General: Treatment for eating disorders must focus on more than just weight gain or weight loss. Treatment must address the underlying cause, which often has a psychological basis. The length of treatment varies among patients. It may last anywhere from several months to years.

Patients who have severe or long-term eating disorders may choose to go to a clinic that specializes in eating disorders. At these clinics, patients receive psychological counseling, nutritional education, exercise training, and support from their peers.

Nutrition education: A healthcare provider may recommend a nutritionist to help plan meals that are appropriate for the patient. A nutritionist can help teach the patient what foods are considered healthy. It is important for the patient to understand the negative impact that poor eating habits has on the body.

Cognitive behavioral therapy: Patients with eating disorders may benefit from a type of psychotherapy called cognitive behavioral therapy. The patient usually meets with a therapist to learn how to change their way of thinking. Patients with eating disorders often have low self-esteem and feel ashamed or embarrassed about their eating disorders. The goal is to turn negative perceptions into positive ones.

Family counseling: Another type of psychotherapy, called family counseling, may be beneficial for some patients. Patients meet with a therapist and family members to discuss events or interpersonal relationships that may have led to the disorder. Including family members in counseling may also provide additional support and encouragement to the patient.

Exercise programs: Patients who are obese due to compulsive eating or binge eating disorders are encouraged to exercise. Individuals should talk to their healthcare providers before starting a physical exercise program. A doctor can help plan a program that is safe and appropriate for the patient's strength and level of endurance. In general, overweight patients should participate in 45-60 minutes of moderate exercise (e.g. brisk walking or jogging) each day in order to prevent becoming obese.

Antidepressants: Depression is commonly associated with eating disorders. Antidepressants may be prescribed to treat depression in some patients. Drugs called selective serotonin reuptake inhibitors (SSRIs) are the most common type of antidepressants used. Commonly prescribed SSRIs include fluoxetine (Prozac®), fluvoxamine (Luvox®), sertraline (Zoloft®), and paroxetine (Paxil®). Less commonly prescribed antidepressants include clomipramine (Anafranil®), mirtazapine (Remeron®), amitriptyline (Elavil®), and bupropion (Wellbutrin®). Side effects may include nausea, nervousness, insomnia, diarrhea, rash, agitation, or sexual side effects (problems with arousal or orgasm).

Strong scientific evidence :

Biotin: Biotin is a water-soluble vitamin that is needed for the metabolism of proteins and carbohydrates. In general, biotin deficiency is rare. However, it may occur in malnourished patients with eating disorders. Strong scientific evidence supports biotin supplementation for the treatment of biotin deficiency.

Avoid if hypersensitive to constituents of biotin supplements.

Calcium: Calcium is the most abundant mineral in the human body. Calcium gluconate is used to treat calcium deficiencies, which may occur in patients who are malnourished due to eating disorders. Supplements should be taken under the supervision of a healthcare provider.

Avoid if allergic to calcium or lactose. High doses (more than 1,000 milligrams in men and women aged 19-50 and more than 1,200 milligrams in individuals older than age 50) taken by mouth may cause kidney stones. Avoid with high levels of calcium in the blood, high levels of calcium in urine, high levels of parathyroid hormone, bone tumors, digitalis toxicity, ventricular fibrillation, kidney stones, kidney disease, kidney failure, high serum phosphate levels, or sarcoidosis. Calcium supplements made from dolomite, oyster shells, or bone meal may contain unacceptable levels of lead. Use cautiously with low levels of stomach acid (achlorhydria) or irregular heartbeat. Calcium appears to be safe in pregnant or breastfeeding women.

Copper: Copper is a mineral that occurs naturally in many foods, including vegetables, legumes, nuts, grains, fruits, shellfish, avocado, beef, and animal organs. Copper can successfully treat copper deficiency in patients who are malnourished.

Avoid if allergic to copper. Avoid use of copper supplements when recovering from diarrhea. Avoid with hypercupremia. Avoid with genetic disorders affecting copper metabolism (e.g. Wilson's disease, Indian childhood cirrhosis, or idiopathic copper toxicosis). Avoid with HIV/AIDS. Use tap water that contains more than 6 milligrams of copper per liter cautiously. Use cautiously with anemia, arthralgias, myalgias, or if at risk for selenium deficiency. Use cautiously if taking birth control pills.

