And Isn’t it Ironic: Anorexia and Ultraendurance Events

Once upon a time while in the middle of a large training block for an upcoming Ironman triathlon, I walked in on a conversation between my husband and our coach. They were having a competition about who had managed to get through their 5 hour ride on the least amount of nutrition – ie, they were competing about who was the better fat-burner, which is a huge factor for success in ultraendurance events like Ironman. Coach thought he was going to be awesome, because he’d had an eating disorder for about a year while running competitively at college (he is now recovered); my husband, on the other hand, had been specifically working on developing his fat-burning engine over the last few months – not an uncommon thing to do amongst Ironman athletes. Controversial? Absolutely. Effective? Most of the time. If you can get away with 20+ hours a week of training on not enough nutrition. Most athletes eventually crash and burn – through either injury or illness – prompting sports dieticians to admit that while these behaviours in high-level athletes can be effective at creating adaptations to fat-burning, they are also highly risky and are to be used sparingly and under the guidance of a qualified coach or dietician.

Husband: I just got through a 5 hour ride with 3 bottles of Gatorade, a banana and 2 Gu’s….beat that….

Coach: (laughs) well I got 3 hours in on nothing but water, then I hit the wall so bad – we had to stop and buy Coke and Mars bars to finish it off! I feel so wiped out now I can’t get off the couch haha.

Me: You two are such amateurs. I was doing the same ride, I wasn’t aware we were having a competition – I had 3 Gu’s for the whole ride and I wasn’t actually trying….and I feel fine now….seriously, you two should stick to short-course triathlon….

Moral of the story? If there has to be an upside to Anorexia, it has to be the amped-up development of the best fat-burning system on the planet. I mean, seriously – my body is out of control with this. It’s actually unfair to my competitors. So often during 3 hour long runs or 5 hour bike rides, I see my husband struggling with fatigue and hitting the wall and yet my engine just keeps on churning it out. I’ve lost count of how many times we have discussed a physical feat that should not be possible, according to the textbooks – and yet I’ve just done it. Case in point: at Busselton Ironman in 2012, I very stupidly accidentally consumed a drink with gluten in it right before the start. As a coeliac, that = disaster. I got about 2 hours in then started vomiting for the next few hours on and off, then came the stomach cramps and gastro. I got nothing but water and a bit of watermelon down during the race, and yet I still managed to finish. Two hours before my husband. In 35 degree heat. It should not be physically possible to exercise in those conditions on that little nutrition for 11+ hours, and yet – there I was, I’d done it. What an engine.

Marino Vanhoenacker passing by an aid station at Melbourne Ironman 2014

Marino Vanhoenacker passing by an aid station at Melbourne Ironman 2014

There isn’t much formal evidence of this phenomenon, but there is a hell of a lot of anecdotal evidence around. A quick look around at the top Ironman, marathon and ultramarathon professional athletes in the world reveals a huge proportion of previously eating-disorder-afflicted athletes. Some still have obvious ED’s. Even more would currently have well-hidden disordered eating patterns. And I’m not just talking about females, either. There are a pair of professional brothers who compete in Ironman and one of them has such a severe eating disorder that despite over 1 million dollars being laid on the line by their sponsor for the two of them to go head to head at Hawaii Ironman a few years back, the ill brother didn’t even make it to the starting line because his ED was so out of control that he was admitted as an inpatient, missing the race altogether.

Then there’s arguably the best female ultramarathoner we have seen to date, Pam Reed, who won Badwater outright two years in a row, beating all the men in the field:

“…And there was also an ironic twist to all of this. Anorexia had ruled my life for 15 years and had done a lot of damage in the process. One of its effects had been to condition my body to an amazing degree for ultrarunning. Something that had hurt me at one time in my life would now help me in another”
– from “The Extra Mile”, Pam Reed.

Need more evidence? Let’s look at the maths, and let’s stick to Ironman since that’s my thing. A typical 65kg athlete who completes the Ironman (3.8km swim/180km bike/42.2km run) in 12 hours will burn around 42000 kj doing so. That’s on top of the roughly 8000kj that same athlete needs just to stay alive that day – breathing, thinking, blinking etc. Think about that for a second: do you think it’s even possible to physically eat that much in a day? Let alone on a day you are exercising – hard – for 12 hours of it, shunting blood away from your digestive system? Well let me tell you, even if you have “Ironguts” like my husband (who is famous at our local pool for chowing down on a large flat white and bacon and egg muffin while getting into the pool to start his 4km swim set….), you cannot ingest that much energy. Not even close. If you’re lucky, you’ll have about 90 minutes worth of carbohydrate stored in your primed muscles, but after that, it’s predominantly the fat system that you’ll rely on. Most of the energy that you consume after that will be split between helping to prolong that fat-burning system, and importantly, to keep your brain happy. Recent research shows that while dieticians used to think we used the fuel from Gu’s and Gatorade to keep our muscles happy, it’s actually more to trick our brain into thinking we are still high on sugar and so it’s safe to continue exercising. Pretty cool stuff.

Unfortunately, Ana doesn't make you immune to blisters!

Unfortunately, Ana doesn’t make you immune to blisters!

So while I would never wish an eating disorder on anyone, I am happy for the gift that it has given me. Happy that something came from all the years of suffering (one must try to look on the bright side!). Before my very first Ironman a few years back, Coach and I were going through my nutrition plans for the day – Plan A, B, C, D….. because nothing ever goes to plan on race day and you must be flexible. His last words to me were “you will dominate this – you are so strong because of everything you’ve been through, when you get to the point where you have to “dig deep” you will absolutely thrive. And……don’t be afraid to start drinking coke early on the marathon!”. Well, he proved to be oh so right. I couldn’t stomach much during the bike leg, so was heading into the marathon feeling a bit flat. I started on coke and water straight away, and kept that up throughout. Sure enough, my brain was super happy with that! While everyone around me was collapsing like flies, I just kept getting stronger and stronger – the fat-burning kicked in and I was having a ball! Indeed, I got to the end and was disappointed that it wasn’t a bit harder.

