334: Breaking Free From The Restrict, Binge, And Purge Cycle

Hey, if you want access to the transcripts and the show notes and the links talked about as part of this episode, you can head to 7, so the word all spelled out, S-E-V-E-N, hyphenhealth.com, forward slash 334. Hey everyone, welcome back to another episode of Real Health Radio. I'm your host, Chris Sandel. I'm a nutritionist and a coach and an eating disorder expert, and I help people to fully recover. So before we get on with today's show, I just want to mention that I am currently taking on new clients. If you are living with an eating disorder and would like to reach a place of full recovery, then I would love to help. And I know the idea of full recovery can feel very out of reach. It might feel like a complete pipe dream. It might feel like that's something for someone else, just not for me, because this has been going on for so long. But irrespective of how long you've been like this, it's going to be a long time. And I'm going to talk to you about living with an eating disorder. I believe that you can fully recover. And this is what I work on with people. So if this is of interest to you, then please get in contact. You can send an email to info at seven hyphen health.com and just put the word coaching in the subject line and I can get the details over to you. So let's get on with today's show. And so what I'm wanting to cover as part of this one is the restrict binge cycle or the restrict binge purge cycle, depending on someone's behaviors. It can be all three of those things or it can be just two of those things. I want to talk about this and help people to understand this cycle and why it happens and what to do to stop perpetuating this cycle. And a big reason for why I want to cover this as well is I think a lot of people have this misunderstanding of the clients they work with. I think so often when people contact me, there's this idea of, oh, I must, only work with people with anorexia because of the way that I talk about recovery. And I think there's this really incorrect notion that people have. And when I say people, this can be people struggling with eating disorders, but I think it's still prevalent even within the eating disorder recovery world where we talk about restrictive eating disorders. And these are things like anorexia or it could be things like ARFID or it could be orthorexia where we see the problem with this eating disorder. And I think that's a really important thing to talk about. Being the restriction piece of it. And we think that that's the thing that is driving this and is causing the problem. And then there are other eating disorders like binge eating disorder where restriction is not the issue. This isn't a restrictive eating disorder and where the blame and the problems is seen as the binges. And that's where we need to put our focus. And this can even be the same with bulimia in terms of it's the purges or sorry, the binges and the purges. That's where the problem lies. And that's the bit we've got to deal with. And really, from my perspective, all eating disorders are restrictive eating disorders. And I've worked with many people with binge eating disorder. And in all circumstances, restriction was at the heart of this. And I think it's, I've said this before on the podcast, but I think it's really important to recognize that someone's weight is often at the heart of the diagnosis that they then receive with eating disorders. And I think this is highly incorrect. And in a lot of ways, I think of eating disorders as being the same thing. And they manifest slightly differently in terms of is there purging going on, what's going on in terms of exercise, what's happening in terms of the style that someone is eating in terms of how they're restricting and all of these different things. But really at the heart of it, they are all the same. And so for example, three people who are doing very similar things. And so we have someone who is in a stereotypically thin body, who is restricting their food intake. At some points, there are some binges that occur. And as a way of them dealing with that is to exercise and to compensate through exercise. And so we have one person who's doing that, who is in a thin body, maybe it's below the BMI cutoff for a healthy weight. And that person would then get diagnosed with having anorexia, anorexia, binge purge subtype. And that diagnosis is largely based on the behaviors they're doing, but also the size of their body. We then have another person and their body size falls into the quote unquote, normal side of the BMI. And they are also doing these behaviors. So there's restriction going on, there's binges going on, there's purging that is going on. And this purging, again, it could be purging just from doing exercise. And that's their way of compensating. This person is then likely to get a diagnosis of bulimia. And they're likely to get that diagnosis because their body is now not small enough for them to be deemed to have anorexia. Exact same things going on, but because of the size of their body, they get that as a diagnosis. We then move on to someone who is in a larger body. So maybe they're in the quote unquote, overweight or obese categories as deemed by the BMI scale. And for this individual, despite doing the exact same things, they're now deemed as having binge eating disorder. And I think that it's a really useful thing and useful and sad thing to recognize. But in each of these cases, despite these three people getting different diagnoses, for their eating disorders, one, the exact same thing is going on with all of them in terms of their different behaviors. And two, restriction is the thing that is driving this. And so I think it's just a really important thing to understand because