Dr. J. Renae Norton, Alternative to Inpatient Treatment. I am an eating disorder specialist in the areas of bulimia, anorexia, bulimarexia, binge eating disorder, BED, emotional eating disorder and obesity.
If you are reading this, you are probably in recovery. (Or you mistook it for some Pro-Ana trash. Sorry, but read on anyway). All of my patients, whether they are suffering from Anorexia, Bulimia, Binge Eating or Obesity want to know what to do at Thanksgiving. Depending upon the disorder, there are very specific challenges. If you have food addictions, the holiday is triggering. If you restrict, you may be attacked with a spoonful of mashed potatoes by a well-meaning grandmother. If you purge, you may be trying to remember where the most remote bathroom is at your Aunt’s house in case you blow it.
I put out a call to action on Twitter and Facebook for questions/concerns about the holiday and here’s what I got:
Any ideas/coping skills to get through eating at a dinner table of 20 or more people? I have to eat in front of people, which I hate doing. I have bulimia. I feel like everyone is staring at me when I’m sitting there.
This is a very common feeling/reaction. There is a lot of shame associated with bulimia. The reality is that no one is paying attention to you and most people are worried about how people are seeing them. Try to focus on making the person next to you feel comfortable and it will make you feel more comfortable. Think of yourself as the helper and not the helpless, the therapist and not the patient.
I have been working really hard to kick my sugar habit. I’ve been stressing about how I am going to face the dessert buffet. There are certain desserts that are “family” recipes that we have every year. I just know that sugar is a very slippery slope for me. I don’t want to start back down that road. Is there a polite way to say no thanks?
I think that you can legitimately say that you are allergic to processed sugar. That’s one way. You could also say, “that looks delicious but I promised myself no dessert.” You could also say you worry about your blood sugar levels and you promised yourself no dessert. (I wouldn’t comment on the fact that you only allow yourself to eat “good sugar.” This can be misconstrued.)
This is going to sound crazy, but then again we’re talking about my family, so here goes: I cannot eat gluten. About three quarters of my family gets it, but inevitably, the preparer of most of the food (my mother) makes everything with all kinds of gluten. I’ve politely suggested adaptions that are easy but she claims she cannot do it. It won’t turn out right. I’ve kind of just given up. Is it rude to just bring my own food?
Absolutely not! If you are gluten intolerant it is your responsibility to take care of your gut and lead by example. Avoiding gluten is absolutely critical. I say, bring your own food!
My question is totally not related to food at all but has more to do with family- when a certain member of the family starts talking politics it gets really uncomfortable because obviously not everyone shares the same feelings on a lot of hot button topics right now (i.e. syrian refugees, presidential candidates, conspiracy theories.) Do you have any advice? I hate having to sit and listen without being able to challenge the person’s point of view, but at the same time, I know better than to engage. Thoughts?
I’d get real behavioral on this person. Nod when you like what the person is saying, make eye contact and smile. Give no response, not even a nervous smile, and make no eye contact if you don’t like what the person is saying. Look at your plate. Then get up. It’s time to go do the dishes. Eventually even an amoeba will learn to stop doing this at the table.
My daughter has been in therapy for anorexia for about six weeks. Any advice or words of wisdom?
Just remember that this is extremely anxiety provoking. Any focus on how she looks, what she is eating, what she is going to eat, or what she ate, just makes it worse. The biggest issue for the parent of the anorexic is dealing with their fear. Because the fear turns into anger in a flash. And your daughter can’t help that she is anorexic. It is a disease (of the mind.) Not a choice.
Finally, my holiday tips which have helped my patients over the years get through the holiday relatively unscathed.
Get perspective. This is a holiday to celebrate survival. The pilgrims and the Indians came together to give thanks that they made it through another bitter winter and that they had enough food. So yes the focus is on food, and we have taken it to the extreme, but the real thanks is about how people, families and even members of different cultures/races work together to survive. This is a holiday that recognizes the importance of the family and the role that our grandparents and their grandparents played in our family history. Families are important, no matter how annoying they are.
