The Effects of Eating Disorders on Nutrition


by Jeannie Versagli, RDN, CN

There is an alarming number of men and women in the United States that suffer from eating disorders. An estimated 20 million women and 10 million men suffer from an eating disorder in their life. Research indicates that eating disorders are six times more prevalent than Alzheimer’s disease, and ten times more prevalent than Autism. Every 62 minutes, at least one person dies as a result of complications related to their eating disorder.

Eating disorders have an insidious reputation for striking the athletic population. In many cases, an eating disorder can fly under the radar for a while since the behaviors seem justified for the sake of improved athletic performance or acceptance of a particular “body-type”. In a study of Division 1 NCAA athletes, over one-third of female athletes reported attitudes and symptoms placing them at risk for anorexia nervosa.  Female athletes that participate in ice skating, gymnastics, diving, and ballet are at greater risk of developing eating disorders. Male athletes are at risk—if competing in sports such as wrestling, bodybuilding, crew, and running. In sports that focus on the individual rather than the entire team, both males and females are more likely to fall victim to an eating disorder.

Types of Eating Disorders

Anorexia Nervosa: This disorder is characterized by low body weight, a distorted perception of body image, and a fear of gaining weight as a result of extreme calorie restriction. The result is often a body starved of all nutrients, which causes constipation, low heart rate, low blood pressure, abdominal pain, dry skin, loss of menstrual periods, bone loss, kidney problems, and a decline in brain function.

Bulimia NervosaThis eating disorder is the result of vomiting and or the overuse of laxatives after a binging episode. The unhealthy purging of calories can lead to swollen glands, mineral and electrolyte imbalance, poor dental health, dehydration, and a decline in brain function.

Binge Eating:  This disorder is defined as consuming unusually large amounts of food and feeling unable to stop eating. The effect of these significant caloric consumption episodes is the pancreas releases large amounts of insulin. Over time this can lead to insulin resistance, causing an increased risk of a heart attack, high blood pressure, high cholesterol, kidney disease, arthritis, bone loss, type 2 diabetes, cancer, and stroke.

Research has identified two new eating disorders that are related to extreme exercising.  These activities are called Anorexia Athletica/Hypergymnasia & Exercise bulimia. Although not yet recognized as clinical diagnoses in the DSM-5, they are considered a subset of bulimia and other eating disorders. Many use the terms interchangeably to describe an eating disorder where people manage their caloric intake via obsessive-compulsive overexercising. To take a further look at the conditions, “Anorexia Athletica” is defined as anorexia plus excessive exercise, while “exercise bulimia” is characterized by using exercise as a compensatory way to purge calories after a binging session or consuming more calories than the individual deems “acceptable”. Both groups of individuals find themselves suffering from extreme anxiety when unable to exercise or if their preferred method of exercise is unavailable. Individuals will exercise even when sick or injured, prioritize exercise over social dates, family functions, work, or school, suffer intense guilt when forced to stray from an exercise routine, and refuse to eat or severely restrict calories if unable to exercise. These individuals have a high risk of injuries, heart problems, suppressed immune function, electrolyte imbalances, sleep disturbances, arthritis, and reproductive problems.

Nutrient deficiencies will manifest long before an eating disorder is diagnosed. Studies show that individuals with eating disorders suffer from low levels of calcium, iron, riboflavin, folic acid, vitamin A, D and C, B6, zinc, and essential fatty acids. Many of these nutrients are important for managing mood and brain health. Eating disorders affect every part of the body from the brain to the gut.  Long-term deprivation of essential nutrients, resulting in malnutrition, causes a host of consequences such as loss of appetite, intestinal pain, constipation, chest pain, anxiety, depression, reduced immune function, loss of lean body mass, altered brain function, chronic fatigue, and poor sleeping habits. A common thread that you see with these disorders is depression, insomnia, irritability, compulsive thoughts, loss of libido, and stress.


The list below identifies some of the major consequences of eating disorders-

  • Cardiovascular consequences. With starvation comes a lack of protein consumption, resulting in a structural change of the heart. This structural change causes a reduction of the heart muscle compromising cardiac output.
  • Brain function. Starvation causes cognitive functions to decline secondary to the lack of essential nutrients available for proper brain function.
  • Gastrointestinal function. Consequences of starvation result in prolonged gastric emptying, constipation, and abdominal pain.
  • Endocrine consequences occur during starvation resulting in amenorrhea (lack of menstrual cycles,) Hypothyroidism, and Osteoporosis (loss of calcium in the bone, resulting in an increased risk of bone fractures). 
  • Dental problems happen as a result of purging, where stomach acids wear down dental enamel of the teeth. The esophagus also gets worn down from the exposure of the stomach acids.

Probiotics: There is compelling evidence that intestinal microbiota regulates weight, energy metabolism signal hunger, improve anxiety, and depression. When these bacteria are compromised in eating disorders, lack of appetite, depression, and anxiety appear and hinder recovery. 

Eating disorders are very complex diseases. So much of the body is affected that, for a full recovery, the following disciplines are necessary to successfully overcome these disorders; nutritional therapy, psychotherapy, and cognitive and behavioral therapy.

Typically, the individual presents with multiple nutrient deficiencies that influence the well-being of an individual. The challenge to the dietitian is to introduce nutrients to improve brain health and gut health. We understand how nutrition plays a critical role in the healing process. The dietitian and client work together to develop a plan that will incorporate necessary nutrients into their everyday life. As professionals, we are challenged to empower and teach individuals how nutrition can be their path to wellness.

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