Strong opinions spark around the topic of orthorexia, the most recently labeled form of disordered eating.

Some people say, “Orthorexia is just intended to pathologize healthy eating. We shouldn’t label healthy eating as an eating disorder.”

Others counter, “Eating disorders take many forms, including high anxiety and control around healthy food.”

I’ve experienced both the destructive consequences and healing effects of a highly restricted diet, and this colors the perspective I offer in this article. I struggled with severe anorexia at age 12, which I’ve shared with you in this article. Recovery from anorexia preceded my diagnosis of Ulcerative Colitis at age 14.

When I turned 18 I used a dietary protocol to heal my autoimmune disease. As a result, I experienced the flip side of a highly controlled diet. My restricted diet allowed me to heal, and I continue to use nutrition to prevent any signs or symptoms of the disease.

This article is also influenced by the work of Dr. Stacy Schilter Pisano, a Certified Eating Disorders Specialist (CEDS), and a family therapist. I recently enjoyed her presentation at the Nutritional Therapy Conference in Vancouver, Washington, where she offered a wealth of wisdom from her clinical practice and research.

What is orthorexia?

Dr. Steven Bratman defined orthorexia in 1996 as an unhealthy obsession with eating healthy foods. He considered it a parallel to anorexia, which is the excessive preoccupation with avoiding weight gain by not ingesting food and nutrients. Orthorexia involves the excessive preoccupation with eating healthy food.

Dr. Bratman offers the following self-test to determine if you may be developing orthorexia. If you answer YES to any of the following questions, this may indicate a tendency toward orthorexia. (This orthorexia self-test is reprinted and credited with permission.)

1. I spend so much of my life thinking about, choosing and preparing healthy food that it interferes with other dimensions of my life, such as love, creativity, family, friendship, work and school.
2. When I eat any food I regard to be unhealthy, I feel anxious, guilty, impure, unclean and/or defiled; even to be near such foods disturbs me, and I feel judgmental of others who eat such foods.
3. My personal sense of peace, happiness, joy, safety and self-esteem is excessively dependent on the purity and rightness of what I eat.
4. Sometimes I would like to relax my self-imposed “good food” rules for a special occasion, such as a wedding or a meal with family or friends, but I find that I cannot. (Note: If you have a medical condition in which it is unsafe for you to make ANY exception to your diet, then this item does not apply.)
5. Over time, I have steadily eliminated more foods and expanded my list of food rules in an attempt to maintain or enhance health benefits; sometimes, I may take an existing food theory and add to it with beliefs of my own.
6. Following my theory of healthy eating has caused me to lose more weight than most people would say is good for me, or has caused other signs of malnutrition such as hair loss, loss of menstruation, or skin problems.

After answering these questions, you may have further queries regarding orthorexia: What if I use nutrition to address a serious health issue? What if I’m following a strict protocol such as the GAPS Diet or Autoimmune Paleo Protocol — does this mean I am orthorexic?

Is it healthy eating or orthorexia?

The following points can help you clarify your present relationship with food. Awareness of these points will also help you experience the benefits of a restricted or elimination diet, while maintaining a balanced and nurturing relationship with food.

1. A fear-based vs. a love-based relationship to food

Do you approach your food with love or fear? After realizing that food is the cause of your health problems or chronic disease, you may understandably fear “bad” foods. You may develop anxiety around eating gluten, pasteurized dairy, or refined sugar.

While these processed, pseudo-foods contribute to the development of disease, I believe we waste our energy fearing these foods. Instead, choose to spend your energy loving the foods that support your wellbeing.

Someone struggling with orthorexia holds the predominant belief: I fear food because it can make me sick.

Someone with a healthy relationship with food holds the belief: I love food because it can heal me.

Dr. Pisano stated in her presentation that she believes no food should be off limits, as this can encourage disordered eating by creating fear-driven inflexibility around food.

As you can imagine, her statement sparked controversy at the NTA conference. Many of us believe that there are foods that should be entirely off limits, especially to those with chronic health conditions. For example, I do not believe our highly-hybridized form of gluten should ever be consumed by anyone with an autoimmune disease, as a one-time dose can trigger a long-term inflammatory reaction.

Can we keep certain foods off limits and still have a healthy relationship with food? Absolutely! Consider the difference between thinking, “I am afraid of eating anything with gluten, because I know it could trigger a long-term inflammatory response,” and “I love how I can enjoy delicious gluten free foods and heal my body at the same time.”

2. Enthusiasm vs. hesitation when re-introducing foods

Highly restricted diets, such as GAPS and AIP, are not permanent diets. Elimination diets are not permanent diets. If you begin one of these protocols and wait too long before introducing new foods, it can indicate orthorexia.

GAPS and AIP are short-term healing diets intended to restore the body so that a wider variety of foods can be enjoyed. This does not mean reverting back to the dietary habits that caused your health problems in the first place, but it does mean eating from a wider selection of healthy foods.

When hesitation accompanies the reintroduction of healthy foods, be aware that this indicates a fear-based relationship with food. Instead, make the conscious choice to feel enthusiasm about broadening your diet.

For specific steps on re-introducing foods, read my post, 3 Ways To Successfully Re-Introduce Foods After Elimination Diets.

3. Trust in your body vs. control of your body

Orthorexia is not about being healthy, but being in control. It is not healthy to fear food, nor is it healthy to limit your nutrient intake due to unnecessarily strict and self-imposed food rules. Orthorexia comes down to control.

I used anorexia as an emotional coping mechanism, because it provided the illusion of control when my life felt out of control. Anorexia or orthorexia may develop as a false sense of control over your health and body when both feel out of your control.

I used anorexia because I didn’t know how to trust myself. I didn’t trust that my body could heal itself. I didn’t trust that my body knew how to take care of me. I didn’t trust my own intuition.

What mindset is the antidote to the false sense of control gained by disordered eating? Trusting yourself and your body. When a deep self-trust develops, the old need for control is effortlessly released. Trust feels scary, but the only way to get to feel trust is to do the action of trust.

In conclusion…

Orthorexia is not necessarily about what you eat, but how you eat and how you think about food. I champion highly restricted, zero-flexibility dietary protocols like the GAPS Diet and AIP because I’ve experienced the healing results myself, when a restricted dietary protocol took me from nearly bedridden to nearly-symptom-free in three days.

However, your mindset is just as important to your healing. How can food heal you, if you fear it?

Only love can truly heal, so love the food you eat.