Can anxiety cause weight loss despite adequate nutrition?

January 9, 2011 12:02 PM

Can anxiety cause weight loss despite adequate nutrition?

Two years ago, I changed my diet, and began eating very healthily. Lots of fresh vegetables, salmon, etc. Definitely lower on the carbs. I lost about 7 pounds (went down to 110, I had always been about 115-117). I then added back whole grains, more starchy veggies, and went on a "diet" (not for weight loss) that had a big emphasis on balancing hormones, so I would always combine fats, protein and carbs. I was eating three solid meals a day with several snacks, and my weight went back up to about where it had always been. But I felt great...until I began experiencing severe anxiety. I had an episode that left me unable to eat or do anything for almost an entire week and I dropped down to 110 pounds in a few days.

Since then, I have tried to no avail to gain weight. This past summer I went down to 100 pounds despite eating a lot of healthy food. I went to the doctor and had some tests done. The results said that my thyroid and everything else is okay. I have no intestinal distress so malnutrition as of the result of an allergy such as celiac disease does not seem likely.

Like I said, I definitely eat enough and people always ask me how I stay so thin. I am 20 years old and have never had this problem before. The only thing is that I am still very anxious on a daily basis.

My question is, is it possible that my anxiety is using up all of the calories I consume? How can I fix this? Doctors have been unhelpful. I am tired of feeling like a breeze could blow me away and of looking so gaunt. Some relevant info is that I am 20, female, and I have very little muscle. Will building muscle round out my figure, and perhaps allow more fat to be gained as well?

Thank you.

posted by DeltaForce to health & fitness (26 answers total)

I'm also pretty thin and have a hard time putting on weight, especially when busy. Are you absolutely sure you're eating the same amount as before? You say you eat a lot of "healthy food." It takes a lot of fruits, veggies, and grains to get enough calories to maintain your weight or to gain weight. Do you eat anything more calorie-dense, like certain meats, cheeses, etc."

If you want to build muscle, the exercise will burn calories, so you'll have to up your food intake even more.

I drink those nutritional drinks (Boost and Ensure are common brands) as breakfast every morning to get a good start because I'm bad about waiting until late in the day to start eating. There are different versions with more or less calories and more or less protein.
posted by elpea at 12:26 PM on January 9, 2011

Yes, I promise I'm eating enough. I can't tell you how many people have looked at me with their eyebrows raised as I'm eating a double meat Chipotle burrito for the second time in a day.
posted by DeltaForce at 12:28 PM on January 9, 2011

I remember your previous question about this issue, and I'm a bit concerned for you. I'm glad your doctor has ruled out most of your major problems, but it seems like you're really stressed out about this weight issue (which likely isn't doing anything for your anxiety). Do you have access to a nutritionist? Because it might be a good idea at this point for you to get some professional help figuring out how to get back to where you want to be.

Re: the building muscle question -- Building muscle is, on balance, a good thing for most people, but it is a form of mass gain as well -- unless you're taking in enough calories to support making more of you, you aren't going to see the gains you want. Adding some muscle will make you stronger and make you feel less like a breeze will carry you away, but if you're worried about having a gaunt-looking face, it might not help so much with that -- that's largely a matter of subcutaneous fat. The good thing is that gaining muscle usually entails gaining some fat as well.
posted by kataclysm at 12:31 PM on January 9, 2011

sentence edit: I'm glad your doctor has ruled out most of your major problems.

what can I say, i had a long night last night...
posted by kataclysm at 12:32 PM on January 9, 2011

Have you ever kept a food diary? What is a typical day's calorie intake and macronutrient breakdown?
posted by Anatoly Pisarenko at 12:36 PM on January 9, 2011

Second food diary. The BBC did a documentary about eating habits a while back and the big revelation was that after actually tracking their food intake, the people who said they were skinny and ate a lot but never gained a pound were, in fact, eating few calories, and the people who felt that they were constantly dieting but kept gaining, were, in fact, eating a lot.

