*REMEMBER THESE ARE MINIMUM GUIDELINES, YOU MAY NEED TO EAT MORE IF YOU STILL FAIL TO GAIN WEIGHT EATING THESE AMOUNTS!

 

Gaining water weight

It is incredibely important that people who are in the early stages of recovery realise that any rapid weight gain is primarily due to water weight (edema) and is not true weight gain. Edema is an anorexics worst nightmare, especially early on in recovery as for an anorexic at thi time weight gain is the scariest thing in the world. So many anorexics become terrified by the rapid 'weight gain' and therefore either start restricting again or fail to increase ther intake to a proper recovery amount. 

Please try your hardest to push through the anxiety and fear associated with water retention and continue on your recovery journeys as otherwise you will be creating many future problems for yourself. Even if you manage to regain weight on a lower calorie intake, your metabolism will not repair and neither will the rest of your body. You may think that you are some kind of exception and that you do not need to eat as much but you honestly do, in order to make a successful recovery. 

I know how scary it can seem when your body swells and you gain weight at an incredbely fast rate but you just need to keep reminding yourself that it is not real body weight. And that the edema will pass and your weight gain will eventually slow down. In order to make a full recovery, weight gain really is necessary but atleast after the edema subsides, this weight gain will happen at a more barable weight. 

I found the following information on the your eatopia site and thought it may be helpful to those struggling with rapid weight gain due to edema at the moment.

'Water retention. Massive water retention. Water retention that hurts. Water retention that aches. Water retention that makes you look pregnant. Water retention that looks like it might be real weight. Water retention that adds 16 lbs. or more on the scale after only 2-3 days of eating recovery guideline amounts of food. Water retention that scares you. Water retention that sends you scurrying back into full-blown relapse.'

Why Does Edema Happen in Recovery?

When you twist your ankle badly it swells up and it hurts. These are symptoms of healing. The swelling is water retention and the pain is the reaction of the tissues to that swelling that signals you to stay off the ankle and rest.

The water retention in recovery is fluid being retained in areas where a whole mess of damage is being cleaned up and removed by all those fabulous cells dedicated to the task. The fluid actually speeds up the process because things travel faster in and out that way.

Think of it as your own personal City of Venice and all the damaged, overworked, cells that have been on shift for months (because restriction means no back-up cells are available to takeover) are now hopping on the gondola and heading out for retirement (finally).

And the sore is the body's way of trying to keep you immobile—it’s a bit harder for the gondolas to do their job if you either flush all the water away with diuretics or you decide to ignore the pain and slosh everything all over the place instead.

Sore is the signal to rest.

That swelling is a badge of healing honor.

You do not want to try to make the water retention go away because with it will go the healing process as well.

Tips To Manage Edema

The first thing to accept is that the body needs you to rest. You have to chill. Relax.

Ideally spend most of your time sitting with your feet up, lounging or lying down.

Eat a lot. Snack constantly. The more energy you provide, the faster those gondolas move nutrients into the area for repairs and damaged cells away from the area as well.

Put nothing on that doesn’t have elastic and lycra. Stretchy and floaty clothes are your best friends.

Don’t use diuretics. Ever. If the swelling is very painful and you still have things you have to do, then (with a doctor’s o.k.) consider compression socks, hose and garments to ease the pain while still allowing the healing to continue.

Nap and sleep as much as you possibly can.

Donate your clothes. Never try on clothes that once fit you. There are several really good reasons for that. First of all, if they fit then you are not recovering. Secondly, if they don’t fit you will get upset despite the fact that it is a clear indicator you are recovering. Thirdly, only weighing yourself or measuring your dimensions is worse than trying on old clothes when it comes to handing a relapse on a silver platter to the eating disorder.

Remember how I mentioned that you to get rid of the scales and the tape measure? Well, it’s worth repeating. Do not weigh yourself or measure yourself. If you are being supported through recovery with a treatment team, then make it very clear you want blind weigh-ins—that means that you do not face the scales and only your treatment team is aware of exact progress.

Use this time to journal. Investigate all the aspects of yourself that have gone by the wayside, or perhaps never even had a chance to flourish.

Have regular massage therapy sessions as they are especially useful for easing some of the edema-related pain while not interfering with the healing progression. Furthermore, massage therapy is clinically proven to help those with restrictive eating disorders have less anxiety about body image, weight gain and food intake and less desire to practice restrictive behaviors when the anxiety strikes as well.

