Talk:Anorexia nervosa/Archive 2

Semi-protection request made
Owing to persistent vandalism by anonymous IPs, I've put a request in for this page to be semi-protected so it can only be edited by registered users. - Vaughan 08:56, 19 April 2007 (UTC)

Thanks Dweller
Thanks Dweller, it was indeed a mistake. I intended to revert back past the vandalism but chose the wrong version! - Vaughan 14:20, 1 June 2007 (UTC)

Lowest weight recorded ?
Shouldn't the lowest recorded weight be replaced by something reflecting the lowest ratio of ideal to actual weight? Furthermore, this claim is counterfactual-- Marya Hornbacher reports being at 52lbs in her memoir "Wasted". So, "recorded"? Published and lauded-within-the-specialty self-reports seem to constitute a recording, plus this statement dismisses the potential for unreleased medical records (I myself have been in the low 50s).

Bleedingcherub 09:48, 11 July 2007 (UTC)


 * Hi Bleedingcherub, I've removed this claim from the article as doesn't actually relate to the reference, and I have to agree, I hardly see the relevance, as it's more to do with body ratio. - Vaughan 13:16, 11 July 2007 (UTC)

Cool, thanks. You're doing an awesome job with this article's upkeep. Bleedingcherub 19:40, 12 July 2007 (UTC)

Article Very Lacking
I have been doing research for several months on eating disorders. I am a little distressed that this article makes no mention of patient perceptions in the perpetuation of the disorder, nor does the article mention how patients have viewed treatments in the past. Considering that biology is linked to perception, I think this is critical. Cultural aspects relating to the stigma of disordered eating also are not discussed (e.g., those with mental disorders pay significantly more in copay, are seen as selfish, etc.). The article focuses primarily on men and does not acknowledge the fact that most data on eating disorders may be skewed by the fact that most data has been collected in treatment centers. The article is woefully silent on the possibility that professionals are exacerbating the eating disorder problem by assuming that the cause is related to dysfunction: Studies have shown that those from disordered homes do very well mentally and that there is no correlation between parenting styles and disordered eating. Abuse statistics range anywhere from 6 to 90% for eating disordered individuals, yet despite having no reliable data to support the assertion, eating disorders are perceived as related to trauma. More than one researcher I looked at claimed to have patients who said, "Well, I don't think I was abused, but since I have an ED, I probably was." The ethical problems related to treatments are not discussed whatsoever aside from the DSM--Vandereycken and Beumont found that as many as a third of professionals DON'T want to treat eating disorders because they perceive those with eating disorders as manipulative and not as fulfilling as other patients. Is there a way that the article can address these issues? I have data to back all of this up and am in the process of writing a manuscript on the topic. Takingdictation 05:45, 2 August 2007 (UTC)takingdictation
 * You bring up many points and I am not sure I have sucessfully sorted them all out. The views of your unpublished manuscript, however, may have to wait until publication to enter the article, per policy on original research. --TeaDrinker 06:46, 2 August 2007 (UTC)


 * I completely understand about the unpublished research. As stated, I would be happy to source any of the data listed above until then.  The point is not necessarily to have MY work change the article.  The point is just to raise awareness that there are other issues that may need to be addressed in order for this article to avoid bias.  Adding alternate viewpoints with refutes is an excellent way to add to credibility of an argument.  Right now I just feel like this article is very one sided and that it does not explore these issues.  Thanks!  67.190.233.230 17:46, 2 August 2007 (UTC)Takingdictation

No Picture Needed, Please
Please do not add a picture of an anorectic to this page, as has been suggested. Such an image could serve as a potential trigger to someone with an eating disorder. For that matter, any example with numbers, BMI, etc. should be added only with caution. I know you want to provide information, but perhaps there is a more general way to explain rather than giving specific digits. Thanks! Takingdictation 05:54, 2 August 2007 (UTC)Takingdictation


 * Wikipedia is not censored. And here is a message from Carlin.--Svetovid 12:39, 31 October 2007 (UTC)

