Eating Disorders


Eating Disorder Introduction

:eating-disorders.jpg American culture is obsessed with body image. From a very young age, the idea of what is beautiful is driven home and children strive to meet this distorted goal. The diet, and diet-related industry, is a 40 billion dollar a year enterprise. With this much monetary value, it begs the question, which came first, the obsession with body image or the drive to profit from an idealistic image of beauty? [1] Although one cannot point fingers solely at the media for being the driving force behind eating disorders, it is important to examine the effects that pop culture has on the psyche.

The most common eating disorders are anorexia nervosa (AN) and bulimia nervosa (BN). These are considered psychiatric conditions characterized by abnormal eating behavior, abnormal weight regulation and conflicting attitudes toward body weight and shape.

Those suffering from anorexia and bulimia are in constant pursuit of a thin physique, resulting in a weight that is not appropriate for their age and weight. Of those suffering from anorexia, there is a fear of becoming ‘fat’ despite their thinness. In fact, often people with anorexia nervosa weigh 85% or less of the norm for their height and age group, and disregard the dangers of being so underweight. These disorders commonly affect females. The highest population affected is younger women, often between the ages of 12 and 25. [2]

Athletics can be a motivating factor for both of these disorders and the behavior of compulsive exercise is common in those with anorexia. Periods of intense and excessive exercise produce brain chemicals called endorphins that make us feel good and can mask pain as well. The combination of starvation and intense exercise may produce a high feeling, creating another addictive component in an already addictive pattern. Unfortunately, this behavior has damaging physiological affects. The body’s protein stores are broken down for fuel, essentially leading to a “wasting” phenomenon.

The origin of the word bulimia means “nervous hunger”. Common to bulimia are cycles of binge eating, consuming large amounts of food at one time followed by purging, and regurgitation of the same food in order to avoid gaining weight. Those that partake in this binge-purge cycle can consume anywhere from 1,000 to 20,000 calories in one episode (any 2 hour period), and then use self-induced vomiting, laxatives, enemas, excessive exercise or other medications to counteract weight gain. In bulimics, these episodes occur two times a week, on average, for a period of three months. Additionally, many persons that suffer from bulimia also suffer from anorexia. A motivating factor of those with bulimia is the belief that this behavior will prevent weight gain, however often the opposite occurs (due to complex physiologic conditions) which leads to the potentiation of the cycle.

Causes of these eating disorders are multi-factoral. Psychological state, socio-cultural influences, possible genetic influence, and physiological imbalances all play a part in the development of these conditions. Due to the variability in causative factors, treatment approaches are also multi-faceted. Interventions range from psychological assessment and treatment, to addressing body image issues and low self esteem. Nutritional and lifestyle counseling is also a common therapy used to reverse the damage done by periods of self abuse.

These conditions are very serious in nature and should not be taken lightly.

It should be noted that those suspected to be suffering from eating disorders should be managed by a physician, as there are a multitude of health related conditions associated with these disorders. A full physical exam is required to rule out other physical disorders and a comprehensive diagnostic interview must be performed by a licensed mental health professional, so that an official diagnosis may be made.

Symptoms of Anemia and Bulimia

Common Signs and Symptoms for Anorexia Nervosa and Bulimia Nervosa:

  • Fear of being fat, or gaining weight
  • Obsessive behavior around food, weight, and appearance
  • compulsive food habits and rituals
  • Feeling cold, even in warm weather, due to electrolyte imbalance, and or lack of body fat
  • Long absences, or unexplained disappearances after meals
  • Swollen glands under the chin (from vomiting)
  • Bloodshot eyes, and popped blood vessels around the eye area (from vomiting)
  • Cooking food excessively for others and obsession with recipes
  • Impulsive/compulsive erratic behavior in all areas of life
  • Severe mood swings
  • Hyperactivity and/or lethargic behavior
  • Anxiety, low self esteem, and depression (often masked)
  • Teeth problems from increased acidic levels from starving and/or vomiting
  • Scars on knuckles from vomiting
  • Perfectionism and restrictive behavior
  • Constant conversation about weight, food, and calories
  • Seeks approval of others and relationships
  • Social withdrawal
  • Wearing baggy clothes to hide their body for fear of being perceived as fat (even if underweight)
  • Fear of adult responsibilities
  • Ineffective coping skills with life problems
  • Absence of menstruation [2]

