Intellect #1 -Genetics, Epigenetics & Psychoneuroimmunology in Eating Disorders

The development of an eating disorder in an individual is a complex and often frightening reality that impacts between 1.25 and 3.4 million people in the UK alone. The statistics are growing at a tremendous rate also, with the exact definition of what encompasses an ‘eating disorder’ simultaneously becoming broader. No longer strictly categorised as being 'just anorexic or bulimic’, there now exists the likes of binge eating disorder, pica, CHSP, rumination disorder, OFSED (other specific feeding or eating disorder) - each with their own underpinning and subconscious reasonings behind the development of the disorder in the given individual. Uncovering the exact cause of the disorder in a patient however is not an easy feat to accomplish, as there are typically multiple contributing factors, ranging from environmental to potential genetic influences also. The subliminal self has many ways of demonstrating past traumas, and it is often in the form of restrictive, or self sabotaging behaviours that an individual attempts to cope or bring attention to the matters lying deep within. This concise essay aims to prompt a new perspective on how to approach individuals with eating disorders when engaged in therapy, and to create a fresh vista for psychologists to utilise when treating and managing someone recovering from the condition, based on the current and progressive research surrounding genetics and epigenetics.

By standardised medical terms, an eating disorder describes illnesses that are characterised by irregular eating habits and severe distress or concern about ones body weight or shape. These kind of disturbances may include inadequate or excessive food intake, which ultimately results in malnutrition amongst many other severe health complications, such as electrolyte disturbances and metabolic dysfunctions. The most common forms of eating disorders include anorexia nervosa, bulimia nervosa and binge eating disorder, though as mentioned in the introduction, there now exists an array of other diagnoses’ including pica, CHSP, rumination disorder and OFSED. All of these conditions affect both genders - male and female - though there is still a greater dominance in women as opposed to men.

According to the ‘psychiatric medical bible’, DSM-5 states that an individual with an eating disorder must demonstrate a particular set of criteria to be diagnosed with one of the conditions. With anorexia for example, one must either be considered a ‘restrictive type’ or ‘binge-eating/purging-type (BEPT)’. Restriction can manifest in many, and often individualised, forms (e.g. maintaining very low calorie count, restricting types of food eaten, eating only one meal a day), and is typically accompanied by obsessive and rigid rules (e.g. only eating food of one colour or eating at specific times of the day). Less recognised, the latter form of anorexia nervosa (BEPT) exhibits when a person restricts their intake as above, but also has regularly engaged in binge-eating or purging behaviour (e.g. self-induced vomiting, over-exercise, misuse of laxatives, diuretics or enemas).

The pool of eating disorders is one of deep waters, with many storms and rocky weathers, which is why it must be acknowledged by mental health professionals that one specific route of treatment for a condition so complex is simply not realistic. Think of an individual with an eating disorder as a pirate ship: Different boats have different sails, thus need different levels of wind to get them sailing. A different crew needs specific needs, variegated maps, incentives and directions. All eating disorders are pirates that steal from the good, but every marauder are poles apart in their story.

Types of eating disorders aside for the time being, no one knows the exact cause, rhyme or reason behind the development of the condition, because understanding the many factors that comprise the perception of our own body image is an extraordinarily circuitous issue. While many may believe that the mass media is largely to blame for the making of poor body image, research is finding that a genetic component is indubitably involved. The media is undoubtedly a culprit for generating images that falsify the reality of human bodies; creating an unachievable image of beauty, for the purpose of selling produce which is no longer even strictly related to fashion. But what drives an individual to idealise and create their own definition of bodily perfection? As scientists unfold the blueprint of our genetic makeup, it is evident that both environment and genetics play an integral role in the formation body image... right from the West to the East.

A prime example of the power of environmental pressures can be taken from a study conducted in the 1980s. In 1988, Harvard Medical School researched Dr Anne E. Becker travelled with her team to the Southern Pacific nation Fiji to document and investigate the shifts in body image and eating practices in Fiji over a three-year period by watching the transition of contributing females to the documentary have their perceptions of themselves alter as a result of having new access to American television and media culture. Dr. Becker and her colleagues surveyed 63 Fijian secondary school girls, whose average age was 17. In Fijian culture, 'you've gained weight'' is a traditional compliment, anthropologists say. In accordance with traditional culture in the South Pacific nation, dinner guests are expected to eat as much as possible. A robust, nicely rounded body is the norm for men and women, and something as blasé in the Western world as saying you have “skinny legs” is actually a major insult. Similarly, ''going thin,'' the Fijian term for losing a noticeable amount of weight, is considered a worrisome condition.

The work began in 1995, one month after satellites began beaming television signals to the region for the first time. Once the satellites were implemented, and time had passed, in 1998, the researchers surveyed another group of 65 girls from the same schools, who were matched in age, weight and other characteristics with the subjects in the earlier group.

