Case Study: Emma. Binge Eating, Purging, Xanax, 4-5 Month Periods, Constipation, Depression, Smoking
Updated: Jul 6
I have an amazing client I want to tell you about.
Her name is Emma. Actually, it is not. I would not tell you her real name. But she is a real person, with real problems, and she has worked real hard to get heathy over the course of the last 5 months.
Emma is in her early 20s and has had a difficult life. Family problems led to more family problems, which led to self-destructive behavior like binging and purging. Smoking. Drinking. Dieting.
Before we met for the first time, Emma had taken on her alcohol demon and won. She decided she did not want to drink anymore and stopped.
"I don't even care about alcohol now. I think I had it so much in my mind to use it as an excuse to get away with so much stuff. It was so much better than thinking that I had a binge/purge problem. I think that is what I put on myself. And there was no denying that. I used alcohol as an excuse for a lot of things."
I was so impressed as I listened to this strong young woman articulating her motives and intentions. I was blown away by the drive it takes to wean oneself off of an addictive substance. She had no help. She just did it.
And this was before we even starting working together! I knew she would be an excellent client- adherent and motivated. We dug right in.
Here are a few issues she was dealing with as of 5 months ago:
- Xanax as needed for anxiety
- Bleeding for 4-5 months at a time
- No bleeding for 1-2 months at a time
- Severe cramping and bleeding since the age of 13
- Birth control from age 13-17 for menstrual symptoms
- No energy for the last 5-6 years
- Years of binging large quantities in secret
- Years of purging
- Desire to stay at home and not leave the house
- Job that was physically, emotionally, and mentally oppressive
- Pneumonia for 7 months at the age of 15
- Constipation (prescription Lizness)
- Bloating, Gas, Distention
- Nightly itching (legs and eyes)
You guys. This poor girl. I wanted to just hug her the first time we met. But we had lots to do, so started right away.
Functional health looks at the body as a whole. We address the symptoms by looking at the systems- where is the system malfunctioning and why?
Where were these cravings coming from? Most likely a lack of nutrients and nourishment due to years of dieting, alcohol abuse, and stress.
Where was the insomnia coming from? Probably a lack of melatonin, due to a gut imbalance. Most melatonin is made in the small intestine.
Where were the anxiety and depression coming from? It's likely they were coming from a dysbiotic gut and inadequate neurotransmitters. The vagus nerve connects the gut to the brain and these two things are inextricably linked.
What about the bloating, constipation, distention, and itching? Her systems of elimination like the liver, large intestine, and skin were probably overwhelmed and needed support and consistency.
Why were her periods so irregular? Most likely her HPA Axis was so overwhelmed that her cortisol levels had tanked (leading to exhaustion and no energy) and stolen away normal levels of estrogen, progesterone, and testosterone.
So we started in with her DRESS protocol.
Plenty of whole, nourishing, protein-rich, fat-rich foods. You know by now that I don't like restriction. Even though Emma wanted to lose some weight, I knew it would come off eventually, as soon as her body felt safe. We had to feed her to do that.
Emma told me she did not like hurting animals and did not care for meat. I firmly told her that her body needed the zinc, amino acids, B vitamins, and cholesterol that she could get only though meat, especially red meat. We looked at my Steroid Hormone Metabolic Pathways Chart to see how B vitamins and dietary fats convert to cholesterol, which converts to necessary hormones, like estrogen, progesterone, DHEA, testosterone, and cortisol. Emma is no fool. The science was out there in front of her and she pledged to pick up some red meat from the grocery store that very day.
We rounded out her diet with more protein, lots of nourishing fats, and plenty of fruits and vegetables. A binge eater needs to feel full. Satiated. Nourished. Without fear of food being scarce. So I told her to eat a huge breakfast while her digestive fire was burning hot. She was to eat a large lunch as well, and a moderately sized dinner. She walked away with a meal plan complete with recipes, shopping list, and daily grids showing her exactly what to do.
If you aren't sleeping, you aren't healing. We had to get Emma sleeping. I routinely use low dose melatonin in my practice. She used 3 mg prolonged-release melatonin and began sleeping better almost immediately. Melatonin is a master antioxidant and as I test for it often, I am surprised to see that almost every woman is deficient in this sleep-promoting hormone.
I usually put my clients on mandated rest for 2-3 weeks when we start working together. An exhausted, depleted body cannot handle exercise. When you are not sleeping and are exhausted and are malnourished, all exercise does is cannibalize your lean muscle and leave you softer, less muscled, and frustrated.
