Anorexia: what it is and why it occurs

Wearing a nasogastric tube clinic and continue with his life he supposed feed. Noa Pothoven made the decision not to do it because, in the Netherlands, a person of 16 years can decide that he does not want to receive treatment. After suffering sexual abuse at 11 and 12 years old and being raped at 14, she was diagnosed with post-traumatic stress, depression and anorexia. Noa became famous in the Netherlands in 2018, after the publication of her autobiography, Win or Learn, which she wrote with the hope of helping vulnerable young people.

"If you're anorexicYou're never too thin, "says Carmen, 21, who, like Noa, grew up in terror of getting fat." When they tell you that you're in the bones, you hear it as a compliment. You skip meals, you cheat on the table (pretending that you chew but hiding the food in your pockets), you burn calories by working muscles when you are lying down or doing squats for hours. To that are added the laxatives, the diuretics and the vomiting, always hidden. The worst is the feeling of control over hunger makes you feel good. That's why it's so difficult to get out of this disorder, "he says.

As in the case of Noa, anorexia also endangered Carmen's life. With 1.65 m of height and 16 years, he came to weigh less than 40 kilos. "I had not had my period for months, my hair fell out, I slept poorly, I had arrhythmias and I felt exhausted, but I hid everything. Proanorexia social networks encouraged me"One day, at 16, Carmen fainted and her parents took her to the ER When the doctor told them that she was very likely to die if she was not treated, she was admitted to the hospital. Unit of Eating Disorders of a hospital. "There I followed a treatment and now I'm fine, but I know that, if you are anorexic, you are all of life, like alcoholics"he says.

According to the ACAB (Association Against Anorexia and Bulimia), there are some 400,000 cases of anorexia in Spain and 90% occur in women. Although half of the patients recover, risk behaviors have increased by 20% since social networks exist. "Adolescence is a critical age, especially because of the Pressure of the environment and vulnerability in that stage of life. The problem is that today people see it normal for someone to go on hunger diets without medical control, "explains Sara Bujalance, director of ACAB.

The case of the Russian twins Daria and Maria Ledeneva, aged 14, is typical. The modeling agency that hired them forced them to lose weight. Upon arrival, both weighed more than 50 kilos. They finished with 36 and 40 kilos respectively. Terrified to see them so squalid, her mother tried to enter them in several hospitals, but none wanted to treat them. In the end, a crowfunding campaign allowed her to enter a private clinic in Moscow.

Brain differences

Why girls with anorexia nervosa Are you able to not eat even if you are hungry? That's the million dollar question. "Our theory is that they have specific cerebral specificities", explained specialists from the program for the Study of Eating Disorders at the University of California, San Diego To test their theory, these researchers took brain images of two groups of girls: one who had overcome anorexia and another healthy young Published in the journal Biological Psychiatry, this study showed that the part of the brain that drives you to eat when you're hungry was less active in the girls integrated in the first group.

In addition, the brain circuit that controls intellectual reasoning was more activated in those with a history of anorexia. What does that mean? Well, although they have overcome their disorder, these girls do not feel as stimulated by hunger as the rest. And also, that they have more self-control in the face of temptations.

The weight of the environment

In comparison with girls without anorexia, Those who suffer from it have up to 12 times more risk of dying and almost 60 times more than committing suicide. In fact, anorexia is the Mental illness with higher mortality rates. However, it is very difficult to deal with.

An analysis of 119 studies concluded that, although half of the patients recover, 30% only partially overcome the symptoms and 20% continue with the disorder. "Of course, positive results depend on early intervention.The longer anorexia takes without being diagnosed and treated, the worse the prognosis," the experts insist.

That eating disorders, including anorexia, occur more in women also has to do with cultural and environmental factors. While Thinness continues to be sold as an ideal of feminine beauty, the risk of developing anorexia increases if that woman is young, she perceives her parents as too demanding; Live or work in environments where being thin or practicing competitive sports is highly valued.

