Exercise is the Best Medicine - unless you have Diarrhea ... Exercising with Inflammatory Bowel Disease

An estimated 1.6 million people in the United States live with inflammatory bowel disease. Inflammatory bowel disease (IBD) is a term used to describe any condition that causes chronic inflammation along the digestive tract.[1] The two most common forms of IBD are Crohn’s Disease and Ulcerative colitis. Crohn’s disease can affect anywhere along the digestive tract, from the mouth to the anus. Ulcerative colitis is strictly in the colon, which is made up of the large intestine and rectum.[1] They are chronic conditions with unpredictable courses of disease. They can be medically managed, but there are currently no cures. In people with IBD, the immune system reacts inappropriately, and can mistake benign or beneficial cells and bacteria for harmful foreign substances.[1] When this happens, your immune system can do harm to your gastrointestinal tract and produce the symptoms of IBD. Symptoms of IBD can include: Diarrhea, rectal bleeding, urgency to move bowels, constipation, abdominal pain and cramping, fatigue, loss of appetite, and other extraintestinal manifestations. Patients with IBD experience periods in which their disease is active, also called a flare, and periods where they experience no symptoms, also called remission. [1]

Currently, the most common way to manage IBD is with medication prescribed by an MD. Taking maintenance medication can reduce risk of flares. There are various classes of medications depending on the severity of the disease. Paying attention to your diet can be another way to reduce symptoms, replace lost nutrients, and promote healing. Dietary recommendations vary depending on what parts of the intestine are affected and what symptoms you have. Complementary medicine can also supplement conventional medicine. [1]

So where does exercise, especially running, fit into all of this? Can someone with IBD run without affecting their symptoms or the progression of their disease? The possible beneficial effects of physical activity on the gastrointestinal tract have been little studied so far. Unfortunately, the effectiveness of exercise has not been well described in these persons, and the mechanisms of potential benefits are poorly understood. [2] Exercise has been shown to be inversely correlated with systemic low-level inflammation, meaning that regular exercise may be responsible for good health effects in patients with chronic disease.[3] The effect of exercise on different immune parameters could depend on type, intensity, and duration of exercise. Lower and moderate intensity exercises have been shown to be well tolerated in patients with IBD who were in a state of remission. According to a study by Ploeger, et. al in 2012,  moderate intensity exercise did not provoke subjective symptoms or changes in gastrointestinal parameters. This same study found that high intensity interval exercise also did not exacerbate symptoms in pediatric patients. [2] However, a review done by Narula and Fedorark found that acute strenuous exercise may induce transient mild systemic inflammation, increasing the amount of inflammatory cytokines. Intense exercise can impair function of the immune system for several hours. [4] Inflammation is characterized by the interaction of pro- and anti-inflammatory cytokines.[5] Cytokines are small proteins that are important to the function of the immune system. They modulate balance between humoral and cell-based immune response, and regulate maturation, growth, and responsiveness of particular cell populations [6]. Myokines, a type of cytokine, are released during exercise via skeletal muscle contraction. Myokines have an anti-inflammatory effect, which, according to research, makes this a benefit of regular exercise. [6] The proper dosage of exercise may be able to alleviate colitis symptoms, reduce inflammation, and counteract some of the adverse effects of pharmacological therapy. [2]

It seems there is still a need to research higher intensity exercise, as well as longer duration exercise. What is considered high intensity and how is intensity of exercise graded? Exercise activity is graded in metabolic equivalents, or METs. One MET is the amount of energy it takes to sit quietly. [7] Vigorous activity is defined as anything greater than six METs. Activities that are greater than six METs include: hiking, playing soccer, basketball, or running at 6 MPH or faster.[7] In healthy athletes, higher intensity exercise has been found to produce GI symptoms and disturbances. It has been hypothesized that bile, pancreatic secretions, and bacteria cross junctions in the small intestine and can create a local immune response.  This phenomenon was found to occur at 80% aerobic capacity peak exercise, however, it was not found to occur during low intensity exercises, typically between 40-60% of peak aerobic exercise. [8] The urge to defecate is another common GI disturbance during exercise. There is a decrease in colonic phasic activity, offering less resistance to colonic flow and decreased transit time, leading to this urge to defecate. This is an undesired side effect for someone with IBD who is diarrhea-prone. [8] For those with moderate to severe symptoms, exercise may be discouraged due to physical restrictions, inconvenience, and discomfort. [3] There has been limited recent data suggesting that high intensity endurance sports may be safe in some IBD patients. In 2016, a small prospective study of ten IBD patients participating in high intensity exercise had no change in fecal calprotectin (a measure of acute inflammation) levels. These were patients who participated in activities like triathlons, marathons, and long distance bicycle races. [9] Eight of the ten patients had no change in their symptoms or disease activity scores. The two patients with Crohn’s disease who had elevations in their disease activity scores had returns to baseline in these scores within one week. [9]

