Sunday, 1 December 2013

Eating Disorders: Bulimia nervosa - Causes and risk factors

Bulimia nervosa is defined as a medical condition of  consuming a large amount of food in a short amount of time or one setting (binge eating), followed by self induced vomiting, taking a laxative or diuretic and/or excessive exercise, etc. to compensate for the binge. Bulimia nervosa also effects almost 90% of female. Unlike anorexia nervosa, people suffering from bulimia nervosa are usually normal or slightly over weight.
Causes and risk factors
A. Causes
The causes of bulimia vervosa is unknown but in  the study to examine the beliefs of women concerning causes and risk factors for eating-disordered behaviour, showed that having low self-esteem' was considered very likely to be a cause of BN by 75.0% of respondents, and the most likely cause by 40.5% of respondents. Other factors perceived as significant were 'problems from childhood', 'portrayal of women in the media', 'being overweight as a child or adolescent' and 'day-to-day problems', while genetic factors and pre-existing psychological problems were perceived to be of minor significance. Most respondents believed that women aged under 25 years were at greatest risk of having or developing BN(9).

B. Risk factors
1. Gender
It you are female, you are at 90% higher risk to develop bulimia nervosa.
2. Age 
In both anorexia nervosa and bulimia nervosa, age at onset showed a significant decrease according to year of birth(10)
3.  Social pressure
The fear of become fat due to wrongly influent in the western society where attractiveness is equal to thinness
4. Family history
If one the member of your direct family has bulimia nervosa, you are at increased risk to have that disease as well.
5. Migraine
Dr. D'Andrea G, and the research team at the Biochemistry Laboratory for the Study of Primary Headaches and Neurological Diseases, Research and Innovation S.p.A suggest that migraine may constitute a risk factor for the occurrence of ED in young females. This hypothesis is supported by the onset of migraine attacks that initiated, in the majority of the patients, before the occurrence of ED symptoms, in the study of Is migraine a risk factor for the occurrence of eating disorders? Prevalence and biochemical evidences(11).

6. Obstetric complications
Researchers found that several complications, such as maternal anemia (P = .03), diabetes mellitus (P = .04), preeclampsia (P = .02), placental infarction (P = .001), neonatal cardiac problems (P = .007), and hyporeactivity (P = .03), were significant independent predictors of the development of anorexia nervosa. The risk of developing anorexia nervosa increased with the total number of obstetric complications, the obstetric complications significantly associated with bulimia nervosa were the following: placental infarction (P = .10), neonatal hyporeactivity (P = .005), early eating difficulties (P = .02), and a low birth weight for gestational age (P = .009). Being shorter for gestational age significantly differentiated subjects with bulimia nervosa from both those with anorexia nervosa (P = .04) and control subjects (P = .05)(12).

7. DRD4 gene
Although there is no evidence of the direct association between DRD4 gene and bulimia nervosa, researchers suggested that its variants are associated with a history of childhood ADHD in BN probands. This may have relevance for the understanding, prevention, and treatment of BN that evolves in the context of childhood ADHD(12a).

8. Other risk factors includes
Low self-esteem', 'problems from childhood', 'portrayal of women in the media', 'being overweight as a child or adolescent' and 'day-to-day problems', while genetic factors and pre-existing psychological problems(13) 

9. Etc.
 
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Sources
(9) http://www.ncbi.nlm.nih.gov/pubmed/15209840
(10) http://www.ncbi.nlm.nih.gov/pubmed/20141711
(11) http://www.ncbi.nlm.nih.gov/pubmed/22644175
(12) http://www.ncbi.nlm.nih.gov/pubmed/16389201
(12a) http://www.ncbi.nlm.nih.gov/pubmed/22271608 
(13) http://www.ncbi.nlm.nih.gov/pubmed/15209840

Eating Disorders: Bulimia nervosa - Symptoms and Signs

Bulimia nervosa is defined as a medical condition of  consuming a large amount of food in a short amount of time or one setting (binge eating), followed by self induced vomiting, taking a laxative or diuretic and/or excessive exercise, etc. to compensate for the binge. Bulimia nervosa also effects almost 90% of female. Unlike anorexia nervosa, people suffering from bulimia nervosa are usually normal or slightly over weight.

