Nutrition & Physical Activity

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Recovering from Anorexia: getting my period back?

Dear Cate,

Congratulations on getting a handle on a difficult situation. Anorexia can be life-threatening, so you've essentially saved your own life — something that hopefully makes you proud. As you point out, a side effect of anorexia can be secondary amenorrhea (loss of period for six months of longer). Typically, women in recovery find their periods come back once they get their weight up to what it was before they stopped getting their period. Some women, who aren't underweight, but who stop getting their periods during times of extreme exercise and erratic eating, regain their period once they get back into a routine of healthy eating and exercise habits. So, your concern is warranted. And, yes, it would be a great idea to seek a medical work-up at this point. Before you head to your health care provider, it might help you to get more information.

There are several possible explanations for secondary amenorrhea. Given your history of living with anorexia you may be experiencing functional hypothalamic amenorrhea (FHA). While FHA seems to occur most frequently in women with low amounts of body fat, it can happen in women of various body shapes. The common denominator seems to be erratic eating patterns and/or excessive exercise. These behaviors disturb the thyroid gland and hypothalamus-pituitary-adrenal gland in ways that lead to increased production and release of steroid hormones, called glucocorticoids (including cortisol, a major stress hormone). Also, low body weight is associated with lower levels of leptin, a necessary chemical that helps to regulate ovulation. In combination, these chemical changes in the body can affect periods and stop them altogether until the chemical balance is restored through changes in behavior and/or hormone therapy. 

While your amenorrhea might be related to your history of anorexia, there are other health-related factors to secondary amenorrhea that you might want to consider:

  • Hormonal contraceptives (e.g., some birth control pills, implanted or injected methods, intrauterine devices)
  • Pregnancy or breast-feeding
  • Extreme mental stress
  • Certain medications (e.g., some antidepressants, chemotherapy drugs for cancer, oral corticosteroids)
  • Chronic illness
  • Thyroid problems
  • Hormonal imbalance
  • Benign pituitary tumor
  • Uterine scarring
  • Premature menopause

You can see there are many possible reasons for secondary amenorrhea. It's also important to know that women with secondary amenorrhea can be at increased risk for some pretty serious health conditions like: osteoporosis, bone fractures, cardiovascular disease, and metabolic problems.

You can contact your primary care provider or women's health specialist. If you don't have a trusted women's health care provider, you might consider finding one soon. If money's a problem, you can check out Planned Parenthood's website to find a local health center. Some Planned Parenthood centers offer sliding-fee services and other programs to cover the cost of care for people who qualify financially.

There's no doubt that secondary amenorrhea is a complex issue with many possible causes and consequences. And, everyone woman's situation is different. If investigating the absence of your period is the next step for you, working with a women's health specialist could help you get the answers you need.

To your continuing good health,

Alice

For more information or to make an appointment, check out these recommended resources:

Medical Services (Morningside)

Student Health Services (CUMC)


January 22, 2013

522172
Hello, I have had the same problem in the past from anorexia. For a while I was only able to get my period when I took birth control pills, and even now with out them my periods are generally light...
Hello, I have had the same problem in the past from anorexia. For a while I was only able to get my period when I took birth control pills, and even now with out them my periods are generally light and last 3 or 4 days. It's been maybe a year and a half, close to two now? I don't mean to say this is what has happened to you but I was told that when I was getting my period that way it might be difficult for me to have children some day. I've also heard that a possible result of not having your period is being barren. It might be a good idea to see a gynacologist soon. I believe they or an endocrinologist would be very helpful to you if you're not already seeing them, and the sooner the better. Best wishes beloved sister. I hope that doesn't happen to you.

Eating soap — obsession

Dear Soap-Eater,

Kudos for thinking about how your behavior might affect your long-term health and writing in to ask about it. What you describe is called pica, an eating disorder where people frequently eat non-nutritive (non-food) substances. Depending on what a person eats, pica can be very dangerous. Ingesting dangerous substances or large amounts of some substances can lead to medical problems, including poisoning. There is also a risk of infection resulting from some substances, such as soil, and stomach problems including constipation, and other issues.

Fortunately, in your case soap is not a very dangerous substance, though in large amounts over time it could disrupt your health. Soap is generally non-toxic and should not lead to poisoning. However, it can cause diarrhea, vomiting or skin irritation.

