Ramey Nutrition Statement: Promoting Positive Body Image through Public Policy

In order to understand the role of policy in promoting positive body image, a broad perspective must be kept as one’s struggle is multi-factorial and not identical to another. We must look past the physical “body” to the deeper struggles – struggles that ignite 10 foot flames to an already burning fire. Although the influence of media cannot be ignored, we can as providers support individuals to a place of empowerment over the messages and images that are before them. Instead of expending efforts to alter advertising companies’ course of action, we can discuss the underlying messages and beliefs being portrayed -- and explore how these align with what is actually true. Policy efforts focused on communicating this message will exert twofold influence: supporting individuals through the healing process and removing attention from the media “culprits” that secondarily influence one’s view of body.
-Rachel Myhre, MS, RD, CD

The Anorexic Brain

The Anorexic Brain

Neuroimaging improves understanding of eating disorder

By Meghan Rosen

Web edition: July 26, 2013
Print edition: August 10, 2013; Vol.184 #3 (p. 20)

A+ A- Text Size

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Luke Lucas

In a spacious hotel room not far from the beach in La Jolla, Calif., Kelsey Heenan gripped her fiancé’s hand. Heenan, a 20-year-old anorexic woman, couldn’t believe what she was hearing. Walter Kaye, director of the eating disorders program at the University of California, San Diego, was telling a handful of rapt patients and their family members what the latest brain imaging research suggested about their disorder.

It’s not your fault, he told them.

Heenan had always assumed that she was to blame for her illness. Kaye’s data told a different story. He handed out a pile of black-and-white brain scans — some showed the brains of healthy people, others were from people with anorexia nervosa. The scans didn’t look the same. “People were shocked,” Heenan says. But above all, she remembers, the group seemed to sigh in relief, breathing out years of buried guilt about the disorder. “It’s something in the way I was wired — it’s something I didn’t choose to do,” Heenan says. “It was pretty freeing to know that there could be something else going on.”

Years of psychological and behavioral research have helped scientists better understand some signs and triggers of anorexia. But that knowledge hasn’t straightened out the disorder’s tangled roots, or pointed scientists to a therapy that works for everyone. “Anorexia has a high death rate, it’s expensive to treat and people are chronically ill,” says Kaye.

Kaye’s program uses a therapy called family-based treatment, or FBT, to teach adolescents and their families how to manage anorexia. A year after therapy, about half of the patients treated with FBT recover. In the world of eating disorders, that’s success: FBT is considered one of the very best treatments doctors have. To many scientists, that just highlights how much about anorexia remains unknown.

Kaye and others are looking to the brain for answers. Using brain imaging tools and other methods to explore what’s going on in patients’ minds, researchers have scraped together clues that suggest anorexics are wired differently than healthy people. The mental brakes people use to curb impulsive instincts, for example, might get jammed in people with anorexia. Some studies suggest that just a taste of sugar can send parts of the brain barrelling into overdrive. Other brain areas appear numb to tastes — and even sensations such as pain. For people with anorexia, a sharp pang of hunger might register instead as a dull thud.

The mishmash of different brain imaging data is just beginning to highlight the neural roots of anorexia, Kaye says. But because starvation physically changes the brain, researchers can run into trouble teasing out whether glitchy brain wiring causes anorexia, or vice versa. Still, Kaye thinks understanding what’s going on in the brain may spark new treatment ideas. It may also help the eating disorder shake off some of its noxious stereotypes.

“One of the biggest problems is that people do not take this disease seriously,” says James Lock, an eating disorders researcher at Stanford University who cowrote the book on family-based treatment. “No one gets upset at a child who has cancer,” he says. “If the treatment is hard, parents still do it because they know they need to do it to make their child well.”

Pop culture often paints anorexics as willful young women who go on diets to be beautiful, he says. But, “you can’t just choose to be anorexic,” Lock adds. “The brain data may help counteract some of the mythology.”

ENLARGE

DIFFERENT WIRING

View larger image | Studies of the brains of people with anorexia have revealed a number of complex brain circuits that show changes in activity compared with healthy people.

Medical RF, adapted by M. Atarod

Beyond dieting

A society that glamorizes thinness can encourage unhealthy eating behaviors in kids, scientists have shown. A 2011 study of Minnesota high school students reported that more than half of girls had dieted within the past year. Just under a sixth had used diet pills, vomiting, laxatives or diuretics.

