Anorectic Health Dictionary

The term ‘eating disorders’ covers OBESITY, feeding problems in childhood, anorexia nervosa, and bulimia nervosa. The latter two are described here.

Anorexia nervosa Often called the slimmer’s disease, this is a syndrome characterised by the loss of at least a quarter of a person’s normal body weight; by fear of normal weight; and, in women, by AMENORRHOEA. An individual’s body image may be distorted so that the sufferer cannot judge real weight and wants to diet even when already very thin.

Anorexia nervosa usually begins in adolescence, affecting about 1–2 per cent of teenagers and college students at any time. It is 20 times more common among women than men. Up to 10 per cent of sufferers’ sisters also have the syndrome. Anorexia may be linked with episodes of bulimia (see below).

The symptoms result from secretive self-starvation, usually with excessive exercise, self-induced vomiting, and misuse of laxatives. An anorexic (or anorectic) person may wear layers of baggy clothes to keep warm and to hide the ?gure. Starvation can cause serious problems such as ANAEMIA, low blood pressure, slow heart rate, swollen ankles, and osteoporosis. Sudden death from heart ARRHYTHMIA may occur, particularly if the sufferer misuses DIURETICS to lose weight and also depletes the body’s level of potassium.

There is probably no single cause of anorexia nervosa. Social pressure to be thin seems to be an important factor and has increased over the past 20–30 years, along with the incidence of the syndrome. Psychological theories include fear of adulthood and fear of losing parents’ attention.

Treatment should start with the general practitioner who should ?rst rule out other illnesses causing similar signs and symptoms. These include DEPRESSION and disorders of the bowel, PITUITARY GLAND, THYROID GLAND, and OVARIES.

If the diagnosis is clearly anorexia nervosa, the general practitioner may refer the sufferer to a psychiatrist or psychologist. Moderately ill sufferers can be treated by COGNITIVE BEHAVIOUR THERAPY. A simple form of this is to agree targets for daily calorie intake and for acceptable body weight. The sufferer and the therapist (the general practitioner or a member of the psychiatric team) then monitor progress towards both targets by keeping a diary of food intake and measuring weight regularly. Counselling or more intensely personal PSYCHOTHERAPY may help too. Severe life-threatening complications will need urgent medical treatment in hospital, including rehydration and feeding using a nasogastric tube or an intravenous drip.

About half of anorectic sufferers recover fully within four years, a quarter improve, and a quarter remain severely underweight with (in the case of women) menstrual abnormalities. Recovery after ten years is rare and about 3 per cent die within that period, half of them by suicide.

Bulimia nervosa is a syndrome characterised by binge eating, self-induced vomiting and laxative misuse, and fear of fatness. There is some overlap between anorexia nervosa and bulimia but, unlike the former, bulimia may start at any age from adolescence to 40 and is probably more directly linked with ordinary dieting. Bulimic sufferers say that, although they feel depressed and guilty after binges, the ‘buzz’ and relief after vomiting and purging are addictive. They often respond well to cognitive behaviour therapy.

Bulimia nervosa does not necessarily cause weight loss because the binges – for example of a loaf of bread, a packet of cereal, and several cans of cold baked beans at one sitting – are cancelled out by purging, by self-induced vomiting and by brief episodes of starvation. The full syndrome has been found in about 1 per cent of women but mild forms may be much more common. In one survey of female college students, 13 per cent admitted to having had bulimic symptoms.

Bulimia nervosa rarely leads to serious physical illness or death. However, repeated vomiting can cause oesophageal burns, salivary gland infections, small tears in the stomach, and occasionally dehydration and chemical imbalances in the blood. Inducing vomiting using ?ngers may produce two tell-tale signs – bite marks on the knuckles and rotten, pitted teeth.

Those suffering from this condition may obtain advice from the Eating Disorders Association.... eating disorders

A neurotic and metabolic condition, mostly in young women who suppress appetite by refusing food in an effort to be thin. Such starvation may result in death.

The patient may start as a food faddist with depressive tendencies. Some gorge huge meals (bulimia) and induce vomiting later. Such women are known to be oestrogen deficient; most have a low dietary intake of calcium, resulting in reduced bone density (osteoporosis). Lack of exercise has a worsening influence, often with severe loss of weight.

