Dr Bryan Lask: A Memorial

Posted on by ncfed

Bryan Lask my colleague and innovative anorexia expert died on October 24th 2015. This is my commemoration to him.

Bryan and I taught together on our childhood eating disorders and obesity course. While he spoke about eating difficulties and anorexia, I would cover the obesity side.  Bryan was at the time involved with working out the neuroscience abnormalities associated with anorexia nervosa. He was very excited to be involved with this research with colleagues in Oslo.

While I was also excited about new thinking for anorexia, it seemed that the old treatments still applied. We still have  no option other than to help break open the thinking and rigid behaviour and discover ways to encourage people to begin taking care of themselves again with food. There was still no pill to correct the anorexia ill.

Until the mid-1990s, it was assumed that the causes of anorexia lay in the personalities and upbringing of sufferers. Inevitably parents felt guilty. What Lask and his colleagues discovered were abnormalities in the way that blood flowed through the brains of people with anorexia. I asked Bryan if this was the cause or effect of starvation. He did not know but his latest researches with Ken Nunn seemed to suggest that abnormalities pre-dated the illness.

Their research coincided with a general move at that time to explore psychiatry through the lens of neuroscience. Bryan, an expert communicator would describe the area of the brain most affected by poor circulation as the Clapham Junction of the brain, connecting many areas which affect how we process information and act on it. When he appeared on a Radio 4 programme  to talk about this, the response was so positive that they considered setting a Bryan Lask fan club!

Bryan was so excited by the neuro. findings on anorexia that he set up a research programme at the University of Oslo and this was on going until his life ended. I had no idea that he was unwell because his energy and enthusiasm was boundless.  I am grateful that he had experienced the joy of having a grandson Raffi who was born during one of our training events.  I am particularly grateful that he was one of the people who inspired my work with anorexia and with the problems of overweight children. The first thing he told me 30 years ago, don’t put fat children on a diet. This has informed my life in many ways.

Thank you Bryan and,  rest in peace.

Children With ADHD And Eating Disorder Risk

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This is a guest blog contributed by Stevan McGrath with some comments by Deanne Jade.  He has found an article attempting to relate ADHD to eating disorders in children. True eating disorders such as anorexia in children are very rare. In addition we must not confuse associations or shared features with cause and effect.

 The evidence does not suggest a strong relationship between ADHD and childhood eating disorders or obesity. In my experience however ADHD if present can complicate treatment. ADHD if treated with medication does not result in a changed relationship with food, nor does it solve a weight problem.

In the last five years, several doctors and other clinicians have attempted see if there is a relationship between attention deficit hyperactivity disorders (ADHD) and eating disorders in children.  They searched for factors that might reveal a possible relationship between having ADHD and eating disorders This article will try to shed light on and discuss the results of these studies in an attempt to explain why  children with ADHD are also at risk for eating disorders. This article will explore several hypotheses and discuss the possible implications for the treatment and management of both ADHD and eating disorders.

ADHD includes a pervasive pattern of inattention and/or hyperactivity and impulsivity. Fernández-Aranda et al. discuss in one study that ADHD, though described as a children’s disorder, could persist well into adulthood. The study of Erhart et al., on the other hand, describes ADHD as a  psychiatric condition of childhood that affects 3-10% of school-aged children.

As for eating disorders in children, it is hard to diagnose these because children do not commonly confess to the body image disturbances that underlie true eating disorders. They may not show weight loss which is typical of anorexia but they may fail to grow and thrive. The most common eating disorders, Compulsive Eating and Bulimia nervosa are rare in pre pubertal children and tends to emerge later in adolescence which anorexia nervosa typically emerges early in adolescence.

Eating disorders are characterized by dietary chaos and sometimes extreme weight control strategies that are harmful to physical and emotional health. They affect many different organ systems of the body, including the gastrointestinal, musculoskeletal, endocrinal, and central nervous systems. An example of a screening test that checks for persistent eating disorders available to paediatricians is the SCOFF (Sick, Control, One stone, Fat, Food) questionnaire. However other conditions which result in changed eating and appetite must be ruled out first.

