REDS or Relative Energy Deficiency In Sport can be dangerous and is, therefore, an important subject to understand and talk about. Renee McGregor joined Heather Fell on the Global Triathlon Network to discuss. Check out the full video below.
The Reformation of Eating Disorder Services – Press Release
“It’s 2021, no one should be dying from an eating disorder”
Experts join forces to fight for the reformation of eating disorder services, because no one should be dying from an eating disorder in 2021.
- Hope Virgo, founder of #DumptheScales forms the world’s first coalition of eating disorder services across the UK to fight government legislation.
- Eating disorders are currently at their highest globally following COVID-19 yet current legislation shows no action to reduce this, if anything policies currently in place are only set to make this worse including the latest ‘calories on menus’ action.
- Eating disorders, including anorexia nervosa, bulimia nervosa, binge-eating disorder (BED) and other specified feeding or eating disorder (OSFED) are responsible for more loss of life than any other mental health condition, and unfortunately are becoming increasingly more common (1).
- It is estimated that over 700,000 people in the UK have an eating disorder, with an already overstretched service at breaking point (2).
- The recent 2019 Health Survey found that 16% of adults aged 16 and over (19% of women and 13% of men) screened positive for a possible eating disorder.
- This is a 266% increase in the last 12 years.
- Hospital admissions have seen a fourfold increase in demand, and to our knowledge, there has been no investment into specialist eating disorder inpatient services during this time.
- Approximately 70% of people needing hospitalisation are adults, and there has been a significant increase in ethnic minorities and males with eating disorders.
What is Hearts, Minds and Genes?
The ‘Hearts, Minds and Genes’ coalition’s mission is to work towards a complete reformation of services to support patients suffering. Their goal is to achieve a world where eating disorders are understood and supported across medical, physical and mental care.
Hearts, Minds and Genes is leading the way in bringing together carers, lived experience, and individuals working in the fields of genetics, research, and treatment. It is made up of Dr Agnes Ayton, Dr Ashish Kumar, Renee McGregor, Helen Missen, Prof Gerome Breen, Suzanne Baker and Simon Brown.
The coalition recently presented its recommendations and plans for reform to the Department of Health and Social Care (DHSC).
“As a group we felt frustrated by the lack of urgency to tackle these issues and believe that together we are more likely to make that impact on others. Eating disorders are preventable and treatable, and with early intervention, the right treatment, funding, pathways, education and support for the whole family they can and will be prevented.”
Hope Virgo, founder of Hearts, Minds and Genes
Eating disorders are mental illnesses with physical consequences. Present treatment in the UK focuses too much on individuals hitting criteria and being able to be classified when in reality a more holistic approach is required.
Renee McGregor, Leading Sports Dietician and founder of the EN:SPIRE clinic
“More research will be central to understanding these life-threatening disorders and to help inform evidence based services. Now is the time for sensible public policy and more direct support for eating disorder services and research. This is what our coalition will strive to achieve”
Gerome Breen, coalition member and Professor of Psychiatric Genetics at King’s College London
Eating Disorders are both psychological and physical in presentation and should be treated with early and ongoing specialised evidence based treatment. We are committed to a coalition-building model of advocacy as well as working collaboratively to ensure better outcomes for all those affected by eating disorders – nobody should be dying of an eating disorder in 2021, neither should anybody have to settle for living with an eating disorder.
Helen Missen and Suzanne Baker of F.E.A.S.T.
Recovery is a Journey
As I sat on the windowsill of my year 10 classroom, I could feel the warmth of the sun on my back. I was desperate for this heat. It was May and the temperature outside was typical of the month, mild, cloudy but with sunny outbreaks. I could hear the laughter from outside, teenage girls in little clusters scattered all over the courtyard, deep in animated conversations. From within the classroom, there was also chatter; conversations about lunch, who was dating who, and plans for the weekend. I tried to focus on what was being discussed, a smile painted on my face, trying to demonstrate that I actually cared, when in reality all I could focus on was willing the sun to warm up my shivering body, which was buried beneath layers of clothing. Whilst everyone else was in full summer uniform of striped blue and white blouse and navy skirts, I was still sporting full thermals, topped with a jumper and blazer to cover my tiny, vulnerable under-nourished body.
