SINGAPORE - An anorexic woman's weight plummeted from 48kg to just 20kg over three to four years before she died last August.
An inquiry into the death of Ms Mindy Chua Zu-Yin, 39, revealed that she had died of a "natural disease process" - electrolyte imbalance due to anorexia.
The Straits Times had earlier reported that an electrolyte imbalance occurs when there are not enough salts in the body. Severe dehydration can also lead to an electrolyte imbalance.
Coroner Samuel Chua said in his findings on Monday (March 9) that, according to her parents, Ms Chua wanted to undergo a regime known as the Gerson Therapy about 10 years ago. This was because she wanted to restore her immunity as a form of "holistic treatment" as she had been putting on weight.
The coroner added: "She changed her diet to purely fruits and vegetables. Throughout the period that the deceased was undergoing Gerson Therapy, she kept losing weight."
The Straits Times had earlier reported that the therapy was developed by Dr Max Gerson in the 1930s in Germany to "reverse cancer".
The Cancer Research UK website states: "Gerson Therapy involves a specific organic vegetarian diet with nutritional supplements and enemas. There is no scientific evidence to use it as a treatment for cancer."
The coroner said Ms Chua was allegedly put on a Gerson liquid diet by a “Dr Raymond Yuen” and told to completely abstain from salt.
But, according to two reports from Dr Raymond Yuen Chuen Fong of Hosanna Medical Centre in January this year, she had only consulted him in October 2011. He also stated that he had not prescribed the Gerson Therapy to her.
Ms Chua later committed an offence, which was not stated in court documents, and the State Courts in 2016 referred her to the Institute of Mental Health (IMH) to assess if she was suitable for a mandatory treatment order (MTO).
Offenders given an MTO have to undergo treatment for their mental condition in lieu of jail time.
Coroner Chua said: "The deceased's history indicated a complicated set of mental health problems that began in her teenage years, characterised by a heightened sense of weight-consciousness - an excessive fear of becoming fat, food restriction, abnormal dietary habits, binging and purging, which were features of an eating disorder... She had no contact with IMH after 2016."
The coroner also said that Ms Chua had a history of complications following dental implants in the United States several years ago.
A report dated Nov 25 last year by a consultant psychiatrist in private practice, Dr Yeo Seem Huat, stated that Ms Chua had been observed for anxiety and kleptomania. She had also complained of being easily anxious and depressed.
She, however, refused psychiatric treatment and received only counselling as well as natural supplements.
On Aug 13 last year, she complained of breathlessness and went to Gleneagles Hospital.
At the hospital, Ms Chua was strongly advised that she needed immediate treatment for severe hyponatraemia (low blood salt levels) with intravenous sodium replacement.
Coroner Chua said she was "absolutely adamant" that she did not wish to be admitted despite being cautioned that her blood salt level was critically low and might be potentially life-threatening.
She was then discharged after her father signed a "request for discharge against medical advice" form.
Ten days later, at around 4pm, she asked her mother to prepare a coffee enema for her Gerson Therapy.
Ms Chua was later found unconscious in a toilet and a Singapore Civil Defence Force ambulance was dispatched to her home. Its location was not stated in court documents. A paramedic pronounced her dead at home at around 8.50pm on Aug 23.