At this point, the question remains: given the characteristics of children diagnosed with ADHD symptoms, and the characteristic of people having eating disorders, do we have evidence relating both of these diseases? Do doctors and other medical practitioners believe that children with ADHD have a significantly higher risk of having eating disorders?  There have been several studies published in medical journals during the last five years. These studies attempt to look at factors that may or may not contribute to a higher risk of eating disorders in children with ADHD.

One study by Stulz et al. discusses a possible connection between three key features of ADHD and eating disorders. The researchers considered the following characteristics: inattention, hyperactivity, and impulsivity, which are ADHD core symptoms, and looks at their manifestation in eating disorder patients. Stulz et al. mention in the study that binge eating and purging behaviors could be often described as impulsive, which is one core feature of bulimia nervosa (BN). Another study mentioned that people suffering from anorexia nervosa (AN) and BN symptoms show impairments in attention in neuropsychological testing compared to healthy control subjects. Excessive exercising, which is a typical of anorexia, can also be considered as an expression of hyperactive or restless behaviour.

(It has to be pointed out by Deanne Jade that some of these “character” elements can be explained simply as being a consequence of starvation and malnutrition).

There are also studies that point in the direction of an increased prevalence of eating disorders in general and BN in particular in samples of ADHD-symptomatic individuals. Wentz et al., as cited by Stulz et al., discovered an ADHD prevalence rate of 10-17% in eating disorder patients, all of whom had purging-type AN. Although there was no control group, the findings of this study suggest that the rate of ADHD may be increased in eating disorder patients. (But is this due to poor diet…) The presence of co-morbid ADHD in eating disorder patients may affect the course of illnesses and thus may be highly relevant for the treatment of eating disorder.

Erhart et al. propose that children and adolescents with ADHD may be at higher risk for overweight and obesity. The prevalence of ADHD in a sample of children was significantly higher for overweight/obese (7%) than for normal weight (3.5%) and underweight (4.9%) children. This means that overweight/obese children are twice as likely to have an ADHD diagnosis.

Subsequent analyses also show that children with ADHD more frequently reported eating problems than their non-ADHD-symptomatic counterparts. Should clinicians thus be alerted to the risk of ADHD in overweight or eating disordered children?  We must bear in mind that this sample is small and the risk of ADHD is also small,  and the ADHD may not therefore play a major role in determining the severity of eating disorder symptoms.

Children and young adults with eating disorders can present a doctor with a variety of signs, including severe weight loss, vomiting, growth/pubertal delay, and amenorrhea. One can suspect an adolescent girl who shows weight loss, exercises excessively, or engages in unhealthy weight control behaviors of having an eating disorder, according to Martin and Golden. The presence of ADHD in childhood, they say, can help in the management of eating disorder symptoms if diagnosed early, since both illnesses manifest some common genetic/behavioural indicators. It is suggested that managing these ADHD symptoms, either by cognitive behaviour therapy or through medical or drug interventions, may result in a significantly lower incidence of eating disorders in the future. Clinical practitioners who work with eating disorders may also want to find out if the patient shows ADHD symptoms. Some of these medical studies observed that some failures in the treatment of eating disorders might be attributable to undiagnosed ADHD symptoms in children and adults.

Although ADHD is sometimes observed in young people with eating disorders, the relationship between these two disorders is complex. In the end, the researchers argue that increased understanding of ADHD symptoms in children versus indicators of eating disorders could result in significantly better management of eating disorders by handling the core symptoms associated with ADHD, such as impulsivity, hyperactivity, and inattentiveness. Conversely, managing the symptoms of eating disorders may have a significant impact on the management of ADHD in both children and adults.

Deanne Jade adds, changing the diet is known to be highly effective in reducing symptoms BELEIVED to be characteristic of ADHD due to the effect of nutrition on the brain.

