Ever since I got back from my super long bike trip (with the accompanying wrist injury), I haven't been able to ride. Basically, until the nerve heals, riding is a no-no. I tried my best to reason my way around that, but I couldn't--at least not without becoming really disordered or risking permanent hand injury. Seeing as I need to type to pay the bills, and crochet is one of my favorite hobbies, permanent injury would be really bad.

So no biking.

It's not been easy. Okay, yes, I miss the exercise part. A LOT.  I can do other things, but (insert whiny voice here) it's not the same. I've been doing an extra drop-in dance class at the community center to get some other type of activity in that doesn't involve my using my hands much. And I can go outside for a walk and do other things.

Really, though? I just want my bike back.

As hard as it is, the enforced rest from cycling has helped me better connect with what I actually like about the sport, above and beyond the endorphin rush. I like the wind in my face and hair. It's limited with a helmet, but still. I love being outside. I love being able to move under my own momentum. I like the solitude of being out by myself and deadline stress melt away because I can't do a damn thing about it when I'm X miles away from my computer. I also like feeling part of a larger community, even if they go much faster than me and are typically outfitted entirely in Spandex, which will never happen here, kids.


I also really like the feeling of achievement after finishing a long ride or improving my time. I try not to get caught up in the numbers and other minutiae, but it does feel really good when I beat times measured loosely on my iPod clock.

These feelings are very different compared to when I thought of exercise in terms of machines, blinking red numbers, and in quantitative categories of calories burned, miles run, and time elapsed.  It's less about "exercising" and more about the experience of cycling. No, thoughts of burning calories aren't really that far from my mind, but it's also not always my primary motivation for going. It's hard being deprived of one of my favorite healthy coping skills, but I'm surviving. I'm cranky and crotchety, but surviving.

I cannot wait, however, to regain strength in my hand so that I can get back out there. Only this time, I will wear my padded gloves the entire damn time, no matter how hot it gets.

Over the last few weeks, I've started taking a Zumba class at my local community center. Several of my friends had said that they enjoyed Zumba, and I thought it would be fun to try. So I went. It's really fun, actually, despite the fact that I look like I'm re-enacting that scene in Date Night when Tina Fey and Steve Carrell do the robot dance when in fact I'm really doing the cha-cha.

Gracefulness has never been my strong point.  I can follow along. I can keep up.  But I'm not very skilled at the intricacies of the movies. I'm just...not.

So I'm following the instructor* and trying to figure out exactly what she's doing with her fancy footwork, and I kept getting frustrated for my first two classes. I couldn't get my feet and legs to move that fast. So I just hopped and trotted and jumped in combinations that I hoped resembled what the teacher was doing, and then soon enough we would be back to a section that involved walking or the grapevine, and I was all good.

When I went the other day, I finally figured out what my problem was.  I was making the moves way more complicated than they really were.  The instructor wasn't actually stepping, just sort of shifting her weight from foot to foot. And there weren't three little jumps, just two, and so on. I was getting angry and frustrated at my inability to keep up with all of the steps, when in actuality, I was keeping up. I was just overcomplicating things rather dramatically.

It's pretty much a metaphor for my life. I make things way more complicated in my head than they actually are in reality. I'll grant that some of this is what I call the ignorance of the newbie: all the moves look really complicated because I haven't mastered them yet. But often, whether it was when I was still in school or working at the bakery, I had an alarming talent for taking a simple task and making it really difficult. Then I would get stuck in that horrible cycle of berating and blaming myself for an inability to do a simple task, which slowed me down further, which made me hate myself even more.

I need to remind myself that most things aren't all that complicated. They might seem that way at first, but once I get going, I need to remember that things also get easier. That if I can quell my initial panic that I suck and I'm in over my head and I'm never going to be any good and holy crap, do I suck!, then I can see more clearly exactly what I need to do.

Of course, it's much easier to identify these things in a relatively meaningless dance class than in more important things like career and recovery, but I guess it's a start.

*The instructor this week was a sub--it was the male yoga teacher. His style was totally different, although the class was still good. It was, however, a total blow to my minimal self-esteem to see a large, hairy male be far more light and graceful on his feet than me. Sigh.

Check out my new Body of Evidence post:

When exercise becomes dangerous.

There's also a list with signs and symptoms of exercise addiction for you to use.

Enjoy!

Pulling myself out of this slip has been exhausting.  It's gotten harder over the past week or two, not because anything has necessarily changed, but because I'm getting burned out.  On the one hand, I can feel the subtle shifts happening; on the other hand, it's just the same old, same old.  It's one thing to push yourself to eat more for a short period because it's time-limited.  Eventually, the hell will be over.

