We also talk about how treating eating disorders in this way can help with recovery and Chris’s framework that he uses with clients to help them heal.

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Summer:
This episode of eat the rules is brought to you by you on fire you on fire is the online group coaching program that I run that gives you a step by step way of building up your self worth beyond your appearance. With personalized coaching from me incredible community support and lifetime access to the program so that you can get free from body shame and live life on your own terms. Get details on what’s included and sign up for the next cycle at summer innanen.com forward slash you on fire. I’d love to have you in that group. This is eat the rules, a podcast about body image self worth, anti dieting, and intersectional feminism. I am your host summer Innanen. a professionally trained coach specializing in body image self worth and confidence and the best selling author of body image remix. If you’re ready to break free of societal standards and stop living behind the number on your scale, then you have come to the right place. Welcome to the show.

This is episode 266. And I’m joined by Chris Sandel, nutritionist and coach, we’re talking about what we can learn about eating disorder and diet recovery from the Minnesota starvation experiment. We’re also talking about why eating disorders are like anxiety disorders and how treating eating disorders in this way can help with recovery. as well. Chris is going to talk about his framework that he uses to help clients heal and fully recover from eating disorders. You can find all the links and resources mentioned at summer innanen.com forward slash 266. I want to give a shout out to Lucy twos who left this review. Thank God for this podcast. I found you at a time when my support has disappeared and I’m treading water. As an autistic woman with an eating disorder you have made me laugh cry, feel deep compassion and shout out loud. Yes, God dammit. Please keep going with the insights and discussions. Huge thanks from the UK. Thank you so much Lucy and I hope that you’ve found more support since you left this review. I really appreciate you taking the time to say these kind words to me. And you can leave a review by going to Apple podcasts search for eat the rules and click ratings and reviews and click to leave a review. If you want some free guides for me, I have a free 10 Day body confidence makeover at summer innanen.com. Forward slash freebies with 10 steps you can take right now to feel better in your body. And if you’re a professional, like if you’re an educator or a coach or a therapist or a dietitian or a personal trainer, if you’re somebody who works with people who also have body image struggles, I have a separate newsletter that I send to you. And you can get on the list for that as well as grab the free body image coaching roadmap at summer innanen.com forward slash roadmap. I’m really excited for today’s episode, Chris is really good at diving into the research around eating disorder recovery. And he’s always kind of ahead of the game in terms of the approaches that are going to be helpful and what we can learn from the studies that have been done. And today we are diving into the Minnesota starvation experiment, which is a study that was done in the 40s. And it’s kind of considered one of those like pivotal pieces of research to help us understand what happens to our body when we restrict food, as well as what it looks like in terms of recovery and how we can use that for eating disorder recovery. as well. We’re talking about how all eating disorders are anxiety disorders, which is like mind blowing. So I’m really excited for you to hear that. Chris sandal is a nutritionist and coach he helps clients with disordered eating and eating disorders reach a place of full recovery. Unlike other alternatives that focus on just one aspect of recovery. Chris takes a multi pronged approach that teaches life enhancing practices that are used well after the eating disorder is gone. Chris takes a Health at Every Size and anti diet approach. He helps clients move from a life that’s dictated by fear, anxiety and avoidance to living a meaningful life that is in alignment with their values. Chris is the founder of seven health and has a weekly podcast show called real health radio. You can find more about him and everything he has at seven s e v e n dash health.com. And of course I will link to that in the show notes. Let’s get started with the show. Hi, Chris, welcome to the show.

Chris:
It’s lovely to be chatting with you again.

Summer:
I know I should have said welcome back to the show. I’m trying to how many? How many have you been on twice before? Just once? I don’t remember

Chris:
once but it feels like a lifetime ago. I think it must have been seven years ago because it was when I was first starting up. My podcast. I actually had a client recently this week say hey, I listened to your show on summer and a part of it was like, oh gosh, I wonder what I said in that first episode. There’s probably been a lot that has changed in this time. So yeah, it’s been a while.

Summer:
I know I You’d like it was probably still really brilliant. Yeah, I was I, I’ll link to it in the show notes. But it was a long time ago, I know you did a separate sort of bonus for my program. But I think that’s what I’m confusing it with. But anyways, I’m excited to have you back today because you’re always full of such great wisdom. And I know, we’re gonna talk about a couple of main things today, but we’re gonna sort of kick it off by talking about the Minnesota starvation experiment, because that will kind of lead into some of our other discussions. So for people who aren’t familiar, can you talk a little bit about what the Minnesota starvation experiment was?

