Thursday, June 8, 2017

Online Advice

Sometimes I read "advice" online that makes me cringe. Please, if you are struggling with an eating disorder, be careful with the advice you take. Not everyone is qualified to be counseling others, especially when it comes to nutrition, psychology and recovery.

Recently, I read a blog post that the author mistakenly called an article, and I was shocked by the amount of incorrect information she was pushing. This is a person who supposedly has a Ph.D. and supposedly gives out advice to the many people who supposedly email her both on Instagram and by way of her blog. In reality, she takes a ton of photos of herself, and that's her main focus. I didn't look to see where she earned her degree, but I'm surprised anyone who has that much of a difficult time writing in coherent sentences can receive one. While wading through her post, it was difficult to decide if she didn't understand the topics she was discussing or if she simply can't write in intelligible sentences. I decided it's a little bit of both.

Let me make this more clear. I can't believe the complete garbage some people put out there. It makes me so angry when people like the lady mentioned above promote warped and potentially damaging ideas around nutrition and recovery. I assume they do so not because they are necessarily bad people but because they have their own unresolved issues around food.

The blogger made an effort to address hormonal imbalance resulting from severe dieting and mistakenly said that hormone levels are low in these dieters, but there are several hormones that play a role in the hunger and satiety feedback loop, most of them not low in those on restrictive diets. Leptin in both obese people and in anorexics is usually high, but it's lower in bulimics. A higher Ghrelin/obstein ratio in anorexics is thought to be related to an increased expression of the preproghrelin gene. In other words, this is also higher in people who restrict, not lower. Stress hormones also tend to be higher in anorexics and people dieting, but reproductive hormones tend to be lower. You can't make these big generalizations when it comes to hormone levels and eating disorders or any condition, really, and you definitely shouldn't be giving out incorrect information in general. If you don't know about hormone levels in people with eating disorders, you're not required to write about them in a blog post. If you choose to, don't just make shit up.

Oops, she did it again when she brought up insulin. I think she was conflating insulin sensitivity with blood sugar levels, but she was vague with what she wrote. It's hard to tell exactly what she meant. Sometimes people toss out terms without knowing or fully understanding what they mean. She did this several times in her post. When she suggests that insulin sensitivity increases during phases of extreme dieting, the information is inaccurate. Really, insulin sensitivity varies from person to person. Fasting (not eating a low-carb diet or dieting in general) typically decreases insulin levels, and this appears to increase sensitivity over time. Low-carb diets are also effective in reducing insulin levels but less effective in improving insulin sensitivity. In other words, when a normal person diets, insulin levels decrease, but there's rarely any immediate effect on insulin sensitivity. However, some studies suggest that fasting at regular intervals for diabetics does exactly this. It can increase insulin sensitivity for those who are insulin resistant.

If you're a diabetic, this kind of information might be important, but since fasting can potentially negatively affect your immune system and organs, cause dizziness, fatigue, and even cause more severe conditions, most doctors don't recommend it. Also, most people don't have insulin resistance (low sensitivity). This blogger seems to be suggesting that normal people would experience some type of insulin resistant hunger if they diet and then allow themselves to eat, which is not accurate, but, again, because the post was poorly written, it was hard to tell.

Yet another mistake she makes is suggesting or implying refeeding syndrome involves dangerous variations in electrolytes. I will give her some credit here because this is partly true, but refeeding syndrome involves much more than electrolyte imbalance. The main concerns with refeeding syndrome are edema and severe metabolic changes, taxing the body when systems that were not functioning or not functioning well begin working again and require nutrients that are not generally found in a starving body. Yes, the syndrome can include electrolyte imbalance, but you can't really describe a syndrome by focusing on one symptom and ignoring the more prevalent ones.

Mistakes are one thing. Everyone makes them. I can forgive her for these errors, but putting yourself in a position where you are giving others advice and then reinforcing complete myths about eating disorders is criminal. It's bad enough that she can't get her facts straight, but she steps over the line when she tries to convince others that people can't control themselves when they resort to intuitive eating after "extreme dieting," because....she can't? It's pure bullshit. 

How the fuck do people like this sleep at night? Mistakes, yeah, the body and its systems are complex and often confusing. I understand that. I've made mistakes or misunderstood various aspects of human biology, too. I hope if I make mistakes in my blog, people will call me out on it. What really pisses me off is someone basically suggesting that a person should continue harming herself, because she might not be emotionally prepared to handle change. In other words, this blogger thinks that if you are under-prepared to address the underlying psychological issues that are often associated with an eating disorder, you should just continue to engage in behaviors that might kill you. Absurd. 

