Friday, July 11, 2014

Gestational Diabetes and Disordered Eating - Real Advice (Thank God!)

There's an awesome website/group/resource up here called Berkeley Parents Network, or BPN for short. When I was getting the runaround from Kaiser last week about how to manage my new diagnosis and feeling horribly beat down by all the restrictions and judgment from the people who were supposed to help me, as well as the total inaccessibility of a nutritionist or someone like that, I turned to their "Advice" Newsletter (one of several I subscribe to) for help. It's an awesome thing - you write in, describing your problem, a few days later a big email with lots of questions goes out, and in one week (hopefully!) you have lots of responses. Here's what I wrote:

Gestational diabetes and eating disorder recovery
-------------------------------------------
I've been in recovery from various eating disorders, mostly bulimia, for about 13 years now. I still have periods of struggling with food and anxiety about weight but for the most part, I'm a healthy eater, emotionally stable, and adept at avoiding triggering situations that might send me down that rabbit hole again. I don't generally check my weight, don't read nutrition labels but eat a whole, mostly unprocessed, vegetarian diet and balanced meals with lots of whole grains and veggies and fruit, and generally eat what sounds good, trusting that my body knows best, and it has for a long time. Not to say I don't have ice cream or cookies or what have you!

Pregnancy, particularly the nausea part and the monitored weight gain, is a little trickier than my usual routine, but I stayed healthy and happy during my first pregnancy, and for most of my 2nd (I'm due in 7 weeks).

But...I was just diagnosed with Gestational Diabetes and now am confronted with all sort of rules and triggers for my disordered eating. 4 times daily blood sugar checks feel like immediate criticism or praise of my meal choices. Having to eat eggs in the morning brings on nausea. The literature that Kaiser is providing recommends all sorts of ''tricks'' that I used to do to avoid food - drink lots of water before meals, put half your food away before you start eating, etc, and there isn't much more help to be had. The weekly call-in for my blood sugar numbers requires me to divulge food choice for ''bad'' meals and listen to criticism about those choices. The registered dietitians have no appointments available to help with diet choices until the end of July, and only my OB seems to understand that giving lists of eating rules to someone like me may cause psychological harm. I was even told by one person over the phone to stop gaining weight, but also don't lose weight (I've gained 15 pounds total in 33 weeks). I'm still crying over that - you'd think a nutritionist would understand how much work went into allowing myself to be ok gaining pregnancy weight, but I guess not.


I'm hoping for success stories from others who have been in similar situations, vegetarian meal ideas, empathy, or any other kind of advice. I'm flailing, and I feel like I have to choose between my mental health and my baby's physical health. Isn't there a way to do this that won't make me feel crazy?

Thanks,
Just want to be healthy

And like the awesome people they are, the Bay Area members of BPN wrote back to me! This afternoon, the "Advice Given" newsletter had 16 (!) responses from people who only wanted to cheer me on and try to help. So I'm gonna share those responses here, in the hope that if someone else out there is looking for support for any combination of eating disorder, pregnancy, diabetes or something like vegetarianism or being gluten-free, that they'll find the same kind of emotional lift that I did from knowing I'm not alone (regardless of how Kaiser or the rest of the internet may have made me feel).

++ Gestational diabetes and eating disorder recovery
-------------------------------------------
I did the gestational diabetes program thru kaiser with the 4 jabs a day and the
weekly calls too but I don't have a history with eating disorders.

But here are my suggestions anyway. First look at it as INTERESTING. It will be
fascinating to see what meals get your blood sugar up. I was often surprised - my
trigger was fat more than carbs. Also I was fascinated to see my idea of a serving of
pasta or rice was way too much so even 10 years later I keep that in mind.

I too had gained too much weight at first. I actually ate more on the Gestational
diet but slowed down the weight gain I think because my blood glucose stopped going
all over the place. I have always had a self-diagnosed problem related to blood sugar
- pasta with creme sauce makes me almost go into a coma I have to lie down etc. so I
think finally for the first time in my life my blood sugar became level and that is
highly related somehow to weight gain - you may find that too that once you have
things level it will be easy to be at the right weight.

