ABSTRACT
Abnormal hormone profiles and responses to challenge are closely related to the “starvation” status of anorexia nervosa (AN) and bulimia nervosa (BN) patients. Hormone abnormalities may also be present, but to a lesser extent, in normalweight women with BN. The presence of starvation in AN is evident from the weight loss, but it may not be recognized in normal-weight bulimics. Although bulimic women often maintain a normal weight, they do so by restricting food intake when not bingeing and purging, and they may have monotonous and poorly balanced meals. Starvation-induced depletion of hepatic glycogen stores results in free fatty acids and ketone bodies replacing glucose as the primary energy source. This shift from glycogenolysis to lipolysis and ketogenesis is associated with an increase in free fatty acids and their metabolites. (β-Hydroxybutyric acid levels are elevated in both AN and BN (1), indicating that bulimic patients are nutritionally depleted in spite of their normal body weight.
