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Effects of Bulimia Nervosa on the Body
by Aubrey Weese
This is the outline for a presentation I gave to my class.
I. Everyone
1. Prealbumin level as a test for malnutritionA general test for malnutrition used in many medical situations with many types of patients is blood prealbumin level. It can be used to decide if a patient is malnourished and needs special attention.
· Prealbumin is a protein found in the blood. The amount changes quickly in response to protein and energy intake, so measuring it's level is one way to get a good idea of a person's nutritional status.
· A study done on 152 bulimic women found that 4.3% of them had low prealbumin levels. These levels were still not low enough to be outside the normal range, however. The study speculated that this might be because when bulimics are not bingeing, they usually select healthy, nutrient dense foods to eat.
· The 4.3% with the lowest levels had significantly more bingeing and vomiting episodes in the two weeks before the study than those with higher levels, leading the study to conclude that those with the highest risk for malnutrition were those who vomited the most.I addition to prealbumin, another test for the nutritional status of an individual is to look at the their immune system.
2. Compromised immune system
· Nutrients play an important role in the development and functionality of immune system cells. Malnourished individuals are often found to have a weak immune system and have greater susceptibility to disease.
· A study was done that compared the white blood cell counts of individuals with anorexia and bulimia to a control group. 40% of the bulimics in the study had a significantly lower number of white blood cells than the control group. However, all these individuals had had the disease for a long period of time (3 ½ years or longer). Another study of those who had had it for a shorter time (only 1 ½ years) showed no reduction.Both the prealbumin and immune system studies show that bulimics aren't under such a high risk for malnutrition as are those with other eating disorders such as anorexics. The risk becomes higher the longer they have the disease, and the more often they vomit. But their most serious health problems come elsewhere, from the damage done the body by the actual act of vomiting or laxative abuse, which I will talk about now.
3. Mouth and throat problems
a. teeth
· Constant exposure to stomach acid eats through the enamel of the teeth, exposing the dentine beneath. This happens especially on the backs of upper front teeth. The teeth may also become chipped and appear ragged.
· Dentists have found that patients with bulimia produce less saliva. This and the wearing away of the enamel can cause them to develop cavities much more easily.
· Stomach acids and enzymes in the vomit can also produce gum disease, cancer sores, and bad breath.
· If it progresses slowly enough, it may not produce any sensitivity of the teeth, and patients may not be aware of it until it has been pointed out by a dentist.b. esophagus
· The esophagus becomes irritated by constant exposure to stomach acid, causing heart burn, sore throats, and an increased risk for cancer of the esophagus.
· If the force and frequency of vomiting is too much, the esophagus can tear, leading to life threatening bleeding episodes.
· Frequent vomiting also weakens the pyloric sphincter, which can lead to acid reflux. In some patients, it gets so bad that they can't keep any food down at all.c. swollen salivary glands
· Frequent vomiting has been reported to irritate the parotid salivary gland, causing it to swell and the cheeks to become puffy.
· Swelling of the salivary glands has been reported in approximately 50 percent of bulimia patients.
· It usually occurs within several days of excessive vomiting, is painless and medically harmless, although it is cosmetically distressing to the patients.4. Electrolyte imbalance
· Electrolytes are substances that break down into charged ions when they dissolve in body fluid. They are essential to the production of the body's "natural electricity" that ensures healthy nerve and muscle impulses.
· They can be lost by frequent vomiting. The most common electrolytes that are lost are potassium, sodium, and magnesium.
· The body sends nerve impulses using the sodium potassium pump. It reversing the presence of potassium inside the nerve cell and sodium outside the nerve cell, and thus reversing the electrical charges inside and out. If the sodium and potassium balance is disturbed, the nerves will not fire correctly, leading to heart and muscle problems.a. heart problems
Electrolyte imbalance can begin by producing heart palpitations, then irregular heartbeat, and eventually possible cardiac arrest and death.b. disfunction of muscles
Spasms, twitching, muscle weakness, cramping, and even temporary paralysis can be caused by electrolyte imbalance.5. Problems from laxative abuse
a. bowel damage
Frequent use of laxatives may make the body dependant on them to stimulate any bowel movement. It can also lead to long term bowel damage, constipation, and long disruptions of normal bowel function.b. dehydration
· Edema, and increase in the concentration of water between the cells, can be caused by dehydration from laxative abuse.
· The balance of water inside and outside of the cells depends on the balance of sodium and potassium ions. These become imbalance with dehydration, causing excess water accumulation, especially in the hands, feet, thighs and stomach.
· This condition is most prevalent during recovery, when dehydration is beginning to end. The excess water can cause bulimic to think they are getting fat, and make them want to go back to the eating disorder.
· Dehydration can also cause low blood pressure by reducing blood volume, since a large portion of blood plasma is made of water. This low blood pressure can cause heart problems, dizziness, headaches, light headedness, and kidney problems.6. Depression caused by chemical factors
· The same study I mentioned before that tested prealbumin levels also found that 5.1% of bulimics have low vitamin B12 levels.
· If you don't count the food eaten during purges, 1/3 of them do not meet the RDA for B12. If you do count this food, the number lowers to 10%, but it is uncertain how many nutrients are lost through purging before they are absorbed.
· A deficiency of vitamin B12 can interfere with chemical systems in the brain (for example, B12 is used in the synthesis of serotonin and dopamine), and can contribute to depression.
· In addition to B12 deficiency, depression can also be caused by many of the things I have mentioned before: electrolyte imbalances, hormone deficiencies, malnutrition and dehydration.
· This can turn into a cycle the patient cannot get out of. Nutritional complications caused by the eating disorder itself causes depression, and this depression in turn furthers the eating disorder and makes the patient unable to break away.
II. Women
1. Irregular menstrual cycles· In a study of 82 bulimic women, 45% reported an irregular menstrual cycle. This irregularity lasted even after 12 months of follow up treatment in 30.5% of the individuals.
· Irregular menstrual cycles seem to occur most often in patients who have a high frequency of vomiting and very low dietary fat intake. After treatment, those patients whose menstrual cycles stayed irregular had a greater difference in past maximum and minimum body weight, were struggling with depression, or were smokers.
· Low fat diets have been known to increase the length of the menstrual cycle because they reduce the concentration of estrogen in the body. The effect is strengthened by a high intake of fiber.Frequency of vomiting may be related to irregular menstrual cycles through insulin and Polycystic ovary syndrome.
2. Polycystic ovary syndrome
· Polycystic ovary syndrome happens when the ovary creates new eggs each month, but does not ovulate because of abnormal hormone levels. This causes many cysts to build up in the ovary, and menstrual cycles to become irregular.
· Many bulimics develop polycystic ovary syndrome because of their frequent vomiting. It has been found that frequent vomiting causes the body to release more insulin. A large variation in food intake can also cause the insulin response to become abnormal.
· Elevated insulin levels in the body cause a rise in androgen levels, particularly testosterone. This elevated testosterone level effects the ovaries, stopping ovulation.
· The irregular periods over a long period of time caused by this syndrome increase the risk for cancer of the lining of the uterus. The abnormal hormone changes also increase the risk for high blood pressure and high cholesterol. And, the high insulin levels over a long period of time increase the risk for developing Type II Diabetes.Return to Aubrey's George Mason University School Bag
