Orthorexia: When Does “Healthy Eating” Become Unhealthy?

A well-intentioned nutritionist friend recently expressed concern that encouraging someone to get nutrients from food could lead them to become “orthorexic”. 

Say, what?!?!? 

Could teaching people to coordinate their macronutrients and micronutrients to align with their goals (as we do in the Micros Masterclass) really be a bad thing? 

Could guiding people to focus on getting the nutrients from the food they eat promote unhealthy behaviours?

It made my head spin with questions. 

This article is my attempt to understand orthorexia and how we can avoid an unhealthy obsession with eating. 

The Bottom Line

To cut to the chase, orthorexia occurs when your belief-based dietary approaches conflict with your body’s nutritional needs.  As a result, your arbitrarily chosen nutritional approach clashes with your healthy appetite signals. 

Foods that are subjectively believed to be “bad” (for whatever reason) are seen as “unclean” for breaching self-set criteria.  People become wracked with guilt for desiring foods that are deemed to be off-limits by their dietary beliefs.  We then develop an “unhealthy relationship” with food when our conscious mind tries to restrict us from eating what we believe to be “bad”. 

This “bad food” vs. “good food” paradigm creates an unnecessary and unsustainable conflict between our beliefs and our appetite to obtain adequate energy and essential nutrients. 

This struggle for dominance between our neocortex and our reptilian “lizard” brain eventually drives us “mad”, or at least to have a diagnosable disordered eating. 

But if we give the body the nutrients and energy it needs, then our lizard brain stands down. 

Once you make peace with your inner lizard, you can enjoy your life without needing to be so food-focused! 

What is Orthorexia?

Anorexia nervosa and bulimia nervosa are eating disorders directly recognised by the American Psychiatric Association.   

By contrast, “orthorexia” is not officially recognised as an eating disorder.  However, it shares some common elements of both conditions. 

“Orthorexia is an obsessive-compulsive process characterised by extreme care for and selection of what is considered to be pure ‘healthy’ food.  This ritual leads to a very restrictive diet and social isolation as compensation.  Orthorexics obsessively avoid foods that may contain artificial colours, flavours, preserving agents, pesticide residues or genetically modified ingredients, unhealthy fats, foods containing too much salt or too much sugar and other components.  The way of preparation, kitchenware and other tools used are also part of the obsessive ritual.”  (Bartrina, 2007)

Notice the above definition uses the word obsessive three times

At the risk of sounding obsessive, let me clarify: orthorexia isn’t contagious.  You can’t “catch” it by taking our Micros Masterclass

But where do you draw the line between healthy eating and becoming obsessed with trying to eat in a way that you believe to be “healthy”? 

The Origin of Orthorexia

The term “orthorexia” was first coined in 1997 by Steven Bratman and is derived from “orthos” – which is Greek for “right.”  

In this essay, Bratman describes his life as a chef in a vegan commune.  Practising his craft among Zealots while cleaving to a list of conflicting food beliefs and sanctioned food preparation techniques challenged his skills and sanity. 

In his essay, Bratman outlines some criteria that may define someone  as “orthorexic”:

  1. I spend so much of my life thinking about, choosing, and preparing healthy food that it interferes with other dimensions of my life, such as love, creativity, family, friendship, work and school.
  2. When I eat any food I consider to be unhealthy, I feel anxious, guilty, impure, unclean and/or defiled; even to be near such foods disturbs me, and I feel judgmental of others who eat such foods.
  3. My personal sense of peace, happiness, joy, safety, and self-esteem is excessively dependent on the purity and rightness of what I eat.
  4. Sometimes I would like to relax my self-imposed “good food” rules for a special occasion such as a wedding or a meal with family or friends, but I find that I cannot.  (Note: If you have a medical condition in which it is unsafe for you to make ANY exception to your diet, then this item does not apply.)
  5. Over time, I have steadily eliminated more foods and expanded my list of food rules in an attempt to maintain or enhance health benefits.  Sometimes, I may take an existing food theory and add to it with beliefs of my own.
  6. Following my theory of healthy eating has caused me to lose more weight than most people would say is good for me or has caused other signs of malnutrition such as hair loss, loss of menstruation, or skin problems.

In a subsequent article, Bratman adds the following clarification:

“Enthusiasm for healthy eating doesn’t become “orthorexia” until a tipping point is achieved and enthusiasm transforms into an obsession.  Orthorexia is an emotionally disturbed, self-punishing relationship with food that involves a progressively shrinking universe of foods deemed acceptable.

“A gradual constriction of many other dimensions of life occurs so that thinking about healthy food can become the central theme of almost every moment of the day, the sword and shield against every kind of anxiety, and the primary source of self-esteem, value and meaning.  This may result in social isolation, psychological disturbance and even physical harm.”

