Earlier this month, we began our two-part series on your body’s response to binge eating. We focused on the difference between overeating and binge eating and introduced a case study of an individual dealing with binge eating disorder (BED).

In today’s blog post, we’ll dive into this patient’s treatment path at The Kahm Clinic and take a closer look at how binge eating impacted her metabolism.

Before we begin, it’s important to remember that there are two pieces to most eating disorders. As the dietitian, nutritionist Elaina Efird, RDN, CD, CEDRD, CSSD worked with this individual on the physiological aspect of her eating disorder, while a therapist helped with the emotional piece. 

Now, let’s consider her metabolic testing results. Her metabolic rate actually stayed fairly high at 2,473 calories per day — which makes sense! “Even though I don’t want her on this cycle of restricting and binging, her total daily calories was upwards of 7,000,” Elaina explains. “Ultimately, her body’s metabolism did not drop because she was still eating the calories she needed each day.”

There is another part of the metabolic test that we don’t often cover in case studies: fat metabolism and carbohydrate metabolism. Before we look at the results, note that, prior to testing, the patient fasts for at least four hours. In this case, the individual actually fasted overnight. 

“The reason that’s important is because the fat utilization is exactly that: your body’s breakdown of fat in the body. Your carbohydrate utilization, then, is your body’s breakdown of food,” Elaina shares. “After fasting overnight, your body’s carbohydrate metabolism should be at zero.” 

In this binge eating case study, though, that’s not the case.

The patient’s body was breaking down a lot of carbohydrate substrate — 14.7 percent above normal, in fact. That means that her body was still digesting the food from her binge the night before. Because her body was spending so much time breaking down the food, it wasn’t effectively burning fat in a fasted state, so her fat metabolism was actually 12.9 percent below normal. “These numbers go hand-in-hand,” Elaina adds. “They’re a result of the binge the night before and her body trying to compensate and digest all of that food.”

So what do we do in a situation like this one? To start, therapy is necessary. This patient was already seeing a therapist, which we recommend for all individuals dealing with BED. As the next step, from a nutrition standpoint and for physiological purposes, this individual needed to eat more calories earlier in the day, even if she had a binge the night before. 

As we mentioned above, her resting metabolic rate was around 2,400 calories. We added to it for general movement and exercise and determined her daily calorie needs to be around 3,200. We recommended that she eat between 2,800 and 3,000 calories each day. 

Her immediate worry was that she was going to eat those calories throughout the day and still binge at night, thus increasing her total intake. 

“That’s a valid concern,” Elaina says. “But the reason we want to eat those calories during the day is an effort to break that binge-and-restrict cycle.” By eating enough earlier in the day, she won’t be hungry in the evening and tempted to binge.” Plus, without the hunger, she can more easily focus on the emotions that are leading to the binge.

In two to three months, she was regularly eating the recommended calories each day during the day. During this time, the frequency of her binges naturally decreased from five to seven days per week to two to three days per week. Of course, the ultimate goal was zero binges, but that takes time. In the following six to eight months, she focused on fueling her body. Her binges, then, decreased to once per month. When she finished working with Elaina, she hadn’t had a binge in nearly five months. 

“You have to trust the process. Realize that it’s important to nourish your body well earlier in the day to get you out of the binge-restrict cycle and allow you to work on the emotions behind the binge,” Elaina explains.

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