Tag Archives: binging

Extreme Hunger – What Is It, Why Is It Happening, and How Do I Handle It?

hunger

It has come to my attention that I have not yet addressed one of the biggest topics of recovery from a restrictive eating disorder in any of my articles on this website (shame on me!). I’m not sure how I managed to miss it but it may be because I have a comprehensive video on the subject, and also refer to Your Eatopia’s articles about it. It was, after all, Gwyneth Olwyn who did coin the term “extreme hunger” (as far as I am aware). But let’s get started.

Extreme hunger is a rather controversial subject in the recovery world. It is rarely recognised by professionals regardless of the clear logic that shows us that it is totally normal and expected to experience a surge in hunger after a period of starvation, not to mention the sheer amount of people that talk about extreme hunger being part of their recovery (or “binging”, which is actually the same thing, but we will get to that later).

Extreme hunger is a very rational experience when you look at the facts. A body that has been starved has a large energy deficit, and therefore calories that are needed for daily expenditure are not going to be enough to get an energy-deficient body back to its energy-balanced state. This is because it will need calories for daily expenditure and calories to make up for the energy deficit. This energy deficit in itself will have resulted in damages to the body, and it can also result in weight loss which also causes harm to the body – and frequently the more extreme the weight loss the more severe the damage. Damages like that require energy to heal, and that has to be energy on top of daily energy needs, as that is expended in – you guessed it – the energy that you use up in your daily life.

balance

So if you imagine that energy-balanced is the number 0 – a neutral place with a healthy body, and let’s say you need around 2,750 calories to stay in this energy-balanced place. Then starvation brings you to -10 on that scale, which means that you are in an energy-deficient place. Let’s say you now enter recovery and bring your calories up to 2,750 again (after increasing gradually because of the risk of refeeding syndrome). Your metabolism is probably very suppressed, so for a while, 2,750 may cause weight gain either slowly or rapidly as your body will store as much energy as it can rather than burning it, to get you to a healthier weight. The metabolism will then speed up and you might a) experience hypermetabolism and end up dropping weight or maintaining a fairly low to low BMI (or a BMI too low for your personal body), which will mean that you will need to increase your calories until you are gaining again or you may b) find that you maintain a certain weight or that your weight gain slows down. This does not mean that you need fewer calories. This means that your body is now able to maintain its weight on those calories. It does not mean that it is done healing the many internal damages done through starvation, so if you experience hunger or cravings for more than the 2,750 your body (theoretically) needs, then it is really important to respond to those signals and eat. Your body is your team mate; your best friend; your rescuer. Listen to it. It if it telling you that it is hungry, then it is hungry. I know – this is ridiculously difficult, and I will talk about that in a moment.

Now let’s say you are recovering on a sub-optimal amount of calories and have stopped gaining weight. My body must be recovered! I hear you say. It must only need this amount of calories! Wrong. Let’s say that you are recovering on 1500 calories. Your body is maintaining a weight that is not its natural or healthy weight because it needs more energy to repair and gain weight. In order for it to gain to its set point and heal the internal damages done to your body, it needs adequate and consistent energy, and that is much more than 1,500 calories (or whatever your sub-optimal is). Let’s say you are recovering on a sub-optimal amount of calories and are gaining weight. Well clearly I don’t need any more calories if I am gaining weight on this! I hear you shout. Wrong. Giving your body an inadequate amount of energy means that it is extremely likely to keep your metabolism suppressed and therefore will continue to store more energy as fat rather than burning it like it would if it had a normal-speed metabolism. To find out how many calories you need (base level, without extreme hunger), check out my recovery guidelines here. Remember that activity level also factors into being energy-balanced, and that if you are engaging in excessive exercise, this will put you in an energy-deficient state too. It is also important to note that whilst your body is healing, any energy put into exercise will put a strain on a body that is desperately trying to heal a multitude of damages, and exercise will eat into much-needed energy for repairs. This is why it is important to rest during recovery (and for more on that  herehere, and here are my videos on exercise).