It would benefit us all to pay attention to Bratman’s observations on orthorexia.  Just as his perspectives serve as a cautionary tale, they also are reassuring.  

Orthorexia is a neurotic obsession with healthy eating.  This is to say that it’s a pathological obsession and not a simple menu choice.  

Conversely, as you will see, prioritising foods that correct nutrient deficiencies and optimise nutrition is arguably the best recipe for actively avoiding orthorexia.

Perusing nutrient density broadens your horizon to new and varied foods and taste sensations.  You can also prioritise the nutrients in your food in any dietary framework, whether it be paleo, vegan, keto, vegetarian, Mediterranean or carnivore, to ensure you’re getting the nutrients you need within your preferred dietary regime.

The Rise of Orthorexia

The term “orthorexia” gained recognition by mainstream social media in 2015 when raw vegan Instagrammer Jordan Younger “The Balanced Blonde” announced she was orthorexic.  She described how her motivation to eat healthily became obsessive to the point of malnutrition. 

As an aside, Dr Bratman notes on his blog that vegans, fruitarians, and those following similar lifestyles that are not allowing them the nutrients they need from their restrictive diets are much more likely to become orthorexic. 

Adequate macronutrients and micronutrients can be harder to find on vegan, fruitarian, or other extreme belief-based diets.  This can ultimately contribute to depression and anxiety, as these nutrients are needed to make feel-good neurochemicals.  Jordan’s experience was an exemplar of “healthy” eating gone obsessively wrong.

You could probably add “social media influencer with a large following whose income depends on maintaining an external appearance” to likely risk factors for orthorexia.

Obsessive-compulsive tendencies and pre-existing eating disorders like anorexia or bulimia are other risk factors for orthorexia.  You are also at a higher risk of becoming orthorexic if you have tendencies towards perfectionism, OCD, high levels of anxiety, or an increased need for control.

While social media can help support people and teach nutrition principles in a supportive and interactive way, there can definitely be downsides.  When a group of media-linked people believes that certain foods are “bad” and prolifically disseminate that message, eating habits can become rigidly rule-based within that population.  Unhealthy levels of groupthink and “cyberchondria” can flourish when we each have our own personalised social media feed reinforcing what we believe is true.

“Optimal Foods” Vs. “Good and Bad Foods”

Rather than providing what your body needs, “healthy food” is unfortunately defined more often by what we should avoid or exclude (i.e. calories, saturated fat, cholesterol, sugar, carbs, fat, plants, animals, dairy, oxalates, anti-nutrients, etc.).  This optimisation by exclusion of ‘bad’ comments of food leads to rediculous conclusions!

Sadly, defining what we should eat by what we should avoid quickly sets us up for disordered eating.  We often get into trouble when we think about “good food” vs. “bad food” without considering context or goals.  For example, you could argue that a doughnut is optimal for a starving caveman.  However, regular doughnut consumption is unlikely to be optimal in our modern food environment saturated with energy-dense, nutrient-poor hyperpalatable foods. 

Foods like doughnuts will lead most of us to consume more energy from nutrient-poor foods than we require because processed foods are intentionally designed to trigger our binge response.  This makes it difficult for our conscious mind to maintain control.   

Conversely, once you focus on food quality, your reptilian brain, sweet “Lizzy”, settles into snooze mode once she is content that no imminent emergency or famine requires her preemptive binge response.  

While “eat less and move more” and “calories in versus calories out” are scientific realities, they’re often too simplistic to actually be helpful in our daily reality.  They also blame the individual and shame them for lack of “willpower” and poor impulse control when they can’t regulate their energy intake, no matter how hard they try. 

But the reality is that we’re set up to fail in our modern food environment when we are wired to eat.  Rather than exerting more conscious willpower, we need to work to control our setting. 

While we need to accept personal responsibility for what goes in our mouths, restricting food quantity without any consideration for food quality is a fool’s errand.  Eventually, your body will rebel, and you’ll find a way to backslide, binge, or fall off the wagon.  Ultimately, you will be wracked with guilt and sucker-punched into feeling like a failure because you tasted the “forbidden food”. 

You try harder to restrict what you eat, but the more motivated you are to be “better,” the closer you skate towards orthorexia. 

“Try harder.” 

“Do better.” 

“Be good.” 

Resist “forbidden” foods that we’ve convinced ourselves are “bad”

Orthorexia is a hellish helix that few victims can unwind.

Rather than thinking in terms of “good food” versus “bad food”, it’s more beneficial to prioritise the foods we should eat by asking,what foods are optimal for me given my current context and goals?  Our unhealthy “good and bad” belief system soon evolves into a healthier mindset of “good, better, and best” and moving toward more optimal nutrition. 

Your body wants you to be healthy!  But our current environment of engineered and ultra-processed foods has hijacked your cravings.  Modern foods are designed to produce a maximal dopamine hit to ensure you return to buy more. 

