An Apple a Day (25 page)

Walking back to the British Library eating my apple (lamely awarding myself a gold star for eating in public), I realize that feeding myself is impossible. Look at me—I don't even know where to start. Of course this is what Tom's “action plan” was designed for: to take the angst out of recovery, to provide simple
rules for me to follow. But it's not working—even the simplest meal plan is a threat. And this is why they call anorexia the “deadliest of mental illnesses”; this is why the mortality rate is so high and the recovery rate so low. Because we feel that feeding ourselves is “giving in.”

I sit down at my corner desk in the reading room, still hungry. Balzac isn't going well. I can't take in the words on the page in front of me, let alone translate them into English. How did I get from that positive upbeat conversation with my mum, when I vowed to eat double portions (and put the weight on quickly), to this experience of utter supermarket paralysis? Why is this process so jerky; why do I keep lurching from determination to helplessness?

I find an old notebook from years back, from one of Dr. Robinson's clinics, I think. Scribbled along the margin are the numbers 101.2, 101.6, 103.6, and 102.5, which I take to be my weight. (God, I was tiny then.) As I flip through the pages it all comes back and I can hear Dr. Robinson's voice, explaining again how the first stage of recovery is usually pretty difficult—he's seen it in hundreds of recovering anorexics, no one can predict how the weight will go on; there's no way to control it, just that the process is different for every patient. “Fluid retention, uneven fat distribution, and replenishing glycogen stores in liver = probable weight fluctuations.” He'd tell me things can take months to settle down, but eventually they will. “The rapid rate of weight gain will slowly drop off, metabolism will continue to increase—and more food will be needed to gain weight later.” Rereading this now, I can't work out whether I feel better or worse.

* * *

In theory, I understand what's happening here: a little food stimulates the appetite. Eat nothing at all and your stomach gives up hope. My natural appetite has kicked back in, simple as that. I suppose I should rejoice that the machine—my appetite and hopefully my metabolism—is grinding back into action. But this is what I feared all along, that I'm greedy, needy, and insatiable. It's the thin end of the wedge, isn't it? Relax the rules, start eating food regularly, and your appetite rages out of control. To be honest, starvation was easier.

This is another reason why anorexia is such a hard nut to crack. Think of other addictions, alcohol or drugs, and it's all about
not doing
. If you can just avoid the addictive substance, that's a start. Avoidance, abstinence—these are concepts I understand. Denying my urges, going cold turkey, not allowing myself things are what I'm good at. But there's no simple roadmap to quitting anorexia: as I've said before, it's about starting something, not stopping. Hard as I found giving up smoking (and I did), I just exerted every inch of my willpower during those first few days of powerful nicotine cravings. I was determined not to give in. I remember how proud I felt, beating an addiction that (as we ex-smokers like to remind everyone) is “stronger than heroin.” But, it turns out, beating anorexia is infinitely harder. You're surrounded by food all the time, but the “greedy” voice in your head is as loud as ever. You can't avoid eating altogether—no one can—but it's the one thing you can't handle.

How does anyone handle food without spiraling out of control into gluttony and obesity? How do other people eat? In all these months of discussing it with close friends and family, I don't think I've ever really asked. I decide to do what I keep being told to do (
reach out, ask for help
) and ask those close to me how I should deal with this hunger thing. I put down Balzac, fire up my laptop, and start typing emails.

The first reply comes from my aunt Alison—my mum's younger sister. She and my uncle Keith now live in Bridgnorth, up near Wales, so I don't see her that often, but we were close when I was a child and we've recently rediscovered each other.

You're hungry? This is excellent news, well done, Em! I'm delighted to hear that you're noticing what your body is telling you. Of course you're ravenous; you aren't eating enough so your brain is sending you messages. Remember learning to swim? Or to ride a bike? It's scary, and you're not sure you're doing it right—and sometimes you don't and hurt yourself and have to pick yourself up and start again—but there's a point when you just have to take the plunge. That's what you've done; that's why you're terrified. All those thoughts that have kept you trapped all these years won't disappear overnight, but I promise you, if you can just hang on in there and use all the loving support you've got around you, then you'll beat them. Focus on people who love you and will support you—like Tom and Katie and me, and no doubt lots of others too. We won't let you fall.

It's really difficult to give any practical advice when I don't know what or how much you're eating now, or how you feel about particular foods. I imagine your stomach will be easily upset if you aren't used to eating much, plus all the stress you're under. I'd maybe think about bland, comfort food, definitely some carbohydrates, which is what generally works for me when I'm really hungry. Do you ever have porridge? It's my great comfort food—granddad used to leave a big pan of it on the stove for us on winter mornings, and funnily enough Keith has started making it recently on our Rayburn! What about good-quality bread—nothing too heavy, maybe something with unbleached white flour. Toast is my other comfort food, and soup! I think the best advice
though is to eat what you feel like and you can worry about all the health stuff later. Honestly, a few months of eating an unbalanced diet really isn't a problem. Just practice staying afloat before you worry about technique.

I think long and hard about porridge, toast, and the alien concept of “comfort” food. I vow to practice staying afloat before I worry about technique. Then I get an email from Sunray in Switzerland, my friend from the BBC Health message board. I suppose it's that odd Internet mix of anonymity and intimacy that have enabled us to be honest with each other from the start: me about food, Sunray about fertility. She's just had two babies in quick succession, both boys, after years of trying. Like her online pseudonym, Sunray is full of optimism; I don't think I've ever once heard her beaten.

As silly as this advice may sound, if you're hungry the only answer is to eat! You're still underweight; your period still hasn't come back. You can't think about “getting fat” at this stage. You have to think about “getting healthy,” and there's a big range of “healthy” before you get anywhere near fat.

