Considering Gut Health in Treating Eating Disorders

by Jason Arnold, PhD, ND

Currently there are approximately around 30 million people in the United States struggling with some form of eating disorder whether it be Anorexia Nervosa, Bulimia Nervosa, or Bing Eating Disorder (National Eating Disorder Association, 2018). According to the American Psychiatric Association, eating disorders have the highest mortality rate of any mental illness described in the Diagnostic and Statistical Manual (DSM; 2013). Clinicians and providers are still searching for new and innovative ways to treat these serious illnesses. We have seen the use of psychopharmacology, therapy, group therapy, family-based treatment, and functional approaches to clinical nutrition – all of which have been met with measured success. One of the areas that has been recently explored is your own body system and how this can influence not only your physical health, but your mental health as well.

There has been a huge amount of attention on the gut microbiome, or the community of microorganisms living in our digestive tracts. It appears that, in the past couple years, many physicians and providers have been looking at gut health as being a link to physical and mental health. For a Cliffs Notes idea of what this means is that your gut has trillions of microbes – “gut bugs”, so to speak – that are used in digestion and other physical processes that enable a person to live.

There is evidence that the health of your gut can impact your mental health. Based on research from the Journal of Psychosomatic Medicine (Kleiman, Watson, & Bulik-Sullivan, 2015) there appears to be a direct link between your gut and your brain. A majority of Serotonin – the neurotransmitter that regulates mood and anxiety states – is actually made in your digestive tract. The link between gut health and eating disorders is even more so. According to Dr. Loren Cordain, a scientist who specializes in nutrition and exercise physiology,  people who are struggling with eating disorders have different types of microbes, or gut bugs, than those who do not have ED. Each individual has close to a trillion bacteria in their gut that aids in digestion and processing of nutrients.  In addition, those who have eating disorders also typically have fewer microbes than those without eating disorders, which may be a result of altered digestive processes or eating disorder behaviors (Kleiman et al., 2015). Research suggests that a change in your gut microbiome can also help a change in your mood and aid in your recovery as well (Thaler, 2015; Deans, 2015).

So here are a couple of helpful hints that could  build back up your gut microbes, which in turn, may potentially help improve your mood, decrease your anxiety, and also help regulate how your body digests food and stores nutrients as you progress through the recovery of an eating disorder:

  1. First things first. The best rubric: Lack of nutrition and a lack of a balanced diet lead to poorer health, symptoms of depression, anxiety, and ultimately can influence the microbiome in your gut. A balanced diet according to Dr. SC Kleiman, a researcher on gut health and eating disorders, leads to more positive outcomes. Meet with your dietician regularly and make sure you ask questions and address any concerns you have about what you are eating and how that may influence your recovery.
  2. Consider the types of foods that you do eat. To strengthen your internal body system and your gut microbes, eating a variety of foods in textures, colors, etc. Research (Heiman & Greenway, 2016) suggests that variety helps to challenge gut microbes, encourages reproduction and diversity in your gut microbes, and strengthens the microbiome. The road to good gut health and an improvement in mood and anxiety, and ultimately a reduction in symptoms of an eating disorder is to allow for variation in your diet. This is a great way to also work on challenge foods as well!
  3. If you have been struggling with an eating disorder for quite some time consider probiotics. As a society, we’ve been using probiotics for years to support good gut health and digestion. These are foods, such as yogurt, that contain good, friendly bacteria that can help restore gut health. According to Dr. Karen Ross, MD, MPH, a physician and columnist from Psychology today, probiotics are associated with positive physical and mental outcomes. Probiotics also come as supplements including products like Culturelle. These can be taken under the direction of a physician.

If this is something you feel is worth exploring, speak to your doctor, dietician, or treatment team. During your recovery, it is important to have the maximum amount of support you can during a time that may be intimidating and sometimes very scary. Your providers can best help direct your treatment in a way that is right for you that will not only keep you healthy, but keep you safe. Everyone has the right to recovery regardless as to where they are in that process. If you need help, please do not hesitate and reach out.

Be well.

 

Bibliography

Deans, E. (2015). Junk food, gut, and brain. Evolutionary Psychiatry. Retrieved from https://www.psychologytoday.com/us/blog/evolutionary-psychiatry/201505/junk-food-gut-and-brain on September 15, 2018.

