21 October 2022 Anorexia and Bulimia: The Eating Disorder Alphabet Winnie the Pooh, also known as ‘Pooh’, a fictional anthropomorphic Teddy bear created by the English author, A. A. Milne, in 1926, and voiced most notably by Jim Cummings, once said “You don’t have to earn food; food is fuel for life. You deserve to eat even if… you haven’t done anything today; you don’t like the way you look; you feel like you’ve eaten to much, you’ve gained weight, or you’re going out later. You need it to stay alive. Do not punish yourself.” This quote means that no matter what the circumstances are, if an individual is hungry, then he or she should eat. This quote breaks the barriers and restrictions individuals have on themselves and their stomachs due to personal insecurities, or upcoming scenarios, assisting in the realization that food is a basic necessity for a healthy lifestyle. Pooh’s lovable character is a foundation in the minds of many young children and even adults. Due to his soft-spoken nature, he is the originator behind ‘food positivity’ around the world. Anorexia nervosa (AN) or anorexia, according to the journal document, “Anorexia Nervosa: A Case Report and Review of Literature” is a psychiatric disorder in which individuals restrict energy intake, leading to severely unhealthy body masses. This is accompanied by an intense fear of gaining weight and a distorted perception of one’s body weight and shape (734). Additionally, according to Michelle P. Warren, in the journal document “Endocrine Manifestations of Eating Disorders” bulimia, or bulimia nervosa, is an eating disorder marked by recurrent episodes of binge eating that may be followed by restrictive eating and inappropriate behavior to prevent weight gain such as selfinduced vomiting or the ingestion of “dieting pills” (333). The debate about whether or not eating disorders should be classified as mental illnesses has long been disproved and instead, have become a frequent topic in society that is no longer labeled as a “cry for attention.” Eating disorders are now held in high regard and are quickly identified in regard to their short-term consequences such as, according to “Anorexia Nervosa” (in the case of anorexia), excessively dry or yellowish skin, swelling of arms and legs, or Lanugo (a layer of soft, downy hair covering the body) or according to “Bulimia: Symptoms, Diagnosis and Treatments” (in the case of bulimia) consequences such as tooth erosion and decay, swollen salivary glands and bone pain during exercise. Yet in the stance of long term-consequences of such serious disorders effects from the constant starvation or binging and purging, even more terrifying results are yielded in comparison to the short-term effects usually deemed as irreversible to one’s body such as permanent decrease or increase in hormones, a fluctuation in osteoporosis and severe cardiovascular difficulties. To begin with, what are hormones? According to the web source, “Hormones”, hormones are chemicals that send messages to an individual’s organs, skin, muscles, and other tissues through your blood to coordinate various body functions. These signs instruct the body on when and how to relay signals. An individual’s life and health depend on hormones. Anorexia Nervosa and Bulimia Nervosa, the most studied eating disorders, show truth to the statement that such eating disorders can cause a permanent increase in decrease in hormones from for example, the journal article, “Anorexia Nervosa: A Case Report and Review of Literature” (734). Hypothalamic amenorrhea according to the web source, “Eating Disorders and Hypothalamic Amenorrhea” is a condition whereby a woman does not receive her menstrual cycle due to an abnormal decrease or an entirely ceased production in the release of the gonadotropin-releasing hormone. With the condition, amenorrhea, according to the web source, “Amenorrhea”, problems such as fertility issues due to a profound estrogen deficiency disrupting the thickening of the uterine lining and not allowing an egg into one of the ovaries. In the journal article, “Endocrine Manifestations of Eating Disorders”, Warren also summarizes other negative endocrine changes throughout the human body due to the eating disorder anorexia. In a table from the journal article “Endocrine Manifestations of Eating Disorders” Warren shows with arrows the decrease or increase in affected hormones. For example, the hormone cortisol, is shown to have an intense increase in the production rate throughout the human body (343). Cortisol according to the web source, “Cortisol” is a hormone that affects one’s adrenal glands; it works as a steroid. Cortisol affects many systems in the human body such as the reproductive system (of both males and females), immune system, and cardiovascular system assisting in the maintenance of the body’s response to stress. Cortisol in its balanced amount plays a positive impact on the human body by suppressing inflammation and regulating blood pressure, yet in excess does more harm than good allowing toxins to pass through the intestines easier. As a result, inflammation and a weakening of the immune system occurs as its inflammatory and antisuppressive abilities prevents the production of progesterone and testosterone, thereby creating a negative impact on one’s libido and sexual desire. Additionally, the long term-consequences of eating disorders such as anorexia and bulimia don’t end on the subject of hormonal imbalances. Mayoclinic defines Osteoporosis as a condition that causes bones to become so weak and brittle that even mild stresses such as bending over or coughing can cause a fracture. Throughout the journal article, “Osteoporosis in Eating Disorders: A Follow-Up Study of Patients with Anorexia and Bulimia Nervosa”, Stephan