Posts by hedgren

Wonderful amalgamation of various studies HouseElf as well as an excellent series of synopses on schools of thought that have been somewhat misguided when it comes to the origins of anorexia and treatment options. I was brought here by a direct message from another user and I'm glad I got a chance to see all of this!

The issues surrounding both hyper and hypo leptinemia (higher than usual or lower than usual leptin levels) still require further study. Generally, we have seen both occur during recovery in transience and, as with many facets of the re-feeding process we can see in the Minnesota Study, it appears to resolve over time.

Hypoleptinemia may be responsible for the necessity of initially needing to weigh more than an optimal weight for a menstrual cycle to return. And, as HouseElf has already highlighted, within the follow-up year beyond recovery, all patients return to their optimal weight (without any restriction or relapse).

A good way to think of it is that sometimes metabolism needs more time to optimize everything yet again in your system. You take the boots to metabolism when you starve. Patience is your best friend in recovery.

However, not all women (about 5%) appear to have their menstrual cycles closely tied to the gating hormone leptin. This is why in some cases, women continue to menstruate through weight loss, or have a menstrual cycle return despite not having yet reached an optimal weight.

Leptin is fat-store linked gating hormone. It is responsible for bone formation, metabolism, appetite, normal hormonal and neurological function and blood formation. When we starve, leptin levels in our system plummets.

Constitutionally lean individuals comprise approximately 1% of the entire population. By definition, assuming an equal distribution of the genetic pre-disposition for the restriction eating disorder spectrum, only 1% of all those attempting to recover are constitutionally lean.

You are constitutionally lean when you eat a larger-than-average amount of food just to maintain your weight and health. Any form of restriction by definition confirms that you are not at your optimal weight set point.

As for severe and enduring eating disorders (SEED), I will not address the specifics of that in detail on this thread, but there are indications that the body makes every effort to adjust to long term starvation to keep the individual alive. It's not a place that any one who is on the restrictive eating disorder spectrum wants to be and I think someone on this thread has already pointed out that the over abundance of clinical data can be both empowering and frightening. 

As the REDS shares many facets with anxiety disorders, it's a good idea to keep in mind that there will never be enough data available to assuage the anxiety about weight re-gain, but the huge body of evidence does allow for those of us attempting to support recovery to point out that the guidelines we quote are based on hard facts.

Best of luck to all of you on your continued success.

PS -- I'll be on this CC board again for the last time this coming Monday (Oct. 31) and then you can find me through my journal entries to my new site. Cheers!

It depends on the kind of oatmeal. Steel-cut oats are beneficial in preventing the development of Type II diabetes in a few clinical trials, whereas instant oatmeal not so. Also (rather obviously) don't be slathering it with sugar.

Steel-cut oats are also good for lowering blood pressure and bad cholesterol levels.

If you like your oatmeal sweet consider a lower glycemic index choice (such as agave nectar). And avoid sweeteners that are artificial and possibly dangerous (like the aspartame family etc.).

Not all carbohydrates are the same. Ultra-processed carbs are problematic, but whole grains provide a more timed-release of the sugars and less of an insulin spike.

So, go the steel-cut oats approach and you'll be able to enjoy oatmeal.

Original Post by rainbowgirl32:

I know that skipping meals is unhealthy and just because I got my period means i'm healthy again, is a sign that i'm getting better but not healthy at all. And ithat healthy does not means I'm fat, i know i'm not fat not at all, and is all in my mind. I just wanna be a normal teenager again, i want to eat when i want and stop when I'm full and don't spend all my time thinking about what to eat, I eat like 1000-1500 calories and I go to the gym almost everyday. And I feel like i eat a lot. I just don't want to be like this forever, and maybe my friends are right and I need help,  so my mom is taking me to the doctor next week i think. Thank youu 

Your friends and others who have posted here are all reading this one right -- you are in trouble and the real you knows it.

That's great you have your Mom involved and she knows that your menstrual cycle has been on and off. Be very honest with the doctor when you go there with her.

As a teenager you should eat about 2300 odd calories a day and upwards of 3000-3300 at least once a week. From age 16-25 women should "binge" about once a week and the energy is needed for brain, skeleton and hormone development -- it's not all about weight.

You are starving at 1000-1500 calories a day, especially with your activity level on top of that.

You are on the restriction eating disorder spectrum and while it is easily treated, you need treatment to recover fully and permanently. In addition to seeing a doctor, ask your mother whether you can also get cognitive behavioral therapy with a trained therapist -- that is the clinically proven way to recover from this eating disorder.

You have some good friends that are being honest and a mother who is paying attention, so all the odds are in your favor that you really can just be a normal teenager again and enjoy eating and living without panicking about "being fat".

Best of luck.

Only your body determines your optimal weight and that will be the weight at which your  period returns.

