Orthorexia Part Three: Risks of Different Diets

Here's Part 1 and Part 2 of the Orthorexia series.

This weekend I was away in Utah at the inaugural Physicians and Ancestral Health conference. More on that later, but I'm linking now to Victoria's take. It was a terrific weekend, and I do want to take some time right now to thank Rick Henriksen, John Barret, and Lucy Flynn for organizing the conference. In addition I would like to thank Jacob Egbert for hosting me and inviting me to check out his incredible gym. We also got to work out at Ute Crossfit and meet some of the athletes who won the 2012 Crossfit Games.  In the midst of all that, I wasn't able to keep up with posting all the comments coming in. All of them should be up at this point.

Cayucas: High School Lover

Back to Orthorexia, a popular term coined by Steven Bratman, MD to describe those pathologically preoccupied with food and diet. His book, Health Food Junkies, is quite an interesting read, and a bit of an indictment of some of the alternative medicine scene (Bratman was an alternative practitioner before becoming an MD, and continued to practice many alternative therapies thereafter).

Anyway, a question arose in the comments of the first post about those of us who follow a paleo or primal-style diet. Is there something about the diet that could lead to Orthorexia? To answer that question, I'll go through some of Bratman's experiences with people in different diets that he thought were especially prone to go over the edge from careful, healthy eating into dietary obsession that interfered with daily life and functioning.

1) Food allergy diets: Bratman found that many people benefited from wheat and dairy removal for all sorts of ailments. But he tells of a number of different sorts of woo-woo sounding tests (bioelectric impedance, energy fields and muscle resistance while holding a vial of a food, and of course the infamous IgG tests*). Anyway, regardless of the method, people would invariably get a list of several foods they had a major intolerance to (almost always including dairy and wheat), and then a longer list of "minor intolerances" of random foods from tomatoes to onions to lamb or parsley or…you get the idea. So the person will get rid of the "major" intolerances and tend to feel a lot better. But there might be some residual lack of energy, or cramping stomach, or mental fog…so they eliminate all the minor foods. In general it is difficult to completely abstain from the off limits food, and people tend to binge or "cheat" and feel guilty, followed by renewed, stricter dieting. Every physical and mental symptoms gets correlated with some sort of food, and diets can get very limited, and life can revolve entirely around food. Ultimately, maybe the person would be happier with residual symptoms and a more varied palate.

I see the food intolerance route as the major avenue into Paleo/Primal Orthorexia. I feel great and my cellulite went away eating paleo…let's try an autoimmune protocol so those funny little red spots on my shoulder will go away…hmm, maybe the histamine in this food is making my nose run, or maybe the FODMAPS are causing that funny cramping I get sometimes…I'm just going to eat pemmican and see how that goes. Now sometimes these dietary trials are fun, interesting, and can lead to positive health changes. Sometimes they are annoying or even debilitating obsessions.

2) Macrobiotics: I had heard of this diet before, but never knew that much about it. The diet is based on Taoist principles and involves vegan foods balancing yin and yang. Mostly that seems to mean eating brown rice, little julienned and lightly sauteed vegetables, and spending a lot of time agonizing over the balance and beauty of the meal. You are also supposed to restrict water to some extent. This diet is perfect for people who get a thrill out of obsessing over food. Bratman practiced macrobiotics for a while, and claimed there is a particular look to people who ate that way:

The skin looks slightly darker than usual; it's tight, without any hanging folds or obvious smile lines. The shape of the face itself seems different, too, perhaps again due to the tightness of the skin. It's more angular, more like a polygon than a circle or an oval.

Like many vegan diets, it can lead to a feeling of lightness that is pursued by the practitioners. Macrobiotics preaches asceticism. Bratman tells a horrible tale of having to call child protective services on one macrobiotic couple who water-restricted their child as part of the diet.

3) Raw Food, Fruitarianism: Bratman felt that the raw foodists and fruitarians were among the most likely to fall into the deadly form of orthorexia, leading to undereating and starvation, or, as one of his patients who only ate raw vegetables did, passing out while driving and dying in an accident. These diets tend to lead to a feeling of airiness and lightness, a pursuit of separation and denial of the physical self. In some ways, the paleo-style diet, being meaty and hedonistic and filling (and more nutritionally complete than any vegan diet, though endurance exercise raw vegans can consume enough calories to get more mirconutrients than you would think) may be the opposite and reasonably unlikely to lead to deadly orthorexia.  However, intermittent fasting can also lead to that light and airy feeling, and one could take that too far.

4) Zone diet: The obsessing over macronutrient ratios, Bratman thought, could lead one into food obsessiveness in general. "Orthorexic Zoners spend much of their day talking about their diet and debating the fine points of their theory like Talmudic scholars using the works of Barry Spears as scripture." (Just replace some names here and you get the paleo/primal-style equivalent).  Bratman does mention the "caveman diet" in his book under "zone" as a "stricter version" of the zone involving eating wild plants (he mentions "weeds ripped out of a nearby wetland and scarfed raw like salad along with fresh deer" What?  He got his information from NeanderThin, which may be as weird a book as I would hope. Any of you read it?). Health Food Junkies was published in 2000. He might have had a field day with his paleo-style diet chapter today…wonder if he's ever been to Paleohacks?

5) "Pill Orthorexia" Bratman has a chapter for the supplement fanatics who come in with their bags of pills, looking for the perfect regimen, alternating between different chelates of magnesium and separating the calcium from the zinc and balancing the A, B, C and D…sound familiar?

All in all, finding the perfect diet reminds me of sanding and painting a wall. One can sand and sand with finer and finer grit, and paint layer after layer and obsess over imperfections for many days and weeks. But ultimately, one gets 90% of the way there, and the extra benefit becomes an asymptote that once can chase forever with increasing percentages of "perfection."

My father gave me some good advice when I was going off to college. He told me to try to get the lowest A in the class. That way I would have spent my time efficiently and collect those 4.0s while having hobbies and a life without making myself nuts trying to achieve the highest possible grades all the time. For the most part, for most people, I think diet is the same way.

*I remember in one of Chris Kresser's podcasts he said he sent off blood for two of these tests at the same time (they are expensive, maybe he got a bargain price ;-), and got back completely different results.