Extreme Hunger II: Profoundly Disturbing

This post is a companion post to Extreme Hunger I: What Is It?

Here you will find answers as to whether you are really hungry during your recovery process or whether it is as you suspect—you are eating because you are bored, experiencing emotional eating, or just plain bingeing for no good reason.

The challenges of hunger, satiation and fullness are a mess throughout the recovery process and this causes a lot of anxiety and grief.

As with the ever-present fear that the metabolism “is broken” many in recovery experience the disconnections between hunger, physical fullness and emotional satiation that are disturbing and worrisome.

Neither the metabolism nor the appetite connections are broken due to restrictive eating disorders. However, they have developed temporary adaptations that are survival-based.

The Belly Dance

Although I speak about this in Extreme Hunger I: What Is It?  it is definitely worth revisiting this point again. By way of sidelining the topic for a moment, that post generated a particularly irate anonymous e-mail that read as follows:

you describe the pathways of the signals that reach the brain and the GI system, and state that the cells in the body require a high amount of calories to "repair damage" done during restriction. I wonder what specific scientific research has been done to prove this mechanism (that the digestive system plays "catch up") and on what scientific evidence you base your statements such as " the cells throughout the body are screaming at the brain "More energy now! " ?”

And, in fairness, it was one post where I neglected to indicate much of the data upon which the post was generated and that is, of course, the Minnesota Starvation Experiment [A. Keys, et. al., 1944].  The biological mechanisms involved in how the cells in our body communicate the need for additional energy are a bit eye-glazingly complex, but I will try to convey a surface version.

In simplified terms, several hormones including leptin and adiponectin can activate AMPK (adenosine monophosphate-activated protein kinase) and that in turn regulates metabolic choices between anabolism (resulting in the building up of tissue) and catabolism (resulting in the breaking down of tissue) [D H Hardie et al., 2003].

These same hormones also act on the brain as well and specifically interact with the hypothalamus, which is responsible for identifying whether energy balance is present or absent throughout the entire body [JS Flier, 2006]. Leptin and adiponectin, as well as resistin and several others, are all generated by fat cells in our body.

In our current understanding of the cycle of these adipocytokines (as these fat-generated hormones are called as a group), their serum levels are affected by restriction of energy intake (even before catabolism occurs); they ‘inform’ the hypothalamus of an energy deficit; and theyactivate AMPK to begin the process of catabolism of existing body tissue (made up of cells obviously) to release energy to support ongoing biological functions.

Fascinatingly, one of the reasons that anorexics often do not appear deficient in many minerals and vitamins may not be due to their heavy use of vitamin and mineral supplements, but rather the release of these minerals and vitamins through catabolism of their own body tissue [R C Casper et al., 1980].

So from a scientific standpoint, clearly “cells do not scream”, as I have poetically stated in the Extreme Hungerpost. However, catabolism (the destruction of cells and tissue) releases the energy necessary to try to remediate the drop in serum adipocytokine levels while at the same time those levels are signaling to the hypothalamus that energy intake is a necessity to reverse the process of catabolism.

When you see the word “catabolism” think: cannibalization of your own being. In that context, I am comfortable taking poetic license by describing that experience as one in which your cells may indeed scream if they could.

It is rather obvious to point out that in the aftermath of restriction, the catabolism (breakdown of tissue) has to be reversed with anabolism (the buildup of tissue).

Nonetheless, it gets bit more complicated as the gastrointestinal tract has its own nervous system, the enteric nervous system, and there are specific peptide hormones released by the gastrointestinal tract in response to the presence of food as well: peptide YY, pancreatic polypeptide, glucagon-like peptide-1 and oxyntomodulin. And these peptides are all presumed to act as post-prandial (after a meal) satiety (fullness) signals [O B Chaudri et al., 2008].

And therein lies the brain fart that is hunger/fullness/satiation sensations in recovery from restrictive eating disorders.

Your Gut and Your Mind

When a person is energy balanced, then hunger, fullness and satiation are all synchronized. But after just a few weeks (let alone months or years) of catabolizing your own body, now things are asynchronous when you begin to reverse the damage.

In the earlier phases of recovery, you experience physical fullness, as identified by your enteric nervous system, and extreme absence of satiation, as experienced by your central nervous system.

And you get complete brain shear as a result:

The concept to me is so confusing, because I can feel not hungry, satiated, or even nauseous with food, but there isn't necessarily fullness in my stomach.” [anonymous789, Forum Post, 2012]

“Sometimes I would not be full and ask for seconds and it would take ten minutes to reheat. By the time I sat down with that second plate I would think, "actually I'm really full now and I don't really want this" but I went to the trouble of getting more so I just ate it anyway.” [chiquepea, Forum Post, 2012]

“I definitely feel some compulsion to "finish everything" now, because I fear being deprived and am still obsessed with food to varying degrees. I am also very, very aware of my hunger. It's weird that I seriously cannot remember how I ate before I started restricting...” [anonymous789, Forum Post, 2012]

“I am not quite sure what you mean when you say that you don't feel the food in your stomach. I think I feel the food in my stomach, and I definitely feel 'full', but I still feel the urge to 'finish everything', too. SOmetimes I feel like I am just forcing the food down. I don't know whether it's a lack of fullness or satiation, but I can definitely relate to never feeling full.”[hesko, Forum Post, 2012]

“Even then if there was still food on my plate I would almost force myself to finish it because it 'tasted so good'. I am really not sure what this is or what it means......if I was not full to bursting I would still feel hungry/not satiated” [blackmagic, Forum Post, 2012]

“On a day-to-basis, I never feel 100% satisfied after eating either. Maybe 90% if I'm lucky, but there is always room for one more bite. So why not just take the one more bite every single time? Because I worry... :-/ Worry that I'm getting my calories within too short a time period in the day and that I should try to spread them out more; that I'm making up extra calories via "junk" food (I know, I know...)” [cuppa tea, Forum Post, 2012] 

For everyone here, the brain structures responsible for conscious thought are dealing with a completely novel experience and you can clearly see the profound struggle that it elicits in everyone. Biologically, they are all gut-full, brain-empty (a poetic way of describing the biology of course).

And look at the contradictions that result in the attempt to describe these sensations! One feels fullness in the stomach, but not satiation and yet the next person will describe the opposite sensations. 

Your enteric nervous system is receiving information that the physical aspects of energy absorption are at peak levels, yet the central nervous system continues to receive information that more anabolism (building up of tissue) is required to return to an energy-balanced state.

Try not to get too caught up in what descriptions your conscious mind comes up with as you move through these phases of recovery. Eating is your job. The anxieties about whether it is “normal”, “emotional”, “the stomach has adapted to more food” are just that: anxieties. And I’m sure no one would be keen on betting against the probability that these are eating-disorder-generated anxieties either!

If you feel the need to eat more, then it doesn’t matter what description gets placed on it after the fact, the drive to eat is fundamentally sound and all about energy restoration, or anabolism.

And when you reach your energy balanced state yet again, then all your hormones and neurotransmitters will be providing the same message at the same time so hunger, fullness and satiation will not be creating any more strange cross-talk in your mind.

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