Medical Complications of Eating Disorders Part 1: Electrolyte Imbalances
Written by CCTC Staff Writer
Blood tests are usually required to start any form of eating disorder treatment. This is because a small number of people suffer from one or more medical complications of eating disorders. Blood tests, specifically, inform treatment providers about potential electrolyte imbalances.
In the first part of our Medical Complications of Eating Disorders series, we’ll discuss the following:
A simple definition of electrolytes
The vital functions of electrolytes
How eating disorder behaviors can affect your delicate electrolyte balance
Signs and symptoms of electrolyte abnormalities
What to do if you experience symptoms
But first and foremost: You do not need any medical complications of an eating disorder to have an eating disorder.
Eating disorders are mental illnesses. The only way to tell if someone has an eating disorder is by their thoughts and behaviors concerning food, body image, exercise, purging, etc.
Your eating disorder is valid and life-threatening whether you have any physical side effects or not. No matter what you look like, how much you weigh, or what any medical test results say, you can still be suffering from an eating disorder.
Do not let anyone, even undereducated medical professionals, tell you otherwise.
Related: Here’s what to do if you feel like you’re “not sick enough” to have an eating disorder.
What are electrolytes?: A Straightforward Definition
Electrolytes are minerals (which are solid and inorganic) that carry an electric charge when they are dissolved in a liquid such as blood. Many automatic (unconconscious) processes need a small electric current to function, and electrolytes provide this current.
The body requires a relatively large amount of macrominerals, including sodium, potassium, chloride, calcium, magnesium, and bicarbonate, to function.
Electrolytes are found in the fluids in your body.
What do electrolytes do? Why do you need them to function?
Regulate Hydration
Over half of the human body is made up of water. The water is restricted to various spaces, called fluid compartments. There are three main compartments: fluid within cells, fluid in the space around cells, and blood.
To function normally, your body has to keep fluid levels in these compartments from changing too much.
The fluid levels within a compartment depend on the amount (the concentration) of electrolytes — sodium, especially — in the space. If the concentration of electrolytes in a compartment is too high, fluid moves into the space. If the concentration is too low, then fluid moves out of the compartment. Having the right balance of electrolytes in each compartment is critical to maintain proper fluid levels in each part of your body.
Think of it like sweetening coffee or tea: If there’s too much, you dilute it with more water. If there’s not enough sugar, you have to add more of it.
Maintain Acid-Base Balance
The blood has certain levels of acids and bases (also known as alkalines). They have to keep a precise balance. Then a minor deviation from the normal acid-base balance can cause serious damage to your vital organs.
Bicarbonate, an electrolyte, acts as a sort of “buffer” to guard against sudden shifts in the level of acidity in your body that occurs during metabolic processes like muscle movement.
Control Muscle and Nerve Functions
The muscles and neurons function using the movement of electrolytes in and out of cells. You need calcium, sodium, and potassium to contract your muscles. So, if there is an imbalance in any of these, your muscles might be too weak to move, or they tense up uncontrollably.
Your nervous system sends electrical impulses to the rest of your body. Sodium generates this electrical charge.
Electrolyte Complications Due to Purging Behaviors
Dehydration and electrolyte loss can occur with every form of purging: vomiting, laxative use, diuretic use, and intense exercise. Patients suffering with anorexia, bulimia, or EDNOS may engage in purging behaviors.
Low Potassium Levels (Hypokalemia)
You lose potassium in vomit, urine, and/or stool. Your kidneys work hard to maintain blood potassium levels, but they can only do so much.
Symptoms of low potassium include:
Muscle weakness and/or cramping
Respiratory muscle weakness (causing shortness of breath)
Very slowed digestion, which leads to severe constipation and abdominal distension
Irregular heartbeat
Cardiomyopathy (weakening heart)
Involuntary muscle contractions
Extremely low potassium levels can cause heart failure and sudden death. Low potassium is a rare, but very serious, complication.
Low Calcium Levels (Hypocalcemia)
Low calcium levels can happen due to the prolonged use of diuretics to purge.
The largest concern of low calcium is the stripping of calcium from the bones, which can lead to brittle bones. Eventually, sufferers may develop osteoporosis, a painful and disabling bone disease.
Low Blood Sodium Levels (Hyponatremia)
Your blood sodium levels are not the amount of salt in your blood. It’s the ratio of water to salt in your blood.
Any form of purging can cause low blood sodium due to the loss of water and salt.
There are two types of hyponatremia: acute and chronic:
Acute hyponatremia is severe. It can cause a person to feel confusion, have seizures, fall into a coma, and go into respiratory failure. Hyponatremia can also lead to brain swelling and herniation, which is fatal.
