My body has been freakishly tired lately, and last night I did something very unusual for me: I went to bed early. I was in bed at 10:30, and asleep by 11. Not only that, I didn't wake up until 10:15 this morning. I slept right through the night. Well, Aria woke me up once climbing all over my pillows and such, but otherwise, I slept right through the night.

And to top it all off, I took another nap this afternoon for about an hour and a half.

Even though a part of me knows I needed the rest, most of me feels pretty guilty. My apartment needs to be picked up. I have another tasks that should be accomplished one of these days. Instead, I slept.

Yes, I know, I will probably be more efficient at these tasks now that I am rested. I get that. But I also get that this is not rational, so rationalizing things with me probably isn't going to be all that effective. Like my old high school history teacher said: if you didn't reason your way into it, I can't reason you out of it.

I have had issues with sleep way before my food issues cropped up. One of my college friends called it, jokingly, "sleep anorexia," and I think there's some truth to that. The deliberate lack of sleep was due, in that case as well, to OCD. I was compulsively studying.

It sounds odd, right? I had all As for the semester (as always- I've never once gotten a B+. You'll know if I do because the world will stop and you will hear a sound something akin to Edvard Munch's "The Scream."), but I was absolutely petrified that there would be a question on a test that I wouldn't be able to answer. So I studied for hours each day. I had to log over 40 hours a week. Yes, I kept track. This was also independent of class and lab time (over 20 hours) and a part time job (over 20 hours). I color coded my notes, copying them out perfectly. One mistake and I had to chuck the page and start over. I memorized chunks of my biochem textbook. For a calc exam, I had to re-do every homework problem until I could do it--you guessed it!--perfectly.

I was a miserable anxious mess.

Lots of people pride themselves on being the most stressed, or being able to go with the least sleep. There's an appeal there, a sort of I-have-more-guts-than-you kind of thing. A willpower kind of thing.

Now, I don't want a job that will force me to work long hours. Partly, I don't want to give up my routine, I don't want to have to eat out all the time because I'm never home to cook, and I don't want to be too busy to exercise like I do. I also do my freelance writing and blogging and Etsy stuff in the evenings, so maybe it really isn't all that different. But all of that work has just lost its appeal. For all of the 11 years of education I've had since middle school, I worked myself to the bone.

Yet I can't shake those last vestiges of that thinking- the idea that I need to be productive, that I'm lazy if I let myself sleep. I don't know if there's a solution. I think I need to simply be more like Aria, who I can guarantee doesn't feel guilty for eating OR sleeping!

The more I read, and the more I think, the more I'm becoming aware that the things I'm striving towards in recovery--a normalized, healthy relationship with food--don't exactly exist in our culture. Sure, they exist here and there, the occasional glimpse that temporarily restores my faith in the idea that such a thing is even possible.

But then I read articles that talk about Frito-Lay's new ad campaign geared at women,* I pause and begin to doubt that I have a chance.

Though Frito-Lay had often tried advertising snacks as guilt-free, this led to the conclusion that “we’re not going to alleviate her guilt,” Ms. Nykoliation said. “This is something in her life. So the question for us was, how do we not trip her guilt?”

Part of the strategy was to follow the success of SunChips by toning down the packaging and showing off healthy ingredients in the snacks.

“She wants a reminder that she’s eating something better for her,” Mr. Jones said.

So basically, the new premise in food advertising is this: our foods will make you feel less guilty for eating. What's next: an oxygen tank to make you feel less guilty for breathing? A toilet that makes you feel less guilty for taking a leak? What this tells me is that people (women in particular, since this is the segment of the population at whom the campaign is directed) are expected to feel guilty about eating. It's standard. Normal.

This has literally become normalized eating- and it's not my goal. I've lived this life for too long, and it SUCKS.

Jezebel had this to say about the new Fling candy bar, marketed as a low-calorie (well, lower anyway) indulgence, just for women. And in case you missed the girlie stuff, the package is pink and the bar contains sparkles**.

What the candy companies don't quite understand is that for those of us who truly love candy, we don't see it as gender-specific. And for every bar like the "Fling," which CandyAddict.com described as "a wanna-be Twix, minus the caramel," that arrives, the idea that candy is something women should feel guilty or careful about is perpetuated, leading to a public perception that some things are "bad" and "good" for women to eat. It's already happened with frozen dinners: you never see a man sitting down to eat a Lean Cuisine in a commercial; the men are always marketed a Hungry Man dinner, complete with "one pound of food!"

Even kids are being sucked into this madness, as highlighted by a wonderful NY Times article today titled "What's eating our kids? Fears about 'bad' foods," featuring our very own Laura Collins. With the health and obesity hysteria that's being promulgated just about, well, everywhere, kids are picking up on the messages and some of them take it to extremes.

Part of it has to do with cognitive maturity: young kids think in black and white. They haven't yet developed the brain functioning to discern between shades of gray. The other part has to do with the way some kids' brains are wired. Some kids will obsess about every detail, fearful of doing something "wrong," of being "unhealthy." Because unhealthy and fat are bad.