If you do experience mini-relapses throughout recovery, and almost everyone does, then be prepared for a few rebound days of water retention—obviously restriction causes damage and the body has to fix it. But you will return to where you were in your recovery process within a few days of getting back onto your recommended food intake guidelines*.

The edema will end. The water, bloating and swelling will all dissipate. Of course it won’t mark the end of the recovery process, but it does mark the end of Phase One.  

*Minimum Recommended Intake Guidelines for Recovery:

a) Females under the age of 25: 3000 calories and sedentary.

b) Females 5’0”-5’8” over the age of 25: 2500 calories and sedentary.

c) Males under the age of 25: 3500 calories and sedentary.

d) Males over the age of 25: 3000 calories and sedentary.

e) Females over 5’8” over age 25: 2700 calories; under age 25: 3200 calories.

f) Females over age 25 and under 5’0” as well as post-menopausal women can lower the minimum intake to 2300, but more is always better.

Feeling happy

The last few days I have been feeling quite strong and happy which has been really nice. Times like these, when everything seems easier can be quite rare in recovery, so I like to make the most of them while I can. My anxiety seems to be relatively good at the moment in all aspects of my life. I have been coping with my continued weight gain ok and I am also finally starting to feel more confident at work and am not doubting myself so much.

The only thing I can think of that could explain this is that my mind is really starting to recover. It can be hard in recovery for a while, as your body always seems to be ahead of your mind in recovery, which means that your unhealthy mind has to deal with your body getting healthier (which is extremely difficult). I think it would be so much easier if it happened the other way around!

I have a long day working at the bank today but then I have the weekend off. I am going to Hobart on Saturday with my mum as I have LOTS of things I need. I am starting to grow out of most of my clothes so need to get some more, for when they are completely too small. I also want to buy some groceries that are way too expensive or unavailable in the town I live in, new sport shoes and a vacuum cleaner, as I currently have to borrow my nans, everytime I want to vacuum my floor.

This will be the first time in a long time that I can go shopping and not have to put everything back because it doesnt fit at all, or worse still have to go shopping in the childrens section. I still have very mixed feelings about it though. It has been hard, seeing my clothes get tighter and tighter but I know that this just means I am getting healthier. I try not to see this as me getting too big for my clothes, but instead that my clothes are getting too small for me. My clothes are the problem, not my body. This is a great excuse to spoil myself and buy some nice new clothes anyway.

Amy has asked to come and spend the day with me Sunday too. I will have to try and think of something interesting for us to do as we always just seem to stay home and do nothing when she comes. But she obviously enjoys it as she always wants to come, whenever she can. I think she just enjoys spending time with me though, as we get along so well. I am very grateful to be so close to my sister as I know I havent always been there for her to give her the time and patience she deserved when I was really sick. I am so lucky that she has stood by me regardless if this and is still so proud to call me her sister.

Amenorrhea, anorexia and the pill

Even though my weight got very low, I never actually completely lost my period. My doctor says that the reason I continued to get my period right throughout my illness (although they were very light) was because I was on the contraceptive pill (also called birth control pills). I went on this pill prior to being diagnosed with anorexia because I had acne as well as irregular and very painful periods.

The following information found here explains why anorexic girls often loose there period whilst underderweight and how it can have long term effects on the anorexic patient. 

Amenorrhea is simply a medical term defined as the absence of menses in a post-pubescent woman of reproductive age. Amenorrhea may be defined as either primary or secondary: in primary amenorrhea menses does not occur by the age of 16 in the presence of normal growth and secondary sexual characteristics while in secondary amenorrhea menstruation ceases after menarche.

There is no consensus definition as to when secondary amenorrhea begins, but in practical terms if a period has not occurred in over 90 days, medical attention should be sought. Both primary and secondary amenorrhea may occur as a result of eating disorders but secondary amenorrhea is by far more commonly seen.

Secondary Amenorrhea Caused by Eating Disorders

The type of secondary amenorrhea caused by eating disorders is termed functional hypothalamic amenorrhea. Although restrictive eating disorders or excessive exercise that lead to low body weight may result in primary amenorrhea if they exist prior to puberty, they usually shut down normal hypothalamic function after the onset of puberty.

Up to 20% of Bulimics may experience amenorrhea while between 5% and 44% ofAnorexics experience amenorrhea. People diagnosed with an Eating Disorder Not Otherwise Specified (EDNOS), Compulsive Exercise, or the Female Athlete Triad, may also experience amenorrhea. Eating disorders associated with a high body weight such as Binge Eating Disorder are not associated with amenorrhea. The presence of amenorrhea is, however, one of the criteria necessary to achieve a diagnosis of Anorexia Nervosa according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM IV).

