Calorie Intake for Recovery -
Here are a few tips to speed your recovery and make things a little easier to handle. Now is NOT the time for weight loss! When people are immobilized, they worry about gaining weight. However, you should NOT decrease your calorie intake because you will be inactive.
In fact, your calorie needs are now greater than usual because your body requires energy from nutritious foods to fuel the healing process. You will need to consume about calories per pound using your current body weight.
If your overall energy and protein needs are not met, body tissues such as muscles and ligaments will begin to break down. This will compromise healing and may prolong your recovery period. Normally, it is important to drink at least 8 cups of water or non-caffeinated, non-alcoholic beverages every day.
If you do not drink this much fluid each day, now is the time to get into the habit. Drinking enough fluid is essential for maintaining adequate hydration and allowing your body to heal. You may need more fluid depending on the type of medication you are taking or the extent of your injury.
Have a water bottle handy and plan for plenty of refreshing beverages throughout the day to keep your body in fluid balance. Eat well-balanced meals and a wide variety of foods to obtain all the nutrients your body needs for tissue repair.
Your body requires more protein and calcium during this time, so take careful note of the daily recommendations and food sources listed below. Cut back on junk food. You want most calories to be packed with nutrition value.
If you're having surgery, plan ahead. Nutrition for Healing After Surgery. However, it is imperative to allow enough caloric intake for the body to fully recover. Weight goals should always be calculated by your medical team.
The return of menses in females is critical. Again a medical team is advised to calculate your specific individual calorie needs as they shift during the recovery process.
If you are consuming more than 1, calories per day as your starting point, are not a risk for refeeding syndrome as discussed above, and have been medically cleared to do so, then you may consider beginning nutritional rehabilitation.
Please consult with a medical doctor and registered dietitian to tailor recommendations specifically for your body. For example, an illustrative nutritional rehabilitation recommendation for a pound patient not at risk for refeeding syndrome could be as follows.
Remember caloric needs commonly increase as weight is gained. Therefore patients recovering from anorexia nervosa commonly require escalating caloric intake in order to maintain a steady weight gain. For this reason, weekly weigh-ins that record progress is desirable.
If and when the rate of weight gain slows or stops, caloric intake must be increased. Since a calorie-focused meal plan could be triggering for those recovering from anorexia, it is not necessarily the first choice for registered dietitians to recommend.
However, it could be helpful to have an idea of what calorie count to target, especially when reading food labels and menus. A good initial rule of thumb for a basic meal plan is three to calorie meals plus at least three calorie snacks, but only after initial caloric estimates are calculated and monitored and the refeeding syndrome has been ruled out.
Again, calorie levels are always a moving target, depending on the rate of weight gain. The preferred meal plan model for anorexia nervosa recovery is the exchange system. It is often used in hospital, residential, and outpatient eating disorder recovery treatment.
Originally designed for patients with diabetes, the system is versatile in recovery because it takes into consideration macronutrient proportions protein, carbohydrate, fat without a direct focus on calories.
This allows for a focus on balanced food group selection during the meal planning process. However, having a balanced diet may not be as important as increased caloric intake during the weight restoration process.
A Registered Dietitian Nutritionist can help calculate and design exchange meal plans taking this all into consideration. An illustrative 3,calorie Exchange System Meal Plan for a day might comprise 12 starch, 4 fruit, 4 milk, 5 vegetables, 9 meat, and 7 fat.
A daily regimen might divide the exchanges into meals and snacks as follows:. In order to increase caloric intake to achieve a steady weight gain course, you can always remember some simple tactics:. Refeeding syndrome is caused by the rapid refeeding of someone in a state of starvation, usually chronic, and it may be fatal.
It is characterized by electrolyte and fluid shifts associated with metabolic abnormalities in malnourished patients undergoing nutritional rehabilitation. How could finally eating after a period of starvation possibly be harmful to the body? Biochemistry tells us that ketone bodies and free fatty acids from the breakdown catabolism of muscle and adipose tissue replace glucose as a major energy source in starvation.
