Diplomate, Board Certification of Emergency Medicine
Bulimia is another disease of young women which can be very
damaging. These young women -- the typical patient -- often
look of normal weight. However they binge eat and then --
usually in secret -- purge. That is, they vomit the food
back, usually by sticking their fingers in their throats.
Sometimes they vacillate between anorexia and bulimia.
There is usually some underlying psychological problem in
these people, although it can be as simple as low self-
esteem, parental or peer pressures or bad family dynamics.
Fortunately, recovery is not uncommon, and there are good
therapies, including psychotherapy and medications --
especially antidepressants which seem to have a good effect
against all obsessive-compulsive behavior.
Another form of eating disorder that can cause severe
problems is undereating in people without an appetite, such
as in the elderly and in cancer patients.
In cancer patients we often prescribe nutritional supplements
such as Ensure or Jevity. Keep in mind that these are
Cholov Stam under the O-U in America. Elderly patients
can often be fed by making a hole in the stomach wall and
feeding them through it. This will not cut down on the
incidence of pneumonia or aspirations, but it does give more
food to those who find it hard to eat. Usually when patients
refuse to eat -- especially in cancer - - it is the end in
most cases.
Depression is another cause of not eating. It is normal for a
grief-stricken patient not to eat, but once a lot of weight
is lost, one must consider a diagnosis of depression. Many
excellent medications exist to treat this.
Overeating is a rarer disorder in the extreme. Pica -- a
disease of brain-impaired people who usually have birth
defects -- is a disease where almost anything will be eaten.
More commonly, people just overeat due to sadness or boredom,
which usually leads to obesity.
Binge eating on Shabbos -- which can happen when you just eat
a much-larger-than-usual Shabbos meal -- is also very bad for
the body. Eat slowly and in small amounts. Write me in care
of the Yated.
A message from GlaxoSmithKline, sponsor of this
column. Zofran is the most effective medication against
vomiting, and is the most common one used for chemotherapy
patients who often have bad vomiting. Unlike other drugs used
in Israel for vomiting, this has much fewer side effects.
