Running on Empty: The Dangers of Running with an Eating Disorder

Running on Empty: The Dangers of Running with an Eating Disorder

Sports Dietician and author Nancy Clark investigates the dangers of running with an eating disorder

AnorexiaIf you are a runner who struggles with losing those last few pounds, take note. Weight issues may have little to do with body fat and more to do with psychological feelings of “I'm not good enough.”

An eating disorder distracts the runner from the feelings that come with being “not good enough.” When you are thinking about whether or not to eat, and how much to exercise, you are not thinking about feeling imperfect or inadequate. Unfortunately, using food to distract from those feelings can end up hurting your performance.

At a conference in Boston organized by the Multiservice Eating Disorders Association (MEDA, there was food for thought for all athletes who struggle with finding the right balance of food, weight, and exercise. Check out the website for helpful resources for teammates, friends and family members, as well as for runners with anorexia, bulimia, and food obsessions.


Food for thought

  • Anorexia has the highest mortality rate of any mental illness. Whether death is from heart arrhythmias or suicide, we need to pay attention when runners struggle with food.
  • Just as runners with anorexia lose muscles in the arms and legs that help them to be stronger athletes, they simultaneously lose heart muscle. The heart gets smaller and cannot respond to stress. The resulting arrhythmias can be a cause of death.
  • The purging associated with bulimia takes its toll in terms of not only electrolyte imbalance associated with vomiting, but also grey teeth (due to erosion of tooth enamel on the inside of the mouth), and dental caries. The person may also suffer from acid reflux, difficulty swallowing, and chronic constipation (if purging includes laxative abuse).
  • Thankfully, many medical issues are reversible but two “biggies” can remain problematic: 1) cognitive dysfunction due to the brain shrinking and 2) bone health. The bones (particularly in the spine, hip, and wrist) lose density. This increases the risk of stress fractures today and osteoporosis in later years. A shocking one in four young women (<20 years) who suffer from anorexia have early osteoporosis. Some end up in severe pain for their lifetime, others in wheelchairs. Teens need to be fully aware they are not only losing bone density but also are not gaining it, as should happen during teenage years. Surprisingly, men with anorexia end up with worse osteoporosis than women.
  • Any female runner with amenorrhea (loss of her menstrual period for more than three months) should get her bone density measured for a baseline. Should she also take a birth control pill to force the return of menses? Current research suggests not. The pill offers a false sense of recovery, plus it does not enhance bone density. The better path is to eat enough food to restore the body to an appropriate weight.
  • Beware that eating a very high fibre diet can interfere with calcium absorption. There is no need for more than 25 to 35 grams of fibre per day!
  • Runners with eating disorders commonly have high cholesterol levels. The solution is not to limit red meat and eggs; rather, the runners need to normalize their entire diet.
  • Medical symptoms that raise red flags include: heart rate less than 40 beats per minute, body temperature less than 95°F (35°C), blood pressure less than 70/40, and low blood glucose (<60 mg/dL) between meals. These numbers are sometimes seen in highly trained runners; hence, to identify those with eating disorders can be tricky. Other red flags include noticeable “fur” on arms and face (lanugo hair, for warmth), brittle fingernails, blue fingertips, itchy dry skin, and a yellow skin tone due to overindulging in carrots and orange vegetables.
  • Runners with anorexia may complain about “feeling full” despite a small food intake, and food that just “sits in the stomach.” The solution is to force themselves to gradually increase their intake. Even though they may not feel hungry, their body is starving and needs fuel.

Do people recover?

Yes, usually with help from a therapist, registered dietitian (RD), and medical team. Some runners get tired of the eating disorder and learn to accept their perceived body flaws. Others get scared when they vomit blood. Some find hope in a new personal relationship (“Maybe I am good enough to be loved!”) or choose to eat better so they can get pregnant. 

One pathway for recovery is to see the eating disorder as being just one part of you. It is the part that tries to protect your other parts that don't like feeling lonely, rejected, or imperfect. For example, perhaps you had traumatic experiences in middle school. Your eating disordered part can distract and numb feelings of pain, shame, and fear. It keeps you feeling more in control of life.

Try talking to your eating disorder and ask, “Please tell me why you are here? What are you trying to do for me?” The ED part might answer “I'm trying to distract you and protect you from painful feelings – you know, the shame you felt as a kid at school...” Yet, we all know that starving one’s body does not solve any problems. Hence, a probing question is, “How effective on a scale of one to 10 (with 10 being 100 per cent effective) is the eating disorder in making you happy in your core?”

Most runners with eating disorders are miserable. Using a model of recovery such as Internal Family Systems (, runners can discover their core that is centered, competent, secure, self-assured, relaxed, and able to both listen to and respond to feedback. These core values can displace the eating disordered voices and lead to a happier, healthier life and improved performance. Is it time for you to stop struggling and start living and performing better?

Nancy Clark, MS, RD, CSSD (Board Certified Specialist in Sports Dietetics) counsels both casual and competitive athletes at her office in Newton, MA (617-795-1875). Her Sports Nutrition Guidebook and food guides for new runners and marathoners offer additional information on resolving weight issues. They are available at See also


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I suffered with an eating disorder for over 15 years.  Luckily for me and with help I am recovered.  I don't believe that the eating disorder ever goes away completely but you learn ways of dealing with it.  Although I eat normally and have been fine for many years now I still have a distorted body image which I'm not sure will ever completely go away.  I'm extremely lucky to have got the help and support i needed and love my life now.