Unless you have experienced a restrictive eating disorder like Anorexia, you will not truly be able to appreciate or understand the cold, even in the height of summer, it seeps into every corner of you, deep into your bones, to the point it aches to move. I don’t remember much of this time but I will never forget what it felt like to be so cold you were numb; to feel so incredibly alone, enhanced by the sheer void and emptiness that had been created within me. The isolation, which I would also experience years later going through my divorce and while not to the full extent, I’m definitely noticing similarities right now as I write these very words in lockdown during a global pandemic; you become enveloped in it and it not only repels any form of care, love or comfort; but also shields you from further hurt pain and suffering. It takes you to a place where thoughts are dark and intrusive but also loud – “You are not good enough. Nobody likes you.” The more isolated you become, the more these thoughts takes over and become your truth.
My Anorexia had caught everyone by surprise; we were in the 1990s and the only real case study was that of Karen Carpenter. No one expected an Indian girl, brought up above a shop in a council estate to develop an eating disorder. I baffled medics for months. Nobody could work out why the weight just kept falling off. Like all Anorexics I was a master at manipulating any situations around food. I disguised my body under layers and layers of clothing and went about my daily tasks with gusto, demonstrating to everyone that I was fine and fully capable. When I finally did get the help I needed, I was literally days away from death.
My recovery from Anorexia was not linear, it never is. Indeed, it has taken me over 2 decades to appreciate this and understand that even times when I thought I was “recovered”; where food really was no longer an issue, there was still a problem. Its only really been in recent years that I can see, the discomfort I felt at 13 years and denied through restrictive eating has plagued me through my adult life. I just used other methods to try and fix it.
I spent my 20s worrying too much; always chasing something- the perfect job, the number on the scale, collecting accolade after accolade to prove I was enough and always in search of that ultimate pair of skinny jeans that worked for me.
In my 30s I chased run paces and finishing times at races. I beat myself up daily for not being an earth mother, feeling a continual disappointment as a wife, and never feeling satisfied with my career path. The search for the perfect pair of jeans continued.
In my 40s, I’ve faced more losses, hurt and adversity but finally I have stop chasing. I have found acceptance and belief. I stopped and took stock. The answers were always there, within me, I just needed to understand. That is, I just needed to understand me.
I have come to the realisation that there has always been so much evidence that I’m enough just the way I am but I chose not to see it; there was always love and friendship that I denied myself because I didn’t feel worthy.
I’ve stopped chasing happiness because it’s not a destination, it’s not a body aesthetic, it’s not about having a partner; it’s not about being successful or receiving external validation through work or races.
It’s a place you reach when you learn to forgive yourself and embrace being uniquely you. It is a place where you can sit comfortably in your skin, being grateful for those that bring love and laughter into your life; where you can drink coffee, eat cake without care; where you don’t assume that acceptance and approval is based on what you look like. It is where you do what makes you smile, whether that’s a run in the mountains or dancing in the kitchen and it’s not about creating an illusion of the “type” of person you want the world to think you are. It’s about being true to yourself, maintaining authenticity, even when the chips are down.
It’s about appreciating “That Life’s Beauty is inseparable from Its Fragility”
“We experience love but also loss; we achieve success but also failure.”
-Susan David
I’m the same Renee but finally, I feel sassy, sexy and in the best shape of my life but most importantly, I am no longer looking for that pair of jeans- I’ve found that I rock a pair of dungarees instead.
Assessment of Echographic Technology in Measuring Bone Health in the Clinical Setting
For limited time, we are offering new, affordable specialised ultrasound scan to determine your bone health.
How? Measuring bone health by ultrasound employing echographic technology does not involve ionising radiation (employed in current method of assessing bone health), so medical referral not required.
