By: Diana Barnes-Brown for Heart1
Most Americans with access to the media know the story of Terri Schiavo, the recently deceased Florida women who fell into a persistent vegetative state (PVS) several years ago as a result of a heart attack, and whose husband and parents were locked in a bitter dispute about whether she should be kept alive with a feeding tube or allowed to die without medical intervention. However, what may be surprising to some is that the cause of the heart attack that set Schiavo’s ordeal into motion was an eating disorder.
|Quick Facts on Eating Disorders
1. The National Institute of Mental Health estimates that between 0.5 and 3.7 percent of females suffer from anorexia nervosa and 1.1 to 4.2 percent of females have bulimia nervosa in their lifetime.
2. Eating disorders are much more commonly diagnosed in females than in males; only 5 to 15 percent of those with anorexia or bulimia are male.
3. Eating disorders most often begin in adolescence, but often continue into adulthood if proper treatment is not sought by parents, doctors and others in caretaking roles.
4. Eating disorders are usually best managed with a combination of psychological counseling, nutritional rehabilitation, medical treatment to address any physical effects, and sometimes medication.
5. Eating disorders often occur with other psychological disorders, including depression, anxiety disorders, substance abuse and other self-destructive behaviors.
Different health experts may have varying definitions of the term “eating disorder.” Some think of eating disorders as being restricted to anorexia nervosa and bulimia nervosa alone, while others extent their definitions to include obesity, binge eating-induced obesity, and a handful of other, less common eating behaviors that lead to destructive physical and psychological consequences.
Schiavo suffered from bulimia nervosa, a condition whose sufferers repeatedly “binge and purge.” People with bulimia generally consume large quantities of food and then attempt to compensate for the overeating by inducing vomiting, taking laxatives or diet pills, or using enemas to get rid of the unwanted food. Sometimes people with bulimia resort to excessive, obsessive exercising in addition to or instead of other purging activity. Others may alternate between binge sessions and starvation diets, with or without the aid of drugs.
While the most common medical effects of bulimia include tooth and esophageal damage from repeated exposure to the stomach acid in vomit, there are other dangers as well. These include tearing of stomach and esophageal tissue from constant forced expulsion of food, laxative dependence and inability to have normal bowel movements, and potential heart failure from the abuse of emetics, such as ipecac, to induce vomiting. Finally, the rapid fluid loss of vomiting and chemical imbalances of starvation behavior can cause kidney and heart damage.
In the case of heart damage, fluid loss can cause a shortage of the electrolytes sodium and potassium from the body and lead to severe dehydration and electrolyte imbalances. Without proper electrolyte levels in the body, the electrical impulses that control muscle movement – including the beating of the heart – cannot fire, leading to dangerous and possibly fatal outcomes.
Schiavo collapsed of a heart attack at 27 years of age, and based on medical records and the accounts of friends and her husband, had suffered from an eating disorder for some time at that point. One hospital account notes that Schiavo had been dieting drastically and attempting to control her weight with a diet that consisted mostly of iced tea and other liquids at the time of her heart attack. Additionally, her potassium levels were 2.0 mEq/L at the time of her admission to the hospital, while normal levels for healthy adults are between 3.5 and 5.0. These low levels accounted for the heart attack that left her unconscious and deprived her brain of oxygen for five minutes, causing the irreversible brain damage that left her in a PVS.
Of course, the consequences of eating disorders go far beyond the physical dangers of abusing one’s system so severely. Eating disorders involve dangerous distortions of self-image, depression, anxiety, and obsessive-compulsive behaviors across the board. But it is important to remember that severely-restricted diets, if not addressed by appropriate support, intervention, and health and nutrition regimens, may in fact lead to life-threatening consequences whose severity is difficult to foresee.