Orthorexia Nervosa: The Health Food Eating Disorder

[Guest guest]

A friend email me this article... I think he is concerned that I might

have contracted this disorder! LOL He might be right, but I am getting

better! LOL

 

http://drbenkim.com/articles-orthorexia.html.

 

This article is from DrBenKim.com, a premier online resource for

practical natural health information.

 

*Orthorexia Nervosa: The Health Food Eating Disorder*

*by Steven Bratman, M.D. <http://www.stevenbratman.com/> *

 

Because I am a physician who practices alternative medicine, patients

who come to me often begin the conversation by asking whether they can

be cured through diet. " Regular medical doctors don't know anything

about nutrition, " they say, believing this will build rapport with me. I

feel obligated to nod wisely. I agree that conventional medicine has

traditionally paid too little attention to the effects of diet. However,

I am no longer the true believer in nutritional medicine I used to be.

My attitude has grown cautious where once it was enthusiastic and even

evangelical.

 

I have lost two beliefs that once encouraged me, and that are still

widely accepted by others who promote dietary methods of healing. One of

these is an assumption that there exists a comprehensive and consistent

theory of healing diseases through nutrition. The other is a faith that

dietary therapy is a uniformly wholesome, side effect free intervention.

 

My attitude has not always been so lukewarm. Twenty years ago I was a

wholehearted, impassioned advocate of healing through food. My optimism

was unbounded as I set forth to cure myself and everyone else. This was

long before I became an alternative physician. In those days, I was a

cook and organic farmer at a large commune in upstate New York. My

experiences there formed the foundation of my early interest in

alternative medicine, and continue to give me insight into the ideals,

dreams and contradictions that underlie the natural health movement.

 

All communes attract idealists. Ours attracted food idealists. As a

staff cook I was required to prepare several separate meals at once to

satisfy the insistent and conflicting demands of the members. The main

entree was always vegetarian. However, a small but vocal group insisted

on an optional serving of meat. Since many vegetarians would not eat

from pots and pans contaminated by fleshly vibrations, this meat had to

be cooked in a separate kitchen. The cooks also had to satisfy the

Lacto-ovo-vegetarians, or Vegans, who eschewed all milk and egg

products. The rights of the non-garlic, non-onion, Hindu-influenced

crowd could not be neglected either. They believed onion-family foods

provoked sexual desire.

 

For the raw foodists (and young children) we always laid out trays of

sliced raw vegetables. However, a visitor once tried to convince me that

chopping a vegetable would destroy its etheric field. I chased him out

of the kitchen with a huge Chinese cleaver.

 

The macrobiotic adherents clamored for cooked vegetables, free, of

course, from " deadly nightshade " plants such as tomatoes, potatoes, bell

peppers and eggplants. Some also insisted on eating fruits and

vegetables only when they were in season, while other communalists

intemperately demanded oranges in January.

 

Besides these opinions on which food to serve, there were as many

opinions on the manner in which it should be prepared. Most everyone

agreed that nothing could be boiled in aluminum, except the gourmet

cooks, who insisted that only aluminum would spread the heat

satisfactorily.

 

By consensus, we always steamed vegetables in the minimum amount of

water to avoid throwing away precious vitamins. Certain enthusiasts

would even hover around the kitchen and volunteer to drink the darkish

liquids left behind. About washing vegetables, however, controversy

swirled. Some commune members firmly believed that vital substances

clinging just under the skins must be preserved at all costs. Others

felt that a host of evil pollutants adhered to the same surfaces that

needed to be vigorously scrubbed away. One visitor explained that the

best policy was to dip all vegetables in bleach, and gave such a

convincing argument for her belief that we would have adopted the

principle at once were it not for a fortuitous bleach shortage.

 

I used to fantasize writing a universal cookbook for eating theorists.

Each food would come complete with a citation from one system or

authority claiming it the most divine edible ever created, and another,

from an opposing view, damning it as the worst pestilence one human

being ever fed to another.

 

This would not be difficult. For example, a famous naturopathic concept

proclaims that raw fruits and vegetables are the ideal foods. Some

proponents of this school exclaim periodically " the greatest enemy of

man is the cooking stove! " However, another popular theory bans raw

foods as unhealthy, and attributes to their consumption such illnesses

as MS, rheumatoid arthritis and cancer. I am referring to macrobiotics.

