How the Paleo Diet Gave me An Eating Disorder
by Karen Pendergrass, CEO of The Paleo Foundation
We are not immune to click-bait titles. So do any justice to that sort of hyperbole will require quite an amount of context.
Before October 31st of 2008, I was in the best shape of my life and had grown accustomed to eating whatever I wanted, living and dying by the calories-in-calories-out (CICO) mantra. Unfortunately, that date marked the onset of a myriad of diseases that would change my life forever.
Soon, I had come to the point where I could no longer exercise for caloric expenditure. This was the day I had two cups of coffee and had to psyche myself up to drive, only to get to my gym and not even be able to open the door because it was too heavy.
I began crying on my way back to my car knowing that things had changed, my health was spiraling out of my control, and I could not stop the sudden weight gain I had been experiencing.
From the time of the onset to April 1st, 2009, I had gained 50 lbs — from 105lbs, to 155lbs— just shy of 50% of my body weight. In case you’re wondering what the hell happened to me (as I was), I was diagnosed with PCOS, liver disease, severe anemia, early menopause, and finally Celiac’s Disease within those very short months. The years of work I had put into the gym had completely vanished, and I was emotionally devastated.
The Paleo Diet came as a blessing at first. It was a grain-free diet which I knew I would need to continue for the duration of my life, and the diet intuitively made sense to me from a biological standpoint. After I began the Paleo Diet, my symptoms improved. The sharp, debilitating pain began to subside. My hypoxic legs turned pink again. I had a period— it wasn’t menopause, after all.
But the scale did not budge.
I Looked Like a Water Balloon
Chronically suffering from generalized edema, I wondered if I could just “pop” myself. At the time, I was 25 years old, I didn’t recognize myself in the mirror, and I was struggling to feel good again in my own skin. But I was also determined not to give up because I desperately wanted to get back to where I was before. This led me to seek the advice of Paleo Diet experts and bloggers.
In 2009, the overwhelming Paleo Diet dogma of the time supported the adherence to a low-carbohydrate diet for metabolic diseases— especially diseases related to insulin resistance like PCOS— and eschewed any and all refined sugars or processed foods or baked goods. This is the same general Paleo Diet Dogma which persists today. Processed foods and baked goods are still considered by many to be antithetical to the entire Paleo Movement. There are even individuals in the Paleo community who have developed derogatory terms for “paleoified baked goods” to shame recipe bloggers and producers, accusing them of being the ruin of the Paleo Diet altogether.
Initially, I bought into this belief system as well. I ate a low-carbohydrate Paleo Diet without any processed foods for almost an entire two years. I went to Crossfit. I was on a Whole365. I was unhappy.
Yet through this exhaustion, the scale did not budge.
Like most Paleo adherents, we were told that in order to have a successful “go” at a Paleo Diet, one would need to clear their entire pantry of any and all “bad foods”, and avoid places where non-paleo foods or processed foods would be served. I was OK with this at the time because somehow I felt like the more strict I got with my eating habits — especially in the processed foods department— the more successful I would be at finally losing the weight and getting rid of the rest of my many symptoms. But I also internalized this belief system on a personal level. I felt like if it wasn’t hard, it wasn’t going to work. I felt like any deviation from this Whole365 meant I wasn’t trying hard enough— as if I didn’t want it enough. I felt like by struggling, I was proving to myself that I had what it took to see this through.
From seeking advice, I’d heard so many times that the answer was just to keep going harder. Crossfit harder. Paleo Harder. Low-Carb harder. I believed this was the key to finally feeling good again. Spoiler alert: the answer was the exact opposite.
During the first couple of years, everyone was careful not to bring foods inside of the house that was not “Paleo Approved.” But once for an occasion, my brother who has a gnarly sweet tooth made almond-flour and honey-sweetened brownies. He was a little heavy on the honey and they were absolutely disgusting— but I ate them anyway. In fact, I snuck around the house in the middle of the night to eat more. I ate them until they were gone— an entire pan.
I binged, they made me physically ill, and I didn’t even like them.
