Thursday, February 26, 2015

Return of the Dietitian

Ever since I got back home from all my visits, finished up all my interviews, I'm feeling like dead weight. I just want to sleep, or watch The Bachelor, or read, and do nothing related to work or school or research or anything. It didn't help that I topped off two extremely high-stress weeks by staying awake for 48 straight hours last Saturday-Sunday as a result of the cancelled flight fiasco. But it seems like since then, I've just been totally sapped of any energy or motivation and still haven't fully recovered. So I'm doing okay, just feeling a little exhausted and listless.

The other thing I've been wanting to write about is that I reached out to that dietitian I saw once or twice and couple of years ago. I didn't really have a great impression of her at the time, but she had followed up a couple of times by e-mail, which I appreciated. Plus my therapist was the one who recommended her, and I really trust Dr. P's judgement. A couple of weeks ago I had been totally freaked out and frustrated about my weight and eating and stuff, so I decided to just reach out and see what happened - somewhat with my tail between my legs, but mostly wary and skeptical, because I have never put much faith in dietitians. 

We had a phone consult because I am poor and have no time for a real appointment, and I'm SO glad I did because it was actually super helpful. My main concerns were that 1) I don't think I'm eating enough because I am always hungry and I'm always tired/drained; but 2) I seem to be slooooowly gaining weight, STILL, more than two years after starting recovery; and 3) I have not upped my intake at all in those two years, and am not at what anyone would consider a "weight-gain" amount of calories. Nutritionist (let's call her N) does not specialize in eating disorders - which can be both good and bad, I think - but agreed that my weight trajectory on my current intake doesn't really make sense. And she agreed that it is probably not a case of me eating too much. Her main thought was that my body is still a little shell-shocked and not functioning optimally, and probably still hanging onto too many calories to protect against starvation. And that I am not really helping anything my keeping my intake low and my variety limited. I have heard this theory before, that eating too little can suppress your metabolism, but have never been totally convinced. But, I almost believed it more coming from a non-ED specialist....I wasn't worried that she was just saying it to trick me into eating more, you know? Sometimes with ED dietitians I got the impression they only knew how to counsel people in weight gain, and nothing else.

But I felt like N was very thoughtful and well-informed, and she cared more about improving the quality of my diet than micromanaging the details. Her main suggestions were to expand my intake dramatically, both in terms of calories and variety. She thinks I am missing out on key nutrients (most notably protein) and should start incorporating much more meat, eggs, cheese, etc. into my diet. In terms of calories, she said that with my age and level of activity, I should probably be eating about 500 more per day than I actually am. So that was eye-opening. Increasing my calories by that much is going to be hard, I know, but I am slowly trying to move the needle a little each day. For some reason I've found it much easier to focus on variety and overall nutrition - I am eating things like hamburgers and pork and string cheese and trail mix, which I never would have touched before because lean poultry and Luna bars are simpler and safer.

Things I liked about N:
1) She was much more concerned with overall nutrition and balance than calories. She was willing to talk calories because I brought it up, but most of our discussion focused on how to get a healthy and varied dose of nutrients at every meal.
2) One of the first things N said was: "I don't want to do anything that will create more food rules for you." She seemed to understand intuitively that I am someone who has had a traumatic history with food, weight, dietitians, meal plans, etc. and is not interested in the "usual" advice. That I very much want to eat healthfully and freely instead of trying to achieve the "perfect diet."
3) She congratulated me about a million times for all the progress I've made, affirmed that fact that I am comparatively in a great place, all while acknowledging and validating that this is still really, really hard for me.

A good experience overall. She is very responsive via e-mail, which is great, and I am going to follow-up with her next week. My eating has been super erratic just with all the traveling lately, but I am really trying to put her recommendations into action and see what happens. I am not weighing myself these days, so am more going by energy and clothes fitting and hunger levels. Will keep you all posted.

1 comment:

  1. I'm really glad you reconnected with your dietitian! It sounds like it was helpful and productive to talk to her. Sounds like she's taking a good approach with you! I'm glad you've been willing to follow her suggestions and work on variety and an increase. Hope it helps!