II. Symptoms and Signs
A. Symptoms
A.1. Binge Eating Symptoms
1. Eating and impulsive behavioral symptoms
In the study of the implications of impulsivity in its relationship with binge-eating or purging behaviors, with all participants (n=180) asked to complete a series of self-reported inventories of impulsive behaviors and other psychological measures. Dr. Tseng MC and  Hu FC. at National Taiwan University Hospital and National Taiwan University College of Medicine showed that three latent classes of bulimic women were identified. These were women who exhibited relatively higher rates of purging, symptoms of impulsive behavior, and multiple purging methods (17.8%), women who used no more than one purging method with a low occurrence of impulsive behavior (41.7%), and women who showed higher rates of purging behaviors and the use of multiple purging methods with a low rate of impulsive behavior (41.7%). The impulsive sub-group had comparable severity of eating-related measures, frequency of binge-eating, and higher levels of general psychopathology than that of the other two sub-groups(1).

2. Greater fat consumption
In the study to investigate the association of fruit, vegetable, and fat consumption to binge eating symptoms in African American (AA) and Hispanic or Latina (HL) women. AA and HL women in the Health Is Power (HIP) study (N=283) reported fruit and vegetable intake, fat intake, and binge eating symptoms. Women were middle aged (M=45.8 years, SD=9.2) and obese (M BMI=34.5 kg/m(2), SD=7.5). Greater fat consumption was correlated with lower fruit and vegetable consumption (r(s)=-0.159, p<0.01). Higher BMI (r(s)=0.209, p<0.01), and greater fat consumption (r(s)=0.227, p<0.05) were correlated with increased binge eating symptoms. Multiple regression analysis demonstrated that for HL women (β=0.130, p=0.024), higher BMI (β=0.148, p=0.012), and greater fat consumption (β=0.196, p=0.001) were associated with increased binge eating symptoms (R(2)=0.086, F(3,278)=8.715, p<0.001). Findings suggest there may be a relationship between fat consumption and binge eating symptoms, warranting further study to determine whether improving dietary habits may serve as a treatment for BED in AA and HL women(2).

3.  Depression and/ or anxiety and eating preocuoation
Binge eating is often triggered by stress, depression, or other negative emotions. Compared with the normal-eater group, the BS(either BN or normal weight Eating Disorder NOS with regular binge eating or purging) women demonstrated significantly less dexamethasone suppression test (DST) suppression. Among BS women, DST non-suppression was associated with more severe depression, anxiety and eating preoccupations. BS women to show less DST suppression compared to normal eater women, and results link extent of non-suppression, in BS individuals, to severity of depression, anxiety and eating preoccupations(3).

4. Other symptoms include
In the study of among the 3,714 women and 1,808 men who responded, men were more likely to report overeating, whereas women were more likely to endorse loss of control while eating. Although statistically significant gender differences were observed, with women significantly more likely than men to report body checking and avoidance, binge eating, fasting, and vomiting, effect sizes ("Number Needed to Treat") were small to moderate(4). Other studies indicated that increasing evidence shows that the combination of ubiquitous ads for foods and emphasis on female beauty and thinness in both advertising and programming leads to confusion and dissatisfaction for many young people and have revealed a link between media exposure and the likelihood of having symptoms of disordered eating or a frank eating disorder(5).