This wasn’t an isolated event, either. It was only the first. Afterward, I psychologically beat myself up for days because I felt that I had been “bad”, and I would find fun little ways to punish myself. Then another pan of brownies or cookies that I didn’t even like would be made, and then I would demolish them again. And again, I would find fun little ways to punish myself for my indiscretions. Rinse, lather, and repeat. It took a while before I realized it, but I had developed an eating disorder.
Now, it’s particularly important to note that this was new to me because I had never had an eating disorder. Before I got sick, I ate whatever I pleased. That didn’t mean that I ate anything and everything available, it simply means that I wouldn’t eat something I didn’t like or something that didn’t make me feel good.
I didn’t eat past fullness to the point of making myself sick, and I certainly didn’t sneak around at night to eat brownies on the floor of the kitchen as quietly as I could so nobody could hear me. No, before the illness, I would have taken one bite out of my brother’s brownies, and then spit it out in a dramatic display of disgust.
The question I needed to answer was simple: What changed, and what could I attribute this new behavior to?
Ancel Keys and the Great Starvation Experiment
I have a tendency to go down rabbit holes when I find something perplexing— especially human behavior. Seeking answers to find the root cause of my newly acquired eating disorder, I stumbled across a study that was conducted in November of 1944 by the University of Minnesota called “The Starvation Experiment”.
The experiment was led by Dr. Ancel Keys (yes, that Ancel Keys), and was designed to determine not just the physiological effects of prolonged dietary restriction, but also the psychological effects of restriction.
Because of Keys’ infamous interest in nutrition— as well as the lack of research on the psychological effects of restricted diets— Keys convinced the military that a study of this nature would offer information that could be of use for both practical, and humanitarian benefit: millions of people were in danger of suffering from postwar famine.
In his study, Keys controlled the caloric intake of 36 men (out of 200 volunteers), and also controlled the type of foods that the subjects would be allowed to consume for the duration of the experiment. They were restricted to a diet that simulated what people in Europe would have eaten during a period of famine: potatoes, cabbage, macaroni, and whole wheat bread.
In “The Great Starvation Experiment: Ancel Keys and the Men Who Starved for Science”, author Tucker Todd describes three phases of physiological and psychological evaluation Keys used for the study. The first 12-week phase served to establish a baseline for each subject; the second phase involved starvation in which the food choices and calories were reduced, and the third phase was the recovery phase to discover rehabilitative diets for the participants.
During the second phase, the effects of the caloric restrictions became apparent. Beyond the drastic reduction in weight, Keys also charted reductions strength and overall energy which is what one would expect from such a physiologically grueling experiment.
But it’s really the psychological results of the study that I find more interesting, and pertinent to my own situation. As Todd describes it, mealtimes became the highlight of men’s day as opposed to normal daily activities, and they savored each and every flavorless bite.
Keys allowed coffee and gum ad libitum, which up to 15 cups of coffee were consumed, as well as up to 40 packs of gum per day. Keys also noted behavioral changes such as apathy, increased social anxiety, and a marked decrease in desire for sexual activity.
Instead, the men compulsively read cookbooks with an almost pornographic obsession. Men who had no prior history of an eating disorder — which Keys screened for specifically— were in the grips of one.
The Psychology of “Lack” and the Paleo Diet Dogma
Although the Starvation Experiment isn’t exactly analogous to my own situation, it did offer me pause. I thought that surely Keys or his attending psychologists would have come up with a more technical term to explain the psychology behind the behavioral changes, but they did not.
So in the absence of a technical term, I simply called this the “Psychology of Lack“. The psychology of lack has a simple premise: We become fixated on that which we lack, and we use “willpower” to continue to deprive ourselves like the study subjects had to.
I believed that to exist in “lack” was necessary to improve my life, and I believed that I simply needed more will-power and self-control to achieve my goals. If I was short on will-power, resulting in “cheating” or eating bad foods, I internalized this to mean that I was too inadequate to achieve my goals. And at the time, “bad foods” meant any non-Paleo foods, high-carbohydrate foods, processed foods, and “paleofied” baked goods.
Influenced by other’s particular brand of dietary restriction, I went beyond medical necessity to further restrict my diet. Abstinence from processed foods or “paleoified” baked goods was an unnecessary restriction. The prevailing Paleo Diet dogma was the paradigm I used to develop a pathological relationship with my food.