I thought I would pull out of the slip much faster than I did.  Perhaps I misjudged exactly how many difficulties I was having. The other factor is that weight gain is going much more slowly even on more calories.  My life feels like a never ending assembly line of meal-snack-meal-snack-meal-snack.  Seriously?  Shoveling in this much food every day is exhausting.  Like I said, there has been progress, but there haven't been signs that the daily shit-ton of food is going to decrease anytime soon.

I had a bit of a meltdown about it the other day.  I was tired of all of the recovery work, tired of the food, tired of always feeling like the sick person.  I was about ready to throw in the towel.  But my therapist had reminded me of something: last week we had talked (briefly) that if I continued to progress weight- and behavior-wise, then we could talk about reintroducing some mild activity.

Apparently I have progressed, and now I am officially off exercise restrictions.  I get a few short walks during the week at this point.  The idea is to move up slowly so I don't just plunge back in head first and everything goes to pot. 

This event greatly improved my mood, and not primarily from the OMG--I can go back to exercise now! standpoint.  It was also that, for the first time, I could see the light at the end of the tunnel.  I don't know when it will be, but sometime soon I can transition from refeeding mode back to recovery mode.

It's been hard, too, because I generally don't get much feedback on how I'm doing.  I would know if I lost weight, and I don't really like being patted on the back for gaining, either.  It makes me feel horribly guilty.  So it was hard for me to judge exactly where I was along the path, which only added to my frustrations.  I don't want or need to be praised for every bite, but a little feedback would have been helpful.

There's still tons of work to be done, even when this phase is over.  I know that getting back to where I was still doesn't make me where I ultimately need to be in recovery.  For now, though, I'll take what I can get.

Recovery, it is said, is more like a marathon than a sprint.  It's long.  It's grueling.  And you have to pace yourself. 

I got thinking about this metaphor today, and I remembered something my old boss (who had run several marathons in the past) used to say.  He said the "obvious" halfway point of a marathon, which is just over 26 miles, is at mile marker 13.  After that, technically, you're on the down slide. 

My old boss said that any marathon runner will tell you that the race isn't half over at mile 13.  No, at mile 13.2, you're still at the beginning.  Many runners don't consider themselves beyond the halfway point until they hit mile 20.  My boss? His "halfway point" was mile 25.

Mathematically, passing mile 25 of a 26.2 mile race is far beyond halfway.  It's not that my boss had math difficulties.  Rather, those last 1.2 miles seemed just as long as the first 25.

Which reminds me a lot of recovery.  It's sort of like you're trudging along, and you look at the mile markers, and you feel like you should be further along.  You think "I'm nearing the end. I must be nearing the end."  But there's always three, seven, ten more miles.  How in the heck are you going to endure for that much longer?

The last bits of recovery seem to take the longest, and sometimes you just have to buckle down and endure.  Those last 1.2 miles--the seeming endgame of recovery--feel as long and as intense as the first 25.  And it's hard for people from the outside to understand this.  Outsiders are measuring distance through math: half of a marathon is 13.1 miles.  Period.  But when you're actually in it, those kinds of calculations don't really capture the emotional experience.

I don't think I'm exactly at mile 25 yet.  But it does help me better understand why recovery can seem to take so damn long, when you feel it should be over by now.

Much of the writing about anorexia is couched in the terms of mind vs. body.  Perhaps it is something of the nature of eating disorders; perhaps it is our conception of what an eating disorder is.  As hunger pulls at your gut, you tell yourself "mind over matter," as you crack open yet another can of Diet Coke.  Starving, you tell yourself, is an all-out war with your body, and your mind is determined to win.

Recovery, then, seems like capitulation.  Surrender.  Okay, stupid body, you win.  I'm waving the white flag. You couldn't vanquish your body and so you break down and eat.

Or, in my case, lay off the exercise, too. 

This past slip didn't see a return of the full-blown exercise addiction that I've shown in the past.  But the urges did increase somewhat, and now I've been advised to basically cease all activity until my weight starts trending upwards.

I know my body needs this to heal.  I try to think about my heart, liver, and kidneys.

But then I start worrying about my mind.  How am I going to stay sane if I am sedentary?  Some people exorcise their demons, but exercise mine.  The repetitive motion is soothing--I'm like a baby being rocked.  And as much as I hate the fatigue, it does turn the volume down (however slightly) on the worries and obsessions.

So exercise right now seems good for my mind and bad for my body, which pits me right back at the crux of the matter.  Of course, exercise addiction is a Very Bad Thing for my brain over the long term.  Anxiety, however, rarely takes the long view.  Sure, it obsesses about the future, but when in the throes of anxiety and stress, all I'm thinking is make this stop NOW.  The long term can go screw itself for all I care.  I'm not going to be around for the long term if I can't ratchet down the anxiety--or at least, not around and sane.

