When it comes to eating disorders, we are often uneducated as to the extent of their risks. Sure, we know they are detrimental, but when I struggled with one for eight years, I had no real awareness of what type of bodily harm I inflicted on my organs.
Of course I noticed the physical effects: thinning hair, sallow eyes and stress fractures from running. I observed the light-headedness and fainting spells, but I never took time to explore what that meant internally, especially for my heart.
Now in recovery from my eating disorder, I spent time speaking with cardiologists and medical professionals around the country to learn more about the harmful effects that eating disorders can have on your organs — specifically, your heart.
While anorexia is most commonly associated with heart complications due to starvation and malnutrition, all eating disorders have the potential to affect the heart.
“With anorexia, the body enters a state of starvation induced by the restricting, and the heart slows down to often dangerously low levels called bradycardia,” Dr. Vikas Duvvuri, medical director at Cielo House, told SheKnows. “But, all forms of eating disorders carry with them the possibility of serious cardiac issues.”
Complications can arise with bulimia and binge eating, as well as exercise bulimia and EDNOS (eating disorder not otherwise specified). Due to the binge and purge associated with bulimia, fluid loss speeds up the heart (tachycardia), so when a person stands up suddenly, it can lead to fainting spells. In addition, purging depletes electrolytes, similar to the effects of dehydration, and the electrolyte imbalances can cause abnormal heart rhythms called arrhythmia, which can result in cardiac arrest, when the heart stops beating.
Binge eating, on the other hand, can involve metabolic changes if continued long-term and in response can damage the blood supply to heart muscles and lead to heart attacks. Complications of the heart are also increased if the patient suffers from obesity due to their binge eating.
Fueled by competitive expectations, it comes at no surprise that eating disorders in athletes are higher than the general population. Whether it be exercise bulimia (working out multiple times per day) or trying to preserve a perfect, restrictive diet (orthorexia) under the guise of training, athletes’ diets can be confusing because from the outside perspective, the patient appears to simply be trying to maintain an advantage.
The true issue lies in the public misconception that an athlete’s heart is healthier than most due to extensive training, and therefore “natural” for their heart to beat at a low resting rate.
“We often treat reluctant patients with bradycardia who are admitted to our facility because they classify themselves as an athlete,” said Dr. Ovidio Bermudez, chief clinical officer and medical director of child and adolescent services at the Eating Recovery Center. “The patient, as well as their family, will argue that a low heart rate is their baseline due to good physical conditioning. However, this is not entirely accurate. Especially if the athlete is underweight, a low resting heart rate is not a sign of good health, but of cardiac damage imposed by the eating disorder.”
So how can doctors adequately distinguish between a healthy heart in an athlete versus an eating disorder heart complication?
“A review of their past medical checks will likely show that their baseline heart rate was higher with a normal blood pressure,” said Duvvuri. “A thorough analysis of their eating and exercise behaviors can indicate whether their heart rate is impacted by the eating disorder.”
Malnourishment often leads to complications with the heart.
“Bradycardia and low blood pressure are the two most common heart issues seen in eating disorders — especially anorexia,” said Dr. Jennifer Haythe, assistant professor of medicine in the Division of Cardiology at Columbia and co-director of the Women’s Center for Cardiovascular Health. “As patients with anorexia lose weight, they lose cardiac muscle mass.”
Due to these cardiac conditions stemming from lack of nutrition, people may have fainting spells. These conditions are easily remedied through proper nutrition. However, they can also lead to more dangerous heart conditions if untreated. The most frequent — and deadliest — of severe heart complications seen in eating disorders is sudden cardiac arrest.
Patients with eating disorders often believe that if they don’t have a heart problem when first admitted to the hospital, then are diagnosed later, they will be able to recover solely with better nourishment. However, the reality is that recovery from anorexia involves a risky period for the patient known as the “refeeding process,” which refers to the time in which trained clinicians provide adequate calories and nourishment to severely underweight patients.
Reintroducing food to a malnourished person has risks and cardiac complications if handled without expertise and can lead to a lethal condition called “refeeding syndrome,” in which malnourished patients might develop fluid and electrolyte disorders when finally nourished. The shifting of electrolytes and fluid balance increases cardiac workload and heart rate, which can lead to acute heart failure or, more commonly, cardiac arrhythmias.
There is hope if you struggle with an eating disorder. The vast majority of complications from eating disorders, including heart conditions, normalize during recovery, which is why early treatment is critical.
However, for people with anorexia, about 20 percent will struggle with a prolapse (slipping) of the mitral valve, which is the heart valve between the upper and lower chambers on the left side of the heart.
“Mitral valve prolapse can absolutely persist even after weight gain,” cautioned Haythe.
If you are struggling with an eating disorder, don’t wait until you feel “sick enough.” Educate yourself, because it might just help you to understand how crucial it is to seek help.
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