Monday, March 12, 2018

Recovering Into Orthorexia

Orthorexia Nervosa: an obsession with eating foods that one considers healthy.
a medical condition in which the sufferer systematically avoids specific foods in the belief that they are harmful.
(source)

Over the past few years, orthorexia has become a better-known term. It is thought to be one of the most common eating disorders, however, because it is not recognized in the Diagnostic and Statistical Manual (DSM), exact medical research is scarce. Orthorexia is thought to be recognized under the Otherwise Specified Feeding and Eating Disorder (OSFED) category, but research on OSFED alone encompasses so many vast behaviors and thought patterns, and cannot reflect orthorexia alone.

So, what is orthorexia? 
The National Eating Disorders Association states the symptoms of orthorexia as:
  • Compulsive checking of ingredient lists and nutritional labels
  • An increase in concern about the health of ingredients
  • Cutting out an increasing number of food groups (all sugar, all carbs, all dairy, all meat, all animal products)
  • An inability to eat anything but a narrow group of foods that are deemed ‘healthy’ or ‘pure’
  • Unusual interest in the health of what others are eating
  • Spending hours per day thinking about what food might be served at upcoming events
  • Showing high levels of distress when ‘safe’ or ‘healthy’ foods aren’t available
  • Obsessive following of food and ‘healthy lifestyle’ blogs on Twitter and Instagram
  • Body image concerns may or may not be present

It is rare to find treatment specifically for orthorexia. However, treatment from general OSFED, anorexia, bulimia, and binge eating is more easily accessible than orthorexia or other specific disorders that fall under the OSFED category. When you're in the beginning of recovery, especially in a treatment program/facility, you're in a tiny bubble of safety. However, sneaky diet culture can slip it's way in and if it doesn't, it will once you're back in the "real world". For those of us diagnosed with an eating disorder, we may be prone to not just relapse but a "switching"of diagnostics. There is no exact statistics, but sources such as Healthy Place, Science of EDs, and Orchid Recovery have stated that switching symptoms is very common. Because of this likelihood being mixed with orthorexia on the rise, not only could people with EDs (especially restrictive ones) slip into orthorexia, but it could be ignored or invisible.

As orthorexia weaves it's way into a sufferer, it is seen to present intentions of health, wellness, and prosperity. The goal of eating disorder recovery is to gain back heath and liveliness, but with a world full of short-term (if any "term" at all) solutions that seem so promising, it can be easy for your eating disorder to seek a new obsession in attempt to not be eradicated. Perhaps it's something commercial such as Atkins, Weight Watchers, or a well known gym. Maybe it's paleo, raw food, or high carb-low fat. Or perhaps it's an exaggerated adaptation of things you always associated with health. When it boils down to it, it doesn't matter what you are or aren't eating that determines "how orthorexic" you are, it's the mindset you have. 

For the next bit of text, I'm going to be talking about my experience with anorexia nervosa and orthorexic tendencies. If you have concerns that it may be triggering, scroll until you see bright blue text like this.

I was around 8 years old when I unknowingly developed anorexia symptoms. I would avoid eating before school weigh ins, only eat a reasonable quantity of food before or after gymnastics, and force myself to look in the mirror during routines for "motivation". I didn't know anything was wrong but after my usual picky eating became less and less, my parents and one coach started to worry. After learning what anorexia was, I was determined not to upset anyone by "getting it". Still, I couldn't bare to let go of what controlled eating gave me. I convinced myself I didn't have anorexia- I couldn't. Even the doctor implied I couldn't possibly at my age. In order to be my healthiest and still not become lazy, or fat, or whatever I dreaded, I used basic elementary nutrition knowledge to build off of that. I wasn't limiting my intake- in fact I could eat lots of food...if it was safe. I went vegetarian (a decision I am now happy about but was probably unhealthy at the time), followed fitness blogs, learned to count macros, exercised relentlessly, uploaded workout pictures, and of course tracked my food. I would freak out about being offered "unhealthy" food and make sure everyone knew I wasn't blind to "how bad I was". But deep inside, I couldn't keep up the healthy front. It wasn't what my eating disorder wanted anymore. I was still anorexic, but developed so many orthorexia symptoms that would not go away, at least not easily. Fitspo lead me to thinspo then to bonespo and so on. I swapped health blogs for pro-ana communities. My ED was thrilled to finally be "free to starve". Fast forward to discharge from the first inpatient. I was more aware of diet culture than ever before. Health was no longer something I wanted, but everyone wanted it for me. If health truly was cleanses, fasts, and macros then why couldn't/shouldn't I participate? My parents always were the wiser, but it was easy to use modern day health claims to keep my eating disorder while portraying I was recovering. But, it got trickier when I was convinced I really was recovering. I was physically recovering but found myself tensing at the thought of not replacing every ingredient with a "superfood" version. It doesn't last long for me before my anorexia decides to say "screw it" and accept my unhealthy intentions, but I always get conflicted between what's real recovery and what's my illness trying to stick around. Still, I speak from a place of privilege, considering I have never dealt with full blown orthorexia.

