You mean, it’s not unhealthy?

Recovering from an eating disorder at MIT, and how we can make our Institute a healthier place
Jun 2020
Matthew
A.
Computational and Systems Biology

TRIGGER WARNING: eating disorders

The road to kale is paved with good intentions

Many students select their college majors because of inspiring teachers, envisioned careers, or particular interests. I was motivated to study Biochemistry for another, somewhat unusual reason: an eating disorder I’d developed at age sixteen.

That year, I watched “Sugar: The Bitter Truth,” a lecture in which Robert Lustig describes fructose metabolism and its harmful byproducts. I had always been short and skinny; most exercises quickly made me yearn to be home reading books on chemistry and biology. “Bitter Truth” revealed a more appealing way of using my scientific interests to achieve wellness: an impeccable diet. I abstained from sweetened cereal and orange juice, soon eating just a few grams per day of added sugars. I munched Swiss chard and goat cheese sandwiches on whole wheat bread.

On my new diet, rich in fiber, my ravenous teenage appetite subsided to constant fullness; no longer could I tell when to start and stop eating. I’d lost the satisfaction described in IHOP’s slogan, “Come hungry. Leave happy.” Reclaiming it became a fixation. Often after school, I snacked on kale dipped in almond butter for over half an hour, hoping I would eventually be satisfied. I was annoyed by any activities that thwarted a leisurely meal.

From years of schooling on the dangers of being overweight (and little on being underweight), I also became preoccupied with body image. Having become bored quickly every time I tried to build muscle, I decided to avoid gaining fat altogether. Since I was eating large volumes to attempt to feel satisfied, I reduced calorie density, eliminating salad dressing, pesto, even pasta for a time. Plain food proved even more unsatisfying, and my stomach often hurt after consuming it copiously. Instead of returning to a typical diet, I further tried eliminating gluten, animal protein, dairy, and nuts, to no effect.

A solution in biochemistry?

Realizing my dysphoria, I thought I could solve my problems with nutrition science. Inspired by “Bitter Truth,” I began skimming scientific papers to learn about the physiological effects of foods. Clear answers proved impossible: the papers contradicted each other. Is saturated fat bad? Depends on the research study. There was only one thing left for me to do: major in Biochemistry to find the true answers.

In college, I performed well in classes but studied inefficiently, often flipping from my assignments to scientific papers on how humans metabolize various chemicals. I progressively restricted oxidized lipids, mTOR activators, immunostimulants, and trace carcinogens. Goodbye, anything aged, fermented, fried, sauteed, or charred; anything with too much ethanol, lecithin, phytate, or advanced glycation endproducts. With every bite of these molecules, I pictured them destroying my proteins or mutating my DNA.

I also took frequent breaks from schoolwork to cook what I deemed “healthy” meals. I obsessively perfected my recipes for kale pesto and low-omega-6 hummus. Yet ceasing work to cook or eat when I wasn’t hungry—and I rarely was—made me feel guilty. I felt less guilty by staying underweight; then, eating seemed somewhat productive. Half of my mind wanted to gain weight; the other half feared I would become normal-weight obese (having high body fat despite normal BMI). My thoughts argued incessantly, “Don’t eat when you’re full: study instead,” “Eat when you're full: you weigh too little,” “Don’t eat when you’re full: fasting is healthy.” I still believed I could fix my problems myself: once I found a group of similarly impeccable eaters and exercised an hour daily, I would be happy.

I am the problem

In the fall of 2018, my first semester at MIT, everything worsened. Studying for a Genetics midterm, I couldn’t focus because I kept snacking on carrots and reading recipes for flourless bread. At the Biology Halloween party on October 26, I ate only beans, rice, and guacamole for dinner and felt wholly unsatisfied. I had come with a few friends but couldn’t sustain a conversation because I was repeatedly compelled to sneak away and snack on pretzels. The next morning, I reflected on my dissatisfaction at the party. Since high school, I had hoped that my dilemmas with food would resolve spontaneously once I made more friends, attained more independence, and attended a renowned university. Now I had found fantastic friends and research opportunities at MIT, yet my problems had worsened. I could no longer hold such hopes. I needed help.