5. Etc.

A.2. Purging Symptoms
Women who develop the Bulimia vervosa may consider purging as a method of regaining control of themselves after binge eating of that can lead to
1. Damage to teeth and gum as a result of self induced vomitting causes of acid exposure
2. Dehydration due to self induced vomiting
3. Fatigue due to nutrients deficiency
4. Irregular heart beat as a result of dehydration cause of low levels of potassium due to self induced vomiting.
5. Colon damage as a result of laxative abuse
6. Gastrointestinal symptoms
In bulimic patients, the most commonly reported gastrointestinal symptoms were bloating (74.4%), flatulence (74.4%), constipation (62.8%), decreased appetite (51.2%), abdominal pain (48.8%), borborygmi (48.8%), and nausea (46.5%). The average symptom score (sum of severity ratings) on the gastrointestinal symptoms questionnaire decreased from 20.6 +/- 10.8 (mean +/- SD) on admission to 13.46 +/- 10.5 (t(27) = 3.31, p < 0.01) on discharge but remained significantly higher than that of the control group (4.4 +/- 6.2, t(43) = 4.02, p < 0.001). However, the severity of reported gastrointestinal symptoms was correlated with the severity of depression (r = 0.43, p < 0.05), and when the possible mediating effects of depression on gastrointestinal symptoms were controlled statistically (analysis of covariance), the effects of treatment on gastrointestinal symptoms were not statistically significant. Dr. Chami TN, and the research team at Florida Medical Clinic indicated(6).

A.3. Psychological  symptoms 
In the review of symptoms of Bulimia vervosa, most of reviews have focused on reductions of binge eating and purging; however, the cognitive model of BN that underlies the CBT approach identifies three additional symptoms as central to the disorder: restrictive eating, concerns with shape and weight, and self-esteem(7).
Other suggested that Binge eating is often triggered by stress, depression, or other negative emotions. Compared with the normal-eater group, the BS(either BN or normal weight Eating Disorder NOS with regular binge eating or purging) women demonstrated significantly less dexamethasone suppression test (DST) suppression. Among BS women, DST non-suppression was associated with more severe depression, anxiety and eating preoccupations. BS women to show less DST suppression compared to normal eater women, and results link extent of non-suppression, in BS individuals, to severity of depression, anxiety and eating preoccupations(8).

A.4. Non Purging technique
Although many bulimics use purging technique, others may engage in excessive exercise and fasting  to prevent weight gain.

B. Signs
People with Bulimia vervosa are very good in hiding the health problems and related symptoms, but some possible signs of a person may have bulimia nervosa include:
1. Eats in isolation
2. Frequent sore throats from vomiting
4. Gastrointestinal symptoms
5. Feelings of withdrawal
6. Frequently spending time alone and wanting privacy
7. Obsession with food, dieting and exercise
9. Mood swings and irritability
10. Perfectionism
11. Etc.

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Sources
(1) http://www.ncbi.nlm.nih.gov/pubmed/22200525
(2) http://www.ncbi.nlm.nih.gov/pubmed/22365808
(3) http://www.ncbi.nlm.nih.gov/pubmed/22575215
(4) http://www.ncbi.nlm.nih.gov/pubmed/19107833
(5) http://www.ncbi.nlm.nih.gov/pubmed/19227390
(6) http://www.ncbi.nlm.nih.gov/pubmed/7801956
(7) http://www.ncbi.nlm.nih.gov/pubmed/11584518
(8) http://www.ncbi.nlm.nih.gov/pubmed/2257521

Thyroid Disease : Euthyroid sick syndrome as a result of Sepsis - The Complications

