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Eating disorders like anorexia nervosa (AN) are mental health conditions, but they can result in a number of physical complications.
Severely restricting dietary and caloric intake, as is nearly always the case with AN, can lead to low body weight, malnutrition, and a loss of muscle mass.
The extreme restriction involved with anorexia nervosa can lead to heart beat irregularities (arrhythmia) and other heart damage in several ways.
The dearth of calories can lead to the loss of muscle mass, including within the heart, which can negatively affect the way the heart functions. Dietary restrictions can also lead to nutritional deficiencies and electrolyte imbalances, which can severely impact heart rhythms.
This range of potential cardiac issues is part of why AN has the highest mortality rate among all eating disorders. (1)
When the heart rate is persistently low, it's called bradycardic. And this issue is especially common in patients with AN, with various studies finding bradycardia anorexia in up to 41% of hospitalized patients, and hypotension in 16% of patients. (6,7)
Low heart rate with anorexia nervosa is most often connected to severe weight loss, which can cause significant changes to metabolism and disrupt electrolyte balance. Overall, most studies show that cardiac changes ensue when someone dips below 80%-85% of their ideal body weight. (3, 5)
The heart must pump so many times per minute and create a high enough blood pressure to send blood to vital organs and tissues throughout the body. When the heart rate is too low, blood can not circulate throughout the entire body. This can lead to tissue and organ damage and, in severe and prolonged cases, organ failure. (3)
Happily, it is possible to improve heart rate and heart muscle with healthy weight restoration, though this process can be dangerous, and should be done under the direct supervision of a physician. When the body lives in a state of severe starvation for a long time, it undergoes major changes to conserve energy. The sudden consumption of calories again can throw this new system into disarray, causing electrolyte imbalance that can lead to a potentially deadly condition called refeeding syndrome. (13)
It's also possible for anorexia nervosa to lead to a high heart rate, called tachycardia.
While low heart rate with anorexia nervosa is usually an adapted response to prolonged starvation and negative energy balance, tachycardia is more usually connected to nutritional deficiencies.
Severe iron deficiency (anemia) is one of the most common issues that can lead to a high heart rate. It's also possible for someone to develop high heart rate due to infection, which people with AN are more susceptible to, due to a lack of adequate nourishment. (12) In fact, when someone with AN develops a resting high heart rate, it's often recommended to investigate for the infectious cause. (12)
This type of arrhythmia can also increase the risk of heart attack. When electrolyte abnormalities, which commonly result from improper nutrition, come into play, it often leads to severe cardiac episodes. (11)
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Slow heart rate and fast heart rate are not the only cardiac complications connected to anorexia nervosa.
If you or a loved one are struggling with an intense fear of gaining weight, severely limited dietary intake, or other symptoms of anorexia nervosa or another eating disorder, it's highly recommended to seek out help.
Speaking with your healthcare provider can be especially helpful if you have concerns regarding your heart rate. But the faster you seek out help, the better. Eating disorders, and their related medical issues, don't go away on their own, and they tend to get worse as time goes on.
Our team at Within Health can help with the treatment of anorexia nervosa or other eating disorders.
Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.
Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.
Yes. Anorexia nervosa can lead to various types of arrhythmia and electrolyte imbalances, which can all contribute to a heart attack. Refeeding after prolonged periods of AN can also potentially lead to cardiac arrest.
Yes. Many studies have shown that heart damage can be reversed with healthy and sustained weight restoration. This may not be the case in all scenarios, however. The longer someone battles with AN, the likelier they will suffer significant damage, which is why it's important to seek out help as quickly as possible.