References:

1) Fernández-Aranda, Fernando, et al. “ADHD Symptomatology In Eating Disorders: A Secondary Psychopathological Measure Of Severity?.” BMC Psychiatry 13.1 (2013): 1-8. Academic Search Premier. Web. 1 May 2015.

2) Erhart, Michael, et al. “Examining The Relationship Between Attention-Deficit/Hyperactivity Disorder And Overweight In Children And Adolescents.” European Child & Adolescent Psychiatry 21.1 (2012): 39-49. Academic Search Premier. Web. 2 May 2015.

 4) Cortese, Samuele, Bernardo Dalla Bernardina, and Marie-Christine Mouren. “Attention-Deficit/Hyperactivity Disorder (ADHD) And Binge Eating.” Nutrition Reviews 65.9 (2007): 404-411. Academic Search Premier. Web. 1 May 2015.

5) “Working To Better Define Eating Disorders In Youth.” Eating Disorders Review 21.4 (2010): 3. Academic Search Premier. Web. 2 May 2015.

 Author Bio: Stevan McGrath’s writing domain revolves around topics like health and fitness, latest technologies, product reviews, etc. He is a contributing writer to various other websites.

 

Do Children Need Fat Camps?

Posted on by ncfed

A mum wants you and me to pay for her child to go to a fat camp. The child says it’s her mother’s fault she is overweight. The child might be right. Fat is a family issue. The fat camps will probably look at the family system and should not just be used to take fat off the child. The child is about to hit puberty anyway, a time of weight gain, and it looks like mum is struggling too.

There are thousands of overweight children in the UK with parents who were overweight well before birth, passing on a dangerous legacy to their children. There is no quick fix for this.  I have some really bad news to pass to the mother, if you can find her. The evidence is that children who lose weight often put it back on at a dangerous rate unless something in the family changes. The family will need to change their diet and lifestyle – FOREVER.  They will need a great deal of help, to manage an obesogenic food environment, they will need to change their ways of having fun, and they will need new ways of bonding together with other people who don’t care about eating healthy food. Its an enormous ask.

So, if you can get hold of this mother, get her to talk to me first. I will help her to understand that the fat camp isn’t a quick fix. The mother needs more help than the child right now. Get her to give me a call.

CHECK THIS ARTICLE OUT RIGHT NOW AND HAVE YOUR SAY

 

 

Do People With Eating Disorders Really Care About Fat And Sugar

Posted on by ncfed

2015-03-11 18.01.11The experts are now making demons of sugar and saying its really OK to eat fat and fat doesn’t make you fat. I think the message will get home in about 100 years but I don’t think that people who suffer with bulimia and anorexia will take much notice. Because eating is the problem and the nutrients don’t matter very much.  I often wonder whether if people with eating disorders could eat anything they liked and not gain weight, they would still be afraid of food. Because food means much more than what it is in it.

Anyway follow my link TO THIS BOOK  and you can read a review about Fat and Sugar in food. The book which is referenced is “Pure White and Deadly by the way, not sweet white and deadly. And I have a  very old copy.

 

 

Diet Fads Are Destroying Us

Posted on by ncfed

Im about to do another obesity training, hot on the heels of more stories about how fat we are becoming. We are told that the great british diet is destroying us and that we should take more responsibility for our food choices. Less sugar, more mung beans so long as they are sprouted. We will live forever, be disease free and get to heaven when we die.

On the other side of the coin, I am doing so much work with people who are terrified to eat and find it hard to manage the idea of eating a piece of cake on their birthday.

And by inbox is full of stuff from nutritional experts trying to convince me that more gluco-oligo-saccharides in my diet are the key to happiness and fitness.

On a practical level, I’ve been visiting my granddaughter in Beirut. Child rearing practices there seem to be a battle between those who let their children and themselves eat whatever, for all sorts of reasons, and those whose children have not seen an ice cream in years. My daughter now asks me, how do we know what is moderate and how do I feed my child without creating either a sense of emotional deprivation by saying NO , or lead my child to physical harm.

