Tuesday 18 December 2012

Tricky challenge for the New Year...

The wonderful private dietician we've been seeing has sent me a print-out all about fats - and why they are ESSENTIAL for health and won't make you fat. It is incredibly illuminating reading - the proverbial "light bulb moment". Well, it is for me. Whether or not it will be for Ben is another matter because, as we all know only too well, Ben and other fats-avoiding eating disorder sufferers know better than the science.

When Ben was going through his worst years, he would argue that black was white until he was blue in the face. Like many people with anorexia, he'd instantly understand the logic of just about every scientific fact in the universe... except those associated with eating and getting well.

It's like arguing that the world is flat when everyone for generations knows - and has proof that - the world is round.

Yet anorexia suffers will insist it's flat. Period.

And I tend to suspect that if you literally took them round the world to physically prove this, they would still find an argument against it.

Fats were always Ben's main sticking point. Fats were evil incarnate. They are the main thing that he cut out of his diet at the start, eating a virtually fat-free diet which not only led to rapid weight loss but which - I suspect - also helped to lower his mood significantly.

"How do I get him to eat fat?" I'd plead on the ATDT forum and at CAMHS till I was blue in the face. "You just do," came the response. They were obviously doing it successfully with their children. Fats were going into their diet like there was no tomorrow. Yet I couldn't get an ounce of the stuff into my stubborn child. He simply refused to eat it. Or he'd go crazy and almost kill himself with violent head-bashing and so on. And never forget that Ben is taller and stronger than me.

I felt - and still do feel - a complete failure when it came and comes to getting "proper" fats into my child. If truth be told, I feel personally responsible for keeping him where he is. Simply because I'm "too scared" to do much about it. The anorexic part of Ben, and also part of Ben's natural personality makeup, is to "always be right" and to bully me into "agreeing" with him in order to keep the peace. And, as I discovered over the weekend, to keep him from doing something dangerous.

(If, indeed, he was planning to do something dangerous. You never know, do you? And it's not something you want to call his bluff on...)

To be truthful, my husband and I are getting sick of being "bullied" and told how to behave as Ben snaps at us for some reason or other. Good God, we're the parents!!!

Anyway... Ben is still frightened of fat, as demonstrated by the recent reduction in fats in his diet.

Yes, he claims he's incorporating them back into his diet. But, frankly, his diet is still a low fat diet even though Ben claims he is "getting all the fat I need".

Back in the spring of 2010 when Ben was battling with the initial re-feeding plan (which he eventually ditched) I got to the stage where I was adding up the fats he was eating to "prove" to him how much fat he needed and wasn't getting. It was a hell of a job, micro-management at its worst and I wouldn't recommend it to anyone that wants to stay sane. But I wonder if I need to begin doing it again. I'll position it as a "test". A short-term "test". Because that's the way the professionals get patients to try things without freaking them out too much. CAMHS used to call it a "test" or "experiment". And that kind of concept appeals to Ben.

Public Enemy Number One for Ben is saturated fat. But the dietician's print-out talks about why sat fats are "absolutely necessary for a whole host of bodily functions" and are not "the enemy". Of course Ben would say (or rather bark at me) "I'm already getting enough sat fats".

It goes on to compare cultures where sat fats are consumed in abundance, yet these cultures display "significantly lower" rates of heart disease and cholesterol levels than in western countries. The difference, it says, is that they also eat a lot of unsaturated fats as well. So, rather than "just restricting saturated fat as was the advice around 15 years ago" we should be INCREASING the 'good fats' in our diet.

 It goes on to compare cultures where sat fats are consumed in abundance, yet these cultures display "significantly lower" rates of heart disease and cholesterol levels than in western countries. The difference, it says, is that they also eat a lot of unsaturated fats as well. So, rather than "just restricting saturated fat as was the advice around 15 years ago" we should be INCREASING the 'good fats' in our diet.

The print-out also talks about why low fats diets are not recommended and why, especially for eating disorder patients, they can lead to unhealthy imbalances in dietary intake. In fact the print-out says "It's a very odd concept that fats are 'bad for us'.

The dietician says: "We never advise low fat diets now - at least 30-40% fat... there is no evidence for low fat". A low fat diet is one that is "around 35% fat or less; diets that go lower than about 25% are not healthy".

"Should I buy low fat products?" asks the print-out. "No!" it shouts in response, explaining about all the nasties that go into these products to make them 'look' and 'feel' the same as standard fat products. "Fat does not make you fat," it says. "In fact you need the essential fatty acids found in fat to live."