The causes of pica are not known but some suggest that the following may contribute to the desire to eat non-food items:

  • Nutritional deficiencies. Some speculate that pica is your body's way of telling you that you are missing some important nutrient. Iron, calcium, zinc, and vitamins C & D deficiencies have been found in people with pica.
  • Culture and family influences. There is some suggestion that certain cultures and social groups accept eating non-food substances. Also, if your parents encouraged this as a child, you may still have the urge to eat these substances.
  • Stress. The desire to eat non-food substances may be a coping strategy for stress.
  • Underlying biochemical disorder. In some cases, pica may result from chemical imbalances in your brain.

You mentioned that eating soap makes you feel good when you're stressed. This could be a sign that your stress level is too high and your body is reacting by craving soap. You could consider finding alternative ways to deal with your stress. See Stress, anxiety and learning to cope and Number one cause of stress for some tips on other ways to combat stress.

Pica is rare in adolescents and adults, and can be the sign of other medical issues including nutrition deficiencies so you should consider contacting a health care professional to help figure out what might be causing this behavior. Columbia students on the Morningside campus can call 212-854-2284 to make an appointment or log on to Open Communicator. Students on the Medical Center campus can contact Student Health at 212-304-3400. You may also want to consider talking with a counselor about healthier strategies for coping. Columbia students can make an appointment with Counseling and Psychological Services (Morningside) or the Mental Health Service (Medical Center).

You took an important first step in asking about your behavior, but it's also important that you take the next step and talk to a health care professional who can help you figure out if there is some underlying cause. Taking care of your health is not silly — it's smart.

All the best,

Alice

December 19, 2014

594651
I've never eaten soap. However, once in a while (since I had my son 8 years ago), I get cravings for soap. I had a craving today and decided to google it. I'm so glad I'm not the only one. I really...
I've never eaten soap. However, once in a while (since I had my son 8 years ago), I get cravings for soap. I had a craving today and decided to google it. I'm so glad I'm not the only one. I really want to taste a piece one day, but idk if the logical part of me will allow me to try it.

February 26, 2014

553088
Believe it or not I have been eating soap for approximately 20yrs and here is some advise. If you can stop start doing so gradually and try not to go back. For me it has caused some skin irritations...
Believe it or not I have been eating soap for approximately 20yrs and here is some advise. If you can stop start doing so gradually and try not to go back. For me it has caused some skin irritations and recently some digestive problems. Although my mouth still waters at the thought, it is not worth it.

February 19, 2014

552436
I too crave soap. I like the taste of Irish Spring, Coast, Silk, Ivory, Jergens and others. I have discovered that it ruins your teeth and gums causing sensitivity and caries. It also creates long-...
I too crave soap. I like the taste of Irish Spring, Coast, Silk, Ivory, Jergens and others. I have discovered that it ruins your teeth and gums causing sensitivity and caries. It also creates long-term digestive issues such that my body is no longer absorbing nutrients as it should because ingesting soap changes the environment necessary for proper digestion. My guess is that the hydrochloric acid gets neutralized so it takes longer for the food to be broken down and pass through the system. Recently, I stopped eating soap because my teeth became so painful that I couldn't chew and was forced to really do something about it. Now, I try to buy brands of soap that I don't like and because iron supplements are too harsh for my stomach, I'm trying to boost my intake by using nettle and oat straw teas as well as spirulina and chlorella. My tooth sensitivity went away within a week of ending my soap eating habit and with intensive action to remineralize using the herbs mentioned along with black walnut tincture. I have stopped before for long periods, but went right back after a while. I can't afford to allow that this time, so I'm investigating tooth soaps to see if they have similar textures and nice tastes. Since these can be ingested, I'll try them if I fall off the bandwagon again and hope for the best. Best wishes everyone and I hope this really helps someone. Kindred Spirit

April 19, 2013

527515
Okay. I don't know what to say. I also thought I was alone. I'm also a soap-eater, and nobody knows this. At first, I thought I was just curious with it's taste, especially when it smells really good...
Okay. I don't know what to say. I also thought I was alone. I'm also a soap-eater, and nobody knows this. At first, I thought I was just curious with it's taste, especially when it smells really good...so it tried licking it, then it became a habit. Everytime I take my bath, I can't keep myself from tasting my bar soap, I became obsess with its taste and smell. I started craving for more. It seems like I can't stop myself from dong it. I'm really worried about this and I want to thank whoever is behind this website because I feel kinda relief knowing I'm not alone.

