The information below has been written and compiled by the ABC registered nurse and the ABC registered dietitian. Please read the information, use it and share as the need arises in your Befriending role.
Size zero/bone health
The use of laxatives
What is a healthy diet?
Social media and the promotion of fad diets
Breaking the bingeing circle with diet
Studies suggest that low bone mass (osteopenia) is common in people with anorexia and that it occurs early in the course of the disease. Girls with Anorexia are less likely to reach their peak bone density, and therefore may be at increased risk of osteoporosis. This is a condition where the bones are very fragile and susceptible to fracturing. Nutritional and hormonal imbalances can negatively impact bone density.
Low body weight in females causes the body to stop producing oestrogen, resulting in a condition known as amenorrhea, or absent menstrual periods. Low oestrogen levels can also contribute to significant losses in bone density. Excessive exercise, particularly if body weight falls and loss of normal periods occurs, will affect bone health in a similar way to the effect of Anorexia Nervosa.
In addition, people with anorexia often produce excessive amounts of the adrenal hormone cortisol, which is known to trigger bone loss. Other problems that contribute to bone loss in girls and women with Anorexia include a decrease in the production of growth hormones and other growth factors, low body weight, calcium deficiency and malnutrition.
Weight loss, restricted dietary intake and testosterone deficiency may be responsible for the low bone density found in males with the disorder.
Size zero/bone health
New research from the Children of the 90s project (ALSPAC), suggests that teenage girls who are too thin may be putting their bones at risk. It has long been known that the amount of muscle in the body is related to bone growth, but this new study shows that fat mass is also important in building bone, particularly in girls. The research examined 4,000 young people aged 15, using sophisticated scanning techniques that calculated the shape and density of their bones, as well as how much body fat they had. Those with higher levels of fat tended to have larger and thicker bones. This connection was particularly marked in the girls. For example, one key measure showed that in girls, a 5kg increase in fat mass was associated with an 8% increase in the circumference of the tibia (lower leg bone).
As girls of normal weight tend to have higher levels of fat than boys, these findings suggest that fat plays an important role in female bone development.
Building strong bones in youth is particularly important for women, as they are 3 times more likely to develop osteoporosis, and suffer 2 to 3 times more hip fractures than men.
Professor Jon Tobias, leader of the research, says:
“There is a good deal of pressure on teenage girls to be thin, but they need to be aware that this could endanger their developing skeleton and put them at increased risk of osteoporosis”.
Many people think that exercise is the key to losing weight and building strong bones at the same time, but this may only be true up to a point. If you do a good deal of low impact exercise, such as walking, you will certainly lose fat but you may not be able to put enough stress on the bones to build them significantly. To offset the detrimental effect of fat loss on your bones, it may be important to include high impact exercise as well, such as running or jumping.
The Avon Longitudinal Study of Parents and Children (ALSPAC, also known as Children of the 90s) is a unique ongoing research project based in the University of Bristol. It enrolled 14,000 mothers during pregnancy in 1991-2 and has followed the children and parents in minute detail ever since.
Many people with an eating disorder will find the prospect of pregnancy and all the associated changes in their body difficult to contemplate. It is important that the healthcare provider is informed about any struggles that may exist regarding eating. This will ensure that correct support is available to safeguard the physical and emotional health of both mother and baby during pregnancy and postnatally.
If stores of carbohydrates, proteins, fats, vitamins, minerals and other essential nutrients are depleted, a woman’s body will drain them to support the growth and development of the baby. If reserves are not sufficiently restored through healthy eating, there is potential for the mother to become severely malnourished, and this in turn can lead to other complications such as depression, exhaustion and many other serious health conditions. Women with a very low BMI or a very high BMI are sadly at a higher risk of miscarriage. People suffering Bulimia Nervosa who continue to purge during pregnancy may suffer dehydration and electrolyte or cardiac irregularities which can cause health complications for mother and baby.
It is advisable for anyone who is planning a pregnancy and is currently suffering from, or has recovered from an eating disorder, to seek the support of a qualified dietitian. It is important that the dietitian has specialist knowledge of eating disorders. The dietitian should guide the person through the pre-conception period, during pregnancy and postnatally, to maximise the health outcomes for mother and baby. Individual counselling during and after pregnancy can be valuable for coping with concerns and fears regarding food, weight gain, body image and being a new mum. The GP and midwife should also be able to provide support. Being honest about your eating disorder makes it more likely that you will receive good care. At ABC, we understand that this can be difficult, but it will help to safeguard your own health, and that of your baby.
The use of Laxatives
Some people with eating disorders abuse laxatives because they believe they can remove food from their bodies before the calories are absorbed. Laxatives remove lots of water from the colon or large intestine as well as food residue. However, laxatives and enemas cannot stimulate the small intestine (the upper part of the digestive tract where food is digested and where nutrients and calories are absorbed). The small intestine does not even have the kinds of nerves that occur in the colon, and is therefore not able to respond to artificial stimulation.
