Several physical complications are associated with anorexia nervosa and bulimia nervosa. Many of these problems are caused by behavior aimed toward controlling body weight in an unhealthy manner, and most of these problems resolve once eating habits and weight have returned to normal.
Effects of binge-purge behavior:
- Injury to the esophagus (the tube connecting the mouth and stomach) can result from repeated vomiting. Acid and bile from the stomach irritates and inflames the membrane that lines the esophagus causing a condition known as esophagitis, which is sometimes severe enough to cause scarring and narrowing. This passageway may become so narrow that it is difficult for food to pass through. The physical stress of vomiting can cause tears in the lining of the esophagus. These tears may bleed massively or cause the esophagus to rupture. This is a life-threatening condition that requires immediate surgery.
- Injury to the stomach may occur due to binge eating. Frequent vomiting commonly causes gastritis, an inflammation of the stomach lining. Also, eating a large meal very rapidly, combined with slower emptying of food from the stomach, on very rare occasions, may cause the stomach to rupture, causing death from peritonitis.
- Injury to the intestines, particularly the colon, commonly results from laxative abuse. Damage to the muscle and nerves causes loss of normal movement.
- Lung complications occur when self-induced vomiting leads to aspiration of food particles, gastric acid, and bacteria from the stomach into the lungs, producing pneumonia.
- Kidney and heart complications are often severe. Fasting, vomiting and other forms of purging result in loss of fluid and crucial minerals from the body. Chronic dehydration and low potassium levels can lead to kidney stones and even kidney failure. Frequent vomiting leads to high alkali levels in the blood and body tissues. This may cause weakness, constipation and fatigue. Severe alkalosis and potassium deficiency can lead to an uneven heart rate or sudden death.
- Injury to the skin occurs in various ways. Most over-the-counter laxatives contain phenolphthalein, which may cause sores in the skin and hyperpigmentation (brown or gray spots). Excessive and forceful vomiting may result in hemorrhages in the blood vessels in the eye.
- Injury to the teeth is quite common. Chronic vomiting increases the acidity of the mouth and results in erosion of the teeth's' enamel and dentin.
Laxatives may seem to move food through the body more rapidly and may relieve abdominal distention after bingeing, but they do not prevent the calories in the food from being absorbed. The temporary weight loss that is seen after using laxatives is mostly due to loss of water and minerals in the bowel movement, and will be naturally regained. Misuse of laxatives is harmful in several ways: they upset your body's mineral balance; they lead to dehydration; they damage the digestive tract lining; and they burn out your colon, so that you may experience severe constipation when you don't use them.
Diuretics, or water pills, increase urine excretion and can cause a sudden weight loss. A person who fails to distinguish between loss of body fat and loss of water may see this as a desirable effect and start using diuretics to lose weight. But because the only loss induced is water, the only gain is dehydration. In addition to causing dehydration, diuretics are also dangerous because they can increase the loss of calcium, potassium, magnesium, and zinc. They can also cause a rebound retention of salt and water, making your body more sensitive to diet changes.
Ipecac syrup, which is taken to induce vomiting, has been linked to deaths of several patients with eating disorders. Emetine, the active ingredient, can build up in tissue and cause muscle or heart weakness. Ipecac is toxic, whether taken as a single large dose or as small dose that can build up over time.
Diet pills are often taken to help with weight loss. The best-known prescription pills are Dexedrine and Benzedrine, but over-the-counter drugs are also misused. These reduce appetite, but only temporarily. Typically the appetite returns to normal after a week or two, the lost weight is regained, and the user then has the problem of trying to get off the drug without gaining more weight. Warning: these drugs are of little use in achieving and maintaining weight loss and can become dangerously addicting and cause abnormal heart rhythms that can be fatal.
Fad diets promise rapid weight loss but actually encourage unhealthy dietary habits. They prey on the dieter's wish for quick results with little effort or make the diet seem exciting because the types of combinations of foods consumed are different from those normally eaten. People are attracted to such diets because of the dramatic weight loss (mostly water) brought about within a few days. Unfortunately, such quick weight-loss schemes do not help the body lose fat or provide the nutrients that are required to keep the body in optimal health.
Starvation symptoms include:
- Preoccupation with food
- Impaired concentration
- Mood swings
- Sleep disturbance
- Social isolation
- Loss of control when food is available
- Depressed immune system
- Reduced energy expenditure
- Water retention
- Binge eating
- Fluid and mineral abnormalities
- Constipation due to low calories and fiber intake
- Slower emptying of food from the stomach, which can cause bloating and early satiety during a meal
- Modified sense of taste, leading to changes in appetite
- High cholesterol levels (This does not signify a cholesterol problem and does not warrant a low-cholesterol diet)
- Amenorrhea, related to overall malnutrition
The dieting cycle - You probably know someone who claims to have tried every diet known, but still can't lose excess weight. The fad diets have backfired and he or she is caught in the dieting cycle. For example, a woman may go on a quick weight-loss diet and boast of losing seven pounds in two days. However, at best she has lost a pound or two of fat and five or six pounds of water, muscle and minerals. When she stops her diet, her body retains the needed water and minerals. Weight lost as muscle is frequently regained as fat. Over time, her body is composed of less muscle and more fat, even if her weight remains unchanged. Since fat tissue requires less energy to maintain itself than does muscle tissue, her basal metabolic rate decreases and caloric needs actually become less - and she must eat even less in order to lose weight! This makes the next dieting cycle increasingly difficult. This "yo-yo" weight loss and gain that results from fad diets is very stressful for the body, which finds it hard to adjust to such rapid changes.
In addition to the physical stress, this dieting cycle is psychologically stressful, and often leads to alternate bingeing and fasting behavior. When the woman goes off her quick weight-loss diet and regains weight, she becomes depressed and feels that she has failed again. To ward off these feelings of depressions, she may overeat or binge. This is followed by feelings of guilt or remorse for having "lost control" and she again fasts to regain control or to punish herself and to lose weight. The cycle of fasting and bingeing continues, and a pattern of healthy eating and exercise is lost.
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