Healthcare practitioners’ jobs would be infinitely easier if patients paid as much attention to what they eat as they do to posting pictures and status updates on an ever-growing list of social media sites. A few extra minutes spent reading labels at the supermarket a bit more effort put into cooking at home using whole food ingredients and a commitment to packing a homemade lunch instead of defaulting to whatever’s handy at the nearest grab and go shop would go a long way toward reducing people’s risk for the many chronic illnesses that are rooted in a poor diet. 

However it’s possible to take things a little too far in that direction. Over time a dedication to healthy eating can morph into a pathological obsession with “clean food” that begins to interfere with an individual’s daily life. This condition is known as orthorexia from the Greek ortho for “correct right” and orexis for “appetite desire.” A consensus on an official definition is lacking but it may be defined as “a pathological fixation with righteous and healthy eating.” The word “righteous” is important. Orthorexia goes beyond an emphasis on healthful and nutritious foods; it often turns into a debilitating belief that only the foods that fall within carefully proscribed rules often self-created are suitable for consumption and all other foods are “impure” “unclean” and in some cases downright dangerous. Orthorexia is as much about the pursuit of dietary perfection as it is about purifying the body exercising total control over one’s fate and possibly even reaching a higher spiritual plane of existence than other individuals who are less meticulous about their food choices.

The doctor who coined the term orthorexia nervosa and who did much of the groundbreaking work on calling attention to the patterns of behavior that comprise it is Steven Bratman MD. He detailed this work in his book Health Food Junkies: Orthorexia Nervosa: Overcoming the Obsession with Healthful Eating. The book is eye-opening for healthcare professionals and is also a helpful resource for laypeople including individuals experiencing orthorexia as well as their loved ones who may be looking for ways to intervene and help in a non-threatening way. 

Orthorexia is not specific to any single dietary paradigm. It may be found among vegetarians vegans low-carbers Paleo dieters low-fat adherents and more. It is also not specific to one gender or specific lifestyle practice unlike the female athlete triad. Orthorexia often begins with a positive change most healthcare professionals would encourage: a dedicated effort toward eating more wholesome foods. However over time this innocuous and seemingly beneficial behavior can take on a life of its own and the desire to “eat healthy” may end up having the opposite effect: detracting from good health physically and psychologically.

In the absence of a precise widely-accepted definition for the condition orthorexia may fall under the umbrella of “we know it when we see it.” Orthorexia should be suspected when the act of sitting down to a meal is no longer an opportunity to nourish the body and spirit but rather becomes an adventure in guilt shame and self-loathing. Sharing a meal has been part of the human communal experience for millennia. Individuals with orthorexia may deny themselves this simple pleasure for fear of inadvertently or by force consuming something outside their small list of “acceptable foods.” They may no longer accept invitations to dine at friends’ homes or join family members at a restaurant because the selection falls outside their dietary comfort zone. For example dedicated vegans may fear their food has come into contact with animal-sourced ingredients; strict Paleo dieters may worry their meal was “contaminated” by being cooked in soybean oil; ardent low-fat eaters may put a moratorium on all dishes for which they cannot verify precisely how much fat was used. 

It is important to note that these behaviors are not rooted in genuine food allergies or sensitivities. If an individual discovers a previously unknown food intolerance orthorexia might start out this way but it progresses to the point where more and more foods are excluded—based on increasingly irrational logic—whether the person is sensitive to them or not. The end result is that an orthorexic individual might have a very limited number of “safe” foods and if an extremely limited diet is followed for a long period of time nutritional deficiencies may develop with significant adverse effects on physical and psychological health. Ironically the desire to improve health backfires.

The fear worry and stress that accompany mealtime for an orthorexic individual may do far more harm than anything having to do with the actual foods themselves. Being in a sympathetic-dominant state while eating is a recipe for disaster. When the body is stuck in “fight or flight” mode the parasympathetic “rest and digest” mode is inhibited which can compromise proper absorption and assimilation of whatever nutrients are being consumed. Oddly enough some of the nutritional deficiencies that may be induced through orthorexic behavior such as DHA B12 iron zinc and iodine can contribute to unstable moods and poor cognitive function thus perpetuating the cycle. 

Unlike bulimia nervosa and anorexia nervosa orthorexia nervosa is not necessarily linked to limiting total food intake managing body weight or losing body fat. It is a near-militant control over the quality and nature of one’s food and a single-minded dedication to this purpose that eventually hinders an individual’s ability to participate in everyday life and maintain healthy social relationships. Moreover food is often simply the vehicle through which a deeper psychological imbalance manifests. 

Treating orthorexia nervosa requires far more than a physician or nutritionist/dietitian explaining the merits of consuming a wide variety of foods (although that is certainly an important aspect). Orthorexic individuals may benefit from direct nutritional support to rebuild the physical body but they also require counseling and guidance from mental health professionals trained to address this type of behavior.