The Microbiome and Eating Disorders

Seitz, Jochen; Trinh, Stefanie; Herpertz‐Dahlmann, Beate

doi:10.1016/j.psc.2018.10.004

Cited by 74 publications

(63 citation statements)

References 66 publications

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“…For example, some authors demonstrated that gut microbiota in AN patients shows a reduction of Roseburia abundance that are involved in gut health and immune defense maintenance, primarily through the production of short-chain fatty acids (especially butyrate), possibly explaining the data about the decreased levels of short-chain fatty acids (SCFAs) in AN patients [117,118,120]. Moreover, butyrate concentrations were negatively correlated with anxiety and depression scores, suggesting in ED patients a correlation between dysbiosis and anxiety-depression disorders that has been supported by other studies [121,122]. In addition, Borgo et al [117] showed an interesting positive correlation between decreased in Roseburia spp., and in particular of Roseburia inulinivorans and insulin levels.…”

Section: Gut Microbiotasupporting

confidence: 53%

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Eating Disorders and Gastrointestinal Diseases

et al. 2019

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Eating disorders (ED) are frequently associated with a wide range of psychiatric or somatic comorbidities. The most relevant ED are anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorders (BED). Patients with ED exhibit both upper and lower gastrointestinal (GI) symptoms. Evidence of alterations throughout the GI tract in ED will be analyzed given the role of the GI tract in food intake and its regulation. It remains a matter of debate whether GI disorders are inherent manifestations of ED or the results of malnutrition occurring from ED. Moreover, recent clinical studies have highlighted the growing role of intestinal microbiota in the pathogenesis of ED, making it possible to hypothesize a modulation of intestinal microbiota as a co-adjuvant to standard therapy. The aim of this review is to analyze the link between ED and GI diseases and to present, where known, the potential key factors underlying these conditions. Conclusions: The presence of GI disorders should be investigated in patients with ED. Screening for ED should also be encouraged in individuals seeking treatment for unexplained GI complaints to better address therapeutic issues that surround these difficult medical conditions. Nutrients 2019, 11, 3038 3 of 17 ED can be associated with anxiety or mood disorders; insomnia; as well as somatic complications such as cardiac alterations, hormonal imbalances and also a wide range of gastrointestinal (GI) symptoms [3].Prevalence estimate of lifetime AN is 0.8% [4]. The overall incidence rate of AN is around 7 per 100,000 persons; however, it is higher in 15-19 year old girls reaching 109.2 cases per 100,000. The incidence is increasing in Italy and other Western countries probably due to earlier diagnosis or earlier onset [5,6].The prevalence of BN is 0.28% [4]. The highest incidence rate of BN is 300 per 100,000 persons in women aged between 16 and 20 [7], although the age at onset is decreasing [5].BED are described in 0.85% of the population [4,8] and are frequently associated with medical comorbidities, especially obesity and its complications such as Type II diabetes mellitus, hypertension, and dyslipidemia [9]. Furthermore, BED may occur in a subset ranging from 27% to 47% in severely obese persons undergoing bariatric surgery [10].The previous edition of DSM (DSM-IV) [11], classified as "Eating Disorders Not Otherwise Specified (EDNOS)", is the ED that does not satisfy all the diagnostic criteria for AN or BN. Previously, EDNOS contained a huge and varied group of individuals and was the most commonly diagnosed ED. However, the DSM-V revised this ED type and called it "Other Specified Feeding or Eating Disorder" (OSFED). Moreover, the DSM-V introduced the definition of Avoidant/restrictive food intake disorder (ARFID) that was distinct from AN and BN in that there is no body image disturbance [2].The first description of AN in the 19th century revealed that the sufferers' reasons for self-starvation generally were strictly connected to inappetence, feelings of fullness and abdominal ...

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Section: Gut Microbiotasupporting

confidence: 53%

“…This hypothesis seems to propose a link between Roseburia spp. and insulin metabolism that helps anorectic patients preserve euglycemia [122].…”

Section: Gut Microbiotamentioning

confidence: 99%

Eating Disorders and Gastrointestinal Diseases

et al. 2019

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“…The chronic stress profile associated with enduring AN [107] is similar to that found in treatment resistant depression [108] and with the 'ecophenotype' associated with childhood maltreatment [109]. This chronic stress response includes hyperactivity of the hypothalamic pituitary adrenal (HPA) axis [101,[110][111][112], activation of the immune system [113,114], and anomalies in the microbiome [115,116]. There is a widespread reduction in brain volume, which is possibly secondary to reduced neurogenesis [117], which may be the most marked in the hippocampus [118] and associated with raised cortisol levels [104].…”

