erica057 (erica057) wrote in ed_ucate,

Calorie restriction vs anorexia

I recall that I've seen a couple posts inquiring about calorie restriction (CR). However, this is the first mainstream article I've seen that fully investigates the psychological underpinnings. The article is at

Forget everything you've ever heard about anorexia. It turns out starving yourself is healthy.

So, at least, one might conclude from recent articles about calorie restriction, which studies have shown to extend the lives of animals like monkeys and mice and which is now being tested with humans. The mechanism by which calorie restriction slows aging in animals isn't yet understood. But it seems to depend on these basic mechanics: When you eat less than you need, your metabolism slows down. Your heart rate ebbs, your temperature drops. It's an evolutionary response meant to help us survive during famines (and it explains why some dieters have such difficulty losing weight).

As a former anorexic, I've found it strange to hear scientists hail low metabolism—a central feature of that disease—as a sign of health and potential longevity. When I was being treated, my doctors invoked my low metabolism as a catchall for the physical damage I was doing. My low heart rate, amenorrhea (the loss of my period), and the goose bumps I got in 70-degree weather were all signs of illness. So, how can something that is a symptom of disease in one person be a marker of good health in another?

This isn't a theoretical question. Although we don't know yet whether the longevity benefits extend to humans, a number of people—probably at least several hundred—have put themselves on draconian diets in the hope of living longer. They refer to their regimen as CR (calorie restriction) or CRON (calorie restriction with optimal nutrition), and they call themselves CRONies. They eat obsessively, measure every calorie, and lose huge amounts of weight. Except for the fact that most of them are men, they look a lot like anorexics. And, on closer examination, it turns out they are a lot like anorexics. Many are trying to jolt themselves out of a midlife crisis, much as many anorexics are seeking relief from adolescent unhappiness. Like anorexics, CRONies discover in starvation an apparent solution to their problems: a source of energy (at least at first), a sense of purpose, and relief from stress.

Remarkably, no one from the eating disorders field has stepped forward to explain what the difference between calorie restriction and anorexia might be. None of the major organizations—the Academy for Eating Disorders, the National Eating Disorders Association, and the Eating Disorders Coalition—has made any statement on calorie restriction. I suspect they don't really know what to say. Doctors I've interviewed say they're concerned about the message that semistarvation is healthy. But, when pressed to say whether reducing one's metabolism is overall healthful or harmful, they admit that we simply don't know. One doctor admitted that there may be benefits to anorexia, assuming you survive it: There is evidence, for instance, that women who recover from anorexia are at lower risk for cardiovascular disease later in life. On the other hand, one risk of long-term calorie restriction (and anorexia) is bone loss, which if severe enough causes osteoporosis. (When your metabolism slows down, the levels of hormones that trigger your body to add calcium to your bones also decrease.)

Proponents of calorie restriction are much more assertive in differentiating CR from anorexia. The Web site of the Calorie Restriction Society, an organization that claims more than 2,000 members, has a page dedicated to listing the differences. It states, "Anorexia: It's All About Appearance. Calorie Restriction: It's All About Health." The next point is that anorexia is the result of low self-esteem ("Anorexia: I Am Bad"), whereas CR is about loving and respecting yourself: "The inner monologue of a CR practitioner is 'Calorie Restriction is worth the effort because it may prolong my life and health.' "

While these distinctions have some superficial truth, they rely on an extreme oversimplification of anorexia, and of CR, as well. To begin with, anorexia is not all about appearance. An anorexic, like a CR practitioner, could easily be motivated by the belief that what she is doing—watching her portions, avoiding "bad-for-you" foods—is healthy.

More importantly, once someone has been restricting food for a certain amount of time, she discovers advantages, not appearance-related, in the way that her mind and body respond to starvation. After this point, the anorexic is motivated by a cost-benefit analysis that sounds very much like the calorie restrictor's: "This is worth the effort/pain/fighting with my parents, because of X benefit." In my case, there were several noticeable pluses. Being hungry gave me energy. It helped me focus on my work. It made me feel emotional and creative in a way that I enjoyed. At the time, in fact, I believed I was eating as I did much more for the intellectual and creative edge it gave me than to look thin.

