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Do I have an eating disorder without knowing it? Disordered eating, fatigue, and irregular periods (hypothalamic amenorrhea)

Do I have an eating disorder, theenergyblueprint.comOne of the biggest keys to health and high energy levels is nutrition. Your energy levels are hugely influenced by the foods that you put into your mouth. Unfortunately, in the pursuit of health, many people get sucked into the trap of “diet myopia — of constantly trying to fix or improve their health with increasingly extreme diets and increasingly long lists of “bad foods” and shorter lists of “good foods.” And in the process, many people develop obsessiveness, unhealthy behaviors, or neuroticism around their diet or food choices, and even develop phobias of many types of food. This situation is not harmless — the stress and anxiety that this type of relationship to food causes is itself counterproductive to good health. People can end up worsening their health in the long run. And what makes things worse is that this whole process is insidious — it may even happen on a diet that initially made you feel better, and then, without you being aware, it slowly starts to become harmful. People become reactive and intolerant to many foods, their gut microbiome diversity is harmed by the strictness of the diet, and people end up creating nocebo effects (like placebo effects, but harmful instead of helpful) due to their food phobias. For some people, it spirals out of control into a full blown eating disorder. And it doesn’t end there. People who are struggling with eating disorders (or disordered eating) are often also suffering from symptoms like fatigue, withdrawal from social activities, food obsession, and anxiety. And for women it is one of the main causes of irregular periods (also known as hypothalamic amenorrhea). What does that mean for you? Could it be that you have an eating disorder without knowing it? Or maybe you just have “disordered eating” habits? What are the effects of these disordered eating habits on your health and day-to-day life? But the most important question is, how can you develop healthy eating habits, heal your relationship with food and heal your energy levels?

This week, I am talking to nutritionist Chris Sandel, the owner of a company called 7 Health. He’s a UK nutritionist and he uses a very special, very unique, non-diet approach to help people resolve their unhealthy eating habits. His primary focus is body image and the relationship with food, and he has a deep interest and a passion for the psychology of eating and helping people to overcome food phobias and disordered eating habits. (Also, I should mention that while I agree with most of what Chris says, there are some small points of disagreement — so as you listen, please also notice some subtle areas of disagreement between he and I, especially in relationship to definitions of “normal” vs. “abnormal” eating habits.)

Listen in, as we discuss how your relationship with food can impact your life and, more importantly, how you can heal your relationship with food. It’s a wonderful podcast, and Chris shares lots of wisdom on this topic!

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Do I have an eating disorder without knowing it? Disordered eating, fatigue, and irregular periods (hypothalamic amenorrhea) with Chris Sandel – Transcript

Ari Whitten: Hey, everyone. Welcome back to the Energy Blueprint podcast. I’m Ari Whitten and today I am with my friend Chris Sandel, who is the owner of a company called 7 Health. He’s a UK nutritionist and he uses a very special, very unique, non-diet approach to help people resolve their relationship with food. That’s really his primary focus is body image, relationship with food, so he has a deep interest and a passion for the psychology of eating and helping people to overcome food phobias and disordered eating habits and so on. He’s become a personal friend of mine over the last few years. It’s a pleasure to finally have you on the podcast, Chris.

Chris Sandel: Cheers, Ari. Well, yeah, you’ve been on my podcast twice over the last couple years, so yeah, it’s good to be on yours.

Ari Whitten: Yeah, great to have you. You have a particular kind of client that tends to seek you out and I would love if you could talk a bit about what kind of client tends to come your way and what kind of work you do with people.

Chris Sandel: Okay. I guess part of the reason I have the kinds of clients that seek me out is now more because of the writing and the content I put out. Initially, I kind of stumbled into what I’m doing now, but found that I really liked this kind of work and then started writing about it and digging more into the research around it and reading more books, etc.

Often, the people who are seeking me out are yo-yo dieters, so people who’ve been on diets their whole life or are one diet, they fail, then they start another one, etc. People with eating disorders, although with eating disorders, I’m very careful with who I can work within that capacity and people who need to have other support or they’re further along, but definitely people on the disordered eating spectrum. We can chat about what those different terms mean.

I also work a lot with fertility issues, particularly around hypothalamic amenorrhea, which is, again, something we can chat about, but people losing their period. Then thyroid issues and low metabolism issues and really the thing that connects all of this is an obsessive relationship with food or an obsessive relationship with exercise. Again, these things happen on a spectrum, but yeah, people just having an unhealthy relationship with food, often that started out as a pursuit of health. They started out trying to do all the healthy things and thought this would lead to better health. Then the thing just spirals and they find that they’re in not a great way. That’s typically the people who are finding their way into my practice.

Disordered eating vs eating disorder

Ari Whitten: Yeah, absolutely. Now, I think this is such an important issue. I see this all the time of people who have started out this journey towards health. A lot of people start off in this position of kind of total lack of awareness, total lack of consciousness around food choices and the relationship of food and health to this sort of hyper-awareness and hyper-consciousness and neuroticism and phobias. Then you end up creating so much harm and it becomes counterproductive because you’re so obsessed with all these different things. A couple things you mentioned there, disordered eating habits and eating disorders. What are these terms? What do they mean?

