Orthorexia: When Your Healthy Diet Threatens Your Health

Orthorexia nervosa is a newcomer to the field of eating disorders. While it may seem like eating disorders were unheard of before the in the twentieth century, anorexia at least has been known for several centuries. It was first described in 1684, identified with its own dignostic criteria in the 1870's, and has been widely known by clinicians since that time. It only came into the public consciousness in the 1970's when it began to be reported in and discussed in the media.

Bulimia seems to be a more recent phenomenon. While the practice of vomiting up food was common in the ancient world, it had little to do the reasons we associate with eating disorders. In the case of the Romans, for instance, purging was practiced during feasts so that they could stuff themselves with even more food; the practice was so widespread that special rooms called "vomitoriums" were made available to guests during feasts (I'd hate to be the slave who had to clean that up!). As a method of controlling weight, however, bulimia nervosa was not described in the medical literature until 1979. Throughout the eighties, it became part of the public consciousness alongside anorexia.

Orthorexia nervosa was unknown until the late nineties, when Dr. Stephen Bratman, MD, wrote an article about the disorder in October, 1997 edition of Yoga Journal. Since then it has gradually become part of the English lexicon, as more and more medical personnel are observing it in their patients. It has been the subject of two clinical studies to date, and thanks to attention from the web and traditional media outlets, knowledge about this condition is proliferating.

Orthorexia has been the subject of only two clinical studies thus far. This means that any scientific understanding of orthorexia is preliminary at best; however, the results of these studies indicate that its underlying causes may be similar to those of other eating disorders. As with anorexia, sufferers of orthorexia have symptoms consistent with obsessive compulsive disorder, and the need for control seems to be a critical motivating factor in the quest to maintain a "correct" diet.

Interestingly, unlike other eating disorders, orthorexia is more likely to effect males. This may or may not have anything do with the fact that other eating disorders are often at least partially about body image. Unlike sufferers of anorexia and bulimia, orthorexics are not motivated by a desire to be thin. Orthorexics want to feel "clean", "pure", or "natural". Their desire is not to be lose weight or even to restrict their overall calorie consumption. Their desire is to restrict their food intake only to those foods that meet their definition of what is "pure", "natural", or "healthy".

Orthorexia also differs from other eating disorders in its seriousness. Anorexia and bulimia are both conditions with dangerous physical repercussions, such as digestive problems, skin ailments, tooth decay, heart problems, and even death. Though it has been known to happen, orthorexia does not often claim lives. Depending on the diet being followed, malnutrition is possible, but in some cases an orthorexic's basic diet may be reasonably healthy. Orthorexics are much more likely to suffer emotionally, in the form of anxiety, obsessive thoughts, and social isolation.

If you or a loved one is having difficulty maintaining a minimum weight, please seek medical attention.

Many people are concerned with what they eat, where their food comes from, and the impact this has on the environment and other people. Therefore they commit to a healthy, whole-foods diet that's as free as possible from additives, fertilizers, and pesticides. This might take the form of a vegetarian, vegan, or raw-foods diet. If managed well, any of these can be a very healthy dietary choice. It only becomes pathological when it begins to interfere with a person's day to day functioning.

If you have a food allergy or sensitivity, or if you've ever tried to be a vegetarian, you know that dietary restrictions can sometimes make eating a little complicated. Additional restrictions like veganism or raw-ism increase the complications, but depending on where you live, it might not be that bad. And if you find yourself in a situation where the only food available has a bit of chicken broth, or dairy, or overcooked veggies, you decide whether it's worth bending the rules or sticking to your diet.

ButiIf you have orthorexia, it is imperative to consume only "healthy" foods and to avoid what is "unhealthy" at all costs. "Healthy" can mean many things depending on the person in question, and, since orthorexics are in constant search of the perfect diet, it is subject to change even in the case of an individual. Food that is "healthy" might be only fruit, only cooked, only raw, or only vegan. Food that is processed, cooked, or farmed in a certain way is viewed as "unhealthy", "unnatural", or even "toxic". I have known people who have chosen to go without eating, even when faced with a long and strenuous day ahead of them, rather than eat something "impure".

So let's say you're an orthorexic following a raw foods diet. It's complicated, but manageable. Then you read somewhere that carbohydrates and proteins should never be eaten together. Oh, and spices are too "stimulating" so you can't eat them at all. And then your friend tells you that your food should only be eaten "instinctively"; so you have to sniff several foods before you start eating anything, and choose the one that "instinctively" smells best; and start eating it and keep eating it until it stops tasting good.

At this point, how much of your time is spent planning, preparing, and shopping for meals? How much money is your "perfect" diet costing you? Are you still able to eat with friends, or do you have trouble finding the time to even see them?

I retrieved this quiz from the Silicon Valley Metro. Answer these ten questions to determine whether you are at risk for orthorexia.

1. Do you spend more than three hours a day thinking about healthy food? (For four hours, give yourself two points.)

2. Do you plan tomorrow's food today?

3. Do you care more about the virtue of what you eat than the pleasure you receive from eating it?

4. Have you found that as the quality of your diet has increased, the quality of your life has correspondingly diminished?

5. Do you keep getting stricter with yourself?

6. Do you sacrifice experiences you once enjoyed to eat the food you believe is right?

7. Do you feel an increased sense of self-esteem when you are eating healthy food? Do you look down on others who don't?

8. Do you feel guilt or self-loathing when you stray from your diet?

9. Does your diet socially isolate you?

10. When you are eating the way you are supposed to, do you feel a peaceful sense of total control?

"If you answer yes to two or three of these questions, you have at least a touch of orthorexia. A score of four or more means that you are in trouble," Bratman writes. "And if all these statements apply to you, you really need help. You don't have a life--you have a menu." (From Silicon Valley Metro).

