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Remission Resources: What To Do When You Can’t Find a Dietitian

After burying my nose in many books and academic articles, I have developed a very strong opinion about the role nutrition plays in the arduous but rewarding process of  ED remission. I believe that proper nutrition, not psychiatrist visits or some form of psychotherapy, is the key to finally being free from your eating disorder. You see, when your brain is malnourished after long-term starvation, it does not have the energy or the capacity to function at an optimal level. That means that all those visits with your therapist and/or shrink are a waste of your time, energy, and money because to get through therapy, you need a brain that actually works.

But of course when you have an eating disorder, getting the sky-high amount of nutrition that is required is basically impossible if you are trying to eat enough on your own. That’s why a registered dietitian is one of the most important members of your treatment team. They have received years of training in helping to heal people with the power of nutrition and they can easily design a meal plan based not only on the unique needs of your body, but also on your dietary preferences.  Throughout my years of being treated by a registered dietitian, I have also found they do an excellent job at focusing on reshaping one’s relationship with food. This is especially important for us eating disorder sufferers since our ED has made food an enemy instead of a something that is not only necessary for sustaining life, but also incredibly enjoyable.

Unfortunately in the US, it is challenging to find a registered dietitian who is experienced in treating eating disorder patients and affording one.  A lot of the times, insurance fails to cover dietitian visits despite the fact that these visits are vital for achieving eating disorder remission.  This means too many ED sufferers are left without the support and knowledge of a dietitian which can hinder their remission progress because they are not getting the nutrition they need.  In these situations, the only option is to start exploring other options. After going on an expedition in the unknown and dangerous territory of the internet, I have gathered some commendable resources that could be used in place of a dietitian. But before I tell you these awesome resources, I want to remind you that these should be used if and only if you are completely unable to see a registered dietitian.  No website can replace the knowledge and compassion of these individuals.

 

The Best Resources for Eating Disorder Remission Nutrition (all of these links will open in a new tab :) )

  • ASK THE DIETITIAN Meal Plan Maker:  I am beyond impressed with this wonderful website and I honestly believe it is the GREATEST resource out there for those in need of a nutritionally-balanced meal plan. The site is the brain-child of Joanne Larson, a licensed registered dietitian who has worked in a myriad of places including hospitals, clinics, and  mental health facilities.  Her website contains informative Q&A articles on a whole host of ailments (including eating disorders) as well as three incredibly helpful tools that will aid you in creating a meal plan that suits your unique nutrition needs.
    • Steps to making your own, one-of-a-kind meal plan
      • 1. Click on the link to be taken to ASK THE DIETITIAN’s “Healthy Eating Plan for Life” tool.
      • 2. Fill in the “Your Body Data” section of the form.
      • 3. Next it’s time to fill in the “Calorie Distribution” part of the form. Do not change the percentages of carbs, fats, or proteins. All you have to worry about in this section is the amount of calories. To figure out how many calories you need, you need to go to ASK THE DIETITIAN’s “Healthy Body Calculator” tool.   Fill in ALL the information except the the Body Fat section and the Waist-to-Hip Ratio section (these can be triggering and they are NOT NEEDED to calculate your calorie needs. When you get to the Weight Goal section, you either need to say you want to maintain or gain. If you have a lost weight due to your eating disorder, you need to accept the fact that you need to gain weight.  Your body and brain deserves to be at a weight where it functions best and that is not at your current eating disorder weight.  Also, when you get to the Calorie Distribution section, DO NOT CHANGE ANYTHING.  Once you complete the form, click “Next”. You will be brought to a page where it tells you how many calories your body needs to be or get healthy.
      • 4. Now that you have the calories you need, go back to the “Healthy Eating Plan for Life” tool. Fill in your preferences. If you are recovering from a restrictive eating disorder, I highly recommend you choose full-fat milk because fat it vital for healthy brain function.  Also higher-fat foods give you more calories for a smaller amount so you will not have to eat as much.
      • 5. Once you complete the form (except the sections I told you not to), click “next”.  You will be taken to a page with your exchange-based meal plan.
      • 6. Highlight and copy your meal plan to a document (Google Docs or Word work best) so that you can save it and print it out.
    • Because this meal plan is based on the exchange-system, it can be quite flexible.  If you are not familiar with the exchange system, click here for a detailed list of food group exchanges.

