8. OBESITY & EATING DISORDERS Flashcards

Question

# Naturopathic approach to insulin resistance Provide dietary/lifestyle recommendations and supplements to reduce inflammation

Answer 1

* Avoid inflammatory foods - refined carbs, damaged fats etc. * Increase a rainbow of plant foods incl. blue, purple, black foods. – Proanthocyanidins modulate inflammation, enhance anti-inflammatory adiponectin and support microbiome: *ginger, turmeric, flaxseeds, tea, apples, berries.* – *Green tea polyphenols* ↓ fasting glucose and ↓ HbA1c. – Foods rich in prebiotic fructans, fructooligosaccharides (FOS), inulin e.g., *chicory, leeks, onions, Jerusalem artichokes.* * Antioxidants (α-lipoic acid, glutathione etc). * Prioritise sleep - sleep deprivation can increase C-reactive protein.

Answer 2

* **Meal timing and frequency** is key to ensure appropriate insulin and glucagon secretion. - *Time Restricted Feeding* (TRF); elimination of snacks. - Eat last meal earlier in the evening then *fast* overnight. * Increase **moderate exercise** - ↑ insulin sensitivity by acting directly on muscle metabolism. * **Prebiotics** - inulin and FOS have been shown to modulate appetite, blood glucose and insulin levels. * *Vitamin D, magnesium, zinc, α-lipoic acid, CoQ10, Chromium, Gymnema sylvestre, cinnamon, bitter melon, fenugreek, garlic.*

Answer 3

* *Smaller portions* - eat from a side plate vs. a dinner plate. * *Protein-based breakfast* - eating a protein-based breakfast helps normalise insulin secretion and reduces the tendency to snack. * *Protein with each meal* - palm size. * *Keep meals simple* - the variety of foods in a meal increases intake: The more foods differ in their flavour, the greater the boost. * Leave 4 hours + between meals. *Fasting* or a fasting window such as 16:8. * *Chew food well* - 30 times. * Turn off all ‘stimulators’ whilst eating. * *Mindful eating* - enjoy the ritual of food vs. ‘food to survive’.

Answer 4

* vitamin A * C * D * folate * iron * zinc * calcium

Answer 5

* *Meal composition* - educate, e.g. low GL; macronutrient balance. * *Breakfast is vital* and should include protein and only low GL carbs. * *Protein at each meal* - increases postprandial thermogenesis. * *Exercise daily* - 35 minutes low intensity. * Food diary and frequent practitioner contact.

Answer 6

False Calorie counting can often be demeaning to the client and it doesn’t always help with healthy food choices. Instead, evaluate if the food advice meets their minimum requirements and does not exceed a maximum amount, or else it will not work. NOTE: Diets are for the short term, people often ‘fail’ and gain back what they lost quickly plus more. Lifestyle change is slower, it has health as its goal - *a journey, not a destination*.

Answer 7

- ↓ leptin levels during weight loss signals to the brain ↑ feeding and ↓ energy expenditure. - Pre-adipocyte proliferation occurs, ↑ fat storage capacity. - Changes occur in the circulating levels of several gut hormones involved in the homeostatic regulation of body weight. - These adaptations are often potent enough to undermine the long-term benefits of lifestyle modification, particularly in an environment replete in highly-calorific foods.

Answer 8

Dosage: 50-100 mg twice daily. Start at a lower dose; build up to minimise possible nausea. - 5-HTP can aid weight loss by increasing feelings of satiety. - Promotes sleep by enhancing melatonin production. - Has free radical scavenging activities.

Answer 9

Dosage: 600–900mg / daily (~3–4 cups of brewed green tea). - Green tea polyphenols * may stimulate *thermogenesis* and *fat oxidation*. | * especially EGCG (the major catechin found in green tea)

Answer 10

Dosage: up to 2000 mg / daily. - For *β-oxidation of fatty acids* in mitochondria. Essential for efficient utilisation of fats for energy. - Improves *leptin resistance*. - In studies L-carnitine supplementation significantly *reduced body weight, BMI, and fat mass*.