Amenorrhea from Eating Disorders - Hormonal Interruption

When a person engages in excessive exercise or disordered eating that results in low body fat and low body weight the normal secretion of Gonadotropin Releasing Hormone (GnRH) from the hypothalamus is interrupted. This leads to disordered secretion of both Follicular Stimulating Hormone (FSH) and Leutenizing Hormone (LH) which are essential to the normal menstrual cycle and ovulation. A critical level of body fat must be present for normal GnRH, LH, and FSH secretion and subsequent menstruation.

Though often reversible and not a medical danger in and of itself, the type of secondary functional hypothalamic amenorrhea associated with eating disorders may result in complications. Both infertility and osteoporosis may occur after prolonged functional hypothalamic amenorrhea.

Treatment for the type of secondary amenorrhea associated with eating disorders requires treatment of the primary cause. Restoring normal body weight is the first course of action. Hormonal therapy may be required in resistant cases.

So even though my hormone production would have most likely been disrupted whilst I was so underweight, my period never stopped because my pill delivered the hormones into my body that my body was no longer making naturally. I didnt really feel right forcing my period by unnatural means but my doctor assured me that since I only give myself a period once every three months, I wouldnt be harming my body by forcing my period. In fact I would be protecting it my lessening my chances of osteoperosis as well as infertility in the future.

This made me wonder why the contraceptive pill isn't given to more anorexics to regulate their reproductive hormones like estrogen, but I think that it is because doctors dont want anorexics to see the pill as some kind of quick fix. Obviously the best treatment for anorexia is weight restoration and for the sufferer to allow their body to repair. Taking the pill therefore could stop an anorexic from making a full physical recovery as they think they are healthy before they actually are. 

It should be noted that just because your period returns, does not necessarily meal you are physically recovered. Some girls dont even lose their period whilst suffering from anorexia and becoming underweight. The following article sourced here explains how the return of an anorexics period can be a good natural indicator that they are weight restored and how the contraceptive pill eliminates this indicator. 

The weight necessary to resume menses can be estimated with great accuracy and success by using the Frisch tables, which are surprisingly not well known to many physicians (Frisch et al., 1974; Frisch, 2004). There are two Frisch tables, one for girls with primary amenorrhea (never had a period) and one for girls with secondary amenorrhea (began then lost menses). The second table (secondary amenorrhea) is the one that should be used for ED patients, including those who have never had a period before (pre-menarchal). Usually I will use the 50th percentile weight for height in determining goal weight range for any given individual with AN, which indicates a 50-50 chance of menstrual function returning at this weight for height. If menses have not returned after maintaining this weight for 3-6 months, then I recommend increasing the goal weight range by 5 lbs, and again wait for 3-6 months for results. Conversely, if menses commence at a weight lower than goal weight, then the goal weight range can be adjusted downward.

As a psychiatrist specializing in the treatment of eating disorders for most of my career, I can say that this approach works in at least 9 out of 10 times. Very commonly, patients do not want to stop their Birth Control Pills and risk having to gain more weight. Instead they prefer the false sense of security that having monthly blood flow brings them, their families and their uninformed health care providers. In summary, 1) Do not allow birth control pills (BCPs) to be prescribed to young women or girls with AN until after full restoration of weight and menses occurs (at least 2-3 cycles on time); 2) BCPs obscure the most reliable indicator of healthy weight recovery for adolescent girls and pre-menopausal women, i.e., restoration of menstrual function; 3) BCPs do absolutely nothing to prevent osteoporosis or osteopenia, which is driven by many other factors related to starvation besides low estrogen levels, e.g., alterations in cortisol, insulin-like growth factor, and leptin (Mehler & MacKenzie, 2009)

I found it interesting to read that this doctor does not think the contraceptive pill has ptotected me from osteoperosis when my doctor said it had. Perhaps I still am at risk because many hormones are involved in the development of osteoperosis, not only estrogen. While my doctor had told me to stay on my pill, I cant help but think it would be better to allow my body to do things naturally. What does anyone else think? If you were in my position, would you stay on the pill?

