Abstracts
Alkaline urine
Notes an association between eating disorders in otherwise healthy individuals and alkaline urine.
Urine pH of the patients with eating disorders (6.8 mean) was significantly higher than urine pH in the controls (5.9 mean).
Explanations include: 1. Self-induced vomiting. 2. Alkaline "tide" from release of bicarbonate into the gastric venous drainage after large meals. 3. Diet low in meat, high in vegetables, citrus fruits and dairy products. 4. Osteoporosis. 5. Hypochloremic alkalosis from hyperaldosteronism or contraction alkalosis from diuretic or laxative abuse.
Elevated pH was seen in all types of eating disorders but especially in self-described vomiters and malnourished patients.
Finding an elevated urinary pH in an adolescent is significant and should be investigated.
"Alkaline Urine is Associated With Eating Disorders", Arden, Martha R., MD, et al, American Journal of Diseases in Children, January 1991;145:28-30.
Lithium carbonate
Patients (#91) at a bulimia clinic were separated into depressed and nondepressed groups and given either lithium carbonate 300 mgs 2 times daily or a placebo.
This lithium supplementation, which yielded relatively low plasma levels, was not more effective than placebo. It was noticed, however, that depression and other psychopathologies decreased with improvement in bulimic behavior.
"Treatment of Bulimia Nervosa With Lithium Carbonate: A Controlled Trial", Hsu, L.K. George, MD, The Journal of Nervous and Mental Disease, 1991;179(6):851-355.
Pain
Pain, Anorexia and Bulimia
There is reduced pain sensitivity in anorexia and bulimia not due to the fasting but possibly a true pathological feature.
"Diet and Pain Sensitivity: A Validation of Clinical Findings", Lautenbacher, S., et al, Physiology and Behavior, 1991;50:629-631.
Leptin levels & Bulimia
Leptin plays an important role in reproductive function.
Hypothesized that low leptin synthesis is associated with amenorrhea. Therefore determined serum leptin levels in 43 underweight female students, who were screened for lifetime occurrence of amenorrhea. Assessed the predictive value of leptin, body mass index (BMI), fat mass and percent body fat, respectively, for lifetime occurrence of amenorrea.
Furthermore, the relationships between serum leptin levels and of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol and progesterone, respectively, were evaluated.
Only leptin predicted lifetime occurrence of amenorrhea in the student cohort. The critical leptin level was in the range of 1.85 micrograms L-1. This level served to largely separate anorectic from bulimic patients. In patients with AN mean serum log10 leptin levels over the first 4 weeks of inpatient treatment were correlated with mean FSH, LH and estradiol levels, respectively. Evidently, a critical leptin level is needed to maintain menstruation.
In affluent populations eating disorders are likely to be a major cause of a low leptin synthesis.
Kopp W et al., Low leptin levels predict amenorrhea in underweight and eating disordered females [see comments]. Mol Psychiatry, 1997 Jul, 2:4, 335-40.
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