351: Body changes, rest, compulsive movement, stillness, extreme hunger and much more…

Chris Sandel: Hey, everyone. Welcome back to another episode of Real Health Radio. I’m your host, Chris Sandel. I’m a nutritionist and a coach and an eating disorder expert, and I help people to fully recover.

Today on the show, it is Part 2 of the Q&A episode. Last time, last episode, or at least the last new episode that I put out, it was a Q&A episode to celebrate 350 episodes of the podcast. But as I mentioned during that episode, I got 17 pages’ worth of questions, and so I didn’t get to all of them. So this is Part 2. I’m going to be doing a Part 3, possibly a Part 4, to finally get to all of them. But yeah, I’m getting through another chunk of questions today.

Some of the topics we’re going to hit today: how long nutrition rehabilitation takes; is full recovery possible; struggling with rest and not standing; recovery in a larger body; body changes in recovery and dealing with that; extreme hunger; all or nothing thinking; changes to exercise; and much more.

Like last time, people sent in lots of lovely comments along with the questions, and just to save time, I’m just going to read out the bit where it is the question that I’m going to answer, but thank you for all the lovely comments alongside this.

00:01:30

How long does it take for adequate nutrition to feel normal?

The first question is from Robin, and she says, “How long does it take for adequate nutrition to feel like the new normal? I’ve had a restrictive eating disorder for 23 or so years. I find it so hard to stay in recovery because when I eat enough, it’s like my whole body is going ‘this feels different and wrong and thus unsafe’. It’s like my nervous system only feels safe when I’m in a state of malnourishment, losing weight. I managed to maintain a healthy weight and generally good levels of nutrition for a few months this year, but it was constantly so overwhelming for my body to feel this alien feeling of not being malnourished, and I couldn’t cope with it anymore and so ended up sliding back into restriction. I’m also autistic and have a history of extreme childhood trauma, so my nervous system is particularly sensitive. So I want to know how long it takes for being well-nourished to feel safe when restriction is what has felt safe on a cellular level to my body for 20+ years.”

Thank you for sharing that, and I’m sorry that this is what it feels like when you eat more. I’m sorry that you’ve been dealing with this for 20 years. That’s a long time. And I can see from what you’ve shared, this is nervous system conditioning. This isn’t a lack of motivation. After 20+ years of restriction, this can become the body’s definition of safe. You normalise to what this feels like, and the eating disorder in lots of big ways and in lots of little ways becomes your way of coping. So when you keep doing those things and live in alignment with the eating disorder, you can get this illusion of safety, or at least it feels like that is safety compared to the alternative of eating more.

So I just want to say that in the beginning, it is going to feel like adequate nutrition is wrong just because it’s unfamiliar. And it’s not because it’s actually dangerous; it’s just your body is not used to feeling that way.

And I would say after this length of time, a couple of months is just not a long enough stretch for you to start to really notice a difference. I would say that – it’s really hard to estimate this, and I know you know it’s hard for me to estimate this because you said this as part of the extra part of the question, but it really depends on what people do as part of the nutritional rehabilitation and changes to the energy debt for one’s body.

I tend to recommend or suggest somewhere between 6 to 12 months if someone is doing recovery in earnest. So they’re eating the food, they’re doing the rest, they’re doing the things to change that energy debt within the body, that’s typically how long it takes. But obviously, there are people who can do it in a shorter amount of time because they really go all-in and it hasn’t been going on quite as long, and there are people where 12 months on, they’re still in the very early stages because they’ve been doing things in a very slow manner.

But I would say if you’re actually giving your body what it needs from an energy standpoint and a rest standpoint, I would estimate somewhere between 6 to 12 months.

And the thing I always say with this and I want to remind clients is, it’s not that you suddenly get to the 6-month mark or the 12-month mark and then everything feels fine, and before that it was all just hell every single day. It is gradual. One of the things that can be useful for this is to look out for the glimmers or to look out for the little changes, because the eating disorder is going to generate all of the things that aren’t working or the things that are more difficult or where “we shouldn’t be doing this because it feels wrong.” You’re going to be getting that information very easily, and what may not come so easily is noticing the things that are improving.

I’ll often suggest to clients, keep a little journal of this to notice, what are the different things that have changed? Or “I had this happen for the first day” or “I was able to do this.” And continue to compile that list, because even when things feel challenging, you’re going to have better or worse days. So when you are having one of those better days, let’s start to journal some of those things down, or the things that we notice, and when it’s one of those harder days, let me pull that thing out and let me remind myself, because it can be very easy to think that nothing’s changed, nothing’s improved when the reality is that things have started to shift.

And I would be interested to know more about what happened over those couple of months, because my speculation would be that actually certain things did improve during that time, and actually the points where it started to feel worse were probably the points where you started to pull back, where you started to do a little more of the eating disorder behaviours, and that’s when it got louder again and it felt too hard or you were convinced that it wasn’t making a difference.

And actually, probably the points where you were consistently keeping something up, that’s where that thing started to normalise a little more. “I did that for 2 weeks in a row, 3 weeks in a row, and that now has become a little more normal for me to have that breakfast or that thing, and I don’t feel quite as uncomfortable in my body when I’m doing that thing in the way that I was doing before” versus “When I start to pull away from that, the eating disorder convinces you you’ll get a sense of relief – and maybe you do momentarily, but actually what you then get is this real destabilizing of the recovery process and all the thoughts about why this isn’t going to work.

So really what I would say is that the safety comes from repetition. It’s not waiting to feel right; it’s doing the thing even though it feels uncomfortable, and consistently doing this.

I would also just add – you mentioned about the autism and the trauma, and these are things that can have an impact in terms of how we deal with recovery, in terms of the way that we approach it. Certain things might need to be done a little differently because there are sensitivities to noise or sound or sensations, so we need to look at how is that actually impacting your body and your nervous system, and what do we need to do connected to this?

