Original Orthorexia Essay

This article, published in the October 1997 issue of Yoga Journal, introduced the term “orthorexia.” Some of the things it says about me or what I believe are no longer true of me or of what I believe. Other parts are clearly dated. (“Chronic candida” was a near-universal alternative medicine health concern at the time, and macrobiotics the most popular orthorexic diet, though its diametrical opposite, raw foodism was a close second.) Still, if you have orthorexia, you will most likely recognize something of yourself here.

Cite as: Bratman, Steven.  Health Food Junkie.  Yoga Journal 1997; September/October:42-50.

 

The Health Food Eating Disorder

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. [Note: This was the late 1970s.]  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 such 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. [NOTE: For current readers who have never heard of macrobiotics, the same is true, pretty much, of all East Asian medicine, the grand health system of which acupuncture is a part.]

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 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!”

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 recommendation 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.  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 asian 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. [Note from current me: I am no longer persuaded of the preventive benefits of a low fat, semi-vegetarian diet, and I now feel that focused dietary interventions only help specific health problems in rare situations.]    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 dose 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. [Note from current me: “Bob” didn’t stay cured.]

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 ignore.

91 thoughts on “Original Orthorexia Essay

  1. I have read a lot of research on food hypersensitivities that don’t appear in skin or blood tests.
    Such hypersensitivities often seem to go along with other kinds of allergy problems.
    If Andrea had this kind of food sensitivity, the kind that seems to be some sort of food allergy, it could be that desensitization would eventually enable her to eat the foods without triggering asthma.
    I went through that same kind of “unmasking” process that you describe, with food sensitivities. More appeared over a couple of years, as I gradually recognized which foods I was sensitive to and eliminated them.
    It didn’t go on indefinitely; after awhile, I was pretty much on a stable diet without many new food sensitivities appearing.
    For most foods, eating them only once every 4 days was sufficient to prevent new food sensitivities appearing.
    Not for all foods. I developed a reaction to poppyseeds even though I only ate them once every 4 days. I think this was because poppyseeds are rather allergenic.
    Now, I’m trying to reintroduce foods into my diet (not including gluten grains)
    I eat a few milligrams of the food once every 4 days, after taking oral cromolyn, loratadine and Singulair.
    Over several months, I’ve managed to build up the amounts of these foods that I can eat without having a reaction. I haven’t yet been able to reintroduce any food in normal quantities, though.
    Oral cromolyn might actually prevent new food allergies from appearing (I think it does in rats/mice). I buy it relatively cheaply as a powder from a compounding pharmacy, and dissolve it in water. The brand-name version, Gastrocrom, is prohibitively expensive.
    SO, it is not necessarily a choice between “take drugs to prevent asthma” or “live on an imprisoning diet”.
    What I would suggest for someone like Andrea is, instead of quitting the food entirely, eat a tiny amount once every 4 days – the max amount that doesn’t provoke a noticeable reaction. Taking cromolyn beforehand might help with this. Over time, build up these tiny amounts and hopefully in time, she would have trained her body out of the allergies.
    I’ve read several times that various alternative practitioners have concluded over time that avoiding more and more foods is a kind of trap. What I suggest may work better than that.
    The other thing is, I suspect from reading research that getting allergy shots might help over several years with food hypersensitivities.
    You didn’t mention whether Andrea had inhalant allergies diagnosed in skin or blood tests, that might contribute to her asthma.
    But if so, getting allergy shots for those allergies might, over several years, train her body away from Th2 immunity.
    From reading research, I suspect that would help with food hypersensitivities also.
    One can also have inhalant allergies that don’t appear on skin or blood tests, that’s called “local allergic rhinitis”.
    And allergy shots also seem to work for local allergic rhinitis.
    I can provide you with citations if you’re interested.

  2. Hi Steven,
    I’m about halfway through your Health Food Junkies book and it’s really speaking to me volumes. I really appreciate that you pick apart some of the most extreme food theories and expose the dangers of them. I got caught up in some of those theories myself in the last 7 years and it’s done me nothing but harm.

