My Experience of Anorexia and the Need for Compassion

Hi everyone!

It's good to be back. After taking almost a year out to focus on my own health, I'm back and raring to go. I've been on quite a journey this past year (excuse the cliché, please) and I'm now so motivated, so focused, and so energised. I've learnt to work at my own pace, to say 'no' when I need to, and to show myself some compassion and not just be compassionate towards others.

Becoming unwell last year was definitely, in part, due to the fact that I wasn't allowing myself enough down-time and respite. Instead I was putting myself out there for anyone and everyone who asked for, or needed, my attention, care and hard work. And I love doing everything I can to help anyone I can, but if there's one lesson I've learnt, and one lesson that from now on will be my message to others, it's:

Love yourself as much as you love those around you. You deserve compassion, kindness and care as much as anyone else, and it's OK to say 'no' and allow yourself time and space to relax and recharge. 

Now I know that's easier said than done - heck it's taken me almost a year to come to terms with that fact. But it's true. And without remembering it, we're all going to burn out and succumb to the stress and non-stop busy-ness that everyday life brings. Or our underlying niggles of self-doubt, or 'I'm not good enough', or 'I don't deserve that' will become louder and louder until they become our confounded beliefs. 

I have learnt so much this year and so much of it I will treasure and pass on to as many people as I can. I began 2014 happy, healthy and committed to helping others through my work as a nutritionist. However personal circumstances caused a part of my past to surge back into my life at full pelt and knocked me to the floor. An insidious illness I went through during my teens and thought I'd overcome returned, the beast was back. And that beast was anorexia.

I had anorexia throughout my teens, until in my early twenties I became reasonably stable. There were little relapses here and there when I was overwhelmed with stress, and I was always a little underweight, but generally I was happy and healthy. So as I was in a place I considered as recovered as I could be (weight restored, all obsessions and compulsions non-existent) I gathered my folders of recipes and food facts and I signed up for a course in Clinical Nutrition so that I could teach others how to enjoy food whilst remaining healthy, how to live their life to the full yet still have time to prepare delicious home-cooked meals, how to lose weight without feeling deprived or restricting themselves. I knew I could teach people in a way that they needed to be taught, and once I was qualified, and now armed with medical knowledge as well as an encyclopedic knowledge of nutrition, I felt a sense of duty to help others improve their relationship with food and with themselves. This is why my approach, with each and every client, is non-faddy, non-restrictive and entirely holistic. So many nutritionists and 'weight loss experts' out there will tell you to cut out carbs or cut out fat or to not eat after 6pm or whatever other nonsense fad is bouncing around, but I will NEVER tell a client to do that. I have experienced the horrendous effects of cutting out entire food groups and of restricting my calories to such a low level that my brain's way of trying to convince me to increase my caloric intake is to force me to think about food every waking moment.

It may seem odd to some that a person with a history of anorexia would want to work in the field of nutrition. Some may believe it's inappropriate and wonder, "How could she possibly be in a position to teach others about nutrition, health and weight if her brain is warped by an eating disorder?". I have heard that exact thing said about me, and it hurt, because no matter how unwell I was in the past, and despite anorexia returning last year, my brain, my intelligence, has not been damaged. Even in the depths of anorexia I could tell you what a healthy portion size looked like or what a healthy weight looked like, but one of the unfathomable things about anorexia is that the rules and standards you apply to yourself are not applied to others; things that you know are 'normal' and healthy for everyone else are 'bad' for you because there's always a sense that, "I don't deserve that. I don't deserve that pleasure, I don't deserve to be healthy.".  In my experience of anorexia, I knew I wasn't eating enough, that I looked emaciated and what I was doing was dangerous, but it's a psychological illness that manifests physically, and with the patience, love and guidance of friends, family and the professionals who worked with me, I was able to reach into the emotional pain I was struggling to cope with, work through it, and release the pain and fear I'd been holding inside.

As soon as my illness hit me last April (and it really did hit me almost literally over night when my 'personal life' world was turned upside down and my heart was smashed to pieces), I knew I had to stop work. It wouldn't be appropriate for me to be teaching others about health and nutrition while I was ill. But I am now healthy when it comes to my body image, my weight and my attitude to food. I have restored my weight and I'm committed to continuing to treat myself well, to ensure I remain healthy and happy. Having had anorexia throughout my teens, I essentially have an extra ten years experience of studying nutrition, food labels, recipes etc. Perhaps at the time I was studying these things for an ultimately negative purpose, but now that I am better I have to take some positive out of that negative experience. I have to take what I've learnt and use it in the best and most appropriate way I can.

I so passionately believe that health, weight loss and even weight gain (for people recovering from an illness or who are struggling to maintain a high enough weight, for example) must be approached with care and compassion. Instructions, rule books, finger-wagging punishments and judgmental attitudes will only drive people's self-esteem into the ground. I know how important it is to consider a person's entire self: mind, body, soul - their lifestyle, their likes and dislikes, their emotional relationship with food, and so on.

