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When 'healthy eating' makes you sick

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For a long time, Deanna Lavanty thought food could be safe or it could be scary.

As a pre-med college student, Lavanty fueled her body with only selections from a strict, pleasureless menu of safe foods: egg whites, dry chicken breasts, steamed veggies, boiled buckwheat, low-fat yogurts, salads tossed in fat-free dressing, Special K cereal and many, many cans of kidney beans stocked under her dorm bed.

“I ate like that for a good three years. I was hungry all the time,” said Lavanty, who is now 45 and a registered dietitian and Kent State nutrition instructor. “When my menstrual cycle stopped, that made me nervous.”

Like others who develop orthorexia nervosa, an emerging eating disorder, a pursuit of health quickly transformed into a sickness.

And individuals whose careers or lifestyles revolve around nutrition and health — performers, athletes, yoga instructors, dietitians and nutrition students, for example — may be at an elevated risk for developing orthorexia, some studies suggest.

People with orthorexia equate health with perfection. They obsessively restrict their diets based on sometimes-unfounded beliefs about the quality of food and how to maximize the purity and nutritional value of meals.

“It becomes a phobia to a food,” Lavanty said. “My life was about constantly thinking about food.”

Experts caution that orthorexia is far different from diets such as veganism or halal that are guided by religious beliefs, environmental sustainability or concern for animal welfare. Instead, orthorexia is driven by a desire for the health benefits of “clean eating,” but that eventually leads to malnourishment and poor life quality.

For example, a person with orthorexia might begin avoiding added sugars, then start to cut out added dyes and preservatives and continue eliminating things until entire food groups are off-limits, said Jenny Beck, director of outpatient services at the Center for Balanced Living in Columbus, which specializes in treating eating disorders.

“It’s a cascading waterfall of things that get omitted,” Beck said.

People affected by orthorexia often fall into myths about eating. They might adopt rules about how much water content their food should have, at what time of day or speed they should eat, or how their blood or personality type should shape their diet.

Lavanty, for instance, believed she needed to eat fruit on an empty stomach before a meal for maximal nutrition absorption.

She and other patients describe spending hours each day distracted by food — planning out meals, checking nutrition labels and weighing and measuring out ingredients. They stop going out to dinner with friends or eating meals prepared by family.

If they break a self-imposed rule, they’re washed over with stress, shame, guilt and disgust. To self-correct, they exercise compulsively or spend a week on a “cleanse.”

Pixie Turner, a London-based blogger and certified nutritionist, developed orthorexia at 19 after trying to follow a doctor’s order to lower her cholesterol.

She cut out gluten, refined sugar and, eventually, all animal products. She allowed herself fruit, vegetables, avocados, legumes and nuts — but not much else.

Turner feared losing control over her meals when she traveled abroad, and anxiously monitored her food blog’s social media accounts on an almost-constant basis.

On one birthday, she snuck into a lecture late and left early so no friends could surprise her with cake or a lunch invitation. Turner spent the day alone in her room, instead.

“Those are all things that should’ve been warning signs: I was miserable,” Turner said. “I wanted to be the picture of health. Looking back, I was definitely not well.”

About 1 percent of the U.S. population suffers from eating disorders, which tend to affect people who are high-achieving and perfectionistic.

The rate for orthorexia is probably even lower, but the malady affects men and women equally, said Thom Dunn, a University of Northern Colorado psychology professor and one of the few researchers studying orthorexia.

Lavanty, who is now a dietitian, said many of her classmates suffered from anorexia, bulimia or orthorexia.

“The whole reason I’m a dietitian is because I realized from personal experience how powerful food is,” she said.

Alexis Joseph, a certified nutritionist, blogger and owner of local cafe chain Alchemy, said she notices when her clients and customers are tunnel-visioning on the health aspects of food — micromanaging their bodies and seeing meals as purely fuel.

“That’s a bigger stress on your body than fat and cheese,” Joseph said. “(Healthy eating) is not just vegan salads. It includes cookies and lattes and fun experiences beyond why you should eat brown rice over white rice.”

Clinicians say they’re seeing more and more patterns of orthorexia among their patients.

Part of its rise has to do with its relative novelty: Orthorexia was first described just two decades ago, said Katie Kovacs, a clinical counselor in Columbus. “So, of course, we’ll see more prevalence as it’s unveiled,” she said.

Orthorexia is not included as its own diagnosis in the standard classification of mental disorders used by mental-health professionals. So clinicians have to nest it under other disorders such as anorexia or obsessive-compulsive disorder.

The future inclusion of orthorexia in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders would affirm the disorder as a recognized illness, reduce stigma and help insurance cover treatment for patients, Kovacs said.

It also could bolster support for academic research about its prevalence and investigate new treatments that might help people recover more quickly, Beck said.

“Because we don’t have diagnostic tools, we don’t have great statistics on how many people are affected by it. … It’s seen as the ‘white-teenage-girl-who’s-rich’ problem,” she said. “This affects people of all shapes and sizes and ethnicities and ages.”

 

mrenault@dispatch.com

@MarionRenault

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