3/24/19
When I posted this originally, I wanted to take a brief look at the brain and in general the importance of neurotransmitters, the chemical messengers in the brain. The most familiar to many parents on this journey is serotonin but there are other important neurotransmitters, as well, among them dopamine, norepinephrine and GABA which is really a derivative of an amino acid. For those who want to learn more, here’s a great synthesis.
I note that serotonin is/may be familiar because one of the first lines of offense for eating disorders other than food are medications called SSRI's (or selective serotonin reuptake inhibitors) like prozac, celexa, lexapro and zoloft. Take note, though, that many of these medications will not work or will not work effectively until the brain itself is functioning better through nutrition.
This chart linked above reveals that these chemical messengers – the neurotransmitters -- don’t just exist indefinitely in the body. Rather, they are manufactured in the body which means we must eat foods that are known to help create these messengers. This is why a full complement of protein, complex carbohydrates, and fats (lipids) is so very important. We need brain food. Our brains need on average 500 calories of glucose each day from complex carbohydrates (so the glucose is released slowly throughout the period between eating) to carry out its functions.
The brain itself is composed of about 78 percent water, 10 to 12 percent lipids (fats) and smaller percentages of protein and carbohydrates and salts. Again, it’s what’s in the food we eat that matters. If, for genetic reasons, our bodies do not manufacture enough or manufacture too much of these substances or if we don’t utilize these substances or if the medications we are given interrupt this balance to our detriment, problems develop.
So, for example, for our bodies to manufacture serotonin, we need an essential amino acid. Amino acids are the building blocks of protein and essential amino acids must come from food sources. L-tryptophan is necessary for our bodies to manufacture serotonin. Food sources include dairy and poultry including eggs, especially. And, if one is taking a medication to block the reuptake of serotonin (e.g. Celexa, Lexapro, and Zoloft) so the neurotransmitters remains available to the neurons (and is therefore depleted eventually), these nutrients are even more important to synthesize more serotonin.
In addition, remember that serotonin decreases dopamine activity in the brain so the person presumably feels more relaxed and less anxious. However, if we aren’t eating well to produce the serotonin in the first place, our levels will drop and dopamine, that is manufactured by the body and that is also stimulated by caffeine and nicotine, for example, will predominate. Excess dopamine can cause anxiety, insomnia, shaking, increased blood pressure, irritability and anger among other things. Folate and Vitamin B12 are also required for the manufacture in the body of neurotransmitters. It all works together and an imbalance can cause havoc.
Moderation and a healthy food plan is key. As material provided by Martie Fankhauser indicates and as the Maudsley Method advocates, “….Work with the healthcare professional [in this case your loved one’s entire team] to be sure that nutrition, sleep (to help the body manufacture more neurotransmitters), exercise (to activate neurotransmitters and to convert melatonin back to serotonin), sun exposure (to combine with cholesterol to manufacture Vitamin D) and hormone balance are brought to maximum potential.”
For me specifically (anorexia/subtype bulimia), I figured out and Martie corroborated this for me in detail, that to prevent the urge to binge and purge, I needed to eat a full breakfast that did not include simple sugars but rather included a good balance of protein, complex carbohydrates and lipids. I chose eggs and dairy for my protein and lipids as well as fruit for complex carbohydrates. Later in my recovery when I gained confidence that this method worked, I added whole grain bread and higher protein cereal. I avoided anything “sugared.” I also made sure to supplement this with my vitamins and minerals and during the day snacked on foods that would not spike my sugar but rather would introduce, through complex carbohydrates and protein with lipids (like peanut butter), nutrients gradually during the day. I frankly didn’t know what I was really doing at that point from a nutritional standpoint, but it seemed to make sense so I did it. I am not saying this will work for everyone with bulimia, either, since we all are different. But, it’s worth investigating as part of the package. And, as I’ll mention when I talk about serotonin, there is a serotonin receptor in the gut that encourages vomiting when one creates too much, perhaps from overeating. One can wonder if our ancestors developed this protective mechanism to avoid becoming too overweight, therefore slower, and therefore unable to go out to hunt and gather. I hope more research continues about this very interesting neurotransmitter that is so important to bodily function.
In the Spring of 2007, when my loved one was rapidly losing ground and I was convinced that something was going on besides “just” starvation, I learned about the National Alliance on Mental Illness from a friend whose adult daughter was also struggling with a brain disorder. NAMI maintains a terrifically informative website on which you’ll also learn about a class offered by chapters nationwide called NAMI Family-to-Family Education. I signed up for the class and was taken through an immense amount of valuable material by two women whose family members had brain disorders and who received training to help us new parents navigate the mental health system with tools and understanding. We all became educated advocates as a result of this class.
I would highly recommend it to anyone whose loved one has an eating disorder because eating disorders have been shown to be the result of brain dysfunction, too. There is a lot of stigma associated with mental illness. We must get beyond that if we are to help those whose brains aren’t working “right.”
In addition, as I’ve written before and others are emphasizing as well, if upon return to (through testing) that nutrition is maximum but behaviors regarded as abnormal or unusual (as was the case for my loved one) are still continuing, then it’s time to get another psychiatric opinion (or more) to evaluate if another brain disorder is present (what’s known as co-morbidity) in which case the eating disorder may have been your loved one’s way of coping with other imbalances such as an anxiety disorder.
A good example of this compound issue is Marya Hornbacher whose memoir Wasted (Harper Collins, 1998) was followed ten years later by her book Madness (Houghton-Mifflin, 2008) in which she reveals that she was later diagnosed with Type 1 rapid-cycle bipolar disorder. Hornbacher's memoir builds upon and adds important information to the earlier published and insightful memoir by Kay Redfield Jamison titled An Unquiet Mind (Vintage Books, 1996).
The fourth week of the NAMI class was devoted to brain biology and the underlying reasons for brain disorders from a chemical point of view. Each class lasted a couple of hours. I think it would be helpful for NEDA and other groups that offer conferences on eating disorders to include this session or one like it to educate parents about the workings of the brain and why nutrition is so very important.
Here is a very simple brain map on which you can click to illustrate which areas of the brain are keys to behavior and abilities. Carrie Arnold's book Decoding Anorexia - How Breakthroughs in Science Offer Hope for Eating Disorders (Routledge, 2013) offers a detailed and in layperson's terms the functions of the different areas of the brain. More recently even more details have been learned by those studying fMRI brain scans.
Clearly, if the brain is starved (remember, the brain itself needs 500 calories each day to function and it needs the neurotransmitters, that are dependent on nutrition and synthesis by the body, to work), everything falls apart. If the brain’s chemicals are all messed up by binging and purging (electrolytes and nutrients are vomited which means the body/brain regulatory systems in their frantic efforts to bring the body back to balance start setting off alarm bells) biochemical balances that are also key to everything working right are disrupted, too.
Wise nutrition is key.
