I am posting this on behalf of my wife - she's heard me mention H&A before, but her native language isn't English, so she asked me to write this.
She has been suffering from some form of mental health problem (perhaps Social Anxiety Disorder, perhaps Post-Natal Depression) for three years or so, and she's gotten very very thin.
She's always been thin, and a very good eater. She used to eat loads, but stayed thin for two reasons. Firstly, her metabolism is super-fast. She burns calories like crazy. Secondly, she's Japanese, so even though she eats a lot it tends to be pretty healthy stuff.
Since she got sick, though, she's been slowly but steadily losing weight. She didn't have any to spare, and is now underweight according to her doc and BMI, and anaemic, presumably from poor nutrition. She started taking iron tablets a week or two ago but they don't seem to have any effect yet.
Yesterday she had her period (she always has heavy periods and terrible PMT - before I lived with her I thought PMT was just a sexist myth) and she got so dizzy and sick that she couldn't walk. She semi-collapsed on the way to work and I had to go get her and bring her home. Which brought me to a new level of worry.
So, I am at my wits end with this. How can she gain weight, what should be be doing? She's clearly very underweight, with all the obvious physical signs of poor health and stress (saggy skin, bags under her eyes, dull thinning hair). She agrees she needs to gain weight, but doesn't know how. She eats snacks and sweets now (my bad influence) but it's nutritious weight-gain she needs. She doesn't feel hungry enough to eat more. She's very passive/depressed, so she finds it hard to address problems - usually she denies there is a problem. This one she is trying to address, but it's still hard for her.
Two things to consider - we live in Japan, so we probably have roughly the same products as wherever you live, but the brand names will be different. Also, I find her psychiatrist to be kinda useless - he gives her lots of meds and is unrelentingly positive in the manner of a kid's TV presenter. I think he is too in love with his own treatment choices to consider changing anything.
Thanks.
I figure I could take a bear.
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My wife used to take the following product, and she said it got good results:
http://www.amazon.com/Universal-Nutrition-System-Vanilla-5-1-pound/dp/B00166FAVQ/ref=sr_1_1?s=hpc&ie=UTF8&qid=1336439394&sr=1-1
In my experience eating lots of sweets is a bad idea if you want to gain weight; it's easy to fill up on sugar without eating real food. I think cooked vegetables are better than raw, because you can eat more before you get full, and can add olive oil or broth or other healthy fats. Ensure tastes horrible, sometimes I'll have this stuff mixed with whole milk instead but that's not really much better in terms of taste.
When I'm getting too thin my bf makes a really good stew dish with leeks and dark chicken meat and mushrooms that makes a ton of tasty broth that is good to drink when you're not hungry. But I don't have the recipe right now, but I can ask if you want it.
No offense intended but theres quite a bit of crap that isn't needed in that. If she were to start on a whey I'd recommend Optimum Nutrition.
http://www.amazon.com/Optimum-Nutrition-Protein-Vanilla-Cream/dp/B001G7QXIY/ref=sr_1_22?s=hpc&ie=UTF8&qid=1336441330&sr=1-22
You also need to track your intake compared to the GDA. A food diary isn't a bad start here.
You say she's seeing a doctor--what exactly has (s)he told you, advice-wise? Sounds like you might need a new one of those, too.
Not nutritionist.
My question is about ideas for her weight and nutrition, if I could affect the rest I would. I mentioned the doctor specifically to try and get advice that wasn't 'ask her doctor'.
Thanks for all the advice so far though.
So...she isn't seeing a physician or gynecologist, only the psychiatrist? I totally understand not being able to force your spouse to go see someone if they're not willing - Christ, do I ever - but if she's weak to the point of literal collapse and continuing to physically and mentally go downhill, then you really, really need to get her to a doctor, in addition to tips people give you here. It's sounding less like "she could use a few pounds" than "her long-term health is at risk."
All of that
I have been very underweight my entire life. My metabolism works against me. There are some things that have worked for me:
1. no more fruits or veggies. They have a lot of good things in there but they are filling without providing enough calories. Fruit shakes and small portions of vegetables should be enough. Yeah there are all sorts of good things in them but she can afford to sacrifice some vitamins in place of calories, because calories are easier to 'make up' than calories are. This was really hard for me and may be for her but I have to admit that fruit fills me up too quickly. I get by on calorie dense fruit shakes now. The exception is dried fruit! Dried fruit is great. Check the nutritional labels, because not all fruits are as dense as others.
