LOW CALORIE DIETING IN THE GENERAL POPULATION
Most people have heard that old throwaway line – EAT LESS, MOVE MORE – and even if you haven’t heard anybody say it, you know what it means because the essence of it is so pervasive in our Western culture. It’s pervasive because it works for a lot of people the first few times they try it which reinforces its potential for it to continue to “work.” And when I say it works, I mean we see a reduction in scale weight. Many people don’t factor in that low calorie dieting leads to a reduction in lean muscle tissue, bone tissue, and resting metabolic rate – these losses are fundamentally critical to the overall health of us as humans. We need to continually build our muscle tissue and bone tissue because they are metabolically active. Deterioration of these tissues is not something to cheer about when we see a lower number on the scale. Our resting metabolic rate is what determines how much energy we burn when we are completely at rest – reducing this rate is detrimental to us but ironically we chip away at it with every low calorie diet we employ.
While this information is pertinent to women in general it’s even more pertinent to women with lipoedema.
LOW CALORIE DIETING AND LIPOEDEMA
For a woman with lipoedema, the “EAT LESS, MOVE MORE” comment is more than just a throwaway line. When you say this to a woman who has spent years of her life doing exactly this and her lipoedema tissue continues to expand and become even more fibrotic, her head explodes on the inside … maybe even a little on the outside too depending where her tipping point is. You probably destroy her a little more than she is already destroyed. If she’s already eating well below her caloric and nutritional needs, and needs to eat less … if she’s already at the gym 2 or 3 hours a day, and needs to move more … the person who has made the “EAT LESS, MOVE MORE” comment needs some intellectual support (this was the best I could come up with without swear words).
She will be humiliated, shamed, furious, belittled, disempowered. And she’ll go home and take it out on herself with eating even less and moving even more. Or rage through a binge until she hates herself enough. Then she’ll get back to the ice-cube-and-a-bit-of-dust-diet with a side serving of self-loathing for as long as she can before she starts her 7 days of no eating at all.
A woman with lipoedema has tried every single diet in existence. She’ll eat anywhere between 1200 calories (a big eating day for somebody with lipoedema) and 400 calories a day. She may even have several days in a row where she doesn’t eat at all. She won’t care whether she is eating nutrient dense food or not, nourishing that gorgeous body won’t even factor in, that number on the scale is much more important than being healthy or feeling fabulous.
Some people will dig a little further and ask exactly how much she is eating, how much she is moving, and no matter what her answer is she is either not believed, or she is told to EAT EVEN LESS, MOVE EVEN MORE.
PHARMACEUTICAL, MECHANICAL, AND SURGICAL METHODS OF EATING LESS
Many women with lipoedema resort to medical professionals to help them eat less. When a woman seeks medical advice to eat less, she is likely already eating under her basal metabolic rate (BMR) – usually far less. Eating less than your BMR is what I refer to when I say “under eating.” I talk about under eating a lot in my line of work with women who have lipoedema because the hardest part of my job is to get them to eat enough food.
The BMR is an estimation of the energy our body burns at rest – it includes energy for things like cellular homeostasis, cardiac and nerve function, muscle function, bone tissue regulation, circulation of blood, digesting food, breathing, and brain function and metabolism. When you eat less than your BMR, these important functions are compromised. To many of you with lipoedema, the EAT LESS, MOVE MORE message is so strong, that the compromise of your important body functions won’t even matter to you if it means you will weigh less and take up less room in the world. I hear you. It makes me sad, but I hear you.
(( There are some variables that impact the BMR, but for the purposes of this article, I’m not taking into account variables like pregnancy, geographic locations, and high percentages of muscle mass . ))
Some medical professionals will advise a woman with lipoedema to use pharmaceuticals to lose weight. Side effects of these pharmaceuticals range from gastrointestinal distress (nausea, diarrhea, constipation, anal leakage, vomiting), to nervous system dysregulation (irritability, dizziness, anxiety, tremors, insomnia, hallucinations) to cardiovascular dysregulation (palpitations, tachycardia, hypotension, arrhythmias).
(( Some of you read these side effects and thought, that’s ok. But will I weigh less? Will I take up less space? Where can I get these drugs? ))
The most extreme of medical treatments to make a woman eat less fall under bariatric “solutions”. This is where the digestive system is modified to a point (either mechanically or surgically) to minimise the amount of food a woman can fit in her stomach. Sadly, for a woman who is already eating only 600 calories a day, these kinds of procedures can be disastrous. The appetite is driven down even further, with nutrient deficiencies, lean muscle tissue loss, bone tissue loss, metabolic rate deterioration, and sleep problems common. To counter these problems, bariatric surgeons typically tell women to consume a high protein diet (but without any guidance as to what “high” means) and to take what can only be described as an ineffective multivitamin supplement for the rest of their lives. Some of these deficiencies and imbalances caused by bariatric “solutions” are not recoverable, and some of them make it very difficult for a woman to lose weight naturally. We need to be able to absorb nutrients from sufficient quantities of food to be healthy and strong – bariatric “solutions” sabotage our natural ability to achieve this. Surgically or mechanically altering the gastrointestinal tract is another disempowering message that a woman with lipoedema cannot trust her own body, her own appetite.
