Ep. 652 Undereating, Fasting, and Bone Density | Undereating, Fasting, Bone Density

Welcome to the latest Midlife Minute.

In this episode, I answer questions related to disordered relationships with food, relative energy deficiency, bone health, and intermittent fasting.

Stay tuned to learn what can happen to your body when you’re undernourished, and how to approach intermittent fasting in a way that supports your health instead of adding more stress.

IN THIS EPISODE, YOU WILL LEARN:

How fasting culture can sometimes intersect with undernourishing the body

The link between a lifetime of anorexia, fasting, and restrictive eating and lower bone mineral density in midlife

The importance of restoring energy availability

The endocrine and metabolic changes that can accompany loss of the menstrual cycle

When transdermal estradiol and progesterone may be appropriate if menstrual recovery does not occur

The importance of getting enough protein, fiber, healthy fats, and overall nourishment when fasting intermittently

What to consider when using electrolytes during a fast

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Research:

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2. The IOC Consensus Statement: Beyond the Female Athlete Triad—Relative Energy Deficiency in Sport (RED-S)British Journal of Sports Medicine, 2014. Mountjoy M, Sundgot-Borgen J, Burke L, et al.

3. Eating DisordersThe Lancet, 2020. Treasure J, Duarte TA, Schmidt U. Review.

4. Eating DisordersThe Journal of the American Medical Association, 2025. Attia E, Walsh BT. Review.

5. All-Cause and Cause-Specific Mortality Risk in Individuals With Eating Disorders: Systematic Review and Meta-Analysis of Relative Risk and Aggravating or Attenuating FactorsWorld Psychiatry, 2026. Semchishen SN, Højlund M, Lemaire D, et al. Recent.

6. ACOG Committee Opinion No. 740: Gynecologic Care for Adolescents and Young Women With Eating DisordersObstetrics & Gynecology, 2018. Committee on Adolescent Health Care. Guideline.

7. Fractures in Women With Eating Disorders—Incidence, Predictive Factors, and the Impact of Disease Remission: Cohort Study With Background Population ControlsInternational Journal of Eating Disorders, 2020. Frølich J, Winkler LA, Abrahamsen B, et al.

8. A Systematic Review and Meta-Analysis of the Association Between Eating Disorders and Bone DensityOsteoporosis International, 2016. Robinson L, Aldridge V, Clark EM, Misra M, Micali N. Systematic Review.

9. Bone Health in Adult Women With ED: A Longitudinal Community-Based StudyJournal of Psychosomatic Research, 2019. Robinson L, Aldridge VK, Clark EM, Misra M, Micali N.

10. Low Energy Availability and Relative Energy Deficiency in Sport: A Systematic Review and Meta-AnalysisSports Medicine, 2025. Gallant TL, Ong LF, Wong L, et al. Systematic Review.

11. Impact of Relative Energy Deficiency in Sport (REDs) on Bone Health in Elite Athletes: A Retrospective AnalysisJournal of Cachexia, Sarcopenia and Muscle, 2025. von Brackel FN, Munzinger R, Bartosik M, et al. Recent.

12. Medical Complications of Anorexia NervosaPediatrics, 2025. Trapani S, Rubino C.

13. Screening for Eating Disorders in Adolescents and AdultsThe Journal of the American Medical Association, 2022. US Preventive Services Task Force, Davidson KW, Barry MJ, et al. Review.