Other Medical Nutrition Therapy – Seattle

Medical nutrition therapy I provide at Ramey Nutrition includes pre-natal, post-natal, Crohn’s disease, Irritable bowel syndrome, allergies, Celiac disease, and many more nutrition related medical issues. Due to extensive study on medical nutrition therapy, I understand the emotional impact any one of these conditions have on you and your loved ones.

Feelings associated with your diagnosis need to be acknowledged in order to truly move through it and beyond. Often grief and pain accompany serious diagnoses, and if processed well, can be healed.

More important than anything else, I need to understand what’s important to you. For example, if anyone took away my coffee and said it was healthier, I would have no reason to come back. Coffee is part of my daily life, and if a professional doesn’t understand that, I need to find someone who does. In our consultations, we address goals your doctor wants you achieve and break them down into smaller more manageable steps that fit in with your lifestyle. We problem solve together to come up with solutions. Often times, based on the questions I ask, you will come up with your own solutions and end up healing yourself.

My number one concern is trust building and creating easy, highly manageable solutions. Sign up for my free newsletter to stay informed.

Eating Disorders – Seattle – Giant Steps in Bulimia Nervosa Recovery

Eating disorder Bulimia Nervosa client quote from KN in Seattle: “I have a fun update, which I have dubbed a “fupdate”. I figured this may make you do a little Scarlett dance. So last night, it was about 11, I kinda felt like binging…there was a leftover omelet AND a chimichanga AND macaroni and cheese in the fridge. I opened the fridge up, took out an apple and peanut butter, went to my room, ate it, and went to bed. The end.”

Why Is This Such a Big Accomplishment?
When trying to quit a cycle of binging, purging, and restricting (Bulimia Nervosa), it is often difficult to stop at any one of these stages due to the severity of the previous stage. When a person with bulimia tries to stop binging, it becomes difficult because, previous to this she has probably been restricting all day and is probably ravenous with hunger.

To eat normally at this point would be difficult due to her hunger. If she tried a different route, and tried not to purge, this would be difficult because, before the need to purge is generally a binge. Waiting through the digestion of this uncomfortable amount of food, however large it is, would feel like torture. If she tried to stop restricting, this would also be challenging due to the nature of wanting nothing to do with food after a binge/purge cycle.

There is a strong feeling of food being the reason for starting a binge/purge cycle, and control over another cycle means avoiding food in the first place. This wonderful girl went from vomiting everything eaten for 6 months to eating and keeping (not vomiting) 75% of daily food intake. This is almost an impossible feat.

Her Goals and Challenges

1. Her goals included eating a nighttime snack which she selected, and to keep it. This is very difficult due to a previous binge and wanting to avoid food that will be kept.
2. There was food in the refrigerator that often triggers her to binge/purge. “…there was a leftover omelet AND a chimichanga AND macaroni and cheese in the fridge.” This could have easily been added to the previous binge/purge, stopping the trigger once gone.
3. She had to take the least tempting food out, eat it, and then sleep while keeping it. Not wanting food while sleeping, and certainly not after a binge/purge episode.

She took this so seriously, and though she did not want to complete her goals, she put her fears away for enough time to force down her nighttime snack. When we are fearful and go on anyway, this is courage.

How did this person obtain her goals?
We started very slow with her, as we do everyone, however, her successes kept popping up in the face of extreme adversity. Completing her food goals while friends yelled, wanting to binge/purge, but instead, truly eating, lead her to stride toward recovery with the inertia of a wrecking ball.

Congratulations sweet girl for amazing feats in recovery! Please look for my next post on the causes of bulimia nervosa.

Eating Disorders – Seattle – Causes of Bulimia Nervosa

Often, the eating disorder bulimia nervosa is caused by a combination of hereditary chemical imbalances, environmental triggers, family genes, family history of psychological disorders, family issues and is often ignited by a multitude of societal influences. Bulimia Nervosa often involves cycles of food restriction, becoming ferociously hungry, binging on large amounts of food in a hurried manner, followed by purging the binged food.

