Eating Disorders - fieldi

Medical Aspects of Anorexia and Bulimia 11
in young men with anorexia. The osteoporosis of anorexia is typically
most severe in the lumbar spine. This can lead to painful fractures,
preclude impact exercise (such as jogging), and lead to vertebral
compression fractures, which create a stooped posture. Unfortunately,
even women who recover fully from anorexia may be left
with irreversible osteoporosis. Although low estrogen levels may
contribute to the bone loss of anorexia, hormone replacement therapy
has not been demonstrated to be of protective value. Nor do the
medications that benefit postmenopausal osteoporosis appear to
help. The only remedy of proven effectiveness at this time is rapid
restoration of weight until menstrual function resumes (Grinspoon,
Herzog, and Klibanski 1997).
The tolls of anorexia on the heart are especially dangerous. The
body burns muscle to provide fuel as starvation progresses. Heart
muscles, like those in the arms and legs, become smaller and weaker.
Blood pressure falls, heart rate slows, and the mitral valve may prolapse.
To protect vital core organs, the heart reduces circulation to
the periphery, visible as acrocyanosis, the bluish-purplish discoloration
of the fingers and toes seen in many anorexics, especially in
the cold. Cardiac impairment also limits the ability of the heart to
increase oxygen delivery to the tissues in response to exercise.
Because of this, continued exercise in underweight patients is especially
dangerous. Even at rest, however, low weight anorexics are at
risk of irregular heart rhythms that can lead to sudden death (Cooke
and Chambers 1995).
Anorexia also causes loss of brain tissue, documented by x-ray
studies using both Computer-Aided Tomography (CAT scans) and
Magnetic Resonance Imaging (MRIs). Cognitive testing shows
associated impairment in thought processes. These changes may be
subtle, especially initially. With recovery, brain mass appears to
improve, at least partially (Swayze et al. 1996).
Stomach function is impaired by anorexia. There is a stomach
emptying delay, so food may “sit there,” as it often feels to patients
(Kamal et al. 1991). Liquids are more readily digested than solids,
and frequent small portions are better tolerated than large meals.
Stomach function corrects after months of improved intake, but
medication to promote stomach emptying may be useful temporarily
if symptoms are severe.