There is a set criteria for clinical eating disorder diagnosis and they are considered medical conditions (anorexia nervosa, bulimia nervosa & binge eating disorder). However, eating disorders go beyond those clinical ones.
Disordered eating is defined as a wide range of abnormal eating patterns, including some of the same behavior typical of anorexia and bulimia, although not to the point that all criteria has been met for a clinical eating disorder diagnosis. There is still a significant negative effect on health and the individual should seek professional help. Visit this site for the various definitions and for more info about eating disorders in general.
But this post is not about eating disorders, it is about sharing a story. My story (Warning, it is long and this is actually the condensed version…)
I never had a clinical eating disorder, but my eating patterns in my late teens and early twenties were far from normal, it just took me a while to realize that. Just a few examples: I used to carry a big 2L bottle around to drink from instead of eating when I got hungry. On most occasions, I ate less than 1200 calories a day, sometime eating less than 1000 calories a day. Then I would go for stuff like crappy cookies and processed foods, which I tried to hide. I should also mention that I was training 20-25 hours a week during that time…
I know those particular numbers thanks to my first sport nutrition class during the first year of my undergrad degree. We had to complete a food diary, then analyze and critique it based on our activity level, goals, etc, using scientific evidence. Pretty standard stuff, really. Macronutrients were expressed as a percentage of total daily caloric intake in the scientific literature (it was 2003), which we now know is inaccurate and misleading. I found that out first hand when I got my assignment back, with a note from my lecturer urging me to start taking care of myself and eat better to support both my training and health. Not only did I dismiss the advice, I resented that lecturer for the next year or so. It took a diagnosis with chronic fatigue syndrome for me to understand that I was, in fact, very unhealthy. As a side note, after my CFS diagnosis leading into my final year of university, I asked that same lecture to be the supervisor for my thesis. She is also the reason I went on to study sport nutrition at a post graduate level.
I dismissed the advice because I did not think anything was wrong. Yes, I acknowledged that my caloric intake was too low. But I thought that because my macronutrient percentages were right in line with the scientific recommendations, I was OK. Let me explain in more detail: I was eating ~55% of my calories from carbohydrates, ~25% from fat and ~20% from protein (numbers are approximate, from memory). At first glace, that is not all that bad. At least based on the current knowledge in 2003. But when we break it into grams per kilogram (the way things should be done now), things look very grim. At 165cm and 53kg, with an average of 1100 calories a day, my numbers were really 2.85g/kg of CHO, 1.03g/kg of protein, and at 25% fat intake, my intake was considered low fat. Remember how many hours of training I had every week? Yeah, not good. For so many reasons. I can go into the scientific detail, but lets get on with the story…
The following year, I had to stop and take time off 3 times. The first time was severe iron issues. I was also sick all the time and even cracked a rib from coughing too much. I kept on training, of course. The second time was more iron issues. This time, I got iron injections twice a week for approx 3 weeks. Let me tell you, those injections were horrible and painful. I certainly do not recommend getting them! I also had liver tests done, that came back showing that my liver albumin and protein levels were much lower than normal. Albumin, among other proteins, is made in the liver and the body needs these proteins to fight infections, etc. Low levels can lead to liver damage and disease and I am now horrified at that thought. Liver damage at 22?! Not good! I took about a month off, then started training again, although I just could not get back to a normal training pattern. I felt like something was holding me back. My eating has improved, but not enough. I was still not eating as much as I should have and the quality of my diet was not good enough either. Of course, instead of losing weight, I was gaining it due to hormonal imbalances! The third time was October or November 2004. I had more tests done and was fast tracked to see an endocrinologist. My cortisol levels were so high, my sport doctor said he has never seen numbers that high. We are not talking about any sport doc here either, he was, and still is, one of the most respected doctors/triathlon coaches around. Luckily, we had periodic test results from the previous year, so we could see the progressive increase in cortisol and testosterone levels.
In December 2004, after many tests and examinations, I was diagnosed with Chronic Fatigue Syndrome that was attributed to several years (close to 3) of disordered eating and overtraining. Most of the CFS symptoms were there along side the hormonal imbalances – muscle/joint aches, short term memory loss, sever fatigue, headaches and insomnia for certain periods of time (At least 4 CFS symptoms need to be present for 6 month or more for clinical diagnosis). Of course, I was also an emotional mess and suffered from low levels of depression. I refused to take medication and went through sessions of cognitive behavioral therapy. I put the university database to good use and started reading everything I could get my hands on, which unfortunately, was not much at the time. I started cleaning up my diet gradually and by the time I graduated in 2005, I was better but not completely healthy. Until 2009/2010, I still had some hormonal imbalances and there were several weeks, a few times a year, where I had to deal with those CFS symptoms again. That was when I made a few key decisions related to my health, along side more changes to my diet, including eating 100% gluten free (that’s a long story on it’s own…). I can’t say that I have not had a single relapse since, but the severity, duration and frequency certainly decreased.
I wish I had received solid nutrition advice earlier on. The ‘wake up call’ I got from my lecturer came at a time when I wasn’t willing to listen, which I think was stupidity on my part. The thing is, we don’t always get to hear what we want, when we want to hear it and the timing is never right, so waiting for ‘the right time’ is pointless. Our reaction to advice that we do not want to hear says a lot about where we are at that point in time: I was immature and stubborn, which ‘earned’ me some hard lessons and a few medical issues that last a lifetime. Luckily, I manage them very well. I have my regrets, but I don’t blame anyone (anymore).
My career choice as a triathlon coach and my decision to study sport nutrition at the graduate level were both heavily influenced by the experiences above. It is also why I decided to combine the two, rather than pick one over the other. I have learned that you are damned if you say something to try and help an athlete and damned if you don’t. Through experience, I know that I prefer trying to help as much as I can, if I can, and that is part of the reason why I share my personal story – I hope that more athletes will take their nutrition seriously and fuel their training properly.
If you made it through the entire post, thank you for taking the time to do so – It was not an easy one to write and I appreciate you reading it! If you feel other athletes can benefit from reading about my experiences, please share this post and if you are an athlete wanting to talk to me about my experience, don’t hesitate to get in touch. After all, this is why I decided to share my story in this format.
Normal, recipe posting schedule will resume tonight :)