MEDICAL COMPLICATIONS INVOLVED IN EATING DISORDERS
(As described by Carolyn Costin, LMFT, MA, MEd in her book “100 Questions & Answers About Eating Disorders)
The medical complications for eating disorders are quite varied. Different people get different symptoms. Some problems are caused by starvation or malnutrition, and others are caused from purging methods such as laxative abuse or vomiting. A variety of medical problems occur as a result of excessive weight gain from bingeing. Refer to the following alphabetical list for the various medical complications usually seen in eating disorder clients.
Acid Reflux: This is very common in eating disorders, especially in people with bulimia. The valve that should control stomach acid becomes faulty. Partially digested items in the stomach, mixed with acid and enzymes, leak back into the esophagus and even the mouth. Reflux can sometimes become severe enough that food cannot be kept down at all, and medical attention should be sought immediately. Persistent unremitting reflux can cause a serious condition called Barrett’s esophagus, which is a change in the cells within the esophagus that can lead to cancer.
Amenorrhea (loss of the menstrual cycle): Lack of adequate nutrition results in insufficient hormone levels and often, but not always, weight loss and loss of body fat. Some combination of these factors causes the loss of menstruation, and a loss of bone density (discussed next).
Bone Density Problems: Thinning of the bones is one of the most serious and possibly irreversible problems with eating disorders, especially in anorexia nervosa. Individuals who have amenorrhea over a period of time lose bone density and can end up with osteopenia, which is below-normal bone mass, or osteoporosis, where the bone loss has become sufficient enough to be called a disease. In osteoporosis the reduction in bone mass causes the bones to be porous and to fracture or break easily.
Bruising of the Skin: Low blood pressure, low platelet count, extreme weight loss, and vitamin/mineral deficiencies all lead to easily bruised skin that can take a long time to heal.
Cardiovascular (slowed or irregular heartbeat, arrhythmias, angina, heart attack): Many factors associated with eating disorders can lead to heart problems or a heart attack. Sudden cardiac arrest is one of the leading causes of death in anorexia nervosa, and there is speculation that this is true for bulimia also. Electrolyte imbalances (especially potassium deficiency), dehydration, low blood pressure, extreme orthostatic hypotension, and abnormally slow heart rate can all cause serious problems with the heart. Excessive weight can cause high blood pressure, accumulation of fat deposits around the heart muscle, high cholesterol, and hormonal imbalances, which also lead to serious problems with the heart
Dehydration: This can be caused by depleting the body of fluids by vomiting, laxative or diuretic abuse, or by the lack of intake of sufficient fluids. It is interesting to note that dehydration can also be caused by restriction of carbohydrates and fat. Symptoms include dizziness, weakness, or darkening of urine and can lead to kidney failure, heart failure, seizures, brain damage and death.
Dental Problems: Stomach acids from vomiting cause erosion of tooth enamel, severe decay and gum disease. Vitamin D, calcium deficiencies and hormonal imbalance cause decalcification of the teeth.
Digestive Difficulties: A deficiency in digestive enzymes leads to the body’s inability to properly digest food and absorb nutrients. This can lead to malabsorption problems, malnutrition and electrolyte imbalances. Delayed gastric emptying is common and individuals complain of early satiety. Digestive enzymes and/or a medication to speed gastric emptying may be necessary.
Dry Skin, Hair and Nails and Hair Loss: This is caused by vitamin and mineral deficiencies, malnutrition and dehydration.
Edema: Swelling of the soft tissues is the result of excess water accumulation from laxative or diuretic abuse.
Electrolyte Imbalances: Electrolytes are essential to the production of the body’s natural impulses to the nerves, muscles and organs and to the delivery of oxygen to the cells. Eating disorder patients can die from cardiac arrest due to electrolyte imbalance. Low potassium (hypokalemia) and high bicarbonate (metabolic alkalosis) are the most common electrolyte abnormalities seen in patients who purge either with diuretics or with vomiting; these abnormalities are potentially the most dangerous. Hypokalemia can cause cardiac conduction defects, and arrhythmias and metabolic alkalosis can cause seizures and arrhythmias. Laxative abuse often, but not always, causes a low potassium level, a low bicarbonate level and a high chloride level, together referred to as hyperchloremic metabolic acidosis.
