The following is a transcript of Season 1, Episode 8 of The ND Will See You Now, a podcast by the Institute for Natural Medicine.
On this episode of The ND Will See You Now, our host Anna-Liza Badaloo talks with Lachlan Crawford, ND, the Director of Integrative Medicine at Walden Behavioral Care, an inpatient and residential facility for eating disorders and psychiatric conditions in New England. Listen in as Dr. Crawford, who also sits on the board of the Psychiatric Association of Naturopathic Physicians, explores some unexpected root causes of eating disorders including nutritional deficiencies, genetic risk factors, and even how the gut-brain axis ought to be considered during treatment. Dr. Crawford also explains how naturopathic medicine fits within the different integrative options that she uses to provide her patients with effective, personalized, and meaningful care.
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Anna-Liza Badaloo (ALB): Hi there, and welcome to the Institute for Natural Medicine’s podcast, The ND Will See You Now. In this podcast, we talk to naturopathic doctors across North America to find out about their whole person approach to health, what patients can expect, and why their work is so very vital to patient health.
I’m your host Anna-Liza, and today, I’m just thrilled to welcome naturopathic doctor Lachlan Crawford to the podcast, who addresses the root causes of mental health using patient-centered, integrative medicine. Dr. Crawford is a licensed naturopathic doctor in both California and Ontario, Canada. She’s the Director of Integrative Medicine at Walden Behavioral Care, which is an inpatient and residential facility for eating disorders and psychiatric conditions in New England. If that wasn’t enough, she also sits on the board at the Psychiatric Association of Naturopathic Physicians, also known as PsychANP. She’s also the co-founder of Water and Wood, a lifestyle and mental health retreat organization which hosts retreats in the beautiful Canadian wilderness. Thanks so much for joining us today, Dr. Crawford!
Dr. Lachlan Crawford, ND (LC): Thank you for having me here, Anna-Liza!
ALB: Dr. Crawford, as I mentioned, you are dedicated to helping people improve their mental health by using an integrative approach. And what are you integrating here? Well, a few things. You’re incorporating naturopathic medicine and conventional medicine. But you’re also bringing in movement (i.e., exercise) and spending time outdoors.
I know that you can speak to a wide range of mental health conditions. Today, I’d like to focus on an often overlooked and misunderstood mental health condition that has been rising during the pandemic: eating disorders and disordered eating. Now, when we think about this, eating is a fairly straightforward activity, in theory. Food gives us fuel to function. But we all know this isn’t the whole story. We may eat when we’re bored, stressed, anxious, depressed; insert emotion here. It’s not just a matter of somebody eating too much or not enough.
Before we get into how you might approach this from an integrative medicine perspective, let’s back up a bit. Dr. Crawford, in your experience, what root causes may contribute to eating disorders?
LC: It’s a great question. First, when I think about eating disorders, they’re really a multifaceted group of disorders that have multifaceted causes. We have anorexia nervosa, bulimia nervosa, ARFID (Avoidant Restrictive Food Intake Disorder), binge eating disorder, night eating syndrome, and others. And we also have subtypes of those as well. Each one has various profiles of things that tend to contribute to their particular symptom or behavioral picture. So really, there’s no one answer. But I’ll go through a number of factors that can contribute to any of these.
Like other mental health conditions, it also has genetic and environmental (or acquired risk) factors that we collect through life, if you will. To start off, some of the more expected root causes would be things that we think about, like socialization of body standards (either by family, friends, or social media is a big one) general culture, or perhaps being a part of a population that tends to have higher eating disorder rates, like athletes, for example.
There are genetic factors as well. Genetic risk factors can include having a family history of eating disorders, but also for some comorbid mental health conditions (like anxiety, OCD, and depression) that can all contribute to the eventual development of an eating disorder. Something we’re certainly paying more attention to these days is that trauma is an important risk factor to be aware of. Direct trauma can increase risk of an eating disorder. This is especially known for eating disorders that start in adolescence. There was a really fabulous study that just came out in this year by Dr. Tim Brewerton, MD, that looked at the correlation between PTSD and eating disorder symptoms arising in adolescence. It’s an important thing for us to look at.
