The 5:2 Diet? Good, Bad or Mad?

Laura and Miriam asked me to comment about the Intermittent Fasting or 5:2 diet which has been attracting rave reviews on the “inter-web”.


Scientists have long known about some of the benefits of fasting for longevity. Fasting reduces levels of hormones like IGF1 (insulin growth factor), implicated in accelerated ageing and age-related diseases like cancer and diabetes. It also seems important to reduce your protein intake, so calorie reduction can’t be attained by eating lots of protein – a la Dukan.

Scientists at the University of Illinois have trialled a variant of continual fasting, which they describe as Intermittent Fasting. In an 8 week programme,  people eat fewer than 600 calories on 2 days a week with eating what you like on the other 5 days. They have claimed that it improves IGF and other ageing markers as well as enabling weight loss. Here I insert a warning, this trial was only for 8 weeks and we don’t know what happens in the long term.

There is a Fasting For Longevity movement in the USA. Members have been studied extensively. While they claim to have no issues with weight and eating, most show similar personality characteristics to people with anorexia and they display all the signs of people with classical eating disorders, preoccupation with food, cravings and high levels of emotional distress.

The 5:2 way of eating intended for longevity has been captured by the weight loss movement. Now there's a surprise!   For weight loss, this isn’t new. In the 1980’s it was deemed useful to eat sparingly during the week and eat everything you like at the weekend. Many people lost weight on this regime and then- hey - they put it all back on again. Feasting and fasting isn’t the good idea that it is supposed to be.

Behind the hype, even the BBC admits that current medical opinion is ambivalent about the benefits of fasting. Psychological opinion concurs. Fasting and feasting drives people into polarized thinking, good and bad day mentality and catastrophic reactions when dietary rules are breached. Apart for providing fodder for the pro- anorexia movement or the orthorexic community, this insensitive publicity may lead people to thinking that they are doing something that they should be proud of, when they may be doing something which isn’t really very good for them at all.

Let’s take some of the research which was NOT given head space by Michael Molesey and his team. A number of robust studies show that after one month on intermittent feeding, experimental aniamals show a series of behaviours similar to the effects of drugs of abuse. They begin bingeing, and during fasting periods there are withdrawal signs indicated by signs of anxiety and behavioural depression together with enhanced longing for sugar.

Brain imaging shows gross and complex changes in opioid systems such as decreased enkephalin expression in the appetitive system in the nucleus accumbens, with reduced dopamine levels (reward chemicals) and increased acetylcholine (stimulating appetite). The net effect is the creation of sugar dependency together with cross sensitising to other drugs of abuse.

Feasting and fasting thus risks bringing forth long term problems with control of food together with the emergence of compulsive behaviours and emotional problems too.

So with humans as with rats and other primates, it’s useless to test one set of behaviours in a vacuum for 8 weeks and present it as a panacea for weight and other issues. Mr Mosely may have felt good on this diet, but it's pointless for the millions of people out there who have eating disorders and for who this diet could make things considerably worse. I have given this issue lots of head space and I conclude that programmes like this are unbalanced and risk creating false hope for anxious people who are trapped in a poor relationship with food. As the man said, “fasting, like eating, is best done in moderation”

An Axe To Grind

Today I received this email from a young woman

“I am taking part in a 54 mile cycle ride from London to Brighton on the 16th September!

I have struggled with anorexia since I was 8 years old……. After two lengthy hospital admissions and being pushed to breaking point, I am now fighting back with the help of day care. I am not alone in my struggles, there are an estimated 1.6 million people in the UK suffering from an eating disorder; anorexia has the highest death rate of any psychiatric disorder. However, it doesn't just impact on the sufferer, …………. It isn't only the sufferer who requires help in coping and b-eat acts to provide such support.

I am fundraising to help show that eating disorders can be beaten and give something back to the services to which I owe so much for still being here today! Money will go to Beat the eating disorder charity.”

I struggle to understand how B-Eat can raise money through promoting excessive exercise, being done in particular by people who are struggling to recover from anorexia. Is this how we teach people to B-eat eating disorders and all its symptoms?

B-Eat, are you listening? I will give money to people you encourage to have a rest-in. I don’t think anything else is smart.

Debate?

The Wrong Treatment

Hi to all my bloggees, I've been away for a while just thinking about what I need to be paying attention to and watching the Olympics.
I’ve just had a 65 year old woman on the phone wondering how much we charge for treatment and if we had a helpline for her to pour out her troubles with lifelong binge eating.

I said, yes treatment costs money and a helpline won’t help you, only treatment will help you.

