285: Symptoms While Recovering

Chris Sandel: Welcome to Episode 285 of Real Health Radio. You can find the show notes and the links talked about as part of this episode at www.seven-health.com/285.

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 I help clients to fully recover.

We are back with another episode. Two episodes in two weeks, so keeping up with my promise of being more on it with the podcast. It’s actually been a pretty challenging 24 hours. Yesterday, I woke up in the morning, was meant to be hanging out with a friend who I haven’t seen for a while, but unfortunately discovered that a badger had got into our henhouse and had killed two of the hens and then was asleep in the henhouse. I didn’t know anything about any of these things and what to do; I spoke to a local farmer, then had to look stuff up online, and basically we just had to release the badger out or put up the doors of the henhouse, and at some point the badger let itself out, and then had to find somewhere to get some electric fencing to put around the henhouse.

Now, at that stage we only had one hen. We got in contact with Ali’s mum and she had a spare hen that we could have so that the hen wasn’t on its own. So we now have just the two hens. But yeah, it was pretty sad. The two hens that were taken were the two favourites of Ramsay’s. They were very cuddly hens. They would allow you to come and pick them up and cuddle them, and that was definitely one of the ways that he used to enjoy giving them cuddles. They were good for regulating his nervous system. So it was really sad to have that happen.

Spent a lot of yesterday dealing with all of that, and then in the evening, both Ali and Rams started feeling not so well. Both of them had a fever in the night and then Ramsay was actually sick, so I was cleaning up puke at three in the morning. They’ve been unwell for most of the day, so I’ve been checking in on them, doing some work, now recording this podcast. Yeah, it’s been quite a 24 hours. But I said that I wanted to keep putting out regular podcasts, so here we are.

00:02:41

Why I want to address symptoms during recovery

What I want to do as part of today’s episode is look at symptoms that happen while in recovery. The reason I want to go through this is I think there can be this real false idea that when you start to recover, everything immediately gets better. So you go on this recovery journey, and because you’ve committed to recovery and because you’ve started to make changes to your eating or your exercise or whatever it may be, that thing should get better, and should get exponentially better, and there should be this nice linear progression – and that’s just not the case.

Often things will get worse in the beginning as part of recovery. There’s two main reasons why this occurs. One is there’s actually a lot of recovery that needs to take place. This is recovery for many different systems and organs and functions within the body. And because of this recovery that needs to take place, there are symptoms that can occur because of the recovery process. So it makes sense that these symptoms are happening.

The second reason why these symptoms occur is that the body has been operating from limited resources. It hasn’t been getting what it needs to be able to function, and what happens when you do start to bring in more energy is there can be a lag time for this to catch up. There’s a lag between more energy coming in and then the body being able to sufficiently give that more energy to the various systems to be able to run properly.

For example, I’ll talk about digestion. If your digestive system has been getting less than what it needs, it’s going to be underperforming. And then when more food starts to come in, there’s a lag time before that food is turned into energy and that energy is funnelled back to your digestive system so that your stomach is now creating more hydrochloric acid or your intestines are now creating more enzymes and things that have atrophied have now grown back. So there is this lag time for this to occur, and because of that there can be more symptoms.

The reason I want to go through this as well is I really want to normalise this, that it is very common, and it makes sense for these symptoms to be occurring. What I think often happens, what I see often happening, is that these symptoms start to occur and someone thinks, “I must be doing recovery wrong” or “I must be eating the wrong kinds of foods” or “I need to change the ratios of the carbohydrates or protein that I’m eating” or whatever it may be. There can then be all of this overthinking and all of this getting stuck in the “I must be doing something wrong if this is occurring.”

So what I want to go through as part of this – I’m not going to go through all of the different symptoms; I’ll go through some of them, some of the more common ones, but just to explain that this should be occurring. This isn’t indicating that you’re doing something wrong. This is your body repairing, recovering, healing. I want you, if this is occurring (1) to be able to say “This makes sense” and (2) to be able to continue on with recovery and not have the eating disorder thoughts that naturally arise when these kinds of things occur – for them not to take hold and for you to get hooked by them and then start to change course and not continue on with recovery.

00:06:11

Water retention / oedema

The first symptom I want to talk about is water retention or oedema. This is really common as part of recovery. There can be a couple reasons why this starts to occur depending on your eating disorder. What’s happened as part of your eating disorder can have an impact on this.

Water retention can be very much connected in terms of electrolyte balance. As your body is starting to make changes with this, there can be more water retention that starts to happen. Electrolyte imbalances can be more affected if there’s been more vomiting or there’s been more laxative use, so if that has been happening, it can be more common to get oedema or water retention. I would say it’s pretty common anyway for that to occur, but it could be just a little more severe if that has been part of your history.