    I was wondering what your opinion is of the no-fat added vegan diets that are prevalent in the vegan community. Some call them whole-foods plant-based (WFPB) diets. I’m talking about the diets that are advocated by doctors such as John McDougall (The Starch Solution), Neal Barnard (Breaking The Food Seduction and Reversing Diabetes), Caldwell Esselstyn (Prevent And Reverse Heart Disease), T. Colin Campbell (The China Study), and, in a slightly different way, Joel Furhman (Eat To Live). These doctors advocate a plant-based diet that includes no added fats (including oils, avocados, nuts/seeds and olives) or what is deemed as higher fat foods (like soy products). These doctors rave about the disease-proof qualities of their diets and they have some pretty convincing scientific studies to show this.

    You talk about some of the more well-known extreme diets in the vegan community, such as raw food and macrobiotic, so I was just wondering what your thoughts are on the no-fat whole foods plant based diet.

    Tam

    1. I eat a lowfat whole-foods (pretty much) vegan diet. I love it. I eat a lot and don’t gain weight; I have plenty of energy, ideal blood pressure, etc. Vegetables are great food, and I had a dislike of flesh foods anyway.
      But
      – Such a diet should probably include a source of omega-3’s
      – The proponents oversell it as a cure for almost anything.
      For your average American eating the Standard American Diet, it would be a big improvement, if they’re sure to take B12 etc.
      However, I first was attracted to the lowfat vegan diet in my search for health; but it did nothing to solve my health problems.
      I have allergy and autoimmune problems (Hashimoto’s and probably celiac disease). I think I’m finally doing good things for my health, but lowfat and vegan had nothing to do with it.
      I don’t like the dogmatic mentality of some of the promoters and adherents to this diet.

    2. I am thoroughly, profoundly, intensely unimpressed with the so-called “science” behind these diets! However, that is another subject.

      There is nothing *inherently* wrong with such a diet. The problem is that for many people it is impossible to follow it without becoming overly caught up on an emotional level. Food is powerful. It taps into loneliness, inner hurt, the interior emptiness we all struggle with. When a diet takes great effort to follow, especially when it involves so much self-deprivation as this one, the very effort can trigger some dark places. The mind and heart can get tied up with food in very intricate knots, turning the search for health into something seriously unhealthy. That would be my concern.

  3. my daughter has orthorexia – I have noticed that a majority of the comments do not include exercising to extremes as well as the “pure” food problem – has anyone had success with overcoming this – she was nearly committed to the backwards eating disorder clinic in NZ but they were going to force her to eat animal products which she is morally opposed to – I discharged her against medical advice with pitying looks from the staff. I have managed for 3 days to stop her exercising and she has upped her calorie intake but I believe she will go back to her old ways. She is a very sick girl and I have taken on but i could use some advice.

    1. It’s a very challenging problem. Basically, you need an eating disorders specialist who either knows about orthorexia, or has the imagination to creatively understand it. Sounds like that particular clinic failed to really listen to your daughter.

  4. Beautiful piece. I used to have orthorexia and have come out of it: it’s good to realize that nutritional medicine isn’t completely hopeless, because it can improve people’s health. When it HURTS your health it’s a problem, otherwise I don’t see how it would be a problem. Dr. B you are a role model to me as a future naturopathic physician!

  5. I was recommended this web site by my cousin. I’m not sure whether this post is written by him as nobody
    else know such detailed about my difficulty. You’re incredible!
    Thanks!

  6. Hello and thank-you for this article and your website. I came across it yesterday as I searched for “mild cases of anorexia”. I wondered if perhaps I was on some scale anorexic, but as I read the descriptions about weight obsession, it didn’t make sense. However, everything I’ve read about orthorexia has made sense to me. Most disturbing I think is the sense of superiority that orthorexics can feel over others. I’ve noticed this in myself before. I am now confident to move ahead to get some external help in this issue. Thanks so much!

