What are the consequences of anorexia?

Introduction

People with anorexia have a high risk of causing permanent damage to their body and psyche due to the lack of nutritional supply and the mental impairment of their disease. This risk increases with the length of time that anorexia remains untreated. Many of these consequences of the disease become visible when they affect the physical appearance, whereas the psychological effects of anorexia remain undiscovered for a long time.

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Hair loss is a common symptom of anorexia, which is caused by the long-term undersupply of essential nutrients. Although this is a rather cosmetic problem, it is a great burden for those affected.

Skin and nails also suffer from the lack of vitamins and trace elements. The reason for this is the constant renewal of these cells, which requires a lot of energy and special nutrients. If these building materials are missing, the hair becomes thinner and eventually falls out, the skin becomes pale and thin and the nails become brittle.

The affected persons look sickly and are more and more attracted to their unhealthy appearance. It is often only these aesthetic problems that lead them to the doctor. Fortunately, in most cases the hair loss is reversible, if sufficient nutrition is restored.

Then the hair grows back and the skin and nails recover. Food supplements can be used to accelerate the regeneration. Most patients with anorexia are women.

Besides hair loss and other aesthetic consequences of their disease, they also suffer from irregularities in their menstrual cycle. Because if the female body loses too much fat, hormone production decreases drastically. This is partly due to the “energy-saving mode” into which the body is placed, which is not enough to supply the most vital organs, and partly to the loss of the fat cells themselves, which like the ovaries can produce estrogen.

Those affected therefore have a lack of female sex hormones, which can no longer regulate the cycle sufficiently. This leads to cycle disorders, ovulation does not occur and the woman has no menstrual period. Consequently, she cannot become pregnant.

This is because the absence of menstruation and the resulting infertility is a protective mechanism of the body to prevent the woman in this physically weakened state from becoming pregnant. If malnutrition persists for too long, the hormone cycle can remain permanently impaired and, in the worst case, lead to persistent infertility. Some women therefore need the help of specialists to become pregnant after a long period of anorexia.

Constipation is also often found as a side effect of anorexia. This is because the intestine only works properly when it is full, which is mainly due to dietary fibre. If the stimulus is missing due to insufficient food intake, the intestine becomes sluggish and hardly moves at all.

The small masses of stool often remain in the gastrointestinal tract for days, which can be accompanied by pain and a bloated stomach. This can also be visually disturbing. The frequent shivering in anorexic patients is not due to a lack of insulation from body fat, as one would initially assume.

It is the metabolism, which is shut down by the lack of nutrients, that is to blame. The body is, so to speak, in “energy saving mode” and temperature regulation is disturbed. Maintaining body temperature costs energy, which is simply lacking in anorexia.

The heat is limited to the vital internal organs, which is why the rest of the body quickly cools down and those affected easily freeze. The bones are also subject to constant build-up and breakdown in order to adapt to the stress of the body. For this they need above all calcium and vitamin D, which must be supplied with food.

In women, estrogen production also plays an important role, inhibiting the breakdown of bone and stimulating its formation. In anorexia, too few nutrients are taken in on the one hand, and on the other hand significantly less hormones are produced, which is why the risk of osteoporosis increases, especially in women. Bone fractures and deformations are the result.The cells of the skin, like hair and nails, are subject to a continuous cycle of regeneration to protect the body from the environment.

This requires various nutrients and energy, which are not available in sufficient quantities in anorexia. Especially important in this context are vitamin B12, folic acid and iron, which are essential for the regeneration of all cells. A deficiency of these substances therefore makes the skin dry, flaky and sallow, wounds heal very slowly and the dwindling elasticity makes the skin look significantly older.

The breakdown of subcutaneous fatty tissue also causes veins and tendons to become more prominent, and the skin shimmers bluish in some areas. In places where the skin has become particularly thin, so-called lanugo hair can also appear, a remnant of embryonic development. It sits on the skin of the foetus like a fuzz, is supposed to protect it from heat and cold and can reappear in anorexic patients.

If the affected person puts on weight again and receives all the important nutrients, the damage usually recedes. The brain is the most important organ of our body and is therefore best supplied. However, it is dependent on a sufficient supply of carbohydrates, as it cannot rely on body fat for energy production.

If the necessary supply of carbohydrates is not available over a longer period of time, the metabolic processes and thus the performance of the brain decrease and cognitive limitations such as concentration problems occur. In addition, persistent anorexia leads to the breakdown of nerve cells and a shrinking of the brain. In adults, this damage is at least partially reduced as soon as a sufficient supply of nutrients is restored.