I joked to Coach we might try the UltraMan next time (back-to-back Ironmans).

We’ll see what the future brings!

K xo

When all else fails, Bake.

Hormones rule the World…ok I get it, I GET IT!

It’s been a pretty stressful last few months, which largely stems from the fact that I am once again faced with the ever-challenging issue of learning to trust my body.

After having a miscarriage 4 months ago, my body has decided that it’s going to do its own thing, regardless of whatever I am choosing to do. Despite zero change in my food or exercise, I have been battling an influx of hormones presumably stemming from the miscarriage. My previously flat stomach is now decidedly curved and my breasts have gone from a small B cup to a large C cup. Initially I thought that this would level off over time, but it seems they are here to stay – at least for the time being.

Tiffany's-inspired Chocolate Cupcakes.  I dare you not to feel uplifted!

Tiffany’s-inspired Chocolate Cupcakes. I dare you not to feel uplifted!

It’s brought all those recovery memories flooding back. The overwhelming feeling that you are drowning in a sea of change and you don’t know when the wave is going to stop pummelling your body against the floor of the ocean. It’s also a bitter pill to swallow: that I would not only lose my baby, but that I would lose control over my body as well. My doctor reassures me that it’s a good thing, that my body is trying to set itself up to become pregnant again (which is what I want more than the world). My psychologist says that I should focus on the positives, like having amazing breasts – my husband has certainly had less trouble than me focussing on this one – and that this will not last forever. But for me, it’s all been downright confusing. Just when you think you truly know your body, know what it likes, know where its set point is, have come to accept a certain size as being healthy for your frame….it all gets thrown to the wayside. I can almost hear God laughing.

Once again it has reminded me that hormones do, in fact, control the world. Or at least our sleep, mood, emotions, fat deposition, curves, weight, fatigue and ultimately, fertility…. So what to do? The only thing I know how to do: make sure I am taking the best possible care of my body and mind and trust that it will settle into itself, wherever it is supposed to be. Which means, for me, cutting out caffeine and alcohol, eating A LOT of fruit, vegetables, good quality protein, nuts, seeds, good fats, and of course steering clear of gluten (I have Coeliac disease, as an aside, which does put me at a higher risk of miscarriage along with a history of Anorexia. Oh the joys.). It also means focussing on nourishing my body with activity that brings me joy and relaxation, namely running, dance, Pilates, group rides and swim sessions with my husband. Not because I have to do a set session or hit a predetermined interval; simply because my body can and it makes me happy. That is an important distinction. It means getting at least 8 hours of good quality sleep a night, and actively trying to relax during the day – deep breaths at work, 5 minutes of meditation when I get the chance, and laughing a lot. And of course, when all else fails, it means baking – the cheapest and best therapy of all.

Death by Chocolate: Chocolate Mousse Layer Cake with Chocolate Ganache

Death by Chocolate: Chocolate Mousse Layer Cake with Chocolate Ganache

I’m not sure that I will ever be able to accept that I cannot control what is happening with my body. Ultimately, your body will change at various stages during your life, and there is very little that you can do to stop that – short of being unhealthy and falling back into eating disorders patterns, or conversely, saying “stuff it” and allowing yourself to become significantly overweight, which is not healthy either. It is well established in the research that your body has a “set point” – a range of about 5 kg, that it will defend at all odds. So just like in recovery, when you have to trust that you won’t keep gaining and gaining indefinitely; I too have to now trust that if I nourish my body and treat it well it will do what it needs to do to create the optimal environment for baby-making and health. I can’t change what that shape ends up looking like on me, but I can change how I react to it. I am faced with a choice – to reject the change and stick to everything I have known up to this point, or to embrace that I do not have control of what is happening and to learn to love my body, no matter what form it presents in. After all, I am still the same person inside.

It’s going to be a challenge, but I’m pretty good at overcoming those.
Keep on keeping on fighting the Good Fight. This one is going to be tough.

“When doubt seeps in, you got two roads, you can take either road. You can go to the left or you can go to the right and believe me, they’ll tell you failure is not an option. That is ridiculous. Failure is always an option. Failure is the most readily available option at all times, but it’s a choice. You can choose to fail or you can choose to succeed.” – Chael Sonnen

K xoxo

Show me how Big your Brave is

Reporters love asking celebrities what they would go back and tell their younger self. They reply with some warm fuzzy blurb along the lines of “things get better” or “be more confident”. If I could go back to my younger self – probably around age 15 – I would say: grow some balls and scream for help, scream so loud that no-one can ignore you, to hell with the fear….it may just save your life”.

Finally - the media doing something proactive towards body confidence

Finally – the media doing something proactive towards body confidence

There is inevitably those fleeting moments in the eating disorder journey where the inner You is strong enough that you could probably ask for help. But these moments are so few and so far between, that the fear quickly envelops the soul and again sets you back down the path to Ana. I can still think of the few times during my decade with Ana – count them on one hand, actually – that I would have accepted help without too much of a fight. Those moments you remember, with clarity when it was just too hard to fight any more. Broken, at last. When I do think back on those few times, it still makes me feel physically violently ill to my stomach and sets my heart pounding, even all these years later. The extent of the fear of ratting Ana out is unlike anything else. To simply say the words “I need help”, comes with a plethora of assumed baggage weighing enough to drown anyone.

While eating disorders are rarely “silent” – those around you know there is something wrong – I would bet money on the fact that no one on this planet knows everything I did to myself during those years; the extent of the body abuse and the tricks that Ana played out. So while Ana may fool you into thinking “if it was that bad, someone would have intervened by now”; in reality, you and I both know that they have no idea what you are truly doing and what goes on in your mind. Looks can be incredibly deceiving.

