The Nutritional Side of Disordered Eating
We live in a world with a lot of misconceptions and, unfortunately, also a lot of stigma around eating disorders. Our culture has emphasized mental health imbalance as the cause of disordered eating (Control needs? Body image concerns? Self-punishment? Self-medication?), and use of behavioral health supports to address the disordered eating patterns. Unfortunately, this limited repertoire of treatment options can be torture for those struggling with food. While trauma and societal pressures do play a role in the formation of eating disorders, one big factor is often overlooked – nutrient deficiencies.
Nutrient deficiencies can be caused by an eating disorder, but they’re also one of the underlying causes. In addition to nutrient deficiencies, there are very strong genetic, epigenetic, and societal factors in the role of developing anorexia, bulimia and other forms of disordered eating.
Let’s first take a look at how epigenetics plays a role.
Epigenetics is how our environment influences our genetic expression – or how our environment switches on and off genes. Our environment, which includes diet, water, air quality, thoughts, beliefs, trauma, stress, and more, can directly impact our genes through a process called methylation. Methylation is a biochemical process involved in many of the body’s functions. Imagine this process as billions of little “off” switches inside the body that control everything from stress response and how the body makes energy from food, to brain chemistry.
Sufficient methylation is required to support neurotransmitter activity. Or, in plain English, this process is important in maintaining a good balance of feel-good brain chemicals. If someone is “undermethylating,” suppressed levels of serotonin, dopamine, and norepinephrine can result. Suboptimal levels of these important neurotransmitters can cause depression, anxiety, perfectionism, obsessive-compulsive and ritualistic behaviors, addictive tendencies, and high achievement and competitive tendencies, among other symptoms.
The methylation cycle requires several key nutrients to run smoothly: Vitamins B6, B12, B9 (folate), and B2 (riboflavin), as well as specific amino acids (broken down proteins). When B vitamins can’t be properly digested and absorbed, due to factors such as certain medications, low stomach acid, and imbalance in gut microbes, nutrient insufficiencies can occur, leading to a sluggish methylation cycle.
What about specific nutrient deficiencies being a root cause of disordered eating?
Let’s take a look at the specific roles of B vitamins, amino acids, and minerals in disordered eating.
B1 (Thiamin): Vitamin B1, which is also referred to as thiamine, is used by the body to metabolize food for energy and to maintain proper heart and nerve functions. It helps us extract energy from the food we eat by turning nutrients into ATP. Common signs of thiamin deficiency are loss of appetite, weight loss, constipation, anxiety, chest pain and even sleep disturbance along with depression and irritation. A 2014 study showed that a diet deficient in B1 may cause anorexia by inhibiting hypothalamic adenosine monophosphate-activated protein kinase (AMPK), which is a critical regulator of food intake.
B6 (Pyridoxine): B6 (and tryptophan) is a critical nutrient for the synthesis of serotonin and dopamine, which we know happens through the methylation cycle. Individuals who are deficient in B6 or who struggle converting B6 to its active form (“P5P” or PLP), may have lower levels of serotonin and/or dopamine. Lowered levels of serotonin and dopamine can leave someone to experience anxiety, OCD, and/or disordered eating tendencies. B6 is also required for the synthesis of GABA, another neurotransmitter that reduces the feelings of anxiety and fear.
B8 (Inositol): Inositol is converted into a substance that regulates the action of serotonin. Having a healthy balance of B8 can reduce depression, feelings of panic, and obsessive thoughts. One study looked at inositol’s use in the treatment of binge eating disorder. Twelve patients with bulimia and binge eating disorders were given 18 grams of either inositol or a placebo and monitored for six weeks. The group taking inositol reported significant improvements in symptoms compared with the placebo group at the end of the study. This demonstrated that inositol can be useful in treating not only patients with depression and obsessive-compulsive disorders, but also those who suffer from bulimia and binge eating.
Tryptophan: Tryptophan is an amino acid that’s necessary for serotonin synthesis. Bulimia and binge-eating are often treated with SSRIs (antidepressants) such as Prozac, Zoloft, and Lexapro, which trick the brain into thinking it has more serotonin than it actually does. Rather than using medication, the raw serotonin-making materials (amino acid L-tryptophan or its relative, 5-HTP (5-hydroxytryptophan)) can be more effective with less side effects and there is research to back it. (Note: SSRIs should never be combined simultaneously with tryptophan or 5HTP.) In her book The Diet Cure, Julia Ross refers to a study where bulimics were deprived of tryptophan. In reaction, their serotonin levels dropped and they binged more violently, ingesting and purging an average of 900 calories more each day. In another study, adding extra tryptophan to the diet reduced bulimic binges and mood problems by raising serotonin levels. More recently, researcher Katherine Smith reported that even years into recovery, bulimics can have a return of their cravings and mood problems after only a few hours of tryptophan depletion, concluding: “Our findings support suggestions that chronic depletion of plasma tryptophan may be one of the mechanisms whereby persistent dieting can lead to the development of eating disorders in vulnerable individuals.”
Glutamate and GABA Imbalance: Glutamate is a non essential amino acid that acts as a neurotransmitter. Specifically, it’s an excitatory neurotransmitter, which means it has stimulating actions and makes neurons more likely to fire. It’s critical for mood stabilization. High glutamate in proportion to GABA may contribute to a number of mental health conditions. GABA is a calming neurotransmitter that can have anti-anxiety effects, while glutamate is more stimulating. An imbalance in these two neurotransmitters is suspected to be at play in some neurological conditions.
Zinc: This multi-purpose mineral is critical for neurotransmitter synthesis, as well as helps regulate appetite and insulin receptors which positively affects blood sugar levels. Erratic blood sugar levels can result in binge eating dynamics. When blood sugar levels drop below a healthy level, individuals can experience cravings, hunger, irritability and will often binge on refined carbs to bring their blood sugar levels back to a “happy” place. Zinc deficiencies are often found in anorexia, which also causes appetite loss and a lowered sense of taste. It is not surprising that we see a large adolescent population with eating disorders because adolescents have a large demand for zinc given the growth, developmental, and hormonal changes that occur and the poor dietary patterns that some of them gravitate towards (outside of peer pressures around ideal appearance).
Copper: Excess copper can have devastating effects on mental health because it lowers dopamine and increases norepinephrine in the brain. Imbalances in these neurotransmitters are related to anxiety and panic disorders, depression (especially postpartum), and bipolar disorder. Copper is a very important metal needed for the body to function optimally, but it must be in balance with zinc.
Magnesium: Magnesium is a critical mineral that’s actually responsible for over 300 enzyme reactions and is found in all body tissues. It’s responsible for calming the body and the brain while stabilizing glucose levels. When imbalanced, this may not only contribute to binge eating, but binge eating may then subsequently wildly fluctuate blood sugar as well. When magnesium levels are stable, cravings decrease. Additionally, magnesium helps support deep sleep, which is also important for keeping cravings for carbs at bay.
Chromium: Chromium is another critical mineral for blood sugar regulation and cravings. It helps insulin get into cells to regulate glucose so that hormones stop sending messages to the brain that more blood sugar is needed.
These nutrient imbalances plus undermethylation in addition to social-cultural-emotional factors may be a difficult combination for some that are genetically susceptible to disordered eating.
When addressing disordered eating through a functional medicine lens, in addition to a therapist as part of the care team, we seek to uncover these critical nutrient insufficiencies and provide support for them. When neurotransmitters are rebalanced, it can make it easier to begin tolerating an expanded diet while working with the therapist around emotional and cultural manifestations of the eating disorder.
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