there are so many times when people do contact me and they say, I'm living with binge eating disorder and this is what's going on. And I see your messaging and it just doesn't really make sense to me because I can't possibly be restricting. I'm living in a larger body, so that can't possibly be what's going on. I eat quote unquote, lots of food, or there's all these reasons why this doesn't fit. And every time when I've been able to have conversations with these people, when we look at what's going on, restriction is really at the heart of what is driving this thing. And so I want to go through what this cycle looks like and how people find themselves in this cycle. Because I think it is really important. And for some people, they are able to consistently restrict and it doesn't then lead to a binge. It doesn't lead to a purge. Although I would say there is restriction and then there's still a lot of compensation going on. And I'll talk about this, that we could often think of the idea of a purge as compensation. And often as people's eating disorder goes on longer and longer as a way of being able to, keep in control of this thing, or to be able to still manage their weight, quote unquote, manage their way that actually we're now having to ramp up the exercise and ramp up the compensation to be able to deal with that. And so what I want to do is I want to go through the restriction piece, the binge piece and the purge piece, just to understand this better. And as I said at the end, restrict binge, that there isn't this, this purge piece or not as, as obviously. And what I've also noticed is that for some people, it's only when binges start to occur that they then begin to see what's going on as a problem. And for lots of people, they could have a period of many years where they've been able to restrict and they've been able to keep it up. And it's then at some point that the binges start to occur. And this is then when the arm bells go off. This is when there's the recognition of, oh my God, something's not right here. But when someone's able to continue on with the restriction, it can often be harder for them to, to recognize that or reach that point. And they reach that point only as the, the compensation starts to, to increase. And they find that, my God, I'm spending so much more time on exercise. Or when there's a decision that actually I want to do something different. I am reliving in this way. And they then realize just, oh, I can't do something different. I feel so powerless to do something different. And, and I often talk about the difference between control and being controlled. Because so often when people talk about the eating disorder, they talk about, it's just so important for me to be able to control, for me to have this sense of control. And actually it's only when you start to deviate from that in terms of actually, I do want to take a day off exercise, or I do want to go out and eat this meal, or I do want to eat earlier. It's that it's in those moments that you realize, oh, actually I'm not in control. I'm being controlled because my ability to do these things is really impaired. And I'm really struggling to actually do something different. So in terms of then the restriction piece, I think we have, again, this, this misconception about what restriction means. And a lot of that is, is guided by or created by one, the stereotype of what we, we think someone with an eating disorder or someone suffering with anorexia is dealing with but two just because of the society we live in and and how we have normalized dieting how we have talked or how we talk about food and health and all of these different things so for us for many people the idea of restriction is oh i didn't eat anything or that that would be what would have to be going on for someone to feel like they're restricting like i clearly ate no food during the day that's really telling me that i'm restricting but that's just not the case and and it's very very rare for me to work with someone where their eating has ever got to that place where they're they're having a day or multiple days where they're not eating anything like that's a very very very small subset of people who struggle with eating disorders and and so that can't be the bar for what is restriction and really restriction is ways in which you are eating less than what your body truly needs to be able to function optimally and so this can look like lots of different things it could be you're not eating enough total calories and this can be someone who is tracking their calories there i'm not able to go over this specific amount of calories and for some people they're not getting into the the carbs and the proteins and the fats or the the unhealthy food or the healthy food whether it's purely just i can't go over this calorie amount and i can work my way up to this calorie amount in whatever foods i want but i'm just not allowed to go over this threshold for someone else it is about particular types of foods so they're low carb or they're low fat or they're making changes in terms of the macronutrients or there are particular types of foods that i'm not allowed to eat so no that's a processed food so i'm not allowed to eat that i only eat things that are a whole food so i'm not allowed to eat that i'm not allowed to eat whole foods or i have these lists of things that are good foods or bad foods and i'm only eating things from the from the the good list it could be something like intermittent fasting and so i'm now only eating during a four-hour eating window or an eight-hour eating window or whatever it may be in terms of that's how i'm doing my restriction and when someone is doing that it can lead to them consuming less calories than they otherwise would but even if a doesn't there is the