ED Recovery – Interesting Information

I came across a cool thread on ED recovery and calorie increasing. One particular comment was really interesting, it’s hella long but I’m going to copy paste it here (If you’d like to see the whole thread you can click here).

“First of all, the bloating and severe gastrointestinal discomfort is happening because you have starved and largely killed off all the bacterial colonies in your gut that are actually responsible for digestion and turning food into energy. You have to dependably eat 2500 calories a day to put enough energy into your system that the bacteria can rebuild the colonies and start digesting properly. You can alleviate some of the bloating, gas, pain and distention, but eating constantly throughout the day in 200 calories increments (that means 12 and half snacks a day). After a few weeks of eating 2500 calories a day, you will be able to return to normal 3 meals a day plus snacks (still 2500 calorie totals however).

While you allow the eating disorder spectrum thoughts to generate all your behaviors, you cannot recover. Recovery includes weight gain. But more importantly, it includes repair. Your current weight is likely right at the marker BMI level for anorexia: 17.5. So you need to accept that the level of damage your doctor has outlined to you has occurred because you have anorexia: purposeful and dangerous starvation (less than 1000 calories a day). Your kidneys may fail. Do you know what dialysis entails? You do not have any more room to continue to cater to your ED-skewed neurotransmitters in your brain. They have to be pulled in line because your health is shot.

You are not connecting enough with your immediate health risks and instead spend most of your post continuing to feed the compulsions and anxieties around weight gain. That’s totally understandable at this point and not a criticism to make you feel worse — just a truism that you must face. As you attempt to recover, you will feel an increase in the anxieties around weight and weight gain. I address how to overcome this with proper support at the end of this post.

You have done hundreds of thousands of calories’ worth of damage to your body. A calorie is an energy unit. You don’t need to burn off food because food is used as energy for all your body’s vital functions. If you burn it all off in excessive exercise, then your body literally has no more energy to keep your heart beating.

Work on reprogramming your thoughts. Be diligent about forcing yourself to think about food as energy for repair.

I’ll apologize now for the length of this post, but I want to cover off four more major things:

1) Why do you have an eating disorder.

2) The math of why you need the calories to fix the damage.

3) What to expect in the phases of recovery.

4) What kind of help you need now to improve the chances of recovery.

1) Restriction Eating Disorder Spectrum

One of the unfortunate aspects of recovery from an ED is that some things have changed in your body in ways that do not occur for non-ED people. So I’ll first explain a bit about the shifts that happen when ED-genetic mutations are activated with starvation.

When a non-ED and ED person both starve their leptin levels plummet in their systems. Leptin is a hormone that manages metabolism, appetite, bone formation and reproductive hormone function. When we are at a healthy weight and taking in adequate energy, then our leptin levels are at an optimal level. When they plummet, two things happen: the metabolism is suppressed and the appetite increases.

For the ED person, the starvation activates genes that shift the normal function of neurotransmitters in the brain. It is these neurotransmitters that generate the anxious and compulsive thoughts, feelings and behaviors surrounding food and weight gain.

A non-ED person will say she feels irritated, fatigued, hungry and moody when starving. The leptin levels dropping are creating unpleasant moods and extreme hunger to signal to the brain that it is time to go find more food/energy to eat.

An ED person will say she is not hungry. Although experts dispute whether she actually does feel hunger or not, it is clear she feels calmer, energized and dissociated from negative feelings (emotionally blunted) as a result of suppressing her hunger. The ED-skewed neurotransmitters are able to override what the leptin levels should be triggering: unpleasant moods and the desire to eat more.

One third of all people who diet end up on the restriction eating disorder spectrum. While not all of them develop clinical cases, they all experience lifelong anxieties and compulsions around food and weight gain (if left untreated). They can develop clinical cases at any point due to life stressors (anything from a cold to a break-up) and they can slide up and down the spectrum or express multiple facets of the same spectrum at once (anorexia, restrict/binge, bulimia, orthorexia (extreme focus on healthy foods) and anorexia athletica (over-exercise)).

