Wednesday, 13 May 2015

BB - Brain and Behaviour: How the Brain Can Predict ED Behaviours

Remember this post that summarized some things I have blogged about on ED and brain changes or findings? Well, now we have a new addition to the list. This study, recently published, explored the relationship between the loss of a certain gene and similar 'ED-like' behaviours that follow. (For those interested in scientific terms, the loss of a gene is also known as a mutation). See
this link for a summary of this study.

The researchers looked at mice and an estrogen-related receptor alpha. or ESRRA. By the way, don't worry about the name of the gene - that's not as important as the results of the study. The loss of ESRRA caused the mice to have less motivation to find and consume high-fat foods, despite being hungry. In a previous study, researchers found that individuals with anorexia also show decreased levels of ESRRA in their brains. What does this tell us?

Well, think about it. Low ESRRA caused mice to not have enough motivation or desire to seek out and eat high-fat foods. What would this mean for individuals with low levels of ESRRA? The same thing! This may help to explain why people with anorexia don't want to - or are not able to - eat when hungry. Their brains literally aren't allowing them to, their brains aren't giving them the normal 'signal' or motivation to look for and eat food.

But wait, there's more. The study also found that the levels of ESRRA are controlled by caloric intake. In mice, eating less than 60% of normal calories over a few days significantly decreased ESRRA levels in the brain - even in normal nice. What does this teach us?

Eating low calories = less ESRRA levels. So, applying this to people, even those without ED may develop ED-like symptoms if they reduce their caloric intake over a delayed time period. Now imagine someone who is already predisposed to ED because of a variety of other reasons. If this individual reduces their caloric intake, their risk for developing ED may very well be increased significantly. Usually, less nutritional or caloric intake causes humans to seek out foods, especially those that are high in calories. But low levels of ESRRA seem to make that response not work as well. The mice in the study weren't just not motivated - they actually put in much less effort to even get food, despite being hungry. Isn't it striking how similar this is to a person with ED: they are hungry. They feel hungry. Their stomachs are growling. And yet, they do not - cannot - eat.

Of course, it would be wonderful if we could say: 'low ESRRA cause theses behaviours. Let's just give patients with ED some ESRRA and then we would sole their problem!'. Well, it isn't that easy. Firstly, more studies need to be conducted to see who this applies to - do ALL people with ED have low ESRRA levels, or just some of them? Why? What are ways in which we can reverse this? Will a medication work? Does recovery restore ESRRA levels? What about people with low ESRRA that DO NOT develop an ED - why does this happen?

The thing with science is this: one question opens up a million others, and one answer does the same. While as of now, we don't have a 'cure' for anorexia (such as a magic pill or procedure), studies like these help us learn more about factors that may lead to the development and maintenance of ED. AND - one of my favourite things - these studies illustrate that EDs are a lot more complicated than we may want to believe. Patients aren't making up their symptoms, nor are they trying to be difficult. It is a mental illness, mediated by many factors, several of them perpetuated by changes in the brain, hormones, genes, and neurotransmitters.

For now, it is safe to say that there are some key things needed for recovery from ED: FOOD, enough calories, weight gain, therapy., and treatment of comorbid illnesses. This may mean using medications to control anxiety, depression, OCD, and more. It may also mean meal-planning, restricting activity, attending family-based therapy sessions, using cognitive-behavioural therapy (CBT)  techniques, expressing emotions, and making a relapse-prevention plan. Oh, and we cannot forget some KEY things: time, patience, love, support, dedication, perseverance, and strength. And hope that recovery truly is possible.




Friday, 24 April 2015

Watch My Latest Presentation: What Future Doctors Need to Know About ED

One of my greatest blessings is being able to use my story to help others. My hope is that my experience with ED can teach others about mental health, ED, treatment, prevention, and identification. My book and blog have been instrumental to this, as they allow anyone all over the world to learn about my journey. The interviews that I do are another way to advocate. And a few months ago, I was asked to give a presentation to medical students at McMaster university. (Note that this presentation occurred in November 2014, but I have only just now had a chance to post it!) The focus of this presentation was to share my journey and shed some light on EDs.

This was a wonderful opportunity. It strikes me how sparse education on EDs is in the healthcare field. In my presentation, I highlighted the signs and symptoms of ED, diagnosis information, treatment goals, and the process of supporting recovery. Although I have this presentation to future physicians, the information in it is also extremely valuable for all doctors, nurses, etc to know. It's also good information for anyone in general to be aware of.


