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anorexia

anorexia a disorder of the mind

Aug 29th 2017

Mental health is a growing concern for parents in the UK, with almost a quarter of a million children and young people receiving help for anxiety, depression and eating disorders.

Earlier this year it was reported that children as young as four were attending health services for eating disorders, while Beat - the UK's charity for anorexia, bulimia and binge eating - have warned that disorders "can affect anyone, regardless of age".

In a bid to open up the conversation around young people and eating, Channel 4's latest documentary, Wasting Away: The Truth About Anorexia, sees journalist Mark Austin discuss destructive impact anorexia had on his daughter Maddy.

At her lowest point, at 18, she weighed just 5-and-a-half stone and developed bone marrow failure.

The programme takes a look at how health issues are continuing to grow among young people, and whether enough is being done to actually treat them.

If you're the parent of a child, like Austin, that has developed an eating disorder, you may feel unsure how to help and how to act around them.

But fear of what other people might say, or being criticised or punished can often stop young people from taking the first step, so it's important that you learn to find ways to help your child cope and manage their eating habits at home.

Here, Pablo Vandenabeele, the Clinical Director for mental health at Bupa, offers his practical advice for parents supporting a child with an eating disorder.

Talk about it

If you’ve noticed a change in your loved one’s eating habits or significant weight loss talk to them about it. Create a safe space, maybe somewhere they are the most comfortable and have an open, judgement-free conversation. Start by asking them if there’s anything that is making them feel anxious or stressed which is having an impact on their eating habits. Try finding out why they are having difficulties with food and work on finding a solution to that issue with them. Also speak to a doctor, they’ll be able to support you and your loved one with your physical and mental health and put you in touch with support groups.

Don’t force it

Although your instinct may be to push them to eat, this may not be right for them. They’re already dealing with a lot of negative emotions when it comes to food, so by adding more pressure onto them won’t help. Instead, ask what they might want to eat, now or in a couple of hours time.

Don’t blame them

Overcoming an eating disorder can be very difficult. Remind yourself during the challenging times that your child is not doing this to hurt you.

Take time for yourself

Caring for a loved one with an eating disorder can be emotionally challenging. You may feel frustrated the person isn’t eating healthily, or worried you’re not doing enough. It’s easy to forget to make time for yourself – speak to a doctor about what you’re going through or seek a support group.

Be honest about your feelings

Caring for a child with an eating disorder is tough and there will be times where you lose your temper, or say something you wish you hadn’t. Explain to your child how you’re feeling and why you acted the way that you. Remind them that you love them and praise them when they do something that makes you proud.

April 4th 2017

Fasting

You probably first came across it with a pale-looking colleague slumped over their office desk. Or with The Fast Diet author Michael Mosely speaking effusively about it on television. Fasting, they’d have told you, is a great way to lose weight. It makes sense: eat fewer calories a couple of days a week, and don’t overeat on the others, and you’ll slim down. What’s less clear is the assumption that fasting from time to time can bring other benefits such as avoiding disease, keeping your brain sharp and even letting you live longer. With all this for the price of just a sprinkle of willpower though, surely it’s all too good to be true?

The answer is not straightforward. Perhaps unsurprisingly, the evidence is strongest with type 2 diabetes – a disease often caused by overeating. The disease means that a person can no longer control their blood sugar levels. Once diagnosed they are left staring down the barrel of a lifetime on medication, unless, think researchers at Newcastle University, they begin to fast.

They’ve tested an extreme low-calorie diet – a hunger-panging 600 calories a day for eight weeks – in 11 people with type 2 diabetes: all were disease-free by the end of the fast; seven were still disease-free three months on. Later studies suggest that the sooner people fast, the better their chances of reversing their disease. Roy Taylor, who leads the group, thinks that fasting is beneficial because it gets rid of dangerous fat in and around your organs, including two that are important in sugar control – the pancreas and the liver.

