In the past, a number of posts in this blog focused on chronic anorexia, people trapped in years of restriction, relentless thoughts about body and weight and no path towards recovery. Some of these people found a middle ground where they ate enough to get by and live a life limited by the eating disorder but also somewhat stable. Others remained very sick; psychiatric care was primarily harm reduction and sometimes palliative care.
The sickest of that group often didn’t survive the illness.
Recent discoveries about medical conditions connected with anorexia uncovered the theory that the sickest cohort actually has an undiagnosed medical condition which left them so disabled, one I have mentioned here recently, mast cell activation syndrome (MCAS).
It’s almost shameful for me to think back to how I saw a variety of symptoms as a result of anorexia rather than signs of a separate but connected illness. These patients experience extreme pain and bloating from eating anything, intractable abdominal distention and constipation, chronic joint and body pain, regular dizziness with passing out, cognitive effects with brain fog and many other symptoms.
Clinicians who treat people with eating disorders still assume these symptoms are a result of chronic malnourishment and refuse to even consider that another medical diagnosis is present. Some people with chronic anorexia don’t have signs of MCAS and they aren’t as sick. For people with both illnesses, treatment providers tend to blame the sickest patients with chronic anorexia and often refuse to treat them because they “won’t comply with treatment.”
Patients with anorexia and MCAS need to be diagnosed and treated earlier so that the MCAS doesn’t become as severe. I have written about histamine blockers like allergy medications and Pepcid, low dose naltrexone and a variety of other mast cell stabilizers before. Treating patients earlier for MCAS can prevent the most severe cases.
I am also seeing a significant number of patients with more severe anorexia and MCAS do surprisingly well on very low dose GLP-1’s. They don’t experience appetite suppression, slowed digestion or weight loss like most people do. In fact, these patients tend to feel more clear hunger and fullness cues, improved digestion and a sharp decrease in discomfort and pain after eating.
It appears to me that GLP-1’s likely treat a gastrointestinal hormonal imbalance and decrease inflammation, very different results from how most people experience the drugs.
Anyone with chronic anorexia needs an evaluation for MCAS. Treating the inflammation symptoms can help make it easier to eat regularly and decrease eating disorder thoughts. Treating MCAS makes recovery from anorexia possible for some people even though the process of treatment remains extremely challenging. Addressing the medical and psychiatric causes gives people with chronic anorexia a fighting chance to get well.
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