Or maybe you’re just anorexic

I have been extra tired lately.  VERY extra-tired.  I go through spells of this and am always fairly convinced that there’s something wrong with me.  It’s not normal for someone to get eight hours of sleep and need one – two naps during the day.  I end up having conversations with my fiance like this:

grey: I think that I’m anemic.
fiance: oh?
grey: I have all the symptoms — fatigue, headache, difficulty concentrating, pale skin, leg cramps…
fiance: Funny, those sound like the same symptoms of anorexia.

Then, the next month…

grey: I think I have hypothyroidism.
fiance: You don’t say.
grey: No, really — I have all the symptoms.  fatigue, dry hair, pale skin, cold intolerance, muscle cramps, depression, abnormal menstrual cycles….
fiance: Kinda like anorexia.

And again….

grey: I think I have mono.
fiance: Let me guess — lack of energy, loss of appetite and chills.
grey: Exactly!
fiance: You don’t have mono, you have anorexia.
grey: I could have anorexia AND mono.
fiance: Do you have a severe sore throat?
grey: Well…. not YET….

Humph.  He is right — these could all be consequences of the eating disorder.  For the most part I know this, but whenever I feel overly tired of cold or crappy, I really feel like it must be something else.  My eating isn’t particularly worse that day — why should I feel worse?

I think that I forget that how I treat (or mistreat) my body compounds over time.  If my eating has been off-track for the past three ways, having a great day today isn’t going to guarantee that I feel okay.  And, even on a larger scale, I think that years of disorderedness has taken a toll on my body.  My eating disorder is nowhere near as severe as it was back in high school, but I still haven’t been 100% over the years.  Now I notice how prone to headaches I am (very prone), how I often have stomach aches, how dysfunctional I am on minimal sleep, etc.  I can’t get away with the things that I used to be able to.  Because my weight is higher and I’m eating more, this doesn’t make sense to me — clearly something ELSE must be wrong with me (like anemia or hypothyroidism or mono).  But… maybe all the years of the eating disorder has taken a toll on my body.  Beyond the bone density and menstrual issues, maybe I am just not as resilient as I once was.

However… I am still going to have labs done at some point to rule everything out.  You know, just in case…. (and in secret hopes of proving my fiance wrong!)

Or maybe you're just anorexic

I have been extra tired lately.  VERY extra-tired.  I go through spells of this and am always fairly convinced that there’s something wrong with me.  It’s not normal for someone to get eight hours of sleep and need one – two naps during the day.  I end up having conversations with my fiance like this:

grey: I think that I’m anemic.
fiance: oh?
grey: I have all the symptoms — fatigue, headache, difficulty concentrating, pale skin, leg cramps…
fiance: Funny, those sound like the same symptoms of anorexia.

Then, the next month…

grey: I think I have hypothyroidism.
fiance: You don’t say.
grey: No, really — I have all the symptoms.  fatigue, dry hair, pale skin, cold intolerance, muscle cramps, depression, abnormal menstrual cycles….
fiance: Kinda like anorexia.

And again….

grey: I think I have mono.
fiance: Let me guess — lack of energy, loss of appetite and chills.
grey: Exactly!
fiance: You don’t have mono, you have anorexia.
grey: I could have anorexia AND mono.
fiance: Do you have a severe sore throat?
grey: Well…. not YET….

Humph.  He is right — these could all be consequences of the eating disorder.  For the most part I know this, but whenever I feel overly tired of cold or crappy, I really feel like it must be something else.  My eating isn’t particularly worse that day — why should I feel worse?

I think that I forget that how I treat (or mistreat) my body compounds over time.  If my eating has been off-track for the past three ways, having a great day today isn’t going to guarantee that I feel okay.  And, even on a larger scale, I think that years of disorderedness has taken a toll on my body.  My eating disorder is nowhere near as severe as it was back in high school, but I still haven’t been 100% over the years.  Now I notice how prone to headaches I am (very prone), how I often have stomach aches, how dysfunctional I am on minimal sleep, etc.  I can’t get away with the things that I used to be able to.  Because my weight is higher and I’m eating more, this doesn’t make sense to me — clearly something ELSE must be wrong with me (like anemia or hypothyroidism or mono).  But… maybe all the years of the eating disorder has taken a toll on my body.  Beyond the bone density and menstrual issues, maybe I am just not as resilient as I once was.

However… I am still going to have labs done at some point to rule everything out.  You know, just in case…. (and in secret hopes of proving my fiance wrong!)

Another strike against amenorrhea

I stumbled upon this article last week:  Metabolic Assessment of Menstruating and Nonmenstruating Normal Weight Adolescents This is something that I have always been curious about — is amenorrhea associated with a low metabolic rate?  I always assumed yes, at least a little bit.  However, I didn’t really base this conclusion on any hard science.  Let’s say that I used “Grey Science,” which goes something like this:

Your body requires a certain number of calories to function at full-capacity.  When you chronically deprive your body of these calories, it has to adapt to the calorie deficit to survive.  One of the ways that it does this is to cut out non-essential functions, like menstruation.  However, in recovery, it’s possible to gain weight without really restoring your metabolism (believe me).  If you’re still subsisting on a sub-optimal number of calories, then your body might still not feel like it can spare the extra calories that menstruation requires.  You are only able to maintain that weight on those calories because there are still processes that are being cut out.  This means that your metabolic rate is lower.