It is now established that one cause is a deficiency of zinc in the diet. Individuals suffering from the condition (with its depression) may recover when given 15mg zinc daily. Starvation causes increased urinary zinc secretion, thus further reducing body levels of the mineral. Most anorectics complain of loss of sense of taste and smell which is a symptom of zinc deficiency. Loss of these two senses reduces further the desire for food.

Symptoms. Excessive thinness. Anaemia. Poor haemoglobin levels. Absence of menses. Episodic hyperactivity. Slow pulse when resting. Teeth decay, brittle bones. Heart weakness. Low blood pressure, hormonal disorders, yellowing skin, blood disorders, abnormal drowsiness and weakness. Reduced bone density may develop during the illness, the subject being prone to bone fracture for years afterwards. Treatment. Correct anaemia with iron-bearing herbs, Vitamin B12, mineral supplements and nourishing food.

Angelica root, Barberry, Bogbean, Burdock root, Calamus, Centuary herb, Chamomile flowers, Condurango bark, Dandelion (coffee), Garden Sage, Gentian, Ginkgo, Helonias, Hops, Marshmallow root, Milk Thistle, Quassia chips, White Poplar.

Alternatives:– Tea. Formula. Equal parts, Centuary, Chamomile, Peppermint. 1 heaped teaspoon to each cup boiling water; infuse 5-15 minutes. Dose: 1 cup thrice daily, before meals.

Decoction. Formula. Combine Angelica root 1; Burdock root 1; Condurango bark half. 1 teaspoon to each cupful water simmered gently 20 minutes. Dose: Half-1 cup thrice daily before meals.

Powders. Formula. German Chamomile 2; Gotu Kola 1; Ginkgo 1. Dose: 500mg (two 00 capsules or one- third teaspoon) before meals thrice daily.

Tinctures. Formula. Combine: Condurango quarter; Burdock root half; White Poplar 1; Ginkgo 1; add 2- 10 drops Tincture Capsicum fort. 1-2 teaspoons in water thrice daily, before meals.

Tincture: Tincture Gentian Co BP. Dose: 2-4ml (30-60 drops).

Ginger, stem. Success reported.

Milk Thistle and Turmeric: popular in general herbal practice.

Diet. High protein, low fat, low salt. Dandelion coffee. Liver. Artichokes. 2-3 bananas (for potassium) daily.

Supplements. Daily. Vitamin B-complex. Vitamin C, 1g. Vitamin E, 200iu. Zinc, 15mg. Magnesium, 250mg morning and evening. ... anorexia nervosa

A condition in which the energy stores of the body (mainly fat) are too large. It is a prevalent nutritional disorder in prosperous countries – increasingly so among children and young people. The Quetelet Index or BODY MASS INDEX, which relates weight in kilograms (W) to height2 in metres (H2), is a widely accepted way of classifying obesity in adults according to severity. For example:

Grade of obesity

BMI (W/H2) III >40 II 30–40 I 25–29·9 not obese <25

Causes Whatever the causes of obesity, the fact remains that energy intake (in the form of food and drink) must exceed energy output (in the form of activity and exercise) over a suf?ciently long period of time.

Obesity tends to aggregate in families. This has led to the suggestion that some people inherit a ‘thrifty’ gene which predisposes them to obesity in later life by lowering their energy output. Indeed, patients often attribute their obesity to such a metabolic defect. Total energy output is made up of the resting metabolic rate (RMR), which represents about 70 per cent of the total; the energy cost of physical activity; and thermogenesis, i.e. the increase in energy output in response to food intake, cold exposure, some drugs and psychological in?uences. In general, obese people are consistently found to have a higher RMR and total energy output, per person – and also when expressed against fat-free mass – than do their lean counterparts. Most obese people do not appear to have a reduced capacity for thermogenesis. Although a genetic component to obesity remains a possibility, it is unlikely to be great or to prevent weight loss from being possible in most patients by reducing energy intake. Environmental in?uences are believed to be more important in explaining the familial association in obesity.

