Anorexia nervosa is a life-threatening illness that is challenging to treat and can be overwhelming for families seeking help. The Minnesota starvation study dating to the 1950’s showed without any doubt that starvation causes psychological as well as physical symptoms – symptoms that mirror symptoms of individuals with anorexia. The current state of treatment for anorexia has ignored this connection and instead resorts to the use of medications that lack FDA approval and therapies that have consistently been shown to be ineffective. What is needed is addressed by my guest, Dr. James Greenblatt who is a pioneer in the field of functional and integrative medicine.
In this episode, you will learn:
1. Why anorexia treatments currently fail miserably.
2. What is the research that could lead to significantly better outcomes for treating those with anorexia.
3. Why therapy is likely to fail unless nutritional deficiencies of self-starvation are addressed.
Guest: Dr. James Greenblatt
A pioneer in the field of functional and integrative medicine, board-certified child and adult psychiatrist, James M. Greenblatt, MD, has treated patients since 1988. After receiving his medical degree and completing his psychiatry residency at George Washington University, Dr. Greenblatt completed a fellowship in child and adolescent psychiatry at Johns Hopkins Medical School. He currently serves as the Chief Medical Officer at Walden Behavioral Care in Waltham, MA and an Assistant Clinical Professor of Psychiatry at Tufts University School of Medicine and Dartmouth College Geisel School of Medicine. Dr. Greenblatt has lectured internationally on the scientific evidence for nutritional interventions in psychiatry and mental illness. He is the author of seven books, including Finally Focused: The Breakthrough Natural Treatment Plan for ADHD. His latest book, Answers to Anorexia, will be released in October 2021 and his newest book, Functional & Integrative Medicine for Antidepressant Withdrawal, will be available in January 2022. He is the founder of Psychiatry Redefined, an educational platform dedicated to the transformation of psychiatry, which offers online courses, webinars, and fellowships for professionals. Please visit www.PsychiatryRedefined.org or www.JamesGreenblattMD.com for more information.
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Hi everyone and welcome to the show. Today I have a special guest with me, Dr. James Greenblatt and he is a pioneer in the field of functional and integrative medicine and he’s board certified in child and adult psychiatry. Dr. Greenblatt currently serves as the Chief Medical officer at Walden Behavioral Care in Waltham, Massachusetts, and assistant clinical professor of psychiatry at Tufts University School of Medicine and Dartmouth College, Geizel School of Medicine. He is the author of seven books. (He’s got me beat there) And we’re going to be talking about his latest book, which has just been released It’s hot off the presses and it’s called answers to anorexia. So Dr. Greenblatt is going to be talking about the nutritional basis of anorexia and why we’re missing the boat in medicine, in how we’re treating anorexia. So please stay tuned.
So I want to welcome my special guest to the show Dr. James Greenblatt, who I told you about his bio in the intro, and we’re going to be talking about his new book Answers to Anorexia.
Dr. Carolyn: So welcome.
Dr. Greenblatt: Thank you. Glad to see you again.
Dr. Carolyn: You too. So the you know, anorexia has been around for a long, long time, and you know I’ve been treating anorexia for decades, and I know you have too, and for the most part, the treatment hasn’t changed in numerous, numerous decades. So what has inspired you to write the book and to talk about a different way of treating anorexia?
Dr. Greenblatt: Well, I think, you know, you’re exactly right, and nothing has changed. And the, a desperate attempt by families and patients and doctors are just increasing. Certainly, you know rates are increasing. I think what has changed for me is that the rest of the medical community for the last five years, one has acknowledged anorexia as a brain-based illness. And two, acknowledge that we don’t know how to treat anorexia. There was a brilliant editorial and this last month journal of the American Journal of Psychiatry by Dr. Bulik an expert and she just kind of hit the medical community between the eyes saying just what you said, nothing has changed we have to do better.
Dr. Carolyn: Yeah. Because the, the mortality rate for anorexia is higher than most other psychiatric conditions. And yet it seems so odd that in the medical community, the nutritional basis of anorexia has been almost completely ignored. And those of us who’ve tried to introduce that have often been marginalized or called alternative, et cetera. So what do you think is the problem in our, you know, whether it be our training or whatever that keeps people who are seeking to treat anorexia from looking at something so obvious that, you know, people are starving. So therefore, there must be some problem with nutrition, right?