Eating Disorders: The Taboo Topic
However, another theory in psychology called “Willpower Depletion” has emerged in recent years to explain the mental toll that is taken after you’ve repeatedly, and laboriously, resisted temptation.
This new theory posits that “Willpower” is similar to a muscle in the sense that it can get fatigued from overuse. Although “Willpower Depletion” isn’t physical fatigue, physiological changes occur.
Scientists at the University of Toronto found that people whose willpower was depleted by self-control tasks began to show decreased activity in an area of the brain called the anterior cingulate cortex, an area involved with cognition and controlling unwanted outcomes.
In effect, this means that over time, “Willpower Depletion” actually causes your brain to function differently, which could account for the drastic behavioral changes witnessed in Keys’ Starvation Experiment. “Willpower Depletion” and “Lack” could also account for the development of my own eating disorder, and it rang true to me. However, this also gave me great pause.
The Paleo Diet is already restrictive in nature, and the claims that further restrictions are a healthy—or even necessary imposition— are dubious. In fact, it’s possible that for some individuals, the dogma is potentially more dangerous than any processed food.
However, disordered eating behaviors and compulsive and unnecessary restrictions have become socially accepted and even praised within the Paleo Community. Completing dietary challenges are positively rewarded socially by the rest of the Paleo Community.
In contrast, no praise is given to those who produce or consume “paleofied” processed foods in an effort to aid in the offering, or discovering one’s own sustainable diet. Instead, they are often shamed by the community, regardless of the fact that they have helped so many avoid feelings of “lack”. As a community, we have failed to discuss health in a manner that takes the physiological and emotional well-being of the individual into account.
And what’s worse? We don’t even discuss it.
In light of the exploration into the psychology of “Willpower Depletion” in tandem with the results of Keys’ experiment, the plethora of post-diet memes circulating through the interwebs showing people gorging on donuts and cakes following a short-term “dietary challenge” should come as no surprise.
One single Google Images search will reveal thousands of memes on this single, common experience. This indicates that the post-dietary gorging behavior is commonplace, and well-recognized by nearly every individual who has participated in a restrictive diet or short-term “dietary challenge”.
What is a surprise, however, is that these individuals are encouraged to “get right back on the horse” and begin the restriction cycle again. This cycle:
The common belief is that this cycle sets the individual up to succeed in the long term on their diet. While for some individuals this may certainly be true and it can become a sustainable lifestyle, for others it may have long-lasting psychological effects and actually promote an unhealthy relationship with food.
Or worse, it could potentially foster a belief that the diet is ideal for their individual physiology when it is not, and cause actual physical harm. This is an inherent danger with any one-size-fits-all dietary approach.
However, discussing the potential dangers of one-size-fits-all dietary approaches, or the increasingly restrictive nature of diets and their potential to cause psychological harm, is considered the taboo subject matter— especially within the Paleo Diet Community. Which is exactly why I want you to take a moment to really consider these questions:
• Why is discussing the potential dangers of one-size-fits-all diets, or diet challenges within the community considered taboo?
• Why is the focus on physical health considered, yet psychological health is not weighted as highly?
• What would compel individuals to promote or restrict diets beyond medical necessity?
• What would compel members of the community to publicly shame producers of “paleoified” options?
And the most important question then becomes, why is the community focus on helping individuals complete a “diet challenge” or promoting extreme restrictions, instead of helping an individual find a long-term sustainable solution to meeting their individual goals? Seems like something may be awry, no?
Unfortunately, the area of psychology has not provided us with a framework to answer these specific questions. Perhaps the answer to these questions requires that we ask harder, more psychologically-involved questions.
Questions like, what compels so many individuals to diet restrictively in the absence of necessity in the first place? And, what are the patterned behavioral changes that occur among individuals who are compelled to engage in unnecessarily restrictive dietary patterns for a prolonged period?
Let’s dig in.