An inactive lifestyle plays a minor role in the development of obesity, but it is unclear whether people are obese because they are inactive or are inactive because they are obese. For the majority of obese people, the explanation must lie in an excessive energy intake. Unfortunately, it is di?cult to demonstrate this directly since the methods used to assess how much people eat are unreliable. For most obese people it seems likely that the defect lies in their failure to regulate energy intake in response to a variety of cognitive factors (e.g. ease of ?tting of clothes) in the long term.

Unfortunately, it can be possible to identify by the time of their ?rst birthday, many of the children destined to be obese.

Rarely, obesity has an endocrine basis and is caused by hypothyroidism (see under THYROID GLAND, DISEASES OF), HYPOPITUITARISM, HYPOGONADISM or CUSHING’S SYNDROME.

Symptoms Obesity has adverse effects on MORBIDITY and mortality (see DEATH RATE) which are greatest in young adults and increase with the severity of obesity. It is associated with an increased mortality and/or morbidity from cardiovascular disease, non-insulin-dependent diabetes mellitus, diseases of the gall-bladder, osteoarthritis, hernia, gout and possibly certain cancers (i.e. colon, rectum and prostate in men, and breast, ovary, endometrium and cervix in women). Menstrual irregularities and ovulatory failure are often experienced by obese women. Obese people are also at greater risk when they undergo surgery. With the exception of gallstone formation, weight loss will reduce these health risks.

Treatment Creation of an energy de?cit is essential for weight loss to occur, so the initial line of treatment is a slimming diet. An average de?cit of 1,000 kcal/day (see CALORIE) will produce a loss of 1 kg of fat/week and should be aimed for. Theoretically, this can be achieved by increasing energy expenditure or reducing energy intake. In practice, a low-energy diet is the usual form of treatment since attempts to increase energy expenditure, either by physical exercise or a thermogenic drug, are relatively ine?ective.

Anorectic drugs, gastric stapling and jaw-wiring are sometimes used to treat severe obesity. They are said to aid compliance with a low-energy diet by either reducing hunger (anorectic drugs) or limiting the amount of food the patient can eat. Unfortunately, the long-term e?ectiveness of gastric stapling is not known, and it is debatable whether the modest reduction in weight achieved by use of anorectic drugs is worthwhile – although a new drug, ORLISTAT, is becoming available that reduces the amount of fat absorbed from food in the gastrointestinal tract. For some grossly obese patients, jaw-wiring can be helpful, but a regain of weight once the wires are removed must be prevented. These procedures carry a risk, so should be done only if an individual’s health is in danger.... obesity