Dr. Greenblatt: You know, I it’s, um, it’s a little frightening because it is quite obvious we’re sitting across from malnourished starving individuals and to think of nutritional supplements is just not part of the protocol. You know, I think it’s a couple of reasons. One is that as you know, there’s no training in nutrition for doctors. So doctors, aren’t kind of leading that. And it there’s no other kind of treatments. There’s no medicines. So people, our medical colleagues feel helpless. And I think the biggest reason is a term that I picked up years about called the tomato effect. It was written by apharmacist and pharmacologists in the 80s just describing the, the cultural mode of treatment and how nutritional therapy. You know, is that part of our culture, just like eating tomatoes, we thought were poisoned for 200 years in the United States. So we never eat tomatoes. And you know, nutritional solutions is just too simple for our medical kind of model, it’s not a medication. And I think it just..
Dr. Carolyn: Do you think that’s driven in part by the fact that the pharmaceutical industry has such a large lobby with physicians and that if it’s not something that we can write on a prescription, you know, that’s seen as just not scientific enough.
Dr. Greenblatt: I think both are our patients and our colleagues are, are pretty, um, kind of, you know, the stock and, and it’s not rigid around a medication solution. I mean, it’s on TV every every day.
Dr. Carolyn: So can you explain to the listeners a little bit about why medication could, you know, cause I know many of the treatment centers where I’ve been called to consult or ones where I’ve worked in, oftentimes psychiatrists will put patients with anorexia on 2 3, 4, 5 medications at a time at the same time. Can you explain a little bit about why that usually is not going to work?
Dr. Greenblatt: Sure. I mean, I think it’s just another example of a desperation trying to help these kids or these adults. So one medicine doesn’t work they keep adding more, the antidepressants I’m most worried about because they, they do not help, uh, anorexia nervosa and it’s usually the first line. And part of the reasons many of these medicines don’t help. It’s likely as just due to the chronic malnutrition these medicines, you know, just some of the neurotransmitters in the brain. And if we don’t have the raw materials to synthesize these neurotransmitters, there’s really no adjusting that can take place or make a difference.
Dr. Carolyn: So just for example, Most physicians remember their biochemistry that it takes, you know, certain co-factors to make those neurotransmitters such as serotonin, dopamine, et cetera, in the, in the brain. And without those nutritional co-factors you, the brain can’t make those feel good chemicals.
Dr. Greenblatt: Right, I mean, they’ve their vitamins minerals and the, um, the precursor molecule is a protein that trip. Our patients are restricting or starving, they’re not getting, um, as you said, any of the factors needed to make these neurotransmitters.
Dr. Carolyn: I also saw that you say in your book that just restoring weight doesn’t mean that good nutrition has been restored.
Dr. Greenblatt: Yeah, that’s been one of the most upsetting parts for me is being in the field because we get excited about, you know, weight restoration and parents are happy and treaters are happy, but you know, calories will help, uh, you know, restore weight, but without the, uh, supplements and without the nutritional repletion, the symptoms are still there. The distorted thinking, the gesture problems and sleep problems. So that’s why relapse rates are so common.
Dr. Carolyn: And the, the symptoms that you’re mentioning that, for example, the distorted thinking are all really symptoms of the nutritional deficits. Is that correct?
Dr. Greenblatt: Yeah, I certainly believe so because as we feed patients and give them supplements, they’re thinking.
Dr. Carolyn: Yeah, absolutely. So do you make the same analogy about patients are at the other end of the weight spectrum? Who many people think maybe over nourished, but who may themselves also be malnourished even though they’re living in larger bodies?
Dr. Greenblatt: I think it’s, it’s similar, uh, different nutrients, different deficiencies, but absolutely, you know, over calorie, malnutrition in our patients with binge eating or obesity, it’s, it’s not uncommon that we detect multiple nutritional deficiencies.
