EATING DISORDERS EXPLAINED: HOW BRAIN STARVATION CHANGES EVERYTHING
By Dr Warren Ward and Lexi Crouch
When people ‘catch’ pneumonia or the common cold or Covid, we don’t blame them. We realise there is something ‘out there’ that has infected them and, once they are infected, their body changes in response to the trigger that caused it. And, of course, treatment is provided to neutralise the cause so they can get better. Although it’s not generally known in the wider community – or among health professionals, for that matter – people who work in the eating disorder sector know what causes eating disorders, and what causes people to catch them.
Simply, eating disorders are caused by brain starvation. Inadequate brain nutrition can tip some people into an anorexic mode, where their brain starts to obsess about food, weight, calories, exercise, thigh gap and umpteen other things until they get to the point where they can hardly eat anything. In other people, brain starvation leads to the vicious cycles of bingeing (and, in some cases, purging) that we see in binge eating disorder and bulimia nervosa.
Inadequate brain nutrition – and therefore eating disorders – can be caused by many things. We have seen eating disorders triggered by unintentional weight loss due to medical illness, mouth ulcers, medications, grief and many other causes. But by far the most common cause of brain starvation is dieting. Dieting is rife in our culture, as is the pressure to shape our bodies into an unreachable ideal. This is especially true for women and adolescents.
If you have two daughters and one goes on a severe diet, she is five to 18 times more likely than her sister to develop anorexia nervosa. If you are a teenager and engage in weight-control practices (i.e. dieting), you are more likely to become overweight or obese in subsequent years than a peer who doesn’t engage in such practices, regardless of your initial weight.
So, although we think of eating disorders as causing dieting, the truth is it’s the other way around: dieting causes eating disorders.
Many of the risk factors for eating disorders are those that, in our culture, make you more likely to diet. These include:
being female;
growing up in a larger body;
being teased or bullied;
being exposed to the media, especially social media; and
being involved in certain occupations, such as
gymnastics, ballet, acting or modelling.
Just as we know the pneumococcus bacterium causes pneumonia, we know that brain starvation causes eating disorders. But you might be thinking this analogy between pneumonia and eating disorders doesn’t really work because not everyone who goes on a diet ‘catches’ an eating disorder. You are absolutely correct. While pneumococci and dieting are both dangerous, not everyone succumbs. Many people who are exposed to pneumococci don’t catch pneumonia, but many perfectly healthy people do, and many perfectly healthy people catch eating disorders if they are exposed to dieting.
To extend the analogy, there are some people who are particularly vulnerable to the pneumococcus, to whom it could do particular damage: the elderly, the immuno- compromised, those with pre-existing lung conditions.
So who is more vulnerable to catching eating disorders?
The role of personality
Eating disorders are more likely to develop in conscientious, perfectionistic, driven people. As a society, we tend to look up to people with these types of personalities. They often end up becoming our doctors, lawyers, sports stars and business leaders. But the brains of these high achievers are more vulnerable, it seems, to the cognitive rigidity caused by dieting.
Personality type is highly determined by one’s genetic make-up. The largest study ever done into the genetics of eating disorders found that people with the genes associated with ‘high educational attainment’ were more likely to develop an eating disorder. Which helps to explain why so many people presenting to our clinics have parents who are doctors, lawyers, engineers or other high-achieving professionals, managers or academics.
When we reveal this ‘risk factor’ to audiences of doctors and other health professionals, it never fails to generate nervous laughter; the laughter of recognition.
Another risk factor for eating disorders is having an early childhood marred by trauma, neglect or less-than- ideal attachments. Most of our skills in managing emotions are developed in the first five years of life, and we develop these skills by internalising the soothing behaviours of our caregivers. If we miss out on that, we are more likely to experience intense negative emotions as adults, and to have trouble soothing ourselves. Some of us achieve that self-soothing by adopting eating disorder behaviours such as fasting, bingeing, purging, counting and compulsive checking.
Our toxic culture
The sad truth is that, in modern society, people of all personalities and backgrounds can catch an eating disorder. The toxicity of our weight-obsessed, capitalistic culture has contributed to an explosion in eating disorders, and recovery depends, in part, on how well a person can question and repudiate aspects of this culture and find their own true north.
The most harmful aspects of our culture include our obsessions with thinness, dieting and individual achievement, and the ‘junk’ food and weight-loss industries.
Our obsession with thinness
The ideal ‘look’ for female actors, models and celebrities, as portrayed in magazines, on screen and in social media, could be described as pre-pubertal. Research has shown that as girls go through puberty, body satisfaction plummets.
The natural deposits of fat that appear on the abdomen, thighs and other parts of the body with the arrival of puberty are not in keeping with this thin ideal. Other studies show that 60 per cent of women reporting to infertility clinics with absent or irregular periods are infertile because they are not eating enough in an effort to appear ‘healthily thin’, which, of course, is not healthy at all. The idealisation of the pre-pubertal look is not limited to teenagers and young women.
Even after giving birth, women today feel extra- ordinary pressure to return to a lean, pre-pubertal look.
In our current society, thinness represents attractiveness, success, virtuous restraint and good health. The low weight many of us associate with good health is associated not just with infertility and a starved brain, but with a shorter life span.
Our obsession with diets
We have seen serious eating disorders develop from all the following diets that deprive the brain of much-needed energy or carbohydrate: carb-free, dairy-free, Paleo, Atkins, intermittent fasting, 5:2 diet and clean eating, not to mention the unscientific liver cleansing and other detox diets. Veganism, while morally laudable, often leads to well-intentioned young people developing serious eating disorders, as not all new vegans know how to ensure their bodies and brains get adequate fuel.
We have worked with scores of dietitians in the eating disorder sector, and none of these dietitians – who are extensively trained in nutrition science – would ever recommend any of the above diets due to the high risk of inadvertently causing brain starvation, and consequent eating disorders. It’s interesting to note that these types of diets are rarely developed by dietitians; many fashionable exhortations to fast or cut out major food groups are promoted by self- styled gurus with no understanding of the risks of brain starvation and its role in causing eating disorders.
Our obsession with individual achievement
As we have heard, eating disorders, and anorexia nervosa in particular, occur much more frequently in elite athletes, PhD graduates and other ‘high-functioning’ individuals.
Our current culture, to some extent, encourages healthy exercise, but it also increasingly promotes the grim, grinding, miserable extremes of compulsive movement that we would label as ‘torturecise’: boot camps, F45 training, hot yoga, gym culture (including 24-hour gyms), ultra-marathons and some overly zealous personal trainers. These cultural trends undoubtedly have some benefits, but the overwhelming focus on diets and exercise has definitely led to significant numbers of vulnerable people getting into the serious difficulties that can be associated with undernutrition of the brain and body.
The weight-loss industry
Big weight-loss companies get a lot of return customers. That is because, as the research has repeatedly shown, diets don’t work. They might result in short-term weight loss, but in nearly all cases this weight will be regained. The physiological reasons for this are well understood.
When a diet fails to result in sustained weight loss, we tend to think of ourselves as failing as individuals, but the failure is caused by the dieting, and by the people who provide scientifically unsupported advice. Health practitioners themselves are often the worst culprits in this regard. Sure, the evidence shows that very high weights can be associated with poor health outcomes, but the science also shows that dieting does not result in sustained weight loss or good health outcomes. And diets can and do cause severe, life-threatening eating disorders.
This is an edited extract from Renourish by Dr Warren Ward and Lexi Crouch (Macmillan Australia, RRP $36.99)
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