Nutrition: Answers to Anorexia by James M. Greenblatt, MD

James Greenblatt, MD, is the author of a recently released book titled Answers to Anorexia - A Breakthrough Nutritional Treatment That is Saving Lives (Sunrise River Press, 2010).    You can learn more about Dr. Greenblatt here.

As noted in the introduction (p. vii), "This book aims to help you understand how nutritional deficiencies affect brain function and the expression of genes, and their relationship with anorexia nervosa."  He goes on to write, "Nutritional deficiencies with anorexia nervosa?" Is this a ridiculous question?  Perhaps, but nutritional deficiencies are still an obvious and neglected component of our current treatment model."

When I first joined the website Something Fishy I was struck by the number of posts by a woman -- I'll call her M -- who constantly reminded those of us who read what she had to say that we needed to think about adding zinc as well as Omega-3's and other supplements to our loved ones' meal plans.  She also offered a lot of information, care and concern to those of us who were new to the world of parental support.  I had up until this point heard and read about feeding one's loved one at home but had understood there to be more focus on finding ways to get calories into the equation but less on specific nutrients as well as why properly balanced nutrition is so important.  Of course my mindset at first was to help my loved one get into treatment so that a knowledgeable team of people could help her regain her weight and hopefully her health.

It's clear to me that there's more to weight gain than just calories.  Dr. Julia O'Toole's Give Food a Chance and Dr. Greenblatt's book offer a more in-depth view.  These two books as well as the information provided to me by Martie Fankhauser as well as my own doctors including my general practitioner, gynecologist, and pulmonologist -- who all now inquire if I'm taking the supplements I'll be mentioning --  offer guidelines to help us help our loved ones and ourselves.

Nutrition: Vitamin D

My closer look at nutrition actually began by looking at myself and thinking back.  I have a hunch that those who develop eating disorders genetically are either more susceptible to the effects of lower levels of specific nutrients in the body or, in my case and perhaps my daughter's and indeed my mother's, our genetic make up makes us less able to either maintain or produce the levels we need.

Having lived overseas for so many years where holistic care was more likely, twice I was given Vitamin B-12 shots (more on this vitamin later) and part of my getting into recovery package included (inadvertently because I didn't understand the connection at the time) adding specific vitamins and supplements to my diet when I was in my early thirties at the recommendation of a long-time runner who researched nutrition extensively.  I honestly do not know if my body developed these deficiencies because I had binged and purged for years or if I was deficient in the first place.  I think it would be interesting to test young girls whose mothers have recovered from an eating disorder or are still battling on to see what their levels are.

I also recommend two important books to supplement (sorry) this discussion.  The first is by James M. Greenblatt, MD titled Answers to Anorexia - A Breakthrough Nutritional Treatment that is Saving Lives (Sunrise River Press, 2010).  The second is by Dr. Julie O'Toole titled Give food a chance: A New view on childhood eating disorders (Perfectly Scientific Press, 2010).

And, again, I'm including information provided to me by Martie Fankhauser whose information I provided in the introduction to this series of posts, titled Nutrition, Nutrition, Nutrition.

This morning's Wall Street Journal article, "Triple That Vitamin D Intake, Panel Prescribes" by Melinda Beck found in Section D - Health (pp. D 1-2) helps me seque and pretty much covers a lot of what I was going to say about Vitamin D including the fact that it's really a hormone and we ordinarily do not get enough of it.  Why?  Because for years now we've been advised to stay out of the sun and slather on the sunscreen which means our natural means of creating this hormone in our bodies has been curtailed.

The article notes that the recommendation to increase the daily amount from 200IU's to 600IU's is to respond to the need for bone health.  Yet, as many doctors will tell you (and which is why so many test their patients and advocate for at least 1-2,000 IU's a day -- mine did shortly after the release of the Scientific American article in 2007), D does a heck of a lot more than just help keep our bones strong.

Scientific American was among the first publications to highlight the importance of Vitamin D noting that Vitamin D has anti-inflammatory and immune balancing functions.   Here are links to two articles:  the first in 2007 and the second in 2009.

Others have focused on Vitamin D and brain function.  An article was just published linking low levels of Vitamin D in mothers to schizophrenia in their children.  I hope more research continues in these areas to learn links between nutrition and neurotransmitters, including serotonin (more on this coming up, too).