My birthday cake.  Made by me, and yes, also eaten by me (well, one piece!  Baby steps)

My birthday cake. Made by me, and yes, also eaten by me (well, one piece! Baby steps)

But then the benefit of hindsight is that in all my wisdom, I can now look back with heartbreak, thinking “if only”. If only I had said to someone that I was unwell, and that I couldn’t stop myself. That I was so scared I wanted to vomit. That I thought I had control of this thing but that turns out to be the ultimate trickery. That I don’t want to fight anymore. I don’t want to “act” like Me anymore; I want to find Me. If only….

There were many people in my life that I could have asked for help. My immediate family were a huge part of my problem and chose to be incredibly ignorant about my condition, so even as a 12 year old, I knew that was not an option. But my Aunty, my best friends, my boyfriend, my coach, and later my resident mentor at college, or my doctor…..any of these people would have given heart and soul to help me – and God knows how much they all tried at various times – if only I’d let them in. It would have taken a huge amount of guts and four words to change my life: “help me, I’m ready”.

Instead, I let Ana rule the world for a decade, pretending I was in control, but knowing full well for the latter years of my illness that I was not. In a final bid for freedom – of myself, not Ana – I jumped on a plane to Canada and set myself free in the world. I was going to get better. Only just 2 weeks in, failing miserably, alone in a backpackers in Vancouver, I collapse on the stairs from a near-lethal combination of starvation and a vomiting bug. For the record, I don’t count medical help that was not given by choice but rather by dire circumstance as “asking” for help. Clearly, this was not going to be a one-woman effort. By that stage, Ana was so strong that it was going to take a lot more than that to break her down.

On returning to Australia, this time as an adult, I checked myself into help for the first time ever. It was my choice. I was scared shitless and felt so out of control of my life, but it was what it came to. It took years of mess and emotional rollercoasters and a lot of help from my friends following that to find health and most importantly, Me. But I got there.

And yet the mind wanders at times…..How would things be different, if I’d gotten help so much sooner?

“Maybe there’s a way out of the cage where you live
Maybe one of these days you can let the light in
Show me how big your brave is”

Help is scary, I know. But living alone with Ana is scarier. Just because it’s familiar, doesn’t mean it’s ok. Deep within every perfect little Anorexic is a voice that wants so desperately to stand up for You, for everything that should be yours and that you deserve just as much as everyone else in the world. Don’t let Ana fool you into thinking you don’t deserve it. Finding that inner voice and learning to use it is often the keystone to the mountain that is Recovery. It certainly was for me.

tattoo edited

Be brave. Kick and Scream. Beg for help. I know You can do it.

“Nothing’s gonna hurt you the way that words do
And they settle ‘neath your skin
Kept on the inside and no sunlight
Sometimes a shadow wins
But I wonder what would happen if you

Say what you wanna say
And let the words fall out
Honestly I wanna see you be brave….

Don’t run, stop holding your tongue
Maybe there’s a way out of the cage where you live
Maybe one of these days you can let the light in
Show me how big your brave is…

Honestly I wanna see you be brave”
– Sara Bareilles

K xoxo

United Nations of Ana

“Be Careful what you wish for; it may just come true”.

Wining and dining in beautiful Queenstown....that wish came true!

Wining and dining in beautiful Queenstown….that wish came true!

I’ve noticed over the years, that when I really visualise and wish for something to happen, more often than not it has come about. As a student of science – two university science-based degrees, in fact – I do understand the absurdity of this statement. But on the flipside, as a Physiotherapist who largely works with athletes, I am also hesitant to brush off the power of the mind and the power of intention in making things happen. An advocate of “hippie medicine” I am not; but a believer in the human mind, very much so.

Just last week a colleague and I gave a presentation to a group of runners about the power of visualisation, in terms of goal setting and forming one’s identity. What athletes do really well, that “normal” people do not, is to clearly establish an image in their minds’ eye of what their goals are, what their body looks and functions like, and how they will perform on race day. They stick posters on their bedroom walls, photos in their wallets and cars, have firm self-affirmations and use frequent visualisation to enable them to see the future they want to create and to assist in their pursuit of excellence.

Let’s flip that equation. How often do you see someone who has been overweight and inactive for their entire adult life, go ahead and lose 20kg, along the way learning how to maintain that loss, only to turn around and put it back on? Often, the new lifestyle has been achieved, but the person has failed in their mind’s eye to identify this new person in the mirror, who is “healthy” weight and active. They don’t recognise themselves. So they go back to their place of comfort.

Sound familiar? Nowhere is this phenomenon more important than with ED patients trying to recover. We are the ultimate masters of visualisation and affirmation – Ana makes damn sure that the little birdy on our shoulder never shuts up, providing an incessant stream of buzz words and “motivations” to become the ultimate weight loss machine. Do we recognize ourselves when we get there? Hell yes, we have been dreaming day and night of reaching that mystical land and no person on the planet is going to take it away. Hello Ana!

Only that is not you. That is Ana you are seeing in the mirror. Somewhere in the process, Ana takes over and the real You becomes a mute little birdy on the other shoulder.

During the long and arduous process of recovery, it becomes so important to bring that birdy back to life, for if you cannot see You in the mirror along the road to health, the risk is that Ana will pull you back to the land of “comfort”.

Easy to say, hard to do. How does one find a new sense of self – particularly for someone like me, who lost that sense of self at around 12 and then had to try to find an adult identity at age 22? We use the same tools that we learnt so well during the Ana years. Flip that bitch on it’s head. When it comes to the power of the mind, no-one – elite athletes included – does it better than an Anorexia sufferer.

