Nutrition New Study looking at Low Carb and IF and Eating Disorders

[silveraw]

Just came across this study that looked at LC and LC with IF compared to "no diet" and screened them for eating disorders.
Super interesting study since I know a lot of people dismissed the correlation between the two for a very long time.

This quote from the study does a good job of summing up the findings:
"Although LC diet appears to be a successful way to lower body weight [27], our data reveal that this restrictive diet is related to worse eating attitudes. Specifically, they reported higher binge eating symptoms, cognitive restriction, and food cravings. Furthermore, individuals with disordered eating attitudes tend to disregard context, frequency, and quantity of food and their attunement with the current state of the body, making choices based on established beliefs [28]. This diet mentality is described in one of the questions of the adapted subscale of cognitive restriction toward carbohydrates: “I do not eat some food (source of carbohydrates) because they make me fat”."

Craving for carbs: food craving and disordered eating in low-carb dieters and its association with intermittent fasting

Studies point to positive outcomes in a diet with reduction of carbohydrates and that the associated practice of intermittent fasting (IF) might increase weight loss. Although dieting might be related to disordered eating, little evidence is available ...

www.ncbi.nlm.nih.gov

I think the big practical takeaway for me is if you try LC or IF and find yourself craving and obsessing about the food you can't have, maybe that particular tool isn't a great choice for you.

Important limitations of the study: most participants were female, and they only looked at IF and LC compared to "no diet", and it was volunteer respondents on a university. So potential biases towards people doing those diets and having concerns.

 

[TimothyGander]

Furthermore, individuals with disordered eating attitudes tend to disregard context, frequency, and quantity of food and their attunement with the current state of the body, making choices based on established beliefs

I cannot quite parse this sentence. What does the "context" of food even mean? How do you "disregard" or, for that matter, "regard" frequency and quantity of food? I assume it must mean the opposite of "making choices based on established beliefs", but it's somewhat hard to conceptualize a rational opposite of that - even if you don't make any food choices at all, isn't it in itself a choice based on established beliefs. For that matter - are there any "non-established beliefs"? Is my IQ that low, or is that a meaningless word salad that generates a pretense of profundity by mere verbosity?

That said, crossover between the keto/fasting and eating disorder communities was as predictable as it is depressing. From what I know, EDs often revolve around the concept of controlling and overcoming the body and biological urges. Unfortunately, some proponents of low carb diets encourage jumping straight into full restriction without the regard of individual's current metabolic state, even glorifying such things as "keto flu" or surviving hunger pangs - in other words, the same theme of overcoming.

I think the big practical takeaway for me is if you try LC or IF and find yourself craving and obsessing about the food you can't have, maybe that particular tool isn't a great choice for you.

I think it's the other way around. I don't think these dietary approaches encourage disordered eating by themselves, but rather that they may seem attractive to people who have an already established tendency for disordered eating. And, maybe a bit controversially, I would suggest that if this tendency exists, it's somewhat better if it's channel into a LC diet rather than, say, anorexia.

 

[silveraw]

I cannot quite parse this sentence. What does the "context" of food even mean? How do you "disregard" or, for that matter, "regard" frequency and quantity of food

Basically if you are focusing on the idea that carbs make you fat and if you eat a bit of carbs you failed and might as well binge eat. Or if you are on LC and IF and day dream about donuts all day then eat a dozen to yourself.

You regard context, portion, and frequency via portion control and how often you eat something, when you eat it, and how much you eat. Eg a donut once a month while having coffee with a friend isn’t bad for you. But a dozen every day is.

Dr Layne Norton has a video that walks through the study pretty well.

think it's the other way around. I don't think these dietary approaches encourage disordered eating by themselves, but rather that they may seem attractive to people who have an already established tendency for disordered eating. And, maybe a bit controversially, I would suggest that if this tendency exists, it's somewhat better if it's channel into a LC diet rather than, say, anorexia.

I think you might have missed the point of the study a bit. The LC and LC with IF groups seemed to increase signs of disordered eating compared to the control group. It isn't saying that LC and IF are disordered eating, but they seem to contribute some risk. For instance, people on low carb and IF in the study had more binge eating tendencies than people who weren't on that diet.

Keep in mind that the population in the study is at the highest risk for eating disorders. It isn’t saying that the LC IF approach is bad for everyone or that it is disordered eating in and of itself, it is saying that it seems to increase the chances of developing an eating disorder.

