Food to Add for Anorexia Nervosa Recovery
Maybe you have done therapy for years. Maybe you have been to treatment, perhaps even more than once. And yet, you continue to struggle with Anorexia Nervosa. The missing piece is likely adequate nutrition. We know that food quite literally becomes your medicine in recovery from an eating disorder. I know many, who are very self-aware, and have had tons of great therapy, but remain undernourished, and below their biologically appropriate weight. As a result, their minds continue very much to be hijacked by this terrible disease.
But how exactly is food medicine? Adequate calories lay the absolute, mandatory foundation for repair. Beyond that, we are also learning that specific nutrients may play a larger role. Zinc, a trace mineral for example, is involved in over 300 pathways in your body and when this falls low can quite literally cause a lack of appetite. As clinicians, and as clients, we should be informed on what specific foods might help speed up the recovery process.
I am currently obsessed with this presentation by Dr. Leanne Barron a physician based in Australia with specialized interest in eating disorders. For us Dietitians, this is a good Chemistry review, for non-science majors this might be a bit overwhelming. In this blog, I will attempt to summarize simply some of the fascinating points she makes.
Dr. Leanne Barron states that the bottom line of what ultimately triggers AN is a lack of nutrition. Psychological issues, medical issues or chemical issues could all have led to the lack of nutrition. Once there is not enough food, the body has to adapt, and we enter the spiral of the eating disorder. But she reminds us, Anorexia Nervosa is reversible with food. I am going to take a closer look at the nutrients of concern in Anorexia Nervosa (and likely in other restrictive disorders such as ARFID) and review the foods that provide them. Let’s go step by step…
The Thyroid
When you are restricting, the thyroid which influences metabolism, development, growth, and temperature has to try to cope with less. When there aren’t enough calories, the thyroid makes the mirror image of the hormone T3 or “reverse” T3 (the inactive form) which puts you into hibernation mode to protect you. Besides adequate calories, you will need Zinc, iodine and selenium to help this pathway turn back on.
Foods to add:
Celtic Sea Salt
Pumpkin seeds
Almonds
Seaweed
Seafood
Salmon
Blueberries
Oysters (highest source of Zinc)
The bones
The combination of low estrogen, high cortisol levels and semi-starvation put your bones at great risk, breaking them down and affecting full growth in children. This can lead to osteoporosis and possible fractures. Calcium, Vitamin K2, Vitamin D, and Phosphorous are all important for the bones.
Foods to add:
Full fat dairy (whole milk, full fat yogurt, brie, gouda cheese, butter)
If lactose is a problem try whole lactaid milk
Three servings of dairy per day at minimum as Phosphorous is particularly important during refeeding
If unable to do cow’s dairy---Silk Protein cashew almond or soy milk are options (Soy milk will also have B12 important for non-meat eaters)
Chia seeds
Almonds
Blood Sugar
It isn’t unusual to experience low blood sugar in restrictive eating disorders. Low Manganese can make all of this worse. The combination of hypoglycemia and low heart rate may very well be the combination that leads to the heart failing. The most commonly low mineral in AN per D. Barron is Manganese. Manganese is important to balance blood sugar. When you start eating better, blood glucose levels can actually get worse (in other words, even lower) because you do not have the glycogen storage to help the blood glucose rise back up after the release of insulin. This is particulary dangerous at night or when you are fasting. If you wake up sweating Dr. Barron says it could indicate a hypoglycemic emergency. The body has its own protection and will release adrenalin to wake you up. It is very important that you eat or drink something then rather than just going back to sleep. She also agrees with what many of us EDRDs already recommend, and that is consuming 3 meals and 3 snacks each day. If you wake up every night sweating, she recommends setting a clock to a time just prior to when this occurs and eating another meal that contains carbohydrates.
Foods to add:
Pineapple (particulary canned)
Oatmeal
Chia seeds
Leafy greens
Dark chocolate
Carbohydrates!
The Heart
As already mentioned, we suspect what kills most people with eating disorders is the combination of low blood sugar and a heart that is conserving energy due to restriction. In other words, bradycardia and hypoglycemia together can be a deadly combination. This is also why we discourage exercise until we know that the heart is no longer hibernating and the body is getting adequate fuel to withstand the additional stress of exercise. Vitamin B1 (thiamin) and Potassium are both important for the proper functioning of the heart.
Foods to add:
Wheat germ
Whole grains
Fruits
Coconut water
Dairy
Anemias
There are different types of anemias including iron-deficiency and vitamin deficiency anemias that can make it difficult to have energy and function. We need Vitamin B12, folate, and iron to make enough red blood cells. These can all be depleted when we are in a state of malnutrition. Anemias are even more likely if you are a restricting vegan or vegetarian as non-heme (non-animal-source iron) is more difficulty to absorb.
Foods to add:
Red meat
Leafy green vegetables
Chickpeas
Nutritional Yeast
Fortified soy milk for Vegans
Tofu for Vegetarians
Hormones
Cholesterol, something we often villainize, is actually mandatory and can be lacking in restrictive disorders. Cholesterol is important for the production of many hormones that are involved in growth and health such as Vitamin D, to make bile so we can digest food, as well as to keep the integrity of our cell walls. If there is a high serum cholesterol level in AN it may be due to cell walls being broken down from starvation. Instead of limiting fats, we have to add more cholesterol.
Foods to add:
Full fat dairy
Eggs
Red meat
Mental Health
Serotonin is a chemical that makes you feel good. Antidepressants recycle Serotonin, which is often why they do not initially work as well in Anorexia Nervosa. Serotonin production is affected by not eating enough food, particularly not consuming adequate carbohydrates. If you are low on serotonin, you often crave carbohydrates. That may be part of the drive for bingeing. Tryptophan is also needed for the production of this neurotransmitter.
Foods to add:
Peas
Carbohydrates particularly whole grains
Turkey
Warm milk
Finally, a word about the Gut
If you struggle with an eating disorder, you know well that bloating and stomach aches are a nauseating (pun intended) part of this reality. Gastrointestinal symptoms can often make it harder to eat. When you do not eat enough consistently, the stomach isn’t used to digesting. Also, the microbiome gets affected. The good bacteria are dying and the bad bacteria is left which gives you gas and bloating. If you also happen to purge through vomiting, this makes the situation worse, as every time you vomit you get rid of more of the good bacteria.
Digesting fats can also be tricky. We need bile to properly digest fats but the gallbladder that normally releases bile can become distended and swollen with eating disorders leading to difficulty emptying. Adding 2 T of stewed apple with meals can sometimes help, as can marinating meats in Apple Cider Vinegar.
Additionally, low food intake decreases the release of hydrochloric acid which is necessary for proper breakdown of food. This can in turn lead to ulcers and an overgrowth of bacteria such as h. pylori. Zinc and Vitamin B1 (thiamin) help the gut make hydrochloric acid.
Foods to add:
Stewed apples with higher fat meals (Peel and dice apples, place a small saucepan or skillet on low heat, and add water, cinnamon and maple syrup)
Bone broth
Fermented foods such as kefir, full fat yogurt, kimchi, sauerkraut, and miso
Apple cider vinegar for marinating or added to dressings
It is important to remember that Anorexia Nervosa can make you hypermetabolic once intake increases. That means, calorie needs can skyrocket to levels hard to keep up with on your own. Adding these foods in small amounts will not help you fully recover if it isn’t done in conjunction with adequate calories. This is why treatment is often necessary.