Cranky? Could Be You’re Hungry

One member posted last year that she finds she gets annoyed when she feels hunger and she resists those signals until she cannot resist any longer. However, she experiences the food she does eat as tasteless and unappealing.

So what’s happening?

ever falling:
ever falling:

Well it’s complicated, of course.

First of all, irritability is common in clinical anxiety [generalized anxiety disorder, post-traumatic stress disorder—DSM IV]. Eating disorders appear to generate some functional anomalies in the brain that are closely related to anxiety disorders and anxiety disorders appear in the familial aggregation of eating disorder probands. 1,2,3

Translation: anxiety associated with the consumption of food is a persistent trait for those on the eating disorder spectrum and the anxiety is genetic in nature.

Irritability is also common for those who have a reduced energy intake.

In fact an interesting study in Morocco during the month of Ramadan (the ninth month of the Islamic calendar)— a religious observance involving a month of fasting from dawn to dusk each day.

Irritability was significantly higher in smokers prior to Ramadan than non-smokers, but irritability increased steadily in both groups reaching its peak at the end of Ramadan. 4

And finally, irritability is a common symptom of hormonal imbalances.  Of course, women who restrict food intake are known to have functional hypothalamic amenorrhea in many cases, but even if the menstrual cycle is present and ovulatory in nature, there can still be measurable anomalies in the levels of the various reproductive hormones. Notably, mild hyperandrogenism that can be linked to heightened irritability. 5

The annoyance and irritability that is present in the face of hunger is likely some immeasurable mixture of the starved brain, the anxious brain and the hormonally-imbalanced body.

And what of the bland, tasteless food that finally gets eaten? The resistance against hunger leads to deeper levels of fatigue, damage and dysfunction. Interestingly, unpalatable foods (in the study I am about to reference think: moldy corn) become less disgusting when subjects are food-deprived than when they are well fed. 6 It means that finding food less palatable with deprivation likely involves facets directly attributable to the eating disorder.

While there are clinical trials that suggest those with eating disorders have lower neural activation in the insula and the ventral and dorsal striatum (of the brain) 8, as well olfactory (smell-capability) deficit 9, it is difficult to determine what these results may mean. For example, lower neural activation in the insula as well as ventral and dorsal striatum may be the result of active repression of reward responses that are the result of efforts to avoid the anxiety of food consumption. The olfactory deficits may be the result of a malfunctioning and starved brain incapable of interpreting olfactory stimuli.

For example Shinya Kojima and colleagues have shown that regional cerebral blood flow normalizes in the insula, right parietal and occipital lobes with weight restoration. 11 However, intriguingly blood flow was not normalized in the anterior cingulate cortex and the ACC is somewhat involved in the ‘mouth feel’ and appeal of dietary fat.

However, we should probably state the obvious beyond all the neurological stuff: maybe your food is really unpalatable.

And no, I’m not suggesting you are a bad cook! I am however pointing out that eating disorder patients will often choose dull, repetitive, and low-energy food choices that become a chore to eat, fill you up quickly and do not match actual energy requirements for the body.

Certainly, a good way to try to up the palatability of your food is to consider varying your food intake and to consciously choose to eat foods that may very well be on your “forbidden list”. A forbidden list of foods, for those unfamiliar, tends to include highly palatable and usually calorie dense foods: pizza, cakes, cookies, ice cream, pastas with sauces, etc. etc. A forbidden food list tends occur naturally as an eating disorder is activated and progresses for each patient. In fact, many patients activate the condition merely by choosing to forego desserts.

I would say anecdotally, that no patient currently in remission continues to express that her food choices are unpalatable. That suggests that any neurological anomalies related to a patient’s ability to find food palatable resolve with energy balance restoration within the body.

In earlier phases of recovery it is best to stick the basics to ensure you get some practice at approaching and eating food:

Eat constantly from the moment you wake: calorie-dense, dietary-fat laden choices.

