Course Description:

$275
Anorexia nervosa (AN) is a vastly complex mental illness marked by etiologic contributions of genetic, psychological, and metabolic origin. With a relapse rate upwards of 50% within the first year after treatment, as well as the highest mortality rate of any psychiatric disorder, AN presents today’s clinicians with a significant and daunting challenge.

Scientific research is illuminating with increasing focus a stark reality – that being that the majority of current AN treatment models often fail to comprehensively address etiologic factors. Therapeutic paradigms that focus solely on psychological contributors do so to the exclusion of potentially significant biologic factors that studies have revealed to be robustly correlated with metabolism, satiety signaling, neurotransmission, and affective regulation, all of which can influence mood and behavior. Lacking etiologic considerations, many of today’s AN models are incomplete.

This 3-module course, presented by Dr. James Greenblatt, introduces a functional medicine model for AN treatment and recovery, in which the concept of AN as the result of a complex and biologically-mediated interplay between environmental, psychosocial, and metabolic factors is explored. Research supporting associations between metabolic abnormalities, dyslipidemia, micronutrient imbalances, and systemic inflammation will be objectively reviewed, illuminating critical treatment targets for today’s functional psychiatry practice and providing an empirically validated blueprint for personalized interventions. Upon completion, students will be able to substantiate the clinical utility of a functional medicine approach for AN, and safely incorporate evidence-based treatment strategies into existing therapeutic models to maximize patient outcomes.

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Course Modules:

Module 1

  1. Exploring Current Models for Anorexia Nervosa (AN) Treatment
    1. The psychopharmacology model
    2. AN epidemiology, prevalence, relapse rates, global trends
    3. Suicidality in AN
    4. Genetics and AN
    5. Who’s to blame? Sociocultural influences
    6. Current DSM classifications, criteria, and guidelines
  2. Etiology of eating disorders
    1. Pathologic fear conditioning and chronicity
    2. Dieting: contributor…or not?</li
    3. Psychiatric comorbidities
    4. Adolescent neurodevelopment – implications
    5. Dyslipidemia in AN
  3. Shifting Paradigms: Psychosocial models – alone – are not enough
    1. Not just “E” (environment) and not just “G” (genetics / biochemistry)…but rather [GxE]
    2. EDs involve external, psychosocial factors and internal, biologic vulnerabilities / susceptibilities; a complete therapeutic model must account for both
    3. Nutrition first, psychotherapeutic insight later

Module 2

  1. A Review of AN Etiology, Pathogenesis
  2. Celiac Disease and AN
    1. What is celiac?
    2. Epidemiology, prevalence
    3. Characterization, classification
    4. Celiac and AN comorbidity
  3. Eating Disorders and Dietary Patterns
    1. Veganism, vegetarianism
  4. The Link to Zinc
    1. Meat avoidance and zinc status
    2. A comparison of symptoms: AN vs. zinc deficiency
    3. Zinc deficiency and dysgeusia
    4. Zinc and digestive enzymes
    5. Pathophysiologic and psychopathologic sequelae of zinc deficiency
    6. Zinc and veganism / vegetarianism
    7. Zinc for depression: research evidence
    8. Sleep disturbances and eating disorders=
    9. Zinc for AN: research evidence
    10. Causes of zinc deficiency
    11. Zinc absorption: special considerations
    12. Zinc mechanisms relevant to A
    13. Optimizing zinc intake
  5. A New Model, Based on Measurement: Functional Psychiatry
    1. Old vs. new paradigms
    2. Lab testing to inform and guide personalized interventions

Module 3

  1. B Vitamins, Psychiatric Health, and AN
    1. Vitamin B3 (niacin)
    2. Vitamin B12
    3. Vitamin B9 (folate)
    4. Vitamin B1 (thiamine)
    5. Vitamin B8 (inositol)
  2.  Vitamin D
    1. Overview: classification, roles in general physiologic and neurologic health
    2. Vitamin D and Neurologic health
    3. Vitamin D status and AN: research evidence
    4. Vitamin D testing and supplementation
  3. The Gut-Brain Axis and Anorexia
    1. Exploring the human microbiota
    2. What does the gut microbiota DO for us?
    3. Factors that negatively impact the gut microbiota
    4. Probiotics and psychiatric symptoms: research evidence
    5. Gut bacteria and eating disorders
    6. Probiotics for AN support and recovery
    7. Small steps, significant implications
  4. Conclusion

Learning Objectives

Upon completion of Module 1, students will be able to:

  • Identify psychosocial and biologic factors supported by research as contributing to the extraordinarily high relapse and fatality rates observed in Anorexia nervosa (AN)
  • Describe the interaction of genetics and environmental factors as they interact to establish individual AN susceptibility / risk
  • Describe the cycle of pathologic fear conditioning and its relevance to AN etiology / symptom persistence
  • Identify common psychiatric comorbidities of AN
  • Elucidate neurodevelopmental changes that occur during adolescence and how these changes may confer increased susceptibility in some individuals
  • Identify three or more essential biologic functions of essential fatty acids (EFAs) and their relevance to AN pathogenesis
  • Describe the pathologic sequelae of EFA deficiency / dyslipidemia
  • Identify the timeframe within which EFA supplementation may reasonably be expected to mitigate a chronic deficiency
  • Discuss key differences between psychosocial models of AN pathogenesis and treatment and functional medicine models that consider both psychosocial and biologic factors

Upon completion of Module 2, students will be able to:

  • Identify factors and symptom constellations characteristic of Celiac disease
  • Describe the proximal impacts of Celiac disease on nutrient absorption
  • Discuss research-supported etiologic links between celiac and AN
  • Discuss sociocultural factors influencing restrictive dietary behaviors that may be associated with AN susceptibility
  • Identify strategies to prevent / mitigate micronutrient deficiency in vegans / vegetarians
  • Discuss symptomatic parallels between AN and zinc deficiency
  • Discuss the proximal and distal impacts of zinc deficiency upon the digestive cascade
  • Elucidate the role of zinc in the serotonin synthesis pathway
  • Identify dietary factors that can interfere with zinc absorption

Upon completion of Module 3, students will be able to:

  • Discuss the role of vitamins B3, B8, B9, and B12 in maintaining optimal physical and neurologic health, and factors that may contribute to or cause a deficiency state
  • Identify genetic polymorphisms of the MTHFR gene impacting folate status
  • Identify 3 or more physical and neurologic symptoms associated with vitamin B12 deficiency
  • Define dysautonomia
  • Describe the physiologic mechanisms underlying POTS syndrome
  • Describe the role of inositol (vitamin B8) in second messenger systems of neurotransmission
  • Identify intrinsic and environmental sources of vitamin D
  • Describe the vitamin D-dependent feedback loop regulating serotonin levels in the gut and brain
  • Identify factors influencing vitamin D status
  • Elucidate parameters for vitamin D deficiency, inadequacy, adequate repletion, optimal repletion, and toxicity
  • Elucidate upon the distinctions between microbiome and microbiota
  • Describe microbial influences upon neurotransmission
  • Define the gut-brain-axis
  • Describe gut microbial characteristics common to AN patients as documented by research
  • Explain how microbial diversity can impact host feeding behaviors, and the relation this may have to AN presentations
  • Describe research studies documenting beneficial effects of probiotic administration in AN treatment / recovery interventions.
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