Zipfel, et al. state that in reference to chronic cases of AN and BN, significant morbidity rates are produced due to serious medical complications of severe osteopenia (5229). The reasoning behind the weak bone density in eating disorder patients is due directly to their diets. The little nutrition anorexics place in their bodies creates deficiencies in calcium and increases fracture risks, early bone loss, and decreased bone density. Once again according to, “Osteoporosis in Eating Disorders: A Follow-Up Study of Patients with Anorexia and Bulimia Nervosa”, bulimics on the other hand are even more prone to osteopetrosis compared to anorexics due to the harsh nature of bulimia in its entirety. The purging process (the expulsion of food ingested usually through vomiting) of bulimia causes dehydration due to the acidity of the vomit, damage of the endocrine glands and interference between digestion and absorption of crucial nutrients resulting in low bone density (5231). Lastly, cardiovascular difficulties are another long-term consequence of eating disorders such as anorexia or bulimia. The journal article “Myocardial Changes in a Patient with Anorexia Nervosa: A Case Report and Review of Literature”, documented by Ihab Lamzabi, Sahr Syed, Vijaya B. Reddy, Richa Jain, Aparna Harbhajanka, and Ponni Arunkumar, states that anorexia nervosa. an eating disorder with a high mortality rate occurs due to cardiovascular complications manifesting within the human body (734). According to clevelandclinic, Cardiovascular difficulties or heart diseases are any structural and/or functional abnormalities within the heart. Common types of these include: heart failure, atrial fibrillation, or a heart attack. According to “Anorexia Nervosa: A Case Report and Review of Literature”, anorexia in itself is associated with many medical complications in the body’s various systems such as the immune, musculoskeletal or endocrine system. Yet, Lamzabi, et al. state the most concerning are those related to the cardiovascular system, such as arrhythmia. Arrhythmia according to the web source, “Arrhythmia” is defined as an irregular heartbeat that either falls into the range of too fast or too slow depending on the individual. The journal article, “Myocardial Changes in a Patient with Anorexia Nervosa: A Case Report and Review of Literature” also documents various other cardiac complications such as hypotension (abnormally low blood pressure), or even cardiac structural abnormalities such as Stenosis (which is the narrowing of one or both of the heart valves making the flow of blood difficult) (Lamzabi et al. 735). Succinctly, anorexia nervosa and bulimia are genuine medical conditions that need constant supervision. Though they are no longer deemed as a “gimmick for attention”, they are still only be viewed at a physical and surfaced level. Yet beneath the ugly phenotypes lies, horrifying consequences ahead in the path of eating disorders, such as cardiac problem that affect all major organs of the human body, the gradually weakening bone density of individuals due to calcium deficiencies and the harmful methods of bulimia and the hormonal imbalances that ruin the body’s homeostasis. Works Cited “Amenorrhea.” 2022 Cleveland Clinic, 30 Sept. 2020. https://my.clevelandclinic.org/health/diseases/3924-amenorrhea, Accessed 19 Nov. 2022. “Anorexia Nervosa: A Case Report and Review of Literature” American Journal of Clinical Pathology, vol. 143, no. 5 May 2015, pp. 734–737. Accessed 21 Oct. 2022. “Anorexia nervosa.” Mayo Foundation for Medical Education and Research (MFMER), 20 Feb. 2018. https://www.mayoclinic.org/diseases-conditions/anorexia-nervosa/symptomscauses/syc-20353591, Accessed 21 Oct. 2022. “Arrythmia.” Mayo Foundation for Medical Education and Research (MFMER), 30 Apr. 2022. https://www.mayoclinic.org/diseases-conditions/heart-arrhythmia/symptomscauses/syc-20350668, Accessed 21 Oct. 2022. “Bulimia: Symptoms, Diagnosis and Treatments.” Health Harvard. The President and Fellows of Harvard College, 19 Dec. 2014. https://www.health.harvard.edu/mind-andmood/bulimia-symptoms-diagnosis-and-treatments, Accessed 21 Oct. 2022. “Cardiovascular Disease.” Cleveland Clinic, 1 Sept. 2022. https://my.clevelandclinic.org/health/diseases/21493-cardiovascular-disease, Accessed 19 Nov. 2022. “Cortisol.” Cleveland Clinic, 12 Oct. 2022. https://my.clevelandclinic.org/health/articles/22187-cortisol , Accessed 22 Oct. 2022. Muhlheim, Lauren. “Eating Disorders and Hypothalamic Amenorrhea.” 13 Feb. 2020. https://www.verywellmind.com/hypothalamic-amenorrhea-4687508, Accessed 19 Nov. 2022 “Hormones.” 2022 Cleveland Clinic, 23 Feb. 2022 https://my.clevelandclinic.org/health/articles/22464-hormones, Accessed 22 Oct. 2022. Ihab Lamzabi, Sahr Syed, Vijaya B. Reddy, Richa Jain, Aparna, Harbhajanka, Ponni Arunkumar, “Myocardial Changes in a Patient with Anorexia Nervosa: A Case Report and Review of Literature” American Journal of Clinical Pathology, vol. 143, no. 5 May 2015, pp. 734– 737. Accessed 21 Oct. 2022. Michelle P. Warren. “Endocrine Manifestations of Eating Disorders” The Journal of Clinical Endocrinology & Metabolism, Volume 96, Issue 2, 1 February 2011, Pages 333– 343. Oxford Academic. Accessed 21 Oct. 2022. “Osteoporosis.” MayoClinic. Mayo Foundation for Medical Education and Research (MFMER), 21 Aug. 2021. https://www.mayoclinic.org/diseases-conditions/osteoporosis/symptomscauses/syc-20351968, Accessed 21 Oct. 2022. Stephan Zipfel, Markus J. Seibel, Bernd Löwe, Peter J. Beumont, Christian Kasperk, and Wolfgang Herzog. “Osteoporosis in Eating Disorders: A Follow-Up Study of Patients with Anorexia and Bulimia Nervosa.” The Journal of Clinical Endocrinology & Metabolism, vol. 86, no. 11, 1 Nov. 2001, pp. 5227–5233. Accessed 21 Oct. 2022.
