If you're a regular reader of this blog, you know that my family used the Maudsley approach to help our 14-year-old daughter recover from anorexia. (Here's a link to the whole story as published in the New York Times Magazine.)
In Maudsley, parents take charge of their child's eating while they're in recovery. So it was up to my husband and me to devise meal plans for our daughter. Like most anorexics, she needed a lot of calories each day to gain weight--upwards of 4,000 calories a day during one phase of recovery. Because the act of eating was so terrifying and difficult for her, and because, like most anorexics, she endured many stomachaches, our strategy was to get as many calories as possible into the smallest volume of food.
What this meant, practically, was that our daughter ate a lot of high-quality, high-fat and -protein foods: Almond butter. Ice cream. Mac and cheese. (Some of our favorite recipes are here.)
Now this study confirms our instincts about what to feed our daughter. Fat, it seems, matters a lot when it comes to recovery from anorexia. Recovering anorexics who ate higher-density (translation: higher fat) foods were less vulnerable to relapse. I could speculate about why, but the bottom line is that for true recovery, you've got to eat fat. Lots of it. Not just x number of calories, but high-fat calories.
Fat can make the difference between true recovery and a lifetime of suffering.
Fat matters.
6 comments:
Would love to hear you speculate about why, actually. That's really interesting.
i think that makes a lot of sense, actually. as i'm sure you well know, calorie-dense foods and foods with fat in them are probably among the "scariest" foods for an anorexic to eat. the hospital programs i've been in would require us to have a certain number of fat exchanges depending on our meal plans, but when i wasn't doing well after leaving the hospital, those were always the first things to go. i think the ability to eat full fat foods evidences a deeper level of recovery on a psychological level than just being able to resume eating normally in general.
I wonder if it has to do with fat's effect on food's transit time in the GI tract. Fat slows gastric emptying, meaning your food might be better digested and/or absorbed.
Better nutrition, both through intake and absorption, would indicate better physical and mental recovery. That said, I haven't read the study yet. I wonder if they address this.
OK, speculation coming up.
I think there are two things going on. One is neurobiology--the brain needs fat to function well. I wish I could articulate this more elegantly; I'm going to try to study up on neurobiology because it fascinates me. This statement--that the brain needs fat to work properly--has been made to me by various medical people, so I tend to think there's truth in it.
But I also think there's a more subtle mechanism at work. When people restrict their eating--and we could be talking here about anything from cutting out desserts to full-blown anorexia; the degree doesn't matter--it seems to set up a conditioned response in the brain. That is, the act of restricting reinforces itself. Think of playing a song on an LP over and over. (Sorry you younger folks won't get this reference. :-)) The needle wears a groove in the impressionable material of the LP. And once that groove is worn it's damn hard to get out of it and damn easy to fall back into it.
Now say you're a recovering anorexic. You're eating enough calories but you're avoiding fat. You're still restricting, and by now your brain is very used to and very good at the restricting pattern. So even though you're eating, the act of avoiding fat perpetuates the restricting mindset, which is a fundamental part of anorexia. This makes you in turn much more vulnerable to relapse--the needle falling back into the old groove.
In order to recover from an eating disorder you have to create new neural pathways that will eventually over time replace the old ones. That's partly why, IMHO, it takes 3 to 12 months at a healthy weight for someone with anorexia to experience mental relief. It takes time to wear those new pathways.
This isn't just out of my fertile imagination, by the way. This theory is based on conversations I've had with a couple of e.d. docs over the last few years. And it certainly jibes with my personal observations of my daughter and other people with AN.
I just got done rereading the article you wrote on your daughter's refeeding. It never fails to cause tears and fears. I have a young daughter of my own, and my own mother was a great deal like your own (encouraging me to diet from a young age, and so on).
Thank you for sharing this blog with us.
Here is one of the big reasons the brain needs fat: the Meylin sheath. Neurons in vertibrates are basically electrical wiring. As anyone who's ever had a shock knows, electicity tends to travel whereever the least resistance is. Electricians learned to solve this problem by encasing wires in insulation with low conductivity. Biology solved this problem by encasing neurons in fat - another excellent insulating material. Meylin is 80% lipids (fat) and 20% protein, and the meylin sheath is rather expensive - in terms of the body's caloric output - to maintain. Chronic inflamation accelerates the rate that meylin decays. When a diet is too low in fat, one of the main things the internal fat stores do is get marshalled to protecting the nervous system and the meylin sheath, particularly in the CNS (brain).
Looking at this basic neurobiology, it makes perfect sense that a diet low in fats would harm the recovery of someone who has suffered AN.
As an anecdote, I used to work at a very large stable. Every so often we would get underfed horses in. The vet always recommended a grain with suet (fat) formula as the best way to get a horse back to normal. Why oh why do we use more sense with animals than with people sometimes?
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