Food Fears II: Waving off the Dessert Cart

“Seize the moment. Remember all those women on the Titanic who waved off the dessert cart.”

Erma Bombeck.

I wanted to post something to address our upcoming food-centric holidays that end yet another year and I began by simply scrolling through quotations on food. 

I cannot remember the last time I was so inspired scrolling through random, usually well-known, quotes on any other topic when compared quotes about food. 

But first let me backtrack to the space where many of you likely reside at the moment as you face upcoming family gatherings and friendly outings all revolving around the consumption of food and drink.

Last year, I wrote on this topic at length in Food Fears I: Food, Family and Fear and if some of you haven’t read that post, or would like to be reminded of how to navigate some of the challenges of mounting anxiety around the holidays for those attempting recovery from an eating disorder, I encourage you to read it before the onslaught of festive dinners arrives at your door. 



The Value of Eating Disorder Hunger

I have already written about some of the current concepts, framed by scientific study, that shape our understanding of why some people have a predisposition to keep restricting food intake once it has begun.

The activation of an eating disorder is achieved through the mere restriction of food and it is best described as a misidentification of food as a threat within the areas of the brain responsible for identifying threats in our environment.

We know that the predisposition for this activation is genetic, thanks to various twin studies and initial genotype isolation efforts as well. All the genetic mutations that are likely involved have not been identified, but promising areas include the genes responsible for norepinephrine re-uptake 1, the 5-HT4 and 5-HT2A receptor serotonergic system 2,3, and even the KCNN3 gene associated with neuronal conductance, function and plasticity. 4

Why would a genetic predisposition to identify food as a threat have any merit in the human gene pool at large? Likely the most ingenious of theories on that topic is Shan Guisinger’s observation that its onset has possible overall value to community-wide survival in times of scarcity of food. 5 Identifying food as a threat is not perhaps valuable to community survival, but it is perhaps the other accompanying traits along with that threat misidentification, that increased survival.

I have also written before of how non-eating-disordered individuals who restrict food intake basically hate the process and cannot persist. They feel foggy headed, tired, irritable, cranky, miserable, short-tempered and exhausted.

Along with misidentifying food as a threat, there are several mood-modulating and hyperactive impacts to food avoidance for those with eating disorders that non-eating disordered people do not experience.

While the rest of the non-eating-disordered tribe was listlessly and fractiously lying around the dying fires feeling sorry for themselves that there was not enough food to eat, the eating disordered tribesmate was feeling ready to take on the world.

She went out foraging. She felt calm, a bit buzzed and most definitely clear-headed. If she managed to score food for the tribe, then the tribe (and its genes) survived. 

But what of this food-avoidant tribesmate who averted the tribe’s extinction? It is likely that the pressures she faced to achieve remission from her activated eating disorder were far greater than those faced by today’s eating disordered patients. 

No meal would have been eaten alone in nomadic cultures of the day. Cultural pressures to eat your share, as the one who averted extinction for the entire tribe, would have been unavoidable. And in all but the most severe expression of the condition, she would survive to procreate and pass on her associated genotype (and its predisposition to identify food as a threat if her progeny faced famine).

Genie Out of the Bottle

Genes are not destiny. They are merely a sometime catalyst if and when all the environmental inputs combine to offer up enough raw materials that a reaction could even take place at all.

It is possible to spend an entire lifetime walking around with the genetic predisposition for an eating disorder and yet never experience one. It is possible to develop an active eating disorder once in your life, attain remission and never see its like again. It is possible to die of an eating disorder within months, years, decades, or never (because some other truly unrelated condition takes you out). 

Now imagine you are a four year old girl and you undergo genetic testing to determine whether you have the predisposition to develop an eating disorder. You undergo this test because your parents are worried. There are several relatives on both sides of the family that have had severe eating and anxiety disorders and two actually died of the condition in their 20s. The test comes back and your parents are apprised of the fact that you do have the genetic predisposition to develop an eating disorder.

