The keto craze has yet to slow down, and for good reason. This high-fat, moderate-protein, low-carb diet has been shown to have a variety of super-cool health benefits, including weight loss, reduced inflammation, increased energy, improved brain function, reduced cravings, and so much more. It's no wonder everyone wants to take advantage of all things keto.
But when undertaking any lifestyle or dietary change, a healthy mindset is always essential—especially when beginning a diet whose success relies on perfectly calculated ratios of macronutrients. As a functional medicine practitioner, I have seen the most well-intentioned people become obsessed with following the conventional keto diet perfectly, and this stress actually ends up causing more harm than good.
With its hyper-focus on macronutrients and carb counting, the way many people do the keto diet today can lead some people to an unintentional unhealthy relationship with food. The desire to be healthy isn't bad. It's when it turns into an obsession that it becomes a problem.
How do you know if your keto fixation has morphed into orthorexia?
First coined in 1998, orthorexia is classified as a type of eating disorder alongside anorexia and bulimia and includes symptoms of obsessive behavior such as anxiety and stress in pursuit of a healthy diet. Simply put, it's an unrelenting obsession with the foods you are eating to a point that it inhibits you from enjoying your life and induces stress.
Here are six signs a well-intentioned diet, whether it's the ketogenic diet or any other way of eating, has likely devolved into disordered eating:
Whole foods take a back seat so you can hit your macros.
With the rise of keto has come the development of hundreds of keto-"friendly" products. All of these are marketed as being super high-fat and super low-carb (often touting claims like "zero net carbs!"), and they can be appealing because you know exactly what you're getting in terms of macronutrients since they're listed on the label.
In a way, it's "easier" to choose these processed foods—along with high-fat, virtually zero-carb foods like bacon and butter—instead of fresh foods like vegetables, which naturally contain some carbs that are harder to calculate as precisely. So, if you are hyper-fixated on being "high-fat, low-carb," while giving little regard to any other aspects of your food or how those foods are making you feel, that's a red flag.
You aren't eating enough—again, so you can hit your macros.
Not wanting to go over your certain macronutrient thresholds (namely carbs and to some extent protein), or being unsure whether or not something is considered "keto" could leave you feeling hesitant to eat enough food. This can cause a significant decrease in overall caloric intake and, in turn, deficiencies in vital micronutrients such as electrolytes and macronutrients your body needs to function on the most basic level. This nutrient depletion can manifest in you feeling run down with less energy than before you started—which might even make you feel like you're not doing keto "hard" enough and cause you to further restrict.
Meals trigger anxiety—especially in social settings.
Whether you are going out to eat, going to a friend's house, or planning meals at home, if you experience anxiety or high levels of distress anytime food is involved (especially when "safe" or "healthy" options aren't available), that's a major indicator that something is not right. If you adjust your social plans or, in extreme cases, avoid eating altogether because it is too overwhelming to find keto-friendly options, you need to re-examine your relationship with a ketogenic diet.
You fluctuate between bingeing and being super strict.
Many times, I have seen binge eating start as a result of underlying shame and anxiety surrounding food—which could happen with any diet, including keto. Following a binge, you may then compensate for it by being ultra strict as a punishment...only for it to all fall apart at the end of the day. It's a vicious cycle. If you're on this binge-deprive-binge roller coaster, it's time to hit pause.
You obsessively think about keto (and your next meal).
Being aware of your food is good. Mindful eating is a great skill to hone, and meal planning is a very useful tool for staying organized and accountable. But if tracking macronutrients, meal prepping, perusing keto blogs and Instagram accounts, and cooking take over the majority of your thoughts and time, that's a sign your keto enthusiasm has morphed into an obsession. In fact, a telltale sign of orthorexia is spending hours each day thinking about what you're going to eat next and what types of food might be served at upcoming events. Following a ketogenic diet should never inhibit you from living your life and fulfilling your other obligations or investing in your relationships.
You silently judge others for eating "unhealthy" foods.
Part of the problem in effectively identifying when you yourself are experiencing orthorexia is that you think what you're doing is right. Often, with orthorexia comes a superiority complex that the way you are eating is the ideal way of eating—and that some people just don't "get it." An unusual interest in the healthfulness of what other people are eating is another warning sign of orthorexia, so if you find yourself silently (or not so silently) critiquing someone's decision to order a slice of pizza or indulge in the pre-dinner bread basket, it may be time to check in with yourself instead.
So, does all this mean keto is a bad idea?
