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Hold That Paleo Line: Checking Labels? Reading Health Blogs? Going Organic? That Doesn’t Mean You’re ORTHOREXIC

By David Whiteside
September 5, 2018
Hold That Paleo Line: Checking Labels? Reading Health Blogs? Going Organic? That Doesn’t Mean You’re ORTHOREXIC image

New Paleo dieters face heavy social and cultural resistance.

Besides all the usual challenges, like giving up fast food, processed food, grains, legumes, dairy, sugars, seed oils and all the rest, they have to overcome a lifetime of media, academic, and government conditioning.

This acculturation affects friends, family and acquaintances as well as the dieter. Input from this social sphere generally resists the perceived “drastic” steps Paleo dieters must take—even in the face of dramatic health and body composition improvements.

Worse yet is the inconsistent reception new dieters get from the medical profession. Many physicians remain nonplussed and are often under-educated or even hostile to Paleo and other diets that avoid refined carbohydrates, industrialized grain- and seed oil-based foods.

Most Paleo dieters have grown up hanging on their doctor’s every word and lack of firm physician support can quickly undermine their resolve.

Dietitians often abet this confusion, as most still cling to the conventional “food pyramid” paradigm (low fat, high fiber, heavy on refined carbs.)

Dietitians may also be the first to suggest that many of the new dieter’s behaviors might indicate an eating disorder called orthorexia nervosa.

Orthorexia Nervosa: Making yourself sick pursuing health?

Dr. Steven Bratman coined the phrase “orthorexia nervosa” in 1996, when he published the book Health Food Junkies. [1]

He used the term, casually at first, to describe obsessive behaviors related to “healthy eating” or “pure foods.” Dietitians and mental health professionals gradually adopted it as a diagnostic descriptive term.

Public awareness grew also, mostly on the Internet.

Today, orthorexia--though never acknowledged by the medical profession as a formal diagnosis--is now prominently featured on the National Eating Disorders Association website. [2]

The NEDA discusses orthorexia with the same gravity as bulimia, anorexia, pica and other “accepted” obsessive or compulsive eating disorders.

The condition can be fatal. On his website, Dr. Bratman describes an instance of orthorexia-induced starvation, leading to heart failure. [3]

Grave health problems should be taken seriously--but as orthorexia surfaced on social media and the Web in the early 2000’s, many expressed doubts or even hostility both toward the concept and Dr. Bratman himself.

What, exactly, is orthorexia?

Dr. Bratman calls it “an unhealthy obsession with healthy food” and considers it similar to anorexia.

The NEDA website [2] gives these “warning signs and symptoms:”

  • Compulsive checking of ingredient lists and nutritional labels
  • An increase in concern about the health of ingredients
  • Cutting out an increasing number of food groups (all sugar, all carbs, all dairy, all meat, all animal products)
  • An inability to eat anything but a narrow group of foods that are deemed ‘healthy’ or ‘pure’
  • Unusual interest in the health of what others are eating
  • Spending hours per day thinking about what food might be served at upcoming events
  • Showing high levels of distress when ‘safe’ or ‘healthy’ foods aren’t available
  • Obsessive following of food and ‘healthy lifestyle’ blogs on Twitter and Instagram
  • Body image concerns may or may not be present

Orthorexics seek “purity,” not necessarily weight loss--though they may effectively starve themselves thin (like anorexics) by restricting supposedly impure or unhealthy foods.

Adverse health impacts range from social (withdrawal, estrangement, superiority complex, unbalanced or extreme food-related behaviors) to major medical: malnutrition, starvation, neurosis and death. [4]

Controversy over signs and symptoms

Taken at face value, the inclusion of ingredient-checking, sincere concern over ingredients, cutting out certain food groups, keen food- or health-blog interest, and distress over lack of healthy food choices seems provocative—possibly even targeted at dieters who resist conventional paradigms.

Large, successful populations of these dieters, including thousands of Paleo adherents, routinely implement these behaviors. The perceived demonization of these widely accepted practices has generated pushback.

Many see this “diagnosis” as suspiciously aligned with corporate and government interests.

Dr. Bratman’s website includes a “hatemail” page, showing accusations of collusion with government, Big Pharma, and other corporate interests. [5] (Dr. Bratman reports that he has made very little money from his original book, and has no financial relationship with any of the above-named entities.) [5]

He also clarifies that healthy dieting, itself, is not obsessive behavior.

The unfortunate power of medical language

Nevertheless, the new dieter or casual reader can easily be alarmed when told they are showing symptoms of an eating disorder. Articles like Orthorexia: do you have an unhealthy obsession with healthy eating? by Emily Fonnesbeck surface periodically, reminding the public of “the dangers of eating clean.” [2]

Readers outside the medical profession may also be confused when dietitians and psychologists express this apparent concern, but also mention that “orthorexia is not an official diagnosis.”

(The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, also called “the DSM” or “DSM-5,” does NOT include orthorexia as a separate, stand-alone eating disorder. Literally, providers can’t code bills for treating orthorexia yet.) [7]

None dispute that “orthorexic” patients, who pathologically obsess over “healthy” diet and food behaviors, really exist. For now, most providers classify and treat these genuinely ill persons similarly to anorexic or OCD patients.

However, careless (or carefully selective?) use of the NEDA symptoms list and medical terminology should still be viewed with suspicion. All too often, hasty or undiscerning readers will assume they are ill—when in fact they are not.

Stampeding gullible or tentative dieters using this language can only serve—artificially and needlessly--to increase the patient population.

Heal the sick, not the dieters.

Eating disorders can be very serious. Raising awareness of any eating disorder can save families and lives. Any information that brings a truly ill patient in for treatment is good information.

Paleo newcomers must also remember that strict dietary observance is not obsessive behavior--and that conscientious dieters don’t need to be herded into medical be screened “just in case.”

Dr. Bratman’s website offers his authorized “orthorexia self-test,” which clearly distinguishes between normal and obsessive dietary pathways. Interested readers should try it. [8]

[Author’s note: this article is not meant to disparage any health condition. No one should ignore any eating disorder. See your doctor if you think you are ill.]


[1] Introduction to orthorexia nervosa by Dr. Steven Bratman, retrieved here

[2] National Eating Disorders Association introduction to Orthorexia, including the video “The Dangers of Dieting and Clean Eating,” retrieved here

[3] History of a patient’s demise, recounted by Dr. Steven Bratman, retrieved here

[4] Health consequences of eating disorders from the National Eating Disorders Association website, retrieved here

[5] “Hatemail” page at the website of Dr. Steven Bratman, retrieved here

[6], “Orthorexia: do you have an unhealthy obsession with healthy eating?” by Emily Fonnesbeck, RD, 6/26/2018, retrieved here

[7] American Mental Health Foundation, “Orthorexia Nervosa: not in the DSM-5” by Evander Lomke, 11/7/2016, retrieved here

[8] The Authorized Bratman Orthorexia Self-Test, created by Dr. Steven Bratman, retrieved here

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