Valuable information from Gwyneth at Eatiopia that is deleted and displaced with Edinstitute.org
One third of the population has the gene to develop a restrictive eating disorder.
Obesity is not a disease. It is a reference to having more than
average amounts of adipose (fat) tissue. Therefore the phrase
"dangerously obese" or "morbidly obese" makes for great popular media
headlines, but it is not a medical reality at all.
Fat tissue is
not a storage unit. It is a critical hormone-producing organ. In fact
only about 5% of the population has what has been nicknamed the "thrifty
gene".
Under stress one-third of the population is hypophagic
(eats less food) and the remaining two-thirds are hyperphagic (eats more
food). But food consumption is not correlated to weight at all. One-third of the population is estimated to carry the genetic predisposition to develop a restrictive eating disorder. The most common trigger for
activating the condition is dieting.
Anyone can be naturally, completely healthy at BMI 41 if that is their natural weight set point.
People
do not keep gaining. No one keeps gaining and gaining. Even those with
the so-called thrifty gene who tend to end up right at the far right of
the weight bell curve (BMI 40+) maintain a stable weight assuming they
do not diet or restrict.
Is it possible to become heavier than
your body's optimal weight set point? Yes. The most common way to do so
is cyclical dieting. Sleep deprivation messes with hormone levels and
rhythms to cause the adipose tissue to demand more energy thereby
increasing weight. Some drugs have similar impacts on adipose tissue as
well.
And because those with restrictive eating disorders
instantly pounce all over the concept -- "But I've been dieting, does
that mean I will end up heavier than I am supposed to be?" No. Cyclical
dieting is a distinct behaviour that is not related to all the forms of
restriction you practice on the REDS.
I'm going to quote all the material that missrising was kind enough to add into another thread:
Mehler's
et al 2010 "Eating Disorders: A Guide to Medical Care and
Complications. Mehler is an MD who works at Denver acute eating
disorders unit. Weight, like height, is a bell- shaped curve,
and someone has to hold down the upper standard deviation from the
average, although few women accept this fact.
70% of all women naturally fall between BMI 21-27. And no, women are not "overweight" at BMI 25-27.
These
are all complicated concepts to synthesize in a post -- that is why the
Fat series on the blog is as long as it is -- there is actually a lot
of clinical data and fact that explains these concepts and it takes time
to unravel all the common misconceptions we all hold.
There is
only one group of individuals for which the act of "gaining and gaining"
really occurs. It occurs for a very rare set of individuals born with
serious genetic mutations whereby all the checks and balances of
hormonal interplay to define hunger and satiation are shot. These
individuals are also often mentally and physically damaged as well. One
of the few genotypes within this class is Prader-Willi syndrome. There
are a few others. The number of individuals afflicted with these
conditions is infinitesimal and if you can read and understand most of
these sentences, then you are not among them.
G.
Phase I- Edema
Digestive
distress is common in this first phase: bloating, gas, pain
and abdominal distention, diarrhea or constipation. You can alleviate
this a bit by eating smaller amounts more constantly throughout the day.
Despite all the physical discomfort of these early days, many
experience
a tremendous sense of relief and initial joy at eating in an
unrestricted way. Carbs, sugars and fat feature prominently
in the early phases and protein makes a surge later on. Hopefully, your
craving for dietary fat has been strong (an important factor in healing
the central, peripheral and enteric nervous systems). However, the
restrictive eating disorder will not allow that relief to
stand for very long. Soon you will find yourself starting to feel edgy
and anxious.
Extreme hunger is a normal
progression in recovery. It does not last. You do not ‘habituate’ to
6000-10,000 calories a day, but you need that energy during refeeding.
No one keeps gaining and gaining.
Your body has an optimal weight set point that it can and will defend.
Pain is normal. Rest. No weighing or exercise.
PhaseII
The body preferentially lays down fat around the mid-section to insulate vital organs from hypothermia.
For
many this tends to be a phase of extreme impatience—following all
the guidelines day and day out and yet still wearing floaty and stretchy
clothes and feeling like an alien in your own body seems unfair. You
may still be restoring weight and that will bother your eating
disorder-generated anxiety. Your body may additionally need to temporarily overshoot its optimal weight set point in this process in order to return to a correct fat mass to fat-free mass ratio.
Phase III—bones, muscles, almost there
Assuming you have been
purposefully eating to your minimum guidelines and responding to
extreme hunger without compensatory restriction up to this phase, then
you start to get rewarded for all your hard work. 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 beginning to be redistributed throughout
the body. Fat mass increase disproportionately to fat-free mass in the
beginning
of recovery, and the fat-free mass play 'catch-up' with the fat mass.
so, both fat-free mass and fat mass are proportionally present after a
solid recovery effort, that is, eating plenty and resting plenty.
Hair, nails and skin begin to have increased pliability and suppleness. You
also start to feel more connected and self-imposed isolation
diminishes. You feel less emotional blunting and start to want things
for your life. This occurs for many at around the 4-6 month mark, but for others it takes shape between months 8-12.
