The Link Between Eating Disorders, Nutrition, and Cholesterol

Eating disorders are more prevalent than you may think—the impact of these conditions in the US alone cost nearly $400 billion in the fiscal year of 2018 to 2019.

 

Eating disorders are often framed as purely psychological conditions driven by trauma, societal pressures, or disordered thinking around food. While the mental health aspect of eating disorders is more widely recognized thanks to advocacy and education, there are still significant misconceptions about the biological and nutritional factors that contribute to these conditions.

 

One critical yet often overlooked piece of the puzzle is how poor nutrition and low cholesterol levels can exacerbate—or even trigger—disordered eating behaviors. Cholesterol plays a vital role in brain health, hormone production, and mood regulation, all of which influence appetite, cravings, and emotional well-being. When the body is deprived of essential nutrients, it can intensify anxiety around food, fuel compulsive behaviors, and make recovery even more challenging.

 

Let’s take a closer look at the lesser-known connections between eating disorders, nutrition, and cholesterol. We’ll break down how these biological factors influence disordered eating patterns, address common misconceptions, and offer practical, science-backed tools for recovery. 

 

Understanding the full picture allows us to move beyond surface-level discussions and approach healing with a more comprehensive, root-cause-focused perspective.

 

What Are Eating Disorders?

 

 

Eating disorders are serious and complex conditions that affect a person’s relationship with food, body image, and overall well-being. They involve persistent, disordered eating behaviors that can have severe physical and psychological consequences. While eating disorders are often associated with restrictive eating or bingeing, they can manifest in various ways, impacting individuals of all ages, genders, and backgrounds.

 

These disorders often stem from deeper emotional, psychological, and even biological imbalances. Many people with eating disorders experience intense feelings of anxiety, guilt, or distress around food and body weight, leading to harmful behaviors that can be difficult to control.

 

Types of Eating Disorders

 

 

Below is a list of eating disorders, including their defining characteristics, symptoms, and associated health risks:

 

1. Anorexia Nervosa

Anorexia nervosa, also referred to as anorexia, is characterized by extreme food restriction, an intense fear of gaining weight, and a distorted body image. Individuals with anorexia may see themselves as overweight even when they are dangerously underweight.

 

Symptoms:

• Severe calorie restriction
• Excessive exercise or compulsive movement
• Extreme fear of weight gain
• Distorted body perception
• Preoccupation with food, dieting, and body size
• Social withdrawal

 

Health Risks:

• Malnutrition and nutrient deficiencies
• Low blood pressure
• Heart complications including cardiac arrest and electrolyte imbalances
• Osteoporosis and brittle bones
• Infertility and hormonal imbalances
• Organ failure and increased risk of death
• Highest mortality rate of any psychiatric disorder

 

2. Bulimia

Bulimia, also known as bulimia nervosa, involves cycles of binge eating followed by compensatory behaviors such as purging, excessive exercise, or fasting. People with bulimia often feel out of control during binge episodes and use purging to prevent weight gain.

 

Symptoms:

• Frequent episodes of overeating followed by purging (vomiting, laxatives, fasting, or excessive exercise)
• Feelings of shame, guilt, and anxiety around food
• Preoccupation with body weight and shape
• Evidence of purging behaviors (frequent bathroom trips after meals)
• Swollen cheeks, dental erosion, and sore throat from vomiting

 

Health Risks:

• Electrolyte imbalances leading to heart arrhythmias
• Gastrointestinal issues and acid reflux
• Tooth decay and gum disease
• Swollen salivary glands
• Increased risk of stroke and heart attack

 

3. Binge Eating Disorder

Binge eating disorder is the most common eating disorder and involves episodes of uncontrollable eating, often in response to stress or emotions, without compensatory behaviors like purging.

 

Symptoms:

• Eating large amounts of food in a short period
• Feeling a loss of control over eating
• Eating when not physically hungry
• Eating rapidly and to the point of discomfort
• Feelings of shame, guilt, and distress after bingeing

 

Health Risks:

• Obesity and related metabolic disorders
• Type 2 diabetes and insulin resistance
• High blood pressure
• Increased risk of heart disease
• Digestive problems and chronic inflammation

 

4. Avoidant/Restrictive Food Intake Disorder (ARFID)

ARFID is characterized by extreme food avoidance or restriction, not due to body image concerns but because of sensory sensitivities, fear of choking, or lack of interest in eating.

 

Symptoms:

• Avoiding specific textures, colors, or types of food
• Fear of eating due to past negative experiences (e.g., choking, vomiting)
• Significant weight loss or nutritional deficiencies
• Lack of appetite or interest in eating
• Difficulty meeting daily energy needs

 

Health Risks:

• Malnutrition and vitamin deficiencies
• Growth and developmental delays in children
• Low energy levels and weakened immune function
• Social isolation due to food-related anxiety

 

5. Pica

Pica is an eating disorder characterized by the persistent consumption of non-nutritive, non-food substances for at least one month. Commonly ingested items include chalk, dirt, clay, ice, paper, soap, hair, paint, or metal. 

 

Symptoms:

• Persistent craving and consumption of non-food substances
• Gastrointestinal discomfort or distress
• Potential nutritional deficiencies
• Damage to teeth and oral health
• Possible lead poisoning (if ingesting paint or contaminated materials)

 

Health Risks:

• Intestinal blockages or perforation of the digestive tract from ingesting hard or indigestible materials
• Toxicity and poisoning from substances such as lead, chemicals, or heavy metals
• Malnutrition and anemia due to the displacement of nutrient-dense foods
• Bacterial infections or parasitic infestations from consuming contaminated materials
• Dental erosion or injury from chewing on hard or corrosive objects

 

6. Rumination Disorder

Rumination disorder, or rumination syndrome, is an eating disorder characterized by the repeated regurgitation, re-chewing, or re-swallowing of food after eating. Unlike vomiting associated with bulimia, this behavior is not typically driven by body image concerns but rather an automatic or habitual response. 

