Refeeding FAQs

Eating to nourish our bodies and help with nutritional healing is key to flourishing in eating disorder recovery. Some nutrition goals include repairing negative food relationships, incorporating foods that induce fear and develop a lifelong routine of normalized eating patterns.1 Weight restoration can also be a key factor in recovery if individuals present as weight suppressed.2 During this stage, the quantity and density of food types is especially important.1Like in other stages of the recovery process, there are no food rules or restrictions. 

Is it normal to feel anxious and overwhelmed in the beginning stages of mechanical eating?

In the first stages of refeeding, individuals are working hard to transition from a negative relationship with food to a positive one. They are challenging their minds to ignore food rules and unrealistic ideals portrayed by the media, and instead, put faith in their bodies again. At this time, we want to focus on eating energy dense foods multiple times each day to meet the body’s nutritional needs while also keeping the volume load of the stomach manageable. This helps to reduce some of the uncomfortable digestive issues that can arise when first starting out 3 IT IS NORMAL TO FEEL ANXIOUS AND OVERWHELMED! You are asking a lot more out of your body than usual. You will be eating more than you’re used to and going against the eating disorder thoughts that constantly reside inside your mind. The good news is, our bodies are quite resilient and get used to the higher amounts of food quickly. The gas, bloating, constipation and/or diarrhea will be alleviated within a couple of months. 

How will I know when and I’m hungry? What if my body doesn’t tell me?

Once our bodies start to receive food on a regular basis, hormones begin to regulate and the body can revert back to its natural bodily processes. Cortisol levels decrease and the fight or flight response subsides in response to our bodies’  and being nourished adequately. Eating several meals throughout the day will eventually stimulate digestive processes to facilitate the response of hunger.3,4 When our bodies’ requires energy, there are a few things that happen. First there is a drop of blood suga, followed by a shift in hormones.  Signals are interpreted by the brain and sent to the body causing our stomachs to growl and the feeling of hunger to kick in.4 Our sensory and psychological cues also influence hunger and the desire to eat, which includes sight, smell, taste and emotions.4

It may take some time for hunger cues to be restored, and that’s why we use mechanical eating in the initial stages of refeeding. Working with a Registered Dietitian trained in the refeeding process can help you learn how to mechanically eat for your own body to help restore your hunger and fullness cues. 

How will I know if I’m eating too much or too little?

Energy consumption is increased gradually throughout the recovery process. Recommendations are individualized and based on the individual’s energy needs and stage of recovery. However, the basis of eating in recovery is relatively the same for everyone. Clients usually start off by repairing their nutritional deficits and increase their food intake. Over time, the amount of food consumed slowly increases to best meet the client’s needs. The important factors of a meal plan for standardized eating are the quantity and type of foods consumed as well as the timing of the meals being consumed.1 It is important to note that some individuals are more susceptible than others to gastrointestinal symptoms and may be vulnerable to bodily complications. A dietitian will work with individuals to help with refeeding syndrome by developing a plan that is tailored to the specific individual needs.1

Why can’t I follow Canada’s Food Guide for eating normally? 

One of the main goals in recovery is to get our clients’ bodies to a place where they can live a life they want to live. In order to accomplish this goal, our team helps clients take steps to repair their body with increased energy and specific nutrients. Canada’s Food Guide can be a useful resource for populations but is not tailored to the specialized needs of individuals living with eating disorders.3 Instead, Registered Dietitians create individualized nutrition care plans with their clients to help them make adequate nourishment a priority.  


References

  1. Garner, DM. Desai, JJ. Desmond, M. Good, A, Wohlers, J. (2017) Nutritional Rehabilitation for Eating Disorders: River Centre Clinic Program Description. In Ann Nutr Disord & Ther. Retrieved from https://www.austinpublishinggroup.com/nutritional-disorders/fulltext/andt-v4-id1044.php
  2. Marzola, E., Nasser, J. A., Hashim, S. A., Shih, P. B., & Kaye, W. H. (2013). Nutritional rehabilitation in anorexia nervosa: review of the literature and implications for treatment. In BMC Psychiatry,13(1), 290. https://doi.org/10.1186/1471-244X-13-290
  3. Waterhous, T. (2015) Normal Eating. Retrieved from https://www.mirror-mirror.org/noreat.htm
  4. Kornell, N. (2014) Hunger Comes From Your Mind, Not Just Your Stomach. Retrieved from http://www.psychologytoday.com/blog/everybody-is-stupid-except-you/201411/hunger-comes-your-mind-not-just-your-stomach

What to Expect During the Refeeding Process

Eating disorder recovery usually involves several treatment interventions. Refeeding, or the refeeding process, is used in treatments with other effective strategies to treat patients who are recovering from disordered eating. Nutrition rehabilitation and weight restoration are the first components of the refeeding process and is taken very seriously to avoid symptoms of refeeding syndrome1. Clinicians and the multidisciplinary team work alongside one another to ensure that the refeeding plan is easy to understand, safe and individualized. During the refeeding process, an individual may experience the usual symptoms of mechanical eating, those being gastrointestinal discomfort, increased satiation, body fluid fluctuations and re-established hunger cues. An individual may also experience feelings of psychological discomfort and may regress by engaging in self-defeating behaviours throughout the process of mechanical eating1. The refeeding process will teach individuals in recovery about normalized eating, restore hunger cues, improve their relationship with food and adopt new eating patterns. 

