Serotonin, antidepressants, and eating disorders

Earlier this week on Twitter (do you follow ED Bites on Twitter? You know you want to...), I ran across an interesting article about why some antidepressants don't work in some patients. The article was published last week in the research journal Neuron and is titled "5-HT1A Autoreceptor Levels Determine Vulnerability to Stress and Response to Antidepressants." (Clicking the link will take you to the free full-text of the article.) I'll let the opening of the article's Science Daily press release explain the research for me:

An excess of one type of serotonin receptor in the center of the brain may explain why antidepressants fail to relieve symptoms of depression for 50 percent of patients, a new study from researchers at Columbia University Medical Center shows.

...Most antidepressants -- including the popular SSRIs -- work by increasing the amount of serotonin made by cells -- called raphe neurons -- deep in the middle of the brain. Serotonin relieves symptoms of depression when it is shipped to other brain regions.

But too many serotonin receptors of the 1A type on the raphe neurons sets up a negative feedback loop that reduces the production of serotonin, Dr. Hen and his colleagues discovered. "The more antidepressants try to increase serotonin production, the less serotonin the neurons actually produce, and behavior in mice does not change," Dr. Hen says.


Seeing as anti-depressant therapy hasn't shown much promise in the treatment of anorexia nervosa (although it does appear to help treat co-morbid conditions like depression and anxiety), this research could help with the development of new treatments for AN. It also seemed like a good a time as any to discuss the links between serotonin levels and eating disorders. In a 2005 review article, titled "Serotonin alterations in anorexia and bulimia nervosa," Walter Kaye wrote that people with either anorexia and/or bulimia showed alterations of brain functioning in specific neural areas:

Importantly, such disturbances are present when subjects are ill and persist after recovery, suggesting that these may be traits that are independent of the state of the illness. Emerging data point to a dysregulation of serotonin pathways in cortical and limbic structures that may be related to anxiety, behavioral inhibition, and body image distortions...Alterations of these circuits may affect mood and impulse control as well as the motivating and hedonic aspects of feeding behavior. Such imaging studies may offer insights into new pharmacology and psychotherapy approaches.

The serotonin/anorexia connection has been researched over the years (searching PubMed for "serotonin anorexia" gives you over 700 results), and the most recent thinking goes something like this. People with anorexia are generally thought to have unusually high levels of serotonin in their brains, and high levels of brain serotonin have been linked to anxiety and obsessionality. An old BBC article titled "Genetic clues to eating disorders" has a quote from Janet Treasure that explains some of the link:

People with high levels of serotonin are prone to anxiety. Dr Janet Treasure, director of the eating disorders unit at the Maudsley, believes this could be behind anorexic patients' ability to suppress appetite. She said: "In anorexia nervosa the drive to eat can be inhibited, but we know that in normal people who are starved they will kill each other and do all sorts of morally repugnant things, and eat all sorts of foodstuffs that you wouldn't normally touch.

"Yet that doesn't happen in anorexia nervosa, so there's some aspect of the appetite system that isn't working."

The unit looked at the biology of stress mechanisms, in particular the fight or flight response. This is where the body prepares itself for action when confronted by a stressful situation. Heart rate and blood pressure rise and two of what are usually humans' highest priorities, eating and reproducing, are put on hold. It is possible that anorexic people are chronically in an acute state of stress reaction - they are constantly in a fight or flight state of mind.

And by restricting food intake, people with anorexia can lower the amount of serotonin their bodies can make (serotonin is ultimately derived from the essential amino acid tryptophan). This actually makes people with anorexia feel better. However, the brain begins to sense the decreased serotonin production and tries to maintain homeostasis by increasing the number of serotonin receptors. Thus the brain is back at Square One, as it is producing less serotonin but is using the decreased amount much more efficiently. So restricting doesn't feel as good, and the (obvious!) solution is to eat even less. And thus that negative cycle is born and the anorexic becomes trapped by their own brain chemistry.

