How giving up delicious food, shopping and other pleasures will change your life

Anorexia

Anorexia nervosa

is a deliberate eating disorder with the aim of losing weight, losing weight or gaining excess weight, which the patient himself causes and subsequently maintains. Anorexia nervosa is characterized by a pathological desire to lose weight and an intense fear of obesity; the patient has a distorted perception of his physical shape and is constantly worried about weight gain, even if this is not true. Anorexia is most often observed in girls and young women.

The main criteria for diagnosing anorexia in ICD-10 and DSM-5 are the same, but there are some differences: the absence of menstruation (amenorrhea), according to the DSM-5 criteria, is not a leading sign for diagnosis, but according to the ICD-10 classification, the absence of one or more leading signs such as amenorrhea or weight loss are highlighted for atypical anorexia nervosa.

All of the following are required to diagnose anorexia nervosa:

1. Body weight is maintained at least 15% below predicted (a higher level is not achieved or decreases) or the Quetelet body mass index (the ratio of body weight in kg to the square of height in meters) reaches a reading of 17.5 or lower. Before reaching puberty, there may be an inability to gain weight during the growth stage.
2. The patient himself causes weight loss: he stops eating food that can make him gain weight, as well as by doing one or more of the following actions: inducing vomiting, taking laxatives, excessively increasing physical activity, taking appetite suppressants or diuretics.
3. Psychopathological distorted perception of the appearance of one’s body and figure, pathological fear of obesity, and this fear takes an obsessive form; The patient considers extremely low weight acceptable.
4. Endocrine disorder of a general type along the hypothalamus-pituitary-gonad axis. In women there is amenorrhea, in men there is loss of potency and libido. There may also be increased levels of growth hormones and cortisol, changes in metabolism, disturbances in insulin secretion, and a lack of thyroid hormones.
5. At the initial stage in prepubertal age, the manifestations of puberty slow down or do not appear at all (growth stops, girls do not develop mammary glands, the first menstruation does not occur, in boys the genitals remain juvenile).

Signs of anorexia also include:

patient's denial of the problem; sleep disorders; panic fear of gaining weight, fear of one’s reflection in the mirror, fear of eating; depression; causeless anger, resentment. Sometimes there is an increase in interest in everything related to food - recipes, articles on cooking and gastronomy, various diets, preparing various dishes only for others, without one’s participation in the process of eating food. The changes also apply to social life: refusal to participate in general events where meals are expected, up to the cessation of all communication; frequent visits to restrooms and long stays there.

Among physiological disorders, problems with regulation and their cycle are noted; cardiac arrhythmia (often leading to sudden cardiac death due to a lack of potassium, magnesium and other minerals); chronic weakness, fainting, dizziness, muscle spasms; constant feeling of cold due to slow heart rate. Hair loss, dry and pale skin, the appearance of small hairs on the face and back, and structural damage to the nails also occur. In the functioning of the digestive system, disorders and painful cramps in the stomach, chronic constipation, nausea, swelling of the abdominal cavity, difficult and painful digestion are observed. Consequences such as osteoporosis, frequent and painful fractures of vertebral bones are not uncommon; reduction in brain mass. Patients are mentally unstable: hyperactivity is replaced by apathy, manifestations of social phobia, panic disorders, anxiety, obsessive-compulsive disorder, and thoughts of suicide are frequent.

The course of the disease, its development and outcome can take various forms: recovery; relapses; death as a result of irreversible changes in internal organs (without treatment, the probability of death reaches 5–10%); development of uncontrolled overeating and progressive weight gain is possible.

Treatment of anorexia

Treatment for this type of eating disorder requires general physical improvement, rehabilitation, and weight restoration. Psychotherapy is of primary importance: behavioral, cognitive and family. Behavioral therapy promotes weight gain. Cognitive – corrects the perception of oneself as obese and overweight, helps overcome feelings of inferiority, and reduces dependence on the appearance of one’s own body. Family therapy is especially indicated for patients in childhood and adolescence.

Rehabilitation

provides support during the entire course of treatment, using physical exercises, correction of sleep patterns, therapeutic diets, informing the patient about the achievement of goals and tasks to be solved.

Starving California

Like (almost) all life extension and biohacking trends, modern intermittent fasting was born in Silicon Valley.
Local fasting biohackers have created an online community called WeFast: there they give advice on how to “enter” a hunger strike, and also invite you to their Facebook and Slack groups to communicate and share experiences. The main method of intermittent fasting for community members is the Monk's Fast. This is a 36-hour water fasting protocol: for one and a half days you can drink water and any other liquids that do not contain calories, such as coffee or tea without milk and sugar, but you cannot eat anything during this period. The point here is this. Our liver can simultaneously contain about 100 g of glycogen - a polysaccharide that is a form of energy reserve in the body - and it is consumed in about 16-24 hours. What should the body rely on for the remaining 12-20 hours of a fast? The answer is ketosis, which many fasting people crave: this is a state in which energy is no longer taken from glucose, but from the product of the breakdown of fats - ketone bodies. Biohackers from WeFast claim that it is in a state of ketosis that the body turns on the process of autophagy—cleansing cellular “garbage.” Autophagy is considered by many life extension activists to prevent most age-related diseases. Also, during ketosis, according to the founders of WeFast, senescent cells are destroyed - “old” cells that have completed their life cycle and stopped dividing, but for some reason did not self-destruct, but remained “wandering” in the body, causing chronic inflammation and bringing the aging of everything closer bodies.

