Expert: Ryan Hale - 1/31/2011

Question
QUESTION: Hello.  Back in May 2010 you answered Emily about lack of metabolism post anorexia.   I read that like it was a mirror.  However, I go even further.  I am 41 and have struggled with weight control for 25 years now!  Like Emily, I go from one extreme to the other.  I can not find a medium that works for me.  I come from an obese family and have been told for years I am "violating" my genetics being slender (not thin).  My cholesterol is at levels that most people would be on medication for; however, my doctor now was also my father's doctor (gone 11 years now).  He knows full well the family history and predisposition to the obesity and levels off the charts for me vs. the normal individual.  I don't eat meat although I am not a vegetarian.  I just don't have a daily taste for it.  I don't eat fried foods.  I rarely go to Mc Donalds or the like; but I'm not a prude.  Occasionally I like a cheese burger and fries and milkshake just like the next person.  I want to eat like a normal person but I cant.  Eating a meal out means no food for 3 days afterwards.  I walk anywhere from 10-20 miles a week.  I am a speed walker and do it for enjoyment as well as exercise.  If I do all of this (walking, basically not eating, and seriously watching my fat intake (due to the cholesterol levels too), I can stay at a weight that I can live with physically and emotionally.  But I want to be normal!  I want to have something besides grilled chicken salads (eating only 1/2 the chicken) when I go out.  I want to get the munchies once in a while and not suffer the weight gain and guilt.  I literally have 4 different sizes in my closet.  If I do let my guard down and gain 6-7 pounds (which happens very fast) and outgrow my current size, I have to literally starve for months to get back down.  My body, after years of doing this!, knows when I am going to pull my starving stunt again.  It holds onto everything it can.  I have also been told that my body might be at times surviving off its own self (muscles and organs) to preserve the fat it has in storage.  I do believe this as physicals and various tests have not been favorable.  I eat healthy, I exercise, etc....  What more can I do?  I am still an anorexic at heart.  I punish my disappointments, failures, and sadness with starvation.  I am OCD and once I tell my body its not hungry, I am off to the races.  I need something safe, reasonable, and with my goals/desires in mind.  Any suggestions?

ANSWER: Pat- I have the impression that you have a very complicated relationship with food... I also get the feeling that there is a real disconnect between how you think about health and food and how you feel about health and food and that they are two very different and distinct things.  Given the OCD and this strained relationship you have that is at odds in your own body, I'd suggest seeing a counselor about it.  Therapy can help you find some balance in this internal dialog that is going on.  It is this disconnect within yourself that is causing the discontentment and a therapist can help with that.

Also, given your diet and exercise history, it would seem that you would be a good candidate for cholesterol lowering drugs.  Talk to your doctor, because even vegetarian marathon runners can have high cholesterol and even die of heart attacks.  

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

QUESTION: You are extremely insightful and I very much appreciate that.  I know I have a love hate relationship and probably always will.  I am wondering however, is there something I can do to increase the metabolism so I can eat a little more normal.  I would like my body to act normal so I can eat normal, if you will.
By OCD I just meant that I am a all or none personality.  I don't drink a cup of coffee, I drink a pot.  I am a smoker and a (now dry) but former heavy alcoholic.  I don't gamble or even buy lotto tickets as I am afraid of getting hooked.  I take on more at work than most and don't stop until its done.  All or none.  ( I am on Wellbrutin 450mg qd and that does help a lot)  
As far as the cholesterol, we are holding off on meds as long as we can because of my age.  I am sure it won't be long and that will be on the docket tho.  
Any suggestions on the metabolism?  Foods, nutrients, whatever...? Don't know what else I can do about intake and exercise.  Thank you so much!!!

Answer
Pat- I think the therapy will help your understanding of what "normal" is and what to expect of yourself.  As for diet and nutrients, any advice I could give I'm sure you have already thought of: eating regular meals with healthy snacks in between, don't skip breakfast, allow yourself to enjoy occasional desserts or "cheat" foods, regular exercise.  One area people sabotage their lifestyle is in the area of sugar and carbohydrates... make sure to limit refined sugar and opt for honey or Aguave instead.  The sugar we eat in between meals can keep our insulin levels high throughout the day and lead to weight gain and even contribute to high cholesterol.  As for other carbs, try to limit meals to one carb per meal, that is, if you have some rice in your dinner, hold off on the dinner rolls, or, if you are having a meal of pasta, skip the bread sticks.  Often, we have dinner rolls, rice, sugar in our coffee, alcohol, then a dessert.  All are carbohydrate sources.  I'm not saying to deprive yourself, but a pasta dinner and a glass of wine are plenty of carbs.  Just a thought.