But that’s okay because there is genetic counseling available and the entire family will be empowered such that you will not be fatalistic about the predisposition. Your parents will nurture you, nourish you and monitor your exposure to a culture awash in the message of the moral superiority of thinness. You will undergo periodic psychological assessments and counseling treatment that are age appropriate as you develop of course as well.

But then, your parents divorce when you are ten years old. That necessitates a move across country with your mother the following year and you miss your friends and are not fitting in at the new school. Your mother no longer has the financial wherewithal to have you see a counselor and so you are referred to a psychiatrist (as this is covered by the medical plan she has) and he prescribes low-dose olanzapine as you appear to be “off your food”. You hate the drug and you start taking laxatives secretly.

Then your beloved grandmother passes away from complications of life-long restriction at age 63. Your grandmother never did hold with all that genetic stuff and often she spoke of good foods and bad foods and staying healthy. She and her daughter (your mother) often argued about her saying such things in front of you, given your predisposition. You loved how neat and clever your grandmother was.

You hit puberty and thus completes the perfect storm of environmental inputs to land you in hospital before your twelfth birthday with what is diagnosed as a severe case of anorexia nervosa.

And herein lies the logic gap for those who see Pandora’s box as offering only the power of knowledge— they overlook the very real potential damage associated with never being able to un-know what you now know.

These complex multivariate living systems mean that quantum Zeno effect is in full force such that the very act of increasing attention on the genetic predisposition you have to develop an eating disorder might commensurately increase the likelihood of activation and sustainment of the condition itself.

One important and well-verified law in quantum physics called the quantum Zeno effect is a key to understanding how focused attention can systematically alter the brain’s response to environmental inputs. Quantum Zeno effect was first described nearly 30 years ago and has been extensively studied many times since then. One classic example of it is the fact that rapid repeated observation of a molecule will hold the molecule in a stable state. It does this by markedly slowing the rate of fluctuation demonstrated in molecules when they are not measured (i.e., observed) in a repetitive fashion. This is a basic principle of quantum physics — the rate of observation has marked measurable effects on the phenomenon being observed.” 6

Quantum physics may seem a ridiculous inclusion, but in fact this is now a very mainstream and serious area of study in neuroscience pertaining to neural plasticity and the human ability to learn and change.

Genetic screening was obviously not available to you at age four, but it might very well be available to your future children or grandchildren.

Revenge Gifts

The ancient Greek legend begins with Prometheus giving humans fire when Zeus did not want us to have it, and so Zeus gave Pandora as a gift to Prometheus’ brother (that old saw of women as chattel). Zeus also gave her a box on her wedding day with instructions that the couple never open the box.  Prometheus had warned his brother never to accept gifts from Zeus, but too late as Pandora inevitably opens the box. All the evils known to humans were unleashed from that box when she sneaks a peak.

Gene hunters often lack a keen sense of the realities of life, the complexities of human development and human nature. It would be good if those who love the thrill of the hunt were also imbued with pragmatism and even pessimism, but these traits do not seem to overlap. It might even be sufficient if they were physicists armed with solid understanding of quantum Zeno effect as well actually.

To get back to our hypothetical genetic screening of you at age four… 

Did your parents divorce because the knowledge of your predisposition added additional and ultimately destructive levels of stress to their marriage? Or was it the fear of losing you to the condition itself so heart-stoppingly intense that no amount of counseling could overcome their dread that your future would be one of starvation, loneliness, weakness, illness and early death?

Did they over-protect you despite their best efforts to “act normal”? Did they distance themselves from you because they feared loving you would mean more heartbreak when the condition was activated in you? Did the very fact of knowing you had the genetic predisposition mean that they actually created the attachment dysfunction that would render you more vulnerable to the condition and not less? 

Did your grandmother’s input have much more salience for you precisely because you were made aware from such a young age that you were predisposed to an eating disorder? Or was your grandmother even more vocal about her own fastidious moralizing regarding food precisely because she had become more attuned to her condition through all that empowering genetic counseling the family endured? 

