Resources for Eating Disorders

Michael Levine, Ph.D. Presented at the 13th National NED0 Conference, Columbus, Ohio, October 3, 1994

1. Preoccupation with weight, food, calories, and dieting, to the extent that it consistently intrudes on conversations and interferes with other activities.
2. Excessive, rigid, exercise regimen—despite weather, fatigue, illness, and injury, the need to "burn off' calories taken in.
3. Withdrawal from, or avoidance of, numerous activities because of weight and shape concerns.
4. Expressions of anxiety about being fat which do not diminish as weight is lost.
5. Evidence of self-induced (often secretive) vomiting, such as:
• Bathroom smells or messes.
• Rushing to the bathroom immediately after a meal and returning with bloodshot eyes.
• Swelling of the submandibular glands to yield a "chipmunk" facial appearance.
6. Evidence (e.g., wrappers, advertisements, coupons) of use of laxatives, diuretics, purgatives, enemas, or emetics.
7. Evidence of binge-eating, including hoarding and/or stealing food, or consumption of huge amounts of food inconsistent with the person's weight.
8. Alternating periods of severely restrictive dieting and overeating; these phasic fluctuations may be accompanied by dramatic weight fluctuations of 10 pounds or more.
9. Inexplicable problems with menstruation and/or fertility.
10. Extreme concern about appearance as a defining feature of self-esteem, often accompanied by dichotomous, perfectionist thinking (e.g., either I am "thin and good" or "gross and bad").
11. Paleness and complaints (evidence) of lightheadedness or disequilibrium not accounted for by other medical problems.

1. Often grew up as Perfectionists.
   • high expectations from father, either verbalized or not
   • often first-borns
2. Mother has a history of dieting.
   • a lot of focus put on weight and appearance
3. Grew up in a home where father was "emotionally distant".
   • desire to please father
   • attempts to gain father's approval
4. Often times had a mother that was a co-dependent.
   • Father may have been an addict
5. Homes with very strict (overly so) discipline, where punishment was severe and physical.
6. Parents who used Guilt/Shame as a method to discipline or punishment.
7. Homes in which sexuality was not discussed or treated in a "dirty" manner.
8. Fathers who used daughters to complain about mother.
9. Homes in which children were forced to be adults.
   • daughters who "raised" other kids.
   • not allowed to be kids
10. Those who have been sexually abused.
    • including fondling
    • including incest
11. Those who have been the victims of any type.
    • neglect
    • verbal abuse
12. Those with Biochemical imbalances.
    • brain allergies
    • hypoglycemia
    • PMS
13. Addictions to diets and dieting.
    • compulsive dieting
    • fasting
    • diuretic use
    • laxative abuse
    • prescription drug abuse
14. Desire to OVERPLEASE.
    • overcontrol through people-pleasing
15. Tendency to ignore or deny anger.
16. Overuse food for pleasure or reward.
    • food becomes the main focus for pleasure

BULIMIA

• 95% to 98% female
• 84% have some collage education
• Usually white
• 64% are closer to proper weight
• On the average, binges occur 11 times per week
• Average number of calories consumed: 4,800
• Average age at onset: 18
• Estimated number of bulimic college women - 20-30%
• Very unhappy and have low self-esteem
• Often depressed
• Tend to be passive individuals
• Tend to rely on others, especially me" for self- validation
• Afraid of rejection
• Perfectionists
• Isolated
• Very secretive
• Unsure how to cope with stresses of life

ANOREXIA

Anorexia, or self-starvation, is a disease and it can be fatal if left untreated. Recognition of its symptoms can be the first step toward saving yourself or someone you love from this dangerous disease.

