Reversal of Damage from Restrictive Eating Disorders

Doubts are more cruel than the worst of truths.–– Molière (Jean-Baptiste Poquelin)

Yes, this was the topic chosen by 112 participants in the vote on what the next blog post should be. Next in line was eating to minimum guidelines despite being a particular body mass index (at 97 votes). 

A distant third at 23 votes was to look at obesity not being a disease, and fourth, with 19 votes, was whether online community involvement is helpful or harmful to a recovery effort.

Before I get to the winning topic, I will say that had the second option actually been the winner, it would have resulted in one of my shortest posts.

In fact, here is the post on that topic:

Eating to the minimum guidelines is not dependent on body mass index. Because the MinnieMaud Guidelines specifically reflect what real, non-eating disordered people of average sizes eat on average every day to maintain weight and health, then eating less than that is likely going to create an energy deficit whether you are BMI 21, 31, 41 or more.

Of course, I probably would have padded it out a bit. I would have pointed out that if you are BMI 41, then the minimum guidelines are likely too low for you because they are based on the peak of the bell curve of height and weight, and that group corresponds to what is actually listed as an average intake. If you are heavier-than-average then your energy requirements are commensurately higher.

I can hear the sharp intake of breath on that one. Thing is, if you don’t meet your total energy expenditure requirements with sufficient energy intake, then the deficit will push your body to suppress its metabolism. And that is likely what has driven everything out of whack in the first place.

And I would’ve also pointed out that the phases of recovery are common to everyone undergoing the process, no matter the starting body mass index as well.

In any case, a few paragraphs and it would have been a done deal. Instead, the community has spoken and so we’ll look at reversing the damage…

Teeth and Humility

I love my dentist. I say this with great depth of feeling. He is brilliant. Yes, he is a world class, internationally renowned dentist who teaches at a prestigious college in the UK while maintaining three practices across the globe. But this is not why I love him.

I love him because he is so immersed in his craft. He is excited about teeth and their relationship to our whole body.

A few weeks back I had an appointment because one tooth, with an aging crown, was getting progressively more sensitive to cold. I assumed a crack in the crown or leakage and that it was time for a replacement.

Now I am not an ideal dental patient. It is extremely difficult to anaesthetize the area fully; I have exceedingly sensitive nerves; I whisk away the anesthetic so quickly that I am usually regaining sensation while the area is wide open; and a childhood of average dentists who assured me I was frozen when I could feel it all, makes me somewhat anxious at each visit.

You know how I talk about the bell curve of skill that renders a credential largely irrelevant in Patient Advocacy Explained? Well my teeth require an exceptional practitioner. Frankly I wouldn’t care if my current dentist were actually a very expensive barber. The fact that he hears me when I say I am not fully frozen is what I need. 

Anyway, back to my recent visit. He confirms that the crown is fully intact, despite its age. He suspects that it might be due to clenching (I am a dutiful night guard wearer). He pours over the x-ray and considers that the bite might be a problem. He then applies the carbon paper getting me to bite and grind on said paper so he can determine the bite. He sands away a fractional amount right where I have been experiencing a lot of sensitivity and I instantly feel an improvement. I express surprise at how much better it feels.

We then get onto the philosophical topic of the wonders of the body. He relays he had a patient who found his knee pain disappeared with a similar adjustment to the bite. He said, “It keeps me humble.”

We agreed that this humility is what keeps it all exciting.

I love my dentist.

And still you are dutifully waiting for me to provide a detailed deconstruction of the reversal of damage when you complete a recovery process from a restrictive eating disorder. You want statistics, data and clinical trial results with which to compare chances.

You want proof and you want your fears allayed: fear that you have done too much damage; fear that it is irreversible; and fear that, really, you are too far-gone and it is not worth it to even attempt recovery.

What if I told you that humility will be your closest ally when it comes to reversing the damage in your body? Withhold your judgment on that one for now and see if the subsequent sprawling text doesn’t lead you to see some validity in that statement…

Respect The Limits of Miracles 

Miracles are not likely to happen if we sabotage the effort. Neither should we assume that miracles are automatic when we do everything right.

