For the past few decades, I have treated an increasing number of runners and athletes suffering from an eating disorder called anorexia nervosa. Anorexia nervosa is a condition that involves reducing calorie intake to the point of starvation. The victim, who is usually female, fasts and exercises or severely restricts their food intake. The symptoms of anorexia include loss of menstruation, dry skin and an extreme fear of gaining weight. Anorectic pretend to eat meals when they are hardly eating at all; or cook large meals for others, which they themselves refuse to eat.

As athletes, anorectic can maintain a high performance level, for a time, but also have serious internal problems. One recent summer, a world-class female runner stayed at my house so that she could train for the Peachtree Road Race (in Georgia). She suffered from anorexia. Her 10k times were very fast, but she had no menstrual cycle and experienced frequent episodes of dizziness.

In severe cases, anorectic can experience hair loss, chronic fatigue, fainting and dizziness, severe temperature sensitivity, dangerously low blood pressure, dehydration, brittle bones due to calcium loss, electrical disruptions of the heart rhythm due to a loss of bodily electrolytes, and eventually, death. Over time, long-term hormone imbalance can have damaging effects upon the reproductive system and the ability to become pregnant.

Anorexia nervosa is also associated with bulimia nervosa, which involves binge eating followed by various efforts to "purge" the food. During a binge, a person may eat anywhere from a couple of extra brownies to as much as several entire cakes. Or a binger may eat a single food in great quantities, such as an entire gallon or two of ice cream. When the binge ends, the individual feels guilty and becomes obsessed with the "need" to purge the food, along with the guilt. Laxatives might be used, as well as intense physical exercise. A binger-purger might overeat and then vomit when they are feeling angry. Food is used as a way of reducing uncomfortable emotions. When the binge is over, the purge is used as a way of "cleansing" oneself from the anxiety of weight gain.

People going through bulimia often develop an obsessive preoccupation with weighing oneself. A person experiencing bulimia often has a preoccupation with body image and a very negative view of themselves. A patient of mine was repeatedly told by her mother that she was a "fat pig" when she was a little girl. This stuck in her mind and she became obsessed with thinness. Twenty years later, she is a bulimic.

Bulimia can result in serious dental, throat and gastrointestinal problems. You can commonly recognize a bulimic by the stains on the teeth from repeated stomach acid contact during vomiting. Other possible symptoms include swelling of the feet, hands and cheeks, stomach and esophageal pain, tooth decay, loss of normal digestive and bowel functions, menstrual disruption, heart irregularities due to electrolyte imbalances, and eventually death.

Counseling and changing the victim's self-image is paramount. If you know a friend, loved one or acquaintance who has an eating disorder, or see the signs in a patient, don't sugarcoat the seriousness of the situation. It could be a matter of life or death.