The oedema can also be part of the healing process. As your various systems and organs and muscles and tissues start to repair, there can be more of the water retention or oedema that comes up. So again, it’s very normal or natural for this to occur, and it does not say that you’re doing something wrong.

I know this can be a challenging thing for someone, especially if there’s oedema around the abdominal / stomach region because there can be such a sensitivity around that, such a focus and a fear around weight or weight gain around the belly. That can be challenging to deal with. There can be a challenge if there’s also pain connected to the oedema because that can create more fear. But I do want to say that oedema or water retention is very common as part of recovery.

00:07:59

Digestive issues

The next one I want to mention is digestive issues. I think this is also one that can be really difficult to deal with because there’s such sensitivity around digestion and around anything connected to the stomach region. There’s just this hyperfocus and hyperawareness, and this can really start to create a lot of unhelpful thoughts or unhelpful fears and worry connected to it.

Some of the digestive issues that can happen – one is gastroparesis, which is slow gastric emptying. This means that food can feel like it’s sitting really heavy and it’s staying in the stomach and it’s just not moving through. You have a meal, and it could be even a pretty small meal, and it feels like it’s just not moving. You could have bloating, which is also very common. There could be constipation or there could be diarrhoea. There can be gas. There can be nausea. I think this is a very common one, especially if there’s the gastroparesis and the food is sitting heavily. There can also be abdominal cramps connected to this.

None of these things are particularly pleasant, and I think when they’re occurring, often the sensation is that “I want to eat less and I want to pull back.” Actually, that is going to make the situation worse because, as I said, you’re wanting the body to be able to get in more energy so it can upregulate all of the different systems, and one of the systems it’s important to upregulate is your digestive system.

So there is this lag time between those things happening, and you can start to look at, what are the foods that can make this easier? The reality with this is these are typically the foods you’re going to be more scared about including, because typically the foods that are going to be most helpful from a digestive perspective are things that are going to be calorie-dense but also have low volume. This is typically the opposite of what most people are eating and what people think of as their safe foods.

So if you’re having lots of vegetables, especially lots of aboveground vegetables or raw vegetables, they’re going to have a very high fibre content but a low amount of calories, and what can often happen is when someone tries to increase what they’re doing, they will keep all of that there. They’ll keep the vegetable intake, the high fibre intake, and then they’ll add a little bit on top of that. And yes, it’s great that there are more calories coming in – and the fact that there is still so much fibre and so much of this low-calorie, high-volume food means that it’s very difficult on the digestive system.

So the thing that probably scares you the most in terms of eating food that are more calorie-dense and low volume will actually be the things that provide you the greatest relief from a digestive standpoint. They’re going to be allowing your body and your digestive system to upregulate more quickly.

I know this scares people to hear and can be very difficult to do, but when working with clients and they’re actually able to make this shift, this is when there is much more relief. It feels safer to have the vegetables or the high-volume, low-calorie foods, but it actually makes the situation worse.

00:11:37

Variable hunger

The next symptom that can come up is variable hunger. You can have a situation where there’s no hunger, and there can be times when there’s real extreme hunger. You can have mental hunger without any physical hunger symptoms. You can have situations where “It feels like I’m not hungry at all and then I start to eat, and wow, this hunger feels like it’s come out of nowhere and it really hits me.” Having this real variability with hunger is very common as part of recovery.

It’s why I think moving away from using hunger and fullness as a guide in the early parts of recovery is really important, and it’s why meal plans can be very useful. It’s why having more structure with eating is useful, just because it means you’re not trying to depend on feedback that can be variable.

And it’s not to say that you can’t pay any attention to this stuff or you can’t start to notice it. I think using your awareness and becoming aware of these different things is important. It’s just that I don’t recommend depending on them, because otherwise what will invariably happen is you’ll have long stretches of not eating enough and then suddenly feel overwhelmed by hunger. So having much more structure is very helpful as part of this, but I do want to really hit home that having variable hunger through your recovery is a really common thing.

00:13:08

Feeling tired + exhausted

Another one is tiredness and exhaustion. I think this is one that can often be a surprise for people. There can be this feeling of “Well, now I’m eating more or now I’m doing less, or now I’m eating more and doing less, and yet I feel like I’ve been hit by a bus. I feel absolutely exhausted.”

This is really an indication of where your body is at. Previously, your body has been getting by on stress hormones and the adrenaline and the cortisol, and that’s been really driving you forward. Now when you’ve started to do less, now when you’ve started to eat more, your body is now prioritising recovery and repair, and in terms of your energy levels, you’re getting to experience where your body is at.

