Bulimia

For many, eating disorders start subtly - with a side comment regarding their weight made by a peer or by observing a parent struggle with their body image - whatever it is, it doesn’t take long before they have become completely lost in it. It is from both a personal and professional viewpoint that I write this article. In my mid-30s I made a career change to become a Naturopathic Doctor because I was sick and tired of being tired and sick and I wanted to help people recover from some of the health challenges I had faced using naturopathy. Previously, I worked in business reporting to a CEO and had been diagnosed with several health challenges: depression (including several suicide attempts), anxiety, panic attacks, cancer (malignant melanoma) and high blood pressure. At the root of many of those health challenges lied a secret – bulimia.

As with most addictive behaviours, the first step to recovery is admitting that you have a problem and are ready for help. But this admission does not come without its share of bumps along the road to recovery. There is often defeat, despair, setbacks, and falls off the wagon; however, the overall trajectory in recovery is moving forward. As NDs, we are always striving to figure out what the root cause of “dis-ease” is – with the idea that if we can determine THAT, then we can fix the problem. The challenge is that the problem is often multi-factorial and therefore requires a solution that is multifaceted. In many cases, we need to look as far back as in utero to ascertain the health of the gut biome and how this starts or more importantly, how it may not start if we are born via C-section. The importance of high quality case taking has been emphasized in previous articles in this magazine, and I want to reiterate the importance of that.

Eating disorders can start “innocently” as mine did and then serve a greater function in a person’s life, thereby becoming a symptom of a bigger problem. Most eating disorders start at the time of puberty and it is important to ask about medication use – specifically antibiotics for acne treatment, as well as the birth control pill which can affect weight. These medications can contribute to eating disorders during the teenage years. Also, most eating disorders are a co-morbid condition – and it is always important to determine what the root condition is – ie depression, anxiety, stress, lack of self-worth, hormone imbalances etc. I would argue that in many cases, bulimia is a branch and we don’t want to chase branches in treatment, we want to address the roots.

TREATMENT OBJECTIVES & STEPS:

There are three “macro” systems in the body that need to be assessed when treating bulimia – neurotransmitters, the neuroendocrine system and the organs of detoxification. Most patients have underlying imbalances in all three areas. The primary neurotransmitters that are implicated include serotonin, GABA, dopamine, norepinephrine, epinephrine and glutamate. In terms of hormones, cortisol, progesterone, estrogen and thyroid hormones need to be addressed. In my practice, I teach patients about the “pillars of health” – diet, sleep, exercise, stress recognition/management, thought processes, emotions/reactions, environment, spirituality and self-love (see Diagram 1). I always offer them faith and hope that they will get well. I affirm that they will, as by the time patients get to me, the medical system has offered them anything but hope.

Diet: Everything that goes into our body informs our body. The goal in treatment is to stabilize blood sugar levels, eat a nutrient rich sugar-free diet and restore GI health. I do not recommend food sensitivity or elimination diets. I prefer an orthomolecular approach to supplementation and the key nutrients that I address are: essential amino acids (ie tryptophan), essential fatty acids, mineral imbalances (typically zinc citrate, magnesium bisglycinate, calcium), all B vitamins with an emphasis on methylation pathways in the body, as well as additional support for anxiety and depression using adaptogen botanical formulations. Since bulimia results in a disrupted gut flora balance, digestive issues are common, such as constipation, heartburn, gas, bloating, electrolyte imbalances and dental concerns.

^{Copyright – Dr. Christina Bjorndal}

Therefore, probiotic reinoculation is key. Other long term health problems can result from bulimia including chronic headaches, osteoporosis and menstrual cycle irregularities, such as amenorrhea, dysmenorrhea, irregular periods and fertility concerns.

Sleep: Sleep is critical to mind and body repair, recovery and restoration. Most patients are getting suboptimal sleep. It is imperative that this area is properly assessed and supported as needed.

Exercise: for most, exercise is considered a good thing. The challenge with bulimia is that exercise may be used as a compensatory mechanism to control binges, especially after cessation of purging. If I suggest anything at all in the initial stages of treatment I encourage gentle, yin type exercises – such as yoga, tai chi, qigong, walking.

