[Chapter 7] The Ketogenic Diet as a Treatment for Obesity… AND Anorexia?

The same exact diet makes fat people lean and anorexics normal weight?

The low-carbohydrate program augments the anabolic processes that contribute to increase body mass… they will eventually reach a larger body mass compared to when they began the low-carbohydrate program. The new weight, however, will be in all the right places. Christian Allan and Wolfgang Lutz, from “Life Without Bread”

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I’m assuming you’re familiar with the low carb (keto) diet. As mentioned, I’ve been on one since 2007—first inspired by Gary Taubes’ Good Calories, Bad Calories—and I remain a zealous keto advocate. I believe these diets should constitute the treatment of first resort for obesity, diabetes, insulin resistance, and other metabolic disorders.

That said, I have gone to great lengths to protect this discussion from any debate about dietary patterns.

I’m only bringing up keto in the context of a peculiar observation.

Millions of people lower carbs specifically to lose unwanted, extra fat. Those who support the Banker Model will tell you why: these diets make you less hungry and/or speed up your metabolism. In other words, they induce a “negative energy balance” and, thus, cause fat loss.

However, did you know that keto can also treat anorexia?

In Life With Bread, authors Christian Allan and Wolfgang Lutz discuss their decades of clinical experience treating various diseases using a bread-free, low carb diet.

Diseases including anorexia. (See the picture above.)

These German doctors weren’t the only ones to have discovered this.

In 2023, Norwitz, Hurn, and Forcen published “Animal-based ketogenic diet puts severe anorexia nervosa into multi-year remission: A case series” in the Journal of Metabolic Health. Per these authors, their anorexic patients saw “improvements in weight, with weight gain of over 20kg each.”

Another clinical trial through UC San Diego School of Medicine is in the works to “test the safety and efficacy of the ketogenic diet for preventing relapse in people with anorexia.”

Peculiar.

In all cases, keto seems to make people healthier. The obese lose fat where they don’t want it (bellies, chins, hips, etc.) The anorexics, meanwhile, gain fat where they DO want it. (Recall the Life Without Bread quote: “The new weight… will be in all the right places.”)

But why should a diet that works for obesity ALSO work for anorexia?

To put the puzzle more precisely: if keto treats obesity because it induces people to eat less / move more, how is the same exact diet able to induce anorexics to eat MORE / move LESS?