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Brain Growth There are two peaks of brain growth, about 26 weeks of gestation and around birth.

In the brain stem, DNA synthesis ontinues at a s!ow but steady rate unti! at !east " year of age. In most regions of the brain, the tota! number of e!!s present in adu!ts is !arge!y determined by the end of the first year of !ife Infants who weighed 2000 gr or less at birth and who died of severe undernutrition during the first year of life have a reduction of 60% total brain cell number In #e$i o and Guatema!a psy ho!ogi a! tests was found to be re!ated to dietary pra ti e and not to differen es in persona! hygiene, housing, ash in ome, rop in ome, proportion of in ome spent on food, parenta! edu ation, or other so ia! or e onomi indi ators. %erforman e of both pres hoo! and s hoo! hi!dren on the Terman and Goodenough draw&a&man tests was positi'e!y orre!ated with body weights and heights Be ause the shorter hi!dren did not ome from fami!ies signifi ant!y !ower in so io&e onomi fa tors, housing, and parenta! edu ation than those of the ta!!er hi!dren, it was on !uded that the most important 'ariab!e ref!e ted by the short stature was poor nutrition during ear!y !ife and that this a!so !ed to the !ag in de'e!opment of sensory integrati'e ompeten e . In a study done in Jamaica, all of the children from a low-income group undernourished at any time during the first 2 years of life had significant behavioral abnormalities at school age study was conducted to a population of !orean children" some were severely undernourished during the first year of life and then adopted by families in the #$. ll of the infants were adopted before their second birthday by merican families. They were then !assified as ma!nourished, moderate!y ma!nourished, and we!! nourished. By the time they rea h ( years of age, there were no differen es in a'erage weight among the three groups and a!! rea hed norma! )orean standards. *hanges in height were simi!ar to those in weight e$ ept that the undernourished hi!dren remained s!ight!y but signifi ant!y sma!!er. The mean I+ of the pre'ious!y undernourished groups was ",2.,-. The margina!!y nourished hi!dren a hie'ed a mean I+ of ",-..-. This is not a statisti a!!y signifi ant differen e. The pre'ious!y we!!&nourished hi!dren rea hed a mean I+ of """.6/, whi h does represent a signifi ant differen e from the undernourished hi!dren. The data a!so suggest that when we!!&nourished hi!dren are p!a ed in a more stimu!ating en'ironment they do e'en better. In a!! pre'ious studies, when the hi!d was returned to his or her pre'ious en'ironment, the I+ was (, or be!ow at s hoo! age. In a study in *o!ombia, se'ere!y undernourished hi!dren after re o'ery ha'e been p!a ed in an enri hed en'ironment at about 2 years of age. The hi!dren are e$posed to a!! types of stimu!ating !earning and p!ay e$perien es. Their nutrition has been kept ade0uate. %re!iminary resu!ts show that the test !e'e!s of the stimu!ated undernourished hi!dren are higher than those of the hi!dren from the higher so io& e onomi group who were not stimu!ated. 1esu!ts show that the we!!&nourished and stimu!ated hi!dren ha'e the highest !earning apa ity. %ryptophan and $erotonin Tryptophan is the pre ursor of 2erotonin. It is an essentia! amino a id and is found in a!! high& 0ua!ity proteins.


A more effe ti'e means is ingestion of a pure tyrosine supp!ement with arbohydrates that stimu!ates insu!in se retion. norepinephrine. and cetylcholine *ho!ine is deri'ed most!y from !e ithin in eggs. Thiamine defi ien y auses )orsakoff8s psy hosis and 4erni ke8s syndrome. It is be ause tryptophan must ompete with other amino a ids to enter the brain. 3n a high&protein mea! is eaten. *ho!ine supp!ementation has produ ed some promising resu!ts in treating tardi'e dyskinesia. *ho!ine has a bitter taste and auses an ob7e tionab!e fishiy body odor in peop!e who take it. 2 . 5ating a high&protein mea! in reases the amount of tyrosine in the b!ood fo!!owed by the !e'e!s in the brain. parti u!ar!y dopamines. secrete pituitary hormones. %ure !e ithin is. 'itamin *. B"2. 'itamin B6. #ore tryptophan enters resu!ting drowsiness. 4hi!e after a arbohydrate&ri h mea!. on!y a sma!! amount is on'erted to serotonin. making it an unp!easant treatment. and dopamine. This strategy has a potentia! benefit for patients suffering from %arkinson8s disease. and perceive pain. 2erious defi ien ies of thiamin. But tyrosine has not been appro'ed by the <DA for use as a drug be ause !itt!e is known about the possib!e harm of !ong&term use at high&dosage !e'e!s (itamins 3ne prob!em that was aused by 'itamin defi ien y is pe!!agra. =itamin B6 defi ien ies !ead to infant menta! retardation. probab!y by in reasing the !e'e!s of norepinephrine. and mood hanges :in some ases. and food additi'e of mayonnaise and ho o!ate. and fo!i a id an a!so pro'oke psy hiatri symptoms. though not as high as the tryptophan&serotonin rea htion. soybeans. insu!in auses these ompeting amino a ids to !ea'e the b!ood and enter mus !e tissue. !i'er. wa$y