Not only that but we must have cholesterol -- the incredible edible egg -- to naturally synthesize D in our bodies and since sunscreen pretty much blocks that natural conversion process, doctors are advocating for supplements.  And principally D3.  Vitamin D can be monitored by a blood test and one should ask for the 25-hydroxy Vitamin D level.  Annecdotally, although a level of 30 ng/ml is considered normal by most experts, those who work with clients who are depressed advocate a level of >50 ng/ml.   As we are all an experiment of one, so to speak, it's important that our levels be tailored to our needs.  Encourage your doctor to test you again a few months later to see if your levels have risen and to make certain that your level isn't approaching toxic levels.  Again, this is a matter between you and your doctor(s).

I was very pleased to see that among the tests required for my loved one at this most recent facility was for her level of 25-hydroxy Vitamin D level.  I encourage all parents of those with loved ones with eating disorders to add this test to the list during that first visit to the doctor.

P.S. A few minutes ago I indulged at our local Starbucks and picked up a New York Times.  Same report; different take.  The Institute of Medicine has recommended the tripling of the current acceptable amount from 200 to 600 international units to the agreement of many.  Yet those interviewed by the New York Times were not among the representatives of several medical groups like the Endocrine Society and the International Osteoporosis Foundation.  These groups indicate that 30 ng/ml is necessary for optimum bone health.  As noted in the Wall Street Journal, "...despite the paucity of randomized-controlled trials, the long list of chronic diseases associated with Vitamin D does make sense, given that it is actually a hormone that affects virtually every organ in the human body and regulates as many as 2,000 genes."

Finally, from the table in the WSJ (p. D2) those who need extra Vitamin D include "....people age 50 and older (our bodies are less efficient in synthesizing the vitamin); people with osteoporosis; people with limited sun exposure; people with dark skin who have moved to less sunny climes; people with fat malabsorption [this is the one that caught my attention given that those with anorexia often refuse to eat any fat] due to, for example, pancreatic enzyme deficiency, Crohn's disease, cyctic fibrosis, celiac disease, surgical removal of part of the stomach or intestines and some forms of liver disease; people taking certain medications; and people who are obese."

Update:  Wall Street Journal, 12/7/2010, p. D3 carries an article titled "Can Vitamin D Replace Flu Shots?" by Laura Johannes.  The article reviews what is known about Vitamin D (actually a hormone).  Vitamin D apparently promotes our immune system's ability to fight off disease - specifically by "....stimulating production of cathelicidin, an antimicrobial protein that serves as a 'natural antibiotic' in the body, says Michael Zasloff, a professor of sugery and pediatrics at Georgetown University Medical Center in Washington, DC."  The article focuses on the idea of taking enough Vitamin D to replace flu shots.  Other studies noted in the article refute this possibility in that those taking the vitamin statistically got the same number of infections as those who didn't.  

My hunch is that one's Vitamin D levels in the body as a result of metabolism and other processes is part of what matters.  Just because you ingest it doesn't mean your levels will necessarily rise.  There are many factors, but I believe that Vitamin D is part of the picture.

Nutrition, Nutrition, Nutrition

Wow!  I have an information headache.  And, it's a good headache to have.  I just spent an hour with a woman I worked with years ago when she, a professor of Pharmacology, was a member of the University of Arizona's Commission on the Status of Women and I was the Program Coordinator Senior for that group as well as the UA's Diversity Action Council.  I've met so many people over these more than sixty years of my life whose path(s) I find I am crossing again.  There must be a reason.  And this crossing of paths is fortuitous.  It also started with a flyer about a nutrition/pharmacology/psychiatric pharmacology oriented seminar that she was offering.  I could not attend due to a conflict so I made an appointment for a personal consultation with her.

But, first more about Martie Fankhauser, so you'll understand why I'm bringing her to this blog.  From her website to which I linked below:  "Martha (Martie) P. Fankhauser, received a Bachelor of Arts degree in biology in 1972 and a Bachelor of Science degree with distinctions in pharmacy in 1974 from the University of Kansas. In 1982, Ms. Fankhauser completed the Master of Science degree in hospital pharmacy at the University of Arizona and a one-year specialty residency in psychiatry. In 1997, she became a Fellow of the American Society of Health-System Pharmacists (FASHP) and was Board Certified in Psychiatric Pharmacy Practice (BCPP) in 2000 by the Board of Pharmaceutical Specialists.

Ms. Fankhauser was a Clinical Professor in the Department of Pharmacy Practice and Science at The University of Arizona College of Pharmacy from 1982 to 2010 (retired July 2010). She was the program director for the ASHP accredited specialty residency program in "Neuropsychiatric Pharmacy Practice: from 1993 to 2004. She trained 12 pharmacy specialists in the residency program and was a preceptor to over 24 Pharm.D. students each year in the psychiatry/ neurology/ pain clerkship program. She was involved in coordinating the Annual Neuropsychiatric Pharmacology Update in Arizona from 1994 to 2005."

