Extreme Hunger in Recovery: What You Need to Know

During recovery from anorexia nervosa and other eating disorders it is common for your metabolism to speed up (that is for you to become hypermetabolic) during weight restoration1,2 and even after weight restoration1,3.

This increase in metabolism is usually referred to as “extreme hunger” … which leaves little to the imagination in terms of how this increased metabolism is experienced…

In today’s post I am going to answer a few of the questions I am commonly asked about extreme hunger including:

What is it?

Why does it happen?

How long does it last?

What should I eat?

and most importantly I’ll be translating all this into what it means in the real world and how you can not only get through what can be an incredibly anxiety provoking experience (there are no words) but also work with extreme hunger when it comes to your own recovery or the recovery of someone you love.

What Is It?

The harmful effects of continuously eating below your body’s needs, malnutrition and starvation are pervasive. All your organ systems are affected including your heart (cardiovascular), digestive (gastrointestinal), hormonal (endocrine) and metabolic alterations4.

Therefore, nutritional restoration is a central component of recovery because of the need to restore weight5 in order to avoid severe physical complications and also to improve your brain function and make psychological work beneficial6.

The more energy (calories/kilojoules) you can get in the quicker your body can stop further damage and then go on to heal. Which is why extreme hunger in recovery from any eating disorder is “normal”.

Essentially extreme hunger is your body trying to first and foremost prevent any further damage occurring from malnutrition and starvation and secondly and only if enough energy continues to come in heal itself.

Which I appreciate does no justice to how utterly traumatic the real life experience of extreme hunger is when you are in a position where nothing is more terrifying than the thought of eating. 

Having been through the process of extreme hunger more than once I know there are no words to describe the internal torment and confusion of having an insatiable appetite no matter what you eat. 

My belly would be popping out like a beach ball (I distinctly remember googling if you could pop your stomach from overeating) and yet I would still be “hungry”. If you’re in this position my heart goes out to you for doing the brave thing and putting your trust in your body. 

Why Does It Happen?

During the first phases of nutritional replenishment people in recovery from anorexia are very energy inefficient.

This is due to a number of reasons including increased energy needed to metabolise food or what’s known as diet-induced thermogenesis. The energy dedicated to diet-induced thermogenesis can be up to 3 times that of the energy a healthy person not in recovery would require to metabolise the same food.

As well as this a variety of hormonal and nervous system (neuroendocrine) alterations further alter your body’s energy usage in ways that make it more difficult to eat enough.

In a nutshell your body is working hard to do the simple tasks of daily living that someone who has never had an eating disorder would do far more easily.

How Long Does It Last?

It lasts as long as it lasts.

Honestly, it takes as long as it takes for your bodily functions to get back on track.

You can’t control this, and you certainly cannot decide how long it “should” last.

All you have to do is give your body the tools to do the work it has to do, and it will do it.

What Should I Eat?

It should come as no surprise here that calorie dense foods are recommended to replenish the necessary nutrients7,8 and studies have shown that low energy dense food and limited variety are associated with poor outcome9

Without increasing your food intake by a substantial amount it is well recognised that the risk for rapid weight loss is high which may partly explain the high rate of relapse for people in recovery from eating disorders (reported to be up to 50% in AN1,10.

What are caloric rich foods? A good place to start is adding foods like full cream dairy, butter or oil, nut butters or tahini to dishes because they are high energy, but low volume and low fibre so have less risk of causing digestive problems.

It is also important to eat regular meals and snacks (3 main meals plus 3 snacks and more if needed). You should never really be going more than 2.5 hours without a meal or snack.

Main meals and snacks should include all of the macronutrient groups (carbs, fats and protein) plus a few milk drinks or adding additional powdered milk or drinking Sustagen/Ensure/fortisips over the day. These are things I found useful in my recovery and there was a time when Sustagen Hospital and powdered milk in milk drinks were 3-4 times a day staples.

You really do have to do what you have to do to heal your body.  

 Definitely consider working with an eating disorder dietitian because there is going to be no one in your personal life who understands how much food it takes to recover.

What This All Means In The Real World

In short what this all means is that during recovery from anorexia nervosa your body has an increased need for energy (caloric need) as well as micronutrients (vitamins and minerals).

That is, you need to eat more food than you would otherwise need to eat were you not in recovery and most likely much more than those around you not in recovery.

Otherwise you’re not going to recover.

It truly is that simple.

So, if you’ve struggled to gain weight on what you or others would typically think of as a large amount of food it’s time to up it.

