Recovery From Undereating - Youreatopia

[tara]

Hi,
Since i keep wanting to raise the issues of low calorie consumption/energy deficit/undereating on other people's threads, i thought I'd try to gather/summarise some ideas on this and point to my sources, in the appropriate forum.

Youreatopia.com is a website run by Gwyneth Olwyn, whose area of expertise is supporting people in recovery from restrictive eating disorders, including clinical and subclinical anorexia, bulimia and orthorexia.
She writes about the physical and emotional processes in recovery, and also has some fantastic articles that contradict the dominant culture's portrayal of fat on many levels. She references and critiques relevant scientific studies.
I think some of the material is relevant for everyone, because we all get saturated in anti-fat messages all the time. And more of it is relevant for those of us who have had periods of undereating, even if we don't fit the restrictive eating disorder definititions. And some of us probably do fit those definitions.
Blog posts New ? Start Here.

 

[tara]

Re: Recovery from undereating - suppressed metabolism

She describes a whole lot of the consequences of undereating that Peat and people here associate with hypothyroidism, and points out that energy deficits result in reduced T3 and T4 levels amongst other things. If we put our bodies into energy deficit, they adapt by catabolising organs (usually more lean than fat) and suppressing many aspects of our metabolism to survive the famine. This includes reducing T3 and T4 production so we don't burn through our fuel too fast, slowing down digestion so we get more out of the inadequate food, osteoporosis, and a host of other negative health consequences. This seems entirely consistent with Peat's ideas. She promotes consistently supplying enough food to meet energy needs and bring metabolism back up. Also entirely consistent with Peat's ideas.

 

[tara]

Re: Recovery from undereating - fat

Fat
As far as I know she is right about:

• Most of the public calorie prescriptions are much too low to support a healthy metabolism. They are not based on sound science. Most studies of what people eat use self-reporting, which has been demonstrated to systematically underestimate peoples' actual food intake (on average).

• The designation of BMI ranges is heavily influenced by the demands of the weight-loss industries, and has little to do with human health.

• Our healthy weight/BMI/fat to fat-free mass ratio varies - there is no 'healthy weight' that applies to everyone - it varies like height etc. Only a few % of people have a natural healthy BMI of 18-21. If we try to force our weight to be lower than our set point, damage ensues.The only way to know what our healthy weight is, is to not restrict calories at all, and let it return to it's natural set point. If this is BMI 35, then forcing it down to the so-called 'healthy' weight range (under 25) will result in significant damage to our health. Statistically, there are studies showing that the risk of death is lower for the so-called 'overweight'' range than for the "healthy" range.

• People with more fat do not routinely eat more than lean people. For those people who have inflamatory conditions that keep them above their healthy weight, she thinks there are many other candidates, including unavoidable stress and hormone-disrupting chemicals in our environment, etc (this also seems compatible with Peat's views).

• The evidence does not show that being fat is either a disease or a cause of disease. There have been large studies showing fatter people had cleaner arteries than skinny ones. Gaining fat may provide some protection against the consequences of metabolic imbalances. For instance, people with more fat may be more likely to survive heart attacks than those with less.

I think people with more fat routinely get treated badly, from explicitly vicious scorn, to patronising assumptions about their character, to discouragement from participating in many physical and social activities, to poor health care, an on. This is widely accepted and very harmful to the majority of people who are not naturally thin. I think the oppression of fat people is one of the factors contributing to many people's (of whatever weight) poor metabolic health. There is no good reason for any of us to participate in it.

 

[tara]

Re: Recovery from undereating - how to

She describes an evidence-based method of recovering from a restrictictive eating disorder. I have no experience of doing this, but as far as I know she knows what she is talking about. She proposes commiting oneself to a daily minimum intake that matches what healthy, weight-stable non-dieting people actually eat (not what they say they eat), and eating way above these minimums when hunger calls. And not working out/exercising beyond gentle yoga, walking or similar.

For anyone who has been severely restricting, she says medical supervision is important because of the risk of refeeding syndrome (involves extreme swelling and dangerous electrolyte imbalances), which is rare and treatable, but sudden and serious if not treated.