I think what often people can be sold – especially if someone’s listening to a lot of the “everyone needs to go all-in in recovery, and if you eat the food then everything’s going to be better” – I just don’t buy that for the vast majority of people with eating disorders. For some people that can be true, but so much of what I work on with clients – yes, there’s the nutritional rehabilitation piece, because if that’s not happening, then you’re just going to have Groundhog Day every day, but we need to then be learning ways of being able to regulate our emotions, support our nervous system, ground ourselves, having these tools come in, and that can then be helpful here.

So it may be that actually what you need is the food piece, and alongside that “I’m doing certain things connected to trauma repair work or I’m doing certain things that are supportive of my nervous system and how that is impacted because of my autism.” That would be the thing that I would add, and if that has been missing and the only thing has been a focus around the food piece, this could also be a reason why it feels like it just wasn’t working for you.

00:09:13

Is full recovery possible?

Then the next question is from Andrea, and she says, “I would like to know if you fully recover or if it is always a struggle.”

If you’ve listened to my podcast for any length of time, if you’ve read any of my blog posts or Instagram posts, I always talk about full recovery. And I talk about it because I truly believe that everyone can get there. It’s not a matter of it might happen if you do the things, maybe it’ll happen. I truly believe that everyone can get there, and it is a matter then of doing the things that allow that to happen.

When I talk about full recovery, I mean that you’re not just coping a little bit better. You reach a place where food, where weight, where eating disorder behaviours are no longer a daily battle. They’re no longer part of your day-to-day life. Life really stops revolving around the eating disorder.

And this doesn’t mean that someone doesn’t have a thought. We live in a world where we’re going to have certain thoughts come up connected to food or our body. I’m not living with an eating disorder, but yes, thoughts come up at various points. But the difference is the meaning that we attach to those thoughts, how much it impacts our behaviour. So it’s one thing to have a thought and just move on; it’s another thing to have a thought and then we start acting on that thought or we spend an hour or two hours a day wrestling with that thought.

You get to a stage where there are occasional thoughts or occasional moments, or you recognise, “When I’m under a particular amount of stress or it’s a really challenging time or I’m not sleeping particularly well, I’m noticing more of those thoughts come up.” And that doesn’t mean that you’re relapsing. It just means that “When my body and my nervous system get into a particular state, this is an old pattern that it mentions, like ‘Oh hey, remember this thing? We used to do this thing when things were stressful’.” It’s your nervous system or your old brain reminding you of something that you used to do, and that doesn’t mean you have to do anything connected to that. You can just thank your brain for that recommendation and move on.

So I just want to mention this because I don’t want it to be this impossibly high bar that you recover from an eating disorder and then you never have a thought again about food or your body or anything along those lines. It’s more that those things become a lot less frequent, have a lot less urgency to them. They just don’t have the power over you.

But what I would also note with this: when I talk about full recovery and that everyone can get there, I don’t just mean that you do the things around food and exercise and then you’re there. What I’ve seen again and again is that people will often get over the eating disorder, but if you haven’t really dealt with the other stuff connected to this, it then just switches to something else. So “I’m no longer using the eating disorder as a harmful coping mechanism, but something else has now filled that void, and now I’m a workaholic, or now my whole self-worth is dictated by the grades that I’m getting at college or university or how I’m doing at work, or I’m using alcohol as my way of dealing with this, or I’m getting into relationships that aren’t particularly helpful and there’s a lot of drama in those relationships and that’s how I’m coping.”

I’ve seen this happen where the eating disorder in essence tends to disappear, but what was driving that underneath and the coping hasn’t then been replaced with something constructive. Like I talked about a moment ago, a lot of what I work on with clients is looking at those different areas. The emotional regulation, the coping practices, the how to create a life that has meaning and purpose – all of these different things that then help to create that full recovery, and where we’re not just switching one thing for another thing; we’ve got to a place where we’ve found other, healthier, more sustainable ways to deal with life when life gets life-y and to really cope.

00:13:50

How to rest when it feels ‘lazy’

The next question is from Amy, and she says, “Anything to do with rest is super useful listening, please, especially around resting when every impulse in you is itching and screaming not to, trying to stand all or most of the day, and reframing laziness or indulgence because of resting.”

What I want to say is what you’re describing is a very common part of an eating disorder and is a common struggle that many people have. I would just say that that urge to not rest is a symptom. It’s not the truth. It becomes a real shift in one’s nervous system, and that long-term restriction, long-term exercise compulsion means that stillness starts to become unsafe. Movement, standing, cleaning, doing low-grade movements become this way of regulating anxiety, and this itching feeling you’re describing isn’t evidence that rest is wrong; it’s just evidence that your nervous system is dysregulated and that you’ve been using movement as a way of coping with that.

I think a lot of this can – you talked about the laziness and the indulgence. It’s amazing what the mind can do around this. It’s a problem to be standing all day and have this inability to sit, but it then gets framed as this thing that is healthy or “it would be lazy for me to not be doing this”, and that’s just not the reality of the situation. If we look at what is truly healthy and what is truly useful for you, it’s recovery. And as part of recovery, it requires downregulation. It is needed for hormones and digestion and bone health and brain health and basically every system of the body to actually repair.

For that to happen, we need the system to not just constantly be on. Rest is not optional as part of this. This is part of the treatment. It is really, really important.

So often with eating disorders, we try and come up with an explanation for why this would be the case, to explain so much of the logical nature of an eating disorder. “I need to come up with an explanation for why it feels uncomfortable to not stand or why it feels uncomfortable to want to rest.” We’ll often grasp at what’s in the culture or “what I’ve been told at various points in my life” to make up an explanation for this and to get an explanation that feels like it fits. So often, there can be the idea of it’s unhealthy.