Had your parents divorced but you had not moved away from the area in which you grew up, would that have been sufficient to maintain latency of your potential condition?

We cannot know. And we sure as heck cannot un-know what is made known to us. The pursuit of genetic identification of any neurobiological condition is poorly thought out in our society at present.

And beyond having the genetic catalyst lying in wait, beyond the complexities of how an eating disorder is activated, there is even more complexity to be found in the progression, prognosis, and actual outcome for each individual patient out there.

Someone with an eating disorder doesn’t keep restricting food just because food has been misidentified as a threat in a neurobiological sense.

Staying Hungry

“No more fear of hunger. A new kind of freedom. But what then ... what? What would my life be like on a daily basis? Most of it has been consumed with the acquisition of food. Take that away and I'm not really sure who I am, what my identity is. The idea scares me some.” – Suzanne Collins, The Hunger Games

I likely don’t have to tell many of you reading this post what it is like to be consumed by thoughts of food. The kind of hunger that anyone with an eating disorder has endured is equivalent to the most tragic of famines wrought upon human beings both past, and sadly, present too.

Hours spent watching cooking shows, flipping through cookbooks and cooking or food magazines. Planning the bites, the morsels, the pieces of food days and weeks into the future. 

I have yet to come across anyone with an eating disorder who is not able to connect viscerally and completely with hunger even as they might deny its presence completely. The only exception to that is when patients are too near death to experience any drive, including hunger, any more. 

But with hunger resides intense levels of anxiety for anyone with an eating disorder. Eating is panic inducing. And so along come all the compulsive, obsessive, avoidant, compensatory, punishment and maladaptive anxiety modulating behaviors to try to navigate needing to eat and yet feeling so driven to avoid food at the same time.

Why wouldn’t anyone seek immediate respite from (or intervention for) this kind of Sisyphean nightmare?

Hunger As Identity

Because this is not merely a condition that resides in brain chemistry, it resides in the mind too. And therefore, it can spread throughout the identity of self like mycelium

“I am the thin gal/guy and that’s who I am”

“I am the fit gal/guy and that’s who I am”

“I was always athletic. Even before the eating disorder.”

“I never really ate much as a kid and was always naturally small.”

“I like being lean.”

Or, my favorite, paraphrased from community member learningtoaccept:

“Everyone else big looks good but I don't because I’m a special snowflake.”— that specialness allows you to hold yourself to a different standard and you would never dream of applying that standard to others.

Usually this thought process allows someone to assure others that they are not fattist and don’t hate fat people, but that they could not accept being fat for themselves.

All variations on these statements boil down to one thing: “My identity has been subsumed by the chronic neurobiological condition I have.” 

But even that annexation of identity by an eating disorder is not exclusively driving the reinforcement of restrictive eating behaviors.

Hunger As Acceptance

Imagine for a moment all the things we believe to be true about being fat in our society was how we viewed being thin. You are thin because you are irresponsible and don’t take care to eat enough to stay healthy. It makes you a bad parent, partner, child, and friend. You are lazy and selfish. Friends pity you and feel sorry for your partner and your family—“How could you let yourself get so thin? I mean it’s not rocket science, you just eat more and stop walking about so much for god’s sake!” They tell you to get yourself together and that they are pointing out your sickly, stick-like appearance to you bluntly “for your own good”.

Well wouldn’t that be a kind of disturbing Opposite Day? But in such a society, the pressure you would feel to rectify your restrictive behaviors would be much more powerful than in the society in which you currently reside where you can easily hide the underlying misery of your condition with the veneer of looking like a beacon of self-discipline, moral authority, health and wellbeing.

That is not to say that those with eating disorders are not subjected to significant misunderstanding and abuse within society as well. There are plenty here who would be able to list dozens of examples of being told that they just simply need to eat more and to stop being “so selfish”. But generally speaking, the compliments received in the early phases of activation for achieving weight loss and “being healthy” provide powerful social acceptability reinforcements that would be impossible to brush aside for any human being (underlying eating disorder or not).

