F.E.A.S.T's Around The Dinner Table forum

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Roseau
Does anyone have any ideas of how to convince my daughter to take iron tablets? She has been iron deficient (but not anemic) for the past four months and was prescribed iron tablets by the GP which she didn't take. Last week she was diagnosed with anaemia and still says she won't take the iron tablets.

Her reasoning is that it is has taken her a long time for the food restriction to have any effect on her body and she is not going to "undo" her "hardwork" by taking the iron tablets.  She has lost a lot of weight but she still sees herself as fat so thinks the iron deficiency is the only thing that shows she is restricting. (She is in denial most of the time about having an ED).

I finally managed to get her referred to an ED service but she is still waiting for her first appointment, which can take up to a month. Obviously I would like her to take the iron tablets but she is a student and doesn't live at home so I can't just hand them to her and tell her to swallow them. Does anyone have any suggestions?

She has a loan which covers her living costs so she is not financially dependent on me so I can't use that as leverage as I have seen people suggesting on other threads.
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Enn
Roseau, 
Your d's ED is so strong. I hope she is getting some help that is pushing her to eat- a month to wait does seem so long. That fact that she does not wish to even consider iron to help her is quite telling of her mental state. 
Ultimately full nutritional rehabilitation will be required and vitamin/mineral supplements may help. I am not sure what to advise you as I agree you cannot just give them to her and have her swallow. 
Just like getting her to eat more, it  won't happen until she does it. I know she is an adult and you do not have much leverage. 

Has she seen Tabitha Farrar's website? 
When within yourself you find the road, the right road will open.  (Dejan Stojanovic)

Food+more food+time+love+good professional help+ATDT+no exercise+ state not just weight+/- the "right" medicine= healing---> recovery(--->life without ED)
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ValentinaGermania
If she has lost a lot of weight and is not taking her prescribed meds, are you sure she is able to study?
How is her physical state? Is she in risk of collapsing there?
Is there a mental health unit at University you could contact?
Can you go there and live with her and help her to eat?
Keep feeding. There is light at the end of the tunnel.
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BetterNow
This must be tough to watch your D reject. I'm sorry. Personally, I had very slight anemia while involved in ED's. I also had other nutrient deficiencies. Being a vegetarian clearly did not help. As Tina advocates, I am now a Flexatarian. Great name for us rigid types to practice! There has been media coverage of the Flexatarian movement recently that was interesting too.

Without being terribly underweight I had multiple physical problems related to what I now know was malnutrition. Supplements were part of recovering for me. In fact, just this second I recalled yet another deficiency- potassium. Had I not taken potassium supplements I could have died as that was one cause of my EKG abnormalities. I took the potassium because my heart rhythm was really uncomfortable and frightening.

I'm wondering if simply appealing to the probable reality that your D will feel much more normal with a better iron level would work? It's so simple, but still might be worth a shot. With my very mild anemia I felt a lot better ("more normal") in about 6 weeks of supplements. I took iron on top of a decent multi-vit/mineral, which contained some iron too, and a quality high potency B-vitamin also, because I managed to become deficient there, as well. My other supplement was a low dose calcium-mag-zinc combination. (I do actually think that the zinc helped food taste better!) And all at a weight that was not super low, but too low for my Irish/German body; too low and undernourished and abused for me. 

I still take a really good multi-vit and mineral daily, some antioxidants, and magnesium just a few times per week. I have to manage my dietary iron, calcium and potassium or I will require extra supplementation with those again too.

As someone who is in her 50's now, I wish I had a parent like you in my corner when I was younger. I would pursue  the iron tablets and try to normalize it: she will feel more "normal," many women need iron supplemented at some point in their lives (E.D. or not) and it is a positive, medically prescribed tool in  her thorough healing so truly is important for her to be at her best.

Iron (esp. Rx iron, but all) can be really constipating. You might want to work out how to prevent that ahead of time. If she'll take probiotics that might be useful and then there are extra fluids, though not a creative "reason" to waterload 😉 and things her doctor could chime in on, of course. Think I took daily stool softeners for a long time. Such a fun topic!! But hey, constipation goes with E.D.'s often, whether on iron or not.

I really hope this doesn't sound patronizing  because it is such a simple idea, on my part.
It certainly is not meant in that way. You have a conundrum and you care.❤






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Roseau
Thank you to those of you have replied. 

I think my daughter's case is probably slightly unusual. She has had serious mental health problems for a long time (depression, suicide attempts and  an in-patient stay as a younger teenager, but there was never even a hint of an eating disorder). She got a lot of help from CAMHS and was much better just before she started university. Something traumatic happened when she started univeristy and the ED has developed as a result of the trauma.

