002 - Food is Medicine in Eating Disorder Recovery

Episode 002 - Food Is Medicine in Eating Disorder Recovery

A conversation with Jenni Gaines and Laura Cohen from FEAST

FULL TRANSCRIPT

Host:

Welcome to The Other Side of the Plate, brought to you by FEAST—Families Empowered and Supporting Treatment of Eating Disorders… Together we'll share personal insights, connect you with professionals, and point you toward helpful resources. And as we say at FEAST: We're here because we've been there.

NOTE:

The content contained in this podcast is not a substitute

for professional or medical treatment, and it may not represent

the views and beliefs of FEAST. Always consult a medical

professional for medical advice and treatment recommendations.

Jenni:

Hi everyone, hi Laura. Today our episode is called Food Is Medicine in Eating Disorder Recovery. We're going to talk about why food is not just fuel or nutrition, it's medicine. It's the foundation for healing and without it, recovery just can't happen. There's also a phrase we're going to discuss, and it's used pretty often in the eating disorder treatment world, and that phrase is, life stops until you eat. We'll look at that and exactly what that means, not only for your loved one, but also for you.

Laura:

Yeah. This is one of my favorite topics. I could talk about this forever and I really want to get started with that big idea. Food is medicine. And when I hear that sometimes that gets co-opted by the health and wellness world and, you know, talking about different nutrients and if you eat this food, this is going to help you with this, this, and this. That's actually not what we're talking about here. So it's not metaphorically, it literally is food is your medicine. Meaning when someone is in recovery from an eating disorder, food just isn't optional. It's not something that you just want to ease into once therapy starts working. Food is actually the treatment and the first step of recovery.

And I want to go back to something I just said right there that I think is really important. And Jenni, I think that you can probably relate to this as well. And when we talk to caregivers, often I will hear from families and I did it myself, as well, they just need to go to therapy, and once therapy starts working, then they'll be able to eat. And what caregivers don't understand, understandably, they don't understand, is that without the proper nutrition to get, and when I say proper nutrition, I'm not talking about nutrients, just food without refeeding. Your loved one's brain, the therapy really doesn't work. And it sounds so backwards.

I know even though that was the first thing that I did when my daughter was diagnosed, I thought I had to find a therapist. And one therapist I reached out to, I got really angry at because they sent me this whole long email telling me that they would not take my daughter on as a patient until she was eating adequately because the therapy wouldn't work. And I was so upset about this person, and lo and behold, now, you know, five and a half years later, that person, I don't even know who it was, I wish I could find them, was so spot on correct. So food is the first line of treatment. And why? Why is that? Because when the brain is undernourished, it actually doesn't work properly.

Starvation, even in somebody that doesn't look underweight, and I will say that again, someone whose body is in starvation could be someone that actually resides in a larger body. They don't need to look starving. But when someone is in starvation mode, they have really rigid thinking. They could be really depressed. And this is all just the side effects of starvation, a lot of obsessive behaviors. You'll hear this over and over again, and I know this happened in my situation and with families I work with. And Jenni, I'm sure this happened. You've seen this as well.

You'll see a lot of obsessiveness. Sometimes it may even look like someone has OCD, obsessive compulsive disorder, and sometimes they do. But you will see in a more starved brain, more obsessive behaviors, needing to touch something five times, needing to do things a certain way, just very rigid, and needing to be done a very certain way. Also being very fearful around food. Food is the scariest thing in the entire world. Something that I used to say to my families to really bring it home is that when your child or your loved one is looking at food, if you have a fear of spiders, you know, snakes and spiders, you know how scary those things are to you or mice, whatever is your biggest fear. Imagine having to look at that multiple times a day. There's no way to avoid it if you're trying to, if you have a drug addiction or alcoholism, not that they're comparable at all, but one big difference is you're actually removing the thing that they're trying. You know that the issue is in eating disorder recovery, you actually cannot remove food. You actually need to bring in food, and that's why it is so hard. So if your loved one seems resistant or their therapist says they're not making progress. You really want to think about progress is not going to happen until they start eating and their brain starts to heal. It's healing a broken leg without a cast and walking on it before the bones are set. It wouldn't make sense that if you had a broken leg to go train for a marathon, right?. I think everyone's common sense would know we need to work on putting a cast on and letting it heal. But with an eating disorder, people don't really see that. And that you really need to do that rehab, wear that cast, which is the food. And Jenni, what was your experience with all of that? How does that land for you?

