Q:What do you know about anorexia? My 22 year old daughter, who is five foot seven, has lost too much weight recently, dropping from nine and a half to eight stone. In my view, she looks terrible, but any exhortations to eat are ignored.
We've been thinking of involving our doctor, but are concerned that he will refer her for psychiatric treatment. We don't think that is the problem, or that she fits the usual description of a young women feeling out of control of her life. We also don't believe we fit the clich of the parents of anorexics, who are supposed to be dominating and overcontrolling. What sort of doctor and therapy would you recommend? C H, Banstead......
A:Most treatments for anorexia and other eating disorders today concentrate on the psychological aspect of the problem. According to author Susie Orbach in Hunger Strike (Penguin), the widespread assumption among the medical community is that anorexia is "the quintessential expression of discomfort with oneself", an "extreme manifestation of the denial of selfhood".
It is said to be prevalent among very bright young women overachievers, usually born to overcontrolling parents. The girls, powerless in every other aspect of their lives, seek to gain control of their situation by controlling (and denying) their food. There is also said to be great ambivalence about emerging sexual identity, a low sense of self esteem and general feelings of being ineffective and controlled by their environment.
Generally, anorectics are obsessed with avoiding food and having exercise. They are often hyperactive and suffer periods of depression. Those suffering from bulimia, often swing between uncontrollable eating binges, followed by self induced vomiting.
The standard treatment is a mix of force feeding, if the situation is desperate, and counselling.
Although most treatments concentrate on addressing the psychological problems, a small band of researchers consider the problem a biochemical one. Nutritional expert Dr Stephen Davies has written that zinc deficiency may play a role in the onset of anorexia nervosa and that there are similarities between the two conditions.
He says that teenage girls are particularly at risk of developing zinc deficiency, because so many in this group are dieting or eating insufficiently; because they may be taking the Pill, which enhances zinc excretion; and because zinc requirements skyrocket during rapid periods of growth. Dr Murray Vimy of the department of medicine at the University of Calgary, who has spent more than a decade studying the effects of amalgam on human biochemistry, also has said that adolescence is the time that most amalgam fillings are placed, and they can also deplete the body's zinc supply. Eating disorders can also start after pregnancy, when the body is depleted of zinc and other nutrients.
Dr Leo Galland believes that most cases of bulimia are a biochemical disturbance often brought on by periods of crash dieting on fewer than 1200 calories a day. In other words, anorexia itself can bring on bulimia. He refers to the work of Stephanie Dalvitt-McPhillips, an American therapist and former bulimic herself, who carried out a controlled study of 215 students suffering from bulimia. She was able to produce rapid and permanent remission by having them consume a high nutrient dense diet of 1400 calories a day, supplemented with a multi vitamin mineral tablet, plus B and C vitamins (Physiol Behav 33(5): 769-75, 1984). The quality and small additional quantity of calories was enough to prevent bulimia from recurring.
The study suggests that besides malnutrition, foods that affect the blood sugar insulin level may bring on bulimia. There may also be a folic acid deficiency, which can be brought on after pregnancy.
Melvyn Werbach, mentioned in our cover story, who has researched nutritional influences on most major mental illnesses, says that a niacin deficiency could precipitate anorexia. As he points out, one of the first symptoms of pellagra, or vitamin B3 deficiency, a condition characterized by dementia, diarrhoea and skin problems, is anorexia.
In one case report, (Int ClinNutr Rev 9(3):137-43, 1989) five anorectics all responded rapidly to supplementation with nicotinic acid.
Dr Werbach cites a case report (Postgrad Med J 62:853-54, 1986), of a young woman with bulimia whose condition resolved after she was given folic acid supplementation.
Numerous studies have shown that zinc deficiency is present in most women suffering from anorexia and bulimia. In the Journal of Nutritional Medicine (1: 171-7, 1990), researcher Neal Ward found that the zinc levels of 15 anorectics were significantly lower than a set of 15 matched controls, the only significant difference. In the same study, Ward showed that the 15 anorectic patients given 15 mg zinc twice a day reported increases in appetite and taste sensitivity after three days and an average body weight increase of 5 to 12 kgs after three months. Other studies have shown that women given zinc supplementation report less depression and anxiety and steady weight gain (Am J Psychiatry 143(8): 1059, 1986).
A zinc deficiency may not be the entire story. According to an article by D F Horrobin in Medical Hypotheses (6 (3):277-96, 1980), substantial evidence demonstrates that anorexia is due to a combined deficiency of zinc and the essential fatty acids, particularly since many symptoms of deficiencies of each are similar, and the two work synergistically. One observational study demonstrates that 17 patients hospitalized with anorexia were found to have near clinical signs of essential fatty acid deficiency, particularly of the omega-6 variety.
These studies, while not definitive, certainly suggest that eating disorders have a biochemical origin. It makes sense to have your daughter seen by a nutritional expert, who, by subtle manipulation of her diet and supplement regime (rather than simply forcing her to eat against her will), might stimulate her appetite, sort out her body chemistry and help her to help herself.