Intestinal microbiota and Anorexia Nervosa

Grzegorz Borenski, Magdalena Wojcik, Julita Poleszak, Przemysław Szabat, Marta Szabat, Joanna Milanowska


Introduction: Eating disorders are severe psychiatric disorders. Anorexia nervosa (AN) has a mortality rate among the highest of any psychiatric illnesses. Anorexia nervosa is characterised by extreme weight loss and fear of gaining weight. Lifestyle and diet have a major influence on gut microbiota composition. Thus, studies of this subject may have potential in better understanding pathophysiology of AN.

The aim of the study: The purpose of this systemic review was to collect and analyse available data about correlations between anorexia nervosa and gut microbiota.

Material and method: Standard criteria were used to review the literature data. The search of articles in the PubMed database was carried out using the following keywords: anorexia nervosa, gut microbiota, diet.

Description of the state of knowledge: Intestinal microbiota plays an important role in weight regulation. Alterations in bidirectional brain-gut microbiota interactions can be responsible for a number of diseases including irritable bowel syndrome or functional gastrointestinal disorders. Studies show differences of gut microbiota composition between AN patients and normal-weight control groups. Composition of intestinal microbiota changes during nutritional rehabilitation. However, the differences between AN and control groups are still present even after substantial weight gain. Moreover, some correlations according to BMI are observed. Also there might be a correlation between increased intestinal permeability and gastrointestinal complaints common in AN.

Summary: Studies showed alterations in intestinal microbiota composition in anorexia nervosa patients comparing to normal-weight individuals. However, more studies of this subject are needed. Knowing more correlations between gut microbiota, diet and weight may be helpful in understanding anorexia nervosa and improving its treatment.


anorexia nervosa; gut microbiota; diet

Full Text:



Steinglass JE, Sysko R, Mayer L, Berner LA, Schebendach J, Wang Y, et al. Pre-meal anxiety and food intake in anorexia nervosa. Appetite. 2010 55(2):214–218.

Glenny EM, Bulik-Sullivan EC, Tang Q, Bulik CM, Carroll IM. Eating Disorders and the Intestinal Microbiota: Mechanisms of Energy Homeostasis and Behavioral Influence. Curr Psychiatry Rep. 2017 19(8):51.

Mehler PS, Brown C. Anorexia nervosa - medical complications. J Eat Disord. 2015 3:11.

Kaye W, Bulik C, Thornton L, Barbarich N, Masters K, Price Foundation Collaborative Group. Comorbidity of anxiety disorders with anorexia and bulimia nervosa. Am J Psychiatry. 2004 161:2215–2221.

Mack I, Penders J, Cook J, Dugmore J, Mazurak N, Enck P. Is the Impact of Starvation on the Gut Microbiota Specific or Unspecific to Anorexia Nervosa? A Narrative Review Based on a Systematic Literature Search. Curr Neuropharmacol. 2018 16(8):1131–1149.

Biedermann L, Rogler G. The intestinal microbiota: its role in health and disease. Eur J Pediatr. 2015 174(2):151-67.

Sender R, Fuchs S, Milo R. Are We Really Vastly Outnumbered? Revisiting the Ratio of Bacterial to Host Cells in Humans.Cell. 2016 164(3):337-40.

Aagaard K, Ma J, Antony KM, Ganu R, Petrosino J, Versalovic J. The placenta harbors a unique microbiome. Science translational medicine. 2014 6(237):237ra65.

Funkhouser LJ, Bordenstein SR. Mom knows best: the universality of maternal microbial transmission. PLoS biology. 2013 11(8):e1001631.

Rajilić-Stojanović M, Jonkers DM, Salonen A, Hanevik K, Raes J, Jalanka J, et al. Intestinal microbiota and diet in IBS: causes, consequences, or epiphenomena?. The American journal of gastroenterology. 2015 110(2):278–287.

Dominguez-Bello MG, Costello EK, Contreras M, Magris M, Hidalgo G, Fierer N, et al. Delivery mode shapes the acquisition and structure of the initial microbiota across multiple body habitats in newborns. Proceedings of the National Academy of Sciences of the United States of America. 2010 107(26):11971–11975.

Goodrich JK, Waters JL, Poole AC, Sutter JL, Koren O, Blekhman R, et al. Human genetics shape the gut microbiome. Cell. 2014 159(4):789–99.

David LA, Maurice CF, Carmody RN, Gootenberg DB, Button JE, Wolfe BE, et al. Diet rapidly and reproducibly alters the human gut microbiome. Nature. 2014 505(7484):559–63.

Grenham S, Clarke G, Cryan JF, Dinan TG. Brain-gut-microbe communication in health and disease. Front Physiol. 2011 2:94.

Ley RE, Bäckhed F, Turnbaugh P, Lozupone CA, Knight RD, Gordon JI. Obesity alters gut microbial ecology. ProcNatlAcadSci U S A. 2005 102(31):11070–11075.