January 4, 2013

521132
I eat Irish Spring not proud of this behavior but I can't seem to stop :( It relaxes me as well for some reason.
I eat Irish Spring not proud of this behavior but I can't seem to stop :( It relaxes me as well for some reason.

December 10, 2012

519919
I'm also a soap eater,and I've been eating soap for over 5 years now and I just can't stop the cravings!
I'm also a soap eater,and I've been eating soap for over 5 years now and I just can't stop the cravings!

August 27, 2012

515527
I also am a soap eater and I thought I was alone. It's relieving to find out there are others out there that also have this problem. I am very health conscious and it disturbs me that I enjoy the...
I also am a soap eater and I thought I was alone. It's relieving to find out there are others out there that also have this problem. I am very health conscious and it disturbs me that I enjoy the taste of soap when the purpose is to wash your body or hands and not to eat. I guess you could say it started when I was a kid when my parents would punish me by making me stick a bar of soap in my mouth for an extended period of time. I just started washing my body with a bar of Irish Spring soap this past year and I would occasionally lick the moist bottom of the bar. It tasted funny at first but now it tastes delicious. I can't help but feel bad that I'm eating it because I know the bar is not meant to be eaten. I'm also stressed and find myself eating it more often then usual. I'm just glad it's not harmful to the body with small amounts and that I'm also not alone. Thanks soap eater!

March 6, 2012

508112
ime so glad i looked this up.....i eat dove soap everyday now,i used 2 nibble imperial leather and knights castile as a child then again in my teens now started again at 41 !!!!!!!!,the cravings are...
ime so glad i looked this up.....i eat dove soap everyday now,i used 2 nibble imperial leather and knights castile as a child then again in my teens now started again at 41 !!!!!!!!,the cravings are so bad that i even brush my teeth with it aswell as bath in it and litterally bite chunks and chew it, i litterally crave it so much my mouth waters,all my friends etc think its disgusting but its like a drug addict needing their fix or an alcholic needing their drink! hopefully now ive looked into it i can get the right treatment and leave the dove alone :)

June 19, 2009

21546
To the reader:

Thank you, I thought that I was the only one and I searched high and low. I feel better knowing that there is a name for it. I opened up and told two relatives and I got scared when...

To the reader:

Thank you, I thought that I was the only one and I searched high and low. I feel better knowing that there is a name for it. I opened up and told two relatives and I got scared when they hinted that it may cause sterility. I also only eat bar soap and it relaxes me. I will take a chunk out of it and it's kinda like woosaa.

Thank you for this post and thank you for opening up soap eater.

Soap eater2

Will probiotic-enriched yogurt aid digestion?

Dear Reader,

It's wise to keep a healthy skepticism about the marketing efforts of some of these huge food corporations. Dannon's probiotic-fortified yogurt, Activia, is certainly an example of a highly promoted product. In recent years, the global market for "functional foods," has grown to billions of dollars annually, and since these supplement-food hybrids are appearing on the shelves ever more rapidly, the FDA doesn't have a chance to evaluate all of their claims. While there is evidence that probiotics do help to improve digestion and gastronomic health, it is hard to say that one brand over another is more effective at doing so.

Probiotics, beneficial bacteria that live in the small intestine, are believed to improve digestion. These gut-friendly bacteria actually help you to digest and eliminate your food, while crowding out the unhealthy gut-dwelling bacteria that cause gas, constipation, and bloating. Studies have shown that certain probiotics can help relieve irritable bowel syndrome, diarrhea, constipation, atopic eczema, and may also help protect against various infections and colon cancer. Researchers have found that stressed-out rats have benefited from a serving of water containing certain probiotics. Not a flattering comparison for us people, who might feel like stressed-out rats from time to time, but the findings of the study may be helpful. Probiotics are found in many types of fermented foods, like yogurt, sauerkraut, tempeh, and miso.

Regular yogurt is made using these live cultures, and serves up a healthy serving of them with each spoonful. But your question, is Dannon's Activia more effective in providing these results than regular good old-fashioned yogurt, is one that begs a good answer. Dannon (of course) says yes. Their Activia yogurt contains Bifidus regularis, a probiotic strain trademarked by Dannon that is not in other yogurts, and they claim that this particular strain speeds wastes through the digestive system and improves immunity in the intestines more effectively than other strains.

