Chapter 1 Eating Disorders

Bulimia nervosa
A. Overview
First called bulimarexia, bulimia nervosa is a more recently recognized eating disorder than anorexia nervosa. Bulimia nervosa is an eating disorder in which a person binges and purges. The person may eat a lot of food at once and then try to get rid of the food by vomiting, using laxatives, or sometimes overexercising. People with bulimia are preoccupied with their weight and body image. Bulimia is associated with depression and other psychiatric disorders and shares symptoms with anorexia nervosa, another major eating disorder. Because many individuals with bulimia can maintain a normal weight, they are able to keep their condition a secret for years. If not treated, bulimia can lead to nutritional deficiencies and even fatal complications. Diagnostic criteria for Bulimia nervosa:

The disturbance does not occur exclusively during episodes of anorexia nervosa.

B. Associated Nutritional Problems

Bulimia is extremely harmful to the body. The exact medical consequences will depend on the type of purging behavior used and the length of time (and severity) involved. Repeated vomiting causes loss of water (causing dehydration), and loss of minerals like sodium and potassium (causing electrolyte imbalance), as well as trauma. In addition, vomiting can lead to tears in the lining of the throat, esophagus and stomach (ulcers). Also it erodes tooth enamel due to the stomach acid vomited with the food (causing cavities). Over-use/ abuse of laxatives and diuretics causes loss of sodium and potassium (causing increased risk of heart damage) as well as seriously irregular bowel movements and constipation. Like individuals with anorexia, many people with bulimia suffer from clinical depression, anxiety, obsessive compulsive disorder (OCD), and other psychiatric conditions. These problems, combined with their impulsive tendencies, place them at higher risk of suicide.

Recurrent episodes of
binge eating. Recurrent, inappropriate compensatory behavior to prevent weight gain, such as self- induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise.

The binge eating and

inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months. Self- evaluation is unduly influenced by body shape and weight.

C. Dietary Measures

used as Treatment
People with bulimia are more likely to have vitamin and mineral deficiencies, which can affect their health. Vitamin deficiencies can contribute to cognitive difficulties such as poor judgment or memory loss. Getting enough vitamins and

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minerals in your diet or through supplements can correct the problems. Some natural therapies, including dietary supplements, may help general health and well-being. Following these nutritional tips may help reduce symptoms: Avoid caffeine, alcohol, and tobacco. Drink 6 - 8 glasses of filtered water daily. Use quality protein sources -such as organic meat and eggs, whey, and vegetable protein shakes -- as part of a balanced program aimed at gaining muscle mass and preventing wasting. Avoid refined sugars, such as candy and soft drinks. before taking 5-HTP. Do not take 5-HTP if you are taking antidepressants. Creatine, 5 - 7 grams daily, when needed for muscle weakness and wasting. Probiotic supplement (containing Lactobacillus acidophilus among other strains), 5 - 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. Refrigerate probiotic supplements for best results. L-glutamine, 500 - 1,000 mg three times daily, for support of gastrointestinal health and immunity.

Herbs Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted. These herbs are not used to treat bulimia specifically, but may be helpful in maintaining overall health: Ashwagandha (Withania somniferum) standardized extract, 450 mg one to two times daily, for general health benefits and stress. Holy basil (Ocimum sanctum) standardized extract, 400 mg daily, for stress. You can also prepare teas from the plant.

Your doctor may suggest addressing nutritional deficiencies with the following supplements: A daily multivitamin, containing the antioxidant vitamins A, C, E, the Bvitamins, and trace minerals, such as magnesium, calcium, zinc, phosphorus, copper, and selenium. Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 tablespoonful oil two to three times daily, to help decrease inflammation and improve immunity. Cold-water fish, such as salmon or halibut, are good sources; eat two servings of fish per week. Coenzyme Q10, 100 - 200 mg at bedtime, for antioxidant, immune, and muscular support. 5-hydroxytryptophan (5-HTP), 50 mg two to three times daily, for mood stabilization. Talk with your health care provider if you are on prescription medications

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Milk thistle (Silybum marianum) seed standardized extract, 80 160 mg two to three times daily, for liver health. Grape seed (Vitis vinifera) standardized extract, 100 200 mg three times daily, for antioxidant effects, and heart and blood vessel protection. Catnip (Nepeta spp.), as a tea two to three times per day, to calm the nerves and soothe the digestive system. Determine whether condition is permanent/ no expectation for resolution. Assess mental/ physical influence of illness/ condition on the clients emotional state. Evaluate level of clients knowledge and anxiety related to situation.

D. Nutritional Monitoring
Fluid volume deficit management Note possible conditions/ processes that may lead to deficit such as:

Anorexia nervosa
A. w
Anorexia nervosa, commonly referred to simply as anorexia, is one type of eating disorder. More importantly, it is also a psychological disorder. Anorexia is a condition that goes beyond out-of-control dieting. A person with anorexia often initially begins dieting to lose weight. Over time, the weight loss becomes a sign of mastery and control. The drive to become thinner is actually secondary to concerns about control and/or fears relating to one's body. The individual continues the endless cycle of restrictive eating, often accompanied by other behaviors such as excessive exercising or the overuse of diet pills, diuretics, laxatives, and/or enemas in order to reduce body weight, often to a point close to starvation in order to feel a sense of control over his or her body. This cycle becomes an obsession and, in this way, is similar to any type of addiction. Diagnostic criteria for Anorexia nervosa: Refusal to maintain body weight at or above a minimally normal weight for age and height.

