Eating Disorders and Dietary Supplements
by Benjamin Bunting BA(Hons) PGCert
Written by Ben Bunting: BA, PGCert. (Sport & Exercise Nutrition) // British Army Physical Training Instructor // S&C Coach.
Eating disorders are serious, potentially life-threatening conditions affecting individuals of all ages. They are characterized by dangerous eating behaviors that prevent your body from receiving enough essential nutrients.
Some activists have cited studies suggesting dietary supplements pose a risk of eating disorders; however, these assertions do not withstand scrutiny by evidence.
What is an Eating Disorder?
Eating disorders are mental illnesses characterized by an obsession with food. Eating disorders can be especially dangerous when leading to extreme weight loss, leading to medical complications as a result. People living with an eating disorder use food as an outlet to cope with emotional and psychological pain; some individuals may be at a greater risk for this illness due to genetics, environment and lifestyle factors interacting.
Anorexia nervosa, bulimia nervosa and binge eating disorder are the three most frequently diagnosed eating disorders; other types may include rumination disorder and avoidant restrictive food intake disorder (ARFID).
People suffering from Bulimia Nervosa often eat large amounts of food quickly, with no control or regulation, before trying to rid their bodies of extra calories by vomiting or using laxatives. This behavior may occur at either a healthy or overweight weight level. People diagnosed with binge eating disorder will eat compulsively, frequently, and indiscriminately; feeling out-of-control during episodes and experiencing regret, shame or guilt afterwards.
Other Specific Feeding or Eating Disorders (OSFED) is a broad classification used to refer to any presentation where symptoms characteristic of an eating disorder cause significant distress or impairment in social, occupational, or other areas of functioning but do not meet all the criteria for any of the specific disorders listed here. For instance, someone suffering from anorexia might only consume certain types of foods due to fears of choking or food poisoning, for instance.
An eating disorder is diagnosed by reviewing a patient's medical history, thought patterns and eating behaviors. Physical exams will also be performed to check heart rate, blood pressure and any signs of illness; depending on its severity, patients may even require hospitalization for medical and nutritional support.
Known Risk Factors for Eating Disorders
Researchers have identified many risk factors for eating disorders, but they cannot pinpoint exactly what causes these illnesses. Unlike other health conditions, such as cancer or diabetes, there are no specific genes that increase the risk for eating disorders. However, genetic vulnerability may increase the chance of developing an eating disorder if there is a precipitating factor, such as dieting or stress.
There are also environmental factors that can contribute to the onset and maintenance of an eating disorder. These include the social and cultural pressures to achieve a certain body type that often tie thinness (for women) and muscularity (for men) to success, happiness and beauty. This pressure can also take the form of peer pressure, particularly among teenagers.
Personality traits can also increase a person’s likelihood of developing an eating disorder. For example, individuals who are highly prone to perfectionism may be at a greater risk for anorexia nervosa or bulimia nervosa. Other personality traits that can be contributing factors include an excessive desire for control, impulsiveness and a fear of abandonment or failure.
Other risk factors for eating disorders include participation in sports and activities that encourage athletes to be thin and quick, such as swimming, gymnastics, wrestling, running and dance. They can also be a risk factor for anorexia nervosa and bulimia nervosa in people who are employed in professions such as fashion modeling or acting, where there is pressure to stay slim and thin.
Dietary Supplement Use in Adolescents
More teens than ever before are turning to supplements in an effort to build muscle, lose weight or enhance athletic performance - but according to a new study published in Journal of Adolescent Health, such supplements could put them at greater risk of serious health problems.
Teenagers trying to gain or lose weight or who use muscle-building supplements like creatine or protein powders are especially prone to experiencing health issues from taking dietary supplements, according to research conducted on national surveys of adolescents.
Researchers discovered that these teens were more likely to experience stomach pain, rashes, allergic reactions, seizures as a result of taking such products than those who didn't take them - sometimes leading to emergency room visits, hospitalization or even death as a result of taking these products.
Slovenian scientists conducted a study involving nearly 1,500 14 to 19 year-old children and adolescents living in Slovenia. Participants were asked about their use and recommendations of dietary supplements; further analysis by gender was then performed on these results.
Results from this study demonstrated that one third of general adolescents were using dietary supplements, with multivitamin/mineral preparations, single ingredient vitamin D supplements, probiotics and melatonin being among the most frequently taken products.
Use of such dietary supplements is cause for concern as they could both alleviate shortfalls while exceeding recommended upper limits.
Athletes at Risk of Eating Disorders
Eating disorders are devastating and sometimes life-threatening illnesses that affect both men and women of all ages, but particularly athletes due to cultural pressures in sports that emphasize weight or appearance (gymnastics, figure skating or wrestling for instance) or require them to meet a particular weight class (such as gymnastics).
Athletes also face an increased risk for eating disorders due to excessive endurance training requirements in certain sports - the former especially can expose athletes to greater risks than most.
Parents, coaches and teammates can also be at risk of encouraging eating disorder behaviors among young athletes. They could place too much focus on dieting to achieve an ideal bodyweight shape or size and promote restrictive and unbalanced exercise patterns that lead to early training in near social isolation and during the daytime hours.
