Saturday, May 10, 2008

Fat matters

If you're a regular reader of this blog, you know that my family used the Maudsley approach to help our 14-year-old daughter recover from anorexia. (Here's a link to the whole story as published in the New York Times Magazine.)

In Maudsley, parents take charge of their child's eating while they're in recovery. So it was up to my husband and me to devise meal plans for our daughter. Like most anorexics, she needed a lot of calories each day to gain weight--upwards of 4,000 calories a day during one phase of recovery. Because the act of eating was so terrifying and difficult for her, and because, like most anorexics, she endured many stomachaches, our strategy was to get as many calories as possible into the smallest volume of food.

What this meant, practically, was that our daughter ate a lot of high-quality, high-fat and -protein foods: Almond butter. Ice cream. Mac and cheese. (Some of our favorite recipes are here.)

Now this study confirms our instincts about what to feed our daughter. Fat, it seems, matters a lot when it comes to recovery from anorexia. Recovering anorexics who ate higher-density (translation: higher fat) foods were less vulnerable to relapse. I could speculate about why, but the bottom line is that for true recovery, you've got to eat fat. Lots of it. Not just x number of calories, but high-fat calories.

Fat can make the difference between true recovery and a lifetime of suffering.

Fat matters.

Friday, May 09, 2008

Drug money and DSM

Tara Parker-Pope's blog about DSM, the psychiatric bible, and ties to Big Pharma, hits on a point of particular interest to anyone who's had experience of an eating disorder.

The truth is that there are few if any medications that have been shown to help treat an eating disorder, especially in the acute phase of the illness (and isn't that when you want them to help?). Psychotropic meds do not seem to help when someone is severely malnourished through anorexia or bulimia. (There are a few atypical anti-psychotics being looked at for treatment, but the jury is still way out on those.)

Despite the accumulating evidence that meds are not the first-line treatment for eating disorders, pretty much every doc you'd see for an e.d. will prescribe an SSRI, or several.

In my daughter's case, she had bad reactions to nearly everything she was put on, which meant more suffering was piled on top of what she was already going through. Oh, and we had to pay big bucks for it, too.

Of course, my daughter was never officially diagnosed with anorexia nervosa. I'm not sure why; she certainly met all the diagnostic criteria listed in DSM-IV. Parker-Pope's piece suggests that such criteria tend to be overly inclusive and vague. I don't think that's true for eating disorders--on the contrary. My daughter's psychiatrist-in-training diagnosed depression with secondary EDNOS--eating disorder not specified. I don't know if it made a difference in her treatment, but it did saddle her with a diagnosis that was completely inaccurate. I don't know how that might affect her down the road.

Any doc treating eating disorders should know that depression is a typical presentation when someone is acutely ill with AN, and it usually goes away with weight restoration.

I know from friends who are psychiatrists and M.D.s that it's increasingly tough to steer clear of drug money and influence. Even if you refuse the free dinners and concert tickets and cutesy pens and other freebies, as Parker-Pope points out, much of the research in the U.S. is being paid for by Big Pharma. For those of you think that's all right because, after all, everyone wants the Best Thing, think back a month or two to this report about cholesterol-lowering drugs. Drug companies will in fact behave unethically if the bottom line is at stake.

Personally, I don't want Big Pharma writing the rulebook for psychiatric disorders. I'm just not sure how to stop them.

Thursday, May 08, 2008

Apparently you can fool all the people all the time

At least that's the story making the rounds about Dove's "Real Beauty" campaign, which was praised to the skies by many FA bloggers and others. According to this story, those unretouched photos of beautiful-but-not-"perfect" women may actually have been, you know, retouched.

I got a good laugh out of the last line of the story:

If only for the excessive amount of self-righteousness that accompanied the PR effort surrounding this ad campaign, let's sincerely hope these retouching allegations are true.

As one of the commenters points out, the company that owns Dove also owns Slimfast. Corporate hypocrisy, anyone?

Tuesday, May 06, 2008

The virtues of a high-fat diet

Since fat has been demonized so consistently in the media lately, I thought it was worth reporting this study on the link between diet and seizures.

For children with seizures, eating a diet high in fat and low in carbohydrates can significantly reduce the number of seizures they have. Which, when you think about it, is a fascinating bit of information.

People in recovery from anorexia need a lot of fat in their diets to restore normal brain functioning. Something I told my daughter over and over while she was recovering was that her brain needed fat in order to work properly.

It's true.

Monday, May 05, 2008

Fat karma

This study, reported in the New York times, confirms what some of us have known for years: Fat cells, like other matter, cannot be destroyed. Each adult has a certain number of fat cells, and that number remains constant throughout your life. When it comes to anything to do with metabolism, the body seems to be very efficient at seeking out and maintaining a state of homeostasis.

E.A. Sims' famous Vermont Prison Studies found that prisoners who were fed 75 percent more than normal gained relatively little weight, and quickly returned to their normal weights when their normal eating resumed, we've understood this mechanism. Notice that the word their is highlighted, because, as we know, there is no one weight that's "normal" for everyone.

So it's not surprising to find that the number of fat cells in an adult human remains more or less constant. But you can bet your sweet tooth that corporations--I mean obesity researchers--are going to keep scrambling to find ways to change that magic number.

So far, every effort we've made to futz with metabolism has either been unsuccessful or backfired and created more harm than good. Maybe we'd do well to take a more Buddhist approach: Your fat karma is unalterable, at least in this lifetime.