Why hasn't my health care professional provided me with the guidelines you offer on this site?

This is actually a question I often get and the person asking means one of 3 things to varying levels:

1) I don't trust or I question your sources;

2) I am uncomfortable with what your sources would recommend and/or

3) I have a trusting and personal relationship with my existing health care provider.

I don't have the answer to the overall question as to why your health care provider has not provided the same data and information, but I hope I can guide you through the process whereby you could arrive at an answer that most suits your needs and requirements.

Firstly, you are right to question all sources, in particular those you cannot verify in some way. You will find on this site a comprehensive, but by no means exhaustive, set of research links and books on which I have attempted to base all the assertions that I make regarding recovery from restrictive eating behaviors. I encourage you to review them and to take them to your health care professionals if you have more questions and want clarification.

Your health care practitioner may or may not have any specific education in the process of recovery and even if they are specifically offering services to support recovery, they may have been schooled in programs and processes that research has now proven are less effective than perhaps more recent approaches.

Tread carefully if you hope to educate your health care practitioner: some may be open to information provided by patients, others will not. On the other hand, do not remain with a practitioner that is not willing to partner with you in developing a recovery program that suits your needs and your understanding of your particular circumstance.

It is also true that your in-person professional health providers have the benefit of knowing your situation and circumstances in ways I cannot. They may be fully aware of all the relevant data and research but have decided to tread carefully with you to allow you to focus on your recovery in doable steps and stages. Just as all patients have distinct approaches, so too do health care providers. I know of many caring and highly skilled health care practitioners who prefer to maintain the role of "leader" in the care process because they have found it alleviates the patient's anxiety levels to do so.

Which brings me to the second reason behind asking me the above question: being uncomfortable with the actual recommendations within the research and information provided. If you sense that the information is correct, and you subsequently confirm it by doing your own research, then you can still be unwilling to accept it because it pushes too hard against all the reasons why you continue to apply eating behaviors that are self-harming.

It is alright to choose your own path and find health practitioners that can work with where you are at right now. These are complex, extremely complex, conditions and there is no one path to the end goal of replacing harmful eating behaviors with nurturing ones.

Finally, you may feel more of a personal relationship conflict when faced with data that you have confirmed is correct, want to embrace fully because you sense it is the path for you, and yet find your health care practitioner will not support the new direction at all.

Not wanting to "hurt" your health care provider is a common feeling. Wanting to trust them despite knowing their advice is not going to be right for you comes from an empathetic soul. You know that your health care provider has your best interests at heart and that s/he is well-trained and means to do the right thing. However, you have to come first.

In this case I encourage you to adopt a mindset that you might apply to health care providers taking care of a loved one: your child, parent or spouse (as examples). In those cases, you find it much less conflicting to apply a clear delineation that the health care provider is offering professional services. Should those services not suit the needs of your child or spouse, then you would be the first to seek second and third opinions.

Ask your own loved ones to support you in ensuring you do not continue to see any health care professional simply because you do not want to hurt his or her feelings.

The systemic aspects of metabolism, optimal weight set points, energy requirements, hunger and satiety are not understood fully by any of us, so it is more likely than not that your health care professional cannot provide you with all the data and information because no one has all the information yet.

If the information and data on this site is different than what you have received from your health care providers then that is likely because we are all the proverbial blind people describing the part of the elephant we happen to be touching. I hope the additional information serves you well in your pursuit of recovery working with the health care practitioners that are best at supporting your goals.

But I've heard you can permanently lower your body's weight set point?

Excerpt from Show Me blog post on the topic:

“When we restrict calorie intake the body has a way to manage it, but it costs.

The energy deficit has to be addressed by filling the deficit from within the body itself. Most biological systems are run to an overdrive level with certain key clamps put on the system to keep it at an optimal state.

It is biologically more energy-intensive and risky to try to run a system right to 100% all the time than to run the system to 200% and just use a few hormones or enzymes to clamp it down to 100%. 