The refeeding process is used in collaboration with other treatments and therapy programs. It is important that the individual manages their stress throughout the varying metabolic changes and weight restoration processes. The goal for an individual in recovery is to achieve their setpoint body weight through mechanical eating and nutrition therapy. This process involves consuming a surplus of energy that the body is not used to and during this change, physiological changes can occur. The body may endure a shift in fluid balances, electrolytes and hormones as the body is working to repair itself and moving away from a state of starvation. The body also shifts from being in a catabolic state to an anabolic state, now using energy and nutrients to build and repair tissues and vital organs2. Weight gain will occur as the body moves from a dehydrated and malnourished state to a hydrated and nourished state. Changes in lean body mass, water retention and body fat are normal and need to occur in order for someone recovering from an eating disorder to reach their setpoint body weight3.  Uncertainty is something that individuals may face as they can experience a fluctuation in weight in result of the extra energy and nutrients that they are now consuming. This is a normal part of the process. Some symptoms reported pertain to the gastrointestinal tract which include bloating, diarrhea and abdominal discomfort4. This is due to the expansion of the abdomen and digestive processes that are being repaired. Digestion remains slow in the first stages of the refeeding process, which is why most patients experience bloating and/or gas4.  The bloating sensation will be reduced as our body gets used to normal eating. Some patients also report constipation while refeeding. Eating more fibre and water can improve this symptom over time4.

Mechanical eating is a way of eating to normalize eating behaviours and restore hunger cues. This integrated eating strategy is used to treat most eating disorders, including anorexia nervosa, bulimia nervosa and binge eating disorder5. It is a structured way of eating three meals and two ot six snacks daily according to an individualized timely schedule5. The idea is to eat every few hours to keep your body engaged, channel hunger cues and adopt normalized eating behaviours. Throughout eating disorder recovery, working with a Registered Dietitian can help individuals to establish a mechanical eating plan that is tailored to their lifestyle, levels of comfort and readiness for change1.

The refeeding process may also trigger psychological discomfort. This can due to the fact that individuals recovering from an eating disorder are undergoing cognitive restructuring and learning how to adopt normalized eating behaviours and cope with the many changes in their body. Eating disorder thoughts may increase as mechanical eating goes against unrealistic health ideologies and food rules that were once followed. Individuals usually experience anxiety in many form such as stress, nervousness and varying emotions of uncertainty and unpredictability3. If the individual has begun to engage in self-defeating behaviours, it is important to remember to be kind to their future selves and to not allow feelings of guilt or shame cloud their thoughts and goals for recovery.  Regression is a normal part in recovery and can be treated by remembering why one started on the path to recovery in the first place.  Don’t allow oneself to get stuck in the past; move on, find self-acceptance and work towards progression. 

 Recovery is a slow process that is not linear; it is very common for people to take steps backward before moving forwards. By trusting the process and working towards a goal with your family and healthcare team, the process can be much more manageable and comfortable. It is important that the individual in recovery is comforted by their support system and is actively talking about their emotions, fears and concerns with their healthcare team.  At this time, a sense of security and reassurance will help the individual to progress and reach further stages in recovery. 

Eating intuitively can be the ultimate goal in the recovery process but this can not be reached without first tackling refeeding. 


References

1) Mehler, P. S., Winkelman, A. B., Andersen, D. M., & Gaudiani, J. L. (2010). Nutritional rehabilitation: practical guidelines for refeeding the anorectic patient. Journal of nutrition and metabolism,625782. doi:10.1155/2010/625782

2) Mascolo, M. (2018) Refeeding Patients with Anorexia Nervosa: What Does Research Show? In Eating Disorder Hope. Retrieved from https://www.eatingdisorderhope.com/information/anorexia/refeeding-patients-with-anorexia-nervosa-what-does-research-show

3) Winkler, J., Alperovitz, D. (2015). The body’s response to adequate fuel in anorexia. In Eating Disorders Catalogue. Retrieved website: https://www.edcatalogue.com/the-bodys-response-to-adequate-fuel-in-response-to-anorexia/

4) Nutrition in Eating Disorders. (n.d.). 2016. In Nova Scotia Health Authority. Retrieved from http://www.nshealth.ca/sites/nshealth.ca/files/patientinformation/0308.pdf

5) Grave, R. D. (2005). A multi-step cognitive behaviour therapy for eating disorders. In European Eating Disorders Review, 13, 373–382. doiI: 10.1002/erv.671

Starvation Syndrome

Starvation syndrome can occur in individuals of all weights when the body is denied energy through food restriction for a prolonged period of time. It is common in individuals with eating disorders because they often restrict food, eat irregularly, and try to compensate ingested calories through overexercising or forcing the body to eliminate food quickly. The symptoms that are commonly associated with eating disorders are often symptoms of starvation syndrome. This blog post discusses several of these symptoms as well as common ways to help combat these uncomfortable symptoms. Remember that it is important to seek help from a Registered Dietitian or doctor if you are struggling with an eating disorder. 