If eggs make you sick, do peanut butter or nuts. I found protein is key in regulating
blood sugar. This will only be complicated for a week - once you get into a routine
it will be easy. But time consuming. It would take me an hour in the morning to pack
up all my snacks.

Here are some I remembered. Oatmeal with some nuts (MUST be real oatmeal, I like
Steel cut), half apple with plain yogurt and almonds. Cheese cubes. Left over salmon
with left over rice and fresh spinach on top - yes I loved this for breakfast. Just
google sample menus for Gest Diabetes and follow one to the T - from there you can
make a few changes. And focus on veggies, salads, broccoli, blahblah. Eat left over
steak for breakfast or lentil soup - homemade, it is the easiest soup in the world to
make, takes like 5 minutes plus 40 minutes simmering.

Re the once a week nurse - yes I know what you mean but they know that you can't
control things perfectly, your body will respond to things in a ways you have no
control over. Just remember that these weekly talks keep you motivated to do it,
otherwise it is easy to slack off and they are not to make you feel bad. Think of it
as interesting, you will learn about your body in ways that will be helpful for the
rest of your life!
anon

-------------------------------------------
My second pregnancy, I was also diagnosed with gestational diabetes. I don't know
your case, but mine was ''borderline'' -- of the 4 blood-sugar draws, 2 were slightly
higher than the cut-off, so I got the label/diagnosis.

I was having all kinds of feelings about my weight and my health, given this. I went
to the nutritional counselor, and she was condescending and gave me the most basic
nutritional information (stuff, if you care at all about your health, you already
know). I was overwhelmed, and it made me feel awful about myself. But then I talked
to my ob-gyn quite frankly about it. We weighed all my feelings, and talked about
risks, and what Kaiser was trying (well-meaning) to do.
I monitored myself daily for two or three weeks, checked in with my ob-gyn, and
decided to scale it back.  We agreed that I just wouldn't subject myself to the
weekly call-in, if I checked in with her.

You know what? YOU DON'T HAVE TO CALL IN, you don't have to take every blood sugar
test, you don't have to do it all. I stopped -- I never called it in, I never
subjected myself to the advice nurse and reporting my daily numbers and meals. I knew
I was okay, and I took my numbers in to my ob-gyn and did spot checks there rest of
my pregnancy.

One thing I think it bears reminding: you know yourself better than anyone (even your
ob-gyn), and you do NOT have to subject yourself to Kaiser and its weekly calls and
oversight (and, in my view, its medical industrial complex). In my first pregnancy
and during delivery, I suddenly realized that I didn't have to say YES to everything
any random medical professional would recommend when she/he came into my delivery
room. And this is empowering: you are in charge, not the weekly call-in nurse. And
you can just NOT DO IT.

Back to Gestational Diabetes: you need to take care of yourself, and that INCLUDES
your mental health. Kaiser is going to over-protect you on the diabetes, because they
can see it and measure it and it protects them from liability. But you need to think
about how YOU are, because YOU are in charge of your own health and well-being.

Just a reminder: you can just say NO. No to weigh-ins, nutritional counseling, etc.
You can stop pricking yourself and feeling awful and bringing up all your old issues.

Take care of yourself, take care of your baby.
But remember, it is OK to say NO to Kaiser. They don't advertise that, because it
makes their jobs harder, but they will accept it.
- Advocate for myself

-------------------------------------------
Yipes. I have leaned towards disordered eating for a long time, and had gestational
diabetes when I was pregnant with my daughter. First, commend yourself for being in
recovery and adapting an intuitive eating style. That's no small feat and something I
continually struggle with. What worked for me with GD was figuring out what foods
sent my blood sugar through the roof, and cutting back or eliminating those. Milk and
cheese were big triggers for my blood sugar, so eliminating those really helped. It
was hard for me not to go back to the black and white thinking and tons of anxiety
with foods being good or bad. But viewing them instead of blood sugar spiking or not
helped a bit. The Kaiser nutritionists (back in 2008 anyway) were horrendous and not
helpful. Can you talk to your OB and ask for some wiggle room on the check ins? For
my second pregnancy I didn't get tested for GD (I refused), but took my own blood
sugar regularly to make sure it wasn't out of control. When I saw
 my numbers trend up a bit, I felt empowered to act on my own volition and I knew
what to do and reported them to my OB. My OB was enormously helpful and recognized
that the extra stress and anxiety was not good for my baby either. It seems like that
might be more helpful. That way you're in control and not feeling like you have to
report to someone, but are on top of it and providing info. Email me if you want to
brainstorm further
Heather