Overvie

Vomiting Salt-wasting diuretics Limited intake Fluid shifts Determine the clients age Evaluation of nutritional status, noting the current intake, weight changes, problems with oral intake, use of supplements/ tube feedings.

Body Image Disturbance Discuss pathophysiology present and/ or situation affecting the individual and refer to additional NDs as appropriate example.

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Intense fear of gaining weight or becoming fat although underweight. Disturbance in the way which ones body weight or shape is experienced, undue influence of body weight or shape on self- evaluation, or denial of the seriousness of the current low body weight. In postmenarcheal women, amenorrhea. An estimated one-third of anorexic patients have mild anemia (low red blood cell count). Leukopenia (low white blood cell count) occurs in up to 50 percent of anorexic patients. Gastrointestinal (stomach and intestines)

Normal movement in intestinal tract often slows down with very restricted eating and severe weight loss. Gaining weight helps to restore normal intestinal motility. Renal (kidney)

B. Problems

Associat

ed Nutritional

Dehydration may be associated with anorexia and results in highly concentrated urine. Polyuria (increased production of urine) may also develop in anorexic patients when the kidneys' ability to concentrate urine decreases. Renal changes usually return to normal with the restoration of normal weight. Endocrine (hormones)

Medical complications that may result from anorexia include, but are not limited to, the following: Cardiovascular (heart)

While it is difficult to predict which anorexic patients might have life-threatening heart problems that result from their illness, the majority of hospitalized anorexic patients have been found to have low heart rates. Myocardial (heart muscle) damage that can occur as a result of malnutrition or repeated vomiting may be life threatening. Common cardiac complications that may occur include the following arrhythmias (a fast, slow, or irregular heartbeat) bradycardia (slow heartbeat) hypotension (low blood pressure) Hematological (blood)

In females, amenorrhea (cessation of the menstrual cycle for at least three consecutive months when otherwise expected) is one of the hallmark symptoms of anorexia. Amenorrhea often precedes severe weight loss and continues after normal weight is restored. Reduced levels of growth hormones are sometimes found on anorexic patients and may explain growth retardation sometimes seen in anorexic patients. Normal nutrition usually restores normal growth. Skeletal (bones)

Persons with anorexia are at an increased risk for skeletal fractures (broken bones).When the onset of anorexic symptoms occurs before peak bone formation has been attained (usually mid to late teens), a greater risk of osteopenia (decreased bone tissue) or

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osteoporosis (bone loss) exists. Bone density is often found to be low in females with anorexia, and low calcium intake and absorption is common. for those being treated against their will. Fear of weight gain is extraordinarily frightening to people with anorexia, and forced weight gain even more so. But research shows that the closer body weight is to normal at the end of treatment, the greater the chance of recovery, so weight restoration should be a top treatment goal. Nutritional therapy for anorexia

C.

Dietary

Measures used as Treatment

Since anorexia involves both mind and body, both attitudes and behaviors, a team approach is often best. Those who may be involved in anorexia treatment include medical doctors, mental health professionals, and dieticians. The participation and support of family members also makes a big difference in anorexia treatment success. TREATING ANOREXIA involves three components:

A second component of anorexia therapy is nutritional counseling. In nutritional counseling, a nutritionist or dietician teaches the patient about healthy eating, proper nutrition, and balanced meals. The nutritionist also helps the person develop and follow meal plans that include enough calories to reach or maintain a normal, healthy weight.

restoring the person to a healthy weight; treating the psychological issues related to the eating disorder; and reducing or eliminating behaviors or thoughts that lead to disordered eating, and preventing relapse.

Counseling and therapy for anorexia

Source: National Institute of Mental Health Medical treatment for anorexia

The first priority in anorexia treatment is to address and stabilize any serious health issues. Hospitalization may be necessary to prevent starvation, suicide, or a medical crisis. Dangerously thin anorexics may also need to be hospitalized until they reach a less critical weight. Outpatient treatment is an option when the patient is not in immediate medical danger. Getting back to a normal weight is no easy task, especially

Therapy plays a crucial role in anorexia treatment. Its goals are to identify the negative thoughts and feelings about weight and the self that are behind the anorexic behaviors, and to replace them with healthier and less distorted attitudes. Another important goal is to teach the anorexic how to deal with difficult emotions, relationship problems, and stress in a productive, rather than a self-destructive, way.

D.

Nutrition

al Monitoring
Fluid volume deficit management Note possible conditions/ processes

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Chapter 1 Eating Disorders

that may lead to deficit such as:

Vomiting Salt-wasting diuretics Limited intake Fluid shifts Determine the clients age Evaluation of nutritional status, noting the current intake, weight changes, problems with oral intake, use of supplements/ tube feedings.

Body Image Disturbance Discuss pathophysiology present and/ or situation affecting the individual and refer to additional NDs as appropriate example. Determine whether condition is permanent/ no expectation for resolution. Assess mental/ physical influence of illness/ condition on the clients emotional state. Evaluate level of clients knowledge and anxiety related to situation.

Nutrition