Category Archives: eating disorder recovery

Digestive Distress in Eating Disorder Recovery

tummy troubles 3

So you’ve started recovery from a restrictive eating disorder, and suddenly you’re experiencing tummy troubles: troubles you may or may not have been expecting. I know that when I started recovery, I was unprepared for the physical symptoms and did not attribute some of them to recovery process. I wish I’d known more: my mum and I were baffled when I started sweating so profusely at night that I was soaking the sheets through, and I thought I had Chronic Fatigue Syndrome at one point when I was unable to even sit up in bed I was so tired. Both of these are normal recovery symptoms (sweating lots indicates your metabolism speeding up, and exhaustion is your body telling you to rest and repair).

The first set of symptoms to normally occur, however, are those related to your digestive system: gas, bloating, constipation, diarrhoea, acid reflux, indigestion, partly digested food, abdominal pain, and having very frequent bowel movements. These symptoms are not fun, and they are certainly not comfortable. However, recovery is about persistence.

tummy troubles 2

Restriction has a huge affect on the body, and with the digestive system, if it the body isn’t processing food regularly and consistently, it will stop wasting energy on working so efficiently. The digestive system slows down: a healthy person’s digestion rate is about 1.5 hours, whereas someone who has been starving themselves can have a digestion rate of 4 or 5 hours. This means that when you start to nourish your body with adequate and consistent energy, the digestive system will need a while to catch up. During the beginning of your recovery, because your digestive system will be working slower, food will sit in the stomach or bowel longer than it should do, which can result in abdominal distension, gas, and constipation. Or the body can go I’VE FORGOTTEN HOW TO PROCESS THAT, which can result in diarrhoea.

Restriction also can result in critical bacteria in the gut being reduced, and digestive enzyme levels being not as they should be, which also contributes towards digestive issues.

Wastage of muscles in the abdominal area can also cause distension as the muscles are not strong enough to hold things in more firmly when food is eaten. Do remember though that your stomach will distend slightly throughout the day naturally – the more food, the more your stomach will distend, and this normal and healthy. Those in recovery though will often find that the bloating and distension is far more extreme than that of a healthy person -and that is normal for the recovery process. Remember that your stomach has most likely shrunken during starvation, and will need to be stretched back to a normal size with refeeding. This is not going to be a great feeling, and it is likely to cause pain and tenderness.

The other thing to talk about is IBS and food sensitivities. During your eating disorder, your body can become unused to processing certain foods, for example, carbohydrates could be one. Dairy products could be another. This could lead you to think that you have a gluten or lactose intolerance if in recovery you start to reintroduce foods like bread, pasta, biscuits, cakes, and pastries, and/or ice cream, cheese, chocolate, and milk back into your diet and you get adverse digestive effects. However, this is generally not the case. If your body has become unused to processing foods that you have restricted for a long time, it is logical that it will now have to work up a tolerance again (like babies have to). It does not mean that you will be permanently intolerant. Abstaining from these foods that you are sensitive to will only mean that the body never gets used to processing it again. Refeeding and reintroducing these foods slowly into your diet – with the help of a doctor if the results are severe – will help your body develop a tolerance to them again and heal the gut. The same is true of IBS. Your doctor may have diagnosed you with IBS if tests for other conditions came back negative. Most of the time, sensitivities and IBS are resolved with refeeding, so give it time. Recovery requires patience and perseverance, so bear with the discomfort and keep on going. If after years, certain symptoms have not resolved themselves, then it is time to look for other causes, but this is fairly uncommon. Obviously if you have diagnosed food allergies or diseases/conditions such as Celiac disease, Crohn’s or ulcerative colitis, neuropathy disease, or have any obstruction in the GI tract, or have any other diagnosed medical condition that would be dangerous and cause damage to you if you were to increase certain foods/types of foods into your diet, then the paragraph above does not apply to you.

So, onto gas. This is probably the most awkward of the recovery symptoms. Smelly gas; loud gas; persistent gas; gas that wakes both you and your partner up with a start when you trump in the night (yes, that happened to me). It can feel embarrassing, but it’s one of the most common symptoms in recovery. If it happens in front of someone (which it probably will) just giggle about it. It may even help to pre-warn them if you are happy to let that person know that you are in recovery from a restrictive eating disorder. It means that they will be expecting it and you can laugh about it (which you can do even if it is a surprise). Everyone farts- you’re just going to be letting off wind a hell of a lot more than the average person for a while.