-------------------------------------------
First of all, you sound like an amazing and strong person with a good head on your
shoulders!  And congrats on #2!  I had GD with my second, and with no history of
eating disorders, I still found it emotionally trying.  The dietician (at Kaiser) was
a complete joke (I created my own diet with zero grains and a treat of fruit or
yogurt once a day and found that it worked much better than the craziness that she
was advising).  I definitely used ''tricks'' but mine were walking after most meals,
and drinking one glass of red wine before dinner (which Kaiser would NEVER have
recommended, but it took my numbers down quite a bit.  The weekly check-ins were
tough, but most of the time I had wonderful and understanding nurses on the other
end.  Even so, I ended up in tears a few times as I was trying SO HARD and still had
a tough time getting my fasting number down.  (I finally moved my prenatal vitamin to
the morning instead of the evening and it totally worked).

All of that to say that this might be a good case for medicating the GD.  I am NOT
one to suggest that lightly, but your state of mind is just as important to your
baby's health as keeping those numbers down, and it would make it so much easier--see
what your OB has to say.

Happy Mama=healthy baby.  You can do it!
GD mama

-------------------------------------------
Hi, I had gestational diabetes and am not a big fan of eating too much meat or a
steak & eggs breakfast.  I'm not sure of what you eat, but if you like nuts or almond
butter, maybe you could combine some with your breakfast of fruit to help those
numbers go down.  My numbers were even harder to control during my second pregnancy
that I ended up using insulin with meals.  I told the dietician I was feeling a
little ill trying to eat so much meat or protein with my meals that they tried to
help me through it with insulin.  They also saw that I was strictly eating very small
portions every two hours throughout the whole day during waking hours which was very
tedious plus I would wake up at night starving because my numbers were so high with
small portions such as 1/2 a cup of beans..  I was kind of at my last straw which is
why I resorted to the insulin.  It made me a much happier person.   That could be a
possible option for you although I do not know your thoughts on meds.  Ha
ng in there and try your best with the dieting..
Anon

-------------------------------------------
You've gained 15 lbs. in 33 weeks, which is excellent, and clearly demonstrates good
self care. At this rate you'll gain a total of 22 lbs. Your development of GD is not
because of poor choices. Your diet has been excellent. So even though you didn't have
high risk factors for GD, you got it anyway. Sometimes life works out like that.
It's too bad that your OB is clueless about your triggers. The standard literature is
aimed at unhealthy/overweight eaters, not you. The advise to ''not gain anymore'' is
BS and totally unrealistic and unhealthy. So you've encountered two health care
professionals that were unhelpful. This is their issue. Not yours. Try not to
internalize their shortcomings as yours.
Certainly you want to try to stabilize your blood sugar in these last few weeks.
Studies show that just 20 minutes of moderate level aerobic activity (the test used
stationary bike) regulated maternal glucose enough so that women with insulin
dependent GD were able to go off meds.
So most likely, you can take control of this by getting a minimum of 20 minutes, (30
would be even better) of moderate level aerobic exercise, daily. Fitness walking,
elliptical, stationary bike, swimming, aqua-aerobics, and treadmill are all good
choices.
BeFit-Mom, http://www.befitmom.com

