Although people with anorexia nervosa restrict their food intake, they may still have high cholesterol levels. Experts believe that genetics, hormones, and other factors may be responsible.

Anorexia nervosa, which people usually refer to as anorexia, is a mental health condition that involves an intense fear of gaining weight. It can lead to malnourishment and serious health problems. In some cases, it can even be life threatening.

People with anorexia may have high cholesterol levels despite restricting their food intake and, in some cases, eating very little. A 2019 meta-analysis found that people with anorexia had higher cholesterol levels than individuals without this condition.

Although experts do not fully understand why this happens, they think that anorexia may cause genetic, hormonal, and gut bacteria changes that contribute to higher cholesterol levels.

Read more to learn about the link between cholesterol and anorexia, how cholesterol levels affect health, and more.

A person holding a rack of test tubes.Share on Pinterest
mixetto/Getty Images

Individuals living with anorexia restrict their food intake and have an intense fear of gaining weight. In some cases, they have an altered image of their weight and body shape.

Despite people with anorexia limiting their food intake, research has linked the condition with high cholesterol levels. Experts think that various factors likely play a role.


A large 2017 study found that there was a strong positive genetic correlation between anorexia and high-density lipoprotein (HDL) cholesterol. This means that people with genetic markers for anorexia were more likely to have markers for HDL cholesterol, as well.

Although HDL is the “good” type of cholesterol, having very high levels may be harmful in some cases.


A diet low in calories and fat can have several effects on the body, including:

  • hypoinsulinemia, or abnormally low insulin in the blood
  • increased insulin sensitivity
  • hypoglycemia, or low blood sugar

Additionally, people with anorexia may have decreased levels of the thyroid hormone triiodothyronine (T3). T3 regulates a lipoprotein called cholesterol ester transfer protein (CETP), which affects cholesterol metabolism.

People with anorexia can have increased CETP activity and, therefore, increased cholesterol.

Increased absorption

Individuals with anorexia may absorb higher levels of phytosterols, which are naturally occurring plant compounds that are similar to cholesterol. The body may absorb them because of changes in the gut microbiota.

Phytosterols structurally resemble the body’s cholesterol, so when an individual consumes them, they compete with cholesterol for absorption in the gut.

Individuals with other eating disorders, such as bulimia nervosa and binge eating disorder (BED), may also experience high cholesterol levels.

Bulimia nervosa, known as bulimia, is a serious eating disorder that involves a cycle of uncontrolled binge eating and “compensatory” behaviors, such as vomiting, fasting, or misusing laxatives. Research suggests that 19–48% of individuals living with bulimia may have high cholesterol.

Experts think that these increased levels result from the cycle of binging and purging or restricting. During a binge, people consume large amounts of food, which can mean taking in high amounts of fat and calories. This can change how the body metabolizes lipoproteins, and it may also contribute to the formation of plaque in the arteries.

Individuals with BED also binge eat, but they typically do not use compensatory measures, such as purging, to try to counter the effects of binge eating. They consume large numbers of calories during episodes of binging and have an increased risk of high cholesterol levels.

Doctors measure cholesterol in milligrams per deciliter (mg/dl) and may classify the levels as high, low, borderline, or healthy.

Total cholesterol

Total cholesterol indicates the total cholesterol in a person’s blood, meaning both low-density lipoprotein (LDL) cholesterol and HDL cholesterol.

A healthy total cholesterol level for adults is under 200 mg/dl. The National Heart, Lung, and Blood Institute notes that doctors consider 200–239 mg/dl to be borderline high and 240 mg/dl and above to be high.

LDL cholesterol

LDL, or “bad” cholesterol, builds up in the walls of the arteries and can cause blockages in these vessels.

Healthy levels are those below 100 mg/dl. Readings of 130–159 mg/dl, 160–189 mg/dl, and 190 mg/dl and above are borderline high, high, and very high, respectively.

HDL cholesterol

HDL cholesterol helps remove LDL cholesterol from the bloodstream.

Doctors recommend levels of 40 mg/dl or higher in adult males and 50 mg/dl or higher in adult females. They consider readings below 40 mg/dl as low and those at or above 60 mg/dl as high.

Anorexia has the highest mortality rate of all mental health conditions.

This eating disorder can lead to many health complications, some of which can be permanent even after successful recovery and weight restoration. Typically, the medical complications are a result of malnutrition and weight loss. They can include:

  • heart problems
  • infertility
  • osteoporosis
  • thyroid abnormalities
  • constipation
  • pneumonia
  • absence of menstruation

A team of healthcare professionals, including doctors, psychologists, psychiatrists, counselors, and dietitians, may provide anorexia treatment in various settings.

A doctor may recommend emergency hospital treatment if the individual is severely malnourished, is mentally distressed, does not have stable vital signs, or has other health conditions, such as diabetes.

Specialist clinics for individuals with eating disorders may offer residential programs with intensive treatment.

These options are suitable for people who are medically stable and require no intensive interventions but have continued mental health difficulties. Individuals receive specially tailored meal plans as part of the program. They may also work with dietitians who will provide guidance on adopting regular eating patterns after returning home.

Learn more about anorexia treatment options.

If an individual is concerned about their relationship with food or thinks that they have an eating disorder, they should make an appointment with a doctor as soon as possible. Although it can be difficult to talk about an eating disorder, treatment is often essential for a person’s long-term physical and mental health.

Anorexia nervosa is an eating disorder that can cause long-term health problems. Despite restricting their food intake, individuals with anorexia may have high cholesterol.

Although experts are not entirely sure why this happens, genetic and hormonal factors may play a role.