Exercise in general has positive effects for persons with IBD and other chronic diseases. Persons with IBD are more susceptible to osteoporosis as nutrients are not digested or absorbed as well, and exercise has been shown to increase bone density.[10] Exercise increases flexibility and strength that can reduce joint pain. Fatigue and low energy are common extra-intestinal symptoms. Exercise increases blood flow throughout the body and improves cardiovascular health and fitness. This allows blood and oxygen to be pumped throughout the body, providing energy to do more work. This can reduce the feelings of fatigue. Exercise also can decrease time for gastric emptying and decrease blood flow to the gastrointestinal system. [10] Persons with IBD tend to have higher levels of stress and lower quality of life reports, and stress can aggravate digestion issues. Studies have shown exercise to be beneficial in both of these categories.

Although there are limited studies showing the how long distance or high intensity running positively or negatively affects the symptoms of IBD, the internet and online forums are littered with tales from runners with IBD. It is important to make sure your gastroenterologist is aware of your activity, and be aware of the way your body responds to the activity.  Moderate to severe symptoms may limit the ability to do more intense exercise, but for those in remission or with mild symptoms, there is promising data and anecdotal support. Further research will have to be done to help establish exercise regimens that can account for each IBD patient’s unique presentation.

1.Crohn's and Colitis Foundation. “Crohn's & Colitis.” Crohn's | Colitis | IBD | Crohn's & Colitis Foundation, Crohn's and Colitis Foundation, 2015, www.crohnscolitisfoundation.org/?referrer=http%3A%2F%2Fwww.crohnscolitisfoundation.org%2Fwhat-are-crohns-and-colitis%2Fwhat-is-crohns-disease%2F%3F.

2.H. Ploeger, J. Obeid, T. Nguyen et al., “Exercise and inflammation in pediatric Crohn’s disease,” International Journal of Sports Medicine, vol. 33, no. 8, pp. 671–679, 2012.

3.  Bilski, J., Brzozowski, B., Mazur-Bialy, A., Sliwowski, Z., & Brzozowski, T. (2014). The Role of Physical Exercise in Inflammatory Bowel Disease. BioMed Research International, 2014, 429031. http://doi.org/10.1155/2014/429031

4.Narula, N., & Fedorak, R. N. (2008). Exercise and inflammatory bowel disease. Canadian Journal of Gastroenterology, 22(5), 497–504.

5. Cavaillon JM (2001) Pro-versus anti-inflammatory cytokines: Myth or Reality. Cell Mol Biol (Noisy-le-grand). 2001 Jun;47(4):695-702.

6. Cytokines. (n.d.). In Cytokines and Cells Online Pathfinder Encyclopedia version(2013 ed., Vol. 31.4).

7.“Measuring Physical Activity.” The Nutrition Source, Harvard School of Public Health, 29 Sept. 2017, www.hsph.harvard.edu/nutritionsource/mets-activity-table/.

8. Ng, V., Millard, W., Lebrun, C., & Howard, J. (2006). Exercise and Crohn’s disease: Speculations on potential benefits. Canadian Journal of Gastroenterology, 20(10), 657–660.

9. Hassid B, Lamere B, Kattah M, Mahadevan U. Effect of intense exercise on inflammatory bowel disease activity. Am J Gastroenterol. 2016;111(S1):S260–S336.

10.Perez, C (2009). .Prescription of physical exercise in Crohn's disease Journal of Crohn's and Colitis, December 2009: 3(4):  225–231,

                                                                               

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               

My Crohn's Story

Crohn's disease still seems fairly new to me. I started experiencing symptoms about 4 and a half years ago. I remember my first really bad day of symptoms. This was in mid-December of 2012 - it was a Thursday. I was driving to a staff meeting at our main hospital campus that morning and I just did not feel good. I felt a little queasy, but I was going to try to get through the work day if able. We had a 2 hour meeting and I just progressively felt worse as time went on. I had to run to the bathroom about 40 minutes into the meeting. I remember telling my supervisor that I was going to try to make it through lunch, but to cancel my afternoon patients. I must have looked as bad as I felt, because he told me to just go home and they would take care of the other patients. I tried to stick it out through the meeting, one of my co-workers told me to go ahead and leave because my face was turning greener and greener. I left the meeting at the hospital and drove back to Alex and my apartment (we lived in an apartment after we first got married). I went home, went to the bathroom again, and just laid on the couch. We had just gotten our two kitties the week before and I remember they just laid beside me or on my stomach that whole morning and into the afternoon. I guess they knew that their new mom was not feeling good ;) I alternated between laying on the couch and going to the bathroom. I believe I had about 8 bowel movements that day, which is definitely way too many (and sorry for the TMI). Over the weekend, I still did not feel great, but it was not as bad as that first day. I was at a continuing education course that weekend, just praying that nothing embarrassing happened! I thought maybe I was not feeling so hot due to the stresses of newfound adulthood, trying to figure out how to do holidays as a busy adult (I still miss you, winter break!!!), and getting caught up in some holiday eating. I felt a little bit better over the next few weeks, but I was definitely not my normal self. About 6 weeks (February of 2013) after my first flare up of symptoms, I noticed blood in my stool. This was different and this was scary to me. I called my (then) primary care doctor's office right away ... literally right after I got out of the bathroom. They got me an appointment in a few days.

