Ipecac, the plant that killed Karen Carpenter, the star who was consumed by anorexia

The recently published biography of 1970s pop star Karen Carpenter has revealed that the announcement of her death from heart failure concealed a death by slow poisoning resulting from her addiction to ipecac root, an ancient indigenous remedy banned from clinical practice since the end of 1970. the 20th century.

Ipecac, an old known tropical phytotherapy

The written history of ipecacuanha (Carapichea ipecacuanha)the “road plan that makes you sick” in Tupi language, began when it arrived in Europe thanks to Willem Piso, in his Historia Naturalis Brasiliae (1648) was first mentioned as a fever and vomiting inducer used by the natives of Amazonia. Doctor Helvetius uses it to treat the dysentery suffered by the relatives of Louis XIV. Then the plant disappeared from the history of the pharmacopoeia until it reappeared in the 18th century in the master formula of the famous Dover Powder, a cure-all based on ground ipecac root, opium and potassium sulfate which, like modern aspirin, was very. popular for treating all kinds of febrile processes for 200 years.

Amoebic dysentery

As for dysentery, whose terrible effects killed thousands of people who died soaked in vomit and bloody diarrhea, one of the first steps towards its eradication took place in 1875 when Fedor Lösch discovered an amoeba ( known today as amoeba). Entamoeba histolytica) in the feces of a patient who suffered from that disease.

In 1961, after overcoming seemingly insurmountable research difficulties, Louis Klein Diamond succeeded in growing the amoeba in vitro. The same decade in which E. histolytica was identified, two bacterial genera, Salmonella and Shigella, have been found to cause other forms of dysentery. It was quickly proven that the root of ipecac has no effect on these bacteria, which made it an effective diagnostic element for food poisoning.

Singer Karen Carpenter behind a microphone in a recording studio, Los Angeles, 1980.Photo by Bonnie Schiffman (Getty Images)

Emetine hydrochloride

In the early 19th century, the Chemical School of Paris discovered that the ipecac root contained two powerful alkaloids, cephaleline and emetine (methylcephealine), which caused continuous vomiting and diarrhea. Emetine is obtained by direct extraction from ipecac root or by methylation of cephaelin in the laboratory.

Emetine has many pharmacological abilities. In eukaryotic cells, it inhibits protein synthesis, preventing the binding of peptide chains. In mammals, it blocks mitochondrial oxidative phosphorylation, interrupting the functioning of cellular respiration and causing important alterations in the heart and nervous system.

The practice of the hospital showed that it was extremely effective in eradicating amebiasis dysentery, but it presented considerable practical difficulties. To begin with, the patient must remain completely at rest during the treatment. In addition, it should be administered by injection and the dose should be precisely adjusted. On the other hand, it was essential to maintain close observation to detect reactions in the gastrointestinal tract (vomiting and diarrhea), the nervous system (polyneuritis) and, above all, potentially fatal cardiovascular alterations, including hypotension and tachycardia

If one of these appeared, the treatment must be stopped immediately because, despite the strict precautions, cases of sudden death were not uncommon.

In the early 1950s, alternative treatments that were effective orally and without potentially lethal cardiac effects were sought. Finally, success was achieved with diloxanide for intestinal amoebiasis and with metronidazole for the hepatic form.

Ipecac and vomiting

Ipecac powder is an effective and safe inducer of vomiting (90% success rate after 20 minutes), which is why it was very useful for gastric lavage in case of poisoning. Only occasionally will it cause serious complications, such as rupture of the esophagus or stomach, pneumomediastinum, pneumoperitoneum and aspiration pneumonia.

Botanical engraving of Ipecacuanha, by William Rhind.THEPALMER (Getty Images)

On the one hand, the dust directly irritates the stomach and the upper intestine and, on the other, once absorbed into the blood, it acts indirectly on the chemoreceptors in the area postrema of the medulla oblongata, which controls vomiting in the mammals.

In the 1990s, there was a broad consensus to abandon its emetic use, replacing it with the instillation of activated carbon. Once its use in the hospital was suppressed, it continued to be used uncontrollably as a drug by patients with anorexia nervosa and bulimia, whose abuse produced a clinical syndrome that included myopathy, neuropathy, convulsions and sudden death

Karen weighed 40 kilos

In 1975, at the peak of her career, Karen weighed 40 kilos (88 pounds). For years he was fighting anorexia nervosa, a disease about which almost nothing is known and whose exact cause is still unknown. In 1982, when he weighed only 34 kilos (75 pounds) and his digestive system was so damaged that he could only be fed intravenously, he underwent psychological treatment.

She confessed that she could ingest more than 90 laxatives based on ipecac at a time and 10 pills a day of a medication based on Levothyroxine, a synthetic form of tyrosine, the thyroid hormone that speeds up the metabolism. In 1983, her mother found her passed out in her room. She arrived at the hospital alive, but her heart could not take it. The autopsy revealed everything: his body contained large doses of ipecac which he had used as an inducer of vomiting.

Forty years have passed since his death. At least it is comforting to know that his voice continues to be a perfect gift to remember a unfortunate young woman who in 2023 would have completed 73 years.

Manuel Peinado Lorca is a university professor and director of the Royal Botanical Garden of the University of Alcalá.

This article was originally published in The Conversation.

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