-------------------------------------------
I have long suffered from whacky, shaky bouts of low blood sugar. Thirty years worth.
Many years ago I met with a nutritionist and learned some basic rules of eating but
never have been able to master the problem. Recently, I was told that I am
pre-diabetic, blood sugar around 110 or so. I am not overweight and don't eat sweets
or fast food, and I've been vegetarian for years. Parents have both been diagnosed as
Type 2 diabetic after many years of poor eating and being overweight. I have found
great value in maintaining control by drinking Optifast shakes. They are
nutritionally complete meal replacements typically utilized by overweight people
under medical supervision during weight loss. I don't use them for weight loss, but
since they are balanced in terms of fats, sugars, protein and minerals / vitamins
they are very satisfying for the 160 calories. I drink one for breakfast and I keep
them with me at the office, in the car, and even in the living room. Anything to
combat wild hunger pangs followed by low blood sugar issues. I realize that you are
dealing with high blood sugars but control is the issue.  Although anyone can
purchase Optifast products over the internet, it might be worthwhile to see if you
can get them by prescription or permission at Kaiser. During Kaiser's medically
supervised weight loss program, the patients can buy Optifast at a very reasonable
cost, so you would save quite a bit purchasing them through Kaiser if possible. My
friend completed the Kaiser Optifast program and I recall his mentioning that the
doctors said that many Type 2 Diabetes patients were able to go off pills and / or
insulin after being on the Optifast program.  Cheers!
Melanie

-------------------------------------------
Not a doctor here, so sorry if this is a ''stupid'' question. Why can't you just take
the easy way out and get some metformin while you are pregnant, and then eat as you
want to? It sounds as if you are eating very well, and so what if you happen to eat a
little more sugar (including starch) sometimes? I have type 2 diabetes, and take
metformin, and my blood sugar is fine. couldn't you do that? Maybe you should ask
your doctor.
Best wishes

-------------------------------------------
I can offer advice on vegetarian eating habits - I was diagnosed with GD 13 weeks
into my pregnancy! I'm vegetarian too and the thought of analyzing each meal (and
snack) overwhelmed me initially. But I quickly got into a routine and I found myself
not spending all my time planning my meals - I kept my regular nutritionist
appointments mainly because they did urine tests to check for the presence of
ketones(?). And don't put pressure on yourself to stay well within the limits all the
time. Sometimes, you will go a little over - just use that as a learning experience
and don't repeat the same combination of foods again. Here's the menu that I followed
-
Breakfast - 2 slices of toast with almond butter and (very little) jelly. 1 cup of
tea with 1/4 cup milk and 1/2 tsp agave syrup.
Snack - 1/2 banana or crackers or a small portion of some fruit.
Lunch - 1 cup quinoa with lentils and some vegetable and cottage cheese (cooked
Indian style). 1/2 cup yogurt
Snack - Tea again, with a slice of toast and some cheese.
Dinner - Similiar to lunch, except that I would substitute the quinoa with brown rice
or whole wheat tortilla.

This is just an example. The trick was to ensure the correct ratio of carbs to
protein (your nutritionist should be able to help you with this). Yes, the only thing
I gave up almost 80% was dessert, but I did indulge from time to time in very very
small portions. And yes, a 10-20 minute walk after every meal will do wonders for
your blood sugar numbers. I think the walk after every meal (especially when you have
eaten something high in carbs) always did the trick.

Good luck, I'm sure you will be fine and so will your baby. You don't have to stop
eating what you like (and it sounds like you already have a great balanced diet), you
just have to tweak the proportions a little bit. Stay on top of the testing though,
test after every meal (and fasting) and report anything unusual back to the doctor
immediately.
P

-------------------------------------------
Oh my god, what a nightmare! I am so sorry! Do you HAVE to opt into Kaiser's handling
of this?

I would call myself a disordered eater, though I have never had a full-blown eating
disorder. I go through periods of obsession over food as well. And I had gestational
diabetes OF COURSE because why should anything ever be easy? ugh.

Fortunately I had a terrific nutritionist AND a terrific friend who had just BTDT,
and both gave me very simple ways to deal with it and I found that their advice kept
my numbers where they were supposed to be.

The rules were:

Never eat just ONE thing. If you eat any carbs, combine them with protein. Bagel WITH
cream cheese never along.

Almonds all the time. Any time you are hungry.