You may be experiencing extreme hunger right now. It may be something that you will experience in the future. It is something that most likely makes you feel terrified beforehand, and extremely guilty after. It is something that may be heavily weighing on your mind (excuse the pun). You may think that you have lost control; that you are spiralling into a different eating disorder; that this is binging and you are never going to eat like a normal person ever again! You are not alone in those fears. I had them too. Extreme hunger is utterly anxiety-provoking. It feels as if it will never end, and it evokes a multitude of negative emotions and thoughts, including shame, terror, and disgust. The eating disorder will scream and scream and scream at you inside your head. It will do anything to stop you eating what you need to eat, and the more you eat, the louder it will usually scream.

This is an extremely chaotic time inside the mind of someone recovering, and you are not alone if you feel completely overwhelmed by your hunger and your eating disorder’s reaction to it. The eating disorder hates anything that goes against its cruel, life-threatening rules, so for something like extreme hunger to hit and be responded to is something that will enrage it. People also have fears that it is binge eating disorder – and these fears are understandable, given the volume of food that might be consumed. Yes, you will be consuming a large amount of energy. You might eat anywhere from 4,000 calories to 10,000+ (although the latter seems to be quite rare – but again, not unheard of and if you are experiencing this you are not the only one). This would be a lot of food for an energy-balanced body. But you do not have an energy-balanced body. You have a starved, damaged, energy-deficient, nutrient-deficient body that needs far more energy than a healthy, energy-balanced body, to get it back to that state of equilibrium again. This is okay. This is necessary for your body. You are not alone.

You may experience extreme hunger at the beginning of your recovery. You may experience it in the middle, or near the end. You may find that it comes and goes throughout your recovery. You may never experience it at all – and that is okay too. This could be because you may need less energy to repair internally – this does not negate your need to recover. It may be that you may have repressed hunger cues and find that you struggle to even eat your calorie guidelines let alone have any desire for more. Extreme hunger may come to you later, or it may not come at all. It may be that you are someone that finds that you eat a little more than what your body needs as an energy-balanced body for a long time and your healing is done more slowly.

It can also be that during extreme hunger you find that you are eating a certain type of food: sugar, carbs, and fats are generally the types of foods that are most highly restricted, and because of that, the body needs and craves foods high in these things. It is also easier for the body to quickly process and get energy from these types of foods. Those who are highly lacking in fats may find themselves eating jars of peanut butter – this seems to be quite common so don’t freak out if you are eating whole jars of peanut butter, nutella etc, and strange combinations also seem quite frequent during extreme hunger or recovery in general. You may find yourself chomping on lots of meat or iron rich foods. You may find yourself digging into ice cream, milk, cream, and cheese because you are deficient in fats or calcium. There is a reason for the foods you crave. Listen to your body and respond to it.

balance 2

The message that I want to get across is that if you have been through a period of restriction, experiencing a raging hunger is totally, absolutely, 100% normal. I want you to know that it is not forever, even though it feels like it could be, and even though that is your greatest fear. Your body will become energy-balanced (or close to energy-balanced) and the intense hunger will dissipate as your body gets healthier. Your extreme hunger may taper down, or it may vanish from one day to the next, but you will not have extreme hunger forever. Everyone I know who has gone through the entire recovery process has experienced extreme hunger, and they have come through it and out the other side. They have eaten whole cakes for breakfast, or pints and pints of ice cream, or whole cheesecakes, or whole large Thortons chocolate boxes (that one was me), and they have all been horrified; ashamed; fearful. They have all been scared witless that it would never end. They have all questioned whether they had gone from one extreme to the other and developed Binge Eating Disorder. And they have all, in one way or another, either come across information on the topic and been a little soothed until the hunger calmed down, or have freaked out and then, in time, found that the hunger normalised. If you (unsurprisingly) need help with anxiety management, check out my article on it here.

Why more research has not been done into this topic, I don’t know. I have talked to thousands of people in recovery since I began my journey over four years ago; on the Your Eatopia forums, on my blog, on this website, on my Youtube channel, and on my Instagram account, and one of the most frequent topics is extreme hunger. I don’t know why it has not been researched or recognised by many health professionals, and it is one of the most frustrating and saddening things for me when people are told not to respond to these very natural, obvious signals from the body. But I can say with conviction that if you are experiencing this, you are far from alone. You are okay. You are healing. Work with your body, not against it. Be strong, and patient, and kind to your body and your soul. What you are experiencing is normal, and expected, and you can get through this.

