Despite the hype about the obesity epidemic, I think just as many people's lives are being blighted by slow starvation. Starvation in the form of dieting.

One of the classic signs of starvation is a lack of interest in sex. One of the men who participated in the Minnesota Starvation Study said, after seeing a movie, he didn't remember much about the scenes that involved kissing and making out, but he was intensely fascinated with the cooking scene.

A recent study (done by Weight Watchers, which makes the results just a tad suspect, nor was it published in a peer-reviewed journal) found that

58 per cent of women surveyed think about sex at least 10 times a day, some 70 per cent admitted having far more regular fantasies about food. According to the research nearly two thirds of UK women are dissatisfied with their size and 53 per cent of those who took part in the survey admitted to thinking about their weight up to 10 times a day.

To me, this doesn't signify women obsessed with their weight. It signifies women who are starving themselves because they think it will improve their health (it won't) or because of social pressures. And those women with the requisite prewiring are at high risk for developing an eating disorder.

The absurdity of Weight Watchers is highlighted in their claim that 11:30 am on a Tuesday is the best time to start a diet. It reminds me of the 17th century claim by Archbishop James Ussher that the world was created at 8:03pm on Sunday, October 23, 4004 BCE. Nice to know clocks were created before the heavens and the earth.

But the worst thing about all of this- not just the time and money wasted, and the lives blighted and ended- is that it's all socially sanctioned. Nowhere in the story did anyone imply that maybe women are obsessed with food because they're not eating enough. Trust me- dieting isn't the solution to that. I hid behind this facade for years. I was just dieting. Just being healthy. Just watching my weight. How many times have you heard women utter these same words?

And I can't help but get sad and frustrated when I realize that things are probably only going to get worse.

I had mentioned about a week or two ago that I was going to begin a blog series on the biology of eating disorders. I wanted to start with something about the causes of EDs or something like that, but I think this topic is extremely relevant and so we can just call this the first post in the series.

I did some more research tonight into the biology and etiology of hypermetabolism. So let's start with a basic definition from Wikipedia:

Hypermetabolism is the physiological state of increased rate of metabolic activity. The impact of the hypermetabolic state on patient nutritional requirements is often understated or overlooked. Hypermetabolism typically occurs after significant insult to the body. In hospitals and institutions, the most common causes are infections, sepsis, burns, multiple trauma, fever, long-bone fractures, hyperthyroidism, prolonged steroid therapy, surgery and bone marrow transplants.

And, yes, eating disorders. Specifically anorexia. As someone falls deeper and deeper into anorexia, their metabolic rate slows dramatically. During the Minnesota Starvation Study, resting energy expenditure (also known as basal metabolic rate- the amount of calories needed just to keep your body functioning and doesn't include ANY physical activity) fell by about one-third. The book "Introduction to Clinical Nutrition" says that

Starvation involves metabolic alterations that enhance the chance of survival by increasing the use of body fat stores, by sparing the use of glucose, by minimizing nitrogen loss, and by decreasing energy expenditure.

But when the ill person begins eating again, their metabolism kicks into high gear. Body temperature rises. A person can experience night sweats, which may also be related to hormone function returning to normal.

Why? It seems a remarkably inefficient use of resources. And indeed, hypermetabolism may not be entirely adaptive from an evolutionary standpoint as the body's use of food becomes remarkably inefficient. Even so, the body needs tremendous amounts of energy to replace lost fat and muscles stores, depleted organs, bone mass, hair, nails, you name it. No organ system is spared during an eating disorder.

The amount of calories needed for people with anorexia to return to a healthy weight can vary by illness severity (a lower BMI means more calories, as well as duration of illness), and by illness subtype. One study found that those with the binge-purge subtype of anorexia needed significantly fewer calories than those with the restricting subtype; another study found that calories were about the same. Other variants include your metabolic rate before illness onset. I've known several good friends curse their fast metabolisms quire vociferously during refeeing.

When looking at the phase after weight restoration, caloric needs between people with anorexia nervosa and those with bulimia nervosa turn out to be quite different. One study found that people with AN needed more calories per kilogram of body weight than normal controls, while those with BN needed fewer. It appears that people with a current diagnoses of BN but a history of AN require more calories than those with BN alone. Further, people with the restricting type of AN needed more calories than those with the binge-purge type, both of which were greater than patients with BN (some of the studies cited above show that, for weight maintenance, caloric needs are basically the same for any patient with a current diagnosis of AN).

Some of these differences may rest in premorbid differences in metabolic rate. It makes intuitive sense that a person who finds it easy to lose weight would have a faster innate metabolism. Other reasons calorie needs may remain unusually high for a person even after weight restoration is the sheer amount of rebuilding the body needs to perform. Bulimia is violently destructive to the body, and I would never say differently. However, some of the damage done by anorexia is slightly different, and the body must rebuild and repair essentially every organ in the body. My psychiatrist told me that the nerves continue to repair themselves for up to two years after weight restoration. This can hardly be the only organ system taking a long time to recover.

How long hypermetabolism lasts will probably vary from person to person, and depends on how long you were sick, how your body responded to the damage from your eating disorder, your activity levels, among others. There's no real way to be sure. If your caloric needs are unusually high--even for hypermetabolism--you can have body composition analysis and resting energy expenditure testing done. Personally, I think this is best left to extreme cases since so many of us have a tendency to fixate on numbers.