Fifteen percent in the 1998 survey reported that they had induced vomiting to control their weight, the researchers said, compared with 3 percent in the 1995 survey. And 29 percent scored highly on a test of eating-disorder risk, compared with 13 percent three years before. What’s more, of the girls who said they watched television three or more nights a week in the 1998 survey were 50 percent more likely to describe themselves as ''too big or fat'' and 30 percent more likely to diet than girls who watched television less frequently. Before 1995, Dr. Becker said, there was little talk of dieting in Fiji. ''The idea of calories was very foreign to them.'' But in the 1998 survey, 69 percent said that at some time they had been on a diet. In fact, preliminary data suggest more teen-age girls in Fiji diet than their American counterparts.

What does this tell us? The media is indefinitely playing a pivotal role in humankind’s phylogenetics. Our evolutionary history and relationships are constantly shifting, and not necessarily entirely for the best. As our mindsets change, so do our cells. And as our cytology changes, so does our biological makeup. The altering of cells is known as epigenetics, whereby portions of our genes quite literally change shape, thus creating new psychological and physiological functionings within an individual. This in turn will then impact the likes of immunology and epidemiology. From a psychoneuroimmunological viewpoint, this is where things gets interesting: to what extent exactly does the alteration and dictation of of psyche and neurology impact our immunology and ability to ward off ill health? Does there reach a point whereby, after suffering with a mental illness for so long, that our biological makeup becomes ill in itself? Whereby our cells arrange themselves to function in ill-health, chronically and unchangeably? The ageing process is supposed to be the key player here: the factor that causes cells to deteriorate and become lesser functioning... but what if the power of our cerebrum is the true dictator of the future of our physical wellbeing?

In Cancer, we know that epigenetic mechanisms regulate gene expression independently of DNA sequence. In most, but not all cases, they produce reversible changes in gene function by modifying DNA and associated histones and via the action of small non-coding RNA molecules - more simply known as gene mutation. These abhorrent epigenetic processes are what is linked to the aetiology of cancer, but are also likely to contribute to the aetiology of numerous non-malignant complex disease phenotypes... and one of these non-malignant diseases could very well be defined as an eating disorder. Somatic mutations will cause polymorphisms, many of which don’t necessarily have a negative effect on a person’s health, but it would be foolish to assume that to some degree, they do not influence the risk of developing certain disorders.

In those with anorexia, a development of neurotransmitter-related disorders are likely to form, leading to uncontrolled changes in the immune and endocrine systems. Interactions between cytokines, neuropeptides, and neurotransmitters play an important role in disease development, so if these connections and communications are disrupted for a long enough period (5+ years), it is highly likely for the individual to start to witness an experience malnutrition induced disorders and alterations in T-cell populations. The study of the functioning of neutrophils in anorexia patients has shown (in previous studies) decreased adhesion and reduced bactericidal and cell activities... and it’s these incredibly important forms of granulocytes that help to protect us from infections - in fact, it’s these white blood cells that are first to arrive on the scene in the the body’s detection of a bacterial infection.

To finalise my curiosities and probings of the importance and likelihood of cellular mutation as a result of malnutrition, I draw your focus on to the amino acid: Glutamine. Glutamine is an important amino acid with many functions in the body. It is a building block of protein and critical part of the immune system, but what many are unaware of is it's prolific role in intestinal health. Your body naturally produces this amino acid, and it is also found in many foods... but what happens when the body is both too weak to produce it, or when nutrition is not adequate to absorb it?

People under physical stress are likely to be at risk for glutamine deficiency, primarily because when the body is taxed by physical stress, blood and muscle concentrations of glutamine are rapidly depleted as the body is unable to manufacture this amino acid fast enough to meet its needs for it. One of the core recognisable symptoms of glutamine-deficiency is muscle mass loss... but there is one condition that also comes hand in hand alongside this deficiency, which is known as intestinal dysbiosis. Gut microbiota dysbiosis, also known as intestinal or gastrointestinal dysbiosis, refers to a condition in which there is an imbalance of the microorganisms within our intestines - which in turn can lead to multiple gastric complaints and developments of ill health such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), Crohn’s disease, Ulcerative colitis (UC) and more.

And so, you are left with many questions that still require much research and exploration in order to unveil their true answers. The power of ExG factors (environments verses genetic), it’s impact on cellular regeneration and formation; how genetics and epigenetics determine the likelihood, development and manifestation fo eating disorders, and above all else... to what extent do these physical strains truly curate a state of cellular metamorphosis that, ultimately, changes our physiological functionings?

These are questions for the present and the future.

Questions that I want to research.

Questions that I want to answer.

And questions that I want to cure.

Written by Darcy Bucci Chola Keverian


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