A typical work-up for any patient includes blood tests. A sample of blood can tell us a lot about the health of a patient, from electrolye levels to cholesterol. For ED patients, this can be very important because it can help us see what we need to do to help them. For example, low iron (typically from low meat or protein intake, as what happens in starvation) can cause anemia, so we might give the patient iron supplements. Similarly, we might see low calcium levels, along with a bone scan, and decide that the patient needs calcium supplements or vitamin D. We can also see their glucose levels and determine if their blood sugar is within the normal range.
All of this sounds helpful, right? But what about when the blood tests come back normal? Is the patient 'fine'? Does that mean that the patient cannot possibly have ED, or is not 'sick enough'? NO. Something I always tell my patients and nursing peers is that medicine is simply ONE tool to help us help others - it cannot be used alone. For example, we would need to conduct a thorough assessment on the patient and see what their hearts sounds are like, breathing sounds, muscular ability is, etc. To top that off, we need to know that blood values, like other things, are not always exactly 'perfect' in the information they tell us. This post is going to give one simple example about a blood value often seen in ED patients, and why so many patients continue to be ill because their medical teams believe that if their tests come back normal, they must be normal, too.
Blood tests can include cholesterol. We know that cholesterol is an essential part of many processes in the body, including making cell membranes and hormones. If a patient has ED and is not eating, you would expect cholesterol levels to be low, right? After all, if they are not eating enough fats, how would their body make cholesterol? Well, the interesting thing is that often in ED patients, cholesterol levels are high (http://www.endocrinetoday.com/comments.aspx?rid=40070 ). Once a physician sees this, they usually tell the patient to eat a low-fat and low-cholesterol diet. BUT WAIT! Patients wtih ED need to eat a variety of foods, including cholesterol and/or fats because our bodies need this to survive and function properly. Is there some kind of mistake here? Do we get another blood test? Or does the patient really need to eat a low-fat diet? Why do some patients with ED have high cholesterol levels?
Let me offer one explaination from a medical perspective: we know that cholesterol is made by the liver. When levels of fat/cholesterol in the body get too low, the liver needs to make more cholesterol to meet demands. In a patient with ED, low levels of fats means that the liver needs to make some. This is important because we need enough cholesterol and fats for normal functioning. So, the liver begins to make more and more cholesterol to keep the body in balance. But, this means that at any given moment, the patient's blood values may show elevated cholesterol levels. Does this mean that they should eat a low-fat diet? NO NO NO NO NO! This means that their liver is now working overtime to keep the body stable. Actually, to be healthy, the liver should be making only enough cholesterol to keep one healthy - not stressed trying to make more because the body is low on fat stores! Blood values in patients can return to normal once they are weight-restored and eating enough variety and the nutrients they need.
What do we learn from this? First, do not go by medical tests only. While they are helpful (I am a nursing student and know the value of my blood tests!), they cannot be used alone. We must use our discretion and careful assessments to better help our patients. We also learn that patients with ED who have high cholesterol levels may not need to be put on a low-fat diet. In fact, one of the best predictors of not relapsing and staying healthy in recovery was eating a diet that had enough fat in it (we need fat for cushioning, warmth, cell membranes, hormones, and so much more!). On a final note, we can learn that while patients may not appear to be sick, this can fool us because the body is extremely efficient at battling the stresses it faces...until it can no longer survive. So, do patients with ED need to eat low-fat diets? No. Not unless there is some strong compelling reason why they should be (as in, a major threat to their health that has been proven and is definite. Please note that this post refers to ED patients only. If you are a patient without ED a have high cholesterol levels, you may very well need to eat a low-fat diet for the sake of your health. Please talk to your doctor in that case!). In other words, don't judge something by simply what it looks like, or what you know. A blood test is a great way to learn about health, but it isn't the ONLY thing to look at. Remember how I always say that weight isn't the only indicator of health? The same thing applies here! Some might be underweight but healthy, whereas others may be a normal weight and still have disordered eating. Do not use one thing to make a judgment - be aware and informed!