The first thing that I did was to find images of athletes who I thought were realistically about the same size frame as me (height and muscularity etc), and had beautiful, fit, lean, muscular and healthy bodies. The more they look like you (a healthy version of you….), the better. Then I wrote out quotes and powerful affirmations for me, as simple as “I am an athlete”, “I am strong”, “I am beautiful”. I needed to be healthy to finish my first Ironman, so I included photos of glowing Ironman finishers as well. I plastered these words and images all around my mirror and through my training diary, as a constant reminder of where I wanted to head. I was creating an image of my future life in my all-important mind’s eye. So that when I got there I would recognise the person staring back at me in the mirror. I knew what Ana looked like; I just had to work out what I looked like.

Over the next months and years, the photos and words got updated and I started to build “me”. And then a funny thing happened. I finished my first Ironman, and the finisher photos get sent out a few weeks later. I stuck one of them up on my wall, then took a step back.  It fit right in, amidst the photos I had put up there to visualise my future with.  I had to smile.

The magical glow of the Ironman Finish Shute - Cairns 2012

The magical glow of the Ironman Finish Shute – Cairns 2012

The transformation didn’t happen overnight, and I still don’t love what I see in the mirror. I still spend countless hours talking to my Psychologist about the division between what I see, and what others in my world see (I get very confused when people tell me I’m attractive, stunning, slim etc as I do not see any of those things – it’s a work in progress). But the most important thing is I do see me in the mirror. It’s familiar, and it’s a body that can achieve amazing things, and a mind that spends most of its days helping people with their health, and that is a beautiful thing.

I will never stop doing this process, as it has bode me well during my recovery years and so long as I am doing my life’s dance on this epic planet, I will never stop trying to achieve amazing things. In the future the images will change as my life evolves, and I can’t wait to see how the rest of my life unfolds.

Bring it on.

K xo

“When I stand before God at the end of my life, I would hope that I would not have a single bit of talent left, and could say, ‘I used everything you gave me’.”

– Erma Bombeck

Insecurities

“Step out the front door like a ghost into the fog
Where no one notices the contrast of white on white

And in between the moon and you, angels get a better view
Of the crumbling difference between wrong and right

Well, I walk in the air between the rain
Through myself and back again
Where? I don’t know”

– Round Here, Counting Crows

Please read the following scenarios and choose the most correct answer:

1) You are an elite female triathlete with the following stats to your name: two sub-9hour Ironman finishes, <12% body fat and arguably one of the fittest bodies on the planet. When asked your weight in an interview, would you:

a. Tell the truth – your body is a weapon, your job, and a beautiful machine and you are proud of it!
b. Take off 5kgs from the true amount; you think you are ‘heavy’ with the muscle on your frame and your height.
c. Refuse to answer.

2) You are an athlete who has had an eating disorder in the past, you are now recovered but do not know your weight. You haven’t been able to run for 6 months due to injury, but have the chance to run on an Alter G treadmill that your sports doctor has arranged. In order to use it, you and your doctor will find out your weight. Do you:

a. Get on it – to hell with my weight I am desperate to run!
b. Agree to use it as long as you don’t need to find out the weight, then proceed to have a meltdown about it anyway, fearing that your doctor will think you’re the most obese athlete on the planet;
c. Gracefully decline. You are desperate to run, but the trauma of going through being weighed is just too much.

What would you do?

WA Ironman 2009

WA Ironman 2009

Impossible scenarios like this face us day in, day out, when we have the tracks of a previous ED in our scar tissue. We may be doing well for the majority of life’s intricacies, but there will always be situations like the above that will either get our blood boiling, or mentally challenge us more than is desirable (I don’t think it’s considered “normal” to have a panic attack at the thought of someone else knowing your weight….).
The first scenario makes me so furious that it sends me searching for my soapbox – in fact, I did send a huge ranting email to my good friend and doctor about the exact situation. I have been in the fortunate scenario to be on a squad alongside professional Ironman athletes for the last few years, and some of the best female triathletes on the planet to that end. Our head coach boasted more sub-9hour females on his squad than any other coach worldwide. It has been incredibly insightful and for the most part beneficial for me to be able to access their wealth of experience and knowledge and to apply that to my own racing and training.

But it doesn’t come without some serious eye-opening of the bad kind. Over the years, as you get more “well”, your triggers become so much more obvious. Racing has always been one of my biggest triggers – lining up on the start line in little more than some loud flimsy lycra is one thing; having that then photographed and marketed back to you in the eschewing weeks is truly disconcerting. No-one looks good in lycra, just putting it out there. The males who don’t have eating disorders love the race photos because they look so buff and muscly; the females – ED or otherwise – hate the photos for the same reason. I continue to race because for the most part it heals my soul. I’m good at it, and so it builds my self-esteem and creates an identity other than “anorexic”; in short, the risk-reward ratio is in the right place for me.

What I have learnt, however, is that disordered eating is rife among these professional women. They are not immune to the pressures; in fact, they feel it more than most.

Which disgusts me. Here you have 5 of the fastest, fittest, most incredible female athletes on the planet, all with bodies which would make any human proud. Their bodies are their livelihood, and to that end are serving them very well. Their self-confidence should be oozing; success is practically their middle name. And yet, they feel the need to lie about their weights, ashamed by the number on the scale.

What does that mean for the rest of us?

What message does that send?

Fast forward to scenario II, where I get this amazing opportunity to start my return to run training 3 months ahead of schedule following my foot surgery, thanks to the Alter G treadmill purchased my sports doc…..and yet I baulk. Frozen. Panic sets in. I know it means being weighed, and for someone who has just had 6 months off normal training, that is paralyzing.

But why should it be? I weigh 5kg more than the average of those 5 elite females put together – their real weight, not the one they put down on our team bio page. I am healthy, lean, fit and carry as much muscle as a good Ironman athlete should. Yes, I’m a few kgs up from my race weight, but that is OK too – because I am not race-fit right now. My body is as it should be right now, and I would like to be able to “own” that.