These facts are precisely why I brought up the whole thing about my teeth. Thing is, we cannot be sure that adjusting my bite will save the nerve or whether I am still inevitably on track for a root canal at some point in the future.

We can do everything right and still it might not be enough. However, we can be sure that if we don’t try, then it is definitely not enough.

Having worked with hundreds of unique individuals each with their unique restrictive eating disorder condition, there are themes that still come up more often than not. One particularly dominant theme, and maybe this is simply a theme found rife in all human beings, is wanting a “for sure”.

To be honest, this blog post has not developed as I anticipated and I doubt it is how any of you likely interpreted the topic in the first place either. No matter how much scientific data I dredge up and make presentable in some fashion, there will be an exception. There are always exceptions.

Are you going to get well? No idea. Is it too late for you to restore your health and reverse all the damage? Um, that depends.

But will the absence of any absolute assurance be reason enough for you to stay where you are?

Fear is the cheapest room in the house.

I’d like to see you in better living conditions

Hafiz, Persian mystic and poet

I had contemplated a body-part-by-body-part analysis of the impacts of starvation and the data, such as they are, indicating the reversal of those impacts through reaching a full remission from a restrictive eating disorder. However, in the end, the evidence has directed me elsewhere. Before I drag you along for the ride, I will at least touch on the constituent elements of physical damage and reversal.  

The Damage

Physiological effects of chronic energy deficiency in the body are as follows: anemia, hypoproliferative bone marrow (failure), leukopenia (low white blood cell counts), decreased thiiodothyronine, thyroxine and luteinizing hormone levels (polyendocrine deficiency syndrome), abnormal gastrointestinal motility, atrophy and possible ulceration, constipation/diarrhea, severe liver dysfunction, myofibrillar destruction (damage to heart muscle) and amenorrhea. Also usually present are: low basal metabolic rate, cold intolerance, abnormal calcium metabolism, osteoporosis, serum protein abnormalities (leading to chronic or acute kidney disease), electroencephalographic abnormalities (impaired brain function) and altered skin texture and pigmentation.

Physiological effects of chronic bouts of starvation/reactive eating cycles are as follows: all of the previous list for the most part, although anemia is less likely to be present, and also hypertension, elevated low-density lipoproteins (bad cholesterol levels), artherosclerosis (progressive deposition of fatty deposits on arterial walls, leading to heart disease) and excessive subcutaneous abdominal fat due to long term elevated serum glucocorticoid levels.

The above lists are by no means comprehensive, but rather indicative of the scope of restricting energy intake such that the body must make up the deficit with catabolism (destruction of its own cells to release energy).

The Reversal

There are two fairly dependable outcomes when a patient reaches full remission from a restrictive eating disorder: complete reversal of the damage in question or cessation of further degradation and progressive damage. Translated it means you will get either a “good as new” or a “won’t get worse” rating.

Can someone die from the recovery process itself? Yes.

Obviously I don’t constantly repeat the necessity of involving medical practitioners before you undertake the recovery process because I just like the way those words look in print! Death by recovery is an exceedingly rare outcome, but we all know that “rarely happens” does not mean “never happens”.

If you have become progressively more fragile as a result of 20+ years of restriction and are already dealing with the signs of organ failure, then the instability necessary throughout the recovery process merits even more intensive medical supervision.

Decades of physical destruction associated with punishing energy deficits may be more likely to net out at a “won’t get worse” rating when the patient reaches full remission. Even then, there are only two areas where long-term restrictors may face a “won’t get worse” outcome: kidney damage and bone mineral density loss.

Long-term restriction in this discussion refers to patients in their late 40s and older who have experienced more than 25 years’ worth of restricting food intake, cycles of restriction and reactive eating, cycles of restriction/reactive eating and purging, and/or excessive expenditure of energy (exercise) relative to food intake, and have also developed medical symptoms and complications due to those restrictive behaviors.