I hope this helps explain hypermetabolism just a little bit. I can't answer every question, as it's been a long time since my college biochemistry days, but I can always look things up.

I first learned about hypermetabolism in my second treatment stint (first residential stay). Up until then, I didn't know that when you start eating again after a long period of starvation, your metabolism typically goes a little bonkers. This is some pretty useful information.

What I also didn't know was that your metabolism stays elevated long after weight restoration, making this time period even more fraught with difficulties and possibly contributing to the high levels of relapse. I think this is useful, necessary stuff that so many treatment providers don't mention because an eating disorder isn't about the food, or so they say. Except it does become about the food if you can't maintain your weight, or you start bingeing and purging, so I think it should be out there, in the open.

Which brings me to my point: my metabolism has once again skyrocketed. And I fundamentally don't like it.

Some of the discomfort is related to the eating disorder: feelings of guilt and shame at having to eat so much more than others, wondering whether I'm going to gain weight from this, thinking that it would be an awfully convenient way to drop a few pounds. Some of the discomfort isn't: I'm tired of the near-constant cooking and meal prep, of the obnoxious grocery bills, of constantly having to be thinking of food and eating.

How I have to approach food and eating right now is pretty much the polar opposite of how people in the US are "supposed" to think about food. Low fat is not a smart option for me, and when you need over 3000 calories to maintain your weight, "healthy" isn't so healthy anymore. I don't get to "eat whatever I want" because of my freaky metabolism- if I ate what I wanted, I can guarantee you it wouldn't be this much. Instead, I have to be careful and mindful and responsible and eat what my body needs.

I'm simply frustrated and exhausted. I second guess all of my food choices, all the time. Have I had enough protein? Too much fat? Too many calories? Am I eating too much in the morning, too much at night? Would a bigger breakfast help? Should I include more fruits and veggies? And when I go to buy food- what about the costs? Can I find item X cheaper? Should I spend money on supplements like Carnation Instant Breakfast? What about premium ice cream like Ben and Jerry's? What about everything I was told about how wasteful it was to buy Ben and Jerry's because it was so expensive? Should I ignore that?

I kind of want to bury my head in the sand for a while, and just let this pass.

Reading back over what I've written, it seems like a long "oh poor me!' whine. I don't know- maybe it is. I only wish eating were simpler, less fraught with the moral perils I've internalized. And I keep getting discouraged that there doesn't seem to be an end in sight.

As a science writer, a variety of press releases on the latest research--from physics to neuroscience--cross my desk each day. But when I saw a press release for the following article, I knew that media outlets around the world were going to have a field day:

Evidence of gender differences in the ability to inhibit brain activation elicited by food stimulation

More than the study, what interested me was how the subject was going to be twisted by desperate reporters the world over. They did not disappoint.

The study itself was based on PET scans of the brains of 23 "normal-weight" individuals who fasted and

then either focused on a favorite food or used a technique called cognitive inhibition to suppress thoughts of hunger and eating. When the subjects focused on their favorite food, the hunger and desire for food increased at a similar rate in both sexes, as shown in brain scans using positron emission tomography (PET). Although cognitive inhibition decreased hunger in both sexes, the technique significantly lowered desire for food only in men. PET brain scans showed that men using cognitive inhibition techniques showed a decrease in brain activation in the regions involved in emotional regulation, conditioning, and motivation. These regions are known to play a role in processing the conscious awareness of the drive to eat.
(from the original press release)*

The headlines, however, told a very different story. Some of the top ones?

Hunger Control: Women the Weaker Sex? (WebMD)
Why Saying No to Foods May Be Harder for Women (Washington Post)
The secret of successful dieting is in your gender (The Independent, UK)
Women Can’t Say No to Their Favourite Food! (eFlux Media)
Women No Good At Resisting Food Temptations: Study (E Canada Now)
Weak-willed women give in to food cravings (Healthcare Republic)
Why Men Are Better Dieters Than Women (Time)
Revealed: Why women find it so hard to diet (Marie Claire UK)

Appalling doesn't even begin to cover the implicit assumptions in the headlines (Women have out of control appetites that must be curbed! Women are weak! Women have no willpower!), nor do they really reflect the content in the paper. Scientific American had a pretty decent summary (and non-offensive headline!), and even looked at the study's limitations, such as a small number of subjects and that the subjects were not actually given the choice whether or not to eat- they were just asked to convince themselves they weren't hungry. And there are plenty of limitations of brain imaging studies, though they also yield fantastic information.

Blogger Sandy Szwarc of Junkfood Science has written several times on the dangers of science by press release. I don't think press releases are going to go away. Most newspapers don't have a science section and fewer still have any health reporters- the Washington Post doesn't. They borrow from other sections for their stories. And most writers don't have the time or expertise to plow through the thousands of research journals out there. However, they should know better than to parrot a study's grand claims without further investigations (wouldn't happen in any other field).

*The original press release isn't openly available online, but if you're really interested, I have a copy saved on my desktop. And please, for my privacy, if you know how I stumbled across this information, please don't mention it in the comments. I'm a professional science writer- 'nuff said.

