Eating Disorders

14 August, 2023

By Alison Cowell

Eating disorders can develop from a number of psychological and physiological sources as well as genetic factors and they need to be treated with sensitivity and patience. Everybody is different, so there is no stock solution to apply. When working with clients, it's about unravelling each story, understanding the individual's lifestyle and priorities, and planning (not imposing!) achievable milestones.

During my 15 years in clinical practice, I have seen over 10,000 individual clients with all manner of health conditions, including eating disorders.

Some come to see me following diagnosis of an eating disorder, others clearly have issues with food but have not been formally assessed. Although eating disorders can affect people of any gender and age, they most often affect adolescents and young women.

The most commonly recognised eating disorders are:

· anorexia nervosa: deliberately starving to keeping body weight far below healthy acceptable ranges for height and age. The condition usually develops around the age of 16 or 17.[1]

Behaviours may include skipping meals, avoiding food groups or suddenly "˜becoming vegan' to deflect difficult questions, or declaring a number of food intolerances

· bulimia nervosa: binge eating followed by self-induced vomiting which usually begins at 18 or 19 years old

· compulsive eating/ binge-eating disorder (BED): as the title suggests, overeating and not stopping when full

In addition to these, I have also dealt with young people who are averse to certain textures of food in their mouth, others who shun food in order to avoid opening their bowels, and those who fear that unless it's organic they will be harming themselves. I remember one mother who brought her 4 year old boy to see me, worried that he was fatigued all the time. Little wonder! He was so weak, pale and lethargic because he wasn't allowed anything with gluten, dairy, soy, yeast, oxalates, sulphites, preservatives or additives in case they caused him harm. His diet was extremely limited and contained insufficient nutrients to support healthy growth. Worse still, unwittingly his mother would have interfered with the child's microbiome (a topic I'll cover later). The mother herself was underweight and pale with huge shadows under her eyes. She had an obsession with cancer and was petrified that she or her son might fall victim to it. So when we talk about eating disorders, it's important to appreciate the whole spectrum, and that includes the home environment (including location).

When I present on children's nutrition, I spend quite a bit of time focusing on the home conditions , e.g. if there is stressful tension when the child is trying to eat ; if there is a faddy mother or father or if there are arguments in the background etc. This awareness is also important when dealing with an individual with an eating disorder. Quite often, those who feel they have no control over certain aspects of their lives (work, study, relationships, bullies, parents etc) gain satisfaction from controlling their food intake.

Whilst psychotherapy and counselling are invaluable in an individual's treatment and recovery, nutritional therapy is also vital.

One area that excites me greatly is the emerging research[2] that has linked the microbiome (our healthy gut bacteria) with the behaviours and choices made by those with eating disorders. The ongoing research suggests potential links between the health of the microbiome and causes and outcomes for eating disorders. People with eating disorders such as anorexia do not experience hunger and satiety in the same way as those who have a healthy relationship with food. New research[3] is showing that the composition of gut bacteria may play a role in the behavioural aspects of anorexia and other eating disorders. In my Mood and Food workshops I have a dedicated session on how certain species of healthy bacteria can help prevent depression and anxiety. By simply prescribing the correct probiotic containing the missing species (helveticus) I have witnessed amazing transformations with clients who were able to overcome depression after years of struggle. Alterations in the gut microbiome can affect how an individual's body functions and how they think, feel and behave. The gut microbiome is critical not only to regulating mood and behaviour, it also plays a vital role in regulating appetite control and weight. A 2015 French study showed that patients with anorexia had lower diversity of gut bacteria than healthy individuals and they also found that the less diverse the gut microbiome, the more depression and anxiety people suffered (back to helveticus!)

Given that the first scientific evidence ( of what would be known as the microbiome) was discovered by Austrian paediatrician Theodor Escherich in the mid 1880's, it's frustrating to think it's taken this long to unravel and appreciate all the microorganisms and strains in this fascinating "˜second brain "˜ of ours. But b