Let’s talk about food anxieties, please

In a few previous posts, I have mentioned that I experience “food anxieties” and that this has shaped the way I eat (mostly for the worse). Most of it seems to be largely psychological in nature, but there is a bit of sensory processing trouble that comes to the fore as well. It is worse when I am stressed and anxious about other things.

Before I get into what the problem might be (without oversharing) and why I feel the need to try and educate an audience about it, I’ll start with the end result, because it’s very easy to dismiss food anxieties if you don’t have them.

I throw up in my mouth.

That’s right. Throwing up. In my mouth. Even if I manage to avoid this, and force myself to swallow whatever it is that I really, really don’t want to eat, I will be nauseated for the remainder of the day. It will be very difficult for me to eat anything even remotely unfamiliar.

So if anything that I describe from here on out makes you think “That’s ridiculous! You should just eat [whatever it is], or grow up, or get over it,” I’d like you to remember the phrase “I throw up in my mouth.”

Because nobody likes the taste of bile.

In my case, it also tastes like shame, humiliation, and judgement, and this is why I feel the need to write this post. It is actually a difficult issue to write about, because although I have a number of anxiety triggers that elicit empathy from people in my life, the food triggers usually elicit contempt, dismissal and/or confusion. There is almost no empathy or sympathy for them at all. Talking about it usually makes me cry.

This is, I feel, because of the social structures we have placed around eating. We are a society that in large part seems to have a really disordered relationship with food, and at the same time we are a society that is trying to fix that, and seems to be going about it all wrong.

We are a society that associates certain kinds of eating with emotional maturity. Kids are the ones that will refuse to eat healthy food (we are told) and demand chicken nuggets and chips, and spaghetti bolognese. Most of them grow out of it. In large part, I didn’t. It’s understandable that parents put pressure on kids to eat healthy food – it really is. The problem is that when you have an oversensitive kid who responds to disapproval by shutting down and/or crying, that ends up making a bad situation worse. Then, when you get confused parents telling the kid not to cry, because it’s just silly to cry about food (even though the kid is actually crying about the disapproval, not the food; crying about the food is an associative response that comes later, when you start to instinctively link food with disapproval. It did not take me long to reach this point), they feel even more disapproval.

It’s bad enough when it’s your own (well-meaning) parents. Then when you go and stay with friends at their house, you start to panic around dinner time, because what is the food going to be? Are you going to be able to eat it without watning to throw up? Are these really scary (quite lovely, but I was extremely shy) adults that you don’t even really know going to yell at you (or even express mild disapproval or disappointment, which is bad enough) for not eating the meal they are serving the friend of their child?

The answer is usually… well, yeah. Even such innocent, friendly questions as “Didn’t you like it?” bring on a panic attack.

(side note: I can’t even physically handle certain foods without wanting to scream and panic. The sensation of these particular foods on the skin of my hands actually triggers panic. I’ll whimper. It’s involuntary. When going on camps – whether they are work-based retreats or the school camps of my youth – I would hastily sign up for any chore that did not involve handling food or cleaning up food (my favourite is vacuuming. I don’t have to touch anything). This may seem weird. I’m a biologist. I’m perfectly comfortable touching icky things and dissecting them. I give zero fucks about that, which should tell you that the food issue is a serious problem.)

Looking back, I can see that I was a really sensitive kid. I was shy, and anxious, particularly around adults. Around other kids I was more bold – brash, even – but it didn’t take much to get me hiding again. The problem is that, when you cry at the drop of a hat, adults stop taking your tears seriously. Again – like all of this – that’s understandable, but I vividly remember that I never cried unless I was really genuinely upset.

It’s just that I was really genuinely upset a lot, and one of the worst triggers was adult disapproval. I genuinely do have some sensory issues around some foods, which is probably why I didn’t want to eat some things in the first place, but the disapproval factor turned the whole thing into a colossal mess.

Sadly, I don’t have any suggestions to make it better for a kid like me. I imagine if and when I have a kid, I too will be flustered by their refusal to eat the healthsome food I have put a lot of effort into cooking. I will probably get to a point of deathly frustration when I tote up what they will actually eat and come up empty on actual nutritional content.

And yet.

I do have some suggestions on how to make it better for adults like me.

If an adult friend does not want to try the “totally awesome and amazing” food that you are recommending, do not push them. Feel free to say that it is awesome and amazing, but don’t ever, ever shame or guilt someone into eating something or trying to eat something.

If someone is actually honest and says, “Look, I can’t eat that, sorry,” just accept it. Maybe a response like “Aha! All the more for me!” is appropriate (I actually often say “Hey, all the more for you,” when explaining what I can’t get my oesophagus to accept. It defuses tension).

You would think that I would know better than to do these things, but sometimes even I have over-encouraged people to eat certain things. I quickly realised I was doing it, and backed off, but I do regret those moments of empathy fail.

And here’s the thing. Even with people who handle it with tact and grace, it’s still awkward, because on the inside, I know that it’s weird (and you can tell. I go bright red. We gingers, we do not have good poker faces).

There’s more.

Do not demand further explanation. Do not even politely ask for further information. Even “I’m just curious.” If you don’t have these issues, you can’t even possibly begin to imagine how awful it is to be the feature of interest at a perfectly normal adult ritual like a dinner or a lunch and be forced to explain your eating habits. It is awful. We have so much emotional baggage around food it’s ridiculous, and you can’t just reason through it in public and decide to be okay. Please, move on and deflect attention elsewhere as quickly as you possibly can. Change the subject, ignore the plate.

You are not the food anxiety whisperer. Even if your food is amazing. Even if you are the greatest chef in all the land and your hours-long meal preparation process results in the sort of gourmand’s delight that makes angels weep and clutch at their overfull bellies. This is not an insult to you. It is just how someone else’s anxieties and sensory system are put together. It is not about you.

Do not say something like, “I could understand if it was [acknowledged confronting food item], but it’s [widely accepted as easy to eat], you can’t even eat that?” Just leave it alone.

And absolutely 100%, for the win, take-it-home-today-and-pay-nothing:

Do not tell the food-anxious person that they are going to die of nutrient deficiencies (or heart disease, or diabetes, or anything).

