Anorexia Nervosa - What Would Be Some Things To Try?

[AnonE]

Hey Ray Peat Forum,

Long time reader, first time poster. I want to try and help out my friend, she is an early 20's female who has been dealing with anorexia nervosa (AN) for about 2 years now. It's not clear to me that the traditional medical system is helping her much, and I want to suggest some more ideas to help get her back on track before the demands of her career start kicking in later this year. Brief history and quick facts on the 'patient':

- Has swung from severely underweight to slightly overweight, to back to normal (physically healthy looking) now
- History of weird binge diets, e.g. keto, fasting, you name it. Used to have intense exercise regimens too
- Has gone through multiple 6 week treatment programs at the hospital, where they basically make sure the patients eat 2 meals and 2 snacks over the day while in clinic, and don't throw up (purge)
- Is currently on SSRIs from psychiatrist, in theory serotonin is supposed to help regulate appetite....
- Has been taking a sleeping pill for last ~6 months, otherwise has trouble falling asleep
- (To me at least) presents classic signs of Asperger's in personality and mannerisms
- Currently has trouble with not purging, will typically have 3+ days per week where she does
- Says she feels terrible when she's full, afraid she's going to 'explode'/instantaneously gain a lot of weight (she's currently at a healthy weight)
- Presents some classic hypothyroid symptoms: always feeling cold (especially extremities), low pulse/heart rate, low blood pressure, but TSH reading is low, ~0.9 (I know, not the be-all measurement for thyroid)
- Seems to lack an 'internal guidance system'. Hard to describe; but imagine someone very submissive, who gets very lost and stressed without an institution (e.g. university) providing directions on what to do, implying a day plan, etc.
- Trouble acknowledging body signals, i.e. will eat what she is told to eat, then ends up getting too full (overeats), feels terrible, purges... Something in the feedback system seems off with bodily signals and/or their mental interpretation

- Is willing to try various new foods/diets at least in small doses in my company. Responds extremely well to orange juice! =D

I'll try and update with more info as I recall, and I can certainly try and answer any additional questions. I would love to hear the thoughts of this forum who may have experience with this type of issue. Open to all ideas, but for practicality sake maybe various tests and diet recommendations to try out would be a good starting point.

Thanks!

 

[johnwester130]

coconut oil can restore metabolism

so can cyproheptadine

yes, anorexia is linked to autism

serotonin is linked to autism too (overwhelmed by everything, so they reduce life to a routine)

Zinc can also be helpful

what triggered the initial anorexia to begin ?

 

[papaya]

she needs electrolytes/minerals asap! instead of purging have her take cascara sagrada.

 

[Pointless]

Naltrexone use in the treatment of anorexia nervosa and bulimia nervosa. - PubMed - NCBI

Cyproheptadine.

 

[Pointless]

she needs electrolytes/minerals asap! instead of purging have her take cascara sagrada.

Something with a laxative effect could be a bad idea.

 

[Wagner83]

There's a short back and forth on this topic here:
Androsterone - Androgenic, Anti-estrogenic, Thyromimetic Neurosteroid

 

[johnwester130]

There's a short back and forth on this topic here:
Androsterone - Androgenic, Anti-estrogenic, Thyromimetic Neurosteroid

Could pufa cause anorexia, by triggering some kind of self defence mechanism in the body ?

 

[Richiebogie]

In addition to what @Pointless posted, Naltrexone is interesting because it has also been suggested for treating autism.

Some autistic people cannot break down dairy and grain peptides that are opioid in structure and cause havoc with the brain and nervous system.

Try avoiding dairy and grain in your friend or use naltrexone to block opioid receptors. (A2 milk may be ok because the opioid-like peptide is in the A1 protein).

[A1 beta casein contains the derivative casomorphin-7 and gluten contains gliadorphin-7.]

 

[lampofred]

Cyproheptadine would be my first guess. Then anything else to reduce stress/obsessiveness/excitation (driven by estrogen and serotonin probably) and increase energy production/relaxation/clear-headedness. From personal experience, it's a broad issue that doesn't have quick fix and requires a consistent and steady long term approach instead.

 

[catan]

I can share some personal experience. I had eating disorders, mostly bulimia nervosa, for about 12 years, although the first 6-8 years were the worst.

Firstly my experience is my eating disorder was how I coped with stress. I never had a weight problem but had depression and anxiety that started in my teens. I also had poor body image and very low self-esteem. It wasn’t until all these were addressed that I could began to heal.

I had chosen not to take antidepressants when prescribed when I was 21 because of how bad it made me feel. I also have no experience with professional help with eating disorders. I never told anyone about it, not even therapists I saw.

Looking back now, I believe I had a lot of nutritional deficiencies. Signs such as very irregular menstrual cycles (fewer than 6 a year), shedding hair, very low pulse, strong cravings for sugary and fatty foods. I also have a very controlling personality so by sheer will power I could choose to not eat. I was a chronic exerciser and long distance runner. I am very introveted and isolated myself a lot.

In the later years, when the eating disorder wasn’t as bad, I experimented with various diets such as paleo, primal, keto, fasting, etc, and all those diets still drove me to binge because of cravings. Also signs of hypothyroid.