Refeeding would then increase the amount of serotonin in the brain before the brain has a chance to decrease the number of serotonin receptors. This could be the neurological equivalent of All Hell Breaking Loose and could very well explain why refeeding is so distressing, although I don't think there has been any formal research done on the subject.

In bulimia, the serotonin problem is reversed. People with BN appear to have much lower than average levels of serotonin in the brain, which may be temporarily increased by binge eating.* Purging increases levels of vasopressin, which can have a euphoric and sedating effect, thus making the binge/purge cycle addictive much in the same way that starvation becomes addictive in AN. The chronic low levels of serotonin in BN also explain why SSRIs can be effective at reducing the urges to binge and purge.

Of course, plenty of people cross over from anorexia to bulimia, and I haven't the slightest idea of how serotonin might affect that crossover. So many brain systems are thrown out of whack during an ED that I don't know an exact answer will ever be found.

*The story is, as usual, a little more complicated than this, but the basic idea is the same.

44 comments:

Anonymous said...

Hi Carrie,

I enjoy reading your blog and like that you discuss emerging research on eating disorders, but it often seems that there are several logical fallacies in your reasoning. Please don't take this as an attack, but it seems like you are absolutely determined to construe anything you read as evidence to confirm a very passionate belief that eating disorders are brain diseases. I'm not saying that anorexia and bulimia are not legitimate illnesses that affect (and are affected by) changes in neurological functioining, but it seems to me that the biomedical model of eating disorders (or the brain-disease model you often advocate) tends to be over-reductive and fails to encapsulate the vast complexity of these syndromes.

For example, a few things you might consider with regards to the research you describe in this post... serotonin has been connected to just about every mental state known to man. Trust me, if you conduct a search of the literature and pair the term "serotonin" with just about any psychological term--whether it be an illness or a positive state of mind--someone has found a correlation.

Correlation is not causation. Neuroscienctific research, and fMRI studies in particular, are fantastic at finding connnections between physiological mechanisms (e.g. serotonin levels, specific gene activaitons, or blood flow to certain brain regions) and psychological phenomenon. However, this does not mean that the mechanism was the CAUSE of the psychological phenomenon. Depression may be caused by disregulation of serotonin levels in the brain; or, alternatively, the serotonin levels may be an artifact of some larger process occurring elsewhere in the body. Moreover, the mechanism CAUSING an individual's depression may not even be in the body at all!

Imagine, say, a fruit that has the unique ability to induce depression in whomever eats it. If a scientist looks at a person who has recently eaten this fruit and discovers that his brain is significantly larger than the other people in the population who hadn't eaten the fruit, would you say the man's depression was CAUSED by his larger brain? No. Maybe the fruit caused swelling in the man's brain, which in turn induced depression and would explain his larger brain size. Or, maybe the man became depressed, started spending more time in the basement of his house to hide away, and was exposed to a special type of radiation in his basement that caused his brain to grow larger .... You get my point?

I draw this example to illustrate how one might come to vastly different conclusions about this type of research. I'm not saying that anorexia or bullimia are caused by radiation in someone's basement. I don't know what causes anorexia and bulimia. However, I don't think that scientists do either... and I don't know that they ever will. Eating disorders are complex illnesses. The medical model oversimplifies the human experience. 'Anorexia' may very well be a bracket term we use to describe a great variety of illnesses and disorders. A ten-year-old in China who meets the criteria for anorexia-nervosa may not be suffering from the same 'disease' as a forty-year-old in the United States who meets the same critera.

Just a few things to consider. I hope I didn't come off as offensive or hypercritical. I really do enjoy reading your blog and I appreciate your enthusiasm and dedication to help alleviate the immense suffering experienced by those affected by these illnesses.

May we all one day come to terms with the meaning our particular ailment (whether it be bulimia, cancer, or a broken leg) has served in our lives and find the strength to heal and journey into wholeness.

Cathy (UK) said...

As someone who enjoys a scientific debate, I would love to have a debate with 'Anonymous' (above).

I don't wish to 'speak' for Carrie - because she speaks very well for herself, but I disagree that Carrie is "determined to construe anything [she] read[s] as evidence to confirm a very passionate belief that eating disorders are brain diseases".