I find this very confusing. This article is headed with a request FOR pictures but a request for there NOT to be pictures is aligned here to censorship. Censorship just is. The only choice is HOW we sensor. Even "uncensored" places like here have policies allowing removal of certain material. (In addition to this there is the ochlocratic censorship here). I personally found the "ad" against anorexia shown at the head of this article inherently contradictory. There are many many people who find such skinny women sexually attractive. The ad shows o woman who is presumably very attractive to those people who have a tendency to anorexia and those who find women who "lean" towards anorexia attractive. The only unarguably (?) offputting aspect of the image was the dry skin around her coccyx! Thank God the article on paedophilia doesn't contain sexualised pictures of children! IMHO the ad should be referred to but not shown. An external link would be fine. I went to find a more suitable picture. Just put an image search into iZito or Google. Glamorous anorexia? I nearly gagged. Point proved? I think. LookingGlass (talk) 17:58, 4 February 2008 (UTC)
 * Despite the glaring obviousness, we cannot just conclude that the model in the image you have presented is anorexic. The image that I have included in the article is an anti-anorexia advertisement modeled by a recovering anorexic. Starczamora (talk) 18:39, 4 February 2008 (UTC)

More detail on age distribution?
I would like to see more detail here about the age distribution of anorexia. For example, I have anecdotal input that "It's rare to encounter an anorexic women in her thirties" but I can't confirm that or quantify what "rare" means here. I'd also like to know, for example, how likely is it that a woman in her forties has anorexia? Nat 09:49, 20 August 2007 (UTC)

Opening Paragraph
'mainly affects Adolescent females in America', implies that the disease is largely an american-only disorder which isnt the case. Could this be rephrased to "In America and other western countries, the disorder mainly affects adolescent females" —Preceding unsigned comment added by 3.14 etc (talk • contribs) 08:54, 5 October 2007 (UTC)

This page is for comments about the article
Um... This talk page is for comments about the article. It is not meant to be a place for people to discuss whether they`re anorexic or not. Please don`t post any ``am i anorexic`` questions anymore. —Preceding unsigned comment added by 74.14.205.156 (talk) 21:09, 18 September 2007 (UTC)

"In the Eyes of an Anorexic"
Someone obviously just threw in a bunch of stuff under this heading on the main page. Anyone object to deletion? Motion to protect the article.

Bleedingcherub 02:40, 9 November 2007 (UTC) 02:39, 9 November 2007 (UTC)

Crazy question about shoes
Recent results have suggested that standing contributes to weight loss. Personally I have the wild idea that perhaps the feet might possess some sort of endocrine activity that would act as an "internal scale". If so, possibly women with the restrictive type of anorexia might be noticed more frequently to wear very tight, uncomfortable shoes. Just as a general impression, I'm curious whether those working with anorexics have noticed any such tendency. 70.15.116.59 (talk) 18:08, 29 November 2007 (UTC)

Endocrine disorder question
...Endocrine disorder, leading to cessation of periods in girls (amenorrhoea) ...
 * So does this mean that anorexia nervosa affects the development of ovals and the female patients will not be able to get pregnant (I forgot the certain word)? Thanks.-- Vintei talk  13:49, 6 December 2007 (UTC)

Disambiguation Definition Summery
As it stands now: "an eating disorder in which people do not eat correctly due to the obsessive fear of weight gain"
 * Is there a better possible definition? "Correctly" seems to be a weighted word. I know it's just the short definition intended to point people in the right direction, but would something closer to standard dictionary definitions be more appropriate? I am totally ignorant of any guidelines regarding these definitions.

Also, what is the policy on cleaning up talk entries that are chatty, or non-contributory (or trolling/inappropriate)? This Talk page is painfully convoluted, and important feedback could be getting lost. Thanks for the hard work on this article!Leighbra (talk) 10:56, 13 December 2007 (UTC)

Inconsistency
If the term "Anorexia" is incorrect, as stated in the first paragraph of the article, shouldn't the remainder of the article then use the correct term "Anorexia nervosa" rather than the incorrect term "Anorexia"? LookingGlass (talk) 17:38, 4 February 2008 (UTC)

Orthomolecular Wackiness
The new item on prevention of anorexia is well referenced and grounded in science. Dismissing it in a word as "wackiness" is not in the spirit of Wikipedia. I believe that Wikipedia rules recommend better reasoning to justify deletion. shbrown (talk) 23:50, 10 March 2008 (UTC)

Thiamine deficiency is a known cause of anorexia. Transport proteins are required to move thiamine salts (hydrochloride and mono-nitrate) across many types of membranes in the body. The efficiency of these proteins will vary from person to person according to biochemical individuality. Fat-soluble forms of thiamine (allithiamines) have the proven ability to be transported throughout the body without the help of thiamine transport proteins.

