Re: Tough case--need advice

October 9, 2004

,

Sounds absolutely like PCOS to me. Until you can get an insulin level on her,

there really are not any recommendations you can make that are going to work.

Can you position your stance as one that needs this missing piece? That you

cannot help her until you know what the problem is? My clients typically, if

PCOS is the problem, are relieved to have the answer and have it be so simple.

A litmus test a psychiatrist once gave me for whether or not a problem is

medical or psychiatric, is that if it is medical, when the solution is offered,

the client is relieved and compliant with accepting it. When the client refuses

the solution and attempts to make things more complex, it is likely a behavioral

issue (they need the illness more than they need the cure.)

It sounds to me like the client may be using the illness to opt out of a career

that fills the mother's needs more than her own. I have seen this often with

athletes whose college scholarships and awards are more for the parents than

for the one who is earning it.

>From a liability standpoint, you might consider setting a limit and not

agreeing to another appointment with the client until she can bring you a lab

test. You are entitled to do so.

Good luck, let us know what happens,

Monika M. Woolsey, MS, RD

www.afterthediet.com

Polycystic Ovary Syndrome: The Perfect Endocrine Storm

Tucson, Arizona, March 11-13, 2005

October 10, 2004

Dear Monika-

Since we both have worked with eating disorder and realize the complications of

diet advice. I wonder to help rule out PCOS- would be to order a high protein

diet/no refined CHO, if the results in one month show a weight reduction then

the need for a medical evaluation would be necessary. Looking at the pushy

mother and being only 17 tends to scream ED. She is right to ask the mother to

back off. But that is really hard for parents to do- Both of them need to go to

therapy and see what they really want and to accept each other for who they are

and not what they want each other to be. That could take awhile. However, as

you said; having a diagnosis that people can understand takes the pressure off.

She does need to get evaluated but since the client refuses to go then ask her

to follow the diet for PCOS for a month. The results will speak if she can

follow the diet?? Good luck and thanks monika

regards

nne Koritz MS RD LDN

" Monika M. Woolsey, MS, RD " wrote:

nne,

My specialty is disordered eating. I know exactly where you are coming from.

However, in the past few years as PCOS has drifted my way and I have started to

understand it...I have learned that many ED cases are actually PCOS in a fancy

wrapper. Women often adopt ED behaviors to manage an endocrine balance that has

gone undetected. It is often when dieting and exercise no longer work, that the

ED is what we see.

I agree that there is an ED component to this case. However, if developing

insulin resistance is complicating this person's appetite response, there is no

amount of psychotherapy that will change her behavior. The most important thing

to do is insist on getting a complete medical/endocrine workup to know what

problems are medical vs. psychological.

Once you resolve endocrine issues the psych issues can change drastically--it is

pointless to do psychotherapy when you don't even know what issues a healthy

brain will need to talk about. I recently had a case of PCOS where, once the

core metabolic imbalance was resolved, body image issues disappeared. I

couldn't believe it myself, but the change has sustained itself long enough for

me to believe it's genuine.

Regards,

Monika M. Woolsey, MS, RD

http://www.afterthediet.com

Re: Tough case--need advice

- obviously you have an eating disorder- no

matter what you recommend nutritional- that is not the

problem. I worked at a university setting where 90%

of my clients were E.D. The parents pressure or lack

of acceptance leads these very intelligent people to

control the one thing they have control over and that

is food. Sounds like the best thing for your patient

is to get help with a professional in E.D. Not many

of them around that can do a great job. Also get her

on a high potency multivitamin and biomega fatty

acids. I am sure she is on a very low fat diet which

also affects the way she'll gain or lose weight. Good

luck

nne Koritz MS RD LDN

--- lesliecoxrd wrote:

>

> Fellow RD's--I need some advice! (sorry for

> cross-posting). I

> have a 17-year old girl who is seeing me for weight

> reduction (for

> the last 6 weeks). She is in the entertainment

> industry and has been

> turned down for many roles because of her weight.