“We’re seeing a lot of anxiety in these kids,” said Cynthia Bulik, the director of the eating disorders program at the University of North Carolina at Chapel Hill. “They go to birthday parties, and if it’s not a granola cake they feel like they can’t eat it. The culture has led both them and their parents to take the public health messages to an extreme.”

On a side note, the article does an excellent job looking at orthorexia, and whether it's a type of obsessive-compulsive disorder, or it's an eating disorder.

We've truly lost our grip on what's healthy. I would easily argue that a steady diet of fast food isn't healthy- you're missing fruits and vegetables that are very tasty and have lots of good vitamins and minerals. I'm not saying Ho-Ho's for breakfast every day. But jeez, if you wake up with a hankering for cold pizza and chocolate milk, remember, it's just food.

From Jezebel again (a different article this time, on servers being conspiratorial about dessert):

I choose to believe it's of a piece with the unhealthy relationship our society has cultivated between women and food, where matter-of-fact enjoyment has no place at the dining table. This is not the fault of any server - most of whom are not even guilty of conspiring - but rather of centuries of creepy marketing, a pernicious diet industry, and six seasons of Sex and the City. In answer to your question, yes, I will have that piece of pie. A la mode. And without a side of knowing winks.

Eating is not a crime. It's not a moral issue. It's normal. It's enjoyable. It just is.

*h/t Sarah for the link
**Okay, ew? Sparkles? Really? It might be safe and all, but still...
***But I bet I could get a 10 year old boy to try it and check to see if his poo is sparkly later.

Here's some sage advice from the mother of a teen with an eating disorder:

A label is a number and a set of washing instructions - not a judgement, a way of life or a measure of worth.

I think that ED Awareness Week tends to focus overmuch on body image and media and everything, to the detriment of other aspects that I think people could use awareness about. That being said, body image does play a role in eating disorders, and clothes shopping can be a minefield.

Sizes aren't consistent from store to store, brand to brand, or item to item. It makes no sense, but it's true. And when your obsessions cause you to fear the size of clothing you wear, the random fluctuations really mess with your head.

Part of recovery is learning how to deal with this. I've gotten better. I think it helps somewhat that I never cared much about clothes and style and still don't, as there's a bit less unlearning to do. It also helps that most of my friends don't care, nor do they think discussing the minutiae of how a particular pair of pants fit is an appropriate topic for conversation.

That our society considers size a moral issue doesn't cause eating disorders. It sure as hell triggers them, though, and it most definitely makes recovery a lot harder. There's power when you start refusing you buy into that nonsense, when a pair of pants is really just a pair of pants.

...but the byline was better.

Check it, kids: the Washington Post actually let me write for them. I convinced them to run a special article for Eating Disorders Awareness Week, on using Maudsley Family-Based Treatment.

Extreme Measures: A Girl's Suffering Drove Her Parents to Explore New Treatment

A special thank you to all those who let me interview them and shared their stories.

Most anyone who reads this blog knows I am a huge fan of metaphor. I even have a whole category of posts tagged "metaphor."

One thing I don't believe, however, is that an eating disorder is a metaphor, or even that it has any particular meaning.

Let me clarify: our lives can have meaning- the meaning that we ascribe to them. And an eating disorder is part of my life, and if you're reading this blog, then I'm guessing it's part of yours, too. But my eating disorder has no, real independent meaning. It says nothing about me or my life except for my possible genetic background and the fact that I once lost a little weight and fell into the hellhole of anorexia. I don't find a meaning to cancer, or depression, or diabetes or any of that.

Nor am I saying that a sufferer's experiences aren't important. They are. They very much are. The experience of an eating disorder does not render a person's opinion on treatment and society and recovery irrelevant. Yet these experiences are also very much shaped by the philosophies of caregivers and clinicians.

So I was very intrigued when I saw two papers published this week about women's experiences with eating disorders. One, titled "Anorexia Nervosa's Meaning to Patients: A Qualitative Synthesis" was fairly inconclusive, although the premise was interesting. The authors undertook the meta-analysis "to provide insight into the patient's experience as a means to help clinicians recognize symptoms of anorexia nervosa." I fully support helping clinicians better recognize eating disorders in their early stages, especially since most patients' inability to understand that they are ill tends to hinder diagnosis. I'd be curious to see their exact reasoning.

The second paper, titled "Understanding women's experiences of developing an eating disorder and recovering: a life-history approach" simply made me cringe.

The development of the condition was attributed to a lack of control, a sense of non-connectedness to family and peers and extreme conflict with significant others. Recovery occurred when the women re-engaged with life, developed skills necessary for conflict resolution and rediscovered their sense of self. Rather than viewing the development of, and recovery from an eating disorder as separate and discrete events, the data from the life-history interviews suggest they are better viewed as one entity - that is, the journey of an individual attempting to discover and develop their sense of self. This perspective challenges some current constructs of eating disorders; it is not a condition in and of itself but a symptom of deeper issues that if addressed, when the individual is 'ready' to make that choice, will lead to recovery.

