Have you lived most of your life as a career dieter?
Do you struggle with body image issues?
Feel you don’t measure up to societal standards?
Are there lots of things you JUST WON’T DO because of how you feel about your body?
Here’s a few examples: wear a certain skin-hugging dress? Enjoy yourself at the beach in a cute swimsuit? Go to the gym?
Do you think things like: “That kind of dress isn’t made for someone with my shape” or “I shouldn’t wear that swimsuit, no one wants to see my rolls” or “Everyone will stare at me when I’m exercising because I’m so fat”
Do these kinds of thoughts hold you back from doing things you’d like to do? Do they keep you cooped up and quiet when you want to be bold and free?
Are you sick and tired of it??
I was too. For a long time I starved, berated, and damaged my body trying to fit a certain mold.
I even did this when I was supposedly “healthy” and paleo.
It was a brutal time where I weighed myself constantly and never felt comfortable in my own skin.
Can you relate?
Cue my life changing transformation in body image and self-love which has helped me not only overcome my own issues, but help thousands of others.
I started with myself, but I had a lot of help along the way.
One of my incredible friends was a major influence on the way I feel now.
She is strong, beautiful, and doesn’t give two f***s what people think about her or her body.
She loves herself unconditionally and she teaches women like you and I to do the same.
She is known for taking sledgehammers to scales and empowering women to love themselves no matter what.
That woman is my friend Summer Innanen.
And I’m fiercely excited about her new program. She’s calling it You, On Fire.
You guys know I love to sign my emails “With fire and love” because I love the idea of women bringing out their fiery, passionate, bold and fierce natures and really loving themselves, despite everything else!
Summer’s new program is the PERFECT option for any of you who struggle with that. It’s for those of you that are DONE with letting diet culture dictate to you or make you feel like your worth is based on a number on the scale, a certain shape or figure, or whatever BS they’re spewing out these days.
It’s for those of you who want to love yourselves and learn how to do that in a safe place with an AMAZING and hilarious woman.
You, On fire is a kickass 12-week group coaching program where you’ll join Summer’s entourage and learn to stick it to societal standards, stop living behind the number on the scale and feel like a total rockstar in your body.
This will be a fun, hilarious, and soulful journey into the depths of who you are, but more importantly, will release your sense of humor!
Summer has the ability to bring humor into anything and I know you’ll love her and her program! I can’t recommend her highly enough!
So check out You, On Fire. Find more info here.
Tell us how you’ve overcome (or not overcome!) your body image issues! What do you still struggle with? What advice has helped you the most?
One of the most common problems I encounter in my audience is binge eating. This is also one of the most common concerns Noelle and I field for our podcast. Everybody wants to know: How do I stop?
I have written about overcoming binge eating at great length before. In the article Binge/Restrict: The Most Common Pattern of Overeating and How to Stop, for example, I argue that while most people think the solution to binge eating is simply to be disciplined enough to get over it, the answer is actually the opposite. The answer, I argue, is to allow yourself abundance. The answer, I argue, is lots of food. Once you stop restricting your diet, you no longer feel the deprivation and obsession that inevitably cause you to overeat later on.
I do still believe that this is one of the most important things you can do to overcome binge eating. But I would like to discuss here the great, biochemical heft behind these processes.
Because here’s the thing: as much as society (and you!) may call you undisciplined, stupid, lazy, gluttonous, fat, insert demoralizing adjective here, for bingeing on whatever kind of food has hooked you, it’s wrong. It’s just plain wrong. You’re up against a huge set of biological, habituated compulsions. Bingeing behavior has now been proven to have potent biological motivators. And you must know it. I believe — I hope — that as you know it, so you may forgive yourself. Then you may more easily walk the path of healing.
To that end, I am going to describe two separate studies. These were both done on rats, so of course we cannot assume they to apply to humans. But there are human analogues and other human studies (such as on the science of sugar addiction – a topic for another time), that indicate the models may well apply.
Binge-Like Consumption of a Palatable Food Accelerates Habitual Control of Behavior and Is Dependent on Activation of the Dorsolateral Striatum
This study investigates the difference between constant, non-restricted access to palatable foods versus restricted access to palatable foods. It ends up revealing that just a few weeks of occasionally being exposed to bursts of sweetened milk cause rats to binge on it, as well as to maintain these eating habits even after the time restrictions have been taken away. It happens because of neural changes that have taken place during the “burst” period. These changes cause long-term habits to form.
Teri Furlong and colleagues at the University of Sydney gave rats a diet of either normal chow or chow plus sweetened condensed milk. The “normal chow” rats were the control group. The rats that received the sweetened milk were divided into two groups: half got milk all day every day, as much as they wanted. The other half got access to the sweet stuff for only two hours every day.
After five weeks, the scientists trained all of the rats to press levers. There were two levers: one for sweet sugar pellets and one for simple grain pellets. In the test, the animals feasted on one of the types of food (either the sugar or the grain) and then exposed to a lever. In the first scenario, rats saw the lever for food they hadn’t yet had. If they had eaten sugar, they got grain. If they had eaten grain, they got sugar. In this scenario, all the rats ate a lot of the new food. Tastebuds like variety.
