Tips For Working With Anorexia

Posted on by ncfed

A “Positive Disposition to Recover”.

Even if someone volunteers for treatment, if is often to seek relief from preoccupation with food, depression or physical symptoms. It could be due to rising concern about the risks of anorexia or to avoid the side effects such as infertility.  Does this represent a real positive disposition to recover from the illness (whatever that means)?

Recovery from anorexia  is not just about gaining weight. In many cases being willing to gain some weight is “conditional” on continuing to eat a very limited diet, often vegetarian or low in carbohydrate and fat. 

Eating more is often conditional on continuing to exercise a great deal. There  is a great debate about what constitutes “excessive exercise” and our opinions are clouded by views about the dangers of sedentary behaviour and the general approval which is given to people who “go to the gym”. 

So what is really a positive disposition to recover?  Many of the features of anorexia just will NOT go away if someone remains underweight. Cravings, depression, preoccupation with food and health risks do not go away if weight remains low. Many people want rid of the bad aspects of anorexia while continuing to have its benefits like staying abnormally  thin. That’s not easy to work with. People will not want to look like you.

A “positive disposition” should include the desire to be free from compulsion to exercise, and the ability to eat a wide diet, with other people, and freedom from the constant chatter about what foods can and cannot be eaten. A positive disposition will include the desire to welcome the feeling of food inside your stomach. This will never be possible if weight is low.

 Secretly though, I wonder how possible this kind of recovery really is –  because all  of these recovery outcomes are inconsistent with what gets someone into anorexia into the first place. The anorexic  desire for simplicity, the fearfulness, the ascetic drives –  are not features that can just “disappear”. These are aspects of personality which must persist forever. You cannot argue someone out of their basic personality.

So I’m not sure that I can demand a positive disposition to recover in what would suit me, and my expectations cannot be too high. I think that people and therapists must come to some sort of compromise with anorexia over what will be kept and what can go away for someone to live more happily. Experts might disagree with me.

Force Feeding The Anorexic

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Anorexia And “Force Feeding”- Self Determination Or Self Annihilation

A while ago I was listening to LBC radio. The subject was  a decision in favour of the so-called force feeding  of patient E.  On Saturday Norman Lamont suggested that the decision to force feed could be an intrusion on her right to self determination . What complicates this case is that the parents of this young medical student,- anorexic since eleven  years of age-wants their daughter to be left to die with dignity.

There is nothing dignified about anorexia or any other mental health condition for that matter. Also, I just wish that people would STOP using the term “force feeding”, which reminds us of the traumas inflicted on suffragettes on hunger strike to obtain the vote for British women. I just wish that people would use the proper term, which is ENTERAL FEEDING.

Many clinicians have been writing in favour of the judge’s decision on Linked In.  We talk to each other about things we know, which is that low weight impairs the ability to think clearly. That at low weights the anorexic voice drowns out logic, reason and happiness.

But not-one said it better than Kate, who came nervously to the radio to express her point of view. Kate has been anorexic since age 9 and in hospital many times during her young years. She said “I have no idea why I just didn’t want to eat, but I didn’t, and there were times when I would have been very happy to just fade away.

But they didn’t let me, and there were times when I was on a section and they threatened me with the tube…. No it wasn’t a threat, it was just something they said would happen but it felt like a threat at the time. Having no control over what they put in it was the worst thing imaginable for me.

But I somehow got to the age of 20 and I said to myself, I’m sick and tired of this anorexia. It took 11 years for me to admit I had a problem. So I made myself start to eat. I’m 24 now and life is so much better.  Life isn’t a bed of roses but anorexia is very hard work; and I had enough.

I spoke to my father about it and he admitted that he had something like me when he was in his teens, but being a man nothing was said or done about it.”

The interviewer asked, “Everyone is saying that it’s all the pressure on young girls to be slim, in magazines and so on?”

“Oh no”, she said, “When I was nine I hadn’t even seen a magazine. It’s nothing to do with magazines and models, it’s just the way the brain is wired”.

So there you have it from the people who really count. Clinicians know very little. Listen to the people who have looked into the pit and been dragged into the light, kicking and screaming. At all costs we have to arbitrate in favour of the wish to live.

Sisters of Anorexia Patients & Bulimia Sufferers Urgently Needed

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Chocad_BN_newChocad_AN_sisters_EEG (2)A study at the University of Reading needs YOU if you are a sister of someone with anorexia or YOU suffer from bulimia.

Dr Stefanie is studying how your brain responds to tasting chocolate.

You can find a link to their webpage below

http://www.ciaramccabe.co.uk/volunteers.html and there is  a facebook page: https://www.facebook.com/chocolateexperiment.

If you can help, do!  We need all the research we can to help people with eating disorders.

Sisters Wanted For Anorexia Research

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The University of Reading is doing a research project involving sisters of anorexia sufferers who have NOT had an eating disorder themselves.

If you can help, call Dr Stefanie on 0118 378 6946.

