I had a really hard week last week. I maintained my weight, I got frustrated, then I came to a realization. I cannot keep trying to make failures work. Does this make sense? If it hasnt worked in the past, it hasnt worked lately, it is NOT going to work. Admitting the way I was going about this was and is wrong was so hard to come to terms with. Maybe, just maybe, I was not doing something right. Admit it, change it, and try something else. I cannot force myself to be or act a certain way thinking the results will magically change this time. It’s hard, recovery is a shithole and changing is so hard. I have developed and entirely new routine in the past 2 days. It starts when I wake up and it does not end until I lay down for bed.
I got a meditation and gratitude book. I highly reccommend them for anyone. Helped me fall asleep last night free from anorexic debate in my head all night. It is called The Language of Letting Go. I am getting my mom a copy tonight and asking her to read from it, as I will be every morning. I figure it sort of gives her a connection to me and my recovery. My parents are part of my ‘Boundaries” i set up because for some reason they trigger me. I will work on that later though. So here’s my week in review and at the end a study/arcticle I found very interesting.
Week 3- Step 2 Completion
Admitting I am willing to put my trust in the program
- I have done this before. I have been here in recovery before. It is where I always assume ‘I am different’ and I know best. I swear I am some special case and somehow what works for others just wont work for me. I ended that Sunday night.
- I know exactly WHAT I need to do. I have everything I need to be successful. I have been told before, but I didn’t do it. This time I am going to do it. IT IS POSSIBLE and I am capable of making the changes
- My meal plan is increasing 500 calories this week because I maintained my weight last week. This scares me but it is do-able and will be done.
- My morning and evening routines are changing. My mornings start with a small stretching session, meditation, and daily gratitude. My evenings end with reading from my meditation book and making sure my calorie requirement has been met and I have a game plan for the next day.
- I have a hard time seeing a therapist because I am just shy of having my own degree in clinical psychology and I know what the deal is. I know what is going to be said, what manipulation will go on, and what is involved. The important thing is I stay honest.
- I plan to follow through with everything 100%, aim for 110% and see where I land
- Trying to use this week to see if attempting to make light of needing to gain from an outside perspective. Most people would kill to ‘need’ to gain weight. Try to laugh off more aspects of myself that I find hard to deal with or do everyday. ‘Fake it till you make it’
ED Talk Sanity- The need to add more food for continued weight gain
“Worst that could happen?”
- I’d gain weight
- It’s physically impossible to suddenly gain tons of weight instantly
- I will become a binge eater
- I wont understand fullness
- I will lose understanding and control on food/my weight
- I will be obese/fat
Reality…. It’s physically impossible to suddenly gain tons of weight instantly
These obsessions are ALL things I NEED to not control. My destiny does not lie in my food intake and weight. With my new routine and finding comfort in it, I will hopefully be able to present a sounder minded and calm person.
Relationship Goals: Don’t distance myself and shut down – communicate how I’m feeling instead but keep boundaries when ED is incapable of being social/triggered. Take myself out of situations I cannot handle and have sole focus on meeting my calorie goal, regardless of what it means/takes.
Problems from the past week:
- When I feel like delaying eating all day, I usually do so because I feel like I have to punish myself – I’m not worth it to feel good. I deserve to feel drained, disconnected, zoned out. I deserve to feel fat and toxic to society. My new routine and preplan, as well as daily morning and night meditation should ease my morning mood & self hate problems. Sleep is my best tool.
- I have problems with self-image. Not eating or delaying eating puts and keeps me in an “I’m a horrible human” sort of mood. I am annoying to be around and i feel the need for control.
- I think people feel like they have to walk on egg shells around me. Asking my particulars about my food & weight trigger me to restrict and skip meals. I don’t mean for things to trigger my head, but they do
- I am incredibly triggered when people expect something out of recovery that is not part of my recovery but they think it is. I am immediately frustrated and feel like a failure. Recovery is NOT me pleasing other people so I NEED to keep up my boundaries I set.
- The person I currently am: This is not how I want to live. This is not the sort of person I want to be. I understand that my emotions matter and that it’s okay for me to communicate that I feel bad, but it’s not okay for me to make others feel bad. And, I feel like if I am not perfect and progress with some great accomplishment every single week, it makes others feel bad and me feel like a failure. Again, I need to stop people pleasing and focus on ME.
