Archive for the ‘eating disorder’ Category

By Sumathi Reddy

The growing interest in eating healthy can at times have unhealthy consequences.

Some doctors and registered dietitians say they are increasingly seeing people whose desire to eat pure or “clean” food—from raw vegans to those who cut out multiple major food sources such as gluten, dairy and sugar—becomes an all-consuming obsession and leads to ill health. In extreme cases, people will end up becoming malnourished.

Some experts refer to the condition as orthorexia nervosa, a little-researched disorder that doesn’t have an official diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, or DSM, considered the bible of psychiatric illnesses. Often, individuals with orthorexia will exhibit symptoms of recognized conditions such as obsessive-compulsive disorder or end up losing unhealthy amounts of weight, similar to someone with anorexia.

Researchers in Colorado recently proposed a series of criteria they say could help clinicians diagnose orthorexia. The guidelines, published online in the journal Psychosomatics earlier this year, also could serve as a standard for future research of the disorder, they say.

Ryan Moroze, a psychiatry fellow at the University of Colorado Denver School of Medicine and senior author of the study, said more research needs to be done to develop a valid screening instrument for orthorexia, determine its prevalence and differentiate it from other more well-known eating disorders.

“There are people who become malnourished, not because they’re restricting how much they eat, it’s what they’re choosing to eat,” said Thomas Dunn, a psychologist and psychology professor at the University of Northern Colorado in Greeley, Colo., and a co-author of the article.

“It’s not that they’re doing it to get thin, they’re doing it to get healthy. It’s just sort of a mind-set where it gets taken to an extreme like what we see with other kinds of mental illness,” Dr. Dunn said.

Among the proposed criteria: an obsession with the quality and composition of meals to the extent that people may spend excessive amounts of time, say three or more hours a day, reading about and preparing specific types of food; and having feelings of guilt after eating unhealthy food. The preoccupation with such eating would have to either lead to nutritional imbalances or interfere with daily functional living to be considered orthorexia.

Some orthorexia patients are receiving treatments similar to those for obsessive-compulsive disorder. “We’re getting the people who aren’t being treated well under an eating-disorder diagnosis and their disorder is better treated under the OCD dial,” said Kimberley Quinlan, clinical director of the OCD Center of Los Angeles, an outpatient clinic.

The condition seems to start with an interest in living healthy and then, over time, people develop an increased anxiety about eating food that is contaminated or that they deem unhealthy, said Ms. Quinlan. Treatment often involves cognitive behavioral therapy, a type of psychotherapy aiming at behavior modification. “We’ve basically taken a model that we use to treat OCD and applied it to this disorder which is so similar,” she said.

Experts say there is a gray area between striving to eat healthy and going to the extreme, which helps to spur skepticism about orthorexia. “People don’t believe how eating healthy can be a disorder,” said Ms. Quinlan.

Sometimes other illnesses can lead to orthorexia. David Rakel, director of integrative medicine at the University of Wisconsin School of Medicine and Public Health, estimated that 10% to 15% of the patients who come in with food allergies and related problems develop an unhealthy fear of particular foods.

Nutritional therapy often involves elimination diets—stopping to eat certain foods to check if they are contributing to an inflammatory condition, Dr. Rakel said. Under the program, the foods are later gradually reintroduced, but some people continue to avoid them. “People are getting so strict with their health choices that they’re not getting the nutrients that they need,” he said.

Some eating-disorder therapists say many of the orthorexia patients they treat also suffer from anorexia. But other experts say orthorexics often aren’t underweight, which can make it difficult to identify them.

“Someone on paper may be perfectly healthy and their blood work is great and their weight is fine but their behavior has become obsessive with food,” said Marjorie Nolan Cohn, a New York City-based dietitian and national spokeswoman for the Academy of Nutrition and Dietetics, a professional organization.

A red flag is when someone’s eating habits are making them avoid social engagements, Ms. Cohn said. “They may not be able to go out to a restaurant with their friends because they don’t know what’s in the food or it’s not cooked in a certain way or what if it’s not organic olive oil?” she said.

Jordan Younger, 24, of Los Angeles, started a popular Instagram and blog last year to post recipes and pictures from her plant-based vegan diet. Then her daily diet became all-consuming.

