Can You Eat Too Clean?

Aiming to eat cleaner is usually a good idea. ‘Clean eating’ simply means eating foods that are as close to their natural state as possible. Potatoes not potato chips. Chicken breast not chicken nuggets. Fresh apples not apple pies. You get the picture. Making healthy food swaps is smart for most, but for some it can be the start of something dangerous.

At its core, the idea behind clean eating is simple – food is the most nutritious when it’s the least processed. Processed foods make up too much of the typical American diet and contain ingredients that are unhealthy, not meant to be ingested or both. Examples: chemical preservatives, food dyes, additives, synthetic ingredients and too much fat, sugar and sodium. Eating a diet filled with processed foods can lead to poor health including heart disease, cancer, diabetes, high blood pressure and obesity.

Clean foods are naturally nutrient rich, filled with healthy fiber, quality protein, terrific vitamins and minerals, anti-oxidants and healthy fats. These foods fuel your body efficiently, help build a stronger immune system, improve heart health, lower cholesterol, increase energy levels, boost brain health and play a key role in weight management.

Eating clean is eating well. Until it isn’t. Almost any healthy habit can become unhealthy when taken to an extreme, and clean eating is no exception. Orthorexia nervosa is the term for being focused on clean eating in an unhealthy way. Eating disorder specialists diagnose someone as having orthorexia when they meet certain specific criteria. For brevity, we’ve presented a condensed version of the proposed diagnostic criteria, parts A and B, for orthorexia nervosa offered by the National Institutes of Health (NIH):

Criterion A

• An obsessive focus on healthy eating (defined by a dietary theory or set of beliefs whose specific details may vary) marked by exaggerated emotional distress in relationship to food choices perceived as unhealthy. Weight loss is not the primary goal but may occur because of dietary choices, evidenced by the following:
• Mental preoccupation (and/or compulsive behavior) around restrictive and affirmative dietary practices a person believes will yield optimal health;
• The violation of these rules or restrictions causes a disproportionate fear of disease, anxiety, shame, sense of personal impurity and/or negative physical sensations;
• Escalation of dietary restrictions as time passes which may include the elimination of entire food groups. A person may also engage in increasingly frequent ‘cleanses’ or fasts which are regarded by them as detoxifying or purifying. This intense, restrictive ideation around only eating ‘healthy’ foods leads to weight loss, but weight loss is not the goal.   

Criterion B

• The person’s mental preoccupation, restrictive diet and/or mental preoccupation becomes clinically impairing in any of the following ways:
• Self-worth, identity, positive body image and/or personal satisfaction is excessively dependent on how well a person has adhered to their self-defined ‘healthy’ eating rules;
• Severe weight loss, malnutrition or other medical/physical complications resulting from subsisting on a restricted diet;
• Damage to relationships or the ability to function socially, academically or at work due to behaviors or beliefs about diet. 

People experiencing orthorexia nervosa may also spend an inordinate amount of time on activities related to food: choosing, planning, purchasing, preparation and consumption. They may attribute exaggerated healing powers to foods on their ‘good’ list or believe that totally eliminating foods they deem problematic will cure or prevent disease. For these folks, food is not a source of pleasure, it is a source of health and they may become visibly uncomfortable when prohibited foods are present. They may also assess moral shortcomings to people whose dietary choices don’t mirror their own. Unlike people suffering from anorexia nervosa, people with orthorexia nervosa experience body dysmorphia (body image distortion) around notions of physical impurity instead of weight. Anorexia nervosa is frequently a co-morbidity (simultaneous occurrence of more than one disease).

Here are some more specific signs that may indicate orthorexia nervosa or another eating disorder:

Food rules rule your mood. Violating your personal eating structure makes you extremely uncomfortable, triggering guilt, anxiety, self-loathing or stress.

In your mind, foods are either ‘good’ or ‘bad.’ Someone with orthorexia nervosa imagines that eating the tiniest morsel of a ‘bad’ food will cause illness or otherwise make them unhealthy.

Thoughts about food preoccupy you. Frequent or compulsive reading of health or diet blogs or books, spending hours planning meals, ruminating about foods you’ve eaten or will eat are all telltale signs.

You’ve established strict, almost unbreakable, rules around food. Your dietary rules include a list of ‘do not eat’ foods. Not even one bite. 

Your behavior around food is no secret. Friends and family have noticed – and even commented on – your extreme food rules and eating habits.
Food dictates your social life. If sweets are on your ‘bad’ list, you may avoid, say, birthday celebrations where cake will be served. 

Your ‘good’ food list is shrinking. It’s a slippery slope. First, you eliminate white foods. Then cheese or dairy. Then you decide that fruits’ benefits don’t outweigh their sugar content, for example.

Physical changes are happening. In extreme cases, or if a person has struggled with orthorexia nervosa or other eating disorders for a while, brittle nails, hair loss, yellow skin and even cardiac abnormalities or kidney problems may occur.

There are ways to work your way through disordered eating and re-establish a healthier relationship with food, whether you’re struggling with orthorexia nervosa, anorexia nervosa or another disorder. You can take steps on your own, but eating disorders can be serious and dangerous, and may require professional help.   

Here are some steps to consider. Some may work for you; some may not. It all depends on where you are in the illness:

Accept that you have an illness. Orthorexia is especially tricky because since when is eating healthy actually unhealthy? See the indicators above. If one or more of these resonate, it’s time to act.

Start small. Perhaps your diet has become so narrow that the thought of eating cheese or grains seems like too much. Think of something that was a favorite or yours from before your disorder took root. Did you love chocolate? Allow yourself to eat a chocolate chip. Or two. Then take a moment to notice what didn’t happen. You didn’t gain five pounds, you didn’t become ill and your overall health did not plummet. 

Take it day by day – or meal by meal. Overcoming disordered eating like orthorexia doesn’t happen overnight. It can take years. For some, it’s a lifelong challenge. There will be days when you lose a little ground, and days where you feel free of your old, disordered ways.

Adopt new criteria. Of course you can still make nutrition your top priority! Just not to the exclusion of your health. Something people with orthorexia lose sight of is that eating a proper number of calories each day is key to good health. Don’t love sweets? Don’t make yourself eat them. But do think about how many calories your body needs to actually function correctly. Most adults need a minimum of 2000 calories to sustain metabolism, muscle activity, and brain function. 

Get professional help. Most of us have a sense of when we’re in a situation that’s gone over our heads. Eating disorders are illnesses, and illnesses sometimes require doctors.