Dr. Carolyn: Yeah. So tell me a little bit about the analogy you make about looking through the wrong end of the telescope. What’s sad about.
Dr. Greenblatt: Well, similar to what you use to earlier. What’s right in front of us. So, you know, when we are patients that are malnourished, um, starving to death, we focus on either therapy or other techniques that have not shown to be helpful. So I use the analogy of you know, rather than a telescope bringing distance objects closer, we turn it around and are starving malnourish patients look very, very far away and it’s not what we address.
Dr. Carolyn: Yeah, absolutely. So there are a dietary factors that go into the development of anorexia and a lot of our patients with anorexia often present as being vegetarian or vegan or being some kind of restrictive diet. What are your thoughts about those kinds of diets in treating people with anorexia?
Dr. Greenblatt: Yeah. My thoughts are, are quite clear when I started about 20 years ago, I run these parent groups and, uh, you know, one parent talked about their child going on a vegan diet and then every other parent would share the same story. So it’s been in my head for 20 years and I think there’s a correlation. And now what is the good news is the research clearly has supported it a vegetarian or vegan diet in particular causes, high relapse rate, lower remission rates and just poor outcomes across the board.
Dr. Carolyn: So even when patients say, oh, I’ve been a vegan since I was nine years old, you will encourage them to expand their, their diet or I’m a vegan because I don’t want to kill animals, animal activist.
Dr. Greenblatt: Yeah, no, it’s complicated and that’s why we as a field, we need to really address it and understand it. And I think that the two issues that need to get addressed are the nutritional deficiencies. And so a vegan diets usually deficient in B12 or zinc. Okay. So we’re not going to make somebody, um, eat animal products, certainly encourage that during puberty and until they get better. But if not, at least acknowledging that there might be nutritional deficiencies associated with the vegan diet. It’s like protein, zinc or b12.
Dr. Carolyn: Awesome. So there’s, you know, the adverse childhood experiences study has been out for almost two decades now, I believe, and was started here in San Diego where I have practice off and on for some time. How do you incorporate, incorporate all of the interesting and almost revolutionary information that has come out about the link between childhood adversity and then later risk for substance use disorders and even eating disorders?
Dr. Greenblatt: Yeah, I mean, I think the longer I practice, the more I, um, kind of get embedded in, um, genetics and strong understanding of the family history and, and as a risk factor and then being able to really dissect all the other risk factors and, um, the, uh, trauma or adverse reactions in childhood clearly plays a role on that genetic vulnerability and the complicated fact on treating eating disorders is many of those environmental factors play just as important role. So we need to understand both the genetic vulnerability and all these environmental stresses that affect our kids. Yeah.
Dr. Carolyn: And it seems as if there’s more and more revelations coming out about, you know, wide swaths of the population of young adults and young people who have been victimized in some way, whether it be the gymnastics. As a Federation or, you know, at university health centers and so on. So it seems to me that that’s, you know, kind of this, the setup or the next generation of people with these disorders, because these things are happening in our society on a regular basis.
Dr. Greenblatt: Yeah, a couple of new studies, you know, came out and looking at them, just the diagnosis of PTSD or PTSD symptoms in adult residential use sort of program across the nation and it was 60% and for kids, it was 50% meeting criteria for post-traumatic stress disorder.
Dr. Carolyn: Yeah. That’s really significant then.
Dr. Greenblatt: Absolutely
Dr. Carolyn: Yeah. So, um, how do you explain the increase in suicide risk in patients with anorexia? Because you said in your book that 20 to 30% of anorexic deaths or deaths of anorexic patient are from suicide. Is that a nutritional component as well? Cause I know that we’ve been studying, you know, mega three fatty acids and suicide risk and even the military has been looking into that. Does that come into play and the nutritional component?
Dr. Greenblatt: Well, I mean, that’s the way, you know, I explained it. I mean, I think the rates again, the highest suicide rates of any psychiatric illness, including bipolar substance abuse and to the, you know, the malnutrition. And I think the omega 3 theory, these girls and boys have been restricting fat for many, many years. And so I think that, low levels of make a three has strikingly been associated with suicide attempts and risk and the other nutritional deficiencies, I think, um, to me has been the most convincing, correlations.