- The more I eat the more I hate myself and the more down on myself I am. The better I do, the more emotional I am. The harder I fight, the worse my sleep is. The worse my sleep is the harder it is to fight. I really feel like I have a split personality. This is only going to get harder, and worse. Maybe this is why people with anorexia are usually locked in a room all day in the hospital.
- It is DAMN HARD to live day-to-day like and work with my state of mind, mood swings, and need to 100% stick to my calorie goal.
I am ashamed to admit that I have had jump on the recovery wagon to late in the day resulting in overeating and then restricting the next day. I have a hard time comprehending when I am full until it is about an hour to late. I NEED TO follow my meal plan EVERY SINGLE DAY. I am also embarrassed to admit that my weight has affected my mood and the way I treat the people. I am angry and frustrated that I am letting this happen. I am usually better served dealing with hate, frustration and fear in the absence of people. I absolutely understand now, as I have never been this far along and passionate about recovery, why people are put in programs away from ‘normal’ people for extended periods until they are capable of being ‘sane’ in public, life and around food. I literally need to separate myself from society often to deal with myself and force food or a better mood.
I am confused. I know and realize some of the things I do aren’t healthy, but they are a part of me and being in recovery and a step I need to move past. Balance is key and so is moderation. I need to moce forward and keep going. As I am constantly told at group- but it is so much easier said than done.
I know what I need to do. I made the decision to start the prescribed incremental refeeds with carbohydrates and I have never made a more honest yet apprehensive, determined and excited/scared decision in my life. There were so many emotions running through me when I wrote down my goal to do this. I will.
Remember: There is no lying
I am giving you the next article not for your approval or disapproval or even for comment but for your knowledge. Again, remember I only ask for your support and not your opinions or critiquing. I am an incredibly capable person and am learning to find confidence in the good of recovery. I have a need to know exactly what is going on in my body/brain and what to expect, so this was a very helpful article for me. Once I read this I was put at peace with what I need to do and what will be done.
Comprehensive Recovery Meal Planning with a Plan- To the Anorexic
You no longer have a regular menstrual cycle or may not have for years — one of the indicators of a BMI that is too low for your natural set point. You have decided to finally stop lying. It is the hardest decision you have ever made. No one understands you. When you start eating and not gaining weight it is time for the next step.
First and foremost realize only 10% of the population is naturally under a BMI of 20. Usually, that tiny proportion of the population actually has to eat huge amounts of food to maintain their BMI 18.5-20.
Not eating enough is very dangerous, as anorexics who go long enough in the maintain-state risk a whole host of problems such as decreased bone mass and density along with a risk of osteoporosis, diabetes, insulin resistance and heart problems. Therefore, refeeding is required on a regular basis of about once every week to two weeks to ensure these problems do not become an issue.
Particular focus and caution need to be paid when dealing with leptin levels, as it is the reason for a halt in reproductive hormones that occur when leptin gets as low as seen in anorexia. This is shown through the stoppage of menstruation, commonly experienced by those with eating disorders.
“After you’ve lost weight, you have an increase in the emotional response to food,” says Columbia University Medical Center researcher Michael Rosenbaum, who studies the body’s response to weight loss and starvation. He says you also see “a decrease in the activity of brain systems that might be more involved in restraint.” This is why anorexia recovery is so ill informed and incurable.
But here’s the fascinating part from studies: When they restored leptin to anorexics by giving them injections of the hormone, the brain response changed. When they saw food, there was more activity in brain areas associated with conscious decisions. Studies show only carbohydrates and a rise in insulin determine the ability in restoring leptin. In the anorexic, this evolutionary programming is out of sync with what’s healthiest for our bodies due to one’s starvation, brain chemical imbalance and incorrect nutrition. The signal evolved over thousands of years when food was scarce. It was the brain’s way of telling the body to seek food and protect fat stores. This is what leptin is for, and what anorexics lack in resistance and signaling.
Multiple studies on anorexia refeeding have shown that periodic mass carbohydrate intake with adequate protein in the absence of fat restored brain chemical balance, leveled serotonin and dopamine, as well as restored menstruation at a 96% effective rate- better than any process to date. This needed to be maintained until menstruation began and functionality in life was restored.
“It’s a feedback mechanism,” says Rexford Ahima of the University of Pennsylvania. “Leptin signals the brain; when there’s a deficiency of the hormone, the areas of the brain associated with reward-seeking become more active. “ With these periodic refeeds on carbohydrates, the anorexic learns to distinguish between hungers and experience a level mind. Restoration of leptin gives way for the ability of the anorexic to fight the disease on their own.
