Eating disorders

The most important step: a doctor, psychotherapy or a specialised counselling service. The earlier, the better the outlook.

You don’t need to be a certain weight to deserve help. Early support works best.

Talking to a close person eases pressure and shame and makes reaching help easier.

In acute distress or physical danger, seek medical help or a helpline immediately — e.g. the National Alliance for Eating Disorder helpline.

In anorexia there is no drug that raises weight — treatment runs through food and therapy, and medicines only work again once weight rises, because an undernourished brain barely responds to them. In bulimia, fluoxetine at a higher dose lowers the episodes measurably. In binge eating disorder, lisdexamfetamine is licensed. In all three the therapy carries the larger part and the drug the smaller.

Underweight is spoken of below a BMI of 18.5, a severe form below 15. In refeeding, the first week is the critical one: give too much too fast and the phosphate level falls — so it is raised slowly and phosphate is checked. Bulimia and binge eating disorder are more common than anorexia and less often recognised. Treatment as a rule lasts one to two years.

Severe restriction of eating, marked fear of weight gain, distorted body image.

Binge episodes followed by compensating (vomiting, laxatives, excessive exercise).

Recurrent binges with loss of control, without regular compensation — often tied to shame.

Often linked to anxiety, depression or difficult experiences — eating becomes an outlet.

With too little energy over time the body powers reproduction down — it is the first thing it gives up. That can show before the weight does.

The most dangerous value. Vomiting and water or laxative tablets lower it, and a low potassium sets off heart rhythm disturbances. It belongs measured early and repeatedly.

The key value when rebuilding nutrition: after a long shortfall, feeding too fast makes the phosphate drop. So one starts slowly and checks daily.

Drinking very large amounts lowers it, vomiting shifts it. A rapidly changed sodium explains confusion and seizures.

With a long shortfall all three cell lines fall. That is harmless at first and reverses with nutrition, but it belongs known.

A lack causes exhaustion, problems concentrating, low mood and forgetfulness — and it is one of the few causes that can be found and put right with a single blood draw.

Without vitamin D only a fraction of the calcium from food is taken up. It is the value that is most often too low with bone and joint complaints.

The building material itself. Better from food than from a tin: hard cheese, yoghurt, calcium-rich mineral water, almonds, broccoli and fortified plant drinks.

An empty store causes tiredness, lack of drive and problems concentrating long before any anaemia becomes visible. In women of childbearing age the most common single reason.

Activates the proteins that build calcium into bone. Green leafy vegetables and fermented foods cover it — under coumarin blood thinning the amount stays steady rather than swinging.

The point one rarely reads: in this field a preparation can become part of the problem, because it replaces the eating instead of supplementing it. What belongs measured and replaced also belongs accompanied — and the return to eating remains the route, not the capsule.

The most dangerous moment is not the going without, but the beginning again: when eating resumes after a long shortfall, the body pulls phosphate, potassium and magnesium abruptly into the cells — the blood level falls, and that strikes heart and breathing. This is why the build-up is slow and measured, not by appetite.

Bone density is here the quietest and most lasting sign: with periods absent over months bone breaks down, and part of it does not come back even after years. Vitamin D and calcium are the groundwork — what actually brings the bone back is the return of the cycle.

Zinc deficiency dulls the sense of taste and the appetite — and it is common with very restricted eating. That is a circle that closes: eat less, less zinc, less appetite. Replacement after measurement opens it a little; it is not a treatment of the disorder.

Clearly worthwhile and well supported when deficient — vegan, older adults, certain drugs. No energy boost without a deficiency.

Clearly effective with proven deficiency, useless without. Take only with a documented deficiency — excess is harmful.

Falls with fatty tissue and reports shortage to the brain. This fall switches off the cycle, lowers body temperature and bone building — and it explains part of the circling thoughts about food.

If the period stops, the most important protection for the bone is missing. That is why absent bleeding is not a side issue but a finding.

With a lasting shortfall the body throttles the conversion into the active hormone. That explains feeling cold, a slow pulse and constipation — and it normalises with nutrition.

The hunger signal rises strongly with a lasting shortfall but is no longer experienced as hunger. This uncoupling is one of the reasons why urging does not help.

The stress axis runs high when supply is short. That keeps one awake, strengthens restlessness and works against the bone as well.

After longer starvation building food back up too fast can become dangerous — phosphate, potassium and magnesium fall. That is why the increase is slow and supervised, not out of caution alone.

Counting calories and daily weighing keep the preoccupation with food alive. In treatment both are often deliberately left out — this includes nutrition apps.

Mindful eating is studied in binge eating and shows small effects there. In anorexia caution applies — any extra preoccupation with food can strengthen control.

Here with restraint: in eating disorders movement is often part of the problem rather than the solution. Whether and how much belongs in the treatment — one of the few cases where less is right.