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Light Therapy for Eating Disorders

November 20, 2010 Written by JP    [Font too small?]

Fall is now officially upon us and the days are becoming shorter with hours of light now replaced with greater stretches of darkness. For some, this change of seasons is a time to rejoice. Many find beauty in the coral, crimson and golden colors adorning trees and relief from the sweltering heat of summer. However, others experience the crisp temperatures and dimmer lighting in a profoundly unsettling way. A form of depression known as seasonal affective disorder (SAD) is a very real phenomenon associated with a relative lack of sunshine. Other mental health conditions such as eating disorders can also be adversely affected by sparse bright light.

Bright light therapy or phototherapy is a treatment modality which exposes individuals to a full spectrum light source in an attempt to positively affect brain chemicals which are implicated in low mood states. The intensity of the lighting and the duration of the sessions vary according to the condition being treated and the equipment used. Light boxes emitting 10,000 lux often require half hour daily exposure. Whereas 2,500 lux light boxes may necessitate up to a two-hour time commitment. As a side note, it’s important to understand that bright light therapy can easily fit into your daily routine. For instance, you can set up a light box next to your home office and bask while reading a book or responding to email. (1)

The term “eating disorder” often conjures graphic images which are typically pejorative in nature. Since only a small fraction of the population is technically living with an eating disorder, I feel it’s important to define it. For the purpose of today’s column, an eating disorder represents any condition which is characterized by out-of-control behavior in relation to food – from anorexia nervosa to overeating. Based on my definition, chances are that you or someone close to you is dealing with this very type of situation to some degree or another.

The two eating disorders that have garnered the most attention over the last several decades are anorexia nervosa and bulimia nervosa. In the most general terms, the former involves various manifestations of restrictive eating and weight manipulation which can ultimately lead to severe health consequences and starvation. The latter is frequently marked by a pattern of food denial alternating with binging and destructive weight control measures (excessive exercise, laxative abuse, purging).

Both anorexia and bulimia appear to respond to bright light therapy. Researchers believe that strategically applying bright light in those with eating disorders may help normalize the circadian rhythm and, thereby, improve mood and pathological eating patterns influenced by this sleep-wake cycle. This theory is bolstered by successful case studies involving light therapy in patients with atypical eating disorders that tend to worsen during the winter months. (2,3)

A new paper appearing in the November 2010 issue of the Journal of Affective Disorders reports that 6 weeks worth of bright light therapy significantly improved depression scores in young women with anorexia nervosa. A total of 24 participants were randomized to receive one of two treatments: a) cognitive behavioral therapy or; b) cognitive behavioral therapy + bright light therapy. Improvements in body weight were evidenced in both groups. However, the young women receiving both therapies demonstrated increases in body weight earlier than the cognitive behavioral therapy only group. This current study is supported by a previous “pilot” trial which found that as little as five 30 minute sessions of bright light therapy (using a 10,000 lux lamp) resulted in “a slight improvement on core eating pathology, a fair decrease of depressive symptoms and a clinically important improvement on global distress”. (4,5)

Some research indicates that bulimic symptoms peak during the fall and winter months. Thus far, two studies have been conducted to evaluate the relative efficacy of light therapy in bulimic patients. In the latest trial, bright light (2,500 lux) was deemed more effective than a placebo (dim light < 500 lux) in terms of improving depressed mood in a group of 47 bulimic adults. A separate crossover study involving 18 bulimic women used a brighter light box (10,000 lux for 30 minutes/day) over a two week period in comparison to dim red light exposure (500 lux for 30 minutes/day). According to researchers from the Department of Psychiatry at the University of British Columbia, “the bright light condition was superior to the dim red light condition for all mood and eating outcome measures”. A special notation in the paper explains that the those with “seasonal” bulimia were more likely to respond to bright light therapy than those with “nonseasonal” bulimia. (6,7,8)

Night Eating Syndrome (NES) Increases Caloric Consumption in the PM Hours
Source: Eat Behav. 2008 August; 9(3): 343ā€“351. (link)