 

Symptoms:

• Repeated regurgitation of partially digested food (within minutes to an hour after eating)
• Re-chewing or re-swallowing regurgitated food
• Bad breath and sour taste in the mouth due to frequent regurgitation
• Unintentional weight loss due to inadequate nutrient absorption
• Discomfort or pain in the upper abdomen or chest

 

Health Risks:

• Malnutrition and unintended weight loss due to insufficient nutrient intake
• Esophageal damage from repeated exposure to stomach acid
• Dental erosion caused by stomach acid exposure
• Aspiration pneumonia (if regurgitated food is accidentally inhaled into the lungs)
• Social distress and avoidance of eating in public due to embarrassment

 

7. Orthorexia Nervosa

Orthorexia nervosa, also known as orthorexia, is an obsession with eating only foods perceived as healthy, often leading to excessive dietary restrictions and negative impacts on physical and mental well-being. Unlike other eating disorders, it is driven by a fixation on food purity rather than body image concerns.

 

Symptoms:

• Preoccupation with food quality, purity, and sourcing
• Strict avoidance of foods deemed “unhealthy” or “impure”
• Anxiety, guilt, or distress when deviating from dietary rules
• Progressive elimination of food groups, leading to a restrictive diet
• Spending excessive time researching or planning meals
• Social isolation or avoidance of events due to food concerns
• Feeling superior or morally “better” based on diet choices
• Physical signs of malnutrition (e.g., fatigue, weight loss, dizziness)

 

Health Risks:

• Nutritional deficiencies (e.g., lack of vitamins, minerals, essential macronutrients)
• Unintentional weight loss and muscle wasting
• Hormonal imbalances, including menstrual irregularities
• Weakened immune function
• Digestive issues due to restrictive eating patterns
• Increased anxiety, depression, or obsessive-compulsive behaviors
• Social isolation and reduced quality of life

 

8. Other Specified Feeding or Eating Disorder (OSFED)

OSFED includes eating disorders that do not fit the exact criteria of anorexia, bulimia, or BED but still cause significant distress and health complications. Examples include atypical anorexia (meeting all anorexia criteria except being underweight) and purging disorder (engaging in purging without bingeing).

 

Health Risks:

• Similar to those of anorexia, bulimia, or BED, depending on the behaviors present

 

Standard Care Treatment for Eating Disorders

 

 

Eating disorders are complex conditions requiring a comprehensive treatment protocol tailored to each individual’s specific needs. Standard care typically involves a combination of medical monitoring, nutritional rehabilitation, psychotherapy, and pharmacotherapy. 

 

The primary goals are to restore healthy eating patterns, address psychological factors, and prevent relapse.

 

General Treatment Components

While each eating disorder requires different support and a personalized plan, they share the following four general treatment components:

 

1. Medical Monitoring and Stabilization

Medical supervision is a crucial aspect of eating disorder treatment, particularly for those experiencing severe malnutrition, electrolyte imbalances, or organ damage. Individuals with conditions such as anorexia, bulimia, and severe binge eating disorder may require inpatient hospitalization or structured outpatient programs to ensure medical stability.

 

• Monitoring of Vital Signs and Organ Function: Malnutrition and disordered eating behaviors can severely impact heart function, liver and kidney health, and electrolyte balance. Frequent lab tests and vitals monitoring (e.g., heart rate, blood pressure) help prevent life-threatening complications.
• Refeeding Syndrome Prevention: In cases of severe restriction, increasing food intake too rapidly can lead to refeeding syndrome, a dangerous shift in fluids and electrolytes that can cause heart failure. Medical teams implement gradual refeeding protocols to ensure safe weight restoration.
• Hydration and Electrolyte Balance: Electrolyte imbalances are common, especially in individuals who engage in purging behaviors or excessive fluid intake. IV fluids or supplements may be necessary for stabilization.
• Gut Health and Digestion Support: Long-term restriction or bingeing can disrupt gut function, leading to bloating, constipation, or intestinal damage. Treatment often includes probiotics, fiber adjustments, and digestive support therapies.

 

2. Nutritional Rehabilitation and Meal Planning

Nutritional rehabilitation is essential for restoring metabolic health, stabilizing weight, and repairing nutritional deficiencies caused by disordered eating patterns.

 

• Structured Meal Plans: Several treatment centers use meal plans to reintroduce balanced eating. This may involve a structured approach where clients are encouraged to consume regular meals and snacks to regulate hunger cues.
• Nutrient Repletion: Many individuals with eating disorders are deficient in essential nutrients such as iron, zinc, vitamin D, B vitamins, and omega-3 fatty acids, which are crucial for brain health, mood stabilization, and hormonal balance. Supplementation is often part of the treatment plan.
• Gradual Exposure to Fear Foods: Many patients have deeply ingrained food fears or rigid dietary rules. Nutritional therapy typically includes exposure therapy to reintegrate previously avoided foods in a safe and controlled way.
• Addressing Metabolic Adaptation: Prolonged caloric restriction can lead to metabolic slowdown, causing extreme fatigue, cold intolerance, and difficulty maintaining a healthy weight. Nutritional therapy helps restore normal metabolic function through adequate caloric intake and macronutrient balance.
• Intuitive Eating and Hunger Awareness Training: Long-term recovery through additional nutritional therapy options involves rebuilding interoceptive awareness (the ability to recognize hunger and fullness cues) and fostering a flexible, non-restrictive approach to eating.

 

3. Psychotherapy and Behavioral Therapy

Since eating disorders are commonly rooted in emotional distress, trauma, or maladaptive coping mechanisms, therapy is a cornerstone of treatment. Several evidence-based approaches are used:

 

• Cognitive Behavioral Therapy (CBT): CBT is one of the most well-researched and effective treatments for bulimia, binge eating disorder, and anorexia. CBT helps individuals identify and challenge distorted thoughts around food, body image, and self-worth while developing healthier coping mechanisms.
• Dialectical Behavior Therapy (DBT): DBT is particularly effective for emotionally dysregulated individuals, including those with binge eating disorder or bulimia. It focuses on emotional regulation, distress tolerance, interpersonal effectiveness, and mindfulness.
• Family-Based Therapy (FBT): Particularly beneficial for adolescents with anorexia or ARFID, FBT involves parents and family members in the recovery process to support structured meal intake and emotional regulation.
• Exposure and Response Prevention (ERP): Used for individuals who experience severe food anxiety, orthorexia, or avoidance behaviors, this modality gradually exposes individuals to feared foods in a controlled setting.
• Somatica and Trauma-Informed Therapy: Since many eating disorders stem from past trauma or nervous system dysregulation, therapies such as somatic experiencing, EMDR (Eye Movement Desensitization and Reprocessing), and polyvagal theory-based interventions are integrated into treatment to help process trauma and develop healthier self-regulation skills.
• Mindfulness-Based Approaches: These practices including mindful eating, yoga therapy, and meditation are often incorporated to help clients develop body awareness, reduce compulsive behaviors, and encourage self-compassion.

