Eating Disorders

What is Eating Disorders?

Eating disorders are conditions in which disturbed eating behavior and excessive concern about body weight impair physical health or daily functioning.^[1] They are serious psychiatric illnesses with high rates of illness and death, not lifestyle choices or phases.^{[1, 2]}

The main types are anorexia nervosa, bulimia nervosa, binge-eating disorder and avoidant/restrictive food intake disorder. The diagnostic manual also lists pica, rumination disorder and other specified disorders.^{[1, 3]}

Common symptoms

Symptoms depend on the type. They include restricting food, repeated binge eating, purging by vomiting or laxatives, excessive exercise, and a strong focus on weight and shape.^{[2, 3]}

Physical effects can include electrolyte problems, a slow heart rate, reduced bone density and lower levels of reproductive hormones.^[2] Depression and anxiety are common alongside them.^[2]

Causes and risk factors

Eating disorders have no single cause. Attitudes toward weight, shape and eating play a central role in how they begin and persist, and changes in the food environment have been implicated.^[3] Genetic, psychological and environmental factors all contribute, and researchers still know little about the underlying biology.^[3]

How it is diagnosed and treated conventionally

Clinicians diagnose eating disorders by interview and medical assessment, using DSM-5 criteria, and check for complications such as electrolyte problems.^{[1, 4]} Primary care providers often manage general medical needs.^[4]

First-line treatment is nutritional support, psychotherapy and sometimes medicines.^[2] Family-based treatment helps young people with anorexia nervosa, and cognitive behavioral therapy may be effective, especially for bulimia nervosa and binge-eating disorder. Fluoxetine and other antidepressants can reduce binge episodes in bulimia nervosa, but no effective medicine for anorexia nervosa itself exists.^[2]

People with serious medical or psychiatric complications, such as a very slow heart rate or suicidal thoughts, should be treated in hospital.^[2] Restoring nutrition after prolonged starvation must be supervised, because refeeding can cause dangerous shifts in fluids and electrolytes.^[5]

Why Eating Disorders calls for a whole-person approach

Eating disorders affect the body, mind and relationships together, so treatment needs a team. A physician, a mental health professional and a dietitian each cover a part that no single approach can.

Supportive care can address stress, sleep and anxiety around that core treatment. It cannot treat the disorder, restore weight or stop harmful behaviors.

Mood and anxiety

Mood and anxiety problems often accompany eating disorders. Lifetime depression is reported in about half of people with anorexia nervosa, about two thirds of those with binge-eating disorder and about three quarters of those with bulimia nervosa.^[2] Suicide attempts are also more common than in people without an eating disorder.^[2]

Nutrition and medical stability

Malnutrition, purging and refeeding can disturb electrolytes and heart rhythm. These problems are medical priorities.^{[2, 5]} Any complementary care has to fit around laboratory monitoring and nutrition plans set by the treating team.

Hormones and bone health

Eating disorders can lower estradiol in females and reduce bone density.^[2] These effects are monitored and managed by physicians.

Stress and body tension

Stress and anxiety around eating and body image often add to distress.^[3] A systematic review of complementary therapies in eating disorders found a possible role for acupuncture and relaxation therapy for state anxiety.^[6]

Acupuncture as supportive care in Eating Disorders

What the research shows

The evidence for acupuncture in eating disorders is very limited. No trials show that acupuncture treats an eating disorder or changes eating behavior.

A systematic review of 16 studies of complementary and alternative medicine in eating disorders concluded that its role is unclear. It found a potential role for acupuncture and relaxation therapy for state anxiety, and for massage and bright light therapy for depression in bulimia nervosa. The authors said such therapies should be used only as an adjunct.^[6]

Beyond eating disorders, acupuncture has been studied for depression and insomnia. A Cochrane review of 64 studies found low-quality evidence that acupuncture may reduce depression severity, and a review of 24 trials in insomnia included a meta-analysis of 15 trials that found better sleep quality with acupuncture than with medication.^{[7, 8]} These are general findings and were not tested in people with eating disorders.

How acupuncture may work

How acupuncture might ease anxiety or sleep problems is not established, and no mechanism has been shown specifically for eating disorders. We make no claim that acupuncture affects appetite, weight or the biology of these disorders.