I am unaware of any studies investigating the potential for allithiamines to prevent anorexia. So, there is no proof that they don't prevent anorexia. In the absence of this proof, it seems to me to be a sensible precaution to supplement children at risk for anorexia. There is almost no risk and a large potential benefit. Anorexia is lethal. 10% of diagnosed anorexics die of the disease. If the allithiamines are ineffective, what's the harm? If they work, the benefits are priceless.shbrown (talk) 01:28, 11 March 2008 (UTC)


 * Simply reference with peer-reviewed articles from PubMed. As far as I can see, there are none that have found a causal link between anorexia and thiamine deficiency. The reference you provide is to a webpage which has no such studies. The only reference on that page to the anorexia-thiamine link is to an alternative medicine journal. Your theory is interesting but unsupported and Wikipedia is not the place for original research. - Vaughan (talk) 07:54, 11 March 2008 (UTC)


 * Are you questioning the assertion that anorexia is an acknowledged clinical marker for anorexia?? Are you questioning Lonsdale's authoritative knowledge of beriberi?  Although the Lonsdale review referenced was in an alternative health journal, his previous reviews were published elsewhere.  Lonsdale D. Thiamine metabolism in disease Crit Rev Lab Sci 1975; 5: 289–313  And what exactly is your inference here?  Articles in alternative medicine journals are not verifiable?  Why not let Wikipedia readers decide for themselves.

Furthermore, page 151 of Bender's textbook on the biochemistry of vitamins notes that thiamine deficiency in animal models is associated with severe anorexia. And here's another reference.

Prevalence of thiamin deficiency in anorexia nervosa. Author:	 Winston, A P : Jamieson, C P : Madira, W : Gatward, N M : Palmer, R L Citation:	 Int-J-Eat-Disord. 2000 Dec; 28(4): 451-4 Abstract:	 OBJECTIVE: Deficiency of thiamin (vitamin B1) causes a range of neuropsychiatric symptoms that resemble those reported in patients with anorexia nervosa (AN) but the prevalence of thiamin deficiency in AN has not been reliably established. This study was designed to investigate the prevalence of thiamin deficiency in AN. METHOD: Thirty-seven patients attending a specialist eating disorders unit and meeting all or some of the DSM-IV criteria for AN were compared with 50 blood donor controls. All subjects underwent measurement of erythrocyte transketolase activation following the addition of thiamin pyrophosphate, the standard biochemical test for thiamin deficiency. Deficiency was defined as a result more than 2 SD above the mean of the control population. RESULTS: Fourteen patients (38%) had results in the deficient range; 7 (19%) met the most stringent published criterion for deficiency. Deficiency was not related to duration of eating restraint, frequency of vomiting, or alcohol consumption. DISCUSSION: Thiamin deficiency may account for some of the neuropsychiatric symptoms of AN and routine screening or supplementation may be indicated. Copyright 2000 by John Wiley & Sons, Inc.

I'm sure there are more references. I'm familiar with the guiding philosophy of Wikipedia. If in doubt, content is to be left in. Stop deleting this factual section that contains no original research until you've provided references contradicting the statements and furthermore proven more than that my facts are wrong. You can add your referenced facts to my referenced facts. This will allow readers to visit both sets of references and decide for themselves.shbrown (talk) 02:40, 12 March 2008 (UTC)


 * Hi there, there is no policy that "If in doubt, content is to be left in". In fact, it's exactly the opposite. See Verifiability (e.g. "The burden of evidence lies with the editor who adds or restores material"). Most alternative health journals do not meet the criteria set out in the verifiability guidelines, furthermore one of your references is to a webpage and so is not covered by the verifiability guidelines. Your abstract above is a) a single study and b) reports a correlation and so says nothing about cause. Thiamine is not a clinical marker for anorexia nervosa (for which there are no blood tests) in your new paragraph you confuse anorexia (the symptom of loss of appetite) with anorexia nervosa (the mental disorder). Furthermore, the description I can find of beriberi online (e.g. this from the NIH or from a PubMed search make no mention of anorexia being a clinical marker for beriberi or even it's association.


