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Biological origin for bulimia suggested

Thursday, October 15, 1998

By Anita Srikameswaran, Post-Gazette Staff Writer

The cultural ideal of a thin, athletic figure may not be what drives some people to engage in binge eating and purging. New research suggests biological factors may be at least partly responsible for this eating disorder, called bulimia nervosa.

Researchers from the University of Pittsburgh School of Medicine and New York State Psychiatric Institute have found alterations in the brain's chemical makeup among women who are recovering from bulimia. They report these findings in the October issue of the journal Archives of General Psychiatry.

The study adds more evidence to the emerging view of eating disorders as biological illnesses, rather than emotional ones, said Dr. Walter Kaye of Western Psychiatric Institute and Clinic.

"In eating disorders, we are where people with schizophrenia were 20 years ago," said Kaye, who led the bulimia study. "Twenty years ago, people were still blaming culture or parents for causing schizophrenia and didn't think there was a biologic influence. It's very clear now that schizophrenia is a brain disease."

Dr. Michael Strober, director of eating disorder programs at the University of California at Los Angeles Neuropsychiatric Institute, said Kaye's evidence doesn't show whether the brain chemistry changes are a cause or an effect of the disease. "But it raises provocative questions," he added, and may prove extremely important in the treatment of bulimia patients.

Symptoms of bulimia include eating binges followed by efforts either to purge food, such as inducing vomiting or taking laxatives, or to compensate by fasting or excessive exercise.

In the study, samples of spinal fluid were drawn from 30 women who had been free of bulimia for at least one year, were normal weight and eating properly, and had regular menstrual cycles. These were compared with those of 31 healthy women who never had an eating disorder. The researchers paid particular attention to serotonin, a neurotransmitter, or brain chemical, involved in mood regulation.

"What we're finding is an indication that people recovering from bulimia have increased serotonin activity in their brain," Kaye said. When the women were given a drug that acts on the serotonin system, the recovering bulimics had more anxiety symptoms than the healthy group.

Levels of other brain chemicals were the same in both groups.

UCLA's Strober said the findings suggest that, whether or not serotonin is involved in causing bulimia, bouts of bulimia have enduring effects, which may help explain why patients frequently suffer relapses.

Patients thus may benefit from long-term management, Strober said. It may prove important to normalize the patient's serotonin levels, perhaps in combination with conventional behavioral therapy, he added.

While high levels of serotonin are associated with anxiety, some studies have shown that low levels are linked to aggressive and impulsive behaviors.

Serotonin is made from an amino acid called tryptophan. Very little tryptophan is needed to meet daily needs and many foods contain it, so deficiencies are unlikely unless a person stops eating.

Kaye said the new research suggests that a person who is predisposed to have an eating disorder has higher levels of serotonin activity than a healthy person.

That high activity "probably makes people kind of anxious and obsessional. It' s not a comfortable state," Kaye explained. "Our guess is that people with anorexia and bulimia starve themselves in order to reduce their tryptophan and reduce their brain serotonin activity. They make themselves, at least temporarily, feel better."

He is recruiting participants for a new international study of bulimic people who have a bulimic relative to look for genetic markers of the eating disorder.

"There must be some genetic predisposition that makes some people more vulnerable to developing it than others," Kaye said. "We need to have a better understanding of why people have this disorder so we can come up with better treatments. "

Because of effects on the serotonin sytem, high doses of drugs like Prozac have been used with some success for the treatment of eating disorders. Anywhere from 30 to 60 percent of people recover from bulimia, he said. The rest have chronic symptoms and don't do well.

People interested in participating in the study of genes and bulimia should call (888) 895-3886 for more information.

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