Vyvanse and BED: Money-making in Disguise as Treatment?

vyvanse pic

Fairly recently, Vyvanse – a drug known for treating ADHD – was approved to treat binge eating disorder (BED). I was first made aware of this drug via a message sent to my blog from a woman living in the US who was angry about the effects this could potentially have on people who were prescribed it. I did a bit of reading up about it, but soon forgot about it. The topic came up again when a friend linked me to an article about the drug being used for treating BED, which I read, and my interest was piqued. I started thinking about the problems that would arise from it’s approval to treat BED that are both numerous and highly concerning.

In May 2013, the DSM-V was published, with BED being newly recognised as a psychiatric disorder. On the surface, this sounds great: sufferers of BED were finally being recognised and validated, but a further look into this and the subsequent approval of Vyvanse to treat it raises some serious questions.

In a society where almost two in five (37%) women and one in six (18%) men in the UK are dieting “most of the time”, and 108 million people are on diets in the US, a huge amount of us are restricting on a daily basis, and when we “fail”, we feel shame, guilt, hopeless, and anger at ourselves. And failing is inevitable, because diets do not work. Dieters often end up in a restriction/binge cycle, and mistake their dieting for normal behaviour, and so only take note of their binging and see this as a weakness rather than a normal biological response to starving the body. If the body has an energy deficit due to restriction, it will seek to restore balance by compensating later on. So with that in mind, we can now look at the criteria for BED:

  • Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
    • eating, in a discrete period of time (for example, within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances
    • a sense of lack of control over eating during the episode (for example, a feeling that one cannot stop eating or control what or how much one is eating)
  • The binge-eating episodes are associated with three (or more) of the following:
    • eating much more rapidly than normal
    • eating until feeling uncomfortably full
    • eating large amounts of food when not feeling physically hungry
    • eating alone because of feeling embarrassed by how much one is eating
    • feeling disgusted with oneself, depressed, or very guilty afterwards
  • Marked distress regarding binge eating is present.
  • The binge eating occurs, on average, at least once a week for three months.
  • The binge eating is not associated with the recurrent use of inappropriate compensatory behavior (for example, purging) and does not occur exclusively during the course Anorexia Nervosa, Bulimia Nervosa, or Avoidant/Restrictive Food Intake Disorder.

For me, this criteria is extremely problematic. This criteria is pretty vague, and in conjunction with a society that vehemently fears over-eating and weight gain, becomes a fit for a large proportion of people. Let’s take a look at it in more detail:
– “an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances” – this is particularly non-specific, and in our society, many people have a distorted view on what is larger than most people, especially when so many are restricting. It is also normal for someone who has been restricting to experience eating more than normal, because of the body trying to restore itself to being energy-balanced.
– “a sense of lack of control over eating during the episode” – many people feel out of control when it comes to food because we are made to feel that out of control if we are not eating in some strict and regimented way. That feeling is even more accentuated when the drive to survive overcomes the person’s desire to diet, and the body makes up for lost energy by “binging”.
– Eating rapidly is also part of the drive to get energy in as fast as possible when it needs it.
– Eating until uncomfortably full is easy to do when the body requires more energy than the stomach has room. The desire for food is just another way for the body to communicate hunger, and people often do not recognise this as a type of physical hunger (the brain is part of our physical being as well).
– Eating alone when eating what someone considers more than normal, or when someone is experiencing reactive eating in response to restriction, is – unfortunately – normal because of the way our society has surrounded food in a thick layer of shame.
– And if you are dieting, or misinterpreting your eating as a “binge” (because I would argue that many people have a distorted view of what a binge actually is), this is likely to happen “at least once a week for three months”.

“With these diagnostic criteria [for BED], there is huge potential for a false positive. Do a lot of people struggle with binge-eating? Absolutely. Are all of these people actually ill? That is the major question around this diagnosis and the Vyvanse treatment,” said Lisa Cosgrove, a professor and clinical Psychologist at the University of Massachusetts, Boston.

So what we have here is a list of things that those with BED suffer from, but written in a way that it could easily fit someone misinterpreting their eating habits because they have distorted ideas of what binging is, or are not aware of the effects that dieting has on the body. This means that these people could go to the doctors, tick all the boxes, and receive a diagnosis. Our fatphobic society steeped in diet culture would have no problem with that. A quote from Ray Moyniham in  Motherboard talks about this:

“You have to be extremely sensitive to the fact that there are people who are really suffering severe and debilitating symptoms from a condition,” said Ray Moynihan, a senior research fellow at Bond University in Australia and the author of Selling Sickness: How the World’s Biggest Pharmaceutical Companies Are Turning Us All Into Patients. “But when we put so much energy into medicalizing normality, it takes resources and attention and care away from people who are seriously ill.”

