When does Fasting (Intermittent or Otherwise) become an eating disorder?

(Erin Macfarland ) #21

@E.Dawn, yes, if you look at all the episodes for the Keto Woman Podcast with @Daisy you will see my name on one of the episodes, it aired a couple of months ago I think. I talk extensively about the science that’s coming out about the genetic adaptations that have led people to develop anorexia (though eating disorders are not exclusively defined as abstaining from food, there are many different types.) If you listen I hope you enjoy it, I tried to share information that not many people know about and what my recovery looked like.

(Erin Macfarland ) #22

@Goal179 when I was going through my eating disorder several years ago, keto was just starting to become popular and there wasn’t nearly as much information out there as there is now. Particularly in regards to fasting. When I read about Dr Fung back then he of course was talking about using fasting to heal metabolic damage. He is a nephrologist not an eating disorder specialist, so I never heard him recommend that one abstain from fasting if there was a history of eating disorders or if one is under weight than one shouldn’t fast. And you have to understand I didn’t know I had an eating disorder, nor did I believe I was underweight (a symptom itself of anorexia) so even if I’d heard him say these things I wouldn’t have thought they applied to me.

(KCKO, KCFO) #23

Not enough hearts for these two statements.

I love food too much to ever become anorexic personally. I also do not like vomiting, so no bulimia either. Just a bad relationship with loving too many foods, lead me to yoyoing, along with some stress.

Keto and fasting work for me. I love to start my fasts, but I LOVE to end them as well. Eating Keto allows me to eat what I want now. So I don’t think I’m in any danger of an eating disorder.

(Dawn) #24

Completely understand. I didn’t realize that over eating was a disorder either. I will try to find where Dr. Fung talks about this. It was in one of his youtube videos. I think he may also mention it in his book. But to your point, it you don’t know you have a disorder, his advice is a moot point. God bless you for getting your life back. You are an inspiration.

(Erin Macfarland ) #25

@collaroygal having anorexia doesn’t mean you don’t love food. Most of those who suffer from this illness love food. But our biology, once the illness is triggered, makes us unable to eat sufficiently. It isn’t a choice , it is a function of our brain.

(Erin Macfarland ) #26

That is very kind of you @Goal179 :heart:

#27

Here it is :smiley:

http://www.ketowomanpodcast.com/erin-macfarland/

(Erin Macfarland ) #28

Thank you @Daisy!

(Richard Morris) #29

I’m not qualified to have an opinion on this, but we have a few people (@Donna, @Terri ) who may have some specific expertise who may want to weigh in on the subject

but my uneducated opinion is that this

rings true to me. But as I said … I know nothing on the subject.

(Dawn Comber) #30

Thank you @Emacfarland ! I look forward to listening later today.

(Dawn Comber) #31

Thank you @Daisy. I plan on listening today! Every day I am thankful for this forum and the amazing people on it. :heart:

#32

IMO it can be a very delicate balance. There are some easy guidelines that will tell you whether your body type is suited to extended fasting and that mostly comes down to how much body fat you have. Body fat is what sustains you through any fast that goes beyond the normal day to day fast that everyone does at night. Generally IF is going to be fine too as long as you are feasting (or at least eating a good amount) when you do eat. If you were say eating OMAD but got a full day’s worth of energy in that one meal then that would work out great. I, for example, find that I don’t eat enough if I do OMAD because the restriction from my sleeve kicks in and I simply can’t eat enough.

My advice to anyone with ED history of any kind would be to approach fasting with caution. I interviewed someone just the other day who told me just how much fasting and keto have helped with he bulimia - basically got rid of the urges completely. @Emacfarland’s story is a little different and my feeling is that fasting is more likely to help the binge eating end of the spectrum than the anorexia end but that could be a naive generalisation on my point. Instinctively and logically it makes sense to me that it would help one more than the other.

