1

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Suggestions for what to tell an ED nutritionist?

Answered on August 19, 2014
Created May 16, 2012 at 4:03 PM

So... I will be starting counselling for an ED soon. Mainly binge eating, with a history of bulimia and anorexic eating. Mostly binge eating, though. That is the main problem I have now.

I'll also be seeing a nutritionist. I've looked up the website for this organisation, and read what they have to say about this portion of treatment. They are advocating eating all four food groups, getting healthy grains, dairy, etc. Not making any food "off-limits" or "bad foods" and so on.

I'm not sure what to do. On the one hand, I want to get better... but on the other hand, I don't feel like I can if I'm doing all of those things. However, I'm the one with the problem, so obviously I should listen to them, right? But what do I tell them?

I feel like I'm kind of stuck. For me, if I have even one bit of wheat, then my binges spiral out of control. Same with sugar, and some kinds of dairy. But I feel like if I argue with them, it will only make me and my disorder look worse. What do I do??!?!

Da2c728c093488e4f2ea87b81619682f

(388)

on October 10, 2012
at 02:52 AM

This is a very, very late reply but I just wanted to say that yes, I usually stop when I run out of binge foods. After that it's like... I can either look for/buy some more wheaty/sugary things, or stop. Eating green beans and so on, as nice as they are, would be like drinking water instead of alcohol. Though good for me, It doesn't have the same effect.

870fdea50f2a9f1cd2890c8e22549300

(2056)

on May 18, 2012
at 12:43 PM

Once a binge is triggered, though, does it end in the absence of trigger foods (e.g. you run out), or do you continue binging on non-trigger foods? If you continue with non-trigger foods then I think the analogy breaks down. If you binge only on your trigger foods then the analogy works.

Da2c728c093488e4f2ea87b81619682f

(388)

on May 17, 2012
at 11:53 PM

Thank you~ That's a good idea. I'll remember to stress the healthy, nutrient dense foods that I DO eat.

Da2c728c093488e4f2ea87b81619682f

(388)

on May 17, 2012
at 11:51 PM

Yeah I guess I'll just say both. Also, I find that only certain foods trigger binges. I have had alcohol issues, and they are JUST LIKE my issues with wheat and sugar. Exactly. In my case, the analogy is perfect (except that sugar doesn't get me drunk, just high...)

870fdea50f2a9f1cd2890c8e22549300

(2056)

on May 16, 2012
at 10:52 PM

I think the analogy to alcohol is really imperfect, for reasons that will take more than the characters in the comment field to explain. Briefly, I think it's a fallacy to think that binging is more about particular foods than it is about the process of binging. If the truth is BOTH that you want to avoid it because it triggers a binge AND that you want to avoid it because you think it is unhealthy for you, why not say both? Telling the truth is always simpler. Less to keep track of.

Cdc21bedc8c5ff5c90a9dc0ea117208b

on May 16, 2012
at 10:00 PM

Other people on here are better at explaining this than I am, so hopefully they can give you a more comprehensive answer, but I hope I helped some. I've noticed a good way to go about informing people about Paleo/Primal eating choices is to let them know the food that you DO eat, and enjoy, and mention that you consume nutrient-dense, whole foods, while saying you dislike processed or refined foods.

Cdc21bedc8c5ff5c90a9dc0ea117208b

on May 16, 2012
at 09:56 PM

That sounds like a very reasonable approach. I'm not very adept at explaining the biological reasons for addiction to foods, but as far as I have been able to discern, gluten causes our brain to produce opiod peptides called gluten exorphins, which may cause addiction. Sugar, and carbohydrates in general cause a 'sugar high', a surge in energy, which doesn't last, so we experience a sugar crash, and crave more sugar to get the 'high' again. I know I experienced euphoric feeling when I ate grains and sweets, and then felt awful after it wore off, so now I just avoid them.

Da2c728c093488e4f2ea87b81619682f

(388)

on May 16, 2012
at 06:13 PM

Thank you. I guess I can tell them that they're trigger foods? But, I would also want to back that up with some kind of science, instead of making it sound *purely* like an emotional addiction and nothing physical either.

