Orthorexia: Just another buzz word? An eating disorder?

The last 2 years have shown a visible increase in literature on the topic of orthorexia nervosa, despite not actually being in the DSM-5. Does this lack of “true” diagnosis make this condition just another buzz word, or is this the start of a new breed of eating disorders? Furthermore, is the lack of diagnostic criteria ignoring a whole new subset of those with disordered eating under the guise of “health”?

Definitions and Diagnostic Criteria

Orthorexia literally means “proper appetite”, a misleading name given the ramifications of those cited with orthorexia. It was first described in 1997 by Bratman and Knight after Bratman described his own experiences with orthorexia. The symptoms vary from focusing purely on “clean” or “healthy” food to feelings of deep guilt when going “off plan” or eating something “not clean.” Compensatory behaviors that are often found with those who suffer from anorexia nervosa or bulimia are very similar. Orthorexics will exercise compulsively to “make up” for their “mistakes.” They also obsess over nutrition labels and will start to isolate themselves from social events surrounding food for fear of going off their diet. These criteria all shadow behaviors of other eating disorders as well as obsessive compulsive behavior.

Venn Diagram

From “The clinical basis of orthorexia”, a venn diagram showing the overlapping criteria of orthorexia, anorexia and OCD

Orthorexia’s onset can be more insidious than this extreme behavior, though. Often someone starts off wanting to “eat healthier.” They decide to remove a food group from their diet, then another, then another. Before too long they have a very strict set of rules around what they can and cannot eat. These rules and structure make them feel safe and in control, and as long as they abide by them they are eating “healthy”.

One very, very important distinction is that this group has no medical, religious or ethical reason to avoid certain food groups. While those suffering from orthorexia will often claim they are allergic or intolerant to dairy, gluten, etc. they often have never been formally diagnosed. Most of those who suffer from orthorexia have self-diagnosed allergies and intolerances to food groups. Those who do actually suffer from allergies and are intolerant to certain food groups may still fall into other categories of disordered eating, however for the sake of this discussion we will not include them.

One major departure from orthorexia and anorexia (according to research) is the motivation behind the disorder, though I personally disagree. Anorexia’s end motivation may be about weight loss, but there is never “skinny enough” for those with anorexia. They often are unable to see how sick they truly are. I would argue that anorexia is ultimately about control, and here it doesn’t depart too sharply from orthorexia. The suggested criteria for orthorexia points to a need for those to feel “pure” or “clean” by controlling what goes into their body. This mirrors the controlling aspect of anorexia. However, those with orthorexia are quick to flaunt their behaviors, while anorexics are very secretive about theirs. More on this can be read in the paper included at the end of this article.

The Dark Consequences of Orthorexia

Some might argue that orthorexia is a word used by those who “don’t get it” to describe the passionate. Without an official diagnostic criteria this might be true, however it’s impossible to ignore the consequences of unchecked orthorexia. Unchecked orthorexia can mirror a lot of the consequences of anorexia. For example, omitting entire food groups can lead to deficiencies in certain micro and macronutrient groups. Side effects include anemia, osteopenia, bradycardia, hyponatremia, and others.

Other consequences involve the effect it can have on your social life. Food anxiety makes any social outing involving food almost impossible for those with orthorexia. Given the serious overlap between orthorexia and anorexia they’re prone to the same binge-restrict cycles as those with anorexia. Deviations from their diet are met with self loathing and guilt. They spend an inordinate amount of time researching, planning and excluding foods from their diet.


Since this condition is not officially diagnosed, nor is there outstanding data involving its manifestations and treatment, it’s hard to pin point the specific causes of orthorexia. However, there are some places we can look to understand the obsession around health and purity.

  • Fake trainers or nutritionists: Every celebrity is endorsing some diet these days with very little understanding of the consequences of their support. It’s not hard to find a book, website, or blog touting a certain type of diet or food exclusion as THE way to lose weight or become healthy. In fact, there are entire companies built on the insecurity of the average person, creating groups and “coaches” out of everyday, unqualified people. While some of these people may mean well, they ultimately are unqualified to give advice about diets. This creates and endless cycle of misinformation, usually involving statements like “I saw celebrity name gave up gluten, so I did, and now I feel amazing!” or “I recently started pyramid scheme diet here, and I lost 20 lbs!” While these statements may be innocent in the beginning, they can quickly lead to feelings of guilt when strayed from. Since they focus on excluding food groups they may eventually lead to the same social anxiety described by many with orthorexia.
Examples of misinformation found in popular diets, all which have been discredited but are still touted by popular diets.

Examples of misinformation found in popular diets, all which have been discredited but are still touted by popular diets. Source: The clinical basis of orthorexia.

