bulimia

How to Do Intuitive Eating When You Don’t Feel Hunger

How to eat intuitively when you don't feel hunger

It’s very common for individuals who have an eating disorder, or even just disordered eating due to “normal” dieting, to say they don’t feel hungry. And so the question is, if you don’t have hunger, how can you eat intuitively? In this post, we’ll talk about what might be interfering with your hunger cues and what to do about it.

What are Hunger Cues?

First, it’s important to understand that when we typically talk about hunger, we’re referring to the grumbling or gnawing sensations in our stomachs. However, our bodies actually give us a range of other hunger cues that you might be missing, even if you’re not feeling anything in your tummy. Some other clues that you’re hungry and need to eat include:

  • Irritability
  • Low energy
  • Headache
  • Trouble concentrating
  • Lightheadedness
  • Shakiness
  • Nausea
  • Thinking about food

What Causes People to Stop Experiencing Hunger?

When we disrupt our bodies’ normal rhythms through restriction and/or chaotic eating patterns, our bodies adjust. If you’ve spent a lot of time ignoring your hunger, your body will sometimes stop sending you those sensations because it’s a waste of energy. It’s like a crying baby who crying eventually gives up when no one responds to them.

Another thing that could be happening is that your digestive system has slowed down. When this occurs, your stomach feels fuller sooner and longer because food empties from the stomach slower than it normally would. Called gastroparesis, this condition is common with restrictive eating disorders, and can include other symptoms such as heartburn, nausea, bloating, and vomiting. If you think you have gastroparesis, I highly suggest working with a gastroenterologist familiar with eating disorders.

Lastly, the other thing I often see with clients who don’t experience hunger is that they aren’t allowing themselves enough time between eating to feel hungry. If you eat more often than your body needs, you’re going to beat your hunger to the punch, so to speak.

How to Eat if You Don’t Feel Hunger

The first step is to put some structure in place in regards to your eating. Start by eating breakfast, even if it’s small, within an hour of waking up. (No, coffee is not breakfast!) Then eat every 3-4 hours, whether you are hungry or not. That likely would have you eating 3 meals a day, with 1-2 snacks. Do not eat before your snack or meal time. Don’t skip any, even if you binged.

I can imagine that you might be asking right now, “How is that intuitive eating?”

But I promise, it’s a necessary part of the healing process that makes intuitive eating possible. I heard Evelyn Tribole, co-author of Intuitive Eating, describe structured meals and snacks like putting a cast on a broken bone. The structure is necessary for healing, but it’s not meant to stay on forever. Once the bone (i.e. your relationship with food) is healed enough, you take the cast off.

Besides, contrary to the misconception that intuitive eating is simply about “eat when you’re hungry, stop when you’re full,” there’s more to it than that. Intuitive eating is not 100% instinct. It’s also based on logic, and when our hunger signals aren’t working properly, logic can ensure that our bodies still get what they need.

The goal is for regular eating of sufficient calories to restore normal digestive function and hopefully, normal hunger sensations. But until that happens, you can still practice attunement with your body by starting to notice other hunger cues that you’re likely missing if you’re focused solely on what’s going on in your stomach.

For more information about this topic, check out this Intuitive Bites podcast episode by Kirsten Ackerman, RD.

One More Thing…

Remember that intuitive eating involves ten principles. Only two of them are about hunger and fullness. Which means, even while you are working on restoring hunger, you can be practicing the other 8 principles related to rejecting diet mentality, making peace with food, respecting your body, and all the rest.

DISCLAIMER: These are general principles I hope you find helpful, but I highly encourage you to work with an eating disorder therapist or dietitian who can help you with this process! Recovery really is an individual thing and you need professionals who understand your unique physical and emotional needs to customize a suitable treatment plan for you. Don’t be afraid to reach out for help. XOXO

Much love,
Cherie Signature

About Cherie Miller @ Dare 2 HopeI’m Cherie Miller, MS, LPC, founder of Food Freedom Therapy™. I offer counseling for chronic dieting as well eating disorder therapy for Anorexia, Bulimia, Binge Eating Disorder, Orthorexia, OSFED, ARFID, and other eating disorder issues. Contact me here or follow me on Instagram or Facebook.

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Exercise Series, Part 3: Developing a Healthy Relationship with Exercise

Now that we’ve talked about figuring out whether you relationship with exercise is toxic and about the role of exercise in eating disorder recovery, let’s take a look at how you can develop a healthy relationship with exercise.

If You Are in Active Eating Disorder Recovery

First and foremost, I need to state that if you are actively struggling with an eating disorder, especially if you are potentially under-nourishing your body, please do not undertake extra physical activity without the guidance of trusted professionals. As discussed on my previous post, exercising while malnourished can be very dangerous. Also, know that people of all sizes can be under-nourished so don’t assume that you are not even if you’re in a larger body!

If you’re not currently seeing a therapist or dietitian—or both—that is a good place to start. Just make sure they specialize in eating disorders because unfortunately, professionals who do not can unintentionally cause harm for eating disorder clients. (Please contact me if you need help finding an eating disorder therapist or dietitian.) Other members of your treatment team might include a medical doctor, a psychiatrist, and an occupational therapist. If you think you might need more treatment than outpatient can provide, check out this post about the levels of care available for eating disorder treatment.

Tips for Exercising In a Mentally and Physically Health Way

Even as you are renourishing (also called weight restoring), there could be a place for movement in your treatment. What your current relationship with exercise is like and your physical condition are critical considerations in developing a plan for exercise, which is why you should ultimately work with your treatment team on creating a plan since they know your specific challenges and needs.

Dr. Jennifer Gaudiani, author of Sick Enough: A Guide to the Medical Complications of Eating Disorders and Medical Director of the Gaudiani Clinic eating disorder treatment facility, recommends a slow increase in movement, making sure to have rest days in between. She also emphasizes the importance of adding more nutrition if needed. I want to mentioned that although exercise during this stage can result in some bone density loss in some patients, Dr. Gaudiani feels this is offset by the fact that a plan involving movement can lead to earlier eating disorder recovery, which can in turn have a better long-term effect on bone health.

What’s the Goal?

If I had to give a name to what a healthy relationship with exercise looks like, I would call it intuitive exercise (or intuitive movement if the word exercise has negative connotations for you). In the Intuitive Eating book, the authors call it joyful movement, so you can use that too if you like it better. 

I personally like having “intuitive” in there because I think that better personifies what it’s all about. Like intuitive eating, intuitive exercise involves tuning into the body and respecting the body’s cues, which means removing the obstacles to attunement—the disordered rules, beliefs, and thoughts that previously surrounded exercise. In other words, it is guided by internal cues rather than external ones. Again, like with intuitive eating, it can be quite a process getting there, but it’s so freeing once you do.

