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  Anorexia / Starvation Tendency  
 
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Although eventual outcomes of anorexia and starvation are very similar, it is important to rule out one or the other. Anorexia is primarily psychological and not simply due to appetite loss whereas starvation may be due to physical, environmental or other factors. Although here we will discuss only anorexia, several of the treatments will also help overcome the effects of starvation. Anorexia is a serious eating disorder in which people deliberately starve themselves to lose weight. No matter how thin they become, they still believe they are overweight. Without proper treatment, the disorder can be fatal. More than 90% of people with anorexia are females, though a growing number of males now have the disorder. It usually begins between the ages of 13 and 18 and is often triggered by a severe emotional shock.

According to a study, 74% of women with bulimia and 33% of women with anorexia recovered fully after 90 months, and full recovery rates increased over time. Women with bulimia nervosa tended to recover more rapidly than women with anorexia nervosa. However, about 35% of bulimics and 40% of anorectics relapsed after full recovery. [Journal of the American Academy of Child and Adolescent Psychiatry July 1999;38: pp.829-837] The earlier the treatment begins, the more rapid the recovery.

Further possible symptoms that we have not asked you about include extreme weight loss due to self-imposed starvation; an obsession with food, such as collecting recipes; hoarding food; an unwillingness to eat in public; an irrational fear of gaining weight.

Common causes:

  • An overwhelming sense of being out of control, and attempting to take control of one's life by regulating food intake
  • Unrealistic fear of developing an adult body
  • Severe trauma or emotional shock during puberty or pre-puberty
  • Anorexia is known to run in families
  • Abnormal levels of certain chemicals in the brain
  • Frequent dieters stand an 8-times greater chance of anorexia
  • Society's unrealistic emphasis on thinness places certain individuals such as cheerleaders, dancers, runners, models, jockeys, wrestlers, and actresses and actors at higher risk for anorexia.
While most people feel uncomfortable when their calorie intake is low or restricted, people with anorexia aren't sensitive to this discomfort or to normal hunger cues. As they begin to starve, they actually experience a feeling of euphoria, very similar to how a runner or jogger gets the well-known "runner's high."

If the onset of anorexia occurs before puberty, a girl's sexual development will stop and menstruation won't begin. Severe anorexia leads to chronic malnutrition, which has damaging effects on the body, especially the thyroid, heart, and digestive and reproductive systems. Untreated anorexia can be severe enough to be fatal.

A health care provider will generally ask questions about eating habits - how much and what is being eaten - and exercise patterns. He or she will do blood and other diagnostic tests to eliminate the possibility that weight loss is caused by medical problems. Referral to a therapist or psychiatrist who understands eating disorders is then possible.

It is best to get treatment as soon as the symptoms appear, from a psychiatrist specially trained both in treating the disorder and in nutritional counseling. You may receive cognitive-behavioral, group, relaxation, or psychodynamic therapy. Your health care provider will help you "relearn" how to eat correctly. In severe cases, hospitalization may be needed. Long-term monitoring and support is necessary.
 

 
 

Signs, symptoms & indicators of Anorexia / Starvation Tendency:
 
 
Symptoms - Bowel Movements  (Tendency to/very) infrequent stools

Symptoms - Food - General

  Weak appetite
  Frequent dieting
 Frequent dieters stand an 8-times greater chance of developing anorexia.


Counter-indicators:
  Strong appetite

Symptoms - Hair

  Brittle hair

Symptoms - Metabolic

  Low body temperature
 Hypothermia is a symptom of anorexia.

Symptoms - Mind - Emotional

  Strictly controlled emotions
  Depression with anxiety
  Irritability

Symptoms - Mind - General

  Being an antisocial person
  Poor creativity/imagination

Symptoms - Nails

  Brittle fingernails

Symptoms - Reproductive - Female Cycle

  Unexplained missed periods

Symptoms - Reproductive - General

  Weak sexual desire

Symptoms - Skin - General

  Cold skin
 Hypothermia is a symptom of anorexia.

Symptoms - Sleep

  Being a light sleeper
 
 

Conditions that suggest Anorexia / Starvation Tendency:
 
 
Circulation  Anemia (Uncommon Nutritional)

Habits

  Overtraining, Effects
 Compulsive exercising is a symptom of anorexia.

Mental

  Depression

Metabolic

  Problem Caused By Being Underweight
  Edema (Water Retention)
 Semi-starvation can cause edema. People with eating disorders may interpret the puffiness of edema or any changes on the scale as weight gain or getting "fat" and may panic and purge or take laxatives even more.