Jenni:

That lands with me right now it all makes sense. But just you, at the beginning I went straight for the therapy thinking this is considered a psychiatric illness. A mental illness. So she needs that mental health help, she needs the therapy, she needs maybe a medication. And I did not understand food as medicine as a concept at all until I started reading as much as I could about eating disorders and learning about them. You're exactly right. Healing just cannot happen from an eating disorder without food and a lot of food.

And that leads us right into another topic that I wanted to discuss today, and that is. Does the medicine, the food, need to be a certain type of food? Does it need to only be "healthy" food? And what we're going to talk about today is that all food is good food. And back in the beginning, and Laura, this may or may not have been true for you also, I did have some categories of food in my mind. I had red light foods that I had been trained my whole life were not healthy. That I didn't need. And so moving into this idea, in order for my daughter to heal from her eating disorder, food is medicine and all food is good food. It took some work on my part. I had to challenge some of my food beliefs and some of my attitudes toward food in order to step up as the best mom that I could be for her during treatment and recovery. And so I think it can be kind of surprising and even uncomfortable to hear that sentence. All food is good.

Laura:

That's hard, right? It's really hard. I always say to people, what does that bring up in you when you hear that all food is good food?

Jenni:

Well then I started thinking about, well, are Oreos good food? Are french fries, good food processed, packaged sugar, loaded foods, good food? And at the time I probably wouldn't have said yes to any of that. And some of the higher fat foods, I mean, I was the mom that had skim milk in the fridge and low fat yogurt in the fridge thinking, oh, this is good. These are good things to have. And all food is good food. It was something I had to gradually get used to. So if you're listening to this right now and you're feeling that just major resistance coming up on this concept, I feel you, I hear you and understand you.

You can work on it over time, but what it means in your child's recovery is that you're not looking to build the healthiest diet. So you're not looking for healthy medicine for your child. You're trying to rebuild their trust with food in general. So that means accepting things processed food, packaged food, sugar containing food, full fat items, all of that is part of the recovery process, becoming comfortable with accepting all food.

And so you're trying to remove fear from specific foods, and as Laura was saying, they'll have a lot of fear around foods when they're malnourished. And so you may start out with them not wanting to eat anything except for maybe a chicken breast and some broccoli or something like that. And you're going to be wanting to expose them to their fear foods and help them begin to trust again that their bodies can eat that. And you let go of moral labels, clean or bad. So clean eating can be something that can even be a precursor to eating disorders. And then you have the "bad foods" that people just kind of have a block in their minds about we never eat this or we never eat that. Another thing to consider here is someone who's becoming a vegetarian or a vegan for the first time as they're developing an eating disorder and thinking that anything outside of those eating categories is not something that they should have.

And what you really need to do when you're in recovery or focusing on your child's recovery is, is to just give the body what it needs to heal. And that's not always the easiest thing to determine. I think after asking what quality of medicine do we need? Does it have to be a certain type of food? I think my next question Laura, would be, how much of that medicine do we need? So what is my dosage? And so I think that's something that we can probably get into, but right now we're just looking at how diet culture has trained all of us to think certain foods are good, certain foods are bad, but in eating disorder recovery, we need to just keep food neutral. So a cupcake and a salad can both be nourishing foods. If your child's eating something that maybe they would've never eaten before, say a Pop-Tart, after months of restricting, that's really a step forward. So just kind of reframing our beliefs and our attitudes about food so that we can allow food to be medicine for our kids.

Laura:

And it's such a big topic, and we are literally just touching the surface and giving you that high level overview. One thing, Jenni, when you were talking that I was thinking about was, we may have some listeners whose loved ones have ARFID, an eating disorder that they're very selective with what they're eating based on consequence. Whether it's sensitivity, it could be, you know, they've had GI issues in the past and they're afraid of pain. They could have a fear of vomiting. So just different consequences why they've become very selective picky eaters. And I think back to when I have kids that are in elementary school and you go to elementary school and you pack them a snack of Cheez-Its, and I don't know of goldfish, but that would be really the same thing. Cheez-Its, and you know, maybe something else, maybe a candy bar and you go to school and the teacher says, well, we don't allow that in our classroom. We only allowed healthy foods and I've worked with families that we have to put, it's called a 504 plan, for those of you that know, but basically put accommodations in that they're allowed to, that no one is allowed to make those comments. That they're allowed to bring whatever food into the classroom they want, and it doesn't need to be healthy.

