It seems absolutely bizarre that weekly blood tests were once a normal part of my life (for such a long time!)
It seems so strange that I could ever have needed those results (along with weight, temperature, blood pressure, ECGs etc) to tell me if I was or wasn’t ok or more accurately to tell the doctor what level of not ok I was that week and if hospitalisation was necessary or if I would be able to keep myself out of hospital just barely for the next 7 days until we could do it again (and again and again and again)…
The interesting thing is even with all the results showing I wasn’t ok I felt powerless to change any of it.
When I thought about what I’d have to do to change it, it seemed impossible.
For one I’d have to eat.
And because I was so completely detached from my body, I wasn’t able to eat by simply listening to my body. Which meant the task of getting it right – what to eat, what not to eat, when to eat and how much to eat seemed monumental.
To be honest it seemed impossible.
How could I ever get it right?
The nitty gritty of it aside the truth is that even if I’d known how to “get it right”, even if I’d had a magical plan (which for a lot of the time I lived with an eating disorder I did have a magical plan designed by a dietitian I came back to again and again and which got me out of tricky places again and again) the fact was I experienced enormous fear around eating which simply made the pain of eating not worth it.
Having a plan didn’t stop the pain.
I was so stuck.
But I tried.
I tried to eat specific foods that would help digestion like stewed apple, that would improve my iron, B12 and zinc levels like eggs, seafood and pepitas, that would give me enough energy to work like bread, pasta and cheese, that would feed my healthy gut bacteria like yoghurt and fermented foods, that would ensure I was making important neurotransmitters (serotonin dopamine etc) like turkey and peas and so on.
I was once so overwhelmed by all the numbers and ranges and what it all meant and trying to balance it and get it right! Like many things while I was living with the disease anorexia nervosa I didn’t really know how much I obsessed over it at the time and it’s only in hindsight and now that none of those things are on my mind that I can see it was all so very unnecessary.
All I was ever doing was trying.
Trying so damn hard.
I want you to know something I wish someone told me and that is if you feel you must “try” to eat, if you feel you are fighting against yourself to eat well, please know that this is the place you should be addressing.
This is the place you need to address if you really want your experience of life to be any other way.
This is what you must address because when you change your reasons for not being able to eat, you will be able to eat.
And what I realise now is that I never actually had to stress and worry about getting it right,
My body just needed me to get out of the way so it could do its job.
My body was built for that.
All human bodies are built to be constantly and tirelessly redirecting and guiding us towards homeostasis. Trust was a concept that was unfathomable to me when I lived with anorexia nervosa. In theory I knew it. In feeling I didn’t believe it.
With all that being said if you’re in recovery from an eating disorder and being medically monitored including blood tests it is really useful to know the truth of what those results mean.
Not all doctors have the time to talk through it all with you.
Not all doctors have the training and understanding of what it all means.
Which is why in this week’s blog I’m taking the time to share with you a quick overview of 5 blood tests I regularly ask doctors to do for my clients, why I ask for these, what the results mean and some practical ways you can begin to improve each, today.
Starting with…
- Electrolytes
Electrolytes are minerals that play important roles in many bodily processes from nerve function to balancing your pH levels and helping with muscle contraction (including your heartbeat).
One of the most common electrolyte problems people with eating disorders experience is hypokalaemia or low potassium.
Potassium is the major electrolyte within nearly all the cells of your body.
Low potassium levels are a result of malnutrition (an inadequate intake of food) as well as vomiting (purging), excessive laxative or diuretic use because electrolytes are lost along with the fluid of vomiting and excessive laxative or diuretic use.
When blood potassium levels are low complications may include weakness, muscle cramps, seizures, paralysis, confusion, respiratory failure, constipation, impaired kidney function, heart palpitations (an irregular heartbeat) low blood pressure and cardiac arrest.
In other words, potassium is important and when you consider that potassium is just one of many electrolytes (other important electrolytes include sodium, chloride, bicarbonate, phosphate and calcium) it becomes evident that malnutrition has immeasurable harmful effects on a human body.
What Can I Do to Improve My Electrolytes?
They may give you electrolytes to take dissolved in water when you’re in hospital but this is only a temporary means of improving your electrolytes and the best thing you can do to improve your electrolytes (and make it just not a thing that they would ever be out of balance again) is to eat well.
If you find you are someone who tends to eat roughly (or exactly) the same things every day or who eats a very restrictive diet in terms of variety, regularity or quantity of food eaten you are at risk of electrolyte imbalances. There are specific foods you could target to ensure you are getting a mix of electrolytes but overall, the easiest way to think about it is to increase your food intake (number of meals, size of meals) and increase your food variety (choose a variety of foods from all 5 food groups. See my earlier blog What is “Healthy Eating” Anyway? for a brief discussion of the 5 food groups if you’re not sure what I’m referring to here).
