Eating disorders such as bulimia and anorexia nervosa (to which bulimia is closely related) are on the increase in Western society: it is estimated that 18-25% of college women have one or both of these problems. The typical patient is white and female (males account for only 5% of patients), and comes from a middle or upper class family. Bulimia is rare in lower socio-economic persons and in Blacks and Orientals. Although pure forms of both anorexia and bulimia exist, it is not infrequent for a sufferer to overlap the two diseases.
In controlled studies bulimic patients almost always respond to individual and group therapy. A year after most treatments, one-third to two-thirds of patients are no longer bulimic but about one-third of recovered patients continue to have mild residual symptoms. The patients least likely to respond to treatment are those who have other psychiatric disorders, especially alcoholism. Although little is known about the long-term course of bulimia, it is uncommon among people over 40.
It has been found that most bulimic patients have abnormal ovarian morphology on ultrasound. Polycystic or multifollicular ovarian cysts are common in bulimics.
The prognosis for bulimia is worse than that of anorexia nervosa because the associated mental/emotional problems tend to be more severe. The suicide rate in patients with bulimia is twice that for those with anorexia nervosa. Other causes of a higher mortality rate include the consequences of chronic vomiting: aspiration pneumonia, gastric or esophageal rupture, acute gastric dilation, tooth decay and pancreatitis.
The primary goals of treatment are to:
- Optimize nutrient status
- Ensure sufficient water intake
- Normalize eating patterns and daily caloric intake
- Keep light exposure high
- Eliminate binge eating
- Relinquish self-evaluation based on body weight and shape
- Enhance self-esteem
- Improve problem-solving and decision-making skills
- Enhance coping skills
- Heighten self-awareness of personal needs
- Develop a solid self-concept.
Although psychological factors are involved, metabolic derangements also appear to play a role. Many bulimics are subclinically malnourished. Individuals have improved when specific nutrient deficiencies were detected and treated. These include tryptophan, zinc (40% of 62 patients), vitamin B2, B3, folate, and potassium.
Don’t Diet
Findings suggest that lowered brain serotonin function can trigger some of the clinical features of bulimia nervosa in individuals vulnerable to the disorder. Moderate dieting is known to lower blood levels of tryptophan, which may alter serotonin levels in the brain. This, therefore, may be one way in which dieting may trigger bulimia in individuals who, by virtue of their genetic endowment and personal experience, are at particular risk for developing the disorder.
Tryptophan given at a dose of 3gm per day with 50mg of B6 has been reported to improve mood and to reduce bingeing in bulimic women.
Clinical experience suggests that carbohydrates, particularly sugar, play a role in binge eating. Many binge eaters preferentially eat sweets during a binge, and sweet snacking is a frequent behavior at times of stress. It is known that consuming carbohydrate along with tryptophan increases passage of tryptophan across the blood brain barrier (BBB). A carbohydrate craving may thus not be coincidental. Among people with eating disorders, bulimics report the highest prevalence of anger attacks. In bulimics there was a trend for anger attacks to be associated with a greater severity of illness. The higher incidence of anger attacks in patients compared to controls may suggest lower serotonin levels.
Ensure optimum nutrient status by testing, or at least supplementation
A good multiple vitamin/mineral with along with potassium (found in vegetables and bananas) may help reduce deficiencies that could be contributing to the disorder. For example, zinc deficiency can act as a “sustaining” factor for abnormal eating behavior in certain patients.
Drink lots of water, especially before meals
Dr. Batmanghelidj, MD. In Your Body’s Many Cries for Water shares his experience that one of the most misunderstood and upsetting conditions that is a complication of severe dehydration is bulimia. He claims that in bulimics, their sensation of “hunger” is, in fact, an indicator of thirst. If bulimics begin to rehydrate their body well and drink water before their food, this problem will disappear. Having no evidence to the contrary at this time, it would be wise to follow his advice and ensure getting at least the recommended eight glasses of water per day.
Make sure to get lots of light exposure
Bright lights reduced the incidence of binging with and without affecting depression, in separate studies. It may be that bright light in the morning over a period of weeks may help.
Conditions that suggest Bulimic Tendency
No history of bulimia
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 Bulimic Tendency
History of bulimia
Recommendations for Bulimic Tendency
Conventional Drugs / Information
Research has lead to the development of selective serotonin reuptake inhibitors (SSRIs) to regulate serotonin in the body while suppressing food craving and promoting weight loss. Fluoxetine (Prozac) and fluvoxamine (Luvox) are two such inhibitors. To date, fluoxetine is the only drug approved by the FDA.
One study has shown that there is little difference between groups that incorporate the use of fluoxetine and psychotherapy and groups with psychotherapy alone (who were given a placebo). Both groups showed tremendous improvement in eating behaviors. The only observable difference was significant weight loss with the group receiving the fluoxetine. However, other studies have shown that when no psychotherapy is used, groups receiving fluoxetine produce dramatically different results than do groups receiving a placebo. Those receiving fluoxetine displayed improved eating behaviors and mood, while those receiving a placebo did not.