Da2c728c093488e4f2ea87b81619682f

(388)

on May 16, 2012
at 06:11 PM

Thanks! That's what I'm worried about; them thinking that I should be able to eat a little bit of "everything" and be ok. I know half of it is mental/emotional, but the other half is not. So.... I hope they understand, since I only have one choice of nutritionist (they're a part of the ED centre)

Da2c728c093488e4f2ea87b81619682f

(388)

on May 16, 2012
at 06:09 PM

Thank you so much for answering. :) Maybe I should print out some info on a paleo based diet, and see what they think. Somehow explain that this will help me. I just don't want them to be like "prohibiting food groups entirely is very unhealthy!" which is what it already sounds like they're doing on the website.

Da2c728c093488e4f2ea87b81619682f

(388)

on May 16, 2012
at 06:07 PM

Thanks! So, what is better to say... "I want to avoid eating wheat because it triggers a binge," or "I want to avoid eating wheat because I believe wheat is an unhealthy food for me to eat"?? I know that eventually I should be able to not binge, but, if it's concerning wheat or sugar, isn't that like saying a recovering alcoholic should eventually be able to have just one drink? Also, I think I should edit my question to say that the nutritionist I will have is a part of the ED centre, so I don't really have a choice in who I get.

Fd70d71f4f8195c3a098eda4fc817d4f

(8014)

on May 16, 2012
at 05:35 PM

Good point. Eating "normally," as defined for the average person out there eating lots of processed grains might not be optimal from a health and wellness standpoint. But you be your own judge as to what's best for your body.

F92e4ca55291c3f3096a3d4d3d854986

(11698)

on May 16, 2012
at 05:26 PM

That MDA post frustrated me. Posts about recovering from an ED which include photos of a tight, hard bod at the end aren't really about recovering from an ED, are they? The whole point is to move beyond the fixation on the body. I mean, this woman still weighs herself every day.

0a819d945f30ae46a104d7a14e50e739

(105)

on May 16, 2012
at 04:52 PM

Hi there. I am not sure I can add to the comments, but I did read this inspiring story on Mark's Daily Apple last Friday: http://www.marksdailyapple.com/the-butterfly/#axzz1v3IuyWvT She also had a history like yours I believe. Good luck.

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5 Answers

2
870fdea50f2a9f1cd2890c8e22549300

(2056)

on May 16, 2012
at 05:15 PM

This answer is a bit of a ramble, because I have several different unrelated thoughts on this subject.

One, I don't know how the initial interview is structured, but I'm pretty sure that at first, the nutritionist will be asking you a number of questions.

It is certainly fair for you to want to ask questions of the nutritionist as well to understand his/her philosophy, and to provide him/her with whatever information you feel is important to know about you. I suspect this will come later in the interview, however, unless you make it clear that you are interviewing several different nutritionists (if you are). You might want to listen to what they have to say first. It might surprise you.

Second, I see a significant difference between saying "I want to avoid eating wheat because it triggers a binge," and "I want to avoid eating wheat because I believe wheat is an unhealthy food for me to eat." If you are being treated for BED, as I understand it the goal is for you to reach a point where no foods trigger a binge. If your motives for not eating wheat are mixed, and you are not upfront about this with the therapist, at least, then you will have problems if for no other reason than your resistance might be misinterpreted.

Third, it's not clear that the nutritionist would want you to eat any particular food. I feel confident that no nutritionist would urge someone with a peanut allergy (=anaphylaxis) to include peanuts in his or her diet. I feel fairly confident that a nutritionist would not urge someone who is kosher or halal (or LDS) to include foods forbidden them for religious reasons. For I also think that nutritionists would (or at least should) honor deeply held ethical principles of vegetarians and vegans (although the advice there may be that their diet is actually harming them). Where things get grayer and grayer is to what extent the CW in the ED community regards non-mainstream food restriction based on an understanding of science that may not be shared.

Really, the ultimate question should be can s/he help you design a day-in, day-out food plan that nourishes you properly from a technical point of view while honoring your food preferences. I can't imagine they'd want you to live on a diet of Twinkies.

Da2c728c093488e4f2ea87b81619682f

(388)

on May 16, 2012
at 06:07 PM

Thanks! So, what is better to say... "I want to avoid eating wheat because it triggers a binge," or "I want to avoid eating wheat because I believe wheat is an unhealthy food for me to eat"?? I know that eventually I should be able to not binge, but, if it's concerning wheat or sugar, isn't that like saying a recovering alcoholic should eventually be able to have just one drink? Also, I think I should edit my question to say that the nutritionist I will have is a part of the ED centre, so I don't really have a choice in who I get.