But also, the effects of trauma that are experienced by parents can be passed down to children simply through epigenetic modifications of the stress response system. We need to be aware of trauma and experiences in the history of the family and in the individual themselves. We see trauma being a part of the eating disorder picture with more chronic and severe cases, but they can be at any level of care, any severity of the condition.
Importantly, it would not be a complete answer if I didn’t talk about nutritional deficiencies. Certainly, through the integrative lens that I use, these can be contributors to eating disorders. Here, I’m mostly talking about zinc, essential fatty acids, B vitamins, minerals, (in some cases lithium), and a number of other nutritional deficiencies that can contribute to the psychiatric and behavioral symptom pictures of eating disorders.
Finally, I’m thinking about the range of eating disorders. We think that all of these would contribute to any of the actual eating disorder behaviors. But when I think about ARFID (Avoidant Restrictive Food Intake Disorder), this is something that we’re seeing more of, and we’re studying more. We’re starting to learn that people who struggle with ARFID can also struggle with sensory overwhelm, sensory overstimulation and processing disorder. That can be part of the development of some ARFIDs as well.
ALB: That was a lot of factors, and really different factors, too! Some of these factors are, as you said, genetic, it could be environmental, it could be socialization-based. You point to social media in particular, which these days is an important factor. And as you mentioned, nutritional deficiencies can also come into this, in addition to interacting with that trauma response. Thanks for that; this gives us a much better sense of the complexity of these issues. And it really is not a straight cause and effect kind of situation.
Now we have a better sense of what some of these root causes may be. Keeping in mind that each patient in front of you is a unique individual, and there’s no one size fits all answer here, can you give us a sense of how you might approach addressing eating disorders using that integrative medical perspective that you mentioned? And how does naturopathic medicine factor in?
LC: Absolutely. Naturopathic medicine is one of the modalities that are included in the whole umbrella of integrative modalities that I might use. And certainly, one of the very first things that I would think about when I’m treating a patient who’s been struggling with disordered eating, or diagnosis of an eating disorder, is really to get to know the person and to really understand what are their fears or beliefs that drive behaviors. Certainly, we don’t recommend any changes in diet until we can really get a handle on understanding some of the core beliefs that are driving those behaviors. That’s a really good thing. I really appreciate that, as a naturopathic doctor, I have an extended amount of time with my patients to really get to know them and to screen. If someone is coming in for general practice, I also screen for anybody who has a history of disordered eating that I might want to be aware of and sensitive to when I’m prescribing anything, for example. So that’s the first piece, to really get to know the patient and spend time with them.
And then, when we get into the naturopathic medicine modalities, again, when we’re looking at root cause, we need to know: what are the mental health comorbidities that could be driving it? We need to know, are there OCD behaviors that are driving this? Is there an extreme amount of anxiety that’s driving the behaviors? Is there trauma that needs to be processed? And then, of course, we refer appropriately if I can’t do all of that work myself. I’m not a family-based therapist. I’m not somebody who could do in-depth trauma work. So, I make sure that I’m working with a team to really address those root causes. That’s so essential to my mind when I look at eating disorders.
And then, of course, like I mentioned with the causative factors, I look at nutritional deficiencies. I will do testing. Sometimes we can start some repleting nutritional regimens before we do the testing because there were some pretty standard nutritional deficiencies. But definitely testing and really getting to know (as you said) each person as an individual. We need to know what their deficiencies are that could be contributing to their behaviors.
In addition to nutritional deficiencies, I might track blood sugar over the course of a day because sometimes that can drive feelings of anxiety, cravings, avoidance, and distress when they’re eating. So, really paying attention to blood glucose levels.