Tips for Learning Intuitive Exercise

In addition to taking a slow-increase approach recommended by Dr. Gaudiani and other experts, here are some other general principles to help you incorporate movement in a healthy way and to heal your relationship with exercise.

Tip #1 – Take a break

For many people who’ve had issues with exercise, taking a break from it can be a necessary step in healing. Yes, this can be very distressing, and that gives you an opportunity to deal with all the things that come up when you don’t exercise. It’s hard but important to learn other coping skills besides just exercise. Plus, taking a break gives you time to do a mental “reset” with the other tips here.

Tip #2 – Change your motivation for exercise

Just like the first step in developing a healthy relationship with food is challenging the diet mentality, it’s also an important starting point for changing your relationship with exercise. Sadly, in our current culture, movement is usually associated with trying to lose or maintain weight. Untangling exercise from those goals is difficult for most people, let alone people with an eating disorder. Yet there are so many benefits to our physical and mental health! Take some time to identify reasons to exercise that matter to you besides staying thin or losing weight. Here are a few that might be important to you:

  • Relieve stress
  • Improve learning and memory
  • Strengthen your heart
  • Build stronger muscles and bones
  • Promote better sleep
  • Improve mood
  • Decrease depression and anxiety
  • Improve digestion to help relieve constipation and help those with digestive disorders like inflammatory bowel disease and liver disease
  • Strengthen immune system
  • Reduces risk for disease like stroke, cardiovascular disease, and some forms of cancer
  • Improve sex life

Tip #3 – Rethink what defines “exercise”

Exercise does not have to be running X miles or doing X minutes on the elliptical. Resist the toxic thinking about exercise having to look a certain way. Often, we think it only “counts” if it’s a certain type, intensity, or amount of time. Not true! We can get a lot of benefits from a variety of movements, and they don’t have to be intense or high-impact. Dr. Jennifer Gaudiani recommends (and I agree) that it’s good to start by incorporating a variety of gentle activities such as yoga, walking, and free weights.

Over time, get creative and think about trying other types of movement like:

  • Walks with your pet or family
  • Hiking
  • Roller skating or ice skating
  • A dance party at home or try a dance class
  • Riding a bike
  • Martial arts
  • Wrestling or playing tag with your kids
  • Play a rec league sport
  • Play laser tag
  • Hula-hoop
  • Jump rope
  • Swimming or water aerobics
  • Think about what you enjoyed as a kid and do that!

In my eating disorder days, I was a compulsive runner. I gave that up when I went into recovery and years later, I’m still exploring what types of movement I enjoy. Watch the video at the end of this post to hear more about my recent journey with intuitive exercise!

Tip #4 – Listen to your body

Since the basis of intuitive exercise is tuning into your body, you need to work on practicing mindfulness, which you’re likely doing with intuitive eating already. Listening to your body means noticing when you feel the urge to move, and then honoring that by moving. It also means noticing when you’re feeling fatigued or sick and need to rest instead of exercising. 

As you’re exercising, respect your body’s cues. It’s okay for exercise to be a bit challenging and uncomfortable at times, but it should not be painful or miserable. The idea that we have to beat up our bodies for a workout to be beneficial is toxic fitness thinking and is just plain false.

A Warning About Starting to Exercise Again

As you get more stable physically and are consistently nourishing yourself, you can increase your intensity… but only if you want to—and want to for the right reasons. Emotions to watch out for are guilt, shame, stress or pressure. If it feels more like “I should” or “I need to” to increase workout intensity or times, that is a red flag that you’re slipping into compulsive exercise again.

Be aware of your thoughts too. If you start thinking about things like how many calories you burned, step back and challenge the diet mentality. Recognize those thoughts and feelings are a slippery slope back into disordered eating… and don’t give into them. With self-compassion, remind yourself of the healthy reasons you are exercising and that there are no rules for how it has to be. The point is for you to enjoy it both physically and mentally, and for it to add to the quality of your life. Scale back, try a different form of exercise, or take a break again if you need to. Like with food, healing our relationship with movement is not a linear process!

My Recent Journey with Intuitive Exercise

(If you missed the first two posts in this exercise series, check them out at Part 1: Is Your Relationship with Exercise Toxic? and Part 2: The Role of Exercise in Eating Disorder Recovery.)

Much love,
Cherie signature

Sources:
Cook, B., Wonderlich, S. A., Mitchell, J., Thompson, R., Sherman, R., & McCallum, K. (2016). Exercise in Eating Disorders Treatment: Systematic Review and Proposal of Guidelines. Medicine and Science in Sports and Exercise, 48(7), 1408–1414. http://doi.org/10.1249/MSS.0000000000000912
https://www.intuitiveeating.org/definition-of-intuitive-eating/

I’m Cherie Miller, MS, LPC, founder of Food Freedom Therapy™. I offer counseling for chronic dieting as well eating disorder therapy for Anorexia, Bulimia, Binge Eating Disorder, Orthorexia, OSFED, ARFID, and other eating disorder issues. Contact me here or follow me on Instagram or Facebook.

Exercise Series, Part 2: The Role of Exercise in Eating Disorder Recovery

The role of exercise in eating disorder treatment is complicated and a topic of some debate within the recovery field. Whereas I used to feel strongly that clients who were operating in a calorie deficit due to restriction should never be allowed extra movement or exercise, I’ve shifted my thinking a bit. Now I think it’s best to avoid approaching the topic with a one-size-fits-all approach, and recommendations should be based on each individual client, weighing the potential pros and cons of exercise during recovery.

What are the pros and cons of exercise during eating disorder recovery?

Potential Benefits

For the general population, exercise has many known health benefits, both mentally as well as physically, including:

  • Improving mood and ability to manage stress and emotions
  • Improving mobility and helping prevent injuries
  • Reducing risk for heart disease and reversing cardiac abnormalities
  • Reducing risk of some cancers
  • Strengthening muscles and increasing bone density
  • Helping manage blood sugar and insulin levels
  • Improving sleep

However, if an individual is not physically stable and properly nourished, exercise can actually worsen their physical condition. Which is a nice lead-in to the discussion about the drawbacks of exercise in recovery…

Potential Drawbacks

One of the most concerning issues for someone with an eating disorder exercising is that expending additional energy during a starvation state puts even more strain on an already stressed and weakened body. In other words, exercise exacerbates the physiological consequences of being malnourished. It can worsen hormonal dysfunctions, harm cardiovascular systems, and further decrease bone density. Injuries are more likely to happen (e.g. stress fractures are common).

I often hear clients say they are not working out to lose weight, and that it’s not wrapped up in their eating disorder. Common statements are “I want to exercise because….

I love it.”
It makes me feel good.”
It makes me feel strong and healthy.”