I'm struggling to find something half as soothing as exercise.  Today was especially hard, as the day was warm and sunny.  Perfect day, I thought, for a bike ride.  Except, oops, I messed up and now going out for a spin wasn't in the cards.  So I crocheted this evening, all gloom and doom and look at me working on this motherf*cking project like a good little girl. Woo woo. {{Say it in an Eeyore voice.}}

Healing my body will heal my mind.  I'm trying to tell my fat starved neurons that avoiding a good sweat is good for me, really it is.  My neurons aren't buying a word of it.  That doesn't make it untrue, just pathetically unbelievable. 

Other members of the Academy for Eating Disorders alerted me to this upsetting/appalling/annoying article in Bicycling Magazine.  It's so awful that I'm not going to link to it for any number of reasons: lots of height/weight stats, weight loss stats, and I also don't want to give the article any more traffic than it's already getting.

One of the hardest things for me to adjust to in recovery was all of the spare time and energy I had.  When I was in the depths of ED, I spent all my awake time perseverating about how much I ate, how much I exercised, what I weighed, and how much I hated life.  I could distract myself for brief periods--maybe for a few pages of an unusually good book or during a movie scene--but the ED always intruded.  This dragged me back to going over and over these things in my head.  Literally, these thoughts were my life.

As they receded, I often felt my brainpan was going to collapse without the constant pressure of those thoughts zinging around.  The obsessive thoughts lessened somewhat as I reached a healthy weight, but they still occupied freaky amounts of my time.  I didn't enjoy obsessing about every little thing, but I didn't know what else to do.  One of the things that left me so vulnerable to relapse was the fact that I didn't have anything to take the place of the ED that had occupied my thoughts for so long.

I found writing to be so helpful not just because it helped me sort through my thoughts, but because it provided me with something to do.  For the first time, I had something much more interesting, enticing and absorbing than the ED crap to think about.

I slowly began to find things that were not only more interesting to think about but could also be totally absorbing when I actually did them.  That's what I loved about mountain biking- I literally could not think of anything besides not crashing.  I hated the constant threat of danger, but I loved the challenge and the total mind-absorbing nature of it.  It's one of the main reasons I fell in love with cycling- I could daydream but the task at hand still demanded almost all of my attention.

I still struggle to clear my head while writing at times.  I'm aware that this is pretty normal, but I get a little more peeved when it's ED stuff creeping in rather than more normal, I-need-to-run-the-dishwasher kind of stuff.  And if writing doesn't do the trick (and I have some free time, which is becoming an increasingly rare phenomenon!), I can get involved in a good book as reading is another major passion of mine.

Finding my passion for writing didn't enable me to recover--there was a lot of hard work and therapy and facing my fears about food one at a time and meal after meal after meal.  But it's one of the best motivations to stay recovered.  Then I can actually get absorbed into books and projects and bike rides.  When I'm malnourished, all I can think about is food.  Now that my brain and body are (mostly) healthy again, I can focus on bigger and better things.

I joined an outdoor club in my area and went to my first gathering, which was a mountain biking excursion, followed by dinner and beers. I've gotten pretty good at road cycling, and so I thought I would try it out both for the physical challenge and for the opportunity to meet people.

Let's just say that although I anticipated that this bike ride would be physically challenging, I in no way anticipated just how physically challenging it would be. My shoulders and biceps are sore because I was holding onto the handlebars for dear life. Several times, my legs just about gave out from exhaustion. I ate a slightly bigger afternoon snack than usual, but it wasn't quite enough.

But during the entire ride, I wasn't thinking about my fat ass or my jiggling thighs. All I was thinking was "Don't fall. Don'tfalldon'tfalldon'tfall." Or "Please, lungs, give me one more liter of air. Fine, a milliliter. Or even just a couple molecules of oxygen." I was stark bloody petrified and had to concentrate intensely on the path in front of me. It was sandy and there were tree roots everywhere- any lapsed attention would have meant that I ate a faceful of dirt.

It was, in short, an exercise in the function of my body over its "form." I'm not much for the adrenaline rush, but I did enjoy the challenge. And I met a very nice group of people who do this every other week.

Will I do it again? Probably. I know I prefer biking on a road (or at least packed dirt) compared to off-roading, but it's fun enough. And it was nice to totally not think of the ED for a while.

I'll admit I moped a bit this morning (well, early afternoon. I didn't wake up until 11am). Then I mailed out a contract, talked to a researcher in Portugal, cringed at the thought of my phone bill with all of these international calls (three others last week), and sat down with a cup of coffee to watch a little TV mid-afternoon. I didn't have anything real pressing, and I was curious to see what was on.

I had just put my feet up when I get a text message from my boss at the bakery- she wants me to come in ASAP and help close. Since I didn't have anything better planned, I said okay. I could use the money and it seemed like a better idea than just trying to find something better to do. I put on my old baseball hat and name badge, and I go into work.

