What's Eating You?
What adverse childhood experiences (ACEs) can teach us about our relationship with food
This week is about food, eating, and nourishing our bodies and minds.
Today’s newsletter (below) is about the common link between adverse childhood experiences and disordered eating.
Today’s podcast is a conversation with co-founder and CEO of Whole30, Melissa Urban, about how she recovered from addiction by erecting healthy boundaries around food, substances, and interpersonal relationships. Listen here!
For Friday’s Q&A, I welcome your questions about nutrition, eating, and developing healthy habits. Submit your questions here.
Our next Zoom hangout is on Wednesday April 19 at 8 pm ET! We will discuss The Four “I”s, i.e., the framework I use to conceptualize health. You can register here! This is for paid subscribers only.
I recently saw a patient frustrated over the 10 pounds she had regained after she stopped intermittent fasting. She asked me what to do. I've known this woman for over a decade. When we first met, she turned herself into a pretzel trying to convince me that she needed to lose weight, even though she didn’t have a medical reason to.
Over the course of our relationship, I repeatedly pushed back on her urge to explore various fad diets, remaining focused on her actual medical issues and helping her develop healthy coping strategies for stress.
Last year at her checkup, she acknowledged that she has struggled with the relationship with food her whole life, stemming from childhood distress around her parents' divorce. We finally discussed her inclinations to nourish her body one day—then punish it the next.
She is not alone.
Research shows that a significant number of adults with disordered eating behaviors have experienced adverse childhood experiences (ACEs), such as physical, emotional, or sexual abuse, neglect, or household dysfunction.
Health is about more than our weight or BMI. We are the integrated sum of complex parts. Health is about having awareness of data and the stories we tell ourselves, acceptance over the things we can't control, and agency over our life.
Are you Okay? For more on how the stories we tell ourselves impact our everyday health, join our conversation!
My advice to my patient?
First, awareness of the data and the stories we tell ourselves
To understand the data on ACEs and how her lifelong struggle with food stems directly from her past. “You’re more normal than you think.” I reminded her.
To realize that she had spent much of her adult life organizing an everyday behavior (eating) around uncomfortable feelings (guilt and shame), thereby depriving herself adequate nutrition and accelerating bone loss and mood instability.
To recognize that intermittent fasting had only propagated the false narrative that she can—and should—put a fence around hunger. Because she is not unlike most people (for whom intermittent fasting has been shown not to be effective in the long run), it only furthered her feelings of failure. As I wrote about in January, I find that most patients who try intermittent fasting on their own report irritability, inattention, or “hanger” that keeps them from sticking to it. And by suppressing hunger cues, they can set themselves up for disappointment and disordered eating when they ultimately bend the “rules.”
Then, acceptance over what she cannot change
To understand that disordered eating is not a personal failure, but rather a coping mechanism that can be unlearned with the right support and tools.
To accept help. I reminded her that asking for help is a skill—and that accepting it is a sign of strength.
To exert agency over aspects she is empowered to change
To see one of my mental health colleagues who specializes in treating disordered eating and trauma. I explained that a therapist can provide a safe and supportive environment to explore her feelings and experiences and to develop new coping tools.
To see one of my nutrition colleagues in order to establish a regular meal and snack schedule. She needed to get back in touch with her hunger and fullness cues, and to give herself permission to nourish her body and mind.
To practice mindfulness and self-compassion. I encouraged my patient to be present in the moment and non-judgmental of her thoughts and feelings to help reduce anxiety and increase self-awareness.
To incorporate enjoyable physical activity into her routine to help connect with her body in a positive way.
To consider medications if necessary. Antidepressants or anti-anxiety medications can be helpful for some individuals with disordered eating and trauma.
Have you ever struggled with your relationship with food? What has helped you cultivate a better relationship with it? I’d love to hear your thoughts in the comments!
This week on the podcast!
co-founder and CEO of Whole30, talks candidly with me about her struggle with drugs—and how her recovery stemmed from creating healthy boundaries around food, substances, and interpersonal relationships.Her latest book, The Book of Boundaries, is about the importance of setting limits on relationships and choices, and putting ourselves back in the driver’s seat of our health and wellbeing.
Melissa is living proof that health is about laddering up from self-awareness to acceptance to agency of our body and mind.
Disclaimer: The views expressed here are entirely my own. They do not reflect those of my employer, nor are they a substitute for advice from your personal physician.
I’m struggling with disordered eating now. I do believe there is a childhood component that I’ve never thought to address. Add to that comments from my doctors over the years telling me I was overweight and “just cut back and exercise more” without any real help. I’ve done WW. HCG. IF. More recently semaglutide (that helped tremendously--but didn’t help me learn to manage emotions). Right now I’m stress eating (sick dog) and what stinks is I RECOGNIZE what I’m doing as I anxiously/mindlessly snack away. I just want the cravings under control....I’m miserable.
Yes I struggled with portion control. If I loved something I wanted to eat it until I was stuffed. My thought was all or nothing. Whenever I experienced eating too much of something I decided I had ruined my diet and that was permission to continue overeating all day. This lead to feelings of regret and failure and loss of control. Many years later I think back and I believe I was depressed. I didn’t have any physical activities to put my energy into and absorb my obsession with food. For some reason my self esteem was directly tied to my weight. I have since been on antidepressants and it was a miracle. I would eat and be satisfied with a normal portion and rarely over indulge. I now make sure I am physically active which has helped my nervous energy go into something positive. I feel this is an area of my life that is healthy and under control. Love your articles and collaborative podcasts !