For now, let’s set aside the issue of whether these statements are actually true or whether the client is trying to maintain disordered behavior. That’s something to unpack with them a bit later. Initially, the foremost concern is that, as previously discussed, exercise can cause harm for those who are malnourished. So if a client talks about wanting to be healthy, then we have an opening with them to discuss how exercise at this point could be incredibly unhealthy for them. 

“Attempting to use the health argument to justify a behaviour that is contributing to energy deficit during starvation and thus helping perpetuate a life-threatening illness is classic eating-disorder logic.”
– Emily T. Troscianko, Ph.D.

So… to exercise or not to exercise?

In her book Sick Enough: A Guide to the Medical Complications of Eating Disorders, Dr. Jennifer Gaudiani makes a good argument that forbidding people in recovery from engaging in physical activity unintentionally reinforces the disordered idea that the main purpose of movement is to burn calories and prevent weight gain. She states that although “serious exercise is a privilege of full recovery… movement during weight restoration makes recovery sustainable.” Dr. Gaudiani supports physical movement as part of the recovery process for most patients. She has observed positive outcomes for patients who experience stronger, more independent bodies through a combination of rest, nutrition and expert physical and occupational therapy.

Once nutritional rehabilitation is achieved and caloric intake is sufficient, more serious exercise becomes safer. This means that good nutrition, weight restoration, and the return of normal hormonal and cardiac physiology are crucial to deciding when such exercise would be advisable.

However, we need to consider more than just the client’s physical condition. The mentality regarding exercise is equally important. Research has found that exercise is a predictor of relapse for approximately 30% of individuals after discharging from higher levels of treatment. Notably, the highest risk occurs between 4 and 17 months after discharge, but the risk of exercise contributing to relapse stays high for up to 2.5 years after treatment.

This is partially due to the fact that in our current culture, exercise is often tied to weight management. It can be tough for an average person to disconnect the two, so it’s understandable how difficult that is for a person recovering from an eating disorder. For many patients, exercise is interwoven into their disorder. The motivation for exercise can to serve many eating disorder functions for individuals, such as burning calories, attempting to control one’s body, managing anxiety about food, and even being a form of self-punishment.

The challenge, therefore, is developing a healthier relationship with exercise and reaping the benefits of it without triggering a relapse. I do think that Dr. Gaudiani’s approach can be helpful in repairing the disordered relationship with exercise, as well incorporating discussion of exercise into the therapy work.

Assessing your relationship with exercise

If you’re not sure whether a client’s (or your) relationship with exercise is healthy, check out my previous post, Is Your Relationship with Exercise Toxic?. Some of the red-flags to look for include:

  • Feeling guilty, anxious or ashamed when a workout is missed or isn’t as long or intense as the individual thinks it should be
  • Exercising even when they’re fatigued, injured, or ill
  • Exercise is focused on getting or staying in a certain type of body
  • “Earning” food through working out
  • Not really enjoying your workouts but feeling compelled to do them anyway
  • Working out causes stress instead of relieving it
  • Needing to exercise displaces other important things in the person’s life
  • Their identity/self-worth is wrapped up in working out

You can also check out these online assessments:

Stay tuned…
for my next post about HOW to incorporate healthy movement during—and after—eating disorder recovery!

Much love,
Cherie signature

Sources:
Bardone-Cone AM, Higgins MK, St George SM, et al. Behavioral and psychological aspects of exercise across stages of eating disorder recovery. Eat Disord. 2016;24(5):424-439. doi:10.1080/10640266.2016.1207452
Cook, B., Wonderlich, S. A., Mitchell, J., Thompson, R., Sherman, R., & McCallum, K. (2016). Exercise in Eating Disorders Treatment: Systematic Review and Proposal of Guidelines. Medicine and Science in Sports and Exercise, 48(7), 1408–1414. http://doi.org/10.1249/MSS.0000000000000912
https://www.psychologytoday.com/us/blog/hunger-artist/201812/should-you-exercise-during-recovery-anorexia-part-1
https://edinstitute.org/paper/2013/2/26/exercise-ii-insidious-activity
https://www.allianceforeatingdisorders.com/exercise-during-recovery/

I’m Cherie Miller, MS, LPC, founder of Food Freedom Therapy™. I offer counseling for chronic dieting as well eating disorder therapy for Anorexia, Bulimia, Binge Eating Disorder, Orthorexia, OSFED, ARFID, and other eating disorder issues. Contact me here or follow me on Instagram or Facebook.

Exercise Series, Part 1: Is Your Relationship with Exercise Toxic?

It’s generally accepted that exercise is healthy, but sometimes it isn’t. Sometimes, it can hurt our physical and emotional health. The line can be a bit blurry, so let’s talk a bit about when exercise stops being healthy and becomes harmful.

Signs of a Toxic Relationship with Exercise

Here are some signs to look for to help determine whether your relationship with exercise it healthy or toxic:

  • You feel guilty, anxious or ashamed when you don’t work out, or don’t work out as long or hard as you think you should
  • You exercise even when you’re fatigued, injured, or ill
  • If you couldn’t work out for a while, you’d freak out
  • Exercise is focused on getting or staying in a certain type of body
  • You “earn” food through working out
  • You don’t really enjoy your workouts anymore
  • Working out causes stress instead of relieving it
  • Needing to exercise displaces other important things in your life
  • Your identity/self-worth is wrapped up in your fitness and you’re not sure who you’d be without it—or you worry about losing the status of being the “fit” person everyone sees you as

If any of these describe you, then you probably need to re-evaluate your relationship with exercise. As Katherine Schreiber, the co-author of The Truth About Exercise Addiction: Understanding the Dark Side of Thinspiration said, “I think we can all agree that canceling plans with friends because you are a slave to the treadmill, running with an injured knee, or being terrified of taking a rest day, is not mentally healthy.”

Yet because working out is considered healthy in our society, we usually don’t question it… even when it becomes excessive, compulsive, or a source of distress. Too often, we’re not honest with ourselves about the ways it has become problematic. I think that can partly be attributed to a phenomena known as toxic fitness.

What is Toxic Fitness?

Toxic fitness happens when exercise and the pursuit of fitness is wrapped up in diet culture. So instead of being about health, it’s actually about weight loss, thinness and shaping our bodies—just like dieting and disordered eating, which, not surprisingly, often accompany toxic fitness.

