Howdy all – I’m going to get a little serious here today. There’s an issue that’s been floating around on the periphery of the Paleo-sphere, and it’s really piqued my interest, as both a Paleo-eater and a psychology graduate. I think it’s something that’s not addressed often enough, and it’s really important to have these issues out in the open, instead of hiding them away in the closet. Really, it’s not just a “Paleo” issue, it’s a broader issue for all healthy eating paradigms – vegetarianism, veganism, raw food-ism, whatever-else-ism… so bear with me, even if you’re not on board the Paleo train.
You may or may not have heard of the term “orthorexia”. It’s a relatively new phrase, and it’s been bandied about a bit in relation to healthy eating and the backlash against a “standard” diet. Indeed, according to the Macmillan English Dictionary, the word has officially entered the English lexicon. I’ve seen it crop up a couple of times in relation to Paleo in particular, which is why I want to explore it a bit further here, and just kind of contribute my thoughts.
What is Orthorexia?
“Orthorexia nervosa” is a term coined by Steve Bratman, M.D., author of the book “Health Food Junkies” (now out of print). The term literally translates to “correct appetite”. Essentially, it describes the condition where one develops an unhealthy obsession with avoiding certain types of food – a fixation so extreme, it may lead to malnutrition, and even death (fatalities have been reported).
It’s important to note right from the outset that this quote-unquote diagnosis is not actually part of the DSM-IV (the manual for psychologists, psychiatrists, and everyone else who works in the mental health field – it describes the diagnostic criteria for all established mental illness). Orthorexia is not even intended for inclusion in the new edition, the DSM-V, which is due to be released next month. So, what we are dealing with here is very new, and not very well defined. Individuals who have symptoms consistent with those described for orthorexia would currently receive a diagnosis of “ED-NOS” (Eating Disorder Not Otherwise Specified) in a clinical setting – this is kind of a grab bag for all the eating issues we don’t know how to deal with or label yet. But I digress…
Being so new and so undefined, not much research has been conducted on this condition, and it remains a very controversial label. Thus far, we can establish that the term describes people who refine and restrict their dietary intake, according to a personal understanding of which foods are “pure”. It is distinct from other more familiar eating disorders, such as anorexia nervosa or bulimia nervosa, in that it is focused solely on the quality of food, rather than the quantity. It’s also worthy mentioning that orthorexia can present in a variety of ways. It can centre on what one eats, how the food is prepared, and/or how the food is produced (e.g., exposure to pesticides).
What Are The Symptoms, Exactly?
Well, being as it’s not classified as a disorder in the DSM, we don’t have a firm set of diagnostic criteria yet. Dr Bratman, however, has provided a kind of “questionnaire” checklist, which does give us some insight. Many of the symptoms that he suggests are consistent with obsessive-compulsive disorder. For instance, sufferers may care more about the virtue of what they eat, rather than the pleasure received from eating it. Their diet may socially isolate them. They may spend more than three hours a day thinking about healthy foods, or plan ahead for meals days in advance. They may feel in complete control when they eat they way they feel they are “supposed” to, and they get a self-esteem boost from healthy eating. Increasing the quality of their diet may have decreased their quality of life, and they may avoid foods that they once enjoyed. Their restrictive dietary requirements may make it difficult for them to eat anywhere but home. They may experience guilt or self loathing when they stray from their diet.
Now, apparently, identifying with two or more of these symptoms may indicate the presence of at least mild orthorexia. That fact in itself has led to a lot of fellow bloggers dismissing this unofficial disorder completely: “But it’s completely healthy to plan ahead for meals!!”, they cry, “Why is it suddenly a disorder to eat healthily?!?!”. Not to sound preachy or anything, but I think they’ve kind of missed the point.
The underlying criterion for considering any behaviour or thought pattern to be disordered is this: does it interfere with normal functioning or relationships? So, perhaps you plan your meals ahead, but is this affecting your ability to function normally in life and in your relationships? If the answer is “no”, then it’s not likely that a clinical disorder is present – indeed, you are “just” eating healthily. If, however, your dedication to eating healthily is interfering with your functioning and relationships, then there may be something darker at play. The toughest part is determining the point where a commitment to eating healthily becomes compulsive and disordered; some of these criteria obviously form part of perfectly normal eating behaviour, and toughing out the occasional craving doesn’t make you orthorexic.
With almost any mental disorder, however, there are shades of grey. There may be what we can refer to as subclinical presentations – where the symptoms don’t quite meet the criteria set out in the DSM-IV, in terms of number or severity, but everything’s not hunky dory either. It may be in this grey area that many of us operate when it comes to Paleo.
