If you've suffered from anorexia or bulimia in the past, you know recovery can be a long road as you make peace with food, your body, and the very real life triggers that led to your eating disorder in the first place. What many of the women I see in my medical practice who have struggled with an eating disorder didn't expect was that they'd find themselves facing long-term consequences in the form of a slow-functioning thyroid and imbalances in the adrenal stress response with symptoms like:
- Fatigue, tiredness, sluggishness
- Trouble keeping weight on—or off
- Night eating syndrome
- Feeling cold all the time
- Sleep problems
- Digestive problems including constipation, loose stools, gas and bloating, IBS
- Anxiety and irritability
- Chronic overwhelm
- Hormone imbalances including irregular periods, PCOS, or fertility challenges
- Dry skin
- Hair thinning or hair loss
- Frequent colds, herpes outbreaks, and yeast infections
- Thyroid problems—including both autoimmune (Hashimoto's) and non-autoimmune hypothyroidism
Many of the suggestions here are based on my experience, observations, and practice as a medical doctor focusing on women's health, particularly adrenal and thyroid problems. Please consult your doctor before making any lifestyle changes, especially if you have a medical history of eating disorders.
What is the relationship between disordered eating, your adrenals, and your thyroid?
Having an eating disorder itself can be a signal that your adrenal response system is in overdrive—usually as a result of underlying life stress or trauma (or sometimes another root cause, for example, an illness, severe disruption in the microbiome due to antibiotic overuse, or a severe food intolerance) that has disrupted the normal signals of eating, fullness, and body perception. Then in turn, eating disorders, particularly anorexia, leads to further disruption in the adrenal stress axis that starts in your brain and leads to the end result of increased cortisol and adrenaline production. When you aren't getting enough nutrition, your brain sends you into survival mode. It freaks out when it registers that its fuel tank is too far below the empty line and sends you into "defcon 3" and tries to protect you by making you conserve energy. It does this by forcing your metabolism and energy expenditure into hibernation.
Here's why it happens and how it works:
You might feel anxious, have brain fog, and be craving fat and sugar.
Your brain requires about 20 percent of the energy you consume from food to do its basic functions; when it gets below that, it can't keep your life in order, and it goes into red alert, causing you discomfort to try to get you to eat—you get anxious, sweaty, cold shakes, your brain gets foggy—all as a result of the stress hormone adrenaline being pumped out to jog you into food-seeking action. Suddenly you want sugar, carbs, fat—anything with energy—and you want it now.
Then, the exhaustion, fatigue, overwhelm, and irritability set in.
Your ancient brain has your entire body hardwired to protect you in the event of famine or very lean times—a real threat to our ancestors—and so when your fuel intake becomes chronically low, not only are you pumping out more adrenaline, but you start to pump out more cortisol. And more and more. This puts you into a state of anxiety, irritability, high alert, and it starts to cause you to wear down your muscle and bone, make your brain get more foggy, affects your sleep, digestion, hormones, immune system and blood sugar response. It confuses the cross talk in your brain, screwing up your hunger and fullness signals. And eventually your brain says, Whoa, I can't keep pumping this stuff out to protect her because it's affecting her health—so I've got to stop producing so much adrenaline and cortisol. The result—your adrenals slow down their production of these important chemical orchestrators of health, mood, and energy, and you can become unmotivated, lethargic, depressed, exhausted, depleted, easily overwhelmed, and in a weird trick of the immune system, you become more at risk of autoimmune disease.
Finally, with long-term restrictive eating, your hormones become imbalanced.
Your ancient brain, also being the wise ruler she is, decides it's best to conserve energy by turning down your metabolism. How does it do that? By slowing down your thyroid function. Cortisol tells your thyroid to stop making the building blocks of active thyroid hormone, socks away the active thyroid hormone that is produced into a kind that you can't use—preventing your from "overdrafting" on your energy bank account, and makes your cells less responsive to thyroid hormone. Attention is also diverted away from tasks you don't need urgently—like regular digestion and making reproductive hormones—leading to the digestive and hormonal symptoms so common with thyroid imbalances.
This can happen with any kind of restrictive eating pattern.
And news flash—you don't have to have had a diagnosed eating disorder to be struggling with the impact of eating too little on your adrenals and thyroid—any excessive restricting—including orthorexia (excessive focus on healthy eating that causes you to undereat), excessive cleansing and detoxing that causes you to undereat, or even skipping meals regularly because you're so busy, can have an impact.
Here's your plan to full mind-body-spirit replenishment.