But a true eating disorder goes well beyond an unhealthy diet. Anorexia involves malnutrition, excessive weight loss and often faulty thinking about one of the body’s most basic drives: hunger. The disorder is also rare. Less than 1 percent of girls develop anorexia. The disease crops up in boys too, but adolescent girls — especially in wealthy countries such as the U.S., Australia and Japan — are most likely to suffer from the illness.

As the disease progresses, people with anorexia become intensely afraid of getting fat and stick to extreme diets or exercise schedules to drop pounds. They also misjudge their own weight. Beyond these diagnostic hallmarks, patients’ symptoms can vary. Some refuse to eat, others binge and purge. Some live for years with the illness, others yo-yo between weight gain and loss. Though most anorexics gain back some weight within five years of becoming ill, anorexia is the deadliest of all mental disorders.

Though anorexia tends to run in families, scientists haven’t yet hammered out the suite of genes at play. Some individuals are particularly vulnerable to developing an eating disorder. In these people, stressful life changes, such as heading off to college, can tip the mental scales toward anorexia.

For decades, scientists have known that anorexic children behave a little differently. In school and sports, anorexic kids strive for perfection. Though Heenan, a former college basketball player, didn’t notice her symptoms creeping in until the end of high school, she remembers initiating strict practice regimens as a child. Starting in second grade, Heenan spent hours perfecting her jump shot, shooting the ball again and again until she had the technique exactly right — until her form was flawless.

“It’s very rare for me to see a person with anorexia in my office who isn’t a straight-A student,” Lock says. Even at an early age, people who later develop the eating disorder tend to exert an almost superhuman ability to practice, focus or study. “They will work and work and work,” says Lock. “The problem is they don’t know when to stop.”

In fact, many scientists think anorexics’ brains might be wired for willpower, for good and ill. Using new imaging tools that let scientists watch as a person’s mental gears grind through different tasks, researchers are starting to pin down how anorexic brains work overtime.

Control signs

ENLARGE

FOOD ALERT

Images of high-calorie foods (left) switched on a self-control center in the brains of anorexic women. Pictures of objects on plates kept the control center quiet.

Courtesy of S. Brooks

To glimpse the circuits that govern self-control, experimental neuropsychologist Samantha Brooks uses functional magnetic resonance imaging, or fMRI, a tool that measures and maps brain activity. Last year, she and colleagues scanned volunteers as they imagined eating high-calorie foods, such as chocolate cake and French fries, or using inedible objects such as clothespins piled on a plate. One result gave Brooks a jolt. A center of self-control in anorexics’ brains sprung to life when the volunteers thought about food — but only in the women who severely restricted their calories, her team reported March 2012 in PLOS ONE.

The control center, two golf ball–sized chunks of tissue called the dorsolateral prefrontal cortex, or DLPFC, helps stamp out primitive urges. “They put a brake on your impulsive behaviors,” says Brooks, now at the University of Cape Town in South Africa.

For Brooks, discovering the DLPFC data was like finding a tiny vein of gold in a heap of granite. The control center could be the nugget that reveals how anorexics clamp down on their appetites. So she and her colleagues devised an experiment to test anorexics’ DLPFC. Using a memory task known to engage the brain region, the researchers quizzed volunteers while showing them subliminal images. The quizzes tested working memory, the mental tool that lets people hold  phone numbers in their heads while hunting for a pen and paper. Compared with healthy people, anorexics tended to get more answers right, Brooks’ team wrote June 2012 in Consciousness and Cognition. “The patients were really good,” Brooks says. “They hardly made any mistakes.”

A turbocharged working memory could help anorexics hold on to rules they set for themselves about food. “It’s like saying ‘I will only eat a salad at noon, I will only eat a salad at noon,’ over and over in your mind,” says Brooks. These mantras may become so ingrained that an anorexic person can’t escape them.

But looking at subliminal images of food distracted anorexics from the memory task. “Then they did just as well as the healthy people,” Brooks says. The results suggest that anorexic people might tap into their DLPFC control circuits when faced with food.

James Lock has also seen signs of self-control circuits gone awry in people with eating disorders. In 2011, he and colleagues scanned the brains of teenagers with different eating disorders while signaling them to push a button. While volunteers lay inside the fMRI machine, researchers flashed pictures of different letters on an interior screen. For every letter but “X,” Lock’s group told the teens to push a button. During the task, anorexic teens who obsessively cut calories tended to have more active visual circuits than healthy teens or those with bulimia, a disorder that compels people to binge and purge. The result isn’t easy to explain, says Lock. “Anorexics may just be more focused in on the task.”