When an otherwise healthy person’s blood sugars get too high, their pancreas makes a hormone called insulin that tells the liver to remove the sugar and store it safely. “If you have fat around these organs it clogs up the way they work and your body can’t control its blood sugars,” says Taylor. After about 12 hours of fasting, he says, the body uses up all the glycogen in the liver, its go-to source of energy, and starts to dip into its fat deposits. “The first type of fat to go is that dangerous fat around the organs, freeing them up to do their job properly.” He stresses that people with diabetes should not fast without consulting their doctor – a combination of insulin drugs and fasting can be lethal.

Taylor and his colleagues are now testing their fasting diet in around 300 people with type 2 diabetes. The results of that study will give a better idea of how beneficial the diet can be. The question is how much of the effect is down to fasting and how much is down to just the weight loss? “It’s almost certain that other forms of dieting will do the same,” says Taylor. “But this low-calorie diet is one that I was confident would let people lose the roughly two and a half stone, or a sixth of their body weight, that we were looking for.”

There is, though, reason to believe that fasting might have benefits over and above weight loss. It’s down to what happens to all living organisms when they don’t have food – they begin to eat themselves. Gruesome, maybe, but it’s beneficial: it lets the body recycle energy and do some housekeeping – the first cells to go are the faulty ones.

Valter Longo is a scientist at the University of Southern California who believes that, because of this process, periodic fasting can help people stay healthy. Faulty immune cells, for instance, could be pruned back so that when a person starts to feed again, new cells are spawned from only the strongest and the fittest.

In experiments in mouse models of multiple sclerosis, a disease in which rogue immune cells erroneously attack a person’s nerve cells, he’s seen that periodic, low-calorie fasting can slow down the destruction of cells and even lead to some regeneration. His preliminary work in people with the disease suggests it could improve their quality of life.

The potential reaches further. Fasting-mimicking diets can help people with cancer undergoing radiation chemotherapy, presumably by promoting the growth of healthy cells and restricting the growth of cancerous ones. Restricting the amount a mouse eats by about 30-40% can extend its lifespan by a third.

This year Longo showed that a fasting-mimicking diet could help mice with diabetes regain blood sugar control, not only those with type 2 but also those with type 1 diabetes, caused not by overeating but by a faulty immune system. The benefits, he says, were down to a reprogramming of beta cells, a type of cell in the pancreas that makes insulin. He also starved cells taken from people with type 1 diabetes and saw a similar reprogramming.

“These results are surprising and completely new territory,” warns Gordon Weir, a diabetes researcher at Harvard Medical School. “I’d be cautious about assuming that fasting will help people with type 1 diabetes until the mouse studies are replicated in other laboratories and it has gone on to be shown to work in human beings, not just in human cells.”

Longo, too, is wary of giving false hope but is bullish about the potential of fasting. “In research over 25 years we’ve seen it in E coli bacteria, in yeast, in human cells, and in mice,” he says. “The foundations are so deep that it’s as old as life itself, but we have to respect the complexity – a yeast is a yeast, a mouse is a mouse, and a person is a person.”

The difficulty in transferring a theory from mouse to man is that people live much longer than mice. At middle age we are much farther from when our stem cells, the type of cells that make other cells, are most active, so our ability to generate new cells might not be as strong.

“We don’t have conclusive data that any of this works in humans,” Longo says, “but we do have some promising data.” He’s referring to a study of 100 generally healthy people given a fasting-mimicking diet low in calories, sugars and protein but high in unsaturated fats. Despite only a minor reduction in weight loss, he says, risk factors for ageing, diabetes, cancer and cardiovascular diseases such as heart attack and stroke were all improved. He’s planning a bigger trial in 250 people to confirm these findings and to figure out which benefits are the result purely of the act of fasting and not just the result of weight loss.

Other tests will take a little longer. Whether fasting will ever make us live longer, given the time needed to prove it, will be for only Dracula and Dorian Gray to know. What could be more compelling is the idea that fasting can keep us in better mental shape.

When the body metabolises its fat deposits during fasting, says Mark Mattson, a neuroscientist at the US National Institute on Ageing and Johns Hopkins University in Baltimore, it produces acids called ketones, a source of food for brain cells. Ketones also trigger the production of a chemical called brain-derived neurotrophic factor, which encourages the brain to make new connections.