So here I am, so grateful for experiencing everything I have during the last year because I have learnt so much and I have so much to share and so much to give. For anyone who may be questioning my ability or wondering how someone who has only in the last few months become healthy again after a short relapse into anorexia (I was unwell for seven months, spent three months restoring weight and in intensive therapy, and have spent a few months just maintaining this level of health, re-discovering 'me', nurturing myself), I want to reassure you. I am physically healthy and I absolutely do not have a 'warped view' of what is healthy, what constitutes overweight and underweight, what healthy portion sizes look like, how many calories or grams of fat one should have each day - I have been given the all-clear by medical professionals to return to work and, let me tell you, I can't wait. My experience with anorexia means I truly, honestly understand what it's like to have issues with food that affect every area of your life, and issues with your body, self-esteem, body image and self-confidence that can lead to negative self-talk, body dysmorphia, unclear boundaries with food and weight, and a whole number of issues around food.

I intend to reach out and guide as many people as I can, to learn from my experience and share with you what I've learnt in order to show you that there is light at the end of the tunnel, you can have a great relationship with food, you can have a wonderful relationship with yourself and your body, and you can find true joy in your life when you treat yourself the way you deserve to be treated: with compassion, respect, care, kindness and love.

If you're suffering from an eating disorder, in recovery, know or worry that someone you know may be struggling, or just want to find more information on eating disorders, these links may be helpful:

www.b-eat.co.uk (National charity supporting anyone suffering from an eating disorder)
www.syeda.co.uk (South Yorkshire Eating Disorder Association, based in Sheffield)
www.eating-disorders.co.uk (UK based treatment for eating disorders and professional training)

The 5:2 Diet: Not All It's Cracked Up To Be

In the last year or so, the 5:2 intermittent fasting diet has become so well known that it has been written about in most magazines and nutrition blogs, been the subject of several television programmes and has many books written about it. It is a diet based in the principle of intermittent fasting: you eat ‘normally’ for five days and you fast for two days of the week. Intermittent fasting came to most people’s attention when it was featured in a BBC documentary in August 2012: ‘Horizon: Eat, Fast and Live Longer’. In this documentary Dr Michael Mosely investigated intermittent fasting and tried living on the diet himself, discovering many aspects of his health improved and his weight reduced in the process.

Michael Moseley and his 5:2 sidekick, Mimi Spencer.  

On the 5:2 intermittent fasting diet you ‘fast’ for two days of the week, eating only 500-600 calories per day which is essentially just another way of reducing the total calories consumed per week. On 'normal' days, you eat, well, normally. So if you're a woman you stick to 2,000 calories and if you're a man you stick to 2,500 calories. The official Fast Diet website describes the five 'normal' days as "days of normal eating, with little thought to calorie control and a slice of pie for pudding". Call me cynical but I would suspect that if a person is overweight - hence they began the diet - it is their  "normal eating, with little thought to calorie control" that lead to them being overweight and therefore needs addressing. To encourage this is not only irresponsible but dangerous, as we all know the consequences of being overweight (heart disease, stroke, Type 2 Diabetes). It also bothers me that there is absolutely no thought given to those people who are overweight because of a negative relationship with food or even an eating disorder such as compulsive overeating disorder. This is a genuine disorder with debilitating effects, not just physically but emotionally and psychologically. It is so important that a person is supported emotionally as they work on reducing their weight, and that they aren't just left to tick boxes and follow instructions to "eat normally" and then starve.

This diet is also a danger for sufferers of other eating disorders, namely anorexia nervosa and bulimia nervosa. As we know this diet encourages a cycle of starving and (potentially) gorging, much like the binge-purge cycle of bulimia, and sometimes of anorexia. The 'fast' days, in encouraging such severe calorie restriction, could easily trigger even a recovered anorexic or bulimic person. I would recommend so, so strongly that if you have ever suffered from an eating disorder, have a negative relationship with food or have a history of comfort eating or food restriction, that you don't touch this diet with a barge pole.

So let's go back to the weight loss people experience on the 5:2 diet. An average woman who requires 2000 calories per day and is on the 5:2 diet is simply reducing her weekly calorie intake from 14,000 to 11,000 which is likely to affect her weight in the same way that reducing her daily calorie intake from 2000 to around 1600 (seven days a week) would; it equates to the same calorie deficit. This creates a weekly calorie deficit of 3000 calories, equating to just under 1lb of weight loss per week. Most doctors, dieticians, nutritionists and sensible weight loss diets will tell you to consume around 1,600 calories per day (if you're a woman - 2,000 if you're a man). This creates a weekly calorie deficit of 3000 calories, equating to just under 1lb of weight loss per week. Nothing new: reduce your calorie intake by 3,000-3,500 and lose a pound in weight. 