Chris:
Yes, sure, I’ll have to start this by saying I first found out about this probably a decade ago, and have been really fascinated with it. during all that time. I’ve done many podcasts on it myself, actually, at the end of last year, interviewed one of the children of the participants of the Minnesota starvation experiment. So this is something I’ve spent a lot of time reading about and looking into. And so I guess it’s done, please, I’ll give an overview. And like, please feel free to just interject and ask questions as I go through this, if there’s anything that just instantly comes to mind. Yeah, so it was an experiment that was conducted between 1944 and 1945. And they wanted to understand what would happen in terms of starvation, because there was so many places in the world that were going to be affected by famine, who were already affected by famine, because of the Second World War. And the two main things they wanted to understand was like, one, how does starvation affect the body. So in terms of all these different things, physiology, behavior, emotion, intellect, social changes, motivation, that kind of thing. But also what would be the nutritional requirements for re feeding a starving person. And if you’re then going to have to go into different countries and refeed their population, what would be required as part of that, and as part of this, there were 4400 applicants and 36 of them, stood up to them the screening process for this and the criteria for it was good physical and mental health, normal weight range, unmarried, the ability to get along with others under difficult conditions, and a genuine interest in relief and rehabilitation work. And all the guys that were part of this were all conscientious objectors. So they weren’t fighting in the war, but they wanted to be able to do something. And a lot of them talked about, like, I wanted to be able to see to say that I did something meaningful during the war. And as part of the experiment, there are really four phases. And there’s three main phases. And then there’s a final one that some of them were were part of. So the first phase was a control phase. And it’s lasted for 12 weeks. And the goal of this stage was really to get the men to a point of being healthy and just understand what their baseline was before any starvation commenced. And there was a ton of tests that were done all throughout the experiment, but they wanted to find out what their baseline were before any of this kicked off. And so there was blood tests, there was post there was metabolic rates, sperm count, like basically anything that could be tested was was tested. And I’m gonna mention calories throughout this, I think it’s kind of important. And it’s I don’t know, if there’s a way I can talk about this experiment without calories. Is there anything you want to suggest?

Summer:
No, I think if it’s going to be triggering to people, then they can know that from this point forward and, and do whatever they need to do to take care of themselves. But I totally understand because I know that it’s really important to the what they did to the participants in the study. So yeah, go ahead.

Chris:
Yeah. So at the beginning point, in this control phase, the men were then all weight stable. And rather than getting everyone to eat the same amount of foods, each subject was treated individually. But if we’re looking at it on a kind of general basis, at this point, they were eating three meals a day, and it was roughly 3200 calories each day. So on average, that was what these men needed to be to be weighed steady. And the control phase was also for the men to get to know each other because they’re going to spend a lot of time together. And this was a point where they were kind of welfare and in high spirits and could bond. So the next phase was then the starvation phase. And this is also referred to as semi starvation, and it lasted for 24 weeks. That’s such a long time. It is a long time. And it’s interesting the fact that they say semi starvation, because on average, they were having their calories cut in half, immediately, like overnight, so they wanted to have it be like what would happen would when a famine happens because of war or because of some natural disaster and it happens very immediately. So overnight, the calories were cut in half, and so it was approximately 1560 calories. But again, each of the participants were dealt with differently and keys who As the person who ran this experiment, he set individual goal weight loss amounts for each subject and this range anywhere from about 19 to 28% of their starting weight. And so what they were doing is over that 24 weeks each week, they would be modifying things to help them get to that intended place. And it meant that some of the disciplines would end up with a lot less food. So there’s a couple of participants because their weight wasn’t going down, as expected, who were on less than 1000 calories a day, as time went on. And they’d have another piece of bread removed, and another piece of this group because they were trying to get them to this place to that end the experiment in the place that that he wanted them to. And as part of that there were significant changes that occurred from the men’s physical, mental and psychological health. And I’ll get to that in a little bit. But let me just finish the sort of overviews of this. After that 24 weeks, they then had a, it was called restricted rehabilitation. And this lasted for about 12 weeks. And this was the part of the experiment where they were wanting to discover what do you need to feed someone to help them recover as part of a famine, and they were split into different groups. And each of the groups received either an extra 400 or 800, or 1200, or 1600 extra calories on top of what they had during the starvation phase. And they were then also divided into two groups where someone would get some extra protein, some of them would get vitamin supplements, and really just wanting to understand what the requirements were for revealing an individual. And interestingly, after five weeks of doing this, the recovery was so much slower than expected, that they decided to then just add in even more food, because even when the guys that were receiving the 1600 extra calories, it just wasn’t making a difference for them. And so their calories were all increased again. And then from this point onwards, there was improvements that started to occur. And there’s actually a really nice quote from Kies, who is the lead on this connected to it, he said, Enough food must be supplied to allow tissues destroyed during starvation to be rebuilt. Our experiment has shown that in an adult man, no appreciable rehabilitation can take place on a diet of 2000 calories a day, the proper level is more likely 4000 calories a day, for some months, the character rehabilitation diet is important also. But unless calories are abundant, the extra proteins vitamins and minerals are of little value, and quote, and I think that’s a really important thing that we will probably circle back to is just like how much calories trumps everything else in terms of how important this is.