One third of the population has the genes to end up on the restriction eating disorder spectrum (REDS), which includes anorexia. The genes are present throughout life but activated by environmental pressures. Not everyone with the activated genes ends up with clinical cases of REDS, however they all have lifelong issues with weight gain, body image and food intake if left untreated. Anorexia nervosa is a very rare misinformed illness. Some can go decades with sub-clinical issues and then develop a full blown case due to a life stressor of some sort.
When the genes are activated they shift neurotransmitter function in the brain and thus leave eating disorders with no cure- it is a lifelong illness. It is that skewed malfunctioning that generates anxieties and compulsions around weight gain, body image and food intake. Once the anorexic begins acting on those thoughts and feelings with restricting food, then the pattern is reinforced. This is why one bad day, and each struggle is so important and necessary in getting well. REDS includes anorexia, restrict/binge, bulimia, orthorexia, and anorexia athletica (compulsive and excessive exercise).
The first step toward recovery is getting to a sub par clinical level BMI. The clinical distinction between sick and ‘okay’ lies in a BMI of 17.5. After years of solid calorie restriction and malnutrition one cannot just start eating. No body knows the consequences of starvation besides Ancel Keys in the Minnesota Starvation Experiment done in the early 1900’s. Incremental increases in food day by day need to be established and maintained. The metabolism will eventually speed up. Blood sugar problems, onset diabetes, and hypoglycemic attacks are all interlinked to the malfunctioning and misfiring in the brain circuits. These lead to anxiety and stress. Blood sugar is leveled and normalized in the anorexic by starvation which lends itself to the nature of the disease.
Cognitive behavioral therapy (CBT) is a process of awareness and techniques that help short-circuit acting on the anxieties and compulsions to restrict food intake. It’s a partnership between the anorexic mind and the self which works to be accountable and responsible. It is the best, clinically proven solution for complete and long term wellness from REDS regardless of restoration in weight and bodily functioning.
Get to it: Think of it as the same as brushing your teeth — you brush your teeth to avoid more invasive and serious dental work in the future. Same thing for anorexic tendencies – keep at it now and the whole effort is less invasive and much more preventative than if you wait for things to get really bad which in reality has already happened.
Nuts and are your best friend. Do not go anywhere without them. You need to snack throughout the day especially if you are finding your appetite is not communicating with you. Depending on your individual approach, you need to count calories or create meal plans. Some anorexics cannot count calories — it’s too stressful and anxiety-provoking. So if you think it will trigger you to restrict then develop meal plans.
You need to eat at least 2500 calories a day- if weight gain stalls add 500 calories as necessary. You will gain weight on that intake until you hit your natural set point. At that point, the metabolism takes over and nutrient-wise everything levels off. Creating meal plans of 2500 calories a day means you get away from counting calories and you just have to tick off each item on the plan every day to be sure you are getting all the nutrients you need. Try to go at gaining weight the way you would a school assignment — you cannot just hope for the best, cram at the last minute, or procrastinate. You need to put a plan in place and then follow it.
Walking is fine and relatively low activity actually helps your brain chemical balance. Do not however force an energy depletion and misbalance. Your muscles will swell and reappear with correct nutrition.
You need to increase calories up to 2500 calories a day as quickly as possible (upping by 200 calorie increments each day). There are many issues that may complicate the process of re-feeding- hypoglycemia, leptin resistance, onset diabetes, heart problems, bowel problems, blood sugar problems. Many were mentioned earlier. Your stomach will hold water and weight as well as your upper arms. After your initial reefed your face and cheeks will swell and your stomach will develop a pouch of water. It is all related to starvation symptoms and the bodies desire to hold onto everything it can.
The best idea is to keep your fat high (until we get to your hormones below) as it will precursor hormones and brain function, omega 3 is necessary for brain normalization and depression.
Leptin is what will essentially cure anorexia and has been proven time and again in treating the body-mind-hormone restoration. However, treatment with leptin is thousands of dollars a week. Raising leptin needs to be done on a weekly or bi-weekly basis as shown in the previous studies. Because the only thing that raises leptin is carbohydrates in the absence of fat, you only periodically reefed with solely carbohydrates because fat is needed in the diet as well but blunts leptin response. For reefeeds focus on sweet potatoes, starchy squash, root vegetables, tubers, GI balanced fruit, fat free yogurt- oats or popcorn and rice cakes if you don’t have bowel problems or have already stabilized blood sugar.
