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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.
Incidence; Causes & Development
Although little is known about the long-term course of bulimia, it is uncommon among people over 40.
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.
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.
Diagnosis & Tests
It has been found that most bulimic patients have abnormal ovarian morphology on ultrasound. Polycystic or multifollicular ovarian cysts are common in bulimics.
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.
In one study, all the bulimic patients were found to have high serum carotene levels, independent of what they ate. Sometimes this was associated with a lower metabolic rate. What this means is currently unclear.
Treatment & Prevention
In controlled studies bulimic patients almost always respond to individual and group therapy.
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.
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.
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.
Prognosis
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.
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.
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Conditions that suggest Bulimic Tendency:
Risk factors for Bulimic Tendency:
Recommendations and treatments for Bulimic Tendency:
KEY | | Weak or unproven link |  | | Strong or generally accepted link |  | | Proven definite or direct link |  | | May do some good |  | | Likely to help |  | | Highly recommended |
GLOSSARY
Amenorrhea
Absence or suppression of menses. Primary amenorrhea is the failure to begin menses by age 16, secondary amenorrhea is tardy menses (from pregnancy, stress, dieting, illness or intensive physical training) in the previously menstruating woman.
Anorexia Nervosa (Anorexia)
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.
Aspiration
Inhalation, or removal of fluids or gases from a cavity using suction.
Bulimia Nervosa (Bulimia)
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.
Carbohydrates (Carbohydrate)
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.
Chronic (Chronicity)
Usually referring to chronic illness: Illness extending over a long period of time.
Crave (Craving, Cravings)
To have a strong desire for; to feel the need for.
Esophagus (Esophageal)
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.
Gastric
Of, relating to, or associated with the stomach.
Gram (gm, gms, Gramme, Grammes, Grams)
A metric unit of weight, there being approximately 28 grams in one ounce.
Metabolism (Metabolic, Metabolize, Metabolizes, Metabolizing)
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. Also defined as the sum total of changes in an organism in order to achieve a balance (homeostasis): Catabolic burns up, anabolic stores and builds up; the sum of their work is metabolism.
Mineral (Minerals)
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.
Ovarian Cysts (Ovarian Cyst)
These occur in two forms, namely "functional" and "organic". Symptoms 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.
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.
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.
Prognosis
A prediction (estimate) of the future course and outcome of a disease and an indication of the likelihood of recovery from that disease.
Riboflavin (B2, B-2, Vitamin B2)
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.
Self-Esteem
The extent to which and ways in which people view themselves. People who view themselves favorably have good self-esteems whereas people who view themselves negatively have poor self-esteems. Self-esteem affects a person's behavior dramatically.
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.
Serum
The cell-free fluid of the bloodstream. It appears in a test tube after the blood clots and is often used in expressions relating to the levels of certain compounds in the blood stream.
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.
Ultrasound
Ultrasound testing uses sound waves projected into the body to produce an image of internal organs, structures, tumors, etc. In this procedure, a gel is applied to the patient's skin, and a small device that emits ultrasonic pulses is slowly passed over the area. The sonic image produced is viewed on a monitor.
Vitamin B6 (B6, B-6)
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.
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.
Last updated: May 11, 2008
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