Heiman, ML & Greenway, FL (2016). A healthy gastrointestinal microbiome is dependent on dietary diversity. Molecular Metabolism, 5(5) 317-320.

Kleiman SC, Watson HJ, Bulik-Sullivan EC (2015). The intestinal microbiota in acute Anorexia Nervosa and during renourishment: Relationship to depression, anxiety, and eating disorder psychopathology. Psychosomatic Medicine. 2015.

Thaler, C. (2015). Eating disorders, mental health, and the gut microbiome. The Paleo Diet. Retrieved from https://thepaleodiet.com/eating-disorders-mental-health-and-the-gut-microbiome on September 12, 2018.

Orthorexia Nervosa: An Emerging Eating Disorder

What is Orthorexia?
By Jason Arnold, PhD, ND

Orthorexia is a proposed eating disorder in which an individual has an unhealthy pre-occupation with “healthy” food. As a diagnosis, it is not recognized by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). An individual with Orthorexia takes “healthy eating” to a very mental and physical extreme. According to Dr. Steven Bratman, MD, an American physician who began seeing patients with these symptoms and coined the term Orthorexia, individuals with Orthorexia are entirely concerned with the types of food and the purity (i.e., none processed, whole food, low fat diets) of the food that he or she puts in their body. That person refines and restricts his or her diet to what they believe is nutritionally pure such as non-processed whole foods or those foods that he would see as being “healthy”. While many people may try to eat a healthy diet, a person who has Orthorexia unfortunately does this to the point where it paradoxically becomes unhealthy both physically, emotionally, and socially. The loss of friendships, emotional well-being, depression, anxiety, the inability to enjoy food, and in severe cases malnutrition and death.

In a recent article in Men’s Health (2018) Dr. Valerie Luxon, a clinical psychologist who specializes in the treatment of eating disorders, noted that there is a higher likelihood of men developing orthorexia due to social expectation of men with respects to health, fitness, and physical aesthetic. Social pressures lead to feelings of anxiety and vulnerability, which may prompt men to engage in healthy eating which, in turn,  can lead to extreme behaviors.

What is the treatment for Orthorexia?

While no empirically-supported treatment protocols exist for Orthorexia, treatment could be similar to the treatment of other eating disorders such as Anorexia Nervosa and Bulimia Nervosa. This could include individual therapy, medication management (if needed) as well as regularly meeting with a Registered Dietician. Similar to empirically established treatments for eating disorders, cognitive behavioral treatment strategies may be helpful for addressing thoughts around “healthy” foods.”  Other techniques could also focus on target behaviors and modifying them with emotional support including challenging patients to eating a food that they believe would be “less healthy” and then process the emotions the person is feeling and the cognitive distortions he may feel. Finally, working with a Registered Dietician to develop a meal plan that includes sensible healthy choices for meals that will provide the appropriate amount of nourishment that an individual’s body needs, not only for nutrition, but for recovery.

Where do I start?

Firstly, everyone is deserving of recovery. It can be scary to begin any type of mental health treatment. People may feel alone and overwhelmed. Many people have struggled with eating disorders and many know that recovery is possible because they have gone through this process. If you are not sure where to start and do not currently have a therapist or psychiatric prescriber, it may be helpful to talk to your Primary Care Physician about your concerns and seek out information on specialized treatment options, as described below. If you are a parent whose son is struggling with what you suspect is Orthorexia, address these concerns directly. Your doctor can often times refer you to a prescriber or therapist for further evaluation. If you would like more information on orthorexia and eating disorders more broadly, including finding treatment providers in your area, you can go to the National Eating Disorders Association (https://www.nationaleatingdisorders.org/find-treatment/treatment-and-support-groups), Eating Disorders Hope (https://www.eatingdisorderhope.com/treatment-for-eating-disorders/therapists-specialists), Academy for Eating Disorders (https://www.aedweb.org/learn/resources/patient-carers). These organizations have a wealth of information on local providers as well as support groups for those in recovery as well as families.
Again, taking the first step can be the most-anxiety provoking. But remember you and your life are worth recovery.

Be well.