Bulimics’ brains told a simpler story. When teens with bulimia saw the letter “X,” broad swaths of their brains danced with activity — more so than the healthy or calorie-cutting anorexic volunteers, Lock’s team reported in theAmerican Journal of Psychiatry. For bulimics, controlling the impulse to push the button may take more brain power than for others, Lock says.

Though the data don’t reveal differences in self-control between anorexics and healthy people, Lock thinks that anorexics’ well-documented ability to swat away urges probably does have signatures in the brain. He notes that his study was small, and that the “healthy” people he used as a control group might have shared similarities with anorexics. “The people who tend to volunteer are generally pretty high performers,” he says. “The chances are good that my controls are a little bit more like anorexics than bulimics.”

Still, Lock’s results offered another flicker of proof that people with eating disorders might have glitches in their self-control circuits. A tight rein on urges could help steer anorexics toward illness, but the parts of their brain tuned into rewards, such as sugary snacks, may also be a little off track.

ENLARGE

SUGAR HIGH

When an anorexic woman unexpectedly gets a taste of sugar (yellow) or misses out on it (blue), her brain's reward circuitry shows more activity than a healthy-weight or obese woman's. Anorexics' reward-processing systems may be out of order.

G. Frank et al/Neuropsychopharmacology2012

Sugar low

For many anorexics, food just doesn’t taste very good. A classic symptom of the disorder is anhedonia, or trouble experiencing pleasure. Parts of Heenan’s past reflect the symptom. When she was ill, she had trouble remembering favorite dishes from childhood, for example — a blank spot common to anorexics. “I think I enjoyed some things,” she says. Beyond frozen yogurt, she can’t really rattle off a list.

After Heenan started seriously restricting her calories in college, only one aspect of food made her feel satisfied. Skipping, rather than eating, meals felt good, she says. Some of Heenan’s symptoms may have stemmed from frays in her reward wiring, the brain circuitry connecting food to pleasure. In the past few years, researchers have found that the chemicals coursing through healthy people’s reward circuits aren’t quite the same in anorexics. And studies in rodents have linked chemical changes in reward circuitry to under- and overeating.

To find out whether under- and overweight people had altered brain chemistry, eating disorder researcher Guido Frank of the University of Colorado Denver studied anorexic, healthy-weight and obese women. He and his colleagues trained volunteers to link images, such as orange or purple shapes, with the taste of a sweet solution, slightly salty water or no liquid. Then, the researchers scanned the women’s brains while showing them the shapes and dispensing tiny squirts of flavors. But the team threw in a twist: Sometimes the flavors didn’t match up with the right images.

When anorexics got an unexpected hit of sugar, a surge of activity bloomed in their brains. Obese people had the opposite response: Their brains didn’t register the surprise. Healthy-weight women fit somewhere in the middle, Frank’s team reported August 2012, in Neuropsychopharmacology. While obese people might not be sensitive to sweets anymore, a little sugar rush goes a long way for anorexics. “It’s just too much stimulation for them,” Frank says.

One of the lively regions in anorexics’ brains was the ventral striatum, a lump of nerve cells that’s part of a person’s reward circuitry. The lump picks up signals from dopamine, a chemical that rushes in when most people see a sugary treat.

Frank says that it’s possible cutting calories could sculpt a person’s brain chemistry, but he thinks some young people are just more likely to become sugar-sensitive than others. Frank suspects anorexics’ dopamine-sensing equipment might be out of alignment to begin with. And he may be onto something. Recently, researchers in Kaye’s lab at UCSD showed that the same chemical that makes people perk up when a coworker brings in a box of doughnuts might actually trigger anxiety in anorexics.

Mixed signals

Usually a rush of dopamine triggers euphoria or a boost of energy, says Ursula Bailer, a psychiatrist and neuroimaging researcher at UCSD. Anorexics don’t seem to pick up those good feelings. 

When Bailer and colleagues gave volunteers amphetamine, a drug known to trigger dopamine release, and then asked them to rate their feelings, healthy people stuck to a familiar script. The drug made them feel intensely happy, Bailer’s team described March 2012 in the International Journal of Eating Disorders. Researchers linked the volunteers’ happy feelings to a wave of dopamine flooding the brain, using an imaging technique to track the chemical’s levels.

But anorexics said something different. “People with anorexia didn’t feel euphoria — they got anxious,” Bailer says. And the more dopamine coursing through anorexics’ brains, the more anxious they felt. Anorexics’ reaction to the chemical could help explain why they steer clear of food — or at least foods that healthy people find tempting. “Anorexics don’t usually get anxious if you give them a plate of cucumbers,” Bailer says.

