**WordPress: 2012 in review**

*****Thanks everyone for joining in my blog. It has changed a lot over the last few months and I only see it getting better. ūüôā Love you guys so much! *****

The WordPress.com stats helper monkeys prepared a 2012 annual report for this blog.

Here’s an excerpt:

The London Olympic Stadium is 53 meters high. This blog had about 570 visitors in 2012. If every visitor were a meter, this blog would be 11 times taller than the Olympic Stadium ‚Äď not too shabby.

Click here to see the complete report.

2 “Dirty” Phrases

Over the holidays I was struck by two phrases from two different conversations that have stuck with me, in a negative way. Instead of writing two blogs to vent about them I have decided to combine them into one.  Here are the two phrases and my thoughts about them: just in case you were wondering.

1. “What a shame, She is such a pretty girl” This is being said in context about a “pretty girl” who has found herself in a relationship with a “jerk” or “bad boy.” There are so many things about this that make me angry but I will stick to a few of them. A girl deserves a “good boy” regardless of if they are “pretty” or “not pretty.”

2. “Do you know how he got HIV? …. He is gay.” ¬†Being gay is not a cause for HIV. Just because someone is gay does not mean they are HIV positive and just because someone is HIV positive does not mean they are gay. That person got HIV because that person had unprotected sex (or somehow swapped bodily fluids) just like anyone can get HIV. ¬†URGH!

The Holiday Recovery Challenge

Most of the time, the holidays’ are seen as breading ground for relapse. But I am in the¬†business¬†of reframing negatives into positives, impossibles into challenges. So instead of viewing the holiday as a certain relapse, how about attempting to view it as a recovery challenge. A chance to prove to yourself just how far you have come, how hard you have worked, and where work still needs to be done.

The best part to face the holidays is to create a plan:

*What are you willing to eat?

*How much of what?

*Prepare something to bring with you that feels safe.

*Have a plan B or “excuse” to leave the party when you are ready too. (family is difficult sometimes)

What are some of the strategies you use to recover through the holidays?

Nutritional Intervention in Eating Disorder Treatment: Literature Review

This last semester I took a Research Methods class where we to put together an entire research proposal. I am refraining from putting my final, 40 page proposal however, I wanted to share a bit of my work for those of you interested. So here is my final literature review:

Nutritional Intervention in Eating Disorder Treatment: Review of Literature

Melinda L. Schneider

University of Missouri- Kansas City

ABSTRACT: As relapse rates continue to be a prevalent occurrence amongst those suffering from an eating disorder it is imperative that research continues to seek new techniques that could improve outcomes for traditional psychotherapy. One area that is frequently missed in this population are they physiological affects of their disorder and how those might impact recovery. This paper aims to review the current literature around the effectiveness of current therapy options and the need for research address the nutritional status of individuals with an eating disorder.

 

There are two main pathways used when studying nutrition in those with an eating disorder (ED): deprivation theory and serotonin uptake. As those with eating disorders become more malnourished due to restriction ability to control food intake decreases, resulting in a binge. The most common deficiencies seen in those with disordered eating are known to result in depression, anxiety and suppression of appetite. Therefore, my hypothesis is that if the nutritional status of those with an ED can be reestablished and maintained, the frequency and duration of relapse will lessen. According to Maslow’s hierarchy of needs, it will also allow the individual to be able to move past meeting physical needs and focus more on behavioral and/or cognitive changes in psychotherapy.

What About Current Treatment Options?

Psychotherapy alone as a means to treat individuals with various eating disorders does not present with adequate success rates. Approximately 5.9% of women and 1.5% of men revealed having eating disturbances in a survey using EDE-Q (Hilbert, A., de Zwaan, M., & Braehler, E., 2012). Current studies have found that nearly 50% of individuals who reach partial remission and 30% of those who reach full remission will relapse (Richard, M., Bauer, S., & Kordy, H. 2005). Remission is defined when a maximum of two symptom episodes per month for two consecutive months occurs. The risk for relapse, meeting diagnostic criteria for three consecutive months, has been reported highest in the first six to seven months after achieving remission (Olmsted, M. P., Kaplan, A. S., & Rockert, W. 2005).

Some of the predicted factors of relapse in individuals with AN that have been published include desired weight, duration of illness, EDI scores, specialization of the clinic used and additional treatment following remission. Predicting factors of relapse for individuals with BN are symptomatic status, continued treatment after remission and motivation for treatment (Richard et al. 2005). Other published predictors of relapse include previous suicide attempts, severity of obsessive-compulsive symptoms, excessive exercise after treatment, residual concern about shape and weight and severe pretreatment caloric restriction (J. C., C., E., B., K., S., & D. B., W., 2004; McFarlane, T., Olmsted, M. P., & Trottier, K., 2008).

The Physiological Aspect

The problem with treating an eating disorder by providing only psychotherapy is that an eating disorder affects more than just an individuals mental or psychological state; it also affects them physiologically. There are two physiological pathways frequently examined within the eating disorder community: deprivation theory and serotonin uptake.