Our bodies are probably quite literally built to burn off excess energy in our sleep if there are any unneeded excesses.

But restrict your calories and now all of the limiting hormones like leptin, ghrelin and insulin and others are left scrambling because you have just dumped the entire metabolic system to well below its 100% functional level. Leptin is a clamping hormone. With nothing to clamp down on, it plummets in our blood streams and this creates a cascade of shut downs throughout the body.

We have evolved to overeat and maintain weight easily, in our sleep no less. We have evolved to survive some environmentally imposed under-eating as well, but not with the same ease and not without some heavy-duty damage for which we must account.

Some lizards can indeed drop their tails, when threatened, as a way to avoid a predator.“The loss of the tail (called autotomy)…is stressful to the lizard, especially if that lizard stores critical fat deposits in the tail, such as leopard geckos. Not only do they need to spend energy healing the stump and regrowing the tail, but the loss of fat may occur at a critical time, such as during gestation or a period of low food availability.” [M. Kaplan, 2002]

Think of dieting as autotomy for humans.”

You will read all manner of incorrect garbage in the mainstream press about how you can change your weight set point permanently using diet or exercise, or both. The only way that a weight set point is permanently adjusted is by restricting calorie intake in perpetuity (and usually at increasing levels as you age— autotomy for humans, remember?) or removing parts of the brain, as has been unequivocally proven with animal studies.

We thankfully have not resorted to removing parts of human brains just yet as a way to stay thin, but given our adoption of stomach mutilations (various gastric-bypass surgeries) perhaps I should not speak too soon.

Is food (any kind of food) addictive?

No.

Food is not a drug and does not have a drug-effect on our bodies or minds -- not sugars, not ultra-processed foods, not fats, not carbohydrates, not any food you can name.

The concept that any type of food is addictive has no good science grounding that statement at all. Some neurological imaging has indicated that we release endocannabinoids when we consume ultra-processed foods, but we release those natural opioids when we eat pretty much anything we enjoy. I explain this fact usually using this example:

Referring to the natural release of endocannabinoids in our system as an addiction (because addictive substances bind to the same receptors) is like saying:

All babies drink some form of milk

Mrs. Jones nextdoor drinks some form of milk

Therefore Mrs. Jones is a baby.

It's called a faulty syllogism: If A=B and B=C then A must also equal C.

Drugs and alcohol are addictive in very specific neuro-chemical ways. They interfere with natural endocannabinoid release and reception. That sex can be classified as an addiction is contested within the neuroscientific communities for good reason -- it is likely more biochemically related to OCD than to chemical dependencies that arise from the interference with natural opioid systems.

Are dietary fats, saturated fats bad?

No.

Dietary fats are critical in recovery and shooting for 45% percent of your daily intake coming from fats (saturated equally critical) helps with specific healing requirements.

Myelin is a fatty covering on nerves that allows for fast and accurate conductance of electric signals. Not all nerves in our nervous system are myelinated, but those that are need to be for us to function well.

During starvation your body uses the myelin on your nerves as fuel to make up the energy deficit created by not eating enough to meet all your biological requirements. As the researcher Janice Russell has said, this is akin to throwing your antique furniture on the fire to keep the house warm -- it's going to work short term, but it has long term negative implications.

Not only does this de-myelination affect brain function, but it also impacts motor function, the dependable contraction of the heart muscle, etc. etc. It can mimic the symptoms of multiple sclerosis but it is not MS (I have seen patients misdiagnosed with MS who are on the restrictive eating disorder spectrum).

De-myelinated nerves due to restriction will be re-myelinated with adequate re-feeding and dietary fats play a critical role in that process. 

Under age 25 there is additional first-time myelination that needs to happen in the frontal lobes of the brain. If you starved between the ages of 16-25 then the natural myelination process in that area of the brain did not happen. And yes it happens at whatever time you are finally able to recover fully.

Dietary fats (saturated and unsaturated) are critical for helping your body to re-myelinate all the nerves.