Euthyroid sick syndrome is defined as a condition of  low T3 low T4 syndrome. According ot the study by the Mayo Clinic, in  other word this is the abnormalities of thyroid hormone concentrations seen commonly in a wide variety of nonthyroidal illnesses, resulting in low triiodothyronine, total thyroxine, and thyroid stimulating hormone concentrations(a). Decreased triiodothyronine (T3) levels are most common. Patients with more severe or prolonged illness also have decreased thyroxine (T4) levels. Serum reverse T3 (rT3) is increased. Patients are clinically euthyroid and do not have elevated thyroid-stimulating hormone (TSH) levels(b). Causes of euthyroid sick syndrome include a number of acute and chronic conditions, including pneumonia, fasting, starvation, sepsis, trauma, cardiopulmonary bypass, malignancy, stress, heart failure, hypothermia, myocardial infarction, chronic renal failure, cirrhosis, and diabetic ketoacidosis and inflammatory bowel disease(c). Others, in the study of classified SES into 3 subgroups according to the different alterations seen in the values of T3, T4, FT3, FT4, TSH, rT3 and TBG suggested that in SES type I the diseases seen, in order of frequency, were: obstructive chronic bronchopneumopathy with acute respiratory failure, diabetic ketoacidosis, neoplasms, ischemic heart disease, cardiac failure, chronic renal failure, liver diseases, acute cerebral vasculopathies, sepsis and collagenopathies. The disease seen in the 2 cases of SES type II was obstructive chronic bronchopneumopathy with acute respiratory failure. In SES type III the diseases seen were, in order of frequency: diabetic ketoacidosis, lung diseases, ischemic heart disease, cardiac failure, peripheral arteriopathies, acute cerebral vasculopathies, neoplasms, liver diseases, acute renal failure(d).
Euthyroid sick syndrome as a result of Sepsis 
C.1. Complications of Sepsis
1. Impaired wound healing 
Sepsis is one of the main causes for morbidity and mortality in hospitalized patients. Moreover, sepsis associated complications involving impaired wound healing are common(19).

2. Damage to Peripheral nerves and skeletal muscles
Among the critical illness myopathies, three main types have been identified: a non-necrotizing "cachectic" myopathy (critical illness myopathy in the strict sense), a myopathy with selective loss of myosin filaments ("thick filament myopathy") and an acute necrotizing myopathy of intensive care. Clinical manifestations of both critical illness myopathies and CIP include delayed weaning from the respirator, muscle weakness, and prolonging of the mobilization phase, according to the study by Ruprecht-Karls University, Heidelberg(20).

3. Organs failure
Bacterial translocation is the invasion of indigenous intestinal bacteria through the gut mucosa to normally sterile tissues and the internal organs. Bacterial translocation may be a normal phenomenon occurring on frequent basis in healthy individuals without any deleterious consequences. But when the immune system is challenged extensively, it breaks down and results in septic complications at different sites away from the main focus. The factors released from the gut and carried in the mesenteric lymphatics but not in the portal blood are enough to cause multi-organ failure, according to Postgraduate Institute of Medical Education and Research(21).

4.  Morbidity and mortality
Acute kidney injury (AKI) is a common and often catastrophic complication in hospitalized patients; however, the impact of AKI in surgical sepsis remains unknown. We used Risk, Injury, Failure, Loss, End stage (RIFLE) consensus criteria to define the incidence of AKI in surgical sepsis and characterize the impact of AKI on patient morbidity and mortality(22). Other study indicated that in patients with sepsis who are admitted to an ICU, cardiac troponin T elevations are independently associated with in-hospital and short-term mortality but not long-term mortality(23).

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Sources
(a) http://en.wikipedia.org/wiki/Sepsis
(b) http://www.mayoclinic.com/health/sepsis/DS01004 
(c) http://www.ncbi.nlm.nih.gov/pubmed/24082613   

(19) http://www.ncbi.nlm.nih.gov/pubmed/24086305
(20) http://www.ncbi.nlm.nih.gov/pubmed/11757954
(21) http://www.ncbi.nlm.nih.gov/pubmed/24064638 
(22) http://www.ncbi.nlm.nih.gov/pubmed/24089113 
(23) http://www.ncbi.nlm.nih.gov/pubmed/24083646 

 

