Lisa thought college would be the perfect opportunity to lose some weight. Typically about five or ten pounds overweight, she had always felt fat and wanted to take advantage of her newfound independence to shed a few pounds. At first she just restricted her eating: no snacks, no fat, just salads. Then she discovered that if she occasionally wavered, she could “undo the damage” by vomiting. Before long she was planning daily binges and purges that sometimes consisted of a dozen doughnuts, pizza, cookies and candy bars. Weighing herself five or six times a day, she became so afraid of gaining weight once she hit 100 pounds that she could barely eat anything without purging.
Two years later she knew she was in trouble. “I was so weak that I would skip classes because I couldn’t make it across campus. I had heart palpitations, my teeth were rotting, I couldn’t stand the cold, I had terrible mood swings, I couldn’t concentrate, and my hair was breaking off and falling out,” she recalls. “It sounds ridiculous in retrospect, but the only thing that made me get help was having too many bad hair days.”
Lisa didn’t realize then that her “bad hair” was just one sign of what had become severe malnutrition. Though her body could digest some food during a binge, the high-fat foods she binged on didn’t stay with her long enough to provide much nutrition.
Diseases of Depletion
Lisa suffered from a combination of related eating disorders: bulimia nervosa and anorexia nervosa. Although these disorders primarily affect females in their teens and twenties, they can also affect men, older women and young children.
Of the two, anorexia is easier to spot. People with this disease have an intense fear of being fat, causing them to starve themselves to emaciation. In women, it also causes amenorrhea, or the cessation of the menstrual cycle. People with bulimia are generally closer to normal weight, but they are also obsessed with body size. Bulimia is characterized by frequent binge-purge episodes, which involve eating a large amount of food in a short period of time and then trying to prevent weight gain by vomiting, using laxatives, dieting, fasting or exercising vigorously. It is common for people to have symptoms of both.
Medical experts don’t know exactly why some women dive headlong into this pool of self-destruction, though they generally agree that the cause includes an intricate web of social, psychological and biological factors. They also agree that malnourishment exacerbates the condition, rendering women less receptive to treatment.
“It’s a vicious cycle,” says Amy Tuttle, R.D., a nutrition therapist at the Renfrew Center in Philadelphia. “Malnutrition creates a physical and emotional shutdown, and the lethargy that results makes reaching out for physical and emotional nourishment even more difficult.”
Feeding Your Brain and Your Body
“It’s a tragedy how often this disease is treated as a mental illness rather than as one of mind-body,” says Joseph D. Beasley, M.D., co-author of Food for Recovery and director of Comprehensive Medical Care in Amityville, New York. Dr. Beasley advocates vitamin and mineral supplements for people with eating disorders. “You could have the world’s most renowned psychotherapists—Freud, Jung and Adler—talk to most of these patients until the sky turns green, and it won’t do any good until you get nourishment to the brain and clear the way for therapy.”
Dr. Beasley is not alone in his beliefs. Contrary to the old practice of first putting people in therapy and then slowly reintroducing food, treatment specialists now know that re-establishing proper nutrition is critical before psychological therapy can be effective. Many use vitamin and mineral sup - plements to help pave the way.
Generally, the supplement of choice is a multivitamin/mineral that provides 100 percent of the Daily Values of all essential nutrients while people are relearning to eat real food. Doctors do not recommend exceeding the Daily Values; they may, however, recommend supplements of certain individual nutrients, particularly potassium, calcium, iron, zinc, vitamin A, vitamin E and the B vitamins.
Note: Experts warn that supplements cannot take the place of food. The body will not properly absorb and use vitamins and minerals without also receiving adequate calories.
“A multivitamin/mineral supplement is disadvantageous for the person who takes it and then thinks she will be okay,” warns dietitian Cheryl Rock, Ph.D., assistant professor in the Program in Human Nutrition at the University of Michigan School of Public Health in Ann Arbor and co-author of Nutrition and Eating Disorders. “With that mind-set, the illness could drag on for ten years or more.”
