tag:blogger.com,1999:blog-3045634714760830992.post6249747985956416783..comments2023-06-05T11:51:38.383-04:00Comments on Evolutionary Psychiatry: Evolution and Anorexia NervosaAnonymoushttp://www.blogger.com/profile/04429177284200775781noreply@blogger.comBlogger19125tag:blogger.com,1999:blog-3045634714760830992.post-31354425561266935192012-05-22T21:33:50.055-04:002012-05-22T21:33:50.055-04:00"You can imagine the typical well-meaning die..."You can imagine the typical well-meaning dietician designed diets for these sick young people. It's the food pyramid with way too many grains, too little fat, and a focus on "healthy" rather than good old fashioned farm fresh food."<br /><br />I hear you. For the last few weeks I've been working on a one-page diet-and-supplement handout for recovering meth addicts for the local health board. Because I have had the experience and known enough other users to know what works.<br />You can imagine the feedback from dieticians, the official websites https://www.healthed.govt.nz/health-topic/healthy-eating<br />, the over-promotion of grains and sidelining of fats. It's as if everyone is already obese, even some starving (literally) tweaker.<br />I managed to get in the line "favour energy and nutrient dense meals". You don't hear that often these days.Puddleghttps://www.blogger.com/profile/00953398103675945541noreply@blogger.comtag:blogger.com,1999:blog-3045634714760830992.post-43105557988323344942011-12-19T11:16:45.012-05:002011-12-19T11:16:45.012-05:00If I may contribute, not knowing as much as you al...If I may contribute, not knowing as much as you all about AN, I believe Kurt's actions are analogous to picking up trash off the street in the hopes of improving the environment, i.e. the effort, although seemingly benevolent, may be utterly meaningless in the grander scheme of things.<br /> <br />There is a woman like this in my gym as well, 70yrs old, cardio junkie, wishing to stay "skinny and cut," and having no interest in training strength for her brittle frame (I work as a personal trainer in a medium sized facility), and there is probably one or two in the gym two blocks down, and two blocks down from that etc. etc. So if Kurt really wishes to help ANs, he would need to work on a much larger scale, perhaps creating an AN awareness month that goes global, not bringing awareness to a single individual in one gym. <br /><br />I think Kurt's behavior certainly does raise the question, was he trying to remove her from his sight or really trying to help? Tolerance is very important but I'd say if you really wanted to help her then you would go and speak with her as a physician with plenty of experience.Anonymoushttps://www.blogger.com/profile/05678720294816251435noreply@blogger.comtag:blogger.com,1999:blog-3045634714760830992.post-89491225093349200782011-12-17T10:19:23.763-05:002011-12-17T10:19:23.763-05:00Woo - I'm not going to post your next comment ...Woo - I'm not going to post your next comment in reply to Kurt. I rather regret posting the first. In a year and a half and nearly 3000 comments I've only every moderated spam and one exceptionally verbose tumeric enthusiast. Commenters have been exceptionally respectful, and I do appreciate the questions, the concerns, and the alternative viewpoints. <br /><br />But I don't want the comments here to descend into anarchy as they have on some other very good blogs, nor do I think passing vitriol back and forth is a useful contribution to the discussion of eating disorders. I posted Kurt's reply as you dropped the first salvo, and it only seemed fair to allow him his response. But that's the end of it. This blog is my totalitarian regime.Anonymoushttps://www.blogger.com/profile/04429177284200775781noreply@blogger.comtag:blogger.com,1999:blog-3045634714760830992.post-83447109498408028902011-12-16T18:44:24.176-05:002011-12-16T18:44:24.176-05:00This comment has been removed by the author.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-3045634714760830992.post-7092862980876256922011-12-16T16:18:04.146-05:002011-12-16T16:18:04.146-05:00Woo - would it help for a strange, older man to co...Woo - would it help for a strange, older man to come up to a young, eating-disordered woman in the gym, identify himself as a doctor, and tell her she needs to stop her behavior? Who knows? Eating disorders are such a conglomeration of disorders - delusions, obsessions, depression, anxiety, addiction… who knows what will cause someone to "hit bottom" so to speak. Sometimes there is no "bottom." From the gym's perspective, often there is a medical clearance before returning to workout after surgery or hospitalization. Uncontrolled eating disorders would be no different, and it would be in the gym's interest not to permit people who are not medically safe working out (uncontrolled, severely underweight anorexia would certainly qualify). I can't see what is controversial or wrong about that.Anonymoushttps://www.blogger.com/profile/04429177284200775781noreply@blogger.comtag:blogger.com,1999:blog-3045634714760830992.post-75900401223469710822011-12-16T16:16:18.096-05:002011-12-16T16:16:18.096-05:00This comment has been removed by the author.