Radically different
A vibrating capsule that assesses how nerve signals from the stomach are registered by the brain could help identify patients with anorexia at risk of relapse, a clinical trial suggests.
The findings, in JAMA Psychiatry, offers an insight into how the eating disorder affects the nervous system as well as a way to personalize and assess the success of treatment.
The results suggest that disruptions in gastrointestinal (GI) interoception—involving the detection, transmission, and processing of signals in the digestive tract—can increase the risk of anorexia returning, even if weight has normalized.
Gastric signals could therefore act as scalable biomarkers to identify who is at increased risk of relapse and track whether treatment is improving gut-brain signaling.
“People with anorexia nervosa do not simply ignore signals from the body,” explained researcher Sahib Khalsa, PhD, at the University of California, Los Angeles.
“Rather, their nervous system may process gut sensations differently, making those signals harder to detect, trust and learn from. Over time, that may contribute to the persistence of symptoms even after weight is restored.”
Khalsa and co-workers asked 62 girls and women with anorexia nervosa whose weight had been restored to healthy levels to swallow the vibrating capsule in their crossover trial.
The capsule could be remotely controlled by the researchers to produce mechanosensory stimulation of different intensities in the stomach.
Participants were asked to press a button upon sensing a vibration, with 54 patients followed up at six months after discharge from hospital and their results compared with 57 healthy control individuals.
Computational modeling was used to estimate how strongly participants anticipated feeling sensations in their stomachs, how heavily their brains depended on body signals, and how quickly they adjusted their expectations as to the presence or absence of signals.
The researchers found that participants with anorexia had abnormal GI interoception across behavioral and computational domains compared with healthy participants, despite having intact neural and physiological responses.
Participants with anorexia were less able to detect subtle stomach sensations and were more likely than others to believe there were no sensations when the pill was vibrating. They were also less likely to update those expectations when gastric signals occurred.
Patients who were more likely to ignore the stomach signals were also at increased likelihood of relapsing to the eating disorder.
“One of the most striking findings was that these differences persisted even after weight restoration,” said Khalsa.
“Recovery from anorexia nervosa isn’t just about restoring body weight. The underlying brain–body communication problems may remain and could contribute to relapse.”
The researchers conclude that their results support the use of ingestible mechanosensory probes and computer modeling as scalable tools to monitor treatment response and guide relapse prevention in eating disorders.
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As a yoga instructor in a clinic for people with eating disorders, I don’t see many straight cisgender male clients. But when I do, many have one thing in common: military service.
It is so common that, anecdotally, I would say a military background is one of the greatest risk factors for eating disorders in this population. Indeed, troops and veterans experience eating disorders and disordered eating at higher rates than civilians. For example, veterans have bulimia at rates about three times higher than civilians. Many of the male service members and veterans I work with feel their bodies will never be lean enough, strong enough, or “combat-ready” enough.