December 12, 2011

Re-feeding: it isn't just for anorexia

I keep hearing people say "food is medicine is only an issue with anorexia." This isn't true. Normalizing nutrition and eating are fundamental elements of treatment for ALL eating disorders.

Yes, with anorexia there is usually a need to regain weight lost or catch up on growth delayed. This isn't a matter of just getting "out of danger" and out of the hospital. This is about getting up to the weight, body composition, and balanced of nourishment that person needs for OPTIMAL health - based on that individual's unique normal body dimensions.

With bulimia the patient may be "average or higher" weight according to population charts but they are still usually either experiencing weight suppression (below highest lifetime weight or body composition) or experiencing erratic nutrition - delayed meals or unbalanced meals. Many have also not recovered from an earlier bout of malnourishment - a process that can take 6-12 months or longer.

The purge cycle, in bulimia and with purging anorexia, involves erratic nourishment and mealtimes.

Binge eating disorder involves intermittent fasting and binging - and unbalanced nourishment.

"Food is medicine" means more than just feed 'em up and gain some weight. It means that the full range of nutrients: fats, proteins, fiber, vitamins, micronutrients, fluids, etc. are being taken in at regular intervals in a calm and safe environment. It means desensitization to feared foods, and "exposure and response prevention" by way of normalized eating. Normalized eating helps to treat the mental symptoms: mood, cognition, attention, obsessions, compulsions.

Food is medicine isn't ALL the treatment needed, but it isn't optional -- and it isn't just about anorexia or about weight loss.

7 comments:

  1. Thank you so much for posting this. It's a very important concept that so many people fail to realize when discussing/treating eating disorders.

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  2. Thank you thank you thank you for posting this. I find it so frustrating when people fail to realize what a huge role restriction and weight suppression play in bulimia and BED.

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  3. I absolutely agree that food is medicine. Eating well and weight gain has had a huge and positive effect on alleviating my ED symptoms. Unfortunately, eating and weight gain haven't done much to alter the co-morbid anxiety and OCD that pre-dated and post-date my AN.

    But here is an interesting observation... It's one I made with my cat, Tigger. As a kitten I thought he was brain damaged, or perhaps autistic. (Yep, an autistic cat...). He was totally unlike his sibling - who was quite relaxed around people and very much your average kitten. But Tigger couldn't make eye contact without getting terrified, was incredibly anxious and had repetitive behaviours (tail biting). When he was 3 years old he started to throw up blood. After a number of tests the vet confirmed various food allergies and intolerances. I played around with his diet over a couple of months and found that all he can tolerate is pure chicken and rice. After 6 months of eating chicken and rice (with added micronutrients) his personality changed completely. He is now very affectionate, very content, far less anxious... And he doesn't bite his tail any more. He is a bit overweight, but who cares... It is amazing to see how his entire temperament and character have changed as a consequence of a change of diet.

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  4. This is so very important for sufferers, parents/caregivers and health providers to understand. It is good to differentiate food being the medicine from getting the weight up. I hear those two concepts collapsed into one at times and get frustrated because often people with BN and BED need the food for medicine but don't need to get the weight up. Thanks for highlighting these important distinctions.
    Becky Henry
    Hope Network

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  5. I came to the conclusion that restriction was driving my starve/binge/compensate cycle as a teenager. Unfortunately once I stopped bingeing I didn't understand that restriction could also drive restriction! It's so complicated...

    I'm a bit like ELT's cat too - my mood and anxiety improved rather drastically once I stopped consuming dairy, after a lifetime of mild to moderate allergic reactions suddenly morphed into life threatening ones after a bad stomach virus. Then again, most of your neurotransmitters are manufactured in your gut, so it makes sense that whatever upsets your digestive system long term could also do your brain some harm.

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  6. I know this is an older post but I need to be able to support this idea with research/professional literature if possible. I'm trying to educate family and professionals about this issue and how a loving and supportive family might help a young adult "re-feed" even when weight gain isn't needed.

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  7. Merrily, this is one of those areas where the expertise is in the heads of the most progressive, well-trained clinicians and not in the popular media or accessible materials. It is also mostly in the medical literature, not the psych literature. The best source is coming out of the Family-Based Maudsley training going on for bulimia, especially out of the University of Chicago where they are currently refining the use of FBT for bulimia, and for older patients.

    Here's one approach, though. Put the burden of proof back on those who might QUESTION whether a loving supportive family should be helping to take care of a loved one who is struggling with an illness with such a high mortality rate and chance of ruining their life. This is a disorder more deadly than many cancers.

    Unfortunately, there are serious barriers in the professional world to including parents on the team for all adults, and especially with eating disorders. That WILL change but may take a generation. Meanwhile, patients deserve the best their friends and families and clinicians can offer.

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