Can You Continue to Eat Vegetarian When Getting Treated for an Eating Disorder

Is eating disorder recovery possible on a vegan or plant-based diet? In recent years, following a vegan or plant-based diet has become increasingly popular. There are a number of reasons that people might choose to follow a plant-based diet including for health, environmental and/or ethical reasons.

Due to the full or partial exclusion of animal products, plant-based diets naturally create some restriction in the diet. In some cases (not all!) this can be associated with disordered eating if the restriction affects a person's relationship with food.

This article explores the link between plant-based diets and eating disorders and whether you can continue to follow a plant-based diet during the eating disorder recovery journey.

What is plant-based eating?

Plant-based eating includes a spectrum of diets that exclude animal products to some degree, including the following:

• Vegans – avoid all animal products including meat, dairy, fish, eggs and often honey
• Ovo-lacto-vegetarians – do not eat meat but consume dairy and eggs, most traditional 'vegetarians' fall into this category
• Pescatarians – eat fish, milk and eggs but avoid other meat products
• Semi-vegetarians or flexitarians – avoid or limit meat products such as red meat

People who eat all types of foods and do not exclude animal products are referred to as 'omnivores'.

Reasons for becoming plant-based or vegan

For many people, following a vegan or plant-based diet is an ethical stance that includes boycotting animal agriculture with the aim to reduce animal exploitation and suffering as far as is possible and practicable.

In Australia, the proportion of people following a vegetarian diet has increased from 2.1 million people (11.2% of the population) in 2016 to 2.5 million people (12.1% of the population) in 2018.

In 2019, market research by Colmar Brunton found that the number one reason Australians chose to eat less meat was for health reasons, closely followed by a tie between the environment, animal welfare, cost and the increasing variety of plant-based options available.

Other reasons for choosing a plant-based diet include religious convictions and sensory issues regarding the taste or texture of meat.

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Types of eating disorders

Before understanding the link between plant-based diets and eating disorders, let's break down the main types of eating disorders .

• Anorexia – characterised by food restriction in an attempt to manipulate body weight or size and a fear of weight gain or 'fatness'
• Bulimia nervosa – characterised by a cycle of binge eating and compensatory behaviours including self-induced vomiting ('purging') to compensate for the effects of binge eating
• Binge eating disorder – associated with recurrent episodes of eating large quantities of food, a sense of loss of control and distress or guilt afterwards without compensatory measures
• Orthorexia – an obsession with 'clean', 'proper' or healthful eating
• Other specified feeding or eating disorder ( OSFED ) – encompassing people who do not meet criteria for the eating disorders above but still have a significant eating disorder
• Avoidant restrictive food intake disorder ( ARFID ) – involves selective limitations in the amount and/or types of food consumed but without concern about body shape/size or fears of fatness

Do plant-based or vegan diets cause eating disorders?

What does the research suggest?

There is no single cause of eating disorders and causes are not fully understood. We do know that there are biological, psychological and socio-cultural factors at play, as well as a strong genetic component.

There is limited research on the connection between plant-based diets and eating disorders. One problem with much of the research is that it is 'correlational', meaning that it cannot definitively show whether plant-based diets cause eating disorders or vice versa.

However, it is well established that following any kind of restrictive diet can trigger the development of an eating disorder in vulnerable people. People with eating disorders do report higher rates of vegetarianism than those in the general public, although most research has focused on patients with anorexia nervosa for which the strongest link has been found.

In a study conducted by Bardone-Cone et al. in the US in 2007-2008, it was found that females with an eating disorder history were significantly more likely to ever have been vegetarians (52% vs. 12%). Forty-two percent were motivated to follow this diet for weight-related reasons. Most felt that their vegetarianism was related to their eating disorder (68%) and emerged after its onset.

Despite some research showing a link between plant-based diets and eating disorders, there is also evidence showing that there is little or no association. It is possible that when ethical and/or environmental considerations are the main driving force behind following a plant-based diet, it is less likely to be linked with disordered eating habits.

