Search This Site
Twitter
« Is it too late for me to recover from restricted eating behaviors? (ages 26-52) | Main
Wednesday
Sep142011

I Need How Many Calories?!!

Daquella Manera: Flickr.com

2000 calories a day is not what any average adult needs to maintain her health, weight and wellbeing. That’s an inadequate daily energy intake. That’s right. It’s too low. And if you are younger than 25, then it’s far too low.

Alright, let's get into this…

 

 

 

Porschelinn: Flickr.com

Introduction and Some Nomenclature 

This blog post entry used to be called “Do I need 2500 calories?” and it tends to be where many begin their investigations on this site. So I am updating this material to ensure that there is enough explanation to have this all hopefully make some sense.

Tim Green aka Atoach: Flickr.com

Restrictive Eating Disorders

Many of you visiting here for the first time may not have ever come across the term restrictive eating disorder spectrum, and it does not refer to anorexia alone. It includes: restriction/reactive eating cycles, bulimia, orthorexia and anorexia athletica as well as anorexia nervosa.

While the Diagnostic and Statistical Manual For Mental Illness (DSM-IV) identifies all these conditions as distinct, they are neurobiologically all one condition. That is why patients will often express multiple facets of the condition at once, or shift from one facet to another over time as well.

The restrictive eating disorder spectrum is a broad spectrum and just under a third of our population resides somewhere on that spectrum. It is a lifelong chronic neurobiological condition and it has two states: active and remission.

You cannot be ‘cured’ from this condition once it is activated,
but you can enter a robust and often permanent remission.

For those who might be a bit taken aback by the idea that a third of our population has this condition, I will reference material in my About section on this site:

“When restrictive eating behaviors are more broadly surveyed and analyzed, then the incidence rate rises to 27% [J. Jones et al., 2001]. 35% of all those who diet progress to pathological levels of dieting and a quarter of those pathological dieters develop clinical eating disorders [C.M. Shisslak and M. Crago, 1995]. Given that somewhere between 84 to 93% of all girls have dieted by the age of 14, then just shy of 1 in 3 girls are developing calorie restriction pathologies.”

These are genetically determined conditions, however the condition can lie dormant. The most common trigger for activating the condition is dieting, or restriction of calorie intake. However, illness, trauma and other significant stressors can activate the condition as well.

The mean age of onset is approximately 11 years old [R. Bryant-Waugh et al., 1988], however “picky-eating” and/or gastrointestinal illness in early childhood is highly correlated with later onset of restrictive eating disorders as well. [C. Jacobi et al., 2003]

Dani PL: Flickr.com

The Facets of Restrictive Eating: It’s About the Food.

Everyone assumes that this condition is only about anorexia nervosa and most people have several misunderstandings about what anorexia nervosa is as well.

As best as we can define this condition at present,
food becomes misidentified as a threat.

The amygdala, one of the emotional centers in the brain associated with threat identification and the fear response, appears to have abnormalities in function for those with this condition (along with other associated brain structures), as per the published research of Walter Kaye, Janice Russell and their respective colleagues.

A blog post of relevance to the genetic component is: The Genetic Superpowers: Another Way to Frame Eating Disorders?

Our preferred response to any threat is avoidance.

Of course that is a useful survival response when the threat is valid, such as a predator moving around in the bushes nearby.

However, when food becomes threatening, then the person affected is now dealing with two monstrous problems:

  1. the sensation that food is a threat is nonsensical to the conscious mind and,
  2. it is impossible to completely avoid food intake because we have to eat to live.

Because being afraid of food is confusing to our conscious minds, the person with this condition scans the environment to try to explain to herself, or himself, why food has become a threat. In today’s world, the most common explanation is that the food will make them fat or unhealthy.  A few hundred years ago, the more common explanation was that food was only restorative for the putrid physical body and that spirituality and attaining a state of transcendence and closeness to God required the avoidance of food.

Just because the conscious mind has to explain the fear of food within a contemporary and changeable framework does not mean that the condition is made-up or caused by societal influence. Without the genetic predisposition, a person does not become anorexic simply because our society is disproportionately focused on unhealthy levels of thinness.

However, the fact that our society discriminates against fat and reveres thinness does mean that many more individuals with the genetic predisposition are liable to develop a restrictive eating disorder, because they are going to restrict food intake to try to achieve acceptable levels of thinness and then find that food becomes typecast as an enemy in their own minds.

Most with an active restrictive eating disorder do not necessarily connect the physiological responses they experience around food with some of the compulsions and behaviors that develop from that discomfort.

When the amygdala receives information from our senses that there is a possible threat nearby, then it generates a cascade of physiological responses that can be summed up as just unpleasant. These reactions drive us to want to remove ourselves from the stimulus that has been identified as a threat.