This is a little like telling a fat person that they are fat. Let me explain.

People who are fat have grown up in a world that is excessively, ludicrously aware of fat. There is not a fat person alive who does not know they are fat. They would have to be literally brain-dead, as in unable to absorb sensory information from the outside world. If a person that you think is fat does not think they are fat, it is much more likely a problem of fuzzy thresholds and ridiculous definitions, and telling them what your definitions are is just going to make them feel (1) angry, (2) offended, (3) hurt, and/or – in the absolute best-case scenario – (4) mystified by your odd behaviour. They have grown up in a world that is constantly going on and on and on and on and fucking on about how “terrible” it is to be fat, and how death-fat is coming for them, and how much energy and money must be spent in order to get rid of fat, keep fat gone, or prevent fat from ever catching up with you in the first place. It is literally impossible to ignore these messages.

And this is, to a certain extent, linked with food anxieties. We have all been told from a very young age about eating fruits and vegetables, the supposed evils of fat (sigh) and sugar, and the food pyramid (double sigh). Healthy eating programmes are run in primary schools. The idea that you might not know that subsisting on certain kinds of heavily processed, nutrient-shallow foods is unhealthy is similarly absurd.

We, the food anxious, are well aware that we are probably eating a diet that is not medically approved. We are probably very worried about it. We really would like to fix the problem. But you are not going to be able to fix it for us. I’ve lost track of how many times I have told people that I would love to be able to eat salads. Salads seem healthy. They seem like you can make them cheaply, and there are lots of ways to make them interesting and tasty. They seem like a great option for hot summer days. They are very easy to construct around allergies and intolerances like fructose malabsorption and insulin issues. Salads seem great.

I can’t do it. Just can’t. I will throw up in my mouth.

So someone looking at my lunch and telling me, “Gosh that’s really unhealthy!” achieves the following:

  • I feel really selfconscious.
  • I feel judged and humiliated for my food choices
  • I probably want to cry (complete with red face and hot eyes)
  • I get really angry, because seriously, what goes in my mouth is my own damn business

Here’s what it does not achieve:

  • any measurable or noticeable change in my eating habits, with one exception.
  • I will now not eat in front of that person. There’s a reason I eat lunch at my desk.

Food anxieties take a lot of energy to maintain. They’re always there, in the back of your head, because sooner or later, you’re going to need to eat again. One of the greatest side benefits of eating keto and tracking my macronutrients for me is that it enables me to plan ahead, and to be confident in my food choices. I am now pretty comfortable with how I eat and what I eat. I’ve covered the bases in terms of macronutrients and the really essential phytonutrients. What my diet does not give me directly, I supplement. I am perfectly comfortable with a few necessary supplements.

I cannot possibly describe how much happier about food I am now. I am now more willing to try new things (although again, I am very unlikely to do that in front of people, because it’s embarrassing when you throw up in your mouth). This isn’t because my sensory processing issues have gone away, or because I no longer have anxiety; it’s because my overall stress level is miles lower, and that gives me more mental energy to challenge myself.

In the back of my mind, I am no longer convinced that I am going to die because of what and how I eat. I am no longer panicking about how I’m going to eat healthy food while accommodating my various issues.

And part of this is because I’ve accepted that there are things I’m never going to be able to eat, and I’ve written them off. I’m no longer constantly guilty about the things I should try. I figure if I get intrigued one day, I can give it a shot in a safe space.

However, there are still some anxieties around eating in front of people. I’m still waiting for someone to ask why I haven’t eaten my salad (that often comes with various meals), and ask when I’m going to grow up. I’m still suspicious that someone will look at my meat-and-cheese-heavy plate and feel the need to comment on it. I’m still incredibly nervous about going to dinner at people’s places if I don’t know them very well. I’m still scared of giving offense because I can’t process certain sensations. And I’m scared that it will get so bad that I will cry, which is beyond humiliating.

So I write this post to help people with food anxieties understand that they are not alone, and to help people without food anxieties understand that it’s not simply a matter of “growing up”; that our relationship with food is actually much more complicated than that, and that society’s well-meaning attempts to boost our nutritional health have actually made it worse.

I write it in the hope that less people, in future, will ask me:

“Oh. What was wrong with it?”

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O Bendy Gymster: Toxic Gym Tropes

It’s no secret at all that I love the gym. I am an unashamed gymster. I came to fitness later in life and have been blindsided by the sheer joy of building up the relationship with my body and the things we can get done when we really try.

There’s a lot that I really love about fitness culture. There’s a lot of encouragement, a lot of support, a lot of “I will totally be your spotter, complete stranger, because we share a love of the bench press and this binds us closer.” There’s a lot of numbers and nerdiness and biometric data (often really inaccurate with huge margins of error, but shhhh). The fitness community can be a really joyful and supportive environment.

It can also be really appalling and toxic, and as much as I don’t want to be completely negative, this post really is about the perpetuated ideas that I view with extraordinary distaste.

The trope: The New You! NOT LIKE THE OLD YOU WHICH WAS CRAP

The response: In a previous post, I made it clear that I dislike this whole concept of the “New you!”, but since that message was hidden down the bottom of the post after my account of the whirlwind training montage that has been the past six months, let me make it clear again:

I think it’s harmful. I think being unkind to the “Old You” is not going to get you far in the long term. Sometimes, when people start exercising and eating better, it’s a temporary health kick. Sometimes it’s a long-term “lifestyle change” (although I feel even that terminology has been semantically polluted, let’s just take it at face value and try not to roll our eyes). Nearly everyone who starts out on a health kick thinks it’s going to be a lifestyle change, so they declare the “New Them!” and quite often they start trash talking the “Old Them!”

The problem is that the “Old Them” has not gone anywhere. Firstly, while the improvement in quality of life is no small thing, getting active and eating healthier food does not change your identity. It is worth it to be kind to that identity, because your sense of self is going to stick with you for the rest of your life. I can certainly think of times in my life that I was less self-aware than I am now, and less considerate, and while I am not proud of those times (and take full responsibility for the consequences thereof), they are still a part of who I am now and the journey towards being a bit more self-aware and considerate. While I want to shy away from memories of myself being an absolute tosser, that would be ignoring the lessons I learnt.

