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Eating Disorders

Introduction

What should I know about Eating Disorders?

It has only been during the past couple of decades that we, as a culture, have discussed and addressed eating disorders. The two eating disorders discussed most often are anorexia nervosa and bulimia. Anorexia nervosa has been defined as a serious eating disorder primarily affecting young women in their teens and early twenties, that is characterized especially by an intense fear of weight gain leading to faulty eating patterns, malnutrition, and usually excessive weight loss. Bulimia nervosa has been defined as a serious eating disorder that occurs chiefly in females, characterized by overeating, usually followed by self-induced vomiting, or laxative or diuretic abuse, and is often accompanied by guilt and depression. (1)

In addition to anorexia and bulimia, the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), includes the diagnosis of eating disorders not otherwise specified (NOS). (2) Individuals with eating disorders in this category manifest symptoms of eating disorders, but do not meet the diagnostic criteria for a specific eating disorder.

Understanding these disorders is difficult due to the many physiologic, biochemical, developmental, psychological, and psychiatric phenomena associated with them. It is difficult to determine whether some biologic changes are causing the eating disorder, or whether the changes are a result of abnormal eating patterns and eventual starvation.

The medical community has not yet concluded the absolute cause for eating disorders, however there are theories which have gained attention. Abnormalities of the hypothalamic-pituitary-adrenal (HPA), hypothalamic-pituitary-gonadal (HPG), and hypothalamic-pituitary-thyroid (HPT) axes have been described as potential causes of anorexia nervosa. (3) Although many abnormalities in the endocrine systems occur in other forms of starvation, the difference is that in anorexia nervosa, the dysfunction may not improve when weight returns to normal. The role of neurotransmitters has also been extensively investigated, particularly serotonin, as it plays an important role in eating. Norepinephrine has a role in the increase or decrease of hunger sensations, and dopamine may play a part in the self-stimulatory behavior of eating binges in bulimia.

The greatest emphasis, however, is placed on psychological and developmental issues in understanding the origin and cause of eating disorders, especially regarding the role of family. Some of the personal issues that may be involved include family separations, losses, and dysfunction. These may trigger abnormal eating behavior. (4) , (5) Whether family-related issues are a cause for eating disorders remains controversial. It is interesting, however, to note that the prognosis is better in persons with a relatively healthy family environment. (6)

Other groups at risk for the development of eating disorders are those with a history of physical and sexual abuse. Also at risk are athletes, particularly female gymnasts, figure skaters, distance runners, and swimmers. Male wrestlers and body builders are included in this risk category as well.

Researchers have determined that up to 68 percent of individuals treated for an eating disorder also have a primary mood disorder. (7) The course of anorexia nervosa most commonly consists of a single episode with a subsequent return to normal weight. Some individuals may experience an unremitting course leading to death, or repeated periods of anorexic behavior. (8) A recent study found that 50 percent of patients had a "good" outcome, 30 percent a "medium" outcome, and 20 percent a "poor" outcome. (9) Long-term follow-up studies have demonstrated that between 10-18 percent of anorexic patients eventually died, primarily from cardiac arrest or suicide.

The medical consequences of eating disorders are vast and are related primarily to self-induced starvation. Patients often have vague complaints of lethargy and pain. In addition, there are metabolic and electrolyte imbalances, and dehydration occurs due to poor dietary intake or induced vomiting, and overuse of laxatives or diuretics. Severe electrolyte disturbances can cause cardiac abnormalities and even sudden death. Possible long-term complications include osteoporosis and infertility. Dental problems are often seen in patients who induce vomiting, including erosion of the enamel and staining of teeth.

Statistic

The Alliance for Eating Disorder Awareness, 2002.

  • Approximately 70 million individuals worldwide struggle with eating disorders.

National Institutes for Health, Eating Disorders NIH Publication No. 99-4584.

    The 3 main types of eating disorders are anorexia nervosa, bulimia nervosa, and binge-eating disorder. Females are much more likely than males to develop an eating disorder. In their lifetime, an estimated 0.5 to 3.7 percent of females suffer from anorexia and an estimated 1.1 to 4.2 percent suffer from bulimia. Community surveys have estimated that between 2 and 5 percent of Americans experience binge-eating disorder in a 6-month period. The mortality rate among people with anorexia has been estimated at 0.56 percent per year, or approximately 5.6 percent per decade, which is about 12 times higher than the annual death rate due to all causes of death among female ages 15-24 in the general population.

United States Department of Health and Human Services, 2003.

    Research shows that more than 90 percent of those who have eating disorders are women between the ages of 12 and 25. However, increasing numbers of older women and men have these disorders. In addition, hundreds of thousands of boys are affected by these disorders.