  7. thank you so much for sharing this experience. i am very certain that i suffer from orthorexia. most of the time i feel sick, uncomfortable and even have anemia and heat palpitations as a result. the strange thing is that despite my desire to change this obsession and live a truly healthy balanced life in which i nourish my self and care for my body (not hurt and starve it) for some reason i have a deep emotional attachment to these damaging behaviours. it’s like spending time with a friend when i walk around the health food store reading labels, or sit alone in a cafe reading nutritional literature, or spend hours at home making spouts and kimchi when others are out with friends having a drink or seeing a movie. i don’t know how to let go and achieve balance….and most importantly end this incessant sick feeling in my guts and take care of myself fully. i went to my doctor for help, hoping i could get a referral for counselling or therapy and he told me “there is nothing for me if i don’t have insurance” and that i should just take anti-anxiety drugs. this further adds to my stress, anxiety, worry and saddness and i just need some help healing the source of the problem so i can be done with it and move on in my life.

    1. Dear Andrea,

      I am sorry your doctor was so stupid. Go to a new doctor. I have a friend with orthorexia who will not seek help for the disorder, so you are way ahead of the game. Antidepressant drugs will help a great deal. Be persistent. You are worth it and can make a huge difference by your actions and seeking help.

  8. In my oppinion people need to stop worrying about what they eat or how much they eat Afterall everyone s going to die one way or the other stop worrying if you want a quarter pounder go eat one and dont have any second thoughts our lives are to short to worry and even if you do get a year or two more in your life, its not about living a hundred years its about doing something good that the world will remember for a hundred years. Whats the use living a hundred years worrying about what you are going to eat when youre worthless

  9. I am grateful for stumbling on to your Web site. As a licensed acupuncturist in California, with my own set of health challenges, and various dietary health obsessions that I am trying to free myself from, I am certain that I will find much to reflect on here!

  10. – It would be more holistic to take time to understand the whole person before making dietary recommendations –

    You said it yourself, so why continue judging peoples choices?
    Peace bro

  11. Thank you for writing this. I suffer from Anorexia and Bulimia. When I’m doing well with my recovery from those, I find myself replacing them with Orthorexia. This article helped me see that I’m merely replacing one set of eating disorders with another. Now that I can recognize that, perhaps I can find a healthy, happy medium in which (despite being a life-long vegetarian) I can eat in a more moderate mentally healthy way.

  12. Extremely refreshing perspective, Dr. Bratman! I have at least one patient who fits this description. Thanks for your personal candor and humility in describing this phenomenon.
    Barbara Quinn, MS, RD, CDE
    Community Hospital of the Monterey Peninsula
    Monterey, CA

  13. Hi Steven. Tried to sent this to holisticharry@live.com but it bounced

    I am an ex-pharmacist-turned-natural-therapies-practitioner and have been “on the fringe” for the past 5 decades. Yes, I am an “old bloke” who isn’t really that “old”

    I was born in South Africa and have been living in Sydney Australia for the past 30+ years.

    A bit about me on http://www.rogerlprice.com

    I now spend my days looking after the detritus of the medical industry, the walking consequences of iatrogenesis, the failures of “4 on the floor” extraction orthodontics and generally people who have tried everything and all has failed.

    My practice is based on the premise that apart from the 4 groups of communicable diseases (viruses, bacteria, parasites and fungal infections) people are not well because of what they DO, and unless the change what they DO they will remain sick – on the slippery slope to an uncomfortable and untimely death.

    We use the principle of differential diagnosis and multi modality treatment and my area focuses on posture and breathing.

    I reckon that if someone is breathing around 30,000 times a day and either sitting, standing or walking for 2/3 of their lives, it might be an idea to learn how to do these things functionally.

    I use a variety of techniques, biofeedback monitoring, counselling, nutritional advice and work with body mechanics, dentists, orthodontists and other allied professionals so that we can offer a well rounded solution.

    We tend to focus on the outcome rather than the income and find that the results speak for themselves.

    Once again,

    Thanks for the read. I enjoyed it immensely.

