Anorexia and Bulimia: The Side Effects
by Emma Leigh
Health Consequences of Eating Disorders
My third take home message:
> Eating disorders are bad for your health<
The degree of harm an eating disorder causes is related to the type of disorder, the duration & life stage over which it develops and the severity of the experience. It goes without saying that the more severe the disease, and the longer the time course, the worse the consequences. With regards to the life stage of the individual – this relates back to the organ system affected. For example, a younger person with AN/BN can have serious consequences for growth, bone mass, and brain development, where someone older may be more at risk for suicide or heart disease. Due to this variability in impact it is hard create a list that fits everyone without reeling out pages worth of material… but I shall attempt to summarize the main points….
Anorexia:
GENERAL STATE OF APPEARANCE AND ENERGY –
Deprive yourself of nutrients and you are going to end up feeling /looking like crud. This includes:
- Muscle wasting and overall weakness
- Dry hair, hair loss, dry and discoloured skin
- Altered thermoregulation resulting in intolerance to cold (especially in the hands and feet) and growth of a layer of hair called lanugo (you know that ‘fluff’ that covers babies) in an attempt to keep the body warm.
CARDIAC -
- Bradycardia (slow heart rate)
- Loss of muscle in the heart – caused by your body breaking down the heart muscle for energy. This can damage muscle tissue and alter the ability of it to pump correctly
- Low blood pressure (due to a combination of dehydration and weak heart muscle)
- Rhythm disturbance (especially if the person involved is abusing laxatives) due to abnormalities in electrolytes critical for electrical pathways of the heart – this is most notably potassium, calcium, magnesium, and phosphate.
- These can result in sudden cardiac death (one of the most common medical cause of death in severe anorexia)
- Cholesterol levels tend to rise due to alterations in cortisol and thyroid hormones
RENAL -
- Severe dehydration – which can lead to kidney failure
- Renal stones
- Dysregulation of antidiuretic hormone secretion (ADH) and alterations in electrolytes
- Hypokalaemic nephropathy (kidney disease/damage)
GASTROINTESNTIAL -
- Slow digestion & constipation caused by decrease energy, decreased bulk in the intestines, and laxative abuse (too much information: can be so severe that people have to ‘manually evacuate’ daily – I’ll leave out the details)
- Decreased digestive enzymes causing bloating and irritable bowel symptoms
- Severe and rapid weight loss can result in gall stones
HAEMATOLOGICAL -
- Anaemia due to malnutrition and lack protein, iron and B-vitamins (at a rate up near 40%) - Decreased immunity due to decreased white cell production
- Decreased bone marrow turn over, platelet abnormalities and an increased risk of bleeding
NEUROLOGICAL –
- Decreased concentration, decreased ability to learn new tasks, decreased reason, altered sleep patterns
- Neuropathy can also occur in extreme cases. This is due to loss of essential vitamins/minerals, external compression from being too bony
- Fainting and fitting if a person has electrolyte disturbances and/ or hypoglycaemia
- Loss of brain tissue due to the stripping of myelin and nutrients from neural tissue (eg: choline).
- Some of these may also be IRREVERSIBLE changes.
MUSCULOSKELETAL -
- Muscle loss (obviously)
- Stunted growth in younger individuals
- Decreased ability to heal connective tissue, increased rate of injury, and a prolonged recovery when injuries occur
- Stress fractures are often seen in those who are ‘athletic’ due to repeated trauma to weak bones.
- The impact of malnutrition and hormone changes (low oestrogen/testosterone, high cortisol, low (active) growth hormone, and changes in DHEA (a adrenal sex hormone)) mean 90% of sufferers end having osteopenia or osteoporosis, and 40-45% having actual osteoporosis.
- This is most severe in adolescents with up to 60-65% of girls failing to reach peak bone mass.
- Importantly – weight gain may not reverse these effects – and the longer the disorder lasts, the more likely the loss will be permanent
HORMONAL –
- There are major changes to many important hormone pathways in the body. I will go into some of these in more detail below… But to touch on them now – the most worrying result from alterations in the HP axis (hypothalamic-pituitary axis) and this includes:
- Reproductive hormones decrease (decreased FSH and LH) – lowering oestrogen, testosterone, and progesterone – all of which are important for correct growth, bones, heart tissue, joints, vasculature and a myriad of other things
- High GH & low IGF-1 – resulting in stunted growth, and dysglycaemia and metabolic abnormalities
- Lower TSH and Free T4/ T3 – which results in lower metabolism and energy conservation
- High Cortisol – a stress response altering healing, vascular integrity, gastrointestinal function, immunity, glycaemic control and many other things
REPRODUCTIVE –
- Delayed puberty
- Low libido and lack of erectile function in males
- Menstrual abnormalities in females (note: if a person’s hypothalamic-pituitary-gonadal axis is fragile this can lead to years of fertility issues. Up to 25% never regain normal menstruation)
- Disruption to normal pregnancy > with increased risk of complications such as miscarriage, caesarean, premature birth, low birth weight, & smaller head-circumference
Bulimia:
Some of the specific health issues related to binge/purge activity include:
- Electrolyte imbalances – which can lead to things like arrhythmia, heart failure and death.