Summer:
Yeah, like what I take away from that is there has to be some sort of an access to the baseline in order to recover. Like, it’s not just about going back to where you were where you should be based on kind of your, you know, your energy output and your size and everything else, but actually going, you know, beyond that in order to repair.

Chris:
Yeah, and I kind of I when I’m working with clients, I talk about when you’re getting into studies is the equivalent of you accruing debt, and you’re then like incurring more and more debt. And so if you’re trying to pay off debt, you can’t just get in what do I need for today? You’re like, what do I need for today, plus, all of the others that have come before this? And so yeah, it means that there is a lot more than is needed than the average day. And as keys kind of pointed out with this for the for the man who was 4000 upwards?

Summer:
Yeah. Wow. Wow.

Chris:
And so then there was, I was using it. And then the final phase was an unrestricted rehabilitation phase. And this was only for some of the volunteers. So most of the volunteers after that restricted rehabilitation phase, that was where the experiment ended. But they then kept on 12 of the volunteers. And they stayed for unrestricted rehabilitation, and they just lasted for eight weeks. And during this phase, rather than them having the set amounts, they were basically allowed to eat whatever they they wanted. And it was during this period that the numbers really increased. So during the first week of unrestricted eating, the individual intake was much higher. So up to 11,000 calories a day, average around about 4400 calories a day, but it was a lot more food that was coming in and some of the men were commented that they would have these very large meals, and we’re still hungry even though they couldn’t ingest any more food. And after sort of a number of weeks of calorie and intakes being around that sort of 10,000 per day, then they started to level off and they were somewhere around like 3202 To 4500 calories a day, although some continued to eat more. And that continued on for eight weeks. And then after that eight weeks, they stopped tracking them in the experiment was over, the men went off and did their and did their thing. And that that is the sort of the overview of what occurred as part of that experiment.

Summer:
Yeah. Wow. And so like, I’m curious to know, like, I think this is really important, this research was really important in terms of like eating disorder, recovery, and stuff like that. But the symptoms in that like recovery phase, what were some of the symptoms? And like, how do you kind of see that show up and individuals that you work with?

Chris:
So I think that the the heart of why this is so important is there’s the symptoms that happen in the recovery phase, which I definitely want to talk to you but also the symptoms that happen as part of being in a malnourished state, and the restriction part of a and I definitely subscribe to the biopsychosocial model with eating disorders. And so much of the symptoms that arise with eating disorders is connected to malnutrition, and connected to the fact that the body just isn’t getting enough of what it needs. And this then leads to physical and behavioral and psychological changes. And this is why this piece of research is is so useful. And so often, like I’ve done a really long podcast on this, and often I’ll share this with clients to have a listen to, to kind of get a sense of like, how much does this match up with my experience. And so what I can do is I can go through a lot of the symptoms that the men started to experience while going through the semi starvation phase, and then we can still look at what happened as part of the recovery. Yeah, sure. Through in terms of the physical symptoms, they had decreased pulse, so their their average heart rate was 55 beats per minute beforehand, and then during the restriction it dropped down to 35. Their heart actually shrunk by 17%. On average, their blood volume dropped by 10%. They had low blood pressure and dizziness and vertigo. Some of them experienced blackouts, their metabolic rate plummeted by as much as 50 percents, they had to take pillows with them to sit on because it hurt so much to sit down, had increased sensitivity to cold, so they were all wearing much heavier clothes and lots of layers and drinking hot drinks. And like a hot shower was their highlight of the day, they had increased tolerance to heat, so they’d have really hot plates, and they’d asked for really hot food and tea and coffee, and their caffeine consumption increase. So when when their coffee intake hit 15 cups a day, they said a nine cup limit, because they were just trying to drink so much to get that sensation of feeling full and they drank tons of water as part of it. Some of them started to smoke to try and stave off hunger, a lot of them chewed gum as a way of dealing with it. And there was some who were up to like 40 packets of gum a day, until again, they just said a limit of okay, you’re allowed two packets of gum a day. They just developed strong cravings for for salt. They became obsessed with food. And it really became this principal topic of conversation. And their thoughts were about it. They read books about it. They collected cookbooks and menus and any information about like food production, many of them said that they wanted to be to be chefs and open restaurants. When it was over, they started to lick their plates and have lots of different bizarre rituals connected to their eating. They would try and subvert their desire for food by by other hobbies. And so they could collect things they would hoard things, they really didn’t like any kind of physical exercise, and they spent as much time lying around to keep warm as they could there was a lot of loss in terms of their their strength. They had a real decrease in interest in insects, and their their sperm count dropped down a lot during the experiments. There was obviously no females as part of the experiment. But the the female equivalent is an obvious story cycles where you’re having a period but not ovulating, or hypothermic amenorrhea where ministration completely stops. They had low red blood cells so anemia that low white blood cells or their immune system, they developed a Deema or water retention. Their hair grew slowly and fell out and then they all stopped growing. The experience frequent urination in the day and the night they became constipated. They went from going once a day to once or twice a week. cuts and bruises we heal slowly they have muscle cramps, sleep became really interrupted. And then from like the mental side The things they did a thing where it’s called the Minnesota Multiphasic Personality Inventory. And it’s a test that looks at different aspects of mood and personality. And they did this before the experiment. And then during the experiment, and there were lots of scores that they would they would look at and scores connected to hypochondria, and depression and hysteria, or increased and it became known as this semi starvation neurosis. One of the participants cut off three of his fingers with an axe during the experiments, and the week before he’d dropped the car on his hand and pulled it, put it away it just the last moment and it crushed one of these fingers. So it had a huge impact on him. There was loss of ambition and increased depression. People spending more time on their own, even if they were extroverts. More irritability, concentration and judgment and comprehension and decision making became impaired, increased irritability and rigidity. So I mean, there’s the list goes on. But I think that probably gives you a fair indication of just some of the changes that started to occur in these guises as part of the restriction.

