Anorexia also starves the gray matter: eating disorder – dwindling brain volume

When anorexics go hungry, the brain also goes hungry: every third person has gray matter, an average of 18 percent. If the weight improves again, the brain volume usually also normalizes. Nevertheless, damage can remain.

  • With anorexia, not only does the body emaciate, the brain can also shrink. Experts call this brain atrophy.
  • A German study found that anorexic adolescents have about 18 percent less volume of gray matter than healthy peers. At the same time, anorexics have around 27 percent more brain fluid than healthy people.
  • A possible explanation for this brain loss: Because of malnutrition, protein biosynthesis in the central nervous system is probably lower – not enough proteins are produced to continuously repair or regenerate nerve cells.
  • When the anorexic person increases again, the size of their brain normalizes.
  • However, especially in adolescents, there is a risk that the hippocampus and the amygdala cannot develop properly due to anorexia – and that the patients will later become more depressed or develop anxiety disorders.

neuron

The neuron is a cell in the body that specializes in signal transmission. It is characterized by the reception and transmission of electrical or chemical signals.

hippocampus

The hippocampus is the largest part of the archicortex and an area in the temporal lobe. It is also an important part of the limbic system. Functionally, he is involved in memory processes, but also in spatial orientation. It comprises the subiculum, the dentate gyrus and the ammonshorn with its four fields CA1-CA4.

Changes in the structure of the hippocampus due to stress are associated with pain chronification. The hippocampus also plays an important role in increasing pain from fear.

amygdala

An important core area in the temporal lobe, which is associated with emotions: it evaluates the emotional content of a situation and reacts particularly to threats. In this context, it is also activated by pain stimuli and plays an important role in the emotional evaluation of sensory stimuli. The amygdala – in German almond kernel – is counted among the limbic system.

If an anorexic person has also been diagnosed with brain atrophy, the hormone leptin could be a starting point for therapy. Leptin is a hormone made by fat cells. Fasting for a short time causes the level of leptin in the blood to drop; in acute anorexics, the level of leptin is even lower. Various studies have shown this. If there is too little leptin in the blood, then a signal goes to the hypothalamus, i.e. to the switching point in the brain that regulates appetite and weight: Warning, too little leptin in the blood – the appetite must be stimulated. "Acute anorexics can psychologically override this hunger signal," says Stefan Ehrlich from the University Clinic in Dresden. However, there are studies that showed that if you gave the hormone extra to mice and anorexic people with leptin deficiency, more gray matter was formed and the brain became heavier. It remains to be determined whether leptin is a safe and helpful medication for anorexia nervosa.

hormone

Hormones are chemical messengers in the body. They are used for the mostly slow transmission of information, usually between the brain and the body, e.g. the regulation of blood sugar levels. Many hormones are formed in glandular cells and released into the blood. At the destination, e.g. an organ, they dock at binding sites and trigger processes inside the cell. Hormones have a broader effect than neurotransmitters; they can affect various functions in many cells in the body.

Gray matter

Gray substance / – / gray matter

A gray substance is a collection of nerve cell bodies that occurs in core areas or in the cortex (cerebral cortex).

Anorexia, also called anorexia nervosa, is an eating disorder that leads to severe underweight. Symptoms include: deliberate weight loss, avoiding high-calorie foods or completely refraining from eating, daily weighing, eating rituals, laxative abuse, urge to move, body pattern disorder, loss of libido, hair loss, hair fluff, cold hands and feet Patients also missed menstrual periods, social isolation, perfectionism, feelings of guilt and shame, fear and grief.

Anorexia nervosa mainly occurs between the ages of 15 and 24, and almost exclusively in girls or young women. It is estimated that about three out of every 1,000 young women are anorexic. Long-term studies show that just under half of anorexics become fully healthy, a third improve symptoms, and about a fifth remain chronically anorectic. About five percent of anorexics die – one of the highest death rates among psychiatric illnesses.

Anorexia is not an addiction in the sense of substance dependence like alcohol addiction. It is also not a slimming craze, as is often said. For example, those affected report that they want to "slim down" in order not to be in the way of anyone. A slim body ideal is a risk factor. The causes of anorexia are different, for example problems with the family structure and fear of “becoming woman” during puberty. The causes are individual and can be interlinked. Studies from recent years also indicate that genetic factors play a major role: the complex genetic disorder is expressed in temperament during childhood, for example in the form of perfectionism or damage avoidance.

From 61 kg to 42 kg in two months: Marie is anorexic. "I stopped eating because I was bullied," says the 13-year-old, who is actually called differently. The girl soon went black in the morning when she got up. Sometimes her head hurt. "I couldn’t concentrate anymore."

Headache and concentration problems: When anorexics go hungry, the brain also starves. So it works slower and not as well anymore. “The intelligence quotient is estimated to be around ten in people with acute anorexia Points lower than in a healthy, normal weight state. ”That is what Stefan Ehrlich, head of the Center for Eating Disorders at the Clinic for Child and Adolescent Psychiatry and Psychotherapy at the University Hospital Dresden says. He and his team treat around 120 anorexic adolescents each year, 40 to 50 of whom are inpatients.

Anorexia, medically anorexia nervosa, is a disease that mainly affects young girls. It usually goes hand in hand with massive feelings of shame and guilt and can be accompanied by anxiety and a depressed mood. Whether this eating disorder is really to be counted among addictions – as a so-called "behavioral addiction" such as computer or gaming addiction – is highly controversial among psychiatrists (see box: "Anorexia: causes and consequences").

