Refeeding
-or-
How To Gain Weight

...because not all people are fat :-/


This one seems like a no-brainer, eh? How do you gain weight? You eat. You cannot gain weight without eating... in the exact opposite of losing weight, actually, you cannot gain weight without consuming more calories than you burn off.

The bigger question, in our weight-loss worshipping world, is why would you want to gain weight? Fact is that sometimes we become too thin, dangerously so, to the point where we begin to suffer all these negative side effects and eventually death. Sometimes gaining weight is a pretty attractive option by comparison. Being at a healthy weight helps every system of our body function better, allows us to heal from damage, and gives us reserves as protection against stress or illness as well.

The tougher part of weight-gain is how to do it in a healthy manner. Just as rapid weight-loss can be dangerous, so can rapid weight gain. Many EDs who go through rapid recovery end up with too high a bodyfat percentage, too much fat stored around their internal organs, compromised health, and high cholesterol. This is in part because traditional anorexic "recovery" diets are aimed at bulking up the patient as quickly as possible by fat-loading everything they eat with no thought for the health quality of the food being given.

It's safer to aim for a gain of one or two pounds a week so as to not put undue stress on your recovering system and to know that you're rebuilding bone, muscle, and nutrient stores instead of just frantically storing fat. It's more important to restore your body's protein, elemental, vitamin, water, fat and sugar balances than to simply send the numbers on the scale up. Once you do this, given sufficient raw materials your body will rebuild itself more strongly.



In The Beginning

If you're deciding to gain weight, odds are it's because you're underweight. If you're underweight, barring a purely illness-related weight-loss problem which should really be addressed by a doctor instead, you have probably not been eating enough. If you haven't been eating enough for a while, your digestive system will need to be retrained. Same goes for extended or extensive purging... it screws with your entire system, and there will need to be plenty of time devoted to patience and healing.

Extended periods of time with insufficient solid food intake causes your entire digestive system to slow down and lose efficiency. Amounts of digestive chemicals in production may drop, and the tiny fingerlike cilia that absorb foods in your small intestine may become paralyzed or die off. The peristaltic muscles that move food through your system may weaken or atrophy. Large meals or a lot of food at once may confuse your stomach and intestines to the point where they cramp up and have trouble remembering what to do at all. All this will need to be repaired slowly, given time to reaccustom itself to the concept of processing and utilizing food again.

Start with liquids. Rehydration is extremely important, since without food our overall water content drops significantly, and the digestive process requires a great deal of water. In the first few days of refeeding you may notice a sudden gain of several pounds... this is most likely, if you're doing everything right, your water balance trying to straighten itself out. You may feel bloated for a while as this happens and it's extremely important that you allow it to take care of itself and do not try to correct it with diuretics; limiting caffeine, which acts as a diuretic, may be a good idea here. Potassium can also act as a mild diuretic but do not try to limit that, as it's an important electrolyte and part of rehydration is bringing your electrolytes back up to a good strong level. You may benefit more from drinking water and juice between meals, instead of with meals, as liquids during meals can make your stomach feel fuller and may slow digestion a bit. Carry a bottle of water or juice around and sip constantly when you're not eating.

The first foods you try should be fairly soft and easy to digest, either mostly liquid or very well-chewed. Supplement drinks work wonders here... Ensure, Balance, even Slimfast. There are a lot of high-protein shakes to be found in health food stores, those are also good. Milkshakes are great, especially if you go for peanut butter or chocolate or caramel ones, after you're sure your stomach is going to be able to tolerate an extreme cold temperature. Cream-based soups, thick soups, and stew broth are very good as well if you're okay with the temperature variation, but remember that hot liquids may make you feel fuller more quickly. Oddly enough, babyfood pureed fruits make a good snack, especially stirred into some good live-culture yogurt. Yogurt, with its assorted intestine-building flora, is usually a good thing.

The caveat to milk or milk-based products is that if you haven't had many dairy products for a while you may have become at least a little bit lactose intolerant. If you can find lactose-free or soy-based supplement drinks they may be the best thing to start with. You may also want to try those Lactaid drops, but I've never tried them and can't really speak one way or the other. And the caveat with soy is that too much soy can be hard on your thyroid and may tamper with some of your hormones, so try not to overload on that especially if you have any thyroid issues.

