Can a Keto Diet Cause Orthorexia?

When it comes to your health, few things are more important than the foods you eat. Nutrition is one of the pillars of a strong body and brain.

I’ve certainly taken this to heart -- maybe too much, at times. Years ago, I was proud to call myself “hardcore” about my health. I did CrossFit and ate a Paleo diet. Really, I was a CrossFitter and was Paleo. I was the stereotypical Crossfit bro who was overly vocal about how healthy I was (you’d have hated me). But what came with this new identity was some mental baggage that I didn’t sign up for: shame, guilt, and anxiety.

I think these feelings are common for a lot of us who pursue better health. What starts with good intentions -- self-improvement, longevity, more energy, and so on -- can become an unhealthy fixation on eating perfectly.

You’ve probably heard of anorexia nervosa. The lesser-known cousin of anorexia is called Orthorexia nervosa. Orthorexia is a pattern of disordered eating that involves an obsession with healthy food. Orthorexic people are extreme in their pursuit of the perfect healthy diet. They feel anxiety about the food they eat, experience guilt or shame when they eat food they’ve deemed “unhealthy,” and systematically restrict certain foods or food groups.

What are the signs that you’re becoming obsessive about the food you eat? Some of the most popular diets these days are quite restrictive -- keto, vegetarian, and carnivore diets come to mind. Are these diets socially acceptable forms of orthorexia? How do you know if you’re taking healthy nutrition to an unhealthy place?

This article is going to cover the warning signs of orthorexia, how to know whether you’re taking clean eating too far, and what you can do to keep a healthy perspective when it comes to your diet. Keep in mind that I’m not a doctor or therapist, nor is this medical advice.

Signs and symptoms of orthorexia

Orthorexia is defined as “an obsession with eating foods that one considers healthy.” There’s also a sub-definition: “Orthorexia sufferers systematically avoid specific foods in the belief that those foods are harmful.”

What’s interesting is that, by the above definition, a lot of modern dieters could be considered orthorexic. People on keto stay away from carbs, vegetarians and vegans don’t eat meat, carnivores don’t eat plants, and so on. Are they orthorexic? Do you have an eating disorder if you follow a diet that restricts certain foods?

Not necessarily. Most successful diets limit certain foods or food groups. It may also be necessary to have a restricted diet to tackle certain conditions. If you have celiac disease or are recovering from an autoimmune disorder for instance, you may have to cut gluten out of your life 100%, without exception.

It’s tricky though, because orthorexia and normal, healthy eating look similar on the surface. The difference comes down to your psychological relationship with food.

Here are some of the warning signs of orthorexia:

Anxiety about eating perfectly, coupled with guilt or shame when you eat something you’ve decided is off-limits.

Obsessive thinking about food for three or more hours every day.

A need for complete control over the food you eat (e.g. feeling you can’t eat anything at a restaurant because you don’t know the sourcing, whether the food is organic, what oils the chef uses in the food, etc.).

Obsession over small details in ingredients (“I won’t have that smoothie because the coconut milk in it contains guar gum”); beating yourself up for eating those minor ingredients.

Social anxiety around food; fear that others are judging you for your food choices.

Feeling like you need to hide your food choices from others, especially when you eat something you’ve deemed unhealthy.

Bingeing on junk food, followed by bargaining with yourself to try to make up for your binge.

A compulsive need to control what other people eat, or to inform them that their food choices are unhealthy.

A sense of superiority over people who don’t eat as healthily as you do, or a sense of insecurity when you see someone you think eats more healthily than you do (these are two sides of the same coin, and often present together).

Distorted ideas about your body, especially after eating “unhealthy” foods.

Feeling like food controls your life, or like you don’t have control over your diet.

If any of these symptoms apply to you, you may have orthorexic tendencies. No need to panic. First off, keep in mind that disordered eating is a spectrum of mild to severity. Many people who get into health have hang ups about food at some level. And if you do have more orthorexic tendencies, first step is being aware of it. The big emotions you want to watch out for are guilt, shame, anxiety, and/or fear about eating food you consider unhealthy.

Do keto and other restrictive diets cause orthorexia?

I would say no. I talked about this in a recent podcast with Ketogains founders Luis Villasenor and Tyler Cartwright. Luis and Tyler have coached thousands of people to live a ketogenic lifestyle; they know a thing or two about healthy eating.