I remember that appointment. I described him my symptoms and he poked around on my abdomen. The right lower quadrant of my abdomen was so uncomfortable. He wanted to get me into a gastroenterologist and sent in a referral for a colonoscopy. He told me he wanted to make sure I was not experiencing something like "skip lesions." I will admit, I Googled skip lesions almost as soon as I left the office. When you Google skip lesions, the words that pop up along with that are ... you guessed it! ... Crohn's disease. My heart sank. Crohn's disease? That's what we were ruling out? I knew people who had Crohn's disease. And all of them had it bad. I am talking about steroids leading to puffy faces, multiple surgeries, whole colons removed. Bad, Bad. Bad. No way this was happening to me. I always prided myself on being the one in my family with the strong stomach. Plus ... I was a newlywed! What a horribly un-sexy disease diagnosis looming over me. I ended up scheduling my colonoscopy with the GI doctor my mom had seen, Dr. Callon. I got this scheduled about 3 weeks after my primary care appointment.

The day before my colonoscopy, I was put on a strict eating plan. I could eat a light lunch and have my caffeine then, also. But for dinner and beyond, it was broth and yellow Gatorade. Oh, yeah and my bowel prep. I cut that with Ginger Ale. That was a real joy. You see, the purpose of bowel prep is to clear out that intestinal tract prior to them shoving a scope up your rearend :) It made for a truly delightful evening and morning prior to this procedure. The prep was almost sickly sweet. It would not have been so bad if it weren't for the sheer volume of fluids I had to ingest. I can no longer smell Ginger Ale without wanting to gag a little. I used to like Ginger Ale. I will probably just have to use it to cut the prep for all my future colonoscopies, I don't want to ruin any other beverages. No food or drink after midnight. I always hate that rule, I always get so thirsty at night because I sleep with my mouth open!!!

My mom took me to my colonoscopy appointment that morning, she was also to be my chauffeur when I was done with the procedure. I was called back into a room with hospital beds and changed into a beautiful gown that loosely covers your back end. One of the nurses chatted with me and got a little history. They wanted to know if I had been on any recent vacations. Alex and I had gone to the Dominican Republic for our honeymoon the month before my symptoms started. I did not think that this meant anything, but apparently there are slow growing parasites that can live in your intestines and the symptoms may take awhile to manifest. That's a comforting thought, isn't it?They stuck me with an IV and I waited until Dr. Callon came in to chat with me. I was wheeled back to a small room where they would do the procedure. Dr. Callon chatted with me about my career and my time at the University of Indianapolis as he filled my IV line with anesthesia :) I faded out and the next 30 minutes of my life are totally blank. What a weird feeling. I woke up in a recovery area and my mom was next to me waiting. They make sure you can pass gas before you leave ... it's really a lovely area. I was wheeled out to my mom's SUV in a wheelchair. There was another equally confused person who challenged me to a wheelchair race, the beauties of coming out of anesthesia. I remember telling him that I did not think it was a good idea! My mom took me out to lunch, because she is a nice mommy like that. I had the rest of the day off to recover ... because you really aren't supposed to do anything after you have been knocked out and scoped.

I was told the results of my scope shortly after this visit, the results from the biopsy would come a little bit later. I had a follow up with Dr. Callon and was told that there was inflammation, erosion, and redness in my terminal ilium (end of my small intestine). There was nothing they could physically see in my large intestine upon inspection. We would find out later that, the biopsies would show that there were "areas of chronicity," or chronic inflammation, in my large intenstine, as well. A diagnosis of Crohn's disease was made, thankfully in a milder stage. I was originally put on an anti-biotic medication to see if this was some other kind of inflammation that could be helped. It did help some of my symptoms, but not completely. After this, I was put on something called Lialda. Lialda is actually used for Ulcerative Colitis (another inflammatory bowel disease isolated to the colon), but it has milder side affects and it was decided that since most of my symptoms were in the colon and very end of the small intestine, that this would be the next step. I am currently still on this medication today, and am hoping that I will not have to change medications any time soon. Other medications have greater side effects on the immune system. The next medication in line would be something called Imuran. I don't know much about it, but I do know that it makes me more susceptible to infections/getting sick and it cannot be taken during pregnancy. I am nearing that time in my life and am hoping to not have to switch from my Lialda (which has not really shown any complications with pregnancy per studies at this time). I am feeling good enough now, I don't anticipate this unless a flare should occur.