2. Unless you are eating fatty fish, make your animal protein beef, pork, chicken, or eggs.
3. Unless she's drinking calorie dense shakes or energy drinks, don't let her drink too many liquids. Drinking water is a great way to quell your appetite. Juices and sodas are marginally better for calories but there are good reasons to not drink those either.
4. If drinking liquids with meals, drink the liquids after you have eaten.
5. Pasta! Italian food is great because it combines pasta and rich sauces and has a short enough list of basic ingredients you should be able to find easily in markets.
6. Olive oil and butter. If you are underweight and unhealthy, gaining weight is your top priority. Butter is your friend in this case. Maybe you feel more comfortable with olive oil, whatever. Cook EVERYTHING in olive oil or butter. It is so easy to sneak into stuff. A nice snack is french bread with olive oil dip. Yum.
It is tough to eat enough when you aren't hungry. For now the best you can do is have her increase how many times she eats per day and make everything calories dense. She might feel uncomfortable eating so much but you have to stretch your stomach out, in essence. I can eat a lot more than I used to be able to, but it takes time. You notice a difference in your eating within a month. You may end up incredibly lethargic after any meals. You may end up with your appetite going into overdrive and you need to eat every hour. It sucks. But eventually it starts to even out. As such, she is going to need to want this, because the changes in energy and appetite can be very distressing and make you want to quit.
Iron Stuff
The iron issue gets serious if it starts to drop cell production. A doctor will request tests for iron in the blood, iron store and red cell count. If it's urgent, you'll be sent for an iron infusion or blood transfusion. If not, you'll be advised to use iron tablets. As mentioned above, hormonal contraceptive is an effective option for females. As for diet, eat your iron sources with vitamin c but away from calcium. Vege sources are best absorbed with meat sources. Clams and other shellfish are the best for iron punch, followed by red meat. Keep in mind it can take years for iron stores to change.
Getting Fatter
Eat slowly, eat more. This will likely mean sitting alone at a table when everyone else is finished, but it gives time for the stomach to expand.
Aim for 5-6 meals a day. They don't all have to be big, but an idle stomach is a wasted opportunity to lay down some calories.
Up fat intake. It's the most energy dense thing you can eat. Muse. has this well covered. I also go for cheese as a snack. Nothing is more nutritious - Jarlsberg is my tip.
Try new things and find things you like. Filling out a day with food can get tiresome so actively pushing for new foods can help in the long run.
Lastly, don't feel bad about eating more than others. Jealousy is the most common response, but we know that's misplaced.
And honestly, ganbarou yo. Mental health care in Japan tends to be a really big pile of shit. Also, this is a medical issue now. Try and find out if there any local clinics that come recommended, or go with your wife to the hospital, get a doctor there to see her and see if they can recommend a local doctor, a mental health expert who isn't worthless, and what she should do with her diet to put weight on.
There are mental aspects to gaining weight, and that is one of them. I'd feel bad about eating more than everyone else but once it turned out I was actually gaining, I didn't feel so bad and my family didn't hold it against me.
Other things I just thought of that tie into that:
Sometimes she'll feel like she needs to scarf down her food fast, once the feeling of fullness sets it in can be hard to continue. If I feel that I can, I'll eat a lot of food really fast, to 'cheat' so to speak. Beat it to the punch and eat more food than I normally would be able to.
Sometimes I have to take my time and eat slowly. And sometimes this will be what your wife needs.
So don't rush her, and don't rag on her for not eating in a ladylike manner.
The only good multitasking you can possibly do while eating is watching tv. It is passive and you don't notice yourself eat, so you can eat more. And this probably sucks to hear, but try to not converse so much while you are eating. I eat a lot less when I am eating with people because I really like to talk, and I lose my appetite that way. It slows down eating, and eventually people get restless and think to themselves, 'a sufficient amount of time has passed at the dinner table, time to clean up'. I normally eat alone for dinner (my biggest meal) because I can better focus on eating, but this is only okay because I'm an unattached college student. Your wife isn't, so if she needs to take her time and seems to start finishing once you're done, maybe stay at the dinner table once you're done eating so she won't feel alone. Do some crosswords or something, I dunno, you have to realize how big an influence other people can have on your eating habits, I certainly 'finished' meals before I felt full because everyone else was ready to go but that wasn't any good for my health. Maybe your wife does this too because she sees you getting fidgety.