Dannon says that their Bifidus regularis, "survives passage through the digestive tract, arriving in the colon as a living culture," whereas other cultures can be destroyed by stomach acids and the natural process of digestion. The consumer reports lab has confirmed Dannon's claim, reporting that about three million of the original three billion probiotic organisms in a four-ounce serving of Activia made it through the stomach to the colon.

There is one other difference you mentioned between this yogurt and the others: the price. Activia typically costs more per ounce than regular Dannon yogurt. There are also other brands on the market that offer yogurts containing probiotics that are similar to those in Activia. If you're willing to spoon out the extra cash for yogurts with these particular probiotics and have noticed a decrease in stomach grumblings as a result, it seems like it working for you and might be worth it. However, now that you know that all yogurts contain healthy amounts of probiotics, it might be interesting to see if those regular yogurts feel just as good as the one with all the advertising. Eat up!

Alice

Food coma

Dear Reader,

The symptoms you describe sound like what many people call the "food coma." Sometimes, after eating a holiday meal, a big dinner or lunch, or even sometimes after meals that didn't seem that big, you may feel a bit drowsy. Some medical conditions can cause this feeling, including anemia, kidney dysfunction, sleep disorders, infections, or an electrolyte imbalance just to name a few. But even people who don't have any of these medical conditions may still feel tired after eating, because this symptom is also a consequence of normal digestion!

Why? Because our bodies spend a lot of energy digesting food. The stomach mechanically churns the food, produces acid to break the food into tiny pieces, and then controls the rate this broken down food can enter the intestines. In the intestines, enzymes use energy to further break down and absorb food particles into the body. For humans, it is normal for the rate of energy use to increase by 25 to 50 percent after a meal. This increased bodily activity could contribute to your feeling flushed after eating.

One explanation for your drowsiness lies in one of the hormones released during digestion — cholecystokinin. Commonly referred to as CCK, this hormone helps make you feel full, but also activates the areas in the brain associated with sleep. So after eating, when CCK levels rise to tell you you're full, you may also start to feel sleepy. Additionally, meals high in carbohydrates can increase the levels of tryptophan (an amino acid) in the blood. In the brain, tryptophan is converted into serotonin (a neurotransmitter that makes people feel both happy and sleepy). This boost in serotonin could also cause someone to feel tired.  

Since you don't feel tired after every meal, you may want to keep a food journal to see what types of food have you craving a post-lunch nap. If carbohydrate-rich or heavy foods like pizza, pasta, or panini slow you down, you could opt for a salad, soup, or sushi on days when you have a lot of work to do in the afternoon. You could also try eating several smaller meals throughout the day, rather than a big lunch, to avoid overwhelming your digestive system.  

Feeling tired after eating is a common experience, and not necessarily linked to a medical condition. However, if you feel your symptoms may be related to a medical problem, it's always a good idea to visit your health care provider, especially if your fatigue begins to seriously impair your ability to get your work done. Students at Columbia can contact Medical Services (Morningside campus) or the Student Health Services (CUMC).

Best of luck in staying alert during your post-meal endeavors,

Alice

Mercury poisoning: Something fishy about too much tuna?

Dear Reader,

Fish can be an important part of a healthy diet; it's loaded with high-quality protein and omega-3 fatty acids and low in saturated fat and cholesterol. It’s also true that nearly all fish have at least trace amounts of methylmercury. The good news is that many of the commonly purchased fish in the United States, including several varieties of tuna, typically have lower levels of mercury and are safe to eat if the amount you consume doesn't exceed the weekly recommended serving size.

To answer your question specifically, Albacore (white) tuna and light tuna are the two most common kinds of canned tuna. Due to its larger size, white tuna contains significantly more mercury — up to three times more — than light tuna. The EPA guidelines state that it's safe to eat up to twelve ounces of light tuna (or any fish low in mercury) a week or six ounces of white tuna a week. Considering that the standard weight of a can of tuna is six ounces, you may be putting yourself at a risk for mercury poisoning if you're eating two to five cans per day.

So why worry about mercury? It's considered a pollutant and is released into the environment, largely from factories and other industrial settings. It eventually travels to streams and oceans where microorganisms present in the water turn it into methylmercury. Fish then absorb this chemical into their bodies from the water. Mercury levels in the fish depend on what they eat, how long they tend to live, and where they are in the underwater food chain. Larger fish typically contain higher levels of mercury not only because they're heavier and have more surface area to absorb mercury, but also because they eat smaller mercury-containing fish, which increases the larger fish's mercury content. Because of this, the Environmental Protection Agency (EPA) recommends staying away from shark, swordfish, king mackerel, and tilefish from the Gulf of Mexico, since on average they have higher levels of mercury.  