So here is a tip: Understand that this is not about you, or your eating disorder. No one really cares how you look, they just want to make sure you are ok. Translated, that means that if you don’t want the focus to be on you, focus on the person next to you. Ask her/him questions. Think of yourself as a Jr. shrink or an investigative reporter. You will find that people love to talk about themselves and you have control of the conversation when you are the one asking the questions. (You like control, right?)
Plan ahead when it comes to the food. If you know that there will be no food there that you can eat without getting triggered or sick, then take some of your own food. The safest thing to eat is turkey, especially the breast meat. Take a side dish to go with the turkey that you can share and you are all set. Try some sweet potatoes, that are prepared this way.
Take your own drink and if you are inspired, your own desert. Don’t feel like making desert? How about some organic gelato or ice cream? Cinnamon flavored ice cream is my personal favorite.
Worried about what people will think? Don’t. No one cares what you are eating. Worry more about them eating the delicious stuff that you bring. In fact, you may want to plan on sharing.
Pace yourself. Use the days off to rest and pamper yourself. Get in an extra workout. Start a new book. Take a walk, before or after dinner. Organize a closet that has been driving you nuts, but don’t organize the whole house or spend days cooking by yourself. Take short cuts wherever and whenever you can. Hold a baby. Pet something.
Just remember, whether you are hosting or are a guest this Thursday, this holiday is about survival, adapting and gratitude. That first brutal winter, after the Mayflower arrived, most of the colonists remained on the ship where they suffered from outbreaks of contagious diseases and scurvy. Only half of the Mayflower’s original passengers and crew lived to see their first New England spring. And it was only because the Native Americans were willing to share their wisdom on how to survive in this new land that the pilgrims were able to survive.
You can see why my patients are such an inspiration, especially at this time of year. On they tread, to territory they don’t necessarily want to explore, and yet they know they have to. They must adapt, their lives depend on it. And as they move through recovery, I see them blossom as individuals and in relationship to their loved ones.
(Imagine Julie Andrews spinning through the alps, praising my favorite fats…)
My four favorite fats are:
I Can’t Believe It’s Not Butter.
Just Kidding! Those are my most disliked fats.
My favorite fats are:
100% grass-fed raw butter
100% grass-fed Ghee
Organic, cold-pressed, extra virgin coconut oil
Italian, cold-pressed, extra virgin olive oil
Best sources of fat:
100% grass-fed animals and game
Wild caught fish that are low in mercury, high in selenium
Coconuts and olives
In general, those first four fats are hydrogenated, rendering them a trans fat and/or they contain GMO ingredients. Whereas my favorite fats are raw except for the Ghee, which is a clarified butter, and the fats found in grazed animals and wild-caught fish.
It is hard to find raw butter in some parts of the country, like Ohio. Here you have to join a herd share. But it’s well worth it. For one thing it tastes amazing. In addition, raw butter from 100% grass fed cows is the best fat you can get. It is the only fat with a perfect ratio of Omega 6 to Omega 3 fats, which is 1:1. This is important because we get way too much Omega 6 fat in the standard American diet, like 30:1. Experts say that the ratio is as high as 60:1 for individuals that are really unhealthy.
Ghee is a class of clarified butter that originated in ancient India and is commonly used in South Asian cuisines, traditional medicine, and religious rituals. Ghee is prepared by simmering butter, which is churned from cream, and removing the liquid residue. The texture, color, and taste of ghee depend on the quality of the butter, source of the milk used in the process, and the duration of the boiling. This is one of the dairy products that can be heated without destroying the goodness because it has no lactose and very little protein.
I am going to do an entire blog on coconut oil. Go here to listen to Bruce Fife and I talk about it. He is the coconut king.