It comes down to recognising that there is no outside plan which can tell you what your body needs.

If you’re not gaining weight, there’s nothing wrong with you and you’re not immune to weight gain you just need to eat more.

Put the judgement (yours and others) aside it truly has no place in your recovery.

Recovery Is Pain With Purpose

Recovery and extreme hunger are not about the weight gain per se. They are all about giving your body the tools to prevent further damage, to repair the damage that has been done and then to advance.

Most of all it’s about giving your brain the fuel it needs to rewire and create new ways of doing things that don’t depend on the old disordered thought patterns and behaviours of the eating disorder because at the end of the day recovery is a time where you are essentially creating a new you.

None of which you can do when your prefrontal cortex (the most “human” part of your brain) is starved because the older parts of your brain (the paleocortex and brain stem) are fuelled first to simply keep you alive and only if there is energy left over will it go to fuelling your prefrontal cortex and helping you truly make conscious changes to the quality of your life.

Which is why it’s important to remember through it all that recovery has a purpose.

Recovery has a destination.

That destination is recovered…

… and recovered is more than anorexia no longer having a say over your life it is when you have magical (or spectacularly normal and mundane) things in its place.

Recovery may stop but your life doesn’t.

Your life goes on and your progress continues because your life continues.

Recovered Is Just the Beginning

So, here we are back to that age old wisdom that will cure all people with anorexia nervosa “just eat more” and I want to say here that I fully recognise having been there myself that the difficulty comes not in the “what” to do (eat) but in the “how” to do it.

If you could eat more, you’d be doing it.

Believe me no healthy, happy fully functioning person enjoying their life (no matter what phenomenal level of willpower they possess) is capable of starving themselves. It’s actually biologically impossible.

Which is why while I could give you a perfect meal plan of what to eat and when to eat it and how much to eat of it and tell you that it’s going to be ok plus some other comforting reassurances thrown in for good measure the truth is this is going to be hard.

The truth is recovery sucks.

People would recover quickly and certainly wouldn’t die of this illness if recovery was easy.

The best meal plan along with all the helpful suggestions and reassurance in the world are not going to heal you; you are going to heal you.

That is when you get the help that can help you do the hard things, not some day but today because if you could do it alone or the way you’ve been doing it you’d be there by now.

Consider doing it different this time round.

Please get great help now because you will never ever recover and wish you’d waited another week, another month, another two years, or another thirty-three and two thirds of a year.

Your life is now.

With All my Heart I Hope You Found This Information Useful & Inspiring.

Become Great.  Live Great.

Bonnie.

Reference

  1. Kaye W, Gwirtsman H, Obarzanek E, George T, Jimerson DC, Ebert MH: Caloric intake necessary for weight maintenance in anorexia nervosa: nonbulimics require greater caloric intake than bulimics. Am J Clin Nutr. 1986, 44: 435-443.
  2. Walker J, Roberts S, Halmi K, Goldberg S: Caloric requirements for weight gain in anorexia nervosa. Am J Clin Nutr. 1979, 32 (7): 1396-1400.
  3. Weltzin TE, Fernstrom MH, Hansen D, McConaha C, Kaye WH: Abnormal caloric requirements for weight maintenance in patients with anorexia and bulimia nervosa. Am J Psychiatry. 1991, 148 (12): 1675-1682.
  4. Mehler PS, Krantz M: Anorexia nervosa medical issues. J Womens Health. 2003, 12 (4): 331-340.
  5. American Psychiatric Association: Treatment of patients with eating disorders, 3rd ed. Am J Psychiatry. 2006, 163 (Suppl): 4-54.
  6. Bruch H: Anorexia nervosa: therapy and theory. Am J Psychol. 1982, 139: 1531-1538.
  7. Reiter C, Graves L: Nutrition therapy for eating disorders. Nutr Clin Pract. 2010, 25 (2): 122-136
  8. Lutter C, Rivera J: Nutritional status of infants and young children and characteristics of their diets. J Nutr. 2003, 133 (9): 2941-2949.
  9. Schebendach J, Mayer L, Devlin M, Attia E, Cotento I, Wolf R, Walsh B: Dietary energy density and diet variety as predictors of outcome in anorexia nervosa. Am J Clin Nutr. 2008, 87 (4): 810-816.
  10. Pike K: Long-term course of anorexia nervosa: response, relapse, remission, and recovery. Clin Psychol Rev. 1998, 18: 447-475. 

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