Frequent bowel movements are also normal. This can be a sign of your digestive system speeding up. I went to the toilet to poop up to seven times in a day for a while (yup, really). If your bowel movements are loose, this could be the I’VE FORGOTTEN HOW TO PROCESS THAT from above.

It is important to continue to eat, even when it is the last thing that you want to do. If you are experiencing a lot of pain, then it is okay to give yourself a break and eat when it feels more tolerable, but discomfort and slight pain is normal and it is important to eat adequately and consistently. However, if you are worried about any symptoms that you are experiencing, please see a doctor to determine if there is anything other than the normal recovery process going on in your body.

So how do you deal with these recovery symptoms?

tummy troubles

Firstly, if you are experiencing constipation, eating fats can help move things along. Getting some fibre never goes amiss to prevent it from happening, but this is recovery, so doing healthy people things won’t necessarily work. Warm water is also extremely helpful for constipation – I’d never heard of it before but it has saved me a couple of times. If your stomach is not feeling so great, herbal teas can help settle it, and a hot water bottle can help ease pain or discomfort. For acid reflux and indigestion, there are over the counter medications that you could use, or you can visit your doctor for other options.

I know it sucks, but don’t give up – these symptoms do not last forever. Be patient, and stay on course. Keep moving forwards. As Churchill once said “If you’re going through hell, keep going.” You will come out the other side.

New Year’s Resolutions vs Eating Disorder Recovery

Happy-New-Year-Banner-2016-15

So New Year’s Eve has come and gone, and people are scribbling their new year’s resolutions all over social media and bringing them up in conversation. And if truth be told, it’s boring. It’s boring and it’s pointless, because most people jump simultaneously on the resolutions and diet culture band wagon and publicise their diet/weightloss/health/exercise #goals for 2016, which predictably (and thankfully) are forgotten about a month or so into the year.

For some people, it’s not just boring, it’s anxiety-provoking, and those people are those recovering from a restrictive eating disorder. After knuckling down and recognising and accepting that weight gain is part of the process, as is eating much more, ceasing exercise during recovery and cutting it down in general for life, and eating and regaining a healthy relationship with “fear foods” which generally consist of high fat, high carb, or high sugar foods/food groups, they then have to watch everyone pledge to lose weight, exercise more, and cut down on “unhealthy” foods.

If you are one of those people, it’s going to be hard seeing and hearing about all these new years resolutions that trigger negative thoughts and emotions, and tempt you to engage in the same behaviours that for most would end in the cessation of them, but for you would end in the spiral back down to misery and sickness, and could end in death. It could be an obvious impulse to just say “fuck it” and relapse, or it could come under the manipulative guise of “health” – that eating disorder voice whispering in your ear that going paleo, cutting down on carbs, or hitting the gym would not be a behaviour but just a way to get healthier (Nope. It’s a behaviour. It would be many steps backwards and the path to full relapse). If you are experiencing any of the above difficulties, you need to remember to focus on yourself. Other people’s behaviours should not impact on your own. You know where it would lead you, and it is important to make it your utmost priority to do what is best for you, your recovery, your happiness, and your health. Don’t allow other people’s insecurities and anxieties about their weight and shape influence your own actions. Instead, empathise with them. Know that they are not feeling happy with themselves and hope for their sake that they find a way to accept their bodies as they are naturally and celebrate themselves as beautiful people with beautiful bodies.

Remove toxic relationships or negative people from your life if you are finding a certain person consistently triggering. Unfollow people on social media who are likely to post/continue posting about weightloss, dieting, exercising, or anything else that triggers you as an individual. Talk to the people in your life who try to have conversation with you about their diet or exercise routines or similar, and let them know that it is unhelpful for you. Those who love you and care about you will cease pushing these topics on you. Those that don’t are the toxic, negative people in your life that I mentioned above.