Being aware of your own habits and tendencies is key. However, our minds are very good at denial and one of the things I learned from Erin was the importance of others speaking up. If someone was to express concern for you, I would take that seriously and go away and consider it. I wouldn’t get into a discussion in the moment because the most likely position is a defensive one, especially if there is a little voice inside you saying they might be right. But then really consider what they have said and evaluate your position anew. There will of course be plenty of people who will just go a bit nuts when they hear the word “fasting” and say it is “starvation” and you will end up with an ED. Those aren’t really the ones to listen to! But the kind of person who takes you to one side and expresses genuine concern is one to be listened to. A number of people don’t realise they are tipping into ED territory or the part of their brain that would warn them and steer them away has switched off for a while.

As always, it is a very individual thing and stepping out of that community was the right thing to do for that person.

(Dawn Comber) #33

Such down to earth common sense and wisdom here. This applies to more than just eating. It is a posture I need/want to hold for many life circumstances.

(Dameon Welch-Abernathy) #34

Unfortunately, those people are often loud and obnoxious.
However, they are generally easy to ignore.

(What The Fast?!) #35

I definitely do this.

This makes sense to me - I believe I’ve developed some disordered eating around fasting and keto, but don’t know how to fix it. (I’m planning to join IDM’s long distance program though, so hoping that helps.)

This too. I don’t hate it as much anymore, but I don’t love it like others do. I have found that it’s the only way for me to see a decrease on the scale though. The disordered eating part comes after that - because I feel like I’m not allowed to eat daily or I’ll gain it back (which does tend to happen to me).

#36

Exactly. They put a big old label on themselves that says, “ignore me” :smiley:

(Meeping up the Science!) #37

I’m writing a longer blog post about it, however, intermittent fasting is not an eating disorder necessarily.

If you are intermittent fasting for health-driven benefits, and you eat healthy despite fasting, it is not a disorder. People who do intermittent fasting eat all of their nutrients within a period of time. That is, they are not avoiding food, nor are they limiting vital nutrition. This is the #1 key difference.

People who fast for extended periods of time do not have an eating disorder if they do not meet the criteria for an eating disorder. Just fasting will not mean anything, necessarily, particularly if you are healthy. And, if you follow say Fung’s protocols for instance, you are still getting all your nutrition when you aren’t fasting. Someone with an eating disorder does not. Binge eating disorder, too, is full of nutritional issues just as anorexia is - they are eating primarily non-nutritive foods. When I weighed over 750 pounds and first went into treatment my ferritin was…10? Something. I was anemic, because I was not eating anything with iron. I’ve seen people with anorexia need amputations for protein deficiency. I’ve never seen people who fast healthy have those issues.

General information:
Eating disorders develop as a response to trauma the majority of the time. There may be a genetic predisposition for them, however the disorder develops as a response to regain control that was lost. The mind does this in order to preserve its homeostasis. Long after the trauma is gone, frequently the eating disorder remains. And, trauma can occur for many reasons, and isn’t necessarily a product of violence or assault.

Eating disorders are thus an addiction to control. They are not about the food or lack of food - they are 100% about the control. They typically occur with comorbid body dysmorphia, PTSD, sometimes bipolar disorder and borderline personality disorder. Often individuals display obsessive, compulsive, or impulsive behaviors as well as rigid black-and-white thinking. Anorexia is typically associated with OCD-like symptoms, and is often co-morbid with OCD actually, as well as PDs, and binge eating disorder and bulimia have many ADHD-like symptoms, and are often co-morbid with ADHD.

With an eating disorder, the goal is not health - it’s regulating the mind via the manipulation of food. It’s 100% about this, even if other symptoms or manifestations present stronger. For instance, I have binge eating disorder, and every time I would feel out of control, guess what I’d do? Yup - straight for the pretzels.

Also, you can also have disordered eating without having an eating disorder. For instance, people with anxiety can eat when they are anxious as a compensatory behavior. This reduces their anxiety, however they then may associate eating with feeling better, and thus begin to use food as emotion regulation. Eating, or not eating, is a common factor in much psychopathology, and if you suspect you have disordered eating or an eating disorder, seek professional assessment ASAP. I would not necessarily consider disordered eating as serious as an eating disorder…depending, as typically they are not as severe physiologically, and also because these often occur as a feature of another mental illness. You can also develop eating disorders in stages, and so I always keep a very close eye on this when present.