During refeeding, there is a shift from fat to carbohydrate metabolism. The resulting insulin released from the pancreas increases cellular uptake of glucose, phosphate, potassium, magnesium, sodium, and water.
The body also shifts into a building anabolic state of protein synthesis, which requires more nutrient uptake into the cells. The body then is at risk for not having enough of these vital nutrients in the bloodstream. Clinical consequences may include irregular heart rate, congestive heart failure, respiratory failure, coma, seizures, skeletal-muscle weakness, loss of control of body movements, and neurological symptoms.
To avoid refeeding syndrome, levels of phosphorus, magnesium, potassium, calcium, and thiamin must be monitored for the first 5 days and every other day for several weeks. Electrocardiogram EKG should also be performed.
Strict medical oversight is required. The National Institute for Health and Clinical Excellence Criteria for Patients advises that there is a significant risk for refeeding syndrome if your starting point is 1, or fewer calories per day.
Refeeding syndrome risk increases greatly with patients who have one of the following indicators:. Patients with two or more of the following indicators are also at higher risk of refeeding syndrome:.
Despite being a flawed measure, BMI is widely used today in the medical community because it is an inexpensive and quick method for analyzing potential health status and outcomes.
Since a primary symptom of the disorder is a dietary restriction, what patient with anorexia will willingly eat more? Resistance is common and calls for direct support from loved ones and a team of professionals who can help hold patients accountable to meal plans and weight gain as well as challenge the eating disorder mindset and encourage consumption of fear foods on a daily basis.
Vegetarian, low fat, low carb, and non-dairy diets should be discouraged unless a diagnosed allergy as they often are a symptom of the disorder and not based on legitimate health concerns. Delayed gastric emptying or gastroparesis is common with anorexia nervosa and can contribute to early fullness and bloating.
This further complicates the renourishing process as eating the required increased intake may be physically uncomfortable. Frequent nutrient-dense meals and snacks that allow for smaller portions without sacrificing calorie content is the key to overcoming this hurdle.
Eating disorder recovery teams can help support renourishing's physical side effects as well as the psychological resistance to such aspects of recovery. Teams usually include a medical doctor, registered dietitian nutritionist, psychotherapist, and psychiatrist.
When searching and building outpatient teams, it is advisable to make sure practitioners have expertise in the treatment of eating disorders. Allowing a loved one to help with accountability and provide recovery support can be extremely powerful in recovery.
Family-Based Treatment FBT or Maudsley is an evidence-based model designating parents as the primary support for refeeding of children and adolescents with anorexia nervosa. Other models of treatment that provide family support for adults with anorexia nervosa have been developed as well. Recovery is not a linear process and may be slow.
Remember that life stresses and major life changes can possibly activate relapse. Support and re-evaluation of progress and goals are constantly needed. Making peace with food and having restored psychological, emotional, and physical health, and well-being are indeed possible.
Garber AK, Mauldin K, Michihata N, Buckelew SM, Shafer MA, Moscicki AB. Higher calorie diets increase rate of weight gain and shorten hospital stay in hospitalized adolescents with anorexia nervosa.
J Adolesc Health. Rienecke RD. Family-based treatment of eating disorders in adolescents: current insights. Adolesc Health Med Ther.
American Psychiatric Association. Treatment of patients with eating disorders, 3rd edition. American Journal of Psychiatry.
Ozier AD, Henry BW. Position of the American Dietetic Association: nutrition intervention in the treatment of eating disorders. J Am Diet Assoc. National Collaborating Centre for Mental Health.
Eating Disorders: Core Interventions in the Treatment and Management of Anorexia Nervosa, Bulimia Nervosa and Related Eating Disorders.
NICE Clinical Guidelines No. Marzola, E. et al. Nutritional rehabilitation in anorexia nervosa: review of the literature and implications for treatment. BMC Psychiatry 13, doi Mehanna HM, Moledina J, Travis J. Refeeding syndrome: what it is, and how to prevent and treat it.
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