“Am I Dying?” and Other Hunger-Related Questions

Hunger is a tricky thing for people with eating disorders. We’ve disregarded it for so long that we forget what it feels like. I, for one, ignored my hunger until it became a perpetual part of my reality. I started experiencing it again in recovery, and I was honestly so confused; I kept asking my dietician “what’s happening to me? what am I feeling? what is this? am I dying?” Today’s post answers these questions and more. Read on to learn about hunger:

Question: What is hunger?

Answer: Hunger is the physical sensation generated by the body when needs more nutrients. It is caused by hypothalamic processing of the hormone ghrelin (lenomorelin), which is secreted by gastrointestinal tract in response to blow blood glucose levels and/or an empty stomach.

Q: How do you know if you’re hungry?

A: We all know about the obvious stomach growling, but hunger can manifest in many other ways, too. Symptoms include a churning, hollowness, or tightness in the stomach, lightheadedness, dizziness, or fainting, headaches, muscle cramps, shakiness/jitters, rapid heartrate, exhaustion and fatigue, irritability/agitation, lack of concentration, and even nausea.

Q: What should you do if you feel hungry?

A: Generally, if you’re hungry, you should eat. Exceptions include if you are fasting for a surgical procedure, on a meal plan that dictates your intake times, or have been otherwise advised by a medical professional not to do so.

Q: Why are you hungrier on some days than on others?

A: Hormone, activity, and stress levels can all influence your hunger. For instance, women tend to require extra nutrition prior to their menstrual periods (on account of increased calorie expenditure), and cardiovascular exercise has been shown to stimulate appetite. Growing children will also consume more calories than average, and studies have shown that lack of sleep leads to inversely proportional food consumption.

Q: What if your hunger can’t keep up with your metabolism or vice versa?

A: A healthy individual’s hunger and fullness cues will be accordance with their body’s nutritional needs, and they will eat enough to maintain a healthy weight at a reasonable activity level. Of course, this is not the case for all people; a number of factors including metabolic syndromes, chronic dieting, eating disorders, autoimmune diseases, certain medications, and economic factors can disrupt the body’s natural rhythm, resulting in skewed conditions on either side. In such cases, dietetic services are required to prevent and treat the effects of malnutrition.

Q: How does hydration affect your hunger?

A: Apparently, 37% of people confuse thirst with hunger. This is primarily due to the lack of stomach volume presented by each.

Q: How do you know whether you hungry or thirsty and what should you do about it?

A: At times, hunger and thirst present with similar indicators, notably dizziness, fatigue/exhaustion, headache, nausea, muscle cramps, tachyarrhythmias, and stomach churning/emptiness. Thirst is often accompanied by the following differentials–dark urine, dry mouth, and perspiration. If you are thirsty, you should rehydrate with fluids or eat foods with a high water content (like melon). In the past, dieticians have advised patients to drink water fifteen to twenty minutes before a meal to make sure they are actually hungry, but due to frequent disordered manipulation of this guidance, doing so is no longer a common practice; instead, nutritional professionals recommend you hydrate throughout the day and honour your hunger signals.

Q: What is emotional hunger and why wasn’t it mentioned above?

A: Emotional hunger is a psychological craving for a certain food. It was not included in the above designation, as it is a separate biochemical process. Emotional hunger is a psychological phenomenon while physical hunger is physiological.

Q: How can you tell if your hunger is emotional or physical?

A: While both physical and emotional hunger can make you crave certain foods, they are very different in nature. If your body is craving something, it is because it needs a specific nutrient contained therein; any food containing that nutrient will satisfy it, and your craving will subside. In instances of emotional hunger a food is desired on account of its associations; that food and only that food will do. Emotional hunger also tends to be accompanied by a (typically negative) emotion; it comes on suddenly and does not respond to physical hunger/fullness cues (the processing and secretion of the hormones ghrelin and leptin respectively), leading to an over- or under eating of the specified food.

Q: What should you do if you experience emotional hunger?

A: A little emotional eating won’t hurt you. It’s perfectly normal to celebrate your promotion with a slice of cake or to pick up pizza from your favourite restaurant after a bad day. Just don’t make it a habit. Food can facilitate celebration and comfort, but it is not (and never should be) a substitute for actually dealing with your feelings.

