When I asked folks on Facebook what topics they’d like me to write about for NEDA week, the most immediate and popular response was orthorexia. It’s a topic I’m both excited and intimidated to discuss. Of all the many forms of disordered eating, orthorexia may be the one most relevant within the so-called healthy living blogosphere. It’s also incredibly difficult to define, and writing about it leads me into complex personal history, so it’s not easy to put words on paper. But I’ll try.

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Orthorexia is defined (on Wikipedia, anyway) as “an extreme or excessive preoccupation with avoiding foods perceived to be unhealthy.” I think most of us have an instinctive sense of what this means, but it’s hardly a straightforward working definition. What’s an “an extreme or excessive preoccupation?” How is being fixated on healthy eating any different from the diet/clean eating crazes that are so culturally prevalent here in the US? How is it different, for that matter, from being a health-oriented, plant-based eater? Is everyone who focuses on healthy food choices orthorexic?

I’m being dramatic, but you see where I’m going with this. It’s tempting to wonder whether the idea of orthorexia stems from a need to problematize everything, healthy eating included. And of course, health consciousness is not a crime, especially within the context of our heavily flawed and often destructive food system. With that said, I do think that orthorexia is a real problem. And to whatever extent that it is, I think it’s a problem I’ve had.

Last summer, Sayward mentioned to me that she’d heard Steven Bratman—the doctor who is famous for coining the term”orthorexic” in the first place—describe the condition as a tendency to assume that every single physical symptom is a direct result of something we’ve eaten. It’s the suspicion that any ailment, no matter how routine (the common cold, say) must have been caused by some insidious, toxic, or unfit food. I think this may be a more insightful definition of orthorexia than the oft-used “unhealthy fixation on healthy eating,” because it better accounts for the disorder’s power. It plays upon our most fundamental impulse, which is to protect our physical well being. It’s important to be health conscious in ways that it’s not important to be thin, which is often the putative goal of other kinds of disordered eating. Whereas it’s easy to say that a disease like anorexia emerges from the “unhealthy” desire to lose an extreme amount of weight, orthorexia seems to emerge from an intention we all applaud, which is to take care of ourselves.

Anybody who feels strongly about the healing potential of a healthy diet is probably tempted to ask, “isn’t it true that many physical ailments are the result of poor food choices?” And the answer is yes: there’s a well established correlation between plenty of diseases, including type II diabetes, heart disease, high blood pressure, and certain types of cancer, and diet. If this weren’t true—if it weren’t the case that certain foods really can be detrimental to health—orthorexia would be an empty concept (and vice versa: if it weren’t true that certain foods can be profoundly healing, then the preoccupations from which orthorexia arises wouldn’t be so powerful). The problem isn’t believing that food and health are meaningfully intertwined. It is believing that we can control our health 100% through what we eat, worrying that each and every “imperfect” food choice will wreak havoc on our bodies, and then narrowing our diets dangerously in an effort to avoid the foods we fear.

The fact that orthorexia stems from a wise intention—healthy eating—makes it difficult to recognize, both from the outside and from the inside. When I was anorexic, or when I was borderline, I couldn’t really kid myself that my behaviors were healthy. I denied their severity and consequences, but I was well aware that obsessive exercise, calorie counting, and crash diets weren’t good for me. I just wanted what they enabled, which was weight loss most immediately, and a sense of power and control and accomplishment more deeply. When I was orthorexic, some time after my last relapse, I actually believed, for a while at least, that I was taking good care of myself. When a friend of mine suggested otherwise, I was indignant. Orthorexia, I thought, was nothing but the unfair scapegoating of health conscious people. It was clearly a defensive posture, which grew from people’s internal guilt about their own poor food choices.

I wish I’d recognized sooner that those are exactly the kind of thoughts I used to have when when people confronted me about weight loss and dieting: “it’s them, not me.”

My friends who were concerned had every right to think that my interest in healthy eating had become excessive. This was the period when my passion for raw foods–originally so celebratory and fun–turned obsessive. It’s when I got seduced by “detoxing” and fasting and eating “light to heavy” and food combining. It’s when I started to eliminate ingredients I’d proudly embraced when I became vegan, including sweets (because I’d somehow managed to convince myself that I had candida). I felt as if I my diet was varied and abundant at the time. “Look!” I’d say to myself. “I’m eating all these avocados, all this nut butter. I never used to do that when I was sick. I can’t possibly still have a problem.”

But all of the avocados in the world couldn’t justify how narrow my diet had become, how obsessively oriented toward “health,” how joyless. It was hard to recognize the dangers here because I wasn’t exactly thinking about weight loss, which had been my ED point of focus in the past. In fact, I was still trying to gain weight from my final relapse, and feeling perplexed that the pounds weren’t coming on quicker. But of course they weren’t; my diet was still narrow and controlled, and the hyper-vigilance I brought to eating was holding me back.