In a nutshell, no pun intended, coconut oil is as good as it gets. I fries well, has a high smoke point, tastes great (no it doesn’t make your food taste like coconut) and doesn’t store as body fat. It basically is pure energy as it goes straight to the liver. It emulsifies fat and actually does reduce cellulite. It is also amazing for your brain and you can use it on your skin and in your hair.
I loved Olive Oil, even as a kid, she was my nerdy, flakey hero! But it just barely makes my list, and I use it sparingly as it is an Omega 6 oil. Usually I only use it in salad dressings (unless I make them from yogurt or heavy cream). I also marinade fish in olive oil and lemon juice, although I fry the fish in butter or ghee. Make sure that your olive oil is actually really olive oil. Word on the street is that they are lacing it with canola oil and other lesser oils. So buy organic and from a known source. I prefer the old Italian family olive oil makers as they seem to make the best oils.
Fat From 100% Grass-fed Beef
The one thing you need to know about this fat is that it stores as muscle, not fat! That’s right conjugated linolenic acid, (CLA) the main fat in grass-fed beef ends up as muscle, not fat. That is why people didn’t like grass-fed beef initially as it did not have the “marbling” or fat that grain-fed beef had. But guess what? The thing that makes the cow full of fat, makes us full of fat too. So you decide. Pastured animal fat is also GMO free, another big plus.
Fat From Wild-caught Fish
Definitely one of the healthiest fats you can eat. Omega-3 fatty acids are helpful for the heart, immune system and against a range of diseases.
They have been shown to lower elevated triglyceride levels, curb stiffness caused by rheumatoid arthritis, lower depression levels, reduce symptoms of attention deficit disorder and protecting against Alzheimer’s disease and dementia, according to WebMD. That’s a lot!
“I simply remember my favorite fats, and then I don’t feeeeeeeeeel, soooooooooo baaaaaaaad!”
For decades, we have been told that saturated fats are unhealthy and that they are the root cause of the epidemics of heart disease, obesity and high cholesterol in our society. This is simply not the case. Ansel Keys was perhaps the most well known researcher associated with these theories followed by Nathan Pritikin, creator of the Pritikin Diet. Both men got it wrong for various reasons. For example, when they looked at coconut oil, which is one of the best oils you can use, they used hydrogenated coconut oil. Any processed oil, especially hydrogenated oil, is going to be bad for you. Heat denatures protein and ruins the oil, making it dangerous to consume. So unrefined cold pressed is the way to go. These two researchers also missed the boat because they didn’t control for the role of other pollutants in processed fats.
Scientifically, their theories were proven to be incorrect decades ago. Yet we are still being told that the good fats are bad and the bad fats are good. Likewise, we are encouraged to eat less fat, when we should be eating more of the good fat and none of the bad fats. But which is which? Well I have a chart for you that is as comprehensive as I can make it and still fit it all on one page
Note the Omega 6 to Omega 3 ratio (green column). The United States tends to consume oils with a 30-60:1 Omega 6 to Omega 3 ratio. That’s way too high.
What is apparent today is that saturated fats are not the problem. It is the polluted and/or processed version of saturated fats, along with the over abundance of processed unsaturated oils that are causing some of the most serious health problems we face today in the U.S.
In a nutshell, the healthy fats are grass-fed animal fats and medium-chain fatty acids such as coconut oil, along with unsaturated Omega 3 fats and the naturally occurring trans/sis fat, conjugated linolenic acid (CLA). They taste delicious, control blood sugar levels and have healing qualities from which everyone benefits. Whereas man-made polluted trans fats and vegetable or seed fats that have been hydrogenated or otherwise processed are literally killing us.
Many people today talk about being “addicted” to a food or foods. I think that most people believe they are using the term loosely, i.e. that they are not really “addicted”. I would disagree. I see far more people in my practice today with food addictions than without, regardless of the type of disordered eating they have. Many of them have been in treatment for years, sometimes half of their lives. Some of them are on disability because of their eating disorders, which I believe are driven by food addiction and by the complications of food addiction. Whether they are anorexic, obese or bulimic, they almost always have food addictions. I can’t tell you how many Anorexic patients I have that are addicted to sugar. Since they are deathly afraid of fat, they treat themselves with candy. I have one patient who suffered from Anorexia that ate jolly ranchers and very little else for years prior to treating with me.