 

4. Pharmacotherapy and Medication Use

In conventional treatment, psychiatric medications are often prescribed to help manage co-occurring mental health conditions such as depression, anxiety, OCD, and impulse control disorders. However, many patients aren’t notified about the many risks and side effects associated with both short-term and long-term use.

 

• Selective Serotonin Reuptake Inhibitors (SSRIs) – (e.g., Fluoxetine, Sertraline): SSRIs are used primarily for bulimia and binge eating disorder to help regulate mood and reduce compulsive behaviors. The risks are significant—SSRIs can cause a host of symptoms including dependency concerns, emotional blunting, fatigue, sexual dysfunction, and gastrointestinal disturbances. You can learn more about these risks here. 
• Anxiolytics (e.g., Benzodiazepines for Anxiety-Related Eating Disorders): Medications like lorazepam or alprazolam are commonly prescribed to manage acute anxiety in individuals with eating disorders, particularly when anxiety exacerbates food-related distress. Anxiolytics are typically prescribed with other psychiatric medications. However, these drugs come with serious risks, including dependency, cognitive impairment, withdrawal complications, higher mortality rate, and increased tolerance, often leading to a need for higher doses over time.
• Stimulants (e.g., Lisdexamfetamine for Binge Eating Disorder): Stimulants may help reduce binge episodes by modulating dopamine pathways and appetite control. The risks and side effects include increased anxiety, elevated heart rate, the potential for addiction, and sleep disturbances.
• Atypical Antipsychotics (e.g., Olanzapine for Anorexia): Antipsychotics are used in severe cases to increase appetite and reduce obsessive food-related thoughts. There are many risks associated with antipsychotics including dependency concerns, insulin resistance, sedation, and metabolic dysfunction. You can learn more about these risks here. 

 

Efficacy and Relapse Rates of Standard Care Treatment Protocols

 

 

While certain components of standard treatments can be effective, relapse remains a significant concern:

 

• Anorexia: Approximately 50% of individuals achieve full recovery; however, some studies indicate that complete recovery is elusive for many, with a substantial proportion experiencing residual symptoms. Relapse rates range from 40% to 50%, with the highest risk occurring within the first two years post-treatment.
• Bulimia: Full recovery rates are estimated at 50%, with up to 70% showing partial remission. Approximately 30% to 44% of individuals may relapse, often within the first six months after treatment.
• Binge Eating Disorder (BED): Studies suggest that 50% to 85% of individuals achieve full recovery. One study found that about 61% of BED patients remained in full remission at two and a half years but only about 46% maintained remission at five years.

 

These statistics highlight the chronic nature of eating disorders and the necessity for long-term support and relapse prevention strategies. Addressing faulty components of standard care and integrating holistic and functional medicine approaches can enhance the effectiveness of treatment. 

 

Let’s take a closer look at the mental health and physiological components of these disorders. 

 

Understanding the Mental Health Connection

While eating disorders have biological and nutritional components, their roots often lie in deeper psychological struggles. Many individuals with eating disorders use food as a way to cope with underlying emotional pain, trauma, or stress. That’s why the mental health aspect of standard care treatment is crucial. 

 

Some common psychological drivers include:

 

Maladaptive Coping Mechanisms

 

 

For many individuals, disordered eating behaviors develop as a response to unresolved trauma, chronic stress, or deep-seated emotional pain. Restrictive eating, bingeing, or purging may provide a temporary sense of control, relief, or emotional numbing, reinforcing the behavior as a coping strategy.

 

• Control and Predictability: People who feel powerless in other aspects of life may use food restriction or bingeing as a way to regain a sense of control. This is common in individuals with a history of chaotic environments, childhood neglect, or trauma. Eating disorders, like many other addictions, may develop with a different reason, like needing to be thin, but over time, they can transform into maladapted coping mechanisms. Many individuals use eating disorders as a way to have control in chaos or lose control if they’re too rigid in their lives. These poor coping mechanisms are used as a bandaid for difficult feelings and not dealing with stressful situations in a healthy way. 
• Numbing or Dissociation: Some use disordered eating to suppress or dissociate from overwhelming emotions. For example, binge eating can create a temporary sense of euphoria or distraction, while starvation may induce a sense of detachment from emotional pain.
• Self-Punishment: Feelings of shame, guilt, or unworthiness—often rooted in past trauma—can drive individuals to engage in self-destructive eating behaviors as a form of punishment. Restricting food, purging, or excessive exercise can serve as a way to atone for perceived failures or inadequacies.
• Identity and Self-Worth: Some individuals tie their self-worth to their ability to control their eating or maintain a certain body size. This is especially common in people who have experienced body shaming or have been praised for weight loss, reinforcing disordered behaviors.

 

Recognizing disordered eating as a maladaptive coping mechanism showcases the importance of addressing underlying emotional wounds in recovery. Without developing healthier ways to cope with distress, individuals can struggle to break free from disordered patterns, even if they address the physical symptoms.

 

Emotional Eating and Food Addiction

 

 

Food is deeply intertwined with emotions, and many people turn to eating as a way to regulate their mood, manage stress, or seek comfort. However, when emotional eating becomes compulsive or addictive, it can spiral into a cycle of shame, distress, and loss of control.

 

• Dopamine and Reward Pathways: Highly processed foods—especially those high in sugar, refined carbs, and unhealthy fats—trigger dopamine release in the brain’s reward system. This creates a temporary sense of pleasure, reinforcing cravings and compulsive eating. Over time, this can develop into a dependency, similar to substance addiction.
• Stress and Cortisol: Chronic stress elevates cortisol levels, which can increase cravings for high-calorie, energy-dense foods. Emotional eaters often turn to comfort foods during times of stress, reinforcing the award system between emotions and eating.
• Childhood Conditioning: Early experiences with food can shape lifelong eating patterns. For example, children who are given food as a reward or comfort may learn to associate eating with emotional regulation, leading to reliance on food in adulthood to manage distress.
• Guilt and Shame Cycles: Emotional eating often leads to feelings of regret or self-judgment, perpetuating the cycle of restriction, bingeing, and more emotional distress. Many individuals who struggle with food addiction experience deep shame around their eating habits, making it harder to seek help.

