Wagons, Wheels and Eating Disorders

This post is a little past its shelf life, but I figured I'd publish it up anyway.  On the tail of Angelo Coppola's remarks on Jimmy Moore's 10 Things Paleo needs to address so I can continue scamming off of "paleo" post -- blogged on here -- Emily Deans over at Evolutionary Psychiatry picked up on another aspect of Angelo's remarks.  If you missed it, the first post was Orthorexia in the Paleo/Primal Community, and she followed up with Orthorexia in the Paleo/Primal Community: Further Considerations.  If I have one general criticism it is that I'm not entirely sure Angelo was talking about orthorexia when he listed "Recognizing and addressing eating disorders among those who are trying Paleo approaches" among his suggestions countering Jimmy's.

So while they are excellent posts, I fear the focus on the more controversial orthorexia overshadows what I see/saw quite frequently -- the development of binge eating disorders.  I'm not so worried about the orthorexics so long as they don't sanctimoniously lecture me about my supposed addictions and failings or inflict their diets and dogma too stringently on their children.  And even those who do, hopefully there are people in real life looking out for those kids, because the internet really isn't the forum to discuss such matters constructively.  No, I'm more concerned for those who previously ate "normally" who now binge frequently and seek assistance breaking the cycle.  It's the people continually falling off the wagon or having the wheels coming off their wagons, hence the title of this post, that I think of when someone mentions the lack of attention to ED in the community.  Whether or not this is what Angelo was referring to or it was orthorexia I don't know.  Both need to be addressed, IMO, but when I hear "eating disorders" I can't help but think bulimia and to a lesser extent anorexia in the Incestral Health Community.  (I won't address anorexis in the remainder of this post, except to say there are some fairly prominent folks in the IHC who may possibly be.  Also, for some reason paleo seems to attract a cadre of recovering anorexics whose specific needs possibly tenuous states are often ignored when blanket advice is being doled out.)


This is all complicated by the fact that there are some genuinely sick people out there who need to remove the "sickening" agents from their diets.  These people often do not have weight issues and are looking to heal.   So they have gone on various diets that include some of those agents ... perhaps many times before and then they discover paleo.  In comments on her second post, Emily seems to have decided the days of low carb paleo are over and irrelevant to the topic of orthorexia  (how I'm not sure, since Angelo's comments were, after all, made on Jimmy Moore's blog but ...).    However many high profile gurus come out in favor of more carb consumption, you still have Mark Sisson's Insidious Carbohydrate Curve out there on the most visited website in the IHC.  Throw in his seemingly arbitrary pronouncements on what is or is not primal (I say seemingly, because for the most part the line is still drawn at carb content, but mostly it's his whim) and it can be a recipe for disaster.   Some of these who are drawn to the IHC to heal, seem to develop what I'll call BLD (bulimia-like disorders) as they find themselves obsessing over their food intake like never before with increasing desire/compulsion to "purge" when they go astray.  I use BLD, because the "classic" bulimic (postprandial emesis -- howzzat for a sciencey term ;-)  ) is but one manifestation of the mindset that includes fasts, detoxes, strict protocols, etc. designed to rid the system of the sins of the indulgence and get the person back on the wagon to the land of Puritopia. This is not much different than what the classic bulimic goes through on shorter time scale with more aggressive means.

Yet caught up with those with true issues are various folks who were just a tad unhealthy.  They get swept up by the success stories and begin to believe that they, too, must have X-osis or whatever the health cause du jour is.  Throw in a hefty dose of those with weight issues who do lose some weight and feel better as a result, now presuming that they, too, must have been suffering from X-osis for decades and dedicate their lives to spread the word on the evilz of X and glories of paleo.  However as the excitement of weight loss wears off, etc. some little ailments seem to reappear.  Were they ever gone?  More importantly, are they due to having a slice of bread a couple times a week, or slacking off on your morning walks because Rover seems to enjoy shorter potty runs.

