Analyzing Healthy Eating vs. Eating Disorders (including Orthorexia), and The Need to Get Out

Whoa long title... but lot's to follow up on in regard to my last post.

Among all the lovely comments, emails and replies to the anorexia post (btw, thank you!), a couple stood out, which makes me want to dive deeper into this very important conversation. Basically the jist of those comments was, "But, Tawnee, it is OK to 'fear' today's food, ingredients and restaurants!"

The folks who said this, folks whom I highly respect for the record, suggested that it's better to prepare your own food (aka cook at home), be seriously skeptical of the restaurant industry and what really goes on in their kitchens (especially in the U.S.), and find ways to socialize or go on dates that don't center around food and dining out.

Valid points.

However, I said, "Yeah, but it's different if you've had an eating disorder (ED). In fact, it's really complicated...."

Letting Go of Control and Loneliness
For one, I've had to work my ass off to overcome some serious fears over food, control issues with food, body dysmorphia, and self-imposed social isolation. When you're suffering from an ED, you are lonely--extremely lonely no matter how many people love you and how many friends you have. And loneliness is not fun. In fact, the latest NBT podcast with Dr. Bryan Walsh explains how loneliness has very negative impact on gut health and overall health. I had to step up and stop isolating myself. There where times where I'd go hide in my car at SDSU (while it was parked in a hot parking structure) to eat my "lunch" for fear of people seeing what I actually ate, and what they may think of me. Those were sad times. I've had to overcome anxiety eating in groups (even with family!), anxiety over dining out, and anxiety over what my body looks like to the world. Thus, it is incredibly important that I continue to GET OUT and make sure I don't get "stuck" in my safe place at home, eating my "safe" meals. Not only physically get out the door to sit at a restaurant but also build up the comfort and confidence to enjoy the company of others--and not feel isolated but rather feel engaged, connected and truly part of a group. (And this isn't just specific to those with ED's either; think about how often we're lonely when we're around others; in or cubicle or social media are good examples too....)

Not to mention I love the experiences and life-lasting memories that often come from dining out--even at the risk of a few less-than-perfect ingredients. John and I have had some amazing times, amazing meals, and guess what? I survived, and he and I thrive as a couple. Plus, since 80 to 90 percent of the time I am cooking at home and eat an incredibly clean diet (even when we travel we do VRBO to get places with kitchens so that we can home-cook some of our meals) I think that extra 10 to 20 percent of the time I'm perfectly ok stepping outside into the world and take risks--and so are you.

My risks don't include "extreme eating" like sketchy hole-in-the-wall buffets, questionable hot dog stands, Outback Steakhouse-type fare or fast-food joints, etc. Hell no! I'll sit out on eating truly bad stuff, and/or go there to be social but not eat--then before (or after) eat something better quality. When we dine out, I am usually very conscious of choosing good restaurants, for health reasons above all--not for the need to control/restrict calories or lose weight. Ok maybe I am too conscious at times of searching for "the perfect" restaurants (getting a little obsessed with Yelp), but I truly care about fueling my body with the best quality foods possible--organic produce, free-range/grass-fed meats, wild fish, healthy fats, locally sourced fare, etc. Especially since I have knowledge (maybe too much knowledge) on nutrition and today's food supply--it is a scary world out there if you're not careful--and because I want to fuel for performance in sport and life. I'm the first to agree, and recommend, that we should give a lot of thought and concern into the the quality of food we eat, the restaurants we choose, and the meals we cook at home.

Happy times at a random restaurant in DC...

...trying creamy, buttery escargot--worry free!

New-Age Eating Disorders
This begs the question.... what's the healthiest approach? Does it always have to be about adhering to the best-quality ingredients, or should we let go more often--let go of the associated stress that comes with seeking perfect food--and be more free and go-with-the-flow. If you get too wrapped up in always trying to eat a perfect, pure, healthy diet, you go down a scary road--one that's lonely and isolated--and risk developing a new-age eating disorder known as orthorexia, the obsession with eating healthy food to the point where it disrupts your life, behavior and happiness.

I've thought about it in my own case: Has my ED past manifested into some form of orthorexia? Are my aforementioned friends who told me I should fear the food and only cook at home also orthorexics? (They both work in the functional health field, after all.) There's plenty of reason to believe, as you'll see below, why a former anorexic could easily fall become orthorexic. I don't want to think that's the case with me... and I'll argue why I don't think I'm orthorexic. But at the same time I don't think you'll ever catch me eating McDonald's or even the salad at Chuck E Cheese's, ever.

So now to the meat of the post. I've got some 'splaining to do. 

