Eating Disorder Guideline

What is Abstinence?

It is important not to make food (and behaviours around it) the issue in recovery from an eating disorder. It is only the symptom. Abstinence from compulsive eating, starving and purging is only the first step and not the goal in itself. What is also true is that many people come into Twelve Step recovery after years, or even a lifetime of disordered eating patterns and the following is an attempt to answer some of the basic questions and issues that often arise about how to be physically abstinent from using food addictively.

The whole purpose of recovery from addictive disease is to be able to rid ourselves of emotional obsessions and their damaging physical consequences. Simply changing an obsession for doing something into an obsession for not doing something (bingeing into starving for example) is no improvement. The correct treatment for both is to follow the guidelines for abstinence ~ in order to relieve the physical manifestation of addictive behaviour ~ and then work the Twelve Step programme in order to facilitate long term emotional and psychological health.

The basic issues of abstinence in an eating disorder are simple and straightforward ~ just as simple as for alcohol or drugs: put down the addictive substances and behaviours, then experience and deal appropriately with the feelings and realities.

The guidelines are useful for patients in early recovery who may have little or no concept of how to fuel their bodies healthily. They are a framework ~ not a diet or strict regime ~ around which we can build a long term, well balanced and healthy way of eating. The basic Twelve Step principle around addictive substances is for total abstinence since we are powerless over them once we engage; thus alcoholics avoid alcohol entirely. Food is essential for life and therefore we must ‘enter the arena.’ Some say it is life having three thimblefuls of vodka each day, but they are wrong: alcoholics have to drink every day in order to stay alive just as sufferers from eating disorders have to eat. However, alcoholics do not have to drink mood altering drinks (anything that contains alcohol) and, correspondingly, eating disorder sufferers do not have to eat specific foods that have a mood altering effect nor do they have to involve themselves in mood altering behaviours around food. Abstinence is possible just as straightforwardly for people with eating disorders as it is for alcoholics. All the more reason to have a clear definition of our abstinence, to reduce the number of choices we need to make and to avoid those food substances that are more likely to lead us back to using food compulsively or obsessively, i.e. refined carbohydrates, sugars and sweeteners.

Behavioural abstinence involves having three regular meals daily with nothing to eat in between. The appetite centre of the brain becomes stimulated by chewing. Once stimulated it remains ‘turned on’ for about twenty minutes. Grazing can therefore result in a constant feeling of hunger/expectation of food and it is also thus possible to still feel hungry after a vast, but rapid binge.

General Information

Eating should be a pleasure: the taste and process of eating should be enjoyable.

Fluid retention, diabetes, thyroid deficiency and various other medical conditions can have an effect on body weight but can easily be controlled medically and should have no effect on the simultaneous treatment of an eating disorder.

As a general rule for good health, one should drink one and a half to two litres (seven to ten cups) of fluid each day.

Bottled sauces are best avoided because many of them contain sugar or white flour or they may be very spicy and stimulate the appetite. They also blunt the palate from progressively getting more sensitive to delicate flavouring.

Appetite suppressants should be totally avoided because they are addictive. It should be realised that nicotine, caffeine and diet drinks tend to be used as appetite suppressants and are also addictive in their own right.

Laxatives should be avoided because they form part of the binge/purge behavioural addiction component of an eating disorder. Bowel function takes time to return to normal after years of abuse through an eating disorder. Patients with anorexia, or example, will often complain that they are ‘constipated’ when what they mean is that they have the sensation of something in their bowels: not constipation but hyper- sensitivity as a result of years of starvation.

Taking regular exercise is healthy but as little as 30 minutes a day for three days a week is quite healthy enough. Exercise and the ‘high’ it can produce can become an addiction in itself.

It takes eleven days for the emotional high and subsequent withdrawal symptoms from sugars to clear. Each sugar binge will result in its; own withdrawal period.

Eat everything on your plate. Don’t have second helpings.

