Eating Disorders - Bulimia

Bulimia is an illness defined by food binges, or recurrent episodes of significant overeating, that are accompanied by a sense of loss of control. The affected person then uses various methods -- such as vomiting or laxative abuse -- to prevent weight gain.

Many, but not all, people with bulimia may also suffer fromanorexia nervosa, an eating disorder involving severe, chronic weight loss that proceeds to starvation.

What Causes It?

There are several different theories about what is involved in the development of bulimia. Bulimia may have a hereditary component; in addition, some experts believe that a family environment with an overemphasis on achievement may be another contributing factor. The role of sexual abuse in the development of bulimia is controversial. Other psychological and environmental factors may be involved; these include mood disorders and substance abuse in families of people with bulimia. Individuals with bulimia may also experience depression, self-mutilation, substance abuse, and obsessive-compulsive behavior. Cultural pressures to appear slender contribute to the disorder, particularly among dancers and athletes.

Nutrition

Nutrition therapy is as important as psychotherapy in treating bulimia. The goals of nutrition therapy are to stabilize your blood sugar levels, to make sure you are getting enough nutrients, and to restore your gastrointestinal health. In one study, 55 women with bulimia were assigned at random to either a nutritional management treatment group or a stress management treatment group. Nutritional management included information on the effects of bulimia, techniques to avoid binge eating, and advice about making meals and eating. Women in this group also had their eating diaries analyzed. Stress management included analysis of stressful situations; short-term stress management strategies, such as relaxation, self-encouragement, and self-distraction; and training in planning, problem solving, and communication. Women in the nutritional management group reduced their binge eating faster and were better able to avoid bingeing over the next year.

Some people with eating disorders are deficient in zinc. Variations in levels of zinc can affect taste, smell, appetite, and response to stress. Zinc deficiency may play a role in eating disorders and altered self-image. Taking zinc supplements may help with your treatment. In a recent study of 47 women with bulimia, zinc supplements seemed to reduce their obsession with weight and concern with body image. Your healthcare provider may also recommend a multivitamin with minerals to maintain levels of other important nutrients. B-complex vitamins may reduce stress and depression.
If you have trouble recognizing feelings of hunger, I recommend eating small meals every 3 hours.

Massage

Therapeutic massage can be an effective part of a bulimia treatment plan. In one study, adolescent women with bulimia were assigned at random either to receive massage therapy for 5 weeks or to be in a control group (not receiving massage therapy). See the link below for info. on various massage (Thai massage)

The 24 women receiving massage improved immediately, while the control group did not improve. Women in the massage group were less anxious and depressed right after their initial massages. They also had better scores on the Eating Disorder Inventory, which helps providers assess psychological and behavioral traits in eating disorders.

Once you are in recovery from an eating disorder, your nutritional needs are similar to those of someone who has not had an eating disorder. Your body's requirements for calories, protein, fat, vitamins and minerals are based on factors which include your age, height, weight, activity level, and medical and genetic history. If you have had anorexia, the number of calories that your body needs to maintain your weight may be higher for several years after weight restoration. A physician or a registered dietitian familiar with eating (like me) disorders can help you determine your unique caloric needs.

I encourage clients to choose mostly whole instead of refined grains, a serving of nuts and beans daily, and to have 4-5 different colours of fruits and vegetables each day. Unsaturated fats are the best choices, especially olive and canola oils. Lean meats, non-fat or low-fat dairy products, poultry, fish and soy foods are good protein sources.

Below is an example of a healthy food plan for a person requiring 2000 calories per day:
Breakfast

1 whole wheat English muffin with peanut butter

1 glass non-fat milk

1 banana

Snack

1 apple

1 (low fat) yoghurt

Lunch

1 chicken (use chicken breast - no skin) sandwich on whole-wheat bread with fat-free cottage cheese, lettuce and tomato

I serving grapes

Snack

4 Pro-Vita or Ryvita crackers with salsa

Dinner

1 chicken breast stir-fried with 1 cup Chinese vegetables

1 1/2 cups brown rice

Snack

1 serving low-fat ice cream, sorbet, brownie or fruit salad