Now on to June 2014, where Shire wins the key patent ruling for the drug Vyvanse. The Telegraph writes:

Shire hopes to increase sales of the drug by broadening its uses into other patient groups, such as very young children and sufferers of the newly-recognised psychiatric problem binge-eating disorder (BED).
The drug maker told investors on Monday that it expected to make $300m from sales of Vyvanse to BED patients by 2020, following a successful clinical trial showing the drug helped control binge eating.

This raises a red flag for me: Shire will desperately want to make as much money as possible before its patent expires, and this means expanding its treatment to those with other illnesses other than ADHD. Shire had already thought of BED as an option, and already had that idea in the pipeline. Is the fact that BED was finally recognised and put into the DSM-V just when Shire needed a new illness to treat a convenient coincidence, or something more dubious?

In January 2015, Vyvanse was approved to treat BED. The fairly vague criteria for BED could mean that BED is over-diagnosed and over treated, with a drug that is an amphetamine. Hang on, what?

Amphetamines became extremely popular in the mid 1900s as a weightloss drug, before concerns about the dangerous side effects caused the FDA to ban amphetamines from diet ads.

The most serious risks include psychiatric problems and heart complications, including sudden death in people who have heart problems or heart defects, and stroke and heart attack in adults. Central nervous system stimulants, like Vyvanse, may cause psychotic or manic symptoms, such as hallucinations, delusional thinking, or mania, even in individuals without a prior history of psychotic illness. The most common side effects reported by people taking Vyvanse in the clinical trials included dry mouth, sleeplessness (insomnia), increased heart rate, jittery feelings, constipation, and anxiety. – take from here.

Vyvanse was approved for treating BED after only two 12-week studies.

“I tried (and failed) to persuade the DSM 5 group that BED was a premature and dangerous idea precisely because I feared it would be a backdoor excuse for drug companies to promote stimulant diet pills,” Dr. Frances Allen, a psychiatrist and frequent critic of the DSM-5, told Motherboard in an email. He has had particular concerns about the new criteria for diagnosing eating disorders. “The rushed approval of Vyvanse realizes my worst fears”

People actually suffering from BED are desperate to get rid of their mental illness, but therein lies the issue: BED is a mental illness. I have severe reservations about an appetite suppressant being used to combat an eating disorder that for a lot of people has roots in trauma, and other deep-seated emotional problems. The appetite of that person isn’t the issue: the drive to eat as a coping mechanism is. And not only are we going to be dealing with actual sufferers, but those misdiagnosed because of the ill-defined criteria, and those faking the illness to get a hold of Vyvanse, either because of its street value, or because of its use as a weightloss drug. Which brings me to the dangers of those with restrictive eating disorders reeling off the list of BED symptoms, and getting a prescription of Vyvanse to continue their downward spiral that only leads closer and closer to death. Because a binge eating disorder diagnosis relies on self-reported behaviour, it means that it is not difficult to fake, and consequently, it is not difficult to get a diagnosis. Pro-ana sites are already sharing their experiences with Vyvanse, and tips on how to get hold of the drug. The consequences of this could be catastrophic.

I received a message to my blog recently when the subject of Vyvanse came up:

I was recently diagnosed with BED and prescribed Vyvanse. My psychiatrist gave it to me because he said I was gaining too much weight. He gave it to me to use as a weightless pill. I don’t think that’s okay. In the past I have suffered from anorexia and bulimia. So of course, I accepted the pill. Hoping it would be easier to not eat at all. I think this may be a problem for a lot of people very soon.

This shows that already Vyvanse is being misused by doctors themselves, who are supposed to be people that we trust with our healthcare. But with the pharmaceutical industry being all about the money-making, it’s hardly surprising.

In my opinion, the inclusion of BED in the DSM-V, the vague diagnosis criteria, the subsequent research into using Vyvanse to treat BED, and the swift approval of that usage, are linked together. The pharmaceutical company have helped themselves to make more profit off both those with BED, and so many without it, with a drug that in my opinion will not successfully treat the disorder it has been approved for. And this drug is likely to have devastating consequences.