Since EDs have the highest mortality rate of any mental illness, it is probably something you want to be aware of. For a while, a lot of IF and LC advocates were adamant that it had a low risk for contributing to eating disorders and now we have new data that suggests otherwise.

*Edited some spelling and autocorrects from initially typing this on my phone... ok it was a lot of spelling and autocorrect errors.

 

[North Coast Miller]

Speaking as someone who had to learn a lot more about eating disorders than I would have liked, many aspects of IF, OMAD, etc are extremely troubling. Esp in context of these practices demonstrating few if any benefits over other isocaloric diets.

The satisfaction with going long periods of time without need to eat, the “increased clarity” of thought that accompanies food restriction (testing has revealed no improvement in cognitive or executive function in otherwise healthy adults), the closely identified with concept that this is a superior means of fueling the body. These assertions are identical to those of someone with an ED.

A common misconception is that ED is triggered by underlying psychological issues, and in some cases it is. The number one risk factor for developing an ED is to engaging in selective restrictive dieting. This is going to sound somewhat confrontational - but some people feel a lot better when food deprived in much the same way that some people are more prone to alcoholism or becoming dependent on specific drugs. You find out the hard way whether your factory wiring has this inclination or not.

 

[HarryBergers]

This looks like a classic example of what happens when you do the keto diet incorrectly. All of the problems associated with non-keto, "Low Carb" cohort are the same as not committing to a ketogenic diet(<50g carbs a day, electrolyte maintenance et al), wherein all those bad things go away. Feeling like crap, food cravings, binging.

I cannot quite parse this sentence. What does the "context" of food even mean? How do you "disregard" or, for that matter, "regard" frequency and quantity of food? I assume it must mean the opposite of "making choices based on established beliefs", but it's somewhat hard to conceptualize a rational opposite of that - even if you don't make any food choices at all, isn't it in itself a choice based on established beliefs. For that matter - are there any "non-established beliefs"? Is my IQ that low, or is that a meaningless word salad that generates a pretense of profundity by mere verbosity?

I think it's the other way around. I don't think these dietary approaches encourage disordered eating by themselves, but rather that they may seem attractive to people who have an already established tendency for disordered eating. And, maybe a bit controversially, I would suggest that if this tendency exists, it's somewhat better if it's channel into a LC diet rather than, say, anorexia.

Its not hard to set up a study to reinforce confirmation bias.
Seems unfair to pick on stressed out college students, too. Self reporting how they feel about something when social pressure is probably a standout contributor to how they gauge their responses over excluding social pressure and actually making a reasonable self assessment. Again, college students.

Dr Layne Norton has a video that walks through the study pretty well.



I think you might have missed the point of the study a bit. The LC and LC with IF groups seemed to increase signs of disordered eating compared to the control group. It isn't saying that LC and IF are disordered eating, but they seem to contribute some risk. For instance, people on low carb and IF in the study had more binge eating tendencies than people who weren't on that diet.

Keep in mind that the population in the study is at the highest risk for eating disorders.

Right, impressionable young people in a high stakes social environment where body image/appearance are the metric for success. ~1:30-2:30 This will heavily weight all subjective assessments in a study based on self reporting.

The satisfaction with going long periods of time without need to eat, the “increased clarity” of thought that accompanies food restriction (testing has revealed no improvement in cognitive or executive function in otherwise healthy adults), the closely identified with concept that this is a superior means of fueling the body. These assertions are identical to those of someone with an ED.

$0.02:
I removed all non green veggy sources of carbs from my diet for over a year with OMAD and found a tremendous increase in productivity at work after week 2 that were consistent. My sales, NPS and productivity KPIs all went up. When fasting during this time(72-96hr) my productivity KPIs when up slightly higher, but my soft skill interactions suffered a little. In general, my stress levels also went way down and I was getting much higher quality sleep(not 96hr fasts tho). I was very obese(high fat stores to utilize for energy easily) and likely alleviating a handful of Type2 diabetes symptoms at the same time. So, its hard to tell what made what difference.

 

[silveraw]

Speaking as someone who had to learn a lot more about eating disorders than I would have liked, many aspects of IF, OMAD, etc are extremely troubling. Esp in context of these practices demonstrating few if any benefits over other isocaloric diets.

Same. Looking back at some of the stuff I’ve done over the years, things like the slow carb diet are pretty awful. Write down your cravings and binge them on cheat day is a recipe for problems.