So, what can we do to be sure were not trading out one eating disorder for a more socially acceptable one?

-eat traditionally "unhealthy" foods when you either have support or feel it necessary. 
-if you can afford to, find an intuitive eating/health at every size dietitian, therapist, physician, or other clinician
-again, if you can afford to, seek treatment at a place that treats orthorexia in addition to your diagnosis (One I've heard of, Timberline Knolls, treats orthorexia)
-build up a supportive network
-discard any photographs, accounts, blogs, etc regarding health and nutrition
-rely on you care provider(s) to make nutritional decisions for you until they can allow your involvement
-challenge your thoughts through journaling or other thought-stimulating activities
-be vulnerable and reach out to a hotline, chatline, or website supporting eating disorders
-open up to a loved one and/or care professional
-don't blame yourself. it's okay to struggle and recover

Because orthorexic behaviors are so normalized, it can be hard to differentiate true health and disordered behaviors. You are not alone or invisible if you're silently struggling with orthorexia. 

Tuesday, February 6, 2018

Vegan In Recovery

You're probably reading this for one of 3 reasons
1) You're vegan and want to see if anything I say is reasonable or justifiable
2) You want to be vegan and prove it's okay if you're in recovery
3) You know someone in recovery who is vegan or wants to be and prove it's not okay or totally fine

So here comes my answer to the question "Is it safe to go vegan in eating disorder recovery"?

Short answer: (ha! there isn't one)

It's a super complicated question that people over simplify.

If you go to any treatment center it'll almost always be a hard, inflexible "NO"

If you explore the YouTube comments, go to a vegan specializing dietitian, it'll be an immediate, nearly forceful "OF COURSE"

So which one is it?

My Personal, Uneducated Opinion
I was personally vegetarian through the entire course of my treatment. I was already disordered as a meat eater, however I do finally acknowledge my parent's accuracy in seeing how allowing this took it to another level. With that in mind, it is hard to determine if being completely vegan in recovery is safe let alone healthy.
It took forever for me to get to a point where I acknowledged that becoming vegetarian or vegan could be remotely disordered.
Once I did, I outlined my own guide to help myself transition safely.

I think that if someone is under the guidance of a professional experienced in both eating disorders and nutrition, it can be more than possible, not to say it can't happen on your own.

I do think that going vegan for anything but ethical reasons (animal, environment, society) is a huge red flag and a reason to step back. Going vegan for any reason that involves "health", control, coping, or weight is a huge sign that you may not be stable or mentally rational enough to go vegan.

If you find yourself doing/thinking any of the following in regards to a vegan lifestyle it may be a good idea to slow down or put off going vegan:
- a desire to also be raw, practice 80/10/10, gluten free(with the exception of celiacs), whole30 etc
-fearing animal products because of affect on weight or health
-only eating safe foods
-focusing on how it affects your body size or health
-feeling you couldn't recover if you weren't vegan
-over analyzing nutrition facts or ingredients
-not eating at all if there isn't a vegan option
-hiding behind ethical reasons

Here are also some signs that you may be able to introduce veganism into your recovery:
-you can eat all food groups
-you can eat fear foods
-you've eaten animal products and worked through it
-you have nearly no interests in veganism in regards to weight or nutrition
-you have a professional or loved one that supports veganism and recovery (even if within limits)
-you feel comfortable knowing that you may not change your weight or have anymore control
-you can be flexible and eat non-vegan things if you must

When it comes down to it, the main difference is the mindset.

A health mindset isn't my favorite, but some people are interested in veganism for health reasons and that's okay, it just gets blurry when it comes to eating disorders and disordered eating.

If you are flexible (as in you can be 95% vegan or 99% vegan and it's okay to not be 100% plant based all the time with no excuses), are not abusing it to change your body/health/control, not relying on it for the sole purpose of recovery, have an ethical and positive mindset, it should be possible to be vegan healthily.

