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    Jennifer Nelson, M.S., R.D. and Katherine Zeratsky, R.D.

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  • Nutrition-wise blog

  • Aug. 2, 2011

    Orthorexia — When eating healthy goes awry

    By Jennifer Nelson, M.S., R.D. and Katherine Zeratsky, R.D.

42 comments posted

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Everyone can benefit by paying more attention to choosing healthy foods, right?

For the most part, yes. However, a small number of people seem to become obsessed with the "perfect diet." These individuals fixate on eating foods that make them feel pure and healthy — to the extent that they avoid foods with any: 

  • Artificial colors, flavors or preservatives
  • Pesticides, genetic modification
  • Unhealthy fat, sugar or added salt

For some people with orthorexia:

  • Preparation techniques must result in "clean food," meaning it's been washed multiple times, cooked to ensure no bacteria and minimally handled.
  • Eating out is out of the question because it's important to avoid food that they don't buy and prepare.

The term "orthorexia" has been used to describe this disorder. It comes from the Greek words "orthos," meaning straight or proper, and "orexia," meaning appetite. According to experts including Dr. Steven Bratman, the doctor who first described and named this disorder, what tips the balance from being committed to healthy eating and having orthorexia is the extreme limitation and obsession in food selection. Orthorexics find themselves being unable to take part in everyday activities. They isolate themselves and often become intolerant of other people's views about food and health.

Studies have looked to at whether this disorder is more common in groups more likely to have a keen interest in a healthy diet, such as medical residents, dietitians, students in nutrition, fitness club members and those in the performing arts (ballet, symphony orchestra and opera singers). Each of the professions studied showed some incidence. However, the studies were unable to determine if the incidence was higher than that in the general population.

Health professionals have proposed that orthorexia be officially recognized as a new mental disorder. Currently it remains controversial and grouped with other not yet accepted disorders such as night eating syndrome, muscle dysmorphia (obsession with muscle building) and emetophobia (constant fear of vomiting).

Whether it's recognized as a true medical problem or not is beside the point. It's important to seek professional help when striving for a healthy diet becomes an overwhelming drive that takes over. Orthorexia that features obsessive compulsive behaviors can be effectively treated with medication and cognitive behavioral therapy by a trained therapist.

42 comments posted

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  • May 14, 2013 11:23 a.m.

    Hahahahahaha BravO! treating "Healthy Eating Disorder" with medication! Would they suggest Xanax? or maybe Prozac?... Epic! Most people who maintain healthy lifestyle, esp to the extreme, would not even touch medication. neither would i; i'd rather meditate and wash my non-organic vegetables three times than pop a pill... p.s. I understand that ANY extremism is bad and THAT should be addressed first; OCD can take any form or shape; one can obsess over veggies or book order on their shelf, or color coding their socks - doesn't matter, still an obsession and it should be addressed, and there are always very indicative signs of obsession. I have mild OCD and can completely understand how healthy can turn unhealthy... but the answer is not in traditional mediCation which causes more harm than good; mediTation is the answer: it cures all psychological problems of suppression or at least helps to keep them at bay; the path should be "from medication to meditation", not to another pill... P.P.S. Women who are scared for their anti-social family members here, don't be: they won't hang out with you meat/potato eaters, but will always find company of likeminded individuals to stick to who won't consider them sick for making healthier choices in life but would rather excitingly discuss some new organic spirulina powder ;)

    - Mimzy

  • May 2, 2013 2:49 p.m.

    I agree with those who note that avoiding processed, GMO & pesticide laden foods is a good thing. Extremism (of any kind actually), however, is not a healthy dietary strategy. Not only does it fly in the face of common sense, simple biological principles, and substantiated scientific evidence, it can, as others have noted, cause social, psychological, and biological/genetic harm. We have family members who adhere to such extreme beliefs about "healthy" foods that they will literally starve themselves if they don't have the foods they deem healthy available. They have cut ties with family & are intolerant of any other views and believe being "thin" is the only "healthy" way to be. They give misinformation to their children to control their diets & the kids are so afraid of food that one of them literally had an anxiety attack in a restaurant because as he said, "I don't think I can eat anything here!" (he's 7& it was NOT a fast food place). This approach to food & diet is indeed "disordered." We are all worried about the chronic effects the lack of nutrients, lack of bonding, and lack of enjoyment in eating, is having on our young family members' physical, emotional, and mental health. Interestingly, the mother is continually finding new "disorders" that she has, so if it's not one thing, it's another, but with each new self diagnosis comes even more extreme dietary restrictions placed on th

    - Rachelle

  • April 29, 2013 1:47 p.m.

