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FOR IMMEDIATE RELEASE
Orthomolecular Medicine News Service, February 9, 2008
Vitamin Supplementation Prevents Anorexia
(OMNS February 9, 2008) Anorexia is primarily due to vitamin deficiency. Approximately one in twenty teenage girls in America is struggling with an eating disorder. Parents can help eliminate the risk of anorexia by providing their children with vitamin supplements.
Anorexia is an acknowledged clinical marker of beriberi, the disease specifically caused by a deficiency of vitamin B1 (thiamine). [1] Anorexia is also commonly observed as an early symptom of pellagra (niacin deficiency) [2] and is a known complication of scurvy, vitamin C deficiency. [3] Prevention is especially important, because beriberi/anorexia often does not respond well even to treatment with high doses of thiamine for months, and sometimes does not respond at all. [1] But as a rule, high potency vitamin supplements are an effective cure for the loss of muscle mass caused by beriberi and the skin lesions caused by pellagra.
The vitamin B1 in almost every multivitamin and B-complex vitamin pill is either thiamine mononitrate or thiamine hydrochloride. The body’s ability to absorb these two forms of thiamine is limited [4] by the maximum amount that can be handled by the body’s two specialized thiamine transport proteins. [5]. This means many doses per day of oral thiamine are necessary for effective treatment. Another class of thiamine molecules, called allithiamines, are much better absorbed. [6] Since allithiamines are not included in standard multivitamin preparations, we recommend their reformulation to include this specific form of B1.
The conventional medical approach to eating disorders such as anorexia typically includes psychological/behavioral treatment, medication, and food-groups dietetics. It is surprisingly rare for physicians to link eating disorders with vitamin deficiency, and few doctors recommend vitamin supplements for prevention.
Dieting without supplementation causes vitamin deficiency, and vitamin deficiency can lead to anorexia. Dieting is the number one cause of vitamin/mineral deficiency in America. Deficiency is entirely preventable with nutrition supplements. A fraction of the population is more prone to becoming thiamine deficient while dieting due to genetic conditions associated with proteins that bind thiamine [7,8]. The risk of thiamine deficiency is also increased by eating processed foods. A high intake of simple carbohydrates requires increased thiamine intake. Vitamin and mineral supplements contain no calories, and do not cause weight loss nor weight gain. They do help promote normal appetite.
Harold Foster, PhD writes:
“In both open and closed trials in sub-Saharan Africa, mixtures of nutrients were given to HIV-positive patients, some of whom were in the late stages of AIDS. Even just twice the US RDA of ascorbic acid and four times the US RDA for thiamine resulted in improvements of appetite . . . after only a few days of supplementation.”
Erik Paterson, MD, writes:
“Many years ago, an emaciated, teenage girl was made to come to see me by her worried parents because of her revulsion against food. She admitted that she hardly ate anything, but explained that she felt that she was fat: a typical case of anorexia nervosa. I tried to persuade her to eat right. She adamantly refused. So I made a deal with her. I pointed out that by not eating she was making herself malnourished with respect to vitamins. The deal was that I would not pester her to eat if she would take vitamin pills, specifically vitamin C and B-complex vitamins. She agreed. Two weeks later she and her parents returned to tell me that she had developed a strong appetite. After another month, her emaciation was clearly disappearing. She never became anorexic again.” [9]
A well-formulated daily multivitamin supplement, at least 1,000 mg per day of vitamin C, plus additional B-vitamins will greatly reduce the incidence of anorexia and other eating disorders. If you are helping to care for a family member with anorexia, and your physician didn’t recommend vitamin supplements, get a second opinion.
References:
[1] D. Lonsdale. Evid Based Complement Alternat Med. 2006 March; 3(1): 49-59.
[2] S. R. Roberts. “Pellagra: Its Symptoms and Treatment,” The American Journal of Nursing, Vol. 20, No. 11 (Aug., 1920), p 885-890.
[3] L. Goebel. http://www.emedicine.com/med/topic2086.htm Last bullet in section on physical symptoms.
[4] D. Bender. “The Nutritional Biochemistry of the Vitamins,” Cambridge University Press, 2003, page 151.
[5] V.S. Subramanian et al. “Vitamin B1 (thiamine) uptake by human retinal pigment epithelial (ARPE-19) cells: mechanism and regulation.” Journal of Physiology (Oxford, United Kingdom, 2006), Volume Date 2007, 582(1), 73-85.
[6] T.P.S. Nibber, “Reply to Dr. Lonsdale,” Townsend Letter for Doctors and Patients, August-Sept. 2004. http://findarticles.com/p/articles/mi_m0ISW/is_253-254/ai_n6176277/pg_2
[7] B.H. Robinson, N. MacKay, K. Chun, and M. Ling, “Disorders of pyruvate carboxylase and the pyruvate dehydrogenase complex.” Journal of Inherited Metabolic Disorders, 19, 452-62.
[8] D. Bender, “The Nutritional Biochemistry of the Vitamins”, Cambridge University Press, 2003. Sections on Thiamine Responsive Pyruvate Dehydrogenase Deficiency (p 156) and on Maple Syrup disease (p 158).
