More on hypermetabolism

I had mentioned about a week or two ago that I was going to begin a blog series on the biology of eating disorders. I wanted to start with something about the causes of EDs or something like that, but I think this topic is extremely relevant and so we can just call this the first post in the series.

I did some more research tonight into the biology and etiology of hypermetabolism. So let's start with a basic definition from Wikipedia:

Hypermetabolism is the physiological state of increased rate of metabolic activity. The impact of the hypermetabolic state on patient nutritional requirements is often understated or overlooked. Hypermetabolism typically occurs after significant insult to the body. In hospitals and institutions, the most common causes are infections, sepsis, burns, multiple trauma, fever, long-bone fractures, hyperthyroidism, prolonged steroid therapy, surgery and bone marrow transplants.

And, yes, eating disorders. Specifically anorexia. As someone falls deeper and deeper into anorexia, their metabolic rate slows dramatically. During the Minnesota Starvation Study, resting energy expenditure (also known as basal metabolic rate- the amount of calories needed just to keep your body functioning and doesn't include ANY physical activity) fell by about one-third. The book "Introduction to Clinical Nutrition" says that

Starvation involves metabolic alterations that enhance the chance of survival by increasing the use of body fat stores, by sparing the use of glucose, by minimizing nitrogen loss, and by decreasing energy expenditure.

But when the ill person begins eating again, their metabolism kicks into high gear. Body temperature rises. A person can experience night sweats, which may also be related to hormone function returning to normal.

Why? It seems a remarkably inefficient use of resources. And indeed, hypermetabolism may not be entirely adaptive from an evolutionary standpoint as the body's use of food becomes remarkably inefficient. Even so, the body needs tremendous amounts of energy to replace lost fat and muscles stores, depleted organs, bone mass, hair, nails, you name it. No organ system is spared during an eating disorder.

The amount of calories needed for people with anorexia to return to a healthy weight can vary by illness severity (a lower BMI means more calories, as well as duration of illness), and by illness subtype. One study found that those with the binge-purge subtype of anorexia needed significantly fewer calories than those with the restricting subtype; another study found that calories were about the same. Other variants include your metabolic rate before illness onset. I've known several good friends curse their fast metabolisms quire vociferously during refeeing.

When looking at the phase after weight restoration, caloric needs between people with anorexia nervosa and those with bulimia nervosa turn out to be quite different. One study found that people with AN needed more calories per kilogram of body weight than normal controls, while those with BN needed fewer. It appears that people with a current diagnoses of BN but a history of AN require more calories than those with BN alone. Further, people with the restricting type of AN needed more calories than those with the binge-purge type, both of which were greater than patients with BN (some of the studies cited above show that, for weight maintenance, caloric needs are basically the same for any patient with a current diagnosis of AN).

Some of these differences may rest in premorbid differences in metabolic rate. It makes intuitive sense that a person who finds it easy to lose weight would have a faster innate metabolism. Other reasons calorie needs may remain unusually high for a person even after weight restoration is the sheer amount of rebuilding the body needs to perform. Bulimia is violently destructive to the body, and I would never say differently. However, some of the damage done by anorexia is slightly different, and the body must rebuild and repair essentially every organ in the body. My psychiatrist told me that the nerves continue to repair themselves for up to two years after weight restoration. This can hardly be the only organ system taking a long time to recover.

How long hypermetabolism lasts will probably vary from person to person, and depends on how long you were sick, how your body responded to the damage from your eating disorder, your activity levels, among others. There's no real way to be sure. If your caloric needs are unusually high--even for hypermetabolism--you can have body composition analysis and resting energy expenditure testing done. Personally, I think this is best left to extreme cases since so many of us have a tendency to fixate on numbers.

I hope this helps explain hypermetabolism just a little bit. I can't answer every question, as it's been a long time since my college biochemistry days, but I can always look things up.

55 comments:

greythinking said...

I've always found hyper-metabolism fascinating. I have a question though, which you may not have the answer to....

I've done the refeeding thing several times and been hyper-metabolic when in intense treatment. However, there have been times when I was outpatient and would eat MORE... but not technically ENOUGH... and I would gain weight much faster than the inpatient times. Why is that? I guess I just don't understand why sometimes you are hypermetabolic and other times you are not? It's something I've always been curious about.

