March 13, 2019
Understanding orthorexia: when trying to be too healthy can become harmful.
The 14-year-old patient sitting in front of me insisted that her decision to become a vegan was unrelated to being bullied and called “chubby” in elementary school.
Instead, she cited reasons related to animal rights and a desire to become “healthier.”
Nothing about this straight-A student with severe muscle wasting, skeletal limbs, and a protruding abdomen heralding liver failure was healthy. She brought to my mind images from global health posters depicting starving children. This local teen was unlike any eating disordered patient I had ever encountered.
That was nearly 10 years ago. Since that time, I have encountered a number of patients at the Loma Linda Behavioral Medicine Center’s Eating Disorders Program with orthorexia—an eating disorder driven by an obsession with healthy eating. The Diagnostic and Statistical Manual doesn’t formally recognize this as a separate eating disorder. By understanding the warning signs, symptoms and health consequences, mental health professionals can better treat patients who present with orthorexia.
The term orthorexia was coined by physician Stephen Bratman in 1996 to better express the obsession with eating healthy. Over time, vigilant focus on proper nutrition can evolve into an increasingly restrictive diet. Patients with orthorexia can no longer eat out at restaurants with others, must rigidly shop for food ingredients, and have ritualized patterns of food preparation and eating. These individuals spend a substantial amount of time researching food, preservatives, or additives. Their diet eventually becomes so restrictive that their physical health becomes compromised.
There is a significant crossover between orthorexia, anorexia, and obsessive compulsive disorder (OCD). Of patients with anorexia, up to 30 percent simultaneously have OCD. A recent study of patients with orthorexia showed limited abilities to process information and problem solve on neuropsychological testing. Additionally, like patients with anorexia and OCD, those with orthorexia struggled with memory, planning, and being able to transfer from one task to another (“set shifting”). As the field of psychiatry advances, we hope to better understand the underlying neurobiological causes of orthorexia.
People who have an obsession with eating healthy are likely to compulsively check the ingredients of each thing they eat, being overly concerned with the health of the ingredients they’re consuming. They also may avoid eating things they do not deem “healthy” or “pure,” and become visibly distressed when healthy foods aren’t available.
Those who suffer orthorexia also restrict the amount and type of foods consumed, making malnutrition a possibility.
Among the warning signs of orthorexia, experts mention rigid eating patterns and extreme inflexibility with diet, serious emotional distress when firm eating rules are broken, and extreme and drastic weight loss.
Some of the potential health consequences of the disorder are permanent health damage, such as osteoporosis, kidney failure, or infertility; a lowered immune system and nutritional deficiencies; and emotional instability and a low sense of self-worth.
I still remember my first orthorexia patient’s response to seeing the health consequences of her mental illness. As we reviewed her lab results together, she began to cry. “I never meant for this to happen,” she said. “I just wanted to be healthy.”
By learning to understand and respond to signs of an eating disorder, you can help the people in your life who may be struggling with this condition.
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Commentary: National Nutrition Month pointers for healthy eating – Delaware State News
Incorporating healthy eating into your daily life is important, but it isn’t always easy. In recognition of National Nutrition Month, here are some tips for healthy eating from to help get you started or back on track.
•Replace refined grains with whole grains. This is one of the easiest changes you can make and, therefore, is a great place to start. For example, instead of choosing refined grains opt for whole grains when choosing breads, tortillas, buns, crackers, bagels, and pastas.
The benefit of this tip for healthy eating is an increase in the amount of fiber you consume, which helps with weight management, satiety, gut health, and lowering cholesterol.
Being brown doesn’t make bread whole wheat. The only way to know for sure is to read the nutrition facts panel to make sure whole-wheat flour is the first ingredient. Experiment with other whole grains such as barley, buckwheat, quinoa, or oatmeal.
• Increase your intake of fruits and vegetables. Strive for five or more servings a day. Fresh, canned or frozen count. Frozen and canned are a great option as long as they don’t have added sodium, sugar or fat. I also recommend trying different cooking methods. If you’re getting tired of steamed vegetables, for example, try roasting them with some olive oil and cracked black pepper instead, and make them the star of your meal.
•Eat a variety of colors and types of fruits and vegetables. To ensure you are getting a wide variety of nutrients, people should eat fruits and vegetables from all of the different color groups such as dark leafy greens like spinach, and orange veggies and fruits like bell peppers or oranges.
•Plan for meals and snacks, and complete all of the prep work for the week on your day off. This will also help you get three or more food groups into each meal, which is another tip for healthy eating.
