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Hypothalamic Amenorrhea – Anna’s Long Diet Recovery Journey

With this blog post I am going to start a series where I am going to tell you about the long recovery from hypothalamic amenorrhea which is the complicated name for what many women do to themselves with their starvation diets and strenuous training. I’ve previously written about hypothalamic amenorrhea, but you can also listen to my podcast with Dr.Nicola Rinaldi. I am not going to repeat everything here. I am just going to summarize that hypothalamic amenorrhea is the last stage that characterizes our destructive attitude toward our own body. When they reach this stage, many women of reproductive age don’t have monthly cycles. Many of them have not yet realized that this is a serious problem and an alarming scream from the body that something is wrong and we need to change our lifestyle. Many women, obsessed by the idea of looking a certain way and believing that deprivation is the only method to achieve their goal, neglect this symptom and delay their recovery. Others start looking for alternatives for recover and often resort to taking synthetic hormones, but depending on how bad their condition is, sometimes even this fails. I must emphasize you should not ignore doctors and their recommendations. In this series of blog posts I am going to tell you about the long, but successful journey of one of the women with whom I work online. It took her two years, a radical change in her way of eating and training, as well as a lot of work with her mind, to recover. I sincerely believe that every illness is a symptom and that any symptom can become unnecessary when we change our lifestyle. There are situations when you really have to resort to medications, but they would still not work so well, if they are not accompanied by a lifestyle change to speed up the healing process.

I am going to share with you my side of the solution, namely, the lifestyle change, as well as some of the stages.

I met Anna (this is not her real name, but she agreed to let me share her story, because it will certainly help a lot of women) 4 years ago. At that time she was obsessed with the idea of being as lean as possible and was following one of those diets where you restrict almost everything and eat only a couple of things. At the same time she was working out quite strenuously and almost on a daily basis. Just by looking at her you could tell she had a problem. She looked rather skinny and her face was sort of gaunt. She had dark circles under her eyes which were probably the result of a chronic lack of sleep. We met a couple of times and she would tell me about herself and what she was going through. She confided in me that she used to have beautiful, curly hair, but now it was falling out and her nails were brittle. She would tell me in a sad voice that she always used to be very energetic, but lately she had been feeling tired all the time and could not understand why – she was supposed to be eating healthy. Or that was what she thought. She told me she would get up quite early in the morning and that even when she wanted to sleep in, she couldn’t. It was as if something kept waking her up at the same time and she couldn’t go back to sleep, no matter how hard she tried. She had not changed the way she trained, but her legs would not stop hurting. She hadn‘t gotten her period in a while, but was putting off finding out the cause. I looked into her eyes and saw a beautiful creature who was at the end of her tether from chasing an ideal that wasn’t making her better, but had only taken away everything she had had. She told me about her emotional eating episodes. One of those painfully familiar moments, when you’ve been eating “perfectly” for a couple of days according to your own standards (but usually quite unhealthy and insufficient amounts) and then your personality seems to split and it feels like someone else makes you eat enormous amounts of the food you least of all want in your diet. She couldn’t understand what that was happening to her and wanted it to end. She wanted to be free from this vicious circle, but couldn’t do it on her own. It was one of those winter days when the cold still does not pierce, but rather just caresses your body. Still, her hands were ice-cold and her fingers were turning white. I asked her if that was always the case and she told me that for the past couple of years her extremities had always been very cold. She laughed and said it was normal – most women have it, right? We talked for a long time and she kept telling me in detail about the way she felt. She told me there were times when she didn’t feel like doing anything and she wanted so desperately to find out what was happening to her life and how she had suddenly lost her desire to live it.  With a smile that concealed bitterness she told me how she used to wake up with enthusiasm for the new day and now she would be happy to skip it. It was as if she lacked the physical strength to bear the requirements of a day. I can write long about this – about how she looked and what was hidden in her words and her facial expression. But now I am going to tell you what followed.

After that two years went by when I never heard from her. Two years, during which all pieces of the puzzle of everything I had been doing began to fall into place and I understood so much about our behavior, our desires and what they are driven by. I myself tried for a very long time to overcome what I had done to myself with all the restricted diets I had experimented with. Studying myself and trying to heal myself, I learned a lot and realized that what Anna had told me was caused by her unhealthy lifestyle which had masked as a healthy one in her mind. But it was far from it. It’s interesting how people sometimes pass by each other at one stage of their lives and it’s only a hint that they are going to play important parts in each other’s lives in the future. But maybe they are not ready yet – to help each other and be useful to each other.

Two years went by and I received a message where Anna reminded me of our meetings. She told me she hadn’t realized at the time what she was doing to her body, but now did. She confided in me that she really wanted to recover, but before she tried something else, she was prepared to do her utmost to change her lifestyle. For her it started with a change in her beliefs. She needed to change her idea of a healthy lifestyle and her perception of her own body. She told me she couldn’t get herself to do it on her own and needed someone who had been down a similar road and understood how she felt. She wanted to know that every week there would be someone who would hold her responsible for not quitting and going back to her old habits and restrictions. That was how the long road to her recovery started. My role was to help her improve her diet and include many of the foods she was terrified of eating for fear of gaining weight. I had to come up with a structured workout plan for her that would make her feel good from being active, but at the same time would not exhaust her, so her body could recover. And of course, when she doubted she had achieved any progress, I was to remind her what had improved and changed and remind her that you can’t destroy your body for years and expect it to recover in a month.

For me the body is like a flower – when you take care of it, it blossoms. When you don’t water it and don’t take care of it, it starts to fade and if you decide to give it its life back after all, you will definitely have to work hard and be patient. Because the only way to breathe life into something is from the inside.  The body recovers from the inside and sometimes, when some processes begin to balance, it may not become visible straight away. But the body certainly has ways to show us if everything is getting better or nothing is changing.

