Anorexia Nervosa - What Would Be Some Things To Try?

tara

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This site has some good information for adult eating disorder recovery. Home
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And the articles on this page could be a good place to start, for both her and you.

Probably important to learn about both the consequences of energy deficiency and the phases of recovery, as well as get support for the emotional issues involved.

It is common for people, both with anorexia and those trying to support them, to get worried about them getting 'overweight'. Remember that anorexia nervosa is much more dangerous than being a bit 'overweight'. She may need help to overcome whatever fears are attached to food for her, and having other people be scared of food and of her eating 'too much' is unlikely to help. She may gain weight - but this is much less dangerous than chronic famine. It is apparently common to overshoot ones natural body weight and then return to it.

Gwyneth Olwyn, who runs that ED institute site, encourages no food restrictions unless severe allergies etc. But if it were me I'd probably pay attention to Peat's information to favour saturated fats over unsaturated ones, and aim to cover all the essential minerals and vitamins daily, as well as eating enough calories regularly.

cyproheptadine
I think cyproheptadine is sometimes used specifically to help restore appetite for people struggling with anorexia. It can also help make sleep easier for some people. Even quite small doses (eg 1/2 mg) can make a difference for some people; others have used more.
It has some anti-serotonin effects, so it won't work the same way as SSRI. Consider reading Peat's article (on his website) on serotonin to see why this may potentially be a benefit. Coming off an SSTI needs to be done carefully, though, I think.

she needs electrolytes/minerals asap! instead of purging have her take cascara sagrada.
Getting enough minerals could well be important.
I agree that purging is a dangerous habit. But I would not encourage regular use of too much cascara sagrada - that could also become a dangerous habit. Just eating enough food regularly is likely to improve transit speed soon - famine tends to slow transit by a couple of mechanisms. Possibly a small amount occasionally could be useful if needed, but just minimal.
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
I agree that vomiting is dangerous, but she is not overeating, she needs to keep the food inside her long enough to digest it and use it, not lose all that nutrition she needs. If she has AN, then recovery - which means eating and retaining nutrition consistently - needs to be a high priority. That doesn't just mean 'normal weight', it means reliably eating enough to sustain a healthy metabolism and grow to maturity. According to Gwyneth's investigations, documented on her site, that takes about 3000 cals for a young woman in early 20s, unless she's exceptionally short or tall. For someone recovering from AN, that's a minimum guide, but hunger may say to eat more to make up the deficit some times.
 

lacto man

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Most addictive disorders are a result of severe childhood trauma, like rape, incest, and physical or emotional abuse. I would suggest your friend find a good EMDR therapist.
 

tara

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johnwester130

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more thoughts :

it sounds very similar to schizohprenia, which is similar to autism, so "curing" it would be very difficult if not impossible.

I believe that autism/schizphrenia/adhd/alzheimers/bipolar/anorexia/ are all being caused by the same thing.

Also, anorexia has different definitions. there is the scientific biological explanation, and a different explanation saying it is caused by beauty magazines etc.

Maybe seeing other women be slim triggers some kind of survival/starvation instinct in the brain,
and anorexia is a natural response to your environment ??

I don't know.
 

lacto man

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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!


Zinc. A zinc deficiency can cause the symptoms of anorexia.
 

johnwester130

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Zinc. A zinc deficiency can cause the symptoms of anorexia.

what about the biological and scientific reasons for it ?

if you believe in the theory that the human being is just an organism reacting to their environment, what triggers someone to avoid food ? is anorexia actually an inborn survival instinct that can be activated, like autism may also be ?
 

lacto man

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what about the biological and scientific reasons for it ?

if you believe in the theory that the human being is just an organism reacting to their environment, what triggers someone to avoid food ? is anorexia actually an inborn survival instinct that can be activated, like autism may also be ?

Sorry, I figured most people would be curious enough to look it up for themselves if it was a serious matter to them.

How does zinc supplementation benefit anorexia nervosa? - PubMed - NCBI

Zinc Supplementation for Eating Disorders

https://www.waldeneatingdisorders.com/popular-searches/new-approaches-to-treating-anorexia/
 

EIRE24

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Most addictive disorders are a result of severe childhood trauma, like rape, incest, and physical or emotional abuse. I would suggest your friend find a good EMDR therapist.
Yes 100% and a result of lowered metabolism
 
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Bumping this cause my sister has severe anorexia. Not severe in that she's being forced to eat and isn't purging afaik, but severe in that she is fighting it extremely hard every step of the way.