Answer 11

Dosage: up to 3.4 g daily. Improves leptin resistance, lipolysis in adipocytes and enhanced fatty acid oxidation in both adipocytes and skeletal muscle cells.

Answer 12

Dosage: 200‒1000 mcg chromium picolinate. - Lowers body weight yet increases lean body mass, likely via increased insulin sensitivity. - May reduce carbohydrate cravings.

Answer 13

Can be taken in capsules, tincture, powder or tea. Look for a product standardised to contain at least 25% gymnemic acid. Dosage: 100 mg 3 times daily. Take with food. Helps to lower blood glucose levels by: - Increasing secretion of insulin. - Promoting regeneration of islet cells. - Increasing utilisation of glucose. - Inhibiting glucose absorption from the intestine. - It is believed to inhibit the sweet taste sensation.

Answer 14

- 5-HTP - Green tea - L-Carnitine - Conjugated Linoleic Acid - Chromium - Gymnema sylvestre

Answer 15

* Evaluate with your client all of the situations in which eating is triggered and come up with an eating change strategies. * Identify stressful occasions, and plan for them. * Allow time and space for ‘favourite’ foods in a *non-reward* setting.

Answer 16

* Anorexia nervosa. * Bulimia nervosa. * Other specified feeding or eating disorder (OSFED) includes: – Orthorexia. – Compulsive eating. – Binge eating. – Night eating syndrome.

Answer 17

* SNPs influencing metabolism and hormones. e.g. a SNP at rs929626 of the ‘early b-cell factor 1’ (EBF1) gene can *dysregulate leptin signalling* and may be involved in anorexia nervosa. * Family history of eating disorders. * Nutritional deficiencies, e.g. *zinc* and *EFAs*. Zinc deficiency has been identified as a risk factor in anorexia nervosa, which is often found in childhood/puberty. This can impact appetite regulation.

Answer 18

* *Depression*, *anxiety* and worry, poor *stress resilience, emotional restraint* and *OCD* tendencies are risk factors. * *Perfectionism* and the *need for control* is also a common theme. This may stem from dysfunctional nurturing relationships (e.g. maternal or paternal). Symptoms can start with aiming to achieve what is considered “the perfect diet” and then the control stems from trying to maintain this.

Answer 19

Anorexia Nervosa (AN) = an eating disorder characterised by abnormally low body weight, a fear of gaining weight and a distorted perception of weight/body image. 50% ‘recover’, 30% improve, 15% remain chronically ill, 5% die from complications and suicide.

Answer 20

- Strict dieting - Excessive calorie counting - Avoidance of all fats in food - Opting for vegetarian / vegan diet to easily remove foods groups - Purging, hiding food and lying about food eaten - Over exercising to compensate for kcal eaten - Controlling appetite by excessive water intake or use of appetite suppressants - Becoming socially isolated, esp. around mealtimes

Answer 21

- Lack of energy and muscle atrophy - Poor concentration and focus - Light-headedness, dizzy spells - Constipation, bloating, abdominal pain - Growing soft, fine hair on body and face. Head hair falling out - Lower body temperature. Low blood pressure. - Increase in anxiety and poor stress resilience - Amenorrhoea

Answer 22

* Gut dysbiosis and low HCL levels. * Food intolerances. * Low absorption capability. * Reproductive problems and menstrual irregularities. * Poor immunity. * Dentition problems. * Anaemia and low mineral levels. * Anxiety and depression. * Poor skin, hair and nails. * Reduced bone mineral density (osteopenia/osteoporosis).

Answer 23

'restrictive' type and 'binge-purge' type

Answer 24

tryptophan

Answer 25

- dehydration - electrolyte imbalances - low blood potassium levels which induce psychological problems.

Answer 26

metabolic alkalosis

Answer 27

* *Aromatase* is expressed in adipose tissue. * *Adipose tissue* is a key site for the peripheral production and metabolism of *oestrogen*. * *Oestrogen deficiency* may cause a decline in serotonin through a decrease in the density of 5HT2A receptors and lower activity of *serotonin*. * *Low serotonin* adds to symptoms of low mood, anxiety, insomnia / sleep disturbances, OCD, migraines and IBS. * *Carbohydrate consumption*, acting via insulin secretion and the plasma tryptophan ratio *increases serotonin* release.