This is a question I'm really beginning to grapple with: after so many years of anorexia, what do I do now?

The more important version of that question is: what do I want more than the eating disorder?

When I was ill, I couldn't imagine not being in the thrall of the eating disorder. It was simply impossible. Either I didn't realize I was ill, or I frankly liked being that way, or I found that being anorexic was preferable to not being anorexic. Don't get me wrong- anorexia was and is hell, but it also numbed the incredible and unmanageable anxiety that I had, and allowed me to push through the depression with the hopes that by tomorrow, I would have lost weight. It gave me a feeling of okay-ness that I had never felt before.

And it destroyed my life.

I realize that you will never be able to reconcile an eating disorder with life- an eating disorder is the fast track to death and disability. Life is so much more. The shitty stuff, yes, absolutely: the traffic jams, the stubbed toes, the paper cuts on knuckles (as I type with a Band-Aid on my ring finger), the losses and grief, the bankruptcy and foreclosures. I don't want this part. I really don't. I feel cheated, often, that life in recovery isn't great. I'm still fatigued, I still have trouble sleeping, I still have wild theories for self improvement that border on the self-destructive.

Some people say that recovery could otherwise be defined as "hope" or "life" or other warm fuzzy feeling. I like to think of recovery as "possibilities," all the things that are within your grasp now that you're not clinging to Ed.

And so on days like today, when the anorexia is screeching in my ear that I'm fat and dumb and worthless and oh, yes, fat, I have to ask myself: what do I want more than ED? What is worth more to me than the eating disorder?

I don't know that I have all the answers to that. I know that what can get me through the next five minutes, the next meal, is a promise I made to my kitty never to leave her again. Or my desire to travel. Or write another book.

I might not always embrace recovery with an effusion of enthusiasm, nor do I have to. Right now, I just need to hang on to the fact that there are better things in life than an eating disorder.

One of the first goals of recovery should be to reach and maintain your weight at your genetic set-point. What is your set point? It will differ for each person, based on their genetics, but it is the weight range (usually around 5 to 10 pounds) your body will maintain comfortably without any external input from you- that is, without calorie counting, food restricting, excessive exercise, or purging.

I think that many professionals buy into our fears over reaching our set-point weight and say that if you weigh X pounds, you'll be "healthy" because they're afraid you'll freak if you hear the truth. But if the truth is that you need to weigh X+5 or X+10 pounds in order to be "healthy," they're really condemning you to a life of illness and misery.

Our culture buys into it as well- they celebrate abnormally low weights. I saw in one of the tabloids that described--in depth!--the "unhealthy" ways in which stars dieted.* How many people are going to use these methods because of this article? And how many lives are being blunted, whether in years or in scope, because we can't accept that people come in all sorts of shapes and sizes?

The blog Treatment Notes had a recent post on Set Point and Weight Regulation, and there was a link to a simple explanation of the Set Point Theory. I was hooked from the first paragraph:

The Salmonella outbreak has been formally tied to a single plant producing peanut butter paste- more information can be found from the FDA and the CDC. No jars of peanut butter are effected, which is a good thing since I eat so much of the stuff! However, a wide variety of products potentially containing the peanut butter paste have been recalled.

The public health blog Effect Measure noted that NutriSystem diet bars had been affected by the recall, and had this to say about it:

"Meanwhile FDA is saying the Peanut Corporation of America's Blakely, Georgia processing plant is the source of the problem. Besides the pet food the plant makes cookies, crackers and ice cream, 125 products in all. The bug was found in unopened containers seeming to rule out post processing contamination. FDA expects more recalls. The latest is peanut butter granola bar in the NutriSystem product line. Salmonella infection would seem to be a pretty good way to lose weight, but I guess the company wants to earn its money the old fashioned way: by scamming you with advertising with the tiny letters at the bottom of the screen that say, 'results not typical.' "

Really? I couldn't have said it better myself.

I just got a brochure in the mail from my health insurance company today telling me about all of their "wellness" initiatives. Some of which--like smoking cessation--are no doubt a good thing. Yet all of this focus on wellness makes me feel more than just a bit uneasy, and I finally figured out why.

It's a way to blame the patient for their illness. Get the flu? Obviously you didn't wash your hands enough, stood by a sick person, didn't get the flu shot, etc. Now I'm not saying that washing your hands is bad- I do have OCD, after all. The same thing with cancer prevention: you didn't get your mammogram/colonoscopy/prostate exam frequently enough, you ate too much of the wrong foods, you didn't eat enough of the right foods, you didn't exercise enough, blah blah blah.

Promoting health is good, but the understanding that people are going to get sick anyways sort of gets lost in translation. Humans want to avoid bad things; it's good for the gene pool, if nothing else. I'm not saying that people should say screw it and ignore that rectal bleeding and inhale flu-laced sneezes. But even if you do everything "right," you still might get sick.

And even if you don't- even if you buck the advice and just try and live your life- and you still get sick, that's okay.

We can't prevent everything. In our zeal, I think we forget that. Even with eating disorders, 100% is essentially impossible. People will say that of course, we don't think we will ever have a world with no eating disorders. But then I see ads that say "Until eating disorders are history..." and I have to wonder.