The following is a list of the observable symptoms:

• Refusal to maintain body weight
• Fear of gaining weight
• Talks about "feeling fat"
• Difficulty with eating full meals
• Rigidity with what they will eat
• An obsessive preoccupation with body size
• Over-exercising
• Intense dissatisfaction with physical appearance
• Personality change from outgoing to withdrawn
• Limit food intake to "arrow selection of low-Cal foods
• Hoarding, concealing, crumbling or throwing away food
• Menstrual difficulties

Bulimia generally includes any of the following:

• A cycle of bingeing and purging
• Prone to substance abuse
• Diuretic abuse
• Vitamin abuse
• Shoplifting
• Suicidal thinking
• Extreme mood swings
• Hypoglycemia
• Likely previous rape or sexual abuse
• Vomiting
• Laxative abuse
• Fasting
• Rigid dieting
• Secret/deceptive eating

1. Tend to hide and bottle up feelings - especially anger
2. Hypersensitive to criticism, though have a critical spirit themselves
3. Shame to control self and others
4. Impulsive in thought and action
5. Has great difficulty with intimacy, both sexual and emotional
6. Obsession with weight, though tend not to be extremely overweight
7. Addicted to the scale
8. Tend to have very strong need for other's approval, but feels as though they never get it
9. Very secretive, deal with very high amounts of guilt
10. Obsessive in thought about physical body
11. Believes that God disapproves of them
12. Tremendous physical exhaustion
13. PMS tendency, irregular periods
14. Dizziness, headaches, constant thirst
15. Digestive disturbances, extreme, bloated
16. Electrolyte imbalance resulting in muscular weakness
17. Dental problems
18. A life of extremes in relationships, spirituality, and emotions
19. Chronic low self-esteem
20. Disturbed metabolism.

What works in treatment?

1. Whole person approach
2. Non-diet approach
3. Self-esteem retraining
4. Nutritional reeducation
5. Spiritual renewal
6. Relationship enhancement
7. Identity development

Fifteen Tendencies Often Present

1. Loneliness in all relationships
   • Inability to experience intimacy
2. Presence of fear of authority figures or being controlled by another person
   • Difficulty in maintaining a "sense of self".
3. Possible history of abuse
   • Neglect of emotional needs
   • Verbal Abuse (overt or covert)
   • Sexual Abuse
4. Early "rejection" of the opposite sex
5. If a male Compulsive Overeater, possible over-identification with mother
• Over-involved emotionally
6. Tendency towards "Social Anxiety"
   • Tend to isolate and use food as a "friend"
   • After social situations, relieve anxiety by bingeing or overeating
7. A history of "diet failures"
8. Preference for food instead of other activities
   • Food is friend
   • Food is hobby
9. History of Guilt/Shame
   • Parents used guilt as a form of control
   • Life filled with "shoulds", "oughts", "always" and "nevers"
10. Possible other addictions
    • Sugar
    • Prescription Drugs
    • Alcohol
    • Sex
11. A long-term, unhappy marriage or other significant relationship
    • Food becomes a point of intimacy instead of spouse
    • Food to cope with conflict
    • Food to fill a void
12. Long-standing relationship difficulties
• Avoidance of conflict
13. Difficulty dealing with Anger
    • Internalization of anger
    • Ends in resentment
14. "Loving Heart" has been damaged (hurt)
• The compassionate heart is buried, though still present
15. Hunger for acceptance and love

Anorexic patients see their restricted caloric intake as a very brave and arduous thing to do. They tend to prize challenges over comfort. By contrast, bulimic patients view their behaviors as shameful and disgusting. In order to recover, patients need help learning to understand the connection between their beliefs about themselves and their eating disorder behaviors. They often view themselves with such hatred that they feel deserving of the painful eating disorder behavior. They need to see that their eating disordered behavior is not an achievement, hut avoidance of true life challenges; not distinctive, hut simply stereotypic. They need to realize their behavior does not clarify their life, but confuses it; and they need to see that the disorder does not serve higher goals, but actually blocks the realization of those goals. The individual suffering from destructive eating disorder behavior must begin to challenge a negative mindset and learn to create and allow positive feelings and thoughts about themselves.

