GIFTED: Genetic Information For Treating Eating Disorders

By Michael Lutter

Eating Disorders are one of the most common, but elusive conditions to treat in all of Psychiatry. While current treatments do help some patients with eating disorders, too many individuals receive little to no benefit from treatment options leading to a lifelong struggle with anxiety around eating and body image. In this book, Michael Lutter, MD/PhD presents the developement of his new program GIFTED: Genetic Information For Treating Eating Disorders. GIFTED utilizes modern genetic testing methods to take a fresh look at the underlying causes of eating disorders, sometimes with shocking insights.

 

GIFTED: Genetic Information For Treating Eating Disorders will be of interest to any patient, family member, or eating disorder clincian who is interested in alternative appraches to current treatment methods. The book is 192 pages with illustrations and links to animations that make difficult concepts of genetics and neuroscience easy to understand.

• Language: English
• Publisher: Michael Lutter
• Release date: Mar 13, 2023
• ISBN: 9798215049723

Book preview

GIFTED: Genetic Information For Treating Eating Disorders

By Michael Lutter, MD/PHD

Published March 2023

© 2023 Michael Lutter. All rights reserved.

ISBN:9798215049723

Disclaimer: This book is not intended as a substitute for medical advice. The reader should consult a physician or medical provider in matters relating to his/her/their health and particularly with respect to any symptoms that may require diagnosis or medical attention.

––––––––

Cover was designed at Canva.com

About the Author

Michael Lutter, MD/PhD is a physician-scientist who has worked in the fields of eating disorders, depression, and anxiety since 2007. Dr. Lutter graduated from the University of Chicago in 1996 with a degree in Biological Chemistry before completing the Medical Scientist Training Program at the University of Texas Southwestern Medical Center in Dallas, Texas and earning MD and PHD degrees in 2003. His interest in eating disorders began during his Psychiatry Residency Program at UT Southwestern. From 2008-2016 he ran a research program on the genetic and neurobiological basis of eating disorders at UT Southwestern Medical Center and later at the University of Iowa before transitioning to full time clinical care working at the Eating Recovery Center from 2016-202.

Dr Lutter founded Precision Psychiatry in 2019 to pursue his vision of integrating new scientific approaches into the treatment of patients with eating disorders, depression, and anxiety. Using the knowledge he gained from his years doing genetic and behavioral neuroscience research, he developed Genetic Information For Treating Eating Disorders (GIFTED).

To learn more about GIFTED and Dr Lutter visit:

www.Precision-Psychiatry.com

Acknowledgements

I would like to thank the following individuals and groups:

Jessica Setnick, A.J. Robison, and Melissa Judd for reviewing early drafts of the manuscript.

Aaron L. Gravely, MD for editing and proofreading of the final manuscript.

Articulate Graphics (http://www.articulategraphics.com/) created the medical illustrations and animations in Chapter 7 (Anorexia Nervosa).

All other illustrations were made using BioRender (https://www.biorender.com/).

Voice acting for the animation was performed by Kim Fuller (www.kimfullervoice.com).

Cover art was designed in Canva (https://www.canva.com/)

Contents

Glossary

Prologue: Something Better

Chapter 1: Chest Pain Syndrome

Chapter 2: The Stakeholders

Chapter 3: How Research Works

Chapter 4: Evidence-based Medicine

Chapter 5: Modern Psychiatry’s Original Sin

Chapter 6: Precision Psychiatry

Chapter 7: Anorexia Nervosa

Chapter 8: Other Pathways That Affect Eating Disorders

Chapter 9: The Promise and Peril of Repurposing Drugs

Chapter 10: The Road Ahead

Glossary

Note: items in the glossary are underlined in the main text of the book

Anesthetic- a medication used to temporarily decrease consciousness and sensation, usually for a surgical procedure

BMI- stands for Body Mass Index, a formula used by many health care providers to determine if a patient is underweight, normal weight, or overweight/obese. BMI is calculated by diving a person’s weight by the square of their height

Bioinformatics- a field of science that uses computers to analyze large sets of biological data