Is there anything else YOU want to know about hunger? Drop your questions in the comments below, and I’ll try to get back to you as soon as I can. Have a delicious day, everyone, and Happy Spring! xo

Wear It Beat It Day

Today 7 million people in the United Kingdom will fight their daily battles with cardiovascular disease. Today 435 people will lose that battle; today 110 of them will be under the age of 75. Today 530 people will go to the hospital with a heart attack; today 190 of those people will die. Today 657 people will have a stroke; today 109 of them won’t survive. Today 12 babies will be diagnosed with a congenital heart defect; today 1 of them won’t get to grow up. Today 82 out-of-hospital cardiac arrests will occur; today less than eight of them will live to see tomorrow. 

Today 34% of people in the United Kingdom will live with high blood pressure; today over half of them will continue to go without treatment. Today 6% of the population has diabetes; today that number does not include the estimated one million who remain undiagnosed. Today 27% of people in the United Kingdom will be obese; today 34% of them are overweight. Today 25% of people will exceed the national alcohol intake recommendations. Today 39% of people will not get adequate physical activity. Today 25% of people will not eat enough fruit and vegetables. Today 17% of people will smoke a cigarette; today smoking-induced cardiovascular complications will kill 55 people. 

Today you can do something about these numbers. Today you can maintain a healthy weight. Today you can quit smoking. Today you can get cardiovascular exercise. Today you can eat balanced diet. Today you can visit your doctor and get heart-checked. 

Today is Wear It Beat It Day. Today we wear red to raise awareness about heart disease. Today we stand in solidarity with those effected. Today we honor the lives lost and lived to and with cardiovascular disease. Today we donate to fund lifesaving research. Today we fight heart disease. 

Exercise in Eating Disorder Recovery

People in eating disorder recovery tend to completely avoid exercise. They have abused it in the past, so they see no point in returning to it; if it wasn’t healthy then, what good could it possibly do now? They figure the best option is just to give it up, but that’s not entirely true. Exercise is a necessary component of physical and mental health, and in MODERATION, it can behove your heart, blood, bones, and mind.

Dr. Jonathan Meyers put it perfectly when he said ‘exercise has a favorable effect on virtually all risk factors of cardiovascular disease’. This is attributed to a dipartite strengthening of the myocardial muscle and a simultaneous elimination of excess adipose tissue, both of which lower blood pressure, stress, and low density lipoprotein (“bad”) cholesterol. The former occurs when the heart gets the stronger and expends less force pumping blood (thusly exerting significantly less pressure upon the arteries) while the latter is causes decreases in body and size and consequent oxygen demand, lowering the rate and force which the heart has to pump. A reduction in body fat also lessens the risk for diabetes (ergo diabetic heart problems including diabetic cardiomyopathy and glycolic arteriosclerosis).

There is evidence, too, that exercise increases “good” cholesterol synthesis and survival (circulation) by 25% and 27%, respectively. It is involved in increasing the production and action of several enzymes that function to enhance the reverse cholesterol transport system (the uptake and excretion of cholesterol by high density lipoproteins). These enzymes are lecithin cholesterol acyltransferase (LCAT), which promotes the esterification of free cholesterol and synthesis of HDL via lipoprotein core sequesterization and hydrophobic gradient formation, as well as lipoprotein lipase (LPL), which delipidizes LDL precursors (chylomicrons and VLDL) for energy expenditure and metabolism causing consequent decreased triglyceride concentration and remnant-based HDL synthesis. Furthermore, endurance training burns adipocytes (for fuel) and preconditions myogenesis, further raising HDL cholesterol by developing LPL synthesizing/secreting (muscular) tissue and decreasing LDL cholesterol through elimination of its partial moiety (triglyceride stores). As HDL cholesterol increases and LDL cholesterol decreases, the risk of cardiovascular disease decreases proportionally by 1% per mg/dL.

Exercise also benefits your blood and bones. Workouts expending 4.2 to 5 megajoules (of energy) per week can increase blood plasma volume by up to 15%, and the stress of weight-bearing induces bone-strengthening osteogenesis, the latter occurring when osteocytes signal the multiplication of osteoblasts. Bone disorders such as osteopoenia and -porosis can thereby be reversed and treated while blood disease and deficiency problems are remitted and managed. This is especially important for people with eating disorders, many of whom have low plasma volume and bone density values due to malnutrition.

Last but not least, exercise is crucial to mental well-being. It improves memory via neurogenesis and elevates energy by transiently increasing cardiac output (stroke volume x heart rate). Exercise is also known to tripartitely alleviate anxiety and depression through thermogenesis (heat production in certain brain regions resulting in feelings of physical and psychological relaxation), endorphin release, and activation of monoamine metabolic pathways. There is an additional correlation between exercise and self-esteem, attributed to the prerequired perspectival shift from body appearance to function, making you not only think but feel better!