At 18, you have not completed development (ages 16-25 is when all the neural, skeletal and hormonal development occurs to get you to adulthood).

While you may have menstruated at 94-96 lbs in the past, that won't have much relevance now because things change constantly through ages 16-25 -- often the body needs to store extra energy at certain points along those years to ensure it has enough to deal with specific development needs.

You have to keep gaining until you do return to regular menstruation and you need to work with a cognitive behavioral therapist to ensure that you are prepared and ready to accept that your body needs what it needs and that whatever weight it decides upon will absolutely be healthy and right for you.

Best of luck on your continued recovery.

Original Post by gemzywemz:

Thankyou very much for both of your replies.

I am glad that I am not alone in my feelings, although sorry to hear that you are also suffering Libby. I can totally relate when you say "I think that is what I like about the ED in that it gives me an excuse not to try on my own." I think it must definately be playing a part in the thought processes that are keeping me trapped in my ED. I also constantly beat myself up for feeling this and feel that it is my own stupid fault for being this way.

Hedgren - as always you offer such wise words and information. I have just looked that book up on amazon and am going to order it today. At this point I am willing to give anything a shot, and the book certainly looks to be one that may be helpful. When you say that you suspect I have suffered from an undiagnosed anxiety disorder, what kind of disorder do you mean? I have often wondered if there isnt anything that lies behind the reasons why I suffer from a range of conditions...the depression, OCD, Ed.... I believe a touch of BDD comes into play too...are they all just co-morbid conditions or is the underlying reason to them one and the same thing? When I was diagnosed at age 15 or suffering from depression I think it was just an easy thing to be diagnosed with really, rather than looking into the specifics.

Whilst in some ways I was very much over-protected as a child, in other ways I do feel I was exposed to a number of my families anxieties - my mother has always been somewhat anxious and I have an elder sister who has been a constant worrier for her whole life. I certainly think that these behaviours rubbed off on me to a certain degree.

I would be interested to hear of any others stories of similar experiances or feelings too ....

There are various kinds of anxiety disorders: post-traumatic stress disorder, generalized anxiety disorder, specific phobias etc.

Those who develop anxiety disorders often have higher vagal tone from birth, which may suggest a genetic/environmental source that occurs even in utero. Babies with higher vagal tone have more pronounced startle responses to unexpected noises, and a slower return to a baseline heart rate.

Untreated anxiety disorders often eventually lead to depression through the exhaustive nature of anxiety. Unfortunately, many with undiagnosed anxiety disorders seek help at the point where depression has developed and are therefore treated for depression while the anxiety remains untreated.

Given your family history, you most likely have generalized anxiety disorder. It's a particularly sensitive looped system in the emotional center of your brain that triggers all the disparate compulsive, restrictive and avoidant behaviors in an attempt to alleviate the discomfort of the underlying fears.

We honestly don't know enough to determine whether there is co-morbidity or progressive development from a single-source underlying condition. It is always chicken and egg. Is an addict an addict to self-medicate for underlying untreated mood disorders or do addictive tendencies generate pscyho-active substance-generated mood disorders? Likely it is neither and both all at once.

All the traits you express fit under the broad category of Axis I disorders in the DSM IV. And perhaps they will all end up being one disorder when we get to the DSM-VI or VII, who knows?

Given that the genotypes (as far as has been identified thus far) all seem to over lap and that the most successful treatment (CBT) is applicable to depression, anxiety disorders, restriction eating disorders and OCD alike, then it is likely that these are all facets of a broader spectrum of biological functions that have some overall population benefit despite individual variation for its actual value.

Researchers hypothesize that because restriction eating disorders exist in other animals as well, it has overall population benefit to have the genotype persist even if some individuals receive a genetic variation that is fatal (just as sickle cell anemia is deadly, but the sickle cell trait protects against malaria).

The same is true of anxiety-ridden/depressed individuals. In studies, they are known to make more measured and careful decisions and to identify problems and issues where 'normal' people forge ahead without a second glance.

In a family with the anxiety genotype, a dozen will be worriers but otherwise they tick along, but one or two may develop intense phobias that render them house-bound or unable to function in the world independently.

For the individuals where the concoction of genes and environment make for a really reduced quality of life, there is CBT -- particularly successful for the Axis I disorders as a way to take back a quality of life you feel you are owed (and deserve).

In your case, it is likely a generalized anxiety that appears to have two peak focal points: food intake/weight gain/body image (the REDS) and various phobias expressed through obsessive and compulsive rituals aimed to rid or lessen the risk of infection/contamination/impurity.

Purely a guess on my part, but something to definitely investigate further with your involved professionals.

Your doctors seem not very up-to-date on recovery.

Your weight is only determined by your body, not your doctors and not anyone else including you.

70% of all women should be between BMI 21-27 and of those half will be BMI 23, 24 and 25.