Signs and Symptoms

The following list does not insure the presence of this health condition. Please see the text and your healthcare professional for more information.

Anorexia consists of several characteristics that must be present in order to be diagnosed with this eating disorder. These symptoms include the following:

    Unrealistic fear of becoming fat, even if already underweight Excessive dieting and exercise or other efforts to lose weight such as water pills or diuretics, laxatives, and enemas Too much weight loss A failure to gain weight in a period of growth Absence of menstrual periods for three or more consecutive months Mind is on food, calories, and food preparation much of the time
The course of anorexia nervosa most commonly consists of a single episode with the patient eventually returning to normal weight. Some patients may experience a disease course of multiple periods of anorexic behavior that may eventually lead to death. A recent study found that 50% of patients had a “good" outcome, 30% a “medium" outcome, and 20% a “poor" outcome. (10) Long term follow-up studies have demonstrated that between 10-18% of anorexic patients eventually died, mainly from heart problems or suicide. There are subtypes of anorexia that are based on binge-eating or purging behavior. Other medical conditions can exist with eating disorders. As many as 68% of these patients have been treated for a mood disorder. (11)

Bulimia nervosa is also included in this discussion since the two disorders occur together in 30-64% of patients, and some patients alternate between the two disorders. The characteristics of bulimia include:

    Unrealistic fear of becoming fat Episodes of binge eating (eating an amount of food that is larger than what people would normally consume in the same period of time) Feeling of lack of control over eating during the binge Self-induced vomiting or using laxatives or other medications to counteract the binge Sometimes other behaviors include excessive exercise, excessive dieting, or fasting
In addition to the medical diagnostic criteria already listed, there are many other signs to watch for in patients with eating disorders. The medical consequences of eating disorders can be extensive. Patients often have vague complaints of lethargy, fatigue, and pain. In addition, metabolic and electrolyte imbalances and dehydration can result due to poor diet, induced vomiting, or overuse of laxatives or diuretics. Severe electrolyte disturbances can cause heart problems and even sudden death. Starvation can also have adverse effects on hormone production, thyroid function, and adrenal function. (12) Possible long-term complications include osteoporosis and infertility. Dental problems are often seen in patients who induce vomiting, including erosion of the enamel and staining of teeth.

Anorexia

  • Unrealistic fear of becoming fat, even if already underweight
  • Excessive dieting and exercise
  • Too much weight loss
  • A failure to gain weight in a period of growth
  • Absence of menstrual periods
  • Mind is on food, calories, and food preparation much of the time

Bulimia

  • Unrealistic fear of becoming fat
  • Episodes of binge eating (eating an amount of food that is larger than what people would normally consume in the same period of time)
  • Feeling of lack of control over eating during the binge
  • Self-induced vomiting or using laxatives or other medications to counteract the binge
  • Sometimes other behaviors include excessive exercise, excessive dieting, or fasting

Treatment Options

Conventional

Cognitive-behavioral therapy has emerged as the primary non-drug strategy in most eating disorder programs. Active patient participation is a must for success in such programs, especially since denial is a large component in most eating disorders. Approaches may differ, but the basic goal of treatment is to restore and maintain a health body weight and reestablish normal eating patterns, reduce distorted body image, improve associated psychological and physical problems, resolve contributory family problems, and prevent relapse. (13)

Drug therapy includes the use of antidepressants. Antidepressants in anorexia nervosa are intended to improve depression, anxiety, and obsessional thought patterns and promote weight gain, although benefit has not been demonstrated in all areas. (14) Careful selection of the appropriate antidepressant is important when the individual is underweight and is generally unhealthy.

Although antipsychotic agents were the first to be used in anorexia nervosa patients, experience has shown that these agents provide little benefit. Anorexia patients also seem to have a greater sensitivity to the adverse effects seen with antipsychotic drug use.

Bulimia is treated similarly to anorexia using antidepressants as first line agents. Fluoxetine is the only antidepressant with FDA approval for treatment of bulimia nervosa. Occasionally, anticonvulsants may be recommended for individuals with bulimia.

There are so many factors involved in addressing eating disorders that the treatment essentially becomes a team effort. The person who is suffering from anorexia or bulimia must become a working part of that team in order for treatment to be successful.

