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How do eating disorders affect the heart?

Eating disorders such as anorexia nervosa (AN), binge eating disorder (BED), and bulimia nervosa (BN) can adversely affect the heart and the function of the circulatory system, in both the short- and long term.

And while some resulting cardiovascular complications are reversible with the treatment of the disorder, others may be permanent or even life-threatening. That's why it's imperative to seek out help for an eating disorder as early on as possible.

6
 minutes read
Last updated on 
June 23, 2023
June 23, 2023
Person making a heart with their hands
In this article

How the circulatory system works

The circulatory and cardiovascular systems are comprised of three major components:

  • The heart
  • Blood vessels
  • Blood

Overall, the circulatory system has a dual purpose: to carry oxygen and other nutrients to the cells, and remove the waste from those same cells. In this task, each aspect of the system plays its own important role.

Blood vessels act as the highways and throughways, giving the blood passage throughout the body. The heart serves as a pump, giving the blood the push it needs to race through these arteries and veins. And the blood itself is what carries the oxygen, nutrients, and other vital substances to different areas of the body.

As the blood travels through, it also picks up waste products from these cells, which are then cleaned through special areas of the body called lymph nodes. The replenished blood eventually makes its way back to the heart, where it can be circulated again.

How do eating disorders affect the heart? 

Eating disorders of all kinds can cause major cardiovascular complications and other related issues, for a variety of reasons.

Anorexia nervosa, ARFID, and heart health

Anorexia nervosa and avoidant restrictive food intake disorder (ARFID) both involve extremely limited food intake, which can contribute to malnutrition and dehydration, among other issues. These, in turn, can lead to cardiac complications, including:1,2,3,4

  • Abnormally slow heart rate
  • Low blood pressure
  • Electrolyte imbalances
  • Arrhythmia, or irregular heartbeat
  • Fluid buildup on the heart that impairs its pumping ability
  • Shrinking of the heart muscle, causing ineffective pumping
  • Faulty heart valves or mitral valve prolapse, related to heart muscle loss
  • An overworked, enlarged heart muscle that contracts poorly
  • Heart failure or sudden cardiac death
Getting help for an eating disorder early on can help you avoid heart issues.

Bulimia nervosa and heart health

Bulimia nervosa involves cycles of binge eating and purging behaviors, which may put undue pressure on the cardiovascular system and lead to other complications, like electrolyte abnormalities.

Overall, this type of disordered eating behavior can increase the risk for cardiac diseases later in life, with one large study showing a 4-fold increase in cardiovascular disease for patients with active BN.7

But BN can also lead to a number of cardiac abnormalities in the short-term, including:5,6

  • Electrolyte imbalances from purging, including through self-induced vomiting or diuretic or laxative abuse
  • Arrhythmias, resulting in abnormal heart muscle contractions
  • Low blood pressure 
  • Sudden death from heart failure or an abnormal rhythm

Long-term, additional cardiac risks connected to bulimia nervosa include:7

  • Heart attack
  • Hardening of the arteries, which can lead to congestive heart failure or stroke
  • Blood vessel damage in the brain, resulting in dementia or strokes

Binge eating disorder and heart health

Binge-eating disorder is similar to BN, but people with this condition don't experience compensatory behavior after binge eating sessions.

Still, binge eating can cause weight gain or otherwise increase the likelihood of developing:8,9

  • Diabetes
  • High cholesterol
  • High blood pressure
  • Chronic pain disorders 
  • Gout (related to high uric acid levels, which can cause kidney or joint disorders)
  • Sleep disorders, such as apnea

These BED-associated medical complications are also all connected to a heightened risk for developing cardiovascular disease. So someone with BED may also be at an elevated risk for experiencing heart attacks, strokes, blood clots, and symptoms related to poor circulation.

Heart hands

Signs of circulation problems in the body

Whether or not you or a loved one are struggling with an eating disorder, you should seek out medical care if you experience any of the following signs or symptoms of circulation problems in the body:5

  • Chest pain or pressure
  • A racing or fluttering heartbeat 
  • Swelling in the feet or ankles
  • Unexplained shortness of breath
  • Dizziness, especially with position change or with exertion
  • An episode of fainting or passing out
  • Severe, recurring muscle cramps

These symptoms may indicate an underlying circulatory system issue, which could require additional treatment. In severe cases, immediate medical attention may be needed to stabilize someone, before any related or underlying conditions can be addressed.

Finding help for circulation problems caused by an eating disorder

The key to treating circulatory problems related to an eating disorder is to seek treatment early. As is true with eating disorders themselves, circulatory system problems can rapidly develop into debilitating or even life-threatening conditions, so the more quickly an intervention can be made, the better.