Many lower intake because they confuse weight restoration
with energy balance. I call it "recover, but not too
much" and it's driven by sociocultural silliness rather than scientific
evidence supported by the Minnesota Starvation Experiment and Andrea
Garber's analyses of IP settings.
So keep eating minimum after
weight restoration. The extra energy will be used for activity when it
is no longer used for healing.
I use the term “in active
recovery” across the site, but what you achieve at the end of a
successful recovery process is, hopefully, a full remission. The end
state is not a full recovery. No one ever recovers from a
restrictive eating disorder. The nature of chronic neurobiological
conditions is that they cannot be cured. I have often reiterated
the following as well: restrictive eating disorders are either active or
in remission. Remission can be permanent, or there can be flares of the
condition in times of stress (a relapse).
Signs of remission:
1) You look forward to gatherings and celebrations that center on
food. Like all those without an eating disorder, you indulge happily and
do not compensate either before or after the event.
2) You have no forbidden foods, unless of course they could actually kill you (think peanut allergy).
3)
You are a force for moral absolution. Your relationship with food is a
morality-free zone and it has far reaching influence on those around
you, not to mention yourself.
4) You experience your body, and
every body, as a miracle every day. You marvel at the healing of a
bruise. You stop to watch your fingers flying over a keyboard and are
amazed. You see form and function and the innate power of the body.
5)
You understand on a cellular level that “savoring” is a state of
transcendence and transubstantiation. Transforming food into life-giving
energy is freaking phenomenal!
6) You feel connected. While
many with eating disorders can feel strangely energized and alive in a
state of extreme energy depletion, they rarely feel connected in that
state. In fact, they feel a high in the disconnection. Connection is
actually an ambivalent state and you are able to hold the ambivalence
with appreciation. It is not always joyous, supportive or healing to be
connected to others. But you are ok with that.
7) You are fluid. (I think she means like fluid, Changable, flexible)
-------
**Here is how you know you are ready to attempt eating to your hunger cues:
Your weight appears stable. (weighing yourself is not necessary to determine that).
If you have dealt with amenorrhea during your restriction, then you have achieved 3 consecutive periods in a row.
You are continuing to eat minimum amounts and it is comfortable to do so.
Other lingering signs of repair seem complete (no longer cold,
tired, achy, dealing with water retention, no brittle hair or nails
etc.)
You think you may need to start eating to hunger cues and are a bit anxious that you can trust those cues.
Note
Item 5—if you are feeling extremely confident about eating to hunger
cues then chances are you are a ways away from remission still. Generally, it will take about 6 months beyond the point at which you
have stopped gaining weight before you can truly depend upon your hunger
cues without benefit of confirming you are eating enough by either
counting calories or using a meal plan.
You
move from meal plans or counting calories to eating to hunger cues by
attempting a 3-day experiment. Eat to your hunger cues but jot down
everything you eat. At the end of those three days you should discover
that your hunger has taken you to approximately the recovery guidelines
you have been following thus far. If so, then you can likely trust your
hunger cues and move into your remission with some confidence.**
If you have a couple of the following you haven't recovered:
- Reflections in mirrors/surfaces are 'dysmorphic' eg look disconnected etc.
- Don't feel muscles properly = nerves not repaired yet.
- fidgeting/restlessness/agitation = bodies way of getting you to move to find food.
-tingling
-no expendable energy
If you are six months or more into the recovery process and
you’ve found yourself unhappy with having to eat to the minimum intake,
then eat to hunger cues for three to five days. Log all the food you eat
in those days and at the end of the test phase, add up all the calories
and average the intake out to arrive at your daily average.
If
the daily average appears within 200 or so calories of the minimum
intake guideline for your age/sex and height, then try another five-day
test period in the same way. If you see no progressive restriction in
your intake, then Huzzah! You are likely in remission.
When body fat is completely recovered and fat free mass
recovery is still well below normal, excessive hunger is still evident, but disappears as fat free mass recovery approach to
100%.
Eat a lot in recovery
1)
Restriction of food can activate a restrictive eating disorder in those
with the genetic predisposition to develop the condition.
2)
Over eating cannot activate binge eating disorder because there is not
an eating disorder genotype involved at all. Binge eating disorder is
not an eating disorder at all, but rather a series of symptoms around
food that are actually part of other very serious psychopathologies
(mental illnesses such as bipolar, schizophrenia, and personality
disorders -- also known as the Axis II disorders). The behaviors show up
in childhood along with a host of other behaviors and they have
absolutely no relationship to restrictive eating disorders at all.
3)
Non-ED people overeat all the time. Constantly. It does not affect
their weight or health. The body is optimized to manage an influx of too
much energy very readily. The body is far less well designed to handle
too little energy intake.
4)
As a society we have believed for about 150 years that we must
consciously suppress our hunger to optimize our health. The unscientific
belief coincided with standardized clothing sizes and industrial
production of clothes. It is so ingrained in our cultural norms that
similar to the point in history where it became obvious to scientific
observers that the earth revolved around the sun, going against the
dominant beliefs is a heretical endeavour.