Answer 28

* *Intense fear of gaining weight* / a healthy BMI. * *BMI 17.5 or under* (combined with other factors) – BMI should not be the only factor taken into account. Note: Not all people with AN are very thin. * *Body dysmorphia* - mental health condition that affects how you see and feel about your body and appearance. * *Denies weight is an issue*.

Answer 29

* When a client with an already low BMI approaches you wanting to lose weight. * Clients with low BMI that come for amenorrhoea issues, with a fear of fat-containing foods. * Young girls in high-risk and elite sports who cannot maintain their energy and body weight. * *Caution: Atypical anorexia* shares many features of ‘typical’ anorexia but without extremely low body weight. * Wearing baggy clothing, a jumper etc., even on warm days. This often indicates hiding the body (body dysmorphia) or temperature dysregulation.

Answer 30

* *Angular cheilitis* – iron, B12, B2 deficiencies. * *Dark circle under the eyes* – iron deficiency and kidney Qi depletion. * *Pallor or yellowing to skin tone* – anaemia

Answer 31

* Re-feeding in hospital or as outpatient. * Psychological support. * Intense dietary re-training. * Anti-depressant medications. * Oestrogen replacement therapy (OCP) in women with amenorrhoea.

Answer 32

**Zinc:** Confusion Loss of appetite and motivation Depression Slow growth and development Emotional instability Recurrent infections; slow wound healing Low stomach acid **Magnesium:** Irritability / Agitation Constipation Insomnia / sleep disorders Depression **Tryptophan (serotonin):** Anxiety, low mood, insomnia Bowel irregularity **Protein:** Fatigue and weakness Poor hair, skin and nails **Omega-3 fatty acids:** Depression / Mental fatigue Dry Skin **B vitamins:** Anxiety and depression Confusion and irritability Poor concentration and memory Poor stress resilience

Answer 33

* Feeding the **brain** is a priority. * Building a rapport and gaining **trust**. * Communicate **appropriate** nutrition messages. * Help to **redefine** the relationship with food. * Place emphasis on **nutrients & health**, NOT kcal & weight. * Correct nutritional **deficiencies**.

Answer 34

* *Never recommend any form of exclusion diet* - e.g. gluten or dairy, unless there is clear evidence that they are detrimental to health. Re-introduction of all foods is essential. * You may have to *contain your own self-beliefs*, as usual dietary advice will need to be set aside to avoid collusion with the client. Do not enter any conversations around calorie content of food. Never trick or lie about nutritional content of food. * *Keep focus upon nutrients* and their impact upon health. * Be *empathetic, but stay firm and consistent* with your recommendations. * *Keep things simple*: Do not overwhelm your client with huge changes, but focus on 1‒2 changes at a time. Don't set unrealistic goals - collaborate with the client. * Be wary of weighing clients. *Focus on health and not simply BMI*.

Answer 35

From a TCM perspective, **Spleen Qi deficiency** is common so use foods that are *warming, well cooked* and nourish the Spleen (focus on slow-cooked and warm foods). Focus on nutrient-dense foods. * Digestive support is often needed to enable nutrient liberation / absorption. Include digestive aids such as *bitters*, as well as *probiotics* for a few months. * Fat deficiency is common - introduce foods that contain *essential fats*, and limited saturated fats to support reproductive function.

Answer 36

* When food is restricted, metabolism reduces to prioritise available energy towards major organs, to maintain body functions in the face of starvation. * When recovery begins, the body increases metabolism as available energy is made available. * There often follows a period of ‘*hypermetabolism*’, where the body utilises new, additional energy to compensate for a huge amount of damage, repair and development.

Answer 37

* Nut butters: 1 tablespoon - 170-200 calories. * Avocado: 1 whole - 320 calories. * Quinoa - 222 calories per cooked cup. * Granola. * Protein flapjacks. * 1 egg - 78 calories. * Omega-3 fish (e.g. salmon) * Natural yoghurt. * Glass of whole milk - 150 calories. * Glass of soy milk - 100 calories.

