Can attention to the intestinal microbiota improve understanding and treatment of anorexia nervosa?

Abstract

Summary Anorexia nervosa (AN) is characterized by severe dietary restriction or other weight loss behaviors and exhibits the highest mortality rate of any psychiatric disorder. Therapeutic renourishment in AN is founded primarily on clinical opinion and guidelines, with a weak evidence base. Genetic factors do not fully account for the etiology of AN, and non-genetic factors that contribute to the onset and persistence of this disease warrant investigation. Compelling evidence that the intestinal microbiota regulates adiposity and metabolism, and more recently, anxiety behavior, provides a strong rationale for exploring the role of this complex microbial community in the onset, maintenance of, and recovery from AN. This review explores the relationship between the intestinal microbiota and AN and a potential role for this enteric microbial community as a therapy for this severe illness.

Bidirectional relationship between eating disorders and autoimmune diseases

“…Current evidence suggests that dysregulated immune function may be one shared underlying mechanism. Several biological factors influencing immune function are described to be predominant or altered in EDs: a female preponderance (Chiaroni‐Clarke, Munro, & Ellis, ; Klein & Flanagan, ; McCarthy, Nugent, & Lenz, ), metabolic changes mediated by adipokines such as leptin and adiponectin (Abella et al., ), elevated cytokines (Solmi et al., ), abnormal levels of estrogen (Khan & Ansar Ahmed, ; Klump, Culbert, & Sisk, ), and lower abundance or diversity of intestinal microbiota (Carr, Kleiman, Bulik, Bulik‐Sullivan, & Carroll, ; Rooks & Garrett, ). These factors potentially influence the relationship between EDs and autoimmunity.…”

Psychopharmacological advances in eating disorders

“…The immunological perspective may also become interesting when taking into account the gastrointestinal microbiome and its interactions with diet, inflammation, and epigenetic alterations. Probiotics and bioactive nutrients have been shown to alter this microbiome as well as immune and brain function [180] and could therefore have therapeutic potential to influence appetite regulation and ED psychopathology [181]. Future genetic research in EDs may not only take human genes, epigenetics and gene expression, but also the genes of bacteria, fungi and other species living in the human body into account.…”

The Microbiota, the Gut and the Brain in Eating and Alcohol Use Disorders: A ‘Ménage à Trois’?

“…Indeed, Anorexia Nervosa (AN) patients have significantly lower amounts of total intestinal bacteria and higher prevalence of specific bacterial strains, which may reflect altered metabolic capacity resulting from the disorder (Armougom et al, 2009;Morita et al, 2015;Bulik, 2016;Carr et al, 2016;Mack et al, 2016). Gut bacteria may play a role in cravings for specific foods or induce dysphoria to motivate the ingestion of foods (Alcock et al, 2014).…”