Binging is often characterized by the rapid and voluminous consumption of high-calorie food in a short period of time. Once the process of a binge begins, it becomes difficult to interrupt. A trance or stupor is often described when a binge takes over. Food can be consumed so rapidly that it’s often not tasted. An average binge can consist of about 1,500 to 60,000 calories or more.

Having seen many forms of binging, Ramey Nutrition has developed its own definition of a binge. When listening to our patients, as they discuss binge episodes, it’s not about calories, or portion sizes, and it rarely concerns hunger.

Scarlett’s Definition of a Binge: Any food eaten in a hurried manner while feeling out of control.

This definition, please note, has no calorie price tag. Patients have reported “binging” on an apple. Any time one of my patients says they felt out of control with food and they ate hurriedly, telling me they binged, I NEVER say “Don’t feel bad, because it wasn’t a true binge.” Acknowledging feelings of control loss is crucial to a patients trust in themselves and their provider. When a patient hears “Your feelings aren’t real,” as the above statement implies, feelings of distrust arise. Feeling crazy due to a provider’s flippancy with a patient’s worst fear, the patient often starts distrusting the provider. Our mission is to put feelings on the table, whatever they may be, and process them. Each feeling is a step toward recovery, and therefore valid. How dare we invalidate a step toward recovery?

Many think of purging only as vomiting, however, there are various forms purging can take on as well. Self-induced vomiting is the predominant method, however, misuse of laxatives, diuretics, enemas, medications; fasting or excessive exercise are also used frequently.

The Biology of Bulimia Nervosa
When a person purges, electrolyte imbalances often transpire, which generally lead to muscles failing to fire when called upon by the brain. The most common prognosis for severe bulimia is heart attack or a stroke. The heart is a muscle, and if not fired precisely, and accurately, could stop beating without the correct mix of electrolytes in the blood.

Some of the most common complications of bulimia are:

• Erosion of tooth enamel because of repeated exposure to acidic gastric contents.
• Dental cavities, sensitivity to hot or cold food
• Swelling and soreness in the salivary glands (from repeated vomiting)
• Stomach Ulcers
• Ruptures of the stomach and esophagus
• Abnormal buildup of fluid in the intestines
• Disruption in the normal bowel release function
• Electrolyte imbalance
• Dehydration
• Irregular heartbeat and in severe cases heart attack
• A greater risk for suicidal behavior
• Decrease in libido

The Psyche behind Bulimia Nervosa
Bulimia nervosa is usually a response to depression, stress, or self esteem issues, and is often a product of pressure a person perceives to succeed, or direct shame. During the binge there is a sense of control loss, however, the sense of a loss is followed by a short-lived tranquility. This calmness is often followed by extreme self-loathing.

People with bulimia are not one size; they can take any shape or size and tend to be high achievers. It’s often difficult to determine whether a person is suffering from bulimia, due to the nature of binging/purging being done in secret and they often deny their condition when confronted.

Eating Disorders – Seattle – Recovery vs Recovered

People with eating disorders, of any type, usually go through a process of eating disorder treatment and recovery to attain what I refer to as a recovered state. Eating disorder treatment includes intense learning about how the eating disorder serves as a coping mechanism, and what feelings are being coped with, using the eating disorder. In recovery, the patient uses new coping skills to deal with emotional issues that arise when the eating disorder is gone, and feelings that were suppressed rise to the surface. Recovered is moving through life’s challenges, not related to the eating disorder or recovery.

Recovery is a phase similar to eating disorder treatment in that it is very much a process of dealing with emotions previously controlled by the eating disorder. Recovery in many ways is more challenging than eating disorder treatment. Eating disorder treatment might be getting over the fear of eating bagels, whereas a recovery challenge might be “Who am I now that I don’t have my eating disorder?”

Patients going through recovery receive one-on-one consultations and group sessions. One-on-one consultations deal with the individual goals and recovery challenges, whereas in group sessions, patients get support from others going through the same process of recovery. Group support comes from sharing similar challenges and instances that have less to do with food, and more to do with emotions.  Recovery group is full of people trying to find themselves without the eating disorder.

