How Much Food to Eat During ED Recovery?
I am sitting on my sofa chilling and having my dessert treat and it got me thinking about the amount of food I used to consume during my eating disorder recovery. To gain weight and recover, one needs to consume a certain number of calories. You can't go against the law of physics. It is all about calories in and calories out. Your energy input from food and drink needs to be greater than the energy output from your base metabolic rate (how much calories your body burns at rest) and any other daily physical activities.
A good amount to consume would be 3000 to 5000 calories daily to ensure a minimum weight gain of 0.5kg to 1kg per week until you reached your overshoot weight and maintained there for a period of time (1-3 months).
Honestly, that should be the very bare minimum especially at the initial weight gaining phase where you are supposed to be gaining the most. Personally, I was gaining 4kg per week in the first month.
This is crucial as your body needs this high number of calories to repair and function optimally since you have been in a caloric deficit for a long time. This is a good starting guide but may vary slightly depending on gender and height as a taller male would require more calories than a shorter female. (Click here to find out what your goal weight should be.)
You may seem like you are eating a lot of food compared to your peers and feel disgusted and guilty. Don’t be too worried and overly concerned. This is VERY NORMAL. Remember that you have not been eating for a long time and they have been eating normally and if you add up, they are eating more than you over all these years of eating disorder that you had.
Standard Meal Plan
The standard meal plan given is 3 main meals and 2-3 snacks a day. There should be no more than 3-4 hours of interval between meals and snacks.
This is the meal plan most nutritionists and dieticians suggest; and is also the one I was given at Singapore General Hospital. A typical meal would be 1 portion of meat and 1 portion of vegetable with a bowl of rice from a Zi Char Stall, and a serving of cut fruit. A typical snack would be yoghurt and some fruits with toppings. (Something like llao llao or Yole.)
Don’t try to tell yourself that you will have 3 BIG MEALS or that you prefer BIG MEALS instead of 5 smaller meals. I tried doing this and it failed so I know. The reason why you should be eating 3 main meals and 2-3 snacks is because during the initial recovery period, you may feel mentally hungry but your appetite is small. This is because your stomach has shrunk from eating a small portion of food for a long time. You need to gradually build it back up.
I initially did this for a few days but I realise I could not follow it as I wanted MORE FOOD. What I realised is once you are ready to let go and recover, this meal plan is too easy and too little food for you, which makes it hard cause you want to consume more than that. If the meal plan tells you to eat 1 cup of yoghurt with toppings and you still feel hungry and want to have another cup, then go ahead and have the extra cup. Don’t limit yourself.
This is why the meal plan should serve as a minimum guide and to kickstart a person to eat more calories than before. It is not to be treated as the maximum. If you can eat more, go ahead. Else following the meal plan only serves as another form of restriction and you cannot truly heal from your eating disorder.
Refeeding is the process of reintroducing food after malnourishment or starvation. Refeeding syndrome is a serious and potentially fatal condition that can occur during refeeding. It’s caused by sudden shifts in the electrolytes that help your body metabolise food.
According to the National Institute for Health and Clinical Excellence, patients who are at risk of refeeding syndrome has one or more of the following
Body mass index (kg/m2) <16
Unintentional weight loss >15% in the past three to six months
Little or no nutritional intake for >10 days
Low levels of potassium, phosphate, or magnesium before feeding
Or the patient has two or more of the following:
Body mass index <18.5
Unintentional weight loss >10% in the past three to six months
Little or no nutritional intake for >5 days
History of alcohol misuse or drugs, including insulin, chemotherapy, antacids, or diuretics
Therefore, to reduce the risk of developing refeeding syndrome for high risk patients, the patient has to draw blood to make sure the electrolyte levels (potassium, phosphate, calcium, and magnesium) are fine before refeeding. This was why I had to draw blood 3 times a day which I hated and found it annoying.
Vitamin and electrolyte supplementation would be given either orally or intravenously unless the blood levels are high before refeeding. The calories will start low depending on your weight before slowly increasing. This is to allow the body to slowly get used to having more food in the system and metabolizing it.
Usually, gaining weight quickly rarely cause problems. The exceptions are the rare cases in which a severely anorexic child who is being tube-fed is at risk for complications from refeeding. But inpatient eating disorder wards in hospitals have to play safe.
The Path I Took
Therefore, I chose to EAT AS MUCH AS I CAN whenever my mental or extreme hunger calls me to. This is the fastest way to recovery and is what I chose to do. It is only for people who are ready to go all-in and act on their mental hunger and extreme hunger.
Basically, you eat as much as you want, as and when you want without restrictions. Your tummy may be full but if you still think about food, it means you are mentally hungry which is a sign of hunger and you should act on it whenever you can.
Doing so consistently will gradually kill off the mental hunger, and soon your mental hunger will decrease, and your whole mind will not be consumed by food thoughts. Your extreme hunger will also die down and soon enough, you will start to consume normal portions similar to your peers without constantly feeling hungry.
I ate 5 meals a day approximating 6000 calories for month 1. This was the month where I ate a pint of Ben & Jerry Ice Cream, apart from other junk food, for 30 days straight until I got sick of it. The first month will be where you gained your most weight. Click here to find out how I recovered from my orthorexia nervosa eating disorder.
After a long period of eating very little, your body’s metabolism will fall to a very low level as your body does not have much energy from food to metabolise. Once you start eating enough, your metabolism rate will take time to increase. Therefore, during the initial period, you will experience a lot of weight gain which is normal and good. (Faster gain faster recover. Slow and steady wins the race does not apply here.)
After consuming ice cream daily for 30 days, I got so sick of it that I stopped. However, I was still eating about 5000 calories in months 2 and 3. Eating whatever snacks and food I want. Just minus the ice cream. I reckon my body craved the ice cream for the first month cause ice cream is caloric dense and my body really needed that number of calories as it was so underfed and starved of nutrition and energy. I was still thinking about food all the time and wanting to eat whatever that is in sight.
In month 4, I reach closer and hit my overshoot weight at 69kg, and maintained it for a month in month 5. I started having less cravings for junk food or food that are high in calories. My mental and extreme hunger reduced during this period. However, I was still eating more than the average person at about 4000 calories.
Finally, over the next 2 months in months 6 and 7, my weight started gradually dropping back to 63kg. I was consuming about 3000 calories a day. This was because I no longer had extreme hunger and my mental hunger was gone. I only think about eating during normal eating hours like 3 times a day and not constantly ringing in my head. I felt so free.