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Cracked Lips and Thermal Regulation Issues With Anorexia

By January 10, 2013

I watched one of your videos about anorexia and it mentioned having some signs and symptoms like cracked lips. I am trying to recover at the moment, albeit slowly. I now weigh *** from ***. I am 5’10” and I am gaining. But my lips are still cracked and my hands and feet are still blue from time to time due to bad circulation. Even though I have three meals a day and some snacks, I am still finding it difficult to eat more than 800 calories a day. I know for a woman I am supposed to eat around 2,000. How can I up this intake? What kind of foods should I be eating to get it up to the healthy amount? Thanks. – VC (England)

Dear VC,

Congratulations on your weight restoration thus far…good job! Sounds like you are on the right track, but in need of a few pointers.

First, if at all possible, it would be great to visit a registered dietitian or equivalent (not sure what credentials are required in the UK) in order to get a meal plan written down with your specific needs in mind. A dietitian can also serve as a great accountability source as well as a coach when the going gets tough. It would not be wise for me to provide an actual meal plan without knowing your individual needs; however, I’m happy to offer some general guidance.

In terms of what to eat, that depends on what you like. Generally, assuming you have no disease condition or medical need for a special diet, a diet that consists of about 55-60% calories from carbohydrate, 25-30%(even up to 35%) calories from fat, and 15-20% calories from protein is what meets the body’s nutrient needs.

I understand the risk of providing actual numbers – a percent of calories-needed can wreak havoc in an anorexic mind. It is all too easy to become obsessed with meeting these percentages “perfectly.” Please resist the urge to count calories and calculate these percentages exactly – that is not the point at all.

Rather, this provides a general guide to encourage eating a wide variety of foods (especially fats) that may have been problematic in the past at a lower body weight.

Overall, weight gain and fats will aid the cracked lips and help the thermal regulation with which you struggle now.

A dietitian can translate these percentages into actual foods and number of servings per day that will meet your needs each day. For now, try to eat every 2 – 3 hours. Eat foods that contain a little of each: carbs, fat and protein. Resist the urge to eat only one type of food or to eliminate an entire category (such as all fats or carbs).

Eat foods that appeal to you and taste good, foods that are satisfying. Try not to have rules around “good” versus “bad” foods or calorie content. Eat with structure right now so that one day you may eat with more freedom: eat when hungry, stop when full, all with balance, variety and moderation.

Right now, since you still have weight to restore, you don’t have the luxury of only eating when hungry. Hunger may be confusing right now and you may not recognize true (physiological) hunger. Or, you may be so ravenously hungry all the time since your body is in an anabolic (rebuilding) state that you are frightened it will last forever and you will never stop gaining weight.

As long as you keep recovering and eat intuitively, this will not happen. If you are dialed into your body’s cues, this hunger naturally subsides the closer you get to your body’s set-point weight. At your maintenance weight is when you can truly eat when hungry, stop when full or satisfied. My guess is, at 5’10” and ***, you still have a way to go to achieve an optimal weight for your body. Again, a dietitian can help you determine what an ideal weight for your body is.

Keep working hard and asking for help. You can do this!

Juliet N. Zuercher, RD