Ralph and Jenny: Flickr.com

So What About the Food?

What happens when you have to keep removing yourself from eating?

Your drive to avoid the food runs into the stronger drive to stay alive.

And here is where all the facets of the condition can be readily explained:

Anorexia Nervosa

Anorexia nervosa, the restriction of food intake is clearly the most well known of responses found in this spectrum disorder. The patient still eats and is extremely hungry, but creates as many distractions and compulsions as possible to minimize the food she must take in. Keep in mind that eating creates a massive fear response for everyone on this spectrum. And when I say she “creates” these distractions, it is not a choice, but rather a compulsion driven by the extreme physical and emotional discomfort that eating generates for her.

Restriction/Reactive Eating Cycles

Restriction/reactive eating cycles involve the patient having to wait until the hunger physically overtakes her. She may even develop elaborate rituals around when and how she may be able to succumb to the hunger as a way to try to alleviate the fear response she must endure while eating. These cycles will often progress to bulimia nervosa, where the patient has to alleviate the fear response post-reactive eating with compensatory restrictive behaviours (abuse of diuretics, laxatives and purging). 

Blog posts addressing restriction/reactive eating cycles in more detail include:

Binge Eating Disorder and Night Eating Syndrome

Why Bingeing Is Not Bingeing When You Are Recovering From Restrictive Eating

Weight Recovered and Still Bingeing

Again, few patients experience only one facet in the progression of this condition and many slide in and out of these facets or express multiple facets at once.

Orthorexia Nervosa

Orthorexia nervosa is the application of fear-modulating behaviors that mimic obsessive-compulsivity. By eating only foods that are considered ‘clean’ or healthy, the patient tries to alleviate the fear of food by convincing herself that the food is not a threat to her as long as it is the right food, in the right amounts and eaten at the right times. A blog post addressing orthorexia nervosa in more detail can be found here: Women Laughing Alone with Salad: Orthorexia Nervosa.

Anorexia Athletica

Anorexia athletica is also a common fear-modulating set of behaviors where the consumption of food can be deemed to be less of a threat if all the energy that was consumed is “burned off” in exercise. This blog post addresses anorexia athletica in more detail: Exercise as a way to restrict? You bet.

Functional hypothalamic amenorrhea is a synonym for what is often called the Female Athlete Triad: inadequate and improperly timed energy intake combined with amenorrhea or oligomenorrhea (absent or infrequent menstruation) and reduced bone mineral density. It is the result of anorexia athletica. Therefore the same recovery guidelines apply for the presence of the functional hypothalamic amenorrhea or female athlete triad as apply to any other facet of the same restrictive eating disorder spectrum.

A blog post pertaining to the issues surrounding this spectrum disorder and family planning can be found here: Restrictive Eating Disorder Spectrum: Fertility and Pregnancy.

Child Is A Rebel: Flickr.com

I Think I Have a Problem

The Phases of Recovery From a Restrictive Eating Disorder blog post has the Telltale Dozen signs that you can review to determine whether you are likely to be on this spectrum or not. But chances are that if you have gotten this far in your reading, then you are pretty sure that you need to turn some things around when it comes to food, exercise and your health.

Many of you are probably already veterans, having gone through several rounds of attempting recovery either on your own, or cycling through various inpatient and outpatient services as well.

And the reason many of you end up at this particular blog entry, usually from other sites, is likely because someone has mentioned you need a lot of energy to restore your weight, your health and to enter a robust remission from a restrictive eating disorder (no matter what facet(s) dominate(s) your existence at the moment).

Alex E. Proimos: Flickr.com

Important Medical Disclaimer

It is important to have any recovery effort from restrictive eating behaviors overseen by medical professionals.

If you have been restricting to 1000 or less calories a day, or you have abused diuretics, laxatives or purged, then you need to increase up to the recovery guideline calorie amounts for your age/height/sex slowly. That usually requires increments of 200-250 calories every 2 to 3 days until you get to 2000 every day. At that point, you can jump to the final amount (2500-3500 depending on age, sex and height).

Because electrolyte balances may be out of whack in starvation, moving the intake back up to normal levels does have medical risks associated with it. Re-feeding syndrome is a life-threatening, but completely treatable condition during this initial phase of recovery, as long as you receive immediate medical intervention.

If at anytime during the early phase of recovery you are dizzy, light-headed, feverish, vomit, experience severe swelling of the hands or feet, and/or experience chills and sweats, you need to seek immediate emergency care.

And remember, while the guidelines to achieve remission from a restrictive eating disorder that are found on this site are evidence-based from a scientific point of view, they are not to be construed as medical advice, nor do they replace in any way the necessity of medical oversight and input if you are attempting recovery from a restrictive eating disorder.