Night eating syndrome (NES) is characterized by overeating in the evening and night time. It is believed to be a widespread contributing factor in the current obesity epidemic. Researchers from the University of Pennsylvania School of Medicine have uncovered a link between “a delayed circadian pattern of food intake” in these patients while still maintaining a normal sleep-wake cycle. In physiological terms, men and women with NES demonstrate abnormal levels and release of various hormones related to hunger and weight including cortisol, ghrelin, insulin and leptin. Studies have yet been conducted to establish whether bright light therapy can help reset the unnatural eating pattern and accompanying biological response to food in those with NES. Such studies are currently being urged by experts in the field. In the meantime, I’ve discovered a few tantalizing clues that may fill in some of the missing pieces to this puzzle: 1) a Japanese study from 2003 explains that a lack of bright light during the day can impair the digestion of the evening meal; 2) the current issue of the Nutrition Journal features a study that reveals that eating nutrient dense foods can reduce levels of “toxic hunger” more efficiently than unhealthy foods that contain more calories. If you put these two details together, one could hypothesize that NES may be exacerbated by the poor absorption of nutrients at dinner which may then lead to overeating to compensate for the lack of nutrition. Assuming this is accurate, the solution may be as simple as using bright light therapy and emphasizing a whole food diet. (9,10,11)

If some of you still feel left out by the previously mentioned content, take heart. The medical literature also contains several studies that indicate that bright light therapy may be a good adjunct to conventional weight loss techniques. This, of course, depends on your natural exposure to bright light in the first place. So if by chance you don’t get out in the sunshine very often, know this: the combination of bright light treatment and exercise has been shown to improve body composition and health via a reduction in visceral fat beyond what is expected using exercise alone. Phototherapy may also curtail carbohydrate cravings by positively modulating the melatonin-serotonin system. This is yet another reason to consider this non-invasive and non-pharmaceutical option to support both body and mind. (12,13,14)

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

Be well!


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Posted in Alternative Therapies, Diet and Weight Loss, Mental Health

14 Comments & Updates to “Light Therapy for Eating Disorders”

  1. Danny Dave Says:

    Great post, fresh information for me. So, how is phototherapy executed?

  2. anne h Says:

    For many many years, I would get up and eat in the night.
    It might have been ulcers…. or just hunger….. or being cold….
    And it might have been SAD.

  3. JP Says:


    Phototherapy is just another term for bright light therapy. Typically, you sit in near proximity to a “box” that emits an unusually bright, full spectrum light for a designated amount of time. This should be done on a regular basis and is often adjusted based on external/outdoor light availability and exposure.


    Be well!


  4. JP Says:


    Perhaps so. Possibly even undiagnosed NES?

    I’m glad that phase of your life is over. šŸ™‚

    Be well!


  5. Mallory Says:

    awesome post….. for ‘years’ i have spent my springs and summers gung ho on the recovery bandwagon exerting all my strength and emotion in recovery from anorexia, both mental and physical. switching to primal this past spring has led me to the biggest mental and physical gains i have accomplished by myself with no help in 6 years.
    there is something about cold weather and lack of sunlight that just makes me feel like i lose everything, go crazy. its nothing vitamind D supps can help either.every winter i seem to hibernate from an active recovery and let to much mental s*** slide. this leads to physical c*** slipping and come spring i need to do it all over again.

    i think CBT is a good concept, but it needs no doctor to be performed. real recovery comes from real strength, real acceptance and real release of a disordered will power and self control. you dont need a doctor to tell you which thoughts are disordered, a sufferer knows good days from bad days.

    the light therapy is interesting. for me, i just hate cold, everything about it and that comes with it. spending a day in the sun literally makes me feel like im on top of the world and nothing can stop me. i have never tried any light therapy but it sounds promising.

    recovery happens when and only when it is coupled with an accepting attitude, until then, the sufferer will be up and down and up and down never really recovering, but suffering the ability to be an ‘active in life eating disordered individual’. there are MANY people who can live their day to day lives in a good manner but still be a mess inside- this is what i try to show people with my blog and recovery….that there is a difference in an active anorexic and a recovered anorexic

  6. JP Says:

    Many thanks for your insightful post, Mallory. It’s much appreciated! šŸ™‚

    Be well!