Deprivation theory utilizes the starvation response pathway. Starvation response assumes that once an individual has reached a state of starvation or malnutrition they will be unable to control their eating when food is available. This response could result in a binge episode for individuals diagnosed with BN or AN-B. Individuals with BN would respond to the binge behavior by purging in order to maintain body weight thereby reinforcing the pathological cycle (Rock, 1987). A study done in 2000 examined the effects of acute food deprivation during a 19 hour fast on eating behaviors with individuals diagnosed with AN-B and BN. Results should that individuals diagnosed with BN receiving inpatient treatment consumed significantly more food than BN individuals in outpatient treatment or individuals diagnosed with AN-B. The study found acute food deprivation did not result in significant food consumption pathology however; the chronic food restriction typically seen within the ED community is not accurately addressed.

The second pathway frequently discussed involves the neurotransmitter serotonin. Often times severe dieting and food restriction seen in individuals with AN leads to malnutrition. Tryptophan, a common deficiency seen in AN, is only available through food intake. It is also a precursor to the serotonin neurotransmitter. Food restriction and malnutrition, therefore, cause a decrease in brain serotonin stores as tryptophan becomes less available. The decrease in serotonin leads to hyperactivity, depression, behavioral impulsivity, anxiety and suppression of appetite. This suppression reinforces AN restricting behaviors.  (Haleem, 2012).

Reported deficiencies in those diagnosed with AN include zinc, iron, riboflavin, B-6 and thiamin (Bakan, 1993; Chu, E., Gaudiani, J., Mascolo, M., Statland, B., Sabel, A., Carroll, K., & Mehler, P. 2012; Rock, C., Vasantharajan, S. 1995; Winston, A. P., Jamieson, C. P., Madira, W. W., Gatward, N. M., & Palmer, R. L., 2000).

Approximately half of individuals diagnosed with AN are also vegetarians. Vegetarian AN individuals consume significantly lower zinc than non-vegetarian AN individuals. Bakan therefore suggested that zinc supplementation should be indicated for those diagnosed with AN who are also vegetarians (1993). One of the problems facing those diagnosed with a zinc deficiency is that a zinc deficiency promotes changes in taste and reduces appetite (Rock, 1987). The reduced appetite caused by a zinc deficiency reinforces AN restriction which is similar to the deprivation theory.

Reported deficiencies in those diagnosed with BN include potassium, calcium, magnesium and phosphorus (Judge, B., Eisenga, B. 2005). Deficiencies in these vitamins are depression and anxiety, both of which are common co-morbid diagnosis in individuals with an ED. Phosphorus deficiency, like zinc, can result in loss of appetite, whi

Current Research on Nutrition Intervention

A study by Hart and Abraham (2011) found that the use of protein supplementation with women diagnosed with BN or BED reduces food intake and binge eating over a 2-week period. A study by McAleavey (2010) provided a nutritional intervention to girls aged 12-18 that resulted in an increase awareness of nutritional knowledge but no change in attitudes toward eating healthy which would support the need to combine both nutrition interventions and psychological/behavioral counseling.

Future Research Implications

More research involving nutritional supplementation and education combined with psychotherapy is needed. It could also be beneficial to look at the use of nutrition with the male population because current treatment outcomes are even less as effective for them than for females. Further research regarding what supplements or nutrition interventions/education result in the greatest impact would also be beneficial.

 

 

Sources

Bakan, R. A. (1993). Dietary Zinc Intake of Vegetarian and Nonvegetarian

Patients with Anorexia Nervosa. International Journal Of Eating

Chu, E., Gaudiani, J., Mascolo, M., Statland, B., Sabel, A., Carroll, K., & Mehler,

P. (2012). ACUTE center for eating disorders. Journal Of Hospital Medicine:

An Official Publication Of The Society Of Hospital Medicine, 7(4), 340-344.

doi:10.1002/jhm.1906

Haleem, D. (2012). Serotonin neurotransmission in anorexia nervosa.

Behavioural Pharmacology, 23(5-6), 478-495.

Hart, S. S., Russell, J. J., & Abraham, S. S. (2011). Nutrition and dietetic practice

in eating disorder management. Journal Of Human Nutrition And Dietetics,

24(2), 144-153. doi:10.1111/j.1365-277X.2010.01140.x

Hilbert, A., de Zwaan, M., & Braehler, E. (2012). How frequent are eating

disturbances in the population? Norms of the Eating Disorder Examination-

Questionnaire. Plos ONE, 7(1), doi:10.1371/journal.pone.0029125

J. C., C., E., B., K., S., & D. B., W. (2004). Relapse in anorexia nervosa: a

survival analysis. Psychological Medicine, 34(4), 671-679.