Gently, we talked about looking into other employment options. Her job was stressing her out and increasing the severity of her symptoms. We talked about speaking the truth kindly to oneself. How would you talk to your boyfriend's daughter? I asked. Talk to yourself the same way. She agreed.
I warned Emma that supplements are merely 1/5 of the health equation and that they would not solve all of her problems; they would simply bolster her fledgling health as we built it back up. She nodded in understanding and ordered her supplements the very same day.
Here is what we put her on:
- Magnesium (stress, sleep, anxiety, and constipation)
- B5, B6 (support healthy cortisol and stress levels)
- Zinc (intestinal and menstrual health)
- Melatonin (sleep and antioxidant activity)
- Berberine (blood sugar/ craving balance)
- Loving Energy (adaptogenic energy)
Emma attacked her program tenaciously. She was determined to win her battle against binging and purging, and all of the symptoms that went along with it. We talked weekly, sometimes daily, as she experienced highs and lows. She ended up quitting her stressful job and looking for employment somewhere else. She decided to go back to school to become a nurse or alternative health care practitioner. She asked for advice on functional medicine books and resources and read them voraciously. All in the first month .
At our second meeting, her mood was sunny and positive.
"I am pooping every day. Sometimes twice a day", she smiled.
"I had energy all month, even though I was not perfect on my diet. I lost control of my eating a few times. Monday I ate pizza and then continued there. I lost control again. I woke up Tuesday morning craving sugar. I was upset at myself because I had not felt that way all month. I did not want to go back again.
But this was the first period I have ever had where I experienced NO CRAVINGS. I didn't even feel my period come on! I was not bloated or anything."
I nodded, furiously taking notes. Sweet.
"How much butter can I have?", she asked.
"All you want," I replied.
Supplements added month 2:
Emma and I continued to talk regularly during the next month. I checked on her weekly, and she felt free to call or text if she needed to. She had a few slippery moments of binging, and I encouraged her to get back on the wagon and eat. If you binge at one meal, do not skip the next meal. It is counterproductive and will lead to subsequent binging behavior. Drink water, go for a walk outside, forget about the binge, and move forward.
When we met for our next official meeting, she was still struggling with binging. This was not surprising. These behaviors had been part of her life for so long. It is unreasonable to expect oneself to not continue to struggle with them as one heals.
"I have not actually felt like I wanted to binge. On Saturday night my boyfriend's daughter wanted to go get ice cream. Then he left the two of us at home, so I took one bite and loved it. I found myself eating so much more. I snapped out of it though.
"I woke up the next morning craving sugar so bad. So I exercised and tried to get my mind off of it. Then I had some smoothie and ate my normal breakfast. When we came back, my boyfriend got out the tortilla chips. I ate a few, and then I ate more of the ice cream, but really did not want to purge.
"I was so surprised that I did not want to binge. Or purge. And I am pooping every single day. That was like years of problems. Weeks without pooping."
We discussed eating dinner earlier, according to her meal plan. She thought the collagen powder was already helping her skin and hair. She decided she wanted to take the collagen permanently.
Supplements added month 3:
- Arctic Cod Liver Oil (inflammation around menstruation)
The next time we met, Emma started our meeting with this:
" I quit smoking and taking Xanax".
Damn, girl. Way to go.
As of Friday, June 1, Emma texted me the following:
"I've officially had 2 periods in the last 2 months. Only the Lord knows how thankful I am. I am so happy and filled with so much thankfulness. This has never happened since I was 14 years old. I am so filled with joy. And I don't feel nuts. That is the best part. Thank you so so much for everything you do."
I was overcome with gratitude to see this shell of a girl burst back into a vibrant and nourished life.
If you think that healing is going to be easy, you are probably wrong. If you think that making meaningful changes in your life should come quickly or without painful effort, you probably won't make much meaningful change. And that's ok. Most of us are content to be where we are. Which is also ok. Sometimes it comes easy for people, but making health-affirming changes on a regular basis is not generally a lot of fun.
But if you are willing to put in the work, and the sacrifice, and the tears, and the confusion- it's possible that you can make changes that work and that last.
And we continue to work. Her anxiety is still there. Life is still hard. But she is committed to taking care of herself for herself and for her future family.
And I couldn't be prouder of her.
Yours in health,
Jennifer Woodward, FDN
note: I obtained Emma's permission to share her case.