  7. JP Says:

    Update 06/15/16:


    Int J Eat Disord. 2015 Jun 6.

    Mindfulness-based prevention for eating disorders: A school-based cluster randomized controlled study.

    OBJECTIVE: Successful prevention of eating disorders represents an important goal due to damaging long-term impacts on health and well-being, modest treatment outcomes, and low treatment seeking among individuals at risk. Mindfulness-based approaches have received early support in the treatment of eating disorders, but have not been evaluated as a prevention strategy. This study aimed to assess the feasibility, acceptability, and efficacy of a novel mindfulness-based intervention for reducing the risk of eating disorders among adolescent females, under both optimal (trained facilitator) and task-shifted (non-expert facilitator) conditions.

    METHOD: A school-based cluster randomized controlled trial was conducted in which 19 classes of adolescent girls (Nā€‰=ā€‰347) were allocated to a three-session mindfulness-based intervention, dissonance-based intervention, or classes as usual control. A subset of classes (N = 156) receiving expert facilitation were analyzed separately as a proxy for delivery under optimal conditions.

    RESULTS: Task-shifted facilitation showed no significant intervention effects across outcomes. Under optimal facilitation, students receiving mindfulness demonstrated significant reductions in weight and shape concern, dietary restraint, thin-ideal internalization, eating disorder symptoms, and psychosocial impairment relative to control by 6-month follow-up. Students receiving dissonance showed significant reductions in socio-cultural pressures. There were no statistically significant differences between the two interventions. Moderate intervention acceptability was reported by both students and teaching staff.

    DISCUSSION: Findings show promise for the application of mindfulness in the prevention of eating disorders; however, further work is required to increase both impact and acceptability, and to enable successful outcomes when delivered by less expert providers.

    Be well!


  8. JP Says:

    Update 06/15/16:


    Psychiatr Pol. 2013 Nov-Dec;47(6):1113-22.

    [Light therapy as a treatment for sexual dysfunctions–beyond a pilot study].

    OBJECTIVES: Seasonal trends were demonstrated in reproduction and sexual activity. Through the secretion ofmelatonin the pineal gland plays an important role in the neuroendocrine control of sexual function and reproductive physiology. We hypothesized that inhibition of the pineal gland activity through a light treatment may favorably affect sexual function.

    METHODS: We recruited 24 subjects with a diagnosis of hypoactive sexual desire disorder and/or primary sexual arousal disorder. The subjects were randomly assigned to either active light treatment (ALT) or placebo light treatment (L-PBO). Participants were assessed during the first evaluation and after 2 weeks of treatment, using the Structured Clinical Interview for Sexual Disorders DSM-IV (SCID-S) and a self-administered rating scale of the level of sexual satisfaction (1 to 10). Repeated ANOVA measures were performed to compare the two groups of patients. Post-hoc analysis was performed by Holm-Sidak test for repeated comparisons. Results. At baseline the two groups were comparable. After 2 weeks the group treated with Light Therapy showed a significant improvement in sexual satisfaction, about 3 times higher than the group that received placebo, while no significant improvement was observed in the group L-PBO. Conclusions. Our results confirm a potentially beneficial effect of Light Therapy on primary sexual dysfunction. In the future, we propose to correlate clinical findings with testosterone levels pre/post treatment.

    Be well!


  9. JP Says:

    Updated 1/1/16:


    J Eat Disord. 2015 Dec 30;3:50.

    The role of music therapy in reducing post meal related anxiety for patients with anorexia nervosa.

    BACKGROUND: It is well known that mealtime is anxiety provoking for patients with Anorexia Nervosa. However, there is little research into effective interventions for reducing meal related anxiety in an inpatient setting.