Starvation impairs physiological, emotional, cognitive, and social functions. The physical changes that may take place can affect several different organs and body systems. Less visible physical changes that can occur are: reduced heart muscle mass, decreased heart rate, decreased blood pressure, slower basal metabolic rate, extreme fatigue, weakness, dizziness, feeling cold all the time, and decreased hormone levels.1More visible physical changes that can occur are: hair loss, blackouts, fluid retention, lack of sexual desire, and dry skin.1Emotional changes often take place as well and can manifest themselves as depression, anxiety, irritability, or loss of interest in life.1Brain function can also be impaired, resulting in impaired concentration, impaired comprehension, impaired judgement and ability to make decisions, obsessional thoughts, and decreased alertness.1Starvation syndrome can also affect friends and family as starving individuals can lose their sense of humour, withdraw from relationships, neglect personal hygiene, and/or isolate themselves.1Additional possible behaviour changes include: frequent thoughts about food, strict meal planning, very fast or slow eating, increased hunger, binge-eating, hoarding, and increasing the use of spices or condiments.1

Although starvation syndrome has a long list of potential side effects, it can be reversed. Treatments to reverse starvation syndrome comprise of physical re-nourishment, weight restoration, and psychological therapy to address negative feelings about food and body-image. Physical re-nourishment, also known as the initial refeeding process,is the foundation for other positive changes. It involves establishing regular eating habits and consuming nourishing meals. The symptoms of starvation may persist in the beginning of re-nourishment, but they will disappear eventually.  

Regular eating is important as it brings the body back into balance. Humans function best when they eat about every 3 hours throughout the day.2When recovering from starvation syndrome, it may be helpful to “eat by the clock” at the beginning to get your body use to consuming food regularly. Try to aim for 3 meals and 2-4 snacks each day. Preparing your meals in advance may also be helpful with staying on schedule. At first, it may feel uncomfortable to eat every 3 hours, but your digestive system will adapt overtime. Once you have a regular eating routine in place, you can begin to increase your portion sizes and broaden your food choices. It may also be helpful to drink fluids between meals so that you have more space for actual food. 

Recovering from starvation syndrome is a long process. You will probably hit a few bumps along the way, but remember that recovery is possible and you CAN do it. Try to make use of some of the resources that you may available to you such as a trusted Registered Dietitian, doctor, friend, and/or family member. You can fight starvation syndrome and take back your life. 


References

  1. What is starvation syndrome? (2018). In Centre for clinical interventions. Retrieved from: https://www.cci.health.wa.gov.au/~/media/CCI/Mental%20Health%20Professionals/Eating%20Disorders/Eating%20Disorders%20-%20Information%20Sheets/Eating%20Disorders%20Information%20Sheet%20-%2033%20-%20What%20is%20Starvation%20Syndrome.pdf.
  2. Flemming, K. (2018). Regular Eating for Recovery. In Centre for clinical interventions. Retrieved from: https://www.cci.health.wa.gov.au/Resources/~/media/95F9A1FC3F1C4D0A92CD31B09166FDDB.ashx.

Am I Ready to Work With a Registered Dietitian?

Investing in our health is just that; an investment. It takes commitment, dedication and perseverance. And in some situations, it is also a financial investment as some individuals may not have an extended health benefits plan that covers dietitian services and psychotherapy, two services that are essential to eating disorder recovery. 

When considering working with a Registered Dietitian, it’s essential to understand that it is not a quick-fix, one-and-done sort of thingfix. Dietitians offer so much more than a band-aid solution to a problem. They work with clients on an ongoing basis to help us live long, thriving lives. This is especially true when working with a dietitian to overcome an eating disorder. Diet culture has been ingrained in our brains for as long as we can remember, so naturally, it will take some time to reverse the damage and change our perceptions as we restructure our beliefs around food. It will take time to recognize that there are certain unhelpful behaviours clients may be using  that although may have once played a role,  are no longer needed in one’s life.

This is something that is rooted in the behaviour change model, which is based on ongoing interpersonal interactions with a trained professional whom may suggest small, attainable changes in behaviour as the individual becomes ready1. Making small changes is beneficial because if the goal seems achievable, we are more likely to be successful in accomplishing that goal. It also helps us to overcome barriers by planning how we will respond to situations before they arise so that we are better equipped to cope in the moment and can start to put planned actions into practice until they eventually become natural2. Implementing these behaviours is a gradual process and developing a trusting relationship with our healthcare team helps to create a collaborative environment where open discussion can occur regarding what is working and what needs to be adapted. 

According to the Transtheoretical Model of Change, there are five different stages of change; pre-contemplation, contemplation, preparation, action, and maintenance3. The pre-contemplation stage reflects a time before we even begin thinking about changing and may still be resistant to change or be in denial of needing help. The contemplation stage demonstrates the process of thinking about reaching out for help and support, followed by the preparation stage where we begin to feel ready to seek help. The action stage is the process of beginning to attempt to implement change, and then maintenance involves the prevention of relapse. Individuals can also move back and forth between these stages of change, which emphasizes the importance of seeking help individually. Meeting with a Registered Dietitian ensures that an individual  can receive the personalized support based on their needs in that moment,what they are ready for or what they need at a specific time. Here at change.creates.change, we often use motivational interviewing to assess how to best help our clients move through the different stages of change, and we focus on demonstrating acceptance and empathy4. Our dietitians are also able to adapt to resistance and take a different approach if needed, as well as supporting self-efficacy. We help our clients to feel empowered that they have the ability to be successful in the recovery process.  

