Although the concept of healthy eating has been around for decades, fad diets continue to grow in popularity.
Google searches for words like “paleo” and “gluten” are on the rise, particularly since 2011.
The global functional foods industry – foods meant to serve a specific purpose, such as sleep-aiding drinks, weight loss supplements, gut-soothing probiotics, and health-promoting superfoods – passed $120 million in sales in 2013 and is on track to hit nearly $160 million by 2017, according to a report by Global Industry Analysts, Inc., a market research publisher.
With obesity rates leveling off, making healthy eating trendy may be a step in the right direction. However, for some people, healthy eating goes too far.
Meet Orthorexia, the Newest Eating Disorder
For people experiencing orthorexia, the quest to eat right becomes an eating disorder in and of itself.
Originally coined by Dr. Steven Bratman in 1997, the word “orthorexia” is derived from anorexia and “ortho,” meaning straight or right. Unlike anorexia, which focuses on restricting food intake in order to achieve a certain body shape, orthorexia restricts foods that are insufficiently clean, healthy, or wholesome.
“It often starts from a place of good intentions – with a person maintaining a healthy lifestyle or making changes to a more healthy lifestyle,” explained Ramani Durvasula, a professor of psychology at California State University, Los Angeles, and a licensed clinical psychologist, in an interview with Healthline. “Over time it becomes a bit more obsessional – with a rigid focus on types of ingredients, types of foods, quantities, and times of day things should be eaten.”
For Jordan from Los Angeles, the process was gradual, though controlling her eating was a must from the start.
“I’ve always had a lot of pain and bloating from eating food,” she told Healthline, “but no doctor or nutritionist was really able to get to the root of the problem. I just had to be really careful about what I ate. Being really strict and regimented about that was really the only thing that would help.”
A vegetarian since the age of 14, Jordan began a vegan cleanse in college, eating only fruits, vegetables, and nuts.
“I absolutely loved it, I felt amazing,” she said. “I told myself at that point, I felt so good, that I’m not gonna go back to the way I had eaten before.”
Jordan cut out all animal proteins, alcohol, oils, gluten, and anything that was “impure, not completely from the earth.” She began a blog, The Blonde Vegan, where she wrote about vegan cooking, vegan restaurants, and the vegan experience. The stomach problems that she’d experienced most of her life went away.
Several months into the diet, the 24-year-old Los Angeles resident began to experience cravings, mostly for animal proteins like eggs or fish. But, by then, being vegan had become an integral part of her identity, supported by a social media following of more than 30,000 people.
“By this point, I was so attached to veganism because I had completely labeled myself as a vegan and was part of this vegan community,” she explained. “I really didn’t feel that it was an option to me to eat anything that was not vegan.”
Despite the restricted diet, Jordan’s digestive troubles began to return.
“Instead of listening to my body and incorporating more foods, I became a lot more limited in what I did eat because I was trying to cleanse myself of these stomach problems that I was having, which were really a nutritional deficiency,” she said.
She began doing juice cleanses, cutting out solid food entirely. At first, it was three-day cleanses, then 10-day, then 30-day.
The restricted diet began to take its toll. Jordan began experiencing skin problems, then her hair began falling out and she stopped getting her period. Starved for nutrients, her body was shutting down.
What Causes Orthorexia?
Plenty of people try new diets in their quest to become healthier without experiencing orthorexia. So who will develop the disorder?
It’s a matter of predispositions combined with environment, argues Sondra Kronberg, director of the Eating Disorder Treatment Collaborative and spokesperson for the National Eating Disorder Association.
“In the general population, eating healthy is healthy,” she told Healthline. “In the population that is predisposed to take things to extremes, to be more addictive, to be more anxious, have low self-esteem, they are more vulnerable to having a problem.”
Other risk factors, she said, include obsessiveness and compulsiveness, rigid or black-and-white thinking, and harm-avoidance.
“In addition to which, if we have a genetic predisposition to be a larger size than our culture affords us … our culture doesn’t allow that, doesn’t promote that,” Kronberg added. “You’re then genetically predisposed, in this culture, to feel bad about yourself. So that mix of genetic predisposition drives one toward an external fix, and in this culture, the external fix is to get thinner … and thinner, and thinner. The diet becomes the trigger for an eating disorder.”
Our health-conscious environment, for all its good intentions, may be what’s tipping vulnerable people over the edge.