Folate (folic acid): Folate occurs naturally in food, and folic acid is the man-made form of this vitamin. Folic acid has been shown to effectively treat megaloblastic and macrocytic anemias due to folate deficiency.

Avoid if allergic to folate or any of the product ingredients. It is recommended that pregnant women consume 400 micrograms daily in order to reduce the risk of the fetus developing a defect. Folate is likely safe if breastfeeding.

Iodine: Iodine is an element that the human body needs to make thyroid hormones. Iodine has been show to effectively treat iodine deficiency in patients who are malnourished. Supplements should be taken under the supervision of a healthcare provider.

There have been reports of severe and even fatal reactions to iodine. Avoid iodine-based products if allergic to iodine. Do not use for more than 14 days. Avoid lugol solution and the saturated solution of potassium iodide (SSKI, PIMA) with high amounts of potassium in the blood, fluid in the lungs, bronchitis, or tuberculosis. Use cautiously when applying to the skin because it may irritate or burn tissues. Use sodium iodide cautiously with kidney failure. Avoid sodium iodide with gastrointestinal obstruction. Iodine is safe in recommended doses for pregnant or breastfeeding women. Avoid povidone-iodine for perianal preparation during delivery or postpartum antisepsis.

Iron: Iron is an essential mineral. Patients with eating disorders may become malnourished and develop iron deficiencies. Ferrous sulfate (Feratab®, Fer-Iron®, Slow-FE®) is the standard treatment for treating iron deficiency anemia. Dextran-iron (INFeD®) is given intravenously by healthcare providers to restore adequate iron levels in bone marrow when oral iron therapy has failed. Ferrous fumarate (Ferretts® or Hemocyte ®) has also been used.

Allergic reactions to iron are unlikely. Avoid if allergic to products containing iron. Avoid excessive intake. Avoid iron supplements with blood disorders that require frequent blood transfusions. Use iron supplement cautiously with a history of kidney disease, intestinal disease, heart disease, peptic ulcer disease, enteritis, colitis, pancreatitis, hepatitis, or alcoholism. Use cautiously if older than 55 years old. Pregnant or breastfeeding women should consult their healthcare professionals before beginning iron supplementation.

L-carnitine: L-carnitine is an amino acid that is made in the liver and muscles. Patients who have eating disorders and are malnourished may have L-carnitine deficiencies. This condition can be effectively treated with L-carnitine supplements (e.g. Carnitor® or Nicetile®), which can be taken by mouth or injected into a vein. Supplements should be taken under the supervision of a healthcare provider.

Avoid with known allergy to carnitine. Use cautiously with peripheral vascular disease, high blood pressure, alcohol-induced liver cirrhosis, and diabetes. Use cautiously in low birth weight infants and individuals on hemodialysis. Use cautiously if taking anticoagulants, beta-blockers, or calcium channel blockers. Avoid if pregnant or breastfeeding.

Niacin: Niacin is a B complex vitamin found in a many foods such as liver, poultry, fish, nuts, and dried beans. Niacin (vitamin B3) and niacinamide are approved by the U.S. Food and Drug Administration (FDA) for the treatment of niacin deficiency (pellagra), which may occur in patients who are malnourished.

Avoid niacin/vitamin B3 if allergic to niacin or niacinamide. Avoid with a history of liver disease, irregular heartbeats, heart disease, blood clotting, bleeding disorders, asthma, anxiety, panic attacks, thyroid disorders, stomach ulcers, gout, or diabetes. Avoid if pregnant or breastfeeding.

Pantothenic acid (vitamin B5): Pantothenic acid (vitamin B5) is found in many foods, including, meats, liver, kidney, fish/shellfish, chicken, vegetables, legumes, yeast, eggs, and milk. In rare cases of malnourishment, patients may develop pantothenic acid deficiency. In such cases, pantothenic acid is taken by mouth. Sometimes patients who have a high risk of developing the deficiency take the supplement as a preventative measure.

Avoid if allergic to pantothenic acid or dexpanthenol. Avoid with gastrointestinal blockage. Pantothenic acid is generally considered safe in pregnant and breastfeeding women when taken at recommended doses.

