What to Expect when you Stop Dieting Part 3: What the Heck is Happening to Me?

This blog series is an exerpt from my book ‘Taking Up Space: a Guide to Escaping the Diet Maze’.

 

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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:

Weight Gain

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.

Edema

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.

Digestive Distress

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.

Increased Libido

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!

Increased Energy

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.

 

 

 

 

 

What to Expect When You Stop Dieting Part 2: How Do I Do This??

This blog series is an exerpt from my eBook ‘Taking Up Space: a Guide to Escaping the Diet Maze’.
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I really like Ellyn Satter‘s definition of ‘Normal Eating’:

 

Normal eating is going to the table hungry and eating until you are satisfied. It is being able to choose food you like and eat it and truly get enough of it -not just stop eating because you think you should. Normal eating is being able to give some thought to your food selection so you get nutritious food, but not being so wary and restrictive that you miss out on enjoyable food. Normal eating is giving yourself permission to eat sometimes because you are happy, sad or bored, or just because it feels good. Normal eating is mostly three meals a day, or four or five, or it can be choosing to munch along the way. It is leaving some cookies on the plate because you know you can have some again tomorrow, or it is eating more now because they taste so wonderful. Normal eating is overeating at times, feeling stuffed and uncomfortable. And it can be undereating at times and wishing you had more. Normal eating is trusting your body to make up for your mistakes in eating. Normal eating takes up some of your time and attention, but keeps its place as only one important area of your life.

In short, normal eating is flexible. It varies in response to your hunger, your schedule, your proximity to food and your feelings.

Some of the things I interpret from Satter’s description:

  • normal eating is being aware of hunger and satiety signals
  • eating foods you enjoy without guilt and shame
  • eating mostly nutritious food but having flexibility to include foods purely for pleasure
  • being aware of the emotional drives to eat, and allowing for them without guilt or shame
  • there is no one ‘right’ meal pattern – eat when works for YOU and your needs
  • being able to indulge without the compulsion to binge
  • eating to support your energy needs over time – with flexibility to eat more some days and less other days as your appetite and activity dictate
  • not obsessing over ‘slip-ups, cheats and mistakes’
  • not fixating on food and eating to the degree that it impacts your quality of life

Getting from here to there can seem like an insurmountable task though, especially when your ‘normal’ is following arbitrary, restrictive rules that someone else made up. Many very wise people have written about working toward Intuitive Eating (I linked to Ellyn Satter above, there is also Geneen Roth, Gwyneth Olwyn (who’s website I link to fairly regularly), the good people at Eat More to Weigh Less, Matt Stone and others, all of whom bring very valuable insight to the table. The recommendations I make here echo many of the recommendations of these other people, and I encourage you to explore their websites and publications.

I’d like to begin by referring you BACK to the first installment of this series, and reiterate the importance of seeking medical treatment if you have symptoms of disordered eating or malnutrition. Refeeding can be dangerous, even life-threatening, if your body is in a state of starvation. Medical supervision is necessary.

Many people, however, are not starving, they simply have a history of unnecessary restriction and unstable eating patterns. The goal here is to get out of the restriction mindset and stabilize your eating habits. I’m going to give you some guildelines to do that. The first order of business is stabilization. You may or may not lose weight here, you may even gain a little. I’ll discuss some of the normal stages of recovery in the next installment of this series. Weight change is not our initial focus, stabilization is. Once your eating and weight are stable, we can begin making small changes, if you want to change your weight. Again, our first task is stabilization. Some people stabilize in a few weeks, others take months, much is dependent on your history and health. The more extreme your dieting history, and the more unstable your health, the more likely it is that you need to be working with a treatment team.

So, here are some guidelines:

  • Acknowledge that there is an appropriate number of calories that your body needs to support your activity and a healthy weight. I talked about the fatal flaw in the ‘calories don’t matter’ paradigm so common in the fad diet world, and the very serious consequences of eating too few calories in my Adrenal Fatigue post here. Your body needs calories, and probably more than you realize, to support a healthy weight. Many fad diets short change you in the calorie department. A calculator that factors in your activity will give you a more realistic idea of your calorie needs than many of the calculators on dieting websites. Some of the best I’ve found are this one at Fat Secret, the Health-Calc here, and Scooby’s calculator here. If you’ve been dieting all your life, the numbers you see here will probably surprise you. Determine your calorie requirements, and eat to support them. It doesn’t have to be exact every day, but aim for a window near the figure the calculators give you. That way you will be supplying your body the energy it needs to meet the demands of day to day life. While eating intuitively is a goal, many people have lost touch with their hunger and satiety signals. Being aware of calorie intake can be a stepping stone toward reconnecting with those signals, by guiding proper portion sizes and ensuring adequate nutrient intake.
  • If you’ve been restricting for a long time, ease your calories up. Many ED professionals recommend adding 200-300 calories every 3 days or so until you reach your required intake. I’ve known people who’ve added calories as slowly as 25 calories per day per week, which I think is unnecessarily slow. I think it’s important to get to an adequate intake as soon as possible. 100 calories per day per week seems to be a good half-way point. So for example, you’d eat 1600 per day for a week, then 1700 per day for a week, then 1800 for a week, etc, until you get to your target. If you’re in treatment, follow your treatment team’s advice. Some people begin eating to their requirements right away, and I think this is probably best if you haven’t been highly restrictive.
  • Eat foods you want to eat*. Yes, seriously. Lift arbitrary restrictions. Some people believe that if they allow themselves to eat what they want, they will eat nothing but junk food. Some people DO eat nothing but junk food for a little while. The vast majority of people very quickly realize that eating nothing but junk food gets tedious, and their energy flails, and they begin to crave more nutritious foods. Every now and then a person comes along who really can eat nothing but junk food indefinitely – I believe that these people are dealing with disordered eating issues that require professional treatment. Most people enjoy a wide variety of foods including many that are very nutritious. Eat what you enjoy! Nutritious and indulgent, there is a place in a healthy diet for both. *If you are allergic to a food, that would qualify as a medical reason not to eat it. Avoiding foods that make you sick is obviously a reasonable ‘restriction’.Likewise, if you have a medical condition (such as Diabetes) that necessitates a specific dietary approach, work with your doctor and a Registered Dietician to implement that diet. Do NOT rely on ‘nutritionists’, diet books or bloggers for medical treatments.
  • Pay attention to how your body responds to the food you eat. This is really the only way to evolve into a way of eating that supports your unique goals and needs. Does it fill you up? Does it give you energy? Does it make you feel good? Bad? Do you LIKE it? Diet Culture has created many food villains, but there are very few foods that are inherently bad regardless of context. Even refined sugar and processed foods can be beneficial under some circumstances, such as recovery from starvation and malabsorption issues stemming from GI conditions, and as fuel for intense physical activity.
  • Get enough protein. This is really the only ‘food rule’ I follow, as it seems to be generally true across the board. If you are physically active, if you are recovering from restrictive dieting, if you are trying to lose weight…any of these conditions and more will increase your protein needs. The current DRI recommendation is quite modest, only .66 – .8 grams of protein per kg of bodyweight per day, but there is some indication that this is inadequate, and sports physiologists have long made higher recommendations. 1.3 – 1.8 grams per kg of bodyweight per day is probably a more realistic goal, and if you are engaging in strenuous activity or losing weight, increasing to 1.8+ grams per kilogram of bodyweight per day will probably be beneficial. I simplify this for my American clients by giving them a target of 1 gram per pound of bodyweight per day; this is more than they absolutely need, but few people actually meet that target, and aiming that high tends to ensure that they do meet their minimum requirements. Get your protein from protein rich foods you enjoy. If you eat mostly plant protein, you will need to eat a little more to ensure your body is able to get what it needs as plant protein is slightly less bioavailable. This doesn’t make it inferior, it just raises your intake requirements. There is nothing wrong with using a protein supplement if you’re having trouble getting enough from food alone. I give some tips for choosing a good protein supplement here.
  • Be patient. Changing your habits takes time, and there will be starts and stops and plateaus and mistakes along the way. These are all part of the process. It can take months, even a year, to see major changes, especially if you’ve been very restrictive in the past. Work toward consistency, balance and stability. That is the goal in the beginning: consistency, balance and stability. Weight change will come later, and it will be easier when you’re consistent, balanced and stable.
  • Move away from guilt and shame. They have not served you in the past. They serve no purpose now. Allow for mistakes and setbacks, not as things to avoid, but as things to learn from.
  • Find a supportive community. Join us in our Eating the Food facebook group, or join the Your Eatopia or Eat More to Weigh Less communities. knowing that you are not alone, and that what you are going through is normal, is one of the most profoundly empowering gifts you can give yourself. And later, down the road, you can be there for others beginning their journey.

Escaping dieting is not easy, and it’s not always pleasant. It’s probably one of the hardest things you will ever do. In my next installment, I’ll discuss some of the normal physiological responses to refeeding. Some are wonderful, others can be downright awful. You don’t have to go through it alone. Many of us have been through it and can offer perspective and support.

Up Next: Part 3

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Related Posts:

What to Expect When You Stop Dieting Part 1: Who is This Post For?

This blog series is an exerpt from my eBook ‘Taking Up Space: a Guide to Escaping the Diet Maze’.

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You’ve been dieting since you were 12 years old. The thought of leaving it behind is terrifying. You don’t really know anything else, dieting has become your normal, it is just The Way Things Are. Surely without the rules and restriction your weight will spiral out of control?

Let me preface this post by saying that if what you are doing is working for you, keep doing it. If you are on a diet and it makes you healthy and happy, that’s fantastic! Go on with your bad self. This post isn’t for you. This post is for those for whom dieting isn’t working.