870fdea50f2a9f1cd2890c8e22549300

(2056)

on May 16, 2012
at 10:52 PM

I think the analogy to alcohol is really imperfect, for reasons that will take more than the characters in the comment field to explain. Briefly, I think it's a fallacy to think that binging is more about particular foods than it is about the process of binging. If the truth is BOTH that you want to avoid it because it triggers a binge AND that you want to avoid it because you think it is unhealthy for you, why not say both? Telling the truth is always simpler. Less to keep track of.

Da2c728c093488e4f2ea87b81619682f

(388)

on May 17, 2012
at 11:51 PM

Yeah I guess I'll just say both. Also, I find that only certain foods trigger binges. I have had alcohol issues, and they are JUST LIKE my issues with wheat and sugar. Exactly. In my case, the analogy is perfect (except that sugar doesn't get me drunk, just high...)

870fdea50f2a9f1cd2890c8e22549300

(2056)

on May 18, 2012
at 12:43 PM

Once a binge is triggered, though, does it end in the absence of trigger foods (e.g. you run out), or do you continue binging on non-trigger foods? If you continue with non-trigger foods then I think the analogy breaks down. If you binge only on your trigger foods then the analogy works.

Da2c728c093488e4f2ea87b81619682f

(388)

on October 10, 2012
at 02:52 AM

This is a very, very late reply but I just wanted to say that yes, I usually stop when I run out of binge foods. After that it's like... I can either look for/buy some more wheaty/sugary things, or stop. Eating green beans and so on, as nice as they are, would be like drinking water instead of alcohol. Though good for me, It doesn't have the same effect.

1
Cb815efa974f52c3d0c2f6a498594ce0

on May 16, 2012
at 04:45 PM

I completely agree with the previous commentator. You know your body and you know your response to various foods. I have been in the same position, cycling between anorexia and near-daily binges on processed sugar and carb-laden foods, and the only way I can maintain a happy medium is to follow a paleo path, avoiding all starches and sugars (sadly, even fruit), eating moderate protein and high quantities of fat. There is actually very little research on eating disorder recovery and there seems to be a pervasive belief that if they can get you eating "normally" then you will be cured, regardless of whether that "normal" eating pattern will make you obese and/or sick. You are hiring them to help you, and if the advice they are giving you is not helpful, then seek advice from someone else.

Fd70d71f4f8195c3a098eda4fc817d4f

(8014)

on May 16, 2012
at 05:35 PM

Good point. Eating "normally," as defined for the average person out there eating lots of processed grains might not be optimal from a health and wellness standpoint. But you be your own judge as to what's best for your body.

Da2c728c093488e4f2ea87b81619682f

(388)

on May 16, 2012
at 06:11 PM

Thanks! That's what I'm worried about; them thinking that I should be able to eat a little bit of "everything" and be ok. I know half of it is mental/emotional, but the other half is not. So.... I hope they understand, since I only have one choice of nutritionist (they're a part of the ED centre)

1
35b2cb4d450e5288895c255dfdfff35d

(5828)

on May 16, 2012
at 04:28 PM

I'm sorry for the struggle you're having with food and congratulations for taking a huge step toward healing.

There was a time in my life when I would eat a loaf of bread in one sitting. I've moved beyond that relationship with bread but eat it pretty rarely now.

My relationship with all professionals is that they are consultants. They give me their advice, they share their expertise, I pay them, I consider their input, I tune into my body, and I do what's best for me. As a culture we deify professionals, especially doctors and other health practitioners.

As painful as this may be, I think you have a great opportunity to take responsibility for what you eat. If you abandon your body to the beliefs of a nutritionist who isn't deeply listening to your concerns then that's not going to help you to heal your relationship with your body. Isn't that what healing an eating disorder is largely about?

If it were me I'd flat out ask the nutritionist if she'll support you on the Paleo path and walk away if she can't. If this nutritionist isn't the right one, I'm sure you can find someone who will be on your wavelength. Perhaps someone on Paleohacks can even recommend a Paleo-friendly nutritionist or ED specialist.

I wish you the best on your path.

Da2c728c093488e4f2ea87b81619682f

(388)

on May 16, 2012
at 06:09 PM

Thank you so much for answering. :) Maybe I should print out some info on a paleo based diet, and see what they think. Somehow explain that this will help me. I just don't want them to be like "prohibiting food groups entirely is very unhealthy!" which is what it already sounds like they're doing on the website.

0
78cb3c4f70de5db2adb52b6b9671894b

on December 10, 2012
at 04:47 AM

I saw your other question and it lead me here. First, when do you usually binge? If it is in the evening, this is probably because she wants you to eat every 4-5 hours so that you won't skip meals and overeat later, which may make you feel too full and trigger a binge.