Problematically there are no solid clinical data on patients in their late 40s and beyond who have spent the bulk of their adult lives with either sub-clinical and/or clinical levels of an eating disorder, wherein they subsequently achieve a robust remission. Case studies are all we have to go on.

And case studies only provide suggestion for further study and not any kind of relevant statistical information about what another patient might be able to expect in her own recovery process and remission.

As best as the research community can identify these things at present, bone mineral density loss is readily reversed if the patient is premenopausal at the time of remission and has about seven years or so ahead of her before entering menopause. Keep in mind that many ED patients are wrongly identified as being menopausal or postmenopausal when in fact they have functional hypothalamic amenorrhea (an absent menstrual cycle due to restriction of energy intake).

For men who reach and maintain remission prior to the age of 50, they can expect to reverse bone mineral density loss fully as well. Should a woman be menopausal or postmenopausal at the time she reaches remission from an eating disorder, she will halt the progression of the bone mineral density loss (a “won’t get worse” rating). Should a man enter remission after age 50, he too can expect a “won’t get worse” rating for his bone mineral density level.

Kidneys are fragile, complex and critical organs. It is possible to damage kidneys sufficiently that they cannot come back. But when a patient is actively restricting, both hypothalamic dysfunction and secondary renal (kidney) damage (i.e. damage attributable to restriction of energy intake) can generate results that would indicate a progression towards kidney failure. Yet the anticipated organ failure is not realized when the patient reaches full remission. In other words, you may be told that you have progressive renal disease that will result in kidney failure, but the complete reversal of hypothalamic dysfunction, when you reach remission, may leave you with kidneys that are inherently not in any danger of failing at all.

As an aside, a somewhat ominous controlled study suggests that the use of antidepressants (increasingly prescribed for those with restrictive eating disorders in the absence of solid clinical data to support their use) exacerbate abnormal osmoregulation (kidney function) [F Evrard et al., 2004].

For the vast majority of patients who undergo a recovery process and achieve full remission, complete reversal of damage throughout the body is the norm. And even those few patients in remission with “won’t get worse” kidneys and bone mineral density, they have still realized the reversal of all other forms of damage throughout their bodies as well.

But between the horror of all the damage and ill health and the joy of all the reversal of that damage and retrieval of good health, there lies the process of healing itself.

Between Points A and B

“The art of medicine consists of keeping the patient in a good mood while nature does the healing.” .–– Voltaire

Voltaire’s observation probably has more truth to it than our current medical industrial complex would be willing to admit. Nonetheless, we have very skewed concepts of what the healing process entails.

Just fire up a new window in your web browser for a moment and type in the word “healing” under Google Images…see what I mean? It’s all colors, light, hands, butterflies, beatific expressions…

The reality of healing any living system is pain, swelling, itching, aches, exhaustion and chaos.

All this focus on whether the end state will be worth it and whether the reversal of damage will be total, and the real challenge actually lies within the healing process itself.

“If there is one thing I'd learned about hospitals, it's that they aren't interested in healing you. They are interested in stabilizing you, and then everyone is supposed to move on. They go to stabilize some more people, and you go off to do whatever you do. Healing, if it happens at all, is done on your own, long after the hospital has submitted your final insurance paperwork.” -- Eric Nuzum

If you are a reader of the forums, then you are likely well aware of the fact that many people struggle greatly through the process of healing. Some have even had full blown medical crises: pancreatitis, diabetic attacks, worsening of pre-existing conditions (eczema, allergic reaction, digestive distress, inflammatory responses) and one or two have faced refeeding syndrome as well.

We tend to acclimatize to progressive worsening of active conditions, but find it shocking when crises occur when we are actively pursuing healing.

Many speak of their frustration at symptoms that plague them throughout recovery that were completely absent when they were actively restricting energy intake.

