I trace the source and legitimacy of a disorder purporting to describe an “unhealthy obsession with healthy eating.” 

Orthorexia nervosa is described as “a fixation on the virtue of food or unhealthy obsession with healthy eating.” Orthorexia has been styled as a type of “self-righteous eating” or “as ‘clean eating’ by those who are involved in these behaviors.” Hold on. Let’s take a step back. First of all, while this phenomenon “has been described in the scientific literature, it is not formally recognized as an official psychiatric diagnosis.” Furthermore, orthorexia doesn’t even have an accepted definition nor validated diagnostic criteria, and if you can’t validly diagnose it or even define it, what good is it? Where did this concept even come from? As I discuss in my video Is Orthorexia a Real Eating Disorder?, it didn’t come from a scholarly source, but from a popular press article called “Confessions of a Health Food Junkie” in a magazine called Yoga Journal. 

Let’s explore its “scientific legitimacy.” Evidently, it looks like orthorexics obsessively avoid processed foods, unhealthy fats, and foods with too much salt or too much sugar. But, by definition, we should avoid unhealthy fats—they’re unhealthy! And anything that has too much salt or sugar has too much salt or sugar. Is a nonsmoker who “obsessively” avoids cigarettes an orthospirexic? Someone obsessed with “right” breathing? “In many cases, parents strictly limit their children’s sugar intake or try to feed them only organic foods.” The horror! Off to the institution they go! 

Orthorexics “make the nutritional value of [a] meal more important than the pleasure of eating it.” If you didn’t do that just a little, wouldn’t you just eat donuts all day? If pleasure trumps health, should we all just start shooting heroin? Absurd. 

One of the proposed criteria is an “unusual concern about one’s own health.” What does that mean? Do you have a mental illness if you decide to hold the bacon on your double cheeseburger? That could be seen as an unusual level of concern in a standard American diet. 

“People with orthorexia pay excessive attention to the quality of consumed food; they also rather do not eat unhealthy food.” I bet they wear their seatbelts, too! “Experts” recommend we reprogram their unhealthy healthy thoughts with cognitive behavioral therapy combined, of course, with drugs, maybe SSRIs, such as Zoloft, Prozac, and Paxil.

Regarding psychotropic medication, SSRIs may help, but you may have to dip into the atypical antipsychotics as well. There may often be a concession, like: “Of course, from a clinical and public health perspective it would not be reasonable to suggest that individuals who follow a strict healthy diet are endangering their health.” It only reaches “‘clinical significance’…when health-directed eating” starts causing problems in relationships or impairs an individual’s social life. But, if someone asks their spouse not to smoke around them and the kids, that “health-directed” behavior could cause “interpersonal distress” in the relationship. Should you just keep quiet then? Or should you yourself keep smoking so you don’t create waves with your smoking spouse? And social-life-wise, do you have mental illness if you tell your date you’d rather not go to the steak house or the smoking lounge? 

“The problem…is when the behavior begins to hinder a person’s ability to take part in everyday society…They might start bringing their own food to…dinner parties.” Maybe I’ve just gone to too many potlucks, but bringing a healthy dish to share with others doesn’t sound like a druggable psychiatric offense to me. 

Then there’s Instagram. Think of “the implications social media can have on psychological well-being…[of] hundreds of thousands of individuals.” Did you know that “healthy food posts tend to receive more support from users than less healthy images, indicating a positive attitude towards healthy foods and healthy eating”? Soon, everyone might be taking pictures of broccoli. Quick, get out the straitjackets! 

In his decades of medical practice, Dr. Dean Ornish says he’s never seen a case of “orthorexia.” “Most people,” he says, “have the opposite problem; they don’t care enough about what they eat.” 

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The case for plant-based eating to reduce the burden of diabetes has never been stronger. 

There are all sorts of different scoring systems to rate diet quality. My favorite, for its simplicity, is the dietary phytochemical index—a fancy name for a simple concept. It’s just the percentage of your calories from whole plant foods, from 0 to 100. (See Calculate Your Healthy Eating Score.) The average American diet has a score of 12—out of 100. So, on a scale of one to ten, our diet is a one.  

