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Nutrition for Women

Orthorexia: When Healthy Eating Is Unhealthy

Turns out there is such a thing as eating too clean. Here's what you need to know about this latest eating disorder — and why you might want to dirty up your diet a bit.

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These days, a food is either classified as good or bad: Vegetables and fruit are righteous and “clean,” while cookies, ice cream and french fries are sinful, guilty pleasures. But in an era of hyper-focused diets — keto, Paleo, vegan, Mediterranean — these lines are getting blurred. Depending on who you ask, certain fruits and veggies have too much sugar, butter is a superfood, milk is a toxin and wheat — even the whole-grain variety — causes a belly pooch and flagging energy.

Skinny woman looking down at a small plate of vegetables

An unintended consequence of this food shaming is that, for some people, the quest to clean up their diets goes way overboard and they head down a path toward disordered eating. Maybe your initial goal was to kick your sugar habit, but you are now obsessed with reading labels and completely avoid anything sweet. Or perhaps a well-intentioned goal to banish processed foods now manifests as an irrational fear of anything sold in a package. Regardless of how you arrived there, you might be eating too clean — and are ironically now putting your health at risk.

A New Nervosa

While healthy eating is important for your overall health and fitness gains, it is not uncommon to take it too far. “Orthorexia nervosa occurs when someone goes overboard in their quest for healthful eating to the point where it becomes pathological,” says Thom Dunn, Ph.D., professor of psychological sciences at the University of Northern Colorado.

He explains that an individual with orthorexia genuinely believes that they are working toward healthy eating by restricting and avoiding certain foods in the hopes of sidestepping various diseases or diet-related symptoms and end up creating overly stringent and rigid rules based on their perception of what clean eating should be. Individuals with orthorexia also may use their diet to achieve a feeling of perfection, purity or superiority. “They can be preachy about eating and may feel judgmental toward those who don’t follow their narrow definition of a healthful diet,” Dunn adds.

While this form of disordered eating isn’t as widely recognized as other types such anorexia or bulimia, Dunn stresses that orthorexia can have severe social, mental and health consequences. “If your friends no longer want to hang out with you and you’ve ruined romantic or work relationships because of your self-imposed rigid eating requirements, it’s a red flag for orthorexia,” Dunn says. After all, it’s hard to order off a menu if you only eat strictly alkaline ingredients or are restricted to meats that come solely from animals that ate gluten-free.

An exaggerated fixation on healthy eating and associated social withdrawal also can spiral into mental issues. “The extreme guilt you feel if you happen to eat something you don’t think is clean enough can [cause] anxiety, depression and feelings of self-hatred,” says Jennifer Mills, Ph.D., associate psychology professor at York University in Toronto.

Mills recently co-wrote a study that revealed that those who have a history of an eating disorder, obsessive-compulsive traits, poor body image and a drive for thinness are at heightened risk for developing this unhealthy fixation. “With orthorexia, the intense and pronounced fear of eating any food you are trying to avoid can be debilitating, and meal planning becomes almost impossible to sustain,” Mills adds.

There is also data to indicate that those who are obsessed with exercise are also at greater risk for developing orthorexia tendencies: According to the National Eating Disorders Association, warning signs and symptoms of orthorexia also include eliminating an increasing number of food groups such as carbs and dairy, compulsive checking of ingredient lists and nutritional labels, obsessively following healthy lifestyle blogs and social media accounts, and feeling high levels of distress when healthy foods are not available.

Aside from social and emotional issues, orthorexia also can cause physical health problems, especially for those who eschew a laundry list of foods, including grains, dairy, sugar, red meat and even legumes. “Over time, these restrictions can lead to malnourishment and excessive loss of muscle and bodyweight,” Dunn says. Deficiencies in everything from iron to protein to calcium can occur when orthorexia takes hold.

Researching Orthorexia

Risk Assessment

While there is a lack of hard science regarding the prevalence of orthorexia, and it has yet to be formally recognized as an eating-related mental health disorder like anorexia and bulimia, experts agree that orthorexia seems to be on the rise: A study in the April 2019 issue of The American Journal of Clinical Nutrition determined that eating disorders remain common among women and that their prevalence had actually increased between 2000 and 2018. And with increased interest in healthful eating driven in part by the internet and social media, the pervasiveness of orthorexia may be mushrooming.

