Welcome to the 59th edition of the NEDC e-Bulletin.
In the world of eating disorder education, support, early intervention and prevention we spend a considerable amount of time looking at eating behaviours or the comorbid medical conditions associated with eating disorders, and what that means for individuals living with or recovering from an eating disorder.
In this e-Bulletin, we look at the brain.
How are we affected by disordered eating behaviours? How is the brain influenced by small changes in our food consumption and what does that mean for the human body? What is the consequence of altering our food consumption?
Our brain truly is the most complex organ within our bodies. It is the producer of every thought, action, feeling and experience that we own (Philips, 2006). Feeding it well and feeding it right is essential to our very existence. Our brain must be functioning to the best of its ability for good mental health, and in turn superior physical health outcomes.
In this e-Bulletin, we will also take a look at the current activities of the NEDC - Take a look at what we have been up to and where we are heading as we progress into the year!
Remember – the NEDC is all about collaboration and connection! Your input and your voice matters to us. If you would like to know more about a topic or would like to contribute to a future edition of the NEDC e-Bulletin, please do not hesitate to contact us! Email email@example.com
You can also participate through membership to the NEDC - JOIN US!
3. On the road with the NEDC: Making eating disorders a priority mainstream health issue in Australia
The critical relationship between our diet and our mental health
The brain is made up of millions of cells (neurons). All that we do, our thoughts, feelings and actions, are reliant on the interactions of the cells, which is made possible by chemicals called neurotransmitters (Altomare et al., 2017). These neurotransmitters are the body’s chemical messengers (The University Of Qld, 2017), and constantly work to keep our brains functioning, managing everything from our breathing and heartbeat to our learning and concentration levels (Cherry, 2018). Neurotransmitters are directly affected by the quality of our nutrition, the food that we do or do not consume (Altomare et al., 2017). Disordered eating behaviours directly affect our brain function and mental health.
Disordered eating is a disturbed and unhealthy eating pattern that can include restrictive dieting, compulsive eating or skipping meals. Dieting is one of the most common forms of disordered eating and is common among people with an eating disorder (NEDC, 2018). Most “fad” diets prescribe far too little food, and/or not eating from all food groups, which tips the body into a state of semi-starvation and induces physical deprivation (Centre for Clinical Interventions, 2018c).
Disordered eating is linked to a reduced ability to cope with stressful situations, as well as an increased incidence of suicidal thoughts and behaviours (NEDC, 2018). Research has found that starvation has widespread and profound effects on mood and cognitive functioning (Brockmeyer et al., 2012).
Severely restricting the amount of food eaten can be a very dangerous practice. When starved of food, the body responds by reducing the rate at which it burns energy (the metabolic rate) (NEDC, 2018). The human brain operates at a very high metabolic rate, using a substantial portion of the body’s total energy and nutrient intake (Sarris et al., 2015). Without proper nutrition to fuel our brain transmission and function, our brain is left vulnerable (Altomare et al., 2017).
The research behind the starved brain
As we look into the research behind the starved brain, none has been more compelling in demonstrating the effects of starvation on the mind and body than the notable study undertaken in 1948 by Ancel Keys, in Minnesota USA, called The Biology of Human Starvation, “The Minnesota Starvation Experiment”.
The experiment highlighted that many of the symptoms assumed to be primary symptoms of an eating disorder are symptoms of starvation (Centre for Clinical Interventions, 2018b).The purpose of the experiment was to demonstrate how the body and mind are affected by not eating, or restricting what we eat. Healthy young men were studied under normal conditions, exposed to dietary restriction by subjection to semi-starvation, and followed through rehabilitation to examine the most successful form of dietary rehabilitation (Centre for Clinical Interventions, 2018) (Keys, A., Brozek, J., Henschel, A., Mickelsen, O., & Taylor, 1950).
This study demonstrated that the effects of starvation on the individual are wide-ranging. Starvation impacts us physiologically, psychologically, cognitively and socially (Centre for Clinical Interventions, 2018b). It can lead to serious health complications that affect all areas of human functioning (Inside Out Institute, 2018).
The study observed the following symptoms as outcomes of semi-starvation:
- Physical: Less energy, reduced heart muscle mass, lower heart rate and blood pressure, headaches, decreased hormone levels, sensitivity to noise and light, a feeling of being cold all the time, loss of strength and greater fatigue and hair loss and dry skin.
