TW: The following article describes information about eating disorders that can be triggering for some people as it aims to describe some of the medical complications that can result from anorexia nervosa. Do not hesitate to contact us if you have any questions.
What are eating disorders? How and why do they happen? Is recovery possible? If you’re reading this article, it’s possible that you or someone you know might be experiencing complications from an eating disorder (ED) and maybe you have some of the same questions.
This article is the first in a 4-part series exploring some of the medical complications of EDs, and how recovery can reverse them or prevent them from worsening.
A Brief Overview of Eating Disorders
Eating disorders are mental health disorders that impact one’s physical, mental and emotional wellbeing. They result in distressing thoughts and emotions around food that cause severe and ongoing disturbances in eating behaviours (1). They can affect people of all ages, genders, shapes, sizes, sexual orientations and social, religious, ethnic and economic backgrounds (1) – all of that to say, they can affect anyone and they are not choices. EDs can develop at any time during a person’s life, though they commonly develop during adolescence and young adulthood.
There are different types of eating disorders that all have their own definitions and classification criteria, outlined by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (1). Why people develop EDs is still not fully understood; however, research suggests that a variety of factors can influence one’s risk, including genetics, environmental, psychological, and social impacts (2). It can be helpful to remember that no one thing, person or event ever causes a person’s eating disorder.
What is anorexia nervosa?
Anorexia Nervosa (AN) is characterized by severe caloric restriction and distorted body image, leading to a significantly low body weight and an intense fear of weight gain.
There are two subtypes of AN (1):
- Restricting type, where the primary behaviours include dieting, fasting or compulsively/excessively exercising
- Binge/purge type, where the primary behaviours include periods of eating large quantities of food in a short amount of time and/or purging (through vomiting, diuretic use, laxative use and others)
Some common signs and behaviours associated with AN include:
- A fixation on food and calorie intake, recording intake, weighing food
- Significant weight loss, or a significantly low body weight for age, sex and height
- Food restriction (in terms of quantity, types of foods, food rules
- Severe body image concerns (ex. intense fear of getting fat, concerns around weight, shape or size)
- Excessive and/or compulsive exercise
- Loss of or irregularity in menstruation
- Low energy, fatigue and/or difficulty concentrating
- Intolerance to the cold
- Hair loss or dry, brittle hair
Some Medical Complications of AN
Our bodies like having consistent, adequate, and satisfying supplies of food, and when those needs are not regularly met, our bodies begin to adapt and conserve energy, prioritising only the most essential functions. Adaptations are not always consistent from person to person (often influenced by genetic adaptations in our ancestral line), but everyone with AN or presenting with AN behaviours will see complications develop. Although in no way an exhaustive list of complications, as outlined below, our body systems can be impacted from head to toe (3,4):
Brain Health
AN is linked to causing a variety of changes in the brain, which are all directly tied to the severity of restriction, weight loss or weight suppression. These changes can include losing brain tissue (meaning losing neurons and the connections between them), and losing significant amounts of the brain’s grey and white matter (meaning that the brain loses some ability to control movement, memory, speech and emotions and some ability for different parts of the brain and body to communicate with one another).
As a result of these changes, the brain also starts to have difficulty with normal functioning, including regulating hormone levels (which can lead to menstruating individuals losing their period), regulating body temperature (which is why many with AN become intolerant to cold, and in serious situations, can develop fine, “fuzzy” hairs on the face and body called lanugo), and create changes in mood, behaviour and cognition.
For example, it is common for people with AN to develop behaviours that are associated with other mental health disorders like obsessive-compulsive disorder (OCD), psychosis, and substance abuse disorders. People with AN often become rigid and strict around eating or exercise, engage in meal and exercise tracking, strive for perfection with food, body and social aspects like school or work, and much more. Up to 75% of those with AN also experience anxiety and depression, and it is also common to develop self-harming behaviours.
