Eating Disorders are life-threatening illnesses with high mortality rates, with the highest occurring in Anorexia Nervosa. These illnesses cause significant disruption in the signaling and balance between the body and mind, making them difficult to treat. An integrative and functional perspective can address the underlying contributing factors reinforcing these serious illnesses.

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What Are Eating Disorders?

Eating disorders (EDs) are complex psychiatric illnesses that cause significant disturbances in one's eating behaviors and are often accompanied by profound physical complications. These illnesses do not manifest by choice. Brain circuitry changes are evident and are further exacerbated by malnutrition and behaviors involved in EDs, causing the body's signals to become dysregulated. Preoccupation with weight/body image, food, and exercise are common features.

Types of Eating Disorders

The three main types of EDs include Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder:

Anorexia Nervosa

(AN) is characterized by significant restriction of food intake relative to one's physical requirements, resulting in extremely low body weight.

Intense fear of weight gain is a hallmark of this disorder, in addition to persistent behaviors that interfere with weight gain, such as food restriction and exercise. Disturbance in the way one's body is perceived is also demonstrated.  

Bulimia Nervosa

(BN) includes recurrent episodes of binge eating, characterized by discreetly consuming large amounts of food in a short period. A sense of lack of control is exhibited during these episodes. Recurrent compensatory behaviors, including self-induced vomiting, use of laxatives, or intense exercise, are evident.

Distress and guilt following compensatory behaviors are often evident, in addition to difficulty with impulse control. Those with BN often have normal body weight.

Binge Eating Disorder

(BED) is the most common ED and is distinguished by recurring episodes of eating large quantities of typically hyper-palatable foods in a short period. Hyper-palatable foods are foods that are hard to stop eating due to their artificially rewarding effects (i.e., chips or other snack foods).

In this disorder, binges are not accompanied by compensatory behaviors. A sense of lack of control is experienced during binges.

Eating Disorder Symptoms

The symptoms of eating disorders vary depending on the type and severity.

Symptoms of Anorexia Nervosa Include:

• Growth of body hair (called lanugo)
• Constipation
• Drop in body temperature

Symptoms of Bulimia Nervosa Include:

• Electrolyte imbalances
• Damaged teeth
• Gastrointestinal issues

Symptoms of Binge Eating Disorder Include:

• Eating until one is feeling uncomfortably full
• Eating when full or not hungry
• Experiencing guilt/distress following binges

What Causes Eating Disorders?

While the exact causes of EDs are unclear, genes, psycho-social and neurobiological factors all appear to play a role.

Genetic Predisposition

Genes can play a strong role in eating disorder etiology by making one more susceptible. Several genes have been identified conferring increased risk in EDs. Those who have family members with EDs may have a greater risk. An individual is 9.6 times more likely to develop BN if they have a relative that also struggles with it, 2.2 times more likely to develop BED, and 11 times more likely to develop AN compared with no family history of the disorder.

Neurobiological Alterations

Alterations in neurobiology can affect certain bodily processes. For example, the brain's reward system is suggested to play a central role in developing EDs, where food is either more or less stimulatory in the brains of those with EDs.

Serotonin and Dopamine are neurotransmitters that are also known as neuromodulators. They affect perception, hunger, satiety, mood, and behavior/reward related to EDs. Altered levels of these neuromodulators have been found in BED and both AN and BN and are suggested to play a role in reinforcing ED behaviors.

Psycho-Social, Sociocultural Factors, & Pre-Existing Mental Health Conditions

Factors such as social stress, pre-existing mental health, and trauma can all play a role in influencing etiology.

A good body of evidence suggests that stress can induce neuronal circuitry alterations involved in ED pathology, thereby increasing risk. Stress makes one more prone to emotional eating, which has been suggested to also play a role in development. Eating behaviors may manifest as a way of coping with stress or negative affect.

Observing a parent dieting or idolizing certain body types may make one with a genetic predisposition more susceptible. Sociocultural influence, such as the portrayal of body image in the media, may also make one more prone to internalizing these body type ideals, all of which can lead to dieting and concerns with body image. Dieting may set off behaviors associated with EDs.

Nutrient Deficiencies

Dieting and calorie restriction can lead to nutritional deficiencies, especially during adolescence when more nutrients are needed for healthy growth. Certain nutritional deficiencies can then influence the onset of eating disorders.

Mineral deficiencies appear to play a role. For example, zinc deficiency has been associated with worsening the pathology of EDs. Those struggling with AN, in particular, have been found to have profound zinc deficiencies, leading to further compromised gut and mood health. Electrolyte imbalances are also greatly evident in EDs due to compensatory behaviors and lack of nutritional intake/hydration. This is important as electrolytes maintain fluid and balance in the body while also having a role in nervous system health and mood.