Then there is an additional truly deadly facet of our societal fear of fat— if you make a run for recovery from an eating disorder then in fairly short order you may likely have parents, family members, friends, doctors, entire treatment teams, therapists, nurses, strangers on the street even, suggest that you are likely done with your recovery and are maybe starting to get a bit (voice drops to whisper here) fat.

Hunger As Distraction

And what of your personal life experiences of loneliness, pain, past abuse, trauma, disappointments, failures, insecurities, feeling like an oddball, not fitting in, desperate for approval, and all the other general challenges of navigating modern life?

Nothing else matters quite as much when the mind is filled with the complexities of avoiding food and yet needing to eat.

Keeping in mind that energy deficiency itself creates emotional blunting for those with eating disorders, the initial onset of the disorder creates a lot of psychological relief.

You cannot feel when you are energy deficient.

“A culture fixated on female thinness is not an obsession about female beauty, but an obsession about female obedience. Dieting is the most potent political sedative in women’s history; a quietly mad population is a tractable one.” – Naomi Woolf

I think that quote applies to men as well these days. Given our society is developing increasing levels of wealth disparity, I think obedience and sedation take on validity for both sexes.

Hunger flattens righteous anger and removes any discomfort of needing to resolve unacceptable situations within your own life: toxic relationships, toxic jobs, buried trauma and/or undefined self.

Your Hunger Is Unique

How your mind is interwoven with the neurobiology of your condition is truly unique. Some of the above very coarse facets of how the mind reinforces the condition may ring true for you, or they may have nothing to do with the expression of your particular eating disorder whatsoever. 

But it is important to identify how your mind reinforces restriction. If you attend to the physical aspects of recovery, rest and re-feeding, and neglect to identify and retrain the mind’s connection to reinforcement of restriction, then relapse is usually right around the corner.

In fact, an eating disorder is a psycho-neuro-immuno-endocrine condition.

I harp on this topic constantly, but it cannot be stated enough: get counseling. No money for counseling? Do an online search for services that are provided at greatly reduced cost or no charge. Borrow from family. See if your school, college or workplace offers, or covers the cost of, any counseling services. Go to the library and get all the workbooks and books available on self-help anxiety treatments. Too starved to read or think? Get book tapes on those topics instead. 

Anxiety lessens with confrontation and worsens with avoidance. Thankfully remission is not just the lessening of anxiety, or the absence of maladaptive behaviors; it is the excitement of exploration and discovery. 

We Are All Explorers

“I am not a glutton - I am an explorer of food” – Erma Bombeck

We are not all imbued with the same drive to explore of course, but without exploration and discovery we do not learn. When we do not learn, then we don’t just stop developing we also lose resilience. When we lose resilience, we are increasingly vulnerable. And when we are vulnerable we are more likely to die, or risk the lives of others (especially the case in a prehistoric and nomadic sense).

Humans, as social primates, are capable of caring for the vulnerable amongst them, because resilience ebbs and flows in us all at different points in our lives. And vulnerability is not about being sick or ill. It is about being afraid to explore.

Some of the most severely ill and disabled individuals I have ever met are also some of the most resilient. They take exploration to a level that humbles me.

Obviously we are not all meant to sign up for the first trip to Mars as the only way to embrace exploration for increased resilience. Our tolerance for exploration, as I have already said, is variable from one individual to the next.

Being afraid to explore has many sources, but chief among those reasons is failing to hold a sense of self lightly in one’s mind. And often anxiety generates a sense of self that is disproportionately based on the “cannot”, “do not”, “will not” labels and classifications of who we are.

“I do not like cheese.”

“I hate parties.”

“I cannot stand any change in my routine.”

“I will not ever be the kind of person who ________.”

And a close relation of the cannot/will not/do not litany is the if/then statements:

“If I don’t restrict before Christmas dinner, then I will be too panicked to eat anything and family will be upset with me.” 