As Carrie has previously discussed on her blog, she could see no powerful environmental/ developmental stimulus (e.g. childhood abuse) for her eating disorder (ED). There is research evidence to support the hypothesis that childhood abuse, failure to develop a healthy (maternal) attachment or repeated bullying can disrupt the development of a healthy, stable identity and lead to a negative sense of self, feelings of having 'no control' etc. In turn, an unstable childhood can result in the developemnt of BPD which is often accompanied by an ED. However, some people develop exactly the same behaviours and clinical presntation when they have had a stable upbringing.

The behaviours of an ED are quite stereotyped, which does suggest some common, underlying brain mechanism - which is most likely linked to disordered eating. In (e.g.) anorexia nervosa (AN), re-feeding does help to reverse anorexic behaviours, although there is a time-lag between being re-fed and eating 'normally/adequately' - and feeling better mentally.

Having scrutinised the research evidence which hypothesises that EDs have a biological basis, I too am too convinced that this is the case. When my AN developed at age 11-12 yrs there came a point when suddenly I felt that some 'alien-like influence' had 'taken over' my mind. When I tried to eat I felt suicidal. Despite my young age, and having no academic knowledge of ED theories at the time, I was convinced that something had gone seriously wrong with my brain. Yet, I had a history of anxiety and OCD.

Having said that, I have also recognised environmental/social triggers for my ED that persist irrespective of whether I am able to manage my anorexic behaviours. As a teen, re-feeding did help me to control my restricting behaviours and over-exercising, but it didn't help my social confidence, a lack of which triggered my AN initially. I have had to learn alternative ways of dealing with my triggers - which don't involve self-starvation and frenetic exercising.

I don't think that anyone would argue that EDs are caused solely by abnormal/unusual brain metabolism/physiology. However, I do believe that it is this unusual neurophysiology that likely increases vulnerability to EDs in the face of various/many toxic social triggers that are unique to each individual.

EDs are not just diseases of a developed world. It is well documented that they exist in developing countries, but have a different clinical presentation.

Happy to debate further...

balancingontwofeet said...

Hi Carrie,
I love you description of "All hell breaking loose" upon refeeding. I was so happy when these studies came out since it validates what I felt in my brain for all those years. I never found SSRI's to help me and only had the side affects from them.

As for the debate...the chronic state of anorexia does have a lot of brain chemistry involved that helps to keep it virtually impossible to simply say"I am done" and let the illness go. That being said the beginning of the disease is very different for each person, and it does take into account environmental factors and can't be all blamed on brain chemistry. Again though, be stuck in the illness does relate back to the brain chemistry. I don't think that Carrie is trying to "prove" one way or another, but rather taking what is out there and talking about it. The fact is that there is a lot of new research about the biochemistry of the illness and if it helps to explain it all then I'll take it!

M said...

No one seems to be excluding psycho-emotional factors in eating disorders.

I see more that the ED community has long embraced variable theories about the role of behavior, emotions, personality and lifestyle issues ... and intervention has almost haphazardly focused on a variety of experiential, behavioral and addiction-model efforts.

Since brain imaging & genetic information is new, it's natural to explore & question connections, whether it's causation, consequence or otherwise. So, when we examine the emerging research, patterns, case reviews, etc., in conjunction with pschyological and psychiatric presentation and what we know about medication efficacy (or not), we have new insight to better understand, possibly, the complex interplay of conditions that manifest in eating disorders.

It would be dim science to ignore emerging information, to dismiss what it might mean and how it might help people, which is what it's all about ... effective treatment to ease suffering, promote education and prevention, guide follow-up, develop cost-effective & empirically-based programs.

Anonymous seems defensive about a "brain disease" model, as if patients are grasping for excuses, to demur responsibility for treatment, compliance, self-care.

Professional treatment is chaotic & not often even evidence-based, perhaps because there's so little evidence to go by. It also explains why patients enter programs that purport to arrive at recovery in all manner of approaches ... but even with the most thoughtful attention to emtions, psychological distress, occupational & cognitive activities, support, and medical care ... it isn't enough.