My body could not stand the abuse anymore into my late 20s. I found Peat when I was 30, and read Eatopia about being under nourished. I resolved to eat a high carbohydrate diet without restriction, while also making sure I got nutrition with liver, etc. It was quite a great mental hurdle to get over eating as much as I want after coming from over a decade of restrictive eating. It took time to do it and Only good things happened. I no longer felt hungry or had uncontrollable cravings, and I felt more resilient to stress. When I was stressed and anxious I would simply eat lots of rice and dates or whatever simple carbs and it would blunt the stress. This was over 4 years ago now and I have not relapsed. I also feel my depression and anxiety levels manageable. I make great effort to be in the sun. It just lifts my mood. I stopped running and all chronic exercise 9 years ago.

That said I also think a lot of my recovery had to do with finding meaning in life. I became a mother at age 29 and because of that I made great effort to get healthy.

 

[AnonE]

Thank you everyone for responses and ideas! catan, I think she would probably resonate with a lot of your experience. Has a big fear of carbs, but anecdotally clean carbs seem to do her well.

I think for the short term, we might focus on simple and easy-to-digest foods eaten at semi-regular times. OJ and rice/meat/veggies (but cooked simply) seems to be our go-to and work well (except when she accidentally overeats), any other practical suggestions? I've been suggesting multi and vit D as minimum supplements. I agree on trying to avoid things like dairy and most grains as perhaps those are hard to digest for some people. Is the rice OK? Seems to be a simple staple of her diet that is tolerated.

Longer-term, I think for her and/or her psychiatrist to try other medications I'd need to build a case using various studies and logical arguments of why such-and-such might be worth trying. Bear in mind I'm not trying to push anything, as it's ultimately not my place, but rather want to empower her to consider other alternatives when current solutions don't seem to be working.

 

[Blossom]

This site has some good information for adult eating disorder recovery. Home

 

[papaya]

Something with a laxative effect could be a bad idea.

i know, but she has an eating disorder. vomiting is so dangerous & needs to be stopped asap, the cascara is much safer. you have to work with her until her head is straight. she still needs a way to get rid of the food she overate or she won't be able to function or think about anything else. btw, dates are a great food to prevent & or stop cravings.

 

[moriwatzi]

Gbolduev sometimes had good suggestions. Don't know about this one, but it is always better having some options. In the q&a thread he was aked "How would you approach treating eating disorders (anorexia/bulimia)"

This was his answer:

"I would check for chloride and volume loss alkalosis in this case. Most cases I met were from that . You just eat and put tons of HCL with food, and it will restore. Of course for some cases you would need to do this thru the vein."​

 

[catan]

AnonE, I have found rice to comforting, and I add bone broth while cooking. For some reason wheat was triggering for me.

As for overeating, I feel like it can’t be avoided early on during recovery. At the time I simply did not know how much food I should be eating, no idea what normal was, and had to overcome being underfed and deficiencies. I stuck to simple carbs, with a lot of fruit. Fat sources were mainly milk and some cheese. All foods cooked in coconut oil. Despite my fears of blowing up, nothing of the sort happened, although some bloating will, especially if there is digestive issues. I tracked my intake (although this can turn out to be obsessive especially for someone with ED) to cover my nutrtional bases. I learned I consistently ate 2500 calories to avoid hunger and cravings, which was a lot more than I expected.

One interesting thing about dairy. I got gas from anything with vitamins added to the milk, so limited to one cup. I tolerate raw milk very well, nothing happens no matter how much I consume.

Does she see a therapist? It really is important to work on those issues underlying the eating disorders. That she has trouble falling asleep is something to work on. I had chronic insomnia for most of my ED years, fueled by a lot of my anxiety. Perhaps activities such as walks outside might help, in addition to more sun.

 

[Jsaute21]

Could pufa cause anorexia, by triggering some kind of self defence mechanism in the body ?

Great theory. I ran into some moderate anorexia nervosa a couple of years ago when PUFA was at an all time high in my diet.

 

[johnwester130]

Great theory. I ran into some moderate anorexia nervosa a couple of years ago when PUFA was at an all time high in my diet.

I also believe it is triggered by environmental stress, which causes the body to change metabolism.

Being overwhelmed by environmental stress, (getting a job, starting a family etc) can cause changes in the body and brain, like autistic who cannot cope.

 

[johnwester130]

some final thoughts on the types of anorexia :

1) autism with anorexia - what the person has is autism, and this affects all areas of their life including their diet. they most likely have an eating disorder, but people would accuse them of having anorexia.

2 ) just anorexia - a mental illness and a self defence mechanism by the body. usually caused by environmental and emotional stress, it is a biological response to something that is not yet fully understood. it can't be cured by 'eating more food'

3) just an obsession with weight - a person can simply be obsessed with becoming fat and it is similar to OCD.

 

[Pointless]

i know, but she has an eating disorder. vomiting is so dangerous & needs to be stopped asap, the cascara is much safer. you have to work with her until her head is straight. she still needs a way to get rid of the food she overate or she won't be able to function or think about anything else. btw, dates are a great food to prevent & or stop cravings.

Oh sorry, I think I misunderstood your suggestion. I thought the cascara was in relation to electrolyte deficiency. I guess some harm reduction could help. It could backfire also, but I guess it works for drug addictions.

 

[Blossom]

As for overeating, I feel like it can’t be avoided early on during recovery. At the time I simply did not know how much food I should be eating, no idea what normal was, and had to overcome being underfed and deficiencies.

That was my experience too. I don't think it's overeating when you have been in a deficit.

Does she see a therapist? It really is important to work on those issues underlying the eating disorders.

So true.