In the second scenario, the rats were given access to levers for the food they had already eaten. So if they had eaten sugar, they got a lever for sugar, and if they had eaten grain, they got a lever for grain. And this is where things really get interesting: rats who had had constant access to the sweetened milk in the training phase ate to satiety. They stopped pressing the lever. They had no interest in either the grain or the sugar. But, rats who were only allowed access to the sweet milk for two hours a day (and for the rest of the day, as much unsweetened food as they wanted), responded differently. They kept pressing for grain, even though they were already full of grain, and they kept pressing for sugar, even though they were already full of sugar. They weren’t pushing these levers because they were hungry. They were pushing these levers because having restricted bouts of access to sweet foods rewired their brains.
Interestingly enough, the researchers found that the obsessive lever-pressing was associated with an area of the brain called the dorsolateral striatum–an area of the brain associated with habitual behaviors. The researchers therefore hypothesize that rats develop long-lasting bingeing behaviors because of the repetitive training they had from the easier phase of the study. In that phase, they simply learned that the sweet stuff was rarely available, so they stuffed their faces when they could. This imprinted in them a long term habit.
Importantly, chemicals injected into their brains that interfered with glutamate and dopamine activity in the dorsolateral striatum caused the bingeing behavior to stop.
In this study, MM Hagan and DE Moss subjected rats to four different patterns of 12-week restriction-refeeding cycles. The animals were either food restricted–constantly on a diet–or restricted plus some free-access binge days. After 12 weeks all rats underwent a re-feed period.
There were four different groups of rats: 1) “normal diet” eating with normal chow in the refeed period, 2) cyclical restricted eating (bingeing) with normal chow in the refeed period, 3) “normal diet” eating with palatable food in the refeed period, and 4) cyclical restricted eating (bingeing) with palatable food in the refeed period.
The rats that ate the “diet eating” consistently received 75% of their normal calorie intake. The rats with cyclical restricted eating went through 4 days of restriction of 75% of their normal intake, then two days of a refeed where they could eat ad libitum.
After 12 weeks of this kind of entrainment, the rats were given 3 tests: 1) 24 hour deprivation and chow feeding; 2) 24 hour deprivation then chow and cookie feeding; 3) spontaneous chow and cookie feeding.
In the first test, with 24 hour deprivation and chow feeding, the rats which had gone through restricted cycles of feeding (on both normal and sweet food) ate 10% more food than the control rats. Interestingly enough, the rats that had been conditioned on sweet food were not all that interested in the chow feeding, and actually ate 20% less chow than the control group.
In the second test, with 24 hour deprivation and cookie feeding, rats that had been in sweet restricted cycles ate almost 20% more food than the control group.
In the third test, in simple spontaneous feeding without a 24 hour deprivation window, rats conditioned by sweet foods ate more than rats on normal chow, regardless of whether they had been restricted or not. The rats who ate non palatable chow and were on normal “diets” were perfectly fine; the rats who had eaten sweets but were on a normal diet ate about 20% more; the rats who had been in restricted cycling patterns and refed on sweets ate 80% more than control mice on normal diets. 80% more.
Researchers in this study conclude, therefore, that “of all the conditions, the restricted/palatable group showed the most bulimic-like eating behavior. That is, a history of restricted eating (dieting) and refeeding on palatable food (bingeing) predicted a persistence of bingeing-eating behavior even after a 30-day period of normalization.”
Other Studies and implications
Of course, these are just two studies, and have been conducted on rats. There are plenty of indicators that similar phenomena are at play in human beings. Recall perhaps most strikingly of all the Minnesota semi-starvation experiment in which “normal men” were food restricted and showed binge eating and insatiable appetites for sweet foods even after many days of unrestricted eating during the rehabilitation phase (Franklin et al 1948). In the 90s, Polivy et al “found that uncontrollable bouts of binge eating were significantly more common among prisoners of WWII who had, over 50 years earlier, experienced severe food restriction compared with nonrestricted combat veterans” (1994).
Via experiments on rats, we can see more clearly mechanisms by which this takes place. Apparently, pleasure neurotransmitters (such as dopamine) are definitely involved, as are, to a significant extent, the parts of the brain that are associated with habit formation.
The bottom line is this: your history of dieting, of binge eating, of restricting and refeeding, has had a concrete affect on the functioning of your brain. I can’t tell you how many thousands of women have expressed terrible guilt and shame with respect to their bingeing behaviors. They are all incorrect. If you feel this way, you are also incorrect. Your biology compels you, and powerfully so.
As I indicated in the start of this post, literally the best thing you can do for yourself is to forgive yourself. Give yourself access to food, and unlimited. Accept your body and delight in how hard it tries for you. Provide it with the nourishment it needs to develop new habits. It may feel rough at first, but over time the body can actually learn to eat well. You may also find that staying away from sweets or certain palatable foods is important. So long as this does not cause you to develop obsessions with these foods, that could be good. It would remove the biological trigger of habit that you have imprinted in your brain. Even switching to a different set of palatable foods could help (so long as your access is unrestricted). They key here is developing a positive, loving, forgiving attitude and helping your body create new habits.