Answer 38

* Dips such as *hummus* made with *olive oil* or *guacamole* can be good to add to a sandwich or dinner (e.g. for healthy fats). * *Oily fish* – contains an abundance of readily available nutrients/energy and is high in EPA/DHA. * *Eggs* – a great source of absorbable protein, but they are generally quite filling. * Introduce sweet potatoes, pumpkin, potato and other *energy-dense foods*. * Increase good sources of *plant protein*, e.g. beans and pulses. * *Smoothies* (for energy and nutrients): Aim to use as snacks and NOT as meal replacements.

Answer 39

* During starvation, insulin levels decrease and glucagon levels increase, resulting in the conversion of glycogen to glucose and the stimulation of gluconeogenesis, which involves the synthesis of glucose from lipid and protein breakdown products. * Subsequent refeeding after starvation causes an *increase in insulin release* and an increased shift of phosphate, glucose, potassium, magnesium, and water to intracellular compartments often resulting in *oedema* (i.e., pulmonary) after fluid administration.

Answer 40

It is suggested that zinc therapy **enhances the rate of recovery** in anorexia nervosa patients by *increasing weight gain* and *improving* their levels of *anxiety and depression*. Zinc supplementation in re-feeding procedures can be used as an adjuvant intervention, as research is beginning to show that even with as little as 15mg a day, there is *quicker recovery time*.

Answer 41

Oral administration of a minimum of **14 mg** of elemental zinc daily **for 2 months** for all AN clients should be routine - vitamin **B6** will enhance absorption.

Answer 42

Studies have suggested yoghurt with the strains *L. bulgaricus* and *S. thermophilus* should be used in the refeeding procedures, as trials have shown an **increase in immune markers**.

Answer 43

L-Arginine – 8.3 g per day for two weeks with no adverse effects.

Answer 44

Identify the cause of any stress/anxiety/depression and address appropriately. Support the nervous system, e.g.: – *Anxiolytics*, e.g., passionflower, chamomile, ashwagandha. – *Serotonin support* e.g., tryptophan, magnesium, B3, B6, B9, zinc; reduce stress, probiotics, breathing exercises, St John’s wort. – consider *adrenal support* - hypercortisolemia is common in AN. For example, stress management strategies, adaptogens, B vitamins, magnesium, L-theanine etc.

Answer 45

* *Crab Apple* helps with body image, body shame, and low self-esteem. * *Cherry Plum* helps with a fear of losing control around food. * *White Chestnut* helps with obsessive thinking about food. * *Star of Bethlehem* helps process past traumatic events. * *Rock Water* helps moderate unrealistic standards of perfection. * *Aspen* helps eradicate feelings of anxiety or of impending doom. * *Elm* helps eliminate feelings of overwhelm, such as anxiety. * *Gentian* helps people overcome feeling down after a setback. * *Gorse* helps people feelings of hopelessness and suicidal tendencies.

Answer 46

* **Calc phos** – due to poor absorption, weakness and prostration physically and mentally. * **Nat mur** – helps improve dry skin, fluid movement within the body and improves hypochlorhydria. * **Kali phos** – when there are states of depletion, especially within the nervous system. There may be great anxiety present. 1 tab 3 x daily for 3-6 months. You can take them individually or combine all three as the requirements seem fit.

Answer 47

* **China 12x** – can help when there is physical weakness accompanied by cold sensitivity, abdominal distension and flatulence. Frequent headaches, insomnia, night sweats and syncope. * **Phos ac 12x** – emotional and physical prostration. Will only eat fruit and fruit juices. Wants to sleep all the time. Slowness in dialogue in the consult. Slow to comprehend the practitioner’s questions, and slow to respond. Taken twice daily for 2-3 months.

Answer 48

Bulimia, also called bulimia nervosa, is a disorder in the eating disorder spectrum: - Characterised by episodes of secretive excessive eating (bingeing) followed by inappropriate compensatory methods of weight control; such as self-induced vomiting (purging), abuse of laxatives and diuretics, or excessive exercise to prevent weight gain. - There is a sense of lack of control during a feeding episode. - Subtypes: *Purging* (vomiting / laxatives / diuretics / enemas) and *non-purging* (fasting / excess exercise). - The diagnostic criteria states that binge eating and compensatory behaviour occur on average at least twice a week for 3 months.