Individuals suffering from eating disorders have restricted emotions and often cannot identify their feelings. What they are aware of is extremely negative thoughts related to their body - an effective diversion from their emotional turmoil and pain. Their thoughts are obsessively locked onto the Irrelevant and their feelings are avoided and hidden, even from themselves.

Adapted from Mary Pabst, MSW, Maryland Association for Anorexia Nervosa and Bulimia (MANA) from Panhellenic Task Force

"Why don't you just stop?" This is the question with which people with eating disorders are confronted again and again by parents, spouses, friends, and themselves. Costly experiences with programs promising an end to the food behaviors once and for all frequently lead to brief abstinence followed by devastating resumption of old and familiar patterns. Regardless of whether the person starves, binges, binges and purges, abuses laxatives, compulsively overeats, gains weight, or loses weight the story of a roller coaster experience with behavior changes is all too common. Until the behaviors in an eating disorder are viewed as the symptoms rather than the problem the focus of recovery remains in the wrong place, and the person is likely to experience limited success in attempts to recover.

Most people have great difficulty understanding the function of the behaviors in an eating disorder. Why would someone starve herself to the point of death, as often happens in anorexia nervosa? Why would someone binge and then induce vomiting or painful diarrhea, as happens in bulimia nervosa? Why would someone eat so much that her stomach hurts so badly that all she can do is lie down and fall asleep, as often happens for compulsive overeaters? Why would someone maintain a body weight that is so high that she is physically uncomfortable and potentially endangering her health, as often happens in obesity?

There is rarely a simple explanation for an eating disorder. It is an extremely complex problem and may be caused by a number of factors, which may include family and cultural pressures. Eating disorders may also occur as a result of psychological and interpersonal factors. Feelings of inadequacy, depression, anxiety and loneliness, difficult family and personal relationships may all play a part.

Frequently the person who has an eating disorder outwardly appears to be managing life very well. She is also a person who feels she would look better if she lost some weight, which means she could be virtually anyone in our society. At some point in that person's life there is an event or a series of occurrences and situations which symbolizes one or more of the following seven scenarios.

1. A Single Traumatic Event:

This is an occurrence that causes extreme emotional pain for a person. Another person may have minimal difficulty facing the same situation, but for this person the pain is too intense, and she doesn't know what to do with it. Examples of such an event include death of a close relative or friend, divorce of a parent, leaving home for the first time, rape, abortion, rejection in a relationship, divorce, first sexual experience, or a degrading comment.

2. A Two- to Three-Year Period of Unusual Stress or Pain:

This person would have been able to manage adequately had only one thing happened, but too much happened too fast, and the and the stress/pain level became too great. An example of this would be the person who leaves home for the first time, has her first sexual experience, is rejected in a relationship, and her mother dies, all within a two- to three-year period.

3. An Extended Period of Emotional Pain:

The person has lived in a painful situation for a period of years and finally reaches the point where she can no longer tolerate the pain. Examples include growing up in an alcoholic family, growing up with physical, sexual or emotional abuse, and living in an unhappy marriage.

4. The Onset of a Mood Disorder

All of a sudden, the person begins to experience depression or mood swings at a level of intensity she has never before experienced. She is not able to control the feelings because they are due to bio-chemical changes. Usually, the person does not understand what is happening, feels scared and out of control, and does not know how to or is afraid to ask for help.

5. Having Been a Very Sensitive Child:

This is a case of a very sensitive child growing up in a family in which there was emotional pain that was not acknowledged or discussed. The family outwardly appeared to be "perfect" and problem-free. Frequently, the family is very religious and spends a significant amount of time attending church or synagogue activities. The source of the family's pain is often very subtle, thus difficult to identify. This child acted like a sponge for the pain and absorbed it, but did not know what to do with it after that.

6. A Controlling Environment:

The person either grows up in, or marries into a situation in which she has a relationship with a parent or spouse who is a very controlling person. The only way she is able to survive is by giving up her own identity while trying to please the other person. Finally, she reaches a point where she finds this too painful and is no longer willing to do it any more, but does not know how to change.

