wg & metabolism

hey everyone! this is my first time posting on here. anyway, i have had anorexia for about 3 years now. i was doing ok for a while (weight wise), but i lost some weight again in the fall and my bmi dropped to about 14.5. i started eating again slowly at about 1200 per day and now i'm at about 1700-2100 per day. my bmi is now about 15.5 so obviously i have gained some on this amount (6lbs). i have been seeing a new doctor ever since i was in the hospital in the fall and my bloodwork and stuff like that has coming back normal for the past 2 months. (theres no problems w/ refeeding, electrolytes, or anything else)

i started seeing a nutritionist again this week (monday) & she told me to do 1800 calories per day this week & see what happens with my weight next week (which i've basically already been doing). that seemed low to me. most of what i see on here is that anyone trying to gain should have over 2500. she also told me i probably won't have to go over 2200 in order to gain to a bmi of at least 19.4 (which is about 25 more pounds than i am now & was also my maintaince weight that was decided by my residental treatment dietitan). the calorie level my current dietitian is suggesting seems weird because when i was in treatment a few years ago, i needed over 4000 calories. i was putting on about 3 pounds a week though. she said that our goal could be just one pound a week.

but basically my question is- should i have more that what she's suggesting? if i am only having about 2200 (at most) to gain, won't my maintance calories be pretty low too? i am scared of gaining and never stopping.. could that happen if i dont gain on a larger amount of calories? i want my metabolism (and the rest of my body) to heal properly.

also will i gain the same amount in the long term if i do 2500 right away.. or just keep increasing very slowly & getting up to about 2200? i know if i jumped up to 2500 my weight would jump up quite a bit too. what have other peoples experiences been with that? how much do you think i would gain and how long does it take for your body to get used to that amount?

i'm sorry this is so long!! i'm just really confused right now. :/ this dietitian is supposed to be really good for eds in my city & knows a lot about weight gain & anorexia and has had a lot of experience which kinda confuses me even more (b/c this site is saying things different from her). but thank you sooo much to anyone that will help me out with all this :)

I think her recommendation was based on her not having all of the information. It sounds like she assumed that you were eating less than 1700-2100 and she suggested 1800 because she thought that would be an increase. You have to make sure to share all of the information with your doctor or else she might recommendations that aren't completely advisable had she known your current intake. Being that you're SEVERELY UNDERWEIGHT i don't think she would have suggested that you stay at whatever calorie intake you are currently at. I would say that you would benefit from talking to your doctor again and laying everything out so that she understands where you are starting from. You can definitely increase your calories without having to worry about "gaining to much" there are plenty of people who bump up their calories to around 3000 and still have a difficult time getting to a healthy weight, you have 25+ pounds to gain before you reach a semi-healthy weight, because a bmi of 20 is actually more appropriate. You would be better off just increasing your calories to 2500 and monitoring the results, that's only 400 more than you're eating now. Your metabolism will likely benefit and you might gain a bit faster but it will level off faster as well so it's a win win situation. i hope this helps =)

I am in the same situation. My nutritionist started me at 900,1200 and now 1400. I lost weight so I do not know why she is not adding more. I am 5'4" 88 pounds with a goal of 120. My nutritionist is from an eating disorder clinic and I have had this on and off 25 years now with ednos in between.I will never gain 4 pounds in 2weeks as she has requested.

thank you!!! and yep i told her about the amount i was eating and showed her my food journal and idk.. i dont think she believed that i was having that much or something. i have been very accurate w/ what i've been eating, but she was like no.. i think you're probably having about 1500-1600. and i was like well there are days where i get to about 2200.. and she just said, well you can always eat more if you want.. & just kinda avoided what i was telling her....

and another thing- if i start eating more, will it be hard to decrease once i am able to maintain? (since i'd be so used to having a lot)

I have been told you will adjust in time. We are in need of food right now and the body craves the nutrients. I was told my maintenance calories will be 1600-1700 once I get close to my goal. I use a food journal too and I would love to be able to eat more to gain but she said not yet. Very confusing.