Breaking it Down
Gets confusing though, right? You're telling me. There are multiple situations going on, and they can't be lumped together. What the former anorexic feels--often irrational fears--is very different than what a non-pathological human feels when going to a restaurant with intent to eat healthy--which is different but similar to the orthorexic. Thus, my friends who promote cooking at home have a fair, valid point, but they have to understand there are reasons why I choose to eat out that are more important to me than ingredients alone. Below I'll attempt to distinguish the differences among the types of people we're talking about:

Person 1: 

Those who strive to eat quality/healthy food but are flexible with no disorder

Person 2: 

Those who've suffered from an eating disorder such as 

anorexia nervosa ("AN") and/or bulimia nervosa ("BN")

Person 3: 

Those who've developed Orthorexia Nervosa ("ON") by taking healthy eating too far

Person 4: 

Those who are all or some of the above

It could be a good practice to find out where you fall on the spectrum in your quest to develop a healthy relationship with food, your body, your mind, and stress levels--and to avoid any loneliness or isolation caused by fear over food.

Person 1: Health-Conscious but Non-Pathological 
This is the person who seeks healthy food and clean ingredients for smart reasons, with no underlying pathology. Their reasoning to eat healthy may include achieving and maintaining good health status, avoiding harmful substances (i.e. pesticides, GMOs, chemicals, additives, hormones, etc), disease prevention, and building a well-functioning body that's not overloaded with sugar, gluten and other disruptive forms of food. Or it's the person who wants to eat healthy and clean as part of their health and fitness routine--perhaps they're in high training mode and need/want to feel their best, or they achieved great weight loss and don't want a setback. Or it's the person who's doing it for more ethical and moral reasons. With the increase of documentaries, books and articles exposing what really goes on behind the scenes in the food industry--from poor treatment of animals to GMO crops--some folks will not support these poor practices and avoid conventional foods for better alternatives--they consciously seek labels that say "organic" or "free range" or "grass-fed" (hint: labeling something "natural" doesn't count--that term is total BS with no governing regulations). Person 1 may develop a sense of pride in choosing quality over the "evil"' stuff, as well as realize how much better quality food in terms of its nutrient density, nourishing properties and superior taste*. Or maybe Person 1 doesn't even care so much about health-food per se, but simply realizes that junk food and empty calories make her feel like crap--and she chooses not to feel like crap.

That said, Person 1 is not overly obsessed with only eating healthy, quality, pure food. She likely has no pathological condition surrounding food or her body and its size/shape. She allows for balance--realizing we can't all be perfect--and sometimes living life means the occasional situation where the food may not be the best, so she adapts, doesn't freak out and understands that the 80-20 rule (or some variation) will ensure she'll be okay. For example, she's flexible and willing to eat most things at holiday gatherings or parties, she can find something to eat at most restaurants or during travel without any food-related stress, she's okay having the occasional "conventional" piece of birthday cake or pizza. Person 1 has good intentions to eat well, but realizes we can't be perfect so we can just do our best, and the idea or reality of a "bad" meal or "bad" day of eating won't shatter her world or have lasting psychological implications like anxiety, fear, doubt, and obsessive thoughts.

Bottom line, she's not eating the Standard America Diet ("SAD") by any means, and rather is much healthier and making conscious decisions for clean, quality food the majority of the time, but she is flexible and doesn't see food, or control over food, as a source of stress.

Btw: I think my fiance, John, is person 1, and I admire him. He definitely makes efforts to eat as healthy as possible but realizes it'll never be perfect, so he doesn't stress it and instead lives a balanced, happy life and goes with the flow. Could he be healthier in his meal choices at times, sure. Does he know that? Yes. But at what price? Maybe more stress that then makes him less healthy?

~~~

Person 2: Healthy-Eating-Turned-Orthorexia
For argument sake, let's assume Person 2 does not have a history of an eating disorder nor a per-existing condition. It started out innocently enough: She got on a health kick, liked how it felt, saw results, and even liked how it felt to be part of an "elite" community of fellow healthy-eaters. She spent free time reading/following blogs and websites on nutrition, clean eating and healthy recipes. She started obsessing more over "pure" eating, eliminating anything that was not deemed healthy, and even letting her obsession with healthy food cut into her social life by declining invites if she knew there's be unhealthy options. She'd get angry if she couldn't stick to her healthy routine, fussy if ingredients weren't up to par. It snowballed, and healthy eating went too far turning into the latest of eating disorders: orthorexia.

Orthorexia was coined by Steven Bratman, MD, in 1996 and literally means "the fixation on righteous eating." Although it's not listed as a disorder in the DSM-5, it is an increasingly growing REAL eating disorder in today's population, and happens when people who let a once-innocent desire to eat clean, quality, and pure go too far. The quest for quality food dominates their life. How does it differ from healthy eating? According to Dr. Bratman, "healthy eating is a conscious choice. Orthorexia is an obsession with healthy food that involves other emotional factors and has become psychologically and perhaps even physically unhealthy. It is an eating disorder."

I can certainly see this being the case for many athletes, especially endurance athletes, who are very in tune with their bodies and very particular about the food they allow in order to look and perform a certain way. In fact it took two seconds to find research validating that theory. On one hand, I think it's fair for an athlete to be strict with diet--or any human, it doesn't have to be athlete--but how do you know that strict approach has gone too far?

When it invades your life and "creates psychological distress and impairs various life dimensions, but does not present a physical danger," says Dr. Bratman (who recovered from orthorexia). Dr. Bratman was also quoted on nationaleatingdisorders.org saying, “I pursued wellness through healthy eating for years, but gradually I began to sense that something was going wrong. The poetry of my life was disappearing. My ability to carry on normal conversations was hindered by intrusive thoughts of food. The need to obtain meals free of meat, fat, and artificial chemicals had put nearly all social forms of eating beyond my reach. I was lonely and obsessed. … I found it terribly difficult to free myself. I had been seduced by righteous eating. The problem of my life's meaning had been transferred inexorably to food, and I could not reclaim it.”

Still, there are some who think it's silly that healthy eating could be considered a terrible thing, but in my eyes--as someone who's lived through an ED--I don't think it's too silly at all. Those addictions and obsessions can go too far, I think. However, I would NOT consider ON on the level of AN or BN.... I just wouldn't...

More on healthy eating vs. ON - and don't be a "wannabe orthorexic."
Here's a test used to assess ON. 
Here's a critical look at ON.

