Eating disorders and Alcohol Flashcards
How many women do not like their body?
70%
How many women control their weight with unhealthy behaviours?
50%
How many men are not satisfied with their body
43%
What is happening with the percentage of eating disorders right now?
Increasing in younger ages and postmenopausal
More prevalent as wealth increases
Unrealistic ideals from social media
What is eating disorder?
General term for abnormal or atypical eating behaviours associated with efforts to control weight.
Psychiatric conditions that must be diagnosed by a psychiatrist, then the people are in mental condition
Name some examples of feeding and eating disorders.
Anorexia Nervosa Bulimia Nervosa Binge-Eating Disorder Other Specified Feeding or Eating Disorder Unspecified Feeding or Eating Disorder
What population group is at high risk for disordered eating?
Risk is high in university students with stress and pressures
Risk for Eating disorders
- Environmental stress/Socio-cultural/Media
- Family, situational
- Individual factors(genetic, Biology,Temperamental/personality traits
- Psychological/Self-esteem/Body image
Monozygotic twins risk of having both eating disorders vs dizygotic twins
50-80%
What are warning signs for disordered eating?
Severe self-criticism Depressed mood Belief that only worthwhile when thin Preoccupation with weight, shape and dieting
What % of female university students suffer from disordered eating?
4% of struggle with Anorexia Nervosa plus 4% suffer from Bulimia Nervosa 61% have some kind of subclinical eating problem, including chronic dieting, binge/purging and subclinical bulimia
What % of male university students suffer from disordered eating?
10-20% suffer from disordered eating plus 2% have clinical Bulimia Nervosa
Proportion of eating disorders in men and women
women 90%
Men 10 %
What is the lifetime risk for anorexia nervosa,bulimia nervosa, Binge Eating disorders(BED),OSFED?
Anorexia - 0.9% women ,0.3 % men
Bulimia- 1.5% women and 0.5% men
BED- women 3.5% and 2% men
OSFED- 3-10%
The widespread of eating disorders that start in adolescence
85%
Incidence of ED increases when
Central to self-worth is the body image
If you recognize sooner the ED, then
There is a bigger chance of successful recovery, 50-70% will recover
Warning signs of ED
Increased fatigue, injury; prolonged training
Decreased concentration/school or work performance; energy, muscle function, coordination, speed
Complaints of dizziness, abdominal pain
Increased isolation
Increased impatience, crankiness, perfectionism
Preoccupation with food, weight, body image, hydration
Avoidance of social eating
Trips to the bathroom after meals; weight changes, etc
What is anorexia characterized by?
distorted body image and excessive dieting that leads to severe weight loss with a pathological fear of becoming fat, despite being underweight. - Intense fear of becoming obese by losing control over eating - Dissatisfaction with body shape
What kind of personality traits do patients with anorexia nervosa have?
• Sense of powerlessness over own life situations • High expectations of self and others • Obsessive-Compulsive personality traits (perfectionism) • “Black or White” thinking • Fear of age, sexuality, independence
What are some unusual eating behaviours for patients with anorexia nervosa?
measuring, vegetarianism, eat in small dishes, excessive consumption of water or gum, eating very slowly
What does anorexia nervosa result in?
Protein-energy malnutrition
What criteria was taken off the DSM for anorexia?
Amenorrhea in females (no menses for 3 months)
BMI<17 for 3 months
What is the age of onset for anorexia nervosa? How long does it usually last? What % are male?
- Ages 11-20 (young) - 1 to 10 years - 10% are male
What other disease does anorexia look like? Why?
- Marasmus - Both result in protein energy malnutrition
Name some anorexia warning signs.
Sudden and drastic weight loss that is not otherwise explainable, (i.e. not due to illness or surgery) Irregular or absent periods The development of narrow, weird food preferences The development of abnormal rituals surrounding food and meal times Refusal to eat in front of others Cooking eagerly for others while refusing themselves to eat prepared food Overdoing exercise and showing signs of anxiety when a workout is interrupted or missed Always feeling cold, even in warm weather Wearing baggy clothes to hide body
The results of anorexia nervosa
- Starvation, feeling cold( hair in the body can grow very long)
- Physiological changes ( heart,brain,Gi tract)
- Amenorrhea(loss of periods)
- Loss bone density-osteoporosis( crucial for children 12-13 when calcium is supposed be storing)
- Not reach the max height
- Causes confusion and delirium
- Death from multiple organs failure
What is bulimia nervosa characterized by?
Characterized by frequent episodes (at least once per week)of binge eating followed by inappropriate behaviors such as self-induced vomiting to avoid weight gain. Feeling of lack of control over binges - Self-induced vomiting, laxative or diuretic use, strict dieting or fasting, vigorous exercise
Which eating disorder may the individual be of normal weight?
Bulimia
What is the bing eating cycle?