 

  • The Kartini Clinic Meal Plan: This straight-forward, no-nonsense meal plan was created and is implemented by the Kartini Clinic in Portland, Oregon. Founded in 1998 by Dr. Julie O’Toole (a physician who is VERY well-known in the Maudsley/FBT community), the Kartini Clinic treats children to young adults suffering from a wide-range of eating disorders including anorexia nervosa, bulimia nervosa, EDNOS, and food phobia. Unlike many eating disorder professionals, Dr. O’Toole believes eating disorders are a biological brain disorder that are not caused by parents or by  patients, which I totally agree with. Of course there are some treatment philosophies of hers that I disagree with completely, but I do believe her meal plan is excellent for patients who prefer more rigidity in their meal plans.
    • The meal begins at a base amount of 2150 calories (which is PERFECTLY ACCEPTABLE). A lot of the times, patients need to add more to the meal plan in order to reach a healthy weight for their unique body type and they do this by adding “extras”. Extras include things like adding Benecalorie to their whole-milk yogurt or drinking calorically-dense nutritional supplements like Boost or Ensure.   Unlike most ED remission meal plans, this meal plan only has patients have 3 meals and 1 snack per day. The thought behind this is that eating less frequently allows patients to not focus on food every waking hour.  Another thing you must know about this meal plan is that that require patients to eat full-fat  foods. This means no skin milk, low-cal almond milk, or low-fat yogurt. I know that that can be quite frightening, but remember fat is VITAL for a healthy brain and body.

 

  • Herrin Food Plan: This  meal plan was designed by Marcia Herrin, a renowned registered dietitian who is actually the founder of the respected Dartmouth College Eating Disorder Treatment Program. Like most meal plans for eating disorder patients, this plan requires patients to consume food 6 times a day (3 meals, 3 snacks) and it is based on choosing certain food groups for each meal and snack.  The plan also requires patients to have one cup or double the serving size of each food group AND to consume two “fun foods” each day. What exactly is a “fun food” you ask? Well, let me tell you right off the bat it is anything BUT fun for eating disorder patients. “Fun foods” are basically Herrin’s term for the foods that show up in the nightmares of ED patients around the world. We’re talking cake, donuts, croissants, non-diet soda, fries, chips – basically EVERYTHING an ED patient refuses to even get close to.   Now I understand that it is important for eating disorder sufferers to begin to enjoy food and eat things that aren’t necessarily health foods, but in my opinion requiring patients to do this TWICE a day is a little excessive. Healthy eating means eating everything in moderation and eating dessert twice a day is definitely NOT moderation. Obviously that is just my opinion, so take it or leave it.

 

Finding a dietitian is hard work and sometimes it just isn’t possible to meet with one for various reasons. I hope these resources are helpful to those who can’t meet with a dietitian and give me a chance at achieving remission :)

The Day that Wouldn’t End

As I laid on my bed wrapped up in my flowery bedspread, my mind began to go over yesterday’s events. The endless arguing, the hateful words, the damn reading on the doctor’s scale, the visit with my psychiatrist . . . all of these recent experiences kept replaying in my mind’s eye like an endless horror film.  Because of the negative nature of yesterday’s occurrences, I wondered if I should even compose a blog post on them. Not too long ago, I had promised all of you that I would do everything I could to make this blog a refuge for ED recovery instead of a virtual hell where I would publish posts laced with pessimism.  But then I realized that it wouldn’t be fair to you if I hid something that was happening in my life.   Many of you that are taking the time to read this post today, have been following my blog since its infancy.  You have been with me in times of fear, sorrow, hope, and joy. For goodness sake, you DESERVE to know what is going on and I think it is ok for me to share how I am feeling because honestly, you guys are the only true support I have.

When I awoke at 3:30am yesturday morning (no that isn’t a typo . . . I really haven’t been sleeping well), I had a terrible knot in my stomach. Today was the day I would have to see my psychiatrist and step on his wretched scale. I knew my weight had dropped since that last time I had seen him and obviously his scale would reflect that.  I also fully realized that once my father saw the number of pounds my body contained, my house would turn into a Nazi encampment. I would be stripped of my freedoms, food would no longer be under my control, and my parents would stalk me  like a hungry lion stalks its kill.

When 2 o’clock came around, I packed up my school belongings, signed out at the school office, and walked on over to my father’s car as if I was walking to the gallows.  As I exited my brick high school, I noticed that the blue afternoon sky had been consumed by a sea of ugly gray clouds and the air had become bitterly cold – so cold in fact, I could feel it in my bones. I took this harsh winter-like weather as an sign of the frightening experience that was yet to come.

Once my father and I made it to the psychiatric clinic, my body was taken over by anxiety. My heart was pounding like a base drum beneath the thin, snow-color skin of my chest. My icy hands became saturated with perspiration and my leg began to uncontrollable bounce up and down. 20 minutes after my scheduled appointment time, Dr. K (my psychiatrist) opened the door to the corridor that lead to the atrociously-decorated offices of  the many shrinks that work in the clinic.  At the end of narrow corridor was the electronic scale that would determine my fate. As calmly as I could, I kicked off my black flats and removed my hot pink winter jacket. Quickly, I stepped on the scale and after a second or two a number popped up. I had lost one pound and that was one pound too many.