Most of the warnings about mercury poisoning are targeted to young children and pregnant women because exposure to mercury during development can cause neurological defects, including impairments in cognition, memory, attention, language, and fine motor skills. This is especially of concern because infants born with these impairments have been observed even when the mother showed no symptoms of poisoning. Mercury poisoning in adults can cause numbness in fingers and toes, muscle weakness, and speech, hearing, and walking impairments. And so far, research has not found that mercury exposure in humans is associated with cancer, but human studies are limited. If you find yourself experiencing any of these symptoms, it’s best to visit your health care provider as soon as possible. If you feel fine but are scared of prematurely swimming with the fishes, you might want to switch up your fish or seafood meals to include a variety of low-mercury choices, such as salmon, shrimp, pollock, catfish, cod, or tilapia.

The National Resources Defense Council's Mercury Contamination in Fish - Consumer Guide to Mercury in Fish provides tools that can help make this transition proceed swimmingly. It contains a list that informs consumers of the frequency that a certain fish can be eaten safely, as well as a mercury calculator that generates a safe value for fish intake based on a person's weight and type of fish. Lastly, if cost is of concern, there are many additional options for protein and nutrients on the cheap. You could also try substituting the tasty and affordable tuna with non-fish sources of protein, such as chopped canned chicken, lean deli meats, or beans; these can also be part of a healthy diet without breaking the bank.

Alice

Blue corn chips — Are they healthier?

Dear Reader,

It's often said that the more (naturally) colorful your plate is, the healthier that meal is for you. This saying holds true in the corn arena: Blue corn does contain more of the amino acid lysine and the antioxidant anthocyanin than "regular" yellow corn; however, it loses much of these nutrients when it's processed into a chip. Blue corn chips may be slightly more nutritious in this sense, but if you're trying to increase the amounts of lysine or antioxidants in your diet, fresh and whole fruits, vegetables, and lean proteins are much better sources.

Research has also found that blue corn tortillas (fresh, not fried into chips) contain more protein than their yellow or white corn counterparts. In addition, blue corn tortillas have a lower starch content and lower glycemic index (GI) than regular corn tortillas. Both of these factors may be helpful to people on low GI diets, such as diabetics, because food with a lower starch and low GI breaks down more slowly into sugars absorbed by the blood stream and can help people avoid spikes in blood sugar levels.

Keep in mind that chips of any color are often fried and can be high in fat and calories, so it's probably best to not make them a regular snack. Baked chips or crackers may be a healthier alternative, especially if they're made with whole grains. Look for the words "whole grain" or "whole" before the grain's name on the ingredients label to make sure it falls into this category. Fiber is another important consideration in a healthy snack, and not all whole grain products are high in fiber, so be sure to look at fiber content on the nutrition label. For more information on whole grains and fiber, check out some of the Related Q&As below.

Alice

Weightloss diets for vegetarians, and everybody

Dear Reader,

Fortunately for people who wish to lose weight, there are universal rules that apply, regardless of your typical diet — whether you're a vegetarian or omnivore. First, to lose weight a person has to use more energy (calories) than s/he takes in. To achieve this deficit you can either make dietary changes (so you're taking in less calories), get more physical activity (so you're using more calories in a day), or you can make changes in both areas. Experts recommend making both dietary changes and getting more physical activity for the best results.

It takes a deficit of about 3500 calories to lose one pound of body weight. This means if you are able to cut 500 calories per day from your regular diet you should be able to lose a pound a week (a healthy weight loss rate). It may be beneficial to consider finding the right balance of increasing your physical activity and decreasing caloric intake. You can check out the ChooseMyPlate.gov SuperTracker as a resource that can help you calculate how many calories you need per day, what nutrients are in the foods you eat, and how many calories you burn doing different exercises.

