Pregnancy and Eating Disorders: Part 2

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Growing a human being from scratch is a unique experience. It becomes even more unique for those of us who have been through an eating disorder. No matter what stage of illness or recovery you are in, there are individual nutritional, physiological, and psychological challenges that you will experience that all the well-meaning ‘practical’ pregnancy books and blogs in the world will not be able to help you with, or that other pregnant women could ever understand.

Currently I’m 6 months into my pregnancy and have been living these mini-battles and celebrations like a rollercoaster ride that still has 4 months to go (because yes, pregnancy is actually 10 months or 40 weeks, not 9 months!) . As the weeks go on and my body changes, the challenges get bigger but so too do the rewards – feeling your little person doing kung-foo fighting in your belly is one of the coolest feelings on the planet, and something I’ve come to focus on when everything else is becoming overwhelming.

I am hoping that like all things in life, it will get easier with time and experience – I want to have 3 children in the long-term scheme of things so I have to find a way to cope with everything during pregnancy in order to be OK with going back into the battle field! Easily the hardest part from an ED perspective has been the nausea, vomiting and constant hunger, which I’ve discussed in previous posts. But wait – there’s more – oh so many more things that may blindside you along the way on this journey of life creation….

Keep calm and stress less...hiking in Milford Sound, NZ

Keep calm and stress less…hiking in Milford Sound, NZ

Getting “weighed in” at the doctor’s office

Everyone is different with their recovery but I know a lot of you do not know your weight once you start down the recovery journey, and I am the same. I have had to find out maybe 5 times over the years I’ve been in recovery (they weigh you in before and after an Ironman to check for dehydration post-race, and also before surgery for the anaesthetist ie before my foot surgery). It doesn’t get less traumatic with time and distance from Ana. I just think it’s one of those things that despite your newfound health, identity and logical reasoning, it just tips you over the edge every time. The good news is that most other things get exponentially easier with time – like eating out and getting dressed in the mornings, but in my experience that number on the scale seems to be like a ticking time bomb.

Which brings us to the Obstetricians office where I get weighed and my blood pressure checked each and every time I see her. I even get competitive about the blood pressure reading – because I know how low mine is when I’m “race-fit” and I love that sense of numbers reflecting my health. See – it’s an issue! So I had to do the hard strategy that you learn soon enough into your recovery – to ask not to know the weight as you take that monumental step onto the scales. Which feels ridiculous when you are a grown woman, and a health professional at that, and look to be a healthy weight. You instantly feel the judgement of the weigher cloud the room (imagined or otherwise) and then usually end up blurting out something about having an eating disorder in the past and then by that point you just want to shrink into the palm of your own hand and disappear.

But here’s the thing. As horrible as that moment seems to you, I guarantee you the doctor or nurse weighing you is not judging you like you think they are. They, of all people, understand eating disorders and even if they don’t, this moment is just one of thousands during their very busy day and they won’t think twice about it after you leave the room. And they will never turn around and tell you the weight despite your request; they are more professional than that.

You, on the other hand, need protection. So it’s a matter of having that conversation to not know the weight, or finding out and then winding up in a spiral of destruction for the next few days/weeks/months……Five minutes of awkwardness vs a month of self-criticism? I’ll take the five minutes, thanks. And THAT conversation does get a little easier, even if the weight thing never does.

Knowing how Much Weight to Gain….and not freaking out about it.

Here’s the thing. This becomes a two-pronged issue as soon as you get pregnant: The things you can control, and the things you can’t. A lot of us have come from a lifetime of rigid eating and exercise patterns, even through to recovery, and control is a big issue for us – indeed often the initial cause for triggering an eating disorder.

So firstly, the part you can control during pregnancy is what you eat, how you exercise, and your stress levels. None of these things will affect the actual growth of your baby much – babies develop even in horrific environments at times and most come out around the same weight and health status – however these factors do greatly affect you, and how you feel during pregnancy. Your health and happiness, shall we say. So work with your dietician or read up on optimal pregnancy nutrition and where you can, try to eat well and adequately so that you as well as your baby can thrive and hopefully enjoy the experience.