Ley RE, Turnbaugh PJ, Klein S, Gordon JI. Microbial ecology: human gut microbes associated with obesity. Nature. 2006 444(7122):1022–1023.

Turnbaugh PJ, Ley RE, Mahowald MA, Magrini V, Mardis ER, Gordon JI. An obesity-associated gut microbiome with increased capacity for energy harvest. Nature. 2006 444(7122):1027–1031.

Mayer EA, Tillisch K, Gupta A. Gut/brain axis and the microbiota. J Clin Invest. 2015 125(3):926–938.

Temko JE, Bouhlal S, Farokhnia M, Lee MR, Cryan JF, Leggio L. The Microbiota, the Gut and the Brain in Eating and Alcohol Use Disorders: A 'Ménage à Trois'?. Alcohol Alcohol. 2017 52(4):403–413.

Sandhu KV, Sherwin E, Schellekens H, Stanton C, Dinan TG, Cryan JF. Feeding the microbiota-gut-brain axis: diet, microbiome, and neuropsychiatry. Transl Res. 2017 179:223-244.

Wang HX, Wang YP. Gut Microbiota-brain Axis. Chin Med J (Engl). 2016 129(19):2373–2380.

Borre YE, O'Keeffe GW, Clarke G, Stanton C, Dinan TG, Cryan JF. Microbiota and neurodevelopmental windows: implications for brain disorders.Trends Mol Med. 2014 20(9):509-18.

Rhee SH, Pothoulakis C, Mayer EA. Principles and clinical implications of the brain-gut-enteric microbiota axis. Nat Rev Gastroenterol Hepatol. 2009 6(5):306–314.

Lembo A, Camilleri M. Chronic constipation.N Engl J Med. 2003 349(14):1360-8.

Macfarlane S, Dillon JF. Microbial biofilms in the human gastrointestinal tract. J. Appl. Microbiol. 2007 102:1187–1196.

Stephens RL, Tache Y. Intracisternal injection of a TRH analogue stimulates gastric luminal serotonin release in rats. Am. J. Physiol. 1989 256:G377–G383.

Santos J, Saperas E, Nogueiras C, Mourelle M, Antolín M, Cadahia A, et al. Release of mast cell mediators into the jejunum by cold pain stress in humans. Gastroenterology. 1998 114:640–648.

Mazmanian SK, Round JL, Kasper DL. A microbial symbiosis factor prevents intestinal inflammatory disease. Nature. 2008 453(7195):620-5.

Cenit MC, Sanz Y, Codoñer-Franch P. Influence of gut microbiota on neuropsychiatric disorders. World J Gastroenterol. 2017 23(30):5486–5498.

Cryan JF, Dinan TG. Mind-altering microorganisms: the impact of the gut microbiota on brain and behaviour. Nat Rev Neurosci. 2012 13:701–712.

Barrett E, Ross RP, O’Toole PW, Fitzgerald GF, Stanton C. γ-Aminobutyric acid production by culturable bacteria from the human intestine. J Appl Microbiol. 2012 113:411–417.

Dinan TG, Stanton C, Cryan JF. Psychobiotics: a novel class of psychotropic. Biol Psychiatry. 2013 74:720–726.

O'Mahony SM, Clarke G, Borre YE, Dinan TG, Cryan JF. Serotonin, tryptophan metabolism and the brain-gut-microbiome axis. Behav Brain Res. 2015 277:32–48.

Morrison DJ, Preston T. Formation of short chain fatty acids by the gut microbiota and their impact on human metabolism. Gut Microbes. 2016 7(3):189–200.

Foley KA, MacFabe DF, Vaz A, Ossenkopp KP, Kavaliers M. Sexually dimorphic effects of prenatal exposure to propionic acid and lipopolysaccharide on social behavior in neonatal, adolescent, and adult rats: implications for autism spectrum disorders. Int J DevNeurosci. 2014 39:68–78.

Tan J, McKenzie C, Potamitis M, Thorburn AN, Mackay CR, Macia L. The role of short-chain fatty acids in health and disease.Adv Immunol. 2014 121:91-119

Borgo F, Riva A, Benetti A, Casiraghi MC, Bertelli S, Garbossa S, et al. Microbiota in anorexia nervosa: The triangle between bacterial species, metabolites and psychological tests. PLoS One. 2017 12(6):e0179739.

Mack I, Cuntz U, Grämer C, Niedermaier S, Pohl C, Schwiertz A, et al. Weight gain in anorexia nervosa does not ameliorate the faecal microbiota, branched chain fatty acid profiles, and gastrointestinal complaints. Sci Rep. 2016 6:26752.

Carr J, Kleiman SC, Bulik CM, Bulik-Sullivan EC, Carroll IM. Can attention to the intestinal microbiota improve understanding and treatment of anorexia nervosa?. Expert Rev Gastroenterol Hepatol. 2016 10(5):565–569.

Lozupone CA, Stombaugh JI, Gordon JI, Jansson JK, Knight R. Diversity, stability and resilience of the human gut microbiota. Nature. 2012 489(7415):220–230.