And my argument with families that will say to me, well, my kid only eats chicken nuggets and pretzels. That's so unhealthy. I had a patient who was 12, and that was literally what he lived on. And what I said to the mom was, well, those foods that you're deeming as unhealthy, the chicken nuggets and pretzels have kept your son alive for 12 years. And that was such a big reframe for her. So we really want to be careful about what we call healthy and unhealthy. Because sometimes something you may deem as the most unhealthy thing in the world is actually the healthiest thing at that time. So yes. Thanks Jenni.

Jenni:

No, that's a really good point. I appreciate you bringing that up there. It's just a lot of reframes. You said the word reframe and I'm thinking another reframe that I had to do was the amount of food that my daughter needed to recover. Early on we tried FBT and I thought, you know, anytime I've ever gone on a diet in my whole life and I've gone back to eating. I gained the weight back really quickly when I went back to just normal eating, and I just kind of assumed that's how this would be. She lost the weight quickly. She'll gain the weight quickly. What I found out was, you know, I was giving her the medicine, she was eating food and she was eating what I considered to be a normal amount of food. And what I learned was there was our normal amount of food. Our normal, which wasn't normal for what she needed for treatment and recovery. And I found out, I learned that that increase in metabolism is very common in eating disorder recovery. So she needed a lot more than I was giving her. So yes, I was giving her a dose of the medicine, but the dose I was giving her was not the proper dose. And I think it takes some trial and error to figure that out if you have a treatment team to kind of walk you through that and help you. But with FBT, the way that we were figuring out if it was enough food was monitoring her weight gain. Our first week when I was so proud of, you know, going up against that restriction and the resistance and getting her to eat and she didn't gain any weight, felt a real failure. But what it was, was just a learning experience and we had to increase the dosage of the medicine is what we had to do. And once we did that, it got a lot smoother.

Laura:

Yeah. It was definitely, it was information, not failure. Right. Information is so important. Right. But yeah, I hear you with all of that.

You know, and one thing that we talk about is, you know, how can I help my loved one without making it worse? I feel that's the golden ticket, right? If someone could just say that and we'll definitely have episodes about things to say and not to say, but you know, again, this is just to even scratch the surface. How can I help my loved one, my child? You know who, whatever it may be, your spouse or your child, without making it worse. And here's just a few little guidelines. Really never comment on what or how much your child eats. I will say that even long into recovery, I would make these comments and my daughter would get really upset and I wouldn't even realize it. They were often misinterpreted. This could still happen to this day, and we always have to remember, and I cannot stress this enough, when you are talking to someone who's in either treatment or is in recovery from an eating disorder, the way that they will hear your words, especially a parent, the way that they will hear your words are going to be different than if you said it to anyone else, even if it's your other child, your other loved one. So no comments. No comments whatsoever about the food, what it looks like, how much, how little just it is, what it is.

I remember once my daughter had eaten a larger portion than she typically did, and I made some, it was a positive remark about, you know, how much Wow, you really ate that rice tonight. That set her into the biggest upset, and I was saying it as a positive. She interpreted it as that evening was me yelling at her that she ate too much rice, which was of course the furthest from the truth. So really staying away from any comments whatsoever about the food and how much and what it looks like or anything? The word healthy is a very, it's a loaded word. Avoiding, so you really want to avoid praising "healthy choices" or expressing surprise at unhealthy ones, because that is, the eating disorder is going to glom onto that. So if you could lose those words ever in your vocabulary, that would be fantastic. So yeah, no comments about healthier or unhealthy as well as. When your loved one is in recovery and you make a comment that you look healthy or I'm only going to make you healthy, they interpret the word healthy as, oh, you're going to make me fat. Or, oh, someone says I look healthy. That must mean that I look fat. So it's all these things you wouldn't think about. I go on my little side tangent sometimes, Instead you, so then you're going to say it. I mean, well, Laura, what else can I say?