Stay away from the scale, test blood sugar only.

And the best one:
Walk after eating. Your are likely to get a blood sugar spike after eating and
walking, physical activity, will mitigate that -- will keep the blood glucose from
spiking no matter what you eat.

I also got an app on my phone to keep track of all my finger-pricks because I just
love quantifying shit, and focusing on the blood sugar numbers kept me from focusing
on the scale numbers.

I have encountered SUCH ignorance around eating disorders. My current GP tried to
talk to me about my weight and I had to tell her ''I need to frame this as getting
healthy, not losing weight,'' and she was just flabbergasted and literally could not
do that. I hope you can -- I hope you don't have to keep talking to the nutritionists
about your food choices, that is such bullcrap and SO dangerous.

I know you can do this. I hope others have more specific advice about how to deal
with Kaiser.


-------------------------------------------
Hi,

Please just stop talking to those Kaiser nutritionists.  You're an educated person,
you're being responsible about your diet and your blood testing.  You've heard what
they have to say and weighed their advice.  Just stop communicating with them.  I had
a friend who had a very similar experience twice with GD at Kaiser - nurses calling
her to chastise her about her diet, making her cry every single day. Her husband is a
doctor at Kaiser and he told her to just stop answering the phone.  Her deliveries
and babies were just fine.

If you had different insurance, you wouldn't be badgered by nutritionists and your
outcome would almost certainly still be good.  You clearly have FAR more insight into
your own health issues than they do.
Press the mute button

-------------------------------------------
I'm breaking my response up into two messages to have room for it all. This is Part I
of my tome:

I sympathize with you. About a year ago I was diagnosed with GD with my second
pregnancy, and I too have a history of eating disorders going back over 20 years.
And I was with Kaiser too!  They have their strengths and weaknesses, and dealing
with a subtle, not-well-understood condition like GD is not one of their strong
points. I too felt shamed, lectured at, etc.

Now that the experience is over, I look back at it with a bit of fondness, as it was
actually very interesting and educational. Here's what I can tell you:

-Try not to feel bad about yourself for having the illness at all!  Before I was
diagnosed, I had some vague sense that GD was what happened to overweight/obese
mothers with bad diets. I should have known better. I was at a healthy weight before
getting pregnant and like you ate a very healthy diet--but I do have a brother with
Type 1 diabetes, a father with Type 2 which may actually be adult-onset Type 1 (he
was never overweight and always ate very healthily), and apparently a
great-grandmother from the old country who was blind as a complication of diabetes.
It clearly has a strong genetic component for some of us. But in addition to my own
personal sense of shame, I had to cope with one or two people who didn't get it
(hello, mother-in-law) and let drop some of those nasty stereotypes floating around
out there about diabetes...if this happens to you (and some of these stereotypes do
seem to be floating around the healthcare community), just say screw 'em.  Oh, and 15
lbs w
eight gain at 33 weeks is NOTHING.

-The cookie-cutter diet you get from a place like Kaiser is a helpful source of ideas
but should NOT be followed to the letter. If your guidelines are like the ones I got,
I actually think--after reading extensively on the topic--that it's not ideal for
controlling GD.  For example, it always said to eat low-fat dairy, whereas full-fat
dairy is generally recommended for controlling blood sugar. There was a lot of
''boneless skinless chicken breast'' type stuff on the recommended diet. I ignored
that. Fat is your friend if blood sugar is your enemy, and I was a big believer in
''eat real food'' before pregnancy.  So I ate chicken cooked on the bone with skin
on, and pork roast, and lots of cheese; and all that worked out fine for me. I also
believe (though I didn't experiment with this personally during my GD days) that
there really isn't that big a difference between ''whole grains'' and white flour for
blood sugar/insulin purposes. So, for example, you may well do just as we
ll with a portion of a butter croissant as with a slice of whole wheat toast...and
it'll taste better. If you were not overweight before pregnancy and have not gained
more than the recommended amount of weight, I recommend you do something similar.
Not being miserable and nauseated by what you eat is important for keeping stress
levels down.
long-winded GD mom