One thing that I think has been really wonderful to bring into my practice more in recent years is to think about the gut lining as an essential organ within our health that drives mental health. We’re learning a lot about the gut-brain axis, and how things that are happening in the gut affect the brain, and how the brain affects things that are happening in the gut. So, really working with helping to heal the gut lining, if there’s been any injury there, if there’s any history of an autoimmune condition, or some sort of digestive issue. Looking at that, seeing if there is a root cause that we need to heal, and then supporting the gut microbiome through food, probiotics, prebiotics, whatever combination is going to work for that person. Really making sure that we take that into consideration as well, the gut lining.
With my role here as Director of Integrative Medicine at Walden Behavioral Care, we have a whole program that really looks at the person as a whole. We incorporate gentle exercise when it’s appropriate, when someone’s at a stage of an eating disorder when they’re able to reincorporate gentle movement. Overexercise is a behavior within some eating disorders. So, making sure that we’re being honest and checking to make sure that any movement we’re doing isn’t contributing to the eating disorder itself. So, working in gentle movements from yoga, going for walks, etc.
Another tool that I use quite often is heart rate variability biofeedback, and this is something that I absolutely love. We use the heart rate sensors through HeartMath. This is something that patients can do at home, if you do it with a practitioner. It’s a really wonderful tool that teaches self-regulation. Essentially, you’re using a very simple heart rate monitor that gives a visual display of what’s going on for your nervous system. You get to learn what helps you regulate your own internal nervous system so that you can gain an internal locus of control for understanding that when I’m feeling stressed, I have the ability to calm myself down. That can go a long way when we’re talking about anxiety, OCD, and compulsions contributing to behaviors within an eating disorder.
These are all integrative tools that I really like to use. It’s important to note that for some people, if they have comorbid mental health (conditions happening at the same time), maybe it’s the mental health that started first that’s contributing to the eating disorder. Or maybe it’s the eating disorder that contributes to the mental health. But all of that needs to be a part of the conversation. The integration of all of these tools is really important, which is why I love the naturopathic and integrative approach to eating disorders.
ALB: Well said, Dr. Crawford. There’s so much in there that you’ve mentioned about what the integrative approach can really bring to people that are having these struggles with eating disorders and disordered eating. You’ve mentioned that it’s that time that naturopathic doctors are spending in really getting to know that patient, getting to know what’s going on with them (past and present).
You’ve also mentioned the importance of working as a team. So, one individual can work integratively by using these different modalities. But that’s another nice extra layer of integration, where you’re using integrative medicine and integrating that within a team, where each healthcare practitioner is able to bring their individual skills, knowledge, and experience to the table for the benefit of that patient.
And I’d be remiss if I didn’t mention the gut-lining issue because this is something that I think may be a surprise to some people. You have drawn our attention to the importance of the gut-brain axis; there is a lot going on there, right? In this ‘conversation’ that the gut and the brain are having, a lot of things going back and forth. And I agree with you. There is a lot of research out there. I certainly encourage our listeners to go ahead and seek out that research and educate yourself on how what’s going on in our gut really is impacting mental health, and other aspects of health. There’s just so much there, so much to work with.
Dr. Crawford, we’ve talked about the root causes. We’ve talked about how you might approach this. We may have people listening to us today who themselves may be struggling with disordered eating or an eating disorder. Or maybe it’s somebody that they know and care about: a neighbor, a family member, a friend, a colleague. People may be thinking about themselves or thinking of recommending that their loved one see a naturopathic doctor to help them address an eating disorder, but maybe they’re hesitant about seeing a naturopathic doctor for that. What would you say, Dr. Crawford, to somebody who is having these experiences but also having these concerns?
