Wednesday, 2 October 2013

Why is eating in recovery 'stressful'?

We've talked about this over and over again - recovery in ED is very hard. The patient must eat, despite being scared of doing so and of gaining weight. We know that this is part of the disorder, which makes eating and being healthy a nearly impossible task. But what happens - on a biological level - when eating actually occurs? How does the patient's brain respond to food? Why are patients so angry, tearful, and scared when eating their meals in recovery?

A study showed that patients with ED who eat shown abnormally high cortisol levels when they eat.(;jsessionid=FcDxHPdkZvLZH71huW6N.10). Let's talk about cortisol for a bit. First, you may remember that cortisol is a 'stress hormone', which our adrenal glands release when we are in a stressful situation. On a short-term basis, this is actually a good thing because coritisol prepares our bodues to 'fight or flight' (ex. increased heart rate, more blood to the muscles, decreased energy going to digestion, etc). This helps us deal with the stressor. On the long run, however, this can be very harmful to our bodies. Long-term effects of excess cotrisol or the 'stress response' include altered reproduction, heart problems, indigestion, etc.

Another effect of cortisol, despite making us aware that we are stressed and are in danger, is that cortisol might make us feel full. Think about this for a moment: if you are in a terrible situation and need to run fast, would you be thinking about eating your next meal? Not likely. Your body would rather save this energy into running! It appears that in patients with ED, this is what happens. Eating activates the stress response and therefore alters the patient that eating is stressful. This makes patients nervous, angry, frustrated, and stressed. Add this effect to all the other brain/hormone changes we have discussed, and you can now begin to see why recovery is so hard.

What about the solution to this? Is there one? Maybe, maybe not. Many patients are put on medication to control their anxiety around meal times, while others actually have comorbid disorders like depression and need other medications. While I am a nurse, I need to make something clear: medicine cannot solve everything! If you need it, then yes - take it and take it according to schedule! But if you do not need it, you might benefit frm trying other things (provided that they are safe and you check with your medical team). What 'other things'? I'm not talking about herbal medicine. I am talking about relaxation techniques or distractions. When I was first recovering (and even today) I always make sure that I have something to do while eating. It helps take away the stress around eating for me and makes me feel relaxed. I can read, write, play a game, talk to someone, etc. Other distractions that people find helpful are watching movies, drawing, studying, etc. Find what works for you.

Like everything else in recovery, this takes time to become normal. Does the brain of a patient ever return to normal and stop secreting excess cortisol in response to meals? We don't know yet - everyone is different, and it totally depends on the patient. To be honest, though, that does not really matter. I do not personally care if my coritsol levels during meals are high, as long as I am dealing with it and there is no harm from it. Note that in ED patients, extra coristol is present only during meal times - this tells us that patients need to get used to eating meals and realize that it is not srressful or dangerous. Maybe in recovery, you will still find meals hard. That is okay, as long as you are eating and sticking to your plan. Find ways to challenge your brain's response that eating is dangerous or stressful. It will take time and practice. But I promise that it gets easier. Today, a year and a bit after very hard work in recovery, I can eat all my meals without a fuss. I might not enjoy feeling full or the weight gain, but I can do it without panicking. Constrast this to last year, when I first started recovery. I would scream (I'm not kidding) at every meal, I would cry, and I would cry even after I finsihed eating. What a difference in a bit more than a year! Stay strong and do not let ED win this battle. Recovery is tough, and now we can appreciate that this is partially due to the many brain changes that occur in patients with ED. But that does not mean that it is impossible to change.


  1. I like what you said ,and I agree with time ,becomes easier and less stressful


    I remember before I went into treatment, all my family used to fight with me.and all my friends criticize me or give me a staring look.
    As hard recovery was but the gain is way better.
    Thank you lovely Marina

    Love Anne

  3. I am completely understanding how one has or had ED feel when eats. I never know that food can be a stress as I used to see it as enjoyment till I learnt about my Broz illness and read your blog.
    My sympathy and prayer for any body has his or her cortisone high when eat


  4. So cortisone mislead us ,telling us we are full when we are dying from hunger??


  5. Despite recovery from any disease is extremely hard especially chronic mental disease especially ED but you Marina pursued your complete recovery despite all the roadblocks.
    You deserve the big congrat.


  6. As usual you presented the problem articulately and then offered the solution.
    You are skillful in problem solving.


  7. I agree.
    Relaxation techniques and mindfulness helped me distract my negative thoughts and worries away .


  8. Good point you mentioned is you are counteracting the effect of cortisone that may take away your appetite by eating any way despite this.
    I remember my soccer couch used to tell us the best way of defence is to attack and be on the offence not defence
    You acting on the tricks of ED even before it happens



  9. Hola Marina
    What a difference a year can make...Holly


  10. I do not agree with this abstract saying AN is a self induced starvation.
    As you explained before Marina ,even AN started as self induced restriction but slowly things gets out of control when the disease affect the rational thinking and decision making centre of the brain.
    Also I would like to add to your excellent post that people with ED used to relate food to fears of anxiety and this stress them and irritate the amygdala and then stimulate hypothalamus and secrete ATCH and this stimulate cortisone release which inhibit serotonin.
    Do you think people with ED needs extra serotonin and may benefit from SSRI even if they are not clinically depressed or diagnosed with anxiety??
    I would like to hear your answer.
    I like and agree your tips helping mitigating the cortisol suppressing effect of appetite so you can achieve your goal of continuing to eat


    Medical student

  11. Excellent post Marina
    I learnt about how stress affecting our feeling and tips how to move on with what We believe to be good for us.
    Thanks Marina


  12. O boy boy boy.
    Food causing stress and hormones suppressing appetite and taste.
    How hard is it for people .
    Yes Marina distraction away from thoughts of stressor working.
    I am witness for this
    I used distraction to be abstinent from alcohol and I am clean now.


  13. Hey Marina
    You do not know how much you helped me in every thing especially my fears about food.
    I may not know about cortisone ,hormones or brain chemicals but my disease made me afraid of food and seeing ,cooking ,shopping or eating foods was stressful and I tried to avoid.
    I followed your tips and I got motivated and I faced my fears and worried head on.
    Now I am a new person, I eat and enjoy and function as a new person
    Thanks to marina


  14. You are raising the awareness about how this disease can affect people and you giving your experience and hope.


  15. Very proud of you Marina


  16. Well written
    really you are knowledgeable


  17. I do not know cortisone or medicine but I admire you for your resilience and eating your meals despite the effect of cortisone .
    You are setting a role model of resilience and perseverance


  18. The thankful mother wants thank you for telling us tips to help whoever suffer.
    No roadblocks whatsoever can stop your recovery .
    I assure you my daughetr has been excellent .
    Thanks again



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