High cholesterol and anorexia might sound like polar opposites. After all, anorexia is often associated with being severely underweight, while high cholesterol is usually thought to be a symptom of obesity or eating a diet high in fat. But you may be surprised to learn that the two can actually be connected. If you’re experiencing this, it can feel confusing and even worrying, but you’re not alone.
What About Other Eating Disorders?
It’s not only anorexia nervosa that can be linked with high cholesterol. Malnutrition from other eating disorders, including atypical anorexia and bulimia nervosa, as well as binge eating disorder(although through different mechanisms), can also affect cholesterol levels. In this blog, we’ll take a closer look at anorexia in particular.
A quick crash course in what cholesterol actually is …
Cholesterol is a fat-like substance that your body needs to stay alive. It’s essential for building cell membranes, making hormones, and much more. Most cholesterol is made by your liver, while a smaller amount (less than 30%) comes from animal-based foods in your diet.
Is cholesterol ‘bad’?
The simple answer is no. Cholesterol itself isn’t bad; it depends on how it’s carried around the body. Think of cholesterol as a passenger, and special transporters called lipoproteins as the vehicles.
- LDL cholesterol
Imagine LDL as a velcro ball carrying cholesterol through your bloodstream. Its job is to deliver cholesterol to cells, where it’s used to make membranes and hormones. At normal levels, LDL is perfectly safe. But if there’s too much of it, or it stays in the blood too long, it can stick to the lining of blood vessels, especially if the particles are damaged. - HDL cholesterol
HDL works in the opposite direction: it collects extra cholesterol from your blood and tissues and carries it back to the liver. There, it can be broken down, recycled, or removed from the body. HDL also supplies cholesterol to organs like the ovaries, testes, and adrenal glands to support hormone production. This “clean-up” role is why HDL is often called the “good” cholesterol.
An easy way to remember the difference is that HDL is the ‘Healthy’ cholesterol because it helps clear out the excess, while LDL can turn ‘Lousy’ if there’s too much of it hanging around in your blood.
Click HERE to watch a short video about cholesterol from the British Heart Foundation
It’s important to understand that high cholesterol in anorexia doesn’t come from the usual culprits, like eating too much fat, not exercising enough, or the liver overproducing cholesterol. In fact, research shows the opposite: during severe or prolonged undernutrition, the body actually reduces its cholesterol production. Instead, raised LDL levels result from a combination of other factors associated with malnutrition and weight loss.
Let’s Dive Deeper into the Science of High Cholesterol in Anorexia
So how do you get high cholesterol in a restrictive eating disorder and what happens to your body? Here’s an overview for you:
Release of cholesterol from body fat: When you lose weight quickly, stored fat (including cholesterol) is broken down and released into the bloodstream. This sudden extra “dump” of cholesterol can raise blood levels.
Thyroid hormone changes : Malnutrition and low-calorie intake reduce thyroid function. Thyroid hormones normally help the body make LDL receptors (little “hooks” on cells that pull LDL out of the blood). With fewer receptors, LDL lingers in the bloodstream for a longer period, and therefore, levels increase.
Reduced bile acid production: The liver turns cholesterol into bile acids, which are mostly excreted in stool. That’s the body’s main way of getting rid of cholesterol. However, in malnutrition, the body conserves energy, so it produces less bile. Additionally, since less dietary fat is eaten, less bile is needed. The result… less cholesterol is broken down and cleared.
Loss of metabolically active tissue: Severe weight loss reduces muscle and fat mass. These tissues produce enzymes like lipoprotein lipase (LPL) and hepatic lipase (HL), which normally remodel LDL. With less enzyme activity, LDL isn’t processed as effectively and… you guessed it, more LDL hangs around in the blood.
In short, losing weight changes how the body moves, clears and breaks down cholesterol, and those changes can raise blood LDL cholesterol even in someone who is very underweight.
So, What Happens if I Have High Cholesterol in Anorexia?
Anorexia and other eating disorders already come with serious health risks, but when high cholesterol is added into the mix, it can raise additional concerns. High cholesterol means there’s too much cholesterol circulating in your blood, and over time, this can build up in your arteries. Think of it like a drain pipe blocked up with gunk (yuck). Although high cholesterol doesn’t usually cause symptoms on its own, it can increase the risk of serious cardiovascular problems, such as:
- Angina (chest pain caused by reduced blood flow to the heart)
- Heart attack (when blood flow to a part of the heart is blocked)
- Stroke (when blood flow to a part of the brain is blocked or reduced)
Because of these risks, it’s important to take high cholesterol seriously, even if you’re underweight or in recovery from an eating disorder. The good news is that the best way to support healthy cholesterol levels is often the same as the best way to recover from anorexia.
What To Do if You Have Anorexia and High Cholesterol
This might sound counterproductive, but the truth is: lowering cholesterol in anorexia actually means eating more, not less. The goal is not to cut out fat or exercise harder; it’s to restore balance and nourish the body back to health. You could think about it as putting more into the body to balance the system out.
Do’s
- Focus on recovery first. Cholesterol levels usually improve as nutritional status improves.
- Eat a balanced diet that includes all three macronutrients: proteins, carbohydrates, and fats.
- Include healthy fats (avocado, olive oil, nuts, seeds, oily fish). These help restore hormones, repair cells, and actually support healthy cholesterol balance. You can read more about fats in our blog on What to Eat to Get My Period Back.
- Prioritise variety: aim for a rainbow of fruits and vegetables to get a wide range of vitamins and minerals that support metabolism and healing.
Don’ts
- Don’t restrict fats or food groups. Cutting out fat can worsen malnutrition and, ironically, exacerbate cholesterol problems.
- Don’t over-exercise. While exercise is often recommended for cholesterol management in the general population, in the context of anorexia or malnutrition, it can be dangerous. Over-exercise adds stress, worsens weight loss, and delays recovery.
The best cholesterol-lowering treatment for anorexia is recovery itself. As nutrition improves, thyroid hormones, bile production, and enzyme function all begin to normalise, and cholesterol levels usually follow.
Take-Home Message for Managing High Cholesterol in Anorexia
Anorexia, in some cases, can lead to high levels of LDL cholesterol. This doesn’t mean you’ve done something wrong or that your body is “broken”; it’s a consequence of malnutrition and the way the body adapts to starvation.
The most important thing to know is that the solution is recovery, not restriction. Trying to cut out fat or exercise more will only make things worse. By restoring balanced nutrition, your body gradually regains normal function.
If you’re struggling with anorexia and high cholesterol, the best step is to work closely with your healthcare team. You don’t need to fight this battle alone, and with the right support, both your health and your cholesterol can recover.
References
Weinbrenner T, Züger M, Jacoby GE, Herpertz S, Liedtke R, Sudhop T, et al. Lipoprotein metabolism in patients with anorexia nervosa: a case–control study investigating the mechanisms leading to hypercholesterolaemia. British Journal of Nutrition. 2004 Jun;91(6):959–69.