Anorexia & Bulimia Nervosa - Dark Side of Wafer Thin Look Part I

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It is reported that nearly half of the patients suffering adverse effects of Anorexia Nervosa or Bulimia Nervosa end in death and those who survive have a frail life to take ahead of them. Anorexia Nervosa is reported to be occurring in 0.3 to 1.3 % of females mostly of adolescent and pre adolescent age group and a tenth of that are males of the same age group. Bulimia Nervosa is reported to occur in 3 % to 7% of the female adolescent age group or young females in 20's. The underlying causes of both eating disorders are very complex as it involves psychological, nutritional and sociological complications to develop in the ghastly disorder that takes over the human into thinking she or in some cases he is not as thin as should be. Both disorders have their own characteristics but their subtype overlap and these are important for diagnosis, approach and patient care.

Anorexia Nervosa - There are two subtypes to this disorder A) Restricting B) Binging. In either cases anorexia nervosa has a common symptomatology of image distortion where the patient constantly feels she is fat or not overweight in some areas of her body, thereby adopting their to restrict food completely or binging and then compensating the binge by inducing purging. In the both subtypes the patient is grossly underweight (upto 85% underweight than accepted weight) and since the condition is usually in the adolescent age the ideal weight doesn't depend upon the height but as per the weight chart from 11 - 17 years of age. Restricting subtype is very calculative about energy intake in the diet and usually doesn't consume more than 1000 kcal per day. Most of the food consumed is very empty in calories and not nutrition dense. They eat very rarely and over a period of time survive a day without eating. They are under the impression that if they eat anymore than they do they won't get back to their desired shape. On the other hand the binging subtype does eat huge portion sizes of at least 1000 - 2000 kcal in just 2 hours mostly of high calorie diet or extremely large portions of low calorie food. After binging they compensate by inducing to purge the food out by their hand or laxatives or diuretics. The binge episodes however should occur at least 2 times a week for around 6 months to be identified. Anorexia Nervosa patients are known to have psychological symptoms of chronic depression, mild depression, obsessive compulsive disease, extremely focused at their goals, non social, stubborn, ambitious, restless, highly irritable by slightest of changes. Some may show all the above symptoms and some just a couple. Anorexia patients are not accommodative towards recognizing their disorder and therefore are against approaching for help or accept offered recommendation. They do not realize they suffer from a disorder as they are convinced about their weight issues and therefore justify their dietary needs. They are highly susceptible to any substance abuse that they perceive to help them reduce weight. Anorexic patients are characterized with amenorrhea (absence of menstrual cycle for months) or retarded sexual growth. They more often than not develop a cardiac complication along with bone frailty due to excessive muscle & mineral wasting. Their death is usually due to cardiac arrest or respiratory failure. They require intensive in patient care until recovery and rehabilitation to normal lifestyle post recovery. 

Bulimia Nervosa - Unlike Anorexia Nervosa bulimic patients are of normal weight or even slightly over weight. However they develop bulimia nervosa by recurring episodes of binging and purging or excessive exercise or alternate therapies. They binge around 2000 kcal of food within a span of 2 hours and purge it out or get alternatives to compensate for the episode. They are known to abuse laxatives and diuretics and also develop medical complications due to this like mineral loss, tissue loss of the gastric system, some hemetemesis (vomiting blood), esophagitis, esophageal ulcers and bleeding, dental carries and loss due to recurring gastric fluid acid being vomited.Laxatives cause loss of minerals like potassium, intestinal tissue erosion, nutrient loss due to sloughing off tissue and food. They suffer from extreme gastro-intestinal complications, bone density loss, dental health problems, kidney failure, sub conjunctive hemorrhage, sleep cycle loss. Bulimic patients also face mild depression or sometimes chronic depression. They are harassed by their binge episodes and themselves seek help. They are obsessed with their weight however they do not wish to continue their trials of binging and purging for too long due to sheer mental and physical exhaustion. Bulimia Nervosa like Anorexia Nervosa needs both psychological and nutritional counselling along with medical support but are comparatively easier to recover. Their treatment can be inpatient care depending on the severity of their complications or even outpatient / day care treatment. 

We will discuss their medical approach and treatment in the upcoming posts till then if you wish to seek nutritional and wellness coaching please contact me here with your specific concerns.

Wish you wellness. 

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SPICE up your WELLNESS

What is your spice of life? Is it your family, your friends, your work or your health that allows you to enjoy all the above ? Whatever it may be the truest spice of your life are spices themselves because without them I only wonder how our evolution could have survived all the natural adversities of diseases and physical harm over these centuries. Whether or not you believe and follow ancient medicine of any kind like Ayurveda these are medicinal facts about the spices you so often see in your food either exotically or regularly. If you are one of those who fancy Indian or South American food this should be music to your eyes while reading what you have been eating so far.