Day 10: list 5 goal you have for yourself (they may be long term or short term)

1. To not give into my anorexia or listen to anything it tells me

In order to recover, I know that I cant listen to any of my anorexic thoughts. Everytime you listen tonyour anorexia you are making it stronger and yourself weaker. Unfortunatel I cannot choose to stop myself getting these anorexic thoughts but I do have the ability to ignore them. My goal is to do the complete opposite of anything my anorexia tells me to do and I will try to not let my anorexia make me feel awful about myself. Eventually, if I continue to ignore my anorexic voice it will fade away and dissappear all together.

2. To reach a normal bmi (above 18.5)

Reaching a minimally acceptable bmi is a short term goal of mine but not my ultimate weight gain goal. I want my body and mind to be healthy and strong and since I did not have a bmi of 18.5 before I got sick, so I think I will need to continue gaining some weight after this point to ensure my body is able to repair properly.

3. To continue to gain weight until I reach my bodies natural set point
Your body will only be able to work optimally at its natural set point which is the weight I want to reach. I dont want to spend my life dieting or trying to fight for a body that isn't supposed to be mine. I honestly dont know what my bodies natural set point is yet but I will do my best to figure it out. Both of my parents are thin people so I dont think it would be incredibely high but I just want to be healthy and happy.

4. To learn how to eat intuitively

After reaching a bmi of 18.5 my goal is to start trying to eat intuitively. For those who dont know, eating intuitively involves listening to your body and allowing your body to tell you what and how much to eat. This will allow me to stop counting calories and allow me to develop a much healthier ralationship with food. I dont plan on changing over to eating completely intuitively from my meal plan in a single day but to do it really gradually, so that I can slowly teach myself how to trust and listen to my body effectively. If I learn to eat intuitively and am fit and healthy, my body weight should settle around my natural set point.

5. To learn to love my new body
I know that it will be hard for me to accept my new body weight. The truth is, I like being thin (or my anorexia likes it anyway) and at times I know I will feel uncomfortable about my new weight. I am determined however to learn how to cope with these types of feelings without trying to lose weight, so I can accept myself for who I am. I know that the healthier I become mentally and physically, the more easily I will find it to accept my new body.

I think that having goals in recovery is incredibely important and helpful. Feel free to comment some goals you have set yourself and are currently working on below :).

A typical Monday in recovery

I haven't really done anything all that exciting today but I though it would be nice to give you all a quick update about of how I am going anyway.

I have been awake since 3:30 this morning so it gas been quite a long day for me but surprisingly im not too tired. Something I have noticed since starting to eat so much more is all the energy I now have. I wake up every morning feeling completely energized and ready to start my day. I almost feel like a child who is 'hyped up' after drinking too much red cordial. It feels amazing to be full of so much energy and it is simply because for the first time In a long time I am providing my body with exactely what it needs.

I worked at the bank all day today and got home in just enough time to walk Tess before tea which was great. Since tea I have eaten an extra yummy dessert of hot apple pie with vanilla custard as well as a vanilla milkshake (as I didnt want a hot chocolate as I am already feeling super hot).

There are a few negative effects of refeeding that I am currently experiencing but I am trying not to let them get me down. Firstly I have been overheating at various times throughout the day, particularly in the mornings, after my meals and of a night. As I mentioned yesterday I think that this is due to something  called hypermetabolism.

The reason anorexics commonly suffer from hot flushes is because their bodies start to use energy quite inefficiently whe they are reintroduced to large amounts of food. THIS site explains that while a normal person will only use up 15% of the total energy consumed to produce heat, 30% of an the energy consumed by a person being refed is used to make heat. This is why so many calories are required for a recovering anorexic to gain weight as a smaller proportion of the energy they consume is actually available for muscle rebuilding and fat storage.

Feeling so hot all the time is very different for me as I have always felt extremely cold at all times throughout my illness so far. While I used to wear jumpers in summer whenever I left the house, I had to take my jumper off this morning while I was walking Tess, even though it was only 8 degrees celcius. Its not a terrible side effect of recovery but these hot flushes can still feel really uncomfortable and they make me sweat a lot which can be quite embarrassing.

Another effect is that my skin is not very good at the moment. I have had pimples at various stages throughout my illness but It had gotten a bit better before I started eating so much. My acne has always been much worse whenever I have been feeling particularly stressed or anxious which explains why my skin is not great now. I obviously do feel worried and anxious at various times while fighting my anorexia but so far it hasnt been anything I cant handle. I also know that my hormones would be going crazy as I refeed my body which could also quite easily contribute to my pimples.

