Episode 214: This week on the show it is a solo episode where we look at the topic of restriction. Restriction can take many forms but is at the heart of the struggles of nearly every person Seven Health works with. It's a big topic that Chris shares his thoughts on.
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Chris Sandel: Welcome to Episode 214 of Real Health Radio. You can find the show notes and the links talked about as part of this episode at seven-health.com/214.
Hey everyone. Welcome back to another episode of Real Health Radio. I’m your host, Chris Sandel. The last handful of weeks, I’ve been starting the show talking about the fact that Seven Health is taking on new clients. At the time of recording this intro, we have just three spots left.
Client work is the core of the business, the core of Seven Health, and it’s the thing I actually enjoy the most. After working with clients for more than a decade, I feel confident in saying I’m very good at what I do. There are many things clients come to work with Seven Health for – getting periods back, eating disorders and disordered eating, being stuck in quasi-recovery, body image struggles and body acceptance.
For me, today’s episode is touching on something that is at the core of all of these. If you listen to this episode and hear yourself in what I’m covering, then I would love to help. You can head over to seven-health.com/help to read about how I work with clients and to also apply for a free initial chat. This will be the last time I’m starting with clients in 2020, and as I said at the start, there are just three spots left. If you are wanting help, then please reach out. The link again, is seven-health.com/help, and I will include that in the show notes.
This week on the podcast, I’m back with a new solo episode. Lately, I’d been feeling a little boxed in with the solo episodes, where I can’t do one unless it’s something I’ve done a ton of research on. These shows really take up a huge amount of time to put together. But I realised this isn’t the only way to do a solo show, and I can still give out lots of useful information without having to be so research-focused.
The intention with this one was for it to be a shorter episode that I knocked together pretty quickly, but once I started thinking about things and what I wanted to recover, it really grew into something much bigger than initially anticipated.
The topic for today is understanding restriction. Over the last 5 or 6 years, I’ve written a number of articles on restriction. I’ve also included it as part of podcasts when talking to guests, or it’s made its way into some of the other solo shows. The most notable recent time that that’s happened is the two-part episode on sleep, where I talked about restriction for a fair bit of Part 2 to start with.
But knowing that (A) not everyone listens to every episode or reads every blog post, I wanted to do this solo episode, and (B) there’s lots of things that I haven’t covered before and that I wanted to include here, where there is this one place where people can go to find out my thoughts along restriction.
Undoubtedly, I’m going to fail to include all of my thoughts. It’s amazing how often I finish one of these, the episode goes out, and then I remember all the additional things I wanted to say. I guess this is my incomplete attempt at doing a complete job.
I also did a recent interview with Carolyn Costin, and in it she mentioned binge eating quite a few times, and I’ve heard from at least one listener that this was confusing and didn’t seem in alignment with what I’d put out in regards to restriction and its connection to binges. With hindsight, I wish I’d done a better job in that interview and clarified her use of the term and explained my position more clearly.
As I’ll go through, I think the word ‘binge’ or ‘binging’ can have many connotations and can come with a lot of baggage. For so many people in recovery, there is this fear that they are secretly a binge eater if they don’t keep a tight grip on restriction, or that recovery is turning them into a binge eater. So I want to make amends for any confusion caused by that episode and really clearly lay out my thoughts on the topic.
As part of this show, I’m going to link to and make reference to other podcasts and articles connected to the topic, which I’ll add to the show notes. If you aren’t used to checking out the show notes and simply listen to the episode on your phone, I’d suggest for this one it’s probably worth going to the show notes and looking at all the supporting information and the stuff I make reference to.
I really want to say that this topic is crucially important. Restriction is at the heart of the struggles with basically every client I work with. As I’ll go through, restriction can take many forms, but in one way or another it really is being practiced by basically every client I see. I think this is an episode that is timely, but also long overdue.
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To start with, I want to go through the many ways that restriction can be occurring. Some of these you may instantly recognize as restriction, but for others it might not be so obvious, or some people might not think of it as being so obvious.
One is calorie counting, where some predetermined number is picked and then you eat in a way that means you match up to that number or you’re below that number – and it’s obviously just an arbitrary number.
Number two would be macros or macro ratios or focusing on macros, where you’re deciding what breakdown of carbs, protein, and fat you’re going to consume. This usually is to restrict one of the macros, so you’re going to be low fat or you’re going to be low carb.
Number three would be weighing food and making sure that you’re not going over certain amounts – again, arbitrary amounts that have been determined.
Number four would be following a specific meal plan. And this meal plan is less than what the body needs, so you’re following something that’s 1,200 calories or 1,600 calories or fill in the blank for the number that you have been recommended by someone, that you read in a book, that someone said on Instagram, wherever it is, but that is actually less than what you need.
Number five is avoiding certain categories or types of food. This could be avoiding carbs or bread or grains or not adding oils or fat to your food or avoiding sugar or dairy, etc.
Number six would be fasting or intermittent fasting or reducing your eating window or eating one meal a day – basically playing around with the times at which you let yourself eat and having some rules around when you can and cannot eat.
Number seven would be detoxes. This is normally for a temporary amount of time, so say for 4 weeks you have a liquid-only diet or you eat in a way that is cutting out whole chunks of categories of food. That could be supposedly ‘toxic’ foods or however it’s being presented as part of that detox. It could be sugar or gluten or whatever makes it in.
And then number eight would be following a specific diet, so paleo or carnivore or low fat, where there is this arbitrary list of foods that are good or bad foods or that you can and can’t have.