Even throwing bunches of money and months/years of time at the problem, patients relapse. Consistently. The long duration of illness acuity is part of its described course. Yet, some providers & programs will say if patients just submit to a particular philosophy, they will get & feel better.

In any supportive, treatment environment, patients may have the structure needed for symptom remission & may feel inspired to do better. But, if there was a particular way, truth & light, it could be replicated for all patients.

What we then consider is that, despite intensive attention to symptoms & emotion, maybe the brain didn't change (which we know to be true from recent studies). That "why-do-I-feel-worse/no-better-even-though ..." thing leads to self-blame and frustration when nutrition is restored and one has processed a lifetime's worth of issues.

Some patients have learned to override the thoughts and the seemingly internal drive.

Patients who go to strict refeeding programs with few "feel-good" components may complain of the milieu, but they seem to be just as likely or unlikely to get better by any degree. God, horses, art, emoting, journaling, yoga, psycho-education, nutrition counseling, biofeedback ... any and all of it may or may not help, but if any one thing *did* help, consistently, everyone would be doing that and people would get better, faster and easier.

So far, CBT and DBT are the most promising interventions, along with prozac for those with bulimia. For children and adolescents, family-based care has been shown effective (which might further lead us to conclude that the developmental phase/brain susceptibility to change + supportive care is key).

The best treatment still seems to mostly consist of breaking the cycle of starvation or bulimia; restoring weight & nutrition; teaching coping skills; building a support network; maintaining intense structure; and treating whatever cluster of concurrent/co-morbid psychiatric symptoms.

No matter the etiology, it's all about the brain in one way or another, and whether there are organic issues, causative, consequential or incidental findings, the more we know, the better ... for patients, families, and society.

A:) said...

I really don't understand this divide. Why can it not be both? Why could causation not be both environmental AND genetic. Why does it have to be primarily one or the other.

We know from looking at twin studies that AN is NOT 100%genetic. Concordance rates are not 100% and similar to schizophrenia, if one twin gets anorexia it does not necessarily follow that the other will.

However, we know that those with ED occurence in their families have an increased tendency to develop the illness. This points to SOME genetic factor or underlying biological cause. The predisposition is inherited -- the DISORDER is not.

I agree with anon -- as a university student studying neuroscience and statistics correlation does NOT mean causation. We cannot 100% say that these brain changes caused the disorder or that they were even there before onset.

However, I think we can hypothesize from what we know about serotonergic systems and the brain that once these changes DO take place they hinder recovery.

M -- I don't believe refeeding alone is enough to cure AN. If that were true, then weight restoration followed by a period of enforced stability would lead to remission or recovery. It is possible to relapse even years after weight restoration with reoccurence of stress, etc.

Also, I don't believe therapy, horses or "God, etc. can cure AN. On the other hand, I don't believe full nutrition can cure AN. I think these factors working TOGETHER have merit in the same manner as therapy and antidepressants have been shown to have better outcome rates in depression than either regime alone.

It seems that there is the FBT/biological/brain disease camp and then there is the airy fairy psychological camp. This is RIDICULOUS -- look at EVERY other freaking dichotomy in psychology and the solution is usually an integration of the two.

End rant.

A:)

Katie said...

I am fascinated by the link with serotonin, because I had dreadful reactions to every antidepressant I was put on from the age of 16 - seven years before I first got to a low weight. I had an eating disorder back then, but I didn't meet the criteria for anorexia until I was 23. SSRIs made me suicidal and effexor, which I think is an SNRI, made me alternately suicidal and manic. I think I had every side effect known to man! I'm glad there's a potential explanation.

On the nature/nurture debate, I agree with M and Cathy. It's clear to me that there are biological processes behind eating disorders, and coming to that understanding has actually made all the difference in my recovery. Now anorexia is something to fight rather than a part of me. Of course people are going to assign meaning to their experience, but so do people with other more clearly biological disorders - my ex has bipolar I and when he was younger he believed that he could overcome it by getting over a rough breakup with his first girlfriend (not me!). It took him a long time to accept that his illness was due to a chemical imbalance. It took me a long time as well - I spent years in therapy teasing out meanings and causes, and but ending up with a list of reasons why I was sick didn't do a thing to help me change. What did help was learning to put my anorexic thoughts in the proper context of symptoms of an illness, not reality. I still see a therapist now but it's just for support, not to dig up dirt.