However, perhaps the increased connectedness is a symptom of improving health and not a means of improving health. Nor is an eating disorder a symptom of anything. Anorexia is not part of a journey of self-discovery, even if some self-discovery occurs during recovery. It's an illness. Period.

I don't think my eating disorder developed because I felt out of control (though that might have been true) or that I felt disconnected from people and society (though I always have) or even that I lacked a strong sense of self (I never really gave this one much thought and frankly still don't). My deeper issues? Only strange neurochemistry and a predilection towards anxiety. No, my eating disorder was more like being dealt a bad hand at cards, a hand I didn't know any better than to play. It wasn't in any supernatural being's Plan For My Life. I don't find my eating disorder to have any sense of worth in my life. My recovery is valuable because it's helping me learn to live again, and I am trying to give my recovery some sense of meaning through all of the blogging and writing and advocacy that I do.

I guess I just fundamentally don't understand the navel gazing that people do about the meaning of anorexia. Perhaps it's because I don't look at the illness as a social construct. And it probably don't help that I find no particular meaning in my own experiences.

But a focus on the meaning of an eating disorder seems somehow...meaningless.

Everyone in the Metro DC area: come meet me (if you haven't already!) tomorrow at a talk given by Laura Collins of the advocacy group FEAST out in Warrenton, VA. I'll be introducing Laura, who will give a presentation on eating disorders, followed by cookies and punch. More information is here.

It starts at 3pm at the Warrenton campus of Lord Fairfax Community College in room 203. An interactive map is below.

Hope to see you there!


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It sounds contradictory- hope for a better future can be detrimental to the cause. An interesting essay in the journal The Ecologist by two environmental researchers posed the idea that hope for a better future may be the wrong reason to promote sustainable living. Rather, they propose, people should live sustainably simply because it is the right thing to do.


Much of the research on the environment is dire, they say, which can reduce people's commitment to living green. What's the point? people might think. "Instead of hope, we need to provide young people with reasons to live sustainably that are rational and effective," the authors say. "We need to lift up examples of sustainable living motivated by virtue more than by a dubious belief that such actions will avert environmental disaster."


Of course, I immediately thought of eating disorders treatment. I don't think that we should totally abandon hope, not by a long shot. But I don't think hope is enough.

So much of what I was told during treatment was contradictory. The chances that I would relapse were high, but I had to stay hopeful that I would make it. I focused on "issues" in therapy even as what remained of my health went down the toilet. Literally. It's hard to stay hopeful when you can practically feel yourself dying a little more each day.

What I really needed was a specific plan for recovery, which I finally got thanks to a helpful therapist and dietitian who could see through the ED bullshit. That plan didn't rely on hope. It relied on three meals and two snacks every day. It relied on love. It relied on science.

And it was this plan that finally gave me hope. I'm not always good at feeling it, to be sure. I am afraid of hope, having seen too many predictions not come true. But there is always that possibility, born of a plan.

Much of my first several years in therapy for my eating disorder was spent looking at how my family was messed up. The assumption from every professional that I talked to was twofold: first, that my family was, in fact, messed up and two, that the messed-up-ness preceded the eating disorder.

My family has issues. What family doesn't? But those issues tend to be amplified when you have a child with a life-threatening illness that few can understand and even fewer can treat.

A recent study in the International Journal of Eating Disorders compared family functioning and maternal distress amongst those with anorexia, those with Type I diabetes, and healthy controls. Why diabetes?

"Specifically, both AN and IDDM (Insulin-Dependent Diabetes Mellitus) represent chronic illnesses involving self-care activities that are crucial to the physical health and psychological well-being of the adolescent. Both conditions involve complex changes in lifestyle in the form of changes in the amount and time of food consumption and exercise, and complicated medical regimens. If left untreated, both problems can have serious physical sequelae, placing an extraordinary burden on the adolescent and family members."

The purpose of the study, the authors say, was to challenge the assumption that family dysfunction not only causes AN, but also predates the onset of illness.

"The inclination to see family dysfunction at the root of AN has made it possible to neglect an alternative hypothesis, the possibility that AN may cause family distress. Research suggests that caring for someone with an eating disorder carries a significant burden, taking a toll on the health and well-being of the caregivers."

Although the authors did find some differences between the two groups (diabetes and AN), they also found quite a bit of similarity.

"When compared with mothers of daughters with IDDM, families of girls with AN experienced greater family conflict, reduced parental alliance, and increased feelings of depression. However, once the emotional impact of the illness on the mothers was statistically controlled, group differences were no longer significant."

Part of this may be attributed to the culture of blame that surrounds eating disorders, the authors hypothesize, as well as the fact that many of the people with AN in the study had been recently diagnosed or had relapsed; those with diabetes were simply receiving ongoing care.

But the last sentence of the study really says it all: "With a change in our understanding of the distress found within families of AN, our view of these families can be transformed from being part of the problem to being part of the solution."