Telling her an ED can be fatal does not bother her particularly as she still has high levels of suicidal ideation. She is seeing a private therapist for the trauma (I gave up waiting for her to get to the top of an NHS waiting list). The private therapist is not an ED specialist and links the ED to her previous forms of self-harm (which I think is correct). I trust the therapist to eventually work through the trauma with her but obviously I don't want her physical health to deteriorate too much in the meantime. She is currently seeing a GP weekly while waiting for an appointment with the ED service so I at least feel someone is monitoring her physically, but I would like her to take the iron tablets. Maybe it is naive of me but I didn't think there would be a battle over taking a supplement. I can understand increasing food intake is hard but why  is taking a supplement so complicated?

in answer to Betternow, I was anemic when I was pregnant (and for a long time afterwards) and I keep telling her she would feel so much better if she took the tablets but she says she likes the way the lack of iron makes her feel and I am at a loss as to how to reason with that! I totally agree with you about the digestive side-effects of the tablets but for the moment I haven't mentioned them too much (I don't want to give her anothe reason for rejecting them!)

In answer to Valentina, she is already in contact with student support because of her original problems. She is a long way from me and I work. Her father died some years ago so I need my salary. I am not prepared to attempt to bring her home as there is trauma linked to her home town and, although having her at home might help with the ED, it would very likely trigger her previous problems and that is a risk I am not prepared to take. Paradoxically, although the ED is worse, she is in a better state mentally than she was a year ago - she still has suicidal ideation but she no longer has a plan.
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Torie
I wonder if she might take the iron for YOU if she will not take it for herself.  (My d says that's why she ate.)  Just a thought - I realize you probably already tried that. xx

-Torie
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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Foodsupport_AUS
Roseau I am still a bit concerned about your D and the time taken to get assistance for the ED. Things can spiral out of control very quickly and GP's sometimes don't understand how ill someone is. Other parents elsewhere have mentioned that ED treatment comes before trauma, and this makes sense to me too. One is life threatening, but of course someone with an ED will often focus on the trauma, and not wish to address the ED or deny it outright. The fact that your D has detectable nutritional deficiencies suggests this may have been going on for some time. She needs on the ground (some one with her) to help her eat, increase her intake etc.. This will not help her feel better initially, in fact it may make her feel worse for a while but it is an essential part of her recovery. 

I was told at the start of my D's illness "we don't negotiate with terrorists". ED is a terrorist to your D, and there is no logic or reason that can be used sometimes to get her to eat a certain food, sometimes to drink, or to take supplements. It would need to be required. Weirdly - just buying them for her and expecting her to take them may help her take them - ED hates spending money too. 
D diagnosed restrictive AN June 2010 age 13. Initially weight restored 2012. Relapse and continuously edging towards recovery. Treatment: multiple hospitalisations and individual and family therapy.
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atdt31_US
Not sure that it changes the equation at all, but there are liquid iron supplement options.  Would that make it better for her ... since her reason is so irrational maybe worth a try to see if she can justify this even though she won't take the tablet.  
Mom of either pre-diagnosis or non-ed underweight 12 yoa (as of March 2018) kid here to learn how to achieve weight gain.  BMI steadily in the mid 12's for nearly her entire life.  Born 2006. UPDATE:  April 2018 diagnosed ARFID, based solely on weight being less than 75% of Ideal Body Weight.  Mildly picky, but mostly the problem is a volume/early satiety issue, along with abdominal discomfort and chronic constipation, all present since birth.  UPDATE:  July 2019 diagnosed with PANS. Dr. said likely started first PANS episode at less than 1 or 2 years of age.  On long-term daily prophylactic antibiotics. BMI now about 16 after period of intense refeeding prior to PANS dx,  followed by stagnation as we sort out what is next. FWIW ED-D is a fraternal twin and we have no other kids.
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MKR
Are you able to add iron into her diet? Would she eat mussels? Or meatballs. Blueberries, spinach, too. They can be served in small mouthfuls that she could manage easier. And you don't need to mention they contain iron, as I think ED is fighting you on principle, rejects anything that sounds like improvement. 
Mum's Kitchen

14-y-o "healthy living" led to AN in 2017 and WR at 16. Current muscle dysmorphia.
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Torie
I wonder if her therapist could help with this.  Her therapist cannot tell you anything about your d without her permission, but she is allowed to listen to what you tell her about your d.  Maybe you could contact her therapist and let her know that your d is anemic and refusing to take iron supplements.  Just a thought.

Also, I agree with FoodSupport that she needs someone to eat with her - ideally, you.  I wonder if there is a way to arrange that in the future. xx

-Torie
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
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