Beyond recovery, dietary fats are critical for maintaining nerve health and supporting reproductive cycles (particularly in women).

But if I eat more I'll get fat.

Fat is not a storage unit, it's a hormone producing organ. Fat cells can get larger. Most cells in our bodies have that capacity in fact. Your body has multiple mechanisms in place to maintain your optimal weight set point and if you provide it with more than it needs (which by the way is not the case in recovery because you are so severely energy depleted) then it can easily manage that without having to resort to increasing fat cell size.

When someone is energy balanced they are not keen to eat 6000-8000 calories a day and in laboratory settings where subjects are purposefully overfed even though they are at their optimal weight set point already and not energy deprived, it is difficult to get the force feeding to result in much weight gain and as soon as the study is over they return to their pre-study optimal weight.

Yes, you live in a society that is completely obsessed with the fear of fat and completely misunderstands how the body works as well.

There is no such thing as morbid obesity. There are individuals who are naturally and optimally above-average weight and they live normal and healthy lives. Our optimal weight is largely determined by our genetics.

There is a thing called inflammatory obesity and that is when the fat organ is no longer functioning correctly — like when any organ stops working then there are numerous chronic conditions that may occur. However food and exercise have nothing to do with the onset of that condition at all.

More likely culprits are a complex combination of: chronic stress, genetic predisposition, exposure to endocrine disruptors in our environments, low socioeconomic status (which is a phenomenal stressor), sleep deprivation and possibly decades-long cycles of going on and off diets.

For more detailed information regarding the misconeptions we have in our society about fat, please read:

Bingeing Is Not Bingeing

Fat: No More Fear, No More Contempt (the entire series is hopefully worth a scan, but particularly from Part V onwards).

When can I start exercising again?

The resumption of a regular period or returning to a pre-eating disorder weight in no way tells us that someone is weight restored or energy balanced just yet. While they are great signs that things are moving in the right direction, it takes about 18 months to reach a solid remission from a restrictive eating disorder.

You are liable to simply shift your eating disorder from to anorexia athletica if you reintroduce exercise. Please re-read Phases of Recovery from a Restrictive Eating Disorder and specifically search for the sub-headings: No Exercise, Honeymoon, Menstruation and Knowing When You Can Trust Your Hunger Cues.

And more specifically, please read Exercise II: Insidious Activity to understand why the resumption of exercise has tremendous pitfalls and problems for those with restrictive eating disorders.

When can I start eating to hunger cues?

Be careful on this one. Many attempt to eat to their hunger cues as soon as they have had three consecutive periods (women obviously) and often it is far too soon to trust hunger cues.

Your hunger cues are always accurate, but those with a restrictive eating disorder have what I call a "signal jamming" issue in their brain such that they are torn between responding to hunger and avoiding the perceived threat (namely eating). It takes a lot of non-restrictive practice before you can be sure your hunger cues are coming through to you loud and clear.

Here is how you know you are ready to attempt eating to your hunger cues:

  1. Your weight appears stable. (weighing yourself is not necessary to determine that).
  2. If you have dealt with amenorrhea during your restriction, then you have achieved 3 consecutive periods in a row.
  3. You are continuing to eat minimum amounts and it is comfortable to do so.
  4. Other lingering signs of repair seem complete (no longer cold, tired, achey, dealing with water retention, no brittle hair or nails etc.)
  5. You think you may need to start eating to hunger cues and are a bit anxious that you can trust those cues.

Note Item 5—if you are feeling extremely confident about eating to hunger cues then chances are you are a ways away from remission still.

[from Phases of Recovery from a Restrictive Eating Disorder]

You should really be comfortable that you have covered off all 5 items on that list, not just item 2, before you attempt to eat to hunger cues.

When you think you might be ready, you log your food intake for 3 days while eating entirely to your hunger. After the 3 days, you tally up the calorie intake for each of those days. If you are averaging the minimum guideline amounts for your age, sex and height, then you can feel fairly confident that you will be able to use your hunger cues to stay in remission from that point forward.