Protein foods are fantastic for filling you up and they're healthy. Brazil nuts are a fabulous way to stop the hunger pains. But, girl, you've got to eat more than 2–3 nuts, okay? Cheese is another treasure food, as is peanut butter. The idea might make you shudder, but now that your body's learning to be properly hungry (not starving hungry, but healthy hungry); you need to encourage that.

I can imagine it's frightening to “give in” to your hunger but you have to realize this is how to beat the anorexia, and it gets you another step closer to the baby you want.

You ask what normal people eat? I concentrate on three big meals a day, plus 2–3 snacks: a huge bowl of cornflakes and
linseeds, rice cakes (about 6–7), an apple, a tomato mozzarella sandwich (big enough that it doesn't easily fit in the mouth, LOL!), corn cakes, some handfuls of mixed nuts, and then a full dinner plate—and I often go for seconds! That amount of food just covers my needs and keeps me full of energy for the boys. Each person is different but that's the sort of quantity you need to be a healthy weight with kids.

A few things to consider when you're pregnant:

—The lighter you are, the more weight you need to gain to make sure you and the baby stay healthy. If you were overweight, you could afford to gain a little weight, but being underweight, you'll need to go over the top when pregnant and eat loads! To give an indication, when I was pregnant first time I gained nearly five stone
(70 pounds)—
yes, you read that right! TBH, I loved putting on the weight, and had a great time pigging out! I was of the opinion of making the most of it and I'm glad I did ;-) That meant that, after giving birth, I had plenty of fat reserves to supply me with desperately needed energy.

—I hope this isn't the case, but you need to be prepared for morning sickness. I was lucky that my morning sickness was mild so I ate as normal. But, unfortunately, many women do suffer from it and lose weight in the first trimester because they're so poorly. You need to have enough fat that you can cope with any morning sickness that might come.

So, how can you eat like a normal person? The only way is to stop food controlling your life. Food is there to enjoy, not get stressed over. At this point in time you need to think about quantity and quality (lots of fats and proteins!). Please don't worry about “getting fat”—at the moment, it's impossible for you. Take care my dear.

I also email my little sister, Alice. She isn't the first person I usually turn to, not because I don't value her advice, but because she has enough health issues of her own to cope with. In Alice's case, the issue is ME or myalgic encephalomyelitis—also known as chronic fatigue syndrome. She's had it for years now, since she left university. At first the symptoms were fairly mild—like bad flu—and she was able to live a normal life. After graduating she moved to Italy, went through a series of handsome Italian boyfriends, and had various jobs in Rome and London. However, over the last five years the ME has become much more severe. For everyone in the family, it's a mystery: not that we don't want to help, but that we don't know how to. There's still no medical consensus on what ME actually is—a virus, a person's autoimmune system attacking itself, a psychological condition—and no cure. Just as anorexia makes those around me feel powerless to help, I feel the same about Alice and ME. I wish there were something I could do.

In many ways, Al and I are the closest of us children—we're the nearest in age (just twenty months apart) and similar in so many ways. Whenever I hear her voice on a phone message I think it's me talking, and we have the same tastes in clothes and makeup (and the same bad-frizzy-hair days). We spent all our time together as teenagers, juggling dates and wild nights out, and we're both much quieter now but still up for the occasional cocktail. We have similar thought processes: I can tell how Al will react to a situation instinctively. Like many close siblings, when we're communicating with each other, we hardly need to finish our sentences.

Al emails back when I ask her how she deals with hunger.

Hey Em, it sounds to me like your natural appetite which has been suppressed for so long has kicked back in, which is healthy
and normal. As you know with the medication I experience a lot of hunger, but I just try to eat plenty of lean protein, vegetables, pasta and oats and things like that. Three proper meals a day is a good place to start with healthy fats like avocados and lovely salads with vinaigrettes. Maybe write a meal plan of some sort? Babe I know you're worried about not being able to stop but if you allow your body to “guide” you it will tell you how much to eat. It's about making friends with yourself, I think, instead of this self-punishment thing. You will not get fat overnight. Remember, it takes years of overeating to put on weight. Try to feed yourself with love and care and that might help with the fear you're feeling. It is possible to put on a bit of weight without getting out of control!

It makes me feel very lucky to have all this help—and yet helpless, and humiliated. A significant part of my anorexia for more than a decade has been about rejecting the outside world and being independent, not needing other people or their food. What an irony, now, to be reduced to this, asking for guidance on such a simple matter. I need constant reassurance that it's going to be OK. I am pathetic. I am like a small child.

And recovery is so erratic. I veer from barriers up to floodgates down; I clam up and then I fall apart. I want to follow everyone's advice; I want to believe Tom when he tells me, “It's just part of the process, Em. In a few months this stage will be behind you and you'll feel strong again. Keep eating, things will work out.” I don't feel strong, I feel weak. I read everyone's advice and I try to put it into practice. I have to believe that a balance will come naturally, that I won't always feel this out of control. But the lion-hunger inside me continues to roar. I don't even know what I'm hungry for. Maybe, just maybe, it's nothing to do with food at all.

Chapter 13

Thank You

L
ong before Tom and I met I had made attempts to recover from anorexia—attempts that always fell by the wayside. My next promotion, or training for a half-marathon, or an ex-boyfriend, or a new bathroom seemed more important at the time. I didn't really want to get better, so anything was a convenient distraction. And I was full of fear: if I managed to gain three pounds I would panic and lose five. But now it's different. Now I see that getting better matters, that life with an eating disorder isn't a full life, that health and babies and love are important. I'm starting to learn that battling oneself every day isn't necessary—and that maybe, one day, cake might be a pleasure.