Hegtor: Flickr.com

2500-3500 Calories A Day. Yes Really. 

It is by far one of the most common questions asked of me: “Do I need that many calories to recover?” The quick answer is always: “Yes.”

I’ve answered this one hundreds of times and I have yet to read details and history that has had me answer it as a “No”.

The reason I get asked this so much is because it is understandable to assume that somehow how long you starve and how underweight you might become are going to change the terms of recovery and that perhaps creating energy deficits through excessive exercise or cycles of restriction (with periods of so-called bingeing) may be more benign and will require less energy intake in recovery to rectify the damage. Not so.

The severity of starvation does impact recovery somewhat but only in so far as the time it will take to recover.

Probably most of you are aware that the clinical marker for active anorexia is body mass index (BMI) 17.5 or less. However this is misleading because while the so-called healthy BMI range is 18.5-25 that does not mean that a single individual is at a healthy weight throughout that entire range. We each have a specific optimal weight.

I usually explain it this way:

If I take two women of the same height and one is naturally meant to be BMI 24 and the other is naturally BMI 21, then this is what happens when they both restrict calories:

  • The woman at BMI 24 diets down to BMI 20. Technically she is still in the healthy weight range and she receives compliments on her dieting efforts.
  • The woman at BMI 21 diets down to BMI 17. People are very worried.

Which one has an active restrictive eating disorder? They both do.

Both women have the same physiological damage and both need intervention to recover and yet only one will likely be identified as having any issue.

AlaskanDude: Flickr.com

Here are the guidelines for when 2500 calories applies as a minimum daily intake for recovery:

You are a 25+ year old female between 5’0” and 5’8” (152.4 to 173 cm) and,

The regular menstrual cycle has stopped and/or,

You have other symptoms of starvation: feeling the cold, fatigued, foggy headed, hair loss, brittle nails, dull skin and/or,

Even if you were only underweight/dieted for a very short space of time (a few months), these guidelines apply.

MartinaK 15: Flickr.com

Here are the guidelines for when 3000 calories applies as a minimum daily intake for recovery:

You are an under 25 year old female between 5’0” and 5’8” (152.4 to 173 cm) or an over 25 year old male between 5’4” and 6’0” (162.5 and 183 cm) and,

The regular menstrual cycle has stopped and/or,

You have other symptoms of starvation: feeling the cold, fatigued, foggy headed, hair loss, brittle nails, dull skin and/or,

Even if you were only underweight/dieted for a very short space of time (a few months), these guidelines apply.

Mike Baird: Flickr.com

Here are the guidelines for when 3500 calories applies as a minimum daily intake for recovery:

You are an under 25 year old male between 5’4” and 6’0” (162.5 and 183 cm) or female with young children or an equivalent and unavoidable level of activity.

The regular menstrual cycle has stopped and/or,

You have other symptoms of starvation: feeling the cold, fatigued, foggy headed, hair loss, brittle nails, dull skin and/or,

Even if you were only underweight/dieted for a very short space of time (a few months), these guidelines apply.

Exceptions:

If you are taller than the guidelines listed above, then add 200 calories to the guidelines that match your age and sex. If you are shorter than the guidelines listed above, then you may eat 200 calories less than what is suggested for your age and sex, however these are all minimum guidelines and everyone is expected to eat well above them for a good portion of the recovery process in any case. Please see this this blog post for more details: Extreme Hunger: What is it?

Everyone in recovery should cease all exercise and workouts and any discretionary activities. The energy you take in is required for weight restoration and repairs.

Michi 03: Flickr.com

What If I Am Already Weight Restored?

A lot of people who ask this question have regained their weight by consuming somewhere between 1800-2200 calories a day instead of the suggested minimums found on this site.

Many continue to feel extremely hungry, suffer persistent symptoms of energy deficits (cold, tired, brittle hair and nails, irregular or absent menstrual cycle etc.) and continue to have restriction a primary driver in their day-to-day lives.

The answer? That’s right, eat to the minimum guidelines until the weight restoration stops (yes, it does that) and the symptoms of energy depletion disappear and menstrual cycles return (when applicable).

It is possible to gain weight on 1600-2200 calories a day when recovering from the restrictive eating disorder spectrum because the metabolic rate is so suppressed.

The body approaches recovery in the following way:

  1. keep everything suppressed and take the energy to deal with the backlog of cellular repair (leading to bloating and water retention initially) and sock the rest away in fat stores (usually disproportionately around the mid-section to insulate vital organs);
  2. assuming there is enough energy still coming in, then address longer term repair issues (bone density etc.) and begin to notch up metabolic rates and bring biological functions back on-line;
  3. assuming adequate energy continues to come in on a daily basis, then fire up the regular neuroendocrine system back to normal and allow the metabolic rate to go back to normal as well.