I hope you enjoy this video (https://www.youtube.com/watch?v=9r8yiFVLxF4)! I received feedback from the medical students that this presentation was very helpful for all of them to have - some even told me it was more meaningful than other lectures on ED because it came from a survivor of ED and as a nurse...someone with personal experience with ED - as well as someone who is the healthcare field! It's a blessing to be able to use my journey not only to advocate, but also to educate others. This is proof that recovery is 100% possible. If you or anyone you know can benefit from the education in this video, please watch it and pass it on. Knowledge is power - learning about ED is the first step towards raising awareness, preventing ED, and supporting others.  I hope you enjoy it!

Wednesday, 8 April 2015

FOUR YEARS OF RECOVERY! - and a Look Back on 'Brain Changes' Posts

I have written many posts about ED and brain changes, and I know that many of you are interested in this topic (as am I...).

This blog post summarizes all the posts I have written thus far on ED and brain changes. Feel free to click on one of the links below and learn more about what I have written!

PS. I LOVE this particular post because reading through my past posts has helped me realize many things. First, I can see how far I have come in my recovery since 2012. Second, I can appreciate how much I have learned about ED and brain changes. I have also reread all the comments, and am so touched by everyone's ongoing support thus far. In addition, reading these posts makes me appreciate that when I was ill with ED, I was suffering from a real illness - I wasn't trying to be a 'difficult patient or person', I wasn't looking for attention, I wasn't being stupid for staring myself, and I wasn't lying when I said that eating was extremely difficult or stressful for me.

I hope these posts teach you something new, and remind us all that EDs are mental illnesses. I hope the research cited in the posts below allow society to realize that EDs are life-threatening illnesses - and not choices. They are not cries for attention, or a result of the need to feel 'in control' or rebel against parents....or whatever crazy theories there exist. Simply put, an eating disorder is a mental illness that makes one feel anxious about food and weight, obsessive about maintaining a certain weight, altered food intake patterns, etc. BUT EDs are also 100% treatable - through sustained and constant nutrition, love, therapy, support, care, and more.

Enjoy browsing through these posts - and feel free to comment on what you learned from these posts, how this changes how you view ED as an illness, etc.

1) Why starvation 'feels good' or is 'easier' for patients with ED than eating
2) Portion Distortion! and Servings sizes of food
3) Always feeling full
4) Starvation = reward for individuals with ED?
5) Food and Mood
6) Why Eating in Recovery is STRESSFUL!
7) Desserts and ED Brain Changes
8 General Overview of Brain Changes

P.P.S - thank you to all my family, friends, and readers. Looking through these posts has truly made me extremely thankful for everyone's support. All your words, love, and care are truly what has gotten me this far and strong in my journey. This month marks my four year recovery mark - four years of solid recovery, full nutrition, health, happiness, and freedom. I wouldn't have made it here without God and without all of you...and without yummy food (like chocolate. Did I mention I love chocolate?) THANK YOU!


Thursday, 26 March 2015

Published again! - and birthday celebrations

I am blessed to say that once again, my writing has been featured on Fr. Anthony's site. This time, my post is about suffering and pain, and how to communicate with God during these times:http://franthony.com/how-long-o-lord/

I will be honest with you, I find that when I get overwhelmed by the troubles in this world, it becomes difficult to do anything. And sometimes, the hardest thing to do during tribulations is to pray. We all have times when we don't feel like talking to God - and this is harder when we feel angry or fearful that God has forgotten about us.

Here is a little secret: God can never forget about us. He loves us unconditionally. And He has His eyes on you all the time, His hands around you to protect you, and His ears ready to listen. I know that sometimes it is hard to pray and communicate with God when we are facing obstacles because we don't understand why things are happening as in our lives. But know this: 'all things work together  for the good for those who love God' (Romans 8:28)

Do not feel that when you pray to God, you need to use lavish, big words. Or fancy terms. The wonderful thing about prayer is that we can do it as informally as we like. I have moments when I talk openly with God, honestly telling Him how tired I am. How I am lacking motivation. How I need hope and peace. And I know that He is always listening.

Please check the post out and feel free to comment here/on Fr. Anthony's blog and let me know what you think!

To add to that, I am also blessed to be celebrating my birthday this week! I cannot believe that another year has passed, and I am alive, healthy, and well. I am a registered nurse, I am a health-advocate, a writer, and a volunteer in many places.