Treat the minimum calorie intake for what it is: an absolute bare minimum. More is advisable and needed in recovery. The minimum stops further progression, but doesn't support reversal of damage, physical repair and a move towards remission.

Do. Not. Weigh. Yourself. At. All.

Do. Not. Exercise. At. All.

You are not afraid of restoring weight or of repairing damage— these are eating disordered thoughts and feelings and while those things will bother you, you should try to work to separate your goals and desires from those that are ED-generated.

It is the eating disorder that is generating feelings of annoyance and irritability at the appearance of hunger cues. Do not identify these feelings as originating from the real you.  Secondly, you are probably also annoyed and irritable precisely because you are energy-deprived.

Treat the appearance of annoyance of any kind as an absolute ultimatum to eat now. You will not go too far wrong if you treat almost all emotional symptoms as an indicator that you should eat in the recovery process.

1. Bailer, Ursula F., Julie C. Price, Carolyn C. Meltzer, Chester A. Mathis, Guido K. Frank, Lisa Weissfeld, Claire W. McConaha et al. "Altered 5-HT2A receptor binding after recovery from bulimia-type anorexia nervosa: relationships to harm avoidance and drive for thinness." Neuropsychopharmacology: official publication of the American College of Neuropsychopharmacology 29, no. 6 (2004): 1143.

2. Kaye, Walter H., Julie L. Fudge, and Martin Paulus. "New insights into symptoms and neurocircuit function of anorexia nervosa." Nature Reviews Neuroscience 10, no. 8 (2009): 573-584.

3  Klump, Kelly L., Cynthia M. Bulik, Walter H. Kaye, Janet Treasure, and Edward Tyson. "Academy for eating disorders position paper: eating disorders are serious mental illnesses." International Journal of Eating Disorders 42, no. 2 (2009): 97-103.

4. Kadri, Nadia, Amina Tilane, Mohamed El Batal, Yamna Taltit, Samia Mechakra Tahiri, and Driss Moussaoui. "Irritability during the month of Ramadan." Psychosomatic Medicine 62, no. 2 (2000): 280-285.

5. Sudi, Karl, Karl Öttl, Doris Payerl, Peter Baumgartl, Klemens Tauschmann, and Wolfram Müller. "Anorexia athletica." Nutrition 20, no. 7 (2004): 657-661.

6. Hoefling, Atilla, Katja U. Likowski, Roland Deutsch, Michael Häfner, Beate Seibt, Andreas Mühlberger, Peter Weyers, and Fritz Strack. "When hunger finds no fault with moldy corn: food deprivation reduces food-related disgust." Emotion 9, no. 1 (2009): 50.

7. Wagner, Angela, Howard Aizenstein, Vijay K. Venkatraman, Julie Fudge, B. A. J Christopher May, Laura Mazurkewicz, Guido K. Frank et al. "Altered reward processing in women recovered from anorexia nervosa." American Journal of Psychiatry (2007).

8. Puddey, Ian B., V. Rakic, S. B. Dimmitt, and L. J. Beilin. "Influence of pattern of drinking on cardiovascular disease and cardiovascular risk factorsa review." Addiction 94, no. 5 (1999): 649-663.

9. Badre, David, and Anthony D. Wagner. "Left ventrolateral prefrontal cortex and the cognitive control of memory." Neuropsychologia 45, no. 13 (2007): 2883-2901.

10. Roessner, Veit, Stefan Bleich, Tobias Banaschewski, and Aribert Rothenberger. "Olfactory deficits in anorexia nervosa." European archives of psychiatry and clinical neuroscience 255, no. 1 (2005): 6-9.

11. Kojima, Shinya, Nobuatshu Nagai, Yoshiaki Nakabeppu, Tetsuro Muranaga, Daisuke Deguchi, Masayuki Nakajo, Akinori Masuda, Shin-ichi Nozoe, and Tetsuro Naruo. "Comparison of regional cerebral blood flow in patients with anorexia nervosa before and after weight gain." Psychiatry Research: Neuroimaging 140, no. 3 (2005): 251-258.