Still wanting junk (ultra-processed) foods?

You will hear lots of things about others in recovery that will generate anxiety that you are somehow not trending as you should.

Quoting myself from Phases of Recovery from a Restrictive Eating Disorder:

Do not read the Phases of Recovery as though you are reading a recipe or following scientific steps that will realize unequivocal and successful results. Think of it as “individual mileage may vary.” 

Do not panic if you find some symptoms are not present, or seem to appear, disappear and re-appear. Your entire recovery process may take you into full remission in as little as 3 months or as long as 24 months. Three months is very, very rare and 18 months is the median time to remission, so be prepared to be patient.”

I sympathize with the impatience that everyone experiences through the recovery process, but try to remain realistic about how long the body really needs to repair all the damage.

When you are unsure about where you are in your process of recovery, then always re-read: Phases of Recovery from a Restrictive Eating Disorder

Food, Family and Fear and I Need How Many Calories?!! can help you reinforce the fact that you need a lot of energy to re-balance the huge energy deficit you have in your body. A preference for ultra-processed foods is explained in the former blog post and the latter blog post provides the clinical data for why the minimum intakes are set as they are. 

I am weight restored but don't have a menstrual cycle. Is it just never coming back?

You are not weight restored if your menstrual cycle has not returned.

The absence of menstruation is called functional hypothalamic amenorrhea and the primary cause of this condition is being underweight relative to your body's optimal weight set point.

Continue to re-feed, allow your body to return to its optimal weight set point, and menstruation will return along with it.

However, the return of menstruation does not always indicate that you are at your body's optimal weight set point. The most telling marker of being at your body's optimal weight set point is that you can dependably eat in a completely unrestricted fashion and your weight remains stable.

Why do I feel worse now I'm eating more?

You may find yourself sleeping a lot more now that you are at the minimum guideline intake. You may find your hair is falling out in clumps. You may find you are struggling with quite a bit of gastrointestinal distress (gas, bloating, mild abdominal pain, acid reflux, constipation or diarrhea). You may develop acne or rashes. You may find you are dealing with night sweats, or hot flashes.

All these symptoms are occurring now because the body is working hard on repairing a lot of major physical and systems damage. Respond to your need to sleep more (but never in place of eating enough food). The hair is simply regenerating. The gastrointestinal issues subside as your body gets up to speed at producing adequate digestive enzymes and the bacterial colonies return to normal. The acne, rashes, night sweats an hot flashes are all the reproductive hormones getting back up to speed.

If you have any concerns about particular symptoms that are bothersome or don't seem to be improving over time, then see your doctor.

 

 

Is it normal to gain this much?

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. 

The increase is almost entirely attributable to water retention and it is necessary for cellular repair. Somewhere in the 4-6 week range the water retention starts to dissipate. That does not mean you lose weight (you are not looking to lose weight), it means that the water starts to be replaced by real weight restoration.

It takes 18 months to recover although you will not likely gain weight throughout that entire time period. From the time at which you begin weight restoration to the time at which your body weight stabilizes, the average per week weight gain is around 1-2 lbs (0.5 to 1 kg).

It is not a linear process and some weeks will be more and some less.

You stop gaining when you reach your body's optimal weight set point while eating the minimum guideline amounts. You should stop weighing yourself and focus on getting the energy in that you need instead because stepping on the scales usually precipitates a relapse.

You may also experience a lot of bloating after meals and, to you, your stomach or abdomen region will appear huge. Again, this lessens as the weeks progress and you get further along in recovery.

Whats with all the hair loss/brittleness/thinness/dryness?

So here's how the hair loss thing works. There is a natural cycle of cell death and new cell production throughout our bodies and that includes the hair follicles.