Beyond the anxiety finding, one other aspect of the study sticks out: Instead of examining sick patients, Bailer, Kaye and colleagues recruited women who had recovered from anorexia. By studying people whose brains are no longer starving, Kaye’s team hopes to sidestep the chicken-and-egg question of whether specific brain signatures predispose people to anorexia or whether anorexia carves those signatures in the brain.

Though Kaye says that there’s still a lot scientists don’t know about anorexia, he’s convinced it’s a disorder that starts in the brain. Compared with healthy children, anorexic children’s brains are getting different signals, he says. “Parents have to realize that it’s very hard for these kids to change.”

Kaye thinks imaging data can help families reframe their beliefs about anorexia, which might help them handle tough treatments. He thinks the data can also offer new insights into therapies tailored for anorexics’ specific traits.

Sensory underload

One trait Kaye has focused on is anorexics’ sense of awareness of their bodies. Peel back the outer lobes of the brain by the temples, and the bit that handles body awareness pops into view. These regions, little islands of tissue called the insula, are one of the first brain areas to register pain, taste and other sensations. When people hold their breath, for example, and feel the panicky claws of air hunger, “the insula lights up like crazy,” Kaye says.

Kaye and colleagues have shown that the insulas of people with anorexia seem to be somewhat dulled to sensations. In a recent study, his team strapped heat-delivering gadgets to volunteers’ arms and cranked the devices to painfully hot temperatures while measuring insula activity via fMRI.

Compared with healthy volunteers, bits of recovered anorexics’ insulas dimmed when the researchers turned up the heat. But when researchers simply warned that pain was coming, other parts of the brain region flared brightly, Kaye’s team reported in January in the International Journal of Eating Disorders. For people who have had anorexia, actually feeling pain didn’t seem as bad as anticipating it. “They don’t seem to be sensing things correctly,” says Kaye.

If anorexics can’t detect sensations like pain properly, they may also have trouble picking up other signals from the body, such as hunger. Typically when people get hungry, their insulas rev up to let them know. And in healthy hungry people, a taste of sugar really gets the insula excited. For anorexics, this hunger-sensing part of the brain seems numb. Parts of the insula barely perked up when recovered anorexic volunteers tasted sugar, Kaye’s team showed this June in the American Journal of Psychiatry. The findings “may help us understand why people can starve themselves and not get hungry,” Kaye says.

Though the brain region that tells people they’re hungry might have trouble detecting sweet signals, some reward circuits seem to overreact to the same cues. Combined with a tendency to swap happiness for anxiety, and a mental vise grip on behavior, anorexics might have just enough snags in their brain wiring to tip them toward disease.

Now, Kaye’s group hopes to tap neuroimaging data for new treatment ideas. One day, he thinks doctors might be able to help anorexics “train” their insulas using biofeedback. With real-time brain scanning, patients could watch as their insulas struggle to pick up sugar signals, and then practice strengthening the response. More effective treatment options could potentially spare anorexics the relapses many patients suffer.

Heenan says she’s one of the lucky ones. Four years have passed since she first saw the anorexic brain images at UCSD. In the months following her treatment, Heenan and her family worked together to rebuild her relationship with food. At first, her fiancé picked out all her meals, but step by step, Heenan earned autonomy over her diet. Today, Heenan, a coordinator for Minneapolis’ public schools, is married and has a new puppy. “Life can be good,” she says. “Life can be fun. I want other people to know the freedom that I do.”

---

Searching for treatments

The bowl of pasta sitting in front of Kelsey Heenan didn’t look especially scary.

Spaghetti, chopped asparagus and chunks of chicken glistened in an olive oil sauce. Usually, such savory fare might make a person’s mouth water. But when Heenan’s fiancé served her a portion, she started sobbing. “You can’t do this to me,” she told him. “I thought you loved me!”

Heenan was confronting her “fear foods” at the Eating Disorders Center for Treatment and Research at UCSD. Therapists in her treatment program, Intensive Multi-Family Therapy, spend five days teaching anorexic patients and families about the disorder and how to encourage healthy eating. “There’s no blame,” says Christina Wierenga, a clinical neuropsychologist at UCSD. “The focus is just on having the parent refeed the child.” Therapists lay out healthy meals and portion sizes for teens, bolster parents’ self-confidence and hammer home the dangers of not eating. Heenan compares the experience to boot camp. But by the end of her time at the center, she says, “I was starting to see glimpses of what life could be like as a healthy person.”

