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3 Common Types of Eating Disorders and Their Effects on the Heart

1. Anorexia nervosa. People with anorexia typically have a distorted body image, an intense fear of gaining weight and an obsession with limiting the amount of food they eat. They often engage in behaviors to prevent weight gain, such as severe calorie restriction and excessive exercise. Anorexia has the highest mortality rate among eating disorders, with cardiac complications accounting for up to of these deaths.

Impact on the heart:

• (slow heart rate). With fewer calories for fuel, the body will try to conserve energy by slowing down all functions, including heart rate. A dangerously low heart rate can lead to fatigue, dizziness and even cardiac arrest. For most adults, a resting (not sleeping) heart rate between 60 and 100 beats per minute is considered normal. A heart rate of fewer than is considered bradycardia. Athletes or adults who are highly physically active can have naturally lower resting heart rates because their cardiovascular system is more efficient at circulating oxygen.
• Hypotension (low blood pressure). Malnutrition and dehydration can cause a drop in blood pressure. This can lead to weakness and fainting.
• Loss of heart muscle mass (atrophy). Because anorexia induces cachexia (profound muscle wasting), the body may break down heart muscle for energy, making the heart smaller and weaker and reducing its ability to pump blood effectively.
• Pericardial effusion. Fluid can build up around the heart, especially in low protein states, restricting its ability to fill with blood and pump effectively.
• Arrhythmia (irregular heartbeats). Electrolyte imbalances from diets without adequate protein, vegetable and mineral content may weaken the heart and disrupt its electrical system. This disruption can interfere with the normal rhythm of heartbeats.
• Heart failure. All of the previously mentioned complications can put a strain on your heart, weakening it and making it less able to pump blood and oxygen to your organs and tissues. A failing heart can lead to:
  • Fluid retention
  • Narrowing of blood vessels
  • Increased heart rate
• Cardiac arrest. This sudden loss of heart function can happen because of extreme electrolyte imbalances, leading to dangerous, life-threatening arrhythmias.

2. Bulimia nervosa. People with bulimia have a cycle of binge eating (consuming large amounts of food in a short period of time) followed by purging to prevent weight gain. Purging methods can include self-induced vomiting as well as the misuse of laxatives and diuretics. Those with bulimia may also engage in compulsive exercise or alternate bingeing with fasting (periods of not eating) to avoid weight gain. While in this cycle, a person’s weight may not fluctuate significantly, making it more difficult for loved ones to notice.

Impact on the heart:

• Electrolyte imbalance. All purging methods can lead to significant losses of essential minerals like potassium, magnesium, sodium and calcium, which are important for proper heart function. Electrolyte imbalances can lead to arrhythmias and even cardiac arrest.
• Dehydration. Vomiting and laxative abuse can cause dehydration and more mineral imbalance, making it harder for the heart to pump blood and potentially increasing your heart rate.
  
• Damage from ipecac syrup. Some people with bulimia use ipecac syrup to induce vomiting. This product is meant for the emergency treatment of some types of poisoning. If misused, it can damage the heart muscle and can cause cardiomyopathy (a disease that weakens the heart muscle) and sudden death.
  
• Heart disease. that bulimia is associated with a higher long-term risk of heart disease, including coronary artery disease, heart attack and stroke.

3. Binge eating disorder.  Binge eating disorder is the eating disorder in adults. People with binge eating disorder have frequent periods of compulsive overeating without purging. In addition to anxiety, depression and feelings of guilt and shame, this disorder can lead to weight gain and obesity, which are independent risk factors for heart disease.

Impact on the heart:

• High blood pressure (hypertension). Excess weight puts extra strain on the heart to pump blood harder, leading to elevated blood pressure.
  
• Hardening of the arteries (atherosclerosis). Unhealthy eating patterns associated with binge eating can lead to increased levels of cholesterol and triglycerides, increasing the risk of plaque buildup. The plaque can narrow and harden artery walls.
  
• Heart disease. The combination of high blood pressure, high cholesterol and obesity significantly increases your risk of heart disease, including coronary artery disease, heart attack and stroke.
  
• Type 2 diabetes. Often associated with obesity, Type 2 diabetes can damage blood vessels and nerves that control the heart, increasing your risk of heart disease.

General Signs and Symptoms of Heart Problems Related to Eating Disorders

The following symptoms can be experienced across all eating disorders due to heart complications, regardless of the specific type of disorder:

• Dizziness or lightheadedness
• Fainting
• Chest pain
• Shortness of breath
• Palpitations
• Fatigue and weakness
• Swelling in your feet or ankles

Importance of Early Detection

Many of the cardiovascular complications of eating disorders can be reversed or improved with timely and appropriate treatment. However, some damage to the heart may be irreversible, emphasizing the importance of early intervention.

According to Alyssa M. Vela, PhD, a cardiac psychologist at the Northwestern Medicine Bluhm Cardiovascular Institute, you can use the following questions as a starting point to help you decide if it’s time for you or a loved one to talk with a medical professional:

• Do you use food to cope with stress or loneliness?
• Does your weight affect your outlook on life?
• Are you preoccupied by food?
• Do you engage in binge eating or purging?
• Do you avoid eating when you are hungry?
• Do you isolate when you eat or eat in secret?
• Do you feel out of control when you eat?
• Do you feel guilt, remorse or disgust after you eat?
• Do you avoid close relationships and activities?
• Do you feel like food has taken over your life?

It’s never too early to ask for help for an eating disorder. An important step is to talk with a healthcare professional like your primary care physician, a mental health specialist or a registered dietitian. Be honest and open about your eating habits, thoughts and feelings. This will help your care team make an accurate assessment and recommend the most appropriate treatment plan.  

Treatment for Eating Disorders

“The most effective treatment for eating disorders is often a combination of cognitive behavioral therapy, nutritional therapy and sometimes medication,” says Dr. Vela. Other treatments can help reverse the heart complications from eating disorders, including:

• Nutritional rehabilitation
• Weight restoration
• Cessation of purging behaviors
• Addressing electrolyte imbalances

Medical specialists may also be necessary for these treatments as well as health problems like low blood pressure or arrhythmia.

According to Clyde W. Yancy, MD, MSc, professor and chief of Cardiology at »ªÌå»á, “It is important to recognize eating disorders as clinical conditions and to especially destigmatize obesity. We now refer to medical obesity and treat it as we would any other risk factor for heart conditions. Breakthrough research now indicates an enormous benefit profile of a healthy weight leading to a reduction in heart events and heart disease. It’s time to be much more vocal about all eating disorders and medical obesity.”

If you or someone you know is experiencing feelings of hopelessness or having thoughts of suicide, call or text the National 988 Suicide & Crisis Lifeline at 988 or chat at . In life-threatening situations, call 911.