The Slow Progression of Symptoms


There is a fable many people have heard. It often comes up at corporate consulting gigs or in self-help circles.

The fable has to do with boiling a frog. It states that if you put a frog in boiling water, it will immediately jump out. But if you put it in a pan with cold water and slowly bring it to a boil, the frog will sit there and be boiled to death.

Despite the fact that this fable is false, there is some truth in the sentiment it is trying to express. Which is that, when change is small and gradual we don’t typically notice it. These incremental changes become the new norm.

Chronic pain can be a good example of this. For many people their path to pain has been years or decades in the making. And even though they may now be at a point where it is debilitating, it didn’t happen over night.

It started out where things were only marginally worse than before. It then progressed to be some little niggles, but only when doing certain movements. Then it gets a little worse, where the pain is constant but it is at a pretty low level.

At this stage if they were able to go back in time and remember what is was like before, they’d probably notice a difference. But in their current place, it just feels like a “normal” amount.

And so things continue on until it reaches some tipping point. Where mobility is impaired to such a degree or the pain becomes so acute that it’s now seen as an issue.

But rather than realising the progression over years or decades, the question is: what did I do recently that’s caused this pain?

This slow progression reminds me of when I used to live in my overdraft. Initially the overdraft was £300. Then I changed it to £1000. And then a couple of years later it was £2500.

And with each extension on the overdraft, the “zero” point just moved further and further back. Being £2500 in debt became the new zero. And whenever I got to actual zero, it felt like I was really up £2500 because that was the amount I could spend due to the overdraft.

I see the same slow progression with many of my clients who are under eating.

There is this idea that if someone under eats, their body will fight back by making them more hungry until they can no longer take it and they end up face first in some chocolate cake.

That if someone is under eating they must be using willpower to suppress their urges.

But in reality, this isn’t always the case. If someone takes it to the extreme and keeps calories really low and is actively restricting, then the rebound hunger and bingeing is a fairly typical result.

But in less extreme cases, this doesn’t generally happen.

Someone can instead get to a place where their hunger and satiety signals become blurred. They never really know what they are feeling, so they tend to err on the side of not eating too much.

Or maybe there is some very low-grade constant level of hunger. But this ends up being like background noise and becomes so much the norm that they don’t really notice it.

But due to the decreased resources coming in, the body isn’t able to perform as it should and so symptoms arise.

Sleep gets worse, periods become more irregular or painful, they start getting headaches, they experience water retention, and they are regularly cold. Someone may even find that their weight is increasing during this time.

Despite all these symptoms, because they start happening over the space of years, people don’t really notice them. They may remember that they weren’t going on when they were in their early 20s, but they just put the changes down to now being a little older or to “life stressors”.

But at some point these symptoms reach a tipping point. No longer are they seen as “normal” and now they start being seen as a problem.

And when this person starts to think about what the cause is, it’s highly unlikely the under eating is the thing they think of. After all, if they needed more food, why wouldn’t they be hungry all the time? Why wouldn’t their body just tell them to eat?

This kind of slow development of symptoms and the disconnection for why they are happening is so common. And these days the likely “causes” that people believe have driven their poor health are gluten, or carbs, or “toxins”, or that they “need to lose weight”.

Obviously not everyone’s problems are due to under eating. But in my practice, it’s amazing how commonplace this issue is (and this is irrespective of what someone weighs).

Poor health or multiple symptoms don’t typically happen overnight. They progress over many years because of thousands of little choices that accumulate. And when stacked together, they make a big difference.

But if you are constantly trying to find that one thing that’s causing the problem or trying to reverse years or decades worth of changes in one “12 week boot camp”, you’re likely to be disappointed.

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Chris Sandel is the founder of He is a nutritionist, working with clients on a one-on-one basis, as well as creating online trainings and products about health and nutrition. He is the author of The Health Trap: Why "Healthy" Eating Isn't Always Healthy which is available on Amazon UK and Amazon USA.

Chris has three free emails series. One is on how to quit dieting. One is on simple tests you can do at home. And the other is his take on the world's healthiest foods.

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