Negative self-perception -> restrictive dieting -> bing eating -> purging
Bulimia nervosa: compensatory behavior
- Self-induced vomiting
- Laxative(poop more) or diuretic abuse(pee more)
- Strict dieting or fasting
- Diet pills
- Vigorous exercise
Dangerous and comorbidities of bulimia
Dangerous: subclinical malnutrition, electrolyte imbalances,GI,heart, death
What happens to the salivary glands during bulimia
-Swelling because of the regular vomiting
Name some BN warning signs.
Binge eating; It is usually done in secret but evidence may present itself in the form of missing food or empty containers. Finding excuses to leave the table after meal Signs of vomiting in bathroom Evidence of excessive laxative or diuretic use Chipmunk-cheeks, repeated vomiting causes glands around the jaw to swell. Pattern of weight fluctuations that are usually in the ten to twenty pound range(yoyo dieting) Excessive exercise Burst blood vessels in eyes
What is binge eating disorder characterized by?
recurring episodes of eating significantly more food in a short period of time than most people would eat under similar circumstances,
How often does binge eating disorder happen?
occurs, on average, at least once a week over three months
What percentage of people who have bariatric surgery have binge eating disorder
25%
What is the behaviour of wrestlers striving to be a lower weight class to have an advantage over small opponents?
Restrict food and fluid intake before match Practice in rubber suits Sit in saunas Take laxatives and diuretics Replenish fluids, glycogen and lean tissue between weigh in and competition (a few hours)
What is the truth behind wrestlers losing water weight?
Reestablishing fluid and electrolytes can take 1-2 days Replenishing glycogen stores can take 2-3 day Replacing lean tissue may take even longer
Risk factors for eating disorders in athletes
- Food deprivation and dehydration practices
- Impair physical performance
- Muscle dysmorphia( people are taking steroids)
- Orthorecia nervosa( preoccupation with healthy food- organic grapes not have money for other food,, )
What does amenorrhea lead to?
Diminished hormones
What are symptoms and warning signs of orthorexia
Compulsive checking of ingredient lists and nutritional labels
An increase in concern about the health of ingredients
Cutting out an increasing number of food groups (all sugar, all carbs, all dairy, all meat, all animal products)
An inability to eat anything but a narrow group of foods that are deemed ‘healthy’ or ‘pure’
Unusual interest in the health of what others are eating
Spending hours per day thinking about what food might be served at upcoming events
Showing high levels of distress when ‘safe’ or ‘healthy’ foods aren’t available
Obsessive following of food and ‘healthy lifestyle’ blogs on Twitter and Instagram
Body image concerns may or may not be present
Two other EDs
Diabulemia- People with T1DM skip/reduce insulin to lose weight
-Drunkorexia- heavy drinking combined with restricting , purging, not eating before drinking , because alcohol are calories
What are therapy options for individuals with eating disorders?
Multi-disciplinary team Cognitive behavioural therapy Group / family therapy Inpatient / outpatient Nutrition counseling Pharmacological intervention
Prevention of eating disorders
Avoid labeling food “bad,” “sinful,” or “junk food.”
Encourage intuitive eating & healthy weight for best performance
Criticize the culture that promotes unhealthy body image, not your self or others. Speak out against the media
Do not encourage or laugh at jokes that make fun of a person’s size, race or body.
Help others to develop self-esteem based on qualities other than physical appearance
Teach how to identify and manage stress
Model a healthy lifestyle
Encourage health at every size
Family meals
One drink is
0.6 oz (18 ml) of pure ethanol (12 oz beer, 10 oz wine cooler, 1 1/2 oz liquor, 5 oz wine)
What are the findings about the safe level of consumption of alcohol
The risk of all-cause mortality, and of cancers specifically, rises with increasing of alcohol consumption
-The level of consumption that minimizes health loss is zero
What are the max drinks per week and per day for women and men
Males – 15 drinks per week NO more than 3 drinks a day
Females –10 drinks/wk NO more than 2 drinks per
What is the max drink amount on special occasion
Max 3 for woman
4 for men
Who should avoid alcohol?
Avoid if pregnant, operating machinery, can’t control intake
What does alcohol has to be consumed with?
With food
Why you should eat CHO and fat before drinking?
CHO- slows absorption
Fat-reduces peristalsis
Is alcohol stored and what is the consequence for that?
Cannot be stored and that is why alcohol is the priority over anything else in the body
What does the conversion of alcohol to acetyl CoA require?
The B vitamins in its role as the coenzyme NAD.
What is NAD+?
NAD+ = niacin
Where is ethanol absorbed from?
If we don’t eat, will absorb fast from the stomach Absorbed quickly from the stomach and duodenum
What is ADH? Where is it found?
Alcohol dehydrogenase and acetaldehyde dehydrogenase - Located in liver and in the stomach (ONLY IN MEN)
What is microsomal ethanol oxidizing system found?
Mitochondria of liver
What is inducible? What is non inducible?
