Acupuncture for eating disorders is not one that you typically hear of in the western world. However, it is gaining ground for aiding individuals with eating disorders in the recovery stages of the condition. Using Chinese herbal medicine and acupuncture along with moxibustion, massage, and dietary therapy in the TCM world are helping patients with eating disorders regain physical and emotional strength. Eating disorders can affect people of all genders, ages, races, religions, ethnicities, body shapes, & weights, and is a very serious but treatable mental & physical illness. According to National Eating Disorders Association, it is estimated that 20 million women and 10 million men in America will have an eating disorder at some point in their lives. It is not known what causes eating disorders, but there is an array of resources for patients seeking recovery, including TCM.
Eating Disorders 101
While most people believe there to be only one or two types of eating disorder, there is actually a variety of other conditions/related issues that directly correlate with or lead to an eating disorder. Additionally, those who suffer from an eating disorder commonly struggle with a co-occurring condition such as substance abuse, anxiety, OCD (obsessive-compulsive disorder), PTSD (post-traumatic stress disorder), or depression.
The two most well-known eating disorders:
- Anorexia Nervosa – a condition where an individual refuses to maintain a normal body weight and refuses to eat. Complications from this condition include slow or irregular heartbeats, heart muscle shrinkage, kidney failure, heart failure, osteoporosis, and death. Anorexia has an estimated mortality rate of around 10% and 1 in 5 of those deaths are by suicide according to the National Association of Anorexia Nervosa and Associated Disorders.
- Bulimia Nervosa – a condition in which an individual has repeated binge-eating episodes followed by behaviors such as excessive exercise, fasting, or purging (vomiting, overuse of laxatives/diuretics). Complications from this condition include heart arrhythmias, tooth erosion, electrolyte imbalances, laxative dependence, esophageal tears, emetic toxicity, heart failure, and death. According to the National Association of Anorexia Nervosa and Associated Disorders, nearly 1 in 10 bulimia patients have substance abuse disorder, usually alcohol use.
There are also types of eating disorders that many are unaware of or is not as commonly talked about as the two listed above. These are a little more specific in nature, and also effect the individual in a same type of negative ways.
Other not commonly known eating disorders:
- Other Specified Feeding or Eating Disorder (OSFED) – includes atypical anorexia nervosa (anorexia without the low weight), bulimia or BED (binge-eating disorder) with lower frequency behaviors, night eating syndrome, and purging disorder.
- Binge Eating Disorder (BED) – this is defined as an individual having recurrent episodes of eating large amounts of food (usually very quickly and to the point of discomfort). Individuals will feel a loss of control during the binge, experiencing guilt, distress, or shame afterwards. It is also the most common eating disorder in the United States.
- Avoidant/Restrictive Food Intake Disorder (ARFID) – defined as extreme picky eating but it is often times much more than that. It is highly selective eating habits, disturbed feeding patterns, or both. Children do not grow out of it often resulting in malnourishment. According to the National Association of Anorexia Nervosa and Associated Disorders, ARFID is still being studied but may be prevalent in 3-5% of children, with boys being at a higher risk than girls.
- Diabulimia – this condition involves individuals with type 1 diabetes deliberately giving themselves less insulin than needed or stop taking it altogether in order to lose weight. Restricting insulin increases risks for neuropathy, diabetic ketoacidosis, and retinopathy.
There are certain conditions that are also more likely to lead to or go hand in hand with eating disorders like pica, ruination disorder, orthorexia, and compulsive exercise. There are also a variety of physical and emotional symptoms & signs that would indicate someone had a possible eating disorder.
Physical & emotional signs and symptoms:
- Preoccupation with weight, calories, food, & dieting
- Progressing restrictions against whole categories of food
- Skipping meals or taking small portions at regular meals
- Withdrawal from usual friends/activities
- Extreme concern with body shape & size
- Extreme mood swings
- Noticeable fluctuations in weight (up & down)
- Menstrual irregularities
- Dental problems
There are a huge number of signs and symptoms when it comes to an eating disorder, and the ones listed above are just the tip of the iceberg. As it was said before, eating disorders are indeed serious but treatable, and acupuncture is a great treatment for someone with an eating disorder in the recovery stage of healing.
Acupuncture for Eating Disorders
In Chinese medicine, as we all know as providers, each eating disorder comes with a unique set of circumstances just like any other condition we treat. Acupuncture can help reduce the distress of recovery which then allows the body to recover. Essentially, acupuncture & Chinese medical diagnosis helps make it possible to treat the emotional and physical problems with eating disorder recovery in an integrated way by addressing the underlying causes of the individuals dysfunctional eating.
Acupuncture/herbal medicine can help eating disorder recovery by treating:
- Anxiety, over-thinking, worry, & stress
- Panic attacks & palpitations
- Digestive issues (bloating, gas, acid reflux, nausea, constipation, etc.)