For example, make an effort to include a veggie, lean protein source and complex carbohydrate at each meal.
Try using non-animal sources of protein such as nuts, seeds, beans, and soy. People aren’t often in the mood or have time to dice vegetables first thing in the morning. If you’re someone who likes to have omelets, try dicing peppers and onions ahead of time so they can be a quick addition.
Get the whole family involved in meal planning so everyone is on board and more likely to stick with healthy eating.
Building upon these tips for healthy eating, here are a few other pieces of advice.
•Plan your snacks. This will help you fill in food groups you’re missing. For example, a lot of people don’t eat fruit with their meals. So a great snack would be apple slices with a tablespoon of peanut butter. Pairing a little bit of protein with other foods can also help tide you over until the next meal.
•Make a list before you go grocery shopping. Related to planning for meals and snacks, I tell people to take an inventory of the food items in their cabinets to avoid buying items they already have on hand, and this can be a good starting point to planning your meals for the week.
•Shop for food that’s in season. Fellows says this will save you money and foods in season taste better.
•Women should aim for 25 grams of fiber per day, while men should aim for 38 grams.
Bayhealth has both inpatient and outpatient dietitians. If you’re interested in talking with an outpatient dietitian, consult your primary care physician. Visit Bayhealth.org/Nutrition-Services for more information about our Nutritional Services or call 302-744-6828.
EDITOR’S NOTE: Jinette Fellows, RD, LDN, is a Bayhealth outpatient registered dietitian.
What's in your pantry? An in-depth look at healthy eating – BYU-I Scroll
This story is part of a Scroll series highlighting hunger in Eastern Idaho.
Healthy eating can be no easy task, especially in a college setting, but senior Shaelie Shaw is working hard to provide meals that are suitable for her family that stay within the healthy limits. Slipping back into old habits doesn’t do much good.
“Once I start rationalizing bad choices, it all goes downhill. I have to stick to the plan,” said Shaw. “Right now I am really trying to lose my baby weight. I love working out and can do it everyday, but it won’t make any difference if I go eat a burger and fries afterwards.”
As a mother balancing school, she continually works at demonstrating strength as she sets goals and encourages others around her to succeed.
In a section entitled “Eat Healthy,” the United States Department of Health and Human Services states, “Good nutrition is an important part of leading a healthy lifestyle. Combined with physical activity, your diet can help you to reach and maintain a healthy weight, reduce your risk of chronic diseases (like heart disease and cancer), and promote your overall health.”
The article continues and mentions the looming and difficult topic of obesity stating, “Unhealthy eating habits have contributed to the obesity epidemic in the United States: about one-third of U.S. adults (33.8 percent) are obese and approximately 17 percent (or 12.5 million) of children and adolescents aged 2—19 years are obese.”
Shaw mentions that finding healthy foods and not wasting them is a contributing factor to the success she finds.
“I will buy fresh things with a purpose,” she explains.
Meal planning can be a daunting task, but Shaw seems to have it down to a science.
“My advice would be to start small,” Shaw said. “Start eliminating bad foods from your diet and think of some staple healthy and easy to make meals. If you try to tackle too much at once you might burn out. Just do your best and if you mess up, don’t let it ruin the rest of your day or week.”
Health check: can eating certain foods make you smarter? – The Conversation AU
Trying to keep up with what constitutes a “healthy” diet can be exhausting. With unending options at the supermarket, and diet advice coming from all directions, filling your shopping trolley with the right things can seem an overwhelming task.
For a long time we’ve known diet is key to maintaining physical health.
But emerging evidence indicates diet quality also plays a critical role in our cognitive function.
We’re learning some of the best things to eat in this regard include vegetables, nuts and berries, foods containing “good fats” and, possibly, fermented foods.
As well as potentially improving our brain function, eating these sorts of foods could improve our mental well-being – and could even help the planet, too.
Diet and brain function
In the face of rising obesity rates, over the past couple of decades, researchers have questioned whether increased weight, or poor diet, could influence cognition. They have since looked at what sorts of diets might impair or improve the function of our brains.
Long term follow-up studies show obesity is associated with mild impairments in several domains of cognitive function, including short-term memory, attention and decision-making.
Research has also shown short-term memory is poorer in people who report eating more saturated fat and sugar.
Conversely, the Mediterranean diet has been associated with better brain health and maintenance of cognitive abilities into older age. A Mediterranean diet is based on vegetables, whole grains, legumes and nuts, with healthy fats such as olive oil. Intake of red meat, saturated fats and sugar is limited.