The same goes for times when I was less logical and sensible (not that I’m a paragon now, but we’re talking relative comparisons here), and yes, certainly times when I have been less healthy. Trash-talking the Kate of Poor Lifestyle Choices Past will do me precisely no good now, and could lead me to dismiss the very real achievements I made in other areas at the time. The Kate of Poor Lifestyle Choices Past was, by the way, writing a thesis, and I think that this was a commendable and impressive achievement, and the fact that I wasn’t running three times a week, eating keto and lifting weights in no way diminishes the fact that I wrote a thesis.

This is getting a bit in depth and personal, but it really cuts to the heart of why I hate all this “New You!” bullshit: it encourages you to hate the current or the past self, to dismiss that self, and to emotionally kick the crap out of it, and it means that when you lapse in your current plan (which you will, regardless of whether you maintain it overall in the long term), you will feel like shit. You will feel like you are incapable of change. You will feel that you are trapped in that “Old You” that you have taught yourself to hate, and that will feel dreadful (particularly if you are prone to depression or anxiety).

If you don’t buy into the identity-change crap, when you lapse, you can say, “Oh well, shit happens, we can move forward.” And if you decide that the path you’ve chosen for your health kick is not sustainable, then you can say, “I didn’t mind myself before, and this didn’t work for me,” and, if you feel like it, find something else.

“New You” is a trap. And of course, yes, it’s a trap designed to sell things. No-one is surprised by this.

A better option: I’m thinking that maybe sitting down and thinking about the things you like about the current you or the “old you”. They can be physical things. They can be emotional things. Maybe it’s about being smart or talented or kind or funny, but maybe it’s about being strong or having good posture or being very flexible. Don’t reinvent yourself; instead, think about all those things you like and how you’re taking them with you for the ride. If you’re going to increase your health and fitness, instead of making a “New you”, you’re adding to a list of things you like about yourself.

The trope: PAIN IS WEAKNESS LEAVING YOUR BODY

The response: Oh, shut the fuck up. Pain is your body sending a message to your brain that the current situation is not good. Sometimes, the message is incorrect: maybe you have a pain processing disorder, or some neuropathic condition. Sometimes the message is overstating the case: yes, it feels like your arms will fall off if you do another bench press, but as long as you are maintaining form, you can do it and benefit from it. And sometimes the message is on point: your technique is bad, you’ve buckled your shoulder (me!) or sprained your ankle (me again) or broken your finger (oh wait… me), and you need to address the situation.

Pain is a message. It takes interpretation. Is it a throbbing pain, or a stabbing pain? Is it muscle pain or joint pain? Is it overuse pain? Is it a cramp? Do you need to stop what you’re doing or is it the kind of pain that just means you’ve pushed yourself a little and you’re building muscle or endurance? Learning to interpret pain is an important part of getting to know your body, and most of us start to figure these things out as we grow up.

As a hypermobile person and a redhead, I have some quirks in pain processing which actually mean that – for the most part – I don’t feel enough pain. I don’t get enough warnings from my body. That’s high pain tolerance, but to an extent, it’s also high pain threshold, which is a different thing. The former means I can push harder, but it also means I run a higher risk of injuring myself (it also means I am an absolute sook by the time I start to actually become aware of pain because I am not used to most of it being at the level that most people get).

The latter is the problem wherein the message of pain is not getting through, until it builds up to a sufficient threshold amount, and then – then, dear readers – it appears all at once. Then you go from thinking, “Something doesn’t feel right…” to “Oh god, I have to pass out and/or throw up, oh god”. This happened to me a couple of days ago. I have endometriosis, which has only recently returned after a surgical treatment kept it in abeyance for a couple of years. I also buckled my shoulder on bench (bendy gymster ladies: do not do higher weights when you have your period if you’re hypermobile. Progesterone makes your collagen even stretchier than it normally is. You think your form is great, and it is, but only for a person whose joints stay where they are damn well told… my wrist shifted, my shoulder buckled, my target region was then way off, and at this point the weight was moving).

The shoulder injury felt really mild. A twinge here, a bit of a stabbing or shooting pain there. Still, I know my body well enough to know that even a mild joint injury needs to be checked out, because I can’t trust a mild message of pain. So I took it to the physio, who drew certain conclusions, and started taping it.

Meanwhile, my endometriosis was bubbling away in the background (so to speak). While my physio was taping my shoulder, the endo-pain suddenly reached threshold and crashed over me. My blood pressure plummeted. My stomach rolled. “IamverysorryIneedtoliedownrightnowIamgoingtopassout.” The physio helped me out and, at my request, fetched some water and a barley sugar (yes, I’m on keto. Still, a quick hit of glucose will restore tanking blood pressure and help settle nausea. Needs must, etc.).

And at that point, my shoulder started hurting properly. “We’ve reached critical mass so now you get to feel everything,” says my pain processing system happily, and now my shoulder felt like a real injury and it’s a good thing I went to a physio instead of worrying that I was overreacting.

Now, the intentions of “Pain is weakness leaving your body!” as a trope are basically to drive you to keep pushing, keep working, keep building, even when it seems hard, and those are in many ways good impulses. In order to build muscle strength and fitness, you have to push your body to the point of mild damage (micro-tears in the muscle) to send the message to your central nervous system that you’d like to build more muscle, please. If you stop when it seems hard, you will not improve. Progressive overload is the way to go.

The problem is that not everyone is good at interpreting pain. I like to think I have become something of a connoisseur, because I have to pick apart some very quiet and subtle messages. I have friends with fibromyalgia who have the opposite problem, where their bodies are shouting at them all the time and they have to sift through all the noise to work out where the damage is and how much they have to listen to (if they wish to exercise).

My body’s pain message says things like, “Excuse me, I don’t mean to bother you, I mean, only if you’ve got a moment, but if you’re not busy, maybe I should tell you – I mean, is it important? Really? – but I should probably mention: the house is on fire.”

That’s until we get to critical mass, at which point my quiet and gently spoken system turns into a complete arsehole. “I TOLD YOU THE HOUSE WAS ON FIRE AND YOU DIDN’T LISTEN! ARE YOU STUPID OR SOMETHING?”