Great post -- I love this stuff.

cbtish said...

Regarding "Why?" here's an uninformed guess.

Nutrition is not just about calories. Calorie intake and use is a rapid cycle, but other nutrients like minerals and some vitamins have a much longer cycle. Even protein, in a hunter-gatherer diet, was a long-term asset.

You see this in modern times in places where food is plentiful, but it's only low-protein food like grain. People have to eat far more calories than they really need to survive, just to get enough protein.

So, to restore other nutrient levels quickly when food is plentiful after a period of starvation, it may be efficient for the body to waste calories.

Carrie Arnold said...

GT,

Part of the reason may be that you weren't stoking the metabolic fire as much as an outpatient, and it slowed down a little. Because if you're not eating enough, your metabolism won't be able to really ramp up.

cbtish,

Very good point about the protein. An unavailability of nitrogen is one of the things that can stimulate hypermetabolism, as protein has nitrogen while carbs and fats do not.

Anonymous said...

What kind of damage is caused to the nerves from anorexia?

Anonymous said...

What kind of damage is caused to the nerves from anorexia?

Carrie Arnold said...

Anon,

I don't know about every different type of damage, but the most common comes from a lack of fat in the diet. Nerve cells (like ALL cells) have a coating of lipids; without that membrane, it can't conduct the electrical impulses properly. Some common problems include numbness and tingling in the extremities. Occasionally, the damage can be permanent, but it usually goes away not just with weight restoration, but also with making sure you eat enough fats.

Starvation also slows down the electrical impulses in the nerves, which leads to a lack of coordination. This is amplified by the electrolyte imbalances common to both anorexia and bulimia.

A said...

Hey Carrie,

I was wondering if with all your wisdom you could answer a question for me. . .

The last two times refeeding I have been hypermetabolic -- this time, as an outpatient, I am gaining on much fewer calories (though my weight is lower). My dietican assures me that my BMR may not have caught up yet with my weight/refeeding. Have you ever heard this happening to anyone?

A

Laur said...

just, in agreement/commiseration with others, my body's reaction was different every time I went into treatment! I'm BN and yet 2 times I went hypermetabolic and others my metabolism was painfully slow. who knows! different time, different age, different severity of symptoms.... I dunno!
Recovery requires so much patience!

Carrie Arnold said...

A,

Yes I've heard of it, but no, I don't know why. I think to some extent, you need to be eating enough for your body to launch into hypermetabolism (though not always).

Laur,

You're right- it does vary. Greatly!

Anonymous said...

Does hyper-metabolism happen to all anorexics, I mean, is it a qualification of an anorexia diagnosis?
I am thirty and was first diagnosed an at 14. i relapsed at 17 and at 27. I do not have to eat a lot to maintain my weight, i have always regained rather quickly. Also, I was an early bloomer, a normal/large kid who did not need to eat a lot to have a healthy weight. I think that is why my e.d. started, i just felt so huge for no reason. Could I just have a naturally slow metabolism? I met standards for a diagnosis but I was never severe - no tube or anything. Losing weight has always been a slow process, even at my sickest when i was barely eating and over exercising. I don't really understand what is going on with my metabolism and have never felt comfortable discussing with medical professionals.

Carrie Arnold said...

Anon,

I'm not sure whether hypermetabolism happens to everyone. I don't think it does, especially if you've had an ED for a long time. Also, the fact that you mentioned you had a slower metabolism to begin with might have made a difference.

But no, it is *definitely* not the criteria for diagnosing AN.

Thanks for writing!

Carrie Arnold said...

Laur! I'm sorry- I just checked your profile and realized how I knew you! Hope things are going well.

Anonymous said...

sunkeThis is Laur, posting from work.

Hey, yeah, I should have introduced myself.

It's been a long time!

but yeah, I think we were both on SF, you sent me mail when I was in Philly (on Hogwarts stationary, I believe!) and I gave your first book a stellar review on amazon!

:-)

Anonymous said...