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-3045634714760830992.post-18097877246605455392011-12-16T13:43:17.822-05:002011-12-16T13:43:17.822-05:00Great post - again. I'm wondering if you'...Great post - again. I'm wondering if you'd consider doing a post sometime on the high overlap and migration of eating disorders? Nothing like making a complex topic even more so. If anyone can make sense of it, though, it's you. <br /><br />And, KGH.... thank you for taking a stand on this. Another reason you rock.Unknownhttps://www.blogger.com/profile/15870835228528895877noreply@blogger.comtag:blogger.com,1999:blog-3045634714760830992.post-20075177584656380532011-12-16T00:04:06.636-05:002011-12-16T00:04:06.636-05:00Kurt Harris - that will accomplish next to nothing...Kurt Harris - that will accomplish next to nothing. Do you honestly think some random teenagers working in a gym are going to convince this mentally ill woman that she needs to stop starving herself? Sometimes people with AN are very very aware of how thin they are and how they are going to die, they can't stop. It's like telling someone with OCD "you know, if you wash your hands 20 times, you aren't making them clean, you are just wasting your time and damaging your skin". They know this. They are crazy and can't help it.<br /><br />As a physician you should be more aware of the mental state of patients; a bunch of 21 year old kids at the gym are not going to be able to help this person. <br /><br />IF it distresses you that much, you should try to contact her family and have a proper intervention, give them contact numbers of good eating disorder resources.<br /><br />Sounds to me like you don't want to look at the scary woman at the gym, and this begins and ends your problem. As long as she is no longer in your presence, then you are cool about it. If she leaves the gym, she'll just find another. Or alternatively she will eat even less, because she was not able to burn off her 300 calories, or whatever.<br /><br />And why are you putting the onus on some random workers at a gym? They have zero medical education, training, and no idea how to help this person. AGain, as a physician, you have far more power to help than they do.ItsTheWooohttps://www.blogger.com/profile/12057537399918684119noreply@blogger.comtag:blogger.com,1999:blog-3045634714760830992.post-19825926878187528492011-12-15T22:25:54.357-05:002011-12-15T22:25:54.357-05:00This comment has been removed by the author.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-3045634714760830992.post-5265311534880503502011-12-13T15:58:38.822-05:002011-12-13T15:58:38.822-05:00Hmm, that makes sense. I guess I just really want...Hmm, that makes sense. I guess I just really wanted to believe that a better environment, good people, and enough hard work can get 99.99% of sufferers to the safety of shore, without such traumatic interventions. Thank you for prescribing prudently, and for presiding over the exquisitely tortured yoghurt rituals :)P2ZRhttps://www.blogger.com/profile/06156172615124219665noreply@blogger.comtag:blogger.com,1999:blog-3045634714760830992.post-89034914896331965502011-12-13T10:55:51.353-05:002011-12-13T10:55:51.353-05:00Well, thanks. Thanks a lot. Now how am I supposed...Well, thanks. Thanks a lot. Now how am I supposed to get back to work after sampling a dose of Margo in the morning!philhttps://www.blogger.com/profile/09376247188799284891noreply@blogger.comtag:blogger.com,1999:blog-3045634714760830992.post-26882309891327560652011-12-12T19:30:01.100-05:002011-12-12T19:30:01.100-05:00Paul - there is a certain sort of stereotypical ob...Paul - there is a certain sort of stereotypical obsessive anorexic patient - (a generalization, of course!) typically high functioning, formerly very good at school, with an emotionally distant father or mother… in some respects similar to the obsessive, repetitive high functioning autistic, but seems to experience pain on an emotional level that is more approachable. Anorexia overlaps so many disorders- delusions, depression, anxiety, addiction, obsessions.