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When does “clean eating” become disordered?

Well+Good logo Well+Good 07/03/2018
a man holding a plate of food on a table: When does clean eating become disordered © Photo: Stocksy/Clique Images When does clean eating become disordered

As Jordan Younger, AKA The Balanced Blonde once said, "No one plans to develop an eating disorder." And yet, she did. Younger has publicly discussed (and even written a book about) her struggles with a sneaky form of disordered eating sometimes referred to as orthorexia.

This term was coined in the late 1990s by Steven Bratman, MD, to describe those experiencing "an unhealthy obsession with eating healthy food." Though not everyone agrees on the label—and it's not currently listed in the Diagnostic and Statistical Manual of Mental Disorders, the assessment criteria used by psychiatrists—a 2011 survey showed that two-thirds of respondents (made up of psychologists, psychiatrists, nurses, and social workers) reported working with patients who presented with "clinically significant orthorexia."

"Orthorexia often starts out as an innocent attempt to eat more healthfully, but can take a turn to a fixation on food quality and purity." —Neeru Bakshi, MD

Neeru Bakshi, MD, medical director of the Eating Recovery Center in Washington, describes how well-intentioned mindful eating can go off the rails. "Orthorexia often starts out as an innocent attempt to eat more healthfully, but can take a turn to a fixation on food quality and purity," she explains. "This then develops into a rigid eating style, which can crowd out other activities, interests, and relationships, and can cause health issues."

As you might imagine, it can be difficult to distinguish between a commitment to healthy eating and this pathological condition. The latter is characterized by rigid dietary restrictions and ritualized eating—but couldn't those same words be used to explain your weekly meal prep or dairy-free life? So, what are the specific signs that identify orthorexia? Below, Dr. Bakshi and other experts weigh in on warnings.

You attempt to control *everything* about the foods you eat

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For starters, Food Coach NYC Founder Dana James says, disordered eaters will need to exercise complete control over their diets. “There’s an extraordinary amount of fear [for them] to eat something that is outside of their healthy eating program, whereas a healthy eater is okay with that,” she explains. So while a healthy eater may be willing to eat non-organic veggies if that's the only option, for example, someone who struggles with orthorexia might choose to not eat at all in this scenario—even if they're very hungry.

According to Dr. Bakshi, this behavior (one Younger documents in her book), can lead to social isolation, e.g. not being able to eat out at a restaurant or even a friend's house. For some who struggle with this disorder, Dr. Bakshi says, an "irrational concern over food preparation techniques, especially the washing of food or sterilization of utensils," may also become an issue.

Food dominates your thoughts (and it stresses you out)

a plate of food on a table: When does clean eating become disordered © Photo: Stocksy/ Darren Muir When does clean eating become disordered

James further notes that a person who is disordered in their relationship to food will have diet-oriented thoughts most of the time. “When you trust the way you eat, you don’t think about it,” she offers by way of contrast.

And these generally aversive musings, she says, are often distorted, too. “‘Healthy’ is actually knowing that your body can handle things like a little bit of sugar,” she explains. In other words, an orthorexic is likely to spiral after eating something they deem to be unhealthy, whereas a healthy eater is more likely to trust that their body is resilient.

Women's health expert Aimee Raupp adds that checking in with your emotional state—e.g. "Does eating give me anxiety? When? Why?"—can help you to gauge whether or not you have an issue. “If [eating something outside of your specific dietary program] is affecting your mood, then for certain there’s a bit of a disorder there,” she says.

Younger builds on this, adding what she's gleaned from her own experience. "I always tell people, when their thoughts about food start to become negative or obsessive in any way, their passion for healthy eating may be taking a swing toward the unhealthy side," she says. She keeps herself in check by asking questions such as, Does my relationship with food make me happy? and Does my food energize and fuel me? Are my thoughts about food positive, balanced, and joyful? "If the answers to any of those questions are a no, I do the internal work to ask myself what I am really trying to control or compensate for with food," Younger explains. "If the answers are a yes, then I know I am in the right place!"

You've excessively eliminated certain foods, even though you're not allergic

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Frequent or excessive elimination of new food groups is another sign of orthorexia that Dr. Bakshi, Raupp, and James all point to. One day you're a vegetarian, then a vegan, then a raw vegan, then a Paleo raw vegan, and so on, until there's almost nothing left to eat. In fact, an ever-narrowing list of acceptable foods is one of the top signs of the disorder as listed by the Eating Recovery Center.

While James does note that sometimes, elimination diets are necessary in order to remedy a health crisis, she'll see patients who have adopted an incredibly restrictive diet prescribed for these purposes as their everyday, forever diet. This, she says, can sometimes become a disordered state. Dr. Bakshi also notes that the elimination of foods for allergy-related reasons without medical input is considered to be a sign of the disorder; however, it's worth noting that avoiding something because it doesn't make you feel good is fine so long as the list of foods avoided doesn't become, say, longer than the list of foods you still allow yourself to eat.

The potential health risks of certain foods terrifies you

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One day, you're terrified of tomatoes because some new study says they cause heartburn. The next day, it's sushi (mercury!). The following, it's legumes. Dr. Bakshi considers this pattern of behavior a stop sign. "Obsessive concern over the relationship between food choices and health concerns such as asthma, digestive problems, low mood, anxiety, or allergies [is another potential warning sign]," she says.

The key in this phrase is "obsessive"—there's nothing wrong with evaluating the health effects of specific foods, to be clear. It's only when these thoughts form repetitious loops, become irrational, or affect your quality of life that they point to an issue.

The Food Therapist author Shira Lenchewski, RD, points out that it's easy for people to become overwhelmed by the sheer volume of health information available today, and that this may cause some to go to unhealthy extremes in their diet curation. "There are so many scare tactics out there," Lenchewski says. "Some of it is based on science, but [people will] pull out one piece of information, take a hardline approach, and then feel like total failures if they’re not implementing it," she says.

Your supplement regimen has gotten a lot more intense

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Perhaps surprisingly, Dr. Bakshi notes that a "noticeable increase in consumption of supplements, herbal remedies, or probiotics," is also considered to be a sign of orthorexia. However, as mentioned above, it's important to note that what she's referring to is a significant increase in the number of supplements taken as well as an uptick in the obsessive thoughts that feed into drastic behavioral changes such as these. So no, adding a turmeric capsule to your routine doesn't mean you have an eating disorder, but relying on supplements alone for the nutrients you need may be a sign it's time to talk to your doc.

You have a superiority complex about your diet

All four experts agree that orthorexia can be tricky to both self-identify and treat in others, for one specific reason: Orthorexics, they say, tend to feel convinced that their way of eating is correct or even superior to other diets. "People who do this truly believe they're doing the right thing, they really do," says James. "That's where the psychology has gone haywire." To gauge whether or not your own mindset might signify an issue, Dr. Bakshi asks, "Have you put yourself on a nutritional pedestal and wonder how others can possibly eat the foods they eat?"

When trying to help someone else who exhibits this sign—or any others on this list—James suggests approaching them with compassion, from a non-judgmental place. "You might say, 'I noticed that there seems to be some fear around eating food that isn’t within your current diet philosophy. Do you want to talk about it?'" she suggests. She doesn't, however, advise use of the label in these discussions (she doesn't use it in her practice, either). "When you’re a healthy eater, there’s a lot of pride in that," she says. "No one is going to like the term orthorexia."

If you think you may be experiencing disordered eating, you can reach out to family or friends for help, connect with a treatment facility such as the Eating Recovery Center for a free evaluation, or call the National Eating Disorders Association helpline.

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