Those are a number of different ways that food is being restricted. Obviously, this is on a continuum, where things can be stricter or looser. There are times where it genuinely makes sense to restrict certain types of food. If you are celiac, restricting and avoiding gluten is a smart idea. It’s not that I’m against restriction or think restriction is bad in all cases, but the problem lies in that restriction typically leads to a reaction. It’s not something that is benign, and with time it starts to have a widespread effect on physiology and psychology, and that’s part of what I want to go through today.
There are three main types of restriction. I obviously went through lots of different ways that people can restrict, but these can then be broken down into three main buckets. I want to go through each of them, and I think it’s really important to understand this.
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The first is physical restriction, which is obvious, and this is what people think of when they hear the word restriction. This is when you’re say restricting your total calories, so this is below what the body needs. Even if you are eating a wide variety of foods, you’re not taking in what the body needs to match up for its calorie demands.
But it can also be restricting where certain categories of foods or specific foods are being restricted. Within this scenario, you could be either meeting your calorie needs but doing it while you’re restricting carbs, for example, or the restricting of certain foods can be happening in combination with the fact that you’re also not meeting your calorie needs.
With clients, I see this second option is much more common, where restriction of certain types or groups of foods also leads to a restriction of total calories.
Humans evolved when food wasn’t in abundant supply. If we failed to eat, and if we fail to eat, we die. It’s become imperative that we were bestowed with a mechanism that drove us with this desire to eat. When we eat less than we need, the tendency is for the body to want to consume more when given the chance. Your body doesn’t understand that you want to be thin or you want to be toned or you want to look a certain way that our society deems appropriate; it sees that you’re under-eating and it’s like, “Okay, this is a famine.” It wants to protect you by getting you to eat food when it does become available.
While in the short term, you can restrict or deprive yourself, as time goes on this becomes more difficult – which is why, for many people, they can restrict to start with, but at some point it results in times where they can’t keep this up and they start eating more.
How long it takes for someone to reach this point really depends on the individual. Maybe it’s a couple of weeks for someone. Maybe it’s a couple of years for someone else. But often there is a point when the ability to consistently restrict stops, and the restriction is then punctuated with times of eating more.
Now, just because you’re eating more, doesn’t mean that the body is now getting enough. It can still be not getting enough to cover your day to day needs, or if you are covering your day to day needs, it’s still not covering the debt that has accrued over the months or years or decades. I actually wrote a blog piece about this called “Your Body Is A Manor House” that goes into the idea of the repairs and fixing the damage that has accrued over years. I’ll link to that in the show notes.
There are those for whom the ability to restrict doesn’t stop, and they can keep it up indefinitely. While many may think that this is the holy grail and the place you want to reach, it really isn’t. As I mentioned earlier, we evolved to have a desire and a drive to eat because it’s important for our survival. Food and eating is crucial so that the body gets the calories and the nutrients it needs to do everything to keep you alive – but hopefully more than just alive, to keep you thriving.
So to be able to indefinitely restrict, thereby taking in less calories than the body needs over an indefinite period, that is a bug and not a future. It means that the debt is constantly amassing without something breaking this pattern. While having times of eating more or having binges are seen as a loss of control or a bad thing, they’re actually the body trying to deal with the increasing debt. It’s attempting to correct the imbalance between what the body truly needs and what’s coming in.
Many years ago, I remember reading the book The Gift of Pain. It’s about Dr. Paul Brand, who was a physician who went to India just after the Second World War, and he got interested in leprosy and wanted to know what was causing it and also what was leading to the horrible deformities that he was seeing. He discovered the answer to both of these questions. Leprosy is caused by an infection, and in terms of the deformities, one of the main symptoms of leprosy is it damages the nerves, and especially those of the skin surfaces, which leads to a loss of sensation – meaning leprosy sufferers become unable to sense physical pain.
He showed that the deformities in the hands and the feet and other areas of the body weren’t because of the disease destroying the tissue; it was because the sufferers weren’t aware that they had burnt themselves or cut themselves or pulled something. He tells the story of watching a leprosy sufferer cooking over a fire, and some of the food dropped into the fire. They tried a couple of times to save the food by getting it out with some sticks, but when this didn’t work, they just put their hand directly into the flames and grabbed it. Their hand was, of course, badly burnt, but they felt no pain.
Obviously, that is an extreme example, but in everyday life, leprosy sufferers can find themselves picking up a hot plate but not realising it because of the lack of sensation. They can dislocate a hand or a foot or an arm after a fall, but not notice it because there’s no pain sensation telling them so.
Imagine when you’re having a conversation with a friend. While having that conversation, you are naturally and unconsciously shifting your weight from side to side, to different parts of your feet, and going back and forth. If you were to stand still without moving a muscle, within a very short space of time you’d start to notice pain. It’s because keeping those muscles engaged for a long time can be damaging, so you constantly make these micro movements, engaging and disengaging different muscles – all of those without any thought.
The same thing when you walk or you run. You don’t hit the exact same spot on your foot with each stride. There are these tiny little shifts so that different parts of the foot take the impact. It can be in a similar location, so you normally strike with your heel or you normally strike with the front of your foot, but there are these subtle changes that mean the burden is being shared. Again, this is done unconsciously.
But for someone with leprosy, they don’t get this feedback. They can stand in the exact same position for hours, never shifting their weight and giving those muscles a break, or they can walk or run for 10K, never making the small changes to their gate but instead hitting the exact same portion of the foot. When this is kept up day after day, month after month, it leads to muscle atrophy and damage to the skin and tendon and structural problems.
