This gets cited here weekly, usually second-hand, so it is worth setting out what it does and does not establish.
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 subgroup findings are the part I trust least — with enough subgroups something is always significant, and these were not all pre-registered.
So the question, as narrowly as I can put it: which deficiencies actually show up when intake drops this far, and which are worth testing rather than supplementing blind. Not looking for reassurance. Looking for the part I have got wrong.
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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View ResultsAnswering the narrow version, because the broad one does not have a single answer. 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.
LarryQC_SD said:Agreed, and for anyone with an eating-disorder history this needs a clinician in the loop rather than a forum.
Adding a me-too, because a thread of one person's experience is not much use.