That said, building muscle will help you look less gaunt and I always recommend it.

If you want to gain weight, either in the form of body fat or muscle (hopefully you'll take my advice and it'll be a bit of both), you have to approach eating like a job. This is the advice that guys who are "hard gainers" usually get when they are trying to build muscle mass but it applies here as well. Plan for a large amount of nutritious and healthy food intake, log it carefully, and accept that sometimes you will have to eat even though you feel full and don't want to. Embrace fat as the magical food that gives you twice as many calories for the same weight of food intake. If you still can't gain any weight after a solid month of doing this, go back to the doctor.
posted by telegraph at 12:46 PM on January 9, 2011 [1 favorite]

This happens to me when I get anxious, because I'm burning more calories by fidgeting, I exercise more to reduce anxiety, and I have trouble eating. I think the best answer is to treat the anxiety.
posted by yarly at 12:49 PM on January 9, 2011

If you look at a book like Anxiety Disorders and Phobias by Aaron Beck and look at the list of symptoms for anxiety disorder, you will find near the top of every list digestion problems. If you look for consensus scientific peer-reviewed information on diet, you will find it is literally all over the place. I have read a bunch of this stuff after a few years of intermittent suffering from both anxiety disorder and digestion problems, which were big enough to bug me but never big enough to make for unambiguous medical diagnosis.

I believe the answer to your question "is it possible that my anxiety is using up all of the calories I consume?" is that nobody yet knows.

One time many years ago (it was in 1997 to be exact) I went from 180 lbs to 135 lbs in three months eating steady but freaked out due to my anxiety and the doctor told me "there isn't anything wrong with you. Do you want some prozac?" Talk to your doc and supplement with your own research and experiments.
posted by bukvich at 12:53 PM on January 9, 2011

Anecdotally, I have lost weight while going through a period of intense stress despite eating adequately. Went down 5-6 kilo for no apparent reason, lost fat and muscle, looked thin and unhealthy, the whole bit. It caused the same cycle of anxiety about the weight loss leading to more weight loss, etc etc. Doctors also ruled everything serious out, and eventually I calmed down and the stress lessened and I now gain and lose weight as normal.

Putting on muscle is always a good thing, and the exercise might lessen your anxiety and improve your appetite too... but you do have to eat a ton of protein while weight training in order to gain muscle, so grain and veggies won't cut it.

Maybe work on anxiety first, such as by trying medication, then add in exercise and food?
posted by jetsetlag at 12:57 PM on January 9, 2011

Note that it is possible to have celiac disease without obviously manifesting intestinal distress.
posted by Andrhia at 1:02 PM on January 9, 2011

I have a buddy who has only ever been able to gain weight by adding muscle. As others have said, it'll mean adding more calories, but as long as you're getting lots of protein (and it sounds like you are), adding guacamole and other good fats to foods should help with those extra needed calories. Muscles also just help me feel badass, which has helped some with my anxiety in general. I say try it!
posted by ldthomps at 1:15 PM on January 9, 2011

In your May 25th post, your last update mentioned that you did have "some borderline hyperthyroid stuff going on". Are you 100% positive that this is not the case again? If you are unable to see a doctor again, perhaps try doing what your doctor recommended to you before? I wish I could give you better advice on this...

Assuming that you are still 5'4", as mentioned in the above quoted post, being 110 pounds would give you a body mass index of 18.9. I understand the scale is not perfect (I personally think it dips down a bit too far on the low side) but for your height 18.5 is the limit for being underweight, so I can understand your concern to gain back those pounds lost.

From the sounds of things you like to keep your diet pretty healthy. Do you enjoy cooking? If not now is a great time to start! Cheese omelets are easy to make (I enjoy eating them on buttered toast when I'm trying to gain more weight). Get creative! Feel free to message/email me if you would like some ideas recipes!

Try taking small steps like adding small amounts of more calorie-dense foods to foods you already enjoy: an extra tablespoon of oil to a stir-fry, some extra melty cheese on top of a chili or in a burrito, switch up a grade of milk (ie 1% to 2%).