"*Minimum Recommended Intake Guidelines for Recovery:
a) Females under the age of 25: 3000 calories and sedentary.
b) Females 5’0”-5’8” over the age of 25: 2500 calories and sedentary.
c) Males under the age of 25: 3500 calories and sedentary.
d) Males over the age of 25: 3000 calories and sedentary.
e) Females over 5’8” over age 25: 2700 calories; under age 25: 3200 calories.
f) Females over age 25 and under 5’0” as well as post-menopausal women can
lower the minimum intake to 2300, but more is always better."

I found these numbers an eye-opening contrast to the usual numbers I've been hearing.

She says the processes of recovery from severe restriction necessarily entail some discomfort, and you can't recover without going through some bloating etc as the body repairs itself. You can drag this process out by backing off the food part-way through. I wonder if there is a way to reduce the discomfort by applying some of Peat's techniques during recovery, without continuing the restriction and therefore preventing full recovery. I don't think I've come across anything from Peat that addresses this area. If you have, I'd love to see it.

When a body gets enough resources (food) every day, it determines it's own priorities for how to use it.
The phases she describes, if you steadfastly continue to eat enough every day, are:
Phase 1: Repair cells, includes edema.
Phase 2: Insulate vital organs by laying down fat round them.
Phase 3: Rebuild bones, muscles etc, bring all hormones and other processes back up to speed, and redistribute fat over the body.
Phase 4: Remission.

You can't decide that you want your body to repair the thymus first, or build muscles before adipose, or whatever. But if it keeps getting enough, it will build a healthier body all round. Sometimes there is a temporary weight overshoot.
If one gets scared off by any of these processes, and goes back to restricting, recovery stops, and more damage is done.

Some of her positions make sense to me in the context of restrictive eating disorders - because they are so dangerous. She encourages people to not restrict any food unless it is known to cause them personally specific bad consequences - eg. anaphylacic allergies are worth avoiding, diagnosed coeliac disease warrants avoiding gluten. My guess is that as long as we are eating enough, then making some choices influenced by Peat's ideas will be helpful for healing - eg minimising PUFAs, optimising micronutrients from food, etc. But if we are systematically eating less than it takes to run a healthy metabolism, then - well, nothing else we do will result in a healthy metabolism.

 

[SQu]

"She says the processes of recovery from severe restriction necessarily entail some discomfort, and you can't recover without going through some bloating etc as the body repairs itself. You can drag this process out by backing off the food part-way through. I wonder if there is a way to reduce the discomfort by applying some of Peat's techniques during recovery, without continuing the restriction and therefore preventing full recovery. I don't think I've come across anything from Peat that addresses this area. If you have, I'd love to see it."

Me too! I'd love the peat perspective on this. And whether some of us over recover weight and then get stuck in estrogen overload , preventing full recovery . Another trap.

I went through much of what she described and it helped to know that this is how recovery happens. It was a shock to see how much of an ED type I was, beneath the radar. Her articles are great. Thanks Tara!

 

[Blossom]

Thanks tara for posting on this topic. I think it's a valuable subject and that truth be told nearly all of us have probably been touched by eating disorders whether in ourselves or people close to us. It's practically promoted in popular culture. This is one of those touchy subject that doesn't get a lot of attention but probably needs to. There's no shortage of confusion and misinformation floating around about weight and health so thanks for bringing this up for further exploration.

 

[tara]

Me too! I'd love the peat perspective on this. And whether some of us over recover weight and then get stuck in estrogen overload , preventing full recovery . Another trap.

Hi Sueq, I think Mittir made the point that if the fat we gain is largely saturated, as it would be if we make it mostly out of carbs and saturated fat we eat, it may not cause the problems often associated with overweight. Don't know if any research has been done to distinguish whether saturated fat in adipose tissue causes excessive estrogen, or whether all the research has failed to make this distinction. It would be interesting to know.

 

[Blossom]

Me too! I'd love the peat perspective on this. And whether some of us over recover weight and then get stuck in estrogen overload , preventing full recovery . Another trap.

