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

A recently published biography of 1970s pop star Karen Carpenter has revealed that the publication of her death from heart failure covered up death from slow poisoning caused by her addiction to ipecac root, an ancient indigenous medicine that has been banned from clinical practice since the late 20th century. .

Ipecak, an old acquaintance of tropical phytotherapy

A written history of ipecac (Carapichea ipecacuanha)the plant by the side of the road that makes you sick in a dull language, begins when it arrived in Europe thanks to Willem Piso, in whose Historia Naturalis Brasiliae (1648) was first listed as an inducer of fever and vomiting used by the natives of the Amazon. The physician Helvetius used it to treat dysentery suffered by Louis XIV’s relatives. Then the plant disappeared from the history of the pharmacopoeia until it reappeared in the 18th century in the main formula of the famous Dover powder, a cure-all based on ground ipecac root, opium and potassium sulfate that, like the modern day aspirin, was very popular for the treatment all kinds of febrile processes for 200 years.

Amoebic dysentery

As for dysentery, the terrible effects of which killed thousands of people who died of vomiting and bloody diarrhea, one of the first milestones for its eradication occurred in 1875 when Fedor Lsh discovered the amoeba (now known as 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 amoeba in vitro. The same decade in which E. histolytica two bacterial genera were identified, Salmonella and Shigella, have been found to cause other forms of dysentery. It was soon proven that ipecac root has no effect on these bacteria, making it an effective diagnostic element for food poisoning.

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

Emetine hydrochloride

In the early 19th century, the Paris School of Chemistry discovered that ipecac root contained two powerful alkaloids, cephalelin and emetine (methylcephaline), which caused persistent vomiting and diarrhea. Emetine is obtained by direct extraction from ipecac root or 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 cellular respiration and causing important changes in the heart and nervous system.

Hospital practice proved extremely effective in eradicating amoebiasis dysentery, but presented considerable practical difficulties. To begin with, the patient had to remain completely still during the treatment. Moreover, it had to be given by injection, and the dosage had to be precisely adjusted. On the other hand, careful observation was necessary to detect reactions in the gastrointestinal tract (vomiting and diarrhea), nervous system (polyneuritis) and, above all, potentially fatal cardiovascular changes, including hypotension and tachycardia.

If any of the above appeared, treatment had to be stopped immediately because, despite strict precautions, cases of sudden death were not uncommon.

Beginning in the 1950s, alternative treatments were sought that were effective orally and without potentially fatal cardiac effects. Finally, success was achieved with diloxanide for intestinal amebiasis and metronidazole for the hepatic form.

Nausea and vomiting

Ipecac powder is an effective and safe emetic (90% success after 20 minutes), which is why it has been very useful for gastric lavage in cases of poisoning. Only occasionally does it cause serious complications such as esophageal or gastric rupture, pneumomediastinum, pneumoperitoneum, and aspiration pneumonia.

A History of the Plant Kingdom, William Rhind 1855
Botanical engraving of Ipecacuanha, William Rhind.THEPALMER (Getty Images)

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

In the 1990s, there was a broad consensus to abandon its use for emetics, replacing it with activated charcoal instillation. When its clinical use was suppressed, it continued to be used uncontrolled as a drug by patients with anorexia nervosa and bulimia, whose abuse caused a clinical syndrome that included myopathy, neuropathy, seizures, and sudden death.

Karen weighed 40 kilograms

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

She admitted that she could simultaneously take more than 90 ipecac-based laxatives and 10 tablets a day of levothyroxine, a synthetic form of tyrosine, a thyroid hormone that speeds up metabolism. In 1983, her mother found her unconscious in her room. She arrived at the hospital alive, but her heart failed. The autopsy revealed everything: in her body there were large doses of ipecac, which she used as an emetic.

Forty years have passed since her death. At least it’s comforting to know that her voice is still the perfect tribute to the memory of the unfortunate young woman who would have turned 73 in 2023.

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

This article was originally published in Conversation.

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