Friday, June 29, 2012

Metabolism--food or exercise?

How many of you believe it is exercise that most impacts your metabolism? After all, if you listen to almost anyone in our society, what you will hear is, "If you want to increase your metabolism, you need to exercise more!"

This is one of my pet peeves. Sure, exercise, or more specifically, increased muscle mass will increase your metabolism. But, BUT....the primary way to increase your metabolism? Well, it's food. Now, again, I am far from being trained as a physiologist, so I cannot say to what extent exercise versus food increases your metabolism, though I must admit, I would likely relish in knowing the exact numbers so I could hammer my point home even more solidly. But, I don't know, so all I can do is describe how what really happens conflicts with what you will hear out there in society.

Food drives our metabolism. And if you really think about it, this really is one of the only ways we can make sense of how our bodies function. When healthy, we don't eat the same number of calories every day, yet our weight stays stable. Our metabolism responds appropriately to normal variation in food. If one day, you eat much more than usual, your metabolism increases to compensate. Same for if you eat less. Now, over time, if you keep eating more than what your body needs, you will gain weight. If you keep eating less, and your body kept burning at the same rate of speed, well, you would actually disappear, right? You'd just keep losing and losing until there was no more you. But that's not how it works.

Think of a time in your life when you went on a diet (and never do it again!!! But that's another post). If it actually caused weight loss, at first you lost weight and then you hit "the plateau," right? Well, the plateau is caused by your drop in metabolism. Your body compensated by lowering metabolism so you burned less calories. Ahhh, just one way diets are shams!

So, back to the original point. If all I have written above is true, here you have the evidence that, in order to increase your metabolism, you need to eat. So, if you exercise, but don't eat enough, metabolism drops. If you consistently eat too little, yep, metabolism drops. A healthy metabolism depends, at least partially, on sufficient food intake. So, all you dieters out there? SERIOUSLY reconsider!!!

Thursday, June 28, 2012

So many topics, so little time!

Throughout a week, as I cover so many different topics with patients, I think over and over of what information I would want to share through this blog. There are so many different things about eating disorders that are misunderstood, and so much to the physiology of eating disorders that is not discussed.

When a new patient comes in, the first priority is to assess their physiological state, because if that is not understood, so much can be missed. For instance, if a patient who has not been eating enough comes in and says they have obsessive-compulsive disorder (OCD), there's an important question to ask. Did that OCD exist prior to the onset of starvation? For many, the answer will be "no." If one does not understand that starvation, which is defined quite broadly, causes a variety of issues that appear to be separate diagnoses (ie, OCD, anxiety, depression, even some symptoms of various personality disorders), the therapist or physician may accidentally give the patient these diagnoses and then attempt to treat them. But, if the therapist understands that starvation alone causes these behavior patterns, they understand there is less need to treat all the individual symptoms, and instead focus on supporting the patient in getting enough food. And, then there's that awesome moment where the patient's starvation-related symptom goes away, and 1) you look super-brilliant, and 2) the patient feels such relief that it IS indeed true that food is the best medicine.

So, how is starvation defined? It is not limited to those everyone would likely think of as starved. Yes, some individuals with eating disorders actually appear starved. But many do not. Many can even be overweight, obese, or morbidly obese. This concept usually makes heads spin a little. "How can someone who is overweight be starved?", I am asked. Body weight is irrelevant in defining starvation. Starvation occurs when someone is not eating enough to support normal functioning of their bodies. That can happen at any weight. What is sad is when starvation is not recognized in those who do not "appear" starved, and goes unaddressed, greatly worsening the patient's physical state over time.

I hear many times that patients do not see themselves as starving because "I eat." Well, yes. In fact, everyone with an eating disorder eats! This is a misconception supported by our society, that in order to have an eating disorder, and anorexia in specific, one must not eat. Everyone eats! Every last one of my clients eats. But they, almost without fail, do not eat enough. The pattern of how and when they do not eat enough varies, but they all do not eat enough at some point.