Typically, the pattern is that women do lose scale “weight” (whether that is body fat is a whole other question) with these procedures quite quickly over the first 12-24 months. It may remain off for another 2-3 years, and then the weight gradually stacks back on again. This is usually the point where they come to see me with weight gain, nutrient deficiencies and imbalances, digestive problems, energy problems, and extremely low self-esteem. Women who have undergone a bariatric “solution” will get support and information from me to help them build up their appetite again, and eat more food than they have for a very long time. Their metabolism improves, and they start losing body fat. They eat real unprocessed foods in appropriate portions for health and strength. They usually need ongoing supplement support if they’ve had a bariatric surgery which can be a lot more targeted than a multi-vitamin.
(( If you’ve had a bariatric procedure and haven’t experienced any of these problems, I’m genuinely excited and happy for you! The fact is that more people have problems than don’t – I’m speaking that issue here. ))
When you come to me with lipoedema and tell me you have a very weak appetite and barely eat anything but cannot lose weight, I believe you. When you tell me you’re killing yourself at the gym, or you have killed yourself at the gym over the years but now have so many injuries and so much joint pain that you can now barely stand, I believe you. When you tell me that you’ve yo-yo dieted between low calorie nutrient poor diets, I believe you – this happens because of that EAT LESS, MOVE MORE message you get all the time. I believe you because I know the road you’ve walked to get to this place in time and I know what you’ve been told, what you’ve told yourself, and the great lengths you’ve gone to … to eat less, move more, take up less space, weigh less.
I believe you.
My strong message to those who recommend pharmaceuticals, or mechanical or surgical procedures that make a woman with lipoedema eat less, is to STOP MAKING THOSE RECOMMENDATIONS PLEASE. Lipoedema is not cured by eating less. It’s not even helped by eating less.
WHAT IS LIPOEDEMA?
Lipoedema is a painful fat disease of loose connective tissue usually misdiagnosed as lifestyle-induced obesity that affects around 10% of women of European descent as well as some other populations. It is characterised by symmetric enlargement of the buttocks, hips, and legs due to increased loose connective tissue; arms are also affected in 80% of patients. Lipoedema loose connective tissue is characterised by hypertrophic adipocytes, inflammatory cells, and dilated leaky blood and lymphatic vessels. Altered fluid flux through the tissue causes accumulation of fluid, protein, and other components in the extracellular matrix resulting in recruitment of inflammatory cells, which in turn stimulates fibrosis and results in difficulty in fat loss. Inflammation and excess interstitial substances may also activate nerve fibers instigating pain in lipoedema impacted tissues. (Thank you https://www.intechopen.com/chapters/68520 for the clear definition!)
No aspect of this disease is helped by eating less and moving more. Not one.
WHAT KIND OF “DIET” DOES HELP WITH LIPOEDEMA?
Low calorie dieting in the scope of lipoedema assumes that the management of lipoedema involves losing weight, and I’d like to clarify that losing body fat percentage might help some women with lipoedema who also suffer with obesity, losing body fat does not address the underlying drivers of lipoedema. Let me find another way of saying that …
LIPOEDEMA MANAGEMENT IS NOT ABOUT LOSING WEIGHT.
Losing weight is appropriate who have a degree of obesity, but LIPOEDEMA IS NOT OBESITY. A person with lipoedema can have an additional obesity problem but these are two different problems.
The low-calorie dieting roundabout can build a solid foundation for an ADDITIONAL issue with obesity that is not related to lipoedema – long term low calorie dieting lowers the metabolic rate. Obesity is something we absolutely can do something about with nutrient density, food choice, appropriate portions, and meal timing.
If you find yourself in the hands of a practitioner who wants to help you manage your lipoedema by putting you on ANY kind of low calorie diet, you're in the wrong place with the wrong person.
Some might go so far as to say that dieting doesn’t “work”, and I would like to clarify that by defining what the word diet actually means – a diet is just the term people use for what they eat reasonably regularly. Even if you are not “on a diet” you have a diet! Diets don’t work or not work, but your diet CAN help. I would like to further clarify the “dieting doesn’t work” statement by saying “low calorie nutrient poor dieting doesn’t work.” There. Fixed it. A diet is defined by the things you consume, and if you understand that, you’ll understand that everybody has a diet. Using a low calorie nutrient poor diet is not going to facilitate a strong beautiful life for anybody, right? Even less so for a woman with lipoedema who has a “low calorie nutrient poor dieting” history. So let’s stop encouraging that.
Can I also address the concepts around sustainability? Honestly there shouldn’t be a problem with treating yourself well every day. If you know your body needs nutrients to feel great and function well, why would you have a problem with making that happen every day it’s in your control? You brushed your teeth yesterday right? And you’ll brush them again today I hope … you might be annoyed that every day you have to brush your teeth, or have a shower, or use the toilet. Is this sustainable? Of course it is! Think about this the next time you wonder if a healthy diet is sustainable – it’s just part of being a healthy human.
A diet that normalises the inflammation process, insulin and leptin sensitivity, cardiovascular health, oxidative process, and fibrosis processes will help lipoedema. These kinds of diets will be nutrient dense and are absolutely sustainable. An approach that recognises the emotional and physical damage already incurred by low calorie nutrient poor dieting history in a woman with lipoedema is essential.
MY OVERARCHING MESSAGE ABOUT EATING LESS, MOVING MORE
I would love the overarching take-home here to be love, acceptance, and respect for each other no matter how our body is showing up and encourage every effort that is made towards health and strength. I really want family members and medical professionals to act this way towards women with lipoedema. I want women with lipoedema to eat enough nutrient dense food and to move in whatever way makes you feel strong and sexy so that you can just get on with your beautiful life. Eating less and being less is not the road to being a strong, healthy, and sexy woman at any size.
EAT BETTER, MOVE IN WHICHEVER WAY YOU CAN.