Nutritional Guidance

            Although most of us have a fair idea of what good nutrition is, sometimes that knowledge is not enough to change eating disorder behavior.  By the time someone reaches out for help with the eating disorder they can be overwhelmed with thoughts of:  Calories, foods, meals, exercise, weight, fat, ‘low fat’, diets, etc…  Feelings of discouragement, fear, panic and hopelessness are normal.

Often individuals have ignored their own body’s signals for true hunger or fullness so long that they are no longer in tune with those signals.  Simply put, they just cannot judge anymore when they are hungry or full.  Additionally purging through vomiting causes the stomach to slow the digestive process significantly.  It may take up to 6 months for the digestive process to return to normal after discontinuing the purging behavior.

Registered Dietitians & the Meal Plan

            A visit with a Registered Dietitian can be of enormous help.  S/he can set up an individualized meal plan. The dietitian figures for likes and dislikes, age, life circumstances, current health needs and daily exercise.  Even with all this they manage to produce a nutritionally sound guide for meals and snacks.

            I do not know of one Registered Dietitian (RD) who would put anyone on a meal plan to make them fat!  It is important to address that fear.  It can be helpful to find a RD familiar with eating disorders but not absolutely necessary.  If you live near enough to a university with a medical or nursing school, a call to them might provide a referral name.  Otherwise, you might contact your physician for the referral.  More than one visit is suggested for adjustments to the meal plan.  Depending on the eating disorder and the individual’s condition changes may be necessary until a safe well-rounded intake level is agreed upon with the entire treatment team that includes the client.  The more support the easier the recovery.  Honesty with the dietitian is essential.  He or she may have helpful suggestions with some of the side effects from giving up purging, especially laxative abuse.

            Now with a nutritionally balanced plan there is a guide and some direction provided.  The questions and confusion can be calmed.  Structure and planning are extremely valuable in recovery.  Remember it has to be a priority, at least until new behavior become habitual.  Be aware though that simply having the meal plan may not calm the ‘obsessions’ or concerns about weight and body image.  Those come from completely different arenas – cognitive distortions - these will be addressed in detail later.

            I would advise against calling the meal plan a ‘diet’.  The term dieting suggests a short term interruption of possibly unhealthy eating patterns.  Recovery from an eating disorder requires life style changes.  By this I do not mean that the structure of the meal plan is forever.  It is a guide that can be used as long as necessary to eliminate the destructive behavior and assist the individual with a safety mechanism.

The meal plan provides safety for the individual to get reacquainted with their body’s own signals of hunger and fullness.  It has been proven effective for individuals to eat at scheduled times within reason.  This will assist the body’s own clock begin to move toward normal functioning again, not to mention how grateful it will be that the abuse has ended.  Remember the body is the vehicle which transports us through our entire life.  Think how far one would get if you neglected to put gas in the car, let the oil burn up or flooded the engine!  Allowing one’s body to get too hungry by missing meals does not work well.  It tends to set people up for trouble no matter what the eating disorder is.  The same applies to overeating.  It can throw a whole day off, but it does not have to.  If either of these should happen a good approach might be to shake it off and look back to the meal plan as a guide for the rest of the day.  The life style changes involve a number of shifts in thinking, perceptions, and behavior all of which will be addressed later within this booklet.     

Purging Behavior

All purging must stop!  It is the only way.  There are positive benefits which come as a result of stopping purging.  Folks tend to decrease or stop binging behavior.  Purging behavior is extremely destructive.  There is nothing more to say.  It has to go and be replaced with healthier coping skills.  Again, it is a choice for a positive lifestyle change!  If you cannot stop it on your own you need to seek professional help.  Purging by any means is a very destructive behavior. 

Purging is dangerous behavior.  Vomiting puts very unhealthy stress on the esophagus and the heart.  The body is not built to purge in this manner.  Causing oneself to purge voluntarily also does not necessarily rid the body of the calories ingested through a binge.  It is not unusual at all once an individual stops purging that they actually lose weight. 

The electrolyte imbalances caused by vomiting/purging can result in a heart attack or stroke.  For those who are not familiar with the idea of ‘purging’ - the individual suffering from bulimia does not simply vomit once during or following a binge.  Often a ‘purge’ involves a series of vomiting episodes.  These episodes can be almost involuntary depending on the length of time the sufferer has had the eating disorder.  But for the most part the purging can involve enormous stress on the body in order for the person to rid the stomach of its contents.

Purging through laxative abuse can result in permanent consequences on the intestinal tract.   The worst case consequences result in some having the misfortune of losing parts or all of their intestines/colon.  This leaves the individual with a bag rather than the normal ability to rid the body of waste material.  A less serious scenario leaves the individual dependent upon laxatives for the rest of their lives.  The electrolyte imbalance caused from this type of purging is very dangerous as well.  Again this form of purging does not rid the body of the calories from eating – those are absorbed much earlier in the digestive process as discussed earlier.  So at this point I am suggesting that purging behavior is closely linked to self-punishing behavior.

Purging through diuretic abuse also doesn’t impact the calorie intake but seriously compromises the electrolyte balance again putting the individual at risk for heart attack or stroke.  Excessive exercise causes a malnourished body additional stress.  Often rather than building muscle mass the individual’s body begins storing fat and feeding itself off muscle tissue to offset the abuse.  The body has its own interventions for malnourishment which is often contrary to how those with eating disorders think it operates.

Planning

            I mentioned previously planning is extremely important.  I cannot emphasize that enough.  Impulses can be dangerous in recovery.  One suggestion is to plan out meals as well as events for the week.  If possible, groceries shop according to the needs for that week.  If you know your plan, the likelihood of slipping decreases dramatically.

            Of course life occurs and things happen off the plan.  Those unexpected times can be helped by using the ‘what if…’ process.  Example:  What if everyone brings goodies to work?  By figuring what can be done in difficult situations that are familiar ahead of time, unhealthy impulsive reactions may be avoided.  This provides additional safety while creating new healthy habits.

            Again, remember no one is perfect.  Slips can be used as education for what works and does not work.  Everyone is different and no one thing works for all.  Experimentation, structure, support and planning are key elements which have provided success for people I have seen recover.