The ways you go about increasing your food intake and the variety of foods you eat are ultimately up to you but please get professional help to do this because sudden increases in food intake after restriction pose their own problems in terms of further dysregulating electrolytes which can be life threatening.
Work with someone who can help not just monitor you but also assist you to increase your food intake and variety.
2. Iron
Iron is one of the minerals that is often low in people living with eating disorders.
This is for a number of reasons. One of the most common ones being it is common for people living with eating disorders to have a desire to be vegan or vegetarian and given that the most bioavailable (best absorbed by our body) sources of iron come from animal products this evidently poses a problem. When people aren’t replacing animal products with adequate sources of plant-based iron deficiency can arise relatively quickly (especially in women who lose iron each month through menstruation).
Any vitamin or mineral deficiency can be due to inadequate overall intake and eating a diet which is low in variety.
Which makes complete sense because the foods we eat are exactly where we get our vitamins and minerals from!
What Can I Do to Improve My Iron Levels?
The most easily absorbed iron is found in animal products (haem iron) including red meat and liver. Also, shellfish, eggs, fish, chicken.
Some of the best plant sources of iron (non-haem) are beans and lentils, tofu and tempeh, nuts, quinoa, fortified foods including breakfast cereals and breads.
If you are getting most or all of your iron from plant-based sources, it is recommended to include some vitamin C containing food at the same meal (such as tomato or citrus) to increase your uptake of non-haem iron.
I’d highly encourage you to work with a dietitian so they can assess your current intake and help you come up with ways that allow you to meet your iron needs, especially if you are plant based.
The amount of people I saw when I was doing my university placement come into clinic who had attempted a vegan diet (with wonderful intentions) and were suffering the consequences of doing little more than switching from eating meat to not eating meat without accounting for where they were now going to get their nutritional needs met was alarming.
It’s easy to cut out animal products, it’s harder to ensure you continue to meet your energy and nutritional needs.
3. Vitamin B12
Vitamin B12 otherwise known as cobalamin is a fat-soluble vitamin that human beings need in very small amounts in comparison to many of the other vitamins.
Despite needing it in such small amounts the roles vitamin B12 plays in our body are crucial. The complications low B12 levels cause vary with degree of deficiency and range from anaemia, fatigue, breathlessness, numbness, poor balance, memory loss, tingling feet, easy bruising and bleeding and weight loss right through to permanent neurological damage and death.
Paradoxically B12 levels can also be high in eating disorder patients.
This is because the pathways which require the use of B12 within our bodies also require a whole swathe of other nutrients to function correctly. If any of these other nutrients (including B2, B6, zinc, magnesium) are not available in adequate supply these pathways slow down.
What Can I Do to Improve My B12 Levels?
Vitamin B12 is found only in animal products.
Therefore, the best thing you can do to improve your B12 levels is to increase products like meat, fish, eggs, milk and cheese in your diet.
Consider how low your B12 blood test results are and if they are critically low it is likely you will need to have a course of 3 injections. This is because when our B12 levels become too low it is no longer possible to restore them adequately through food alone. After the injections and your stores are replenished the B12 that you get through eating an adequate diet is sufficient.
If you do not want to eat a diet containing animal products the next best thing you can do is take a supplement.
Ask your dietitian for recommendations on good B12 supplements.
If your B12 levels are high, it’s likely you are nutritionally deficient in other vitamins and minerals and/or your enzymes aren’t functioning adequately to use the B12 you have within your body in the ways it would normally be used were you not nutritionally compromised. Nothing within our body works in isolation.
4. Cholesterol
Many people with anorexia nervosa come to me with confusion over their blood test results coming back showing their blood cholesterol is high (triglycerides and LDL typically).
If you know the basics of cholesterol, you’ll know that LDL cholesterol is the “bad” cholesterol and high levels of LDL cholesterol have been linked to increased risk of heart disease. You may also know that typical recommendations to reduce cholesterol levels include exercise and eating a diet low in saturated fats. Both of which are the opposite to what people living with anorexia nervosa actually need to do to improve their cholesterol levels!
Before we get into what you can do to improve your cholesterol levels let’s look at why cholesterol levels are often high in patients with anorexia nervosa. The reason is actually pretty straight forward (although it might not be something your doctor is knowledgeable on and therefore may not tell you).
The membrane of our body cells contain cholesterol. It is an integral component of cell membranes and is involved in modulating the fluidity, thickness, compressibility, water penetration and intrinsic curvature of the membrane1.