Stress management & Mental thought processes:In my practice, this is the crux of my work with patients. For many, stress is what underlies emotional, binge and unconscious eating. I utilize aspects of four forms of therapy: Mindfulness, Compassion focused, Cognitive behavioural therapy and Gestalt psychotherapy. I teach patients how to recognize the “emotional wave” as it starts to rise within their physical body and work on strengthening their ability to refrain from acting on their emotions by relaxing into their breath. A critical part of working with patients is teaching them to observe their minds and uncover unhelpful core beliefs/thoughts. Most of us are unconsciously driven by our subconscious minds and by reprogramming faulty beliefs we can change our lives.

Emotions/reactions: : In my personal recovery, dealing with past “hurts” has been a huge component of my healing journey. At 20 years of age, I was diagnosed with a major mental health condition I deeply felt the stigma and shame of the label and consequently, I felt ostracized. The counseling techniques mentioned above are utilized to help patients understand their emotions and how they behave and react in the world – and most importantly how they can change these behaviors.

Environment: : This is addressed from two perspectives. Firstly, the environment we grow up in creates a profound psychological imprint. This is addressed not to blame, but to understand how we may be “programmed” and to uncover core beliefs that may not be serving us. With awareness of faulty beliefs, we can change our future behaviour. Ultimately, all we can do about the past is change our relationship to it in the present moment. The second aspect of environment is the quality of the air, food and water that we consume. For many it is helpful to address heavy metals and levels of environmental toxins.

Spiritual: : The spirit in you is your life form. It is my personal belief that a connection to spirit, whatever your chosen practice is, is critical and vital to healing yourself and the current state of the planet.

Love for self: I ask every patient to rate their love for themselves on a scale of 1 to 10, with 10 being the highest. Thus far in practice, nobody has rated themselves a 10/10. I feel this is the most important area to assess and address with patients and why I have shown it as a foundational building block in my diagram (see diagram 1). Patients have to value their own worth in order to make the changes that are necessary to recover from bulimia. Patients need to learn to love themselves and let that be a key force guiding their recovery.

By no means is the above meant to be an exhaustive list. There are many other resources that are recommended and suggested, such as:

• Inpatient treatment centers may be required depending on the severity of the case – refer accordingly
• Therapists: Gestalt psychotherapy or Cognitive-behavioral therapy. The workbook I use in clinical practice is Mind over Mood by Christine Padesky
• Resources by: Geneen Roth, Dr. Christianne Northrup, Jennie Schaeffer
• 12 step groups such as Overeaters Anonymous

Recovery

Recovery is a continuum that looks like this: patients stop purging, but still binge. To compensate for binge activity, patients may start to over-exercise. Eventually, when they recognize this, they will stop binging and develop a healthy relationship to exercise. It may take an injury or life event, (divorce) to force them to truly wake-up. You have to be careful that the suggestion to eat healthfully is not taken to the extreme where they develop orthorexia nervosa – which is when patients become fixated or obsessive about healthy eating.^[1] Often individuals with eating disorders are reluctant to seek out treatment. Many times it will be a family member that calls your office for advice. Remember that each case is unique. My recommendations for family members are to:

• Understand your loved one may resist help – do not take this personally and continue to try to get them help. Recognize that many people with eating disorders refuse to accept the diagnosis (yet still have to live with the symptoms).
• If you suspect your loved one has an undiagnosed problem, go to a support group meeting in your area or talk to a professional regarding your loved one. The next step would be to ask your loved one to go for an assessment. Be persistent if you encounter resistance. It is scary at first for someone to acknowledge that they have a problem, and it is equally rewarding to accept help.
• Recognize that you cannot control your loved one. Sometimes you need to give more and sometimes you need to give less, depending on how your loved one is managing their illness. Remember to be kind to yourself and refuel yourself on a daily basis (i.e. yoga, going for a walk, preparing a healthy meal for yourself, having a warm bath, getting a massage, etc.). Ultimately, you are a guide on the journey for your loved one – however, it is their life to live.

Lastly, the first step on a new path is always the hardest to take. Make it a small one, and you will be surprised that, in time, you will be running down the road of recovery. Remember that there may be potholes along the road and it may feel like the journey is long and slow at times. Trust in the healing process, be patient and you will get “there”. There is no quick-fix solution to multi-factorial conditions. Everyone needs to find their own balance point – in their weight, with stress and in life. Don’t compare yourself to others. Trust in your own intuitive self and the inherent healing powers you have at your fingertips while at the same time working with experienced healthcare professionals. Most humans have addictions, issues, and things to get over, learn or adjust to – life is about how we navigate the waves of our lives. It really is about the journey, not the destination. For most of my life, I lived for the destination while ignoring the journey. Now, I am learning to enjoy the journey as much as I appreciate the destination.