Anorexia Nervosa

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Anorexia Nervosa

 

Anorexia nervosa is an eating disorder typified by a distorted body image, an abnormally low body weight, and an extreme fear of gaining weight.

 

Causes

In many cases, the onset of anorexia nervosa can be attributed to either or both of hereditary and social factors; namely, the cultural stigma associated with obesity.

The disorder usually develops during or slightly prior to adolescence, and is most prevalent in those of middle to upper socioeconomic status.

 

Symptoms and diagnosis

The symptoms of anorexia nervosa will vary greatly, depending on the severity of the disorder. Some mild cases may not even be identified.

The first indication of anorexia nervosa may be a preoccupation with dieting and weight loss. They are preoccupied with food; counting calories, studying diets and cooking for others, while abstaining from consumption.

Some people with anorexia nervosa binge eat then purge, while others restrict their consumption significantly.

Other symptoms of anorexia nervosa include:

·         Severe weight loss;

·         Amenorrhoea – loss of menstruation;

·         Low heart rate, body temperature and blood pressure;

·         Growth of fine soft hair over skin;

·         Bloating and constipation;

·         Erosion of tooth enamel, from excess regurgitation.

Diagnosis of anorexia nervosa is often achieved by physical examination, along with the doctor questioning and evaluating the patient’s mental state; particularly in regard to their weight and body image. Anorexia nervosa is considered to be likely if the patient presents with one or more of the following:

·         Low body weight, or a body mass index (BMI) less than 17.5;

·         Denial of the disorder;

·         Absence of menstruation in women of reproductive age; and

·         Abnormal fear of obesity.

 

Treatment

In severe cases, people with anorexia nervosa are hospitalized to ensure that they consume sufficiently many calories and nutrients. People with milder cases are treated as outpatients, with regular check-ups from a doctor and/or nutritionist.

Other problems arising from poor nutrient intake may also need to be addressed; for example, calcium supplements may be needed for lost bone density. Sometimes psychiatric counseling is also required.

 

Efficacy of Alternative and Other Treatments According to GRADE* Ranking:

Vitamin B Complex [1, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47]:

Please note, this management does NOT treat the condition itself. It may mildly help in preventing some of the symptoms, and even then has insufficient evidence to back up this claim at present. Please note, this acts as a PREVENTATIVE treatment, and not necessarily symptomatic relief. Supplements should only be taken if they contain no more than 100% of the recommended daily value

Recommendation: Strongly in favor (Vitamin B may help in preventing anorexia due to its role in maintaining appetite)

Grade of Evidence: High quality of evidence

Vitamin A [1, 31, 32, 33, 34, 35, 36, 37]:

Please note, this management does NOT treat the condition itself. It may mildly help in preventing some of the symptoms, and even then has insufficient evidence to back up this claim at present. Please note, this acts as a PREVENTATIVE treatment, and not necessarily symptomatic relief.

Recommendation: Strongly in favor (Vitamin A may help in treating/preventing anorexia nervosa due to its role in improving poor appetite)

Grade of Evidence: High quality of evidence

Strychnos Nux-Vomica (Maqianzi, Poison Nut) [1, 28, 29, 30]:

WARNING! This substance is HIGHLY POISONOUS. The seeds contain Strychnine, which may cause convulsions, breathing difficulties and death, even if as little as 5 milligrams is ingested.

Recommendation: Strongly against (There is no evidence in the form of clinical trials which reports the effectiveness of Strychnos Nux-Vomica, because it is highly poisonous to humans, and is not recommended.)

Grade of Evidence: Very low quality of evidence

Saw Palmetto Extract [1, 21, 22, 23, 24, 25, 26, 27]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present. Palmetto extract may cause side effects, though these are uncommon. They may include headache, vomiting, dizziness, constipation, diarrhoea, insomnia or fatigue. Long term effects have not yet been researched.

Recommendation: No recommendation (There is insufficient evidence to support claims that saw palmetto helps to treat anorexia nervosa. More research is needed.)

