Eating and

Weight Management
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Anorexia

A person who refuses to eat food and loses weight dramatically causes great consternation among family members, physicians and support staff. The diagnosis often is anorexia nervosa. Some anorexic patients have a history of binge-eating and were overweight. Others may alternate binge eating and starvation. All these patterns of eating disorders suggest an appetite control system in their brain that is malfunctioning.  Unstable appetite is often associated with distortions in body image and emotional disturbances, suggesting a pervasive brain disorder

 I am convinced that most theories and therapies are misguided attempts to deal with a biological problem. The more authoritarian treatment strategies verge on cruel and usual treatment of patients who need understanding, affectionate support, and, hopefully, better strategies of achieving adequate nutrient intake such as replacing food with Alpha ENF. Some patients receive wrong diagnoses and are subjected to futile treatments for diseases they do not have. Parents may deny that their child has a eating disorder and shop for diagnoses that conceal the true nature of the eating disorder.  Doley et al stated:” Stigma is a problem for individuals with eating disorders (EDs), forming a barrier to disclosure and help-seeking. Interventions to reduce ED stigma may help remove these barriers. Biological explanations reduced stigma relative to other explanations, including sociocultural explanations. Combined education and contact interventions improved stigma relative to control groups or over time. Most studies examined Anorexia Nervosa (AN) stigma and had mostly female, undergraduate participants.” 

In a review of psychotherapies, Barclay and Lie [i] suggested that cognitive behavior therapy [CBT] treats food avoidance as a habit pattern that can be corrected by changing behaviors through education rewards and punishments. Clinics that use this approach define healthy eating in a dogmatic manner, make no effort to understand or provide customized diets and have no knowledge of food allergy and other food intolerances. They focus unreasonably on weight issues. Another popular treatment, interpersonal psychotherapy, links life events to eating problems and uses four interpersonal areas of grief, disputes, role transitions, and interpersonal deficits to identify problems and assess symptoms. Nonspecific supportive clinical management uses education and support such as praise, reassurance, and advice. McIntosh et al compared CBT and interpersonal psychotherapy to supportive but nonspecific management and found that supportive management was superiors to the other two strategies. [ii]

In my view, “psychotherapies” are based on false premises and can be unreasonable and punitive. They should be phased out.

Persona Experience

Arnold described her own experiences with anorexia complete with repeated bone fractures, surgeries to repair and disability that followed; "Not long after I started cutting back on food and increasing my exercising, my periods stopped. Far from being worried, I was thrilled. No more tampons! No more mood swings! Not long after I was finally diagnosed, my doctor ordered a bone density scan. The results were awful: marked osteoporosis in the spine, hip, and femur. I was 21…At 24, I slipped on the ice outside of my Michigan apartment. It was the type of fall that should have resulted in bruises and maybe a sprained ankle. Instead, I ended up shattering three bones in my ankle, requiring surgery and months of rehab. My surgeon told me my bones were so soft he could barely install the screws. I was briefly scared into eating regularly, but all too soon, the fears fade and my old habits return. My eating disorder continued for more than a decade before I finally entered recovery. I challenged myself to eat foods I haven’t touched since high school. I gained weight. I gave up my gym membership in favor of hiking and cycling. I repaired my relationship with my parents. I quit my job and started freelancing. Surprisingly, it all came together. Although I was not free of eating disorder thoughts, I figured the worst of it was behind me. I was wrong…Recovery from a long-term eating disorder is a bit of a statistical anomaly. It happens, of course, but the less time a person is sick, the better their chances of recovery. As I got better, I also got curious about what happened to other patients like me. What happens to us after the eating disorder? Are we scarred for life? And what about our physical bodies? I asked my therapist and other eating disorder experts. No one had any answers. Many of my friends are in a similar position: we consider ourselves in recovery from an eating disorder (or at least vastly improved) but we are walking in an area of physical and mental health where no one has any advice.”[iii]

Eigenstates

Williams and Reid explored the subjective perspective that is of great interest to me. I have described two important aspects of the mind that are not understood: 1. Self-talk and 2. Eigenstates. No person has a single personality but rather shifts in a context-dependent manner among different personalities that can be very different, even contradictory. Every person talks to himself or herself in a continues narrative the shifts as eigenstates change. They wrote:" This study explores the lived experience of anorexia nervosa... Participants described their disorder as a functional tool for avoiding and coping with negative emotions, changing their identity and obtaining control. A central theme was the experience of an ‘anorexic voice’ with both demonic and friendly qualities. This voice felt like an external entity that criticized individuals and sometimes dominated their sense of self, particularly as anorexia nervosa got worse. ..the anorexic voice is a self-critical position, which disagrees with and attempts to dominate the more rational self. It is suggested that to move on from anorexia nervosa, the individual needs to address his/her anorexic voice and develop a new dominant position that accepts and values his/her sense of self." [iv]

Recovery

Hay et al explored the personal narrative of anorexic women looking for clues to recovery and relapse. "Less than half of people with anorexia nervosa achieve full recovery. Previous qualitative research has identified a “tipping point” for change in people who have experienced recovery. The present study's goal was to explore factors that might contribute to this time in personal published accounts, an alternate source for understanding lived experience.. In all the accounts a “tipping point” or change in the person's attitude toward treatment and recovery did appear. We identified four main themes: desire for recovery, positive experiences in treatment, an aspect of life outside work or study, and positive and helpful experiences with new or renewed relationships. The themes were a mix of internal and external themes, as well as themes independent of a treatment experience. The findings support other research that indicates experiences, such as personal and spiritual relationships, in addition to specific psychotherapies or treatments, are important in recovery. Further research into how to facilitate and integrate these external factors with formal treatment is indicated in order to improve understanding of outcomes in anorexia nervosa." [v]