Have you had treatment before?

I hear that she has had some really good treatment. She has had “counselling”. Her counsellor told her to imagine that there was a bowl of sick in the fridge alongside all the other foods. Her counsellor told her that she would lose her toes if she continued overeating and that being fat made her a bad mother. Her counsellor knew bugger-all about nutrition and the brain. Her counsellor told her just to eat cereals whenever she felt cravings. Duuh?

Then she had really good CBT. Among other things this person told her to imagine that hair was all over her favourite foods. Was this CBT person an eating disorder specialist? She didn’t know.

Now she has spent some time at a slimming club. Her leader suggests that she should eat a whole chicken every time she wants to binge and this will cure her.

This poor soul has gone through this counselling travesty believing that she is a hopeless case. I told her that I was sorry for her, having such appalling “professional” help.

People with eating disorders need  Eating Disorder Specialists. They don’t need ex-sufferers or addiction specialists, or generalists, or therapies not grounded in evidence at the very least. Therapists can only play with their toolboxes when they have the right kind of training. This training must be very long and very deep.

I don’t know whether we will hear from this poor soul again. I hope we do. I hope that she can look inside her purse and come to us to change her life.
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Have you had lousy treatment?  Tell me all about your rogues galleries of bad therapists. We can put your stories up on the blog and stick pins in them. Or just stick pins in them.

Eating Disorder Recovery - What Helps

This is how it is from the view of sufferers

Its not just about being a good therapist. Or having the right tools.  We must realise how scary change can be. We must know what isnt helpful - that's the subject of my next blog!

The client is the expert, not us, as Emma Woolf showed us in her memoire of recovery, “An Apple A Day”. But, the client still needs us by their side as what… A therapist? A mentor? A guru? They need our wisdom alongside their own. They need our sense of humour and basic optimism. They dont necessarily need our University Degrees. They certainly dont need "what worked for us".

This is what they tell us aids their recovery; in no order of importance

Reconnection: – but not, I think the pro anorexia, community. People way that doing things like YOGA JOURNALING and SPIRITUALITY helps them to reconnect to themselves. Therapists take note!

Close relationships: Knowing that your family and friends really care about you and you are in reach.

Statements of support: "I know you're trying"  “I’m there for you” – what other statements are useful and what are not.? If someone says “You are looking better these days” it can send your client into a spiral of worry.

Empathetic Friends: Its useful if your friends know what they can and can't do and say.

Compassion: Eating disorders are such hard work.Compassion must flow from us to them and they need to learn to be compassionate for themselves whatever they are doing.

Therapy: it’s good to know that therapy helps as well, but looking forward is more important than looking back. Beware of therapists who don't know anything about nutrition, or the link between food and mood. But beware of therapists who focus on food instead of your general wellbeing.

Learning HOW to eat healthfully: Now there's a big chunk. There are so many food rules inside eating disorders, like being scared of carbs and counting all your calories. Wisdom, education, experimenting and reconnecting to natural cycles of hunger and satiety must be given by an expert not just someone who wants you to start eating more (or less).

This was in The Journal of Treatment And Prevention:  May-June 2012

The NCFED website tries to provide this help to people with eating problems. If there is anything that we can do or write to help people on their recovery journey, let us know. A quick email to admin@ncfed.com will always guarantee a personal reply from the Founder, Deanne

The Men Who Make Us Fat

Last night I walked down Marylebone High Street, London. Every two yards there was another place to eat, a Pain Quotidien, a cafe, an epicerie, a Costa Coffee and a cake shop from heaven. People were eating as they walked along the street.


20 years ago I walked down the same street and every 100 yards there was a place to eat and very few people ate as they walked.

40 years ago I walked down Marylebone High Street. There were no places to eat, lots of other shops and no one ate as they walked.

They assume that people who gain weight are weak willed. On the contrary, people who keep their weight stable have to work really hard 24 hours a day 7 days a week to avoid - like bouncing bagatelles- the food they see around them saying "eat me now, you will feel nice, I will give you a lift, you don't need to be hungry -you just need to be wanting a bit of fun and what's the harm in that".

On top of that are the dangers that we can't see; the men who made us fat have inserted them quietly into the food we eat. Corn syrup, tastes so nice but it is food that our body cannot deal with properly. Relax, have a beer, or a bit of ketchup on your chips. It will make you fat while it makes them rich.

Going shopping? Have a packet of crisps, it will reward you for doing all that hard work. They made it big so you would spend more money and feel virtuous because you hadn't bought 2. They knew that you would eat it all up in one go because thats what people do. And while you were scoffing, it made them rich.

