By: Jennifer L. Gaudiani, MD, CEDS

Many people with eating disorders are in denial about the severity of their illness and believe that they are fine – something we at ACUTE term the “I’m fine” syndrome. Despite family, friends, and colleagues expressing their worry over food habits, withdrawal from previously enjoyed activities, and health issues, somehow the eating disorder makes people ignore the concerns of their loved ones. They think that because they can still engage in their normal, everyday activities including going to school, work, exercise, hobbies and social events, that there must be nothing wrong with them. Well my friends, this is absolutely not the case. 

In restricting disorders, blood tests are often normal because there isn’t any sort of electrolyte loss through purging. In addition to the already existing denial, these normal blood tests can further contribute to the “I’m fine” syndrome. Well-meaning primary care providers can unwittingly contribute to this issue by focusing too heavily on measurable data (i.e.: potassium levels) and not on the whole person…the person who is clearly NOT fine! 

However, there is an important blood test to watch out for that may be abnormal even in those who purely restrict, most typically in anorexia nervosa or individuals who have experienced significant rapid weight loss – the white blood cell count.

There are three main cell types in our blood: the white blood cells (infection fighters), the red blood cells (oxygen and carbon dioxide carriers), and the platelets (the cells that help stop bleeding). These cells are all produced in the inside of your bones – the bone marrow. In severe underweight or rapid weight loss, the cellular bone marrow is replaced by a dysfunctional “goo” that does not produce cells normally. Essentially, faced with limited caloric resources, the body cannot sustain normal bone marrow function. As a result, one of the red flags to watch out for in standard blood tests is a low white blood cell count. A low white blood cell count may not be dangerous in-and-of itself, but it’s a serious sign of nutritional deficiency. If you have bone marrow failure of starvation, you are NOT fine. 

Don’t allow anyone to shrug off a low blood count of any type – white, red or platelet. It’s serious and can mean that the current nutritional state is putting severe and harmful strain on your body. The good news? All cell lines will recover with sustained nutritional rehabilitation and weight restoration.