Eating Disorders

Most of us want to trim off a few unwanted pounds at some point in our lives. And when we shed them, we are satisfied. But for some people, losing weight or keeping weight off becomes an obsession that can lead to irreversible health damage, such as stunted growth, thinning bones, infertility, injury to teeth and internal organs, and even to death.

This fact sheet addresses two of the most common eating disorders—anorexia nervosa and bulimia nervosa. It is by no means exhaustive, nor does it include the full range of symptoms and treatments. Keep in mind that new research can yield rapid and dramatic changes in our understanding of, and approaches to, mental disorders.

Eating disorders often are chronic in nature and, as a result, may require long-term treatment. The medical consequences of anorexia, which include death in about 10 percent of the cases, usually are more severe than bulimia. The earlier these disorders are diagnosed and treated, the better the prospects are for full recovery. 

Statistics show 95 percent of those who have eating disorders are women between the ages of 12 and 25. However, the incidence of eating disorders among people who are older and men may be increasing. Studies have found that women who have bulimia nervosa are often impulsive and are at high risk for other disorders such as substance abuse. Many people with eating disorders also appear to have co-occurring depression.

If you believe you or a loved one has an eating disorder, seek competent, professional help from someone who has been trained specifically to recognize and treat eating disorders.

Symptoms:

Anorexia nervosa—People who have this disorder often develop elaborate rituals around food, continue to lose weight, and can literally starve themselves to death. They also may exercise excessively. 

Bulimia nervosa—Those who have bulimia gorge themselves, then almost immediately make themselves vomit or use laxatives or diuretics to purge their bodies of food. This often is referred to as the “binge/purge” cycle. Preoccupation with weight is a primary trait of both disorders.

Medical Complications:

Anorexia nervosa—Breathing, pulse, and blood pressure rates drop and thyroid function slows. Hair and nails may grow brittle. Similarly, skin may dry, yellow, and develop a covering of soft hair called lanugo. Mild anemia, swollen joints, reduced muscle mass, and light-headedness also commonly occur. Severe cases also lead to brittle bones that easily break as a result of calcium loss. Heart failure is a risk for those who use drugs to stimulate vomiting, bowel movements, or urination. Starvation can also damage the heart and brain.

Bulimia nervosa—Acid in vomit can wear down the outer layer of the teeth, inflame the esophagus, and enlarge the glands near the cheeks. Binge eating can also cause the stomach to rupture, and purging can result in heart failure as a result of the loss of vital minerals, such as potassium. 

Formal Diagnosis:

Anorexia—Body weight that is at least 15 percent below normal for age and height; distorted body image; fear of gaining weight; and, in women, absence of at least three consecutive menstrual cycles. 

Bulimia—A minimum average of two binge eating episodes a week for at least 3 months; self-induced purging; and feeling a lack of control over eating behavior.

Treatment:

Anorexia nervosa—Assuring physical health, including restoring weight, is the first goal of treatment. This may require hospitalization. After a person’s physical condition has been stabilized, treatment usually involves individual psychotherapy that may include psychoanalytic approaches, family therapy, and, later, supportive group therapy. Self-help groups in communities may provide ongoing support. Cognitive behavioral therapy has been effective for helping people who have anorexia nervosa maintain healthy eating habits. Psychoactive medication may be combined with psychotherapy for people who have problems with underlying anxiety, depression, or who spend inordinate amounts of time involved in elaborate food rituals. 

Bulimia nervosa—Unless malnutrition is severe, any co-occurring substance abuse problems should be treated first. Cognitive behavioral therapy helps most people who have this disorder to reduce symptoms. Psychotherapies—such as cognitive, psychodynamic, or psychoanalytic approaches—have proven effective in helping prevent relapse and in addressing underlying interpersonal issues. As with anorexia, family therapy is recommended. 

Nutritional supplements that may be helpful: People with eating disorders who restrict their food intake are at risk for multiple nutrient deficiencies, including protein, calcium, iron, riboflavin, niacin, folic acid, vitamin A, vitamin C, and vitamin B6, and essential fatty acids. 

Zinc deficiency has also been detected in people with anorexia or bulimia in most, though not all, studies. In addition, some of the manifestations of zinc deficiency, such as reduced appetite, taste, and smell, are similar to symptoms observed in some cases of anorexia or bulimia. 

In an uncontrolled trial, supplementation with 45–90 mg per day of zinc resulted in weight gain in 17 out of 20 anorexics after 8–56 months. In a double-blind study, 35 women hospitalized with anorexia, given 14 mg of zinc per day, achieved a 10% increase in weight twice as fast as the group that received a placebo.In another report, a group of adolescent girls with anorexia, some of whom were hospitalized, was found to be consuming 7.7 mg of zinc per day in their diet—only half the recommended amount. Providing these girls with 50 mg of zinc per day in a double-blind trial helped diminish their depression and anxiety levels, but had no significant effect on weight gain. Anyone taking zinc supplements for more than a few weeks should also supplement with 1 to 3 mg per day of copper to prevent a zinc-induced copper deficiency. Niacin can also improve appetite and mental state. Other studies have reported high levels of vitamins A and B12 and low levels of vitamins D and E.

Serotonin, a hormone that helps regulate food intake and appetite, is synthesized in the brain from the amino acid. Preliminary data suggest that some people with bulimia have low serotonin levels. Researchers have reported that bulimic women with experimentally induced tryptophan deficiency tend to eat more and become more irritable compared to healthy women fed the same diet, though not all studies have demonstrated these effects.

Weight-loss diets result in lower L-tryptophan and serotonin levels in women, which could theoretically trigger bingeing and purging in susceptible people. However, the benefits of L-tryptophan supplementation are unclear. One small, double-blind trial reported significant improvement in eating behavior, feelings about eating, and mood among women with bulimia who were given 1 gram of L-tryptophan and 45 mg of vitamin B6 three times per day.  Other double-blind studies using only L-tryptophan have failed to confirm these findings.  L-tryptophan is available by prescription only; most drug stores do not carry it, but “compounding” pharmacies do. Most cities have at least one compounding pharmacy, which prepares customized prescription medications to meet individual patient’s needs. 

A natural remedy that has had success is a switch to a nutrient dense and sugar-free diet.

Bulimics may be deficient in nutrients, particularly B vitamins such as folic acid and pyridoxine (B6).

B6 has been shown to improve mood with consequential benefits in eating behaviour and feelings about eating.

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