At 5'5" and 130 -- your body has just decided it's not there yet.

Also, your doctors likely don't know that clinical studies show of all fully recovered anorexics only 2% end up above BMI 25. Even more critically for that tiny minority of 2% is that 0% of them are still above BMI 25 one year after complete recovery. That's with no relapse and no restriction.

The metabolic rate and leptin levels will optimize everything for you.

You are still hungry not just because your body may need a few more pounds for everything (especially your metabolic rate) to return to normal, but there is still likely a significant amount of energy needed still for repair.

You damage every major system in your body with anorexia. Your body has to rebuild its bone strength, major organs have to be repaired, the whole reproductive hormone system has to come on-line again... that translates into hundreds of thousands of calories' worth of energy to rebuild it all.

You are not just eating to have it end up as extra weight.

Trust your body and not your perhaps out-of-date doctors on this one.

Have you returned to a regular menstrual cycle as yet? And if you have, has it been 3 months in a row? If it's yes to both of those then use this calculator (below) to correctly assess how much energy you really need and then add 250-500 calories on top (whatever eases the extreme hunger):

http://www.health-calc.com/diet/energy-expend iture-advanced

If you answered no to one or both of the questions, then you know you still have to gain weight to recover to your optimal weight, and that means returning to a minimum of 2500 calories a day (more if you need it -- 3500+ is fine as long as you never go below 2500 on any given day).

The calculator I provide uses TEE instead of BMR x activity level and clinical studies show TEE is much more accurate at determining actual energy requirements for adults (BMR x activity is too low).

You gain on 2500+ until you hit your optimal weight and then you keep eating 2500 approx (see TEE) for the rest of your life to maintain your weight. The reason you don't keep gaining and gaining is that your metabolism returns to a normal range and biological functions that have been on hiatus due to starvation fire up again and need that extra energy that was going to weight gain and repair.

You are basically at the final phase of recovery -- it's a tough one because there can be that real desire to restrict as there is so much continued demand for extra energy in. Do whatever you can to trust your body and it will reward you in the end.

Congratulations on getting to this point! All the odds are now in your favor that you will recover completely and permanently. And that means all the damage is going to be completely reversed as well.

Best of luck.

Unfortunately your circumstance is a common one.

Because a disproportionate number of dieticians and nutritionists are on the restriction eating disorder spectrum themselves (studies comparing those with nutritional sciences majors with the rest of the university student populations), often their guidelines for ED recovery are woefully inadequate. 

A professional nutritionist or dietician is most helpful in ED recovery when they develop meal plans in partnership with the patient.

2500 calories a day is a minimal daily amount for recovery. And if the patient is not managing to gain 1-2 lbs. a week, then the amount is increased.

While your nutritionist's style may indeed be to 'protect' the patient by providing minimal information, protection is not necessary for those on the restriction eating disorder spectrum and is more often counter productive to their recovery.

The restriction eating disorder spectrum is a neurological disorder. It is best treated with cognitive behavioral therapy with a registered CBT therapist.

You are also best served in recovery if your treatment team is honest and up front with you, especially as your recovery depends upon you being up front and honest with them. Trust is developed on a two-way basis.

The best way to recover is to have a CBT therapist anchor you in developing non-restrictive behaviors in response to anxieties about weight gain, body image and food intake.

Then you involve a physician to ensure two things: 1) that your vital stats are all as they should be and 2) that any discomfort through the recovery process is monitored and supported to keep things moving along (issues with bloating, aching joints...etc.).

And finally, you can involve a nutritionist or dietician to help develop meal plans that provide you with a minimum of 2500 calories every day, or more if the weight is not increasing as it should.

A nutritionist should probably not be your anchor person for recovery. They are not trained in the neurological underpinnings of the disorder and that is where the lion's share of the work will be done to help your recovery be complete and permanent.

I think your instinct is right in telling you that a vague and circumspect nutritionist is simply not suitable for your needs and your personality.

In fact, anorexics generally do much better if they know exactly what to expect at each point in recovery and can identify and address anxieties associated with those steps in detail through CBT.

Best of luck on your continued progress!

Vagueness will likely only add to the anxiety that is the foundation of the restriction eating disorder spectrum for you.

2-7 lbs fluctuations within the day, or the week or each month are all normal.

Usually if someone finds such a small shift worrisome, there may be an underlying restriction eating disorder spectrum at work.

You have nothing to worry about, and if you are unable to stop worrying about it despite that assurance, then you might want to investigate cognitive behavioral therapy treatment to address the underlying anxieties around weight gain.

Well, first of all if you have had challenges with excess weight and acne, then you may want to be screened first for poly-cystic ovarian syndrome (PCOS).