The American Heart Association recommends three to four thirty minute sessions of moderate intensity activity per week. Ask your doctor if you’re healthy enough for exercise, and get up and get moving. Take a walk, try a dance class, do some yoga! Find what works for you and have fun with it!

(Thank you so much to Dr. Sheila Sahni and Kaleigh Kessler, RD for your help on this post. You are both spectacular and so, so smart.)

Underweight and Underrepresented: The Cardiac Complications of Disordered Eating

We get it. Being overweight is bad for you. Extra weight strains the heart, forcing it to work harder, consequently raising your blood pressure and increasing your risk of myocardial infarction, cardiomyopathies, and stroke. Spending your days on the couch binge-watching Grey’s Anatomy probably isn’t the best lifestyle choice, and a diet of salty, trans-fat-fried carbohydrates cannot possibly be good for you. You do need some exercise to strengthen your heart, and fruits and vegetables are a nutritional necessity, but that’s common knowledge; we all know that already. So, let’s discuss something different; let’s discuss the other extreme–severe emaciation, caloric restriction, and compulsive purging. Underweights are underrepresented by/in the cardiovascular health community, and thusly, I have taken it upon myself to educate you on this equally unhealthy lifestyle.

Bradycardia and hypotension are the two most common cardiac complications of anorexia. In an endeavor to conserve energy, the body begins to shut down, slowing the heart rate and consequently lowering the blood pressure; neither matter is helped by nutritional irregularities/deficiencies (such as B-12, iron, magnesium). Both bradycardia and hypotension are generally benign, but prolonged cases of each can result in confusion, dizziness, fainting, fatigue, heart failure, and tissue death. Many bradycardic and hypotensive patients notice spikes in their heart rate and blood pressure when they stand up; some even experience palpitations, lightheadedness, and collapse. And that’s just standing–imagine what exercise can do!

Exercise in and of itself cannot cause a heart attack, but it can trigger one. The stress on your heart can induce palpitations, arrhythmias, arterial spasms, sudden cardiac death, and, yes, a heart attack. This exercise, while it should strengthen your heart, ends up weakening it because of the atrophic nature of muscles during starvation; you break down the muscle without giving it the energy it needs to build up again. Do I really need to tell you how dangerous this is?

This brings me to the second half of my post, the nutritional component. When deprived of nutrients, the body starts to eat itself. Contrary to popular belief (read: diet industry propaganda), fat is not the first thing to go; on account of their nutritional density, muscles are devoured, and the heart, as one of the largest muscles, is a natural victim. You can literally eat your heart out.

This catastrophic self-consumption leads to many dire results, including mitral valve prolapse, the flopping of the mitral valve, where its flaps collapse and allow for valvular leakage and regurgitation, eventually leading to arrhythmias, left ventricular enlargement, strokes, and heart attacks. Self-consumption is premised by malnutrition, an incredibly harmful state in its own right. A caloric deficit is also a nutritional deficit, since calories are not just energy, but couriers, carrying vital vitamins and minerals, including essential electrolytes. Electrolytes are necessary for heart function, as the heart’s de- and repolarisation is facilitated by ionic channels. A severe shortage of electrolytes can have immediate results like life-threatening cardiac arrhythmias; these, including the frequently fatal ventricular fibrillation, can cause cardiac arrest and, in rare instances (represent!), a heart attack. Consequences can be lasting as well, with electrolyte deficiencies yielding permanent extrasystoles (both atrial and ventricular, including various varieties of geminy) and Long QT Syndrome, the latter of which predisposes one to chaotic heartbeats, and in turn, heart attacks and/or cardiac arrests. It is also worth noting that heart attacks do permanent damage to the myocardial muscle, creating eventual and incurable cardiomyopathies.

Additionally, many underweight individuals are susceptible to vicious binge/purge cycles. A binge’s rapid influx of calories can cause systemic shock, manifesting as cardiac arrest, and self-induced emesis can do the same, with dehydration and the abrupt loss of electrolytes rendering similar effects. The cardiac complications of anorexia can be fatal, and if you are lucky enough to escape them, you are still susceptible to recovery-occurrent ones such as refeeding syndrome, a type of systemic shock analogous to that of a binge. Sounds fun, right?

Please do not do this to yourself. Maintain a healthy weight, eat a balanced diet, and exercise in moderation! Your body will thank you.