Of course I was interrogated during the appointment. I was asked by Dr. K all the typical ED questions one could imagine. Are you restricting? Are you stressed? Do you think you are fat? I responded to all those questions with a strong “no”.  Though I was certainly telling the truth by denying his accusations, I knew Dr. K didn’t believe me at all and I also knew my father didn’t give a shit about what I was saying either.

Throughout the rest of the day, my father constantly ridiculed me, especially when I didn’t complete my dinner. I tried to tell him that I wasn’t able to and that I felt too ill, but he had already had his mind set that I had relapsed.

Now I just don’t know where to go from here because even when I tell the truth, all my parents and doctors hear are lies.

New Eating Disorder Q&A Video!!!!! YAY!!!!!!!!

Hello Everybody,

Guess what, I have SUPER exciting news for you! I FINALLY was able to make that Q&A video I have been just dying to create! I hope this video answers some of your questions and also gives you more of a peak into how my little brain works! I love all you guys and remember, if you have any video suggestions just comment down below!

~Claire

Eating Disorder/Anorexia Update !

Remission Resources: Picking Your Outpatient Team

This is my very first Remission Resources post and I am incredibly excited to write it today.  Last week I published a post saying that I would be making some positive changes to this blog that would help encourage people to fight back against their eating disorders. These new “Remission Resources” posts (which will be published every Monday) are apart of these new changes that will be taking place.

Today’s “Remission Resources” post will be focused on giving you the tools you need to help you put together an experienced outpatient treatment team. Throughout my years in being a member of the eating disorder community, I have meant so many women and men who have tried to battle their eating disorders are their own. In my opinion, that is one of the most ludicrous ideas I have ever heard of in my life. Eating disorders are life-threatening brain disorders that won’t hesitate to kill.  If you had any other potentially fatal illness and were told the only chance you had for survival was to undergo a specific treatment, what would you do? Get the treatment of course!  You would not try to recover from the illness on your own! That would be insane! Now what on earth makes you think an eating disorder is any different?

If you want to get into a solid remission from your ED, you need help from a multi-disciplinary team of ED professionals. I know that putting together a team on your own can be challenging and sometimes seemingly impossible, but you are not alone in this. I have your back. This post will guide you through the steps of creating the best, most  supportive outpatient treatment team possible.

Creating an Outpatient Treatment Steps

1. It is extremely important to remember that you need a multi-disciplinary team of ED professionals in order to help you fight your eating disorder. This means your team must consists of a psychiatrist to monitor your mental health and medications, a registered dietitian,a primary care physician to monitor your physical well-being, and a therapist or psychologist to help you tackle the tough emotional stuff.  All of these health professionals need to be experienced in the treatment of eating disorders and should be fluent in current research.

2. Go to AED’s Find a Professional tool. Here you can easily search for psychologists, dietitians, psychiatrists, and primary care physicians. Another superb website is IAEDP’s Find an Eating Disorder Professional tool. Though both these tools are rather similar, I like the IAEDP’s tool better because I feel like the professionals who are members of that organization are more qualified.   If you still are struggling to find people, go to EdReferral.com .

3. After you gather a potential list of people to be in your treatment team, contact these people. Ask them what their treatment philosophy is and what evidence they have that supports this philosophy. Ask them how long they have been treating eating disorder patients and if they are members of any eating disorder organizations.

4. If you like what you hear, see if you can make an appointment to meet with them. If you find them to not be qualified enough to treat ED patients or if you think they are using “old-school” treatment methods, hang up and start searching again.

 

Finding a proper treatment will be difficult, but it will be worth it. You deserve to get better. You deserve to live a life without worrying about calories, exercise, binging, purging, and laxatives. You deserve to get better!

A Friday to Remember

It was early Thursday morning when my dad left the house with a deep blue suitcase in tow. The mundane suburban landscape was still  trapped in a sea of darkness and the crisp fall air bit the skin with its cold, sharp teeth. As my dad drove his little white car and disappear  into the lightless morning abyss, I couldn’t help but be overcome with a feeling of uneasiness. I knew he would be back from Florida on Sunday with stories of the state’s sky-blue oceans and hot yellow sun, but the idea of being with just my mom for even this short amount of time was a frightening thing to think about.

I am not really used to my mom being home for a even a tiny period of time. Due to her demanding job, she usually stays in Chicago during the week and if she’s not in Chicago, well she’s in some other state around the US. Now since my mom isn’t really there during the week at all, I bet you would expect that I would be overjoyed when she returns home. I hate to break it to you, but that is far from the case. To be brutally honest, I have come to dread the moment when she walks through the door after a long week of work.  For a few short moments after she’s come home, she is thrilled to see my dog, sister, dad, and me. She hugs us and as she walks to her room to unpack the over-organized contents of her suitcase, she asks us how are week went. But after she completes this little ritual, her whole disposition becomes choleric. She begins to ridicule us if the house isn’t spotless and makes us feel like we are lazy and worthless. Her anger and frustration spreads throughout the house like wildfire and soon everyone is burning with rage. Fights begin to break out for absolutely no reason and most of these fights are between my mom and I.