“If I stop exercising, then I will have to cut my food intake.”

“If I eat everything I want, then I will get fat.”

“If I eat enough that I start to feel emotional, then I get so angry that I hurt the people I love.”

…or not.

Things Happen Differently With Suspended Labels

This past year I went traveling, very last minute decision, with my father. The last time I traveled with my father (and the rest of the family) was when I was twelve years old.

It’s not as if I went into it thinking that we were well-matched travel companions. I come by my anxiety honestly, which is why we were both liable to arrive at the airport with hours to spare. But other than that, we have few other behaviors in common. 

My mother cannot travel and without my roping him into the trip, he would never have gone solo. While the trip was ostensibly for him, it was no less about me really.

Ever since I developed migraines, I have had a flying time expiry limit. I could handle a maximum of 7 hours in the air. Well this was a 10-hour flight, so I was going to have to be philosophical and not dread the migraine.

My father is an extravert and I am not. I knew I would be awash in unrelenting family and stranger interactions, plus my father would be my constant companion to boot. Well, I was going to simply channel the possibility that I am an ambivert— capable of managing solid socializing without complete physical and mental exhaustion. 

The low point was predictably at the beginning of the entire trip. I got to the hotel 14 hours’ after leaving Vancouver and 36 hours’ beyond my last sleep.

I had a migraine that reduced to me to tears. I was completely maxed out on my prescription with the daunting possibility that I would be in that kind of pain for a further 24 hours before I could take any more drugs to try to alleviate that pain.

Turns out that I am even more sensitive to the pressure changes of a flight now than I was a decade ago. And, I discovered later, it also turns out that prescription drugs are notoriously ineffective at 40,000 feet in the air too. 

We were scheduled to meet family within the hour. To add to the general misery, my father struggles mightily with my mother’s debilitating migraines and here we were re-enacting the very thing that we were attempting to keep my father well away from: traveling with an invalid.

At that point I thought to myself: “What an utter disaster I am. What was I thinking that I would just think myself into being able to accomplish these things? How could I be so far from home, in so much pain and be such a complete idiot despite years of knowing myself and my limitations?”

So I lied to my father and said I would be ready to head over to the reception (yes, my cousin’s wedding reception) in just a bit. I cried on the bed. I threw myself into the shower and miraculously the heat of the shower began the process of helping the migraine to go. By the time we got to the reception, I was fine. I was more than fine. I was a freakin’ hero in my own mind.

We took a further four flights with accompanying migraines for each of those flights but one. But I was ready— no more wasting prescriptions while up in the air. I’d take it when we’d land and it would go within the hour or so. 

And I was a pretty accomplished ambivert throughout the trip. My father and I are not merely still on speaking terms, but we actually did turn out to be pretty good travel companions.

No interaction was without food. Great food. Unremarkable food. Surprising food. Predictable food. Food graciously prepared. Food hastily prepared. Complex meals. Simple snacks. Food always offered. Always.

And the company was always memorable. 

All explorations of our world are about self-exploration. And the foundational exploration of life is food itself.

Go Forth

The above image is of my cousin dancing with her new husband (artistic effort mine taken directly from the original photo). They are fabulous dancers. 

I started this post mentioning the inspiration I found in quotes about food. Please consider as you enter all the food-centric interactions that are coming up for so many at this time of year the following possibilities: 

  1. Hold your sense of self lightly. Put aside the cannot/will not/do not and if/then thoughts altogether.
  2. Exploration is your birthright. Start with food. Travel your culture, your connections, your feelings, your emotions (the good, the bad and the ugly) all through food.
  3. It’s ok to find yourself crying on the bed, as I did, overwhelmed with the thought that you have set yourself up to fail. Then get up and try. 