Because we work exclusively with those looking to repair their relationship with food and their body, the change.creates.change team focuses on offering packages and not stand-alone sessions in the beginning of the nutrition counselling relationship. This is to allow time to establish a strong rapport and provides clients the opportunity to affect behaviour change. Furthermore, it is to ensure clients have adequate support and monitoring as they move through the stages of refeeding, which can have some uncomfortable physical and psychological effects for clients with disordered eating.


References

1Duffy, F.D. (2012) Counseling for behaviour change. Goldman’s Cecil Medicine (Twenty Fourth Edition). Retrieved from: https://www-sciencedirect-com.proxy1.lib.uwo.ca/topics/medicine-and-dentistry/behavior-change

2Hsieh, H., Kanda, Y., Fuji, S. (2019) Incorporation of coping planning to the behaviour change model that accounts for implementation intention. Transportation Research Part F: Traffic Psychology and Behaviour. Vol. 60. Retrieved from:https://www-sciencedirect-com.proxy1.lib.uwo.ca/science/article/pii/S136984781830086X?via%3Dihub

3Dawson, L., Mullan, B., Sainsbury, K. (2015) Using the theory of planned behaviour to measure motivation for recovery in anorexia nervosa. Appetite. Vol. 84. Retrieved from: https://www-sciencedirect-com.proxy1.lib.uwo.ca/science/article/pii/S0195666314005091?via%3Dihub

4Wilson, G.T., Schalm, T.R. (2004). The transtheoretical model and motivational interviewing in the treatment of eating and weight disorders. Clinical Pyschology Review. Vol. 24. Retrieved from: https://www-sciencedirect-com.proxy1.lib.uwo.ca/science/article/pii/S027273580400039X?via%3Dihub

How Our Dietitians Can Help You in Eating Disorder Recovery

A Registered Dietitian (RD) is an integral part of the multidisciplinary healthcare team that should be involved in eating disorder recovery. An eating disorder is a mental health diagnosis and therefore requires the involvement of healthcare professionals from various disciplines, including a General Physician (GP), a therapist (a psychologist, psychotherapist or social work) and a dietitian. RDs are regulated health professionals who have gone through years of school and training and are qualified to provide evidence-based recommendations to help clients meet their nutritional needs. Dietitians who specialize in eating disorders have undergone further specialized training related to eating disorders to qualify them to work with this high-risk population.

The dietitians at change.creates.change Nutrition Counselling are here to support the client throughout the eating disorder recovery process. As this is intended to be a long term counselling relationship, it is extremely important that time is given to build trust and a strong rapport between the RD and the client. This means that our dietitians will spend time getting to know the client so they feel comfortable discussing their food behaviours, as well and their thoughts and emotions related to eating. This will build the foundation for the dietitian-client relationship so the client feels they can disclose personal information without fear of being judged. Additionally, there is no pressure for the client to set goals right away. It may take time for the client to feel that they are ready to begin changing their eating behaviours and that is completely okay Our dietitians are here to support our clients throughout the entire process, even when the client is not yet ready to change.

Over the first one or two sessions, our dietitians will conduct an in-depth nutritional assessment with the client to determine their usual eating patterns, food intake, feelings and fears surrounding food, supplement use and goals the client wishes to achieve1. Our dietitians will not only explore the factors which influence what the client eats, but also where, how and whether the client eats as well. This aspect of the dietitian-client relationship can be emotionally draining as the questions may stir up some strong thoughts and feelings in our clients. We encourage that our clients take fresh-air breaks during sessions when needed and that they are gentle with themselves following appointments. Oftentimes, our clients report experiencing a “vulnerability hangover” and we ask that our clients use self-soothing skills and reach out to their supports while they process their experience. 

One of the main roles of a dietitan in eating disorder recovery is helping the client normalize their eating behaviours. Since an eating disorder is a mental health diagnosis, those suffering from an eating disorder will most often have a distorted view of food, exercise and/or their own body. Our dietitians help clients to work through these distortions and help overcome their fear surrounding food. Normalizing eating behaviours is also important for recovery because the brain must be adequately nourished to function properly and do the hard work that is required in their therapy sessions. One of the ways this may be achieved is through the development of a mechanical eating plan. This eating plan will help the clients’ bodies get used to eating regularly again and help them relearn hunger and satiety cues which may have been diminished by their eating disorder. Eventually, the client will ease off of the eating plan as they relearn these cues and get more comfortable and skilled in eating normally2. This eating plan will be individualized to include a recommended number of meals and snacks per day and examples of food categories that should be included at each meal time to best meet the client’s nutritional needs and reduce the negative physical symptoms of refeeding their body. 

Those struggling with eating disorders tend to have misconceptions about nutrition and what foods they should be eating. An RD understands the vital role food plays in the body and why it is essential for health. They have studied the effects of food in the body and why many nutrients are needed each and every day. Our dietitians can also help the client view food in a more positive way. For example, a client may have the misconception that eating foods containing fat will make them gain weight. An RD would explore this food belief in detail with the client while also providing education around why fat is essential for the absorption of fat-soluble vitamins, production of hormones, and maintenance of the reproductive system, among many other functions3

Our dietitians will also assess the client’s current food skills. This includes their efficacy in meal planning, grocery shopping, food preparation, and general knowledge of food4. In addition to improving the client’s knowledge of food, there may also be the option to work on further developing such skills like meal planning and grocery shopping. Furthermore, our dietitians can provide meal support therapy to provide encouragement and guidance to clients during meal times and reinforce normalized eating through social modeling. Clients may also be invited to go on restaurant outings in order to practice their learned skills in a real-world setting. 