If you experience any cravings to binge, purge or starve you should share these feelings with someone at the time, if possible. Cravings are not something to be ashamed about, nor are they a sign that you are ‘doing badly.’ Indeed, they are entirely normal for an addict in early recovery.

‘Forbidden foods.’ Sufferers, particularly anorexics tend to develop lists of forbidden foods ~ often the fatty ones, meats and carbohydrates ~ which are perfectly healthy. This can even sometimes take the form of supposed food allergies and tactical vegetarianism. It is important to reconsider what we are prepared to eat when we enter into recovery

‘NO SUGAR AND WHITE FLOUR’

Sufferers from eating disorders have particular sensitivity to refined carbohydrates. Sugar and white flour of any kind, where the fibre roughage has been purified away, have a chemical reaction within the brain, producing a lift and setting up a physical and emotional craving. This is one of the reasons that one chocolate turns into the whole box, and why we often crave things such as pastries, cakes or sweets. This craving is exactly similar to the craving for alcohol set up by the first use in any day of any other mood altering substance or process relevant to any form of addiction.

Physical abstinence which avoids all sugar, including honey and syrups, and all refined carbohydrates of any kind, dramatically reduces the likelihood of craving or bingeing. On the whole, other foods should be confronted just as an alcoholic would confront milk or orange juice: with no problem whatsoever.

Artificial sweeteners are the equivalent of a non alcoholic beer for an alcoholic: they keep the sense of taste attuned to what we used to like. Many eating disorder sufferers have well developed addictive relationships with diet drinks and sugar free gums. Similarly, adding salt and pepper and various spices and bottled sauces will tend to stimulate the appetite excessively and keep our tastebuds over stimulated. It is better to avoid these substances and allow ourselves to develop a sense of taste for the more subtle flavours in food. Sufferers tend to like to eat stronger, sweeter, saltier, spicier foods than most. It can take several months for our tastebuds to get used to normal flavours.

MSG - monosodium glutamate is often present in Chinese and Indian food and is best avoided as it is a general sweetener and preservative. We need to retrain our palates to enjoy foods that are less sweet. The risk of artificial sweeteners is the same risk of alcohol free beer: sooner or later we crave the real thing.

Some names of sugars/sweeteners - if a label has a sugar listed 5 or lower in the list of ingredients, then the traces can be considered fairly negligible.

Avoid any white or brown sugar, caramel, fructose, raw/pure/anything - honey, malto-anything, anything malt, molasses, cane/corn/anything - syrup, sucrose, lactose, glucose, dextrose, sorbitol, auamiel, stevia, manitol, saccharin, aspartate: avoid all of these.

Unrefined carbohydrates - It is easier to list safe carbohydrates: wholemeal bread, wholewheat grain crackers, wholewheat pasta, brown rice, potatoes, wholegrain cereals. Watch out for ‘wheat flour’ which is refined and is often present in sauces as a thickening agent.

Mealtimes - Many sufferers find excuses to breakfast at 5.00 a.m. or put dinner off until 11.00 p.m. Learn to keep within normal parameters: breakfast between 7.00 and 9.00 a.m., lunch between 12 noon and 2.00 p.m. and dinner between 7.00 and 9.00 p.m. These are guidelines only and may not suit certain lifestyles.

Bulimics should avoid using the lavatory for at least an hour after each meal and they should try to keep in company rather than isolate. This is likely to be a vulnerable and uncomfortable time and it is a good idea to talk about feelings at these times.

Anorexics should eat with other people at regular times and allow themselves to be seen to be eating.

Amounts - The quantity that we should eat at any time should be determined by physical hunger, the same as for other people, rather then the need to satisfy emotional craving in one way or another. Food is a fuel for the body, like putting petrol into a car.