Untreated, 10 to 15 percent of people with anorexia die, usually after losing at least half of their body weight. And over the long term, people with bulimia increase their risk of serious complications, such as abnormal heartbeat and stomach rupture. So even if you’re taking supplements, it’s important to work with a specialist to learn how to eat normally again.
| Food Factors Part of the recovery process for people with eating disorders is making peace with food instead of battling with it. Here are some tips that many experts believe might prove helpful. Say no to joe and sugar. It's very common for people with eating disorders to use caffeine and sugar to boost blood sugar levels to combat feelings of fatigue and depression, says Joseph D. Beasley, M.D., co-author of Food for Recovery and director of Comprehensive Medical Care in Amityville, New York. "It's better to eat a nutritionally balanced meal than to maintain this cycle of dramatic ups and downs, which always leaves you feeling worse," he says. Go organic. "My patients do better if they stay away from insecticides, pesticides, steroids and all of the other chemicals that are found in refined or processed foods," says Dr. Beasley. |
Balancing Electrolytes
It is well-documented that one of the consequences of eating disorders is a potentially life-threatening electrolyte imbalance. Electrolytes are minerals that, when dissolved in the body’s fluid, become electrically charged. They are responsible for controlling heart rate and blood pressure.
Potassium and sodium are the body’s major electrolytes. Although potassium deficiency is not common, rapid weight loss and dehydration can cause potassium to plummet, leaving you at risk for serious heart problems, including heart attack.
“People with eating disorders need to have these nutrients stabilized as quickly as possible,” says Dr. Beasley, who often recommends supplements of potassium as well as magnesium, another electrolyte that can lead to serious heart problems if deficient. “I have never seen an eating disorder patient who didn’t have major deficits of these nutrients.”
Because too much potassium can make you ill, it is best to get the Daily Value of this mineral (3,500 milligrams) by eating fruits and vegetables such as bananas, oranges, spinach and celery. You can get 885 milligrams just by eating half of a cantaloupe. Magnesium supplements are available in various forms, but eating seafood and green, leafy vegetables can help you easily get your Daily Value of 400 milligrams. People who have heart or kidney problems or diabetes should check with their doctors before supplementing these minerals.
Experts recommend that people with eating disorders have a physician monitor all of their electrolytes: potassium, magnesium and sodium as well as phosphorus and chloride, which can also become dangerously low.
Calcium to Protect Bones
Calcium, an essential mineral in the development and maintenance of bone health, is one of the nutrients most likely to be deficient in people with eating disorders. Those who treat eating disorders say the impact of severe calcium deficiency, especially when combined with amenorrhea, can be devastating.
“We see 28-year-old women with the bones of 80-year-olds,” says Tuttle. “They are already in the middle stages of osteoporosis. It’s sad, but fortunately, sometimes this serious medical issue is the alarm that helps a woman choose to move forward in her recovery.” Tuttle notes that doctors often give women with eating disorders calcium supplements of 1,000 milligrams (the Daily Value) or more while also attending to the amenorrhea.
“Certainly, it’s important that these girls get sufficient amounts of calcium in their diets,” says Steven A. Abrams, M.D., a research scientist at the U.S. Department of Agriculture Children’s Nutrition Research Center and associate professor of pediatrics, both at Baylor College of Medicine in Houston. “But supplements may not be sufficient to resolve osteoporosis if hormonal inadequacy remains present.”
