SHARES
In 2017, a physician in Nova Scotia attended to a strange case. The case involved an 8 year old boy who lost 8.2 kg (18 pounds)! Strange symptoms began a couple months before. Upon attending a healthy eating lesson, the 8 year old began scrutinising his food. He even started to doubt what his mom had prepared in his food. Besides that, he avoided fat and carbs all together. He started preparing his own meals and in no time, he was only consuming 200 calories a day.
On admission, the boy believed the nurses were “evil” and that he could inject other people with his fat cells simply by walking pass them. Additionally, the 8 year old boy also developed idiosyncrasies – he’d flap his arms and tap his mouth in hopes of ridding himself of the “contamination”. The boy was an anxious child growing up, although these eating disorder symptoms are far exceeding that of anxiety.
Months later, doctors discovered the missing puzzle piece.
The boy had known history of recurring strep throat. Ultimately, this information helped doctors identify the reason behind the sudden development of the eating disorder. Upon removal of his tonsils, the symptoms of his eating disorder disappeared.
Relationship of streptococcal infections to an autoimmune disorder – PANDAS
In a report on the patient, the doctor, Carlo Candarang described the disorder as a paediatric autoimmune neuropsychiatric disorder associated with Streptococcal infection, or PANDAS.
PANDAS, a type of obsessive-compulsive disorder that sometimes comes on in children with a bout of strep throat. It was unusual how this well-established infection brought about eating disorder.
Could there really be a relationship between the infections and eating disorders ?
But childhood infections are so common, and eating disorders so multifaceted. It seems so implausible. Why would a sore throat lead to a state in which a person feels irrationally preoccupied with being thin?
This year, though, a large study found that the case of the 8 year old boy was not an isolated incident. Infections might, in fact, spark eating disorders in some people. Lauren Breithaupt, a clinical psychologist from the Massachusetts General Hospital looked at the health histories of 525,643 Danish girls. The researchers examined the girls’ medical records to see if they had ever been admitted to hospital for a range of infections. The cases include rheumatic fever, strep throat, viral meningitis, mycoplasma pneumonia, coccidioidomycosis, or influenza. In addition, researchers also checked whether they ever had an eating disorder diagnosis.
A connection between the two immediately became clear. The study found that the teens hospitalised with a severe infection were 22 percent more likely to be diagnosed with anorexia, 35 percent more likely to be diagnosed with bulimia, and 39 percent more likely to have an eating disorder that doesn’t quite meet the criteria for an anorexia or bulimia diagnosis.
The diagnosis of an eating disorder tended to happen soon after the infection took place. The girls were at their greatest risk of developing one within the first three months after being in hospital for an infection.
PANDAS and the Theory behind it
While, no one truly knows the cause of this connection. Breithaupt suggests that either the infection itself or the antibiotic might be disrupting the patient’s gut microbiome. Gut microbiome is the collection of microorganisms in the intestine that plays a role in health and disease. This disruption might change the amount neuropeptides circulating in the gut. Because the gut communicates with the brain, the quantities of neuropeptides circulating in the brain might then change.
One competing theory is that the body’s own immune response to an infection might end up invading the brain. When the body senses a dangerous bug, it produces proteins that destroy the invader. But some of those proteins can also attack our own cells. In possible cases of anorexia or bulimia induced by bacteria, some scientists suspect that these proteins get into parts of the brain that control impulses such as disgust and hunger. There, they might attack the brain tissues or switch on the “I’m not hungry anymore” impulse, or even the “I’m disgusted by my own body” impulse.
There’s no direct evidence for these theories; for now they’re merely speculation. And even if one of them proved correct, researchers would still have to contend with the mystery of why people get infections all the time but relatively few develop eating disorders. Or, for that matter, why not everyone with an eating disorder recently dealt with an infection.
Conclusion
If researchers confirm these findings, this could eventually change treatment of eating disorders. Doctors would have to check if their eating-disorder patients have any lingering infections. Breithaupt says, “The results also have the potential to radically change our notion of the many ways eating disorders might originate.” While most professionals acknowledge that anorexia and bulimia have deep psychologically roots, some eating-disorder patients still face stigma for supposedly being so “vain” as to starve themselves. It’s less likely that people would accuse a person of getting meningitis on purpose. So, this would bust the notion that people’s compulsive dieting is out of vanity as they might simply be under the spell of antibodies gone awry.
by Yashwini Ravindranath
Born & raised in Malaysia, Yashwini earned her M.D. studying in Moscow's Russian National Research Medical University. With an affiliation towards research, all things coffee and the startup ecosystem, she now contributes articles to GetDocSays View all articles by Yashwini Ravindranath.
