0 What it takes

I'm currently reading up on hypermetabolism - a physiological state of increased rate of metabolic activity. Research has shown that although patients with AN are hypometabolic during the starved state (conservation of energy, glucose-sparing), they become hypermetabolic during refeeding. It appears to be counter-productive to the body and why this is so remains unclear. Nonetheless, this increase in metabolic rate can slow the rate of weight gain by significantly increasing caloric requirements beyond what can be predicted by the increase in body weight. As summarized neatly in a study by Garber (2011):

Obarzanek et al demonstrated an increase in REE (resting energy expenditure) of 21% over baseline when calorie intake advanced from 1,105 to 2,105 calories, and a further increase of 63% over baseline at an intake of 3,216 calories [10]. Van Wymelbeke et al (2004) showed 13% increase in REE when calories increased from 823 to 2,057 in 1 week, with a total increase of 43% over baseline after 10 weeks of feeding, when subjects reached 2,615 calories [9]. These increases are partly due to increases in the energy required to process, digest, and absorb nutrients, or the thermic effect of feeding (TEF) [7], [12], [13]. However, increased TEF does not completely explain the dramatically elevated metabolic needs during refeeding in AN patients. More recent studies have shown that psychological factors, including anxiety, depression, and fear of weight gain, may contribute to the hypermetabolic state [9], [12], [16]. Rigaud et al administered blind loads (such that patients were unaware of the calories ingested) to AN patients through tube feeding and demonstrated a calorie-dependent increase in REE [12]. This study demonstrated unadjusted correlations between TEF and increased calories, plasma cortisol, adrenocorticotropic hormone (ACTH), and catecholamines, decreased beta-endorphin, fear of becoming fat, and feelings of satiety and anxiety. These findings underscore the complexity associated with energy expenditure in AN.

The conclusion of another study speaks much for the sentiments expressed by many recovering AN:

According to our results, a body-weight gain of 150 g/d requires the intake of not only the assumed 6500 kJ but also a further 4500 kJ (ie,11 000 kJ, or 2630 kcal/d), or 300 kJ (ie, 75 kcal)/kg body weight/d. One can understand why it is so difficult in such conditions to obtain a weight gain of >1 kg/wk. And thus, it is often unfair to accuse most of these AN patients of discarding their food when they do not gain body weight.

When I read that, I was like MY SENTIMENTS EXACTLY! So many people just think that we don't eat or refuse to eat when we actually make tremendous effort to put on weight. They don't realize the body is so much more complex than input>output. That said, now that I am more educated on the prospect of my body of being in a hypermetabolic state, I too must be more conscious of how much more effort I must put in and eat eat eat. On forums, recovering ANs talk about having a minimum of 3000-4000 kcal/day just to kick start the weight gain process. Based on my current diet plan, I don't think I hit anywhere near that. Time to change that.

References
Garber AK et al (2011) A prospective examination of weight gain in hospitalized adolescents with anorexia nervosa on a recommended refeeding protocol. J Adol Health 24-29.
Wymelbeke VV et al (2004) Factors associated with the increase in resting energy expenditure during refeeding in malnourished anorexia nervosa patients. Am J Clin Nutr 1469-1477.

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Yesterday I attempted again to make my own nut butter. My first attempt was quite long ago, with almond butter. It turned out disastrous, more like chopped nuts than a butter. I used a blender then. This time round with cashew butter, I used a chopper which yielded better results, though still on the crumbly side and far from the gold creamy standards of Artisana. I did add oil - walnut oil - while processing; maybe I added too little? It was 2 teaspoons I think. I had some for breakfast (protein oatmeal/Magoo's granola) and it tasted not bad, though I would skip the soaking step cause I think it washed away some of the flavour. Being packed in a generic plastic vacuum bag without any indication of it being raw or roasted, I thought the precautionary soaking step would be better. Finally finished the last of the durians (3 entire durians in 4 days). Scrummy till the last seed :)

Today before Heritage I went to Mac Commons. Quiet and spacious, with luxurious iMacs, huge tables and comfy chairs, this is an ideal studying place... except the cold from the blasting air-con, as usual.