Those who binge eat assume they do not have enough willpower to stop eating. But, no, again almost without fail, a binge will be triggered by some period of not eating enough. How many of you, eating disordered or not, go through your day eating fairly little and then eat a lot at night? This is such a common pattern in our society. How many have gone on a diet, only to end up eating a significant amount of food, "breaking the diet." Anyone who has experience something like these situations can now understand bingeing. Sure, not everyone will binge, but you can understand how the physiology of your body works and how that can create binge eating in some. Bingeing is, I believe, most often caused by undereating. Your body needs a certain amount of food to function, and if you eat less than what it needs, you will experience a drive towards food. There certainly are emotional components also; I am not denying that. I'm just saying treatment has to start with addressing the physiology, and THEN dealing with the emotion. Through changing eating patterns alone, and helping a patient eat enough during the day (which, is information provided by a dietitian working with the patient), many times the bingeing will decrease significantly.

Well, it seems I could go on forever on this topic. I could endlessly address the physiology of eating disorders. I'm kind of a physiology junkie, though I certainly cannot claim to be extensively trained in human physiology. There's so much to learn! But, my challenge is this: If you treat eating disorders, and do not understand the physiological impact of starvation, refeeding, bingeing, then go learn about it! And, if you have an eating disorder and don't understand the physiological impact, then have someone teach you about it. You will come out of it feeling much less like a "failure," or someone with "no willpower" and your treatment process, what your body goes through, will make a lot more sense.

Never fear, fair readers, this is not the last you will hear of this topic from me!

Wednesday, June 13, 2012

Well, here it is! The inaugural blog post. Where, you might wonder, did this idea come from? A friend from high school told me the other day that I should write a blog, and my first thought was "NO WAY!" But then I thought about it more, and I realized, maybe my writing style and our approach to eating disorder treatment is worth combining, and sharing! So, we discussed it in treatment team today; discussed the pros and the cons, the pitfalls and the benefits, and in the end, we concluded it was worth a try.

One thing I really did not want to do is write a dry, dare I say boring, blog about how to treat eating disorders. After all, if I wouldn't want to read it, why would I assume anyone else would? But then, to be light-hearted about something as serious, as life-threatening, as eating disorders is also a risk. So, here we will try to walk that line and walk it well, because eating disorders are such a serious topic, but at the same time, to survive in this field, and with an eating disorder, you generally have to have a fairly good sense of humor. I have found that patients with eating disorders are some of the wittiest, funniest people out there, and I believe that humor can be life-saving, and something that is often used in therapy. It's one of the things I truly love about my job.

Now, for my first humorous experience on this trek. I thought, what's a good blog without a picture that represents something, so I start typing into Google images and searching for something relevant to eating disorders. And I learned, very quickly, it is easy to find offensive things, and it is incredibly hard to find images that are neither so cheesy a select few of my patients would mock me endlessly, nor so cliche that, well, the same thing would happen. So, here the blog is, completely devoid of an image. I hope to improve on this front, though I make no promises.

I will confess, I don't have a strong sense of the direction of this blog. Of course, I'm a therapist, so we have the obvious answer, which is that I want to help. Of course I do. I am so passionate about eating disorder treatment and believe we have a lot to share about what we have learned along the path of treating these disorders. I believe what we have to offer, as treatment providers, is a relationship. Yes, also expertise in the physiological, medical and nutritional aspects of these disorders, but mostly? Mostly, a relationship. And a blog is another way to initiate that connection with those who need a sense of connectedness. I spend my day fighting the most lethal psychiatric disorder, and honestly, I love doing it. So does my partner, Elena. So, write we will, and we will hope that what we write connects with some of you.

We hope to hear back from you....your thoughts, what you would like to hear more about. Of course, what we cannot do is offer treatment advice over the internet. Unfortunately, we will not be able to respond to individual comments other than to follow up in a future blog post. This does not demonstrate lack of interest, caring, or desire to help. It is simple logistics, that's all.