All Females Must See This Short Film

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AMAZING!  http://www.upworthy.com/5-minutes-of-what-the-media-actually-does-to-women-8?c=ufb3

Binge Eater? Don’t take Vyvanse!

Posted on by ncfed

Mr Ornskov, Chief Executive of Shire pharmaceuticals is seeking to expand Vyvanse into new areas, well he would, wouldn’t he. This is a HUGE market.

Vyvanse is an amphetamine – like drug which can lead to an addiction in a population already struggling with control issues. It may have an effect on impulse control, but impulse control is not the main issue present for binge eaters.

Lisdexamfetamine has a high risk for abuse. It may be habit-forming if used for a long period of time.  Abuse of Lisdexamfetamine may cause serious heart problems, blood vessel problems, or sudden death. We have been here before.

Will it cure binge eating?  I think not. Is there anything we can do to prevent Shire from getting approval to market this drug to a gullible public. I fear not.

 

Carbohydrate Phobia: Go Enjoy Your Toast!

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Quoting Hannah Devlin,  the Science Editor of the Times; she  claims that nearly half of women say that they feel guilty about eating carbohydrates, despite their essential role in a healthy diet.

 A survey of 3,000 people found that women were twice as likely as men to suffer from ‘carb guilt’, even though they were more likely to be a healthy weight.  Nearly everyone I treat for an eating disorder considers carbs to be poison. But is this making us thinner?  Nowadays about 65 % of men and 58 % of women in Britain are overweight or obese, compared with 58 %and 49 % respectively in  1993.

Holidays like Christmas are becoming increasingly  indulgent with the average person having about 6,000 kcal on  Christmas day and an extra 500 kcals daily during the festive period, according to the British Dietetic Association. I’m not sure whether this includes alcohol which is consumed in enormous quantities during the holidays. Whatever, it leads to an average weight gain of about 5lb by the beginning of the new year.

 My niece who lives usually in the USA has visited London this January and expressed alarm at the number of dieting programmes she has seen on TV and in the papers. She says that there is nothing like it back home. A big part of this includes a recommendation to banish carbs from our diet as an effective way to lose weight quickly, despite clinicians saying that  this can be harmful.

 Jane Ogden, a professor in health psychology at the University of Surrey who is involved in this research  said  that people are irrationally demonising carbohydrates. “If they realise that carbohydrates have an essential part in  their diets, not only for energy but also  for building long-term sustainable healthy habits, then carbohydrates can  resume their place as a central part of how they eat”, she said.

Most people are unaware of how much carbohydrate they should be eating .  The recommended daily allowance is 250g – around half of a person’s daily calories – but when asked what that might amount to in food, most people significantly underestimated it.  A correct balance would be a bowl of breakfast cereal, two slices of bread, one plate of pasta and three oatcakes. That is what we could and should be eating. Basically, that is what I eat.

A recent Horizon investigation into the effects of a fat versus carbohydrate diet shows that you can live very well on carbohydrates, regulate your insulin very well – despite claims to the contrary – and also lose weight.

 But that’s not what people think. We have been taught from the 1950s onwards to fear the humble carb. Of those questioned, 1 in 10 women said they felt guilty all the time about the amount of carbohydrates they ate and about a quarter said they would avoid them in the week to allow themselves to indulge at the weekend.

 Instead of trying to cut out carbohydrate, Professor Ogden – and me too – say that the focus should be on mostly avoiding food with a lot of added sugar, and trying to include foods with healthy complex carbohydrates, such as whole grains, beans, fruits and vegetables. I say mostly because one piece of cake won’t hurt you now and then.

A diet low in carbs can make people feel permanently  hungry, which can lead to snacking and grazing on foods full of fat and simple sugars.  People feel that they are denying themselves the foods they really want to eat and , in the end, most people end up over-eating the very foods they are trying to avoid.

This, in turn, results in feelings of guilt and the need to deprive oneself again.  Ultimately, it becomes an unhealthy, vicious cycle”.

So, we are afraid of fat and we are afraid of carbs. Neither it appears will hurt you. It is only when they are stuck together in processed foods that they seem to do us harm. And booze, that’s another matter for another blog.  So go and enjoy your toast.

 

 

Having And Eating Your Cake

Posted on by ncfed

The desire for two mutually exclusive events bedevils eating disorder treatment. You see it in someone with anorexia who wants to get rid of the effects of starving but remain very thin. You see it in someone who wants to get rid of bulimia but eat very little to become their perfect weight.

Eating disorder symptoms are cravings, binge eating, purging, tiredness, panic, depression, fainting, getting the shakes, anxiety, obsessions and crazy destructive moods. Many of these symptoms are the result of dietary chaos and its effects on the brain and the nervous system.

There is no way out of an eating disorder unless someone is willing to eat a balanced highly nutritional diet for a while even if they are still purging. This will include carbs and it will include some fat.  This must be done with guidance and support because it is NOT just healthy eating. Then, surprisingly, many of these symptoms will calm down, allowing the real emotional strengthening to take place where it is needed.