Who? Scans offered to those exercisers, athletes and dancers attending EN:SPIRE clinic. Self-referral also welcome from all those with an interest in their bone health, men and women, all ages.
Why? Optimising bone health lowers risk of bone injuries, including fracture.
What? Bone health is to a large extent determined by lifestyle factors such as exercise and nutrition, which is under your control to modify.
What else? Scan results will be explained and discussed.
Appropriate blood tests also available via Forth with analysis at UK accredited laboratory and medical interpretation for an additional cost.
Where? Pure Practice, 20 St James’s Parade, Bath BA1 1UL Few minutes walk from Bath Spa station
Ethical approval applied for at Durham University (Dr Nicky Keay Research Fellow)
In collaboration with Pure Practice (Sonja Bass), EN:SPIRE (ReneeMcGregor) and Strength for Performance. Cost £65 for scan and explanation/discussion of results payable to Pure Practice on arrival
What next? To register interest and book an appointment please fill in the form below
Athletes! Is food and training the answer? (Part 2)
Start with Part 1 of this blog here.
Physically, when the body is under “stress” levels of cortisol rise. When this is chronic, it prevents the pituitary gland from working effectively, leading to hormonal disturbances that have serious negative consequences.(1-3) The more obsessive and restrictive an athlete becomes, the more the workings of neurotransmitters are affected, which in turn structurally affects the brain. In addition to this, there is a heightened sense of anxiety, which leaves an individual feeling physically and mentally uncomfortable. In an attempt to control and contain these emotions, the individual’s behaviours become even more rigid and controlled.(4)
The importance of self acceptance and how to achieve it
Emotional problems need to be dealt with. A lack of self worth and ability to believe you are good enough develops through a number of different means –your experiences, your interpretations of situations and your personality type. In order to be able to navigate through life, you have to learn accept yourself and I would highly recommend working with a clinical psychologist trained in this field. So many of us allow our circumstances to define who we are and yet just because you didn’t achieve a podium finish, does that really make you a failure or a bad person? Of course not, you are still you, the same you, you were a few days earlier, and the person that may have been flying in a training session last week.
So what’s involved in the road to “recovery”. Well first let’s look at the term “recovery”. An eating disorder is a part of you– it is that perfectionist side of you that has gone into overdrive and never lets you rest or believe you are enough. Awareness of this is the first step, because understanding this helps you to then appreciate that it is something you need to learn to challenge. After this, “recovery” is possible because its about managing your expectations, however, it is also highly possible that at time of high stress and anxiety, when life “feels” chaotic, your default coping mechanism will be to once again restrict and “contain”.(5)
The multi-disciplinary team approach
To get the best chance of “recovery” for the athlete, I choose to work in a multi-disciplinary team. The team should comprise of medic, a clinical psychologist, a specialist dietitian and I also like to work with an endocrinologist so we can test and monitor biomarkers that give us information on physical status. It’s important to highlight the importance of clinical practitioners here in both psychology and nutrition. Dietitians are the only nutritional practitioners regulated and trained to work in clinical areas such as Eating Disorders and RED-s.(6)
One of the key aspects of recovery is to restore weight (if the athlete is underweight) but also regulate their hormones. This can be achieved through a process of mechanical eating where the athlete needs to eat at regular intervals regardless of how they might “feel”. While many athletes will want to learn how to “eat intuitively” this will not be possible until hormones and biochemistry return to and remain consistently in a normal range. At this stage hunger cues may finally return.
My practise involves working through a number of tasks, both nutritional and behavioural. I help the athlete challenge their behaviours but also create a tool kit that they can continue to use so that they return back to their sports as a more resilient robust athlete both physically and mentally.
