***Disclaimer*** All quotes and information compliments of Gwyneth Olwyn, owner of Your Eatopia. She is a patient advocate and a member of the Alliance of Professional Health Advocates.
If someone had shown me the site “Your Eatopia” (CHECK IT OUT) during my initial attempt at recovery, I feel I would have felt a lot better. This site is a recount of blogs based on the successes of the MinnieMaud guidelines and treatment plan for recovery.
There are three stages of recovery:
- Weight restoration
- Repair of physical damage
- Developing new non-restrictive neural patterns in response to usual anxiety triggers. To restore one’s weight, one must engage in
- Unrestricted eating with minimum intakes that are set to reflect actual average consumption of non-restricting equivalents.
- No workouts or exercise.
No weighing or taking measurements of self.
MinnieMaud’s guide lists various ages and heights to be used to determine how many calories one should eat daily, at minimum, to begin weight restoration. What I am intrigued about here is that it is not a meal plan. Nowhere does it say that one should eat half a cup of cereal at 9am, two tablespoons of peanut butter at 8pm, or 4 servings of vegetables each day. This guide says to eat unrestrictedly. Doesn’t that make all the sense in the world? To overcome a restrictive eating disorder, one should stop restricting. Brilliance. More and more I feel that my being put on a meal plan, while serving the purpose to put meat back on my bones, only allowed me to continue on a regimented schedule, though I was eating more. I was able to eat safe foods every day in a predictable fashion. I was thus allowed to continue my restricted eating.
It goes on to mention the phases of weight restoration and the accompanying symptoms. If I had seen these, if I had been told to expect them and to welcome them and assured they would not persist, I too might have reached stability and happiness soon after my initial attempt.
The first phase is edema. During it, one effect with which I am too familiar is water retention. I was often bloated after eating seemingly little food, and this caused my anorexic mind to believe I had become obese in a matter of hours. MinnieMaud states: “Someone not prepared for this will panic and restrict before she gets too far along. The “weight” almost exclusively water retention (edema). The body needs the water for cellular repair and the normalization of both liver and kidney functions [WB Salt, 2004; GFM Russell, JT Bruce, 1990].” Was I prepared for that extra water weight and girth? No. Did I panic and try to restrict even more? Yes.
The second phase also rings true in my memory, past and recent: digestive distress. More often than not this summer I have felt some form of constipation. Several days were marked with bouts of diarrhea. For a while I knew eating any amount of refined sugar would result in a watery bowel movement the next morning. Further, the stomach apparently does not empty itself sufficiently when one is starving, and to correct this takes much time and much food:
…they also have to overcome gastroparesis. [RW McCallum et. al., 1990]. Gastroparesis is a survival mechanism whereby the stomach doubles its emptying time to the small intestine, meaning the food is churned in the stomach for longer to try to allow for the small intestine to maximize the too-little energy coming in to the body. Gastroparesis begins easing within a few days of doggedly staying at or above the minimum intake and it resolves quickly if you persist in eating the recovery guideline amounts, usually within a couple of weeks to a month. In fact the motility of the entire gut is slowed to try to extract as much energy as possible during starvation [M Hirakawa et. al., 1990] and this resolves during dedicated refeeding efforts.
THIS MAKES SO MUCH SENSE.
Linked to digestive distress is pain… and, again, I have been in pain. It is said to be mostly caused from the water retention, as the body is essentially swollen. It will hurt to be touched. It might hurt to move. And, this is normal.
Another effect is rest. Recovery and weight restoration will leave you feeling exhausted, and this will be most confusing due to the hyperactivity you probably felt while restricting. This is because the brain has been tricked for so long to function on so little, and it is now overwhelmed and confused itself. Oh yeah, I often go to bed by 9:30pm after a long day of doing nothing but eating….
MinnieMaud stresses no exercise during refeeding. While I know I too was told not to exercise during recovery, it was very challenging. I can see the point though: why expend calories that you need? For me too, the exercise was just as regimented as the eating. If I had been allowed to exercise, I probably would have fared even worse in recovery. I would have been able to keep a strict mindset of thinking I needed to do X, Y, and Z at the gym every day or the whole day would be a failure. While I will admit that I have been exercising during this final shot at reaching full recovery, I can completely see where it would be beneficial for me to stop. The fact that it is difficult for me to even admit that should be a strong indicator that this suggestion is worthy of consideration.
The next effect, The Honeymoon, is one I hold dear to my heart. When beginning to eat, the recovering anorexic will feel new freedom and relief in eating without restriction. He or she will be so excited to be seemingly free from the disorder thoughts. But, “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.” Oh speak to me, MinnieMaud. This is so true as well. I remember one early appointment with my nutritionist during which I asked her if I could possibly overeat. She said, “Absolutely not.” That was great. I remember feeling like I had suddenly been granted permission to eat! I went home that evening and ate ice cream (fat free) from the container in pure bliss. I felt so happy. I felt strong and independent, confident even. And then that night, I felt weak. I had let myself down. I had deviated from the plan. I had lost my resolve. The next day of eating was strictly following the meal plan and trying to take all the shortcuts within it that I could possibly devise. If only I would have been told MinnieMaud’s truths:
- Your body has an optimal weight set point that it can and will defend. [RE Keesey et al., 1997; RE Keesey, 1988] Your body can manage without your conscious interference. Your set point is managed and distributed throughout brain structures that are far more mature, evolutionarily speaking, than your late-to-the-party conscious thought. Think of this as your prime directive: do not interfere in a process that your body can manage.