What I notice is even when someone can recognise that actually, the healthiest thing to do is rest, it doesn’t change the desire or the compulsion to move. And the same with this – I often will ask people, “If you had a friend or if you had your son or your daughter or a family member, would you think it would be lazy for them? Do you think it would be indulgent for them to rest or to not stand?” and the answer is, “No, of course not. This is different. It’s for me.”

This just points to the fact that it’s not really about those things. You’re not the exception to the rule. It’s true that it’s not the case for everyone else and you’re included in that. So just recognising that “Hey, all of these things that I’m saying around laziness or indulgence or unhealthiness or any of those things, they’re not the true thing that’s driving it.” And this isn’t to say that there isn’t feelings or sensations that come up in that situation. There truly is. But the reason for that isn’t because “I’m feeling lazy or I’m feeling indulgent.” That’s our explanation to it. It’s that when a nervous system is living with an eating disorder, it miscatalogues, it mis-predicts certain things as being threats, and that then leads to certain sensations within the body. And those are the things you’re feeling, and then “I need to come up with an explanation for why this is the case.”

I just want to get that across, because you can get into “I have to come up with a better explanation about why this isn’t lazy or why this isn’t indulgent or why this isn’t unhealthy, and I’ve got to try and convince myself,” and there is no amount of convincing. You will change your thinking through taking the action and resting, and by doing that consistently, your nervous system starts to change and your thinking then starts to change around this.

So just really understanding that in the beginning, all of those thoughts and feelings are going to be there, and that doesn’t change the fact that actually the thing that’s most important is leaning in and doing the thing that is uncomfortable. Just remembering that it’s not going to feel comfortable to start with. It will get there over time.

00:19:21

Does the approach change when recovering in a larger body?

The next question is from Michelle, and she says, “I’m recovering from a restrictive eating disorder in a larger body, and I think what I would love to know more about is, can one really trust themselves through the weight restoring or possibly overshoot stage in all body types? Is it a one-size-fits-all to eat three meals, three snacks no matter who you are? Because what if one’s health is truly impacted like with sleep apnoea and foot/joint issues? My treatment team is so kind, and so are you. Truly the recovery space alone has been healing in so many ways to my lifelong battle with being overweight and feeling so judged by society, perhaps even life-saving. But over and over I think, when an expert is straight sized saying ‘Eat more, eat to abandon, eat because you deserve it’, do they actually know how it is to literally carry the consequences? It’s so tough.”

Thank you for your question. I just want to acknowledge up front, it is hard, everything you’re describing. For me, when I’m working with clients – and I know you’ll say, “You’re straight sized and you’re saying these things,” but truly, when I’m working with clients, their body size does not impact my treatment recommendations. When I’m working with someone, I’m looking at, how much have they been eating? What movement have they been doing? What symptoms are going on? How is this affecting them mentally, emotionally, physically? All of these different things to understand where they are at in terms of their recovery.

The number on the scale or the size of someone’s body or the BMI that they’re at has really very little impact on that. It’s not that that information can’t be used at all, but in terms of me saying, “Oh well, if you’re in a ‘normal’ BMI, we’re going to do this thing differently, or if you’re in a larger BMI we’re going to do this thing differently.” It’s just not true. My recommendations and how I work with someone is based on what they are presenting with in terms of their thoughts and their symptoms and all of that.

Given that, trust isn’t body size dependent. It really is nervous system dependent, and regardless of the size that someone is at, restriction has an impact. It has an impact on appetite regulation. So trust then returns through consistent nourishment, not restriction, not through trying to control, not through any of these other means, but through giving your body what it needs. And again, this applies to all body sizes.

Your question about three meals and three snacks – this is true for everyone, and again, it’s not that everyone ends up doing that, but it’s not dependent on someone’s body size. There are certain people where we find a slightly different structure because of what works best for them, which could be connected to the job they’ve got, could be connected to other constraints they have. But we’re not making decisions around “Oh, you shouldn’t have that third snack” because of someone’s body size.

The point of three meals and three snacks is that we’re wanting to have regular energy coming in. We’re wanting to have energy from when someone wakes up through to the point at which they’re going to sleep, having that consistent energy in there – one, to let the body know that it’s no longer in a famine, but two, to provide the energy that the body needs for today plus all the repair that needs to be done for all the restriction and the eating disorder behaviours that have had damage before today.

I get and I understand that it is really hard with co-occurring conditions in recovery. You mentioned joint pain, sleep apnoea. There can be fatigue, there can be lots of different symptoms. And what I also want to add with this is, I’ve seen this in people all across the weight spectrum. I know it can be very easy to blame this on someone’s weight, especially something like sleep apnoea, but people in all sizes of body can get sleep apnoea.

So what I would suggest is, one, there can be ways of treating these things outside of restriction or outside of weight loss. What are the ways that we would look at this for someone who is in a smaller size body? I think this can often be a useful question when a doctor is telling you< “Hey, we need to lose weight to deal with this.” Would it be okay if there’s someone in a smaller body who ‘didn’t need to lose weight’ and they had joint pain? How would you deal with it? If there was someone who had sleep apnoea who was in a ‘smaller’ body who didn’t need to lose weight, how would they deal with it? Start from that place.

Because the thing is, even if the weight is impacting some of these things, if we’re choosing between joint pain or having an eating disorder, I know which one is the better one for your quality of life and for your health. And I know sometimes it can feel like you’re choosing between some rather shitty options, and actually I would like an option where I didn’t have this thing and I didn’t have that thing and I didn’t have this other thing, and I want to be in absolute perfect health.