Blood and Heart Health
With severe caloric restriction, the body loses heart muscle in order to preserve other muscle. One can experience a variety of symptoms including weakness, dizziness, fatigue, and lightheadedness. A drop in normal blood pressure and heart rate is also commonly experienced, due to factors like dehydration. Dehydration with an inadequate intake can also cause dangerous electrolyte imbalances that can become fatal. Orthostatic vital signs should be checked regularly by a doctor or a nurse practitioner (by testing blood pressure while laying down and standing and comparing variations) to monitor and assess heart function and stability. Anyone with AN or suspected AN with a heart rate below 40 bpm also requires close medical supervision, even if the person is an athlete/athletic.
Gastrointestinal Health
One of the ways that the body adapts to energy restriction is by reducing the functioning of the body processes that are less important for survival (like, digestion when eating is limited). Similarly, one’s metabolism (or the sum of reactions that occur in the body to provide itself with energy) significantly reduces. The body does this to try to favour survival and try to limit weight loss from burning more energy than what’s being eaten (think of a bear in hibernation for the winter).
Because of these adaptations, the gut can slow by up to 50%, and many people with AN often experience symptoms similar to irritable bowel syndrome, like gas, bloating, cramping and abnormal bowel movements (especially constipation). Some can also develop a condition called gastroparesis, where digestion in the stomach is slowed so much that one can feel really full for hours after only having a few bites (among other symptoms).
Bone Health
Bones are porous structures in the body that require a variety of nutrients to keep strong. A lot of those nutrients, like calcium, vitamin D, magnesium and more, are required to be eaten since the body cannot make them itself. With the extreme restriction of intake, the body relies on bones to retrieve these vitamins and minerals for their other body uses, which depletes bones and increases the risk of osteoporosis.
The risk of osteoporosis is also increased in those with low estrogen levels (which we know can be caused by restriction), as estrogen plays a role in supporting bone density. Around 40% of women with AN experience osteoporosis over the course of their ED. Women with AN for over 5 years have an annual fracture rate around 7 times higher than that of women without AN. Studies also show that men with AN tend to have more severe bone loss than women with a similar course of illness.
Conclusion
Anorexia nervosa, whether diagnosed or not, can lead to a variety of medical complications that can significantly impact one’s current and future quality of life. It can have impacts on body functions from head to toe and cause various physical, psychological, emotional, behavioural and medical challenges. AN can be deadly, and at the same time, some people experience these symptoms and still live “their life”, which can make the disease confusing. Regardless, recovery is an essential part of treatment for anyone with an eating disorder.
Stay tuned for our article about the effects of eating disorder recovery, to learn more about how most ED symptoms resolve with adequate nourishment. If you or someone you know is struggling with their eating, body image or is presenting with signs of AN, feel free to reach out to the Sööma team for support at (514) 437-4260 or by email at info@sooma.ca.
By: Justine Chriqui, Registered Dietitian
Sööma est une entreprise bilingue qui fonctionne en anglais et en français. Nous fournissons des articles de blogue, des recettes et des articles de diverses sources qui sont parfois écrits en anglais et parfois en français. Si vous vous sentez incapable d’accéder à un article ou à un sujet spécifique en raison d’une barrière linguistique, veuillez nous contacter à info@sooma.ca et nous serons heureux de traduire le contenu pour vous.
Sööma is a bilingual company that operates in both English and in French. We will provide blog posts, recipes and articles from various sources that are sometimes written in English and sometimes in French. If you feel unable to access a specific article or topic due to a language barrier, please reach out to us at info@sooma.ca and we will be happy to translate the content for you.
References
- Guarda, A. (Feb 2023). What are Eating Disorders?. American Psychiatric Association. Retrieved from https://www.psychiatry.org/patients-families/eating-disorders/what-are-eating-disorders
- Eating Disorders: About More Than Food. (2021). National Institute of Mental Health. Retrieved from https://www.nimh.nih.gov/sites/default/files/documents/health/publications/eating-disorders/eating-disorders-about-more-than-food.pdf
- Herrin, M., & Larkin, M. (2013). Nutrition counseling in the treatment of eating disorders (2nd ed.). Routledge/Taylor & Francis Group.
- Gaudiani, J.L. (2018). Sick Enough: A Guide to the Medical Complications of Eating Disorders (1st ed.). Routledge.