substan e that must be taken in !arge amounts to be effe ti'e and added a nine a!ories a gram to a person8s diet.2erotonin is needed to regulate sleep. In rease in brain tyrosine wi!! in rease the !e'e!s of ate ho!amines. It is due to the fa t that transport of ho!ine from the b!ood into the brain and the subse0uent synthesis of a ety! ho!ine are more omp!e$ omparing to the tryptophan&serotonin system. in adu!ts. Gi'ing !e ithin instead of ho!ine resu!ts a simi!ar su ess in treating tardi'e dyskinesia without the same drawba ks. Tyrosine has a!so been used with !imited su ess to treat depression. gi'en supp!ementation ha'e no dramati resu!ts and suggest that this approa h is not effi a ious in A!9heimer8s disease or in enhan ing memory %yrosine and the 'atecholamines The *ate ho!amines in !udes epinephrine. psy hosis. a bu!ky. 'holine. The effe t of !e'odopa e'ident!y has a simi!ar effe t to that of tyrosine. %eop!e who eat a high& arbohydrate !un h are !ess a!ert fo!!owing the mea! than peop!e who eat a sma!!. %eop!e with A!9heimer8s disease :who tend to be defi ient in a ety! ho!ine. Anima!s in7e ted with ho!ine ha'e in reases in a ety! ho!ine !e'e!s in the brain. howe'er. %he levels of serotonin in the brain can be altered by ingestion of tryptophan. with symptoms ranging from physi a! and psy hiatri . The effe t that ho!ine has on a ety ho!ine N5613T1AN2#ITT51 is !ess dramati than that in the tryptophan&serotonin onne tion. high&protein !un h &ecithin.

there is no on rete e'iden e that any other psy hiatri i!!nesses are aused by nutritiona! defi ien ies or that su h i!!nesses an be treated with diet in ountries with !ow ma!nutrition number. mood swings. espe ia!!y the optimum on entration of substan es norma!!y present in the human bodyA. <urther tests are needed. in !uding the brain. %re!iminary resear h a!!eges that !arge doses of 'itamin B6 might be benefi ia! in treating some autisti hi!dren. ?ypo a! aemia an produ e menta! aberrations. Aside from these. The resu!t. fo!i a id. Iodine defi ien y may !ead to thyroid defi ien y and retinism whi h is hara teri9ed by menta! retardation and serious prob!ems in growth and de'e!opment. B6. But e$ esses of manganese in the brain is found in %arkinson8s disease and some forms of dementia. sin e it is essentia! to proper o$ygen transport in the body. diets that redu e b!ood&g!u ose !e'e!s. minera!s. But nutrition s ientists are autious about it and re0uire ade0uate e'iden e before rea hing a definite on !usion %race )inerals There has been onsiderab!e resear h into the ro!e of tra e minera!s in brain and ner'e fun tion. irritabi!ity.(B. and s!eep disturban es. B"2. *opper is a!so essentia! to norma! fun tioning of the entra! ner'ous system. A%A found no e'iden e to support the pra ti e of it. #ost !aims that !arge doses of 'itamins are usefu! in treating brain&fun tion disorders !a k support from ontro!!ed studies. *a! ium and magnesium a!so p!ay a ro!e in some brain fun tions. 3n the other hand. =itamin * defi ien ies auses s ur'y. *rthomolecular and )egavitamin %herapy 3rthomo!e u!ar therapy is defined as the @treatment of menta! disease by the pro'ision of the optimum mo!e u!ar en'ironment for the mind. In ". 'itamin *. <o!i a id defi ien ies auses mega!ob!asti anemia that is sometimes pre eded or a ompanied by menta! disturban es in !uding irritabi!ity. o'er time. Iron defi ien y is be!ie'ed to impair neuropsy ho!ogi a! fun tion in hi!dren. The minera! #anganese is essentia! for norma! brain fun tion.=itamin B"2 defi ien ies auses anemia and neuro!ogi damage whi h in turn damages menta! fun tion. It has been a!!eged that mi!d 'itamin defi ien ies might ause some impairment of brain fun tion. They an be harmfu! B . is a deterioration of menta! fun tion. This is probab!y aused by inade0uate o$ygen rea hing the brain.. It appears to be in'o!'ed in the on'ersion of !e'odopa to dopamine in the brain. before !arge doses of 'itamin B6 an be re ommended as treatment. and hara teri9ed the under!ying therapy as superfi ia!. 4i!son8s disease is the resu!t of gradua! a umu!ation of opper in the body tissues. manifesting itse!f in part as !a k of attention and a!ertness in s hoo!. howe'er. in onsistent. hormones. and paranoid beha'ior. a!though no know!edge is a'ai!ab!e on its ro!e in the de'e!opment of these onditions ?igh !ead and mer ury !e'e!s resu!t in entra! ner'ous system abnorma!ities that may !ead to persona!ity hanges. and ontradi tory. and diets free of foods a!!eged to ause a!!ergies. The word @optimumA !e'e! appears to be a synonym for megadoses of 'itamins. The therapy in !udes nia in. whose symptoms may in !ude depression and hypo hondriasis. Diseases su h as #enkes8 disease whi h auses inade0uate intestina! absorption of opper !eads to brain and growth retardation in infants. In two studies of autisti hi!drean C both of whi h ha'e been a!!ed into 0uestion in terms of their 'a!idity C impro'ement was seen with administration of 'itamin B6. >in is another minera! that is essentia! in a number of ma7or bio hemi a! pro esses that affe t brain fun tion.