~~~

Person 3: The Recovered ED
I don't want to take the space here to define an ED other than they are mental disorders, often life-threatening; read more here. What I do want to distinguish is the difference between ON and other EDs: AN/BN are more related more to the quantity of food, while ON is more about quality. AN/BN patients seek an ideal body image, while ONs seek a pure body. Usually there are strong biological roots in AN/BN cases (my story supports this), whereas I would argue that ON may be more of a phenomenon of our modern world (and the person with the "right" traits falls victim). ON often has roots in obsession to look good and fit in, including on social media--AN/BN not so much. Not too many ANs want to post full-body selfies. Instead, AN/BN often reach a level where they knowingly don't take care of their bodies--they realize the harm but still continue on. TO complicate it further, as you will read in Person 4, it seems that these days the lines are often blurred between ON and AN/BN.

So for the Recovered ED (aka Recovered AN/BN), it's complicated... there are stages to get through. Let's assume we're talking about someone in a maintenance and relapse-prevention stage, or beyond. Whether you finished rehab yesterday or 20 years ago, it doesn't just shrivel up and die as soon as treatment is over. If you've never experienced an ED don't assume that this illness can be expelled from the mind and body once and for all.

There's a lot of shit that can still surface, those unwelcome inner "demons" that rear their ugly heads:

1) Sometimes food choices may or may not not have pure intentions about healthy, clean eating. Perhaps eating healthy is just another manifestation of restriction or quantity control. Research supports that some Recovered ED's still have a strong urge to control food, ingredients and/or weight even in the management post-ED phases, and healthy eating or having dietary restrictions (i.e. vegan, gluten free) is the perfect excuse; for more see Person 4.

2) Maybe exercise addiction is still present along with body dysmorphia and the need to control weight. The Recovered ED may be a normal weight but inside feels strong impulses to keep strict control over bodyweight, fears getting fat, and maybe even feels fat or obese even if that's not the case. An "easy solution" is to take up a sport that requires a lot of training, or some highly-regimented fitness routine. There's a bit of comfort found in the calories-in, calories-out equation.

3) Speaking of punishment, it's hard for the Recovered ED  to let go of feelings of guilt and self-hate. For example, say she over-indulged--not binged--but simply enjoyed eating whatever food was present and let go of that damn voice telling her to control. It felt so good for a second--free and liberating--but then... then the guilt set in. The desire for self-punishment and future restrictions started brewing... 

4) Or, there is some presence of obsessions, the need for control, and anxiety issues. There are still "pizza stories" that pop up. Perhaps these obsessions manifest into a new issue. Enter Person 4.

I could go on... keep in mind I'm highlighting the problematic behavior for a Recovered ED (for the purpose of this post) not the positive gains they've made. Whatever the problem is, it's all about self-management and belief in one's self that they are better than the ED.

~~~

Person 4: The Recovered-ED-Turned-Othrorexic
Yikes. Person 4 is not just someone I made up, there is strong evidence in the research of this being and actual person. This study, for example, had a small sample size, but it showed how "easy" it is to develop ON if there's a history of AN or BN. ON symptoms are highly prevalent among patients with, or recovering from, AN and BN. ON tends to increase after treatment of and improvement from AN/BN--it's migration toward a "less severe" form of an ED.

I see how this can be. Coming off AN/BN it seems very logical that one would develop a new obsession for eating healthy--the obsession for quality, to some degree, replaces an obsession over quantity. Let's assume that she even lets go of obsessing over weight loss and calorie control. Now the obsessions are about organic, gluten-free, chemical-free, etc--all those distinguishing variables I listed with Person 1 (oh, Person 1, it was so simple then lol). Again, seems innocent enough, right? But not so fast...

Since there are biological roots in someone who develops AN/BN, the new ON obsessions may trigger the same old anxiety or irrational fears over food, and bring back the same old habits, rituals and tricks. More and more food is "off the table" for being considered edible, dining out once again becomes a problem (god forbid eating non-organic), there's more secrecy and seclusion surrounding food. The fun is taking out of food, anxiety comes back, and the quest for healthy food is no longer pure. All of a sudden it appears a worse relapse may be occurring: social isolation, psychological disturbance and even treating the body maliciously again.

Perhaps even the desire to control weight and calories comes back. Dr. Bratman says there are "covert anorexics" who use healthy food as an excuse for low calorie. Even the diagnosis of "anorexia" now includes one's desire to eat healthy food--not just restriction. Equally confusing, there's research to support that some orthorexics start to take on AN/BN behaviors like binge/purge or severe restriction and weight loss obsessions. It gets to a point where you have to question what really is going on here? What's the diagnosis?! It's complicated!

"Today, the majority of people with orthorexia may best described as having orthorexia with anorexic features, and a large percentage of those with anorexia as having anorexia with orthorexic features," says Bratman.

