How are you all? Things are beautiful over here FINALLY! Full sun, 20 degrees and we are all loving life. This is the type of weather I think we are meant to be in all the time because people are just happier. Do you find that too?
As for general life, I have one exam down, one to go then I start my new research job next Monday. Student life for ya. Never ending. As for my health, still working away and still making gains in the gym, so a positive direction I would say. Oh and how could I forget…
More and more food. This weekend I actually got another BIG increase and, as normal, my heart began running a marathon in my chest..
Why I red the email before my exam I have no idea… Self sabatoge much?
The increases always do this to me, but this one was rather dramatic and I’m getting anxious for Monday (tomorrow) when I have to deal with it starting.
This leads me into the topic I wanted to discuss today. I don’t know if it was this increase that sparked this question in my mind or if my constant complaining about why my tiny body needs so much food just to even maintain my weight has finally made me want to check things out but, regardless, this was my random question that led me to some journal reading…
Does your metabolism heal fully post recovery?
Is my metabolism messed up and that’s why I can’t gain?
These are what I started asking myself. Maybe I never really went into search because I just assumed it was similar to dieting…
Eat less food…metabolism decreases
Eat more food…metabolism begins to heal, readjust and speed back up to normal.
So given what recovered individuals go through, I just assumed that during the severe restriction that the metabolism would be damaged and then with the re-feed it would just heal itself back to normal eventually provided you kept the weight on.
I was also told by the doctors that post re-feed, those with anorexia tend to be in a ‘loosing mode’ but given that I gained the weight during the re-feed, obviously, and kept it on when I left, I never really thought about things like my metabolism much. I really never thought about this problem at all to be honest.
It also never occurred to me to think about it throughout the years because I was just eating when I wanted to. It wasn’t until I lost (not intentional, I just wasn’t aware in the beginning what I was doing and then being unable to reverse it) and was ‘trying to gain on my own’ that it really hit me that I needed to eat A LOT.
This is when the questioning started.
I’m 5 feet tall.
Yes I work out hard but for real, I’m eating more then some guys cutting…
This is hard I don’t want to have to eat this much
Now hear me out, I rationally know that everyone’s body is different and that exercise and building muscle leads to an increased amount of food required, but by me being a person who used to look at the diets of others (including competitors), it began to mess with my ability to stay rational when it occurred to me that I was eating more calories then they were.
They work out hard, they are taller then me and eating less?!?
I actually started getting really irrational and thinking that maybe I wasn’t seeing myself right and that I was ‘getting bigger’ because.. how could I not be? I’m eating a house (Or so thought at the time…). It just didn’t make sense to me that I was eating what felt like so much and not gaining anything so every possible theory, no matter how crazy and unrealistic it was, came up.
I’m still working at not comparing and doubting my rational side but I decided to actually look into the research instead of just letting my ED spread it’s lies in my mind and driving me crazy.
As I began to search around, I figured that this information would be quite beneficial to many of your guys, as I know that there are some of my readers that have gone through similar situations. So I hope you can gain something out of it or just at least find it interesting.
Oh the body and it’s workings…
So what did I find?
***Disclaimer. Please note that the research behind post re-feed metabolism is still young and many of the the findings are not in full agreeance but there does appear to be a general consensus that there is a period of “hyper metabolism.” ***
To keep it brief and not too wordy (so I loose you all), I will stick to the main bullets from some studies then sum it up at the end.
So not only do those suffering with anorexia (AN) have to eat an increasing amount of calories throughout the re-feeding process to start and continue to gain weight at the same rate, they also need it afterwards. Specifically, there tends to be a duration of time post re-feed where a significantly higher number of calories needs to be consumed then what would typically be estimated for an individual of the same height/weight without an eating disorder history just to maintain that restored weight.
Marzola and et (2013) did a PubMed review and reported quite a few interesting findings:
~The graph above suggested that, compared to healthy weight female controls, patients with anorexia nervosa (AN), both restrictive and binge/purge types, required more calories per day for their body weight directly after treatment. Following one year (the long-term recovered), restrictor types still required significantly more calories for weight maintenance then controls.
~Although studies appear varied, there is a quite a dramatic increase in calories per kg of body weight that has been found to be required for weight maintenance in those with AN. When compared to normal weight female controls, who needed approximately 20-40 cal/kg/day for weight maintenance, those with AN have been found to need 50-60 cal/kg/day or more to keep the restored weight on. Post-refeed the increased calories appears to be required or rapid weight loss is often the result.