<br /><br />Woo - I would say there are as many different ways to design an ultimate diet for anorexics as there are those who suffer. Some have significant food phobia and do much, much better if they don't have to eat all the time. Others prefer controlled, small portion meals - but they can be so very ritualized and take so much time - ever watch someone on an eating disordered unit eat a yogurt? It can take 30 minutes, with delicate sweeps of the top creating a small bead on the spoon to be carefully tested with the tongue, then consumed… as with everything by the time we get down to the individual level it has to be very personalized, though I can't help but think nutrient-rich calories in any form would be helpful. I really don't see how the adipocytes would hold sway when the hormonal regulation is masterminded by the brain, but I suppose we all pick which chicken and egg we want to see.<br /><br />Cavegirl - yes, the major flaw of "evidenced-based" medicine is that the evidence base is for the statistical average, the prototype patient, not the individual. <br /><br />Sarah - the medical approach and the refeeding is based on the principal that no therapy will work while a person is actively starving - there is a lot of evidence proving this fact. Thus the faster one is able to refeed, the faster other therapies will work - this will presumably decrease costs of hospital admission and make outpatient treatment feasible at an earlier date. Sometimes those sorts of practicalities outweigh the traumatic option (though increasing appetite via a pill is less traumatic than the nasogastric tube feeding)Anonymoushttps://www.blogger.com/profile/04429177284200775781noreply@blogger.comtag:blogger.com,1999:blog-3045634714760830992.post-44844875994040802012011-12-12T18:34:39.683-05:002011-12-12T18:34:39.683-05:00Thanks for this fascinating post, Emily.
"Ca...Thanks for this fascinating post, Emily.<br /><br />"Caloric restriction and weight loss predispose to additional episodes of dieting, especially in susceptible individuals wih defective regulation of their starvation response, or...obsessive thoughts and compulsivity."<br /><br />My experience is 100% in line with this, as well as your assertion that "a single episode of excessive caloric restriction" can be all it takes. For me, it began with overzealously losing the freshman 15 (which had brought me up to a non-underweight BMI for the first time in my life)--and being so relieved that I'd ridden myself of this overnight ballooning that I decided to keep going, and going, and going....<br /><br />My concern is whether it's desirable to use IGF-1 (or any other substance) to increase appetite. I'm sure anorexics do have a certain 'cognitive phenotype' one that is prone to environmental stressors causing a 'starve to live' (cf.: fight or flight) response. So I'm positing (again, I have not had extensive interaction with other crazies) that lack of appetite is *learned* to enable starvation as a coping mechanism. And because anorexics are predisposed to a 'crazy brain cycle', wouldn't eliminating lack of appetite just make for more craziness? Because you would be removing a major outlet for dealing with things that she doesn't have the resources/skills to deal with.<br /><br />I was never in in-patient treatment because I told some fantastically tall tales to wriggle out of it, but I would be reassured if increasing appetite via a drug/exogenous hormone is a last resort. With the perverse notions of 'being [mentally] strong' that an anorexic harbors, it seems that acquiring a foreign uncontrollable appetite (where one is actively 'losing control') would in some sense be worse than being fed through a tube (where clearly someone else is in control, and one is just a rag doll)....<br /><br />"Better that we never begin dieting in the first place. [Skip] the processed foods...." Let's shout it from the rooftops; that's a crystal-clear gem if there ever was one!P2ZRhttps://www.blogger.com/profile/06156172615124219665noreply@blogger.comtag:blogger.com,1999:blog-3045634714760830992.post-13152302557508137272011-12-12T15:09:29.559-05:002011-12-12T15:09:29.559-05:00I find the perfect mental balance and energy level...I find the perfect mental balance and energy level that I achieve in a fasted state to be a very desirable condition. I am not in a danger to be anorexic, being a middle-aged women with BMI 27, with no coach to please. I changed my diet on LC after 45 for several reasons, when, together with other health problems, horrible moods started to torture me. Normally my fast don't last longer than 24 hours. It is easy to imagine that somebody with the same appreciation for fasting as me could