Eating Disorder Statistics

  • The average woman is 5”4’ and weighs 140 pounds. The average model is 5”11’ and weighs 117 pounds. Most fashion models are thinner than 98% of American women. [3]
  • 0.5% - 3.7% of females suffer from anorexia nervosa in their lifetime and 1.1% - 4.2% of females suffer from bulimia nervosa in their lifetime. [4]
  • Men develop eating disorders; yet, the occurrence of such diseases is less frequent, with only 10% of all anorexics and bulimics are men. [5]
  • Without proper medical intervention many will die; 10%-25% of all those battling anorexia will die as a direct result of the eating disorder.[6]

Treatments for Anorexia and Bulimia

Those suffering from eating disorders usually respond best to a tri-fold approach: re-establishing a healthy weight lost to severe dieting and purging; treating psychological disturbances such as distortion of body image (low self-esteem); and achieving long-term remission and rehabilitation. This is achieved by nutritional rehabilitation, psychosocial intervention, and medication management when appropriate. Due to the varied picture of these conditions, and the many associated health concerns, each individual undergoes an individually tailored intervention. Some can benefit from anti-depressants as a palliative approach to a deep imbalance, while others will respond to psychotherapy as a means to dealing with underlying emotional issues. [7]

Supplements helpful for Anorexia and Bulimia

Essential fatty acids

Essential fatty acid status is greatly altered in anorexics, due to periods of food restriction. A study that examined the levels of essential fatty acids in anorexics revealed that in those with anorexia nervosa, fatty acid deficiencies were different compared to those seen in simple fatty acid deficiencies, as well as that of long term malnutrition. Researchers noted that replacement fatty acids were produced in those with anorexia nervosa, but these were not suitable for optimal cellular function. [8] This lead to a decrease in membrane fluidity, thereby diminishing the communication between cells throughout the body.

Furthermore, some research suggests that an inappropriate utilization and deficiency of essential fatty acids may actually lead to anorexia nervosa. [9] In combination with other metabolic disturbances of hormone systems, a chain of irregularities of fatty acid metabolism results in an impairment of the endocrine system. This may lead to sensations of fullness and alterations in body image perception by the affected individual. [10]


Inositol plays several roles in the body as it has many important physiological functions. A vital component of the cellular membrane, inositol is also necessary for proper functioning of the brain and nervous system, among other functions elsewhere in the body. Part of its importance in brain function is related to its role as a precursor in the messenger system for various serotonin receptors.

It has been investigated as a treatment for several neurologically related disorders and its role in bulimia continues to be uncovered. Studies have shown a reduction in symptoms associated with bulimia, as well as comparable benefit from inositol to pharmaceutical treatment. In fact in one study, the effect was so positive, that the subjects achieved remission with continued inositol treatment. [11, 12, 13]


Among other nutrients studied in anorexia and bulimia, the role of zinc has been studied in fair detail. The second most abundant trace element in the body, zinc is used as a catalyst in nearly 100 different enzyme systems. [14] It takes part in the synthesis of chemicals in the brain, and has specified roles in gene expression, as well as behavior and learning. Because of its versatility, zinc deficiency may have several effects on the nature of anorexia and bulimia. In one study, a deficiency of zinc was found in 40% of bulimic patients; this finding led to speculation that a deficiency could to contribute the chronic nature of abnormal eating behaviors in these patients. [15] The outcome of another study showed that anorexic and bulimic patients supplied with a large dose of zinc resulted in a shift in self- perception, meaning that there was a reduction in the patient’s self reported feelings of symptoms. [16]

5-hydroxytryptophan (5-HTP)/ L- tryptophan

Some studies suggest that these eating disorders are partially a result of altered brain chemistry. Although this isn’t a completely curative approach, supplementation with some neurotransmitter precursors seems to have a positive effect.

