Restrictive eating plans continue to dominate the healthy food landscape—where does that leave eating disorder survivors?

Plant-based eating has never been more popular, as people have slowly become more aware of the negative health and environmental impacts of meat and dairy products. But for Melissa Stanger, LCSW, a love of animals and the planet was not the primary reason why she decided to go vegan in college. She did it, she says, because she was grappling with an eating disorder.

“[Going vegan] was a way to control what kinds of foods I allowed myself. It was not a healthy way of doing things,” she says. She became extremely rigid about her exercise routine and eating patterns, and was ultimately diagnosed with anorexia. After she recovered, she earned her masters in clinical social work with a focus on eating disorders. She’s now 30, and works as a psychotherapist in New York City.

This is not to say that becoming vegan is inherently going to lead to an eating disorder. But as the healthy eating space continues to be dominated by restrictive eating plans like the ketogenic diet, Paleo, Whole30, and intermittent fasting (IF)—all of which require people to cut out certain food groups or limit what and when a person is “allowed” to eat—experts warn that the continued trend is dicey for anyone with a history with disordered eating.

The link between eating disorders and diets

The DSM-5, the manual psychologists and psychiatrists use to diagnose patients, identifies three eating disorders: anorexia nervosa, bulimia nervosa, and binge eating disorder. While each has various characteristics, “in general, they all involve a preoccupation with food and body size,” says Whitney Linsenmeyer, PhD, RD, a spokesperson for the Academy of Nutrition and Dietetics and an assistant professor of nutrition at Saint Louis University, who frequently counsels students with eating disorders. Beyond the psychological consequences, the potential outcomes of an eating disorder can be severe, including nutrient deficiencies, bacterial infections, stomach rupture, intestinal perforation, and even heart failure.

There is unfortunately a connection between restrictive diets and eating disorders. Past research has found that teenage girls who even moderately dieted had a five times higher risk of developing an eating disorder than those who did not diet; those who dieted at “a severe level” were 18 times more likely to develop an eating disorder. “Restriction is the biggest symptom of anorexia,” says Stanger. “For a lot of people who engage in keto, Paleo, or even veganism, a diet may be a convenient mask for an eating disorder or disordered behaviors. It gives them a way to refuse or avoid foods they don’t want to eat.”

“For a lot of people who engage in keto, Paleo, or even veganism, a diet may be a convenient mask for an eating disorder or disordered behaviors. It gives them a way to refuse or avoid foods they don’t want to eat.” —Melissa Stanger, LMSW

Following a restrictive eating plan (or several concurrently) can also lead a person to orthorexia territory. While it’s not officially diagnosable in the DSM-5, it’s pretty widely accepted in the medical community. It involves an extreme fixation on eating healthy—e.g., eating all-organic or zero sugar. It’s often overlooked by doctors who don’t have experience in eating disorders, says Stanger, because people with orthorexia can be physically healthy even though they’re struggling with an unhealthy relationship with food. “It does harm when it becomes obsessed and hyper-focused, or when it causes feelings of guilt and shame when you don’t eat perfectly,” says Dr. Linsenmeyer.

For people who are more prone to obsessive-compulsive ways of thinking or who have addictive personalities, a restrictive diet may be the gateway to anorexia, bulimia, or binge eating, says Stanger. The many rules to follow “[could set] up an unhealthy mindset towards food instead of seeing it as nourishment or celebration,” says Dr. Linsenmeyer.  “It’s something to grasp onto or identify with that creates a sense of self.”

So are restrictive diets safe for people with a history of eating disorders?

At the end of her second year of college, Catherine Brown, 44, a writer and co-editor of the book Hope for Recovery: Stories of Healing from Eating Disorders, severely restricted her diet and exercised compulsively to lose the “freshman 15.” “I find the process of dieting and losing weight addictive. Dieting can provide a sense of accomplishment and feeling of virtuousness that can be hard to find in other ways,” she says.

In her recovery, Brown has dabbled with restrictive diets and eliminating carbs and sugar altogether. But she says that those ways of eating became problematic for her very quickly. “There are times when I become obsessed with trying to change some part of my body and try to find ways to do that through restriction and excessive exercise,” she says. “I have to work hard to resist that kind of thinking and focus on eating healthy foods and staying active.” She now aims to eat a balanced diet founded on whole, fresh foods.

Other disordered eating survivors might find certain eating plans helpful to their recovery efforts. Claire*, who was diagnosed with anorexia when she was 14 and has been in and out of remission for more than three decades, has tried restrictive diets like Paleo and Whole30 to limited success. “[Eating plans] take the anxiety out of organizing my food intake, as someone else is doing the thinking and planning for me,” she says. Having the framework of an eating plan provides helpful structure that prevents her from thinking too much about what she will eat, which can be triggering.

However, following a restrictive eating plan can be a very slippery slope, which is why Dr. Linsenmeyer and Stanger say survivors should work with a therapist to try and understand their underlying motivations. For example, Stanger says, is a person following an eating plan because they like those certain foods or want the health benefits from a particular plan, or are they coming at it from a more “disordered” mindset? It’s also important to recognize how diet culture (meaning our current culture that praises thinness, demonizes certain types of food, and promotes a particular body type as being the healthiest and most beautiful) plays into people’s motivation to try a restrictive eating plan. “It’s about creating distance from that culture so you can continue recovery,” says Dr. Linsenmeyer.

“The goal is to liberalize the way people eat and make them comfortable with all kinds of foods.” —Whitney Lisenmeyer, PhD, RD

Stanger says that the risks of an eating disorder survivor trying keto or IF or any other type of more restrictive diet varies from person to person. If one’s intentions are coming from the right place (say having a passion for the environment, or wanting to eat more whole foods), she says a person can consider dabbling in tenets of one of these diets while working with a nutritionist who specializes in eating disorders. The danger is when an eating plan’s rules become strict and unbendable. “Labeling some foods as good and others as bad can be really problematic. Without the help of professional, it can lead to relapse for people who struggled with disorder in past,” she says.

Dr. Lisenmeyer is a bit more stringent—she believes that all restrictive eating plans are a bad idea, especially for people at risk of an eating disorder. “The goal is to liberalize the way people eat and make them comfortable with all kinds of foods,” she says. Some eating disorder facilities, she adds, won’t allow vegan patients to avoid animal proteins unless it’s for religious beliefs. “It’s a big controversy in the field. But [veganism] can be seen as a means to restriction,” she says.

Dr. Lisenmeyer is generally on board with the Mediterranean and DASH diets, which have a more balanced eating pattern that includes all of the food groups. “It’s a different style of eating that I think is very healthy and balanced, and it’s well supported by research,” she says. Other nutrition experts like intuitive eating, which is often used in eating disorder recovery as a way to reset a person’s relationship with food.

For her part, Stanger returned to veganism three years ago—this time, she says, with the sole intention of supporting the environment and animal welfare. “The difference from the first time when I was anorexic is now there’s no anxiety around food,” she says. “I don’t do it for weight or body image or to control calories. If that’s still on your mind, you might want to rethink your engagement in that diet, because that’s where it can become a slippery slope.”

*Name has been changed

How one writer approaches wellness after combatting an eating disorder. And here’s more intel on intuitive eating.