~~~

Final Thoughts
I can't help but think about where I fall.... I wish I was Person 1. I'm not quite there. I'm likely some hybrid of a Recovered ED with ON tendencies--but I certainly don't consider myself to be ON. If I weren't careful, I probably could go down that road. I won't go down that road. I don't want to be lonely and isolated due to food ever again. So I have to be proactive. How so? Keep it real. Go outside my comfort zone. Face situations that will allow me to toughen up and manage it. I don't like going out of my way to introduce stress (like the pizza episode), but sometimes risking a little potential stress up front ends up saving a lot of big stress down the line--and could even promote better health going back to the Bryan Walsh/NBT podcast. It's the same with sport, the podcast, entrepreneurship, even backpacking--none of these things are "easy" and there are definitely associated stresses and fears at times, but that doesn't mean I hide from them by quitting or getting a "safe" desk job instead. I step up to the challenge--and I also become a part of some great communities as a result, making life-long friends and lasting relationships in the process. Just look at lucho and I--he's my BFF! All because I got over myself and public speaking fear to do the podcast AND bring on a co-host who at first intimidated me due to his amazing race resume/reputation.

So with food, hell yea, I will proudly eat healthy and clean, and hell yea, there are still certain unhealthy foods that I'll absolutely refuse to eat for health reasons. But I'm equally set on branching out and maintaining balance and quality relationships--let me say that again QUALITY RELATIONSHIPS. I do my best to maintain an open mind and a flexible approach and attitude. I don't want to go down a path of stress, isolation, loneliness and misery just because of food... 
Sometimes that means facing those very stressors to stand up to them, and sometimes I have to fight really hard to overcome the old demons. But I got it. I can and will stay strong. Attitude prevails.

ED or not, maybe we can all take this as a lesson to ease up a bit... don't always stress... think deeply if you are feeling lonely or isolated (for food reasons or otherwise), and know that we won't be perfect, but there are tools to have a damn fulfilling, fun life--pizza included.

What do you think: 

How far should we take our healthy habits? How far is too far?

Have you ever felt lonely or isolated because of your eating habits/dietary needs?

Anorexia Nervosa

John and I grabbed a table after ordering our dinner where we proceeded to make small talk, sip our drinks, and take in the ambiance as we waited.

Then, for about the billionth time, my mind started freaking out. Here we go. I didn't let him on to the inner turmoil and nervousness bubbling up inside of me. Anxiety-filled thoughts about the food, the ingredients and the impending meal clouded my brain. I was fidgety. I practically began chugging my glass of wine as an attempt to chill out. I felt my heart beating faster. Flushed. Brain on overload. Obsessive thoughts about food overwhelmed me. More wine....

I was second-guessing the order we just made. What were the ingredients? Was it the healthiest, best choice? Does this place really use quality ingredients or are they BS-ing? Should I have found a "better" restaurant for us? I had spent an hour on Yelp researching what was nearby, deciding that this one restaurant--an artisan pizza place with quality ingredients--would meet our needs for a healthy yet somewhat indulgent delicious Friday night dinner date. But now I wasn't so sure (for no reason). Shit.

C'mon wine, set in, I thought. It was the first time in a long time that I was "using" wine for this reason again.

The anxiety was real. I had control over the choice of restaurant, but now I had no more control over the situation. All I could do was wait. The meal was in the hands of someone else. I had to let go... but... ugh. John hadn't caught on to anything being wrong with me. I was pretending to be as cool and casual as ever. I've gotten pretty damn good at that over the years.

Finally pizza No. 1 came. A "personal size" gourmet pizza. It looked good--great actually. I wondered if they remembered to use the gluten-free crust. I hoped the GF crust didn't have too much starch or gum-type ingredients, which upset my GI system. They brought pizza No. 2, but it was the wrong one! Shit. We sent it back, hoping they'd remake it the right.

Ugh...

SHUT UP AND ENJOY THIS! ENJOY YOUR MAN! ENJOY THE FOOD!

I dove in for a slice.

My heart was pounding. John was already halfway through his first slice at this point. He had no idea.

I tried to take a moment before that first bite to calm down and ease my mind. Telling myself the same old, "You're fine. What's the worst that can happen? Just enjoy.... Don't scarf it down. Don't turn this into something ridiculous." I know from past experience that I'm more likely to get an upset stomach and digestive issues if I eat while overly anxious.

I found some peace after a little self-talk, breathing and positive thinking.