Phosphates (phosphorus): Phosphorus is a mineral found in many foods, including milk, cheese, dried beans, peas, nuts, and peanut butter. Phosphate is the most common form of phosphorus. Patients with eating disorders who are malnourished may develop low levels of phosphorus in the blood. This condition, called hypophosphatemia, is an FDA-labeled use of phosphates in adults. Taking sodium phosphate or potassium phosphate can effectively prevent and treat most causes of hypophosphatemia. Supplements should be taken under the supervision of a healthcare provider.

Avoid if allergic to any ingredients in phosphorus/phosphate preparations. Use phosphorus/phosphate salts cautiously with kidney, liver disease, heart failure, chest pain, high phosphate blood levels, low levels of calcium in the blood, low potassium blood level, high sodium blood level, Addison's disease, intestinal obstruction of the ileus, bowel perforation, severe constipation, acute colitis, toxic megacolon, hypomotility syndrome, hypothyroidism, scleroderma, gastric retention, or after recent heart surgery. Avoid sodium phosphate enemas with congenital or abnormalities of the intestine. Too much phosphorus may cause serious or life-threatening toxicity, which may cause symptoms such as electrolyte imbalances, low blood pressure, palpitations, and difficulty breathing.

Riboflavin: Riboflavin is a vitamin that is needed for normal cell function, growth, and energy production. Patients with eating disorders who are malnourished may develop riboflavin deficiencies, also called ariboflavinosis. Studies suggest that riboflavin supplementation is an effective treatment for this condition.

Avoid if allergic to riboflavin. Since the amount of riboflavin a human can absorb is limited, riboflavin is generally considered safe. Riboflavin is generally regarded as being safe during pregnancy and breastfeeding when taken at the recommended dosages

Soy: Patients with eating disorders may not consume a healthy amount of protein. Soy products, such as tofu, are high in protein and are an acceptable source of dietary protein.

Avoid if allergic to soy. Soy, as a part of the regular diet, is traditionally considered to be safe during pregnancy and breastfeeding, but there is limited scientific data. The effects of high doses of soy or soy isoflavones in humans are unclear, and therefore, not recommended. There has been one case report of vitamin D deficiency rickets in an infant nursed with soybean milk that was not specifically designed for infants. People who experience intestinal irritation from cow's milk may experience intestinal damage or diarrhea from soy. It is unknown if soy or soy isoflavones share the same side effects as estrogens (e.g. increased risk of blood clots). The use of soy is often discouraged in patients with hormone-sensitive cancers, such as breast or prostate cancers. Other hormone-sensitive conditions, such as endometriosis, may also be worsened. Patients taking blood-thinning drugs (e.g. warfarin or aspirin) should check with their doctors before taking soy supplements.

Thiamin (thiamine), vitamin B1: Thiamin (thiamine), also called vitamin B1, is a water-soluble vitamin. Patients with eating disorders who are malnourished have an increased risk of developing thiamin deficiencies. Very little thiamin is stored in the body, which means depletion can occur quickly. Severe chronic thiamin deficiency can result in potentially serious complications involving the nervous system/brain, muscles, heart, and gastrointestinal system. Patients with thiamin deficiency or related conditions should receive supplemental thiamin under medical supervision.

Thiamin is generally considered safe and relatively nontoxic, even at high doses. Avoid if allergic or hypersensitive to thiamin. Thiamin appears safe if pregnant or breastfeeding when taken in the recommended dosages.

Vitamin A: Vitamin A is a fat-soluble vitamin that is needed for vision. Patients with eating disorders who are malnourished may develop vitamin A deficiency. Patients should receive prompt treatment with vitamin a supplements because long-term deficiencies may lead to permanent blindness.

Avoid if allergic to vitamin A. Vitamin A toxicity can occur if taken at high dosages. Use cautiously with liver disease or alcoholism. Smokers who consume alcohol and beta-carotene may have an increased risk of developing lung cancer or heart disease. Vitamin A appears safe in pregnant women if taken in recommended doses. Use cautiously if breastfeeding because the benefits or dangers to nursing infants are not clearly established.