Treatment options for anorexia include a broad mix of behavioral and medication-based therapies. Most don’t work very well, and many lack the support of evidence-based trials. Hospitalizing patients can boost short-term weight gain, “but when people go home they lose all the weight again,” says Stanford University’s James Lock, one of the architects of family-based treatment. That treatment is currently considered the most effective therapy for adolescent anorexics.

In a 2010 clinical trial, half of teens who underwent FBT maintained a normal weight a year after therapy. In contrast, only a fifth of teens treated with adolescent-focused individual therapy, which aims to help kids cope with emotions without using starvation, hit the healthy weight goal.

Few good options exist for adult anorexics, a group notorious for dropping out of therapy. New work hints that cognitive remediation therapy, or CRT, which uses cognitive exercises to change anorexics’ behaviors, has potential. After two months of CRT, only 13 percent of patients abandoned treatment, and most regained some weight, Lock and colleagues reported in the April International Journal of Eating Disorders. Researchers still need to find out, however, if CRT helps patients keep weight on long-term. —Meghan Rosen

COMMENT

CITATIONS

U. F. Bailer et al. Amphetamine induced dopamine release increases anxiety in individuals recovered from anorexia nervosa. International Journal of Eating Disorders. Vol. 45, March 2012, p. 263. doi: 10.1002/eat.20937. [Go to]

S. J. Brooks et al. Subliminal food images compromise superior working memory
performance in women with restricting anorexia nervosa. Consciousness and cognition. Vol. 21, June 2012, p. 751 doi: 10.1016/j.concog.2012.02.006. [Go to]

S. J. Brooks et al. Thinking about eating food activates visual cortex with reduced bilateral Cerebellar Activation in Females with Anorexia Nervosa: An fMRI Study. PLOS ONE. Vol. 7, March 2012, p. 1. doi: 10.1371/journal.pone.0034000. [Go to]

G. K. W Frank et al. Anorexia Nervosa and Obesity are Associated with Opposite Brain Reward Response. Neuropsychopharmacology. Vol. 37, August 2012, p. 2031. doi: 10.1038/npp.2012.51. [Go to]

J. Lock et al. Aberrant brain activation during a response inhibition task in adolescent eating disorder subtypes. American Journal of Psychiatry. Vol. 168, January 2011, p. 55. doi: 10.1176/appi.ajp.2010.10010056. [Go to]

J. Lock et al. Is outpatient cognitive remediation therapy feasible to use in randomized clinical trials for anorexia nervosa? International Journal of Eating Disorders. Published online April 29, 2013. doi: 10.1002/eat.22134. [Go to]

T. A. Oberndorfer et al. Altered Insula Response to Sweet Taste Processing After Recovery From Anorexia and Bulimia Nervosa. American Journal of Psychiatry. Published online June 4, 2013. doi: 10.1176/appi.ajp.2013.11111745. [Go to]

I.A. Strigo et al. Altered Insula Activation during Pain Anticipation in Individuals Recovered from Anorexia Nervosa: Evidence of Interoceptive Dysregulation. International Journal of Eating Disorders. Vol. 46, January 2013, p. 22. doi: 10.1002/eat.22045. [Go to]

SUGGESTED READING

Eating Disorders Center for Treatment and Research at the University of California, San Diego: [Go to]

L. Sanders. Extreme eaters show abnormal brain activity. Science News. Vol. 181, May 5, 2012, p. 13. Available online: [Go to]

B. Bower. Starved for Assistance: Coercion finds a place in the treatment of two eating disorders. Science News. Vol. 171, January 20, 2007, p. 38. Available online:[Go to]

B. Bower. Wasting Away: Prozac loses promise as anorexia nervosa fighter. Science News. Vol. 169, June 17, 2006, p. 374. Available online: [Go to]

Weight Stigma Awareness Week

Ramey Nutrition is honoring Binge Eating Disorder Association's National "Weight Stigma Awareness Week" September 23-27, 2013 by sharing some of our intimate weight stigma experiences.  We would love your participation with any submitted stories, experiences, poetry, art or videos.  Please send all submissions to my direct email at: scarlett@rameynutrition.com

Just to show how weight stigma is all around us, one of Ramey Nutrition’s employees, Rachel was willing to share about when she went to Albania with a group from her church. Rachel’s friend, Haley, and her husband were also on this trip. When the group was in Albania, they befriended many of the people living in the area. Rachel overheard a conversation that Haley had with one of the Albanian men. Haley was explaining to him which man was her husband. She said, “My husband is the guy over there with the white t-shirt on.” The Albanian friend responded by saying, “Oh, the fat one!”