and s!eep!essness found that on!y a sma!! per entage suffered from genuine food a!!ergies. #a!nourished hi!dren tend to ha'e diffi u!ties in !earning to speak. depression. parti u!ar!y in hi!dren. but ob7e ti'e !ini a! tria!s ha'e fai!ed to show that they do so. and beha'iora! prob!ems aused by a!!ergies are e$ eptiona!!y rare. an$iety. poor on entration.ehavior A!!ergi rea tions to spe ifi foods are be!ie'ed by many peop!e to ause beha'iora! abnorma!ities. it is more !ogi a! that sugar wou!d ha'e a a!ming effe t *affeine has been !aimed to ause hypera ti'ity.+yperactivity in 'hildren The use of diet therapy to treat hypera ti'e hi!dren has a!ways been 0uestionab!e. or that they an a ount for neuro!ogi a! or psy hiatri prob!ems. whi h was arried out at the Nationa! Institute of #enta! ?ea!th and was high!y redib!e. and artifi ia! f!a'ors aused hypera ti'ity. The optima! breakfast was one that was ba!an ed in protein. The truth is affeine auses in reased motor a ti'ity and fidgetiness in pre&ado!es ent boys )alnutrition and .erformance <ar more subt!e are the !earning diffi u!ties that may or may not re!ate to fasting in s hoo!& hi!dren. interpersona! re!ationships. arbohydrates. ompared to hi!dren re ei'ing a p!a ebo. se'era! other studies ha'e shown that sugar a tua!!y an ha'e a a!ming effe t on hi!dren. and aggressi'e they were. artifi ia! food o!ors. and de'e!opment of motor ski!!s . Doub!e&b!ind s ientifi studies gathered at onsiderab!e e$pense o'er the years ha'e been unab!e to substantiate his !aims. but the su ess has nothing to do with the diet itse!f. it was found that hi!dren who ate breakfast performed better throught the morning on different measures of ogniti'e performan e than those who skipped it. ommon foods that are genera!!y hi!dren8s fa'orites are a!most omp!ete!y e!iminated. These studies !ear!y showed that the belief a <eingo!d diet was being used was what worked. rest!ess. In genera!.rea-fast and $chool . The restri ting diet works.ehavior 4hi!e most !inks between diet and beha'ior are weak. irritabi!ity. 6nder <eingo!d8s dietary restri tions. Ben7amin <eingo!d proposed that sa!i y!ates. 2in e onsuming sugar dire t!y enhan es serotonin produ tion. 1esponsib!e immuno!ogists and a!!ergists genera!!y find that true food a!!ergies are un ommon. in adapti'e and moti'ationa! beha'ior. Dr. and fats /ood llergies and . <eingo!d8s !aims of su ess in treating hypera ti'e hi!dren were ane dota!. Dr. there is no 0uestion that se'ere ma!nutrition an ha'e a signifi ant impa t on beha'ior. and some ha'e found that hi!dren re ei'ing !arge doses of 'itamins a tua!!y be ame more hypera ti'e. 2ome studies reported that the more sugar a group of hypera ti'e hi!dren onsumed. mood swings. D . 2e'era! studies of peop!e who !aimed that food a!!ergies were ausing su h symptoms as !ethargy. the more destru ti'e. ?owe'er. 1esponsib!e s ientifi studies ha'e fai!ed to find any re!ation between 'itamin megadoses therapy and !essened hypera ti'ity.