2. Chronic hyponatremia is more subtle. Symptoms include:
Headaches
Lethargy
Nausea
Vomiting
Dizziness
Muscle cramps
There is a risk of brain damage if chronic low blood sodium is corrected too quickly, so sodium levels are usually balanced in a hospital setting.
High Bicarbonate Levels (Metabolic Alkalosis)
This is one of the most common electrolyte abnormalities associated with purging. Vomiting, laxative and diuretic abuse can cause a rise in bicarbonate because of dehydration.
Recall that bicarbonate is a “buffer” electrolyte that upholds the body’s acid-base balance when it goes through metabolic processes like digesting sugar, storing energy, and muscle movement.
When there is too much bicarbonate in the blood, it's pH level is too basic. Because the "buffer system" is slow acting, it's hard for the body to quickly get back to the acid-base balance.
Someone with high bicarbonate levels may not notice, as they may not experience any symptoms. But severe metabolic alkalosis can cause muscle spasms and seizures.
Low Bicarbonate Levels (Metabolic Acidosis)
Purging behaviors can cause both high and low bicarbonate levels. Low bicarbonate levels are due to laxative abuse, as the body loses bicarbonate through stool. Low bicarbonate levels cause the blood to be too acidic.
Symptoms of low bicarbonate levels, also known as metabolic acidosis, include:
Rapid breathing
Weakness
Fatigue
Nausea
Decreased appetite
Low Magnesium Levels (Hypomagnesemia)
The body does not naturally produce magnesium, so we can only get it through nutritional intake.
Frequent purging can cause malnutrition, especially low magnesium.
A magnesium deficiency can also cause calcium and potassium deficiencies, as magnesium helps absorb and transport these electrolytes through the body.
Symptoms of mild hypomagnesemia include:
Twitches, especially in the facial muscles
Weakness and exhaustion
Nausea
Vomiting
Personality changes
Tremors
Very pronounced reflexes
Constipation
Numbness
Severe magnesium deficiency can also cause muscle contractions, seizures and potentially fatal changes in the heart’s rhythm.
Electrolyte Abnormalities Due to Restrictive Behaviors
We get electrolytes (which, again, are minerals) like sodium, potassium, calcium and chloride from the food we eat. We need a variety of foods to get an adequate amount of electrolytes.
Ketoacidosis (Excess Ketone Production)
When a person fasts or restricts carbs for a long time, they do not get enough in enough glucose (aka sugar) to use as it's main source of energy. So, it has to rely on another source of energy: fatty acids.
Ketones build up, because they are a byproduct of fatty acid breakdown. This buildup, which is called ketosis, starts after a mere twelve to fourteen hours without taking in sugar.
Ketoacidosis is a dangerous buildup of ketones, which turns the blood acidic. It happens after two or three days of not eating. Once the body runs out of fat to break down, muscle breakdown may begin.
Symptoms of ketoacidosis include:
Rapid breathing
Weakness
Fatigue
Nausea
Decreased appetite
Muscle weakness
Ketoacidosis can happen to anyone with any eating disorder.
Any eating disorder tendency can lead to ketosis/ketoacidosis:
Restricting food groups as part of "clean eating"
Long term restriction leading to malnutrition
Purging nutrients before they can be absorbed and used
Fasting after a binge
Intermittent fasting
Fad dieting
Restricting insulin is a separate eating disorder called diabulimia. People with Type 1 and Type 2 diabetes can suffer from this disorder.
Ketoacidosis can happen to anyone who does not get proper nutrition, no matter what they weigh.
Low Blood Sodium Levels
Recall that blood sodium levels are not the amount of sodium in the blood, but the ratio of sodium to water in the blood. Malnutrition can lead to a lack of sodium in the blood, which causes low sodium levels.
Excess fluid intake to stave off feelings of hunger can also cause the ratio of water and sodium to be imbalanced. This also causes low sodium levels.
Low Magnesium Levels
Restricting food groups causes malnutrition. Magnesium is often found in foods high in carbs and fat, so restricting foods in these groups can cause a magnesium deficiency.
What should you do if you have an electrolyte imbalance?
Severe dehydration is a huge risk factor when it comes to electrolyte imbalances. If you are experiencing dehydration, drinking something with electrolytes can help. If you are experiencing any symptoms on this list, consider getting tested for electrolyte issues.
Sudden electrolyte abnormalities may require immediate medical intervention. If you are experiencing severe dehydration, heart palpitations, fainting spells, or any other severe symptoms, seek out help immediately.
The best long-term treatment for electrolyte imbalances, though, is tackling the underlying eating disorder behaviors.
So take the first step towards mental and physical health — ask for help.
If you or a loved one is suffering from an eating disorder, take the first step today and talk to someone about recovery or simply learn more about the holistic eating disorder recovery programs we offer.