I care about my sister a lot, but there's also somewhat of an ulterior motive here frankly, in that I really am close to bedridden and need more help dealing with my illness from my parents. But caring for my sister is a full time job for them, so while i'm really ill restraining her and forcing her to eat takes immediate priority b/c it's such a possibly deadly problem. It's also stressful and hard to rest with all this yelling going on all the time, and rest is a huge priority for me rn.

I figure that it would help family dynamics a lot to be able to help her. She also is indicating that the behavioral approach isn't working b/c her feelings of dysmorphia, etc are so strong and she wants to be medicated for it, or helped with this intangible feeling somehow. She's on SSRIs and risperidone. i don't think the SSRIs are a good call. The risperidone is a dirty drug but the fact that it has some anti-serotonin activity and seems to relax her really intense anxiety at night, she likes it, so I wonder if something along the lines of an anti-serotonin drug like cypro or trazodone would be good.

Also have seen some stuff about zinc.

That MCT link is interesting @Blossom , it seems that coconut oil can cure everything, huh. I was also thinking about other inhibitory things, glycine, collagen, etc. But it would be a really hard sell to get her to take supplements like that, but if it makes her feel better I think she'll go along with it.
 

Blossom

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I don't know anyone who has personally used MCT oil for anorexia but it certainly seems worth trying. Eating zinc rich foods couldn't hurt either. Attending to the psychological component is super important. Ultimately she has to want to recover.
 
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I don't know anyone who has personally used MCT oil for anorexia but it certainly seems worth trying. Eating zinc rich foods couldn't hurt either. Attending to the psychological component is super important. Ultimately she has to want to recover.
I think she wants to want to recover if that makes sense. The way she talks about needing something makes it sound like she knows something is off with her brain and she wants to fix it. Unfortunately mainstream psychiatry seems no help. parents are talking about residential treatment
 

Blossom

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I think she wants to want to recover if that makes sense. The way she talks about needing something makes it sound like she knows something is off with her brain and she wants to fix it. Unfortunately mainstream psychiatry seems no help. parents are talking about residential treatment
How old is she?
 
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I'm not sure where you are located but the Maudsley Recovery method might be worth exploring. It's a family based method that could possibly help keep her out of inpatient.
Maudsley family therapy - Wikipedia
They did a retreat for family based therapy and are doing family based therapy but it's not working, I think it's a case of my parents being a little on the older side and working a lot and not quite having the resources to take care of her. It seems like she's at such an extreme stage that she might need medication. I tried to get her to eat zinc but she wouldn't. I was wondering about serotonin antagonists, mirtazapine, etc.
 

Blossom

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I've read that cyproheptadine has been used in some cases to help with appetite.
 
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AnonE

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To reduce or improve?

It seems for my friend the main issue is binging, it happens compulsively, then afterwards purguing occurs from guilt, and/or bloated stomach.

I really think there's a potential dopamine issue here. Her concentration gets shot after a few hours then it leads to eating massive amounts of (oftentimes junk) food. Symptoms are far less when there's less studying to be done for the day. It's like she's trying to force/squeeze out productivity till the brain stops working or something.

Edit - also I wanted to mention for my dopamine/binging theory. It turns out the only FDA approved drug for binge eating disorder is Vyvanse, an ADHD medication. Very recent stuff, this is from 2015. The RCTs showed good promise, I'm considering getting her to try something along these lines.
 
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To reduce or improve?

It seems for my friend the main issue is binging, it happens compulsively, then afterwards purguing occurs from guilt, and/or bloated stomach.

I really think there's a potential dopamine issue here. Her concentration gets shot after a few hours then it leads to eating massive amounts of (oftentimes junk) food. Symptoms are far less when there's less studying to be done for the day. It's like she's trying to force/squeeze out productivity till the brain stops working or something.

Edit - also I wanted to mention for my dopamine/binging theory. It turns out the only FDA approved drug for binge eating disorder is Vyvanse, an ADHD medication. Very recent stuff, this is from 2015. The RCTs showed good promise, I'm considering getting her to try something along these lines.
it seems incredibly dangerous to use dexamphetamine to treat anorexia.
 
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AnonE

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Sorry I should have updated. She's not anorexic, at a very healthy weight.

Mainly dealing with combined binging and purguing, where the latter is a response to feeling bloated or psychologically guilty for the binge.
 

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