Anorexia Nervosa Flashcards
1
Q
Anorexia nervosa (AN)
A
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.
- It accounts for 10% of all eating disorder cases.
- Onset is normally in adolescence or early adulthood.
- Of those with AN, 50% ‘recover’, 30% improve, 15% remain chronically ill, 5% die from complications and suicide.
- Males now account for 25% of reported anorexic cases and are at a higher risk of death, as they are often diagnosed later.
2
Q
Signs and symptoms
A
3
Q
Concomitant symptoms / complications:
A
- 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).
4
Q
Anorexia sub-types
A
5
Q
Pathophysiology — biochemical
A
When the body is deprived of the nutrients it needs, changes in brain chemistry and activities can be seen, resulting in:
- Increased symptoms of depression and anxiety as a result of acute tryptophan depletion.
- Disruption to cognitive functions.
- Nerve-related conditions including seizures and numbness or nerve sensations in the hands or feet.
- Starvation, vomiting, abusing purgatives and laxatives and excessive exercise may lead to dehydration, electrolyte imbalances and low blood potassium levels which will induce psychological problems.
- Self-induced vomiting and dehydration cause metabolic alkalosis due to loss of K and Cl, leading to further muscle fatigue and tingling in hands and feet.
- May ultimately lead to cardiovascular complications.
6
Q
Pathophysiology — serotonin / oestrogen link
A
- 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 density of 5HT 2A 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
7
Q
Clinical diagnosis:
A
- Intense fear of gaining weight / a healthy BMI.
- BMI 17.5 or under (combined with other factors)
- Body dysmorphia.
- Denies weight is an issue.
8
Q
Diagnosis — when to suspect an eating disorder
A
- 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.
- Angular cheilitis — iron, B12, B2 deficiencies.
- Dark circle under the eyes — iron deficiency and kidney Qi depletion.
- Pallor or yellowing to skin tone — anaemia
9
Q
Orthodox medical treatment:
A
- Re-feeding in hospital or as outpatient.
- Psychological support.
- Intense dietary re-training.
- Anti-depressant medications.
- Oestrogen replacement therapy (OCP) in women with amenorrhoea.
10
Q
Orthodox treatment — refeeding
A
- Refeeding programmes are used to restore BMI.
- Using high calorific diet incl.
milk, butter and cream.
- Behavioural reward systems are used to encourage finishing prescribed meals.
- In serious cases naso-gastric feeding may be required but this requires either permission from the patient or sectioning under the Mental Health Act 5
11
Q
Nutrient deficiencies
Zinc
Mg
A
12
Q
Nutrient deficiencies
Tryptophan
Protein
Omega 3
B vitamins
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13
Q
Nutritional therapy approach
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- When working with the anorexic mindset, always work as part of an integrated team and gain client permission to openly share feedback.
- There may be 3 people in the consultation:
- You.
- The client.
- The condition.
- Nutritional advice, however well meant, can be dangerous, if you are talking to the condition and not the client.
- 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 and health, and not kcal and weight.
- Correct nutritional deficiencies.
14
Q
Anorexic consultation
A
AN clients will know much more about the calorie content of foods than you ever will, even with your training: * Do not enter into any conversations around this. Foods that are nutrient or fat dense are often thought of as ‘bad’.
- Keep focus upon nutrients and their impact upon health.
- Re-introduction of all foods is essential, even chocolate and other high fat foods should not be discouraged.
- Never recommend any form of exclusion diet ― e.g., gluten or dairy, unless there is clear evidence that they are detrimental to health.
- You may have to contain your own self-beliefs, as usual dietary advice will need setting aside to avoid collusion with client
.
15
Q
Therapeutics — weight gain
A
- The traditional recommended weight gain for a recovering anorexic of 0.5–1 kg per week is totally unrealistic.
- This equates to 3500–7000 extra calories a week!
- Take care if agreeing a calorific target with your client as you may be ‘capping’ food intake. An anorexic will rarely eat 1510 kcal, if you have recommended 1500.
- Collaborate with the client to create step-by-step changes to the food plan which are moving them to a more diverse range of foods. Remain aware of the client tendency to control the situation.
- Be wary of weighing clients, as others in the recovery team may already be doing this. Focus on health and not simply BMI.
- An anorexic’s defence mechanism to change, may be to tell you what they think you want to hear, or to conceal and hide reality ― this usually stems from fear.
- Be empathetic, but stay firm and consistent with your recommendations.
- Never try to ‘trick’ or lie about nutritional content of foods. They need to develop trust in the relationship with you and their body.
- Keep things simple: Do not overwhelm your client with huge changes but focus on 1‒2 changes at a time.
- 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 well as probiotics for a few months. appetite:
- Fat deficiency is common — introduce foods that contain essential fats, and limited saturated fats to support reproductive function.
