Eating disorders affect approximately 4% of the Australian population which is around 1 million people at any given time. (1) Eating disorders are complex mental health conditions that involve complicated relationships with food, eating, exercise, and body image. They can also have an impact on fertility which is why It is important to understand how an eating disorder can affect your reproductive health.
An eating disorder is defined as “a behavioural condition which is characterised by severe and persistent disturbance in eating behaviours and associated and distressing thoughts and emotions”. (2) This can prevent individuals from having a healthy relationship with food and depending on the condition they may eat too much or too little.
The most common eating disorders include:
– Anorexia nervosa – a significant restriction of food intake and starvation which results in considerable weight loss and intense feelings of fear of gaining weight. (3)
– Bulimia nervosa – regular episodes of binge eating followed by self-induced compensatory behaviours such as vomiting or taking laxatives to avoid extra calories and weight gain. (4)
– Binge eating disorder – eating large amounts of food in a short period, accompanied by feelings of a loss of control over the amount an individual has eaten. (2)
– Other specified feeding or eating disorder – presents with symptoms of an eating disorder but does not meet the criteria (e.g., weight threshold or binging frequency) to be diagnosed with another eating disorder. (5)
All eating disorders can impact your chances of becoming pregnant, however, this doesn’t necessarily mean that they will.
How does my eating disorder affect my ability to conceive?
Eating disorders can affect the endocrine system which is made up of all the body’s different hormones and is responsible for the growth and function of the reproductive system. Women who have a low body weight may have changes in the menstrual cycle such as irregular periods and/or the absence of periods. This, therefore, affects ovulation which can make it difficult to conceive. In contrast to this, women with a higher body fat percentage can also have hormonal imbalances which can result in difficulties ovulating.
Due to these hormonal changes, women who have eating disorders may have low levels of the reproductive hormones, oestrogen, and progesterone. These hormones are built upon a backbone of cholesterol which means we need to have an adequate intake of healthy fats in the diet so that these hormones can be made. Women with eating disorders may significantly restrict their food intake or insufficiently consume enough of these healthy fats which can lead to an inadequate diet. (3) Healthy fats include:
– Monounsaturated fats – found in almonds, hazelnuts, pecans, avocadoes, pumpkin seeds, sesame seeds, olive oil, olives, and peanut butter/peanuts.
– Polyunsaturated fats – found in fish such as salmon and trout, chia seeds, walnuts, flax seeds/oil, and sunflower oil.
These foods will help to increase the levels of oestrogen and progesterone which are necessary for the preparation of the endometrium for pregnancy. Additionally, these healthy fats help to lower the “bad” cholesterol (LDL cholesterol) and increase your “good” cholesterol (HDL cholesterol) which is important for overall general health.
So, how can nutrition help?
There are other aspects of the diet we need to focus on too! People with an eating disorder are more likely to be malnourished which refers to deficiencies, excesses, or imbalances in a person’s intake of energy and/or nutrients meaning that those with a higher body weight are also at risk of malnutrition. (6) In women, this can lead to suppressed ovulation which can subsequently increase the risk of infertility. (7) With that being said, we need to make sure we are getting enough energy or calories into our bodies each day which is essential to produce our fertility hormones and for regular menstruation.
Although it may be difficult to conceive with an eating disorder, it is still possible and can happen. (8) If you happen to be pregnant with an eating disorder your energy requirements will increase further in the second and third trimesters. Therefore, if you are underweight it is vital you are getting enough energy from food to not only restore your weight but also to help the development of your baby.
Key Nutrients to be aware of
Another important nutrient to be aware of is iron. Iron is needed to make red blood cells which transport oxygen around the body. During pregnancy, iron requirements increase by nearly 50% because your body is making more blood as you and your baby are growing. The recommendations for iron during pregnancy are 27 milligrams per day compared to 18 milligrams per day for women who are not pregnant. It is important to note that, while we can store iron, our bodies are unable to make it meaning the only way to get iron is from food. Therefore, if you are restricting your food intake you may find it difficult to reach these recommended requirements. Supplements may be recommended however, chat to your GP or dietitian for more information.
Folate or folic acid is important before and during the first three months of pregnancy as it can not only help prevent neural tube defects such as spina bifida but also helps with the growth and development of the foetus. (9) Folate is found in foods such as green leafy vegetables, fruit, beans, peas, eggs, and grain foods. It is recommended to have 500 micrograms of folate which can be quite difficult to reach through diet alone. (10) Supplementation will be necessary, however depending on your circumstances, the dose may be greater which will need to be discussed with your GP.
Calcium is essential during pregnancy especially if you have an eating disorder. If you are not getting enough calcium from your diet, your body will start to use the calcium in your bones for the other parts of your body. (11) This may mean you have reduced strength in your bones which can result in an increased risk of falls and fractures which can eventually lead to osteoporosis. Therefore, it is important to have a diet that is adequate in calcium as this helps to maintain healthy teeth and bones for you and your baby. Dairy products such as milk, cheese and yoghurt are rich in calcium and usually tend to be best absorbed by the body. Again, if you are restricting your food intake you may find it difficult to be able to reach the required amount of at least 1000mg of calcium per day.
What if I am trying to conceive?
Eating disorders can increase the risk of miscarriages as well as pregnancy complications. Therefore, being able to get your eating disorder under control can help you to have a healthy pregnancy whilst minimising the risk of complications. Some studies have shown that it is unlikely that your reproductive health is affected if you have undergone proper treatment for your eating disorder (12).
Eating disorders come with intense physical and emotional stress which is why it is important to feel supported throughout your journey. Talk to your GP or experienced dietitian to seek help during your pregnancy which can also result in helping you to make healthier choices for you and your baby.
If you feel like you need additional support with disordered eating in pregnancy, BOOK HERE for an initial consultation.
This blog was written in collaboration with Sarah D’Angelo (APD) during her time on placement with Big Sis Nutrition.