Building physically and mentally robust athletes
“The key to our wellbeing is not low expectations. It is the ability to interpret unexpected negative outcomes in a positive way. We should look at failure as an opportunity to learn and do better, and bask in our high expectations”.(7)
References
- Keay et al. Bone mineral density in professional female dancer, BJSM, 2016
- Keay et al.Low energy availability assessed by a sport-specific questionnaire and clinical interview indicative of bone health, endocrine profile and cycling performance in competitive male cyclists, BJSM, 2018
- Burke et al. Relative Energy Deficiency in Sport in Male Athletes: A Commentary on Its Presentation Among Selected Groups of Male Athletes. IJSNEM, 2018.
- McGregor, R. Why Do Athletes use Food and training as a Means of Coping. Presentation to Sport Wales, 2019.
- Flett and Hewitt. The Perils of Perfectionism in Sports and Exercise, CURRENT DIRECTIONS IN PSYCHOLOGICAL SCIENCE, 2005.
- Joy, EB et al. Update On Eating Disorders In Athletes. A comprehensive narrative review with a focus on clinical assessment and management. BJSM, 2016: https://edinstitute.org/paper/2012/11/23/phases-of-recovery-from-an-eating-disorder)
- Should You Manage Your Expectations? A lesson about optimism from the 2012 London Olympics. Posted Jul 29, 2012 – original quote, George Loewenstein (1987)
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Renee @mcgregor_renee is a Sports and Eating disorder specialist Dietitian who works with a number of NGBs, Coaches, professional athletes and sports science teams to provide nutritional strategies to enhance sport performance and manage eating disorders. She has an undergraduate in Biochemistry, a post graduate in Dietetics, a further postgraduate in Applied Sports Nutrition and is currently working towards a post graduate in mental health and neuroscience psychology.
Renee works collaboratively with Nicky Keay, Consultant Sports Endocrinologist and they are excited to announce the opening of the EN:SPIRE clinic in Bath 10thApril. EN:SPIRE is the UK’s first Sport and Dance RED-s, Overtraining and Eating Disorder Specific recovery clinic.
This article was originally posted by the British Journal of Sports Medicine (BJSM) on April 16, 2019 – Athletes! Is food and training the answer? (Part 2)
Renee McGregor on #TRAINBRAVE & Running Ultras
In a Q&A with Katie from lessonsinbadassery.com Renee talks about running ultras and #TRAINBRAVE.
Renee McGregor is a sports and eating disorders dietitian and author who works with elite athletes, Olympians and Paralympians. A specialist in eating disorders, earlier this year Renee co-founded #TRAINBRAVE with athlete Tom Fairbrother to raise awareness of ED in sport, address the culture that contributes to it and encourage openness.
An accomplished ultra-runner herself, Renee is a two-time finisher of the seven-day Manaslu trail race (220km through the Himalayas) and has completed, amongst many other ultras, the Gower 50 ultramarathon. We cover this, #TRAINBRAVE and more in this Q&A.
Read the full interview here >>
Athletes! Is food & training the answer? (Pt. 1)
Human competitive nature is a biological trait that has co-evolved with the basic need for survival(1). It motivates us to get out of bed and show up every day. But is all competitiveness good for us?
From my 8-years of sports specific and 20-years total dietetic experience working with athletes of all levels (recreational through to Olympic and Paralympic standard; young and old, male and female), it’s like walking on a tight rope. If you can stay balanced, you will make it to the other side, but remember: it doesn’t take much to push the balance off-kilter.
Society today: the ‘prove your worth’ attitude
We live in a society that demands us to prove our worth through our achievements, and for athletes this means sporting success. While healthy competition doesn’t hurt, it can also create anxiety and define one’s worth, which is destructive and can become dysfunctional. The pursuit for constant happiness, success and completeness often results in extreme behaviours, resulting in short- and long-term health problems. Let’s take the example of restrictive eating in athletes, the culture within their given sport often creates a belief that being lighter will improve their performance. What they don’t stop to consider is that maybe their body is already as low as it needs to be. The feeling of “not being good enough” drives them to a place where they overly restrict their calorie intake and significantly increase their training. While an athlete may find that they initially have positive results, this soon plateaus and usually declines rapidly. Commonly, athletes further crack the whip, believing that they are still not working hard enough. Over time their high training volume and low energy intake becomes so restrictive, it leads to biochemical and hormonal irregularities, resulting in depression, anxiety and many long-term physical consequences such as low bone density, gastro-intestinal symptoms and a depressed immune system (2-4).