 

Because emotional eating and food addiction are deeply rooted in brain chemistry and learned behaviors, recovery often requires a comprehensive approach that includes nutritional therapy, nervous system regulation, and psychological healing. Breaking free from compulsive eating patterns involves rewiring reward pathways, addressing emotional triggers, and learning alternative coping strategies that do not involve food.

 

Societal and Cultural Pressures

 

 

Cultural expectations and social influences play a significant role in shaping body image and eating behaviors. The prevalence of diet culture, social media, and extreme beauty standards has contributed to the rise of eating disorders, particularly among young people.

 

• Thin Ideal and Diet Culture: The glorification of thinness, weight loss, and restrictive eating in mainstream media can lead to body dissatisfaction and unhealthy eating patterns. Many individuals internalize the belief that their worth is tied to their appearance, driving obsessive dieting and food restriction.
• Social Media and Comparison: Constant exposure to edited, filtered, and curated images on social media can distort perceptions of beauty and normal eating behaviors. People struggling with disordered eating often compare themselves to influencers or celebrities, reinforcing unrealistic body expectations.
• Fat Positivity and Binge Eating: While the fat positivity movement may have helped reduce weight stigma and promote body acceptance, it also dismisses legitimate health concerns related to obesity and binge eating disorder. In some cases, it can unintentionally discourage individuals from seeking help for compulsive overeating or metabolic health issues.
• Mukbang and Extreme Eating Trends: The rise of mukbang content—where influencers consume massive amounts of food on camera—has contributed to the normalization of binge eating and engaging in unhealthy eating habits. While intended as entertainment, these videos can reinforce disordered eating behaviors and serve as triggers for individuals struggling with food addiction or binge eating disorder.

 

Understanding the varied nature of eating disorders is crucial for effective recovery. These disorders are deeply intertwined with emotional resilience, societal influences, and physiological imbalances. 

 

In the next section, we’ll explore how poor nutrition and low cholesterol levels can contribute to disordered eating behaviors—and how addressing these factors can support long-term healing.

 

The Role of Nutrition in Eating Disorders

Emerging research suggests that poor nutrition itself can both cause and exacerbate eating disorders. Poor nutrition is also a consequence of these conditions, often causing a vicious cycle. Nutrient deficiencies, imbalanced macronutrient intake, and metabolic dysfunction can alter brain chemistry, impacting mood, appetite regulation, and impulse control—all of which play a role in disordered eating behaviors. 

 

Let’s take a closer look at the intricate connection between nutrition, brain function, and eating disorders, shedding light on how addressing nutritional imbalances can support prevention and long-term recovery.

 

Micronutrient Deficiencies

 

 

Micronutrient deficiencies have been increasingly recognized as both potential contributors to the development of eating disorders and exacerbating factors in existing cases. 

 

Zinc

Zinc plays a crucial role in numerous bodily functions, including appetite regulation, cognitive function, and emotional well-being. A deficiency in zinc can lead to decreased appetite, which may progress into disordered eating such as anorexia. This creates a vicious cycle where reduced food intake further depletes zinc levels, worsening the eating disorder. 

 

Moreover, zinc deficiency has been associated with impairments in cognitive and motor functions, particularly in children. Such deficiencies can interfere with brain development, leading to increased emotionality, poor memory, and abnormal responses to stress—all of which can contribute to the onset or worsening of eating disorders.

 

Addressing these deficiencies through appropriate supplementation and dietary interventions is crucial. For example, zinc supplementation has been shown to improve weight gain in individuals with anorexia, effectively breaking the cycle of malnutrition-induced malnutrition.

 

Vitamin D

Vitamin D deficiency is a widespread issue among individuals with anorexia and other eating disorders, playing a significant role in both the onset and exacerbation of these conditions. 

 

A retrospective study of hospitalized patients with severe anorexia found that 54.2% were deficient in vitamin D, making it one of the most common micronutrient deficiencies in this population. 

 

Since vitamin D is critical for bone health, immune function, mood regulation, and metabolic processes, its deficiency can contribute to the worsening of both physical and psychological symptoms in those struggling with disordered eating.

 

Vitamin D plays a direct role in brain function and emotional regulation by influencing serotonin production, a neurotransmitter essential for mood stability and impulse control. 

 

Low serotonin levels are frequently observed in individuals with eating disorders and are associated with increased anxiety and obsessive-compulsive tendencies—symptoms that are hallmarks of anorexia and binge eating disorder. Deficient vitamin D levels can further impair cognitive function, reduce motivation, and increase stress sensitivity, making it harder for individuals to engage in recovery.

 

Additionally, vitamin D deficiency has been linked to altered appetite regulation through its effects on the hypothalamus. Research suggests that low levels may disrupt hunger and satiety cues, reinforcing the restrictive or binge-purge cycles seen in eating disorders.

 

B Vitamins

B vitamin deficiencies are common in individuals with eating disorders, particularly in those with anorexia and restrictive eating patterns. 

 

These vitamins play a critical role in neurological function, mood regulation, and cognitive flexibility, and their depletion can exacerbate anxiety, depression, and compulsive behaviors, all of which are hallmark features of eating disorders. 

 

Studies show that deficiencies in vitamin B1 (thiamine), B6 (pyridoxine), B9 (folate), and B12 are particularly concerning, as they are linked to neurological dysfunction, cognitive impairments, and increased risk of psychiatric disorders.

 

Deficiency in thiamine is common in individuals with malnutrition and restrictive eating patterns, as it plays a key role in energy metabolism and brain function. Low levels of thiamine can cause fatigue, irritability, poor memory, and brain fog, which can further contribute to disordered eating behaviors, cognitive rigidity, and anxiety about food intake.

 

Vitamin B6 deficiency can significantly affect neurotransmitter production, particularly serotonin, dopamine, and GABA, which are essential for emotional stability and impulse control. Low levels of B6 have been associated with increased anxiety, depression, and irritability, making it even more difficult for individuals with eating disorders to regulate their emotions and engage in recovery-focused behaviors.

 

Folate deficiency has been directly linked to cognitive dysfunction, mood disorders, and increased depression risk, all of which frequently co-occur with eating disorders. Research shows that 10% of the US population is deficient in folate. Since folate is essential for DNA synthesis, neurotransmitter function, and cognitive health, inadequate levels may contribute to disordered thinking, rigid behaviors, and a higher likelihood of engaging in restrictive eating patterns.