Tyler (who lost 300 lbs. on a keto diet) made an excellent point: it’s less that a specific diet causes orthorexia, and more that people with obsessive or controlling tendencies may gravitate toward restrictive diets, because those diets make it more socially acceptable to focus heavily on “clean eating.”

Orthorexia is primarily about the emotions that food brings up for you. Obsessiveness, shame, fear, and guilt are the big ones. It’s totally possible to eat a restrictive diet and have a healthy relationship with food -- in fact, the structure of a restrictive diet may even help you get past an eating disorder. Before he started Ketogains, Luis was an overweight teenager. He began starving himself to lose fat and ended up anorexic in college. Keto helped Luis get rid of his anorexia and restore a healthy relationship with food, largely because it gave him both the structure of a diet and the freedom to eat foods he enjoyed, without guilt or obsessive calorie-counting.

If you currently struggle or have struggled with disordered eating, I recommend listening to Luis’s story. You may find solidarity in it, as well as some good actionable advice.

In any case, restrictive diets don’t cause orthorexia. They’re some of the most successful diets, and you can follow them sustainably for years in good health. If you tend toward orthorexia, the key is not to change your diet; it’s to improve your psychological relationship with food.

How to manage an obsession with healthy eating

First things first: for professional help with orthorexia, your best bet is to talk to a therapist. Therapy is incredibly helpful for improving your relationship with food. Cognitive behavioral therapy is especially good at treating the root causes of orthorexia, particularly when it comes to perfectionism, need for control, and a distorted idea of one’s health/body[*].

That said, there are things you can do to manage orthorexic tendencies yourself. Researchers have found that orthorexia usually comes from a good place: a desire to improve your health. Because of that, orthorexia is easier to treat than other eating disorders are. It helps to notice your orthorexic behavior, and to realize that when it comes to health, an obsession with the perfect diet does you more harm than good[*]. Here are a few things that may help:

Notice your thoughts and emotions involving food. Take special note of any guilt, shame, fear, anxiety, or feelings of helplessness that develop around healthy eating. Look out for obsessive thought patterns related to food, too (e.g. beating yourself up or feeling like you did something wrong because the steak you just ate wasn’t grass-fed, the dressing on your salad contained canola oil, etc.).

Recognize that there’s more to health than diet. Mental and emotional health have just as large an impact on your wellbeing as physical health does. The stress of pursuing a perfect diet -- and beating yourself up when you feel you’ve fallen short -- takes a major psychological toll on you. In fact, feeling physically bad after eating something unhealthy (brain fog, low energy, etc.) can be a self-fulfilling prophecy. if you can separate out the mental punishment and expectation that comes with eating “bad” foods, you may find that you’re much more physically resilient than you think.

Watch your language. How often do you say “I should / can’t / need to eat XYZ food”? The words “should” and “shouldn’t” imply a false morality to food, while the words “can’t and “need” imply that you have no free will. The reality is, foods aren’t inherently good or bad, and you can eat whatever you want. You’re not a bad person for eating anything. You simply incur consequences for eating a certain way. Language is powerful, so consider instead replacing these words with more precise language: “it would be beneficial / fun if I did / didn’t eat XYZ food.”

Eat for the joy of it. Food is one of life’s great pleasures, and sometimes the joy you get out of a delicious meal outweighs its unhealthiness. Assuming you have no medical necessity for avoiding certain foods (celiac disease, lactose intolerance, etc.), aim for the 80-20 rule -- eat well 80% of the time, and eat what you want the other 20% of the time. If that feels too lenient, try 90-10. Whatever you choose, make it a point to enjoy the food you eat, and recognize that sometimes, the joy of good food does more for your health than the stress of trying to be perfect with your diet.

Final thoughts on orthorexia

Orthorexia and other disordered eating patterns are becoming more common in the health world. I’m happy to say that my shame, guilt, and anxiety around eating healthy are gone. I mostly eat for health, but I also eat ice cream now and then. For me, a healthy dose of introspection and an engaging life and identity outside of fitness were the keys to release the grip these negative emotions.

Pay attention to your thoughts and feelings around food, exercise, and other aspects of health. If you think they’re becoming too obsessive and are doing you more harm than good, try the above tools. You can also find a disordered eating therapist near you and learn how to improve your relationship with food. It’s worth the effort; you’ll be healthier and happier in the long run.