Section: Chronic Stress Response: Co-morbidity With Depression and Anmentioning

confidence: 99%

Cognitive Interpersonal Model for Anorexia Nervosa Revisited: The Perpetuating Factors that Contribute to the Development of the Severe and Enduring Illness

Treasure

Willmott

Ambwani

et al. 2020

JCM

132

122

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The cognitive interpersonal model was outlined initially in 2006 in a paper describing the valued and visible aspects of anorexia nervosa (Schmidt and Treasure, 2006). In 2013, we summarised many of the cognitive and emotional traits underpinning the model (Treasure and Schmidt, 2013). In this paper, we describe in more detail the perpetuating aspects of the model, which include the inter- and intrapersonal related consequences of isolation, depression, and chronic stress that accumulate in the severe and enduring stage of the illness. Since we developed the model, we have been using it to frame research and development at the Maudsley. We have developed and tested interventions for both patients and close others, refining the model through iterative cycles of model/intervention development in line with the Medical Research Council (MRC) framework for complex interventions. For example, we have defined the consequences of living with the illness on close others (including medical professionals) and characterised the intense emotional reactions and behaviours that follow. For the individual with an eating disorder, these counter-reactions can allow the eating disorder to become entrenched. In addition, the consequent chronic stress from starvation and social pain set in motion processes such as depression, neuroprogression, and neuroadaptation. Thus, anorexia nervosa develops a life of its own that is resistant to treatment. In this paper, we describe the underpinnings of the model and how this can be targeted into treatment.

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“…In brief, the authors discuss the benefits of targeting the microbiota with approaches including nutritional interventions, pre-and probiotics, and drugs to improve energy retrieval, anxiety, and depressive symptoms in individuals with AN. 104,105 Other studies have confirmed differences in the diversity and composition of the intestinal microbiota in individuals with AN compared to healthy controls and across the course of therapeutic renourishment. [94][95][96][106][107][108] Whether the microbial profile is distinct in each of the two types of AN (restrictive and binge-purging), has only occasionally been explored, 94,95 with one study finding no significant difference in bacterial abundance between the two subpopulations, 94 and another reporting distinct perturbations in microbial composition in each AN type and decreased microbial diversity in those who had history of laxative use.…”

Section: Clinical Neurosciencesmentioning

confidence: 93%

“…Herpertz‐Dahlmann and coworkers have reviewed the therapeutic implications of gut microbiota specifically in relation to AN. In brief, the authors discuss the benefits of targeting the microbiota with approaches including nutritional interventions, pre‐ and probiotics, and drugs to improve energy retrieval, anxiety, and depressive symptoms in individuals with AN …”

Section: Formative Workmentioning

confidence: 99%

Reconceptualizing anorexia nervosa

Bulik

Flatt

Abbaspour

et al. 2019

Psychiatry Clin Neurosci

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Anorexia nervosa (AN) has one of the highest mortality rates of any psychiatric disorder. Treatments are often ineffective and relapse is common. Most research attempting to understand the underlying causes and maintenance factors of AN has focused on environmental contributions, yet there is much to be explored in terms of biological risk and maintenance factors. In this paper, we focus primarily on AN research related to genetics and the complex microbial community in the gut (intestinal microbiota), and how these impact our conceptualization of this disorder. Emerging research identifying significant negative genetic correlations between AN and obesity suggests that the conditions may represent ‘metabolic bookends’. The identification of underlying biological mechanisms may provide both insight into extreme weight dysregulation on both ends of the spectrum and new possible points of entry for AN treatment. Additionally, the reported microbial imbalance (dysbiosis) in the gut microbiota in AN patients, potentially due to a nutrient‐ and energy‐deprived gut environment, implies alterations in functional and metabolic capacity of the gut microbiome. The extent to which AN and obesity can also be considered to be ‘microbiome bookends’ requires further investigation. Finally, we discuss ongoing and future AN projects exploring the interplay between host genomics, the environment, and cumulative microbial genomes (microbiome) as well as interventions at the microbial and gut level.

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The Microbiome and Eating Disorders

Cited by 74 publications

References 66 publications

Eating Disorders and Gastrointestinal Diseases

Eating Disorders and Gastrointestinal Diseases

Cognitive Interpersonal Model for Anorexia Nervosa Revisited: The Perpetuating Factors that Contribute to the Development of the Severe and Enduring Illness

Reconceptualizing anorexia nervosa

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