Also, if you can afford it, eat out a little more. There are still a large majority of restaurants that care more about how their food tastes rather than how healthy it is for you. You can still order healthy dishes and chances are they will be richer than the food you make at home.

Just keep trying, stay positive, and most of all, be patient about it. The best way for your body to accept and stay at a new weight is to slowly gravitate in the direction you want.
posted by lovecricket at 1:43 PM on January 9, 2011

Are you doing anything to treat the anxiety itself? Because yeah, constant stress will do all sorts of wacky things to your hormone levels which can affect your weight. I'd also be inclined to get a second opinion about your thyroid, too - that age seems to be when hyperthyroid starts to kick in real good. (Both my mom and my sister are hyperthyroid - my mom lost a scary amount of weight, and my sister developed what appeared to be ADHD that went away as soon as she got her thyroid levels straightened out.)
posted by restless_nomad at 1:48 PM on January 9, 2011

Thank you for all the replies, advice, and anecdotes. Right now I am 5'4 and 104 pounds, which puts me at 17.8 on the bmi scale, in case that is relevant to any further responses. As for the borderline hyperthyroid stuff, it's like really really really borderline and the doctor doesn't think it's a problem.

I think weight lifting is going in the right direction, and I will definitely start with a food journal. I think if in another year of food journaling, weight lifting, and stress management, I still have not gained weight, I will go back to the doctor.

But despite the lack of solid scientific evidence, my gut tells me this is a stress thing. So definitely this needs to be addressed first and foremost. Thanks again everyone.
posted by DeltaForce at 1:51 PM on January 9, 2011

*opps! Forgot to mention... when I say slowly gravitate, I mean it. Like 1-2 pounds per month.

Also, I agree with everyone else, exercise is amazing for anxiety. Yoga does wonders for my anxiety, when I'm real stressed I'll go jogging. Find out what works best for you! Just be sure to eat enough small snacks throughout the day to compensate for the calories you burn off so you can still accomplish your goal of gaining back those pounds!

Classes help when your first starting out... Look around for a community center or something of the sort in your area that offers discounted exercise classes! Ask around if anyone knows of a good workshop/class that won't break your budget! :)

Good luck! We're cheering for ya!
posted by lovecricket at 1:54 PM on January 9, 2011

Completely anecdotal here, but when I was about your age, I went through the exact same thing. I am 5'7 and had always been about 125 pounds. Around 19, I suddenly dropped 10 pounds for no explainable reason. I wasn't working out more, I was probably eating a much higher fat and calorie diet than I ever had, and yet I still lost the weight. I wasn't experiencing anxiety per se, but I was pretty stressed out (school, work, etc). I looked very thin, but my energy levels were good and I felt fine. Got checked out by a doc and nothing was wrong. By the time I hit 25, I started gaining the weight back (and an extra 20 pounds to boot, unfortunately).

For me, since I felt fine and didn't continue to lose scary amounts of weight, I just attributed it to a change in my metabolism combined with increased stress and didn't worry much about it.
posted by tryniti at 2:11 PM on January 9, 2011

Not to freak you out or anything, but another cause of unexplained weight loss is diabetes. And yes, you can get it at 20 even if you are thin and fit. Did your doctor do a fasting blood glucose test? (I.e., did you have to go get blood drawn first thing in the AM, before breakfast?)
posted by kestrel251 at 2:25 PM on January 9, 2011

If you are having borderline thyroid issues, they could be causing the stress and the weight loss.
posted by gjc at 2:34 PM on January 9, 2011

Definitely continue to check out any underlying health issues and try to control your anxiety, but could you just be naturally thin with a high metabolism? Purely anecdotal but I had a friend who was 5'8" and weighed about 115. She was in her late 30s by the time I met her and still keen to gain weight but nothing worked. In addition to eating well, she tried adding a protein shake every night (in addition to her evening meal). She was otherwise healthy and noted that this had been a lifelong problem. She mentioned that although she had enjoyed running, she had to quit the track team in high school because she lost too much weight. She didn't seem overly anxious, but she was a bit of a perfectionist. However, as noted above, she was very keen to gain weight, so I didn't get the sense that her low weight was the result of an eating disorder.