  • Weight loss/health as a social status: We are often to praise people for losing weight or being healthy without truly understanding what it meant to that individual. “Healthy” and “fit” are a social status that are openly praised. Someone who updates social media with their workout or posts about not indulging in the bagels at work are seen as “strong” and someone to look up to. Diets are often associated with strength and willpower to the point where those who don’t adhere to diets 100% are seen as “weak” and “lack willpower.”
  • Good Food/Bad Food Dichotomy: The minute certain food groups are seen as “bad” or “unhealthy” a dichotomy is created. Labeling food as “good” or “bad” without any true understanding of what it means to an individuals diet or health is unrealistic and unhealthy. Research has shown time and time again that if you tell someone they can’t have a certain food type they will crave it. This can contribute to the food binges experienced by orthorexics when they eat one thing off their “meal plan.”
  • Fad Diets: Researchers have noted that orthorexia patterns of food aversion parallel whichever fad diet is currently circulating.

Where To Go From Here

I have stated many times that this condition lacks an official diagnostic criteria, and is not currently recognized by the DSM-5. However, the National Association for Eating Disorders has been compiling data on the topic and has a page devoted to education on orthorexia. This topic has also been explored by a number of popular websites around health and fitness. While it is not currently an eating disorder it IS a type of disordered eating. It is something that interferes with daily life and disallows enjoyment of life. If you feel that you’ve spent an inordinate amount of time worrying about food, or you feel like you might have orthorexia, it is important to seek the health of a trained professional. Disordered eating can lead to eating disorders, and the associated complications from dietary restrictions are severe enough to warrant intervention in some cases.

If you’d like to learn more about the current research of orthorexia, The clinical basis of orthorexia: emerging perspectives is a great paper to help inform you about orthorexia.

A Case Against Breakfast

Let me preface this article by saying “If you’re hungry, you should eat.” Plenty of people wake up ravenous, enjoy breakfast, and go on with their day. Others wake up without an appetite and report that when they do eat breakfast, they feel like crap all morning, or they’re hungry twenty minutes later. Without delving into the “What are you eating? How much? Etc” argument, I’d like to present this little piece of science for those of you who want it. If you find breakfast a chore here’s some ammo to shoot at the pro-breakfast crowd always trying to get in your face. If you’re not hungry, you’re not hungry: end of story. Every body is different.

Let’s start with hormones and waking. Cortisol (click the link to read about it) is a huge part of your sensation to wake up. It gradually rises through the night, and reaches its peak when you open your eyes. Your cortisol is highest in the morning and may continue to rise after you wake up, until about 30-45 minutes later. That’s breakfast time. Here’s the deal with cortisol – it antagonizes insulin. Insulin helps pull the sugar from your bloodstream after a meal and put it into your cells to refuel them. Because of this, you end up with a higher blood sugar than you would normally.

The issue is that with a blunted insulin response your cells aren’t getting the energy they need. Simply put, insulin gives the energy directly to the cells, and cortisol gets in the way of them doing that. If your cells are yearning for energy they’re going to send hunger signals to your brain to encourage you to eat and feed your cells. This is the case with people with chronically elevated cortisol levels as well who have trouble maintaining a normal appetite.

What about the fit person?

A fit person will have increased insulin sensitivity, especially as they lean out. They tend to be very responsive to an increase in blood sugar and quick and efficiently pump out insulin to compensate. These people then see their blood glucose drop faster, and tend to get hungrier faster. This is exacerbated in the fasted morning states with a high cortisol. You have an extremely active pancreas pumping out insulin and being countered by cortisol, so you’re pumping out more. This can mean a dramatic decrease in blood glucose. Not so much as to cause hypoglycemia, per se, but enough for your hunger signals to fire up just a short time later.

But why does this not affect ALL people – why are some people breakfast lovers and others aren’t? The level of cortisol in your blood is highly dependent on a lot of factors. Some people simply do not have a high enough level of cortisol to counteract any of the breakfast-induced blood sugar problems. Others, such as diabetics, have a need for a regular blood sugar management. Every individual is different, which is why I say again – if you’re hungry, eat!

Lastly, let’s look at a very specific study targeted at the traditional “If you skip breakfast you’ll gain weight” hoopla. This study was a 16 week controlled study in overweight and obese adults, one group ate breakfast, the other didn’t. Between both groups the average weight loss was 1.18 kgs vs. 1.17 kgs. Essentially, the results showed little difference in weight loss between breakfast eaters and non-breakfast eaters.

So, as I said earlier – eat if you’re hungry, don’t eat if you’re not. If you find breakfast is detrimental to your state of mind (no one likes being ravenous at 9am!) then skip it. It’s your individual choice.

What is Creatine?

I remember the first time someone told me to take creatine to improve my performance. Like most newbies to fitness I had absolutely no idea what it was or why I’d use it, or even if I should use it. I placed it on the same level as a fat burner or some other useless supplement parroted by people wanting to make money.  In reality, creatine is one of the most effective performance enhancing nutritional supplements out there.

How does it work?

During stress your body releases phosphocreatine to aid in cellular function. Creatine is integral in storing phosphocreatine. This is why it’s cited as increasing strength, but why it’s also important for brain, bones, muscle and liver. Creatine essentially puts more gas in the tank to allow you to perform at higher levels.

Is it safe?

Creatine has undergone a plethora of tests that have confirmed its safety. Most people recommend 2g-5g a day taken with 8oz of water. When taken without water GI upset has been a side effect. If you’ve taken too much diarrhea is a common side effect. It’s important to maintain a good hydration status (drink plenty of water!) while taking creatine. Some people have reported an increase in water retention up to 5 pounds, but this is a highly individualized response.