The condition of telogen effluvium is when a large amount of hair loss is noticeable and it can be traced to a severe stressful condition about 3 months prior. In those conditions the patient's hair cycle is essentially fast-forwarded to early follicle death, rather than experiencing the usual prolonged growth phase and resting phase.

This is one way in which patients may experience hair loss while they are in fact in recovery -- it is a delayed response to starvation because the normal follicle growth and renewal process is running about 3 months after the stressful starvation period occurred.

However, patients may also experience an elongated catagen phase (the regressive phase of the follicle) during their starvation period. In this situation, the hair is not aging and falling out as it should normally (about 100 odd hairs a day). And in these cases the apoptosis (natural cell death) that the catagen phase is supposed to induce is halted. The body simply doesn't have enough energy to have the cells go through their natural process.

As soon as you begin refeeding, then the process of having the follicle die and the hair fall out can now proceed and there is a back log. In these cases you may have noticed your hair was becoming increasingly brittle and opaque during the restriction phase of your condition, but did not really note much increased hair loss (if any).

While of course it is distressing, it is not a permanent state and new healthy hair will replace the old in fairly short order.

The condition of hair is directly attributable to nutritional status and that is likely why "healthy-looking" hair is important in most societies as it reflects the evolutionary value of the individual as a mate.

If you want healthy-looking hair, then pursue your health with adequate re-feeding and rest.

What is quasi-recovery and why is it bad? or not?

Quasi-recovery is a term I invented to describe the situation when a patient is no longer actively trying to eat less, lose weight, reach a target shape of some sort but they continue to create sub-clinical levels of energy deficits every day in their bodies.

A patient with an active restrictive eating disorder is not applying any effort to suppress, replace or otherwise turnaround restrictive behaviours. Restrictive behaviours include: eating less than what your body requires, exercising a lot and not eating enough to cover off that exependiture of energy, eating such a restrictive number of foods (clean eating, paleo, vegan, raw...) that there is an energy deficit, or restricting intake for many days with intermittent bouts of reactive eating (and/or possibly purging, abusing laxatives or diuretics, or prescription drugs or alcohol specifically to reduce energy intake).

A patient in quasi-recovery will have reduced the frequency or stopped compensatory behaviours (purging, extreme exertion, laxative abuse etc. etc.). He or she will have also increased food intake. For many non-scientific treatment programs for eating disorders these attributes are actually considered a process of full recovery. The patient is able to restore weight and once that weight is within 85% to 90% of an expected weight, then the patient will be discharged often to an outpatient program to continue "maintaining" that state.

A woman who is attempting to recovery from an eating disorder and who is under the age of 25 and eating 2200 calories a day is in a quasi-recovery state. She will restore weight, but not repair damage. Her metabolism will remain suppressed because there is not enough energy coming in to reverse the energy deficit within her body and repair enough of the damage so that all biological functions can run once again in an optimal state.

A woman under the age of 25 needs at least 3000 calories a day on average to maintain her weight and health. That's a non-ED woman. A woman in recovery under the age of 25 is going to need more than 3000 a day to actually return to an optimal state and enter remission.

The longer that a patient stays at a quasi-recovered state, the more efficient her body will become at shutting down non-essential biological functions to try to minimize the amount of catabolism (destroying cells to release energy into the blood stream) that has to occur to try to make up the energy deficit. Everybody's metabolic efficiency varies, but it is not unusual for a patient (after 20 years in a quasi-recovered state) to find herself gaining weight while eating 1800 calories a day. That is not a sign that she needs to cut back on her energy intake, but rather she needs to up her intake to allow her body to take the brakes off of all the biological functions that have had to be suppressed to keep going under energy deficit circumstances.

Fat is the largest hormone producing organ in the body. It is not a storage unit. Under stress (energy deficits are stressful to our body) stress hormones are released and while they have value for short-term survival, they cause damage when they flow more persistently and over months and years. That your fat organ gets larger when you are under stress is not because you are a lazy fat pig who needs to exercise more and eat less. Your fat organ is having to get larger to produce more hormones to maintain some balance within a skewed metabolic state in the body. In fact, Peter Attia's research suggests that when there are metabolic problems, a body that is able to get fat to respond to that metabolic problem or failure is more likely to survive than a body that cannot get fat under the same circumstance.