This is the exact same with restriction. You want the body to give you feedback that you aren’t eating enough to support your body. If you didn’t get these messages, you’d be in trouble.
I know in many ways people wish that they didn’t feel pain, but as I just explained, this has some real drawbacks and isn’t the superpower that you may have thought it would be. The same is true with hunger. Many clients say that they wish they were never hungry, but the reality is, if this was the case, just like with leprosy, it would end very differently to how they initially imagined.
There are many clients that feel like they don’t get clear hunger signals. This is true, and it’s something I work on a lot with clients. But on closer inspection, when we do start to chat about this, this isn’t actually true. Maybe they aren’t getting a growling stomach or some overt hunger symptom that they connect to their digestive system, but they are getting many hunger signals.
I recently wrote an article called “You’re Really Just Hungry,” which looks at all the ways the body lets you know it’s hungry. People have just disconnected all these symptoms from hunger. They’re happening, but it’s just not registered as hunger; it’s chalked up to something else. I’ll link to that article in the show notes, and if you haven’t read it, then I highly recommend checking it out.
So that is the first type of restriction, which is actual physical restriction.
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The next type is impending physical restriction. What is impending physical restriction? It is when you tell yourself that some form of restriction is ahead. So you’re eating something, telling yourself that after this meal, you’re not going to eat for a whole day, or you’re eating a food and telling yourself that after this meal, you’re never eating this kind of food again. Or you’re coming up to a meal and you’re telling yourself that you’re only allowed to have a small amount of it – that say when you go out for dinner tonight, you’re going to control how much you eat; you’re not going to have a starter or have a dessert, and you’re just going to get something ‘healthy’. Maybe you even check the menu in advance and decide what you’re allowed to eat.
Or you’re reducing your eating window. You’re saying, “Now I’m only allowed to eat for 6 hours a day or 8 hours a day,” or whatever it may be. So while you’re eating dinner at 5 p.m., you’re telling yourself that you won’t be eating again until tomorrow morning. Or that next week you’re starting a new diet, so next week you’re going low carb. From next Monday, all the carbs are off the menu, and it will mean you’re just having lean protein and lots of veggies.
It’s basically all the ways that you’re telling your body that some form of restriction is just around the corner. Obviously, this backfires. The most common way is that your body does the opposite of restriction. If your body feels like a famine or a period of deprivation is just round the corner, then it will want to eat. It wants to stock up as a precaution.
Again, this makes sense from an evolutionary perspective. If food was in abundance in the summertime but was harder to come by in the wintertime, it would make sense to be able to eat more and stock up your reserves in preparation for the leaner food months ahead. So there’s probably some biological drive that is connected here where the body knows that “If we’re going to be entering into a period of famine, I need to be eating more in preparation.”
But there’s also a psychological component here as well, and this is especially true if someone breaks the restriction that they’ve set for themselves. Say you go out for dinner and you tell yourself in advance that you’re only allowed to have a main and nothing else, and then you arrive and you’re super hungry, so while you’re waiting you start to have some bread or some olives. Then it comes time to order, and already there’s this guilt that you haven’t followed the plan, so now instead of getting the ‘healthy’ option that you were going to get and that you had decided in advance when you looked at the menu earlier that day, you instead get something else.
Then you’re eating that and realising that you’ve messed up, and you really have already eaten too much. So now you decide that tomorrow, you’re going to make amends. Tomorrow you’re going to hit the gym hard and you’re just not going to eat much all day. Or maybe you’re going to go the whole day without eating anything at all. Then you get a dessert because the new diet starts tomorrow, and obviously today is already ruined.
Clients often talk about the experience of eating all the food before going on a diet. They decide that next week their new diet starts, and then the preceding week they feel this uncontrollable feeling around food, and they find themselves eating way more than usual. If the diet is going to be cutting out carbs, then they eat more carbs. If it’s going to cutting out fat, it’s eating more fat. If it’s going to be going vegetarian, it’s eating more meat and fish. They are preemptively stocking up on the foods that they’re not going to be able to have before the restriction starts.
I’ve previously written about experiments that have been done with milkshakes and ice creams. For those who are most restrictive in their thoughts and are restrained eaters, once they have foods like milkshakes and ice cream and break their diet rules, they end up eating the most. Because some threshold is being crossed or some food rule has been broken, it then becomes this ‘screw you’ mentality, ‘new diet starts tomorrow’, and they end up eating more than they otherwise would if there wasn’t this restrictive mentality.
I will link again to that article in the show notes that looks at the studies, if you want to check them out. But that is the second form of restriction, which is the impending physical restriction.
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The third form of restriction is mental restriction. This is where you aren’t physically depriving yourself, so you are eating the food, but mentally you’re not allowing yourself to eat it.
For example, you’re eating a chocolate brownie and therefore not physically depriving yourself of it, but while you’re eating it you are chastising yourself for eating it or trying to eat it so fast that it didn’t even happen. This is actually the case at the start of recovery. You are physically eating food that you fear, and in the beginning you really don’t want to be doing it. On one hand, you know that this is what recovery is about and that it is for the better, but on the other hand, you’re afraid of this food and what it will do to your body.
So there is this ambivalence, which typically means that physical restriction is disappearing or slowly disappearing, but the mental restriction is just as strong. This is completely normal, and it can take time to mentally get on board with all these changes, but the goal here is moving in the direction of leaving behind the mental restriction as well as the physical restriction and the impending physical restriction.