Patients not only observed, speculated, and made assumptions about their therapists’ bodies but also that their assumptions and speculations had the potential to influence both their beliefs about the therapist's ability to help them, and their willingness to engage in therapy. [vi]

Neuroscience

Joss et al added to the neuroscience view of AN as a brain disorder, not amenable to psychotherapy of any type. The reported:"Functional imaging studies had often investigated heterogeneous samples of anorexia nervosa (AN) patients with varying paradigms and methodologies that had resulted in divergent results. The present study aimed to examine these issues by studying a well-defined sample of restrictive AN …Subjects showed increased blood oxygen level dependent responses of the cingulate, frontal, insular and parietal cortices. Group comparisons demonstrated increased activity of the right amygdala in the sample of restrictive AN patients. Our results point to a pivotal role of the right amygdala in AN. Signals of the midcingulum were reduced in comparison to healthy controls. The constellation of increased activity of the amygdala and decreased activity of the cingulate cortex likely represents parts of a negative feedback loop of emotional processing. Disgust ratings correlated with the amygdala signal negatively, which points to the complex role of this structure in eating disorders."[vii]

Avraham et al contributed one piece of the biochemical puzzle facing AN patients. There a many ideas to explaining the onset of the disorder and many concerns about the deteriorating health of food deprived patients. These concerns should by the main emphasis in treatment programs. They stated:" Severe malnutrition resulting from anorexia nervosa or involuntary starvation leads to low weight, cognitive deficits and increased mortality rates. We examined whether fish oil supplementation, compared with that of canola oil, would ameliorate the morbidity and mortality associated with these conditions by normalizing endocannabinoid and monoaminergic systems as well as other systems involved in satiety and cognitive function within the hypothalamus and hippocampus. Female Sabra mice restricted to 40% of their daily food intake exhibited decreased body weight, were sickly in appearance, displayed cognitive deficits and had increased mortality rates. Strikingly, fish oil supplementation that contains high omega-3 fatty acids levels decreased mortality and morbidity, and normalized the expression of genes and neurotransmitters in the hippocampus and hypothalamus. Fish oil supplementation, but not canola oil, increased survival rates, improved general appearance and prevented cognitive decline, despite the facts that both diets contained an equivalent number of calories and that there were no differences in weight between mice maintained on the two diets in 100% but decrease in the 40%. In the hypothalamus, the beneficial effects of fish oil supplementation were related to normalization of the endocannabinoid 2-arachidonylglycerol, serotonin (5-HT) (P<.056), dopamine, neuropeptide Y (NPY) and Ca2+/calmodulin (CaM)-dependent protein kinase (Camkk2). In the hippocampus, fish oil supplementation normalized 5-HT, Camkk2, silent mating type information regulation 1 and brain-derived neurotrophic factor. Dietary supplements of fish oil, as source of omega-3 fatty acids, may alleviate cognitive impairments associated with severe diet restriction and prolong survival independently of weight gain by normalizing neurochemical systems." [viii]

[i] Laurie Barclay, Désirée Lie. Nonspecific Supportive Clinical Management May Be Effective for Anorexia. Medscape CME Online. Release Date: April 7, 2005. http://www.medscape.com/viewarticle/502619?src=mp

[ii] Am J Psych. 2005;162:741-747

[iii]Carrie Arnold. You-re-never-cured-of-an-eating-disorder. http://www.thedailybeast.com Dec. 20 2014

[iv] Sarah Williams & Marie Reid. . ‘It's like there are two people in my head’: A phenomenological exploration of anorexia nervosa and its relationship to the self. Psychology & Health. Volume 27, Issue 7, 2012

[v] Phillipa J. Hay DPhil MDab* & Kenneth Ch. A Qualitative Exploration of Influences on the Process of Recovery from Personal Written Accounts of People with Anorexia Nervosa. Women & Health. Volume 53, Issue 7, 2013

[vi] Victoria Clarke & Naomi P. MolleraIf. I See Somebody … I'll Immediately Scope Them Out: Anorexia Nervosa Clients’ Perceptions of Their Therapists’ Body. Eating Disorders: The Journal of Treatment & Prevention. Volume 22, Issue 2, 2014

[vii] Joos, Andreas A.B. et alAmygdala hyperreactivity in restrictive anorexia nervosa. Psychiatry Research: Neuroimaging , Volume 191 , Issue 3 , 189 - 195 March 2011

[viii] Avraham, Yosefa et al. Fish oil promotes survival and protects against cognitive decline in severely undernourished mice by normalizing satiety signals. Journal of Nutritional Biochemistry , Volume 22 , Issue 8 , 766 - 776. Nov 2010

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Alpha ENF is the principle meal replacement formula. Alpha PMX is a fat free version of Alpha ENF can be used as food replacement. Alpha DMX is used instead of of Alpha ENF for diabetes 2 and whenever reduced caloric intake is desirable.

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Eating and Weight
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