You may also wish to supplement with low doses of l-tyrosine and/or l-tryptophan. These are precursors to dopamine and serotonin, respectively. They have been demonstrated to sometimes be quite potent for curbing people’s compulsions to overeat (an argument famously made by Julia Ross in The Diet Cure). I have personally noticed that when I take L-tryptophan (I take it for sleep) my constant feeling of “I could eat” disappears, and I feel more like a “normal person.”
Do you have experience that lines up with what I’ve discussed here? Contradicts it? I’d love to hear about what you’ve gone through, and anything you share could be a great help to someone else in the community.
One of the more esoteric but much beloved tools in the paleo dieter’s tool-kit is intermittent fasting.
What is intermittent fasting? I.F. is the practice of maintaining overall caloric intake while consuming those calories in fewer meals or in reduced time windows throughout the day. The goal is to create conditions of fasting in the body, but not for extreme lengths of time.
Some examples of intermittent fast strategies include 10, 8, or 5 hour eating windows throughout the day, or perhaps eating just two meals each day: one in the morning, and one at night. The evolutionary premise — the argument that proponents of intermittent fasting make — is that humans evolved to optimize their health under less-than-optimal conditions. Intermittent fasting, they say, is a natural and perhaps even necessary part of being human.
The modern-day scientific correlate appears promising, too:
Most people are nowadays aware that a calorie-restricted diet has the ability not just to decrease body weight but also to lengthen a human life. Emerging research is beginning to show, however, that intermittent fasting is just as effective as calorie restriction in ensuring these health benefits! Amazingly enough, this happens without any of the psychological crippling side effects of cravings and food obsession that practictioners of calorie-restriction often experience.
Intermittent fasting, proponents say, also may benefit the fight against cancer, diabetes, and autoimmunity. Here is an excellent, up-to-date review of the “benefits” of fasting. It is wholly understandable that fasting is all the rage these days.
Intermittent fasting women is a specific interest of mine because of what I have witnessed both in myself and in working with literally thousands of women in the PfW community.
Many women report to me (read more about that in this awesome book) that intermittent fasting causes sleeplessness, anxiety, and irregular periods, among many other symptoms hormone imbalance, such as cystic acne.
I have also personally experienced metabolic distress as a result of fasting, which is evidenced by my interest in hypocretin neurons. Hypocretin neurons have the ability to incite energetic wakefulness, and to prevent a person from falling asleep, in reaction to the body detecting a “starved” state. Hypocretin neurons are one way in which intermittent fasting may dysregulate a woman’s normal hormonal function.
After my own bad experience with IF, I decided to investigate intermittent fasting. I looked into both a) the fasting literature that paleo fasting advocates refer to, and b) the literature that exists out in the metabolic and reproductive research archives.
Intermittent Fasting Women: Problems in the Paleosphere
What I found is that the research articles cited by Mark’s Daily Apple (and others), focus on health benefits such as cancer-fighting properties, insulin sensitivity, and immune function.
However. I was struck by what seemed like an egregious sex-based oversight in that MDA post I linked to above. MDA cites this article as a “great overview” of the health benefits of intermittent fasting. This startled me because the article MDA cited was for me one of the strongest proponents of sex-specific differences in response to fasting.
Sex differences were relevant in two striking areas:
1) women in studies covered by the review did not experience increased insulin sensitivity with IF regimes and
2) intermittent fasting women actually experienced a decrease in glucose tolerance.
These two phenomena mean that women’s metabolisms suffered from IF. The men’s metabolisms on the other hand improved with IF across the board. Recall that the review was reported by MDA as “a great overview of benefits [of IF].”
Secondly, in another fasting post at MDA, of which there are many, the health benefits of fasting are listed and reviewed, but the sex-specific aspects of the hormonal response go unmentioned, and reproduction/fertility/menstrual health isn’t mentioned at all.
This is not to say that Mark is not attentive to who should and who should not be fasting. He knows very well and cautions people against the dangers of fasting while stressed. Still, the mere fact of being more sensitive to fasting simply by being a woman is, I would assert, pretty important for a woman who is contemplating or already practicing IF.
This goes nearly unmentioned in the blogosphere.
Intermittent Fasting Women: Problems in the Literature
Beyond reporting biases in the blogosphere, there remains an even greater problem of a significant testing bias in the fasting literature. Searching “men” + “intermittent fasting” in a Harvard article database yields 71 peer-reviewed articles. Searching “intermittent fasting women” yields 13, none of which are a) solely about women b) controlled studies or c) about more than body weight or cardiovascular benefits.
The animal studies are more equitable, but also a bit less applicable to human studies.
It is well-known in both the research and the nutritional communities that caloric restriction is horrible for female reproductive health. This is not news. There is an infertility condition – called hypothalamic amenorrhea – that millions of women suffer from due to being overly restrictive. But what of fasting?
