Understanding yellow skin in anorexia nervosa

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Anorexia nervosa (AN) is a serious medical condition that can cause damage to the liver, which may result in a yellowing of the skin, known as jaundice.

Read on to learn more about why yellow skin in anorexia patients may occur, and how it can be resolved in eating disorder treatment.

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What is jaundice?

Jaundice is when the whites of your eyes or skin turn yellow. It’s caused by the build-up of a yellow substance called bilirubin in the body. (1)

Bilirubin is found in red blood cells, and when red blood cells die, the yellow substance is filtered from the bloodstream by the liver. However, if there’s a problem and the liver can’t keep up, bilirubin builds up, causing the yellow tinge to skin and eyes. (2)

Several things can cause jaundice, including: (2)

  • Gallstones
  • Alcohol-related liver disease
  • Hepatitis
  • Sickle-cell disease
  • Pancreatitis
  • Blocked bile ducts
  • Certain medications, like steroids, that are linked to liver disease

What’s the connection between AN, the liver, and jaundice?

Inflammation and elevated liver enzymes

Abnormal liver functioning can also be one of the complications of an eating disorder, like anorexia nervosa. Research shows that AN can cause inflammation in the liver, as well as an excess of liver enzymes. (3)

These signs of liver damage are more likely to be seen in people with anorexia who are severely malnourished, and can prevent the liver from effectively cleaning bilirubin from the body, resulting in jaundice. (4)

Laxative jaundice

People with anorexia nervosa who regularly use laxatives can experience what’s known as laxative jaundice. The more laxatives a person uses the less sensitive their body becomes to them. As a result, they need to take more laxatives to get the desired effect.

As the liver is responsible for breaking down any drugs ingested and filtering out toxins, it can become overwhelmed by the excessive amount of laxatives. This results in bilirubin remaining in the body, leading to jaundice. (3)

What’s the difference between jaundice and carotenemia?

Carotenemia is also something that is seen in those with anorexia, which causes a build up of yellow pigmentation of the skin as a result of increased beta-carotene levels in the blood. In most cases, it’s caused by prolonged and excessive ingestion of carotene-rich foods, such as carrots, sweet potatoes, dark leafy greens, and cantaloupe. (6)

This over-consumption of these low calorie foods is common in people with AN and the resultant yellow skin is often mistaken for jaundice. However, where those with jaundice have a yellow tinge all over the body, including the whites of the eyes, in cases of carotenemia, the yellow tone is usually concentrated on the hands, palms, and soles of the feet, and never in the eyes.

The discoloration of carotenemia usually fades once the excessive consumption of beta-carotene rich foods. Jaundice takes longer to resolve, requiring the treatment of the underlying cause of liver damage.

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How to manage jaundice and anorexia nervosa?

If you or someone you know has a yellowing of the skin and is also suffering from anorexia nervosa, seeking immediate treatment is really important as it can indicate serious liver damage, which requires early intervention.

Anorexia nervosa treatment provides nutritional rehabilitation and psychotherapy, as well as medical treatment for organ dysfunction, including liver damage. During treatment for AN, behavioral and group therapy will address the underlying causes and triggers for disordered eating behaviors.

Nutrition counseling provides an education around the nutrients the body needs to function properly, as well as providing a meal plan to ensure patients are getting the right caloric intake through a balanced diet. Supervised meals provide support for those with anorexia nervosa who still find it difficult to refrain from disordered eating behaviors or still struggle with the urge to purge.

The good news is that a sufficient caloric intake and a return to an adequate body weight will usually lead to reestablishment of normal liver enzyme levels and therefore resolve jaundice. Even acute cases of liver failure in people with anorexia nervosa are reversible with improved nutritional intake. (5)

Patients will often receive regular liver function tests during treatment, which may show an increase in liver enzymes following the start of the refeeding process. This is normal, as it may take several days or more for the liver to replenish its nutrition stores and return to normal function. (7)

When the liver is finally out of starvation mode, it will once again begin to break down excess bilirubin from the blood, and yellow skin will fade back to normal.

Healing from yellow skin anorexia is possible with treatment, and care. If you or someone you love is looking for help in healing from an eating disorder, our team at Within Health is here to support you. Our clinical care team provides virtual care programs attuned to your specific needs. Start healing today.

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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.

Resources

  1. NHS. (n.d.). Jaundice. NHS choices. Retrieved April 29, 2022, from https://www.nhs.uk/conditions/jaundice/ 
  2. WebMD. (n.d.). Jaundice: Why it happens in adults. WebMD. Retrieved April 29, 2022, from https://www.webmd.com/hepatitis/jaundice-why-happens-adults 
  3. Eating disorders and correlating digestive problems. Eating Disorder Hope. (2021, December 8). Retrieved April 29, 2022, from https://www.eatingdisorderhope.com/long-term-effects-health/digestive-problems 
  4. Hoffman, M. (n.d.). Liver function test. WebMD. Retrieved April 29, 2022, from https://www.webmd.com/hepatitis/liver-function-test-lft 
  5. Rosen, E., Bakshi, N., Watters, A., Rosen, H. R., & Mehler, P. S. (2017). Hepatic Complications of Anorexia Nervosa. Digestive diseases and sciences, 62(11), 2977–2981. https://doi.org/10.1007/s10620-017-4766-9
  6. Robert A Schwartz, M. D. (2021, March 26). Carotenemia. Background, Pathophysiology, Etiology. Retrieved April 29, 2022, from https://emedicine.medscape.com/article/1104368-overview 
  7. Mayo Foundation for Medical Education and Research. (2018, February 20). Anorexia nervosa. Mayo Clinic. Retrieved April 27, 2022, from https://www.mayoclinic.org/diseases-conditions/anorexia-nervosa/diagnosis-treatment/drc-20353597

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