 * So I've moved the text below. It's quite a simple process to include it in the article, you just to find and provide provide references that meet WP:Verifiability criteria for all claims in the paragraph. I've looked and have found none although I would be pleased to hear of some I have missed. - Vaughan (talk) 08:02, 12 March 2008 (UTC)


 * Anorexia is an acknowledged clinical marker of beriberi, the disease specifically caused by a deficiency of thiamine (vitamin B1).  Supplementation with thiamine prevents beriberi, and therefore anorexia.   Dietary thiamine phosphates are hydrolyzed by enzymes in the intestines.  The resulting free thiamine requires energy and functional thiamine transport proteins to be absorbed.  The transport system is readily saturated, limiting the amount of thiamine that can be absorbed in a single dose to 2.5 mg.  Less common fat-soluble forms of thiamine, known as allithiamines, do not require energy and thiamine transport proteins to be absorbed.  Both free thiamine and allithiamines are readily available as supplements.

Anorexia is a clinical marker for beriberi
I searched and found 106 references. There are surely many more in old books and journals that are not so easily found on electronic databases.

Many of the 106 references are to numerous animal models including monkeys. I already referenced the Benton text book above to that effect. Here are the most persuasive refereces - ones with direct evidence on human beings. Although, personally, I find controlled trials with large numbers of animals models equally if not more compelling. I will provide dozens of such references upon request.

Clinical studies of experimental human vitamin B complex deficiency. Elsom, K. O'Shea; Lewy, F. H.; Heublein, G. W.   American Journal of the Medical Sciences  (1940),  200  757-64.

Abstract

cf. C. A. 34, 5120.7. Studies were made on a healthy woman aged 60 who was placed for 4 months on a diet deficient only in vitamin B. Pulse rate increased but blood pressure and electrocardiogram were not altered; cardiovascular abnormalities subsided during thiamine administration. Anorexia was relieved by thiamine, but improvement of other gastrointestinal symptoms required yeast in the diet. The mild neurologic symptoms and physical signs disappeared following thiamine, but the prominent mental symptoms while responding somewhat to thiamine required yeast for complete relief. Mild macrocytic anemia, uninfluenced by thiamine or riboflavin, was relieved by general diet and yeast. There were both edema and loss of body weight, corrected only by yeast.

The determination of vitamin B1 deficiency. Goth, Endre. Orvosi Hetilap (1941),  85  138-9.

Abstract

Clinical experiments show that anorexia is a milder and less important symptom of vitamin B1 deficiency than are the neuritic symptoms. A reliable test for vitamin B1 deficiency is to inject 10 mg. of the vitamin and analyze the urine passed during the following 24 hrs. fluorometrically with K ferricyanide. In normal cases the vitamin content ranges from 20 to 30  %. Values below 18 mg. % indicate deficiency.

Induced thiamine (vitamin B1) deficiency in man. Relation of depletion of thiamine to development of biochemical defect and of polyneuropathy. Williams, Ray D.; Mason, Harold L.; Power, Marschelle H.; Wilder, Russell M.   Archives of Internal Medicine  (1943),  71  38-53.

Abstract

cf. C. A. 36, 4863.6; 37, 3481.7. Two human volunteers were restricted by diet to a thiamine (I) intake of 0.2 mg./day (2000 cal.) for 120 days. A test dose of 1.0 mg. I-HCl was administered subcutaneously about every 2 weeks; this raises the av. daily intake to 0.35 mg. I (0.175 mg. per 1000 cal.). This "periodic partial cure" was attended by increase in appetite and activity 7-10 days after administration. Symptoms of I deficiency were manifested as early as the 30th day of restriction. The first objective evidence of abnormality in these subjects consisted of a decrease in their ordinary urinary excretion of I. At about the 50th day the urinary excretion after a test dose of 1 mg. I was reduced. After this time whenever dextrose was given, abnormally high values for pyruvic and lactic acids in the blood were observed. Also anorexia and weakness became more severe and paresthesia of the legs was observed. The earliest stages of I deficiency were demonstrated by detn. of excretion after administration of a test dose of I, more advanced stages by data on blood lactic and pyruvic acids, and still more advanced stages by progressively higher blood pyruvate curves after administration of dextrose.