You'll want to be taking in small or moderate amounts of calories every two to four hours, since small frequent meals will help keep your insides from any extended slowdown periods while they're getting used to motion again. This may also help keep your blood sugar more stable; that can often swing around pretty wildly during food-intake changes. If you find that you stomach isn't emptying within four hours then go for a liquid-calorie snack every other feeding instead of having solids at every snackmeal. And, speaking of solids...



Eating Food Again

Be nice to your innards, they've been through a lot. Be nice to the rest of your body as well, since it's managed to get you through insane amounts of stress with very few resources and could probably use a little TLC. What you give yourself now is what you'll be made of from here on out. Treat yourself to good healthy high-nutrient foods, natural sources of vitamins and minerals; pick items that will give you the most benefit per bite. This means staying away from overprocessed, chemical filled, trans-fatty, empty calorie crap. Sure, you'll leap to a higher weight like crazy on a diet of Oreos and CheezWhiz and Big Macs, but you won't be very happy when you get there.

Bread

Whole-grain bread is one of the best things I've found for repairing insides. Find something with at least a few grams of fiber per serving and "whole wheat" instead of "enriched wheat flour" as the primary ingredient. If you can get hold of something with nuts, seeds, or other grains included as well then that's a bonus. If you're used to eating that pasty fluffy white stuff then it may take a little while to learn to love the whole-grain natural stuff. Try it toasted with butter and a slice of real cheese, or butter and peanut butter. Most popular pb brands come with hydrogenated oil, which is not so good; look for the natural, unsweetened versions made with only peanuts and salt instead. If this isn't sweet enough for you, a drizzle of honey over the top goes marvelously well.

Nuts

So, nuts. They're high in good fats and pretty high in protein as well... paired with bread they make up a complete protein, which will help your muscles rebuild themselves more effectively. There are a lot of nutrients and a good amount of calories in a small amount of nuts or nut butter, which is a good thing especially while your stomach is having trouble dealing with a lot of food at once. Try making trail mix or gorp with mixed nuts, dried fruit, dry high-fiber cereal, bite-sized whole-wheat pretzels and so forth. Or just have a sandwich.

Meat

For complete protein you can't beat meat (ahem... yeah). If you're a vegetarian or a priest you may want to skip this part. If you don't get the joke, please just smile and nod and continue onwards. You may want to eat smaller portions of meat for a while because it is a little harder than most other foods for your stomach and intestines to handle. Ground beef may be the highest fat- and calorie-rich meat available, but a diet that high in saturated fat after a long near-fast is maybe not that good for your heart. Leaner cuts of beef and steak are healthier, but can be a little hard to digest and tend to hang out in your stomach for even longer. Ground lean chicken and turkey make yummy hamburgers instead with less saturated fat. Any lean chicken or turkey is good; you may want to fry it in olive or canola oil or bread it and stick it in the oven for a few more calories since it is very lowfat. Venison and buffalo and ostrich, if you want to get fancy, are also nutritious while being lower in saturated fat than beef. Turkey jerky rocks and makes a good quick portable snack if you get it in those flat little packets. Stew or pot roast, where the meat has been cooked long enough for the fibers to start breaking down, is a good option.

Fat
(no, it's not a bad word)

Fat helps keep your skin, nerves and brain in good working order. Fat is also needed for proper absorption of some essential vitamins, and fat is one of the most concentrated neat calorie-sources you can get (nine calories per gram, whereas protein and carbohydrates only have four calories per gram). Fat is also stored as, well, fat in the body more easily than either protein or carbohydrates, which must both be converted to fat before it's packed away. Fat tends to either go along with cholesterol or affect cholesterol levels in some direction. It is a myth that all fat raises cholesterol; unsaturated fats lower it, while saturated fats and trans-fats both raise it. There are two kinds of cholesterol, good and bad. It's the buildup of bad cholesterol with insufficient good cholesterol which leads to heart disease and high blood pressure.

