Eating disorders can develop from a number of psychological and physiological sources as well as genetic factors and they need to be treated with sensitivity and patience. Everybody is different, so there is no stock solution to apply. When working with clients, it’s about unravelling each story, understanding the individual’s lifestyle and priorities, and planning (not imposing!) achievable milestones.
During my 15 years in clinical practice, I have seen over 10,000 individual clients with all manner of health conditions, including eating disorders.
Some come to see me following diagnosis of an eating disorder, others clearly have issues with food but have not been formally assessed. Although eating disorders can affect people of any gender and age, they most often affect adolescents and young women.
The most commonly recognised eating disorders are:
· anorexia nervosa: deliberately starving to keeping body weight far below healthy acceptable ranges for height and age. The condition usually develops around the age of 16 or 17.
Behaviours may include skipping meals, avoiding food groups or suddenly ‘becoming vegan’ to deflect difficult questions, or declaring a number of food intolerances
· bulimia nervosa: binge eating followed by self-induced vomiting which usually begins at 18 or 19 years old
· compulsive eating/ binge-eating disorder (BED): as the title suggests, overeating and not stopping when full
In addition to these, I have also dealt with young people who are averse to certain textures of food in their mouth, others who shun food in order to avoid opening their bowels, and those who fear that unless it’s organic they will be harming themselves. I remember one mother who brought her 4 year old boy to see me, worried that he was fatigued all the time. Little wonder! He was so weak, pale and lethargic because he wasn’t allowed anything with gluten, dairy, soy, yeast, oxalates, sulphites, preservatives or additives in case they caused him harm. His diet was extremely limited and contained insufficient nutrients to support healthy growth. Worse still, unwittingly his mother would have interfered with the child’s microbiome (a topic I’ll cover later). The mother herself was underweight and pale with huge shadows under her eyes. She had an obsession with cancer and was petrified that she or her son might fall victim to it. So when we talk about eating disorders, it’s important to appreciate the whole spectrum, and that includes the home environment (including location).
When I present on children's nutrition, I spend quite a bit of time focusing on the home conditions , e.g. if there is stressful tension when the child is trying to eat ; if there is a faddy mother or father or if there are arguments in the background etc. This awareness is also important when dealing with an individual with an eating disorder. Quite often, those who feel they have no control over certain aspects of their lives (work, study, relationships, bullies, parents etc) gain satisfaction from controlling their food intake.
Whilst psychotherapy and counselling are invaluable in an individual’s treatment and recovery, nutritional therapy is also vital.
One area that excites me greatly is the emerging research that has linked the microbiome (our healthy gut bacteria) with the behaviours and choices made by those with eating disorders. The ongoing research suggests potential links between the health of the microbiome and causes and outcomes for eating disorders. People with eating disorders such as anorexia do not experience hunger and satiety in the same way as those who have a healthy relationship with food. New research is showing that the composition of gut bacteria may play a role in the behavioural aspects of anorexia and other eating disorders. In my Mood and Food workshops I have a dedicated session on how certain species of healthy bacteria can help prevent depression and anxiety. By simply prescribing the correct probiotic containing the missing species (helveticus) I have witnessed amazing transformations with clients who were able to overcome depression after years of struggle. Alterations in the gut microbiome can affect how an individual’s body functions and how they think, feel and behave. The gut microbiome is critical not only to regulating mood and behaviour, it also plays a vital role in regulating appetite control and weight. A 2015 French study showed that patients with anorexia had lower diversity of gut bacteria than healthy individuals and they also found that the less diverse the gut microbiome, the more depression and anxiety people suffered (back to helveticus!)
Given that the first scientific evidence ( of what would be known as the microbiome) was discovered by Austrian paediatrician Theodor Escherich in the mid 1880’s, it’s frustrating to think it’s taken this long to unravel and appreciate all the microorganisms and strains in this fascinating ‘second brain ‘ of ours. But better late than never I suppose!
Apart from mental apprehensions, many individuals struggle with digestive distress when reintroducing foods. Probiotics can assist this phase of recovery. These amazing revelations are incredibly enthusing and are going to do so much to transform the health and mindset of so many. It would be a great step forward, in my opinion, to see the NHS featuring probiotics amongst the resources on their Eating Disorders website.
Currently, less than half of people with eating disorders fully recover, highlighting that conventional treatments need to be reviewed and revised. For instance, liquid (enteric) feeding is often used to treat individuals as they start the road to recovery. However, liquids don’t contain vital fibre, leading to gastrointestinal problems including constipation, bloating and pain, which can impede progress.