While I wish I was not experiencing these negative effects of refeeding, they dont make me want to stop what I am doing for even a moment. Who cares if I get a few pimples or if I need to take a cold shower to cool myself down when I start to overheat. At the end of the day those tiny little things are nothing compared to what recovery would mean for me. We must also always remember that these types of effects are only temporary. I hope that everyone has had a great weekend and that you are feeling ready and energised for the week ahead!

recovery= more than just gaining weight

After writing two posts yesterday which were both to do with the weight related aspects of recovery, I wanted to write a post highlighting the fact that recovery is about more than just gaining weight. Since anorexia is a mental illness with physical side effects, whether a person is recovered should  be determined by what is happening in a persons mind, rather than just how they appear on the outside.


Considering Anorexia is a mental illness, I think that there has been far too much focus on weight when determining whether a person is suffering/recovered from anorexia in the past. One of the diagnostic criteria for anorexia was once that the patient needed to have a bmi under a certain range- I think it was 17.5. Now however this is not considered as an important diagnistic criteria as a patient could be having anorexic thoughts and behaviours while at a slightly higher bmi than 17.5.

If you think about it, it is ridiculous to say that out of two girls with the exact same mindset, the girl with a bmi of 17.6 is not anorexic while the girl with a bmi of 17.4 is anorexic. For example  I was struggling with anorexic thoughts for the 6 months leading up to becoming underweight. While I was initially unable to lose the weight, my mind and behaviors were still really unhealthy.

An anorexic patient should never be declared recovered until a full psychological examination is performed on the patient as well as a physical exam.

When I left hospital I was weight restored and no one would have ever guessed I had anorexia but my mind was still as anorexic as ever. I was not recovered, in fact my anorexia was every bit as bad the day I left hospital as it was the day I went to hospital. It is completely normal for people to experience weight restoration and physical recovery before they recover mentally. The reasons why this is the case are explained in the following information, sourced from here.

There is one finding about anorexia which seems to me more crucial to treating it successfully than anything else.  It is a counterintuitive insight, but one that seems – like all the best facts – completely obvious when once one knows it.  It is this: that for the anorexic, gaining weight is the prerequisite for mental recovery, rather than vice versa.  Put another way: you can’t make an anorexic want to put on weight until he or she has begun to do so.  Put yet another way: the mind may make the body sick, but only the body can help the mind be well again.

It is essential that you firstly gain weight in order to fully recover as your mind will no be able to repair otherwise. So while weight restoration is an important factor in anorexia recovery, alone it does not constitute full recovery. You are not fully recovered from anorexia until you no longer have any of the following physical or emotional/behavioural symptoms. 

Symptoms 

By Mayo Clinic Staff

The physical signs and symptoms of anorexia nervosa are related to starvation, but the disorder also includes emotional and behavior issues related to an unrealistic perception of body weight and an extremely strong fear of gaining weight or becoming fat.

The Minnesota Starvation Experiment, also known as the Minnesota Semi-Starvation Experiment, the Minnesota Starvation-Recovery Experiment and the Starvation Study, was a clinical study performed at the University of Minnesota between November 19, 1944 and December 20, 1945. The investigation was designed to determine the physiological and psychological effects of severe and prolonged dietary restriction and the effectiveness of dietary rehabilitation strategies.

Physical symptoms

Physical signs and symptoms of anorexia may include:

• Extreme weight loss
• Thin appearance
• Abnormal blood counts
• Fatigue
• Insomnia
• Dizziness or fainting
• Bluish discoloration of the fingers
• Hair that thins, breaks or falls out
• Soft, downy hair covering the body
• Absence of menstruation
• Constipation
• Dry or yellowish skin
• Intolerance of cold
• Irregular heart rhythms
• Low blood pressure
• Dehydration
• Osteoporosis
• Swelling of arms or legs

Emotional and behavioral symptoms

Behavioral symptoms of anorexia may include attempts to lose weight by either:

• Severely restricting food intake through dieting or fasting and may include excessive exercise
• Bingeing and self-induced vomiting to get rid of the food and may include use of laxatives, enemas, diet aids or herbal products

Other emotional and behavioral signs and symptoms related to anorexia may include:

• Preoccupation with food
• Refusal to eat
• Denial of hunger
• Fear of gaining weight
• Lying about how much food has been eaten
• Flat mood (lack of emotion)
• Social withdrawal
• Irritability
• Reduced interest in sex
• Depressed mood
• Thoughts of suicide

Keep fighting everyone, and one day you will be free of all of these symptoms. Full recovery is possible as long as you believe that it is. Xx