However, if the disease affects children and adolescents in whom brain development is not yet complete, some areas of the brain may remain permanently impaired. Especially the amygdala as the central circuitry of emotions and the hippocampus as the integration point for memory and learning are affected. This results in a high susceptibility to depression and other psychiatric diseases.

For the kidneys to work properly, they need a constant supply of electrolytes such as sodium, potassium and other charged particles (ions). This enables the kidneys to concentrate the urine and excrete harmful substances. If these electrolytes are missing, kidney function is restricted, water is stored in the tissue and pollutants such as uric acid are only excreted inefficiently.

The resulting high level of uric acid damages the kidney tissue and can deposit in the form of crystals in joints, causing pain in the form of gout. In addition, hormones are produced in the kidney, which are important for bone metabolism and blood formation, and are consequently reduced in anorexic patients. Damage to the kidney can therefore lead to bone problems and anaemia.

Unfortunately, the kidneys are very sensitive organs that often do not regenerate completely. Anorexia therefore often results in chronic renal insufficiency. The adrenal glands, small organs that are located on top of the kidneys and produce vital hormones such as cortisol, are also damaged by the lack of nutrients.

After many years of anorexia, patients can therefore be dependent on taking these hormones if their own body no longer produces them in sufficient quantities. If the body switches to low levels due to a lack of nutrients, the heart rate slows down and blood pressure drops. As a result, those affected are quickly tired, hardly able to perform and lose their breath even at the slightest exertion.

In addition, the electrolyte disorders described above not only affect the kidneys, but also the heart. The individual heart muscle cells are dependent on a balanced electrolyte concentration in order to be properly activated and to contract simultaneously. If an electrolyte imbalance occurs, the heart cannot beat properly and cardiac arrhythmia occurs, which can be potentially life-threatening.

A so-called pericardial effusion, i.e. an accumulation of fluid in the connective tissue around the heart, is also more common in anorexic patients. This is painful and can constrict the heart. If the eating disorder persists over a longer period of time, such damage to the heart often remains more or less pronounced, even if the person affected is eating normally again.The gastrointestinal tract suffers from the disease depending on the form of anorexia and the method of weight reduction.

The upper parts, e.g. the esophagus, are damaged especially in the case of forced vomiting in the context of bulimia, as the acid from the stomach attacks the mucous membrane. The consequences are inflammations, some of which heal scarred and leave narrow spots. These can cause problems again and again in the course of life.

In addition, the mucous membrane cells can degenerate due to the constant damage, i.e. develop malignant tumors. The lower parts of the gastrointestinal tract, i.e. the small and large intestine, are damaged because the cells are unable to regenerate properly due to the lack of nutrients, the stimulus from the passage of the supplied food is missing and the sensitive intestinal flora is disturbed. This leads to digestive problems and constipation, which can be very painful and distressing for the patient.

Especially the sensitive milieu of the intestinal flora regenerates itself only slowly, which is why problems in the gastrointestinal tract can persist for some time after a therapy. Anorexia is basically a mental illness. It is particularly common in people with an ambitious and performance-oriented character, who suffer from low self-esteem and for whom anorexia is a kind of feeling of power.

The food restriction gives the affected person a certain amount of control over their body that others do not have over them, and thus, in their view, sets them apart from the masses. In addition, the brain reacts (at least initially) with an increase in performance. This mechanism is intended to help them better survive upcoming lean periods and is based, among other things, on a dopamine release that plays a central role in the development of addiction.

At the onset of an anorexic disorder, the person therefore feels very good, almost intoxicated, and is encouraged to take action by biological mechanisms. These processes confirm the person’s belief that he or she is only worth something if he or she maintains anorexia. Over time, therefore, due to the ever-increasing pressure and physical degradation, many psychological stresses are added.

Depression in particular is frequently observed in anorexic patients. But the brain also suffers biologically from the reduced supply and decomposes, which leads to a loss of concentration and performance and changes in its nature. The psychological consequences of anorexia are therefore usually more serious than the physical ones.

A loss of libido is another typical consequence of malnutrition. In women, this is due, among other things, to hormonal imbalance, which prevents ovulation and the associated increase in libido. In men, the hormonal imbalance leads to a loss of potency. In addition, the psyche is an important factor, as patients usually feel uncomfortable and unattractive in their bodies. In addition, physical weakness as a direct consequence of the deficiency makes sexual intercourse more difficult.