may exist, just as post-viral fatigue syndrome (M.E.) may exist, but there are times when individual patients are utterly convinced that they have one - or even all - of these problemswhen there is no evidence for that. Fortunately there are specific tests that can be done, such as blood tests to assess the total level of immunoglobulins and the specific responses to individual food substances and other potential allergens, gut fermentation tests to assess the possibility of intestinal candidiasis, and blood tests assessing the level of reaction to the Epstein Bur virus and also other viral tests when assessing post-viral fatigue syndrome (Myalgic Encephalopathy: M.E.). These three clinical conditions - food allergies, intestinal candidiasis and M.E. - are what I term "band-wagon" illnesses: they may genuinely affect some people but a lot of other patients may jump on the band-wagon in trying to make out that they themselves are special and different from the general population in these particular clinical respects. Their beliefs tend not to be substantiated by the proper clinical tests. The validity of these tests may be questioned but at least they provide some measure of scientific objectivity to counter the almost religious fervour with which patients may ding to these diagnoses.

Our experience at PROMIS is that patients may come in to treatment with all sorts of reasons why they cannot eat this or that but, by the time they leave treatment, they have switched their focus of attention to themselves rather than what is on the plate. Some foods, such as salt and spices, are stimulants of the appetite. They can be used safely in cooking for patients with eating disorders but, as a general principle, they should not be added to food afterwards. Patients at the anorexic end of the eating disorder spectrum will at times try to flood their taste buds with salt or spices so that they get stimulus overload and hence turn on the satiety centre in the brain and switch off the appetite centre.

Once stimulated, the appetite centre in the brain tends to stay active for about twenty minutes. It is for this reason that patients of PROMIS are advised not to have any snacks between meals. If they feel hungry they should have a drink of water or milk or freshly squeezed fruit juice (other fruit juices often have a significant sugar content as preservatives even though the labels on the packets may describe them as being "sugar free"). For the same reason we advise patients who come from the compulsive overeating or bulimic end of the eating disorder spectrum to eat slowly so that a meal lasts at least twenty minutes. Otherwise they may bolt down a large quantity of food but still feel hungry. The exercise that we sometimes do on "gentle" eating, in which patients chew each mouthful to liquid before swallowing, demonstrates that the appetite centre reacts to time rather than quantity of food. Patients doing this exercise find that they are no longer hungry after twenty minutes even though they may have consumed much less than they would normally eat.

Canapes and other "cocktail" foods served before the main meal can be a disaster area for patients with eating disorders since they may stimulate a binge because of their high salt content. They also tend to prolong the meal beyond the twenty minutes of activity of the appetite centre so that, by the time they get to the meal itself, eating disorder patients are no longer eating to satisfy hunger, which is precisely what