It is a blessing to be able to breathe on my own, to walk, to talk, to play, and to engage in everyday activities. My life has definitely been full of ups and downs...but each time there was a low point, God and the support of all my friends and family (and you, dear readers!) has brought me back up again. And do you know what? I am truly thankful for every obstacle I have faced, every challenge I endured, and every tear I cried. Because these experiences have honestly made me into the person I am today. I pray that in this new year of my life, I can continue to help others, to share my story to new listeners, and to grow in wisdom, love, understanding, kindness, compassion, and every good virtue.

Sunday, 15 March 2015

What changes in the brain of a patient with ED?

By now, you must know that I love relating brain changes and science to what I can. The differences that occur in the brains of patients with ED are still being studied. Remember how we talked about differences in neurotransmitters and hormones, such as dopamine, leptin, etc? Well, I was able to find a document that summarizes many different studies and what brain changes were found to occur in ED patients. I'm not suggesting that you even try to read the document, as it is long and uses a lot of scientific and research terminology. However, for the purpose of referencing, I will provide a link to it here: http://anp.sagepub.com/content/early/2013/10/24/0004867413509693.abstract. The picture here is an extremely simplified depiction of the brain and different regions and their functions.

So, what changes in the brains of ED patients? One of my favourite changes to discuss is what happens to the amygdala and the limbic system. This is the part of the brain involved in emotions. Studies show that these areas are smaller or less stimulated in patients with ED, highlighting the difficulties that patients have with emotion and expressing them. At the same time, these areas are not stimulated during eating, which is supposed to be an enjoyable time for humans.

Throughout the brain, there is a decreased activation and sensitivity to dopamine, which we know is involved in reward patterns. This is important because it tells us a lot about patients with ED. First, they are not rewarded when they eat because their brains do not register this is as being fun or pleasurable. Furthermore, patients often do not feel happy or pleased with things that usually or normally cause joy, such as social time, relationships, laughing, etc. Again, we can relate this to the lack of dopamine or its malfunctioning in the brains of ED patients. This is commonly called anhedonia: a lack of pleasure from things that normally cause pleasure.

We also know that serotonin doesn't work properly either. Serotonin, or 5 HT, is involved in mood. There has been shown to be decreased 5HT in patients, which can help us explain the depression, anxiety, or bad moods that ED patients experience. New research is also finding a connection between 5HT and eating - namely, in patients with ED, 5HT works to make eating less enjoyable. Thus. when patients with ED eat, the lack of 5HT may actually cause negative emotions, discomfort, anxiety, a sense of doom, etc.

There are many other changes that have been observed, studied, and researched. I won't get into them because it would take me years to explain them all - and I am still learning as well. But what I want you to get from this post is that ED is a mental illness. What is important to understand as well is the fact that changes in the brain occur in patients with ED. What does this tell us? First, that ED is a REAL illness and not simply a choice that people make. It also helps us understand some of the symptoms and signs associated with ED. Moreover, we can empathize with patients and learn that what they are feeling and experiencing is very real - they are not trying to be difficult or starve themselves; rather, it is changes in the brain and other factors of the illness that change their behaviours and moods and contribute to the illness.


 Finally, this helps us realize that the treatment of ED is more complex than simply feeding the patient and getting their weight stable - recovery, if it is to be successful, must address the many different factors that have been found to be implicated in ED. This may include medications, food, therapy, massages, etc. We cannot expect to 'fix' a patient with ED if we simply feed them and neglect that there are other things we must address: moods, behaviours, changes in hormones, self harm, suicidal thoughts, self-esteem, motivation, and more (please note, however, that food is VITAL for all people, including patients with ED. Studies have shown that with proper nutrition and adequate food intake and weight restoration, many changes in ED patients can become reversible and treated. FOOD IS MEDICINE!). Perhaps this is why recovery is so complex, and why it takes so long. But what keeps me hopeful is that all of this does not end in despair, as I am proof that true recovery is possible. It takes work, social support, love, and determination. Things often feel that they get worse before they get better. But just keep going. When a door closes, don't waste your time staring at it - look for another one. And if all doors are closed, look for an open window. Just don't give up.



 

Saturday, 28 February 2015

Laughter...and Health?

Have you ever laughed so hard that your cheeks started to hurt? I have! Laughter is arguably one of the simplest ways to feel happy. It can be because of a silly joke, a funny movie clip, or even an embarrassing moment...but the results are the same: when we laugh, we feel better. We feel good. It is almost as though for a single quick moment, our worries are gone from our minds. For that quick laugh, we can think of nothing else but the hilarity that has just occurred. Now, more than ever, the world needs some laughter...

