Eating Disorders & The Microbiome

In recent years there’s been increasing recognition that eating disorders are physical diseases with a biological etiology. Once deemed to be driven by a preoccupation by body image, it’s now understood that they are complex illnesses with varied causes.

There is a growing body of literature that associates gut microbiota and eating disorders. Given that food intake plays a determining role in the gut microbial profile and eating disorders are characterized by an irregular diet, this makes a lot of sense.

Anorexia is a physical and mental illness with dietary and brain components, and just like the microbiome, is linked to both the gut and the brain. Communication pathways between the gut microbiome and the brain are influenced by the diet. ‘Given the established gut–brain and gut–diet interactions, the gut microbiota may well be the critical mechanistic link between psychological and biological factors in these illnesses’ say Lam, Maguire and colleagues in a 2017 article in Nutrients Journal. The gut–brain axis is influences appetite control and brain function and so any alteration to the gut bacteria through eating patterns and psychological stress can compromise physiological, cognitive, and social functioning – all the aspects of life that an eating disorder impacts. The impact is not one way. Unhealthy and distorted gut microbes can impact brain functioning and eating patterns, and dysfunctional diet will affect the microbiome. A limited food profile, long periods of fasting, binging and purging will all impact the health of the intestine and gut microbes.

Cynthia Bulik, PhD, Distinguished Professor of Eating Disorders, and her team of researchers at the University of North Carolina at Chapel Hill have been researching the link between the microbiome and eating disorders. In the first study they identified an microbial imbalance in anorexia nervosa. Individuals with anorexia nervosa displayed lower diversity of the gut microbiota than healthy individuals. Since a healthy microbiota is a diverse microbiota, this result made sense. They also found that as they were renourished, their microbiota became partially restored, adding another reason for recovery. A nutritionally dense and diverse diet was linked to a healthy and diverse microbiome. Finally, they also found that microbial diversity was inversely correlated with depression and anxiety (higher depression, lower diversity), providing evidence for the microbe-gut- brain axis. The prevalence of comorbidities is high, and again this might be linked to the impact that the gut microbiome has on brain function.

The research could play a critical role not only in understanding the etiology of eating disorders, but their treatment. For one, the intestinal microbiota plays a critical role in metabolic function and weight regulation. It also places a challenge to the tendency to psychopathologise all patients. Many people with eating disorders do not experience hunger and satiety in the same was as a healthy individual might. Refeeding is also typically very uncomfortable for individuals with anorexia nervosa, and they experience gut pain, bloating, constipation and other gastrointestinal symptoms. UNC are looking to see whether targeted probiotics could ease the discomfort of refeeding and improve our ability to renourish individuals with anorexia nervosa.

Beate Herpertz-Dahlmann and colleagues concluded in their meta study that ‘gut–brain interactions may be important for treatment regarding the determination of target weight, rapidity of weight gain, refeeding methods and composition of the diet.’ It’s been found that a proportion of certain bacteria is significantly correlated with BMI, suggesting that a higher target weight is crucial.

The research is powerful because it offers an opportunity to understand causes and alter treatment. Less than half of people with eating disorders fully recover. This isn’t because they fail treatment, but because treatment fails them. Any opportunity to improve treatment and outcomes is an opportunity to change lives.

Dr. Amy Coleman

Doctor Guest Blog: Interview with Dr. Amy Coleman

We are excited to welcome Dr. Amy Coleman to the uBiome Doctor’s Corner blog, where we are passionate about learning more about the microbiome and how it can improve the health of our patients.

Enjoy this interview with Dr. Coleman to learn more about her and her work, and perhaps get some inspiration for yours!

How did you get interested in the microbiome field?

As a sick child that received so so many antibiotics, I ended up “catching everything,” especially respiratory viruses and infections. It seems that I could never stay well.

Then, at 14, I started staying away from antibiotics for the sniffles, cooking healthy for myself, working out, and sensing that my body needed to come into balance – although at that time, we had no understanding of the gut biome. Over time, I found that I built an interior resilience toward infection.

When I learned of the microbiome, it was a true passion for me because I know that feeling of the strength of my body in balance. It’s all about reaching within your own resources for the strength to be well. This empowers us beyond so many modalities that require a pill to be popped. We have had a powerful kind of “medicine” within us, all along.

What are you most excited about with the microbiome?

The revolutionary effects of the microbiome extend to every corner of medicine. However, distributing that knowledge in the form of education to patients and providers is what I am most excited about.

Thanks to what we know about gut flora, patients can now learn to tune into their bodies’ needs in a way never known before. The microbiome also invites a new way for patients and doctors to come together and have great conversations about (interior) gardening.

There is a real need now for a patient and doctor to relate to one another without threatening lab work, fearful medication side effects, or scary procedures. The microbiome ushers in a whole new age of holistic medicine which is personalized, precise, and based on cutting edge genetic science.