In the end, I guess you could call me a hypocrite. It upsets me that those women feel the need to lie about their weights, and it saddens me that that will send a very wrong message to young impressionable athletes coming through. It’s as if we are expected to achieve the impossible: to have muscle and minimal fat, and good bone density, and yet to weigh in at featherweight. Consider who is setting these expectations, and whether it is a sad modern extension of the female bullying epidemic, insisting we be perfect and able to do-it-all and yet so ruthlessly judging one another for how we all look/dress/work/live/parent…..the list goes on. I can tell you that my doctor, who is a male, didn’t give two hoots about my weight. And you rarely hear males bitching about their fellow mates, judging how they live their lives. Food for thought.

My plea is for female athletes to start “owning” their beautiful bodies. Be proud that you weigh a little more than your unfit skinny counterparts because you actually have muscle tone. Be proud of what your body can do, and how far it has come. For those of us who have climbed from the dark depths of an eating disorder, also be kind and forgiving – for your body has been through so much more than you will ever know, and every day it wakes ready to heal a little more and to help you to keep fighting the good fight.

Never forget that. Own what you are, and be proud. Starting a revolution starts with one tiny step, and you just never know who you’re inspiring by how you live your life.

insecurity blog

K xoxo

Recovered.

Recover.
Recovered, recovering, recovers.
v.tr.

1. To get back; regain.
2. To restore (oneself) to a normal state (‘He recovered himself after a slip on the ice’)
3. To compensate for (‘She recovered her losses’)
4. To procure (usable substances, such as metal) from unusable substances, such as ore or waste.
5. To bring under observation again.

v.intr.
1. To regain a normal or usual condition, as of health.
2. To receive a favourable judgement in a lawsuit.

tottoo and coffee NZ

Psychologist: “Exactly when do you think this magical line will be, where you will consider yourself to be “recovered”?
Me: Pause. “Well, I think I’ll be recovered when I manage to get married at a healthy weight, and not want to burn the photos or kill myself when I see them. And also when I finish an Ironman in one piece”.
Psychologist: laughs “Well we’ll see, I don’t think your body will be able to do any Ironmans in this lifetime after everything its been through”.

Challenge accepted.

Well it is almost 3 years to the day from when I married the man of my dreams, had finished said Ironman and celebrated by getting my recovery tattoo while on our honeymoon. A few weeks ago we went back to that magical place and celebrated the last 3 wonderful years, several more Ironmans and much laughter together.

neda-logo

I call that “winning”.

Rock on.

K xoxo

The Dirt on Dieticians

Everything you’ve wanted to know that the internet won’t tell you.

“Experience is the father of all wisdom.
And assumption is his bitch” – Brett Sutton.

Cake.  It's just cake....not the spawn of the devil.....

Cake. It’s just cake….not the spawn of the devil…..

If there’s one thing certain to strike fear into the bones of most humans, it’s someone knowing the intimate details of your daily doings – every morsel of food and fluid intake scrutinised, every measure of fitness and body fat calculated, every minute of calorie-sapping exercise tallied. And judged. Usually by an underweight and pale young woman sitting unusually upright on the other side of a cold desk (sorry for the stereotype but I know a lot of dieticians and it’s hard to argue with it!).
OK so they get a bad rap. But here’s the thing – they can be your ticket to freedom and your greatest ally. They can get you what you want, faster than you can get there on your own. They can take you to new heights of perfectionism in the body composition department and by default, they can lift your athletic performances through the roof. And lower your injury and illness count. They can help you learn to eat more normally, without necessarily putting on weight.

So what’s the catch? Like any industry, there are bad ones and good ones, and you need to get it right. A bad experience can be nothing short of traumatising, so do the work first to limit the chances of hitting a bad one.

Look for an Accredited Sports Dietician (whether you’re an athlete or not…).

In Australia to become a dietician requires a 4 year-degree. During that time they learn a lot about a lot….but don’t become specialists in any one field. They’re basically good at general nutrition and hospital nutrition. To then become an Accredited Sports Dietician they have to do an extremely difficult course which involves training in the specifics of manipulating body composition in athletes and also in dealing with eating disorders, which come with a host of specific challenges (physiologically, metabolically and emotionally). I actually know good dietician friends of mine who openly admit they won’t treat ED’s, so challenging is the task. So rule number 1 to avoid a horrible experience with a dietician is to find a good one with appropriate training, and you can minimise that risk by searching on the Sports Dieticians Australia website (or relevant body in your country).

Even better: Find a Sports Dietician who has an interest in treating Eating Disorders (note I did not say “find a dietician who obviously HAS an eating disorder….).

I’ve had several bad experiences with the stereotypical uptight-skinny-hospital-dietician in my time and while they were great at boosting my weight when I probably needed it, they weren’t great at inspiring my faith in the recovery process being all rainbows and unicorns (it’s not, but it doesn’t have to be as bad with the help of someone more useful and “real-world”). So how do you find a good one without totally blowing your cover? Well I was lucky enough to have a close friend go through the dietician process first, and I knew that she was seeing someone but not gaining any weight. I probed. She confided that she instructed the dietician that she wants to learn to eat more normally, but only under the proviso she didn’t gain any weight and didn’t have to stop exercising. And the dietician obliged. I booked in the next week.

Failing being that lucky, the internet is a good resource for searching – most good dieticians will have a bio on their website and state their treatment interests. Also check their photos if they have them and see if they have a glint in their eye, shiny hair, glowing skin, no collarbones sticking out…..the healthier they are the better off you’ll be with them.

“The thought of fronting up for the first time makes me want to vomit”, “they’re going to see straight through me!”, “I’m too fat to have an eating disorder”, “If they find out how little I eat they’ll tell my family” …..and other irrational fears.

I 100% understand all of the above fears and many more. So having been through it myself, here’s the actual facts of the matter.

