Vegan Diet & Eating Disorders
Written by Beth Francois, Registered Dietitian
Veganism is on the rise, with record numbers of people signing up to veganuary this year (1). Veganism is a way of living and ethical movement, not just a diet as the exclusion of animal products extends beyond food to clothing, skin care and other industries. We know that reducing our consumption of animal products is associated with a positive impact for health and the environment however, for those living with an eating disorder adopting a vegan diet can have a detrimental impact on recovery and the motivation and drive for this dietary change needs to be carefully considered.
Why is it important to challenge veganism in ED recovery?
Often, an attempt to adopt ‘healthy’ eating habits may precede an eating disorder and individuals may move towards pescatarian, vegetarian or vegan eating. Although this may not appear problematic, these dietary restrictions allow people to mask their illness by hiding behind socially acceptable forms of dietary restriction. A large number of people with eating disorders will decide to become vegetarian or vegan as a form of restriction with the aim of controlling weight. One study reported half of patients seeking treatment for anorexia nervosa practiced some form of vegetarianism, with 61% believing there was a relationship between their drive to become a vegetarian and their eating disorder (3).
There are increasing numbers of people who are moving towards vegan diets at certain points in recovery from their eating disorder. Whilst from a physical health point of view, a carefully considered vegan diet may allow nutritional requirements to be met; from a psychological perspective, the detrimental impact of dietary rules (irrespective of the intention) for those with a history of an eating disorder, cannot be ignored. An eating disorder provides a function to enable individuals to cope; and this is often by providing a sense of control. If a vegan diet simply steps in to provide this function, it is likely to maintain eating disorder symptoms and increase the risk of relapse.
The Impact of a vegan diet on recovery
Maintaining eating disorder symptoms
Adopting any form of dietary habit or restriction is likely to increase preoccupation with food. Veganism may allow individuals to feel that they are able to retain some sort of control and not completely give up their illness. A statement that sums this up might be ‘I ate this and it was scary, but it was vegan so I feel less guilty about it’. In other words, veganism may provide the same reassurance and justification seen with compensatory behaviours.
Avoidance of fear foods
As a clinician, many of the fear foods I see individuals describe, are those that would be excluded in a vegan diet for example cheese, butter, creamy sauces/dressings, chocolate, cakes and ice-cream. It is easier to ask for modifications to be made to a meal based on dietary requirements, despite the underlying reason perhaps stemming from a place of fear and anxiety. Whilst there are many vegan alternatives available, these may feel safer to the individual and therefore be less challenging to the eating disorder. The need to confirm whether foods are vegan may also result in more frequent checking of food packaging, in turn, increasing anxieties regarding nutritional content.
It is possible for a carefully considered vegan diet to meet macro and micronutrient requirements. However, it does require more planning and an increased focus on nutritional content. You can read more about the key nutrients at risk while following a vegan diet here.
Impact on the gut
A typical vegan diet tends to be high in fibre. This can result in increased abdominal discomfort and distress which is already exacerbated during eating disorder recovery. Vegan food tends to have a low energy density. This means a larger volume needs to be consumed to meet energy requirements. This will be challenging for individuals who experience gastroparesis (slow digestion) and early satiety (feeling full quickly), both of which are commonly seen in those with eating disorders. Low energy dense food is not something that would be advised in the weight restoration phase of recovery.
Having different dietary requirements to your family and loved ones is likely to increase self-isolation, something eating disorders thrive on. Being able to have food cooked by others is an important aspect of recovery and veganism may offer an excuse to avoid this by retaining control over food preparation. It may also decrease the opportunity for social eating if there are not appropriate options available.
In certain individuals, particularly those in recovery or with a history of an eating disorder, implementing a vegan diet may result in additional obsessive or restrictive eating behaviours and delay the recovery process. It may be necessary to suspend a vegan or vegetarian diet, for the duration of treatment for an eating disorder due to the increased risk of nutritional deficiency and risk of psychological harm. It might be possible to reintroduce a vegan diet after a substantial period of recovery when you can be sure that the intention behind this is not intertwined with any eating disorder cognitions. This should ideally be done with the support of a specialist dietitian.
What can I do Instead?
For those who want to play their part in protecting animals and the environment during recovery, consider the following:
1. Buy cruelty free make-up & beauty products
2. Avoid buying leather
3. Donate to organisations supporting animal welfare
5. Join your local community litter pick
6. Buy second hand clothes
7. Reduce air travel
8. Use reusable bags/bottles/cups.
Written by Beth Francois
Beth is a specialist eating disorder dietitian working in a child and adolescent specialist eating disorder service. Make sure to follow her on instagram at @theeddietitian where she posts informative content, tips and resources.
1. The Vegan Society https://www.vegansociety.com/news/media/statistics
2. The Vegan Society https://www.vegansociety.com/go-vegan/definition-veganism
3. Bardone-Cone, A., Fitzsimmons-Craft, E., Harney, M., Maldonado, C., Lawson, M., Smith, R. and Robinson, D. (2012). The Inter-Relationships between Vegetarianism and Eating Disorders among Females. Journal of the Academy of Nutrition and Dietetics, 112(8), pp.1247-1252.
Talia is a registered dietitian working in private practice and as an eating disorder specialist dietitian in London's leading private mental health hospital. As a freelance dietitian, Talia not only offers 1:1 consultations but can present at your workplace, create recipes or articles or host a cooking demonstration. To enquire please fill out a contact form.