Food addiction as a component of an eating disorder is a change that has come about largely because U.S. foods are increasingly polluted due to the manner in which they are processed or grown. For example, U.S. grains, which are hyper-hybridized, meaning they took the protein out and left the starch in, are super addicting. That’s one of the reasons you cannot lay off the bread or the cereal once you start eating it.
Likewise, one of the most common food additives, processed free glutamate (aka MSG) which, is added to nearly every packaged food and drink, is also highly addicting, as well as fattening. It has been used for 75 years to fatten lab rats in obesity studies. The problem is that it is not labeled as MSG. Instead it is hidden from the consumer and called such innocuous names as “citric acid” or “malted barley” or “hydrolyzed yeast”. If you are eating packaged foods or drinks, it is virtually impossible to avoid processed free glutamate unless you are familiar with the 30 or 40 names by which it may be labeled.
Then there is U.S. genetically engineered sugar, especially that found in the form of High Fructose Corn Syrup (HFCS) that has been shown to be as addicting as Heroin or Cocaine, and is in virtually every processed food, including condiments. The content of sugar in some cereals targeted to children is as high as 60%! Ever wonder why your kid will eat nothing but cereal for breakfast? Or why one of your favorite “healthy” binge foods is cereal? Or how about that Coke that you love so much? It has the equivalent of 12 teaspoons of sugar in the form of HFCS (classic) or GMO table sugar if you go with the new improved version from Mexico.
The other reason people are dealing with addiction without realizing it, is that no one is minding the store when it comes to treatment. By that I mean that treatment is still all about moderation instead of abstinence. There is a myth that U.S. foods are safe and that the obesity epidemic, which has made us the most obese country in the world, is the result of overeating due to a lack of willpower. Not true. Americans do not lack willpower. They lack information. U.S. foods are anything but safe. They are polluted, causing disordered eating among the majority of the population, unwanted weight gain, premature aging and the escalation of killer diseases. U.S. foods are obesogenic, autogenic, carcinogenic, and allergenic for most of the people eating them. Unfortunately, Americans are clueless about the safety of their food. The true nature of this problem is simply below the radar of the average person.
While I can understand, no matter how strenuously I disagree, with the food industry’s tactics, i.e. they look at making us addicted to their product as a way to create customer loyalty. I do not understand how those of us entrusted with responsibility for protecting and healing, can promote the ingestion of polluted foods during re-feeding when it comes to bulimia, anorexia, or obesity.
Isn’t it the job of the residential and intensive out-patient eating disorder centers, and/or the diet industry expert/coach, to know about the impact that polluted food has on bingeing, overeating and food addiction? I mean, isn’t that kind of fundamental? Where is the accurate information? Where is the science in their treatment protocols? How do they get away with such abysmal results? Why do insurance companies pay so much money for such poor outcomes?
Thanksgiving is a really hard holiday for a lot of people.
For people who are newly recovering from an eating disorder it can be tough. For obese patients, the thought of having to face all that food is enough to make them want to skip the holiday altogether. For binge eaters, who are in an already stressful situation, they just want to hide out in the kitchen eating. For a patient with an eating disorder who is not in treatment, it can be an incredibly uncomfortable situation. For parents of a child with an eating disorder, the thought of having all that food on the table and the person not eating can make them livid. I could go on and on. But I won’t.
Instead, I want to hear from you. What is your concern about Thanksgiving? Do you have a specific question? I’d love to hear from you. I’m compiling questions to answer in a blog post right before Thanksgiving. My goal is provide some tools to manage the holiday. I’ll also include my answers in my newsletter on Tuesday November 24th.