For a body to maintain its natural optimal weight set point it has to be at its optimal metabolic state as well. For a patient with an eating disorder, to arrive at that state he or she has to take all the clamps off of eating and intake and rest so that body can not just restore weight, but can actually heal and return to an optimal run rate as well.

There is nothing automatically bad about being in "quasi-recovery". It is a comparatively better state to be in for the body than active restriction. However, physical damage is ongoing and still accumulating unless and until a patient decides to provide enough energy to reverse damage and return to an optimal state.

What about liquid intake and thirst during recovery?

As you up your caloric intake to re-feeding guideline amounts for your age, sex and height (keeping in mind that there should be medical oversight as you up your food intake of course), you may find you are quite thirsty.

Some of this thirst will be genuine and some of it might be anxiety-based responses to actual hunger cues. Either way, try to make your liquid intake always an energy dense choice.

Avoid drinking water, sodas, or fruit juices as these can fill you up and make getting to your intake guideline amounts difficult.

Choose ice-cream shakes, or fruit smoothies with whole-fat yogurt. Add nut or seed butters, bananas, and oils as well. One former member found freezing the bananas and then adding them into the blender with the rest of the fruit, whole fat yogurt and nutella made for a really tasty blended drink.

If you notice symptoms of extreme thirst along with frequent urination and any accompanying changes in vision, then please see your doctor immediately. Insulin regulation in the early phases of re-feeding can sometimes be problematic, although it will almost always resolve with continued monitored re-feeding. 

Food intolerance? Likely not.

Food intolerances are huge topic which I will cover off in more depth in a blog post in future. Until then here is a brief overview: a food intolerance does not involve an immune-mediated response to the food in question.

The most common food intolerance is of course lactose intolerance. Primary lactose intolerance is genetically determined and by the age of four, the body switches off lactase production (the enzyme that breaks down and digests lactose).

For most of Northern European decent, they have a genetic mutation that keeps lactase production switched on for life. These individuals can develop secondary lactose intolerance due to illness -- where the body is so stressed it cannot produce enough lactase to digest the lactose.

Secondary lactose intolerance is common for many who have restrictive eating disorders because, of course, starving creates tremendous stress on the body and eventually the organs responsible for producing all manner of digestive enzymes are too depleted of energy to pump out the necessary enzymes.

Secondary lactose intolerance resolves quickly with re-feeding. Lactose is present in creams, milks, ice-cream. However it is not present in most cheese and yogurts have enough lactase within them that most with secondary lactose intolerance have no issues consuming yogurt either. You can use digestive enzyme supplements such as Lactaid for the first couple of weeks in recovery until your body is able to produce its own lactase.

Many of the food "sensitivities" and "intolerances" that you either have determined you have (due to physical symptoms after consumption), or have been diagnosed in you by various dubious screening tests, are most likely a reflection of a stressed digestive system unable to produce sufficient digestive enzymes to support comfortable digestion.

You are not likely to find your food intolerances or sensitivities will remain beyond a few weeks into your full rest and recovery effort from a restrictive eating disorder.

I can't eat this much! Is it normal to feel so nauseous and full?

Yes it's normal. Not fun, but normal.

Quoting myself from Phases of Recovery from a Restrictive Eating Disorder:

"For many patients in this phase they also have to overcome gastroparesis. [RW McCallum et. al., 1990]. Gastroparesis is a survival mechanism whereby the stomach doubles its emptying time to the small intestine, meaning the food is churned in the stomach for longer to try to allow for the small intestine to maximize the too-little energy coming in to the body.