Obesity gets the lion's share of "wellness" initiatives directed at it and is pretty much the most stigmatized medical condition I can think of. If you'd only eat fewer calories than you burn, you'd be thin. Right? Except it's a little more complicated than that. Instead of addition and subtraction, think path integrals.

Patients get blamed enough. Many medical professionals unwittingly assume that something you did led to you're being in their office. Maybe that's true, maybe it isn't. But no matter how much money we pour into "prevention" and "wellness" efforts, people are still going to get cancer, they're still going to get diabetes, and they're still going to be fat.

And you know what? That's okay.

...I'm at some other mighty fine places on the web.

I think finding out what websites people frequent (okay, if you're into those kind of websites...) gives you a little insight into who they are and what makes them tick. The same thing goes for music and books and even TV and movies.

Much of my non-work-related online reading is related to eating disorders and other mental health issues. I'm leaving these websites out of my list. Why? Most of you probably know them, and I think it's important to start constructing a life outside of the eating disorder.

So here are a few of my faves:

Cute critters (things that make you go awwww...)

Cute Overload
I Can Has Cheezburger?
The Daily Kitten
Funny Animal Videos

Things that make me laugh

Postcards from Yo Momma
Not Always Right
The Onion
Some Ecards

Things that make me think

Indexed
New York Times
Science Blogs
National Geographic News

Creativity

Make Zine
Etsy
E How
All Recipes
Recipe Zaar

Any must-visit websites? Share in the comments!

Evolutionary biologist Marlene Zuk wrote a great essay in today's New York Times titled "The evolutionary search for our perfect past," in which she focused on the fallacies of assuming that all of today's supposed health woes (specifically those many people relate, accurately or not, to nutrition and obesity) would be remedied by our Pleistocene past.

But the difficulty with using our hunter-gatherer selves as icons of well-being goes much deeper. It is not as if we finally achieved harmony with our environment during the Pleistocene, heaved a sigh of relief and stopped.

In fact, Pleistocene humans might not have been any more in sync with their environment than we were, as the mass extinction of large mammals (megafauna) in both North America and Australia coincided with the arrival of humans.

Nor were all so-called "caveman" diets identical. Zuk points out that the relative ratio of meat to plants varied depending on local resources, making such books as "NeanderThin" all that much more ridiculous. A recent discussion on Shapely Prose further elaborates on this assumption that cave-people were somehow the epitome of thinness and health.

Concludes Zuk:

Instead, evolution lurches along, with successive generations sometimes unchanged, sometimes better suited to their surroundings in some ways but not others. At any one point, adaptations take place: individuals who can endure heat or cold or famine leave more offspring than their less hardy counterparts. But there is no one point when one can say, “Voilà! Finished.”

...We have never been a seamless match with the environment. Instead, our adaptation is more like a broken zipper, with some teeth that align and others that gape apart. The paleontologist Neal Shubin points out that our inner fish constrains the human body’s performance and health, because adaptations that arose in one environment bedevil us in another. Hiccups, hernias and hemorrhoids are all caused by an imperfect transfer of anatomical technology from our fish ancestors.

This isn’t to say that we wouldn’t be better off eating fewer processed foods. And certainly we have health concerns that never struck our ancestors. But we shouldn’t flagellate ourselves for having modern bodies, and we shouldn’t assume that tweaking our diets or our posture will rescue us from all our current ills. That’s just a paleofantasy about the future.

Our bodies are naturally imperfect; evolution works with what exists and builds on it*. Perfect health and immortality are pipe dreams and not rooted in reality. Our bodies are amazing things, no doubt about it, but perfection ain't possible.

*As a staunch evolutionist and anti-creationist/anti-intelligent design-ist, I think this is some of the most powerful evidence we have for evolution- the lack of perfection.

Okay, so I'm going to use a Western metaphor for a literal Hindu belief, that was inspired by a recent post from the blog On Simplicity.

We all have sacred cows—those rules, guidelines, and things that we feel are immutable and untouchable, writes blog author Sara. I’m of the opinion that some things really are sacred, but they’re few and far between. Most of things we’re “supposed” to do are really quite optional.

An eating disorder kind of requires many sacred cows- rules that cannot be broken no matter how inane or inconvenient, concepts and delusions held tight by the sufferer that no one else can quite understand. One of my sacred cows has to do with calories, which for an eating disorder, really isn't surprising. However, you throw in a large pinch of OCD and you have my problem: foods need to have a "nice" number of calories. Despite my math major and smashing ability at mental arithmetic, my food needs to come in increments of 25, 50, 75 or 100. And numbers that end in 50 and 100 are far better than those that end in 25 or 75.

So when I discover that the Eggo waffles I want to buy have calories that look like X+10, I kind of have a meltdown in the freezer aisle. Thermodynamics be damned- it is possible. Yes, I bought the Eggos, largely because I knew that the 90 calorie yogurts I had in the fridge would not only make a nice topping, but also make the waffles into a "nice" number and the world would be well.

Yep. Sacred cow.

It's really a pain in the ass, and even I know this. I know it's not rational, I know those extra 10 calories aren't going to appear on my thighs in all of their waffle-y goodness and make the crazy guy next to me on the Metro squirt some syrup on me (I've seen stranger things happen).

