Eating Disorders & Disordered Eating

Can the keto diet cause eating disorders?

November 14, 2023

Written by Chandana (Chandy) Balasubramanian

Medically reviewed by

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Key Points

  • The low-carb, high-fat keto diet is very popular for weight loss
  • You can lose weight, lower insulin resistance, and get other benefits from this diet
  • However, keto has risks for people with eating disorders or a history of disordered eating
  • Getting more information and working with a Registered Dietitian can help 

Lately, does it feel like everyone you talk to is on the keto diet or has tried it in the past? While many may "go keto," reviews are mixed.

Everyone agrees that you can lose weight fast, but in time, many regain their weight and face other health issues.

There are other concerns about the keto diet, particularly for people battling eating disorders or who have a history of disordered eating.

If you want to go on a keto diet but are worried about its eating disorder risks, here's a look at what the science says.

What is the keto diet?

The keto diet, or ketogenic diet, is popular because it offers rapid weight loss, including in the belly fat area. This high-fat, low-carbohydrate diet also provides health benefits for epilepsy, metabolic disease, and more.

How does it work?

Our bodies are typically designed to break carbohydrates into sugar for energy. However, in a ketogenic diet, the body enters starvation mode and kickstarts a process called ketosis.

In ketosis, the body breaks down fats instead of carbohydrates for fuel. During this process, the body also produces ketones, which are acids used as alternative sources of energy for the brain and muscles.

What are the benefits of keto for the body?

Because carbohydrates are restricted, insulin levels decrease, and blood glucose control may improve, which can be helpful for individuals with obesity, type 2 diabetes, and metabolic syndrome.

Some studies also report that people on keto lowered their blood pressure, but these studies were conducted in obese individuals. So, it is not clear if the general weight loss from the diet or the keto diet itself is responsible for the drop in blood pressure.

Despite these benefits, some experts are concerned about the ketogenic diet because of the risks involved.

Can keto trigger an eating disorder?

According to the National Eating Disorder Association (NEDA), eating disorders are serious mental health conditions that affect 28.8 million people across the United States.

The keto diet may trigger disordered eating because it:

Promotes rigid rules around food

Following the keto diet involves following rigid rules around food and fighting against the body's natural urge for carbohydrates as fuel. To stay in ketosis, you need to eat 70-80% of fats and only 5% of carbohydrates (the rest is protein).

Staying on track with this diet involves avoiding dairy milk, different types of vegetables, all fruit, and grains like rice, wheat, pasta, bread, and more.

This can lead people to obsess over their weight loss and diets, which is a risk factor for eating disorders.

Severely restricts carbohydrates

Signs of an eating disorder include a general preoccupation with weight loss, types of food, caloric intake, and dieting. People with eating disorders may also eliminate entire food groups from their diet.

Frequent dieting, in general, can lead to disordered eating. Because keto heavily restricts carbohydrates, the body’s preferred fuel source, it may be a risk factor for disordered eating.

May increase carb cravings

The science is mixed when it comes to this. On the one hand, having a list of 'forbidden' foods' can increase their appeal, and people on keto may crave these foods more intensely. This could potentially trigger binge eating or a relapse of binge eating disorder.

People who cannot resist their cravings may also resort to purging or other harmful practices to control their weight.

However, a study of three individuals with binge eating disorder showed that the keto diet helped reduce carb cravings and lower their appetite. More research is needed on larger groups of people to know for sure.

Want to know more about how a keto diet may affect you or a loved one? Fay can connect you to a Registered Dietitian near you, covered by your insurance.

Is unsustainable in the long term

According to the National Eating Disorder Association (NEDA), 95% of all dieters regain their lost weight in seven years.

Another review of over 120 studies and 22,000 adults on various diets showed that participants gained most of their weight back within a year. This includes low-carbohydrate, high-fat diets like Atkins (similar to keto).

Gaining the weight back (or even more) after losing it can be dangerous for people at a higher risk of developing an eating disorder or with a history of disordered eating. It can worsen mental health conditions like anxiety and depression.

To compensate, they may begin purging or over-exercising. They may also fall into a binge-purge cycle (bulimia nervosa) by eating large amounts of food and compensating by purging or using laxatives.

May lead to orthorexia

A restrictive diet like keto may lead to a preoccupation with labeling foods as "good" or "bad' and an obsession with eating healthy foods called orthorexia.

Now, it's perfectly fine if someone wants to get healthy and eat more nutritious food. But when thoughts of food turn into a fixation that affects other parts of their lives, it can turn into an eating disorder.

Unlike anorexia or bulimia, orthorexia revolves around the quality of food, not quantity.

According to NEDA, signs of orthorexia include:

  • A fear of "unhealthy" foods
  • An obsession with nutrition labels
  • Facing high anxiety when having to deviate from their rigid rules.
  • Cutting out entire food groups (without a medical, religious, or ethical reason)
  • Deep worry about eating in public or attending social events where the person does not have control over the food being served.

Other health risks from a keto diet

Moreover, there is an intense diet culture surrounding the keto diet. And if there is a tendency towards perfectionism, failure to maintain a rigid diet can lead to guilt, shame, low self-esteem, and poor body image, which can trigger a full-blown eating disorder.

Other health risks are associated with low-carbohydrate diets, like nutritional deficiencies from cutting out major food groups or inadequate fiber intake.

In some cases, people on a keto diet may develop a life-threatening condition called ketoacidosis. Ketoacidosis can occur when the body does not have enough insulin.

In these cases, the body breaks down fat too fast, which releases too many ketone bodies into the blood, making it too acidic. This can lead to swelling in the brain, low potassium levels, and other health issues.

Final thoughts

The keto diet does not directly cause eating disorders. However, it can trigger eating disorders such as binge eating disorder, bulimia nervosa, orthorexia, and other types of disordered eating in high-risk individuals.

While there are benefits to a keto diet, it can be risky for anyone with a history of disordered eating.

But what if you need to lose weight for medical reasons, after pregnancy, or adopt a healthy diet for better health?

Building a new relationship with food after an eating disorder can be difficult. If you or a loved one has a history of disordered eating or are worried about eating disorder triggers, consider talking to a professional.

Fay can help you find a Registered Dietitian near you, covered by your insurance.


The views expressed by authors and contributors of such content are not endorsed or approved by Fay and are intended for informational purposes only. The content is reviewed by Fay only to confirm educational value and audience interest. You are encouraged to discuss any questions that you may have about your health with a healthcare provider.


Sources

Fay Nutrition has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references.

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Chandana (Chandy) Balasubramanian

Written by Chandana (Chandy) Balasubramanian

Chandana Balasubramanian is an experienced healthcare executive who writes on the intersection of healthcare and technology. She is the President of Global Insight Advisory Network and has a Master’s degree in Biomedical Engineering from the University of Wisconsin-Madison, USA.

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