Anorexia & Bulimia – Eating Disorders
Anorexia nervosa is an emotional eating disorder characterised by severe and potentially life-threatening weight loss through self-induced reduction in total food intake. People with this disorder have an intense fear of weight gain, even when they are underweight. They may diet or exercise obsessively in order to lose weight.
Bulimia is an eating disorder characterised by alternate binging on food or overeating, associated with feelings of loss of control, followed by self-induced purging (vomiting or laxative abuse) to avoid gaining weight. People with bulimia are often of normal weight, unlike anorexics, but may see themselves as overweight.
Causes / Risk factors of Eating Disorders
The exact causes of eating disorders are unknown, but many factors may be involved.
- White, middle-class female
- Social attitudes/expectations
- Family history of eating disorders
- Early onset of puberty
- Personality type: high academic achiever, goal-oriented, perfectionist, controlling
- Lack of self-esteem; negative self-image
- Serotonin imbalance
- Dopamine imbalance
- MTHFR and methylation imbalances
- History of anxiety and depression in childhood
- History of emotional stress, sexual abuse or other traumatic event
- Personality disorders e.g. OCD, narcissism, anxiety
Signs and symptoms of Eating Disorders
- Anorexia nervosa
- Intense fear of gaining weight, even when underweight
- Refusal to maintain normal body weight
- Distorted body image
- Obsessive dieting or refusal to eat certain foods or around other people
- Obsessive exercising
- Scanty menstruation or absent menstruation
- Blotchy or yellow skin covered with fine hair
- Confused or shallow thinking
- Poor memory or judgement
- Dry mouth
- Extreme sensitivity to cold
- Loss of bone strength
- Wasting of muscles and loss of body fat
- Thin, brittle, dry hair
- Eating binges involving large amounts of high-calorie foods, often in secret
- Feelings of lack of control and guilt during eating binges
- Purging e.g. self-induced vomiting, laxative abuse, excessive exercise
- May have distorted body image
TREATMENT STRATEGY FOR EATING DISORDERS
Treatment of eating disorders is complex and requires a multi-disciplinary approach. The biggest challenge can be convincing the patient that they have an eating disorder. Treatment involves major lifestyle changes – not only must eating habits be altered but the patient‘s self-perception must be developed to the point where they no longer perceive a distorted body image. Recovery can take a long time and the risk of relapse is high.
Treatment involves balancing the neurotransmitters, gut health in conjunction with counselling / psychiatrist consultation.
If the patient is severely malnourished (<70% normal body weight), they may need initial hospitalisation with carefully administered feeding.
The following outlines a nutritional strategy for out-patients:
- Slowly increase food intake to support gradual weight gain
- A realistic goal is around 0.25 – 0.5 kg weight gain per week based on progressively increasing energy intake by around 400-800 kJ every 2-3 days
- Calm sympathetic nervous system response
- Support serotonin levels and GABA levels
- Stimulate digestion and improve appetite
- Replace macro and micronutrients
- Dietary education
- Address underlying psychological issues
Diet plan guidelines that support Eating Disorders
- Establish good eating patterns and a healthy diet
- A specific menu plan should initially be prescribed to the patient with a healthy balance of carbohydrate, fats and proteins
- Educate the patient on general healthy eating principles rather than expecting them to stick to specific amounts (e.g. counting calories, weighing foods, etc) – this can encourage food obsession.
- A food diary or assessment form may be useful here so that food intake may be monitored and analysed by the practitioner
- As the patient improves, they can begin to take responsibility for their own meal planning
- Care should be taken to keep the eating guidelines achievable in the patients mind and not too overwhelming
- Include complex carbohydrates e.g. whole grains if tolerated, legumes, starchy fruit and vegetables
- Include adequate protein in every meal to maintain muscle mass e.g. lean meat, eggs, fish, legumes, tofu
- Include healthy fats in every meal e.g. olive oil, coconut oil, coconut milk, avocado, nuts and seeds, butter
- Include apple cider vinegar or lemon juice with meals to stimulate digestion
Supplements that support Eating Disorders
- Multi-vitamin and mineral complex – suffers are often very nutritionally depleted so a good multi is essential
- Protein powder supplement – to help promote weight gain, muscle growth and supply building blocks for neurotransmitter production
- B-complex – to support healthy brain and neurotransmitter function
- Magnesium – to calm sympathetic nervous system
- Omega-3 fatty acids – to support healthy brain and neurotransmitter function
- L-tryptophan – to support serotonin production
- Zinc – to stimulate appetite and support immune response
- Digestive enzymes: to stimulate appetite and support digestion
- Any other specific nutrients as needed (depending on assessment): iron, D3, B12, Methyl donors etc
Herbal Medicine Treatment for Eating Disorders
- Appetite stimulants – angelica, blessed thistle, fenugreek, gentian, cinnamon, dandelion, ginger, wormwood
- Anti-depressants – St John‘s wort, lavender, saffron, vervain
- Anxiolytics – scullcap, passionflower, zizyphus, hops
- Blood sugar balancers – gymnema, fringe tree, cinnamon
Lifestyle / Physical measures
- Professional counselling is essential
- Dietary counselling to educate patient about healthy foods that do not cause weight gain
- Development of a support system and attendance in a group for help with stress and emotional issues
- Modification of exercise as obsessive exercise is often part of the disease
- Mind/body therapies may be useful – cognitive-behavioural therapy, family therapy, hypnosis, biofeedback
FUNCTIONAL MEDICINE NATURAL TREATMENT OF EATING DISORDERS
Eating Disorders are complex conditions that require a carefully structured approach to balance and calm the mind and re-educate the patient on healthy eating habits. Patients with eating disorders such as anorexia and bulimia often have a range of imbalances throughout their body that are contributing to the condition.
Serotonin and dopamine levels we find are commonly at levels that are causing abnormal function in the brain and require regulation. In addition, other aspects such as a compromised gut, dysregulation of the adrenal / HPA axis and methylation imbalances are regularly present.
At our Perth clinic of Functional Medicine we treat patients with eating disorders with great success. A neurochemistry balancing approach while addressing other body system dysfunctions is required in conjunction with psychiatrist / counselling work.
If you or a family member are suffering from an eating disorder we would love to hear from you. Have you had a comprehensive assessment of your neurotransmitters, methylation and gut health? Are you currently seeing a psych or a counsellor? What interventions have worked best for you? Please leave a comment below.