Cannabinoid hyperemesis syndrome- severe nausea and vomiting that is sometimes seen in regular cannabis (marijuana) users who suddenly stop using cannabis

Carnitine- a molecule that helps transport long-chain fatty acids into the mitochondria to be turned into energy

Case report- A detailed report describing a rare or unusual occurrence in a single patient or small group of patients. Case reports are considered to be low-quality medical research

Circadian entrainment therapy- a behavioral therapy that uses powerful entrainers of the biological clock to regulate sleep/wake cycles and meal patterns in patients with unstable circadian rhythms

Circadian rhythm- any bodily process that fluctuates on a 24-hour cycle, including sleep/wake cycles, appetite, body temperature, and metabolism

Citation- a reference to another scientific article or book to support claims that are made

CoQ10- also known as coenzyme Q10 or ubiquinone-10, is a molecule made by the body that helps the mitochondria convert food into energy

Cytokine- a group of proteins that mainly function by sending signals between immune system cells

Diagnostic and Statistical Manual- a book published by the American Psychiatric Association that lists the criteria to diagnose all mental illnesses

Effectiveness study- a type of research study that looks at how treatments work in ‘real world settings’

Efficacy study- a type of research study that looks at how treatments work under ‘ideal settings’

Endocannabinoids- a system of lipid neurotransmitters in the body that send retrograde (backward) to regulate signaling of neurons, the endocannabinoid system affects a wide-range of bodily functions including mood, pain, appetite, and memory and is the target of drug cannabis (marijuana)

Endogenous opioid system- a system composed of several peptide neurotransmitters and their receptors that regulate many bodily processes including pain, stress responses, breathing, appetite, and digestive function, the endogenous opioid system is the target of several medications like morphine and oxycodone and drugs of abuse like heroin

Epigenomics- a scientific field that studies how modifications to DNA affects the expression of genes encoded by DNA

Essential amino acid- the nine amino acids that cannot be made by the body and are therefore essential to obtain in the diet, they are isoleucine, leucine, valine, lysine, histidine, methionine, phenylalanine, threonine, and tryptophan

Exome- the part of the DNA that includes the protein-encoding genes

Expert opinion- medical recommendations made by a group of designated experts, usually when high quality research (like randomized controlled trials) is not yet available

Fatty acids- are the building blocks of more complex fats or lipids, consisting of a carboxylic acid group (-COOH) attached to a chain of 4-28 hydrocarbons (-CH2).

Functional MRI- a type of MRI scan that looks at the brain activity of a person while performing a task

Genetic mutation- a change in the DNA code that damages protein functioning

Genetic variant- a change in the DNA code that either has no effect on protein functioning or changes protein functioning in a way that is not harmful

Genome- all of the DNA in the chromosomes

Genome-wide association study- a type of genetic study that scientists use to find genetic factors that are associated with a specific disease or trait

Gut-brain neuropeptides- Neurotransmitters that are made from genes in the DNA and that regulate a variety of functions related to appetite, metabolism, and GI system function

Hamwi formula- a method for estimating ideal body weight, in women the formula is 100 lb + 5 lb for every inch in height above 5 foot tall, in men the formula is 106 lb + 6 lb for every inch in height above 5 foot tall

Impact factor- a statistic frequently used to measure the influence of a scientific journal, it is calculated by finding the average number of a times a scientific paper published in that journal was cited in the previous two years

Lipidomics- a field of biology that tries to identify and measure all of the lipids in a cell or organism

Lipoic Acid- a cofactor that is required for several of the chemical reactions involved in turning food into energy

Long chain fatty acid- a fatty acid with a hydrocarbon chain that is between 13-21 carbons long, requires carnitine and the carnitine palmitoyl transferase system in order to enter the mitochondria and be broken down into energy

Major allele- when there are two possible nucleotides at a certain position in the DNA, the major allele is the one that is more common in the population

Mediobasal hypothalamus- a region of the brain that is involved in the control of appetite, fat storage and energy expenditure

