Scientists don't yet know much about the long-term consequences of calorie restriction for humans. As I explained yesterday, this makes it hard to distinguish between calorie restriction (i.e., "healthy" starving) and anorexia ("unhealthy" starving) on a purely physical level.
But the psychological aspects of anorexia and CR are easier to compare. I read archived e-mail exchanges of the Calorie Restriction Society and found five people to interview: Dean, a software engineer; Paul and Meredith, a couple who practice CR together; Al, a retired scientist; and Nerissa, a preoperative male-to-female transsexual. It was a limited survey but a revealing one.
In its psychology, I found, CR closely resembles anorexia. Both represent an attempt to change your life by drastically changing your diet. The explicit rationales differ: A CR person says he wants to live longer; an anorexic typically says she wants to be thin. But the deeper wish for a sense of purpose—and the discovery of that purpose in the rewards of not eating—are the same.
CRONies vary from those who go on a moderate, if very long-term, diet to extreme food-restrictors. Dean qualifies as an extremist. Before I talked to him, I followed a link from the CR Society Web site to a PowerPoint presentation that he put together on the psychological effects of CR. In it, Dean acknowledges that calorie restriction has severe consequences. These include obsessiveness, particularly about food; he adopted behaviors that are also common among anorexics, such as watching food shows on TV and seasoning food with salt or spices to a degree that most people would find unpleasant. He also describes experiencing a kind of emotional "smoothness" or placidity, which at a certain point morphed into a kind of deadening.
Dean also discusses a common side effect of CR in men: loss of libido. Unlike the obsessive behaviors, which he succeeded in cutting out, he found he couldn't boost his sex drive. Instead, by mental effort, he turned the drawback into a benefit: He came to enjoy having more time and attention for things other than sex. Dean connects his loss of libido to a decline in other instincts that he identifies as conventionally masculine: He feels less aggressive and selfish, and has less of an urge to use people for his own ends. He has become very interested in Buddhism and in the teachings of Ghandi (who, of course, also starved himself).
On many levels, this reminded me of anorexia—being in a self-enclosed world with its own spiritual and emotional rules. In our interview, Dean acknowledged that the mindset of extreme CR is impenetrable from the outside: "I've likened it to two sides of a chasm. When you're on the normal male side of the chasm, you can't imagine the life I lead now being very satisfying, without the obsession with sex and winning. And when I was on that side, if I had known CR was going to take that direction, I would have said, 'No way in hell.' But [now] I don't want to go back."
Dean said he practices CR primarily for these mental and emotional effects, not any potential health benefits. "Even if there were a pill that mimicked CR, or even if there were a longevity downside, I would continue," he said. The couple I talked to expressed a different view of Dean's psychological response to CR.
My next interview was so upsetting that it is difficult to write about, and it shows that CR can, in certain cases, lead to full-blown anorexia. I called Al at home; his voice was quiet and somewhat difficult to hear. I asked how many calories a day he ate (1,950, he said) and how much he weighed.
"Ninety-two," he answered. I hoped I'd heard wrong. "How tall are you?" I asked. "Five-four," he said. "But I used to be 5-feet-11." He paused. "Osteoporosis." His spine had compressed a full 7 inches—or perhaps he was bent over. I was glad we were on the phone and I couldn't see him.
Al, who is 59, said he began CR in 1989 after reading about it in a textbook co-written by CR guru Roy Walford. Though he was never overweight, Al was concerned about his diet because there is a history of cardiovascular disease in his family.
Al used to be a professor at a university; now he is on permanent disability. He has had pneumonia five or six times. In the middle of one of these episodes, he collapsed from low blood sugar and went into a coma. Al acknowledged that his CR has turned into anorexia. Nonetheless, he refused to criticize the theory behind it, and he spoke sharply about the damage Americans do to themselves by eating too much. "I firmly believe in caloric restriction," he said, before adding quietly: "I believe I've gone too far."
The person I interviewed who seemed most rational about CR was Nerissa, the transsexual. She started practicing her version of the diet—which involves eating normally one day and restrictively the next—when she began her gender-transitioning five years ago. She's 5'8" and then weighed 194 pounds, which she knew wouldn't look good on a woman's frame. She doesn't believe that CR will make her live longer, nor does she think most people who practice CR really do it for that reason. Instead, she said, they're motivated by other desires: wanting to change their bodies, to be more energetic, or even to lower their sex drive. Just as her gender dysphoria led her to seek a sex change, Nerissa speculated that many people start CR because they want to change something about themselves.
Many CRONies take it too far, she said—particularly the men, who are the ones who usually lose their libido. But she said these men often make the same comments as men in the process of transitioning into women: that they're relieved to be freed from fixating on sex.
While male CRONies rarely admit that they enjoy losing weight, she thinks they do. "I think there's a lot of guys in the group who like what they see in the mirror," she said. If she's right, this kind of denial has a parallel in anorexia, too: When I was at my worst in college, I would stand in front of the full-length mirror in my dorm room and say out loud to my reflection, "You look terrible!" I believed that I knew I looked unhealthy and didn't like it, but that this was part of the trade-off for being hungry and sharp. Claiming that I didn't like being thin helped me maintain the belief that what I was doing was rational—that I wasn't driven by vanity or, worse, by a psychological disease.
Are CRONies anorexic? No, not exactly—except in rare cases like Al's, where fear of eating has progressed to such a lethal stage that it would be hard to label it as anything else. But in many cases, CR rises to the level of a different eating disorder—a new one, in which talk of better health and longevity cloaks other unspoken, and possibly unconscious, motives.
I've always thought that voluntary starvation has potential appeal for a lot of people. It just happens that in our society it's mostly women who push dieting far enough to discover the possible benefits: the emotional solace, the outlet for anger, the spiritual elevation, or intellectual edge. But CR now offers an opportunity for hyperrational, slightly obsessive men—men who are uncomfortable with aspects of a conventional male identity—to discover the upside of starvation.
It may or may not turn out that CR does slow aging in people. Right now, the National Institute on Aging, a division of the NIH, is spending millions of dollars on a human study called the Comprehensive Assessment of Long-Term Effects of Reduced Intake of Energy. Here's the little they've learned so far. What's most important, though, is not to focus on the aging factor in isolation. Any serious consideration of the effects of calorie restriction should examine closely the effects that it has on a person's brain and personality—which, as a recovered anorexic, I'm in a position to say are substantial and probably undesirable.
If that sounds weak, it's because I don't want to oversimplify. Endangering your health through anorexia or calorie restriction, or stunting your growth (as I did), is bad. But the mental effects? Deciding whether they're good or bad is a little like deciding whether to take a drug that has advantages but also changes your personality: It calms you, but it also dramatically narrows the scope of your interests and attention.
Unfortunately, I don't think the folks at the NIH get this. Partly, it's a problem of expertise: They're gerontologists, not psychiatrists. Also, the NIH has its own bias: to sound the alarm about an obesity crisis that is poised to increase health-care costs. They probably won't hesitate to promote research that will encourage Americans to eat less and lose weight. Even the psychologists on the CALERIE study seem hostile to a comparison between calorie restriction and anorexia. When I asked one of them about anorexia's effects, he said in a challenging tone, "How many anorexics have you known well?" I said maybe 20. "Well, I've known thousands," he retorted.
One thing is clear: It's time for doctors who study eating disorders to stop wishing the conversation about calorie restriction would go away. Instead they need to join it, adding their crucial perspective on the effects of starvation. In the meantime, should the rest of us start messing with our bodies' functions in the hope of extending the natural lifespan? Until much more research is done—by scientists who understand the close connection between our bodies and minds—let's be skeptical, and eat.