The Eating Disorder Thyroid Disease Connection

What is the connection?

I have found that a high percentage of individuals with Anorexia, Bulimia and Bulimarexia have thyroid disease.  It makes sense.  Stress is one of the most common underlying conditions associated with thyroid disease and individuals with eating disorders have stress, in spades.  Sometimes it is the stress that causes the eating disorder and sometimes it is the eating disorder that causes the stress, but stress is always involved. 

Thyroid disease involves the hypothalamic/pituitary/adrenal axis.  These are just three glands that are involved in providing the hormones that the thyroid needs.  Having an eating disorder, particularly anorexia, bulimia or bulimarexia, or even excessive weight gain, puts a lot of pressure on all three of these glands, which in turn can damage the thyroid.  Part of the problem is that the anxiety or fear of gaining weight leads to increased cortisol and adrenaline production.  If this is a constant, and it is for many people, it puts a lot of stress on the systems that manage everything from mood to metabolism.

For the individual suffering from Anorexia or Bulimiarexia, it is even more complicated in that if you aren’t getting enough nutrition, your brain sends you into survival mode and then you get even more adrenal production.  It is an adaptive mechanism that will save your life in an emergency.  It’s called the flight or fight hormone for that reason.  But it can do a great deal of harm if it continues indefinitely. 

What happens if you are starving yourself, is that the system goes into panic mode when it registers that there is no fuel in the fuel tank, so to speak.  So it tries to protect you by making you conserve energy.  It does this by forcing your metabolism and energy expenditure into hibernation. In other words, excessively high levels of the anxiety hormone, cortisol, tell your thyroid to stop producing T3, the thyroid hormone that causes the body to burn calories. 

Think about that.  Anxiety can cause weight gain. (We already know that weight gain can cause anxiety…so this is a very vicious cycle.)

Here’s what happens:

The brain requires 20 percent of the energy we consume to do its basic functions.  If it is deprived of the energy it needs it can’t function and it goes into red alert.  It creates “symptoms” by releasing adrenalin and cortisol in the hopes that you will be motivated to eat.  In other words you may get anxious, sweaty, maybe you get the cold chills, and your brain gets foggy.  All of these things are the result of the stress hormones being pumped out to jog you into food-seeking behaviors.

So when it works, you all of a sudden want sugar, carbs, fat—anything with energy—and you want it now. This is part of the reason why if you are Anorexic, you think about food all the time. 

If you ignore the call, and if you are anorexic, you probably do, then, the exhaustion, fatigue, and irritability set in. You will also feel overwhelmed at this point as you are also pumping out a lot of cortisol besides the adrenalin.  Talk about anxiety. It is the worst, like having mini panic attacks, on a regular basis. 

There is a part of you that knows that you should be doing something, but you can’t do what you need to do, which is eat, so you just stay on high alert: You pace, stress out, loose your temper, withdraw from family and friends, stay up all night, sleep all day, miss class, miss work…..meltdown time.

Been there?

And if this isn’t bad enough, your brain starts working at cross purposes, sending messages to the hunger hormones to do the opposite of what they are supposed to be doing. When this happens you can get something called Leptin resistance where you can feel hungry all the time even after you have eaten.[1]  This is something that usually affects obese individuals, however, it can also impact someone with Anorexia, by this strange twist of fate with your hormones turning on you. 

Finally, the self-imposed starvation results in damage to the hypothalamic/pituitary/adrenal axis and in so doing, it damages the thyroid. [2] Over time this state causes wear and tear on your muscle and bone, causing osteopedia, or worse osteoporosis, you can’t sleep, your blood sugar levels drop, you do not digest food well, which means more bloating when you do eat, and more anxiety as a result.  Wow!

Eventually the brain does a reset, as if recognizing that it can’t keep pumping all this stuff out to protect you because it’s not working. So it stops producing so much adrenaline and cortisol. Now, your adrenals slow down the production of these important mediators of health, mood, and energy.  What happens next is that you can become unmotivated, lethargic, depressed, exhausted, depleted, and easily overwhelmed. 

Sound familiar? 

Even worse, if you consult with a conventional physician or even an ED specialist, they will likely say you are “just depressed ” and put you on an antidepressant.  This is a big miss, because what can happen from there due to a weird trick of nature is that the immune system goes into overdrive and you become more at risk for an autoimmune disease. Enter Psoriasis, PICO’s, Rosacia, Hives, Renaud’s, Lupus, Multiple Sclerosis, etc. 

These are all the things I was seeing in my patients beginning 10 years ago, when I started this journey.  Initially I could not figure out what all of these autoimmune symptoms were and where they were coming from.  What I discovered was that there was a direct connection between eating disorders and damage to the thyroid, hypothalamus and pituitary and autoimmune disease.

Finally, with the damage to the thyroid, hypothalamus, and pituitary, and the strain on the adrenals, continued restricting causes your hormones to become unbalanced. Now the old part of your brain, recognizes that the only thing it can do is try to conserve energy by dialing down your metabolism.

