One of the most difficult symptoms to deal with, both while living with an eating disorder or recovering from one, is water retention or edema. The best way to explain how and why this occurs is to tell you about my experience with edema, first after a period of extreme dieting and secondly while I was bulimic.

Edema During Metabolism Recovery

During the summer of 2018, after being fed up with all of my symptoms of a low metabolism, I made my very first attempt to end dieting and get my metabolism running smoothly again.

As with most summers, I had been following a strict diet, this time keto, and I was eating much less than my body needed. The next day I started eating anything I wanted to satiety, but I quickly felt horrible– I gained over 10 pounds in 24 hours and almost none of my clothes fit. 

Most of this weight being water weight of course, but that doesn’t make it much easier to handle. During that week it hurt to bend over to put on my shoes because my stomach was so swollen from the edema and digestive issues that I discuss here. I was working an internship at the time and my co-workers noticed the change as well. On the second day of this refeeding, one of my co-workers asked if I was allergic to something because I looked like I was swollen, especially my face. There is actually a straightforward explanation of why facial edema can be so pronounced in metabolism and/or eating disorder recovery– Parotid Glands.

Swelling of the Salivary Glands

Edema and swelling in the face is likely the most difficult area to handle because there is not real way to hide it. Interestingly, much of the facial swelling seen in recovery, is not solely from edema, but in part due to enlarged parotid (salivary) glands as pictured (Mehler). The common advice given by medical professionals to help relieve this swelling is “The Lemon Drop Protocol”–Yep, sucking on lemon drop candies has been known to help.

Edema: 1 / Christophe: 0

After a week of dealing with edema and the many short-term negative symptoms of recovery, I began to doubt that I was on the right track. I might have had symptoms before, but nothing like this. Maybe my body just didn’t handle these foods. After all, that was the entire premise of most of the diets I had followed up to that point. Come the weekend I began to restrict once again. It is very common for those of us who attempt to recover from disordered eating to initially fail because we run into confusing symptoms and various recovery “traps” that I wrote about here. While edema is one of the most common of these traps that convince us to retreat back to restriction and purging, overtime many find that edema can occur not just during recovery, but in restriction as well.

Round 2: Edema From Purging

Take a look at these two pictures. In which picture would guess that I weighed more? While it might be hard to believe, I actually weighed 5-10 pounds less in the picture on the left than I did in the picture on the right, taken about a year later. So why do I appear to weigh much more on the left?

I was deep into my bulimia by that point, using both purging and occasional diuretics to control my weight. Since I had a wedding coming up (where this picture was taken), I did some extra purging that week to make sure I fit into my suite, which was never easy because I bought it during a period when I was very lean. From what I recall I stopped taking the diuretics 24 hours earlier, thinking my water weight would not return in that short amount of time; however, as you can see in the picture on the left it did.

Why do diuretics and purging cause edema?

While purging and diuretics cause an initial loss of water weight, our bodies respond to this drain of important water and minerals by increasing the levels of antidiuretic hormones, especially aldosterone. This rise is antidiuretic hormones signals to your body to hold on to as much of the water and minerals that it can, resulting in water retention or edema. That’s what you can see in the picture on the left. 

The longer and more extreme you go with draining your body, the stronger it will fight back, until at some point you will be bloated and holding on to water almost constantly. In fact, toward the end of my eating disorder I noticed that I would consistently weight more on the mornings after I purged than the mornings after I kept everything down, despite going to bed with an empty stomach.

Finally Recovering My Metabolism

A few months after this picture was taken, when attempting recovery again, this time successfully, I actually lost a few pounds in the first week. I’m convinced that this was entirely water weight because after this initial weight loss, I did gain bodyweight over the next few months, which was needed.

This rather sudden drop in water weight likely occurred because my body was already holding onto as much water as it. Thus, when I stopped the purging it was finally able to rebalance my fluid levels.

What You Can Expect

Everyone’s body and circumstances are different so there is no way of knowing for certain how long your edema will last. Based on the research I’ve done and the men and women I’ve talked to, I’d say my edema dropped much faster than average, which for most people is usually somewhere around three weeks (Farrar, 2018). With that being said, I have personally spoke to several women who had anorexia and/or bulimia for over a decade and for a few of them, it took several months of recovery before their edema finally subsided.

Heuristics For Edema in Metabolism Recovery:

•  The further you are below your natural bodyweight, the more edema you can expect when refeeding. I experienced this first hand in the difference between first and last recovery attempt. At my first attempt I was around 20 pounds below my set-point and my edema was far more extreme and painful than when I attempted recovery again 6 months later while only around 5 pounds below my set-point. As I mentioned earlier, I actually lost water weight this latest and final refeed.
• The more you have purged of used diuretics, the more you are likely to experience water retention. In fact, edema is known to be worse in recovery bulimics than in those recovering from anorexia (Mehler). Although, if you are already be experiencing edema, any changes may be less abrupt, or you could end up losing water weight as in my case. You might be wondering how diuretics can both lead to edema and also be used to treat edema. The difference comes down to the way they are used: when diuretics are used to treat edema, the dosing is precise and steady; on the other hand, while dieting they are usually used sporadically and at higher doses, resulting is wild fluctuations in fluid levels, much like in my anecdote I shared earlier. The question of whether you should avoid diuretics in recovery is a sperate issue that I will touch on in a second.
• The fewer times you succumb to any desires to restrict, the faster the edema will subside.
• The longer you have engaged in restriction and/or purging, the more intense the edema will be and the longer it will last.
• To sum up these points: edema is dependent on your current weight relative to your set-point, your metabolic function, and time.

Is Edema Feature or a Flaw of Eating Disorder Recovery?

This is an area where most eating disorder bloggers and the medical community disagree. Is edema an important healing mechanism or is the body simply overcompensating fluid levels in an attempt to find balance? While most in the ed recovery space tend to believe the former, most doctors subscribe to the latter and often prescribe mild diuretics, usually spironolactone (Westmoreland, 2015) – I fall somewhere in the middle.

While I am of the opinion that it’s often best to recover naturally, it is obviously better to recover with diuretics than to not recover at all. Recovery is already difficult enough, so if you are experiencing severe edema and your doctor suggests a diuretic, don’t think you won’t recover if you give them a try.

At the very least, the fact that you are experiencing edema in recovery, whether you treat it or not, is a good sign that you are on the right track. Again, this is just my opinion so take it with a grain of salt…and some bread and butter too. Haha sorry, bad joke. Anyway, have a good week!

References:

Farrar, T. (2018, April 25). Ask Dr G: Edema. Retrieved from https://tabithafarrar.com/2018/04/ask-dr-g-edema/