APPENDIX 14
EFFECTS OF STARVATION
Anorexia Nervosa is only one condition which leads to starvation. For example,
severe protein calorie malnutrition as seen in many developing nations is a cause, as
is serious physical illness, for example for kinds of cancer.
It is important for you to realise that many of the symptoms you experience and
many of the physical effects described in this handout are not specific to anorexia
nervosa but occur in any condition leading to starvation. The practical importance of
this is that many of these things and indeed many psychological symptoms you will
hear about in therapy will disappear as you regain weight.
The physical effects of starvation will be considered under several different
headings.
1)
Metabolic and Endocrine Effects
Initially these effects are adaptive and really the body’s attempts to conserve
body mass. Growth rate become slowed down and in pre-pubertal people
puberty is delayed. Normally physical activity is also reduced but in anorexia
nervosa psychological factors may over-ride this.
If starvation continues, these protective mechanisms are bypassed and
serious illness, possibly even shortened life-span, may supervene. Your body
tries to keep on adapting by changing the secretion rates of various
hormones, for example insulin (secreted by the pancreas) and cortisol
(secreted by adrenal glands). Your body starts using muscle as an energy
source which contributes to the wasted, haggard appearance you have.
Your metabolic rate will fall which will make it increasingly difficult for you to
lose weight. Your body will also be unable to make new proteins. Proteins
are required to build up muscles and also carry various chemicals around the
body. Amino-acids which are usually used to make protein are instead used
to make glucose which your brain requires to keep on functioning.
Later on in the starvation process, serious loss of other important chemicals,
for example calcium, potassium, sodium and magnesium occurs. This is
likely to be the cause of the marked loss of calcium from your bones. Patients
with anorexia nervosa are as much at risk of osteoporosis as women in their
70’s and 80’s.
All the organs in your body do not shrink at the same rate. Your brain for
example does not lose weight at all, but muscle, liver and gut all shrink very
rapidly. The shrinkage in your gut means that you feel full even when you
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have eaten very little. Later on your kidneys and your heart may also start
shrinking.
2)
Responses of Heart and Kidney
In severe starvation the heart’s ability to pump blood round the body
deteriorates. Blood pressure becomes low (leading to symptoms like
dizziness, faintness) and the kidney’s ability to excrete acids and to filter out
waste products becomes impaired.
3)
Changes in Your Gut
As already mentioned, the whole of your gut, right from your gullet through to
your rectum, will eventually shrink. The enzymes required to digest food
normally become disrupted. Bacteria may grow rapidly in your small bowel
leading to poor absorption of even the little food that you are managing to eat.
4)
Changes in the Immune System
The immune system is responsible for defending the body against things like
bacteria, viruses and other illnesses. In starved people immunity is impaired,
the ability of white blood cells to deal with invasive bacteria is lessened, the
healing of wounds is grossly impaired and infection with unusual organisms,
e.g. fungi, is much more common.
5)
Regulation of Temperature
Metabolic rate is reduced. Hypothermia is common, partially due to hormonal
changes, partially due to loss of fat and partially due to a resetting of the
body’s thermostat which is in a part of your brain called hypothalamus.
6)
Reproductive Changes
Amenorrhea (cessation of periods) occurs in starved persons and fertility is
reduced. If by chance the starved person manages to become pregnant there
is an increased risk of miscarriage and also a great risk that any baby born
will be growth restricted, under nourished and subsequently have impairment
in their learning capacity in later life.
Physical Symptoms You Will Experience When You Starve
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Tiredness
Feelings of coldness
Dry, cracked skin
Swelling of the ankles
Dizziness
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Physical Signs
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A thin, drawn face
Skin hanging in folds
Flaky skin
Pale, lucid skin
Low blood pressure
Low pulse
Low body temperature
Cold extremities
In severe cases there may also be signs of vitamin deficiency. These include
osteomalacia (serious bone disease), anaemia, scurvy (bruises and bleeding),
muscle tenderness and weakness, loss of sensation in hands and feet, heart failure,
broken cracked lips, diarrhoea, fits and occasional dementia.
Obviously, many of the above symptoms can be very serious and threaten life. All
are reversible, at least in the earlier stages. We have listed them in this handout not
to depress or frighten you, but to give you the information you need to make an
intelligent and responsible decision about your eating.
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