Unfortunately that might not be the case in terms of an available option, especially not during recovery. It might be later on we can do things where this isn’t going on, but in recovery, this is part and parcel of what is going on and what is necessary at this point. And if I start going down the route of trying to deal with this from a restriction or a weight loss way, I’m going to find myself having a lot of other problems starting to occur outside of just this.

I also just want to add that you are allowed to name the difference in lived experience and notice that it could be easier for that person or it can be easier for this coach to be saying this, and that is true – and you can do that without abandoning recovery. You can say it’s harder to do this in this body size, and I’m still going to do the things that are required for recovery.” Because I do work with clients all across the weight spectrum, and I’ve had many conversations with people around this, and I can acknowledge that it is harder in some ways, many ways – and this doesn’t change the fact that there are certain things that are required for recovery. And I truly believe that if you do recovery, you can have a very good, high quality of life. And again, if I’m choosing between being in a larger body and being free from an eating disorder or being in a smaller body but living with an eating disorder, it would be choosing the former.

00:26:40

Dealing with oedema + other body changes after weight restoration

Then the next question is from Kara, and she says, “I’m 10 months into recovery. I was extremely underweight. I’m now weight restored but I’m quite unformed, like a big lump without a regular shape. I feel like I’m wrapped in bubble wrap and my skin feels like dough. I also have terrible oedema in my face, neck, stomach, and entire body. My face is unrecognisable. My eyes are still quite sunken in and my face is very swollen. I have a lot of belly fat but I feel like it’s starting to redistribute. I’ve gained some muscle, but I can tell that my body still has a lot of rebuilding to do. I’d appreciate any information about these topics and experiences of others, as it is a very difficult phase to endure physically and emotionally.”

Kara, thank you for your question, and I do agree that the phase that you’re going through is a challenging one, and it is a common one as part of recovery. It’s not a sign that you’re doing anything wrong. It’s just a sign of where you are as part of recovery. After being severely underweight, the body has a lot to restore. It’s got fluids to restore, connective tissues, fats, and then it starts to restore things like muscle tone and organs and structure and all of this. This can then create this doughy or puffy, bubble-wrap feeling, especially in the face or the abdomen or the limbs.

One of the ways I often describe this with clients is it’s like going through a second puberty – or if your eating disorder started before going through puberty, it’s you going through your first puberty. If you look at people going through puberty, it’s not all uniform. People have height spurts before they have weight spurts, or they have weight spurts before they have height spurts, or as they grow, it’s not done in this nice uniform way. It can be more lumpy and asymmetrical and all of these things. So recognising that, “Hey, this is what my body is going through.”

The reason the analogy also works is most people I speak to don’t want to go through being a teenager again. I’ve said this on the podcast many times: there’s not enough money in the world that would make me want to be a teenager again. It’s just not a fun time. There’s so much of what is going on in this stage of recovery that is similar to being a teenager. You’re dealing with stuff around identity, you’re trying to figure out who you are in this world, your body is changing, you don’t know where it’s going to end up, you’re often having a lot of the same kinds of symptoms around getting acne or getting my period for the first time in a long time.

There’s so many aspects that are similar to puberty, and the reason of mentioning or recognising it, you can then have a little more compassion for yourself through that. You can recognise, “Oh, okay, it makes sense that I’m struggling more with this or that this thing feels uncomfortable because that’s what it was like going through puberty.”

The other piece I would say with this is oedema – and it sounds like what you’re describing is that there is a lot of oedema that is going on, or there’s a decent amount of oedema going on, and this can then persist long after the weight restoration phase, especially if there has been this longer or severe restriction. I think, again, this can be one of those misconceptions where people think about oedema as just being in the early refeeding point. But I’ve had many clients where it lasts for much, much longer than that, and this is because blood volume is normalising, capillaries are repairing, albumen and hormones are stabilising, your lymphatic system is trying to catch up. All of these things then lead to more of that puffiness that you describe or that bubble-wrap sensation you described.

It’s really common to have that around the face or to have that around the abdomen. It often feels like it moves from body section to body section, like “This thing’s now no longer so bad, but this other thing is worse.” I know it can feel uncomfortable physically, it can feel distressing, and just recognising that this will improve with time.

The unshapeliness or the un-uniform thing, this will come with time. Redistribution is a real process, but it is a slow process, so it can be that there is this more portly shape to begin with, and as you continue on with the nutritional rehabilitation and muscle rebuilds and fat redistributes and posture and tones change, the body may become more recognisable to what it used to be like before the eating disorder, or it just becomes this new version of you.

I will also add with this, while I say things will redistribute and it will change, bodies are, by their very nature, un-uniform. I will often recommend clients go to the local YMCA or local pool to see a real mix of bodies. Where I am in Scotland, and it used to be the same in England, we would go to the pool with Ramsay and you get to see people in all different shapes and sizes. Being in changing rooms with people who are young kids through to people in their eighties, you get to see a whole range of different body shapes and sizes.

I think this can be a useful thing to do because if the only bodies you’re seeing are on social media or on TV or that kind of thing, you can have this skewed idea of what a body looks like. So find somewhere where there is a real mix of ages and socioeconomics and all of these different things to see that bodies do really come in a wide variety of shapes and sizes.

The thing I would also say with this is you’re wanting to, as you go through this, develop different tools – and I know I’ve said this already in other questions, but developing tools to then deal with the thoughts and the feelings and the sensations that come up connected to this. Because I think what often happens, or what can happen, is there can be this feeling of “I just need to hole myself up. I’m going to shut out the world, I’m going to do this, and I’m going to wait until my body gets back to a place that I feel happy with and then I’m going to go back out into the world.”

I don’t think that that’s a very helpful way of dealing with this, one, because eating disorders are anxiety disorders, and you’re wanting to be able to challenge those times where you want to avoid and you’re wanting to just sit this one out and “I don’t want to do that and it feels too uncomfortable.” It’s about building the resilience to do the things that are uncomfortable. It is about going out or going to the pool or going to dinner or doing these different things that challenge the eating disorder.