There are other rules, of course. I have a specific breakfast I eat pretty much every day. I might mix things up and have blueberries or an apple instead of my banana, but otherwise? I eat the same breakfast everyday. And I'm pretty okay with that. Part of it is liking the breakfast, and that it's easy to prepare in less than 5 minutes when you're 90% comatose. Part of it, thought, is the rituals and rigidity that's a part of the disorder. I'm working with my therapist not to stop eating that breakfast for good, because that's not the point. I want to be able to eat a different breakfast if I choose and be okay with that.

Eating breakfast is a sacred cow that must stay. Skipping meals is bad. I've learned a few things in my recovery and that is probably the top one. But what I have for breakfast- whether it's my standard fare, my X+10 calorie waffles, or something completely different, can't be so stinking sacred.

Eating disorder research is made especially difficult due to the large number of patients who prematurely drop out of treatment (which is examined in depth here). Sometimes, this happens in such numbers that the studies are, essentially, invalid. This is also why studies of eating disorders in adolescents are much more successful than those in adults: parents can usually (but not always) be called upon to insist that their child receive care, even when the child isn't exactly enthusiastic about the whole idea.

Some researchers asked "What happened to the ones who dropped out?"* They didn't necessarily look at why people dropped out, but what happened in terms of treatment outcome. In other words, despite not participating in the study, how have these people fared?

No significant differences were found between groups at follow-up, except for more treatment dissatisfaction reported among dropouts. When patterns of change were examined between groups, patients who completed treatment were found to have made significantly greater changes (less eating disorder symptoms, less psychological problems and more positive self-image) compared to dropouts.

What I couldn't find out was whether these people obtained non-study-related treatment, nor if the treatment in the study produced clinically meaningful changes. I think these are two quite major variables, although it doesn't necessarily take away from my conclusion.

The moral of the story here is that we really don't know a whole lot about how to treat eating disorders in adults. Because if people getting treatment essentially look the same as those not getting treatment, then what does this say about the treatments?

*Which can be performed to the tune of "Beauty School Dropout" from Grease for extra bonus points. At least, that's what I'm humming right now...

The number of "cosmetic" procedures among American teens continues to rise, with more and more teens seeking surgical solutions to self-esteem problems.

To the rigors of teenage grooming — waxing, plucking, body training and skin care regimens that were once the province of adults — add cosmetic surgery, which is fast becoming a mainstream option among teenagers. But with this popularity, some experts are concerned that the underlying motivation for many of the young people seeking surgery — namely, self-esteem — is being disregarded in the drive to look, as Kristen puts it, “normal.”

The stereotype of someone suffering from Body Dysmorphic Disorder (BDD) is a vain, plastic surgery addict. Which, of course, is precisely as false as the stereotype of a person with an eating disorder as vain and vapid. Yet the increase in plastic surgery, paralleling the increase in teenage dieting, opens the doors to some of the issues that might led to the development of these disorders.

Obviously, the social phenomena surrounding both BDD and EDs are important. A constant emphasis on appearance can make you uncertain and more than a little paranoid, which can spark the body-related obsessions of BDD. A pressure to be "thin" and "healthy" can make a young person look at his/her food intake more carefully and make some innocent-seeming changes that result in a trip down the rabbit hole of an ED.

Although these are certainly triggers for the development of these disorders, they aren't a cause. The evidence is pretty clear that both disorders are rooted firmly in biology. They play out on a social stage, with social and environmental cues as to how symptoms are interpreted. But BDD is more than just an attempt to "look good." The article didn't address BDD specifically, but I think it's important to take a good, hard look at these phenomena and how they might be affecting people, and how they might serve as a disguise for a full-blown disorder. Perhaps lesser discussed, how these phenomena serve to perpetuate the disordered thinking.

I think we all need to take a good, hard look at the values we're passing on to kids.

Want to learn more about eating disorders? Although the internet has some splendidly horrific resources, solid science-based information also exists. Here are a few of my favorites:

Podcasts from the Yale University Rudd Center for Food Policy and Obesity

Okay, many of these are standard obesity-prevention fare. However, there are one or two that are really interesting:

"Rethinking Thin" by Gina Kolata (based on her recent book)

"How News is Made" by Cole Kazdin

"Relation of Obesity to Disturbances in Reward from Food Instake and Anticipated Intake: An fMRI Study" by Eric Stice (I don't always agree with him, but he's a good scientist and has some interesting ideas)

And if you look in iTunes, you can find a free podcast from Kelly Brownell and Tim Walsh called "The Rudd Report: Eating Disorders and Obesity". Just search for "Rudd Report" in the iTunes store and you can download it for free, as this one doesn't appear to be on the website.

(h/t to Ai Lu for alerting me to these!)

Video Seminars from the Centre for Eating and Dieting Disorders

There are numerous video seminars on this Australian site available for free- I haven't watched all of them, but the ones I have seen are quite good.

Videos from Maudsley Parents

Maudsley Parents is an organization of parents in favor of evidence-based treatments for eating disorders, and as part of their outreach efforts have produced several lovely videos, all of which are top notch. These include:

• Family Based Treatment for Anorexia Nervosa
• Family Based Treatment for Bulimia Nervosa
• Eating Disorder Research: Information for Families (with Cynthia Bulik)
• Eating Disorders in Adolescents (with Daniel LeGrange)
• Brain Imaging and Eating Disorders (with Walter Kaye)
• Fighting Stigma with Science (with Cynthia Bulik)

Time Magazine has a really good article out called "The Mystery of Borderline Personality Disorder," and it explores the intricacies of this poorly understood illness.