The part that you cannot control is how your body grows. Where you carry your belly (high/low/front/spread etc), how big your boobs get, how much morning sickness you get, how much weight you gain, and where you gain it. If you are eating well, exercising sensibly and keeping stress under control, the rest is up to your body. You will likely gain between 9-15kg and it won’t necessarily be in a nice steady increment – sometimes the baby (and you) will grow a lot in a month, other times not so much. This has been a challenge for me, sometimes it feels like I’m watching an alien take over my body. But it has helped extraordinarily knowing that hey, I am doing everything that is within my control to be healthy, so the rest is up to Mother Nature. It’s important to note also that very little of that total amount is fat gain – most of it is baby, water weight, placenta, breast tissue and the like. I have found it helpful to look up the average breakdown of weight gain with respect to these things to keep the feelings of “fatness” in perspective!

And a final word….don’t buy into all the online bullshit popping up with “All Belly Pregnancies” and the like which seem to promote gaining absolutely the minimal weight and getting back to pre-pregnancy weight within 2.5 seconds of giving birth. It’s unrealistic and a ticking time bomb for eating disorder sufferers….it’s best to just not go there!

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Coping with comments from the world at large and worse….people touching you

So apparently once you fall pregnant, everyone in the world becomes an expert in pregnancy, childbirth and breastfeeding. They want you to know how knowledgeable they are, which they express by shoving it down your throat with a good dose of judgement on the size of your bump (and sometimes boobs and butt…) and possibly a feel of your belly. Yup, not joking. I will preface this with the fact that I have always hated people touching my stomach, even my husband doesn’t go there when I’m lean and fit and sporting a washboard down there. So to say that I feel self-conscious about the ever-growing beach ball in my mid-section, and people launching their hands at it when you least expect it is an understatement! And as for the birthing and breastfeeding horror stories, well everyone seems to have gone through World War III giving birth to their brood, wearing their drama like a badge of honour. Makes you wonder how humans did it for all those centuries without the intervention of medical specialists and fancy hospitals, right? Right….

We are just animals after all, and we must remember that pregnancy and childbirth are one of the most normal, natural things that females can go through. The baby knows what it’s doing; the body knows what it’s doing…..you and your overactive, impressionable brain are just along for the ride. And you can make that ride calm and magical, embracing what nature does best, or you can listen to the horror stories and spend 10 months stressing about what will or probably won’t go wrong during childbirth. The way I see it is that we are blessed to have the fancy hospitals and specialists available on the small chance that something does go wrong. But I’ll be happy to go through the experience knowing that my body knows what it’s doing, even if it’s new to my mind….and that it’s a great day if I don’t have to see my Obstetrician during the birth because it means that all is well (midwives, on the other hand – the more the merrier!).

As for the comments on size…the only consensus I have on this is that 100% of the time, the people telling me “gee you’re huge!” or my personal favourite “wow you’re really looking pregnant now” are not….well….pictures of health. They are the ones who are a little on the tubby side and clearly insecure about their own weight. My friends who I train with or who are healthy weight tell me how awesome I’m looking. It all comes down to the common denominator once pointed out to me by a very smart psychologist: people talk about themselves. So when someone is bitching about so-and-so’s choices in life or commenting on your weight, just smile and think to yourself “wow you must have an insecurity about that within yourself”. Think about it. It can be a very informative experience! And maybe next time you catch yourself about to say something judgemental about another….stop and think – is this my issue or theirs?

Much more to come on the intricacies of growing a baby within one’s post-ED body, but for now this baby-mumma needs to get to work.

Happy training,
K xo

FUNCTION OVER FORM. ALWAYS.

You never quite realise how much you take your mental cues from the physical body – that is, until you try to recover from an eating disorder. Or get pregnant. That glimpse of flat abs, outline of a six-pack, the toned and lean legs, tanned and glowing skin from hours in the sunshine; these things you take for granted at the time, but are all a daily reminder that you are fit, healthy and an athlete. Recovered.

Being so recovered, I thought of myself as being “above” all of that. Above needing physical clues – indeed, I didn’t even realise how much I relied on them until they went away. You do all this work on the mind during recovery, establishing yourself as a whole person being so much more meaningful than a weight on the scales or a dress size. But what I didn’t realise is that in my successful quest for recovery, I had replaced many of the anorexic cues with athlete cues – arguably, much more healthy for me, but nonetheless a crutch of sorts for self-esteem and self-worth.

