Supporting People With Eating Disorders Through Nutrition

Eating disorders are common among girls between the ages of 12-20. 13.2% of girls meet the criteria for eating disorders by the age of 20. These are significant numbers. 

Several factors affect the development of eating disorders. These include genetic factors, diet, stress, physical inactivity, drugs, and environmental factors [1]. 

A person with disturbed cognition (including attention, learning, memory, reasoning, judgment, and decision-making problems), disturbed emotional regulation (anger, guilt feelings, fear), and behavioral issues, are more likely to suffer from mental health issues including eating disorders. However, what is not often mentioned, is that nutrition also has much to do with triggering such conditions. 

Although eating disorders clearly cause nutritional deficiencies, nutritional deficiencies are also often at the core of the development of such diseases.

Through my experience with people with eating disorders, I have found that people with eating disorders suffer from two types of nutritional deficiencies:

a) Nutrient deficiencies that lead to their eating disorder, and b) nutrient deficiencies that are formed by the eating disorder. Because dietary interventions are extremely beneficial and relatively easy to incorporate into one’s life and help manipulate brain function and mental health, I recommend parents or caretakers of children prone to eating disorders or other mental health issues to consider supplementing their children with the following nutrients.

To begin with, I will talk about nutritional deficiencies or excesses that may lead to mental health states. Later in this article, I will cover common nutrient deficiencies and health issues that I have witnessed in patients with eating disorders.

Nutrient deficiencies or excesses that may lead to mental health states, including eating disorders:

1. Omega-3 FAs and phospholipid deficiencies:

The brain is of the organs with the most fat in the body. The gray matter in the brain contains 50% polyunsaturated fatty acids, of which around 33% are omega-3 fatty acids, which have to be supplied through one’s diet and transported to the brain. Omega-3 fatty acids have been extensively studied concerning brain health. Omega-3 fatty acids regulate the integrity and fluidity of membranes. But they also play a vital role in nerve cell growth, neurotransmitter function, neural cell survival, and reducing inflammation.

Dietary omega-3 fatty acids play a role in the prevention of some disorders, including mental health disorders. [2-4]

Although the quantities of specific fatty acids may vary, the ratio between omega-6 and omega-3 polyunsaturated fatty acid is what really affects cell membrane health. 

When the diet has sufficient omega-3 fatty acids, depression decreases [5-6].

In general, 1 g daily intake of EPA and DHA is recommended to maintain brain health. [7-10]

What about phospholipids?

These have a principal function in the structural formation of cell membranes. They can also be split to function as messengers in cells.

Altered phospholipids were observed in people with eating disorders and were identified as markers for the possible progression of eating disorders. [11-16]. 

You can add phospholipids and omega-3 fatty acids into your diet either by consuming foods such as chia and flax seeds, walnuts, soy products, and a hard-boiled egg no more than once a week.

2. Unvaried gut microbiome following excessive antibiotic treatment

The brain and the gut can influence each other through the microbiota-gut-brain axis [17-18]. 

Some bacteria of the gut microbiome also produce phospholipids as metabolites. This occurs with the bacteria from the Bacteroidetes group. They produce sphingolipids, a phospholipid. These particular phospholipids made from these bacteria are essential for gut health. A lack of these phospholipids resulted in increased intestinal inflammation leading to mental decline. [19]. This lack can be caused when taking antibiotics.

Therefore, I recommend taking probiotic supplements that have bacterial strains from the Bacteroidetes group. These are usually found in probiotic supplements that have at least ten different bacterial strains in them. Check the ingredients to be sure.

3. B vitamin deficiency

The B vitamins are involved in energy metabolism, and the B vitamins, niacin, folate, B6, and B12, also affect mental health. The ‘homocysteine hypothesis’ states that high levels of homocysteine cause the development of psychiatric symptoms. Folate, vitamin B6, and vitamin B12 are involved in homocysteine metabolism. Low levels of these vitamins lead to high levels of homocysteine which has been shown to lead to mental health conditions. Elevated homocysteine levels are typical among people with eating disorders and depression [20-24]. High homocysteine levels increase brain toxicity and free radical damage in the brain [25-26]. 

Niacin (vitamin B3) deficiency has also been connected to psychiatric disorders, mainly behavioral deterioration, which is recovered by niacin supplementation [27]. I recommend supplementing with a B complex supplement which has all of the B vitamins in it.

Ensure that in the B complex supplement you choose one with at least 0.8 mg of folic acid per day and 0.4 mg of vitamin B12 per day to reduce mental health symptoms [28]. Also, ensure that niacin is in the form of nicotinamide riboside in the supplement as this has a brain-protecting effect.

One study found it beneficial to take B complex supplements daily for one year. [29]

4. Excess of saturated fat 

Fat is often seen as a negative macronutrient. However, there is a growing understanding of dietary phospholipid and other fats’ positive effects on brain health. This is most notable in studies investigating the ability of phospholipids to improve cognition across lifespan also in disease states. But not all fats are equal in their ability to support brain health. Most saturated animal fats and trans fats have a devastating effect on brain health and influence drivers of mental disease and eating disorders.