When the precursors of serotonin, 5-HTP, and L-tryptophan were given, there was a significant improvement in bulimic symptoms and mood. [17] It should be noted that B6 was also administered in this study, and is included as a nutrient that seems to be diminished in those with bulimia. The positive effects of supplementation with serotonin precursors could be related to the fact that those with bulimia do not utilize 5-HTP as well as normal individuals and have less serotonin in there brains. [18] Another study examined the effect of depriving subjects from tryptophan for a number of hours. This was achieved by giving female bulimic patients a tryptophan-free diet over a period of seven hours. The result was poor body image, depressed mood, and a feeling of lack of control with regard to food intake. [19]

Multivitamin/mineral supplementation

In those suffering from eating disorders, their vitamin, mineral, and electrolyte status fluctuates due to erratic nutritional habit, including purging, starvation, and excessive exercise. The lack of attention to proper nutrition sets the body up to form deficiencies and imbalances of key nutrients. Supplementing with a multivitamin/mineral may allow the body to catch up from the depleting effect of these conditions. Investigation into the relationship between vitamin status and clinical evaluation of both bulimic and anorexic patients showed that vitamin deficiencies in those with eating disorders leads to a dysfunctional neuropsychological state, and could be a direct precursor to cognitive dysfunction. [20] It may be possible to halt this cycle if proper supplemental support was provided those suffering from either disorder.


[1] Online source:

[2] Casper RC. Depression and eating disorders. Depress Anxiety. 1998;8 Suppl 1:96-104.

[3] Smolak, L. (1996). National Eating Disorders Association

[4] National Institute of Mental Health (NIMH) 2000

[5] Online source:

[6] ibid.

[7] American Journal of Psychiatry, 2000 157(1 Suppl): 1-39

[8] Holman RT, Adams CE, Nelson RA, Grater SJ, Jaskiewicz JA, Johnson SB, Erdman JW Jr. Patients with anorexia nervosa demonstrate deficiencies of selected essential fatty acids, compensatory changes in nonessential fatty acids and decreased fluidity of plasma lipids. J Nutr. 1995 Apr;125(4):901-7.

[9] Naisberg Y, Modai I, Weizman A. Metabolic bioenergy homeostatic disruption: a cause of anorexia nervosa. Med Hypotheses. 2001 Apr;56(4):454-61.

[10] Naisberg Y, Modai I, Weizman A. Metabolic bioenergy homeostatic disruption: a cause of anorexia nervosa. Med Hypotheses. 2001 Apr;56(4):454-61.

[11] Gelber D, Levine J, Belmaker RH. Effect of inositol on bulimia nervosa and binge eating. Int J Eat Disord. 2001 Apr;29(3):345-8.

[12] No authors listed. Fluoxetine in the treatment of bulimia nervosa. A multicenter, placebo controlled, double-blind trial. Fluoxetine Bulimia Nervosa Collaborative Study Group. Arch Gen Psychiatry 1992;49:139-147.

[13] Patrick L. Eating disorders: a review of the literature with emphasis on medical complications and clinical nutrition. Altern Med Rev. 2002 Jun;7(3):184-202.

[14] Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002. Available at :

[15] Humphries L, Vivian B, Stuart M, McClain CJ. Zinc deficiency and eating disorders. Clin Psychiatry. 1989 Dec;50(12):456-9

[16] Schauss A, Costin C. Zinc as a nutrient in the treatment of eating disorders. Am J Nat Med 1997;4:8-13.

[17] Mira M, Abraham S. L-tryptophan as an adjunct to treatment of bulimia nervosa. Lancet 1989;2:1162-1163.

[18] Goldbloom DS, Garfinkel PE, Katz R, Brown GM. The hormonal response to intravenous 5-hydroxytryptophan in bulimia nervosa. J Psychosom Res 1996;40:289-297.

[19] Smith KA, Fairburn CG, Cowen PJ. Symptomatic relapse in bulimia nervosa following acute tryptophan depletion. Arch Gen Psychiatry 1999;56:171-176.

[20] Rock CL, Vasantharajan S. Vitamin status of eating disorder patients: relationship to clinical indices and effect of treatment. Int J Eat Disord. 1995 Nov;18(3):257-62.


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