I wish I knew the answer, but I don’t. So it is back to grandmother. A little bit of what you fancy does you good. And no one will perish by eating a little sugar or wheat or dairy ice cream. So please take a minute to check this out.

Diet Fads Are Destroying Us

 

How To Build A Girl

Posted on by ncfed

Caitlin Moran writes in the Times, such a good article. She gives me permission to share it with you since not everyone reads The Times

“What I would say to all teenage girls who are struggling or overwhelmed right now”

I have just finished a tour where I spoke on stage, for two hours, about doubt and self loathing, anxiety, eating disorders, hope, joy and wanting to change both yourself and the world – because those are the subjects of my latest book, How to Build a Girl. And unless I was ill, I would always sign books and meet everyone after.

……..

When you are someone who talks about the bloody war of attrition that adolescence can so often be – especially for girls – you tend to get two kinds of people coming to the gigs. Half are the ones who’ve already been through it – winking and hooting, “Thank you for telling the truth. And thank God it’s all over”.And the other half? They are the ones still going through it. You can tell instantly as they step up. The posture, the sleeves over the hands, something in the eyes – the girls who are struggling right now.

Some of them are hard and tense with overeating. Others , anorexic, feeling like starving baby birds when you hug them – a handful of brittle bamboo canes. There are arms furious with criss-cross razor lines. Studs in the ear, the nose, the tongue, where they have tried to reclaim their bodies from something, or someone, with the snap of a piercing gun.

Sometimes their parents are there – standing in the background, nervous, their faces anxiously projecting, “She likes you. Please make her feel better now. Oh Christ, don’t break her”.

Other times, the parents aren’t there, but still present – their carelessness or rejection as tangible as if they were standing a foot away, casting mile-long shadows. What do I say to these girls? The ones who are having the Bad Year – the Bad Year where you cannot remember why you were happy aged 12, and cannot imagine being happy at 21? What can you say in one minute, two minutes, three minutes?

So many things. That panic and anxiety will lie to you – they are gonzo, malign commentators on the events of your life. Their counsel is wrong. You are as high wired and badly advised by adrenaline as you would be by cocaine. Panic and anxiety are mad, drugged fools. Do not listen to their grinding-toothed, sweaty bulls****.

Here is a promise, and a fact: you will never, in your life, ever have to deal with anything more than the next minute. However much it feels like you are approaching an event – an exam, a conversation, a decision, a kiss – where, if you screw it up, the entire future will just burn to hell in front of you and you will end, you are not. That will never happen. That is not what happens. The minutes always come one at a time, inside hours that come one at a time, inside days that come one at a time – all orderly strung, like pearls on a necklace, suspended in a graceful line. You will never, ever have to deal with more than the next 60 seconds. Do the calm, right thing that needs to be done in that minute. The work, or the breathing, or the smile. You can do that, for just one minute. And if you can do a minute, you can do the next.

Pretend you are your own baby. You would never cut that baby or starve it, or overfeed it until it cried in pain, or tell it it was worthless. Sometimes, girls have to be mothers to themselves. Your body wants to live – that’s all and everything it was born to do. Let it do that, in the safety you provide it. Protect it. That is your biggest job. To protect your skin, and heart.

Buy flowers – or if you are poor, steal one from someone’s garden; the world owes you that much at least: blossom – and put them at the end of the bed. When you wake, look at it, and tell yourself you are the kind of person who wakes up and sees flowers. This stops your first thought being, “I fear today. Today is the day maybe I cannot survive anymore, ” which I know is what you would otherwise think. Thinking about blossom before you think about terror is what girls must always do, in the Bad Years.

And the most important thing? To know that you were not born like this. You were not born scared and self-loathing and overwhelmed. Things have been done – which means things can be undone. It is hard work. But you are not scared of hard work, compared with everything else you have dealt with. Because what you must do right now, and for the rest of your life, is learn how to build a girl. You.

And Deanne says. Thank you Caitlin for saying these things with the words I can’t always find.