7. Lack of Validation of Feelings:

The people with eating disorders who have the most difficulty identifying a "reason" why they developed an eating disorder are those who grew up in families and/or married into relationships in which there was no overt abuse or problem but rather a very subtle undermining of self-esteem. The person whom this describes is someone who repeatedly experienced lack of validation of her thoughts or feelings. She was given the message that she shouldn't feel that way, or that it was wrong to feel that way, or that she was selfish to feel that way. Since she did feel that way, the only explanation she could find as a child was that she must be bad or crazy. Over time, she learned to direct her negative emotions inwardly or to take them out on herself, since direct expression was not allowed.

The common thread in all seven scenarios is that a person is experiencing emotional pain at a level of intensity that she does not know how to manage in a healthy way, mainly because she did not learn to express feelings directly while growing up. Many families are not able to model or teach how to express feelings in a way that promotes closeness, support, or resolution of conflict. So when a person who grew up lacking these skills experiences intense emotional pain she lacks the tools to talk about it or to ask for support.

It is at this point that something very significant happens. The person begins to focus upon her body or food, looking outside rather than inside for the source and solution to the emotional pain. Once this starts, the person travels one of two paths. Following the first path she begins to eat and finds food a source of comfort and nurturing. Food is consistent, reliable, and always there. It is something to look forward to coming home to at the end of the day as well as something to which to turn to when alone and scared. The person finds that when she eats, the pain does not hurt quite so much. This person is vulnerable to becoming overweight or obese due to compulsive eating.

Following the second path, the person begins to restrict food intake or to binge and purge and starts to lose weight. As she loses weight, people make comments like "Oh, you look so good! You've lost weight!" In a world that is very painful, suddenly there is something that feels good, brings positive attention, and is within her control. The person finds that the more she focuses on counting calories, exercising, dieting, losing weight, or purging, the less she feels the emotional pain. This person is vulnerable to developing anorexia nervosa or bulimia nervosa.

Portions of this article are reprinted from Eating Disorders: Nutrition Therapy in the Recovery Process (1990) by Dan Reiff and Kim Reiff phD of Mercer Island, WA published by Aspen Publishers, Inc. Aspen, Co.

People who abuse laxatives often find themselves in a no-win situation. They use laxatives to "feel thin," which is an immediate, positive result. Eventually, however, the exact opposite occurs. They find themselves "feeling fat" from excessive water retention-a delayed, negative result. Here are some steps to stop abusing laxatives:

1. Stop taking laxatives right now, and do not take any more unless your physician instructs you to do so. Remember that stimulant-type laxatives are especially harmful to the body.
2. Drink at least 6 to 10 cups of water (and decaffeinated beverages-not caffeinated beverages because they act like a diuretic, promoting loss of fluid) a day. Restricting your fluid intake at this time promotes dehydration and only worsens the constipation.
3. Including some physical activity in your regular daily pattern can also help to regulate your bowel function, although you should discuss the intensity and type of activity first with your health care provider or therapist. Too much or too vigorous exercise can worsen constipation, due to the effects on your metabolism and fluid balance.
4. Eat regularly. It is important that you spread the amount of food recommended to you on your meal plan across at least 3 meals a day, and to eat these meals at regular intervals.
5. Eat more foods that promote normal bowel movements. The healthiest dietary approach to promoting normal bowel function is to eat more whole-grain breads, cereals, and crackers and wheat bran or foods with wheat bran added. This dietary approach should be done in tandem with drinking more fluids. Vegetables and fruits also contribute to normal bowel function. Prunes and prune juice are not recommended because the ingredient in prunes that promotes bowel movements is actually an irritant laxative, and long-term use of prunes and prune juice can result in the same problem as long-term use of laxatives.
6. Write down the frequency of your bowel movements on a sheet of paper. If you are constipated for more than 3 days, call your physician, dietitian, or psychotherapist.