Again, this is my unscientific reason, that happens to make a lot of sense in my mind.  Thankfully some researchers came along to actually research this…

From the article:

“The purpose of this study was to investigate a possible mechanism for amenorrhea in adolescents who were  90-130% expected body weight with a history of anorexia nervosa, bulimia nervosa, or eating disorder not otherwise specified.  Using indirect calorimetry, we examined the metabolic differences between participants who were menstruating regularly compared with those who were amenorrheic.  Our hypothesis was that participants with amenorrhea would have a lower REE than those with regular menses.  We also proposed that both groups would have a lower REE than would be expected for age, weight, and height due to their dieting, calorie restriction, and eating disorder behaviors.”

And the conclusion:

“Using indirect calorimetry to assess REE, we showed that a hypometabolic state persists despite weight restoration.  There were significant metabolic differences found in weight-restored participants was amenorrhea as compared to participants who had regular menses.  Participants with amenorrhea consumed a lower fat diet, that a lower REE, and were at a lower mean body weight.”

So… overall, I was on the right track.  However, the article leaves me with several questions:

1. Why do recovered anorexics/bulimics have a lower REE than others their age without an ED history?
2. What is necessary for resuming menses?
3. I have been told by several doctors that often a stint on birth control is necessary to “jump-start” your period.  How does that relate?  And, how does that affect REE?

I think that the situation is a Catch-22.  Weight-restored patients with amenorrhea have a lower REE, so their metabolic rate is reduced and therefore need fewer calories.  However, they are still not getting their period, so do they need to be eating more?  I understand that you need to eat more to raise your metabolic rate and get your period back (in theory), but as a weight-restored anorexic I will tell you that my ED is screaming, “See!  You DON’T need that much food!  Your metabolism is slower!”  I think that it is a particularly difficult spot to be in since you can’t tell yourself “Well, you do need to gain…”  I am waiting for a follow-up study that shows that increasing caloric intake fixes said metabolic and menstrual issues.  Now THAT is a study I would be excited to read.

(Unrelated P.S. – This is the 100th Grey Thinking post!)

Ignorant Doctor Comments

Cammy wrote a post about an experience that I (and probably many individuals with eating disorders) have been able to relate to on many occasions–an appointment with an ED-ignorant physician.  It happens all the time, and sometimes the professionals are VERY nice… they just don’t know anything about eating disorders.  So, rather than commandeer her comments with my own experiences, I thought I’d dedicate a post to some of the more frustrating remarks that I’ve received from doctors (and nurses–not dietitians, therapists, psychiatrists, etc.  I’ll save those for another day).

1. The nurse practitioner that I saw in college insisted that I NOT see a gynecologist.  This was after I had lost my period for several years, gained back to a normal weight, and still not gotten it back.  She insisted that there was nothing any professional could tell me and that if my body decided to menstruate again, it would.
2. I took an ED medical clearance form to my doctor, and on it there were two blanks for blood pressure–one for sitting and one for standing.  The nurse looked at it and said “Now that’s a silly question–I don’t see why they wouldn’t be the same.”  She took my blood pressure once and wrote the number down twice.
3. I was planning on starting accutane for acne when we learned that there was a high incidence of depression/suicide and accutane treatment.  When we mentioned this to my dermatologist (since I was already struggling with depression), she said “Oh, that statistic MUST be wrong.  When people have clearer skin they are happier!!”  (for the record, accutane did worsen my depression–even though it did really help my skin).
4. My cholesterol registered as high on a blood test (even though the bad cholesterol was low and my good cholesterol was really high… and this is common with anorexia) and my doctor sent me a letter instructing me to watch my diet and exercise more.

I feel like I could go on and on, but I will stop there.  Back in the day I took a lot of things personally (like being told that “if you lose 5-10 lbs then we’ll start monitoring you” or “all your labs came back fine so you are A-OK”) and as an indication that I didn’t have a problem and was asking for help when I didn’t need it… but really, once you’ve seen enough doctors, you start to realize that most of them just don’t know.  And the ones who do get it?  It’s usually because either they themselves or their loved ones have struggled with an eating disorder in the past.

Amenorrhea — not just about the weight

The relationship between ghrelin, amenorrhea, and eating disorders has been examined time and time again. The consensus seems to be that persistent amenorrhea is likely attributed to disordered eating rather than low body weight. I’ll admit that I am particularly interested in this subject because I do have hypothalamic amenorrhea. This finding is interesting for a few reasons:

1. Return of menses is often a benchmark of physical recovery. Goal weights are subject upon your menstrual cycle… if you’re still not getting your period, then you still don’t weigh enough.

2. If you really are at a healthy weight and still don’t get your period, then it just needs to be “jump-started.” I was told this for years without the professional questioning my current ED behavior.

3. I’ve known several eating disordered women who lost their period well within (or above) the healthy weight range. This study clearly shows how possible that is.

4. If you read the study, those with hypothalamic amenorrhea actually consumed MORE calories than those with normal menses. Granted they score higher on the EAT, but still… I wish someone would explain how this is possible — aside from basing it purely on purging behavior. I just have this cartoon image in my head of my body trying to communicate that it disapproves of food rituals 🙂

Now, I realize the adaptive value of this condition… from an evolutionary perspective, not enough expendable energy = not a good time to get pregnant. If you put a modern twist on this, nature seems to be saying: Hey, you’re still not taking care of yourself — no way should you be influencing a kid! You know… kinda limiting the anorexic/bulimic population…

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