The other part is that I don’t know where your body is going to end up. I think often people can have this idea of “This is what it will be when I’m recovered,” and sometimes that happens and sometimes that doesn’t. Rather than just putting your whole life on hold, I want you to go out and start living it. Again, if you’re a teenager, the goal of being a teenager isn’t just to hide yourself away. It’s “Hey, I went out on that date even though my whole face was covered in pimples” or “I went on that date even though I was feeling really uncoordinated because I just had this growth spurt.” It’s “Hey, this is who I am, this is who I am showing up at this point.”

I very much think of acceptance as being a verb. Acceptance is the doing piece, and it’s through continuing to do things. And look, within reason, and again, with protecting your recovery. If doing too many things is then overwhelming your nervous system and is leading to “I’m getting poorer appetite regulation and I’m unable to do these other things as part of recovery,” that’s not helpful. But there is a middle ground with this stuff where “Hey, I’m not doing avoidance and I’m not completely overwhelming myself, but I’m doing enough so that I’m not just having my whole life fall by the wayside and being put on hold while I do recovery.”

That would be the advice I would have around how to deal with this at a more psychological / emotional level: continuing to do your life and to have different tools to then be able to deal with the thoughts and feelings and sensations that arise.

00:36:29

Changes in food + movement during extreme hunger

Then the next question is from Kayleigh, and she says, “Anything regarding extreme hunger allowance and judgment of food choices? Because when in extreme hunger, often the choices of food aren’t healthy ones. Find myself in bouts of extreme hunger before my mind can really listen in, like my body drives the wheel before I can realise what happens, and unfortunately the only things I want is chock full of sugar, literally no desire for vegetables nor to keep exercising. So it’s like I have to give up things I do eat that make me feel good about myself.”

Thank you for the question, and again, this is a very common experience for people. What I tend to find is the people who have no appetite at all wish for the extreme hunger, and the people who have extreme hunger wish that they had no appetite at all. It always feels like “The hand I’m being dealt as part of recovery is the tough one,” except for a few exceptions of cases.

What I would say is, yeah, extreme hunger is driving your body, and it’s driving your body for a really important reason. After the body has been restricted and hasn’t got what it needs, the body really prioritises “Hey, we want to get out of this situation. We want to get out of the energy debt that has occurred,” and the way to do that is to prioritise fast, energy-dense foods. When that occurs, you can find that hunger can really surge, and it can be surging in some ways before your conscious awareness even catches up because this is like a survival reflex. This isn’t a choice. This isn’t you thinking, “Hey, I wonder what feels good today.” It’s more just like, “Hey, I’m in this primal drive to get this food, and this is what happens. Often as soon as I start eating, I recognise I’m even hungrier than I was before I’d started eating.”

So it is this real primal drive that is pushing you towards these things. And I know you talked about sugar and everything’s chock full of sugar – that’s not a bad thing. Sugar or refined carbohydrates are the fastest way for your body to restore depleted glycogen, to give your brain fuel, to help with hormones. It’s important that you’re getting in this form of energy because it is so needed as part of recovery. And a lack of interest in vegetables or in exercise is not regression. It’s, again, wisdom of your body. Your body is recognising, “Hey, vegetables don’t give me the kind of energy that I need right now.” It might be also, “Hey, I ate a ton of vegetables for a very long time even though I didn’t want them,” so there’s a feeling of like, “I’ve had my fill of vegetables.”

It’s also common to feel like “I don’t want to do exercise right now.” And again, that could come from “I spent a very long time doing a lot of this when my body really didn’t want to be doing this, and now when I’ve stopped, I just don’t really want to start again.” It’s also when you start to bring in more energy for the body, you realise the baseline of what is going on. It’s often at that point that someone is like, “Oh my God, I just didn’t realise how tired I was and how depleted I was.”

And part of that is when you’re not eating enough, a lot of what is propping you up is these fake versions of energy. One, it’s “Hey, I’m using stress hormones, adrenaline and cortisol and the whole stress response is the thing that is keeping me going and I don’t even really notice it, or I’m using lots of coffee or I’m using lots of energy drinks or I’m using these things that give me this fake sense of energy, and when I bring in a lot of food and do that in quite a short amount of time, that turns off those stress hormones, and I now get to see what my baseline is. If I’m then stopping drinking coffee at the same time, I really get to see what my baseline is.”

The body’s goal at this point is just to repair and recover, and if we can then save energy by having you do the least amount of movement possible, then that is actually what we’re wanting to do.

I think what I want to add with this as well, just because of the way that things are phrased, is that health is context-dependent. There can be a lot of ideas of “Oh, but lots of sugar isn’t healthy” or “Vegetables are healthy.” And really, what makes something healthy or unhealthy isn’t the food per se; it’s the body that it is going into and what is needed from that body. That means that broccoli or kale, we think of as ‘healthy’, actually could be very unhealthy because one, you might not digest it very well because of where your system’s at; two, if that’s taking up space and it means you’re getting in less energy-dense things and your body desperately needs energy, then that’s an unhealthy thing for you and for your body.

In the same way, pizza or donuts or ice cream or sweets or these things that we think of as being ‘unhealthy’ can be the quickest and the easiest and the most palatable and the lowest volume way of you getting in energy, and if that’s the most important thing for recovery, that is the healthiest thing for you.

So just really understanding that health is not this thing that is set in stone in terms of “these things are unequivocally healthy and these things are unequivocally unhealthy.” It depends on the context and the body.