Summer:
Yeah, yeah, totally. And then so what happened in the recovery phase, like with the symptoms, like was there still that obsession with food for a long time? Like, I guess, yeah, what did what what did you What do you notice there and especially like, as it relates to, you know, people that you work with when they’re recovering from an eating disorder.

Chris:
So I think the biggest thing that I think is useful to see with this in terms of recovery is the body really has a hierarchy of how it recovers. And that it goes about things in an order that someone if they were getting to choose, it would possibly choose something differently. And this is always a conversation I have of like, yeah, I understand, this is what you would like to have happen. And I really get how much of a challenge this could be. And this is the way that the body heals as part of this. And the thing that is kind of the standout is that the body prioritizes fat gain, and weight gain really above all else to start with. So obviously, as part of this, your body has to repair all the tissues and organs that have been damaged as part of this. But that’s just not where, where it starts. And there is a prioritizing of fat gain, there’s a prioritizing of fat around the middle. And this happens in much higher amounts than then in other places. And so for example, the point at which the the body fat percentage match the pre experiment levels, the guys were still much lighter than when they started. And when their their lean mass was back to pre experiment levels, their abdominal fat was like 40%, higher than when they started. And so the body just has a way of prioritizing these these things differently. And as time went on, and when that lean tissue then reached the premium experiment levels, this was when the weight gain typically started to level out. And then with time it started to, to drop down. But that’s just the order of things. And I do want to make just like two notes with this, like one, when I talk about fat levels and lean mass. And all of this, I’m doing so in a in a neutral way and just explaining what happened. It’s not like I think that it’s bad, that the body prioritizes fat gain or that it’s a good thing that fat levels then came down. It’s like just simply explaining the physiology of what happens in terms of the the healing. And then the other one with this is just it takes time. And I think that this is a really important thing to remember and understand because in the study in the way it was presented by keys, it was as if everything was resolved within a year, particularly around the the weight changes. But with subsequent there has been other research that’s done since this study, they’ve interviewed the guys, there’s a great bit of research, they interviewed the guys many, many decades later. And what it turns out is it was really about five years for total restoration, or up to five years. And the average is about two years.

Summer:
More and what’s different about this too, is that these guys, like did it as part of an experiment. It wasn’t like they didn’t have the other you know, like psychological factors that would actually that would trigger an eating disorder and somebody else as well as the cultural like component of, you know, fat phobia influencing their beliefs like not to say that didn’t exist back then. But I think that, you know, recovery is even harder when you’re, you know, like when you’re outside of that experimental setting because you’ve got all these other factors that drove you to have those behaviors in the first place. One understand

Chris:
it Totally agree. And that’s the thing. There are limitations with this, like, all of these guys were white men who are in there. They’re like between 22 and 33 years of, of age. This hadn’t started when they were in their early teens. And this was like, yes, their food was restricted, and they lost a lot of weight. But this was a very acute thing that happened over a 24 week period. It’s not something that has gone on for for years and years. And as you you said, like, there’s all these other influences that weren’t there, like none of the guys developed an eating disorders, or they were all counting down the days for this thing to be over. And they were doing the minimal amount of exercise that they were required to do, as part of the experiment. They weren’t doing anything extra, like they were waiting for this to be over. And so that’s a whole different experience to, for someone with an eating disorder. And so I think the value of this piece of research is just to be able to look at how much restriction in and of itself has an impact on physiology and psychology and behavior. And then obviously, there’s all of these other things that then are on top of that, for someone who has an eating disorder.

