The Medical and Psychological Risks of Eating Disorders

Dr. Sacker joined us to discuss the medical risks of eating disorders (anorexia and bulimia), which range from hair loss, kidney failure, electrolyte imbalance, esophageal rupture, loss of menstrual period, to heart failure. He also commented on the problems that the audience shared, including how eating disorders affect fertility and pregnant women and problems with diet pills. What if you abused ipecac syrup, or abuse diuretics, or have been abusing laxatives?

To find out what these behaviors can result in, read the transcript below.

David Roberts is the HealthyPlace.com moderator.

The people in blue are audience members.

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David: Good Evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our topic tonight is "The Medical and Psychological Risks of Eating Disorders." Our guest is Dr. Ira Sacker, director of the Eating Disorders Program at Brookdale Medical Center and co-author of the book, Dying To Be Thin.

Dr. Sacker is also the founder of HEED, "Helping To End Eating Disorders," a support and information organization based in New York. Just so everyone knows, Dr. Sacker is a medical doctor and so he's well-qualified to speak to the medical complications involved in eating disorders.

Good evening, Dr. Sacker, and welcome to HealthyPlace.com. Thank you for joining us tonight. Am I right in assuming that most people do NOT die from an eating disorder, but are more likely to suffer from different medical complications as a result of having anorexia or bulimia?

Dr. Sacker: Yes and no. Up to 20% still die from the complications. Usually a death certificate won't read "death from anorexia." It will read something like "death from heart failure."

David: From emails I receive, I think many people are under the mistaken impression that the only real medical problem that results from anorexia or bulimia is malnutrition. But that's not true, is it?

Dr. Sacker: No, it is definitely not true.

David: Maybe you can talk a bit about the medical complications of anorexia.

Dr. Sacker: Okay. Some of the medical complications of anorexia include hair loss, kidney failure, electrolyte imbalance, esophageal rupture secondary to vomiting, and loss of menstrual period, resulting in possibilities of osteoporosis and infertility. There are also cardiac complications which can result in sudden death.

David: And what about medical complications of bulimia? (risks of bulimia)

Dr. Sacker: Additional complications include ruptured blood vessels in eyes, all of the cardiac and renal complications, as well as multiple ulcers of the esophagus and stomach.

David: If one starts engaging in disordered eating behaviors, how long does it take for medical complications to arise?

Dr. Sacker: That really depends on the individual.

David: On the average though, are we talking about a few weeks or a few months, or many months, even years before any serious medical complications arise?

Dr. Sacker: Certain complications, like hair loss and loss of menstrual period, may occur rather soon, but other complications such as osteoporosis or heart and kidney disease, may not been seen at first, therefore giving the person a false sense of health.

David: The reason I asked that question is that there are many people suffering from eating disorders who think "this will never happen to me."

Dr. Sacker: That is where they are mistaken. This is a very seductive and unforgiving illness. You think that you are in control initially, but then realize that you actually have no control at all.

David: We have a lot of audience questions, Dr. Sacker. Let's get to a few of those right now, and then I want to address some of the psychological complications resulting from eating disorders. Here's the first question:

ChristineCC: What causes the ruptured blood vessels in the eyes, Dr. Sacker? I have those.

Dr. Sacker: Purging causes increased pressure which can be transmitted to the chambers of the eye.

BurnhamBuggirl: How long can you go without a period before you are infertile?

Dr. Sacker: The earlier the diagnosis is made, and the earlier the malnutrition is corrected, the greater the chance of full recovery of fertility.

David: Can one become permanently infertile as a result of prolonged anorexia or bulimia?

Dr. Sacker: Yes, you certainly can.

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rleehunter: Can you help me understand why, after a 15 year battle with anorexia, and at 86 lbs., 64" tall, I am still bleeding so heavily each month, even ovulating (as surmised from lab tests)? It is baffling to me that my body would sacrifice the protein each month.

Dr. Sacker: You are one of the fortunate few. Take this as a sign from your body that it wants you to get the help you so desperately need.

