5 Truths You Need to Know About Eating Disorders and Your Heart

Here’s the truth about eating disorders: we are often uneducated as to their risks.

Sure, we “know” they are detrimental, but when I struggled for 8 years I had no real awareness as to what type of bodily harm I inflected on my organs.

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.

Here’s what they had to share:

• Anorexia is NOT the only eating disorder that puts hearts at risk

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,” said Dr. Vikas Duvvuri, MD, Medical Director at Cielo House. “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 where 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 that lad to heart attacks. Complications of the heart are also increased if the patient suffers from obesity due to their binge eating.

“The surge of insulin takes its toll as well as high glucose levels for obese binge eaters,” said Dr. Jennifer Haythe, MD, Assistant Professor of Medicine in the Division of Cardiology at Columbia, and Co-Director of the Women’s Center for Cardiovascular Health. “In obese patients, the risks of hypercholesterolemia, hypertension, and diabetes are high. All of these can lead to cardiac complications.”

• There is a misconception about athletes and the heart that could be deadly

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.”

The question at the end of the day is how can Doctors adequately conclude the difference 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 Dr. Duvvuri. “A thorough analysis of their eating and exercise behaviors can indicate whether their heart rate is impacted by the eating disorder.”

• Eating Disorder Sufferers Can Suffer Cardiac Arrest – Without Warning

While in treatment, I once remember catching a fellow patient as she fainted from standing too fast. Immediately, she was sent to have tests done on her heart. At the time, I was misinformed enough to think it was simply from lack of nutrition. I didn’t realize that malnourishment often equates to complications within the heart.

“Bradycardia and low blood pressure are the two most common heart issues seen in eating disorders – especially anorexia,” said Dr. Haythe. “As patients with anorexia lose weight, they lose cardiac muscle mass.”

Due to these cardiac conditions stemmed from lack of nutrition, it can often lead to fainting spells. Upon proper diet and sustenance, 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 Cardiac Arrest or “Sudden Cardiac Arrest.”

“Patients often have a false sense of security that they are doing fine despite chronic symptoms. Individuals who are not adhering to their treatment team’s recommendations, and believe they do not need the indicated amount of nutrition, are more likely to be caught off guard by sudden cardiac events,” explained Dr. Duvvuri.

Sudden Cardiac Arrest is a condition that can stem from bradycardia in which the heart suddenly and unexpectedly stops beating. In other words, the electrical impulses that cause the heart to beat are turned off due to its slow heart rate and beats per minute.

“Continued treatment and an open and collaborative relationship with your treatment team is a great way to hedge against the possibility of such events,” said Matt Keck, MFT, Clinical Director and Founder of Cielo House.

• Recovery is More Complicated than “Just Eating More.”

In the beginning of my eating disorder treatment, I had my heart monitored multiple times a day.

“Why?” I complained. “There was nothing wrong with my heart when I was admitted.”

This mentality is a common misconception with eating disorders – especially anorexia. Patients often believe that if they don’t have a problem when first admitted, it’s only going to get better with 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,” where malnourished patients might develop fluid and electrolyte disorders when finally being nourished.

For a patient with anorexia, the body goes into “starvation mode” and switches its main fuel source from carbohydrates to fatty acids or amino acids as the main energy source. During refeeding, insulin secretion resumes in response to increased blood sugar from nourishment; resulting in increased glycogen, fat and protein synthesis among other complications. The shifting of electrolytes and fluid balance increases cardiac workload and heart rate. This can lead to acute heart failure or, more commonly, cardiac arrhythmias.

“At Eating Recovery Center, our patients are monitored during the refeeding process for complications that may arise,” explained Dr. Bermudez. “We assess the cardiovascular state of an individual at risk for or with known cardiovascular complications and address these as needed and depending on the severity of the complications.”

Patients entering treatment with present heart complications often need to be hospitalized in a specialized telemetry unit that can track heart rhythms until they can be cleared for a lower level of care.

“After a period of stabilization, continued treatment and monitoring is necessary to ensure that the heart heals adequately,” cautioned Mr. Keck. “Fortunately, it can often be done at lower levels of care, once the client has resumed normal nutrition, which is often the best medicine.”

• Your Heart CAN recover from an eating disorder – But there’s a caveat

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 mitral valve prolapse, which is the heart valve between the upper and lower chambers on the left side of the heart. The valve closes when the lower heart chamber contracts to pump blood throughout the body. The changes in the heart muscle mass compared to the structure of the heart valve can affect the closing of the valve.

“Mitral valve prolapse can absolutely persist even after weight gain,” cautioned Dr. Haythe.

At the end of the day, humans are malleable and the heart is an adaptable organ that strives to work for you, not against you. However, the heart ages like the rest of the body and with prior damage to the heart from an eating disorder, a relapse easily becomes more life-threatening and the heart has less potential to recover as effortlessly or as wholly.

If you are struggling with an eating disorder, don’t wait until you feel “sick enough.” Educate yourself because, perhaps, it will help you to understand how crucial it is to seek help.