I hope you find these quotes not just food for thought, but food for exploration:

“Let food be thy medicine and medicine be thy food” Hippocrates

“Food, a French man told me once, is the first wealth. Grow it right, and you feel insanely rich, no matter what you own.”  Kristin Kimball

“After I was diagnosed with celiac disease, I said yes to food, with great enthusiasm. . . . I vowed to taste everything I could eat, rather than focusing on what I could not.”  Shauna James Ahern

“The word indulgent has become a popular catchphrase for dishes we should not eat for health's sake. I never use it to describe food, only poor parenting.”  Martha Hall Foose

“If you're afraid of butter, use cream.”  Julia Child

“Your body is not a temple, it's an amusement park. Enjoy the ride.”  Anthony Bourdain

“Everything you see I owe to spaghetti.”  Sohpia Loren

“Cookery means…English thoroughness, French art, and Arabian hospitality; it means the knowledge of all fruits and herbs and balms and spices; it means carefulness, inventiveness, and watchfulness.”  John Ruskin

“Always start out with a larger pot than what you think you need.”  Julia Child

“The gentle art of gastronomy is a friendly one. It hurdles the language barrier, makes friends among civilized people, and warms the heart.”  Samuel V. Chamberlain

“If man be sensible and one fine morning, while he is lying in bed, counts at the tips of his fingers how many things in this life truly will give him enjoyment, invariably he will find food is the first one.”  Lin Yutang

“It struck her how eating was a comfort during a hard time because it reminded you that there had been other days, good days, when you’d eaten the same thing. Reminded you there were good days in life, when precious little else did.”  Ron Rash

“Ponder well on this point: the pleasant hours of our life are all connected by a more or less tangible link, with some memory of the table.”  Charles Pierre Monselet

“He showed the words “chocolate cake” to a group of Americans and recorded their word associations. “Guilt” was the top response. If that strikes you as unexceptional, consider the response of French eaters to the same prompt: “celebration.”  Michael Pollan

“But the goal of the arts, culinary or otherwise, is not to increase our comfort. That is the goal of an easy chair.”  Jeffrey Steingarten

“For a moment, or a second, the pinched expressions of the cynical, world-weary, throat-cutting, miserable bastards we've all had to become disappears, when we're confronted with something as simple as a plate of food.”  Anthony Bourdain

“... food is not simply organic fuel to keep body and soul together, it is a perishable art that must be savoured at the peak of perfection.”  E.A. Bucchianeri

“The lesson about food is that the most predictable and the most orderly outcomes are always not the best. They are just easier to describe. Fads are orderly. Food carts and fires aren't. Feeding the world could be a delicious mess, full of diverse flavors and sometimes good old-fashioned smoke.”  Tyler Cowen

“You'll not sit at the dining table and expect the food to jump into your mouth. If you're hungry, pick a spoon and start eating. Stop sitting in the dining world to look at the eaters, it is your turn to start eating if you know you're hungry.”  Michael Bassey Johnson

“I can throw an orange like a baseball, but I can’t eat a baseball like an orange. Let that be a life lesson for you. ”  Jarod Kintz

“Food didn't kill people, for God's sake, people killed people. With their harping, and criticizing, and careful living.”  Nina Killham

“All men are hungry. They always have been. They must eat, and when they deny themselves the pleasures of carrying out that need, they are cutting off part of their possible fullness, their natural realization of life, whether they are rich or poor.”  M.F.K. Fisher

“…food is capable of feeding far more than a rumbling stomach. Food is life; our well-being demands it. Food is art and magic; it evokes emotion and colors memory, and in skilled hands, meals become greater than the sum of their ingredients. Food is self-evident; plucked right from the ground or vine or sea, its power to delight is immediate. Food is discovery; finding an untried spice or cuisine is for me like uncovering a new element. Food is evolution; how we interpret it remains ever fluid. Food is humanitarian: sharing it bridges cultures, making friends of strangers pleasantly surprised to learn how much common ground they ultimately share.”  Anthony Beal

“Food is everything.

It provides energy and strength to the elemental self;

With knowing self; evolving side by side.”  Gian Kumar

Don't wait until 2014 to begin your explorations. Merry Christmas and Happy Holidays.

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