I don't miss the bakery, not really, and I still don't. But I think there is something therapeutic in mild physical labor, in having heaps to do and just bulling your way (mostly) through it. There was the connections with my coworkers as well, or even just being in someone else's company. Perhaps just as importantly, it got me out of my head. All of that.

I'm done with my shift and feeling much better. I do better when I have a lot to get done. I really enjoy feeling productive and checking things off my to do list. And it felt good to be really busy (though not the sweating buckets bit...that wasn't pleasant in the slightest) and now to be tired in the way that signifies you've really worked hard.

I know I work hard at my writing, but this is a different kind of hard work. It's given me a bit of insight into why I found exercise so addicting: it was this pseudo-productivity, the good tired of having exerted myself, along with the endorphins and semi-dissociation from what was bothering me, and the OCD ritual of it all. My brain sort of shut off when I was exercising, just as my brain powered down a bit during work. The moment became about the doing rather than the thinking.

Don't get me wrong. My back hurts and my feet hurt and I really stink at the moment. But about 6 hours at the bakery just flinging bread and packaging croissants and getting disgustingly sweaty really improved my mood and my outlook.

I've never really considered myself athletic. For starters, my coordination and grace are pretty minimal (I was voted "Class Klutz" in high school). Second, sports were never really a big thing in my family. Lastly, I always thought of myself as too chubby to play sports (even though I wasn't). I was almost always chosen last in gym class, which ultimately made sports a humiliating experience that I wrote off as quickly as possible.

I started exercising in college to manage stress, but I never really integrated that into my identity. Then I ultimately gravitated to compulsive exercise as part of the eating disorder. Carrie the Gym Rat was very much a part of my identity, but I still didn't see myself as particularly athletic. The actual exercise was fairly irrelevant--as long as I was burning calories, engaging in the ritual, and mentally checking out while exercising, it didn't matter.

That has changed as I've gotten stronger in my recovery. I've been doing a fair amount of cycling, and I took a Pilates class for a while. I've been thinking about taking a kickboxing class, or an Irish dance class, or even a dance aerobics class (I did it a few years ago and it was pretty fun). I would love to go kayaking and learn how to play tennis. I took tennis lessons when I was about 12 or so, but I quit after I nailed my teacher in the nads with a ball--he did say "Aim it at me!"--and I was too embarrassed to go back because I had a big crush on him. I would love to get back into it.

All of these activities has caused me to rethink the absence of "athletic" from my self-concept. I'm not much into team sports like basketball or volleyball. I'm still not at all coordinated, and since I don't like many quote-unquote "sports" (at least as they're mostly thought of in the US), I don't feel entirely comfortable calling myself athletic. But I have started to think of myself as "sporty." I like being active, even above and beyond the eating disorder. I'm not super-adventurous, but I do like to try new activities, especially water sports.

It's been interesting, this learning to think of myself as a sporty person. And I like it. It feels genuine and authentic, a side of myself I never thought I had.

I was chatting with one of my co-workers today in the bakery (though not the one who told me to "let my titties hang out"), and griping about always being hungry because my metabolism is now fighting back. Between work and my recreational cycling, my body needs a lot of fuel. I'm not exactly fond of this always hungry state. It's pretty annoying. But my co-worker looked at me and said:

"Isn't the point of cycling so that you can eat everything?"

I thought, hmmm, that's interesting. Although I am still very aware of the fact that exercise burns calories--both from my ED history and from the fact that living in this culture, it's kind of hard not to be aware of it--that was never my motivation for starting to exercise. I did it to manage stress and to improve my health. Did I harbor secret fantasies about losing weight because of my new exercise habits? Yep. But that wasn't the sole reason I was exercising.

Even at the height of my eating disorder, the exercise was as much an OCD ritual, an addiction (damn didn't I loves me some endorphins), and a way to absolve guilt over eating (my therapist didn't describe my routines as "punishing" for nothing) as it was a way to burn calories. After a while, I didn't really have a motivation for working out- it was just something I had to do, like brushing my teeth and wearing deodorant. I did feel extremely guilty for not burning calories when I didn't exercise, but it wasn't a major motivator.

I've been trying to break my OCD obsessions with counting calories, miles biked/run/climbed, speed, etc, by avoiding exercise machines. It just makes it too easy for me to obsess over this minutiae that the ultimate goal of exercise--the stress relief, the enjoyment of it--gets lost. Buying my bike was a big step in this direction. Exercise still has the connotations of weight loss about it, and I guess given my history that shouldn't be all that surprising.

But the one thing that made me laugh about my co-worker's comment was that I couldn't understand why someone would want to eat more? It's annoying. I have to think about food even more than I already am, just from a practicality standpoint. I have to spend more time on food prep and grocery shopping. All around, I wish I could do my biking and not have my metabolism be all "FEEEEEEEEEED MEEEEEEEEE!!" like the plant in Little Shop of Horrors. Even though I haven't lost weight while riding my bike or being on my feet, I continue to do them. I know that the benefits my rides (and my job) give me make the extra calories worthwhile.