> She very much

> wants to lose weight as acting is her dream (she has

> been in several

> movies and is very talented). She is 5'3 " and

> 163-lbs. I have her

> on a reduced calorie meal plan (about 1500 cals),

> she is keeping a

> food diary, but also recording hunger/fullness,

> moods/thoughts/feelings, etc. She is exercising at

> least 5 days a

> week. I have not limited any foods groups ('all

> foods can fit'

> approach, but encourage portion control and

> journaling, etc).

> Despite this, she has not lost any weight. Mom

> comes with her to

> the appointments (and I ask Mom to wait in the

> waiting

> room, but the patient has her come back sometimes).

> Mom is

> reporting that she has found candy wrappers and

> other

> evidence of binge eating in her daughter's car and

> room. We talked

> about this together and the patient flatly denies

> that she is

> binging (states the wrappers are old or not hers).

> Mom does not

> believe her. Mom has spent huge amounts of money on

> her daughter's

> career so there is added pressure for her to

> succeed. The patient

> is stressed out and frustrated.

> After her first session, I noticed her stress

> level and

> recommended a counselor who she has been meeting

> with weekly. I

> suspect she may have PCOS (she has irregular

> periods) and recommeded

> a work up. The patient has refused because she is

> afraid that if

> there is nothing medically wrong with her, it will

> come back on her

> that she must be " cheating " . At her last session,

> the patient was

> very angry and upset with mom for violating her

> privacy. I have

> told mom to " back off " on her daughter as mom tends

> to be

> overbearing. I am meeting with her counselor next

> week to discuss

> how best to approach the situation. Any advice on

> what I should

> do? Am I correct in my nutrition recommendations?

>

> I appreciate any suggestions,

> , RD, LD

>

_______________________________

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October 10, 2004

,

So many thoughts, but 2 to share for now--

1) Was it MOM who scheduled nutrition appointments for daughter? Was this NOT

her idea in the first place?

2) If client has bulimia (which I suspected before I read the part that there

is evidence for that!) I would think she needs to resolve the bulimia before

more involvement in the entertainment industry, which will exacerbate the

problem with body image obsession fueling eating disorder, or at the very least

it will be a fight for her to keep on with healthy processes and goals while the

" culture " around her is offering her a different solution at every turn--she

would have to be a very strong gal to stay true to course with that pressure,

ESPECIALLY since her acting goals are so important to her.

I hope I'm wrong and you can provide a strong support system for her while she

is pursuing her goal--I would like to hear of that type of success!

Respectfully,

Diane Noack, M.S., R.D.

N.E.W. LIFE (Nutrition, Exercise, Wellness for LIFE)

www.newlifeforhealth.com

e-mail: 4newlife@...

Tough case--need advice

Fellow RD's--I need some advice! (sorry for cross-posting). I

have a 17-year old girl who is seeing me for weight reduction (for

the last 6 weeks). She is in the entertainment industry and has been

turned down for many roles because of her weight. She very much

wants to lose weight as acting is her dream (she has been in several

movies and is very talented). She is 5'3 " and 163-lbs. I have her

on a reduced calorie meal plan (about 1500 cals), she is keeping a

food diary, but also recording hunger/fullness,

moods/thoughts/feelings, etc. She is exercising at least 5 days a

week. I have not limited any foods groups ('all foods can fit'

approach, but encourage portion control and journaling, etc).

Despite this, she has not lost any weight. Mom comes with her to

the appointments (and I ask Mom to wait in the waiting

room, but the patient has her come back sometimes). Mom is

reporting that she has found candy wrappers and other

evidence of binge eating in her daughter's car and room. We talked

about this together and the patient flatly denies that she is

binging (states the wrappers are old or not hers). Mom does not

believe her. Mom has spent huge amounts of money on her daughter's

career so there is added pressure for her to succeed. The patient

is stressed out and frustrated.

After her first session, I noticed her stress level and

recommended a counselor who she has been meeting with weekly. I

suspect she may have PCOS (she has irregular periods) and recommeded

a work up. The patient has refused because she is afraid that if

there is nothing medically wrong with her, it will come back on her

that she must be " cheating " . At her last session, the patient was

very angry and upset with mom for violating her privacy. I have

told mom to " back off " on her daughter as mom tends to be

overbearing. I am meeting with her counselor next week to discuss

how best to approach the situation. Any advice on what I should

do? Am I correct in my nutrition recommendations?