I know you said the good and the healthy and around your identity, and I do get that it can feel like you’re losing the foods or the behaviours that made you feel disciplined or virtuous or okay about yourself, and there can be this whole identity piece connected to this. I will just say in the last Q&A that I did, Episode 350, I talked about this and I went into a lot of detail because someone else asked a question around the identity piece. So I’m going to suggest that you go back and listen to that to find out about how to deal with that part of this.

Just the final thing I would say is judging food choices keeps you stuck, and it keeps the body in this mode of thinking about these foods as being a threat. So when food or eating is paired with shame, “This is bad,” “I shouldn’t be doing this,” extreme hunger tends to stay longer. And when allowance and permission instead of control is brought in, it’s what actually shortens this phase.

I understand that that’s easier said than done and we’re not thinking our thoughts, these thoughts are naturally coming up in us, or we’re not creating these emotions of our own accord, they’re naturally arising in those moments. So if I’m then having a thought of “This is bad,” I’m going to use some form of diffusion. “I’m noticing my mind is generating the thought that this is bad.” Or I’m going to do some journalling to help remind myself that this is okay, it’s fine, what I’m doing is actually really helpful and supportive.

So it’s not that you can’t have these certain thoughts. Those thoughts are going to come up or those emotions are going to come up. It’s just, how do I navigate them? Am I navigating them and supporting myself in a way that is compassionate and helpful for recovery, or am I doing things that are colluding with the eating disorder and making this situation worse and prolonging it?

My suggestion would be to just notice when these things are coming up, and when they do, how can you then support yourself, and support yourself in recovery as opposed to doing more of the eating disorder?

00:45:04

Can full recovery be hindered by starting the wrong way?

The next question is: “If I’ve already gained some weight in an inpatient setting with typical focus on calories, weight, etc., is it then too late to gain the remaining weight trying to follow the migration weight? So to say, can full recovery be hindered by starting the wrong way?”

Let me explain for listeners, and I’m going to explain for you just to make sure I’m understanding your question correctly. You mentioned about migration theory. I’m assuming based on that that you’re talking about the ‘adapt to flee famine’ perspective of anorexia, and this is something that was proposed by Dr Shan Guisinger, and it comes from this evolutionary perspective that when humans historically faced famine, the body needed a way to survive and escape environments where food was scarce, and they would keep moving and keep moving and keep moving until food was plentiful again. It was then when the food was plentiful again and they were able to eat with abandon and eat in abundance that that would then turn off that shift within the body.

If we move outside of humans, I often think about birds in the wintertime. They’re happy to fly an inordinate long amount of distance, and the thing that keeps them flying and flying and flying is this same kind of mechanism that “Hey, I’m moving from this place to this other place,” and this is where the migration piece comes in, and it’s only when I get to my final destination that there is this abundance of food, and it then turns this off.

With all of that preamble, what I would say is no, it is not too late, and no, you haven’t ruined everything. Weight gain via inpatient where it’s structured and calorie-focused doesn’t block healing. It doesn’t mean that you’ve now missed your one chance to do recovery. While I do agree with the ‘adapt to flee famine’ perspective and it does make sense, I think there are different ways of doing recovery and that not everyone has to instantly start with going all-in and if you’re not doing that, you’re not really doing recovery. You can do it in different ways.

For some people, that is “In the beginning I did it in a more structured way to get started, and then at some point it did feel much more doable to do the more all-in and give myself complete full permission to eat whenever I was hungry, and that was the point I started.” I’ve seen that for many people. And for other people, they never get to that complete place and it is more structured, but the way that they’re doing it structured is getting to a high enough amount of calories. We’re still doing recovery even though it hasn’t turned into the ‘all-in’.

So even if your desire now is “Hey, I want to take that more all-in approach,” all of the stuff you’ve done up until now will be helping. The energy’s going to be helping in terms of doing the repair work. There still would’ve been some neural rewiring that has occurred from what you’ve done in the inpatient setting. And from what you’re describing, you’re still not completely there. There are many systems, whether that be appetite regulation or metabolism or hormones or nervous system or whatever, that haven’t completely recalibrated yet, so there is still plenty repair to do.

My perspective isn’t because you didn’t do it the ‘right’ way to start with, that’s the only reason those things are hanging around. So I would just say start now. If this is how you want to approach recovery, don’t let anything else that has come before it get in the way. Yeah, go for it from now on, and I would love to hear how it goes for you.

00:49:22

Dealing with an all-or-nothing mindset

Then the next question is – I think this is from someone on Instagram. There’s some numbers in the name, so I think it’s meant to be Fairy Julie, but I’m not sure. The question is: “How to recover when you have the all-or-nothing mindset, a.k.a. black-and-white thinking, the perfect recovery, and if I don’t follow my perfect plan, I relapse immediately.”

The thing with all-or-nothing thinking is, it is part of the eating disorder. It’s not a personality flaw. It’s very common as part of an eating disorder and just the way that the brain changes. Starvation narrows thinking, and the brain looks for certainty and for control, so the ‘perfect or failed’ mentality feels much safer than flexibility. It’s very binary, it’s very easy. With time, that will then soften – and when I say with time, I mean with nourishment, with nutritional rehabilitation, that will start to shift.

And look, it’s not that you will then get to a stage where you never have all-or-nothing thinking. I think as human beings, we all have these different cognitive distortions in different aspects of life. So maybe you have the all-or-nothing thinking change with the eating disorder, but there is this other thing or these other moments where that comes up.

In terms of this idea of “I either do it perfectly or I relapse,” this is in a sense just setting yourself up for failure. It’s something that the eating disorder then uses to justify why to go back to behaviours. And I see this very often with clients, especially if we’ve got a couple of things that are changing throughout the day. For example, “I’m going to change my breakfast and I’m going to add this thing into my snack, and then I’m going to do this journalling thing in the evening time” or whatever it may be. There can be this idea of “I didn’t do the morning one, so everything’s ruined. I’ll start recovery again tomorrow.”