Genes and medications

If a few decades ago it was thought that this was a disorder suffered by some girls in response to family, cultural or social conflicts, new studies (such as one conducted with more than 31,000 identical twins) have shown that the genes are also determinants in the risk of suffering it. In fact, if one of the parents has had a psychiatric illness that risk increases markedly.

Anorexia itself has an 80% chance of including depression, anxiety, bipolar disorder, personality problems, attention deficit, obsessive compulsive disorder… Having suffered sexual abuse or abuse also triggers the risk of this disorder.

Luckily, the strategy CBT-E (acronym Cognitive Therapy and Enhanced Behavior) recently developed at the University of Oxford, is proving effective to treat it. Compared to previous treatments, the girls who followed this treatment maintained their improvement in the five years after it. Instead, the cognitive behavioral therapy, how well it works in other psychological disorders, has limited efficacy with anorexia.

The same goes for the SSRI antidepressants (inhibitors of serotonin reuptake), a type of drug commonly used in depression. In fact, although there are no specific drugs to treat anorexia, these patients are medicated. A study of 500 hospitalized girls found that 86% of them took at least one from a list of 41 different drugs. 47% took two; 25% three and 11%, four or more. Y the antidepressants were the most used.

Nutritional deficit

What scientists are now studying is the relationship between nutritional deficits and anorexito. "Micronutrients regulate neurotransmitters and hormones that direct both eating and emotional behaviors, one of which is zinc, present in all the cells of the organism and that intervenes in more than 300 enzymatic functions. In other words: Having adequate levels of zinc is essential for good physical and mental health", said recently the authors of a study published in the International Society for Orthomolecular Medicine.

Although studies of 1970 already related zinc deficit with anorexia, that variable had been little studied until recently. Now, new scientific data supports the use of zinc supplements. As explained by Drs. James Greenblatt and Desiree Delane, of the Walden Center for Behavioral Disorders of the USA. and authors of the work published in ISOM, "the symptoms of zinc deficit are very similar to those of anorexia. They range from problems of physical and sexual development to sensory alterations, loss of appetite and weight, through amenorrhea, altered sense of taste, apathy, depression and irritability. "

The deficit of zinc began to be valued in 1961, when a 21-year-old Iranian who ate only unleavened bread, potatoes and milk developed serious problems of growth and sexual maturation. His rapid response to a treatment with zinc encouraged research into it.

Most trials today recommend a preventive dose of 15 mg of zinc daily, both through food and supplements, and at least two months with doses of between 15 and 20 mg in case of zinc deficit. It is not advisable to exceed 50 mg unless by medical prescription. Refering to dietare rich in zinc Lean meats and poultry, fish and seafood, and eggs. "Although not all cases of anorexia can be related to zinc deficiency, there is evidence that supplementation is useful both for prevention and for treatment.What is clear is that saying" eat and gain weight "does not work. they end up locked in a vicious circle that can lead to progressive deterioration and self destruction. That is why it is urgent to continue investigating, "Desiree Delane concludes.

Other experts cite the importance of zinc for metabolism of the fatty acids and, in particular, of the omega-3 EPA and DHA, essential for manufacturing neuronal membranes and brain function. Present in fish, shellfish, krill and algae, those affected by anorexia are especially deficient in them.

"New studies have linked low levels of omega-3 DHA and EPA with an increased risk of psychiatric disorders, including depression, schizophrenia, attention deficit hyperactivity, bipolar disorder and eating disorders in general, "explains Professor Guillermo Reglero, professor of Food Sciences at the Autonomous University of Madrid.

Luckily, personalized medicine has reached anorexia. "As we know more about the neurobiological processes linked to these disorders, we can innovate in the treatments and make them more specific." With everything and with that, the assistance must always be humanized, because the response improves with a supportive environment. that support must include families, because both anorexia and the rest of eating disorders affect the entire family unit, "says Dr. Montserrat Graell, head of the Psychiatry and Clinical Psychology Service of the Niño Jesús Hospital in Madrid. A Food Behavior Disorders Unit has been in operation in our country for 27 years, and today, in this hospital, they care for more than 200 new patients a year.