“Since research using brain neuro-imaging has revealed that higher serotonin levels in the brain may exist in clients prior to and during restrictive behaviors from anorexia as well as after weight restoration, are anti-depressants beneficial in the treatment of Anorexia?”

Great question from a participant in Alsana’s “The Gut Brain and Eating Disorders: Nutrition Therapy’s Role in the Healing Process” webinar. According to Dr. Timothy Walsh, “starvation and lack of precursor molecules required for synthesis of neurotransmitters may prevent a medical response” to SSRI medications (Walsh,BT. In: UptoDate, Waltham, MA. Accessed on April 12, 2016).  Furthermore, a meta-analysis (4 randomized trials, of which 1 was specific to fluoxetine SSRI; 146 total patients) found antidepressants were no more effective for weight gain than placebo.  However, “it is reasonable to try an SSRI for patients with severe co-morbid depression or anxiety that persists despite weight restoration”, although no benefit has been seen in randomized trials.

Therefore, even though anti-depressants (SSRIs) are not currently considered evidence-based in treatment of anorexia specifically, the co-morbid conditions experienced by these clients may warrant use of these medications and should be individually determined by the collaboration of the treatment team. The fact that malnutrition itself mimics all of the signs and symptoms of depression, the registered dietitian’s role in weight restoration is critical.

As the RD guides the client towards weight restoration, the use of probiotic foods is a proactive tool for not only energy fuel but also the restorative benefits of specific probiotic strains for natural healing of the gut microbial environment. Another participant asked, “What kind of yogurt is needed for the anxiety calming effect of probiotics on the gut brain system?” Research has not specifically targeted brands of yogurt to date, but several studies have indicated the probiotic lactobacillus casei strain has been shown to relieve stress-related symptoms in both human and animal studies and the probiotic bifidobacterium longum (as a probiotic pill consumed for one month by 22 healthy men) reduced feelings of stress compared to the month trail on placebo.  These same men also had clinically lower levels of cortisol while under duress and improvements on visual memory test (Society for Neuroscience annual meeting. Chicago, IL. October 18, 2015. Allen AP, et al. Towards psychobiotics for stress & cognition: Bifidobacterium longum blocks stress-induced behavioral and physiology changes and modulates brain activity and neurocognitive performance in healthy human subjects). It seems wise to choose a yogurt that contains both lactobacillus and Bifidobacterium strains as a minimum.

What yogurt should you choose? The National Yogurt Association recommends choosing a yogurt that has a seal indicating that a minimum number of live starter cultures was used during fermentation, although a seal doesn’t necessarily mean that the bacteria it contains are probiotic or exist in large enough quantities to have positive effects (frustrating, yes!). Activia brand has been tested with proof that lactobacillus and one other strain survive the digestive process. Stoneyfield brand has a proprietary blend of six live probiotic strains of which three are in the lactobacillus family. Certainly other brands are beneficial, so always look for yogurt that states “live and active cultures” which indicate that the probiotics have been added after heat processing.

How does this relate to our clients struggling with anorexia specifically? We are not sure, but the growing evidence of the benefits of probiotics in both pill form and food sources in not only animal studies but also healthy human studies is intriguing and warrants a closer look.

Join us for next month’s Tuesday’s with Tammy blog where I will address these questions: “Does serotonin increase or decrease fluid in the gut?” and “What should we look for in a probiotic?”