[This post in not only for you but relatives and friends as well. If people had strokes or TBIs, for example, their eating disorders might cause you concerns. And you should say something. Just sayin’…. It seems like research is desperately needed. So here we go.]
Ed Roth, Communications Director, Brain Injury Alliance of Arizona, wrote:
“It’s been established that brain injuries can cause mental health issues, such as depression and anxiety. But what about eating disorders? Anecdotal evidence would suggest so, but are anorexia, binging, and purging related to brain trauma? The answer is, well, complicated.”
Roth goes on to say that a recent 38-month study of 107 traumatic brain injury (TBI) survivors found that 42% gained weight and 29% lost weight. While some of this data could be traced to changes in overall behavior, these findings definitely show the need for recognizing the perils of not providing nutritional advice as part of brain injury revival.
Before we proceed, let’s examine the names of typical eating disorders:
- Anorexia–Being more worried about, or paying more attention to, weight and body shape and having a negative self-image
- Bulimia–Excessive quantities of food is eaten in a short period of time, followed by feelings of shame, and resulting in vomiting or purging
- Binge eating–Chronic, compulsive overeating in a short period of time and feeling like you can’t stop
Dr. Lesley Williams, Family Medicine Physician at Mayo Clinic, is a member of the International Academy for Eating Disorders and subscribes to a correlation which can be found between malnutrition and brain health.
“With severe malnutrition, a body can’t function appropriately, including cognition and memory,” she says. “In chronic cases of anorexia, brain scans reveal evidence of atrophy. The brain actually ages at a more rapid pace. Most younger people who are treated will improve.
“Eating disorders can starve the brain. With bulimia, you can see an electrolyte imbalance. Losing phosphorus can translate into difficulties with cognition, putting a person at higher risk for seizure or heart attack,” Dr. Williams says.
Phoenix Public Relations Executive Elizabeth Lowney can attest to a link between brain injury and a change in her eating habits. She’s had five concussions, each of which brought about a range of difficulties, including brain fog and loss of memory. However, her most recent brain injury two years ago was quite unlike the others.
“I never put the two together, but for the past couple years, I don’t get hungry until dinner,” Lowney says. “The concussion may have affected my central nervous system, slowing down my metabolism. The effects of brain injury are just so random.”
Brittany Sweeney-Lawson, a manager for Brain Injury Alliance of Arizona Resource Facilitation, says many people are often shocked at how greatly a brain injury can affect the “function of the rest of their body’s systems. There’s a reason it’s referred to as ‘the mind-body connection’—a brain starved of nutrients doesn’t function as quickly, thus slowing communication to the rest of the body.”
She goes to say that mind-body connection occurs more often in lower-income households, where access to wholesome foods may be more restricted, but those with bigger incomes who do have a passageway to the foods may intentionally restrict themselves.
The goal of any intervention towards an eating disorder is to essentially:
- Restore physical health
- Develop normal patterns of eating habits and/or attitudes
- Reduce the impact of illness and day to day functioning
The goal is fairly obvious but achieving it is not. Eating disorders mostly affect young females. One study found that 4 to every 100,000 in people aged 10-39 years. But what was more alarming is that Anorexia is often said to have the highest death rate among all of the psychiatric disorders.
Anorexia Nervosa (or as it is commonly referred to as “Anorexia”) is a serious and debilitating condition. Without early interference, the condition usually makes the individual suffer for many years.
The World Health Organization says about Anorexia:
“A disorder characterized by deliberate weight loss, induced and sustained by the patient. It occurs most commonly in adolescent girls and young women, but adolescent boys and young men may also be affected, as may children approaching puberty and older women up to the menopause. The disorder is associated with a specific psychopathology whereby a dread of fatness and flabbiness of body contour persists as an intrusive overvalued idea, and the patients impose a low weight threshold on themselves. The symptoms include restricted dietary choice, excessive exercise, induced vomiting and purgation, and use of appetite suppressants and diuretics.”
One case study in the UK said, “All [who contracted Anorexia] had a frontal subcortical syndrome, expressed by neuropsychologic dysfunction, neuroimaging (frontal and basal ganglia lesions) and also as personality changes.”
A growing body of research looks at the connection between eating disorders and brain injury, specifically in how traumatic brain injury or stroke can control appetite, eating behaviors, and body image awareness.
Specifically, brain injury can confuse appetite Hypothalamus damage:
- The hypothalamus controls hunger and satiety
- A brain injury affecting this area can lead to:
- Hypophagia (undereating, linked to Anorexia symptoms)
- Hyperphagia (overeating, linked to binge eating disorder)
Prefrontal Cortex damage can exacerbate impulse control problems
- The prefrontal cortex determines self-control and decision-making
- Damage from Stroke or TBI can lead to:
- Compulsive binge eating
- Emotional eating with frustration or mood swings
Brain injury can trigger body image bias
- Stroke and TBI patients can develop body dysmorphia, perceiving their body negatively than before
- Damage to the right parietal lobe can lead to distorted self-image
Emotional Trauma from Brain Injury Can Lead to Eating Disorders
- Brain injuries increase depression, anxiety, and PTSD risk, which can trigger poor eating as a coping mechanism
- TBI individuals may experience poor emotional supervision, leading to comfort eating or food avoidance
Ways to assist are these:
- Cognitive Behavioral Therapy–Helps re-establish healthy eating habits
- Nutritional support–Seek advice from a dietitians trained in TBI recovery & eating disorders
- Management of meds–Use medication for impulse control, mood swings, and/or depression
- Brain recovery–Supports self-regulation and emotional balance
Stroke and TBI increase the brain’s nutritional needs, so eating nutrient-dense foods is essential:
- Healthy Fats (avocados, nuts, olive oil, salmon)–Support brain cell repair
- Leafy Greens (spinach, kale, broccoli)–Improve cognition & reduce brain fog
- Berries (blueberries, blackberries)–Protect brain cells with antioxidants
- Whole Grains (brown rice, quinoa, oats)–Provide steady energy & regulate mood
Eat Enough Protein:
- Helps repair brain cells and improves focus
- Best sources: Eggs, beans, lentils, tofu, fish, lean meats
Stay Hydrated:
- Dehydration can worsen memory & focus
- Aim for 8 glasses of water daily
Manage Appetite Moods:
- If you’re not hungry:
- Smaller, frequent meals–Eat 5-6 small meals a day instead of 3 big ones
- Calorie-dense, nutrient-rich foods such as smoothies, peanut butter, nuts, avocado, eggs for easy nutrition
- Set reminders by a phone alarm or a meal-tracking app to remind you to eat
- If you’re always hungry:
- High-fiber foods–Consume vegetables, beans, lentils, whole grains to stay full longer
- Use smaller plates and bowls–Fool your brain into feeling full with smaller portions
- Eat slowly–Take 20-30 minutes to eat, chewing completely
Pair Carbs with Protein & Healthy Fats
- Instead of just toast, eat whole-grain toast, avocado, and/or eggs to balance blood sugar
- Instead of just fruit, eat berries and/or almonds for steady energy
Limit Processed Sugar & Refined Carbs
- Avoid white bread, pastries, soda, candy which cause energy cravings
- Replace fruit, dark chocolate, dates with natural sugars
As Tommy Lasorda, an American professional baseball pitcher who became manager of the Los Angeles Dodgers from 1976 through 1996, said, “When we win, I’m so happy, I eat a lot. When we lose, I’m so depressed, I eat a lot. When we’re rained out, I’m so disappointed, I eat a lot.”
Eating disorders are serious. Tommy Lasorda and his cast iron belly humor are priceless, but that’s not what we’re talking about here in this blog.
Terrific review, covers all areas so well. Thanks!!