149: Discipline, Restriction and Disordered Eating with Carly Stagg, RN, FNTP
Carly’s story starts out like many of ours do when we set a health goal– eliminating unhealthy foods and exercising regularly. But what began as a pursuit of health quickly unraveled into disordered eating and a constant compulsion to exercise. She restricted her food, she worked out incessantly and she panicked in social settings that interfered with her food and exercise plans.
In this week’s podcast episode, my friend and colleague Carly bravely shares her story in hopes of shedding some light on the spectrum of disordered eating to eating disorders.
Now, on the other side of it, she’s also researched the fascinating connection of dysregulated hunger hormones and neurotransmitters associated with these conditions.
There are lots of signs and behaviors we need to be aware of for ourselves, our friends, and our daughters. Listen in for important information on this sensitive topic.
EPISODE 149: Discipline, Restriction and Disordered Eating with Carly Stagg, RN, FNTP
Show Notes
(0:00) Intro
Hello my friend! Welcome back to the club, how are you today?
Today we have our special regular guest Carly back on the podcast.
(3:49) Carly’s early life:
Diabetes diagnosis at age 12.
I started out at age 16, eliminating gluten, processed sugars out of my diet and I thought… Okay, this is it! I feel good. I realized how much power nutrition had in positively impacting my symptoms.
(6:25) Eating disorder background:
Triggered by “freshman 40” which I gained from not sleeping enough and living in a moldy dorm in college. Never had a weight problem before.
Started with restricting food and exercising after class In a healthy manner
Went on AIP- autoimmune protocol of Paleo- wasn’t eating anything except protein and vegetables.
Once I started to see the numbers on the scale drop, it continued to feed the obsession/addiction with the numbers dropping down.
Only wore workout clothes because the idea of not being able to exercise at any moment was panic inducing
Progressed to anorexia, severe anxiety, social isolation, exercise bulimia (working out 2+ hours a day, couldn’t sit still, sitting still in a car or traveling was unbearable and I would cry on road trips), Orthorexia (At Chipotle with friends in college, I ran to the bathroom to spit out what I thought was a jalapeno in my guacamole, it was a piece of red onion).
(21:21) What is an eating disorder?
Eating disorders are actually serious and often fatal illnesses that are associated with severe disturbances in people’s eating behaviors and related thoughts and emotions. Preoccupation with food, body weight, and shape may also signal an eating disorder. Common eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorder.
Anorexia: People with anorexia nervosa may see themselves as overweight, even when they are dangerously underweight. People with anorexia nervosa typically weigh themselves repeatedly, severely restrict the amount of food they eat, often exercise excessively,
Bulimia: People with bulimia nervosa have recurrent and frequent episodes of eating unusually large amounts of food and feeling a lack of control over these episodes. This binge-eating is followed by behavior that compensates for the overeating such as forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination of these behaviors. People with bulimia nervosa may be slightly underweight, normal weight, or over overweight.
Binge-eating: People with binge-eating disorder lose control over his or her eating. Unlike bulimia nervosa, periods of binge-eating are not followed by purging, excessive exercise, or fasting. As a result, people with binge-eating disorder often are overweight or obese. Binge-eating disorder is the most common eating disorder in the U.S.
Eating for up to 2 hours continuously
Eating past the point of fullness
Eating alone or in secret
Orthorexia: a new eating disorder on the block which has been more discussed lately due to the prevalence of “healing diets- obsessive concerns about food, righteous eating, and fixations on diet standards and food preparation, social impairment.