Vitamin B12: Vitamin B12 is a water-soluble vitamin and is commonly found in many foods like fish, shellfish, meats and dairy products. Vitamin B12 helps maintain healthy nerve cells and red blood cells. Patients with eating disorders who are malnourished may develop vitamin B12 deficiencies. Vitamin B12 supplements can effectively treat this condition and help prevent neurological and psychiatric damage.

Avoid vitamin B12 supplements if allergic to cobalamin, cobalt, or any other product ingredients. Avoid with coronary stents or Leber's disease. Use cautiously if undergoing angioplasty. Vitamin B12 is generally considered safe when taken in amounts that are not higher than the recommended dietary allowance (RDA).

Vitamin B6: Vitamin B6 (also called prixidoxine) is commonly found in cereal grains, legumes, vegetables (e.g. carrots, spinach, or peas), potatoes, milk, cheese, eggs, fish, liver, meat, and flour. Pyridoxine supplements are effective for preventing and treating pyridoxine deficiency and neuritis due to inadequate dietary intake. Supplements should be taken under the supervision of a healthcare provider.

Some individuals are particularly sensitive to vitamin B6 and may have problems at lower doses. Avoid excessive dosing. Vitamin B6 is likely safe when taken by mouth in doses that do not exceed the recommended dietary allowance (RDA).

Vitamin C (ascorbic acid): Vitamin C (ascorbic acid) is a vitamin that the body needs to form collagen in bones, cartilage, muscle, and blood vessels. Patients with eating disorders may not consume enough vitamin C, which causes a condition called scurvy. Vitamin C supplements, taken by mouth or injection, have been shown to effectively treat scurvy. Treatment should be under strict medical supervision.

Vitamin C is generally considered safe in the amounts found in foods. Vitamin C supplements are also generally considered safe in most individuals if taken in recommended doses. Avoid high doses of vitamin C with glucose 6-phosphate dehydrogenase deficiency, kidney disorders or stones, cirrhosis (inflammation of the liver), gout, or paroxysmal nocturnal hemoglobinuria (bleeding disorder). Vitamin C intake from food is generally considered safe if pregnant or breastfeeding. It is not clear if vitamin C supplements in doses higher than dietary reference intake recommendations are safe for pregnant or breastfeeding women. Vitamin C is naturally found in breast milk.

Vitamin D: Vitamin D is found in many foods, including fish, eggs, fortified milk, and cod liver oil. The sun also helps the body produce vitamin D. Patients with eating disorders may not consume enough vitamin D in their diet. As a result, they may develop a condition called rickets, which causes the bones to become weak. Vitamin D supplements have been shown to improve vitamin D deficiencies and effectively treat rickets.

Avoid if allergic or hypersensitive to vitamin D or any of its components. Vitamin D is generally well-tolerated in recommended doses. Doses higher than recommended may cause toxic effects. Individuals with hyperparathyroidism (overactive thyroid), kidney disease, sarcoidosis, tuberculosis, or histoplasmosis have a higher risk of experiencing toxic effects. Vitamin D is generally considered safe for pregnant women. It may be necessary to give infants vitamin D supplements along with breast milk. The recommended intake of vitamin D for normal infants, children, and adolescents is 200 international units daily.

Vitamin E: Vitamin E exists in eight different forms: alpha-, beta-, gamma- and delta- tocopherol; and alpha-, beta-, gamma- and delta- tocotrienol. Alpha-tocopherol is the most active form in humans. Patients with eating disorders may not consume enough vitamin E in their diet. Vitamin E supplementation is accepted as an effective therapy for vitamin E deficiency to stop the progression of complications. Supplements should be taken under the supervision of a healthcare provider.

Avoid if allergic or hypersensitive to vitamin E. When taken for short periods of time, vitamin E supplementation is generally considered safe when consumed in recommended dosages.

Vitamin K: Vitamin K is found in green leafy vegetables, such as spinach, broccoli, asparagus, watercress, cabbage, cauliflower, green peas, beans, olives, canola, soybeans, meat, cereals, and dairy products. Patients with eating disorders may not consume enough vitamin K in the diet. As a result, they may develop blood clotting problems and increased bleeding, as well as osteoporosis. Vitamin K supplements have been shown to effectively treat deficiencies. Supplements should be taken under the supervision of a healthcare professional.