I appreciate any suggestions,

, RD, LD

October 10, 2004

Actually nne, ever since I heard Shane Broughton speak on fish oils at my

conference in April, I have been using them incredibly successfully with PCOS

and ED's. If my clients have signs and symptoms of PCOS or other symptoms of a

fatty acid deficiency (which I believe PCOS actually is) my advice to them is,

" Go to Costco, get a bucket o' fish oils, and take twice the recommended dose. "

If we don't see any improvement in your carbohydrate cravings within 10 days,

we'll need to engage the help of an endocrinologist.

I have yet to need to do that. Within 10 days the cravings literally disappear,

which builds trust and allows me to get into the diet and build a plan that

maintains nervous system function. It's pretty miraculous, I have been more

successful with clients in the 6 months using fish oils than I was in the first

21 years of my counseling.

Shane helped me to put the pieces together, to stand back and see the big

picture instead of going at it in a compartmentalized fashion like my

Westernized training had me doing.

Monika

Re: Tough case--need advice

- obviously you have an eating disorder- no

matter what you recommend nutritional- that is not the

problem. I worked at a university setting where 90%

of my clients were E.D. The parents pressure or lack

of acceptance leads these very intelligent people to

control the one thing they have control over and that

is food. Sounds like the best thing for your patient

is to get help with a professional in E.D. Not many

of them around that can do a great job. Also get her

on a high potency multivitamin and biomega fatty

acids. I am sure she is on a very low fat diet which

also affects the way she'll gain or lose weight. Good

luck

nne Koritz MS RD LDN

--- lesliecoxrd wrote:

>

> Fellow RD's--I need some advice! (sorry for

> cross-posting). I

> have a 17-year old girl who is seeing me for weight

> reduction (for

> the last 6 weeks). She is in the entertainment

> industry and has been

> turned down for many roles because of her weight.

> She very much

> wants to lose weight as acting is her dream (she has

> been in several

> movies and is very talented). She is 5'3 " and

> 163-lbs. I have her

> on a reduced calorie meal plan (about 1500 cals),

> she is keeping a

> food diary, but also recording hunger/fullness,

> moods/thoughts/feelings, etc. She is exercising at

> least 5 days a

> week. I have not limited any foods groups ('all

> foods can fit'

> approach, but encourage portion control and

> journaling, etc).

> Despite this, she has not lost any weight. Mom

> comes with her to

> the appointments (and I ask Mom to wait in the

> waiting

> room, but the patient has her come back sometimes).

> Mom is

> reporting that she has found candy wrappers and

> other

> evidence of binge eating in her daughter's car and

> room. We talked

> about this together and the patient flatly denies

> that she is

> binging (states the wrappers are old or not hers).

> Mom does not

> believe her. Mom has spent huge amounts of money on

> her daughter's

> career so there is added pressure for her to

> succeed. The patient

> is stressed out and frustrated.

> After her first session, I noticed her stress

> level and

> recommended a counselor who she has been meeting

> with weekly. I

> suspect she may have PCOS (she has irregular

> periods) and recommeded

> a work up. The patient has refused because she is

> afraid that if

> there is nothing medically wrong with her, it will

> come back on her

> that she must be " cheating " . At her last session,

> the patient was

> very angry and upset with mom for violating her

> privacy. I have

> told mom to " back off " on her daughter as mom tends

> to be

> overbearing. I am meeting with her counselor next

> week to discuss

> how best to approach the situation. Any advice on

> what I should

> do? Am I correct in my nutrition recommendations?

>

> I appreciate any suggestions,

> , RD, LD

>

_______________________________

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Declare Yourself - Register online to vote today!

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October 10, 2004

wow monika- that was my next question to you. I feel all these years of low

fat/nofat dieting has depleted our FA's hence the increase in ED , ADHD,

depression...I have had lots of success with the same method. I use the USANA

fish oil called biomega. They test for mercury before distribution. Several

studies I have read on supplements show a higher concentration in the average

market. Could you send me some info on Shane Brougton- haven't heard him speak.

thanks

I also use the essentials by usana- their brand of multivitamins. It was rated

#1 in a compendium of over 500 multivitamins in north america written by Lyle

Macwilliams from Canada. I have had amazing success with improving health.