Summer:
Yeah, well, and even like the, you know, the caloric amount that they were given, is something that like, a lot of more extreme diets recommend us, like, you know, here do this to be healthy, you know, and so you can see, like, how, I guess it just puts it into perspective, right? Like, I think people would think to starve your feet, like 500 calories a day, but it’s actually like, you know, things that a lot of mainstream diets recommend, like 1500 calories and things like that. And so, and then obviously, it’s always lower for women. But that’s the other kind of, you know, thing that I noticed from it is just that those things are readily promoted in the mainstream as to eat 1500 calories. And it’s like, no, like, that’s, that’s what was used in the Minnesota starvation experiment. Yeah.

Chris:
Yeah. And I always then kind of laugh when they say that semi starvation of like,

Summer:
yeah, yeah. And, and I think the expectation that like, when you’re recovering from an eating disorder, then you should only eat a certain amount, and you’re wrong, if you are, you know, wanting like this kind of, you know, refeeding phase that people go through. So, I do feel like there’s a lot of helpful just perspectives from it, as well as the weight gain around the middle. Because I think that for a lot of women, especially like, that’s a really vulnerable sort of place to put on weight. And so that also just, you know, it’s like, that’s a part of the recovery process. And so doing healing around your relationship with that is also going to be really important to be able to, you know, accept it and know that, like, your body’s really just doing the best it can.

Chris:
Yeah, and I because I think so often with recovery, is that there’s this way of like, how do I do recovery where I gain the least amount of weight? Well, how do I do recovery, so they don’t really gain weight, or I don’t gain weight around the meal. And again, this is what I liked about this experiment, like, it shows you how much the body is going to do what the body is going to do. And like you try to, I’m going to keep my protein higher, I’m going to do this thing as a way of trying to safeguard against that. All it leads to is you’re just the repair isn’t happening. And this was what they found out when they they did that the restricted rehabilitation phase of like, unless you’re hitting up against a certain amount of calories, it doesn’t matter about those, those other those other things. And so I think it’s yeah, really helpful for me to then talk about this with clients, like the fact that we’re putting a weight around your belly. It’s not because you’re doing something wrong. It’s because this is how the body chooses to repair and recover. And that’s a very natural process.

Summer:
Yeah, that’s super helpful. So I know that kind of leads into sort of our other topic that I really wanted to get into with you today. And that is something that you’ve been researching and that you did a podcast on, I guess last year, and that’s really looking at eating disorders as anxiety disorders. So can you speak to that?

Chris:
Yeah, sure. And so this was something that it was maybe a couple years ago that a client of mine shared a talk with me and it was a lecture given by Dr. Sasha Goro. And Sasha is a psychologist and a assistant professor at the University of California in San Francisco, in the Department of Psychiatry and Behavioral Sciences, and her focus is really on the treatment of eating disorders. And the talk that she gave was called is anorexia nervosa and anxiety disorder. And as part of the lecture, she looked at the the similarities between anxiety disorders and how anxiety disorders predate the eating disorder, and just the overlap between the two and how much in sorters were similar to anxiety disorders and how much it made sense for, from a kind of treatment perspective to think of eating disorders as anxiety disorders. And I’m obviously hugely simplifying her talk. I had her on the podcast, we chatted for about two hours on this as a topic, but I think just as a as a starting point, or is like, in a nutshell, is just that eating disorders are anxiety disorders.

Summer:
Mm hmm. Yeah. And so the other thing that’s interesting about that is that like, because I was talking to on a podcast I did a couple months ago with Gillian McCollum and Tamsin broster, who are both practitioners out in the UK as well, actually, I think one of them might be in Scotland, anyways, they were saying that, like, a hungry body is an anxious body. So at the same time, like, as your body loses nourishment, or as you as you deprive your body of nourishment, that also up regulates anxiety. So it’s interesting that you kind of have like almost this twofold effect of like the anxiety kind of creating the, or being like a precursor to the eating disorder, and then at the same time, that restriction, like increasing the anxiety simultaneously, like is that something that you’ve noticed, too, like?