Many fibro sufferers get messages like, “OH MY FUCKING GOD WE SPILLED SOME MILK! WE ARE ALL GOING TO DIE, DIE RIGHT NOW, OH THE DEATH!”

(please note, I am not implying that people with fibro are sooking; quite the opposite. They are experiencing extreme phenomenal pain. It just doesn’t mean that there is corresponding damage. The fact that many learn to ignore high levels of pain and go about their lives anyway is extraordinary. Some hypermobility sufferers also get to a point of chronic pain where they have to learn that pain does not always mean damage. I am not at that point yet. I consider myself very fortunate)

A better option: pain is a message you need to interpret. Sometimes you need to push a bit further. Sometimes you need to stop and hand out some TLC to your body so that you can push further next time – and maybe ask for advice on form or technique so that pain doesn’t happen next time.

The trope: KILL YOUR FAT SELF

The response: Do I really need to explain why this is toxic? Anything that teaches you to hate any part of your body is probably not going to be great for you in the long run, and our society’s horrendously unhealthy obsession with fat and the locations and amounts thereof is all about building a really shitty, self-loathing relationship with your body. I do not think there is anything redeeming in this message. If people want to lose fat and change up their body composition, that’s their personal choice (my body is doing those things at the moment); but doing it via hate is, in the long run, a problem. It also leads people to start hating on other fat people, some of whom have made different choices (and some who have made exactly the same choices), because they’ve learned to hate fat and they no longer seem to care exactly whose fat they are hating.

There’s an in-group/out-group phenomenon that cuts in, not to mention the “good fatty/bad fatty” dichotomy.

I do not believe that being fat is inherently unhealthy, or metabolically healthy obesity would not be a thing (and it is not even a particularly rare thing). Having said that, if someone decides that they want to give it a shot at changing up the system, they can do it without hating on their body.

To be a bit confessional, way back in the past I have hit the gym in an attempt to lose weight. I have, in the past, declared war on my body. I have certainly felt disgust at my squishy parts. The end result was that I didn’t enjoy working out. I didn’t enjoy moving my body as much because it was an act of aggression, and not one of achievement. I have pushed myself based on these impulses – and guess what! It didn’t work. In fact, not only did it not work, but it made me feel even worse about my body. It meant I started noticing and obsessing over my perceived flaws, and started wanting really quick results to justify all this adrenaline and frustration. When I was focusing on those results, I wasn’t focusing on getting fitter and stronger – the things that make me happy about gym – and even the endorphin high wasn’t as much fun.

This is, of course, just my experience.

A better option: Going keto means that I’ve actually increased the ability of my body to use stored fat as an energy source – something that it was very inefficient about before. So, if I think about the fact that my body fat percentage is going to decrease as a result of my exercise, I think of it mostly as using fat. Hurrah, my body has stored up energy and now I am using it to do things. It’s fuel. I actually don’t want to stash it, to be honest, because I’ve internalised the same conflicting body crap that most of us have, and I haven’t completely got past that; but thinking of it as “insulation” (because I do get colder without it), or “padding” (because goddamn my knees are bony now that I have lost some of it, I now sleep with a pillow between my knees), or “fuel” (because now I can run and use it to keep going and going and going) is about eight hundred times better than thinking of it as disgusting or repulsive or something dreadful.

I could also think of it as “buoyancy assistance”, but actually that irritates me in diving and is not a positive thing (divers will spot the pun there). If, however, you like to float, then it would be a good thing!

Summary

In the long run, I think these sorts of tropes are harmful, not just in terms of one’s relationship to one’s body, but in the way one thinks of health and fitness. I think they can lead to injury (ignoring pain), disordered relationships with food and your body (hating on your body fat) and difficulties with long-term planning and identity (new you/old you).

On top of that, though, I think it’s simply bad PR. People are turned off by gym culture for a lot of reasons, but these sorts of tropes have a lot to answer for. They don’t make gyms welcoming – they make them intimidating. They make them seem like temples to judgement and desperation, rather than potentially fun places to work out, and they absolutely can be the latter.

This is a real problem: while my gym has been very welcoming and friendly and judgement-free, not all gyms are so good. I’ve heard tales of women copping abuse in the weights room, newbies getting laughed at and fat people of any gender copping abuse in pretty much any part of the gym, no matter how experienced/fit/strong they are. How is this helpful?

I want more people in my gym. I want a mix of body types and genders and levels of experience. I want people to feel comfortable asking questions of the staff. Alright, yes, a packed gym can be a pain, but then the answer is for someone else to come along and open another gym. I don’t want people to think that everyone is staring at them for being fat or inexperienced or female. I don’t want them to think they have to ignore pain, or apologise for their fat bodies, or change their identities to enjoy the gym. I want people to feel welcome and enjoy this particular option for exercise.

So, next time, just to make things a bit more positive, I’m going to try and dig out the gym tropes I do like, and share those.

“Why do you want me dead? What did I ever do to you?” , or, A Personal Experience Based Guide to the Fallacious Appeal to Nature

I admit I don’t always have the greatest amount of patience when it comes to encountering the appeal to nature. A great deal has been written concerning this most common of human logical errors. In case you’re not familiar with the term, the appeal to nature is the generalised assumption that something that is natural (term poorly defined) is always going to be better (term poorly defined – better for physical health? For mental health? For long-term job security? For basic rhythm? For syncopated rhythm and a 3/4 time signature?) than something that is unnatural (term poorly defined).

Don’t misunderstand me. I’m not just a scientist – I’m a marine biologist. I have a deep love for the natural world. I love bushwalking. I love watching David Attenborough documentaries. I am a fan of the carefully-researched-for-appropriate-ethical-practices eco-tourism par excellence. I am quite happy to spend several hours underwater with a tank of air (although for reasons of not wanting to die, I’ll have to take a few breaks throughout that period). I am sometimes slack on my slacktivism, but I do care, and nature is important.

I just don’t happen to think that that nature is there to help me personally. As glorious as nature is, it’s glorious in a terribly chaotic and amoral way; or, to put it another way:

Study evolution for five minutes and you quickly realise that Nature Is A Douche.