When I saw an article called "The Daisy Duke Diet" in my newsfeed, I elected not to read it, figuring it was the standard drivel. However, I was wrong. What was that I said about assuming making an ass out of "u" and me?

Thanks to Tiptoe, I decided to read the article and was pleasantly surprised to the point of astonishment. Not only did it thoroughly debunk the idea of models causing eating disorders, it included some of the latest research explained rather well.

If it isn’t skinny models, what’s the cause? In the last dozen years or so, scientists have linked anorexia to many different physiological conditions: high levels of estrogen in the womb; low levels of serotonin in the brain; a genetic mutation; overactivity by dopamine receptors; a general tendency toward anxiety and obsessionality; high age at menarche; elevated amounts of a mysterious peptide called CART; autism (which is underdiagnosed in girls, perhaps because it sometimes manifests itself in the form of eating disorders); premature birth or other birth complications; irregular activity in the insular cortex of the brain; post-traumatic stress disorder; an autoimmune disorder affecting the hypothalamus and pituitary gland; variations in the structure of the anterior ventral striatum (the brain region responsible for emotional responses); and even being born in June (seriously — one theory is that a winter-type disease in the mother at a certain vulnerable point during the pregnancy is responsible). Some of these causes may overlap with one another, but biomedical researchers are virtually unanimous that anorexia has physical roots, though the mechanism remains poorly understood.

Writer Fred Schwartz concludes that

Anorexia is a dreadful disease, and still poorly understood. If the growing scientific knowledge about it can be pieced together, we may eventually learn to identify, prevent, treat, and even cure it. But political activists do not help its sufferers when they oversimplify a complicated condition and blame it on their stock assortment of evil forces in American society.

Keep in mind that the National Review is a conservative magazine. I don't think big business and the beauty industry are pure innocent things being targeted by evil people trying to pin the blame for eating disorders. I do think their messages are harmful. I do think we need to do something about it.

I just don't think they cause eating disorders.

Dear Faceless Person Giving Nutrition Advice on the Internet,

First off, don't. No really, don't. I don't care if you have an "RD" after your name. Why? Because you have to make a lot of assumptions about your audience that renders your advice damn near useless.

Telling people what they should eat is a lot like medical advice (in fact, it pretty much IS medical advice), and no doctor with more than just a smidgen of brains would assume to tell you what to do about that cough. It could be a virus. It could be bacteria. It could be asthma. It could be lung cancer. We don't know. And because the doctor doesn't want to be sued, he or she covers his or her bases and we get articles on how to tell the difference between the cold and the flu, neither of which need antibiotics.

This is not the case when I read about nutrition online. I generally try to ignore reading about nutrition online largely because it's a) bad, b) inaccurate, or c) both. However, sometimes I will see a link saying something like "great snack ideas!" and think that the article contains something like "great snack ideas!" However, I should know better, because any article about nutrition on the internet written by you, FPGNAotI, will contain ideas for losing weight. Except at Maudsley Parents and FEAST.

So this article about great snack ideas told me that I should have snacks containing no more than X calories. I laughed. Because the amount of calories would be like an appetizer for my snacks.

FPGNAotI, when you say that snacks should only be X calories, you are kind of assuming that your readers are basically fat and lazy and trying to lose weight. Some of your readers may very well be fat and lazy and trying to lose weight. But some of your readers may really just be sick of eating the same trail mix every day and want to mix things up a bit. They might not be trying to lose weight. They might be physically active and in need of food that is both tasty and filling.

Even saying things like "eat less fat" or "eat more leafy greens" runs into dangerous grounds. If your diet doesn't contain enough fat, your period stops and your bones become bubble wrap and will pop sooner rather than later. And too many leafy greens can leave you bereft of valuable vitamins and nutrients. How do you know I'm eating too much fat? Or not enough leafy greens?

Nutrition is pretty individualized, and nutrition advice should be, too. Telling an unknown group of people how to eat is a dangerous job, requiring numerous dubious assumptions about what your audience eats, what their lifestyles are, and what you think is best for someone you don't know and never will.

Because you know what happens when you assume things, FPGNAotI. You make an ASS out of U and ME. But mostly you.

Part of the goal of National Eating Disorders Awareness Week is what's known as "awareness-raising." People want to raise awareness of what eating disorders are, what causes them, and how they can be treated. This is not necessarily a bad thing. However, the information that is spread, and the topics covered by the media, don't necessarily reflect that latest scientific understanding of eating disorders.

So many stories discuss the need to look "perfect," and society's pressures to be thin. I'm not going to deny that these factors are true, but I think the blame is a little misplaced. These things can trigger eating disorders and allow them to flourish, but that's a far cry from looking at them as a cause.

Some of the people I know who are desperately trying to prevent eating disorders--a noble cause regardless!--are looking at things like discontinuing the use of emaciated models, changing the way women are used in advertising, and promoting gender equality. Again, these are all things that I support. I just have to question their impact on preventing eating disorders. It's easy to zero in on these things because sufferers tend to be inexplicably drawn to thin models and fashion magazines during their illness.