Ah but I'll never forget the occasion when the CAMHS dietician tried to wean Ben off skimmed milk... He broke down in floods of tears at the prospect of semi-skimmed. We tried him on "orange top" (a half-way house), but he couldn't even handle that. I am sorry to say that we are still on skimmed milk.

I know for a fact that if I suddenly cleared the fridge of these low fat products he simply wouldn't eat the standard equivalent. He would also be extremely anxious. As with the weekend's performance this is another example of where the eating disorder still has a hold on Ben - and why it's often referred to as the "bully" because of the way it "bullies" the carer into taking the easier option because the alternative, the carer perceives (and don't get me wrong, it might be an accurate perception) is worse - for example the threat of suicide.

So the eating disorder "bully" has you, the carer, by the short and curlies.

Scream, scream, scream!!!!

So this is my New Year Resolution: to work on FATS. And the day I manage to wean Ben off all those horrible low fat foods (Flora Lite, Fat Reduced Cheddar, Low Fat Mayo, Skimmed Milk, etc) - and when he willingly eats these things as opposed to "because YOU tell me I have to"... and when they become a normal part of his diet i.e. he doesn't even think about it - is the day when I can well and truly say, hand on heart, that I believe Ben is fully recovered.

Until then, I can't.

And it's not just a case of getting over the fats issue, it's a case of proving to him at the same time that a few extra kilo won't be the end of the world. Because you can bet your back teeth that, if I introduce these standard fat products and Ben does put on weight, he will go absolutely crazy. Which is why we still need support. Yet he refuses to have any.

Good God, have I got my work cut out for the New Year.

(Says she gloomily with her head on the desk...)


  1. I really love reading your blog. It's a great knowledge to acquire, the perspective of the parent that lives with the ED. From my own perspective, anorexia really, truly is worse than anything that could be conjured up in the universe. Of course, to that equation, one must wonder what it is like for the carer, watching whom they love suffer - especially when the most notable effects of the illness, to other onlookers, are not as apparent anymore. I think the grey part of recovery is the most difficult.

    The problem with fats, mostly that of saturates, is that for so long the media/diet industry has perpetuated they are unhealthy. There is only one that is unhealthy, and that is trans-fat - not really even a fat, as it is man-made (essentially - certain oils become trans-fats as they are heated, such as canola oil). Even then, in a healthy young adult they do not have a directly adverse effect.

    Blaming fat for the issues of today's society is a very easy way to make money, make products people will buy, and influence people to have this bright 'low-fat' look on life. It really becomes a culture of its own.

    I'm sorry if I'm typing a novel, it's a subject I feel very strongly about outside of ED's!

    The most important thing to remember is, the consumption of fats in those suffering from ED's is almost absolutely vital to a full, sustained recovery. Low-fat isn't healthy, in the sense that it's unnatural, firstly, and secondly, interacts with leptin (the hormone that is best know for regulating appetite, and correlates with the level of body fat i.e. why weight restoration is completely necessary for full recovery) in a manner that the body will not be normal.

    In Ben's best interests, fat is the most important thing right now. It will not make him *fat* at all. From my own observations of my recovery, as well as many others, the introduction of fats will feed the brain and help ease the obsession surrounding food. In fact, as his brain will use the fat to help repair itself, getting used to the idea of a few kilos here and there will be easier.

    It's like kcals, a few more one day and a few less another - it will even out. Weight fluctuates as much as anything else that really, weight loss or gain each week isn't a thing to get worked up over. A consistent period of losing IS, however!

    ...I've typed a lot. I just feel so passionately about this and also, frankly, I've been reading your blog for a while now and I tend to be more motivated in my own recovery (reaffirming my beliefs, so to speak).

    One final thing, I promise: I know and understand the science, why we need fat, why we need to be healthy and eat REAL food, but for a long time I considered myself exempt. I found out that is not quite the case.

    It takes a while to get past it and realise this. Honestly, I used to be dead afraid of carbohydrates (Dad did Atkins, never bloody shut up about it for years) but now I am long past it! I guess that's how the illness manifests itself. Same genetic predisposition, different environmental trigger.

    One day black will be black, and white will be white. It just takes a long period of grey.

    1. I love reading your replies! I will be printing this out and showing it to Ben. Though, doubtless, he will claim "to be eating enough fats". Hence my New Year's Resolution in my latest post. It might be micro-management at a period in an illness when we're trying to wean them off micro-management, but there is a point to it - and it's a short term "test". Also, this year, I will have the "I hold the purse strings for uni" leverage - plus the fact that I know he doesn't want to spend another 12 months vegetating at home!!! But, as always with this kind of thing, I need to adopt the softly-softly approach even though my whole being screams to go right in there like a steamroller!!!!!

      I love hearing from you, Sarah, and find your insight soooooo useful. xx