Ninety-two percent of the sample of anorexic women in their mid-20s studied at the Massachusetts General Hospital had osteopenia in either the spine or hip areas (Annals of Internal Medicine, November 21, 2000). Of those, more than 50% had osteopenia at the spine and almost 25% had osteoporosis there; 47% had osteopenia at the hip and 16% had osteoporosis there. The women who weighed the least showed the most serious loss of bone. Estrogen deficiency (as indicated by loss of menstrual periods) was most highly linked with loss of bone density in the spinal region. Unfortunately, neither estrogen, calcium, nor Vitamin D supplements had any positive effect on bone density of the hip or spine in any of the research subjects! Another study done at the same hospital found that even when the nutritional status of anorexic girls improved in a year's time, the bone mineral density improved more slowly than in girls who had no history of anorexia (journal of Clinical Endocrinological Metababolism, Sept. 2002, 87-9:4177-85).
Researchers in Denmark believe that anorexia may cause permanent skeletal damage that is later made worse by the normal bone loss that occurs with aging. This study found that compared with non-eating-disordered people, anorexic patients were approximately twice as likely to break a bone; the risk remained for up to 10 years post-diagnosis! (International Journal of Eating Disorders, 2002,32:301-308). For a more thorough discussion of osteoporosis and bone density testing, an excellent resource is the Mayo Foundation for Education and Research, www.mayvclinic.com.
Another interesting Harvard study based on interviews with hundreds of ninth and tenth grade girls found that those girls had a higher chance of suffering bone fractures if they drank cola—five times greater than those who didn't drink any sodas! Although the reason for this is not 100% certain, it may be due to the fact that colas have phosphoric acid, that potentially affects how the body metabolizes calcium, which affects the development of bone mass. Or it may be due to the fact that girls who drink sodas drink less milk to begin with (New York Times, 6/20/00, F8) and therefore have less calcium with which to develop strong bones. Since many girls with anorexia drink enormous quantities of diet sodas, this study can point to one source of an anorexic female's bone density problems.
If you're female and anorexic, your periods may stop (or not start at all if you hadn't menstruated before you developed anorexia). The good news is that various studies have shown that menstruation resumes in a large percentage of women who manage to return to ideal body weight. Many doctors will prescribe a choice of hormone replacements, such as birth control pills, to help get the menstrual cycle started. It's important to discuss this option with your physician and understand the physical changes that are likely to occur as you start the hormone replacement therapy. It's also important to remember that the pills alone without appropriate nutrition aren't sufficient to conquer the physical effects of anorexia.
You may also have problems with your blood sugar levels, which are most commonly on the low side in anorexics. You may feel listless, tired, exhausted, unfocused, "zoned," or disoriented. You may have cold sweats or heart palpitations, feel panic, or faint. If your blood sugar levels get too low, you are at risk for sudden death. It is very important to have a minimum of 300 to 400 calories of glycogen stored in your liver, in case you have not eaten appropriately (this is why marathon runners will load up on carbohydrates before a race, for example). Most anorexics don't have adequate stores of glycogen.
You may have constipation problems. Your gastric emptying rate (the time it takes for food to be digested, pass through your system, and be excreted) is much slower than it would be if you were eating sufficient amounts of food in a more regular pattern. In some cases, it can take from four to eight days for a meal to be eliminated after an anorexic begins to eat again.
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