There's also some intuitive sense there: many women want to look like the models in magazines, even if it's just on a subconscious level. And some of these women may go on diets or exercise to look just a little more like that (though it is typically covered in improving "health"), but most don't develop eating disorders.

I do think our culture is more than a little toxic, but if that were the case, more people would have eating disorders. I absolutely think we should stop using emaciated models- for their sake and also for ours. But there's a difference between doing that and trying to prevent eating disorders. A few studies have found that challenging the thin ideal can help lower the risk of eating disorders short term, but I remain skeptical.

I think our obsession with dieting and freakish fears of obesity are far more damaging. Why? Diets (which are really just socially sanctioned forms of malnutrition) become normal and EDs love to hide behind things like "diets" and "healthy eating." And we stop getting worried. Most people are afraid of fat, and we buy into what people with eating disorders say.

So maybe it's time to let Barbie off the hook, and instead look at little closer at what our own "health" industries are promoting.

I was excited to see that my recent survey about sleep/wake habits here on the blog supported my hypothesis: that those with restrictive patterns tend to rise earlier, and those with more binge/purge patterns rise later. Of course, in order to really look at the data, I'd need to compare the early bird and night owl percentages of each category with those of a non-ED sample.

Although many things affect circadian rhythm--most of which are under genetic control--one of the key hormones is cortisol. Released from the adrenal cortex, cortisol levels generally peak upon waking and reach a low point shortly after you go to sleep. What's more, cortisol is released during times of stress or anxiety, increasing both blood pressure and blood sugar.

A PubMed search of eating disorders and circadian rhythm produced mainly results on night eating syndrome. However, one study found a negative correlation between awakening cortisol response and "high anxiety, disinhibition and hunger scores, as well as poor body esteem and a high weight preoccupation" in women, but not men. That means that women with a low awakening cortisol response have high levels of anxiety, poor body esteem, etc. Of course, we don't know if this is cause or effect- just that it exists.

A study in men found a significant relationship between cortisol and perfectionism, which makes sense. Perfectionism is stressful (and don't I know that!), and higher stress means higher cortisol. As well, abnormalities in cortisol have been found in other psychiatric disorders, such as depression.

And indeed, women with anorexia were found not only to have higher cortisol levels but a significant proportion lacked a circadian cortisol rhythm. These abnormal cortisol levels are directly related to the starvation state- after weight restoration, cortisol levels return to normal. I'm not sure how the lack of cortisol rhythm is important. In general, starvation disturbs the sleep cycle, and refeeding is typically associated with improvements in sleep. The general school of thought is that the body is urging the starving person to go get food, and this may be true. But the high levels of cortisol brought out by the stress of malnutrition and starvation may also play a role.

High cortisol levels in people with AN have been positively associated with both osteoporosis and
hyperactivity.

Although one study found that overall daily cortisol rhythms in normal weight bulimic women were pretty much the same as in healthy women, another found evidence of greatly increased cortisol levels. It appears that, in bulimia, cortisol levels might be much higher than usual, although they still have a daily rhythm, unlike in anorexia. Even recovered bulimic patients continued to show a hyperreactivity to corticotropin-releasing hormone, which stimulates the release of cortisol, indicating an underlying neuroendocrine dysfunction.

Yet when cortisol levels were examined in relation to impulsivity, researchers found an inverse relationship between cortisol levels and impulsivity:

Patients with bulimic symptoms had significantly higher rates of cortisol suppression than controls and than restrictive anorectic patients. Percent cortisol suppression showed a strong and significant correlation with the patient's score on the Barratt Impulsiveness Scale. A hypersensitive cortisol response to dexamethasone, which might reflect hypothalamic-pituitary-adrenal axis dysfunctions might be specifically associated with impulsive subtypes of eating disorders.

Clearly, cortisol is just one player on a much larger field. Nor is it clear whether abnormalities in cortisol levels are cause or effect, and perhaps it's a little bit of either. Certainly the eating disorder exaggerates any underlying abnormalities. Whether the ED behaviors themselves cause the specific differences observed in cortisol levels in anorexia and bulimia, or whether these differences are part of the underlying risk factors for these illnesses also remains unclear.

Any questions?

I'm traveling for work, and I just got back from a reception that was all finger food- even some items that probably shouldn't have been.

And so, just for fun, I thought I would post a brief history of eating utensils from Mental Floss.

The first utensils were chopsticks, designed due to a change in cooking practices resulting from a lack of firewood. To save wood, the Chinese began chopping up their meat and vegetables into small pieces, thus creating the first stir-fry.

No wood for fires also meant no wood for tables, so in order to eat, people had to be able to hold their food bowl while eating with the other hand. An expert chopsticks user could pick up small bits of meat, vegetables, and rice without ever touching the utensils to his or her lips—making the chopsticks more sanitary and pleasing to even the most fastidious of diners.

Among other things, spoons predated forks, and likely originated from shells found in Southern Europe, as both the Greek and Latin word for spoon is cochlea, a snail shell.

