ED Science Stuff by Trisha Gura

Anorexics have Fatty Bones

Now here’s one I hadn’t heard before. Researchers recently discovered that anorexics have extra fat -- in their bone marrow. The results came from radiologists at Children’s Hospital Boston, who used MRI to image the knees of 20 girls with anorexia and 20 healthy girls of the same age.

MRI of a control patient's knee

MRI of an anorexic patient's knee

It turned out that patients with anorexia had markedly increased fat content--visualized as "yellow marrow"--and less than half as much healthy red marrow in their knees.

What does this mean?

No one knows. The researchers are guessing that fatty knees has something to do with the body's attempt to store energy and preserve warmth in the face of starvation. Researchers are also bantering about the hormonal consequences of malnutrition.  Hormonal changes can prompt stem cells in the bone to mature into fat cells (adipocytes) rather than bone-forming cells (osteoblasts). This altered-path phenomenon may explain why people with anorexia nervosa lose bone mass, sometimes leading to osteoporosis and fractures.

The finding is provocative and worthy of further study.

“It’s counter-intuitive that an emaciated young woman with almost no subcutaneous fat would be storing fat in her marrow," says endocrinologist Catherine Gordon, MD, MSc, director of the Bone Health Program at Children's and the study's senior investigator.

But perhaps that's nature way of keeping the body alive during times of famine. And something we just really don't understand very well.

Kudos to nature and human resilience. But how sad that such an insidious disease must continually test nature’s limits. Let’s hope the research brings news avenues for therapy. And better yet, more maneuvers to outwit anorexia.             

Don't Say, "Don't Panic."

It’s only a number. A number on a bathroom scale. But when the number ventures into new territory, higher territory, than the number to a recovering anorexic isn’t just a number. It’s source of panic.

Panic is a form of anxiety. It’s fast. It’s rush-like. It’s awful. Some components are mental: an apprehensive mood. Others physical: drumbeat racing from the heart. Panic is also emotional; something is really wrong and that fear is escalating. Panic prompts behaviors such as starving oneself for a day to try and avoid experiencing the same discomfort at the offending number.

And therein lays the connection to an eating disorder.

For many who suffer, an eating disorder is, in part, an attempt to escape, avoid or override panic. Ironically, panic often hits hardest when a person is trying to relax. It’s as if she lets her guard down and in the panic flows. But that’s because she’s spent so long trying to fend it off, using her eating disorder as one misguided weapon.

Therefore, a key step in dealing with such bursts of high anxiety is learning how to ride through the experience – and without seeking out the eating disorder as a crutch.

There are many books and cognitive behavioral therapies that work with exactly this approach. For the purposes of this blog, I turn to psychologist Larina Kase who in an article entitled “Don't Panic:Taking Control of Your Anxiety,” lays out a simpler a five-step strategy to help an anxiety-sufferer through.

• Get to Know Your Panic Cycle

Maybe you get a feeling of restlessness, followed by nervousness. Maybe you start thinking about food, getting ready for a binge. Maybe you make a plan to get your favored foods. Stop for a moment. Recognize that panic is about to happen. And prepare yourself for the surge.

• Remember Panic Won’t Kill You
  Panic simply is your body’s evolutionary fight-or-flight response set in motion by a false trigger. Fight or flight is good. It allowed cavemen to deal with life and death crises. But try to remember that a number on a bathroom scale is not the same thing as an attack by a wooly mammoth. It’s an illusion that the mind has cleverly played to get you to act a certain way.

 

• Try to Derail in Your Negative Thought Train
  Often the thoughts that arise during this phase are highly irrational. If I gain weight, I’ll never be able to stop, for example.  Challenge the thought. Is it really true? Write it down and see. It may look pretty ridiculous on paper.

• Realize that You Really Are in Control
  Panic is so uncomfortable that you might vow you will never experience it again. After you binge, for example, you rush to purge to avoid the discomfort, thinking you can.  But this strategy backfires because you will probably experience the same anxiety again, the next time you encounter food. That’s because you never dealt with the anxiety. See what happens if you don’t dodge the discomfort. If you practice enough times, you’ll gain confidence and control as you realize you can handle it.

• Practice through Staging
  The worst feelings often hit when you are at your worst. So why not try letting down your guard when you are feeling at your best. Put yourself in a controlled situation that evokes the anxiety. Stand in front of a mirror while with your therapist, for example. Then work on experiencing the feelings. Be in your body, as you do. Tools like mindfulness can help. The see what happens.

Remember that trying to fight off, shut off or steer off panic actually intensifies it in the long run. You need to experience anxiety to overcome it. And then practice your reactions.

One way to think of it is biological.  Panic can’t last forever because it’s a sympathetic nervous system response. Fight-or-flight. Your body won’t let you stay that way. Eventually the parasympathetic nervous system kicks in, a puts you back into balance. You’ll feel tired. Maybe a bit drained. But as you realize you’ve made it through and the panic has dissolved, you gain a sense of control.

On a metaphorical level, high anxiety is like a current and you are a rock on the middle of river. By not reacting, you can discover that panic won’t destroy you. It may move you a bit. Or feel overwhelming. But you’ll make it. And get better at coping for the next time.

This is the first in a series of blogs on the emotions behind an eating disorder.

What Makes You Go Back?

About a year ago, I gave a talk to a group of patients with eating disorders at Sheppard Pratt. Apart from obvious signs of eating disorders (e.g., low weight), the group couldn’t have been more different, given the age range was 11 to 55 years. What could I say to a preteen to which a mid-lifer could also relate?

The answer was simple: the eating disorder itself. I described what happened when my eating disorder was active. I spoke about a voice in my head, harsh sometimes, seductive others.  It cajoles me into old behaviors. I saw the nods and the tears and I knew I hit my mark.

And then one young girl raised her hand. “What do you do when you start to recover and you go back out into the world, and you start slipping back?

The temptation is so common. But the what-to-do is not.  How to prevent relapse often comes from the individual. How else can a person feel empowered to get better -- other than finding his or her way to confront the voice?

To help in that journey, I’d like to begin a series of blog posts that deal with the mind.

There’s a wide body of research that looks at eating disorder causes. One of great interest is genetics. The idea is that genes give a person a predisposition for an eating disorder. It manifests as a personality style. Someone prone to an eating disorder is generally, driven, thin-skinned and hyper-perfectionist. For bulimia and binge eating disorder, notes of impulsiveness and depression can also chime in. The idea is that experiments with food and weight are means to numb out, swallow, override, distract from or generally cope with the pain a person with the predisposition feels when his or her personality type collides with life.

The eating disorder, then, becomes the means to check out of experiencing the full force of life. While palliative in the moment, however, disordered eating backfires in the end. The person afflicted never learns the skills to face trauma or cope with everyday life because the eating disorder has stifled the growing pains. So there is stunted psychic growth.

On the recovery end, taking away the eating disorder leaves hole. Back out in the world, reality hits. But reality to a child-minded person is too much. And then comes the voice, offering refuge.

In the next series of blogs, I’d like to explore that “hole.” It’s not necessarily a dark place. More like sitting in the epicenter of emotions, long unfelt – worry, depression, joy, anger, contentment, boredom and so on. How does one cope without the eating disorder behaviors to buffer?

I’d like to explore the answers, emotion by emotion. Explorations yield insights. And insights can bring real change. You can learn to tolerate the discomfort. It passes. And then you can move on…