I’ve been neglecting the Skribit app on the sidebar and decided to hit that for a topic. Today, we’re looking at the following question with 533 votes:
How to correct a metabolism damaged during an eating disorder.
This seems to be a hot topic given the number of votes it has. I’ll go ahead and admit that this is completely new ground for me. I’ve never looked into this topic in the slightest, so take everything I say here with a bigger grain of salt than you already should. And I’m not even going to begin to touch on the psychological or possible societal issues driving these disorders.
Classifying Eating Disorders
The three main eating disorders are anorexia nervosa, bulimia nervosa, and binge eating disorder. Anorexia nervosa (AN) is “deliberate and sustained weight loss driven by a fear of distorted body image”. It has the highest mortality rate of any mental illness at 6% and is classified symptomatically as abnormally low body weight, amenorrhea in women, and intense fear of gaining weight or preoccupation with body shape and weight. Fifteen to nineteen year old girls account for 40% of the cases of AN, with strict diagnosis showing approximately a 0.5-1% incidence of late adolescent or adult women meeting the criteria for an anorexia nervosa diagnosis. Approximately 90% of all AN cases are women.
Bulimia nervosa is a disease of recurrent cycles of binge eating followed by compensatory behavior to make up for it, such as vomiting, laxatives, or excessive exercising. One- to two-percent of late adolescent or adult women meet the criteria for bulimia nervosa diagnosis, though diagnosis is more difficult than with anorexia since bulimics tend to be of normal to above normal weight.
Binge Eating Disorder is simply associated with periods of extreme overeating, affecting about 3% of the population. I’m assuming that the main difference between Binge Eating Disorder and bulimia nervosa is the lack of compensatory behavior in Binge Eating Disorder. Obesity is often a result.
So what does all of this disordered eating do to the body from a metabolic perspective? The lack of nutrition suppresses the metabolism through various mechanisms. As we learned in the series on the physiology of fasting, the body has ways of dealing with acute food shortages, including recycling amino acids, using body fat as fuel, and eventually consuming muscles.
But because the eating disorder amounts to a chronic stressor, a “famine” of sorts, the body reduces energy expenditure as much as possible. Muscles and fat are consumed and energy expenditure is minimal. Thyroid function is likely messed up. Further, the lack of real food means a lack of vitamins and minerals, nutrients essential for the body to function properly.
And that doesn’t even begin to touch on the damage done to the organs and bones due to lack of sufficient calories, vitamins, and minerals. If vomiting is the method of compensation, other damage can be done to the teeth and esophagus.
Repairing The Damage
Returning to Normal Eating First, you need to start eating normally. That means ensuring that you’re getting enough calories and that you’re eating real food. These unprocessed, nutrient-rich foods will do two things. They will ensure that you’re getting plenty of vitamins and minerals, which are ultimately what the body uses for biochemical processes. They’ll help you get your hormones in line with what they should be.
They will also help you regulate your appetite. The protein and fat in the animal foods will promote the release of hormones that keep you from overeating. Coupled with the bulk from the vegetables and fruits, you’ll find it hard to eat too much, especially important for bingers. Cutting out the processed foods really is the most nutrient-dense way of eating and is likely the quickest way to get your body back on track. Adequate calorie intake will tell your body that the famine is over.
It doesn’t seem to me that now is the right time to implement Intermittent Fasting. Right now is the time to establish regular patterns of eating (which doesn’t have to be 5-6 times per day) and habits of choosing good foods to allow the body to figure out proper hormonal working again.
Rebuilding The Body It’s likely that strength and body composition are off, so I’d suggest attempting to build some muscle with compound exercises like squats and deadlifts. Of course, that should all be done under the trained eye of someone that can make sure you don’t kill yourself by going too hard too fast.
Your body is trying to rebuild damaged organs and muscles, so you want to get some exercise, but not overdo it. You want to adopt normal exercise patterns, ensuring that you’re not exercising too much. You don’t want to reverse course and damage your body through excessive exercising. And now isn’t the time to be concerned with your six-pack.
Completing The Circle Step away from the scale. Throw it out. Weight is unimportant. Far more important is what that weight is made up of, fat or muscle. We want a lean body that weighs more than it appears to. Recall that muscle weighs more than fat, so two 150lb women can appear vastly different. Don’t use the BMI as a measuring stick.
Finally, make sure that you get sufficient sleep to allow the body to repair. Along with diet, sleep is the most important thing you can do for overall health.
As I understand it, the metabolism can be repaired, though it will likely take longer in individuals recovering from this type of bodily abuse. Basically, while there is likely a need for medical supervision to ensure vitamin and mineral status is maintained, the actions that will right the metabolism of one with an eating disorder are likely to be the same actions that we all use to stay healthy.
Finally, the only other advice I’ll offer is to get help if you have (or know someone who has) an eating disorder. These patterns of eating are highly detrimental to the body and to health, both present and future. Speak with someone well-versed in dealing with the medical effects of these disorders. It’s not enough to just start eating properly again. There are typically psychological issues underlying these disorders that also need to be dealt with.
Any questions that I didn’t answer? Do you have other advice for people recovering from eating disorders?
Results: No differences in body weight were observed betweenthe IF and SD groups. Peripheral glucose uptake and hepaticinsulin sensitivity during the clamp did not significantly differbetween the IF and SD groups. Likewise, lipolysis and proteolysiswere not different between the IF and SD groups. IF decreasedresting energy expenditure. IF had no effect on the phosphorylationof AKT but significantly increased the phosphorylation of glycogensynthase kinase. Phosphorylation of mTOR was significantly lowerafter IF than after the SD.
Conclusions: IF does not affect whole-body glucose, lipid, orprotein metabolism in healthy lean men despite changes in musclephosphorylation of GSK and mTOR. The decrease in resting energyexpenditure after IF indicates the possibility of an increasein weight during IF when caloric intake is not adjusted. Thisstudy was registered at www.trialregister.nl as NTR1841.
Results:Subjects who completed the study maintained their bodyweight within 2 kg of their initial weight throughout the 6-moperiod. There were no significant effects of meal frequencyon heart rate, body temperature, or most of the blood variablesmeasured. However, when consuming 1 meal/d, subjects had a significantincrease in hunger; a significant modification of body composition,including reductions in fat mass; significant increases in bloodpressure and in total, LDL-, and HDL-cholesterol concentrations;and a significant decrease in concentrations of cortisol.
Conclusions:Normal-weight subjects are able to comply with a1 meal/d diet. When meal frequency is decreased without a reductionin overall calorie intake, modest changes occur in body composition,some cardiovascular disease risk factors, and hematologic variables.Diurnal variations may affect outcomes.
Impact of reduced meal frequency without caloric restriction on glucose regulation in healthy, normal-weight middle-aged men and women. O Carlson, B Martin, KS Stote, E Golden, S Maudsley, … - Metabolism, 2007 - Elsevier
Collectively, the available data therefore suggest that meal skipping or intermittent CR diets can result in health benefits including improvedglucose regulation, but only if there is an overall reduction in energy intake.