                Later on, Haley and her husband were approached by another Albanian who had also overheard the conversation. He told them that they shouldn't be offended by the description of “fat”. He went on to explain how calling somebody fat in Albania is very similar to calling someone tall, short, blonde, or brunette.

Isn't it interesting how many connotations we have for the word "Fat" and how it has become such an emotional trigger for us, where in other countries, it is just a simple descriptor.

Between a Kidney and a Sick Place

Sometimes I feel like the only reason I get back on track is so that I can get derailed. I'm starting to think that I secretly enjoy it in some sick twisted way. I mean, after all  I *am sick. I even have the T-Shirt. It says right on it: S I C K. 
The kidney shit has got me bummed out but I try not to think about it. I'm not ready to fully embrace the reality surrounding this whole dilemma ... And for now that's cool with me. Long story short, I have exactly 1 kidney kidney and it doesn't want to work anymore. I think it's retiring. I think I've pretty much beat the shit out of it and so now it's decided to beat the shit out of me. For the moment I'm living in a state of kind of denial. I understand what's going on but I'm exercising my right to compartmentalize and avoid emotional tags. 
I don't think I'm mentally prepared to handle the road this is going to take me on yet. All the terminology makes the whole thing sound so much more dramatic than it really is ... and I don't mean to minimize here, but you kind of have to. If I walked up to you and said I had Stage 4 Kidney Disease and have just completed a series of Venofer infusions you would think I was going to die tomorrow. It sounds like Cancer, Stage 4. You'd have no idea that what that means is my kidney has a GFR of 22, which you could potentially live with for the rest of your life with minimal life style changes and that Venofer is a fancy word for Iron. Or that I'm waiting for EPO injections so that my bone marrow will produce more red blood cells and my hemoglobin will get out of the range of needing a blood transfusion simply means my thigh is going to be in pain after the needle goes into my muscle for the shot. 
And ALL of this is just fireworks and smoke and illusions to cover up the other reality that I am also in the midst of recovering from a raging eating disorder. I'm still trying to figure it out in my head. Am I a kidney patient or am I an eating disorder patient? I don't even fucking know how to merge the two. Can I honestly do everything I can to save my kidney and still have an eating disorder? Can I just "get over" my eating disorder to save my kidney? No, I can't. I don't know how to. If it were that easy, if it were as simple as trading one for the other I think I would have found something positive to substitute it by now. I can't just stop being sick because now my kidney is sick. I wish I could just turn it off like that. I wish it were that simple. 
And so the guilt is horrendous. Why can't I just do what I'm supposed to do and stop these crazy thoughts? Why aren't the eating disorder thoughts and distortions stopping? Why can't I say 8 Ensures? Why not 9 or 10, let's just drink em until I'm at a healthy weight? Dive into this head first? Because it's a disease, that's why. Because it's not a fucking choice, that's why.

B is for Boring

I need a hobby. I have decided that I'm unusually boring these days. Sitting in my bed feeling sorry for myself makes me feel icky, like I'm wasting space. I feel like I was more of a human when I was active in my eating disorder. I need to figure out how to get that person back ... sans eating disorder, of course.
I had this project once, that I worked on every night when I didn't sleep. Instead of laying lame in my bed staring at the ceiling I sat on my floor, spread out all my art supplies, turned on my music and went to town. It was meditative for me, calming. A way to express what I was feeling without having to speak. I had it for at least 10 years and then one day I just stopped. I don't even know where it is. Tonight I'm going to start my project over. I'm going to start being more interesting in my life.
Kidney update: Barf, I don't even want to talk about it.
What I don't miss about my eating disorder this far in my recovery today: Not sure. I'm kind of a Negative Nancy today so I'm drawing a blank on the positives.
What I'm not going to miss about my eating disorder when I'm recovered: Obviously the boring me. I need more substance, so I'm going to create it. And Ensures, I'm still sick of Ensures.

ADHD & Eating Disorders

There may be a link between ADHD and eating disorders.

“ADHD in teens may cause symptoms of boredom and restlessness that are temporarily relieved by compulsive or addictive eating behaviors. Overeating or binge eating may stimulate the dopamine reward system and dopamine pathways in the brain.” 

-Eric Hollander, MD

Read the rest of the article here!

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ADHD Teens at Risk of Eating Disorders By Chris Iliades, MD Medically reviewed by Pat F. Bass III, MD, MPH

Teen eating disorders are on the rise — and they're becoming more prevalent in kids with ADHD. Experts explain why.

ADHD: My Son Nathan
One to 2 percent of students in America struggle with an eating disorder — and according to studies, eating disorders are significantly more common in teenage girls with ADHD than in girls without ADHD.