Hi Sueq, I think Mittir made the point that if the fat we gain is largely saturated, as it would be if we make it mostly out of carbs and saturated fat we eat, it may not cause the problems often associated with overweight. Don't know if any research has been done to distinguish whether saturated fat in adipose tissue causes excessive estrogen, or whether all the research has failed to make this distinction. It would be interesting to know.

I read that post about the saturated fat weight not contributing to high estrogen. It would be good to find the source although I believe it is true. I will start looking to see what I can find! Maybe that will help people not fear additional weight that may come with healing!

 

[tara]

Re: Recovery from undereating - Peat-inspired recovery

There are several reasons I think this topic may be relevant to those of us trying to use Peat's work to help us recover.

One is because I've read posts from quite a lot of poeople who say they are eating what looks like very little - under 2000 calories, sometime quite a bit under. My current view is that in general any attempt to systematically hold back from eating when we are hungry is stressful and harmful. And if we've been holding back for a while, our metabolism and appetite can adapt to the point where we don't even feel hungry for more. Probably there is some natural variation in how much people need, but the figures above are probably reasonable estimates for relatively sedentary people. So if we are eating far below these guidelines, it seems like that could well be a key cause of reduced metabolism and health problems, and key part of the route to recovering.

The second reason is that many people report edema, digestive distress, and other unpleasant symptoms. For people who have been systematically undereating (catabolising their system), I don't know whether it is possible to repair and restore their body, metabolism and health without some bloating or edema. So if we back off from our experiments because of edema, we might sometimes be stopping the recovery, and resuming the behaviour that caused the damage. I have questions about this -
To what extent is edema necessary to recovery?
How do we tell the difference between edema that is an essential and supportive part of the recovery, and edema that is a reaction to unhelpful factors that we would do better to change?
To what extent does it apply if the energy deficit has not been severe, or if it was historical but not current?
I think Gwyneth's protocol for recovery is based partly on what promotes the most rapid and complete recovery of physical health, and also on what reduces the risk of major/prolonged relapse into anorexia etc, which is dangerous. If we are not in this category (eg never went below 2000calorie (f) or 2500 (m)), can we ease ourselves into recovery more gently, and still get all the gains while minimising the discomfort?

The third reason is that people often report digestive distress. It would not be surprising, if the digestive organs have been under-used and under-fed, that they would not be so fit. In this case, I think it makes great sense to eat lots of high- nutirent (including energy), easy-to-digest food. But gastroparesis is an inevitable consequence of undereating, and it can take a little while for the guts to adapt to an increased food supply. Again, if we back off from eating enough because our guts are having trouble keeping up, maybe we just perpetuate the problem. It's great to figure out which food we can handle more easily, but if we are not supplying enough food, we may never get out of this bind. It may be necessary to persevere with eating enough, even if it takes a while to get comfortable.
My question here is: how we can tell the difference between unnecessarily irritating food and the inevitable processes that occur as the digestive system adapts?

The fourth reason is that many people express concern about gaining weight and/or fat, and some are adamantly against it. If Gwyneth is right, for those of us who have been systematically undereating, there is no way to recover health and metabolism without allowing our adipose organ to grow. Apparently, if we keep eating enough - to the above minimum guidelines and more in response to hunger, our bodies will work it out. This generally means gaining fat first, and if we keep eating enough, then rebuilding our other organs too. The fat gain may for some people (but not everyone) temporarily overshoot our optimal weight, in which case it will come back to optimal on it's own if we keep up the supply. If she is right, then backing off eating enough because we are gaining fat would be stopping our recovery. (I wonder wheter backing off when we are in the overshoot, would keep us there, too, when continuing to meet the bodies needs would allow it to come down to optimal?)
This problem is compounded because so much of the culture (including medical culture) daily reinforces the message that it is healthy to lose weight, and that we should exercise more and control our eating.
My guess is she is right for people who are severely unfed. My question here would be: if the deficit has been mild, is there anyway to make this transmission smoother? My guess is she would say eat enough and your body will figure it out on its own.

 

[charlie]

I'm with tara and Gweynth on this one.