The previous subject is obviously an endless one, but as this is the glossary of an herbal nature, let me assure you, virtually no plants have a direct steroid hormone-mimicking effect. There are a few notable exceptions with limited application, like Cimicifuga and Licorice. Plant steroids are usually called phytosterols, and, when they have any hormonal effect at all, it is usually to interfere with human hormone functions. Beta sitosterol, found in lots of food, interferes with the ability to absorb cholesterol from the diet. Corn oil and legumes are two well-endowed sources that can help lower cholesterol absorption. This is of only limited value, however, since cholesterol is readily manufactured in the body, and elevated cholesterol in the blood is often the result of internal hormone and neurologic stimulus, not the diet. Cannabis can act to interfere with androgenic hormones, and Taraxacum phytosterols can both block the synthesis of some new cholesterol by the liver and increase the excretion of cholesterol as bile acids; but other than that, plants offer little direct hormonal implication. The first method discovered for synthesizing pharmaceutical hormones used a saponin, diosgenin, and a five-step chemical degradation, to get to progesterone, and another, using stigmasterol and bacterial culturing, to get to cortisol. These were chemical procedures that have nothing to do with human synthesis of such hormones, and the plants used for the starting materials-Mexican Wild Yam, Agave, and Soy were nothing more than commercially feasible sources of compounds widely distributed in the plant kingdom. A clever biochemist could obtain testosterone from potato sterols, but no one would be likely to make the leap of faith that eating potatoes makes you manly (or less womanly), and there is no reason to presume that Wild Yam (Dioscorea) has any progesterone effects in humans. First, the method of synthesis from diosgenin to progesterone has nothing to do with human synthesis of the corpus luteum hormone; second, oral progesterone has virtually no effect since it is rapidly digested; and third, orally active synthetic progesterones such as norethindrone are test-tube born, and never saw a Wild Yam. The only “precursor” the ovaries, testes and adrenal cortices EVER need (and the ONLY one that they can use if synthesizing from scratch) is something almost NONE of us ever run out of...Low Density Cholesterol. Unless you are grimly fasting, anorectic, alcoholic, seriously ill or training for a triathlon, you only need blood to make steroid hormones from. If hormones are off, it isn’t from any lack of building materials...and any product claiming to supply “precursors” better contain lard or butter (they don’t)...or they are profoundly mistaken, or worse. The recent gaggle of “Wild Yam” creams actually do contain some Wild Yam. (Dioscorea villosa, NOT even the old plant source of diosgenin, D. mexicana...if you are going to make these mistakes, at least get the PLANT right) This is a useful and once widely used antispasmodic herb...I have had great success using it for my three separate bouts with kidney stones...until I learned to drink more water and alkalizing teas and NEVER stay in a hot tub for three hours. What these various Wild Yam creams DO contain, is Natural Progesterone. Although this is inactive orally (oral progesterone is really a synthetic relative of testosterone), it IS active when injected...or, to a lesser degree, when applied topically. This is pharmaceutical progesterone, synthesized from stigmasterol, an inexpensive (soy-bean oil) starting substance, and, although it is identical to ovarian progesterone, it is a completely manufactured pharmaceutical. Taking advantage of an FDA loophole (to them this is only a cosmetic use...they have the misguided belief that it is not bioactive topically), coupled with some rather convincing (if irregular) studies showing the anti-osteoporotic value of topical progesterone for SOME women, a dozen or so manufacturers are marketing synthetic Natural Progesterone for topical use, yet inferring that Wild Yam is what’s doing good. I am not taking issue with the use of topical progesterone. It takes advantage of the natural slow release into the bloodstream of ANY steroid hormones that have been absorbed into subcutaneous adipose tissue. It enters the blood from general circulation the same way normal extra-ovarian estradiol is released, and this is philosophically (and physiologically) preferable to oral steroids, cagily constructed to blast on through the liver before it can break them down. This causes the liver to react FIRST to the hormones, instead of, if the source is general circulation, LAST. My objection is both moral and herbal: the user may believe hormonal effects are “natural”, the Wild Yam somehow supplying “precursors” her body can use if needed, rejected if not. This implies self-empowerment, the honoring of a woman’s metabolic choice...something often lacking in medicine. This is a cheat. The creams supply a steady source of pharmaceutical hormone (no precursor here) , but they are being SOLD as if the benefits alone come from the Wild Yam extract, seemingly formulated with the intent of having Wild Yam the most abundant substance so it can be listed first in the list of constituents. I have even seen the pharmaceutical Natural Progesterone labeled as “Wild Yam Progesterone” or “Wild Yam Estrogen precursor” or, with utter fraud, “Wild Yam Hormone”. To my knowledge, the use of Mexican Yam for its saponins ceased to be important by the early 1960’s, with other processes for synthesizing steroids proving to be cheaper and more reliable. I have been unable to find ANY manufacturer of progesterone that has used the old Marker Degradation Method and/or diosgenin (from whatever Dioscorea) within the last twenty years. Just think of it as a low-tech, non invasive and non-prescription source of progesterone, applied topically and having a slow release of moderate amounts of the hormone. Read some of the reputable monographs on its use, make your choice based solely on the presence of the synthetic hormone, and use it or don’t. It has helped some women indefinitely, for others it helped various symptoms for a month or two and then stopped working, for still other women I have spoken with it caused unpleasant symptoms until they ceased its use. Since marketing a product means selling as much as possible and (understandably) presenting only the product’s positive aspects, it would be better to try and find the parameters of “use” or “don’t use” from articles, monographs, and best of all, other women who have used it. Then ask them again in a month or two and see if their personal evaluation has changed. If you have some bad uterine cramps, however, feel free to try some Wild Yam itself...it often helps. Unless there is organic disease, hormones are off is because the whole body is making the wrong choices in the hormones it does or doesn’t make. It’s a constitutional or metabolic or dietary or life-stress problem, not something akin to a lack of essential amino acids or essential fatty acids that will clear up if only you supply some mythic plant-derived “precursor”. End of tirade.... steroids, plant