When Orthorexia Goes Bad

Orthorexia.  

According to the National Eating Disorders Association  {all emphasis mine}

Those who have an “unhealthy obsession” with otherwise healthy eating may be suffering from “orthorexia nervosa,” a term which literally means “fixation on righteous eating.”   Orthorexia starts out as an innocent attempt to eat more healthfully, but orthorexics become fixated on food quality and purity.   They become consumed with what and how much to eat, and how to deal with “slip-ups.” An iron-clad will is needed to maintain this rigid eating style. Every day is a chance to eat right, be “good,” rise above others in dietary prowess, and self-punish if temptation wins (usually through stricter eating, fasts and exercise). Self-esteem becomes wrapped up in the purity of orthorexics’ diet and they sometimes feel superior to others, especially in regard to food intake.

Eventually food choices become so restrictive, in both variety and calories, that health suffers – an ironic twist for a person so completely dedicated to healthy eating. Eventually, the obsession with healthy eating can crowd out other activities and interests, impair relationships, and become physically dangerous.

If you ask me, the first paragraph above is epitomized by the Whole9 approach an their Whole30 regiment enshrined in It Starts With Food.    (pg. 9 Kindle Ed.)

We have a theory about food that directly influences the rest of this book.

The food you eat either makes you more healthy or less healthy.

Those are your options.

There is no food neutral; there is no food Switzerland— every single thing you put in your mouth is either making you more healthy or less healthy.

I submit that viewing food in this manner is an invitation to orthorexia.  Back to NEDA website:

 [Orthorexia] is not an officially recognized disorder, but is similar to other eating disorders – those with anorexia nervosa or bulimia nervosa obsess about calories and weight while orthorexics obsess about healthy eating (not about being “thin” and losing weight).

And yet, orthorexia can lead to an officially recognized eating disorder.  If not anorexia or bulimia, an EDNOS (eating disorder not otherwise specified).   Indeed, IMO, it's probably not necessary to have a special term for the obsession with the healthfulness.  The behaviors developed during your life changing 30 days can lead to all of the things characteristic of your garden variety ED.   Indeed although there are various signs and symptoms of anorexia, it is not generally diagnosed as such until a person has reached a certain degree of underweight.  Does that mean that a person that is exhibiting all the classic behaviors of an anorexic doesn't have an ED until they reach 80 lbs?  They are fine at 90 lbs?  100 lbs?  Obviously this is not true, there can be no definitive line, and sadly most anorexics don't get help until they have reached a weight that finally gets the notice of others.  

When I hung around Paleo Hacks for a while, there were periodic questions asked, usually by young women, who "went paleo" for the first time and were now stuck in a binge-restrict cycle.  They would be good on paleo but then the weekend came and they succumbed to the pizza and beer or the ice cream and Doritos.  Feelings of guilt would ensue and come Monday, a new dedication "for their health" would ensue.  You had teenagers and young adults still living at home that were pissed off at their parents, because the nerve of those people putting food on the table for not acquiescing to their child's newfound diet.  Nevermind that oatmeal had never been a problem before all of this started ...

I think paleo is more likely to trigger an eating disorder than your garden variety calorie restricted diet, and here's why.  First, let's be honest here.  While some folks who had heart attacks had the bejeebers scared out of them over fats (sat fats in particular), most people adopting a low fat diet for weight loss did so because of the calories.  Thus the binges that often ensued from such restriction were not shoveling as much butter in one's mouth as possible, it was the "fattening foods".  Nobody seems to blame the fat in pizza or ice cream or donuts for this behavior, yet sugar is consistently demonized as akin to heroin ... garden variety carbs being not far behind.  Because, after all, sugar is sugar, a teaspoon and all that.

The paleos and the low carbers repeat a battery of made-up pseudoscientific mantras with deafening regularity.  A common "coping mechanism" for remaining LC was to imagine glucose being shards of glass ripping your blood vessels apart, or to equate carbohydrates with rat poison.  Some version of the image at right was posted on Dr. Eades blog once!   I have seen many describe a stack of pancakes with syrup as "diabetes on a plate", despite there being pretty much zero evidence that eating carbohydrates causes diabetes.

Use of such hyperbole is nothing unique to low carbers, of which there is a fairly large overlap with the paleo community, so let's drop that ruse too.  No, I'm not talking about the few genuinely high "paleo carb" consuming folks out there, I'm talking about the paleos who insist they are eating a lot of carbs because they have a piece of fruit and a Big Ass salad but won't touch a potato, or describe a small ramekin with shredded sweet potato in it as "mounds of" hash.   You're still a carbophobe if you believe that over 150g or so of *real* carbs has sent you over the pinnacle of "perfect health" or on the road to "insidious fattening" unless you run ultramarathons.  (And you are simply misinformed if you believe the Pima and the Thai ate LCHF ... ever.)   But I'm often chided for being "down on" paleo and LC and "why don't you pick on the vegans"?   