So it’s very common that you’ll notice that “I’m now eating more food, I’m bringing in more actual energy to my body, I’m taking it easier in terms of the amount of movement or exercise I’m doing, and yet I feel even more tired than I did before.” I know that can sound counterintuitive or not make sense, but hopefully by the way that I’ve explained it here, it does make sense for why that is occurring. This is something that is very common.

Depending on how long the eating disorder has been going on, depending on someone’s level of restriction, depending on the level of repair that needs to happen, it will have an impact on how long this is. For some people this can be a number of weeks where they’re exhausted and then they start to notice their energy coming back; for others, it can be a much, much longer stretch than that. There can be many months of feeling really wiped out and needing a lot more rest and downtime. How able and capable someone is to give that to themselves will depend also on how long it goes on for.

For some people, there is an inability to do that – and I don’t mean from a psychological standpoint; I mean the fact that there is a family that they’re looking after, there’s a particular job they have to do. There are some genuine constraints on the amount of downtime that someone can take, and when working with people, I’m always suggesting, do as much as you humanly can. If there’s a way that you can start to get other members of the household to be helping you out more, then go for it. If there’s ways that you can start to pull back on some of your work or some of your responsibilities, great, really go for it. Because this is a temporary thing; it’s not forever, but the more you’re able to allow your body to conserve energy so that it can be putting that energy more into the recovery and the repair, the better for you.

00:16:00

Strong emotions

Another one that comes up a lot is lots of strong emotions. Often, these will be negative emotions or what we consider negative emotions. There can be grief, there can be resentment, there can be anger, there can be hopelessness, there can be guilt, there can be shame. There can be lots of different emotions that come up connected to this.

This is particularly true as an eating disorder has gone on for longer and longer. If this is something that has been occurring for the last 10 years or 20 years or 30 years, it makes sense that there are a lot of emotions that come up, and it makes sense for a number of different reasons.

One is that when you are in a more low-energy state, this can start to be quite numbing of a lot of emotions and a lot of your experiences. This is both for positive and negative emotions. You get in this place where it all feels a little bit same-ish and it’s kind of numb and there’s not a lot there. And it’s not that there can’t be high anxiety or there can’t be panic or there can’t be worry, but there’s a lot of this numbness that is there.

It’s through starting to eat more and have different changes that are occurring from a pro-recovery standpoint that a lot more of these emotions start to come online. There can be uncomfortableness as part of this, and it makes sense that there can be grief, for example, coming up. There can be grief about all the time lost as part of this eating disorder. There can be grief about the fact that “I’ve now lost this coping mechanism that I’ve been using for such a long time and it’s so difficult to be able to deal with life without having this coping mechanism.” There can be grief about the fact that your body is changing, or there can be grief about the fact that “I had all these hopes about having this particular life in this particular body, and that’s starting to change.”

So there can be many different reasons why grief comes up, in the same way as there can be many reasons why anger starts to come up. What I just want to say is, again, if you’re having this experience of strong emotions arising, this is not pointing towards the fact that you are doing something wrong. It’s pointing towards the fact that this is part of the process and part of the healing and recovery that occurs throughout this journey.

It could point to the fact that you need to have ways of being able to express these different emotions. This could be about, “I need to be able to do more journalling to process it” or “I need to be able to reach out to a friend and talk more openly about this stuff or speak to a therapist and talk openly about this stuff” or “I need to have ways of being able to regulate my nervous system to support me with this.” And I know in the podcast I did previously to this, I gave a whole long list of different ways that you could regulate your nervous system, so you can definitely check back to that. But this is a very common thing that happens and a common symptom that arises as part of recovery.

00:19:29

Night sweats

The next one is night sweats. This is a really common thing that occurs often – it’s often a little further into recovery, so not at the very early point, but it can occur in the very early point. But this is often pointing towards the fact that, one, your metabolism has started to increase, and when we take in more energy as part of the body turning that food into energy, into ATP, it creates heat at the same time. What can start to happen is your body is heating up as part of this. So there can be a warmer body all throughout the day, but often you’ll notice it in terms of night sweats.

It can be this is to do with hormones. Reproductive hormones, if your period, for example, has been absent or if you’re a guy, if you haven’t been getting erections in the morning, you’ve got very low libido – as part of these hormones coming back online and your body starting to prioritise reproduction, as these hormones are changing, this can be part of the reason why there are night sweats as well.

I’m not saying that this is pointing towards the fact that your period is just about to start or anything along those lines, but there is definitely a connection between them, and this can be hormone-related.

I’d also say that there can be increased sweating not just at nighttime. It can be during the daytime as well. And there can also be a really strong smell to the sweat, and often an unpleasant strong smell to this sweat. I don’t have an explanation for why this occurs, but it’s something that I’ve had happen with many clients. I’ve seen it in the literature. So there’s just this much stronger body sweat that can occur, and that’s for some length of time. It’s not a permanent thing that you now have very strong-smelling sweat; it’s just as your body is going through this transition healing phase, that can happen for some period of time.