    Yours in good health.

    Roger Price
    Consultant Respiratory Physiologist
    Edgecliff Respiratory and Sleep Apnoea Centre
    Sydney
    Australia.

    http://www.edgecliffrespiratory.com.au

  14. I very much appreciate your article…I liked the range of diametrically opposed food-beliefs presented.

    My wife Amy was diagnosed with terminal cancer in 1994 and (pre-Internet) most of what we found about healing cancer said to avoid wheat and drink organic juice and eat lots of organic vegetables and avoid milk and meat…This was our baseline before she was diagnosed.

    I was a vegan for a while and did a 30-day juice and Spirulina-algae fast with daily enemas once upon a time, in my youth.

    After Amy’s death, I remember getting into making waffles with Millet flour and no eggs or milk…(I got a big 10 or 25 pound bag of millet flour through our local food co-op)

    I made brown rice sushi and ordered brown rice at our local Thai restaurant

    I remarried some years later and started Falling off the wagon
    I started focusing on flavor for my kids – Cream Scones and waffles tasted better with wheat (or white spelt) flour and buttermilk or cream rather than water as the liquid.

    Sushi and Thai food tasted better with white rice

    I read your article above from 1997 that was reprinted in the UTNE Reader
    http://chetday.com/healthfoodjunkie.html

    I remember telling a friend about this piece in Utne when she asked me about the perfect diet and I told her that each person/expert had their own perspective and the more I learned the more, I learned that there was no one right way to eat for everyone.

    Some of the contrasting viewpoint I remember facing myself were.

    Macrobiotic- Cook everything (even blanch/boil salad leaves) vs. Eat only raw live food full of enzymes destroyed by cooking.

    Macrobiotic – no flour because the energy is of breaking the grain up and mixing is disorganized compared to whole grains

    Macrobiotic eat not animal products- Ayurveda consume milk and ghee (clarified butter) and honey

    Macrobiotic – No cooking with electricity

    Macrobiotic – No cooking with microwaves

    Macrobiotic – Eat only foods available in your region during the right season- No apples from New Zealand or Washington. No fruits or Veggies from South America

    Sprouts are good vs. Sprouts inhibit digestion

    Fermented foods good vs. fermented foods are rotten eat only raw foods

    I was a Food-Combining adherent for a long time which prescribed specific ways to eat food combinations (no cooked tomatoes, no tomatoes with grains, no protein with grains or fruit or sweets) vs. Eat protein with every meal and combine with whole grains.

    Now just turned 50 am I am still mostly organic vegetarian, with an occasional bite of meat to see what I am missing. I tend to eat fewer vegetables than ideal and exercise less than would be good for my health and my current Body Mass Index (BMI) is 25 which means I need to loose 25 pounds to be in the ideal range.

    I am now more flexible rather than ossified and instead of rigor I tend to choose ease and flavor… I still have in my mind that homemade whole foods (preferably organic) made with love are best of all.

  15. You need to meet Vicki Talmage.com She has been vegan for 30+ years and a 95% raw foodist (she does recomend cooked beets during a cleanse) for 20+ yrs. She is healthy, vibrant and energetic. One key – dark leafy green salads – lots of them. Another key – get rid of parasites – she’s very good at getting results.

  16. Dear Mr. Bratman,
    I`m a student of nutrion science in Vienna/Austria, and I`m currently writing my degree dissertation about eating disorders in particular othorexia. Among other things I want to find out if students of nutrion science suffer more often from orthorexia than other students. For that reason I would like to use your questionnaire, therefore I´m kindly ask you for permission to use it.

    Kind regards, Ursula Nowak

  17. ps Do you routinely test your patients for celiac disease? It’s extremely underdiagnosed. About 1% of people have it, but it used to be diagnosed only in 1/4500.
    It’s quite common for celiacs to have other food sensitivities. These go away after a while on a gluten-free diet. I was told it takes 5-10 years.
    So I think maybe a lot of people who have food sensitivities are gluten intolerant, maybe that’s the root cause of their sensitivities. Maybe if they just stay gluten free, they can stop worrying about other foods after a few years.

