Expert: Meg - 6/7/2007

Question
I have had an eating disorder for the past 6 years. The first two years, it wasn't too bad. I took diet pills constantly and occasionally starved and purged food. Four years ago, it started to get worse. I started starving myself all week and then binging to the point of being completely stuffed on the weekends. Then, I began purging my food when I binged on the weekends. This went on for a few years: restricting calories to about 800-1100 calories Monday through Friday, and stuffing myself all day long on Saturday and Sundays, and then purging. Last year, I stopped purging because I hated it so much. I haven't purged in a year now! However, I still restrict my calories to about 950-1100. On Saturday and Sunday, I do allow myself to eat what I want, but I don't binge anymore. So, I'm slightly anorexic, but not SEVERELY.
For the past couple of years, I've been mildly anemic too. Not an iron deficiency anemic though, nor folic acid or B vitamin anemic. My red blood cells are just small. My hemoglobin is always around 11, 11.5, 11.3, etc. A normal level is supposed to be 12-18 I beleive. I've tried taking more iron supplements, but, it never goes up. I'm also a vegetarian by the way. However, all of my nutrients that would normally cause anemia are at normal levels. I take supplements (iron, b complex, multivitamin, calcium). The doctor has checked me for a bunch of different things and I seem to be fine, so she can't figure out why exactly I'm anemic. She says my red blood cells are just small. Do you think this has something to do with my eating disorder? Also, I don't feel good a lot. Not sick or anything, but just feeling a little weak at times and tired. Sometimes I feel a little dizzy and faint. I have low blood pressure, anywhere between 83-100 is usually the top number. And, I often feel as though I can't get a satisfying breath. Doctor's have checked my heart and lungs, and both seem to be fine. They say that it may be because I have low blood pressure/anemic, or anxiety about food. Do you think my nutrition has something to do with all of this? I wonder because I'm really not restricting THAT much. I tend to keep around 1000-1100 calories Monday through Friday. Saturday's and Sundays I don't restrict, I probably eat around 2000-2500 calories per day. I could see having health issues if I was eating an EXTREMELY low calorie diet. But, although my calories are low, they are not THAT low. Is it low enough to cause some of the issues I'm having, do you think? I am 26 years old, 5'3, and weigh about 110-112 lbs. I am somewhat active, not overly. I have a deskjob and sit for 8 hours of the day, and when I get home, I'm on my feet doing general house chores and I try to get at least 60 minutes of exercise per day. It's mostly just walking. I'd appreciate hearing your thoughts, thank you.

Answer
Hi there,

Thanks for your question and I hope that I can help.  I have to say that while I'm happy to give you my opinion, I would definitely trust the medical advice of your doctors first and foremost.  That said, it sounds to me based on the symptoms that you are describing (and the fact that your medical doctors haven't found any physical cause for what is going on) I'd say that perhaps your nutrition isn't giving your body the fuel it needs to be energized and function properly.   

I know that you restrict at 1000 or so calories during the week which definitely *isn't* adequate for someone your height and age, but still is enough to function.  Anyway, my first question is what is the composition of the calories that you are consuming.  I know you mentioned being vegetarian and while its absolutely possible to be a vegetarian and healthy, it can take work to get all of the protein and nutrients that you need.  Do you think your diet is balanced?  Are you getting protein, fat and carbs (which many of us who have eds tend to cut out).  If your 1000 calories is really unbalanced, then even the vitamins you are taking won't work as well and it can lead to your feeling out of balance.  So first off, I'd take an honest look at your diet and figure out if that might  be causing these problems.

Another thought is that perhaps, after 6 years of this, your  body is just somewhat worn down.  This makes sense if there is kind of cumulative damage that is not as sudden as restricting at a really low caloric level can produce, but more a general wearing down of your immune system and overall health.  As someone who also spent a long period of time with an eating disorder, I often felt just not right even when I wasn't restricting as heavily as I had at one point.  So, it could be that although you aren't being "severely anorexic" as you put it, you are still being somewhat anorexic and that is having an overall effect on your body.  

Another thought (and I'm sure that your doctors have probably already looked at this) but is your thyroid functioning well?  Sometimes, restricting can lead to that being a bit off which can definitely affect energy level and one's overall feeling of zest.

Another thing I'm wondering is how you're spacing out your meals during the week.  When I worked at a deskjob and was still active in my eating disorder, I generally restricted pretty heavily during the day (justifying that I wasn't as active and thus didn't need much food) and then would eat my daily calories at night.  If you are doing something like this, or even just not dispersing your 1000 calories through out the day then it is likely to affect your overall feelings of wellness as well as leave you feeling pretty drained a lot of the time.  So, that's another thing you can think about.

Finally, I want to ask you this.  With all of the troubling symptoms you described (feeling dizzy, low blood pressure, being anemic, feeling anxious about food and your body, feeling like you can't breathe, feeling weak and tired a lot of the time and just generally not feeling good) do you really think these things are worth holding onto your eating disorder?  I ask this only because you still sound like you're not totally sure that your being "slightly anorexic" is a bad thing.  I know that its easy to think that you're not AS SICK as the anorexics that are usually shown on TV and thus reason that its all okay.  But, honestly, its really not and the sad truth about having an eating disorder is that you never feel secure in it.  You can never *be* thin enough and its the promise that if you get there you'll be happy/okay/whatever...but you can never  get there.  You sound like a smart young woman and I'm sure that there are so many better things that you can give your energy to (and even better, *have* more energy to give) if you can let go of this.  I know, its not easy and our ED's serve some sort of function of we wouldn't  develop them.

Anyway, I hope that this helps at least a little and if nothing else will get you thinking about maybe making some changes (even little ones) so that you can start feeling better.  I know it might sound cheesy (but its true)...you are simply worth more than this will ever give you.

Take care and please feel free to write again if I didn't fully answer your question or if there is anything else that I can help with.

Good luck to you and take care!

Meg