Avoid if allergic to vitamin K. Injection into the muscle or vein should only be done by a healthcare professional. Many serious side effects have occurred after injection. Menadiol (type of vitamin K that is not available in the United States) should be avoided with glucose-6-phosphate dehydrogenase deficiency. Avoid if pregnant. The American Academy of Pediatrics recommends giving a single vitamin K1 injection into the muscle for all newborns to prevent vitamin K deficiency bleeding (VKDB). However, large amounts of vitamin K may cause serious side effects or death. Vitamin K is generally considered safe for breastfeeding mothers.

Good scientific evidence :

Phosphates (phosphorus): Phosphorus is a mineral found in many foods, including milk, cheese, dried beans, peas, nuts, and peanut butter. Phosphate is the most common form of phosphorus. After periods of severe malnutrition or starvation (for example, anorexia nervosa), intravenous phosphate may be necessary in order to prevent a re-feeding syndrome. This syndrome occurs when the patient experiences metabolic disturbances after reinstitution of nutrition. Phosphate levels should be closely monitored in such patients.

Avoid if allergic to any ingredients in phosphorus/phosphate preparations. Use phosphorus/phosphate salts cautiously with kidney, liver disease, heart failure, chest pain, high phosphate blood levels, low levels of calcium in the blood, low potassium blood levels, high sodium blood levels, Addison's disease, intestinal obstruction of the ileus, bowel perforation, severe constipation, acute colitis, toxic megacolon, hypomotility syndrome, hypothyroidism, scleroderma, gastric retention, or after recent heart surgery. Avoid sodium phosphate enemas with congenital or abnormalities of the intestine. Too much phosphorus may cause serious or life-threatening toxicity.

Psychotherapy: Psychotherapy is an interactive process between a person and a qualified mental health professional. The patient will explore thoughts, feelings and behavior to help with problem solving. Psychotherapy may improve outcome, prevent relapse, improve sexual and social adjustment, and encourage weight gain in patients with anorexia nervosa.

Psychotherapy, especially cognitive behavioral therapy, may help bulimics reduce binge eating, purging, and relapse, as well as improve dietary restraint and attitudes towards body shape and weight. Prescription medications may be used with psychotherapy but may not be as successful alone.

Psychotherapy cannot always fix mental or emotional conditions. Psychiatric drugs are sometimes needed. In some cases symptoms may get worse if the proper medication is not taken. Not all therapists are qualified to work with all problems. Use cautiously with serious mental illness and some medical conditions because some forms of psychotherapy may stir up strong emotional feelings and expression.

Safflower: Some patients with eating disorders may not consume enough fatty acids in the diet. Fatty acid intake is required for many biological processes in the body. Safflower oil may improve fatty acid deficiency, especially oleic acid, linoleic acid, and archadonic acid levels. Additional study is needed in this area before a strong conclusion can be made.

Avoid if allergic to safflower (Carthamus tinctorius), safflower oil, daisies, ragweed, chrysanthemums, marigolds, or any related constituents. Use parenteral safflower oil emulsions cautiously in newborns. Use cautiously if taking anticoagulants, anti-platelet drugs, immunosuppressants, or pentobarbital. Use cautiously with diabetes, low blood pressure, liver disorder, bleeding disorders, or skin pigmentation conditions. Use cautiously if pregnant or breastfeeding.

Thiamin (thiamine), vitamin B1: Thiamin (thiamine), also called vitamin B1, is a water-soluble vitamin. Thiamin should be added to TPN formulations for patients who are unable to receive thiamin through other sources, such as a multivitamins, for more than seven days.

Thiamin is generally considered safe and relatively nontoxic, even at high doses. Avoid if allergic or hypersensitive to thiamin. Thiamin appears safe if pregnant or breastfeeding when taken in the recommended dosages.

Vitamin C (ascorbic acid): Vitamin C (ascorbic acid) is a vitamin that the body needs to form collagen in bones, cartilage, muscle, and blood vessels. Based on scientific research, vitamin C appears to improve oral absorption of iron. Concurrent vitamin C may aid in the absorption of iron dietary supplements.

