Expert: Jeanne Rust, PhD - 7/31/2009

Question
QUESTION: Hi...I was wondering whether someone who had been restricting/purging for 4+ years could actually lose the ability to stomach "real" foods. I've been eating fairly minimally since junior year of high school (I had surgery on my foot and went on a diet so I wouldn't gain weight while I was recovering since I couldn't train with my swim or cross country teams)...and at this point I'm fairly convinced that my body just isn't meant for food anymore. I typically only eat liquids now...solid foods that aren't fresh fruit or steamed veggies make my stomach hurt terribly, but my doctor claims that it isn't physical and that I need to "grow up" and eat. I know I'm underweight, but I like it...I feel small and happy about it, which is something I'm NOT used to (I'm pretty tall, 5'10", and always the "big" one). I really really really do NOT want to gain weight and my body really doesn't feel okay when I eat as much as a standard meal plan claims I'm supposed to. I'm not sure what to do. I'm 22 and I know that I should be able to just suck it up and stop this dieting thing, but I also can't bear either eating "normally" or gaining weight. I haven't been over 118 in years, and the thought of creeping up over that is terrifying...yet I do eat plenty in my safer foods like fruit and smoothies and such so I don't really think I NEED to go back to eating "normally"...can't some people's bodies just adapt so they can't handle that anymore?  I feel like that's what's happened...I guess I'm just very confused.

Any idea would be appreciated...

Lia

ANSWER: Dear Lia,

I am so glad that you wrote me!  You are certainly anorexic and you are at risk!  Anorexia is the highest cause of death for adolescents and young women in their early 20s.  

You have a BMI of less than 17 which tells me that you're at risk for medical consequences -- which you're already having!

Eating disorders are chronic stress related conditions -- you've been using anorexia and bulimia as a way coping with a lot of stress in your life for 4+ years!  This is about much more than not being able to eat solid food.  This is about a serious eating disorder that can literally kill you.  Most people think, this can never happen to me, but it does!  I'm not trying to frighten you, but I want to bring you into awareness.  Anorexics have heart attacks and bulimics have heart attacks and esophageal hemorrhages.

It is your eating disorder that is telling you that your body is not meant for food.  It's not your healthy self.  Just for fun, take a sheet of paper, draw a vertical line down the middle of the page. Label one column Healthy Voice and the other one Eating Disorder Voice -- do a little journaling.  Which voice is it that is telling you that you can't eat solid food?  Which voice is it that tells you not to gain weight?  Which voice is it that tells you you'll feel huge if you go over 118 pounds?

This is an eating disorder, big time.    The eating disorder behaviors are merely symptoms of underlying issues.  It's serious -- the thing you need to do right away is to go to a therapist that specializes in eating disorders.  Have an assessment.  If the therapist is doing her job, she'll refer you to a a good nutritionist.  Weight gain should be slow.  Never more than 1-2 pounds a week -- more than that you won't be able to keep up with it psychologically.

If seeing a therapist a minimum of twice a week doesn't work, then you'll need to look for a good holistic eating disorder program where you can have the structure you need.  At that time, you will gain a real sense of personal identity -- about what and who you are without having your identity tied up with your weight.  You'll get to the place where you'll have other coping mechanisms other than ones which are harmful to your body.

It's hard to imagine a life any other way than the way you've been living it -- but the freedom you'll experience will be wonderful.  It will seem like a miracle!!

Let me know how I can help!

Warmly,
Jeannie Rust, PhD
www.mirasol.net
www.edrecovery.com

---------- FOLLOW-UP ----------

QUESTION: I just tried the journaling activity you suggested, but nothing came to mind as having two separate voices...I'm not sure how to do that. Isn't it just...me? My mind? I am the one who's choosing to limit my food and only eat things I think are healthy or low calorie...and most of the things I eat are really nutrient dense even if they are low calorie, so how could I have a heart attack? I run at least an hour every day and I feel like my heart is strong as a horse! Hmm. It really surprised me to hear you say that it was a major problem...I've always just thought that I might be a little overboard, but then again most American's are overweight or obese and severely nutritionally dilapidated, so I figured it was better to be on the thin side and eating healthy food than on the fat side and eating crap with no nutrients in it that would clog up my arteries and that THAT is what would give me a heart attack. No?

