Help re diet for refeeding
skinbonz
Posts: 12 Member
Hi am needing some help around nutrition. My 16 year old was recently diagnosed with anorexia and is severely underweight. I am in the process of refeeding her and am still trying to get her macros right. I seem to be going over with fat and under with protein. She is eating all whole foods and very little of anything processed. She is eating between 2500-3000 calories a day. It is working out around 45% carbs, 40% fat and 15% protein. Recommendations through my fitness pal is 50% carbs, 30% fat and 20% protein. Is the macros she is getting Ok or do I need to change it up? As she has been so undernourished for so long am wanting to feed her the best foods possible and little processed so her body doesn't have to work majorily hard to process it all. Any other helpful info re refeeding?
I will add that we have just been told to refeed and we do not have a dietician or the likes of as someone commented this in another forum I posted in. I am pretty clued up about nutrition etc just bit stuck on these few things
I will add that we have just been told to refeed and we do not have a dietician or the likes of as someone commented this in another forum I posted in. I am pretty clued up about nutrition etc just bit stuck on these few things
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Replies
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The professional who diagnosed your daughter didn't provide any guidance on this topic?
This seems very odd to me.
At any rate, this is something outside the scope of practice of practitioners who are not medical professionals or RDs.
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No they have not given any guidance as to what to feed her. I have a medical background myself and a great understanding on nutrition after my on personal journey so am not just a "jo blog" on the subject. Just wanted to know how important the protein intake is and does the 5% we are under really matter.0
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And the professional that diagnosed it is a psychiatrist so don't think he works with diets0
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You don't have a whole treatment team? Maybe contact some in patient treatment centres for some help?1
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Not with the type of treatment we are doing we just have 1 person we see in this stage of treatment who guides us. We are doing FBT which means the family makes ALL the decisions. Immediate treatment is just to feed so maybe the rest comes later incl a dietician?0
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I help people with their nutrition but am not a doctor or medical professional. I usually recommend to my clients 40% carbs, 35% protein, 25% fats. The other thing to keep in mind is eating often, every 2 1/2 to 3 hours. You may also want to consider supplements to boost the nutritional content.0
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coachsaralee wrote: »I help people with their nutrition but am not a doctor or medical professional. I usually recommend to my clients 40% carbs, 35% protein, 25% fats. The other thing to keep in mind is eating often, every 2 1/2 to 3 hours. You may also want to consider supplements to boost the nutritional content.
Just for my own curiosity on this topic, is there a reason you advocate for eating often?1 -
coachsaralee wrote: »I help people with their nutrition but am not a doctor or medical professional. I usually recommend to my clients 40% carbs, 35% protein, 25% fats. The other thing to keep in mind is eating often, every 2 1/2 to 3 hours. You may also want to consider supplements to boost the nutritional content.
Awesome, thank you so much. I am feeding her that often already but that confirms my thought with trying to increase the protein a bit. I posted this in another food forum Web page and ended up being bombarded with every bit of unhelpful advice except what I was actually asking so I really appreciate your post.0 -
Protein is important, but it's the healthy fats that are really going to be vital when treating someone who's been severely underweight. Most 'average' diets get plenty of protein, and the recommended daily intake for anyone who's not trying to build a lot of extra muscle is only about 10% of your total daily calories (http://www.health.harvard.edu/blog/how-much-protein-do-you-need-every-day-201506188096)
I have many years of first-hand experience in this topic. What concerns me more than anything is the lack of a treatment team. Unless you're VERY well educated on eating disorders, their mental and physical side effects, re-feeding is not going to stick. You can force your child to gain weight, but you can't fix the wires that crossed which made her sick in the first place. Those issues are lurking and gnawing beneath the surface, and without understanding the root cause, they WILL come back.
A lot of professional therapists specialize in eating disorders. I highly, HIGHLY recommend you get your daughter help from one of these specialists. Having dealt with this particular hell for over 15 years, I can't stress enough that FOOD IS NOT THE PROBLEM. There are others, hidden and malicious, that will not go away and need to be addressed before her mind is too rigid and unable to overcome them.2 -
OP does your daughter want to get better? Is she working with you on this, or is there some resistance?0
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Christine_72 wrote: »OP does your daughter want to get better? Is she working with you on this, or is there some resistance?