Challenging your bad habits
While love and happiness are positive emotions to experience, many of us run a mile (quite literally) when it comes to experiencing difficult emotions such as loss, uncertainty, pain and trauma. Many of us who suffer with anxiety and know that it can be debilitating; the severe physical feelings, that you can sense deep within you and make you want to just unzip and escape from your body. The issue is that no matter what ‘coping mechanisms’ you put in place to ‘control, contain and numb’ these difficult emotions, such as restrictive eating, over exercising, alcohol, sex or drugs, they are always temporary. Those difficult emotions always come back –eventually one must choose to accept them, work their way through them. This may be terrifying but working with a qualified psychological practitioner is critical.
To change a behaviour, we have to challenge it which means stepping out of your comfort zone and accepting discomfort, understanding that while it may cause you temporary unease, in the long-term, it will serve you for the better.
My work as a dietician
My work with athletes is two-fold; helping then firstly understand where their need “for control” comes from and then re-educating them about how to fuel their body optimally to get the performance results they are chasing. Many athletes have a particular personality trait and combined with a competitive environment creates the perfect storm (5).
It is my role to help athletes appreciate that they will never find answers or outcomes in food or exercise. While these are important components to a healthy life and often a career focus for many, if they are not managed well, they can fast become the crux of the problem too.
In the Part 2 of this blog, I will explain an approach to recovery for an athlete experiencing The Perfect Storm.
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Renee @mcgregor_renee is a Sports and Eating disorder specialist Dietitian who works with a number of NGBs, Coaches, professional athletes and sports science teams to provide nutritional strategies to enhance sport performance and manage eating disorders. She has an undergraduate in Biochemistry, a post graduate in Dietetics, a further postgraduate in Applied Sports Nutrition and is currently working towards a post graduate in mental health and neuroscience psychology. Email: rm@reneemcgregor.com
Renee works collaboratively with Nicky Keay, Consultant Sports Endocrinologist and they are excited to announce the opening of the EN:SPIRE clinic in Bath 10thApril. EN:SPIRE is the UK’s first Sport and Dance RED-s, Overtraining and Eating Disorder Specific recovery clinic.
References
Linden S. The Psychology of Competition (2015). Retrieved from https://www.psychologytoday.com/ca/blog/socially-relevant/201506/the-psychology-competition
Leng G. The Heart of The Brain: The Hypothalamus and Its Hormones (2018). MIT Press.
Keay, N et al.Relative Deficiency in Sport. An Infographic Guide. BJSM 2019
Joy, EB et al. Update On Eating Disorders In Athletes. A comprehensive narrative review with a focus on clinical assessment and management. BJSM, 2016
Orthorexia: When Health Eating Goes Bad, Renee McGregor 2017. Nourish books
This article was originally posted by the British Journal of Sports Medicine (BJSM) on April 5, 2019 – Athletes! Is food and training the answer? (Part 1)
Empowering Balance in a Performance Driven Society
My work means I meet people constantly. While they all come with different needs and nutritional concerns; from performance outcomes to food anxiety, fundamentally they are all looking for that golden nugget, that something that is going to make them feel “complete”.
Indeed, none of us are immune, talking to my close friends, it does feel like so many of us are just trying to “make sense” of what life is and should be. However, in the case of many that I work with, this pursuit for “constant happiness/success/completeness” often results in extreme behaviours, which can result in short and long term health problems.
Its important to remember that the mind and body are not separate entities; making a change at one level can have severe implications and consequences at another point within the body.