What do you do in your daily life to improve the health of your and your patients microbiomes?

For myself, I enjoy foods that nurture my gut. I have perfected, over years, a prebiotic/probiotic morning protein powerhouse shake that includes various important fiber sources like psyllium, flaxseed meal, and tigernuts, plus my favorite anti-inflammation fruits like acai, dragonfruit, and berries. It’s very purple, and very delicious!

Where do you hope microbiome work will be in 10 years?

I hope it will be seen as one of our body’s greatest natural resources, and I hope that people as well as all medical establishments will be given the tools and education to nurture, fortify, and protect it.

What is your biggest concern with microbiome testing?

Currently, we are entering the dawn of a whole new realm of thinking about what the microbiome is, and how it works. I believe that there will be attempts to oversimplify the whole ecosystem of it, and claim an understanding of how it all works, which could be misleading and inaccurate. In all honesty, just like the discovery of the genetic code, it will be many decades until we begin to understand the quantum nature of this realm within us, and to truly be able to apply its full potential towards best benefits for all.

What do you think are the three top ways to improve the health of one’s microbiome?

Only take antibiotics when absolutely needed, keep sugar consumption to a minimum (which includes alcohol), and realize that you are are not just eating for yourself, but for trillions of microbes (that’s a BIG picnic!).

What is your favorite microbiome friendly food?

Onions and garlic, which I love to put in my homemade tomato sauce and vegetable with shrimp stir-frys.

What is your favorite microbe?

Like a mother with many children would say, “I love them all!” However, I am very happy about Akkermansia‘s abilities to decrease inflammation and help with weight control. And, the name is quite fantastic, too.

To learn more about Dr. Amy Coleman, please visit, or connect with Wellsmart on Facebook, Twitter @wellinsidenout, or Instagram @wellsmartservice.

I Tested Positive for HPV. Now what?

Smart Jane™ tests for gonorrhea, chlamydia, syphilis, mycoplasma genitalium, and 19 strains of HPV, and it provides you with information about vaginal risk factors. In this blog post, we wanted to discuss HPV in particular. It’s the most common sexually transmitted infection in the US. If you or someone you know tests positive, you may wonder, now what?

First, schedule a visit with the healthcare provider that ordered the test. They will already have your test results from uBiome and will be able to help you with your next steps.

Know that most people with healthy immune systems will clear the virus naturally within six months to two years. If the high-risk virus does not clear, it can change normal cells into abnormal cells, which have the potential to turn into cancer. About 10% of people with high-risk strains will develop these long-lasting HPV infections that put them at risk for cervical cancer. However, HPV can take decades to develop into cervical cancer, and there are things you can do now to reduce your risk and support your body in clearing the virus.

For example, the healthcare provider may recommend more frequent pap smears. Paps check for the presence of abnormal, or precancerous, cervical cells and cancerous cervical cells. You may find you are positive for high-risk HPV but have a normal pap smear. In other words, your cervical cells are normal, but HPV is present. If the pap smear is abnormal, meaning abnormal cervical cells were detected, your doctor may want to take a closer look with a colposcopy, biopsy the cells, and possibly remove them to prevent cervical cancer. If you develop warts, a doctor can remove them. After the removal of warts or abnormal cervical cells, the virus itself may still exist and can be spread.

With the information uBiome provides about your vaginal flora, you can also take measures to to help your body clear HPV. Studies have shown a vaginal microbiome with an abundance of Lactobacillus bacteria can protect against the acquisition and persistence of HPV. Here are a few things you can do routinely to promote Lactobacilli growth and limit the growth of other bacteria:

  • Take pre- and probiotics that contain lactobacilli.
  • Avoid douching and vaginal soaps, which can eliminate lactobacilli.
  • Eat plain, lactobacillus-containing yogurt and fermented foods, like kimchi and sauerkraut, and drink fermented beverages, like kombucha.
  • Avoid cigarette smoking, as smoking has been linked to decreased amounts of vaginal lactobacillus.

You’ll also want to continue to protect yourself and any sexual partners. HPV is spread primarily through genital-to-genital contact, including vaginal and anal intercourse and rubbing genitals together. Using condoms and dental dams can reduce the risk of transmission significantly (but not completely). The most effective way to reduce HPV transmission is abstaining from genital-to-genital contact. More research is needed on HPV transmission via sex toys. If you’re sharing sex toys, disinfect them per the manufacturer’s recommendations and put a new condom on them between each partner’s use. Additionally, there is no HPV test for people with penises, so right now low-risk HPV can only be detected if they have warts. Whether or not you’ve tested positive for STIs, discussing STI testing and history prior to any sexual contact is important for a fully consensual intimate experience.

If you want more information about body literacy, informed choice, and consent, find us at The Fifth Vital Sign.