Wouldn't it be great if we actually had studies to support that laughter is good for our health? Well. it appears that we do! I did a lot of research on this, and there is quite a bit of literature out there on this topic. For the sake of time and my fingers that have to type all this out, I have chosen a few articles to discuss here. The first was a large, cross-cultural study that tested the relationship between laughter and health: http://www.ncbi.nlm.nih.gov.libaccess.lib.mcmaster.ca/pmc/articles/PMC2719285/. This study attempted to correlate laughter with disease prevalence  - that is, the presence of disease. The results? Those who laughed more had fewer chronic (long-term, 'on and off' illnesses) than those who did not laugh as much (or at all).

Now, here is an important point: this is a correlation. That means that laughter and less disease are related/ It does not mean that laughter CAUSES less diseases to be present. But what it DOES indicate is that there is some sort of relationship between the two, such that more laughter may indicate that the same person may experience less disease.

I like what the authors in this study conclude: laughter is really an important part of our lives. Whether it is related to less disease or simply a better mood, laughter is critical! Imagine how beneficial laughter can be if we implemented it in various areas of our lives. For example, what if we used more humour in stressful situations, like when we are freaking out because our assignment is due in two days? Or what if we can turn a tense moment, such as in a heated argument, into a joke? (Note that laughter always needs to be introduced appropriately. For example, it clearly is not a good time to bring in a joke if your loved one is furious that you forgot about their birthday).

In terms of healthcare providers, what we if simply smiled more at patients? Think about this: how do you feel when your doctor or nurse walks in and is frowning? Probably not great. But what about when they come in smiling or make the situation light-hearted? It makes a huge difference! This is truly what I have tried to implement in my own nursing experiences. I always walk in with a smile on my face, and when possible, make the situation fun or funny. There is always time to be serious. But then again, there is always time to have fun and laugh! It is amazing how simply making something humorous can change the way we feel, the way we think of situations, and our abilities to problem-solve and cope.

Of course, we cannot always laugh. But one thing we can do: make laughter a priority. Try to joke around (when appropriate) and get some humour into your life. Make others laugh and feel contentment as you realize how you've made their day jut a little more special, a little more tolerable. Try watching a funny show or reading some good jokes...and feel your face ache as you cannot stop laughing. Then feel the relief on the inside, that for a quick moment, all you could do is laugh. For someone who struggled with a degree of depression in the ICU, I can assure you that laughter works! Three years from then - today - I am strong in my recovery and do not suffer from depression. I have learned ways to cope, to heal, and to sustain my health. And allow me to fill you in on a secret: laughter is one of the best things that I have discovered. There is nothing like a smile or a good laugh to make the situation more manageable, to give hope, and to renew strength. (P.S. Note the hilarious joke in the picture about the tuna sandwich named Kevin!)

Please, take some time today (and tomorrow, and the day after that, and the day after that!) to laugh! (Also, if you look online for jokes, please - search for CLEAN jokes. Here is a site that got me laughing - check it out! http://www.laughfactory.com/jokes/clean-jokes). (P.s. Also note the funny joke in this picture about laughter and medicine. Yes, so it is a little silly and 'nasty' ... but I seriously laughed out loud!). See the joke below to get you started - it really made me laugh out loud!

A Minnesota couple decided to vacation to Florida during the winter. They planned to stay at the very same hotel where they spent their honeymoon 20 years earlier. Because of hectic schedules, it was difficult to coordinate their travel schedules. So, the husband left Minnesota and flew to Florida on Thursday. His wife would fly down the following day.


The husband checked into the hotel. There was a computer in his room, so he decided to send an e-mail to his wife. However, he accidentally left out one letter in her e-mail address, and without realizing his error, he sent the e-mail.


Meanwhile.....somewhere in Houston, a widow had just returned home from her husband's funeral. He was a minister of many years who was called home to glory following a sudden heart attack. The widow decided to check her e-mail, expecting messages from relatives and friends. After reading the first message, she fainted.


The widow's son rushed into the room, found his mother on the floor, and saw the computer screen which read:

To: My Loving Wife
Subject: I've Arrived
Date: 16 May 2003

I know you're surprised to hear from me. They have computers here now and you are allowed to send e-mails to your loved ones. I've just arrived and have been checked in. I see that everything has been prepared for your arrival tomorrow. Looking forward to seeing you then! Hope your journey is not as uneventful as mine was.
P.S. Sure is hot down here!