Navigating Disordered Eating During Perimenopause
Warning: Below post references 'eating disorders', which may be triggering to some readers.
This is the 3rd of 4 posts this month related to approaching nutrition without burning yourself out. In post from 2 weeks ago, I talked about the effects of yo-yo dieting and how setting protein goals matters for longevity. This week’s guest post covers disordered eating as it pertains to eating disorders.
All of us have heard of eating disorders, but have you heard of disordered eating? I’m bringing it up again as it is more pervasive than eating disorders, especially in the women over 40 demographic.
For this post, I connected with Teresa Romano, who is a registered dietitian and specializes in eating disorders, disordered eating and women’s health. She has been working with eating disorders/disordered eating since 2015 and obtained her advanced Certified Eating Disorder Dietitian certification (CEDRD) in 2021 from International Association of Eating Disorder Professionals. Below are Teresa’s insights on disordered eating, particularly the impacts on hormones for women going through perimenopause.
Teresa Romano of Teresa Romano Nutrition
NOTE: This is not intended to be medical advice. For any treatments related to your own health, nutrition and fitness, please check with your own medical team.
Disordered Eating can have the same negative health effects as a diagnosed Eating Disorder
Eating disorders are diagnosed using DSM-V criteria, which require a clinical assessment, physical examination, and psychological evaluation by health professionals. The DSM-V specifies criteria for Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, and OSFED (Other specified feeding or eating disorder), focusing on behaviors, psychological patterns, and physical symptoms. Diagnosis involves a comprehensive assessment from a healthcare professional, often a primary care physician, psychologist, or psychiatrist.
Disordered eating refers to a large range of irregular eating patterns that can negatively impact physical and psychological health. This may include patterns of meal skipping, compulsive eating, and/or restricting certain foods.. Disordered eating falls somewhere between normal eating and eating disorder. Disordered eating doesn't meet DSM-V criteria but still poses health risks. It can lead to nutrient deficiencies, muscle loss, and decreased bone density, impacting overall health and longevity. Disordered eating always holds the potential for developing into a diagnosable eating disorder.
The treatment for disordered eating mirrors that for eating disorders, aiming to reduce anxiety about food and body image. It emphasizes consistent, balanced meals and snacks, including breakfast, and maintaining a proper balance of all the major food groups. .
Normalization of food interactions is key, ensuring all foods are consumed with consistency and in moderation. We are looking to restore a healthy or normal way of eating. Nutrition treatment approaches discourage irregular eating such as breaking the cycle between restrictive or other compensatory behaviors leading to compulsive eating or a feeling of loss of control around food followed by subsequent guilt and promises of “being better tomorrow.”
Intermittent Fasting and Perimenopause
Intermittent fasting has become mainstream but can lead to irregular or disordered eating problems like a "good or bad" diet mindset. It can promote under-eating, triggering biological hunger, resulting in subsequent binge eating due to loss of control during unrestricted eating windows.
We might feel “good” when following the restriction just to feel “bad” when our biological hunger takes hold. This approach may not lead to weight loss and could worsen disordered eating due to the guilt associated with chronic dieting or “failing” the diet.
“In the clientele that I’ve seen. I don’t see a lot of people who can do intermittent fasting successfully.”
Intermittent fasting has become a popular approach to weight management and health improvement in recent years. Many people swear by its benefits, ranging from weight loss to improved metabolic health. However, when it comes to menopause, the story is a bit more complicated. Menopause brings about a unique set of physiological changes that can make intermittent fasting less effective and potentially even harmful.
Intermittent fasting can exacerbate this imbalance, as it can lead to further fluctuations in insulin and cortisol levels. Elevated cortisol, the stress hormone, can increase blood glucose and disrupt sleep, compounding the already challenging symptoms of menopause. Fluctuating estrogen levels during menopause can lead to insulin resistance, increasing the risk of type 2 diabetes. Intermittent fasting can cause significant swings in blood sugar levels, which might exacerbate insulin resistance and make blood sugar management more difficult.
For individuals, especially in perimenopause, intermittent fasting can exacerbate stress on hormones and increase cortisol levels. Given these risks, my recommendation is to avoid intermittent fasting to prevent additional hormonal stress and focus on balanced, nutrient-dense meals to support the body through the menopausal transition, ensuring that you remain healthy, energetic, and resilient during this significant life stage.
Supplements are a billion dollar market, especially for perimenopause. If you’re really into supplements, there is typically a prerequisite of being interested in nutrition. Some supplements do make sense depending on the patient’s situation. The ideal is to get nutrition from food first, then through supplementation only if needed based on lab work or medical conditions. Social media makes this very problematic with the “miracle drug” style of marketing promising results while lacking the recommendations for each individual’s specific health concern An example:
Take Inositol. You may go to a reputable website such as Consumer Labs and find a well-rated supplement. But it doesn’t cover what is in peer-reviewed studies. The site won’t cover appropriate dosages for you. Some side effects may be covered but it can’t cover all of the permutations for life-saving prescription medications you may be on (e.g., blood pressure medication, anti-seizure medications, insulin, etc.). Talk to your doctor before taking these.
Ashawagandha is a perfect example. It’s very popular right now and is being recommended by so many influencers. Here’s the thing–it’s a stimulating herb. If you are someone who is high energy, it’s probably not going to give you the benefits you’re looking for.
The Difference Between Diets and Approaches That Are Culturally-/Ethically-Based
Keto! Vegan! Pescetarian! Vegetarian! Weight Watchers Points!
Not all health diets are “healthy”. The common theme with many of these is that people adopt the mindset of “I can eat whatever I want as long as it follows the “diet”” This means they can be abused, if you want to. I see people do low carb Keto with lots of animal meats, which are very nutritious. But You also have to eat a balance of everything that the body needs to function appropriately, including produce and fiber. Otherwise, this style of eating is not sustainable in the long term.
“I had a friend in high school that was vegan and all she ate was Oreos and french fries. She was a vegan, yes. Was it healthy? No.”
In looking at whether something is a diet or a lifestyle, we call it cultural food preferences. Why I call it that is because how you choose to feed yourself could be cultural (e.g., Indian, Kosher), it could be ethical (e.g, vegan, pescetarian) Where it crosses into a diet is the results-focused mentality, particularly if it is centered around a weight loss journey.
More Facts on Disordered Eating
People often overlook the negative health consequences of disordered eating. Despite being less severe than eating disorders, disordered eating can still lead to serious physical and mental health issues. It forms part of a spectrum that ranges from normal eating to clinical eating disorders, carrying risks like snowballing into harder-to-treat conditions as severity increases.
Disordered eating increases the risk of cardiovascular diseases, elevating LDL cholesterol and blood pressure. Coupled with yo-yo dieting, it causes the body to consume its lean muscle instead of fat, leading to a cycle of weight loss and gain. This not only disrupts your relationship with food but also impacts self-perception negatively.
For instance, engaging in strength training while experiencing disordered eating results in the body depleting its own reserves, such as bone or muscle, mirroring the effects seen in malnutrition. This can cause hormonal imbalances, cardiovascular issues, and bone degradation, counteracting any benefits from exercise.
If you’re interested in working with Teresa, you can contact her here. You can also reply to this email and Go Long can connect you.
If you or someone you know is suffering from an eating disorder, here are some resources to check out:
National Eating Disorders Association (NEDA): 1-800-931-2237
National Association of Anorexia Nervosa and Associated Disorders (ANAD): 1-847-831-3438
National Institute of Mental Health (NIMH): 1-866-615-6464
This is not meant to be medical advice. Before starting any program around wellness, you should check with your medical team.