  18. Just because this Andrea person found a lot of food sensitivities that made her life difficult doesn’t mean it was wrong to quit the foods.
    Maybe in the future there will be better treatment for food sensitivities. There’s a protein called zonulin that increases intestinal permeability, which might lead to food sensitivities. Zonulin is apparently associated with autoimmune tendencies. There is a zonulin blocker drug, AT-1001, being developed by Alba.
    Her story is very familiar to me. I probably have celiac disease, and really severe reactions to many foods – groggy stupor that comes on in hours after eating the food and lasts about 4 days, joint pains, depression, rage, tension, paranoia, anxiety, frequent urination, itching, sometimes a lot of back pain. But things were SO much better after I eliminated the foods! Things it would have been horribly masochistic to live with just for the sake of being sociable. Like, my knee used to hurt for a long time if I ran a lot; after I eliminated foods I’d gotten sick from, I could run every day without pain. I have arthritis in that knee now and I wonder if it was partly caused by chronic inflammation from eating foods I was sensitive to.
    I don’t think it has to get in the way of sociability. I take food with me when I go places. When I join people at restaurants, I eat beforehand and just talk. I have enough foods I can still eat, that I can have a nutritious diet. My food reactions after 7 years of being gluten-free are much less severe, and maybe they’ll eventually fade away completely. I plan to stay gluten and probably dairy free the rest of my life, but hopefully I can eventually start eating the other foods again. My inhalant allergies have gone from 54 a few years ago to 3 on my last allergy test, so hopefully my immune system is cooling down.
    So I can sympathize with becoming over-involved with food. But that’s a separate issue from having physical and psychological problems because of hidden food sensitivities.

    1. An update for me:
      I found out that my food sensitivities didn’t fade away with avoiding the foods.
      So recently, I’ve been reintroducing some of the foods I have these delayed-reaction allergies to, in tiny quantities – 10-20 mg or so, so I don’t get too sick. I take allergy meds before doing this: cromolyn, loratadine, Singulair to reduce the reaction.
      My food reactions fade somewhat after a few months of doing this, but I haven’t been able to reintroduce any foods in normal quantities yet.
      I think it might be better for my immune system over time, to learn to cope with food allergens, rather than avoiding them.

  19. Hi!

    I loved this article.

    And of course I want to join a forum about it to discuss the phenomenon, exchange experiences, compare and contrast paths, get and give support/advice, learn from others, laugh about it, the same way I’ve joined forums about gluten-free and beyond ( eg. dairy, corn, soya, sugar etc ), VLC-Zero carbohydrate diets, Carnivore, Paleo and Raw Paleo, Fructose-free and other diets, and would have done for macrobiotics and vegetarianism and high-fruit and … and … and … in the past if the internet had been around then.

    Is there a forum about orthorexia somewhere?

    Had to laugh at your descriptions of the different and conflicting diets, at the minuteness of the rules, and grimaced with unease at the description of Valerie.

    Interesting how a certain subset of the “healthy eaters” are offended by the concept of orthorexia, as if they *do* identify with their perfect exquisitely natural diet like some people identify with the interior decoration of their house, the perfect “lamp” etc ( I read and enjoyed the article on “beyondveg.com” called “Do you identify with your lunch?” a year or more ago, without feeling concerned though! :lol ). I realise that some people do eat organic/wholesome/unprocessed, semi-veggie, seasonal, local, etc and still “have lives”, but I somehow don’t think that they are the ones getting upset about your “label”.

    I got into all this because I discovered ( 18 years ago now ) that a g-f diet cured my mood-disorder/depression and hypomania, and have tried many combinations of food, exclusions and inclusions, ( aswell as totally throwing in the towel on many occasions ), in my search for the “best me”, and only very recently begun to wonder if what I do is avoid those foods whose chemical effects on my mood, etc make it difficult for me to accept, tolerate and enjoy my current lifestyle, … and that the times when I cut out the most foods have been, ARE, those times when I am finding it very difficult to tolerate let alone enjoy, my life.

