Why bulimia is not all in the mind, and the dietary approach that can put a stop to this condition

The National Institute for Clinical Excellence (NICE) here in the UK recently published a report which stressed the role of psychological therapies in the treatment of eating disorders such as bulimia and anorexia nervosa. However, while conventional wisdom has been that these conditions are essentially mental disorders for which a head-first approach should prevail, mounting evidence suggests that disordered eating may be rooted in issues that have more to do with the body, than the brain. In particular, studies suggest that the bingeing of food typically exhibited by sufferers of bulimia may be manifestations of biochemical processes gone awry. Scientific research shows that dietary modification can put pay to the symptoms of bulimia, and is an approach that may be considered to be a no-brainer for those seeking an effective treatment for this condition.

One common cry heard from those suffering from bulimia is that once they start eating, they can struggle to stop. While any food may be the object of a bulimic’s desire, experience shows that most gravitate to carbohydrate-based foods rich in sugar and/or starch. The sort of carb-fest many find themselves engaged in will generally ignite a skyrocketing of blood sugar levels. There is some evidence that this surge in the system has the potential to skew the delicate biochemistry of the brain, and this may have repercussions for both appetite and mood.

In one study published in the journal Biological Psychiatry, an injection of sugar was found to provoke feelings such as depression and anxiety in a group of bulimic women, while a placebo injection did not. Interestingly, women subjected to an influx of real sugar also led to an upsurge in their urge to binge. The precise biochemical mechanism responsible for this phenomenon is unknown. However, the results of this study do at least seem to lend some credence to the common bulimic experience of getting stuck on a roll.

Another hallmark symptom of bulimia is the purging of food from the body, for which induced vomiting and/or laxatives are commonly employed. Interestingly, a study published in the International Journal of Eating Disorders found that purging tends lead to sub-normal levels of blood sugar in the body. The relevance of this is that when blood sugar levels are low, there is a tendency for the body to crave carbohydrate foods, and usually plenty of them too. The available evidence suggests that those suffering from bulimia can be caught in a viscous cycle fuelled by highs and lows of blood sugar.

In practice, I have seen many individuals break this cycle by adopting a diet designed to get blood sugar levels on an even keel. Three meals are day are recommended, and these are best based on relatively slow sugar-releasing foods such as meat, fish, eggs, vegetables and a limited amount of unrefined starch-based foods such as potato, brown rice and wholemeal pasta. Snacks of fresh fruit and/or nuts had between meals can also be useful for keeping blood sugar levels buoyant. Scientific validation for such an approach comes in the form of a study in which 20 bulimic women put on a sugar-stabilising diet. Within three weeks, all 20 of the women had stopped bingeing, and remained free from binges in the long term too. The evidence suggests that a nutritional approach often proves effective for curbing uncontrolled eating, and promises significant benefits for individuals keen to get bulimia out of their system.

4 Responses to Why bulimia is not all in the mind, and the dietary approach that can put a stop to this condition

  1. retiredmom 21 December 2009 at 12:26 am #

    how about unsweetened carob? how about agave as a sweetener for soy milk?

  2. nb 10 April 2010 at 11:56 pm #

    This sounds about right, I used to be bulimic. But surely it isn’t what bulimics eat that is causing the problem – it is what they don’t eat. The craving for carbohydrates most likely came from purging in the first place because of an emotional connection to their weight? Also, some bulimics don’t vomit, they just starve themselves (though I’d think this would have a similar effect on blood sugar?)

    The above is still valid but it must be difficult to put into practice, as most bulimics would not be able to stick to the routine of three meals a day because they are trying to limit their food intake (for psychological reasons) and it’s too upsetting to eat “normally” because you fear you won’t lose weight.

    Just speaking from my own experience, but not everybody is the same.

  3. ap 11 April 2010 at 10:35 pm #

    It’s a very complex disorder, and totally agree with nb that not everyone is the same. Definitely can’t ignore/deny the socio-cultural (emphaisis on thinness & appearance, women’s status) and psycholgoical (low self-esteem) factors. But it seems to me that the nutritional aspects have not received much attention in the research. Slow release carbs are part of it, but based on some of what I’ve been reading (and my own personal experience), having sufficient and proper fats is also important.

    nb – congrats on getting through the hell-ish experience of bulimia

  4. Linda 10 February 2012 at 3:08 am #

    I rarely binge but am left with the unsavoury effects of my bulimia: GERD, bad digestion, a slow metabolism. Yep, after the first two years that’s what get. Besides all this, the urge to puke happens at a chemical level, not because of body image. It’s like an itch that needs scratching. Unless I take aloe vera, I can have the tinest meal and still want to throw it all up.

    But when I’m mindful, this is what helps:
    - mainly raw food (raspberry spinach smoothies ftw);
    - no brown rice or pasta; no wheat products;
    - no honey;
    - brown sugar and ginger tea when I get heartburn or feel like digestion is “stuck”
    - walking for half an hour after meals.
    - 2 meals a day (an omelette with spinach or smoothie in the morning and a pretty big salad in the evening- goat cheese and whatever veg is in season); this is because having a larger break between big meals gives the stomach a break, but instead of lunch i will have:
    - 2 snacks (almonds and dates or an apple being my faves; nut butters and celery too)

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