Why intuitive eating won’t work
Caveat: when I say that intuitive eating won’t work, this is in the context of an eating disorder recovery.
Why I like intuitive eating
I’m a big fan intuitive eating and I’d say that the way I eat is pretty intuitive: I eat what I like and what feels right at the time. Sometimes it’s more nutritious than other times, but I trust that my body can cope with that because it did before I got ill, and it has done it ever since I have recovered. Often when people come to me, they tell me that they want to be able to eat “normally”, a bit of everything and without guilt, which sounds a lot like intuitive eating. “I wish I could just go to a café and order something I like without fearing the consequences. Other people do it all the time, why couldn’t I?”
Why I don’t recommend intuitive eating to everyone
The answer to this is that you can eat intuitively but not straightaway. Intuitive eating is marathon and both your legs got broken with the ED, so right now you’re having to relearn how to walk.
Intuitive eating is seductive, but one must proceed with caution. Is it seductive because it would confer you with more brain space and that you’d finally be able to eat normally? Or, is it because the ED sees it as a way to restrict?
You see, intuitive eating is a great idea for someone whose physiology is “normal” i.e., the body responds to given and predictive cues. Anorexia, however, implies a pathophysiology i.e., things aren’t as they should and so we can’t imply the same principles as we would with normal eaters.
What does eating intuitively mean anyway?
The main principles of intuitive eating are as follows:
- Eat when you are hungry and stop when you are full.
- Eat Slowly.
- Pay attention to the tastes and textures, as well as the sensations in your body.
- Take time to appreciate how good the food is.
- Eat without distraction, away from screens.
Let’s review them and see why they can’t apply to anorexia recovery.
Eat when you are hungry and stop when you are full.
People in recovery from anorexia, especially at the start and if they are on a structured meal plan, will almost never be hungry and always feel full. This is because their digestive system has slowed right down, this is called gastroparesis and 98% of my clients present with this when they first come to see me. When we restrict, we don’t just lose fat, we also lose muscle. Muscle doesn’t just mean biceps, quads etc., it also means our smooth muscles and that includes our digestive tract. Our digestive system becomes less active and therefore doesn’t move the food as fast as it normally would. There may also be an attempt from the digestive tract to slow things down so that it can mop up the little nutrients provided in the diet. Restriction also leads to a slowing down on the metabolism and this isn’t to be annoying but to save you.
Your metabolism will slow down to save you
You see, if you, let’s say, need 2,000kcal and that you eat 2,000kcal, the body is happy and it does what it’s supposed to do metabolically. If it needs 2,000kcal but that you only give it 1,000kcal, you lose weight because of the deficit, but the body will also start to panic a bit “thinking” that if it carries on, you’re going to disappear into thin air. That’s not ideal as far as the body is concerned, the body wants to live, that’s its main job. So, it will react by slowing down the metabolism and that means doing things more slowly (perhaps not doing things at all, like periods) to spend less energy. Calories are energy by the way, so the body will try to do what it has to, spending less energy doing so. Of course, there are very important things like the heart and brain that it will try to protect for as long as possible, so this is not where the slowing down first happens. The digestive system, however, is important but not as vitally tuned so it can afford a bit of slowing down. So, the combination of the loss of muscle tone and your metabolism slowing down leads to a digestion that has slowed right down – gastroparesis means paralysis of the gastrointestinal tract. It’s obviously not a complete paralysis.
You are going to feel full all the time
So, it takes you ages to digest and on top of that you are required to eat a fair amount of food because you need to restore the weight that you have lost (or at least some). That’s the irony of this illness: the more weight you lose through restriction, the more food you will have to eat to get better. The effect of this is that you are going to feel full all the time. It’s not uncommon for people to tell me that at lunch they are still full from their breakfast and morning snack and I believe them. Regardless, lunch needs to happen. No, you can follow the intuitive eating principles at that moment because listening to your body would get in the way of your recovery. Worse, those cues would in time be giving free rein to the ED to restrict.
Eat Slowly
Slow eating with careful mastication is something nutritionists often recommend, it’s a way to help with digestion, a way to properly taste your food and a way to make your meals last longer. “It would help my digestion!!”, I hear you say. You are not wrong there but that’s not enough to turn a blind eye to two problems with this idea of eating slowly.
The longer you are at the table, the more time you are having to face what scares you the most. If the last thing you want to do is eat that plate of macaroni cheese, is it really a good idea to spend 2h looking at macaroni cheese gradually congealing on your plate? Get it over and done with. Yes, it’s going to be hard and yes, the thoughts after will be loud but let’s be real for a minute: as far as anorexia is concerned any food is bad/too much, so if you’re going to be shouted at, it may as well be for something. You can’t recover from anorexia without eating enough, you can’t talk yourself out of this I’m afraid.
Satiety isn’t your friend right now
Did you know that feeling satiated normally takes around 20min or so? This is because this sensation of satiation relies on a dance of hormones and hormones take a bit of time to do their jobs. The thing is, as far as your brain is concerned, feeling full is the same as feeling fat and when you feel fat what do you want to do? Eat less. Can you see, therefore, why spending ages to eat might not be the smartest of moves?
This is why, by the way, meals usually cannot be longer than 30min in in-patient settings. It’s not just because they want to clear the table.
Pay attention to the tastes and textures, as well as the sensations in your body
A starved brain is a scared brain. Normally, when we eat, a small part of the brain, called the insula, is in charge of telling us whether this feels good and whether we should carry on. With anorexia, the insula is quiet and that triggers another part of the brain, the amygdala, to panic. Textures become slimy, gritty, yucky etc. You’re not lying, this tastes disgusting.
Also, since you are going to feel really full, paying attention to your body’s sensations is going to be like having someone repeatedly shouting in your ears with a megaphone: THIS IS ALL WRONG! Not a good move. Eat mechanically, get it done.
Take time to appreciate how good the food is.
As seen above, this isn’t going to be possible in your case. Food isn’t going to taste good. Even the food you used to love won’t taste good, it’s just not. Not yet. Everything will feel wrong in recovery. It’ll come back though. All of this will come back when you are renourished and that your brain isn’t panicking constantly.
Small caveat here, if food does feel good or at least some food, you’re not doing anorexia “wrong”. It probably just means that your brain is trying its best to save you by giving you glimmers.
Eat without distraction, away from screens.
This is something we get told all the time, isn’t it? And yet I disagree. I disagree even, to an extent, for normal eaters. When we have a conversation with someone at the table, are we really mindful of all the tastes and textures? Nope and yet how many memories were created around animated dinner tables?
Anyway, let’s go back to anorexia recovery. Eating on your own at the table might feel like being thrown in a pit full of spiders when you have arachnophobia. It’s going to be horrendous. The very thing you need is distraction, so eat with people you feel comfortable with, listen to a podcast, or eat in front of your favourite series. Your only job is to put the food in your mouth and to swallow it.
Intuitive is great but only when you are ready. You’re not ready for a marathon yet. First you need rest, then physio, then training and then you can give it a go.