on weight and rebuilding muscle mass

Today I weighed myself at work (in the employee restroom of our lab on the hospital side of the building... I've always thought this was peculiar). I have officially lost 20 lbs this month due to this flare. Precipitous weight loss like this always makes me a little depressed when I finally realize it has occurred. The two reasons are these:

1. I honestly don't mind being this size and it is going to be frustrating when I gain weight again from prednisone and eating real food (whenever this day comes).
   
2. Building back my muscle mass is a very slow process, and it is always difficult for me to accept the immoderately slow pace at which I have to proceed in order for my body to respond positively.

Because I know these are popular symptoms following flares, and because I need to remind myself of their importance, I am about to discuss - at length - the logic behind their successful alleviation.

1. When we burn fat, what happens is that the amount of fat stored in each cell decreases, and the cells themselves shrink. This is why weight loss through consistent exercise works. What accompanies a dramatic weight loss due to a flare (or an eating disorder), however, is that your fat cells try to compensate for being malnourished. They do store less fat in them, but they do not shrink. They become concerned for their survival, and therefore gluttonous. When you begin to reintroduce food after starving your body, your fat cells will fight harder to retain what you provide in effort to build stores for whenever the next assault ensues [Buccholz 2008, Nature; Spalding et al 2007, Nature].

This protective mechanism is encouraged by obligatory sedation following a flare. Recovering from a flare often requires a very mild re-introduction of physical activity. Often, it is most energy efficient to begin reintroducing foods with the right supportive nutrients, and then to increase physical activity, giving your body the opportunity to utilize food calories instead of stored calories. During this slow reintroduction, your fat cells are more likely to hoard than when you are regularly active.

In other words, easing your body back into regular activity (walking, running, biking, weights, whatever sports are your fancy) is a slow process. You will probably gain more weight than you'd like to in the process, courtesy of prednisone, gluttonous fat cells and - let's be honest - the allure of suddenly-pain-free foods that were missed during the flare. The good news is that your weight is almost always able to return to normal once you have recalibrated your body to whatever combination of diet and exercise is most sustainable. Depending on your individual sensitivities, vitamins and supplements can be of great help during this re-equilibration period... but this is where you consult your gastro and your gut for specific direction.

You may gain a little more weight than you'd prefer in the process of commandeering your health. Allowing yourself to distress about weight will exacerbate it [Colles et al 2007; Rigaud et al, 1994; review]. So keep in mind that re-training your body is a process, and a slow one, but the most sustainable benefits come from responding to your body's needs and not pushing beyond its tolerance.

2. I am an ex-gymnast. The prospect of losing muscle mass is always depressing to me. Therefore, I typically have fits of neurotic ambition following Crohn's flares during which I lose a great deal of muscle mass... I am convinced that I'm going to get all of my muscle back. Immediately. And yes, as an athlete, I do understand how manic this is. This time, I have resolved to go about it differently.

Even in remission, Crohnies are prone to various nutrient deficiencies [Fillipi et al 2006, Inflam Bowel Dis]. These can make the reconstituting of lost muscle mass even more tenuous. I cannot stress enough how helpful Yoga, Pilates and Tai Chi have been for me during the transition from sedentary malnourished-mode to healthy active-mode. These remain the best ways I have encountered to combat weakened muscles after a major flare. In time, my bike will see me again.