Answer 49

* Most often normal weight to slightly overweight. * Binge eating large amounts of food. * Often follows anorexia or previous episodes of dieting. * Associated depression, anxiety and tension. * Periods of fasting and / or laxative abuse. * Erratic menstrual periods. * Frequent weight changes. * Disappearing to the toilet after meals. * Periods of relapse and episodic purging. * Sore throat, tooth erosion and swollen parotid glands. * Reluctant to socialise where food is involved.

Answer 50

* Personality types that are more giving and passive. * Jobs which demand weight control or place people near food. * Shift working. * Increased alcohol consumption. * People with glucose intolerance and food intolerances. * People with low esteem coupled with poor body image. * Obesity or perceived obesity of specific body parts.

Answer 51

* CBT; SSRIs are commonly used to prevent binges. * Encouragement of ‘proper’ eating patterns.

Answer 52

Binge Eating Disorder clients don’t use dangerous weight loss methods - purging / laxatives / extreme dieting etc. Most do not seek medical help, unless for obesity - unlike BN sufferers, those with BED are typically overweight.

Answer 53

* Discreet episodes of rapid and excessive food consumption not necessarily driven by hunger or metabolic need. * Individuals will eat until they feel uncomfortably full and may or may not use compensatory behaviours such as self-induced vomiting. * Binge eating is often accompanied by feelings of *loss of control* and psychological distress.

Answer 54

Recurrent episodes of binge eating. * Lacks control over eating during the binge episode. * Episodes are associated with three of the following: – Eats more rapidly than normal. – Eats until uncomfortably full. – Eats large amounts of food when not feeling hungry. – Eats alone - is embarrassed about the amounts eaten. – Feels disgusted with self, depressed or guilty for overeating. * Is very distressed about binge eating. * Binge eating occurs at least two days a week for six months or more.

Answer 55

* Food deprivation patterns (dieting / starvation patterns). * Stress and stress responses. * Adaptations within the natural reward pathways, specifically the endogenous opioids and dopamine. * Acute tryptophan depletion and disturbances in serotonin levels.

Answer 56

* To reduce the number of binges by addressing any blood sugar imbalances and increasing insulin receptor sensitivity. * To encourage healthy eating patterns and dispel any food myths. * To increase inhibitory neurotransmitter levels. * BN, specifically, fosters harm minimisation and prevents the use of purging techniques. * Eating regular meals (even if a binge has occurred). * Mindfulness programmes can help to facilitate healthy eating patterns again, as listening to body signs of hunger and giving the body what it needs can help to break the binge-purge-starve cycle.

Answer 57

Protein-rich meal supplements enhance recovery time compared to carbohydrate rich supplements. It is therefore indicated to use good quality protein to aid recovery.

Answer 58

Acute tryptophan depletion in bulimics increases the urge to binge and lowers mood. Therefore, a diet lacking tryptophan can increase BN and BED risk in vulnerable people.

Answer 59

Inositol is thought to increase serotonin receptor sensitivity and has therapeutic benefits in those with BN and BED.

Answer 60

* Keeping a food, symptom and emotional diary can help to identify trigger situations to binge (e.g., seeing mum, confrontation, feeling sad etc.). * Explaining to clients the link between mood and fluctuating blood sugar levels and tryptophan levels is important to help with understanding the physiological sensations of needing to binge. * Identifying triggers is extremely important - as then choice can be given to other options to use at the time of stress.

Answer 61

* Reinforce healthy food choices and dispel any food myths that may have arisen. * Try to encourage regular eating patterns. * Be aware of the impact of exercise on the calorie needs of the day. * Be on the look out for fad dieting in between binges, as this will make it worse. * When the binge happens, not allowing guilt to be an option.

8. OBESITY & EATING DISORDERS Flashcards

This module covers: • Obesity • Key drivers of obesity. • Adipose Tissue. • Appetite and satiety. • Insulin resistance. • Reducing obesity. • Changing eating behaviours. • Eating Disorders • Anorexia Nervosa. • Bulimia Nervosa. • Binge Eating Disorder.