A Runaway Train

It rained all day today. I started a walk with Sage early this morning and half way noted the sky turned dark and the wind came up out of nowhere. I debated whether to keep going or turn around and head home. I decided to push forward. Not good. After what seemed like a few minutes the heavens opened and the rains gushed. Sage was not happy as her tail pressed between her legs and her ears slicked completely back.

We abruptly turned around in a walk/run pace and headed home. We were soaked. After peeling off my wet clothes and slipping into something dry I began to work on my manuscript on compulsive eating. It continued to rain the entire day and I sat in this very spot painfully making revisions and cutting out paragraphs that did not fit.

Writing about a subject so close to my heart reminds me of days struggling with weight and food. Sometimes I get accused of simplifying the ability to release the obsession to food. It was not an easy decision to make. I cried, bargained, and relapsed for decades before accepting I have an eating disorder. It has been years since I ate simple carbohydrates. I think about chocolate, doughnuts, and thick loaves of Italian bread from time to time, but I know eating them would only pull me back into out of control eating and low grade depression. It is not worth it.

As I wrote and revised I thought about many patients who relapsed and began compulsively eating after a few months of relief. Although each has their own story, they often resemble each other. Often I am asked how do you stop a binge? It is as difficult to redirect thinking as it is to stop a train when it is going full speed. It slowly grinds to a halt.

A binge must be stopped before it starts or it will run full speed out of control until the stomach is full beyond "normal" capacity and shame and remorse for the behavior begins to set in. My questions are: What was going on before the binge? Were you hungry? Did you miss a meal? What did you last eat? Were you tired or possibly irritable and angry? Are you overwhelmed about something? Answers to these questions teach awareness and triggers to binge.

Writing and revising my manuscript reminds me of times when I experienced the questions above. I eat meals no later than 5 hours apart. I prefer four. I make sure I get at least seven hours of sleep and exercise daily to release stress. My food is whole food never simple carbohydrates and always balanced with nutritious foods to keep my body running smooth and ward off cravings.

A patient who relapsed and began compulsively eating was certain she did everything to stay on her healthy eating course. We went through each question and discovered she skipped dinner the day before because she was too tired. The next day she felt she could eat more than her usual meal to make up for the meal she missed the day before. She felt full and fat after eating and proceeded with thoughts of imagined weight gain. Old familiar self-talk ensued. She felt angry, out of control, and foolish for eating more than she needed. This led to out of control eating.

Another patient forgot to take her lunch to work and decided to wing it with fast-food. She intended to take the bun off her sandwich and order a side salad skipping fries. The instructions to the cashier were misunderstood. By the time she got back to the office to eat her food she realized she had the wrong meal. She was very hungry as it was six hours since she ate. She wolfed the food down without thinking: similar to a runaway train.

What is the moral of this story? You must be prepared with each meal never depending on someone else to get it right. I take my meals with me unless I know exactly what I am eating and it fits my food program. This is the part where some get annoyed and call this rigid. I call it lifesaving. I see it as vigilant. I spent too many years suffering with obesity and obsessive eating which is now replaced with peace and tranquility, not to mention normal weight.

The rain is starting to subside and the sounds of birds singing is filling the once steady pound of water against the windows. The sun is peaking out between a few lingering clouds. Maybe Sage is ready to go out and run around in the yard as she easily forgets her fear of storms.

Photos by Dr. Lisa Ortigara Crego

A Summer Afternoon Swim...

A lazy Sunday afternoon swim with thunder rolling in the distance is my idea of a perfect setting. The sun is still shinning, yet dark luminous clouds hang over simultaneously. I marvel at how I swam laps with such ease, yet with urgency knowing a storm is not too far off. I am reminded of last year when I gasped for breath with only 5 laps of swimming.

I never was much of a swimmer. As a child, raised on the beach every summer in Wautoma Wisconsin, enjoying boating, skiing, rowing and catching frogs in the pond, you would think I would be “naturally” a strong swimmer. I even lived with my sister Debbie half our childhood summers smack on the beach in our little tent. Sometimes at night we would take a little night swim, but I never strayed out too far.