This influential system of alternative dietary principles insists that

all vegetables should be cooked; fruits should not be eaten at all.

 

Similar discrepancies abound in alternative dietary medicine. The

following rules may be found in one or another food theory:

 

Spicy food is bad.

Cayenne peppers are health promoting.

Fasting on oranges is healthy.

Citrus fruits are too acidic.

Fruits are the ideal food.

Fruit causes candida.

Milk is good only for young cows.

Pasteurized milk is even worse.

Boiled milk " is the food of the gods. "

Fermented foods, such as sauerkraut, are essentially rotten.

Fermented foods aid digestion.

Sweets are bad.

Honey is nature's most perfect food.

Vinegar is a poison.

Apple cider vinegar cures most illnesses.

Proteins should not be combined with starches.

Aduki beans and brown rice should always be cooked together.

 

The discovery that nutritional medicine was so chaotic troubled me. Yet

I could always hope that a universal theory of nutrition might

eventually be found. What disturbed me more was observing the extremism

that so frequently develops among those who propound dietary cures.

 

I remember a macrobiotic seminar at the commune, led by Mr. L. of the

Kushi institute. An audience of at least thirty-five listened with rapt

attention as Mr. L. lectured on the evils of milk. It slows the

digestion, he explained, clogs the metabolism, plugs the arteries,

dampens the digestive fire, and causes mucous, respiratory diseases and

cancer.

 

At that time, a member of the commune by the name of John lived in a

small room upstairs from the seminar hall. He was a " recovering "

alcoholic who rather frequently failed to abstain. Although only in his

fifties, John's face showed the marks of a lifetime of alcohol abuse.

But he had been on the wagon for nearly six months when he tiptoed

through the class.

 

John was a shy and private man who would never voluntarily have so

exposed himself. But upon returning from the kitchen with a beverage he

discovered that there was no way he could reach his room without

crossing through the crowded seminar. The leader noticed him immediately.

 

Pointing to the glass of milk in John's hand, Mr. L. boomed, " Don't you

realize what that stuff is doing to your body, sir! Class, look at him!

He is a testament to the health destroying properties of milk. Study the

puffy skin of his face. Note the bags under his eyes. Look at the

stiffness of his walk. Milk, class, milk has done this to him! "

 

Bewildered, John looked at his glass, then up at the condemning faces,

then back to the milk again. His lower lip quivered. " But, " he

whimpered, " but, this is only milk, isn't it? "

 

In the alcoholics anonymous meetings with which John was familiar, milk

was practically mother's milk, synonymous with rectitude and purity. " I

mean, " he continued, to the unforgiving students, " I mean, it isn't

whiskey, is it? "

 

By focusing on diet singlemindedly and ignoring all other aspects of

life, alternative practitioners like Dr. L. come to practice a form of

medicine that lacks a holistic perspective on life. This is ironic, of

course, since holism is one of the strongest ideals of alternative

medicine, and its most ubiquitous catchphrase (next to " natural " ).

 

It would be more holistic to take time to understand the whole person

before making dietary recommendations, and occasionally temper those

recommendations with an acknowledgment of other elements in that

person's life. But too often patient and alternative practitioner work

together to create an exaggerated focus on food.

 

Many of the most unbalanced people I have ever met are those have

devoted themselves to healthy eating. In fact, I believe many of them

have contracted a novel eating disorder, for which I have coined the

name " orthorexia nervosa. " The term uses " ortho, " in its meaning as

straight, correct and true, to modify " anorexia nervosa. " Orthorexia

nervosa refers to a fixation on eating proper food.

 

Orthorexia begins innocently enough, as a desire to overcome chronic

illness or to improve general health. But because it requires

considerable willpower to adopt a diet which differs radically from the

food habits of childhood and the surrounding culture, few accomplish the

change gracefully. Most must resort to an iron self-discipline bolstered

by a hefty sense of superiority over those who eat junk food. Over time,

what they eat, how much, and the consequences of dietary indiscretion

come to occupy a greater and greater proportion of the orthorexic's day.

