Saturday, 30 November 2013

Cholesterol...and ED?

A typical work-up for any patient includes blood tests. A sample of blood can tell us a lot about the health of a patient, from electrolye levels to cholesterol. For ED patients, this can be very important because it can help us see what we need to do to help them. For example, low iron (typically from low meat or protein intake, as what happens in starvation) can cause anemia, so we might give the patient iron supplements. Similarly, we might see low calcium levels, along with a bone scan, and decide that the patient needs calcium supplements or vitamin D. We can also see their glucose levels and determine if their blood sugar is within the normal range.

All of this sounds helpful, right? But what about when the blood tests come back normal? Is the patient 'fine'? Does that mean that the patient cannot possibly have ED, or is not 'sick enough'? NO. Something I always tell my patients and nursing peers is that medicine is simply ONE tool to help us help others - it cannot be used alone. For example, we would need to conduct a thorough assessment on the patient and see what their hearts sounds are like, breathing sounds, muscular ability is, etc. To top that off, we need to know that blood values, like other things, are not always exactly 'perfect' in the information they tell us. This post is going to give one simple example about a blood value often seen in ED patients, and why so many patients continue to be ill because their medical teams believe that if their tests come back normal, they must be normal, too.

Blood tests can include cholesterol. We know that cholesterol is an essential part of many processes in the body, including making cell membranes and hormones. If a patient has ED and is not eating, you would expect cholesterol levels to be low, right? After all, if they are not eating enough fats, how would their body make cholesterol? Well, the interesting thing is that often in ED patients, cholesterol levels are high ( ). Once a physician sees this, they usually tell the patient to eat a low-fat and low-cholesterol diet. BUT WAIT! Patients wtih ED need to eat a variety of foods, including cholesterol and/or fats because our bodies need this to survive and function properly. Is there some kind of mistake here? Do we get another blood test? Or does the patient really need to eat a low-fat diet? Why do some patients with ED have high cholesterol levels?

Let me offer one explaination from a medical perspective: we know that cholesterol is made by the liver. When levels of fat/cholesterol in the body get too low, the liver needs to make more cholesterol to meet demands. In a patient with ED, low levels of fats means that the liver needs to make some. This is important because we need enough cholesterol and fats for normal functioning. So, the liver begins to make more and more cholesterol to keep the body in balance. But, this means that at any given moment, the patient's blood values may show elevated cholesterol levels. Does this mean that they should eat a low-fat diet? NO NO NO NO NO! This means that their liver is now working overtime to keep the body stable. Actually, to be healthy, the liver should be making only enough cholesterol to keep one healthy - not stressed trying to make more because the body is low on fat stores! Blood values in patients can return to normal once they are weight-restored and eating enough variety and the nutrients they need.

What do we learn from this? First, do not go by medical tests only. While they are helpful (I am a nursing student and know the value of my blood tests!), they cannot be used alone. We must use our discretion and careful assessments to better help our patients. We also learn that patients with ED who have high cholesterol levels may not need to be put on a low-fat diet. In fact, one of the best predictors of not relapsing and staying healthy in recovery was eating a diet that had enough fat in it (we need fat for cushioning, warmth, cell membranes, hormones, and so much more!). On a final note, we can learn that while patients may not appear to be sick, this can fool us because the body is extremely efficient at battling the stresses it faces...until it can no longer survive. So, do patients with ED need to eat low-fat diets? No. Not unless there is some strong compelling reason why they should be (as in, a major threat to their health that has been proven and is definite. Please note that this post refers to ED patients only. If you are a patient without ED a have high cholesterol levels, you may very well need to eat a low-fat diet for the sake of your health. Please talk to your doctor in that case!). In other words, don't judge something by simply what it looks like, or what you know. A blood test is a great way to learn about health, but it isn't the ONLY thing to look at. Remember how I always say that weight isn't the only indicator of health? The same thing applies here! Some might be underweight but healthy, whereas others may be a normal weight and still have disordered eating. Do not use one thing to make a judgment - be aware and informed!


  1. This post is lovely Marina.
    I had several discussion with my dietitians and doctors the conclusion is exactly as you said

    Recovered ED victim

  2. As you know during my treatment program We discussed this and the recommendation is as you highlighted Marina.
    Please all Ed recovering or recovered eat balanced diet with high carb and cholesterol that very important for rebuilding the cells that damaged from restriction. You will never ever have problems from high cholesterol.
    I am happy now that I am eating my normal foods


  3. I do not have ED but I do have low iron and low vit D and my doc wants me take 2000 units vit D daily and also iron tab but he said take vit D with some fat foods and iron with some orange juice ,why is that .??