5)
True overcompensation of actual energy requirements is incredibly
difficult to achieve. To tell someone in recovery that they must be wary
of overcompensation is a useless warning that will cause far more harm
than good. When a patient has a massive energy deficit they have to compensate for that deficit with massive over eating. They have an energy deficit.
There
are people who overcompensate when they are energy balanced for
professional reasons: wrestlers do it all the time to "make weight". And
it's really hard to overeat constantly and dependably for the purpose
of pushing your body above its inherited optimal weight set point. Their
regimen involves not just eating more than they want; it involves
enforced sleep immediately after a meal to avoid NEAT (non-exercise
activity thermogenesis) from whisking away the unwanted energy. And
unlike those in recovery with a real energy deficit, these individuals
never think about food.
So while non-ED people believe they
should restrict food intake and avoid overeating at all costs, they
don't actually follow through on that belief (thankfully) because the
body runs our energy balance system and like all biological systems it
is optimized to run over 100% and not under it. Basically non-ED people
talk a lot and do not follow through.
The
issue for ED people is that they do walk the walk. They take to heart
all the cultural claptrap on restriction and the evils of over
indulgence. G.
Binging
Bingeing in the true clinical sense only occurs for the tiny group
suffering what appear to be rare circadian rhythm and endocrine
disorders that result in binge eating disorder or night eating syndrome.
Critically,
those with BED are not able to apply any restrictive responses to their
overeating. The condition appears in pre-pubescent childhood and
usually involves being classified as ‘obese’ by age 11.
I’m going to repeat that: Binge eating as a clinical disorder involves an inability to apply any restriction.
That
means, if you are on the restriction eating disorder spectrum, you are
unable to develop BED. Your bingeing experience is an expression of
required energy needs in reaction to restrictive eating behaviors. It is
why I call this behavior reactive eating and not bingeing.
Will I Become A Binge-Eater?
Does someone who recovers from
the restrictive eating disorder, no matter the restrictive facets they
experience, develop a binge eating disorder?
The answer is “no”.
However, it is important to note that the process of recovery from an
energy deficient state most certainly involves a period of extreme
hunger and eating. It is a transient condition that disappears once
energy balance is restored.
Here are the likely reasons why those
who reach a complete remission from a restrictive eating disorder do not
develop binge eating disorder:
The
candidate genes associated with inflammatory obesity, cholesterol,
insulin and glucose levels are unrelated to the genes identified thus
far for restrictive eating disorders [R Stöger, 2012; AW Drong et al.,
2012; CJ Nolan et al., 2011; A. Hinney et al., 1999 and 2000].
Patients fully recovered from the restrictive eating disorder rarely reach final
restored weights above BMI 25. 2% of the recovered population does go
above BMI 25, however ALL return to weights at or below BMI 25 after one
full year beyond recovery (with no relapse of restriction involved) [CM
Bulik et al., 2006].
Leptin
resistance is not a factor in either the activation or resolution of a
restrictive eating disorder. Yet, leptin resistance is often present in
patients with inflammatory obesity. [P. Dandona et al., 2004; JF Caro et
al., 1996; S Herpertz et al., 1998 and 2000]
Restriction
is the enemy. Be vigilant against restriction and put your trust in
your body’s ability to find it’s optimal weight set point if you just
give it the energy it is demanding (no matter your current weight).
No
one keeps gaining and gaining. We each have an optimal weight set point
[RE Keesey et al., 1997; RE Keesey, 1988]. On average 70% of adult
females reside between BMI 21-27 [Statistics Canada, 1978] but our
heights and weights exist on a bell curve and you are only going to be
healthy at your particular optimal weight set point.
Non-ED men and women ‘overeat’ regularly and it is not bingeing in
any clinical sense nor does it impact optimal weight stability.
Between
the ages of 10-16 it is common for the body to store extra energy in
anticipation of physical growth requirements. It is difficult for anyone
in our obese-fearing and weight-obsessed culture to not react to these
phases of extra weight with immediate restriction. Sadly, for those with
the restrictive eating disorder genotype, it is usually this very
circumstance that catapults them into years of cycling through
restrictions and quasi-recoveries.
Between the ages of 16-25, the
body will occasionally store extra energy, but usually it is using the
extra energy coming in (through natural overeating sessions) as it
happens. However, if a restrictive eating disorder patient hijacked his
or her normal development as a child with self-administered starvation
and/or excessive exercise, then the recovery process may mimic the
energy storage/growth spurt that was supposed to happen but was stalled
by the onset of the eating disorder. Give it time and it works itself
out.
The answer to getting out of this quasi-recovered state and reaching
full recovery is to eat to the recovery guideline amounts (and more)
every single day. Responding to any extreme hunger is as critical now as
it is all throughout the recovery process.
Despite restrictive
eating disorder-based fears that there is no way to eat this much and
not become obese when you are already ‘weight restored’, no clinical
evidence supports those fears.
Your
metabolism will ensure that your body adjusts to its optimal weight set
point and the excess energy is necessarily needed to complete the
lingering repair and to finally push the metabolism back to its optimal
functioning rate. And no, your metabolism is not broken and your brain
responds accurately to leptin levels.