Both ovarian dysfunction and reproductive hormone anomalies in PCOS lead to excess weight, hirsutism (excess hair), and breakouts of acne. It also involves irregular menstrual cycles and lowered fertility levels.

It could be coincidental you have begun losing weight and are now dealing with an outbreak of acne, or not.

If PCOS is not the underlying condition then you may be dealing with reproductive hormone fluctuations that are more a reflection of perhaps too-aggressive calorie restriction.

Fat stores do have and release hormones, but not the androgenic hormone associated with outbreaks of acne.

If you are creating daily calorie deficits of more than 1000 calories then that can be sufficient to suppress your metabolism and will lead to accompanying suppression in your reproductive hormones. And if the reproductive hormones are out of whack, then that could be sufficient to cause an outbreak of acne.

To determine what your energy requirements are use this:

http://www.health-calc.com/diet/energy-expend iture-advanced

TEE (total energy expenditure) is more accurate than the calculations based on BMR x activity level (which is what this site and most others use). Then from there, if you are clinically overweight right now, then you can eat between 500-800 less than what your TEE recommends. As soon as you get into a health BMI range, then you lower the deficit to 200-400 calories less than what TEE would recommend.

That is the slow and steady way to lose weight and it will help to support your metabolic rate throughout the process. And that greatly improves the chance the weight will stay off permanently as well.

Hopefully these possibilities give you something to work with.

It can take about 2 years to get good at identifying everything that has gluten.

After about 2 weeks you should have seen a marked improvement in the gastrointestinal (GI) symptoms. If you feel about the same (and you have clearly been diagnosed with gluten sensitive enteropathy aka celiac disease) then you need to revisit whether there is something in your diet you have overlooked.

You can find gluten in ice cream, soy sauce, dried spices (used as filler and to avoid clumping), salad dressings, french fries (as a coating)...you name it. About 95% of all the gluten you can accidentally ingest is wheat. Barley is not used in too much with the exception of course of beer. Rye is of course only found in breads and crackers. Oats are a concern mostly because they are milled along with wheat and suffer cross-contamination. You can get gluten-free oats (Bob's Red Mill is one supplier).

Restaurant visits are challenging and often result in accidental gluten-poisoning if you just go by what you think looks gluten-free on the menu.

Whether you can stand her or not, Elisabeth Hasselback's book the G-Free Diet is well-researched and covers off some good basics on how to navigate the modern world as a celiac disease person. An excellent site for all kinds of information on celiac disease is www.celiac.com.

So, if you are self-diagnosing as being gluten-intolerant, then there's of course a chance that isn't the source of your GI complaints.

About 2/3 of all self-diagnosed celiac disease patients were correct about their diagnosis (in clinical trials where it was investigated how accurate self-diagnosis could be).

As the GI symptoms for gluten sensitive enteropathy (the clinical term for celiac disease or gluten intolerance) can also mimic having an intestinal pathogen (bad bug), if your symptoms are not really improved by being on a 100% gluten-free diet for 2-3 months, then you will want to investigate with your doctor whether there are intestinal pathogens that are actually to blame for your symptoms.

While it can take 2-3 months on a gluten-free diet to see all the physical improvements in the symptoms, you should feel much better after 2-3 weeks on a 100% gluten-free diet and the symptoms should be much less in intensity and duration.

So, first check that your diet really is 100% gluten-free (wheat is everywhere). Second, don't cheat even once as that will set everything off again (not to mention that it causes real serious GI damage and can lead to certain cancers in later life). Then, see if all the GI symptoms start to trend in the right direction. If they do, then continue. If not, see your doctor to confirm what may be the root cause of your GI symptoms (you can be screened for celiac disease as well as tested for intestinal pathogens at that point).

For me, it took a few weeks to feel hugely better. It took 2 years to get good at the diet (I accidentally poisoned myself with gluten on a few occasions just because I wasn't aware of the hidden wheat in certain products), so I fit the norm on that too. And it took 1 final year where I had to actually remove all the gluten hygiene products (particularly shampoo, conditioner and lip balms -- anything that can end up in the mouth) before all my symptoms were really gone. 

Also, I am now more sensitive to accidental gluten ingestion. That last time it happened at a restaurant where I was assured the caramelized sugar basket was gluten-free (it was not) -- I was so sick all night. I had a horrendous migraine, vomiting, and horrible abdominal cramps that started about 2 hours after the meal and lasted about 6 hours in total.

My uncle actually collapsed when he was accidentally served a sandwich that was meant to be on gluten-free bread but the order had been switched by accident. He had to be raced to emergency.

It is common for the body to become even more sensitized to gluten once it is removed from the system. It's assumed that this happens because the immune system was overwhelmed and exhausted during the time undiagnosed patient is eating gluten and once it recovers with the removal of gluten, it has a more robust and intense reaction from that point forward (lucky us!).

Hope this helps a bit. H.