Those first couple bites settled well. I was feeling better. I was over the hurdle. The anxiety left. Relaxed. No longer feeling threatened. It was no longer Tawnee vs. Food. Flight or fight over; transitioned into rest and digest mode. And thankfully the wine pour was meager so I never even got a buzz—I was clear-headed. I laid off the wine... I enjoy the taste, but I didn't "need" it nor a buzz.

The second pizza came, the right order this time, along with a side of veggies. We enjoyed the evening. I was able to recover from that little episode and have a happy fun date with my man. I didn't make a dramatic scene about it... although, the next day I did tell him what had happened. He understood. He knows.

Stress and anxiety over food is nothing new for me. There's a history. And in this post I want to open up about a battle I've fought that I've never shared publicly.

~~~

Anorexia Nervosa: Overview

In 2003 I developed anorexia nervosa (AN), an eating disorder (ED) characterized by self-starvation and excessive weight loss. It's been more than 10 years since I battled this disease, but it changed me forever. When it happened it was a like an all-consuming force that took over nearly instantly and it became my everything. The ED felt safe like being wrapped up in a warm blanket. But that blanket was suffocating me and leading me down a very scary path. The "why"—as in why did I develop AN?—actually makes a lot of sense if you look at the variables, my personality and the situation I was in when it started. ED's are something I've explored deeply in research, books and case studies, and my situation makes sense. Normally the stories don't always have such a bright ending and relapse is common. That's where I differ. I recovered. I got back on my feet and was able to look at myself, see the damage I was doing, where my life was going and put an end to it. I could have given in and stayed on a path of self-destruction; it would have either left me helpless needing care 24/7, or worse, it would have killed me. But I knew better. I wanted a thriving life.

In this past decade post-ED I've learned how to fight a vicious addiction and use all my might to build back health and performance. I don't feel like an ED defines me in any way, but I think it's important to have it be known that it's part of my history and I'm not afraid to admit it.

One one hand I consider myself incredibly lucky for the fast recovery I made; however, unfortunately, I've since battled with periods of disordered eating behaviors, disordered thoughts and episodes of inner turmoil. Each year since '03 I know the ED tendencies have haunted me, but each year the issues fade away more and more. I think 2013 was a huge turning point; I started to pursue true health and more self-love, and in the process learned how seriously harmful any level of an ED can be. I realized I allowed years of those disordered behaviors to manifest in sport and daily life—I certainly had the female athlete triad even back then though I would have never admitted it. My ongoing issues were not enough to be considered a relapse, but enough to be unhealthy. As of this year, 2015, I know the worst is behind me; I don't sneakily allow disordered behaviors, and I certainly don't restrict. Instead, I'm continuing to work on me and my so-called weaknesses—things like fostering more self-love, which was lacking for so long, and trying not to be so damn hard on myself, nor push my body to extremes like I know how to do all too well. I can be very disciplined and live very extreme in a way that few could sustain, and while sometimes this works toward my benefit, I know it's equally self-destructive when it gets out of hand.

The one area where it still gets sticky in all the years since, even currently, is when that old "ED stress" blindsides me and takes over. The closest thing I can relate it to a form of PTSD for a former anorexic, and it varies in severity, but I have these "ED flashbacks" where the stress and anxiety are sometimes too much to handle and I shut down. Triggers may be: Having no knowledge or control over food ingredients and prep; if the food being served might be iffy but I know I'm going to be asked to eat it; too many food choices and decisions to make; if I fear that others might judge or question my healthy choices (i.e. "no bread please," "dressing or sauce on the side," or "no thanks, I don't want to eat at Denny's." These things sometimes may lead me to internally (or externally) freak out, worry like crazy and go into fight or flight mode. Thanksgiving is tough—I've been known to worry about that meal for days in advance. Going to shitty restaurants is no fun. Social gatherings can be a high-alert situation. I can even get overwhelmed at a place like Whole Foods trying to decide the healthiest things to eat and scrutinizing all the choices. I also have deeply worries about others judging my food choices, and I fear having to explain myself and why I eat how I do. I can't stay at home and cook every meal forever, I won't avoid social connections, I have to branch out and live my life, and actually later on in this post I'll talk about why I think it's good "therapy" to go outside one's comfort zone and face reality (it doesn't mean being forced to eat the bad stuff, either).

First, let's back up to the beginnings of this ED...

How It Happened

My anorexia began when I was in college at SDSU, during Winter Break of my freshman year, and it accelerated quickly. It triggered due to many variables—I had gained the freshman 15 and 15+ more, I so much desired to be skinnier like the other girls around me, I was a perfectionist to the max degree, Type A and easily obsessed, and I was also subconsciously having separation issues being "all alone" away from home for the first time. The final nail in the coffin that triggered a full-blown eating disorder was after I got my tonsils out over Winter Break and couldn't eat much for a period of time; it happened to be a long, delayed recovery due to the wound re-opening and needed a second round of treatment. That kick-started weight loss and the light bulb went on in my head that restricting calories could get me the leaner body I so deeply wanted, and I could have the ultimate control in the process. This was very attractive to my 18-year-old self. At the time I was far from my normal, healthy weight and sick of what I saw in the mirror; I was insecure and vulnerable; I needed something to grasp onto.