Vitamin C is generally considered safe in amounts found in foods. Vitamin C supplements are also generally considered safe in most individuals if taken in recommended doses. Avoid high doses of vitamin C with glucose 6-phosphate dehydrogenase deficiency, kidney disorders or stones, cirrhosis (inflammation of the liver), gout, or paroxysmal nocturnal hemoglobinuria (bleeding disorder). Vitamin C intake from food is generally considered safe if pregnant or breastfeeding. It is not clear if vitamin C supplements in doses higher than dietary reference intake recommendations are safe for pregnant or breastfeeding women. Vitamin C is naturally found in breast milk.

Unclear or conflicting scientific evidence :

Beta-carotene: Beta-carotene is a member of the carotenoids, which are very colorful (red, orange, yellow) fat-soluble compounds. Although consumption of provitamin A carotenoids (alpha-carotene, beta-carotene, and beta-cryptoxanthin) can prevent vitamin A deficiency, no overt deficiency symptoms have been identified in people consuming low-carotenoid diets if they consume adequate vitamin A. After reviewing the published scientific research, the Food and Nutrition Board of the Institute of Medicine (IOM) concluded that the existing evidence in 2000 was insufficient to establish a recommended dietary allowance (RDA) or adequate intake (AI) for carotenoids.

Avoid if sensitive to beta-carotene, vitamin A, or any other ingredients in beta-carotene products.

Biotin: Biotin is a water-soluble vitamin that is needed for the metabolism of proteins and carbohydrates. If patients with eating disorders become extremely malnourished, then they may require intravenous feeding solutions. Research suggests that these solutions, called total parenteral nutrition (TPN), should contain biotin in order to avoid biotin deficiency in recipient patients. This applies to patients who are receiving TPN as the sole source of nutrition. More study is needed in this area to make a firm conclusion.

Avoid if hypersensitive to constituents of biotin supplements.

Borage seed oil: Currently, there is insufficient available evidence evaluating the effectiveness of borage in the treatment of malnutrition.

Avoid if allergic to borage, its constituents, or members of the Boraginaceae family. Use cautiously with bleeding disorders or epilepsy. Use cautiously if taking blood thinners or anticonvulsants. Avoid with immune system disorders. Avoid if pregnant because borage oil may harm the fetus or cause miscarriage. Avoid if breastfeeding.

Bromelain: Bromelain is classified as an herb and contains a digestive enzyme that comes from the stem and the fruit of the pineapple plant. There is not enough information to recommend for or against the use of bromelain as a nutritional supplement.

Avoid if allergic to bromelain, pineapple, honeybee, venom, latex, birth pollen, carrots, celery, fennel, cypress pollen, grass pollen, papain, rye flour, wheat flour, or other members of the Bromeliaceaefamily. Use cautiously with history of bleeding disorder, stomach ulcers, heart disease, liver or kidney disease. Use cautiously before dental or surgical procedures with bleeding risks. Use cautiously while driving or operating machinery. Avoid if pregnant or breastfeeding.

Carrot: Patients with eating disorders may not consume enough vitamin A in the diet. Jam made from carrots may improve growth in young children with vitamin A deficiency. Although the results seem promising, more research is needed.

Avoid if allergic or hypersensitive to carrot, its constituents, or members of the Apiaceae family. Use cautiously with hypoglycemia (low blood sugar), diabetes, bowel obstruction, and hormone-sensitive conditions. Use cautiously if taking hypoglycemic agents. Use cautiously in children. Use cautiously with known allergy/hypersensitivity to carrot or birch pollen-related allergens, as cross-sensitivity has been documented. Use cautiously and only in food amounts in pregnant and breastfeeding women.

Chondroitin sulfate: Chondroitin sulfate is manufactured from natural sources (e.g. shark, beef cartilage, or bovine trachea) or by artificial means. Early evidence suggests that taking chondroitin sulfate with iron may help improve iron absorption in the body.

Use cautiously if allergic to chondroitin sulfate products. Use cautiously with bleeding disorders or if taking blood thinners (i.e. anticoagulants or anti-platelet drugs). Avoid if pregnant or breastfeeding.

