We discussed identifying disordered eating in Part 1, and the path out of the maze in Part 2. Now we’re going to get into the nitty gritty of what happens to the body when it’s finally getting adequate calories and nutrition after a long period of either undereating, or inconsistent eating. Each person’s experience is unique, and largely dependent on their history of restriction and their current state of health. If you are dealing with symptoms of malnutrition or disordered eating, do NOT attempt to undertake the process of refeeding on your own. It can be dangerous, and you need to be monitored by a medical professional.
Your Eatopia really has the most in depth description of the stages of recovery from restrictive eating. Most of what I’ll share here is an overview of the info presented there. I’ll also add my own observations of the experiences of clients and readers. Some people won’t have any of these symptoms, some will have only mild symptoms, and some will have them all. I can’t give any guarantees, or tell you how long it will take your body to heal, or tell you how extreme your symptoms will be. I can only tell you what is normal, and that you WILL get through it. In general, the longer and ‘harder’ you’ve restricted, the more extreme your recovery symptoms will be, and I’ll reiterate again the importance of working with a medical professional if you are dealing with disordered eating and/or starvation symptoms. Some common symptoms of refeeding:
Almost everyone sees an initial 5-10 pound bump in scale weight. This is fluid retention, and completely normal. It is not fat. Your body holds on to extra water as it begins the process of tissue repair, think DOMS, but on a more systemic level. If you’ve been restricting carbs, or calories drastically, your muscles will also reglycogenate, and this can bring a 5+ pound bump in scale weight from the water that is bound to glycogen. It is normal and healthy! This edema seems to resolve at the 6-8 week mark for the majority of people.
Some people continue to gain weight because their body needs it. They may have been maintaining a weight or body fat percentage that was too low for their body to function optimally at. What I’m saying is, some people need to gain weight, even if they don’t think they do. A person may wish to look like a runway model or maintain a very low BMI or body fat percentage, but their body may need to weigh more to be healthy. Health is the priority here.
A few people continue to gain weight because they’ve overestimated their activity level, or are underestimating their calorie intake. If you don’t have a history of extreme restriction, and your weight continues to climb beyond the 6-8 week mark, and you’re at the upper end of your healthy weight range, take a long and honest look at your activity and your calorie intake. You may simply be eating more than your activity level demands. It’s an easy fix. Either increase your activity or decrease your calories modestly.
Go Maleo wrote a good post on calorie underestimating and metabolic derangement. There are two things worth noting here. In the study that looked at 10 women who all believed that their metabolisms were ‘slow’, in reality all but one of them were burning 2500 calories or more per day (the one study participant who truly did have a depressed metabolic rate had hypothyroid issues). Most of them were also drastically underestimating their calorie intake, hence their inability to lose weight. If you’re gaining weight at what you believe is an appropriate intake, it may be a good idea to spend a few days really weighing and measuring everything you’re eating, to make sure you’re really eating what you think you’re eating. If you are, then a visit to an endocrinologist is in order, there may be an underlying illness that needs to be addressed.
I discussed edema a bit already. This really throws a lot of people for a loop. You feel squishy and swollen. Your rings don’t fit, your clothes feel snug, your ankles swell and disappear. This is all normal. Your body is retaining water to aid in the cellular repair process. Most people see a 5-10 pound bump in weight but 15 or even 20 pounds isn’t unheard of. It’s uncomfortable, I won’t lie. It’s temporary though. Many people see it start to subside within a couple weeks, most see it resolve by the 6-8 week mark. You can read more about the edema of recovery here.
If you’ve been undereating for any length of time, your body has slowed your digestive processes. When you increase the volume of food you’re consuming, your GI system can’t quite keep up, so you’ll experience bloating, gas and other lovely discomforts. If you’ve restricted macronutrients or food groups, your gut flora may have been seriously altered, and will take time to repopulate. People can mistake this for an intolerance, so giving your system time to repair and adjust is important. Again, this can cause bloating, gas, distension and poor digestion. Like edema, this is a normal stage of recovery. You will get through it. You may look 6 months pregnant for a few weeks, but you will get through it. Eating smaller meals more frequently, and taking probiotics, can help ease some of these symptoms.
Fatigue and Joint Pain
For the most part, the fatigue and joint pain are a normal physiological response to the process of cellular repair. Gwyneth Olwyn says that this pain is your body’s way of forcing you to rest, and I like that way of looking at it.
Belly Fat Accumulation
In the early stages of recovery, as your weight begins to restore, the body preferentially stores fat around the internal organs. In combination with the edema and bloating from digestive distress, this can be very distressing and even trigger relapse. In time, this fat redistributes to a more normal distribution pattern. Be patient and allow your body to do what it needs to do to recover fully.
Not all of the body’s responses to refeeding are negative! Many people experience a dramatic increase in libido and sexual response. During starvation, the body shuts down reproductive function. When you are getting adequate nutrition again, reproductive hormones rev back up. Enjoy!
Lots of people experience dramatic improvements in energy levels. Workouts become more enjoyable, strength and stamina increase, and the body begins building new muscle mass. Even though they may see an increase in scale weight, measurements and pictures show that it is lean mass that is increasing.
Hair, Skin and Nail Improvements
Better nutrition means your hair skin and nails get the nutrients they need to thrive.
Improved Thyroid Function
We’ve had several people experience reversal of hypothyroid in our Eating the Food group. Again, if you have a medical condition like hypothyroid, work with a qualified medical professional (an endocrinologist for example) in addition to any dietary changes you make. Do not rely on bloggers, alternative health practitioners or diet books for treatment of medical conditions.
Changes in Self Perception
Disordered eating can mess with your mind. Most people with eating disorders have distorted body images, and lack of adequate energy intake can trigger and magnify these disordered thoughts. Many people, when finally getting adequate calories, begin to have a more realistic self image, realizing that their body really isn’t as abnormal as their disorder led them to believe. This is my favorite change to observe, the moment when a person realizes that there is, in reality, nothing wrong with their body. It is life changing.
Recovery is a mixed bag. Parts of it are wonderful, and parts of it can be so unpleasant that a person relapses to restrictive behaviors. Fortunately there are communities of people who’ve powered through and come out the other said (I linked to them in Part 2). Please seek out community support, it is so important to know you are not alone and there is a light at the end of the tunnel! A supportive community and a qualified treatment team can set you on a path to a healthy relationship with food and a healthy body image. You deserve to be healthy and thrive, free of the burden of obsession and disorder.