D?A is stored in the fish8s mus !e tissue and an a!so be obtained from marine a!gae as supp!ements. is primari!y found in fish. and do osahe$aenoi a id :D?A.. as we!! as wi!d aught sa!mon. 2icosapentaenoic cid 02. but effe ti'e in re!apse pre'ention :after the patient has regained fat. an be a'oided by taking fish&oi!&supp!emented margarine and omega&B eggs. #i roen apsu!ated <ish 3i! %owder.F. 1 and 3ocosahe4aenoic cid 03+ 1 5%A :2. The produ t then was used as additi'e on other produ ts - . In rats fed a D?A&defi ient diet. D?A and 5%A %rodu ed by 3ther Ei'esto k and #arine A!gae H #enhaden is a pe!agi . hippo ampus :memory enter. Ade0uate D?A is important for maintaining hea!thy neurotransmitter fun tion. and peri!!a. as we!! as important !ifesty!e and @ma roAnutritiona! hoi es. neuron atrophy was obser'ed in the parieta! orte$ :!ogi a! thinking enter. where antidepressant is not effe ti'e for promoting the i!!ness :when the body fat is sti!! minima!. D?A has the abi!ity to raise the sei9ure thresho!d of the ner'ous system. !ist. This has made most e$perts do not re ommend the re!ian e of AEA as a sour e of 5%A and D?A. and !imited 'ariety of 'itamins and minera!s further !imits it. pro'iding stru ture to neurons and is an an hor point for neurotransmitter re eptor.. The effe t of D?A and 5%A on sei9ure a ti'ity may partia!!y be e$p!ained by their effe t on neuron e$ itabi!ity or neura! hypera ti'ity 3BTAINING AD5+6AT5 D?A AND 5%A 3btaining and retaining D?A and 5%A depend on ade0uate intake. fish oi!s ha'e been found to ha'e therapeuti 'a!ue in diseases that tent to worsen under stress. ha!ibut.regnancy and &actation Go'ernmenta! warnings about fishes to$i !e'e! of mer ury :that is harmfu! to feta! growth. surfa e feeding fish that is not typi a!!y onsumed by huans be ause its bony stru ture doesn8t render mu h edib!e f!esh. 6nder onditions of tissue D?A saturation. in !uding for dopamine and serotonin. *urrent!y D?A and 5%A are appearing in foods in four different formsF #enhaden. ?owe'er the oi! of this fish was designed by the <ood and Drug Administration to be on the Genera!!y 1egarded As 2afe :G1A2. It is found in f!a$ and f!a$seed oi!. It is often what is eaten in addition to D?A and 5%A that determines whether o'era!! essentia! fatty a id !e'e!s are ade0uate 3uring . 3#5GA&B <ATTG A*ID2 AND B1AIN <6N*TI3N D?A is the brain8s bui!ding b!o k.. D?A an @retro on'ertA into 5%A. as we!! as in se'era! 'arieties of nuts and their oi!s. whi h obtain it by eating marine a!gae. herring.n&B. D?A :22F6 n&B. It an fun tion as a pre ursor for the n&B fatty a ids ei osapentaenoi a id :5%A. This has been shown in anore$ia patients. with a hain !ength "/ arbons !ong and three bonds that are unsaturated. and hypotha!amus :hormone enter. pro'ided that ma$imum intake did not e$ eed B gIpersonIday. is a!so primari!y found in fish. and tuna. ano!a oi!. soybeans.a-&inolenic cid 0 & 1 AEA is known as "/FB n&B. By redu ing ner'ous system a ti'ity. D?A a!so has an antio$idant effe t. sardines. with a !ow on'ersion e'en in the most optimum nutritiona! onditions.

%atients a! oho!ism. 2upp!ementations of D?A may he!p in menta! i!!ness of 'egan 'egetarian.. or if this is what is needed in a popu!ation su h as in the 6nited 2tates with !ess fish intake and a pandemi defi ien y of omega&B fatty a ids. and if it happens to the brain and ner'ous system !eads to an in rease in menta! i!!ness. 3uring dulthood Eong& hain fatty a id patho!ogy. is 22. This had made them ontain on!y D?A. supp!ements wi!! often impro'e depression and its re!ated with 'itamin 5 supp!ementation to make sure that they are not o$idi9ed with bipo!ar disorder. They shou!d be used and are thus effe ti'e. 5oal 27 )aintenance of a 3iet with a &ow %otal 3aily *mega-6 to *mega-8 9atio A high n&6Fn&B ratio :K". 4hen onsidering a re ommendation of fish or fish oi! supp!ements.a new heat&stab!e powder produ t was introdu ed in the 62. It is important to note that Eggs and marine algae-based products contain DHA only 3uring Infancy 3ne of the most important sour es of D?A and 5%A is mother8s mi!k. They are eaten by fishes and thus rise up in the food hain to humans. mg ea h of both D?A and 5%A. ?owe'er. s hi9ophrenia. appears to promote inf!ammation and o$idation. as the high DNA on entrations may be retro on'erted to 5%A. Ironi a!!y. 5oal 87 voidance of 9estrictive 3iets that 2ncourage 9apid :eight &oss 6 . pro'iding an a!ternati'e to fish and fish oi!s H 3ther sour e produ ed by !i'esto k with higher 5%A and D?A ontent in !udesF 5ggs of hi kens fed a suffi ient amount of f!a$seedJ #i!k from ows fed with grasses high in omega&B fatty a idsJ #eat of anima!s feed primari!y on grasses. the needs may be mu h higher. and other psy hiatri onditions may a!so impro'e with E*<A N6T1ITI3N 15*3##5NDATI3N2 5oal 67 'onsumption of 3ietary 3+ and 2. H #arine A!gae is the primary sour e of D?A and 5%A.. dementia. tardi'e dyskinesia supp!ementation :E*<A..H #i roen apsu!ated <ish 3i! %owder is produ ed by for ing fish oi! through a sie'e and reating sma!! f!akes that an be in orporated into food produ ts su h as bread. A benefi ia! ratio is probab!y !ose to 2F". and po!yunsaturated fat in addition to in reasing the n&B intake. The dai!y needs of omega&B fatty a ids re ommended by Internationa! 2o iety for the 2tudy of <atty A ids and Eipids :I22<AE. 2ome baby formu!as were made with marine a!gae as the sour e. postpartum depression. onsider that the in !usion of fish in a mea! impro'es the o'era!! ba!an e of fat. In 2. saturated fat. It is the n&6Fn&B ratio that is important. I22<AE does not !arify whether its re ommendations are spe ifi a!!y for an apparent!y hea!thy popu!ation. in 'egan 'egetarian diets was found to ha'e some of the highest ratio. =egan 'egetarians ha'e been found to ha'e !ower tissue D?A on entrations than non'egetarians. 1edu ed time spent between mother and babies has redu ed the a'ai!abi!ity of omega&B fatty a ids to babies. It is important to know that a!! seafood is benefi ia! with regard to omega&B ontent. not the tota! amount of n&B.

the amount of arbohydrate. A!though D?A is an antio$idant.. medi a! nutrition therapy :#NT. Assessing typi a! energy intake wi!! pre'ent o'erIunderfeeding at the start of rehabi!itation and open a dia!ogue regarding a!ori re0uirements during the refeeding and weight maintenan e phases BN patients energy intake may be unpredi tab!e due to the a!ori ontent of a binge. And as a!orie intake drops. the a!orie e!iminated during the 'omit was on!y . The nutritiona! rehabi!itation in !udes nutrition assessment. and this may be in the a'erage to abo'e&a'erage range. The treatment of eating disorders re0uires a mu!tidis ip!inary approa h in !uding psy hiatri I psy ho!ogi a!. Nutrition assessment routine!y in !udes a diet history and the assessment of bio hemi a!. nutrition ounse!ing.. Inade0uate intake resu!ts in de reased onsumption of arbohydrate. wi!! resu!t in inade0uate 'itamin and minera! onsumption. medi a!. In addition. 5'en an omega&B AEA supp!ementation during a weight !oss diet has been found not to preser'e n&B stores in tissue.(. C 5ating Disorders Not 3therwise 2pe ified :5DN32. fat. or protein intake is a!so redu ed. affe t brain fun tion. and they usua!!y o'erestimate their food and energy intake. It is be ause the per entage ontributed is re!ati'e to tota! amount of a!ori intake. A diet ri h in fruits and 'egetab!es is an important strategy.N energy onsumed during a binge is retained after purging. so a good supp!ement shou!d ontain 'itamin 5. a study of "( BN sub7e ts onsuming a mean of 2"B" k a! during binge. 6sua!!y an AN patient onsume !ess than ". spe ifi a!!y spatia! !earning and o!fa tory& ued re'ersa! !earning task. another antio$idant may preser'ing these fats. and anthropometri indi es of nutrition status DI5T ?I2T31G In diet history. 5oal . Though they assume that 'omiting may e!iminate a!ories onsumed during the binge episodes. M-. AN patients tend to a'oid arbohydrate and fat ontaining foods.7 Increased ntio4idant Inta-e #aintenan e of hea!thy fatty a id !e'e!s ha'e 2 goa!s F to in rease the !e'e!s through dietary hoi es and to pre'ent their o$idation through dietary food hoi es. ma ro L mi ronutrient onsumption. eating attitudes L beha'iors shou!d be in !uded in the guide!ines. metabo!i . C Binge 5ating Disorder :B5D. the degree of a!ori absorption after a purge. the assessment of energy intake.. k a!. and nutrition edu ation. simi!arities e$ist in nutritiona! onse0uen es and nutritiona! management. a!though the re!ati'e to tota! a!ori onsumption may not. C Bu!imia Ner'osa :BN. C Anore$ia Ner'osa :AN. k a! per day. A!though the eating disorders are distin t i!!ness. In genera!. and nutritiona! inter'ention. they an be important arriers of omega&B fatty a ids. with !imited 'ariety and poor food group representation.Dietary manipu!ation and restri tion annot spe ify whi h type of fat is !ost. As a ru!e of thumb. This. Two or more generations of D?A defi ien y : aused by restri ti'e eating. This !eads to a on !usion that energy e!imination is be!ow energy onsumption. and the e$tent of a!orie restri tion between binge episodes. mi ronutrient intake para!!e!s ( . when prepared with 'inaigrettes and marinades. Another assumption is that the a!orie onsumed during a binge an be omp!ete!y purged is a!so a mis on eption. protein and fat.

determine a!so unusua! or ritua!isti beha'iors :ingestion of food in atypi a! manner. true defi ien y diseases are un ommon. but some present with e!e'ated serum ho!estero! !e'e!s. But this does not warrant the ontinuation of a fat& and ho!estero!&restri ted diet during nutritiona! rehabi!itation =ITA#IN AND #IN51AE D5<I*I5N*I52 Despite the !ow intake diets.J then a'erage them. assistan e with reintrodu tion of ontro!!ed amounts of these foods at regu!ar times and inter'a!s is he!pfu!. shou!d be norma!i9ed during the ourse of nutrition rehabi!itation. It is important to know whether the patient fo!!owed 'egetarianism before or after she de'e!op AN. This shou!d be identified and ha!!enged throughout the treatment pro ess. determine the number of non& binge days :either restri ti'e or norma! intake. In addition. 5ATING B5?A=I31 AN and BN patient ommon!y de'e!op food a'ersions. !emon 7ui e. and se!e tion of mi ronutrient&ri h foods may be prote ti'e. ?b may de rease from base!ine 'a!ues ?yper arotenemia. These may be regarded as a ta ti to a'oid food intake or an effe t of star'ation EAB31AT31G A22522#5NT A!though patients tend to onsume a !ow a!orie diet..N :purged. ommon!y found in AN though e$ essi'e dietary intake of arotenoids is !ess ommon. and appro$imate their a!ori ontentJ determine the binge days and appro$imate a!ori ontent and dedu t -. mea! spa ing and !ength of time a!!o ated for a mea!. A!though they may prefer a'oidan e. Be ause of day&to&day 'ariabi!ity in eating disorder. They tend to regard foods as abso!ute!y @goodA or abso!ute!y @badA. Iron defi ien y anemia is a!so un ommon in AN due to de reased re0uirements. The de reased need for mi ronutrients in a atabo!i state. 5$treme f!uid restri tion or onsumption may re0uire monitoring of urine spe ifi gra'ity and serum e!e tro!ytes. with nontraditiona! utensi!sJ unusua! food ombinationsJ e$ essi'e use of spi es. <irst. 3n e refeeding has been initiated. a 2D&hour re a!! is not parti u!ar!y usefu!. 2o it is important to ompare the a!ori intake with ronutrient intake :fat  fatty a id L fat so!ub!e 'itamins. ha'e a @binge&triggering food@ and de'e!ops an a!!&or&nothing approa h towards it. and artifi ia! sweeteners. Assessment of the patient8s diet history before AN and the fami!y diet may be re0uired. the patients eat in an e$ essi'e!y s!ow manner. It is better to estimate dai!y food onsumption o'er the ourse of a week. use of 'itamin supp!ements. Typi a! f!uid intake shou!d a!so be determined be ause abnorma!ities in f!uid ba!an e are pre'a!ent in this popu!ation. often p!aying with their food and utting it into sma!! pie es. The true pi ture may be masked by hemo on entration resu!ting from dehydration in ear!y treatment. This affe ts the 0ua!ity and 0uantity of protein intake.. #any AN patients fo!!ow 'egetarian diets. #any BN patients eat 0ui k!y. 5N51GG 5O%5NDIT615 / . In AN. 'inegar.

degree of medi a! and psy hiatri instabi!ity. In genera!i9ation. 5oals of <utritional 9ehabilitation o *orre tion of bio!ogi and psy ho!ogi a! se0ue!ae of ma!nutrition o 1estoration of body weights o Norma!i9ation of eating patterns. basa! metabo!i rate fa!!s as mu h as ". the distribution may not be norma!. Dietary restraint may p!a e them in a state of semistar'ation :a hypometabo!i rate. se'ere!y ma!nourished. and hungerIsatiety ues ?ospita!&based programs or residentia! treatment is warranted when the AN patient is medi a!!y unstab!e. the a!ori pres riptions are determined by the medi a! do tor or treatment team.1esting energy e$penditure :155. is hara teristi a!!y !ow in ma!nourished AN patients..N&"-N to onser'e energy. a hange of B-. in some ases the in rease in 155 is e$ essi'e and presents as metabo!i resistan e to weight gain. T?5 #5DI*AE N6T1ITI3N T?51A%G AND *36N25EING Outpatient Outpatient Intensive Outpatient Intensive Outpatient Day Treatment (Day Hospital) Day Treatment (Day Hospital) Inpatient Inpatient Anorexi a Nervosa Bulimia Nervos a AN315OIA N51=32A Treatment of AN may begin at one of four !e'e!s of are depending on the se'erity of ma!nutrition. 6nder these ir umstan es. and binge&purge an in rease the metabo!i rate se ondary to a preabsorpti'e re!ease of insu!in. Body weight is assessed and routine!y monitored in patients with eating disorders. A!though the tota! body fat norma!i9es after short&term weight restoration. others may begin on an outpatient basis and may step up. and growth fai!ure. The patient may either parti ipate in menu p!anning from the beginning of treatment or when her weight is restored. . ?owe'er. The proto o! for menu p!anning may 'ary. In AN. ANT?13%3#5T1I* A22522#5NT A goa! of nutritiona! rehabi!itation is restoration of body fat and fat&free mass. 2ometimes the patient may need to omp!y guide!ines in menu p!anning . BN patients an ha'e unpredi tab!e metabo!i rates. weight maintenan e is the short&term goa!. and refeeding wi!! in rease it. weight gain is ne essary whi!e in BN. or growth retarded. duration of i!!ness. k a! in a!ori intake is fo!!owed by a hange of " !b in body weight. eating beha'iors. 2ome begin with inpatient hospita!i9ation and stepped down.

The 1egistered Dietitian :1D. a!ori pres ription may be s!ow!y de reased to promote weight maintenan e.. the team has !ess ontro! o'er the hoi es.rescriptions The treatment p!an shou!d in !ude an e$pe ted rate of weight gainF about 2&B !bIweek for hospita!i9ed patient and .&"6. %ara!!e! to weight gain. abdomina! distention and dis omfort  di'ide mea!s with afternoonIe'ening sna ks o %atient fear to be a ustomed to !arge food amount  use !i0uid supp!ement B6EI#IA N51=32A Treatment of BN typi a!!y begins and ontinues on an outpatient basis.lan and 'aloric . 3n o asion a BN patient may be dire t!y admitted to an intensi'e outpatient or day treatment program. and the 1egistered Dietitian :1D. nasogastri . an be e$treme!y he!pfu!.N J en ourage sma!! in reases in fat intake unti! goa! an be attained J pro'ide sour e of essentia! fatty a id o %rotein intake F "-N&2.&2..-&" !bIweek for the outpatient. k a!Iday are suffi ient to initiate weight gain. minimum F 1DA in gIkg idea! body weight J high bio!ogi 'a!ue sour es o *arbohydrate F -.. the a!orie intake shou!d a!so be in reased. *a!ori pres ription in ado!es ents may remain higher due to growth and de'e!opment. 5uidelines for )edical <utrition %herapy o Dietary fat intake F 2-N&B...&". AN patients are typi a!!y pre ontemp!ati'e or ambi'a!ent about making hanges in eating beha'ior. inpatient hospita!i9ation is re!ati'e!y un ommon and genera!!y is of short duration and for the spe ifi purpose of f!uid and e!e tro!yte stabi!i9ation. as we!! as an in rease in a ti'ity shou!d a!so be in !uded.. Aggressi'e refeeding of se'ere!y ma!nourished AN patients may pre ipitate !ife&threatening omp!i ations of the refeeding syndrome during the first week of ora!. . k a!Ikg of body weight. diet. and despite the differen e. and must progressi'e!y in rease :about ". a!ories per 2&B days.&D. k a!Iday for ma!e. 'omiting.N. is an essentia! part of the treatment team at a!! !e'e!s of are.N&--N J en ourage inso!ub!e fiber for treatment of onstipation o =itamin and minera! supp!ementation to rea h ".. ".. and D. or intra'enous refeeding. In an outpatient setting.&D-.... %reatment . After the goa! is a hie'ed. and body weightJ some are defiant and hosti!e on initia! presentation  the nutrition ounse!or an he!p to reso!'e the ambi'a!en e. the pres ription is about B. AN patients onsistent!y find it diffi u!t to make food hoi es..There are no out ome studies to suggest that one method is better than others. and e$ essi'e physi a! a ti'ity in !uding fidgeting o De!ayed gastri emptying.. with a measure of (. *a!ori pres riptions in the range of "..N 1DA o *a! ium and =itamin D due to in reased risk of osteopenia and osteoporosis o Iron& ontaining preparations may aggra'ate onstipations Important <otes o %ossibi!ity of food dis arding. ?owe'er. In genera!. to promote ontro!!ed weight gain.. k a!Iday. e$er ising. so the 1D must use ounse!ing ski!!s to begin the p!an de'e!opment.