Finally, know that your recovery is mandatory. You need to do what is best for you and your recovery, and that means fighting the negative thoughts and getting rid of any constantly triggering people. You deserve to live a happy and healthy life. Keep working for that, and keep moving forwards. You can do this.

Christmas and New Year: Anxiety Aftermath

anxiety

So Christmas and New Year are finally over. Most people with eating disorders approached the Christmas period with intense fear and have probably left it with intense guilt. And that’s okay and that’s not okay. By that I mean that it is okay to experience those feelings. You are not alone and those feelings are not your fault. What’s not okay is that your eating disorder has control over your life, so keep fighting the war against it, and don’t respond to those negative feelings. You are going to be okay and you can get through this.

If you ate more than you usually would this Christmas, went outside your meal plan, or ate what a normal person would eat over the Christmas period, I can imagine that right now you are feeling extremely stressed, and terrified that you have put on weight or that your body composition will change. And if you have put on weight or your body composition has changed, that’s okay. If you have stayed the same, that’s okay too, but remember that part of recovery is about gaining weight, and along with that does come a changing body.

The guilt of going against those eating disorder rules can be overwhelming, but it is important to remember that this is part of recovery. Going against your eating disorder and doing what you deserve is part of fighting the battle inside your head. Eating whatever you want, whenever you want, is the goal, and so if you were able to do that for a day, or two, or more, or even if you were able to eat a little more than normal, you are making small steps towards achieving that outcome. That is a wonderful thing, however terrible it might feel right now.

Unfortunately, feeling negative feelings and thinking negative thoughts are part of recovery. If it wasn’t, recovery would be pretty easy-going. It’s important to push past that and sit with the feeling of anxiety (and other negative feelings) rather than respond to them. The feeling will pass if you give it time to. You can read my post on anxiety management that may help you sit with anxiety and other negative emotions and thoughts.

You may also be feeling triggered by the people around you, complaining that they have put on weight or have eaten “too much” this Christmas, or need to go on a diet because of that. Please ignore them. They are battling their own insecurities and are looking for reassurance that this is okay and that other people feel the same and that they are not alone. This is really, really sad, and something that no one should have to feel. Enjoying the Christmas food is part of the festivity, and no one should have to feel guilty for it. Know that other people’s worries are not a reflection on you, and you should keep in mind that it is not something positive that they are experiencing, but guilt and anxiety and insecurity. So instead of letting their negativity impact on you, empathise with them, as guilt, anxiety, and insecurity are emotions that you are likely experiencing also (albeit on a much grander scale to those who do not have eating disorders). Keep moving forwards towards your goals. Keep moving forward on your journey towards health and happiness. Keep in mind your motivations, and remember that the way you respond to others only affects you primarily. You can do this. Keep moving forwards.

 

Exercise (pt 2): Exercise and Eating Disorders

exercise addiction

This is the second part to the article I wrote last time, which talked about exercise in general and the way that an unhealthy mindset around exercise has infiltrated our society as a whole.

Today I want to talk about exercise and eating disorders.

Like I spoke about two weeks ago, nearly everyone views exercise as something that is healthy, regardless of how it is used. During my recovery from my eating disorder, I told a friend about my compulsive exercise and about how I was trying to challenge it because I was doing x amount of exercise a week because I felt that I had to, and hadn’t been able to stop myself from doing it even when I didn’t want to. She genuinely replied with “Yeah but that’s fine because exercise is good!” Because we have such a warped view about exercise, many people don’t seem to understand how detrimental it is to those with eating disorders, especially when it doesn’t appear to be severe.

Some people with eating disorders push themselves to the extreme when it comes to exercise. Some people exercise for five hours a day, and some more. Some people never let themselves sit down – ever – except when sleeping (and I’ve even known someone to sleep standing up). It is easier for people without eating disorders to understand why this might be a problem, but when you are someone with an eating disorder who exercises in a way that people might perceive as inspiring and healthy; in a way that people might see as #goals; in a way that people aspire to, you may end up with congratulations rather than concern.