Judge, B., & Eisenga, B. (2005). Disorders of fuel metabolism: medical

complications associated with starvation, eating disorders, dietary fads, and

supplements. Emergency Medicine Clinics Of North America, 23(3), 789.

McAleavey, K. (2010). Nutritional Intervention in Young Women with Eating

Disorders: A Brief Report. Journal Of Child & Family Studies, 19(5), 669-673.

 

McFarlane, T., Olmsted, M. P., & Trottier, K. (2008). Timing and prediction of

relapse in a transdiagnostic eating disorder sample. International Journal Of

Eating Disorders, 41(7), 587-593. doi:10.1002/eat.20550

Olmsted, M. P., Kaplan, A. S., & Rockert, W. (2005). Defining Remission and

Relapse in Bulimia Nervosa. International Journal Of Eating Disorders, 38(1),

1-6. doi:10.1002/eat.20144

Richard, M., Bauer, S., & Kordy, H. (2005). Relapse in Anorexia and Bulimia

Nervosa–A 2.5-Year Follow-Up Study. European Eating Disorders Review,

13(3), 180-190. doi:10.1002/erv.638

Rock, C. (1987). Nutrition and Eating Disorders: A Primer for

Clinicians.International Journal Of Eating Disorders, 6(2), 267-280.

Rock, C. L., & Vasantharajan, S. (1995). Vitamin status of eating disorder

patients: Relationship to clinical indices and effect of treatment. International

Journal Of Eating Disorders, 18(3), 257-262. doi:10.1002/1098-

108X(199511)18:3<257::AID-EAT2260180307>3.0.CO;2-Q

Winston, A. P., Jamieson, C. P., Madira, W. W., Gatward, N. M., & Palmer, R. L.

(2000). Prevalence of thiamin deficiency in anorexia nervosa. International

    Journal Of Eating Disorders, 28(4), 451-454. doi:10.1002/1098-

108X(200012)28:4<451::AID-EAT14>3.0.CO;2-I

 

 

Chaos (again)

**After writing my previous post- The universe decided I needed to learn what I was preaching, again**

My life got a bit crazy these past few weeks and it finally caught up with me. I had to set boundaries and enforce them with people who I normally wouldn’t speak up too (aka my bosses). But I learned a few things

1. I have a need for some form of stability in my life. If it can’t be found, I will make it happen.

2. Nothing I do to “make stable happen” is actually going to help. In other words, wanting to be thinner, not eating, over eating, drinking, smoking, over exercising (whatever your addiction or go to coping method is) will NOT CHANGE the fact that other things in life are in chaos mode. It ultimately just makes things more chaotic

and

3. Sometimes, in the midst of chaos, the only stable thing we can “make happen” is how we choose to respond to chaos. Choosing to respond to chaos by taking care of ourselves and sticking with recovery can be the stable thing in the midst of chaos and uncertainty if we allow it to take that place.

C: Chaos

                

12/10/2012

Any of you who have considered recovery, are currently in recovery, have recovered or have supported someone in any of those states you know that Chaos is just part of the process. Therefore, I found it fitting to add into my recovery alphabet.

Everybody who struggles with an eating disorder, or any addiction for that matter, has a unique story. What binds them all together is that they all result in a struggle, a rock bottom, never going to be able to get back up, low. And at this point chaos surrounds every bit of our lives. You know exactly what I mean if you have been there. If you have never been in one of the roles I stated before, be forewarned that if you ever find yourself in one of those roles, there WILL BE CHAOS!

BUT

There is also HOPE. Because when chaos surrounds and pushes harder than it has ever seem to before, is when recovery starts, change begins and growth happens.

The problem with chaos is that people who grow up in chaos (broken famililes and homes) they know chaos, they are comfortable and familiar with chaos. And when life isn’t chaotic enough, they find ways to create chaos. Sometimes, the hardest part of recovery is maintaining the work that has been done. WHY? Because maintaining health, balance, and order is contrary to everything that was previously comfortable.

So when you start struggling and life seems to be falling about around you, remember that chaos results in hope, recovery, growth and change. It makes the stress and the uncertain much more bearable.

12/15/2012

**After writing my previous post- The universe decided I needed to learn what I was preaching, again**

My life got a bit crazy these past few weeks and it finally caught up with me. I had to set boundaries and enforce them with people who I normally wouldn’t speak up too (aka my bosses). But I learned a few things

1. I have a need for some form of stability in my life. If it can’t be found, I will make it happen.

2. Nothing I do to “make stable happen” is actually going to help. In other words, wanting to be thinner, not eating, over eating, drinking, smoking, over exercising (whatever your addiction or go to coping method is) will NOT CHANGE the fact that other things in life are in chaos mode. It ultimately just makes things more chaotic

and

3. Sometimes, in the midst of chaos, the only stable thing we can “make happen” is how we choose to respond to chaos. Choosing to respond to chaos by taking care of ourselves and sticking with recovery can be the stable thing in the midst of chaos and uncertainty if we allow it to take that place.