Chris Sandel: With an eating disorder, this is something that is clinically diagnosed. There’s a book called the DSM, so Diagnostic and Statistical Manual of mental disorders. They’re up to edition five now. This is what psychologists and psychiatrists use to diagnose a condition for someone. Within this book, you can then be diagnosed with anorexia nervosa or bulimia nervosa or a binge eating disorder or rumination disorder and there’s a couple of others. The thing is with them is there’s a checklist that someone has to go through to meet that diagnosis. For example, if you have anorexia nervosa, you could have all of the characteristics of it, but if you’re an adult and your BMI is not below I think the cutoff is 17.5, 18, somewhere around that, you’re not going to receive that diagnosis. You could be doing the same restriction. You could have the same problems, but because your BMI is higher, you’re not going to receive that diagnosis. This is the same with all of the different types of eating disorders. You have to tick many boxes.

What has then sprung up is another term, which is disordered eating or the disordered eating spectrum. This really just encapsulates everything else that doesn’t fall into those specific categories within the DSM. It can be someone who has a little bit of binge eating disorder and a little bit of anorexia or it could be someone who has these to lesser degrees so that they’re not making the full checklist, but it’s still having a real impact and having an impact on their health, on their functioning, their sanity, their psychology, etc. when you look at eating disorders in that very narrow band, it is really quite a small percentage. The estimates are somewhere between like 0.2, 0.3% of the population up to around about 3% depending on what you’re looking at. When you then take in disordered eating, it’s anywhere from like 25 to 35% of the population. Again, it depends on how you’re defining that, what studies, but it means that this is a lot more rampant than people realize and it’s a lot more rampant for people who think they’re “healthy”.

Ari Whitten: What’s your sense of how common these are? I know this is tough to answer, but I’m curious if you have any sense of how common it is among people who start off on a journey towards better health who then get pulled down into this spiral, negative spiral of disordered eating habits.

Chris Sandel: It’s hard for me to answer that and the reason is I have a skewed perspective. Pretty much everyone who is ending up in my practice would fall into this category. That’s because of the kinds of things I talk about, the kinds of things I write about, so for me, I’m like it’s really common. I do get the impression just from you know when you’re out and you’re like oh, I’m a nutritionist and then people start asking you questions and from that kind of conversations, I get the impression it’s fairly common. I would say that the 20 to 30% figure is probably about right.

If you’re looking at statistics around dieting, I think the averages are anywhere between 30 and 40% of Americans are dieting at any point. We know that with dieting, typically, that can lead to eating disorders and not everyone who diets ends up with an eating disorder, but basically, everyone with an eating disorder typically started out with some form of diet.

I do think it’s more commonplace than people think and it’s often quite easy to hide these things under what we think about as healthy. Oh, I don’t eat gluten. I’m gluten intolerant or I’m intolerant to this food or I’m vegetarian or I’m vegan. I’m not saying there’s anything wrong with being a vegetarian or being a vegan, but it can be a very easy way of hiding food issues and doing it in a way where people aren’t so up in your grill or questioning why you’re doing certain things or if they are questioning why you’re doing certain things, it’s presented as something that’s really healthy and something that someone else should be looking to you and thinking how good you’re doing.

The extreme diets that serve as tools for disordered eating habits

Ari Whitten: Now, you kind of singled out vegetarianism and veganism. I’m curious if that’s something you find is unique to a vegetarian or vegan diet or if you feel there are lots of other more extreme diets that maybe also can serve as a tool for people to hide their disordered eating habits.

Chris Sandel: Sure. I mentioned those two because a lot of my clients were past vegetarians or vegans and by their own admission that yes, some of it was ethical reasons, but often, it’s a way of being able to further restrict. Basically, any diet that I think is quite restrictive often is like an [inaudible] to people who are more predisposed to this kind of thing. A lot of the clients that I work with have gone low carb or have tried keto or have used intermittent fasting when it became a thing as a way of describing what they were already doing. What they were already doing was just restricting all day, then being uncontrollable around food at night and then being able to say, “Oh, it’s fine. I just intermittently fast.”

How to identify disordered eating habits and eating disorders

Ari Whitten: Right. Interesting. Let’s get practical and you just gave an example there, but I’m curious maybe about some other examples, practical things that people might experience or become aware of as far as what disordered eating habits or an eating disorder actually looks like in terms of someone’s daily behaviors.

Chris Sandel: Okay. Different behaviors and as I said, often, this can be difficult because so many of the behaviors that I’m going to run through now are often normalized and are thought about as healthy things to do and this is what you need to do to have a healthy body or to look a certain way, etc.

Not every one of these things says okay, you’ve got disordered eating or you’ve got an eating disorder. The more of these things that are going on and the more that they’re going on on a regular basis, especially when we start to look at different symptoms that can be occurring, which we can go through, but yeah, the more of this that’s happening, the more it could point towards it.

It would be things like constant and repetitive dieting, regular denial of hunger or fasting or cognitive dietary restraint, having someone’s self-worth be really based on their body shape or their weight and having that be a big factor in their life.

Excessive or compulsive patterns of eating, a lot of body checking, having lists of good foods and bad foods. Often, these lists are very arbitrary, like I know for myself, there are certain foods that I do better on. There are certain foods that I do worse on. People having these really strong good foods and bad foods and often, it’s related to do these things make me put on weight.