And as a consequence of this, the “appeal to nature” is pretty easy to knock over.

When the home birthing crowd start crowing about how medical intervention in childbirth is unnecessary because women have been doing it for millennia, just point out maternal and neonatal mortality rates over recorded history, i.e., say, “Yes! We’ve been doing it for millennia. We’ve also been dying the whole freaking time.

When people start blathering about chemicals as ingredients in food, it’s a quick moment only to point out that water is a chemical. As is oxygen. And sugar. And, alright, every molecular structure ever. This is how we define chemicals: “a distinct compound or substance.” Then people say, “I mean unnatural chemicals. That didn’t come from nature.” And then you have to point out that all chemicals ultimately came from this poorly defined concept of nature. Even if the end product was synthesised under laboratory conditions, the ingredients were no doubt extracted and refined from natural resources. Or perhaps the ingredients were synthesised from other ingredients extracted and refined from natural resources… and then we quickly run into definitional problems. Yes, to a certain extent, that’s a naive argument from the other end as well – but we really need to address why some additives could be a problem without saying “They’re unnatural!” because that misses the point entirely.

But that’s all fine. Really. It’s when we start to get into the anti-vaccine, anti-medications-especially-antibiotics crowd that I start to take the whole thing very personally indeed.

And I start to ask, why do you want me dead?

When I was about eighteen months old, my mother noticed that I was having difficulty breathing. I don’t have any more details about how the rest of that day went because she flatly refuses to talk about it. My mother loves drama, so this is very telling. My father gets very grim as well, and my father doesn’t generally do grim, as a concept. He runs the emotional gamut from jolly to furious, but grim is not in his repertoire. The memory of that day still apparently scares them both shitless.

This is because I nearly died.

Here’s how: we have a little flap of flesh in our throats that stops us from inhaling our food. It divides your oesophagus (stomach tube) from your trachea (breathing tube) and is called the epiglottis. When functioning correctly, it’s a nifty little structure. Mine was swelling up and blocking my throat, essentially choking me, and it wasn’t just doing this for shits and giggles. In 95% of cases, this response (epiglottitis) is caused by a bacterial disease called Haemophilus influenzae B. Surgical medical intervention was required to stop me from essentially choking on my own throat.

This particular disease has a high mortality rate in children. If epiglottitis is not caught in time, it is generally lethal. Then a vaccine was developed, and in 1993, it became part of the regular schedule of vaccines for infants in Australia. Then – and this may shock you – children stopped dying from it. There was a 95% reduction in reported infections, meaning that less children died from epiglottitis and other resulting complications like meningitis and pneumonia.

I know. Colour me stunned. If there had been a vaccine when I was a baby, I wouldn’t have nearly died. And if I hadn’t had surgical medical intervention as a choking infant, I would have died. Guaranteed. To paraphrase Dr House, “Oxygen is so important to a developing brain, don’t you think?”

So when people talk about how bad and evil and poisonous vaccines are, I want to ask them if they prefer that doctors have to cut into the throat of an 18 month old infant to save their life, or, if they’re really not a fan of that level of medical intervention, if they wouldn’t perhaps prefer the aforementioned infant to choke to fucking death.

And then I want to say, “So that infant was me. Why do you want me dead?”

Not long after that, I developed juvenile asthma – I never actually suffered a wheezing attack and was always able to get the minimal air in, but my asthma attacks presented as severe coughing fits and often led the way to secondary lung infections. Bronchitis episodes were scattered regularly throughout my childhood, and were best treated with antibiotics. Without these, I would quite likely have ended up with scarring in my lungs. There’s a lot that I wouldn’t have been able to do, not the least of which is SCUBA diving.

And it’s even possible that, again, I would be dead.

When I was fifteen, I began to present symptoms of a very unpleasant condition called hidradenitis suppurativa. It’s a pretty unattractive thing, so don’t click the link unless you have a really strong tolerance for pus. It’s a poorly understood autoimmune condition with a genetic component, and I have perhaps the mildest possible presentation of it.

This means I am only hospitalised for it – on average – once every two years. And I probably need medical treatment for it in a GP clinic about – rough guesstimate – once a year. Regardless of whether I end up being surgically treated or whether we can avoid this with the application of copious amounts of broad-spectrum antibiotics supplied in pills the size of which would send your average donkey wandering off for a large glass of water, intervention of some sort is ultimately required.

It’s not a lethal condition. Really, it isn’t. It can be excruciatingly painful, really exhausting (a massive infection site puts a drain on the immune system), extremely gross, and quite embarrassing to deal with, but it won’t kill you… not now, anyway.

However, the main symptom is abscess formation. If an abscess is untreated, then it could burst outwardly and leak infected pus everywhere – which is painful and gross, but manageable – or it could break internally and then you end up with septicaemia, a.k.a. sepsis, i.e. blood poisoning, and you die in considerable pain.

Wow. Guess we hate those evil antibiotics. Guess those bastards are just sooooo bad to have because they’re unnatural. Guess I should have just taken some fucking echinacea.

And died of sepsis.

Here’s another one! A few years ago, I managed to slip on a wet floor, go flying through the air, and land spectacularly on my back. It was hilarious and sore and a bit embarrassing, but I wasn’t worried until the next afternoon when I started peeing blood and passing out.

Lo and behold, someone (who may have been me) thumped their kidney, busted something, and ended up with a kidney infection. I spent the night in hospital on intravenous antibiotics and heavy painkillers, vowing never again to run across a wet kitchen floor, no matter how much I might want to get the shampoo from the shopping bag and then get back in the shower.

But a kidney infection without antibiotics? Why, it’s your old pal sepsis again!

I honestly could not tell you how many times I’ve been on antibiotics for a condition that might otherwise have killed me, but it’s at least fifteen.

I don’t have a genetic predisposition to any of these things other than the HS. They were just bad freaking luck. They couldn’t be prevented with echinacea, St Johns wort, or a few more gallons of breastmilk. This is real shit that happens, and before we had the antibiotics and other various medications, we died from these things. We died in large numbers, and we died in pain.