be carried out of balance without desire to be very thin, but for the reason of seeking for balanced mental state.Galina L.https://www.blogger.com/profile/09156132815504279615noreply@blogger.comtag:blogger.com,1999:blog-3045634714760830992.post-24805596471641759412011-12-12T13:35:09.341-05:002011-12-12T13:35:09.341-05:00My latest hobby is coming up with ways to describe...My latest hobby is coming up with ways to describe my way of eating that are succinct, non-confrontational and low on the food freak scale. Thanks for the great new addition of "good old fashioned farm fresh food"!Elysehttps://www.blogger.com/profile/17971012273413591858noreply@blogger.comtag:blogger.com,1999:blog-3045634714760830992.post-20862317958643609292011-12-12T05:11:07.708-05:002011-12-12T05:11:07.708-05:00Another fascinating post. Through a decade of iro...Another fascinating post. Through a decade of ironman racing I certainly became a disordered eater with an incredible ability to restrict food intake even during high training loads in order to achieve the 'ultimate' racing body, and to please my coach ... and herein lies another key for me in the whole scenario of eating disorders ... 'to please my coach'. <br /><br />As you mention environmental stresses are a big factor alongside genetic predispositions. I have a genetic predisposition to bipolar through my father's mother (also gestational diabetes so an insulin link there too), I can also display some spectacular compulsive obsessive traits (training and racing to the level I did is evidence in itself with obsessive record keeping of hours spent in various training zones, calories burned and consumed etc, etc; training to and beyond exhaustion).<br /><br />The first step to recovery for me was reading Taubes and following what turned out to be a Primal/Evolutionary diet - this gave me the mental stability to see how mad my former life had been.<br /><br />However, once through a period of stability I was still bouncing up against various issues but with my vastly improved mental state was able to start unravelling why and this has been the crucial breakthrough in understanding for me, and I suspect relates to many other 'suffers' too.<br /><br />I have been going back through my life history (in tandem with TCM 5 element acupuncture) and believe I have now found the trigger for a lifetime of dysfunctional behaviours ... the emotional environment of my childhood just wasn't compatible with my natural temperament. I'd clocked up 10 homes by aged 9 and 13 by aged 18, 9 educational establishments. My mother says she did her best to squash any exuberant behaviour she felt might lead me down the path of her manic depressive mother-in-law or that would deem me precocious. Add to that a father who was a high achiever and expected you to perform and who the family followed around the country (and world) following his ambitions. Oh and they argued regularly, without warning, unpredictable angry outbursts that can still leave me feeling like a quivering four year old 40 years on when they occur in my prescence. <br /><br />But to the outsider we had an aspiring middle class upbringing, we we envied (apparently) and I've always been told what a happy, non-traumatic childhood I had. That isn't how I experienced it - I can see now I came out of it with many coping strategies that buried who I was in order to please and not to trigger angry outbursts - this leads to self-loathing and beyond.<br /><br />The perfect storm arises (in terms of developing mental dysfunction) when this kind of stressful background (which was actually quite hidden under the RADAR with a veneer of happy go-get-it family life) for my kind of character is COMBINED with a genetic predisposition. <br /><br />Again, it's never just one thing, its the whole scenario that needs to be looked at. We are so advanced with the biochemical science we can now perform that we are in danger, in my opinion, of missing the whole picture. That's what I find so satisfying about Chinese medicine take it looks at the whole energetic entity and treats every person on an individual basis.Cavegirlhttps://www.blogger.com/profile/02319318255360473712noreply@blogger.comtag:blogger.com,1999:blog-3045634714760830992.post-78881020073905433572011-12-12T02:22:10.407-05:002011-12-12T02:22:10.407-05:00The adipocytes are controlling the brain, mostly, ...The adipocytes are controlling the brain, mostly, although it is definitely a two way street.