Some suggestions for dietary changes to reduce calories:

  • Steam, boil or bake foods instead of frying in butter or oil.
  • Sauté foods in vegetable broth, wine, or water instead of oil.
  • Limit of high-fat condiments (like mayonnaise, margarine, sour cream, cream cheese, salad dressing, etc.).
  • Try low-fat dairy products and nut- or peanut butter. Vegetarians sometimes begin to rely heavily on these foods as sources of protein, but low-fat dairy and nut products provide the same amount of protein as their full-fat counterparts.
  • Add beans and legumes to your diet as low-fat sources of protein.
  • Eat actual fruit or vegetables rather than drinking them in juice or smoothie form. The fiber in fresh produce works well to satisfy hunger.
  • Substitute water, tea, and diet beverages for regular soda, juices, and other high-sugar drinks.
  • Limit the amount of alcoholic beverages consumed (empty calories for everyone).
  • Begin lunch or dinner with a broth-based, vegetable filled soup or a large salad with a small amount of low-fat or fat-free dressing. These foods take longer to eat and can help curb your hunger so you don't overeat during the rest of the meal.
  • Be mindful of portion sizes — read nutrition fact labels to find out serving sizes. Some rules of thumb:
    • A medium apple or orange is the size of a tennis ball.
    • A medium potato is the size of a computer mouse.
    • An average bagel is the size of a hockey puck.
    • An ounce of cheese is size of four dice.

Some suggestions for incorporating more physical activity into your day:

  • Take the stairs as often as possible.
  • Park at the far end of the parking lot or get off the bus or subway a stop early.
  • Schedule your cardiovascular exercise (walking, jogging, swimming, biking, frantically cleaning your apartment before visitors come over, etc.) so you know you will be able to fit it in. If you're at Columbia, you can participate with CU Move to help stay motivated with your physical activity efforts and earn incentives.  Check out the site to learn more. 

Hopefully, you'll find some of these suggestions new and helpful. Good luck!

Alice

Is soreness a good indicator of a good workout?

Dear Pushed too far,

The old axiom, "no pain, no gain," is just that... old and outdated. Pain and soreness aren't valid measures of the benefits of exercise. Muscle soreness can occur with anyone who exercises, from a beginning exerciser embarking on a new program to a conditioned veteran who is working at a greater intensity, frequency, and/or duration than s/he is used to. It frequently happens to well-trained people as they begin a new activity. Muscle soreness may also be a result of overuse, which may eventually lead to injury. It's important to listen to your body and seek treatment for injuries.

Meeting goals in terms of developing strength or endurance needs to be the focus of any exercise program. Well-defined goals guide results that you are able to attain through gradual behavior change. Examples: I want to be able to do 20 push-ups; I want to be able to run a 10K by the end of the year, etc. Goals are specific and measurable and can be useful in guiding any training program. Soreness can be a consequence of working toward a training goal, but should not be a goal in and of itself.

You write: "I think it's kind of odd that he bases his progress on how sore his clients are." It's important to consider who is looking for the progress here: you the client or the trainer? Your development and achievement should be the trainer's first concern. Some trainers feel the way a client looks or how much s/he can lift is a direct reflection of her or his ability. Does it make sense for you to have a conversation with your trainer about your concerns? You may want to reference Selecting and Effectively Using a Personal Trainer, developed by The American College of Sports Medicine. If you are a Columbia student, you can contact the Dodge Fitness Center to set up an appointment with personal trainer. 

Since soreness is not a reliable indicator of a "good" workout, it sounds your trainer may need a little training. Best of luck toning up!

Alice

I want to recover from my eating disorder and need to learn how

Dear Reader,

It is understandable that you feel eager to get better and frustrated with the idea that you have tried to quit many times, and that it hasn't worked. It isn't clear if you have tried to quit on your own, if you have been in a program, or have gotten the help you need. Bulimia is a serious eating disorder that needs intensive long-term treatment to overcome. Healing takes time, as well as support, skills of a clinician, and your own involvement each day. The clinician will assess which level of care is appropriate for you.

Although the eating disorder may not disappear immediately, what needs to be done immediately is intervention. And you want it now.

Your pediatrician or family doctor may be able to help you find an in-/outpatient program in your area for intensive treatment before the semester begins. Then you can receive follow-up treatment when you begin college, and be referred to an outside provider for long-term care, if necessary. Websites such as www.eating-disorder.com are designed as "treatment finders" and may guide you towards programs near you.

