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Originally published in the November 2001 issue of Oxygen Magazine.

Health Obsessed:

Do you know someone who seems excessively absorbed with healthy eating or vitamins? Has she greatly restricted her food choices, carrying fare with her or even staying home alone because she can't follow her new diet any other way? Does she act superior to others who aren't so interested in all-natural edibles? Your friend could be orthorexic.

Montague is a substance abuse counselor in Colorado. She makes her living helping people overcome addictions, but didn't detect orthorexia creeping slowly into her life. At 21, she became a vegetarian; but looking back she says her interest in food was relatively innocent until she reached her 30s. That's when she began using her diet to address a health problem. "I started to cut out things," she says. "Dairy, corn, wheat, tomatoes [all common food allergens]. It didn't work, but that didn't stop me."

Her family thought she was crazy, but she had like-minded company in a group of friends with similar eating habits. She and her cooking buddies would cheerfully create meals together, minus the forbidden ingredients.

But other areas of her life weren't so comfortable. "I brought food everywhere," she says. "I always had a sack of food with me." Friends got annoyed with her in restaurants as she quizzed staff about ingredients. Thanksgiving with her family was torture; Montague often ate a single squash for dinner while the rest of the family enjoyed a sumptuous meal. "Potlucks were hard," she adds. "In the 80s it was hard for me to avoid meat. By the 90s, it was meat, cheese, tomatoes -- the list goes on. I always made sure I brought a main dish so I would have something to eat."

Eventually her regimen became more extreme, and she undertook regular 10-day fasts, drinking only fruit and vegetable juices. Montague never noticed any particular health benefit from these long vigils; she just felt convinced she should adhere to an increasingly restrictive diet.

Then a few years ago, a friend, Dr. Steven Bratman, asked her to read the first draft of his book, Health Food Junkies, in which he described his own road back from orthorexia. It detailed the causes and effects of this relatively new, but fast-growing, eating disorder. The book gave Montague a jolt -- she saw herself in it.

Dr. Bratman first coined the term orthorexia to describe and obsession with eating correctly. The expression comes from the Greek words ortho (meaning correct or true) and orexia (which refers to eating). Orthorexia is often difficult to diagnose because, to many, eating too healthy seems impossible. Orthorexics often buy all their food at health food stores, and most insist on eating only organic products, so they give the impression of being on a noble dietary path. Many even develop a sense of superiority toward people whose diets are less disciplined. "I thought they were the fools who hadn't seen the light," says Montague. There can be a vast difference, however between choosing only natural, organic foods and consuming a sound, balanced diet. The challenge for orthorexics is finding a balance -- that's the tricky part. "With alcohol and drugs the solution is not to do the things that relate to the addiction," says Montague. "But we can't not eat." Orthorexics need to control their substance of abuse.

Orthorexics start out with a sincere interest in finding an alternative to the unhealthy standard American diet. Often a patient will attempt to cure an illness through diet. People with food allergies are particularly at risk, since dietary changes often produce dramatic, positive results. For most, finding a solution to their illness is enough. But others start a search for perfect health that can lead to increasingly strict and nutritionally deficient diets. They reason that since eliminating a few foods helped them in one instance, excluding others will accomplish more.

According to Dr. Bratman, it's not the desire to eat organic or natural foods that defines the disorder; it's the obsession. "If you can eat a diet without thinking about it too much, you are probably not orthorexic," he says. "When diet becomes an escape from life, it begins to resemble an eating disorder more than a sensible nutritional choice."

Many orthorexics are vegetarians, and there are various severe regimens they adopt, including: macrobiotics (a Japanese diet that emphasizes brown rice and cooked vegetables, and forbids dairy products, meats and other foods), raw-foodism, fruitarianism (eating only fruit) and vitamin obsession. The most extreme is the almost unbelievable breatharianism, in which people are convinced they can live on air alone.

Dr. Bratman names several plausible causes for the disorder, including the illusion of health safety, in which people seek absolute protection from illness through food or vitamins. The need for control or the desire to lose weight can also be factors. Some may try to meet spiritual needs or develop an identity through food, or even use food obsession to avoid contact with other people. Montague also realized that her self-image as a non-conformist helped fuel her orthorexia. "At first, being vegetarian was enough. Then so many people became vegetarian that it wasn't different enough."

Dr Bratman draws parallels between orthorexia and other eating disorders. "Whereas the bulimic and anorexic focus on the quantity of food, the orthorexic focuses on quality," he states. Self starvation characterizes anorexia, bulimia sufferers consume large amounts of food and induce purging, and orthorexics often eat such a limited diet they miss out on major nutrients and are deficient in calories. "All three give food an excessive place in the scheme of life," says the doctor.

Vivian Hanson Meehan, R.N., is the founder of the National Association of Anorexia Nervosa and Associated Disorders (ANAD). She agrees that there may be a link between orthorexia and anorexia. "If you look at the eating habits, they all follow a central theme. Orthorexia takes the same toll: not being able to eat a regular meal," she says. They often avoid meat, but "have no clear idea of how to become a vegetarian in an appropriate way. They just see all those leafy green vegetables and no calories."

Orthorexia, like other eating disorders, tends to get worse with time. Sufferers think about food constantly; their health eventually declines; and their social circle narrows as they turn down invitations to eat with friends or family because the fare isn't organically grown. The most common consequences of orthorexia are isolation and depression, but Dr. Bratman describes several orthorexics who became so malnourished they eventually died. If the foods they want aren't available, they won't eat anything, regardless of how hungry they are.

While she never adopted some of the more dangerous regimens favored by some orthorexics, by the time she read Bratman's book, Montague was feeling the strain. It was "20 years of worrying every day, and constantly thinking about what I was going to eat," she says. "I felt good when I ate well, but bad if I ate Cheetos."

Now, at 40, Montague considers herself in recovery. Being a therapist herself, as well as going through a lot of personal therapy, has helped her heal. Her first step to recovery was admitting there was a problem. Montague is still a vegetarian, but she has dropped most of her former diet restrictions. It's about being kinder and gentler with yourself," she says. "It's a gradual relaxing of the dialogue in my head about food. I really don't want to spend that much time worrying about it."

Still, some wisps of orthorexia remain. "I think if I got some really serious illness, like cancer, it would bring out a lot of fear and motivate me to do extreme things again."

Orthorexia will no doubt continue to draw attention as more worried eaters are seduced by its siren song. No studies have been done to estimate how many people currently suffer from this disorder, but Dr. Bratman has received letters from as far away as Europe and Japan, from people aged 14 to 79.

Since the publication of Health Food Junkies, Dr. Bratman has developed an analogy that may help readers further understand the disorder. "Workaholism is rather like orthorexia," he says. "The name has shock value. The point of calling it that is to get people to reevaluate how they are spending their lives, in the hope of moving them more into balance."

Wordwind Communications Copyright 2001. All rights reserved.