Copper: Copper is a mineral that occurs naturally in many foods, including vegetables, legumes, nuts, grains, fruits, shellfish, avocado, beef, and animal organs. Patients with eating disorders may not consume enough calories and proteins. This may lead to a condition called marasmus. Patients with marasmus may also have copper deficiencies. Copper has been studied as a possible treatment for infants with marasmus and copper deficiency. Further research is warranted in this area. Copper supplements should be taken under the supervision of a healthcare provider.

Avoid if allergic to copper. Avoid use of copper supplements when recovering from diarrhea. Avoid with hypercupremia. Avoid with genetic disorders affecting copper metabolism (e.g. Wilson's disease, Indian childhood cirrhosis, or idiopathic copper toxicosis). Avoid with HIV/AIDS. Use water that contains more than six milligrams of copper per liter cautiously. Use cautiously with anemia, arthralgias, myalgias, or if at risk for selenium deficiency. Use cautiously if taking birth control pills.

Devil's claw: Traditionally, devil's claw was commonly used as an appetite stimulant, and this remains a popular use. However, there is no reliable scientific evidence in this area, and it remains unclear if devil's claw is beneficial as an appetite stimulant.

Avoid if allergic to devil's claw and to plants in the Pedaliaceae family. Use cautiously with stomach ulcers or history of bleeding disorders, diabetes, gallstones, gout, heart disease, stroke, ulcers or with prescription drugs used for these conditions. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risks. Avoid if pregnant or breastfeeding.

Guided imagery: Guided imagery refers to a number of techniques, including metaphor, storytelling, fantasy, game playing, dream interpretation, drawing, visualization, active imagination, or direct suggestion using imagery. Evidence from early research suggests that guided imagery may be an effective treatment for bulimia nervosa, at least in the short term. Further study is needed before firm conclusions can be drawn.

Guided imagery is usually intended to supplement medical care, not to replace it, and guided imagery should not be relied on as the sole therapy for a medical problem.

Hypnotherapy, hypnosis: Hypnosis is a trance-like state in which a person becomes more aware and focused and is more open to suggestion. Hypnotherapy has been suggested as a possible treatment for eating disorders. However, early studies have produced conflicting results. Further research is warranted in this area.

Use cautiously with mental illnesses (e.g. psychosis, schizophrenia, manic depression, multiple personality disorder or dissociative disorders) or seizure disorders.

Lime: "Lime" refers to many different citrus fruits that are usually round and green or yellow. Patients with eating disorders may not consume enough iron in the diet. There is conflicting evidence regarding the effectiveness of lime's ability to increase iron absorption. Additional study is needed before a firm conclusion can be drawn

Lime is considered safe when used in amounts typically found in foods. Avoid if allergic to lime or any members in the Rutaceae family. Use cautiously if taking drugs that are broken down by the liver or with drugs that cause sun sensitivity. Avoid if pregnant or breastfeeding.

Phosphates (phosphorus): Phosphorus is a mineral found in many foods, such as milk, cheese, dried beans, peas, nuts, and peanut butter. Phosphate is the most common form of phosphorus. Patients with eating disorders may develop a condition called rickets if they do not consume enough vitamin D in their diet. In most cases, this bone disease can be treated with vitamin D supplements. However, some patients develop vitamin D-resistant rickets that do not respond to the supplements. Phosphates have not been proven to be a beneficial treatment for vitamin D-resistant rickets. Further research is needed in this area.

Avoid if allergic to any ingredients in phosphorus/phosphate preparations. Use phosphorus/phosphate salts cautiously with kidney, liver disease, heart failure, chest pain, high phosphate blood levels, low levels of calcium in the blood, low potassium blood levels, high sodium blood levels, Addison's disease, intestinal obstruction of the ileus, bowel perforation, severe constipation, acute colitis, toxic megacolon, hypomotility syndrome, hypothyroidism, scleroderma, gastric retention, or after a recent heart surgery. Avoid sodium phosphate enemas with congenital or abnormalities of the intestine. Too much phosphorus may cause serious or life-threatening toxicity.

Riboflavin: Riboflavin is a vitamin that is needed for normal cell function, growth, and energy production. Levels of important nutrients are often low in individuals with anorexia or bulimia, with up to 20-33% of patients deficient in vitamins B2 (riboflavin) and B6 (pyridoxine). Dietary changes alone, without additional supplements, can often bring vitamin B levels back to normal. However, extra B2 and B6 may be required. Nutritional and medical guidance for such patients should be under the direction of a qualified healthcare professional.