The scales may indicate "weight loss" after a laxative-induced bowel movement, but it is false weight loss. The ounces or pounds return as the body rehydrates. It is very important to rehydrate to reduce the risk of fainting spells and electrolyte imbalances. Electrolytes are minerals, such as sodium and potassium, which are dissolved in the blood and other body fluids. They must be present in very specific amounts for proper functioning of nerves and muscles, including the heart muscle.
In order to avoid becoming dependent on laxatives, and to have any kind of bowel movement at all, it is essential to eat enough food. Foods such as fruit and vegetables, pulses and wholegrains are recommended.
It is possible to recover from laxative misuse. However, it is always advisable to seek support from your GP, in order for your physical health to be assessed and monitored.
What is a healthy diet?
Contrary to what people may believe, the correct definition of a healthy diet is one that is unrestrained, and in which a person chooses to eat foods from all the food groups, ensuring no foods or ingredients are demonised. There are no restrictions and there is no planning. They eat intuitively, their choices fluctuating on a daily basis.
Many people fear carbohydrates. This is often due to being bombarded with information in the media and social media which identifies carbohydrates as negative.Carbohydrates get a bad press because it is easy to eat the unhealthy types to excess. However, nutrient dense sources of carbohydrates such as whole grains, pasta, rice, sweet potatoes, potatoes, oats, beans/pulses, dairy, fruit and vegetables are necessary for the body to function efficiently. These foods provide energy and also key nutrients including B Vitamins, fibre, calcium, zinc and iron.
Many people are fearful of sugar. However, it is important to empahsise that no food group should be demonised. Eating sugar to excess is not ideal but consuming a small amount on a daily basis is not a problem.
People of a low weight, particularly women who have not been menstruating, are encouraged to increase their dairy intake. Women who miss 3 consecutive periods will be putting their bone health at risk. Sustained absence of periods could cause the development of osteopenia, which if unaddressed can lead to osteoporosis.
The ABC registered dietitian suggests 3-4 servings a day, one serving consisting of:
o 1/3 pint of milk
o match box size portion of cheddar
o 150g pot of yoghurt
o 100g pot of cottage cheese
This will help to meet daily calcium requirements. Women who have missed 3 consecutive periods may also benefit from a high dose Vitamin D supplement. If a person is dairy intolerant then soya will be one suitable alternative. Almond/hazelnut/oat/rice/hemp milk are very low in calories and protein and do not have sufficient nutrients in them.
Many people who are battling an eating disorder will be fearful of fat, and will therefore avoid oils, butter, cream etc. It is important to understand that we all need some fat in our diet. Body fat stores are physiologically necessary for nerve contractions, cell membranes and most importantly for our brains to function. In addition, a person needs to consume fat in order to facilitate the absorption of the fat-soluble vitamins A, D, E and K.
Social Media and the promotion of fad diets.
Many people who are battling an eating disorder believe that it keeps their life in control, and keeps them safe and secure. People with an eating disorder make and maintain many rules in order to keep the eating disorder in place. For some people, choosing to become vegetarian/vegan; eat raw; gluten free or paleo etc. is not as a result of ethical or health reasons but instead makes it easier to remove foods/food groups.
It is important to recognise that many food bloggers include unsubstantiated facts, "pseudo-science" and unrealistic photos to support their nutritional advice. This adivce is subjective and not scientifically proven. Following these bloggers and copying their lifestyle is not recommended.
Some people struggling with an eating disorder will use messages from social media, blogs, magazines, television and the internet, whether relevant to them or not, to consolidate their decisions around nutrition and exercise, which adds to their fear of foods.
It is important to ask;
- where do the advisors get their information?
- who validates their advice?
- are they qualified and informed experts in this field?
- what are their qualifications and who regulates them?
Please remember that: -
Registered dietitians are the only nutrition practitioners who are legally allowed to provide nutritional advice for medical and clinical conditions such as eating disorders.
Breaking the bingeing cycle with diet
If a person is bingeing regularly then start by looking at what a typical day looks like. Are they eating sufficient amounts throughout the day? Or are they following the classic trap of restricting intake during the day to compensate for a binge the previous day, or planning for one? Irregular eating and bingeing lead to low blood sugar levels, which in turn have a huge potential to trigger further binges.
Binge eating has a physiological element which is related to fluctuating sugar levels, but there will also be a huge emotional element. People establish rules about their food intake which help them to feel as if they are in control when their life feels chaotic. If they break their rules, then there is a tendency for them to think “That’s it! I’ve blown it now” and this can lead to a binge. People will binge to “push down” feelings of anxiety or stress.
When a person binges their body produces a higher concentration of insulin. This level continues to be high in the hours after a binge, so if a person restricts to compensate, a higher insulin level will still be circulating around the body. This increased level of insulin subseqently causes low blood sugar level, which in turn can physiologically trigger another binge.
One of the most useful ways to reduce bingeing is to establish a regular eating pattern every 3-4 hours, aiming to base meals and snacks around a combination of food groups.