Yes, they will likely see straight away that you have disordered eating of some type but they will not bring that up with you, at least not initially. They legally cannot tell anyone, unless you are under 18 and extremely, about-to-drop-dead underweight (if you are over 18 you will have a say in the matter). Anything that is said to them – exercise patterns, food intake, weight etc – is legally confidential. It’s a safe space. A good dietician probably won’t weight you, and especially won’t if you ask not to be. My dietician always took other measures like circumferences but never told me what they were, just whether they were up or down. People with dietary issues come in all shapes and sizes – seriously sick bulimics can be overweight, just like someone who’s had anorexia for a very long time can be normal weight due to metabolism dysfunction – so they will never, ever look at you and think “you’re too fat to have an eating disorder”. Ever. Promise.

If you’re seeing a private dietician, and you’re paying for it, their job is to facilitate you with your goal. Whatever that goal is.
If you go in and request to eat more and stay the same weight (so long as you’re not about to die on the spot from malnutrition, in which case a hospital dietician is actually more useful to you), they will work with you on that. When I first started seeing my dietician, I was 8kg less than I am now, my “healthy adult weight”. So, not grossly underweight, but not ideal either. I was hardly eating anything, exercising the house down, miserable…..and my metabolism was getting more thrifty by the year (making it harder to lose weight). I was over it.

What she did then single-handedly prompted my recovery, in earnest this time. Over the course of a long time, she introduced more foods and more volume, and – miraculously – I actually maintained weight, even lost it at one point. During this “trust” experiment, we also included a period of 2 weeks of zero exercise, to overcome my greatest fear – of putting on weight if I stopped training. It was the scariest thing and still makes me feel sick remembering how stressful it was. I actually lost weight, which gave me a huge confidence boost in my mind and body.

Of course, I did need to gain weight in order to be healthy. But she never pushed me, just gently supported me and taught me to trust food and my body. I maintained that weight for a further 3 years, then eventually when I was ready I allowed my weight to very slowly increase to where it sits today. And I can honestly say, now that my body has hit its set point, I can pretty much eat whatever I like and it stays within 1-2 kgs. I put this down to having such a good program to start with.

You don’t need a referral from a doctor to book in.
In Australia you can call and book with a private dietician without a referral. You do not need to tell the receptionist over the phone what you want to be treated for. The cost will vary, depending on the practitioner (generally better ones are more expensive); you can claim about half the fee back from your private health cover.
Ultimately you are paying for the service and hence their job is to meet your goals. They will discuss your goals with you and go through relevant information, give you little things to work on. They’ll send you off for a couple of weeks to work on it and then remeasure and continue. Every single day they see patients who have exercise addictions, want to improve body composition, have disordered eating, thrifty metabolisms and crazy dietary practices, and who think “they’re too fat to have an eating problem”. There’s nothing they won’t have seen.

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My road to recovery would have been a rollercoaster of metabolism riots and psychological warfare – as opposed to a relatively smooth upwards progress curve – had I not made the mighty step to make contact with my dietician. How do I know? Because I’d tried the other way for a decade beforehand. And it was failing miserably.

“You do not drown simply by falling into dark waters; you only drown if you stay beneath the surface” – Paolo Coelho

You can do it.

K xo

The broken. A Survival Guide.

Part II:

So you’re fractured – body and brain. You want to scream at the world and pull your hair out and cry, simultaneously. I get it.

In the previous post I introduced the concept that perhaps it is essentially the mind that causes stress fractures in the large majority of athletes, moreso than just the body failing, as modern medicine would have us believe. Specifically, the sheer force of power that is that voice in your head that will not allow the body to stop, even when presented with increasing physical pain. We are a smart bunch; it’s not like we don’t know that something’s wrong and it’s getting worse. It’s just that stopping is infinitely harder than pushing through a little physical pain. Hell, sometimes the physical pain feels good – euphoric even – like you are fighting the beast in a different way. And yes, the pain of a stress fracture is “little” in comparison to running 35km after not eating much for a few days….there’s levels of relativity and most of you here have an abnormal sense of ‘perspective’ when it comes to matters of human suffering. I wish it wasn’t so, I really do.

Sometimes the beast wins, and you find yourself in the doctor’s or physio’s office with a full-blown stress fracture or major overuse injury, which essentially you did to yourself. Yet another kick in the guts. Facing down the barrel of 6-12 weeks off your beloved sport, you feel the red rush of hot panic bubbling up from the fracture site and seeping into your heart. Staring at the image of a clear break on a clear scan, suddenly the pain feels so much worse.

What now?

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There are hundreds of well researched and accessible texts on gold standard treatment protocols for stress fractures, ranging from stopping running right through to the extreme of surgery, depending on the site and severity of your injury. But there are very few resources written on coping with the emotional and psychological backlash of injuries, much less if you also have an eating disorder or disordered eating and you are now faced with the removal of one crutch – running (emotional) and the replacement by another crutch (literal).

1) Take time to digest the news and go through the stages of grieving, so that you can recognise what you are dealing with. If possible, have a close friend or loved one with you to help with the support and to remember information. The average patient only retains 30% of what is said to them during a medical consultation. Even better – write it down. The doc won’t mind.

2) Embrace the “Athlete Mindset”. The fact that you are in this situation means that you are dedicated enough to your pursuit of excellence that you are already in the top minority of athletes. BUT….you need to learn when that line is approaching and how to not cross it in the future. Allow yourself to recognise your best traits (discipline, commitment, passion), but also to define what you would like to work on in the future (the strategies in part I – prevention; listening to your body; allowing yourself to rest and letting go of some of that perfectionism….). Your “training” now is recovery. That is no.1.

3) Get some Sun. It’ll help with the bone healing thanks to its Vitamin-D inducing properties. It will also assist with depression, appetite and most importantly it will get you outside into the fresh air.

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4) Ensure Social Contacts. It’s more important now than ever to make sure that you stay involved somehow – whether that be with group catch-ups after training, going to training or dance class and assisting the coach or teacher, keeping up with dance or running magazines. While it seems counterintuitive, this can actually help you to keep the “athlete mindset” and to help with staying on track in order to achieve bigger goals in the future.

