Therapy for bulimia nervosa, as for anorexia nervosa, requires a team of experienced clinicians. These patients are less likely than those with anorexia to enter treatment in a state of semistarvation. However, if a bulimic patient has lost significant weight, this must be treated before psychological treatment begins. Although clinicians have yet to agree on the best therapy for bulimia nervosa, they generally agree that treatment should last at least 16 weeks. Hospitalization may be indicated in cases of extreme laxative abuse, regular vomiting, substance abuse, and depression, especially if physical harm is evident.
The first goal of treatment for bulimia nervosa is to decrease the amount of food consumed in a binge session in order to decrease the risk of esophageal tears from related purging by vomiting. A decrease in the number of this type of purges will also decrease damage to the teeth.
The primary aim of psychotherapy is to improve patients' self-acceptance and help them to be less concerned about body weight. Cognitive behavior therapy is generally used. Psychotherapy helps correct the all-or-none thinking typical of bulimic persons— "If I eat one cookie, I'm a failure and might as well binge." A patient may be asked to analyze the statement as a scientist would do when testing assumptions. In this way, patient and therapist together examine the validity of food and weight beliefs. The premise of this therapy is that, if abnormal attitudes and beliefs can be altered, normal eating will follow. In addition, the therapist guides the person in establishing food habits that will minimize bingeing: avoiding fasting, eating regular meals, and using alternative methods—other than eating—to cope with stressful situations. Group therapy is often useful to foster strong social support. One goal of therapy is to help bulimic persons accept as normal some depression and self-doubt.
Although pharmacological agents should not be used as the sole treatment for bulimia nervosa, studies indicate that some medications may be beneficial in conjunction with other therapies. Fluoxetine (Prozac) is the only antidepressant that has been approved by PDA for use in the treatment of bulimia nervosa, but physicians also may prescribe other forms of antidepressants and related medications.
Nutritional counseling has two main goals: correcting misconceptions about food and re-establishing regular eating habits. Patients are given information about bulimia nervosa and its consequences. Avoiding binge foods and not constantly stepping on a scale may be recommended early in treatment. The primary goal, however, is to develop a normal eating pattern. To achieve this goal, some specialists encourage patients to develop daily meal plans and keep a food diary in which they record food intake, internal sensations of hunger, environmental factors that precipitate binges, and thoughts and feelings that accompany binge-purge cycles. Keeping a food diary not only is an accurate way to monitor food intake but also may help identify situations that seem to trigger binge episodes. With the help of a therapist, patients can develop alternative coping strategies.
In general, the focus is not on stopping bingeing and purging per se but on developing regular eating habits. Once this is achieved, the binge-purge cycle should stop by itself. Patients are discouraged from following strict rules about healthy food choices, because this simply mimics the typical obsessive attitudes associated with bulimia nervosa. Rather, encouraging a mature perspective on nutrient intake—that is, regular consumption of moderate amounts of a variety of foods balanced among the food groups—helps patients overcome this disorder.
Setting time limits for the completion of meals and snacks is important for people with eating disorders. Many bulimic persons eat very quickly, reflecting their difficulties with satiety. Suggesting that the patient put his or her utensil down after each bite is a behavioral technique that a therapist might try with a recovering bulimic person. (In comparison, many anorexic persons eat in an excessively slow manner—for example, taking 1 hour to eat a muffin because it was cut into tiny, bite-size pieces.)
People with bulimia nervosa must recognize that it is a serious disorder that canhave grave medical complications if not treated. Because relapse is likely, therapyshould be long term. Note that those with bulimia nervosa need professional help because they can be very depressed and are at a high risk for suicide. About 50% of people with bulimia nervosa recover completely from the disorder. Others continue tostruggle with it to varying degrees for the rest of their lives. This fact underscores theneed for prevention because treatment is difficult.