She working with us and is doing exceptionally well. When we started treatment a few weeks back she was using school to restrict her food but now she is no longer going to school.she has been very compliant and we've had no resistance at all. I'm hoping that's not going to come.0 -
beetle_stomper wrote: »Protein is important, but it's the healthy fats that are really going to be vital when treating someone who's been severely underweight. Most 'average' diets get plenty of protein, and the recommended daily intake for anyone who's not trying to build a lot of extra muscle is only about 10% of your total daily calories (http://www.health.harvard.edu/blog/how-much-protein-do-you-need-every-day-201506188096)
I have many years of first-hand experience in this topic. What concerns me more than anything is the lack of a treatment team. Unless you're VERY well educated on eating disorders, their mental and physical side effects, re-feeding is not going to stick. You can force your child to gain weight, but you can't fix the wires that crossed which made her sick in the first place. Those issues are lurking and gnawing beneath the surface, and without understanding the root cause, they WILL come back.
A lot of professional therapists specialize in eating disorders. I highly, HIGHLY recommend you get your daughter help from one of these specialists. Having dealt with this particular hell for over 15 years, I can't stress enough that FOOD IS NOT THE PROBLEM. There are others, hidden and malicious, that will not go away and need to be addressed before her mind is too rigid and unable to overcome them.
Thank you so much. I do not have any experience in eating disorders but do have a medical background and am pretty clued up. My initial thought is to keep the fats slightly higher (good fats that is) as they are calorie dense so a good way to get calories in with a small amount of food for those times when she is too full. I also share your concern for the what's happening in the head stuff and funnily enough my daughter is also concerned about that. My understanding and I will double check again at this weeks meeting is that once she has gained some weight and her head is functioning properly again then they will work on that. Because she was so underweight (27%, 42 kgs and 167 cms tall) the immediate treatment is just to feed her.0 -
Christine_72 wrote: »OP does your daughter want to get better? Is she working with you on this, or is there some resistance?
She working with us and is doing exceptionally well. When we started treatment a few weeks back she was using school to restrict her food but now she is no longer going to school.she has been very compliant and we've had no resistance at all. I'm hoping that's not going to come.
That's wonderful, half the battle is won. The reason i ask, is a friend of mines daughter went through the same thing at 16 and she fought her parents all the way, which made every little thing 1000 times harder.0 -
Christine_72 wrote: »Christine_72 wrote: »OP does your daughter want to get better? Is she working with you on this, or is there some resistance?
She working with us and is doing exceptionally well. When we started treatment a few weeks back she was using school to restrict her food but now she is no longer going to school.she has been very compliant and we've had no resistance at all. I'm hoping that's not going to come.
That's wonderful, half the battle is won. The reason i ask, is a friend of mines daughter went through the same thing at 16 and she fought her parents all the way, which made every little thing 1000 times harder.
Yeah I've heard that had a good friend go through it with his step daughter and she was pretty bad as well, took them 3 years and several hospital stays but she has been good now for 6 months. Can't imagine how hard that would be and am hoping we have just caught her before it got to that stage. She is very intelligent and wonder whether she is able at times override the voice either that or we have a lot of *kitten* to come0 -
I would not be too concerned about the science of macros right now and continue to focus on healthy, whole foods and most importantly, foods your daughter can begin to enjoy again so she can start eating intuitively. Is your daughter vegetarian? If so, eggs are a great way to get adequate protein, in addition to beans/legumes and high carb/protein combinations like quinoa. If she is happy to eat meat, chicken, turkey and fish are great options that will be easy for her to digest and not make her feel too 'full'.0
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I'd also be curious if you've been advised to track her intake or not.0
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I'd also be curious if you've been advised to track her intake or not.
I have not been advised too and am not tracking it as such. I just put in about 5 days worth for a few reasons mainly to see how many calories she is having so that when they weigh her I can adjust accordingly but also was interested to see how she was sitting with her carb, fat and protein %'s.0 -
Eggs are a good source of protein, and easy on the stomach. So an omelette with cheese could be good.1
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Does your daughter like smoothies? I can make some yummy 1000 calorie bombs.0
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The "standard" MFP breakdown is really only a starting place anyway, and lots of people change it up depending on their goals and preferences. I don't think that anyone on MFP is going to have the ED-specific knowledge to be able to tell you whether a slightly higher protein intake would be slightly more beneficial for her.
I would say that trying to control her diet that much seems like a very bad idea when she's in recovery. Calories are important, and getting a somewhat varied diet is important, but don't reinforce the idea that there is any kind of "ideal" eating pattern. Just let her eat.1 -
The "standard" MFP breakdown is really only a starting place anyway, and lots of people change it up depending on their goals and preferences. I don't think that anyone on MFP is going to have the ED-specific knowledge to be able to tell you whether a slightly higher protein intake would be slightly more beneficial for her.
I would say that trying to control her diet that much seems like a very bad idea when she's in recovery. Calories are important, and getting a somewhat varied diet is important, but don't reinforce the idea that there is any kind of "ideal" eating pattern. Just let her eat.