As for whether the temporary overshoot is necessary, there is some
evidence that it may indeed have value in ensuring the return of an
optimal fat-mass to fat-free-mass ratio. In fact, Abdul Dulloo and
colleagues re-examined the Minnesota trial data and discovered that the
depletion of fat-free mass and fat mass (occurring during starvation)
separately trigger hyperphagia (excessive eating) in post-starvation
subjects and that the hyperphagia will persist until both fat and
fat-free mass are restored [A Dulloo et al., 1997].
We also know
from numerous other studies that anorexics often maintain a higher
proportion of fat mass post-re-feeding [CI Orphanidou et al., 1997; M
Probst et al., 2001; C Mantzoros et al., 1997] and this is likely due to
the prevailing attitudes that hyperphagia must be avoided during
recovery at all costs as it is considered a marker of “bingeing”.
Instead, what these post-recovery data may show is that the prohibition
of hyperphagia in recovery from restrictive eating disorders serves to
halt the body’s ability to return to an optimal fat mass to fat-free
mass ratio.
Bone
mineral density loss is readily reversed if the patient is
premenopausal at the time of remission and has about seven years or so
ahead of her before entering menopause. For
men who reach and maintain remission prior to the age of 50, they can
expect to reverse bone mineral density loss fully as well. Should a
woman be menopausal or postmenopausal at the time she reaches remission
from an eating disorder, she will halt the progression of the bone
mineral density loss (a “won’t get worse” rating). Should a man enter
remission after age 50, he too can expect a “won’t get worse” rating for
his bone mineral density level. Source:http://www.youreatopia.com/blog/2013/9/11/reversal-of-damage-from-restrictive-eating-disorders.html#comment20540372
Exercise
"...folks in remission should not be exercising. Exercise for a
workout's sake is not something that those in full remission even want
to return to and it is not necessary to do so to be healthy and
long-lived either.
However, regular activities are likely safe to
resume when the patient is weight stable and symptoms associated with
energy deficiency have gone (amenorrhea, tiredness, pain, soreness,
flaking skin, acne, brittle nails and hair, etc.). Given that many have
the menstrual cycle return long before their bodies have finished
repairs and weight restoration, 3 consecutive periods is not a good
enough marker. Also, if there are any signs of fatigue, aches, pains, or
swelling after an attempt to resume an activity, then the activities
need to be put on hold for longer.
And because I learn more as I
see outcomes from patients, reintroduction of exercise (a workout)
precipitates relapse more commonly than not."
You are far less likely to overshoot by very much if you embrace the
minimum guidelines (i.e. don't pussy foot around too long at 2000-2200
calories a day) and then equally embrace massive hunger will ensuring
you do not allow the eating disorder to respond with restriction the
next day.
A yo-yo dieter can go through a cycle of restriction and then normal
eating enough times that she doesn't just have a suppressed metabolic
rate, she has broken the complex and sensitive ways in which her body
can naturally maintain its optimal weight set point. These individual
often present with leptin and insulin resistance (key markers that allow
the body to stay at its optimal set point). Conversely, those on the
REDS do not develop leptin and insulin resistance and their metabolic
rate returns to normal as soon as they recover from restrictive
behaviours.
Even then, it appears these individuals can get to a
point where the homeostatic ability of their body returns as long as
they never restrict calories (never go on a diet again). However, it can
take several years.
Lack of sleep, certain drugs and extreme unrelenting stress can mess with
the body's ability to maintain its optimal weight set point.
Those with bulimia tend to persist with water retention in recovery much longer than
those who do not purge.
You should eat breakfast then snack right up until lunch and keep
snacking until dinner. You do not have to wait 4 hours for anything. If
you are hungry, then you eat whatever appeals.
Extreme hunger does not always equate to the body's need to restore weight.
The
more you keep suppressing the body's need to get the energy in, the
more likely the body will be to store energy in the fat tissue because
there is just never enough coming in to rectify the metabolic
suppression or deal with lingering repair issues.
A regular menstrual cycle ensures proper bone mineral density. That
is why anorexics who lose their regular ovular menstrual cycles start to
lose bone density fast and are at risk for severe osteoporosis in later
life.
Intracellular edema is not identifiable in the way that intercellular edema is.
Basically, the sloshy, pitting, swollen edema is intercellular in nature.
Intracellular edema is indistinguishable from your own tissue (it resides inside the cells obviously).
Starving is extremely stressful. Cortisol (steroid) is surging through
your body and this fires up your immune system beyond its usual level
(for a while). Eventually the long-term impacts of higher-than-normal
levels of cortisol will move patients in one direction or another:
autoimmune illness (body attacking its own cells as though they were
foreign), or immunosuppression (getting very sick all the time). When you stop restricting, the entire stress system is told to stand
down. So now you’re feeling the pain and you may have a wicked cold
along with it as well.
If you began from a weight restored point in your recovery, then it
takes about 5-6 months of eating minimum before you consider going
to hunger cues. If you were below your optimal weight set point when
you began recovery then you need to tick along for
about 9 months eating minimum+.
