Extreme hunger is a common experience for almost everyone undergoing recovery from any kind of restrictive eating disorder.
Next to the presence of edema (water retention), extreme hunger is one of the most anxiety-provoking elements of recovery.
It can happen at any time in the recovery process and varies for everyone as to how long it lasts. Many of you will have already seen this information, but it is worth repeating:
1) Starts day one.
2) Starts a few days or weeks in.
3) Does not happen.
4) Lasts from months two through six uninterrupted.
5) Shows up and disappears intermittently throughout.
6) Shows up near the end of weight restoration.
7) Blasts away like a fire hose from start to finish.
And if I have missed any variation in the above 7 items I can assure you that it is still perfectly normal.
During this time you will want (and very much need) far more than 2500-3500 calories a day and may find yourself consuming anywhere from 6,000-10,000 calories in a single day. That causes panic for pretty much everyone on the restrictive eating disorder and they lock down on the incorrect thoughts that they will “just keep going” and are “bingeing”.
The enemy is restriction. When extreme hunger hits then you commit to never eating less than the recommended guidelines* on any given day no matter what you ate the day before. It is restriction that will pull you to relapse, not the extreme hunger itself.
*Minimum Recommended Intake Guidelines for Recovery:
a) Females under the age of 25: 3000 calories and sedentary.
b) Females 5’0”-5’8” over the age of 25: 2500 calories and sedentary.
c) Males under the age of 25: 3500 calories and sedentary.
d) Males over the age of 25: 3000 calories and sedentary.
e) Females over 5’8” over age 25: 2700 calories; under age 25: 3200 calories.
f) Females over age 25 and under 5’0” as well as post-menopausal women can lower the minimum intake to 2300, but more is always better.
A few patients (very, very few) do not experience extreme hunger and just go through the process steadily at the minimum required intake plus a few hundred extra calories here and there as desired. The vast majority hit extreme hunger.
It is a unique experience because often the digestive system struggles to keep up with demand. Many describe it as "I'm not hungry, but I'm hungry", or (because the emotions are so difficult to put into words) they will define it as though they are just eating out of boredom.
Usually for non-ED humans the complex signals that arrive from both the digestive system and all other areas of the body are in agreement. The physical fullness of the digestive system coincides with the much more arcane and complex satiation experienced throughout the body's cells.
The signals that the brain receives as to whether the digestive tract is physically capable of handling more food or not is best described as the sensation of "fullness".
The signals the brain receives as to whether there is sufficient energy present throughout the body is the experience of satiation and it involves an emotional response as well that reinforces the neural pattern demanding action.
For those in recovery, often the digestive system is somewhat atrophied in several ways: the stomach may be practicing gastroparesis (drastic slowing of the emptying of the contents into the small intestine to try to extract maximum energy from the too-little food coming in); the enzyme-producing organs are running at half-speed (again to conserve energy); and the bacterial colonies in the large intestine (the good ones) have been decimated due to insufficient energy as well.
As you begin eating to the recommended minimal guidelines, the digestive system has quite a bit of catch-up. And if that coincides with the cells throughout the body demanding a massive infusion of energy to repair damage, then you end up experiencing fullness and hunger at the same time, which is disturbing of course.
The digestive system is frantically sending messages to the brain "I'm going as fast as I can here" and the cells throughout the body are screaming at the brain "More energy now!
Respond to the hunger always; never allow any restriction to creep in. To deal with a digestive system still getting up to speed, eat very calorie-dense foods (lots of ultra-processed, fast food options are great for this phase), snack on nuts and seeds constantly and eat tons of small meals to help the digestive system cope as it gets back to normal.
To summarize, you may find extreme hunger triggers relapse and you need to be prepared and remind yourself of the following facts when it happens:
1) You do not keep eating 6,000-10,000 calories a day indefinitely. There is no concept of "getting used to" the amounts, or being unable to stop.
2) Your body really, really needs that amount of energy.
Sewing Your Body Back Together
A daily dose of wear and tear is naturally repaired each day in the human body.
Now imagine a fully stitched hem on a skirt, but there are always five stitches of the hem that come undone by the end of the day and have to be sewn up that night.
After only a few months' worth of restrictive eating behaviors of any kind and the hem is now frayed throughout. There are stitches missing everywhere, long loose threads that can catch really easily and unravel even more of the hem, and so on.
Now, the owner of this skirt finally decides she's going to get out the thread and fix the whole mess. But she still wears the skirt everyday and those five stitches still have to be dealt with at the end of the day.
If she only pulls out enough thread to support fixing the usual five stitches, well that hem will never get fully repaired and will continue to deteriorate -- think of that as analogous to providing 2200 calories per day to your body to 'recover' from an eating disorder.
If she pulls out more thread, she's able to attend to some of the other stitches and that's an analogy for eating the recommended guidelines every day to recover from an eating disorder.
If she pulls out even more thread to attend to some of the areas where loose threads may unravel the whole hem, then that's extreme hunger.
Because the woman sewing is essentially the body and we cannot see the hem it needs to fix, we just go with the demand for more thread when it comes up.
Nature Abhors a Vacuum—Aristotle
Extreme hunger happens because your body is not just addressing the need to restore weight to the optimal set point, it also has to repair a lot of physical damage that occurs when you create energy deficits within the ecosystem that is your body.
When you restrict energy intake and/or create energy deficits with exercise and exertion, then the body does two things in response to that vacuum you are creating: 1) stops whatever biological functions it can to save energy and 2) takes energy from fat tissue, bones, muscles, organs and nerves to fill the void.
I'll now provide yet another analogy to try to reinforce why extreme hunger makes sense in a recovery context and why you are better off responding to the hunger rather than ignoring it:
During restriction, you essentially damage the power plant and steal raw materials as well. If you just replenish the raw materials, then that’s not good enough because you also need to bring in additional materials and crews to repair the damage to the power plant otherwise the raw materials still can’t effectively be transformed into energy.
And in the middle of this entire restoration project, the power plant still has to be up and running to some extent. That is why extreme hunger hits.
Think of extreme hunger as hiring a crew of 25 guys to fix damaged equipment in the plant while the plant still provides the town with basic electricity needs.
Think of denying extreme hunger as insisting that one guy can work on the damaged equipment while the plant still provides the town with the same basic electricity needs.
That one guy bitterly complains each day that all he can manage to get done is fix the one faulty bolt on the equipment because while you continue to provide the town with electricity that bolt keeps breaking and he can’t get to all the other problems.
Obviously providing the town with electricity is non-negotiable. We cannot take the town off-line anymore than we could take you “off-line”.
I think I’ve come up with as many different analogies as I can at this point to try to relay the reason why extreme hunger occurs in the recovery process for almost everyone, and why it is critical to respond to those demands for energy to achieve a robust and complete remission.