Tag Archives: eating disorders

Low Potassium can be dangerous!

I myself have been suffering from low Potassium, from consistent Diarrhea do to my Autonomic Dysfunction, Every time I have been hospitalized, my Potassium is dangerously low, but they would give it to my IV, also drink the awful drink and tell me to eat bananas. I didn’t understand that part of my drop attacks, head pain, and paralysis was caused by Potassium. Now with all my hospital stays, don’t ya think one Doctor would say, you can’t walk because you have critically low potassium, your throat is paralyzing because of your potassium. Instead they just send me on my way. So I contacted my Doctor at Stanford and we need to talk about the seriousness of your potassium. Have a great 4th of July. So a new Prescription of Potassium is called into the pharmacy so I can get my levels up and now that I recognize what’s happening, I am more aware. I didn’t realize how dangerous low Potassium was. So I researched it myself and here Is a little information for low Potassium. and the results can be permanent.

WARNING – LOW POTASSIUM IS DANGEROUS

When a person gets methylation going, even only partially, the single most dangerous side effect is dropping potassium. In the absence of kidney damage which people usually know about and certain drugs that cause the potassium to accumulate, low potassium is the odds on favorite after staerting methylation. As methylation starts up, no ifs ands or buts typically, in a day or less with the active protocol, when those symptoms hit on the 3rd day typically or a little later, it’s virtually always potassium. This can get dangerous, how quickly is the only question. I have had enough disturbing communications in the past couple of weeks to issue this repeating the warnings.

From Pubmed –
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001510/
Hypokalemia

Potassium – low; Low blood potassium

Last reviewed: May 29, 2011.

Hypokalemia is a lower-than-normal amount of potassium in the blood.

Causes, incidence, and risk factors

Potassium is needed for cells, especially nerve and muscle cells, to function properly. You get potassium through food. The kidneys remove excess potassium in the urine to keep a proper balance of the mineral in the body.

Hypokalemia is a metabolic disorder that occurs when the level of potassium in the blood drops too low.

Possible causes of hypokalemia include:
Antibiotics (penicillin, nafcillin, carbenicillin, gentamicin, amphotericin B, foscarnet)

Diarrhea (including the use of too many laxatives, which can cause diarrhea)

Diseases that affect the kidneys’ ability to retain potassium (Liddle syndrome, Cushing syndrome, hyperaldosteronism, Bartter syndrome, Fanconi syndrome)

Diuretic medications, which can cause excess urination

Eating disorders (such as bulimia)

Eating large amounts of licorice or using products such as herbal teas and chewing tobaccos that contain licorice made with glycyrrhetinic acid (this substance is no longer used in licorice made in the United States)

Magnesium deficiency

Sweating

Vomiting

Symptoms

A small drop in potassium usually doesn’t cause symptoms. However, a big drop in the level can be life threatening.
Symptoms of hypokalemia include:
Abnormal heart rhythms (dysrhythmias), especially in people with heart disease

Constipation

Fatigue

Muscle damage (rhabdomyolysis)

Muscle weakness or spasms

Paralysis (which can include the lungs)

Signs and tests

Your health care provider will take a sample of your blood to check potassium levels.

Other tests might include:
Arterial blood gas

Basic or comprehensive metabolic panel

Electrocardiogram (ECG)

Blood tests to check glucose, magnesium, calcium, sodium, phosphorous, thyroxine, and aldosterone levels

Treatment

Mild hypokalemia can be treated by taking potassium supplements by mouth. Persons with more severe cases may need to get potassium through a vein (intravenously).

If you need to use diuretics, your doctor may switch you to a form that keeps potassium in the body (such as triamterene, amiloride, or spironolactone).

One type of hypokalemia that causes paralysis occurs when there is too much thyroid hormone in the blood (thyrotoxic periodic paralysis). Treatment lowers the thyroid hormone level, and raises the potassium level in the blood.

Expectations (prognosis)

Taking potassium supplements can usually correct the problem. In severe cases, without proper treatment a severe drop in potassium levels can lead to serious heart rhythm problems that can be fatal.

Complications

In severe cases, patients can develop paralysis that can be life threatening. Hypokalemia also can lead to dangerous irregular heartbeat. Over time, lack of potassium can lead to kidney damage (hypokalemic nephropathy).
 

