Food is the
vehicle of an eating disorder. Food
influences your physical and mental health, and consequently, your very
existence in the world. Food is vital to your recovery from an eating
disorder.
Adequate
nutrition allows your brain to think-- to examine and understand
both internal and external experiences. Adequate nourishment allows your
body to perform vital processes for survival and health; however, in
anorexia and bulimia, food moves beyond the role of nourishment for the
body and becomes the object of rules, regulations and judgments that
dominate one's life. The lack of food, via restrictive intake, purging
and/or excessive exercise, physiologically drives the mounting obsession
with weight and body shape so characteristic of an eating disorder.
Let's look at the
transition of the healthful use of food as nourishment to the painful use
of food as a dominating force of esteem using a metaphor. As an eating
disorder begins, so do food rules. The persistent,
progressive evolution of "food rules" can be likened to the development of
a large, complex computer file complete with a directory and
subdirectories.
Rules are logged
alphabetically in the directory. For example, all food rules related to
fat can be found under "F" and in the subdirector under "Fat." Initially,
food, health, exercise and weight beliefs did not require so much
organization and memory. Simple, healthful guidelines easily fit in a
small, basic file. There was no need for a directory or subdirectories.
But, as an eating disorder develops more rules and regulations
about food, weight, and nutrition are written and enforced. All
of these new rules require memory space and greater organization. The file
becomes complex, demanding and powerful. Other files that contained
information about health, eating, weight and exercise are deleted to
accommodate the memory needed for this new file, the Eating Disorder.
Files which contained information on interests outside food and eating are
either shortened or deleted. This master file is stuffed with
rules and guidelines about food, eating, exercise and weight, and
continues to grow as the eating disorder develops and influences a
person's life. If you are a person with an eating disorder, you may feel
controlled by the rules contained in these files--they become your central
rules for living and it may feel as if you cannot live without them.
Through the new
rules and regulations food takes on a different meaning. Foods
you once enjoyed are now categorized as "bad" and only permitted in small
quantities or not allowed at all. Guidelines from various diets you may
have read about are merged, producing the strictest rules possible to lose
weight or maintain a goal weight. Nutrition and health guidelines for the
general public, delivered through the media and marketed by authors of
diet books, are rigorously enforced as if they were written precisely for
you. Frequently, they are enforced at a level several times beyond the
general recommendation. The rules of the Eating Disorder file demand it.
Choices seem to
disappear. Eating becomes rigid, limited, and a source of personal
judgment and scorn. Every action must be in accord with the
rules, which constantly up the ante for weight loss and discipline.
Many professionals
believe that dieting is one entry path for an eating disorder. The impetus
for dieting can come from a variety of events or situations, culminating
in a desire to lose weight. An offhand, weight-related remark from a
friend or a stranger, the break up of a relationship or the loss
of a loved one can trigger the desire for weight loss in some
individuals. Frequently, eating disorders begin during adolescence, when
young women and men experience the changes of puberty in their bodies.
These natural changes in body shape and composition are frequently viewed
by young women as undesirable and they feel out of control.
Women in our
society experience cultural pressure to achieve an
unrealistic, prepubescent, thin body shape and are encouraged to
sculpt their bodies by any means possible to achieve this commercially
promoted ideal. For some, dieting unleashes the Eating Disorder file,
causing eating and weight to take on some new, unhealthful, meanings.
Some research has been
done on eating patterns in anorexia and bulimia. There is no exact eating
pattern in any situation, but trends do emerge. In anorexia, there is an
absolute reduction in caloric intake, many times accentuated by a
significant increase in activity.
The primary dietary
trends are the consumption of a low fat diet, vegetarianism and a
preference toward or avoidance of sweets such as candy or frozen yogurt.
Individual eating styles are unique, but what is universal, when evaluated
alone or with energy expended through activity, is that the amount
of energy consumed is inadequate for good health. Because overall
food intake is low, intake of the macronutrients protein, fat and
carbohydrate suffers. Many times carbohydrate, found in
vegetables, fruits, breads and cereals, etc. becomes the mainstay
of the diet to the exclusion of protein and fat. Frequently, dietary
intake of fat is drastically reduced. This reduction may emanate from the
well-publicized emphasis on a low fat diet for good health and weight
loss. However, the levels permitted by the Eating Disorder file are
usually far below those recommended for good health.
Protein intake is
also reduced, frequently to unhealthful levels. This reduction
may occur as part of an individual's overall decrease in calories or
protein may be specifically targeted for its supposed high fat content.
This creates a deficit in the raw materials that the body needs to
function.