Physiological effects of chronic energy deficiency in the
body are as follows: anemia, hypoproliferative bone marrow (failure),
leukopenia (low white blood cell counts), decreased thiodothyronine,
thyroxine and luteinizing hormone levels (polyendocrine deficiency
syndrome), abnormal gastrointestinal motility, atrophy and possible
ulceration, constipation/diarrhea, severe liver dysfunction,
myofibrillar destruction (damage to heart muscle) and amenorrhea. Also
usually present are: low basal metabolic rate, cold intolerance,
abnormal calcium metabolism, osteoporosis, serum protein abnormalities
(leading to chronic or acute kidney disease), electroencephalographic
abnormalities (impaired brain function) and altered skin texture and
pigmentation.
Physiological effects of chronic bouts of
starvation/reactive eating cycles are as follows: all of the previous
list for the most part, although anemia is less likely to be present,
and also hypertension, elevated low-density lipoproteins (bad
cholesterol levels), artherosclerosis (progressive deposition of fatty
deposits on arterial walls, leading to heart disease) and excessive
subcutaneous abdominal fat due to long term elevated serum
glucocorticoid levels.
None of us wants to be uncomfortable in our own skin, but that is
entirely a mindset that is in our control to change. The most attractive
human beings in the world are almost always not celebrities or actors, they are those people in a room that everyone is drawn to.
And
those people are attractive because they are so interested in others.
It's not self-confidence that defines beauty and attractiveness, it's
the ability to be more interested in others than self.
In fact,
often everyone is really perplexed at why someone who is clearly not the
most handsome guy or beautiful girl in the room, by cultural standards,
gets all the attention and appreciation from both sexes.
The reason someone with an ED can maintain progressive restriction is that the mood modulation combined with the misidentification of food as a threat (not felt in the conscious mind, but essentially what is happening in the limbic system) jams many of the distressing signals the body sends out to indicate the energy deficit is damaging the system as a whole.
Fat tissue is not a storage unit. It is a critical hormone-producing organ. In fact only about 5% of the population has what has been nicknamed the "thrifty gene".
Under stress one-third of the population is hypophagic (eats less food) and the remaining two-thirds are hyperphagic (eats more food). But food consumption is not correlated to weight at all.
One-third of the population is estimated to carry the genetic predisposition to develop a restrictive eating disorder. The most common trigger for activating the condition is dieting.
People do not keep gaining. No one keeps gaining and gaining. Even those with the so-called thrifty gene who tend to end up right at the far right of the weight bell curve (BMI 40+) maintain a stable weight assuming they do not diet or restrict.
And because those with restrictive eating disorders instantly pounce all over the concept -- "But I've been dieting, does that mean I will end up heavier than I am supposed to be?" No. Cyclical dieting is a distinct behaviour that is not related to all the forms of restriction you practice on the REDS.
I'm going to quote all the material that missrising was kind enough to add into another thread:
Mehler's et al 2010 "Eating Disorders: A Guide to Medical Care and Complications. Mehler is an MD who works at Denver acute eating disorders unit.
Weight, like height, is a bell- shaped curve, and someone has to hold down the upper standard deviation from the average, although few women accept this fact.
70% of all women naturally fall between BMI 21-27. And no, women are not "overweight" at BMI 25-27.
These are all complicated concepts to synthesize in a post -- that is why the Fat series on the blog is as long as it is -- there is actually a lot of clinical data and fact that explains these concepts and it takes time to unravel all the common misconceptions we all hold.
There is only one group of individuals for which the act of "gaining and gaining" really occurs. It occurs for a very rare set of individuals born with serious genetic mutations whereby all the checks and balances of hormonal interplay to define hunger and satiation are shot. These individuals are also often mentally and physically damaged as well. One of the few genotypes within this class is Prader-Willi syndrome. There are a few others. The number of individuals afflicted with these conditions is infinitesimal and if you can read and understand most of these sentences, then you are not among them.
G.
Unless you are over the age of 25 any previous weight you have had is irrelevant because there is so much skeletal restructuring that happens between the age of 16-25 that we cannot remain at an earlier BMI because the shape of our bodies change such that we need more flesh to cover it proportionately.
G.
22 march, 2012
Found on Youreatopia.com:http://www.youreatopia.com/blog/2012/11/23/phases-of-recovery-from-a-restrictive-eating-disorder.html
Phase I- Edema
Digestive distress is common in this first phase: bloating, gas, pain and abdominal distention, diarrhea or constipation. You can alleviate this a bit by eating smaller amounts more constantly throughout the day. Despite all the physical discomfort of these early days, many experience a tremendous sense of relief and initial joy at eating in an unrestricted way. Carbs, sugars and fat feature prominently in the early phases and protein makes a surge later on. Hopefully, your craving for dietary fat has been strong (an important factor in healing the central, peripheral and enteric nervous systems). However, the restrictive eating disorder will not allow that relief to stand for very long. Soon you will find yourself starting to feel edgy and anxious.
- Extreme hunger is a normal
progression in recovery. It does not last. You do not ‘habituate’ to
6000-10,000 calories a day, but you need that energy during refeeding.