It’s not an entirely new concept; in fact, the ancient Romans stumbled across it. Roman doctors found that by locking epileptics in a room with no food for a few days they could cure them of their disease. “They thought they were causing demons to go away but really these people’s ketones were increasing and suppressing their seizures,” says Mattson. Today, ketogenic diets that increase ketones by mimicking fasting are increasingly prescribed to people with epilepsy to help them control their seizures.

Mattson’s experiments in mice suggest that fasting could slow the onset of brain diseases such Alzheimer’s and Parkinson’s disease. “We’ve also got evidence in mice that fasting reduces anxiety and depression,” he says.

So far so good, but mouse does not equal man. The way you test anxiety or depression in a mouse is by chucking it into a beaker of water or dangling it by its tail. While we can all empathise with how that mouse might feel, the relevance of these studies to us with our more complicated lives and more complicated brains remains to be seen. Still, these are the same tests drug companies use to find promising antidepressants, so there might be something in it.

That fasting might have a beneficial effect on our brain makes sense from an evolutionary perspective. If our caveman ancestors hadn’t eaten for a few days it would make sense for them to do something about it. “This ketone signal tells the brain ‘hey, brain, you better figure out how to get some food because if you don’t there’s going to be a problem soon’,” says Mattson. “Now we’re eating three meals a day plus snacks so we’re never going to raise our ketones. If we fast from time to time, maybe we can take advantage of this evolutionary adaptation to help us in modern life.”

Like most people, if I’m going to skip a sandwich to help my inner caveman, I want him to be as pumped up and raring to go as Rocky at the end of a training montage. The problem is that nobody knows exactly how you’d do that.

“Simply too few studies have been done to know the long-term effects in people,” says Susan Jebb, a nutrition scientist at the University of Oxford. “There’s clearly something about not putting food in your system that’s beneficial, especially for diabetes, but how close to fasting do we need to get? Is it the 5:2 diet or is it long periods of a low-calorie intake? Do we need to eat only 600 calories or can we get away with 1,200?”

One reason for the paucity of studies is the lack of money to be made. With no drugs to sell, drug companies are not testing it. Nobody is suggesting they are sitting on data or getting skinny professors whacked, it’s just that it’s not their responsibility. “Pharmaceutical companies are there to make useful drugs and to turn a profit,” says Taylor. It’s as simple as that.

In lieu of evidence that periodic fasting is beneficial, we should consider the potential harms – which are few for overweight people. People with medical conditions, especially diabetes, should consult their doctor first. People should not do water-only fasts, which cause your body to start breaking down its own proteins. Messaging needs to be careful not to condone eating disorders such as anorexia.

With so much unknown about the relationship between fasting and health, Jebb urges that we don’t lose sight of the basics. “We know that if you’re overweight, losing weight will reduce your risk of disease,” she says. “For many people an intermittent fasting diet will help them lose weight, for others eating a few less biscuits every day will be better. The trick is to find the diet that works for you and go for it.”

Fast habit, free

A no-nonsense stopwatch app. Tell it how many hours you want to fast for then press a button to start. It tracks your fasting over time and, helpfully, lets you edit your record in case you “forget” to log a fast.

Zero – Fasting Tracker, free

Zero has two predefined fasting plans: 5:2 and another one based on work done by US researchers that suggests fasting has added benefits if done at night. It uses your phone’s location to remind you when the sun will set. You can download your data to a spreadsheet and geek out over long-term performance analyses.

5:2 Diet TrackMyFast, 99p

Despite having 5:2 its title, this app has other plans including alternate day fasts and the frankly weirdly named Johnson Up Day Down Day Diet. The usual weight and fasting tracking functions are supplemented with recipe ideas, which you can contribute to and share with other users.

5:2 Diet Complete Meal Planner, £1.99

This app is just a collection of recipes within different calorie brackets. Useful, but it’s tough to justify the price given that lots of recipes are available for free online. Warning: the recipes look incredible but when you make them they come out tiny.