Thankfully, the phase was short lived. I was in therapy at the time, which helped me to identify what was going on faster than I would have on my own. I recalled how enthusiastic and happy I’d been when I first became vegan and got into raw foods. That moment had marked the end of my excessive, self-destructive focus on weight and shape. But what good had any of my strides forward been, I wondered, if my obsession with having a thin body simply morphed into an obsession with having a “clean” body? I was tired of saying no to more foods than I said yes to, of fearing foods I’d previously enjoyed, and of feeling (justifiably) that my diet had been drained of fun. I looked enviously at my friends, who went out to eat and enjoyed every bite, and I recognized that their robust approach was far healthier than my ostensibly “health-oriented” self-denial. And I began to loosen up, big time. I expanded my diet and stopped focusing on raw for raw’s sake (in other words, I allowed raw foods to be something I really enjoyed, not something I felt I had to eat). The more inclusive my diet became, the stronger and healthier I felt. Anyone who has been reading CR for a long time has seen a chapter of that process unfold, and has no doubt seen how much richer my diet and perspective is because of it.

It’s hard for all of us to distinguish health consciousness from health fixation. If you feel that you’re walking a fine line between these two states, though, you don’t have to struggle alone. Please consider reaching out to someone who is in a position to help you out, even if that just means an honest conversation. It could be a friend or family member, a therapist, a school nurse, a physician, or a dietician. Once again, I offer a link to resources via NEDA.

In the meantime, these tips can help you to draw the line between dedication and obsession.

1. Remember that your body may be more resilient than you think it is.

My experience of orthorexia included a sensation of fragility, a certainty that if I ate one wrong thing, my body would be instantly compromised. As someone who lives with a digestive illness, it’s true that I have to be a bit more mindful of what and how I eat than others. But it has been a delight to realize that I can eat all sorts of foods, not all of them roughage or quinoa, and feel perfectly fine; that I can savor my morning coffee; that I can enjoy a glass of wine if I feel like it; and that I can travel, eat out, eat foods that might be a little richer than what I make at home, and feel tip top. We all have an instinctive sense of what feels right for our bodies, and I’d never suggest you eat foods that will make you feel unwell. But there is a good chance that your body is actually stronger and more resilient than you think it is.

2. Be discerning with what you read.

I often tell nutrient clients that they only “detox” they need is a detox of health and wellness reading material! Spend a day perusing any mind/body health website and you’re likely to be bombarded with articles to the tune of “why sugar/bread/wheat is the devil,” “could ________ be destroying your health?!” or “ten foods you should never eat.” There is a point to these articles, which is to help folks identify ingredients that don’t help them to thrive. But that point can be taken much too far, and if you ask me, “everything in moderation” has far more science and research behind it than this kind of cheap alarmism.

3. Variety is healthy.

Orthorexia can often manifest as a very narrow (and ever narrowing) range of acceptable/safe foods. While this can seem like the “healthy” choice, remember that dietary variety will help you to get a wider array of macro and micronutrients, which will in turn help to keep you better nourished. Know, too, that dietary variety also helps to help bolster digestive strength—a fact I’ve witnessed firsthand working for a GI doctor.

4. “Heatlhy” goes beyond nutrition.

Another lesson I’ve learned working in a physician’s office, as well as through my own experience, is that “healthfulness” is not only a matter of eating certain nutritious foods, or avoiding foods that are less nutritious. Pleasure and stress reduction also contribute enormously to good health, which is why I believe firmly that savoring something indulgent is far healthier than constant stressing out about maintaining a rigidly “healthy” diet.

5. Eating healthily is not a black or white affair.

My friend Laura left a comment on Monday’s post that stuck with me. She said, “it’s not either-or. Not either thin or happy. Not food or self-esteem. Not all the food or none of the food. Not good-weight bad-weight. I’m still working on this one, but enjoying the challenge of uncovering how I construct and maintain those equations myself, and can write new ones with some effort.”

I would add that it’s not either/or when it comes to health. It’s not necessary to choose between leafy greens, whole grains, and legumes and lovingly prepared comfort food, exciting or unusual restaurant meals, local delicacies, and rich desserts. It’s not necessary to choose between establishing a routine with movement you love (yoga, dance, running, whatever) and focusing on rest and relaxation. Eithor/or thinking was for me, as it seems to have been for Laura, a major part of the disorder. My tendency toward extremes remains a part of who I am, and at times, it’s a part that I love. But recognizing that I don’t have to operate exclusively in dichotomies has been a vital part of my recovery process.

My intention with this post is not to disavow healthy eating. I believe wholeheartedly that my recovery was aided by nutrient dense, plant based ingredients, which helped to restore my body after so many years of restriction. And I know that eating a conscious vegan diet showed me that food didn’t have to be the enemy: it could contribute to my sense of well-being, rather than compromise it. For this reason and so many others, I’ll always advocate the importance of good nutrition. The lesson I’ve learned, though, is that healthful choices can coexist peacefully—even synergistically—with ones that are (superficially, anyway) less healthful. My love of vegetables is not undone by the extra cups of coffee I drink when I know I’ve really had enough, the vegan treats that delight my senses, no matter how sweet they are, the late nights I sometimes spend out or listening to music or chatting with friends when sleep might be more prudent. My life can accommodate all of those pleasurable moments, and many more.

Such are my thoughts, friends. I would of course love to hear yours. Good night from the West Coast!


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