Embracing a New Treatment Model for Anorexia Nervosa

Anorexia nervosa (AN) is a treatable condition, especially when you focus on the underlying nutritional and biochemical causes. Having worked in the field of eating disorders for over 25 years, I’ve seen the benefits of an integrative and functional approach. And while improved outcomes are attainable, little change has taken place to the standard treatment model over the last few decades.

Unfortunately, nothing highlights the tragedy of the standard approach more than a recent report about doctors authorizing euthanasia for patients struggling with the condition (Roff 2024). In the published report, mental health care providers invented a new diagnosis, “terminal anorexia,” to allow patients to commit medically-assisted suicide. It’s deeply disturbing that the standard treatment model for AN is so unsuccessful, that in some cases, death is considered the best and only option. The tragedy of our current approach can not be overstated, especially considering the fact that we already know a better way.

Anorexia Nervosa and Nutritional Deficiencies

Unfortunately, for decades, the eating disorder community has struggled to acknowledge, study and pursue an understanding of how integrative and functional medicine can save lives. Yet even the minimal research that has been completed, and my own clinical experience with thousands of patients, suggests the utility of such an approach.

Nutritional deficiencies, often including zinc (Su 2002), are a core component that drives AN symptoms. These nutritional deficiencies need to be treated directly to restore normal neural biochemistry. The standard approach of just focusing on calories—calories that often include ultra-processed junk food—is not effective for restoring optimal nutrition and brain function.

Anorexia Nervosa and PANS

Beyond nutritional deficits, research has also begun to highlight the significant overlap between eating disorders and pediatric acute-onset neuropsychiatric syndrome (PANS). As a diagnosis, PANS is characterized by the sudden onset of psychiatric symptoms that can include obsessions, compulsions and food restriction. PANS is a condition caused by inflammation and neural dysregulation that stems from an underlying infectious disease process. When the infection is treated, significant improvements or even elimination of the psychiatric symptoms is possible.

And while clinics connected with top medical institutions, including Harvard, Stanford and Dartmouth, all specialize in the treatment of PANS, the eating disorder community still struggles to recognize PANS as a potential factor in eating disorder symptoms and treatment. Yet a study on the incidence of PANS in children with eating disorders found that over 50% fit the definition of the condition, although the authors actually downplayed the association (Aman 2022).

While clinical studies into PANS treatment have shown modest benefits overall, most suffered from significant bias and lacked important, relevant functional outcomes, including school attendance and health-related quality of life (Johnson 2021). Case reports have documented rapid improvements in eating disorder symptoms when PANS is treated appropriately, often with antimicrobials and anti-inflammatory agents (Rice 2021, Kinderlehrer 2021). Overall, the research suggests the potential benefits of proper treatment for PANS but also the complexity of treating a condition that can have an infectious origin that is not always easy or straightforward to identify.

Anorexia Nervosa and the Microbiome

Other research that is promising, but underutilized, is the exploration of the gastrointestinal microbiome and its relationship to AN. Recent assessments of the microbiome in patients struggling with AN have found proinflammatory changes in the gut flora (Zhao 2024). The disturbances in the microbiome may also contribute to the dysregulation of hormonal systems and energy metabolism (Zhao 2024). A small clinical trial in AN patients found that 93% achieved weight normalization with probiotic supplementation as compared to 63% without (Žaja 2021). And again, my own personal experience has found probiotics to be instrumental in helping to address the common gastrointestinal comorbidities that are so commonly present in AN patients.

Conclusion

There are numerous integrative and functional medicine tools that can have a profound impact on the treatment of AN. My own experience and those of others using these techniques attests to their benefits.

AN is not a condition of inexorable decline leading to death. The condition does not have to be “terminal” and it is unethical to be described as such. Through the implementation of a number of straightforward strategies, AN outcomes can be improved, often reversing the course of this challenging illness.