Monounsaturated and polyunsaturated fats are healthy for you in the right amounts; monounsaturated tends to lower bad cholesterol and raise good cholesterol, while polyunsaturated tends to lower both bad and good cholesterol. Unsaturated fats are liquid at room temperature and are found mostly in vegetable oils and nuts. Olive and canola oil are the best common oils; use them in cooking in place of shortening or butter whenever possible. And yes, canola oil works in cookies and cakes, just mix the same amount as you would use of butter into the flour-base until it's in little soft pieces, then add the rest of your wet ingredients. Olive oil is not so good in sweet baked goods but a drizzle of it over pasta, salad or bread is very nice.

Saturated fats are unhealthy for you except in fairly small amounts; they tend to raise bad cholesterol while not affecting good cholesterol. Saturated fats are usually solid at room temperature and we encounter them primarily in meat, egg yolks, whole milk, cheese, butter, palm kernel oil and coconut oil.

Trans-fatty acids (hydrogenated or partially-hydrogenated oils) are bad for you in any amounts; they tend to raise bad cholesterol and lower good cholesterol in a vicious double-whammy. They're what happen when you take some perfectly good vegetable oil and add an extra hydrogen atom, stabilizing it to be solid at room temperature (like saturated fat) and to have a longer shelf life. They're freaking everywhere... margarine, virtually every commercial baked or processed food you'll ever find, you can't turn around in a grocery store without having a dozen of the damn things leaping at your head. The best way to avoid these is to find a good local health-food grocery store and huddle in the aisles whimpering until a nice salesperson takes pity on you and hands you a carrot stick.

Aim to get most of your fat from unsaturated sources, followed by lean meat and milk products. Cheese and butter, though high in saturated fat, are great for gaining weight since they make nearly everything absolutely irresistable and add a good amount of calories without too much mass. A ground-turkey cheeseburger with greenleaf lettuce and ketchup on a whole-grain bun with a side order of homemade sweet potato fries and some fresh fruit would be really good right about now, for me at least. Get your own.

Produce
(the noun, not the verb)

Fruit and vegetables are naturally high in water and fiber and low in calories and fat (with a few exceptions), making them the perfect diet foods but not so hot for weight gain. However, they're superhealthy and a better way to get your vitamins than any pill has ever been. A diet rich in fruit and plant matter is in nearly every imaginable circumstance only a good thing, possibly the best thing you can do for yourself.

In general, richer colors and stronger flavors equal more nutritional value. Dark green leafy lettuce kicks the *** of that wimpy pale iceburg nonsense. Naturally-ripened and organic produce also tends to be higher in nutrition than pasty artificially-ripened conventional produce, but frankly any veggie's better than none so eat what you like. The current advice is to "eat the rainbow", which may sound kind of stupid but which is actually a pretty sound idea... the more variety in kind and color of produce you eat, the better a mix of different vitamins you'll be getting. Try to eat a few different colors of fruit and vegetable each day. Fresh is optimal, but frozen and even canned produce is still beneficial. Tomato sauce and tomato paste, in fact, is richer in some nutrients than fresh tomatoes.

Now, calories. There is that whole filling low-cal aspect, which in this case is not desirable. Add stuff to your crunchy bits. Grill or stir-fry vegetables in olive oil, add a pat of butter or some flax seed oil to steamed veggies, grate some cheese over the top. Most fruit is great sliced over ice cream and added to cottage cheese or yogurt. Peanut butter and bananas is a classic, as is apple with cheddar cheese. Salads can be tossed with a variety of bite-sized vegetables plus cheese, sunflower seeds, raisins, oil and vinegar, flax seed oil, nuts, so forth. Grilled vegetables with cheese go very well in a whole-wheat pita or tortilla, maybe with some grilled chicken strips as well. Provolone, tomato, fresh basil and sliced black olives makes a kickass sandwich. Avocado is a great source of fat and calories. Improvise as per your own inclinations.

Grains and Legumes

Nearly any whole grain gets a high score on the food-value meter. Avoid refined or processed grains, or white rice, as these are invariably stripped of the protein and fiber that make them best. Brown and wild rice are good, and there are a ton of interesting breeds of rice out there to try, red and black and sweet and so on. Rice is also pretty easy to digest and makes a good base for a meal while your digestive system is straightening itself out. Oatmeal and other whole-grain hot cereals are also stomach-friendly; try adding milk or soymilk and butter, or brown sugar and maple syrup, or bits of dried fruit and honey, or sliced apples and raisins with sugar and some apple-pie spice.