Key
| Weak or unproven link |
| Strong or generally accepted link |
| Very strongly or absolutely counter-indicative |
| May do some good |
| Likely to help |
| Highly recommended |
Glossary
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.
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.
Ovarian Cysts
These occur in two forms, namely "functional" and "organic". may not be present but can include pressure or pain in the abdomen, problems with urine flow or pain during sexual intercourse. Rarely, a very large cyst can become twisted and stop its own blood supply, possibly causing nausea, fever or severe abdominal pain. Functional ovarian cysts form part of the normal functioning of the ovary and are always benign. They may be either "follicular cysts", produced by all menstruating women every month and reaching up to 2-3cm in diameter before they rupture at ovulation, or "corpus luteum cysts", which appear after ovulation and may grow to produce "hemorrhagic cysts" if ovulation does not occur or is delayed. Rupture of such a cyst can sometimes cause painful ovulation or bleeding, which is often moderate and resolves by itself. Organic ovarian cysts may be benign or malignant and are not linked to the functioning of the ovary. They occur as either "dermoid cysts", which are benign tumors that may nevertheless recur on either ovary and contain elements derived from the skin (hairs, sebum, teeth), or other organic cysts.
Chronic
Usually Chronic illness: Illness extending over a long period of time.
Aspiration
Inhalation, or removal of fluids or gases from a cavity using suction.
Esophagus
Commonly called the "food pipe", it is a narrow muscular tube, about nine and a half inches long, that begins below the tongue and ends at the stomach. It consists of an outer layer of fibrous tissue, a middle layer containing smoother muscle, and an inner membrane, which contains numerous tiny glands. It has muscular sphincters at both its upper and lower ends. The upper sphincter relaxes to allow passage of swallowed food that is then propelled down the esophagus into the stomach by the wave-like peristaltic contractions of the esophageal muscles. There is no protective mucosal layer, so problems can arise when digestive acids reflux into the esophagus from the stomach.
Acute
An illness or symptom of sudden onset, which generally has a short duration.
Pancreatitis
Inflammation of the pancreas. Symptoms begin as those of acute pancreatitis: a gradual or sudden severe pain in the center part of the upper abdomen goes through to the back, perhaps becoming worse when eating and building to a persistent pain; nausea and vomiting; fever; jaundice (yellowing of the skin); shock; weight loss; symptoms of diabetes mellitus. Chronic pancreatitis occurs when the symptoms of acute pancreatitis continue to recur.
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.
Tryptophan
Essential amino acid. Natural relaxant and sleep aid due to its precursor role in serotonin (a neurotransmitter) synthesis. Along with tyrosine, it is used in the treatment of addictions.
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.
Riboflavin
(Vitamin B-2): A B-complex vitamin that acts as a coenzyme that activates the breakdown and utilization of carbohydrates, fats and proteins. It is essential for cellular oxidation and necessary for healthy skin and eyes.
Niacin
(Vitamin B-3): A coenzyme B-complex vitamin that assists in the breakdown of carbohydrates, fats and proteins. Essential for the health of the skin, nerves, tongue and digestive system. It is found in every cell of the body and is necessary for energy production. Niacin is also needed for DNA formation.
Potassium
A mineral that serves as an electrolyte and is involved in the balance of fluid within the body. Our bodies contain more than twice as much potassium as sodium (typically 9oz versus 4oz). About 98% of total body potassium is inside our cells. Potassium is the principal cation (positive ion) of the fluid within cells and is important in controlling the activity of the heart, muscles, nervous system and just about every cell in the body. Potassium regulates the water balance and acid-base balance in the blood and tissues. Evidence is showing that potassium is also involved in bone calcification. Potassium is a cofactor in many reactions, especially those involving energy production and muscle building.
Serotonin
A phenolic amine neurotransmitter (C10H12N2O) that is a powerful vasoconstrictor and is found especially in the brain, blood serum and gastric membranes of mammals. Considered essential for relaxation, sleep, and concentration.
Gram
(gm): A metric unit of weight, there being approximately 28 grams in one ounce.
Milligram
(mg): 1/1,000 of a gram by weight.
Vitamin B6
Influences many body functions including regulating blood glucose levels, manufacturing hemoglobin and aiding the utilization of protein, carbohydrates and fats. It also aids in the function of the nervous system.
Carbohydrates
The sugars and starches in food. Sugars are called simple carbohydrates and found in such foods as fruit and table sugar. Complex carbohydrates are composed of large numbers of sugar molecules joined together, and are found in grains, legumes, and vegetables like potatoes, squash, and corn.
Mineral
Plays a vital role in regulating many body functions. They act as catalysts in nerve response, muscle contraction and the metabolism of nutrients in foods. They regulate electrolyte balance and hormonal production, and they strengthen skeletal structures.