<br /><br />Decreased leptin ffa glucose and insulin (all of which are strongly related if not directly caused by small adipocytes - the smaller the adipocyte size, the less leptin, ffa, glucose int he blood, and insulin in the blood there will be) lead to changes in the brain , appetite and food interest... .the changes in the brain are a direct result of changes in the fat tissue. Small adipocytes that easily suppress FFA release and glucose levels that eaisly fall, and very low basal leptin levels, all are a result of fat tissue, and all lead to starvation adaptation, and changes in the brain.<br /><br />Starvation adaptation - the changes in endocrine system and the brain - thryoid, adrenal, reproductive - depressive/obsessive/compulsive behaviors of food restricted semistarved people are a direct result not only of energy imbalance but of atrophied adopcytes.<br /><br />I see no reason to believe why obesity is different. Hypertrophy/plasia of fat tissue due to chronic hyperinsulism, due to abnormalities in energy use (possibly mitochondrial-level even) should and could lead to similar changes in the brain and endocrine system, so that obesity fuels itself. Step one would be control the abnormal direction of fat tissue growth (abnormally pro weighted toward fat synthesis) and then we find the brain/endocrine normalizes as a result.<br /><br /><br />The med diet you suggest for anorexia sounds like a recipe to relapse; from speaking with many eating disordered people, energy imbalance triggers symptoms, which is why many if not most anoretic people develop the illness after going without adequate caloric intake for otherwise normal reasons (e.g. athletic competitions, harmless vanity dieting, an attempt to improve health via fasting, or depression/stress induced loss of appetite). <br /><br />Being in ketosis and going without meals, sounds like a terrible idea for a restrictive AN, as this starts the crazy brain cycle... but it is probably quite beneficial for a bulimic/B&P AN, as bulimia , pathological food obsession, is often a direct result of disordered glucose metabolism / reactivity to food in vulnerable individuals. If the bulimic has normal insulin reactions no hypoglycemia and easily uses bodyfat for energy their binge/purge thing gets better. Bulimia and anorexia are very different disorders, even though they are often lumped together, the vulnerabilities are polar opposite. Bulimics have a lack of inhibition/control and very high responsiveness/reward to food with signs of glucose disorders (redundant with the previous). Anorexics are very inhibited by personality, depressive, and have an abnormally low reward response to food and are anhedonic chronically.<br /><br /><br />I also agree with Paul... there appears to be evidence that autistic-like brain patterns are a risk for anorexia, probably also modulates defects in pain & reward sensing/responsiveness (no differentiation between pleasure and pain) and other thought patterns like an inability to shift attention, inability to see larger point/picture, tendency to stereotype, poor ability to communicate/express/understand their own emotions and needs in general, similar to autistic children.ItsTheWooohttps://www.blogger.com/profile/12057537399918684119noreply@blogger.comtag:blogger.com,1999:blog-3045634714760830992.post-35891475902630164462011-12-11T22:42:19.195-05:002011-12-11T22:42:19.195-05:00Good post on a terrible disease. The view of the p...Good post on a terrible disease. The view of the photo is difficult to tolerate. Also, it surprises me that some european designers chose models that are too thin, not nice or sexy.<br />I know there is much controversy among psychologist on how to treat this disorder.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-3045634714760830992.post-31913520393675909992011-12-11T17:27:08.629-05:002011-12-11T17:27:08.629-05:00Interesting post. There has been quite a lot of in...Interesting post. There has been quite a lot of interest on the cognitive 'phenotype' of AN and other eating disorders particularly overlapping with some of the traits tied into autism: http://www.ncbi.nlm.nih.gov/pubmed/21810110<br />The question is what comes first: the mindset (e.g. attention to detail, executive function issues) or the behaviour? <br />If there are cognitive 'similarities', the question is whether the two conditions can learn from one and another. Gut permeability issues have been (preliminary) ruled out in AN (see de Magistris et al study: http://www.ncbi.nlm.nih.gov/pubmed/14699443) but one does wonder about gut bacterial issues: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2742902/ (whether this is down to the dietary changes or present beforehand is another question).Paul Whiteleyhttps://www.blogger.com/profile/14288851488012254897noreply@blogger.com