To A - I don't see M saying that refeeding alone is the answer, she mentioned CBT and DBT as effective therapies. Also, I'm not overly familiar with the subject, but I was reading about epigenetics recently and that seemed to be a very interesting way of explaining the results of twin studies.

Thanks for such an interesting post Carrie :)

A:) said...

Katie,

I'm not saying that it is one or the other -- just that it doesn't look as if it is only environment or only genetics/biology.

I agree that there are biological processes behind eating disorders and I think I made that clear in my first post -- I am just not completely convinced that one can develop an eating disorder in a vacuum -- environment plays a role. It is more likely that environment and biology have an integrated effect to produce the disorder such the disorder is neither wholey organic or psychological.

You mention epigenics and that is quite interesting. I think it is possible the environmental factors CAN alter gene expression such that certain genes are turned on/off. It would mean that the environment has a powerful role in determining disease/illness and cure.

For example: it was recently found that in a study about type II diabetes, exercise/healthy diet in suffering participants improved insulin function compared to the control group. So I think altering environment and behaviour does have a powerful effect on the brain. We cannot simply isolate an illness as a brain disease or a psychological problem. As you stated, there are interactions.

Can you explain more about epigenics and twin studies? I would be interested to hear it.

Thanks,

A:)

M said...

A ... I *was* saying EDs are a complex interplay of neurology, psychology, personaly, circumstances, etc.

And, I wasn't promoting FBT ... just pointing it out among the approaches and underscoring it as one of the only treatments that has garnered some clinical endorsement (along with CBT, DBT and particular medications for particular patients and for specific conditions).

I *don't* believe that nutrition alone can cure anorexia ... and I think I pointed that out when I noted the disparity in patients who are weight-restored and have a ton of therapy/processing under the bridge ... but still struggle with the eating disorder. Food didn't fix it. Therapy didn't fix it. Spitting in the wind doesn't fix it.

Exploring the neurology and parts of the brain that we previously haven't had ready access to question is just the next/current frontier in the search for effective treatment for eating disorders.

My biggest peeve is the promotion of any one thing/approach/idea is the golden ticket, since no one treatment has been proven scientifically. End of *my* rant :)

Carrie Arnold said...

Anon,

Well, to be honest, I probably *am* biased. I favor ideas with evidence, and I'm not going to apologize for it or try to defend it. The blog is what it is. I don't pretend to be totally unbiased, although I try to be as objective as possible. Anyone who says they can be totally unbiased is either delusional or they're lying.

I am more than aware that serotonin has links to many different conditions and organ systems. The "serotonin anorexia" search was my way of showing that the links between serotonin and anorexia weren't just my own Cockamamie Ideas, and that research on the subject had been going on for many years. I am well aware that a PubMed search proves nothing.

I don't generally talk about my grad school work, in part because it's not always relevant and in part because I don't like to seem all high and mighty because I have gone to grad school. But I have a Master's in Public Health in Epidemiology- I know darn well the differences between correlation and causation and I NEVER said in this post that abnormalities in serotonin cause anorexia. Just as you mentioned that I seemed biased in favor of the brain disease model, it seems that your own bias against the model made you see high-serotonin-causes-anorexia when it really wasn't there.

The fact is, no one knows what causes anorexia and I have never ONCE said that it's all biology. An eating disorder is a complex combination of nature and nurture, culture and chemistry. Do I think that a biological predisposition is sufficient to cause an eating disorder? No. Do I think a biological predisposition is necessary before an ED can be triggered? Absolutely. Anyone who says "I know what causes eating disorders" is likely (pardon my French) completely full of shit. We don't know. But the evidence also points to a role for serotonin in the etiology of eating disorders.

(To be continued)...

Carrie Arnold said...