But obviously this isn’t always the case, and often mental restriction isn’t something someone is trying to get over. A dieter could have mental restriction go on for decades without ever wanting to get rid of it. They don’t want to be eating the cake or the ice cream or the chips or whatever the food may be, so they aren’t trying to get over the mental restriction. They’re just wanting to get better at the actual physical restriction.
If you have a mentality of not allowing yourself some food, even when you are eating it, then what is this saying to your body? It’s telling your body that it’s likely in the near future that this food will be off-limits again, that deprivation of this food will be starting, and then we’re back in the territory or the realm of impending physical restriction and potential actual physical restriction.
This is how these all work together, as really these three types of restriction are connected and they do overlap. Most clients, especially in the beginning, are experiencing all of these at once. It’s not one type or another. Typically there is a clear cause and effect relationship where actual restriction leads to the planning for further impending restriction, and when this isn’t ‘successful’ and when someone is eating something they wish they weren’t, there is then the mental restriction going on.
Because of this, they’re telling themselves that they aren’t allowed it, and this then prompts more restriction, more impending restriction, and the cycle continues.
This is why I believe that restriction is at the heart of all eating disorders and is at the heart of dieting. Whether we’re talking about anorexia or bulimia or binge eating disorder or orthorexia, restriction is at its core. Typically this means physical restriction and impending restriction and mental restriction. It’s not just one of them.
Maybe this is obvious for anorexia, but it may seem less straightforward for bulimia or binge eating disorder – the thought being, “How can this really be restricting? They are eating large amounts in a single sitting. How is physical restriction going on?” But even though there are moments of eating food, and seemingly large amounts of food, leading up to this, physical restriction is occurring. And then post this eating, physical restriction is occurring. Even if they are meeting their calorie needs because of the binge or because of this eating experience, the point at which it is coming in is only after a period of physical restriction and someone trying to avoid this occurring. It’s not about allowance.
This is the part of the Carolyn Costin interview where I wish I’d done better – that when she was talking about binges, that this was clarified. Working on binges on their own isn’t going to do anything if the core reason of restriction isn’t addressed. If the focus is that binging is the problem, this isn’t going to work when the binges are really a symptom of restriction.
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I think it would be useful to talk about binges here. This is definitely a messy topic because the word ‘binge’ comes with so much baggage. Where restriction and anorexia is thought of at one end of the spectrum, and bizarrely is often thought about as good and about control, the other end of the spectrum is binges, which is thought of as bad and a loss of control.
It is typical for clients to think of restriction and binges as being separate things, where they’re not connected at all. It’s amazing how many people I’ve spoken to who, while they were restricting and were able to consistently keep it up, didn’t see this as a problem. They actually saw it as a solution and being a really good thing. But it’s then when they started to binge that they saw things were going awry. This is when they noticed that they had a problem and they needed help.
For them, the restriction wasn’t the cause of the binges; the binges were suddenly this thing that has come out of nowhere and they don’t understand why it’s happening. Or maybe they think that actually, they were always a binge eater, that for a length of time they had it under control but now it’s back, and that this is their default and will be the way they’re going to be for the rest of their life unless they can get the restriction back in order.
I find it hard to get on board with many of the common definitions of binging. A couple of examples to sharpen it up a little bit is that binge eating is an episode of uncontrolled eating in which a person rapidly consumes an excessive quantity of food. Another example is an unstrained, compulsive, and excessive consumption of food.
The word ‘excessive’ really starts out for me here, because what does excessive actually mean? From many experiences with clients and from doing this for a really long time, ‘excessive’ can be highly subjective.
If you’re trying to keep calories below a certain amount, then eating a biscuit or eating a piece of chocolate, it’s easy for that to be thought of as being excessive and therefore a binge. If you believe that sugar is evil and is destroying your health, eating any amount of ice cream whatsoever could easily be thought about as a binge. Or maybe you’re trying to eat to 80% full or have some rule of what level of fullness you deem appropriate, and then you find yourself in a situation where you’ve gone above this and you feel overly full or just fuller than what you want, and you therefore rationalise that you’ve eaten an excessive amount of food and it seems logical to then characterise this as a binge.
For many people, what they are describing as a binge actually looks and sounds like very normal eating behaviour if they didn’t have strict rules and hang-ups around food and their body, and in other circumstances they wouldn’t think twice about it.
Or they’ve gone 14 to 16 hours since their last meal, so of course they’re going to eat more at the next meal. Or lunch was nothing more than a collection of salad leaves and leafy vegetables, so it makes sense that they’re eating more in the evening time. So sometimes ‘excessive’ can really be subjective and impacted upon just by someone’s restrictive thoughts around what they deem appropriate.
But also, ‘excessive’ needs to be thought about in the appropriate context, and this often means extending the timescale out when thinking about it. There can be times when what someone eats in one sitting is a large volume of food. They’re not just confused about why they’re hungry after having a salad for lunch; they actually sat down and ate a significant number of calories in one go.
But what about when we look at this in comparison to what they consumed across a whole day or across a whole week or across a whole month? Is it still excessive? If someone ends up having a binge in the evening but they consistently ate less that day than they needed at every single meal, is it really a binge, or is it really excessive? Or maybe that evening meal is the only meal that they’ve eaten all day. Or someone ends up having a binge for days or weeks, even, but preceding this they did a juice cleanse for two weeks.