    I totally agree that I get a sense of purpose out of this; it is a “project”. And I have been obnoxiously evangelical about it, superior, etc, paranoid about contamination, etc, isolationist in order to maintain it, etc and also grown out of that, but I have become increasingly rigid about certain things, and have always been anxious about getting it wrong/right, … and the “project” never ends … I have begun to think, just recently, even before I read your article, ( which a friend with the same sort of issue sent me ), that there is something a little pathological about my attention to it.

    Would love to know if there is somewhere affiliated with this site or the book ( online ) where people can/could talk about this, because it is dawning on me that I have gradually reified food, ascribed agency to it, concentrated on what it *does*, while ignoring or denying what my eating habits/patterns *say* ( about my life, etc ), as an “effect” caused by “non-food” things, and I am interested in working out why I do it, and how to stop it dominating, if not exactly “ruling, my life.

    Thank you for the brilliant description and comment.

    Olivia

  20. Excellent article.
    You say you dont believe everything in it now – what are your main targets today?
    I have recently persuaded my family to be almost Vegan. We have an amazing array of vegetables for meals plus meat just once a week and fish once a week. Avoiding dairy apart from a Friday morning bagel with philly.
    Like Jojo Bizarro above….Giving up cheese is the hardest thing!

  21. Hello Steven,

    thank you, that is reassuring to hear – even though my BMI anyway suggests that I am nowhere near the peril of starving!

    Best regards,
    Andy

  22. If you’re a vegan for moral reasons, there is no way in the world that’s orthorexia! Even without the moral motivation, I don’t think I’ve ever met an orthorexic whose sole dietary restriction was veganism/vegetarianism. I have met a few vegetarians who weren’t careful to eat a balanced diet (“french fry vegetarians,” mostly) and a great many more vegans with the same problem (mostly due to ideological issues about B12 and the like), but in none of these cases would I even think of applying the term “orthorexia.’

    FYI: “orthorexia nervosa” is not currently a diagnosis, nor do I have any personal interest in making it one. It’s a description.

    1. I used to be a french fry vegan myself, not touching meat (fish included), dairy or eggs, for health reasons but eating anything and everything else that didn’t have any of these things in them … to the best of my knowledge. I read Harvey Diamond’s Fit For Life book before 1989, when I became a vegan at age 21. (Yes, I still drank beer. ^_^) After 19 years of veganism, I wasn’t feeling any healthier, and I was a tub of lard due to lack of exercise. Finally, one fine night back in 2007, when I was living in Japan, I went to the store and bought me a few cans of tuna. Yum!

      Gone are the days of me obsessively reading ingredient labels to make sure they didn’t have “poison” in them. Now, I live in Turkey, where döner kepabs are ubiquitous, and I feel free to eat good stuff knowing I’m no longer chained to this notion of meat, milk or eggs being “dirty.”

      P.S.: I really missed cheese!!!!

  23. Hello Steven,

    having been a vegetarian for 20 years and a vegan for one year, I would be quite interested to hear whether you would include vegetarianism / veganism as indicators of orthorexia nervosa (or whether there are different clinical terms for those conditions).

    I certainly abstain from many foodstuffs that I could eat, solely because of my personal belief that I want to avoid causing harm to animals (which has nothing to do with my own health or nutrition), it sometimes isolates me from sharing social meals with friends (being the only one eating grilled vegetables at a barbecue come to mind), I would definitely have a very bad conscience if I lapsed and ate a burger, and I sometimes still do crave a nice piece of Cheddar cheese or a milk cappuccino instead one of the soymilk variety (but still will not have it as I do not like what dairy farming does to the animals).

    However, I do not spend the whole day thinking about food, nor do I have revelations of sprouts (yet).

    What would be your diagnosis? I am really interested.