Kleiman SC, Watson HJ, Bulik-Sullivan EC, Huh EY, Tarantino LM, Bulik CM, et al. The Intestinal Microbiota in Acute Anorexia Nervosa and During Renourishment: Relationship to Depression, Anxiety, and Eating Disorder Psychopathology. Psychosom Med. 2015 77(9):969–981.

Morita C, Tsuji H, Hata T, Gondo M, Takakura S, Kawai K, et al. Gut Dysbiosis in Patients with Anorexia Nervosa. PLoS One. 2015 10(12):e0145274.

Armougom F, Henry M, Vialettes B, Raccah D, Raoult D. Monitoring bacterial community of human gut microbiota reveals an increase in Lactobacillus in obese patients and Methanogens in anorexic patients. PLoS One. 2009 4(9):e7125.

Mu Q, Kirby J, Reilly CM, Luo XM. Leaky Gut As a Danger Signal for Autoimmune Diseases. Front Immunol. 2017 8:598.

Herpertz-Dahlmann B, Seitz J, Baines J. Food matters: how the microbiome and gut-brain interaction might impact the development and course of anorexia nervosa. Eur Child Adolesc Psychiatry. 2017 26(9):1031–1041.

Ruusunen A, Rocks T, Jacka F, Loughman A. The gut microbiome in anorexia nervosa: relevance for nutritional rehabilitation. Psychopharmacology (Berl). 2019 236(5):1545–1558.

Liang S, Wu X, Hu X, Wang T, Jin F. Recognizing Depression from the Microbiota⁻Gut⁻Brain Axis. Int J Mol Sci. 2018 19(6):1592.

Mendez-Figueroa V, Biscaia JM, Mohedano RB, Blanco-Fernandez A, Bailen M, Bressa C, et al. Can Gut Microbiota and Lifestyle Help Us in the Handling of Anorexia Nervosa Patients?. Microorganisms. 2019 7(2):58.

Vlainić JV, Šuran J, Vlainić T, Vukorep AL. Probiotics as an Adjuvant Therapy in Major Depressive Disorder. Curr Neuropharmacol. 2016 14(8):952–958.



  • There are currently no refbacks.

Copyright (c) 2019 © The Author(s)

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Journal of Education, Health and Sport formerly Journal of Health Sciences

Declaration on the original version.

Editors indicates that the main version of the magazine is to issue a "electronic".

The journal has had 5 points in Ministry of Science and Higher Education parametric evaluation. § 8. 2) and § 12. 1. 2) 22.02.2019.

1223 Journal of Education, Health and Sport eISSN 2391-8306 7

ISSN 2391-8306 formerly ISSN: 1429-9623 / 2300-665X

Archives 2011 - 2014

PBN 2011 - 2014

POL-index 2011 - 2014

BASE 2011 - 2014

Indexed in Bases, Bazy indeksacyjne: ERIH Plus, Worldcat, PBN/POL-Index, ICI Journals Master List, Directory of Open Access Journals (DOAJ), ZBD, Ulrich's periodicals, Google Scholar, Polska Bibliografia Lekarska

US NLM = 101679844

101679844 - NLM Catalog Result - NCBI

Find a library that holds this journal:

Journal Language(s): English 

PBN Poland



Redaction, Publisher and Editorial Office

Instytut Kultury Fizycznej Uniwersytet Kazimierza Wielkiego w Bydgoszczy, Institute of Physical Education Kazimierz Wielki University in Bydgoszcz, Poland 85-091 Bydgoszcz ul. Sportowa 2 Copyright by Instytut Kultury Fizycznej UKW w Bydgoszczy  Open Access ISSN 2391-8306 formerly ISSN: 1429-9623 / 2300-665X

The journal has been approved for inclusion in ERIH PLUS.

The ERIH PLUS listing of the journal is available at

SIC Science citation index (calculated on the basis of TCI and Page Rank) 0

Russian Impact factor 0.16

Indexed in Index Copernicus Journals Master List.,p24782242,3.html

ICV 2018 = 95.95 ICV 2017 = 91.30 ICV 2016 = 84.69 ICV 2015 = 93.34 ICV 2014 = 89.51 Standardized Value: 8.27 ICV 2013: 7.32 ICV 2012: 6.41 ICV 20115.48

The InfoBase Index IBI Factor for the year 2015 is 3.56 in InfoBase


Universal Impact Factor 1.78 for year 2012. (

Indexed in Polish Scholarly Bibliography (PBN) (PBN Polska Bibliografia Naukowa) (

is a portal of the Polish Ministry of Science and Higher Education, collecting information on publications of Polish scientists and on Polish and foreign scholarly journals. Polish Scholarly Bibliograhpy is a part of POL-on - System of Information on Higher Education. It is operated by the Interdisciplinary Centre for Mathematical and Computational Modelling, University of Warsaw.

Indexed in Russian Sciences Index Российский индекс научного цитирования (РИНЦ)

Indexed in Arianta Polish scientific and professional electronic journals Aneta Drabek i Arkadiusz Pulikowski