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Anorexia's Hidden Toll: The Heart Fails
Anorexia on the Rise
Unfortunately, anorexia nervosa is an increasing problem in children and young adults. Children with anxiety disorder may be at higher risk. It is often thought to affect mainly women, but young men, and men in general, are increasingly developing the disease. Early recognition and treatment are essential to prevent anorexia from becoming a chronic condition and minimize health risks. This is a disease with significant risks - death rates are estimated between 5-6 percent.
As in the case of my patient, the heart is one of the organs that is most vulnerable to anorexia.
Anorexia and the Heart
Here are four broad patterns in which the heart is affected with both short- and long-term exposure to 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 thin and weaken. The heart chambers then enlarge. The pumping function of the heart declines and with it, blood pressure falls. Organs that are very sensitive to blood pressure and blood flow such as the kidneys and liver then begin to fail. Fortunately with weight gain and replenishment of essential vitamins and minerals the heart muscle often recovers.
2. Abnormal heart rhythms. A number of abnormal heart rhythms can occur with anorexia. One is that the heart beats slowly, a pattern called bradycardia. This is a particular problem in people who have weak heart muscles. 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. 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.
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 body electrolytes such as sodium, potassium, and magnesium. The electrical aspects of the heart that create heartbeats are critically dependent on these electrolytes. When they fall, chaotic electrical patterns can develop in the lower heart chambers that result in cardiac arrest.
3. Loss of the autonomic regulation of the heart and blood vessels.Our bodies do a lot of things that we are 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.
4. Mitral valve prolapse.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 the structure of the heart valve can affect the closing of the valve. The mitral valve then can close less tightly and prolapse into the upper heart chamber. In people with anorexia about 20 percent will have mitral valve prolapse. Unfortunately, the heart valve condition appears to persist even after weight gain.
I am seeing more patients with anorexia in my clinic. To a physician, low body weight and in particular the pattern of muscle loss are noticeable signs. Most of my 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 weight loss goals they hope to attain. More recently, I have encountered a surge in 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 prescription laxatives and diuretics, and can lead to severe mineral and electrolyte depletion and significant weight loss.
How Do You Know It's Anorexia Nervosa?
According to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the diagnosis of anorexia nervosa depends on each of the following criteria:
- 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.
- 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 restriction, etc.
- A distorted personal perception of your body shape, weight, and characteristics that results in a negative influence on your self-worth or results in a denial of being underweight.
There are two general forms of anorexia nervosa. These are determined by patterns of behavior or symptoms over a 3-month period.
- A pattern of restricting intake that results in significant weight loss through dieting, fasting, and/or excessive exercise.
- A pattern of binge eating and purging characterized by episodes of binge eating and purging. Purging can be through vomiting, or inappropriate use of diuretics, enemas, or laxatives.
When to Contact Your 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. Remember that one of the attributes of anorexia is the inability to recognize the problem in yourself despite being severely underweight.
In writing this column, I can’t help but think whether something could have been done to help my patient 10 to 20 years earlier, before anorexia had destroyed her body. When she died, we lost an amazing person. I hope as a society we won’t lose any more to anorexia.
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