Jus: You've talked a lot about the medical complications of anorexia , but what about if you are a bulimic who is restricting instead of bingeing and purging? Are there the same risks?

Dr. Sacker: If you are restricting, rather than bingeing and purging, then you are engaging in anorexic behavior.

David: Some of the medical problems we are discussing tonight are explained in some detail on the Peace, Love and Hope Eating Disorders site here at HealthyPlace.com

Jus: If you are not underweight, are there the same medical concerns?

Dr. Sacker: Absolutely the same medical risks.

David: What about the psychological problems that can result from having an eating disorder?

Dr. Sacker: Some of the psychological problems include depression, isolation, mood swings, suicidal ideation, social withdrawal, feelings of rejection, unworthiness, loneliness, and obsessive compulsive behavior.

David: Are some of these disorders, like depression or mood swings, a result of possibly a situation the person finds themselves in or is it because of an imbalance in the brain chemicals?

Dr. Sacker: Both. In most cases, it is a combination of the two.

David: So how does a person deal with that?

Dr. Sacker: The first step is admitting that there is a problem, then you must realize that eating disorders are not all about food. Once this is accomplished, you can slowly begin to process the emotions behind the behaviors.

David: A few site notes, then we'll continue.

Here's the link to the HealthyPlace.com Eating Disorders Community.

Also, some of you are asking about whether you have anorexia or bulimia. Here are the definitions of those two eating disorders:

• Anorexia information
• Bulimia information

Here's the next audience question:

JBee: I struggled with bulimia / bulimarexia for about 2 years. It's been about 5 months since I purged, but when I did, I heavily abused ipecac syrup - so much so that, eventually, it had no effect and would not always come up. Could this still be a problem?

Dr. Sacker: Ipecac syrup can KILL you! It contains emetine, which gets lodged in your heart and brain, and has led to numerous deaths. Please, please do not take ipecac syrup.

David: No one has mentioned this yet, but some people abuse diuretics, pills that cause fluid loss in the body. What impact can that have?

Dr. Sacker: Death... kidney failure, dialysis, and a total false sense of weight loss leading to severe dehydration.

David: And what is the impact of abusing laxatives on the body?

Dr. Sacker: Abusing laxatives can cause all of the above complications, as well as chronic constipation, obstruction of the colon, and ultimate rupture of the rectum.

wayout: Is it true that for people who have low metabolism rates, they have to eat more in order for them to lose weight? I mean, my doctor told me that I have to eat more in order to lose weight, because I screwed up my metabolism so much.

Dr. Sacker: When you decrease your caloric intake, your metabolism will slow down. You need to eat more not to LOSE more, you need to eat more to stay alive.

David: Dr. Sacker's website is here: http://www.sackermd.com

Here's the next audience question:

krissyl: Hi, my name is Krissy. I have an eating disorder. I eat nothing but lettuce. If I eat anything else, I throw it up. I see a therapist for depression and am going tomorrow with my mom. Neither one of them knows of my disorder. I'm scared if I tell them, they will make me eat. Help!

David: Krissy is 21 years old, by the way.

Dr. Sacker: I know it may be frightening, but you are putting yourself in a lot of danger. You need to find a therapist who you trust, and, in turn, tell them what you are doing to yourself. You cannot survive on lettuce alone. Please reach out for the help you need.

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David: I think this may be a good point in time to ask what happens when you initially see a doctor about an eating disorder. What is an exam likely to entail?

Dr. Sacker: A history of the illness, previous eating habits, your family structure, recent behavioral changes, and a complete physical exam including laboratory tests.

David: And here's some information on the basics of eating disorders psychotherapy. Now, we have a few audience comments regarding medical complications people suffered as a result of their eating disorder:

stormie: I had trouble carrying my babies to full-term because I allowed my body to gain weight.

Jus: I was restricting and blacked out while going up some stairs. I went face first into the concrete steps and lost half of my 2 front teeth. I also have some liver damage as a result.

