Alva Review-Courier -

MADISON, Wis. (AP) — On one of the last nights before he died, Max Briles treated himself to part of a cucumber.

He figured it had 20 calories, which would keep his total below 1,000 for the day, less than half of what health officials say an adult male should eat, the Wisconsin State Journal (http://bit.ly/2jyYEhs ) reported.

"It did seem to increase water weight, but it was totally worth it," Briles wrote in his journal.

Briles, 26, of Madison, died in October, at least in part from anorexia nervosa, an eating disorder in which people starve themselves because they fear gaining weight even though they are thin.

His parents encouraged him to get treatment, but he refused.

"I'll be the only guy," he said, according to his mother, Becky Briles.

Anorexia and other eating disorders, often perceived as female conditions, also affect men, said Dr. Brad Smith, medical director of eating disorder services at Rogers Memorial Hospital, a behavioral health care system based in Oconomowoc.

Men are more reluctant than women to discuss any kind of mental health problem, but the challenge is even greater with eating disorders because they are characterized as female, Smith said.

"It adds to the stigma for a man or boy to come forward," he said. "If a man does seek treatment, his introduction to treatment services may be in a setting where he is the only male."

Rogers has an eating disorders program designed for men, but some programs around the country accept only women, Smith said.

About 25 percent of people with anorexia and bulimia are male, as are about 36 percent of those with binge eating disorder, according to the National Eating Disorders Association. Binge eating disorder involves eating large quantities of food recurrently, while bulimia is defined by binging and purging through vomiting, fasting or exercise.

The estimates of men with eating disorders are likely low, Smith said. One reason is that questionnaires used to diagnose anorexia focus on attaining a certain weight or size of clothes, expectations that resonate more with women than men, he said.

With men, "there's more of a concern about the percentage of body fat," he said.

Gay men, and men who do sports that require weight control, such as wrestling and boxing, are somewhat more prone to eating disorders than other men, Smith said.

Men and women with anorexia face similar physical complications, such as irregular heartbeats and digestive problems, Smith said. Men often see a reduction in sex drive because their testosterone levels drop.

The message for anyone with an eating disorder is the same, regardless of gender, Smith said: "Treatment is available, and the earlier we can get people into treatment, the more likely they can have success."

Becky Briles found her son dead in his home Oct. 11, after she and her husband, David, had been out of town a couple of days.

Max lived about a mile from his parents' house on Madison's West Side.

An investigator from the Dane County Medical Examiner's Office told the family Max died a few days earlier, perhaps on Oct. 6.

An autopsy found that he had heart damage typical of anorexia, Becky and David Briles said.

At 5 feet 7 inches, Max weighed just under 100 pounds. It's possible drug use may have contributed to his death; toxicology results, and the official cause of death, are pending.

The Brileses agreed to talk about their son's struggle with anorexia to raise awareness about eating disorders in men. Even though Max didn't seek help for his condition, he acknowledged he had it and was frustrated that most information about it focused on women, they said.

He was a "self-proclaimed anorexic," obsessed with whether he looked fat and fixated on calorie intake and digestion, Becky Briles said.

"He could tell you off the top of his head how many calories are in a spoonful of this or that," David Briles said.

"He had to know where the food was in his body," his father said. "If it was still in his stomach, but it should have been moving down to his small intestine, we'd get a phone call. He'd say, 'Something is wrong.'"

After a seemingly happy early childhood, Max developed facial and vocal tics in third or fourth grade. His parents, Madison School District teachers who are now retired, sought help.

Max was diagnosed with anxiety and later with depression. Despite therapy and medications, he acted out in school and was expelled.

He graduated in 2008 from Shabazz City High School, a Madison alternative school.

Afterward, he had a hard time finding his way, his parents said. He got jobs at a grocery store, a pet store, a pizza restaurant and a delivery service, but he promptly quit them or was fired because he couldn't abide by rules such as reporting to work at a certain time.

He lived in an apartment but couldn't adjust to people's noise, the Brileses said.

In 2012, he went on disability, for anxiety and depression, conditions for which he was being treated. A year later, his parents bought him a small house.

Max became preoccupied by food and his weight. He wrote daily calorie allowances on his arms. He limited himself at times to pinto beans, Jell-O and lettuce. When cooking, he had to use a particular measuring cup because he thought other cups were inaccurate.

He did push-ups and crunches over and over again, and lifted small amounts of weight in repetition, in order to become stronger but not larger, his father said.

David Briles realized the extent of the problem in 2012, on a road trip with Max up the California and Oregon coast.

Max refused to eat in restaurants, insisting that they buy cereal, soy milk and fruit from grocery stores and eat in their hotel rooms.

"It was taking over his life," said David Briles, 66.

Becky Briles had no trouble spotting the symptoms of anorexia. She had the disorder herself, in middle school, when her weight dropped to 67 pounds. Her sister and aunt had it, too, she said.

When a doctor told her mother that Becky might not be able to have children if she remained abnormally thin, she started to recover.

She and David had two children, including a boy born two years after Max who died at 3 months from a heart defect.

Today, Becky, 62, is a marathon runner. At just over 5 feet tall, she weighs a healthy 110 pounds.

"It's so hard to suffer from (anorexia)," she said. "It's prison for the person who has it."

As malnutrition took a toll on Max's body, he became cold even in summer and so weak he could no longer ride his bicycle, his parents said. He mostly stayed at home and watched movies.

"He didn't want to go anywhere because of how he looked," David Briles said. "He thought he looked too fat."

The degree to which food ruled Max's life is clear from his journal.

"Lose water weight daily — eat beans and jello," he wrote in April.

"Eat one meal (a day) always," he wrote two weeks later.

In June: "I'm the skinniest I've ever been in my entire life."

Undated: "This hunger is unbearable and is what causes the binging behavior. Go back downstairs and eat a few carrots, corn, celery, just keep it under 50 calories."

On Oct. 2, he said a friend had visited the night before. Max had eaten a "ton" of food. "Back to 800-1,000 (calories) a day," he wrote.

The following day, after abiding by his strict diet, he rewarded himself with the bit of cucumber.

His last entry came on the night of Oct. 6. He had just woken up, he wrote, and couldn't recall what had happened earlier that day. He mentioned making popcorn.

His last words: "The bean soup meal is fully prepared."