A possible explanation: Eating disorder behaviors like binge eating may be a way of self-medicating for ADHD teens. "The key link between eating disorders and ADHD is the impulsive need for stimulation,” explains Eric Hollander, MD, professor of psychiatry and behavioral medicine and director of the Compulsive, Impulsive, and Autism Spectrum Disorders Program at Albert Einstein College of Medicine and Montefiore Medical Center in Bronx, New York.

“ADHD in teens may cause symptoms of boredom and restlessness that are temporarily relieved by compulsive or addictive eating behaviors. Overeating or binge eating may stimulate the dopamine reward system and dopamine pathways in the brain.”

Dopamine is a brain chemical that tends to be low in people with ADHD. Dopamine is also important in appetite regulation and some compulsive eating behaviors have been shown to activate dopamine pathways.

Adolescent girls with ADHD also frequently develop dissatisfaction with their body image, which can lead to repeated bouts of binge eating and bulimia, notes Hollander.

ADHD usually begins in childhood, but girls are more likely to reach their teens being undiagnosed and untreated for their ADHD. Untreated teen ADHD increases the risk for compulsive eating and other eating disorders like bulimia or binge eating.”

Here are some ADHD symptoms kids and parents should be aware of:

Difficulty paying attention and staying focused
Problems at school
Constantly losing things or making careless mistakes
Restlessness and impatience
Parents who know or suspect that their teen has ADHD should also be aware of the warning signs of a possible eating disorder:

Dramatic change in weight
Excessive concern over diet
Being depressed about body image
Use of laxatives, diuretics, or enemas
Avoidance of family meals
ADHD in Teens and Eating Disorder Treatment

Parents and teens need to learn as much as they can about these disorders and take an active role in treatment. ADHD and eating disorders are both treatable. Teen ADHD can be controlled through a combination of medication and behavioral therapy. Teen eating disorder treatment often involves both individual and family therapy and education about healthful eating. Treatment of ADHD symptoms may also help symptoms of eating disorders.

The key is to recognize the problem and take action. Teen ADHD and eating disorders that go unrecognized and untreated can cause lasting damage to both mind and body.

Ramey Nutrition Taking New Day Program Patients!

Providing eating disorder treatment that leads efficiently to full recovery was the guiding principal on which Ramey Nutrition was founded. Eating disorders are frequently “treated” in the field of nutrition counseling; however we focus on empowering our patients to be recovered in order to move on with lives that are meaningful to them. By avoiding a focus on education and meal plans, we are able to respect the knowledge our patients already have. As they feel safe in knowing this, we are in a better position to simply remind them of the power they have to heal their issues; the nutrition naturally follows their healing.
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"A mother who radiates self-love and self-acceptance vaccinates her daughter against low self-esteem." -Naomi Wolf

Ramey Nutrition's First Referring Doctor Killed in an Avalanche

The woman who died after she was buried in an avalanche near Snoqualmie Pass has been identified as Bellevue naturopathic physician Dr. Joy Yu. The search for a man caught in a second slide has been suspended.

