Nutritional Therapy for Anorexia Nervosa & Bulimia Nervosa

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Previously we saw through the symptomatology of the two most prevalent eating disorders amongst females anorexia nervosa and bulimia nervosa. Today we look at how we approach their treatment nutritionally. To begin with we need to understand what is the immediate call to action in rehabilitating an eating disorder patient. While counselling a patient it is important to understand the energy intake through the day by analyzing an average weekly diet recall.

Energy Intake - Be sure of it that the patient is extremely cautious of how many calories are consumed and what is their daily intake, therefore you must account for everything that they could be telling you. In anorexic patients who refrain from receiving any treatment escalate their caloric intake so to give an impression that they are eating well in which case one must judiciously gauge a week to week diet history. In taking the caloric intake of a bulimic patient we must first calculate an average calories on a restrictive phase and then calculate the purging phase separately. Now how we get to the reality of the energy intake on binge-purge phase is by accounting the food that doesn't come out. Bulimia patients think that while purging they remove all the food out where as the truth is only half of the food is thrown out or sometimes nearly half. Which brings us to the e.g. that if on a binge the patient ingested 2000 Kcal of food then after the purge approximately 1000 Kcal can still be accounted for in the energy intake. While calculating the binge phase energy intake first see how many binges have there been in a week or month then calculate the total caloric intake on a binge day and account for half of it then take the average intake per day along with restrictive diet days.

Carbohydrates - Malnourishment is the obvious effect of the eating disorders and although bulimia doesn't leave the person looking malnourished the constant purging leaves the gastrointestinal canal devoid of its good microorganisms and its tissue layer which secrets enzymes for digestion and also helps in absorbing the nutrients. By regular purging the cell layer sloughs off leaving the body malnourished as the nutrients do not get absorbed in the intestine. Due to the low carbs fixation common amongst anorexic patients the rehabilitation must account for lactic acidosis in the body, ketoacidosis, elevated serum amino acids and hypoglycemia. It should also be considered that due to constant starvation or binge eating the insulin secretion has been continuously tampered with and thus a very careful increase in the carbohydrate content should be taken. In patients with bulimia who undergo repeated purging could have esophageal bleeding which cannot allow roughage and hence low fiber carbohydrate should be included in the rehabilitation process. If fiber could be allowed then fruits rich in vitamins like E, C, and A should enrich the diet to reduce the oxidative stress developed int he body due to anaerobic respiration, mental stress, and substance abuse that occurs during reduction of body weight. So as to not set the insulin levels ballistic and also to provide as much energy in little food that gets ingested during initial stages, a frequent yet small quantity of simple carbohydrates rich in nutrients should be added such as dried figs, fruit pulp, sorbets, cottage cheese on small toasts, etc.

Protein - The muscle and tissue have been wasted to provide the body with some energy source and derive vitamins and minerals as they lack from the scanty food ingested. For binge - purgers there is a lot to deal with since they have corroded their teeth along with anorexics who have brittle fragile hair with scaly skin and fragile bones have a long way to sail till they rejuvenate their whole body with good protein that would heal, repair, build & strength the body frame to flesh all over. High biological value protein is the most essential in these cases as the intestinal aborption has been reduced and more over easily absorbed proteins would rehabilitate the body of its lost stores of essential amino acids, key building blocks in repair, immunity, strength. Proteins that like meat, veal, offal, seafood (shell & mollusks) even poultry and pulses should be given a wait for a while till the dairy, tofu, egg and fish (very little). In eating disorder s the kidney function does get affected as the body is dehydrated, filled with toxins, or on only protein diet. It becomes important to give protein in the diet based on the renal profile of the patient.

Fat - Well it will be a task to get a patient of an eating disorder to ingest fat in their diet but since we need to rehabilitate sparing the liver that has been over worked due to all the toxins, protein wasting and glucose deprivation, best suited fat could be with medium chain fatty acids or clarified butter, butter, dairy fat. Well one can also look at inherent essential fatty acids for immunity, repair and antioxidants by supplementing the diet with nuts and dried fruits as well as steamed or grilled fish. Fat in the diet will spare the proteins to be wasted and give the body lubrication, insulation, skin repair, protection against heart disease and gastric complications. Since the body is frail and so is the heart of the anorexic patients it would be advisable to stick to omega 3 rich fat source like vegetable oils.

Now the best thing you can do if you have anyone close to you who needs rehabilitation from an eating disorder is to make sure when they are rehabilitated in a 24 hour center and be given extreme love and support as they need it. For more information about your health related consultation please do fill out the contact form on top of the page.

Wish you wellness.

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