Counter-indicators:
  Normal Weight
  Problem Caused By Being Overweight

Musculo-Skeletal

  Osteoporosis / Risk
 The common medical complications of anorexia/starvation include osteoporosis.

Organ Health

  Kidney Weakness / Disease
 The common medical complications of being severely underweight include kidney damage.

  Kidney Failure
 The common medical complications of being severely underweight include kidney damage.

Risks

  Increased Risk of Coronary Disease / Heart Attack
 Being severely underweight can cause heart failure.

Skin-Hair-Nails

  Dry skin
  Female Hair Loss

Symptoms - Food - General

Counter-indicators:
  No history of anorexia

Uro-Genital

  Susceptibility To Miscarriages
 Anorexia or starvation causes difficulties in conceiving and carrying a baby to term.

  Female Infertility
 Anorexia or starvation causes difficulties in conceiving and carrying a baby to term.

  Amenorrhea
 Women with anorexia and/or bulimia often experience amenorrhea as a result of maintaining a body weight that would be too low to sustain a pregnancy. As a result, as a form of protection for the body, the reproductive system shuts down because it is severely malnourished.
 
 

Risk factors for Anorexia / Starvation Tendency:
 
 
Infections  Lyme Disease

Lab Values - Chemistries

  Low CO2

Metabolic

  Methylation, Insufficient

Nutrients

  Magnesium Requirement
 Early symptoms of magnesium deficiency can include fatigue, anorexia, irritability, insomnia, and muscle tremors or twitching.

Supplements and Medications

  Typical/low/high Metformin use
 Metformin is used to treat type II diabetes, but several studies show that it helps people to lose weight by reducing hunger in people whether they have diabetes or not. Metformin reduces sugar release from your liver to prevent blood sugar levels from rising too high, so your body doesn't need to produce as much insulin. Insulin makes you hungry and causes fat cells in your abdomen to fill with fat. If you are very underweight, see your doctor about lowering your dose or force yourself to eat more food.

  Prednisone use
 A side-effect of treatment with prednisone can include anorexia.

Symptoms - Food - General

  History of anorexia
  History of frequent dieting
 Frequent dieters stand an 8-times greater chance of developing anorexia.

Symptoms - Food - Intake

  Insufficient calorific intake

Counter-indicators:
  Excess calorific intake

Symptoms - Metabolic

  Recent unexplained weight loss
 
 

Anorexia / Starvation Tendency suggests the following may be present:
 
 
Emergency Care  A Potentially Urgent Medical Need
 Hospitalization is recommended for anorexics with any of the following characteristics:
  • Weight of 40% or more below normal; or weight loss over a three-month period of more than 30 pounds.
  • Severely disturbed metabolism.
  • Severe binging and purging.
  • Signs of psychosis.
  • Severe depression or risk of suicide.
  • Family in crisis.
Hospital treatment includes individual and group therapy as well as refeeding and monitoring of the patient's physical condition. Treatment usually requires 2-4 months in the hospital. In extreme cases, hospitalized patients may be force-fed through a tube inserted in the nose (nasogastric tube) or by over-feeding (hyperalimentation techniques).

Metabolic

Counter-indicators:
  Problem Caused By Being Overweight

Nutrients

  Zinc Requirement
 54 women who were hospitalized due to anorexia nervosa randomly received zinc at only 14mg daily or a placebo. The rate of weight gain as measured by the increase in body mass index was significantly greater in the zinc-supplemented group than in the placebo group. [Int J Eat Disord 15: pp.251- 5, 1994]

  EFA (Essential Fatty Acid) Type 3 Requirement
 Animal studies suggest that supplementation with omega- 3 fatty acids would increase appetite in patients with anorexia nervosa. [Ann N Y Acad Sci 587: pp.332- 8, 1990]
 
 

Anorexia / Starvation Tendency can lead to:
 
 
Autoimmune  Ulcerative Colitis

Mental

  Depression

Metabolic

  Problem Caused By Being Underweight

Musculo-Skeletal

  Osteoporosis / Risk
 The common medical complications of anorexia/starvation include osteoporosis.

Nutrients

  Hypokalemia / Potassium Need

Organ Health

  Kidney Weakness / Disease
 The common medical complications of being severely underweight include kidney damage.

Risks

  Increased Risk of Coronary Disease / Heart Attack
 Being severely underweight can cause heart failure.

Uro-Genital

  Susceptibility To Miscarriages
 Anorexia or starvation causes difficulties in conceiving and carrying a baby to term.

  Female Infertility
 Anorexia or starvation causes difficulties in conceiving and carrying a baby to term.
 