Most days, I feel pretty good. My symptoms are not perfect and there are some things that I deal with daily. I can eat most of the foods I like, just not excessive amounts of sugar, alcohol, or anything that could really stop up my system (like too much dairy!). I have sudden urges to go to the bathroom (sometimes while I am in the middle of the run), so I have to be aware of my surroundings and know where the nearest bathroom is! There are times when I get bad cramping and stomach pain that will double me over and leave me on the couch for a bit. This is the worst and can be very painful. Those days are few and for that I am grateful. Other days, I get super bloated. I have had days where I am 5 pounds heavier because of this bloating. It is pretty uncomfortable.  I am still learning about how my body will react to certain things and how to respond to these not so great days. There is much I am still learning about this disease in general! There is no cure for inflammatory bowel diseases at this time, and Crohn's disease is progressive. There will be good days and bad days, and there is a chance that my personal disease will worsen.  I plan to use this blog as a means to also give you all an honest account of those not so good days, just to give you all an idea of what it is like to live and run with Crohn's disease. Right now, though, I am grateful for pretty good health, strong lungs, and every good day and good run I get :)

The struggles, the good news, and the good(est) news!

Hey! I am back! It's been a crazy month ... the craziness has not extended to running alone. I was out of town for a week at the end of March to go to Atlanta to take a Vestibular Rehabilitation Certification course. It was intense! I loved all of the things that I learned, but the skills check offs in front of the experts of all experts were nerve-wracking. I had to do canalith repositioning maneuvers in front of Susan Herdman, the queen of Vestibular Rehab. It nearly sent me into a stress related Crohn's flare ... oh, man. That was fun. I am glad I took the course, but I was so glad to be done and come home to my hubby, my kitties, and my own bed!!

As far as running goes, I have continued my Mini Marathon training. It is about 3 and half weeks away and approaching quickly. I started to have some of my 2nd toe issues again. It feels like I am stepping on  a rock at times. I normally feel it at the start of runs, then it fades out some. I feel it more when I have been standing for long periods of time, actually. Alex did some dry needling to my calf and my anterior tibialis muscle. My calf felt like it had been punched the rest of the day! It felt better afterwards. I am not feeling the numbness so much, but still have that stepping on a rock feeling at times. I can manage it, but I may end up needing to get it checked out again (most likely after all of my training for the Mini and the Tinkerbell Half). Right now, I am taking some anti-inflammatories, not wearing tight shoes, taking off my shoes when I don't need them on, and trying to be good about icing. This is the struggle part of the title, but it's one I can manage!

I did the Indy Miler Series 10 Miler run on 4/8/17. I was very pleased with how it went! I had spent the week before in Atlanta, so I was not sure how I would feel. I felt pretty good and managed to run a 1:22:09 - 8:13 min/mi pace. It was good enough for 24th woman overall! It was a little chilly start, but it felt good by the end of the race. I enjoyed the course, it gave us a great chance to run through so much of downtown Indy. At mile 8, the course went past the new cat cafe!!! I was so tempted to stop :) I guess I just have to go some other time when I am not running. Since I ran all 3 of the miler series runs, I got a medal at the end of this run! And I did not forget to get my M&M cookie this time. After this run, I feel a little better prepared for the Mini coming up. I am not anticipating a PR, but if I can run like I did last Saturday, I am hoping to have a very solid run!

My medal for finishing all 3 miler series runs!

10 Miler Finish Line - a beautiful day downtown!

And now ... for the best news! So, I randomly entered a contest that I saw on Facebook that was related to the Mini. I checked my email the other day ... and you know what? I won! You want to know what I won? Yes ... you do! I was chosen as one of 50 people who will get to do a shake out run the day before the Mini with the one, the only ... MEB! MEB Keflezighi!!! Ahhhhhhhhhhhhhhhhhhhhhhhhhhhh! I can't believe it! I am so excited! My Wednesday running buddy, Danielle, also gets to do this. We chatted about our excitement this morning :) I will be sure to let you all know, in detail, how this goes.

And .. that's all for now! I will try to be better about updating in a more timely fashion with continued Mini training updates and/or personal posts. I am still working on a Crohn's story post, as well. Have a beautiful week, friends!

Reggie!!!!

March Madness or Something of that Sort

Hey everybody!

March is flying by! It seems that February and March seem to have switched weather patterns, and by golly, my sinuses are finally cracking. They have held up so well throughout this wacky winter, and they had to give at some point. 

