How do people with eating disorders (specifically not eating enough) manage?

Miscellaneous and Personal Stuff I Must Share
41

I have reactive hypoglycemia. I produce more insulin than necessary to deal with sugar overloads, and so getting too much at once produces a “crisis,” or crash, where my sugar can get very low-- I’ve been walking and talking rationally with blood sugars below 50. Someone not accustomed to sugar lows would pass out.

My doctor says my brain has learned to function on ketones, and that’s why I don’t pass out. The bad part of that is that I have recorded sugar lows as low as 20, and that’s when I’m feeling shaky and dizzy-- the way a normal person would feel with a blood sugar of 70 or so.

But, 0 is dead, so matter how well your brain may function on ketones, your body dies with no sugar at all.

That’s one reason the constant glucose monitor is so important to me-- it lets me know when my sugar is below 65, by sounding an alarm on my phone. I rarely feel loopy at 65, when a lot of people would pass out.

So the short version is that your body can learn to deal with a lot of things, but doing so, while keeping you alive in the short-term, may not be the best thing for you long-term.

People on essentially a starvation diet are doing their bones and organs no favors. Adrenalin, and the ability to use ketones, may keep them going when they are young, but they are candidates for osteoporosis, and early-onset organ failure, as well as a lot of other problems from not healing well from things time after time when they were young, and it mattered less.

I’ll let the doctors explain more in-depth, because IANAD, just someone who knows a lot about their own condition. I’m still likely to wander afield, if I try to be too much of an expert, or to just write a TL;DR wall of text. MDs know more, and have more experience explaining it to people with not much background.

42

I didn’t mean to suggest that a keto diet was a good idea as a long-term or permanent diet. If my post came off as seeming to suggest that, thank you for pointing it out. It is meant to trick your body into believing it’s starving, so it goes into fat-burning mode. Not a good thing to be doing for years at a time obviously, especially after reaching a weight loss goal. My doctor told me when I was on the diet not to do it for any longer than 4 months.

I was using my keto experience as an extreme example of avoiding the sugar spike-and-crash cycle. A good middle ground between that and eating a simple carb heavy, low-fiber diet would be eating a diet of mostly unprocessed foods with lots of fruit and vegetables; high fiber and complex carbs, very little to no sugar other than the sugar from natural sources like fruit, which is delivered with fiber.

43

Just to be clear to folks who are unfamiliar with the term, bonking is not feeling tired, hungry, or flat. That’s just a normal body response to lots of exercise. Bonking is your body running out of glycogen for your muscles, which has much more serious implications. Common symptoms include:

  • Extreme physical weakness
  • Nausea
  • Poor Coordination
  • Shaking hands
  • Dizziness
  • Cognitive impairment

Having a gel once you bonk isn’t going to solve the problem. You’ll need time to recover.

44

Well, right. Kinda the same thing, or near enough. Horrible story.

45

I do agree with you there. Very sad for all parties.

46

  That’s pretty much what the Wikipedia says about his death.  Apparently, he had a close friend that was murdered, which triggered the start of some serious paranoia on his part.  He only trusted food that was prepared by his wife, and when a stroke left her unable to prepare food for him, he starved to death rather than eat anything prepaid by anyone else.

47

Quite a bit.

I had gotten to the point where I couldn’t even eat a hamburger. I even had to spit out the first bite.

One bite of pasta and I was done.

Now, I’m pretty much back to normal, but several pounds lighter.

48

Or, I gather, rather than prepare his own food?

49

I had the same thought. Ok, most men of those times couldn’t cook, but I assume you can live fine on just sandwiches if you keep a certain variety, and everybody can fix a sandwich, I could do it at age 8. So the real reason he starved himself to death must’ve been mental illness.

50

A lot of those guys were brilliant in certain fields, but had trouble with ordinary matters. I read Niels Bohr or somebody like that would show up at the secure compound inside Los Alamos wearing mismatched clothes, and a rope belt, Jed Clampett style, whenever his wife was out of town. Much hilarity would ensue.

Johnny Von Neumann’s wife wrote that she became ill and confined to her bed. She asked Johnny for a glass of water. He was gone for about 10 minutes or so, and when he returned he asked “Where do we keep the glasses?”. She pointed out they had lived at that house for 17 years. LOL

51

I can answer this from a personal perspective.

