I am an eating disorder dietitian and spend a lot of my clinical time working with clients who have anorexia nervosa. Over the 17 years I have been doing this work I have written many hundreds of meal plans alongside my clients & patients.
Whilst it would be amazing if I could give you a “one-size-fits-all” plan….as with most parts of recovery, it is just not that simple! It really does need to be personalised. And also must take into account the risk of refeeding syndrome (and this is a good thing to discuss with your GP or treatment team).
However, from the perspective of what you could be aiming for – balance in your diet is key. So often certain macronutrients are demonised, both by the eating disorder voice and also by our society and media.
I have written this blog post to try and help you to cut through the “noise” and get the facts – which will hopefully allow you to be able to have more of a balance in your diet.
The latest on Carbohydrates why do we need them?
Pasta in various forms provides us with the macronutrient carbohydrate
We are surrounded by self-proclaimed nutrition “experts” who have come into the limelight often promoting their version of fad eating plans.
There are a lot of myths concerning carbohydrates and this will hopefully help you to distinguish the facts from the fiction.
Carbohydrates, as a macronutrient, cover a broad category of food and not all carbs are the same.
Types of carbohydrates
Carbohydrates are one of three macronutrients found in food – the others being fat and protein.
Hardly any foods contain only one nutrient and most are a combination of the macronutrients, carbohydrates, fats and proteins, in varying amounts.
There are three different types of carbohydrate: sugar, starch and fibre
Sugar is found naturally in some foods, including fruit, fruit juices, milk (lactose) and vegetables. Other forms of sugar (free sugars) can be added to food and drink such as sweets, chocolates, biscuits and soft drinks during manufacturing, or added when cooking or baking at home. In the UK the maximum amount of free sugars (that is, the added sugars) should be 5% of the total daily energy intake or around 7tsp of sugar.
How carbs affect the body
From there, the glucose enters the body’s cells with the help of insulin, released from your pancreas. Your body uses glucose for energy to fuel all of your activities; whether going for a run or breathing.
Unused glucose can be converted to glycogen found in the liver and muscles. If unused, glucose can be converted to fat, for longer-term storage of energy.
Some carbohydrate is stored in the body, however there is a limited supply, and when you exercise these stores are depleted.
The best way to replenish the carb stores is to eat a carbohydrate rich snack or meal as soon as possible after finishing exercise. This should also contain some protein as this helps to replenish the stores more quickly.
So, for example, you may choose breakfast cereal with milk, a yoghurt or fruit smoothie, or a stir-fry with rice or noodles. A diet too low in carbs can lead to a lack of energy during exercise, early fatigue and delayed recovery.
So, all carbohydrates are converted to glucose and absorbed into blood. Blood glucose concentrations are maintained between 4-7mmol/l by hormones released from your pancreas called insulin and glucagon.
Insulin reduces glucose in the blood and glucagon releases glycogen from liver and muscles to increase glucose in the blood.
Which carbs should I be eating?
Fruit, vegetables, pulses and wholegrain starchy foods provide a wide range of vitamins and minerals and the fibre in these foods can help to keep your bowels healthy and adds bulk to your meal helping you to feel full. Try to increase the amount of fibre in your diet by choosing wholegrain varieties of starchy foods and eating potatoes with the skins on. Try to aim for an average intake of 30g of fibre a day.
Sweets, chocolates, biscuits, cakes and soft drinks with added sugar are usually high in sugar and calories, and provide very few other nutrients. However, it is completely normal to have these types of foods, and they taste great!
What happens if we don’t have carbohydrates in our diets?
- Low carbohydrate diets continue to be popular and get a lot of media attention. However, they are not healthy, not sustainable, and can put a great deal of extra stress on the body
- Muscles are lost as they are used as energy for the body
- Much greater risk of some cancers – e.g. bowel cancer
- Tiredness, fatigue, irritability due to low blood sugar levels (no other nutrient provides glucose)
- Inability to concentrate since the brain primarily uses glucose to work
- Poor performance – in everyday life and sport
Fat – what should we be eating?
Although fats are often thought of as “bad”, in fact they are completely necessary for our bodies to function.