“The prevalence of obesity has increased, along with the stigmatization of people who are obese,” explained Edward Abramson, professor emeritus of psychology at California State University, Chico and author of “Emotional Eating.”
“It’s widely believed that obesity is just a matter of willpower, and therefore people who have weight issues are somehow morally deficient or psychologically limited. If you take the obverse of that, then one is virtuous or psychologically more advanced if one can really control their eating. The area in which one exerts control is a function of whatever is the latest fad diet or whatever is in the media. So if some movie star is into paleo, you’re more virtuous if you religiously follow paleo.”
For many people struggling with their self-image, this feeling of control and virtue is exactly what they’re looking for.
“There’s this moral rectitude to it – whenever I saw people eating poorly, I immediately judged them, not just for their bad food choices but as bad people,” said Kaila, 28, from San Jose, California, in an interview with Healthline.
Kaila also fell into the trap of orthorexia gradually. She learned how to read food labels when she was 13 and grew repulsed by the amount of impurities and additives, triggering orthorexic anorexia that would come and go for years.
When she discovered the clean eating movement as an adult, her restrictive eating tendencies spiraled into full-blown orthorexia. Her social life began to dissolve as she lost her ability to eat in restaurants or go on dates without experiencing panic at her lack of food choices. If she “slipped,” it triggered a wave of self-loathing that drove her even further into orthorexia.
Healthy eating crossed the line into orthorexia when it began to have negative effects on her social life and her health.
Different Bodies, Different Diets
In Kaila’s case, a vegan diet turned out to be the wrong decision.
Animal proteins are filled with vitamin B12, which is necessary to run a wide range of the body’s metabolic functions. For this reason, people on a vegan diet often take vitamin B12 supplements, which usually contain a synthetic form of the vitamin cyanocobalamin.
However, unbeknownst to her, Kaila carried a mutation in a gene called MTHFR, which affects how the body metabolizes B12 and folate. Her body could only digest hydroxocobalamin, a natural form of B12.
Despite taking cyanocobalamin supplements, her body was still starving for B12 that it could use. She began to experience thyroid problems, acne, depression, panic attacks, severe weight loss, and she stopped getting her period as well.
For Kaila, discovering this deficiency drove home an important point: There is no one right diet for everyone.
“You have to understand that the marketing machine needs to sell things, and maybe those things are the right products for you, but maybe, and probably, they’re not,” she said. “You need to be an educated consumer, not just in terms of consuming but consuming what’s right for your body.”
Kaila, who now works in marketing, cautions health-oriented people to find out where their information is coming from. Much of the information available about healthy eating comes from the marketing efforts of health food companies.
“We’re all so obsessed with getting the perfect body and having perfect health,” she said, “and so when somebody puts a label on something and says this is ‘the thing,’ we’re willing to listen, because there’s nowhere else to turn.”
Durvasula shares this concern.
“Every day a new fad or fruit or food is shoved in our faces by magazines, TV, Internet,” she said, “and everyone is so confused about how to eat healthy in today's world that orthorexia is sometimes the attempt to control all the messages by controlling everything about food consumption.”
The Road to Recovery
For Jordan, now a certified health coach, recovering from orthorexia involved seeing an eating disorder therapist and a nutritionist.
She learned she had to let go of the label of being vegan and instead focus on eating with balance and flexibility. She added animal proteins back into her diet and learned to accept that eating less-healthy food at social occasions was OK.
Today, she’s working on a book called “Breaking Vegan” about her experiences with orthorexia and how others can avoid or escape the disorder. Her blog has been renamed The Balanced Blonde.
Kaila is also a certified health coach. She overcame orthorexia with the help of a functional doctor, who found her MTHFR mutation and helped her build a new diet, custom-tailored to her personal needs. She urges anyone struggling with orthorexia to seek help.
“Healthy eating is not rocket science,” said Durvasula. “Fresh fruits and vegetables, less sugar, multigrains instead of white breads, lean proteins, more water, less sodas, being mindful, and an occasional cup of ice cream or burger is just fine. A healthy life is not just about rigid adherence to an eating regimen. It is also about relationships, and balance. Counting out chickpeas for lunch or calling out your friends for eating a slice of birthday cake is not living.”
For more information on getting treatment for orthorexia, visit www.nationaleatingdisorders.org or call NEDA’s helpline at (800) 931-2237.