So, please tweet me your questions @drrenae, send me an email at email@example.com with the subject Turkey Time, or message me on Facebook. All questions will remain anonymous.
I promise, with a little courage from you asking the questions, and me giving you the tools, this Thanksgiving will be different. Because you’ll be prepared. Let’s face the fear before we sit down at the table.
For the past week or so I have been talking about the moderation versus abstinence model when it comes to recovery from eating disorders and obesity. I advocate clean eating, or abstinence from polluted foods, which I define as follows:
All organic fruits and vegetables (or sticking with the clean 15 and avoiding the dirty dozen)
100% grass-fed sources of animal protein
Wild-caught fish low in mercury and not exposed to nuclear waste
Oils that have been minimally processed, are organic and Non-GMO, – coconut, olive, ghee, grass-fed raw butter
Foods free of MSG, GMOs and food additives, food coloring or chemicals used in processing
Minimal grains – substitute hemp seed florettes or nut flowers
No protein powders – use Sacha Inchi instead
No sodas made with sugar, no cigarettes and minimal alcohol – red wine in very limited amounts
No table sugar – use Xylitol
No table salt – use naturally harvested Himalayan sea salt
Good bottled water – FIJI is nice
Lots of pre-biotics and pro-biotics
Lots of fermented vegetables and drinks – like Kombucha and kimchi
Sea weed (unless you have Hashimotos)
Eating this way and getting sunshine will stabilize your weight, reverse the aging process, prevent or reverse autoimmunity, decrease or eliminate inflammation, support your neuro and cardio vascular systems, help to stabilize your hormones, clear your gut and improve your immunity. So with all of those benefits, why isn’t everyone eating healthy? Because they are in denial.
According to the results of a poll conducted by Consumer Reports Health “Americans tend to give themselves high marks for healthy eating, but when we asked how many sugary drinks, fatty foods, and fruits and veggies they consumed, we found that their definition of healthy eating was questionable,” said Nancy Metcalf of Consumer Reports Health, which conducted the poll.
Of the 1,234 American adults polled, 89.7 percent said their diet was “somewhat” (52.6 percent), “very” (31.5 percent), or “extremely” healthy (5.6 percent).
But 43 percent of the survey respondents said they drank at least one sugary soda or other sweetened drink every day, and just one in four said they limited sweets, sugars or fats in their diet. Just looking at the sugar alone; we know now how deadly sugar is when it comes to inflammation, especially neurovascular health. Sugar has recently been shown to be as addicting as heroin or cocaine. It is also a problem when it comes to neurological health. For example, it is now believed that Alzheimer’s is a new form of diabetes. Indeed some are calling it Type 3 diabetes and of course it is largely driven by the excessive amounts of sugar in the US diet, especially the sugar in soft drinks. But it also driven by the high fructose corn syrup (HFCS) that can be found in most US processed foods. HFCS is in everything from catsup to cookies.
Instead of avoiding these “foods,” Americans are trying to use them in moderation. The poll found that 4 in 10 Americans said they ate “pretty much everything” or “mostly everything” that they want. Given that the United States is the number one fattest country in the world with the distinction of being the unhealthiest, wealthiest country in the world, I’d say we are in denial.
The poll also found that few count calories or weigh themselves, but when they were asked to report their weight, 4 in 10 were wrong. Huh, go figure! A third said they were at a healthy weight when they actually were overweight or obese according to the researchers. Interestingly, 8% thought they were overweight or obese when they were actually a normal weight using their BMIs. Budding Anorexics?
Only 3 in 10 Americans surveyed by Consumer Reports said they eat the recommended five or more servings of fresh fruit or vegetables daily. For those who do not eat the recommended amounts, the most common reason was that they thought they were consuming enough already. Denial.
