Orthorexia in the Paleo/Primal Community: Further Considerations

I knew Friday's post on orthorexia would hit a nerve, but didn't anticipate it would gather steam quite as fast as it did…and (for my moderated blog) a bit of a lively discussion has developed in the comments, raising some important questions and concerns. Thus worthy of a Part Deux. There will be (maybe somewhat irreverent) digressions based on my personal and clinical experiences rather than a Pubmed literature review. So here we go.

Citizens True Romance

1) What about the kids? Are we raising a bunch of gluten-free dairy-free peanut-free neurotic orthorexics?

A subject close to my heart, as the mother of three and five year old little girls, who mercifully have (knock on wood) no health problems or body image issues. In fact, the three year old, who lives life with gusto, invariably runs around the room with her arms upraised giggling whenever she is naked (at least twice a day, with changing back and forth into PJs and clothes and tubby and spilled things, etc.) because being naked and free is clearly just so awesome. Now I know several adult men who still think this way (you know who you are), but I don't know any women who do. Which is sad. Someday soon my kids will start worrying about their thighs. Ugh.

I don't want my children to grow up neurotic about food. On the other hand, when you look at the advertisements and the grocery stores and the incentives out there, popular kid food is pretty wretched, processed, sugary, blue gooey crap. Kids have growing brains and bodies and need appropriate nutrition to fuel that growth.

(Speaking of incentives, one of the things that really bugs me about my daughter's pre-school is that they require than lunches and snacks be brought in recyclable containers. That sounds all good and responsible on the face, but "real food" is bulky, requires more prep, and my little girl has a good appetite. If I try to cram some orange slices in a plastic baggie into the top little space left in her lunch box, I get a supercilious little paper reminder of the rules that comes back in her empty lunchbox. Meanwhile, pre-wrapped convenience food is allowed (I suppose it would be ridiculous to tear the goldfish crackers out of the snack pack and pour it into a little bowl with a plastic top). So, parents being busy and kids being kids and no one liking to get obnoxious notes, most of the kids get pre-wrapped convenience foods like juice and gogurt and little packages of goldfish crackers for snacks because its easy and it fits.)

So all thoughtful parents have to find a line between running after little Jimmie and ripping the cupcake out of his hand as he sobs at the birthday party (unless there is particularly good reason) and raising little sugarized zombies who only eat rice krispie treats, lunchables, and dinosaur shaped fried chicken nuggets. I tend to have my kids eat what I eat when I'm cooking and not make a big fuss about it. But they have cookies and whatever at parties and on play dates and when their father brings one home, and I also don't make a big fuss about it. If the five year old asks me why I don't drink milk, I just tell her it upsets my stomach or something of that nature. I do make it clear that we should eat mostly "healthy food" and that the sugary candy and processed stuff doesn't nourish our bodies and brains like we need, but it can be happily enjoyed as an occasional treat. Now there are many tales of kids with behavioral and health issues that respond to taking some major players (like gluten, for example) completely out of the diet, and those parents have to draw the line a little further than I do.

Bratman's book, Health Food Junkies has some horror stories about moms with food allergies diagnosed with some sort of naturopathic test using electric voltage changes in the skin (or the IgG tests) who put their kids on crazy restricted diets too, and little four year old Jane babbles about not eating chocolate, oysters,  tomatoes and yak meat because it gives her migraines. I think we need to be very careful about restricting diets too much and putting too much importance on every molecule of food that goes into our mouth or those of our kids. That's also why I tend to prefer the Paleo 2.0 ancestral "real food" approach which includes dairy (particularly fermented) and cooked legumes (except most soy and peanuts), potatoes, and rice for everyday eating and things like 80/20 rules so we can enjoy anything we want from time to time and not wig out about it.

2) Orthorexia is just a BS problem for bored yuppies and everyone should just get a new hobby already.