...Continued from above.

You mention the brain size. And indeed, if it was one person who was depressed and happened to have a big brain, I would agree with you 100% that it could darn well be a coincidence. But if you measured the head circumference of a number of people with depression and compared it to the head circumference of people without depression and found that, on average, the people with depression had a larger head size, then you would be amiss not to look into that further. If you repeated these studies in different cultures and in people of different ages and tried to look before, during, and after the depression went into remission, you might be able to make some good data about the connection of head size and depression. Why? You have LOTS OF DATA. One person is an interesting story, it's what's known in the research world as a case study. I didn't use case studies for this post- I used larger experiments (though the sample sizes were relatively small). Because anorexia and bulimia are relatively rare conditions, it would be time consuming and rather expensive to follow a group of girls who don't have eating disorders and regularly measure serotonin levels and see who gets EDs and who doesn't and what the connection might be. I'd love to see it done, but I'm guessing it would be cost prohibitive.

I fully agree that fMRI isn't perfect, and we don't know whether the serotonin abnormalities are the result of the ED or an underlying cause. What we do know is that people typically have the same personality traits after recovery as they did before, and we also know that higher levels of brain serotonin are linked to feelings of high anxiety. Thus, it's not unreasonable to make the connection that high serotonin levels probably existed before the onset of the AN.

I'm not sure why people are so quick to call biology a reductionist approach to eating disorders. To me, biology is a rich wonderful field that only opens up many avenues of trying to figure out what causes EDs and how we can treat them. We are biological beings, as much as we are cultural ones. People have no problem saying that a 10 year old Chinese girl with diabetes and a 40 year old American man with diabetes have the same disease. Why should it be different for the brain? Of course their experiences of an illness and the meanings they ascribe to their symptoms and how they understand their illness are going to be different. Even identical twins would probably understand the same illness from different perspectives. But that doesn't mean the diseases are different.

Katie said...

This won't add anything to the discussion but wow, brilliant reply Carrie! I actually want to say something like 'awesome' or 'epic' but that would make me sound like I was 15 rather than 25, so I will resist temptation...

A:) said...

Hey Carrie,

I didn't mean to make any waves or piss anyone off. I agree with you 100% and I think sometimes when we all have strong feelings about a certain school of thought we lose sight of the fact that we actually agree with each other. . .

I was wondering though -- depression is often comorbid with AN -- either before onset or after weight restoration. How do you think this relates to AN as a surplus of serotonin?

A:)

Carrie Arnold said...

A,

No, you raised some very good points. I hope this blog does encourage debate and the exchange of information in a civil, respectful manner. You have nothing to apologize for.

With respect to the relationship between AN, depression, and serotonin, that is a confusing one. I've been meaning to ask Walt Kaye about this (having his information is often feeling like I have a personal phone line to god!) and I'll have to do so. What I do know from my research is that the links between anxiety and anorexia are much stronger than depression and anorexia--although a link still exists between AN and depression. It's really one of the $15 million questions in ED research out there right now. I'll let you know what I find out!

Carrie Arnold said...

Katie,

Why thank you! ;) You're pretty awesome and rad, too.

Katy said...

Given the high comorbidity of anxiety & depression diagnoses (I want to say close to 50% of people w/ one have the other, but I can't remember where that stat came from so don't hold me to it) it doesn't make a whole lot of sense to me that one would be associated with high levels of serotonin & the other with low levels. Happen to know of any research that might clear that up? My curiosity has been piqued...

Katy said...

Hehe, I just read thru the posts, & I guess I'm not the only one wondering about how comorbid illnesses & differing levels of serotonin fit together...sorry to (essentially) repeat the question! Someone seriously needs to do a study on this to make this make sense or I'm going to obsess over it for days. :-)

Jessi said...

why do people post anonymously when they are being constructive/argumentative/critical (?) hmmmm

i like all the points you have raised Carrie and accept that this is a blog and never take it for anything other than that. I appreciate all you share! I like to have my thoughts questioned and really respect that you do this for me and so many others. :)

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Antidepressants are given out like candy these days. It's an easy fix.