Havenly: I have had a cardiac arrest due to an electrolyte imbalance--hypokalemia (a potassium level of 1.4). That resulted in severe edema and kidney failure. I still have my kidneys, but I still suffer from problems of edema. I want to get well, but I now have chronic tachycardia.

krissyl: I'm not sure if it is from my eating disorder but I am ALWAYS freezing, tired, bruised all the time, and lost my periods for 6 months.

babygumm: My stomach ruptured. I had to have emergency surgery.

SugarSpunSadness: I recently went into renal failure as a result of a chronic laxative addiction.

Dr. Sacker: Very often, people with eating disorders have a difficult time realizing the devastating effects it can have (eating disorder complications). These complications are not something to be proud of, but rather something to indicate that you desperately need to get help immediately.

David: What medical issues would require someone to be hospitalized?

Dr. Sacker: Unstable vital signs including irregular pulse rate, blood pressure problems, electrolyte imbalance, or severe malnutrition of over 15%.

Havenly: My sphincter muscle, at the bottom of my esophagus, is not working correctly. I have chronic heartburn and food automatically comes back up into my mouth. I have a 17-year history of purging behavior. I no longer purge so much. What can help the sphincter muscle to heal?

Dr. Sacker: First, you must stop the purging completely. This will alleviate some of your pain. You may need a GI evaluation and there are some new medications that have been proven effective.

David: Here are some more audience comments on the medical effects of eating disorders:

Sueszy: I have been abusing laxatives for years and purging. This caused severe dehydration! I now have edema and kidney failure. God if only I ate properly! That's all it would have taken!!!

David: Here's an audience comment on the earlier question about an initial exam for an eating disorder:

ktmcroo: They will take blood, weigh you, ask you a bunch of questions very bluntly and you will want to lie, but you have to fight the fear and shame and tell the truth. This is the first step to not being as ashamed and understanding your disease.

David: Thanks for that comment, ktmcroo. Here's a question on the psychological aspect of an eating disorder:

scarlet47: I'm one that believes nothing will become of my 82 lb. weight loss. I am 51 and have had anorexia for 4 years. I am seeking help weekly with a psychiatrist. I live on 500 calories a day and wonder if this will catch up with complications. I now weigh about 100 lbs., still have periods and energy. I seem to starve for self punishment. I can't relate to the young that starve for thinness; that's not me. I can't seem to believe that I could ever die from this painful illness.

Dr. Sacker: Unfortunately, you can die from this illness - anyone can. Self punishment is a major aspect of the disease. You need to ask yourself why you feel you need to be punished.

fawnberry: My sister was like me when she was younger. She used to starve herself to the same extent that I'm doing now... And now, years and years later, she's perfectly healthy. I think I'm healthy now and I don't think I'm going to get sick. Is it possible to have an eating disorder and never get any medical effects from it?

Dr. Sacker: It is possible, but I would not take this as a sign to continue your eating disorder behaviors.

SugarSpunSadness: How bad does anemia have to get before it can be life threatening? What are the threats to life?

Dr. Sacker: Anemia is also a major complication, and is the beginning of total bone marrow failure. This can result in death.

SugarSpunSadness: What is bone marrow failure? How long does it take?

Dr. Sacker: When your bone marrow stops making blood cells, it is known as bone marrow failure. No one knows when or if this will occur.

sarahwhite: What's the best way to build bones back up?

Dr. Sacker: You need to increase your caloric intake, and under a physician's care, the addition of vitamin D, calcium, and other hormonal supplements may be helpful.

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florencia: Which are the signs of lack of potassium?

Dr. Sacker: This is known as hypokalemia, and is one of the main reasons for cardiac irregularity and sudden death.

David: And what are the signs of a potassium problem?

Dr. Sacker: The signs are lightheadedness, dizziness, vertigo.

WM: Hello Dr Sacker. Your book, Dying to Be Thin, was very sensitive to the needs of both patient and parent. What are some of the most common misconceptions you see parents showing regarding their ill children?

