Medicine / Internal Medicine

Eating disorders: Anorexia and Bulemia.
Matthew Vasey, MD
Editor, New York Journal of Style and Medicine

Eating disorders are a very serious and potentially deadly problem in today's culture. Without even looking to the literature I would suspect that nearly everyone reading this knows of someone affected by anorexia nervosa or bulemia, and perhaps have even battled or are battling an eating disorder personally. While there are specific features that lead to a clinical diagnosis of an eating disorder, anorexia nervosa in essence is starvation, whereas bulimia is binge eating followed by a purge of various means.

With this website's attention to an industry where eating disorders may be assumed far more prevalent than that of its viewing audience the purpose of this is not to pass judgment, rather to provide information on the impact a disorder may have on one's body. A relationship one has with their body is personal. Each and everyone has a right to weigh risks and benefits, and make an educated decision based on their particular cicumstance. Below is a systematic presentation of some ways an eating disorder may impact the human body.

Endocrine: Starvation affects the bodies' hormones of all types, including reproductive, metabolic and growth hormones. Circulating levels of blood sugar may become dangerously low. This can cause hypothermia, coma and death. If you will remember the Kreb's Cycle or Glycolysis from high school, sugar is turned in to ATP or energy. ATP, like fuel to a cellular engine keeps you warm among countless other vital functions.

Gastrointestinal: Severe purging episodes can lead to difficulty swallowing, bloody vomit, or rupture of the esophagus. A ruptured esophogus may drain into the cavity surrounding the heart causing a fatal process called mediastinitis. Binge vomiting after an extended period of starvation can cause a potentially fatal pancreatitis where enzymes that should digest food end up digesting your own body. Laxative abuse can lead to diarrhea, constipation, cramping and bloating. More concerningly, laxative abuse may cause the intestines to be paralyzed requiring a large surgery to remove it. Depending which area is paralyzed the intestine may be attached to a hole cut through the skin for a bag to be attached to the front of the torso in order to collect liquid stool.

Renal or Kidney: Abuse of water pills can loose important electrolytes needed for cellular activity, including sodium, potassium, magnesium and calcium.

Hematologic or Blood:  Poor dietary intake and absorption of blood clotting factors can lead to easy bruising and bleeding.

Respiratory or Lungs: Lungs become stiffer due to lack of a lubrication-like fluid called surfactant and more likely to collapse. Collapsed lungs can require a large tube to be cut through your chest to the area where the lung deflated. Since the diaphragm is a muscle and responsible for breathing normal breathing patterns are affected.

Cardiovascular or Heart and Vessels: Reduction of circulating blood volume can be due to either vomiting or reduced fluid intake. Drinking products to induce vomiting may lead to malfunction and destruction of heart muscle. Potentially fatal arrhythmias may result from electrolyte imbalances as well as EKG changes similarly to what you might find in a heart attack. Reflex-like activity of the blood vessels may malfunction causing someone to pass out upon standing.

Neurologic or Nerves: Numbness, weakness and tingling may result from nerve compression due to loss the protective cushion provided for by fat cells.

Musculoskeletal: Excessive exercise can kill muscle cells. Persistant aches, pains, weakness and rash-like symptoms can also result from drinking certain products to induce vomiting called a dermatomyositis-like syndrome. Osteoporosis and subsequent fracture is common, particularly stress fractures in obsessive exercisers.

Dermatologic or Skin: Repeated episodes of throwing up leads to teeth problems because of the acid found in the stomach. Bulemics in attempting to conceal their behavior can actually worsen things with aggressive brushing causing erosion and gingivitis. Glands inside the mouth can be enlarged. Repeated gagging can produce cuts and bruises in the mouth and callous formation on the hands. Hair and nails can become crunchy and easily breakable.

For more information please visit these recommended websites:

National Eating Disorders Association
www.nationaleatingdisorders.org

The Renfrew Foundation
www.renfrew.org

REFERENCES:

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Galetta F, Franzoni F, Cupisti A, et al: QT interval dispersion in young women with anorexia nervosa. J Pediatr 140:456, 2002.
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LaBan MM, Wilkins JC, Sackeyfio AH, Taylor RS: Osteoporotic stress fractures in anorexia nervosa. Arch Phys Med Rehabil 76;884, 1996.
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