Nutritional Medicine is Orthomolecular Medicine
Orthomolecular medicine uses safe, effective nutritional therapy to fight illness. For more information: http://www.orthomolecular.org
The peer-reviewed Orthomolecular Medicine News Service is a non-profit and non-commercial informational resource.
Editorial Review Board:
Carolyn Dean, M.D., N.D.
Damien Downing, M.D.
Harold D. Foster, Ph.D.
Steve Hickey, Ph.D.
Abram Hoffer, M.D., Ph.D.
Bo H. Jonsson, MD, PhD
Thomas Levy, M.D., J.D.
Erik Paterson, M.D.
Andrew W. Saul, Ph.D., Editor and contact person. Email: omns@orthomolecular.org
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DR. LUKA KOVAC’S NOTES:
Here is a breakdown of the key connections between smoking and anorexia:
1. Smoking as a Weight Control Tool
This is the most direct link. Individuals with anorexia (and other eating disorders) may use smoking for two primary reasons:
- Appetite Suppression: Nicotine is a stimulant that suppresses appetite and can delay hunger cues. This makes it easier to restrict food intake.
- Metabolic Effect: Nicotine slightly increases metabolic rate, causing the body to burn slightly more calories at rest. For someone intensely focused on weight control, even this small effect can be seen as desirable.
As a result, people with anorexia have significantly higher rates of smoking than the general population. Many start smoking after developing the eating disorder specifically for these perceived benefits.
2. Shared Risk Factors and Biology
Research suggests overlapping vulnerabilities:
- Dopamine Pathways: Both eating disorders and nicotine addiction involve the brain’s reward system (dopamine). Genetic or environmental factors that affect dopamine signaling may increase susceptibility to both conditions.
- Personality Traits: High rates of perfectionism, anxiety, impulsivity, and obsessive-compulsive traits are common in both anorexia and nicotine dependence.
- Co-occurring Mental Health Conditions: Depression, anxiety disorders, and OCD are common in anorexia. People may use nicotine to self-medigate these symptoms, inadvertently developing an addiction.
3. Dangerous Health Consequences (Synergistic Effects)
This is where the combination becomes especially hazardous. Smoking and anorexia don’t just add risks—they multiply them.
| Health System | Effect of Anorexia Alone | Effect of Smoking Alone | Combined Effect |
|---|---|---|---|
| Cardiovascular | Low blood pressure, bradycardia (slow heart rate), heart muscle loss | Increased heart rate, high blood pressure, narrowed arteries | Extreme stress on the heart; erratic rhythm, higher risk of sudden cardiac arrest. |
| Bone Health | Low estrogen/testosterone leads to osteoporosis | Toxins reduce bone formation, increase fracture risk | Severe, early osteoporosis. Fractures from minor falls or even just walking. |
| Lungs | Respiratory muscle weakness, reduced lung capacity | Emphysema, chronic bronchitis | Accelerated lung damage. Pneumonia and respiratory failure are much more likely. |
| Metabolism/Electrolytes | Low potassium, sodium, magnesium (arrhythmia risk) | Nicotine alters electrolyte balance | Much higher risk of deadly heart arrhythmias. |
| Cancer | (No direct link, but starvation weakens immune surveillance) | Lung, throat, mouth, bladder, etc. | Weakened body less able to fight early cancers. Higher mortality. |
Key danger: Anorexia already strains the heart. Adding nicotine, a stimulant that forces the heart to work harder, is a particularly dangerous combination. Sudden cardiac death is a leading cause of mortality in anorexia, and smoking significantly increases that risk.
4. Treatment Challenges
Treating a person with both anorexia and nicotine addiction is very difficult for a specific reason:
- Weight gain anxiety: In recovery from anorexia, weight gain is essential but terrifying. Quitting smoking often leads to temporary weight gain (due to improved appetite and metabolism returning to normal).
- Fear of recovery: The individual may resist smoking cessation because they fear the weight gain will be extreme or uncontrollable. They may see smoking as “protective” against their worst fear.
For this reason, most treatment programs address the eating disorder first or concurrently, with careful planning. Abruptly forcing smoking cessation without nutritional and psychological support for the anorexia can trigger a severe relapse of the eating disorder.
5. Harm Reduction Perspective
Some clinicians will not prioritize smoking cessation in an actively anorexic, underweight patient. The immediate, life-threatening risks of starvation (cardiac instability, organ failure) outweigh the long-term risks of smoking. Once weight is restored and eating behaviors stabilize, smoking cessation can be addressed safely.
Summary of Key Points
- Smoking is often used as a maladaptive tool to suppress appetite and increase metabolism in anorexia.
- The combination is far more dangerous than either condition alone, especially for the heart and bones.
- Rates of smoking are very high in people with anorexia.
- Treatment is challenging because quitting smoking can trigger fear of weight gain.
- Clinical priority is usually to treat the life-threatening anorexia first, then address smoking.
Where to Get Help
- National Eating Disorders Association (NEDA) Helpline: (800) 931-2237 (US)
- Crisis Text Line: Text “HOME” to 741741 (24/7 support for any crisis)
- SAMHSA National Helpline: 1-800-662-HELP (4357) (Treatment referral for mental health and substance use)
- Talk to your doctor or a therapist who specializes in eating disorders and/or addiction.