It is true that we do screen for fasting-like behavior when doing our assessments. The difference with fasting is that it has a set end date or time and refeeding is done carefully. With disorders such as anorexia, fasting is not planned in the same way and is done despite severe physiological issues. There are also many other criteria which occur at the same time. Fasting on its own is not indicative of a disorder. If that were true, every time you had to fast for blood work you’d be on your way to eating disorder town.

To be honest, I believe that anyone with a history of anorexia or other restriction-based disorders with a purging aspect (overexercise, expectorating, etc) should probably not fast for extended periods of time unless it is under strict medical oversight as it can cause the disorders to return with a vengeance. If you have a history of eating disorders, I would think twice about any extended fasting, particularly past IF windows.

When should we worry if we have an eating disorder? It’s complicated. Certainly, not if you just do IF.

  • Do you spend way more time focused on food than others, to the point where it dominates your entire day?
  • Do you plan all your daily activities around food rather than the activities?
  • Do you feel great shame about your body size, type, or weight?
  • Do you feel a strong need to hide what you eat from others?
  • Do you feel shame, embarassment, or guilt, when you eat in front of others?
  • Do you feel a need to hide your lack of eating around others to the point where it is disruptive to socializing?
  • Do you avoid eating with others?
  • Do you try to mask how much you are eating by either cutting food into tiny pieces and moving it around giving the appearance of eating, or if you sneak food in and out of places and hide it.
  • Have you ever develop vitamin deficiencies or have disruptions in important biological processes?
  • Do you have otherwise unexplained issues as a result of not eating or eating too much, such as: anemia, halt of menstruation, heavy menstruation, muscle pain, headaches, confusion, dizziness, hypoglycemia?
  • Do you avoid food and eating or do have you experienced a total lack of food and eating?
  • Do you experience a loss of control when you eat and feel that you cannot stop?
  • Have you been isolating yourself due to sadness or irritability? If so, how often?
  • Do you ever eat to the point of being painfully full on a regular basis?
(Meeping up the Science!) #38

Clinically, we regard most eating disorders as developing as a response to trauma. You will not get an eating disorder just from genetics. Genetics may predispose someone to being more likely to developing one in aversive situations.

For instance, without genetics, most people would have to go through severe trauma to have their ED develop - typically assault, abuse, or other things. With genetics, something like childbirth could be an experience that triggers it, even. Childbirth is actually a very common trigger for anorexia to develop in some populations.

I would say, though, that by and large most individuals I have treated for eating disorders have them begin after experiencing trauma, usually sexual assault or molestation.

Really, though, it’s an epigenic change - so while there may possibly be a biological foundation, it’s really environment that causes this. Most people with the genes for schizophrenia don’t develop it, for instance, by and large…perhaps only a very small percent do.

A lot of research shows that we also develop them due to culture and societal influences. Even in occurrences over hundreds of years of food restriction, most were done for religious reasons (i.e., severe fasting in the middle ages, for example) and not due to body image/control issues, which are the main diagnostic criteria currently.

(Dawn Comber) #39

@Donna Thanks for the clarification. I think you’re saying that while genes can play a role, they’re not a sole factor. And that environmental factors are more likely to be the central factor. Right?

I listened to @Daisy’s podcast with @Emacfarland and learned a lot.

(Meeping up the Science!) #40

Yep! Genes are absolutely a factor. We see trauma as the main cause, though, and the reason the distinction is important is because many people will not get treatment because trauma is complex. Many people I see for AN for instance also have PTSD, or had it in the past, and it went untreated for decades, sometimes.

Conversely, trauma is a big causative factor for obesity, actually.

And, the podcast was 100% fabulous…Erin did a great job. I can’t say enough good things about it. I actually have sent many clients to listen to it. :slight_smile: