A metabolic assessment is rarely integrated into a psychiatric evaluation. Many mental health professionals and psychiatrists are only beginning to understand how important nutrition may be for optimal brain function and mental health. Rather than treating symptoms alone, the most effective treatment targets nutritional and metabolic imbalances that interfere with the body’s ability to regulate appetite. Once balance is restored, the symptoms often diminish—or even disappear.
A number of physician-ordered tests, such as those for food allergies, magnesium, and cholesterol, can help you discover underlying nutritional deficiencies that may be contributing to your health and appetite disturbances. Some of these problems, such as thyroid abnormalities, will require medical attention. But others will respond to nutritional supplements. I suggest that you work with a healthcare provider familiar with biochemical individuality to create an individualized supplement program based on the results of your metabolic tests. Don’t try to figure it out yourself—overloading on supplements or taking those you don’t need can be expensive and frustrating, and it may lead you on another journey toward failure.
A comprehensive metabolic evaluation is a critical part of regaining appetite control. After you have restored all nutritional deficiencies, additional supplements can support neurotransmitter synthesis and minimize the out-of-control appetite that prompts disordered eating. In my many years of clinical experience, I have found these nutritional supplements invaluable in the treatment of eating disorders and help fight binge eating. When your body is provided with the right nutrients, you are better equipped to achieve success and regain control over your appetite, cravings, and binge eating.
In addition to amino acids—particularly those related to appetite, such as tryptophan, phenylalanine, and glutamine—the core nutritional program for the New Hope model incorporates the following nutrients:
- Digestive enzymes
- B vitamins
- Trace minerals (zinc, chromium, magnesium)
- Essential fatty acids
- Gymnema, a targeted nutritional supplement for sugar cravings
>> Digestive Enzymes
Recovery from disordered eating depends on a healthy digestive system. Often, I see patients eating healthy diets consisting of organic foods and adequate protein, yet their blood work reveals they are malnourished. Nutritional status is not based on what you eat. Instead, it depends upon your ability to digest and absorb the nutrients from food.
A healthy digestive system is like a well-oiled machine with smooth transitions between its phases. When you see a plate of food, smell its aroma, and think about the first bite, chemical messengers in the brain send signals to the digestive system. After food is swallowed, it travels down the esophagus and into the stomach, helped along by rhythmic contractions of the ring-like muscles in the esophagus. Once the food arrives in the stomach, the stomach’s expansion triggers the secretion of digestive enzymes and gastric acid. The stomach chemically and mechanically transforms the food into a liquid mixture, composed of partially digested food, water, digestive enzymes, and hydrochloric acid (HCL). The extremely acidic nature of HCL is essential for proper digestion because it helps break down protein, absorb vitamins and minerals, and communicate to the brain that you are full. In other words, hydrochloric acid is good for digestion.
The supplemental digestive enzyme combination should be a broad-spectrum type that helps you digest carbohydrates, proteins, and fat. The number of enzymes each individual should take varies according to diet, lifestyle, and biochemical individuality. For people with binge eating disorder, the digestive enzyme combination should include betaine HCL, essential for breaking down protein to the precursor amino acids required for neurotransmitter and peptide synthesis to regulate appetite.
Your appetite depends, in part, on the proper function of your intestines, and one of the key ways to improve intestinal functioning is through the use of probiotics. Probiotics are microorganisms—“good” bacteria that help the body digest and absorb vitamins, fatty acids, and other nutrients. The human intestinal tract is home to as many as 100 trillion of these organisms, which form the intestinal environment, or microbiota. The quality, quantity, and physiological activity of the bacteria can easily be changed for the worse by antibiotics, birth control pills, laxative abuse, poor nutrition, and stress. As their levels decrease or otherwise change, a corresponding increase in physical and psychological problems may occur, including changes in appetite and weight.
>> B Vitamins
The complex of B vitamins is important for normalizing eating patterns because they help stabilize blood glucose levels. The vitamins that make up the B complex include thiamin, riboflavin, niacin, B6, B12, pantothenic acid, inositol, biotin, folate, and others that work together to convert carbohydrates into glucose—which means these vitamins help provide energy, decrease sugar cravings, fight fatigue, and ease hypoglycemia-related mood swings. These vitamins are also important in preventing depression. The B vitamins that are most important to appetite control include vitamin B6, vitamin B12, inositol, and folate. They can be taken as individual supplements or, in many cases, taken together in the form of a B complex.
>> Folate (L-methylfolate)
The B vitamin folate is crucial to the growth and maintenance of all cells and the synthesis of DNA. It markedly affects the production of all new proteins, particularly those with a fast turnover rate, such as those found in the red blood cells, the cells lining the digestive tract, and those forming a growing fetus. Low levels of folate can cause anemia, gastrointestinal upset, and major defects in the fetal brain and spine (known as neural tube defects). Those with too little folate can also develop elevated blood levels of homocysteine, a risk factor for cardiovascular disease and Alzheimer’s disease.
Folate assists in the manufacture of serotonin, dopamine, and norepinephrine, and low levels of the vitamin are often seen in depressed people, with lower folate levels correlated with more severe depression. Numerous studies have also found that depressed people with low folate levels respond worse to antidepressant treatment and relapse more frequently than others. Higher folate levels, on the other hand, are linked to less depression. Taking folate supplements seems to also enhance the effects of antidepressants and relieve depression more effectively than simply taking antidepressants alone. However, those with a particular biochemical makeup may respond best to a form of the vitamin called L-methylfolate.
Inositol, also known as vitamin B8, is responsible for forming healthy cell membranes and maintaining nutrient transfer between cells. Inositol is converted into a substance that regulates the action of serotonin. Restoring normal levels of this vitamin may help alleviate psychiatric symptoms, including depression, feelings of panic, and obsessive thoughts.
One study looked at inositol’s use in the treatment of binge eating disorder. Twelve patients with bulimia and binge eating disorders were given 18 grams of either inositol or a placebo and monitored for six weeks. The group taking inositol reported significant improvements in symptoms compared with the placebo group at the end of the study. This demonstrated that inositol can be useful in treating not only patients with depression and obsessive-compulsive disorders, but also those who suffer from bulimia and binge eating.
>> Trace Minerals
Numerous trace minerals are essential for human health and optimal brain function, but three minerals in particular can be helpful in treating eating disturbances. These are chromium, which helps to regulate glucose and control the symptoms of depression; magnesium, which fights insulin-resistant hunger, depression, and anxiety; and zinc, which can be critical to the treatment of depression and the restoration of a normal appetite.
// ZINC The mineral zinc plays important roles in growth and development, neurological function, the immune response, reproduction, and neurotransmitter synthesis. Vital chemical reactions involving nearly 100 different enzymes, including digestive enzymes, cannot be catalyzed without zinc. The mineral is also critical to the senses of taste and smell, bone growth, the production of proteins, DNA synthesis, cell division, and wound healing. Because the body cannot store zinc, daily intake is necessary. Symptoms of zinc deficiency include hair loss, skin lesions, acne, diarrhea, and depression. White marks on the fingernails are an early sign of zinc deficiency.
// CHROMIUM Inadequate chromium levels result in carbohydrate cravings, impaired glucose tolerance, hypoglycemia, and depression. Chromium is an essential part of glucose tolerance factor, a compound that helps insulin move blood sugar into the cells. Chromium works with the insulin receptors on the cells and helps “open the doors” so that glucose can enter. And even though the body contains a trace amount of chromium, when its stores become depleted, the effectiveness of insulin and the body’s ability to handle glucose can markedly decrease. Poorly controlled glucose levels, in turn, can result in sugar or carbohydrate cravings and an increase in hunger.
// MAGNESIUM Magnesium plays vital roles in many of the body’s metabolic processes, including the conversion of protein, fat, and carbohydrates into energy. Moreover, magnesium is necessary for the proper function of more than 300 enzymes, including those necessary for the synthesis of neurotransmitters such as serotonin. Common symptoms associated with a lack of magnesium include headaches, constipation, insomnia, premenstrual syndrome, fatigue, anxiety, insulin resistance, and sugar cravings.
>> Essential Fatty Acids
Necessary for several biological processes, the essential fatty acids (EFAs) can’t be manufactured by the body, so they must be consumed through the diet. There are two families of EFAs: the omega-3s, which are found primarily in fish or fish oil and can be created in the body from flax oil (although some people have a genetic trait that prevents this conversion); and the omega-6s, which are found primarily in vegetable oils and grains and consumed in abundance through Western diets.
Growth and development, brain and nerve function, the control of inflammation, and the regulation of metabolism all depend on sufficient amounts of omega-3s. In adolescents, low levels of EFAs have been correlated with depression, although higher levels of fatty acids seem to protect against it. Several studies have found that taking
EFA supplements can reduce depressive and aggressive symptoms as well as suicidal thinking.
Recent studies reveal the healing powers of curcumin, a component of the household spice turmeric. With antioxidant and anti-inflammatory properties, curcumin imitates the antidepressant actions of two prescription drugs (fluoxetine and imipramine) without any of the side effects. It has also been touted as an antiobesity agent for its ability to reduce body fat and weight gain. In a study published in the Journal of Nutrition, mice that were fed a high-fat diet supplemented with curcumin had decreased weight gain and lowered cholesterol levels. Though more research is needed to validate the importance of dietary curcumin in helping to regain appetite control, extensive research has focused on curcumin’s ability to combat symptoms of depression, a condition that often coexists with disordered eating.
Gymnema sylvestre is a traditional ayurvedic herb that is native to Central and Western India, Africa, and Australia. Its Hindi name, gurmar, means “destroyer of sugar.” Commonly found in most health food stores in a tea form, it is considered to have anti-diabetic properties and is used to control obesity. When the leaves are chewed, they interfere with the ability to taste sweetness, so it can be helpful for suppressing sugar cravings.
The active property of gymnema is gymnemic acid, which has the ability to delay glucose absorption in the blood. Because the molecular structure of gymnemic acid is similar to that of glucose, it can help curb sugar cravings by filling in the receptor locations of sweet taste buds. Though more research is needed, gymnema may be an alternative medicine to treat sugar cravings because of its efficacy in blocking sugar-binding sites and inhibiting sugar molecules from accumulating in the body.
Nutrient deficiencies often contribute to the stranglehold of appetite disturbances and intensify devastating patterns of disordered eating. Working with a qualified healthcare practitioner to identify personal nutrient imbalances and implement a unique supplementation plan can be a very powerful step in recovery.
When used as part of an individualized and integrative treatment plan, supplements can help to enhance metabolism, stabilize blood sugar, and resynchronize hormones, thereby restoring appetite to a helpful and harmonious normal. Many of these targeted supplements may work to not only normalize your appetite, but also to balance your mood and fight depression. Taking supplements to correct nutritional deficiencies is the foundation of the New Hope model for restoring appetite control and to help avoid those episodes of binge eating.
By James Greenblatt, MD, with Virginia Ross-Taylor, PhD