Proponents of intermittent fasting claim that fasting can not only improve health, but also increase productivity - although this seems counterintuitive. From an evolutionary point of view, they say, humans are adapted to certain periods of forced famine—simply due to a lack of food. When the body begins to starve, it mobilizes all its strength to turn on “hunter mode” and quickly get more nourishing food. We, in our comfortable modern world with access to food 24/7, have forgotten what “hunter mode” is - and biohacker entrepreneurs suggest turning it on by voluntarily limiting yourself in food. For those who are not able to withstand 36 hours without food, even with the help of dietary supplements, the founders of WeFast offer simpler modes - for example, the most popular method in the scientific community is 16:8 intermittent fasting. The idea is simple - eat during an eight-hour “window” during the day, and the rest of the time only drink water or tea/coffee without sugar. In general, this fasting protocol can be considered a creative rethinking of the legendary “don’t eat after six.”

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How to survive prolonged hunger? The creators of WeFast give several recommendations: drink a lot of water to avoid dehydration, stay cool to save energy, and also drink a lot of coffee or tea or nootropics with caffeine. The latter is especially interesting: after all, ketosis itself should make the brain more productive - so why additional stimulants with questionable effectiveness?

Bulimia

Bulimia nervosa

– an eating disorder, which is characterized by regular bouts of overeating against a background of obsessive control over body weight and the adoption of extraordinary measures to reduce the influence of the food eaten on weight gain. These measures include: cleansing the body using induced vomiting or enemas, taking diuretics and laxatives. Bulimia is common in certain diseases of the central nervous and endocrine systems.

Bulimia nervosa, both according to the DSM-III-R classification and the ICD-10 criteria, is included in the group of mental disorders. Clinical manifestations include symptoms such as: dehydration, low potassium levels, metabolic disorders, arrhythmia. With frequent vomiting, erosion of tooth enamel occurs.

When diagnosing, there are three main signs:

1. Overeating, uncontrolled consumption of large quantities of food. Manifestation: attacks of sudden appetite and absorption of huge amounts of food; attacks of painful hunger and night hunger and/or night eating.
2. Regular use of vomiting, taking diuretics and laxatives, strict diets, grueling physical activity as a way to influence body weight.
3. The dependence of self-assessment on body shape and weight.

Treatment for bulimia

Bulimia nervosa is treatable and many disorders are reversible. Complex treatment is carried out by a psychotherapist, psychiatrist and nutritionist. First, you need somatic treatment aimed at restoring your physical condition.

The use of medications, in particular antidepressants, may be prescribed if there are clear signs of depression and/or anxiety or in the presence of concomitant mental disorders (neuroses or obsessive-compulsive disorder).

Among the various methods of psychotherapy for bulimia, cognitive behavioral therapy is especially indicated, the task of which is to bring the patient to an awareness of his responsibility and control over nutrition. Other types of therapy are also used: behavioral, interpersonal, family therapy. The final goal of any method of psychotherapy is the patient’s acceptance of himself, his appearance, his individual physical parameters and the transition to an emotionally healthy attitude towards life.

Psychogenic overeating

- This is compulsive overeating, which leads to excess weight and occurs as a consequence of distress. People who are prone to obesity are especially susceptible to overeating, and the presence of negative stressful situations (loss of loved ones, accident, etc.) is a trigger. Sometimes the disorder begins after childbirth or surgery.

With compulsive overeating, there is often no real physical feeling of hunger. This is why you choose foods rich in carbohydrates or fats (fast food, snacks, sweets). Such an attack-like snack distracts from stress, but not for long, and the person soon needs a new meal.

Psychogenic binge eating varies in severity from mild to extreme, bordering on bulimia. The following possible symptoms are identified:

1. episodic loss of control over the process of food absorption;
2. episodic overeating in stressful situations;
3. eating an abnormally large amount of food in a short period of time;
4. eating large quantities of food without feeling hungry;
5. absorption of food until it is impossible to breathe and move;
6. eating in a depressed state (dejection, sadness, boredom);
7. eating alone out of a sense of shame associated with the very act of eating;
8. eating alone in order to hide the fact of gluttony;
9. feeling disgusted, guilty, or depressed after eating.

Compulsive overeating

is designated as a special diagnosis of “Eating and Eating Disorders” in both ICD-11 and DSM-5, and is characterized as the patient consuming an amount of food over a given period of time that is many times more than most people would eat in a similar period of time in a similar situation. It is also necessary to acknowledge the loss of control over both the amount of food and the cessation of the eating process. To be diagnosed with binge eating disorder, three or more of the following symptoms are required:

1. Consuming food until you feel uncomfortably full.
2. Eating occurs much faster than usual.
3. Feeling disgusted with yourself, guilty, or sad after eating.
4. Eating large amounts of food without feeling hungry.
5. The habit of eating alone due to the shame of realizing how much has been eaten.