Patients with eating disorders often experience a lack of identity, safety, or control, all which produce pain. Patients often think, “If I allow myself to feel, it will be too painful and if I focus on food, I’ll have control over my feelings.”

People with eating disorders often think about food related things 95% of their day, so the idea of not having an eating disorder can cause fear, due to losing 95% of their day, control, coping skills, etc. Now they have to fill that gap with an identity that they are not familiar with, and have to figure out who they are in recovery. It is a very different challenge going through “Who am I” and What is my identity?” versus “How many carbs are in this bagel?”

During recovery, a patient can be triggered without actually going into the eating disorder. For example, a patient is triggered to binge and purge and comes into recovery group and says: “I’m really really urged to do this and I’m triggered by the stress of my father in law, but I didn’t do it, because I used another coping mechanism instead.” They could also be in recovery and use their eating disorder, but be processing through it emotionally. In recovery, patients learn how to use healthy coping skills and put them to action.

Recovered people have graduated from the recovery group. Coping skills start to come naturally, and they seem to know who they truly are and what they need to have good self care. They are who they want to be and feel safe in the world with all the world’s stimuli that used to trigger, charge, or inspire their eating disorder.

They are now living the way they strived to in recovery. A person who is recovered rarely attends group or individual sessions. This is discouraged due to wanting them to practice living in the recovered state.

The goal for my patients with eating disorders is empowerment to deal with challenges that life has to offer, without having to continue eating disorder treatment or maintain recovery for life.

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Eating Disorders – Seattle – Media and Body Image

Eating disorders, media and body image are intricately woven together. Unrealistic images of the human body portrayed in the media often influence the way Americans view themselves in their own bodies. There’s an idea of the perfect body, however, few attain it due to its consistent change. I think the media’s unrealistic portrayal of the human body, has contributed to the epidemic of eating disorders and unhealthy habits in Americans lives. For example, using radical diets that are not healthy in order to achieve something that, in the end, is not achievable.

I don’t blame the media for the rise in eating disorders by any means, but I do believe it contributes. If someone has a pre-disposition to an eating disorder, I believe that  media can have a powerful affect on the tipping point of a disorder developing or not.  A person may be pre-disposed to an eating disorder due to a trauma (85%), perfectionist ideals, high expectations from family, friends, or even perceived high expectations. People with eating disorders are hypersensitive and hyperintuitive. They become hyper-aware of everything going on. For example, if someone is whispering in the corner they know about it, if someone says “You’ve got a terrible hairstyle”, they think they are a terrible person. They are very permeable to most comments and their feelings are hurt easily and they feel everything more intensely than the normal person.

After these people are recovered from eating disorders their intuition becomes honed into mental health habits, such as intuitive eating, how they are feeling and what would feel best, instead of feeling hungry and not knowing what to eat.” They are still sensitive yet they now use it to serve them. They recognize and quickly process comments that would have bothered them in the past.

When looking at an advertisement, ask these questions:

• What is the motive of the advertisement?
• What emotional jugular are they accessing?
• Are they targeting women or men?
• What emotional response do advertisers want me have to buy the product or service they’re selling?

Educating patients on effects the media is looking for becomes critical. One exercise used in treatment group is perusing favorite magazines, selecting different ads and analyze what emotional response they are aiming for, which audience they are targeting, and how they entice each audience to be hooked into their emotion, enough to buy a product.

In group sessions, we go through different ads, emotions that are evoked and the reasons people fall for these tactics. My patients learn to critically analyze what advertisers are trying to do so they end up feeling empowered instead of victimized by media.

Inpatient facilities often disallow media due to possible triggers presented, however media is everywhere in the real world so instead of avoiding it I exploit the exploiters without judgment. It’s their job to sell using emotion, however we can be empowered to make cognitive decisions without falling privy to emotions that advertisers want to evoke. My groups become educated on how advertisers do their job, and empower themselves over emotions ads try to evoke. We see media in the grocery store checkout line, and all over the real world, so I want to teach my patients how to deal with it, rather than ignore it.

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