- No one keeps gaining and gaining.
- Your body has an optimal weight set point that it can and will defend.
- Pain is normal. Rest. No weighing or exercise.
PhaseIIThe body preferentially lays down fat around the mid-section to insulate vital organs from hypothermia.
For many this tends to be a phase of extreme impatience—following all the guidelines day and day out and yet still wearing floaty and stretchy clothes and feeling like an alien in your own body seems unfair. You may still be restoring weight and that will bother your eating disorder-generated anxiety. Your body may additionally need to temporarily overshoot its optimal weight set point in this process in order to return to a correct fat mass to fat-free mass ratio.
Phase III—bones, muscles, almost there
Assuming you have been purposefully eating to your minimum guidelines and responding to extreme hunger without compensatory restriction up to this phase, then you start to get rewarded for all your hard work. 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 beginning to be redistributed throughout the body. Fat mass increase disproportionately to fat-free mass in the beginning of recovery, and the fat-free mass play 'catch-up' with the fat mass. so, both fat-free mass and fat mass are proportionally present after a solid recovery effort, that is, eating plenty and resting plenty.
Hair, nails and skin begin to have increased pliability and suppleness. You also start to feel more connected and self-imposed isolation diminishes. You feel less emotional blunting and start to want things for your life. This occurs for many at around the 4-6 month mark, but for others it takes shape between months 8-12.
Many lower intake because they confuse weight restoration with energy balance. I call it "recover, but not too much" and it's driven by sociocultural silliness rather than scientific evidence supported by the Minnesota Starvation Experiment and Andrea Garber's analyses of IP settings.
So keep eating minimum after weight restoration. The extra energy will be used for activity when it is no longer used for healing.
Remission
Signs of remission:
1) You look forward to gatherings and celebrations that center on food. Like all those without an eating disorder, you indulge happily and do not compensate either before or after the event.
2) You have no forbidden foods, unless of course they could actually kill you (think peanut allergy).
3) You are a force for moral absolution. Your relationship with food is a morality-free zone and it has far reaching influence on those around you, not to mention yourself.
4) You experience your body, and every body, as a miracle every day. You marvel at the healing of a bruise. You stop to watch your fingers flying over a keyboard and are amazed. You see form and function and the innate power of the body.
5) You understand on a cellular level that “savoring” is a state of transcendence and transubstantiation. Transforming food into life-giving energy is freaking phenomenal!
6) You feel connected. While many with eating disorders can feel strangely energized and alive in a state of extreme energy depletion, they rarely feel connected in that state. In fact, they feel a high in the disconnection. Connection is actually an ambivalent state and you are able to hold the ambivalence with appreciation. It is not always joyous, supportive or healing to be connected to others. But you are ok with that.
-------
**Here is how you know you are ready to attempt eating to your hunger cues:
Your weight appears stable. (weighing yourself is not necessary to determine that).
If you have dealt with amenorrhea during your restriction, then you have achieved 3 consecutive periods in a row.
You are continuing to eat minimum amounts and it is comfortable to do so.
Other lingering signs of repair seem complete (no longer cold, tired, achy, dealing with water retention, no brittle hair or nails etc.)
You think you may need to start eating to hunger cues and are a bit anxious that you can trust those cues.
Note Item 5—if you are feeling extremely confident about eating to hunger cues then chances are you are a ways away from remission still. Generally, it will take about 6 months beyond the point at which you have stopped gaining weight before you can truly depend upon your hunger cues without benefit of confirming you are eating enough by either counting calories or using a meal plan.
You move from meal plans or counting calories to eating to hunger cues by attempting a 3-day experiment. Eat to your hunger cues but jot down everything you eat. At the end of those three days you should discover that your hunger has taken you to approximately the recovery guidelines you have been following thus far. If so, then you can likely trust your hunger cues and move into your remission with some confidence.**
If you have a couple of the following you haven't recovered:
- Reflections in mirrors/surfaces are 'dysmorphic' eg look disconnected etc.
- Don't feel muscles properly = nerves not repaired yet.
- fidgeting/restlessness/agitation = bodies way of getting you to move to find food.
-tingling
-no expendable energy
If you are six months or more into the recovery process and you’ve found yourself unhappy with having to eat to the minimum intake, then eat to hunger cues for three to five days. Log all the food you eat in those days and at the end of the test phase, add up all the calories and average the intake out to arrive at your daily average.
If the daily average appears within 200 or so calories of the minimum intake guideline for your age/sex and height, then try another five-day test period in the same way. If you see no progressive restriction in your intake, then Huzzah! You are likely in remission.
When body fat is completely recovered and fat free mass recovery is still well below normal, excessive hunger is still evident, but disappears as fat free mass recovery approach to 100%.
Eat a lot in recovery
Binging
Bingeing in the true clinical sense only occurs for the tiny group suffering what appear to be rare circadian rhythm and endocrine disorders that result in binge eating disorder or night eating syndrome.
Critically, those with BED are not able to apply any restrictive responses to their overeating. The condition appears in pre-pubescent childhood and usually involves being classified as ‘obese’ by age 11.