Most dietary saturated fats and definitely a Western-style diet may impair cognitive function [30-32] and reduce mental health indicators.

Much research has shown that saturated fat harms mental health.

Dietary interventions are helpful and easy tools to manipulate brain function. Therefore, I recommend removing the unhealthy saturated fats from your diet by removing dairy products completely, and instead consuming any type of lentils, beans, or peas, while consuming one egg and meat only once per week. There is no physiological need for more, and meat and dairy products, being rich in unhealthy fats, will harm health in general, including mental health issues. By adding nuts and seeds, even though they are rich in fats, you are supporting brain health and not leading to weight gain, a threat any person with the urge and inclination for eating disorders is fearful of.

Nuts, seeds, and sea vegetables are rich in healthy fats that support phospholipid production and are rich in omega-3 fatty acids that do not lead to weight gain. On the other hand, dairy products will lead to weight gain as this is their primary role when supplied to the baby. They lead to weight gain and inflammation when consumed by adults. 

5. Too few whole carbohydrates and too many simple sugars 

Carbohydrates play a vital role in the structure and function of the human body and affect brain health, mood and behavior. Eating a carbohydrate-rich meal will trigger insulin release in the body. Insulin helps let blood sugar into cells where it can be used for energy, and simultaneously it supports the entry of tryptophan into the brain. Tryptophan in the brain leads to feelings of well-being as it leads to the production of serotonin.

Diets low in healthy, whole carbohydrates are hazardous for brain health, increasing the risk for mental illnesses and metabolic disorders, including diabetes and heart diseases [4]. 

This is because the production of serotonin from carbohydrate-rich meals that promote feelings of well-being is lacking in such diets. 

Carbohydrates with low glycemic indexes, including some vegetables, raw fruits, whole grains, whole grain pasta, whole grain bread, etc., provide a moderate but lasting effect on brain health and function, mood, and energy levels, as opposed to high glycemic index foods which include primarily sweets, cakes, cookies, and processed foods. These provide immediate but temporary relief.

People prone to mental health issues, including eating disorders, should consume a carbohydrate-rich whole-grain breakfast daily with nut spreads. Lunch and dinner should also have whole grain carbohydrates to prevent hunger that leads to binge eating. Whole carbohydrates also do not lead to weight gain reducing this fear. These whole carbohydrates also influence the microbiome to produce a relaxing effect on the brain, preventing mental health issues from escalating.

Deficiencies that form in people with eating disorders:

When people engage in eating disorders, such as refusal to eat certain foods, controlling meal portions, and purging, they have damaging consequences that affect the body. Restricting food intake for prolonged periods can lead to chronic malnutrition and nutrient deficiencies. I have seen many blood test results of people with eating disorders, and the results were similar. Here are the common deficiencies and how you should supplement to prevent the spiraling adverse health effects of such deficiencies: 

1. Iron deficiency

Iron is necessary for oxygenation, energy production, nerve impulse production, and nerve fiber protection. Iron deficiency leads to clinical depression, apathy, and tiredness especially when exercising.[33]

Because of iron deficiency and the loss of weight, often, women with eating disorders stop menstruating.

I recommend doing a complete blood count test to check hemoglobin and hematocrit levels. Depending on the results, I recommend taking “gentle iron” (iron bisglycinate) that does not cause constipation if needed. The dose should be decided upon after results are received. If you need help with dosages, I offer two consulting options on my website theguerrilladiet.com/consult

2. Magnesium deficiency

I have seen magnesium deficiency in some of my clients with eating disorders, but not in all clients. Several studies have shown magnesium to be helpful in neurological and psychiatric diseases because of its roles in brain function, mood, and optimal nerve transmission. Furthermore, magnesium is associated with the structure of membrane phospholipids.

Studies show that magnesium levels are lowered in some mental disorders, but deficiency does not affect everyone. That being said, from the available evidence, supplementation with magnesium can be beneficial. Therefore I recommend supplementing with 200 mg magnesium daily before bedtime. The rest can come from the diet.

3. Zinc deficiency

Researchers found zinc to have the highest deficiency prevalence in a study on 374 severely malnourished patients diagnosed with anorexia nervosa. [34] The team from the Nutrition Unit at the Raymond Poincaré University Hospital in Paris discovered that 64.3% of patients had zinc deficiencies.  

Common symptoms of zinc deficiency include hair thinning, dry skin, stunted growth, impaired immune function, and recurring infections. Because zinc deficiencies may also lead to a decreased ability to taste food, the condition also causes loss of appetite.

Studies also show lower zinc levels in people with clinical depression.[35-36] Zinc also protects the brain cells against potential damage caused by free radicals. I recommend supplementation for a limited period with 15 to 30 mg zinc picolinate daily in the evening 1 hour after food.

4. Copper deficiency

According to a study on micronutrient deficiencies, copper had another of the highest deficiency prevalences in severely malnourished patients diagnosed with anorexia nervosa.