A healthy diet has many elements, so let’s look at what particular foods might explain these benefits.
Vegetables, nuts and berries
Evidence indicates eating more vegetables slows the gradual decline in cognitive abilities that occurs naturally as we age.
While all veggies are likely to contribute, those in the cruciferous (Brassicaceae) family may confer particular benefits through their high fibre, folate, potassium and vitamin content. Vegetables in this family include broccoli, cauliflower, brussels sprouts, and fad favourites kale and rocket.
Interestingly, while there’s good evidence for the protective role of vegetables, there’s less evidence when it comes to fruit.
Berries, though, contain high levels of antioxidants. These compounds protect the body by scavenging harmful free radicals and reducing inflammation. Together these functions are likely to protect our cognitive ability.
Studies in rats, and in older people with mild cognitive impairment, indicate supplementing diets with berries improves performance in various memory tasks.
Nuts, meanwhile, are excellent sources of monounsaturated and polyunsaturated fats, minerals and vitamins. Studies in animals have shown the addition of nuts improves learning and memory. Emerging evidence in humans suggests consuming nuts within a Mediterranean-style diet improves measures of cognition, such as the capacity for verbal reasoning.
Healthy diets such as the Mediterranean diet are also characterised by foods such as oily fish, avocados, olive oil and small amounts of animal-derived fats (such as from red meat).
One of our experiments in rats showed diets high in saturated fat from lard or high in sugar led to memory impairments, whereas an oil-based diet high in polyunsaturated fats didn’t.
Importantly, rats fed these different diets did not differ in their total energy intake – only the type of fat and sugar varied.
While we can’t comment directly on the effects in humans, these findings suggest eating excess sugar, or animal-based fats, may negatively impact cognition.
For thousands of years humans have prolonged the life of foods through fermentation, which increases the proportion of Lactobacillus and other healthy gut bacteria.
Kombucha and kefir are trendy right now, but other popular fermented foods include kimchi, miso, yoghurt and sauerkraut. Intake of these foods is thought to maintain the diversity of the gut microbiome.
Interest in the potential cognitive effects of fermented foods stems from emerging evidence for the importance of the gut microbiota in cognition and health.
It’s well known that a poor diet can reduce the diversity of the gut microbiome. Our work in rats has shown the cognitive impairments produced by exposure to an unhealthy “cafeteria” diet – a Western-style diet high in saturated fat and sugar – are linked to changes in the gut microbiome.
It’s not possible to attribute “miracle” properties to one food group alone. We suggest a balanced, varied diet is the best approach to sustain not only brain health, but heart health too.
And there may be other reasons to seek out these foods. A newly published study showed eating fruit and vegetables improved mental well-being. Subjects tended to feel happier, less worried, and reported higher levels of overall life satisfaction.
The link between diet quality and better mental health is now well-established.
The recently published EAT-Lancet report adds a further compelling reason to eat healthily: the environment. This commission argued for a “planetary health” diet – akin to the Mediterranean diet – consisting of whole grains, vegetables, fruits, nuts and dairy, healthy fats, with low animal protein and few processed foods.
It is thought that shifting to such a diet, together with reducing food waste and adopting more sustainable food production systems, will minimise environmental damage and safeguard individual health.
The central message is the health of individuals and of the planet are inextricably linked, and this requires a rethink of global food systems.
Overhauling food systems – and individual food habits – will not be simple while foods high in fat and sugar are so readily available and relatively cheap.
Nonetheless, recognising that eating well might benefit the planet, as well as the body and brain, might motivate people to change their dietary habits.
- Commentary: National Nutrition Month pointers for healthy eating – Delaware State News
- Google accused of selling ads for unproven health supplements – Becker's Hospital Review
- What's in your pantry? An in-depth look at healthy eating – BYU-I Scroll
- Dietary Supplements Market To Reach USD 210.3 Billion By 2026 | Reports And Data – GlobeNewswire
- More evidence links weight gain to meal times – Medical News Today
Commentary: National Nutrition Month pointers for healthy eating – Delaware State News
Google accused of selling ads for unproven health supplements – Becker's Hospital Review
What's in your pantry? An in-depth look at healthy eating – BYU-I Scroll
Dietary Supplements Market To Reach USD 210.3 Billion By 2026 | Reports And Data – GlobeNewswire
More evidence links weight gain to meal times – Medical News Today
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