Anorexia – essentially, self-starvation – was first identified by Dr William Gull in 1874. This is his treatment: ‘The patient should be fed at regular intervals, and surrounded by persons who could have moral control over them, relations and friends being generally the worst attendants.’ Today, treatment is often essentially the same, summed up as ‘drug them, feed them and let them get on with their lives’ in an article in the Guardian describing treatment in ‘leading hospitals’. The ‘modern’ approach includes ‘behaviour therapy’, that is, rewards and privileges, and drugs to induce compliance. The drugs include psychotropic drugs such as chlorpromazine, sedatives and antidepressants. The diet is high carbohydrate, sometimes as much as 5,000kcals, with little regard to quality.
Bulimia is binge eating followed by self-induced vomiting or laxative use, and is probably a more common condition nowadays – although it may also be the easiest to hide, as bulimics may approach or exceed normal weight. Some anorexics are also bulimic. Some bulimics are not anorexic. It is still a food/weight compulsive/obsessive disorder, characterised by:
• Recurrent episodes of binge eating (rapid consumption of large amounts of food in a discrete period of time)
• A feeling of lack of control over eating behaviour during the binges
• The person regularly engages in self-induced vomiting, use of laxatives, diuretics, strict dieting, fasting, or exercise in order to prevent weight gain.
• A minimum average of two binge eating sessions a week.
• Persistent over-concern with body shape and weight.
The Zinc Link
The idea that nutrition, or malnutrition, could play a part in the development and treatment of this condition did not really emerge until the 1980s, when scientists began to realise just how similar the symptoms and risk factors of anorexia and zinc deficiency were (see table below). As early as 1973 two zinc researchers, K. Hambidge and A. Silverman, concluded that ‘whenever there is appetite loss in children zinc deficiency should be suspected’ . In 1979, Rita Bakan, a Canadian health researcher, noticed that the symptoms of anorexia and zinc deficiency were similar in a number of respects and proposed that clinical trials be undertaken to test its effectiveness in treatment . Meanwhile, David Horrobin, most renowned for his research into evening primrose oil, proposed that ‘anorexia nervosa is due to a combined deficiency of zinc and EFAs’ .
More recently, strong evidence has come to light that those with anorexia and bulimia may be more prone to tryptophan deficiency. Tryptophan is the building block for serotonin, the brain’s ‘happy’ neurotransmitter, that also helps control appetite. Zinc Hypothesis Confirmed In 1980, when the zinc link had been reported, the first trial started at the University of Kentucky. The researchers discovered that 10 out of 13 patients admitted with anorexia and 8 out of 14 patients with bulimia were zinc deficient on admission. After vigorous feeding they became even more zinc deficient. Since zinc is required to digest and utilise protein, from which body tissue is made, they recommended that extra zinc, above that required to correct deficiency, should be given as the anorexic starts to eat and gain weight . In 1984 the penny dropped with two important research findings and the first case of an anorexic treated with zinc.
The first study, since confirmed, showed that animals deprived of zinc very rapidly developed anorexic behaviour and loss of appetite, and that if these animals were force-fed a zinc-deficient diet to gain weight, they became seriously ill . The second study showed that zinc deficiency damages the intestinal wall and therefore the absorption of nutrients including zinc, potentially leading to a vicious spiral of deficiency . Then, in 1984, Professor Derek Bryce-Smith, now patron of the Institute for Optimum Nutrition, reported the first case of anorexia treated with zinc. The patient was a 13-year-old girl, tearful and depressed, weighing 37kg. She was referred to a consultant psychiatrist, but, despite counselling, three months later her weight was 31.5kg (under 5 stone). Within two months of zinc supplementation at a level of 45mg per day, her weight returned to 44.5kg, she was cheerful again, and tests for zinc deficiency were normal .
Meanwhile, the first double-blind trial with 15 anorexics was being carried out at the University of California. In 1987 the researchers reported: ‘Zinc supplementation was followed by a decrease in depression and anxiety. Our data suggest that individuals with anorexia nervosa may be at risk for zinc deficiency and may respond favourably after zinc supplementation.’ By 1990, many researchers had found that over half of anorexic patients showed clear biochemical evidence of zinc deficiency . In 1994 Dr Carl Birmingham and colleagues carried out a double-blind controlled trial giving 100mg of zinc gluconate or a placebo to 35 women with anorexia. They concluded that ‘the rate of increase in body mass of the zinc supplemented group was twice that of the placebo group and this difference was statistically significant’ .
Sadly, many treatment centres still fail to supplement those suffering from anorexia with zinc. Zinc: The Chicken or the Egg? The evidence linking zinc and anorexia is now beyond question. In fact, a recent review of all the research concludes: ‘There is evidence that suggests zinc deficiency may be intimately involved with anorexia in humans: if not as an initiating cause, then as an accelerating or exacerbating factor that may deepen the pathology of anorexia.’  The fact that high levels of zinc supplementation help to treat anorexia does not mean the cause of anorexia is zinc deficiency. Psychological issues may, and probably do, bring about change in the eating habits of susceptible people. By avoiding eating, a young girl can repress the signs of growing up. Menstruation stops, breast size decreases and the body stays small.
Starvation induces a kind of &......
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