 

Recommendations for Anorexia / Starvation Tendency:
 
 
Amino Acid / Protein  Tryptophan / 5 HTP
 Post-meal plasma amino acids in 13 female patients with anorexia nervosa (mean age 24 yrs.) who were 72% of ideal body weight were compared to those of healthy controls. The data suggest that post-meal brain tyrosine availability was probably improved, while post-meal brain tryptophan was reduced, especially following a protein-rich diet. This may explain the low serotonin metabolism noted in anorectic patients. Since serotonin has been implicated in the control of appetite and macronutrient selection, this may be a self-perpetuating mechanism. [Metabolism 35( 10): pp.938-43, 1986]

Brain tryptophan levels may be reduced in patients who are markedly underweight, which normalizes after weight is gained. [Biol Psychiatry 23: pp.102- 5, 1988]

Evaluation of serotonin and tryptophan metabolism suggest that biological differences may contribute to the higher prevalence of eating disorders among women. [Psychol Med 17( 4): pp.839-42, 1987]

Botanical

  Goldenseal (Hydrastis canadensis)
 Goldenseal, a strong digestive stimulant and tonic to the digestive tract, is especially useful for anorexia nervosa.

  Lemon balm (Melissa officinalis)
 A mild sedative, spasmolytic, it may also gently help regulate thyroid-stimulating hormone and thyroid function.

  Condurango (Marsdenia condurango)
 Condurango is a digestive stimulant for diminished appetite or dietary abuse; is a specific to anorexia nervosa.

  Siberian Ginseng (Eleuthrococcus senticosus)
 A supportive adaptogen used to improve vitality and stamina.

  Valerian Root (Valeriana officinalis)
 A sedative, digestive bitter, and appetite stimulant.

  Wild Yam (Dioscorea villosa)
 Wild yam is hormone balancing and an antidepressant.

  Oatstraw (Avena sativa)
 A nerve tonic and antidepressant, it also relieves irritation of mucous membranes. This herb is slow to start acting but is long-lasting.

  Fenugreek (Trigonella foenum-graecum)
 A nutritive and digestive tonic used where there is digestive debility and poor nutrition.

  Saw Palmetto (Serenoa repens)
 A digestive tonic and connective-tissue rebuilder.

  Licorice Root (Glycyrrhiza glabra)
 Possesses antidepressant effects, and heals mucous membranes of the digestive tract.

  St John's Wort (Hypericum perforatum)
 Used for depression or anxiety that leads to fatigue and adrenal gland exhaustion.

Diet

  High/Increased Protein Diet
 Protein supplements at 1 to 3 servings per day will help ensure sufficient amino acids and help prevent wasting.


Not recommended:
  Therapeutic Fasting

Mineral

  Calcium
 A study evaluated 7 girls, 13 to 20 years of age, with anorexia nervosa compared to 7 health controls. The percentage of calcium absorption was 16.2% for the anorexic patients and 24.6% in the control subjects. Urinary calcium excretion was 4 times greater in the anorexics and was related to bone resorption. Anorexics have significant increased bone resorption and decreased bone formation rates. Calcium intake and hormonal abnormalities should be analyzed to treat this situation. [Journal of Pediatrics, 1993;123: pp.326-331]

  Zinc
 In anorexia nervosa, especially if zinc is deficient, supplementation may improve appetite, taste sensitivity and mental state.
45-90mg of zinc daily resulted in a weight gain of 0.7 kg/ month in a study of 5 patients. [Am J Psychiatry 143( 8): p.1059, 1986]

Psychological

  Counseling
 Anorexia requires counseling as it is mainly a psychological problem.

Vitamins

  Multiple Vitamin Supplement
 A multivitamin will help compensate for dietary deficiencies.

  Vitamin B Complex
  Vitamin B3 (Niacin)
 Anorexia is one of the first symptoms of pellagra, and it has been suggested that anorexia nervosa is simply sub-clinical pellagra. Niacin deficiency causes low NAD levels which causes deterioration in the Krebs cycle. With low ATP, sodium accumulates inside the cell, causing it to swell. When niacin is given, the most dramatic change is the movement of fluid out of the body. In anorexia nervosa, supplementation may improve appetite and mental state. Case Reports: 4 patients with anorexia nervosa and 1 patient with bulimia all responded rapidly to supplementation with niacin 500mg daily. [ Int Clin Nutr Rev 9( 3): pp.137-43, 1989]

  Vitamin B2 (Riboflavin)
 Four of 13 hospitalized subjects with anorexia or bulimia nervosa were riboflavin-deficient, and there was a positive association between body weight and riboflavin status. [Int J Eating Disorders 18( 3): pp.257- 62, 1995]
 
 


KEY
Weak or unproven link
Strong or generally accepted link
Weakly counter-indicative
Strongly counter-indicative
Very strongly or absolutely counter-indicative
May do some good
Likely to help
Highly recommended
Reasonably likely to cause problems







GLOSSARY

Anorexia Nervosa:  An eating disorder characterized by excess control - a morbid fear of obesity leads the sufferer to try and limit or reduce their weight by excessive dieting, exercising, vomiting, purging and use of diuretics. Sufferers are typically more than 15% below the average weight for their height/sex/age and typically have amenorrhea (if female) or low libido (if male). 1-2% of female teenagers are anorexic.

