Episode 167: Answers to Anorexia—Personalized Care for a Brain-Based Illness

The Better Behavior Show with Dr. Nicole Beurkens

My guest this week is Dr. James Greenblatt, he is a pioneer in the field of functional integrative medicine, a board-certified child and adult psychiatrist, and has treated patients since 1988. He received his medical degree and did his psychiatry residency at George Washington University and completed a Fellowship in Child and Adolescent Psychiatry at Johns Hopkins Medical School. He currently serves as the Chief Medical Officer at Walden Behavioral Care and an Assistant Clinical Professor of Psychiatry at Tufts University School of Medicine and Dartmouth College. Dr. Greenblatt has lectured internationally on the scientific evidence for nutritional interventions in psychiatry and mental illness. He is the author of seven books, and his latest book Answers To Anorexia is released right now, and we are excited about that. He is also the founder of Psychiatry Redefined, which is a really innovative educational platform dedicated to the transformation of psychiatry, and they offer online courses, webinars, and even fellowships for professionals.

In this episode, Dr. Greenblatt and I discuss his new book, Answers to Anorexia. Anorexia nervosa is on the rise, especially in young children, and the relapse and suicide rates are among the highest for psychiatric illnesses. We discuss warning signs, underlying causes, and effective treatment approaches.

Anorexia Affects All Age Groups

• Anorexia nervosa is the most life-threatening of the psychiatric illnesses (highest rate of suicide)
• Early intervention and treatment is critical
• Increasing rates, especially in preteens and younger, but seen in all genders and races
• Often starts in adolescence

What is Anorexia Nervosa?

• Listed as one of the eating disorders; as a psychiatric diagnosis
• Symptoms include distorted body image along with restrictive eating/weight loss
  • The brain plays tricks on the body, where there is a complete distortion of reality
• Scientists now can articulate that this is a brain-based illness, that the neurophysiological changes are different in those with anorexia however, this has not been translated into clinical care
• Caregivers and professionals need to focus on a more empathic collaborative treatment model

Early Warning Signs & Risk Factors

• Very high genetic component, whether it is a parent or an aunt/uncle
• One of the most dramatic, well-proven risk factors is going on a vegan/vegetarian diet in puberty, certainly pre-puberty
  • Any change in diet is usually the onset
  • Literature showing that a vegan diet in adolescence with a genetic vulnerability is a very high risk for an eating disorder, poorer outcomes, and a higher relapse rate
  • The restricting of those (animal-based) foods, which are particularly high in nutrients such as zinc and vitamin B12, are critical for puberty and one of the core deficiencies in anorexia nervosa

Treatments Historically Have Been Ineffective

• Massive lack of proper training about eating disorders and nutrition for practitioners
• For anorexia nervosa, there are no approved medications
  • So every practitioner is making an educated guess as to what would be helpful for medication and/or therapy
• Dr. Greenblatt’s thesis is it's a brain-based illness due to malnutrition, and without that nutritional repletion, therapy is often ineffective
• High relapse rate especially since typically patients are released with no ongoing care
• Lack of treatment centers puts a large time, financial, and stress burden on families to have to travel further
• Insurance companies limit treatment
• The highest risk of suicide of any psychiatric illnesses
  • Not a lot of research as to why, but Dr Greenblatt’s theory is the relationship between depleted levels of essential fatty acids (EPA and DHA) and brain function

• Low levels of those nutrients are associated with a higher risk of suicide

Proper Treatment and Prevention

• First, need to address the (chronic) malnutrition and genetic vulnerability as a first red flag as well as changes in diet in early adolescence
• All nutritional deficiencies of major nutrients affect brain function and brain distortion
• Forcing a patient to eat during in inpatient care to stabilize weight while not addressing a nutrient-dense diet is not an effective solution

Key Nutrients Needed for Recovery

• Zinc, especially during puberty
  • Low zinc is related to loss of appetite and taste, poor digestion, depression, and sleep problems
• Other essential nutrients: B vitamins, amino acids, and fatty acids
• Treatment centers are not necessarily providing nutrient-dense foods or additional supplementation
• Magnesium is one of the most common nutrient deficiencies in the U.S., and particularly in those with anxiety, mental health, sleep, or constipation
  • Nutrient testing is not always helpful/accurately providing the full picture as most nutrients are found in multiple parts of the body, not just blood

Where to Start for Support

• Schedule a nutritional augmentation consultation
  • Try in the fields of functional or integrative medicine as they are typically trained across multiple disciplines and are either well-versed in nutrition or work closely with nutritional professionals
• Early interventions with personalized care/therapy and dietitian are critical
  • Psychotherapy, so that children and adolescents are feeling valued and heard
• Using food as a therapeutic approach along with targeted supplementation and nutrients; nutrition as being profoundly important in even some of these most severe clinical presentations.
• Consider any underlying medical contributors such as undiagnosed celiac, PANDAS, etc.
• Stay curious and keep asking good questions
• Genetic testing can be helpful

Answers to Anorexia

• Book: Answers to Anorexia
  • An overview of the lack of a current effective model and a proposal around a nutritional repletion model
  • Available on Amazon.com and jamesgreenblattmd.com
• For clinicians, therapists, nurse practitioners, and psychiatrists there is an educational platform (psychiatryredefined.org) with hundreds of hours of content for functional medicine for mental health and functional psychiatry where they can learn a model to dig deeper

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