 

Vitamin B12 deficiency is particularly concerning in eating disorder patients, especially those following plant-based or restrictive diets, as it is only found in animal-based foods. B12 is crucial for nervous system function, red blood cell production, and cognitive clarity. A lack of B12 can lead to brain fog, memory issues, depression, and even nerve damage, further complicating recovery for those with eating disorders. Research has also found that patients with anorexia who have low B12 levels tend to have a longer disease duration and more severe physical symptoms.

 

One of the most important aspects of eating disorder recovery is developing cognitive flexibility, or the ability to adapt to new ways of thinking and responding to food. B vitamins, particularly B6, B9, and B12, are critical for this process because they help regulate serotonin, dopamine, and GABA, all of which influence mood, stress resilience, and emotional stability.

 

Iron

Iron deficiency is a well-documented contributor to disordered eating behaviors, with a particularly strong connection to pica, an eating disorder characterized by the consumption of non-food substances such as dirt, clay, ice, or paper. The body’s craving for non-nutritive substances in pica is often linked to iron-deficiency anemia, suggesting that the body is attempting to compensate for a severe lack of bioavailable iron. However, iron deficiency’s impact extends beyond pica, playing a role in fatigue, cognitive impairment, and depression, all of which can exacerbate other eating disorders such as anorexia, bulimia, and binge eating disorder.

 

Iron plays a fundamental role in oxygen transport, cognitive function, and neurotransmitter balance. Low iron levels can lead to persistent fatigue, poor concentration, irritability, and low motivation, which can reinforce disordered eating behaviors. 

 

Individuals with anorexia are particularly vulnerable to iron deficiency due to chronic undernutrition, poor absorption, and avoidance of iron-rich animal foods. Since iron deficiency has been shown to cause DNA damage similar to radiation exposure, the long-term consequences on metabolism and brain function can be severe, further complicating eating disorder recovery.

 

For individuals with bulimia or binge eating disorder, iron deficiency may contribute to unstable energy levels and mood dysregulation, increasing episodes of emotional eating, compulsive food behaviors, and cravings for processed foods that lack essential nutrients. In some cases, low iron status is linked to dysregulated appetite signals, leading to irregular eating patterns that disrupt hunger and satiety cues.

 

Iron is essential for dopamine production and serotonin metabolism, two neurotransmitters that regulate mood, motivation, and impulse control. When iron levels are low, individuals may experience depressive symptoms, heightened anxiety, and impaired cognitive function, which can further fuel restrictive eating, compulsive food behaviors, or emotional eating cycles.

 

Omega-3 Fatty Acids

Omega-3 fatty acids play a critical role in brain function, mood regulation, and cognitive health, yet research suggests that deficiency in these essential fats may contribute to eating disorder development and severity. Studies on adolescents with eating disorders have found that those with more severe depressive symptoms had significantly lower levels of omega-3 and omega-6 fatty acids compared to healthy controls. 

 

Since mood disorders, obsessive-compulsive tendencies, and cognitive rigidity are key features of many eating disorders, insufficient omega-3 levels may worsen emotional dysregulation and reinforce disordered eating behaviors.

 

Abnormal levels of polyunsaturated fatty acids (PUFAs), including omega-3 and omega-6, have been observed in individuals with eating disorders. A meta-analysis found that patients with eating disorders had lower omega-6 to omega-3 ratios, suggesting that this imbalance may be a factor in mood instability, poor impulse control, and heightened anxiety. 

 

A separate study focusing on adolescent girls with eating disorders found that their omega-3 levels were significantly lower before treatment. After undergoing nutritional rehabilitation, their omega-3 status improved, reinforcing the idea that omega-3 deficiency is closely linked to both malnutrition and deteriorating mental health. 

 

Given that eating disorders often involve long periods of dietary restriction, limited fat intake, or avoidance of nutrient-dense foods, omega-3 depletion may further exacerbate cognitive dysfunction and emotional distress in affected individuals.

 

Omega-3 fatty acids are crucial for neurotransmitter function, particularly in regulating serotonin and dopamine, both of which are essential for mood balance, emotional resilience, and impulse control. A review on omega-3 supplementation in eating disorders suggests that deprivation of omega-3s may contribute to the development of disordered eating, particularly in relation to obsessive-compulsive tendencies and depression. 

 

These findings align with existing research showing that brain inflammation and oxidative stress, which are worsened by omega-3 deficiency, can increase rigidity in thought patterns, making recovery from eating disorders more difficult.

 

Selenium and Copper

Deficiencies in selenium and copper are often overlooked in eating disorder treatment, yet they play a critical role in metabolic function, immune health, oxidative stress regulation, and neurotransmitter balance. 

 

A study comparing individuals with restricting-type anorexia (AN-R) and binge-eating/purging-type anorexia (AN-BP) found that selenium levels were lower in those with binge-purge behaviors (AN-BP), while copper levels were lower in those with restrictive eating behaviors (AN-R). These deficiencies can worsen cognitive function, mood stability, and overall health, further exacerbating disordered eating patterns.

 

Selenium is a potent antioxidant that helps protect the body from oxidative stress and inflammation, both of which are elevated in individuals with chronic malnutrition and disordered eating behaviors. It is also essential for thyroid function, as it plays a key role in producing thyroid hormones (T3 and T4). Since thyroid dysfunction is common in anorexia due to prolonged caloric restriction, inadequate selenium levels can further impair metabolism, energy levels, and mood stability.

 

Individuals with binge-purge behaviors (AN-BP) may be at a greater risk for selenium deficiency due to increased oxidative stress from repeated purging, electrolyte imbalances, and malabsorption. The consequences of low selenium levels can extend beyond metabolism and include weakened immune function, hair loss, cognitive fog, and increased anxiety, all of which can reinforce restrictive eating patterns and compulsive behaviors.

 

Copper is essential for energy production, red blood cell formation, and nervous system function. It plays a major role in neurotransmitter synthesis, particularly in the regulation of dopamine and norepinephrine, which influence mood, motivation, and cognitive flexibility. One study found that individuals with restricting-type anorexia had lower copper levels, which may contribute to fatigue, anemia, mood instability, and increased anxiety—all of which make eating disorder recovery even more difficult.

