Last week I presented a talk at the annual MEDA Conference on an often ignored fact about eating disorders—those struggling with eating disorders have high suicide rates and are at increased risk of suicide.

Buried in a new study led by Sonja Swanson, Sc.M., of the National Institute of Mental Health were new statistics on suicidality among adolescent with eating disorders. The study examined eating disorder data from a nationally representative sample of 10,123 adolescents ages 13 to 18 years. The primary purpose of the study was to determine the prevalence rates of anorexia, bulimia, binge eating disorder, and subthreshold eating disorders.

In a few short paragraphs in the article were data on suicidality in eating disorders. The study’s authors found that adolescents with eating disorders had higher rates of suicidal ideation, planning, and attempts than their peers without eating disorders.

A sample of the study results:

Rates for Suicidal Ideation (thoughts about suicide)

• One-third of adolescents struggling with anorexia
• One-third adolescents struggling with binge eating disorder
• More than half of those with bulimia
• A little more than 10% of adolescents without an eating disorder

Rates for Suicide Attempts

• About 8% for those with anorexia
• About 35% for bulimics
• 15% for those struggling with binge eating disorder
• 3% of adolescents without an eating disorder

Suicide is a deadly byproduct of eating disorders. Those struggling with eating disorders are more apt to think about suicide, plan and ultimately attempt suicide.

More light needs to be shed on this issue.

As Passover descends upon us this year, I came across this article highlighting the growing concerns about eating disorders in the Orthodox Jewish community.

Although it may not be well known, the Orthodox community faces unique pressures and challenges that may put young women at risk of eating disorders.

• Although Orthodox women dress modestly, matchmakers routinely ask about a prospective bride’s dress size, with the implication that smaller is better.
• Girls are often expected to help care for younger siblings in large Orthodox families, limiting time to pursue their own interests.
• Orthodox women subscribe to a strict code of conduct, with few outlets for rebellion.
• Young women may avoid psychiatric care in fear that it may affect their chances of a successful match.

Although research is limited and exact figures are not known, many rabbis are calling attention to the growing problem of eating disorders in the Orthodox community in the US. As more Orthodox Jews seek treatment for eating disorders, treatment centers now accommodate their needs. The Renfrew Center, a residential eating disorder facility, now offers kosher food at its clinics in Philadelphia, New York, Dallas and Florida.

As more attention is drawn to this issue in the Orthodox community, hopefully more young women will get help for their eating disorders.

Just the other day I came across a news story about a woman who had committed suicide after a long-term battle with depression and an eating disorder. Helen Williams was only 38 years old.

Helen’s story is not uncommon. Many patients struggling with eating disorders often have depression. The statistics associated with both illnesses are shocking.

• 1 in 5 diagnosed with anorexia will die within 20 years after initial diagnosis
• Anorexia has the highest death rate of any disorder treated by psychiatrists
• Currently only 30-40% of individuals with anorexia fully recover
• Up to 88% of patients with anorexia have a diagnosis of depression
• Roughly 70% of individuals with depression will experience recurring episodes throughout their lifetime

Why is anorexia (and other eating disorders) so inexplicably linked to depression? Malnutrition.

Malnutrition exacerbates depression and eating disorder behaviors by depleting the brain and body of vital nutrients. These nutritional deficiencies can and do have profound effects on the brain. Several studies have shown that deficiencies of zinc, cholesterol, and B vitamins are found in patients with depression. People struggling with eating disorders may also have abnormal levels of zinc and other nutrients.

Treating the malnutrition is a key step to recovery from anorexia, other eating disorders, and depression.

In April and May, I will be addressing these issues of malnutrition in depression and eating disorders at various seminars and conferences. I welcome you all to join me as I concentrate on topics such as nutritional strategies in the treatment and prevention of depression and eating disorders, focusing specifically on zinc, cholesterol, essential fatty acids, and B vitamins.

Helen’s story is too common. It doesn’t have to be.

Any provider in the field of eating disorders recognizes the voice. The caller on the other line sounds tired, frustrated, helpless, hopeless, and in need of a friendly voice.

The story sounds vaguely familiar. A young child, who at first was a picky eater, delves into the world of dieting. The amount of weight loss is significant enough to catch the attention of the parents, the school and the pediatrician. A plan is devised and there is progress until relapse happens. Then the parents’ worst fear becomes reality – outpatient level of care is not enough. They must send their child to an inpatient eating disorder facility. The parents scour the country in search of the best hospital that will offer their child the greatest opportunity to achieve recovery. Cost is not a concern, only the child’s health.

But what happens if the care the child is receiving does not match up with parents’ expectations? What if the old way of treating eating disorders no longer works?

That call I received was a reminder that providers in the field of eating disorders continue to be unwilling to alter current treatment models to better serve our patients. The end results are often an extended treatment stay, higher rate of relapse and an even more discouraged family.

The call in question concerned the use of multivitamins. Those small, chewable or swallowable tablets and capsules that many doctors today encourage children and adults to take regularly, was the tipping point for one family.

After months of self-starvation, a young boy’s medical and emotional health was greatly compromised. After much research his parents sent him to a prestigious and highly reputable medical center in the Midwest to be treated for anorexia nervosa. Once there doctors found that he was deficient in a number of essential vitamins and nutrients. When his parents asked the hospital staff to provide their son with a daily multivitamin they were told No. His nutrients were to come from food only, not through supplements.

Why would a hospital take such a hard stance on what most would consider a relatively harmless request?