Well, now I'm going to pick on the vegans.  Mostly I don't pick on them because I really could care less about the infighting between vegan ex-meat eaters and paleo ex-vegans and their competition for the souls of the young.   The paleo community is populated by a high proportion of ex-vegans and ex-vegetarians ... which might tell you something.  Denise Minger was originally scheduled to speak at AHS this past weekend (yes I will make a public announcement shortly as to why I wasn't there) on the topic of what the paleo movement could learn from vegans or something like that.   I'd have to look through the old schedules, but as I recall the gist of this would be the mistakes made by vegans and how the paleos could avoid them (too late, in my opinion).  But the vegans have their own relationships with medical woo woo and pseudoscientific food edicts.  I really wonder what goes through the minds of bloggers as they debunk the latest "meat causes death" study to come down the pike while they peck away at their keyboards in Wheat is Murder tees and Vibrams.  Do they not see it?  Not even a little bit?  But I digress.

It's Not Just Paleo

I have made friends in different communities, several formerly raw vegans, over the past year.  In February, one of those friends posted a link to this video in a group we both belong to.  

This is Carmella Soleil of Carmella's Sunny Raw Kitchen.  If you do nothing else, please look at the website and spend about 20 seconds as the food headers flip by.   From her Health Journey:  

For as long as I can remember, I’ve always loved food. ... But my relationship with food has been “tough love” at best! Ironically, I have a very delicate digestive system. ... In addition to my difficulties digesting certain foods, particularly meat, I also had food allergies ... There was a time when I was afraid of eating altogether because of the almost inevitable stomach pains that were sure to come along. ....

... Eventually, in 1995, inspired by my sister’s own dabbling into the vegetarian diet, and no longer being able to ‘stomach’ the way eating meat, poultry and fish made me feel, both physically and psychologically, I became a vegetarian. Even though my new diet did help in some ways, I was still far from thriving.

By 1999 I was in the worst shape I’d ever been in my life. I had quite a few extra pounds and was suffering from a number of health issues. I was extremely irritable and depressed, had chronic vicious mood swings, insomnia, migraine headaches, low energy, constipation, and my digestive problems hadn’t let up. ....

...When a naturopath offered to do a reading of my condition with some new and complex computer device, I thought: “What the heck! What do I have to lose?” Even though I was relieved, at some level, to find out what was going on inside my body, the news was far from comforting. It was determined that all of my organs and meridians were totally out of balance (surprise, surprise!), except for my heart (thankfully!) According to the reading, I was also suffering from candida, and had allergies to foods such as corn, gluten and dairy. And, to top it all off, my immune system was completely shot to pieces. It’s amazing that I was still standing!...

Does ANY of this sound familiar???   In 2000 Carmella meets Don, her platonic life partner and woo woo master extraordinaire (that last description being mine).  She does Master Cleanse (along with 10 days of silent meditation):

... I decided my body was in dire need of a fast after all the abuse I’d put it through over the years. Doing the cleanse had a powerful impact; it helped me see with greater clarity what bad shape my body was in and how I needed to start taking better care of it....

Don had been experimenting with vegetarian/veganism and raw foods and related he never felt better during the 7 months he ate nothing but raw fruit and nuts.  In 2001, Carmella began to dabble:

... gradually started including more and more raw foods into our diets, while at the same time paying close attention to the issue of control. ...If we refused to get caught in ideals and control how we should eat, then how did we manage to change our diet? This is difficult to explain, as it isn’t a linear thing. One way to describe it would be to say that it began with our unbending intent to lead more fulfilling, healthier lives. The improvement in our diets – which has been slow and gradual over the years – has only been a side effect of our process of personal growth.

Fast forward to "today" which I believe would be 2010.

As incredible as it may seem, most of the physical problems I experienced prior to eating more raw foods have disappeared. The constant lethargy that used to overcome me has been mostly replaced by a vitality I never knew was even possible. Other significant changes that I’ve noticed include a dramatic improvement in both my hair and skin, much better digestion and elimination, no more bloating and a stronger immune system (I’ve only had a cold once in 10 years!)

Again .... ANY of this sounding familiar to people??   She discusses being diagnosed with SAD (seasonal affective disorder) in 2003 and going "fully raw" in 2006 "curing that".  While she's hesitant to ascribe that to her diet, what else can she attribute it to?  She then runs down a list of changes from about that time:

• I had no cravings for cooked food (and I mean zero, none, ziltch!)
• I didn’t feel ‘internally’ cold as I did in my 2 previous ‘raw winters’
• My sleep was deeper and more restful
• I was more stable both mentally and emotionally. ...
• I had virtually no depressive, pessimistic thoughts 
• I experienced very little conscious fear or anxiety, to speak of
• I didn’t feel the usual lethargy in the wintertime....

Carmella admits she still has a few food allergies and digeative upset and carpal tunnel syndrome.   

Now, I realize I heavily excerpted from that bio, but it had to be done.  Substitute meat for grains and legumes or neolithic foods or carbohydrates, and there you have it.  And if anyone reading this doesn't see substantial similarities between this story and that of at least one (if not pretty much all of them) paleo gurus, then I'm sorry I wasted your time today.  For the rest of you, especially those who harp on the overweight (like myself) and presume we are unhealthy, don't care about our health, or whatever ... realize that one person's "healthy diet" is another's "poison", and weight loss is certainly not everything or necessarily healthy.