Having obsessive rituals around food or food preparation, so insisting that meals have to be at a really specific time or eating your food or your plate in a very particular order. Avoidance of social situations involving food or general social withdrawal or isolation from friends or activities that someone used to really enjoy doing.

Avoidance of eating meals by giving excuses, so as we talked about before like I’m gluten intolerant or I’m vegetarian or I can’t eat that for whatever reason. Then more deceptive behavior around food, so secretly throwing food out or eating foods in secret, that kind of thing. That’s a list. Not everyone ticks all of those boxes, but it gives a bit of an array of different behaviors.

Healthy food habits

Ari Whitten: Got you. I actually want to dig into this point a little bit more because I think it’s worth teasing out some nuances here. I want to start that unpacking process by asking you the reverse of the question that I just asked you which is what do you think a good relationship, a healthy relationship with food looks like in terms of daily behaviors?

Chris Sandel: Okay. I would say having good hunger and satiety cues and being in tune with your hunger and fullness. Being able to eat a meal and then just get on with your life, not it be a big drama, not be thinking about it constantly afterward. Yes, there can be some pre-planning of food, but again, not have that be all-encompassing. I don’t think that there’s anything inherently wrong with vanity, but up unto a point and when someone’s weight and someone’s appearance is the real determiner is a problem, so sort of being okay with that, I think, acceptance in general for lots of things in life. Exercise and being able to exercise and move your body in an enjoyable way, but again, not having that be obsessive where the fact that I missed an exercise routine or I missed a day or I’ve got a cold so I can’t exercise, not having that be completely crippling.

I’m trying to think of other things I would think about. Yeah, being able to go out and eat food freely with friends and being able to enjoy the social interaction part of that and being present, as opposed to being completely in your head for the meal because you’re thinking about the food that’s on your plate or the food that’s going to come or what can I be able to order at this place.

How to balance your healthy relationship with foods

Ari Whitten: Okay. That’s actually a nice entry point into what I want to dig a little deeper into. What I want to get at is that there seems to be a lot of gray area here that is important, I think, for people to navigate. What if, for example, on that last point you mentioned around a social life and totally understandable if you’re a person that’s saying you’re so obsessive about food and neurotic about food that you’re going to not hang out with friends or family because you’re so concerned over what food might be there that it’s just like you’re going to avoid the whole situation and stay at home by yourself. Obviously, that’s a sign of some kind of issue.

On the other end of the spectrum, what if a person says and I know lots of people who will say this like you’re so restrictive that you’re not going to have pizza and ice cream and cake and potato chips and have this burrito from this crappy restaurant. That means you’re too restrictive. You have an eating disorder, when, in fact, there’s an area here where someone just may be conscious of hey, I want to eat food that is from ethically raised sources. I only want to eat grass maybe even for just purely ethical, not even health reasons. I want to eat grass-fed or free-range chicken, grass-fed beef or free-range chicken or I don’t eat … I generally stay away from processed foods like donuts and pizza and ice cream and so on.

Where does one draw the line of … I guess what I’m getting at is a lot of people will justify their indulgences in junk food by saying, “Oh, well, anybody who doesn’t do that is disordered.” What if somebody then has get-togethers with friends three times a week and they have cake and ice cream and donuts and cookies and whatever else. Well, then you’re getting to a point where you are doing things which are going to lead you in a bad direction as far as your health. You are doing things which are going to lead you in a bad direction as far as your body composition and to what degree can you be conscious and mindful of making good decisions without necessarily having an eating disorder or having disordered eating habits?

Chris Sandel: Yeah. Look, I think you raise a good point. The things I would say to that are one, let’s then look at how that’s working out for you in terms of symptoms and we can go through this in a sec of what are the symptoms that are then associated with someone’s eating habits.

I would say the other part of that is looking at someone’s psychology around this because if you’re someone who turns up and everyone’s eating pizza and you’re like you know what? I genuinely don’t care about pizza. I’m going to have something to eat when I get home. You’re still able to be engaged and hang out with those people, then fine, but if you’re sitting there and it’s absolute torture for you and you’re not able to be engaged as well and you’re like oh, I really want the pizza, no, I shouldn’t have the pizza and this is this whole, big thing for you, then maybe it’s a little different.

It is a gray area. I get that. That’s why there’s not normally just one piece of this. It’s looking at okay, what are all of those different things that I mentioned and how much are they coming up and then what are different symptoms that you’re then noticing within your body that could be pointing towards the fact that while you think what I’m doing is healthy, maybe it’s not so healthy because it’s obviously leading to restrictions that are causing certain symptoms within your body.

Ari Whitten: Got you. Yeah, I was just thinking as you were describing that setting. For someone like me, I’m so used to eating healthy foods, making good decisions around food, and I also really enjoy eating healthy, whole foods, generally unprocessed foods. I also will occasionally indulge in certain things here or there. I’m not terribly strict, but I genuinely prefer healthy food and I tend to mostly be indifferent. I’m not the type of person that if there’s somebody eating cookies or donuts or pizza or whatever, I’m not there drooling over it and then forcing myself to deprive myself of this thing that I intensely desire so much. Of course, I also like the taste of donuts and pizza, but it’s not this intense, obsessive thing.

I was just thinking that if you take someone who is currently eating mostly processed junk food and soda and Doritos and whatever else, in that initial stage where if they’re trying to lose weight and you ask them to start eating more whole foods, unprocessed foods and start to limit or eliminate the processed stuff, there might be scenarios where they are sitting next to people eating pizza and intensely desire that. That can mean that there’s this huge, just burning desire to indulge in that and they have to mount this huge force of willpower to resist having that.

