[When a healthful eating pattern goes too far, it may turn into an
eating disorder that scientists are just beginning to study.]
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PORTSIDE CULTURE

WHEN EFFORTS TO EAT 'CLEAN' BECOME AN UNHEALTHY OBSESSION  
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April Fulton
October 7, 2019
NPR/The Salt
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_ When a healthful eating pattern goes too far, it may turn into an
eating disorder that scientists are just beginning to study. _

Orthorexia occurs when people become so fixated on the idea of eating
"cleanly," or choosing only whole foods in their natural state, that
they end up imperiling their physical and mental health. Sometimes
this means missing critical nutrients or not gett, Meredith Rizzo/NPR

 

Whether it's gluten-free, dairy-free, raw food, or all-organic, many
people these days are committed to so-called "clean eating" — the
idea that choosing only whole foods in their natural state and
avoiding processed ones can improve health.

It's not necessarily a bad thing to eat this way, but sometimes these
kinds of food preferences can begin to take over people's lives,
making them fear social events where they won't be able to find the
"right" foods. When a healthful eating pattern goes too far, it may
turn into an eating disorder that scientists are just beginning to
study.

Alex Everakes, 25, is a public relations account executive from
Chicago. As a kid, he struggled with being overweight. In his teens
and 20s, he tried to diet, and he gained and lost and regained about
100 pounds.

When he moved to Los Angeles after college, he took his diet to a new
level. He started working out twice a day. At one point, he ate just
10 foods — "Spinach, chicken, egg whites, red peppers — because
green peppers make you bloated — spaghetti squash, asparagus,
salmon, berries, unsweetened almond milk, almond butter," Everakes
says.

 He went from 250 pounds at his heaviest, down to 140. He posted
pictures of his six-pack abs and his "clean" diet online and was
praised for it. He felt virtuous, but at the same time, he was
starving, tired and lonely.

"My life literally was modeled to put myself away from destruction of
my fitness," Everakes says.

He became afraid to eat certain foods. He worked at home to avoid
office parties where he'd have to eat in front of others. He didn't go
out or make friends because he didn't want to have to explain his
diet.

It turns out Everakes was struggling with something called orthorexia
nervosa.

Orthorexia is a fairly recent phenomenon. Dr. Steven Bratman, an
alternative medicine practitioner in the 1990s, first coined the term
in an essay in the nonscientific Yoga Journal in 1997. Many of his
patients eschewed traditional medicine and believed that the key to
good health was simply eating the "right" foods. Some of them would
ask him what foods they should cut out.

 "People would think they should cut out all dairy and they should
cut out all lentils, all wheat ... And it dawned on me gradually that
many of these patients, their primary problem was that they were ...
far too strict with themselves," he says.

So Bratman made up the name orthorexia, borrowing ortho from the Greek
word meaning "right" and -orexia meaning "appetite." He added nervosa
as a reference to anorexia nervosa, the well-known eating disorder
which causes people to starve themselves to be thin.

"From then on, whenever a patient would ask me what food to cut out, I
would say, 'We need to work on your orthorexia.' This would often make
them laugh and let them loosen up, and sometimes it helped people move
from extremism to moderation," he recalls.

Bratman had no idea that the concept of "clean eating" would explode
over the next two decades.

Where dieters once gobbled down no-sugar gelatin or fat-free shakes,
now they might seek out organic kale and wild salmon.

 The rise of celebrity diet gurus and glamorous food photos on social
media reinforce the idea that eating only certain foods and avoiding
others is a virtue — practically a religion.

Sondra Kronberg, founder and executive director of the Eating Disorder
Treatment Collaborative outside New York City, has seen a lot of diet
trends over the past 40 years.

"So orthorexia is a reflection on a larger scale of the cultural
perspective on 'eating cleanly,' eating ... healthfully, avoiding
toxins — including foods that might have some 'super power,' " she
says.

Now, Kronberg and other nutritionists applaud efforts to eat
healthfully. The problem comes, she says, when you are so focused on
your diet that "it begins to infringe on the quality of your life —
your ability to be spontaneous and engage." That's when you should
start to worry about an eating disorder, she says.

"In the case of orthorexia, it centers around eating 'cleanly' and
purely, where the other eating disorders center around size and weight
and a drive for thinness," she says.

Sometimes these problems overlap, and some people who only eat "clean"
foods miss critical nutrients from the foods they cut out or don't
consume enough calories. "It could become a health hazard and
ultimately, it can be fatal," Kronberg says.

 While people with these symptoms are showing up in clinics like
Kronberg's, scientists don't agree on what orthorexia is.

Dr. S.E. Specter, a psychiatrist and nutrition scientist based in
Beverly Hills who specializes in eating disorders, notes that there
are only 145 published scientific articles on orthorexia. "For
anorexia nervosa, there are 16,064 published studies and for eating
disorders in general, there are 41,258. So [orthorexia] doesn't stack
up in terms of the knowledge base so far," he says.

A 2018 review of orthorexia studies published in the journal Eating
and Weight Disorders finds no common definition, standard diagnostic
criteria, or reliable ways to measure orthorexia's psychological
impact.

Orthorexia is not listed specifically in the DSM — the Diagnostic
and Statistical Manual of Mental Disorders — but that doesn't mean
it's untreatable.

"I just think orthorexia is maybe a little bit too hard to pin down,
or it's looked at as a piece of the other related disorders — the
eating disorders, obsessive compulsive disorder, and general anxiety
disorder as well," Specter says.

To treat it, "we have to look at the thought process and try to
disentangle the beliefs that a person has. They become very
entrenched," he says.

"It's a very kind of gradual process for ... many in terms of trying
to back out of a need to always check to see that, you know, locks are
locked or that a food is not going to be harmful to them — cause
their skin to break out or increase their risk of cancer," he says.

Alex Everakes has been in treatment for two years. While he's still
significantly underweight, he says he's happier and learning to see
his diet a little differently.

 Everakes eats more freely on the weekends now and tries to add a new
food every few days. He's made some friends who don't restrict their
eating.

For Everakes, taking control of his orthorexia is "knowing that your
world isn't going to come crashing down if you have like, a piece of
pizza."

He's managed this by taking baby steps. Instead of going right for a
slice of standard pizza, he started with cauliflower crust pizza. He
ordered frozen yogurt before going for full-fat ice cream.

Eating disorders can strike anyone. Roughly 1 in 3 people struggling
with eating disorders is male, according to the National Eating
Disorders Association. And these disorders affect athletes at a higher
rate than the rest of the population.

If you think you have orthorexia or any eating disorder, it's
important to seek professional help and friends who support you,
Everakes says.

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