Athletes suffering from eating disorders frequently report feeling that they must hide their symptoms from peers.
If you suspect an athlete may be at risk for an eating disorder, it is essential that they be informed. Discuss this privately and in a supportive manner.
Although initially they may appear defensive and minimize or deny your concerns, early intervention is key for treating eating disorders in athletes effectively. You could refer them to a provider or program with expertise treating such disorders.
Obsessive Compulsive Disorder (OCD)
Obsessive Compulsive Disorder (OCD) is a mental illness affecting individuals of all ages. It produces unwanted, distressing thoughts (obsessions) and an urge to perform actions (compulsions).
People living with OCD know their thoughts are unreasonable but can't stop them. Obsessions often cause feelings of anxiety and tension, disgust, fear or uneasiness that manifest as anxiety-provoking feelings such as tension, tension or disgust; fears related to harming family members or exposure to germs may also play a factor. As such, obsessive-compulsive behaviors often serve to decrease anxiety levels by trying to relieve it through compulsive behavior.
Compulsions, such as washing hands or checking locks, often become time-consuming and repetitive habits that offer no lasting relief. Compulsions may occupy much of a person's day-to-day life, making it hard to work, study or socialise as well as possibly interfering with relationships to the point of dissatisfaction, separation or divorce.
Psychotherapy and behavioral treatments, such as cognitive behavioural therapy and exposure and response prevention may help individuals overcome OCD.
Exposure and response prevention, where people are put into situations which trigger anxiety or compulsive behaviors to help teach them that their fears are unjustified, will teach people that over time their anxiety will lessen over time.
Medication such as selective serotonin reuptake inhibitors (SSRIs), such as Citalopram, Clomipramine, Escitalopram Fluvoxamine or Paroxetine may require 2 - 4 months to start working properly.
Research has identified an association between childhood trauma and OCD and additional studies needed to understand this relationship more fully. Brain imaging studies may indicate differences in certain parts of the brain structure and function as well.
Avoidant/Restrictive Food Intake Disorder (ARFID)
ARFID, first recognized in 2013 in the Diagnostic and Statistical Manual of Mental Disorders' fifth edition (DSM-5), refers to individuals who cannot consume enough calories to meet their nutritional requirements resulting in weight loss, malnutrition, or other health complications.
ARFID often occurs alongside anxiety or depression but may also be related to physical causes like food allergies and digestive illnesses that impede nutrition absorption.
Individuals living with ARFID experience difficulty eating foods and exhibit extreme pickiness regarding certain items, or have no interest in food at all. ARFID can lead to fear-based responses including fear of choking, nausea and vomiting when food is eaten - unlike with other eating disorders which focus on body weight obsession.
Family and friends of those diagnosed with ARFID can often become frustrated due to weight loss and nutritional deficiencies caused by their behavior, particularly when this food sharing practice is considered an honorable gesture in culture. This can create strain in relationships between those diagnosed with ARFID and others in their social circle.
Individuals living with ARFID often require the assistance of professionals in order to overcome this disorder. Therapists can assist by challenging rigid food beliefs and working toward developing healthier relationships with food.
Furthermore, dietitians and primary care providers can provide nutrition advice as well as health advice so as to ensure an individual receiving appropriate nourishment from all sources. Medications typically aren't used as treatments; however a doctor may prescribe nutritional supplements in order to address nutritional deficits caused by ARFID.
People suffering from Bulimia Nervosa often binge-eat, feeling out of control over their food intake. Additionally, they engage in compensatory behaviors to try to stop weight gain, such as making themselves vomit, using laxatives/enemas/fasting or overexercising to prevent weight gain.
Most often those affected with Bulimia have great concern over their body shape or weight; often feeling like society expects them to conform with idealized images in media depicting thin bodies - thus finding it hard to accept normal sizes like anyone else would.
They also tend to suffer low self-esteem/negative body image which often contributes towards depression/other mood disorders.
Binge eating often leaves its participants feeling ashamed or guilty, prompting them to attempt to conceal their behavior by keeping hidden caches of food or wrappers and hiding evidence of purging, such as hiding empty water bottles or inserting breath mints before and after each meal.
Their behavior could lead to multiple episodes of bulimia; typically between 8-13 episodes every week.
Long-term consequences of bulimia include malnutrition, dehydration, irregular heartbeat/cardiovascular issues, dental issues and stomach infections.
Bulimia can reduce natural fertility by leading to menstrual irregularities; damage teeth and bones; as well as decrease reproductive hormone levels leading to amenorrhea (no period).
As soon as they suspect they have bulimia, it is imperative that they seek help from their doctor immediately. Early treatment will make recovery much simpler and reduce long-term complications.
Furthermore, mental health professionals may help identify any emotional or psychological factors contributing to their disorder.
Binge Eating Disorder
Binge eating disorder (BED) is an eating disorder characterized by episodes in which one consumes large quantities of food quickly, feeling out-of-control during and after their binges, feeling shame and guilt afterwards, as well as low self-image, high stress levels and depression levels, poor family support systems.