And I think that these are very personal too, and I think Jenni and I, I think we talked about this at our last episode, that sometimes praising your loved one, that you're doing a really good job that may feel really yucky to your loved one. And some kids love to hear that. I think a good thing sometimes to say is, you're really doing a hard thing and I'm proud of you. See how that sounds so different than good job eating all that food today. Right? Just acknowledging that it's hard. You know, I can see that you're really struggling. You really struggled with that meal and I'm really proud of you for sticking through it.

Again, food is your medicine and I'm here with you with something you can say. I agree with it. And at times, that reframe of saying that their food is their medicine, even though that's the title of our podcast today. Sometimes that may not land with someone who's just very triggered about their food. But I think it also could be a really good reframe. And again, it's a little bit of shooting from the hip as to, you know, what people are going to find helpful. I the reframe of food as your medicine, and it needs to be taken in doses. Someone else may really not like that. So give it a try. Try it on. If it doesn't work, then leave it by the side of the road. When your loved one is asking you about ingredients or calories, which they will continuously do over and over and over and over again. You want to become a broken record. That's one of the skills that we talk about becoming a broken record. We're not talking about calories or ingredients, we're just eating and healing. Some people may not want to hear that, but healing, but that's just an example. But I would repeat that over and over again. We're not talking about calories or ingredients. Take a bite of your food and then they ask you again, we're not talking. And if you say it enough, hopefully eventually they're going to stop asking you because you're not giving them any more information than that. Your job is really to be the calm in the storm, okay? Right now, as I talked about how the fear of snakes and spiders, food is absolutely terrifying. Your job, the best thing you can do as a support is try your hardest to be the calm in that storm.

Jenni:

Those were such great examples that you gave Laura about what to say, because I would say that's one of the most common questions that we get at FEAST, whether it's an email that comes in from a concerned parent or it's within a support group, but what do I say? Because it seems anything I say is the wrong thing to say. So giving those examples is wonderful. And I love that you said you're going to kind of be shooting from the hip at first, and if you don't like something, leave it by the side of the road. That is such good advice, because I definitely said a lot of the things that were not helpful to my daughter, but it was only by trying them that I figured out what did work.

And one of the things that I did was validate how hard it was. Exactly what you suggested, Laura. But another one that I used was, you can trust me. I'm your mom. I would say something like that. Because she was so terrified. I mean, it's not defiance or being, you know, difficult. No, it's not that. Yeah, they're absolutely terrified. And when I looked at it that way, that was really helpful to me. I remember I have three kids and my daughter, the one that had the eating disorder, taking her in to get her vaccinations was so stressful for me because she was a very emotive person. I mean, she really expressed herself. She would scream really loudly at the top of her lungs and enough so that I would dread it every single time I went in. And that actually, that experience with her reminded me that I can sit with her through this and make her, you know, take her medicine and I can tolerate her distress. I can do that and just let her know I'm here with you. I know this is really hard for you. You can do it. It goes back to if you're questioning at all your ability to get through this with your child. Think back to some other examples of how you've been there for them in really uncomfortable situations and you made it through and they made it through that. That for some reason really helped me at the time.

Laura:

I think that's such a good call out, Jenni, because think about, and ironically my kid was the same way with vaccines. The silver lining to an eating disorder for her. Because there's always silver lining somewhere. Is that after eating disorder treatment, she wasn't scared of getting blood anymore and shots because she had to get used to them. But anyway, but what I was going to say was, you know, when you're sitting in the car, and Lord, I know Jenni and I both have been there and your kid is flipping out about having a vaccine, you don't turn around and not, you may want to turn around and say, okay, well we're not going to get that today. Or Yep, you're not going to do that today. Or, you know, I know you need this medicine that's going to save your life. I often use, you know, there's plenty of medications that sometimes, you know, patients have to have and they're going to have really bad side effects and it's not going to feel good. But you wouldn't tell your kid not to take an antibiotic because it doesn't taste good. You're making your kid do it. And that is often the analogies that I use with food. They don't want to do it, but you need to really look at that as this really is their medicine.