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Eating Disorders

At age 22, Julia Russell began an intense fitness regimen that would rival most Olympians’. From two-a-day workouts to a strict diet, you might think she were actually training for something. And she was: to feel good. The endorphin high helped her cope with an unfulfilling, post-college job that she took after moving back home to Cincinnati, OH. Between dealing with a miserable office life and missing her college friends, she made the gym her happy place, visiting it before and after work every day for seven years straight. (Did you know Runner’s High Is As Strong As a Drug High?)

“My workouts were pretty intense. I became obsessed with counting calories too—I was eating less than 1,000 calories a day and doing two-a-day workouts, like boot camps, high-intensity cardio, spinning and weight lifting,” Russell says. Despite having low energy that made her extremely irritable, she stuck to this rigid routine from 2004 to 2011. “If I had to skip a day, I would get very anxious and feel very bad about myself,” she admits, though at the time, she kept her frustrations to herself.

“I never told anyone how I felt. I was also getting a lot of compliments, like ‘Oh, wow, you’ve lost a lot of weight,’ or ‘You look great!’ My body type is athletic, and although I was thin, you wouldn’t look at me and say, ‘That girl has a problem.’ I looked normal,” says Russell, who grew up doing gymnastics, practicing synchronized swimming, and playing tennis. “But for my body type, I knew that was not normal. So it was very deceiving for me and the people around me. In my mind, I didn’t have a problem. I just wasn’t skinny enough,” she says, revealing that being slim was a notion she had been chasing for as long as she could remember, as far back as pre-kindergarten.

During those seven years, only one friend—an acquaintance, really—expressed concern for Russell while they were both attending graduate school at the University of New Hampshire in 2008. “Sometimes it’s the people you’re closest to who don’t say anything. This stuff happens gradually so they might not notice. Also, in our society, everyone is so health-obsessed that nobody thinks it’s weird. But this girl at school thought I was too workout-obsessed and too thin,” she says. Though Russell brushed off her comments at first, she eventually visited her school’s psychologist. “I went one time, cried through the whole session and never went back,” she says of her session with the counselor. “It was too terrifying to confront. A part of me knew something was up, but I didn’t want to deal.”

And after graduate school, people actually congratulated Russell on her weight loss and talked about how jealous they were that she had such self-control. “That made me feel superior and made me want to engage more in the dangerous exercise and dieting behaviors,” she says. Plus, “I was in grad school. I had a boyfriend. From the outside, I was doing just fine. Other people have way worse problems than me. I was just being emotional. So I dissociated and moved on.”

Facing Reality
It wasn’t until Thanksgiving in 2011 that Russell’s denial caught up with her. “I hadn’t been able to keep a relationship for a while. I was always canceling on dates because I didn’t want to go out to dinner or because I wanted to work out. I had eating disorder things to take care of. Also, I was a very stressful job working at the public defender’s office. I felt like part of my life was failing,” she says. That November, Russell invited people over for a Friendsgiving potluck before a night out on the town. When she got home later, she was so hungry, she had some leftover chocolate cake…and couldn’t stop eating.

“I literally ate half of it and made myself throw up. I had never thrown up for that reason before. I remember sitting in the bathroom crying. At that moment, I realized things were not right. It had gone too far. I called my best friend and, for the first time, told her what was happening. She was so supportive and told me to see my doctor. My primary care physician referred me to a psychiatrist who referred me to my psychologist, who then referred me to a dietitian and group therapy,” she says. Even after being diagnosed with an eating disorder—a condition that affects 20 million women and 10 million men in the U.S. alone—Russell wasn’t convinced she had a serious problem.

“I remember her telling me that I was anorexic and I responded with a sassy, ‘Are you sure about that?’ I do things that are healthy. I work out, I eat well, I don’t eat dessert or engage in bad diet habits. Maybe I have some anxiety and depression, but an eating disorder feels too farfetched. Those people are extremely skinny and look disgusting. They don’t have any friends. I didn’t think that that was me,” Russell recalls. “When I started going to group, I was around 10 other girls who had very similar lives to me. That was really shocking. Some were bigger than me, some were smaller. They all had friends and came from good families. It was just a realization. It was so overwhelming.” (Read how another woman’s Healthy Habits Turned Into an Eating Disorder.)