Dr. Sacker: Blaming themselves, thinking that they can make everything all better, or blaming the individual for hurting them, or just trying to make them eat.

sandy6: How does one deal with strong denial?

Dr. Sacker: Generally, when you are in denial, a loved one will notice that there is a problem and intervene. This helps the sufferer to become aware that a problem really does exist.

cv terra: I am on paxil (Paroxetine) for eating disorders and I just went off it because I hate it, and I keep falling and passing out, and I don't know what to do.

Dr. Sacker: Please seek medical attention immediately.

David: cv terra, if you are falling and passing out, that is a signal that something is seriously wrong. I hope you contact your doctor right away.

tatuma: Sometimes after eating a normal meal, my stomach will be in pain, and it seems like the food is not digesting at all. So it becomes easier to purge or not eat. Why is normal eating hard?

Dr. Sacker: It is not easier to purge, it makes you feel better. When you begin to re-feed your body, you are going to experience some discomfort initially. This is not permanent, the complications from purging are.

vancek: I have used diet pills for a few years. I'm concerned that combined with my coffee intake, this will cause problems.

Dr. Sacker: You are right to be concerned. My advice to you is to discontinue the use of diet pills immediately.

David: What is the effect of long-term use of diet pills on the body?

Dr. Sacker: Diet pills can cause permanent emotional dependence, all the complications of malnutrition, and the cardiac effects that can result in sudden death.

tinkrbell: I have been struggling with anorexia for over 3 years now and my doctor says that I have been losing a lot of muscle mass, while reminding me that the heart is also a muscle. How much muscle would you have to lose before your heart would really be in danger? I mean, would the body start losing some of the heart muscle even with other muscle still available?

Dr. Sacker: Yes it would. If you are concerning yourself with your heart muscle, I would advise you to seek professional anorexia help immediately.

David: Here's an audience comment on how laxative abuse affected her:

ktmcroo: I have abused laxatives, and aside from the initial effect that it had on the loss of intake, I felt much more fatigued and sickly. I always felt like that anyway, but being dehydrated was really hard to fight at the same time. I slept a lot and couldn't move. I just wanted to slip away.

kellkell: I'm no longer bulimic and anorexic like I was in my 20s. Now that I'm 40, should I be concerned about any damage that I might have done?

Dr. Sacker: Why not have a physical evaluation just to make sure that everything checks out.

babygumm: Hi. I'm 23. I recently was in the hospital and had surgery for a ruptured, perforated ulcer. I have anorexia and bulimia. I am eating now, but my metabolism has slowed down a lot. My insulin levels are low too. How can I speed up my metabolism? I am afraid to gain weight.

Dr. Sacker: You need a team, including a medical specialist in eating disorders, nutritionist, and possibly an endocrinologist, to evaluate you at this time.

ladyblacksheep28906: I'm bulimic and I can't stop getting up all night to eat. Then I am sick in the morning and after I eat each meal I vomit. Doctor, how can one that is bulimic and purges and still is overweight be helped?

Dr. Sacker: It sounds like you are stuck in a chronic cycle of restricting after you have binged and purged, then the behavior continues. You need to start to explore the underlying issues that are causing these behaviors to occur.

flute: I've had problems my whole life with weight. I was a compulsive overeater and now I am bulimic. I've lost 130 pounds by purging sometimes up to 6 or 7 times a day for a year-and-a-half now. I want to stop but I have this fear of food now and I don't even enjoy binges. How can I stop this terrible illness? I also abuse laxatives and faint constantly. Is my fainting from the laxatives or starvation?

Dr. Sacker: Fainting is a combination of all the abuse you are doing to your body. You need immediate professional intervention now to help you stop these destructive behaviors.

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David: A few minutes ago, we talked about the effects of long-term use of diet pills. Here's an audience comment on that:

Sueszy: I can answer that! If you could see me now, you would see all the effects of diet pills right before you're very eyes! Swollen everything and severe kidney failure!!! Don't take diet pills!!!!! DON'T!