Despite the difference of materials, it’s highly probable that the Anglo spoon was influenced by the Southern European version. The Romans designed two spoons in the first century CE: (1) a ligula, which sported a pointed oval bowl and decorative handle, for soups and soft foods and (2) a cochleare, a small spoon with a round bowl and pointed handle, for shellfish and eggs. When the Romans occupied Britain (43 CE to 410 CE), they likely brought their cutlery, inspiring the English design.

Then we have the fantastic fork, the most recent of the big three utensils.

Sure, forks are handy, but they were once counted as the most scandalous of utensils. One legend tells that the fork got its start in Europe during the superstitious Middle Ages. In the 11th century, a Byzantium princess flouted her delicate, two-tined golden fork at her wedding to Domenico Selvo, son of the Venetian Doge. The Venetian clergy had clearly stated their position on the subject: God provided humans with natural forks (i.e., fingers) and it was an insult to his design to use a metal version. Moreover, fork use represented “excessive delicacy,” which was apparently very bad. When the princess died shortly after her wedding, people didn’t look to natural causes (or even fork injury). They assumed the death must be divine punishment.

Somehow, fork use still spread through Europe over the next 500 years, and despite the wishes of the clergy, it was considered an Italian affectation in Northern Europe. Part of the bad rap came from, again, the prissy factor. Although the fork’s functional value is similar to a spoon nowadays, the first forks originally evolved from the knife. Aristocrats would use one knife to cut the food and a second to spear and eat it. The two- and four-pronged knife substitutes must have looked as overwrought as a double-layer dinner fork would seem to us today.

And lest we forget, the most important spork:

Ah, the spork. Our favorite utensil—perfect for scooping up ice cream and spearing pie without dirtying extra cutlery. As its name indicates, the spork is half-spoon, half-fork, and while America was clearly behind on the other cutlery trends, the spork is a true American eating utensil. First mentioned by name in a 1909 supply catalogue, the spork achieved notoriety through another American original—Kentucky Fried Chicken. Back in 1970, KFC started including plastic sporks with their meals as a cheap convenience, and the Van Brode Milling Company of Massachusetts patented the invention for their “combination plastic spoon, fork, and knife” the same year. Due to its handy nature, the spork eventually became a common dessert and travel utensil, available in silver and other metals.

Considering how much time we probably spend obsessing about food, at least this can let us pause for a minute and think about all of the different utensils that help us eat.

Many people are now becoming aware of new research in the field of pharmacogenomics is showing that a person's genes help determine what medications s/he will respond to. Although these results are profoundly important for any field of medicine, whether its oncology or cardiology, high hopes remain in the field of psychiatry, especially due to the trial and error nature of prescribing meds.

In fact, a gene chip has recently become available where researchers can test your potential response to a wide variety of medications. How? It looks at mutations in genes that metabolize the drugs. People with genes that cause a slow metabolism of drugs* tend to get walloped with wide effects; those with faster drug metabolism might not even feel an effect.

However, researchers from Canada have examined the relationship between several different variants of serotonin transporter and receptor genes in people with bulimia and their response to a multimodal course of psychotherapy. As it turns out, the particular variant has a significant effect on a person's response to therapy.

People with a low function serotonin transporter gene showed smaller reductions in binge eating and depression and anxiety, regardless of what treatment they received. Those patients with a low functioning serotonin receptor gene showed a smaller decrease in binge eating and impulsivity, again, regardless of the treatment they received. The authors of the paper did not state if there were any participants with low functioning versions of both genes and how they fared. A dose-response effect (that is, people with both low functioning versions of the genes would show even less reduction in these factors that those with either the low functioning transporter or the low functioning receptor) would really add strength to their findings.

However, I think this study is fascinating and really opened my eyes to a new area of research. I had never thought about this, and I hope that others continue to look at this relationship between genetics and treatment, be it pharmaceutical or armchair.

*I'm not honestly sure whether this is related to your metabolism of food- I have no reason to think it is as different enzymes would be involved. Metabolism really just means the breaking down of a substance into smaller parts with the body. The opposite of metabolism is catabolism, the building of larger molecules from smaller ones.

**The cortisol post will appear later today, my little chickadees. I got swamped in outside work the past few days and haven't been able to finish.

Those of you who have been reading this blog from the beginning know firsthand of what happened when I returned to work after a six week leave for severe depression and anorexia and stumbled upon a workplace weight loss contest. For several months (until I quit in protest), I lived with calories, fat grams and sugar grams labeled on the coffee creamers, having the bowl of chocolates I kept on my desk forcibly removed (by vote no less! And might I add that I did not get to vote in this Survivor-esque "election"), and as much food/weight chatter going on outside my head as there was inside. Charts of pounds lost hung in the break room, but I did succeed in having those removed. I also removed the label on the coffee creamer, but the damn thing kept reappearing. And I kept removing it.

Keep in mind, I worked at a health department, who really should know that rapid weight loss is the least likely to be maintained. And these contests are only becoming more popular, not the least thanks to the popular show "The Biggest Loser."