- Microsomal Ethanol Oxidizing System is inducible - ADH is non inducible
Acetyl CoA molecules are blocked from getting into the TCA cycle by high levels of what? What does that cause?
- By NADH - Become building blocks for fatty acids - increased serum TG, increased risk of fatty liver - cirrhosis, ketones,
How does alcohol disturb metabolism?
- Less NAD+ - More H+ (generating acid) - Acetyl CoA produced produces fatty acids and ketones rather than entering TCA cycle - Decreased gluconeogenesis - Decreased protein synthesis - Liver damage
How does less NAD+ compromise metabolism?
pyruvate produces lactate rather than acetyl CoA Slows down glycolysis and TCA cycle
How does more H+ compromise metabolism?
acidosis along with lactate and increased ketone bodies
How does decreased gluconeogenesis compromise metabolism?
Ketosis
When do people experience hangovers?
When accumulating acetaldehyde
What happens to drugs when consumed with alcohol
Drug tolerance is created, because it stays more in the body
70 % of the ethanol is metabolized by____, and 20% of the ethanol is metabolized with ____
70 %- by Alcohol dehydrogenase
20% by Microsomal Ethanol Oxidizing System
How is ethanol metabolized with ADH?
Ethanol->( with ADH in liver and stomach(men)) to acetaldehyde by NAD+ to NADH and H+->( with acetaldehyde hydrogenase only in the liver) to Acetate via NAD+ to NADH and H+ reaction-> CoA is added->FA->Liver
What happens with ethanol metabolism with MEOS? What is the other application of this circuit
Ethanol->( with MEOS in the mitochondria liver) NADPH and H+ and 1/2O2 to NADP+H2O->Acetaldehyde
The same circuit to utilize the drugs
What is the rate of metabolism of alcohol
1 drink/hour
Where is the rest 10% of ethanol go?
Excreted through urine and breath
Why people black out when drinking?
Increased acidity in the blood-> cannot make glucose->black out
Where does acetylaldehyde go?
to Acetyl coa
OR
It can decline protein synthesize and cause cell damage->fibrosis->cirrhosis
What is fibrosis?
When the tissues in the liver start to collagenize
What inducible means?
Inducible- the rate of metabolizing the alcohol can change
Non-inducible- cannot be changedd
What happens with glucose part of metabolism with prolonged alcohol consumption?
-In liver increased glycolysis, decreased glycoenogenesis( from fat, AA)->low blood sugar->coma
What happens with pyruvate part of metabolism with prolonged alcohol consumption?
Increased pyruvate conversion to lactate->lactic acidosis->damage of the liver
What happens with fat part of metabolism with prolonged alcohol consumption?
Decreased fat breakdown,Increased fat synthesize->fatty liver
How you get fatty liver?
Acetyl CoA->Fat synthesis or ketones->Fatty liver->cirrhosis
What is cirrhosis? What is it caused by?
IRREVERSIBLE liver damage caused by alcohol, hepatitis B or C, iron toxicity (hemachromatosis)
What is the fatty accumulation called in cirrhosis? Inflammation?
Fatty accumulation: steatosis Inflammation: hepatitis
How does cirrhosis develop? What can it lead to? How do you treat?
- As liver constantly repairs, accumulation of fibrosis tissue, scars and nodules and connective tissue – impaired function - Leads to carcinoma –> liver resection, transplant
Can brain cells cure form alcohol damage ?
No
What does alcohol do to the brain?
- Sendates inhibitory nerves( central nerval system depressant )
- Less muscle control, less balance
Why do you want to pee more when drinking?
-Depression of antidiuretic hormone ->Loss of water and loss of important minerals
Name some compromised vitamin status due to alcohol and malnutrition.
Wernicke-Korsakoff Syndrome – thiamin destruction Anemia – folate excretion Decreased vitamin D activation in liver B6 loss from binding protein
1 oz of EtOH=
0.5g fat
What happens to food consumption as alcohol consumption increases?
Less eating -> not eating a variety of other nutrients AND hard to break down alcohol
What does the French Paradox study state?
France: low CVD despite high saturated fat intake France was the only country that did not have a high death rate from CVD despite high saturated fat intake
What causes the French Paradox?
Very unclear, points to an association - Alcohol or flavinoids or combination - Resveratrol protects against LDL oxidation
What does consuming alcohol in moderation increase the risk of?
hypertension stroke cirrhosis cancer - oral, stomach, colon, breast, prostate ulcers osteoporosis psychological depression fetal alcohol syndrome drunk driving insomnia Alcoholism Cost $200 billion/y
What are personal strategies to prevent alcoholism?
drink non-alcoholic beverages drink in moderation drink slowly drink with food don’t drive seek help if needed
What are medications used to treat alcoholism?
Antabuse (blocks AcAld DH) - higher sensitivity to alcohol, effects of a hangover are felt almost immediately after consumption Reviva (decrease craving and the high)