I've been advised by some to completely ban Itsthewoo from my blog because she can be quite aggressive, and frankly I have to steel myself whenever I see the email pop up that she has commented, but she can be entertaining and has some penetrating observations. Her original comment was a bit beyond the pale, but fortunately she allowed me to moderate it for "public consumption." I didn't moderate it that much. This comment is a bit of a poke at psychiatry in general and the explosion of diagnoses and are we just trying to medicate and treat everyone to be a brave new world sort of useful worker for their mismatched sock disorder and weird goth teenager disorder and most of mental illness doesn't actually exist.  My response is that orthorexia is a popular term for kind of food/health anxiety that can be very debilitating and, in some rare cases, fatal (Bratman's book, which is very good and has some hilarious statements such as "tofu is healthy" details several such cases). I would also say that just being a little anxious about what you eat or paying attention to what you eat or trying to eat healthfully is NOT orthorexia. It's when healthy eating crosses the line and becomes the entire focus of your life, and that focus disrupts your life or your relationship with your loved ones. Life is short, and there is more to life than food, and food should be enjoyable and sometimes fun, not a always penance or a purification ritual. Orthorexia is almost never as dangerous as anorexia or bulimia nervosa, and I don't think anyone would argue that.

3) Should eating disordered people be handing out advice about eating disorders?

Actively eating disordered folks could give out some pretty bad advice (consider the ana and mia forums, and if you don't know what that is, you are better off and the world is a brighter place for you, though if you are a health care professional or the loved one of someone with eating disorders you should know what that is). I can't get all bent out of shape about people who are in recovery from eating disorders counseling others, because in treatment settings it is often people who have had eating disorders or relatives with eating disorders who dedicate their lives to treating them. Eating disorders are tough, heartbreaking, and difficult to treat, and it takes a special sort of motivation and energy. In general these settings are supervised and work along standard lines, and there are some treatment models quite similar to AA, with peer counselors and sponsors. Should random bloggers be doling out advice about eating disorders and should be people be getting medical/nutritional advice from random bloggers? Random bloggers can and will say whatever they care to, for the most part, and people ought to consider what they take as fact or wisdom from the internet, obviously.

4) Is low carb dieting (and, particularly, the mythos behind low carb dieting, that carbs=insulin=burnt out pancreas and diabetes and foot ulcers) a fast lane pass to an eating disorder?

I'm reminded of the "Ask the Paleo Experts" panel at PaleoFx12 where I suddenly became a "Paleo Expert" because Chris Kresser hadn't been told (apparently) that he was supposed to be on this 8:20am panel, had slept in a little, and I was around and available. This incident occured at the height of the carb wars (sigh) and I put in my little push for bananas and starches as most bodies can very efficiently and happily process glucose with little to no problems, and being metabolically flexible (being able to process both fats and glucose with pleasantly clean and efficient mitochondria) is associated with the healthiest people. Nora Gedgaudus, Jack Kruse, and Ron Rosedale sort of cluck-clucked that very young sorts of people (and I do look very young) could unwisely consume the poisonous glucose that obviously ages you and kills you dead…but that the wise elders would never consume starch (in the winter for one, pretty much at all for the others). Yes, I think that sort of view can instill some unwarranted anxiety and fear in people. On the other hand, low carb and ketogenic diets can be very helpful and useful for certain conditions. In my practice I've seen some people get pretty anxious and overly burnt out and and troubled who came in on essentially zero carb diets who tend to be happier and healthier eating starch. I don't know if it was the carbs that made them better or the lack of worrying about carbs that made them feel better. I tend to favor higher-end low carb diets (like perfect health diet) and higher-carb end ketogenic diets (with MCT oil/coconut oil supplements to allow for more carb consumption) because they tend to be more flexible, easier, and less restrictive of a wide variety of foods.

5) Does Paleo dieting put you at particular risk for something like orthorexia?
I'm running out of time this morning! I feel like Robb Wolf and his carbohydrate manifesto. This one has a lot of interesting bits so I will wait to address it in Part Three.