    Best regards,
    Andy

  24. As a traditional allopathic physician I have long felt that some of my patients who restrict their diets for their health had crossed into an unhealthy state of excessive control and malnutrition. They seemed like a sub type of anorexics. Recently I heard from one of theses patients that her son had been diagnosed with orthorexia and was near death. I had never heard this word before and was curious. Googling it brought me to this website and this essay. You have made a tremendous contribution by bringing this idea to the fore from your position in alternative medicine. I can’t say these things nearly as convincingly as you because my criticism would just seem like distrust of alternative medicine. Now perhaps it is time for me to publish on a condition I know well and have contributed to more than once: compulsive polypharmacy! We should all be so honest with ourselves about the harm we can cause with our most tightly held beliefs and practices. Bravo!

  25. Wow. When I first heard of orthorexia last year, I realized that I had gone through it myself. I’m now in a place where I feel able to eat just about anything, though I choose healthy, home-cooked foods most of the time because I like them. I do not feel deprived. As a food therapist and health counselor, I still struggle to keep my diet suggestions simple: add in whole, organic, fresh foods (you’ll find that they quickly and effortlessly start to replace some of the “bad” food in your diet without having to use willpower), and focus on the other areas of your life (career, relationships, spirituality) where you are starving and need non-food sustenance.

    Food is a powerful substance–as powerful as any drug or spiritual experience. Orthorexics suffer, I believe, from the same thing as fast-food addicts, overeaters, and anyone who puts their focus on the tangible: lack of purpose. We all need purpose in our lives: and purpose is found in our careers, relationships, and spiritual disciplines. We need exercise that isn’t only for the sake of effort or weight loss, but also for clearing our heads, enjoying our bodies and what they can do, and celebrating nature. When we are unhappy or focused too much on any one of these areas, we become imbalanced, and what we eat is almost always affected.

  26. Absolutely wonderful!
    Thank you!
    I feel there is yet another classification:
    orthorexia paranoia

    For over 30 years I’ve been controlling severe migraines, mood swings, asthma, muscular and joint pains with my diet. With the alternative being blinding, crippling pain and unpleasant, unsociable outbursts, the choice was easy enough to make. I am obsessive and somewhat gratified to find that – while it takes three to five years – eventually society seems to catch up to meeting my limitations.
    Then I develop another round of new allergies, need to move foods from the “can” section of the list to the “can’t”.

    Occasionally I wonder how sick I’d actually get if I just broke down and had that pizza and the fries, a taco and some peanut M&M’s, a hotdog, a pretzel, strawberry ice cream, some fresh mango, a sushi roll, some tempura and all the sauces, a BLT with mayo and a glass of orange juice or a cola…
    And I don’t try to find out.
    I drink a glass of warm filtered water and try to work up an interest in the stuff still on the “can” side of the list.
    And you’re right – this life style totally trashes a social life – unless I’m cooking, I can count on eating alone.

  27. Hi Steven, very much enjoyed this article but would so like to know where you stand today, 13 years after writing this. Enthusiasm still tempered? What’s no longer true? Were are you today?
    Thanks!

  28. Thank you for this wonderful article. As an herbalist and alternative healer, it has really bothered me how people become addicted to dietary “isms” that practically become a religion to them. I think people eat too much from their head and don’t pay enough attention to their bodies, that is, how food makes them feel.

    I find there is no “perfect” diet. I do think people are wise to stay away from refined and processed foods in general, but I doubt that indulging in the occasional treat does them any serious harm. Different people have different allergens, so the fact that a particular food doesn’t suit me well doesn’t mean it’s universally “bad.”

    Furthermore, our dietary needs change throughout our life. They change with the seasons of the year and the life stresses we are under. They change with the aging process, too.

    Again, thank you for pointing out this “side effect” of trying to teach people to eat healthier.

  29. Very interesting journey! Thank you for sharing. You might try adding NAET to your alternative bag of tricks. I find it much easier to eliminate things that I am sensitive to for 25 hours rather than a lifetime and it works. In fact, it works quite well. I’d be happy to put you in touch with my practitioner.

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