Paleo and Orthorexia
From the outset, I will say this: eating Paleo on its own does not constitute “orthorexia”. Ditto for any other nutritional paradigm that sways from the mainstream. It is impossible to care about what one eats – indeed, we could argue that it is necessary, in some measure – without engaging in disordered thinking or behaviour.
However, it would seem that people within the Paleo community are more at risk for orthorexia – and I would assume that the same could hold true for any other nutrition-focused community. We are a population of people who may tend to be a little obsessive, or at the very least “passionate”, and obviously we simultaneously care greatly about what we are eating. It is foreseeable that a perfect storm of these traits could occur, especially given that we often see great health benefits from transitioning to this lifestyle, leading to a cycle of further restricting and tweaking that may ultimately become highly disruptive and dysfunctional.
Furthermore, it would seem – anecdotally, at least – that many people who gravitate toward Paleo have a history of some kind of disordered eating, if not a clinically diagnosed eating disorder. This is both a good and a bad thing, depending on the individual. Paleo may help free some of us from food obsession and unhealthy habits, while for others, the strictness of the approach may trigger further disordered thoughts and behaviour. Even for someone with no history of disordered eating, we can see how the diet itself could trigger a type of orthorexia, feeding unhealthy obsessions with eating the “right”, “proper” or “best” food. We pile scientific finding on top of scientific finding, we research and we record and we measure and we observe – it can easily get out of control, our dedication shooting out of proportion to actual health benefits received as a result of these behaviours.
So, Is Paleo A Bad Idea Then??
I certainly wouldn’t say that. I still believe that Paleo is a sound nutritional paradigm, that can help us improve our health status, and maintain those improvements over the long term. I would hate to see people shy away from Paleo, because they fear the orthorexic label, or even simply because they dislike it’s “strictness”.
I don’t think the nutritional paradigm itself has to change – I think the way we speak about it has to change. The language we use to describe and talk about Paleo has power that we don’t necessarily consider or respect.
Think about it. For those of you who eat Paleo, or are transitioning into this way of life, have you ever thought to yourselves “I was so good today!”, or “I behaved, and ate really well!”? What about “I cheated on my diet!” or “I was so bad today!”? Not everyone has these thoughts or uses these terms, but many do. How about saying “sugar/gluten/legumes/vegetable oils are evil“? We often assign these moral qualities to food – they are “good” or “bad” – without actually realising that we’re doing it. Saying sugar is “evil” definitely goes one step beyond saying it’s “unhealthy”.
Indeed, assigning these extreme moral values to food could potentially fuel an orthorexic mindset – it’s not much of a leap to believe that eating “bad” food makes you a “bad” person. This is a line of thinking often seen in other types of eating disorder as well; one’s self esteem becomes so wrapped up in their food consumption, that they come to believe that they are a “good” person or a “bad” person based almost solely on their food choices. We lose the capacity to think of ourselves as simply a person who made a choice – those choices become laden with moral judgements. And that doesn’t seem right, does it?
So much of the language I see in discussions on Paleo blogs and forums is scary in this regard – people are truly vilified for continuing to eat rice or quinoa, or sneered at for eating dairy, or admired and put on some kind of pedestal for supposedly achieving a “perfect” dietary intake. Is that really how we want to speak to one another? In the end, we are all striving for the same thing: health. We can go about that different ways, and moral judgements should not come into that. Moral judgements of food quickly become moral judgements of people, which we reflect in our moral judgements about ourselves – if you call someone else stupid or bad or irresponsible or evil for consuming gluten, it’s not much of a leap to think that you are stupid or bad or irresponsible or evil for consuming gluten.
What’s more, as a community, we seem to have developed a rabid obsession with food production, as well as our consumption. Generally, I feel this is justified. I want to know where my food came from, who grew it or raised it, how it got from their hands to my plate. I want to make the most ethical, healthful, sustainable, and reasonable choices possible. But how far is too far? I hear so many newbies to Paleo absolutely freak out about the added expense of buying organic 100% grass-fed beef for every meal, or the difficulty of sourcing raw dairy products in a country where it’s illegal to sell them – where do they get the idea that these things are “necessary” to be successful on a Paleo diet? Why, from us, of course – the ones who have been doing it for a while, and scare the bajeezus out of everyone else with talk about factory farming and omega-6 ratios and degraded soil. Please don’t get me wrong, I’m certainly not advocating these practices; what I’m saying is that an obsession with avoiding them can become unhealthy. Experiencing extreme anxiety because you’re not sure if the steak you got in a restaurant is entirely grass fed is not healthy. Refusing to speak to your grandmother for six months because she made your birthday dinner with conventionally farmed veggies is not cool. There is dedication and tenacity, and there is disordered and unhealthy – we need to make sure we’re not encouraging folks to cross that line.