“Toxic fitness culture has made working out into some kind of competition of who can look the slimmest or have the best body. It makes us feel like we have to push ourselves past our limits and prioritize fitness above everything else in our lives. It can have damaging effects on our body image and our fitness.” ~ Alice Kelly

Be discerning about the content and people you let influence your relationship with your body, exercise, and food. Here are some toxic fitness red flags:

  • Exercise for the primary purpose of losing or maintaining weight.
  • Promoting “fit” as a specific look (you know the one — the lean and toned ideal that’s plastered everywhere).
  • Motivating people with things like getting “bikini ready,” achieving a “new you,” looking good in a strapless wedding dress, or any other body-shaming tactic.
  • Promoting exercise as a “no pain, no gain” activity that only really counts if you beat your body up or it hurts.
  • Encouraging people to work out even when they are injured or should rest.
  • Associating exercise with food in a negative way (e.g. earning food through exercise or warning against negating a work out with what you eat).
  • Fitness gurus who don’t include body-diversity in their programs, which means featuring diverse people (sizes, color, etc.) as well as being able to offer exercises that accommodate people in larger or differently-abled bodies.
  • Emphasis on exercise and diet as the only ways to be healthy.
  • Shaming people—directly or indirectly—for not working out long enough or more often.
  • Tying one’s identity or self-worth to exercise or level of fitness.

No Pain, No Gain is Crap

Exercise shouldn’t be about punishing or even manipulating your body. It should be about taking care of it. It might be tough to develop a healthy relationship with exercise if it’s been toxic for you up until now, but you can change it—just like you can change your relationship with food. Stay tuned in the upcoming weeks for tips on how to do that!

Random side note, but …

Pleeeeease stop taking nutrition advice from personal trainers. One, that is outside their scope! My husband was a personal trainer for years and it drove him bonkers to hear other trainers coaching their clients on their diet. And two, he also believes that the majority (not all of course, but most) personal trainers have their own struggles with body image and food. There’s not a lot of research on the subject, but what is there supports his personal experience—there is a high rate of disordered eating amongst fitness professionals. That’s something to keep in mind when taking advice from them.

If you do need help with nutrition or your relationship with food, please talk to an anti-diet, Health at Every Size® therapist or dietitian. If you can’t find one in your area or don’t know where to start looking, reach out to me and I will do my best to help you find someone!

Much love,
Cherie signature

I’m Cherie Miller, MS, LPC, founder of Food Freedom Therapy™. I offer counseling for chronic dieting as well eating disorder therapy for Anorexia, Bulimia, Binge Eating Disorder, Orthorexia, OSFED, ARFID, and other eating disorder issues. Contact me here or follow me on Instagram or Facebook.

Quasi-Recovery

Qausi-Eating Disorder Recovery Dandelion Pic

A previous post, Is Full Eating Disorder Recovery Possible?, brought up a lot of questions about a common challenge for people pursuing eating disorder recovery that I want to talk about today: partial recovery. I actually like the term qausi-recovery because the word “qausi” can mean both “almost but not fully” as well as “seemingly but not actually”. Though sometimes we are aware we are only partially recovered, other times, we think we are fully recovered when we’re not actually 100 percent there. My personal journey fell into the latter category. 

When I relapsed, I had been free of eating disorder behavior for 8 years and believed I was recovered. Slipping back into old behaviors took me by surprise because I didn’t think I was in danger of a relapse since I hadn’t really struggled with my eating disorder for so many years. I didn’t understand why it happened for a while, but eventually came to realize that all those years, I had really been in quasi-recovery.

Some might not agree, and that’s understandable. Part of the difficulty with this topic is that there is no one definition for recovery. Everyone defines it a bit differently, so for our discussion here, I wanted to clarify what I mean by recovery.

What is Full Eating Disorder Recovery?

From a clinical perspective, we would use the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) to see if a person still meets any criteria for an eating disorder. The three most-known are anorexia nervosa, bulimia nervosa, and binge eating disorder. However, many people don’t meet all the criteria for these disorders, but could still be diagnosed with an eating disorder known as Other Specified Feeding and Eating Disorder (OSFED).

OSFED is diagnosed when a person has feeding or eating behaviors that cause clinically significant distress and impairment, but do not meet the full criteria for any of the other disorders. While some people start out with an OSFED diagnosis, some start with a different diagnosis and are later diagnosed with OSFED when they no longer meet criteria for anorexia, bulimia, and binge eating disorder. Some examples include:

  • Someone who has restored weight to a “normal” range but continues to significantly restrict
  • Someone who binges or binges/purges but not as frequently
  • Someone who doesn’t restrict caloric intake anymore, but has become overly conscientious about eating only “healthy” foods (now known as orthorexia) 

Anyone who still meets the diagnosis criteria for an eating disorder is still not recovered. I imagine most people would agree with that. But does not meeting criteria mean you’re recovered, as I was those 8 years? Perhaps from a clinical perspective, but I personally believe recovery goes beyond a clinical definition. For me, recovery from an eating disorder is more than just abstaining from eating disorder behaviors—it involves a real healing of the relationship with food and your body. 

What Quasi-Recovery Can Look Like

Some signs you might not be fully recovered from your eating disorder include (and during my qausi-recovery stage, I could check several of these boxes!):

  • Eating more than you did before but still not consistently honoring your hunger and/or eating an appropriate amount
  • Eating more foods than you did before but still labeling food as “good” and “bad” and avoiding “bad” foods much of the time
  • Having anxiety around food
  • Using exercise to “earn” or “make up” for what you eat
  • Having food rules about what, how much, or when you can eat
  • Continuing to hate your body and/or fear weight gain

How to Push Through Quasi-Recovery

Being honest with yourself about not having fully healed your relationship with food and your body is an important place to start, if you’re not there already. It’s equally important to believe that full recovery is possible. Don’t settle for believing that this is the best it can be for you, though I understand those feelings as well. I have vivid memories of saying through sobs that I would never be able to make peace with my body and therefore food, even though I wasn’t using explicit behaviors anymore. 

But recovery is about rooting out eating disorder thinking just as much as it is about quitting behaviors. So keep doing that internal work to challenge all the eating disorder/diet culture mentality that continues to drive food anxiety and fear of fatness. Here are some great books I recommend:

Read these and other anti-diet, fat-acceptance books and follow fat-positive, intuitive eating accounts on social media (sign up for my newsletter and I’ll send you a list of influencers!). Then unfollow, cancel, or otherwise disengage with people and content that continues to keep you in bondage to food issues. What we surround ourselves with influences us in a MAJOR way. Finding community with people who promote true body acceptance and food freedom is vital in changing your mindset. It made all the difference for me and I hear the same from so many others.

Final Thoughts

Based on my own experience and those of my clients, qausi-recovery is a common stage for many people with eating disorders. So if that’s where you find yourself, that’s totally okay. Please don’t feel like a failure or get discouraged. The journey to full eating disorder recovery is not a straight line, and it’s certainly not easy. Especially considering how disordered our culture’s relationship with food and bodies is! You CAN get there. It might be cliché, but it’s true:

Progress, not perfection, dear one.

Please reach out to me if there’s anything I can do to help you in your journey. If you’re ready to start therapy with me, you can schedule an appointment online.