For those who have exercise addiction, you can’t just stop when you want to, or give yourself a day off (unless you already have a “scheduled” day/time, and then it must be that day/time and none other). You will miss social events if it coincides with your sessions. You will feel incredibly anxious before exercising, and after the exhilaration of finishing a workout has subsided, you will feel the dread of knowing that in less than 24 hours you will be repeating the same monotonous and exhausting work out. You will continue with your exercise routine however much you don’t want to do it, however tired you feel, or however sick you are. It is not enjoyment that drives someone with exercise addiction: it is the perceived need to do so.

As well as being mentally draining, compulsive exercise (also known an obligatory exercise or in extreme cases, anorexia athletica) can have a negative effect on the body. Firstly, by working out intensely every day, the body is being put under a lot of strain, and is not being given any time to recover, which is needed. Those addicted to exercise will work out even if they are ill or injured, which could have serious consequences to their health, including damage to tendons, ligaments, bones, cartilage, and joints. When injuries happen and are not given enough rest to heal, this can result in long-term damage. If the body is not getting the nutrition that it needs, muscle can be broken down for energy instead of building muscle. Girls and women could disrupt the balance of hormones in their bodies, which can change menstrual cycles and even lead to the absence of them altogether. It can also increase the risk of premature bone loss, which is known as osteoporosis. The most serious risk is the stress that excessively exercising can place on the heart, particularly when someone is also restricting their intake, or using self-induced vomiting to control their weight. Using diet pills or supplements can also increase the risk for heart complications. In worst case scenarios, restrictive eating disorders and compulsive exercise can result in death.

The reasons behind exercise addiction can be complicated when it comes to eating disorders. For many people it is an additional means of furthering and/or quickening weight loss, or it could be the main part of someone’s eating disorder, in order to get “fit” or muscular (anorexia athletica). It could be about control. It could be, like the rest of the eating disorder, a form of distraction from feeling or thinking certain things. It could be part of orthorexia (an obsession with eating “healthy” or “pure” foods and leading “healthy” or “pure” lifestyle). Athletes, dancers, wrestlers, gymnasts, and other people who are fixated with keeping in shape and keeping their weight down for their careers are also susceptible to developing exercise addiction.

Although it is not listed in the Diagnostic and Statistical Manual of Mental Disorders, exercise addiction is a serious and potentially life-threatening obsession, and needs to be taken extremely seriously. It is not just a strain on the body but a strain on the mind. It is absolutely exhausting, and completely miserable to experience. It can take up a huge amount of your life and a huge amount of your thoughts, and is extremely unhealthy for your physical and mental health. Whether it  is the main part of an eating disorder, a lesser part of an eating disorder, or a disorder on its own, compulsive exercise is serious. It is something that must be challenged and overcome as part of recovery from an eating disorder, and must be ceased until the unhealthy relationship with exercise is broken and remade into something healthy. Only in remission can someone make an informed and healthy decision about whether to restart exercise and how much/what to do in regards to moving their body. Even then, it’s a fine line.

I talk more about a healthy relationship with exercise in part 1.

If you think you may be developing/have developed an addiction to exercise, seek medical help from your GP.

Signs that you or someone you know may be suffering from compulsive exercise include (but are not limited to) the following:

  • Not enjoying exercise sessions, but feeling obligated to do them
  • Seeming (or being) anxious or guilty when missing even one workout
  • Not missing a single workout and possibly exercising twice as long if one is missed
  • Seeming (or being) constantly preoccupied with his or her (or your) weight and exercise routine
  • Not being able to sit still or relax because of worry that not enough calories are being burnt
  • A significant amount of weightloss
  • Increase in exercise after eating more
  • Not skipping a workout, even if tired, sick, or injured
  • Skipping seeing friends, or giving up activities/hobbies to make more time for exercise
  • Basing self-worth on the number of workouts completed and the effort put into training
  • Never being satisfied with his or her (or your) own physical achievements
  • Working out alone, isolated from others, or so that other people are not aware of how much exercise is being done
  • Following the same rigid exercise pattern.
  • Exercising for more than two hours daily, repeatedly

(sites used for reference and more information: 

http://www.brainphysics.com/exercise-addiction.php
http://addictions.about.com/od/lesserknownaddictions/a/exerciseadd.htm
http://kidshealth.org/parent/emotions/behavior/compulsive_exercise.html
http://en.wikipedia.org/wiki/Exercise_addiction )

Exercise (pt 1): Is it Part of Your Healthy Lifestyle, or Are You Waging War on Your Body?

personal-exercise

My first ever blog post was on the dangers of exercise addiction, but I wanted to reboot this topic and do it over in two parts, focusing more on exercise in recovery from an eating disorder (in part 2), as well as exercise in the general community (part 1 right here), and the effects it can have on both sets of people.