Avoid if allergic to riboflavin. Since the amount of riboflavin a human can absorb is limited, riboflavin is generally considered safe.

Safflower: Safflower oil has been used in patients with protein-energy malnutrition to promote balance in their nutritional intake. Although the patient has improved, the effect cannot be isolated to safflower oil intake because of the many other nutrients the patients were ingesting. Additional study is warranted in this area.

Avoid if allergic to safflower (Carthamus tinctorius), safflower oil, daisies, ragweed, chrysanthemums, marigolds, or any related constituents. Use parenteral safflower oil emulsions cautiously in newborns. Use cautiously if taking anticoagulants, anti-platelet drugs, immunosuppressants, or pentobarbital. Use cautiously with diabetes, low blood pressure, liver disorder, bleeding disorders, or skin pigmentation conditions. Use cautiously if pregnant or breastfeeding.

Taurine: Taurine is an amino acid that is produced in the body. Early research suggests that taurine may help treat patients with iron deficiency anemia. This type of anemia may occur in patients with eating disorders if they do not consume enough iron in the diet. Further research is needed in this area.

The use of taurine has been examined in various patient groups (trauma, cancer, and long term patients) who were receiving feeding solutions. Preliminary study is promising, but more study is needed in this area.

It is unlikely that there are allergies related to taurine. However, allergies may occur from multi-ingredient products that contain taurine. Use cautiously with high very low density lipoprotein (VLDL) cholesterol, hypertriglyceridemia, or with a history of low blood pressure, bleeding disorders, mania, or epilepsy. Use cautiously if taking hypolipidemic medications, hypotensive drugs, hypoglycemic drugs, anti-platelet drugs or anticoagulants. Avoid consumption of energy drinks containing taurine, caffeine, glucuronolactone, B vitamins, and other ingredients, and then consuming alcohol or exercising. Use cautiously if pregnant or breastfeeding. Taurine is a natural component of breast milk.

Vitamin A: Vitamin A is a fat-soluble vitamin that is needed for vision. Vitamin A supplementation in combination with iron may have beneficial effects in patients with iron deficiency anemia. It is not clear if there are benefits in individuals who are not vitamin A deficient. This area remains controversial, and further evidence is necessary before a clear conclusion can be drawn.

Avoid if allergic to vitamin A. Vitamin A toxicity can occur if taken at high dosages. Use cautiously with liver disease or alcoholism. Smokers who consume alcohol and beta-carotene may have an increased risk of developing lung cancer or heart disease. Vitamin A appears safe in pregnant women if taken in recommended doses. Use cautiously if breastfeeding because the benefits or dangers to nursing infants are not clearly established.

Zinc: Zinc formulations have been used since ancient Egyptian times to enhance wound healing. Available studies suggest that zinc may effectively treat symptoms of anorexia nervosa in young adults. However, these initial results are based on small, non-randomized studies. Well-designed trials with a larger number of participants are needed to confirm these results.

Short-term zinc supplementation may increase weight gain and decrease infections, but cause swelling, diarrhea, anorexia and skin ulcers in children with extreme malnourishment. Further research is warranted in this area.

Zinc (zinc sulfate, zinc acetate, zinc glycine, zinc oxide, zinc chelate, and zinc gluconate) is generally considered safe when taken in the recommended dosages. Avoid zinc chloride since studies have not been done on its safety or effectiveness. While zinc appears safe during pregnancy in amounts lower than the established upper intake level, caution should be used since studies cannot rule out the possibility of harm to the fetus.

Make an effort to maintain positive and healthy attitudes and behaviors.

Parents should teach their children the importance of healthy eating habits and regular exercise.

Parents should teach their children about the true diversity of body types. The models portrayed in the media do not represent the majority of people.

It is important to be educated on the signs and symptoms of eating disorders. Recognizing and treating the disorder early can increase the long-term prognosis of the patient.

Patients with eating disorders should maintain a close support group of friends and family members. This helps reduce the risk of relapse.