Much love,
Cherie signature

I’m Cherie Miller, MS, LPC, founder of Food Freedom Therapy™. I offer counseling for chronic dieting as well eating disorder therapy for Anorexia, Bulimia, Binge Eating Disorder, Orthorexia, OSFED, ARFID, and other eating disorder issues. Contact me here or follow me on Instagram or Facebook.

Is Full Eating Disorder Recovery Possible?

Is Eating Disoder Recovery Possible

Sometimes clients will ask me if I believe full eating disorder recovery is possible. This is such an understandable question given how difficult recovery is and, for some clients, how long they have been struggling. It’s not uncommon for eating disorder treatment to last years, and sometimes include repeated periods of being in a higher level of care.

Even with all those challenges, my answer to whether full eating disorder recovery is possible is YES.

I believe that because I’ve lived it myself and seen others recover too. And all of us questioned whether it was possible. It felt too hard at times. It was too messy, and we slipped up a lot. And it took much longer than we thought it should, much longer than we wanted it to.

Friend, I promise that is just the reality of eating disorder recovery and none of those things is evidence that you can’t do it.

What about “recovered” versus “recovering”?

There is some debate in the eating disorder community about whether people can be fully recovered without intentional maintenance or whether it is more like always being in recovery… that is, having to intentionally maintain being free of the eating disorder. Many alcoholics describe themselves as being in recovery, even years after they have stopped drinking. It implies a sense of fragility to recovery, as if losing that recovery is always a near possibility. I’ve found this thinking to be common in the 12-step communities.

I personally believe that full recovery without having to intentionally maintain it is possible. That is my experience and the experience of many others I’ve seen. However, I would never minimize the experiences of those who describe themselves in a state of recovery. I certainly have no right to tell them they are wrong. Yet I can’t help but wonder if those people just have settled for a state of qausi-recovery (a topic I’ll write about soon). It’s possible that they haven’t fully healed their relationship with food and their bodies, even though they are free of actual eating disorder behaviors. In the alcohol recovery world, that’s called being a dry drunk.

I have found qausi-recovery to be a very common experience for many people with eating disorders, so if that’s where you find yourself, you’re completely normal in that regard too. It doesn’t mean you’ve failed or can’t do it, it just means there are still some things to work on, things that still need healing. I was in qausi-recovery for 8 years so I know about that in-between place quite well. But against all odds, here I am, now completely recovered.

You can have full recovery too. Just don’t give up.

Please reach out to me if there’s anything I can do to help you in your journey. If you’re ready to start therapy with me, you can schedule an appointment online.

Much love,
Cherie signature

I’m Cherie Miller, MS, LPC, founder of Food Freedom Therapy™. I offer counseling for chronic dieting as well eating disorder therapy for Anorexia, Bulimia, Binge Eating Disorder, Orthorexia, OSFED, ARFID, and other eating disorder issues. Contact me here or follow me on Instagram or Facebook.

Eating Disorder Treatment

Eating Disorder Treatment

Deciding what level of care you need or your loved one needs can be daunting. Today I will give an overview of the five levels of care that are available for eating disorder treatment and describe the type of person who would be a good fit for each level. If you’re still not sure which is right for you, please reach out to me so we can talk about it.

When deciding what level of care is needed, several factors should be considered. Historically, weight was the main determinant, but thankfully, we are slowly moving away from that approach. Now, most treatment providers and insurance companies take into account your overall physical condition, psychology, eating disorder behaviors, and other factors. The American Psychological Association (APA) provides suggested criteria for each level of eating disorder treatment. These criteria include:

  • Medical status
  • Suicidality
  • Weight (as a percentage of healthy body weight)
  • Motivation to recover, including cooperativeness, insight, and ability to control obsessive thoughts
  • Co-occurring disorders, including substance use, depression, and anxiety
  • Structure is needed for eating and gaining weight
  • Ability to control compulsive exercising

Let’s take a look a the levels of eating disorder treatment and how the APA’s guidelines apply to each of them.

Level One: Outpatient: Outpatient treatment includes individual sessions with a therapist and/or dietitian, typically once or twice a week. Outpatient treatment typically last for months to years, and can sometimes include periods of being in a higher level of care. Also, sometimes outpatient care can include group therapy. Outpatient eating disorder treatment is likely right for you if you:

  • are medically stable
  • have at least some motivation for recovery
  • can implement some structure on your own regarding meals
  • are able to at times limit your eating disorder behaviors, including compulsive exercise
  • are not suicidal with a plan or intent to harm yourself

Level Two: Intensive Outpatient Programs (IOP): IOPs usually include about three hours of programming for at least two to three days a week. At this level of care, you would live at home and could probably still work or go to school. Usually, one meal or snack takes place at the treatment center. IOP eating disorder treatment is likely right for you if you:

  • are medically stable
  • have at least some motivation for recovery
  • can implement some structure on your own regarding meals but need a bit of support/accountability
  • are able to at times limit your eating disorder behaviors, including compulsive exercise, but need a bit of support/accountability
  • are not suicidal with a plan or intent to harm yourself

Level Three: Partial Hospitalization (aka Day Programs): Partial hospitalization (PHP) is typically treatment during the day, while letting you still go home at night. PHP is usually 6 to 11 hours a day for at least five days a week, so the majority of meals are at the treatment center. PHP eating disorder treatment is likely right for you if you:

  • are medically stable
  • have some motivation for recovery but are struggling to feel motivated at times
  • need structure and support for most meals 
  • struggle to limit your eating disorder behaviors, including compulsive exercise and need quite a bit of support/accountability
  • are not suicidal with a plan or intent to harm yourself

Level Four: Residential Treatment: Residential treatment provides 24-hour care for those who are medically stable but still require round-the-clock supervision meals and behaviors. Residential treatment is typically 6 weeks or longer. This level of care is likely right for you if you are medically stable and have a/an:

  • need for supervision to eat 
  • need for supervision to not purge or use other behaviors
  • inability to stop exercising
  • lack of treatment options near home

Level Five: Inpatient Treatment: Inpatient treatment is 24-hour care in a medical hospital. This level is for individuals who are not medically stable and need round-the-clock medical assistance or monitoring (including intravenous fluids, tube feeds, and constant monitoring of vital signs). This is often a necessary level of care for individuals who do not cooperate with treatment protocols at lower levels of care. Inpatient stays can last days to weeks. This is likely the right level for you if you are not medically stable or if you have:

  • unstable heart rate or blood pressure
  • significant weight decline and/or food refusal
  • evidence of malnutrition
  • other psychiatric disorders that would require hospitalization
  • suicidal thoughts with intent to harm yourself

A quick note in case you’re asking yourself Am I Really Sick Enough for Treatment?…

I hear this question all the time. Sweet friend, the answer is always “YES!”