Proteins which are found
in meat, fish , poultry, eggs, cheese, milk, beans and legumes, are the
building blocks of the body. Protein's primary role in the body is
to repair and build new tissue. Skeletal muscle, hair, eyes, the
immune system, heart, skin are all made of protein. When dietary protein
is inadequate, these tissues are not repaired and begin to break down
(hair loss, weakened heart, brittle nails for example.) Inadequate fat
intake also has its consequences. It can lead to poor absorption of fat
soluble vitamins such as vitamins E, D and A, cold intolerance, dry skin,
loss of menstrual function, and even a clinical deficiency of essential
fatty acids.
Dietary trends seen in
bulimia include a number of different eating patterns.
Similar to anorexia there is a pattern of restricted food intake.
Individuals may classify this minimal food intake as "good" and necessary
to achieve or maintain a desired weight. In addition, there is binge
eating, classically described as consuming a large quantity of food in a
brief period of time.
Looking beyond the
definition, a binge is a very subjective experience and
can be defined in a number of ways, 1) eating more than allowed on the
"good" plan, by a lot or very little, 2) eating in a very frenzied, "out
of body" fashion, not tasting the food, just stuffing it down, or 3)
eating a forbidden food (a food not allowed in the "good" diet.) Binge
eating can be spontaneous; a "good" meal goes too far: you begin eating
and just can't stop, an unrestrainable hunger emerges. Or, binges can take
on a life of their own; planned, guarded, feared and relished. For some,
every eating episode is a binge, and eating in control is no longer a
possibility.
Purging, ridding the body
of the unwanted food is a component of bulimia. This may be accomplished
through vomiting, laxatives, diet pills, exercise or food restriction.
Each of these purging methods affects the way the body functions and can
be life threatening. Tangible problems such as electrolyte imbalance,
cardiac arrhythmia, esophageal tears (leaving blood in vomit or stools),
dehydration, colonic damage, etc. can and do occur from purging.
Feeling like one's been hit by a Mack truck is a common sensation after a
binge/purge episode. The body is reacting to receiving and losing
(possibly violently) nutrients, water and electrolytes. Individuals
struggling with anorexia may also use binge eating and purging and
experience negative physical effects.
As you can see, eating
disorders are not without consequences. Most of the physical
consequences are related to malnutrition, starvation and purging.
Physically, you might notice hair loss (by the handful is not uncommon),
bruises and cuts that do not heal, dry and cracked skin, fine downy hair
on your face and arms, being cold (even on a warm, sunny day), dizziness
when sitting up or standing, and extreme fatigue. These symptoms
occur through a number of different pathways in the body, but the common
cause is malnutrition. The body is not receiving enough
nourishment to function; that means there are not enough calories,
protein, fat, carbohydrates, vitamins, minerals and fluids.
A medical
clinician can assess additional parameters where eating patterns affect
one's health. These may
include pulse, blood pressure, and temperature. Blood tests that evaluate
electrolyte and hormone levels may also be taken. And, if appropriate,
bone scans may be completed to assess bone density. Individuals with
eating disorders frequently have decreased pulse rates, low blood pressure
(below a level that is healthy), and low body temperature. Tests of
electrolytes and hormone levels may also come back abnormal.
Electrolyte imbalances
resulting from starvation and/or purging play havoc with the body's
ability to conduct electrical impulses. These impulses are the workhorses
of basic bodily functions, such as heart beat. Women with anorexia and
some women with bulimia lose their periods. For most, this is due to
hormonal changes resulting from weight loss brought about by poor diet,
and sometimes, by excessive exercise. Others may lose their periods prior
to weight loss, due to chaotic and poor eating habits. To protect itself,
the body makes hormonal changes which then can often put individuals with
eating disorders at risk for losing bone density, which may not be
recovered.
There have been studies
of what happens to the body when it does not get the energy and nutrients
it needs to function, resulting in significant weight loss--it starves. An
important note, significant weight loss does not have to occur for
the body to be malnourished. Many individuals with bulimia,
including those whose weight hasn't changed or has increased since the
beginning of the eating disorder, are malnourished and may be at medical
risk.
During starvation, the
body must look to itself to supply the energy that is not being provided
through food. The body uses stored carbohydrate and fat. But it does not
use these alone. The body also goes to internal sources of protein,
including skeletal muscle, heart tissue, and blood proteins for energy.
The body begins to break
itself down to survive using a type of "cannibalism." There is a loss of
lean tissue, skeletal muscle for example, with any weight loss, but
drastic reductions of energy intake result in much higher levels of lean
tissue loss. As weight loss progresses, there is no carbohydrate or fat
left to process, only lean, functional tissue, that which makes a person
breathe, think and move. This loss of protein affects the whole
body including the heart. The heart gets smaller and weaker and
is not able to function very well. It becomes vulnerable to malfunctions,
such as heart attacks.
