Anorexia nervosa is a potentially life-threatening disease characterized by an extreme pathological desire to lose weight and a compulsive preoccupation with eating and body image. In the past, it was customary to categorize it as a disease of mental origin, with a genetic predisposition, but recent studies indicate that there may also be physical and metabolic factors that contribute to the development of the disease in certain people and not in others.
After a long struggle with anorexia: Karin Bowman passed away
There are two subtypes of anorexia nervosa:
One – restrictive anorexia, in which the patient will limit the amount of calories eaten, by eating very little.
The second – the bulimic anorexia, in which in addition to restricting food, the patient will experience episodes of binge eating and vomiting alternately.
The disease is especially common in women, and in particular among adolescent or young women. It is characterized by trying to maintain an extremely low body weight, by eating very little, exercising very quickly, or a combination of both.
With proper treatment, it is possible to cure the disease in about 46% of patients, but a disease that deteriorates may end in death, with a chance of about 5%.
How do we recognize anorexia?
There are several criteria for identifying anorexia. The first of which is a drastic weight loss, of over 15% of normal body weight.
This condition, which lasts for more than three months, may also manifest itself in hair loss, dry skin, broken nails and the cessation of menstruation in women.
In most patients, it is possible to notice an excessive preoccupation with food and rituals surrounding it: taking the chewed food out of the mouth, preparing meals for others and refusing to taste them, and obsessive food purchasing.
At this stage, they may also experience a poor and distorted body image that perceives the body as fat even when it is not fat at all, and is sometimes expressed by wearing large clothes that will hide the body, a real fear of gaining weight after eating something small and the beginning of hiding behavior: throwing the food in the trash, sometimes vomiting or any behavior to hide the amount of food that was actually eaten.
Untreated anorexia can lead to a variety of long-term effects:
Menstrual problems and problems getting pregnant
Hormonal problems, such as damage to the thyroid gland
A decrease in constant body temperature
Damage to bone density
Constipation and intestinal problems
Low blood pressure
low heart rate
Heart problems, such as heart rhythm disorders
Depression and suicidal thoughts
To understand how the disease can progress to death, it is important to understand the three stages of starvation:
The body recognizes a state of hunger when we have not eaten for more than four consecutive hours during the day when we are active. At night the body knows it is fasting time. In the first stage, the body will use up the glycogen stores in the body. These are the same long glucose chains that are stored in the liver and muscles for short periods of hunger. They will be enough for the body for a day, and will be secreted directly into the brain. The brain’s fuel is glucose, so the body will prioritize brain maintenance throughout the starvation, over non-essential functions in the body. At the same time, the body will learn to make glucose from other substances in the body: proteins that it perceives as non-essential, such as those in the muscles, skin and hair, and fats, if it is provided with these. In such a situation, the body breaks down those proteins and fats and produces glucose from them.
In the second stage, after about three weeks without a proper supply of calories, the body will undergo change and adaptation – adjustment to the new situation, and will slow down the rate of the body’s metabolism, in order to preserve the little energy the body receives. The meaning of this situation is that if before we needed 1500 calories, let’s say, to maintain the body in a state of rest, just for breathing, kidney, heart and brain activity, now if we go back to eating as before the starvation, we will gain weight, because the body has learned to be more efficient and spend less calories. At this stage, the body will also switch to another fuel for the brain – ketone bodies, when the liver will break down fats into ketone bodies, which will be used for energy and fuel for the brain. This stage can last months or even years – depending on the degree of starvation and the body’s functioning, and at this stage there will be a significant loss of weight and fat stores.
This is a phase experienced by most of those who have lost weight after diets, that when they return to eating normally, they will experience weight gain, beyond what they had before, since the metabolism has slowed down and the body has learned to work more efficiently, with less food.
In the third and extreme stage, the fat reserves will also be completely depleted and the body will also have to break down essential proteins to maintain brain and body activity, then it will break down the proteins in the heart, liver, and other organs in the body and system collapse and death will result. Anorexic patients who reach this stage will be hospitalized and given an infusion.
The treatment of anorexia is important and it includes the treatment of dietitians and mental therapy. It is important to pay attention to the disease in the initial stages to avoid suffering and long-term damage to the patient.
The author is a clinical dietitian and consultant for the Herbalife company