Ryle: After 24 years of being bulimic, have you ever had anyone get better? Also, is this more of a brain disorder at this stage than an emotional one? Any suggestions on drug therapy (I've tried all anti-depressants)?

Dr. Sacker: Yes, recovery is still possible. At this point, however, you have to really want to get better to see positive changes occur. Oftentimes, you have had this disorder for so long that you believe that it is your only identity, but that is not true. You need to find a specialist who treats chronic eating disorders and have them recommend medication for you.

dancr122: Hello. I am in recovery from bulimia and anorexia. About a year ago, I tore my esophagus. I am trying very hard not to purge and now do it extremely infrequently (still trying not to at all). My question is, does the esophagus ever heal completely, or will I always have to worry about it tearing further or again?

Dr. Sacker: If you do not completely refrain from purging, you will always have to worry.

David: If you stop purging, will the esophagus heal completely?

Dr. Sacker: It depends on the individual case.

David: Here are some notes before we continue.

I received some questions tonight on overeating...and yes, that is considered an eating disorder. You can visit the Triumphant Journey site inside the HealthyPlace.com Eating Disorders Community for information on that.

LexiLuvs2Cheer: I'm 7 months pregnant and none of my doctors will tell me anything that I might have done to the babies (twins). Could you tell me what the eating disorder is/was doing to my babies?

Dr. Sacker: I need to know more about the disordered eating behaviors you were engaging in prior to and throughout your pregnancy. Let your obstetrician know your eating disorder history.

LexiLuvs2Cheer: Before I was pregnant, I was severely underweight. I'm still underweight for my height, and during the pregnancy everything was pretty good, except for now I have serious pains all over the body. I'm kind of weak and I have not gone to school for the past 3 days. My doctor knows I have an eating disorder, yet she won't tell me anything that is happening with that.

Dr. Sacker: If your sonograms are normal, and all other tests have been within normal limits, then right now, everything seems ok. If you are still concerned and you've shared these concerns with your present OB and not received an appropriate response, why not go to another obstetrician for a second opinion.

David: Here's the next question:

mickey19mouse28: When someone says they are "in recovery," what is considered "recovery," if one is anorexic?

Dr. Sacker: Recovery is when you have reached a healthy weight, you have been able to work through the issues that have caused your disordered eating, and when you are able to resume doing the things that you used to enjoy doing.

starandcrew: Is it possible for an eating disorder to be the cause of leukemia?

Dr. Sacker: Eating disorders lower one's immunity. We are unsure if there is a direct connection.

Di: Does having nosebleeds have any reflection on a person's being anorexic? I've had these nosebleeds for about a year and they are frequent.

Dr. Sacker: One cannot rule anything out. Please have this checked by your physician.

Keatherwood: I've been anorexic and bulimic most of my 45 years. I don't purge as much (only about 3 times/week) as I used to, but I am throwing up blood. Could this just be from irritation? I am too scared to see the doctor as I can't stand anything being put down my throat.

Dr. Sacker: You need to seek immediate medical attention. Throwing up blood is very dangerous.

David: I know it's getting very late on the east coast. Thank you so much, Dr. Sacker, for staying late this evening and answering audience questions. We appreciate you sharing this information with us. And to those in the audience, thank you for coming and participating. I hope you found it helpful. We have a very large and active community here at HealthyPlace.com. You will always find people in the chatrooms and interacting with various sites.

Also, if you found our site beneficial, I hope you'll pass our URL around to your friends, mail list buddies, and others. http://www.healthyplace.com

Thank you, again, Dr. Sacker for being our guest tonight.

Dr. Sacker: It was my pleasure.

David: Good night, everyone. And I hope that if you are suffering from medical complications of anorexia or bulimia, that you get help immediately. As we've found out from many audience members and Dr. Sacker tonight, an eating disorder can cause serious medical problems.

Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

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