Anorexia nervosa - Treatments In Traditional Chinese medicine perspective

Anorexia nervosa
Anorexia nervosa is a type of eating disorder usually develop in the teen years and effect over 90% of female, because of excessive food restriction and irrational fear to become fat due the wrongly influenced media as attractiveness is equated to thinness.
Treatments
In traditional Chinese medicine  
According to Perspectives on Eating Disorders and Traditional Chinese Medicine Norman Kraft, LST, DCH, MTOM, Dipl.Ac., L.Ac(60) 
1. Kidney deficiency 
a. Kidney deficiency (primarily of Yin and Essence) leads to Empty Fire (pathological Will) and poor control of the Heart’s Fire.
b. Chinese herbal formula: Liu Wei Di Huang Wan, ingredients include
b.1. Sheng Di Huang (Rhemannia) 15-20 gm
b.2. Shan Zhu Yu (Cornus) 12-15 gm
b.3. Shan Yao (Dioscorea) 10-15 gm
b.4. Ze Xie (Alisma) 9-12 gm
b.5. Mu Dan Pi (Moutan) 6-9 gm
b.6. Fu Ling/Fu Shen (Poria/Poria Spirit) 9-12 gm
Fu Shen is preferred over Fu Ling in this formula

2.   Kidney Yang Deficiency 
a. But One must be careful in using Yang tonics and warming herbs with bulimia in particular, for while the overall picture may be Yang Deficiency the constant abuse of the stomach tends to quickly lead to Stomach Yin Deficiency with Heat.
b. Chinese herbal formula: Jin Gui Shen Qi Wan, ingredients include
b.1. Fu Zi (Aconite) 6 gm
b.2. Rou Gui (Cinnamomum)  6 gm
b.3. Shu Di Huang (Rehmannia) 20-30 gm
b.4. Shan Zhu Yu (Cornus)  10-15 gm
b.4. Mu Dan Pi (Moutan) 10-12 gm
b.4. Fu Ling/Fu Shen (Poria/Poria Spirit) 10-15 gm
b.5. Shan Yao (Dioscorea) 10-15 gm
b.6. Ze Xie (Alisma) 10-15 gm

3. Fire/Heart deficiencies
a. Fire/Heart deficiencies than Water/Kidney issues,
b. Chinese Modification of Gui Pi Tang, ingredients
b.1. Ren Shen (Ginseng) 6-9gm
b.2. Huang Qi (Astragalus) 9-12gm
b.3. Bai Zhu (Atractylodes)  9-12gm
b.4. Dang Gui (Angelica) 6-9gm
b.5. Fu Shen (Poria) 6-9gm
b.6. Suan Zao Ren (Zizyphus) 9-12gm
b.7. Long Yan Rou (Euphoria) 9-12gm
b.8. Yuan Zhi (Polygala) 3-6gm
b.8. Mu Xiang (Saussurea) 3-6gm
b.9. Zhi Gan Cao (Glycyrrhiza)  3-6gm
b.10. Hong Zao (Jujuba) 3-5 pc
b.11. Bai Zi Ren (Biota) 6-9gm
b.12. He Huan Pi (Albizzia) 6-9gm
b.13. Shi Chang Pu (Acori) 6-9gm
b.14. Bai He (Lilii) 6-9gm

4. The author also notes that with care in formulation taking into account the cold temperature of the herb, Bai He could be added to the other two formulas above as well. In Liu Wei Di Huang Wan I usually combine Bai He with Zhi Mu (Anemarrhena) as these two herbs work very well together to calm Shen disturbed by interior Heat due to Deficiency of Yin.

Eating Disorders At Home - A Parent's Guide
An Invaluable Resource For Parents Of Sufferers Of 
Anorexia Or Bulimia, And Other Eating Disorders. Critical Information 

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Sources
(60) http://www.myacudoc.com/images/ED.article.pdf

Anorexia nervosa - Treatments In Herbal medicine perspective

Anorexia nervosa
Anorexia nervosa is a type of eating disorder usually develop in the teen years and effect over 90% of female, because of excessive food restriction and irrational fear to become fat due the wrongly influenced media as attractiveness is equated to thinness.
Treatments
In herbal medicine perspective