Your eating disorder will try to convince you that you don’t need or don’t deserve help. It will whisper lies about things not being that bad, about you being able to handle it, about not looking like you even have an eating disorder…

Don’t listen to any of that or any other excuse your ED gives you. Eating disorders don’t have a “look” despite the stereotype, and people at all weighs can have an ED. And you don’t have to be at the point of needing hospitalization to be “sick enough”. Please, please don’t wait for that point to get help.

You could miss out on spending years of your life with joy and purpose instead of spending them still consumed with your ED. You could do irreparable damage to your body, or yes, even die.

Don’t believe your eating disorder. You are worthy of help and support. Today. Not sometime in the future when things get worse. TODAY.

xo.

Final Thoughts…

Again, I know it might feel overwhelming trying to figure out the right eating disorder treatment for you (or your loved one). If you’re still not sure which is right or if you need a referral to higher level of care, please reach out to me. If you’re ready to start outpatient therapy, it’s easy: schedule an appointment online.

Much love,
Cherie signature

Sources
https://www.nationaleatingdisorders.org/toolkit/parent-toolkit/level-care-guidelines-patients
About Cherie Miller @ Dare 2 Hope

I’m Cherie Miller, MS, LPC, founder of Food Freedom Therapy™. I offer counseling for chronic dieting as well eating disorder therapy for Anorexia, Bulimia, Binge Eating Disorder, Orthorexia, OSFED, ARFID, and other eating disorder issues. Contact me here or follow me on Instagram or Facebook.

5 Myths about Intuitive Eating

Intuitive Eating Myths

If you’re not familiar with intuitive eating at all, you can read the basics about it here. In this post, I want to address some of the misconceptions I often hear about intuitive eating.

Myth #1: Intuitive Eating is a Diet

Intuitive eating is not a diet, although, unfortunately some people approach it that way. Intuitive eating is about having unconditional permission to eat all foods, which requires rejecting diet mentality and making peace with food. The goal of intuitive eating cannot be to lose weight because that will inevitably conflict with listening to and honoring your body.

Myth #2: Intuitive Eating Means Eating Whatever You Want, Whenever You Want

This is an oversimplification of intuitive eating, which does teach having unconditional permission to eat all foods and honoring your cravings, as we’ve already discussed. However, intuitive eating teaches ten principles that work together, so it doesn’t work well for a single principle to be applied without the others.

For example, principle #8 is “Respect your body.” To do that, you have to be attune to how your body feels and what it is communicating to you. If you eat nothing but ice cream,  your body will not function optimally and will tell you so through stomach discomfort, blood sugar fluctuations, or a number of physical symptoms. (Interestingly, research shows the ability to perceive these sensations—called interoceptive awareness—is higher in intuitive eaters.) So the question when considering what and when to eat is not just what will taste good, but also, what will feel good to my body now as well as later?

Additionally, I’d like to point out that because intuitive eating rejects restriction and food policing, cravings for “junk” food typically decrease in frequency and intensity. Studies have shown that intuitive eating typically ends up with people eating a wider variety of foods. Yes, at first, you might find yourself eating a lot of the foods you previously restricted and that’s normal. As the Intuitive Eating book says,

“When you first begin the healing process, you may find that you’re eating more of the foods that you had previously restricted. This restriction has led to deprivation, and you may end up eating more of these foods for a while. Once the deprivation has healed, these foods will take a balanced place in your eating life.”

Myth #3: Intuitive Eating Just Means Eat When You’re Hungry and Stop When You’re Full

While two of the principles of intuitive eating are honoring hunger and fullness cues, that can be more challenging than it sounds. Which is why the other eight intuitive eating principles are just as important! Recognizing and responding to hunger and fullness is complicated if you’re still steeped in diet mentality, aren’t truly satisfied by your food choices, or are habitually using food to cope with feelings.

Intuitive Eating is Not a Diet

Myth #4: There’s No Care About Nutrition with Intuitive Eating

“Honor your health: is #10 of the principles, so definitely, nutrition is a factor in intuitive eating, and is often referred to as “gentle nutrition.” Being attuned to your body while making food choices will naturally lead to some care in nutrition, because while no foods are “bad,” some are obviously more nutrient-dense than others. Our bodies do not feel good eating less nutrient-rich foods all the time, so being attune to our bodies means we will notice that and want more nutritious foods as well. I’ve seen people swear they hated vegetables and they’d never want anything but cookies and cake if they let themselves eat intuitively who actually end up craving sugar less and wanting salads sometimes!

Myth #5: You Will Gain Weight with Intuitive Eating

I think this fear comes from the belief that letting go of food rules means eating high fat and/or high sugar foods all the time. We’ve already talked about how once feelings of deprivation are healed and principles of gentle nutrition are learned, intuitive eaters actually eat a variety of foods. Several studies have associated intuitive eating with having a lower BMI, though please, please don’t take that to mean you’ll lose weight eating intuitively. (Remember, this is NOT a diet and trying to lose weight will always undermine true intuitive eating!)

The truth is everyone will have a unique experience in regards to weight as they transition to intuitive eating. Some will gain weight while others will lose weight, and some will stay exactly the same. It depends on what weight your body wants to be at as well as how responsive you were to your body’s food and movement needs before versus how responsive to those needs you become as an intuitive eater.

Final Thoughts

Intuitive eating really is simple in theory, but it can be hard to put into practice. It’s a completely different relationship with food and your body than most of us have had since we were very young. While it does take time to unlearn diet culture and become an intuitive eater, it’s totally doable! If you’d like to talk with me about learning intuitive eating or have questions about it, please contact me or schedule an appointment.

Much love,
Cherie Signature

Sources
Tribole, E., & Resch, E. (2012). Intuitive eating: A revolutionary program that works (3rd ed.). New York: St. Martins Griffin.
Herbert BM, Blechert J, Hautzinger M, Matthias E, Herbert C. Intuitive eating is associated with interoceptive sensitivity. Effects on body mass index. Appetite. 2013;70:22-30.
Gast, J., Madanat H., & Nielson A. (2012). Are Men More Intuitive When It Comes to Eating and Physical Activity?  Am J Mens Health, vol. 6 no. 2 164-17.
Madden C.E., Leong, S.L., Gray A., and Horwath C.C. ( 2012). Eating in response to hunger and satiety signals is related to BMI in a nationwide sample of 1601 mid-age New Zealand women. Public Health Nutrition. Mar 23:1-8. [Epub ahead of print].

About Cherie Miller @ Dare 2 HopeI’m Cherie Miller, MS, LPC, founder of Food Freedom Therapy™. I offer counseling for chronic dieting as well eating disorder therapy for Anorexia, Bulimia, Binge Eating Disorder, Orthorexia, ARFID, and other eating disorder issues. Contact me here or follow me on Instagram or Facebook.