Drinking skim milk is a good way to increase your dietary calcium, as just three cups packs more than 1,000 milligrams. Other sources include broccoli, tofu and fortified orange juice.
| Prescriptions for Healing Although eating food is absolutely essential to preventing the damage that eating disorders can do to the body, some doctors believe that vitamin and mineral supplements can expedite the process of recovery and healing. Nutrient Daily Amount
Calcium 1,000 milligrams Iron 18 milligrams Magnesium 400 milligrams Niacin 20 milligrams Potassium 3,500 milligrams thiamin 1.5 milligrams Vitamin A 5,000 international units Vitamin E 30 international units Zinc 15 milligrams Plus a multivitamin/mineral supplement containing the Daily Values of all essential vitamins and minerals
MEDICAL ALERT: Experts warn that supplements cannot take the place of food in someone who has an eating disorder. The body will not properly absorb and use vitamins and minerals without also receiving adequate calories. It is important to be under a doctor's care when treating this condition. People who have heart or kidney problems should check with their doctors before taking magnesium supplements. People who have kidney problems or diabetes should check with their doctors before taking potassium supplements. If you are taking anticoagulant drugs, you should not take vitamin E supplements. |
Breaking the Cycle with Zinc
Because zinc deficiency causes symptoms that are similar to those seen in people with anorexia and bulimia, including weight loss, depression, stomach bloating and amenorrhea, many researchers believe that low zinc intake, which is common in people with eating disorders, helps to perpetuate the illness.
Fortunately, studies have found that zinc supplementation can help turn the tables. In fact, researchers studying 35 girls with anorexia at St. Paul’s Hospital in Vancouver found that those who took just 14 milligrams of zinc a day were able to achieve their target weight gains twice as fast as those not taking zinc.
The Daily Value for zinc is 15 milligrams, an amount you can come close to by eating just one cooked medium-size oyster. You can also find this essential mineral in roast beef, wheat germ and whole grains.
A and E to the Rescue
Because vitamins A and E are fat-soluble, if you don’t have fat in your body, you don’t have enough of these vitamins. So in people with eating disorders, these important nutrients can be in short supply.
One study, by researchers at Hebrew University in Israel, found that women with anorexia had significantly lower levels of both vitamin A and vitamin E in their bodies than women without anorexia.
“We generally supplement the fat-soluble vitamins in the beginning of treatment, because these women have no fat,” says Kathryn J. Zerbe, M.D., vice-president for education and research and staff psychoanalyst at the Menninger Clinic in Topeka, Kansas, and author of The Body Betrayed: Women, Eating Disorders and Treatment. “Fortunately, you don’t have to get your fat stores up too high before your body is able to store the vitamins again.”
If you want to get your Daily Value of 5,000 international units of vitamin A and build your stores of this important vitamin, two of the best food sources are spinach and pumpkin. And you can get plenty of beta-carotene, which turns to vitamin A in the body, by eating carrots, sweet potatoes and other bright orange and yellow fruits and vegetables as well as dark green, leafy vegetables.
The Daily Value for vitamin E is 30 international units, and good dietary sources include whole-grain cereals, eggs and green, leafy vegetables.
Iron against Anemia
Because people with eating disorders generally shun red meat and don’t eat enough to get iron elsewhere, they sometimes develop iron-deficiency anemia.
“Anemia is caused by not having the fuel to produce energy, which adds to the fatigue and general lack of interest,” says Dr. Zerbe. She prefers that women get iron from foods but notes that supplementation can be helpful for reaching the Daily Value.
Though red meat is one of the best sources of iron, you can also get the Daily Value of 18 milligrams by eating clams, chick-peas, tomato juice, raisins, Cream of Wheat, tofu and soybeans.
Beat Depression with B
Depression is such a common thread in eating disorders that many doctors now use the drug fluoxetine (Prozac) to treat bulimia.
Many experts who prefer a drug-free approach, however, believe that depression is a natural consequence of starvation and that it can be alleviated with proper nutrition.
“If it’s a case of serious depression, we’ll use antidepressant therapy. But we always try the nutritional route first. Many people are greatly improved just by getting their nutrition stable,” says Dr. Beasley. Deficiencies in thiamin and niacin in particular cause psychological symptoms, including depression, he notes.
The Daily Value for thiamin is 1.5 milligrams. The vitamin can be found in virtually all plant and animal foods but especially in brown rice, seafood and beans. Niacin is plentiful in lean meats, fish and poultry, and its Daily Value is 20 milligrams.