The reason that there is a lot of media interest in fats and, in particular, emphasis on fat reduction is because a lot of people in the UK are eating a lot more fat than the recommended amounts.
What are fats used for?
- Providing energy
- Keeps us warm
- Absorption of fat soluble vitamins (A, D, E and K) – humans are unable to absorb these essential vitamins without having fats in their diet
- Palatability of foods – making them taste nice!
- Providing a protective layer around organs (e.g. kidneys, etc) to protect them from impact, like falls
- Fats contribute to the structure of blood vessels, and form a major component of cell membranes. A low fat intake will therefore increase the risk of bruising very easily, and affect skin health.
- Fats transport cholesterol around the body. Many people who are a low weight can have a high cholesterol level, which reduces if fat is added to the diet and weight is gained.
- Fat contributes to the structure of hormones, such as oestrogen. A lack of oestrogen will lead to a lack of periods, which increases the risk of osteoporosis. Therefore, a diet low in fat may delay the return of menstruation, or the body may need to be a higher weight before periods return if a low fat diet is consumed.
- Increasing satiety, which means that you will feel fuller more quickly than if you do not include fats. Therefore you will not feel that you have to keep eating/will not be able to stop eating after finishing a meal or snack
Dietary fat provides the essential fatty acids linoleic acid and linolenic acid (also known as omega 3 and omega 6 fatty acids). We need to eat these on a daily basis. They are essential for brain function, including the brain development of the growing foetus. They are also very important in improving brain function when returning to a normal weight after being a low weight. They also have a role in preventing heart disease.
Types of fats in our diet
- Saturated fats: from animal fats and products derived from animal fats (including biscuits, etc). These are necessary to provide cell membrane structure, but can raise LDL blood cholesterol if eaten large quantities
- Monounsaturated fats: olive, rapeseed and almond oil, nuts, olives, peanut butter
Most beneficial, especially when used to replace saturated fats
Polyunsaturated fats: Omega-3 and Omega-6
Omega-3 fatty acids are essential for our health and important as part of a balanced diet
what are they?
Why are essential fats important?
How much do we need?
What if I don’t eat fish, can I have supplements?
- Avoid supplements made from fish liver oil as this has less omega-3 fatty acid and may have more contaminants. Find a supplement made from the oil from the fish body.
- Check the vitamin A content -The Scientific Advisory Committee on Nutrition (SACN) advises that if you take supplements containing vitamin A, you should not have more than a total of 1.5mg (1500ug) a day from food and supplements combined (also in pregnancy you must not take supplements containing vitamin A)
- Check labels for DHA and EPA content – stick to the daily amount provided by eating one to two portions of fish per week (about 450mg EPA and DHA per daily adult dose)
There are currently no UK recommendations for omega-3 supplements as there is not enough evidence that they benefit healthy adults and children.
Vegetarian sources of omega-3 fats:
Fats are not automatically converted into body fat. As long as you are eating the correct amount of energy to maintain your body weight, the fat you eat (and energy you get from the other nutrients) will be used for energy.
If you need to increase your weight then the energy you consume over and above your needs to maintain your weight, will be used to start to replenish your muscles. You will also notice that your fat stores do increase (adipose tissue) and this is entirely necessary for recovery to full health.
Protein: Your Body’s Building Blocks
What is protein?
Protein is required by the body for many different functions including:
- Growth and repair of body tissues
- transporting nutrients around the body
- forming enzymes
Foods high in protein:
Amino acids are found in animal products (as complete protein) and a few plant sources (as incomplete protein).
– Good sources of plant-based protein include: tofu, chickpeas, lentil, baked beans, nuts, and kidney beans.
These protein rich foods also provide iron, calcium, vitamin B12 and omega-3 too.
Fish, beans and nuts contain the macronutrient protein
What happens when we don’t consume enough protein?
How much protein should I eat?
Protein should contribute to 15% of our total energy.
Very high protein diets that cut out or drastically reduce other macronutrients are not helpful for anyone and this can lead to eating disorder development.
Aim to eat a variety of food, regularly throughout the day, leaving no more than 3-4 hours between meals and snacks and aiming for 3 meals and 3-4 snacks a day (as a minimum!) as a goal.
And remembering small steps are great – celebrate every win!