Intermittent Fasting Women: Should we Fast?
The few studies that exist point towards no.
It is not definitive, since the literature is so sparse, and it necessarily differs for women who are overweight versus normal weight (and who have different genetic makeups), but when it comes to hormones, women of reproductive age may do well to err on the side of caution with fasting.
What follows first is a brief review of what can be gleaned in sex-specific responses to fasting in animal studies. Afterwards I talk about what has been concluded by the few relevant human studies.
Mice & Rats
First up is a study that demonstrates the hippocampal changes of calorie restriction and intermittent fasting for both male and female rats. In this study, they do alternate day fasting, which entails free eating on one day and a fast day on the next.
The study found that brain states while fasting were different for male and female rats. For male rats the change in hippocampus size, hippocampal gene expression, and ambulatory behavior was the same no matter what kind of restricted diet they were on – but for female rats, the degree of change in brain chemistry and in behavior was directly proportional to degree of calorie intake, demonstrating the unique sensitivity of female rats to the starvation response.
” The organization of the females’ response to the energy restricted diets is suggestive of some underlying mechanism that may allow for an organized, pre-programmed, response to enhance survival in times of food scarcity. Comparatively, the males’ genetic response was less specific, suggesting that the males respond to a general stressor but they seem to lack the ability to discriminate between a high energy and low energy stressor.”
Moreover, “IF down-regulated many gene pathways in males including those involved in protein degradation and apoptosis, but up-regulated many gene pathways in females including those involved in cellular energy metabolism (glycolysis, gluconeogenesis, pentose phosphate pathway, electron transport and PGC1-α), cell cycle regulation and protein deacetylation.” In this study, both male and female rats gained small amounts of weight on IF diets.
For female rats, even in the most innocuous form of restriction–intermittent fasting–significant physiological changes take place. Male rats do not experience as dramatic hippocampal and general brain chemistry change as female rats do, and their behaviors, specifically their cognition and their dirunal and nocturnal activity, do not change.
Female rats, on the other hand, “masculinize.” They stop ovulating and menstruating. They become hyper-alert, have better memories, and are more energetic during the periods in which they are supposed to be sleep. Theoretically, according to these researchers, this is an adaptive response to starvation. The more the female rats need calories– or at least the more their bodies detect a “starvation” state– the more they develop traits that will help them find food. They get smart, they get energetic, they get active, and they stop sleeping.
In a follow-up study conducted by the same researchers who explored the masculinzation of female rats, the researchers analyzed the gonadal transcription of male and female rats subjected to IF regimes.
This study found that male reproductivity up-regulates in response to metabolic stress. Female reproductivity down-regulates.
Completely opposite to the female rats becoming infertile while fasting, male rats become more fertile. In the researchers’ own words: “our data show that at the level of gonadal gene responses, the male rats on the IF regime adapt to their environment in a manner that is expected to increase the probability of eventual fertilization of females that the males predict are likely to be sub-fertile due to their perception of a food deficient environment.”
In the final relevant IF rat study I could find, researchers subjected rats to the same diets– to 20 and 40 percent Calorie-Restricted (CR) diets, as well as to alternate-day fasting diets, and monitored them over the long term for hormonal responses. The results were striking. Below is the abstract in full because it’s so powerful:
Females and males typically play different roles in survival of the species and would be expected to respond differently to food scarcity or excess. To elucidate the physiological basis of sex differences in responses to energy intake, we maintained groups of male and female rats for 6 months on diets with usual, reduced [20% and 40% caloric restriction (CR), and intermittent fasting (IF)], or elevated (high-fat/high-glucose) energy levels and measured multiple physiological variables related to reproduction, energy metabolism, and behavior.
In response to 40% CR, females became emaciated, ceased cycling, underwent endocrine masculinization, exhibited a heightened stress response, increased their spontaneous activity, improved their learning and memory, and maintained elevated levels of circulating brain-derived neurotrophic factor. In contrast, males on 40% CR maintained a higher body weight than the 40% CR females and did not change their activity levels as significantly as the 40% CR females. Additionally, there was no significant change in the cognitive ability of the males on the 40% CR diet.
Males and females exhibited similar responses of circulating lipids (cholesterols/triglycerides) and energy-regulating hormones (insulin, leptin, adiponectin, ghrelin) to energy restriction, with the changes being quantitatively greater in males. The high-fat/high-glucose diet had no significant effects on most variables measured but adversely affected the reproductive cycle in females. Heightened cognition and motor activity, combined with reproductive shutdown, in females may maximize the probability of their survival during periods of energy scarcity and may be an evolutionary basis for the vulnerability of women to anorexia nervosa.
They also found this:
The weight of the adrenal gland was similar in rats on all diets; however, when normalized to body weight CR and IF diets caused a relative increase in adrenal size, the magnitude of which was greater in females, compared with males.
The testicular weight was unaffected by any of the diets. In contrast, both CR diets and the IF diet caused a decrease in the size of the ovaries.