What treatment involves

Treatment uses fine, sterile, single-use needles at points on the body, usually left in place for about 20 to 40 minutes. We reassess after a short course of visits and coordinate with your treating team.

Serious problems from acupuncture are rare. In prospective studies, about 9 in 100 patients had a minor reaction such as brief bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[9] People with a very low body weight, a slow heart rate or electrolyte problems should be stable under medical care first. Tell the practitioner if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture).

Ayurvedic medicine as supportive care in Eating Disorders

The Ayurvedic view

Ayurveda has no category equal to an eating disorder. Loss of appetite and a weak digestive fire (agni) are described in the classical texts, along with stress and an agitated mind, usually tied to Vata imbalance. These are traditional frameworks, not diagnoses, and they do not explain eating disorders.

Therapies that may be used

Alongside your treating team, supportive care may include:

• Regular, calm routines for meals, sleep and rest, matched to the nutrition plan from your dietitian
• Breathing practices and meditation for stress and anxiety
• Gentle warm oil massage

Fasting, cleansing diets, purgation, enemas and Panchakarma are not appropriate for people with eating disorders. They resemble the behaviors that cause harm, and Panchakarma is not appropriate in frailty, acute illness or pregnancy.

What the research shows

We found no trials of Ayurvedic medicine for eating disorders. The evidence is none for the condition itself. Any benefit for stress or anxiety would have to be inferred from studies in other groups, such as a meta-analysis in which ashwagandha, an Ayurvedic herb, reduced stress and anxiety in adults without eating disorders, with low-certainty evidence.^[10] We do not present such an inference as proof.

Ayurvedic products also carry a quality concern. About one fifth of those bought online in one study contained detectable lead, mercury or arsenic.^[11]

Herbal medicine as supportive care in Eating Disorders

Herbs and formulas that have been studied

No herbs or formulas have been shown in trials to treat an eating disorder. A review of nutritional supplements in eating disorders focused on dietary deficiencies rather than herbs, and described current therapies as only partly effective.^[12] Herbs such as ashwagandha are used in Ayurveda for stress and have been studied in general adult populations.

What the research shows

The evidence for herbs in eating disorders is none. For stress and anxiety in general, a meta-analysis of 12 trials found that ashwagandha reduced both compared with placebo, but the certainty was low and results varied widely.^[10] That finding comes from people without eating disorders, so it may not apply.

Safety and herb-drug interactions

Herbs need extra caution in eating disorders. Licorice can cause low potassium and high blood pressure, and its side effects are increased by low potassium, slowed gut transit and anorexia nervosa.^[13] Herbs with weight-loss, appetite-suppressing, laxative or diuretic effects are not appropriate.

Herbs can also interact with medicines, including antidepressants and blood thinners, and may affect the liver.^{[14, 15]} In one study, about one fifth of Ayurvedic medicines bought online contained detectable lead, mercury or arsenic.^[11] Tell us about every medicine and supplement you take.

Translating traditional medicine into modern biological language

The links drawn here are interpretation, not equivalence. Chinese medicine may describe patterns such as spleen deficiency or liver qi stagnation in people with poor appetite and tension. These ideas loosely parallel the biological topics researchers study in eating disorders: stress and anxiety, disturbed nutrition and altered gut and hormone function.^{[2, 3]}

Ayurveda's weak agni and Vata imbalance similarly describe poor digestion and an unsettled mind. No study has shown that a TCM pattern or a dosha corresponds to a specific biological process in an eating disorder.

How this care fits with your medical care

Eating disorders need medical treatment, and our care is supportive only. For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care.

We do not diagnose or manage eating disorders, change medicines or give nutrition plans. Please bring your diagnosis, your treatment team's contact details, recent laboratory and heart test results, and a list of medicines and supplements. Follow the advice of your physician, therapist and dietitian.

When to seek urgent medical care

Eating disorders can become medical emergencies, and some of the signs are easy to miss.

• Fainting, chest pain, a very slow or irregular heartbeat, or severe weakness
• Confusion, seizures or severe dizziness
• Persistent vomiting, or an inability to keep fluids down
• Thoughts of suicide or self-harm (call or text 988, the Suicide and Crisis Lifeline)
• Rapid weight loss or refusal to eat or drink
• Swelling in the legs or trouble breathing after resuming eating

If any of these occur, call 911 or go to the nearest emergency department.