Vitamin deficiencies are also essential to pay attention to. B Vitamins are commonly deficient in those with EDs. These vitamins are necessary for the production of neurotransmitters that are often imbalanced in EDs. Vitamin D has been found to be deficient in those with EDs, contributing to digestive and gut health imbalances and affecting mood.

Insufficient levels of fatty acids have also been found in EDs. 60% of the brain is made up of fat and requires it to function, so when it is starved of fat, brain function declines, and symptoms become more severe. Amino acids from proteins play many critical roles in the body and are often deficient in EDs. They are vital for synthesizing neurotransmitters important for mood, among other regulatory factors.

GI Dysfunction & Microbiome Imbalances

GI function and microbiome balance are compromised in those with eating disorders, which can affect the balance of other systems. The gut is a key regulator of homeostatic processes in the body, affecting food intake, mood, and behavior.

A lack of diversity within the gut microbiome is evident in eating disorders. Dysbiosis, the imbalance of gut bacteria, has also been suggested to have an etiological role.

Gut health is important as 95% of Serotonin is made in the gut and nearly 50% of dopamine. These are important for regulatory processes in the body. GABA is also produced in the gut and is also suggested to impact EDs.

Functional and Integrative Medicine Labs That Can Help Patients With Eating Disorders

Several labs can be utilized to assess underlying imbalances in the body, providing insight into areas that warrant the most support.

Micronutrient Testing

Nutritional deficiencies are a hallmark of EDs and can contribute to and exacerbate symptoms. Identifying deficiencies can provide targeted supplementation, helping to improve symptoms. This test analyzes an array of 31 different nutrients one may be deficient in, including vitamins, minerals, antioxidants, and amino/fatty acids.

GI-MAP

Imbalances in gut bacteria are evident in EDs, possibly contributing to symptoms. The gut is an integral regulator of homeostatic processes in the body, influencing hunger, satiety, and mood. This test provides a comprehensive analysis of gut health, evaluating key markers related to digestion/absorption, microbiome diversity, and identifying microbes that may disrupt the overall balance.

Comprehensive Metabolic Panel

This test evaluates imbalances in the body's processes, such as electrolytes necessary to maintain fluid balance. Electrolytes are often imbalanced in EDs, notably BN, and are essential for regulating homeostatic processes in the body and supporting nervous system health. The CMP also assesses liver and kidney function, which are often medical complications associated with EDs.  

NeuroAdrenal Profile

This test provides a comprehensive view of HPA axis functioning (the stress regulation system), which has been suggested to be altered in EDs. It measures the body's cortisol levels shedding light on the role stress may have in influencing the ED. This test also measures several urinary neurotransmitters that have been suggested to be of significance, including Serotonin, Dopamine, and GABA.

Genetic/Epigenetic Function

Genes have been suggested to play a strong role in EDs. This comprehensive test provides valuable insights into genetic factors that may make one more susceptible, such as Serotonin, Dopamine, and GABA variants, helping to provide more efficient treatment protocols with nutrition and lifestyle.

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Functional and Integrative Medicine Eating Disorder Treatment

This approach aims to restore balance in the body by addressing the underlying contributors that may reinforce the disorder.

Cognitive Behavioral Therapy for Eating Disorders

Cognitive Behavioral Therapy (CBT) is a widely used and evidence-based approach for treating eating disorders. It focuses on the connection between thoughts, feelings, and behaviors and aims to help individuals develop healthier thinking patterns and behaviors related to food, body image, and weight.

Below are some key aspects of Cognitive Behavioral Therapy for eating disorders:

• Psychoeducation
• Self-monitoring
• Identification of dysfunctional thoughts and beliefs
• Cognitive restructuring
• Behavioral interventions
• Exposure and response prevention
• Body image interventions
• Relapse prevention
  

It's important to note that CBT for eating disorders is usually delivered by trained therapists in individual or group settings. Additionally, CBT is commonly used in conjunction with other integrative therapeutic approaches and interventions as part of a comprehensive treatment program. The duration and frequency of therapy sessions may vary depending on the individual's needs and treatment pla

Formation of New Habits

Those with EDs have significant disruptions in the body and brain's signals that regulate eating and behavior. Forming new habits is important to disrupt behaviors and drive new neural circuitry associated with eating in healthy ways. Seeking guidance with the help of a mental health professional is recommended.

Support Genetic Variants

Those with genetic predispositions to EDs can tailor their nutrition and lifestyle approaches to help prevent the progression and provide more insight into etiology. Supporting a healthy relationship with food, body image, and emotional regulation are all important factors.