Jenni:

Yes. And it's not going to be easy for you as the parent either. I mean, I remember internally feeling how can I possibly ask her to eat that? That is so much food. And I had to learn, and it took a lot of practice to be the calm in the storm, as you said, Laura and I encourage anyone who it doesn't come naturally to to keep practicing because it will be something that with enough practice, you will get better and better at. And it's not only good for them to see that you're calm, it's also good for you to learn how to remain calm. And I think we will have many episodes about that. Because there are lots of skills to learn. These are not skills that we come into parenthood with.

Laura:

No, think about when, again, back to that vaccine example, because it was a good one. If you are so anxious sitting there, right, with your kid getting a vaccine, your kid's going to be a lot more anxious about it. It's the same thing if you're sitting down in a meal and I understand feeling anxious because I had that too. But you know, this is, again, we're going to get into other episodes this way, but if you are in there feeling that anxiety, the anxiety is going to be that much higher. So, you know, really working on our own distress. So yeah.

Jenni:

Yeah. Laura, we started out at the beginning of this episode talking about how we were going to discuss life stops until you eat. And I think we've kind of talked around that, but what exactly does that mean? What is life stops until you eat, and why is that important when we're looking at the concept of food as medicine?

Laura:

It's such a good question and people don't really realize the severity or the seriousness of the answer is truly life stops until you eat. That could mean school. That can mean college. That can mean elementary school, it can be middle school, high school, whatever, therapy, socializing. Because food is truly the foundation on which all of this is built. And one thing I really want to be clear, because people are probably hearing that and going, okay, that doesn't make sense. You don't understand my kid, and school is everything to them and they have to go play soccer and they have to dance and they have to do all these things. And I do hear all of that. I 100% hear all of that. And again, if your child had a broken leg, would you be sending them to track practice to run? And I know the answer is no. And this is the seriousness that it needs.

What you want to think about is if you are not drawing the line in the sand, that life stops until you eat. You are not taking eating disorder treatment serious enough, and if you as a caregiver are not taking this serious enough, then recovery is going to be really hard because that eating disorder is going to slip into all the cracks. But if you, as the caregiver are nope, everything stops until you eat. It allows them to realize the severity of it. If you say, oh, you know what? They're going to continue dance season until competition is over, you're not showing. And then that kid in their brain goes, well, I guess I'm really not that sick. They're not taking it seriously. I'm going to keep going. And the truth is, if you said, Nope, life stops until you eat. It's going to suck for a little bit. Excuse my language, and in the end, that's how you make those steps forward. And I'm not saying it's easy. There can be some really ugly times. But the good news is once that nourishment starts to return, so does life, you get back joy. You get back energy, you get back some curiosity. And my favorite word, hope, if you guys could see, I've got that tattooed on my arm. But without taking this as seriously as it is, you're just going to be dragging it on. And it really, you know, life stops until they eat shows that seriousness.

Jenni:

So well said Laura. And when you were first talking about it, I was thinking that concept was another hard one for me. Life stops until you eat. I had this extremely academic child, which I think most kids with eating disorders are those high performing types. And she had goals and I didn't want to interfere with those goals. And she also was in a ballet company and had performances that she was wanting to audition for, but I am so grateful that I did take it seriously and I stopped her life until she ate and she did miss some school and she was out of dance for a very long time. But I think that the stopping will be so much shorter if you truly stop at the beginning and it won't drag out for as long. So just, I encourage anyone who thinks it seems impossible to know that you're doing such a good thing for your child when you treat food as medicine and you don't let there be any exceptions to the eating of that food.

I think Laura mentioned an antibiotic. I just know that if your child had something where they were told to take the pills until they were gone and to not stop until they were gone, they would probably do that and you would make sure they did that. Even if they're oh, I feel fine. My symptoms are gone. Take that whole bottle. Because if you only take part of it, chances are you're going to get whatever it is that you went in for the medication in the first place. So that's another analogy that's helpful for me. So to treat food as medicine, to figure out what the right dose is, and to stop life just temporarily until they eat.

Laura:

Yeah, absolutely. Absolutely. Anything else that you can think of, Jenni, along these lines?

Jenni:

Yeah, I'm just curious. I have a question for you, Laura, because I know you're a registered dietitian and to me that means you probably know so much more about nutrition than say I do, or the average person does. I'm just wondering how did that prepare you for your child's eating disorder?