 

The act of eating pure food begins to carry pseudo-spiritual

connotations. As orthorexia progresses, a day filled with sprouts,

umeboshi plums and amaranth biscuits comes to feel as holy as one spent

serving the poor and homeless. When an orthorexic slips up, (which,

depending on the pertinent theory, may involve anything from devouring a

single raisin in violation of the law to consuming a gallon of Haagen

Daz ice cream and a supreme pizza), he experiences a fall from grace,

and must take on numerous acts of penitence. These usually involve ever

stricter diets and fasts.

 

Over time, this " kitchen spirituality " begins to override other sources

of meaning. An orthorexic will be plunged into gloom by eating a hot

dog, even if his team has just won the world series. Conversely, he can

redeem any disappointment by extra efforts at dietary purity.

 

Orthorexia eventually reaches a point where the sufferer spends most of

his time planning, purchasing and eating meals. The orthorexic's inner

life becomes dominated by efforts to resist temptation,

self-condemnation for lapses, self-praise for success at complying with

the self-chosen regime, and feelings of superiority over others less

pure in their dietary habits.

 

It is this transference of all life's value into the act of eating which

makes orthorexia a true disorder. In this essential characteristic,

orthorexia bears many similarities to the two named eating disorders:

anorexia and bulemia. Whereas the bulimic and anorexic focus on the

quantity of food, the orthorexic fixates on its quality. All three give

to food a vastly excessive place in the scheme of life.

 

It often surprises me how blissfully unaware proponents of nutritional

medicine remain of the propensity for their technique to create an

obsession. Indeed, popular books on natural medicine seem to actively

promote orthorexia in their enthusiasm for sweeping dietary changes. No

doubt, this is a compensation for the diet-averse stance of modern

medicine. However, when healthy eating becomes a disease in its own

right, it is arguably worse than the health problems which began the

cycle of fixation.

 

As often happens, my sensitivity to the problem of orthorexia comes

through personal experience. I myself passed through a phase of extreme

dietary purity when I lived at the commune. In those days, when I wasn't

cooking I managed the organic farm. This gave me constant access to

fresh, high-quality produce. Eventually, I became such a snob that I

disdained to eat any vegetable that had been plucked from the ground

more than fifteen minutes ago. I was a total vegetarian, chewed each

mouthful of food fifty times, always ate in a quiet place (which meant

alone), and left my stomach partially empty at the end of each meal.

 

After a year or so of this self imposed regime, I felt light, clear

headed, energetic, strong and self-righteous. I regarded the wretched,

debauched souls about me downing their chocolate chip cookies and fries

as mere animals reduced to satisfying gustatory lusts. But I wasn't

complacent in my virtue. Feeling an obligation to enlighten my weaker

brethren, I continuously lectured friends and family on the evils of

refined, processed food and the dangers of pesticides and artificial

fertilizers.

 

For two years I pursued wellness through healthy eating, as outlined by

naturopathic tradition and emphasized with little change in the health

food literature of today. Gradually, however, I began to sense that

something was wrong.

 

The need to obtain food free of meat, fat and artificial chemicals put

nearly all social forms of eating out of reach. Furthermore, intrusive

thoughts of sprouts came between me and good conversation. Perhaps most

dismaying of all, I began to sense that the poetry of my life had

diminished. All I could think about was food.

 

But even when I became aware that my scrabbling in the dirt after raw

vegetables and wild plants had become an obsession, I found it terribly

difficult to free myself. I had been seduced by righteous eating. The

problem of my life's meaning had been transferred inexorably to food,

and I could not reclaim it.

 

I was eventually saved from the doom of eternal health food addiction

through three fortuitous events. The first occurred when my guru in

eating, a lacto-ovo-vegetarian headed on his way toward Fruitarianism,

suddenly abandoned his quest. He explained that he had received a sudden

revelation. " It came to me last night in a dream, " he said. " Rather than

eat my sprouts alone, it would be better for me to share a pizza with

some friends. " I looked at him dubiously, but did not completely

disregard his message.

 

The second event occurred when an elderly gentleman (whom I had been

visiting as a volunteer home-health aide) offered me a piece of Kraft

Swiss cheese. Normally, I wouldn't have considered accepting. I did not

eat cheese, much less pasteurized, processed and artificially flavored

cheese. Worse still, I happened to be sick with a head cold that day.