And this, bearing in mind that “daytime” for nocturnal rats is “nighttime” for humans:
The daytime activity of females was doubled in response to IF, whereas the IF diet did not affect the activity level of males. Nighttime activity levels of males and females were unaffected by dietary energy restriction.
Uterine activity was monitored daily with vaginal smear tests; cyclicity was scored as regular, irregular, or absent. The mild energy-restriction diets (20% CR and IF) significantly increased the proportion of animals displaying irregular cycling patterns, whereas the 40% CR animals displayed an almost complete loss of estrous cyclicity.
In males, corticosterone levels were elevated only in response to the 40% CR diet, whereas in females corticosterone levels were significantly elevated in response to all three energy-restriction diets, suggesting a relative hyperactivation in females of the adrenal stress response to reduced energy availability.
For lipids, all the rats did well: “Collectively, these data suggest that atherogenic profiles of both males and females are improved by dietary energy restriction.” Interestingly, too, as they pointed out in the abstract, human females also perform cognitively much “better” (memory and alertness) on CR and IF diets than on normal feeding schedules.
There are of course some caveats to this study: A) They are rats. B) They are somewhat “metabolically morbid” rats, which may make them more susceptible to disease. C) The rats were allowed to eat ad libitum on the IF days, but they simply did not meet their caloric requirements this way. So while it is a somewhat natural form of IF, it is still calorically reduced, such that that must be taken into account when gasping in horror at the hormonal responses of IF-ing female rats.
The Few Human Studies
I mentioned above that through the same review that MDA used as a “great overview” of IF benefits for all sexes, I found harmful metabolic effects for women subjected to alternate-day fasting regimes.
This is the study:
Heilbronn et al found that with IF, insulin sensitivity improved in men (21 participants) but not in women (20 participants): after three weeks of alternate day fasting, insulin response to a test meal was reduced in men. Women experienced no significant change. “It is interesting that this effect on insulin sensitivity occurred only in male subjects,” they report.
With respect to other health markers female health actually declined, specifically with respect to glucose tolerance:
“Another diabetes risk factor that has shown a sex-specific effect is glucose tolerance. After 3 weeks of ADF, women but not men had an increase in the area under the glucose curve. This unfavorable effect on glucose tolerance in women, accompanied by an apparent lack of an effect on insulin sensitivity, suggests that short-term ADF may be more beneficial in men than in women in reducing type 2 diabetes risk. ” The opening line of their discussion reads: “Alternate day fasting may adversely affect glucose tolerance in nonobese women but not in nonobese men.”
In a follow up study, Heibron et. al studied the effects of alternate-day fasting on cardiovascular risk. When human subjects fasted on alternate days for another three week period, circulating concentrations of HDL cholesterol increased, whereas triacylglycerol concentrations decreased. This is a good thing. However, the shifts in lipid concentrations were shown to be sex specific: ie, only the women had an increase in HDL-cholesterol concentrations, and only the men had a decrease in triacylglycerol concentrations.
The most recent review of IF agrees with my conclusion: sex-specific differences in metabolism exist and need to be studied further.
This study of alternate day fasting included 12 women and 4 men. In eight weeks, body weight decreased by about 10 pounds, and body fat percentage decreased from 45 to 42. Blood pressure decreased, total cholesterol, LDL cholesterol, and traicylglycerol decreased. These people were significantly obese, which limits the results of this study to an obese population. However, “perimenopausal women were excluded from the study, and postmenopausal women (absence of menses for >2 y) were required to maintain their current hormone replacement therapy regimen for the duration of the study.” (Their words, my emphasis)
The one, big study of intermittent fasting conducted on men and women looked at differences between isocaloric feeding schedules: 3 meals/day feeding versus 1 meal/day.
The study focused on body weight composition, blood pressure, and body temperature in subjects. Subjects were fed isocalorically either one meal each day or three meals each day. All subjects were between 40 and 50 years old (excluding women of reproductive age), and between BMIs of 18 and 25. They ate, so far as I can tell, a healthy diet with 35 percent fat, PUFA < MUFA < SFA. Only 15 of the original 69 completed the study (which goes to show just how fun everyone thought fasting was). As for the results,
“Systolic and diastolic blood pressures were significantly lowered by ≈6% during the period when subjects were consuming 3 meals/d than when they were consuming 1 meal/d. No significant differences in heart rate and body temperature were observed between the 2 diet regimens. Hunger was enormously larger in the one meal/day than in the three meals/day group. “The 1 meal/d diet was significantly higher for hunger (P = 0.003), desire to eat (P = 0.004), and prospective consumption (P = 0.006) than was the 3 meals/d diet. Feelings of fullness were significantly (P = 0.001) lower in the 1 meal/d than in the 3 meals/diet.” Body weight dropped only four pounds after several months. Cortisol dropped, but Total, LDL, and HDL cholesterol were 11.7%, 16.8%, and 8.4% higher, respectively, in subjects consuming 1 meal/d than in those consuming 3 meals/d.
In sum: patients on the one meal/day regiment were unhappy, hungry, lost a little bit of weight, increased cholesterol. This was a small sample, included somewhat menopausal women, and all people of normal body weight.