Tuesday, June 29, 2010
Food Prejudices
Price and prejudice removed (which is rare), most people eat what is good for them. If they didn't, they would not survive. Unprejudice normal appetite is the best guide to nutrition. Man and rat are omnivorous creatures; they eat everything. Even some of the things we call prejudices or superstitions about eating have a sensible basis, sunk sometimes in deep folk wisdom. For example; on a particular island in the South Pacific, it was observed that all food was liberally sprinkled with pepper made from a pepper tree that grew in front of every household. Indeed, the marriage ritual of people on this island absolutely required that the girl to be married must take shoots or seeds from the pepper tree in front of her mother's house, and plant and grow them in front of her own. When a scientific analysis of the diet of these people was made, it was discovered that the pepper tree was the only source of vitamin C on the island.
Some personal food prejudices also have a reasonable basis in physiology and psychology. When a person says he doesn't like milk or eggs, or chocolate, or onions he may well know by personal experience that this particular food or beverage does not agree with him. He may indeed have a slight or pronounced allergy to it. Allergy to cow's milk, for instance, occurs both in infancy and later life.
Generally speaking, it is a good idea to avoid foods that you can still taste for several hours after eating foods that "repeat on you," as the saying goes. It is also understandable that you may resist foods that were forced upon you at some time earlier in your life. You may secretly feel that you are swallowing your pride with every mouthful, and this masked resentment is a detriment to digestion. On the other hand you may learn to like foods that you formerly disliked sometimes because you have discovered their nutritional value.
The child who cries for candy, ice cream, or soda pop may sometimes be expressing a real need for the extra caloric values that they make quickly available or for the love and affection the giving of them represents. The disgruntled, crying child may also be lacking other nutrients often minerals in his diet.
We must also reconcile sex differences in attitudes toward food. Women have a different outlook from men. Father may "bring home the bacon," but mother cooks it. Woman has traditionally played the role of food-giver in the household; indeed, this may be considered an extension of the mammary function. As food-giver, a woman holds a position of power in the household, and the psychological implications of this fact should not be overlooked. To give (or withhold) food is in the final analysis to have the power of life or death, and even in subtler ways it is a means of controlling members of a family.
Men are interested in good food ("good home-cooked meals, like mother used to make," they say), but women spend more time with food (count the hours in the grocery store and the kitchen) and have special interest in the preparing and giving of food which men do not generally share. Of course, there are famous male chefs, such as Oscar of the Waldorf, but this is a professional business, not a matter of crucial interpersonal relationships. Most men eat what is set before them by their mothers and wives. Hence it is not surprising that women are often more interested than men in learning about foodstuffs.
Some personal food prejudices also have a reasonable basis in physiology and psychology. When a person says he doesn't like milk or eggs, or chocolate, or onions he may well know by personal experience that this particular food or beverage does not agree with him. He may indeed have a slight or pronounced allergy to it. Allergy to cow's milk, for instance, occurs both in infancy and later life.
Generally speaking, it is a good idea to avoid foods that you can still taste for several hours after eating foods that "repeat on you," as the saying goes. It is also understandable that you may resist foods that were forced upon you at some time earlier in your life. You may secretly feel that you are swallowing your pride with every mouthful, and this masked resentment is a detriment to digestion. On the other hand you may learn to like foods that you formerly disliked sometimes because you have discovered their nutritional value.
The child who cries for candy, ice cream, or soda pop may sometimes be expressing a real need for the extra caloric values that they make quickly available or for the love and affection the giving of them represents. The disgruntled, crying child may also be lacking other nutrients often minerals in his diet.
We must also reconcile sex differences in attitudes toward food. Women have a different outlook from men. Father may "bring home the bacon," but mother cooks it. Woman has traditionally played the role of food-giver in the household; indeed, this may be considered an extension of the mammary function. As food-giver, a woman holds a position of power in the household, and the psychological implications of this fact should not be overlooked. To give (or withhold) food is in the final analysis to have the power of life or death, and even in subtler ways it is a means of controlling members of a family.