According to my belief system at that time, if I fasted on juice I would

be over the cold in a day. However, if I allowed great lumps of

indigestible dairy products to adhere to my innards I would no doubt

remain sick for a week -- if I did not go on to develop pneumonia.

 

But, Mr. Davis was earnest and persistent in his expression of

gratitude, and would have taken as a personal rebuke my refusal of the

cheese. Shaking with trepidation, I chewed the dread processed product.

 

To my great surprise, it seemed to have a healing effect. My cold

symptoms disappeared within an hour. It was as if my acceptance of his

gratitude healed me.

 

Nonetheless, even after this miracle I could not let go. I actually quit

visiting Davis to avoid further defiling myself. This was a shameful

moment, a sign that I was drowning.

 

The life-ring which finally drew me out was tossed by a Benedictine monk

named Brother David Stendal-Rast. I had met him at a seminar he gave on

the subject of gratitude. Afterwards, I volunteered to drive him home,

for the covert purpose of getting to know him better. (This may be

called " opportunistic volunteerism. " ) On the way to his monastery,

although secretly sick of it, I bragged a bit about my oral

self-discipline, hoping to impress the monk. I thought that he would

respect me for never filling my stomach more than by half, and so on.

David's actions over the subsequent days were a marvelous example of

teaching through action.

 

The drive was long. In the late afternoon, we stopped for lunch at one

of those out of place Chinese restaurants -- the kind that flourish in

small towns where it seems no one of remotely oriental ancestry has ever

lived. As expected, all the waiters were Caucasian, but the food was

unexpectedly good. The sauces were fragrant and tasty, the vegetables

fresh, and the eggrolls crisp. We were both pleasantly surprised.

 

After I had eaten the small portion which sufficed to fill my stomach

halfway, Brother David casually mentioned his belief that it was an

offense against God to leave food uneaten on the table. This was

particularly the case when such a great restaurant had so clearly been

placed in our path as a special grace. David was a slim man and a monk,

so I found it hardly credible that he followed this precept generally.

But he continued to eat so much that I felt good manners, if not actual

spiritual guidance, required me to imitate his example. I filled my

belly for the first time in a year.

 

Then, he upped the ante. " I always think that ice cream goes well with

Chinese food, don't you? " he asked, blandly. Ignoring my incoherent

reply, Brother David directed us to a Friendly's Ice Cream Parlor, and

purchased me a triple scoop cone.

 

David led me on a two mile walk through the unexceptional town as we ate

our ice cream, edifying me with spiritual stories and, in every way,

keeping my mind from dwelling on the offense against Health Food I had

just committed. Later that evening, Brother David ate an immense dinner

in the monastery dining room, all the while urging me to have more of

one dish or another. I understood the point. But what mattered more was

the fact that this man, for whom I had the greatest respect, was giving

me permission to break my Health Food vows. It proved a liberating stroke.

 

Yet, it was more than a month later that I finally decided to make a

decisive break. I was filled with feverish anticipation. Hordes of long

suppressed gluttonous desires, their legitimacy restored, clamored to

receive their due. On the twenty minute drive into town, I planned and

re-planned my junk food menu. Within ten minutes of arriving, I had

eaten three tacos, a medium pizza, and a large milkshake. I brought the

ice cream sandwich and banana split home, for I was too stuffed to

violate my former vows further. My stomach was stretched to my knees.

 

The next morning I felt guilty and defiled. Only the memory of Brother

David kept me from embarking on a five day fast. (I only fasted two

days.) It took me at least two more years to attain the ability to

follow a middle way in eating easily, without rigid calculation or wild

swings.

 

Anyone who has ever suffered from anorexia or bulimia will recognize

classic patterns in this story: the cyclic extremes, the obsession, the

separation from others. These are all symptoms of an eating disorder.

Having experienced them so vividly in myself twenty years ago, I cannot

overlook their presence in others.