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#ScrewYourBeautyStandards

We are not born disliking our bodies. We are innocent in our self-acceptance until we learn there is a “right” way to look. After that, we evaluate ourselves against whatever ideal we are taught because it is our nature to compare. If we are fortunate, we will grow up in a family that values inner qualities over appearance. Sometimes that can protect us from internalizing the broader culture’s narrow beauty ideal. But it’s difficult to stay immune to all the messages from everywhere else… the teasing from kids at school… the magazine covers with Photoshopped images… the TV commercials pushing their weight-loss products…

And some are not fortunate enough to grow up in families where beauty is recognized in a diversity of shapes, sizes and colors. For too many, the pain starts at home and family opens the first wounds, which are only deepened by peers and the media.

Seemingly from all corners, the message is clear: We aren’t good enough. Not T-H-I-N enough.

Because thin = good and we so reason, therefore, fat must = bad, right? Some will even directly say that it is.

I used to buy into all of it, like so many do. I hated my body long before I developed an eating disorder, and it laid the foundation for me to go down that path. I was so desperate to lose weight, to be accepted, to feel okay for once. I was so mad at myself for not being thin like my friends and the pretty girls I saw in the media.

Thankfully, now I’m recovered—from both my eating disorder and my body hatred. But I’m still angry. I’m angry that we live in a culture that works so dang hard to make us feel bad about ourselves. You can’t go a day without seeing advertisements for products related to weight loss, makeup, hair dye, eye creams, tummy-control pants, and on and on and on. If you don’t feel pretty, thin, or young enough, then they promise to change that if you’re willing to spend enough time and money.

And I mean lots of money. Beauty is a $532 billion industry and is expected to just keep growing. The problem is that every commercial you see isn’t simply trying to sell you something; first, it tries to convince you that you need what they’re selling. It plays on, sometimes even creates, insecurities. The subtle goal is for you to feel bad about yourself so that you’ll then want to buy something that will (supposedly) make you feel more confident.

.

While common sense likely tells us that we’re influenced by the media, it never hurts to have some research to back that up—which of course, it does. Indeed, research shows that media influence can lead children and adolescents to internalize ideals imposed by society, which also increases the probability that they will suffer from issues like body dysmorphia and eating disorders. Studies suggest this can start as young as six years old, if not even earlier. We’re talking Kindergarteners, maybe younger!

That makes me angry for every little girl that is harmed by these messages poured into her about her value and what she is supposed to be. I hope that like I have, you’ll learn to turn that anger and disgust that you direct at yourself for not being what you “should” be, and you’ll start getting angry at the diet and beauty cultures instead. Not because makeup is evil or dyeing your hair is inherently bad, but because being sold the idea that you can’t feel good about yourself without those things is wrong. Being told we have to be a certain BMI to be attractive and worthwhile is beyond shallow—it’s destructive and sick, and I will never stop fighting for a better world for my son and daughter.

If you’d like to talk about how to get break free from these destructive cultural messages and finally accept yourself as you are, please contact me about a teletherapy appointment or follow me on Instagram or Facebook.

Much love,
Cherie signature

Sources
http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.572.7007&rep=rep1&type=pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6540021/

About Cherie Miller @ Dare 2 Hope

I’m Cherie Miller, MS, LPC, founder of Food Freedom Therapy™. I offer counseling for chronic dieting as well eating disorder therapy for Anorexia, Bulimia, Binge Eating Disorder, Orthorexia, ARFID, and other eating disorder issues. Contact me here or follow me on Instagram or Facebook.

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The Effects of Dieting on Your Body and Mind

In my last post, I talked about the diet-binge cycle that results from trying to restrict certain foods or overall calories. I didn’t go into detail about the physical and psychological effects of dieting, so that’s what we’ll discuss today. And there are a lot of negative effects of dieting, despite the widely-accepted belief that dieting is good for your health.

Brain and Hormone Changes

Many dieters restrict carbohydrates, which is a primary source for glucose, but our brains needs glucose to function properly. “If carbs are strictly reduced, the brain will be cut off from its main energy source, which can drastically alter brain functioning,” says Cheryl Mussatto, RD (registered dietitian). “One such change can occur with serotonin, a chemical produced by the brain. Serotonin regulates our sleep cycle, mood and appetite, all of which will be noticeably altered along with experiencing brain fog.”

Also, as Jillian Greaves, RD explains, “If you’re overly restricting carbohydrates, this is a form of stress on the body that can disrupt normal endocrine function.” The endocrine system, responsible for your hormones, is related to many other systems in the body. “This disruption may contribute to cravings, an irregular or stopped menstrual cycle, hypoglycemia, mood swings, anxiety, chronic fatigue, suppressed immune function and thyroid disturbances.” Some studies show that low-calorie diets raise the stress hormone, cortisol, which can have some serious negative health effects over time.

Additionally, our brain is made up of 80% fat and also needs dietary fats to function properly. If you don’t eat enough fat, you may miss out on some of the brain-boosting benefits of dietary fats including better memory, lower risk of dementia and Alzheimer’s, and better focus and concentration. Medical studies indicate that people on diets have slower reaction times and less ability to concentrate than people not on a diet.

Dieting causes your metabolism to slow down to conserve energy and send it right back into building up fat stores. Also, a 2011 study shows that changes to appetite mediators—so-called “hunger hormones”—promote weight regain after diet-induced weight loss. These compensatory mechanisms driving weight regain last for at least one year and could be long-term or even permanent.

Sleep Problems

Some research connects restrictive dieting with poor sleep quality. In one study, even a short period of dieting (just four weeks) resulted in a significant decrease in the amount of time women spent asleep and a greater difficulty falling asleep. Sleep is an important part of health and a lack of sleep can result in inflammation, an increased risk for diseases, and other concerning side effects.

Nutrient Deficiencies

Many important vitamins like vitamins A, D, E and K, are fat-soluble, and your body needs fat to properly absorb those vitamins. Without enough fats, the vitamins you eat can pass through your system unabsorbed and can result in nutrient deficiencies. Also, restricting entire food groups can cut out main sources of important nutrients.

Weight Cycling (aka Yo-Yo Dieting)

Weight cycling describes the pattern of repeatedly losing and regaining weight, often with increased overall weight in the long-term. “Long-term diet research (two years or longer) suggests that most people regain all the weight lost during a diet, whether they stick to the diet or not,” Julie Dillon, RD says. “In fact, many regain more weight than was lost in the first place.” One 2016 study found that repeatedly going through these starvation cycles prompts your body to store more fat, which is likely a survival response against starvation. Also, dieting slows down your metabolism, as previously discussed. “If you follow people over the long term, dieters are more likely than equivalent non-dieters to end up gaining weight over the next 2 to 15 years after the diet,” says Sandra Aamodt, PhD, author of Why Diets Make Us Fat.

