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Bulimia is an eating disorder where excessive eating or bingeing is followed by induced vomiting or purging with laxatives. Due to their obsession with food, people with Bulimia tend not to lose a lot of weight and may be prone to depression.

Like people suffering from anorexia nervosa, people with Bulimia have a distorted body image. They may suffer from a high or unrealistic expectation of how they should look. The disease may also be associated with past medical illnesses, and a mother's over-concern with eating and weight control. Bulimics may have a history of being overweight and past history of emotional problems.

Binge eaters tend to consume large quantities of food at night. Often they will awake from sleep and start eating. The habit of eating at night is more associated with an eating disorder rather than being overweight.

Bulimics tend to binge on carbohydrate foods. Carbohydrates increase the levels of brain serotonin, which is a chemical that increases the feeling of satisfaction and fullness after a meal. Research is demonstrating that there may be a problem with serotonin metabolism in Bulimic people.

Bulimic and anorexic women are unlikely to reach the normal bone density and may possibly develop osteoporosis later in life. Frequent vomiting can lead to an erosion of tooth enamel and gum problems. Other side effects of this eating disorder are reduced digestive function, infertility, amenorrhoea (lack of menstrual periods) and irregular heart beats.

Childhood sexual abuse is found to have occurred to a substantial minority of women with Bulimia. Some Bulimics may also suffer alcohol and drug dependence, conduct and behavioural disorders and avoidant personality disorders.

This patient must be under the care of a Doctor at all times. The patient needs careful monitoring and care. Psychotherapy may be needed to help control the ailment. The initial step may have to include hospitalisation. As Bulimics may make themselves vomit after eating, it is IMPORTANT to closely monitor their actions. The patients are encouraged to put on bodyweight and gain confidence in their body shape. Assessment should include an evaluation of the quality of interpersonal relationships and family environment.

This ailment is very difficult to treat with a simple "diet" as the patient is usually resistant to suggestions to eat and has already developed severe food restrictions. Sometimes he/she pretends to have an appetite and eats a large meal only to disgorge it as soon as possible by induced vomiting.
One suggestion is to encourage the Bulimic to eat with other members of the family. Encourage nutritious snacks between meals and concentrate initially on a good amount of foods she/he feels comfortable eating. Avoid eating rich or sugary foods that may encourage binge eating.
Encourage the use of normal foods, rather than "diet" foods or low fat foods. Ensure some protein is eaten daily and if possible, include oysters and red meat for zinc. Present the food in an appetising way. Protein supplements contain all the essential amino acids and are easy to digest.

Nutritional supplements are only to be taken if the dietary vitamin intake is inadequate.
• A Multi-vitamin/mineral is recommended to replace some of the nutrients lost through vomiting. A liquid form is recommended to aid absorption.
• Supplementation with zinc may help to resume normal eating patterns, as zinc deficiency can lead to a reduction in the sense of smell and taste.
• Calcium helps to improve bone density. Studies show osteoporosis is a common complication in people with Bulimia.
• The amino acid Glutamine helps thicken and regenerate the lining of the gut, which may be damaged in people with Bulimia.
• Slippery elm (Ulmus fulva) is a herb which when ingested helps to protect and reduce inflammation in the lining of the digestive tract.
• Chamomile (Matricaria chamomilla) and Passionflower (Passiflora incarnata) are herbs with calming properties, which may help to reduce anxiety commonly associated with Bulimia.
• St. John's Wort (Hypericum perforatum) is a herb proven to be effective in mild to moderately severe depressed outpatients. St John's Wort should not be taken in conjunction with certain types of prescription medication. Check with your Doctor.
• Isotonic drinks - these drinks (in powder or pre-prepared form) help to reduce the risk of an electrolyte imbalance developing as a result of dehydration from repeated vomiting or laxative abuse.

Ask your MedAux Pharmacist for advice.
1. Follow the Diet Hints.
2. Do not eat junk food, sugar and refined carbohydrates as these foods are harder to digest and do not provide the necessary nutrients for good health.
3. Do not drink any caffeine drinks. They include tea, coffee and cola. Caffeine increases nervous tension and can suppress appetite.
4. The practise of vomiting after a meal is NEVER encouraged. This Practise can lead to tooth decay due to the acidity of the contents of the stomach during vomiting. Rinsing with bicarbonate of soda and water or another alkalising agent after vomiting can help to alkalise the mouth.
5. Moderate any alcohol consumption as this puts extra strain on the liver. Alcohol dependence has been associated with some eating disorders.
6. Diuretic abuse may lead to low levels of sodium, potassium, and magnesium along with elevated levels of uric acid and calcium. Daily potassium and magnesium supplements and regular monitoring of serum electrolyte levels in a person who cannot stop purging may be considered.
7. Have adequate rest and relaxation and try to avoid unnecessary stress. There is a notable interaction between anxiety disorders and eating disorders.
8. If the diet is considered inadequate, include vitamin C, B Group vitamins, and zinc to enhance the immune system of the body. Zinc deficiency can lead to a reduction in the sense of smell and taste. Tryptophan is a precursor of serotonin and can be prescribed by your Doctor. Together with vitamin B6 it is effective in improving mood and eating behaviors. Tryptophan is found in soybeans, cottage cheese, fish, beef, lentils, pumpkin seeds and sesame seeds.

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