Now, over time, as a person practiced this and does this and makes this transition in terms of how they eat, it may eventually get to the indifference that I was describing with myself with where they can be next to people eating pizza and it’s really no big deal at all and they don’t have this intense, burning desire and they don’t have to mount this huge force of willpower to resist. In that initial stage, they might be in that scenario. Now, is that something that we should classify as disordered eating habits or is that something else?

Chris Sandel: Again, I’d be looking at the bigger picture around that. It might not be looking at disordered eating, but okay, let’s talk about your relationship with food. Why is that food so overwhelmingly powerful for you? Is it just the food or is there some other reward that you’re getting from that? What are things that we could do throughout the day in terms of your eating habits? That could mean that when you’re in that setting, that doesn’t have so much of an impact on you.

Yeah, it’s hard to give a specific answer to that. I would be saying I’d be looking at other factors. Look, you are right that during a transition period, it can be more difficult in certain situations, but yeah, for me, I’d be looking more at the bigger picture.

How to identify whether someone has a disordered eating habit

Ari Whitten: Okay. What does that bigger picture look like? What do some of these symptoms look like that cue you into the fact that a person has developed some sort of disordered eating habits?

Chris Sandel: One of the good ways, if I’m talking about this, if you’re aware, I take it, of the Minnesota starvation experiment?

Ari Whitten: Yeah, but maybe lots of listeners aren’t, so it might be good to explain it.

Chris Sandel: Okay. Cool. The Minnesota starvation experiment was conducted between 1944 and 1945. It started out because they were really worried about what was going to happen after the war was over in terms of famine. There was a prediction that large sections of the world were going to be dealing with famine and so they wanted to see what would happen when you starve people and what their reaction is. What they were trying to discover as part of the study was what would be the best foods to put someone on after they’d gone through a starvation.

They did this. It was 36 men, although in the end, the results were only of 32 of them and I’ll explain why some of them dropped out. There was initial control period where they were for 12 weeks fed 3200 calories and that control period was basically to keep them at a stable weight. These were young guys. They’re in good health. Psychologically they’re in good health. That was to just keep them at baseline. Then they had them for 26 weeks basically halve their calories, so it was around 1500, 1600 calories, somewhere in that amount. Then after that, as I said, there was a 12-week period where they looked at what different diets would do in terms of their recovery. Then there was a rehabilitation period of eight weeks where they could eat as much as they wanted and were able to eat whatever foods.

What happened over that 26-week period was on average, the men lost around 25% of their body weight, which worked out at 16-1/2 kilos, 37 pounds, but they had a whole load of symptoms that showed up as part of this. The reason I’m mentioning this is that this is a lot of what happens when people have an eating disorder or disordered eating. I will just add there is no way today that they would be able to do a study like this. The ethics board would not approve it. There’s actually a lot of studies that have been really influential and have given us a lot of insight that they just wouldn’t be able to do today.

Ari Whitten: Right. That’s why we still make reference to this famous starvation experiment study from 70 years ago.

Chris Sandel: Right. The other one was done by Ancel Keys and I know Ancel Keys cops a lot of flak in terms of people saying he didn’t know what he was talking about in terms of fat and cholesterol and all of that. This was something he did prior to all of that and yeah, he wrote … I think the report about this study is in a two-volume book that spans, I don’t know 1000 or 2000 pages. It’s huge. Yeah, getting back to the different symptoms, so the men basal metabolic rate dropped and fell by about 50%.

They had their pulses decreased, so they were looking at somewhere between 30 and 40 beats per minute at rest. They had a real increased sensitivity to cold, so all the men were wearing much heavier clothes, many more layers, had very freezing cold hands and feet, tips of the nose, skin, extremities, and their tolerance for heat really increased. The subjects, the men, could hold really hot plates without discomfort and they asked for their food or their coffee or their tea to be served piping hot. They spent their days lying in the sun just trying to keep warm. Their tea and coffee, the intake of this stuff increased because their satisfaction for it increased because they weren’t eating. When one of the guys, I think, hit 15 cups a day, they then set a nine cup a day limit.

Ari Whitten: 15 cups of tea?

Chris Sandel: Tea or coffee.

Ari Whitten: Okay.

Chris Sandel: They were just trying to … They were also drinking tons of water just to try and get that fullness feeling in their stomach. They were eating lots of gum. I think when one of them hit 40 packets of gum a day, they said okay, there’s a two packet of gum maximum a day. They had a real increased amount of irritability. They had a decreased interest in sex and lot less frequent erections. They actually started to look at their sperm count and by the end, their sperm count was so low that it was basically non-reproductive.

That happened, obviously, with the men. There were no women in this study, but this links into hypothalamic amenorrhea, which I’ll come back to talk about, but basically, just suppression of reproduction. They had lower amounts of red blood cells, so anemia. They had lower amounts of white blood cells, some decreasing by about 30%.

Their hair grew really slowly and actually stopped growing and then was prematurely falling out. They had loss of nails, so their nails stopped growing. They developed real strong cravings for salt. They also started getting lots of mental health type issues. I said at the beginning that there were four people who didn’t end up completing the study. It started out with 36 men. It ended with 32. One of the men in the study actually chopped off his own finger.