Weight cycling is linked with increased insulin resistance, a condition which can develop into type 2 diabetes (T2D). In other words, maybe yo-yo dieting is a more likely cause of T2D than weight itself! Weight cycling also causes other health complications such as higher blood sugar, blood pressure, cholesterol, risk of heart disease, and inflammation. In many cases, acute inflammation is a necessary and helpful human function that can promote healing in response to infection or injury. However, sometimes inflammation is chronic, which can make you feel drained or foggy and harms health, Dillon explains. “Short-term research suggests many diets lower inflammation, but research looking six months out or more shows that inflammatory markers increase.”

Overeating & Bingeing

Weight is actually regulated by our bodies, and each of our bodies prefers to be within a certain weight range, called a set point. “Your brain will defend this amount just like it defends your body temperature,” explains says Stephan Guyenet, PhD, author of The Hungry Brain. As you lose weight, the amount of leptin in your bloodstream drops and sends a signal to your brain to help you fight to bring that fat back (remember those hunger hormones I mentioned earlier?). This is at the heart of why diets don’t work, says Aamodt (author of Why Diets Make Us Fat). “Whenever your weight changes too much, your brain will intervene to push it back to what it thinks is the correct weight for you.” This push-back from your brain is what Guyenet and others call a classic starvation response: your brain responds by upping hunger and cravings.

“In lab experiments, when scientists want to induce rodents to binge eat, the most reliable method for doing it is to reduce food intake until they’re at a lower weight and then expose them to super tasty food, like Cocoa Puffs or Oreos,” Aamodt explains. She adds that in human research, some studies that look at the brain show that this type of junk food activates reward centers even more fiercely in those who have lost weight. And, she says, animal research may suggest that repeated dieting makes the brain more vulnerable to binging behavior even after the diet is done.

Your body prefers to use carbs for a number of basic brain functions, so eating too few of them can cause your brain to fight back. “Cutting out carbs through any low-carb diet (including paleo and keto) can set a person up for binge eating in part because when we don’t eat enough carbohydrates, our body releases a brain chemical called neuropeptide Y,” says Julie Dillon, RD. “This chemical’s job is to tell our body to eat carbs — and eat them now.” When a person’s brain is flooded with this chemical, it can result in an animal-like instinct to go crazy on carbs — attack a plate of brownies or eat an entire pizza, for example. “It can feel like every cell in your body is demanding carbs, which can lead you to feel that you lack willpower,” Dillon explains. “But it has nothing to do with discipline. Rather, this neurochemical is trying to save your body from experiencing fainting, dizziness or worse!”

Body Image & Self-Esteem Issues

You might think that going on a diet would make you feel better about your body, but research shows quite the opposite. A study of college students showed that for men and women, dieting (even diets described as “normal” in severity) resulted in an increased concern with weight and a lower self-esteem. Another larger study showed that both men and women who reported dieting behaviors were less likely to have a positive body image. And of course, I think we are all familiar with the feelings of shame, failure, and poor self-image that happens whenever we “fail” at a diet.

Preoccupation with Food & Eating Disorders

The Minnesota Starvation Experiment, conducted in the 1940s, revealed groundbreaking information about how calorie deprivation affects the human brain. “It demonstrated that a lower calorie intake provokes the mind to overly think about food,” explains Dillon. Even years after the study had ended and participants again began eating a higher number of calories, participants who had been limited to diets of 1,500 calories per day found they felt fixated on food. Some participants even changed their careers, eventually becoming chefs. “Dieting provokes the brain to dream about food and consume thoughts. We believe this is a necessary evolutionary response to not eating enough,” Dillon says. And as we previously discussed, the response to deprivation is often bingeing, which can lead to eating disorders like binge eating disorder (BED) and bulimia nervosa.

But problems can arise even if the body is getting enough calories. Some dieters aren’t focused on consuming fewer calories as much as they are concerned about avoiding certain foods, sometimes entire food groups. Though these types of dieters might start out with good intentions of eating healthy, too often the diet rules progress into rigid thinking about food and disordered eating… sometimes even an eating disorder that has been termed “orthorexia” (orthorexia is characterized by an obsession with “healthy” eating).

Mood Changes

“Research suggests going on any restricted diet places a person at a higher risk for experiencing depression,” Dillon says. Numerous studies also link chronic dieting with increased stress and anxiety. Neither is surprising since, as we learned earlier, dieting affects serotonin functioning. Of the approximately 40 million brain cells we have, most are influenced either directly or indirectly by serotonin. This includes brain cells related to mood, sexual desire and function, appetite, sleep, memory and learning, temperature regulation, and even some social behavior.

Other Problems

  • Some people who diet, especially those on keto, might experience bad breath and even vaginal odor (a side effect referred to as “keto crotch”)
  • Dizziness, light-headedness, and lethargy/decreased energy
  • Decreased sex drive
  • Not eating enough carbs, a primary source of fiber, can lead to constipation, bloating and other digestive issues
  • Social isolation due to not being able to participate in social activities involving food
  • Decreased hunger and fullness cues

If Not Dieting, Then What?

Like me, Aamodt (author of Why Diets Make Us Fat) and other anti-diet professionals advocates for a style of eating called intuitive eating. It’s a non-dieting approach that allows you to listen to your body and nourish it with what it wants (sometimes kale, sometimes a brownie) in the amounts it wants (more or less depending on your hunger). It might sound too good to be true, and while it’s not, there is a catch. Intuitive eating is not just another diet disguised as “wellness”; the goal is not weight loss and that can be a barrier for some who are intent on losing weight.

As I said in my last post, I totally understand that giving up on intentional weight loss is difficult for so many reasons. It can be done though! If you’re interested in learning how to ditch dieting and making peace with your body and food, check out my resources page or please contact me.

Much love,
Cherie Signature

Sources:
https://www.nbcnews.com/better/health/what-happens-your-brain-when-you-go-diet-ncna802626 
https://uhs.berkeley.edu/sites/default/files/bewell_nodieting.pdf
https://time.com/3092086/weight-loss-depression/
https://www.thedailymeal.com/healthy-eating/hidden-side-effects-popular-diets/slide-35 
https://www.webmd.com/depression/features/serotonin#1 

About Cherie Miller @ Dare 2 HopeI’m Cherie Miller, MS, LPC, founder of Food Freedom Therapy™. I offer counseling for chronic dieting as well eating disorder therapy for Anorexia, Bulimia, Binge Eating Disorder, Orthorexia, ARFID, and other eating disorder issues. Contact me here or follow me on Instagram or Facebook.

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