- Emotional and Cognitive changes: Depression, anxiety, irritability, increased mood fluctuations, intense and negative emotional reactions, decreased enthusiasm, reduced motivation, impaired concentration, problem solving and comprehension, increased rigidity, obsessional thinking and reduced alertness.
- Attitudes and behaviours related to food: Thinking about food all the time, eating very slow or very fast, increased hunger, unusual food routines and rituals, binge eating, increased use of condiments for flavour.
- Social changes: Feeling more critical of others, withdrawn and isolated, loss of sense of humour, feelings of social inadequacy, neglect of personal hygiene and strained relationships.
What is the link between semi-starvation and eating disorders?
Research undertaken by the World Health Organisation found that the prevalence of mental health disorders has increased in developed countries alongside the deterioration of the western diet (Altomare et al., 2017). Additionally, The Minnesota Starvation Experiment has shown the importance of “feeding” the brain and the direct correlation between the food we consume and our mental health. As a result, we know that nutritional deficiencies are associated with mental disorders and mental health.
This experiment further demonstrated that a person does not have to be underweight to display symptoms of starvation, rather, symptoms can be experienced by a person with any significant calorie deficit, in a body of any size. A person can appear to have an adequate caloric intake and still experience the social, emotional, cognitive and behavioural symptoms of starvation (Centre for Clinical Interventions, 2018b).
We know that brain activity is affected by even modest dieting. When a person is malnourished, their brain is not adequately fuelled; they struggle to make decisions, solve problems and regulate their emotions (Centre for Clinical Interventions, 2018a). Restricted eating, malnourishment, and excessive weight loss can lead to changes in our brain chemistry, resulting in increased symptoms of depression and anxiety (Centre for Clinical Interventions, 2018b).
These changes in brain chemistry and poor mental health outcomes skew reality. For individuals living with an eating disorder, the effects of an undernourished brain bring with it fear and anxiety about body shape, weight, appearance and eating (Centre for Clinical Interventions, 2018b).
How is this information useful in treatment and recovery?
Research shows us that a starved brain does not function properly. Renourishment is critical as a first or very early step, in the treatment of an eating disorder (Centre for Clinical Interventions, 2018a).
The Minnesota Starvation experiment employed a three-month recovery phase for renourishment (Centre for Clinical Interventions, 2018b). During this refeeding period, some participants noted feeling anxious and experiencing a sense of ‘loss of control’ when reintroduced to eating, others reported overeating and binge eating episodes (Eckert, Gottesman, Swigart, & Casper, 2018). This difference in response to food in the refeeding phase highlights that recovery is different for everybody and that despite normalising eating using a consistent approach during this period, some individuals continued to experience emotional and cognitive symptoms, which affected their mental health and wellbeing for an extended period after renourishment.
Similarly, the experiment highlighted a higher incidence of depression with anxiety, and abnormal behavioural and psychological changes amongst participants as a reaction to being in a starved state. However, the experiment demonstrated that consuming higher amounts of calories, during the refeeding phase, led to an earlier improvement in health outcomes and a reduction in levels of depression (Eckert et al., 2018).
These findings highlight the importance of a collaborative approach to the treatment and recovery of eating disorders. To encourage positive changes cognitively, we must first address the eating patterns and nutritional level of the individual; a person cannot engage meaningfully in psychological therapies while their brain is starved.
We know that changing eating behaviour is possible. With the right support and treatment, and a high level of personal commitment, the body can learn to function to its full capacity again (NEDC, 2018).
Seeking help from a practitioner with specialised knowledge in health and nutrition will support the individual in reversing the adverse effects of disordered eating and restoring emotional, mental and physical health. The role of the dietitian is critical in supporting an individual to receive the right level of vitamins and minerals, and to help develop normal and beneficial eating habits and behaviours that support the individual cognitively (NEDC, 2018). Once this is achieved, the individual is better positioned to work with psychologists, general practitioners and other health professionals in addressing the thoughts and emotions behind their disordered eating behaviours.