 

Low Cholesterol

 

 

Cholesterol has long been demonized in mainstream health narratives, with decades of public health campaigns promoting low-cholesterol diets and cholesterol-lowering medications as key strategies for heart disease prevention. 

 

However, emerging research suggests that low cholesterol levels may be a contributing factor in mental health disorders, including eating disorders. While cholesterol is often viewed solely through the lens of cardiovascular health, it plays a fundamental role in brain function, hormone production, and neurotransmitter signaling—all of which are critical for mood regulation, impulse control, and cognitive stability.

 

Low cholesterol levels have been correlated with increased rates of depression, anxiety, self-harm, and suicidal ideation. Given that eating disorders often co-exist with these psychiatric conditions, it is crucial to examine how insufficient cholesterol may exacerbate disordered eating behaviors and hinder recovery.

 

How Cholesterol Supports Brain Function and Mental Health

Cholesterol is an essential structural component of every cell membrane in the body, but it is particularly abundant in the brain, which is composed of nearly 60% fat. Some of the key roles cholesterol plays in mental and neurological health include:

 

1. Neurotransmitter Function and Mood Regulation

Cholesterol is necessary for the production and function of serotonin, the neurotransmitter responsible for regulating mood, emotional stability, and decision-making. 

 

Low cholesterol levels have been linked to serotonin dysfunction, which may contribute to depression, impulsivity, and emotional dysregulation—common traits observed in individuals with eating disorders.

 

2. Hormone Synthesis and Appetite Regulation

Cholesterol is the precursor for steroid hormones, including cortisol, estrogen, progesterone, and testosterone—all of which play a role in appetite regulation, stress response, and emotional balance.

 

Disruptions in these hormones due to low cholesterol may lead to increased anxiety, metabolic imbalances, and dysfunctional eating behaviors.

 

3. Brain Growth and Development in Adolescents

The brain undergoes significant growth and neurotransmitter shifts during adolescence and early adulthood, a critical period when eating disorders often develop.

 

Research suggests that low cholesterol levels during these developmental years may increase vulnerability to psychiatric disorders, including anorexia and bulimia.

 

The Link Between Low Cholesterol and Eating Disorders

 

 

Several studies have highlighted the association between low cholesterol and increased risk for psychiatric distress, including eating disorders. Below are some key findings that illustrate this connection:

 

Cholesterol and Anorexia

• Patients with anorexia often have abnormally low cholesterol levels, which may further contribute to depressive symptoms, self-harm tendencies, and increased suicidal ideation.
• Low cholesterol impairs serotonin function, exacerbating rigid thinking, obsessive behaviors, and emotional distress—all hallmark features of anorexia.
• Research indicates that reintroducing cholesterol-rich foods in recovery can improve mood stability and cognitive flexibility, aiding in the healing process.

 

Cholesterol and Binge Eating Disorder (BED)

• Studies on impulse control and addiction have found that low cholesterol may be associated with increased cravings, compulsive behaviors, and difficulty resisting urges.
• Cocaine addicts with low cholesterol levels were more likely to relapse, suggesting that adequate cholesterol levels may be necessary for maintaining self-control and breaking addictive patterns—an important consideration for those struggling with binge eating behaviors.

 

Cholesterol and Self-Harm/Suicidal Behavior

• Low cholesterol levels have been repeatedly linked to increased aggression, self-injury, and suicide risk in various populations, including psychiatric patients, individuals with PTSD, and adolescents.
• People with eating disorders—particularly those with restrictive eating patterns—are at a significantly higher risk for self-harm and suicidal ideation.

 

Cholesterol-Lowering Medications and Psychiatric Side Effects

The widespread use of statins and other cholesterol-lowering drugs has further highlighted the importance of cholesterol for mental well-being. They have also been linked to cognitive impairments, mood instability, and increased risk of psychiatric symptoms.

 

• In 2012, the FDA issued a black-box warning on statins due to clinical trial findings showing negative effects on cognition and psychological well-being.
• Long-term statin use has been associated with increased rates of depression, irritability, and aggression, reinforcing the role of cholesterol in brain function and emotional regulation.
• Interestingly, overall mortality in statin use has not seen any reduction, as deaths from suicide and other psychiatric-related causes have increased.

 

These findings further suggest that low cholesterol levels—whether due to dietary restriction, metabolic dysfunction, or medication use—can contribute to psychiatric symptoms that can worsen disordered eating behaviors.

 

Plant-Based Diets

 

 

Plant-based diets have surged in popularity, and are often touted as an ethical, environmental, and health-conscious choice. However, these misconceptions couldn’t be farther from the truth. We won’t get into those arguments in this article but you can read more about the misconceptions around meat in regard to the environment and health below:

 

• Beyond Meat: Meat-Alternative Solution?
• Tufts Food Compass Guide – A Nutritionist’s Review
• White House Conference on Hunger, Nutrition, and Health 
• 2023 United Nations FAO Report: Meat Is Essential
• Meat and Climate Change

 

Recent research suggests a strong correlation between plant-based diets and eating disorders—particularly anorexia.

 

Many individuals with restrictive eating disorders, especially adolescents and young adults, report adopting vegetarian or vegan diets as a socially acceptable way to limit food intake and control body weight. Additionally, plant-based diets often lack critical nutrients essential for mental health and neurotransmitter balance, which can further exacerbate disordered eating behaviors.

 

The Link Between Plant-Based Diets and Eating Disorders

 

 

 

Several studies have established a connection between plant-based diets and an increased risk of eating disorders. The key findings include:

 

1. Higher Prevalence of Eating Disorders Among Vegetarians

Vegetarians and vegans are significantly more likely to engage in restrictive eating behaviors, engage in binge eating, report body dissatisfaction, and exhibit weight preoccupation compared to their non-vegetarian peers.

 

Research indicates that up to 50% of patients in sample populations with anorexia report being vegetarian before their diagnosis.

 

2. Vegetarians with Anorexia Tend to Be More “Weight-Phobic”

Studies show that vegetarians diagnosed with anorexia exhibit a greater fear of weight gain than their non-vegetarian counterparts.

 

They also report a stronger aversion to high-protein animal foods, which are essential for recovery and neurotransmitter balance.

 

3. Self-Imposed Dietary Restrictions as a Mask for Disordered Eating

Many individuals use vegetarianism or veganism as a socially acceptable way to restrict calories and avoid entire food groups.

 

When young individuals, especially teenage girls, suddenly stop eating meat, it may signal an emerging eating disorder rather than a purely ethical or health-based choice.