It then just becomes this loop where “As soon as I deviate the tiniest little amount, I just throw my hands up and say I’m not doing it perfectly, so I need to just not do recovery today and I’ll pick it up tomorrow.” And I think that’s just an eating disorder trap. It’s just the eating disorder using this against you.

The reality is, recovery is built on consistency, and you don’t want to miss the forest for the trees. When you are consistent, we can look at, what does consistency really mean? Consistency could be “Hey, there were a handful of things I wanted to do today, and one of them was missing and I did the others. And then the next day there were some things that I was going to do and there was one that was missing and I did the others.” If we then look at that across a week and you kept that up, you’ve actually been pretty consistent. Yes, we can look at the one thing you’re not doing, is with the same thing every time? What could be going on there, or how do we approach that?

But we need to think about it bigger picture. I think of the analogy where people think about “I need to eat in a more balanced way” and they’re then looking at every single meal. Is every single meal completely balanced in terms of carbohydrates and proteins and fats and micronutrients and all of this, as opposed to looking at across a week, was I getting all of those things in?

I think this can be the same here, getting into that mindset of consistency doesn’t mean I did every single thing absolutely perfectly. And this isn’t to say that people shouldn’t have goals. It’s not to say that people shouldn’t treat those goals as non-negotiable. Hey, let’s aim for doing everything that we set out to do – and it isn’t this really black-and-white thing.

Recovery isn’t ruined by imperfection. It’s strengthened by not quitting when that imperfection shows up. That’s the thing that really makes the difference.

I would also add that I’ve done a whole podcast on cognitive distortions – not just on all-or-nothing or black-and-white thinking, but looking at a number of other cognitive distortions. It’s Episode 295. If you haven’t listened to that one, I will link to it in the show notes, and I highly recommend checking it out.

What I often recommend – and this is something I go through with clients around cognitive distortions – is understanding what they all are so that you know that there is this one and this one and this one, and then spend a week where you do some journalling every time those thoughts come up, so you start to notice “Oh okay, I’m doing this one here and I’m doing mind-reading there and I’m doing…” So you start to recognise your patterns around this and you start to be able to be much more aware when certain thoughts come up as opposed to just believing them or being hooked by them. You can just notice, “Oh, yeah, my mind is doing that in that moment. Isn’t that interesting?”

00:54:48

Is binge eating common in anorexia recovery?

Then the next question is from Sadie. She says, “Is binge eating common in anorexia recovery?”

The short answer to this is yes, it is very common. It’s usually temporary if it has just come about through the recovery process. Like I’ve talked about earlier with extreme hunger, after prolonged restriction, the body responds with intense hunger and urgent eating, and this is a biological imperative. It’s primal. It’s really important. It’s your body saving your ass, is the simple way of describing it. Your body is smarter than you and it knows that we need to get this energy in for us to actually be able to survive. So it is common.

I’ll also add that binges or even binging and purging can also be common with anorexia while in the disorder, so not just during the recovery phase. There is – they call it binge/purge subtype with anorexia, so that even though someone has anorexia, there is binging and purging that is going on. This is more common than people think.

I think with so much of the classifications within the DSM, how eating disorders are classified is based on someone’s body size. If someone’s in a small enough body and they’re having binging and purging, we talk about it as being binge/purge subtype of anorexia; if they’re in a larger body, we’re talking about it as binge eating disorder. If they’re in a smaller body but not a tiny body, we’ll call it bulimia. It can be the exact same thing going on, and the only differentiating factor here is the size of someone’s body and we’re telling them they have a different eating disorders.

I totally disagree with that way of thinking. So much of eating disorders, irrespective of someone’s body size, are the same thing. It’s about restriction and what happens when a body gets into a malnourished state, and that starts to have an impact on thoughts and feelings and physical symptoms and how the body is able to function.

In terms of this, yes, it is really common. I think that language matters and descriptors matter, and there can be a lot of baggage that we associate with different terms, so what I would suggest is, how does the phrase ‘binge eating’ feel to you? And if there is a lot of negativity associated with this, is there a different phrase that can be helpful? How does it feel when you say ‘extreme hunger’? Is that neutral? Has that got negative connotations with it? Is there something that you can come up with that either feels positive – or if positive is too much of a stretch, at least feels neutral and more of a descriptor of what’s going on?

It might be ‘feast eating’, ‘recovery eating’, ‘rehabilitation eating’ – finding some descriptor that doesn’t have the baggage associated with it to be able to describe what is occurring during these situations or over these next couple of months or however long this goes on for. Because I think if I’m constantly referring to this thing as a binge and I have this real association with that term in a negative way, that can lead to more shame or more guilt or more negative emotions arising. So I think it’s important to recognise the language that one’s using.

It’s the same with one’s body. If the only way you’re able to describe your stomach at this point is in a negative way, there’s no way that you’re going to possibly feel good about your stomach because those words have associations. So can we find a way of being able to describe the stomach in a neutral way? And not with the goal of that then makes you instantly love it, but as I said, if the only words we have are negative words, then there’s no possible way we’re going to feel neutral about this thing. So using the same in terms of your eating as part of recovery.

Again, as I mentioned with a previous question, restriction or the fear of the binging is then what keeps it going. So if you are trying to limit your intake, if you’re trying to eat ‘normally’ or you’re compensating afterward, this then tends to prolong the period. Focusing on “How can I get consistent, adequate nutrition or nourishment? How can I do this consistently? How can I do this even if I have had a period where I’ve eaten a lot more at a particular snack or a particular meal or a particular day?”, being able to keep up that consistency irrespective of what has happened.

00:59:50

Can exercise be stopped gradually vs a complete break?