Chris:
Yeah, definitely. And it is like when you’re malnourished, when there’s not enough energy coming in, like it does have that effect. And I think the trick is with this, in the beginning, if you have anxiety, and that’s then leading to the eating disorder, there is this sort of honeymoon period, where it does seem to, it does seem to work. And you do have some level of calmness or euphoria or something that’s like, oh, there’s like a really good bit of feedback here of like, why I want to keep doing this. And then at some point, as the malnutrition increases, and the, the body’s then kind of dealing with that, then the anxiety starts to really ramp up again. And then you’re in a situation where I’m like, I’m damned if I do, and I’m damned, if I don’t, like if I don’t eat, I’ve still got all this anxiety. And if I do it, the anxiety is even worse. But I’m not like I’m not really getting away from the anxiety, like I now just have this horrible baseline like baseline anxiety, anyway, stay with the status quo. That’s what it is. But if I try and change something, it feels worse, at least in the short term. And I think the thing with this is, and the bit that really kind of hit home with this is like, the thing with anxiety disorders, is they’re about avoidance. And this is true, whether like we’re talking about OCD, or whether we’re talking about an eating disorder, you are trying to avoid something, whether that is a particular feeling a particular thought, etc. And so I feel uncomfortable when I think about eating cake, for example, and so I don’t eat cake, or it feels uncomfortable for me to have breakfast. And so I now don’t have breakfast. And the tricky thing with this is avoidance begets more avoidance. And this is definitely the case with an eating disorder is you constantly creating this new normal and new normal in a very unhelpful direction. So yesterday, I did X amount of exercise, and that was an increase from the day before, this now becomes my new norm. And it feels anxious to now do something less, or I now didn’t have breakfast for the last three days to now try and bring breakfast back in now feels so much more anxiety provoking, because my new norm is that I now don’t have breakfast. And so there’s this kind of like a symmetry with it, where it becomes more and more easy to do things that are in support of the eating disorder. And it’s more and more anxiety provoking to do something that is then different to move in the opposite direction.

Summer:
And I think that really ties to body size and the way someone feels in their body. It’s like, if they gain a little bit of weight that is extremely anxiety provoking, and so therefore, they’re trying to avoid that through the restriction so and so then that drives those restrictive behaviors with the food as well. So it’s like, yeah, I can see that with clients like just that, you know, that panicky feeling that comes if you notice any changes to your body?

Chris:
Yeah, yeah, definitely. And I think one of the things that Sasha talked about in in the talk was that there is so many similarities with eating disorders with this. And so I know how top was framed as is anorexia nervosa, and anxiety disorder. But really, if you look at all of the eating disorders, that there’s sort of three common things that they have, that they share. And so one is a fear of the consequences of eating. And so that’s anxiety provoking and the consequence could be weight gain. It could be the unhealthiness of food. It could be a fear of choking in terms of like our Read. So there is this like fear of a consequence of eating, there is weight suppression. And so if someone is at a low weight than where they historically, were, and that this is part of the eating disorder, and then there are the behaviors that then maintain that eating disorder. And again, this comes back into the, the avoidance piece, you’re doing more behaviors to avoid doing the things that are uncomfortable. And it then continues to sort of just go in that in that vicious cycle. And so it’s not just because I think it could be very easy to hear this and be like, okay, that that only applies to anorexia, and I don’t have anorexia and, like I enjoy, I just want to make it really clear like this is this is all eating disorders. This isn’t just anorexia.

Summer:
And I think it applies to even just a disordered relationship with food or exercise to that might not be like, completely clinical diagnosed, you know, like, if I think about my own situation. And the other thing, I just want to caveat, because you mentioned like a lower weight. But that doesn’t mean you’re in a low weight category, it means that your body is like, you can still be larger bodied or higher weight, and be at a lower weight than like where you’re meant to be. And I think that that trips people up and obviously, that’s like, there’s a lot of weight stigma and in eating disorder, Recovery has people don’t get diagnosed because of the way they look. But I just wanted to just caveat that for people listening, because sometimes people will think like, well, I, you know, this is not sick enough or at but it’s yeah, it’s not about the actual body size. It’s more about the change.