Moving Forward
For the next two years, Russell worked with her team of mental health and nutrition experts plus support group to learn how to get to a new happy place. She didn’t enter a facility, but rather kept her full-time job to help pay for her treatments and squeezed in appointments into her busy schedule. Four years later, Russell finally understands what it truly means to be healthy.

“Now I try to work out maybe three times a week—in only fun ways. I ride my bike. I do yoga. Exercise is good for you, but I don’t let it become a chore. I have no idea how much I weigh. I haven’t stepped on a scale since 2012. Also, I try not to restrict foods. All foods have good and bad things; it’s all about proportions and ratios. And I live with my boyfriend of two years. We have a healthy relationship that’s awesome,” says Russell, now a 30-year-old MBA student at DePaul University in Chicago. Despite her excellent progress, Russell continues to see her psychologist every other week to avoid a relapse and keep daily stresses from leading to harmful thoughts like, ‘You’re fat. You need to work out. You have to count your calories.’ (Fat Shaming Could Actually Lead to a Higher Mortality Risk.)

One of the most surprising lessons Russell learned from her experience is that eating disorders don’t discriminate. “There’s no weight requirement. People with eating disorders come in all shapes and sizes. No one looked the same, but we all had the same problem,” she says of the women in her support group. When it’s not visibly obvious that you might be taking your fitness and diet routine too far, then it’s easier for your extreme measures to fly under the radar—that is, until you suffer severe medical consequences, such as an increased risk of heart and kidney failure, reduced bone density, tooth decay, and overall weakness and fatigue.

Where’s the Line Between Normal and Disordered?
Eating disorders are tricky to notice and diagnose. So we tapped psychiatrist Wendy Oliver-Pyatt, M.D., an active member of the National Eating Disorders Association, to point out three seemingly subtle signs of unhealthy behaviors that can pass off as “normal” but could actually lead to developing an eating disorder.

1. Pursuing unnecessary weight loss. Every woman has a dream number they want to see on the scale. As some work towards that goal, they may discover along the way that if you’re healthy, fit and feel good, it doesn’t matter what the scale or BMI chart reads. “Weight is a very poor indicator of health,” says Oliver-Pyatt, founder and executive director of the Oliver-Pyatt Centers in Miami, FL. “The World Health Organization (WHO) has their own definition of health, which actually encompasses a broader spectrum of health, including physical, mental, social, spiritual well-being. Oftentimes, people think they are doing something healthy when, in fact, it may not be,” she says.

A perfect example of this is when people try to force their body to be in the “normal range” of 18.5 and 24.9 on the Body Mass Index (BMI), a measure of a person’s weight in relation to height. “There are many people whose natural body weight would put them at higher than 24.9 BMI. Some of the most elite athletes in the world have a technically obese BMI,” she explains. In other words, BMI is bunk. And the scale is no better. “One big problem is that people are losing too much body fat, which can bring about infertility and osteoporosis. Women, on average, should have about 25 percent body fat—it’s a physiological necessity. Fat helps your body and brain function better. It’s not a bad thing,” says Oliver-Pyatt.

2. Exercising through an injury. The rise of intense workouts, like CrossFit, Tabata, and other HIIT or boot-camp-style programs, has unintentionally set us up for an increased risk of injury, including back, shoulder, knee, and foot pain. When this happens, you need to know when to pull back and rest before you exacerbate the problem, which could lead to surgery. People who are exercise-obsessed, however, might miss the cues when to stop. Instead they may adopt that old mentality of no pain, no gain. (BTW, that’s one of our 7 Fitness Rules Meant to Be Broken.)

“When a person is working out while wearing, say, a stress-fracture boot, a lot of times, you may see this being applauded. They might hear, ‘Wow, you’re really tough! Good job!'” Oliver-Pyatt says. “When it comes to alcoholism or a drug problem, everyone agrees that you should stay away from those vices that are causing harm. But with exercise and healthy eating, a person can get into this area where they are having problems with it, and since it generally falls into this healthy category, people—from friends to doctors—may reinforce it,” Oliver-Pyatt says.