A normal quantity of food at any time is easily determined by seeing whether one would be perfectly happy to exchange one’s own plate of food for that of anyone else who does not have an eating disorder. If the prospect of doing so fills one with fear, that one will have either too little or too much, then our perceptions are still being ruled by our addictive disease.

The total quantity of food that we require in any one day is that which enables body weight to remain constant without thinking about it and without using exercise, laxatives, diuretics, strict control of food intake and various purgative processes as control mechanisms for body weight.

In early days of abstinence some guidance may be useful on the concept of normal eating, but making out particular ‘food plans’ can be dangerously obsessive. It gives food a power that it does not possess. There is no need to count out exact weights, portions or calories. We need to learn to eat according to hunger.

Body Issues

The ideal body weight or goal weight can easily be determined from medical charts. It is not determined by fashion, nor by any individual patient’s feelings of what he or she ought to look like, feel like or fit into. Recovery is about getting away from trying to control our feelings through our addictive relationship with food and exercise and through changing our physical appearance.

We do not need to talk about food nor about body weight. Body weight will vary a few pounds on a day to day basis in any case, according to body fluid content. Attempting to control one’s exact body weight or body image, and the constant weighing of both food and self is part of the obsession of an eating disorder, often handing emotional power over to what the scales say that day. As long as we are abstinent there should be no real need to weigh ourselves more than once a month ~ at most ~ as an occasional check. It is an excellent idea for us to throw out the bathroom scales and hand over our occasional check to a trusted friend or partner.

Body image is an exceedingly complex subject. Naturally we want to look and feel good, but this if often a decision on what we feel we ‘ought’ to look like in terms of body shape, clothing and fashion. These are emotional concepts rather than physical absolutes. Actuarial tables for normal height and weight give a range of five to ten pounds for each height and frame. It is important to get away from the concept of an ‘excess’ five pounds which ‘makes all the difference’ to how we feel about ourselves.

Patients with eating disorders tend to have a distorted body image so that a sufferer from anorexia will perceive him or herself as being fatter than anyone else would perceive. Correspondingly, a compulsive overeater might see him or herself as much thinner than reality and a bulimic may have a very narrow range that he or she would perceive as ‘normal.’

Perhaps the most difficult aspect of receiving help for an eating disorder is, as with any other addiction, coming to see that one’s own concepts may be passionately held but may nonetheless be deluded.

An Abstinent Day

Eat three meals: breakfast, lunch and dinner. *Eat nothing at all between these meals. Avoid all white flour/refined carbohydrates. Avoid all sugar/artificial sweeteners. Avoid all alcohol because alcohol itself is a refined carbohydrate and sets up cravings for others.

*Those needing to gain some weight may also be advised to have a couple of build up drinks in the course of the day/evening. This should be discussed with a counsellor.

A normal healthy diet should comprise a daily intake of three principal food groups:

a. Fats - milk, butter, cheese and oils.
b. Carbohydrates - bread, cereals, pastas, grains, fresh fruit and vegetables.
c. Proteins - meat, fish, eggs, cheese, pulses, tofu, soya, nuts and yoghurt.

The exact composition of a sensible diet, with a range of proteins, carbohydrates, fats and minerals is not of any great interest to people in recovery from eating disorders. Healthy eating is simply a matter of having a well balanced intake, exactly the same balance as for anything else in life. Sufferers do not need to be told anything elaborate about balance because it can be obsessive. However, we may need basic information in early days. The food pyramid below is a good general guide as to how an average day’s food may be constructed, clearly indicating the importance of carbohydrates as an energy provider.

An average breakfast may consist of a couple of slices of wholewheat toast with butter and sugar free jam or a portion of porridge or cereal, or an egg and a piece of toast. Lunch and dinner should be a balanced plate of food roughly split into three between the three main food groups and followed by a sugar free pudding or piece of fruit or cheese. The healthiest way to ‘measure’ one’s food, as mentioned, is to check whether you could comfortably exchange plates with a normal eater. Keep to one glass of fruit juice a day.