Exercise is something that those with eating disorders use and abuse to lose weight, change their bodies, and deal with negative thoughts and feelings in a negative and unhealthy way, but it is also something that has become a toxic part of many people’s lives in the community at large. It has become something that is unhealthy for many people who are engaging in it.

“Exercise…unhealthy?!” you gasp in disbelief, “How can something that is clearly part of a healthy lifestyle be a problem?”

The issue with exercise in our society now is the way people exercise. The issue is why people exercise. The issues are the mentality: the thoughts and feelings behind what is driving someone to exercise, and the outcome that they are looking for.

If you look around at the media, at health food blogs, at doctors recommendations, at magazines, books, and website articles, then you will see that women primarily, but also men too, are constantly being told that they should be exercising in order to lose weight or become toned, or in some way alter the way that their bodies look. I frequently see my friends updating their Facebook statuses letting us all know they have had an intense session at the gym, or tweeting about how they don’t want to go out for a run because it’s cold but that they need to. I see “healthy” lifestyles which include clean eating (eliminating all processed foods and extra additives from your diet, and only eating whole, unrefined foods) and regular exercise all over blogging sites. I can’t seem to avoid fitspo. Society has become obsessed with it.

There are people who genuinely enjoy the physical activities that they pursue as hobbies. There are people who don’t like the physical activities that they choose to do but feel that the results are worth it.  There are people who cannot stand to do the physical activity that they force themselves to do but feel like they have to do it because of whatever the driving force behind their exercise is – which is usually body hatred.

In my opinion, only the first of the three types of active people that I mentioned should be exercising. The others should cease exercise and heal their relationships with their bodies and themselves before resuming any physical activity. They should find physical activities that they genuinely enjoy that are primarily focused on having fun and/or socialising rather than changing the way their bodies look.

Don’t get me wrong, I am not condoning a lifestyle of sitting on the couch eating Chinese takeaways and playing videogames forever after (but if that’s what makes you happy, by all means, go for it! No judgements made), as I believe movement is part of a healthy lifestyle, but I do not think that anyone should be forcing themselves to do a workout that they don’t find any enjoyment in. I do not think that anyone should be wasting time engaging in activities that they do want to do purely because they are driven by a society telling them that their bodies are not good enough as they are and/or that they are lazy and unhealthy if they do not engage in x amount of physical activity doing certain types of exercise.

“I really don’t want to go the gym today, but I know I need to/have to/should,” is a common comment that I hear from colleagues, friends, and strangers, and this is a result of the insidious and toxic system that is diet culture. Nobody has an obligation to engage in physical activities that they don’t enjoy. Nobody should.  These days we see exercise as something we don’t want to do, but something that we have to do. Doctor’s orders. Exercise has become something we associate with gyms and aerobics and gruelling runs, which most people don’t really enjoy. We’ve lost touch of recreational activity: doing things that we enjoy that involves physical activity. The enjoyment part is primary, and the activity secondary.

Being active is great, but only when you have found something that you actually enjoy. This could just be leisurely strolls through the countryside, or hikes in the hills. This could be swimming with your kids, or challenging a friend to a few badminton games. This could be finding a team sport that makes your heart race and your grin wide. It could be practising mindfulness through yoga, or getting competitive with a colleague whilst playing squash. This could be once a week or once a day. Whatever makes you happy. Not whatever makes you lose weight, or whatever gives you abs. Not whatever gives you a tiny waist or bulging arm muscles. Not whatever burns the most calories. Whatever makes you happy.

Physical activity should be done only if it adding to your life, not something that comes at a cost. Not something that you dread. Not something that you have to make yourself do. Exercise is something that is pushed on us as categorically healthy, but it’s just not when it comes at the expense of someone’s mental or physical health, and it’s not when the drive behind it is body dissatisfaction, or downright body hatred. On the extreme end of the spectrum, exercise can also turn into a dangerous addiction, and in the case where exercise becomes the focus of someone’s life it needs to be taken very seriously, and this is something that I will talk about in my next article in the coming weeks (part 2).