“People do die from eating disorders and so if someone is injured or malnourished and obsessively exercising, it is important for people to step in. Try to use ‘I’ language so that you’re not blaming anyone. Maybe say something like: ‘I want to know if I could talk to you about something. It’s a bit of a difficult subject, but I’m concerned and I wasn’t sure how to approach you about it. I just have some concerns about your well-being, considering that you’re wearing a boot and still putting so many demands on your body. I feel like you might need a break and it’s hard for you to give it to yourself.'” Sometimes helping someone realize that they need to give themselves permission to relax is all they need to ease up and take better care of themselves.

3. Choosing to work out rather than hang out. “Someone who is an over-exerciser will forfeit social activities for the sake of having an opportunity to work out. The term is called normative discontent, which is the normalization of food and body preoccupation. It’s normalized, but this behavior (i.e. always being on Weight Watchers or Jenny Craig or using being vegan as an excuse to bring snacks to a restaurant) isn’t actually bringing about the definition of overall health that the WHO talks about,” Oliver-Pyatt says.

When approaching someone about this behavior, try to put yourself in their shoes and bring up what you have in common to make sure you get heard. Also, always try to validate their emotional state, Oliver-Pyatt says. “For example, if you say, ‘When you decided to go running instead of come to my birthday party, I understood that was really important to you because you really care about your health. At the same time, I was really hurt because our relationship really means a lot to me and I missed you.’ Once you validate them and show them that you are emotionally vulnerable too, they’ll be more willing to hear what you say next,” Oliver-Pyatt says. “Appealing to the emotional experience you are having and trying to describe it can help you form a bridge of co

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Just what is Dialectical Behavior Therapy?

What is DBT?

Overview

Dialectical Behavior Therapy (DBT) is a cognitive behavioral treatment that was originally developed to treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD) and it is now recognized as the gold standard psychological treatment for this population. In addition, research has shown that it is effective in treating a wide range of other disorders such as substance dependence, depression, post-traumatic stress disorder (PTSD), and eating disorders.

What are the components of DBT?

In its standard form, there are four components of DBT: skills training group, individual treatment, DBT phone coaching, and consultation team.

  1. DBT skills training group is focused on enhancing clients’ capabilities by teaching them behavioral skills. The group is run like a class where the group leader teaches the skills and assigns homework for clients to practice using the skills in their everyday lives. Groups meet on a weekly basis for approximately 2.5 hours and it takes 24 weeks to get through the full skills curriculum, which is often repeated to create a 1-year program. Briefer schedules that teach only a subset of the skills have also been developed for particular populations and settings.
  2. DBT individual therapy is focused on enhancing client motivation and helping clients to apply the skills to specific challenges and events in their lives. In the standard DBT model, individual therapy takes place once a week for as long as the client is in therapy and runs concurrently with skills groups.
  3. DBT phone coaching is focused on providing clients with in-the-moment coaching on how to use skills to effectively cope with difficult situations that arise in their everyday lives. Clients can call their individual therapist between sessions to receive coaching at the times when they need help the most.
  4. DBT therapist consultation team is intended to be therapy for the therapists and to support DBT providers in their work with people who often have severe, complex, difficult-to-treat disorders. The consultation team is designed to help therapists stay motivated and competent so they can provide the best treatment possible. Teams typically meet weekly and are composed of individual therapists and group leaders who share responsibility for each client’s care.

What skills are taught in DBT?

DBT includes four sets of behavioral skills.

  • Mindfulness: the practice of being fully aware and present in this one moment
  • Distress Tolerance: how to tolerate pain in difficult situations, not change it
  • Interpersonal Effectiveness: how to ask for what you want and say no while maintaining self-respect and relationships with others
  • Emotion Regulation: how to change emotions that you want to change

There is increasing evidence that DBT skills training alone is a promising intervention for a wide variety of both clinical and nonclinical populations and across settings.

What does “dialectical” mean?

The term “dialectical” means a synthesis or integration of opposites. The primary dialectic within DBT is between the seemingly opposite strategies of acceptance and change. For example, DBT therapists accept clients as they are while also acknowledging that they need to change in order to reach their goals. In addition, all of the skills and strategies taught in DBT are balanced in terms of acceptance and change. For example, the four skills modules include two sets of acceptance-oriented skills (mindfulness and distress tolerance) and two sets of change-oriented skills (emotion regulation and interpersonal effectiveness).