Nutritional standards for men in tropical climates. Johnson, R. E.   Gastroenterology  (1943),  1  832-40.

Abstract

cf. C.A. 38, 3709.3, 4293.1, 46689, 59083. Dietary requirements are qualitatively similar in hot and in temperate climates. However, they are quantitatively altered in hot climates by increased losses of sweat, anorexia and suggested specific increases in requirements by mere exposure to heat. Water, cals., NaCl and vitamin B complex are considered crit. for emergency rations intended for use over short periods. Water deficiency can be one of the most rapidly induced of all deficiency syndromes and may have deleterious effects in only a few hrs. Deficiency of NaCl does not produce heat cramps in a single day even under severe conditions; replacement day by day (15-20 g. per day for most working men) is desirable. Within very wide limits protein intake appears to have little effect on the well-being or performance of working men. No considerable loss of thiamine or ascorbic acid in the sweat was noted; even under the most severe conditions the loss of vitamins was much greater in the urine than in the sweat. Maintenance of caloric balance, essential in the long run, is not necessary from day to day. Palatability is as important as the quant. compn. of any ration. A table is given showing the rapidity of onset of undesirable effects in deficiency of the various nutrients.

Beriberi in Japanese prison camp. Hibbs, Ralph E.   Cleveland Clinic,  O.    Annals of Internal Medicine  (1946),  25  270-82.

Abstract

Thiamine chloride alone corrected the anorexia, nervous manifestations, tachycardia, and arrhythmia, and improved exercise tolerance of the heart in patients with beriberi. Peripheral neuritis responded sooner to the entire B complex. Intrathecal was no more efficient than subcutaneous administration. Complete satn. was not attained by a short course of large doses. There may be a nutritional cause of polyneuritis in beriberi other than lack of thiamine. Posterior column degeneration of the spinal cord may result from lack of vitamin B1. An irreversible optic atrophy may be caused by beriberi.

The Lonsdale article you are rejecting on this page is an allowed reference on Wikipedia's thiamine page. Lonsdale reviewed thiamine deficiency symptoms in 1973. I also can't understand why you rejected that reference. I found 13 publications from Lonsdale who has been publishing on thiamine deficiency for 30 years.

Regarding web pages as references. Your assertion that references to web pages aren't allowed is obviously incorrect. They are all over the place in Wikipedia, and will and should become more and more common. I'm sure you are aware that there are several others in this article.

However, I agree that web pages deserve scrutiny. I did not refer readers to just any web page. The web page links to the Orthomolecular News Service, which is provided by the editors of the Journal of Orthomolecular Medicine. The press releases are peer reviewed and heavily referenced. There was no doubt in my mind that I would find anorexia as a clinical marker of beriberi. The JOM editors are the most authoritative voice that I know of when it comes to facts about vitamins. They are physicians and scientists in good standing. What group of individuals do you know of that is more qualified to speak about vitamins?shbrown (talk) 00:42, 13 March 2008 (UTC)


 * Hi there, the anorexia referred in these articles is NOT anorexia nervosa, the mental illness, but anorexia the symptom of reduced appetite. The articles you cite are not talking about the subject of this page, please read them in more detail. Also, to make clear (again), as you'll not from the WP:Verifiability page, webpages are not considered reasonable references for scientific claims.


 * So, to back up the claims you have made you need to provide references to peer reviewed studies showing that thiamine definciency causes anorexia nervosa, the mental illness. So far, you have provided none. Vaughan (talk) 07:16, 13 March 2008 (UTC)

jkljklshbrown (talk) 23:10, 13 March 2008 (UTC)

Disgusting Picture
Is this really how anorexics end up looking image:Anorexia_billboard.jpg or is this just a scare tactic?Maersayer (talk) 02:38, 16 March 2008 (UTC)

Probably, but I don't like how she's not wearing anything.