People struggling with eating disorders, or those close to them, should keep an eye out for any related signs or symptoms, and act quickly if they see or experience them. A doctor can then perform an analysis, which may examine:

  • Vital signs, such as blood pressure, pulse rate, and temperature
  • Blood chemistries, to evaluate electrolyte levels
  • Heart rhythms, as seen through an electrocardiogram (ECG)
  • Cardiac muscle and valve function, seen through an echocardiogram or heart ultrasound5,10

With results in hand, the doctor can then make an official diagnosis, decide on any additional tests they may want to conduct, or help a patient create an appropriate treatment plan.

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How heart and circulatory problems are treated

Different cardiovascular complications of eating disorders can be treated with different methods, medications, and other types of care.

In cases of low blood pressure, fluid replacement may be able to help. Intravenous electrolyte replacement can mitigate electrolyte imbalances. Correction of these two problems may help prevent cardiac arrhythmias and improve fatigue, dizziness, or cramping symptoms.5

There are medications available to treat an abnormal heart rhythm or reduced heart pumping. Addressing the underlying eating disorder with improved nutritional intake can prevent or reduce the chance of heart attack, heart muscle-related dysfunction, and long-term cardiovascular disease risk in persons with anorexia nervosa and bulimia nervosa. 

And those with blood sugar, cholesterol, and blood pressure issues should also seek out medical help as early as possible to reduce the risk of experiencing a cardiovascular event.5

Finding help for an eating disorder

Eating disorders are dangerous and potentially deadly conditions, and finding help is a crucial aspect of overcoming these issues. Reporting circulatory signs or symptoms related to an eating disorder can be lifesaving.

At Within Health, our professionals are ready and available to help. Contact us to learn about our eating disorder treatment program if you or a loved one need support.

Call (866) 293-0041

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.

Resources

  1. Burns, J., Shank, C., Ganigara, M., Saldanha, N., & Dhar, A. (2021). Cardiac complications of malnutrition in adolescent patients: a narrative review of contemporary literature. Annals of Pediatric Cardiology, 14(4), 501–506.
  2. Choi, S. Y., Lee, K. J., Kim, S. C., Lee, E. H., Lee, Y. M., Kim, Y.-B., Yi, D. Y., Kim, J. Y., Kang, B., Jang, H.-J., Hong, S. J., Choi, Y. J., & Kim, H. J. (2022). Cardiac complications associated with eating disorders in children: a Multicenter retrospective study. Pediatric Gastroenterology, Hepatology & Nutrition, 25(5), 432–440.
  3. Cost, J., Krantz, M. J., & Mehler, P. S. (2020). Medical complications of anorexia nervosa. Cleveland Clinic Journal of Medicine, 87(6), 361–366.
  4. Springall, G. A. C., Caughey, M., Zannino, D., Kyprianou, K., Mynard, J. P., Rudolph, S., Cheong, J., Yeo, M., & Cheung, M. M. H. (2023). Long-term cardiovascular consequences of adolescent anorexia nervosa. Pediatric Research, 1–8.
  5. Friars, D., Walsh, O., & McNicholas, F. (2023). Assessment and management of cardiovascular complications in eating disorders. Journal of Eating Disorders, 11(1), 13.
  6. Brown, C. A., & Mehler, P. S. (2013). Medical complications of self-induced vomiting. Eating Disorders, 21(4), 287–294.
  7. Tith, R. M., Paradis, G., Potter, B. J., Low, N., Healy-Profitós, J., He, S., & Auger, N. (2020). Association of bulimia nervosa with long-term risk of cardiovascular disease and mortality among women. JAMA Psychiatry, 77(1), 44–51.
  8. Harris, S. R., Carrillo, M., & Fujioka, K. (2021). Binge-eating disorder and Type 2 diabetes: a review. Endocrine Practice: Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, 27(2), 158–164.
  9. Olguin, P., Fuentes, M., Gabler, G., Guerdjikova, A. I., Keck, P. E., & McElroy, S. L. (2017). Medical comorbidity of binge eating disorder. Eating and Weight Disorders, 22(1), 13–26.
  10. Sachs, K. V., Harnke, B., Mehler, P. S., & Krantz, M. J. (2016). Cardiovascular complications of anorexia nervosa: a systematic review. The International Journal of Eating Disorders, 49(3), 238–248.

FAQs

Can anorexia cause heart problems?

Yes. Malnutrition, dehydration, and starvation associated with anorexia nervosa can cause abnormal heart rhythms, heart muscle defects, and blood pressure problems that can be life-threatening.

Can bulimia cause heart problems?

The purging behaviors, diuretic use, or laxative overuse which often accompany bulimia nervosa can cause a severe electrolyte imbalance, leading to heart rhythm problems and, potentially, death.

Can starvation cause a heart attack?

Malnutrition and starvation can lead to heart rhythm problems and heart muscle dysfunction that can cause the heart muscle not to contract correctly. The result can be cardiac oxygen deprivation and, ultimately, a heart attack.5

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Further reading

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