Hi Carrie,

I am someone who is recovering from an eating disorder and recently relapsed. However, my relapse was not to a point where I was eating a starvation level of calories, but closer to about 1300-1600 most days with some variation. However my BMI is now very low again and I've recently been eating back around 2500 calories with some days over that. Before, I was eating 3000+ and yet this time around I've already "put on" about four and a half pounds in six days. That's not humanly possible, is it? I don't know. I know I should not be weighing more than once a week and probably not at all for a couple of weeks while adjusting to my high intake again due to water retention and such, but I'm worried I have screwed up my metabolism because I did not technically "starve" to lose weight this time even though my weight is low again. Will my body still have damage to repair, to expend those extra calories on? Organs, and so on? Does this rapid gain stop?

What is your view on this? If it makes any sense at all. I know I am rambling somewhat.

Anon

Daveen said...

this article explained a lot! I have a question though, when I was inpatient, I had really bad night sweats...how'ever they went away but now they keep coming back on and off...its been 6 months and it still kicks in and out...I dont really understand what is happening
Thanks!
D

Anonymous said...

Hi Carrie,

Really enjoyed your books and blog. We've been refeeding my 15 year old with RAN sor almost 11 weeks (she's gained about 13 pounds) and is quite warm usually. Her feet and hands swell and get red/hot usually in the morning and at night. Not sure if it's also related to stress. Her doctor did a thyroid check; it's fine. Have you ever heard of this? THANKS!!!

Carrie Arnold said...

Yes, I've heard of this. I believe it's called Raynaud's Phenomenon.

You can find a link here:
http://www.medicinenet.com/raynauds_phenomenon/article.htm

Anonymous said...

Carrie,

Wow - you are good! I think that's exactly what my daughter is experiencing. Her doctor and therapists didn't know, so thanks for solving the mystery and giving me some piece of mind. Wish you could know how very, very much I appreciate it! Thanks, too, for this blog and all you are doing to help others. You are one amazing person, Carrie; don't forget that!!!
Warmly,

Laura

Anonymous said...

Is this condition only brought on by poor nutrition and eating habits or can it be a symptom to a more serious problem such as cancer? I have researched this term and not found much information about it... The condition is concerning my brother and his health. He does not have an eating disorder..but discovered a spot on his lung and an enlarged arota. Thanks

Carrie Arnold said...

Anon,

Hypermetabolism can happen for any number of reasons, only one of which is recovering from starvation/malnutrition. Wikipedia has a decent summary if you want more information.

Hope your brother is on the mend soon.

Anonymous said...

interesting to read that most with AN b/p don't require as many calories as those with AN-r during refeeding.. i myself was AN-b/p and was hypermetabolic, requiring the highest meal plan possible (won't say numbers but was A LOT of calories)..
and at the time i was surprised, didn't think i'd need that much to gain, and i don't think my pre-ED metabolism was anything remarkable, though it was certainly at least average if not above-average. now, a diff. story :/

Anonymous said...

me again. what CBTISH said makes sense, but on an inpatient unit, the diet is balanced and not low-protein.. yet patients there experience hypermetab. i guess because with a loss of weight (ie, muscle) PRE hospitalization, there's a loss of Nitrogen?

Anonymous said...

Will everyone who has had an eating disorder (I have AN) have a hyper metabolism?

Anonymous said...

...so if someone regains weight rapidly on a low calorie level, meaning that during their "recovery" their body never got out of the adaptive thermogenesis of starvation, is it possible that a drastic increase in calories AFTER weight restoration could induce a hypermetabolic state?

Anonymous said...

...so if someone regains weight rapidly on a low calorie level, meaning that during their "recovery" their body never got out of the adaptive thermogenesis of starvation, is it possible that a drastic increase in calories AFTER weight restoration could induce a hypermetabolic state?

findingASignInNameIsTedious said...
This comment has been removed by the author.
Yvonne Madden said...

Carrie,fascinating topic,thanks a million for your research and efforts responding to questions.

Luckily for me (kinda), I'm out of my anorectic times and far into recovery from BN so this post doesn't exactly apply,though I can identify.

I just followed you on Twitter,not sure if you'll get this comment but said I'd give it a go.I'm excited to check out this blog - I LOVE uncovering new,interesting blogs and the more physiological the better! :)

Yvonne X

petersmith said...

The impact of the hypermetabolic state on patient nutritional requirements is often understated or overlooked. It is basically occurs after significant insult to the body.
regards
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petersmith said...