How does DBT prioritize treatment targets?

Clients who receive DBT typically have multiple problems that require treatment. DBT uses a hierarchy of treatment targets to help the therapist determine the order in which problems should be addressed. The treatment targets in order of priority are:

  1. Life-threatening behaviors: First and foremost, behaviors that could lead to the client’s death are targeted, including all forms of suicidal and non-suicidal self-injury, suicidal ideation, suicide communications, and other behaviors engaged in for the purpose of causing bodily harm.
  2. Therapy-interfering behaviors: This includes any behavior that interferes with the client receiving effective treatment. These behaviors can be on the part of the client and/or the therapist, such as coming late to sessions, cancelling appointments, and being non-collaborative in working towards treatment goals.
  3. Quality of life behaviors: This category includes any other type of behavior that interferes with clients having a reasonable quality of life, such as mental disorders, relationship problems, and financial or housing crises.
  4. Skills acquisition: This refers to the need for clients to learn new skillful behaviors to replace ineffective behaviors and help them achieve their goals.

Within a session, presenting problems are addressed in the above order. For example, if the client is expressing a wish to commit suicide and reports recurrent binge eating, the therapist will target the suicidal behaviors first. The underlying assumption is that DBT will be ineffective if the client is dead or refuses to attend treatment sessions.

What are the stages of treatment in DBT?

DBT is divided into four stages of treatment. Stages are defined by the severity of the client’s behaviors, and therapists work with their clients to reach the goals of each stage in their progress toward having a life that they experience as worth living.

  1. In Stage 1, the client is miserable and their behavior is out of control: they may be trying to kill themselves, self-harming, using drugs and alcohol, and/or engaging in other types of self-destructive behaviors. When clients first start DBT treatment, they often describe their experience of their mental illness as “being in hell.” The goal of Stage 1 is for the client to move from being out of control to achieving behavioral control.
  2. In Stage 2, they’re living a life of quiet desperation: their behavior is under control but they continue to suffer, often due to past trauma and invalidation. Their emotional experience is inhibited. The goal of Stage 2 is to help the client move from a state of quiet desperation to one of full emotional experiencing. This is the stage in which post-traumatic stress disorder (PTSD) would be treated.
  3. In Stage 3, the challenge is to learn to live: to define life goals, build self-respect, and find peace and happiness. The goal is that the client leads a life of ordinary happiness and unhappiness.
  4. For some people, a fourth stage is needed: finding a deeper meaning through a spiritual existence. Linehan has posited a Stage 4 specifically for those clients for whom a life of ordinary happiness and unhappiness fails to meet a further goal of spiritual fulfillment or a sense of connectedness of a greater whole. In this stage, the goal of treatment is for the client to move from a sense of incompleteness towards a life that involves an ongoing capacity for experiences of joy and freedom.

How effective is DBT?

Research has shown DBT to be effective in reducing suicidal behavior, non-suicidal self-injury, psychiatric hospitalization, treatment dropout, substance use, anger, and depression and improving social and global functioning. For a review of the research on DBT, click here. In this video, DBT Developer and Behavioral Tech founder Dr. Marsha Linehan describes the amazing changes she’s seen in people who have received DBT and gotten out of hell.

Dive Deeper

Philosophy and Principles of DBT

DBT is based on three philosophical positions. Behavioral science underpins the DBT bio-social model of the development of BPD, as well as the DBT behavioral change strategies and protocols. Zen and contemplative practices underpin DBT mindfulness skills and acceptance practices for both therapists and clients. DBT was the first psychotherapy to incorporate mindfulness as a core component, and the Mindfulness skills in DBT are a behavioral translation of Zen practice. The dialectical synthesis of a “technology” of acceptance with a “technology” of change was what distinguished DBT from the behavioral interventions of the 1970s and 1980s. Dialectics furthermore keeps the entire treatment focused on a synthesis of opposites, primarily on acceptance and change, but also on the whole as well as the parts, and maintains an emphasis on flexibility, movement, speed, and flow in the treatment.

Video on the therapy treatment mentioned above.

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