Although my co-worker's comment did make me laugh a bit, it also made me realize just how much exercise and weight loss are linked in our culture, and how so many other factors played into my exercise issues. It also made me realize that the idea of me, biking for the sheer enjoyment of the wind in my hair--in my helmet, really--makes me pretty unusual. All I can think is how much nicer the world would be if we all got back to this primal enjoyment rather than the drudgery of calories burned.

A post on the DANA Foundation blog, titled "Wired for Hunger," looks at obesity, how the body regulates hunger and satiety, and what happens when these systems malfunction. But that's not the real interesting part. The interesting part was the sidebar on anorexia. It was both interesting and scientifically astute, with some testable hypotheses and potential interventions for anorexia. I'm copying it in its entirety here because I really think its worth reading.

Anorexia Nervosa: A Mortal Clash between Reward and Hunger

A few days ago, I was in a sporting goods store with my mom, helping her pick out a mat for her new Pilates class. We passed by the elliptical machines, and I thought I saw one with an iPod dock and (get this!) built in speakers. So I stepped in the little foot thingies--I'm assuming there's an actual name, but it totally escapes me right now--to get a closer look at the iPod dock.

This was not a smart idea. I didn't exercise in the store, other than about a half a stride to steady myself on the foot thingies, but since then, I have been craving exercise machines like, well, like a junky.

Hi, my name is Carrie, and I'm an exercise addict.

I haven't ridden my bike at all this week, as the weather has been freakishly cold, even for this Midwestern native. I started Pilates classes, which are fun and challenging in ways that my cardio marathon sessions never were. Those sessions were a question of endurance, and part of the hook of working out was just to see how hard I could push myself on so little food. My Pilates classes are challenging in that it's hard for me to coordinate positioning my body, doing the breathing, and everything else that goes with it.

The interesting thing is that I'm not craving a bike ride (although I do wish the weather would warm up because I miss riding) or an extra Pilates class. No, I'm missing that damn elliptical machine. All I can think about right now is that machine and the stupid little red flashing lights and yes, that having an iPod dock and speakers would be awfully fun. Except that fun wouldn't last for very long before the trouble started. In a sense, I suppose that being so particularly attached to the machines is a good thing because it doesn't rule out other forms of activity. It just means that I probably shouldn't be setting foot in a gym anytime soon.

The other interesting thing is that the exercise cravings are a (relatively) new phenomena with my eating disorder. Before, I used to mostly miss restricting, or occasionally, purging. My ED-related "urges" were mostly to skip a meal. Not that I don't have those urges now, but it seems that this past relapse altered some of the behaviors that I find myself missing somehow. A lot of it is the exercise and the endorphin rush, but some of these feelings of "missing" exercise has to do with both the routine I had in place for so long to accommodate all of the exercising and the self-identification I had as Carrie the Exercise Freak. I miss the utter certainty I had in knowing exactly what I was going to be doing at every moment in time. I'm far from bored, but my schedule has been much freer since starting to do freelance writing full time.

The identity issue is another thorny one. I don't identify as an eating disordered person and nothing else, but the eating disorder has been such a part of my life for so long that I often feel lost trying to navigate my way through life without having anorexia as my Plan B. This is perhaps not one of the most savory thoughts I've ever had--nor is it particularly flattering of my character in general, but it is what it is--but I miss the feelings of "virtue" I had when I was uber into exercise. I liked knowing how mentioning one of my several daily workouts would give me a social pat on the back. Yes, it was irritating because I knew I wasn't exercising because I wanted to, but it also provided a shred of self-esteem for me. Maybe it was a half of a Milk Bone when I needed a can of Alpo, but nonetheless, it was self-esteem. When I seemed to screw up everything else I did, at least I could be really good at exercising and losing weight. Also losing my mind.

I don't know if there is a solution to these exercise cravings, other than to keep avoiding machines, maintain my activity at a level my treatment team approves of, and trying not to judge myself too much for having these cravings. One step is that I'm naming and admitting these cravings for all the world to see, and I think I need to accept that missing my ED behaviors in a sense is a normal part of recovery. It's not freakish and doesn't make me a bad recovery advocate and doesn't mean I'm doomed to have these thoughts for the rest of my life. It just makes me real.

As I've written before, I'm not much into resolutions. I like the idea (self-improvement), but I've spent so long trying to change myself that I kind of want a break. Nor have any of these so-called "changes" actually resulted in anything positive. But, as the premise of Dialectical Behavioral Therapy (DBT) states, I am doing the best I can right now, but I can always do better.