If the non-ED person and ED person are both of the same age/weight/height (pre-starvation) and we ensure they both return to that pre-starvation weight, the non-ED person returns to optimal leptin levels, but the ED person does not. Her leptin levels remain sub-optimal despite being at that pre-starvation healthy BMI.

As leptin acts as a gating hormone for the normal functioning of reproductive hormones, a weight-recovered ED patient needs sufficient leptin in her system to normalize reproductive function, bone formation function and neurotransmitter function.

In weight-recovered female patients where their periods have not returned, we know that further weight gain will be needed to return to optimal leptin levels which is needed for normal resumption of reproductive hormones, bone formation and neurotransmitter function.

Usually optimal leptin levels are achieved in a recovered ED patient between BMI 21-25.

Much of our understanding of how to best help ED patients fully recover and avoid relapse has come through the research of W.H. Kaye et. al.

We also know that weight-recovered ED patients are less likely to relapse the higher up they go on the healthy BMI range — it’s linear and a patient at BMI 25 is the least likely to relapse. BMI 18.5-20 are most likely to relapse.

2) The math of why you need the calories

And here’s the math to explain it all. If you eat 3000 calories every day and stay completely sedentary, then that’s 21,000 calories that go into you for one week.

Sounds huge however we have to subtract the 7,000 needed for the actual fat and muscle rebuilding that has to happen each week (the fat stores are the only way you get your period back and reverse osteoporosis).

That leaves 14,000. But then there is the amount just to keep you breathing, heart beating — that basal metabolic rate thing that just keeps you alive. Estimating, that swacks off another 6,800 or so calories.

To repair damaged heart, skin, nails, hair, kidneys, digestive system, brain areas, bone and blood formation systems…you are actually giving your body only 1,000 calories a day to go to that effort. That’s if you dependably eat 3,000 calories each day.

The less you eat, the longer it takes to recover because the harder it is for your body to find any excess energy to repair the damage.

So 2500 a day is the minimum (only giving your body 500 calories a day for repair). 3500 is better, 4500 is excellent. Anorexics who embrace recovery can find themselves eating 9000 calories or more and as long as they eat a minimum of 2500 the very next day then they have just moved themselves faster to the finish line of full recovery.

There is not a cell in your body that is not in need of extra energy for repair at this point.

3) The Phases of Recovery

There are three distinct phases and one critical final phase for complete weight recovery and here’s a bit of what to expect.

Phase I — water hoarding.

The body seems to gain 7-16 lbs. in the first couple of months. An anorexic that has not been prepared for this will panic and restrict before she gets too far along. The “weight” almost exclusively water hoarding. The body needs the water for cellular repair. The water retention dissipates past the second month, but only if the anorexic is reliably eating 2500 calories every day throughout that time.

Digestive distress is common in this first phase: bloating, gas, pain and abdominal distention. You can alleviate this by eating smaller amounts more constantly throughout the day: 200 calorie increments 12 and a half times a day. This digestive distress occurs because starvation has drastically reduced all the critical bacteria in your gut that do most of the digestion for you. In order for them to recolonize to acceptable levels they need the energy in.

Don’t be tempted to lower the calorie intake because of the discomfort — just space the food out throughout the day. Yogurt with active cultures will be your best friend.

If you could tolerate lactose before anorexia, then you will again once recovered. However, many anorexic patients in recovery can experience transient lactose intolerance. This is because the system is so stressed that it can no longer reliably produce lactase to break down the lactose. If you find having milk, cream and ice cream cause bloating and diarrhea, then replace them with soy and rice options. Do not have any low-fat or non-fat options for any foods in your home.

Also, while dehydrated in the early phases, resist the urge to drink lots of water. You will get adequate hydration if you eat 2500 calories a day. If you do have drinks, make sure they are full of nutrition. So instead of sodas, it’s fruit juices and soy milk.

