As a psychiatrist, I am clearly familiar with the psychodynamic issues underlying eating disorders, and I see psychotherapy as a vital part of treatment. At the same time, I would like to share my experience with observing and treating some of the biochemical underpinnings, hastening recovery and helping to maintain it as well.
Many years ago, a psychologist who specializes in eating disorders began to send me her clients because she had heard that antidepressant medications worked for these patients. I had by then shifted to a more holistic approach, so I told her that before I prescribed antidepressants, I wanted to try some more natural methods. I had discovered that in many cases of eating disorders, there is an underlying biochemical issue—a combination of food sensitivity, blood sugar imbalance and nutrient deficiency. She agreed, her patients cooperated, and we had some excellent, medication-free results. This encouraged me to continue on this natural path as I have to this day. Here are some of my discoveries, as well as subsequent research by others in this growing field.
We crave the foods that we are sensitive or “allergic” too. Not a typical allergy with hives or stomach aches, these sensitivities are intolerances, often inherited, and show up in any number of ways—for example, depression, inability to lose weight, eating disorders, tinnitus, unexplained aches and pains—many, many others. The very foods we crave will create the most symptoms and are the most damaging. In fact, food cravings are similar to an addiction to alcohol. As you withdraw from the foods you're addicted to, you begin to have withdrawal symptoms and the cravings begin. And if you happen to be addicted to wheat or baked goods, you can never get enough of them, so you binge on them, despite your best intentions to the contrary. People addicted to grains may drink excessive amounts of grain-based liquor or beer and can become alcoholics. They're sensitive to and addicted to the alcohol, but it's the grain-base that is causing the problem. They can even feel “drunk” after eating cereal or baked goods. Not so different from your regular carb-binger, except the target is alcohol instead of refined carbs.
It's not just a matter of willpower. In order to break the addiction cycle, in addition to avoiding the undesirable foods, you have to supply the body with a good, supportive nutritional program of healthful food, vitamins, minerals, and amino acids. Then, the cravings will often simply go away! It's quite remarkable; with a nutrient rich diet, and good vitamin and mineral formula, you can stop the cycle. In fact, once the diet and nutrients are in place, the cravings and addictions will often just fall away. Remember that nutritional supplements are not a substitute for healthy food, but a supplement to restore missing ingredients and balance biochemistry.
Magnesium is often deficient, and taking it can be very helpful. It's great, too, for muscle tension, insomnia, and even, heart palpitations. The amino acid glutamine is also useful for reducing cravings. I've had former alcoholics (yes, former) say that the glutamine cut their cravings for good; they no longer were battling the desire to drink. They were done for good. Glutamine works similarly with bulimics and binge eaters.
Zinc: Some years ago, researcher Alex Schauss did a study on patients who were suffering from anorexia nervosa. By using a simple test called a zinc taste test, he found that they were zinc-deficient. He then gave them liquid zinc therapeutically, with very successful results. The test consists of the person taking some liquid zinc sulfate solution in their mouth, and if they describe it as having a bad or strong taste, they usually have sufficient levels of zinc. On the other hand, if they can't taste the solution or if it tastes just like water, then they may have a cellular zinc deficiency, even if their blood levels look adequate. It's a vicious cycle since zinc deficiency affects taste; so zinc-deficient anorexics don't taste their food, so are less motivated to eat it. Zinc supplementation has continued to be used in nutritionally oriented settings, including my own practice.
Serotonin: Bulimia and binge-eating is often treated with the SSRI antidepressants such as Prozac, Zoloft and Lexapro They raise brain levels of serotonin, a neurotransmitter or chemical messenger in the brain that causes a feeling of well-being and relaxation, and reduces hunger. Rather than using medication, my preference is to prescribe the materials that make serotonin, the amino acids L-tryptophan or it's relative, 5-HTP (5-hydroxytryptophane), and there is research to back it.
In her book, The Diet Cure, Julia Ross refers to a study where bulimics were deprived of tryptophan. In reaction, their serotonin levels dropped and they binged more violently, ingesting and purging an average of 900 calories more each day. In another study, adding extra tryptophan to the diet reduced bulimic binges and mood problems by raising serotonin levels. More recently, an Oxford researcher, Katherine Smith, reported that even years into recovery, bulimics can have a return of their cravings and mood problems after only a few hours of tryptophan depletion, concluding that, “Our findings support suggestions that chronic depletion of plasma tryptophan may be one of the mechanisms whereby persistent dieting can lead to the development of eating disorders in vulnerable individuals.”
The herb St. John's Wort provides another way to raise serotonin levels. I have discussed this along with dosages of tryptophan and other nutrients in my book, Natural Highs.
Thiamine: As we have seen, nutrient deficiencies can aggravate anorexia, and it should be treated with nutrient rich diets. For example, restricting your diet will make you deficient in such vitamins as vitamin B1 (thiamin). It's found in foods that people with eating disorders rarely eat—including beans, whole grains, seeds, meats and vegetables. Common signs of thiamine deficiency are loss of appetite, weight loss, constipation, anxiety, chest pain and even sleep disturbance along with depression and irritation. Sound familiar?
Blood Sugar Swings
One mechanism underlying the craving and eating (or drinking) cycle is blood sugar imbalance: low blood sugar sets off the craving. The brain experiences this dip as life-threatening starvation, followed by a frantic search for whatever will raise blood sugar. Just picture our ancestors in the jungle, short on food, and having to hunt for their next meal—or die. We, on the other hand, just go to the refrigerator. The quickest fixes here are sugary foods or other refined carbs such as bread or pastries. And we don't even burn any calories on our hunt.
Bottom Line: Treat Nutrient Deficiency with Nutrients
I will often order a blood test to see which amino acids are low. By replacing them the body (and brain) comes into balance. As a result the food cravings will often be greatly relieved or even come to a halt, as noted in the case of glutamine for acute cravings.
There are other natural treatments, as well, for cravings due to food sensitivities. Acupuncture and acupressure has been shown to help, especially some techniques such as NAET that can actually eliminate the food sensitivities themselves.
The point is, instead of simply taking an antidepressant, there are many other ways to approach what at first appears to be strictly a psychological problem. The combination of psychotherapy and a nutritional/biochemical approach is the most useful, and I have successfully treated many patients without resorting to medication at all. Not only does this approach work as well as medication but in my experience working with the body's chemistry, rather than introducing more chemicals in the form of medication, is often superior. It's faster, has none of the side effects, and has many side benefits. I developed Brain Recovery AM & PM formula to provide many of the nutrients mentioned here and more, to balance amino acids, serotonin, blood sugar, and mood.
For more information, see my books, Natural Highs, and 8 Weeks to Vibrant Health. Also sign up for my free e-newsletter, and get a free copy of my e-book, Reclaim Your Brain.
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Hyla Cass, MD
Hyla Cass M.D. graduated from the University of Toronto School of Medicine, interned at Los Angeles County-USC Medical Center, and completed a psychiatric residency at Cedars-Sinai Medical Center/UCLA School of Medicine. She was an Assistant Clinical Professor of Psychiatry at UCLA School of Medicine until 2005, and is in private clinical practice in Pacific Palisades, CA.