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 and 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 and 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
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 and 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.
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.
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.