    For my daughter it started with IBS. She is a Nutrition major who started researching everything trying to cure herself and has now eliminated almost everything from her diet. She is under 90 pounds and I'm scared to death. She too only eats what she knows to be organic, healthy, and with out additives. She's in college so her meals in the cafeteria are down to only rice and vegetables. I pray there's hope. I would like to hear from someone who is "recovering" please!

    - Pam

  • April 3, 2013 6:29 p.m.

    i have a daughter that has orthorexia. She is 5ft 7in and weighs 105lbs. She is not orthorexic to lose weight, she is "getting rid of all the bad cells in her body". She has been doing this for 2 years and "detoxes" a couple times a month where she only drinks lemon water for a week. She states that she has to get down to "skin and bones" before she can start producing "good" cells. She is totally consumed by eating only organic raw veggies and fruit. She has separated herself totally from her family and basically has become a hermit. She cannot talk to anyone without preaching about food and her beliefs, there by running off family and friends, except those who believe what she believes. The scary thing is that now she has a new granddaughter and has convinced her daughter to feed the baby only coconut milk, although her daughter does not follow her food extremes. She is "mentally ill" and won't even hear of it. Now she is planning on opening a store for people like her. She claims she can "cure" cancer, autism, everything! She claims, now, that she has, at the age of 50, reversed her menopause and will continue having her periods the rest of her life. I only hope she lives long enough to find out. I am truly worried about her health. She make her own medicine and thinks all Doctors are quacks and only intersted in making money selling drugs that will kill you. SHE IS SICK!!!

    - Joanie

  • March 14, 2013 1:56 p.m.

    wow, so someone who is obsessed with not consuming genetically modified foods, unhealthy preservatives and pesticides is now classified as having a mental disorder? This is a natural way of eating and how everyone used to eat at one time - now our food is filled with pesticides, tomatoes made with fish dna to survive the cold, high fructose corn syrup.. ugh. And we label the healthy eaters as having a mental disorder, lol.

    - Sarah

  • March 1, 2013 7:20 p.m.

    Seriously? A 'Healthy Eating Disorder'...now it's considered a mental illness? "Orthorexia that features obsessive compulsive behaviors can be effectively treated with medication and cognitive behavioral therapy by a trained therapist." It won't be long and the Gov't & Pharmaceutical companies will have the entire population on some type of drug or another, how convenient for them both. As 48 yr old woman, that has suffered from anorexia & bulimia since she was 14 yrs old - I say BS. This classifying the entire population with one type or another of 'nervosa' has really got to stop. I could only DREAM of being able to have a 'Healthy Eating Disorder'. -Leave the healthy people, the one's who finally got it right, alone - will ya???

    - Molly

  • October 22, 2012 4:12 a.m.

    Has anyone every thought the GMO's in our food could be causing allergic reactions to foods that we were never allergic to before. Do some research. more and more people are becoming allergic to gluten foods that have pesticides grown in them (genetically modified organisims). I think that people need to start educating themselves before labeling people with orthorexia. Eating healthy and knowing what's in our food is NOT a mental disorder. Some people choose to not live their life with their head not in the sand.

    - Richelle

  • October 19, 2012 1:20 p.m.

    what many people are missing in these posts is the harm this disease can do to others. I have a daughter-in-law that I believe is suffering from this disease she is now passing this on to her two young children who cannot attend a birthday party or eat any foods outside of the home. Her claim is she is allergic to literally everything and her children must be as well. She just began seeing a gastroenterologist who told her right off the bat that she could not possibly be allergic to all foods. Hopefully this will begin a treatment regimine. My son cannot broach the subject with her not becomming extremely angry. I never knew this diagnosis existed. There are people who need help, pray for them

    - Judy

  • October 18, 2012 11:26 a.m.

    I am in the health food industry and indeed, this IS a "thing" if you will. I am constantly faced with others in the undustry who make rash and severe judgments upon others who do not partake in their very specific pattern of dieting. I believe it stems from underlying issues of control and perfectionism, sometimes also prevalent amongst individuals with Obsessive-Compulsive Disorder. Weight Management and health are wonderful things to strive for, but health is about balance, not perfectionism, and when it becomes such, that is when it has crossed the line from a positive action to a disorder. Like many other disorders, it has many stages and varies according to the individual and what they personally value to be ideal. The KEY warning sign occurs when one's perception of health and diet becomes their only outlook and these individuals refuse any and all opposing advice from health professionals, even when much evidence proves their perception flawed. Often these individuals have symptoms of paranoia, strongly believing in nutritional conspiracies, that they will die if they do not embrace the ideation of their nutritional lifestyle, etc. As always, above all, embrace health, balance, and happiness. With this, you can not fail.