People who subscribe to these appeals to nature and natural treatment seem to believe that none of these bad things could ever happen to them, because they’re just so very healthy. These diseases don’t happen to them, or anyone down the street. No-one gets sick. No-one needs antibiotics or vaccines, according to them, because they’re so healthy.

I assure you, measles can cause encephalitis in very healthy people, and then they are not healthy anymore. There’s a cause and effect problem here: you are healthy because you lack disease. You don’t lack disease because you’re so healthy. It’s the wrong way around. It’s true that there are some less robust pathogens that are opportunistic and will only really get on board if you’re immunocompromised or a little bit run down, but we don’t vaccinate against those. Measles, pertussis (whooping cough), chicken pox – these are not those diseases. Those can and will kill formerly healthy adults, children and babies, no matter how much breastmilk was provided in childhood.

I’m here now because of these unnatural interventions. I’m here, and I’m relatively healthy. I like to go to gym five or six days a week. I do weights. I run (admittedly not well). I swim. I SCUBA dive. I’m an active person in spite of all those things I’ve been through, and it’s due solely to the wide availability of basic medical care.

Nature is a beautiful, amoral killing machine. It is not better for us. It’s been trying to kill us for a very long time, and we’ve been simultaneously trying to thwart it. So when I run into someone who doesn’t believe in vaccinations or antibiotics, I take it personally. I want to know what I ever did to them, and why they want me dead.

And if they don’t want me dead, and they don’t want other people who get sick to die, maybe a little more thought is in order.

Hypermobility, Episode 2: The flesh machine

At this point there is disagreement over whether hypermobility syndrome – HMS – is simply a subclass of Ehlers-Danlos syndrome or a separate disorder. What is known, is that the problem of generalised hypermobility (where it affects all joints, and is not just an issue of shallow sockets) is a problem of collagen. While it is constantly invoked in skincare ads of doubtful veracity (this amazing serum will stimulate the production of collagen! Sure it will. Sure), it is actually a fairly important protein (edit: collagens are actually a whole class of diverse proteins, but for simplicity’s sake, I’m referring to it as the one item). Collagen is a major component of your connective tissues: skin, ligaments, tendons, and so on. It needs to be reasonably strong in order to keep bones and muscles attached where they should be, but it also needs to be reasonably flexible, in order to allow them to move.

In the case of hypermobility, there is a genetic flaw in the production of collagen (thanks, Mum). It is too flexible. For example:

I thought it was normal to be able to pull out stretchy skin (note: hyperelasticity is not a feature of hypermobility- generally it’s associated with other forms of EDS. However, people with EDS/hypermobility class or HMS will generally show more elasticity in the skin than most people).

I thought it was normal to be able to bend your wrist back past ninety degrees, or your knees and elbows back past zero (hyperextension).

I even thought it was awesome that I could bend over and put my hands flat on the floor. I thought it meant I had flexible hamstrings. Sadly, it just means I have a very flexible lower back, and that this stretch is just going to do me damage in the long run unless I consciously “hinge” from my hips (at which point I actually am stretching my hammies, and not my back).

…although I suspected that my very bendy feet had something to do with the mysterious plague of sprained ankles that has haunted me throughout my life.

I’m not that severe, to be honest. My joints shift and subluxate (partially dislocate) but don’t fully dislocate (with the exception of my kneecaps, which have wandered off far too many times for my comfort), and unlike some people with HMS, I’m not in constant, severe, chronic pain.

It’s still bad enough to cause me injuries. Hypermobile people tend to sprain things. They tend to experience overuse injuries. More importantly, it’s quite common for some very useful muscles to simply not activate the way they should, because they are not properly supported.

Knock-on effects due to leverage

It all comes down to angles.

If, as a small child figuring out how to walk, your joints are lax, then your legs are going to move at a different angle than they are “supposed” to. Instead of staying straight, your knees might fold inwards and forwards due to loose hips. This can in turn send your ankles outwards. What this means, O bendy small child, is that you aren’t actually using the same muscles that everyone else uses, even when you’re trying to do the same thing. Muscles activate in response to a particular angle of pressure.

An easy example is the upper arm. When you want to curl your arm up towards yourself, you activate your bicep. When you want to extend it, you activate your tricep. That’s a really obvious one, but when it comes to hips and back and shoulders, there are a whole bunch of medium sized muscles that kick in due to different angles of movement.

This means that the muscles that bendy child is supposed to be using don’t develop properly, or at least not to the same extent that they do in non-hypermobile people. We end up with sway backs, weak core muscles, and butt muscles that just don’t do what they’re meant to. I can activate some of these muscles, but it has required physiotherapy, clinical pilates, and sheer bloodymindedness to get them working, and I’m still not very good at it.

These are called “bad motor habits”, and they have long-term consequences.

Why does that matter, as long as you get from A to B?

Well, setting aside that one gets a certain amount of heckling when one spends one’s childhood and adolescence “walking funny”, it turns out that you end up putting pressure in places that weren’t meant to experience it. This leads to sore backs, shoulders, and joints in general; a tendency for joints to buckle unexpectedly; and an overwhelming tendency to fatigue.

I am not good at holding a position. Anyone who has sat next to me at a conference (or in a lecture, or on a plane…) is probably aware of this. I get comfortable. Then I shift. I cross my legs. I straighten them. I lean forward. I sit back. I turn to the side. And generally, I take a seat at the end of the row so I don’t bug people (ever since I realised that not everyone does this). Why is this to do with HMS, though? Couldn’t I just be fidgety?

When most people maintain a seated position, they have their ligaments holding their joints in place with very little effort (if any) on their part.

My stretchy ligaments aren’t going to hold jack shit in place, so I end up activating a whole bunch of small (underdeveloped) postural muscles to hold a seated position. These muscles get very tired, very quickly. It is very, very tiring for me to hold a position, so I am constantly shifting to work different muscle groups.

This is a special kind of hell on long-haul flights. Everyone else seems to be able to sit upright with their feet on the ground whereas I desperately want to lock my feet up against the back of the seat in front (something of a faux pas I understand if one is older than six years of age) because otherwise sitting up requires me to use core muscles that, in my case, suck and it is miserable and painful and exhausting. It is far more comfortable for me to just fall into my joints.