So now I hope you can see why the whole idea of my mom staying with my sister and I for a little bit sounded just plain terrible! I thought I would be counting  the minutes till my dad returned home.  But something happened last night that completely altered my whole idea of what my time with my mom was going to be like. It was one of the greatest surprises I have ever had.

Yesterday afternoon was when I began to think this girls-only weekend was going to be a phenomenal bonding experience. You may remember from yesterday’s blog post that I had an appointment with my psychiatrist’s, Dr.K.  Dr. K was running incredibly late and my mom and I were trapped in the mundane waiting of the private psychiatric clinic where he works. For over an hour, we sat waiting. Usually when Dr. K is this behind, I turn into a cantankerous and rather disrespectful juvenile. That day though, that didn’t happen at all. The whole time my mom and I were joking, laughing, and even having conversations that weren’t superficial! I mean IT WAS AMAZING. Who knew that being stuck in a waiting room with some pretty irritable patients for an hour (including a VERY angry drug addict) could be such a pleasant experience?!?!?!?!? :)

After our visit with Dr. K, we headed on home and decided to have a movie night! We ordered food from a local, nutritious Asian fusion restaurant and watched one of the greatest DreamWorks films EVER – The Prince of Egypt! We had such an excellent time and I think today will just as good or even better!

A Frightening Day to Overcome

“To conquer fear is the beginning of wisdom.” ~Bertrand Russell

What many people living outside the eating disorder community don’t know is that anorexia nervosa is not homogenous disease. Though many characteristics of this illness remain constant over a population of sufferers, there are many qualities that are unique to each individual anorexic.  For example, if you were to put just even 10 anorexics in a room and were to question them about their eating disorder behaviors, they would all be completely different. One anorexic may have an intense fear of dairy products while another is completely fine with consuming a yogurt. You may discover an anorexic who believes that even smelling food or drinking water will result in weight gain while another has never had that thought cross her mind.

But despite the wide range of differences in the world of anorexia sufferers, there are many similarities. All anorexics struggle with an intense fear of weight gain and they all restrict their intake in some way, shape, or form. These two things are quite obvious qualities, but if you think these are just the two main qualities anorexics have in common, then you are way off base. You are forgetting one of the most prominent fears in the anorexic community. A fear so severe that it makes the palm sweats, the heart pound, and the mind race a million miles a second. It is the fear of weigh-ins.

For those you who have been lucky enough to not be living with anorexia or any other eating disorder for that matter, weigh-ins are when you head over to the office of a member of your treatment team and step on a scale. Whatever number appears on that dreaded piece of machinery apparently can tell the treatment team member all about the current state of your eating disorder. If you have gained weight, it is a sign a progress and of eating disorder recovery. If you lose weight – even if it is a single ounce – the treatment team member obviously takes it as solid, undebatable evidence that you are involved in eating disorder activity.

Now there are of course many things that are flawed with this method of eating disorder severity measurement.  A number on a scale is only a number on a scale. It does not say if you have been be following a healthful meal plan, have tried foods that your eating disorder forbid you from consuming, have made an effort to stop isolating yourself, or in my case – have been struggling with a physical ailment resulting in weight-loss. In my opinion, a scale is just giving a treatment team member a set of eyes but what it doesn’t give them is the ability to truly see.

Today at 2:20pm I will be in my psychiatrists office waiting impatiently for him to force me to step on a scale. I fear that I have lost weight despite my efforts to try to avoid this from occurring. My appetite has been minimal and I feel fluish a considerable amount of time during the day.  Obviously these two things make it quite a challenge to keep the psychiatrist pleased with my weight.  I know if I tell him the truth about me not feeling up to par, he won’t believe me.  I have informed him before of these symptoms and he has passed my complaints off as nothing more than mere excuses for my weight-loss. I find this very frustrating and I am sure a lot of other ED sufferers are in the same boat I am with this whole weigh-in thing. I understand my psychiatrist just wants me to see me be free from my eating disorder, but just because I have an eating disorder doesn’t mean that is the only problem I have.

I guess I just pray that things will work out and that I haven’t lost weight.  I have made so much progress eating disorder-wise and I plan to share with him that. If he refuses to believe me and justs looks at my numbers, well then there is nothing I can do. He can believe what he wants but I will keep moving forward. I will beat my eating disorder despite the fact that I have been feeling incredibly shitty AND I will prove him wrong.

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