In terms of recovery, this year has been incredibly rocky. I don't know exactly where I'm at or if there's even a map or a guidebook anyways. But I know that before I can say that I'm "recovered" or "in remission" or that the AN has finally become dormant, I have to work on a bunch of things. So, in no particular order, here they are:

Better utilize my support system. This was a big deal when I relapsed earlier this year- I don't know whether reaching out would have changed anything, or even if I was mentally able to reach out once things got going, but (and this is a big "but") I could have reached out when the depression and anxiety once again started to overwhelm me. I don't know whether I'm just not good at reaching out for help, if I'm just too damn stubborn, or if the issue is more related to not wanting to ask for help. I suppose the "why" doesn't matter as much as my response.

Develop better ways to cope with anxiety. I've come to realize that anxiety is a bigger driver of my eating disorder than even perhaps depression. When they both strike together, it's like a version of the perfect storm. The anorexia props up my self-esteem and reduces my anxiety--what more could a girl ask for? Uh, quite a bit, I think. My medication hasn't "cured" my depression, but I can manage my moods just fine. The SSRI doesn't do the same for the anxiety. At all. I need to find ways to manage my anxiety that doesn't involve excessive exercise and food restriction.

Stop counting calories. 'Nuff said. It's as much of an OCD ritual as it is an ED behavior, and it's almost instinctual. Drives me bonkers not to do it.

Find fun movement. My brain gets this jolt of dopamine when I exercise, so it's hard for me determine the real relationship between "fun" and "exercise." However, I want to find activities that I look forward to, rather than just waiting breathlessly for that endorphin rush. There were any number of things I wanted to try when I was in the DC area, but they all "interfered" with my exercise routine, so I never actually tried them. Then there was the fact that my office and my apartment had fitness centers, and I could never quite bring myself to pay for the privilege of working out when I could do it for free without getting in my car. Mainly, though, it was the "routine" thing.

There will no doubt be other things I will add to this list, and I have some life goals that I'm not especially keen on sharing with the whole wide world out there, but I think this makes a good start with what I need to work on in order to keep moving forward in recovery.

Despite being the end of December, today was unusually balmy (near 60F!). As such, I spotted an unusual number of runners out today. Many of these runners were just using one of the many trails available, or the bike lanes, or whatever. And as I drove past, I realised with a jolt that I was jealous of them. After all, they were burning calories while I was sitting in my car like a Lazy Fat American™. Even more than that, they were getting the wonderful endorphin high that I so often find myself craving. The runners and other "exercisers" seemed somehow so much more virtuous than me, that if the Candid Camera crew snuck up on them, they would get a high-five and a pat on the back, while health officials would only shake their heads at me.

(Have I ever mentioned that those Ambush Makeover deals on talk shows scare the living crap out of me? I am terrified that I am going to be stopped and someone is going to play Tim Gunn or "What Not to Wear" and tell me how horrible I dress. I am also abnormally paranoid when I'm in a public eating setting that some journalist is going to pop up like a jack-in-the-box and ask me if I know how many calories I'm currently eating, and then I will be seen on national TV with my dinner plate. Scenario B says that I will be seen on national TV kicking the guy's ass, followed by a Central Booking mug shot.)

I am currently allowed moderate exercise by my treatment team. Usually, I ride my bike several times per week and just enjoy myself. This is good. But I still feel incredibly guilty when I compare my psycho exercise regimen when I was living in DC to what I do now. I'm aware, on a cognitive level, anyway, that I was exercising way the hell too much, and it led to my relapse and all sorts of other bad things. Yet the guilt remains. I have tremendous anxiety about the wide variety of "exercise recommendations" given out by almost every health agency and advocacy group around the world, and how almost none of them agree. The numbers that seem to stick in my head are the highest number of minutes people are "supposed to" exercise each week. I do less than that, and so I worry what people must think of me when they hear I only exercise X times each week.

This is where The Therapist will usually stop you in your long, rambling monologue about how disgusting you are for not following the guidelines and ask you to come up with a powerful! positive! and affirming! statement about exercise and your eating disorder, such as "Today, I am Choosing Health," or "Every step I run is one step further from recovery." Which may very well be true, but I've always wanted to grab The Therapist by the shoulders and scream, "Who the f*ck are you kidding? I want to be out exercising right now!" And so it goes.

Although a paper from the research journal Nature was typically covered as yet another reason why fat people are fat, it actually has quite a bit of application to eating disorders. The paper, titled "Regulation of adaptive behaviour during fasting by hypothalamic Foxa2," looked at the relationship between hormones released during short periods of fasting and activity levels in mice.

I'll let a press release from Science Daily do some of the explaining for me:

The key switch player in this is a transcription factor called Foxa2. Transcription factors are proteins that make sure other genes are activated and converted into proteins. Foxa2 is found in the liver, where it influences fatburning, but also in two important neuron populations in the hypothalamus -- the region of the brain that controls the daily rhythm, sleep, intake of food and sexual behavior. The control element for Foxa2 activity is insulin, in both the liver and the hypothalamus.