I live in Northern California. People here are pretty health-conscious, and they tend to watch what they eat for a variety of reasons related not just to their own health, but also to the health of the environment and reasons of social justice. To boot, a lot of the people I meet are very much into alternative, non-medical healing practices, and these often involves dietary intervention. I've been in places where the mere mention of feeling tired will have total strangers leaping out of the woodwork, drawing up my horoscope to tell me my Star Sign Optimized Fair-Trade Raw Juice Cleanse that I need to start Right Now to correct my Dangerous Energy Imbalance.

I've learned to be cautious about mentioning any of my various learning disabilities, mood disorders, and chronic health conditions when I'm in certain company. If I so much as let slip that I'm allergic to dust, someone will lecture me about the dangers of "dairy toxicity". I've been told that learning disabilities are "caused" by high fructose corn syrup and artificial coloring, that ADHD is "really" a massive food allergy, and that I could free myself of depression and anxiety disorder forever by either eliminating all wheat from my diet -- or by taking wheat germ at every meal, depending who I'm talking to.

Now, I'm originally from Minnesota, where we don't get into personal discussions all that much. Someone lecturing another person on the evils of their diet would be met by polite, passive-aggressive silence until they got the hint and changed the subject. When I first moved here I wondered if Californians had ever been taught manners. Then I decided that the two cultures just had different ideas of what constituted polite conversation. Now that I've learned about orthorexia, I'm beginning to suspect that it's especially prevalent in NorCal.

I came across a reference to orthorexia on an autism blog called Ballastexistenz and my interest was piqued. Like people with ADD (or LD, mood disorders, fibromyalgia, allergies, chronic fatigue syndrome, dropsy, or wandering lung), people with autism are often told that diet is their "real" problem; though people with autism can be vulnerable to diets being imposed upon them in ways that others are not. The blog article linked to Stephen Bratman's Orthorexia site, which not only defines and describes orthorexia, but relates the personal story of the physician who coined the term orthorexia nervosa.

That story is interesting to me because the site's author, in addition to being an MD, is also an alternative health practitioner who believes in the importance of diet when treating any long-term health condition. Where he was once a dietary evangelist, however, he is now a great deal more cautious about the notion that with enough work, a person's diet can be a panacea. What makes the story even more interesting is that the Dr. Bratman does what medical professionals rarely do -- he reveals his own struggle with orthorexia.

Stephen Bratman begins by describing his life as a young man in a commune kitchen, and the "food fights" that went on there between the various dietary factions. There were vegetarians who refused to eat food from cookware that touched meat, and people who insisted on meat being served; those who followed a macrobiotic diet believed raw vegetables taxed the digestion, and those on a raw-food diet viewed cooked food as poison. All the while he himself followed a vegetarian diet and would only eat in silence, chewing each mouthful of food fifty times ... oh yeah, and he refused to eat any vegetable that had been out of the ground for more than 15 minutes.

Later in his article, Bratman discusses his medical practice. He writes of "Andrea", who has asthma, and at one point took four different medications to treat it. Dr. Bratman helped her to identify the foods to which she was sensitive and eliminate them from her diet. The first to go were milk, wheat, soy, and corn; at this point Andrea was able to eliminate one of her medications.

Excited by this success, Andrea was determined to eliminate still more foods until she could get off all of her medications. She identified sensitivities to eggs, avocado, tomatoes, barley, rye, chicken, beef, turkey, and tuna; then to broccoli, lettuce, apples, and trout. She was able to drop all her meds, and she felt great -- for about three months.

Then she began to discover sensitivities to other foods, finally determining that the only two foods she could tolerate were lamb and white sugar. This required that she enact a complex rotation schedule, varying grains and vegetables at every meal, and fasting occasionally to "clear". She has headaches, nausea, and mood swings, but no asthma, so she's still enthusiastic about her diet. I guess that's a good thing, because her entire life revolves around it.

Dr. Bratman writes, "... when we started treatment, all she had was asthma. If she took her four medications, she also had a life. Now all she has is a menu. She might have been better off if she had never heard of dietary medicine."

Andrea's story caught my attention in light of all the many, many people who have told me that all of my health problems can be reduced to food sensitivity.

It's not that I think diet doesn't matter -- it absolutely does. I'm a vegetarian, I shop at my local farmers' market, and I eat a Mediterranean diet rich in legumes, whole grains, and fresh produce. These are dietary choices I've made for myself based on my physical health and my ethics. As for food sensitivities, I've learned that my ADD symptoms are much worse when I consume caffeine and simple sugars (icing makes me almost high, and not in a good way), and they're much better when I eat greens at every meal (yes, even breakfast). So my diet is not what you'd call "typical".

But what if I tried to do what Andrea did?

Maybe my symptoms would disappear completely if I started an elimination diet, and got rid of corn, soy, milk, wheat, peaches, apples, barley, broccoli, avocados, tomatoes, celery, rice, potatoes, and who knows what else. Maybe I would never need medication again.

But what would I eat, and who would I eat it with? How much time would I have to spend planning menus, shopping for food, and preparing meals? Would I still have time to exercise, socialize, make art, play music, and make Squidoo lenses?

Or would I, like Andrea, have a menu but no life?