Altomare, R., Damiano, G., Palumbo, V. D., Buscemi, S., Spinelli, G., Cacciabaudo, F., … Monte, L. (2017). Feeding the brain : the importance of nutrients for brain functions and health, 19(15), 243–247. https://doi.org/10.23751/pn.v19i3.4821
Brockmeyer, T., Holtforth, M. G., Bents, H., Kämmerer, A., Herzog, W., & Friederich, H. C. (2012). Starvation and emotion regulation in anorexia nervosa. Comprehensive Psychiatry, 53(5), 496–501. https://doi.org/10.1016/j.comppsych.2011.09.003
Centre for Clinical Interventions. (2018a). Eating Disorders & Neurobiology. Retrieved from https://www.cci.health.wa.gov.au/Resources/~/media/7644CF6DB09443138A975DEE6EF725DD.ashx
Centre for Clinical Interventions. (2018b). What is Starvation Syndrome ? What is Starvation Syndrome ? Department of Health, Government of Western Australia. Retrieved from https://www.cci.health.wa.gov.au/Resources/Looking-After-Yourself/~/media/7FA3FBD42D5E46BBAAB151408F7C08ED.ashx
Centre for Clinical Interventions. (2018c). Why Diets Don’t Work. Retrieved from https://www.cci.health.wa.gov.au/~/media/CCI/Mental Health Professionals/Eating Disorders/Eating Disorders - Information Sheets/Eating Disorders Information Sheet - 34 - Why Diets Do Not Work.pdf\
Cherry, K. (2018). Identifying a Neurotransmitter. Retrieved from https://www.verywellmind.com/what-is-a-neurotransmitter-2795394
Eckert, E. D., Gottesman, I. I., Swigart, S. E., & Casper, R. C. (2018). A 57-Year Follow-Up Investigation and Review of the Minnesota Study on Human Starvation and its Relevance to Eating Disorders, 2(3), 1–19.
Feuerbach, L. A. (1841). The Essence of Christianity.
Inside Out Institute. (2018). The Effects of Starvation. Retrieved February 15, 2019, from https://insideoutinstitute.org.au/resource-library/the-effects-of-starvation
Keys, A., Brozek, J., Henschel, A., Mickelsen, O., & Taylor, H. L. (1950). (1950). The Biology of Human Starvation. The Biology of Human Starvation (2 Vols. (Vol. 2). Minneapolis; MN: University of Minnesota Press.
NEDC. (2018). Disordered Eating. Retrieved February 15, 2018, from https://www.nedc.com.au/eating-disorders/eating-disorders-explained/disordered-eating-and-dieting/
Sarris, J., Logan, A. C., Akbaraly, T. N., Amminger, G. P., Balanzá-martínez, V., Freeman, M. P., & Hibbeln, J. (2015). Nutritional medicine as mainstream in psychiatry, 271–274. https://doi.org/10.1016/S2215-0366(14)00051-0
The University Of Qld, Q. B. I. (2017). What are neurotransmitters? Retrieved from https://qbi.uq.edu.au/brain/brain-physiology/what-are-neurotransmitters
Resources about nutrition and the brain
For information about eating disorders, visit the NEDC website at https://www.nedc.com.au/eating-disorders/eating-disorders-explained/
E-Learning tools are available on the professional development area of our website about eating disorders and related topics. In this area, you will find a video presentation from Accredited Practising Dietitian and Nutritionist Gabriella Heruc of Appetite for Change, titled “Hidden Truths - Dispelling nutrition myths in an over-informed world". This video presentation, discusses nutrition myths, touching on nutrition and brain function.
PowerPoint slides of the video presentation are also available at https://www.nedc.com.au/assets/Uploads/GabriellaHeruc-NutritionMyths-2018NEDCMEMBERSMEETING.pdf
The NEDC is currently working to develop additional tools and resources to support dietitians and nutritionists working with individuals living with disordered eating behaviours.
Additional information about the effects of starvation on the body and the starvation syndrome are available through the Centre for Clinical Interventions (CCI) athttps://www.cci.health.wa.gov.au
The Centre for Clinical Interventions (CCI) has produced a resource for consumers and healthcare professionals to assist in providing interventions for eating disorders. This is a psychoeducation tool that can be worked through by individuals living with an eating disorder. The CCI Workbook on Disordered Eating can be found online athttps://www.cci.health.wa.gov.au/resources/looking-after-yourself/disordered-eating
Some practitioners in inpatient settings may encounter a patient who experiences refeeding syndrome during the period of renourishment. This serious and potentially fatal syndrome requires rapid response from an experienced dietitian. More information can be found from the InsideOut Institute at https://insideoutinstitute.org.au/resource-library/refeeding-syndrome . Clinicians working in community settings should be aware that the risk of refeeding syndrome when supporting a person through renourishment as an outpatient is very low.