And as if living on the beach was not enough to make a swimmer out of me, my grandmother graduated with a degree in physical education and taught swimming as well as competed on swim teams. Go figure! Ma (how we addressed her) even lived in the main house near our cottage on the beach. You would think I would somehow absorb her talent and strength as a swimmer. Nope.

So, the question that begs to be asked is why I had such fear of swimming. I have no idea. I have vivid memories of being stuffed in an orange life jacket and feeling confined. I was not comfortable wearing it nor was I comfortable without it. My siblings joyfully swam out to the raft to play "King of the Raft." The goal was to push everyone off the raft and last person standing was king...or should I say queen. My memory of attempting to swim to the raft screamed of fear. I recall paddling and paddling trying to reach the raft engulfed by dark cold water only to approach the huge barrels holding up the raft and peering at the emptiness underneath it. No...I did not want to be queen of the raft. I wanted to be safe on shore eating something sweet and gooey. I had neither energy nor desire to join my siblings.

I was a skinny scrawny kid, always fatigued. I had zero energy. I preferred junk food over real food. I was anemic and was on daily iron drops. Of course I did not stay skinny long. When I hit my teen years I grew quite voluptuous…and then chunky…and then darn right obese. These were the starting years of my on and off dieting, binging, and fluctuating up and down in weight. I have countless pictures wearing an oversized t-shirt covering my shorts. I never wore a swim suit during my adolescence because I was ashamed of my body.

Now here I am 40 years later at my pool wearing my suit and very comfortable in my own body, no longer binging, no longer with weight up or down. It just stays steadily at a nice comfortable maintained weight. I wish I knew then what I know now as I sit at the edge of my pool taking in a lovely afternoon. Well…until the loud piercing thunder shook me out of my daze and inside the house I went. The sky was quickly darkening and a storm was near at hand. Since Florida is the lightening capital of the world I think it's time to back myself inside and finish this blog.

Celebrating and Mourning Simultaneously...

Happy Birthday America! Today is the Fourth of July...a day worth remembering and reminiscing. Today is the day America decided to become independent of Great Britain. This day represents freedom to make our own rules and be responsible for our welfare.

My day began with sunny, blue skies, white puffy clouds, birds singing. A picture perfect South Florida day! A time for America to remember and celebrate what was and what is. Although a truly glorious day, somewhere someone is mourning. Someone is sick. Someone is losing someone. I think of Mom and recall several Fourth of Julys after she suffered a massive stroke (days before her 64th birthday), I was filled with sadness and questioned how the world could still be moving forward while I was suspended in gripping emotional pain.

The same holds true on this fourth day of July celebration. Even though some of us might be grappling with an emotional, physical, or spiritual loss, the 4th of July must go on. It is no doubt a time for celebration, which includes: picnics, boat outings, Barbeques, et cetera. Of course, with celebrations come foods, drinks and temptations. This is the American way! But...perhaps not everyone is so festive. Many suffer from illnesses and losses. Certainly Michael Jackson's family is mourning their loss. And in my own life I have losses and family members suffering from illnesses and aging.

I can't help but wonder what role food plays in illnesses, losses, and death. Take Michael Jackson for instance. He was a 50 year old icon, weighing in at 112 pounds at the time of his death. It is my understanding he was somewhere between 5-8 and 5-10 in height. In my line of work (eating disorders, body image dysmorphia, and mood disorders) this would be a huge red flag. Did he suffer from a low self body image? It seems evident by his history of plastic surgery and total change in body appearance he did. Did he suffer from addictions to prescription drugs? With all the surgeries and other medical issues he had he was in chronic pain and may have become addicted to prescription medications. I have witnessed in my practice as a certified addiction professional, addictions to medications quite common. Did he have an eating disorder tied in? Maybe. I did not hear anything regarding this; however, he definitely was not of a normal weight and did seem to have an issue with growing up. Perhaps he kept his body frame boy-like to avoid growing up.

