Dr James Greenblatt, MD, bills himself as a ‘functional psychiatrist’ who takes an integrative approach to the treatment of mental conditions. He is the chief medical officer at Walden Behavioral Care in MA, serves as an assistant professor at Tufts University School of Medicine and Dartmouth College Geisel School of Medicine.
Dr Greenblatt said he believes nutritional aspects have been given short shrift in the treatment of a number of conditions, including anorexia, ADHD and suicidal depression. In his recent book Answers to Anorexia, he argues that zinc status can play a crucial role both in understanding how the malady develops and how it can best be dealt with.
Anorexia not modern condition
Anorexia nervosa (AN) is not a new problem. Dr Greenblatt says mentions of the malady can be found in manuscripts dating back to the 1600s.
Nor, as some older research has suggested, is it necessarily getting worse in this era of emaciated supermodels as idols and online fat shaming. The best data reveals the prevalence hovering at around a stubborn 1% lifetime prevalence in the population. Data from 2012 indicates that between 0.9% and 2.0% of females and 0.1% to 0.3% of males will develop anorexia.
Even if the problem is not worsening, that still means that in the United States, according to one 2016 study, someone dies from an eating disorder every 62 seconds. It is by far the leading cause of death of women aged 15-24 in the US.
Treatment outcomes are mediocre at best. Dr Greenblatt said traditional treatment approaches show a 50% relapse rate and a fatality rate for AN higher than that of any other psychiatric disorder.
Micronutrient deficiency hypothesis
He noted that it becomes harder and harder to reach a successful outcome the longer the condition persists. That’s why it is critical to focus on proper nutrition for teenage girls and young women, to make sure that the preconditions aren’t there for the problem to develop in the first place in susceptible individuals.
Dr Greenblatt argues that traditional pharmaceutical approaches to AN have focused on neurotransmitter imbalances. But in his view this is an incomplete picture.
“A micronutrient deficiency hypothesis offers a much more robust and comprehensive explanation at the root of these manifestations,” he has written.
Dr Greenblatt argues that adequate levels of micronutrients are crucial for many processes in the body and are vital regulators of neurotransmitters and hormones that regulate eating behaviors. In his view zinc is a key brick in this wall.
AN patients show significant brain abnormalities, though Dr Greenblatt noted that it’s unclear whether these precede or are a result of the condition. And the highest levels of zinc in the body are found in the hippocampus and cerebral cortex, though these levels can be variable. In the diet zinc is most abundant in meat, fish, shellfish and legumes.
Zinc deficiency a fairly modern discovery
The importance of zinc was only recognized fairly recently, Dr Greenblatt said. In 1961 a young Iranian man, who was subsisting almost exclusively on flatbread, potatoes and milk, was seen by a healthcare professional. The case report showed he presented with anemia and severe stunting of growth and sexual maturation. His stunning response to zinc supplementation opened the door to the concept of zinc deficiency and the modern field of research.
The people in the US most at risk of zinc deficiency problems tend to be younger and on vegan diets, Dr Greenblatt said.
Start of dangerous slide
“It can be a subtle factor that pushes them from going on a vegan diet like all their other 12-year-old friends to developing an outright zinc deficiency that interferes with digestion, sleep and body image,” Dr Greenblatt said.
“That then sets the stage for a slide into an eating disorder,” he said.
The link between zinc and anorexia is not a discovery of Dr Greenblatt’s. Indeed, a 2006 study in the journal Eating and Weight Disorders concluded: “Oral administration of 14 mg of elemental zinc daily for 2 months in all patients with AN should be routine.”
Data supports idea, but some professionals still resist notion
But even though this connection has been known for a while, it still is underemphasized, Dr Greenblatt argues. Many dietitians are involved in the treatment of AN patients, and some of them bring their food-first, food-only biases with them, he said.
“There is a bias that nutritional supplements are not needed and I think that is a tragedy in the treatment of anorexia. Many of these patients may have not been eating nutrient-dense food for six months, or in some cases maybe as much as 10 years,” he said.
“We have not seen any treatment improvements in 20 years, and I think this nutritional protocol holds the greatest promise. Our society and our medical community does in some way see this as a terminal illness and it doesn’t have to be,” he concluded.