Chris:
Yeah, yeah. So weight suppress from where you have historically been. And also, like, with time, if your body starts to weight cycle, you could still be at a higher weight from where you’ve been previously, but your body still hasn’t recovered properly and got the the energy that it needs to do all of that repair. And so you’re still stuck within that place. And so yeah, I’m like you, I’m always very careful to talk about this with clients in terms of you know, you can be malnourished at any size. If you’re not taking enough for what your body needs. You can make it you don’t have to get to a place of being emaciated, and most people don’t even get there. Like the majority of people. Even if we’re looking very specifically at anorexia, the majority of people who have anorexia are not diagnosed with the Dinos with atypical anorexia, which is anorexia in in Ohio, in Ohio a weight or at least a weight. That’s not what we stereotypically think of as anorexia. Yeah,

Summer:
yeah, absolutely. So I know, we wanted to talk about exposure, but I also wanted you to talk about your framework, I’m assuming maybe exposure is part of your framework. So. So yeah, so maybe we’ll just go right into your framework, then. And you can tie the exposure into that. But so yeah, so you’ve developed your own framework for for this, like, that’s really kind of, you know, influenced by the notion that eating disorders or anxiety disorders, as well as what you’ve learned from the Minnesota starvation experiment, so I’d love you to share, you know, like, what that framework is, and walk us through it.

Chris:
Yeah, sure. And just in terms of the the exposure piece, I will just before I talk about the room, I would just say that the gold standard for how to deal with anxiety disorders, is exposure. And so it is it is doing the thing that you’re afraid of? And so, yeah, that’s how you deal with that. And so yes, I’ve come up with a framework and this is how I work with with really all clients and helping with with recovery. But honestly, I would say this is universal, like I don’t have an eating disorder, I am not in recovery, but I regularly use this framework in my own life. And I call it the simplifying success framework. And I reflected on the fact that everything I work on with clients is about three areas and the three areas are state story and structure and each of these areas are impacted upon by one another and impact on one another. And so, we break it down so state is the state that your body is in and state can be affected by by different things. So if we look at like the Minnesota starvation experiment state can be the energy balance that you have coming in the amount of energy that is that is coming in and how that affects you. State can also be affected by your your nervous system, and where your your nervous system is I don’t know if you’ve done any episodes on like polyvagal theory but that’s a big part of of how how I work and what I talk about with clients.

Summer:
I haven’t but I know what it is but yeah, go ahead.

Chris:
Okay, cool, and stake and then just be different symptoms that are that are occurring and where someone is in terms of recovery and healing and that kind of thing. So stadia is is one thing, then story and story is really all the the thoughts that that you have the beliefs that you have The perceptions that you have, it can be the emotions and sensations that you you feel. So really the information and feedback that you’re you’re getting from your, your mind and body and what your level of discernment is with these things, how much you’re able to take this on board, how much you’re able to create distance between these things. And then the final piece is structure. And structure is like, what is your day to day look like? What are the things that you are doing across the day? What are the habits do you keep up so this can include the eating that you do across the day, it can include your sleeping, your social connection, movement, work, journaling, time outside, like all the different things that make up your day. And when I’m working with a client, if we’re looking at like, are things going in the right direction, in terms of like a pro recovery direction, or if things are going in a in a not so great, right direction, we can pretty much look at all like one of these things or all of these things together. And it can give us a fairly good indication of, of what’s going on. And kind of the thing that connects all this is taking action. So if someone is moving in the right direction, they’re taking action. And if someone isn’t, there’s avoidance that is that is occurring. And so I can I can kind of give an example with this, just to kind of clarify a little bit. So for example, a client is saying, Okay, I am wanting to make a change, I’m going to set the goal, the fact that I’m going to have, I’m going to start to include breakfast, so I’m going to make my breakfast bigger than that I’ve been been having, and that’s the goal. And then they wake up on that that morning. And maybe there’s some some thoughts that start to arise in them about, Okay, should I should I do this thing I don’t, I don’t know, maybe they can feel that there’s a shift in in their nervous system, and they’re becoming more panicked or, or more worried, or there’s more of a kind of fight or flight connected to that. And then in that situation, they they choose not to, to have their breakfasts that they said they were going to have as part of that. And so in that situation, their their state is affected because they’re now not getting the energy coming in as as part of that choice, it’s affected the structure of their day, because they’re no not having that breakfast, they had certain thoughts that came to mind. And they, they then became hooked by those thoughts and follow through on the thoughts of the eating disorder generated, and then kind of just led to that chain of events. And if for example, they’re the opposite how they occurred. And so they had that uncomfortableness that had arisen. And they’d have those thoughts that that had come up in their mind, and they were able to diffuse from those thoughts and create some distance. And notice, okay, these are, these are just thoughts, my mind is generating a thought here, and they were able to still have the breakfast, they are then bringing in some some energy. And that then has a knock on effect in terms of their state, it has a knock on effect in terms of their structure, because they kept up with that. And they then it comes time to to have that snack, and they then keep on doing doing that thing. And so really, it’s just looking at what direction is things going like I used to trending in an upward direction in terms of taking action, or are you trending in a downward direction in terms of avoidance? And I will say that, like, it’s not linear like this, they’ll there’ll be days where things are working in a better direction and days where it’s not, but it’s just a way of starting to look at okay, if things are not going so well, let’s have a look at let’s have a chat about what’s going on from a state perspective. Let’s have a chat about what’s going on in terms of your your, your stories, and the kinds of thoughts that are coming up and the kinds of feelings that are coming up. Let’s have a look in terms of your structure, and what’s what’s getting in the way of that or what’s been happening across the day. Hmm,

