12th Aug 2012

The Scary Version of Recovery

Recovery from an eating disorder cannot avoid getting to your true, healthy, own weight. You are kidding yourself if you think that unnaturally forcing your body to stay at a BMI of x by exercising regularly, counting your calories and/or eating ‘clean’ is going to get you fully recovered.

Letting go of all rules and beliefs and behaviours is going to get you recovered. Let this sink in for a minute. Even if you’re eating fear foods now, but your intake is obsessively 1200 daily, then something’s got to change in order for you to make progress.

You can only recover by constantly challenging yourself. Recovery doesn’t have a day off.

Which leads me nicely to:

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If you’ve seen the 'Scarier Version' of how to recover, and the thought of listening to your hunger makes you panic, then you might find a more ‘structured’ recovery meal plan useful in the meantime.

I will add though that either way, you will still be hungry all the time and gaining weight basically at the same pace (i.e. the pace that’s right for your body), so you may as well do the harder thing and start listening to your body instead of conforming it to a strict schedule.

I mean, I started recovery by having a very rigid meal plan that insisted on weighing everything. This made me physically better, but my attitude to food went absolutely crazy. I became so dependent on weighing everything, and eating things only on my meal plan, and eating at set times.

The idea of ‘normal, intuitive eating’ was even harder to get used to after my somewhat OCD/manic attitude to food in recovery.

I completely regret not following my true hunger in recovery, and making my poor body stick to yet another strict schedule. My body - and my mind - were sick of rules by this point. 

So, as to the weight-gaining meal-planning rough-calorie-counting part, see here for much more detail. As for the little things you can do to help yourself let go of the eating disorder mentality, click here.

Relevant previously answered questions:

  • 'Will recovery make me gain weight if I'm already at a healthy weight?' See answer here.
  • 'I'm scared of starting to put on weight in recovery, and then carrying on and ending up overweight. Could that happen?' See answer here.
  • 'I haven't got a meal plan yet, could you maybe give me an example?' See answer here.

Follow the links, have a read-through, get some answers, get some questions, wonder, think, consider, and think how all of this meal plan/no meal plan stuff applies to you.

In case some of you don’t end up on Gwyneth Olwyn’s blog post by following through the links, I’ve posted a very short extract of her wonderful post here for you.

[Note that this post was originally aimed strictly at those recovering from “classic” anorexia nervosa, and the BMI numbers used will reflect that. However, any person recovering from starvation/restriction will experience these stages, so please don’t let the original numbers used trigger you and convince you that “this doesn’t apply to you”.]

3) The Phases of Recovery

Phase I — water hoarding.

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

Digestive distress is common in this first phase: gas, pain and abdominal distention (bloating). You can alleviate this a bit by eating smaller amounts more constantly throughout the day: 200 calorie increments 12 and a half times a day. This digestive distress occurs because starvation has drastically reduced all the critical bacteria in your gut as well as all your digestive enzyme levels. In order for the bacteria to recolonize to acceptable levels they need the energy in as well…resist the urge to drink lots of water. You will get adequate hydration if you eat 2500 calories a day. If you do have drinks, make sure they are full of nutrition.

Phase II - vital organ insulation

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

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

Phase III - bones, muscles, almost there

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

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

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

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

Instead, she relapses again [no matter to what extent] within the year. Why?

Final Critical Phase: Leptin or relapse.

It is rare that an ED patient will attain pre-ED leptin [‘hunger hormone’] levels at BMI 18.5-20. Usually, due to the physiological implications of having an ED, leptin levels are lower in recovered ED patients than in normal controls who are exactly the same weight/height/age as the ED patient.

Furthermore, [only a very small percentage of the population] is naturally at BMI 18.5-20—i.e. naturally thin.

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

From there, you can now maintain your weight—but even then there is a catch. You maintain by eating the amount you ate to regain all the weight in the first place. So in fact you don’t maintain your weight, your body does.

You would think that doing that would mean you will actually just keep gaining and gaining.

Instead, once your body reaches its own optimal weight set point (and only your body decides what that is) then it just stops gaining weight and starts maintaining the optimal set point it has reached. It does this seamlessly because the metabolic rate moves back into the optimal range at that same time and biological functions that were on hold are now back on line.

You gain weight through all those phases of recovery because the metabolism is suppressed—that energy went to weight gain and repair. But now you are recovered, the energy now goes to day-to-day functions (all the neuroendocrine systems that had been on hold up to that point).

You gain on 2500 and then you maintain on right about the same amount. And once you stop gaining weight then you can also depend on your hunger cues to keep you eating what your body needs to maintain your health and weight for the rest of your life.

Also, screenshot from here:

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Before anybody asks about the calorie intake guidelines, see the following:

'Is it true about the 2500 thing?' answer here.

'I've never been underweight and I'm maintaining on 1300 calories…' answer here.

'This is stupid, why you force everybody to eat 2500 a day…' answer here.

'I know people who've recovered on 1500 calories, so…' answer here.

'2500 seems WAY too much…' answer here.

'Do I need 2500+ calories?' answer here (external link).

External article link: 'Extreme Hunger' [in recovery from restrictive eating disorders (AN, BN, EDNOS)].

Wow, I think that’s enough links and reading material for now. I hope at least one person finds this useful, I tried pretty hard! :) 

All my love x

This post has 91 notes
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  5. suffonsified reblogged this from princessofgenovia and added:
    God I hate how true this is
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  9. princessofgenovia reblogged this from fyoured and added:
    so true and important. the constant obsession won’t get you anywhere.
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