EATING DISORDERS
Eating disorders are common in America and affect an estimated 5-10 million women and 1 million men. The cause of eating disorders is complex and poorly understood. Genetics seem to predispose a person to have this type of problem. Other contributors include birth trauma, premature birth and childhood physical or sexual abuse.
Anorexia nervosa is defined as weight loss at least 15% below normal for age and height, intense fear of weight gain, distorted body self image, weight loss self induced by restricting caloric intake and amenorrhea for 3 months. This particular eating disorder has a high mortality rate of an estimated 10% within 10 years of diagnosis in young females between ages 15 to 24 years old. Death is due to suicide, infection or starvation.
Bulimia nervosa is defined as recurrent episodes of overeating at least twice a week over a period of 3 months, feeling of loss of control over the compulsion to overeat, inappropriate compensatory behavior such as food restriction, self-induced vomiting, laxative or diuretic abuse, enemas, appetite suppressants or thyroid medication. Mortality however, is only 1% over 10 years after diagnosis.
Medical complications of eating disorders are numerous. Fluid and electrolyte loss can lead to kidney damage, heart rhythm problems, and nerve and muscle disease. Slow heart rate and abnormally low blood pressure can lead to fatigue, fainting and dizziness. Swollen parotid glands (salivary gland in the cheek), inflamed esophagus, pancreatitis, constipation and irritable bowel symptoms are gastrointestinal problems that can be caused by anorexia. The endocrine hormonal system is frequently imbalanced with elevated cortisol levels, lower sex hormone levels and abnormal thyroid function. Young female type 1 diabetics have a high incidence of eating disorders. This makes control of their blood sugar impossible. Loss of bone mass and early osteoporosis is a problem in young women.
Serotonin is a brain chemical involved in regulating feeding behavior. Most eating disordered people have malfunctions of this system. The newer anti-depressant drugs such as Prozac are able to increase serotonin levels and are useful in treating the eating disorders. Cognitive-behavioral therapy is the most effective therapy for bulimia although high doses of Prozac have some benefit. Use of supplements of L-tryptophan and 5-HTP have evidence of benefit as well. Taking 12-18 grams of the supplement inositol (phytic acid) showed that 6 out 12 binge eaters had a significant reduction in binge eating.
Nutritional deficiencies are common. Low levels of zinc, calcium, Vitamin D, folate, Vitamin B12, magnesium, essential fatty acids and other B vitamins are frequently a problem. Taking supplements of these vital nutrients is important in the early stages of treatment until normal eating behavior is well established.
The prognosis for cure of these disorders is good with 60-80% recovery. Recovery is typically a protracted process and may take years of therapy.
Daniel Blodgett MD