Herbs can be used to strengthen and tone the body's systems.
1. Ashwagandha also known as Withania somnifera is a nightshape plant in the genus of Withania, belonging to the family Solanaceae, native to the dry parts of India, North Africa, Middle East, and the Mediterranean. It has been considered as Indian ginseng and used in Ayurvedic medicine over 3000 years to treat tumors and tubercular glands, carbuncles, memory loss and ulcers and considered as anti-stress, cognition-facilitating, anti-inflammatory and anti-aging herbal medicine. According to the article of "Steroidal lactones from Withania somnifera, an ancient plant for novel medicine" by Mirjalili MH, Moyano E, Bonfill M, Cusido RM, Palazón J.(55). Ashwagandha root may be used to treat the stress and antioxidants causes of anorexia nervosa(56)


2. Fenugreek 
Fenugreek may be used to treat free redical cause of anorexia nervosa, In the study of total phenolics and antioxidant activities of fenugreek, green tea, black tea, grape seed, ginger, rosemary, gotu kola, and ginkgo extracts found that The total phenolics of the plant extracts, determined by the Folin-Ciocalteu method, ranged from 24.8 to 92.5 mg of chlorogenic acid equivalent/g dry material. The antioxidant activities of methanolic extracts determined by conjugated diene measurement of methyl linoleate were 3.4-86.3%. The antioxidant activity of the extracts using chicken fat by an oxidative stability instrument (4.6-10.2 h of induction time), according to "Total phenolics and antioxidant activities of fenugreek, green tea, black tea, grape seed, ginger, rosemary, gotu kola, and ginkgo extracts, vitamin E, and tert-butylhydroquinone" by Rababah TM, Hettiarachchy NS, Horax R.(57)

3. Milk thistle  
In the observation of the active extract of milk thistle, silymarin, is a mixture of flavonolignans and its antioxidant effect found that Exposure to light significantly reduced sprout growth and significantly increased the polyphenol content and antioxidative capacity. The polyphenol content was 30% higher in seeds originating from purple inflorescences than in those from white ones. We thus found milk thistle to be a good candidate source of healthy edible sprouts, according to "The potential of milk thistle (Silybum marianum L.), an Israeli native, as a source of edible sprouts rich in antioxidants" by Vaknin Y, Hadas R, Schafferman D, Murkhovsky L, Bashan N.(58)

4. Catnip 
Catnip is to calm the nerves and soothe the digestive system. The alcohol extract of catnip has a biphasic effect on the behavior of young chicks. Low and moderate dose levels (25--1800 mg/kg) cause increasing numbers of chicks to sleep, while high dose levels (i.e. above 2 g/kg) cause a decreasing number of chicks to sleep, according to the study of `The effect of an ethanol extract of catnip (Nepeta cataria) on the behavior of the young chick`by Sherry CJ, Hunter PS.(59)

5. Etc. Chinese Secrets To Fatty Liver And Obesity Reversal
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Sources
(56) http://www.ncbi.nlm.nih.gov/pubmed/9582008
(57) http://www.ncbi.nlm.nih.gov/pubmed/15291494
(58) http://www.ncbi.nlm.nih.gov/pubmed/20709593
(59) http://www.ncbi.nlm.nih.gov/pubmed/421844  

Anorexia nervosa - Treatments In conventional medicine perspective

Anorexia nervosa
Anorexia nervosa is a type of eating disorder usually develop in the teen years and effect over 90% of female, because of excessive food restriction and irrational fear to become fat due the wrongly influenced media as attractiveness is equated to thinness.
Treatments 
A. In conventional medicine perspective
A.1. Non medical therapy
1. Cognitive behavior therapy (CBT) 
In the examining psychological factors that influence the level of weight gain across the first 20 sessions of cognitive behavioral therapy (CBT) for anorexia nervosa, found that during CBT for anorexia nervosa, weight gain might be enhanced by addressing a range of aspects of axis 1 pathology (e.g., depression, hostility, and features of anxiety). However, the approach is likely to be less important at first than directly addressing eating pathology and overvalued ideas about eating, shape, and weight(51).