Dr. Carolyn: Yeah, I have just to go back to the trauma link I wanted to ask you, cause I know I’ve seen patients with anorexia who have had pretty severe trauma and every time you start to do work on the trauma, their anorexia, their behaviors, they’re restricting behaviors and other behaviors around food kind of get worse. So is there do the supplements help with making sure, you know, bridging that gap there.
Dr. Greenblatt: Well, I mean, in my experience, you know, helping support, uh, you know, brain function with optimal nutrition, uh, really supports, uh, psychotherapy and particularly some of the psychotherapy that might be directed towards the trauma, both, um, substance abuse, um, and trauma in particular, it’s just seesaws. One gets better eating, sort of gets worse and vice versa. And I think, um, with some biological interventions, nutritional therapy, maybe medicines that we can kind of balance that. And help patients move forward.
Dr. Carolyn: Do you have a case that you could share from your book that illustrates some of these principles we’ve been talking about or even a newer case of someone?
Dr. Greenblatt: Sure. There, there, there are just so many, um, kids and young adults that we have seen that have just gone through multiple, um, treatment programs and it’s just one or two, they go to different states and different programs. And, um, so, you know, one case said, um, I spoke to the family recently that they’re doing well. This is, you know, 22 year old girl and it in treatments since age teenager, 15 or 16 does well in a treatment program, restore some weight and then relapses. And, um, one of the powerful interventions around nutritional support is I believe that it can prevent the relapse because it’s just beyond the calories. So, you know, this young lady ended up going to one of our residential treatment program did well and then started losing weight again. And the, and the family contacted me and without a hospitalization and just by the patient’s motivation, um, wanting to get back to college, started taking supplements. And these were, you know, amino acids, powders, zinc, fatty acid powders, and just helping them kind of focus on kind of nutrient dense food. And the most important message I share with parents and the patient can, we’re not trying to help you gain weight, which is trying to restore nutrition so your brain is better, your congestion’s better and anxiety improves. And that usually supports. And for this girl, she was able to get to get back to college without getting back into a program.
Dr. Carolyn: Just one last question and that has to do with anxiety now that you’ve mentioned it. Because many of our patients with anorexia have predisposition to anxiety. And in your book, you talk a lot about how, what an integral role that plays in anorexia. Can you say a little bit more about that?
Dr. Greenblatt: Sure, anxiety is, is one of the few things our patients are looking for relief for. They want help because the anxiety, I think, drives so much of their behaviors because restricting not eating actually decreases the anxiety. And a lot of the anxiety is these intrusive thoughts about their weight, that, about their body image. And then when it gets bad, it’s what’s going to happen. If I eat, somebody will get her if not be able to function. So whatever we can do to decrease the anxiety is kind of the first step in treating patients with anorexia.
Dr. Carolyn: Yeah, well, I love your new book. I think it’s a wonderful guide for clinicians and even for parents who are looking for answers for their kids, because it really gives it a completely different approach, but with research and scientific basis on how to treat this hard to treat disorder anorexia. I find is, is much harder to treat than any of the eating disorders. And I think it gives hope to people that they can actually recover. And it’s, it makes sense to you know that that it makes sense. It’s logical. So appreciate having you on the podcast and look forward to seeing you on one of your next webinars. Thanks
Dr. Greenblatt: Thanks. Take care
So I hope you found that interesting, as interesting as I did his book is chock-full of cases that have been literally transformed people with you know longstanding anorexia and, you know, frequent relapses and multiple treatments who have responded to some of the nutritional therapies that he mentions in his book. I also have his other book, one of his other books called Finally Focused The Breakthrough Natural Treatment Plan for ADHD. And that’s another great book, he talks a lot about how we’re missing the boat in medicine by ignoring the nutritional bases of these mental health issues. And I think if you have anyone in your circle or you have a loved one with anorexia or any of the other subjects of his other books, I would highly recommend that get his book.
I’ve put a link to his website in the show notes. Please rate us, give us five stars. Please share the podcast with anyone who you think might be interested or be able to benefit. And we’ll be talking again soon. Thank you for listening.