The ED just exploded from there, looking back it makes perfect sense. My restrictive behavior was further validated when I got comments from college friends noticing the weight loss and new bod, and saying how good I looked. Guys were paying attention to me finally, and I was the one being chased for once. Little did they know they were fueling the fire...  I loved the attention, and I went even more extreme. My behavior toward food clearly became odd, and I know my close girl friends probably noticed but just didn't know what to say. I became more distant and closed off. I would spend all my extra effort thinking about food, analyzing my body and figuring out how little I could eat to still function but lose more weight. It was a complete obsession. Before I knew it I was a shadow of my former self. I couldn't even surf anymore because I was too cold. I wouldn't even eat with my friends because my behaviors were too odd, I had to eat alone. If I did go out with friends or on weekend trips I'd make excuses as to why I wouldn't eat—or I'd have a salad with no dressing, no meat, no fat, as low of calories as possible. I was definitely terrified of any dietary fat, but meanwhile "safe carbs" i.e. those with lots of fiber, were my friend, as were all the diet/low calorie products... and gum.

Meanwhile, I was running and exercising daily, walking miles and miles around campus, and going to the gym—the exercise was part of the formula.

I never completely stopped eating, I just ate as little as possible to still function, and I'd only eat the same handful of foods that were deemed safe. It was easy for me to turn down invites to eat out or offers to share someone's food. I had impeccable discipline and control. Every day was a victory when I got away with barely eating and becoming leaner. Meanwhile, I was still getting straight A's and appearing as if I were "perfect" or so I thought. I was partying a lot too, burning the candle on both ends, and at parties I'd get a bunch of attention unlike I ever had before. I was also drinking with reckless abandon, which brought out a confidence I didn't have when I was sober. I'd be sure to eat less on days I knew we would drink to balance out my calories.

It was all ridiculously unhealthy and a serious problem.

By spring '04 I had withered away into nothing. My parents didn't know how bad it had gotten until they saw me, and they quickly intervened. After my freshman year wrapped up, I moved home for the summer for rehab. I never was hospitalized (thank god, because I hear horror stories about treatment in hospital), but my case did require treatment and therapy, which detoured my life for a period of time. Namely we did family-based therapy; regular appointments with a nutritionist, psychologist, psychiatrist; and straight-up one-on-one time with myself to figure shit out.

Recovering

I recovered within a year from the worst of it because I was able to adopt the right mindset and attitude. I would have self-talk that entailed something like, "I will not let this bring me down, I have to much to do, too many goals, and an awesome life to live."

There were several keys to my recovery: 1) admitting it out loud to myself and everyone else; 2) an incredibly supportive family who didn't judge, but just loved me and gave me the loving attention I needed; 3) family-based therapy which gave me the freedom to reconnect with food and exercise in a healthy way (nothing forced); and 4) my own mind telling me to rise above to live a healthy, fun, fulfilling life and to develop a strong, capable body—which is how it once was when I was a varsity volleyball player, surfer girl, snowboarder, and mountain biker back in high school. (I finally realized that it doesn't feel good to be so weak that you can't do anything fun with your body.)

Meanwhile, the "doctors" tried to tell me I was depressed and all that. I call bullshit. I wasn't depressed. They prescribed me anti-depressants, I reluctantly tried them, nothing happened other than feeling even worse and actually feeling for a moment that maybe I was more fucked up than I thought, and that I was not worthy of happiness. My brain started to convince myself that I was depressed. That is scary shit. I threw out those meds and never looked back.

It's like that phrase from Dirty Dancing, "No one puts Baby in the corner." In my case, it was like, "No one tells Tawnee she's depressed and has to be on drugs." Screw you and your medical degree, Mr. Psychiatrist, you don't know me!

Many anorexics get to the point where it's not even really about being stick thin anymore—instead, the disorder takes over and it's the obsessions, need for control and restrictive nature from which they can't break free, so they continue down that path even if they understand the harm they're doing. But somehow I was able to avoid this path with a strong mindset. I saw the harm I was doing and was said, "Shit, this has to end."

Those same traits that led to developing anorexia (the perfectionist, over-achiever, Type A, obsessive personality) were also the same ones that helped me recover, move on, and now thrive. I became obsessed with recovering as fast as possible and my goal was to make it back to SDSU for sophomore year and not have to take a leave of absence. Maybe it was not totally healthy to force it so quickly, but I was determined and it worked. I proved to my parents, counselors, and friends that I was back on my feet.

It could have been way worse. I could have given in and lived labeled as "anorexic"—and I won't lie, there were days where it sounded attractive to just give into the disease and let that be it forever. But I said fuck that. I was determined not to let anorexia define me, control me, nor ruin me. Not me! I was/am lucky to be a tough chick.

I never relapsed to that really "bad" place. I can assume it's because I was not going to let my zest for life and potential go to waste with a disease like AN. And being weak is seriously not fun.

But It Doesn't Disappear That Easily

The psychology of the eating disorder, the ability to become anxious over food on the drop of a dime, the body-images issues, and issues with weight.... All of that didn't just disappear. It takes time and so much effort to truly heal. My healing is 10+ years in the making.

