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circumstances. Binge eating is followed by purging—self-induced vomiting and the misuse of diuretics, laxatives, emetics, and enemas—or by other compensatory behaviors such as severe caloric restriction, excessive exercising, or the use of diet pills. People with bulimia are usually within a normal weight range and are aware that their eating patterns are abnormal. However, bulimic people may express a lack of control over the eating. They often experience fear of not being able to stop eating and experience depression, guilt, and remorse after a binge. In addition, bulimia tends to occur in combination with other psychiatric disorders such as depression, obsessive-compulsive disorder, substance abuse, and self-injurious behavior. Clinical symptoms of bulimia include possible tooth erosion, calloused knuckles, swollen parotid (salivary) glands, broken blood vessels in the eyes or face, stomach lacerations, and esophageal and sinus infections resulting from excessive vomiting. Electrolyte imbalances lead to muscle weakness and cramps, abnormal heart rhythms, cardiac complications, and, occasionally, suddendeath. Proper treatment for bulimia, like that for anorexia nervosa, is multidisciplinary. Psychological counseling and therapy are necessary. Nutritional goals include improving dietary intake to correct nutritional deficiencies and electrolyte imbalances, and cessation of binge-purgebehavior with reestablishment of normal eating patterns. Binge-Eating Disorder - Binge-eating disorder is a disorder sometimes referred to as compulsive overeating. Some authorities believe that this is the most common eating disorder, affecting millions of Americans. Binge-eating disorder is characterized by frequent, recurrent episodes of binge eating; that is, eating a larger amount of food than normal during a short
period of time. People with a binge-eating disorder often report a feeling of lack of control over eating during the binge episode. Unlike bulimia nervosa, binge-eating disorder is not associated with purging or inappropriate compensatory behavior. Many people with binge-eating disorder are obese. Encourage them to consider treatment that focuses on their binge-eating behavior before they attempt to lose weight. Treatment typically includes some combination of cognitive-behavioral therapy, interpersonal psychotherapy, antidepressants, and self-help groups. Carbohydrate-Modified Diets - Diabetes Mellitus Carbohydrate-modified diets are most often used in the treatment of diabetes mellitus. Diabetes mellitus is a disease in which the body does not produce or properly use insulin. Insulin is a hormone that is needed to convert sugar, starches, and other food into the energy needed for daily life. The cause of diabetes is unknown, although both genetics and environmental factors such as obesity and lack of exercise appear to play a role. There are two major types of diabetes mellitus. Type 1 diabetes mellitus, most often diagnosed in children and young adults, is a disease in which the body does not produce any insulin (hormone produced by the pancreas needed to utilize glucose). People with type 1