What to Expect from Laxative Withdrawal

There is no way to predict exactly how stopping laxatives will affect you. For example, the amount or length of time laxatives have been used is not an indicator of how severe the withdrawal symptoms will be. The best way to lessen the unpleasant effects of laxative withdrawal is to prepare yourself for these effects and to develop an action plan for coping in case the unpleasant side effects do occur.

Common side effects of laxative withdrawal are:

• Constipation
• fluid retention
• feeling bloated
• temporary weight gain

Just reading this list, you can see that laxative withdrawal is especially difficult for people with eating disorders. You already are highly reactive to "feeling far and the symptoms of laxative withdrawal only worsen this feeling. To help you get through the process of laxative withdrawal, it is essential to remember that any weight gain associated with laxative withdrawal is only temporary. Symptoms of laxative withdrawal do not lead to permanent weight gain.

How long will laxative withdrawal last? This varies greatly. A few people have these symptoms for 2 days; a few others have had them for 2 to 3 months. Most people have symptoms of laxative abuse for 1 to 3 weeks after stopping laxatives.
Eating Disorders Review PO Box 2238 Carlsbad, CA 92018 (800) 756-7533

MYTH: If you induce diarrhea with laxatives, you can the absorption of food and limit weight gain.

FACT: Inducing diarrhea by laxatives does not significantly change the absorption of food in the body. Consequently, laxatives do not significantly prevent weight gain. What appears to be weight loss is actually dehydration or water deprivation. Laxatives work near the end of the bowel, where they primarily affect absorption of water and electrolytes (like sodium and potassium). They thus work after most of the nutrients from the food have been absorbed into the body.

MYTH: You need to use a laxative every time you feel constipated.

FACT: "Feeling" constipated does not necessarily mean that you are constipated. This is especially true of people who have problems with eating. Eating too little food or eating sporadically can result in the sensation of constipation. In this case the problem is not constipation but poor eating habits.

MYTH: When you actually are constipated, you need to use a laxative.

FACT: People who use excessive amounts of laxatives will eventually find the exact opposite happening-the laxatives will cause reflex constipation.

MYTH: All laxatives are alike.

FACT: There are many different types of laxatives that are taken by mouth or as a suppository. The ones most commonly used are:
Stimulant-type laxatives, including Ex-Laxâ , Correctolâ , Senokotâ , Ducolaxâ , Feen-a Mintâ , and some of the so-called herbal laxatives.

Osmotic-type laxatives, including Milk of Magnesia

Bulk agents, including Metamucilâ , Colaceâ , and unprocessed bran. Bulk agents promote bowel movement. When bulk agents are used as directed (with large amounts of water), they don't have the same physical effects on the bowel as the stimulant and osmotic laxatives. However, when these bulk agents are misused, they have the same psychological consequences as regular laxatives. Misusing these agents must be discontinued.

MYTH: Laxatives, particularly over-the-counter products, are safe.

FACT: Laxative abuse can be medically dangerous. Laxative abuse is defined as (1) use of laxative for weight control, or ( 2 ) frequent use of laxatives over an extended period of time.

Medical Complications of Laxative Abuse

The medical complications of laxative abuse depend on several factors, including the type of laxatives used, the amount used, and how long they have been used. Some of the more common complications of laxative abuse:

Constipation. Repeated use of laxatives actually causes constipation. This may lead people to increase the dosage of the amount of laxative, which in turn only worsens the constipation problem.

Dehydration. Laxatives cause fluid loss through the intestines. Dehydration then impairs body functioning.

Electrolyte abnormalities. Many people who abuse laxatives often demonstrate electrolyte imbalances. Electrolytes such as potassium, sodium, and chloride are important to life functions. With chronic diarrhea, electrolytes are drawn of the body through the feces. This leads to an electrolyte imbalance in the body.