We expect the healing process to be full of color, light, hands, rainbows and unicorns. I addressed some of these misconceptions in my post The Power of Naming and Eating Disorders. You enter a maze when you begin the process of recovery and you are not climbing a mountain where you will feel, with each step, a deep and abiding sense of progress and the inevitability of reaching your ultimate goal.

“I couldn't help but be reminded of the maze in Harry Potter and the Goblet of Fire. As Dumbledore says in the film version: 'In the maze you'll find no dragons or creatures of the deep. Instead you'll face something even more challenging. You see, people change in the maze.' 

'How can you succeed? It is not measured in those terms.' I think this is one of the most important lessons recovery has taught me, and perhaps one of the hardest to accept. People do change in this maze - but there's no enchanted Goblet to whisk us away - only, perhaps, the gradual realisation that we're no longer lost.

The above quote is from Gloria, a member of this site, and author of our next upcoming guest post here on the site! It’s another must read by the way.

The thing you face as you contemplate your future existence in remission is not whether the damage is reversible or not (it largely is in any case), but whether you can accommodate the fact that healing is often a process filled with chaos, crises and violence.

And that is where I have been led on this topic: the processes that have maintained your life thus far must be destroyed to allow for new, and more resilient, processes to take their place to support remission. What has kept you together thus far as you sink slowly into the oblivion of an eating disorder will not take you forward to remission.

The recovery process is not without risk. Healing is a risky proposition. We have long ago lost contact with an ability to differentiate between symptoms that denote devolution of life systems and symptoms that denote rebuilding of life systems.

We have all convinced ourselves, especially in medicine, that stability is an ideal state. But stability and healing are often mutually exclusive states.

Let’s now look at this concept of stability vs. healing in more detail…

Chemical Elements

The chemical elements required for life are: carbon, hydrogen, nitrogen, oxygen, sulfur and phosphorus (CHNOPS). Much of our food is a variety of combined carbon, hydrogen and oxygen molecules.

Amino acids, the building blocks of protein, have an amino group (nitrogen and hydrogen) and an organic acid group (COOH). Proteins also have some sulfur because both amino acids cysteine and methionine contain sulfur.

Deoxyribonucleic acid (DNA), ribonucleic acid (RNA), adenosine triphosphate (ATP, responsible for providing cells with energy), and the phospholipid layer that protects your cells, all have phosphorus as a critical component [NOVA program: Ingredients for Lifefor more information on CHNOPS].

The study of food chemistry supposedly dates back to Carl Wilhelm Scheele in 1785 when he isolated malic acid from apples. A contemporary of Scheele, Antoine-Laurent Lavoisier, was considered the founder of the “Chemical Revolution”. Lavoisier established the law of conservation of mass and determined that combustion and respiration are caused by chemical reactions with what he named “oxygen” [Chemical Heritage Foundation].

Food Chemistry: A Mixed Blessing

The chemists of the 18th and 19th centuries wanted an understanding of the chemical nature of food because they believed that such understanding would create dietary standards in the world that would ensure health and prosperity.

On the plus side, chemists of the day played a huge role in exposing the malpractices of food suppliers. From the outset, these chemists were employed by the British government to ensure the revenue from excise duties on alcohol and tea was protected [TP Coultate, Food: the Chemistry of its Components, The Royal Society of Chemistry, 2009, Cambridge, UK, pp 1-2].

By the time the Second World War ended, massive corporations that had huge rosters of chemists supporting weapons manufacture of all kinds needed new markets. Some became pharmaceutical companies, others moved into agribusiness, and still others became food or consumer product manufacturers.

I.G. Farben, the German industrial conglomerate, was dismantled after WWII but you will recognize the surviving sub-companies: Bayer, BASF, Agfa, Rhône-Poulenc and Aventis. And of course we all likely know Dow Chemical, Dupont and Monsanto. Before World War II, all crops were organic.

More recently there has been a much-needed shift from the chemical components of food towards the study of the inter-related behaviors of those chemicals in food and in the digestion of food to generate energy. New integrated sciences developed to try to encompass the complexity of this process include nutritional biochemistry and food biophysics.