It is very easy to get stuck in the first and second phases of recovery because the natural inclination is to assume that if you are back at BMI 20 then you are recovered and need to start restricting calories to avoid getting huge.

While that may be an understandable inclination generated from eating disorder anxieties, it is a false one.

Recovery is not the opposite process of dieting. With dieting you create a calorie deficit so that your body makes up the difference by using energy stores in fat, bone, muscles and major organs.  But with recovery, you have to provide not only enough energy to replenish fat tissue, but also even more energy is required to reverse pervasive physiological damage.

When you dependably eat the minimum calories every day (often much more than that when you feel like it), you won’t get stuck in a quasi-recovered state that usually leads to relapse or a shift from frank anorexia to restrict/reactive eating cycles, bulimia or anorexia athletica.

You can adjust up to the minimum guidelines at any point in your recovery.

If you are already BMI 21-24 and yet your period has not returned, then up the calories. You will not keep gaining and gaining. You need more energy in to normalize the neuroendocrine system and metabolic rate.

Once you hit your body’s optimal weight set point, then the metabolism is normalized and that means that the extra energy you were taking in for weight gain and repair now goes to the usual day-to-day functions that were not happening at all from the moment you first restricted calories (whenever that was).

You gain on the minimum guideline calories+ and then you maintain on pretty close to that same amount. Shocking, but true.

TruthOut.org: Flickr.com

The Facts

I expect many of you have seen popular media stories about how we all eat a third more calories than we think we do and the story usually wraps up by suggesting that this is why we are all getting ‘obese’ (cue ominous sawing violins now).

We Lie About What We Eat

Yes, in fact health survey after health survey, adult women report eating on average just under 2000 calories a day and men around 2500 calories a day [Statistics Canada Canadian Community Healthy Survey 2004; NHANES 1999-2000; National Diet and Nutrition Survey UK 2009]

And yet, when we actually measure the intake in laboratory settings rather than relying on self-generated food journals or survey responses, then we eat about one quarter to one third more than the surveys would suggest we are eating.

The measurement of dietary intake by self-report has played a central role in nutritional science for decades... Recently, the doubly-labeled water method has been validated for the measurement of total energy expenditure in free-living subjects, and this method can serve as a reference for validating the accuracy of self-reported energy intake. Such comparisons have been made in nine recent studies, and considerable inaccuracy in self-reports of energy intake has been documented. Reported intakes tend to be lower than expenditure and thus are often underestimates of true habitual energy intake. Because the degree of underreporting increases with intake, it is speculated that individuals tend to report intakes that are closer to perceived norms than to actual intake.” (emphasis mine) [D.A. Schoeller, 2009].

Social desirability and social approval distort energy intake estimates from structured questionnaires, in a manner that appears to vary by educational status.” [JR Hebert et al., 2002]

Both 7 day or 14 day self-reports trials are all over the map in the actual under-reporting that occurs and many researchers will classify trial subjects as failed-dieters, obese, average-weighted etc. etc., which likely removes validity from the trial data as an inherent bias stands that obese individuals are more prone to underreport food intake—a bias that does not stand up in clinical trial scrutiny. And that bias fails to address other valid influences such as social desirability and approval as being strong motivators for the underreporting of food intake, as highlighted by JR Hebert and colleagues in 2002.

The underreporting for both men and women can range from 2% to 58%. However, in the one and only trial where two groups of women were identified as either non-restrictors or restrictors of food intake and all were weight-stable, the non-restricting group ate on average 2400 kcal/day and the restricting group eat just shy of 2000 kcal/day [RJ Tuschl et al., 1990]. Admittedly this is a small study, but I use it because it provides an unrestricting control group at least.

If we average the studies reviewed by JR Hebert and his colleagues, then people eat on average 25% more than they think they do (or report that they do). As most adult women say they eat just shy of 2000 kcal/day, then on average they actually eat 2500 kcal/day to maintain their health and weight.

But the fact that we eat much more than we say we do does not have any correlation to ‘obesity’. It only scientifically correlates to the fact that our actual intakes maintain a steady optimal weight set point.

Buyalex: Flickr.com

The Under 25’s

I want to address the fact that the studies that identify what teens and young adults actually require from a total energy expenditure point of view and what they actually consume is of particular concern and sex-based differences are present.

In self-reports that form the basis of calorie guidelines around the world, girls between the ages of 12-25 report they eat 2000 calories a day. Boys in that same age range, report they eat 2800 calories a day on average [see surveys mentioned above].

Given that the developmental process in that age range is distinct yet equivalent for both sexes, how is it that in self-reports females suggest they consume exactly what adult females say they consume, where as males at least suggest they consume 300 calories more a day than what their adult counterparts are saying they consume?