 

Nutrient Deficiencies in Plant-Based Diets That Can Worsen Eating Disorders

 

 

One of the biggest concerns with vegetarian and vegan diets is their likeliness to cause or worsen key nutrient deficiencies. Many essential vitamins, minerals, and amino acids needed for mental health and appetite regulation are found primarily in animal-based foods.

 

Protein Deficiency

 

 

Individuals who eliminate meat often fail to replace it with adequate high-quality protein sources. Animal sources provide the most bioavailable and complete proteins, as they contain all essential amino acids in optimal ratios, whereas plant-based proteins often have limiting amino acids, requiring careful food combining to achieve adequate intake, which can be difficult and less efficient. Additionally, plant anti-nutrients such as tannins and phytates can reduce protein digestibility. 

 

Protein is critical for neurotransmitter production, muscle maintenance, and metabolic function—all of which can be severely compromised in eating disorder patients.

 

Zinc Deficiency

Zinc plays a critical role in appetite regulation, digestion, and neurotransmitter function. Studies show that female vegetarians have lower blood, urine, and hair zinc levels than their non-vegetarian counterparts.

 

Zinc deficiency can cause:

 

• Loss of appetite and aversion to meat (a hallmark sign of anorexia)
• Depression, anxiety, and cognitive impairment
• Digestive problems that make food intolerances worse

 

Additionally, plant foods contain phytates and oxalates, which block and reduce zinc absorption, making it harder for vegetarians to maintain adequate zinc levels.

 

Iron Deficiency

 

 

Iron deficiency is a well-documented factor across all eating disorders, including pica. Research supports that vegetarians have a higher prevalence of iron deficiency compared to meat-eating individuals. 

 

Iron deficiency can exacerbate:

 

• Fatigue 
• Cognitive impairment 
• Anxiety 
• Mood disturbances

 

The type of iron consumed also plays a crucial role; heme iron, found in animal-based foods such as red meat, is highly bioavailable, while non-heme iron, present in plant-based sources and supplementation, has significantly lower absorption rates. 

 

Vitamin B12 Deficiency

 

 

B12 is essential for neurotransmitter production, brain health, and energy metabolism—and is found exclusively in animal-based foods. One review of 18 studies found that there were higher rates of vitamin b12 deficiency among vegetarians and vegans.

 

Symptoms of B12 deficiency include:

 

• Depression and anxiety
• Fatigue and cognitive impairment
• Increased irritability and panic attacks

 

Many psychiatrists note that B12 deficiency is common in anorexia patients, further exacerbating mood instability and difficulty tolerating food reintroduction.

 

Omega-3 Fatty Acid Deficiency

 

 

Plant-based diets commonly lead to omega-3 fatty acid deficiency because they lack bioavailable EPA and DHA, which are only found in seafood, with smaller amounts available in grass-finished ruminants and pasture-raised eggs, whereas plant-based omega-3 sources contain ALA, which has poor conversion rates in the body.

 

Symptoms of omega-3 deficiency can cause:

 

• Increased anxiety and depression, worsening mood instability
• Cognitive rigidity and impaired impulse control, reinforcing restrictive behaviors
• Heightened inflammation and oxidative stress, leading to brain fog and fatigue

 

Tryptophan Deficiency

Tryptophan, an essential amino acid for serotonin production, is required for serotonin synthesis and is found in high concentrations in meat, poultry, dairy, and eggs. High-protein plant-based diets are still at risk for low intake of tryptophan. 

 

Low tryptophan intake can impair serotonin function, contributing to:

 

• Depressed mood and anxiety
• Increased compulsive behaviors
• Poor response to antidepressant medications in eating disorder patients

 

Low Cholesterol: A Compounding Risk Factor

 

 

As mentioned above, cholesterol is a key structural component of brain cells and is essential for neurotransmitter signaling, hormone synthesis, and cell membrane function. Low cholesterol levels have been linked to increased rates of depression, anxiety, impulsivity, and suicidal ideation—all of which are highly relevant to eating disorders.

 

Studies show that vegetarians and vegans naturally have lower cholesterol levels, which may further impair mood regulation and cognitive function, increasing the risk of disordered eating behaviors and relapse in recovery.

 

The Overlap Between Micronutrient Deficiencies, Low Cholesterol, and Plant-Based Diets

 

 

Both micronutrient deficiencies and low cholesterol levels have been identified as factors that contribute to the development and persistence of eating disorders. These two factors are highly prevalent in plant-based diets, further strengthening the connection between vegetarianism/veganism and disordered eating behaviors.

 

• Micronutrient deficiencies are common in plant-based diets and have been strongly linked to appetite loss, mood disorders, and increased risk of anorexia and restrictive eating behaviors.
• Low cholesterol, often seen in vegetarians and vegans, has been correlated with increased impulsivity, depression, and self-harm—symptoms that are frequently seen in individuals with eating disorders.

 

This combination of micronutrient deficiencies and inadequate cholesterol intake in plant-based diets may create an environment where disordered eating behaviors are more likely to develop and persist.

 

I personally went plant-based for over 12 years. Yes, no animal proteins for over a decade. Less than one year into being plant-based, I started experiencing insatiable hunger at night. Nothing could stop me from raiding the fridge for any food. At first, it felt exhilarating to turn off the rigid “diet mentality” in my mind. It was like breaking free from chains—I could finally eat without guilt. But that feeling of elation was fleeting. Shame would creep in after just a few bites, followed by a crushing sense of weakness and desperation: “I’ll never be strong enough. I’ll never be thin enough. I’ll never be good enough.”

 

What began as an occasional lapse spiraled into a full-blown cycle of bingeing and purging. Each episode left me more defeated than the last. I’d tell myself, “This has to stop,” but the cycle always returned, sometimes just hours later. Looking back, I now see that I was nutritionally starved. So much of what I was going through wasn’t about a lack of willpower. My low-fat, plant-based meals—big bowls of salad, quinoa, and beans—offered very little in the way of real sustenance. I was depriving my body of the nutrients it needed to thrive, and it was crying out for help in the only way it could.

 

You can read more about my experience with being plant-based and struggling with an eating disorder here and here.

 

Why the Eating Disorder Standard Care Treatment Model Needs to Change

 

 

The standard care treatment model for eating disorders has helped some individuals recover, particularly through psychotherapy and behavioral therapy. However, many other components of the model are outdated and require significant changes, especially in the areas of nutritional rehabilitation, medical monitoring, and pharmacotherapy. 

