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Nutrition and Fertility Connection

Type of eating disorders

Nutrition strongly affects the gynecological health of women. Fighting your natural size and shape can lead to unhealthy dieting practices, poor body image and chronic eating disorders. Eating disorders are serious medical illnesses, diagnosed via psychological, behavioral and physiologic characteristics. There are three groups of eating disorders: anorexia nervosa; bulimia nervosa and eating disorders not otherwise specified (EDNOS). EDNOS includes binge eating disorder, compulsive overeaters and night eating syndrome. Eating disorders mostly affects young adult women, and it is estimated that 3.2% of women between 18 and 30 years suffer from this condition. The peak age for onset is 15 -19 years.

Symptoms of Anorexia Nervosa and Bulimia Nervosa

We focus on anorexia nervosa and bulimia nervosa in this article, however all forms of eating disorders are serious and should be urgently dealt with. Anorexia nervosa is characterized by an exaggerated drive for thinness. The symptoms include a refusal to maintain a body weight above the standard minimum (i.e. less than 85% of expected weight), an intense fear of becoming fat, evidence of an endocrine disorder, amenorrhea (absence of three menstrual cycles without cause). In bulimia nervosa, individuals lack a sense of control in food consumption with overwhelming urges to eat and frequent recourse to purging. Deviant behavior includes binge episodes such as vomiting, excessive exercise, alternating   periods of starvation, and abuse of laxatives or drugs. Both anorexic and bulimic individuals have similar fears of being overweight. They are obsessed with food, weight and thinness. Their body suffers from protein-energy malnutrition and various micronutrient deficiencies in different stages.

Under nutrition destroys fertility; it is estimated that 30% of the cases of impaired fertility are related to simple weight loss or weight related amenorrhea. Women with eating disorders have difficulty in conception and 1 in 5 patients at infertility clinics are there as a result of an eating disorder.
Anorexia nervosa and bulimia nervosa will be interchangeably referred in this article.

Facts about Weight Loss and Fertility

  • Losing 10-15% of ideal body weight can decrease estrogen hormones. When a women’s percentage of body fat falls below a certain minimum her body  doesn’t produce the levels of hormone necessary to stimulate ovulation. Also, negative energy restriction leads to amenorrhea. Sustained stress causes an elevation of the stress hormone (cortisol) and results in lower estrogen. This shuts off the reproductive axis.
  • Gaining weight to within 95% of ideal body weight can return hormone levels to normal.
  • Both anorexia nervosa and bulimia lead to menstrual irregularities and poor fertility.
  • Anorexic females undergo severe changes in endocrine and hypothalamic function vs. normal weight females who are losing weight.
  • Hormone therapy is not as effective until weight is gained.
  • Underweight women give birth to twice as many underweight infants vs. those who gain weight and experience unassisted conception.
  • Anorexic and bulimic pregnant women have severe vomiting spells and gain less weight during pregnancy.
  • Even after returning to their ideal weight, more than half of such women experience reproductive disorders such as absence of menstrual bleeding, or scanty, irregular periods.
  • Prolonged energy restriction leads to “Energy Drain”, It affects all systems including the reproductive, thyroid, immune, and skeletal. It is also accompanied by poor concentration.

Infertility and Eating Disorder Connection

Eating disorders frequently cause the following fertility problems:

  • Amenhorrea
  • Irregular menstrual cycles
  • Reduced egg quality
  • Ovarian failure
  • Poor uterine environment
  • Miscarriage

Treatment Approaches

Effective treatment requires an intricate understanding of the complexities of eating disorders, such as influencing factors, comorbid illnesses, as well as medical and psychological complications. This is even more effective if a collaborative approach is taken by an interdisciplinary team of psychological, nutritional, and medical specialists.

A Nutritionist or Dietitian may be the primary clinician to recognize and address eating disorder behaviors and provide care for food-related behaviors and medical problems. Dietitians contribute to the care process through nutrition assessment, recommendations, and implementation of therapeutic interventions, as well as by communicating the results to the other members of the team

The primary therapeutic goal is to restore body weight and return menses, and thereby make conception possible, and lay the groundwork for a healthy child. Unfortunately, aggressive feeding of cachectic (wasting/starving) individuals is associated with multiple risks such as re-feeding syndrome (low potassium, low phosphorus, low magnesium), edema, cardiac failure, seizures and death. Sudden and unplanned changes in eating behavior can be very risky for those who suffer from eating disorders; however ignoring the problem is not a healthy option either.

Gradual adjustments in nutrient intake and weight progress to achieve a 0.5 to 1.0 pound gain per week is advisable. With proper nutritional rehabilitation, the patient will be able to return to a healthy weight and normal eating patterns. Nutrition education is central to the effort, and encompasses principles of normal eating, psychological and physiological effects of starvation, nutritional requirements, metabolism, misconceptions about body weight regulation, and consequences of purging behavior. Unless the patient internalizes the desire to change, is educated about the best course of action and understands the consequences of failure, the changes of success are slim.

For eating disorders, Food is the “drug of choice”. However, tackling eating healthy is not determined by the number of calories you consume, but how they are distributed among foods at regular times of the day. If you are suffering from an eating disorder and would like to become pregnant and give birth to a healthy child, please consult with your health care provider and nutritionist.


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