    - Deborah

  • September 3, 2012 12:40 p.m.

    It's not a conspiracy...how exciting that would be! It's when being this selective about the types of foods consumed becomes unhealthy and even dangerous. Similar to when being restrictive with calories becomes unhealthy and even dangerous, as in AN.

    - Kim

  • August 20, 2012 12:10 p.m.

    We have a family member with this condition. I am all for healthy eating but she avoids almost all protein, and will only eat raw organic fruits and veggies. Would rather starve then eat something that may not be organic. Is obsessed with food and can only shop at Whole Foods. Uses Colonics, wants to be PURE and looks like a skinny scarecrow. These people think they are going to avoid all disease by eating this way and they may be right because they just might have a heart attack or starve themselves to death. My Dr. recently had to sign a death certificate for someone with this condition. Cause of death "starvation". They need to see a mental health counselor that treats Orthorexia.

    - CW

  • August 19, 2012 10:13 a.m.

    Our government allows the food supply to get poisoned by companies like Monsanto, and then create a “disorder” so that we are socially rejected. People become obsessed with healthy eating because there is fluoride in our water, pesticides on our food, and our vegetables are grown in labs. Why do people have to go out of our way to buy organic food? People who try to sell raw milk, or grow their own gardens get arrested during midnight raids. What is the point here? To give us all Orthorexia sufferers a pill? Maybe I suffer from “conspirirexia” too, but this is a part of America’s Psychological Operations to control the food supply and depopulate the planet.

    - Jack

  • August 15, 2012 4:44 p.m.

    I think most of the commenters here are missing the point. I eat a relatively restricted diet (ketogenic paleo) for health and weight-loss reasons, and occasionally fast. Some people would find eating zero grains, and zero sugar or sweeteners "extreme." However, my diet does not impede my social life (I eat out quite a bit) doesn't consume my daily activities, and though I track it carefully, I'm not obsessed with it. The difference would be someone with orthorexia would starve rather than eat "bad" foods. Me, if nothing else were available I'd eat the bread and sugar and wouldn't worry about it. Your friends and relatives who commit to strict diets are most likely not suffering from a mental condition.

    - SentWest

  • August 3, 2012 6:23 a.m.

    I believe my son suffers from orthonexia; he will only eat organic foods and believes that eating other foods and cooking with any pot or pan coated with teflon or aluminum causes him anxiety. the previous post:April 28, 2011 12:56 a.m. I know someone who went through and is going through this organic, home remedy regimen. I totally agree with healthy eating, but this was carried to an extreme. After a couple of years of doing this, her daughter and then she found they had developed many food allergies. Dr. said she did herself no favors with the diet. Now she eats even less and is very frail. I was actually glad to see there is a term for this and hope she goes for help. Many small health things are occurring and I am very concerned.; This is what I'm concerned with.....my son is down to 144 lbs....He can't sleep well , is always obsessed with cooking his broths and "kosher' foods. He will not eat out, unless he takes his own food along. What can be done to help him. We are terrible concerned!!!!

    - lynn

  • March 22, 2012 5:43 p.m.

    Your description of orthrexia sounds just like me, however Iam sulfite and preservative sensative. Believe me if you had to use an epi pen every tome you messed up, you would tow the line straight and narrow also. I dont eat out either. The only time you can insure a food is correct and without additive is when you prepare your self. I dont consider my problem a disease just a miserable sensativity.

    - Kathy

  • January 1, 2012 11:16 a.m.

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  • August 13, 2011 3:49 p.m.

    C'mon you guys. Many of you posting a comment have not gotten the real gist of this article: "... what tips the balance from being committed to healthy eating and having orthorexia is the extreme limitation and obsession in food selection. Orthorexics find themselves being unable to take part in everyday activities. They isolate themselves and often become intolerant of other people's views about food and health." Those who wrote the article are talking about the extreme nature of a true obsession -- not to be confused with healthy eating habits.

    - SusanB

  • August 10, 2011 10:04 a.m.

    Anything taken to an extreme is harmful. I don't believe the point of the article is that carefully monitoring what you put in your body is a disorder. The mindset that you can only eat peticide free, artificial color free,preservative free, free range, organic, etc.... to restrict your calorie intake and therefore control your weight becomes very unhealthy and is a disorder. This lifestyle choice has more to do with body image than maintaining a healthy diet.

