Putting this up for argument rather than for agreement. I have read it twice and I am still not certain what it supports.
A sustained drop to 1,100 or 1,200 calories reliably under-delivers a predictable set: B12, vitamin D, iron, folate, zinc and magnesium. Two of those are worth testing rather than guessing because the tests are cheap and the symptoms overlap with everything else — ferritin and B12. The rest a decent multivitamin covers, and there is no benefit in megadosing any of them.
Where I think it is weakest: the population was selected and supported in ways a real cohort is not, so I would read the effect size as a ceiling rather than an expectation.
What I am after is which deficiencies actually show up when intake drops this far, and which are worth testing rather than supplementing blind. If the honest answer is that nobody knows, that is a useful answer and I would rather have it.
B12Beth said:A sustained drop to 1,100 or 1,200 calories reliably under-delivers a predictable set: B12, vitamin D, iron, folate, zinc and magnesium.
Agreed, and for anyone with an eating-disorder history this needs a clinician in the loop rather than a forum. The same drug can be therapeutic in binge-eating disorder and actively harmful in a restrictive disorder.
B12Beth said:A sustained drop to 1,100 or 1,200 calories reliably under-delivers a predictable set: B12, vitamin D, iron, folate, zinc and magnesium.
Pushing back on B12Beth here. I would be careful about how confidently the flatness reports get attributed. Rapid weight loss, a large deficit and disrupted sleep produce low mood on their own, and separating that from a drug effect is genuinely hard.
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Shop Reference StandardsThis one has a reasonably settled answer, so here it is. The mental-health dimension is under-measured in the trial literature and the reports here are consistent enough to take seriously. On the positive side: reduced anxiety around food, better self-image, more confidence. On the difficult side: grief for the years lost, identity disruption, relationships built around eating, and the loss of food as a coping mechanism with nothing put in its place. Rarer but real: anhedonia and emotional flatness. Regulators have started asking for validated patient-reported outcomes in this class; the existing data gap is not evidence of absence.
That is the short version; the long version is somebody else's post.
Dr.GastroMayo said:Agreed, and for anyone with an eating-disorder history this needs a clinician in the loop rather than a forum.
Second this.