There does appear to be some overlap between many of the personality traits of Borderline Personality Disorder (BPD) and people with binge/purge behaviors. Some clinicians freely make the BPD diagnosis, which may or may not be ultimately true. While a person is malnourished and engaging in ED behaviors, it's impossible to tell which actions are driven by a starved brain and which by BPD.

Regardless, one of the key therapies for BPD--indeed, the only evidence-based treatment for the illness--is now being used to help treat eating disorders. Dialectical Behavioral Therapy is based on four core modules: mindfulness, emotion regulation, interpersonal effectiveness, and distress tolerance. While the evidence base is pretty strong for DBT as a treatment for BPD, it is growing for eating disorders. Indeed, many residential treatment centers incorporate DBT into their treatment programs (more or less).

The article is very well written and non-judgemental, and I love seeing how science is opening people's eyes to both the illness itself and into possible treatments. But the best part of the article is a quote from Marsha Linehan, the developer of DBT- a quote I wish was just as embraced by the ED world:

It's important to note that Linehan doesn't just practice tough love with her patients; she also tells them she knows they are hurting and doing the best they can. She emphasizes that she believes in them even though many therapists have tossed them aside. "Clients cannot fail," she says. "But both treatment and a therapist can fail."
(emphasis mine)

On my last post about my upcoming series on the biology of EDs, Susie asked this:

i'd certainly be interested in medical complications. you never know, i may read something that shocks/scares me into gaining weight.

To be honest (and bluntness is a character fault of mine, so I do apologize if I sound harsh), there are two answers to your question. The short answer and the long answer.

The short answer? Nothing will scare you into gaining weight.

The long answer? Unfortunately, the more you read, the more convinced you become that you can escape the consequences. Or, for me, the longer I was sick, the more I began to experience these medical consequences. And so where I was originally faced with a list of problems A through F that could arise from my ED behaviors, I found that A, B, and C had happened and I had lived to tell the tale. Ergo, I wasn't that sick. So D, E, and F really couldn't be that big of a deal. Then D, E, and F happened and I was still sick and unable to see that I was sick and then I learned about G and H.

You get the drift.

The fact that you have an eating disorder prevents you from understanding the full extent of your illness. It's called anosognosia- a lack of insight into illness. It's not a character flaw, it's just the way starvation monkeys with the brain.

Furthermore, fear doesn't change behavior. It just doesn't. Lasting behavior change really needs positive reinforcement, not negative. Because if fear worked, there would be a lot fewer smokers in the world. And the obesity hysteria certainly has people all worked up over the possible dangers of fat- yet most people tend to weigh about the same. Heroin addicts shoot up despite risks of HIV and Hepatitis C. People gamble knowing they could lose their house.

There are many positive reasons to get into recovery. But your brain needs to heal from malnutrition first, before you can really focus on that. Right now, when you're underweight, you're like a heroin addict, high as a freaking kite. You need to detox (ie, gain back to a healthy weight), and then you can try to find positive ways to stay healthy.

Find someone to help coach you back to a healthy weight. Reading about the medical complications that can happen if you don't probably won't help, though.

I have a number of fancy tricks of my sleeve, some of which actually have a chance of coming to fruition. In the meantime, I've been starting work on a new blog series on the biology of EDs. Most people don't get the up-to-date information when they're diagnosed, and it's hard to ultimately understand and take charge of your illness if you don't know what's really going on. Some of the good research is publicised in the wider media; however, these results are piecemeal, the incremental building of science. This is how research is- it's just the nature of the beast.

In this series, I want to look at things like differences in neurochemistry, genetic predispositions, medical complications, why people get sick, how they stay sick, and how to get better. I will weave together all of these piecemeal findings into something approximating the knowledge you need.

I'm hoping to post a new article once or twice a week- I'd like to do it more regularly, but those little tricks up my sleeve are going to likely suck up much of my free time.

In the meantime, sit back and enjoy. And feel free to post any subject you'd like to see covered in the "comments" section, or drop me an email at carrie and then the little at sign thing, followed by edbites and then a period and then com.

If you (or a loved one) have been diagnosed with an eating disorder, the medical horror stories are almost inevitable. I'm not necessarily talking about the harrowing close calls with death. I'm talking about the idiocy that only someone with a medical degree can command.

Some of my personal favorites:

"You can't be anorexic- you're not wearing enough clothes!"
"So your mother was pretty controlling, huh?" (Psychology PhD)
"You don't have anorexia- you just have a thyroid problem." (I was less than 70% IBW at this point)
"Aren't you a little old for this nonsense?"
"I wish I had your problem!"

And a study out of the UK looking at how physicians' attitudes affect their treatment of ED patients has just quantified the degree of ignorance on eating disorders by GPs (or PCPs in the US). While virtually everyone knew that weight loss was a cardinal feature of anorexia--pat yourselves on the back for a job well done!--far fewer understood the other, equally important, features of anorexia. Over half of all GPs thought the diagnostic criteria for AN meant a BMI of 16.0 or lower, but less than 40% knew to look for amenorrhea.