I’m going to repeat that:
Binge eating as a clinical disorder involves an inability to apply any restriction.
That means, if you are on the restriction eating disorder spectrum, you are unable to develop BED. Your bingeing experience is an expression of required energy needs in reaction to restrictive eating behaviors. It is why I call this behavior reactive eating and not bingeing.
Will I Become A Binge-Eater?
Does someone who recovers from the restrictive eating disorder, no matter the restrictive facets they experience, develop a binge eating disorder?The answer is “no”. However, it is important to note that the process of recovery from an energy deficient state most certainly involves a period of extreme hunger and eating. It is a transient condition that disappears once energy balance is restored.
Here are the likely reasons why those who reach a complete remission from a restrictive eating disorder do not develop binge eating disorder:
- The
candidate genes associated with inflammatory obesity, cholesterol,
insulin and glucose levels are unrelated to the genes identified thus
far for restrictive eating disorders [R Stöger, 2012; AW Drong et al.,
2012; CJ Nolan et al., 2011; A. Hinney et al., 1999 and 2000].
- Patients fully recovered from the restrictive eating disorder rarely reach final
restored weights above BMI 25. 2% of the recovered population does go
above BMI 25, however ALL return to weights at or below BMI 25 after one
full year beyond recovery (with no relapse of restriction involved) [CM
Bulik et al., 2006].
- Leptin
resistance is not a factor in either the activation or resolution of a
restrictive eating disorder. Yet, leptin resistance is often present in
patients with inflammatory obesity. [P. Dandona et al., 2004; JF Caro et
al., 1996; S Herpertz et al., 1998 and 2000]
Restriction is the enemy. Be vigilant against restriction and put your trust in your body’s ability to find it’s optimal weight set point if you just give it the energy it is demanding (no matter your current weight).No one keeps gaining and gaining. We each have an optimal weight set point [RE Keesey et al., 1997; RE Keesey, 1988]. On average 70% of adult females reside between BMI 21-27 [Statistics Canada, 1978] but our heights and weights exist on a bell curve and you are only going to be healthy at your particular optimal weight set point.
Non-ED men and women ‘overeat’ regularly and it is not bingeing in any clinical sense nor does it impact optimal weight stability.
Between the ages of 10-16 it is common for the body to store extra energy in anticipation of physical growth requirements. It is difficult for anyone in our obese-fearing and weight-obsessed culture to not react to these phases of extra weight with immediate restriction. Sadly, for those with the restrictive eating disorder genotype, it is usually this very circumstance that catapults them into years of cycling through restrictions and quasi-recoveries.
Between the ages of 16-25, the body will occasionally store extra energy, but usually it is using the extra energy coming in (through natural overeating sessions) as it happens. However, if a restrictive eating disorder patient hijacked his or her normal development as a child with self-administered starvation and/or excessive exercise, then the recovery process may mimic the energy storage/growth spurt that was supposed to happen but was stalled by the onset of the eating disorder. Give it time and it works itself out.
The answer to getting out of this quasi-recovered state and reaching full recovery is to eat to the recovery guideline amounts (and more) every single day. Responding to any extreme hunger is as critical now as it is all throughout the recovery process.
Despite restrictive eating disorder-based fears that there is no way to eat this much and not become obese when you are already ‘weight restored’, no clinical evidence supports those fears.
As for whether the temporary overshoot is necessary, there is some evidence that it may indeed have value in ensuring the return of an optimal fat-mass to fat-free-mass ratio. In fact, Abdul Dulloo and colleagues re-examined the Minnesota trial data and discovered that the depletion of fat-free mass and fat mass (occurring during starvation) separately trigger hyperphagia (excessive eating) in post-starvation subjects and that the hyperphagia will persist until both fat and fat-free mass are restored [A Dulloo et al., 1997].
We also know from numerous other studies that anorexics often maintain a higher proportion of fat mass post-re-feeding [CI Orphanidou et al., 1997; M Probst et al., 2001; C Mantzoros et al., 1997] and this is likely due to the prevailing attitudes that hyperphagia must be avoided during recovery at all costs as it is considered a marker of “bingeing”. Instead, what these post-recovery data may show is that the prohibition of hyperphagia in recovery from restrictive eating disorders serves to halt the body’s ability to return to an optimal fat mass to fat-free mass ratio.
also take a look at http://www.youreatopia.com/blog/2011/11/3/binge-eating-disorder-and-night-eating-syndrome.html
Bone mineral density
Bone mineral density loss is readily reversed if the patient is premenopausal at the time of remission and has about seven years or so ahead of her before entering menopause. For men who reach and maintain remission prior to the age of 50, they can expect to reverse bone mineral density loss fully as well. Should a woman be menopausal or postmenopausal at the time she reaches remission from an eating disorder, she will halt the progression of the bone mineral density loss (a “won’t get worse” rating). Should a man enter remission after age 50, he too can expect a “won’t get worse” rating for his bone mineral density level. Source:http://www.youreatopia.com/blog/2013/9/11/reversal-of-damage-from-restrictive-eating-disorders.html#comment20540372
Exercise
"...folks in remission should not be exercising. Exercise for a workout's sake is not something that those in full remission even want to return to and it is not necessary to do so to be healthy and long-lived either.
