What actually causes eating disorders? Conventional mental health models have a very specific model for how eating disorders develop, that relate to mental and emotional trauma as well as faulty thinking patterns. The interventions tend to be purely psychological, and centered around “re learning” values around food and eating. Patients are encourage to think that “all food is good food” and any sign of any type of restriction is demonized.
But is this really what the root of the problem is? And does this approach even work? According to the National Institute of Health, relapse rate for people diagnosed with eating disorders after going into treatment is between 35 and 41% after just 18 months. Not great statistics.
However, the suggestion that not all eating disorders stem from an emotional root is met with a lot of anger and defensiveness among mental health practitioners. Understandably, people have traumatic histories around body shaming, dieting, and use of food as punishment and reward in childhood. This can lead to complex psychological relationships with food that certainly should be addressed through holistic approaches, which sometimes include cognitive interventions.
However, many of the symptoms of eating disorders are largely physiological. This can include severe cases of anorexia and food restriction, binge eating, and food addiction. The obsessive compulsive nature of these disorders is often driven by chemical and hormonal imbalances, rather than being a purely emotional phenomena. In these cases, common mental health interventions such as “thought replacement” in CBT, intuitive eating, and the “all food is good food” approaches actually EXACERBATE the root causes.
Here are some of the factors that can PHYSIOLOGICALLY cause symptoms of eating disorders:
Low protein diets. This is the most common factor I see in binge eating cases. Over and over again, when a client comes to me with a binge eating disorder, they are under eating protein. This leaves their body in a state of high calorie malnutrition for essential amino acids they have not gotten in their diet. Blood sugar becomes dysregulated, mental function and decision making becomes poor, and binge eating is often the result. Notice that no one “binges” on steak. It is always more of the foods that are causing the problem in the first place. Instill a MINIMUM 90g of protein a day diet, and most often symptoms will resolve on their own. Amino acid deficiency can in itself be a cause for imbalanced mood and thinking patterns. I have had clients whose anxiety, depression, and even body dysmorphia spontaneously resolved when they started consistently getting enough protein in their diet. That is why my mini course YOUR STARVING BRAIN emphasizes amino acids so much in the diet plan.
Zinc and B vitamin deficiencies, ESPECIALLY B1 (thiamine) deficiency, are actually major causes of people who have a lack of appetite and end up engaging in restricting eating habits, often getting diagnosed as anorexic. B1 deficiency causes a metabolic shut down in the body- where we go into a critical “hibernation” mode which manifests as low energy, apathy, and appetite suppression. There is a very common pattern of especially girls becoming zinc and B vitamin deficient as they get into puberty, losing their joy in life, feeling tired all the time, not wanting to eat anymore, and transitioning to a vegan or vegetarian diet. Because most foods that contain high levels of zinc and B vitamins are animal foods, this turns into a terrible feedback loop that exacerbates the underlying problem. Many times, when girls like this come to my practice, they relate to me that they don’t necessary try to restrict food, rather they don’t like food, have no appetite, and as a side effect to this become obsessed with seeing how long they can go without eating (note that obsessive/compulsive behaviors are also correlated with zinc and B vitamin deficiencies, especially B1 and B6). Correcting the diet and using strategic supplementation is the solution- not necessarily a deep dive into emotions or psychology.
Diet culture, or the idea that there are moral values around certain foods, or that body aesthetics relates in any way to inherent self worth, it harmful and should be squashed in all forms. On the other hand, the idea that therapeutic diets or strategic restriction of certain foods or food groups is inherently harmful in itself ignores key aspects of human physiology that nutrition science has known for decades. We need to find a healthy balance, recognizing the important of nuance when we talk about these issues.