The woman who died after she was buried in an avalanche Saturday on Red Mountain has been identified as Dr. Joy Yu, a naturopathic physician.
Yu worked at the Creekside Center for Integrative Medicine in Bellevue, according to a billing receptionist at the office who was too upset to provide additional details. She said Yu’s relatives were on their way to town after learning of the accident.
Yu has a blog that identifies her as an active Northwest hiker and dog lover.
Yu was one of two people hit by an avalanche in separate incidents Saturday near Snoqualmie Pass. A man who’s been missing in an avalanche on Granite Mountain has been identified as 61-year-old Mitch Hungate, a Renton dentist, according to KING 5 news, a Seattle Times news partner.
The search for Hungate has been suspended indefinitely, as rescuers believe the conditions on Granite Mountain nare too dangerous.
Two other men were carried along with Hungate in the Granite Mountain avalanche, but they have been located. A GPS device worn by one of the men showed they tumbled down the slope more than 1,200 feet in less than one minute, according to the King County Sheriff’s Office.
Hungate did not emerge from the snow slide. Described as an experienced outdoorsman, Hungate was “always out hiking and climbing,” according to Bruce Kolpack, who has climbed with him. “He stays in really good shape.”
Hungate’s wife and sister are on the mountain awaiting news.
“All of us stayed up here in the hope against hope that there would be a rescue,” Hungate’s wife, Marilynn, told KING 5. “I really didn’t want to leave him. I want to be with him until he can be here with us.”
Yu was pronounced dead after rescuers transported her down from Red Mountain at about midnight . The Sheriff’s Office said she had a pulse when she was dug from the snow. Rescuers, who hiked nearly three hours to reach her, spent six hours carrying her on a sled off the mountain, but she did not survive.
Other snowshoers located Yu about 45 minutes after an avalanche hit and found her face down in about 5 feet of snow. Her dog, a black-and-white border collie/sheltie mix named Blue, showed up unaccompanied, alerting them that the woman was missing.
The search for Hungate was suspended about 8 p.m. Saturday and did not resume Sunday.
“It’s so unstable, we don’t want to risk our search-and-rescue members’ lives,” said Cindi West, of the Sheriff’s Office.
The Sheriff’s Office is warning the public to stay away from the area, she added.
About 50 rescuers with dog teams searched for Hungate on Saturday but battled “horrible” conditions, according to Katie Larson, of the Sheriff’s Office. Overnight, the mountain got another “big dump of snow,” making the conditions too dangerous to send in searchers, she said.
His two companions suffered non-life-threatening shoulder and hamstring injuries, the Sheriff’s Office said.
The Granite Mountain avalanche occurred first, at about noon Saturday, near Interstate 90s exit 47. The Red Mountain slide hit about a half-hour later, a few miles east near the Alpental ski area.
In all, more than 100 members of search-and-rescue teams from Seattle, Everett, Pierce County and Yakima participated in searches at the two avalanche scenes.
At the Red Mountain site, Yu had been snowshoeing with her dog behind a group of 12 other snowshoers when the avalanche struck.
The group of 12 was split up by the avalanche, with four making it off the mountain on their own by 5 p.m.
The remaining eight snowshoers, who were at about 4,800 feet, realized Yu was missing when the dog came up to them afterward. They were able to find Yu and dig her out. They tried to keep her warm as they waited about 2½ hours for rescuers to reach them. The rescue party did not reach the parking lot until about midnight Saturday, and by that time Yu had died.
The last avalanche fatalities in this area occurred in February 2012 when four people were killed at Stevens Pass and near the Summit at Snoqualmie, Larson said.
She said avalanches can be common this time of year.
“Whenever you have warm weather and then cold weather and snow, it can be bad,” she said.
Paul Baugher, director of the Northwest Avalanche Institute, which offers avalanche consulting and safety training, said the forecast for avalanches at Snoqualmie was “high” on Saturday.
“Because of the cold temperatures, the snow underneath is relatively well frozen and stable,” he said. “But there’s a poor bond between the new snow coming down and old snow, which is very hard and slippery. That produces soft slabs of very sensitive snow.”

Our hearts and prayers go out to Texas today. @rameynutrition

Talking About Old Age Or Being Fat Linked To Physical And Mental Health Problems by Joseph Nordqvist

Talking about being old is an important indicator of body dissatisfaction, in the same way that talking about being fat is, according to a recent study published in the Journal of Eating Disorders.

Body dissatisfaction is associated with a number of physical and mental health problems, such as depression, low self-esteem, and stress. So-called "fat talk" and "old talk" have been found to contribute towards feelings of body dissatisfaction. It occurs when women express distaste about the appearance of their body and wish they were either better looking, thinner, or younger.

Researchers from the University of West England and Trinity University investigated the impact of "fat-talk" and "old-talk" throughout women's lives. They surveyed a total of 1,000 women aged 18 to 87 from various parts of the world; they assessed their fat talk, old talk, body image disturbance and eating disorder pathology.

Interestingly, a previous study published in Psychology of Women Quarterly identified that it's worrying how some women believe "fat talk" to be a helpful coping mechanism when in fact it actually exacerbates body image disturbance. In addition, those who engage in fat talk on a frequent basis are more likely to have an ultra-thin body ideal than those who don't.

They found that "fat talk" and "old talk" occur throughout the majority of women's lives. In general women talk more about their weight and appearance than they do about their age. However, as they get older they tend to talk less about their weight and more about their age.

Those who reported talking about being old or fat were more likely to have a negative body image than those who didn't.

As with fat talk, old talk is associated with body image disturbance as well as eating disorder pathology.

According to Dr. Carolyn Black Becker, who led this study:

"Until now, most research has focused on the negative effects of the thin-ideal and speech, such as 'fat talk', in younger women, but we need to remember that the thin-ideal is also a young-ideal which, as our results show, becomes increasingly important to negative body image as women age."


Written by Joseph Nordqvist
Copyright: Medical News Today