However, regular activities are likely safe to resume when the patient is weight stable and symptoms associated with energy deficiency have gone (amenorrhea, tiredness, pain, soreness, flaking skin, acne, brittle nails and hair, etc.). Given that many have the menstrual cycle return long before their bodies have finished repairs and weight restoration, 3 consecutive periods is not a good enough marker. Also, if there are any signs of fatigue, aches, pains, or swelling after an attempt to resume an activity, then the activities need to be put on hold for longer.
And because I learn more as I see outcomes from patients, reintroduction of exercise (a workout) precipitates relapse more commonly than not."
You are far less likely to overshoot by very much if you embrace the minimum guidelines (i.e. don't pussy foot around too long at 2000-2200 calories a day) and then equally embrace massive hunger will ensuring you do not allow the eating disorder to respond with restriction the next day.
A yo-yo dieter can go through a cycle of restriction and then normal eating enough times that she doesn't just have a suppressed metabolic rate, she has broken the complex and sensitive ways in which her body can naturally maintain its optimal weight set point. These individual often present with leptin and insulin resistance (key markers that allow the body to stay at its optimal set point). Conversely, those on the REDS do not develop leptin and insulin resistance and their metabolic rate returns to normal as soon as they recover from restrictive behaviours.
Even then, it appears these individuals can get to a point where the homeostatic ability of their body returns as long as they never restrict calories (never go on a diet again). However, it can take several years.
Lack of sleep, certain drugs and extreme unrelenting stress can mess with the body's ability to maintain its optimal weight set point.
Those with bulimia tend to persist with water retention in recovery much longer than those who do not purge.
You should eat breakfast then snack right up until lunch and keep snacking until dinner. You do not have to wait 4 hours for anything. If you are hungry, then you eat whatever appeals.
Extreme hunger does not always equate to the body's need to restore weight.
The more you keep suppressing the body's need to get the energy in, the more likely the body will be to store energy in the fat tissue because there is just never enough coming in to rectify the metabolic suppression or deal with lingering repair issues.
A regular menstrual cycle ensures proper bone mineral density. That is why anorexics who lose their regular ovular menstrual cycles start to lose bone density fast and are at risk for severe osteoporosis in later life.
Intracellular edema is not identifiable in the way that intercellular edema is.
Basically, the sloshy, pitting, swollen edema is intercellular in nature.
Intracellular edema is indistinguishable from your own tissue (it resides inside the cells obviously).
Starving is extremely stressful. Cortisol (steroid) is surging through your body and this fires up your immune system beyond its usual level (for a while). Eventually the long-term impacts of higher-than-normal levels of cortisol will move patients in one direction or another: autoimmune illness (body attacking its own cells as though they were foreign), or immunosuppression (getting very sick all the time). When you stop restricting, the entire stress system is told to stand down. So now you’re feeling the pain and you may have a wicked cold along with it as well.
If you began from a weight restored point in your recovery, then it takes about 5-6 months of eating minimum before you consider going to hunger cues. If you were below your optimal weight set point when you began recovery then you need to tick along for about 9 months eating minimum+.
Physiological effects of chronic energy deficiency in the body are as follows: anemia, hypoproliferative bone marrow (failure), leukopenia (low white blood cell counts), decreased thiodothyronine, thyroxine and luteinizing hormone levels (polyendocrine deficiency syndrome), abnormal gastrointestinal motility, atrophy and possible ulceration, constipation/diarrhea, severe liver dysfunction, myofibrillar destruction (damage to heart muscle) and amenorrhea. Also usually present are: low basal metabolic rate, cold intolerance, abnormal calcium metabolism, osteoporosis, serum protein abnormalities (leading to chronic or acute kidney disease), electroencephalographic abnormalities (impaired brain function) and altered skin texture and pigmentation.
Physiological effects of chronic bouts of starvation/reactive eating cycles are as follows: all of the previous list for the most part, although anemia is less likely to be present, and also hypertension, elevated low-density lipoproteins (bad cholesterol levels), artherosclerosis (progressive deposition of fatty deposits on arterial walls, leading to heart disease) and excessive subcutaneous abdominal fat due to long term elevated serum glucocorticoid levels.
None of us wants to be uncomfortable in our own skin, but that is entirely a mindset that is in our control to change. The most attractive human beings in the world are almost always not celebrities or actors, they are those people in a room that everyone is drawn to.
And those people are attractive because they are so interested in others. It's not self-confidence that defines beauty and attractiveness, it's the ability to be more interested in others than self.
In fact, often everyone is really perplexed at why someone who is clearly not the most handsome guy or beautiful girl in the room, by cultural standards, gets all the attention and appreciation from both sexes.
The reason someone with an ED can maintain progressive restriction is that the mood modulation combined with the misidentification of food as a threat (not felt in the conscious mind, but essentially what is happening in the limbic system) jams many of the distressing signals the body sends out to indicate the energy deficit is damaging the system as a whole.