Basically all of the GPs knew about the possible complications of osteoporosis, and to test for hyponatremia and hypokalemia with vomiting/laxative abuse. But fewer than half knew about the cerebral and neuromuscular changes that accompanied AN, and only one-third knew about the possibilities of delayed gastric emptying for both AN and BN. Furthermore, most GPs overestimated the prevalence of AN but underestimated the prevalence of BN.

The utter shocker? Only one-third would refer to a specialist eating disorder service. Okay, yes, this is the UK and I'm not super familiar with the ins and outs of the system. What disturbs me isn't just the lack of knowledge from the GPs; it's that they think they are, in fact, knowledgeable.

The majority of GPs agreed with these two statements:

Patients with this condition are largely responsible for their own condition.
Patients can do a lot to control these symptoms.

Though anyone who has lived with an eating disordered person can testify to the fact that their behaviors are very much out of the sufferer's control. Hence the name disorder.

Yet none of the attitudes about eating disorders were correlated whatsoever with the knowledge about these conditions. The study's authors pointed out that this could be good, because a lack of knowledge didn't result in stigma. But if this means that patients are being left to fend for themselves not just because of a lack of resources but because the GP things the patient really can handle it herself, then this might not be such a good thing.

This study really just left me feeling astonished that these ignorant comments and general idiocy from medical professionals really wasn't more common. Sigh.

Life is just so...daily. I wake up, smack the snooze button a few times, go to work, come home, cook dinner, do stuff, go to bed. And most people's lives aren't a whole lot more exciting. Recovery is such a monumental task that it's easy to start putting things off. Some of the things I'm postponing are necessary- do I really want to take a trip when there's a chance Ed might join me? But recovery is a part of life, and to do that with everything would only make our work so much harder.

I found these tips for simple ways to start enjoying today on the blog On Simplicity:

• Spend a few extra minutes in bed today, luxuriating in the warmth of slept-in sheets.
• Eat breakfast without multi-tasking. Enjoy the sight, smell, and taste of your food.
• Play a song that gets you revved up before you start your day. Repeat as many times as you need. (”Here I Go Again” by Whitesnake is my embarrassingly regular go-to song. I get to feel like a bad-ass and complete dork at the same time. Sweet!)
• Stop saying, “I’ll be happy when…” You don’t need security, true love, prestige, or good taste to be happy. Food, safety, and a good sense of humor will get you through in a pinch.
• When you step out the door for the first time, take 10 seconds to really notice your surroundings. Drink them in without judging. (Even if, like me, you live uncomfortably close to cow pastures…)
• Remember how badly you wanted to be an adult so that you could live life by your own rules? Enjoy the fact that, for the most part, you get to make your own decisions today.
• Say “hi” to your coworkers instead of brushing by them. Ditto for family members.
• Celebrate inconsequential victories just for the fun of it. Didn’t burn dinner? You clearly rock.
• Leave a kind note for someone to find. Your spouse, child, or janitor will appreciate it, and you’ll probably feel better as well.
• Stop waiting for someone else’s approval. If you like where you’re at (or simply where you’re headed), that’s good enough.
• Check your progress on your larger goals. The steps you take to get there can be the best part.
• Give in to a craving! Nearly everything is okay in moderation.
• Find five minutes to sit back and just breathe. Close your eyes and let your concerns take a backseat for just a few moments. Remember that even high priorities are rarely as urgent as our adrenaline tells us they are.
• Smile for absolutely no reason. You’re alive; that’s a pretty damn good excuse.
• Slip into a pair of comfy socks.
• Set aside 15+ minutes for something that’s purely fun. Not all hobbies need to have a purpose or redeeming value. Remind yourself that’s it okay to just have fun.

The Pentagon has decided not to award the Purple Heart to soldiers who had developed PTSD as a result of their combat experiences.

Their reasoning?

PTSD is "not a physical wound." The New York Times article goes on to say that "...a Pentagon advisory group decided against the award because, it said, the condition had not been intentionally caused by enemy action, like a bomb or bullet, and because it remained difficult to diagnose and quantify."

Other soldiers and Pentagon officials expressed concerns that people could fake PTSD symptoms to obtain the award, or that expanding the medal to psychological concerns would "debase" the honor.

To me, this just exemplifies our society's confusion about what mental illness really is, and what causes it. PTSD causes physical and structural changes to the brain- just because the symptoms are changes in behavior doesn't mean that the problem doesn't have a physical basis. People with amputated legs may have Phantom Limb Syndrome, but because you can physically see the lost limbs, it's somehow more real than PTSD.

Military officials can--and will--award the medal how they see fit. Their conditions are their conditions, and there's not much I can do about that. But whatever they say, PTSD is as real and physical as a bullet wound.

Anorexia nervosa is a very destructive disease. If it doesn't kill you, it often makes you wish it has. It destroys you- mind, body, and spirit.

So how on Earth could anorexia serve an adaptive function? It's a deadly disease. Except that certain traits of anorexia could be adaptive, if you think of humans as hunter-gatherers, nomads collecting roots and berries and the occasional auroch.

At the risk of overgeneralizing, people with anorexia have an easier time avoiding food than other people, withstand starvation better, and are hyperactive (especially during the acute phase of illness). In a time and place where food isn't a guarantee, these things can be beneficial to the human species as a whole.

