What is orthorexia?

Dietitian and food sensitivity expert Wendy Busse explains how an interest in healthy eating, often allied with food sensitivities, can turn into an unhealthy obsession.

Orthorexia is a preoccupation with healthy eating.

Those that suffer from orthorexia have strict rules about what to eat and experience anxiety or even panic if they deviate from these rules. There are a variety of beliefs about what health eating means, which vary between people, or even from year to year for the same person. Examples include:

• Raw Veganism: eating only an uncooked plant-based diet
• Paleo: avoiding foods that came into common usage since the invention of agriculture (such as legumes and grains)
• Clean Eating: avoiding pesticides, artificial fertilizers, artificial colors, foods seen as overly “refined” or “processed,” as well as other foods believed by the individual to be unhealthy or toxic.
• Food Sensitivities: eliminating a long list of foods believed to cause subtle or overt allergeric reactions
• Focusing diet on certain “superfoods”

Like all conditions, orthorexia has a spectrum of severity. Personally, I would be at the low end of the spectrum. I am more concerned about eating processed foods than most people. It occasionally causes problems with my children and husband, when I try to impose my rules on them. However, I enjoy some processed foods and rarely think about it beyond meal times.

Jacob is a family friend who is further along the spectrum. He avoids all processed foods and will not eat out (except a few trusted restaurants) and avoids social gatherings that involve food. His life revolves around making sure he sticks with his strict diet rules. He often lectures friends and family members about their eating habits and gets visibly angry if others do not agree with his rules. His fixation on food has significantly reduced his enjoyment with eating and life in general.

Is orthorexia more common in food sensitivity?

I’ve worked with food sensitive clients for over 25 years, and orthorexia has become an increasing concern. Most of the clients that I currently see are affected, to varying degrees. In some cases, orthorexia leads to food sensitivity as explained below, but in other cases, food sensitivity can lead to orthorexia.

How can orthorexia lead to an experience of food sensitivity?

One of my clients, Mabel, is a good example. At our first appointment, she had a long list of problematic foods. When we dug a little deeper, she had not experienced any definite symptoms when eating these foods but eliminated them because she felt they were unhealthy.

For example, she felt that nightshade vegetables caused severe inflammation and that everyone should avoid them (including me). When she reintroduced a small amount of bell pepper, she instantly felt sick and saw this as confirmation that nightshade vegetables were inflammatory. It is possible that she had an unusual reaction to bell pepper, but it is more likely that breaking her rule about avoiding night shade vegetables caused a sense of panic which is perceived as a food sensitivity.

How can food sensitivity be the cause of orthorexia? 

Food sensitivity is not a common route to orthorexia, but it can be a factor for some people.

Jodi is a good example.  She loved eating a variety of food for most of her life until she started experiencing digestive upset when she ate. It was unpredictable - sometimes a meal bothered her, but at other times, she could eat the same thing without symptoms. No one had answers, and she became very frustrated. She read fearful, misinformation about the dangers of grains on the internet. She also started wondering if her grocery store was spraying the fruit and vegetables with chemicals. She later experimented with her diet, and her digestive upset was a lot better when she reduced lactose, but her fear of food remained.

What are some “red flags” that a client may suffer from orthorexia?

I cannot diagnosis orthorexia since I am not a physician or psychologist, but these would be some signs. 

• Very strict food rules based on “beliefs”.  I would be less concerned if a client had “softer” rules, for example: “I’ve cut dairy out of my diet, but I eat some once in awhile.” Restriction based on objective (non-emotional) observation of benefit or a medical condition (e.g. strict gluten-free diet for celiac disease) are probably not related to orthorexia.
• Food dominates the client’s life. Clients that spend a lot of time and energy thinking about food are more likely to suffer from orthorexia.
• It has been suggested that individuals suffering from orthorexia often feel superior to others because they have more willpower to control their diet. However, I have not found this among my clients.   

If someone suspects they may suffer from orthorexia, what should they do?

Recognising the problem is the first (and hardest) step. Here are a few tips to help you on your journey to a better quality of life:

• Self – compassion is the most important component of every healing journey. Without self-compassion, true healing does not occur.  Orthorexia is very common, especially for those that spend time on the internet. Don’t be too hard on yourself. It is an easy trap to fall in.
• Be very selective about the information and social media you read.
  Observe how you feel when you engage in certain social media groups or read certain websites. Avoid the sources that increase your anxiety.
• Check out some credible online resources (stick with these, rather than getting sucked into “alarmist” information). Examples include:
• Orthorexia.com
• NEDA/Orthorexia
• Find professional support.  I work with clients to help them gradually expand their diet and enjoy eating. However, I am a registered dietitian, so if a client is experiencing severe fear, I suggest they consult a psychologist knowledgeable in this area, before working with me to expand their diet.  

June 2018

See here for many more articles on the emotional effects of allergy.

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