Many female anorexics keep their body's girl-like, stop menses, and appear to harbor a flat chest to hide their femininity perhaps to be in control. My Mom did not restrict, she was the opposite. She wore her weight and then some. She ate large portions of high fat, salty foods. Perhaps she grew her body rather than restricted to accomplish the same goal of hiding her feminine side. As pointed out with Michael Jackson, men are not free from eating disorders and/or body image dysmorphia. My uncle, a rather large man, died from cancer. He ate heavy meals, did not exercise, wore extra weight, and may not have been spiritually connected. He died young...late fifties. I believe unprocessed foods play a huge role in healthy minds and healthy bodies. All of my self-hypnosis CDs address the importance of clean eating, exercise, and spiritual recovery.

And so here we are on this glorious day. The Florida sun tucked away for the evening as festivities of 4th of July come to a halt. I wonder, as the last bits of fireworks fall from the sky, sounds still within ear shot, how many close this day with full bellies and empty bellies both rumbling from restricting or binging. Many are alone and lonely, turning to food for comfort...or not. Eating disorders come in many guises. It does not matter if your black or white...or somewhere in between. It does not matter if you're rich or poor...or somewhere in the middle.

Look at Michael Jackson, Elvis Presley, Elizabeth Taylor, Oprah...all rich and famous, all suffered/ suffering from eating disorders and/or addictions of some type. Today, I celebrate America's Independence. I celebrate my independence. I broke away from food controlling me...and now live free. I hope those suffering and hurting today will find independence from pain and sadness...and the loss of loved ones. Life is to be celebrated. America is to be celebrated. Let's wave our flag proudly. We live in a country that offers help and hope to all.

Photos by: Dr. Lisa Ortigara Crego

Yo Yo Dieting

When I explain what is really going on with binge eating and food addiction patients often resemble the deer in the headlights look. It is like they are caught! As Oprah often says, "It is a light bulb moment!" Suddenly understanding their up and down weight loss and gain becomes clear. The yo yo dieting syndrome has an explanation...an answer. It's not their fault!


Yo yo dieting is more the norm than not. The other day I was watching a recorded Oprah show (April 30, 2009) interviewing Kirstie Alley and a second person (a non-movie star) Michael Hebranko. Both were telling their heart-felt stories of losing and gaining weight. A story I know all too well. I felt their pain and urgency. Not only do I understand their yo yo diet syndrome, the patients I work with day in and day out share a similar story. What is the answer?

As I watched, Kirstie promised with such conviction she would lose her weight again and owned the "secret" way to drop weight quickly. I sadly shook my head thinking about how many times I promised to lose the weight and that I had the quick weight loss secret too. Kirstie swore she lost 20 pounds in a few short weeks and would reach her "goal" weight come November(which I need remind you she had promised for her bikini debut back in 2007). Oprah interjected, suggesting she might be setting herself up for failure. I (alone watching this taped video) was cheering Oprah for stepping in and recognizing Kirstie's "diet" mentality perhaps being detrimental to her success. Sadly, at no time did Oprah or Kirstie acknowledge abstinence from their drug(s): sugar, flour, and wheat. It reminds me of the addict who promises they will never take another hit, snort, or shoot up again, but without admission to the addictive components, rather only looking from a "will power" frame of mind. I was hearing diet and addiction mentality.

Michael Hebranko was different than Kirstie in that he was not a movie star bearing the glitz and twinkle. He reminded me of one of the first patients I saw in my early days of practice. He was wearing close to 1,000 pounds of weight like Michael. I made weekly house calls (back in the 90's when I was new in my profession) and conducted psychotherapy. He was a delight to work with. He understood sugar, flour, and wheat were drugs to him and agreed to abstain. He understood developing a spiritual connection to something greater than himself was the key. Like Michael, he dropped hundreds of pounds. When he was at a safe place weight-wise we agreed he would drive in for therapy. Instead, he began to binge. Again, like Michael, he put his weight back on. Unlike Michael my patient passed away. He was only 27 years old. Addictions are stronger and bigger than our will to stop using.

Michael, unlike Kirstie, was aware he needed to take one day at a time and practice recovery. He was no longer reaching for the "quick" fix. He was humble and focused. He seemed to have an understanding that certain foods were triggers for him, but I did not hear words of abstinence from these foods, particularly flour. He also recognized a higher power (he called God) as he kept referring to God in the interview and how thankful and grateful he was for this second opportunity to correct his weight. He released 300 pounds. Although he had several hundreds of pounds to go, he was focused on the here and now, working his program one meal at a time with progress not perfection. I think he will make it!