Coffee tends to increase gut motility (that means moving things faster through the colon) — which is usually not an issue as most anorexics have very slow gut motility due to starvation. However, do limit coffee intake to one or two cups a day and make sure they are loaded with creams and sugars (ideally) to focus on getting food in the system.

Phase II — vital organ insulation

If you get here, then the body is now desperate to protect your vital organs. It assumes you will starve it again soon enough and without insulation around your mid-section, your organs are in grave danger.

The body preferentially lays down fat around the mid-section to insulate. Again, an anorexic that is not prepared for this will freak. You can feel huge (a combination of fat around the middle and the residual bloating and gas of a digestive system struggling to get up to speed again). Unfortunately, many relapse here.

Sadly, the redistribution of all that fat around the mid-section to the rest of the body only occurs if the anorexic persists right the final phase.

Phase III – Bones, muscles, almost there

Assuming you have been purposefully eating your 2500 calories right up to this phase, then you start to get rewarded for all your hard work to help your body repair itself.

Osteopenia and osteoporosis begin to reverse (the completion of that may take up to 7 years, but it begins to reverse in this phase).

The fat deposited around the mid-section is now carefully redistributed throughout the body.

Hair, nails and skin begin to have increased pliability and suppleness.

You also start to feel more connected and self-imposed isolation diminishes. You feels less emotional blunting and start to want things for your life.

This occurs about 4-6 months along the recovery path (depending on the starting point) and will be around BMI 18.5-20.

A few anorexics will resume their menstrual cycles at this point, although they are the minority.

Unfortunately this is often when an almost-fully recovered anorexic makes a series of mistakes (often also due to misguided advice even from her own medical and professional team). She assumes she can now maintain her weight and that she is recovered.

Instead, she relapses again within the year. Why?

Final Critical Phase: Leptin or Relapse.

It is rare that an ED patient will attain pre-ED leptin levels at BMI 18.5-20. Usually, due to the physiological implications of having an ED, leptin levels are lower in recovered ED patients than in normal controls who are exactly the same weight/height/age as the ED patient. (as I mentioned earlier)

To get an optimal leptin level as a recovered ED patient, you need to shoot for the high range of a healthy BMI (21-25). We know that the higher a recovered ED patient ends up on the BMI scale, the less likely she is to relapse.

A marker for sufficient leptin in your body will be the resumption of a regular period. An anorexic needs to continue to gain until her periods resume  — she also needs to avoid exercise until that happens.

From there, you can now maintain your weight — but even then there is a catch. You must have a maintenance intake plus an additional 30% more calories every day for another 6 months beyond hitting your maintenance BMI.

You can resume modest activity through these final 6 months, however (taking care to add that into the maintenance amount so there is never an energy deficit — always energy plus 30%)

You will not continue to gain weight during that time. The extra energy intake is used to completely normalize the neuroendocrine system. This final phase is critical for quieting the neurotransmitters in the brain that cause all the ED thoughts and behaviors.

4) What kind of help improves the chance of recovery

You need a recovery team around you that you see pretty-much weekly to ensure some accountability and support.

While your GP is there for the physical check-ups and confirmation that your refeeding is going as planned, she is not too much help (as you discovered) in providing with many ideas on how to up calories etc.

So, a dietician or nutritionist is a great addition to your team — helping you with food ideas and perhaps meal plans if you find counting calories is creating too much initial anxiety and reactive restriction.

A psychologist or psychiatrist that you like and trust who will offer you cognitive behavioral therapy is the single most effective way of ensuring you have a complete and permanent recovery. If you see one and don’t like him or her, move on to the next one. But the accountability of the process will help generate new neuronal pathways that will initially side-step the ED-skewed neurotransmitter pathways and eventually weaken them and override them.

Again, sorry for the huge post but I wanted to give you some background so you can frame your next steps for recovery in ways that will ensure you not only survive, but thrive.”

Hope that was a little bit enlightening for you too 🙂


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