Right, impressionable young people in a high stakes social environment where body image/appearance are the metric for success. ~1:30-2:30 This will heavily weight all subjective assessments in a study based on self reporting.

Thankfully they had a control group.

All of the problems associated with non-keto, "Low Carb" cohort are the same as not committing to a ketogenic diet(<50g carbs a day, electrolyte maintenance et al), wherein all those bad things go away. Feeling like crap, food cravings, binging.

A lot of those studies were cited in this one. I was surprised to see extremely small sample sizes in the ones supporting keto as reducing cravings. One of them had four people in it. And that’s it.

But if it works for you without adverse effects, it works for you without adverse effects.

 

[HarryBergers]

A lot of those studies were cited in this one. I was surprised to see extremely small sample sizes in the ones supporting keto as reducing cravings. One of them had four people in it. And that’s it.

But if it works for you without adverse effects, it works for you without adverse effects.

I've talked to many people I've worked with that have "attempted" a keto diet but always modified it to a similar diet to the LC(+IF) cohort. It always ends up being somebody either not eating enough salt, keeping carbs above 50g because reasons and they crash out because they have little discipline, plus myriad internal/external pressures/impulses to stop.

To steal a phrase, "compliance is the science." The path of least resistance/discomfort wins when the option exists. It takes quite a lot of willpower to decide to ignore the easy way out.

The "whether keto is right for you!" argument is hopelessly moot. Too many conflicts of interest, internally and externally. The physical limitations to keto adaptation are few and far between.

Anyways, what I'm saying is that the carbs per day range that they selected is guaranteed to produce these results, further exacerbated by the context of the subjects' daily experience. Reproducing expected results seems to be the point, to me at least--If that wasn't the point, credibility is suspect.

 

[silveraw]

they crash out because they have little discipline, plus myriad internal/external pressures/impulses to stop.

Yeah it isn't super strict keto... But this study looks at those internal pressures and impulses, which is pretty novel and worth considering.

 

[HarryBergers]

Yeah it isn't super strict keto... But this study looks at those internal pressures and impulses, which is pretty novel and worth considering.

I should have read it instead of skimming.
That is what they said(paleolithic style whole food diet). Looks like the is the survey prior to a more thorough investigation. They almost make it sound like the Whole Foods diet is causing psychological harm to college age Brazilians.. lol

 

[silveraw]

I should have read it instead of skimming.

Always a good decision.

Certainly brings up some issues as being very real that have previously dismissed with little evidence. Hope to see more on this in the future as the worlds of nutrition and mental health don’t seem to overlap much for some reason despite being important parts of overall health and well being.

 

[HarryBergers]

Always a good decision.

Certainly brings up some issues as being very real that have previously dismissed with little evidence. Hope to see more on this in the future as the worlds of nutrition and mental health don’t seem to overlap much for some reason despite being important parts of overall health and well being.

I think I remember seeing some videos years ago with Dr Rhonda Patrick specifically calling out the association of gut health ie diet and mental well being, with some emphasis on the microbiome. I've seen reporting on low dietary fat levels being correlated with poor mental health(some prepper content creators make a point of including oils in their prep for mental performance), I wonder how much of the carb restricted cohort may have been restricting fats as well..

 

[silveraw]

wonder how much of the carb restricted cohort may have been restricting fats as well..

None. You see the incidence of eating disorder almost double when you add in intermittent fasting. Fairly certain the mechanism of action is the blunt restriction with no allowance for context, quantity, or frequency.

Although funny enough there are a few studies showing keto diets greatly reduce the number and diversity of beneficial bacteria in the gut biome. So maybe something to that

 

[HarryBergers]

None. You see the incidence of eating disorder almost double when you add in intermittent fasting. Fairly certain the mechanism of action is the blunt restriction with no allowance for context, quantity, or frequency.

You got all that from a questionnaire. A questionnaire that asked an admittedly bias group of people to give an  impression about their own eating habits.

Do you see OMAD/IF as an eating disorder? And if so, why?

 

[silveraw]

Do you see OMAD/IF as an eating disorder? And if so, why?

Nope. I do think in some people it can contribute to eating disorders in some people though. Not sure if the food log is still up, but there was one on this site that followed someone's journey into IF which morphed into very disordered eating. It is a great tool, but it isn't a panacea and it has risks.
Edit: just checked and it is gone thankfully.

A questionnaire that asked an admittedly bias group of people to give an  impression about their own eating habits.