But nowhere in the NY Times coverage was any dangers of losing too much weight, even when one of the men interviewed said that he went a little overboard. The article said this:

“I wanted to win, and I blew everyone away,” said Christopher Fallon, 36, a medical sales representative from West Orange, N.J. Mr. Fallon participated in a three-month diet bet with nine other colleagues, everyone contributing $100 to a winner-take-all pool. At a sales meeting a few weeks before the end of the bet, Mr. Fallon’s fellow bettors realized that he was way ahead.

“When I saw Chris at the gym at 6 a.m. looking skeletal, I knew it was over for me,” said one colleague, Carolyn Kramaritsch.

Mr. Fallon admitted that he enjoyed vanquishing his peers even more than losing the pounds. “I didn’t even need to lose much weight,” he said, “but when I saw everyone else, I thought, ‘I just won $900!’ ”

And that won't even pay for one day of inpatient or residential treatment for an eating disorder, so Mr. Fallon was lucky, indeed.

Why won't anyone say how dangerous this is? No one appeared remotely concerned that this man lost too much weight, just that they might lose their bet. Raise your hand if this makes you proud of humanity... I can't tell you how many stories I've heard from men and women with eating disorders whose illness was triggered by a pact to lose weight or eat healthier. Yet dieting and exercise are treated as if they are fail safe and no ill can possibly come from a group of people trying to see who can lose the most weight. People on pro-anorexia sites do this, and people judge these "silly girls" who are no different from anyone else. It's not healthy, period.

“It makes life easier if everyone around you is cutting calories, and the amicable competition keeps people driven. You are less likely to eat bad things from the candy jar,” says nutritionist Joy Bauer.

Yeah, except if you're the person who realizes that dieting is a) futile, b) stupid, and c) not likely to increase your health in the long run and then you realize you are completely shut out of this. To me, that was the worst part of the workplace diet bonanza: I had nothing to discuss with my co-workers. All they would talk about was food, weight, and exercise, and I couldn't or wouldn't participate. I was totally isolated and desperately lonely in a time when I really needed the support.

Nor does this "diet betting" address the really sticky issue of weight loss: how to keep it off. Figuring out how to lose weight has proven much easier than figuring out how to keep it off. A lot of it is, I'm guessing, the body defending its set point weight. But even if it weren't the case, a crash diet is unlikely to involve real and lasting weight loss and even less likely to make you healthier.

You just never read about that.

As I read others' blogs (of which there are many, though surprisingly it hasn't eaten into my book reading, as I manage about 3 week still, thanks to living at the end of the DC Metro lines), people refer to their blogs in one of two ways:

• this is MY blog- usually if trolls arrive, and is meant in the don't-you-think-a-public-blog-gives-you-permission-to-be-an-ass way. Or in the choice of subjects, etc.
• this is YOUR blog- tell me what you want me to write about, give me your input, I'm writing for others to read.

And, like so many things in life, I fall somewhere in between. I am painfully aware that my blog is public--very public. My writing style is much more linear, much less Faulkner stream of consciousness (sans the Nobel Prize literary merit) than in my personal journals. It also contains less swearing and less open self-loathing. I'm not navel gazing here.

I write about research that I think sufferers and caregivers and friends and family need to know. I write about stuff that gets twisted in mainstream media because I want people to be aware. In that sense, ED Bites is a bit of a literary soapbox.

On the other hand, a lot of what I write, I write for me. I write about how to be okay with your body because I need to learn that, too. I need those reminders. When I write recovery-oriented stuff, it helps place me in that frame of mind, helps me see the upside of leaving anorexia behind.
In the end, I'm not sure whose blog this is, nor if it really matters. What I write ceases to become entirely mine the second I put it out there, and I think that's a good thing. Change comes from dialogues, not monologues.

As researchers make more and more progress into what causes various mental illnesses, they're getting a clearer picture of what happens before the onset of clinical illness. And knowing what happens before illness onset can mean figuring out a way to start preventative treatment.

Although we're quite a long way off from discovering this in eating disorders, there was an interesting study on how people with schizophrenia do not respond to "bizarre" faces (photos were altered in Photoshop for the experiment). Not only do normal people respond visually, their brains set off a sort of alarm when they see these abnormal faces.

“The visual areas of the brain are highly connected to other areas, including the prefrontal cortex and the amygdala, but in schizophrenic patients, there is a diminished connection between the various parts, leading to disturbed integration of information — and thus to distorted experiences," Prof. Talma Hendler says.

The key to the findings is this: emotional understanding and processing begins early- very early. Given that schizophrenia is strongly rooted in genetics, it is likely that this abnormal emotional processing begins early, too. So a screening test could be developed for high-risk children to determine if they have these characteristics, too.

Of course, we don't know if antipsychotics work as a prophylactic treatment, nor do we know if this abnormal processing is predictive of future schizophrenia. For instance, brain functioning was altered in those people closely related to OCD sufferers, even though they didn't have any symptoms themselves. But we know the genetics, and perhaps being able to keep a watchful eye on those most likely to suffer may be just as good. Still, every tool should be evaluated and this could prove very interesting and useful

EDITED: Laura just posted about a potential test for predicting postpartum depression.

