2023-04-21 15:15:54
The role of the intestinal flora in anorexia
The number of adolescents treated as inpatients with eating disorders has increased by up to 40 percent during the pandemic
What: Getty Images/Olga Pankova
Young women and girls going through puberty are often affected by it: anorexia. Recently, diagnoses have risen drastically nationwide. The disease often ends fatally. According to a study, changes in the intestinal flora could contribute to the development.
AAccording to a study, the intestinal flora can also be significantly involved in the development of anorexia. This is reported by an international research team after analyzing the bacteria in the digestive tract of 147 women, 77 of them with anorexia nervosa (AN). Accordingly, the eating disorder is associated with a change in the microbiome, which in turn affects metabolism – and appetite and mood.
A German expert speaks of a “very good study”, but sees no evidence of a causal involvement of the microbiome in the development of the eating disorder. Nevertheless, the study could give impetus to the development of possible therapeutic approaches, says Beate Herpertz-Dahlmann from the University Hospital Aachen, who was not involved in the work.
The team led by Oluf Pedersen from the University of Copenhagen writes in the journal “Anorexia nervosa, which usually begins during puberty, but recently also increasingly in childhood, affects 95 percent of women.Nature Microbiology“. Although therapies could reduce damage from the potentially deadly disease, many sufferers would not be completely cured.
It is known that genetic material can play a very important role and that puberty-related hormonal changes can be involved in the development of anorexia nervosa. The research group, which included employees from the University of Mainz, now examined whether microorganisms in the intestine could influence appetite, emotions and behavior, among other things, and thus contribute to the development of the disorder.
To do this, the team first examined the intestinal flora of 77 affected and 70 normal-weight women, who were on average 23 years old. In fact, the researchers found clear changes: some groups of bacteria were less common in women with anorexia nervosa, while others were clearly overrepresented. The frequency and diversity of viruses also differed between the two groups.
The altered gut flora and its metabolites could affect the formation of various neurotransmitters such as serotonin, dopamine and glutamate, the group writes. This can affect mood as well as appetite and eating habits.
Disrupted gut microbiome could contribute to anorexia
To demonstrate a causal relationship, the team transplanted stool samples from comparable women in both groups into young germ-free mice that were initially fed a low-calorie diet for three weeks. Those animals that received feces from women with anorexia nervosa had reduced body weight after the three weeks. This did not change fundamentally even when the animals could eat at will. In general, genes for proteins involved in feelings of satiety and mood were activated in their fatty tissue and in the brain area of the hypothalamus.
“Both serotonin activity and appetite regulation may be involved in the development and/or maintenance of AN syndrome,” the group writes. “Our results support the hypothesis that a severely disrupted gut microbiome contributes to some processes involved in the development of anorexia nervosa.”
Herpertz-Dahlmann would question whether an altered microbiome is actually a major cause of anorexia nervosa. It is also possible that the eating disorder itself changes the composition of the intestinal flora over the years due to insufficient and changed food intake, says the director of the Clinic for Psychiatry, Psychosomatic Medicine and Psychotherapy of Children and Adolescents. In this context, she specifically complains that the study does not contain any information on how long the participants had had the eating disorder.
However, it is quite possible that the changes in the intestines found in the study could contribute to the eating disorder becoming more entrenched over time. This complicates the already difficult therapy. And that could explain why many patients have problems gaining weight and then maintaining their weight.
The results could therefore have an impact on future therapies, says the expert: Studies are being carried out, for example, to enrich the diet with certain nutrients such as omega-3 fatty acids or with living bacteria during therapy in order to specifically change the intestinal flora. Stool transplants are also being researched – so far, however, with different results.
What is clear, however, and is not taken into account in the current study: the disease also has a clear psychosocial component. The number of young people and children treated as inpatients in Germany during the Covid pandemic and the associated lockdowns increased increased by 30 to 40 percent.
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