1. Turmeric - Turmeric is the most popular of spices used in Indian food without realizing what its medicinal value has been offering to the food. The most known fact about turmeric is its antiseptic value but there are at least a handful more that are discovered and many more that aren't. Turmeric contains Curcumin one of the 3 curcuminoid phytochemicals that plays a pivotal role in our wellness. Turmeric or more specifically curcumin is acts as an  anti-inflammatory, anti-viral, antioxidant, anti-bacterial, anti-fungal. The good old grandma's therapy of drinking warm milk with a tea spoon of turmeric powder is a stat cure for common cold, cough and fever. Curcumin is known to have induce bile and helps in gall bladder problems except for gall stones or any bile duct obstructive problem. Bile helps in breakdown of fats thus also helping fat metabolism. Research has shown turmeric along with Vitamin D3 to help clear amyloid beta that causes Alzheimer plaques in brain. Curcumin has benefits to autoimmune diseases like rheumatoid arthritis and  other joint disorders, it is shown its effectiveness with antioxidant qualities to prevent lesions on the arterial walls caused by oxidative stress due to cholesterol and triglycerides. Turmeric also helps prevent cancer proliferation by the anti-inflammatory and antioxidant qualities. Turmeric is well absorbed the body in the presence of black pepper which is explained ahead. 

2. Chili Peppers - Mexican, Oriental, Indian, and other Latin American food uses a lot of these red hot ladies. Red hot chili, Cayenne, Green Chillies, all those who have the heat are very good for your wellness especially of the nerves, joints and pancreas. Chillies come from the same genus of Capsicum (Pepper) and posses a phytochemical 'Capsaicin' which is responsible for producing the heat in the chillies. This ability to produce heat is what makes the chillies medicinal to the nerves and endocrine system. Capsaicin induces the heat on ingestion which lets the body react as if it were combating pain due to this heat is felt and the body releases endorphins (pleasure or euphoria hormone). Endorphins are known to make us feel happy or energetic and thus help relieve pain of any kind in the body. Capsaicin is also known to react with the mitochondria of prostate and pancreatic cancer cells so as to obstruct its proliferation. It was seen in a study that the capsaicin reduced the cancerous tumor cells of the prostate gland. Capsaicin is also used in many pain relievers as they interact with the nerve endings that produces heat sensation making the nerves insensitive to pain. Capsaicin also interferes with substance P in autoimmune diseases like arthritis that relieves the pain sensation. Capsaicin overdose does cause gastric ulcers & gastric cancers but it in minimum amounts it protects the gastric cells as well. Besides this chillies are rich in Vitamin C & A that act as antioxidants in the body. 

3. Black Peppers - Black pepper is a dry condiment most commonly used in South Indian food especially in curries. Black pepper is a mix of many important phytochemicals like piperine, quercetine, myrcene, eugenol, kampferol & rutin. But the most important one amongst these is piperine because of its ability to enhance bio availability of other nutrients. Piperine helps other phytochemicals and nutrients to be absorbed by the body one such example is curcumin. Curcumin is absorbed in the presence of a lot of piperine and enhances it availability. It also enhances other nutrients such as antioxidants to reduce oxidative stress in the body. The combined effect of all the phytochemicals in black pepper helps fight cancer cells, inflammation, other autoimmune diseases too. 

4. Cumin - Cumin has the essential oil which has components called cuminaldehyde and thymol that aid in digestion, carminitive, lactation, blood circulation, and other infections. Cuminaldehyde is known to relieve gastric bloating, purify blood, and respiratory problems. Its essential oil specially thymol also helps in relaxing the nerves which also helps combat insomnia and other stress. It is rich in iron and this benefits in lactation as well as pregnancy and anemic disorders. 

5. Cardamom - Cardamom like cumin has digestion aiding properties. Cardamom is also known to relieve blood impurities and help in respiratory problems. It has detoxifying properties and also helps blood circulation to the lungs. 

These are some of the main medicinal spice and condiments that are most commonly used and can be of essential value if taken in appropriate amounts. Now you can gorge on the Latino diet or Indian food that keeps tempting you just don't overdo the spices they only help in moderation like everything else in life. 

Wish you wellness. 

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SALT and FITNESS

Salt is truly what gets us to approach our food with a sweet smile. Fashionably salt is a strict no no for all the dieters and weight watchers but there are more facets to this tiny crystal than just bloating you up with water retention. Salt is the most misunderstood of all food ingredients I have come across. I have in my counselling sessions observed that people either overdo the salt intake without knowing it or completely cut it out for no apparent reason. Sodium as the key component of salt is a prime controller for our basic fitness and most important for sportsmen/ women. Sodium can play a vital role in the whether you get energized or not.