Let’s take the example of restrictive eating. It usually starts with the individual believing that changing their nutritional intake; going gluten free will improve their overall health and energy levels. This in turn will make them happier and more accepted. However, when this change doesn’t provide the response they were hoping for, they may remove a further food group. Over time their diet and energy intake becomes so restrictive, it leads to biochemical and hormonal irregularities, resulting in depression, anxiety and bone health problems. Similarly, many of us turn to exercise to help with stress and improve general health parameters; while we know exercise is good for us, there is a dose related response. So if we take it to an extreme, it can become obsessional, leaving the individual feeling more anxious when life or circumstances means they are unable to train.
Where does this all come from? Why the constant need and search for “perfect”? It does feel that we are a society that defines individuals by external validation. We are only deemed successful if we have “achieved”. The constant pressure to live by ideals, from what we look like, to what we eat, even to what the interior of our home looks like. It feels like we live in a constant state of judgment. For those of us who are vulnerable, who struggle with our sense of self, this creates more anxiety; we crack the whip harder but no matter what we do, we are never good enough. While love and happiness are positive emotions to experience, many of us run a mile (quite literally) when it comes to experiencing these difficult emotions such as loss, uncertainty, pain and trauma. Its fairly understandable –any of us who suffer with anxiety know that it can be debilitating; the severe physical feelings, that you can sense deep within you and make you want to just unzip and escape from your body. However, the problem is that no matter what “coping mechanisms” you put in place to “control, contain and numb” these difficult emotions, such as restrictive eating, over exercising, alcohol, sex or drugs, they are always temporary. Those difficult emotions always come back –eventually you have to choose to accept them, work your way through them in order to finally come out the other side and get on with your life. This obviously feels terrifying but working with a qualified psychological practitioner is critical. In order to change a behavior, we have to challenge it which means stepping out of your comfort zone and accepting discomfort, understanding that while it may cause you unease, nothing awful actually happens.
You will never find your answer in food or exercise. These are important components to a healthy life but as we have seen, they can fast become the crux too. Emotional problems need to be dealt with – you lack of self worth and ability to believe you are good enough will have developed through a number of different means –your experiences, your interpretations of situations. In order to be able to navigate through life, you have to learn self acceptance and, as said previously, I highly recommend working with a clinical psychologist trained in this field. So many of us allow our circumstances to define who we are and yet just because you didn’t’ achieve your job promotion, does that really make you a failure or a bad person? Of course not, fundamentally you are still you, the same you, you were a few days earlier when you felt comfortable in your present job.
When it comes to food and exercise, here are my top tips:
- Healthy eating is not about deprivation. In fact, I often describe it as unrestrained eating. Don’t follow fads, they are not the answer to eternal happiness and only leave you feeling low in energy and depleted of essential nutrients for required for optimal health. The key is to keep meals balanced and colorful; nothing should be off limits but be mindful of portion sizes of certain foods and frequency of eating them. Thinks of foods like friends, some you will want to spend more time with than others.
- Don’t compare –most of us have a love, hate relationship with it. More and more studies are finding that social media negative impact on mental health; we find ourselves socially comparing ourselves to everyone we follow. While it may not always be conscious, this can drip feed into our psyche and start to affect how we view ourselves. How come they can work a full time job, train 20 hours a week and have time for family? It makes us feel inadequate and thus feed into our desire to prove we are good enough. The thing you have to remember about social media is that it is rarely real. Most people will only post when life is going well. You also need to ask yourself, why do I need to compare? Fundamentally we are all unique, this is actually what makes us human; comparing yourself to another is futile because there is no-one who is going to have the exact same genetic and lifestyle make up as you. There really is no ideal as rarely are two human beings the same, with the exception of identical twins.
- And finally show yourself self compassion. Even if you do have a training session booked in, if you are tired or you just don’t feel like training, then take the day off. Or change what you are doing. Some mornings I wake and I just don’t feel ready to run; I’ve learnt that pushing through a session is not the answer. Listening to your body and understanding what it needs is. On these days, I just swap my morning run for morning yoga and a gentle walk. I still get the benefits but at a pace that is more suitable for me that particular day.