Grade of Evidence: Very low level of evidence

Mugwort (Artemisa Vulgaris) [1, 18, 19, 20]:

Please note, this management does NOT treat the condition itself. It has been proposed only as a weak supportive symptomatic support, and even then, has been discounted due life-threatening side effects

Recommendation: No recommendation (There is insufficient evidence to support claims that mugwart helps to treat symptoms of anorexia nervosa. More research is needed.)

Grade of Evidence: Very low quality of evidence

Cannabis (Marijuana, weed, hemp) [1, 9, 10, 11, 12, 13, 14, 15, 16, 17]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: Weakly in favor (Evidence shows that smoking or ingesting cannabis may help in relieving symptoms of decreased appetite in anorexia nervosa, and may aid in patients regaining lost weight, although some studies have yielded mixed results)

Grade of Evidence: Low quality of evidence

Goldenseal (Hydrastis Canadensis) [1, 4, 5, 6, 7, 8]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: Weakly against (There is insufficient evidence to support claims that Goldenseal helps to treat anorexia nervosa. More studies are needed. Goldenseal may produce toxic effects, including depression, constipation, rapid heartbeat, stomach pain, mouth ulcers and vomiting.)

Grade of Evidence: Low quality of evidence

Essiac Tea (Flor Essence) [1, 2, 3]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: No recommendation  (available evidence does not support claims that Essiac Tea helps to treat anorexia nervosa)

Grade of Evidence: Low quality of evidence

Red Pepper (Capsaicin):

Please note, this management does NOT treat the condition itself. It is proposed only as a weak supportive symptomatic support, and even then, has insufficient evidence to back up this claim at present.

Recommendation: No recommendation (Available evidence does not support claims that Red Peppers help to treat or prevent anorexia nervosa in any way)

Grade of Evidence: Low quality of evidence

Creative Art Therapy (Expressive Therapy):

Recomendation: Weakly in favor (Studies have shown the benefits of Expressive Therapy on eating disorders like Anorexia Nervosa)

Grade of Evidence: Very low quality of evidence

Vitamin D Supplement [48, 49, 50]:

Recomendation: Weakly in favor (There are some studies that show vitamin D may be able to help treat symptoms of Anorexia Nervosa. More studies are needed)

Grade of Evidence: Low quality of evidence

Calcium Supplement [51, 52, 53, 54]:

Recomendation: Weakly in favor (There are some studies that show calcium supplements may be able to help treat symptoms of Anorexia Nervosa. More studies are needed)

Grade of Evidence: Low quality of evidence

* www.gradeworkinggroup.org

 

Summary References

Treatments:

1. Ades T, Alteri R, Gansler T, Yeargin P, "Complete Guide to Complimentary & Alternative Cancer Therapies", American Cancer Society, Atlanta USA, 2009

2. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/essiac-tea

3.http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-essiac.html

4. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/goldenseal

3. http://nccam.nih.gov/health/goldenseal/

4. Tierra Michael (1998): The Way of Herbs. New York, Pocket Books

5. Grieve M. (1971): A Modern Herbal. New York, Dover Publications, Inc

6. Mills S. and Bone K. (2000): Principles and Practice of Phytotherapy. Philadelphia, Churchill Livingstone

7. Tice Raymond (1997): Goldenseal and Two of its constituent alkaloids: berberine and hydrastine Research Triangle Park, National Institute of Environmental Health Sciences, in Seiger E: Review of Toxilogical Literature

8. http://www.henriettesherbal.com/eclectic/ellingwood/hydrastis.html

9. http://www.nlm.nih.gov/medlineplus/marijuana.html

10. http://nccam.nih.gov/research/extramural/awards/2004/

11. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/marijuana

12. http://www.nationalmssociety.org/about-multiple-sclerosis/what-we-know-about-ms/treatments/complementary--alternative-medicine/marijuana/index.aspx

13. http://www.ncbi.nlm.nih.gov/pubmed/16957511

14. http://www.ncbi.nlm.nih.gov/pubmed/12965981

15. http://www.ncbi.nlm.nih.gov/pubmed/17589370

16. http://mct.aacrjournals.org/content/6/11/2921.long

17. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2562334/?tool=pmcentrez 

18. Anliker MD, Borelli S, Wüthrich B. Occupational protein contact dermatitis from spices in a butcher: a new presentation of the mugwort-spice syndrome. Contact Dermatitis. 2002;46:72-74.

19. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/mugwort

20. Fetrow CW, Avila JR. Professional's Handbook of Complementary & Alternative Medicines. Philadelphia, PA: Lippincott Williams & Wilkins; 2004.

21. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/saw-palmetto

22. http://nccam.nih.gov/health/palmetto/

23. http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-sawpalmetto.html

24. http://www.ncbi.nlm.nih.gov/pubmed/12137626

25. http://www.ncbi.nlm.nih.gov/pubmed/16467543

26. http://www.ncbi.nlm.nih.gov/pubmed/18423748

27. http://www.mayoclinic.com/health/saw-palmetto/NS_patient-sawpalmetto

28. David Michael Wood et al. Case report: Survival after deliberate strychnine self-poisoning, with toxicokinetic data. Critical Care October 2002 Vol 6 No 5

29. Arnold, M.D., Harry L. (1968). Poisonous Plants of Hawaii. Tokyo, Japan: Charles E. Tuttle Co.. p. 20. ISBN 0804804745.

30. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/strychnos-nux-vomica

31. http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-vitamina.html

32. http://www.nlm.nih.gov/medlineplus/vitamina.html

33. http://ods.od.nih.gov/factsheets/vitamina.asp

34. http://www.who.int/nutrition/topics/vad/en/

35. Latham, Michael E. (1997). Human Nutrition in the Developing World (Fao Food and Nutrition Paper). Food & Agriculture Organization of the United. ISBN 92-5-103818-X.

36. Sommer, Alfred (1995). Vitamin a Deficiency and Its Consequences: A Field Guide to Detection and Control. Geneva: World Health Organization. ISBN 92-4-154478-3.

37. http://www.unicef.org/worldfitforchildren/files/A-RES-S27-2E.pdf

38. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/vitamin-b-complex

39. http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-folate.html

40. Butterworth RF. Thiamin. In: Shils ME, Shike M, Ross AC, Caballero B, Cousins RJ, editors. Modern Nutrition in Health and Disease, 10th ed. Baltimore: Lippincott Williams & Wilkins; 2006.

41. http://www.ncbi.nlm.nih.gov/pubmed/18220605

42. http://news.bbc.co.uk/2/hi/health/6935482.stm

43. http://www.ncbi.nlm.nih.gov/pubmed/19061687

44. Gropper, S. S, Smith, J. L., Groff, J. L. (2009). Advanced nutrition and human metabolism. Belmont, CA: Wadsworth, Cengage learning.

45. Otten, J. J., Hellwig, J. P., Meyers, L. D. (2008). Dietary reference intakes: The essential guide to nutrient requirements. Washington, DC: The National Academies Press

46. http://recipes.howstuffworks.com/vitamin-b1.htm

47. Higdon, Jane (2003). "Biotin". An evidence-based approach to vitamins and minerals. Thieme. ISBN 9781588901248.

48. http://www.ncbi.nlm.nih.gov/pubmed/21632810

49. http://jcp.bmj.com/content/41/2/195

50. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3199303/

51. http://press.endocrine.org/doi/full/10.1210/jcem.86.11.8050

52. http://www.niams.nih.gov/Health_Info/Bone/Osteoporosis/Conditions_Behaviors/anorexia_nervosa.asp

53. http://www.andjrnl.org/article/S0002-8223(99)00144-3/abstract

54. http://www.ncbi.nlm.nih.gov/pubmed/8345437


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