Essential Transport Channel - To supply sugar you need sodium, how ironic. Did you know that sodium is the active transport channel for glucose molecule ? Yes insulin lets it in the cells but sodium pumps the molecule physically from the intestinal lumen into the blood. Without adequate sodium there is no primary energy source to begin with for the body. Sodium channels are present where glucose molecule needs to be actively (with help of extra energy and not osmosis) transported into a cell or tissue. While working out or exercising we are recommended a sugar - salt solution for this same reason to aid the immediate uptake of energy and water into the blood. 

Rehydration Must have - Thirst is the bad indicator for dehydration and thats because when we feel thirsty our body is actually 3 times more dehydrated than the amount of water that quenches our thirst. When exercising for above an hour or 5 hours like in case of a marathon rehydration should be done every 15- 20 min with a electrolyte - carbohydrate isotonic solution for normal to mildly cold temperature (if the weather is hot & dry / humid). The rehydration solution should have 1.5 gm of sodium per litre water and 1.5 - 6 % of carbohydrate. Simply put for every litre of water add 1/2 tsp of salt and 2 1/2 tsp of sugar or glucose. This solution in 1- 2 glasses (300 - 600 ml) should be ingested 2 hours before a prolonged exercise and sips every 15 min during exercise. Post exercise rehydrate with the solution of at least 500 - 600 ml within first 15 min followed by a carbs- protein meal. Everyone has a misconception that water is immediately absorbed from the intestine into the blood but that is not true. Water is absorbed as per the gastric emptying and the quantity, quality, temperature of the water as well as the activity of the body. If the body is warmed up for exercise or any stress activity gastric emptying will be slowed. What sodium does here is it pulls the water and the glucose from the lumen of the intestine into the blood as its uptake is faster. Of course that does not imply that sodium (salt) should be loaded into a drink as it will hold the water in the lumen causing abdominal cramps. Sodium is a very minor component of water loss due to sweat unlike popular belief and mostly is needed to build up the blood volume and restrict water loss through excretion which is the case if plain water is ingested during and before exercise. 

Brain and other vital activity - Sodium is also important for normal neuromuscular transmission and activity. It has a major role to play in the alertness of the brain and muscular tone. The sodium channels present in the axon (nerve ending) of the brain cells are responsible to transmit the nerve charge to conduct the impulse to the muscle or other organ. Same is the case with the muscular contraction and relaxation. Sodium balance extracellularly also controls the brain volume and keeps it maintained at all times. When there is a disturbance in extracellular sodium levels there can be minor to severe neurological problems ranging from headache to disorders. Sodium channels are responsible for all muscular activity along with the calcium channels this includes the vital organ muscles like heart etc. 

Blood Pressure & More - Sodium is the major cation of extracellular fluid (water outside each cell) this makes it important for the dehydration and rehydration of every cell in the body. The normal level in blood is 135 - 145 mEq / L. Any change in this range can have massive impact on the entire body primarily the brain. When the level is low it is termed as hyponatremia and the blood volume and therefore pressure decreases due to this as sodium pulls water wherever it goes. When the level is high there is excess of blood volume causing the pressure to rise. The pressure receptors in the blood vessels monitors the levels as well as the receptors in the brain (hypothalamus) that causes the sensation of thirst when the blood volume goes down. Besides the blood pressure & volume changes in sodium levels extracellularly can cause cell damage due to shriveling (dehydration) when sodium level outside the cell is high and pulls the cell water out causing oedema or water retention. If the sodium level extracellularly is less it may swell the cell with excess water thus damaging its normal functions and in case of brain cells causing headaches. Sodium levels in the body are monitored by the Renin- Angiotensin system in the kidney that causes diuretic effect or leads to reabsorption of sodium and water. The kidneys however have a solute threshold of 1400 mOsm/ kg in an adult. If the sodium levels are high enough then the adequate excretion of sodium won't be possible and hence adding up concentration in the blood & thereby kidneys. The nutritional recommendation of sodium through food is 1.7 - 3 gm for an adult which is around 3 - 6 gm of salt. However the western population consumes at least 10 - 15 gm of salt daily and the Asian population around 15 - 20 gm which is beyond the acceptable levels for our body. 

FITNESS EXTREME - People give up on salt completely due to medical condition like blood pressure but it is always advisable to monitor your salt intake before stopping it without professional recommendation. There are some who give up on salt for the sake of fitness for eg women to reduce weight and men to reduce water weight for lean cut abs and muscle tone. Male models and actors are known to starve themselves of salt or any food with sodium just before the shoot to show their extremely well chiseled abs but this is highly not recommended practice and instead a low salt intake is a must and replacing raw and natural food to processed food. Women who suffer from weight problems give up on salt completely but the advisable thing to do is cut back on excess added salt and stick to low sodium food which is natural and not processed. 

Sodium and salt form a very integral part of our health and fitness but only if used well and not sacrificed or over used. 

Wish you wellness. 

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