LC: It’s lovely to get a chance to speak to individuals directly. One of the biggest things I think is important to talk about with eating disorders is that it’s often hard to reach out and get help. There is a lot of stigma around eating disorders. Sometimes the eating disorder can feel like it’s helping solve problems. It’s what we call in the in the medical world egosyntonic, which means that it’s acting like it’s helping you solve all your problems when really, the eating disorder is something that is a maladaptive coping mechanism.
When you are thinking about reaching out and getting help, it feels scary, because it feels like you’re giving up an important coping mechanism or something that has helped you in the past to manage feelings, physiology, or whatever it might be. It’s important to know that there are tools and skills that can help you not just manage without it but thrive without it. And you can do that with the help of a team. If you trust them, and you go in, and you understand that there are people who are really trained well to help people thrive when they start to let go of their eating disorder behaviors and some of those symptoms. The anxiety, depression, or some of the other feelings that are alongside the eating disorder, it makes it a tricky thing to address. But there are people out there that are trained. That’s the main first thing that I want to say.
Second, importantly, is that eating disorders don’t have to look a certain way. All eating disorders look different. Your body doesn’t have to look a certain way, your behaviors don’t have to look a certain way, your feelings don’t have to look a certain way. If you are thinking that you might need some help or you want to talk to somebody about your relationship to food, something that we say in my day-to-day work here, is that you deserve help. You are “sick enough,” is what we say. You are in a state where you deserve help. If you want to have that conversation, then please do reach out. I know that it’s scary to do.
If you do want to go to a naturopathic doctor, it is important to have a conversation with them to make sure that they’re the right fit for having those conversations around your relationship with food. It’s a good thing to ask if they’ve worked with folks who have struggled with eating disorders or disordered eating before. There are some formal trainings that doctors and other practitioners can have, such as the CEDS (letters after their name), that stands for Certified Eating Disorder Specialist. You can look for those letters, you can look for people that have done trainings through national organizations like NEDA, the National Eating Disorder Association. It’s good to look out for folks that have an understanding of what it takes to work with an eating disorder. All naturopathic doctors are trained and Board certified. But it helps to have somebody who might have had that experience to be really eating disorder informed (as we say). Thank you for that opportunity to speak directly to those folks. I think it’s always good to do.
ALB: We’re very happy to give you that opportunity. And I want to thank you, Dr. Crawford, for bringing our attention what is actually a very central issue in eating disorders: the fact that they can be a maladaptive coping mechanism. And I think that when family, friends, colleagues, neighbors and whatnot see somebody struggling with an eating disorder, it can be very mystifying to them to figure out what’s going on. Why they can’t just solve it, either eat or don’t eat? It seems so simple to them.
But when you frame it and think about it in that context, as far as that person is concerned, this is what’s getting them through life. This is the thing that’s actually helping them. Yet, at the same time, it can be so very, very destructive, both to an individual’s health and even to their relationships and those around them. I really appreciate you bringing us back to that very, very central and important point that it really is a maladaptive coping mechanism. Hopefully, that helps people understand someone that is suffering from these conditions a little bit better.
Dr. Crawford, there’s much more to say, but that is all the time we have for today. I want to thank you for taking us through this really, really complex topic and demystifying some of these key pieces for us. You’ve given us quite a good sense of what some of the potential root causes of eating disorders may be about what an integrative approach might look like. You’ve given us some great tips for those thinking of seeing a naturopathic doctor for disordered eating or an eating disorder. We have some great tips there. Now, listeners, you may be wondering where you can find a transcript of this interview and links to learn more about Dr. Crawford’s work. Please check out the podcast notes; it’s all there for you.
And Dr. Crawford, do you have any final thoughts to leave us with today?
LC: Just to tell folks that they deserve the care that a naturopath and other practitioners can give. You deserve care. That’s what I’d like to leave them with.
ALB: Well said. You deserve care. You deserve care. That’s the perfect place to end it. Everyone, thanks for joining us. Dr. Crawford, thanks for joining us as well, and we’ll see you next time!
LC: Thank you very much.