DarkestMoonlight (talk) 15:34, 17 March 2008 (UTC)
 * The model is a recovering anorexic, so yeah...anorexics probably look like that. Starczamora (talk) 22:28, 20 March 2008 (UTC)

Continued Discussion about the proposed Prevention Edit
Here's from the verifiability page you sent me to. I followed the link on reliable sources.

This page in a nutshell: Articles should be based on reliable, third-party, published sources with a reputation for fact-checking and accuracy.

As I mentioned above, the webpage I linked to that is published by the JOM editors meet this criterion. Their press releases are peer reviewed and well-referenced. I don't see a problem and, as I also mentioned above, I don't think that's the issue here. Almost every Wikipedia page references web pages that don't meet this criteria. The issue my edit raises is this one from the "red flags section". My edit raises:

> surprising or apparently important claims not covered by mainstream sources

My edit claims that anorexia is a recognized clinical marker for beriberi and most main stream sources do not. Nonetheless, my claim is supported by multiple sources that meet Wikipedia's verifiability criteria and is therefore eligible for inclusion.

Here are your own words:

"So I've moved the text below. It's quite a simple process to include it in the article, you just to find and provide provide references that meet WP:Verifiability criteria for all claims in the paragraph. I've looked and have found none although I would be pleased to hear of some I have missed."

I provided the references you requested and you again deleted my edit. I'm asking you to restore what you have deleted.

With that said, let's move to your final objection - that my edit is off-topic because it deals with the symptom of loss of appetite and not the mental disease associated with loss of appetite. Again, I'll start with what I see as the real issue. I am editing this page and not the "anorexia" page, because this is the page that people read. When parents and friends become concerned about the behavior and weight-loss of a loved one, they will often type "anorexia" into a search engine. The #1 hit is Wikipedia's "anorexia nervosa" page. I believe these readers would like to know that anorexia is a clinical marker for thiamine deficiency, that anorexia caused by thiamine is easily prevented with supplements, and that there are different kinds of thiamine supplements (supplements that require transport proteins to be distributed throughout the body and supplements that don't). According to the prevalence statistics on this Wikipedia page, in the next 20 years another 500,000 women will develop anorexia in their teenage years. Are you really that sure supplements won't help even a small fraction of these women?

Now let's get directly to your objection. The references I provided do not distinguish between anorexia and anorexia nervosa. I wouldn't be surprised to learn that the distinction didn't exist when some of them were written in the 1940's. As you pointed out, there is no blood test, tissue test, or any other type of biochemical marker test to distinguish between anorexia (the symptom of loss of appetite) and anorexia nervosa (the mental disease). If I sent a psychiatrist the anorexic group of Japanese prisoners discussed in the one article, how do can you say none would be diagnosed with anorexia nervosa? I imagine you would respond that the article said the anorexia was cured by thiamine alone and therefore was obviously not a mental disease. In reply, I would note that the article did not say that all the anorexics were cured, only that most of the anorexics were cured. If you read much about thiamine deficiency, you'll find it frightening. It is important to diagnose thiamine deficiency early and supplement with thiamine immediately. Prolonged thiamine deficiency causes irreversible damage.

Next, I would like to point out that thiamine deficiency, in addition to causing a loss of appetite, causes mental disease. Just read the Wikipedia article on Wernicke-Korsakoff syndrome. Thiamine deficiency causes widespread damage to the central nervous system and specifically causes damage to the brain.

Have I identified the right issues? Is there any way for us to reach a compromise position, or are we at an impasse? I'll wait a day to hear back from you before I repost the text. shbrown (talk) 00:17, 14 March 2008 (UTC)


 * Hi there, it boils down to the fact you have yet to provide a SINGLE STUDY which provides evidence for the causal role of thiamine deficiency in the development of this mental illness. A webpage, that also fails to a single reference to such a study is not sufficient.