Not only that, but when you have HMS, you are always, always thinking about what your body is doing and how it is doing it (case in point: while typing that sentence, I just hooked my right ankle around my left shin to lock it in place). If you don’t think about it, even just in the back of your mind, that’s when ankles roll and muscles tear and you trip over your own goddamn feet (again). And that’s pretty tiring and distracting too.

I get tired when studying from having to shift positions over a textbook. I get tired when writing in a notebook from having to constantly change the angle of the book against my arm.

Why yes, HMS is linked to chronic fatigue syndrome. When sitting can make you ludicrously tired, fatigue is just a given. I actually find that a good gym workout is, in many ways, less fatiguing than sitting up on the couch. It’s still tiring – obviously I’m deliberately working to develop certain muscle groups – but the machines support all the flaily, falling-over bits of me while I work the target group.

I repeat: up until recently I thought all this shit was normal. It’s thought that between 5 and 10% of the population are generally hypermobile but don’t necessarily experience all these symptoms: you can be generally hypermobile without experiencing HMS.

There are other symptoms that are even less fun than being somewhat bendy and spraining the odd ankle (edit: I have a sprained ankle at the moment. The synergy, it burns).

Collagen, unfortunately, is all through your body. This means that HMS and/or Ehlers-Danlo are systemic conditions – having excessively elastic connective tissues leads to problems in your gut (weak intestines which in my case result in the occasional genuinely agonising gut cramp), problems with airways (tendency to asthma), problems with blood vessels (low blood pressure, orthostatic issues as in a tendency to pass out), problems with vision (yes, there’s collagen in your eyes; HMS is linked to myopia a.k.a. shortsightedness) and problems with various components of your autonomic nervous system – that is, the bits of your nervous system that are supposed to do things without having to be told. Some people can have seizures. Some people have temperature anomalies (hot head, cold feet, etc.).

What is common to most people with some form of this condition is chronic pain. I’m not sure how I got lucky on that one. I don’t have chronic pain (or if I do, it’s so mild that I’m obviously disregarding it).

At the moment, I have a sore left ankle bone on the inside, a weird stabbing pain in my right toe for no reason I can think of, shoulder pain and back pain. None of these pains are serious enough to even need ibuprofen, let alone anything stronger. For many who have HMS, however, the pain appears to have no cause and is a function of an over-sensitised nervous system.

So what does this all mean?

The problems that I have because of this condition are problems that I’ve had all my life. Although I’ve been tired enough to miss out on things from time to time, I don’t have chronic fatigue, and although I tend to be a bit achey and sore, I don’t have chronic pain. The only reason this is an epiphany is because it explains so many weird and odd things about my body in a rather elegant way.

But… HMS has implications for pregnancy and childbirth. The collagen problems are exacerbated by exposure to progesterone, leading to pelvic girdle pain, even looser joints than normal, and all sorts of problems in childbirth. You have a much higher chance of experiencing permanent damage throughout the process. Husband and I have been considering adding to the population some time over the next year or so, and in that light, suddenly a caesarean is starting to sound pretty good (because who wants their pubic symphisis to permanently separate? Freaking no-one, that’s who).

Also, the agonising gut pains… they’re pretty bad. To give you an idea of the pain, I was checked out for gallstones, kidney stones and appendicitis (none of which I appear to have). My vision goes grey. I’ve actually passed out from it. It’s like being stabbed (I imagine). It doesn’t happen often, but when it does, Jesus fucking Christ, it hurts.

Can any of this be fixed?

Well… not really. It’s genetic. It can get better, though, through rigorous exercise designed to strengthen the muscles supporting the loose joints and to stabilise and activate those neglected core muscles (at least one of which, apparently, everyone else activates automatically without even thinking about it, whereas I was staring at an ultrasound, randomly flexing, trying to figure out where the damn thing was). Apparently strengthening those deep core muscles will actually help with the gut pain. That’s promising.

One thing to remember is that, if you are hypermobile and show a bunch of these systems, exercise is not entirely optional (if you want to stay mobile and active and free of back pain and so on for an extended period).

When I went to the physio as a precursor to undertaking clinical pilates, I filled out a new customer form asking me what goals I hoped to achieve.

I kind of stared at it for a while. I knew I needed to do pilates if I was going to fix the problems with my core muscles, but that was part of a general desire for health and fitness.

In the end I wrote: “1. Stabilise core muscles. 2. Reduce pain and injury risk. 3. Improve proprioception.”

In the actual appointment, of course, the physiotherapist administered the Beighton test. When asked to bend forward and put my hands as close to the floor as they could go, I asked, “Really? As far as I can go?” because hey, it’s nice to be good at something, even if the thing you’re good at it is ultimately pretty bad for you.

About eight months on, and the core work has actually, genuinely helped. I can hold a ninety second plank. I can stand and walk for longer without getting lower back pain. My form with free weights is improved. I still can’t sit still in one position for very long, but I don’t think that’s ever really going to change – my joints are what they are.

Unfortunately, nothing can really be done about the gut pain that strikes like a vindictive ninja a few times a year. One takes a couple of very strong painkillers and tries to pass out until the pain goes away.

So, while HMS/EDS has an extremely varied presentation, this is what it means for me.

Diving Fit!

[Note: I was in New Zealand for a few days for work-related business, and at the moment I am wrestling with a particular blog post that requires more attention and editing and fancy pictures than I can generally churn out on short notice, so here is something I prepared earlier. -KN]

Before getting my dive ticket, I agonised over whether I was “diving fit”. I spent most of my childhood and adolescence being more-or-less sedentary, and had this notion in my head that people had to be extremely buff gymsters in order to be able to SCUBA dive.

This is… not the case. Of course, the more fit you are, the better: diving will be easier. Walking down the pier wearing weights and tank will be easier. You will be more efficient with air. You may be asked to carry other people’s tanks, and thus earn their eternal gratitude and numerous blackmailing opportunities. Your tendency to get fatigued and dehydrated and develop some form of DCI (decompression illness) will be reduced.

Fitness isn’t, as a concept, well defined. It is better to apply fitness to a particular goal.