-------------------------------------------
Part II of two-part response:

-Personal nutrition is an art, not a science. In the beginning, I tried to do exactly
what the diet guidelines said, and it didn't always keep my blood sugar where it
needed to be. So I experimented. By the end of my pregnancy, I was an expert in what
I needed to do to keep my own sugars within range (for example, eating even fewer
carbs than they recommended at breakfast).  In my weekly meetings with the food/blood
sugar police ladies, I went from a B- student to an A+ student.  So if you have
trouble controlling your blood sugar at first, don't despair, and don't beat up on
yourself. Pay attention to what you eat, look for patterns, and you'll find something
that works.

-Exercise after meals had a HUGE impact for me and seems to for many others. If I
walked at a vigorous pace for 10-20 minutes after each meal, I'd always end up with
blood sugar where it needed to be. Over time I realized that this gave me more
freedom to eat, like, TWO slices of bread at a meal and still be fine.

-I could not for the life of me get my fasting blood sugar in the recommended range.
They put me on nighttime insulin early, and even that wasn't working.  So I turned to
the internet for advice, and found the answer: a small serving of full-fat vanilla
ice cream mixed with a little nut butter every night before bed. That worked where
nothing else had--and had the added bonus of soothing any carb/sugar cravings I had.
This would have been verboten among the people monitoring me at Kaiser, so I just
lied in my log and said it was Greek yogurt rather than ice cream. Which goes to my
point about: find what works for you, and don't take the professionals THAT
seriously.

-Are you a vegetarian for health reasons or ethical reasons?  If the former, you may
want to consider changing that. If you have GD, diabetes becomes one of your
long-term health bogeymen, and I think it's easier to stave it off if you eat meat. I
too hate eggs in the morning and would not have made it through GD without Trader
Joe's chicken breakfast sausage.

-BUT if you're looking for ideas for GD-friendly vegetarian non-egg breakfast, my
advice is to toss the concept of breakfast out the window and eat, say, vegetables
roasted with olive oil and parmesan cheese.  I'm currently on a quest to lose the 5
lbs that never came off after baby #1, and to do so I'm avoiding starchy carbs 2 days
out of 3, at the same time that I'm trying to dial my meat consumption back some. So
I've had roasted cauliflower and heirloom tomato salad for breakfast, and I've grown
to love it. When I'm feeling lazy, I go to the Korean market and get a variety of
Korean vegetable banchan and pull that out of the fridge in the morning.

-This page is a wonderful, intelligent resource that acknowledges and explores all
the complexity of GD: http://www.plus-size-pregnancy.org/gd/gd_index.html.

Good luck!  You can ask the moderator for my personal email if you want to talk
further.
long-winded GD mom

-------------------------------------------
Hi

I'm sorry this sounds really difficult.
I too had gb, and found the diet onorous and emotionally taxing.

However, I think if you push, maybe you an find a dietitian who give a you more
constructive diet advice. Through alta bates, their primary advice was to balance
proteins and carbs. I ate a lot of cheese sticks and nuts with everything. Of course,
all sweets were out, and fruit and carbs I had to meter out. Also, even though I felt
tired fr the pregnancy, I made sure to take a ten minute walk after every meal to try
to balance things out.
If you are a vegetarian, maybe beans, quinoa, nuts and cheese will help you balance
out the carbs.
I ate a lot of meat and eggs.
Wishing you well.
-
Me