Did you know that the food industry has blackmailed, denigrated, rubbished and possibly even murdered the people who wanted to tell you the truth? They have bought or crushed the politicians who could have done something about this. They wanted to make you fat so that you would need what they had to sell you.

And everyone is frightened of taking them on. See that bag of treat sized chocs? See that double caramel flavoured frappucino? JUST SAY NO.

Bulimia Suicide: Is Fashion To Blame?

A 14 year old doctor’s daughter has hanged herself. She has been suffering from bulimia resulting apparently from fat teasing at school. The coroner blames the fashion industry. He suggests that 30 years ago young women were not exposed to as many thin images as they will find now everywhere they look – not just in magazines. He is right.

The death of a young woman on the threshold of her adult life is horrible. Equally horrible is living with the stress of bulimia. Equally awful is the pain of having so many emotions that are so unbearable and overwhelming that the only way out is to self destruct in this final way.

We don’t know the full story; her parents had taken her laptop away and this is information which we don’t yet understand.

We do live in a different world right now which crept up on us silently like cats paws. So many things - not just fashion magazines - make it hard to float above the waves. 40 years ago I could walk for 5 minutes down the High Street without seeing one fast food joint, not one single restaurant and not even a coffee shop. People only ate at home.

I could go shopping without having to choose between 30 different types of crisps or 40 varieties of yoghurt and we bought our chocolate in bars so small that they were gone in just two bites.

I didn’t have to worry about being left behind in case I missed an episode of East Enders, or stay awake at night in case my friends were talking about me on Facebook. There was very little fat teasing since very few people then were fat.

I didn’t have to worry in case I couldn’t get into skinny jeans and cropped tops because they simply weren’t cool back then. We didn’t have to be exposed or die.

We were able to have fun in our own way without being in the glare of social media for people to comment on and pass judgment on. We were able to have fun without the need for drugs or drink.

Life went by more slowly, so even unhappy people had time to digest their emotions and try to make sense of them without the help of this army of counsellors and psychotherapies and peddlars of happiness that we have today.

So the coroner wasn’t quite right to pour blame on the fashion industry. There have been too many changes making it hard for anyone to survive their teens intact.

But why didn’t this young girl get proper help from an eating disorder specialist? Perhaps I could have saved her life. This haunts me. If you know a 14 year old with bulimia call me NOW! 0845 838 2040.

Anorexia And “Force Feeding”- Self Determination Or Self Annihilation

Today I was listening to LBC radio regarding decision in favour of the so-called force feeding of patient E. On Saturday Norman Lamont suggested that the decision to force feed could be an intrusion on her right to self determination . What complicates this case is that the parents of this young medical student,- anorexic since eleven years of age-wants their daughter to be left to die with dignity.

There is nothing dignified about anorexia or any other mental health condition for that matter. Also, I just wish that people would STOP using the term “force feeding”, which reminds us of the traumas inflicted on hunger striking suffragettes wanting to obtain the vote for British women. I just wish that people would use the proper term, which is ENTERAL FEEDING.

Many clinicians have been writing in favour of the judge’s decision on Linked In. We talk to each other about things we know, which is that low weight impairs the ability to think clearly. That at low weights the anorexic voice drowns out logic, reason and happiness.

But nothing said it better than Kate, who came nervously to the radio to express her point of view. Kate has been anorexic since age 9 and in hospital many times during her young years. She said “I have no idea why I just didn’t want to eat, but I didn’t, and there were times when I would have been very happy to just fade away.


“But they didn’t let me, and there were times when I was on a section and they threatened me with the tube…. No it wasn’t a threat, it was just something they said would happen but it felt like a threat at the time. Having no control over what they put in it was the worst thing imaginable for me.


But I somehow got to the age of 20 and I said to myself, I’m sick and tired of this anorexia. It took 11 years for me to admit I had a problem. So I made myself start to eat. I’m 24 now and life is so much better. Life isn’t a bed of roses but anorexia is very hard work; and I had enough.


I spoke to my father about it and he admitted that he had something like me when he was in his teens, but being a man nothing was said or done about it.”

The interviewer asked, “Everyone is saying that it’s all the pressure on young girls to be slim, in magazines and so on?

“Oh no”, she said, “When I was nine I hadn’t even seen a magazine. It’s nothing to do with magazines and models, it’s just the way the brain is wired”.

So there you have it from the people who really count. Clinicians know very little. Listen to the people who have looked into the pit and been dragged into the light, kicking and screaming. At all costs we have to arbitrate in favour of the wish to live.