Intermittent Fasting Women: In Conclusion
All that being said, that’s it. That’s all that exists! Women don’t have much to go on.
There are a few rodent studies. They found that when alternate-day fasting,female rats and found significant negative hormonal changes occurring in the females.
There are even fewer human studies. Human studies on alternate day fasting have not been conducted on women of reproductive age at all, nor have any studies analyzed reproductive responses to fasting.
Moreover, the few studies that have been conducted on non-obese women have demonstrated that their metabolic responses are not nearly as robust as those of men, and may in fact be antagonistic to their health.
This post has focused on sex-specific responses to fasting, specifically intermittent fasting women. Another important distinction to make is between different body weights. Overweight and obese patients appear to experience significant improvements with IF regimes, but normal weight patients do not show the same across-the-board benefits. For women this may be a particularly sensitive issue. Overweight women may experience metabolic benefits, whereas normal weight women do not. I suspect that that may roughly be the case, but who knows. Honestly, no one at this point.
The practical solution, then, I believe, is to look at options, to be honest about priorities, and to listen to one’s body with awareness and love.
Is fasting worth trying if a woman is overweight and trying to improve her metabolic markers, and so far hasn’t had much success? Perhaps. Should it be undertaken if a woman is of normal weight? What if she is a light sleeper? What if her periods begin to dysregulate? Or stop? What if she starts getting acne, getting a stronger appetite, or losing her appetite altogether? These things happen, and I see them in women who fast and contact me time and time again.
We women (people!) should be honest with ourselves about our priorities, and act constantly with our mental and physical health foremost in our minds. All women are different. But the literature is so sparse in this area that we cannot make any real statements or predictions about the effects of fasting, other than that we just don’t know, and that we should continue to emphasize the centrality of awareness, caution, and loving nourishment in moving forward.
IF is one realm in which the female body has unique characteristics and needs that demand attention. There are boatloads of others. If you’re interested in reading about the collective set of them and learning how to optimize female skin, weight loss, and hormone balance, for a few examples, you could do worse than my best-selling book, Sexy by Nature, here.
And that’s a wrap! What do you think?
Did you know that there are actually three different major types of eating issues?
There are eating disorders, disordered eating, and then something similar to disordered eating called ‘problematic eating behavior’.
One of the interesting types of problematic eating behavior seems to describe MANY of the people that I talk with in the nutrition world and many of my readers- they are called restrained eaters.
Restrained eaters are eaters who struggle with chronic restrictiveness- either eliminating foods or chronically dieting.
If you are a yo-yo dieter or find yourself continually in the cycle of losing or gaining weight, you may be a restrained eater.
When restrained eaters are confronted with weight gain, they feel negative emotions which can then cause them to overeat. They also feel guilt when they eat a food they’ve deemed “bad”. Restrained eaters also have an obsession with body shape and weight and may use self-judgement as a tool to spur their weight loss goals.
Sound a little familiar?
In the paleo community, we eliminate certain foods for health reasons. In other forms of dieting we restrict processed foods or calories to help lose weight.
Research shows that these things DO help people lose weight. But research also shows that restrained eating can actually promote eating disorders.
Approaching weight loss from a perspective of restraint and negativity- the “i’m getting so fat I’ve got to lose weight” mentality, is a moving target. Nothing will ever be good enough. And when/if it is, it won’t last, because the way we get there is unsustainable.
Now, I know some people who do make restrained eating a lifelong change and feel great.
But there’s a difference.
These people restrict certain foods not because they are afraid of them (i.e. GRAINS and CARBS), but because they are making other choices that are healthier for them.
They are thinking about what foods they can eat to be as healthy, happy, and energetic as possible. They are approaching restraint from a POSITIVE perspective.
With these people, it’s not about eating as few carbs as humanly possible, it’s about eating how many feel right.
Of course there’s always the disclaimer that our modern world of processed, hyperpalatable foods makes knowing how many carbs are right difficult. And some people struggle with conditions like insulin resistance that make unhealthy carb cravings REAL.
But for most eating all whole, unprocessed food, there’s no reason to be afraid!
Research shows that these positive eaters have higher self-esteem and better long term weight management success.
My friends will tell you that they have an emotional freedom they never had before as well.
It just worries me in this day and age of “keto”, which is basically paleo circa 2011, being masqueraded as the all-powerful life changing, freedom giving lifestyle, that so many of these people are just restrained eaters on another diet.
25 grams of carbs is not right for many women. It’s just not. And obsessively tracking and counting them is just the kind of behavior that leads to chronic dieting.
How do we break that cycle?
It’s both easy and hard.
It requires turning to a type of eating called intuitive or mindful that focuses on listening to the body, to what it needs and what it wants, listening to the emotions that so often control us and taking everything in without judgement.
From there, we make food choices. We don’t count macros. We just listen and lovingly try to make each meal and food choice about HEALTH and NOT about weight.
That sounds too easy for most restrained eaters. They want to track, count, weigh, obsess and ruminate. I’ve been there too.