Take yours truly. I am not spectacularly fit. I go to gym a few times a week, I do my weight training, I spend a lot of time on flexibility, and at the moment I am trying to get through the Zombies! Run! 5k training app. I am probably stronger than most of my cohort (age/sex/etc.) and have an advantage in terms of muscle mass. But if you watch me running, you will be appalled. I am slow. I am ungainly. I have bad feet. I have hypermobile joints. I am, basically, horrifying to watch. My podiatrist referred to me, in slightly awed tones, as “the most flaily runner I have ever seen.”

In short, I am not running fit.

Fortunately, I am diving fit.

To be basically diving fit means that you can accomplish the following things:

  • You can swim 200 metres (any stroke; I like backstroke) without stopping. You can take as long as you like to do this.
  • You can tread water for ten minutes (this can be quite soothing).
  • You can lift and carry your own tank (it’s okay to need help getting it on. That shit is heavy and awkward right there. Park benches, fence posts, retaining walls and dive buddies are popular aids for this process).
  • You can walk around wearing the unit and the weights that you need to descend (more on that in a moment).
  • You can climb ladders onto boats and piers wearing the unit and the weights.

A standard sized 12L steel tank weighs slightly under 14 kgs, although this varies depending on the manufacturer and how much air is actually in it at the time. For most people this is a bit uncomfortable, but not a major obstacle.

The real problem comes down to weighting.

If you are diving in warm, tropical waters, you may not need thermal protection. It’s warm and pleasant, so you might dive in a lycra suit or, if you’re not concerned about jellyfish and fire corals, a bikini. Bikinis and lycra suits are not particularly buoyant, so you won’t need much weight.

If you are diving in cold waters (Melbourne. Sigh), you need thermal protection. I dive with at least a 7mm neoprene semi-dry wetsuit. These are, to use a technical term, very floaty. In cold months, I wear a drysuit. These are even more buoyant, since they don’t take on water. You don’t sink in this gear; you just bob around on the surface of the water. That’s not diving. That’s just very expensive snorkelling.

Because of this flotatious thermal protection, I need to wear more weight. The amount of weight you need to use is reduced as you get more experience in diving: you relax, you breathe more slowly, you learn to control your buoyancy. I am down to about 7 kgs in my 7mm suit, which suits me just fine (I used to wear about 10 kgs). That means that, including the tank, I’ll be wearing over 20 kgs strapped to my person, not counting the wetsuit itself and other accoutrements; and let’s remember that it is not strapped on in a particularly ergonomic fashion. I can walk in that without getting exhausted, but it is a workout not to be sneezed at.

In my dry suit I wear about 11 kgs of lead – so over 24 kgs in total. That makes a difference. Again, I can walk in that, but I do so very slowly, and have a breather before I descend (note: descending while out of breath or with an above-resting heart rate is not a great idea. You’ll guzzle air on the way down).

This is me. I am of a very average build. You might think that if you put on weight, you’ll have to carry less lead – because, naturally, you’ll be heavier.

Unfortunately (and believe me that I curse this), fat is positively buoyant in water. So even if you are very heavy on land, if that heaviness is fat rather than muscle, you will need more weight. I’ve known people who wear upwards of 20 kgs of lead alone, not counting their tank. This doesn’t mean they can’t dive; on the contrary, people of all sizes and shapes can master our not-so-ancient art, since people of all sizes and shapes can be diving fit.

But it does mean they have to be very strong if they are going to do cold water diving, because they are going to be walking around wearing that gear. You don’t usually park on the pier. Generally, you walk at least a hundred metres from the carpark to the water entry, and frequently it’s further than that. Not only are you walking, though; you’re bending down to pick up things if you drop them, or put your fins on if you are doing a jump entry; you’re helping your dive buddy get their own gear on; you are still bending and moving and doing heavy work, it’s just that now you’re wearing a metric fuckton of weight. You need to be able to do these things and help your buddy do these things if they get stuck.

This is not meant to be discouraging. I found it embarrassingly difficult to do anything in full kit at first. You get stronger, and it gets easier, and then it feels fantastic. It’s better to go in with your eyes open, though.

This is the main reason why diving requires fitness – for the most part, it’s not the actual diving and swimming. You wear fins when diving, and most of the time people swim quite slowly so they can look at things. In fact, you are encouraged to be relaxed and breathe slowly; diving is exercise, but it’s not supposed to be work when you’re under water (unless you are actually diving as part of your employment, which may involve diving in crappy conditions). The biggest risk is before and after you get in the water.

My recommendation for “stay dive ready” exercise is weight training focusing on back, legs and core work. Those are the muscles you use to handle your gear, get it on, walk around in it, and swim against current if necessary. Cardio is obviously a net benefit, but that is always true, and it’s not everything. I’ve seen numerous divers with excellent cardio fitness struggle to get onto the boat at the end of the dive because, when gravity reasserts itself, their glutes and hamstrings start to give out.

That’s right. You need a strong arse. You can climb a ladder wearing weights, but you need to take it slowly and use the big muscles.

I nearly met my match on a particularly awful ladder in Albany, Western Australia. It was an old, slightly rusted ladder hanging from the town jetty, and only the bottom rung was in the water; this meant I had to hook my knee over it to even get leverage. There was a moment where my supervisor looked at me and offered to take my weight belt so I could get up the ladder. I am nothing if not bloody-minded and managed to get my feet under me and straighten my legs (not without some cost and limping and very sore muscles for the following couple of days), but it was touch and go for a moment. This was also back when I was wearing a lot more weight, and, not coincidentally, I had less muscle strength than I have now.

Essentially, if I can do it – even at the cost of some wincing and whimpering for a day or so afterwards – it is pretty much achievable for most people, barring some particular circumstances.

There are a few conditions and situations that make SCUBA diving a spectacularly bad idea, and some that merely make it slightly more tricky, including but not limited to asthma and diabetes, as well as some temporary advice. I am not a doyenne of diving health or general SCUBA safety, but I plan to do some research and post some more general and basic information on the above conditions and general Thing You Should Not Do but which some people do anyway (much of this would be covered in an Open Water course, but refreshers are always good). If you want a heads up in the mean time, I suggest contacting someone listed among the South Pacific Underwater Medical Society (www.spums.org.au).