How To Respect & Love Your Body

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People send me the loveliest things. Here is one Kat sent me today if you follow this link to You Tube. Please keep sending me your lovely things. We want inspiration, more than accounts of suffering which can inspire people to do the same… or am I wrong?

Kats film about self esteem

 

 

From Big Bottoms To Thin Waists

Posted on by ncfed

Tanith Carey, author of Where Has My Little Girl Gone (and other books) see our Books pages, writes with a little help from me (Deanne) about the new rib-breaking trend to make your waist pint sized. Read her article here which was published in the Daily Mail today.

> Posted in Body image, Deanne's BlogTagged ,

Burning To Be Thin : DNP

Posted on by ncfed

Dear Eloise Parry,

I am sorry that you aren’t alive any more. I have seen your picture smiling from the newspapers and you look as if you don’t have a care in the world. But something must have been really on your mind to take so much time and trouble to buy some rogue tablets that you hoped would make you thin.  I imagine that you had terrible body image problems. You must have been really at war with yourself to take 8 tablets. You must have had an eating disorder.

I wish you could tell me what was going through your mind when you bought these things. I wonder who told you about them. What was the agony you were feeling when you went searching for this poison?  Did you think you had stumbled on a good idea?

I wonder what was going through your mind as you swallowed them one by one. Did you know that you were about to lose your life, your dreams. All for being a little bit thinner.

Did you think that you would be able to take these monstrous things for the rest of your life? Did you think that getting thin would keep you thin? Everyone who goes on a diet; everyone who swallows pills –  thinks that being thin will keep you thin forever. It doesn’t happen.

Did you want to be another eating disorder victim?  It won’t bring you any medals. Life will still go on but not for you. If only I could rewind time and say to you, please don’t buy into the madness of trying to feel better by destroying your body. Rest in peace.

Understanding Fasting

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Both ascetics and anorectics strive for perfection . . . Striving towards the ascetic image is a source of satisfaction, and a source of liberation from imprisonment of the body (or from its definition by others) and its bondage to an unacceptable world. In both cases, asceticism is not experienced as self-destructive, but as self-liberating.

Many with anorexia use their religious beliefs to justify extreme fasting, using some of the same rationalisations as the religious ascetic Both have similar goals, such as:

  • Drawing closer to Divinity
  • Becoming more God-like
  • Becoming more worthy of Grace
  • Weakening the body in order to reduce or eliminate human appetites.

Now these aims are very spiritual and appear worthy. There have been many reports of fasting saints especially before medieval times. These saints were venerated.  Ascetic aims can also mask emotional illness in both the religious ascetic and the anorexic.  So let’s just say that there are connections between all people who fast to bring them closer to a nirvana of one sort or another. It is not just about getting a thigh gap or wearing size zero. They develop a relationship with fasting which becomes more important than the relationship with anything or anyone else.

Virtually every recovering anorectic has had a close relationship with fasting. If a therapist lacks a thorough understanding of fasting from spiritual, psychological, and medical perspectives, he or she could unintentionally allow the anorectic to keep their relationship with fasting a secret. Imagine the therapy session in this way; the anorexic patient is describing a personal experience about fasting, but it becomes clear to the patient that the therapist has only a peripheral understanding of fasting. The anorectic is now the expert on what is a critical feature of their psychiatric disorder and the therapist loses credibility when discussing the topic.

We therapists need to  understand of the importance of exploring fasting behaviour in anorexic patients. And treatment needs to include a discussion of what fasting means to each patient. It is not just about fear of food, it is sometimes the quest for an unattainable emotion or an exalted state of mind.  
There is a saying among mental health professionals, “You’re only as sick as your secrets”.  This implies that holding onto secrets—as opposed to revealing them in a safe setting such as during psychotherapy—could potentially impede the recovery of the eating disordered patient.

So as part of this, therapists even without religious feelings themselves should examine the religious and spiritual beliefs of someone with anorexia. Time spent to helping a sufferer to achieve elation in more helpful ways is known to make a difference.