- Fatigue & insomnia
- Regulate menstrual cycle
- Restore functional metabolism
In addition to helping the underlying conditions associated with eating disorders, acupuncture also nourishes related organs, and helps regain a healthy functioning of the digestive system.
Organs treated in eating disorder patients:
- Heart – housing the Shen, there is always some level of Shen imbalance in those who are struggling with an eating disorder. The conditions of eating disorders, whether that is binging, vomiting, not eating, or restricting your food intake in an unhealthy way, the heart & spirit are out of balance, usually considering an eating disorder a Shen disturbance in Chinese medicine.
- Liver – being the organ that is responsible for smooth flow of everything in the body (including emotions), when what the patient desires differs from the reality, it can evoke very strong emotions including anger, frustration, and low self-esteem/worth. Those with eating disorders are constantly suppressing these feelings causing the liver energy to be stuck showing up as angry outbursts, irritability, and, you guessed it, compulsive eating behaviors. There is usually some level of Liver stagnation in eating disorder patients.
- Spleen – this is the organ that is most damaged by eating disorders as it along with the Stomach is responsible for digestion in the body. Even years after recovery from eating disorder, the spleen may be damaged by having an impaired digestive process or by things like trying to become pregnant.
- Kidney – being the home of all the vital substances in the body, a patient’s body constitution is damaged with an eating disorder, and as a result, the health of the Kidney.
Essentially what we want to do is providers for those recovering from eating disorders is calm the Shen, soothe the Liver, strengthen the Spleen, and rebuild & strengthen the Kidney.
Acupuncture Points & Herbs for Eating Disorders:
- CV12 – Central Venter – Zhong Wan – located midway between CV8 & CV16, 4 cun above CV8. In the way of eating disorders, it treats acute abdominal pain, vomiting, pain due to overeating, gastric pain, gas, and diarrhea.
- ST36 – Leg Three Li – Zusanli – located 3 cun below ST35, one finger width lateral from the anterior border of the tibia. This point helps boost energy and strengthens the whole body. In the way of eating disorders, it treats gastric pain, vomiting, diarrhea, abdominal distention, constipation, dizziness, mental fog & disorders, and poor digestion.
- SP6 – Three Yin Intersection – Sanyinjiao – located 3 cun directly above the top of the medial malleolus on the posterior border of the tibia. In the way of eating disorders, it treats irregular menstruation, abdominal distention, loose stools with undigested food, clinical depression, immune deficiency disorders, chronic fatigue, regulate hormone function, insomnia, and cold limbs.
- LI4 – Union Valley – He Gu – located in the middle of the 2nd metacarpal bone on the radial side. In the way of eating disorders, it treats delayed menstrual cycles, and absence of menstruation in addition to balancing the energy in the body.
- LI11 – Pool at the Bend – Qu Chi – located at the lateral end of the transverse cubital crease midway between LU5 and the lateral epicondyle of the humerus. In the way of eating disorders, it treats diarrhea & vomiting, in addition to balancing the energy in the body.
- P6 – Inner Pass – Nei Guan – located 2 cun above the wrist crease between the tendons of palmaris longus and flexor carpi radialis. In the way of eating disorders, it treats nausea, palpitations, increasing appetite, vomiting, mental disorders, emotional/physical chest pains, decreases panic attacks, and stops several types of addictions (alcohol, food, drugs).
- Shenmen – an ear point, is located at the bifurcation point of the upper and lower arms of the triangular fossa, veering slightly towards the lateral side. In the way of eating disorders, it treats overeating, and calming the mind & removing nervousness.
- ST4 – Earth Granary – Dicang – located directly below the pupil lateral to the corner of the mouth. In the way of eating disorders, it treats the inability to eat.
As with any patient in any condition, it is important to do a thorough analysis of their history with the eating disorder as well as their current status in it to see what TCM treatment, whether it be herbs or acupuncture or both, would be appropriate.
Herbs for eating disorders:
- Gui Pi Tang – anxiety as well as bloating & poor digestion
- Liu Wei Di Huang – light or no periods as well as dry hair & skin
- Jin Gui Shen Qi Wan – metabolic problems from long-term restrictive eating
- Tian Wan Bu Xin Dan – anxiety as well as treating will power that is either too strong or too little depending on the eating disorder.
Many patients who are recovering prefer to incorporate acupuncture & herbal remedies into their recovery as it is a drug-free treatment option.
Treatment Protocol for Eating Disorder Patients
As an acupuncturist on a patient’s eating disorder recovery journey, it is important that this condition is considered carefully in the way of diagnosis and interacting with the patient. An eating disorder tends to engulf the person completely, and they are usually dealing with some kind of underlying emotional issues and/or possible addiction. If you as the provider are involved in their healing it is important to discuss case management in order to provide a safe treatment experience for your eating disorder patient.
