How do eating disorders affect the heart?

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

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.

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 ultrasound^5,10

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.

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