If someone has an eating disorder, such as anorexia nervosa, should the clinical goal for recovery be the patient regaining weight, whether that’s fat or muscle, and being able to eat everything in moderation?
Or is there a role for eliminating certain food groups, like sugar and carbs, and promoting the consumption of protein and healthy fat to improve the patient’s metabolic health, increase muscle, and reduce possible triggers for the patient’s disordered eating?
US registered dietitian Michelle Hurn says that discussion is still highly controversial in eating disorders care. She will discuss those contentious issues and more during the IPTN’s free Webinar on April 10, 2024: The Emerging Role of Therapeutic Nutrition in Anorexia and Binge-Eating Disorders.
“Currently, the vast majority of dietitians, physicians, and health professionals working in eating disorder programs will say you simply cannot eliminate certain food groups, like high glycemic carbs. That is too restrictive. That is the dogma we are all taught,” says Hurn, a clinical dietitian, endurance athlete, and author of The Dietitian’s Dilemma and the children's book The Fox Family Food Fight.
Up until 2019 Hurn believed and followed the dogma about no food restrictions, too. Not only was she an RD trained in that standard of care, but she’d been hospitalized at age 12 for anorexia nervosa and indoctrinated with the belief carbs were essential and any restriction was a sign of a still-present eating disorder.
Her Dietitian's Dilemma subtitle gives a good idea about what happened to her in 2019: What would you do if your health was restored by doing the opposite of everything you were taught?
In 2019, Hurn was training for the Olympic trials, hoping to qualify, but her body was falling apart. She was eating a very high carbohydrate diet which she thought was essential for endurance running, and under-eating protein and fat. And, she was racked by pain, inflammation, and fatigue, and struggling with anxiety, depression, and panic attacks. The specter of a relapse of her eating disorder always haunted her.
She felt so physically unwell, however, that she was out of mainstream options and ideas for what to do. She decided to try a ketogenic diet. Within a short time, she had alleviated her mental health symptoms, improved her physical health and athletic performance, and silenced the eating disorder demon she had battled with since adolescence.
Since then she has been counseling private clients, and promoting more research in the area of therapeutic nutrition and eating disorders. Hurn recently co-authored an important 2023 publication with Nicholas Norwitz PhD and Dr. Fernando Espi Forcen, both of Harvard Medical School, entitled “Animal-based ketogenic diet puts severe anorexia nervosa into multi-year remission: A case series.”
The article notes that anorexia is a metabolic psychiatric condition with a rate of death five times higher than normal and a high rate of relapse. Ketogenic diets (with very low carbohydrates and high fat) are a neuromodulatory intervention with a long history of use in epilepsy and more recently in other systemic, neurological, and mental health conditions.
The article documents three cases of treatment-resistant anorexia that went into remission for 1 to 5 years with a ketogenic diet. Not only did the patients regain weight as muscle, but they also experienced reduced anxiety and enhanced mental health. The article concludes ketogenic diets may be useful in eating disorders but more research is necessary.
“We have to get rid of the dogma and look at treatment options with a more open mind. We are not saying that the ketogenic diet will work in all cases; in our paper we were very careful to say we need more research,” stresses Hurn. “But anecdotally, I am hearing more and more about women with eating disorders who have been helped by a low carb or ketogenic diet. It is not just with improved body weight, with every single one, the mental health changes are significant."
At the April 10 webinar, Hurn will discuss why the current renourishment strategies for individuals with anorexia nervosa are not conducive to long-term patient success and outline the impacts of prolonged malnutrition on their microbiome and gastrointestinal health.
Hurn will review the bio-physiological reasons why a low carbohydrate diet, focusing on the intake of healthy fats and adequate well-sourced proteins, might be a plausible and successful refeeding strategy for individuals recovering from anorexia nervosa.
In the webinar, Hurn will not only discuss anorexia, but also discuss why current dietary guidelines fail to support the recovery in people with binge eating disorder (BED) from a bio-physiological standpoint. She will summarize the evidence supporting the concept of food addiction, which may underlie some binge eating behaviors. She will review why therapeutic carbohydrate restriction with optional nutritional ketosis may also be a viable treatment option for BED and other eating disorders like bulimia.
“Some people who have struggled with eating disorders know that eating certain foods may trigger their disordered eating behaviours. So just like we wouldn’t tell someone with alcoholism to drink in moderation, we need to examine why we still give that moderation message for people with eating disorders,” says Hurn.
The webinar takes place Wednesday, April 10 at 5 pm Pacific and will be recorded.
Register here.
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