Then the final question, anonymous this one – it says, “If exercise is your biggest problem and it’s compulsive, can you break off gradually in stages, or does it require a complete break to the habit and dependence?”

Before I answer this, I will just say that I’ve done a whole episode on exercise and recovery. I go into it in that episode in way more detail, so if you haven’t listened to that one, then I recommend checking it out. It’s Episode 322 of the podcast, and I’ll put that in the show notes.

To answer the question, it depends. How I think about exercise with clients and whether we need to immediately stop this thing or whether it can be gradual just depends on the function of exercise that it’s having for that person. If exercise is being used to regulate anxiety and to earn food and to control weight and to avoid rest, then it is a really big part of the eating disorder. My tendency would be more to say, yeah, we need to have a complete break straight away.

Versus if for someone they’re doing a lot less exercise, maybe it’s not even every day, maybe it’s something that’s more at the gentler end of things, and actually there’s much bigger areas that we need to be focused on in terms of their recovery, and maybe there’s stuff around food, that’s where I’ll put my focus. And it might be to begin with we can just leave the exercise. We’re going to come to it at some point, but we can’t change everything on Day 1, so let’s focus on this other area that feels most pressing.

The thing I’m always asking myself is, how central is this to driving the eating disorder, and how much inroads can someone truly make if they’re not changing this thing? More often than not, the reality is you’re not going to make much of an inroad if you’re leaving this thing here.

What I also notice is that when exercise is compulsive, gradual reductions don’t actually provide the psychological relief that one thinks it will. You get into this situation where “I used to be doing X amount; I’m now doing Y amount, and it’s actually not really helping. I’m thinking more and more about the exercise. It feels like it’s so hard to actually get myself to stop at the point I said I was going to stop, and it feels like it’s continuing to creep up a little bit.”

In essence, you just get the worst of both worlds. “I’m not doing enough so that my eating disorder is happy” – and I know the eating disorder is never completely happy, but where “Hey, this is what I’ve been doing and I can at least be staying at this level” – and then you’re not doing enough to actually get the upside in terms of the real changes in terms of your nervous system and your body starting to do the repair work and all of that side of things. So you get stuck in this no man’s land where “I feel like I’m thinking about this more, it feels like it’s even more difficult now to not exercise, and I’ve got absolutely nothing to show for it.”

This is why, again, I think having that break is so important. And also, when you’re trying to do it in that other way, in that more gradual way, it’s easier to then start to believe that “This is all too much. I couldn’t possibly take that break from exercise. If it feels this hard to reduce it by that amount, imagine completely stopping.” There’s just this asymmetry with those two things where actually, having the complete break, yes, on Day 1 and Day 2 and Day 5, that can be hard, but pretty quickly – 7 days, 14 days – you start to adjust to not doing that exercise.

It is one of the few things in recovery where it is pretty black-and-white and binary, where “Hey, I know I didn’t do this thing today.” The difficulty with so much of eating disorder recovery is it’s all shades of grey. Like “I still have to eat this food and I still have to do these things, so I’m doing more or less of certain things,” whereas with exercise, there can be a “I’m just not doing this thing.” I think that’s where and why, despite it feeling like the thing you’re most terrified of and the most difficult thing, it’s actually the thing, often, people adjust to the quickest, as I said, within a matter of weeks.

And look, I know from experience with clients that it can often take a while to get to that place, and again, I think there can be this feeling of “If I reduce it a little bit and reduce it a little bit, I can build up the confidence to then take it off,” and I don’t see that happening very often. There can be some exceptions to that, but especially when the eating disorder is really central to keeping it alive and having such an impact on someone’s thoughts around whether I can eat or I can’t eat or having to earn my food and all of those things. If you are continuing to exercise, it doesn’t tend to change even if you’ve reduced a little bit.

So my short answer after all that is: if it feels like, given what you’ve described, exercise if your biggest problem, it is compulsive, I would be suggesting having a break and just going cold turkey with it.

And if you’re not going to do that, I would be working towards that, but working towards in a fairly – ‘aggressive’ is probably not the right word, but I would be being very on top of yourself with this in terms of, “Okay, if I’m going to have a break and I’m working towards having that break and I know I need to get there gradually, I’m going to get there within 2 weeks or a month” or whatever it may be. “I need to be telling myself how I’m going to get there. If this is my destination and I’m giving myself 4 weeks to get there, by Week 1 I need to be at this point. By Week 2 I need to be at this point. By Week 3 I need to be at this point.” And you need to hold yourself to that.

If you’re not then getting there by Week 2, I know it feels like “This proves that I need to take longer to get there,” and I would say it actually proves the opposite. If you’re unable to keep to your promises of “I’m going to do this in a gradual manner,” then it normally proves we need to completely put a pause on this, deal with the uncomfortableness that comes up with that in the short term, and say within a short amount of time we’re going to start to feel a little differently about this.

Because otherwise it gets into, “Well, I said I was going to do this and then I did it a little bit or I did it for one day, and then by two days afterwards it had kind of crept back up,” and you get into this place where you’re just adding and reducing the same little bit of exercise. And again, you’re in the worst of all worlds in that situation.

So that is it for this lot of questions. I hope you found this useful. I’m currently taking on new clients; if what I’ve gone through today has demonstrated by knowledge or has resonated with you or there’s stuff that I’ve talked about and that is things that you’re going through, all of these things are stuff I work on really regularly with clients. I’ve been working with people for 15+ years and I feel very good in terms of knowing that I can help people and I can help people get to that place of full recovery.

So if that’s what you’re after and you’re interested, then please get in contact. You can send an email to info@seven-health.com and just put ‘support’ in the subject line, or you can send me a DM on Instagram. It’s @sevenhealthcompany.

So that is it for this week’s episode. I’ll be back next week with another episode. Until then, take care, and I will see you soon!

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