Sadly, much of our public understanding of nutrition still rests very much in the component realm and the reason I am burbling on at all about this topic is that it plays a big part in much of the damage that occurs for those with restrictive eating disorders.

Namely, patients with active eating disorders often try to backfill the huge energy deficits with constituent parts and our bodies are not optimized to respond to the intake of parts (chemical sub-components) when compared to the whole (food).

Mineral Metabolism

Beyond the chemical elements, our entire mineral metabolism maintains our health on a cellular level.

Please meet the electrolytes: sodium, potassium, calcium, magnesium, chloride, hydrogen phosphate and hydrogen carbonate.

The minerals within these electrolytic solutions are not electrolytes in their mineral state, but when dissolved in water they become electrically charged and that charge allows things to flow through the cell wall barrier.

The entire system of moving things back and forth across the cell wall is always in a state of flux but things go horribly wrong pretty fast when overall input and output do not match.

The kidneys are the dominant organs maintaining this overall electrolytic balance, but the digestive, respiratory and cardiovascular systems are all critically involved as well.

An average, unrestricted diet allows us to take in all the minerals and fluid necessary to create electrolytes to keep everything flowing in its usual homeodynamic state.

Dehydration is often synonymous with elevated sodium in the blood: hypernatremia. Usually, any slight build-up in sodium in the cells triggers thirst— a way for the body to balance the sodium to water levels. Severe hypernatremia occurs when someone is unable to obtain water to correct the imbalance.

The initial symptoms of dehydration include sluggishness, irritability, twitchiness (neuromuscular excitability) and swelling. Unchecked, it will lead to seizures and coma.

On occasion the depletion of water in the body will outstrip the ability of someone to replenish the water. Extreme sweating and stomach flu, with vomiting and diarrhea, are two examples where intravenous administration of free water may be required to restore electrolyte balance.

Those with restrictive eating disorders often generate hypernatremia through purging, diuretic and laxative abuse (mimicking a stomach flu in effect).

The opposite of hypernatremia is, of course, hyponatremia. Those with restrictive eating disorders are just as likely to suffer hypernatremia and hyponatremia. Why? In an effort to try to stave off severe dehydration, patients will drink a lot of water. They quickly find that “water loading” is also a way to take the edge off of hunger.

Excessive water intake can also lower optimal electrolyte levels and that, too, is life threatening. And of course, insufficient intake of food rich in all these minerals will create hyponatremia as well. Symptoms of hyponatremia include nausea, vomiting, headache, confusion and, as with hypernatremia, eventually seizures and coma.

Many with intractable eating disorders will attempt to manage mineral metabolism in the absence of eating enough food. Sadly, the body is the best arbiter of mineral metabolism, and often patients attempting to keep mineral and water levels at an optimal state, in the absence of real food, are constantly overshooting in one direction or another.

The damage associated with mineral metabolism imbalances primarily impacts the kidneys.

Trace Minerals

“Trace minerals do not exist by themselves but in relationship to one another. Too much of one trace element can lead to imbalances in others...Most trace elements need to be in ionic form to be well absorbed in the intestine.”

[AG Schauss, Minerals, Trace Elements and Human Health, BioSocial Publications, Tacoma, WA, 1995].

The devil is in the details, and Alexander Schauss, quoted above, has spent a good amount of time investigating the impacts of trace mineral imbalances and behavioral problems.

There are nine accepted trace minerals relevant to human health: iron (Fe), zinc (Zn), copper (Cu), iodine (I), selenium (Se), manganese (Mn), fluorine (F), chromium (Cr) and molybdenum (Mo) [Learning Seed, 2009].

Of course, there are likely hundreds of trace minerals and their isotopes that are equally critical to human health (found in our omnivore diets) but as yet to be identified when it comes to particular biological function and value.

It turns out that dirt is key to our health and survival. Soil is critical in providing bioavailable trace minerals in both the plants and animals that we eat. And, unfortunately, the shift to chemical-based applications for both the growing of plants and animals since the Second World War (see above) has actually depleted much of these trace elements in soil and hence their depletion in our food sources as well.

