The Initial Stages of Recovering From Anorexia – Behind The Scenes

About two and a half weeks ago, I made the brave decision to recover. I plan on doing a post about what happened for me to have this change of mind towards recovery, in hope of saving someone else going through what I did. However this will most likely be at a later date, as the point at which I got to for this decision to happen is not something that is easy/one that I am ready to talk about.

Since deciding to seek professional medical help and to start eating again, I wanted to share some of the effects sufferer’s may experience during the first stages of recovery from a restrictive eating disorder.

There are two aspects of this; the physical side and the psychological side. Let’s start with the physical side.

When you first begin to eat again after a period of intense restriction, there is the risk of refeeding syndrome. Though it is not common, refeeding syndrome is a serious and potentially fatal condition that can occur during refeeding (the process of re-introducing food after malnourishment). It is caused by the sudden shifts in fluids and electrolytes that help your body metabolize food. The risk of developing refeeding syndrome is reduced by ensuring very gradual refeeding to begin with and ideally by continual monitoring of blood electrolyte levels, fluid balance, and organ function. I won’t babble on about this for much longer, but if you would like to know more about this syndrome, please click here.

Below is a list of some of the physical effects people can experience during weight restoration:

  • Edema (water retention) – this is seen especially in the ankles, feet, and around the eyes, and it is caused by hormonal changes brought on by starvation or purging. Water retention usually causes disproportionately rapid weight gain in the first days or weeks of eating, as fluid in the tissues between the body’s cells and glycogen stores in the liver and muscles are replenished. This can cause a lot of distress in patients but it’s important to remember that this rapid weight gain isn’t actual body mass, and that it will soon drop off once your body achieves normal hydration.
  • Gastric and intestinal problems – gas, diarrhoea, constipation, undigested food, abdominal pain, acid reflux, indigestion. I don’t think we need to go into any more detail here…
  • Gastroparesis (slowed emptying of the stomach) – weight loss due to calorie restriction causes the gastrointestinal system to slow down. This means that when beginning to eat again, many/all patients will experience bloating, early fullness, nausea, acid reflux, and even vomiting. Symptoms will usually resolve with continued weight gain but this may take close to four to six weeks. Therefore, during the first few weeks of refeeding, my tip would be to avoid mirrors and wear baggy clothes/anything that makes you feel as comfortable as possible!
  • Bloating – as mentioned above, this is usually a result of gastroparesis. I have made this into a separate point though as it can be an extremely anxiety provoking and potentially triggering effect. Bloating during weight restoration is exceptionally uncomfortable and sometimes painful due to the skin having to adapt to your stomach expanding. The constant hard, round stomach, even first thing in the morning, can leave many feeling stressed, panicked and in fear that they will look like this forever. It can also make many sufferer’s feel the urge to start restricting again in order to lose the balloon like belly, however, you must actually do the opposite of this and eat more! Yes that’s right, in order to reduce and overcome bloating, you must keep eating!!!
  • Hot flushes – After being malnourished and cold for so long, you then jump to the other extreme and find yourself sweating in a vest top as your body is working overtime to process this thing called ‘food’ that you are now giving it. You go from being cold all the time even when indoors, to feeling like you’re going through the menopause at the tender age of 20. But it is all completely normal. As we get back to eating, we tend of convert more of our energy to heat than building tissue; “Our clinical experience is that patients often complain of becoming hot and sweaty during nutritional restoration, particularly during the night. It is not uncommon that they will wake up sweating and their sheets are soaked. . . . This notion is supported by studies showing that the thermic effect of food in anorexia patients during refeeding (particularly at the beginning) is high, representing up to the 30% of energy expenditure instead of the 14-16% in healthy controls“.
  • Extreme hunger – This is quite literally what it says on the tin. It is driven by signalling mechanisms from both fat mass and fat-free mass i.e. you carry on feeling hungrier than usual until both types of tissue are fully restored. Hunger signals are unpredictable and intense, and can happen even on very high calorie meal plans designed for weight gain – in the famous Ancel Keys Starvation Study, subjects were eating up to 6,000 calories per day yet many reported still feeling hungry or unsatisfied.  People who experience extreme hunger (which is nearly everyone who goes through weight restoration) can find themselves eating between 5,000- 10,000 calories a day but do not fear! This will not last forever. The hunger will subside and so the worst thing you can do in these situations is to ignore your body telling you that it needs more food and restricting yourself – this in itself is anorexia creeping its way back into your head.

Other effects include aching joints and muscles, fidgeting, restlessness, general agitation and speeding heart rate. None of these side effects are particularly nice, however this should NOT be a reason to put you off recovery. You must bear in mind what the effects are if you DON’T start to recover and gain weight: insomnia, fatigue, dizziness, fainting, periods stopping, muscle wastage, weak bladder, pressure sores, over sensitivity to the cold (many of my colleagues will be familiar to this as I would always be cold in the office), hair falling out, bad breath, brittle nails – I could go on for a while but I think you get the picture.

The psychological side effects are probably easy to guess after reading some of the changes that can happen to your body during weight restoration. Though I believe that recovery is psychologically harder when you are fully weight restored (as you no longer fit society’s criteria of suffering from anorexia), it is still difficult to deal with the thoughts and voices in your head when going through weight restoration. You are losing an identity that may have felt like a part of you for a long time, and this can feel like losing a best friend rather than the real enemy that any eating disorder usually is.

For most patients, being on a restoration diet involves eating 3,000+ calories a day and eating every 2-3 hours. I know some people may think that we’re ‘so lucky’ to have such a high daily calorie intake and a necessity to eat high calorie and sweet foods, but going through the life destroying process of an eating disorder and having to go through weight restoration is far from lucky. It’s not as if we can eat all these calories and whatever we want without putting on any weight (which is for some reason how most people see it as). We are restoring our weight. We are putting back on all the weight that we put so much hard work and effort into losing. Sufferer’s of anorexia have an immense fear of weight gain, and that is why beginning to eat again is one of the scariest, bravest and most important steps a person can take towards anorexia recovery.

There is no doubt that there will be hundreds of times where you will feel periods of immense guilt. Where you will feel like you’re a pig, a monster, worse than a murderer for eating. Times where you fear that gaining weight will prevent you from being ‘worthy’ of support, and cause you to feel like a ‘fraud’. Times where you wonder if you’re even good enough for recovery or believe that you’re nothing without your eating disorder. We all know that all of these thoughts are just Ana trying to regain the control that you are now taking back, yet it is still so hard and draining to battle through these thoughts and feelings on a daily basis.

At the end of the day, recovery isn’t easy – it’s messy and frustrating and I don’t think many people realise just how damn hard it is!! But by surrounding yourself with positive people, having a good support system and more importantly letting others know how you feel, this will make the whole process that little by easier. You have to do this for yourself, but you are never alone along the way.

-K xxx

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