Eating well again: where to start

After a very restrictive diet, many people find themselves at a standstill: the body is asking for food, hair has started to fall, energy is low, yet there is a fear of regaining the weight lost. Eating well again is not "going on another diet". It means returning, gradually and without extreme rules, to a varied way of eating that gives the body what it needs.

For most people, this can be done at home, in phases, over a few weeks: first regularity, then protein at every meal, then variety. There is one important exception: anyone who has gone many days eating almost nothing, or who has a very low weight, should restart under medical supervision, for safety.

In this guide we propose a four-phase plan, and explain how to deal with hunger and the fear of gaining weight, how to build habits that last and what to expect for your hair and body.

Before you start: when medical supervision is needed

When the body has spent a long time with almost no food and then suddenly receives it again, dangerous changes can occur in the blood's mineral levels, such as phosphorus, potassium and magnesium. This is called refeeding syndrome and it can affect the heart, the muscles and breathing.

The UK's National Institute for Health and Care Excellence (NICE) considers there to be a high risk if one of these situations applies:

• body mass index below 16;
• unintentional weight loss of more than 15% in the last 3 to 6 months;
• little or no food intake for more than 10 days;
• low potassium, phosphorus or magnesium in blood tests.

Or two of these:

• body mass index below 18.5;
• unintentional weight loss of more than 10% in the last 3 to 6 months;
• little or no food intake for more than 5 days;
• a history of excessive alcohol consumption, or use of medicines such as insulin, diuretics, antacids or chemotherapy (NICE, CG32).

If any of these situations applies to you, do not restart on your own: speak to your doctor first. Refeeding should be done gradually, with blood tests and, sometimes, supplements.

The same applies if the restrictive diet is linked to a difficult relationship with food: intense fear of gaining weight, episodes of eating a lot followed by guilt or compensation, or constant thoughts about food and weight. In that case, help from health professionals, including psychology, is part of the treatment.

For most people who followed a restrictive diet for weeks but kept eating something, the plan below is safe.

A four-phase plan

You do not need to change everything at once. Each phase usually lasts 1 to 2 weeks; move on when the previous one feels comfortable.

Phase 1: regularity (weeks 1 and 2)

The first goal is to go back to eating at set times, without skipping meals.

• 3 main meals and 1 to 2 snacks, 3 to 4 hours apart;
• moderate portions, without trying to "make up for it" all at once;
• drink water throughout the day, 1.5 to 3 litres, according to the Portuguese Food Wheel;
• do not count calories at this stage.

If your stomach has got used to little food, it is normal to feel full quickly or to have some bloating at first. It usually passes within a few days.

Phase 2: protein at every meal (weeks 2 to 4)

Protein is the nutrient that does most to protect hair and muscle, and the one most lacking after restrictive diets.

• a source of protein at every main meal: fish, meat, eggs, dairy, pulses, tofu;
• special attention to breakfast, where it most often falls short;
• the European reference for adults is 0.83 g per kg of body weight per day.

See how much each food contains in Protein, iron and zinc: what hair needs.

Phase 3: variety (weeks 3 to 6)

Reintroduce the groups that were cut out, one at a time:

• cereals and tubers (bread, rice, pasta, potatoes), preferably wholegrain;
• healthy fats, such as olive oil, nuts and avocado;
• fruit and vegetables of different colours;
• dairy, if it was eliminated without a medical reason.

The aim is for no group to be "forbidden", except because of allergy, intolerance or illness.

Phase 4: consolidate (from week 6)

• keep regularity and protein as your core habits;
• plan the week's meals and cook in batches;
• include regular exercise, with strength training two to three times a week;
• if you still want to lose weight, do so with a moderate deficit, of about 0.5 kg per week, as the European guidelines recommend (Yumuk et al., 2015).

The pillars of a balanced diet

The Food Wheel

The Portuguese Food Wheel is a good reference for balancing your plate through the day. It divides foods into seven groups, in different proportions:

Water is at the centre: 1.5 to 3 litres a day. The number of servings varies with age, sex and physical activity (DECO Proteste, based on the Food Wheel).