 * Your argument that anorexia nervosa wasn't recognised in the 1940s is just plain wrong (see ISBN 0452263271 for a history, which the diagnosis first recognised in the 19th century) and your suggestion that psychiatrists can't distinguish between the symptom and the mental illness is just bizarre. Yes, thiamine deficiency does cause cognitive problems, no this has nothing to do with anorexia nervosa.


 * We have reached an impasse because you have not provided a single study which backs up your claims. Do so, and we will have solved the issue - Vaughan (talk) 13:31, 15 March 2008 (UTC)

Continued Discussion
Let's go through the proposed edit:

Anorexia is an acknowledged clinical marker of beriberi, the disease specifically caused by a deficiency of thiamine (vitamin B1). Supplementation with thiamine prevents beriberi, and therefore anorexia. Dietary thiamine phosphates are hydrolyzed by enzymes in the intestines. The resulting free thiamine requires energy and functional thiamine transport proteins to be absorbed. The transport system is readily saturated, limiting the amount of thiamine that can be absorbed in a single dose to 2.5 mg. Less common fat-soluble forms of thiamine, known as allithiamines, do not require energy and thiamine transport proteins to be absorbed. Both free thiamine and allithiamines are readily available as supplements.

I've provided verifiable references for each statement, including multiple references backing the claim that anorexia is an acknowledged clinical marker of beriberi. After the first sentence, all the statements are drawn from Benton's authoritative textbook on the biochemistry of vitamins. (D. Bender. "The Nutritional Biochemistry of the Vitamins," Cambridge University Press, 2003) Now you have asked me to clear a higher hurdle and get into the distinctions between anorexia (the symptom) and anorexia (the mental disorder). Even on this subject, I have one reference. Here it is again:

Prevalence of thiamin deficiency in anorexia nervosa. Author:	 Winston, A P : Jamieson, C P : Madira, W : Gatward, N M : Palmer, R L Citation:	 Int-J-Eat-Disord. 2000 Dec; 28(4): 451-4 Abstract:	 OBJECTIVE: Deficiency of thiamin (vitamin B1) causes a range of neuropsychiatric symptoms that resemble those reported in patients with anorexia nervosa (AN) but the prevalence of thiamin deficiency in AN has not been reliably established. This study was designed to investigate the prevalence of thiamin deficiency in AN. METHOD: Thirty-seven patients attending a specialist eating disorders unit and meeting all or some of the DSM-IV criteria for AN were compared with 50 blood donor controls. All subjects underwent measurement of erythrocyte transketolase activation following the addition of thiamin pyrophosphate, the standard biochemical test for thiamin deficiency. Deficiency was defined as a result more than 2 SD above the mean of the control population. RESULTS: Fourteen patients (38%) had results in the deficient range; 7 (19%) met the most stringent published criterion for deficiency. Deficiency was not related to duration of eating restraint, frequency of vomiting, or alcohol consumption. DISCUSSION: Thiamin deficiency may account for some of the neuropsychiatric symptoms of AN and routine screening or supplementation may be indicated. Copyright 2000 by John Wiley & Sons, Inc.

You say, "Yes, thiamine deficiency does cause cognitive problems, no this has nothing to do with anorexia nervosa." The authors of the abstract above disagree. They say, "Deficiency of thiamin (vitamin B1) causes a range of neuropsychiatric symptoms that resemble those reported in patients with anorexia nervosa (AN)". Even without this reference I would not agree. Unlike the results of autopsies of patients dying from/with thiamine deficiencies (e.g. ,Wernicke-Korsakoff syndrome) the diagnosis of cognitive problems is subjective. I provided many references showing the scientific consensus that thiamine deficiency both causes anorexia (the symptom) and damage to the nervous system. I believe these references are sufficient to establish a connection between thiamine deficiency and anorexia nervosa (the "mental" disorder).

I'd like to add to my above comments about the "webpage" I referenced and Wikipedia verifiability. The Wikipedia rules again:

"Articles should be based on reliable, third-party, published sources with a reputation for fact-checking and accuracy."

You commented above that alternative health publications generally do not meet this standard. Wikipedia encourages balanced articulation of alternative views. Here's the text from the verifiability page:

"All articles must adhere to Wikipedia's neutrality policy, fairly representing all majority and significant-minority viewpoints that have been published by reliable sources, in rough proportion to the prominence of each view."

