Remember when food was just food? I don't. But I try to imagine it sometimes. I grew up in the throes of fast food, Halloween candy, and plates of bacon at breakfast buffets only to learn that I was just another victim of the food processing industry. Food issues are fascinating if for no other reason that they instill a constant sense of humility.

With all this information about food, I have been compelled toward ambivalence. On the one hand, the issues are compelling and require large-scale change. On the other hand, the potential obsession about what we put in our bodies can lead to a sophisticated brand of narcissism.

So writes Jennifer Jacquet, in a post titled "Use the Force against the Dark Side of Food" on her blog Guilty Planet. I haven't read many other of her posts, but she used the term "eco-douchebag," so it has to be good.

Thoughts on this?

(Today's post on eating disorders vs. disordered eating has been postponed because I ended up at TJ Maxx for quite some time and uh, Aria needs a bath. The details are a little gross for the blog, but needless to say, her hindquarters need a good scrub. ATDT ladies, any virtual strap-on gonad donations will be greatly appreciated...)

My therapy sessions this week were unusually productive, yielding several important insights. I spoke with my dietitian at length to start integrating "enjoyable activity" into my life, and I got the go-ahead to begin yoga and walking, so that's good. Along with that came the dreaded meal plan increase, which irritated me (more food? Seriously?) but not as much as it might have.

The food-related insight has several different parts. My food was increased not only in preparation for my increased activity, but also because I wasn't sleeping well. Before my appointment, I was attributing my rise in insomnia with caffeine carelessness or anxiety or whatever. I never thought I might not be sleeping well because I was, you know, hungry or something. Case in point: last night I was up late reading and then I couldn't fall asleep. I didn't really feel hungry, just that my brain wouldn't shut off. I went downstairs and had some mommy time, and then she suggested I get something to eat. Despite my protests that I was fine (and I seriously thought I was), my mom cut me a slice of zucchini bread. And as soon as I started nibbling at it, I realized: Oh. I was hungry. After, I didn't fall asleep right away, but I eventually drifted off.

So the one insight is that even non-perceived hunger can keep me awake. It's a sign that my body really does know what it needs. The other insight is that I'm trying to look at the food increase not as just more to eat, but as a tool to help me sleep better. I'm still not thrilled about it, but I guess that's okay. I don't need to like it in order to eat more.

The other insight came during my therapy session, as my therapist and I discussed my ongoing body image woes. I can't not see myself as anything more than a jiggling ball of lard. And all I can think about when I'm in public is that people are staring at and disgusted by) my quivering thighs. I mean, aren't they giving off aftershocks that can be measured on the Richter scale? And I also brought up how I still have no clue (subjective or objective) what I really look like, especially when it seems I'm constantly watching the National Skinny Person's Convention while I'm waiting to be crowned Miss Blubber. I understand, on some level, that the evidence for this is pretty negligible. I know that the size of my shorts and jeans (Size X) is well below the population average and only contains one digit. Ergo, I'm far from fat. But looking at myself or looking in a mirror, and Elvis and rationality have just left the building.

So my therapist turned the question around a bit. "What would you say if I told you to guess the approximate size of someone who is five foot five and wears a Size X?" Well, I'm five foot five, and my shorts were Size X that day. Yet when I heard it coming from someone else, someone who I know isn't going to bother me with BS, I was able to realize this: "I'd say that person was pretty thin."

And my therapist, bless her red-headed, caffeine-loving heart, said: That person is you.

Although I still have several pounds to go in terms of weight restoration, I am currently about the same size I was before I relapsed. The Size X shorts are still kind of loose, but not freakishly so. So that is me, at my normal healthy weight, and that's just fine. Anyone else would call me on the thin side of average. I've told myself before, "I wear a Size X and people who wear Size X are not fat," and it never seemed o hold much weight (uh, har har) in my brain. But evaluating myself the same way I would evaluate other people, I can better understand that I really don't see myself accurately.

The point of this insight is not Holy Revelation, Batman: Carrie is Thin! It's not so much that I'm seeing myself as thin that makes me feel better. It's that I have a concrete clue to hold onto that just may help me perceive my body accurately. Not that it always works (it doesn't), but it's a way to remind myself that objects in the mirror are smaller than they appear.

Although malnutrition and eating disorders go hand-in-hand, EDs aren't the only conditions that are frequently accompanied by malnutrition. Cancer is, too, with up to 87% of cancer patients becoming malnourished at some point during treatment.

A new study looks at the relationship between malnutrition and the psychological distress experienced by cancer patients. The 213 cancer patients were taking part in a nutrition rehabilitation program, and were asked to rate their psychological distress on a scale of 0 (no distress) to 10 (high distress). Researchers found a significant correlation between malnutrition and distress: the higher the distress, the greater the malnutrition.

"Our data suggest that nutrition status may contribute to the level of distress in patients with cancer," Dr Amdouni says. "Evaluation of the nutrition status should be included in the evaluation of distress experienced by these patients."

The connection between malnutrition and psychological distress in cancer patients seems somewhat obvious, and lots of people are (hopefully) going to coax the cancer patient into eating and improving their nutritional status, which will then improve their psychological distress.

So why is the same thing so controverisal and seemingly unorthodox among ED patients? Why is it that people don't flat-out say: of course you're depressed and feel like crap. You're not eating properly! Instead, hours of therapy and thousands of dollars are spent trying to make you feel better in the hopes that you might eat. Of course, one meal isn't a cure. One meal won't make you feel better.

Brain tumor or brain disease, nutrition is important.

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.

It's not only eating disordered teens (and sufferers of all ages!) who need supported nutrition. Elderly patients in nursing homes and residential centers also benefit from mealtime support.