Men are interested in good food ("good home-cooked meals, like mother used to make," they say), but women spend more time with food (count the hours in the grocery store and the kitchen) and have special interest in the preparing and giving of food which men do not generally share. Of course, there are famous male chefs, such as Oscar of the Waldorf, but this is a professional business, not a matter of crucial interpersonal relationships. Most men eat what is set before them by their mothers and wives. Hence it is not surprising that women are often more interested than men in learning about foodstuffs.
Minerals in the Body
About 4% of the total weight of the body is made up of inorganic or mineral elements, chiefly calcium and phosphorus. Still, there is enough iron to make a good size nail and enough sodium for a small shaker of table salt. In general, the minerals are regulators of metabolic processes. The fourteen so-called mineral elements deemed essential in human nutrition are calcium, phosphorus, iron, sodium, zinc, copper, potassium, sulfur, manganese, magnesium, cobalt, iodine, fluorine and chlorine. "Trace amounts" of other minerals such as aluminum, silicon, and nickel are also present.
From the standpoint of human diet, however, we must give the most important consideration to the three mineral elements which are most likely to be lacking in the American diet—namely calcium, iron, and iodine. When these elements are supplied from natural food sources, the other mineral elements needed are also likely to be present. A good variety of common foods supplies required minerals in adequate quantities. The body stores and utilizes them well.
Calcium plays many roles. It is essential to the growth, development, and maintenance of bones and teeth. It is necessary to the clotting of the blood. It helps to regulate the heartbeat, to maintain the acid-base balance in the body, and to control the irritability of the neuromuscular system.
Calcium is needed throughout life, but is most important in the early years. The richest source of calcium in the human diet is milk — mother's, cow's, goat's, camel's, or mare's. Another good source is shellfish.
Phosphorus likewise is essential for the development of the bony structure of the body and the regulation of acid-base balance. In many respects calcium and phosphorus play complementary roles. Phosphorus plays an added role in carbohydrate and fat metabolism. Phosphorus is widely distributed in many foodstuffs, often in the form of phosphates. If calcium intake is adequate, phosphorus usually comes along with it.
Iron in the human body is concentrated largely in the blood and blood-forming organs, chiefly the bone marrow. It is an essential constituent of hemoglobin the crucial element in the red blood cells. It is needed for the transport of oxygen by the red blood cells.
Actually, the amount of iron required by the body is small only a few specks, equivalent to the daily intake of about 12 milligrams. Variety meats, like liver, are the best sources of iron.
Copper, as a dietary essential, usually goes along with iron, but only about one-quarter as much as needed. Sodium and potassium are another pair of minerals that complement each other's effects in cell and body metabolism; they are importantly concerned with water balance. Sodium is found in common table salt, along with chlorine that appears as hydrochloric acid in the stomach juices. Iodine is essential for the manufacture of thyroxin by the thyroid gland- Iodine is found in seafood and it is added to common table salt in the form of potassium iodide.
From the standpoint of human diet, however, we must give the most important consideration to the three mineral elements which are most likely to be lacking in the American diet—namely calcium, iron, and iodine. When these elements are supplied from natural food sources, the other mineral elements needed are also likely to be present. A good variety of common foods supplies required minerals in adequate quantities. The body stores and utilizes them well.
Calcium plays many roles. It is essential to the growth, development, and maintenance of bones and teeth. It is necessary to the clotting of the blood. It helps to regulate the heartbeat, to maintain the acid-base balance in the body, and to control the irritability of the neuromuscular system.
Calcium is needed throughout life, but is most important in the early years. The richest source of calcium in the human diet is milk — mother's, cow's, goat's, camel's, or mare's. Another good source is shellfish.
Phosphorus likewise is essential for the development of the bony structure of the body and the regulation of acid-base balance. In many respects calcium and phosphorus play complementary roles. Phosphorus plays an added role in carbohydrate and fat metabolism. Phosphorus is widely distributed in many foodstuffs, often in the form of phosphates. If calcium intake is adequate, phosphorus usually comes along with it.