But there is another consequence for the brain. One that is not so obvious: As the body continues to emaciate, the brain also shrinks. Atrophy of the brain, as doctors say, is colloquially called “brain loss”. Above all, the gray matter declines, i.e. the nerve cell bodies that make up the cerebral cortex, among other things. “Then the outer liquor space is expanded. This is the area between two meninges that surround the brain, ”says Ehrlich.

eye

Eyeball / Bulbus oculi / eye bulb

The eye is the sense organ for the perception of light stimuli – of electromagnetic radiation of a certain frequency range. The light visible to humans is in the range between 380 and 780 nanometers.

intelligence quotient

Intelligence quotient (IQ) / – / intelligence quotient

A parameter that is supposed to express a person’s intellectual performance. Corresponding tests to determine intelligence go hand in hand with the concept that there is a general general factor of intelligence that is normally distributed in the population. The first IQ tests were developed in the early 20th century by Alfred Binet, who wanted to determine the relative intelligence age of schoolchildren. According to its definition, the IQ denotes the quotient of the age of intelligence and age multiplied by 100. This is therefore also the average IQ of a person. 95 percent of the population with their IQ values ​​lie between 70 and 130. If someone reaches a value below 70, one speaks of a reduction in intelligence, while a result beyond 130 is considered to be highly gifted.

Gray matter

Gray substance / – / gray matter

A gray substance is a collection of nerve cell bodies that occurs in core areas or in the cortex (cerebral cortex).

Cortex

Cerebral cortex / cortex cerebri / cerebral cortex

The cortex cerebri, or cortex for short, denotes the outermost layer of the cerebrum. It is 2.5 mm to 5 mm thick and rich in nerve cells. The cerebral cortex is strongly folded, comparable to a handkerchief in a cup. This creates numerous turns (gyri), crevices (fissurae) and furrows (sulci). When unfolded, the surface of the cortex is approximately 1,800 cm 2 .

Gray matter shrinks by a fifth

A study carried out at the RWTH Aachen University Clinic and published in 2012 provides exceptionally concrete figures. The study examined 19 anorexic girls between the ages of 12 and 17 who had just been admitted to hospital to begin inpatient therapy. In the control group, 19 girls were the same age, had a similar intelligence quotient, but were not eating disorders. The total brain volume per se – that is, the amount of gray matter, white matter and brain fluid – differed only slightly between the two groups. However, the details revealed that the gray matter had an average volume of 739 cubic centimeters in healthy girls – an average 605 cubic centimeters in anorexic girls, or around 18 percent less. The healthy girls had an average of 422 cubic centimeters of brain fluid – the anorexic girls, on the other hand, 535 cubic centimeters, a good 27 percent more. The white Substance was only slightly less in the sick girls than in the healthy ones.

However, one thing has to be considered with all these numbers: they are always average values. An anorexic can have more gray matter than a healthy schoolmate. Anorexia researcher Ehrlich assumes: "In the case of adolescent anorexics, about a third of them are affected by radiologically noticeable atrophy."

Marie doesn’t know if she is one of them. After the two months in which she lost a good third of her weight, the parents went to the psychologist with her. Diagnosis: Anorexia nervosa – anorexia.

Marie was immediately sent to Stefan Ehrlich for inpatient therapy. “Here I was put in a tube to take pictures of my head. But I preferred not to ask what came out of it, ”says the seventh grader. "I was already completely done." According to Ehrlich, however, Marie’s magnetic resonance imaging (MRI) was not performed to see whether her brain had shrunk. “The MRI was for research purposes. A clinical MRI is only necessary if organic causes such as a brain tumor are to be excluded. The cognitive losses sometimes occur without a clear atrophy. "

intelligence quotient

Intelligence quotient (IQ) / – / intelligence quotient

A parameter that is supposed to express a person’s intellectual performance. Corresponding tests to determine intelligence go hand in hand with the concept that there is a general general factor of intelligence that is normally distributed in the population. The first IQ tests were developed in the early 20th century by Alfred Binet, who wanted to determine the relative intelligence age of schoolchildren. According to its definition, the IQ denotes the quotient of the age of intelligence and age multiplied by 100. This is therefore also the average IQ of a person. 95 percent of the population with their IQ values ​​lie between 70 and 130. If someone reaches a value below 70, one speaks of a reduction in intelligence while an Result beyond the 130 is considered a gift.

Gray matter

Gray substance / – / gray matter

A gray substance is a collection of nerve cell bodies that occurs in core areas or in the cortex (cerebral cortex).

magnetic resonance imaging

Magnetic resonance imaging / – / magnetic resonance imaging

An imaging process that doctors use to diagnose malformations in different tissues or organs of the body. The method is colloquially called nuclear spin. It is based on the fact that the nuclei of some atoms have their own angular momentum, which can change direction in the magnetic field. This property applies to hydrogen, among other things. Therefore, tissues that contain a lot of water can be displayed particularly well. Abbreviation: MRI.

magnetic resonance imaging

Magnetic resonance imaging / – / magnetic resonance imaging

An imaging process that doctors use to diagnose malformations in different tissues or organs of the body. The method is colloquially called nuclear spin. It is based on the fact that the nuclei of some atoms have their own angular momentum, which can change direction in the magnetic field. This property applies to hydrogen, among other things. Therefore, tissues that contain a lot of water can be displayed particularly well. Abbreviation: MRI.

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