In addition to lunchtime as well this is when she will eat.
She needs to get out of the, only eat when I'm hungry idea. Eat at pre-meditated times a pre-meditated meal (even if it's a calorie dense shake). You can help by pre-planning meals (for both of you) for the week.
The simplest high calorie snack meals (for ten and three) would be, shakes, curried eggs, and nuts.
Satans..... hints.....
Whey in general is not really good for this situation. Whey passes through your body more quickly than it can be used aside from a serious immediate need for protein (to be fair, her body could be in that condition right now). It also doesn't really provide much else in the way of nutrients. Something like Ensure, which was recommended above, is going to be much better because it's intended to provide more nutrients.
@Poshniallo How badly do you want to have kids? I'd say for now she needs to be on a hormonal birth control until she can get her BMI, anemia, and heavy periods under control. This is pretty much the main use, aside from baby making, that birth control is used for. I don't know what the taboo is like in Japan for stuff like this though. I imagine cultural things are heavy influence and I'm sure her doctor is very prideful in his own handiwork. They are probably 100% related, especially with an underweight person.
Diet wise, she needs to increase her iron intake. Spinach, red meat, most beans (usually kidney beans), etc. For putting on weight it's just as simple as making more food and eating it.
Drop the psychaitrist and get a GP/PCP or whatever they are in Japan. And that last sentence is what I was worried about. I think the BCP will be your best bet to be honest. Most women put on weight when they take it, as well as fixes issues with heavy periods and anemia resulting from that which I'm almost positive your wife is getting it from (not poor nutrition), and it fixes a lot of hormone issues and might actually help the depression.
Also it gives bigger boobs.
PS, how long do her periods last, longer than 3-5 days? Or are they just super heavy?
Golden Gains by Controled Labs is wonderful and tastes great!
We had a good talk now about doctors - she took some time off work to rest, so she is calmer and easier to talk to than usual.
We are thinking to get her psych to refer her to a dietician/nutritionist (whichever is the proper professional one, perhaps someone who is also an MD - we'll be using Japanese terms and the Japanese system so the English term isn't important.)
We are also talking about her seeing a gynaecologist and talking about the pill. Part of the problem is that she's just so sick of seeing doctors and spending all her free time at the doctor or group session. And I can understand that completely, having been in that situation myself sometimes.
But I am still interested in more food advice if anyone has any!
but they're listening to every word I say
Read my fairy tale webcomic, The Fox & The Firebird, at: http://www.fairytaletwisted.com
And above all: Seek a Dietician. If you have insurance, and get a referral from your primary physician, you can usually get 1-5 visits at no charge or at least a $25 deductible.
It's advice he gives me constantly because of my rail-thin body build. It's not advice I follow but still . . .
Well maybe it's less applicable if you're malnourished.
For instance, you'd have to drink 500 mg of caffeine to get a diuretic effect... which is 3-7 cups of coffee (depends on type)... and you've drank enough water to offset that. Now if you add 500 mg of caffeine to your food because you like the buzz...
Doc: That's right, twenty five years into the future. I've always dreamed on seeing the future, looking beyond my years, seeing the progress of mankind. I'll also be able to see who wins the next twenty-five world series.
TylerJ on League of Legends (it's free and fun!)
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Yeah any iron dense foods are great in this instance.
posh's lady likely has undiagnosed menorrhagia ... not sure how that works in Japan but in the US usually a GP/PCP can figure that out pretty quickly. Judging by the PMS/PMT comment too, I'd say dysmenorrhea too. But I'm no doctor. Maybe a gynacologist since there's no PCPs?
This is because of the sugar - cheese won't really help here.
But yeah, if she wants to just "gain weight" in general, she needs to eat more carbohydrates and add in some fats. Proteins are obviously important but for someone with her body mass, she can get her required protein without eating much of anything.
Pasta, potatoes, fatty treats like ice cream, throw some delicious fatty red meat in there (some good ribeyes would be both delicious and great for her) - weight gain won't be an issue. Considering how thin she is, this seemingly sub-par diet will probably actually be good for her, and it's hard to imagine a person not enjoying some ice cream and pasta.
Obviously don't let this become her gaining 100 pounds or anything.