Recent research from the Basque region in Spain found that boys have greater psychological well-being than girls because they have a better physical self-concept.

First off, some definitions. A person's self-concept is "the totality of perceptions that each person has of themselves," which doesn't help a whole lot. I think a lot of your self-concept has to do with the adjectives you use to describe yourself, and what talents and traits you value in yourself. But the author here looked at one specific aspect of self-concept: how you perceived yourself physically. In other words: body image.

The author looked at the relationship between physical self-concept and general psychological well-being, depression and anxiety, and eating disorders. The study found that

the more one is happy with one’s physique, the more psychological well-being one has, with less levels of anxiety and depression and less risk of suffering from an Eating Behavior Disorder.

Now, in general, I think the results make a lot of sense, especially now that your weight isn't just about being "thin" or "pretty." People can and do equate your weight with your moral worth. Though this is catching up for men and boys, I think it's safe to say that women and girls get it worse. I also think that if you have major body image issues, you're less likely to be happy with yourself. This leads, not surprisingly, to increased rates of depression and anxiety.

But I read this research summary shortly after I read something that Laura had posts on how childhood balance problems could be linked to anxiety disorders. This got me thinking about how your physical self-concept extends far before the window of time when one is most prone to developing an eating disorder. And maybe that a poor physical self-concept may not cause an eating disorder, but rather be a side effect of the genetic wiring that makes you prone to such disorders.

To be fair, the author never implied that poor physical self-concept caused eating disorders, but the timeline was clear: poor physical self-concept can lead to an eating disorder down the line. But the genetic predisposition to an eating disorder happens long before a child has a chance to develop a concept of body image, and indeed, research has shown that people with eating disorders perceive their own bodies differently.

It could also be true that those teens with depression and anxiety think negatively about everything, including their bodies. The author didn't, I don't think, separate these out in time (as in the chicken or the egg kind of thing). Nor does it have to be one or the other. Likely things like risk factors for EDs, depression and anxiety, and physical self-concept interact with each other, ebbing and flowing, waxing and waning over time.

So it could very well be that this negative physical self-concept is a symptom of something else going on deep in the brain, just as it is a symptom of a society that places exceptionally high value on appearance.

I am super stoked to find out that all of you have voted me one of the Top 100 Health Blogs! In fact, your efforts put me in the Top 50.

Thanks to all who voted, and a special heads up to my mom who made the effort to vote early and vote often. :)

I am really touched and honored that ya'll took the time and effort to do this.

Thanks again!

I try to keep most of my content here completely original, but this post from the blog On Simplicity just spoke to me so much that I'm copying and pasting the entire thing here. And working on letting go of my perfectionism that tells me I'm being lazy for doing such a thing...





1. No one gasps in horror when you inevitably screw something up. Instead, you can get away with an “Oops” and a charming smile.
2. When you do get something incredibly right, you get to celebrate and bask in the glory–not get a chorus of “Yeah, yeah—what else is new?”
3. You get to try new things without fearing they’ll ruin your perfect track record.
4. People trust your advice because it came from trial and error, not from some superhuman talent.
5. Expecting amazing things from yourself can be a great thing. Having the outside world expect amazing things from you can be soul-crushing. Just ask Superman.
6. Sometimes the best ideas, art, and inspiration come from mistakes.
7. Who wants to color inside the lines all the time or live life like a paint by number?
8. The straight and narrow may be the fastest way to get somewhere, but it sure as hell isn’t the most exciting or even fulfilling.
9. Incredibly high standards of perfection can only alienate the people in your life and make them feel judged.
10. Having “off” days is a part of life. They’re what make the other days sparkle.
11. Perfection is so much more thrilling when it hasn’t become routine and mundane.
12. Persistence can work just as well as perfectionism, without all the stress and guilt.

(full image credits here)

I am a confirmed night owl, and so is my mom. I don't like mornings, don't function at my best really early in the morning, and if left to my own devices, I don't naturally start to feel sleep until about 2am.

But I've noticed several things during my times in treatment and with all of the people I've met: those who have more anorexic patterns tend to be morning people, but those with a more binge/purge cycle are night owls.

I have no idea if this is true, or if this is just me. So I'm doing a little poll to try and find out. Several things about the questions:

--you can be recovered from your eating disorder and still answer this question. As far as I know, your circadian preferences don't change over time.
--you don't have to have ever met the strict criteria for AN or BN- I used anorexia and bulimia as shorthand for "restricting" and "binge/purge."
--if you have both restricting and binge/purge cycles, pick the one that most regularly crops up in times of stress. Also, if you primarily binge eat, just pick the "bulimia" one. If I had chosen too many options, the data would be meaningless.
--don't know if you're a night owl or early bird? If you have a lot to get done, do you stay up late or get up early? I'm a night owl- I stay up late.

Happy polling!