Now I understand what happened better: My starvation triggered the release of endorphins. In evolutionary terms, this is designed to give humans heightened coping powers in an emergency. In my case, it gave me a sense of well-being and made me feel sharp and energetic. This feeling became an addiction, so that I pursued it even as my tolerance level rose and the same amount of endorphins no longer produced the same effect, at which point I became quite depressed.

The same thing happens in people who practice CR seriously. Your body doesn't know whether you're eating only two-thirds of a normal caloric intake in order to lose weight, or to live forever, or because the crops have failed or the antelope died out. And I'd argue that a lot of CRONies are susceptible to the addictive nature of starvation, because they begin CR out of a sense of dissatisfaction with their lives.

How do I know? Because to write about this, I joined the Calorie Restriction Society, browsed the archives of their e-mail list, and interviewed several CRONies. Tomorrow, I'll explain how my interviews led me to conclude that calorie restriction, while not anorexia, constitutes its own new kind of eating disorder.

Scientists don't yet know much about the long-term consequences of calorie restriction for humans. As I explained yesterday, this makes it hard to distinguish between calorie restriction (i.e., "healthy" starving) and anorexia ("unhealthy" starving) on a purely physical level.

But the psychological aspects of anorexia and CR are easier to compare. I read archived e-mail exchanges of the Calorie Restriction Society and found five people to interview: Dean, a software engineer; Paul and Meredith, a couple who practice CR together; Al, a retired scientist; and Nerissa, a preoperative male-to-female transsexual. It was a limited survey but a revealing one.

In its psychology, I found, CR closely resembles anorexia. Both represent an attempt to change your life by drastically changing your diet. The explicit rationales differ: A CR person says he wants to live longer; an anorexic typically says she wants to be thin. But the deeper wish for a sense of purpose—and the discovery of that purpose in the rewards of not eating—are the same.

CRONies vary from those who go on a moderate, if very long-term, diet to extreme food-restrictors. Dean qualifies as an extremist. Before I talked to him, I followed a link from the CR Society Web site to a PowerPoint presentation that he put together on the psychological effects of CR. In it, Dean acknowledges that calorie restriction has severe consequences. These include obsessiveness, particularly about food; he adopted behaviors that are also common among anorexics, such as watching food shows on TV and seasoning food with salt or spices to a degree that most people would find unpleasant. He also describes experiencing a kind of emotional "smoothness" or placidity, which at a certain point morphed into a kind of deadening.

Dean also discusses a common side effect of CR in men: loss of libido. Unlike the obsessive behaviors, which he succeeded in cutting out, he found he couldn't boost his sex drive. Instead, by mental effort, he turned the drawback into a benefit: He came to enjoy having more time and attention for things other than sex. Dean connects his loss of libido to a decline in other instincts that he identifies as conventionally masculine: He feels less aggressive and selfish, and has less of an urge to use people for his own ends. He has become very interested in Buddhism and in the teachings of Ghandi (who, of course, also starved himself).

On many levels, this reminded me of anorexia—being in a self-enclosed world with its own spiritual and emotional rules. In our interview, Dean acknowledged that the mindset of extreme CR is impenetrable from the outside: "I've likened it to two sides of a chasm. When you're on the normal male side of the chasm, you can't imagine the life I lead now being very satisfying, without the obsession with sex and winning. And when I was on that side, if I had known CR was going to take that direction, I would have said, 'No way in hell.' But [now] I don't want to go back."

Dean said he practices CR primarily for these mental and emotional effects, not any potential health benefits. "Even if there were a pill that mimicked CR, or even if there were a longevity downside, I would continue," he said. The couple I talked to expressed a different view of Dean's psychological response to CR.

My next interview was so upsetting that it is difficult to write about, and it shows that CR can, in certain cases, lead to full-blown anorexia. I called Al at home; his voice was quiet and somewhat difficult to hear. I asked how many calories a day he ate (1,950, he said) and how much he weighed.

"Ninety-two," he answered. I hoped I'd heard wrong. "How tall are you?" I asked. "Five-four," he said. "But I used to be 5-feet-11." He paused. "Osteoporosis." His spine had compressed a full 7 inches—or perhaps he was bent over. I was glad we were on the phone and I couldn't see him.

Al, who is 59, said he began CR in 1989 after reading about it in a textbook co-written by CR guru Roy Walford. Though he was never overweight, Al was concerned about his diet because there is a history of cardiovascular disease in his family.

