Physical Changes during Weight Restoration after Starvation
After a period of starvation, your body gets used to the low input of energy and the metabolism slows down to allow any energy reserves available go to basic functional needs. You start feeling tired, and all your motivation and drive to do anything is diminished. This is to stop you from wanting to do anything and rest, since the lack of food does not give you adequate sources of energy to do those things, and it cannot afford to expand any more of its precious energy on non-essential bodily functioning.
Therefore, the moment you start putting sufficient food and energy into your body, many physical and hormonal changes start to take place. Initially, you may feel worse when you start eating more. The same happened to me. However, don’t give up. It is temporary and there will be light at the end of the tunnel, and eventually you will start feeling better.
Fluid Retention, Weight Gain, and Fat Restoration
For most sufferers who are in recovery, the symptoms will be unpleasant but not life-threatening. I remembered when I was warded at SGH, the nurse told me that most patients suffer from edema at the ankles. Thankfully I did not. This is all due to water retention.
Most of the weight I gained in the first month (15kg) is actually due to water weight. Taken from the edinstitute.org, “It is normal to see an increase of 8-16 lbs. (3.6 to 7.3 kg) within days of starting to eat to the minimum guidelines every day. It is equally common to see 20-40 lbs. (9-18 kg) within 1-2 weeks.”
This can be uncomfortable since the physical change is so obvious. However, it is not possible to physically gain that amount of actual body weight in such a short period of time. Again, this is due to water retention as the body aims to gain water weight to achieve hydration. It is necessary for cellular repair.
However, even though I did not suffer from edema at my ankles, I had water retention in my face and overall body. I may not have a sharp jawline that can cut fruits, but you could definitely tell that my face was very round and bloated during the first 4 months of recovery.
After 4-6 weeks of consistent eating and weight gain, water retention in the body starts to dissipate and is replaced by real weight restoration. Most of it will be fat deposits, in a thin layer all over the body, serving as insulation and protective padding, and helping to restore hormonal balance. Sunken cheeks and the hollows between bones are filled in.
Refeeding Belly & Poor Digestion
I would like to talk about the refeeding belly in particular. When you start eating, research has shown that most of the weight will go to the belly first before slowly dispersing to the legs and then the arms. The adaptive process occurs for body fat to protect the vital organs.
The imbalance in body fat reserves generally normalises in a year. It is important to remember it serves as a purpose and part of the healing process. Fat distribution will be uneven for the first few months before slowly evening out. For me, I had a refeeding belly for the first 4 months, and only after 6 months did it start to even out.
An example I like to give is that of a baby. Most of the weight will go to the belly before it gradually moves to other parts of the body as he/she grows older and taller. I understand any change to the belly is very likely to cause anorexic fears. But you need to continue with it and break the cycle of restriction again.
Apart from that, gastrointestinal issues, such as gas, bloating, mild abdominal pain, acid reflux, constipation or diarrhoea, are likely to occur as the digestive system adapts to larger amounts of food, and the muscles involved are stretched and lengthened. This is because your digestive system has been at rest for such a long time. But just stick with it and continue eating. The gastrointestinal issues subside as your body gets up to speed at producing adequate digestive enzymes and the bacterial colonies return to normal.
Sweating, Hot flushes, Acne, Rashes
Once you start consuming more food and adequate calories, the body metabolism rate starts to kick in and increase. Calories help fire up the metabolism rate, and the more calories you consume, the higher your base metabolism rate is going to be.
The risk associated with refeeding syndrome is when the body starts to make more energy but yet it does not have sufficient energy to meet the demand. Though rare, consequences range from low lab values to mild edema to heart failure and death.
When your metabolism rate start to increase, you will notice that you tend to sweat more and at random times of the day. I recall having nightly sweats and hot flushes. Sometimes, I had insomnia and other times, I would wake up in the middle of the night in discomfort as I started randomly sweating, having my whole t-shirt drenched.
Hair Loss, Brittleness, Thinness and Dryness
Our hair follicles have a natural cycle of cell death and new cell production. During an eating disorder, most people experienced hair loss due to lack of nutrition. However, once you start recovery and refeeding, new hair follicles do not immediately grow out.
This is due to a condition called telogen effluvium, when a large amount of hair loss is noticeable and can be traced to a severe stressful condition about 3 months prior. Therefore, it is normal to continue experiencing hair loss for about 3 months after recovery as normal follicle growth and renewal process takes time and you need to be patient.
I know the fear of being bald and hair loss sucks. I was once in that position but trust me, your hair will grow out stronger and healthier than before. The old brittle, thin and dry hair you currently have is not permanent and will drop to make way for the new regrowth.
Going through recovery and forcing yourself to eat for your health sake is not easy. At times, all these physical changes add on to the mental stress that you are already currently facing. It may make you want to find a reason to quit recovery. But just push through. The more you persist, the faster you get through it compared to going back and forth with food restriction.
Just take it as a test to build character and strength. I believe you are strong enough to overcome it. Trust me, there is light at the end of the tunnel, and you will feel much happier and proud of yourself after conquering it. You can do it.