Ari Whitten: Wow.

Chris Sandel: Even when he was interviewed later about it, he said that he doesn’t know or he’s not going to say whether he knew what he was doing or not. It almost sounds like he tried to chop his finger off intentionally to get out of the study.

Ari Whitten: Wow.

Chris Sandel: Intense food obsession, so these guys really couldn’t care less about food prior to going into this. Yes, they enjoyed eating food. They were eating regularly, obviously, if they were eating 3200 calories a day to maintain their weight that they were consuming food, but it wasn’t an interest of theirs. What happened was they started just reading books all about food, so cookbooks. They would read menus. They’d read stuff on food production and just became interested in it.

A lot of them said that when the study was over, they were going to become cooks or were going to open up restaurants. They’d start licking their plates and had really strange eating behaviors in terms of how they would eat things in certain orders. They’d keep food in their mouth for a really long time.

As time went on, it became more and more difficult for them to keep to the restricted eating and so most of the time, they were sort of housed and kept all together, but they would have times where they would go out to the real world. They would go to the movies, that kind of thing. This was how another person got kicked off the experiment because on one of those journeys out, he just couldn’t cope anymore and he just went into shop after shop after shop and just stole food and ate food.

There were other men, so there were another two men who had really bad neurosis and just mental health issues. They prematurely aged, low blood pressure, lots of dizziness on standing, vertigo. Some even were having blackouts, really frequent urination, so frequent during the day, frequent during the night, couldn’t make it through the night without urinating. Constipation, so they started going once a day. By the end of the experiment, they were going once, maybe twice a week. They had cuts and bruises that would heal really, really slowly.

They were getting muscle cramps and muscle pains. Their skin was rough and thin. Totally lost their ambition. They had difficulty concentrating, increased depression, wanted to spend more and more time alone, more time in isolation. They just became very reluctant to plan activities, to make decisions, to participate in group activities.

That’s the long list of all of the things that they started to experience.

This is what I then start to look at when I’m going through someone’s not just their relationship with food, but let’s look at the outcomes. What you were talking about before, it would then be looking at okay, what’s happening as part of your healthy eating practice, whatever that means in terms of how this is then affecting your body.

Ari Whitten: Right. Got you. Now, do you always expect symptoms to line up more with somebody who’s under eating and is it possible to have disordered eating habits that are leading somebody towards fat gain and maybe a different set of metabolic problems that result from that side of the coin?

Chris Sandel: Surprisingly no and the reason I say that is typically, the people who are in the heavier body or is leading to fat gain are also restricting, so it’s not that they’re just constantly eating. It’s normally a period of restriction for however long they can abstain followed by then that period of binge eating.

A lot of the symptoms I’m talking about here will still apply to those people because from a body perspective, it still thinks that it’s in a famine. It doesn’t know when food’s going to come in. It’s in that stressed state where it’s not prioritizing longterm health. It’s prioritizing short-term survival.

This is even true. You can have people in a much heavier body who still suffer from anorexia. I think this is one of the big misconceptions that when we think of anorexia or when we think of an eating disorder, it’s very many women, middle class. It’s all about looking a certain way. It’s about being really thin. It’s like runway models, etc. That’s just not true.

You can have someone in a much higher body and because they’re then restricted and because they’re then sitting at a weight that is lower than where their body wants them to be because of their weight set point and what the body thinks is going on, it then stops giving resources to all of these different areas, so you can start to get all of these symptoms.

The causes of eating disorders

Ari Whitten: Got you. What do you think drives this whole process and what do you think drives people to start to develop eating disorders? What’s going on either psychologically or biologically, physiologically that is really driving this whole process?

Chris Sandel: There isn’t a clear answer on this and this is something that’s still getting investigated, but there’s a number of different things. I think dieting, as I mentioned before. Majority of people or basically everyone who ends up with an eating disorder started dieting at some point.

I think as a society, we are fairly diet-obsessed and so that is definitely having a role to play.

There are genetic factors that are in there, as well, so people are more predisposed to that. That doesn’t mean that just because you have the genes you’re going to end up with it. It’s the gene’s environment. If you have those genes and then you restrict your food, that’s when it can then turn on and turn into an eating disorder because you can have someone who does a diet and six weeks later, they’re like oh, this just isn’t for me and they forget about it and they move on with their life.

You have, then, someone else who does it and then it’s like a switch has been turned on and they find themselves just spiraling more and more into it and they just can’t get out. I would say that dieting definitely has a role to play and dieting in the broad sense of having a real obsessiveness on thinness and the thin ideal and culturally being obsessed about how people look, etc.

I would also say trauma and stress are a big component of that, as well, and why people can end up with them. A lot of it, as well, is I said we have these misconceptions about what an eating disorder is, i.e. it’s someone who is thin, middle class, who are wanting to look more and more thin. Often, it’s a coping mechanism and it’s how people are trying to deal with their life. It’s often a way of trying to get control when everything else is uncontrollable.

I don’t know how to deal with my relationship. I don’t know how to deal with my kids or whatever it may be, but if I can focus on the diet, if I can focus on my food, if I can focus on my exercise, it then means that I can forget about those other things. I can get that little semblance of control.

I would say those are the broad categories of why I think it’s occurring.