I was a decent high school track and cross country athlete in the US (I never won anything big, but coaches from D3 schools came to talk to me). On my 19th birthday, about 9 months after the end of high school sports, I was diagnosed with celiac disease with the highest intestinal damage score (Marsh 3b). I was deficient in all the fat-soluble vitamins (A, D, E, K), iron, B6, B9, B12, and maybe some other stuff I forget. I had also lost a lot of weight and a disproportionate amount of muscle (serum albumin was low too). This had clearly been going on for my whole high school career but was just diagnosed late (only when I had such a Vit E deficiency that I had neurological issues).

In my case, it was purely willpower. This fit in with the general advice about willpower given to childre who run middle-distance about how it’s going to suck but you have to power through etc etc. I interpreted my body sensations in that context and understood it as normal.

I think ketosis has something to do with it to. One’s body adapts to keep one alive in the context of reduced oral intake.

52

Bob himself can just about handle heat-and-serve, which was much less of an option in the 1950s than it is now. I’m guessing Godel either never learned anything about cooking (either due to gender roles of his time or simple lack of aptitude, which is Bob’s situation. His mother swore she’d at least tried to teach all three of her kids to cook, and Bob’s brother is quite competent in the kitchen), or mistrusted his supply sources such as grocery stores. Or both, given his known mental issues.

53

You’ve used that diminutive form of his given name twice in two threads in just a few days.

I’ve never heard anyone anywhere use that form for one of the great minds of the 20th Century.

Do you know something other scholars don’t?

54

Your Concern Has Been:

[X] Noted

[ ] Not Noted

As it happens, everybody called him “Johnny”. Hope that’s OK, and doesn’t impinge on any delicate sensibilities.

55

I’d just never heard it before and wondered where you’d gotten it from.

All good. Thank you.

56

I find that whole story interesting, and another illustration of how bad people can be at assessing risk (not withstanding mental illness). The guy wouldn’t eat food prepared for him by anyone other than his wife because “fears.” And when she became unable to do so, he instead took the safer path by starving to death?

57

My FIL was a brilliant structural engineer, but could not manage to make instant coffee in the microwave. He always forgot that the coffee is better if you stir it to dissolve the powder/crystals. And the extent of his cooking skill was to make a cold cheese sandwich.

58

Yes I heard the same thing. I happened to be at a meeting at U. Durham in England and a close friend of his spent 15 minutes on the phone (in the days that a transatlantic call was very expensive) trying in vain to convince him to eat. He died a few months later.

59

The muscles use different energy sources at different times and intensities of activity. At lower intensities the body can use fat for fuel, but at higher intensities of cardio your body uses a lot of glycogen stored in the muscle and liver since the body can’t break down bodyfat fast enough to use it for fuel at higher intensities. Glycogen is carbs stored in the liver and muscles.

Eventually your body gets depleted of glycogen (theres like 500g of glycogen in muscles, about 100g in the liver, so about 2400 calories of carbs stored in the body). When that happens all your body has left is what you eat, what glucose your liver can produce, and your fat stores.

The body can’t produce energy from fat stores or from generating it from the liver fast enough in this situation, so the brain and muscles run low on energy and the person collapses/bonks/hits the wall.

You may be burning 1000 calories every hour in exercise, but maybe your liver is only producing 100 calories per hour of glucose via gluconeogenesis and your body is only using 500 calories every hour from broken down bodyfat. So your brain and muscles run out of fuel.

My understanding is the brain is the limiting step. Tissues like muscle can use a half dozen forms of energy, but the brain can only use 2. Glucose and ketones. You can get glucose from what you eat, or from glycogen stored in the liver, or from glucose produced by the liver. But it can take a day or two of fasting for the brain to start making ketones in adequate numbers to keep the brain fed. A person can get hypoglycemia and have severe health issues if they aren’t eating carbs, don’t have any liver glycogen, the liver can’t produce enough glycogen and the body isn’t producing ketones enough yet.

The brain needs about 500 calories a day of energy from glucose or ketones. If it doesn’t get that you get hypoglycemia which makes you confused and can possibly kill you.

60

Just out of curiosity, have you had a fasting and post prandial insulin test to see how much insulin you are producing?

Also have you looked into the hypertension medicine like verapamil or nifedipine as a possible therapy for reactive hypoglycemia? The beta islet cells in the pancreas that produce insulin have calcium channels on them, Nifedipine blocks them, reducing the amount of insulin the pancreas releases. Some studies have found relief from reactive hypoglycemia from taking them.

https://pubmed.ncbi.nlm.nih.gov/3762399/

https://www.sciencedirect.com/science/article/abs/pii/S1530891X20403465

Diazoxide is also an option. Obviously your medical team would know better than me, but I don’t know if they’ve discussed them as options.