-------------------------------------------
First of all, I want to say that I relate so much to your post. While I didn't suffer
from anorexia as seriously as you have suffered from your eating disorder, it did
consume my life in high school and I was about 25 lbs underweight. I still remember
the counting and the obsessions and the self-hate like it was yesterday. My only
escape was to stop thinking about food/calories/thinness entirely, and so many years
later I'm overweight because I never ever put myself on a diet, never ever allow
myself to feel defined by my weight, and while I try to eat healthy overall indulge
myself in treats a lot. It's not healthy to be 40 lbs overweight either I know, but I
needed to go cold-turkey or the anorexia would have taken over my life and possibly
killed me. So, I'm sorry that you have suffered with an eating disorder - it's
miserable and so hard to escape. Congratulations. I also had gestational diabetes
(was diagnosed at 29 weeks) and when I had to cope with the diet and finger
pricks and eventually had to take medication to keep in under control, I immediately
felt like it could trigger an anorexia relapse. I suddenly was counting every carb,
mapping out meals way in advance, keeping a diary of my food, feeling shame over
explaining my eating decisions to doctors, feeling like no matter how strictly I
adhered to the diabetes diet (I was fanatical), it wasn't enough and I still needed
medicine. I felt like a failure, GD was all-consuming and taking over my thoughts and
life. I remember thinking ''what would I do if I was still a vegetarian?'' (was
veggie for 10 years). I don't have answers for you on the vegetarian front. Eggs also
make me gag so I made a lot of tofu scrambles. I ate so much chicken, cottage cheese,
almonds and peanut butter when I was on the GD diet that I can barely stomach those
items nearly 3 years later. It's REALLY HARD to deal with GD - drs don't emphasize
that enough. Please allow yourself to cry and get upset that you have
 to face this illness while pregnant. It is not fair. It is !
not fun, and it is REALLY stressful. But you will get though it. I got a big
calendar and made large red X's every day that went by as my pregnancy progressed. I
found 10-15 meals that worked for me and repeatedly ate those meals week after week.
I couldn't go to restaurants, I cried many many times unable to satisfy pregnancy
cravings, I cried at the grocery store, I sobbed when my husband ate pancakes once.
It was extremely emotional. Please just hang in there. Eat as much protein and fiber
as you can (I know, I know). I treated myself to lattes and eating 2 avocados a day.
I just want you to know you're not alone. The only silver lining was that I felt much
much better physically when I was on the GD diet (I knew something was wrong and
could feel my body change under the diet). It also allowed me to only gain 25 lbs
while pregnant and the weight came off quickly once I gave birth. My child is totally
healthy. YOU CAN DO IT.
Soul Sister

-------------------------------------------
First and foremost, HUGE respect for conquering your eating disorder and a big
congratulations on your pregnancy.  This is hard, and of course I can not condone how
you are being treated.  But I'm not going to focus on that; I think the value here is
focusing on YOU and how you can respond to this negative input.  Can you think of
this as a kind of Phase II of your recovery?  It's beyond admirable that you have
come so far, creating a safe space for yourself around food and surrounding yourself
with positivity and support.  Now here comes a big dose of the real world, and it's a
tough pill to swallow.  And you can stay strong despite this.  Think of yourself,
maybe, as an addict re-entering the world after rehab.  You get well and strong in
this supportive environment, and then that strength is tested when faced with the
reality that the world will not be kind to you all the time or acknowledge your
struggle and your triggers.  That's ok.  You can stay strong.  You can detach
 from this negative input; it does not have to break you.  It doesn't even have to
hurt you.  It's an annoying and inconvenient process that has a definitive end date
(when you meet your sweet baby!).

In the meantime, up that support.  Talk about this as much as possible.  There is no
shame in your past or the fact that this is a trigger for you.  I have deep respect
and admiration for you and people who want to support you will feel the same way.

Here's to a happy, healthy pregnancy and birth that only reinforces your strength,
power, and profound inner wisdom.
Katie 

So there it is...I was almost in tears by the end, but also I felt so much better. I'd had a crummy call with the diabetes number checker yesterday (seriously, how many times do I have to say "I WAS CAMPING FOR 3 DAYS" before you get that not all food options were available? Also, you don't have to explain to me that there are carbs in dried fruit and M&Ms. I'm pregnant, not stupid. I didn't even eat any fucking M&Ms. Ugh.) so this was like a breath of fresh air. Mom's encouraged me to just tell people the conversation is over if they can't understand how to talk to someone who's had an eating disorder, and man, did BPN back her up.

Now here's hoping I've got the strength to actually do it when I have my next appointment - finally seeing a nutritionist on Tuesday...wanna take bets about how helpful she'll be?

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