Iron in the human body is concentrated largely in the blood and blood-forming organs, chiefly the bone marrow. It is an essential constituent of hemoglobin the crucial element in the red blood cells. It is needed for the transport of oxygen by the red blood cells.
Actually, the amount of iron required by the body is small only a few specks, equivalent to the daily intake of about 12 milligrams. Variety meats, like liver, are the best sources of iron.
Copper, as a dietary essential, usually goes along with iron, but only about one-quarter as much as needed. Sodium and potassium are another pair of minerals that complement each other's effects in cell and body metabolism; they are importantly concerned with water balance. Sodium is found in common table salt, along with chlorine that appears as hydrochloric acid in the stomach juices. Iodine is essential for the manufacture of thyroxin by the thyroid gland- Iodine is found in seafood and it is added to common table salt in the form of potassium iodide.
Fluorine and the Teeth
The story of fluorine in relation to the teeth is a fascinating example of controlled research and bears brief retelling. Back in the 1890's the dentists in Colorado began to observe that children and adults who had lived in the area of Colorado Springs for the first eight years of their lives had a strange kind of enamel on their teeth. It was mottled enamel, pocked with little brown or chalky-white patches.
Later this mottled enamel began turning up in other communities. Eventually it was traced to the drinking water of the community. About 1931, the specific element in the water which caused the mottled enamel was discovered. It was fluorine Of course; this gaseous element appears in chemical composition as fluoride.
Then, in the 1930's the dentists began to make a careful study of the people with mottled enamel. Contrary to previous assumption, it turned out that these people had about 60% fewer cavities than people who were brought up in areas where there were no fluorides in the water supply. In other words, the fluorides helped to protect teeth from decay.
The U.S. Public Health Service, whose dental division has conducted much of the fluoride research, then set out to determine how much fluorine added to the drinking water would cut down the caries rate and still not produce mottled enamel. The answer came out about one part per million. This amount is perfectly safe and does not mottle the teeth.
On the basis of this research some ten cities in the United States and Canada began the mass public health experiment of adding fluoride (one part per million) to their drinking water. This is called fluoridation. The results were so convincing that hundreds of communities have now added fluorides to their municipal water supplies, but not, it may be said, without public objection in many places.
Campaigns for fluoridation of public drinking water supplies as a strong line of defense against dental caries were pioneered by the U.S. Public Health Service and have been approved by virtually all important public health agencies. Nevertheless there are still many "crackpot" and a few responsible voices raised against it.
Later this mottled enamel began turning up in other communities. Eventually it was traced to the drinking water of the community. About 1931, the specific element in the water which caused the mottled enamel was discovered. It was fluorine Of course; this gaseous element appears in chemical composition as fluoride.
Then, in the 1930's the dentists began to make a careful study of the people with mottled enamel. Contrary to previous assumption, it turned out that these people had about 60% fewer cavities than people who were brought up in areas where there were no fluorides in the water supply. In other words, the fluorides helped to protect teeth from decay.
The U.S. Public Health Service, whose dental division has conducted much of the fluoride research, then set out to determine how much fluorine added to the drinking water would cut down the caries rate and still not produce mottled enamel. The answer came out about one part per million. This amount is perfectly safe and does not mottle the teeth.
On the basis of this research some ten cities in the United States and Canada began the mass public health experiment of adding fluoride (one part per million) to their drinking water. This is called fluoridation. The results were so convincing that hundreds of communities have now added fluorides to their municipal water supplies, but not, it may be said, without public objection in many places.
Campaigns for fluoridation of public drinking water supplies as a strong line of defense against dental caries were pioneered by the U.S. Public Health Service and have been approved by virtually all important public health agencies. Nevertheless there are still many "crackpot" and a few responsible voices raised against it.
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