    1. Hi Sally, the iron and orange juice is common: iron is better absorbed in the body if we have it with something acidic, like vitamin C. Since orange juice is a source of vit C, this is why we often tell patients to take iron with some orange juice.

      The vitamin D with fat is because vit D is a fat-soluble vitamin. This means that it needs fat to be absorbed in the body (vit A, D, E, and K are all fat-soluble). So, having fat is needed for the vitamin to be better absorbed.

      I hope this helps answer your questions!

  4. Thanks Marina
    Now I can tell why they told me take Vit D after cereal and milk morning time and take my iron with juice after dinner.
    Thanks Marina again
    Your blog is the most helpful one re healthy life


  5. I was very sick last year and doctor did testing and told me you are o k.I was not o k and so I changed doctors till I met my current walk in clinic doctor who told me the most important is We listen to you and trying to understand your complains. Having blood test normal does not mean you are o k and he gave me example when you have low blood ,still can have normal test till your iron becomes very very low then you get some abnormal test.
    Also people have very low vit D and do not know .
    I like this post.


  6. Marina
    I forgot to mention that the key factor that I stopped relapsing on my ED for the last 7 years is when I started eating balanced diet with enough fat content.
    Really fat and carb were very important along with enough proteins.
    Hadn't had changed my diet and included enough fat, I would have continued to relapse .
    Great post Marina

  7. I always love the picture.


  8. Marina
    Each post I read, I feel you are talking about me.
    You remember, I was telling you that I have just mild even very mild disordered eating till you advised me and holly my blood sugar was low ,iron very low ,calcium,magnisium and phosphors ,all low and my liver tests were sky high and my doctor told me your liver was trying to keep you alive by working extra hard to make you sugar and cholesterol till now liver is exhausted and failing .
    Only eating saved me.
    I will continue eating all my foods including fatty foods ,meat ,protein and carb plus veggies and fruits.
    I will not put myself through this ever again.
    I am done with ED
    All the thanks to you Marina
    I will continue reading your blog ,not only the new post but old posts help me marinating my recovery


  9. Balanced healthy meals should include fat and cholesterol.


  10. Excellent discussion about eating that help understanding healthy eating even you address this to ED victims but I think help every body to know fat and cholesterol is necessary for maintaining our health.
    I believe for all of us We need fat and cholesterol in our daily diets except when We are diabetic or recovering for heart attacks and having abnormal lipids ,then we need to consult doctors and dietitian of consult Marina

    With my humble respect


  11. For ED victims this post is assuring and encouraging for all of them to maintain the healthy meals that should include fat to restore what was lost and maintain the recovery


  12. Eating is the only guarantee for ED to maintain recovery


  13. All Ed and most of normal people have to eat fat and get enough amount of cholesterol for their body to function.


  14. Marina ,the picture is self explanatory.


  15. You said exactly what I was reading long ago in an article about how important taking fat and cholestrol to all normal people .I appreciate you when you addressing this to all ED and I understand and I may add healthy people need to take some fat and choelrstol to maintain health.
    Only those who are obese ,have familial hyperchoeserol or heart attack or stroke need limit fat but all normal people need not restrict fat and choesterol.
    ED persons in particular need to do this for life to maintain the health and as the endocrinologist said when Ed restart feeding ,cholesteol will start to normalize .

    medical student

  16. Recently I met a friend whom i have not seen for long time and we were chatting about life and stress and We mentioned your blog.The friend disclose to me he had ED before and now he is survivor of ED.Interstly he tells me he disagree with the word ED victim and he rather We call him and every body suffred as survivors rather than victims as it has postive meanings.

    Just wanted to share this .


    1. Thanks for sharing - love the optimism! Great way to look at it!

    2. You are very welcome Marina
      We learn from you quite a lot.


  17. I love to read that all foods including fats and cholesterol are necssary for our body to survive the daily stress and for our brain to be able to think and manage and also healthy eating help our sleep and immune system.
    Your blog is famous Marina because it promotes healthy life style and nutrition not only for ED victims but for all of us .


  18. I am glad to know more about cholesterol and ED.
    Thanks Marina


  19. WOW the endocrinologist said exactly what you have been saying .
    I am very proud of you Marina


  20. excellent post


  21. You are making an excellent point.
    All ED need to continue eating balanced diet that is rich in fats and cholesterol to restore the damaged cells over the starvation years.

    S K

  22. I like this post and I also like to call ED survivors rather than victims .
    ED people are smart, strong,
    determined and problem solver
    They can survive any hurdle


  23. I am pleased to know that people who were restricting before like myself and now in recovery, even if never diagnosed formally with ED ,need to eat meals contain fat and cholesterol and not restrict fat even if they have high cholesterol.



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