First, let me make one thing clear: No one has to go keto, and there are a number of dietary approaches that can lead to great health. That said, the ketogenic diet, done properly, can have some great fat-burning, brain-boosting, anti-inflammatory, and craving-crushing properties. What I do have a problem with, though, is how the ketogenic diet is often done today. It is also important to note that just about every way of eating can be done improperly. So no matter how we choose to eat, we have to make sure we have really nailed down the "why" and "how." Meaning why you're doing it (i.e., your goals) and how to accomplish that in a sustainable way—which I dive into below.
How to go keto in a healthier, more sustainable way.
Jumping into a new diet when you have an unhealthy relationship with food or your body is not a good idea. As I always say, you can't heal a body you hate. So, your reasoning for going keto should not be to punish your body or "fix" things about your body that are broken or flawed, but rather, it should ideally come from a place of love and a desire to fuel your body so it has the tools it needs to feel great and function optimally for the long haul. Having the right motivation or reasoning behind adopting a new diet can help shift your relationship with food from one of avoidance and deprivation to nourishment and mindfulness.
One of the main things you can do to help ensure your keto diet doesn't devolve into an obsession is this: Shift your focus away from hitting specific macronutrient numbers and tune into how you feel. Why did you want to go keto in the first place? Was it to think clearer, lose weight, restore your energy, or something else? Focusing on your improvements, rather than the numbers, will reveal more about your success than numbers ever will. Even if you missed the mark one day, if you are feeling healthier and stronger overall, that's ultimately why you began this way of eating.
Give yourself grace and lightness, and go into the keto diet (or any way of eating) with this positive mindset. If you can't, consider holding off and working on your relationship with yourself until you can.
Additionally, I do not suggest the conventional "dirty" keto diet, with bacon and butter all day, every day. This way of eating is unsustainable for most people in the long run. I suggest going keto the balanced way, something I call ketotarian: a mostly plant-based keto approach that I talk about in my book (here's a typical ketotarian day of meals).
Here are some tips to help you take a more balanced, intuitive approach to your keto diet:
- Eat real food.
- Don't fear vegetables! Fiber is needed for a healthy keto diet, and nonstarchy vegetables can be eaten in abundance.
- Keep your carbs low.
- Keep your healthy fats high.
- If you eat a nonstarchy vegetable, add some healthy fats.
- If you eat a healthy fat, add some nonstarchy vegetables.
- Eat when you are hungry.
- Eat until you are satiated.
Remember, you don't have to be on a strict keto diet forever.
Not too complicated, right? I suggest that people try a plant-heavy keto diet for eight weeks. Committing to eight weeks of keto helps create metabolic flexibility (so you can go from being just a "sugar burner" to having the ability to seamlessly alternate between burning fat and sugar for fuel), but most people don't actually need to be in ketosis long term. So after eight weeks, I often suggest ramping up the carbs slightly in an approach I call cyclical ketotarian: four to five days per week you eat a keto diet, and the other two to three days you incorporate additional carbs in the form of fruits and starches like sweet potatoes and rice. This cyclical method allows for a balanced, intuitive approach that just about anyone can benefit from. To make sure this diet is safe for you, get lab tests done and consult with your doctor. Also remember, you must drink a ton of water to burn fat.
If you think you have a problem, ask for help.
With any sort of eating disorder, seeking professional help should be priority. You shouldn't expect to tackle this on your own. There are many people who are specifically trained in how to come alongside you and support you in this journey to a healthier mindset. Consider contacting the National Eating Disorders Association helpline or seeking out a therapist or registered dietitian who specializes in disordered eating. On GoodTherapy.org, you can specifically search for therapists who deal with eating and food-related issues.
Of course, shifting your mindset and mending your relationship with food won't happen overnight. So remember to give yourself grace—wellness is a journey.
Will Cole, IFMCP, DNM, D.C., is a leading functional medicine expert who consults people around the world via webcam and locally in Pittsburgh. He has holds a level 2 Doctor of Natural Medicine (DNM) certification. Named one of the top 50 functional and integrative doctors in the nation, Cole specializes in clinically investigating underlying factors of chronic disease and customizing a functional medicine approach for thyroid issues, autoimmune conditions, hormonal imbalances, digestive disorders, and brain problems. He is also the host of the popular The Art Of Being Well podcast and bestselling author of Ketotarian, The Inflammation Spectrum, and the New York Times bestseller Intuitive Fasting.