Other reasons given were that vegetables are hard to store or spoil too quickly — an excuse given by 29 percent of Americans. I hear this a lot in my practice. Can you say frozen vegetables? As a single person, I am a big believer. They have been shown to be just as nutritious, sometimes even more nutritious. They are definitely easier and faster to prepare. (I pride myself on being able to prepare a scrumptious meal in under 8 minutes.) Costco has the best deal, a 5 pound bag of frozen fruits or vegetables for around $6.50. They are delicious and great for smoothies and you cannot beat that price.
Many people say they don’t like vegetables. In the poll, 17% said someone in their household didn’t like vegetables, and 13% said they don’t like them. I believe this is a consequence of eating so much polluted food that is loaded with MSG which over excites the taste buds and makes you crave fake salt and sugar. If you prepare the vegetable correctly, I defy you not to like them. Steam, boil or even nuke them and add coconut oil, sea salt, along with your favorite herbs and spices…..so delicious!
Those polled also said that vegetables take too long to prepare or are too difficult to prepare. Come on! There is nothing easier than sticking the frozen vegetable in a microwave safe dish adding some coconut oil and sprinkling on organic seasonings. Three minutes and 30 seconds and voila!
I care deeply about my patients. I have to dispel a lot of food myths in my practice and one of the biggest is the Moderation Myth. Moderation worked for a previous generation because our food was nowhere near as polluted as it is now.
The new food truth is this: In light of what we know about polluted food, Abstinence is the only guarantee of health.
My theory is that the individual suffering from Anorexia conditions this response (not necessarily consciously) by continuously programming the advantages of fat free foods and demonizing foods with fat until the brain reacts accordingly.
It’s a sort of feedback loop, s/he sees fat free food, the part of the brain that drives addiction fires up, and she is reinforced for seeking out more fat free foods. And/or s/he sees foods with fat and experiences fear, does not eat the foods with fat, experiences relief, which again, reinforces eating more fat free foods.
Of course, this is a very dangerous solution to a very serious problem. Giving up fat, which is actually very good for you when it is the right fat, is definitely not the solution. And restricting is incredibly dangerous.
But I cannot ignore that many foods in the United States are polluted and eating them is also not good for you!
As the obesity rate soars, Anorexia is affecting more of the population, with younger children, older women and more men. I cannot help thinking that what the individual suffering from Anorexia is reacting to, in part, is the truly unhealthy nature of U.S. foods.
It is fascinating. I have been saying for years that those suffering from Anorexia are addicted to restricting. When it comes to treating Anorexia, I believe that it is this dynamic that makes it impossible for approaches using a moderation model to be effective and helps to explain why abstinence from polluted foods works so much better for this population.
The problem with the moderation model used by most treatment centers is that processed foods are designed as binge foods. Yes, I said “designed”. The food industry refers to the ideal customer as a “heavy user” and does everything possible to insure that once we eat the food, we will never want to stop.
Polluted foods are loaded with MSG, an excitatory neurotoxin, that has been used for years to fatten lab rats. When the Anorexic patient goes into residential treatment, where she will be forced or strongly pressured into eating polluted foods, she often enters as an Anorexic and exits as a Bulimic or a Bulimarexic.
Impact Residential Treatment Has Had on Me:
Years of research, and personal, as well as clinical experience, has shown me that eating polluted food is dangerous, even if you eat it in moderation. It actually attacks the parts of the brain that regulate healthy eating. I think avoiding it altogether by eating clean food is safer. It offers the opportunity for great healing to take place. I am a believer in what Hippocrates taught us: Let food be thy medicine and medicine be thy food.
At the end of the day, my Anorexic patients are much more willing to eat clean unpolluted food, than they are to eat polluted or processed foods. This is a good thing, as the clean food not only nourishes them but allows them to gain weight slowly, usually as muscle, instead of as middle fat. Clean eating also “feels better” in them, i.e. it doesn’t cause bloating or inflammation or migraines or rashes….. They report that they learn how to trust food again. I am convinced that this is why patients that recover by eating clean are significantly less likely to relapse.