If a person or animal ingests food, the beta cells in the pancreas release insulin, which blocks Foxa2. When fasting, there is a lack of insulin and Foxa2 is active. In the brain, the scientists have discovered, Foxa2 assists the formation of two proteins: MCH and orexin. These two brain messenger substances trigger different behavior patterns: the intake of food and spontaneous movement. If mammals are hungry, they are more alert and physically active. In short, they hunt and look for food. "If you watch a cat or a dog before feeding it, you can see this very clearly," says [lead researcher Markus] Stoffel.

The researchers discovered a disorder in obese mice: in these animals, Foxa2 is permanently active, regardless of whether the animals are fasting or full. This explains a well-known but until now unaccountable phenomenon: the lack of movement in obese people and animals.

To prove this, the researchers used a genetic trick to breed mice, in the brains of which Foxa2 is always active, regardless of whether they have just eaten or are fasting. These mice produce more MCH and orexin and move five times more than normal animals, in which insulin deactivates Foxa2 after eating or which are obese. The genetically modified mice lose fatty tissue and form larger muscles. Their sugar and fat metabolism works flat out and their blood values are considerably improved.

To simplify even further: hungry mice were more active.

Starving people with eating disorders tend to be more active as well. Excessive exercise is very common in people with eating disorders, and is associated with higher levels of anxiety and somatization (that is, physical ailments brought about by psychological stress). Although most people with EDs cite exercise as a way to lose weight or otherwise self-regulate, it may be driven by other biological factors as well.

So why would biology be prodding an organism to get moving when common sense would indicate that they should be resting and conserving every last calorie? One explanation is that a more active animal will move further afield to seek out food. Sitting around won't get you fed; seeking out food just might. Short-term, this is a costly strategy, as there is no guarantee there will be food anywhere else, either. But long-term, you'll definitely starve if you stay in your den where there's no food, so it makes sense.

Of course, for people with eating disorders, the problem isn't the lack of food as much as it is an inability to eat the food that's already there. The body, however, doesn't really care why you're starving. It just knows you are and prods you to go get soemthing to eat, dammit!

I've been pretty honest here on ED Bites about my struggles with exercise addiction and anxiety, both of which have played a large role in the formation and maintenance of my eating disorder. I began formally exercising in college as a way to "get in shape" and also because I heard exercise was good at helping people manage stress. I was stressed to the max, having leaped right into all sophomore classes my freshman year, and so I began the daily trek to the fitness center at my college.

Before my eating and exercise turned pathological on me, and even now that I am in a very different place, recovery-wise, my exercise sessions were very therapeutic. I do feel better--mentally and physically--after a ride on my bike or a brisk walk. In the past, though, when my anxiety has risen from its usual normal highs into the stratosphere on a straight shot to the ex-planet Pluto, I became dependent upon exercise to help manage this anxiety. And I needed more and more exercise to get the same effects. In short, I was in trouble.

The link between exercise and reduced anxiety is fairly well known in psychology and neuroscience circles, but scientists had yet to figure out how exactly this worked. At this year's annual Society for Neuroscience conference, a group of scientists presented research results that give some indication as to how exactly exercise could help with anxiety management.

From the Well blog by Tara Parker-Pope:

In the experiment...scientists allowed one group of rats to run. Another set of rodents was not allowed to exercise. Then all of the rats swam in cold water, which they don’t like to do. Afterward, the scientists examined the animals’ brains. They found that the stress of the swimming activated neurons in all of the brains. (The researchers could tell which neurons were activated because the cells expressed specific genes in response to the stress.) But the youngest brain cells in the running rats, the cells that the scientists assumed were created by running, were less likely to express the genes. They generally remained quiet. The “cells born from running,” the researchers concluded, appeared to have been “specifically buffered from exposure to a stressful experience.” The rats had created, through running, a brain that seemed biochemically, molecularly, calm.

...Anxiety in rodents and people has been linked with excessive oxidative stress, which can lead to cell death, including in the brain. Moderate exercise, though, appears to dampen the effects of oxidative stress.

...“It looks more and more like the positive stress of exercise prepares cells and structures and pathways within the brain so that they’re more equipped to handle stress in other forms,” says Michael Hopkins, a graduate student affiliated with the Neurobiology of Learning and Memory Laboratory at Dartmouth, who has been studying how exercise differently affects thinking and emotion. “It’s pretty amazing, really, that you can get this translation from the realm of purely physical stresses to the realm of psychological stressors.”

Precisely what causes some people to slide over from the beneficial anxiety-reducing effects of exercise and into exercise addiction is unknown. Some of it might be a growing tolerance to the anxiolytic effects of one's current exercise program. Some of it might have something to do with dopamine and the brain's addiction circuits. And some of it, I can't even guess at.

