Expert: Leigh-Anne Persing, PA-C - 6/30/2008

Question
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.

Leigh-Anne

---------- FOLLOW-UP ----------

QUESTION: Hey,

Thank you for getting back to me! I have one more "problem". The truth is, for an anorexic, I am really scared of hunger (I hate the feeling and love the feeling of being stuffed). When I "starved" myself, what I really did was eating veggies soups and broccoli and drank lots of diet soda to make myself full. Though I am eating more calories now, I still eat two plates of salad and drink three or more cups of water at dinner, because I am scared of not being "full" after I eat my caloric allotment (usually 400) for a meal.

I know I have some terrible meal habits that I need to break out of. I know that veggies are good for you, but essentially I am binging on them to myself feel bloated and not hungry. It is really hard for me to change this because I am scared that if I don't eat that amount of veggies or drink with meals, I won't feel full and have to deal with the feeling of hunger. Today I resolved to eat "normally" again, which for me means no more eating two giant plates of steamed veggies, no more water loading, and no more adding incredible amounts of seasoning on all my food. But I am terribly scared that I'll be hungry. Furthermore, I have met and read the journals of other anorexic-recovered people, and they say that they have allowed themselves to eat freely (chocolate bars and peanut butter... fried foods). I don't want to necessarily binge on them, but I crave these, too. However, unlike them if I eat these, I think I will just put on massive amounts of weight. They said that at first the weight comes on, but after a while, it all balances out as the weight gain plateaus. I feel like I am restricting myself to only boca burgers and salads every day to stay low in my caloric range, and I know that this is not a long term solution. When you recovered, did you eat junk food? How did you manage cravings (like I crave apples like crazy)? And how did you, if you had them, manage the desire to binge on foods like peanut butter? Should I let myself eat it? A lot of people claim that they just freely ate and felt so happy, but I am afraid my weight gain will go crazy if I allowed myself to eat what I wanted.

Thanks again!

Answer
Recovering from anorexia is a very hard thing to do, especially if you are trying to go it alone. Sometimes there are a lot of broken promises to yourself. Little steps are key in the recovery process. When I really started to go into recovery I was in an inpatient unit (I was also 4 months pregnant) and was kind of forced to eat whatever they gave me. Part of that was eating snacks... getting exposure to foods that were forbidden before ("junk food" like swedish fish, candy bars, etc). Of course, I always craved the foods that I deprived myself of... the snack foods. I manage cravings by eating regularly and not completely depriving myself of those foods that I crave. If you love apples and you crave peanut butter, why not have that as your daily snack??? An apple sliced up, spoon out 2 tablespoons of peanut butter into a bowl and then put the jar away... don't let yourself have anymore. Once what you have in your bowl is gone, don't get more.

You need to get rid of the scale. You need to stop gauging your recovery by your weight gain. You just need to eat to nourish your body and be healthy. I don't think that just eating freely is the way to go... why go from one extreme to the next. You need to find a happy medium where you can eat normally, maintain a healthy weight and be at peace with all of that.