If you are exercising not because you want to, but because you feel that you should, or have to, then I would highly suggest that you take time out, stop the exercise that you have been engaging in, and take the time to evaluate if what you are doing is actually benefiting you. Assess your reasons for exercising, and start building a positive and healthy relationship between you and your body. Because you need it, and you deserve it. Your body is perfect just as it is. Learn to love it, not to wage war on it. Then find movement in your life that makes you smile. Find movement in your life that you look forward to. Find movement that brings you positivity, and never expend energy in the name of diet culture ever again. You are beautiful, and this is what you deserve.

 

Recovered Does Not Mean Cured

recovery

I like to write positive posts about recovery and what it means to be recovered and all the fantastic things about it. I like to illustrate how amazing it is to go from being very mentally and physically sick to being a functioning human being with passions and interests. I like to talk about going from empty to fulfilled; suicidal to content. But I also want to talk about the realities of recovery, and talk about where the eating disorder goes once you reach remission.

In an ideal world, reaching full recovery would mean that the eating disorder was banished from our brains for good. It would mean that the war, once won, was never to be fought again. In a way, that can be the case. You don’t have to fight that war ever again if you remain stable and strong in your remission, but there will be a few riots to deal with, and the odd battle here and there. The war will be won, but the eating disorder will always try and rebel where it can.

The eating disorder will always be there, in each and every one of us who have been a victim of this deadly disease. It is part of our genetic make up, and worse than that, it’s a part that has been triggered. It cannot be un-triggered, and it cannot be un-learnt. But that’s okay: people who have suffered from an eating disorder and fought it are some of the bravest and strongest people. If you’ve never had an eating disorder you will never know how exhausting and gruelling it is to fight it, but take my word on it: it’s one of the toughest (if not the toughest) that we will ever have to do. With all that strength we have, after beating the eating disorder, keeping it in check is a hell of a lot easier than what we have already been through.But it is important to know that it will be there, and you have to make sure that you are the one that stays in control at all times.

It is a mistake that those who haven’t had an eating disorder can easily make: that once it has been defeated, then it is gone. Sometimes people don’t understand that once a day, or once a week, or once a month, there will be a little battle that we have to fight. And it is fairly easy to win it, but if we give in due to not being vigilant, or feeling too tired to resist it that day, it is something that can quickly spiral out of control.

Take my last 24 hours, for instance. I had to go home from work with a severely upset stomach. My mum told me not to eat for 24 hours (a sensible thing to do in this situation), so I geared up for that challenge. After eight hours, I was starving, so I ate a cracker and smoked a cigarette, and my hunger pretty much vanished. That reared the head of the beast, and a little voice said see how easy it is to make your appetite disappear. I also kept stroking my stomach to see if it felt flatter, because when I was sick and would have an upset stomach, my stomach always felt super flat and I liked that. After 20 hours with only 3 crackers, I tentatively made some toast to test out my stomach. The little voice told me that I could just go longer without eating, and that I’m too sick to eat at all, and I felt resistance to wanting to start eating again. I will fight that small battle every time I get a stomach bug and can’t eat for a while, because for me, once I stop eating, I find it a small challenge to start again. I know that I can fight that, but there is always the possibility that I could give in to it and that the eating disorder would take the wheel and I would fall into the back seat. It is so important to recognise when the eating disorder is trying to worm its way into your thoughts and influence your actions, so that you can roar at it to get back in its place (metaphorically, of course – I’m not sure how those around you would react to that kind of outburst).

Another example is exercise. I enjoy some types of physical activity like badminton, swimming, and walking. I love doing it, but so does my eating disorder. That means that I have to constantly assess how I am feeling towards it. It means that when I can’t do exercise (like now, being ill), I feel anxiety. It means that I have to consistently challenge myself to make sure that I am in control, not my eating disorder. This means that I take rest days where I don’t exercise whatsoever. If ever I told myself to take a rest day or two, and couldn’t do it, there would be a problem. It would not be me taking charge in that situation, and I’d then have to work through that and fight a bigger fight. I think anyone who chooses to be active in their remission and has had exercise addiction will always walk a line with it. If I ever exercise when I am ill or injured, or when I have challenged myself not to, or because I feel I have to even though I am not enjoying it, that is when there will be an issue. I have to watch out for that, and so does everyone else in my position.