“We have more access than ever to nutrition information from sources like diet books and social media, which can be problematic for those who are vulnerable to taking even dubious messages about healthy eating to the extreme,” Mills explains. “Social media has made it easier for people to share their personal food beliefs and for others to latch onto them.”

A recent study published in the journal Eating and Weight Disorders suggests that those who have an Instagram feed dominated by imagery of beautiful, clean foods have a higher prevalence of orthorexia, with more orthorexia symptoms being linked to higher Instagram use.

Surprisingly, gender does not seem to be a risk factor. “Unlike other eating disorders, cases of orthorexia appear to be fairly equal in both men and women unlike other eating disorders,” Mills notes. The reason for the parity might be that orthorexia is more driven by the desire to eat healthier than by perceived body image.

Woman on phone uninterested in eating

Are You At Risk?

How can you determine whether you’re at risk for orthorexia — or if you’ve already arrived at its door? “Ask yourself if you’re giving too much thought to what you’re eating, if you feel extremely anxious or guilty when eating something not considered healthy, or if you have lost all enjoyment in eating and are eating in isolation,” Mills says. “If you answer yes to any of these, it’s a red flag for potential orthorexia.”

All that being said, Dunn cautions that simply adopting a certain diet, whether based on sound science or pseudoscience, doesn’t mean someone has orthorexia. “If there are no social, mental or physical consequences due to your eating habits, then you don’t have orthorexia,” he says. In other words, if you prefer to make pizza with cauliflower crust over wheat crust doesn’t mean your desire for healthy eating has gone too far.

Clean Eating— Done Right

Being overly obsessed with clean eating is not healthy for your body or your mind, but it’s still preferable to maintain a diet that focuses on nutritious, whole foods than to go hog-wild with your nutrition. Here’s how to be sane about eating clean.

Loosen up

“Have guidelines but not rules, and think about how your diet could be better balanced by including a variety of foods,” says Rebecca Scritchfield, RDN, author of Body Kindness: Transform Your Health From the Inside Out — and Never Say Diet Again (Workman Publishing, 2016). “Try to view healthy eating as a pattern of choosing more nutritious foods while still leaving room for items like ice cream that you might desire at certain times.”

One popular approach is the 80/20 method in which 80 percent of the time you choose clean, healthy foods and the remaining 20 percent is open for “cheats” or “vice” options. This gives you all the nutrition you need for great health and fitness gains while eliminating cravings and feelings of restriction and guilt. Scritchfield also suggests writing a list of 10 foods you would love to eat if their health merits didn’t matter, then finding room for those in your diet.

Vet your sources

From the dangers of soy to the virtues of juice cleanses — take what you read online with a huge grain of salt. Many times, advice from celebrities and social media influencers is based on personal opinion rather than hard scientific research and knowledge from the true experts like dietitians is sidelined. If it sounds too good to be true (i.e., cutting out sugar cures diabetes) or not really plausible (eat more bacon and less fruit for better health), then it probably is. Real research shows that for most people, a diet that includes more — not fewer — whole foods, such as fruits, vegetables, whole grains, legumes and unprocessed meats, is key to a healthy body.

Reframe the message

Stop beating yourself up and feeling shameful about occasionally “cheating” on your diet and reword your thought process. For example, instead of thinking, If I eat pizza, it’s over, come up with an alternative thought process such as, I like pizza and I want to enjoy it with friends or family, Scritchfield suggests. This will reduce your need to strictly control your diet, which can unravel into disordered eating. “Learning to be more relaxed when it comes to your dietary rules may help you create a better eating pattern so you get more enjoyment out of your food,” she says.

Do a social media detox

Platforms such as Pinterest and Instagram can indeed provide #foodporn, but they also can spread fear. If your food-following tendencies make a trip to the grocery store stressful, it might be time to unplug. Alternatively, use your own social media outlets to proudly flaunt some of your not-so-clean or picture-perfect food choices. This hunger for real-world food photos can set you up — and maybe a few of your own followers — for a more level-headed way to live.

Ask for help

“If your clean-eating food rules have gotten in the way of a joyful life, it’s probably time to talk to someone,” Scritchfield advises. “A professional who works with eating disorders is a good place to start, even if you don’t believe you have an eating disorder.” Thankfully, orthorexia is becoming better understood among professionals like dietitians and psychologists, and treatment usually involves a combination of nutrition and psychotherapy to guide a patient back toward healthy eating — mentally, socially and physically.