ICD-10 does not identify compulsive overeating as a separate mental disorder, but, nevertheless, determines that excessive obesity can lead to an individual’s lack of confidence in his appearance and contribute to depressive states. Obesity, as a side effect of the use of antipsychotics or antidepressants, is also not considered in the context of binge eating disorder, but is classified as drug-induced obesity. When diagnosing psychogenic overeating, it is necessary to exclude polyphagia (gluttony, constant need for food).

Compulsive overeating

is an eating disorder that combines physiological (excess weight and associated metabolic problems, etc.) and psychological (severe emotional experiences of the patient, difficulties with restrictions and diets) factors. Accordingly, treatment can only be effective with an integrated approach to therapy conducted by a psychotherapist/psychiatrist and a nutritionist. Antidepressants, antiepileptic drugs and drugs for the treatment of obesity are prescribed as medications.

Situation #1

Guests are served a dish that does not look very appetizing. Offending the owner is clearly not part of your plans, but you don’t want to agree to a treat either. What to do in this situation?

The situation is unfortunately common. There are several possible solutions. Firstly, you can still try the dish: often what is visually “inedible” turns out to be tasty.

Let me put some on your plate. One of my acquaintances, a diplomat, spending a lot of time in the embassies of exotic countries, often encountered a situation where guests were treated to, let’s say, a dish that was not the most familiar to him. You cannot refuse categorically; putting something unfamiliar into your mouth at your own peril and risk is also dangerous. Therefore, a method was invented that is jokingly called “tasting” in narrow circles. That is, it creates the appearance that you are eating: cutting food into pieces, shifting them, stabbing them on a fork, pausing to take a sip of water or eat a piece of bread, and maintaining a conversation. Sitting in front of an empty plate or not even touching the offered dish is a big risk of offending the host. Such a small everyday trick will allow you to remain a pleasant and good guest. And, of course, your ability to compliment the dish and the efforts of the chef is very important. This is always pleasant and makes the owner happy.

You can also resort to a little cunning. If for some reason you don’t want to eat the treat offered to you, then at least give a more valid reason than just “I don’t want to, it’s not tasty.” For example, you may be allergic to some ingredient or you cannot do something for medical reasons. The argument that you are on a diet may increase your housewife's urge to feed you. But you can’t argue with the argument that refusing a dish only because of a doctor’s recommendation.

Moreover, you don’t have to explain anything, saying: “Unfortunately, I can’t have this dish.” For greater persuasiveness, you can even raise your eyebrows slightly significantly. Sometimes this is quite enough. And they may offer you something else, but it’s up to your discretion. I recommend eating it, even if it’s different. The situation when all the guests are eating, and one is defiantly sitting in front of an empty plate, creates terrible awkwardness.

Other eating disorders

Allotriophagy

– a specific disorder associated with eating inedible substances of a nonbiotic nature (sharp metal or glass objects, bolts, pins), in a mild form, occurs in pregnant women (chalk, cardboard) as a consequence of endointoxication. This disorder is common in adulthood and may occur due to unhealthy appetite.

Diabulimia

– Patients with insulin-dependent diabetes deliberately take an insufficient dose of insulin or stop taking it completely in order to lose weight.

Drankorexia

(“alcohol diet”) – meals are replaced by drinking alcohol with the intention of controlling body weight or losing weight.

Orthorexia nervosa

– obsessive eating only healthy foods.

Selective eating disorder

– refusal to eat a certain type of food, limiting the names of foods that can be eaten, refusal to try new foods, preferences in color, shape or type of food.

Pregorexia

– a specific eating disorder in pregnant women, manifested in a conscious refusal to eat in order to maintain a slim figure, the adoption of various tricks to hide a growing belly and not gain weight, and exhausting sports activities.

Among the possible causes of eating disorders, there are somatic (metabolic disorders, hormonal imbalance leading to impaired serotonin uptake, dysfunctional disorder of satiety mechanisms), affective (distress, depression), social (stereotypes and values ​​in society), personal (parental influence , family situation, personality traits). In any case, each eating disorder requires an integrated approach to treatment and joint patient work of the patient and specialists - physiologists, nutritionists and psychotherapists.

Reduce your intake of unhealthy foods gradually

The desire to minimize the amount of junk food in your diet is laudable, but suddenly completely cutting out sweets or salty snacks can be quite painful and ultimately result in a “relapse.”

Therefore, it will be more effective and easier to gradually reduce the dose of unhealthy food consumption - a little bit, but every week. According to nutritionist Margaret Eich, with this approach, after a while you will need very little sugar to satisfy your sweet cravings.

By the way, for additional motivation, we suggest reading what will happen to your body if you give up sweets for several months.

• Author: Maria Minaeva

How can we help?

Our clinic, near the Eastern Administrative District of Moscow, in Reutov, employs specialists who have extensive experience in treating mental disorders. We use the most modern and advanced techniques, guided by the principles of evidence-based medicine. Effective assistance and confidentiality of information constituting medical confidentiality are guaranteed.