    - Paula

  • August 9, 2011 7:55 p.m.

    This article totally ignores the FACT of allergies to specific preservatives and chemical sensitivity--an increasing phenomenon, especially among older women. Not a balanced view.

    - k

  • August 9, 2011 2:18 p.m.

    I am surprised to see that avoiding artificial colors, preservatives, GMOs, pesticides, sugar, salt and unhealthy fat is now a disorder. I have eliminated these things from my nutrition plan and have enjoyed greatly improved health, more lean mass, lower body fat, and have significantly improved my lifting strength. I'm concerned that a respected institution like Mayo would suggest that it's okay to eat these things. I agree with Susan; read Eat to Live.

    - Susan

  • August 4, 2011 12:36 p.m.

    Obsessing over food to the point where it disrupts normal living is clearly disordered. The article has that part right. But there is nothing wrong with avoiding unhealthy processed foods. The article has it wrong there. Unhealthy added fats, sugars, salts, etc... in processed food all have been shown to cause disruptions in appetites and metabolisms, making people who are struggling with weight and overeating blame themselves for losing control when really it is the food they are eating that is messing with them. Processed diet foods are particularly bad culprits which is completely messed up since the very people who need the most help are being targeted the heaviest. Seriously, check out _Eat To Live_ by Dr. Joel Fuhrman. I really don't think he has Orthorexia. The whole United Kingdom banned the use of artificial colors in foods because they know how bad they are. And pesticides can cause cancer, CANCER. Leave it to Americans to delude themselves into thinking that being healthy is unhealthy.

    - Susan

  • April 28, 2011 12:56 a.m.

    I know someone who went through and is going through this organic, home remedy regimen. I totally agree with healthy eating, but this was carried to an extreme. After a couple of years of doing this, her daughter and then she found they had developed many food allergies. Dr. said she did herself no favors with the diet. Now she eats even less and is very frail. I was actually glad to see there is a term for this and hope she goes for help. Many small health things are occurring and I am very concerned.

    - Sandy

  • March 30, 2011 4:55 p.m.

    I don't believe this to be a legitimate disorder. There is a lot of scary hype out there regarding the condition of our food supplies, etc. I can see how some people may react to this in a self-preserving sort of way; especially if very young and impressionable. Personally, I'm at the age where I'm over the perfect eating/body phase, but it is still an important, daily consideration. Honestly, I think that orthorexia was conceptualized by a mentally and emotionally unstable individual that feels threatened by those that choose more healthfully responsible lifestyles.

    - Rouillie

  • March 10, 2011 12:39 a.m.

    Since when is avoiding foods made with pesticides,GMO, artificial colors, unhealthy fats,etc... considered so wrong that it needs to be labeled as an eating disorder? Are you nuts? Maybe the growing number of thinking people who refuse to follow your "healthy" diet advices is giving you a big scare or you are so brainwashed that you don/t know what you are talking about!Either way I am discusted and sorry that I read your article. Who knows probably tomorrow I will find that I need psychiatric treatment because I refuse to drink water contaminated with all kinds of "goodies"produced by our chemical society.

    - Vanya

  • May 12, 2010 10:24 p.m.

    Just thought I'd say, I agree with Shelby. This Orthorexia seems to be a psychological problem with major physical effects on one's body. I can tell you I know firsthand because if this was a true, classified disorder, I would be diagnosed with it. As an OCD perfectionist, my body image relies on my obsession with self control. I avoid and refuse to eat food I have not prepared myself and food I consider 'bad' food(i.e. food with perservatives, hydrogenated oils, animal products, high fructose corn syrup, and so on). To a normal person, that may seem like a ridiculous idea, but to me, it's my lifestyle and I take it seriously. I'm also a vegan, so I don't eat ANY animal products(NO milk, eggs, meat, fish, etc). To prepare my meals doesn't take up ALL my time in the day(though it does take time), since I'm actually a professional cook(odd, isn't it?). I can cook amazing meals for others(yes, even with animal meats and seafood), but I won't eat the meal myself. Instead, I usually make myself a salad or soup or sandwich. About 99% of the food I purchase is 'organic' or 'natural', and I ALWAYS read the labels. My BMI is currently 17.6 since I'm 5' 2'' at exactly 96 lbs. Although, I don't excercise much, if at all. The one thing I don't agree with is about a guy who came up with a certain diet that orthorexics follow? I never heard of such a thing. My anorexic behaviors started all of a sudden after a great deal of family related distress, following the still ongoing depression.

    - Marie

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