I have had 2 races this month so far, so let me give you a quick little recap. On Saturday the 11th, I participated in the Indy Miler Series 6 Mile race. It was a crisp day! I met up with a few friends prior to the race. Again, another busy race with lots of people running it! It took a little bit of time to finally find a comfortable position without weaving in and out and around all of the people! I ran with my friend Ryan for the first 2 miles and then we split up. I felt pretty good during this race and I loved all of the enthusiastic volunteers. The 500 Festival Princesses had a water stop at mile 5 and they were so enthusiastic, it really helped us runners getting through the last mile! The course itself was pretty nice, I enjoyed running down Mass Ave. They had cookies again at the end of the race! I never turn down a post-race cookie. I had an oatmeal raisin cookie and it was delightful :) It was nice to hang out in Banker's Life Fieldhouse after the race to warm up! The final Miler Series Run is next month ... the 10 mile race. Looking forward to more cookies ;)

Members of my running posse

Today, I participated in the No Luck Run 5K. Alex also ran today and did the half marathon. I am so glad I opted to do the 5K today and not the half. I slept like absolute garbage last night. I had difficulty falling asleep due to some Crohn's related nausea. I just could not get comfortable. I woke up several times in the middle of the night. I probably got about 3-4 hours of sleep despite my attempts to get 8. Ugh. I still managed to run fairly well. I started off a little too fast, but found my stride until about mile 2. The last mile was where that lack of sleep from last night really kicked 
my boo-tay. I managed somehow. I came in just over 24 minutes and ended up winning my age group! I am not ready to move up to the 30-34 year old age group ... it seems like it is full of fast ladies!!! Alex set a new PR for his half marathon ... that crazy guy! I am super proud of him and how hard he works. This was another race put on by Racemaker Productions. I love that they do all these local races! It took me only 10 minutes to get to this one. They also combine several service projects each year with their race experience and for this particular one, you could stuff and seal pre-packaged meals for a group called Rise Against Hunger. Alex and I did a shift stuffing meals yesterday and between all of the volunteers, over 10,000 meals were packaged! Awesome! 

So, how is my mini training going? Not too bad. I have been (and have another stint) out of town several times during this training cycle and that tends to throw things off a little. I don't think this Mini is going to be a PR (it's hard to PR anymore in the Mini because of the sheer volume of runners!), so I am thinking this may be the year I try to get my selfie with Frank Shorter. I love him! Also, Meb is going to be at one of the turns on the track, so I may just stalk ...er, find... him, as well. I have had some good speed workouts, so who knows? I may make the Women's Half Marathon my target race this year. 

Also, on a personal note. I went to Las Vegas the first weekend of this month to see the Backstreet Boys with my friend Brianne and our moms. I felt like I was 12 again. AJ literally was right behind us during one of the songs, and I screamed and jumped up and down like my pre-teen self again. It was a blast :)

See ... right behind me! I love you AJ! :)

Five of my favorite men 

Happy running, everyone! I will write again soon!

February Races!

How in the world is it March already? To be honest, February is usually my least favorite month. It is toward the end of winter, and it just feels like it has been cold forever! That has not been the case this February. What a weird month of weather! More often than not, it has been in the 50's or 60's ... this is crazy even for the state of Indiana. I did two races this past month. The first one was on February 4th, the Frosty Feet 5K. This one lived up to its name, it was truly frosty. The temperature at the start was about 15 deg, not including wind chill. There were some fast ladies at this one! Glad most of them were in their 30's (this makes this years age group jump all the more frightening!) It was nice seeing some of my fellow trail runners out there. Alex ended up winning his age group and I ended up winning mine! I ran in 23-something. I was hoping to break 23 minutes, but had some struggles a little after 2 miles that slowed me down temporarily. The Frosty Feet 5K is the first in a series of 3 runs in our town that goes to benefit the local track and field teams. So even if it meant enduring the cold, it was for a good cause.

My second February race was the next week on February 11th, and my, was it just the opposite experience of the previous week's race. I participated in the Indy Miler Series 3 Mile race, a series of 3 runs leading up to the Mini Marathon this May. This started out at Bankers Life Fieldhouse, which was nice to hang out in prior to the race. Only one bathroom for women was open prior to the race, so this was probably the one downside of this race! I have never been in a pre-race bathroom line that was so long! I met up with my friends Beth, Ryan, and Casey prior to the race. Ryan, Casey, and I ran together on a lovely 50 degree morning in downtown Indy, a very large swing in temperatures over the week! This race was also much more crowded than the local 5K, and it took awhile to fight through some of the crowd at the beginning. We didn't really run for a fast time, but still finished around 25 minutes. The best part was definitely the heart-shaped sugar cookies at the end :)

The gang post 3 miler

I have a few races coming up in the month of March, including the second of the Miler Series - a 6 mile race downtown. Alex and I are running another local race, the No Luck Run (a St. Patrick's Day themed one). Alex is going to do the half marathon, but I am focusing on the 5K. Both should be fun! I will give you the scoop on those after they happen. Have a great week, everyone!

