By Vernon Rowe M.D.
Some types of eating disorder seem to appear “out of the blue” in teenagers, and change their lives forever. Interestingly, this is when Narcolepsy, a sleep disorder associated with severe sleepiness, frequently appears. Both involve an area deep in the brain, called the hypothalamus.
Narcolepsy, we now know, results when few thousand nerve cells in the hypothalamus are destroyed by the body’s immune system. This happens because of something the immunologists call “molecular mimicry.” Essentially, the body’s immune system mistakes those cells for harmful viruses or bacteria and destroys them. (ref)
The cells that are destroyed in Narcolepsy are necessary to keep us awake and are involved in the transition of the waking state to the sleeping state. These cells produce a transmitter called Hypocretin 1. Ironically, this same peptide transmitter was discovered simultaneously by other researchers working on the control of eating, and they called the transmitter Orexin A.
Recently, I began to realize that patients with Hypermobility Spectrum Disorder frequently have problems with their immune system, in the form of Hashimoto’s Thyroiditis. In this disorder, the cause of 90% of hypothyroidism in the US, the body’s immune system attacks the thyroid gland in the neck. The thyroid gland is the “thermostat” of the body. Without it, people gain weight and cannot lose it, and have a host of other problems. (Wentz)
Hashimoto’s is frequently under-recognized, even by endocrinologists, specialists in thyroid and other endocrine glands. Some of them believe that thyroid antibodies are not significant and no treatment of Hashimoto’s is necessary until the gland starts to fail, even if there are cysts in the gland itself and the patient may have many symptoms of thyroid dysfunction along the way. But we know that with appropriate dietary changes and the addition of necessary supplements, antibody titers can be brought down, and patients can feel better. (Subclinical Hypothyroidism references, NEJM). This just doesn’t make any sense to me.
Recently I saw a patient with the sudden onset of anorexia after a viral infection in her late teens. She also had problems with sleep. She has Hypermobility Spectrum Disorder. And yes, she has had other hypothalamic symptoms such as depression, even severe enough to lead to self-harming behavior.
So are all this patient’s symptoms just due to coincidence in an unfortunate teenager? Or is she trying to teach us something about the onset of anorexia in teenagers and its possible autoimmune cause? In other words, is this patient’s anorexia associated with an attack by her immune system on her hypothalamus? Would it respond to the same type of treatment approach we use for patients with other autoimmune disorders and Hypermobility Spectrum Disorder?
No one knows the answer to these questions. But just as the journey of a thousand miles begins with a single step, many advances in medicine begin with the linking together of factors that previously seemed to be due to chance, and the refusal to attribute them to coincidence. (ref Austin)