00:21:50

Sleep changes

The final one I want to mention – and this connects into what I was just talking about – is changes with sleep. Sleep can go in a lot of different directions. Also, with someone before getting into recovery, sleep can go in different directions. I’ve worked with clients where their sleep has been terrible before starting recovery. They were really struggling to get decent sleep, they were waking multiple times a night. Equally, I’ve had clients who are in a very similar state in terms of low energy and malnourished and needing recovery, and yet they’ve been able to sleep perfectly through the eating disorder. Their head hit the pillow, within 10 minutes they were asleep, and they were sleeping through the night.

I think we all have inherent strengths and weaknesses, especially with eating disorders. There’ll be certain symptoms that occur very early in the eating disorder and others that are much later down the line. So with sleep, this is one of those things where for some people – and I would say for most people – it is affected because of the eating disorder, but there are those few people who actually, their sleep was fine through the eating disorder.

What can then happen is that when you get into recovery, things can change. You’ve been able to sleep all through your eating disorder, and now that you’re starting to recover, this is where your sleep starts to go haywire, and this is where you’re having a lot more difficulty getting to sleep, or you fall asleep and then you’re waking up two or three hours later or you’re waking up at 2 a.m. or 3 a.m. every morning and spending a couple hours trying to get back to sleep.

Or there can be waking in the night feeling hungry, and you’re then having to have something to eat in the night just to be able to try and get back to sleep.

Or you could be waking and having nightmares. This is something that is quite common as part of recovery; it is also quite common in the eating disorder that there are nightmares going on. But this is something that can then start to occur while in recovery.

I know this can be, especially around sleep, a little bit disconcerting – especially if it feels like sleep was better than it is now. “When I was in the midst of my eating disorder, my sleep was better than it is now.” One of the things I think occurs and one of the reasons this happens is that your body is recognising that finally, food is available, that finally your body is starting to get energy coming in. From your body’s perspective, if it’s choosing between sleep and more energy coming in, more energy coming in is going to trump that. So there’s a period where it’s like, “We want to get our food in. There’s food available. Let’s not sleep. Sleep is not important right now. We need to have more food coming in.”

This can be a reason why sleep can get worse to start with, because when the body is triaging its most important priorities, more energy is trumping getting more sleep.

And look, sleep is hugely important as part of recovery. It’s where your body is doing a lot more of its repair work than when you’re awake, so there’s a huge amount of things that are going on while you’re asleep from a repair standpoint, and this is a physical repair standpoint for your organs and tissues and muscles and all of that, but also in terms of your brain and rewiring your brain and how you make sense of what has happened during that day, how you consolidate memory, all of these different things.

So sleep is hugely important as part of recovery. It’s just at certain stages, it’s less important from your body’s standpoint than getting in more energy. If your sleep is going not so great as part of recovery, I want to say that that is quite a common thing to occur. I would say typically as more food is coming in and that is happening more consistently and the body’s getting more energy and is getting out of the low-energy state that it’s in, then it will continue to improve and your sleep will start to get better.

I also want to say there’s the other end of the spectrum, where people are like, “Oh my gosh, I’m so tired now, I’m going to bed and I’m waking up 12 hours later and I still feel exhausted.” That is also something that can happen as part of this. Again, this is normal; it makes sense why your body would want to be doing that.

00:26:34

Concluding thoughts + my free course

So those are just some of the symptoms that can occur in recovery. As I said, I wanted to go through these ones just because these are probably more of the common ones, but there are definitely more than just this. I hope that by going through this, one, I was able to normalise a lot of these, and two, if you’re about to start recovering and you haven’t done it, you have a bit of a managing of expectations so that you know what can start to occur, so when that does start to occur, you’re not freaking out. You’re able to say, “I remember hearing that on the podcast. I know this is normal as part of it.”

Because recovery isn’t linear. Recovery doesn’t mean that everything immediately gets better. It takes time for that to happen. So if these symptoms are occurring, this is part of your body healing and repairing and getting you to that better place that you will reach.

So that is it for today’s episode. I hope you found it helpful. I want to mention that I have a free course that is available. The course is The First 5 Steps to Take in Your Recovery, and it’s got I think 10, 12, 14 videos, something like that. It’s walking you through these different steps. There’s different writing exercises as part of it. I’m really proud of what I’ve put together. Lots of people have signed up; I’ve got lots of great feedback as part of this. It’s something that you can get for free.

If you go to the show notes as part of this episode, www.seven-health.com/285, there will be a link on that page that you can click, and then you can sign up to this free programme.

That is it for this week’s episode. I will catch you again soon.

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