That Eating Disorder Thing

        So you may have noticed a little detail about me that stuck out in the About Me section. Yeah, that eating disorder thing. For awhile, it was a really big thing. I’ve been active in some way shape or  form since I was 8 years old when I started playing soccer. We usually practiced 2 days a week and then had 2 games during the weekend. When I started high school soccer, my workouts increased in frequency and intensity. I also stopped drinking regular soda and swapped it for diet soda or more water. I lost a few pounds and people noticed. I began to think that if a few pounds had this effect, obviously I would fit in more and be more attractive if I continued to lose a few more pounds. That transition into high school is not easy for a lot of people. Bodies change and we tend to be more critical about each other and the way we look. We (especially young women) are bombarded with images of models and celebrities that society has deemed as having "perfect" bodies. Unattainable images set unrealistic expectations on those who are most impressionable. When soccer season was over, I began working out and running more compulsively. I lost more and more weight. Some days, I would work out as many as four hours. I would do a workout video and if I felt I had not done enough exercise for the day, I would rewind it and do it all over again.  As the pounds continued to drop, I also became more and more obsessed with how much I was eating. I began significantly restricting how much I was eating. I developed (and was later diagnosed officially) full blown anorexia nervosa. My days revolved around my meals and how much I was or was not consuming. If I went to bed with my stomach growling, it was a successful day. I did my best to avoid social situations in which eating was the primary activity. I denied to others that I had any problems. There were a few concerned teachers (along with my parents) who asked if I was okay, but I tried to shrug off their concerns. I could pick out every single flaw on my body. Why couldn't they see all the fat on my body like I could? The way I saw myself was not the way others saw me. I started developing some of the beautiful side effects that come along with disordered eating, especially anorexia. I was developing a downy hair covering over my face, called lanugo (really only present otherwise on fetuses before they are fully developed). My body fat had dropped so low, the lanugo was my body's attempt to insulate me. My heart rate dropped to the low 40's. This is the heart rate of an elite athlete, and despite my time spent exercising, I was no elite athlete. This was a defense mechanism - my body was fighting back since I wasn't providing it with the energy it needed to get through the day. I also did not menstruate for over a year. Because of this, I underwent blood testing and it was found that I had Hashimoto's hypothyroidism. Sometimes with Hashimoto's, I guess the thyroid can get a little overactive before it settles into the underactive state. People can lose weight initially. This gave me a way to disguise the problems that were really happening underneath. Perhaps the worst side effects, though, were those of the psychological nature. Mentally and physically, I was shutting down.

        Eventually, I could not keep up with the high amount of activity and lower food intake. I remember vividly one day having to skip soccer practice because all I was physically capable of doing was laying in my bed. I was exhausted. I spent so much energy and time just thinking about food and how to avoid it. Occasionally, I would be so hungry that I began compulsively binge eating. I would try to keep it secret. I would eat bowls and bowls of ice cream, multiple bowls of cereal, packets of poptarts. I was so embarrassed and began feeling out of control. Control was what I thrived on at that time. If I kept this up, I was going to gain weight. What could have been worse at that time than seeing the number rise on the scale? I had to find a way to get rid of all of the foods I had excessively consumed. Eventually, I figured out a way to purge myself of the large quantities of food I was consuming. I won't go into details, but this was an extremely dangerous time in my eating disorder. In general, I still was not eating enough on most days with occasional binge days. I starting purging every day (multiple times ...every day) despite how much I did or did not eat. So not only was I not getting enough nutrients and caloric energy on most days, I was finding ways to get rid of it. I tried really hard to keep my binge episodes secret from the people I loved. I started eating more and more and purging more and more. Anorexia nervosa was developing quickly into bulimia nervosa. I thought I was hiding it well, but then my mom confronted me after a particularly binge heavy day. That confrontation saved me. I guess I just was waiting for someone to tell me I had a problem and offer me a concrete solution. It had gone on for long enough, that I was getting exhausted by my starve-binge-purge cycle. My guard was down, and I knew it was time. I know it was hard for my parents to see this happening to me and hard for my mom to bring this to light. I couldn't be more thankful for that moment now.

