This is my final post in this first series on metabolic derangement.
Subtitle is “One of the Mechanisms Through Which I Think Eat the Food May Work” but that was too long and untitley.
I’m going back to the touchier subject again. The subject of the people who report very low calorie intake and either lose no weight or even report weight gain. I will again be discussing some of the data out of the final study discussed in the first post and again in the second post. I will be presenting more raw data from that study, but also getting into the realm of speculation and opinion. Some of that speculation and opinion will revolve around why I personally think the concept of ETF may work. If talking about calorie restriction triggers you to want to restrict, please do not read this. My wish is for everyone to eat an adequate number of calories to support a healthy metabolism and enough activity to make substantive change in health.
Again the abstract for this study can be read here: http://www.ncbi.nlm.nih.gov/pubmed/7594141
In the first post of the series I examined the data to suggest that slowing of metabolism is a real phenomenon. Likewise there is likely a cap on how slow it can get and touched on this study showing that people greatly underestimated calorie intake. In the second post I examined the demographics of people reporting very low calorie intake and found that some really weren’t as overweight as you’d assume someone would be for trying to eat 1000 calories a day.
In this post I’d specifically like to discuss two things. I’ll get into details on the dramatic underestimation of calorie intake of almost everyone in that study and then talk about the infamous subject 10 who really did have a pretty slow metabolism and was accurately recording calories.
Before I launch into the full discussion, let me again reiterate that no where in here should you construe me as saying “no one can eat 1000 calories per day”. I know that is a fact-people can and do. I wrestled at a weight class my senior year that required a very low body fat % and frequently restricted my calorie intake severely to cut weight. It got harder as the season went on (I’m sure as my metabolism slowed and possibly after I cannibalized some lean body mass). Also wrestlers, boxers, MMA fighters, fitness competitors, and body builders frequently use severe calorie restriction for specific purposes. I don’t think it’s healthy and it’s common in those groups to end up with metabolic derangement (frequently discussed in the female fitness competitor circle) as a result. Also, as discussed in my first post, anorexics often maintain severely low calorie intakes, resulting in low body weight and potentially ending in death. They also slow metabolisms.
But then there’s another group that reports very low calorie intakes and no weight loss or even report gaining weight! I made the case in my first post that those people are likely under reporting their calorie intake. So let’s dive back into the study I mentioned above. 10 women reporting restrictive intakes and no weight loss. They are recording strict food diaries over a two week period. Their TDEE and calorie intake is measured using the doubly labeled water method. Now let’s look at what I consider to be the most fascinating piece of information from that study.
So much to see here. Let me briefly explain what you are looking at in the event that the figure doesn’t make sense. The subjects are numbered at the bottom. The black bars are the total number of calories these women are burning per day. The striped bar is the calorie intake they report through a food diary. Before study entrance the subjects had completed a one week food diary (without training) that showed low calorie intake. All of the subjects from 1-8 had essentially normal metabolisms based on measured RMR. At study entry each of the ten underwent training by a nutritionist and watched a video on preparing a food diary.
So these people all had more training than most of us on taking a food diary. How did they do? Let’s zoom in on subject 1 because I think her history is so similar to a lot of women in our modern world. In the study they report that Subject 1 had first noted being overweight at age 8. Had been on “hundreds” (her words) of diets. History of depression, though currently stable and off treatment. Normal thyroid function. Highest adult weight was 112 kg (246 pounds) and currently at 88.5 kg (195 pounds). After training to take a food diary and knowing that they were going to measure her real intake she recorded taking in around 1100 kcal per day. Her measured TDEE is 3000. This is an active woman actually! Her RMR is actually higher than predicted. Active, normal metabolism woman, thinks she is eating 1100 calories per day. Really ate ~3300 calories per day. Above her TDEE. During a study when she knows that she is going to have her real calorie intake measured chemically and there will be no way to “lie”.
Let that sink in for a minute. She’s not the only one, in-fact 9/10 totally underestimated calories. It’s not like Subject 1 was even an outlier. Subjects 2, 6, and 7, also all recorded/reported intakes below 1000 calories and ate at or above their TDEE with intakes of roughly 2700, 2600, and 3100 respectively.
