Keto & Eating Disorders – Breaking the Vicious Circle

Some ten years ago, I worked closely with a therapist specialising on eating disorders. Before that, I’d had a stereotypical image of people suffering from eating disorders as girls who eat too little. I’d assumed that eating disorders are visible, picturing these girls as very thin and anaemic. I soon learned that the lion part of those suffering from eating disorders do not, in fact, eat too little. Nor are they particularly thin. Most people suffering from eating disorders are diagnosed with bulimia nervosa, binge eating syndrome, or the like. Most of the girls I and the therapist met during our common project were slightly overweight, struggling with shame, guilt and disturbed eating patterns; this, she explained, was to be statistically expected. Some of the participants were diagnosed with anorexia nervosa, but they were in minority.

Gendered Eating Norms

The majority of the participants had developed a similar pattern. They avoided eating during the day; many said they could not eat in public, because they didn’t think overweight women should flaunt their failure to restrict themselves. Above all, they avoided eating food deemed heavy and masculine, like meat, fat and rich, sturdy dishes. If anything, they allowed themselves yogurt, fruit, bread, vegetables or even small amounts of sweets: food considered feminine, light, modern and healthy. One of the participants remembered saying “Oh, I’ll just have a sallad”, every single time she went to a restaurant, for at least a decade. This remark made many of the girls laugh out loud, sharing the same experience.

salad and burger

Having starved throughout the day, or perhaps a few days in a row, the participants secretly stuffed themselves in the privacy of their rooms, in the bathroom, or some other place away from the eyes of family and friends, come night. They were, by then, very hungry. At night, they would binge eat things like bread, ice cream, cookies and crisps – low quality carbohydrates with no nutritional value. Many of them ended up seriously malnourished – indeed anaemic – but overweight.

The project included girls aged 13-19 with clinical diagnoses, but the pattern seems to be very common, doesn’t it? Many women adhere to a low calorie diet throughout the day, or during weekdays, only to “fail” and binge eat at night or during weekends. And, like many of the clinically diagnosed participants, they feel ashamed of their perceived inability to control their bodies and their food intake.

Throughout the project, I learned that malnourishment, overweight and disordered eating patterns go hand in hand. Part of the equation is gender norms telling women to settle for low fat, high carb food with low nutritional value. The irony is that such diets will have adverse effects on your glucose response, making you hungrier and even more prone to binge eat sugar and carbohydrates – which easily leads to overweight; reinforcing a vicious circle of starvation, depletion, binge eating and shame.

Keto as a Counterweight

Speaking from my own experience of subclinical eating disorders, I find ketogenic eating to be an efficient counterweight to any impulse or habit of overly restricting food intake. There are two main reasons for this.

One reason has to do with ketosis and its effect on brain chemistry and, subsequently, a range of brain disorders; ketosis may, according to a growing body of scientific studies, prove efficient for treating such diverse conditions as epilepsy, Alzheimer’s disease, Parkinson’s disease and bipolar disorder. Barbara Scolnic and her Boston University colleagues hypothesise that ketosis may mitigate the biochemical impulse to starve, as it mimics starvation induced ketosis, but without caloric deprivation or other adverse effects. In the quote below, they first refer to a couple of classical studies on rodents, showing that rodents propelled to develop eating disorders were much more likely to starve to death on a high carb diet than on a ketogenic diet, due to the high fat content of the latter. They also refer to a recent study showing that the vicious circle of caloric deprivation, excessive exercise and the development of anorexia nervosa may be broken by a ketogenic diet, simply because the initial starvation – spurring on the biochemical responses leading to anorexia nervosa – never occurs:

The animals were fasted for one day, and then access to food was limited to one hour/day but access to the running wheel was continuous. In the regular chow group 8/10 starved to death; in the high fat (probable ketogenic) diet 1/10 died of starvation. The fat content of the diet was the protective factor. In 2008 Brown, Avena, and Hoebel demonstrated that introduction of a fat-enriched diet (although not necessarily ketogenic) interferes with the cascade leading to self-starvation in the activity-based-anorexia rodent model, both by preventing the initial self starvation, and rescuing animals once the starvation had begun.

Scolnic et al. conclude that while there are no published studies on the effect of a ketogenic diet on patients diagnosed with anorexia nervosa, there are some interesting cases motivating further research. One such case tells of a young woman showing “striking improvement in anxiety and eating disorder symptoms” when on keto.  “She is now recovered”, they say,  “but when she notices hints of returning to self starvation behaviors, she reinstitutes the [ketogenic diet] and has experienced resolution of the cravings to starve.” In other words, keto food may take the edge off any impulse or habit of restricting food intake in an unhealthy manner – resolving the craving to starve. Here is a podcast episode containing two other testimonies to the same mechanisms (if you can stand the commercials).

Nice, ketogenic brunch: three scrambled eggs with 50 grams of butter, an avocado with salt and olive oil, and a cucumber and tomato salad.

The second reason why keto may be beneficial for anyone struggling to recover from eating disorders, or subclinical disordered eating is, admittedly, more superficial. It has to do with body image and weight gain – or, for that matter, weight loss.

Let’s be realistic and honest: it’s no fun to put on excessive water and body fat as a result of weight gain, nor to lose muscle mass as a result of weight loss. Both scenarios may trigger body image issues and relapses into disordered eating patterns. In a utopian world rid of all gendered beauty standards, recovering from eating disorders could perhaps entail the complete freedom from body ideals. In this faulty world of ours, it probably doesn’t. Most people recovering from eating disorders will still care about their looks as much as anyone, preferring a tight and lean silhouette to a bloated and spongy one. I think this deserves some non-moralistic recognition.

People needing to put on weight as part of their recovery testify to doing so in a relatively angst-free way on keto, since they never feel bloated or stuffed – which, again, is very triggering. They also say that the first thing that changed once they started eating healthy amounts of keto food was their bone density, followed by increased muscle mass, improved skin and hair quality and, for those who needed it, increased body fat. People who needed to lose weight firstly got rid of excess water, then fat – but none of their muscle mass. Personally, I’ve put on some five, well needed kilograms over the last few years, but I still fit into my favourite pair of jeans. This is because most – but not all – of those sweet kilos are muscle mass. I used to be too skinny and did need to put on some fat as well; and, which is good news if we do manage to cut the moralistic crap – those kilos are distributed very evenly. Putting on weight eating sugar and other carbs, in contrast, often means gaining unbecoming fat depots on your tummy, where it’s actually unhealthy.

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