What role do supplements play in the treatment of eating disorders?

Role of Supplements in the Treatment of Eating Disorders

Nutritional supplements should be used as part of a comprehensive multidisciplinary treatment approach for eating disorders, but there is no clear evidence that dietary supplementation with vitamins, minerals, herbs, or spices can improve outcomes in people who do not have underlying deficiencies. 1

Assessment and Screening

• Individuals with eating disorders should be screened for nutritional deficiencies as part of their initial assessment, which is essential for determining appropriate supplementation needs 1, 2
• Registered dietitians play a crucial role in screening for disordered eating behaviors and should be alert to potential red flags such as insulin restriction in diabetes patients, excessive food label reading, or rigid eating patterns 1
• Laboratory assessment should include complete blood count and comprehensive metabolic panel to detect nutritional abnormalities common in eating disorders 2
• For patients with restrictive eating disorders or severe purging behaviors, an electrocardiogram is recommended to assess cardiac health that may be affected by electrolyte imbalances 2

Supplement Recommendations

• There is no clear evidence supporting routine use of dietary supplements with vitamins, minerals (such as chromium and vitamin D), herbs, or spices (such as cinnamon or aloe vera) for individuals with eating disorders who do not have underlying deficiencies 1
• Oral nutritional supplements (ONS) may be beneficial for patients whose nutritional status remains poor despite efforts to encourage higher dietary intake 1
• Supplements should be considered as an adjunct to, not a replacement for, a comprehensive treatment plan that includes nutritional counseling and psychological therapy 1
• When prescribing supplements, clinicians should regularly review and re-evaluate patients to determine whether they should continue taking them 1

Multidisciplinary Approach

• Nutrition professionals are essential members of the multidisciplinary team treating individuals with eating disorders, possessing knowledge in nutrition, physiology, and skills for promoting behavior change 3
• Treatment should incorporate medical, psychiatric, psychological, and nutritional expertise via a coordinated multidisciplinary team 2
• The registered dietitian is an integral member of the treatment team and uniquely qualified to provide medical nutrition therapy for the normalization of eating patterns and nutritional status 4
• For patients with diabetes and eating disorders, dietitians should work collaboratively with both diabetes and eating disorder treatment teams 1

Treatment Considerations

• Nutrition therapy should be individualized to accommodate specific eating disorder patterns and should focus on normalizing eating behaviors 1
• For patients with severe malnutrition who cannot maintain adequate oral intake, enteral tube feeding may be necessary to improve nutritional status 1
• When treating patients with diabetes and eating disorders, a non-restrictive eating approach is recommended, with flexible, intuitive dietary guidance rather than rigid meal plans 1
• Supplements should be considered within the context of the patient's overall treatment goals, including weight restoration, normalization of eating patterns, and improvement of psychological symptoms 5, 6

Monitoring and Follow-up

• Patients taking nutritional supplements should be regularly monitored for effectiveness, side effects, and continued need 1
• Monitoring should include assessment of weight trends, laboratory values, psychological symptoms, and eating behaviors 6
• For patients with eating disorders and comorbid conditions like diabetes, more frequent monitoring may be necessary to ensure appropriate management of both conditions 1

Common Pitfalls to Avoid

• Relying solely on supplements without addressing underlying psychological issues and disordered eating behaviors 4
• Prescribing rigid supplement regimens that may reinforce obsessive behaviors around food and nutrition 1
• Failing to coordinate supplement recommendations with the entire treatment team, which may lead to conflicting messages 1
• Overlooking the potential for supplement misuse or abuse in patients with eating disorders 1

Remember that while supplements may address specific nutritional deficiencies, they are just one component of comprehensive eating disorder treatment that must include psychological therapy, medical monitoring, and nutritional counseling.