There are also bad body image days. In our society this is – tragically – normal, but for those with an eating disorder it can be accentuated, or a trigger and therefore more dangerous. It means accepting the bad day, or week, or month, and not responding to it, which can be incredibly hard as someone without an eating disorder, let alone someone with one.

There are many different things that will trigger different people, and although a lot of triggers become null and void, most people have one or two (or more) that remain with them. Having those triggers, and having the eating disorder itself, means that we are always at risk of relapse. It means that we do still have to fight battles that other people do not have to fight. It means that we have to be vigilant and careful and assess our thoughts and behaviours towards things like food, exercise, and our bodies on a regular basis.

Recovered does not mean cured. Recovered means in remission. It means that it can come back, and it means that we will always be fighting, even if the fight is a million times easier to win.

Counting Calories and Recovery

numbers

It seems like something that would be counter-productive to suggest, but counting calories is a really important part of recovery – especially during the initial stages. Counting calories is very likely a large part of you or your child’s (or partner’s/sibling’s/friend’s et) eating disorder, so it can seem like madness to say ‘continue doing this’, but hear me out.

Whilst counting calories was used as a way to restrict, it now needs to be used as a way to heal. So we are turning around a negative habit and using it to make sure that the person recovering gets enough energy into their body. Getting enough energy is essential for recovery, and it is likely to be something that proves impossible to do unless someone is counting the calories of the person recovering.

For most people it will be you; the recoverer, that counts. Sometimes it will be parents or partners. Either way, those calories need to be counted because after an eating disorder, people have unreliable hunger cues. The body has gone so long without food that it has repressed the signals, and so it can take a long time for reliable hunger cues to return again and for the body to learn to expect food and give signs as to when it needs it. This can mean that eating can feel like a chore to some. It could mean that you will have no appetite and feel too full, but it is important to ensure that you continue eating adequately regardless. It could mean that you feel really hungry sometimes, but other times have no appetite. Respond to any hunger or cravings that you have, and continue eating enough even when you don’t have an appetite. You may have reliable hunger cues straight away, which would be great and would lead you to eat what you need to eat in order to recover. Responding to mental hunger is also really important. Mental hunger is just another signal from the brain to tell you that you are hungry. All signals come from the brain, and it is crucial to listen. So if you don’t feel the physical signs of hunger but are wanting or craving food, then it is necessary to listen to that signal and respond to it – always.

So how are you going to count calories? I would advise staying away from apps such as MyFitnessPal, as they can be incredibly triggering due to the fact that they try to suggest restrictive amounts to eat, and they are an app focused on weight loss. You could just use a ‘notes’ app and count it up yourself and keep the number on record for the day there, or you could write ‘500’ as many times as adds up to how much you need to eat on a sheet of paper or on a notes app on your phone, and just cross it off every time you reach 500 calories. This can mean that you know you are getting closer to your goal but don’t need to count the number if not thinking of the number helps. If your parents or partner are very involved in your recovery, they could do the counting for you if this is possible and more beneficial for your recovery.

Calorie counting can be triggering for many people, but the alternative of under-eating is much more harmful. Under-eating – which many people in recovery will do due to unreliable hunger cues if they do not count calories or have them counted for them – will mean that the body cannot heal. Mental and physical recovery are interconnected, so if the body is not getting enough energy, this will also impact on mental recovery also. Under-eating means that neither mental nor physical recovery will be able to take place, so counting calories until your hunger is reliable is a necessity. This is one habit that will have to be saved until a bit later to break – which is okay, because there are many habits and thought processes to manage, change, and break, and there has to be something that is saved until last (or later on)!