Carmella lost weight on her raw vegan diet because such a diet largely excludes a wide swath of food, many of them very calorie dense.  It wasn't necessarily a weight loss diet, but lookie at the amazing transformation!!  Interspersed in those pictures is one from 2006.  That one reminded me of someone.

 Raw vegan →

                                  Paleo ↓

image link

image link

(I have not even used the most stark example in the paleo community)

For all the focus on us supposedly unhealthy folks, I post these pictures because, I'm sorry, but when did skeletons become synonymous with health?  And if not skeletons, when did simply losing weight become the focus irregardless of health?  Jimmy Moore may have re-lost around 80 lbs, about 50 or so of which he relost for the third or fourth time since 2004 not counting other yo yos.  Meanwhile his urine pH is elevated, urine contains mucus, proteins and oxalate crystals and his lipid panel is nightmarish.  Ahh, but in a week or so we can look forward to a book about the cholesterol and sometime next year we'll get the Keto version.  Because ... paleo + LC = health.   But I digress ....

So ... fast foward to February 2013 and Carmella was apparently convinced by her svengali to undergo yet another cleansing regime -- liver gall bladder flush.  A liver detox of some unspecified sort.  Not at all unlike those you will find sold by Smash the Fat's Sam Feltham, Dr. Johnny Bowden or Amy Kubal's "Functional Medicine" doc,  Dr. Amy Myers -- the preceding list being FAR from all inclusive of purveyors of potentially dangerous woo woo.  

"For whatever reason we were moved to do this"

One flush led to another.  Not uncommon to do 20-30 flushes to clear all the stones.  Became fat intolerant.  More flushes.  She developed IBS.  Soluble fiber (raw foods!) triggered it, and fats.  She did try cooked foods and had to include grains because pureed squash becomes boring -- but her grain was white rice.  Safe starch?  Apparently not for Carmella.  Very stressful.  Her whole bowels are inflamed.  Carmella had gotten down to 80 lbs.  The updates on her main website left off with Part V, but in searching for if there was any further update, another blog turned up where she has updated beginning of July in Part VIII.    Before I get to that update, I will point out some clear differences between Carmella and the underweight paleos:  She (a) acknowledges her problem, (b) is trying to gain weight (at one point I think she put on like 15 lbs), (c) consuming some foods that are not normally on her extreme plan to do so, and, most importantly, (d) not writing articles on a highly traveled website with strategies for how people should cope with their extreme diets, shun moderation, eat less, and be more pure and healthy.

It was only a matter of time ....

Raw vegan woo woo meets paleo woo woo ... Carmella found the Specific Carb Diet (please see comment exchange with Gwen for clarification here):

While my getting rid of parasites last month did help somewhat in healing the inflammation in my gut, I'm still having some digestive issues. To my surprise, research online about my ongoing pain (where the descending colon begins) quickly revealed what seems to be the real culprits.

The discomfort I've been experiencing below my left ribcage is a condition known as Splenic Flexure Syndrome; gas is getting trapped in the bend of the colon, hence the strange 'bubbly' feeling and pain. For some reason I have developed an intolerance to fructose, which prevents its proper absorption into my bloodstream. As a result bad bacteria is happily feasting on it, causing gas and bloating.

And so I finally decided to take the plunge and give the Specific Carbohydrate Diet a try. After experimenting unsuccessfully with Jini Patel Thompson's Elemental Diet, juice and fruit fasting, and eating whatever few foods didn't irritate my intestines (mostly sweet potatoes, potatoes, white rice and gluten free rice-based goodies; in other words starches and complex carbohydrates), I figured that this is one of the few options that I still have left.

Perhaps her next desperate attempt at "health" will be to follow Karen Pendergrass' (who founded the International Paleo Movement Group on FB, and has a Paleo Approved label etc. )  lead and try a DIY fecal transplant of Don's feces.  You see, in incredibly irresponsible fashion, this is exactly what was discussed in a recent podcast on the SCD website:  How a Fecal Transplant Saved Karen’s Life.   These transplants have their utility.  They should also be done in the appropriate clinical setting for diagnosed gut dysbiosis.  Karen's was self diagnosed.  Her donor?  Nice hair and skin and a "good diet" known to her.  A friend.  Did she have their feces analyzed?  Of course not.  But now she's cured.  For $18 and dinner.  Please, don't fall down this rabbit hole.  

In Closing:

Does Carmella have an eating disorder?  Not in the classic sense.  She is certainly a victim of orthorexia.  What is heart breaking in her case is that the body can only be pushed so far.  Many of her ailments that used to be imagined or diagnosed by woo woo are likely very real at this point.  At some point the body begins to reject even the most gentle of foods.  This happens to anorexics as well, regardless of the diet that brings one to that state of self starvation.  The organs begin to shut down.  REAL medical care is essential at this point.  No amount of more perfect dietary purity is going to reverse the train.  I hope if anyone reading this recognizes this in a loved one, they get that person help.  

I hope to continue this discussion ...