Who should take it?

Anyone looking to increase their performance may benefit from creatine. Creatine is found naturally in food (like meats, eggs and dairy) and also naturally produced in the body, so in no way is it a “foreign” supplement.

Do not confuse creatine with creatinine, which is the breakdown product of creatine in muscle.

Let’s talk about SUPPS baby!


What is a supplement?

A supplement is anything you take in addition to your everyday diet. This can be anything from creatine to a pre-work out to a vitamin to fish oils. A supplement isn’t inherently a bad or good thing, it’s just something that is in addition to whatever you’re currently eating.

Why take supplements?

People with certain food allergies or food preferences often find it hard to get certain micro and macronutrients. Someone who is allergic to dairy may take calcium or vitamin C to make up for a lack of it in his or her diet. Additionally, different metabolic disorders may make it hard for someone to get their daily dose of Vitamin D.

There are less complex reasons for taking supplements. A pre-workout may be utilized for a morning workout, or for someone who feels as if they are too tired to perform without one. Protein powders are ideal for people who travel and don’t have access to a microwave and need something filling and fast. Supplements can also have certain benefits that aid in someone’s everyday life or with their performance in sports or at work.

Who regulates supplements?

This is a very important topic, because supplements fall into a gray area when it comes to regulation. The Food and Drug Administration does not test supplements for efficacy, safety or to see if the claims on the bottle are true. This is why there has been a large turn over of “diet drugs” in the last few years that claim to block fat or decrease appetite. As these products come out they can claim a certain level of efficacy or safety, but as the public becomes aware of the truth they tend to phase out. This is common and is why these supplements can be seen as unsafe.

Because of this lack of regulation it’s important to consult a doctor before starting a new supplement or vitamin. Preexisting conditions and individual intolerances can lead to bad reactions that may be documented online but not through a specific organization. One example is the use of DMAA in pre-workout stimulants and diet pills. This substance has been suspected in the deaths of several people from marathon runners to military personnel. Because the FDA does not regulate the use of this substance you should educate yourself on which products do or do not carry it, and if you’re at risk for having a reaction.

What are some popular supplements?

Protein powder may be the most popular supplement to date, though calling it a “supplement” is controversial to some people. Protein powder comes in many different types – whey, casein, egg, vegan, and plant just to name a few. Each of these types of protein powders have different digestion times, tastes and uses. Vegans, vegetarians and people that don’t enjoy eating meat would benefit from adding a protein shake in their diet regiment. Because of the wide range of flavors available for protein powders (whipped cream, chocolate, peanut butter, etc) they’re also great for cooking for people who are on a strict diet and crave something sweet. Protein powder may also be ideal to the everyday athlete for a quick pre or post workout snack. It’s easily one of the most versatile supplements on the market.

Fish oil is another popular supplement that many athletes take. Fish oil is toted for its anti-inflammatory properties that boast everything from quicker recovery post workout to increased memory. Fish oil pills are high in Omega-3 fatty oils and come in different flavors for people who don’t like the fishy aftertaste some pills have. Recent research has implicated fish oils in an increase in prostate cancer, but like most studies these results are currently being debated.

Creatine is a popular supplement used in the weight lifting community. Creatine is part of skeletal muscle and helps deliver ATP (energy) to the muscle. It’s used for increased muscle gains, decreased soreness post exercise, increased recovery, and for a myriad of other benefits. It’s one of the most tested supplements on the planet and appears to have little to no side effects. Still, there are some hypotheses that exist about its role in kidney or liver damage, or to asthmatics. If you have any of these conditions be sure to see your regular physician before starting creatine.

BCAA’s, or branched chain amino acids, are widely used for their muscle growth and recovery benefits. Branched chain amino acids are important in anabolism (growth of muscle) and helping cells get glucose (energy). They’re often consumed before, during or after a workout to prevent fatigue and help with muscle recovery. Like protein powder these come in a lot of different flavors that make them enjoyable and easy to take. They’re also available in pill form for those who don’t like flavored powders.

Lastly, “Pre Workouts” are supplements usually filled with stimulants to help provide energy before or during a workout. They utilize anything from beta-alanine to caffeine and come in many different flavors, varieties and with many different stimulants in them. Some people simply use a cup of coffee or tea as a pre workout, whereas other people prefer actual pre workout powders. Because there’s such a wide variety of products it’s crucial that you do your own research and experimentation to see how these affect you. Most pre workouts suggest taking ½ a dose and seeing how it affects you before using full dosing, or before workout out while taking them. People with heart problems or who are sensitive to caffeine should consult their physician before starting any of these because of the mixed ingredients.

These are only a few of a plethora of supplements commonly used in the fitness world. If you have any additional questions about supplements you can speak to your doctor or look them up on trusted websites such as Avoid going to the website of the product because they’re going to toot their own horn. Also take any review comments with a grain of salt because everyone reacts differently to different products. Experiment, get samples, see what works for you…but most of all BE SAFE! Educate yourself on what you’re taking. Don’t take supplements just because someone told you to use them, look into what you’re taking and make your own decisions.