Orthorexia: When Health Choices Turn Problematic

On a morning in June 2013, I woke up from a nightmare in a cold sweat. My heart was pounding. I could still feel the echoes of stress and emotions the dream had inspired in me. Part of me was convinced that the dream had been real. I tried to pull my thoughts together, to get a grip on reality. What had I been dreaming about? Food choices. I dreamed that I ate a bowl of strawberries.

Yes. I literally had a nightmare about eating fruit.

I should put this into context for you. Last June I had recently completed a half-marathon, and during the final weeks of training I had been carb-loading (mostly on fruits and starchy vegetables). After it was done, I was still having cravings for high-sugar foods even though I was no longer participating in any glycogen-demanding activities. I wanted to break this cycle of cravings, so I decided that for three weeks I would avoid all sugar. In addition to grains and refined sugars which I regularly avoid, I removed unrefined sugars (i.e. maple syrup, honey); starchy vegetables (i.e. potatoes, rutabaga); fruit; and alcohol from my diet for three weeks. My reasoning was that these three weeks would break the cycle of carb cravings and get me out of the habit of eating sugary snacks and desserts every day.

This sort of cold-turkey approach works for some people. For other people, like me, challenges like this can be really problematic. For people like me, having a list of “forbidden foods” that cannot be eaten for any given period of time can lead to a disordered way of thinking about those foods and about eating in general. This type of thinking is known as “orthorexia nervosa.” Though orthorexia is not an officially recognized disorder, it is a widely-recognized label for this common sort of disordered thinking. The National Eating Disorders Association defines orthorexia as follows:

“Those who have an “unhealthy obsession” with otherwise healthy eating may be suffering from “orthorexia nervosa,” a term which literally means “fixation on righteous eating.”  Orthorexia starts out as an innocent attempt to eat more healthfully, but orthorexics become fixated on food quality and purity.  They become consumed with what and how much to eat, and how to deal with “slip-ups.”  An iron-clad will is needed to maintain this rigid eating style.  Every day is a chance to eat right, be “good,” rise above others in dietary prowess, and self-punish if temptation wins (usually through stricter eating, fasts and exercise).  Self-esteem becomes wrapped up in the purity of orthorexics’ diet and they sometimes feel superior to others, especially in regard to food intake.” (Karin Kratina, PhD, RD, LD/N)

Orthorexia can present as strict calorie-counting, adherence to a specific diet, or obsessive exercise: these are things we see often in North American society, but the important thing to remember is that it is the thought process behind orthorexia that is problematic. Choosing to eliminate soda from one’s diet, for instance, is arguably a healthy decision. However, if giving into temptation and having a single soda leads to overwhelming guilt and self-punishment, then that is not a healthy way to live.

It’s ironic that such an unhealthy way of thinking could be associated with a search for health. Looking back on the last few years of my life, I know I have had quite a bit of personal experience with this sort of thinking, but it was only on that day in June 2013 that I really recognized it in myself and knew I had to fight against it. When I woke up from that nightmare, in which I was genuinely freaking out at the idea that I had failed in this challenge I had set myself, I knew I had to change something about the way I was thinking about food.

I won’t claim here to be completely “cured”: I’m sure that elements of this disordered way of thinking will follow me for my entire life. I have in the last seven months, however, figured out a few things to help deal with it. The first is being aware of how I’m feeling and reacting to food choices: am I choosing to eat or not eat something because it’s my conscious choice? or because it’s a “rule”? The second is making sure that I never feel deprived: I may choose not to eat grains or processed foods most of the time, but it’s always a choice, and when I feel like having a chocolate bar, I have one. The third is focusing on adding good stuff to my diet instead of eliminating bad stuff: instead of focusing on not eating pasta, I focus on eating more of my favourite vegetables at each meal. The more I consciously think this way, the easier it gets to avoid more problematic ways of thinking about food, but I’ve still got a long way to go.

I’m putting this out there today because I don’t think I’m alone in this. I have battled with binge eating for many years, and I thought I’d overcome it only to find that I’d just replaced it with orthorexia. Eating disorders come in many forms, but besides anorexia and bulimia very few are widely acknowledged. It’s beyond painful to admit to yourself that these are issues you need to face, but it’s important to be open about it, to talk about it, and to hope that doing so may help someone else.