Expert: Joanne - 1/16/2009

Question
Hello Doctor,
I am 5"2', 19 years old almost 20, female. I have had problems with food throughout my teen years gained and lost, binged and purged, but in July 2007 I became anorexic. I dropped from around 135 pounds to just 60 by April 2008. I was eating only about 50 to 100 calories a day, every day or every other day. I was my lowest in April 2008 when I lost my ability to do pretty much anything. I couldn't walk and had edema and heart problems. I never went to the hospital, and I don't have a doctor or nutritionist. I worked up my calories gradually, adding 100 every week or two, until I got around 600. I would skip eating some days to keep my weight down to what I wanted, which was 85lb. I realized I shouldn't do that, I should eat healthy, eat every day, and just try to beat this thing.

The problem is I have gained since, and it is all in my stomach and sides. I am constantly bloated and in pain. In my head I blame it on over eating, I think I shouldn't eat every day, or not eat as much. I've been looking at sites and people say that when they were anorexic they were taking in 1,200 calories! Then why am I taking in 600 and gaining weight?

I'm terribly afraid that if I hike my calories up to 1,200-1,500 I will gain weight even more rapidly.

I am a vegan [I have been for a long time and it has nothing to do with the eating disorder.] I eat mostly fruit and veggies, but you have to eat so much to even get to 600 calories and by the time I get there, I physically can't eat anymore, even though I'm still hungry. [Well I'm not sure if I'm actually hungry, or if I just messed up my hunger trigger in my brain.]

I'm really scared that if I eat more, and higher calorie foods, I will continue to gain. I'm having a hard time dealing with this 10-15lb gain over the past few weeks, although I think it might only be water retention, bloat and gas from all the veggies. I literally have bloating so bad I look pregnant when I am done eating at the end of the night.

Is there anything I can do for the bloating? Also, will I have to gain more before my metabolism kicks in if I increase my calories? Why hasn't it kicked in to make up for the 600-700 calories I'm eating? And should I change my diet? I have always had slow metabolism.

Please help, I am in so much pain, physically and mentally, and I am so confused. Thank you. :)

Answer
Christann

Firstly, just so that there is no confusion, I am not a doctor, only a med student just now, and the advice I give is not so much anything that I have experienced professionally, but through my own battles with eating disorders.

You have to remember that you were existing on 50 calories a day, sometimes only 50 calories every 2 days, increasing your calorie intake was likely to cause some weight gain initially as your body has slowed down so much so as to get by on so little calories, so give it more, and it doesn't know what to do with them.  This weight gain could possibly be due to water retention after eating, but could be some weight gain, this weight gain is unlikely to be enough, as many anorexics in recovery may need to eat over 3000 calories a day in order to gain weight and regain their health!

When you gain weight, it is very common for you to gain it on your abdomen first.  This weight gain later should redistribute more evenly over your body, and well the bloating you are experiencing is unlikely to be helping that.

I think you need to look at ways in which you can improve your diet in order to try and incorporate more into it.  You may be vegan for moral reasons, and that is fine, but in order to be healthy and recover from your anorexia you are really going to need to get a dietician or nutritionist's advice to develop a meal plan in order to make sure that you are eating enough.  I'm struggling to think of ways to add calories to your diet that don't contain dairy, etc, so you really need to speak to someone who is much more experienced in vegan diets.

I think that you should look into changing your diet - possibly vegetarian would be easier (if that was what you were suggesting) and you really need to increase your diet still.  If you believe yourself to have a slow metabolism naturally, that is something you should have investigated by a doctor to make sure that there is nothing going on, but that really does require you to eat at least 1200 calories a day, but preferably more than 1500 calories a day for a while to make sure that your metabolism has recovered and can be looked at properly.

All I can really advise you to do is to visit your doctor and soon!  Eating disorders can be deadly, and with every day that passes, you are risking more and more health complications.  For as long as you keep stressing your body like this, the iller you are becoming, and things like your heart just keep getting weaker!  By having such a low weight, you are putting yourself at risk of complications such as cardiac arrest.  I don't want to scare you, but I think it is important that you consider exactly what is going on!  Just search the effects of anorexia in your search engine and you can see what you are possibly doing to yourself, and please do not be fooled and think that they won't happen to you, anorexia has the highest death rate of all mental illnesses!

You are only 19, think about everything that is still to come for you!  By allowing this illness to win, you are risking not having the career you want, not falling in love as it is hard to have relationships with another person when you have such a full-on relationship with anorexia, risking your fertility and therefore having kids, is continuing these disordered behaviours enough for you seeing as by continuing you are risking your entire future, love, happiness, and literally your life?!

I think you should consider talking to someone about what is going on, be it a doctor, counsellor, tutor, relative, anyone that you feel you can trust and open up to!  It is important to be honest, and I really hope that you can find the strength to do that!  Taking that first step in asking for help is usually the hardest part, but can be so rewarding.  If the person you confide in can't help properly themselves, I am pretty sure that they should be able to point you in the direction of someone that can!

Joanne