5) Create a different outlet. Use your emotions as a guide. Do what makes you feel good; steer away from things or people that make you feel more down or frustrated. Be aware of being pulled towards bad habits – they can be strong and start sneakily. Tune into your emotional radar early when it’s slightly easier to resist.

6) Develop a nutrition plan. And stick to it. Most notably:

a. Avoid regular and diet sodas due to the bone-leeching phosphoric acid contained in these liquids.

b. Reduce caffeine intake, ideally to less than 2 cups a day. Caffeine also leeches the skeleton of calcium, critical when the bones are in healing mode.

c. Avoid alcohol, which can induce a pro-inflammatory environment and affect absorption of important nutrients in your food. Aside from this, it is a depressant so probably not helpful on the brain given the current situation.

d. Maximise sleep, as this is where your largest surge of growth hormone occurs – crucial for healing and mental health as well. Talk to your doctor about this if you are struggling, which is common when you are used to expending so much energy on a daily basis.

e. Most challenging of all….keep the focus on nourishing the body with high quality foods, now is not the time to diet or restrict food groups. Keep in mind that healing takes up a huge amount of energy. Accredited Sports Dieticians are very experienced in this field thanks to the high injury rate in elite athletes – and yes, you can totally book an appointment and request a meal plan to maintain your current weight while injured, whatever that weight may be. Even if they suspect you have a phobia of certain foods or a controlling personality, they will respect that and all information shared is legally confidential.

7) Most importantly, give yourself permission to rest and heal. If you cannot give it to yourself, ask your health professional – whether it be your dietician, psychologist, physio, doctor or even a friend or loved one. The most weighted words you can hear are “you are not allowed to exercise with this”. You have permission, to just heal. That is your number 1 job. There will be plenty of time once you’re back on your feet to concentrate on training; for now, the more you rest, the faster you will heal.

Of course, it all sounds so practical and easy when it’s neatly typed out on a page. It won’t be – it’s going to be hard, much harder than the physical pain of the initial injury or the discipline of full training. But if there’s one thing that’s certain, it’s that with no plan at all, things will likely slip downhill fast on the sliperyslope to ED-land. You will have a much harder fight on your hands in the mental department during your down time, but it is worth fighting for and you will come through the other side a stronger, better, more passionate athlete. In my younger (Ana) darker days I had a tibia stress fracture which I couldn’t (mentally) stop running on, eventually I ended up in a cast. When the repeat XRays were done at 8 weeks there was zero evidence of healing, mainly because I had been stressing and severely restricting food during that time and had consequently lost a significant amount of weight. Yes, that can happen. Don’t muck around with it – the psychological setback is so much worse the longer it goes on.

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Stay strong, fight the good fight, and learn from your experience so that you can come out fighting.

K xo

Stress Fractures – Dealing with the Emotional Backlash of Injury

Part I: Prevention

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“And so that I do remember
to never go that far,
Could you leave me with a scar?”
– Missy Higgins

So you’ve found yourself staring down the barrel of some time away from your most-loved activity, likely due to impending injury, an exercise ban, a fatigue-related illness or something similar. It’s not bad enough that you feel like your legs have been cut out from under you however it is bad enough that you feel some fear and insecurity fast-arising in the knowledge that you need to rest, and you’re not very good at that. I’m going to focus on strategies to help specifically with preventing stress fractures in the early stages, mainly because of the high incidence of them in athletes with disordered eating of some sort. However many of you will find these tips helpful for other situations as well.

Eating disorders occur in up to 19% of male athletes and 45% of female athletes, according to the literature. Which logically speaking puts this group at the highest risk of sustaining the dreaded stress fracture, simply put – too much overload on a weakened skeleton, too much exercise, and not enough nourishment to keep up with the bone turnover. The most high-risk sports for sustaining stress fractures are also those with the highest rates of disordered eating: ballet, distance running, skating, gymnastics and rowing.

But here’s the thing: stress fractures are also arguably the easiest of the overuse injuries to prevent from happening, or at least prevent from worsening once they start. They are thoughtful little devils, in that they give you warning signs as they gently create microcracks in the bone, one painful step at a time. Should you choose to ignore the progressing microcracks, they will get crankier day by day, eventually making it painful for you to walk. Should you choose to really blow them off, you can run yourself into a full bone fracture – bringing with it night pain, throbbing and swelling at rest, and usually some time non-weight bearing (in a cast for the lower limb, crutches for the hip and femur, typically 6-12 weeks IF you eat well during recovery, longer if not).

So while health professionals and researchers are spending oodles of money researching how to best prevent and treat these debilitating injuries, I’m going to talk about the elephant in the room. The fact that most of these stress fractures wouldn’t eventuate, if the athlete made the choice to stop the aggravating activity when it first surfaced its head. A newly formed stress reaction (the stage before a stress fracture) will heal with just a couple of weeks off running – you can usually keep walking and doing all other exercise. Seems simple – just stop running, or dancing. Have a week off.

Only it’s not that simple, because you can’t. You have a voice in your head that wants you to push through the pain, because if you stop running, you’ll get fat and lose everything you’ve been working for. You try to argue with the voice, reasoning that a week off now is far better than 8 weeks in a cast if you keep running…..but you can’t. Simply put: the pain from ignoring/fighting the voice in your head is worse than the pain of the stress fracture. Far worse. And that is something that only someone who has been through an ED would understand; certainly your doctor or physio is unlikely to get it. “You have such a high pain threshold”, they say. Oh if only they could walk a day in your shoes! Physical pain is a mere annoyance; mental pain on the other hand is nothing short of crippling. And it never stops. Like a repetitious steak knife to the brain.
So, my goal for myself and others is to work out strategies to help fight the beast at this crucial moment in time when things are make or break, quite literally:

1) Fight the Fear Head-On. In this day and age, with a little Google-action combined with the high IQ of most high-achieving individuals, it is likely that you already know when you are at risk of an impending stress fracture (Google “foot pain in a runner” and see what comes up….). Next step then: google the treatment protocol. While I spend much of my work life as a Physio hating when patients self-diagnose, in this case it can be useful as a head-on tool for fighting the ED voices that are insisting that you push through the pain. Sometimes, having the weaponry of “if we keep pushing through this pain we won’t be able to run or walk for 6 weeks!” is helpful in the daily warfare and can assist in avoiding a full-blown bone break.

