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On Nutrition

Good nutrition is a cornerstone of good health, but when taken to extremes, the pursuit of a healthful diet can become unhealthy. Orthorexia is an unhealthy obsession with eating healthy food that can lead to diets so strict that they interfere with social relationships and may become dangerously low in calories and essential nutrients.

Unlike the “classic” eating disorders anorexia and bulimia, orthorexia generally doesn’t have weight loss as a goal. The focus is on the quality of food, not the quantity.

“They start with wanting to be more healthy, and then they take it to the next level,” said Dr. Neeru Bakshi, a psychiatrist at The Moore Center for Eating Disorders in Bellevue. Orthorexia isn’t an officially recognized eating disorder, but it has the potential to morph into anorexia, especially if the list of foods to avoid grows too long.

Some people are prone to adopting any socially acceptable diet that restricts certain food groups, said Raven Bonnar-Pizzorno, The Moore Center’s director of nutrition and dietary services. Vegetarian, vegan, gluten-free, raw food and paleo diets are a few.

If the diet becomes too strict, unhealthy weight loss and nutrient deficiencies can result. “Many people benefit from being reminded of how important moderation is,” she said. “It’s easy to fall prey to the ‘should monster.’ ”

Where does healthful eating end and orthorexia begin? It’s one thing to generally try to eat organic or eat whole grains instead of refined grains. It’s another to be so fixated on avoiding pesticides, GMOs or white flour that your diet becomes inflexible.

Bakshi said concerned family and friends are often the catalyst for seeking treatment. “They’ll say, ‘You won’t go out with us to restaurants, you’re not letting dad cook the food — and you’re not looking well.’ ”

Bakshi says that what orthorexia has in common with anorexia and bulimia is a sense of control and predictability — you can’t control life, but you can control your food — and that obsessing about food can be a way of avoiding negative feelings.

Wendy Spin, of Colorado, developed orthorexia nine years ago as a 21-year-old bodybuilder. “I was restricting certain foods, counting calories obsessively, making sure I got a certain amount of protein.” When she was under stress, she coped by tightening her control on food.

The downside is that when control cracks and a forbidden food is eaten, feelings of failure, guilt and self-hatred often follow. Spin tried to stop her food obsessions by trading bodybuilding for CrossFit, only to run into trouble when she entered a paleo diet challenge.

“Every time I ate something that wasn’t paleo, I would just beat myself up. I finally said, ‘I just can’t do this any more.’ ” She sought treatment two years ago. While she still struggles, she says she’s generally better today.

Orthorexics often use their diet to achieve a feeling of perfection, purity or superiority. “It’s really a judgmental kind of elitist denial you’re in,” Spin said. “You dismiss what everyone else says, thinking ‘What do they know … look at how they eat.’ ”

Ultimately, Bonnar-Pizzorno said that people with orthorexia start to base their very identity on how they eat. “You need to not find the meaning of life through your diet,” she said.

Next time: Get to know the glycemic index.

Carrie Dennett:

Dennett is a graduate student in the Nutritional Sciences Program at the UW; her blog is