    METHODS: This study compared the levels of distress and anxiety of patients with Anorexia Nervosa pre and post music therapy, in comparison to standard post meal support therapy. Data was collected using the Subjective Units of Distress (SUDS) scale which was administered pre and post each condition.

    RESULTS: A total of 89 intervention and 84 control sessions were recorded. Results from an unpaired t-test analysis indicated statistically significant differences between the music therapy and supported meal conditions.

    CONCLUSIONS: Results indicated that participation in music therapy significantly decreases post meal related anxiety and distress in comparison to standard post meal support therapy. This research provides support for the use of music therapy in this setting as an effective clinical intervention in reducing meal related anxiety.

    Be well!


  10. JP Says:

    Updated 03/30/16:


    Eat Behav. 2016 Mar 6;21:179-188.

    The role of complementary and alternative medicine in the treatment of eating disorders: A systematic review.

    This systematic review critically appraises the role of complementary and alternative medicine in the treatment of those with an eating disorder. Sixteen studies were included in the review. The results of this review show that the role of complementary and alternative medicine in the treatment of those with an eating disorder is unclear and further studies should be conducted. A potential role was found for massage and bright light therapy for depression in those with Bulimia Nervosa and a potential role for acupuncture and relaxation therapy, in the treatment of State Anxiety, for those with an eating disorder. The role of these complementary therapies in treating eating disorders should only be provided as an adjunctive treatment only.

    Be well!


  11. JP Says:

    Updated 10/11/16:


    Eat Disord. 2016 Oct 10:1-15.

    Yoga in the treatment of eating disorders within a residential program: A randomized controlled trial.

    To investigate the effect of yoga on negative affect (an eating disorders risk factor), 38 individuals in a residential eating disorder treatment program were randomized to a control or yoga intervention: 1 hour of yoga before dinner for 5 days. Negative affect was assessed pre- and post-meal. Mixed-effects models compared negative affect between groups during the intervention period. Yoga significantly reduced pre-meal negative affect compared to treatment as usual; however, the effect was attenuated post-meal. Many eating disorders programs incorporate yoga into treatment. This preliminary evidence sets the stage for larger studies examining yoga and eating disorder treatment and prevention.

    Be well!


  12. JP Says:

    Updated 12/20/16:


    J Eat Disord. 2016 Dec 9;4:38.

    Use of yoga in outpatient eating disorder treatment: a pilot study.

    BACKGROUND: Individuals with restrictive eating disorders present with co-morbid psychiatric disorders and many attempt to control symptoms using strenuous exercises that increase caloric expenditure. Yoga offers a safe avenue for the engagement in physical activity while providing an outlet for disease-associated symptoms. This study sought to examine use of yoga practice in an outpatient setting and its impact on anxiety, depression and body image disturbance in adolescents with eating disorders.

    METHODS: Twenty adolescent girls were recruited from an urban eating disorders clinic who participated in weekly yoga classes at a local studio, in addition to standard multidisciplinary care. Yoga instructors underwent training regarding this patient population. Participants completed questionnaires focused on anxiety, depression and body image disturbance prior to the first class, and following completion of 6 and 12 classes.

    RESULTS: In participants who completed the study, a statistically significant decrease in anxiety, depression, and body image disturbance was seen, including: Spielberger State anxiety mean scores decreased after the completion of 7-12 yoga classes [47 (95%CI 42-52) to 42 (95%CI 37-47), adj. pā€‰=ā€‰0.0316]; as did the anorexia nervosa scale [10 (95% CI 7-12) vs. 6 (95%CI 4-8), adj. pā€‰=ā€‰.0004], scores on Beck depression scales [18 (95%CI 15-22) to 10 (95%CI 6-14), adj. pā€‰=ā€‰.0001], and weight and shape concern scores [16 (95%CI 12-20) to 12 (95%CI 8-16), adj. pā€‰=0.0120] and [31 (95%CI 25-37) to 20 (95%CI 13-27), adj. pā€‰=ā€‰0.0034], respectively. No significant changes in body mass index were seen throughout the trial.