When someone is living with an eating disorder and their body isn’t receiving the nutrition and energy it needs to carry out bodily processes necessary to survival the body begins to breakdown its own cells to supply the necessary energy and nutrients.
As these cells are broken down the cholesterol in their membranes is released into the bloodstream and raises blood cholesterol levels.
When someone is malnourished, and bodily processes aren’t working correctly the removal of this cholesterol from the body is also reduced.
What Can I Do to Improve My Blood Cholesterol?
Eat well.
You’ve probably started to notice a common theme within this post by now… and it is to eat but it is more than “just eat” it is eating well.
At the end of the day all the recommendations I give within this post come down to eating.
Eating regularly, adequately and consistently for your body.
Which, in recovery from an eating disorder I appreciate is easier said than done which is why I highly encourage you to seek outside professional help from someone who can help you make it easier, faster and potentially even possible for you to eat enough to make real and sustainable changes in your life.
The only way you are going to improve your cholesterol levels is to be eating adequate food for your body so that it feels safe and no longer has to sacrifice its own cells in order to get the nutrition and energy it needs to simply survive from breaking itself down. Food should be serving this purpose, not the cells of your body.
I really encourage you to work with a fantastic dietitian to get clear on just how much food it’s going to take to recover from an eating disorder because if you’re trying to figure this out alone or looking for examples in the world around you, you’re going to be going in circles for so much longer than is necessary.
Your “eating well” will be different to any other person in your life’s “eating well”.
5. White Blood Cells
A low white blood cell count may seem uninteresting in comparison to some of the more well-known nutritional deficiencies such as low zinc, iron or magnesium that show up in blood test results because it’s not going to cause immediate death or impairment, but the reality is a low white blood cell count is a serious sign of nutritional deficiency that should never go ignored.
Your blood cells including white blood cells, red blood cells and platelets are made in your bone marrow. When you are nutritionally depleted your bone marrow is unable to continue to produce blood cells to the level it once did.
This not only means you are likely more susceptible to infectious disease because your white blood cells are an important part of your immune system and involved in fighting infection but also that your bones are suffering.
What Can I Do to Improve My White Blood Cell Count?
Your body needs amino acids to make white blood cells. You can get amino acids from eating protein.
Good sources of protein include meant, fish, eggs, milk, cheese, nuts and seeds, beans, tofu and tempeh.
Your body needs energy to make white blood cells.
You can get more energy by increasing the amounts of foods you eat, the regularity with which you eat and also the energy density of the types of foods you eat.
There are also a number of other micronutrients (vitamins and minerals) your body needs in order to make white blood cells including vitamin C and zinc.
The overall best way to ensure you are getting your micronutrient needs met is to increase the variety of foods you eat and to eat enough foods overall.
I highly encourage you to work with an eating disorder dietitian for strategies on how to increase the types and amounts of foods you’re eating.
I highly encourage you to work with a mental health professional/s for help to head in the direction with being ok (and even happy) with increasing the types and amounts of foods you eat.
The Important Bits
After reading this you may be wondering what it means if my blood test results are ok?
Your blood is medium through which all your nutrients and wastes are delivered to or taken away from the cells of your body.
This means that your body works really, really, really hard to keep your blood looking good. Including sacrificing the cells of your body.
Which means that your body cells may be suffering and not gaining the nutrients they need in adequate amounts even if your blood tests are within the “normal” ranges.
If you have in the past or are currently restricting what you eat intentionally or unintentionally your body is suffering.
If you’re not eating what you need your body is suffering.
You don’t need your blood test results to tell you this.
Your body needs what it needs.
Your blood test results are important, but you shouldn’t have to use them as a justification or motivation for eating.
Therefore, do what you can to follow the above tips because it will make a monumental difference to your life and your capabilities when your body is physically healthy but if you find it is always a chore, always painful or on any level often an effort to eat then please get help with this.
Get help because it doesn’t have to be that way (even if you truly believe there is no other way of being or that’s just how you are).
It is that way for you now and it may have been that way for you for a long time, maybe even as long as you can remember but that is different to it having to be that way.
Much of the damage caused by eating disorders are reversible with food (not all but much).
Many people recover from eating disorders.
Many people transform their lives.
Get fantastic help and you may surprise yourself with what you discover…
With my whole heart I hope you fround this information useful and inspiring.
Become Great. Live Great.
Bonnie.
Reference
- Yang ST, Kreutzberger AJB, Lee J, Kiessling V, Tamm LK. The role of cholesterol in membrane fusion. Chem Phys Lipids. 2016;199:136-143. doi:10.1016/j.chemphyslip.2016.05.003