On October 31, I hid in a vacant nook in Building 66, dialed 617-253-2916 for MIT Mental Health and Counseling, and requested an appointment with an MIT therapist. During my visit, she agreed that I had an eating disorder and said it seemed so entrenched that I might require a year or two of residential treatment. This was not the news I had hoped for: one to two years! Granted, my PhD would likely take five or six years anyways, but the thought of delaying graduation that much was quite distressing. The therapist referred me to an MIT primary care provider, who said my weight was nearly low enough to require hospitalization and told me to call the Cambridge Eating Disorder Center (CEDC). I exited MIT Medical in a half-panicked daze and bought groceries from TechMart immediately, then called my brother.

A few days later, I called CEDC, as well as my insurance company to confirm that the MIT Student Extended Insurance Plan would cover any treatment there (it would, in full). I met a case manager at CEDC for an intake on November 26. She handed me informational packets on a 36 hr/week partial hospitalization program (PHP) and a 9 hr/week intensive outpatient program (IOP) and recommended PHP. Skeptical that PHP would be necessary, and not wanting to derail my studies, I said I’d think about it. But while reading the packets, I realized I did find appealing many of the PHP activities, such as guided meal prep. I also figured that I might be able to fit in PHP during MIT’s Independent Activities Period (IAP), without disrupting my PhD too much. Before winter break, I would do two weeks of IOP and then decide whether to do PHP during IAP. CEDC approved this plan, leaving one obstacle: permission from my PhD program director to skip my mandatory IAP lab rotation. Alone in Building 68, I rehearsed the conversation, then walked into his office and explained I needed treatment for an eating disorder. He encouraged me to prioritize my health and granted me permission. I was in.

Learning to eat again

CEDC required me to bring balanced dinners to IOP (grain, protein, fat, and vegetable/fruit). This requirement stressed me out; I wasn’t sure I could. My first evening, I packed pasta with homemade kale pesto, an egg, and a banana: sufficient, but not cohesive. The second evening, I set goals to stop working while eating and to plate all of my food before eating. This immediately reduced the anxiety I experienced at every meal. Trusting the advice of my case manager, I experimented with foods of higher calorie density by eating crackers, cheese, chicken, and a plethora of desserts like tiramisu at a series of MIT holiday parties. Delightfully, once I allowed myself to eat what I wanted, I felt more satisfied and less distracted by food. For the first time in six years, I enjoyed eating at restaurants with my family over winter break.

Much work remained, however. My first day of PHP, my case manager gave me a meal plan with quotas for servings of grains, fats, proteins, dairy, vegetables, and fruit. The quantity was about 25% more than I had ever eaten daily in my life and physically uncomfortable to stomach. For motivation to follow my meal plan, I regarded it as one of my Systems Biology psets: unpleasant, but required. Counting servings, I successfully stopped counting calories, alleviating considerable anxiety. Still, eating many foods, particularly meat, cheese, and fruit juice, made me feel like I’d committed some crime against my cells. A CEDC nutritionist noted I was viewing these foods as single nutrients (saturated fat and sugar) and reminded me that they also contain protein, minerals, and vitamins. No food is intrinsically healthy or unhealthy: balance and moderation are healthy. The nutritionist recommended a balance of 80% nutritious, minimally processed foods with 20% of whatever I wanted. This guideline has worked for me ever since.

During PHP, other patients and I spent most of the time discussing not food, but rather other underlying insecurities, such as impostor syndrome and low self-confidence. I realized that eating disorders are not really about food. They are about anxiety, perfectionism, obsession, guilt, and desperate yearning for control, which merely present themselves through food. That’s why the advice “Just eat better” doesn’t help.

