Eating disorders don't just result in drastic changes in body weight, up and down. They can also disturb electrolyte balance, cause anemia, and trigger the symptoms of malnutrition. Here are 10 things you need to know.
Many people who live with anorexia or bulimia can receive emergency refeeding over and over again
Malnutrition becomes chronic in people who live with anorexia or bulimia. They may need supervised refeeding programs to treat malnutrition over and over again in the course of their gradual recovery.
There are objective symptoms that indicate malnutrition needing urgent treatment
Anyone who has an eating disorder who has a pulse slower than 45 beats per minute, or blood pressure below 90/60, or a temperature below 97 degrees F (36 degrees C) probably needs emergency feeding in a hospital setting. Blood tests that indicate a potassium level lower than 3 meq/liter or who has muscle weakness, muscle cramps, or constipation due to failure of the muscles controlling the rectum and anus likewise probably needs emergency attention.
Restoring normal nutrition after malnutrition caused by an eating disorder is not a do-it-yourself activity
One of the dangers of restoring normal nutrition after starvation is giving people too much food too fast. The body can get so busy rebuilding its supply glycogen in the liver and the muscles and fat in fat cells that bloodstream concentrations of potassium, magnesium, and phosphorus can become dangerously low. The resulting electrolyte imbalances can cause disturbances in heart rhythm and kidney function and even convulsions and coma. These complications of refeeding sometimes are fatal. Anything more than small amounts of food given to someone coming out of a state of starvation is dangerous.
Vitamin A-deficiency blindness can result from eating disorders
Every year, millions of children in 75 developing countries, most of them in sub-Saharan Africa and South Asia, lose their night vision or go completely blind due to vitamin A deficiency. It only takes a single large dose of vitamin A, consumed with fat so the body can absorb it, to prevent night blindness and even total blindness. However, vitamin A-deficiency blindness doesn't just occur in developing nations. It can also strike adults who don't get their vitamin A, or who can't absorb vitamin A because they refuse to eat fat. Both anorexia nervosa and bulimia nervosa occasionally are associated with loss of sight.
People who live with anorexia or bulimia can develop an Alzheimer's-like condition
A form of dementia known as Wernicke-Korsakoff syndrome is not unknown in people who live with eating disorders. Caused by a deficiency of the B-vitamin thiamine, Wernicke-Korsakoff can produce loss of coordination, leg tremors, drooping eyelids, double vision, and memory loss. These symptoms may persist for a year or more even after B-vitamin supplementation.
Calcium deficiency leads to osteoporosis in anorexia
People who have anorexia are prone to osteoporosis not just in the hip, lower back, and wrist but all the bones of the body due to prolonged deficiencies in calcium, magnesium, phosphorus, and vitamins D and K2.
Eating disorders sometimes cause a kind of anemia due to iron deficiency, but more often the problem is vitamin B12
Not eating enough can cause iron-deficiency anemia. But not eating enough and subjecting the stomach lining to damage by inducing vomiting can result in megaloblastic anemia, due to a deficiency of vitamin B12. The two types of anemia can both occur at the same time, and are easily identified by a blood test.
Anorexia and dehydration can become a vicious cycle
People who don't eat enough usually don't drink enough. And people who drink so little water and other fluids that they become dehydrated lose their appetite. It may be necessary to keep track of water/electrolyte consumption to make sure dehydration does not occur. As little as 1200 ml (three cups, not even three "glasses") of water per day is enough to prevent dehydration in sedentary people not exposed to heat.
Binge-eating disorders often result in vitamin D deficiency
Binge eaters usually don't get a lot of sun so their bodies don't make a lot of vitamin D. Vitamin D deficiency, however, has more to do with fat mass. Vitamin D is soluble in fat. In binge eaters (assuming they are overweight, as most binge eaters are) tend to have large amounts of fat underneath the skin. This subcutaneous fat traps vitamin D and keeps it from traveling into the bloodstream to be circulated to the rest of the body.
Highly selective eating habits can lead to scurvy
The vitamin C-deficiency disease known as scorbutus or scurvy was once a scourge of sailors on the high seas who failed to receive fruit or vegetables for weeks or months at a time. Scurvy causes deterioration of connective tissues, noticeably between the gums and teeth, general muscle weakness, and susceptibility to infection. Scurvy occurs in eating disorders when the person with the disorder refuses fruit and vegetables. It is easily corrected with vitamin C supplementation as long as there is at least a small amount of vegetable or fruit consumption to provide a vitamin C cofactor.