Or in the case of recovery, when someone is hit by extreme hunger and they’re eating 3,000 or 5,000 or 10,000 calories in a day, but preceding this there were years and years of restriction and overexercise.
Typically when you look at the binge not just in terms of that one meal, but take in the longer timeframe, the excessiveness disappears. In actuality, the body is just trying to make up for the past restriction rather than this being about overconsumption. I actually can’t think of any client I’ve dealt with where there wasn’t physical restriction connected to their binges.
Lu actually wrote an article about binge eating earlier this year that, again, I’ve included in the show notes, and I really like her definition. She stated: “Binge eating, or reactionary eating, is a psychobiological response to restrictive thoughts or behaviours around food, overexercise, and other causes of prolonged and consistent physical energy deficits. In other words, binge eating isn’t simply what you do with food; it goes beyond behaviour to include your thoughts and feelings and demonstrates the intimate connection between body, mind, and emotion in response to restriction.”
What I like about this definition is that it encompasses all three of the types of restriction that I’ve gone through already – the physical restriction, the impending restriction, and the mental restriction. Binging doesn’t happen randomly. It happens as a response to restriction.
As I mentioned earlier, if the focus is trying to get over binges, say through willpower or trying to wait for the urges to pass, long term, this will backfire. Yes, you may be able to do it for some length of time, but if the underlying cause of deprivation and the energy deficit is still there, this won’t magically go away. The way to deal with binges long term is to deal with the different types of restriction that are occurring and to nutritionally rehabilitate the physical body and to change the mind and the emotions and the beliefs around food.
In the beginning, the binges will most probably get worse, or at least they won’t be reduced, even though more food is included at other parts of the day. But that is the order that things happen. This is a trap I see people getting into and that they’re hoping for: that they will start to make their changes to their eating and to their allowance around eating only after the binges are under control. But this is backwards. The way the binges start to decrease is by easing and abolishing the restriction and dealing with deficit.
I should add that sometimes there is a real protection of binges, so it’s not that everyone wants them to disappear. There can be this fear that I’m going to be telling someone that they have to stop doing this, or that this allowance is going to be taken away from them.
For me, this is never going to happen. I’m never going to tell anyone that they aren’t allowed to eat a certain food or foods or that they’re eating too much and it needs to be stopped. As I said, restriction is at the heart of all of this, so I’m not going to pile on and add my own restrictive thoughts because restriction is already occurring within that individual.
For many people, they feel like they are a binge eater or they are food-obsessed and this is a permanent state and it is never going to change. But again, this is something that is occurring because of restriction. There is a lack of allowance that is going on and there is a lack of actual physical food coming in. This is the driver. This isn’t a permanent state, even if it feels that way. It is the body’s response to restriction.
Can binging be occurring when physical restriction is no longer a problem? Yes, it can. But I think this is much less likely than most people think, and really as an idea should only be entertained once the physical restriction has clearly been dealt with. This can take months, and years in some cases.
I’m going to go through some of the symptoms connected to physical restriction so you can get a sense of “has this rehabilitation really occurred?” Because typically it hasn’t. And if it is occurring post-physical restriction, it’s connected to the mental restriction and the not allowing, or it’s to do with pending physical restriction, even if someone is then failing to be able to actually restrict. If binging is occurring post-physical restriction and once all the debt has been paid in terms of the energy debt, then it is really those other two restrictions that are at play.
And there may be exceptions to this. I can’t say that this is definitely 100% true all of the time. But this is what I’ve seen with the clients I’ve worked with and the people I’ve spoken with.
I should also add that often to deal with binges, there needs to be a change of language. The word ‘binge’ can actually get in the way of this because a binge means eating in an excessive way. It’s seen as this negative event that is going against someone’s progress, like it’s a really bad thing.
But as I talked about, from a physiological perspective, it’s something that is trying to save you. It’s trying to end the restriction. It’s trying to pay off some of the debt that has accrued. Far from being negative, it’s a mechanism that is keeping you alive.
Either there needs to be a reclaiming of the word ‘binge’ so that when someone hears the word or says the word, it doesn’t have those negatives associated with it – that to them, it carries the positives that I’ve described above – or a new word is used instead that better describes what is going on in a positive light. ‘rehabilitative eating’ or ‘repair eating’ or even just “I had a large meal” or “I had a larger meal,” and where ‘large’ or ‘larger’ isn’t a bad thing; it’s just a descriptor.
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I want to go through some of the reasons why someone may fail to see or fail to think that they are restricting. It’s one thing for me to look at the situation and have a view of why it is occurring, but what really matters is for the person who is restricting to see this. There’s many reasons why someone can be confused or not seeing what’s going on.
For some, they are very much attached to the numbers. They’ve been told by some online calculator that they need some amount of calories, or they read it in a book or a magazine, or a personal trainer told them this or Jillian Michaels said so. So they have this number in their mind of what an appropriate amount is, and they stick to it. This number is lower than what they need, but they just can’t entertain eating more because it doesn’t make sense that they would need more. This is their number, and so they just think that is all that they could need.
For others, they are actually eating a lot of food, but this food is high volume and low calorie – lots of steamed vegetables or rice cakes or corn things, lots of salads. They can be finishing meals feeling full or oftentimes over-full or bloated, but actually what they’ve taken in isn’t very high from a calorie perspective and is lower than what they need.
Sometimes connected to this is a statement I’ve heard many times, which is “I like healthy food.” There’s this feeling that “This isn’t restriction; I’m just someone who likes lots of vegetables and I really like salads. If this is what I like,” and they’re supposedly listening to their body, “how could this really be restriction?”