Needing to follow my meal plan despite being full desensitized me to eating when I was not hungry, so I no longer felt that I was wasting time and money. Moreover, by eating sufficient portions regularly, I began to wake up hungry sometimes and become hungry again by lunch and dinner. I managed to attain a healthy weight around the end of January. My intrusive thoughts about food abated nearly to zero. Thoughts about body image, however, remained. Several shirts and pairs of pants became too tight. I repeatedly checked my girth in the mirror and noticed with some dismay that it was expanding. However, every time I worried that I was becoming too fat, I reminded myself that those fears were disordered and I needed to trust my case manager.

At the beginning of the spring semester, my case manager thought I had made enough progress to switch back to IOP. Balancing nine hours per week at IOP with lab rotations and two classes proved difficult; my grades dropped somewhat, but that price was tiny compared to the benefits of CEDC. I wrote a Python program to organize recipes and make grocery lists. I experimented with new frozen foods from Trader Joe’s and meals that were more cohesive than I had previously assembled, such as chicken with rice and stir-fried vegetables. One of my friends whom I had told about CEDC invited me to a creamery (after asking if it was okay), and that was the first time I’d enjoyed eating ice cream in years. I was able to buy a bag of sugar, with which I baked cookies for my lab. For my birthday, I invited several friends over for dinner and homemade cake.

My case manager had me rank favorite childhood foods from 1 (tame) to 10 (terrifying). Then she told me to bring them to IOP, starting with chicken tenders and fries (fear = 6). As I placed my order at Mr. Bartley’s, I had to remind myself that the other customers were not judging me. Surprisingly, I enjoyed the meal more than I worried about the fat. Two weeks later, I brought a hamburger (fear = 9), the first I’d eaten since 2014; and, on Pi Day, two hot dogs (fear = 10) and an apple pie. In the controlled and supportive environment of IOP, I was finally able to realize that occasionally eating these foods would not kill me prematurely, but orthorexia could. Pleased with my progress, CEDC discharged me on April 10, 2019.

A healthier future for us all

As I’m writing this, over a year later, I have experienced only one minor relapse, for about two weeks in July. Still, I often think about glucose or saturated fatty acids filling my blood after a rich meal, or think “Don’t eat that food: it has too much whatever.” To avoid relapse, I eat the food; I can now convince myself that it poses no problem so long as I eat it in moderation. The problem is, I see “Don’t eat that food” everywhere: ads, blogs, books, Trader Joe’s “Reduced Guilt” wheat crisps, even conversations with well-meaning friends. For most people, being bombarded with messages to eat healthily probably does no harm. However, in people who have or have had eating disorders, messages to eliminate this or that food can trigger harmful behaviors.

More people than you think may have eating disorders. Many patients I met at CEDC were high-achieving students or postdocs at MIT or Harvard. The Healthy Minds Study 2015 reported that 1 in 20 MIT grad students (1 in 13 nationwide) has an eating disorder. Most of my graduate classes have had at least 20 students.

As the opportunity has arisen in conversation, I’ve mentioned my eating disorder to most of my friends, most of the PIs I’d worked with, several administrators, many healthcare providers, and many strangers. Everyone has responded favorably, some expressing sympathy and others even confiding their own mental illnesses, and I’m very grateful for that support.

But I think we, collectively, can do a much better job at encouraging a peaceful relationship with food. Wellness culture is so inculcated in many of us (including me) that we can inadvertently vocalize judgements that may trigger eating disorder behaviors in others. Have you ever publicly chided yourself for “eating like shit,” praised a fad diet, or described a certain food as “unhealthy?” (I once heard an MIT student call a praline “dangerous.”)

If we want to mitigate the grad student mental health crisis, a great place to start is to stop judging food. I don’t mean we’d best eat pizza three meals per day. But I do mean we would do well to stop condemning carbs and belittling ourselves when we eat them. To stop touting restrictive diets without proper evidence that they would benefit everyone listening. To start supporting each other’s food choices, so long as they are balanced over time. To tell an indecisive friend, “If you want that slice of pizza, go for it.” This attitude alone will not cure eating disorders, but it could reduce the triggers, help those who are recovering, and encourage those with eating disorders to seek treatment. It could be a simple step towards a healthier MIT.