Gastrointestinal Complaints (cramps, bloating constipation, diarrhea and incontinence): Bowel and stomach complaints are the most common. There can be increased or decreased bowel activity. Lack of food or cessation of laxative use may lead to severe constipation, and if there is pain and the constipation persists, a blockage should be ruled out. Gastric rupture has occurred from binging, and sometimes there is gastrointestinal bleeding into the digestive tract.
Hypo- and Hyperglycemia: Hypoglycemia (low blood sugar) can indicate problems with the liver or kidneys and can lead to neurological and mental deterioration. Hyperglycemia (high blood sugar as a result of low production of insulin) can be a result of poor eating habits and excess weight and can lead to diabetes.
Hyponatremia (low sodium): Water is good for us, but earing disorder clients often drink too much, believing it is healthy, using it to distract from hunger, or “water loading” to artificially raise their scale weight for a weigh in. Drinking too much water (more than eight 8-ounce glasses in less than 12 hours) can cause fluid in the lungs, the brain to swell, nauseousness, vomiting, confusion and even death.
Infertility: Loss of menstrual cycle, hormonal imbalances, malnutrition and vitamin deficiencies can affect the ability to have children and can also increase problems with pregnancy and birth defects. Additionally, at least one study has suggested that people with eating disorders were at an increased risk for developing polycystic ovarian syndrome.
Iron-deficiency Anemia: Low iron makes the oxygen-transporting units within the blood useless and can lead to fatigue, shortness of breath, increased infections and heart palpitations.
Ketoacidosis: A high level of acids build up in the blood (know as ketones) when the body burns fat instead of sugar and carbohydrate. This can lead to coma and death. This problem has arisen with people on high fat and severely low carbohydrate diets, such as the Atkins diet. Ketoacidosis can be caused by starvation, excessive purging, dehydration, hyperglycemia, alcohol abuse and diabetes.
Kidney Infection and Failure: Kidneys are the body clearinghouse. Our kidneys clear poisons from the body, regulate acid concentration and maintain water balance. Dehydration, infection and low blood pressure increase the risks of kidney problems.
Lanugo (soft downy hair on face, back and arms): There is a protective mechanism built into our bodies to help keep us warm during periods of starvation and malnutrition. This mechanism causes us to grow fine hair on the body to protect it from the cold. Occasionally, the eyelashes of a person with an eating disorder get fuller as part of the same mechanism.
Liver Failure: The liver aids in removing waste from cells and aids in digestion. Loss of menstruation, dehydration and chronic heart failure can lead to liver damage or failure.
Low Blood Pressure or Hypotension: Low blood pressure can be cause by starvation, lowered body temperature, malnutrition and dehydration. This can cause heart arrhythmias, shock or cardiac arrest. Orthostatic hypotension occurs when there is a sudden drop in blood pressure upon sitting up or standing. Symptoms include dizziness, blurred vision, fainting, heart pounding and headaches.
Low Body Temperature: Most people with anorexia and some with bulimia complain of being cold all the time. This is caused by low blood pressure and the loss of body fat and muscle. The healthy insulating layer of fat that normally protects from the cold is gone and the person is not eating enough to generate heat.
Malnutrition: Malnutrition means there is a deficiency in some or all of the following: calories, protein, fat, carbohydrates, certain nutrient, or micronutrients necessary for health. Malnutrition can cause sever health risks, including (but not limited to) respiratory infections, kidney failure, blindness, heart attack and death.
Pancreatitis: Excessive use of laxatives or diet pills can cause digestive enzymes to attack the pancreas, causing pancreatitis.
Parotid Gland Swelling: Parotid glands (salivary glands) are located behind the cheek and under the ear. Both parotid glands swell as a result of vomiting, usually after an individual has stopped for a day or more. The swelling makes the person look like they have the mumps. To help alleviate the swelling, the person can suck on tart candies.
Seizures: There seems to be an increased risk of seizures in individuals with anorexia and bulimia, which may be caused by dehydration, hyperglycemia or ketoacidosis. It is also possible that long-term malnutrition and lack of oxygen-carrying cells to the brain may play a role.
Sleep Problems: Eating disorder clients often have problems falling and/or staying asleep, which could be caused by a variety of issues.
Tearing of Esophagus: Tiny tears, now as Mallory-Weiss tears, can be caused by repeated, forceful, self-induced vomiting. Individuals may notice blood in their vomit, but this condition is not usually dangerous.
Weakness and Fatigue: This is caused by generalized poor eating habits, electrolyte imbalances, vitamin and mineral deficiencies, depression, malnutrition and hear problems.