Even more worrisome is that there appears to be no doubly-labeled water trials that specifically identify what weight stable non-restricting adolescent and young adult females actually consume. Therefore, you will find recommendations that teenaged girls eat 2000 calories a day simply because self-reports and surveys suggest that is what they eat.

The appalling truth is that over half of teenage girls do not eat enough for health, energy and strength. They do not eat enough to feel or look their best. But it is the lower 25 percent of girls — the hungry one-fourth — who are at most risk. . . .” [FM Berg, 2003].

Due to this gap in data, we have to extrapolate using comparative data from developing and adult males to conclude that actual calorie intake discrepancies between self-reports/surveys and actual intake suggest that females under the age of 25 actually require somewhere between 2800 to 3100 calories per day to maintain health and weight.

That suggests that females under the age of 25 (who are non-restrictors) feel compelled to under report their actual intake by closer to 30% and that likely a very large proportion of females under the age of 25 are indeed restrictors and are consuming some 30% less than what would be required to maintain their health and development.

What Do We Actually Eat

As you can see, it’s tough to figure out these days who’s doing the eating and whether they represent unrestrained or average eaters or not.

Here are the facts that we can glean so far:

Adult women (age 25+) do not eat only 2000 calories a day. Adult men (age 25+) do not eat only 2500 calories a day.

All the guidelines for calorie intakes you see in the world are based on self-reports and national surveys.

The surveys have all been shown to be inaccurate when doubly-labeled water methods are applied in laboratory settings. In fact, surveys and self-reports appear to underestimate actual intake by between 25 to 30%.

However, it is important to keep in mind that one population sub-group never answer these surveys by underestimating their actual food intake:

"People with eating disorders often know the caloric value of foods, read food labels obsessively, and keep records of food intake, often overestimating their daily calories." [Columbia University, 2010].

Jessica.Tam: Flickr.com

Guess What This Means for Recovery Guidelines?

For those in recovery, you are being asked to eat what actual non-restricting individuals eat in the real world, not what they say they eat.

You enter recovery by making sure you do not restrict intake, and it stays that way for the rest of your life. While you will experience a period of extreme hunger (Extreme Hunger: What Is It?) well beyond the minimum guidelines above, that is specifically because you have weight to restore and damage to repair. Your extreme hunger will not persist beyond your recovery effort. But not restricting intake is something you will do for the rest of your life.

Visit the Tools for Recovery Shop Tools for Recovery are available in the gwynetholwyn.com Shop

Reader Comments (56)

Hi! I have a question...not sure if this is the right place to ask it though? I'm 21 years old, female, and have been maintaining my weight on 2,100 calories/day (I'm in recovery from anorexia nervosa). Since I still get my period, do I not need to up my calories to 2,500+ then?

April 25, 2012 | Registered Commenterlittlesusiehomemaker

Actually the best place to ask this question is: Is this me?

So, the answer is you do need to up your calories to 2500 (if you are over age 25) and 3000 (if you are under age 25).

Your period is only one marker of whether you may or may not be at your body's optimal weight. There are women who can continue to menstruate at too-low weights (however, the cycle is usually anovular -- meaning that the uterine lining still sheds each month but there is no egg released in the cycle and that means osteoporosis still progresses if you are underweight for what your body needs).

You'll get more input on the forum on this topic and you can ask follow-up questions (as per link above). Best wishes, Gwyneth.

April 25, 2012 | Registered CommenterGwyneth

Does this mean I won't get my period back if I'm not eating 2,500? I've been working my way up to 2,000 for the past month.

April 27, 2012 | Registered Commentermiranda013

Probably yes. 2000 calories is an energy deficit for almost all women.

April 27, 2012 | Registered CommenterGwyneth

I was in the throes of Anorexia around 2 years ago and I have been in recovery ever since. I still do not have my period and it has been around 3 years now. I recently got my hormone levels tested and they all appeared to be normal and I have a fairly high body fat percentage according to some measurements (150 lbs, 5'6"). I still work out 7 times a week, but I have maintained by weight at this level for some time with this level of activity and I haven't lost any weight or regained my period. I probably eat around 1700 calories a day and I do not eat consistently every 2-3 hours. Do you have any suggestions as to what my body is doing? Thanks for the help!

May 14, 2012 | Registered Commenterlweber

Thank you for posting this information. I am at a BMI of 21 but am still not getting my period. If I eat the 2,500 calories and resume my menstrual cycles, where do you go from there? I want to get to a point where I am eating enough for my weight/body but I'm not sure how to transition? How long do you continue to eat the 2,500 calories? And how do you transition back?

May 18, 2012 | Registered Commenterml2330

What if 22 years old girl who is petite size like 5 feet?? how many calories she need to eat in order to get her period back??