The Case For Veganism In Recovery (ft. sources)
Both the vegan community and the recovery community seem to have a lot of positive intersection. There's a lot of guilt in eating when you're coming from an eating disorder so it's a very common thought that alleviating the guilt that comes along with promoting an industry that kills, tortures, and exploits animals can help ease a bit of the less rational guilt that the disorder brings along. Also, for those who were vegan BEFORE treatment/recovery it can be safer to be vegan even if it's temporary. When we cut out any food, our body will treat it as if it's foreign when we re-introduce it. So for someone who has been vegan for years, having them eat pepperoni pizza on the first day of inpatient could cause the less than pleasant GI symptoms to be even more unpleasant. For people motivated in recovery it can serve as a reason to recover. A goal to reach, in a sense that it is something worth becoming healthy and happy for. Fortunately there are much wider varieties of vegan foods now a days which can disprove the idea that veganism is inherently restrictive. It can help put black and white thinking of foods into a gray zone. Knowing that a delicious new food is vegan may help encourage recovering eaters to try it and explore. It can make food fun again. Looking at food from a perspective outside of numbers, fears, and disordered patterns can be exhilarating. Instead of seeing low calorie vs high calorie, your decisions come from a place of compassion, ethics, and morals. When a food fits your beliefs it's easier to invite it. 

Sources: 
https://www.vegansociety.com/whats-new/blog/veganism-and-eating-disorder-recovery-part-1
http://followtheintuition.com/being-vegan-in-recovery/
https://www.youtube.com/watch?v=hqJuaEIVmiwhttp://www.veginout.com/blog/going-vegan-can-improve-both-your-physical-and-mental-health/
The Case Against Veganism In Recovery (ft. sources)
A huge reason people are against veganism in recovery is the thought it's restrictive. While I address it in the pro-vegan section, it is just as true as it is untrue. It is true that it is much harder to eat as much and as variously in today's world as a vegan. Even if the intentions aren't restrictive, it does require a lot of effort to not eat considerably less whether it be calories, quantity, or variety. And when it comes to a restrictive eating disorder, it is nearly impossible not to use veganism to restrict. Veganism has been widely abused for "health" (forgetting that all foods have a place in health and happiness) and bodily obsessions. Despite positive intentions, it's hard to look up a vegan recipe and not also find "gluten free" "low carb" "keto" etc. You will be completely bombarded with diet culture, which can be damaging.  Becoming vegan allows for more opportunities to hide eating disorder behaviors as well even if it isn't intentional. People with eating disorders tend to be more emotional and have perfectionistic qualities and a desire to please. The overwhelming emotions for animal welfare may have the best desires and be truly non-disordered, but when mixed with the perfectionism and feeling as though they'll never truly make a difference or please anyone, it can be a lethal mix.


Sources: 
https://spoonuniversity.com/lifestyle/the-problem-with-going-vegan-after-recovering-from-an-eating-disorder
https://www.youtube.com/watch?v=gQAOiyi_CpY
http://www.thebalancedblonde.com/2014/06/23/why-im-transitioning-away-from-veganism/
http://tabithafarrar.com/2017/02/daughter-ethical-vegan-anorexia/
http://tabithafarrar.com/2016/06/back-veganism-eating-disorders-conversation/
http://glossary.feast-ed.org/6-associated-or-co-morbid-conditions/personality-characteristics-associated-with-eating-disorders

Words From Instagram
Here I asked followers to identify pros and/or cons of being vegan in eating disorder recovery, and they delivered! It addresses more than just restrictive EDs as well, which is much needed!
(note: some are edited for clarity or grammar)

Pros:

"Going vegan took away some guilt for me because at least I wasn't eating a dead animal who had a life and was a sentient being" -anon
"For people who have been vegan for a while for non ED reasons, eating meat etc would wreck all relationships with food they have left" - @discovering.kelly
"It's easier to have compassion for yourself when you're living a life of compassion outwardly" - @orbit_the_moon
"[It] makes you feel mentally good because you're doing something for something bigger than you" - @_growing.flower_


Cons:
"A con would be that weight loss is always a big topic in the vegan community & sometimes it can be really triggering" -anon
"A lot of vegan food is lower calorie or can be. It's also harder ([but]not impossible) to get all macros and micros" - @discovering.kelly
"[It] can make you too used to not eating fatty food or high calorie food and might over do it [when opportunity avails]" -@_growing.flower_

In Conclusion
There is no answer. There's no official study. We all have a different relationship with our eating disorder and its effects on food. As I said before, ethical and environmental veganism can be safe but definitely hesitate when it comes to health goals especially if you are deep in your eating disorder. It is best to seek out professional advice for your journey. If you can safely be vegan in recovery, I'm so happy for you! And if you are not, that is okay! You're not a bad person and I'm proud of you for forging through. 
As long as we stay on the path to recovery, we are doing just fine.
Vegan or not we can make all kinds of positive differences in the world when we take care of ourselves.