Exhausted in Recovery

First and foremost, it's important to note, this blog is not entitled 'Exhaustion in Eating Disorder". If you are still actively restricting your food intake, and perhaps simultaneously over-exercising, you do not need an explanation behind your symptoms. You know that your exhaustion is because you are trying to run an entire power station on a single lithium battery. This blog is about the confusing and seemingly non-sensical experience of feeling increasingly tired as you begin to eat more and rest more.

After 2 full years of rather nifty Covid-dodging, in late April of this year, a tiny tickle in my throat indicated that my evasion of the virus has come to an end. Woe is me!

Jokes aside and much unlike others I know, I got off very lightly. Other than a sore throat and a very bizarre metallic taste in my mouth upon consuming anything, I was feeling fine. Those two symptoms alongside generally feeling pretty worn out was really all there was to it. It was gone as swiftly as it had arrived.

The part of all of that which is important for this blog post is the what I mention last there - the bit about feeling worn out. For a moment, I want you to think back to a time you were recovering from flu. Maybe it was Covid. Maybe it was another time. Can you remember how your body felt? Can you remember how the normal daily things you tried to do just felt like an almighty task?

My bet is, that as you were healing, you won’t have felt energized nor will you have felt like doing a lot of stuff. It’s very likely you will have felt exhausted, aching and weakened.

Something I didn't realise for quite a while was that in the case of the flu, it is actually your immune system response, not the virus itself, that causes muscle aches and joint pain. As well as Interleukin-6 (IL-6) and its associated cytokines contributing to this pain, we must acknowledge that the entire system employs much of its energy into fighting off the foreign pathogens. Thus - we are left with little else.

Obviously, recovering from an Eating Disorder is not a direct parallel to recovering from the flu. However, I think it is incredibly important to remember that when your body is so busy building you back up to full health, it is unlikely to have an abundance of 'spare' energy.

So, like as when you are recovering from flu, if you are recovering from restriction (from not eating enough and from any other associated disordered behaviours), then your body is likely to experience this same fatigue.

Maybe your restriction only lasted for a few weeks or months. Maybe it lasted for many years. Maybe you never over-exercised. Whatever. Your body is still recovering and still restoring itself after a period of deprivation. Deeply. Right now, it has more important duties than giving you daily energy to continue your normal daily life at the pace that might be convenient. You must listen to this as best you can, taking it extremely seriously.

Firstly, it has to repair all the inner damage restriction and the disordered behaviours have created. It must heal a lowered metabolism, digestive issues and hormonal imbalances. It also, of course, must restore muscle mass and tissue (which often involves healing really important parts of you, like your liver, your heart and your brain) and additionally must do what it can to support your bones, restrengthen hair, nails, skin... the list of jobs goes on and on.

And as it's doing all of this repairing, of course, whilst in energy debt. Your body is having to digest the food you are now (hopefully) eating plenty more of, with a compromised digestive system.

And it may well be doing all of this stuff whilst not getting a peaceful nights sleep. Many people in recovery experience anxiety so acutely (especially at night), that the body fails to ever fully switch off.

And finally, it has to do all of this whilst still doing the stuff a body has to do even when it isn't under fed. You know... stir your pasta sauce, fold the washing, water the plants, keep your heart pumping - those kind of day to day things.

The Analogy of Triage

If you've ever had the misfortune of finding yourself in A&E (that's the ER, for my American friends), you'd have typically experienced seeing a member of staff called a triage nurse before seeing somebody more senior, like a doctor. This is actually quite a helpful parallel to draw on to understand more about what’s happening in your body when you are recovering.

Triage is typically used in hospitals when there are many patients to take care of but you have to make a choice of who is the first one you need to take care of, in terms of who is in the most critical condition. For example, when I broke my leg playing netball when I was young, it was a clean break. Though I was wailing, the old chap with severe chest pain was of far more pressing concern than me. Therefore, upon assessment of us both, he would be seen by more senior staff before I would be.

The body also operates in a similar way. It will choose to take care of the most important tasks first. This means energy won't always be redirected towards having energy for your normal life 'nice to haves' first (e.g. returning your sense of humour), or more superficial bodily things (like reinvigorating dulled hair) after you first decide to eat more. It will likely go to the (invisible) things which you immediately need to survive better. This is life preserving.

And that, right there, is ultimately why you will feel so exhausted in recovery. Your life is being saved. If you are in recovery and feel exhausted, you are not doing something wrong. Your body is, right now, operating on important tasks that need to be taken care of. All of what you are consuming is being directed and utilised.

“But why did I have so much energy when I was restricting?”

Firstly, it's important to say, every single body reacts differently to restriction. Some people feel totally exhausted in their restriction (and this makes total sense). Others, however, feel as though they have more energy. One explanation for the latter is that this feeling of being energized wasn’t the “real energy”that comes from having a healthy functioning body. Instead, it was more of the “fake energy” that comes from running on your stress hormones in survival mode.

This is because when you’ve been restricting and your body senses that you are starving, it may increase your cortisol levels. In a primal environment, this anxious and jittery energy may have spurred movement. Evolutionarily speaking this makes total sense: having more (false) energy that “keeps you wired”, alert and on-the-go might help you reach a place with more food. Though it is hard to identify this at the time, this "false energy" is a very different feeling than the calm and happy energy that comes from truly being healthy and at peace.

However, once the body finally gets enough food in recovery, it can finally relax and put all this energy towards healing. This might be the point when you feel more tired. As I said, it varies from body to body.

From restriction, your starting point is debt

When you are in monetary debt, and suddenly decide to repay it, you aren't immediately free of debt just because you made that decision. You're still very much 'in the red'.

In the same way, do remember that you are not starting from energy balance when you decide on recovery. You are starting from energy debt. All the damage restriction has created has to be restored, whilst your daily functioning is still requiring energy. That full rehabilitation does continue long after initial 'weight restoration', too.

Due to this, please don't be disheartened if you have gained weight, even quite a considerable amount of it, and don't feel full of energy. Your body is most likely still prioritising inner healing and repair work. It also adds to the list of reasons why not returning to exercise for a good while after complete weight restoration is advised. Exercise will demand the energy you simply do not have leftover right now (let alone may potentially uphold belief systems about control over body shape/size).

All in all:

Your body doesn’t care if all of this feels very inconvenient to you right now.

Yes, you may have work to do.

Yes, you may have school.

Yes, you may have other obligations.

But recovery is the body’s top priority right now.

You body wants and needs rest, be this more sleep, or just more sofa time.

There is no way around it. Even if more sofa time isn't your thing, for now, it must be.

If you feel exhausted, you need to rest and keep eating.