Edema. As noted before, laxatives cause fluid loss. Dramatic changes or fluctuations in fluid balance confuse the body's self-regulating protective mechanisms by retaining fluid. As a result, prolonged laxative abuse frequently leads to fluid retention or edema.

Bleeding. People who abuse laxatives, especially the stimulant-type laxatives, can develop blood in their stools. Chronic blood loss associated with laxative abuse can lead to anemia.

Impaired bowel function. People who abuse stimulant-type laxatives can develop permanent impairment of bowel function.
Eating Disorders Review PO Box 2238 Carlsbad, CA 92018 (800) 756-7533 This handout may be reproduced.

• Learn to relax and slow down by using exercise and mediation.
• Practice new behaviors and activities, such as self-improvement classes and hobbies for the early evening hour.
• Change old rules, such as "No eating in the car," and "Remove binge foods from the house and car."
• Just eat, without combining reading, working, watching T V, etc.
• Talk to yourself. ;What is the pay off for bingeing this time?" and, "What isn't working?
  What do I need that I'm not getting?"
• Leave the binge environment, especially when frustrated, under pressure, stressed or bored.
• Get enough rest and expand positive relationships.
• Take deep breaths, close your eyes, picture yourself in a field or at a beach. Turn on quiet music; any method of relaxation helps.
• Begin an enjoyable task or project immediately after eating a meal.
• Carry food to work rather than buying it there. Pack healthy, satisfying food.
• Call a friend who knows about your problem and have him/her just Listen
• Learn your triggers, learn your danger zones.
• Work on your perfectionism. It's okay to not be perfect about every external matter.
  For more information, contact Eating Disorders Awareness and Prevention, Inc. (EDAP) at 603 Stewart street, Suite 803, Seattle, WA 98901, 206-382-3587.

• Thirty percent (30%) of women who seek treatment to lose weight have binge eating disorder.
• About seventy-two percent (72%) of alcoholic women younger than 30 also have eating disorders . (Health Magazine, Jan/Feb 2002)
• Without treatment, up to twenty percent (20%) of people with serious eating disorders die. With treatment that number falls to two to three percent (2-3%).
• With treatment about sixty percent (60%) of people with eating disorders recover.
• Approximately 1 million males have an eating disorder.
• It is estimated that currently eleven percent (11%) of high school students have been diagnosed with an eating disorder. (ANAD)
• Eight percent (80%) of all children have been on a diet by the time they have reached the fourth grade. (Time Magazine)
• Fifteen percent (15%) of young women have substantially disordered eating attitudes and behaviors. (National Eating Disorder Screening Program)
• 2 out of 5 women and 1 out of 5 men would trade 3 to 5 years of their life to achieve their goal body weight. (Radar Programs)
• Ninety-one percent (91%) of women surveyed on a college campus had attempted to control their weight through dieting, 22% dieted "often" or "always".
• Thirty-five (35%) of "normal dieters" progress to pathological dieting. Of those, twenty to twenty-five percent (20-25%) progress to partial or full syndrome eating disorders. (Shisslak & Crag)
• A study conducted by Cornell University found that 40% of male football players surveyed engaged in some sort of disordered eating behavior. (Newsweek)
• Men constitute as many as forty percent (40%) of those exhibiting Binge Eating Disorder.
• An estimated 1 in 3 of all dieters develop compulsive dieting attitudes and behaviors. Of these, one quarter will develop full or partial eating disorders.
• In a study done on men in the navy, 51.3% had an eating disorder, anorexia (scoring 13%) being the most common one.
• Forty-two (42% of men with bulimia are homosexual or bisexual. Fifty to seventy (50-70%) of all eating disorder suffers also suffer from depression and/or anxiety.

Nonprescription Products for Weight Loss

Numerous nonprescription products for weight loss are available at drugstores, supermarkets, and over the Internet. Many of these have never been proven effective and those that are effective often come with warnings. For example, many diet pills promote water loss from the body and may lead to dehydration or loss of essential minerals.

Nonprescription appetite suppressants often work by making you hungry less often.