The main difference in treating an eating disorder patient is that unlike other health issues, there is potentially a patient resistance to recovery (depending on when they come to you in the recovery process), and an impaired perception of themselves. Often it seems as though you are interacting with the patient along with the eating disorder itself as it takes on its own voice within the patient driving self-destructive behavior, and depending on conversations & information given can have potentially dangerous effects.
Safe case management strategies:
- Understand that suggestions that may be uncomplicated/helpful for another patient can be problematic to one with an eating disorder. Especially in the way of dietary recommendations, such as advising a patient to avoid foods, even if these instructions are appropriate for the patient’s pattern, it must be handled with care. The suggestion that certain foods are “bad” can create distress/panic for an eating disorder patient. Although unintentional, it can foster phobias about certain foods creating an obstacle for full recovery. For example, although the patient may have spleen deficiency & dampness, a fear of all dairy products is a more difficult obstacle for an eating disorder patient’s health than the occasional consumption of dairy.
- It is important to be specific as possible when it comes to dosages and timing of supplements and/or herbs. If there is any confusion or room to improvise, it can lend room for opportunity for the eating disorder to relapse. Example being saying to the patient “take one teaspoon before bed” instead of “take one to three teaspoons in the afternoon or evening.”
- Ensure that your office is a safe space for someone with an eating disorder. Once again, some things that seem like unharmful elements can be disastrous in their recovery. Something like a scale that patients could use unsupervised, magazines in the waiting room full of articles & ads showing the virtues of being thin, beautiful, and unwrinkled or fad cleanses/diets are things to be aware of if you are treating an eating disorder patient.
- Work diligently & cooperatively with other practitioners that the patient may be seeing in their recovery. Collaborating with potentially a psychotherapist, western physician, and nutritionist/dietitian is essential for the eating disorder patient so that each provider is aware of what the others are doing, any concerns about the patient, and prevents contradictory suggestions. Closely collaborating and monitoring of the eating disorder patient, and forming of a united front, ensures the patient’s safety, and appropriate level of care.
Making sure to be mindful of what information your patients encounter before, during, and after treatments can help to create a safer environment for them on the road to recovery.
Acupuncture & Eating Disorders
Acupuncture can be a great way of addressing the root issues of eating disorders, and restoring flow and function to the body. Eating disorders are, without a doubt, very challenging to treat. However, the advantage of TCM treatment is the emphasis on treating the whole person on an individualized basis, and our understanding of the connection of the emotional & physical self. The mortality rates are high, in fact, every 62 minutes at least one person dies as a direct result of an eating disorder, and have the highest mortality rate of any mental illness.
Although studies are limited for acupuncture for eating disorders, acupuncture has proven to be a great adjunct therapy in the recovery of eating disorder patients.
Acupuncture for eating disorder studies:
- A study in 2010 was done on 9 females with eating disorders, and showed that acupuncture improved the patient’s quality of life as measured by the Eating Disorder Quality of Life scale as well as showing decreased anxiety & perfectionism.
- A study in 2017 sought out to show the effectiveness of acupuncture as an adjunct therapy in anorexia nervosa patients. Patients in the study (9 patients for a length of 12 weeks), described acupuncture as offering a pause in a very stressful situation, and that the relaxation was palpable. This study concluded that it allowed anorexia nervosa patients to rest providing better mental clarity, and decreased anxiety & gaining weight became easier to endure.
Western medicine does seem to also have a crucial role in the treatment of eating disorders, but acupuncture has a lot to offer on the road to recovery for eating disorder patients. It is increasingly being added to treatment protocols for suffering patients to provide long-term health & well-being, and providing an environment to support efforts in re-establishing a healthy, loving respect for their bodies.
Fogarty S, Harris D, Zaslawski C, McAinch AJ, Stojanovska L. Acupuncture as an adjunct therapy in the treatment of eating disorders: a randomised cross-over pilot study. Complement Ther Med. 2010;18(6):233-240. doi:10.1016/j.ctim.2010.09.006
McIntire N. TCM and the Treatment of Eating Disorders. Acupuncture Today. March 9, 2020. Accessed March 9 2020. https://www.acupuncturetoday.com/mpacms/at/article.php?id=32640
Siiri Hedlund & Kajsa Landgren (2017) Creating an Opportunity to Reflect: Ear Acupuncture in Anorexia Nervosa – Inpatients’ Experiences, Issues in Mental Health Nursing, 38:7, 549-556, DOI: 10.1080/01612840.2017.1303858
*for additional resources and information for your patients struggling with an eating disorder, visit nationaleatingdisorders.org