- Gastrointestinal concerns such as oesophageal tears, gastric rupture, reflux, stomach ulcers
- Tooth decay and staining from stomach acids released during frequent vomiting.
- Facial swelling – so called “chipmunk cheeks” due to acids in the salivary glands. You can also get stones in the salivary ducts
- Pancreatitis
- Chronic constipation and irritable bowel concerns as a result of laxative abuse
Sounds fun, yes?
Of course, for both of these diseases, there is also: Death… As mentioned above – both diseases have death rates of up to 20%. Causes include heart disease, overwhelming infection, and organ failure. Suicide is also very high. There is a greater risk of death in those with:
- Younger onset, late diagnosis & severely low weight at the time of starting treatment
- Having an accompanying severe psychological disorder or personality disorder
- Previously being obese
- Being male (may be due to the fact that men tend to be diagnosed with anorexia later than women)
- Poor social supports (e.g.: poor family/ dysfunctional marriage )
- Chronic disease (the longer it lasts, the more at risk you are of dying)
Psychological and Social Impacts
Ok… enough with the take home messages… And I am not going to discuss this area in detail – simply because the more I talk, the deeper it will go – and this topic deserves an article in its own right…
As mentioned – There are often associated with other co-existing psychiatric disorders, particularly mood disorders. The role of ‘pre-morbid personality’ has a lot to do with this. For example – Bulimia nervosa, as it is seen more in those with Cluster A traits (impulsivity etc), is particularly associated with alcohol and/or drug abuse problems. Anorexia, more common in those with ‘cluster B’ traits (perfectionism, dependence etc) often presents with co-morbid anxiety disorders, depression and obsessive-compulsive disorder.
Psychological impact cannot be understated – these diseases often results in chronic low mood, feelings of guilt, and frustration, and can go so far as to cause the degradation of an individual’s entire identity. This is especially the case in adolescents – who essentially ‘grow up’ as their ‘eating disorder’ and, as such, they often have significant issues with discovering ‘what they are’ when they are not ‘Anorexia’.
Both diseases will also impact markedly on their global social functioning – Causing issues with interpersonal relationships, and job performance… And although most sufferers tend to be highly functioning – and can ‘maintain’ their social functioning for many years of the disease, there is a gradual deterioration that can often leave them in sudden psychosocial crisis when they do finally ‘hit that wall’.
Impact on Fitness & Performance
So now that the ‘general health’ impacts have been touched on… We can get onto some of the specifics regarding the impact of these things in the athlete (and alter – the impact on those who just want to look athletic).
To start with – it goes without saying that being involved in the athletic industry immediately puts an individual at a significantly higher risk for developing these diseases with both males and females feeling the pressure to achieve ‘perfection’. Some figures quote numbers as high as 60% of those involved in sports being impacted. This is especially for those that need a competitor to ‘hit a weight’ or ‘look a way’ (gymnastics, wrestling, bodybuilding, rowing, and dancers). Interesting to note – there is also a greater risk associated with anaerobic sports rather than aerobic sports.
Females in the industry are at risk of what is known as the ‘Female Athlete Triad’ which is a fancy name for the combination of ‘disordered eating’, osteoporosis and amenorrhea… It actually used to be the case that in some circles/sports, it was thought a female was not ‘training hard enough’ unless she suffered from amenorrhea. Luckily, this has changed, because we now know that the impact of amenorrhea on bone health is significant and needs to be addressed to prevent consequences such as osteoporosis. The impact on menstruation was originally thought to be related to weight/body fat alone – but it is now recognized that there are many other factors that come into play with more evidence pointing toward the overall ‘energy balance’ of the individual. In fact, some state that no matter how hard a female trains if she is ‘eating enough’ to combat the energy output she *should* remain ‘intact’ in a hormonal sense. The evidence is not convincing either way – many variables and confounders make it difficult to fully assess. And although it is often seen in those not fully ‘categorized’ with AN/BN (disordered eating) it is noted more frequent in Anorexia than Bulimia.
Moving on and getting back to the impact on performance – It is no surprise that those suffering with eating disorders/disordered eating while trying to maintain athletic output will eventually face consequences in regards to their performance. I will not dwell excessively here (it really a ‘no brainer’), but the malnutrition/inadequate energy, and disturbances to hydration and electrolytes that these individuals suffer will eventually results in the following:
- increased fatigue/ decreased endurance,
- decreased power/ strength/ speed,
- decreased co-ordination and reaction time,
- altered thermoregulation with increased risk of hyperthermia, muscle cramping,
- increased risk of injury (both due to increased fatigue and decreased judgment but also due to decreased recovery rates and increased propensity to overtraining)
To read comments or to leave a comment click here
–
Feature Product: If looking for a program to help aid recovery for AN or Bulimia check out the Metabolic Repair Manual as part of The Fat Loss Troubleshoot program.
Comments
Trackbacks