At this point, you don't really hear Mark Sisson's 80:20 rule/message cautioning against perfectionism.  This is actually a very lax rule, and, frankly, allows for almost an entire week out of every month of non-primal debauchery.  He wrote it, but he rarely mentions it, and the primal paleo bloggers who pick up Grok's torch and run with it almost never do either.  Further you read how one dinner roll derailed Grokarina Gurette's quest for immortality and vow never to "go there" ... or go there again.  The whole notion of moderation is impossible in the paleo world, even if you preach the 80:20 word, or whatever you want to call it.  Put simply:

You cannot hand down decrees from on high that demonize some food item/type/class/macro and scare the bejeebers out of people, and then say it's OK to indulge in said poisonous agent here and there, it won't kill you. 

That message is contradictory.  I mean take Lustig who asserts that fructose is a poison.  We have no use for it.  It's metabolized just like alcohol so there's no difference between them, which inspired this meme I came across (no, not my doing).  Eenfeldt is so steeped in his dogma, he didn't get it as he featured it on his blog!

Now we have to couple with calorie denialism.  Whether it's micronutrient deficiencies or food intolerances or bacteria gone wild or hormonal mahem or greedy renegade fat cells or too much of the demon nutrient ... many of the purveyors of the way out of the "trap" will vehemently deny the role calories play in weight.  On first blush these purveyors are like saviors.  No doubt calorie obsessiveness has triggered eating disorders in many.  A very low calorie diet was my ticket, but so too can be restriction of carbs, or favorite foods, etc.  Calorie counting certainly can become obsessive and rise to disordered standards, but I'm beginning to think that irrational fear of calorie counting might well be a more insidious eating disorder!!

Where weight loss is concerned, here is where I am so passionate about sharing the scientific truths behind the myths peddled to convince people that it is the carbs, O6's, fructose, toxins, wheat, etc.etc. that made them fat and if only they just cut that from their diet, they'll be magically thin.  Because if obsessing over something so easily quantified as calories can lead to problems, obsessing over mysterious metabolic mayhems -- most of which cannot be readily measured on any sort of accessible fashion -- sure can breed a new class of eating disorders.  But not only do you end up with weight gain anxiety, you can add a whole lot of health anxieties on top of that!

The low carb diet is an interesting case, because as I have discussed here before the original Atkins book was almost all about the calories.  The claim was that you peed out thousands of calories in ketones, thus why one bite of mashed potatoes could undo all your ketotic diligence for days.  This is why so many never really make it out of induction, especially those who peed with bated breath on that ketostick.  All was lost if you fell out of ketosis.   Now I was a lucky one in that LC didn't trigger carb binges and whatnot, but the "science" behind Atkins at that time made it an all or nothing deal -- if you weren't in ketosis there really wasn't a point, and if you have some carbs you might as well just eat "normally".  What I see in the LC forums is too many who have some carbs and then go face down into the plate of pasta or ice cream because they've "fallen off the wagon".  They then berate themselves for giving into their addictions and go back to induction.

We see this repeated throughout the IHC.  If you decide to eat a normal Thanksgiving dinner, many will look down on you for not heeding all of their sage advice and follow the recipes and meal plans they've so thoughtfully laid out for you.  If you survive the sanctimony and eat it anyway, you are then bombarded by fellow sinners who feel they must cleanse their systems to repent.  But how about this? Just eat however you normally eat when you're hungry the next day?  There is no easier way to induce disordered eating than to overcompensate for an indulgence with a "cleanse", fast, etc.

But it seems the overwhelming majority of gurus in this community will have none of that.  For some, the very notion of "cheating" is a sign of your weak moral character.  The worst of this is this crap about feeding one's carb addiction -- implying we all are addicted and in denial of said addiction if we choose to consume the addictive agent.  Sigh.  I cannot overstate how utterly irresponsible this kind of diet advice is if these people really want to help people achieve lasting weight loss maintained in non-neurotic fashion.  Because atop all of the fears of fattening, the gurus of the IHC have piled on fear of this or that toxin or  agent of inflammation, etc.  Nora Gedgaudas sees no reason to ever eat a carbohydrate, if it's poison then why eat just a little, or "gasp" in moderation!  I'm not sure who is worse, her or Rosedale, but I've seen L.Ron state he does eat a small nibble of bread from time to time but he actually considers that it will shorten his life before doing so.  Couple this with the "allowed" foods on various IHC plans that are consumed in excess for that very reason.  Stacy of Paleo Parents brought that up in comments on her Metabolically Broken post.  Jimmy Moore is adamant that his body can't tolerate fruit while nowadays he consumes 2-3 oz regular (sucrose sweetened) dark chocolate most days.  Ever notice how much coffee some of these people drink (and I'm not casting stones, I am a coffee drinker myself)??    Many of these people think the Buttertons were paleo!   Cheaters and sinners are now living in fear that they will become diabetic ... dropping out of pee-stick ketosis is so passe.