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Valencia Grimsley said...



Hello everyone out there i'm Valencia Grimsley,Do you know that there is a great Herbal doctor who can cure any deadly disease? Like Cancer, Hiv, syphilis, diabetes, herpes madness, low spam count and fertility problem e.t.c. Well my main reason why i am writing this right now is to inform the whole world about the great deeds, Dr.Ebosa did for me. I was diagnosed of this deadly disease in the year 2007 ever since then i was taking my medications, until i met the great herbal doctor, though i never believed in herbal med. I saw many testimonies on how a great herbal doctor cured their deadly diseases. I contacted him through his phone number. I called him, he asked me to send him my email, which i did. He gave me a form to fill, I filled it and send it back to him. He told me that he required some items in which he will use in preparing the herbal medicine for me. I don't know where to find the items he required. He told me that the only alternative is for me to send him the money, then he can help me to purchase the items from the items sellers. I promised myself to do anything to get cured. I sent him the money. He bought the items and he prepared the herbal medicine and send to me through courier service delivery and i make use of it as he instructed. few weeks later he asked me to go for check-up, when i did the check-up i was tested HIV Negative. If you are passing through hardship and you need a way out, kindly contact him via his email on ebosaherbalremedy@hotmail.com and drabosaherbscure@gmail.com or http://ebosaherbalremedy.blogspot.com.

peter weller said...

My name is Peter Weller
Today is the happiest day of my life, because problems I have been battling with over the years are now solved. My wife almost left me because she was unable to put in (pregnant) as result of my weak erection and premature ejaculation, I looked everywhere for a solution all to no avail, I have even been scammed severally before I met a Man called Lawson, who put an end to my problem. If you are having erectile dysfunction contact him with this email: dr.lawson52@gmail.com

Alex Neil said...

Not very many people in my life know that I was also once on antidepressants but I found them helpful for just getting me into a better place to get on with things and to manage the longer term things I needed to put in place to look after my mental health for the rest of my life.

Michaell Alienn said...

Big Thanks to Margret for showing up to my house and introduce Dr Olorun to me who cure me from this deadly Anorexia Nervosa disease. Dr Olorun has been faithful and truthful to work with. ever since the day i contacted him he has assure me his powers are sufficent to cure me and now am a living testimony. i have been cured finally and am fully healed by Dr Olorun, and now i want to use this medium to announce to everyone suffering from Anorexia Nervosa to contact Dr Olorun now get your treatment and cured immediately, email dr now at; Olorunoduduwaspiritualtemple@gmail.com

Alfred Susan said...

I am Alfred Susan, from New york, USA I can’t stop thanking DR Worrior Africa for this Great thing that he has done in my life, I am so grateful to him, i was suffering from HIV virus for 11years,when i contacted DR Worrior Africa after reading the wonderful testimony that people has been sharing about him. I have being on medication and trying looking for cure to my ailment. I went through internet doctors and i contacted a Tradomedical/Traditional doctor named, Dr. Worrior Africa for help. He give me all his rules and regulations,that if he cured me that I should write about him on internet site and that is what I’m doing now. He assure me that he will cure me with his herbal medicine which he really did, and I’m now completely cured from HIV virus. What will i say rather than thanking him for saving me. Why suffering in silence when there is remedy to your diseases.Dr.Worrior Africa also specialize in curing the following disease:
*HIV/AIDS
*Herpes
*Kidney failure
*Arthritis
*Diabetes
*Hypertension
*Stroke
*Obesity
*Infertility/Impotency
*Cancer
*Eye Problem
*Skin Problem
*Fibroid Tumor
*Ulcer
*Prostate Problem
*Asthma
*Weight Management
*Gonorrhea/Staphylococcus
*Candidie
*Low sperm can
*Weak erection
*Weak ejaculation
*Pile
*Elephantiasis
*Skin Infection
*Paralysis
*If you want your ex back.
*If you always have bad dreams.
*If you want to be promoted in your office.
For more information contact Dr.Worrior Africa via email:(drworriorafrca@gmail.com), you can also call him on his mobile number +2348112276982 or (WHAt'sapp)

jaklin steven said...