Patterned Behaviors from Restrictive Dieters
First, let’s take a look at some common behavioral changes and that often emerge from completing unnecessarily restrictive dietary tasks for clues to answer the aforementioned questions. These include:
• Ideations of superiority
• Intolerance towards the diets of others
• Dietary “righteousness”
• Labeling of “good” or “bad” foods
• Self-inflicted punishments or emotional responses to indulging in “bad foods”
Another layer of pathology can manifest in other detrimental ways to the individual and others whom they encounter. Self-superiority through the accomplishment of overcoming “Willpower Depletion”, in conjunction with the belief in the superiority of the unnecessary dietary restrictions themselves, can also lend itself to other ways to use control. Ideological and behavioral patterns often include:
• Inability to logically consider evidence to support another dietary modality.
• Compulsively engaging others to join their particular brand of unnecessarily restrictive dieting behaviors.
• At the extreme, compulsive subjugation
• Deteriorating health or inability to improve health, in tandem with an inability to correlate with the diet.
These 4 behaviors are all linked with a need for validation for the belief system, but the end result is in what is called confirmation bias, or the tendency to search for, interpret, favor, and recall information in a way that confirms one’s preexisting beliefs or hypotheses.
While these behaviors are consistent with the diagnoses of Orthorexia Nervosa, I believe that Orthorexia Nervosa as a disorder misses the mark and is merely descriptive of a behavioral pattern, and does not adequately address the underlying psychological facets of the identified behaviors, specifically: Validation, and the Rewards Pathway.
Validation, Feeling Good, and the Rewards Pathway
The feeling of not being able to overcome “Willpower Depletion” may cause certain predisposed individuals to experience deep feelings of insecurity or inadequacy.
At the expense of finding a diet that will work for their goals in the long term, individuals who engage in restrictive diets and “diet challenges” feel a sense of self-control, accomplishment, and validation from overcoming “Willpower Depletion.” This sense of “Validation” is also intertwined with the dopaminergic Rewards Pathway.
In simple terms, dopamine is a chemical that is released in the brain when something occurs that makes us feel good. The brain includes several distinct dopaminergic pathways, one of which plays a major role in reward-motivated behavior: the Rewards Pathway.
In essence, when a behavior makes us feel good, the brain is flooded with dopamine which motivates our behavior in an effort to continue to experience those feelings through this pathway. And because validation offers us a sense of feeling good, dopamine is released and the Rewards Pathway is revoked, resulting in a compulsion to continue the behavior.
I believe this pathway is tied to the underlying patterned, and pathological behaviors associated with unnecessary and prolonged restrictive dieting. I propose a theory, called “Validation and Rewards Pathway Theory of Unnecessarily Restrictive Dieting” to explain the psychological underpinnings of confirmation bias, and patterned behaviors of individuals compulsively practicing unnecessarily restrictive diets in a fashion that Orthorexia Nervosa does not:
“Individuals who compulsively and voluntarily engage in, impose, and promote unnecessarily restrictive diets in the absence of necessity do so as a means to increase self-esteem, self-worth, and self-identity by way of accomplishing challenging feats of self-control, or exerting control over others, evoking the dopaminergic Rewards Pathway, resulting in a positive feedback loop causing the individual to compulsively repeat the restrictive behavior.”
Confirmation bias is an important facet, as it allows the individual to maintain the cycle while still feeling good about themselves and their behaviors. In fact, the confirmation bias stemming from self-validation may account for what causes individuals to maintain an almost infallible sense of self-confidence in their dietary “righteousness” over time in spite of conflicting evidence—even in such a nuanced and convoluted science such as nutrition — while maintaining the top-most point of the Duning Kruger scale.
Because of the involvement of the Rewards Pathway, is it possible that the individual is “addicted” to their own sense of superiority, which leads to intolerance and confirmation bias? And, is the individual who uses dietary control and restriction as a means for self-validation in danger of developing an eating disorder, or worse, in danger of becoming a leader in promoting unnecessarily strict diets to other susceptible individuals?
And if so, shouldn’t we at the very least talk about it?
Self-Experimentation to Strike a Balance
In the Paleo Diet community, it had always perplexed me that so many individual recipe and product developers were unsupported when they went against the “Paleo-Orthodoxy” in search of their own sustainable means to making this work for them as a lifestyle. Yet, it has been so often said that the diet you stick to is the diet that will work— which is ultimately true. For the individual, finding a sustainable diet is key. Self-experimentation therefore is also key.