Gastroparesis begins easing within a few days of doggedly staying at or above the minimum intake and it resolves quickly if you persist in eating the recovery guideline amounts, usually within a couple of weeks to a month. In fact the motility of the entire gut is slowed to try to extract as much energy as possible during starvation [M Hirakawa et. al., 1990] and this resolves during dedicated refeeding efforts.

Don't be tempted to lower the calorie intake because of the discomfort—just space the food out throughout the day. Yogurt with active cultures will be your best friend [C Coker Ross, 2008; E Nova et. al., 2006]"

The nausea will pass. Use heating pads around the abdomen or cool cloths around the neck (depending on what feels right for you). Lie down and rest. Nibble on seeds and nuts to keep your intake up to minimum guidelines and then go back to eat more when the nausea, bloating and sensation of physical abdominal fullness eases just a bit.

It gets better as you persist with re-feeding.

Insomnia and I'm exhausted, what should I do?

Insomnia is common if you are not reaching the minimum guideline intake and/or if you are clamping down (restricting) when it comes to extreme hunger.

Either struggling to get to sleep or finding you are waking up and unable to get back to sleep are often indicators, when you are recovering from a restrictive eating disorder, of hunger.

As you up your daily intake you are liable to find your anxiety about food is ratcheting up as well. Restrictive eating disorders are inherently the misidentification of food as a threat (a somewhat awkward way of trying to explain what is happening in the emotional centers of your brain). As a result you may be treating the minimum guidelines as your maximum and preventing your body from receiving the energy levels it actually requires during the recovery process.

Respond to insomnia with more food: up your daily intake until you find you are able to fall asleep and stay asleep, and if you find you are awake in the night, then get up and have a substantial snack (followed by upping the intake the next day).

Keep in mind that extreme hunger will take you far beyond minimum guideline intakes and that is normal and desired. Please read: 

Extreme Hunger I: What Is It?

Extreme Hunger II: Extremely Disturbing.

As you re-feed you are going to likely experience a heightened level of anxiety precisely because you are eating food rather than avoiding it. To alleviate this agitation somewhat, consider applying relaxation exercises, meditation and very slow yoga stretches throughout the day to help lower your stress levels and make sleep a bit easier to bring on as well.

Is this symptom (see the list in the answer) to be expected in recovery?

Here are the usual suspects:

  1. Bloating (‘huge’ stomach), edema (water retention), swelling.
  2. Gastric and intestinal problems: gas, diarrhea, constipation, undigested food, abdominal pain, acid reflux, indigestion.
  3. Extreme fatigue: sleeping much more than usual, loss of energy.
  4. Brain fog: hard to remember or follow trains of thought.
  5. Skin sensations: tingling, burning, prickliness, numbness, itching, rashes. 
  6. Anxiety, paranoia, fear, depression, crying a lot.
  7. Hair falling out, dry and flaky skin, nail breakage.
  8. Orange colored skin (particularly palms of hands).
  9. Dizziness/heart beat issues: slow resting heart rate (bradycardia) or speeding heart rate while resting (tachycardia) or dizziness when going from lying to sitting or sitting to standing (orthostatic hypotension)*
  10. Cold when others are not, hot flushes, sweating and night sweats (drenching night attire and bedding).
  11. Aching joints, hips or leg pain.
  12. Fidgeting, restlessness, general agitation.
  13. Aching muscles (as if you had completed a strenuous workout).

* Damage to the heart muscle due to restrictive eating behaviors is reversible. However, if you have any of these symptoms at the start of recovery, then do not reintroduce exercise until cleared to do so by your medical advisor.

If any symptom causes you any concern, appears to be steadily worsening despite continued re-feeding and rest, or does not seem to be easing steadily as the weeks progress, then consult your physician.

However, the above list is a fairly comprehensive list of the common symptoms you can experience in the early phases of recovery from a restrictive eating disorder. All these symptoms are indicative of either damage that was done while restricting and/or signs that healing is underway. All these symptoms should steadily improve throughout the recovery process.

Please remember that you should never attempt refeeding from a restrictive eating disorder without medical supervision.