Nutritional Suplementation

General Nutrition: Diets of individuals with anorexia were found to be significantly lower in total energy, reflecting a disturbance in nutrient intake when data were compared to a normal population. Dietary intake of calcium, iron, thiamin, riboflavin, niacin, and ascorbic acid of anorectics were significantly lower than in normal subjects. (15) Another study reported that patients with anorexia nervosa are more likely to have elevated levels of total homocysteine, which is likely due to inadequate levels of vitamin B6, folic acid, and vitamin B12. In one study of 43 adolescent females with anorexia, 34% had elevated homocysteine levels and 53% had values in the high-normal range. (16)


Zinc

Zinc deficiency is known to reduce the ability to taste foods in both animals and humans and there is limited evidence that zinc deficiency also impairs the sense of smell in humans. (17) Many aspects of zinc deficiency-induced anorexia have been extensively studied in experimental animals and there is evidence suggesting that zinc deficiency may be involved with anorexia in humans. In addition to possibly being an initiating cause, zinc deficiency may also be an accelerating or exacerbating factor that may make the condition worse. (18) Low zinc levels are also common in childhood-onset anorexia nervosa. (19)

Herbal Suplementation


Rhodiola

Rhodiola has long been used in traditional folk medicine in China, Serbia, and the Carpathian Mountains of the Ukraine. In the former Soviet Union, it has long been used as an adaptogen, decreasing fatigue and increasing the body’s natural resistance to various stresses. In Siberia it is said that "those who drink rhodiola tea regularly will live more than 100 years."

Rhodiola seems to enhance the body's physical and mental work capacity and productivity, working to strengthen the nervous system, fight depression, enhance immunity, elevate the capacity for exercise, enhance memorization, improve energy levels, and possibly prolong the life span, all positive aspects of therapy when dealing with individuals with eating disorders. (20) In Siberia it was taken regularly especially during the cold and wet winters to prevent sickness. Rhodiola has been used by Russian scientists alone or in combination with antidepressants to enhance mental state and decrease the symptoms of SAD or Seasonal Affective Disorder common to Northern European countries.


St. John's Wort

St. John’s wort has gained a great deal of attention for its use in minor depression. Its popularity has stemmed from its extensive use by physicians in Europe as an agent of choice in the treatment of mild to moderate depression. As stated earlier, it is well published that eating disorders may be related to fluctuations in neuro-chemicals including serotonin and subsequent depression. (21) , (22)

There are a variety of studies which are claimed to support the use of St. John’s wort in treating depression. (23) , (24) , (25) Studies with St. John’s wort have centered around the use of a 0.3 percent hypericin content standardized extract at a dose of 300mg, three times a day. It is viewed as safe and effective in Europe and its monograph is part of the Commission E Monographs for herbal medicines in Europe.


Kava

Kava has been used for centuries by South Pacific natives. The root is used in the preparation of a recreational beverage known by a variety of local names (kava, yaqona, awa) and occupies a prominent position in the social, ceremonial, and daily life of Pacific island peoples as coffee or tea does in the Western cultures. In European phytomedicine, kava has long been used as a safe, effective treatment for mild anxiety states, nervous tension, muscular tension, and mild insomnia. (26) , (27) Studies have reported that kava preparations compare favorably to benzodiazepines in controlling symptoms of anxiety and minor depression, while increasing vigilance, sociability, memory, and reaction time. (28) , (29) Anxiety has been reported to contribute to eating disorders in susceptible individuals. (30)


Eleuthero, Siberian Ginseng

Eleuthero is a different genus than other popular ginsengs such as the American and Panax or Asian varieties. The use of eleuthero root dates back 2,000 years in the records of Chinese medicine. It was used for respiratory tract infections, as well as colds and influenza. (31) The Chinese also believed that eleuthero provided energy and vitality. In Russia, it was originally used by the Siberian people to increase physical performance and to increase the quality of life and decrease infections. Eleuthero has been studied extensively since the 1940's. The root has been found to have many adaptogenic benefits. (32) , (33) Eleuthero has been reported to increase stamina and endurance and protect the body systems against stress-induced illness. (34) , (35) It is rumored that Soviet Olympic athletes have used eleuthero successfully to enhance sports performance and concentration.

Eleuthero root is frequently prescribed in Europe and Russia as an herbal "tonic," improving immune function and general well-being. It has been classified as an "adaptogen," meaning a substance that increases nonspecific resistance of the body to a wide range of chemical, physical, psychological, and biological factors (stressors). Adaptogens have the unique ability to switch from stimulating to sedating effects based on the body's needs. According to tradition and the literature, eleuthero possesses this kind of balancing, tonic, and anti-stress action on the body. The chief component in eleuthero that has the adaptogenic ability has been found to be the eleutheroside content, and high quality preparations are standardized or guaranteed to have a certain amount of this compound. (36)

References

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