Sometimes fear of the impending "worst case scenario" can help you to protect your body before the worst happens....stick it somewhere you see it often

Sometimes fear of the impending “worst case scenario” can help you to protect your body before the worst happens….stick it somewhere you see it often

2) Verbalise what is going on to someone that you trust. It’s OK to say “I don’t trust myself to not run at the moment”. Even better if you can get some company – ask a friend to come walking or to the gym with you, so that they can be in charge of not letting you hurt yourself. Or tell your dance teacher or coach what you are and aren’t allowed to do. It’s OK to ask for help, and it’ll give you that exercise outlet without having to fight the self-destructive urges for at least a small amount of time.

3) Create a plan, write it down, and obsessively stick to it. Channel the beast into a set program of a different kind – one that won’t cause further hurt. If you’ve caught it early, you’ll likely need about 2 weeks off pounding activities. So write a plan filled with core work, swimming, cycling and other safe activities and commit to recording your sessions. Often the objectivity of having a written plan helps to quieten the irrational urges that surface.

4) Create a goal that relies on you not worsening this injury. You may have a dance concert in 3 months, a fun run in 4 months, an Ironman in 6 months or even a holiday or event that you’d love to be strutting around in high heels for. Get something visual to remind you of this, and stick it somewhere you’ll see it – screensaver, dresser mirror etc.

5) Visualise yourself at your fittest and healthiest. Defend your health at all costs – you only have one body. Whenever we break it down, whether it be through malnutrition or injury, it takes a huge amount of time and energy to rebuild the body. Same with the starvation cycle – every time you go through the process, your metabolism gets damaged just that bit more and it’s harder for it to bounce back (trust me after 10+ years of that cycle the body becomes very thrifty!). As painful as the ‘now’ is, try to focus on the bigger, long-term picture as much as possible.

6) Distract yourself. Plan activities ahead of time, so that idleness doesn’t allow for unhelpful thoughts to sneak in. Anything you love that maybe you usually don’t make time for when you are training – baking, art, writing, reading, coffee with friends, photography. A gratitude journal can be extremely helpful at this time for focusing on all the wonderful things that you do still have.

7) Failing all of that: get your Physio involved. I have both been a patient, and had patients of my own, who need to be “protected from themselves” (or more accurately, Ana or an exercise addiction or both). You may think you are insane asking for help, but your Physio (if they are decent) will already know that you are struggling to stop exercising, and will have treated others like you before. There are options to put patients in a cast or boot or on crutches even in the early stages of a stress reaction if they aren’t able to stop themselves from making the injury worse. ‘Do no harm’ is always the number one priority, whatever form of protection that comes in. If you can muster the strength to tell your Physio that you cannot stop yourself from running, they will take over with the rest and you are allowed to feel the sheer relief of not having to fight the beast, at least for a few weeks.

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In part II of this post I will go into strategies for psychologically coping with more serious injuries or down time from your beloved sport.

K xo

Multiple Choice Questionnaire

Multiple Choice:

Please read the scenario and choose the most correct answer from the list below.

You randomly wake with your head in a fog, suddenly your work pants feel two sizes too small and you feel approximately 6 months pregnant with a food baby. You:

a) Acknowledge that yesterday your clothes fitted fine, and that it is likely just fluid retention or a case of flash insecurity and you refuse to panic;
b) Decide to take the “logical” objective approach, taking your measures to compare to yesterday and determine that it is, in fact, a large exaggeration from your mind’s eye;
c) Throw your entire wardrobe on the floor and begin to throw a tantrum, hating the world;
d) Think “fuck this, I’m not eating (indefinitely)” and feel the calmness warmly ooze over you knowing that you are going to be just fine…..
e) All of the above, in any given order.

I’m going to propose another option, option (f): The Two Day Rule. Given that the majority of us out there will indeed pick option (e), probably several times over, and put oneself at the risk of the relapse-merry-go-round, we need a set strategy for days like this (good tune, Van Morrison).

Give yourself two more days. 48 more precious hours. You’re not having to be so strong that you’re defiantly pushing Ana to the curb, you’re just gently turning your back on her for a couple of days. You only need to be strong for two days. All you have to do, is just keep on keeping on…..give the body nourishment, just like you did yesterday. Baby steps (meal-snack-meal-snack-meal-sleep repeat x 2). One foot in front of the other. Don’t go and punish yourself with a 3 hour training session. Head up, face the world. As a random side note, I find it helpful on days like this where your self-confidence is about the size of an ant, to utilise the self-affirmation “fuck you, world!”…..for no reason in particular except that it gives me the strength to leave the house, face other humans and pretend to be normal….and sometimes provides for some humorous self-talk while walking down the street. Fake it till you make it, or something like that.

Then on day 2, you can reassess. Chances are, your soul has gathered that ounce more strength to fight; your body gained that much needed fuel to cradle to mind through the dark room and out into the glorious sunlight. You’ve probably managed a few moments of clarity, sane thought, objective reasoning, realistic assessment…..hopefully all of the above.

And it becomes much easier to flick Ana back to the dark room where she belongs. Don’t let the Wrecking Ball win; fight the good fight.

Two days. You can do it.

K xo

....note to self: when faced with a bar full of Moet, do not drink yourself into oblivion, tempting as it may be.....

….note to self: when faced with a bar full of Moet, do not drink yourself into oblivious, tempting as it may be…..