Anorexia nervosa often simply called anorexia — is an eating disorder characterized by an abnormally low body weight, intense

fear of gaining weight and a distorted perception of body weight. People with anorexia place a high value on controlling

their weight and shape, using extreme efforts that tend to significantly interfere with activities in their lives. We suggest

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Catlin Jacob said...

Good day to the whole wide world, with joy and happiness in my heart i want to share the wonderful healing i got from the great and powerful herbalist Called Dr Akuna, i have been having this unbearable Diabetes disease in my body since i was ten years old,over the years of growing up i have tried several medication, but all my efforts was to no avail,but i was happy when i came in contact with this powerful man through the internet, various people have testified about him on how he has cured various persons disease, on his email address:drakunasolutiontemple@gmail.com when i contacted him i believed he was going to cure me of my Diabetes disease,he told me not to worry that once i receive his herbal medicine i will be totally cured, and just as he has promised me i was indeed cure when i start using his herbal medicine in 2 week, i went to the hospital and was confirm negative. so you can also contact him today,he is able to cure any type of disease, contact him on his mobile number:+2348154625070 or you can visit his website:http://drakunasolutiontem.wix.com/dr-akuna

Adam Walker said...

My name is Adam Walker, from USA, i am 45 years old, i started experiencing weak erection and premature ejaculation for the past 6 years, for this reason i have to separate from my wife because i wasn't satisfying her in bed and we always had issues every now and then, i tries to search for a solution i could not find, i went various hospital but all was up to no avail, so luckily for me i came across a man named GREAT PAPA , i contacted him through his email: greatpapax@gmail.com ,Email:greatpapax@gmail.com and i also had his whatssap +2348106431263, so i told him what has been going on with me and he said he could help me, i thought it was joke, so i gave him a try and to God who made me, he cured me with his herbal herpes, he made me a full man again, i was so active, i can now perform stronger and better than before, i got my wife back again, his product has no side effect. he cast the spell ask follows:
Low sperm count
Love spell
Herpes spell
HIV spell
Pregnancy spell
Marriage for spell
cancer
watering sperm
womb fertilization
penis erection
witch craft attack
s t d diseases
internal heat
rashes
low sperm count
dairy
long time sickness
kidney,heart,lungs,problem
with doctor,PAPA you are in safe hands your healing is assured
Email:greatpapax@gmail.com, whatssap +2348106431263
you can contact him also for any kind of disease
hiv/aids
cardiac problem

Adam Walker said...

My name is Adam Walker, from USA, i am 45 years old, i started experiencing weak erection and premature ejaculation for the past 6 years, for this reason i have to separate from my wife because i wasn't satisfying her in bed and we always had issues every now and then, i tries to search for a solution i could not find, i went various hospital but all was up to no avail, so luckily for me i came across a man named GREAT PAPA , i contacted him through his email: greatpapax@gmail.com ,Email:greatpapax@gmail.com and i also had his whatssap +2348106431263, so i told him what has been going on with me and he said he could help me, i thought it was joke, so i gave him a try and to God who made me, he cured me with his herbal herpes, he made me a full man again, i was so active, i can now perform stronger and better than before, i got my wife back again, his product has no side effect. he cast the spell ask follows:
Low sperm count
Love spell
Herpes spell
HIV spell
Pregnancy spell
Marriage for spell
cancer
watering sperm
womb fertilization
penis erection
witch craft attack
s t d diseases
internal heat
rashes
low sperm count
dairy
long time sickness
kidney,heart,lungs,problem
with doctor,PAPA you are in safe hands your healing is assured
Email:greatpapax@gmail.com, whatssap +2348106431263
you can contact him also for any kind of disease
hiv/aids
cardiac problem

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About Me

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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

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Have any questions or comments about this blog? Feel free to email me at carrie@edbites.com



nour·ish: (v); to sustain with food or nutriment; supply with what is necessary for life, health, and growth; to cherish, foster, keep alive; to strengthen, build up, or promote



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