How does it do that? By slowing down your thyroid function.  That’s right, cortisol tells your thyroid to stop making the building blocks of the active thyroid hormone, T3, and to produce a form that the body cannot use, Reverse T3, preventing you from “overdrafting” your energy bank account.  Over time this makes the cells in your body less responsive to thyroid hormone.  This is just another way of saying that it slows down your metabolism. 

The brain also diverts energy away from tasks you don’t need urgently—like regular digestion (so you become constipated) and making reproductive hormones (so you stop having periods and may become infertile).  This leads to the digestive and hormonal symptoms that are so common with eating disorders.  They are also common with thyroid disease.

A thing to take note of is that this can happen with any kind of restrictive eating pattern.  In other words, you don’t have to have a diagnosed eating disorder to be struggling with the impact of eating too little to maintain healthy adrenals and thyroid function.  In other words, excessive cleansing and detoxing, yoyo dieting, or even skipping meals regularly because you’re so busy, can have a very negative impact on your thyroid and consequently your metabolism.

I have a very expensive piece of equipment that measures resting metabolism.  I have found that when my patients who are suffering from Anorexia first come in for treatment, their resting metabolism can be as low as 500 calories/day.  After they begin to re-feed, it begins to go up and by the end of treatment, most of my patients have achieved a metabolic burn rate of between 2500 and 3000 calories/day.  The same thing holds true for my patients who are overweight or obese.

What to Do?

What I tell my patients is that if you destroy your thyroid, which has one job and one job only, to burn calories, you will always have to worry about your weight.  To get out of survival mode and allow your adrenals and thyroid to reset to normal, your brain has to realize you’re safe and that it can turn off the alarm. 

To that end, you have to heal and then protect your thyroid.  If you heal it, you will never have to worry about your weight as long as you do a few simple things:

  1. Test for thyroid disease/damage and treat accordingly. (For help with getting your doctor to order the right tests and for help in accurately assessing the results contact me)
  2. The key is clean eating.  By that I mean 6 to 7 organic fruits and vegetables plus 6 servings of healthy proteins every day, lots of good fiber, plenty of clean water, little to no processed sugar – loose the chewing gum, diet soft drinks
  3. Determine if you are iodine deficient and supplement if necessary – (to learn more contact me)
  4. Reduce stress – Engage in fitness activities (HIIT or PULSE) Try the adaptogenic herb Ashwagandha, use emotional freedom tapping, yoga, pet a dog…in other words take active steps to manage your stress

In summary, whether the anxiety created by a diseased thyroid needs a focus and restricting becomes the focus, or the weight gain from a sluggish thyroid is intolerable for someone with Anorexic tendencies, who then begins to restrict, does not matter. 

For those of us treating eating disorders, the possibility of a connection between the anxiety, the eating disorder and the diseased thyroid is too important to ignore if we want to improve treatment outcomes for the ED and obese population, which currently are abysmal with a 35 to 50% success rate in sever cases of Anorexia and even worse for the obese population. 

It is also important to understand this connection for those who have diseased thyroids to prevent them from graduating to also having an eating disorder. Likewise, it is important if you have a specific eating disorder or if you have disordered eating (yoyo dieting, restricting, bingeing, etc.) to get the help you need to prevent damage to the thyroid.

The implication is that if you do not know about this connection as a practitioner, you may not be as effective in recognizing and treating the presenting condition.  Likewise, if
you are suffering from the strange and seemingly unconnected symptoms of thyroid disease, you may be suffering needlessly and putting yourself more at risk for an eating disorder and/or obesity.

Patients often blame themselves for the problems that they are having, especially patients with eating disorders and obesity, and they go from doctor to doctor looking for solutions all the while getting worse.  This is in part because so much of medicine today treats the symptom and not the cause.  In the case of the thyroid, which is admittedly difficult to diagnose, given how many organs and systems it impacts, this is a disaster.

For help identifying thyroid disease, treating an eating disorder, or dealing with excessive weight gain, contact The Norton Center at 513 205 6543 today!

Dr. J. Renae Norton

  • [1] Leptin resistance can cause hunger and reduced the number of calories you burn. Reference:
  • [2] Multiple abnormalities of the neuroendocrine system, in large part thought to reflect starvation-induced changes, include activation of the hypothalamic-pituitary-adrenal axis and suppression of the thyroid and gonadal axes (11).

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Materials contained on this site are made available solely for educational purposes and as part of an effort to raise general awareness of the psychological treatments available to individuals with health issues. These materials are not intended to be, and are not a substitute for, direct professional medical or psychological care based on your individual condition and circumstances.  Dr. J. Renae Norton does not diagnose or treat medical conditions. While this site may contain descriptions of pharmacological, psychiatric and psychological treatments, such descriptions and any related materials should not be used to diagnose or treat a mental health problem without consulting a qualified mental health care provider.  You are advised to consult your medical health provider about your personal questions or concerns.