But once you reduce your exposure to foods that don’t align with your goals, your gut, brain, and instincts will become trustworthy again.  Your recalibrated appetite signals will guide you to the nutrition you need to thrive without provoking feelings of shame, intense guilt, or constant deprivation.

While there’s no perfect diet, we have worked hard to quantitatively rank common foods and meals to identify the ones that provide more of the nutrients your body is craving. 

The “Problem” with Nutrient Density

The “problem”, with foods that provide the most micronutrients per calorie is that they are tough to overeat.  That is, they are very satiating. You would not be able to maintain your body weight in the long term if you only had access to these high-satiety foods. 

The chart below illustrates our propensity to eat less as our nutrient density improves.  As Optimisers increase the nutrient density of their diet, they eat less.

To overcome this “problem”, we have created several categories of  food lists and recipes tailored for different goals, including:

After three years of intense work, we now have 600+ NutriBooster recipes optimised for different goals.  These are all embedded into Nutrient Optimiser, which we use in the Macros Masterclass and Micros Masterclass.  

The chart below shows where a section of the NutriBooster recipe books sit on the carbs vs fat landscape.  The NutriBooster recipe books towards the bottom left corner tend to be the highest protein % and nutrient density.  However, if you’re looking for something less aggressive there are other more gentle nutrient-focused approaches to suit your context and goals. 

Not everyone needs to eat optimally, all the time!  However, we’ve found that once people prioritise more optimal foods and meals, they fast-forward toward their goals.  Conversely, if you are not getting the desired results, you can reduce the ‘less optimal foods’ in your daily feeding routine. 

Once you reach your initial goal of weight loss, stable blood sugars, or both, you may be able to relax and focus on health maintenance for a while before focusing on a new goal (i.e. gaining muscle or athletic performance).

Final Word

You won’t catch orthorexia because you’re eager to eat in a way that supports your health.

Orthorexia occurs when we set up our body’s innate need for energy and nutrients in opposition to our misguided beliefs about ‘bad foods’ or properties of food that we believe we should avoid.

You don’t need to become obsessive about food.  But prioritising giving your body the nutrients from the food you eat will bring peace as your appetite settles down and your survival instincts (aka Lizzy) go back to sleep, assured that it will get what it needs when it needs it. 

Nutritional optimisation is about moving towards optimal.  You don’t need to recant from your “evil ways” and adopt a new dogmatic dietary religion.  It’s the people who approach Nutritional Optimisation as a curious student and make small progressive changes that get the best results. 

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5 thoughts on “Orthorexia: When Does “Healthy Eating” Become Unhealthy?”

  1. My encounter with orthorexia came about when I A) stopped taking digestive enzymes (I don’t remember what my rationale for this was) followed by B) starting tracking my blood sugar in order to avoid yeast infections. Slowly I eliminated all sources of starch in my diet, and my daytime blood sugar went down, and the yeast infections stopped…but the fact that my fasting blood sugar was high (dawn effect) lead me to eat less (“there isn’t a healthy enough choice available, I’ll just eat later”) combined with high-nutrients-low-appetite, I lost enough weight that my period stopped. So from Bratman’s criteria above, 1, 5 and 6 are spot-on, but 2 and 3 were never where I was at. It still seems more right to call what I experienced orthorexia than anorexia given I was putting away 8 oz steaks…just not the potatoes.

    I’m afraid that doing the Masterclass would feed my obsession and get in the way of me doing anything besides growing / shopping for food, reading recipes, cooking, eating, exercising and sleeping (and that list seems limited enough to count as dysfunctional). Otherwise, I should probably check out some of NutriBooster’s maintenance recipes, as a 30/30/40 calorie split seems to work better than any other ratio I’ve tried, so long as I take the digestive enzymes so that what enters my mouth also visits my blood stream.

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  2. Great article! So many food issues come from within us (obsessions and fears), that eating what our body needs to survive can certainly help calm those obsessions and help us create habits of eating what should just be considered “normal”. Thanks for your research!

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  3. Excellent article and I plant to share it with a friend who may be orthorexic. Even though I have a tiny dollop of both perfectionism and OCD, and I track and restrict carefully what I eat, I know I am not orthorexic because I am not totally rigid about my rules, never feel guilt or shame if I don’t meet my mark, and am open minded to changing things up. I just return to tracking the next day and do my best. On the rare occasion when I really, really crave a food (e.g. popcorn), the craving lasts for a few days, and I feel lousy, I listen to my body and eat the food. Have recently discovered through blood tests that when the massive popcorn craving happens, I am very low salt. Yes, there are better choices and maybe I will return to drinking salt water daily. Ah, wanted popcorn yesterday, so perhaps start today. LOL

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