honestly it does get easier because i am also in recovery and i get less and less hungry as this process goes on so i think it will be easy to reduce my calories when that time comes, but that's something that is in the future. right now i have to focus on being healthy and increasing my weight, so do you. that's a small detail that can be tended to when you get there, for now it's a non-issue because you're at such a low weight that your priority needs to be your health NOW not what will happen in 2,3, or 4 months from now. I will say from experience that my appetite is much lesser and I cannot imagine eating as much as i do forever even though it first it felt like all i wanted to do was eat, but my body is starting to trust me now and it's not starving for food so my appetite isn't as great! i hope this provides you with at least a bit of comfort. =)

Just want to point out:

Also, a maintainence of 1600-1700 is quite low depending on your height, age, and activity. I can say for myself, I lost on 2000, going from ~100-93ish in around 5 weeks (albeit working out ~9 hours a week), and I'm a smidge over 5'1 (also 15). So likely, 1700 will be too low for maintainence.

Fact of the matter is, if you're gaining on what you are, what on earth will you maintain on? When you restrict and are severely underweight your body is going to need a lot to repair. To quote one of my most recent journals here on CC:

I guide people in the weight gain forum: "Aim for a minimum of 2500 a day for sedentary females and 3000 for sedentary males." Why? The majority of our weight gainers are either recovering from restrictive eating disorders or a restrictive intake (deliberate or situational), or are larger, more active males, or are those with high burn rates one way or another - a demanding exercise schedule, a damaged body thanks to illness, it goes on - and every single on those demands high needs. 2500/3000 are the best places to BEGIN. Yes, okay, you may end up needing less - but that's pretty unlikely. Yes, okay, you may end up needing more - but at least you find that out.

Of course you will initially gain. You're giving a body food that has not had food in so long and is going "What the heck do I do with this?!" and clings to water. You also have to remember, food and drink weigh something. Introduction of more of it (particularly if you consume a lot of bulk in your diet) is going to weigh something.

When you introduce carbohydrate into the body you hold a certain amount of water for each gram of carbohydrate you consume. This does not mean less carbs mean less water retention and carbohydrate is a CRUCIAL part of anyone's diet (should make up to 50-60% of any person's caloric intake) because it is your primary fuel source. This is why people experience water retention when increasing in any situation, largely, as well as the factors of sodium, food weight, bowel movements, and in cases of refeeding sometimes edema. If you experience edema (the obvious swelling of extremities), go to your doctor.

When I first made my increases I gained a little on the 1400 to 1800 range. When I got to 2000 I started to lose - fast. When I got to 2500 I was still losing. When I got to 3000 I stabilised. When I got to the 4000 range only then did I gain. Oh, and I was on bedrest. Point being? Your metabolism probably hasn't caught up, yet. This sort of reaction to increases is quite common though not always as extreme (a lot start gaining in the 3000 range). You ought to push a bit higher. 300 calories? That isn't a lot, at all. That's around 40g to 50g of nuts, a wholemeal pitta stuffed to the gills with whole fat hummus or whole fat cream cheese and strawberry jam (really nice btw) - heck, it's just over two tablespoons of olive oil.

Don't cheat yourself. Recovery is the time for your body to heal, but only if you fuel it right.

Study: Abnormal caloric requirements for weight maintenance in patients with anorexia and bulimia nervosa. - Weltzin TE, Fernstrom MH, Hansen D, McConaha C, Kaye WH, Department of Psychiatry, University of Pittsburgh School of Medicine, PA.

"CONCLUSIONS: To maintain stable weight after weight restoration, restricting anorexic patients require a significantly higher caloric intake than do bulimic anorexic patients. Differences in caloric needs between normal-weight bulimic patients with and without histories of anorexia may depend on the methods used to correct caloric requirements. Body surface area may be the most precise correction factor across different subgroups of eating disorder patients. Elevated caloric requirements, when coupled with reduced food intake, may particularly contribute to relapse in anorexic patients." Am J Psychiatry. 1991 Dec;148(12):1675-82."

thank you all so much!!! :) i really appreciate it. i'm aiming for about 2500 today. so far i'm half way there and i still have dinner and 2 snacks to have. i'm pretty full but i've had lots of stuff like peanut butter, dried fruit, and avocado which has made it easier. i've been having larabars for a while, but today i tried dates (their main ingredient) and i loved them! :)

but i'm kinda worried though about what she will think because im going against her goal of 1800... & i'm still confused though as to why she said i will probably never have to go over 2200 to gain (25+lbs)... does anyone have any idea why that would happen?