Nutrition or Dietary Considerations For Eating Disorder Recovery

It is important for those recovering from an ED to re-integrate to eating nourishing foods that address macronutrient and micronutrient needs and support gut health/digestion. It is imperative to restore body weight depending on individual needs with appropriate ratios of macronutrients.

Consuming smaller meals gradually throughout the day can support the refeeding process. Ensuring sufficient hydration and addressing electrolyte imbalances is also significant, as many compensatory and food restriction behaviors affect electrolyte status. Refeeding, rehydrating, and restoring body weight should all occur under the supervision of a medical professional.

A Mediterranean Diet can support renourishment in the body, as it is rich in whole, nutrient-dense foods and recommends ample amounts of macro and micronutrients. This diet, therefore, supports nutrient repletion via the recommended fruits, vegetables, proteins, and healthy fatty acids. The Mediterranean Diet is also well evidenced to support mood and gut health. It is also rich in Tryptophan, found in poultry and fish. This amino acid specifically supports quality sleep, which is imperative in ED recovery.

GI health is often very much affected by eating disorders which can further exacerbate imbalances in the body. Therefore it is important to consider adding probiotic-rich foods like yogurt to support gut and mood health. Foods rich in natural sources of digestive enzymes, like pineapple, may also be recommended as they support the breakdown of food and the absorption of nutrients the body can utilize, making digestion easier for those renourishing their bodies.

Supplements For Eating Disorder Recovery

The following supplements may be supportive for those in ED recovery. Dosages will vary depending on individual needs:  

Vitamin B Complex for Eating Disorder Recovery

B Vitamins support energy and neurotransmitter synthesis, which is imperative for mood and regulating stress. They are often very much deficient in eating disorders. B vitamins can be supplemented individually or via B Complex supplements, encompassing many or all of the B vitamins.

Zinc for Eating Disorder Recovery

Zinc serves important regulatory functions in the body. Lower levels of Zinc have been found in eating disorders. Zinc is significant for digestion, regulation of neurotransmitter synthesis, taste, and appetite, which are often dysregulated in EDs. The recommended dose for eating disorder recovery is 14 mg per day for 2 months.

Vitamin D & Omega-3s for Eating Disorder Recovery

Vitamin D may help to improve symptoms associated with impeded digestion and mood. Vitamin D deficiency may also be associated with impulsivity, common in BN. Vitamin D deficiency is prevalent among those with EDs. Dosage should be individualized based on results from laboratory testing.

Omega-3 fatty acids may support individuals with eating disorders due to their neuroprotective and anti-inflammatory properties supporting brain function. They also support neurotransmitter balance vital for mood. Supplementing may be beneficial at doses of 250-500 mg or more.

Vitamin D and Omega-3s also help modulate serotonin levels by supporting the conversion of tryptophan into serotonin.

Probiotics for Eating Disorder Recovery

In addition to probiotic-rich foods, probiotic supplements support gut microbiome balance which is compromised in EDs. This is important as the gut can support regulating other processes in the body related to eating behaviors and mood since several neurotransmitters, nutrients, and hormones are synthesized in the gut.

Complementary and Integrative Medicine For Eating Disorder Recovery

CIM therapies are an important part of ED treatment as they can help to reduce stress and may help to promote the development of new neural pathways and support mind-body attunement.

Yoga for Eating Disorder Recovery

Yoga has been suggested to have promise in those struggling with EDs. In this research, participants were randomly assigned to 12 weeks of yoga in conjunction with counseling. Those who participated in yoga had significant reductions in ED symptoms. Yoga may support a healthier relationship with one's body and instill greater trust in its signals.

Mindfulness & Self-Compassion for Eating Disorder Recovery

Mindfulness, bringing awareness to the present moment without judgment, has been suggested to reduce negative affect and body image concerns in those with EDs. Mindfulness-based practices have also been suggested to support redirecting attention away from urges and impulses around behaviors.

Cultivating self-compassion and being kind to oneself in the face of difficulty has also been suggested to support ED treatment by playing a role in emotional regulation.

Acupuncture for Eating Disorder Recovery

Acupuncture, the use of thin and tiny needles to evoke responses in the body that facilitate relaxation, has been suggested to be an adjunct therapy in support of EDs by helping to reduce anxiety and stress.

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Summary

Eating disorders are serious illnesses that evolve from the dynamic interplay of genetics, psycho-social and neurobiological factors such as alterations in regulating signals between the brain and body. This perspective addresses underlying contributing factors to these illnesses by taking a personalized approach.