September 22, 2012 | Registered Commenterappleveggie

Iam new here. My lowest BMI was 17.5 and it was november 2012. I started eating and last 2 weeks i was 44kgs from 42kgs. The last 2 weeks i ate a lot. like 3000calories per day. Then, I gained a lot till now i reached 49kgs for 2 weeks. Is that to fast for recovery? and now my BMI is 20.1. I still havent got my period. How much calories do i need actually?

January 23, 2013 | Registered Commenterledyan

As the forums are on hiatus on this site at present, many of you who are new here will likely find it helpful to visit the following forums to seek out specific answers.

uzilu.com
edsafehaven.com
webiteback.com

And additional useful sites include:

fyoured.tumblr.com
scienceofeds.com
ed-bites.blogspot.ca

However for those who have recently posted regarding their specific heights and experiences, please refer to the post above as it includes height ranges as well.

If you approach recovery for only looking to get your period back, then unfortunately relapse is much more likely. Please check out Phases of Recovery from a Restrictive Eating Disorder to learn more about the elements you need to include in a recovery effort in order to reach a robust remission.

As mentioned the intake guidelines are actually for energy-balanced non-ED folk and that means you continue to eat in an unrestricted fashion both during and post recovery. There is no "transition back" to anything. Your body will stop gaining weight when it is at its own optimal weight set point.

Your period will return when you reach your optimal weight set point. For some the period returns earlier than reaching your optimal weight set point and that's why your menstrual cycle is not the definitive marker that you are "done" with recovery. You are "done" with recovery when your weight stabilizes eating to the recovery guidelines for your age/sex and height.

Hope this helps, G.

January 23, 2013 | Registered CommenterGwyneth

Okay, So i'm 5'2' and weigh currently 117 pounds and still haven't had my period and im 18 so i'm suppose to eat 2000 or is that too much? Im so so confused. I am cold 24/7 and im shedding ALOT and lately ive been dizzy........ I've been eating around 1300-800,,,,

February 9, 2013 | Registered Commenterthisissomethingihate

Quoting from the above blog post:

Here are the guidelines for when 3000 calories applies as a minimum daily intake for recovery:
You are an under 25 year old female between 5’0” and 5’8” (152.4 to 173 cm) or an over 25 year old male between 5’4” and 6’0” (162.5 and 183 cm) and,

The regular menstrual cycle has stopped and/or,

You have other symptoms of starvation: feeling the cold, fatigued, foggy headed, hair loss, brittle nails, dull skin and/or,

Even if you were only underweight/dieted for a very short space of time (a few months), these guidelines apply.

3000 calories a day is what normal, non-ED women of your age/height eat. It's a minimum amount for recovery and you need to recover. You should see your doctor before attempting recovery especially as you are experiencing dizziness. Best wishes, G.

February 9, 2013 | Registered CommenterGwyneth

Dear Gwyneth,

Thank you for a very interesting post! I can basically subscribe to the telltale dozen and I would like to hear your advice how many kcal I need and how to split that between protein/fat/carbs. I'm especially thinking about if it's OK for me to eat more than 2g protein/kg in this recovery phase? I'm 26y male, 178cm weighing 50-52kg currently. I bike 40-45min each day (commuting), weight train three times per week and have some stairs to climb at work too. Do I actually need more 3500kcal in the recovery phase?

Your help is very much appreciated! Thank you.


Best regards,

Hemming

February 28, 2013 | Registered Commenterhemming

Hemming - You are BMI 16.4 -- greatly below the marker for clinical onset of anorexia.

I am not sure what phase of recovery you are in but at your current weight you should be under medical supervision to up your calories incrementally (unless you are above 2000 calories per day at the moment and have also had no history of using diuretics, laxatives or purging at all) and you need to stop all exercise immediately because your heart will have been damaged from your restriction at this point. And you should see your physician now no matter what.

3500 calories is the bare minimum (sedentary) for someone your age. Yes you will need far, far more than that -- likely 10,000+ for a period of recovery when Extreme Hunger hits Extreme Hunger: What Is It? and Bingeing Is Not Bingeing

You may want to read my most recent post: Insidious Activity

Best wishes on your recovery effort, but please get some medical support immediately. G.

February 28, 2013 | Registered CommenterGwyneth

Dear Gwyneth,

Your advice is extremely appreciated as I'm trying to figure out how to get out of this situation. I'm currently trying to increase my calories and eat around 2600-3000. I have never used diuretics, laxatives but definitely had the purging thinking - well I still do. My weight is a result of too much exercise and personal stress. I had a blood sample done some weeks ago and all the markers which were tested this time were normal (previously my thrombocytes have been off the scale almost). I'm seeing a psychiatrist about my entire mental state.