It's such a great feeling to improve people's health and see them smiling again.

regards,

julianne koritz

" Monika M. Woolsey, MS, RD " wrote:

Actually nne, ever since I heard Shane Broughton speak on fish oils at my

conference in April, I have been using them incredibly successfully with PCOS

and ED's. If my clients have signs and symptoms of PCOS or other symptoms of a

fatty acid deficiency (which I believe PCOS actually is) my advice to them is,

" Go to Costco, get a bucket o' fish oils, and take twice the recommended dose. "

If we don't see any improvement in your carbohydrate cravings within 10 days,

we'll need to engage the help of an endocrinologist.

I have yet to need to do that. Within 10 days the cravings literally disappear,

which builds trust and allows me to get into the diet and build a plan that

maintains nervous system function. It's pretty miraculous, I have been more

successful with clients in the 6 months using fish oils than I was in the first

21 years of my counseling.

Shane helped me to put the pieces together, to stand back and see the big

picture instead of going at it in a compartmentalized fashion like my

Westernized training had me doing.

Monika

Re: Tough case--need advice

- obviously you have an eating disorder- no

matter what you recommend nutritional- that is not the

problem. I worked at a university setting where 90%

of my clients were E.D. The parents pressure or lack

of acceptance leads these very intelligent people to

control the one thing they have control over and that

is food. Sounds like the best thing for your patient

is to get help with a professional in E.D. Not many

of them around that can do a great job. Also get her

on a high potency multivitamin and biomega fatty

acids. I am sure she is on a very low fat diet which

also affects the way she'll gain or lose weight. Good

luck

nne Koritz MS RD LDN

--- lesliecoxrd wrote:

>

> Fellow RD's--I need some advice! (sorry for

> cross-posting). I

> have a 17-year old girl who is seeing me for weight

> reduction (for

> the last 6 weeks). She is in the entertainment

> industry and has been

> turned down for many roles because of her weight.

> She very much

> wants to lose weight as acting is her dream (she has

> been in several

> movies and is very talented). She is 5'3 " and

> 163-lbs. I have her

> on a reduced calorie meal plan (about 1500 cals),

> she is keeping a

> food diary, but also recording hunger/fullness,

> moods/thoughts/feelings, etc. She is exercising at

> least 5 days a

> week. I have not limited any foods groups ('all

> foods can fit'

> approach, but encourage portion control and

> journaling, etc).

> Despite this, she has not lost any weight. Mom

> comes with her to

> the appointments (and I ask Mom to wait in the

> waiting

> room, but the patient has her come back sometimes).

> Mom is

> reporting that she has found candy wrappers and

> other

> evidence of binge eating in her daughter's car and

> room. We talked

> about this together and the patient flatly denies

> that she is

> binging (states the wrappers are old or not hers).

> Mom does not

> believe her. Mom has spent huge amounts of money on

> her daughter's

> career so there is added pressure for her to

> succeed. The patient

> is stressed out and frustrated.

> After her first session, I noticed her stress

> level and

> recommended a counselor who she has been meeting

> with weekly. I

> suspect she may have PCOS (she has irregular

> periods) and recommeded

> a work up. The patient has refused because she is

> afraid that if

> there is nothing medically wrong with her, it will

> come back on her

> that she must be " cheating " . At her last session,

> the patient was

> very angry and upset with mom for violating her

> privacy. I have

> told mom to " back off " on her daughter as mom tends

> to be

> overbearing. I am meeting with her counselor next

> week to discuss

> how best to approach the situation. Any advice on

> what I should

> do? Am I correct in my nutrition recommendations?

>

> I appreciate any suggestions,

> , RD, LD

>

_______________________________

Do you Yahoo!?

Declare Yourself - Register online to vote today!

http://vote.yahoo.com

October 12, 2004

Actually, algae is vegan. Algae is not an " animal " nor can it feel pain (as

far as we know). I suppose it's possible that some people will have moral

objections to it, but, as a vegan who's active in the vegan community, I've

never

met a vegan who thought that algae was not vegan. In my lectures on vegetarian

nutrition, I push heavily for supplementation with DHA from an algae source.