Additionally, she seems to think that, because she is obsessed with food and hasn't resolved her own issues, anyone else who tries to eat intuitively after restricting will suddenly become overwhelmed with choices and want to eat and eat and eat. In my book, I write about a phase I went through in which I did eat a lot of junk, but I didn't have any idea what a sensible diet looked like at that point. Plus, my body desperately needed food. If your body needs calories and a lot of them, of course you are going to want to eat once you allow yourself, but you have to have some faith that you will be able to find balance once your health is more stable. It takes time. And if you are aiming for a nutrient-dense, well-balanced, varied diet, chances are less likely that you will swing to any extremes. 

There's no doubt that if you are struggling with an eating disorder, it's best to work with professionals. It's true that you can get some useful advice online, but you really have to be careful not to take advice from people who try to inflict their issues and insecurities onto others. Take everything you read with a grain, or in some cases a shaker, of salt. It's so important to consider your own beliefs and recognize when others are stuck in theirs. Seeing reality clearly can be difficult when you're struggling with an eating disorder, but do your best to trust that you can and eventually will figure it all out. Rather than reading random blogs, a safer bet when it comes to reaching out for advice and online support is to look into some of the eating disorder recovery forums on Facebook.  

In the end, the one good thing about this woman's post is that she admits that she is ill prepared to address questions related to severe eating disorders and that people who are struggling should go to a professional. Yes, thank you. Finally a bit of rational thought in an otherwise large pile of crap.   

Obviously, it takes working on the physical, emotional, mental and even spiritual aspects of the disorder, but the first and often the scariest step is refeeding, eating consistently and enough. Of course, if you are at a point where actual refeeding syndrome is a concern, this stage should definitely be supervised by someone in the medical field. I think it would be rare for someone in that state to be hanging out online asking bloggers who aren't specifically addressing recovery questions about diet, though it might happen. Anyway, what I did was risky, dangerous given where I was, but I also knew I would die if I continued restricting the way I had been. I wasn't prepared mentally or emotionally to handle eating again, but I had to do something to save my life. I at least knew that much. Is anyone ever really ready for change? There probably are some who can go into recovery more prepared. There's no real right or wrong when it comes to saving yourself. 


  1. This person is to endocrinology what Ken Ham is to evolutionary biology. Just like a committed creationist will almost always see he bullshit on "Answers in Genesis" as deeply scientific, someone looking to normalize her own self-starvation might take refuge in the nonsense the target of your post throws out there.

    Happily, though, whatever her *intentions* are, and however erroneous the crap she contributes to cyberspace may be, her actual reach is minimal. I'm convinced that very few human beings actually upvote her pics and the accompanying banalities she tirelessly, mindlessly generates. She uses the same plethora of hashtags pretty much every time and I'm sure this is to game Instagram into giving her ersatz love. (This is something I will never understand, either -- how can anyone derive satisfaction from a load of nonexistent social-media followers fully knowing they don't exist? Is seeing a contrived number really better than the truth? I mean...)

    So anyway, look at the silver lining. Just like those on the science side of the evolution "debate" get to brush up on their biology and other fields in the course of rebutting the fundagelicals, you've been spurred on to explore a little human physiology and pathophysiology.

    I understand your frustration -- this is far from a "nothing to worry about" hand-waving away of your concerns. But everything she says about her Internet fans is almost certainly bullshit, as it almost always is when people with mental problems start burbling on about the armies of curiously silent supporters they have. Delusions are normally multifaceted, and this one you've described is in seriously dire straits.

    1. Thank you for the comment.

      I hope you're right about her reach being minimal.

  2. This was a really refreshing post. I believe I know this individual whom you wrote about. I quickly realized that she had the ability to synthesize data in a way to make it work to her advantage-essentially "allowing" herself to continue to engage in disordered behavior while using "facts" to support it. I ultimately withdrew from the relationship because I among other reasons, I couldn't continue to passively support her by listening to her reasoning.
    I find it really validating to find others out there who also see through the facade of data and science. It's hard to sit back and see others turn to her for advice as an "expert."
    Thanks for a great post. It helps me feel just a bit better to think that her reach may not be as vast as I suspected and that there are others who see her as I do.

    1. Thank you so much for your comment, Sara.
      I'm sorry you ended up having to end a relationship, but I'm glad you set the appropriate boundaries you needed in order to protect yourself.

      I hope her reach isn't vast. My concern with people like her is that they may reach people who are vulnerable and might end up being influenced by their unhealthy suggestions and examples. I am glad, though, that there are others who can see that what she is doing and what she is ultimately promoting, on purpose or not, isn't right.