Ultimately, our dietitians at change.creates.change Nutrition Counselling are here to support clients during their eating disorder recovery. They play an integral role in helping to normalize eating behaviours and repair client’s relationship with food, ultimately supporting individuals throughout eating disorder recovery. 


References

  1. Gurze- Salucore Eating Disorder Resource Catalogue. (2014). The Role of the Registered Dietitian/Nutritionist on the Eating Disorder Team. Retrieved fromhttps://www.edcatalogue.com/role-registered-dietitian-nutritionist-eating-disorder-team-2/
  2. Mirror Mirror. (2015). Normal Eating. Retrieved from https://www.mirror-mirror.org/noreat.htm
  3. Centre for Clinical Interventions. (2018). The Facts on Fat [PDF file]. Retrieved from https://www.cci.health.wa.gov.au/~/media/CCI/Mental%20Health%20Professionals/Eating%20Disorders/Eating%20Disorders%20%20Information%20Sheets/Eating%20Disorders%20Information%20Sheet%20-%2025%20-%20The%20Facts%20on%20Fat.pdf
  4. Practice-based Evidence in Nutrition. (2014). Food Skills. Retrieved from http://www.pennutrition.com.proxy1.lib.uwo.ca/KnowledgePathway.aspx?kpid=22933&trid=22982&trcatid=38

To Exercise or Not To Exercise

When considering whether it’s a good idea to add or re-introduce exercise into the recovery process, it’s important to reflect on a variety of things. These include: a)what the motive is for wanting to exercise?, b) are we are in a physical state that can handle exercise?, and b) what our experience has been with it in the past? Is exercise something we have used previously as a way to compensate, burn calories, or avoid feelings, and if so, how does this relate to how we feel about it currently? What kind of exercise are we interested in trying?

Perhaps we view exercise as s a variety of methods of movement, all of which we enjoy doing, or maybe we long for structure and control and think we ‘have to’ exercise. Of course, being active can relate to wellness and an overall nurturing lifestyle, but it ultimately depends on our relationship with it. It can also be a hindrance to eating disorder recovery if we don’t recognize that exercise is sometimes used as a tool to compensate for something else1. Becoming more aware of how we feel about exercise and what drives us to want to participate in it can help us to discover whether it is something positive in our lives or whether it is something that is negatively affecting us. Our team here at change.creates.change created an algorithm as a starting point to guide you through the decision process.

Algorithm.png

Remember that this is just a guideline. In any case, it is important to discuss options with your healthcare team and decide together what is best for your individual needs. We might all need something different. Generally, it’s good to focus on movement that brings us joy, as opposed to a structured regime. Finding an activity that involves a group social setting can be beneficial to our well-being and foster connections, and also helps if we’re at risk of over exercising and in need of support from others, as well as a timeline of when it’s appropriate to stop.

Alternatively, participating in an activity with a friend or loved one that can help to support our needs might also be beneficial. We want to encourage listening to our bodies’ cues (such as when we are tired,) as opposed to exercising for prolonged periods of time. If this is something that is still difficult to do then perhaps you can establish a (short) time frame with your team and set a timer for when to stop2. It can also be helpful to focus on activities that are more mindful such as going for a walk outside in nature or practicing gentle yoga. Finding a variety of activities that are truly enjoyable is key, as well as learning to let go of the activities that aren’t.

It’s crucial to determine that it is medically appropriate to exercise before trying to implement any new activities. If an adequate body weight is not being maintained or signs of heartbeat irregularities are present, exercise should not be introduced as it can put us at risk3. We must make sure that we are cleared to exercise by our doctor and talk about it with our treatment team before beginning any form of physical activity. Additionally, we need to ensure that we are consuming enough calories to support exercise. Putting out more energy for movement requires that we put more in to fuel our bodies so we want to be sure that we are at a stage where we are consistently meeting our nutritional needs. Allowing others to help and support us in this process can enable us to create a safety net of trusted people that we can turn to if we need help. Overall, if iexercise is something that is going to be fun, like trying new activities or engaging in activities in a group setting, then this type of movement can be a good thing and improve overall wellbeing and quality of life. Just remember that every individual is different, and how exercise fits into our own lives is not going to be the same for everyone. Each journey is unique and should be treated as such.


