F.E.A.S.T's Around The Dinner Table forum

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mom26kids
Anyone else here had an issue with RAN during recovery getting up multiple times a night and eating? My daughter is currently recovering and has been in this battle almost 4 years but thanks to a great therapist and support she is steadily gaining and is at her highest weight yet.  Still a lot of OCD behaviors and quite a ways to go, but she is having real problems staying asleep all night and often gets up and eats a lot.  have tried locking up food that is particularly attractive (dairy, nuts) but to no avail. She is not purging but  of course after a night of little sleep and eating random foods she starts off her day feeling terrible.  Any suggestions?
mom26kids
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deenl
No experience but it may link into the hyperpalatable foods that Dr Julie O'Toole talks about. Maybe worth a bit of research.

Best of luck
D

Edited to provide links:
https://www.kartiniclinic.com/blog/post/the-kartini-meal-plan-de-mystified The bit you want is half way down the page.

https://www.kartiniclinic.com/blog/post/eating-too-much/

I hope your daughter is just going through a phase but in the ED world it is better to be safe than sorry.

Kind regards,
D
2015 12yo son restricting but no body image issues, no fat phobia; lost weight IP! Oct 2015 home, no progress. Medical hosp to kick start recovery Feb 2016. Slowly gaining at home, seeing signs of our real kid.

May 2017 Hovering around WR. Mood great, mostly. Summer 2017 Happy, first trip away in years, food variety, begin socialising. Sept 2017, back to school FT first time in 2 years. 2018 growing so fast hard to keep pace with weight. 2020 Off to university, healthy and happy.
  • Swedish proverb: Love me when I least deserve it because that's when I need it most.
  • We are what we repeatedly do. Excellence Recovery, then, is not an act but a habit. Aristotle.
  • If the plan doesn't work, change the plan but never the goal.
  • We cannot control the wind but we can direct the sail.
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Calm_USA
After my d was "weight-restored" she went through a period of binge eating, particularly at night.  To be honest this behavior is not true binge eating, it is better to refer to it as reactive eating.  Their bodies have endured restrictive eating.  Now with refeeding they are receiving a steady supply of nutrition.  Trying to restore/rebuild and fearing more restriction the body demands more food (reacts).  It's a struggle and highly emotional but it is actually good.  Their bodies are healing.  We found that it helped to increase (amount or density) each meal/snack and to maintain the schedule - breakfast, mid-morning snack, lunch, afternoon snack, dinner, evening snack.  I also spent more than a few nights sleeping on the couch in front of the kitchen, or getting up throughout the night to fend off a "binge".  My d did gain 15 - 20 lbs above the "weight-restored" weight and has hovered around that weight for a year now.  That is her body's set-point. She eats freely and independently and experiences no ED behavior.  We are still coping with her pre-anorexia anxiety/depression but she has come to love her body as it is. 

Best of luck to you and your d
Mom of a 19 yr old. RAN diagnosed 1/2014. Residential, PHP, IOP. W/R since late summer 2014. Now in remission and thriving in her second year at university. My Faith remains.
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IrishUp
mom26 - 

I think this is something that really does need to be addressed with the help of the T. Your D is at a very vulnerable point, and this is disordered eating - it's at extremely high risk of becoming a full blown part of her ED. At a similar stage in our Ds recovery, is when she developed binge/purge. The restrict/binge - with or without purge! - cycle is DEFO something you don't want to get "hardened" into her disordered behavior. It's really tough to break.

I believe Calm is correct in calling it "reactive" eating. If your D is at her highest wt and close to being w/r, it's very likely her caloric needs are increasing faster than her intake is increasing. This is setting up the binge-urge; she can't sleep b/c she's hungry, and her body is poking her with "need more calories now" signals. But she's still in recovery, and lacks ordered eating skills, so she's foraging at night rather than telling you she's hungry (she may not yet even be able to identify hunger properly!) and having seconds or an extra or bigger snack!

The dairy & nuts foraging suggests she needs to up her fats and protein intake - that's where I would start, anyway! And in a way, that is terrific because high fat/protein foods can be easily added to her current eating without greatly bulking up the "visual footprint" of her diet - so it's often easier to deal with from an eating-stress level (but not always, of course).

It also strongly suggests that this is not, at this time, a hyper-palatable foods problem. Briefly outlined, fats and sugars taste good - they are palatable to us, because they are markers of high-quality foods. Specifically, as really big-brained primates, we need a lot of carbohydrates throughout the day to feed those brains, and high-quality fats to maintain brain cells (your brain alone may use 20%+ of all the food you eat to run, and +500kcal on top of that if it is recovering from injury). it seems that some people are very vulnerable to certain kinds of foods that contain fat and/or simple sugars in densities not found without industrial food production, hence "hyper-palatable". High-fructose corn-syrup (HFCS) in particular has been identified as a culprit, because it is sweeter than any sugar found in nature.

In vulnerable people - and someone with an ED is defo vulnerable - hyper-palatable foods appear to have "addicting" properties and to trigger binge urges, both physically and psychologically. Our D is vulnerable to hyper-palatable foods. The big red-flag food that you are dealing with this kind of problem is sugary breakfast cereals, or any other food that predominantly simple carbs/HFCS. Part of the problem with them is that since many people with ED avoid fats and animal meats, their diets are often deficient in proteins & fats that the body needs. Fats in particular act as satiety signals to the brain - the gut's way of saying "OK, we're full!". But if you're eating sugary foods without fats, you'll keep getting hunger signals. So you wind up with someone avoiding the foods their body needs, but taking down two whole boxes of cereal in one go.

As we know, the foundation of treatment for disordered eating, is to counter it with Ordered Eating
  • 3 meals + snacks;
  • Spaced throughout the day so that the person doesn't go longer than 3-4hrs without eating (after this amount of time, "restriction physiology" starts to set in);
  • But NOT at night - uninterrupted sleep is important, and "off-hours" eating is a sign something is wrong;
  • Containing ENOUGH calories;
  • In a 30:30:40 ratio, meaning the proportion of calories in the diet averages out to 30% from fats, 30% from proteins, 40% from carbs. For people with ED still struggling with normalized eating, it's best to try to make all meals & snacks be 30/30/40
  • Done consistently - 24/7 for as long as you can, is the goal here.

Things you might try -
  • Evaluate her current diet to ensure that there are enough calories in good proportions
  • Make sure there are no "hunger holes" during the day - have a ready supply of energy bars / nuts / quick rounded snacks to fill any gaps.
  • Up calories each day in case she's currently at enough, but her body is signalling for more because she's still growing (our bodies mature well into our 20s, and people with malnutrition histories may experience catch-up growth well past the age of expected growth, if they are now being well nourished on a regular basis).
  • Have an energy dense snack right before bed - if you search the High Calorie Recipe thread, there is one for Super Hot Chocolate that might be a good one to add - a lot of the time an "extra" snack is met with less resistance if it is liquid.
  • Further brainstorming with T
Anything you can do to prevent access to the food may be helpful as well, and maybe she, you, and her T can come up with some kind of plan for distraction or redirection to counter the night binge urge (eg, you help her back to bed and put on soothing music). If anxiety is a factor, something like SAM-e or melatonin might be useful as well.

Good luck!

IrishUp
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