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

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D's lab results came back.  Most were good.

However, her lipoprotein a is elevated, which is very depressing.  Her dad had this, and when Lp(a) is elevated, it means substantially increased risk for heart disease.

Also, D's vitamin D level is low.

I'm now getting conflicting medical advice.  D's new internist is planning to tell her to cut down on butter, ice cream, etc. (?!?), to try to lower her LDL (which is 116).  I have a phone call in to her.

Thank God for Dr. Peebles.  I contacted her, and she wrote and sent an article by a physician stating that "A low-fat diet is the worst possible diet for Lp(a).  I tell my patients to add healthy oils to every meal."

The article continues:  "You know what fraction of fat is most effective for reducing Lp(a)?  Saturated fat!  Peculiar, isn't it?  However, it doesn't mean you people with this pattern should eat unlimited saturated fat sources.  I tell my patients to eat saturated fat sources selectively, such as real cheeses, lean meats, and eggs (but not cured meats, fried foods, and processed foods made with saturated fats)."

Meanwhile, D's new local internist has talked to the new FBT therapist with whom D and I are meeting Monday.  She told therapist that she thinks D should go back to college this month.  I told new therapist on the phone that right now, I feel that paying the tuition bill would be like handing a large sum of money to the ED.  She asked if I still wanted the Monday appt.  I said yes, if she thought that she could keep an open mind.  I think that she was a bit offended, but she said yes.  She acknowledged that she trusts the opinions of the local internist.

I know that D will be extremely upset (understandably) about the elevated Lp(a).  I think that there will be a psychic struggle between her ED and this new dietary advice.  It makes it seem even more likely to me that she should take a semester off from college, and that I can start by plating meals -- possibly according to Kartini meal plan.

I asked my 22-year-old son what he thought should happen, if his sister were "neutral" on the topic.  He answered just as I thought -- that she should not go back this month, that it would be better for her health and recovery not too.  Of course, he added, she's not "neutral" . . .



I am totally confused.  Do you plan on using this new internist instead of DR. Peebles?  I know I mentioned to you that she  (local internist) was the one who set my D's weight way too low and gave her a lot of inappropriate directives.  We stopped seeing her because she was triangulating with my D's ED and we just worked with the FBT.  You are fortunate to have already gone to Dr P who did a thorough evaluation.

If the FBT who sent you to that Dr can not remain neutral then you need to talk to her again and say that you want to work with Dr. Peebles along with her, since Dr. P seems to know more   Amoma has a great idea to have a conference call with Dr. Peebles.  You need  UNITED team, not one professional who gave her professional opinion to send your D back to school after having met her for a short time and not hearing from you and your history of growth chart. It's not just having your D cut out fats - she set the weight too low.

You are the Mom and you are the one who can decide which professional/s to work with.

I think the more you feel confident and remain calm, it will help your D in the long run.
If it were me, I would be taking my D up to Dr. Peebles in the coming week and not back to this internist.

And I would tell the FBT that is what I'm planning to do rather than continuing with an internist who made a quick/hasty recommendation without even hearing from you about your D's growth chart.  Dr Peebles did a much more thorough evaluation and recommended a higher weight for your D based on her growth chart.

In hindsight I know every time I kept going to someone who triangulated with my D's ED - it put another notch into her coffin.

You have already taken your D to Dr. Peebles and she is telling you good sound information - and can continue monitoring your D as her ED physician.  

The other thing you can see if your D has lost weight while being on a trip at the beach for a week or more.

If she has (and of course you need to get an accurate weight and notice her STATE when she returns), that will give you and the FBT more data.  

If it were me, I would let the FBT know that you want her to hear from Dr. Peebles since she is the one you were working with from the onset.
ED's thrive on triangulation and parent's lack of confidence.  I know you know what to do.

Your son is giving you good feedback that your D is not neutral.  She can always visit her bf if she takes a semester off to recover

Sending you strength and hope

WenWinning (formerly wenlow) - a Mom who has learned patience, determination, empathy, and inner strength to help her young adult daughter gain full remission after over a decade of illness and clinician set inaccurate weights

I remember reading something about high lipids as a sign of malnutrion.  You might want to read this article:  http://feastingonresearch.blogspot.com/2009/05/high-cholesterol-in-anorexia-nervosa.html.  There are others if you google lipids and anorexia.

I am so sorry for the challenges that you have before you.

Some good advice has been given already.

I like the idea of having a conference call with Dr. P and the internist.

Was this internist recommended by Dr. P?

You say that the FBT seems to have confidence in the internist but frankly, based on Wenlow's experience with the internist, I would be wary.

As to fats, people in recovery from anorexia absolutely need a high level of fat in their diet.

Butter, olive oil, real cheese, lean meats, eggs, even milk and cream - the French exist on diets that include plenty of those and they do well.

As to Vitamin D deficiency, I too had that. For awhile, I took a therapeutic dose of Vitamin D 3 - 3-4 tiny capsules that I bought at Trader Joe's per my doctor's recommendation. My Vitamin D got back to normal relatively fast. I now take 1-2 a day for maintenance.

Hang in there, Marilyn.

Lots of hugs for you today.
Cathy V.
Southern California
Just a quick note:  If your d is on any medication for depression or others, "fats" are necessary to transport the medication throughout the body and esp. the brain.  She needs them for the medication to work properly.  In the case of my 14 yo D on medication for ED, a slight decrease in fats that we initiated because of elevated bloodwork DID start to affect her behavior.  Increasing her milk intake, etc... made a difference. 
one hour at a time
Marilyn,  We're all here to support you.  How are you doing?  Were you able to get information you need for the appt on Monday?   Sending you strength and more strength
WenWinning (formerly wenlow) - a Mom who has learned patience, determination, empathy, and inner strength to help her young adult daughter gain full remission after over a decade of illness and clinician set inaccurate weights