Laura:

Well, I was a registered dietitian and I think that in a lot of ways that hindered my daughter's recovery until I learned better. Because as a dietitian I was really taught all about healthy food and, you know, all the good and bad food things. And it was really hard when I realized that I had to let all of those food rules go, and really learn the way that I was going to refeed my daughter was with heavy whipping cream butter, olive oil, ice, full fat, ice cream, full fat, yogurt, full fat, everything. And that, you know, fruits and vegetables, only if they had butter on them, or cheese or, you know, kind of mixed in something. That was a really hard concept for me. And one thing I had to really learn was that this is for now, right? This is for this point in time, was that I needed to get the weight back on her body as soon as possible, and refeed her brain and the other things, you know. It's not her entire life that I'm not going to be focusing on broccoli, not that I'm ever focusing on, although I do really like broccoli. But that just wasn't the most important thing on the plate at that time. Right? And they've got, this is just a snapshot of their time, of their nutritional journey and their time. And that was a really hard concept for me. And it was one that I had to give myself grace to really unlearn all the things that I had always been taught and that were my core values. So yeah, thanks for bringing that up. Because I think that I'm not alone in that. I talk to a lot of parents that really struggle with that. Especially our age group, you know, that we were really brought up in, you know, the eighties and the nineties when it very much was about restricting and fat free and diet foods. So, a lot of unpacking to do.

Jenni:

A lot of unpacking and a lot of unlearning and relearning exactly what you said. And I know that you wrote a blog post for FEAST a while back. We Only Eat Healthy Foods in Our House was the title of it, so I want to make sure and link that in the show notes. I found that before I ever even met you, I read that blog post. It was helpful for me and I think it will be helpful for our listeners today too. And that also made me think when you were talking about, unlearning and relearning and some of the ideas that you had about food before the eating disorder. I just want to highlight one specific food that for me, was something I stayed away from for, you know, from the time I was a teenager until I was an adult, and my daughter got an eating disorder and that's butter. Butter became my best friend when it came to how am I going to get more nutrition on this plate without more volume, because when they've been restricting for a long time, the volume of food, I mean, they can get full really quickly. And so creating more volume in order to get more calories in can become such a challenge. And so I learned from FEAST that I could use really high fat foods, heavy whipping cream. You talked about, I think in your blog post—

Laura:

Heavy whipping cream butter was our staple—

Jenni:

—the high fat ice creams. Yes, those were all our friends, but butter and oatmeal, that was what I would say was the secret weapon for us. I could get so many calories in during breakfast because she already ate oatmeal. I would just load it up. I used to think, how am I going to amp up the oatmeal today? I put four tablespoons of butter in it, put some heavy whipping cream in it, or put some whole milk in it, or half and half, put nuts in it, dried fruit, anything that I could. And so it was the same amount in her bowl. Really didn't increase the volume very much, but it really packed a punch. And those are just the kind of things that you learn to do, and you don't know going into this, it's such a huge learning curve.

Laura:

Yeah. But yeah, we'll definitely talk about more tips and tricks to add calories in. My biggest goal always was the smallest amount of real estate with the most calories in it. Because they're full. They get full quickly. So you can have something small, physically looking small, but you're loading it with calories. You want as many calories per bite as possible.

Jenni:

Exactly. And that was not something I really knew how to do very well going into this. I had to learn. So I guess we'll leave everyone today with letting them know you're, if you're a parent, you're a caregiver of someone with an eating disorder, it's a really hard thing to do, but you being there and loving them, learning as much as you can about eating disorders, listening to this podcast, validating them. Just going one step at a time through this. It's really important. It matters and it makes a big difference, and we're just so glad that you've been here today. We're looking forward to our next episode already, and it's going to be when our child is diagnosed with an eating disorder, what do we tell our friends and family? Another really important topic and such a hard one. Another one. We don't have any idea what to do until we're in the situation and we're trying to figure it out. So that's what we're going to bring you next time. And in the show notes, we'll link some good resources on this topic, Food As Medicine. The blog post that Laura wrote that I talked about. FEAST 30 days that we spoke about in our first episode, days five and six, specifically talk about food as medicine and nutrition and the importance of nutrition and eating disorders. We will also give you a guide to Refeeding that's on the FEAST website and a family guide to nutrition. I think all of those will be really helpful in digging a little bit deeper in this topic. And we thank you very much for being here and we'll see you next time.

Laura:

Bye everyone.

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