Now let's mix in the hefty dose of those for whom the dietary prescriptions du jour are not working but who are now so utterly petrified of eating food they don't know where to turn, and is it any wonder that sites like Paleo Hacks are rife with posts begging for help to "stay on the wagon"??   Many of those questions disappeared from PH.  During my years at Jimmy's forum and perusing other LC forums the number of folks who fell off, came back, did induction, lasted 3-4 days, "blew it" then rededicated anew again and again was astounding.  If you dared suggest to such people an approach other than fewer and fewer carbs and more and more restriction of allowed foods, the shout down was  harsh.

Which brings me to comment once again about Stefani Ruper of Paleoforwomen.  If I hear eating disorders and paleo, she is name number one that comes to mind.  There are some others that come to mind, like two prominent examples of nuttyK experimenters, but this really was Ruper's schtick before her popularity ballooned artificially thanks to the bizarro paleo world.  It is truly disturbing that people like Stefani are counseling people on eatind when they are clearly still suffering themselves.  Emily Deans seems to think that Stefani's work on fasting outweighs this, because she got the dialog started.  Really?  First of all, a keyed in to the buzz in this community as I am, I was unaware of her post criticizing Mark Sisson until quite a while afterwards from her FTA guest post.  It was a lightly referenced piece on gender differences.  Important?  Sure.   But I know that Martin Berkhan of leangains.com -- the IF guru -- had addressed gender differences years ago and uses a 12 hour window for women, which is hardly much of a true fast.  But how about IF vs. periodic fasting, vs. occasional random fasting?

But how about the prevalence of fasting in a community with many eating disordered people?  I recall someone on a LC forum insisting that IF was not calorie restriction and how this person literally shoveled food in during the eating window like the Cookie Monster.   There would always be people who could not adapt to the IF and would end up binging.  Then there was Jimmy Moore's infamous 6 day fast.  While there is certainly a place for fasting (I'll cover the other side of this coin in another post, e.g. needless fear-mongering over fasting and/or losing weight too fast, etc.) I have always found its prevalence in a community almost anti-obsessed with any sort of structured eating or attempt at portion control to be odd.

This has been a ramble, more than usual, which is why it's sat in pieces in the bin for a bit.  But I do wish Angelo's words had been heard regarding eating disorders in general.  Eating real, whole, nutritious foods in no way guarantees effortless weight loss, and when it doesn't happen, you see ever more stringent protocols.  This coupled with fasting and all of these various cleanses -- especially when suggested to "undo" all of that damage from one's indulgences -- and you've got a recipe for eating disorders.

Before I go, I'm going to call out Robb Wolf and Chris Kresser for their Paleologix supplements that are really designed to assist the transition to VLC HF paleo.  If someone  develops cravings for carbohydrates when they "go paleo" this is a problem!  Eat some carbs.  There are people who cannot get past the Atkins flu.   I say these people should probably not be on a low carb diet, or if they think they must be, a cold turkey "induction" style approach is not for them.  But no, you just need some (overpriced) supplements to help you with that transition.  Whether it's their's or some other supplement if it doesn't work, you need more.  Or you are even more broken, obviously, than we previously thought.  You need more and more supplements.  There are folks who take a boatload of supplements to support their way of eating.  I think this at least deserves more attention than it   gets as well.

Lastly, because I'm sure someone will take objection.  Following a necessary therapeutic diet is not an eating disorder.  Following one when you don't need to may be, however.  And insisting that all others should follow it or that it is the healthiest diet for all, is irresponsible and can contribute to others adopting diets that lead them down the path of eating disorders.