• Do not use these nonprescription medications if you have heart disease, high blood pressure, diabetes, kidney problems, thyroid problems, glaucoma, or depression.
• Appetite suppressants are only intended for use for a short time (8 to 12 weeks). However, control of obesity is a lifelong activity. It is costly and possibly dangerous to depend on the use of these medications to control your weight for long periods of time. If you are going to use these drugs to help you lose weight, be sure you also make healthy changes to your diet and get regular exercise.

FDA bans ephedra

The U.S. Food and Drug Administration (FDA) has banned the sale of ephedra because of concerns about safety. The product has been linked to heart attacks, strokes, and some deaths.

Ephedra and ephedrine—the active ingredient in ephedra—decrease appetite by increasing metabolic rate.

Some people use water-loss pills (diuretics, such as Aqua-Ban) to lose weight. However, these pills only get rid of water and do not reduce the amount of fat in your body. Using water pills this way is not recommended and can be dangerous.

Food combination diets for weight loss

Food combination diets such as the Zone are based on the idea that certain combinations of food will help a person lose weight. The Zone Diet was developed by Dr. Barry Sears to achieve an optimal metabolic state by reducing calories and eating the appropriate balance of proper sources of carbohydrate, protein, and fat to control levels of insulin. These diets may cause weight loss, but that is because they are low in calories, not because of a combination of foods. They are very hard to follow over time.

There is no scientific evidence that particular food combinations are needed to lose weight.

Rapid weight-loss diets

A very low-calorie diet (less than 1,000 calories a day) that causes rapid weight loss negatively affects your body in several ways:

• Your metabolism slows to conserve energy because the body thinks it is starving.
• Certain tissues, such as the brain and nervous system, need carbohydrate (as blood sugar or glucose) for much of their fuel. When not available from the diet, the body gets this blood sugar by breaking down proteins. This causes a loss of protein tissue, or lean body mass.
• Lean body tissues (muscle and organ tissue) are lost. During starvation or when eating a very low-calorie diet, about half the weight you lose is fat and the other half is lean tissue, such as muscle. On a more moderate diet, the loss is about 75% fat and 25% lean tissue. It is important to preserve lean tissue, since it increases your resting metabolic rate. Losing too much lean tissue increases the percentage of fat in your body. The result is a reduced metabolism. This is one reason it is so easy to regain weight when you lose weight quickly.
• Mineral and electrolyte imbalances can occur, which can be life-threatening. This is the reason low-calorie diets must be used under a doctor's supervision.
• Bone mass is lost. This is more risky for women, because they are the ones who diet the most often, and they are also at higher risk for developing osteoporosis.
• Finally, regaining weight is almost certain on these very low-calorie diets. This is damaging both physically and psychologically.

Rapid weight-loss diets are harmful to your health, unless you are monitored closely by a doctor. Don't use such a diet without talking with your doctor first. If you need to lose weight, it is better to lose weight slowly. You will be more likely to lose the weight safely and keep it off.

Low-carbohydrate diets for weight loss (Like Atkins)

Low-carbohydrate diets are based on the idea that eating a lot of carbohydrates, such as pasta, bread, rice, cereal, fruits, and starchy vegetables, causes weight gain. These diets are usually high in protein and fat.

The appeal of low-carbohydrate diets, such as the Atkins diet, is rapid weight loss in the first few days. However, most of the initial weight loss is water. Once you add carbohydrates back into your diet, your body will again retain water.

Over the long term, however, low-carbohydrate diets also result in a more gradual weight loss because they contain fewer calories. Recent research on low-carbohydrate diets shows that it isn't the reduction in carbohydrates that causes the weight loss; instead, it is due to decrease in calories.

Two new studies confirm those findings, suggesting that:

• People on a low-carbohydrate diet may eat fewer calories because the high-fat foods allowed in the diet are better at satisfying hunger.
• A low-carbohydrate diet may be easier to follow than a low-fat diet.