Grains are, however, almost entirely carbohydrates. Which means they'll turn into sugar and spike you into what may become a feeding frenzy, which is not a good thing to subject your healing belly to. If you pair a small serving of grains with a high-protein item then you'll feel full faster, your blood sugar will remain a little more stable, and you're less likely to go off on a binge. Including a scrambled egg or some yogurt with breakfast, or some diced chicken and cheese with a cup of rice, or some beans with whatever, may work out a little better.

Beans (kidney, pinto, black, red, navy, etcetera) are usually the most common legumes. Others include garbanzo / chickpeas, green or yellow peas, and peanuts (yes, technically a legume, not really a nut at all). Most legumes are high in fiber and protein, and many are pretty rich in iron as well... paired up with a grain they'll make a complete protein. However, they also tend to be low-cal and low-fat, and are best in smaller amounts with some source of fat added for a calorie boost.

Fish and Seafood

I know very little about either fish or seafood, since I've never really eaten much of either of them. But here goes.

Cold-water ocean fish are very high in good fats and protein and are especially good for your heart and circulatory system. However, the large ocean fish (shark, large tuna, swordfish, etcetera) tend to be far too high in mercury levels for safety and they should not be eaten more than rarely, and probably should not be eaten much at all by small children or people with compromised health.

While almost all fish is low in cholesterol and high in cholesterol-lowering fats, some seafood is extremely high in cholesterol. Shrimp in particular, though you'll want to look this up for yourself if you eat a lot of seafood. Even thinking about eating those scaly little waterbugs is giving me the willies.

Octopuses (octopi?) are very cool and can change colors like little squirmy fireworks. Just keep this in mind the next time you're chewing on a rubbery tentacle... it may at one point have been bright purple or yellow or plaid.



Miscellaneous

Protein powder from various sources (though usually soy or milk) can be found in most health-food stores. They're usually low in fat, but provide a decent calorie and protein boost when mixed into baked goods, milkshakes, smoothies, and the like. Milk powder or condensed milk, from full-fat to skim, can also be stirred into cream soups or shakes or hot chocolate for some extra calories. Check cholesterol on the milk-based stuff.

Carry nonperishable portable snacks with you, in your car or your bag or wherever. A meal bar, a granola bar, a little bag of nuts, whatever. If it looks as if you're going to miss or be late for a meal, you'll at least have something available.

Extra calories through liquid are good things. Drink whole-fruit juice, vegetable juice, chocolate milk, etcetera in addition to your water.

While antacids (like Tums) may help your stomach feel better temporarily, they should only be used if you do indeed have acid problems. Often the problem facing refeeding is too little stomach acid instead of too much. It can be hard to tell the difference. Antacids will only further suppress stomach acid and further slow your food digestion, so use them sparingly and try not to take any before or right after snacks or meals.

You may get some really unpleasant stomach and intestinal cramping while your unused musculature tries to straighten itself out. Warm liquids may help relax the muscles... tea with a squeeze of lemon, or mild coffee, or hot cider, or hot chocolate, whatever. Just sit back and relax and don't even think about exercising or getting yourself tense for an hour or so after eating. An ounce or two of alcohol (if you're of legal drinking age in your area) might also help relax your stomach muscles; port, brandy, cordial, liqueurs used to be commonly used as an after-dinner digestive aid for this purpose.

Experiment with different sleep positions. Eating shortly before bed and then sleeping flat on your back may make it hard for your stomach to deal with the food, as digestive processes slow down during the night. If you do eat before bed try to sleep either on your left side or with your head/shoulders propped up at an angle instead of flat. Sticking some books or bricks below the head legs of your bed to tilt the bed at an angle might make sleep easier overall; it's worth a try.
Source(s):

Disclaimer
The following section is cobbled together from various readings and research, dealing with my kid's allergies and nutritional difficulties, and my own experiences with refeeding, digestive problems, orthorexia and pregnancy. I did not keep track of all the sources. I do therefore encourage you to take any information you may find in here and look it up yourself so you can make your own decisions and reach your own conclusions. Please keep in mind that I'm not a medical or nutritional professional of any sort.