Orthorexia is an eating disorder. Well, actually, it’s not an eating disorder, so orthorexia is a term for a disordered eating that is becoming more commonplace. I say it’s not an eating disorder because it hasn’t made it into the DSM-5 yet or it hasn’t made it into the DSM, which is a diagnostic manual for diagnosing an eating disorder. Orthorexia is an obsession with clean eating or with the healthfulness of food or an over obsession with being healthy. I think over the last however many years we’ve had the real clean eating movement and, from my perspective, a much more extreme focus on trying to be healthy. I think that is a factor has had an impact.

What normal, non-disordered, healthy eating habits are

Ari Whitten: Yeah, I think so, too. I want to go back to something that we talked a bit about earlier, but on this point of orthorexia, I think when anything different from the norm, from baseline habits of what’s standard in a particular culture, when a person deviates from that, it is immediately something that is technically “abnormal.” It’s disordered. It’s nontypical. What do we do in a situation where the norm, where the typical standard food culture and the norm of what kinds of foods people eat and how often they eat and how much they eat are linked to so many different diseases, obesity, diabetes, heart disease, dozens of other different conditions are linked with the standard Western diet and the diet that most people in our cultures are existing on.

In other words, I’m saying what is normal, non-disordered eating? Is it to eat all of the standard foods on the standard Western diet and with the same frequency and the same amount as most other people eat in our culture? Is that the default definition of what is non-abnormal or non-disordered is you do what’s normal and what everybody else does? Because I think there are a lot of people that would argue that that is actually disordered and that is actually unhealthy.

Now, of course, you can go to the opposite end of the spectrum and end up in orthorexia and develop all these debilitating phobias of different foods and end up creating all these nocebo effects for yourself by being so fearful of food and having such a strict diet and maybe you develop deficiencies because you’re so … I’ve seen people who have convinced themselves they have or who have been convinced, I should say, as having all sorts of different food intolerances and end up eating a diet where they’re eating three or five or six different foods total in their entire diet.

It seems to me that there’s a spectrum here. On one end, you have extreme obsession, neuroticism, fear of food, but I also see the norm of what’s in our society as its own sort of disordered eating habits that are leading to their own maybe not the same set of problems as far as psychological obsession with food and so on, but they’re certainly leading to lots of health problems and, I would say, it’s own kind of bad relationship with food.

Chris Sandel: Yeah. A lot of the clients that I work with might fall into that second category of you saying they’re eating processed foods. They’re eating junk foods, etc., but again, I don’t find that the people and this could be that I’m skewed and it’s just the people I’m working with. I don’t find that they’re eating that stuff all the time.

What I find is that they have patches of eating really well or trying to eat really well or trying to restrict what they eat and then patterns of eating more of that stuff. What people then focus on is okay, well, how do we get someone eating healthy all of the time?

The problem with that is often that then just creates more of that real wide pendulum swing between those two things. What I’m normally working on when I’m working with someone who has more of those eating more “junk food” is getting them to start to pay attention to how they feel because just like I said, there’s a lot of symptoms that arise when someone is restricting and going down that disordered eating path. There’s a lot of symptoms that then arise when someone’s eating then that other way and so starting to pay attention to okay, cool. What happens when you have this to eat? What happens when you go this long between meals versus some other length of time between your eating?

Also starting to focus on and this is the other pit that I think people miss is that it all becomes about food and that everyone’s health problems are just because of the food that they’re eating. It’s like that’s not actually true. It’s also because you’re not getting proper sleep. You have problems with your relationship. You’ve had past trauma that you’ve not dealt with.

You’ve got all of these other things that are going on and when you just obsess about food, you miss out on all of that other stuff. It’s then starting to look at okay, all of those pieces of the puzzle to start to work out okay, how do we get someone so that they are consistently eating better quality food and enjoying that process because you could have two people who are eating the exact same meals every day.

One person loves it, feels great on it, wouldn’t want to change a thing and for someone else, it’s taking absolute willpower to do it and they’re hating every moment of it. It’s then looking at okay, well what is going on in that person’s life? How are they using food? What are their coping skills, etc.?

For me, I do just feel that there’s too much of a focus on just the food as if that’s the real problem when often, it’s a symptom of a lot of other things.

How disordered eating habits are linked with, irregular periods, hypothalamic amenorrhea, and fertility issues

Ari Whitten: Yeah, 100% and well said. I want to dig into something that you mentioned a couple times in passing thus far, which is hypothalamic amenorrhea and fertility issues that are linked to these sorts of disordered eating habits. First of all, can you describe what that actually is and what’s going on?

Chris Sandel: Okay. Hypothalamic amenorrhea is when … It’s basically a fancy term for saying you’re not getting your period anymore. Your hypothalamus is a part of the brain and it’s one of the main regulators of different functions within the body, but with reproduction, it has quite a key role.

For your body to reproduce, it’s pretty low on the pecking order in terms of importance. Your body’s only going to want to be giving you a monthly cycle, which can then give you the chance of getting pregnant, which is roughly 50,000, 60,000 calories to go through pregnancy, a thousand calories a day to nurse a child. Your body’s only going to want to put you in that situation if it knows there’s enough energy coming in on a regular basis.

What happens when that doesn’t happen is your hypothalamus basically just stops you getting a period and it does this by changing different hormones or not releasing them in or signaling for them to be released in certain amounts.

