Anorexia Invokes the Human Genetic Response to Starvation

Anorexia and restrictive eating disorders present a very confusing medical picture for doctors and patients alike. Other eating disorders lead to clear medical problems easily diagnosed by physical exam and blood tests, but anorexic patients appear erroneously healthy by labs. Once the blood tests finally become abnormal, the patients are extremely ill. This confusion leads people to minimize the effects of starvation for far too long.

Because doctors never see starving patients except for people with anorexia, they have limited knowledge of how the body survives in these circumstances.

However, the human body has a long history of adaptation to starvation. Long before the world of abundant food we live in now, famine was a reality of human life. The laws of natural selection meant that people who genetically were programmed to survive famine would live. Examples of adaptations are slowed metabolism, conservation of energy and preservation of necessary organ function all in the face of prolonged starvation.

These genes to survive famine have been passed down through generations even though many cultures have more than enough food. For the large majority of people, their genetic response to starvation is never tested unless they start to diet severely or develop an eating disorder.

The primary method the body uses to survive famine is through homeostasis, maintenance of normal blood concentrations of all blood cells and electrolytes. Clearly, starvation will affect the amount of blood cells and electrolytes available to the body. Limited food supply means much decreased intake of electrolytes, and malnutrition leads to an inability to produce sufficient blood cells.

But blood tests do not measure amounts but instead concentrations. The body adapts by shrinking down blood volume which means that concentrations remain the same while amounts of blood cells and electrolytes diminish significantly. 

Blood levels remain stable which masks the worsening of the person’s health. If someone has fewer red blood cells, that person becomes anemic, even if the blood tests appear normal.

Education of doctors and patients can decrease the chance that people will ignore the worsening medical condition of a patient and not be fooled by the body’s genetic ability to survive starvation. Early intervention and treatment can help people with anorexia avoid getting severely ill.

Brain Function and Eating Disorder Recovery

In order to understand why eating disorders are so hard to recover from, it’s best to try to consider some basics about brain function.

Behaviors around food are among the most essential and automatic actions humans have. Like sleeping or breathing, eating enough food is necessary for basic survival, and in the end our bodies and brains are programmed to survive.

The most necessary functions are built into the automatic, unconscious parts of our brain. It is almost as if the brain doesn’t trust our more fickle attention spans with such a crucial human need.

In fact, we share the need for basic functions with all mammals, so our brains force us to act quite similarly to most animals when it comes to food, especially if our bodies are a state of malnutrition.

Higher order brain function differentiates humans from other animals. However, those cognitive processes of organization and abstract thinking don’t apply to food when it comes to survival. We can convince ourselves we get to choose how and what we eat, but that all changes if we deprive our bodies of enough food. In a state of starvation, automatic, unconscious actions demand eating food under any circumstances.

Automatic behaviors are almost a backup system to ensure adequate nutrition no matter the circumstance. Willpower or personal desire can’t withstand the urgent need for survival.

But when new patterns of behavior around food begin, even if they are disordered, they will become ingrained in the same automatic system in the brain as any food behaviors. If that means binging and purging, eating at night or eating all day, once a new pattern is set, a person must pay a significant amount of conscious attention for a period of months to start a new pattern.

It is the need for so much effort to change these unconscious patterns that makes eating disorder recovery so difficult. The process of recovery isn’t just understanding the emotional reasons for the behaviors. It’s also the difficult task of reversing longstanding neurological patterns around a necessary human function.

IndividualIzed Eating Disorder Treatment

The initial treatment for someone with an eating disorder is very similar for everyone. It focuses specifically on normalizing eating patterns, stabilizing nutrition and promoting medical stability.

After that first step, all aspects of recovery are very much individualized based on many factors, for example, personality, age, length of illness and need for personal growth. A cookie-cutter approach to treatment after the first stage tends to be ineffective and certainly doesn’t lead to long lasting wellness.

IndividualIzed treatment needs to take into account an individual’s preferences and also the issues that are exposed by regular eating patterns. The range of issues is very broad. For some people, depression, anxiety and hopelessness are central. For others, the prospect of living an adult life is terrifying. Sometimes traumatic experiences surface, or instead the focus could solely be on personal and emotional growth.

Due the the myriad needs of someone seeking help for an eating disorder, the clinician and team need to view each person as an individual. Flexibility is a key to overall effective support rather than dogmatic rigidity. Most eating disorders already function on rules and inflexibility so recovery needs to present a different model for life.

There are two key points to note. The first is that it can be challenging to differentiate the desire for flexibility from the eating disorder thoughts attempting to sabotage recovery so joint attention by the team and patient is necessary to avoid this pitfall. Second, patients need to be sure the clinicians they see approach sessions in a way that feels real and genuine for them. If the conversations seem forced or phony, then treatment is not likely to help someone reengage in the world. 

Paying attention to instincts about personal connection will go a long way to ensure treatment is successful and is right for the individual.

Personal Connection is Necessary for Successful Eating Disorder Treatment

Understanding the complex nature of eating disorders is difficult. It’s not intuitive why someone would suddenly have difficulty eating food or start eating large quantities and throwing the food up. A person without an eating disorder approaches food and meals intuitively with little conscious thought. Even people concerned with food and weight but without an eating disorder have very automatic food behaviors. Similarly, eating disorder behaviors also become very automatic and thus difficult to change.

Recovery from an eating disorder involves paying conscious attention to change these ingrained behaviors. Although understanding eating disorders may can be hard, the methods that are effective in promoting recovery and changing behaviors tend to be very straightforward.

One tool is consistent connection between the person in recovery and people who support the process. The goal of these regular, daily contacts is to reinforce and usually reiterate the same recovery tropes to counter the constant disordered thoughts that dominate the mind of someone with an eating disorder.

The eating disorder says that food is not necessary, that the person is fat and must lose weight, that everyone else is wrong, that being alone and following the eating rules are paramount and the list goes on and on.

If there is a concurrent dialogue around recovery with people in one’s life, the eating disorder thoughts no longer have a captive audience. The statements to contradict the eating disorder are also pretty basic: food is necessary for survival; the body knows how to manage and handle food and weight; being alone with the eating disorder only leads to a small, meaningless life, and no your body is normal, not fat.

Hearing these healthy thoughts isn’t a magic fix, but the most successful therapy involves a consistent dose of these reminders throughout each day and week. A few appointments per week are no match for the relentlessness of the eating disorder. Regular reminders, usually many times per day, as a consistent part of any recovery are an important indicator of beneficial treatment.