Interestingly, in this scenario, when we do start to focus on things like satisfaction and satiety and clients really tune into this, they realise that these meals aren’t as great as they first thought. They actually aren’t very satisfied. What they’ve been chalking up to “I like healthy food” is more of a cover for their fears around weight gain or eating too many calories or eating foods they deem unhealthy. They’ve convinced themselves that they are a ‘healthy eater’, but really with another layer of awareness, their preferences are there for a different reason.
Eating too infrequently can also be a problem and be a reason that someone isn’t getting enough calories coming in but not really noticing. This could be someone who’s eating three meals a day but they’re not snacking, but where each of these meals isn’t large enough.
But often what I see – and this is probably more common – is clients who are saving up more of their eating for the evening time or for a later part of the day. Maybe they do eat breakfast or they do eat some snacks earlier in the day, but the bulk of what they eat, say 60% or 70% or 80% of the calories, are coming in in the evening time or are starting late in the afternoon. Or in some cases they are just eating one meal a day, and this is in the evening time.
If the majority of eating is happening later in the day or in the evening time, even if you eat dinner to a point of fullness or over-fullness, this doesn’t guarantee you’ve covered the energy demands for the day, and most of the time it doesn’t. This one meal seems so large that it skews the perception of how much food is coming in, and that this must be enough food, or even that this must be too much food.
Exercise is another factor that impacts on calorie needs. The exercise is pushing up what someone needs, but they just don’t see it as a big deal or a big energy demand. This is especially true if someone was used to doing so much more and now they’ve reduced what they’re doing, or they used to be doing something more intense and now they’re ‘only’ walking. Even if walking is taking up hours a day, it’s just not thought of as exercise because of what they used to do previously. For them, it now feels like they’re doing so much less – which is true – but in relation to the energy requirements for their body, this reduced amount of exercise is still creating a situation where there is not enough energy coming in each day.
This can also come back to the energy debt part as well and the debt that has been accrued through years or decades of the overtraining and under-fuelling. Someone could get to a point where they are consuming a large amount of calories and amounts that could be matching up with or even surpassing what they used on that day, but with the debt that is still outstanding, the body is still physically deprived for what it needs.
This idea is actually connected with all of these examples. There is previous underlying restriction that has happened, and this has never been dealt with at all or dealt with fully. The issue isn’t just about what you did today; it’s also about what’s happened in the past and the fact that this hasn’t been made amends for yet.
Another reason someone may struggle to see what they’re doing is restriction is because they’re having binges or times of overeating more than they intend. So when they remember these incidents, it makes them feel that they are getting enough in, or more often that they’re eating too much. Regularly in response to this, they then increase their exercise the next day or they delay their eating the next day. But again, for them it doesn’t feel like restriction because obviously they just ate all of this food, and it’s clearly more than the body needs.
Another scenario is where someone is going out for dinner or going out for a meal on the weekend, maybe they’re going to someone’s for a barbecue, so it makes sense to eat less during the day or to ramp up the exercise during the day in preparation. To them, again, this doesn’t feel like restriction. It’s just what you do when you’re going to be in a situation where you’re having food that you haven’t prepared yourself or you’re eating in a way that is different to how you usually eat.
There’s probably other examples, but those are the most common ones that come to mind for how restriction can be occurring, but it just fails to be recognised as restriction.
Because it can be so hard for many people to get their heads around the fact that they may be restricting, sometimes it’s easier to take the focus off the food and put it onto the symptoms because there’s many symptoms that can be associated with being in a malnourished or restrictive state. This is something I cover in detail in the two episodes I’ve done on the Minnesota Starvation Experiment, which, if you haven’t listened to, you should. They’re Episodes 42 and 147 of the podcast, and I’ll link to them in the show notes.
Tabitha Farrar’s book Rehabilitate, Rewire, Recover! also does an excellent job of going through all the various components and symptoms that occur because of restriction. I’ll link to the book, again, in the show notes. It is definitely worth checking out.
I also want to add that restriction can happen at any size. Restriction isn’t only a thing if someone is emaciated and matches up to the stereotypical idea of what an anorexic looks like. This is a huge stumbling block for many people and it’s a real myth. They think that if they were really restricting, they would obviously be completely emaciated, and that’s not the case so obviously restriction is not occurring – which, again, is why I find this list of symptoms so helpful. If you have many of these going on, then restriction is likely at play even if you don’t feel like you’re restricting your food.
I’m going to break these down into different categories or groups. Some of these overlap and could appear in a different section, so it’s not so much about where they appear; it just seemed to make more sense to be able to break them down this way.
00:47:16
There’s physical symptoms that you will likely recognize. Feeling cold and an increased sensitivity to cold. Poor sleep, with difficulty falling asleep, staying asleep. Increased nightmares, maybe getting night sweats. Restlessness.
Increased digestive upset, so gas or bloating or constipation or loose stools or undigested food in your stools. Acid reflux. Delayed gastric emptying or stomach emptying. Decreased metabolic rate. Decreased libido, often with menstrual cycles becoming irregular or stopping altogether in women and lack of erections or erectile dysfunction in men. Vaginal atrophy, leading to pain with sex, or vaginal itchiness or dryness. Brittle hair, nails, and skin, where these grow and repair more slowly. Poor dental or gum health.