For elderly patients, any sort of weight loss greatly contributes to morbidity and mortality, so maintaining proper weight and nutrition is extra important. But as people get older, the effort of eating and cooking increases immensely, taste buds decline, and a person can be physically capable of eating less. As well, ongoing health problems and certain medications decrease appetite, so it's ultra important that people have the support they need.

A recent study found that

Individualized attention during daily meals and snacks in between minimizes weight loss among long-stay nursing home residents...

The amount and quality of daily feeding assistance "can and does make a significant difference on the nutritional health status of a frail population," Dr. Sandra F. Simmons told Reuters Health.

And not only will this attention help nutritionally, it can also provide important social contact and bonding.

Eat with your anorexic...and your granny.

I suppose all of my griping about crap media coverage of eating disorders wasn't in vain. I just stumbled across this gem from the Edmonton Vue:

Well, Well, Well

Because it is so good, I'm reprinting it in its entirety here.

It’s Eating Disorders Awareness Week, and this is for the beautiful young women living with the largely closeted heartbreak of anorexia or bulimia, and for their families. It’s for those so far unable to acknowledge their secret, and for those in psychotherapy or on meds yet again wondering if they’ll ever successfully tame the monster, and for those resisting meds because they’re not sure the side effects are worth it, and for those who thought they had it licked only to be now ever more protective of their secret.

Not that everyone with an eating disorder falls under that umbrella. Many do find healing with a combination of psychotherapy, antidepressants and/or alternative therapies. But not all do, or they do for a while and then relapse, the dashed hope of relapse sometimes being even more difficult than initial admission of illness.

Both anorexia and bulimia are medical conditions that occur alongside other neuroendocrine, biochemical and psychological loss of balance, making the job of pinpointing cause and finding effective treatment a challenging one.

Eating orders don’t, of course, restrict themselves to young women, but young women make up the majority of those afflicted, and it afflicts more of them than we suspect. And like seemingly everything else, we’re developing these things at ever-younger ages, the average age of onset having dropped from the teen years to the pre-teen years, which coincides with girls reaching puberty at ever-younger ages and putting on weight when they are psychologically ill-prepared to deal with societal pressure to be thin.

But although it is almost certainly exacerbated by the thin-is-beautiful cult that is our culture and the almost-habitual dieting that goes with it, and though the Neanderthals still sending the message that a woman can never be too thin are cruel, whether their toxic energy is directed at a daughter, a lover, or channelled into the beauty industry that says it most powerfully, there is much more to it than that.

Because whatever the psychological triggers, eating disorders are biologically sustained when brain systems regulating appetite malfunction. The big question is how those systems can be restored to normal function, but whatever the cause and whatever the treatment path chosen, our successes will be limited by the availability of basic building blocks for healthy brain chemistry.

What we know for sure is that normal appetite regulation and healthy neurotransmission go hand in hand, and for healthy, non-inflamed neurotransmission to take place, key nutrients need to be available. Given the prevalence of dieting among young women, coupled with the already thin nutritional status of our convenience-food, Coke-preferring (or no-food preferring) young and the thin-ish nutritional quality of much of our food supply, key nutritional deficiencies are all too common.

Some of the most fascinating research with eating disorders has focused on leptin and ghrelin levels, those two little chemicals that regulate appetite, and while we still have much to learn about them we know that appetite-stimulating ghrelin has been found elevated in patients in bulimia research subjects, while appetite-suppressing leptin has been shown to be abnormally low, and we know that intake of high-sugar foods and the absence of key nutrients play a key role in that balance.

Zinc, B12 and omega-3 deficiencies (common among vegetarians as well as dieters and candy-bar lovers) are key nutrients for healthy nerve myelin and serotonin transmission and have been linked to altered appetite control. None of us are exempt from these deficiencies of course, but given that meat and dairy are such solid sources of these nutrients, vegetarians, dieters and those with eating disorders will always be more prone to coming up short.

While eating disorders are more complex than simply changing our nutritional intake, nutritional status is all too often an overlooked but critical component of recovery. Because whatever progress made with improved serotonin transmission or psychotherapy, lasting change is not likely without the essential high-grade fuel required to sustain it.

---------------------------
Thank the writer, Connie Howard. You can email her at health@vueweekly.com. I know I did.

I was sitting in the waiting room of my therapist's office, paging through a recent newspaper when I was (mysteriously) attracted by an article that said "Test your nutrition IQ!" I read on and learned that this was a quiz about weight loss.

Think about it.

You're basically supposed to eat in order to...lose weight. That's all that "nutrition" means anymore. Recipes for kids have calories and fat grams at the bottom. That bugs me. I'm all for the consumption of fruits and veggies by anyone. But it's a matter of why. Since when do healthy, growing kids need to be focused on their weight?

Here's the supreme irony- the more Americans diet, the fatter they get. Maybe it's not that it's getting harder and harder to lose weight (though I did get a chuckle at the Jenny Craig ad that followed a McDonald's ad), but that diets aren't the solution. My co-worker (one of the members of the Weight Watchers at Work club) swore off chocolate a month or two ago. Not more than a day later, I found her sneaking a bite out of the communal jar of Hershey's kisses. I have long since learned better than to swear off chocolate. It's ludicrous. I also find it hilarious that while most Americans are buying low-fat food as part of their New Year's resolutions, I'm stocking up on premium ice cream and candy bars in order to recover from my eating disorder.

That being said, my favorite food irony is on the jar of my peanut butter. Warning: may contain peanuts. Which naturally poses the question- what if it doesn't?