The Mediterranean pattern

The Mediterranean diet, traditional in Portugal, brings together many of these principles: plenty of vegetables, fruit, pulses and minimally refined cereals, olive oil as the main fat, fish often, meat in moderation, and shared meals. It is one of the eating patterns with the best evidence for long-term health.

A reference plate

At main meals, a simple way to put your plate together:

• half: vegetables (soup, salad, cooked vegetables);
• a quarter: protein (fish, meat, eggs, pulses);
• a quarter: cereals or tubers (rice, pasta, potatoes, bread);
• a drizzle of olive oil and fruit for dessert.

Hunger, fullness and the fear of gaining weight

Learning to hear hunger again

After weeks of ignoring hunger, the body's signals become confused. Some people feel constantly hungry; others hardly feel it at all. Regular meals help to recalibrate these signals within a few weeks.

• Eat slowly, seated, without screens.
• Halfway through the meal, pause for a moment and ask yourself how hungry you are.
• Protein, fibre and a little olive oil at every meal increase fullness.

Will my weight go up?

In the first few days it is normal for weight to rise a little. Much of it is water and the contents of the gut, which return to normal when you eat regularly, and it is not fat. Weighing yourself every day at this stage tends to increase anxiety without giving useful information; once a week, or even less often, is enough.

If the restrictive diet led to a loss of muscle mass, regaining some weight with protein and strength exercise is part of a healthier body composition.

The "yo-yo" effect

Very restrictive diets are hard to keep up and often lead to regaining the weight lost, which prompts a new diet. Breaking out of this cycle is precisely the aim of eating well again: a way of eating you can sustain for years, not just for weeks.

Building habits that last

How long does a habit take?

In a University College London study, volunteers chose a healthy behaviour, such as eating a piece of fruit at lunch or drinking water, and repeated it every day in the same context. The median time until the behaviour became automatic was 66 days, but it varied widely: from 18 to 254 days. Missing a single day did not compromise the process (Lally et al., 2010).

The practical lessons:

• count on about two months, not "21 days";
• start with small, concrete habits, such as "an egg at breakfast" instead of "eat better";
• link the habit to a fixed moment of the day, always the same;
• a slip does not cancel out progress. What matters is getting back on track at the next meal.

Strategies that help

1. Plan the week:10 minutes on Sunday to decide the main meals.
2. Keep the basics at home:eggs, yoghurt, pulses in jars, tinned tuna, frozen vegetables, fruit, mixed-grain bread, olive oil.
3. Cook doubleand freeze portions.
4. Ready-to-eat snacks:fruit, yoghurts, nuts, fresh cheese.
5. Eat with otherswhenever possible.
6. Avoid "all or nothing":no foods are "forbidden"; there are frequencies and quantities.
7. Note how you feel,more than what you eat: energy, sleep, mood, hair.

What to expect for your hair and body

Why hair takes longer

Hair reacts with a delay. The hairs that fall now entered the resting phase 2 to 4 months earlier, during the diet. That is why shedding often continues, or even starts, when you are already eating well. It is not a sign that the plan is not working.

In a classic report of people on crash diets, hair grew back when they resumed a diet with enough calories (Goette, 1976). We explain this process in Very restrictive diets and hair loss.

If recovery does not happen

If after 6 months of balanced eating the shedding continues, or hair is getting thinner in a specific area, there may be a deficiency still to be corrected, such as iron, or an androgenetic alopecia that the diet made visible. An assessment and blood tests are worthwhile. See Blood tests for hair loss: what to ask for.

When to seek a medical assessment

Before restarting, talk to your doctor if you have gone more than 5 to 10 days eating almost nothing, if your weight is very low or if you have lost a lot of weight unintentionally.

At Luxmed, the Hair Medicine consultation assesses hair loss with trichoscopy and, when indicated, blood tests, and follows your recovery.

This article is for information only and does not replace the follow-up of your doctor or dietitian.

Frequently asked questions