Increased craving for salt. Increased desire for hot beverages, especially caffeinated drinks. Decreased pulse. Low blood pressure – and this can lead to occurrences of dizziness and feeling faint, especially when getting up from lying down or sitting down or with exercise. It can lead to actual blackouts. Hyperglycaemia or low blood sugar, which can also lead to dizziness and feeling faint as well as nausea. In extreme cases, this can be deadly.
Heart palpitations. Increased frequency and urgency of urination – and this could also be happening throughout the nighttime. Muscle cramps and pain. Counterintuitively, this can sometimes be worse in the beginning when someone starts to rest or have a cessation from exercise.
Oedema or swelling. This can happen all over the body but is common in ankles and feet and legs and arms and under the chin and the cheeks and around the eyes.
Decreased training performance or ability to exercise – although with something like walking or other sports, this can often be overridden. Often in the beginning, as the body is spiralling with this stuff, exercise performance can even increase. But at some point this starts to stop.
Cuts being slow to heal and bruising more easily. Increased incidence of bone fractures or injuries. Elevated carotene in the blood, which can lead to yellowing of the skin.
There can be immune system changes. For some people, this means lots of recurrent infections and issues going on, and for others this means never getting sick.
Anaemia or lower amounts of red blood cells, which are the ones that carry around oxygen. This can lead to lower energy, but some people don’t notice it as lower energy per se; they just have this feeling of being tired and wired.
There can be difficulty swallowing. There can be lanugo, which is the fine hair that develops over the body.
There can be an increased pain threshold. Basically, you become more numb to physical body signals – which is why, often, people can push through with the training and the exercise even when their energy levels are lower and in other circumstances they would be pulling up and stopping.
Physical symptoms that you won’t necessarily recognise can be a reduction in heart size, brain atrophy, bone density reduction. Obviously you can recognise these if you’re getting scans or they’re being investigated, but in your day to day you won’t recognise them.
00:51:34
There’s then mental and emotional symptoms. There’s increased neuroses with things like depression and anxiety and hypochondria and hysteria. This can lead to suicidal ideation. There can be increased irritability and impatience, and this is especially true the hungrier someone gets, even though they won’t necessarily notice this as hunger. There can be increased paranoia and defensiveness.
There can be increased food thoughts, and these can be obsessive food thoughts; they can also be anxiety-provoking food thoughts. There’s a hyper-awareness of food and movement, so noticing what other people are eating and being triggered by comments or other people doing exercise or other people dieting. There’s a fear of eating too much or of eating calorically dense or supposedly unhealthy food. There can be a fear of weight gain.
Regret and guilt because of eating. Eating becoming highly emotional. This can mean that it can be incredibly difficult and incredibly challenging emotionally as well as it being really prized and defended and the highlight of someone’s day. Dreams about food. There can be a fear of stillness and stopping.
Difficulty focusing and concentrating and retaining information – although in the beginning, the ability to focus and concentrate can get better. There can be a loss of ambition. Feeling more alone and shut off, which in reality can also be the case, where someone is isolating more and spending more time on their own.
Indecisiveness. This can be with food choices and what to have, but it can be indecisiveness in general, in life, in all decisions.
Obsession with weight and with body checking. A sensitivity to noises and crowds. Many clients are already Highly Sensitive People, and this makes things even worse. I did a whole podcast on HSPs, and that’s with Barbara Allen. It’s Episode 190, so you can check that out if that’s a topic that interests you.
The dulling of senses and emotions, so someone feeling numb. An increased incidence of disassociation. Often as a coping mechanism to deal with exercise or the difficulties of life, they disassociate. It can be body dysmorphia and seeing your body differently to how it is in reality.
00:54:27
Then there’s behavioural symptoms. Increased length of time with your meals, eating more slowly. Eating foods in a specific order or other rituals around eating. Or if you’re eating something that you ‘shouldn’t’ be eating, you could be eating it very quickly or eating it while standing up or eating it while watching TV or doing something else to distract yourself.
There can be chewing and spitting of food, or the regular use of chewing gum or low calorie sweets. The avoidance of eating in front of other people. An increased interest in preparing food and reading recipes and buying cookbooks and watching food-based TV programs or watching cooking shows or food stuff on YouTube.
Increased walking and housework and standing and fidgeting and pacing, and favouring occupations that allow for movement. There can be a reluctance to participate in activities where the body will be viewed by others, say swimming. This is true even if somebody’s body matches up to society’s standards and they supposedly have nothing to hide.
There can be possessiveness and hoarding cookbooks and recipes and keeping the fridge and cupboards completely stocked with safe foods, but also hoarding of non-food items – plastic bags or magazines or cleaning stuff.
Kleptomania, an urge to steal. This can be food items but can also be non-food stuff. Eating food out of dumpsters or food that’s been thrown away. Compulsive spending or being extremely frugal. Those are at opposite ends of the spectrum, but both can occur.
Prone to forming strong habitual habits or increased OCD or OCD-like behaviours. A focus on trying to take care of everyone else instead of yourself. An increased ability to lie, particularly in connection with food. This isn’t always the case, but if someone isn’t ready to give up the disorder and they’re being challenged, then this can be the case.
That is a long but incomplete list of the many symptoms that can arise because of restriction. Some may occur earlier than others, and others, it’s occurring much later and when they’re more in the depths of being in energy debt. You won’t necessarily have all of these if you’re restricting, but if you are hearing that list and noticing that you’re experiencing many of them, then restriction is the likely driver.
00:57:25
One final piece I want to mention before I start to wrap this up is the concept of cognitive dietary restraint. Cognitive dietary restraint is the perceived ongoing effort to limit dietary intake to manage body weight.