I realized I had fallen into an unsustainable “Validation and Rewards Pathway” trap and failed to find a diet that not only would work long-term for my physiological needs and medical restrictions but also my mental and emotional well-being.
I needed a diet that wouldn’t deplete my “Willpower” because I knew I would need to be on some variation of this diet for years to come. So after having an intense period of introspection— essentially trying to understand what would possess me to adhere to a Paleo Diet Dogma that for years did not serve me— I made a new rule: Do what makes me feel good in a healthier way.
If I didn’t feel good after eating a food, I would evaluate whether the feeling was physical, or emotional. Key points of that over-arching rule:
• Feeling emotionally bad over eating a “bad” food needed to be recognized as pathological behavior, and was countered by taking note of my physical feelings.
• If the food made me feel emotionally good but physiologically bad, it would need to be weighed by my own sense of a risk-benefit ratio.
• If the food made me feel emotionally good and physiologically good, it would become part of my staple diet.
Following this rule, many previously labeled “bad foods” were brought back into my house as an experiment. This resulted in an overall reduction of fixation and feelings of “lack”. Today, chocolate will sit in my apartment for weeks. Foods that I do not like, I do not feel compelled to eat.
And, while my diet is still overwhelmingly comprised of non-processed, whole foods, I have a deep appreciation for the “paleoified” baked goods that I indulge in— they have their place in my balanced diet.
Since focusing on my own path to a sustainable lifestyle and focusing on these rules, I am pleased to say that the scale finally moved. In fact, I lost 40 lbs. and it has stayed off for several years now— even with the occasional bowl of pho or peanut butter cup. That is the power of sustainability.
On a personal note, I now compulsively post what Paleo Dieters would consider “cheat meals” as a means to let folks know I am not striving towards “Paleo Perfectionism”— instead I am striving for honesty. I am showing that this is how I make it work for me, and I get a fair share of backlash “for setting a bad example.”
What I think sets a bad example is creating the illusion of living in an Ivory Tower that only serves to make those who are compelled to use food as a means for self-validation— who cannot achieve that level of Paleo Perfectionism— feel worse.
Don’t Expect The Paleo Foundation to Proselytize
It is often expected that a Certification Organization like the Paleo Foundation would offer strict dietary guidelines or a dieting template, or engage in bad-mouthing other diet modalities, or incessantly covering the dangers of non-Paleo foods. The reason we don’t operate like that is quite simple: we’re not here for validation, we are here for something else.
The Paleo Foundation exists to offer options to individuals who must maintain a restrictive diet for health reasons, instead of judgment from “Validation seekers” while ensuring that individuals buying Certified Paleo products are getting what they expect through quality assurance and auditing processes. There are so many of us that cannot afford to not make this a sustainable lifestyle.
Furthermore, we don’t exist to convince anyone to join our Paleo Community. We cannot, in good conscience, tell an individual what will offer them a balanced lifestyle. All we will maintain is that our belief is that the Paleo Diet is the best baseline to start from— as a self-experimentation platform— for individuals concerned about their physical health. We maintain this ethos because we recognize that not everyone has the same physiological or psychological responses to the same foods, nor do they have the same goals.
Some Paleo Diet adherents may strike their absolute balance in being more strict with their diet— or can complete the restrictive cycle without developing an unhealthy self-validation relationship with food— while others may find that they need to be more liberal. Some may find they do best on lower carbs, some may find that they do well on higher carbs as was my personal case. Some may find that they can’t get away with the occasional “paleofied” baked goods without falling into a “Rewards Pathway Trap”, while others may find they don’t present as a problem at all.
The Paleo Foundation is squarely in the “Do Whatever Works” camp. We are all different.
In short: the Paleo Foundation exists to help people find foods that we hope will make them feel emotional and physically good, that adhere to a specific theoretical template called the Paleo Diet. What we do is write standards that adhere to this theoretical framework based on logic and reasoning, and ensure that products we certify have met those strictures. We do this so that those who must make this a sustainable lifestyle, can.
Finally, as an organization, we don’t want to be part of the problem when it comes to disordered eating. We want to be part of the solution by offering more choices, and less restriction.
Life is hard enough as it is.