        My mom found a nearby outpatient center that specialized in the care of persons with eating disorders. This place was called the Charis Center. As far as I know, it is the only partial hospital program for eating disorders in Indiana (meaning there are more intensive outpatient and inpatient options available). It is hard to find centers like this with specialization in eating disorders. It is hard to find centers like this that will be covered by insurance. It is hard to find centers like this that are close by. I have no idea how much my parents'  insurance helped with this or not. I am forever grateful that it was found and that it wasn't too far away. So many aren't as fortunate as I was. I met with a nutritionist for a short period of time, but most of my time was spent with a psychologist (Dr. Carrie Proffitt) who truly made a difference for me. Dr. Mary Rouse helped establish this facility to address an often overlooked and severely misunderstood psychological group of conditions. We had to hide/get rid of scales in our home and each time I was weighed at the facility, I had to step on the scale backwards. I had no idea how much I weighed for an extended period of time. I was not allowed to run and my mom hid my workout videos (I could still do soccer activities, but nothing outside of that). I had to write down what I was eating each day and when I purged. I tried so hard to be good, but on the days I purged, I would just draw frustrated squiggly lines through the day's entry. I wrote in a journal about how food made me feel and how ashamed I was of my body. I hated my body. I hated my brain. I hated how I felt. I was so in control that I was out of control. A project that Dr. Proffitt had me work on one particularly difficult week is something that has stuck with me for a long time. We had a bunch of magazines out in front of us and she had me cut out pictures of women who were not the stick thin picture of perfection. Women who were strong, proud, and confident in their bodies and even in their imperfections. Women like Serena Williams, Christina Aguilera (who was being criticized around that time for putting a few pounds on her tiny frame), Mia Hamm. I took the project home and added more pictures and inspiring phrases. It hung on my wall for years. Because of this project, I always try to remember the great things that my body can do rather than pick apart the cosmetic appearance of it. For example, I always thought my calves were too muscular. They were something I fixated on. Now I can look at those calves and any time I think about their size, I remind myself that these calf muscles have carried me through marathons, thousands of miles, have hiked in the Grand Canyon, etc. It changed the way I see other women's bodies and helped me realize that comparing myself to them shouldn't make me feel better or worse. We are so critical of ourselves that we forget the amazing and beautiful things that our bodies can do.

I started gaining weight back and getting back into healthier habits, but the most difficult challenge was overcoming the depression and anxiety that had taken over. I had associated my happiness with the number on the scale and with thinness for so long. I really struggled. I was prescribed an anti-depressant when I started treatment at the Charis Center. I was a  16 year old on Prozac. Say what you will, it helped me. It gave me a little more energy to fight. There were days where the will to fight my eating disorder significantly waned. Wouldn't it just be easier to end it all? It felt dark and scary to think those things. I didn't want that. I wanted to be who I was before I started caring too much about what others thought of me, or what I thought I had to be in order to be a more perfect person. Perfectionism is a hard habit to break. I graduated from the Charis Center about a year after I started treatment. I remember stepping on the scale backwards for the last time. Life has brought its share of difficulties and challenges since then. When I was younger (and not long after my significant recovery period), I would try to control my food intake for a bit because part of me still hadn't fully recovered despite my physical recovery. If someone didn't like me or hurt my feelings (silly high school heartbreaks), I would be reminded of some of those old feelings of inadequacy. I felt like maybe if I could lose just a few pounds again, maybe, just maybe, a certain guy would find me more attractive or care about me more. That's how deeply I associated my weight with my self worth and ability to be loved. As I have gotten older, I have learned to be kinder to my body in these hard moments (I still care about what people think of me more than I would like, but I care much less than I used to!). There are times where grief and sadness make food your last priority, but I remind myself that it will give me the energy I need to emotionally recover. That is not to say there are still not days where I am not horribly critical of myself for no good reason. I look in the mirror and I hate the way a shirt fits on my hips or that I will always struggle to get my jeans on or off over my muscular calves. I fixate on my mistakes and sometimes I just can't shake the notion of how I could go back in time and change the stupid things I did. I also still struggle with those occasional feelings of sadness, but have developed better coping mechanisms. I've lost people I loved and have sought out counseling when I have felt like the world was too big and hard to understand. I can't begin to describe how beneficial this was for me.

Aside from the love from my family, meeting my husband was a big game changer in the way I treat myself.  He was the first guy to make me feel beautiful - not just admiring physical beauty, but he appreciated my sense of humor, my intelligence, and my interests (maybe my pop culture knowledge was more impressive ;) ). His unconditional love and support has lifted me up in the hardest parts of life. I am forever thankful. 