When people are split up based on how they score, researchers find that the higher the score, the better the metabolic markers when it comes to diabetes risk. As I discuss in my video The Best Diet for Diabetes, there appears to be a stepwise drop in insulin resistance and insulin-producing beta-cell dysfunction as you eat more and more plant-based. Researchers reported the highest group was only scoring about 30 (out of 100). Less than a third of their diet was whole plant foods. Not great, but better than the lowest group, whose score was down around the level of the standard American diet, as you can see below and at 0:49 in my video. 

No wonder diets centered around plants, “eating patterns that emphasize legumes [beans, split peas, chickpeas, and lentils], whole grains, vegetables, fruits, nuts, and seeds and discourage most or all animal products…are especially potent in preventing type 2 diabetes and have been associated with much lower rates of obesity, hypertension, hyperlipidemia, cardiovascular mortality, and cancer”—and not just preventing type 2 diabetes, but treating it as well. A systematic review and meta-analysis found that the consumption of vegetarian diets is associated with improved blood sugar control, but how much of an improvement? 

One of the latest trials, a 12-week, randomized clinical trial done in Asia, studied the effect of a strictly plant-based diet centered around brown rice versus the conventional diabetic diet on blood sugar control of patients with type 2 diabetes. For the diabetic control diet, researchers set up food exchanges and calculated specific calorie and portion controls, whereas on the plant-based diet, people could eat as much as they wanted, which is one of the benefits of that eating pattern: The emphasis is on food quality rather than quantity. Yet, the participants still lost more weight. Even after controlling for the greater abdominal fat loss in the plant-based group, they still won out. Of course, it only works if you actually do it, but those who pretty much stuck to the healthier diet dropped their A1c levels by 0.9 percent. That’s what you may get taking the leading diabetes drug, but, eating plant-based, they only got good side effects. 

Would it work in an underserved population? Researchers studied the impact of a plant-based diet support program on mitigating type 2 diabetes in San Bernadino, the poorest city of its size in California. This was a randomized controlled trial, but not of a plant-based diet itself as the title suggests. It was a trial of an education program telling people about the benefits of a plant-based diet for diabetes, then it was up to them. Participants still got a significant improvement in blood sugar control. As you can see below and at 3:10 in my video The Best Diet for Diabetes, the numbers got a little better in the control group, but much better in the plant-based instruction and support group. 

And, more plant-based diets are effective not just in the prevention and management of diabetes, but also its complications. One of the most devastating complications of diabetes is kidney failure. As you can see below and at 3:26 in my video, eight diabetics all showed a steady, inexorable decline in kidney function in the one or two years before switching their diets. They were on a fast track to complete kidney failure and dialysis. But, after they switched to a special supplemented vegan diet, their kidney decline was stopped in its tracks. Imagine if they had switched a year or two earlier! 

Most diabetics don’t actually end up on dialysis, though, because they die first. “Cardiovascular disease is the major cause of premature mortality in the diabetic population,” which is why plant-based diets are perfect. “There is a general [scientific] consensus that the elements of a whole-foods plant-based diet—legumes, whole grains, fruits, vegetables, and nuts, with limited or no intake of processed foods and animal products—are highly beneficial for preventing and treating type 2 diabetes. Equally important, plant-based diets address the bigger picture for patients with diabetes by simultaneously treating cardiovascular disease, the leading cause of death in the United States, and its risk factors such as obesity, hypertension [high blood pressure], hyper-lipidemia, and inflammation,” and we can throw cancer in the mix, too, which is our number two killer. The bottom line is that “the case for using a plant-based diet to reduce the burden of diabetes and improve overall health has never been stronger.” 

If all a plant-based diet could do is prevent and reverse heart disease, the number one killer of men and women, shouldn’t it be the default diet until proven otherwise? I’d say so, and the evidence for the benefits of a more plant-based diet continues to emerge for a variety of other life-threatening chronic diseases. For starters, see How Not to Die from Heart Disease. 

 

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Sweet potatoes are one of my favorite vegetables and a delicious way for me to tick off the “other vegetables” boxes on my Daily Dozen checklist.

What has the latest research on their benefits found? What is the best way to cook them? This infographic summarizes the main takeaways and features some simple recipes. 

Get this infographic as a PDF here.

For more details about these studies, watch the free videos on the NutritionFacts.org’s YouTube channel or on the website’s sweet potato topic page.

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