The problem with hypothalamic amenorrhea is the hormones don’t always match up so well and so I often look at someone’s blood tests and I can look and be like you know what? You maybe should be getting your period based on these blood tests and for someone else, it’s like okay, you clearly shouldn’t be getting a period based on these blood tests.

Typically, the hormone that is most signaling for hypothalamic amenorrhea is luteinizing hormone and just having a low amount of luteinizing hormone and luteinizing hormone is a hormone that is released more in the first half of the cycle, but actually spikes to allow ovulation to occur. If you don’t have that spike in luteinizing hormone, you don’t ovulate. You don’t get your period.

What happens with hypothalamic amenorrhea is you typically have low amounts of luteinizing hormone. You can have low amounts of follicle stimulating hormone, also estrogen, typically progesterone because you’re not ovulating and you don’t have that progesterone produced as part of that.

Basically, it’s a fancy way for saying your body is choosing not to ovulate or not to give you a period because it doesn’t think that there are the resources or it’s important right now.

Ari Whitten: Got you. Why does this happen and what’s going on most typically for a woman to actually experience this?

Chris Sandel: Typically, what I’m saying for the women I’m working with, there is some disordered eating/eating disorder and what that means is that they’re often restricting their eating, so they’re below a certain amount of calories and there’s no set calorie amount. It will just depend on what’s going on for them. It’s often really true that there’ll be high amounts of exercise, as well. It’s often endurance exercise or intense exercise that then coupled with that restrictive eating and then often, as well, some form of stress. Those two things are stressful enough, but there’s often psychological stress going along with that and that can be in lots of different realms, whether that’s psychological stress around body image or whether it’s to do with a relationship, that kind of thing, but those three things seem to be the key drivers with that.

I will just say again it’s not always someone who is in a lower body. There’s a lady Nicola Rinaldi who has written a great book called No Period. Now What? I had actually come to a lot of the conclusions that she talks about in this book and then found her book later on and it was really interesting. I’ve had her on my podcast. I’ve chatted with her a lot about this stuff. What she found and as part of writing the book, she had set up a forum back when forums were things. This is before Facebook and had many women as part of that. I think she did a survey with about 300 different women. She’s got a Ph.D. She’s incredibly smart. She was able to do the statistical analysis and all that as part of it.

What she found was that typically, preceding hypothalamic amenorrhea was a drop in weight and often as small as 10%. It didn’t necessarily matter where someone’s BMI was. Yes, if you’re at the lower end it was possibly more likely or you didn’t need as much of a drop, but even someone in a higher weight, in a higher BMI, just that drop in weight for that individual and I will add that people have tendencies, so there are people who can be under an inordinate amount of stress. Their periods are always fine, but they get issues with their digestion or someone else doesn’t matter how much stress. They’ve got an iron stomach, but they have some other issue, so there’s definitely inherent strengths and weaknesses that we all have.

Yeah, what she found was that even in people who are in a high BMI, if they had a drop in weight and there was restrictive eating, if there was intensive exercise as part of that, it could then lead to hypothalamic amenorrhea.

Ari Whitten: Got you. What can someone do to recover from this and actually start having their period again?

Chris Sandel: It’s normally the reverse of everything I’ve just said there. It’s them having time off of exercise and typically, some walking or low-grade exercise or some stretching isn’t an issue, but it will depend on the individual. Typically, if people are keeping up with the intense exercise, periods just don’t tend to come back. Again, I think this is the message that’s being sent to the body about what’s important right now and by having that real ceasing in exercise, the body’s ability to use those calories to deal with the damages that have been going on from the overexercise and the restrictive eating.

Having people increase their calories. She recommends in the book like 2500 as a minimum. Again, it will depend on the individual. I know within this culture we’re afraid of junk food and processed food, etc., but definitely with clients like this and especially with eating disorder clients, people need to tend toward more of those processed foods just to be able to get the calories in and to just get the needs because trying to do it on whole foods they will often struggle to do it.

Then dealing with the psychological side of things, whatever that may be, and it is often dealing with body image issues, with self-esteem issues, with issues wrapped up in self-worth being dictated by how they look or how much exercise they can do, etc.

Ari Whitten: Got you. Is overexercising something that you pretty much universally see with hypothalamic amenorrhea or …

Chris Sandel: Yeah.

Ari Whitten: Okay. You don’t-

Chris Sandel: Yeah, so you, I imagine, have heard of the female athlete triad. I don’t know if your listeners have, but yeah, so what happens often with athletes, especially athletes where there is a real endurance focus or a high-intensity focus or a physique focus as part of their training, you’ll get a thing known as the female athlete triad. The triad is losing your period or having irregular periods, having restrictive eating or keeping food low and that can go across a real spectrum, and then osteopenia or osteoporosis, so thinning of bones.

I’d say this is also really common with clients or with people with hypothalamic amenorrhea when they do their bone density tests and this is people who are in their mid-20s, their mid-30s. They’ve got bones of someone who’s 70 or 80 just because of the fact that they’re not getting their period, the fact that a lot of the hormones that are produced as part of your cycle and this, again, I think is a misunderstanding that people think well, I’m not wanting to have kids at the moment. It doesn’t really matter if I’m not getting my period. Oh, it’s great. I don’t have that inconvenience.