 

[tara]

One of the difficulties is that our optimal healthy weight, the weight at which our metabolism works at it's best, may not fit the currrently fashionable size promoted by the diet, weight loss and gym industries, by the (clothes) fashion industry, by models and movies, by the 'health' industry, by the average person on the street, and quite possibly by the person you want a date with (if you are single). Most people are not at their natural healthy weight if they are fashionably thin. (It's not hard to find a BMI calculator that will tell a BMI 26 peron that they are at increased risk of heart attack and should lose weight).

So we might have to make a choice between being healthy and being thin. This takes courage.
I'm quoting myself from someone else's thread here:

I remind myself now and then that I don't generally think it's a good idea support bodily damage to women in the name of fashion (and to keep women powerless), in various times and cultures. I'm not thrilled about foot-binding, FGM, rib-cracking corsets, and the current 'beatification' industries pressure to spend all our time and money on make-up and silicon breast enlargements etc. So there is no good reason for me to believe or go along with anti-health fat oppression, either. But I still keep catching myself going along with it now and again - a continuing battle.

 

[tara]

Re: Recovery from undereating - Health at Every Size

Linda Bacon (http://www.lindabacon.org/) wrote a book Health at Every Size. I haven't read it, but I've read a couple of her articles. She writes about how to provide health care that focusses on well-being not weight loss, and related issue. She has lots of resources on her site about fat and health.

 

[tara]

Re: Recovery from undereating - thyroid supplement?

Do you think supplementing thyroid in the absence of sufficient fuel supply is likely to help or hinder? My guess is it might be stressful, that getting nutrition (including calories) up first makes sense, and in some cases this may be enough. But since we all have different context, I guess this could vary from person to person. Have you seen anything about this from Peat?

 

[charlie]

In my opinion, hinder.

I have heard Peat use the word hyper-nourishment.

 

[tara]

Re: Recovery from undereating - thyroid supplement?

In my opinion, hinder.

I have heard Peat use the word hyper-nourishment.

So as a rough guide, possibly before supplementing thyroid, you'd want to get above the minimum calorie guidelines above for a while. And see if you still need it then.

 

[j.]

I don't think the calories are as important as the vitamins and minerals and proteins if you're supplementing thyroid. A bunch of calories from junk food probably won't have the value of the relatively low-calorie serving of beef liver.

But you do need to eat a lot, and if you supplement with too much thyroid, I think there won't be enough nutrients regardless of what you eat.

 

[j.]

I wondered if getting fat on a Peat diet is a defense mechanism to increase the ratio of saturated/unsaturated fats in adipose tissue and therefore the bloodstream.

 

[charlie]

I wondered if getting fat on a Peat diet is a defense mechanism to increase the ratio of saturated/unsaturated fats in adipose tissue and therefore the bloodstream.

I have had that thought before.

 

[tara]

Re: Recovery from undereating - thyroid suppement

I don't think the calories are as important as the vitamins and minerals and proteins if you're supplementing thyroid. A bunch of calories from junk food probably won't have the value of the relatively low-calorie serving of beef liver.

But you do need to eat a lot, and if you supplement with too much thyroid, I think there won't be enough nutrients regardless of what you eat.

All those other nutrients are important too.
My understanding of Peat's work is that he is very keen on optimising efficient energy production in cells. This requires a steady supply of fuel - sugar or fat - to the cells. The fuel either comes from the food we just ate, or from glycogen released from the liver, or from catabolising our tissue. For people who have been chronicly undereating, there is likely to be inadequate glycogen storage, and other tissues already depleted that can't afford to be further catabolised. Adding thyroid would increase the demand for fuel, and it has to come from somewhere. If we don't eat at least enough calories to meet this need, where's it going to come from? Won't it risk further damage to already depleted organs?

 

[j.]

I don't think you can satisfy your nutrients requirements without eating a lot of calories, but it's possible to eat a lot calories without satisfying the demand of nutrients, if you don't eat enough nutrient dense foods and enough variety, that's why I choose to emphasize the nutrients aspect. Once you satisfy it, you also get the required amount of calories.