Summer:
yeah, that makes so much sense. And yeah, like to your point, it’s like it does take that action, like to make the change, which is really uncomfortable to do. And but that’s the only way that things really change, like avoidance doesn’t result in change. Like it would be great if we could make these changes through osmosis. But it doesn’t happen that way. Yeah, and I see

Chris:
that oh, for people to then be also like a lot of what I’ll focus on is then like, self compassion and to be to be having compassion for yourself when that when that is difficult. And, and so, yes, as I said, it’s not linear. And you’re right, like, one of the things I say a lot to clients is you don’t think your way into acting differently. You act your way into thinking differently. I am very much a big proponent of like, you take out Shouldn’t you do it again and again, and your beliefs start to shift? As opposed to I’m going to change my beliefs in advance, and then I will start to do this thing. It just doesn’t work in that order. And so it’s it’s very much action exposure orientated.

Summer:
Yeah, yeah. 100%. Yeah, that’s been my experience with it, as well. I mean, I wish we could avoid stuff and have things changed, but it doesn’t happen.

Chris:
Trust me, totally. And as I said, like, I can reflect on this in my own life in terms of things. I’m afraid of doing sending an email or having a conversation with someone or setting a boundary or whatever. And I can tell what happens in terms of avoidance and how that affects my state and the stories that start to come up. And so yeah, I can catch myself with this stuff, as well. And know that there will be times where I do follow through and take action, and there’ll be times where I don’t, yep, you tell

Summer:
me to Nope. Same. I totally relate to that. So you’re not alone. I guess, if you’re feeling that way. And it’s not to say that, you know, there’s something wrong with you, or that we’re the if you’re if you’re having trouble, or that you need to strive for perfection, but rather, it’s just like, yeah, trying to be curious about your own situation, as well as get support, if you feel like you are getting stuck, and you need that push of someone to kind of guide you or help you make it a little bit more feasible for you to take some of these actions.

Chris:
Yeah, yeah, and definitely with with eating disorder, recovery, I think there are people out there who did it on their own, and they’re there. They’ve made a business out of that. And I think the vast, vast majority people need support like this, this is a really difficult thing. This, I say this to clients all the time, this will most likely to be the most difficult thing you ever do. And to try and do that on your own is is very, very challenging. And most people don’t succeed when they do try and do it on their own.

Summer:
Yeah, well, I mean, it’s like putting together Ikea furniture. It’s like, yeah, you could do it on your own. But like, if you have somebody who’s an expert, helping you, it’s gonna be so much faster. Yeah, well, this has been so helpful, Chris, where can people find more of you?

Chris:
So if they come to seven hyphen, health.com. That’s my, my website and my business name. I also have a podcast called real health radio that touches on lots of topics like this. And as part of this, I’ll send over to you somewhere and you can put in the show notes, some of the episodes that I’ve referenced as part of this. Just

Summer:
amazing. And then how are you? You’re working with people one on one as well?

Chris:
Yeah. So so my work is predominantly with eating disorder recovery? And yeah, it’s one on one work. And if people can come over to the website, and they can read about how I how I work with clients, and then they can apply for a free recovery strategy session, and we can have a conversation about okay, what would that look like and figure out if we’re a good fit?

Summer:
Yeah, amazing. So good to see you again, and have you back on the show. Always super knowledgeable, and definitely check out Chris’s podcasts for more and work with him if he can. Perfect. Well, thanks for having me. Thanks, Rock on. There is so much good content in this episode, I feel like it’s one of those ones I can go back and listen to over and over. I am linking the articles and podcast episodes that Chris has done on the subjects as well. So if you want to look at this in a little bit more detail than what we were able to cover in this episode, you’ll be able to find those in the show notes as well as anything else that was mentioned in this episode. You can find that at summer innanen.com forward slash 266. If you don’t know how to spell my name, you can always just go to the body image coach.com Thank you so much for being here today. I really appreciate you listening rock on.

I’m Summer Innanen. And I want to thank you for listening today. You can follow me on Instagram and Facebook at summer Innanen. And if you haven’t yet, go to Apple podcasts search eat the rules and subscribe rate and review this show. I would be so grateful. Until next time, rock on.