This may lead to isolation, social avoidance, weight gain and weight gain; those experiencing this eating disorder who are obese or overweight may also have other health problems like heart disease, joint issues and type 2 diabetes.
Eating for comfort or to reduce emotional distress is a natural part of life; however, when it becomes an ongoing way to manage emotions, it can turn into an eating disorder.
People living with this condition may find it hard to ask for help as they believe their condition is minor or out of their control; additionally they often try to hide binge eating by secretly eating more or by lying about how much food is eaten each time.
Quality treatment centers place great emphasis on family involvement. They offer education and therapy sessions for family members to assist their loved one as they work toward recovery, nutritional counseling, medication assistance (Lisdexamfetamine dimesylate/Vyvanse is FDA-approved to treat attention-deficit hyperactivity disorder) as well as medical management of binge eating disorder in adults.
Psychological therapies often prove effective in treating eating disorders, such as cognitive behavioral therapy. Cognitive behavioral therapy helps people change the way they view food and develop healthier coping mechanisms; additionally, therapy sessions teach individuals skills for dealing with stress management, emotional regulation and improving family relations - ultimately leading to improved well-being overall.
Is there a Link between Dietary Supplements and Eating Disorders
It is widely recognized that eating disorders are serious mental health conditions with serious potential health implications, often impacting multiple body systems and leading to medical complications.
Many forms, including bulimia nervosa and binge eating disorder, have links with inadequate or improper nutrition.
Yet some have used questionable research in an attempt to pass laws restricting access to nutritional supplements for people suffering from eating disorders - especially adolescents - this approach fails to take an responsible stance towards this important public health issue.
Each individual who develops an eating disorder faces their own set of risk factors that contribute to its underlying psychopathology.
These can include an inaccurate perception of body shape, low self-esteem and shame, dysfunctional food relationships, familial history of anorexia nervosa or eating disorders in general, poor dietary intake as well as environmental and cultural influences that lead to this illness.
Restricting an individual's access to essential nutritional supplements that promote good health compromises their ability to overcome an eating disorder and may undermine treatment effectiveness, contrary to advice from major health professional organizations that offer guidelines for prevention and treatment of eating disorders.
Legal Strategies for State Action attempts to justify state legislation with claims that some supplements may contribute to eating disorders by providing supposed evidence linking some supplements with developing eating disorders.
They cited an unvalidated survey in which participants from 10 top NCAA Division I universities completed a questionnaire including questions regarding use of ergogenic supplements. Unfortunately this question incorrectly classified these substances as dietary supplements, rendering its answers useless as measures of risk factors associated with eating disorders.
In 2021, the American Academy of Pediatrics issued a clinical report outlining recommended questions for healthcare providers to ask when screening for eating disorders.
While not specifically mentioning dietary supplement use as one factor to be assessed in their report, instead the report suggests focusing on mental health, prescription and nonprescription drug usage, stimulant use and laxative consumption among other things as potential trigger
This is also noted by Academy of Nutrition and Dietetics' guidance for professionals:
"Eating disorder triggers differ according to each eating disorder type, thus placing too much focus on one behavior or substance will miss its mark and be counterproductive".
Can Dietary Supplements Assist Eating Disorder Treatments?
People suffering from eating disorders usually arrive inpatient or residential care severely underweight, often necessitating medically assisted weight restoration.
Gaining weight quickly is often not easy; too rapid weight gain may lead to dangerous electrolyte imbalances and bone loss.
Therefore, doctors typically prescribe dietary supplements as part of treatment to facilitate weight gain, restore bone density and decrease the risk of osteoporosis and other chronic diseases associated with anorexia.
Reintroducing food, including nutritional supplements, is an essential element of eating disorder recovery. But it should be done gradually so that your body has time to adapt and heal itself from years of deprivation and restriction.
For this reason, initial nutritional supplements reintroduced during eating disorder recovery typically include potassium (in the form of either potassium chelate powder capsules or in soluble form), and zinc.
Many supplements used to assist remission from an eating disorder are natural and plant-based; gymnema, an herbal remedy that reduces sugar cravings by blocking receptor locations of sweet taste buds and delaying glucose absorption is one such supplement.
Although some research suggests a relationship between anorexia and diet pill use, evidence does not support such claims. In fact, an American Academy of Pediatrics clinical report from 2021 recommends against asking about such use during an initial screening and assessment for eating disorders.
Eating disorders are associated with severe health complications including death. Their root causes range from psychological, social and biological influences so any attempt at mitigating their effect by targeting only one specific behavior would likely only add fuel to fire.
Dietary supplement abuse or non-use could be seen as a symptom or warning sign of an eating disorder rather than as a risk factor.
Furthermore, research into the relationship between supplements and eating disorders is often poorly designed and has significant limitations.
People suffering from anorexia typically use extreme measures to keep weight control under their control and often become deficient in essential vitamins such as Iodine, Magnesium Calcium or Vitamin D.
Therefore, basing policy decisions off such studies would be irresponsible and could impede progress made through clinically effective preventative and treatment programs.