But the truth is, it sounds too easy because it actually is really, really hard.
A restrained eater is often not as self-aware or in touch with themselves as they think they are. They don’t know how to navigate health without a map of good and bad foods to guide them. The vast world of food choices is scary and they are afraid, above all, of gaining weight or staying in one place.
But it does represent a way out. Still restrained? Sure. No one’s recommending you binge on twinkies. That’s not the point. A mindful body will rarely ask for twinkies.
But if it does ask for chocolate sometimes or an apple? Or even *gasp*, a potato? A mindful eater will eat, without self-judgement. They will also probably choose more fruits and vegetables and crave less fast food.
Want to give it a try? I made a program to help you do just this. It’s called Weight Loss Unlocked and you can find it here.
Either way, I want you to know that I’ve fought this battle and I know how it feels.
I know the pain of those self-judgments and I can tell you I’d rather be the weight I am now, whatever it is, and be this happy and free, than be constantly angry and mean to myself for not being a weight that isn’t right for me.
True diet freedom is never having to be on a diet, even one cleverly disguised as a lifestyle, again.
Do you struggle with restrained eating? How do you overcome these issues?
In recent months, there has been a resurgence of diets I had long thought were old, buried news.
I am speaking specifically of ketosis and of fasting. In ketosis, the goal is to eat so few carbohydrates that the body produces ketones as an alternative fuel source. In fasting, you simply stop eating.
Both of these dietary practices are aimed at reducing insulin and blood sugar levels as much as possible. This is supposed to predispose the body to “fat burning mode.”
These methods appear to actually be helpful to some people. There can be substantial health benefits to both ketosis and fasting for certain groups of the population. People who have very high body fat percentages and are insulin resistant may benefit—at least in terms of their body fat percentages–from fasting. Ketosis may also benefit people who have dysregulated insulin levels, but it also has the unique benefit of being able to help people with certain kinds of cancers and neurological conditions. I do not deny the potential potency of either of these diets, given the right clinical needs and application.
(You can read more about the physiology of ketosis in this post here.)
But I would here like to address the concept of freedom.
I have recently heard people call bboth fasting and ketosis “freedom.” You can read a post about it and fasting, here, or a whole book on ketosis and freedom, called Keto Freedom, here.
I do not mean to detract from the worthiness of each of these people and what potential they have to offer many people. But I do wish to shed some light on this whole “freedom” thing.
Two ways to define freedom
There are, so far as I can best tell from my philosophical training, two primary ways to define freedom. One is as freedom from something; the other is as freedom to do something.
Freedom from something is what we find most common in discourse about restrictive diets.
In talk about ketosis, fasting, and other kinds of dietary (including paleo) freedom, advocates walk around talking about how great their freedom is. People are sometimes confused. The word “freedom” is very appealing. Yet what kind of freedom are the gurus talking about? When pressed, they typically that their diets enable them to achieve freedom from some symptom. (Sometimes they say the diets provide freedom from negative body image or disordered eating, which while not impossible is also kind of ludicrous.)
Ketosis is “freedom from blood sugar swings.” Intermittent fasting is “freedom from obesity.” Paleo is “freedom from gut distress” or etc.
These are all important points. It is great to finally be liberated from health concerns that have dogged you your entire life. I know this quite well, as I have suffered from many chronic symptoms such as generalized anxiety disorder, insomnia, acne, PCOS, and migraines throughout the course of my life.
But this concept of freedom is actually not the most popular one. It’s not the one that makes immediate sense to people.
The most popular idea of freedom is the one in which we have degrees of freedom with which to act. For example, most people intuitively understand that people in the USA have more freedom than people in North Korea. People who are not incarcerated have more freedom than those who are. People who have so much money they don’t have to work are more free than those chained to minimum wage 9-5 jobs. This is because they have more options and abilities due to their circumstances. They are more free.
If we analyze diets in terms of this kind of freedom, we come up with a spectrum. On one end – the most free end – people eat whatever they want, whenever they want. On the other far end are highly restrictive diets, ones that require a lot of control and very few options.
I would argue that there is almost nothing less free than ceasing to eat for several days or periods at a time, as is what people do when they fast.
Perhaps worse, and more importantly, there is almost nothing less free than ketosis. There is almost nothing less free than having to pee on a stick to determine if your diet is “pure” enough.
Any time you go on a diet, and deliberately restrict the kinds of food you can eat, you limit your freedom.
If you give yourself a rule that you cannot break, you limit your freedom.
If you give yourself a set of acceptable foods and feel guilty if you eat outside of it, you limit your freedom.
If you struggle at all with your body image, your self love, your sense of self worth, or your love and forgiveness for yourself as a result of the diet you’re on, you limit your freedom.
Yes, I believe there are psychologically healthy ways to limit the food groups you eat. Yes, I think focusing on whole, natural foods is probably best for health. Yes, I do think certain health conditions such as leukemia and neurodegenerative disease (both possibly helped by ketosis) can call for severe measures. Yes, I do think weight loss is an acceptable goal given that it is done well on both physical and psychological levels (as I attempt to do here).