It’s the mental burden of trying to keep up restriction – to cut calories or to cut carbs or to avoid certain foods with the intention of modulating weight. This would typically be because you’re wanting to lose weight but also could be to maintain a specific weight.
This is the burden that happens across all three types of restriction I’ve touched on, whether we’re talking about the burden to actually restrict, to plan to restrict, so the impending restriction, or the judgment and the mental anguish when you’re eating something that you are telling yourself you aren’t allowed.
The key thing to understand with cognitive dietary restraint is that it is a mental process. It’s not actually having to happen in reality. Someone could be following a strict diet and experiencing cognitive dietary restraint, or they could be not following a diet but simply thinking about their body weight and that they should be restricting and feeling like they’re failing.
This means that cognitive dietary restraint is separate in its actions to the changes that happen in the body because of actual reduced calories. Often they go hand in hand, but they can be looked at separately.
Why this is important is that the consequences of restriction or dieting don’t only occur because of the malnutrition or when a certain level of weight is lost. Irrespective of weight, the mental and emotional impact of cognitive dietary restraint impacts on health.
I’ve actually done two podcasts on the topic. They’re titled “How Your Thinking Affects Your Health,” Part 1 and Part 2, and they’re Episodes 102 and 127. Again, I’ll link to them in the show notes.
The reason I’m mentioning them is really just to add an extra layer to this idea of restriction because, as I go through in those episodes, many of the issues that occur in the studies that I look at aren’t being driven by physical restriction. Sure, it is part of what is going on, but the mental component and the amount of cognitive burden that it places on the body contributes to the real physical symptoms.
It’s a good example for why just eating more food, while this is essential, isn’t enough. The mental repair and the changed relationship with food a la the mental restriction piece is so important. Without that final hurdle or that final piece, even if the calories are coming in, the healing is not going to be complete.
I want to close out this episode with a couple of thoughts. The more you try and control your food, the less control you will actually have over it. In the short term you may gain some control, but over the long haul you will lose your grip. This is true whether this means you’re ending up in a binge-restrict cycle or whether you are able to keep up the restriction and are able to be continually rigid.
This rigidity then stops being a choice. If you wanted to do something different, you then can’t. So it’s no longer that you are controlling your food; it is that you are being controlled by food. Being able to stick to something isn’t proof that you’re in control if you are then unable to do anything different.
Too regularly, there is a focus on weight and becoming weight-restored as the goal – that at some weight or some BMI, this is when things are better. But for me, this doesn’t make much sense. Why does some arbitrary BMI determine that things are better?
Restoration is complete when symptoms have corrected themselves, not when some weight or BMI is reached. Weight is a poor predictor of rehabilitation, and the focus on it as the arbitrator of restoration really is a problem. It keeps weight as a focal point when its significance really needs to be drifting into the background.
[Note: Don’t misconstrue the quote above, I’m firmly in favour of weight restoration and believe it is essential to recovery. What I’m arguing is that we don’t know where this weight point will be in advance of the process. So rather than aiming for a specific weight, recovery and weight gain needs to continue on as long as it needs to. That it will be the body, and the symptom abatement, that will tell one that the restoration has occurred. And rather than continuing to focus on a specific number that one is aiming for, instead have the worry about the number drift into the background because you are prioritising the habits and practices that lead to full recovery.]
If you want to know that restriction has now been abolished and you’ve dealt with all of the debt that had occurred over the months or years, you are much better going through the list of symptoms that I read out than focusing on weight. When you are physically better, when you’re emotionally and mentally better, this is when restoration is complete.
This isn’t to say that this will all be about restriction. Potentially there are mental and emotional things that you will still need to work on with a therapist, and there’s regularly issues and incidents that predate an eating disorder or predate the restriction that need to be dealt with. So I don’t want it to sound like repairing restriction is everything and that everything will be repaired when this is dealt with, but I think the symptoms list is a much better guide than the number on a scale if we’re thinking about the restriction piece.
That is it for this week’s episode. As I said at the top, I’m currently taking on new clients. At the time of recording this, there are just three spots left. If restriction in any of its forms is part of your life and you want help getting past it, then I would really love to be able to help. Or if you struggle to think of what you’re doing as restriction but that list of symptoms I went through matches up with your experience, then please reach out. You can get in contact by heading to seven-health.com/help.
That is it for me. I’ll be back next week with another show. Have a great week, stay safe, and I’ll catch you then.
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Thanks for explaining this so well! I feel like I can really relate to a lot of what you are saying! I used to always be in a permanent state of restriction but since doing years of therapy for dissociation from childhood trauma, I find it much harder to restrict. I believe this is a sign of healing, but I keep cycling through trying (and failing) to restrict because I really believe (perhaps falsely) I won’t lose weight if I don’t restrict.
Also please correct me if I am wrong but it seems like most of your clients are women who have their own income. I am a stay at home mom with 5 kids. Do you work with many stay at home moms? Just curious.
Fantastic article, thank you so very much. I have every single symptom in spades. My only hesitation in purchasing your program is that you never actually address how to achieve and keep a normal sized body. You seem to have a more HAES approach. I will never accept living in a fat body. I’d rather binge and purge forever than be obese. I’m not finding a reasonable solution out there, outside of surgery-that I can never qualify for because I’m not fat enough. BLE is too religious for me. Keto OMAD between binges seems to be a crutch that allows me to get away looking fairly normal. I’m sure its only a matter of time for my myocardial infarction.