Personal Response: Perhaps this is why there is such a high rate of relapse? The fact that patients are no where near psychologically recovered directly after re-feeding and then on top of that have to maintain such a high caloric intake may be too much of a demand for them to handle. Furthermore, weight loss is even more favourable as the body is slow to fully heal and has this hypermetabolism issue.
~They did also mention that this tends to normalize itself after about 3-6 months.
~Overall, this suggests that those with anorexia become hyper metabolic during the re-feed process which is actually kind of the opposite of what occurs in cases of calorie reduction for the sake of weight loss in overweight individuals. In the latter case, the overweight struggle to loose weight because as they reduce their calories they become HYPOmetabolic so the slower burn makes it more difficult for them to reach the required deficit. On top of that, if their calories are increased, they rapidly gain because their metabolism is in a less efficient state. Contrarily, for the individual with AN, they need even more calories then before just to gain anything because their metabolism is just hummin too fast. This increase, however, is not that it’s more efficient but rather, that their bodies are simply using more thermogenic processes then normal. In other words, they are just burning off more of their intake as heat rather then using it for building or attributing to new mass.
What about Bulimia Nervosa?
As you saw with the graph above, those suffering with bulimia (BN) may not have the same issue. Directly after treatment, Marzola et al (2013) found a slight increase in caloric needs, but that did not hold true for the long term as it did for AN. Similarly, an earlier study by Weltzin et al (1991) that looked at the difference in weight maintenance requirements in patients with restricting AN vs. BN found that AN requires a significantly higher number of calories to keep the restored weight steady.
Does it last forever?
It doesn’t seem to.
Most studies that I came across gave a range of anywhere from weeks post re-feed to 6 months where the metabolism was generally restored itself and the caloric needs returned to what was considered normal. Although the exact mechanism behind this hyper metabolism during and post re-feed is still unclear, there have been a few suggestions as to why it occurs. One of the more consistent theories is that the endocrine system takes a bit longer to fully recover and return to a normal functioning and so for weight to be sustained post re-feed, the increased caloric intake is required to be sustained (Kaye, 1986, Mazola, 2013). Another contributor to this increased need may be increased exercise. Many studies have found that those with AN tend to have greater exercise generated energy expenditure through behaviours such as fidgeting, pacing, and increased walking (Kaye, 1986). As a result, their caloric needs would increase more then the average person in addition to their already higher requirements for weight stability.
Alrighty for the sake of not boring you too death by having something 40 miles long, I suppose I will end it there. What did you think?
As a final reflection back to my own situation, I suppose some people would call what I have gone through a relapse as I lost a dramatic amount of weight post re-feed back when I was 16. Although it was not intentional and it was so slow that I really didn’t pay attention until it started becoming more of an issue, the point is that I went back to unhealthy body fat and weight levels for my size. As a result, working with my coach is more like a re-feed period once again. Lucky him…
Due to that, it looks like I may have to endure this caloric surplus once again (FML right?) in order to get fully back on my feet. This is also on top of my increased needs from lifting….I can say that I’m thankful that my mind did not relapse, if you know what I mean, but still, the physical gaining process and accepting will not come without dealing with body image issues and dysmorphia. This unfortunately will then promise to make this journey quite the mind fu** for me.
But I just need to…
So to conclude, this research was interesting for me to do as many things are making more sense to me, even more things then I shared in this post. I hope you can benefit in some way from this discussion and, as always, hit me up in the comments with your lovely thoughts.
Much love! ❤
Kaye, W., H., Gwirtsman, H., George, T., Ebert, M., H., Petersen, R. (1986). Caloric consumption and activity levels after weight recovery in anorexia nervosa: a prolonged delay in normalization. International Journal of Eating Disorders, 5(3), 489-502.
Mazola, E., Nasser J., A, Hashim S., A, Shih P., A, Kaye W., H. (November 7, 2013). Nutritional rehabilitation in anorexia nervosa: review of the literature and implications for treatment. BMC Psychiatry, 2013(13), 290. doi: 10.1186/1471-244X-13-290.
Tatyana, (2014). Hypermetabolism in anorexia nervosa. Retrieved April 17, 2015 from http://www.scienceofeds.org/2014/05/07/hypermetabolism-in-anorexia-nervosa/
Weltzin, T., E., Fernstrom, M., H., Hansen, D., McConaha, C., Kaye, W., H. (1991). Abnormal caloric requirements for weight maintenance in patients with anorexia and bulimia nervosa. American Journal of Psychiatry, 148(12), 1675-1682.