But I do not think we should ever make the mistake of calling a diet freedom – unless of course we are very clear from the outset that it is freedom from, not freedom for. To call a diet “freedom” is to do psychological health and real honest-to-god freedom a serious disservice.
If you seek any of these things:
Overcoming an obsession with food
Then I would never recommend a set of diet rules – and again, especially one where you can’t eat for days or one where you have to pee on a stick — to help you.
I would recommend instead doing the hard, psychological work of sitting down with a friend, a therapist, or a pen and paper and digging deep into your heart. I would recommend discovering and deconstructing the demons that haunt you. I would recommend learning to embrace body fat as a natural part of what it means to be a human being – of what it means to be an animal – of what it means to be you, in your skin, nourishing your body the best way you know how.
Ketosis and fasting may be many things. They may even liberate you from serious health conditions. But if we want to have an honest discussion about what these kinds of diets can do for us, we need to stop calling them “freedom.” They are pretty much anything but.
If you’ve done any searching on my website you have probably learned a lot about your PCOS and how to try to heal its many underlying causes and symptoms.
You may have even purchased my helpful e-book, PCOS Unlocked (find it here).
But I have a fear for you, my readers, that I feel its important to point out.
You need a doctor.
Here me out, because I know that in the natural health world, it’s pretty common practice to think you’ve got all the tools at your fingertips, that food is your medicine, and you don’t need anything else.
That given time, your body will heal itself.
I don’t mean to be pessimistic, of course. I DO believe that food is medicine and that there is much that can be done for PCOS with nutrition and lifestyle alone.
But that doesn’t mean that those who follow those nutritional rules to the letter will succeed in eliminating the condition.
And MOST importantly, that doesn’t mean you don’t need to be followed by a medical professional.
This has been on my mind lately with the diagnosis of endometrial cancer in a friend.
She did everything right, watched her diet, did her exercise, went off birth control pills.
But her periods didn’t normalize and she didn’t see a doctor and eventually, because she was not ovulating, the lining of her uterus became too thick, turned into complex hyperplasia with atypia and eventually developed into early stage cancer.
It’s rare, it’s absolutely uncommon in a woman her age, but according to many doctors, it’s becoming more and more common.
Endometrial cancer used to be considered a cancer of older women, something that would occur during menopause.
But more and more women with PCOS are suffering from it.
There is no ideal situation here. It sucks any way you look at it.
Because what she should have done is gone to her doctor when she didn’t menstruate and the doctor would have prescribed a progesterone pill to induce her to menstruate.
There’s potential issues with those progesterone pills, sure, just like with anything prescribed.
It would have prevented cancer.
So I’m asking you ladies, you know who you are, the ones who are sick of ill-informed doctors and being told to go on birth control.
The ones who are tired of being judged for their weight.
The ones who are sick of the old advice to just lose “10%”.
The ones who are looking to natural health to fill the void of medicine.
I’m asking you to please keep them both.
Do the natural thing, absolutely.
But don’t neglect those important screenings- vaginal ultrasounds and sometimes, endometrial biopsies, that are vital to knowing the state of one’s health.
No matter what we do with our diet, some of us are just going to be facing a higher wall than others and we have to be cautious and careful in that climb.
Here’s some of the things that make that wall so high:
- Having to eat conventional meat with antibiotics and hormones. If you can afford to do so, we recommend meat from Butcher Box (find more info here), or any grass-fed, pastured meat because it is healthier. At the very least, go organic if you can.
- BPA in the environment, the water, and basically everywhere. You can cut some of the BPA you take in by using BPA free products like these, but you can never eliminate it all.
- Being more prone to craving sweets and sugar, even though they are much worse for your health when you have insulin issues and having hyperinsulinemia, which most women with PCOS do, in which you produce excessive insulin in relation to the food you eat. There are several supplements that can increase insulin sensitivity like L-carnitine (find more information here), inositol (find it here), and others, but none can fully solve the underlying problem.
- Being overweight and inflamed or being normal weight and inflamed. Carrying excess weight in the stomach produces inflammation, no way around it, and that inflammation harms the whole body.
- Having poor gut health, bowel irregularities, or digestive illness. Here’s my post about having a healthy gut.
That means trying our best, but also listening to the advice of a good doctor. It’s a TEAM effort.
My friend found a wonderful OBGYN who is super knowledgeable and informed, but there are great reproductive endocrinologists and even primary care providers out there.
By all means, shop around! Find a doctor that stays up to date on PCOS research, that specializes in PCOS, or at least one who recognizes the important role diet plays in insulin sensitivity.
Find a doctor you are comfortable with, who doesn’t think all supplements and nutrition advice is quack science, and who supports your goals.
But find a doctor.
And see them regularly.
And face your PCOS head on.
The last thing you want to do is bury your head in the sand by eating paleo and thinking everything will just work itself out.
That may happen, but please, don’t take the risk.
Have you learned this valuable lesson? I’d love to hear your stories.