There has to be some give and take when you go into treatment. I dislike how high carb my meal plan is, but I have accepted that first comes my relationship with food. I can work on tweaking my plan after I have more trust in myself to eat healthily. Nutritionists/dietitians are there for you not just to help you recover physically, but emotionally as well. Work with him/her. Don't go in fighting.

I asked to sub in sweet potatoes as a starch as opposed to grains. It offers the complex carbohydrates that meet my meal plan. If you are primal, you can also ask about tweaking your plan to have dairy to count for some of your carbohydrates. I ate a sweet potato as my first "starch" that I've allowed myself today (outside of binging), and I almost cried after feeling okay with it because it was "safe". It is freeing not to have too much emotion attached to food. I am eating to live right now, and I am okay with that. I am trying to follow my plan and am thinking of it is medicine--and sticking to paleo as best as I can.

If you binge eat, the point of trying to get you to face your trigger foods is so that in the future, if someone asks you to take a bite of cake at a party, or you have just one small "lapse" that you can sit with the feeling, understand that you have control, and not turn it into a full-fledged binge. You have to learn that one bite of a "unsafe" food means that you still have control--that you don't have to give in, say, "screw today" and give up.

You talk about one bite of wheat sending you out of control. You know, after recovery, you never have to touch wheat again. But the point is to not view it as a "bad food" that you will trigger a binge anytime you eat it if you.

ED recovery is about re-wiring your brain to respond differently to environmental cues, and this includes triggers that come with certain foods. If you are at a social outing, for example, and you decide to take a bite out of bread for the first time in say, 4 months, it should be okay. Lots of people on here have slips, eat 80/20, or will occasionally eat something non-paleo. The trick is to train yourself to respond to that emotional feeling towards food...are you going to throw in the towel and binge? Or are you just going to take that bite, not see it as a "trigger food" and move on with your life?

0
Cdc21bedc8c5ff5c90a9dc0ea117208b

on May 16, 2012
at 04:45 PM

I'm going to say pretty much what Sol said...

First of all, I'm really glad you decided to get help.

Second, I had almost the same exact problems with food as you do, for 10 years. I would tell the nutritionist that, for you, grains, sugar, and some dairy trigger a binge. To me, this is not a further manifestation of disordered eating, because you are taking responsibility and admitting you sometimes cannot control your impulses. Your nutritionist is an expert, and should be paid attention to, however YOU know your body, and how it reacts to certain foods, better than they do.

Your nutritionist needs to be able to accept you, personally, or you cannot get personalized treatment. They need to empower your positive choices, and tell you how to avoid making harmful ones. If they can't do that, then I would suggest getting a different nutritionist.

It will be difficult to change your behavior and develop a healthy relationship with food, but it will be worth it, to no longer have food control your life.

And, as Sol said, I wish you the best, as well.

Da2c728c093488e4f2ea87b81619682f

(388)

on May 16, 2012
at 06:13 PM

Thank you. I guess I can tell them that they're trigger foods? But, I would also want to back that up with some kind of science, instead of making it sound *purely* like an emotional addiction and nothing physical either.

Cdc21bedc8c5ff5c90a9dc0ea117208b

on May 16, 2012
at 10:00 PM

Other people on here are better at explaining this than I am, so hopefully they can give you a more comprehensive answer, but I hope I helped some. I've noticed a good way to go about informing people about Paleo/Primal eating choices is to let them know the food that you DO eat, and enjoy, and mention that you consume nutrient-dense, whole foods, while saying you dislike processed or refined foods.

Cdc21bedc8c5ff5c90a9dc0ea117208b

on May 16, 2012
at 09:56 PM

That sounds like a very reasonable approach. I'm not very adept at explaining the biological reasons for addiction to foods, but as far as I have been able to discern, gluten causes our brain to produce opiod peptides called gluten exorphins, which may cause addiction. Sugar, and carbohydrates in general cause a 'sugar high', a surge in energy, which doesn't last, so we experience a sugar crash, and crave more sugar to get the 'high' again. I know I experienced euphoric feeling when I ate grains and sweets, and then felt awful after it wore off, so now I just avoid them.

Da2c728c093488e4f2ea87b81619682f

(388)

on May 17, 2012
at 11:53 PM

Thank you~ That's a good idea. I'll remember to stress the healthy, nutrient dense foods that I DO eat.

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