Ep. 652 Undereating, Fasting, and Bone Density

Cynthia Thurlow (0:02)

Welcome to Everyday Wellness Podcast. I'm your host, nurse practitioner, Cynthia Thurlow. This podcast is designed to educate, empower, and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week, and impact over a million lives.

We are officially back to our regular cadence of Midlife Minutes. This is where I am answering themes and questions by my everyday wellness community. One of my favorite ways that I like to honor the listeners. This will run the gamut from topics related to hormones, perimenopause, menopause, gut health, mental health, everything that you can imagine, even the open door slash empty nest of those of us that are transitioning to being in a different phase of life. And I look forward to the topics we're going to explore. And please know how much I appreciate each and every listener.

Hey there, this is the latest Midlife Minute. And I have to be honest with you, I occasionally get emotional when I read listeners' questions. It makes me feel badly that there are clinicians out there that essentially tell women, you've had a distorted relationship with food and you're just stuck. Like, I'm not going to help you so what they don't feel good. And she's in recovery. So this is going to be a dedicated podcast episode around relative energy deficiency. What's the research on distorted relationships of food or for undernourishing our bodies? And then also fasting because a lot of these questions kind of overlap one another. And so I want to start off with this listener and I'm not going to share her name because I want to be respectful of her personal circumstances. But she mentioned she has a history of distorted eating and no longer gets her cycle. She's young. She's in her thirties. Her neurotransmitter panel was low. She was appropriately started on HRT. So thank goodness someone is on top of the research that's making her feel worse. And was told by her doctor, she's just stuck and just kind of left it there and didn't really provide any assistance. And so we're going to cover these topics. We're going to talk about people that end up having bone related issues, even with being thoughtful. And then there's a lot of fasting related questions, which all kind of feed into the same thing. People that have big appetites and are struggling with, and this is their use of language, big appetites and struggling with fasting. What to do if you're already lean? What breaks a fast? How do you calculate macros in an 8-hour window? And so I just thought this would be a good opportunity to review some of these questions. And again, it, more often than not, there are questions, there's always a few, that really make me emotional because we as clinicians, even if we don't have the answers, we should be referring patients like this to someone who is experienced with someone that's in recovery from eating disorder behavior. I certainly do. And when I was in Northern Virginia, I had a couple clinicians that I would refer out to. I would say, you know, this patient needs you more than they need me. And when they're fully in recovery, then we can revisit working together, but always doing what's right for our patient. But at least this one patient was put on HRT. So the physician acknowledged that she needed to be on hormones. And that is a bravo to that physician. But the other stuff, obviously, we need to work on. Okay. So let's talk about what is red. It's Relative Energy Deficiency Syndrome. We've unpacked it a few times on the podcast. But it's essentially if we are, whether it's done purposefully or not, if we are exercising too much, not eating enough food, and how that chronic low energy availability suppresses our hypothalamus, pituitary, ovarian axis, because our bodies are exquisitely attuned to whether or not we are eating or eating enough. And this is where sometimes that fasting culture can intersect with us. I think there are absolutely women out there that through no fault of their own, they are just under eating and they don't even realize they're doing it, because maybe they feel good when they're eating less often. I certainly felt good fasting for a long time, and then I realized I was not fueling my body enough to be able to build muscle, and that's a whole separate conversation that I've talked about multiple times on the podcast. With that being said, I also think there is a small subset of women that do still have a latent eating disorder that just don't eat, and they hide it under the guise of intermittent fasting. That is without question. There's a lot of it. There are a few people on social media that I know for sure just don't eat, and they tell people they're fasting, they do OMAD, and clearly they're malnourished, they look emaciated and incredibly frail, and clearly they're just not eating.