I always had stomach problems growing up and into young adulthood. You name it, I had it – indigestion, pain, bloating, gas, even an ulcer. I went to doctors, had unpleasant and even invasive tests, but no one could tell me what was wrong, and nothing seemed to help. No one I went to for help asked what I ate.
Finally, after a GI doctor “diagnosed” me with “a bad stomach,” I gave up, figuring this was just my lot.
Then, seven years ago, out of curiosity, I participated in an elimination diet with a group, under the guidance of a dietitian. For two weeks, we were to eliminate wheat, soy, corn, sugar and all other sweeteners, dairy, alcohol and even coffee (ouch!).
Not-so-great expectations – but surprising results
I wasn’t expecting much. I was already a conventionally healthy eater, eating lots of vegetables, whole grains, beans and light on the meat. I didn’t think I ate that much dairy – I didn’t give it much thought. Same for sugar. So I figured it would just be an exercise.
Within 48 hours, my “bad stomach” was cured. I had no symptoms at all. I felt the best I ever had in my life. I could eat a meal and not have pain or discomfort after, something I had never experienced before. I was brimming with energy, sleeping better, feeling sharp and alert. After the two weeks were up, I experimented further, and I found that I do best without legumes and grains (except white rice), with very limited dairy and almost no refined sugar. (Thankfully, coffee wasn’t an issue.) And today, I’m stronger and healthier than at any other point in my life so far, and absolutely free of the stomach problems that plagued me for decades. Great, right?
The buzz about orthorexia
Then, over the last few months, I started seeing an uptick in social media posts from dietitians and wellness influencers saying that limiting your diet is akin to disordered eating, that any dietary style that cuts certain food groups is restrictive (and therefore unnecessary), that if you avoid gluten but don’t have celiac, for example, you’re falling for marketing or celebrity influence and harming yourself.
Orthorexia – an obsessive focus on “healthy” eating – is a condition that’s gained a lot of attention recently. Though it’s not recognized in the American Psychological Association’s Diagnostic & Statistical Manual of Mental Disorders, the go-to guide within the mental health and psychiatric world, experts do see orthorexia in clinical practice, and research links it to social media use, especially Instagram.
So if you’re someone who watches what they eat and even tries out things like the keto diet or going vegetarian or other eating styles, does that mean you have an eating disorder? When is it healthy experimentation and self-care, versus worrisome, extreme behavior that may require professional intervention?
“Eating disorders are highly driven by fear,” says Dr. Kathy Chen, PsyD, LP, director of clinical programming at New Oakland Family Centers in Michigan. “That leads to a lot of food rules, food judgment and significant psychological inflexibility. Eating disorders are characterized by rigid thinking, and usually that impacts that person’s quality of life and their relationships with others.”
Not sure if it’s healthy eating or orthorexia? Here are warning signs:
1. You feel very anxious about food
One red flag is “a lot of emotional distress, especially during meal times,” notes Dr. Chen. This can show up as “a hyper focus on food labels, a hyper focus on where the food is sourced, obsessive thoughts about eating only healthy foods.”
For people with orthorexia, food shopping can be a cause of extreme anxiety. “They might become confused about what to buy,” notes psychiatrist and trained chef Dr. Uma Naidoo, author of This Is Your Brain On Food. “They become conditioned to only buy certain foods. And now that they’ve restricted their diet in a particular way, they wonder what they should include, what they shouldn’t include, what should they buy?”
2. You avoid events and social interaction because of food
If food interferes with your relationships or social interaction, that can be a warning sign, Dr. Naidoo says.
People suffering from orthorexia “tend to be very isolated,” Dr. Naidoo says. “They tend not to eat with other people because they’re so carefully managing what they’re focused on eating that they perceive to be healthy.” Skipping holiday meals, avoiding social events and feeling fearful of dining out are all potential warning signs.
3. Your self esteem is wrapped up in how you eat
If you feel good about yourself when you think you’re eating well, and experience anxiety or guilt when you think you aren’t, that’s a potential red flag, Dr. Naidoo says. Someone with orthorexia will be “rigid, managing what they eat so tightly. And then they have a lot of worry associated with those foods and with their own health. They might spend several hours a day worrying about it. And if they veer from that rigid plan, they become very guilty if they step outside of that and eat something else.”
4. Self-punishment plays a role
Research shows that guilt can sometimes show up as self-punishment, such as over-exercising. The guilt, shame and fear also can lead to a refusal to eat. “It can be like anorexia, [especially] if there is a body image concern with it,” Dr. Chen says. “It might lean toward anorexia nervosa. Sometimes what we see is a clear refusal, especially with the younger patients, to eat when they’re at home. It’s a recurring pattern and maybe they’re voicing, ‘I don’t want to gain weight.’ It can be that clear sometimes.”
When it’s not orthorexia
Of course, it is possible to experiment with your diet and play around with adding or subtracting foods in a healthy way.
“One of the things I always say is, any good food is not necessarily good for you. Meaning that even a good food may be problematic with someone because it may not, for whatever reason, agree with you,” Dr. Naidoo says. “With the science of the microbiome and the gut-brain axis, we know the gut microbiome is so unique to each one of us. If you or I eat the same healthy food, we may not have the same response.”
If you feel uncertain about how to experiment with your diet, you can try a program like Whole30, which has resources and community built in, as well as a specific start and end date. Or, if you’re concerned that your eating style might be disordered, or you might have a tendency toward disordered eating, you can work with a dietitian or nutritional psychiatrist to get personalized, expert guidance – the opposite of what you’ll often find on social media.
“What tends to happen on social media and other platforms, is people are trying to share good information and even qualified professionals are trying to do that,” Dr. Naidoo says. “But I really don’t feel that calling people out and labeling people is helpful, especially as a mental health practitioner, when you don’t have a clinical relationship and you’re not sure what the full picture is.”
As for me, my so-called restrictive diet has been incredibly freeing. I don’t have to worry anymore about how I’m going to feel after eating, and knowing that allows me to be more social, not less. If I go to a friend’s place or an unfamiliar restaurant, I never have trouble finding something to eat, and sometimes that means being more flexible than I tend to be on my own.
I’m one example of someone who cut out whole food groups who is not orthorexic, so it is absolutely possible. Ask yourself, does your eating style make you feel better, or worse? If it enhances your life, rather than limiting it, you know you’re on the right track.