Although I personally never weighed more than one hundred pounds above my ideal weight, I can relate to both Kirstie Alley and Michael Hebranko. When I was in the food I promised I would stop. I too vowed to lose the weight and never binge again. I meant it! After I would drop some weight and start looking good I would fall into a binge. It was not until I realized I had to let go of the addictive foods in order to be free of the obsessions and cravings. It was not a question of will power but rather of letting go of an addiction to specific foods. As simple as it sounds it worked. My weight corrected and I am free of cravings. Many patients I work with also are free from cravings and have returned to their normal weight. I wish I could say they all followed my path, but truth be told, many are on the same ride as Kirstie Alley and Michael Hebranko, gaining weight they lost.

Statistics show about 5% of people keep off the weight they have lost for more than a year. And, those that have the weight off for more than 5 years have a better chance of staying thin. Thank you God I fall into this category! I believe Kirstie is setting herself up for failure vowing once again to wear a bikini in November and rushing to lose her weight. This is diet mentality. I did not hear the same diet talk from Michael. I heard a clear understanding it was a process that would take time. He seemed to understand eating balanced meals and taking one day at a time was the ticket to his recovery. Although I did not hear specific talk about spiritual recovery, Michael echoed some thoughts regarding God. Kirstie did not mention any spiritual understanding. Perhaps this could be part of her missing link. It is not about the food, nor is it about the weight. It is about having an addiction to food. It is about turning to a physical, emotional, and spiritual recovery.

So, as I finished watching Oprah’s interview with two very familiar stories it allowed me to reflect where I had been and where I am today. Their story is my story; however, I am on the flip side of it and live life free of weight, worry, and diet mentality. No more deer in the headlights. The answer is eating free of sugar, flour, and wheat and turning it over to a power greater than our own. This power can be whatever is fitting for each person. It could be God, energy, the sun, et cetera...



Photos taken by: Dr. Lisa Ortigara Crego

Memories of Time Passed....

I was up early this morning walking along the beach and feeling so alive and connected to myself and beyond. I have walked this very beach over and over for the past 40-something years and it always tugs at my heart. I have so many memories of where I was and where I am.

Last night my youngest son and I watched old videos we recorded 11 years ago. My have we changed! He was so little with a sweet young voice. My hair was long, blond and flowing. I remember back then thinking how fat I was and yet, looking at the video I was not.

The lesson is to be present rather than thinking about where I was or where I want to be...how about just sitting with the now. Sometimes, even today, I think I am fat or ugly, or some other negative kind of thinking. It would be sad to look at a video 11 years from now and think I looked pretty darn good then...but now do not. On and on that negative cycle of thinking could go. I am okay right now in this very moment. I have all I need and I am able to bask in it.

At this moment, writing this blog, I am looking out at the dock that I painted red wood with turquoise benches. Mom would like the "art deco" look if she were here. It is such a beautiful view. A window she looked out many times herself. The same window Ma (my grandmother) looked out. Both women obese and both women suffered from strokes. I wonder what their dreams were as they stared off onto the blue sparkly waters. Did they have regrets of yesterday or hopes and dreams for tomorrow?





Last night, watching the videos there was one with Mom after her stroke. We (all my siblings) were gathered around her talking and laughing and exchanging quibbles of nothing. It was beautiful to see us all congregated around her. I think about her stroke and how maybe it did not have to be. She was significantly over weight, did not exercise, and ate high fat foods. The "what ifs" start to sprout as I ponder. Would she still be here if she had eaten free of sugar, flour, wheat, and high fat foods? Do I go there in my thoughts? Perhaps not. I need to stay present.


My lesson this morning, while walking the beach I had traveled on hundreds of mornings when life was younger and simpler ( or was it?), was to stay in the now. To be where I am. And where I am, is sitting looking out the window seeing a boat or two passing by, big egrets sauntering by, pelicans diving for a treat... and me experiencing the pure joy of being in paradise.