- No one keeps gaining and gaining.
- 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.
Phase Two is the insulation of vital organs. I could show you my belly right now. It looks a little pudgy. My waist is much wider, fuller, than it was before. My trunk is thick. This is my body’s decision. It is trying to protect my vital organs by enveloping them with a blanket of fatty protection. Finally, they are cushioned and corralled. And again, I think I was perhaps at this phase before, but I never allowed myself past this.
The key: “Again, someone in recovery who 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. [LES Mayer et. al., 2009]” I know I did. Any time my belly became bigger than I thought it should be, which, granted, was not a large range of sizes, I relapsed. I cut calories. I worked out harder, longer, more frequently. I limited carbs. I avoided sugar. I threw myself into my school work. I isolated myself.
If I had only been told that “the redistribution of all that fat around the mid-section to the rest of the body only occurs if you persist right the final phase. [LES Mayer et. al., 2009]” If only I had known that when I pushed past this, this challenge like no other, I would get a body back that was my own to keep, a body that looked a lot like those around me, and a body that was healthy.
I think a large part of me felt that once I reached my lowest, minimal weight at which I was classified in the “healthy” BMI range, that it was time to cut back, time to restrict again. After all, disordered eaters fear becoming overweight, so to reach a weight beyond that that was set by a medical team seems to be failing additionally. No one told me that it was good and acceptable to overshoot my target weight. And, really, my target weight was likely too low for my own set point.
This is where I see a big flaw in most eating disorder treatments. That target weight may as well be an arbitrary number. It again serves as a way the disordered eater can focus and obsess over something. Perhaps it is a healthier number, but it is again a controlled number. Why not let the body tell you what the number should be? By setting a target, the brain is again in charge. When the brain is already sick, it will not heal when left in charge.
So, today I carry a new mantra: the “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. [A Dulloo et. al., 1996, 1999]”
The third phase is the body’s restoration of muscles, and this is the phase that might be most rewarding. Though it may take seven years, osteopenia and osteoporosis will start to reverse. Weight redistribution will begin too, and that midsection weight will be pushed to other body parts. Your hair, nails, and skin will increase in suppleness. Even more importantly, I will feel more connected to myself. I will want more purpose to my life and will develop new goals. Emotions will be better regulated. The MinnieMaud Treatment suggests these changes happen around the six-month mark, which means I have a ways to go. And, of course, everyone is different. But I so look forward to this change.
The final phase is that of remission or of relapse. I think I have experienced both at this point. This time around, I want remission. I want this to be the last time I try to recover. I want this to be the last time I have to write about recovering and wanting to recover. I was to be in remission. MinnieMaud believes that the body will determine its own set point. Once it is reached. Your metabolism will revamp itself to allow you to continue eating nearly what you were eating in recovery without gaining too much more weight. During recovery your metabolism is suppressed, as all your energy is going into weight gain and repairing the body. Once weight has been restored, the metabolism will again send energy to systems that were previously on hold. This is when the body will be able to better send its own hunger cues and when the brain will be better equipped to interpret them and to act upon them.
Here though is where relapse just may happen again. Many professionals will encourage a patient to “restrict under the auspices of maintenance of … weight and health. Restriction of food intake will always precipitate relapse.” Again MinnieMaud is referring to society’s skewed view of what health looks like and how BMI numbers can be deathly inaccurate measures of one’s health range.
When I had reached my lowest target weight, I was released, seemingly cured. All I had to do now was maintain. But, that of course would mean eating less. And I began that, and I began restricting, and I definitely experienced what MinnieMaud calls the Reverse Honeymoon: “an initial phase of comfort and ease as your restrictive eating disorder begins to take hold.” All too often I can remember feeling this way even just after a weekend spent at my parents’ house. I would be driving back to school, feeling the seatbelt on my abdomen, swearing to myself that it was pinching me because I had added flesh to my stomach. How could I have been so loose with my diet? With every mile driven I was one vow closer to restricting again. A sense of peace would wash over me as I turned into my school’s campus. Finally, I could eat nothing again. All was well, or would be well. I knew the weight I had gained would be gone within the next 48 hours. I was back on track.
If only I had known about the way my hormones and body were affected by my restricted eating, and how they would respond during recovery. If I had known this:
“The restrictive eating disorder spectrum does not include binge eating disorder or night eating syndrome. Those sit on a completely different ED spectrum and have completely different genotypes involved.
On the restrictive eating disorder spectrum, your system responds to leptin in your body correctly and that system not broken.
Once your leptin levels get back to optimal levels (which will happen when you hit your natural weight set-point) then you will stop gaining weight. Leptin runs your appetite and metabolism—when it is optimal then everything is in balance. You maintain your weight naturally and eat when you are hungry when you get to that point.
So, every time the ED-skewed thoughts get you all panicked about gaining weight and not stopping, remind yourself that it is not biologically possible for that to happen to you.”
So much of my recovery would have been different. I might have recovered four years ago.