The hardest thing for a recoveree to accept is the massive amount of carbohydrates periodically needed for mental health and hormone regulation. Besides that, resuming your meal plan is most important after a carbohydrate feeding.
Due to anorexia you will never have a normal appetite or leptin level which is the reason 85-90% of recovered anorexics are overweight or binge eaters. This keeps the disease at bay however; they suffer the consequences with diabetes, social anxiety problems and blood sugar mishaps for life. Don’t let this scare you and again, meeting your meal plan with discipline is crucial.
As a recovering anorexic, once a week you NEED to spike leptin and insulin (stability is important here with blood sugar problems) by boosting carbohydrates. Try to aim for 2-3g per lb of body weight in carbohydrates once every week or so. Focus solely on carbohydrates. Expect your body to undoubtedly hold a good 5 pounds of water as a result and stay off the scale. Resuming your meal plan without restricting will allow nutrient assimilation and hormone regulation and stabilization.
When you see a drastic mental clarity and improvement following the first reefed with resumption of your meal plan, you will be convinced more so that refeeds aren’t a scary thing and are absolutely necessary if you hope to achieve all your goals and restore menstruation.
The key is carbohydrates, low fat and adequate protein done in a cyclical manner. Load up on natural carbohydrate sources because they have the most nutrients. Make sure you hit your calorie mark as well, and try to get 50 grams of carbohydrate ever couple hours throughout the day until you hit your caloric requirement. Wasting your day with junk like cereal and simple carbohydrates will not help your leptin as there is no nutrition in them and studies show unnatural food blunts leptin response, worsens blood sugar, and enhances insulin resistance.
This is not to prescribe your daily meal plan to exclude carbohydrates as they are good for you; however when eaten in unison with fat and protein, insulin and leptin are blunted and thus not ever released. What you need are good sources of carbohydrates, their nutrients and reaction in the body. You still need to hit the calories from your meal plan and note doing this may be hard. This will be the most agonizing day mentally on your meal plan as it is usually done in an inpatient program – anxiety and panic are greatly induced until you become comfortable with your body and food balance. You will probably have the desire to not be around to many people and definitely not a day to spend by the pool. KEY POINT: RESUME YOUR MEAL PLAN. Ask for accountability by your sponsor in resuming your meal plan. As you have been told time and again, following your meal plan is your number one priority.
Zinc is the mediator of leptin. Zinc is present in mushrooms, eggs, liver, beef and spinach in good amounts. Get it with fats in your meal plan to ensure nutrient absorption which your body already lacks ability wise. Leptin, when released by the body is sent to the hypothalamus and thus connecting to the adrenal-pituitary hypothalamic gland (where anorexia starts) which signals the body to store fat and release hormones. Do not be scared of this; it is essentially the reason behind refeedings. The key is raising leptin, which should be done incrementally due to its need and success stemming from low fat and adequate protein. After about 6 months or when menstruation is restored, you will be able to stop these refeedings and simply follow a balance diet and meal plan. This maintenance stage is the hardest aspect of recovery from any eating disorder.
While you feel very disconnected to your appetite at the moment, if you just eat and follow your meal plan regardless with discipline hitting 2500 calories or more depending upon the individual, your appetite will come back in a few months. This can also freak you out — don’t worry it’s a great sign when this happens. Respond to the need to eat constantly and work to avoid acting on the desire to restrict again. Food is food- calories are calories. It will never change. Carbohydrates, fat and protein are not fattening in themselves and are needed for a healthy body. Carbohydrates work hormonally in your body with leptin and store 3g of water per gram, thus resulting in more weight. Fat stores and releases hormones for fertility. Protein rebuilds organs, muscle and strengthens the body. Obesity is the result of a flawed insulin-leptin regulation by the brain similar to anorexia.
On a final note: if you do not think you are mentally capable of handling a carbohydrate loads to raise leptin and stabilize brain circuits and hormones, then ask someone to help you, or simply disregard the refeedings. For inpatient this process is the most painful and for outpatient the determination and follow through lies in the individual and his or her support system. Don’t be scared to admit your fear and apprehension, but do not let it guide your decisions.