You can read more about her and what she does here and also here.

I consulted her for three reasons:  first, as I've shared, I am in recovery from anorexia/bulimia probably based in life-long dysthymia (a form of depression) and I believe firmly there is a genetic basis to my disorder as well as a psychopharmacological/biological result; second, because the celexa I started taking late last Spring interferes (I believe) with too many other pieces of myself so I wanted to find out why; and third, because I wanted to get her take on the entire issue of drugs for those with eating disorders, including my loved one.

As I said, I came home with a good headache because I now have a heck of a lot of information to process.  It is said a little knowledge is a dangerous thing.   So, I'm being very careful here but also believe I have a tremendous background of acquired information through my early training in nursing until I changed fields as well as my life-long interest in medicine and more recently voluminous study and reading in neuropsychology/eating disorders/mental illness/brain disorders.  So I think I might have something to offer to others by distilling what I've learned, including today.

Because I am in recovery and because I am taking a medication that I am experiencing to interfere with other aspects of my life/mental health, I decided to learn more about the interaction of medications and nutrition with the neurotransmitters active in our brains.  What I came away with leads me to make three observations:

First, as many are saying but I don't think, based on what I've been reading, that many understand the extensive ramifications about what they're saying, which is nutrition is key --  including nutrition before birth and for the first three years after birth, especially, until the child eats a full complement of protein, complex carbohydrates, and fats.

Second, more needs to be understood by those prescribing medications like antidepressants and mixing those with other meds  that affect our brain and other bodily mechanisms including, for example, blood clotting ability;

And, third, I am delving deeper into why I believe the term eating disorder needs to be done away with and replaced with a term that better communicates what is going on in our vastly complicated psychophysiological make-up when genes interfere with proper balance.

Whew.  As I said, I have an information headache.

So, I am going to start in my next post with the first point about nutrition and explain some of the things I learned this morning including the point that registered dietitians (look for those initials, R.D.) must have this information in their training programs if they are to adequately treat those with eating disorders.   I believe my comments will again (as so many others have likewise contributed) underscore the value of the Maudsley Method in terms of the scope of nutrition.  I do not mean to say that the behavioral information is secondary; far from it.  Those who undertake this at home must have guidance and the tools to make it work.

However, it's not just about the food we put in our mouths and our loved ones' mouths.  It's what is in the food and what the food provides and what the appropriate balance of food is doing to keep our bodies -- our systems -- working well so we are healthy and our behavior is to our benefit.

And, I am also advocating for the inclusion of the information that Martie Fankhauser provided to me today in forthcoming NEDA conferences as well as IAEDP and others' gatherings.  I believe that the knowledge she has will add much to the progress being made in the field of Eating Disorders.

Inside The Teenage Brain

I'm always excited when I see an article in the Mass Media -- this time, Parade Magazine accompanying today's Sunday paper (Sunday, November 28, 2010) -- that presents an up-to-date description of how the teenage brain works and how vulnerable it is to assaults, so to speak, by things like alcohol as well as to impulsive thoughts, among other things.

Today's article What's Really Going On Inside Your Teen's Head by Judith Newman pp. 4-6 is very important.  The content also illustrates why it's so difficult to distinguish, at this age, between behaviors associated with some brain disorders and plain old teenager-hood that I used to call testosterone poisoning when it came to adolescent male behavior.  I never figured out a term for what I went through (in my parent's eyes although I was sent away to boarding school which may have been the best solution for all of us) or what my daughter went through.  We were different and yet we both developed eating disorders.

Basically, the teenage brain is different.  Or rather, the teenage brain is still developing as PET scans as well as fMRI's are illustrating.  Not only that but the human brain isn't done baking, so to speak, until one is well into one's twenties and in some cases early thirties.  The prefrontal cortex is the last area of the brain to develop!!!

So, what is going on in there?  and will it be possible to work with a pre-teen and a teen to develop skills to prevent eating disorders from developing?

P.S.   Later today I remembered one of the comments I continued to hear at the NEDA conference, which was that many parents couldn't get a handle on the information provided because it was too technical.  Perhaps at the next conference there might be an opening seminar on the brain that describes the different regions in a layperson's terms and what those regions do.

P.P.S.  Carrie Arnold's book Decoding Anorexia (Routledge 2013) includes a chapter on the brain's regions in layperson's terms.  Chapter 2: Interoception and the Insula, pp 22-37.