Improving anorexia care starts with nutrition
If you or a loved one is living with anorexia, or if you are a clinician caring for people with anorexia, Dr. James Greenblatt’s new book, Anorexia responses: master the balance between hope and healing, may prove to be useful reading. Dr Greenblatt is the medical director of Walden Behavioral Care, a consortium of eating disorder treatment centers. He is also a functional psychiatrist and one of the original pioneers in the field of orthomolecular psychiatry, which seeks to correct biochemical imbalances with the help of nutritional supplements. He has put his three decades of experience working with thousands of people with anorexia into this book, resulting in a comprehensive and accessible guide for patients, families and professionals.
Anorexia is one of the most frustrating conditions psychiatrists face in our clinical work, and one of the deadliest. Disordered eating behavior is just one of many facets of this extraordinarily complex illness, which is often accompanied by intense anxiety, delusional thinking, cognitive impairment, irritability, severe depression and suicidal ideation. . In my 20 years of clinical experience as a general psychiatrist, including 13 years in mental health at university, I know firsthand how difficult this disease is to treat. People with anorexia rarely seek care for their condition on their own, as poor understanding of the condition and resistance to treatment are hallmarks of this condition. These symptoms are often misinterpreted as mistrust, which can foster feelings of hopelessness, helplessness, and even anger in those trying to help.
Conventional treatment models seek to increase food intake and achieve normal body weight, but since the defining characteristic of anorexia nervosa is the refusal, or inability, to eat enough food to maintain healthy bodily functions , increasing food intake is no easy task.
Dr. Greenblatt views the signs and symptoms of anorexia as the predictable consequences of starvation. When the brain and body lack the basic ingredients they need to function properly, a host of behavioral, cognitive, emotional and physiological issues will naturally follow. Dr Greenblatt strives to tackle their root causes using innovative strategies so logical that it is surprising that they are not more widely used.
One of these strategies is to treat the underlying malnutrition with supplements, including essential nutrients such as amino acids, vitamins, and fatty acids, which patients are more likely to accept and tolerate early on. than a food expansion. When patients say they can’t eat because the food hurts their stomachs, he believes them and prescribes digestive enzymes and other supportive supplements, explaining that malnutrition will naturally reduce the body’s ability to produce the molecules needed to process food in the gastrointestinal tract.
From his experience, he has found that correcting nutritional deficiencies can help improve cognition, mood, and gastrointestinal symptoms, paving the way for dietary strategies and other personalized treatment options, including psychotherapy and medication.
A fascinating example of an intervention he has found useful in his work is lithium nutritional therapy, a topic he devotes an entire chapter to. He argues that lithium, a trace element naturally found in water and soil, is a mineral essential for neurological health, and believes that many people are deficient in the mineral. He found that “micro-doses” of just two milligrams per day were safe and beneficial for many of his patients by stabilizing mood, tempering impulsivity and reducing suicidal thoughts; this is much lower than the lowest pharmaceutical dose of lithium prescribed as a mood stabilizer in general psychiatry, which is 150 mg.
It has always baffled me that nutritional quality is rarely considered important in anorexia nervosa. The prevailing wisdom is that people with anorexia should simply follow an unrestricted diet that contains enough calories to restore normal body weight. Wisely, Dr. Greenblatt focuses on nutrition first. “It’s not the weight, it’s the nutrition,” he wrote. “If you get the right nutrition, the weight takes care of itself.”
One of the most frustrating practices I see in this area is that patients admitted to hospitals are generally required to eat all the food served to them on the unit, as refusal of any item is considered behavior. of non-compliant eating disorder. Unfortunately, these hospital diets include many foods with little or no nutritional value and contain ingredients that work against optimal nutrition and brain health, such as cookies, juices, and processed grain products.
This brings me to a point of view expressed in the book that I disagree with. Dr Greenblatt writes that following special diets that exclude certain foods or food groups, including vegan, vegetarian, and gluten-free diets, can be a warning sign of emerging anorexia. He therefore advises against eliminating or removing any food group in his work (except in documented cases of celiac disease, which requires a gluten-free diet). I am convinced that wheat has no place in the human diet and jeopardizes optimal brain nutrition and mental health. I encourage all of my patients to use the Paleo Diet (which excludes all grains, legumes, dairy products, and modern processed foods) as the first step towards their recovery from any mental health issues.
Other than that, I have learned a lot from reading this book which has broadened my thinking about anorexia and which will inform and improve my clinical practice. While there is unfortunately too little formal clinical trial research to understand how many people can accept, tolerate, and benefit from the strategies recommended by Greenblatt, it stands to reason that the risk-benefit calculation would make it a valuable tool for patients. patients and clinicians looking for new methods. forward – especially since there are no drugs that are effective in treating anorexia.
Responses to anorexia is scientifically well-referenced and includes descriptions of the latest research studies, recommendations for lab tests, supplements, and medications, plenty of real-life case examples, and helpful summaries at the end of each chapter. Dr. Greenblatt’s supplement recommendations are descriptive rather than commercial, as he does not endorse or sell specific brands of supplements in his book. This important guide is a welcome roadmap to revolutionizing the care of this complicated disease. His hopeful conclusion is that real and lasting recovery is possible when anorexia is treated first and foremost as a disease of malnutrition.
Disclaimer: I only write reviews for the books I’ve read cover to cover. I have no financial relationship with Dr. Greenblatt and do not receive any portion of the proceeds from the sale of his books.