Here’s a sad story about the secret cost of Anorexia to your heart.
She was admitted to the intensive care unit because her heart, liver, and kidneys had failed. She was on a ventilator so they communicated by writing questions and answers on a clipboard.
The patient weighed less than 80 pounds despite being nearly 6 feet tall. Her skin was thin and tight and just outlined her skeleton. Her hair was almost all gone.
When she was younger she had been a beautiful model. Looking at her modeling pictures, the person looking back from the pages was so different from the frail woman lying in that hospital bed.
The only outward attribute that seemed to link the past and the present were her light blue eyes that sparkled when she smiled.
The disease that ravaged her body was anorexia nervosa. A few months later, the young Doctor had the privilege of caring for her as she died.
In the case of this young woman, anorexia led to heart failure, which in turn led to both liver and kidney failure.
Unfortunately, anorexia nervosa is an increasing problem in children and young adults. Children with an anxiety disorder may be at higher risk.
But it’s not just a “woman’s problem.” Men, even young men, are increasingly developing this disease.
And, make no mistake, it IS a disease, just like Multiple Sclerosis, Parkinson’s. etc.
It’s becoming a chronic condition with significant risks attached. Early recognition and treatment are essential. Current death rates from Anorexia are above 5% of the population…and that doesn’t even take into consideration other diseases such as Bulimia, Bingeing Disorders, etc.
This is a disease with significant risks – death rates are estimated between 5-6 percent.
As in the case of this patient, the heart is one of the organs that is most vulnerable to anorexia.
Here’s the secret cost of anorexia to your heart:
There are four broad patterns in which the heart is affected by both short-term and long-term anorexia nervosa:
1. Loss of heart muscle.
Just like the skeletal muscles in your arms and legs that you can see, the heart muscle loses mass.
➡ In patients with longstanding anorexia, the heart walls become thin and weaken.
Because of that, the pumping function of the heart declines, causing the blood pressure to fall.
➡ Next, the organs that are very sensitive to blood pressure and blood flow, such as the kidneys and liver, begin to fail.
Fortunately for some, with weight gain and replenishment of essential vitamins and minerals, the heart muscle often recovers.
For others, it’s too late.
2. Abnormal heart rhythms.
A number of abnormal heart rhythms can occur with anorexia.
➡ One of them, called bradycardia, means that the heart beats slowly. This is a particular problem in people who have weak heart muscles, such as anorexics.
Normally if the heart function weakens and less blood is pumped with each beat, the heart has to increase the number of beats per minute to maintain the same average blood flow.
BUT, with anorexia, if the energy stores in the heart are so depleted that the heart rhythm cannot increase to compensate for a weakened heart failure, blood pressure falls more quickly and organ failure develops rapidly.
➡ In the alternative, another concern is fast abnormal heart rhythms.
People tend to be most sensitive to these types of rhythms if they follow a pattern of binge eating and purging.
➡ This can result in dangerous shifts and loss of essential body electrolytes such as sodium, potassium, and magnesium.
The electrical aspects of the heart that create heartbeats are critically dependent on these electrolytes.
➡ When the electrolyte levels fall, chaotic electrical patterns can develop in the lower heart chambers that result in cardiac arrest. The heat literally stops.
It’s estimated that 20% of sudden deaths in the young adult could be due to myocarditis. That is an inflammation of the heart muscle, (the myocardium).
➡ Myocarditis cannot only affect your heart muscle but also your heart’s electrical system, reducing your heart’s ability to pump and causing rapid or abnormal heart rhythms (arrhythmias).
4. Loss of the autonomic regulation of the heart and blood vessels.
The autonomic nervous system is a control system that acts largely unconsciously and regulates bodily functions such as the heart rate.
Our bodies do a lot of things that we’re unaware of to help us function.
For example, the simple act of sitting or standing requires multiple complex changes in the body.
➡ Among these are constricting of the blood vessels to raise blood pressure, and a subtle elevation of the heart rate and contractility of the heart.
➡ In people with anorexia, these reflexes can be impaired or lost. This can result in profound drops in blood pressure when attempting to sit, stand, or walk.
➡ People with anorexia can experience severe lightheadedness, fainting spells, and even cognitive changes.
The heart valve between the upper and lower chambers on the left side of the heart is called the mitral valve. It closes when the lower heart chamber contracts to pump blood throughout the body.
➡ The changes in the heart muscle mass compared to the structure of the heart valve can affect the closing of the valve.
➡ The valve will not be able to close tightly, and it will fall into the upper heart chamber.
➡ In people with anorexia, about 20% will have mitral valve prolapse.
➡ Unfortunately, the heart valve condition appears to persist even after they regain the weight.
To a physician, low body weight and in particular the pattern of muscle loss, are noticeable warning signs.
➡ Most patients with anorexia eat a low to low-normal calorie content in a day but then exercise excessively.
➡ Despite being very underweight they still discuss the weight loss goals they hope to attain.
More recently, we are seeing a substantial increase in the misuse of “natural” therapies to cleanse or purge the colon or work as a diuretic.
These therapies are every bit as dangerous when misused as laxatives and diuretics, and can lead to severe mineral and electrolyte depletion, significant weight loss and death.
So, how do you know it’s Anorexia Nervosa?
According to the American Psychiatric Association’s Diagnostic and Statistical Manual, the diagnosis of anorexia nervosa depends on each of the following criteria:
1. An intentional restriction of calories, food, or energy intake to obtain a low body weight, which is defined as a body mass index, less than 18.5.
2. An intense fear of becoming fat or gaining weight, or a behavior that prevents normal weight gain, despite being underweight, such as excessive exercise, food restrictions, etc.
There are two general forms of anorexia nervosa. These are determined by patterns of behavior or symptoms over a 3-month period.
1. A pattern of restricting intake that results in significant weight loss through dieting, fasting, and/or excessive exercise.
2. A pattern of binge eating and purging.
Purging can be through vomiting, or inappropriate use of diuretics, enemas, or laxatives.
When to Contact A Physician
If these patterns characterize you, or if you know somebody that has anorexia, please contact your physician. There are many ways to help and treat anorexia.
The first step is to recognize it.
I hope that as a society, through a continual stream of education, we won’t lose any more people to anorexia.
And the first step starts with us.