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This was a deliberate strategy to a large extent on the behalf of both my psychologist and my dietician: as being particularly resistant to treatment after 10+ years of anorexia, it was eventually discovered that I work best when we replace the focus of weight with the focus of athletic performance. Function over form. As I’ve discussed in previous posts, a key component to the success of this strategy was in allowing me to continue with my athletic and University endeavours during this treatment process. My incentive was as simple as this: If I don’t fuel my body correctly, I cannot perform athletically to my potential nor academically. And for me, my self-esteem and self-worth became more hinged over time on my identity as an athlete and a smart, successful woman. I fuelled my body and mind and discovered, in doing so, that my potential was far greater than I had ever dreamed of. I found my niche in Ironman and my passion in physiotherapy and succeeded in recovery life. Together we created visions of where I wanted to be – career-wise and athletically – and honed in on what I required of my body and mind in order to achieve these goals. Ana did not fit in with those dreams. Fuelling my body for hard training sessions, recovering well for my mind to work, and achieving some sort of balance in the way of sleep and relaxation were all imperative to the puzzle working.

I realise this strategy may not work and indeed may not be necessary for some ED sufferers. It worked for me primarily because physiologically I was, while underweight, stable enough to be allowed to keep exercising, albeit at a reduced load to my previous program. I was also at a key age: old enough to be independent and choosing to be in recovery; but also still studying at University and therefore able to easily manipulate where I wished my career pathway to go from here. You could call it “lucky”; I prefer to think it was my time – I had been in several treatment programs at younger ages and none had worked. So successful was the strategy that even now, when I’m having particularly challenging Ana thoughts that last more than a few days, I am able to trace it back to either work or training not going well for me. Focus has gone away from the things I’m most passionate about and my go-to backup is Ana. It happens subconsciously, only now I am so much better at recognising it and addressing it. Function over form. Recalibrate your life, sort it out….there we go.

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The reason all of this is on my mind is that with the last 8 weeks of hell (being pregnant with the worse morning sickness ever) – there has been little training, time in the sun, intake of nutritious food, all-important sleep; even work has gone largely out the window (it’s difficult to treat patients when spontaneously vomiting). You’re growing a baby – possibly the ultimate function! – but you are so sick that it’s hard to comprehend this, and it’s also such a new identity: baby-grower. Person-manufacturer. Mum. So, day by day the Ana thoughts creep back and to make matters worse, all those lovely physical cues you didn’t even know you loved so much start slipping away – the stomach and boobs rounded, the skin grey and pale, dark circles under the eyes, muscle tone going….

But alas the solution lies in the past. Let’s get the focus back to my newest function: growing an awesome human. And yes, let’s remember that the morning sickness does not last forever. It is not Ana returning, just a transient loss of all the things that make me, me. Now that I am starting to get back outdoors, get into work, swimming and running, baking, and eating wonderful food again, sure enough the happiness grows too day by day. It might take me a while to get used to this new addition to my identity (“baby-grower”), but in time, it will come. It took a long time to see myself as an athlete, I can’t expect to click my fingers and have this happen overnight.

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Chin up, stay strong, and remember that those thoughts aren’t you…..you, my friend, are far more beautiful than that.

K xoxoxo

Exercise and Recovery

I’m going to be a little controversial with this post. I’m going to suggest that for a large majority of ED sufferers, recovery would be best done while they maintain their work or school, and for athletes, their training.

Before everyone gets riled up about it, I am not talking about those so severely undernourished that they are at risk of dropping dead from a massive heart attack at any minute, or those with suicidal tendencies….clearly an inpatient program would be best for these patients (at that stage in their recovery, even if those programs for the most part keep people alive but do not really assist in long term recovery and have notoriously high relapse rates….but that’s a post for another day). I am talking about the majority of ED sufferers who are under their individual ideal weight (note I did not say “under BMI 18” – how ridiculous, what about the person with a bigger frame who is still starving but able to maintain a BMI of 21? Are they “less sick”? of course not), are still participating in work or school, and particularly those who are athletes and see that as a part of their identity. I’m talking about the people who are functioning in society, but are significantly affected day to day by their eating disorder – maybe with the accompanying depression, lack of energy and concentration, fatigue, social isolation and the other joyous side effects.