For me, the exercise was a time when I would "hide out" from my anxiety. When I was exercising, I had my iPod blaring and my cell phone switched to vibrate. The report that was due at work the next day didn't matter while I was working out. Figuring out how to pay the bills didn't matter. My sad, pathetic excuse for a social life didn't matter. In the same way one of my friends would stay in bed all day when her anxiety got really bad, I stayed at the gym all day. After exercising, I was usually too exhausted to care much about the things that were making me anxious.

Still, the understanding of how our brains respond to exercise is fascinating and important in helping people better benefit from physical activity and in understanding how to better treat exercise dependence and addiction.

That's the question raised by researcher Rony Duncan. In his "News and Views" piece for the British Medical Journal, published this past September, Duncan argues that gyms do have some responsibility, and lays out three main areas in which this could be beneficial.

1) It provides a possibility for intervention.
2) It can help promote a healthy body image.
3) It can help break through the delusional thinking that accompanies EDs.

The possibility for intervention is well-intentioned and will probably fall on deaf ears. It would have for me. This isn't to say that people shouldn't speak up, just that speaking up will not necessarily produce a newly-converted couch potato. Frankly, if someone had spoken up to me, I would have just switched to a new gym. In fact, I was so paranoid about someone noticing that I took all sorts of steps to make sure I never exercise excessively in any one place at any one time. I spread my exercise sessions throughout the day and in several different locations: outside, my apartment, the gym at work, the gym at home. No one knew, of course, that I worked out several times each day.

The second point is almost laughable. First of all, Duncan is making the assumption that anyone who exercises excessively is visibly underweight. I rarely was. And many others aren't, either. Do we not have a problem until you can count our vertebrae? Secondly, preventing the visibly anorexic from exercising will probably not have a large impact on most people's body image, nor is that something that other people can control. Kicking someone out of a gym because they're very thin and giving other people a complex sounds more like playground logic.

There's also the problem that many men have exercise addictions, and also that someone can have a lower BMI (known as being constitutionally thin) and be perfectly healthy.

The third point is, perhaps, the most valuable. Writes Duncan:

...when gyms fail to intervene over members who are below a healthy body weight, they risk becoming complicit in the delusions held by these individuals, strengthening the perception that more exercise and weight loss are needed.


My long experience with anorexia has left me peeved at any number of things, including the paucity of good treatments (and treatment providers!). One of my other peeves is that, other than my mom, no one really spoke up and told me I was exercising too much or losing too much weight. Would the truth have made a bit of difference? Probably not then. But it's very hard to convince yourself you have a problem when everyone else seems to be living in the same delusional world as you are. If I were sick, I thought, surely somebody would say something.

And because they didn't, it only reinforced the idea that I was fine.

I don't necessarily think that speaking up to an exercise addict about his/her gym habits will magically take off the blinders. I don't know that it will decrease his/her overall exercise. I don't know that it will improve others' body image. I don't even know that it will break through the wall of delusion and anosognosia that comes along with eating disorders.

But there is value in speaking the truth, in saying what needs to be said whether the listener wants to hear it or is ready to hear it. I am incredibly angry that so few people said anything to me during my illness, when I ran to the bathroom after meals, when I basically moved into the gym, when I was using binder clips to keep my pants up. I was secretive, yes, but you would have had to be blind to miss some of this stuff.

Speaking up says one incredibly priceless thing to a sufferer: I care about you. And that is a message that sufferers need to hear, over and over and over again.

I found two related stories on exercise bulimia in my news feed today, and although they weren't glaringly inaccurate, there were some aspects I found mighty amusing (but not in a funny way).

The two stories were: Emerging Eating Disorder- Exercise Bulimia, and San Diego Clinic Helps Exercise Bulimics. The first aired on the CBS "Early Show," and the second appeared to be from their San Diego syndicate.

First of all, exercise bulimia isn't an "emerging" disorder. It's a fairly new name for a really old phenomenon. When the first clinical descriptions of anorexia were written in the 1870s, doctors noted the patients' hyperactivity in the face of starvation. Compulsive exercise has long been a feature of eating disorders, and our current cultural obsession to try and burn off excess calories through exercise only feeds this mentality and normalizes the disorder.

Secondly, a link on "related articles" on the first piece linked to an item called "Want to Lose Weight? You Gotta Work Out."

I mean, Holy Irony, Batman!

Also, very 80s graphic they have going there. Yikes.

Thirdly, the text about the San Diego clinic opened with the following: For most of us, hitting the gym is a necessary evil to keep those extra pounds at bay.

*headdesk*

This just confirms that so many people just don't get it. The mentality that exercise is all about weight loss and that more exercise is better because it means more weight loss and dedication only fuels the problem. During my exercise addiction, no one ever asked if I had better things to do than live in my rank sports bra. I get that these articles are meant to be helpful, but they also continue the subtle misinformation about the nature of these disorders.