Your brain's perception that you are at risk of starvation put your brain into the red alert of chronic survival mode. 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. The key is to learn to live a Replenished Life, allowing you to restore what has been depleted and stay out of the empty zone 100 percent going forward.
Here are five ways you can start replenishing your health with food, starting immediately:
1. On a whole-body level: Never get too hungry.
Never let yourself get to the point where you're so hungry that you're shaky or cranky or jittery or you can't focus or concentrate or you feel like you could just eat an entire box of anything right now that's filled with carbs or sugar or fat. That's low blood sugar, which is the primo signal to your brain to go into survival mode. To prevent this from happening:
- Listen to your body—often—so you can recognize and respond to your body's signals.
- Eat breakfast within an hour of waking up and if you're a coffee drinker, have your morning cup with or after your meal but not before or instead of it.
- Eat a modest-size meal every 3 to 4 hours with a good-quality protein and fat at every meal.
- Have a midmorning and midafternoon snack if needed, of some nuts, a protein shake or smoothie, a green drink, a hard-boiled eggs, some hummus with vegetables.
2. On an energetic level: Eat healthy carbs.
Carbs (carbohydrates) have become the modern villain. But super-low carb diets over time have been shown to rebound on women, leading to imbalances in our cortisol, while having some healthy kinds, like whole grains and starchy vegetables (sweet potatoes, winter squash, even modest amounts of white potatoes baked or roasted as long as not slathered in sour cream!) can keep your cortisol in a healthy rhythm, especially when you cycle them at the right time of day. Here's how this is done:
- Skip the carbs at breakfast and don't ever start your day with sweetened carbs (cereals, granola, muffins, pancakes with maple syrup, even if they're paleo pancakes)
- At lunch have 1 portion of a whole grain or a starchy energy vegetable and at dinner have 1 to 2 portions. Examples include half a cup of cooked quinoa, red or pink or black rice, brown rice, and millet, a sweet potato, a portion of winter squash or baked or roasted white potatoes.
- Eating a healthy carbohydrate about 5 hours before bed has been shown to normalize cortisol, improve sleep, and help reduce excess weight. But don't eat anything within 3 hours of bed, because that can do the opposite.
3. On a cellular level: Get enough sleep.
We really do need seven to eight hours of sleep each night to replenish our cells and restore healthy cortisol rhythm. Try getting to bed at the same time each night and waking up at the same time each day, turning off the electronics an hour before sleep, and skip the evening glass of wine.
4. On a mind and spirit level: Meditate or get in "the zone" daily.
Meditation takes your entire being out of what is called sympathetic overdrive—the same fight-or-flight mode you're in when your adrenal stress response is overactivated—and puts you into a parasympathetic mode—how you feel in savasana at the end of yoga session, during a massage, or when you are deeply at peace. Practiced for even 15 minutes each day, meditation and deep relaxation practices begin to heal your adrenal system by creating an inner sense of safety that allows the alarm system to turn off. If meditation is not your thing, try other activities that get you "in the zone"—dance, painting, journaling, a hot bath and a novel…and make a daily practice out of giving yourself "permission to pause" and replenish your spirit and mind with relaxation. It can help with digestion, too.
5. On a glandular level (adrenals and thyroid): Use the right herbs and supplements for healing.
Herbs known as adaptogens can be used to restore health in the adrenal stress axis, in turn, lifting the message your thyroid is getting that you're in an energy crisis, once again allowing your metabolism to rev up. They calm and nourish the adrenal glands and support the processes that are controlled by the adrenals—from blood sugar and immune system regulation, to hormones and mood. Amazingly, they work whether you are experiencing adrenal overstimulation or adrenal fatigue. Some of the adaptogens I most commonly recommend when you are restoring your adrenal and thyroid function are ashwagandha (which yes, can be used when you have hypothyroidism), shatavari, holy basil, turmeric, and reishi mushroom—all of which are gentle and thus prevent you from overstimulating your already depleted adrenal response. Additionally, vitamin C, magnesium, and phosphatidylserine are nutrients that may be supplemented to help replenish the adrenal stress response system.
Your thyroid may also need some nourishment—you have to get ample zinc, iodine, selenium, vitamin A, for example, for your thyroid to make active thyroid hormone and stay healthy. A multivitamin can make a huge difference in making sure you're getting what you need daily.
You can learn more about healing your adrenals and thyroid, and how to use the right supplements, in my new book The Adrenal Thyroid Revolution. It's a plan for getting replenished—and staying that way. You've been through a lot—and now it's time to enjoy the life you were meant to live—revitalized, whole, and ready to take on the world!