First of all, even though I was at an ok weight by 2005 and able to eat more normally, I think I allowed some level of an eating disorder for the rest of my time at SDSU (i.e. through 2007) and the disordered behaviors continued thereafter, but I kept it at bay. I truly didn't want to go back to that horrible state, yet I was still often defaulting to those odd behaviors and/or ED tricks. For example, I would stress out and "run away" from food situations that were too risky (i.e. a pizza party at work); and instead I'd hide in my car and eat my safe foods all alone instead—where no one would judge my food choices. I was still often very worried about my body and size, and deeply feared getting chubby again, so I did everything to control my weight so I wasn't fat but also not too skinny where it would be a red flag. I had a boyfriend whose family loved gourmet food and eating out, and of course I was always invited along. I'd often freak out internally over the chosen restaurants and would research menus for hours, figuring out what was a safe dish to order, and I'd make sure to exercise heavily prior to the dinner. At the restaurant I'd battle stressful moments until realizing the food was not going to kill me and that not everyone was going to scrutinize my choices nor corner me and drill me on anorexia. Despite the stress and odd behavior, I didn't avoid dining out like I once had. I stepped up to to the plate and participated in life. In fact, I went a step further and became somewhat of a foodie once I realized 80-20ish living is ok, and that trying a variety of foods can be fun. The older I got, the more I loosened up and enjoyed dining out and having fun experiences, allowing more variety and formerly "unsafe foods" were allowed back in.

Then there are the triathlon years.

Triathlon was a blessing but a challenge at the same time as it related to my ED history. On one hand, triathlon allowed me to see food as fuel and my ally to build a strong, capable body. Food was no longer the enemy and I embraced eating well to become a better athlete (granted, like most endurance athletes I I thought eating well meant high-carb, and I had my sugar-addiction phase while still fearing dietary fat, but eventually I wised up and that changed). On the other hand, for many years as a hardcore endurance athlete I think I very much allowed disordered eating and disordered exercise behaviors to win. Triathlon was an easy way to mask continued disordered behaviors, namely training to eat and training to earn my calories. I could keep the lean frame and eat lots as long as I maintained my rigid exercise routine. I was clearly out of energy balance having no period and probably other hormonal and health issues (though, I didn't start testing until '13). Bottom line: I was totally suffering from the female athlete triad, but I didn't recognize it let alone admit it. Even in grad school I read about the triad but literally thought, "That's not me. I had an ED, and I don't know. I'm ok." What I didn't realize is that you don't need a full-blown ED to suffer from the triad.

Earning calories and staying lean are certainly not the only reasons I did triathlon—I truly love the sport, love competing, love the challenge of swim-bike-run, love the process, love physiology and sports nutrition, and I especially love that it is all on me (not a team) to make it to improve and race to the finish line as fast as possible. Triathlon came into my life in '07 and made me feel alive unlike anything I've ever felt! Sadly, though, those old ED tricks were sabotaging me. I was still lacking self-love and respect for my body, thus allowing destructive, stressful behaviors that longterm I'd find weren't sustainable. I now see that I would underfuel during training and even racing sometimes, and train way too hard (where was Maffetone?!). I still maintained a rigid control over my food, eating what I thought was healthy and avoiding dietary fats, and and the only times I'd "go big" with food were after a huge training days or a race—and in those cases I'd "binge" on things like burgers, booze and desserts letting all inhibitions down. I hadn't grasped the art of fueling for true health and performance. Meanwhile, I lived on the stress train; I was fueled by high-stress living, and asking so much of my body. This went on for years before tanking and taking a stand to change my ways.

Many of us, especially athletes, have some issues with food and body image—questioning what to eat, what will be best for our bodies, what foods to avoid (especially challenging in this day and age), how we can control food and exercise to get the body we want, how training/racing validates gluttonous behavior, or how sport literally is masking an eating disorder. None of that is healthy. But I don't blame you or me so much. We've created a society that's obsessed with image, looks and performance. Athletes, especially female athletes, are subject to scrutiny on so many levels, we're asked to be lean, fast, hot, sexy, successful and meanwhile work, cook, have babies and do it all. The "requirements" of the modern woman are pathetic and it's no wonder women like I take it to an extreme. Guys have it almost as bad. As such, it seems like many of us are constantly in a battle with our selves, never totally satisfied with appearance, always worrying about calories, and in the process developing severe body-image issues and ED-like behaviors. It's tough. I get it.

But let's get real. Take a step back, face it, own it, and don't pretend it's not happening. I finally did that (the same way when I first recovered from an ED), and it's helped more than I can describe.

Moving On & Striving for True Healthy

All in all, I've been able to regain a level of health and fitness that's quite incredible if you think about where I've been. I've built myself back up from nothing—built back my muscles, my endurance, my hormones and health, and all of it! I've never lost my zest for life, and I've always held on to happiness. Today the idea of restricting or even being wrapped up in the female athlete triad sounds awful to me. The idea of being too skinny sounds so painfully cruel to do to my body. I strive to be strong, healthy and thrive, using food as fuel to nourish a healthy body and life. It makes me sad when I see women and men clearly suffering, and letting ED behaviors rule their life and sport—I can spot it from a mile away.