The Battle Against The New Year Headlines…
I’ve said this many times but I have a love, hate relationship with social media – probably more so at this time of year than any other; its always the same, the conflicting messages alternating between holiday cheer, to a high state frenzy about how many calories we will all consume, to advice on how we should “burn the excess”.
And while we may well have eaten a bit more than normal for a few days, in reality its often that we have eaten differently and the “excess” may not actually be anywhere near as much as we are scare mongered into thinking.
Just to be clear I’m not saying that we should all become sloth like and take up residency on our sofa; lets face it, isn’t it tradition in most families to go for long walks before or after mealtimes? A time to catch up, reconnect with each other and enjoy the benefits of just being outside. What I am opposed to is the pressure that so many of us feel that you HAVE TO, and must EXERCISE in order to “beat the bloat”.
I’m sure that most of you reading this will still be in the post Christmas lull, still enjoying spending time with our families, catching up on well needed down time, as well as finishing off turkey and cheese board left overs. But, for those with an Eating disorder, this is one of the biggest challenges of the festive period –a change to normal eating patterns and food choices –it throws them into a state of panic with their anxious minds working over time creating all sorts of catastrophic outcomes. Its important to appreciate that individuals with an Eating disorder will always look for validation to maintain their behaviours –it makes them feel safe –controlled and contained, even when it will be apparent to those closest to them that the behaviours are anything but safe. Remember an eating disorder is not really about food or body image, this is just the medium they use to project how anxious, unhappy and uncomfortable they feel within themselves; it is their inability to sit with difficult emotions, constantly looking for ways to run away or numb deep rooted fears and perceptions.
Over the last few days I have been inundated with messages from those I work with, as well as new individuals, in a complete state of anxiety. Concerns that they won’t “get it right” because their normal foods are not available; the stress about having to sit around watching films or playing board games. Their minds playing tricks on them, with more and more intrusive thoughts about how this “lack of control” is going to end in tears. Somehow if they deviate from their usual food and training rules, they will become unfit, unhappy and balloon over night.
This is how irrational the eating disorder mind is.
The reality of course is that while they have an eating disorder and are restricting their intake and/or underweight, they are not making any training gains; and if anything they are just putting their already vulnerable body under more stress. That’s a huge challenge when working with eating disorders –it’s a silent illness in that so much of it is psychological but at the same time the body is slowly deteriorating –hormones, digestive system, bones and heart –individuals only sit up and take notice when its too late.
And when it comes to the fear of changes to weight, have you ever seen anyone physically balloon over the festive period?
No, because it is not a thing. In reality when our bodies are working optimally, they automatically regulate through homeostatic control. It will adjust our metabolism and send signals around satiety and hunger, because fundamentally, the body is always trying to achieve energy balance. Its only when we try to override this internal barometer to either extremes of severe restriction or over consumption that we may find our body works against us; but even then it doesn’t have to be long lived.
Helping individuals understand physiological recovery from an eating disorder is one of my roles –helping them to challenge their pre-conceived mind sets and well rehearsed “coping” behaviours is all part of the process. Of course physiological “recovery” doesn’t automatically equate to full recovery. Eating disorders are complex and while some have described it as being “taken over by an external force”, the reality is that an eating disorder really is a manifestation of your personality traits that have gone off kilter. So recovery involves working with trained psychologists and counsellors who can help you manage these personality traits – the perfectionism, the self criticism, the concern over other people’s perceptions of them. And this, is an evolving and on going process; it is something you have to continue to work on through your life. Learning to navigate emotions and not having to react to every single thought.
That said, physical recovery alongside this is imperative; as the body becomes restored physiologically, biochemically and endocrinologically, only then can we engage our brain and learn to become more rational.
As we go into 2019, the inevitable onslaught of food and wellness trends are going to hit us –we cannot avoid it. While they may be dressed up with new titles and slightly different food rules, the bottom line is, they are all still selling you a so called formula to happiness and yet can you really dress up happiness as a method of eating or a fitness trend?
For those who are vulnerable, either already suffering from or susceptible to developing a dysfunctional relationship with food, they will be in search of this golden nugget, this fast forward button and it is these individuals I worry about the most.