References

1. Danielsen, M., Rø, Ø., Bjørnelv, S. (2018) How to integrate physical activity and exercise approaches into inpatient treatment for eating disorders: fifteen years of clinical experience and research. Journal of Eating Disorders, Vol. 6Retrieved from: https://www-ncbi-nlm-nih-gov.proxy1.lib.uwo.ca/pmc/articles/PMC6154924/#CR16

2. Cruze, R. (2016) How to find balance with exercise in eating disorder recovery. Retrieved from: https://www.eatingrecoverycenter.com/blog/2016/08/24/how-to-find-balance-with-exercise-in-eating-disorder-recovery-robyn-cruze

3. Murray, E. (2018) Eating disorder recovery: when can I exercise again? Retrieved from: https://themighty.com/2018/03/eating-disorder-can-i-exercise/

The Body’s Built-in Safety Nets

Our bodies are capable of amazing things, and there is a lot going on in there to keep us alive and attempt to make sure that we are functioning at our best. When we upset the optimal levels that our body needs to function, there are coping mechanisms that take place as built-in safety nets to help us survive. There are also specific things that happen in the presence of an eating disorder, and some of these can be exhibited as signs or symptoms to warn us of the underlying issues. For example, in times of starvation or malnutrition, when we are not getting enough energy through calories consumed, our bodies attempt to slow down metabolism in order to conserve energy1. One of the ways that the body accomplishes this is by lowering its’ body temperature. Blood circulation is decreased, and blood is conserved around the internal organs for protection, which causes a lack of warm blood flow to the extremities of the body such as the hands and feet. The blood that is sitting in the extremities gets cold due to the lack of circulation, and thus causes the hands and feet to feel especially cold. Another reason for always feeling cold is the loss of the body’s insulating layer of fat, which is normally used to keep the body warm2. Individuals with eating disorders sometimes explain feeling cold often and this is why it occurs. If this is something that is happening for you or a loved one, it’s important to speak with a health care professional to let them know. Our bodies have a specific temperature range where they function optimally, and a lower temperature range can lead to dangerous health complications.s

Other adaptive changes that the body makes in times of stress can include a reduced respiration rate or hypotension (low blood pressure), which are both also due to the slowing down of the body’s metabolism to conserve energy3. There can also be growth of a fine hair on various parts of the body in an effort to keep the body warm and insulated and try to regulate temperature. This hair growth is referred to as lanugo4. With all of this being said, when these warning signs appear it is extremely important to seek help from a professional before trying to reintroduce a higher calorie intake. The reintroduction process needs to be gradual to avoid refeeding syndrome, where your body cannot adapt quickly enough to the change and cannot cope properly. After prolonged starvation, the body shifts to get energy from different places, and is potentially deficient in essential vitamins and minerals. When refeeding, the metabolism can overwork itself trying to make up for lost tissues and it can be difficult to adapt again to a new change5. Consulting with a physician or dietitian first can help to make personal recommendations while also monitoring nutrient levels and maintaining safety above all in the recovery process.


References

1. Gaudiani, J.L. 2015. Why feeling cold can be a dangerous sign in anorexia nervosa. Retrieved from: http://www.gaudianiclinic.com/gaudiani-clinic-blog/2015/12/21/why-feeling-cold-can-be-a-dangerous-sign-in-anorexia-nervosa

2. Eating Disorders Glossary. Hypothermia (low body temperature). Retrieved from: http://glossary.feast-ed.org/3-treatment-medical-management/hypothermia

3. Ahacic, J.A. 2016. Nursing made incredibly easy! Vol 14-2Retrieved from: https://www.nursingcenter.com/cearticle?an=00152258-201603000-00007&journal_ID=417221&issue_ID=3331856

4. Mascolo, M. 2018. Anorexia recovery and overcoming physical side effects of an eating disorder. Retrieved from: https://www.eatingdisorderhope.com/information/bulimia/anorexia-recovery-and-overcoming-physical-side-effects-of-an-eating-disorder

5. Grubiak, K. 2018. Restoring nutritional health in anorexia nervosa recovery. Retrieved from: https://www.verywellmind.com/restoring-nutritional-health-in-anorexia-nervosa-recovery-4115081

 

Breakfast: Is it Really the Most Important Meal of the Day?

Many of us have been told since we were children that breakfast is the most important meal of the day. Truth is, it’s not a myth! Eating within an hour of waking “breaks the fast” (ie. break-fast) and helps our body to wake up and get ready for the day. In order to tackle our daily tasks, we must first fuel our brains and provide our bodies with substantial energy to thrive during the day. Eating meals and snacks throughout the day not only provide us structure but also assists in the recovery process by helping our body get used to adequate nutrition again.

What does “breaking the fast” really mean? Well, during the night our bodies are in a fasted state which means that bodily processes slow down to rest. This includes our breathing, our heart rate and digestion. Upon awakening, our bodies seek energy primarily in the form of carbohydrates which is utilized to supply fuel to our brains. Further, the digestive tract begins its’ natural rhythm as it knows that food is on its way.Consuming breakfast after the night’s fast helps to regulate blood sugars and hormones such as cortisol, the “stress hormone”.By fuelling our bodies with food, cortisol levels naturally balance out and our body is no longer in a stressed state due to the overnight fast.2

Eating breakfast also helps to set up our appetite. Hunger hormones, leptin and ghrelin, are noticeably balanced after consuming a meal.2 A large piece of eating disorder recovery is re-learning our hunger and fullness cues and eating breakfast can be tremendously helpful in this endeavour. People who do not eat breakfast will often notice increased feelings of fatigue and brain fog as the day goes on.The cycle perpetuates itself, often impacting cognition and the ability to learn.4