Additional information is available through The Victorian Centre for Excellence in Eating Disorders (CEED) athttp://www.ceed.org.au/resources-and-links about the associated medical complications of malnutrition on the human body.
The NEDC has additional screening and assessment tools available to health professionals working within the area of eating disorders. Information is available by contacting the NEDC at firstname.lastname@example.org or by visiting our website at www.nedc.com.au
NEDC on the road with our PHN's
The NEDC team have been busy working within the sector; building on our relationships within the workforce and developing our reach across the PHN network in aid of creating a skilled workforce, where professionals are well equipped to provide best practice treatment and referral for eating disorder patients.
We have moved quickly into 2019. The NEDC has been out on the road and working with our PHN's. Since January 2019, we have delivered training workshops across Queensland and New South Wales.
Each workshop that we undertake is tailored specifically to the needs of the PHN or organisation with which we will be working.
Some of the recent and current collaborations include:
1) COORDINARE, South Eastern NSW PHN
During the first week of February over 50 people attended three sessions on “Addressing Eating Disorders in Primary Care” in Batemans Bay and Bega. The NEDC and South Eastern NSW PHN, Coordinare, conducted introductory workshops, in collaboration with the local Eating Disorder Coordinator for the Southern NSW Local Health District. Sessions covered included:
• Signs & Symptoms
• Common Misconceptions
• Screening & Management
• Treatment Options
• Working with Carers, Families and Friends
• Recovery & Essential Elements of Care
• Referral Pathways & Support Services
During our visit, Coordinare PHN informed us about the access to Eating Disorders HealthPathways Development and Active Service Plan that will be implemented in the region. It was great to hear about the implementation of this service for people with eating disorders in the region.
2) Darling Downs and West Moreton PHN
During the second week of February NEDC delivered introductory education to medical and health professionals in collaboration with Darling Downs and West Moreton PHN. There was an overflow of health professionals in attendance. GPs, Psychologists, Dietitians, Social Workers, Occupational Therapists and nurses joined us in Toowoomba along with guest speaker Associate Professor Warren Ward, from the Queensland Eating Disorder Service (QuEDS), who highlighted the risk factors and implications of a starved brain in identifying and working alongside individuals experiencing an eating disorder.
3) Western Queensland PHN
Following a high level of interest in the Addressing Eating Disorders in Primary Care workshop in Mt Isa, Queensland, in November 2018, the NEDC recently had the pleasure of working with Western Queensland PHN (WQPHN) once again in Roma. Working collaboratively with WQPHN and QuEDS, over 30 additional primary health care professionals have now received the Addressing Eating Disorders in Primary Care training.
3) WHAT’S NEXT
As the NEDC continues to engage with Primary Health Networks throughout Australia, we look forward to collaborating with the following PHNs and other local service providers to present introductory workshops ‘Addressing Eating Disorders in Primary Care’ in the coming months. Workshops are scheduled to be carried out in the following areas working in collaboration with the relevant PHN’s.
• North Coast
• Central and Eastern Sydney
• Western Sydney – WentWest,
• Western Victoria
• Western Australia Primary Health Alliance,
• Central Queensland, Wide Bay, Sunshine Coast
• Brisbane North
• Gold Coast
Our Introduction to Eating Disorders Workshop has been designed to increase awareness among professionals who interact with people with eating disorders as part of their professional role, even if it is not the primary focus of their role. These workshops are helpful for health professionals, teachers, community workers, fitness professionals, and emergency workers, although they are available to all professionals that feel the workshop and training would contribute to professional development and service improvement.
The NEDC can tailor our workshops to include training specific to your organisational needs and or the healthcare/educational setting.
In delivering this training, we work in collaboration with eating disorder-specific organisations and with professionals with expertise and a shared interest in eating disorders.
If you would like more information about our work with the Australian Primary Health Network’s (PHN’s) or would like to request training in eating disorders, please contact the NEDC by email at email@example.com