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Can you eat yourself to death on one occasion of very excessive eating? We know that America’s eating problem is bad, albeit gradual: No one’s ever died from eating three Big Macs, but plenty of people may have died from eating three Big Macs twice a week for thirty years (some, miraculously, have managed to avoid that fate). But what about the bingers? The people who, during Thanksgiving, or after receiving a bit of horrific personal news, find themselves eating way more than they’re used to? You don’t need to be an addict to overdose on drugs; might the same apply to food?

In this week’s Giz Asks, we posed that question to a number of medical professionals, who were simultaneously reassuring and disturbing—think exploding stomachs, infected esophageal tracts, etc. That stuff probably won’t happen to you, but that doesn’t mean it can’t.

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John O. Clarke, MD

Director of the Esophageal Program and Clinical Associate Professor of Gastroenterology & Hepatology at Stanford University School of Medicine

It’s very rare to eat yourself to death, but it’s not theoretically impossible.

The one everyone thinks about is bursting the stomach, but I think that’s exceedingly rare—the stomach is more thick-muscled than any other segment of the gut, and it’s generally built to expand. It typically accommodates to try and deal with large meals, and if you extend the stomach too much, then you usually trigger vomiting. So while there are a few case reports of bursting stomachs, overeating to the point that you get higher gastric pressures is exceedingly rare, because the stomach typically can expand rapidly. The average person will expand the stomach by about a liter during any given meal, but it’s certainly not uncommon to expand more. For instance people who eat like fifty or sixty hot dogs, they usually get massive stomach expansion, and somewhat paradoxically they actually get slower gastric emptying. It’s a little bit unclear why exactly that is. The thought is that maybe the slower gastric emptying takes away the hunger to some extent, so they can keep on eating. In those situations, despite the massive amount of food they eat you almost never hear of anyone who gets gastric rupture that way.

The more common scenario is vomiting from overeating. The big one there is Boerhaave syndrome, and that’s where, from vomiting and from forceful movements of the esophagus, you get esophageal rupture. I can say that I’ve never seen in my entire career anyone who’s had gastric rupture, but i have seen a couple Boerhaave’s.

Another possibility that wouldn’t necessarily be a rupture is a condition which is called a Mallory-Weiss tear, where you can get esophageal tearing at the gastroesophageal junction. That can be associated with pretty significant bleeding, though most times it’s not at a rate that’s brisk enough that people are going to hemorrhage and die right there. But if they, let’s say, were both indulging massively and in some place that was remote from medical attention— you could in theory die from that.

In theory, if you were overeating something that had high levels of metal, or a mineral that you can overdose from, then you could have issues with that. I can say that I personally have never seen that in my practice, but I was talking to a friend who told me that they once saw someone who eat a massive amount of lobster—like a ten pound lobster—and ended up, in that context, getting iodine toxicity, which turned out to be pretty significant, and they ended up in the hospital for some period of time. But you’d really have to eat a massive amount of something that was heavy in mercury or iodine or some mineral that we typically get in only trace amounts.

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Barbara Jung, M.D.

Thomas J. Layden Endowed Professor and Chief of the Division of Gastroenterology and Hepatology at University of Illinois at Chicago

In the long run, obviously, yes: you can eat yourself to death. I think the increase of obesity in the American population is a very clear sign of that. A huge majority of the mortality that we have in the US is directly linked to obesity, either from complications of obesity itself, or from associated complications—cardiovascular disease, cancer, etc.

If people are concerned about [eating themselves to death] during the holidays: For the most part, our body wants to survive, so it will tell us when we’ve had enough and when we really can’t eat anymore. I would say very few people have kept going, because it’s actually very difficult to keep going.

One [way you could die from overeating] is if, let’s say, the temperature of the food you consume is very low, and you develop hypothermia, because you’ve digested large quantities of something that is too cold for your body. Another is if what you’ve eaten exceeds the capacity of your stomach. Food has to sit in your stomach, and then it has to move through your intestines, and if the stomach is full, the only way out is up. And complications of vomiting might include either asphyxiation (from getting food in the pulmonary airway) or bleeding, because the feeding pipe in the esophagus may rupture, and if it really ruptures terribly then you could get an infection of the area around the esophagus, and that can be deadly. But these consequences are very rare, and usually not achieved, because our body regulates and really does not want to be overfed.

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Merlin Butler

Director of the Division of Research and the Genetics Clinic and Professor of Psychiatry, Behavioral Sciences and Pediatrics at Kansas University Medical Center

[Eating oneself to death] is certainly is a phenomenon that we see in the condition called Prader-Willi syndrome, which is the most common known cause of morbid obesity in humans. It’s a rare disease—there’s probably 400 born per year in the United States, maybe 400,000 in the world at any one time.

Individuals with Prader-Willi syndrome have two major clinical stages. The first stage is failure to thrive: They’re born very floppy, with decreased fetal activity. They’re very hypotonic, which leads to feeding differently.

That’ll last several months, up a year or so, maybe longer, and then they start developing an appetite. That side can be quite extreme—so-called hyperphasia. They become morbidly obese very quickly. All food in sight will be consumed, until they fall asleep or their stomach ruptures. Stomach rupturing is a common cause of death in Prader Willi syndrome. That’s the cardinal feature.

Often what happens is that they’re placed on a very strict diet in a controlled environment, so they don’t have access to food, and their stomachs become quite small. Then they get into an episode where they’re able to overeat, and their stomach is kind of like a shriveled prune: they overeat, and their stomachs explode.

They know they should’ve be overeating, because they’ve had their food intake restricted, so they have this ravenous, driven appetite to consume food, and they have no sensation of fullness. Their brain is saying, “I’m hungry I’m hungry I’m hungry,” and there’s no feedback from the brain saying “hey, I’m full, I can’t eat any more.” They start eating more rapidly, because they know they’re going to be caught if they don’t consume everything right away, and their gag reflex is low, so they end up choking. Prader-Willi patients also have an inability to vomit. It’s a catch-22, it’s a perfect storm. It is just unbelievable the stories we hear: Prader-Willi kids will jump out of windows if they hear an ice cream truck.

And this eating behavior is unlimited; [Prader-Willi children eat] even things that you and I would not consider food—things that we wouldn’t consider edible items they’ll consume. It’s can be very life-threatening.

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