One of the videos we watched was of a 4Th of July celebration in 2001. We were gathered with dear friends sharing a meal and watched the fire works. Benjamin (my son) had the camera on me and was commenting on how I was breaking my "diet." And I responded so defensively on how it was all worked in my plan. I was still in the diet defensive mode. I did not learn yet that life would be simpler, more spiritual, and the diet clenched attitude would be released. I did not know I would find an answer to my own obesity, binge eating, and food addiction.


As our video movie night continued to unfold there also was footage of our oldest son wearing a great deal of weight. He was darn right obese. Watching me eat clean and healthy for years has rubbed off on him. He is now lean and healthy and moving in a positive direction. Videos can teach us a great deal. I learned to live now but take the nuggets of treasures from what I learned watching me in the past.

I am blessed and fortunate right now. Not last year...and not tomorrow...right now. My body is healthy, thin, and I can walk for very long distances...just as I did 11 years ago...and 11 years before that. The difference is today I don't binge and I don't harbor "crazy" diet talks. The difference is I am free of sugar, flour, and wheat and my weight is "normal" and my thoughts are clear.

Life today is good. Yesterday is gone. Tomorrow is not here yet. My body is thin and strong. I don't binge. Food cravings are nonexistent. This morning I was up early walking the very beach I had wishes, hopes, and dreams when I was barely 12 years of age. Now, 40 years later I still have wishes, hopes, and dreams but they are not about my body, my weight, my newest diet, or latest binge. I dream of living more in the present and experiencing this beach, this dock, this paradise that I love so.

Photos taken by: Dr. Lisa Ortigara Crego

Eating Disorders and Certified Eating Disorder Professionals

Today is one of those glorious Sunday afternoons when the sun is out and the birds are chirping. It is one of those days where the world feels right and excitement, for no apparent reason, looms above. And yet, somewhere out there someone is suffering alone from an eating disorder. Someone is wondering when the binge will end and the weight will be released. That someone used to be me. It is a lonely, scary place to be.

Today I was reading an e-mail from The International Association of Eating Disorder Professionals (also known as iaedp) and learned something I was not aware of. To date, iaedp is the only organization in the world that certifies professional competency to treat eating disorders through its Certified Eating Disorder Specialist (CEDS) and Certified Eating Disorder Specialist-Nutritionist (CEDS-N) certifications (Cumella, 2009). There currently are only 104 CEDS or CEDS-N professionals with active certifications. Interestingly, I am one of the 104 certified eating disorder specialists, and yet there are 923,000 healthcare providers who can offer counseling services in the United States! How could this be? Only 104, or 0.01%, have a CEDS or CEDS-N!

More interesting, to date, there are 642 healthcare providers in the US and Canada who claim to specialize in eating disorder treatment; however, only 104, or 16%, have evidence of their competency to do so through a recognized certification program, the CEDS or CEDS-N (Cumella, 2009). This baffles my mind! Eating disorders are chronic, progressive, and fatal. We need more certified experts working with patients with such a deadly disease.

I read a few years ago that by the year 2015 if preventative measures are not in place we could see 75% of the population overweight or obese. This is a huge number! Think about it, 75 people out of 100 will be wearing extra weight. What will this do to healthcare? What is the answer? I believe we need to move closer to "real" food and further from "processed" foods. Sugar, flour, and wheat, along with high fatty foods seem to be the culprit, especially for us who suffer from eating disorders. And there are plenty of us!

Today, as a provider certified to treat eating disorders, I carry a qualification that few have achieved. It seems unthinkable there are 923,000 healthcare providers who can offer counseling services in the United States, and yet there are only 104, or 0.01%, certified as eating disorder specialists! I think what makes me most uncomfortable is learning healthcare providers are claiming to specialize in eating disorder treatment and yet few have the education, certification and/or authority to do so. The International Association of Eating Disorder Professionals is recognized for certification programs that train and prepare practitioners to deal with a disorder that is growing with each passing minute. Perhaps if the word gets out more and more will sign up to join the certified eating disorder specialists to help those suffering from eating disorders reach a place of recovery.