 

The current approach fails to address nutritional deficiencies, the addictive nature of certain foods, the role of gut health in food cravings, and the over-reliance on medications.

 

For true root-cause healing, the treatment model must evolve to incorporate a biologically-informed, holistic approach that prioritizes nutrient-dense, bioavailable foods, proper digestive support, and personalized nutrition strategies while maintaining the comprehensive mental health aspects.

 

The Need for Change in Nutritional Rehabilitation

 

 

Current nutritional rehabilitation focuses on restoring caloric intake and gradual exposure to fear foods, assuming that all foods should be included in a balanced diet. However, this method lacks critical nuance and ignores the impact of nutritional deficiencies, food addiction, and gut health on eating behaviors.

 

Nutritional deficiencies are not adequately addressed in standard care. The common practice is to rely on synthetic supplementation rather than whole-food sources for nutrient repletion. Synthetic supplements pose bioavailability concerns in addition to specific requirements such as methylated forms of certain vitamins for MTHFR mutations. Additionally, low cholesterol levels are often overlooked, despite research linking them to eating disorders and other mental health conditions. 

 

Nutritional rehabilitation should emphasize nutrient-dense, animal-based foods, which are far more bioavailable than synthetic vitamins or plant-based sources, which often contain anti-nutrients that impair mineral absorption. It requires a deeper, nuanced look at patient history and how their physiology and life experiences are driving this disorder.

 

 

The approach to fear food exposure and intuitive eating requires much more nuance as well. Standard treatment encourages individuals to consume all types of food, including ultra-processed and highly palatable foods, with the idea that a “balanced diet” includes everything in moderation. 

 

 

This fails to account for food addiction, gut imbalances, and the fact that certain foods can trigger compulsive eating behaviors. Many foods, particularly those high in sugar, refined carbs, and processed ingredients, can lead to addictive patterns in vulnerable individuals. Asking these people to moderate their sugar and carb intake is like asking an alcoholic to moderate their alcohol—we know moderation doesn’t work for addiction, so why wouldn’t it apply here? For these individuals, consuming these foods only reinforces the cycle of cravings and bingeing.

 

Another overlooked factor is how gut imbalances and infections influence cravings. Many individuals with eating disorders have dysbiosis or fungal overgrowth, such as Candida, which can drive intense cravings for sugar and processed carbs. Exposure therapy that encourages individuals to eat these foods without addressing underlying gut health imbalances can exacerbate symptoms rather than support recovery.

 

 

For individuals struggling with food addiction, the conventional model of moderation is ineffective. A more appropriate strategy involves complete abstinence from ultra-processed foods or even carbs, similar to how addiction recovery models eliminate substances that drive dependency. This is where ketogenic (keto) and Carnivore diets can play a groundbreaking role in recovery. 

 

These diets help stabilize blood sugar, reduce cravings, and promote brain health by supporting neurotransmitter function with ketones. Additionally, meat-based diets are rich in bioavailable sources of cholesterol and the micronutrients listed above that have been linked to contributing to and exacerbating eating disorders. 

 

 

Studies support the therapeutic potential of keto diets (Carnivore is a type of keto diet) for anorexia:

 

• A case series documented three patients with severe, treatment-resistant anorexia who achieved long-term remission using a high-fat, animal-based keto diet, leading to significant weight gain, diminished anxiety, and overall improved mental well-being. The findings challenge traditional anorexia treatments that prioritize unrestricted caloric intake, suggesting that metabolic and neuromodulatory interventions including keto diets may play a crucial role in eating disorder recovery.
• One study reports that keto diets can address the neurobiological alterations in anorexia. Keto diets may also help reduce body-related fears and food restriction behaviors by stabilizing brain energy metabolism and neurotransmitter function.  
• A case report illuminated the experience of a 29-year-old woman with severe, long-term anorexia experiencing full remission after adopting a keto diet. She reported reduced compulsions, obsessions, and body dissatisfaction after following a strict keto diet, followed by ketamine therapy.
• Another study reviewed novel interventions for anorexia including the keto diet. It highlights keto diets as promising strategies for improving eating disorder cognition and stabilizing energy metabolism. 

 

For those who struggle with compulsive eating and binge-restrict cycles, these diets provide a structured approach that eliminates problematic foods while ensuring nutrient density. 

 

Medical Monitoring and Stabilization Requires a Functional Medicine Approach

Standard care focuses primarily on calorie restoration and weight gain as indicators of recovery, but this approach often ignores deeper biochemical imbalances that drive disordered eating behaviors. Proper electrolyte balance, gut health support, and digestive function restoration are frequently overlooked in favor of one-size-fits-all recommendations.

 

 

Electrolyte balance in standard treatment is often managed with sugar-laden sports drinks or processed electrolyte solutions, which can further destabilize blood sugar and contribute to gut dysbiosis. A more effective approach prioritizes whole-food sources of electrolytes, such as sole water, unrefined salts, potassium-rich animal foods, and magnesium supplementation without added sugars.

 

 

Fiber supplementation is another commonly prescribed intervention for gut health, but this recommendation fails to consider individual digestive function. Many individuals with eating disorders already suffer from low stomach acid, sluggish bile production, and gut inflammation, all of which make digesting fiber more challenging. 

 

Overloading the system with fiber without correcting underlying digestive deficiencies can lead to bloating, gas, and malabsorption. Instead of recommending fiber, treatment should focus on enhancing stomach acid levels, bile flow, and overall gut function. You can learn more about why fiber isn’t essential for gut health here.

 

Digestive support is rarely included in standard care but is crucial for long-term recovery. Many individuals with eating disorders struggle with low stomach acid (hypochlorhydria), sluggish gallbladder function, and impaired enzyme production. Symptoms of acid reflux are often treated with antacids in standard care when these are actually a result of low stomach acid. 

 

Low stomach acid, in particular, is common due to chronic stress, nutrient depletion, and past plant-heavy diets. Without adequate stomach acid, nutrients such as iron, zinc, and B12 cannot be properly absorbed, worsening malnutrition. A more holistic approach should include temporary supports like betaine HCl supplementation to improve protein digestion, ox bile for fat support,  digestive enzymes for digestion, and gut-healing protocols to restore microbial balance.[/vc_column_text]