Four out of ten of these women (who knew their real calorie intake would be measured) underestimated their calorie intake by 1/3. So far I’ve essentially just reported fact from the study. I’m now going to move into what I think this says. I think this says that they aren’t lying. How would 40% of these women choose to lie, even knowing their lie would be found out? The demographics of these women can be seen in my second post, they are all somewhat different with different backgrounds so you can’t just speculate “They found a bunch of crazy people”. I honestly think, that even when recording what they think they are eating, they eat more then they realize. I can’t speculate on if that is eating substantially larger portions, legitimately forgetting to record food, unconscious binging, binging at night or even in their sleep, or some combination of the above. I really think that these people’s view of and relationship with food is so broken that through whatever combination of events they are eating 3 times what they think they are. Even subject 8 with her normal BMI I discussed previously, she underestimated by 50% and ate over TDEE. I think people’s eating shame, food guilt, orthorexia, body image, mental state, etc becomes so injured, they are essentially blind to what they are really eating. Even more philosophically- the ID takes over for the ego when you try to do stupid things to it, like feed it 1000 calories per day.
So back to a fact: the reason these women were not losing or even gaining while reporting 1000 calorie intake (or less) is they were eating more then they burned. It’s the hard truth of how sucky we are at estimating our calorie intake (see section 2 of my first post). In fact the hard truth is that only 20% -while under the watchful eye of a food diary and study conditions- were able to make a net negative in calories for the two weeks. I know subject 10 did lose weight (more on her in a minute), they don’t report on subject 4, but I assume she also lost weight having created a ~800 calorie deficit per day. Which, as my previous posts have suggested, is too much and you can see in her TDEE which is lower then many of the other patients that had similar body weights. While 20% in the study created a deficit, 50% actually ate above TDEE during the study.
So here’s where I suspect the concept of ETF comes in. I suspect it maybe is less about “healing metabolism” as it is about “healing relationship with food”. Because frankly something isn’t working if you underestimate by 3-fold under strict study conditions when you know you are being observed. I think if a person embraces the concept of ETF and begins to gives themselves permission to eat enough calories they heal their relationship with food to the point that instead of saying they eat 1000 and eat 3000, they can then sustain intakes of 2500-2700 and make slow loss over time. Oh there’s certainly some metabolic healing in people with slow metabolisms which were only 40% of the people in this study in people who reported chronically low calorie intake. I have no idea how long it takes in those people. As I previously presented in severe anorexics their metabolisms are above predicted by 4 weeks of re-feeding- how that applies here, I don’t know for sure.
So back to subject 10. Not only was her metabolism super slow (23% below predicted) she accurately measured and recorded her intake. During the study period she created a deficit of roughly 300 below her very low TDEE of 1600. She lost weight, which again suggests that when not under the strict observation period of the study, she was probably eating at her TDEE. Many people who report no weight loss or weight gain on very low calorie intakes will then look at this case and suspect that this patient is the one that applies to them. There are many confounders with her however. She had hyperthyroidism treated with thyroid ablation 17 years before which is what led to her weight gain. She was also on three psychiatric medications which could be either slowing metabolism or affecting appetite. At study entrance she had normal thyroid studies, but 18 months after the study ended was found to have hypothyroidism. Ugh. Complicated.
But beyond the possibly complicating factors for her having a low metabolism, let’s remember her demographics: age 52, weight 153, height roughly 5’3″. Knowing that her metabolism is almost 25% slow, when I look at the health calc and play around with the numbers- even for her to have a TDEE of 1600 requires her to be very sedentary. When put her in and put the sleep nob to 7 hours it would give her a predicted TDEE of 1950, which is 18% higher then her real TDEE. There’s not much room for movement based on the information we have. I’d suggest that I’ve presented information previously to suggest that her low calorie intake is in-part related to her low TDEE. Also her weight may not be as much the issue given her weight and height (her body fat is reported at 44%). I’d say she really does need to eat more and move more and work on some recomposition of her body fat, focus less on her body weight. For her ETF really probably is about healing metabolism and having energy to move!
The rest of us, know matter where we are, need to give ourselves a break. Chances are, depending on your age and weight, you need closer to 2500-3000 calories per day and thinking that you are going to be able to sustain on levels far below that is wrong headed. Chances are, as suggested above, even if you try to get way, way below a healthy intake your body will find a way to protect itself. Eat the food, play more, just move.