When we place fitness and health high on our lifestyle priority list, being more conscious and intentional about our food choices just comes with the territory. We’re aware of the macro-nutrient content and caloric value of food, and a little more in tune with how much food is necessary to nourish our body and keep it healthy.
There’s no arguing that this higher level of awareness and knowledge is a good thing, considering that overconsumption (especially of highly processed foods) is one of the main reasons we’ve got a growing epidemic of obesity and poor health. Indeed, it’s a great thing. Mostly.
Yep. Mostly. There is a bit of a dark side to being so aware about the details. There is an invisible line that can be easy to cross without even realizing it, beyond which many well-intentioned women develop concerning health issues.
What kind of issues? The kind none of us sets out to find when we adopt what we envision to be a healthy lifestyle—low bone mineral density, poor exercise recovery, loss of their periods (known as oligo- and amenorrhea), sleep disorders, anxiety, depression, and an inability to gain or retain healthy skeletal muscle tissue.
No matter how lean or fit some of us are or become, poor body image and constant comparison can drive almost anyone toward unhealthy thoughts and behaviors. Instead of appreciating the wonder and beauty of our bodies as they are right now, we think negative thoughts and criticize ourselves for not being lean enough, strong enough, muscular enough, or perfect enough.
All that unrelenting criticism can take you to a place where you’ll never be happy in your body no matter what it actually looks like. And here’s where we begin to approach that invisible line between using that awareness and knowledge to nourish your body and fuel your life, and using that same knowledge to exert control and chase after goals that become ever more unattainable. This can lead to the health problems I mentioned above.
In clinical terms, this is referred to as Cognitive Dietary Restraint (CDR), and is defined as “the conscious attempt to limit and monitor food intake to achieve or maintain a desired weight”.1 It’s controlled by our own thoughts and beliefs, rather than by rational physiological cues like hunger or nutritional requirements.
Cognitive Dietary Restraint is highly associated with menstrual disturbances among women, which include missing a period every few months (Oligomenorrhea) or complete lack of menses for more than 6 months (Amenorrhea). 2, 3, 4 Along with menstrual changes, a woman can experience increased cortisol, decreased bone mineral density, increased bone fractures, and changes of the not-so-good kind in their Leptin, TSH, T3 and T4 hormones.
Some women may not have any of these symptoms, while others only experience a few, and others experience all of them. Each individual woman’s susceptibility to stress influences how the restraint of food affects her overall stress and perception of stress.
Some women are very sensitive to any kind of stress, leading to all kinds of negative outcomes. Other women can keep on keeping on, no matter how stressful the situation is.
Perhaps these differences depend on each woman’s personal support system (her family, spouse and friends), and her history of self-love and appreciation (has she always criticized her body and been critical of other’s bodies around her?). It’s hard to say.
Sadly, as a Registered Dietitian in the fitness industry, I meet many women with only the best intentions, who look fantastic and are very physically fit. Yet they absolutely detest the skin they live in. They constantly restrict their food to the point of social isolation, with the goal of looking and feeling better. Instead, they feel worse and end up in poor health and lacking vitality.
I was recently consulting with a married couple, and the woman, who was very lean and fit, wanted me to help her lose the “love handles” she had. When she lifted up her shirt to show me, what she revealed was a lean six-pack.
Understanding we’re often our own worst critics, I gently spoke about ways to develop a little more appreciation for what she has and to celebrate her fit physique and all she can do with her body. I also discussed some things she could do to lean out a bit, if she really wanted to (she was enjoying a beer and munching on some crackers while we sat and talked in the hot summer sun). But would those sacrifices even be worth it, or could she be happy with her body where she was right now?
I too have been down this path. In the name of fitness I used to weigh or measure all my food meticulously, so that I could calculate the exact calories I was putting in my body, striving to never go over 1200 calories a day. I traveled with a food scale, or with all my food pre-measured and packed. I was scared to be in a social situation for fear of eating a “forbidden food.”
I was lean, sure. I was also incredibly unhealthy and unhappy. Even when I was measured at 10% body fat on a DEXA, which is very low for a woman, I still never thought I looked good enough.
The author then at 115 lbs. (L) and now at 138 lbs. (R)
At the time, I was amenorrheic (which lasted for five years!), had elevated cortisol, low T3 hormone, high lipoprotein(a), and was always stressed out. I absolutely had to be in the gym every day for at least two hours or I would freak out. I had a very hard time sleeping, so I took sleeping pills. Like I said, I was lean, but not in a good place. I hated myself.
These days I weigh a lot more and carry more body fat. But I am happier and more balanced in my everyday life, and don’t envy extremely lean women anymore. If a woman is genetically built that way, great for her. Since I’m not, I won’t destroy myself to be something I’m not. And, I don’t encourage anyone to do that.
So how can you strike a balance between eating well and staying healthy?
I’m totally on the healthy eating bandwagon, but now I educate women to eat well, within context, including foods they may have previously considered taboo. Ice cream on a hot summer day? A cold beer while camping with your family? A nice dessert to celebrate a life achievement or birthday? None of that will lead to fat gain or negative health effects overnight. All of these indulgent foods can fit within the context of overall healthy eating habits.
If you have any of the issues associated with CDR, you can turn it around by reframing the way you think about food and your body.2
Many nutritionists suggest taking an 80/20 approach—80% of your meals are wonderfully balanced with natural proteins, fats and carbohydrates, along with plenty of water-rich beverages, while the remaining 20% might be foods with more sugar or rich with fats. The key is to steer clear of the “all-or-nothing” mentality.
The bigger picture is what is most important—you are healthy, active and knowledgeable about what eating well consists of, and you practice these habits most of the time, with a little flexibility and no guilty or judgmental feelings about it.
Overall, eating a healthy diet should not make you physically and psychologically unhealthy. Yes, you can reduce your body fat, but approach it reasonably. There’s no need to run yourself into the ground in the name of a six pack. Appreciate your body today for what it has to offer: strong legs that help you run mud runs, amazing abs that allow you to work a hula hoop like a pro, and a healthy heart that pumps blood to all your muscles in all your activities, big and small, and never quits on you.
- Waugh EJ, Polivy J, Ridout R, Hawker GA. A prospective investigation of the relations among cognitive dietary restraint, subclinical ovulatory disturbances, physical activity, and bone mass in healthy young women. Am J Clin Nutr. 2007 Dec;86(6):1791-801.
- Berga SL, Marcus MD, Loucks TL, Hlastala S, Ringham R, Krohn MA. Recovery of ovarian activity in women with functional hypothalamic amenorrhea who were treated with cognitive behavior therapy. Fertil Steril. 2003 Oct;80(4):976-81.
- Guest NS, Barr SI. Cognitive dietary restraint is associated with stress fractures in women runners. Int J Sport Nutr Exerc Metab. 2005 Apr;15(2):147-59.
- Bedford JL, Prior JC, Barr SI. A prospective exploration of cognitive dietary restraint, subclinical ovulatory disturbances, cortisol, and change in bone density over two years in healthy young women. J Clin Endocrinol Metab. 2010 Jul;95(7):3291-9.
- Michopoulos V, Mancini F, Loucks TL, Berga SL. Neuroendocrine recovery initiated by cognitive behavioral therapy in women with functional hypothalamic amenorrhea: a randomized, controlled trial. Fertil Steril. 2013 Jun;99(7):2084-91.