Although bulimia is difficult it is to treat and change, it is not impossible. Since the causes of bulimia are so complex, effective treatment requires a multidisciplinary team of professionals who specialize in eating disorders treatment. The team will address the medical, psychological, psychiatric, and medical nutrition needs of the person with the eating disorder. Because persistent vomiting erodes tooth enamel, dental care also needs to be a part of the treatment program. Your team will work with you to determine what method of treatment will work best for you, whether it be a combination of therapy and anti-depressant medication or cognitive-behavioral therapy,  group therapy and/or support groups or a combination of all of the aforementioned treatment options.

Some treatment options include:

  • Out-patient treatment programs are community programs set up for people with eating disorders who are more medically stable and are able to remain in their own environments during treatment without risk to their health. Hospitals that treat people with eating disorders may also have out-patient programs, but they may also be privately owned. Many universities also have multi-disciplinary teams that treat eating disorders.
  • In-patient/Residential treatment. While out-patient treatment alone is sufficient for the recovery of most people with bulimia, some individuals may require hospitalization or residential treatment. Extreme purging puts a tremendous strain on the body's organs, and drugs such as ipecac (used to stimulate vomiting), laxatives, and diuretics can be toxic when abused. Conditions warranting hospitalization include heart abnormalities, metabolic imbalances, substance abuse, clinical depression, or risk of suicide. A physician, nurse practitioner, or nurse can assess whether or not hospitalization is medically necessary.

Regardless of treatment modality, family therapy is a necessary aspect of the recovery process. The treatment team involves the person's family to help the family understand treatment goals, the eating disorder itself, and the functions it serves for both the person and family.

After the end of intensified treatment, on-going follow-up is extremely important with sustained contact between the person and those who work with the treatment program. Many people with bulimia benefit from participating in self-help or psychotherapy groups during their on-going recovery.

It's courageous and admirable of you to acknowledge that you need help and would like to recover. By taking these first steps, and by taking them in a measured, informed way, you can find the treatment plan that is more likely to work, and can then begin to heal.

Alice

I'm bored, so I eat

Dear Fat Frat Guy,

You write that you're sitting around the frat house bored. It sounds as though you may have more time to fit in activity than you realize. Exercise doesn't always need to be a long, intensive workout. Short, frequent bouts can be just as effective as longer ones. Why not go out for a walk? Does your frat house have weights in the basement or other area? Taking advantage of exercise equipment is a great idea, but if there isn't any available, jumping rope between sets of push-ups and sit-ups, in your room or a living room or den, can help alleviate boredom.

If these ideas aren't possible, or you still need some suggestions to resist snacking, a few questions to ask yourself may help. First of all, are you actually hungry? When was the last time you ate? Could you put off eating for 15 minutes? If you can wait 15 minutes and then see how you feel, you may decide that you really weren't hungry after all, or you may even forget all about that snack. If you don't and still want to eat — try to quantify your hunger.

Consider the Hunger and Fullness scale. On a scale from 0 - 10, with 0 being BEYOND HUNGRY as though you haven't eaten in an entire day (not recommended) and 10 representing BEYOND FULL as if you ate three Thanksgiving dinners — again not recommended, see where your hunger or fullness falls:

0 Beyond hungry
1 Extremely hungry, irritable, and cranky
2 Very hungry
3 You have a strong urge to eat, but aren't ready to fall over.
4 Just a little hungry
5 Totally neutral... neither hungry nor full
6 You are a notch past neutral — you could eat more but aren't hungry
7 You are feeling satisfied. If you stopped eating at this point, you would need to eat again in about 4 - 4½ hrs.
8 You are getting pretty full. If you stopped eating at this level, you would probably get hungry again in 5 - 6 hours.
9 You are getting really full, and uncomfortable.
10 Beyond full

One way to use this scale is to try to rate your feelings of hunger and fullness. You have to work on paying attention to your body's signals. Make an agreement with yourself that you will eat when your hunger is at 3, and stop eating when you reach 7. If you can ask yourself how you are feeling before taking a snack, you may be able to alleviate or at least cut down on boredom eating. Remember, food's for nutrition and nourishment. If another part of yourself needs nourishment, it's important to figure out what that is and create other ways of meeting that need. Excessive snacking often catches up with us in the form of excess pounds, as you have found. If you repeatedly find yourself eating when you aren't hungry, or when you are no longer hungry, you probably don't need those excess calories.

So, once you realize that you aren't hungry, there are probably a ton of things you can do to pass the time. Getting off your duff and moving your body — somewhere further away from the kitchen — would be a good start!

Alice

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