I'm just wondering when eating that many calories how do I distribute those between protein/fat/carbs? As I wrote in my previous post, do you think it's safe to consume around 200g of protein each day, even in my situation? Or should I just eat whatever I want and stop worrying so much about the macronutrients?

Again, thank you so much for taking the time to reply!


Best regards,

Hemming

March 1, 2013 | Registered Commenterhemming

Quick question! About this section....

“The measurement of dietary intake by self-report has played a central role in nutritional science for decades... Recently, the doubly-labeled water method has been validated for the measurement of total energy expenditure in free-living subjects, and this method can serve as a reference for validating the accuracy of self-reported energy intake. Such comparisons have been made in nine recent studies, and considerable inaccuracy in self-reports of energy intake has been documented. Reported intakes tend to be lower than expenditure and thus are often underestimates of true habitual energy intake. Because the degree of underreporting increases with intake, it is speculated that individuals tend to report intakes that are closer to perceived norms than to actual intake.” (emphasis mine) [D.A. Schoeller, 2009].

Over the course of this trial, were the subjects found to remain weight-stable and not gain weight overall? And these were non-restrictors?

I suppose I'm just a bit dubious about what 'maintain their weight and health' means. I'm still finding it very difficult to believe that you can't just overgain extra weight if you don't conciously keep an eye on things....I mean, people must eat more than their body needs all the time right? does that not cause them to gain weight?

Ok, so that was a few questions.....sorry! Bad day :( x

March 8, 2013 | Registered Commentermaibelle

No. How much you eat is not correlated to weight gain.

Yes, the above trial involved non-restrictors and yes they remained weight stable. The most weight stable individuals in our populations are never-dieters [WJ Pasman et al., 1999]. In fact one of several markers that correlate with weight gain is restriction and not non-restriction [MR Yeomans, E Coughlan, 2009].

For non-restrictors, their intake will vary significantly from day-to-day but their energy balance remains unchanged. The body has a myriad hormonal clamps designed to allow the body to run with an excess of energy and very rarely will that energy find its way to the adipose organ.

The circumstances under which energy travels to the adipose organ are more associated with socioeconomic status, unrelenting stress, exposure to endocrine disruptors, genetic predispositions and likely protracted bouts of yo-yo dieting as well. Food intake is not linked to obesity onset or obesity prevalence (see my various recent posts for the references).

Just because you can apply your conscious mind to control your breath, you likely wouldn't do very well if you decided that that is the best way to keep yourself breathing. We assume, very wrongly, that just because we can forego food that that behaviour is somehow healthier than if we simply allow all the very robust, distributed and much older parts of our brain and body (evolutionarily speaking) handle the job of keeping us energy balanced. All we have to do is keep our conscious minds out of the way of what our body's can do without our interference -- namely keep us at our optimal weight and healthy.

G.

March 11, 2013 | Registered CommenterGwyneth

I only just joined this site - I am avidly reading all the blogs and finding much of it resonates with me - a woman in her 50s with decades of bulimia behind me.....

My question..... how do I handle the fear??? I see what you are saying, there is even a degree of "relief as well as belief". BUT I am terrified. I currently weigh about 145lbs at 5'5" up from my "ideal" of 135. I have weighed 260+. How do I embark on what I instinctively feel I do need to do when the terror is already coming over me in waves?? How do I "believe" I won't become what I have been before?

March 25, 2013 | Registered Commenterdeniwint2

deniwint2 -- you might want to checkout:

Rebounding to Calm Part I and Part II.

I also tend to recommend cognitive behavioural therapy (CBT) with a counsellor or therapist, or dialectical behavioural therapy (DBT) if you'd prefer.

Restrictive eating disorders are, at heart, really an anxiety disorder of sorts. Food has been misidentified as a threat, for lack of a better way of describing the condition. When you eat, you experience a threat response that is what we all call anxiety. It's a physiological response and you can feel very uncomfortable as a result.

A very foundational part of recovery is re-training that threat response and CBT is a helpful tool.

You'll also find I have some additional tools in the Recovery Journal if you want to purchase it.

I also suggest self-compassion.org as a very useful site to investigate further for your recovery effort as well.

Hope this helps, G.

March 26, 2013 | Registered CommenterGwyneth

Hello, finding it quite comforting reading your article and feeling slightly less anxious than previously, but just wondered if it applies to me:

Extreme dieted for a year and a bit, height 5'0, age 16, lowest weight 65lb, current weight 103lb, started recovery mid-December 2012. Still no sign of menstrual cycle return yet, still gaining weight and feeling panicky that these two things will continue in this way. Currently consuming 1600-1800 a day, so is this enough/too much?