Running has also been a huge factor in the mental recovery from my eating disorder. I know it sounds counter-intuitive based on how all of my body image issues began. I was over-exercising, using running and activity as a tool to make myself shrink.  When I was getting back on track with healthier habits, I joined the high school track team. Because I was a soccer player, I had natural longer distance endurance. Instead of running to lose weight, I saw that I could use running in a new way. I found out that in order to run well, I needed to more adequately fuel myself. And running well helped lead to running faster. And isn't that the purpose of track? Getting faster? I guess it was trading one addiction for another, but it was a more meaningful and healthier addiction. When high school sports were done for me, running became a primary means of staying in shape. I loved the way I felt after a good run. If running was the only thing I did that day, then it was still a good day. It helped me focus, helped me solve problems and think things out. It was (and definitely still is) my quiet time. I notice the little details of the world around me and appreciate the beauty of the outdoors. I've run in rain, snow, through sunrises and sunsets. Gradually, the distances I could run got longer. I ran my first half marathon in 2009 and was hooked. There was no turning back on running after that. In the spring of 2015, I ran my first marathon. Crossing that finish line was probably the most amazing thing my body has done to this point in my life. I was so thankful for my health, for my physical and mental strength. There is no way I would ever have been able to do this at the peak of my eating disorder. In that case, thinness did not equate to health or endurance or strength. I was 40 pounds heavier crossing that marathon finish line than I had been at my lowest weight. It was one of the moments in my life where I felt like I was at my most beautiful. I was achy, sweaty, stinky, but oh so beautiful! Running has shown me the beautiful things my body is physically capable of doing at a healthy weight. Running has made me more beautiful in my own way. 

I have wanted to share this story for awhile, but have always been afraid of how people would react to me afterwards. There are a lot of stigmas surrounding eating disorders. How often have we heard someone tell a slender person to "go eat a cheeseburger," or criticized someone for putting on weight? Eating disorders aren't cured by "just eating." They are complex, requiring treatment for the body and mind. Maybe, just maybe, my story may help someone who is struggling ... or maybe it can give someone an idea of how to help someone who is struggling. I knew I had to try to put my story into words after seeing the story below. I was again reminded how fortunate I was to have the treatment I needed nearby and how fortunate I was to have the support of my family. The story below broke my heart and brought back some hard feelings. Eating disorders have one of the highest, if not the highest, mortality rate of all mental illnesses. Around ten percent of people who develop an eating disorder die from complications of the disorder or from committing suicide. If I had not been surrounded by so much love and support and a treatment facility, I could very well have been part of that statistic. I was heading down that path. Eating disorders are not a joke, an eating disorder is a mental disorder. There are serious health consequences. 
http://www.womenshealthmag.com/health/eating-disorder-suicide-link

Below is a link to the National Eating Disorders Association website. Here you can find more details and statistics about eating disorders and their prevalence. There is also information on how to find support for you or someone you love should they be struggling with any of these conditions. 
https://www.nationaleatingdisorders.org/

Thank you all for reading this long, but important, post about me. Do not hesitate to ask me any questions about my path to recovery. It is part of my story and has lead me to where I am today. My body is not perfect, and I accept that, but is capable of so much more than I ever could have imagined when I was fifteen. It is flawed, but it is strong and it has carried me through the worst and best days. 

What the what?!

I like winter running. 

There. I said it. 

Who am I? Up until about 2 years ago, I would have told you just the opposite. You would not find me outside before March! The beginning of spring half marathon training was done on treadmills, save for those crazy few warm Indiana winter days that crop up every now and then. Why the change in heart, Megan? When I began training for the Carmel Marathon in January of 2015, it just became impractical to do longer runs on the treadmill. Anything more than 5 miles on the treadmill really makes me cringe, anyway. I found that as long as I layered appropriately, I found that outside running was actually pretty pleasant. One of the great things is the feeling of isolation, like it is just me and nature. There are still some crazy runners out braving the temperatures, but there is a peace in the stillness and companionless trail stretches. It also makes me feel a little hardcore. I love the thought of someone driving by while I am running bundled up in my layers thinking that I am a crazy runner. And let's not forget the scenery. As long as the trails are clear-ish ( ;) ), there is beauty in some powdery snow lining the sides of the trail and sticking to the trees. This brings me to my run today! It was a cold day (17 with wind chill) with a light dusting of snow falling. Nothing too slick as far as footing went. There is one part of  one of the trails I like to run in which there is a bridge over a creek. Trees line both sides and there are some stretches of field behind part of the trail. Today, I just took the time to stop on this bridge, let the snow fall around me, let the snow land on my hat and face, and take a few breaths of cold and refreshing air. I am generally just working on keeping up my miles in the winter (until half marathon training starts!), so there is no pressure on hitting any paces or getting through intervals. It reminds me why I enjoy running so much. I am just out there, legs moving, lungs breathing in cold air, and looking at the beauty around me. So, thank you winter running, for bringing me this joy. And making me look like a ninja/bank robber. A hardcore one. 

Hubby and I prepped for a particularly cold day of running - single digits with 0 degree windchill!