Now that that’s out of the way, who IS this series of posts for? Anyone who is tired of the eternal struggle with eating and weight. Anyone who has bounced from diet to diet, hoping that this one will be the Magic Diet, the one that solves all your weight and health problems once and for all. Anyone who feels great on a new diet for a few weeks or even months, but then starts to see their weight creeping up again, their health problems getting worse again. Anyone who is hungry all the time. Anyone who fantasizes about the foods their diet forbids, and who feels ashamed for having those fantasies, and who may even secretly eat them, hiding the evidence and heaping shame and guilt upon themselves for their ‘weakness’. Anyone who has a history of restricting and bingeing in an endless cycle. Anyone who has grown terrified of food. Who feels anxiety in the face of a simple meal. Who has ended friendships over food choices. Who’s life has come to revolve around food and eating…or not eating.

First Things First

The first and most important question to ask yourself is: do you have an eating disorder? Eating disorders often go unrecognized, even by the people suffering from them, because the symptoms can come on so insidiously and be so different from the stereotypes we’ve come to believe about them. Diet Culture has normalized behaviors that are pathological, so that we don’t recognize them as such. Many people believe eating disorders are confined to the young female demographic, and that if a person isn’t underweight or making themselves throw up they don’t have a ‘real’ eating disorder. Disordered eating is becoming more and more prevalent among men and older adults, and the symptoms are far more varied than pop culture makes them out to be. A person doesn’t even need to be underweight to have an eating disorder, in fact MANY people with disordered eating are overweight or obese.   So I’m going to begin this post by having you give some honest thought to the symptoms I’m going to list. Do you see yourself here?

Signs of disordered eating, from the Mayo Clinic:

●  Skipping meals
●  Making excuses for not eating
●  Eating only a few certain “safe” foods
●  Adopting rigid meal or eating rituals
●  Cooking elaborate meals for others, but refusing to eat them yourself
●  Collecting recipes
●  Withdrawing from normal social activities
●  Persistent worry about being fat or gaining weight
●  A distorted body image, such as feeling fat despite being normal- or underweight
●  Not wanting to eat in public
●  Frequent checking in the mirror for perceived flaws
●  Repeatedly eating large amounts of sweet or high ­fat foods
●  Use of syrup of ipecac, laxatives, the over ­the­ counter weight­loss drug orlistat (Alli), or over­ the ­counter drugs that can cause fluid loss, such as menstrual symptom relief medications, or excessive exercising or fasting after eating
●  Use of dietary supplements or herbal products for weight loss
●  Food hoarding
●  Eating in secret
These are signs of Binge Eating Disorder, which is frequently brushed off as ‘sugar addiction’:
  • eating to excess, even when already full
  • a feeling of loss of control over food intake, inability to stop eating
  • a sense of guilt and shame over your eating
  • never feeling satiated
  • stockpiling high reward food and eating it in secret
  • feelings of stress and anxiety that are relieved by eating
Here are some other, even more insidious, signs I often see hand-in-hand with those listed above:
  • You make fun of, or hang out with people who make fun of, people who make different dietary choices than you do.
  • You use your valuable free time to visit other people’s blogs and argue with them about their dietary choices.
  • You’ve completely eliminated foods from your diet that you enjoy eating, and that you have no intolerance to, because your guru has told you they aren’t ‘optimal’.
  • You experience stress, shame or guilt when you eat (or WANT to eat) something forbidden by your diet.
  • You’ve alienated your real life friends and family by constantly criticizing their dietary choices, and you are ok with that because your ‘real’ family is your group of online friends who share your dietary philosophy.
  • You believe that your diet is the one true ‘optimal’ human diet, and that anyone who makes different dietary choices than you simply hasn’t heard the ‘truth’ yet.
  • You focus on diet to the exclusion of other healthy lifestyle choices like regular exercise, proper sleep, stress management and sunlight, and believe that eating the ‘right’ diet can make up for not practicing those other lifestyle choices.
  • You believe that if you just eat ‘right’ all your health problems will go away, and that if someone is still experiencing health problems on your diet they just aren’t ‘doing it right’.
  • You believe that the entire medical establishment is out to get you.
  • When your diet is not producing results you keep on doing it because you’ve convinced yourself that you can’t eat any other way.

If you’re dealing with any of these symptoms, seek professional treatment. I’ll list some internet resources below. An eating disorder professional can help guide you through refeeding (which I will discuss further in the next installment in this series), and have the resources to help you tackle these issues properly. While the things I discuss here can help you know what to expect, they are NOT an adequate substitute for proper medical treatment. Please don’t take this subject lightly, eating disorders can be fatal.

Eating Disorder Resources:

http://www.nationaleatingdisorders.org/find-help-support

http://www.youreatopia.com/support

http://www.nimh.nih.gov/health/publications/eating-disorders/index.shtml

http://www.helpguide.org/mental/eating_disorder_treatment.htm

http://www.something-fishy.org/treatmentfinder/

Next Up in Part 2: How?