And as the menstrual cycle has not returned yet, is it true that I am not yet at my optimum weight point? I feel that I gained weight too quickly during recovery and this is the reason for lack of menstruation. Or is this silly to think?

Would be so grateful for a reply as I feel a little anxious still about these things. Also still suffer badly from bloating, and should this not have disappeared by my point and weight? As I am technically at a 'healthy weight' now, according to bmi and weight for height calculations etc.

Ok, sorry for so many questions, I am just a little anxious. Struggling a little today and this week in general for various reasons in recovery :( Would love a reply to even one, if any, of them, thank you so much

S

March 27, 2013 | Registered Commentersbhummingbird

You are not eating nearly enough to recovery and get to a full remission.

A non-ED woman of your age eats 3000 calories a day. That's why it is a minimum intake in recovery -- you should find yourself eating way more than that during recovery -- and that's not weight-determined either. Extreme hunger is part of the process.

You are suppressing your metabolic rate at 1600-1800 calories a day and that will inhibit your body's ability to bring back all the biological functions (like your reproductive cycle). All your body has been able to do is just put a bit of weight back on to try to insulate your vital organs enough that you won't die of hypothermia. You have a long way to go yet.

No such thing as "healthy weight". You are only "healthy" at your body's optimal weight set point and no one gets to decide what that is, including you. You eat in an unrestricted way and your body will stop gaining weight when it is at its optimal point.

I encourage you to involve your parents and have them read through all the blog posts here on this site -- they can be a great source of support for you so you can reach a full and permanent remission.

Best wishes on your continued recovery effort. G.

March 27, 2013 | Registered CommenterGwyneth

Hi Gwen, I stumbled upon your blog today and have loved reading them! I am 173cm, 24 year old female and 58kg. I am recovering from calorie restriction from the past 4 years. I haven't got my period back (stopped getting it 3 years ago) & am slowly increasing my weight by not restricting my eating. I do get stressed about putting weight on and everything you have written about the fear involved in eating unhealthily or eating "bad foods" resonates with me. I am trying not to count my calories however From reading your blog i don't think I am eating the required 2500-3000 calories a day. I think im eating between 1800-2000 per day. I am just wondering if most of those calories should be cereals/proteins/veg/fruit/healthy fats plus a moderate amount of "sometimes foods". I guess like you have written there is a lot of media which highlights the high percentage of people who are obese and I always fear that I'm going to get "fat" or eventually obese.....if your body determines its optimal weight and maintains it then how do people actually get obese?
Sorry for all the questions! Thank you SO MUCH!!!

April 22, 2013 | Registered Commenterrachviss88

I forgot to say I also exercise 4 times a week and am really scared to stop exercise all together....

April 22, 2013 | Registered Commenterrachviss88

Sorry also forgot to say have only been eating unrestricted for 1 month so far

April 22, 2013 | Registered Commenterrachviss88

Rach,

In case Gwyn doesn't get to answering your post for a bit I can pretty much predict the answers because either I have asked those questions or seen someone else ask them or they are somewhere on this blog (particularly in the Phases of Recovery post).
1) Calories are calories and you really don't need to worry about eating "healthy." Much more important to satisfy your hunger with whatever you are craving, and in fact ultraprocessed ("junk") foods might be better because they're easier for the body to get energy from.
2) As long as you are not eating at least to the minimum, your body will not go into the full recovery process--it'll get stuck at phase 1 (above), just storing away extra energy for the next time you starve yourself.
3) You gotta stop exercising. (I've just finally eased myself into this one...) Even if you were eating what would support the calories burned for a non-ED person--which you definitely are NOT at 1800-2000--it would stall the recovery process, because it seems, as if Gwyn says in Phases, that the body 'thinks' something like, well, if she's going to take me out running every morning [or 4 times a week], no point in allocating those calories for repair--better just store 'em up.

Join us at uzilu.com, rach!

Hope it wasn't inappropriate for me to try to answer these. Obviously if I've got anything wrong please delete this or correct.

I do have a follow up question, Gwyn, which is--"is more always better?" That is, should I be actively trying to eat as much as I can each day, even if I'm not hungry and have already met my minimum? Is there a limit to what the body can use at one time, which it signals through hunger (assuming one has hunger cues, which I seem to)? Do I need to actually try to stuff myself or will recovery proceed apace if I just meet the min. + respond to hunger/cravings?

April 22, 2013 | Registered Commenterlinds

Thanks so much Linds! I am really freaking about upping my calories that much AND stopping exercise.....Have you done this and found that you are in the recovery phase?
Are there success stories from Gwen's blog?
Thanks for inviting me to join Uzilu, I will definitely come and check it out :)

April 22, 2013 | Registered Commenterrachviss88
Comments for this entry have been disabled. Additional comments may not be added to this entry at this time.