Treatments for eating disorders

• DEFINITION: Treatment of eating disorders.
• PRINCIPAL PROPOSED TREATMENTS: None
• OTHER PROPOSED TREATMENTS: Dehidroepiandrosterone (DHEA), yoga, zinc

Introduction

There are three major types of eating disorders: anorexia nervosa (AN), bulimia nervosa, and binge-eating disorder. Anorexia nervosa involves compulsive dieting and exercise to reduce weight, leading to dangerous weight loss and, in women, the absence of menstrual periods. Bulimia nervosa is characterized by binge-eating followed by purging. The recently identified binge-eating disorder is marked by binge-eating that is not followed by purging.

Eating disorders are most common in teenage girls and young adult women from the middle and upper socioeconomic classes. The causes of the various disorders are not known, but it seems indisputable that the Western emphasis on slimness as a mark of feminine attractiveness contributes greatly. However, the rate of eating disorders among males has grown over the twenty-first century. Males account for around 20 percent of people with anorexia nervosa, 30 percent of people with bulimia nervosa, and 43 percent of people with binge-eating disorders. From 1999 to 2009, hospitalization of males for eating disorders increased by 53 percent.

Because severe anorexia can be life-threatening, treatment generally combines a weight-gain program with psychotherapy and, sometimes, antidepressant drugs. Bulimia nervosa and binge-eating disorder are both treated with psychotherapy, antidepressants, or appetite suppressants to help control binge-eating.

Proposed Treatments

While there are no well-established natural treatments for eating disorders, there is some evidence that zinc supplements, when used in conjunction with conventional medical treatments, may help people with anorexia with healthy weight gain. Preliminary attempts to treat bulimia by altering serotonin levels have also been promising. In addition, the supplement dehydroepiandrosterone (DHEA) might be helpful for protecting bone mass.

Zinc. The relationship between anorexia nervosa and zinc deficiency is the subject of many studies. Because symptoms of zinc deficiency include weight loss, appetite loss, and behavior changes, they often present as those of anorexia nervosa to some extent. This has led some researchers to theorize that low zinc levels may be related to the onset of the eating disorder. Necessary zinc levels can vary by geographical location and culture based on variations in climate, stress levels, rates of infection, and dietary composition. However, people with deficiencies can begin to experience food avoidance and the loss of certain senses like smell and taste within three to five days.

Preliminary evidence, including an initial small double-blind trial, suggests that zinc supplements might indeed be helpful in treating anorexia nervosa, possibly enhancing weight gain and helping to stabilize mood. One frequently quoted study that has often been used to discredit the use of zinc in AN appears to be relatively faulty when inspected closely. A later study noted the symptomatic overlaps between anorexia and zinc deficiency led to the idea of using zinc supplements as a treated for anorexia. The study included twenty-six zinc-deficient children with anorexia who were treated with zinc and a nutritious diet for six weeks showed that the zinc supplementation was associated with a rapid recovery of a normal growth curve. Another study involved thirteen anorexia patients between the ages of fourteen and eighteen who were given either a zinc supplement or a placebo for six months. The patients who took the zinc supplements showed greater weight gain and height increase and a resolution of issues associated with anorexia such as skin abnormalities.

Zinc is safe when used as directed but is toxic in high doses and may cause anemia, copper deficiency, impaired immunity, and other serious health issues.

Tryptophan. Animal and human studies suggest that when levels of the brain chemical serotonin rise, hunger decreases. People who engage in binge-eating may have a different response to changes in serotonin levels. In an attempt to change binge-eating behavior, some researchers have tried to alter serotonin levels. Standard antidepressant drugs are most often used for this purpose. However, it might be possible to achieve similar results with tryptophan and related supplements.

The body uses the amino acid L-tryptophan to make serotonin. Preliminary evidence from a small, double-blind, placebo-controlled study suggests that a combination of L-tryptophan and vitamin B6 significantly reduced binge-eating among people with bulimia. This evidence, however, is contradicted by results of another small study that found no significant difference between the effects of L-tryptophan and those of placebo on binge-eating.

L-tryptophan is no longer sold as a supplement because of safety concerns. The dietary supplement 5-hydroxytryptophan might be a safer option; however, it has not been studied in eating disorders. The antidepressant herb St. John’s wort might also raise serotonin levels.

Dehydroepiandrosterone. Women with anorexia often experience bone loss, partly because of decreases in estrogen levels. In a one-year double-blind study, women with anorexia received either dehydroepiandrosterone (DHEA) at a dose of 50 milligrams per day or standard hormone replacement therapy. The results showed equivalent bone preservation in both groups. However, because there is considerable doubt that hormone replacement therapy is truly helpful for preventing bone loss caused by anorexia, these results mean little to researchers.

Other proposed treatments. A small trial involving fifty-four adolescents with eating disorders found that adding eight weeks of yoga twice weekly to standard therapy was associated with improved eating-disorder-related thoughts and behaviors compared with standard therapy alone. Another small study published in 2016 involved twenty adolescent girls from an urban eating disorders clinic. The subjects did yoga on a weekly basis for twelve weeks in addition to standard multidisciplinary care. The study concluded that yoga practice in combination with outpatient eating disorder treatment decreased anxiety, depression, and body image disturbance without adversely affecting weight. The authors of the study noted that while yoga may be a promising adjunct therapy, further study is required to determine whether they would endorse yoga as a standard part of outpatient treatment for eating disorders.

Bibliography

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