Nutrition supports growth and bodily functions. For example, during infancy, childhood and adolescence, nutrition supports cognitive development and growth. During the later years, nutrition helps to maintain a strong immunity and maintain cognitive performance.3,5 Many studies illustrate the connection of eating a nutrient dense breakfast to increased academic performance and sustained energy. Eating breakfast also enhances concentration, memory and alertness.2,3 It provides us with the brain power to critically think and reason out outcomes during problem solving.Consuming regular meals and snacks helps in meeting nutrient and energy needs, facilitates the development of normalized eating patterns and reduces the likelihood of disordered eating.6

Consuming breakfast is one of the first nutrition goals when working with our dietitians to overcome an eating disorder.By engaging in regular eating for recovery, one will recognize and respond to their hunger cues and become more in tuned with their body providing it with sustained energy throughout the day.This is also known as mechanical eating, suggesting that individuals should eat every 2-4 hours while awake. This technique disrupts disordered eating, grazing, binge eating, purging and relieves anxiety associated to food rules.4 Committing to this nutrition goal benefits the individual by providing them with structure to their day and encourages routine to plan, prepare and prioritize meals.4 Ultimately it is protective to recovery as it allows the body to heal and repair and stimulates a positive mind set.


References

1. Betts, J. A., Chowdhury, E. A., Gonzalez, J. T., Richardson, J. D., Tsintzas, K., & Thompson, D. (2016). Is breakfast the most important meal of the day? In Proceedings of the Nutrition Society, 75(04), 464–474. https://doi.org/10.1017/S0029665116000318

2.  Spence, C. (2017). Breakfast: The most important meal of the day? In International Journal of Gastronomy and Food Science, 8, 1–6. https://doi.org/10.1016/j.ijgfs.2017.01.003

3. Affinita, A., Catalani, L., Cecchetto, G., De Lorenzo, G., Dilillo, D., Donegani, G., Zuccotti, G. V. (2013). Breakfast: a multidisciplinary approach. In Italian Journal of Pediatrics, 39(1), 44. https://doi.org/10.1186/1824-7288-39-44

4. Ferrer-Cascales, R., Sánchez-SanSegundo, M., Ruiz-Robledillo, N., Albaladejo-Blázquez, N., Laguna-Pérez, A., & Zaragoza-Martí, A. (2018). Eat or skip breakfast? the important role of breakfast quality for health-related quality of life, stress and depression in spanish adolescents.International Journal of Environmental Research and Public Health, 15(8), 1781. doi:10.3390/ijerph15081781

5. B, C. (2018). The Physical and Mental Health Benefits of Eating Breakfast. In Brookhaven Blog. Retrieved from https://www.brookhavenretreat.com/cms/blog-22/item/3090-mental-physical-benefits-eating-breakfast

6. Fleming, K. (2018). Regular eating for recovery. In Center for Clinical Interventions. Retrieved from https://www.cci.health.wa.gov.au/Resources/~/media/95F9A1FC3F1C4D0A92CD31B09166FDDB.ashx

 

Sick Day Management: How to Stay on Track With Recovery When You Have a Cold

Over the winter months, we welcome frigid temperatures, frequent snowfalls and of course, cold and flu season”. During this time, we begin to experience a weakened immunity due to the change in weather, the lack of sunlight and shorter days.1Certain measures can be taken to avoid getting sick, such as frequent hand washing and getting the flu vaccine.2It’s also helpful to  get adequate sleep, stay hydrated and nourish our bodies with food.

Sick day management can be challenging. You may be experiencing fatigue, congestion,  and a lack of an appetite.3When we’re not feeling so well, it’s normal for our appetites to be suppressed. Our days may feel dull and dragged out and our energy levels lower than usual. During recovery from an eating disorder, this can become more challenging and requires extra attention to stay on track with recovery.4Efforts should be made in order to consume a sufficient amount of energy required for eating disorder recovery and also to recover from the cold or flu. Since hunger cues may be affected, without proper attention an individual can easily under-eat, become dehydrated and as a result prolong their sickness and regress in their recovery.5

When we are ill, our body’s defense army will work extra hard to attack the virus impairing our wellness. This is why maintaining regular eating habits and nourishing our bodies is crucial to repairing and strengthening our immune system. It can be beneficial for individuals in eating disorder recovery to practice mechanical eating during times of sickness. Eating based the clock, every 2-4 hours, will help meet energy and micronutrient needs despite feeling unwell.5Intuitive eating should be avoided as appetites tend to be suppressed during times of sickness.

Since we know that the common cold can diminish our hunger and speed up satiation, an easy way to manage our energy intake during recovery is to choose more nutrient dense foods and drink energy rich fluids5. A simple way to add extra energy to our meals and snacks is to use full fats in recipes and meals, such as rich cheeses, full fat yogurts and heavy creams. Increasing the nutrient content in beverages is highly recommended and can be accomplished by replacing water with milk, soda or fruit juices..Choosing to make soups and smoothies when we are feeling sick can also been a good choice rather than consuming heavy meals when our appetites are suppressed. Finally, staying warm and scheduling in adequate time to rest is imperative for your body to heal sufficiently.


