by Natalie Mulligan, BSc, ND
The Spark Institute
9401 Jane Street
Vaughan, ON, L6A 4H7
Eating disorders (including anorexia and bulimia nervosa, binge eating disorder and eating disorder not otherwise specified) continue to be incredibly challenging to treat therapeutically and continue to be very misunderstood among the general public and the medical profession. In medicine, there are different labels given to patients based on their symptomology but what we see clinically is very little distinction between the disorders; as there will be elements of restriction, bingeing and purging seen in every single patient with an eating disorder. Labels in fact create stigma among eating disorder patients (where some labels are considered much more “desirable” than others) and have not been tremendously useful from a treatment perspective given the very low recovery rate and high relapse rate that is the reality in the eating disorder programs that exist in Canada (1).
In general, there are three types of eating disorders that are most common, although patients may exhibit symptoms of many disorders to varying degrees. First and anorexia; this is where there is usually an obsessive fear of gaining weight and as a result food intake is dramatically reduced. Anorexia is the most dangerous of the disorders because it can lead to death. Second is bulimia; this is where binge eating is typically followed by forced vomiting, excessive exercise, or the use of laxatives. Lastly; binge eating disorder is when control over eating is lost, but may not be followed by compensatory behaviours such as purging.
The model for treatment in government-funded programs is highly food-focused with the intention being weight restoration or symptom reduction. The trouble with this is although food behaviours become a huge problem for these patients, the eating disorder has nothing to do with food. Food symptoms are an expression of what a patient is feeling emotionally and without proper attention to the huge psychological component, the cause of the illness is never being addressed and therefore likely to continue recurring. This disconnect between the basis of the disorder and the treatment method likely accounts for the low recovery rates and high relapse rates (2).
The model that makes sense when treat eating disorders is a holistic approach, meaning treating the whole person and every single factor at play in the disorder. From our perspective, the nutritional aspect, the psychological/emotional aspect and the physical aspect of the eating disorder all need attention. The food symptoms are a huge problem and need to be addressed; this is equally as important as the emotional aspect which is where the eating disorder lives; and the physical harm that is endured by the body from the symptoms is again, equally important.
A complete treatment plan will address all three of these aspects simultaneously. We know that mental health is so multi-factorial that it’s impossible to tease out exactly what the problematic pieces are - it’s usually an accumulation of multiple factors from multiple sources that lead to breakdown when in combination. When we address the three aspects of health that are affected by an eating disorder (nutritional, physical and psychological) things seem to click into place and patients can move forward. We will discuss some of these aspects in more detail below.
From a physical perspective - most patients seen by Naturopathic Doctors are having serious issues with digestion, sleep, energy, hormones, and other areas. Some of these issues can be a serious hindrance to moving forward in recovery. So typically Naturopathic Doctors will provide patients with supplements or herbs as well as do acupuncture to minimize these symptoms, which may help pave the way for the further treatment options (specifically nutrition and counseling).
From an emotional perspective - in therapy patients are able to work through patterns that are at play with the eating disorder and their life, address any anxiety that is present as a result of changes being made in their life in recovery, and start exploring ways to let go of the eating disorder and fill that space with a healthy coping mechanism. One of the best treatments with the highest level of evidence supporting its use is cognitive behavioural therapy, or CBT (3). CBT is conducted over several sessions and systematically addresses underlying thoughts, emotions, and behaviours that the patient is experiencing. It has been shown to decrease negative eating behaviours and help improve wellbeing, while decreasing the intensity of negative experiences such as anxiety.
Many additional treatment options available have been studied. The results of a systematic review showed that exercise is helpful (specifically aerobic and resistance training), as well as yoga, massage, and basic body awareness therapy – that have been shown to reduce scores on validated questionnaires that measure symptom severity and depression (4). It’s helpful for practitioners to identify which subset of therapies may be most appropriate for patients, based on their preferences and based on what is most realistically accomplished.
From a nutrition perspective - the symptoms of an eating disorder live in the world of food so in nutrition the work is individualized and specialized to meet a patient exactly where they are at. Nutrition often involves education about food, cooking, meal planning together, outings to restaurants; really anything that involves food. Many practitioners will not even discuss food until some of the underlying emotional issues have been addressed. However, food eventually should be discussed, especially if there is a lack of education with the individual patient’s presentation. Diets that focus on whole foods, include fruits and vegetables, and healthy amounts of protein should be discussed.
We know that throughout recovery there are times when the food piece is harder and therapy is a place to process that; there are times when the therapeutic piece is harder and that’s when more acupuncture or supplements to help with anxiety are really helpful. The process of recovery is dynamic, always changing and constantly requiring different support - so incorporating the 3 components of treatment the patients’ program is able to be adjusted accordingly.
Recovery is possible, but can be very difficult for many. Support from many realms is often helpful (family, work, relationships, social support). These conditions are often shielded from loved ones out of shame or guilt. However, many patients find that when they share their concerns with others, they usually get more support and feel better. It’s really hard work and often really scary to take the leap but we have seen so many people find wellness. We always encourage you to seek the care and guidance of a trained professional, such as a licensed Naturopathic Doctor.