restriction that is going on and i do want to say as part of this episode i will make reference to other episodes or blog posts that i've done connected to these topics i've done a whole podcast all about restriction so i'll put that in the show notes and it will go into this in a lot more detail the other thing with restriction there are three types of restriction so there there is physical restriction so that is i'm not eating that particular food so if i think rice is bad for example i'm not eating rice there is the physical restriction of of rice then there is the impending physical restriction and so that is the man i i've been really bad today quote unquote tomorrow i'm going to start my new diet or uh from monday i'm not eating these things anymore and so it's this restriction that is just around the corner so i'm telling myself that this thing is going to be off limits in the future and then the final piece is the mental restriction piece and this can be that i'm actually eating something and at the same time i'm telling myself that i shouldn't be eating this thing and so i'm having a cupcake or i'm having a piece of cake and while i'm eating it there's this telling to myself of i shouldn't be doing this i'm not meant to be eating this kind of food this is the wrong kind of food to be to be eating and all of these types of restrictions are restriction i think there can be this misunderstanding of yeah but i ate that food so i'm not restricting if you're eating a food while at the same time telling yourself you shouldn't be eating this thing or tomorrow we are not eating this thing this is not something that we should be eating this is sending signals to your body to your brain to your nervous system that what i'm doing is not right like this is a threat and we need to to stop doing this thing and so if any of those kinds of restrictions are going on this is then what can then continue to to lead into other parts of this cycle or to keep people stuck in the the restriction phase of of the eating disorder and in terms of other episodes i've done i've looked at how restriction affects the brain so if you haven't listened to that one i highly recommend listening to it because i think it's really important to to see some research around the different stages as part of recovery and how that then affects someone's brain and their perception and i think it's an important thing to understand and then the next piece is i've done an article looking at weight gain even while restricting because i think this is another thing where people say i can't possibly be restricting because my weight is steady or actually my weight has started to go up and the reality is and i've seen this happen for many people especially as an eating disorder has gone on for a longer amount of time someone could not change anything they can be eating in the exact same way they can be doing the same amount of compulsive movement etc and yet suddenly they start to gain weight and this can be really terrifying for people because this is like in essence someone's absolute worst nightmare of now my body is malfunctioning now my body is starting to gain weight and it shouldn't be doing this and i have no idea why it's it's doing this and the reality is as you keep restricting going on longer and longer your body's way of being able to deal with that is it has to turn things down and turn things off to be able to function it's having to run everything on less and less resources and at some point it can get to a place where nothing has changed in terms of what's coming in but from the body's perspective it's got into more and more of a depleted state so now it's just turning things down even more so even though nothing has fundamentally changed with the amount coming in your body's now just using less of that and is starting to store more of it because it feels totally unsafe that this thing is just unsustainable we can't go on like this and this is why someone can have a situation where nothing has actually changed coming in but actually the body is now starting to to gain weight and so if you want to want to understand more about that there is an article that i've written connected to it and will often happen with restriction and it doesn't occur all the time but it happens for i would say the vast majority of of people is that at some point the body fights back the body's wisdom is we can't keep doing this we can't keep surviving on these small rations we can't keep surviving on just this small eating window it's just not enough and so what the body does is it turns on various hormones that lead to different cravings different um pulls toward bringing in more food like food even though the body or your mind maybe thinking of this thing as this really terrible threat we shouldn't be eating food food's bad food leads to weight gain food is just calories etc etc food is essential it's it's really important for us to be able to to live it's important for us to be able to function it's important for the body to then be able to run all of the the various systems and organs and everything within the body and so when it's not getting what it needs it doesn't understand why this is going on like it doesn't understand i'm trying to do this as my way of coping or i'm trying to do this because it's important for me to to lose weight to fit into a particular dress or to be bikini ready or whatever someone's drive for this thing is the body doesn't understand that all it knows is we're not getting the resources that we need we need to change some things within someone's physiology to help them start to go back to normal so i think it's important for us to go out and get this food and so what this then can lead to is a binge and i think there can be lots of different definitions