Expert: Leigh-Anne Persing, PA-C - 9/13/2008

Question
i am 5'2'' and alter between binge eating and anorexia.  right now i am 98 lbs.  
i knooow i need to gain.  i want to be anywhere from 102-105 lbs i think.  i
am still eating 900 cals a day and count my splenda and spray butter and
pam and coffee in my count... prob adds up to 30 of my cals a day.  i eat a lb
in a half to 2 lbs of fruit a day as my food bc its safe.  i stick to protein and
fruit and veggies.  i dont eat meat but i eat fish  i am scared.  i will binge if i
eat carbs like breads or cereals or fats like nuts or sauces.  i dont know what
to eat.  i dont know how many cals to raise a day to gain.  i do see a
nutritionist and she asked me to go to 1500 and im scared.

how many can i do?  i know i messed up my metabolism and im scared.  ive
been heavy and when i gain too much i use drugs.  i have 6 months clean and
dont want to relapse.

chocolate is a huuuge drug for me... i will binge baaaad on it and then not
eat for a week.  i have not binged since july 6th.  but i cant lose anymore and
i look gross.  i am weak and have chest pain.

Answer
If you are trying to increase your calorie intake on an outpatient basis I would suggest increasing by 100calories per day each week. So you are taking in about 900 a day now... so at the beginning of next week do 1000 calories per day. Obviously if you were an inpatient they would probably put you at your goal intake rather quickly. When I was in treatment we used the American Diabetic Associations food system. You had so many fruits, starches, proteins, fats and snacks per day that you were supposed to get and their guide gives you how much is considered a serving. For example... for breakfast you might have to have 2 starches, 2 proteins, a fat and a fruit. Which may essentially be 2 slices of toast with 2 eggs and either a piece of fruit or a 4oz glass of orange juice. Not too bad when you really think about it. Peanuts can be either a protein or a fat... and a serving size is only about 17 peanuts...

I always tried to get foods that I could get the biggest bang out of my buck... meaning... a protein bar may be a whole meal in and of itself. Snacks would be worked in between breakfast and lunch and another before bedtime... and are usually what we call "exposure foods"... foods that we normally avoid because they are unsafe or a trigger. But you have a preset amount you can have and THAT'S it!!! Your nutritionist should be working on a meal plan that best fits your needs... she should not just be handing you a prescribed daily calorie amount and be expecting you to make food choices to fit those expectations.

If a slow and steady increase works best for you and will keep you from relapsing in your drug habits, then that's the way you need to go. Obviously I would recommend that you continue seeing your nutritionist and therapist as well as your medical doctor to monitor possible complications associated with eating disorders (mainly electrolyte imbalances that can cause heart arrhythmias and other possibly fatal problems).

I hope this helps... please let me know if I didn't answer your question properly or if you have any other questions. Good luck! You can regain control!!!!