I don't really understand what is going on with my metabolism and have never felt comfortable discussing with medical professionals.
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CherylC said...

Hi, i would like to ask if hypermetabolism occurs to everyone in recovery? and what are some symptoms that come along with it? usually how much should a person be eating to experience this? and how long does it take for a person to experience this?
thanks!
Cheryl :)

Cheryl Chua said...

Hi, i would like to ask if hypermetabolism occurs to everyone in recovery? and what are some symptoms that come along with it? usually how much should a person be eating to experience this? and how long does it take for a person to experience this?
thanks!
Cheryl :)

petersmith said...

I have researched this term and not found much information about it.
Pawnbroker

sam: soccersammy22@yahoo.com said...

hello,
i just came across this and was wondering if you could help me with a quick wquestion. i have suffered from annorexia for a few yrs and have finally reached a healthy weight. HOWEVER, my metabolism is still very slow and i know to increase my metaolic rate i must increase the amount of calories im consuming however this would entail weight gain which i do not want nor need. can you please explain how to increase my metabolism without excess weight gain?

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Good day to all the viewers that is reading this article this moment, i am so much glad to be writing to express how grateful and happy i am toward the great manifestation that the great Dr otaru did for me, since when i was 12years i have been diagnosed of having HIV/AIDS disease, ever since that time my living everyday has been so much unbearable i have been humiliated by my peers and mates in school and even at my office, anytime there is a little quarrel i am always reminded of this incurable disease, before now i have visited several physicians and hospitals just to be cured but all my endless effort was deserted, until one fateful day when i was browsing on the internet on any help or remedy to be cured and as i was going through the numerous testimony u came across so many testimonies of how Dr otaru has cured so many people of their HIV/AIDS, so i contacted him immediately on his email address:otarusolutionhome@gmail.com, then after writing to him through his email, he replied back to me and told me that i will be cured, thereafter he told me that he will prepared a herbal medicine and send to me, and that after using his herbal medicine in 2 weeks i will be cured,that was it, i was totally cured, contact him today on his Mobil:+2348107345943

ruiz mary said...

Good day to all the viewers that is reading this article this moment, i am so much glad to be writing to express how grateful and happy i am toward the great manifestation that the great Dr otaru did for me, since when i was 12years i have been diagnosed of having HIV/AIDS disease, ever since that time my living everyday has been so much unbearable i have been humiliated by my peers and mates in school and even at my office, anytime there is a little quarrel i am always reminded of this incurable disease, before now i have visited several physicians and hospitals just to be cured but all my endless effort was deserted, until one fateful day when i was browsing on the internet on any help or remedy to be cured and as i was going through the numerous testimony u came across so many testimonies of how Dr otaru has cured so many people of their HIV/AIDS, so i contacted him immediately on his email address:otarusolutionhome@gmail.com, then after writing to him through his email, he replied back to me and told me that i will be cured, thereafter he told me that he will prepared a herbal medicine and send to me, and that after using his herbal medicine in 2 weeks i will be cured,that was it, i was totally cured, contact him today on his Mobil:+2348107345943

Felix Clark said...

Hello viewers..i don't just know the reason why some people are still finding it difficult to believe that there is no cure for Herpes virus i have been Herpes since last six years,and my doctor say there is no cure for herpes and anyone that will say herbal medicine can cure herpes is lies,then discus with a friend of mine who was once troubled with herpes disease,he told me it a lie that herbal medicine exist, that Dr.Suku cured him,thereafter he referred to a doctor called Dr.Suku and told me to contact him,so i contacted Dr Suku lo and behold after 2 weeks my herpes virus was cured totally am now herpes negative by Dr.Suku Herbal medicine,so i no that there is some people that can't still believe that herpes have no cure so friends i will not lie to you Dr.Suku is a great herbalist that cure any types of Disease,HERPES.HIV/AIDS.CaANCER.HEPATITIS B.LOW SPERM CAM.DIABETICS.
visit his website: http://greatsukusolutiontem.wix.com/dr-suku
his Mobil number +2348074839242
him email now:greatsukusolutiontemple@hotmail.com

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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

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nour·ish: (v); to sustain with food or nutriment; supply with what is necessary for life, health, and growth; to cherish, foster, keep alive; to strengthen, build up, or promote



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