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Here’s why. Think about this: What is the biggest challenge in recovery? I would argue that one of the hardest parts about recovery is learning to lose the “ED” identity and to learn who you really are as a person. Only once that has occurred can one begin to truly move on with their lives and to want to nourish their mind and body. Only then do they have a sense of self to take care of – a reason to recover, if you will. For recovering for someone else, or to get out of Inpatient care, or for the sake of a “goal weight”, will never do it. That typically leads quickly back to a relapse and the cycle that entails.

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Inpatient care, while necessary to sustain a life on the edge, takes away all the other factors in the patient’s life that will be the foundation of their true identity as they return to health: their job, their hobbies, their social network, and for athletes, their training and usually tightknit support crew – coaches and fellow athletes. Not only does it take those things away, it actually forces the patient to focus 100% of their time and energy on the eating disorder. Their days are spent focusing on food, psychology, analysis, resting, scales, and usually the added bonus of in-house competition between patients on who is the “most sick”. Statistically, success rates aren’t good – the weight is temporarily gained, yes; but in the long term, recovery rates can be as low as 20% for patients who have had an ED for an extended time period. The statistics have not improved even after a few decades of treatment in this way. Why not?

At some point, the patient needs to learn how to function in society in a healthy way, and for this to happen there needs to be a reason for the patient to want to get better. Want being the key word here. When an athlete-patient is allowed to keep training, albeit at a reduced load, there is an all-important reason for them to put in all the hard yards day to day that go with recovering from an eating disorder. There can be clear goals and rewards: you gain X weight, you get to train X amount. You eat X foods, you get to attend X training sessions. If you don’t, you can attend but you have to sit out and watch. Sure, it’s harder to gain weight while still training. But guess what? Eating like an athlete is hard, full stop. Years on I still find it a challenge day to day. When you train hard, you have to work even harder on fuelling your “machine” (body), and the sooner a patient gets used to that process the sooner they can master it. Secondly, gaining the weight as muscle, bone density and fat via increased food and some continuation of training is much healthier and less traumatic for the patient than gaining fat alone on a resting protocol. Lastly but most importantly, there are three overwhelming psychological benefits to this approach:

1) the motivation-reward system is clear and immediate;

2) the social interaction with teammates and coaches is maintained, which is so important;

3) the patient is nurtured through the process of minimising their ED identity and replacing that empty space with their “healthy athlete identity”. {You can replace “athlete” and “training” with anything else relevant – student and school, physio and work, etc.}

The key to this process is to have a fantastic support team who can facilitate this transition. For me, it was a brilliant Sports Dietician (it was her idea to allow me to keep training – every other rehab program I had entered forced me to rest and spiral into depression), a brilliant Psychologist who specialises in treating athletes with eating disorders, a Coach who was on board with the plan, and a flexible workplace (I was still studying at University but my part-time job as a research assistant allowed me to set my own work hours, so I could go in when my energy levels were highest – early in the morning). For the most part, my dietician set out my goals for the week and my rewards – when and if I could train etc. All the while she communicated with my psychologist, who from the get-go has focussed on establishing my identity as an athlete. As he reminded me recently, I have always done best when we focus on what my body can do (as an athlete), not how it looks. All body fat % and weight measures were taken away from me, and replaced by more relevant measures like time trials and power outputs. And the only way I can get stronger, fitter, faster, and keep up with my teammates? To eat. Simple as that. I know when I skimp, I fall behind, and as a competitive person, that is motivation enough to nourish my body.

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The best part is that the system WORKS. And it’s not just a bandaid fix – it works in the long term. To this day, years on from the start of my “recovery”, I still have a crappy day at work, feel “fat” as my go-to coping mechanism, and then know that if I go and do a solid training session, by the time I walk back through that door at the end I am going to be happy with my body and what it can do for me. Nothing to do with how it looks or what it weighs. Simply what it can do. And that’s pretty cool. Add in the extra bonuses of a good training session – fresh air, endorphins, improved fitness, mental clarity, relaxation – and it’s a win-win situation.

I make it sound easy and like the obvious solution, which for me, it was (obvious, not easy!). Nothing else had worked over the decade beforehand. And certainly this system wouldn’t work for everyone either, but for athletes, I would argue that it is the best way to structure treatment. Realistically, there needs to be a change in the way we treat eating disorders in Australia as the current inpatient systems are not working in terms of long-term outcomes and relapse rates. There is no easy answer.

Food for thought anyway.

Happy training xo

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