In the 10-plus years since my ED, my relationship with food and body has evolved. It started as a destructive disease of restriction and dangerously low body weight, then active recovery and re-gaining my life, then it manifested into the female athlete triad while I relentlessly pursued triathlon, then I started figuring it out and tried to avoid destruction, and now I'm into the phase of pursuing honest true health, nourishment, self-love and peace. Healthy eating and a healthy body have always been important to me, but for a long time my definition of healthy was skewed. Not any more. I understand the truth and through practice, I've learned how real healthy eating makes me feel great, whereas crappy food or dieting or restricting or "fake healthy" or living off sugar and stress does not bode well for me. And I've learned that with the right food and treatment my body maintains a healthy state. With all I've been through, why at this point would I want to put crap in me and feel like crap? My body has suffered enough.

So the last piece I'm working on is the stress and worry as it relates to food and body. As mentioned earlier, the closest thing I can relate it to is someone with PTSD. I can easily snap and go off the deep end worrying about food and my body. I know I can't let it be this much of a stressor nor send me off the deep end anymore.

Going back to the pizza episode. Here's what I think. I think it's fair that I concern myself with ingredients in these situations especially considering the world in which we live and that food quality in the US is sketchy at best if you're not careful. However, I'm not like your casual human who just wants to make an innocent healthy choice. I'm dealing with this history, my brain is too familiar with extreme stress over food. Irrational anxiety will take over, and I just have to manage it and use my tools to calm down. I don't want to avoid eating out either. Some of you may suggest to just always cook at home or only go to the trusted healthy restaurants. I don't want to have to confine myself to that, so I haven't. I believe it's good for me—and all of us—to avoid getting stuck at familiar and safe restaurants or with home-cooking. It builds strength to branch out, take risks, face potentially challenging situations, figure out solutions, and understand that it'll work out. I think the more I fight, the more likely I'll be able to win and break free for good. And this doesn't mean I'm going to go off the deep end and adopt an unhealthy diet akin to the SAD, c'mon we all know that won't happen ;)

Hold up. There is actually one more final component of this that makes it complicated these days, and that would be my gut issues, which are not just pretend in my head. My gut problems are very real and have been quite severe since my ED, but only since 2014 did I start connecting the dots, wake up to the fact that what I'm experiencing is NOT normal, and what I eat or don't eat makes a huge difference—so I choose wisely trying not to make it about a mental disorder. Interestingly, there is research stating that those with a history of an eating disorder are very likely to develop some level of gut issues within 10 years of the ED. This was a huge finding for me. Turns out, there's a very high correlation between those with ED's and gut disorders. I know there are other variables that contributed to my sensitive gut (from being a C-section baby to stress and overtraining), but there's no denying the ED played a role too. I guess I just have to work harder at fixing my gut :)

So that's where I'm at. Some who've had an ED say that the issues with food/body never go away but you just get better at managing. I'm not sure if that's true. I've dealt with this now for more than 10 years and every year I'm getting so much better, the issues are fewer and far between and certainly don't rule my life. These past fews years have been some of the best yet, and I've been feeling more and more freed up. I'm in much better balance and a much better headspace overall. In fact, I think the act of writing this blog is major progress because I no longer feel ashamed of this secret, and it's ok to lay it all out there.

I have faith that there can be peace and closure.

Lastly...

Why didn't I bring it up before?

As you might guess: Fear.

Fear of what you may think of me. I held back for years out of fear of the opinion and judgements of others, and fear of losing credibility as an athlete, coach and expert in my field. But I will not go forward in fear because this is a journey that needs to be told—I know it can help someone else who's struggling and inspire many others. It's time. I think it's extremely important to tell the whole story.

I'm not afraid anymore. I am so incredibly confident in who I am, what I do, and my knowledge base, and anorexia does not take away any of that. I am not defined by that piece of my history, but it is part of who I am and what I've become.

Meanwhile, I see many athletes out there silently suffering. No more! I feel it's my duty to open up about my history and let you know there's hope. You can recover and get back your zest for life! Consider me your go-to girl on how to break free from an ED and build back health and performance!

What's next for me? Lots. I started writing about my journey on this blog in fact (a separate post from this one), and about how the anorexia came to be, with intentions of describing in detail my post-anorexia days in triathlon, building a better relationship with food and my body, and all that. The blog started getting long, really long, like thousands of words. Not to mention all the research I started uncovering and citing in addition to my own story. I realized this is--and needs to be--much more than a blog post. This will be the biggest project of my life so far.

Whew.

Go hug someone, for me... thanks xo


Please note that I am not a doctor nor counselor. If you or someone you love has an eating disorder, or you suspect someone you know might have an ED, the right treatment plan is in your grasp. Here are some resources. Don't wait another second. There is life beyond this dark place.