(29:10) DISORDERED EATING:
Spectrum/continuum between “normal eating” and “eating disorder”
The same food choices/behaviors can be “disordered” for one person and totally normal/healthy for another
ED Warning signs
“Souping” food- mixing it with water
Cutting food into tiny pieces
Refusing to eat food that is not pre-portioned
Body checking constantly
Or the opposite, avoiding mirrors (showing body dysmorphia)
(31:38) Neuroscience Background
Hunger hormones
Leptin- high leptin levels decrease hunger (negative feedback loop)
DECREASED leptin: anorexia or bulimia
Even controlling for low-weight, women with anorexia had INCREASED leptin- hungry, but not as hungry as they should be
INCREASED leptin: binge eating disorder
Ghrelin- high ghrelin increases hunger, levels typically increase before eating and drop after
Relationship with ghrelin and ED less straightforward then leptin
Ghrelin is elevated in Anorexia due to “starvation” perceived by body
Ghrelin drops less after meals in bulimia and binge eating- so you continue to get brain “reward” for continuing to eat past fullness
(35:55) Differences in the brains of eating disorder-prone people
Anorexia: Worrying, pessimism, shyness, low levels of novelty seeking (reduced impulsivity), high levels of harm avoidance
decreased reward sensitivity, as well as an over-response to punishment (Harrison et al., 2010). Neuroimaging studies also revealed unusually high levels of cognitive processing when individuals with anorexia viewed images of food (Cowdrey et al., 2011). Because food is less rewarding and appears to be associated with fear and punishment, people with anorexia tend to place a higher emphasis on the long-term goal of weight loss and maintaining anorexic behaviors rather than food’s more immediate rewards (Kaye et al., 2013). They also tend to report high levels of ascetic behaviors (Keating et al., 2012).
Harrison et al 2010: Sensitivity to reward and punishment in eating disorders https://pubmed.ncbi.nlm.nih.gov/20381877/
Cowdrey et al 2011: Increased neural processing of rewarding and aversive food stimuli in recovered anorexia nervosa
Kaye et al 2013: Nothing Tastes as Good as Skinny Feels: The Neurobiology of Anorexia Nervosa
Keating et al 2012: Reward processing in anorexia nervosa
Bulimia + binge eating
High levels of impulsivity, emotional dysregulation, and anxiety
High levels of harm avoidance and high levels of novelty seeking
History of childhood trauma, sexual abuse, neglect, bullying, emotional and/or physical neglect, PTSD
This is due to “dissociation” tendency- eating disorder behaviors take the sufferer away from uncomfortable feelings/behaviors and allow them to exert control over their life/environment when previously they may have lacked control.
(44:07) Body image:
Increased levels of body dysmorphia
Brains of ED patients tend to have difficulty with the parietal cortex function, which helps with perceiving the size of objects in space- this leads to body dysmorphia.
In a neuroimaging study of women recovered from binge/purge anorexia, researchers found that higher serotonin receptor activity in the left parietal cortex was associated with lower drive for thinness (Bailer et al., 2004). A separate study also found abnormal activation of the parietal cortex when individuals with anorexia were asked to look at pictures of themselves (Wagner et al., 2003). The parietal cortex helps to create a map of the body using the sensory information it processes, and researchers have hypothesized that problems with creating this body map may at least in part underlie body image distortions in eating disorders (Titova et al., 2013). This hypothesis is supported by research that showed patients currently ill with anorexia had problems retrieving accurate information about their body shape that caused them to overestimate their current body size (Mohr et al., 2010).
(46:43) Neurotransmitter levels
Serotonin
Serotonin is a neurotransmitter (brain hormone) that acts to mitigate the effects of stress. We don’t want excessively high serotonin levels- just like we don’t want them too low- as that can demonstrate we are under too substantial of a stress load (physical, mental, emotional).
Impact of Serotonin on Anorexia
In an article published in 2009 in Nature Neuroscience, leading eating disorder researcher Walter Kaye hypothesizes that starvation actually makes people with anorexia feel better by decreasing the serotonin in their brains (Kaye, Fudge, & Paulus, 2009).
As they continue to starve themselves, however, the brain responds by increasing the number of serotonin receptors to more efficiently utilize the remaining serotonin.
So in order to keep feeling better, the person needs to starve themselves further (creates more serotonin), creating the illness’s vicious cycle. When someone with anorexia starts eating again, however, serotonin levels spike, causing extreme anxiety and emotional chaos, which makes recovery difficult without adequate support.
Impact of Serotonin on Bulimia and Binge Eating
Researchers generally believe that individuals with binge eating and/or bulimia also suffer from chronically low serotonin levels, which is thought to contribute to binge eating in an attempt to relieve the depressed mood caused (in part) by this low serotonin (Haedt-Matt & Keel, 2011).