“I would wake up in a panic thinking, ‘What am I going to eat today?’ ” said Ms. Younger. “I would go to a juice place or Whole Foods or a natural grocery store and would spend so much time in there looking at everything trying to plan out the whole day. It just began to take over my mind in a way that I started to see was unhealthy,” she said.

Ms. Younger, already slim, said she lost 25 pounds on her restrictive diet. Her skin turned orange and she stopped menstruating. In May, she started seeing an eating-disorder specialist and nutritionist who helped her recover.

Now, Ms. Younger said she doesn’t restrict herself from eating anything except for processed food. Her skin has returned to its normal color, her hair has thickened and grown 5 inches and she has put back on her weight.

“With all these different dietary philosophies, there’s a lot more room for orthorexia to develop,” she said. “It makes it really hard to eat if you’re listening to all these theories and it gives eating and food a ton of anxiety when really food should be enjoyable.”



Eating disorders like anorexia nervosa and bulimia often run in families, but identifying specific genes that increase a person’s risk for these complex disorders has proved difficult.

Now scientists from the University of Iowa and University of Texas Southwestern Medical Center have discovered — by studying the genetics of two families severely affected by eating disorders — two gene mutations, one in each family, that are associated with increased risk of developing eating disorders.

Moreover, the new study shows that the two genes interact in the same signaling pathway in the brain, and that the two mutations produce the same biological effect. The findings suggest that this pathway might represent a new target for understanding and potentially treating eating disorders.

“If you’re considering two randomly discovered genes, the chance that they will interact is small. But, what really sealed the deal for us that the association was real was that the mutations have the same effect,” says Michael Lutter, M.D., Ph.D., UI assistant professor of psychiatry and senior author of the study.

Overall, the study, published Oct. 8 in the Journal of Clinical Investigation, suggests that mutations that decrease the activity of a transcription factor — a protein that turns on the expression of other genes — called estrogen-related receptor alpha (ESRRA) increase the risk of eating disorders.

Anorexia nervosa and bulimia nervosa are fairly common, especially among women. They affect between 1 and 3 percent of women. They also are among the most lethal of all psychiatric diseases; about 1 in 1,000 women will die from anorexia.

Finding genes associated with complex diseases like eating disorders is challenging. Scientists can analyze the genetics of thousands of people and use statistics to find common, low-risk gene variations, the accumulation of which causes complex disorders from psychiatric conditions like eating disorders to conditions like heart disease or obesity.

On the other end of the spectrum are very rare gene variants, which confer an almost 100 percent risk of getting the disease. To track down these variants, researchers turn to large families that are severely affected by an illness.

Lutter and his colleagues were able to work with two such families to identify the two new genes associated with eating disorders.

“It’s basically a matter of finding out what the people with the disorder share in common that people without the disease don’t have,” Lutter explains. “From a theoretical perspective, it’s straightforward. But the difficulty comes in having a large enough group to find these rare genes. You have to have large families to get the statistical power.”

In the new study, 20 members from three generations of one family (10 affected individuals and 10 unaffected), and eight members of a second family (six affected and two unaffected) were analyzed.

The gene discovered in the larger family was ESRRA, a transcription factor that turns on the expression of other genes. The mutation associated with eating disorders decreases ESSRA activity.

The gene found in the second family is a transcriptional repressor called histone deacetylase 4 (HDAC4), which turns off transcription factors, including ESRRA. This mutation is unusual in the sense that it increases the gene’s activity — most mutations decrease or destroy a gene’s activity.

Importantly, the team also found that the two affected proteins interacted with one another; HDAC4 binds to ESRRA and inhibits it.

“The fact that the HDAC4 mutation happens to increase the gene activity and happens to increase its ability to repress the ESSRA protein we found in the other family was just beyond coincidence,” Lutter says.

The two genes are already known to be involved in metabolic pathways in muscle and fat tissue. They also are both regulated by exercise.

In the brain, HDAC4 is very important for regulating genes that form connections between neurons. However, there’s almost nothing known about ESRRA in the brain, although it is expressed in many brain regions that are disrupted in anorexia.

Lutter and his colleagues plan to study the role of these genes in mice and in cultured neurons to find out exactly what they are doing in the brain. They will also look for ways to modify the genes’ activity, with the long-term goal of finding small molecules that might be developed into therapies for eating disorders.

They also plan to study patients with eating disorders and see if other genes associated with the ESSRA/HDAC4 brain pathway are affected in humans.