In her case, her weight remained stable. She may have gained a pound or two when she was calorie loading but she never went below her admittedly below average weight. It just seemed to be her body's natural set point. Maybe you just have a really low set point as well?
posted by kaybdc at 3:03 PM on January 9, 2011

I will definitely start with a food journal

Yeah, this needs to be your first step. Anything else is putting the cart before the horse. In all likelihood you're not eating enough. There are lots of easy ways to add some healthy calories to your diet. Try a couple of glasses of whole milk throughout the day.

Lifting weights is a great idea, but it won't do anything to make you gain weight in and of itself, except in that exercise can make you hungrier.
posted by Anatoly Pisarenko at 3:17 PM on January 9, 2011

If you want to eat a lot of the same things but pack in lots of extra good calories just drizzle extra virgin olive oil on everything you eat.
posted by zephyr_words at 3:44 PM on January 9, 2011

It's very possible you're not absorbing all the nutrients you're eating, either because you're not digesting all your food or because certain food components are blocking your absorption of certain other nutrients.

Grains bind to certain nutrients (including some vitamins and some minerals) and prevent absorption. Grains and legumes contain antinutrients that are like mini-doses of poison and increase gut permeability (a bad thing known as "leaky gut").

I encourage you, since you seem disciplined enough to make dietary decisions and stick with them, to try out the Paleo Diet, which involves all the whole foods you were eating in your first-described healthy diet, and which excludes grains. This is a lifetime-appropriate diet and your hormones should be balanced just fine.

Read the books The Paleo Diet and/or The Primal Blueprint for more information and support. Another great resource is biochemist Robb Wolf's podcast, which is called The Paleolithic Solution if you look it up on iTunes. You could be having serious gut issues, which could also affect your mental state, without being diagnosed with celiac. Good luck!
posted by Franzilla at 3:51 PM on January 9, 2011

Do not try the Paleo diet. Do not change your diet. Do not lower the carbohydrates in your diet. Do not do dietary experiments when your weight has dropped without explanation. You could really screw yourself up.

I would start with stress and go from there. Keep eating what is normal for you.
posted by zeek321 at 4:32 PM on January 9, 2011

And the food journal. Even if you just do it for a couple days, you'll get much better intuition. Also:

http://www.chipotlefan.com/index.php?id=nutrition_calculator
posted by zeek321 at 4:34 PM on January 9, 2011

nthing food journaling. I know I am a very poor estimator of my actual food intake unles I write everything down.

I know this sounds terrible, but how are your bowel movements? Have you had any changes? I have heard of people who thought nothing of their "usual diarrhea" until it was diagnosed as celiac's disease. If you have had any changes in your bowel habits make sure to mention them to your doctor.

How long ago was your last trip to the doctor?

If I were in your shoes, I'd go back to the doctor, let them know I'm still concerned about my weight, show them my food journal and ask them what they think is up. They might say that nothing is up, or they might do more tests. I'd personally want some pretty basic screenings: CBC, serum glucose, electrolytes, liver function panel, basic urinalysis and thyroid function test. They're all fairly standard tests that are typical for an annual physical. I'd ask for a photocopy of my results, and ask the doctor if everything looked normal.

You might just have a fast metabolism, but if you're concerned, it's a good idea to see the doctor to set your mind at ease.
posted by abirae at 4:41 PM on January 9, 2011

Get checked for diabetes. Type I diabetes can cause major weight loss and an inability to gain weight. I watched a friend drop from almost 300 pounds to 140 in six months. He was in his 30s, so he wasn't checked for Type I diabetes but, that is what it is. He is now on insulin and at a much better size.
posted by SuzySmith at 8:35 PM on January 9, 2011