With all the usual caveats that the following book parrots the dogma associated with ‘obesity’, Farmacology, by Dr. Daphne Miller, provides a very readable and pleasant romp through the inter-relationships between human health and soil.

But for the purpose of this post and more scientifically stated:

The transfer of trace elements within the soil–plant chain is a part of the biochemical cycling of chemical elements—it is an element flow from nonliving to the living compartments of the biosphere. Several factors control the processes of mobility and availability of elements; in general, they are of geochemical, climatic, biological, as well as of anthropogenic origin.” [A. Kabata-Pendias, 2004]

What does any of this have to do with damage from restrictive eating or the potential for the reversal of that damage? Everything.

As with electrolytes, trace minerals are not easy to manipulate for optimal health within a lone individual outside of the soil-to-food-to-energy cycles that connect that individual to the entire planetary biosphere.

The critical takeaway from this entire discussion on chemical constituents, minerals and health is that it is the inter-relationship of these items, and not their mere presence, that determines health. Sodium levels are only relevant in relation to water levels and in relation to environmental conditions both within and outside the body as a whole.

Biomatrix Systems Theory and Teleonics

Cells, humans and organizations are the result of their processes and not vice versa. This differentiates teleonics from the normal systems theories. In the latter one would define the system by drawing a boundary and identifying the subsystems and evaluating the interactions between them. In teleonics one defines the processes and searches for the subsystems which contribute to them. Boundaries play a lesser role, all process boundaries are extremely permeable.”[G Járos, 1999]

Biomatrix systems theory is the framework by which scientists look to understand a system by studying it as a system, and not by examining it as the sum of its constituent parts. Within the field of biomatrix systems theory, teleonics looks to understand a system through the lens of defining the processes that link subsystems to suprasystems.

“To focus on processes as the major ingredients of life, of course, does not deny the existence of entities. Although, according to Teleonics, I am principally a bundle of processes, I remain an individual, albeit with somewhat indefinable boundaries. For example, the ideas I am putting into my computer at the moment remain very much part of me, even though they are situated outside my skin in a machine which will take them away to distant countries, where they will pass through someone else's machine and eventually someone else's mind. The ideas you are contemplating at the moment, are they yours or mine? Neither. They are part of a process of explaining teleonics, that has flown through my mind and at the present is flowing through your mind and interacting with some of your processes of thinking about systems. My skin and your skin become unimportant as boundaries in this game. We are both part of the same system.”[G Járos, 2006]

Perhaps someday we might have a suite of nutritional science programs in universities that applies teleonics rather than the basic chemical discoveries of the 18th and 19th centuries as a way to unleash a pack of practitioners on the world who finally focus attention on the energetic importance of food to the processes of the body that define health and vitality.

In the meantime, we will continue to flail about with experts who admonish their patients for not applying correct constituent parts in their diets, as if that really will result in health and vitality for the entire human system in question.

The unit of function in teleonics is the teleon: a goal-directed process. A teleon can be morphostatic (meaning the process is responsible for the maintenance of the system) or it can be morphogenetic (responsible for growth or development). Additionally I would argue that a teleon might also be morphoptotic (responsible for destruction or reduction).

And of course, the goal-directed process may not reach its goal—enter the concept of telentropy. All living systems have the potential for telentropy—a level of uncertainty as to whether the identified teleon will achieve its goal or not. Sometimes that uncertainty will result in the complete failure of the system, or it might generate an ultimately more resilient and robust system.

“Teleons are concerned with the processing of matter, energy and information which are inseparably bound together.” [G Járos, 1994]

By restricting the adequate input of energy into your living system, you introduce a massive cascade of telentropy throughout all the goal-directed processes that keep you alive and well.

Interestingly, the telentropy present in the devolution of life systems is often unremarkable and lacks medical crisis whereas the telentropy present during the healing of life systems often involves spectacular medical chaos.

