AboutLeigh-Anne Persing, PA-C Expertise Currently a Physician Assistant in General Surgery. Have personal experience with anorexia and bulimia, as well as eating disorders in pregnancy.
Experience Personal experience. Health care professional
Education/Credentials Certified Physician Assistant. "A Body to Die for" training for health care professionals (held by the Renfrew Center Foundation)
Expert: Leigh-Anne Persing, PA-C Date: 6/30/2008 Subject: Water retention, energy intake, and free-eating in anorexia recovery
Question Hi Leigh-Anne,
I have been restricting my caloric intake since late last year, and was diagnosed with anorexia mid-Spring this year. I have been trying to recovery on my own since, bringing my caloric intake up from 500 to about 1600 in a little over a month. I have not yet gained much weight, but the last week put on about three pounds eating not more than 1800-2000 a day. I tried to up my calories by allowing myself to eat some of the foods I enjoyed (instead of eating only lean proteins, veggies, and a piece or two or whole grain bread). I ate some cereal and some beef noodle soup as well as casseroles from the school cafeteria. However, I tried to keep within 2000 caloric range to see what would happen to my weight. I noticed that I was retaining water over the week and my weight went up four pounds in four days. While it is true that I got my period just two days ago, I don't usually have water retention issues around my time of the month.
I have been struggling a lot with the edema since prior to recovery. I had edema when I was anorexic, and I didn't know why. We suspected it was low protein, but I am certain I eat about or more than 60g of protein every day. My blood albumin is not low. However, my carb intake has been restricted and I don't eat much refined carbs. My edema has been pretty much under control this last month, gradually decreasing, but now that it's come back, I am scared to eat, especially because I don't know if it is edema or real weight that is on the scale. If it's real weight then I think I need to up my caloric intake at a slower pace.
Do you have an idea of what is causing my edema, and how I can eat more freely without worrying about excess water retention. Other recovering anorexics talk about how they can eat "junk" foods and try out new things they restrict, and I would like to do that as part of my recovery, but how can I begin to let go if I am getting this horrible swelling in my legs and feet?
Just to let you know, I do about an hour of cardio and weight lift some every day to try to help gain back muscle and not only fat. I know I should have a caloric intake of about 2000 given my activity level, so should I keep trying for this or lower it back to 1600 for a while to see what the weight does?
Thank you so much!
Answer I have a few suggestions, and maybe you should just try one at a time to see what, if anything, does help with your edema.
1) Watch your salt intake, especially around the time of your period. While you may not have had issues with water retention during this time before, you are making changes in your diet/lifestyle as well, so that may cause changes in other aspects as well. Seasonings for meats and such sometimes have a lot of salt in them, so if you are using something like that watch how much you use, or try something like "Mrs. Dash" which is a no salt seasoning and comes in many varieties (I got hooked on this when I was in treatment the first time... love it!!)
2) As a general rule... when an individual with anorexia starts eating again they tend to retain flui... and food. Your body may not be out of starvation mode yet, meaning that it is going to hang on to every bit it's got. And if you restrict again, even only a day or two... your body remembers what it has been through and if it gets a "taste" of that restriction again it will recognize it and hang on to all it can (sorry if that sounds confusing). So... maybe you need to rearrange your eating schedule. If you are eating 3 regular meals a day, perhaps you should try eating 5 or 6 smaller meals so that your body has a more steady stream of nourishment rather than being hit hard 3 times a day!
3) Back off the calorie intake a tad. I don't want to push you back into not enough calories for the day, but maybe you should increase your calories at smaller increments and give your body a longer period of time to adjust to that increase. Say, maybe increase 100 calories every 2 weeks or so.
Try one or more of these suggestions and let me know if this helps! If I can help any other way please let me know. I applaud your efforts at recovery... it certainly is a difficult thing to go through.
