EATING DISORDER SERVICE


EFFECTS OF STARVATION

Anorexia Nervosa is only one condition which leads to starvation. For example, severe protein calorie malnutrition as seen in many developing nations is a cause, as is serious physical illness, for example for kinds of cancer.

It is important for you to realise that many of the symptoms you experience and many of the physical effects described in this handout are not specific to anorexia nervosa but occur in any condition leading to starvation. The practical importance of this is that many of these things and indeed many psychological symptoms you will hear about in therapy will disappear as you regain weight.

The physical effects of starvation will be considered under several different headings.

1)Metabolic and Endocrine Effects

Initially these effects are adaptive and really the body’s attempts to conserve body mass. Growth rate become slowed down and in pre-pubertal people puberty is delayed. Normally physical activity is also reduced but in anorexia nervosa psychological factors may over-ride this.

If starvation continues, these protective mechanisms are bypassed and serious illness, possibly even shortened life-span, may supervene. Your body tries to keep on adapting by changing the secretion rates of various hormones, for example insulin (secreted by the pancreas) and cortisol (secreted by adrenal glands). Your body starts using muscle as an energy source which contributes to the wasted, haggard appearance you have.

Your metabolic rate will fall which will make it increasingly difficult for you to lose weight. Your body will also be unable to make new proteins. Proteins are required to build up muscles and also carry various chemicals around the body. Amino-acids which are usually used to make protein are instead used to make glucose which your brain requires to keep on functioning.

Later on in the starvation process, serious loss of other important chemicals, for example calcium, potassium, sodium and magnesium occurs. This is likely to be the cause of the marked loss of calcium from your bones. Patients with anorexia nervosa are as much at risk of osteoporosis as women in their 70’s and 80’s.

All the organs in your body do not shrink at the same rate. Your brain for example does not lose weight at all, but muscle, liver and gut all shrink very rapidly. The shrinkage in your gut means that you feel full even when you have eaten very little. Later on your kidneys and your heart may also start shrinking.

2)Responses of Heart and Kidney

In severe starvation the heart’s ability to pump blood round the body deteriorates. Blood pressure becomes low (leading to symptoms like dizziness, faintness) and the kidney’s ability to excrete acids and to filter out waste products becomes impaired.

3)Changes in Your Gut

As already mentioned, the whole of your gut, right from your gullet through to your rectum, will eventually shrink. The enzymes required to digest food normally become disrupted. Bacteria may grow rapidly in your small bowel leading to poor absorption of even the little food that you are managing to eat.

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4)Changes in the Immune System

The immune system is responsible for defending the body against things like bacteria, viruses and other illnesses. In starved people immunity is impaired, the ability of white blood cells to deal with invasive bacteria is lessened, the healing of wounds is grossly impaired and infection with unusual organisms, e.g. fungi, is much more common.

5)Regulation of Temperature

Metabolic rate is reduced. Hypothermia is common, partially due to hormonal changes, partially due to loss of fat and partially due to a resetting of the body’s thermostat which is in a part of your brain called hypothalamus.

6)Reproductive Changes

Amenorrhoea (cessation of periods) occurs in starved persons and fertility is reduced. If by chance the starved person manages to become pregnant there is an increased risk of miscarriage and also a great risk that any baby born will be growth restricted, under nourished and subsequently have impairment in their learning capacity in later life.

Physical Symptoms You Will Experience When You Starve

  • Tiredness
  • Feelings of coldness
  • Dry, cracked skin
  • Swelling of the ankles
  • Dizziness

Physical Signs

  • A thin, drawn face
  • Skin hanging in folds
  • Flaky skin
  • Pale, lucid skin
  • Low blood pressure
  • Low pulse
  • Low body temperature
  • Cold extremities

In severe cases there may also be signs of vitamin deficiency. These include osteomalacia (serious bone disease), anaemia, scurvy (bruises and bleeding), muscle tenderness and weakness, loss of sensation in hands and feet, heart failure, broken cracked lips, diarrhoea, fits and occasional dementia.

Obviously, many of the above symptoms can be very serious and threaten life. All are reversible, at least in the earlier stages. We have listed them in this handout not to depress or frighten you, but to give you the information you need to make an intelligent and responsible decision about your eating.

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