 

For this reason, as a practicing alternative physician I often feel

conflicted. I almost always recommend dietary improvements to my

patients. How could I not? A low fat, semi-vegetarian diet is potent

preventive medicine for nearly all major illnesses, and more focused

dietary interventions can often dramatically improve specific health

problems. But I do not feel entirely innocent when I make dietary

suggestions. Like drug therapy, I have come to regard dietary

modification as a treatment with serious potential side effects.

 

Consider Andrea, a patient of mine who once suffered from chronic

asthma. When she first came to see me, she depended on several

medications to stay alive, but with my help she managed to free herself

from all drugs.

 

The method we used involved identifying foods to which Andrea was

sensitive and removing them from the diet. Milk was the first to go,

then wheat, soy and corn. After eliminating those four foods the asthma

symptoms decreased so much Andrea was able to cut out one medication.

But she wasn't satisfied.

 

Diligent effort identified other allergens: eggs, avocado, tomatoes,

barley, rye, chicken, beef, turkey, salmon and tuna. These too Andrea

eliminated, and was soon able to drop another drug entirely. Next went

broccoli, lettuce, apples, buckwheat and trout, and the rest of her

medications.

 

Unfortunately, after about three months of feeling well Andrea began to

discover that there were now other foods to which she was sensitive.

Oranges, peaches, celery and rice didn't suit her, nor potatoes, turkey

or amaranth biscuits. The only foods she could definitely tolerate were

lamb and (strangely) white sugar. Since she couldn't actually live on

those foods alone, Andrea was forced to adopt a complex rotation diet,

alternating grains on a meal by meal basis, with an occasional complete

abstention to allow her to " clear. " She did the same for vegetables,

with somewhat more ease since there was a greater variety to choose from.

 

Last week, Andrea came in for a follow-up visit, and described the

present state of her life to me. Wherever she goes, Andrea carries a

supply of her own particular foods. She doesn't go many places. Most of

the time she stays at home and thinks carefully about what to eat next,

because if she slips up the consequences continue for weeks. The asthma

doesn't come back, but she develops headaches, nausea and strange moods.

She must continuously exert her will against cravings for foods as

licentious as tomatoes and and bread.

 

Andrea is happy with the treatment I've given her, and has referred many

of her friends to see me. Yet, I feel ill when I see her name on my

schedule. The first rule of medicine is " above all, do no harm. " Have I

helped Andrea by freeing her from drugs, only to draw her into the

bondage of diet? My conscience isn't clear.

 

If it was cancer she had been cured of, or multiple sclerosis, I suppose

the development of an obsession wouldn't be too high a price for

physical health. However, all Andrea had was asthma. I have asthma too.

When she took her four medications, she had a life. Now, all she has is

a menu. Andrea might have been better off had she never heard of dietary

medicine.

 

I am generally lifted out of such melancholy reflections by some

substantial success. After Andrea, I saw Bob in follow-up, a man whose

rheumatoid arthritis was thrown into full remission by one simple

intervention: adding foods high in trace minerals to his diet. Before he

met me, he took prednisone, gold shots and high doses of

anti-inflammatories. Now he has gone a full year without a problem.

Seeing him encourages me not to give up entirely on making dietary

recommendations.

 

But my enthusiasm will remain tempered. Like all other medical

interventions -- like all other solutions to difficult problems --

dietary medicine dwells in a grey zone of unclarity and imperfection.

It's neither a simple, ideal treatment, as some of its proponents

believe, nor the complete waste of time conventional medicine has too

long presumed it to be. Diet is an ambiguous and powerful tool, too

unclear and emotionally charged for comfort, too powerful to be ignored.

 

 

 

 

 

[Guest guest]

Great article Steven, I just wanted to thank you and can certainly relate

to orthorexia. For example I have been eating organic hot cerial from

trader joes everyday for breatfast, made mostly from organic oats and

wheat mixed with organic blueberries until the other day I read that oats

and wheat are two of the worste things for you because of the glutin.

For years now I've been saying I'm running out of things to eat. Worse

yet, when I find something I think is good for me I eat it to excess like

the aformentioned hot cerial. When I find out it's not good anymore I feel

like I am worse of than if I had done nothing. In the rhelm of quantum

machanics I also believe that how we think about our reality effects

it and I certainly spend much more time than the average person worrying

about what I consume. Sigh...

D.