But eating is often the thing most feared. They say to me, I want you to stop me bingeing, perhaps with hypnosis or discussing my unhappy childhood. I don’t want to eat, because I want to lose some weight (or stay at the weight I am now).

In my very long experience, people with compulsive eating problems and bulimia often lose weight after treatment. But there is no way around it for the anorexia sufferer. Remaining thin will feel safe, but  will keep you demented. If someone doesn’t get what they really want, it is because they are bargaining with the price.

For some people with eating disorders, the price of recovery is too high. Eating is worse than murder. We have to be so patient, and so able to help someone to see that we cannot have our cake, and eat it too.

 

 

 

 

Does Anorexia Ever Really Go?

Posted on by ncfed

In the Times way back in August 2013 Lizzie Porter wrote movingly about the after-effects of the illness, which are still with her.

In her book about Anorexia, Emma Woolf also writes movingly about her struggle to get well. Despite being able to move away from the cachexia of severe anorexia, she documents in her column An Apple A Day how residual anorexic thinking prevents her from being able to eat cheese. Her recovery  is conditional upon maintaining an orthorexic relationship with food.

I was, oh so briefly anorexic  years ago, and now I eat a very broad diet. Only yesterday  I dug happily into  a meringue made by one of my friends. I stir fry quite a lot of food. I have butter on my jackets.  But I do eat more healthfully and in smaller quantities than most of my friends.  Even now, after all these years,  you won’t see me tucking into the canapes at parties. I drink very little alcohol and rarely want  dessert, only ice cream, perhaps one boule.  I eat cheese although dainty little chunks. I’m not very interested in food.  Am I just looking after my health, or, does anorexia ever really go?

Lizzie Porter’s account of her 10 year struggle with anorexia needs to be read by all eating disorder professionals who feel stuck after working with a young patient for 2 or 3 or even 10 years.  While it is clearly a mental disorder, the manipulation of food has very physical effects. Perhaps the physical effects of eating trump the emotional ones and make it easier for someone to become or stay anorexic rather than  depressed or psychotic. Lizzie writes about all the medicines she has to take to manage indigestion, cramping,  bloating and nausea. Is this an effect of the anorexia or did it make the anorexia happen?

In my case for example, from as early as I can remember, I couldn’t eat large platefuls of food. The usual party food loved by kids made me queasy when I was very young.  I was only interested to eat fish and chips when I went out.  I only wanted to drink milk or bitter lemon. I couldn’t stomach biscuits or coloured ice creams. Unlike other kids, I was not interested in food. My tummy is very unhappy if I eat a lot of fat or drink more than half a glass of wine. That was there before I had any concerns about weight.

Lizzie says that the anorexia is still with her long after therapists think her treatment is done. Until recently she says, the idea of sex was repulsive but she seems to have dragged herself out of that. What an effort everything is for her, although outwardly she seems to be successful, she is still secretly weighing food and scheduling her day around mealtimes.  She wishes to be free of the fears  of food and its effects  like occasional dizzy spells while and enjoys being thin.

I would say to Lizzie that anorexia never really goes, but as one gets older, one becomes more forgiving.  We learn to be “anorexic” and also well. We can learn to live without thinking about food at all. We can have fat moments and fat days and give them no attention at all.

So to therapists who agonise about the extent to which someone is stuck with their anorexia I would say this. If the patient is bulimic, they need constant care since they are those most likely to be very, very sick.  But if  your patient is safe and functioning reasonably well, endless therapy probably isn’t going to do much at all other than provide the illusion that something is being done.  Anorexia isn’t a quick fix, a life sentence or something that has to be chewed on by well meaning therapists until someone is maintaining a totally normal weight .

Many therapists might disagree with me and argue in favour of treatments that represent a complete cure. This is ideal, but is it possible if anorexia doesn’t really ever go?  I’ve met some eating disorder experts running well known treatment services who are still extremely thin.  YES,  YOU KNOW WHO YOU ARE…. They argue in favour of health. But has their anorexia ever really gone?

Obesity Experts For Sale To VLCD?

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Today I found myself arguing with the NICE co-ordination team who are on the verge of recommending VLCD liquid diets for Obese Type 2 diabetics.

VLCD diets are associated with addictive behaviours, long term weight loss failure and severe binge eating, which can make people even more  unhealthy. Of course they “work” in the short run, as does anything.  Is it any surprise that some of the expert obesity specialists who endorse diet systems and who “do the research” are in the pay of these commercial operations?

In 2010 it was reported that Susan Jebb, obesity expert, is being paid by Rosemary Conley and Weight Watchers presumably to lobby on their behalf. Or something else. Just about all commercial weight loss enterprises have their expert obesity academic on their letterhead.to confer “authority” on their products. Do you think that such organisations should be compelled to disclose what they pay and to whom? Shame on the academics for taking the “kings silver” and for not having the courage to say that everything works for someone, that long term outcomes are pretty much the same for everything, and for not being able to admit which enterprises are causing harm.

I should know about harm – I pick up the pieces. On behalf of the overweight and ill, it is naughty.