Completely controlling her diet in this stage of treatment is mandatory and part of the treatment plan the next stage is where she starts getting control back again. As she restricts food by me controlling it she is not able too0 -
Christine_72 wrote: »Does your daughter like smoothies? I can make some yummy 1000 calorie bombs.
I've just started giving her smoothies and have them at 750 calories I add protein powder, Greek yoghurt, pumpkin seeds, almonds, Chia seeds, banana, frozen berries, what else do you think I could add?0 -
Here's my recipe, i won't post the quantity as you can add however much you like.
Chocolate/peanut butter casein
Coconut oil
full fat yogurt
heavy cream
full cream milk
chia seeds
flax seed meal
Banana
Avocado
Spinach (you cant taste it)0 -
The "standard" MFP breakdown is really only a starting place anyway, and lots of people change it up depending on their goals and preferences. I don't think that anyone on MFP is going to have the ED-specific knowledge to be able to tell you whether a slightly higher protein intake would be slightly more beneficial for her.
I would say that trying to control her diet that much seems like a very bad idea when she's in recovery. Calories are important, and getting a somewhat varied diet is important, but don't reinforce the idea that there is any kind of "ideal" eating pattern. Just let her eat.
Completely controlling her diet in this stage of treatment is mandatory and part of the treatment plan the next stage is where she starts getting control back again. As she restricts food by me controlling it she is not able too
Agreed, you cannot give her ANY control until she gains weight and is doing well for awhile. My sister had anorexia and every little bit of control she was given, even though she wanted to recover, her eating disorder took advantage of. It is good that you know calories because many teens "fool" their parents by eating "high volume low cal" foods to make it appear as though they are eating 2000+ calories. That is what my sister did. She took every opportunity to fool my parents, hide food, etc even though she wanted to recover. It is just part of the disorder. She needs to be EXTREMELY closely watched and not trusted until she makes steady progress for months. You are doing the right thing, she is lucky to have you.0 -
Christine_72 wrote: »Does your daughter like smoothies? I can make some yummy 1000 calorie bombs.
I've just started giving her smoothies and have them at 750 calories I add protein powder, Greek yoghurt, pumpkin seeds, almonds, Chia seeds, banana, frozen berries, what else do you think I could add?
Peanut butter1 -
TavistockToad wrote: »Christine_72 wrote: »Does your daughter like smoothies? I can make some yummy 1000 calorie bombs.
I've just started giving her smoothies and have them at 750 calories I add protein powder, Greek yoghurt, pumpkin seeds, almonds, Chia seeds, banana, frozen berries, what else do you think I could add?
Peanut butter
OMG i totally forgot the holy grail. Yes op, definitely add peanut butter.
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Noreenmarie1234 wrote: »The "standard" MFP breakdown is really only a starting place anyway, and lots of people change it up depending on their goals and preferences. I don't think that anyone on MFP is going to have the ED-specific knowledge to be able to tell you whether a slightly higher protein intake would be slightly more beneficial for her.
I would say that trying to control her diet that much seems like a very bad idea when she's in recovery. Calories are important, and getting a somewhat varied diet is important, but don't reinforce the idea that there is any kind of "ideal" eating pattern. Just let her eat.
Completely controlling her diet in this stage of treatment is mandatory and part of the treatment plan the next stage is where she starts getting control back again. As she restricts food by me controlling it she is not able too
Agreed, you cannot give her ANY control until she gains weight and is doing well for awhile. My sister had anorexia and every little bit of control she was given, even though she wanted to recover, her eating disorder took advantage of. It is good that you know calories because many teens "fool" their parents by eating "high volume low cal" foods to make it appear as though they are eating 2000+ calories. That is what my sister did. She took every opportunity to fool my parents, hide food, etc even though she wanted to recover. It is just part of the disorder. She needs to be EXTREMELY closely watched and not trusted until she makes steady progress for months. You are doing the right thing, she is lucky to have you.
Thank you so much that is so kind. It's a horrid disease and I hope your sister is in recovery and doing well now. Yes they are definitely sneaky although she is very upfront when she has missed a meal but she has proved that if I do not bring her food she will not eat. She is in no way able to control what she eats. We are so lucky she isn't resisting and being so compliant it certainly makes it easier.0 -
It may be terrifying for her, but I would also encourage eating out once in a while so that she cannot track and estimate calories. With foods made at home, especially when she can see you preparing the meal, it will be very easy for her to evaluate the calorie content, whereas out in a restaurant, it is much harder to be so specific. I know a lot of dietitians recommend this approach, which also encourages the social enjoyment of eating to be reinforced. It sounds like right now she is being very accommodating of you preparing the meals, but just something to think about if things don't continue to go as well.1
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