The weight loss experienced during intermittent fasting depends on not overeating on the five remaining ‘normal’ days of the week. In this respect, the 5:2 diet offers nothing new or miraculous, it is simply a method of reducing calories. It may feel tempting to reach for the biscuit tin after two days of restrictive eating, your body will certainly be screaming out for an energy quick-fix as it slips into starvation mode and the metabolism slows down. However it is vital - if you really must follow this diet - that you don't binge eat or eat sugary, high-fat, refined and processed foods on your 'normal' days. The idea is that you eat a wholesome, healthy diet full of wholegrains, protein, healthy fats, natural sugars and plenty of fresh fruits and vegetables, which is great, until day six comes around and you have to starve yourself. However for people who struggle to diet 24/7, having to only restrict calories twice a week may be an ideal option.

Research has shown that intermittent fasting is just as effective as constant calorie restriction in terms of weight loss, insulin sensitivity and other health risks such as heart disease and high blood pressure (Harvie et al., 2010). Previous to the 2010 study led by Dr Michelle Harvie, the benefits of intermittent fasting had only been tested on rodents yet showed equal – sometimes more – effectiveness than constant calorie restriction with regards to weight loss and reducing disease risk. Harvie’s experiment involved prescribing a 25% calorie restriction diet to two groups of women over six months: one group was intermittently fasting, the other was constantly restricting calories. Harvie found that the women who intermittently fasted lost more body weight than those who constantly restricted and fat loss was the same for both groups, demonstrating that intermittent fasting could be an ideal diet for anyone who struggles to stick to a constant calorie restriction diet.

In Harvie’s experiment, intermittent fasters experienced greater improvements in insulin sensitivity, greater reductions in insulin resistance and a greater increase in adiponectin (a protein involved in the regulation of blood-glucose levels and fatty acid breakdown which, in higher quantities, can aid weight loss) compared with constant calorie restrictors. Other research suggests that along with these benefits, intermittent fasting can increase lifespan, improve cognitive function thus protecting from conditions such as dementia and Alzheimer’s, and protect from diseases such as heart disease (NHS, 2013). However, the NHS propose that currently there is not enough detailed research into the 5:2 intermittent fasting diet to understand how exactly these benefits occur. For example, although the 5:2 diet recommends women eat 500 calories and men eat 600 calories on fast days, there is no evidence offering good reasons for these specific figures. Equally, it is unclear whether 5:2 fasting is the most beneficial form of intermitting fasting – it could instead be alternative day fasting, for example. Also, as the 5:2 diet has only been popular for around 18 months, its sustainability in the long term is currently unclear (NHS, 2013).

On Horizon’s ‘Eat, Fast and Live Longer’, Dr Michael Mosely discovered that by consuming only 600 calories per day on his ‘fast’ days twice a week and eating his normal diet on his ‘feed’ days, for a total of five weeks, he lost a stone in body weight. He also found his blood markers such as IGF-1, glucose and cholesterol improved which will, in the long term, reduce his risk of age-related diseases like cancer and diabetes (BBC, 2012). Mosely also found that by eating a balanced 300 calorie breakfast to kick-start his ‘fast’ days, he would have adequate energy throughout the day and would not feel the need to binge, even on ‘feed’ days.

It is evident that the 5:2 intermittent fasting diet has some benefits, particularly to people who can stick to a healthy, well-balanced diet on 'normal days' and are not easily triggered into a binge-purge or binge-starve cycle. And as Michael Mosely discovered, there are some other health benefits to the 5:2, although nothing that a balanced diet 7 days a week wouldn't also produce. It appears to be an ideal diet for people who have struggled to be on a diet 24/7 before, as calorie restriction only takes place on two days per week. What seems to make this diet more sustainable for most people is the fact that you are never more than one day away from eating ‘normally’ again. But is this not just another diet which pulls us back into the cycle of trying one fad diet after another, overeating, undereating, cutting out food groups, making up for lost calories, restricting, guilt, weight gain, weight loss, repeat?  

 P.S. Michael Moseley trained as a doctor and went on to work at the BBC as a trainee producer. He's since made several science and history documentaries. Mimi Spencer, co-author of The Fast Diet (the 5:2 instruction manual) is a journalist who "writes on women's and lifestyle issues", according to hers and Michael's website (TheFastDiet.co.uk). Neither seem to have worked in, or trained in, nutrition, yet they have somehow managed to revolutionise the way many people think about food and dieting. That's some very good PR. 

References

Harvie et al., 2010, ‘The effects of intermittent or continuous energy restriction on weight loss and metabolic disease risk markers: a randomised trial in young overweight women’, 5 October 2010, published by Int J Obes (Lond). http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3017674/

NHS, 2013, ‘Does the 5:2 Intermittent Fasting Diet Work?’, NHS Choices, January 2013. http://www.nhs.uk/news/2013/01January/Pages/Does-the-5-2-intermittent-fasting-diet-work.aspx

BBC, 2012, ‘The Power of Intermittent Fasting’, 5 August 2012, http://www.bbc.co.uk/news/health-19112549