Metabolomics- a field of biology that tries to identify and measure all of the biological molecules in a cell or organism

Microbiome- all of the microorganisms living in the GI tract

Minor allele- when there are two possible nucleotides at a certain position in the DNA, the minor allele is the one that is less common in the population

Mitochondria- a part of the cell that is mainly involved in converting food into energy, but has a number of other functions including heat production, making certain molecules for the cell to use, and regulating cell death

Monogenic- monogenic diseases are caused by mutations in a single gene

mTOR- stands for either Mammalian Target Of Rapamycin (mTOR) or Mechanistic Target Of Rapamycin, it serves as one of the primary nutrient sensors in the cells of the body

Neuropeptide- a neurotransmitter that is made with instructions from a gene in the DNA

Neurotransmitter- a molecule that is released by a neuron to send a signal to another part of the body, such as a muscle, gland, or another neuron

Number needed to harm- the number of people who need to receive a specific medical treatment to cause one person to have a specific side effect (such as a blood clot, liver failure, or death)

Number needed to treat- the number of people who need to receive a specific medical treatment to prevent one person from having a bad outcome (such as a heart attack, stroke, or death).

Peer review process- a method for evaluating the value of a scientific work (such as a grant or paper) by using one or more people with similar expertise (peers) to judge its quality

Polygenic- polygenic diseases are caused by mutations in more than one gene

Precision medicine- or personalized medicine, is a field of study that uses information relating to a person’s genes, environment, and lifestyle to create individually tailored medical treatments

Private mutation- a rare or novel gene mutation that is usually found only in a single person or family

Proteomics- a field of biology that tries to identify and measure all of the proteins in a cell or organism

Psychoactive- a drug or medication that alters one’s thoughts, perceptions, mood, consciousness, or behavior.

Psychoanalytic psychotherapy- or psychoanalysis is a method of exploring the unconscious impulses using techniques such as dream interpretation, free association, and analysis of resistance to change

Psychopharmacology- a field of study examining psychoactive substances

Randomized controlled trial- a type of research study in which individuals are randomly assigned to a treatment (the experimental group) or a placebo (the control group)

Recovered- when a patient no longer has any symptoms after receiving a specific treatment

Responded- when a patient’s symptoms have decreased by more than 50% after a treatment but are still present

Satiation- refers to how long a person feels full or satisfied after a meal, satiation controls when a person is hungry again after eating

Satiety- refers to feelings of fullness or satisfaction during a meal, satiety controls how much a person eats during a meal

Signs- outward manifestations of a psychiatric illness, such as bizarre behavior or talking very quickly

Single-blinded- the peer review process is said to be single-blinded if the reviewers know the identity of the author, but author is not aware of the identities of the reviewers, a work is double-blinded if neither side is aware of the other’s identity, and unblinded if both side know the identities of the other

SPECT- or Single-Photon Emission Computed Tomography, is a brain imaging technique that uses small amounts of a radioactive compound to measure brain activity of an awake person

Symptoms- manifestations of a psychiatric illness that only a person experiences, such as intrusive thoughts or hallucinations

Tetrahydrobiopterin- a molecule made by the body that is required for the synthesis of several neurotransmitters including serotonin, dopamine, norepinephrine, and melatonin

Transcription factor- a protein that controls the a certain set of genes are turned on or turned off

Transcriptomics- a field of biology that tries to identify and measure all of the mRNA molecules in a cell or organism

Triglycerides- a type of fat composed of three fatty acids linked together by a glycerol molecule, primarily used as a way to store energy for later use

Vitamin B- a group of water-soluble vitamins that play important roles in metabolism, especially in processes related to turning food into energy, patients with anorexia are more likely to have mutations in gene related to

Thiamine (B1)

Niacin (B3)

Panthothenic acid (B5)

Pyridoxine (B6)

Biotin (B7)

Folate (B9)

Cobalamin (B12)

Vitamin D- a vitamin that can either be produced by the skin in response to sunlight or obtained in the diet, vitamin D is a key regulator of calcium and phosphorus levels in