2. Psychodynamic therapy
In the reviews of the results of process research, outcome in psychodynamic psychotherapy is related to the competent delivery of therapeutic techniques and to the development of a therapeutic alliance. With regard to psychoanalytic therapy, controlled quasi-experimental effectiveness studies provide evidence that psychoanalytic therapy is (1) more effective than no treatment or treatment as usual, and (2) more effective than shorter forms of psychodynamic therapy. Conclusions are drawn for future research(52).

3. Interpersonal therapy 
The goals of the therapy are to improve interpersonal functioning and thereby decrease symptomatology. Factors identified as important in the development of anorexia nervosa are readily conceptualized within the interpersonal psychotherapy problem areas of grief, interpersonal disputes, interpersonal deficits, and role transitions(53).

4. Family therapy 
In six randomised controlled trials investigating the use of family therapy in the treatment of adolescents with anorexia nervosa, and these all had small sample sizes. Some, but not all, of these trials suggest that family therapy may be advantageous over individual psychotherapy in terms of physical improvement (weight gain and resumption of menstruation) and reduction of cognitive distortions, particularly in younger patients(54).

A.2. Medication
The aim of medical intervention is to treat physical problems associated with anorexia, but rarely changes behavior. There are no medications specifically approved to treat anorexia, but medical conditions caused by anorexia can be treated with certain medication depending to the condition.
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Sources
(51) http://www.ncbi.nlm.nih.gov/pubmed/22422613
(52) http://www.ncbi.nlm.nih.gov/pubmed/16096078
(53) http://www.ncbi.nlm.nih.gov/pubmed/10657886
(54) http://www.ncbi.nlm.nih.gov/pubmed/21894130

Anorexia nervosa - The Antioxidants

Anorexia nervosa
Anorexia nervosa is a type of eating disorder usually develop in the teen years and effect over 90% of female, because of excessive food restriction and irrational fear to become fat due the wrongly influenced media as attractiveness is equated to thinness.
Prventions
Antioxidants to prevent anorexia nervosa
An antioxidant is a chemical that  protect cells against damage caused by free radicals and chain reaction of free radicals by inhibiting the oxidation of other molecules
 1. In the study of the antioxidant status in female adolescents (N = 82) with anorexia nervosa, by the measurement of erythrocyte tocopherol concentration, and the determination of activities of the main antioxidant enzymes: superoxide dismutase, catalase, glutathione peroxidase, and glutathione reductase.
showed that tocopherol was significantly decreased in the anorexic patients compared to reference values (p < .02). In 21% of patients, tocopherol levels were below the reference interval. Superoxide dismutase activity was significantly decreased (p < .0001), while catalase activity was increased (p < .0001). The activity of the glutathione system enzymes did not show significant differences between patients and controls.The deficient concentration of erythrocyte tocopherol together with the altered antioxidant enzyme activities suggest a certain degree of oxidative damage in anorexia nervosa owing to both factors deficient micronutrient intake and oxidative stress(49).

2. Antioxidant vitamins in Anorexia Nervosa by V. MATZKIN¹, C. GEISSLER¹ and M. BELLO, indicated that antioxidant vitamins (tocopherol, retinol and carotene) protect against lipid peroxidation caused by free radicals and active oxygen species. Patients with Anorexia Nervosa (AN) are at a greater risk of oxidative damage due to undernutrition and stress (Moyano, et. al., 1999). There is contradictory evidence concerning concentrations of tocopherol (Mira et. al. 1987, Phillip et. al., 1998 and Moyano et. al., 1999), retinol (Robboy et. al., 1974, Lagan and Farrell, 1985 and Vaisman, et. al., 1992) and carotene (Van Binsbergen et. al., 1988, Rock et. al., 1996) in AN(50).

3. Etc.
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Sources
(49) http://www.ncbi.nlm.nih.gov/pubmed/9924658
(50) http://www.fac.org.ar/fec/foros/cardtran/gral/antioxidant.htm