Dr Oli: Diving and anorexia

Q: I am a 24 year old female with an eating disorder (anorexia nervosa), which I was diagnosed with in my teens. I have been diving since I was 14. I have been feeling out of sorts for the last few weeks, but have a holiday booked soon and was hoping to dive. My GP organised an ECG test and it showed my heart rate was slower than normal (in the 50's). Does this put me at increased risk when diving?

A: Characterised by attempts to lose weight through various means, sometimes to the point of starvation, anorexia nervosa is a serious mental health condition. It typically causes low body weight, body image distortion and an obsessive fear of gaining weight. In general terms, the problems that this would cause for diving are several. Reduced strength and exercise tolerance are common, meaning kit-carrying and hard finning may produce early fatigue. Psychological issues might jeopardise safety, with panic and phobic behaviours a prominent feature. The heart can be affected in a number of ways, with disorders of rhythm, valve disease, and heart failure all possible complications. Any medication taken for the disorder might have repercussions also. Interestingly, there is a related condition termed anorexia mirabilis (literally a "miraculous lack of appetite"), in which similar symptoms are frequently coupled with assorted penitential practices such as lifelong virginity, self flagellation, the donning of hairshirts and sleeping on beds of thorns. Such "fasting girls" have been around since the Middle Ages, and were often claimed to have miraculous or magical powers, usually by exploitative museums. Sadly, whenever these claims were tested, the girls in question starved.

As far as your specific heart rate query goes, a slow pulse can be a sign of a very fit heart. If the ECG is otherwise normal then the rate itself would not put you at any increased risk of diving problems. Nevertheless, I would suggest you are assessed by a qualified diving doctor before you go, for all the reasons outlined above. The fact that you have been diving for 10 years already should be in your favour though.

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