Could the Keto Diet Hide Eating Disorders More Easily?

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Unless you’ve been living under a rock, you’ve probably heard of the keto diet. Often touted as a weight-loss miracle diet, the keto lifestyle is generating a lot of buzz. Keto is actually short for ketogenic

The Ketogenic Diet is a high-fat, low-carbohydrate diet that focuses primarily on calories from fat. There are many health benefits and weight-loss promises associated with this diet, but there are also many risks. The keto diet might actually make it easier to hide an unhealthy relationship with food.

Part of the problem with the keto diet is that it is incredibly restrictive in terms of what you can eat, how much of it you should eat, and perhaps more importantly, what you cannot eat. Those restrictions could pose severe problems for people struggling with eating disorders. 

Experts worry that the keto diet could encourage intensely restricted eating among people with unhealthy relationships with food. It could also make certain eating disorders, such as binge eating, easier to hide.

Ketogenic Diet 101

At its core, a ketogenic diet is a high-fat, moderate-protein, low-carb diet. Meaning the bulk of your calories and food intake are high-fat foods, and you’ll minimize (if not eliminate) carbohydrates. Yes, you’ve seen the concept of low-carb diets before (cough, Atkins, cough), but the Keto diet is different. It involves replacing that drastically reduced carb intake with fats. 

The idea is your body will enter a state called ketosis when you become efficient at burning fat for energy — because you do not have carbs to process. The result is increased energy, weight loss, reduced inflammation, and improved brain function, just to name a few. Instead of your body burning glucose (from carbs) to create energy, it burns ketones (from fats), believed to increase your metabolism, reduce hunger, increase muscle mass, and improve heart health.

The Keto diet is pretty specific in terms of proportions and precisely what you can and cannot eat. The breakdown of your meals should be about 70-80 percent fat, 20 percent protein, and a measly 5 percent carbohydrates (pretty much nothing) in the form of whole grains, crackers, chips and sugars, and minimal fruits.

So, if carbs are pretty much off-limits, what can you eat?

Lots of healthy proteins and high-fat foods. Think fish and seafood, cheese, avocados, poultry, eggs, nuts, and seeds. Veggies are okay, but only the low-carb variety — non-starchy vegetables like broccoli, cauliflower, green beans, and spinach. Yogurt is great too but opt for full-fat yogurt and not the fruit-flavored products loaded with hidden sugars. Berries are okay if you’re craving fruit because they are chock full of antioxidants and fiber, but are low in carbs. Caffeine is allowed but go for unsweetened coffee and tea.

While this diet is undoubtedly strict regarding what is and isn’t allowed, some experts argue that nothing is truly off-limits with the keto diet. 

According to dietitians Emily Stone and Laura Dority, M.S., R.D., L.D., with Keto Knowledge LLC, the keto diet is less about off-limits and more about how you choose to “spend” your carbs. “The exact amount needed to achieve ketosis can vary on the individual, though, with carb prescriptions ranging from 10 to 60 grams per day. This total is for net carbohydrates (total carbs minus fiber),” Stone told Eating Well. It is also important to note that if you are an athlete or are super active, you can eat more carbs and still achieve ketosis. 

Ketogenic Diet and Eating Disorders – What’s the Connection?

Eating disorders, by definition, are “serious conditions related to persistent eating behaviors that negatively impact your health, your emotions, and your ability to function in important areas of life,” according to the Mayo Clinic. 

While there is a wide range of eating disorders in terms of how they manifest, most eating disorders involve focusing too much on your weight, body shape, and food, leading to dangerous eating behaviors.

Here’s where things get a little tricky. 

Eating disorders can be extreme and often comprise unhealthy behaviors surrounding how a person eats and their relationship with food. But some might argue that extreme diets in which an individual is deprived of an entire food group (in the case of the Keto diet, carbs) are also extreme behaviors involving food, especially if the goal is fast or drastic weight loss.