A woman’s reproductive cycle every month is really important for overall health. The hormones that are produced as part of that, the estrogen, the progesterone, they do lots of things that are important for pretty much every system within the body and one of those is bone health. That’s why you start to see more of the osteoporosis and osteopenia.

How to think about health

Ari Whitten: Got you. Very, very interesting stuff. On a final note because we’re running out of time here, I’m wondering if you had to give people one bit of advice as far as how they should think about health, what would you say?

Chris Sandel: My advice would be to think about health more broadly. I do think, as I said before, that health has become this thing where you focus just on what you’re eating or it can be people who are focusing on just what the number on the scale says.

I think that that doesn’t typically lead to health or people focusing on really narrow parameters. What I’m wanting to do and when working with people is looking at all aspects of their life, so what is their mental health like? What is their emotional health like? What are their relationships like? What’s their ability like to be able to play with their kids or to be able to work and what’s their ability like to be able to feel joy or happiness?

As I said earlier, I think often, people’s pursuits of health don’t lead to better health, especially if we’re thinking about in this broader sense and just starting to look at how can my health enhance my life and be the thing that helps me to do the important things in life, not have the health be the most important things in life and looking at things like the Harvard study of adult development and how important relationships are or the blue zones. I know you’ve talked about this before and them having a purpose. I really think people need to think more broadly about A, what does it mean to be healthy, but B, what am I getting out of being healthy? What is it really allowing me to do?

Ari Whitten: Beautiful. That was actually going to be my last question, but I just thought of one more question I want to ask you, which is kind of the same vein as the last one, which is if people are listening to this right now who are maybe at the beginning of a journey where they’re embarking upon trying to improve their health or maybe they’re even in the middle of that journey and maybe they’re starting to develop some of these disordered eating habits, what is your top piece of advice for people who are either starting that journey now or in the middle of it and maybe starting to get a little neurotic and obsessive about some of these habits? What would you say to them to help them not go down into that downward spiral of developing disordered eating habits?

Chris Sandel: Probably the biggest one would get some help because it does spiral really easily for a lot of people and most people and by most, I mean like 99.9% of people don’t get out of this on their own and they need help. That could be helping lots of different ways. It could be seeing someone who is a psychologist. It could be seeing someone to deal with trauma. It could be for a whole different array of practitioners, but I would say getting some help would be what I would suggest.

Ari Whitten: Excellent. Chris, thank you so much. This has been an absolute pleasure to finally do this podcast with you. I’ve been meaning to do this for a long time, so it’s been great to have you on. On a final note, where can people reach you and find out more about your work or work with you one-on-one?

Chris Sandel: My website is www.SEVEN-health.com. There you can find all of my information, blog posts, etc. I also have a podcast. I mentioned Ari had been on my podcast a number of times. I have a podcast called Real Health Radio, been going for a number of years, has 110, 115-odd episodes, somewhere in there, so yeah, a lot of information. Yeah, I’d say they are the best places to find out more.

Ari Whitten: Awesome. Well, thank you so much, Chris. Been an absolute pleasure and enjoy the rest of your day, my friend.

Chris Sandel: Cheers. Thanks, Ari.

Do I have an eating disorder without knowing it? Disordered eating, fatigue, and irregular periods (hypothalamic amenorrhea) with Chris Sandel – Show Notes

Disordered eating vs eating disorder (03:03)
The extreme diets that serve as tools for disordered eating habits (08:38)
How to identify disordered eating habits and eating disorders (09:56)
Healthy food behaviors (12:54)
How to balance your healthy relationship with foods (14:56)
How to identify whether someone has a disordered eating habit (22:35)
The causes of eating disorders (32:24)
What normal, non-disordered, healthy eating habits are (38:15)
How disordered eating habits are linked with, irregular periods, hypothalamic amenorrhea, and fertility issues (44:14)
How to think about health (54:19)

Links

Learn more about Chris Sandel here: www.seven-health.com

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Comments

2 thoughts on “Do I have an eating disorder without knowing it? Disordered eating, fatigue, and irregular periods (hypothalamic amenorrhea)

  1. Really good questions from Ari – for those of us who have no desire for processed food anymore- a lot of disordered eating going on among those eating the typical Standard American diets. Deciding not to eat sugar and processed grains cuts out lots of food at a typical restaurant or potluck – add to that if you can’t eat dairy! I would balance this information with Susan Peirce-Thompsons teachings about the addictive power of sugar and processed grains.
    Totally disagree with his comment about the fact that it is hard to gain weight eating whole foods!!!!What? Just add some extra nuts and you can get the extra calories. No one needs to eat processed junk food for any good reason. I know for myself that during our Canadian winters, an extra handfuls or two of nuts a day puts on the extra weight my body seems to want when it is cold, sometimes more than I need. And I would add finally that the “keto” movement in some respects adds to the problem for some – not enough carbs (from good sources) coming in to keep the body happy and balanced, and for some thyroid challenges! especially in a cold climate. ….all in the name of health but sometimes an obsession with weight. With much appreciation Ari, I look forward to your interviews – brilliant and balanced. Sarah

    1. Sarah, I agree completely with your comments. These were my two major points of disagreement with his views. Though I think that Chris’s clientele is so skewed towards restrictors, chronic dieters, and orthorexics that his views are heavily influenced by that.

      Thanks for the comment!

      -Ari

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