around this and and i've done a whole podcast looking at binge eating and binge eating disorder and so i will make reference to them in in in the show notes and you can go and check them out but if i'm using a fairly lay definition of a binge it is an episode of uncontrolled eating in which a person rapidly consumes an excess quantity of food and what i think is useful to start to explore here is the idea of excessive and what constitutes excessive because really this is often fairly arbitrary and is often defined by the individual and so i've had clients where they tell me that they had a binge and then when we talk about what they they had as part of that binge it's the equivalent of a small snack and to them it feels like a binge because i'm not a binge eater and i'm not a binge eater and i'm not a binge eater i'm not even used to having something to eat at that point of the day or that's way bigger than what i would normally eat at a meal and so from a relative term it feels like a much bigger eating experience and so for them it is quote unquote a binge. But for lots of other people like myself or an outsider, actually that doesn't constitute quote unquote a binge. And in essence, it doesn't matter what other people think. If this person is defining this as a binge, that's what we're going to work with, at least from my perspective. I'm going to then have a conversation around that. But I think what is useful to recognize is that we have our own definition of what constitutes excessive. And so for people where they're describing a binge, it's that there is some threshold that is being crossed. And then there is some story of why this means this thing is a binge. And so it could be that I felt different in terms of my speed of eating. There could be different symptoms connected. Okay, I noticed my heart was beating more. But this experience gets categorized. As someone having a binge. And what's interesting here is I often think about myself in that I don't suffer with binge eating disorder. I have a very healthy relationship with food, thankfully. And there are lots of things that I will do that I know that if a client was doing this, that it could very easily be considered a binge. So for example, I can finish my dinner and then I may walk over to the pan because there's still a binge. And then I can finish my dinner and then I may walk over to some of the risotto leftover, for example. And I'm just eating out of that pan with a ladle. And I could be eating it kind of messily. It's probably not what I want to record a video of and put up on Instagram. But I'm just doing that in that moment. And for me, I think nothing of it. I think, okay, maybe I should have put it on a plate. And this isn't the greatest viewing experience if someone is watching me. But in the whole scheme of things, it's not a big deal. It means absolutely nothing. It's I'm just eating some extra food over this pan. versus someone else could be having a very similar experience. But there's all this story or meaning that is is attributed to this experience. And I'm noticing that I've finished my meal, but yet I'm still hungry. And I'm now having this experience where I'm standing up, I'm eating and I'm not really present. And all of these things then get added, added on. Or I was recently on holiday. And as part of that, I was eating differently. Because when you're away, differently. And so I remember having a chocolate donut as part of breakfast, I remember going out to a cafe and had a couple of croissants for breakfast, I had cheese and ham croissant. And then I had an almond croissant as part of breakfast. And again, I didn't think anything of this, it was just a very normal, natural experience. And I know for someone else that could have been thought about as a binge because I don't normally have breakfast. And now I've I've had this thing or my normal breakfast is having this other thing. Why? And that thing is much more calorie dense than my when my normal breakfast. And so now this is a binge. And I'm saying all this because I think it's useful to reflect on what are the stories that are that are coming up connected to this to this thing, because I do think so much of it is around some arbitrary threshold being crossed. And then the then the the story that we're, we're making a to describe why this thing is happening, or why the thing is important, or what is the meaning behind this thing. I also think just with the word excessive, I would suggest thinking about this in more than just this moment. So for example, someone could actually sit down and eat a large amount of food that lots of people would consider excessive. And for that, single meal, it is a large amount of food. And yet, if I think about, okay, well, what's happened over the last week, what's happened over the last month, what's happened over the last multiple years, when we think about it in that way, actually, there's been so much restriction that has occurred over that time. So this bigger eating that is going on, yes, someone may feel that it is a binge. But in comparison to what is actually needed as part of the body, this is your body behaving and responding in a totally normal way. And where there is food available saying, great, we really need to get some of that food in. And so I think when we talk about binges, I think another thing I would say just connected to this is binge has such a negative connotation for so many people. And I will often have conversations with with clients about okay, what does that word mean to you? What is the does it have a negative valence? Is it a majority word in your mind? And if the answer to that question is yes, is there another word that we can come up with that describes what's happened here, but it doesn't have those negative