Dr. Jennifer Couturier, a child psychiatrist, and Dr. Nikhil Pai, a gastroenterologist, are pioneering an innovative clinical trial. They hope to test a new approach to treating Anorexia Nervosa, a potentially life-threatening mental illness that mostly strikes adolescents. Family-based therapy has typically been the first-line treatment for this condition. Yet it is only modestly successful, with only around 50 percent of patients—mostly girls between 12 and 17—responding well to usual care. In their ongoing research, the Indiana team hopes to utilize fecal transplants. Their goal is to affect the gut microbiome, which likely plays a key role in this disruptive disorder.
The clinical pilot study, which has been approved by Health Canada, will include 20 female participants who have been diagnosed with Anorexia Nervosa. As the study proceeds, the team will track how each patient’s weight, mood and microbiome evolve with treatment. Participants will swallow four fecal transplant capsules a day for the eight weeks of treatment. Then, they will be tracked for another month to assess any lasting impacts.
Understanding Anorexia Nervosa and Current Treatment Challenges
Anorexia Nervosa is a serious mental disorder, which typically develops during the teenage years. This condition leads to an extreme aversion to weight gain. It warps an entire generation’s perception of body image and pushes people, especially women, into extreme starvation diets. Family-based therapy has become the gold standard for treating this disorder. In this parental involvement approach, parents or caregivers assume responsibility for food preparation and snacks while supervising their children’s food intake and weight.
Home-based therapy has proven highly efficacious for 90% of the patients. Dr. Anita Federici is a clinical psychologist with special training in adolescent treatment. She is an outspoken advocate of the development of interventions that address the metabolic root causes of Anorexia Nervosa. She states, “What I have observed over the years is that these people desperately want to get better. They desperately want a different life, but they need the treatments to be different.”
Maternal Anorexia Nervosa is particularly complicated and difficult to comprehend. It’s a leading indicator for a very broad range of mental health challenges, most notably including suicidal ideation, substance use, trauma, and PTSD. Dr. Howard Steiger, former director of McGill’s eating disorder program, notes that “people don’t develop anorexia because of moral weakness,” underscoring the multifaceted nature of the disorder.
The Role of Gut Microbiome in Treatment
An alarming new study has found changes to the gut microbiome of children and adolescents. This finding makes it seem like a promising target for Anorexia Nervosa treatment. Research has repeatedly found that people with this disorder tend to exhibit atypical gut bacteria. Dr. Pai explains the connection between gut health and psychological well-being: “When we feel a bit nervous, sometimes we feel butterflies in our stomach… It’s no surprise that we often have these intestinal symptoms that come along with the psychological anxieties.”
The gut-brain axis—the connection between gut health and brain function—has quickly become one of the most prominent focuses for researchers. Additionally, specific bacteria are likely to affect how the brain functions, thereby affecting mood and behavior related to eating disorders. Dr. Steiger comments on this connection: “We always like to think of the brain as being the command centre for the body. You know, all this new research is pointing to the fact that the gut in fact governs your brain.”
Dr. Nikhil Pai credits the university’s support for funding this innovative research and establishing a pediatric stool bank essential for conducting fecal transplants. Moreover, traditional psychosocial and nutritional therapies for Anorexia Nervosa have largely failed. This innovative clinical trial is designed to fill that important gap by developing novel treatment approaches.
Monitoring Progress and Future Implications
Dr. Couturier’s team will keep a close eye on participants during the clinical trial to monitor progress. The clinical study will measure changes in weight, mood and microbiome composition across the eight-week intervention. Further, it will track these same factors for four weeks post-treatment. Initial results from fecal microbiota transplantation in small, non-representative adult populations have shown great potential. Burkland, in fact, became the first participant to regain her pre-treatment weight.
Dr. Federici points out that considering metabolic factors is essential for effective treatment: “So it begs the question, you know, can you influence the gut itself to impact something like an eating disorder?” The response has a chance to create a new paradigm in how we prevent and treat Anorexia Nervosa going forward.