Sorry to keep bothering you, but I'm a wee bit taken aback at how strongly you believe that I have a life-threatening problem...

Lia

ANSWER: Dear Lia,

In your original email you talked about not being able to eat real foods and that you mostly just had liquids!  You said that you could only tolerate vegies and fruits --

That is not normal eating.  It's not healthy eating.  Healthy eating is having protein, fats, and carbohydrates (fruit and vegetables are carbs).  Your weight is very low -- anorexic!

See if you can answer this question -- what would be a healthy way of eating?  I know what a healthy voice says -- and I know that it's an eating disorder voice that is telling you that what you're eating is OK.

The body is like a little stove.  It operates only with food as fuel.  That is what keeps the body working -- when the body isn't getting the food it needs (protein, carbs, and fats), it begins to feed off of itself -- it feeds on your muscle mass, on the major organs in the body, including the heart -- as I said this is why anorexics mostly die of heart attacks.  The body also feeds off of the brain where the person becomes unable to think clearly!  They think that they're OK when they really are in denial over the severity of their condition.

It isn't choice etween eing anorxic or fat -- healthy does not equal fat.  You can be slim and healthy and not be fat!!  

I'm glad you wrote back, Lia!

warmly,
Jeannie

---------- FOLLOW-UP ----------

QUESTION: I know that most people would be okay to eat "healthily" and "normally" and still be slim...I get that moderation works for most people. I just don't think that my body works the same for some reason. Example: I weighed 108.2 two days ago, and that day I only ate 1/2 cup lowfat frozen yogurt (~130 cals?) in addition to my usual 565 cals and then yesterday morning, I weighed 109.4. My body gains from the tiniest change or added fat in my diet, and because I never eat fat and I'm still almost normal-sized, I think maybe my body just stores it if I eat any.   

I want to believe you that I can change and at the same time it terrifies me. I don't know how to think about this. I know that somewhere in me must want to change or else why would I want to keep answering you...but it's not a big part. I feel like it's silly to think that I can be normal and that word itself scares me because normal, healthy, etc equal fat which equals disgusting. I feel like everything I hated about myself I can fix with staying thin and up until this morning, I was sure that I was at least somewhat healthy. Reading what you wrote was like getting slapped. "...eating disorder, big time." my head is screaming "LIE LIE LIE! You're FINE!" and I feel like its got to be true...if I can't trust myself, I can't trust anyone...and here you are asking me to believe you (which I should, I'm the one who solicited you're advice!) but I don't know how to reconcile my own thoughts/fears with something a perfect stranger is telling me.

I will concede, if a friend or one of my sisters came to me and told me that they ate the way I did, I would consider it very strange and unhealthy and worrisome. But somehow that doesn't apply to me. when you asked for me to write what healthy eating is, my answer would be different for me and for any other person. Like two sets of rules. I agree that fat, carbs, and protein, and moderation and all that IS healthy...for someone else. I just don't see it for me. I don't know what to think right now.

Thank you for all your effort to respond to me! I really appreciate it.

Lia

Answer
Dear Lia,

I love talking with you!  There is a phrase in the recovery community that is "terminally unique."  This is exactly where you are -- you could be terminal at some point without even knowing what is happening to you.  You feel that you're unique because all of the healthy points you've made are directed towards other people but not to you -- "You're unique" in your mind.

You've described perfectly to me the difference between the eating disorder voice and the healthy voice.  The healthy voice is the one that knows what you'd tell a friend or your sisters and the eating disorder voice is speaking loud and clear about what you consider OK for yourself (notice I didn't say healthy).

Of course you're not going to trust me or anyone else right now when you hear what I'm telling you!  As an eating disorder therapist and healer, my job is to fight eating disorders --not you and the person you really are inside that is covered all up by the eating disorder.  I'm an eating disorder buster!  :o)  But you have a little place inside of you where there is a light -- the light of what you were like when you were a little girl, the healthy person --

Warmly,
Jeannie