Ep. 652 Undereating, Fasting, and 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 find out what can happen to your body when you’re undernourished, and how to approach intermittent fasting in a way that supports your health rather than 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

Connect with Cynthia Thurlow  

• Follow on X, Instagram & LinkedIn

• Check out Cynthia’s website.

• Submit your questions to support@cynthiathurlow.com 

• Join other like-minded women in a supportive, nurturing community: The Midlife Pause/Cynthia Thurlow. 

• Purchase Cynthia’s book, The Menopause Gut.

• Cynthia’s Intermittent Fasting Transformation Book

• The Midlife Pause Supplement Line

Research:

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Endocrine Reviews. 2024. Angelidi AM, Stefanakis K, Chou SH, et al. Review

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.

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Lancet. 2020. Treasure J, Duarte TA, Schmidt U. Review

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The 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 Factors.

World Psychiatry: Official Journal of the World Psychiatric Association. 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 Disorders.

Obstetrics and 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 controls.

The International 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 Density.

Osteoporosis International: A Journal Established as Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2016. Robinson L, Aldridge V, Clark EM, Misra M, Micali N. SR

9. Bone Health in Adult Women With ED: A Longitudinal Community-Based Study.

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10. Low Energy Availability and Relative Energy Deficiency in Sport: A Systematic Review and Meta-Analysis.

Sports Medicine. 2025. Gallant TL, Ong LF, Wong L, et al. SR

11. Impact of Relative Energy Deficiency in Sport (REDs) on Bone Health in Elite Athletes: A Retrospective Analysis.

Journal of Cachexia, Sarcopenia and Muscle. 2025. von Brackel FN, Munzinger R, Bartosik M, et al. Recent

12. Medical Complications of Anorexia Nervosa.

Pediatrics. 2025. Trapani S, Rubino C.

13. Screening for Eating Disorders in Adolescents and Adults.

The Journal of the American Medical Association. 2022. US Preventive Services Task Force, Davidson KW, Barry MJ, et al. Review