Although there are many hurdles the eating disorder professional must jump through in order to stay abreast to the ever-changing field of eating disorders, it is well worth the efforts. Every day I am reaching out and helping someone who is suffering as I had. Every day I know someone is dying from this disease. Every day I know I can reach out my hand to another and lift them out of their pain. Nobody has to suffer from this disease. There are answers and help that can take you to recovery. I know...I live in recovery every day.

It is no secret there are millions suffering from eating disorders. As I sit here comfortable in my own recovery on this beautiful Sunday late afternoon I wonder how many out there are feeling alone, binging, purging, or restricting today. I know I will be able to go to sleep tonight with no shame or regrets for having eaten foods that are causing me to binge, crave, or purge. Thank God I never purged with food, but I certainly did my share with over exercising and an occasional bout with laxatives. Just writing the words down makes me wiggle with discomfort. It is hard to believe a decade and a half ago I was really suffering and yet I looked so good on the outside. I was working a program for the most part...but then the disease would rear its ugly head with no warning. Tonight, I will be able to close my eyes and drift off to sleep knowing I am in a good place spiritually, physically, and emotionally.

References:

US Department of Labor, Bureau of Labor Statistics. Retrieved May 3, 2009 from http://www.bls.gov/oco/cg/cgs035.htm#emply

Academy for Eating Disorders. Retrieved May 3, 2009 from http://www.aedweb.org/public/results.cfm

Cumella, E. J. (2009). News for Eating Disorders Professionals. International Association of Eating Disorder Professionals. Retrieved on May 13 from: http://www.iaedp.com/

Photos taken by: Dr. Lisa Ortigara Crego

Chicago Bound...and Back....

I spent the past few days in Chicago. Today is my Dad's 83rd birthday and he continues to work his empire. I am amazed at his strength, motivation, and continuous vision.

Sitting on the plane with my handsome 20 year old son, headed for Chicago in honor of my father’s 83rd birthday, I found myself sandwiched between my son and an adorable, but severely overweight college girl. I was her...once upon a time. As I was settling into my seat, arranging my carry-on with ease, I realized how difficult it was back in the days when my weight was peaked out at 234 pounds. I am flying Spirit airlines, which is known for great economical prices, but also very small seats!

I realized, snug in my seat, how far my life has come. There was a time I would have purchased muffins, candy bars, chips, and coffee before even boarding the plane just to have my “stash” of goodies for the ride. Today, I still need my stash of food, but the nutrients are quite different. I am toting homemade apple-raspberry muffins and a decaffeinated coffee. A far cry from where I had been not so long ago.

I feel snug no longer worried about my last binge, future diet, or future binge. I have my routine in place, always vigilant regarding what is my food, and what is not: never taking chances. While waiting at the airport terminal, I observed so many scurrying to get doughnuts, coffee, muffins (not my “natural” sugar-free muffins). I could see the familiar urgency and frenzy written over their faces and body language. I wondered if they were plotting the upcoming diet, if the guilt and shame set in, or if they were at the euphoric state we addicts reach on the first bite of gooey chocolate laden treat.

As the plane began descending, I embraced the thought of 3 days in Chicago with my family of origin. There will be parties and dinners to attend, and I will partake in all of the festivities, but the difference will be no flour, sugar, or wheat, for me. I will walk in the morning, strolling near lake Michigan observing the neighborhood mansions for my a.m. routine exercise. I will ring in Dad’s 83rd birthday conscious and present, rather than numbed out on sugar, flour, and wheat. This trip was a friendly reminder of where I have been and where I am, and where I am headed. Life is delicious.

Sitting at the airport on my return to Ft. Lauderdale, Florida I am snug and full of joy. My trip was very good. I enjoyed family and what it represents. I did not dream about foods I was not eating, or wishing to eat, or feeling guilty for having eaten them. I am with my fresh salad, topped with chunks of chicken and lemon knowing another day is closing clean and healthy. I have learned to be prepared for my trips and work my routine. The rest is easy. My father and his siblings are all elderly, but you would not know. They are healthy, vibrant, and still working a strong and prosperous business. I have learned many of my good habits from watching them. And of course some things I have to step away from them…like eating the sweets, breads, and pastas…all a part of the Italian way.