connotations connected to it? If we describe this is, yeah, I had a bigger meal, or I had that there was more feast eating that went on there. Like, can we find a descriptor that describes what happened, but it doesn't have this negative connotation? And the real reason why this is important, again, comes back to this idea of, we're telling a story connected to this, this thing. So we've gone over some particular threshold, or we've had this experience that we're now creating meaning with. And so using a different word from binge can help relate to that differently. And why this is important is because typically the knee jerk reaction, when this happens, is either to, one, run back to the restriction piece, or two, do some kind of purge compensation. And so if someone's able to recognize, I had a moment where I've eaten more food here, and I now don't need to be going back to restriction, and I now don't need to be compensating anyway, I think that's a really helpful thing to start to some of this, to break this cycle. And again, I've done a whole article looking at what to do after binges that goes through lots and lots of different ideas connected to this. So if this is something that is happening in your life, then I would highly recommend checking out that article. So then the final piece is the purge. And I would say the final piece depends on what someone's cycle is. So it could be restrict, then binge, and then we're straight back to restriction. So then in that scenario, the binge was the final piece, and we just keep going back between those two things. And then the final piece is the purge. And I would say the final piece depends on what or the purge can then be someone's final piece of this. And I think what often happens, again, because of stereotypes, when people hear the word purge, they think of vomiting, or they think of laxatives. And so I would want to suggest that maybe a better word for this would just be compensating. Because even with people who are diagnosed with bulimia, the purging piece doesn't have to be vomiting or laxatives. The purging piece can be exercise, or it can be other ways of compensating for this. And I would say that for a lot of people, this is how they purge. So I had this eating that occurred, and now I need to increase my exercise. And I would say that this also can then lead to other things that feel like they're more aligned with restriction, but may just happen after someone a binge. And so it's not their everyday go-to form of restriction, but this is one of the things that they do after that as their way of compensating. So for example, chewing and spitting can be something that happens. And I will also want to add that this is something that happens a lot more frequently than people imagine. Every time that I have a consult with someone where I'm having either the initial consult with them, or when we're starting to work together, and they mention it, I'm like, oh, I'm going to do this. And I'm like, oh, I'm going to do this. The question about the chewing and spitting piece is they feel like they are the only person who ever does this. And I know that that is somewhat common with many of the aspects connected to eating disorders. But I feel like this one in particular, it just, for whatever reason, hasn't got the airtime. It's not listed on lots of things in terms of particular symptoms or behaviors or whatever. But this is something that I do see fairly commonly, where people are using this as a way of restricting. So the chewing and spitting, that can be going on all the time, or it can happen after a binge. There can be high water consumption. So, okay, I'm not eating for the rest of the day. I'm just going to have lots of water. And these notions of like, oh, if I use the water, that's a way of cleansing or detoxifying or all this sort of orthorexic language around it, when really it's just someone's attempt to, how do I start eating? How do I stop eating? How do I do restriction? There could be sort of not eating for a specified time. And so normally someone's eating between these hours of the day, or they're pretty rigid in terms of their meals and meal timings and all that. But after this binge episode, that's when, okay, for the rest of the day, I'm not eating, or I'm not eating until this thing happens. And so this then becomes, again, it's a form of restriction, but often it can be specific to this is what I do after a binge. Really, then this cycle just continues. After we've done our day of drinking water as our way of trying to make amends for what just happened, we then just go right back into our usual default of restriction. We do that until at some point it becomes too much and we end up having a binge. Then once that's over, we go back into this purge cycle. It just becomes this real loop. As I said at the beginning, depending on the size of someone's body will depend on one, the diagnosis that they get, but two, what gets suggested as how to deal with this thing. If someone is in a smaller body, we are more likely to suggest, okay, this is about restriction. We need to stop doing the restriction and the restriction is part of what's leading to the binges. If we can start to deal with the restriction and get out of it, then we're that depleted state, then that's going to help the binges. If someone is not in that body and if they're in a quote-unquote normal body or if they're in a larger body, what is often the advice is we need to figure out how to stop you having these binges. Not where, okay, let's address the restriction that's going on, but more about how do we get more willpower? How do we do things to trick the mind so that we're not in that state? That's going to help the binges. When those cravings come up where we're doing something else and we're