MyFitness Pal Calorie Counter, free

Not a fasting tracker per se but contains a massive database of foods – more than 4m can be scanned by barcode – to help you manage your calorie intake.

A tale of rescue

One day when she was browsing Instagram, she stumbled across an account using a body positive hashtag that changed everything for her.

One day you'll see, that it was inside you all along - the power to smash the mirror into pieces too small to ever pierce through your self esteem again. One day you'll see, that you could have lived unburdened by lies about your worth residing in your reflection. That you could have laughed with your whole body shaking. That you could have devoured every bite without shame. That you could have lived every moment, for yourself.

 

Anorexia nervosa

A serious disorder in eating behavior primarily of young women in their teens and early twenties that is characterized especially by a pathological fear of weight gain leading to faulty eating patterns, malnutrition, and usually excessive weight loss

This article is taken directly from the National Health Service in the UK

Anorexia nervosa is a serious mental health condition. It's an eating disorder where a person keeps their body weight as low as possible.

People with anorexia usually do this by restricting the amount of food they eat, making themselves vomit, and exercising excessively. 

The condition often develops out of an anxiety about body shape and weight that originates from a fear of being fat or a desire to be thin. Many people with anorexia have a distorted image of themselves, thinking they're fat when they're not.

Anorexia most commonly affects girls and women, although it has become more common in boys and men in recent years. On average, the condition first develops at around the age of 16 to 17.

Read more about the causes of anorexia.

Signs and symptoms of anorexia

People with anorexia often go to great lengths to hide their behaviour from family and friends by lying about what they've eaten or pretending to have eaten earlier.

Signs someone may have anorexia or another eating disorder include:

  • missing meals, eating very little, or avoiding eating any fatty foods
  • obsessively counting calories in food 
  • leaving the table immediately after eating so they can vomit
  • taking appetite suppressants, laxatives, or diuretics (a type of medication that helps remove fluid from the body)
  • repeatedly weighing themselves or checking their body in the mirror
  • physical problems, such as feeling lightheaded or dizzy, hair loss, or dry skin

Anorexia can also be associated with other psychological problems, such as depression, anxiety, low self-esteem, alcohol misuse, and self-harm.

Read more about the symptoms of anorexia.

Getting help

People with anorexia often don't seek help, perhaps because they're afraid or don't recognise they have a problem. Many have hidden their condition for a long time – sometimes years.

The most important first step is for someone with anorexia to realise they need help and want to get better.

If you think someone you know has anorexia, try talking to them about your worries and encourage them to seek help.

This can be a very difficult conversation because they may be defensive and refuse to accept they have a problem. However, it's important not to criticise or pressure them as this can make things worse.

You may want to seek advice from an eating disorder support group such as Beat about the best way to raise the subject.

If you think you may have anorexia, try to seek help as soon as possible. You could start by talking to a person you trust, such as a member of your family or a friend, and perhaps ask them to go with you to see your GP.

Read more about supporting someone with an eating disorder and advice for parents of a child with an eating disorder.

Treating anorexia

Before anorexia can be treated, a physical, psychological and social needs assessment will need to be carried out by a GP or an eating disorders specialist. This will help them work out a suitable care plan.

In most cases, treatment will involve a combination of psychological therapy and individually tailored advice on eating and nutrition to help gain weight safely.

A range of different healthcare professionals will usually be involved in your care, such as GPs, psychiatrists, specialist nurses and dietitians.

Most people are able to be treated on an outpatient basis, which means you can go home between appointments. More serious cases are treated in hospital or specialist eating disorder clinics.

Read more about diagnosing anorexia and treating anorexia.

Outlook

It can take several years of treatment to fully recover from anorexia, and relapses are common. For example, a woman may relapse if she tries to lose weight gained during pregnancy.

Around half of people with anorexia will continue to have some level of eating problem despite treatment.

If anorexia remains unsuccessfully treated for a long time, a number of other serious problems can develop. These can include fragile bones (osteoporosis), infertility, an irregular heartbeat, and other heart problems.

Despite being an uncommon condition, anorexia is one of the leading causes of mental health-related deaths. This can be because of the effects of malnutrition or as a result of suicide.

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