So Where Does That Leave Us?
I feel that, as a community, we need to really focus on making sure that the food we eat does not become a measurement of our self worth. We need to emphasise that complete and obsessive control over our food, and achieving Paleo perfection, is neither attainable, nor necessarily desirable.
What if we changed the language we use about food? What if we didn’t use words like “cheat”, “evil”, “slip”? What if we removed judgement from the equation? We can say that we believe gluten to be unhealthy, yes – but making an unhealthy choice doesn’t make you a “bad” person. What if we said it was okay to simply make the best choice of a bad bunch? Eating a grain-fed steak is not ideal, but it’s certainly going to be better for you than a piece of bread – we need to start emphasising that that’s okay.
I think we also need to practice a high degree of self-awareness. When eating this way becomes disruptive to your normal functioning, when you’re experiencing anxiety or major problems in your relationships because of it, when you can’t enjoy your life the way you want to because eating Paleo is holding you back – you may have a problem, and it’s okay to seek help. We need to care for one another, and look out for one another – if you notice that someone is becoming a bit too obsessive or a bit too extreme, it needs to be okay to speak up and ask them about it.
Where Do I Stand?
Well, unsurprisingly, I identified with quite a few of the symptoms of orthorexia. I do find it difficult to eat out sometimes and prefer to prepare food myself. I do feel better about myself when I eat nutritious foods, and there are foods that I used to enjoy that I no longer eat because I am concerned about their affect on my health.
Does this make me orthorexic? I would say that the answer to this question is very subjective. To someone who is unfamiliar with Paleo or its philosophies, I can definitely see how my eating could be considered disordered. I have been attacked and questioned and made fun of for the way I eat, and specifically the foods that I avoid; some people are honestly incredulous that I can’t remember the last time I had McDonalds, that I wait until Easter Sunday to have any Easter chocolate, or that I’d prefer to have liver for breakfast instead of Coco Pops. It really gets their goat. However, simultaneously, there are so many people in the Paleo camp who would look down on the way I eat, because I still consume dairy, or because I still eat from restaurants once a month or so (without checking ahead to see if they use vegetable oils, even!), or because I have a folder full of Paleo dessert recipes – after all, caveman didn’t have no chocolate cake, even if it was made with coconut flour!
Personally, I don’t think that my eating is severely disordered. I don’t think I have a perfectly healthy relationship with food, but I don’t think it reaches the clinical level. If anything, my relationship with food has become much healthier since transitioning to Paleo. I used to religiously weigh and measure every single morsel of food that passed my lips. I counted calories so closely and so fanatically, I could recite calorie counts from memory (tomatoes had 20 calories per 100g, 105 calories in an average banana, etc. etc.). I wouldn’t eat at a restaurant unless I had inspected their menu ahead of time – preferably it displayed kilojoule counts – so that I could determine what would be acceptable fare. I don’t do any of those things anymore, and I would say it’s a much more healthy approach.
Sometimes, I eat Neolithic foods, or at least foods that are only Paleo-ish. Sometimes, I eat at restaurants. Sometimes, I eat too much. Other times, like now, I undertake a program like the Whole30, where I don’t do any of those things – for a predetermined period of time. On the one hand, I monitor my intake very strictly and stick to foods that I believe to be the most healthy. On the other, if the apocalypse broke out tomorrow, I’d happily eat bread if it kept me alive. So I think I’m doing okay.
The Take-Home Message
Even though it is not yet a clinical eating disorder, I think orthorexia is a real concern, especially for the Paleo community. We can easily become bogged down in rules and scientific findings and restrictions, and there is a blurry line between passion and unhealthy disordered obsession. I would like to see us change the way we talk about food, and about ourselves and others in relation to food. This is something even I need to work on myself – I am definitely guilty of thinking certain foods are “evil”, and believing my food choices reflect my worthiness, but I think I’m making progress. More than anything, I want us to be aware, and to help those that need it. If you believe that you or someone you care about may be experiencing disordered thoughts or behaviours about eating, or if anything is stressing you out really, please contact Lifeline on 13 11 14, or visit http://thebutterflyfoundation.org.au/.
What do you think? Do you think orthorexia is a real concern? Have you ever experienced disordered eating, or known someone who has? How would you like to see the Paleo community handle this issue?