Eh, I think you might have misunderstood the study. It wasn't focused on eating habits, it was focused on people's attitude towards food through the lens of eating disorders and sorted the answers by eating habits. I'd take a look at the video I posted, Dr Norton does a great job of walking through the study, its implications, and its limitations. If your takeaway is that IF is an eating disorder you missed the point.

 

[HarryBergers]

I think you might have misunderstood the study. It wasn't focused on eating habits, it was focused on people's attitude towards food through the lens of eating disorders and sorted the answers by eating habits.

From abstract:
"This study aimed to explore if doing low-carb (LC) diets was related to disordered eating and if IF would increase these symptoms."

From Introduction:
"Therefore, this study aims to assess the presence of disordered eating behaviors in individuals who practice LC diet. Specifically, we aim to evaluate the presence and intensity of FC, binge eating, cognitive restraint, and cognitive restraint directed to carbohydrates in individuals that practice LC diet versus non-dieters. In addition, we also intend to verify if the practice of IF in LC dieters influences disordered eating behaviors. The hypotheses raised were that (i) LC dieters have higher levels of FC, binge eating, cognitive restraint, and cognitive restraint directed to carbohydrates than non-dieters; and (ii) the practice of IF associated with LC aggravates the severity of binge eating symptoms, cognitive restraint, and cognitive restraint toward carbohydrates"

It would seem the point of the study is closer to identifying/confirming LC dieters as having, and increased frequency of, eating disorders and disordered eating than it is to how LC dieters feel about their eating disorders. I did see they included the feelings surrounding their answer selections in the discussion, but I wouldn't call that the focus of the study. Definitely worth investigating.

Without revoking all charity towards the intention of the study creators, I would take them at their word. If we focus in the cognitive restraint part, well that's just downright Nelsonian..

 

[silveraw]

It would seem the point of the study is closer to identifying/confirming LC dieters as having, and increased frequency of, eating disorders and disordered eating than it is to how LC dieters feel about their eating disorders. I did see they included the feelings surrounding their answer selections in the discussion, but I wouldn't call that the focus of the study. Definitely worth investigating.

Without revoking all charity towards the intention of the study creators, I would take them at their word. If we focus in the cognitive restraint part, well that's just downright Nelsonian..

I wouldn't call it Nelsonian... Unless you are taking issue with the broader toolset of identifying eating disorders which isn't something I'm really able to discuss intelligently.

It wasn't so much the point of the study as the results of the study. But like... If you struggle with a lot of cognitive restraint on your diet, maybe look into that a bit. Kind of the reason I posted this in the first place was to help out people struggling with the popular advice.

 

[North Coast Miller]

There are a number of published peer-reviewed studies that demonstrate a link between IF practitioners and ED, this is only one of them. Part of it might be that IF superficially presents as disordered eating no matter what other factors come into play. Am not sure the entire contents of the ‘Eating Disorder Examination Questionnaire; EDE-Q’ but might be worth taking a look since the answers are a big part of the association.

 

[Deleted member 316]

To me, meticulously weighing every portion of food to get exactly the right amount of macros would be considered an eating disorder. Oh I can't have that because these two carrot sticks put me at x amount of whatever, but I can have a leaf of iceberg lettuce.

 

[North Coast Miller]

To me, meticulously weighing every portion of food to get exactly the right amount of macros would be considered an eating disorder. Oh I can't have that because these two carrot sticks put me at x amount of whatever, but I can have a leaf of iceberg lettuce.

What if you only weigh your carbs in that manner? Eg weighing a small dish of blueberries by the gram.

 

[silveraw]

To me, meticulously weighing every portion of food to get exactly the right amount of macros would be considered an eating disorder. Oh I can't have that because these two carrot sticks put me at x amount of whatever, but I can have a leaf of iceberg lettuce.

If you are meal prepping you are measuring out ingredients anyways so it isn't exactly a big deal. But yes, it can aggravate cognitive dietary restraint symptoms in some people, but I don't think it shows up to the degree as in very restrictive diets from what I've seen.

But there are other ways to reduce caloric intake that don't seem to have the same issues and are great tools. Simple things like plating enough protein, having half your plate veggies and fruit, and taking at least 20 minutes to finish a meal. There are a lot of options that work well that don't involve scales, stopwatches, phone apps, questionable historic food classifications, and ketone strips. Not every method is right for every person. It's important to know the risks of a particular method and make choices that work best for you.