So you’ve been counting calories for a while and making sure you that you get the energy that your body needs. How do you know when you can stop counting and start going by hunger? When you start feeling like your hunger is happening in a reliable way which is consistent with when you should be eating and how much you should be eating, you can start thinking about testing out that hunger to make sure that it is naturally bringing you to the amount you need. A good way to test how reliable your hunger is, is to write out everything you eat for a week (or two weeks), and then count it up for each day, add it all up to get the total amount, and divide it by seven (or fourteen). The average figure should come to around the amount that is suggested as the minimum for you to eat during your recovery (this is around the amount that you should need forever). If it is three hundred to four hundred calories below that total, then I would really suggest that you continue to count calories as your hunger signals are likely to be unreliable. Most people will naturally and intuitively eat the amount recommended for them, or close to it, as this is the amount that an energy-balanced body needs each and every day. Some people do have hunger that is below or above the average (for example, someone who is expected to need 3000 calories for their age, gender, height, and activity levels could find that they naturally eat 2400, or 3600), and that is absolutely okay. However, if you are eating more than three hundred to four hundred less than what is recommended as adequate, it is more than likely that it is your hunger cues that are unreliable and you still have a little way to go before they are back to normal. If, say, 2400 calories is your normal hunger, eating 3000 for while longer will not have a negative effect on your recovery process, and will not have an impact on your weight. Your body will adapt to deal with the excess energy by putting it to good use (e.g. to continue repairing your body) or the metabolism will speed up to burn it off. (As a side note, when you are adding up your calories for those tester seven days, if one day has a really low amount, and another a higher amount, for example, 1000 calories one day and 4500 the next, this is a sign of unreliable hunger cues, even if the average does come to around the amount suggested for you. As a second side note, if you are consistently eating well above and beyond the minimum you require for recovery, your hunger cues are working and you are experiencing extreme hunger or higher energy needs still, which is totally normal for recovery).

So let’s say your hunger cues seemed reliable, and testing this out has shown that they are, now what? You can start trying to eat intuitively, but you will need to keep reassessing yourself to make sure your eating disorder is not sneaking in and manipulating the situation. It is important that you eat what you want, when you want, and don’t let the anxiety of stopping calorie counting come out in other ways, such as restricting certain foods types or resisting eating something you want because you are worried you are eating more now you have stopped counting. It is going to make you feel more out of control, but it is important to continue onwards, and not use any other behaviours.

But how do you go about stopping counting calories? Calorie counting is a hard habit to break. It can become so ingrained in you that it can happen even without consciously thinking. There will be different things that work for different people, but here is a list I put together with some suggestions about how to stop counting:

  1. Get yourself and your family to put labels over the calorie amounts on packets etc. This can deter you from looking and also remind you when out of habit you try to check that your goal is to not look and not to count.
  2. Get your family to serve you at dinner time, to challenge skewed perceptions of portion sizes, and to learn to relinquish control over amounts.
  3. Stop measuring foods or liquids.
  4. Eat intuitively for one day (or even one meal). In a week or so, try doing it for two days (or meals). Work your way up until you can ditch the habit altogether.
  5. Visit cafes, restaurants, cinemas, and other places that are uncaloried to get you used to eating meals where you don’t know the calories to face that anxiety and start to overcome it. You can then start trying to do this at home and challenging yourself there.
  6. Listen to your body and its signals (this is also something you should start doing as soon as you get into recovery, even when you are counting calories). Follow your body and tune in to what it is telling you, rather than going by calories you’ve already eaten today or any other calorie “rules” you are sticking by. Start learning to listen to mental and physical hunger, and also learn that you can also eat when you are not hungry if you fancy it.

There are only six suggestions here, and there will be countless other things that can help. If you have any tips that helped you or someone you know, write them in the comments below so that others can benefit from it too!

Counting calories and not counting calories are both big parts of the recovery process, and both relevant at different stages in your journey. Again, make sure that you are not using compensatory behaviours when you start trying to eat intuitively and stop counting calories, such as eating smaller portions, cutting out calorie dense foods, or not drinking liquid calories, out of anxiety. Learning to eat intuitively without compensating due to anxiety is a big part of recovery. You need to learn to eat what you want, when you want, without letting your ED get on the stage with you. Make sure it is not running the show, or even making compromises with you. It doesn’t have a place in the life that you are creating for yourself. This life is yours, and yours only.