Bulimia May Result from Hormonal Imbalance

This is some new data linking bulimia with hormonal imbalance. I don't agree with using birth control pills, but would favor bioidentical hormones: Bulimia is normally regarded as a mental illness that should be treated with cognitive behavioural therapy. A newly published thesis from Karolinska Institutet, however, shows that the condition depends in certain cases on a hormonal imbalance that can be corrected with common oral contraceptives. "We have shown that one third of female bulimics have metabolic disorders that may explain the occurrence of the eating disorder. These disorders may in certain cases express the hormonal constitution of the patient, rather than any mental illness", says Sabine Naessén about the research results that are presented in her Ph. D. thesis. Bulimia nervosa, compulsive overeating, is probably the most common form of eating disorder, and it is approximately ten times more common in women than in men. The condition is normally considered to have psychological causes, and it is for this reason normally treated with cognitive behavioural therapy and antidepressive drugs. The results that Sabine Naessén has obtained show that bulimia is a complex condition that contains hormonal and genetic components, in addition to psychological components. The bulimics in the studies had higher levels of the male sex hormone testosterone and lower levels of the female sex hormone oestrogen than healthy subjects in the control group had. Testosterone is directly involved in the normal appetite regulation of the body, and an increased level may lead to an increased feeling of hunger. The testosterone level of patients with bulimia could be reduced by treating these patients with oestrogen-dominated oral contraceptives. The result was that the craving for fat and sugar decreased, as did the feeling of hunger, in approximately half of the bulimics after as short a period of treatment as three months. Three subjects became completely free of the eating disorder as a consequence of the treatment. "This is a very strong effect. Hormone treatment may very well be an alternative to cognitive behavioural treatment", says Sabine Naessén. The Thesis: Endocrine and metabolic disorders in bulimic women and effects of antiandrogenic treatment by Sabine Naessén, The Department of Woman and Child Health. http://ki.se/ki/jsp/polopoly.jsp?d=130&a=22684&l=en PhD-dissertation at the Karolinska Institute Naessén, Sabine Endocrine and metabolic disorders in bulimic women and effects of antiandrogenic treatment Wednesday, December 20th, 2006, 09.00. Skandiasalen, Astrid Lindgrens Barnsjukhus, Karolinska Universitetssjukhuset Solna. ISBN: 91-7357-003-6 Diss: 06:375 ABSTRACT Background: Bulimia is a mental disorder frequently associated with menstrual disturbances and low estradiol levels although most bulimic women are of normal weight. Low bone mass has also been reported in these women. Furthermore, increased androgen levels and polycystic ovaries (PCO) have been described in bulimic women. Little is known about the mechanisms of these hormonal disturbances and the role of sex hormones in the etiology of the disease has not been fully explored. Androgens may promote bulimic behavior by influencing food craving or impulse control. Aims: The specific aims of this work were to compare women with bulimia to healthy controls with respect to: 1) menstrual disturbances and the occurrence of polycystic ovary syndrome (PCOS) 2) endocrine and nutritionrelated factors predicting bone mass 3) estrogen receptor (ER) β polymorphism in view of the potential role of estrogen signalling in bulimic disease 4) effects of an antiandrogenic oral contraceptive (OC) on appetite and eating behaviour. Methods: Seventy-seven bulimics and 59 controls were investigated with respect to menstrual status, PCO, symptoms of hyperandrogenism, bone mineral density (BMD), sex hormone levels and ERβ polymorphism. Meal-related appetite response and bulimic symptoms were evaluated in 21 women with bulimia nervosa before and after three months of treatment with an antiandrogenic OC. Results: 1) Bulimics had a higher occurrence of menstrual disturbances, hirsutism and PCOS than controls. Positive correlations between hirsutism and levels of biologically active testosterone were found in bulimics but not in controls. 2) Bulimics had a lower spinal BMD and higher frequency of osteopenia in the total body than controls. Subgroups of bulimics with a history of amenorrhea or previous anorexia nervosa had the lowest BMD values, whereas those without such history did not differ from controls. Multiple regression analysis including significant endocrine and nutrition-related variables, revealed previous anorexia nervosa to be the strongest determinant of spinal BMD in bulimic women. 3) An association was found between two common polymorphisms in the ERβ gene and bulimic disease. A novel variant changing the primary structure of ERβ protein was identified in one bulimic patient, but an initial characterization of this variant did not reveal any differences compared to the wild type protein. 4) Antiandrogenic OC treatment reduced meal-related hunger and gastric distention in women with bulimia nervosa and improved bulimic behavior in relation to reduced testosterone levels. Conclusions: 1) Our study supports an increased frequency of PCOS in bulimic women. This endocrine disorder may be of importance for the development of bulimia. 2) Low bone mass in bulimics could be explained by previous anorexia nervosa, whereas bulimia per se does not influence bone mass negatively. 3) Genetic variation in ERβ may play a role in the etiology of bulimic disease. 4) An antiandrogenic OC may develop into a new strategy for treatment of women with bulimia nervosa not responding to conventional therapy and particularly in those with hyperandrogenic symptoms. Keywords: Bulimia nervosa, anorexia nervosa, polycystic ovary syndrome, bone mineral density, estrogen receptor β, appetite, oral contraceptives http://diss.kib.ki.se/2006/91-7357-003-6/