APPENDIX 13
Effects of Starvation
Anorexia Nervosa is a condition of self-induced starvation. Starvation affects many
systems. Most changes are completely reversible as weight is regained and these
include psychological symptoms.
1. Metabolic and Endocrine Effects: these are changes that are adaptive and are
about trying to conserve body mass. Growth rate is slowed and puberty will be
delayed. Physical activity is often initially reduced but there can be symptoms
of hyperactivity in some. Cortisol and insulin secretion are both altered.
Muscle starts being broken down to use as an energy source. As starvation
proceeds losses of electrolytes such as calcium, potassium, sodium and
magnesium occur. There will be marked loss of calcium from bones. Patients
with Anorexia Nervosa are as much at risk of osteoporosis as women in their
70's and 80's. Overall muscle, liver and gut all shrink very rapidly. Shrinkage
in the gastrointestinal tract means feelings of fullness even after only little
amounts of food are eaten. Later on kidneys and heart may also lose mass.
Women, if post puberty, will become amenorrhoeaic and Anorexia Nervosa
and Bulimia Nervosa are diagnosis that should be considered in cases of
infertility.
2. Cardiovascular Changes: with weight loss a patient can become bradycardic
and arrhythmia's are sometimes seen particularly where there is low
potassium. Cardiac arrest occasionally occurs. Blood pressure is low in
Anorexia Nervosa and there may be postural hypotension.
3. Biochemistry: dehydration can occur with vomiting, laxative misuse or fluid
restriction.
4. Low Sodium, Low Potassium and sometimes low levels of other elements
such as calcium magnesium are sometimes seen. Phosphate supplements
may be needed, especially when patients are being re-fed. Repeated vomiting
can cause an alkalosis.
5. Vomiting and Laxative Abuse: can disturb fluid balance which can lead to an
accumulation of fluid, especially in the ankles. Hypoglycaemia and abnormal
glucose tolerance are sometimes seen and there can be a variety of protein
and vitamin deficiencies. All these disturbances can cause weakness and lack
of energy.
6. Skeletal Changes: in Anorexia Nervosa, osteoporosis is frequently seen. Due
to lack of calcium and vitamin D particularly. Low oestrogen levels also play a
part. There can be growth retardation before full stature is reached. A milder
form of bone thinning is osteopaenia. Fractures can occur as a result.
7. Body Temperature: cold intolerance is seen with Anorexia Nervosa and very
low body temperature or hypothermia can occur. Reynard's Phenomenon is
also often seen.
MCN Website – Appendix 13
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8. Gastrointestinal Tract: damage to the teeth can result from repeated vomiting
as well as inflammation of the throat and swelling of the parotid glands.
Oesophageal tears are sometimes seen and atomic bowel can occur from
excessive laxative abuse. Dependence on laxatives is then seen.
9. Haematological: anaemia can occur adding to weakness and tiredness. White
cell counts are also impaired and immune deficiency states can result.
Occasionally low platelet concentrations can lead to clotting problems.
10. Dermatological: skin may become dry or discoloured. Excess hair growth on
the face, arms and down the back is often seen in Anorexia Nervosa. Lanugo
hair.
11. Renal, Liver and Pancreatic Function: in advanced Anorexia Nervosa these
three systems can all be impaired.
12. Neuro-Psychiatric: cognition is slowed, concentration is impaired and thinking
becomes very restricted and focused in established Anorexia Nervosa. States
of depression and anxiety can result in both Bulimia and Anorexia Nervosa.
13. Muscle Changes: in advanced stages of Anorexia Nervosa there can be
severe muscle weakness.
MCN Website – Appendix 13
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