Both studies also found that the low-carbohydrate diets may have a positive effect on levels of certain fats in the blood—triglycerides and high-density lipoprotein (HDL, "good") cholesterol. Some people participating in the studies did have a increase in low-density lipoprotein (LDL, "bad") cholesterol levels, however.

One of the studies lasted 6 months; the other lasted 1 year. People in the 6-month study were either mildly or moderately obese and had high levels of LDL cholesterol or triglycerides but were otherwise healthy..

Findings of the 6-month study included:

• In the first 2 weeks of the study, people on the low-carbohydrate diet lost more weight than those on the low-fat diet, but the loss was mainly from water weight.
• At the end of the 6-month period, those following the low-carbohydrate diet lost more body weight and body fat than those on the low-fat diet.
• People in the low-carbohydrate group had lower triglyceride levels and higher HDL cholesterol levels than those on the low-fat diet. HDL is considered the good cholesterol.
• About a third of the people in the low-carbohydrate group had a 10% increase in their levels of LDL cholesterol by the end of the study. LDL is considered the bad cholesterol.
• People in the low-carbohydrate diet group were more likely to stick with the study for the 6-month period than those in the low-fat group.
• People on the low-carbohydrate diet had more side effects than the low-fat group, including constipation, headache, bad breath, muscle cramps, diarrhea, general weakness, and rash.
• Results of the study may have been affected by vitamins and other nutritional supplements taken by the low-carbohydrate group. This group took essential oils supplements containing fish oils, which have been shown to decrease triglyceride levels and raise HDL levels, and may have prevented some side effects of the diet, such as kidney stones.

The 1-year study of low-carbohydrate versus low-fat diets included people who were severely obese. Most had diabetes or metabolic syndrome. Findings included: 3

• The total amount of weight loss between the groups was similar after 1 year.
• Changes in total cholesterol and LDL ("bad") cholesterol were not significantly different between the two groups.
• Those in the low-carbohydrate group had more favorable levels of triglyceride and HDL. Low-carbohydrate diets may positively affect blood sugar levels in those with diabetes.
• This study was influenced by a high dropout rate and the fact that most people didn't closely follow the requirements of their diets: less than 30 grams of carbohydrates per day in the low-carbohydrate group, and for the low-fat group, eating 500 fewer calories per day with less than 30% of calories from fat.

The American Dietetic Association and American Heart Association do not recommend low-carbohydrate diets. People who have serious medical conditions, such as heart disease, type 2 diabetes, high cholesterol or high blood pressure, should talk to their doctors before starting a low-carbohydrate diet.

Because low-carbohydrate diets cause the accumulation of ketones, they may cause the abnormal metabolism of insulin, impaired liver and kidney function, and salt and water depletion. Also, low-carbohydrate diets usually are high in fat and protein, which can lead to impaired kidney function, constipation, and fatigue.

Also, the American Heart Association does not recommend low-carbohydrate diets because they often restrict healthful foods, such as fruits and vegetables, and do not provide essential vitamins, minerals and fiber.

Although research shows these diets may not be harmful for a short time (1 year), researchers believe more studies are needed. There are, however, long-term studies that show the health benefits of eating plant foods that are high in carbohydrates.

The American Dietetic Association recommends choosing complex carbohydrates such as whole grains, vegetables, and beans because they provide a large variety of nutrients and fiber. Simple carbohydrates, such as sweets and soda, are high in calories, provide few nutrients, and should be limited in any diet.

If you are pregnant, do not go on a low-carbohydrate diet because it can be harmful to your fetus.

Bravata DM, et al. (2003). Efficacy and safety of low-carbohydrate diets: A systematic review. JAMA, 289 (14): 1837–1850.

Yancy WS, et al. (2004). A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia. Annals of Internal Medicine, 140 (10): 769–779.

Stern L, et al. (2004). The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: One-year follow-up of a randomized trial.

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This information is not intended to replace the advice of a doctor.