    CONCLUSIONS: Yoga practice combined with outpatient eating disorder treatment were shown to decrease anxiety, depression, and body image disturbance without negatively impacting weight. These preliminary results suggest yoga to be a promising adjunct treatment strategy, along with standard multidisciplinary care. However, whether yoga should be endorsed as a standard component of outpatient eating disorder treatment merits further study.

    Be well!


  13. JP Says:

    Updated 04/07/17:


    Clin Nutr ESPEN. 2017 Feb;17:100-104.

    Ghrelin activation and neuropeptide Y elevation in response to medium chain triglyceride administration in anorexia nervosa patients.

    BACKGROUND & AIMS: Ghrelin, a peptide found in the stomach, increases appetite and fat-free mass while suppressing energy expenditure. Ghrelin requires modification by medium-chain triglycerides (MCTs) to exert its physiological effects. In this study, we investigated ghrelin activation and the resulting physiological changes following MCT administration.

    METHODS: Thirty participants were selected from among inpatients diagnosed with anorexia nervosa (AN). The patients were randomly divided into three groups by the MCT content of their nutritional supplement: (1) ‘MCT high’ (>6 g/day), (2) ‘MCT moderate’ (1-6 g/day), and (3) ‘MCT low’ (<1 g/day). Physical factors such as body weight and composition, as well as levels of nutrition-related serum factors such as acylated (active form) and desacyl (inactive form) ghrelin, leptin, growth hormone, insulin-like growth factor, and neuropeptide Y (NPY) were measured at weeks 0, 2, 4, and 6 of the treatment protocol.

    RESULTS: Significantly higher ghrelin activation was found in the 'MCT high' than in the 'MCT low' group (P < 0.05). The amount of consumed MCT had a curvilinear relationship with the active ghrelin level (P = 0.00). NPY levels in the 'MCT high' group were significantly more elevated than in the 'MCT low' group (P < 0.05). MCT administration did not significantly affect the remaining factors. CONCLUSIONS: This study clearly demonstrated that MCT activates ghrelin and increases NPY, suggesting that nutritional supplementation with MCT may be effective for the treatment of AN patients in an emaciated state. Be well! JP

  14. JP Says:

    Updated 06/22/17:


    PLoS One. 2017 Jun 21;12(6):e0179739.

    Microbiota in anorexia nervosa: The triangle between bacterial species, metabolites and psychological tests.

    Anorexia nervosa (AN) is a psychiatric disease with devastating physical consequences, with a pathophysiological mechanism still to be elucidated. Metagenomic studies on anorexia nervosa have revealed profound gut microbiome perturbations as a possible environmental factor involved in the disease. In this study we performed a comprehensive analysis integrating data on gut microbiota with clinical, anthropometric and psychological traits to gain new insight in the pathophysiology of AN. Fifteen AN women were compared with fifteen age-, sex- and ethnicity-matched healthy controls. AN diet was characterized by a significant lower energy intake, but macronutrient analysis highlighted a restriction only in fats and carbohydrates consumption. Next generation sequencing showed that AN intestinal microbiota was significantly affected at every taxonomic level, showing a significant increase of Enterobacteriaceae, and of the archeon Methanobrevibacter smithii compared with healthy controls. On the contrary, the genera Roseburia, Ruminococcus and Clostridium, were depleted, in line with the observed reduction in AN of total short chain fatty acids, butyrate, and propionate. Butyrate concentrations inversely correlated with anxiety levels, whereas propionate directly correlated with insulin levels and with the relative abundance of Roseburia inulinivorans, a known propionate producer. BMI represented the best predictive value for gut dysbiosis and metabolic alterations, showing a negative correlation with Bacteroides uniformis (microbiota), with alanine aminotransferase (liver function), and with psychopathological scores (obsession-compulsion, anxiety, and depression), and a positive correlation with white blood cells count. In conclusion, our findings corroborate the hypothesis that the gut dysbiosis could take part in the AN neurobiology, in particular in sustaining the persistence of alterations that eventually result in relapses after renourishment and psychological therapy, but causality still needs to be proven.

    Be well!


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