Stage 1:

At this point Anna had realized that her way of life had led to her condition and that she had to change it radically in order to recover. The hardest battle at this stage was with her mind and her convictions. When you’ve believed in something, it’s very difficult to turn your back on it and go in the opposite direction. It’s very difficult when you have to retrace your steps and face everything you’ve been denying and then invite it into your life, because you know it’s your only chance to recover. In Anna’s life that thing was all the foods she had refused to eat for years. All the foods she believed would make her fat. Inside her the conflict between what she knew she had to do and what she didn’t want others to see was arising. She was terrified of the thought she could gain a couple of kilograms and everyone would ask why she put on weight. She was terrified of the thought that every time she ate something she had not eaten for years others would ask why she had changed her mind. It’s hard to meet your reflections – the people around you who are actually only verbalizing what you think about yourself. But this is one of those times when something inside you prevails. Something inside you knows that whatever you have to go through, you can do it and it’s going to be for the best. A person who hasn’t been through something like that can hardly understand the thoughts and emotions that overpower you. The panic and the desperation and the desire to hide from the world, because it seems as if everyone can see what you feel. An insecurity that doesn’t allow you to assert yourself before the world.

This whole battle with the mind is something a person has to go through on their own. Naturally, it always helps to have people in your life who can help you and tell you the right thing, when you need it. You need books in which to search for yourself and gather yourself among the pages in an attempt to be whole again. But at the end of the day you are the only person who can calm your own mind and show it that something better is coming and there’s no need to panic. At the end of the day only you know what you feel and only you can deal with your emotions. And the more important thing is that at this stage Anna began to understand that food has a key role in the way we feel about ourselves and even the way we think. I have already written so much about how every emotion and thought is first formed on a biochemical level and how what we eat and our way of life in general helps us reprogram our biology.

The most important thing I could give Anna at that stage was to show her that everything she was going through had started with the first starvation diet she had embarked on. All these emotional eating episodes, followed by restrictions, had been a consequence of the diets that were depriving her body of healthy food and nutrients. I helped her go on a journey through her past, so that she could see for herself that this was the case. I saw it and knew it, because I had already been there. But she needed to realize it herself.

When she fully believed what I told her, I could help her change her way of eating. I had gained her trust and I knew that even if her mind sabotaged her that I would tell her to add more fat and carbohydrates and more calories, something in her would make her take my advice.

So we significantly increased her caloric intake and included more animal fats and carbohydrates in the form of rice and potatoes in her diet. The first week went surprisingly well. Anna was enthusiastic and told me her food tasted much better this way and she felt full. She said that was the first week in years when she had not had an emotional eating episode. I loved reading her messages. She told me how every morning she would have some of the pancakes on my blog for breakfast and that it felt good to be able to call your food a pancake or cake and not feel guilty you were eating it. This enthusiasm set my mind at ease, because I knew we were going to need it in order to successfully move on to the next stage.

That was when I had to help her overcome her fear not just of potatoes and rice, but of food in general. I had to show her that it wouldn’t be the end of the world, if she had a chocolate praline or something else she thought of as a forbidden food. And not because I thought that a person must eat pralines at all costs, but because I believe it must be a conscious choice which is not prompted by fear. I wanted to include more foods and combinations in her diet as well, because I had to help her start anew. Go back to where she had been before she embarked on the first restrictive diet and then build a healthy nutrition plan from scratch. I knew what was ahead of her and I knew it was one of the toughest stages. I know how the body responds, when you haven’t given it certain foods in years and you suddenly include them – it responds just like the flower that hasn’t been watered. The soil is dry and when you pour some water on it, it instantly disappears and it looks like the soil can take much more. It takes a lot more water until the soil is thoroughly saturated and regains its balance when it will need a moderate amount once again. The same happens to the body – at first it is insatiable and if you are not mindful of these moments, you can quit – right when you are on your way to taking the biggest step forward. Naturally, I didn’t leave Anna clueless and even before I encouraged her to make changes, I told her what she could expect. This way I knew she wouldn’t take it as something out of the ordinary. Because in most cases this is the main problem – many people think that it only happens to them and don’t know that this is the body’s natural response. They feel like a failure, they start blaming themselves, while in reality, even though it may look like a step backward, it’s a quantum leap forward.

Anna made the changes that were necessary. Her body responded exactly like this – during the first two weeks she ate slightly more than she needed and sometimes she ate more of certain foods. Can you guess which ones? The very foods she had denied herself for a long time. But since I know how important the mind is at this stage and if you present things to it a certain way, it will be easier for it to take them, I told Anna from the very beginning that I wanted her to aim for more calories than she had been consuming so far. I simply knew that her body would want them, so I told her that I was expecting them from her. In reality her body would demand them. :) I warned her that she could expect to gain approximately 2 kilograms during these two weeks.  And although 2 kilograms are a real nightmare for any woman, they are nothing, when it means they will help you recover. I assured her that even if she gained some weight at the beginning, it would be beneficial, because it would reassure her body that it was not restricted and had enough fat to turn on functions it had turned off. I reassured her that when a person has regained their health, they can lose some weight in a healthy and rather easy way later on without putting the body into this state of stress.

She trusted me now, because she probably thought I was a prophet that could always tell what was going to happen over the coming weeks. But the truth is I have been down a similar road and have seen the same in other people that I work with. We all think we are different and what happens to us doesn’t happen to anybody else. But in reality we are all very much alike and go through similar situations. I only wish we would share them more often, so others could find inspiration and hope in our stories.

In my next post I will tell you what happened when these two weeks were over and what body signals we were monitoring to make sure that her body was recovering.

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