But medical crisis does not necessarily denote the failure of the healing process.

Medical Dilemmas and the Recovery Process

“Wait and see” is not a standard of care within the medical community. For a host of understandable reasons, doctors get in there with stabilizing interventions at the earliest possible opportunity.

First and foremost among the drive to intervene is liability. If a doctor believes she has a life-saving intervention at hand and she knowingly withholds the intervention in the interests of waiting and seeing how the condition will progress, then she is merely a walking lawsuit waiting to happen. And that is not cynical, that is practical—any physician who is not cognizant of that fact will soon be separated from his or her practice altogether.

Secondly, and no less compelling, are the ethical unknowns a physician, and her patient, must face. Imagine you discover a lump and it’s cancerous. But no one has any real way to determine whether the cancer will eventually be the cause of your death or whether you will live a long life with a very slow growing cancer that has no part to play in your eventual natural death from other causes.

The dirty secret of the entire war on cancer is that early detection and intervention does not likely save lives.

You’ve probably heard that the survival rates from cancer that are detected and treated early are better than when such screenings and interventions did not exist. But in actual fact, you are merely looking at the same trajectories at an earlier point in the progression. In other words, if you are destined to have terminal cancer that takes 15 years from its inception until you die, then if I detect that cancer 3 months after its inception instead of 5 years after its inception, the survival rate from detection looks different. In the former, the patient lives 14 years and 9 months; in the latter she lives 10 years. And if you state survivability in those relative terms, then it does indeed look as if a patient lives longer with earlier detection and intervention. In point of fact, the patient lived 15 years in both scenarios.

That is not to say that treatment and intervention for many cancers are not utterly valid and life saving! But we struggle mightily as both health practitioners and patients to back away from the intervention option even when we know that iatrogenic impacts from those interventions can be deadly in and of themselves. Iatrogenic impacts are the negative health outcomes (including death) that are actually caused by medical interventions and not the underlying illness or condition that is being treated.

For more information and research data on the topic of iatrogenesis, just use the word “iatrogenic” as a search word in the search engine of your choice, or consider reading: Disease, Diagnosis and Dollars by Robert M. Kaplan.

And although I have not read this one (as yet) I have read another book by this author and I suspect this one will be a very interesting read: Antifragile: Things That Gain From Disorder, by Nicholas Nassim Taleb.

And that is the issue at hand when it comes to the process of recovery: gaining from disorder.

It is important, and yet exceedingly difficult, to work with a physician who is driven to ask: in what direction are the symptoms heading?

The stability that we often see with patients who have endured years of restriction and its commensurate damage is often misidentified as a good thing. It is, instead, an insidiously fragile stability where almost literally a puff of wind will collapse the entire system.

Taleb uses the term “antifragile” to denote that a system gets stronger with shocks, rather than remaining the same despite those shocks. You are building your own antifragile system from the inside out when you enter the recovery process, and it is a roiling, tectonic and intense process.

While medical intervention may be an absolute necessity as you undergo the process of recovery— there is no way that pancreatitis is a wait-and-see crisis, as one example— keep asking questions about the risks of non-intervention and of taking that wait-and-see approach.

Remember my Mount St. Helen’s analogy in Phases of Recovery from a Restrictive Eating Disorder? Well, I have yet another image to add to these mounting analogies: Shiva: Destroyer (or Transformer) of Worlds (the image used at the beginning of this final section).

Technically, the above image is of Shiva Yogi Raj. Shiva takes on many forms, and it is the form of Shiva Nataraj that pertains to the dance of destruction (see below).

Consider that your focus, as you embark on recovery from a restrictive eating disorder, should not be reversal of damage, but rather the Dance of Destruction or the Dance of the Antifragile.

Stay aware of your symptoms and close to your medical team, of course. But you are not looking to them to smear stability all over a process that inherently has nothing to do with light, color, healing hands, unicorns or rainbows.

Oh and let’s throw a proverb into the mix just to bring the point home:

“You have to break a few eggs to make an omelet.”

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