The brand of choice for vegans is:

O-Mega-Zen3, which is in veggie-based capsules and is available on the Web

from Pangea, www.veganstore.com (1) and www.veganessentials.com

(1866-88-VEGAN). I recommend 200-300 mg/day.

By the way, thank you for the comment about FAs working best when DHA and EPA

are used in equal quantities. I've been keeping up on FA research and I can't

seem to find research backing this up. Would you mind providing a source for

that? Thanks so much!

Dina

Dina Aronson, MS, RD

Registered Dietitian and Nutrition Consultant

nutrawiz@...

www.nutrawiz.com

Message: 4

Date: Mon, 11 Oct 2004 09:38:46 -0700

Subject: Re: Tough case--need advice

Shirley,

One of the most readily available brands is Neuromins. It is made from

marine algae (technically not vegan but most vegans will use it).

Keep in mind marine algae is DHA only, there is no EPA. Most psychiatrists

who use fish oils note that they work best when DHA and EPA are used in equal

quantities. DHA will retroconvert to EPA once tissues are saturated, but in

the case of an ED where DHA is likely depleted, it can take some time for this

to happen. So the rapid changes I refer to may not be so rapid when

malnutrition complicates the picture and the client is " going through the back

door " to

get the essential nutrient.

Monika

October 12, 2004

Just a thought. . . I'd think that algae was 'technically' not vegan because

of the high levels of plankton and such that would be harvested along with the

algae.. . ??? Just my guess. . . but, then, little buggers get killed all

the time when we harvest veggies and grains too. . .

Jan

In a message dated 10/12/2004 8:43:12 AM Mountain Daylight Time,

NutraWiz@... writes:

> Subj: Re: Tough case--need advice

> Date: 10/12/2004 8:43:12 AM Mountain Daylight Time

> From: NutraWiz@...

> Reply-to: rd-usa

> To: rd-usa

> Sent from the Internet

>

> Actually, algae is vegan. Algae is not an " animal " nor can it feel pain (as

> far as we know). I suppose it's possible that some people will have moral

> objections to it, but, as a vegan who's active in the vegan community, I've

> never

> met a vegan who thought that algae was not vegan. In my lectures on

> vegetarian

> nutrition, I push heavily for supplementation with DHA from an algae source.

>

> The brand of choice for vegans is:

> O-Mega-Zen3, which is in veggie-based capsules and is available on the Web

> from Pangea, www.veganstore.com (1) and www.veganessentials.com

> (1866-88-VEGAN). I recommend 200-300 mg/day.

>

> By the way, thank you for the comment about FAs working best when DHA and

> EPA

> are used in equal quantities. I've been keeping up on FA research and I

> can't

> seem to find research backing this up. Would you mind providing a source for

>

> that? Thanks so much!

>

> Dina

>

> Dina Aronson, MS, RD

> Registered Dietitian and Nutrition Consultant

>

> nutrawiz@...

> www.nutrawiz.com

>

> Message: 4

> Date: Mon, 11 Oct 2004 09:38:46 -0700

>

> Subject: Re: Tough case--need advice

>

> Shirley,

>

> One of the most readily available brands is Neuromins. It is made from

> marine algae (technically not vegan but most vegans will use it).

>

> Keep in mind marine algae is DHA only, there is no EPA. Most psychiatrists

> who use fish oils note that they work best when DHA and EPA are used in

> equal

> quantities. DHA will retroconvert to EPA once tissues are saturated, but in

>

> the case of an ED where DHA is likely depleted, it can take some time for

> this

> to happen. So the rapid changes I refer to may not be so rapid when

> malnutrition complicates the picture and the client is " going through the

> back door " to

> get the essential nutrient.

>

> Monika

>

October 12, 2004

Dina,

Check out the book, " The Omega 3 Connection, " by Stoll. He is the

researcher who published the first double blind study using fish oil for bipolar

disorder.

In my eating disorder work, I apparently work with vegetarian extremists who

will often look for any excuse to avoid doing something new! But then by my

definition they are not true vegetarians--a vegetarian meets his/her daily needs

without the use of animal products, while a person with an eating disorder does

not eat animal products and does not replace those eliminations with adequate

substitutes. I don't even allow my clients to call themselves vegetarian unless

their diet is adequate.