With my clients, I begin by gathering data to assess the impact of the eating disorder, especially if it has been ongoing for some time. This might be through blood tests to consider organ function (liver and kidneys etc), a stool sample to ascertain bacterias and further testing for mineral and vitamin deficiencies, so that when foods are eventually re-introduced, I will choose foods highest in the missing nutrients.
I will also perform an Organic Acids test (OAT) to look at neurotransmitters, specifically serotonin and dopamine. Serotonin is our ‘feel-good’ brain chemical and 90% of it is produced in the gut, yet again emphasising the importance of a healthy gut when it comes to mood and emotions. Meanwhile, dopamine helps with self-worth and motivation, and can help control cravings. Both serotonin and dopamine have been shown to play a role in eating disorders. Continual starving, binging and undereating may indicate a deficiency in either or both of these important neurotransmitters.
In Scotland, estimates show that the annual incidence of anorexia nervosa is 8.1 per 100,000 population and incidence of bulimia nervosa is 11.4 per 100,000 population with approximately 90% of all cases being women. However, I believe figures quantifying the extent of eating disorders may be flawed due to the fact that many sufferers do not come forward or are not recognised as having an eating disorder because they don’t fall into the identified categories (remember my client with the 4-year old boy).
My diploma in NLP has been enormously beneficial in my nutrition consultations- for all clients, not just those with eating disorders. For instance, the constipated client may not have issues with food or digestion at all, but rather marriage problems or struggles at work. Constipation becomes the symptom, but the cause is multi-layered and requires an approach that will support emotional as well as physical wellbeing. I’m always looking for body language and other ‘emotional’ clues that will help with the outcome for my clients.
As I mentioned earlier, because eating disorders are so personal, there is no one stock solution for everyone. My initial consultation can last a good 90 minutes (always making sure the individual remains comfortable and not distressed at any time) to really begin to understand the causation of the condition. I acknowledge and validate what they've been (or are still) feeling and reassure them that I am with them on their road to recovery. Feedback has suggested that this ‘togetherness’ comes as a relief, especially as almost everyone affected by an eating disorder tends to isolate themselves.
The strategy that seems to work best is when I emphasise the importance of cellular health and the replenishment of the microbiome. Focusing on an internal image takes the pressure away from the external body image. I encourage an awareness of the link between these and their impact on mood and food. In the talks that I do, my slides characterise the digestive organs, giving them personalities. It's worked very well to get the message home!
I’m also honest with them and recognise that refeeding is likely to be difficult and they might have increased disturbed thoughts at first. However, if they are reassured that it’s perfectly normal then it becomes easier. Knowing they also have the tangible support of a selected probiotic is also very encouraging (for them and for me!). I also like to monitor progress. Blood tests are great for evidencing results before, during and after dietary changes and this can help spur people on.
I have found that a plant-based diet works very well in the early weeks, and people seem to feel ‘safe’ with these foods, both physically and mentally. The benefits of this approach also means that the gut microbiome is strengthened
I don’t choose gluten or dairy foods at the beginning of the treatment simply because they are not only two of the top foods that cause intolerances, they are also difficult for weak digestive systems to digest. It’s the same for my clients who have had gastric band surgeries. We need to honour the digestive ‘team’ and treat them with care and respect (I have a wonderful PowerPoint slide depicting unhappy, protesting organs with placards!).
Some considerations for counsellors:
· is the disorder connected with body image, health worries, taking control or other triggers
· review home environment and other external stressors
· consider probiotic use
· encourage visualisations of a happy and healthy future self; or visualisations of the microbiome expanding to create a supportive ‘army’
· consider complementary therapies
I mention the latter point because I firmly believe complementary therapies such as reiki, acupuncture, massage and reflexology can really help when it comes to eating disorders. When I worked in New Zealand I formed a health collaborative of wonderful practitioners offering complementary treatments and we found that the combined power of our services enhanced the individual’s wellbeing and speeded recovery. I'm in the throes of forming such a collaborative here in Scotland and I'm very excited about that!
 NHS inform.scot  M. Rastelli et al 2018  Ian Carroll, PhD - assistant professor of medicine for Gastrointestinal Biology and Disease  According to statistics provide by NICE – National Institute for Health Care and Excellence  Marchesi et al  Healthcare Improvement Scotland