I find the human body absolutely fascinating (which is probably good considering I’m a nurse!). The way that it can adapt to almost anything is truly remarkable. And the way that it can be restored to normalcy, once we start treating it well, is miraculous. When it comes to eating disorders, every body system can be affected. The heart can change shape, the intestines can slow, the reproductive system can shut down… And it can all be restored! The blood is no different.
Since eating disorders develop slowly, the body has time to adapt to malnutrition, and blood work often looks perfect. Just because there are no lab abnormalities doesn’t mean the eating disorder “isn’t that bad.” On the other hand, sometimes there are abnormalities. Among other things, we often see electrolyte abnormalities (changes in sodium, potassium, glucose…), blood count abnormalities (low white blood cells, low hemoglobin…), and vitamin deficiencies. But, with proper nutrition everything can normalize!
When someone first admits into treatment I often hear “they’re VAMPIRES!” or “they poke me ALL the time!” And I need to validate those statements – WE DO! It’s not uncommon for someone first coming into treatment to get lab work done 2-3x/week. Why – because the re-introduction of food can be taxing on the body. If the body can tolerate it, we might never see a lab abnormality, but there is a high risk for refeeding syndrome with the reintroduction of food, and we are checking to make sure that abnormalities don’t arise in the first few weeks.
While lab abnormalities can be scary, they also resolve quickly with food. Again, our bodies are incredible. When we nourish them, they respond. So what happens when labs normalize, or are never abnormal? Sometimes very early on into the treatment process (2-3 weeks in) I am sharing good news with a client that lab frequency has been decreased (YAY – you won’t be poked so much anymore!!!). At that point the client is usually thankful that her arms will be spared, and does not say to me “see, I’m all better – my labs are normal.”
But 3 weeks later the story can change. The honeymoon phase ends, weight restoration begins, body image distress increases, and the eating disorder voice starts screaming “get me out of here!!!” This is often when negotiation regarding medical stability begins. Comments begin like “my labs are normal. I’m fine, I don’t need to be here anymore,” or “I don’t need to gain any more weight, my labs are normal.” When that happens it’s important to recognize that the eating disorder is very loud, and we can’t back down. At that point it’s important to point out that labs may have been normal for several weeks, but you weren’t asking to leave then. What changed? And the answer is always – this work just got really hard. And that’s true. Meal plans have increased, therapeutic work has started to get at roots of the eating disorder, body image has become distressing. But it’s not about the labs. The human body will bounce back quickly, but it’s not maintainable without true recovery from the eating disorder, and that takes time.