In her "Adapted to Flee Famine" hypothesis, psychologist Shan Guisinger writes that these "distinctive symptoms" of anorexia nervosa are

likely to be evolved adaptive mechanisms that facilitated ancestral nomadic foragers leaving depleted environments; genetically susceptible individuals who lose too much weight may trigger these archaic adaptations. This hypothesis accounts for the occurrence of AN-like syndromes in both humans and animals and is consistent with changes observed in the physiology, cognitions, and behavior of patients with AN.

(The entire paper is about 17 pages, but well worth the read)

A new paper out in the Annals of the New York Academy of Sciences takes an evolutionary look specifically at the overactivity aspect of this trio of symptoms. CP Arun writes

Some patients with AN exhibit overactivity that can worsen their state of malnutrition. Employing an evolutionary psychiatry line of inquiry, we propose that rigidity of thinking and overactivity are behavioral phenotypic changes in AN patients that are normal to tree-dwelling mammals, such as monkeys. Such behavior can lead to good functioning as ballet dancers and athletes but lead to certain disadvantages in other areas of modern life. The overactivity in AN, though under conscious control may be neurobehavioral and driven subconsciously by disordered cerebral neuropsychopharmacology.

Though I might debate exactly how much "conscious control" a sufferer has, seeing these traits as potentially adaptive at another time and place helps me take a little bit of the mystery out of this illness.

Considering how many people who have New Year's resolutions to lose weight, there's something else they might lose: a super-healthy immune system. New research has found that dieters are less able to fight off the influenza virus. A news article from the BBC said that

The team at Michigan State University found even though the mice on the lower calorie diet received adequate amounts of vitamins and minerals, their bodies were still not able to produce the number of killer cells needed to fight an infection.

As well as being more likely to die from the virus, the mice - which were consuming around 40% of the calories given to their counterparts on a normal diet - took longer to recover, lost more weight and displayed other symptoms of poor health.

"Our research shows that having a body ready to fight a virus will lead to a faster recovery and less-severe effects than if it is calorically restricted," said study author Professor Elizabeth Gardner.

As fillyjonk over at Shapely Prose noted (h/t to her for posting the original BBC story), you don't get to chose where you restrict calories from. You can't just pick your arms or your ass- in fact, the needed calories are just as likely to come from your heart, your liver, or your immune system. Yes, your butt might shrink. And so might your brain. Your body ain't picky.

Dieting is starving your body. Period. And your body doesn't like that and can communicate it in the form of a decreased abilityto fight influenza. Payback's a bitch, huh?

Does anyone else find it interesting that this story wasn't plastered all over the internet like practically every other dieting story out there? I'm not surprised.

I was reading a story about a person with anxiety/panic disorder, who told of her relief upon diagnosis. "What I had was real," she said. "It wasn't just all in my head!"

Although her problem was real, it was also in her head. She had a mental illness- where else could it have come from? But this got me to thinking about the assumption behind something being "all in your head," and that you are thusly making things up. While many people (and their doctors) might misattribute symptoms, few out-and-out make them up. Yet when presented with something baffling and frightening, it's much easier for someone to think that a person is just making this up than to understand it for what it is: a brain disease.

I felt enormous relief when I was diagnosed with OCD in college. The obsessions terrified me, and the compulsions left me exhausted and in despair. I was both relieved and reassured to learn that my problem had a name, and there was a treatment for it. Yet this, too, was "all in my head" in the most literal sense. Not that I was making things up--my symptoms were very real--but that I had a mental illness.

This phrase always grated on me, and now that I think about it, I'm realizing why. It's that a mental illness is somehow not real, or at least less real than another illness of another body part. I mean, brain cancer is "all in your head," so is Alzheimer's disease. But even when people believed my depression symptoms, there was often a pull-yourself-up-by-your-bootstraps attitude. I was making things out to be worse than they really were, if I just tried harder (which, as anyone who has been depressed will know, is just so simple, right? Ha!) then I wouldn't feel so bad.

When my paternal grandmother was diagnosed with Alzheimer's disease about 15 or so years ago, I don't think anyone in our family told her, "Oh, you're just not trying hard enough to remember things!" Yet her illness was as much in her head as mine were.

Obviously, environmental factors are important in any illness. But a real physiological definition of mental illness is so important because they aren't treated on par with other brain diseases by either society or the medical world. I don't know that mental illness has a chance until we have a better understanding of what causes them and, to a lesser extent, how to treat them.

All in your head might not mean you're making your symptoms and feelings up- it could just mean that you have a brain disease. And that's okay.

Bullfighting is a very unfair sport. Despite the fact that you have a very large animal with very big horns that can give you a very large injury, the matadors (literally Spanish for "killer") have swords and a hell of a lot more intelligence than the bull. And if I was stuck in a ring and could be the bull or the matador, I'd be the bullfighter, let's put it that way.

These high-speed photographs will really mess with your perceptions of reality:

http://www.smashingmagazine.com/2008/11/02/when-time-freezes-50-beautiful-examples-of-freeze-photography/

It really drove home how little of "reality" we really see, and how so many of our perceptions are based on such a tiny snippet of what is really "real."