Most Americans are not consuming a varied enough diet to meet their vitamin needs through food. The U.S. diet, especially the diet of adolescents, often lacks fruits and vegetables, which contain many vitamins and nutrients. Certain populations likely to be vitamin deficient include pregnant women, the elderly, vegans and patients with malabsorption problems (often patients with eating disorders).

Low vitamin and nutrient intake can be risk factors for diseases. In a scientific review published in the Journal of the American Medical Association, the authors discussed how vitamin deficiency and “suboptimal vitamin status” can be risk factors for chronic diseases such as, cardiovascular disease, neural tube defects, colon and breast cancer, and osteopenia which can lead to increased risk of fractures.

There is little harm associated with taking a multivitamin, as long as it’s taken appropriately. Like any supplement, a multivitamin serves the needs of an individual who lacks proper nutrition. Taking a multivitamin or any supplement helps the body adjust to receiving nutrients and move from a state of deficiency to full health. As the brain becomes well nourished, more stable thought processes occur.

While in an ideal world all individuals would be able to have their nutrient needs met through food, the fact is that in today’s world this is not a possibility for most people. In light of this, it is especially important for a patient battling an eating disorder to be given a multivitamin in addition to food.

Until the eating disorder field recognizes there is no one way to recover and encourages more eclectic treatment plans, calls like the one above will continue.

Is fat good or bad? Well, the answer is it depends.

Bad fats include saturated and trans fats often found in fried, greasy foods or anything made with butter, shortening, lard, or hydrogenated or partially hydrogenated fats. There are few who would argue that these fats have any role in good nutrition and health.

The good fats, on the other hand, play a critical role in your body’s maintenance and have a major impact on mental and physical health. Every cell in your body needs these good fats. The membrane surrounding each cell is made of fat and without this fat the cell loses its structure and stability. Even more important, the brain needs essential fatty acids (good fats) for proper function, growth, and development. About 60 percent of the dry weight of the brain is fat.

Fat is particularly important in anorexia. Individuals struggling with anorexia commonly have an extreme fear of gaining weight leading them to avoid eating foods containing any amount of fat. Over a short amount of time this can lead to deficiencies in EFAs which can contribute to higher cholesterol levels, osteoporosis, depression, increased cardiac episodes and even increased suicide risk.

Not surprisingly some researchers are looking into EFA supplementation to treat patients with anorexia. In one study patients with anorexia experienced improved mood (less anxiety and decreased preoccupation with food) and overall health when they received a daily EFA supplement in addition to standard treatment. While individuals were receiving supplementation, not one relapsed and all restored some weight.

Getting enough good fat is important for those with anorexia and for everyone.

Ever wonder what happens to certain ideas in medicine? Ideas that seem far-fetched, but would be miraculous if they worked…

They get tossed out like a rotten tomato.

Dr. James Goodwin and his wife Dr. Jean Goodwin coined the term the “tomato effect” in 1984 to describe what happens in medicine when “an efficacious treatment for a certain disease is ignored or rejected because it does not ‘make sense’ in light of accepted theories of disease mechanism and drug action.”

The rejection of a potentially effective treatment because “everyone knows it won’t work” is named for Americans’ belief from the 16th to the 19th centuries that tomatoes were poisonous.

And the tomato effect helps explain the reluctance of the medical community to embrace nutritional therapies for anorexia nervosa.

For decades the medical community has widely accepted that returning to a healthy body weight would lead to a healthy mind and ultimately recovery from anorexia. But treatment based on this flawed idea is failing innumerable patients and their loved ones. Nearly 35% of patients with anorexia who reach near-normal weight relapse!

Looking only at a person’s health in terms of pounds over-simplifies this complicated disease.

Anorexia is a disorder of self-starvation and profound malnutrition; yet, nutritional supplementation is rarely part of standard treatment. Even when weight is restored nutritional deficiencies (i.e. zinc, B12, amino acids, and essential fatty acids) often continue.

Doctors, patients, loved ones, and the general public need to be aware of the tomato effect in the treatment of anorexia nervosa. It’s time to view anorexia nervosa as a disease of extreme malnutrition.

Thanksgiving without turkey may seem like heresy, but for many Americans Thanksgiving (and the rest of the year) will be meatless.

According to a 2008 study published by the Vegetarian Times about 3.2% of Americans, or 7.3 million people, are vegetarians who choose not to eat meat, poultry, fish, and their by-products. Of these vegetarians, 59% are female.

So, what is so shocking about choosing not to eat meat? Absolutely nothing, as long as vegetarians meet their nutrient needs (especially iron, zinc, and vitamin B12). Health studies have shown that adult vegetarians tend to exercise more, drink less, and maintain a lower weight than non-vegetarians.

But not all vegetarians are so healthy and for some, vegetarianism can be an excuse for diet restriction, especially amongst those 59% of vegetarians who are women.

Several studies conducted with adolescents and college students have found alarming trends among female vegetarians. Here are some results from those studies:

• An Australian study of more than 2,000 teenagers found that self-described female vegetarians were more likely to be preoccupied with thinness and practice food restriction to burn calories.
• One study found that 56% of the patients in an eating disorder clinic cut out meat from their diets anywhere from 1 to 6 years prior to the onset of anorexia.
• A Minnesota study found adolescent vegetarians were significantly more likely to exhibit bulimic behaviors than non-vegetarians.

So this Thanksgiving, whether it’s filled with turkey or not, make sure you get the nutrients you need. For those who choose a vegetarian diet be aware that vegetarianism can be associated with deficiencies of iron, zinc, and vitamin B12.