References

  1. Influenza (Flu). (2018). In Center for Disease Control and Prevention. Retrieved from https://www.cdc.gov/flu/about/season/flu-season.htm
  2. Allan, G. M., Arroll, B. (2014). Prevention and treatment of the common cold: making sense of the evidence. InCanadian Medical Association journal186(3), 190-9.
  3. Influenza (Flu). (2018). In Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/flu/about/qa/coldflu.htm
  4. Karges, C. (2016). Dealing With Sickness: Maintaining Recovery During the Holiday Season. In Eating Disorder Hope. Retrieved from https://www.eatingdisorderhope.com/blog/dealing-with-sickness-maintaining-recovery-during-the-holiday-season
  5. Leech, R. M., Worsley, A., Timperio, A., & Mcnaughton, S. A. (2015). Understanding meal patterns: Definitions, methodology and impact on nutrient intake and diet quality. In Nutrition Research Reviews,28(01), 1-21. doi:10.1017/s0954422414000262

 

 

 

New Year’s Resolutions: Helping or Hindering Recovery?

Following the holiday season, there comes the time of year where people tend to reflect on all the experiences and milestones that they have accomplished and begin to assess what they can change.  January 1st becomes the marked date where resolutions are made in hopes to change a habit, better yourself or make new commitments to name a few.  Many see it as an opportunity to leave certain habits or negative vibes behind and start fresh with a new year. Some may even say “new year, new me”1. This particular time of year can be very exciting but also very triggering for individuals living with disordered eating. There are societal pressures encouraging many people to become the best version of themselves1. What we hear less of is that this can backfire and cause people to make unrealistic goals or create negative mindsets. By being kind to yourself, we can choose to either make helpful, healing resolutions or opt out of resolutions altogether! Either way, we can reach our goals while embracing self-love and self-acceptance.

We have noticed that the majority of people who make new year’s resolutions strive for perfection. They make too many goals with the hopes to change old habits or make major life changes all at once1. This can be quite overwhelming! To no surprise, the University of Scranton noted that only 8% of people successfully translate their resolutions into their lifestyle while 92% fail to continue2. Why is this? When we make too many goals at once, it can be hard to keep track and sustain each goal; creating a negative attitude towards the rest. Guilt and shame suddenly overwhelm our thoughts and our abilities to succeed. Just like eating disorder recovery, making a change in life requires steps and should be regarded as a journey3.

Whether the goal is to set boundaries, practice more self-compassion, budget your money, or incorporate a new self-care activity, there is sure to be some regression and progression. SMART goals may be a helpful tool in helping you to sustain a change or successfully incorporate new year’s resolution into our lifestyles. SMART goals represents the need for goals to be specific, measurable, attainable, realistic and time based4. It is very easy to get caught up in the pressure in making resolutions and dismissing reality. By making your resolutions a journey, you maybegin to understand the process. It it may even mean that you take a few steps back before you can take a few steps forward.

Especially around this time of year, there is a great emphasis and focus on the word “health”. A lot of resolutions stem from a negative mindset of wanting to make changes to our weight, eating patterns and body shape1. This can be triggering to many individuals, especially those who are on their journey to recovery. It is important to consider your audience when discussing anything around food and exercise to ensure you are not risking harm to your peers. We all need to be gentle with ourselves, but especially as we are in the process of healing and can be easily influenced by the negative body ideals, social media blasts and diet culture surrounding us.

It is important to be conscious of helpful versus hindering resolutions. Individuals who are in recovery from an eating disorder can be susceptible to the diet culture language and can easily fall into disordered thoughts, behaviours and patterns if they are not mindful. Over-exercising and food rules (just to name a few) can hinder recovery and cause regression. Try to be gentle with yourself, acknowledge how far you have come and embrace your accomplishments. Remain aware of your triggers and strive for a mindset that is free from restriction, rules and perfection. By shifting focus from a new resolution to the journey of recovery, it may be easier to focus on nourishing your body and make yourself a priority each and every day.

If you are someone who finds goal-setting or new year resolutions helpful and healthful, here are some ideas:

Begin everyday with positive affirmations.

Look in the mirror and remind yourself how strong, courageous and beautiful you are.  By doing this, you will begin each day with a positive mindset and know that you can overcome any challenges that you may be faced with.

Focus on your well-being.

Do something each day that you love.  Take this time for yourself to reflect and relax.  This can be as simple as reading a book, journaling, disconnecting from social media, taking a bath or baking something delicious.

Make yourself a priority.

Take charge and do what’s best for you and do not be afraid to remove yourself from a situation that may hinder your recovery.  Practise intuitive eating and self-love.

Spend time with your loved ones. 

Spend more time with family members, call a friend or plan a social gathering.  Embracing your support system will benefit your well-being and enhance your confidence.



References

  1. Bradley, G. (2018). New Year’s Resolutions That Will Actually Make You Feel Good. In National Eating disorders. Retrieved from https://www.nationaleatingdisorders.org/blog/7-new-years-resolutions-will-actually-make-you-feel-good
  2. New Years Resolution Statistics. (2018). Statistics Brain Research Institute. Retrieved from https://www.statisticbrain.com/new-years-resolution-statistics/
  3. Are New Year’s Resolutions helpful in Eating Disorder Recovery?. (2016). In Eating Disorder Hope. Retrieved from https://www.eatingdisorderhope.com/blog/resolutions-eating-disorder-recovery
  4. Effective goal setting: applying SMART goals. (2010). In Healthcare Registration. Retrieved from http://link.galegroup.com.proxy1.lib.uwo.ca/apps/doc/A234795397/AONE?u=lond95336&sid=AONE&xid=95cc921e