The field of alternative health has grown in America into a major industry. The views of this industry must qualify as a "significant-minority viewpoint". The webpage I referenced is published by the editors of the Journal of Orthomolecular Medicine, arguably the highest quality scientific publication in the world of alternative medicine. Each of the editors is highly accomplished and a distinguished member of the communities they serve. Here are their names: Carolyn Dean, M.D., Damien Downing, M.D., Harold Foster, Ph.D., Steve Hickey, Ph.D., Abram Hoffer, M.D., Bo H. Jonsson, MD, PhD., Thomas Levy M.D. J.D., Erik Paterson, M.D. Andrew W. Saul Ph.D. Abram Hoffer, although controversial, is sufficiently distinguished to merit a page in Wikipedia. He is a degreed psychiatrist and the pioneer of orthomolecular psychiatry. Andrew Saul is the publisher of the well-trafficked doctoryourself.com website. This distinguished group has spoken. They clearly believe that thiamine deficiency causes cognitive problems, and that these cognitive problems have something to do with anorexia nervosa." I ask you again to put the proposed edit back into the article.shbrown (talk) 14:15, 16 March 2008 (UTC)


 * You have still not supplied a reference to a single study that has found a causal role for thiamine deficiency in the development of anorexia nervosa or the use of supplementation in treatment or prevention of the disorder. It's simple, supply references to studies (not people) which back up the points you want to make in your addition to the article and they get included. - Vaughan (talk) 18:59, 16 March 2008 (UTC)


 * Shbrown asked me to weigh in. To be frank, the whole context of the disputed edit is whether giving lots of people thiamine will stop them from getting anorexia nervosa. I cannot find any evidence for this in the peer-reviewed literature.
 * On a further point, it will be extremely hard to separate chicken and egg here. Prolonged dietary restriction will cause thiamine levels to fall, as seen in alcoholics. If you check thiamine levels (or actually the somewhat imprecise transketolase essay) in a bunch of anorexics you are bound to find low levels! Furthermore, the typical features of thiamine deficiency are those of Korsakoff's psychosis and Wernicke's encephalopathy, two very specific neuropsychiatric syndromes.
 * I am afraid I have to agree with Vaughan that the Orthomolecular Medicine News Service page does not expand on its methodology and therefore has significant verifiability problems. JFW | T@lk  06:46, 17 March 2008 (UTC)


 * I am utterly miscommunicating with both of you, and finally am perhaps seeing the problem. I'm putting my information in the wrong place (and I think I really am).  How about this.  I think the factual information I believe should be communicated belongs in the causes section.  This section currently starts:
 * It is clear that there is no single cause for anorexia and that it stems from a mixture of social, psychological and biological factors.
 * How about the following edit that would replace this sentence with the following:
 * The cause or causes of anorexia nervosa are highly controversial. Some experts point to the fact that anorexia (the symptom of loss of appetite) and psychosis are both clinical markers for beriberi and claim that anorexia nervosa is caused by nutrient deficiency.  Other experts believe that social and psychological factors are the primary causes.  Most experts probably believe that all these factors are involved.shbrown (talk) 00:16, 18 March 2008 (UTC)


 * You are not putting the information in the wrong place are you are not miscommunicating. You are simply making claims that aren't backed up by evidence. Your new paragraph is similarly unsupported. And you still cannot distinguish between the symptom and the mental disorder. For example, many people with anorexia nervosa do not present with the symptom. For example, this study shows no difference in levels of hunger and food craving in people diagnosed with the mental illness compared to health controls. - Vaughan (talk) 09:36, 18 March 2008 (UTC)


 * Shbrown, I grokked your intentions the first time round. We have all tried to find scientific evidence for a nutrient cause (rather than effect) of anorexia nervosa, and there is no evidence. Still, if a link is found, you were proposing to use nutritional supplements to prevent this condition; apart from arguments about cost-effectiveness, there would need to be dedicated studies about using interventions on a (targeted or blanket) population level before such claims could be made.
 * Unless you have other evidence you haven't shown us yet, I don't think I will be able to add anything further to this discussion. JFW | T@lk  12:12, 18 March 2008 (UTC)