One new trend that is fast emerging is around the theme of “Intuitive Eating”. Its not new, its been around for a while and also has previously been branded as “Mindful Eating” however since the middle of 2018, it has definitely become a buzz word and hailed as the “non-diet approach” to eating.
There is some evidence that this approach can work in those that need to lose weight and previous over restrictive diets have failed; it has a health rather than weight loss outcome focus, which I completely agree with. Its about tuning into those innate basic instincts of hunger signals we are all born with.
However, there a few areas where I do not condone the use of these Intuitive eating practices; during the recovery from Anorexia, Bulimia. Orthorexia or in athletes.
In those individuals recovering from an Eating Disorder, I have spoken to many experts in the field of eating disorders, psychiatrists, endocrinologists and academics and they all agree with also what I observe in clinic. When an individual has severely restricted their nutritional intake, it results in endocrine dysfunction and the body responds in a way that preserves energy. Hunger signals disappear and will not return until the body’s physical, biochemical and endocrine function restores.
Until this point, if you ask an individual with an eating disorder to intuitively eat, they will intuitively eat nothing.
Its also important to remember that restrictive eating behaviours, especially chronic, also cause huge structural changes to the brain. Studies have demonstrated that in many cases, it can take up to 5 years after an individual a has restored and maintained their health physically, before the brain catches up. So while there may be a time and place further down the line to teach someone recovering from an Eating Disorder to intuitively eat, it is likely that by this point, they will already have tuned into their hunger signals and will be managing it without having to be taught something their body instinctively can do.
From an Athletic point of view, exercise, especially intense exercise can often result in an immediate decrease in appetite. If an athlete tunes into this, rather than responding to appropriate recovery requirements, it can lead to chronic under fuelling, once again hampering endocrine response to get the progression they are looking for and potentially causing a decline in their metabolic adaptations; many will not see the body composition or performance outcomes they would expect.
So before you embark on any New Year, New You trends, take a moment to think about your real motives –why are you looking for answers through how or what you eat? Has this formula ever worked previously? If not, then why set yourself up to fail again?
Maybe its actually time to understand where the root problem with your discomfort and poor sense of self lies.
Make 2019 the year you learn to live your life not just exist it.
What it means to be human…words by Renee McGregor
Time, give yourself time;
Allow yourself the space to process, reflect and accept.
Life doesn’t come with any guarantees,
It’s a journey you need to learn to navigate.
Sometimes the paths you choose will lead to Eden,
Sometimes not.
Either way, the journey is what you make of it.
Anxiety causes distress and discomfort;
It increases the production of intrusive and destructive thoughts.
It pulls you into despair; allowing that nagging doubt to swallow you whole.
Life becomes a restless fight encompassing every aspect of you.
You thrash about, this way then that, looking for any opportunity to escape.
You look for comfort but everything is short lived; a momentary release before you are plunged back down into the abyss of negative emotions.
But what if there was another option?
It can take a long time to appreciate that life is a choice.
Pain, suffering, loss and sadness all part of our story but equally weighted with love, happiness, joy and hope.
What if we choose not to let self doubt or intrusive thoughts in?
What if we let them pass- put them on a receding wave and watch them go out to the horizon?
What if we choose not to let those perceptions define us or dictate how our day may pan out?
Surely we can choose to celebrate rather than berate ourselves?
“Life is what you make of it”
“Feel the fear and do it anyway”
That’s what we are told and while they may not be your chosen words, the sentiment is there to be understood.
By allowing ourselves time, time to mourn, time to heal but mainly time to just be,
we learn to appreciate that this is allowed- We are human after all;
We don’t have to wrap all our emotions into knots, put them in a box, lock the box and throw away the key.
We can feel and accept- moments of sadness and equal moments of happiness- that’s the merry-go-round that is life.
But most importantly we have to choose to believe, believe that through the rutted and bumpy path, with time, our path will change again and this time it may end with blue sky and a pot of gold.