Dopamine
Dopamine: “pleasure” chemical, involved in reward-motivated behavior (such as studying to get good grades, or going to work early to get a raise), it also helps regulate movement, memory, hormones and pregnancy, and sensory processing (Beaulieu & Gainetdinov, 2011).
Impact of Dopamine on Anorexia
In anorexia, the leading hypothesis is that the disorder is associated with an over-production of dopamine, leading to anxiety, harm avoidance, hyperactivity and the ability to go without pleasurable things like food.
Anxiety + hypervigilance
Impact of Dopamine on Bulimia + binging
Bulimia is associated with lower levels of both dopamine and certain of its receptors, and that binge eating is significantly associated with dopamine release in certain parts of the brain (Broft et al., 2012). Binge eating disorder has been linked to a hyper-responsiveness to rewards such as food, which makes eating more rewarding and pleasurable than in people without this disorder (Davis et al., 2012) and leads to a continuation of compulsive overeating (Bello & Hajnal, 2010).
(52:48) Science of hunger and starvation- Minnesota Starvation Experiment
(58:11) Safety Weight
Body Weight Set Point
Why does this happen?
The more we decrease caloric intake, our body compensates by inducing chronic “fight or flight” state which reduces what our body is burning- “I’m not safe” signal => we have to conserve, we have to store up energy! So it will burn way less than it should.
How do we recover from this?
All is not lost, the body is amazingly resilient and can bounce back
Gets worse before it gets better
Get out of a state of nutritional state => eat plenty of food, combo of carbs, proteins, fats.
HA Recovery
https://nutritionj.biomedcentral.com/articles/10.1186/1475-2891-10-9
NEDA Helpline
CALL
(800) 931-2237
Monday—Thursday 11am—9pm ET
Friday 11am—5pm ET
Translation services are available on the phone
(102:38) How did you overcome it? What role did/does your faith play in it?
Faith/Testimony
Counseling
Disconnected from social media for over a year
Disconnected from the environment
Hardest thing I’ve ever done
Can you indulge now with mental peace?
Yes! I ate fries with my mom out to dinner- shocking at times!
(106:50) How to know if you are making choices from a healthy place…
Examine
Your methods
Are your actions objectively healthy or unhealthy?
Your motivations
Rooted in the pursuit of thinness or due to shame or guilt? Rooted in a genuine desire for health and wellness?
Your thoughts surrounding “slip-ups”/”failures”
Failure => complete stop to healthy behaviors, I can’t break the chain or I’ll never get back to this place
Or, a healthy mindset- get back up and try again tomorrow.
Are you flexible and filled with grace when things don’t go your way? Are you irritable, rigid, controlling and just plain mean when you can’t work out or eat your perfectly healthy food?
Remember
Food is not just fuel; food is an emotional experience as well that connects us to the present moment, to our life experiences, to our loved ones.
Not ever “emotionally eating” is not a goal many of us can achieve.
Instead, choose these times mindfully and don’t allow yourself to feel guilt or shame surrounding food
Always take into account that your body is a holy temple- are your actions honoring God? Are you honoring yourself? Are you trying to hate yourself into a healthier body? Or are you being loving, kind and honoring?
How this has impacted working with clients
Shy away from restrictive diets
(110:15) Body Image Resources
Body Kindness- Rebecca Scritchfield RDN
Breaking free from Body Shame- Jess Connolly https://www.amazon.com/gp/product/0310352460/ref=ox_sc_act_title_6?smid=ATVPDKIKX0DER&psc=1
(1:11:15) Anchor Questions:
Anchor meal: grassfed ground beef, garlic powder, salt, 1 onion in a skillet with EVOO or ghee
+ roasted cabbage or brussels sprouts
Verse- ****thought about God using weaknesses for good
Colossians 3:1-2
3 1- Since, then, you have been raised with Christ, set your hearts on things above, where Christ is, seated at the right hand of God. 2 Set your minds on things above, not on earthly things.
Work with Carly: wholehearted.care
(1:15:30) Outro & Disclaimer
Thanks for listening! Have a healthy and blessed week!