focusing somewhere else and where we just basically ignore that restriction is going on and we put the problem solely on the shoulders of this is a binge problem. I really want to just say that irrespective of the size of body that someone is living in, that is not the right approach. Restriction is at the heart of what is going on, whether that is actual physical restriction, whether that's impending physical restriction, whether that's mental restriction or all of the above. And so it's important to understand this because otherwise it can feel like it's just a binge purge cycle. And actually it's the restrict binge purge cycle. And so I really want to get that message across because I just don't see that being what is told to many people or, okay, we started focusing a little bit on the restriction in the beginning, but now you're at a quote unquote healthy weight. So that's not the problem anymore. And maybe we should be cutting back on those snacks and no, you don't need the full fat version anymore. And all of this kind of advice that really keeps someone stuck in this quasi state of recovery or not even quasi recovery. It's this version of you're passing for not having an eating disorder. And that's just not what I want for people. Like, as I said at the top, I work with people to help them fully recover from an eating disorder, not to be able to, to pass as not having an eating disorder. Cause most people aren't going to notice that this is what's going on. Like I want to genuinely improve the quality of your life by I'm no longer engaging in these, in these behaviors. And I truly believe that everyone can get to that, that place. And for, for, for many people, the way to get there is first having the awareness around how much of the restriction piece is doing the heavy lifting in creating so much of this. So what is, would also just say, just as a final piece connected, this is this cycle can be longer or shorter depending on the individual. Um, it can change with an individual depending on how depleted they get, depending on what level of restrictions going on. And so someone could be going through this cycle on a daily basis where again, restricting really heavily in the morning, I'm binging in the evening time and purging in the evening time and then just kind of rinse repeat. And this is happening every, every single day, or it could be, okay. It's normally by the end of the week. Like I've been restricting so much that, and again, someone might not use this language because they don't even recognize that this is what going on. They'll say I'm so good for so much of the week and then come the weekend or this thing happens on Friday. And then just, it just feels like everything falls apart. And that's when I get into that, that place. And so it could be much more this, weekly cycle where weekdays are quote unquote good and weekends are quote unquote, not so good. It could be a much longer cycle than, than just that. And so it's over a couple of weeks, things start to build up and then it starts to happen. And for some people that can be this pattern where, okay, I restricted for quite a while and there was no problem. And then the binger started to happen. And I had this, this number of days or this couple of weeks where I was, doing the binging and been trudging really hard. And then I wrestled the reins back and I was able to get back to the, just the restriction piece. And then I was able to keep that up for, for a period. And then it kind of just goes again in, in, in that pattern. And it's not just the food piece that is driving this as well. Like obviously you getting into a more depleted state and the restriction going on is a really big part of it, but it also then connects to challenges within, within life. Like as things become more difficult, whether that be because, you know, I stepped on the scale and I noticed my, my way to change, or I've got this dinner coming up and I don't know how to, to handle it. Or it could be, I had a review at work and, and they weren't particularly happy with my performance. And I don't know how to handle that. Like there can be these other life things that happen that then have an impact on when the restriction then increases. Because that's my way of coping. Or when the binge, uh, occurs because now it's just become all too much. And this is just the result of, of what happens when I'm in this restricted state and, and these things occur. And so I, I think so much of this, I said, it's sort of the awareness of the restriction piece, but also the awareness of, of the pattern and how this, this plays out. Um, because it is so, so cyclical and, uh, I can have a conversation with someone, um, within a, in a fairly short amount of time and be able to start to notice all of those patterns. And even when I'm working with someone, when someone is able to tell me, okay, this thing happened, I'm able to predict pretty accurately. Okay. What could be the, the outcome of that based on where someone's at in their recovery, the state that they're in, et cetera, because it just follows this, this real obvious pattern. So that is it for this week's episode. I hope that this has been useful to you to, to really understand this more and why there is this pattern. As I've said a number of times, like I do really believe that everyone can fully recover. And so if this is a pattern that you find yourself in and you don't want to be in this pattern anymore, you, you want to break out of this, uh, I would love to help you to, to do so. And so you can send an email to info at seven hyphen health.com. And if you just put coaching in the subject, line, then I can send over the details. Uh, I will be back next week with another new show, uh, until then take care of yourself and I will see you soon.