The importance of intention

As we cannot say that plant-based eating causes eating disorders, an important factor to consider is the intention behind following a plant-based diet.

For example, those following a plant-based diet for health reasons may be more likely to suffer from orthorexia if they are fixated on healthy eating to the point that they damage their own wellbeing. This may show up as only eating 'raw' plant foods, avoiding packaged products or completely excluding oil from the diet. Read our blog on Whole Food Plant Based Oil Free diets here.

If you are struggling with eating disorder recovery on a vegan or plant-based diet, here are some questions you can ask yourself to work out whether there is a link between the two:

• When did you start following a plant-based diet? Was it before or after developing disordered eating habits?
• What was your intention for eating plant-based? Has it changed over time? If it was related to 'clean eating' or attempts to change your body shape or size, this may be a red flag.
• Do you eat plant-based 'fun foods' such as chocolate, crisps, cream, pizza, burgers, ice cream or baked goods? If these foods are 'off-limits', this may be cause for concern.
• Do you have any food rules? Examples include avoiding carbohydrates or foods in a packet.
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Can you recover from an eating disorder while following a vegan or plant-based diet?

Things to consider

You can absolutely pursue eating disorder recovery on a vegan or plant-based diet, however it is important to understand the timeline of your eating disorder and how plant-based eating fits into this.

If you are eating plant-based solely for ethical, environmental, religious or cultural reasons, this may be completely separate from disordered eating. With guidance and support from your treatment team you may be able to safely continue eating plant-based during recovery.

If you think the eating disorder and plant-based diet are linked, here are some reasons why you might consider introducing certain animal products into your diet:

• To challenge strict food rules or rigid dietary rules. It may be that following a plant-based diet provides an opportunity to avoid 'feared foods' however this keeps you limited to a list of 'safe foods' and doesn't challenge the eating disorder.
• Making sure you are getting enough nutrients. Plant-based diets are naturally lower in calories and protein, and tend to be higher in fibre which is filling. This can make it difficult to get enough nutrients, especially if you have a poor appetite.

Once you are further along in your eating disorder recovery journey, you may want to explore returning to vegan or plant-based eating. Your treatment providers will be able to provide guidance around this and help you monitor whether it triggers any disordered eating thoughts or behaviours.

Seeking help

Are you struggling with eating disorder recovery on a vegan or plant-based diet and you're not sure how to get started on your recovery journey?

You could start by talking to a supportive family member, friend or trusted person about your difficulties with eating. You may like to ask them to help you with the next steps in your recovery journey.

You will need a doctor, dietitian and psychologist (and psychiatrist, if relevant) on your care team to support the medical, nutritional and psychological aspects of eating disorder recovery. The next step is talking to your doctor about your difficulties with eating. In Australia, if you fit certain criteria for an eating disorder diagnosis, you may be eligible for an Eating Disorder Care Plan which provides rebates for 20 dietitian appointments and 40 psychologist appointments in a 12 month period.

At Plant Nutrition and Wellness, our dietitians are highly trained in the areas of plant-based nutrition and eating disorders. Ask us how we can support you as part of your eating disorder recovery team, or book an appointment or free discovery call with us to get started.

References

1. https://animalsaustralia.org/latest-news/study-shows-surge-in-aussies-eating-veg/
2. https://www.choice.com.au/food-and-drink/meat-fish-and-eggs/meat-substitutes/articles/plant-based-food
3. https://www.nationaleatingdisorders.org/information-eating-disorder
4. https://www.foodfrontier.org/wp-content/uploads/2019/10/Hungry-For-Plant-Based-Australian-Consumer-Insights-Oct-2019.pdf
5. https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.162.12.2249
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3402905/

This article was written by PNW Clinic dietitian Megan Boswell.

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Source: https://www.plantnutritionwellness.com/eating-disorder-recovery-on-a-vegan-or-plant-based-diet/