Copper deficiency symptoms are similar to vitamin B12 deficiency, including pale skin, constantly feeling cold, easy bruising, unexplained muscle soreness, and skin inflammation. Severely low levels of copper also lead to easy bone breakage and poor muscle movement. Copper is found in abundance in spirulina. One tablespoon of spirulina provides all of the daily recommended intakes for copper and supplies many other essential nutrients. I recommend taking one tablespoon a day of spirulina added to water. 

Also, a handful of cashews or almonds provide sufficient copper a day, and all leafy green vegetables are rich in copper.

5. Selenium deficiency

Zinc, copper, and selenium had the highest deficiency prevalence in an extensive study that followed patients with eating disorders and malnutrition between 2011 and 2017. Over 20% of the almost 400 patients had selenium deficiency. Another study showed that selenium deficiency was the most frequent deficit among people with eating disorders.

As an antioxidant, selenium plays a crucial role in healthy brain functioning. Low levels of selenium cause hair loss, weakened immune system, mental fog, muscle weakness, and chronic fatigue. Selenium deficiencies can also lead to infertility in men and women. 

In an extensive review, it was shown that low selenium levels were associated with lowered mood status.[37] 

Intervention studies with selenium show that selenium, being an antioxidant, not only improves immune health but also improves mood and diminishes anxiety. But why is this important? Because depression and anxiety are frequent comorbid conditions common in people with eating disorders [38-40]

Chronic malnutrition leads to antioxidant deficiencies and increased oxidative stress in patients with anorexia. Careful supplementation of selenium during refeeding is warranted in anorexia patients to reduce oxidative stress. [41-43]

6. Vitamin D deficiency

A study on the link between vitamin D deficiencies and eating disorders observed 236 patients between 2014 and 2018. Those with impulse behaviors related to their eating disorders were found to have lower vitamin D levels. [44]

Vitamin D is essential for many aspects of health including mental health. Vitamin D deficiency symptoms often include muscle cramps or weakness, bone, and joint pain, twitching, and fatigue. People with low levels of vitamin D often experience mood swings.

I recommend supplementing according to the instructions in my video on vitamin D here

7. Thiamine (Vitamin B1) deficiency 

Thiamine is an important cofactor in biochemical pathways. Malnutrition, as seen in all types of eating disorders, is a well-known predisposing factor for thiamine deficiency. People with low levels of thiamine experience loss of appetite, chronic fatigue, muscle weakness, irritability, and neuropsychiatric diseases. Some people with thiamine deficiencies have also reported blurry vision, reduced reflexes, and loss of sensation in their extremities. [45-46]

Patients hospitalized with restrictive eating disorders typically receive thiamine supplementation. [47] I recommend taking a B complex supplement that has all of the B vitamins according to my recommendations above in the section about common deficiencies that lead people to mental health disorders.

8. High cholesterol 

I often witness high cholesterol levels in patients with anorexia. It is thought to be caused by severe loss of body fat leading to changes in thyroid hormones, increased fat breakdown, and decreased production of cholesterol in the body. These lead to reduced LDL removal of fats. Also, it has been suggested that there may be changes in the absorption of fats, there is higher rates of fat absorption from foods. This may lead to alterations of the gut microbiome in people with anorexia nervosa.

With an increase in body fat naturally following a wholesome whole-food, primarily plant-based diet, the hormone, and cholesterol levels will slowly come back to normal. 

9. High blood sugar levels

Hyperglycemia and poor glucose control may occur during the refeeding time after the person with anorexia nervosa get treatment. However, this period of high blood sugar levels lasts only for a few weeks during the refeeding program.

If the hyperglycemia is not excessive (meaning blood glucose levels remain under 250 mg/dL), it is considered “permissive hyperglycemia,” allowed during the refeeding program of a person with anorexia nervosa. However, this should be monitored after the person leaves the program and goes back to daily life. Also, increased insulin sensitivity was witnessed in people with eating disorders often leading to hypoglycemia and then hyperglycemia. [47-48]

Takeaway

Eating disorders may be caused by nutritional deficiencies in people prone genetically and environmentally to eating disorders. To prevent these conditions from taking off, I recommend parents and caretakers to keep their eyes open for any signs of mental health issues during adolescence.  If there is a fear of the development of an eating disorder or mental health issue, parents and caretakers should not become complacent and try to prevent the downward spiral of these disorders by paying close attention to dietary habits and nutrient supplies as mentioned above and supplementing where necessary.

People suffering from eating disorders have negative health consequences, particularly malnutrition, which presents various symptoms related to nutrient deficiencies, including zinc (found to be deficient in 64.3% of those with eating disorders), copper (in 37.1%), selenium (in 20.5%), vitamin D (in 54.2%), vitamin B1 (in 15%), vitamin B12 (in 4.7%), and vitamin B9 (in 8.9%). [49]

Surprisingly, many people with eating disorders don’t always appear underweight, despite the severely low nutrient levels in their bodies. Therefore, they should be supported nutritionally for a speedy and complete recovery.

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