also she's going to weigh me on monday when i see her again. i'm kinda nervous about what to expect with eating more. how much more should i be expecting with this increase? i don't want to be too shocked or freaked out lol...i know that a pound is about 3500 excess calories and i'll be having about 600-700 more than i'm used to (& basically maintaining on) for 4 days til i see her, which would be under 1 pound of actual weight + some water weight. does your body end up dropping that extra water weight? and how long does it usually take for the metabolism to adjust? would it be like a week or two or a month? (i do know it's different for everyone though)

sorry i have so many questions!! i'm just nervous about all of this and want to have an idea of what to expect. i'm trying to let go of the fear and just do it & not care/think too much about it, but it's hard. :/ either way i'm going to do it though because i really want this out of my life. i've heard a lot of the thoughts get better too as you get healthier. is that true for most of you? (sorry another question lol) :p i'm seeing a therapist again now too

i also agree that 1600-1700 seems low for matainance. even my dietitian who has me pretty low right now said it will probably be about 2200 to maintain... but then she also said i wouldn't have to go over 2200 to gain.... what a confusing lady.

uuum...i really would avoid weighing myself on Monday...that's too soon and you're likely to get freaked out even though you will have barely gained any actual weight. When i increased i noticed about 4-5 pounds within a week and then over the next 2-3 weeks i lost about 3 of that so in 3 weeks total I only gained about 2 pounds. your metabolism definitely kicks up and the water weight goes away once you get used to the sodium and the increased intake. there is likely to be food in your bowels as well which will add to the weight, though not actual weight. The worst thing you can do is weigh yourself then freak out and restrict because then you confuse your body even more and it's really detrimental for your metabolism. Give it about a month and you will have a pretty stable gain on 2500, with minimal water weight and relatively slow gain. I hope this helps :)

aw thank you so much for all of the support. :) and guess what?!? i actually ended up having like exactly 2500 calories yesterday!!!! i was and am still so proud of myself & i was proud that i was proud haha if that makes sense. i have never been able to have that much here at home over like the past 3 years. im doing pretty well today too so far even though i woke up pretty full. i really hope i can keep this up. it would be a bad idea to drop down again.

and idk if it's possible for her not to weigh me... i didn't want her to last time, but she talked me into it. maybe if she ends up weighing me, i could ask her not to tell me though. i kinda dont like her knowing when i dont though.. oh well.. oh and i also haven't weighed myself in a couple days which is good. :)

oh and do you think it would be better to have about 2300 for now and then jump up to 2500 in about 4-5 days? is there much of a difference in weight or metabolism with doing it slower or faster?

thanks everyone :)

just keep it at 2500, that will be more consistent and predictable for your body. just increase your weight and then worry about the minor details. honestly, you have nothing to worry about. i think fluctuating  calories in the beginning is not a good idea because it becomes too easy to restrict and not get all of your calories in!! So, just eat the foods you've deemed off limits for so long and enjoy it!! honestly, it's refreshing and uplifting once you really let go!!

Steph,  good luck with your gaining.  I just wanted to tell you that I have a weird nutritionist too....he knows why I am there (to gain after restricting) but he told me to eat 1500 calories a day and he seriously just printed out an about.com article about weight gain and gave it to me for advice!!! WTF I could have just gotten that myself!  He also took all of my measurements and measured my bodyfat percentage, and it was 19%, and then he was saying weird stuff like "For instance, if you want to get your bodyfat down to, say, 15%, you'd have to lose 6 pounds of fat" blah blah!  He kept going on about this kind of weird stuff, and about how I should be avoiding saturated fats, etc.....it was actually really triggering to me!  I felt like he was telling me that I needed to LOSE weight.

Do you have any other options for a nutritionist?   Because the advice she gave you does sound weird, and if you and I did not come on CC to learn from other people who had to gain, we might be following that crazy advice right now instead of eating the 2500 calories we need.

Yyyyeaah... a few posters here have come away from nutritionists going "what the crap?"

Steph: Like Chrissy said keep it consistent. Don't dip, don't shoot lower. Your body adjusts faster through consistency. As for the weighing - if they refuse, ask to be blind weighed or weighed backwards. Tell them you would, for now, not like to know the number.