We’re not saying that the Keto diet and eating disorders go hand in hand or that the Keto diet could cause an eating disorder. But some worry that it is a slippery slope.

A healthy mindset is essential with any dietary change, especially one that requires diligence, commitment, and detailed tracking of caloric intake. Consider just how much effort it takes to calculate ratios of macronutrients, as you must do with the Ketogenic diet. It’s not as simple as “eat wholesome foods,” or “stick to as much fresh produce as possible,” or “avoid processed junk.” The Keto diet is specific. It’s strict. It requires hyper-focus on every bite and calorie you put into your body. 

This rigidity could trigger unhealthy behaviors or fuel an unhealthy relationship with food already in place. In fact, that overwhelming and unhealthy obsession with healthy eating has a name — orthorexia. 

Orthorexia was coined in 1998, and it describes the obsessive actions taken to maintain a healthy diet. “It’s an unrelenting obsession with the foods you are eating to the point that it inhibits you from enjoying your life and induces stress,” explains author and leading functional-medicine expert William Cole, IFMCP, DNM, D.C. 

It is quite understandable that some people might slip from a strict diet to obsessive eating habits, especially with a diet such as the Keto diet. “I have seen the most well-intentioned people become obsessed with following the conventional keto diet perfectly, and this stress actually ends up causing more harm than good,” Cole told Mind, Body, Green. “The desire to be healthy isn’t bad. It’s when it turns into an obsession that it becomes a problem,” he said.

In addition, some experts worry that the Keto diet could actually lead to or exacerbate binge eating disorder, involving eating large amounts of food and feeling unable to stop. 

Because the Keto diet is so restricting in terms of what you can eat, it often leads to weight loss. But for people with problems bingeing, knowing they can eat as much high-fat food as they want might lead to more over-eating and worsening symptoms. According to the Mayo Clinic, restricting your diet can make the problem worse and lead to more bingeing.

While that seems to be somewhat backward — restricting your diet should actually encourage you to eat less — many people who want to lose weight are drawn to restrictive diets that end up backfiring. 

“Individuals struggling with binge eating who desire to lose weight may see the Keto diet as a way to obtain that goal,” explains Johnny Williamson, MD, the medical director at Timberline Knolls Residential Treatment Center. But because they are often vulnerable to unhealthy eating habits, the Keto diet could potentially both encourage those dangerous behaviors and help hide those habits that can be masked as healthy dietary restrictions. 

It’s not necessarily that the Keto diet could cause an eating disorder, but “it’s possible that those vulnerable to developing an eating disorder could identify with the keto diet and then utilize its principles to act on and manage their eating disorder behaviors,” Williamson explained to Everyday Health.

Think of it this way, any extreme deprivation or intensely restrictive diet can border on disordered eating if taken too far, or if a person is already vulnerable to such behaviors. For people who already struggle with eating disorders and unhealthy relationships with food, it can get dangerous and obsessive quickly.

Do the Benefits Outweigh the Risks? 

To be clear: there are many benefits of a keto diet. Preliminary research suggests that the Keto diet can improve heart disease risk factors, help reduce symptoms of Alzheimer’s disease, cause significant reductions in seizures in people with epilepsy, and more. It has also been shown to increase energy, improve brain functioning, encourage weight loss, and reduce inflammation. 

While we should not overlook these benefits, as with any diet, there are risks as well. 

There is the risk of nutrient deficiency, liver, and kidney problems due to the high-fat content, and an increase in “bad” LDL cholesterol, which can be linked to heart disease. And then, of course, the risk of triggering disordered eating in some cases. 

So, what’s the bottom line? As with any diet, approach the Keto diet with caution; do your research, be responsible, and pay attention to how your body feels. Understand that there is no “one-size-fits-all” approach to health and weight loss.

If the Keto diet is doing more harm than good for your health and eating habits, it’s time to move on to a more balanced diet routine. Make sure you are educated about your dietary choices and the pros and cons of your actions. Always consult with your doctor or a registered dietician to discuss drastic nutritional changes.