Al used to be a professor at a university; now he is on permanent disability. He has had pneumonia five or six times. In the middle of one of these episodes, he collapsed from low blood sugar and went into a coma. Al acknowledged that his CR has turned into anorexia. Nonetheless, he refused to criticize the theory behind it, and he spoke sharply about the damage Americans do to themselves by eating too much. "I firmly believe in caloric restriction," he said, before adding quietly: "I believe I've gone too far."

The person I interviewed who seemed most rational about CR was Nerissa, the transsexual. She started practicing her version of the diet—which involves eating normally one day and restrictively the next—when she began her gender-transitioning five years ago. She's 5'8" and then weighed 194 pounds, which she knew wouldn't look good on a woman's frame. She doesn't believe that CR will make her live longer, nor does she think most people who practice CR really do it for that reason. Instead, she said, they're motivated by other desires: wanting to change their bodies, to be more energetic, or even to lower their sex drive. Just as her gender dysphoria led her to seek a sex change, Nerissa speculated that many people start CR because they want to change something about themselves.

Many CRONies take it too far, she said—particularly the men, who are the ones who usually lose their libido. But she said these men often make the same comments as men in the process of transitioning into women: that they're relieved to be freed from fixating on sex.

While male CRONies rarely admit that they enjoy losing weight, she thinks they do. "I think there's a lot of guys in the group who like what they see in the mirror," she said. If she's right, this kind of denial has a parallel in anorexia, too: When I was at my worst in college, I would stand in front of the full-length mirror in my dorm room and say out loud to my reflection, "You look terrible!" I believed that I knew I looked unhealthy and didn't like it, but that this was part of the trade-off for being hungry and sharp. Claiming that I didn't like being thin helped me maintain the belief that what I was doing was rational—that I wasn't driven by vanity or, worse, by a psychological disease.

Are CRONies anorexic? No, not exactly—except in rare cases like Al's, where fear of eating has progressed to such a lethal stage that it would be hard to label it as anything else. But in many cases, CR rises to the level of a different eating disorder—a new one, in which talk of better health and longevity cloaks other unspoken, and possibly unconscious, motives.

I've always thought that voluntary starvation has potential appeal for a lot of people. It just happens that in our society it's mostly women who push dieting far enough to discover the possible benefits: the emotional solace, the outlet for anger, the spiritual elevation, or intellectual edge. But CR now offers an opportunity for hyperrational, slightly obsessive men—men who are uncomfortable with aspects of a conventional male identity—to discover the upside of starvation.

It may or may not turn out that CR does slow aging in people. Right now, the National Institute on Aging, a division of the NIH, is spending millions of dollars on a human study called the Comprehensive Assessment of Long-Term Effects of Reduced Intake of Energy. Here's the little they've learned so far. What's most important, though, is not to focus on the aging factor in isolation. Any serious consideration of the effects of calorie restriction should examine closely the effects that it has on a person's brain and personality—which, as a recovered anorexic, I'm in a position to say are substantial and probably undesirable.

If that sounds weak, it's because I don't want to oversimplify. Endangering your health through anorexia or calorie restriction, or stunting your growth (as I did), is bad. But the mental effects? Deciding whether they're good or bad is a little like deciding whether to take a drug that has advantages but also changes your personality: It calms you, but it also dramatically narrows the scope of your interests and attention.

Unfortunately, I don't think the folks at the NIH get this. Partly, it's a problem of expertise: They're gerontologists, not psychiatrists. Also, the NIH has its own bias: to sound the alarm about an obesity crisis that is poised to increase health-care costs. They probably won't hesitate to promote research that will encourage Americans to eat less and lose weight. Even the psychologists on the CALERIE study seem hostile to a comparison between calorie restriction and anorexia. When I asked one of them about anorexia's effects, he said in a challenging tone, "How many anorexics have you known well?" I said maybe 20. "Well, I've known thousands," he retorted.

One thing is clear: It's time for doctors who study eating disorders to stop wishing the conversation about calorie restriction would go away. Instead they need to join it, adding their crucial perspective on the effects of starvation. In the meantime, should the rest of us start messing with our bodies' functions in the hope of extending the natural lifespan? Until much more research is done—by scientists who understand the close connection between our bodies and minds—let's be skeptical, and eat.
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