and restrained&intake days. o *a! u!ate the tota! a!ori intake o'er the (&day period o *a! u!ate an a'erage dai!y intake.5oals of <utritional 9ehabilitation o Interruption of the binge&and&purge y !e o 1estoration of norma! eating beha'ior o 2tabi!i9ation of body weight %reatment . moderate& intake days. parti u!ar!y in the initia! phase 'ognitive . moderate&intake days.%1 *BT is the treatment of hoi e in BN. minimum F 1DA in gIkg idea! body weight J high bio!ogi 'a!ue sour es o *arbohydrate F -. If a !ow metabo!ism is suspe ted.& week inter'ention that onsists of three distin t and systemati phases of treatmentF o 5stab!ishing a regu!ar eating pattern o 5'a!uating and hanging be!iefs about shape and weight o %re'enting re!apse 4hen the BN patient is re ei'ing *BT. o 5stimate -. sma!! but onsistent in reases in the a!ori intake shou!d be pres ribed e'ery "&2 weeks. o ?a'e the patient des ribe a typi a! food on a bingeIpurge days. *BT is typi a!!y a 2. The goa! in monitoring goa! is weight stabi!i9ation. If the weight is stabi!i9ed on a !ower&than& a'erage a!ori intake. and restrained&intake days. a!ories dai!y is a reasonab!e p!an to start. is usefu! in determining the a!ori pres ription.N on the bingeInonpurge days.. bingeInonpurge days. the 1D an be instrumenta! in he!ping the patient to estab!ish a regu!ar mea! pattern. and ". This wi!! indu e in rementa! in reases in the metabo!i rate.rescriptions Assessment of 155 a!ong with !assi signs of a hypometabo!i state :su h as a !ow T B !e'e! and o!d into!eran e. 4hen app!ied to an eating disorder. bingeInonpurge days.&"6. a a!ori pres ription of "-. The 1D and the psy hotherapist must maintain a it'e ommuni ation to a'oid "" . moderate&intake days. %atien e and support are essentia! in this pro ess of making positi'e hanges in their eating habits.lan and 'aloric .rescriptions o <or a typi a! week.N J pro'ide sour e of essentia! fatty a ids o %rotein F "-N&2.ehavioral %herapy 0'.N of the a!ori intake on the bingeIpurge days. purging. 2stimating Initial 'aloric . and restrained intake often impair re ognition of hunger and satiety ues.N.. The 1egistered Dietitian an than formu!ate an initia! eating and mea! p!an based on this estimated a'erage dai!y intake 5uidelines for )edical <utrition %herapy o <at F 2-N&B. and restrained&intake days.N&--N J en ourage inso!ub!e fiber for treatment of onstipation o #u!ti'itamin&minera! preparation to ensure ade0ua y. The essation of purging beha'ior oup!ed with a reasonab!e dai!y distribution of a!ories at three mea!s and pres ribed sna ks an be instrumenta! in strengthening these bio!ogi ues. ask patient to estimate the number of bingeIpurge days.. Bingeing.

BING5&5ATING DI231D51 o 2trategies for treatmentF nutrition ounse!ing and dietary management. If the BN patient is engaged in a type of psy hotherapy other than *BT. The patients may re ei'e from unre!iab!e sour es or ha'e distorted interpretation. #orta!ity rates in AN is among the highest in psy hiatri i!!ness. Appro$imate!y ha!f of these deaths are due to the effe ts of e$treme ema iation and about ha!f to sui ide :%a!mer. in reased physi a! a ti'ity. AN women are "2 times more !ike!y to die than women of simi!ar ages in the genera! popu!ation.. N6T1ITI3N 5D6*ATI3N Though patients tend to ha'e know!edge about food and nutrition. nutrition edu ation is sti!! an essentia! omponent of the treatment p!an.N&/-N. impro'ed body image. indi'idua! and group psy hotherapy.N.N patients re0uiring rehospita!i9ation within " year of inpatient treatment.N&(. and medi ation. BN patients ha'e a short&term su ess rate of -. "2 . and better o'era!! nutrition.. Ado!es ents ha'e better out omes than adu!t. ". %13GN32I2 1e!apse rates after weight restoration in AN is high. the 1D shou!d in orporate more *BT ski!!s into the nutrition ounse!ing sessions. as many as -.. And remember to hoose the information arefu!!y. Two thirds of AN wi!! ha'e enduring food and weight preo upation. and a re!apse rates of B. A sour e that indi ates a !ow& fat !ow& a!orie intake for pre'enting hroni disease is not orrespondent to the treatment p!an. o Goa! of treatmentF 2e!f&a eptan e. and younger ado!es ents is better than o!der ado!es ents..o'er!ap in the ounse!ing sessions.