The body will try
to save itself from this "cannibalization" by reducing the metabolic rate,
therefore reducing the amount of energy expended. This reduction in
metabolic rate is reversed when adequate energy and nutrients are consumed
in the diet. Serum cholesterol levels can be very low or high due to
changes the body makes to survive starvation. An elevated cholesterol
level in this situation does not warrant a low fat diet! Electrolyte
imbalances can occur, especially if one vomits and/or uses laxatives.
Initially, an eating disorder can cause your body systems to begin showing
signs of stress (low blood pressure, pulse and temperature), if unchecked,
ones entire body systems can fail (heart attack, kidney failure, death).
Other changes associated
with the malnutrition of eating disorders include early satiety
(feeling full) and bloating due to delayed digestion in the
stomach. You may experience decreased appetite for brief or extended
periods of time due to increased levels of metabolites from an alternative
energy pathway.
Sometimes, when
you are in this state, eating will cause the lack of appetite to go away
and an intense hunger may appear.
The hunger is real, not a betrayal by your body. Actually, it is a much
more accurate reflection of your body's nutritive state. Constipation can
occur due to low calories and altered metabolic rate. In many cases, the
small amount of food consumed does not provide enough bulk for normal
bowel movements.
The malnutrition
of an eating disorder also affects the way your brain functions.
It may be more difficult to identify these changes, because in many ways
they work with the eating disorder's rules and regulations. Behavioral
changes seen in starvation and eating disorders include a preoccupation
with food, binge eating, or a loss of control when food is available,
impaired concentration, indecisiveness, mood swings, depression and social
isolation. These consequences make it difficult to clearly assess what is
going on, therefore enabling the eating disorder to thrive.
Recovery can be a
very difficult process, and understandably more than an individual can do
on her or his own. Because an eating disorder is so pervasive,
treatment usually includes a team of professionals so that each area of
your life and health can be appropriately addressed. Nutrition is
vital to recovery. Changing your diet by incorporating the
energy, nutrients and fluids necessary for proper brain, heart, and immune
function makes it possible for you to become physically stronger. This
strength enables you to move to a new place. A place, perhaps, where you
can continue on a path leading to recovery. It is difficult, if not
impossible, to think about such a process with a brain that isn't
functioning well. The Eating Disorder file is running the show, and the
weakened physical state frequently seen in eating disorders (even if you
exercise a lot) makes it so difficult to make changes.
The good news is
that much of the medical deterioration from an eating disorder is
reversible with time and nutritional rehabilitation.
This requires providing your body with the energy, nutrients, vitamins,
minerals and fluid necessary to function. Nutritional recovery is not
about excesses. It is not about "fattening up." Nutritional recovery is a
progressive process where food, an element vital to life, is reintroduced
in a fashion to promote your health and well-being. The help of a health
professional, a Registered Dietitian, can make dietary changes seem more
attainable by providing education and constant feedback as to your
nutritional state and the rationale for changes. Meal plans that focus on
goals that directly improve your health can complement other areas of
treatment, namely therapy and medical visits.
When seeking help to
improve your food intake, it is important to work with a health
professional who is qualified and knowledgeable. It is important
to know that anyone can call themselves a nutritionist. There are no
education or training requirements for a nutritionist title. For help with
nutrition, seek out a Registered Dietitian (R.D.) A Registered Dietitian
is the health professional who is trained to help individuals make
positive changes in their eating habits, promoting better health. All
R.D.'s have completed prerequisite education and training in nutrition,
including a bachelor's degree and required classes in biochemistry and
nutrition, and clinical training in nutrition as part of a dietetic
internship.
All registered dietitians
are nationally registered with the Commission on Dietetic Registration.
There is one catch: many Registered Dietitians call themselves
nutritionists. So, when inquiring about a nutritionist's qualifications,
be sure to ask if they are a Registered Dietitian.
There are R.D.s
who specialize in working with individuals who are recovering from eating
disorders. As with most health professionals there are many ways
to locate a Registered Dietitian. Your therapist and/or medical clinician
may be able to provide you with referrals. You can also contact eating
disorder treatment centers and inquire if the dietitian is available for
individual consults or has a private practice. Large medical centers may
also offer outpatient nutritional counseling by a dietitian.
There are also
many R.D.s in private practice. You can check the Yellow Pages
under the headings "Dietitians," "Eating Disorders Information and
Treatment Centers" or "Nutritionists." The American Dietetic Association
provides a National Nutrition Referral Service. Registered Dietitians
across the U.S. are listed by location and specialty. The service is free
and the toll-free number is 1-800-366-1655. You can also
locate registered dietitians who specialize in eating disorders under Finding a Dietitian at the American Dietetic Associations web page,
located at http://www.eatright.org.
OPTIMAL EATING
thanks Tami Lyon, R.D., M.P.H., C.D.E. for this informative and
interesting article.