Bulimia Nervosa:  An eating disorder characterized by lack of control - abnormal eating behavior including dieting, vomiting, purging and particularly bingeing that is usually associated with normal weight or obesity (unlike anorexics, who tend to be considerably underweight). The syndrome is associated with guilt, depressed mood, low self-esteem and sometimes with childhood sexual abuse, alcoholism or promiscuity.

Chronic:  Usually Chronic illness: Illness extending over a long period of time.

Diabetes Mellitus:  A disease with increased blood glucose levels due to lack or ineffectiveness of insulin. Diabetes is found in two forms; insulin-dependent diabetes (juvenile-onset) and non-insulin-dependent (adult-onset). Symptoms include increased thirst; increased urination; weight loss in spite of increased appetite; fatigue; nausea; vomiting; frequent infections including bladder, vaginal, and skin; blurred vision; impotence in men; bad breath; cessation of menses; diminished skin fullness. Other symptoms include bleeding gums; ear noise/buzzing; diarrhea; depression; confusion.

Edema:  Abnormal accumulation of fluids within tissues resulting in swelling.

Fatty Acids:  Chemical chains of carbon, hydrogen, and oxygen atoms that are part of a fat (lipid) and are the major component of triglycerides. Depending on the number and arrangement of these atoms, fatty acids are classified as either saturated, polyunsaturated, or monounsaturated. They are nutritional substances found in nature which include cholesterol, prostaglandins, and stearic, palmitic, linoleic, linolenic, eicosapentanoic (EPA), and decohexanoic acids. Important nutritional lipids include lecithin, choline, gamma-linoleic acid, and inositol.

Hypothermia:  Abnormally low body temperature.

Insulin:  A hormone secreted by the pancreas in response to elevated blood glucose levels. Insulin stimulates the liver, muscles, and fat cells to remove glucose from the blood for use or storage.

Magnesium:  An essential mineral. The chief function of magnesium is to activate certain enzymes, especially those related to carbohydrate metabolism. Another role is to maintain the electrical potential across nerve and muscle membranes. It is essential for proper heartbeat and nerve transmission. Magnesium controls many cellular functions. It is involved in protein formation, DNA production and function and in the storage and release of energy in ATP. Magnesium is closely related to calcium and phosphorus in body function. The average adult body contains approximately one ounce of magnesium. It is the fifth mineral in abundance within the body--behind calcium, phosphorus, potassium and sodium. Although about 70 percent of the body's magnesium is contained in the teeth and bones, its most important functions are carried out by the remainder which is present in the cells of the soft tissues and in the fluid surrounding those cells.

Metabolism:  The chemical processes of living cells in which energy is produced in order to replace and repair tissues and maintain a healthy body. Responsible for the production of energy, biosynthesis of important substances, and degradation of various compounds.

Milligram:  (mg): 1/1,000 of a gram by weight.

Osteoporosis:  A disease in which bone tissue becomes porous and brittle. The disease primarily affects postmenopausal women.

Placebo:  A pharmacologically inactive substance. Often used to compare clinical responses against the effects of pharmacologically active substances in experiments.

Thyroid:  Thyroid Gland: An organ with many veins. It is at the front of the neck. It is essential to normal body growth in infancy and childhood. It releases thyroid hormones - iodine-containing compounds that increase the rate of metabolism, affect body temperature, regulate protein, fat, and carbohydrate catabolism in all cells. They keep up growth hormone release, skeletal maturation, and heart rate, force, and output. They promote central nervous system growth, stimulate the making of many enzymes, and are necessary for muscle tone and vigor.

Zinc:  An essential trace mineral. The functions of zinc are enzymatic. There are over 70 metalloenzymes known to require zinc for their functions. The main biochemicals in which zinc has been found to be necessary include: enzymes and enzymatic function, protein synthesis and carbohydrate metabolism. Zinc is a constituent of insulin and male reproductive fluid. Zinc is necessary for the proper metabolism of alcohol, to get rid of the lactic acid that builds up in working muscles and to transfer it to the lungs. Zinc is involved in the health of the immune system, assists vitamin A utilization and is involved in the formation of bone and teeth.