by Jessica Cushing-Murray
Anorexia, bulimia, obsessive-compulsive disorder. These are terms that are pretty universally known to the general population. But “orthorexia”? Not so much.
“Orthorexia” is defined by the National Eating Disorders Association (NEDA) as, “an obsession with proper or ‘healthful’ eating.” It is a fairly new term to describe those people you may know who are always looking at the nutritional labels on their food or can’t seem to eat food if they don’t know exactly what ingredients are in it. Orthorexia was coined only in the past couple of decades, and awareness of this term is increasing as the number of people concerned about “healthy” eating increases simultaneously. A deeper definition of the term originates from the man who coined the term himself, Dr. Stephen Bratman, who expressed, “Orthorexia commonly begins as an “exuberant” interest in healthy eating that escalates over time. What was originally a choice becomes a compulsion and the individual can no longer choose to relax their own rules. Eventually, the person’s restrictive eating starts to negatively impact both their health and social and occupational functioning; eating the right foods becomes increasingly important and squeezes out other pursuits.”
So why has orthorexia become a condition recognized by NEDA and important to us today?
It is an interesting phenomenon when a condition such as this one can be tied to society’s standards, as well as growing regulations put in place for nutrition in first-world countries. By this, I mean that all chain restaurants are now required to keep a copy of their nutritional facts in every restaurant for their consumers’ reference. Likewise, most places we eat have the calories, fat, and carbohydrate contents all directly on the menu, where these facts can sway anyone toward or away from certain meals based on the number of calories next to that food. In addition, there is a newer emphasis on vegetarian and vegan options, or a page of the menu that is classified “600 calories or less” and “lite meals.” All of these are ways that calories and nutrition facts are seemingly “thrown in our faces” everywhere we go, which certainly may correlate to the development of orthorexia.
In terms of treatment and diagnoses, Orthorexia is not specifically recognized as it’s own disorder in the Diagnostic and Statistic Manual (DSM) that health professionals abide by. This makes it very difficult to “diagnose” people as orthorexic. However, orthorexia itself is an obsession with healthy eating, so it is often thought of as combination of a classified eating disorder (such as anorexia) paired with a form of obsessive-compulsive disorder (OCD). Therefore, people who are be orthorexic may be constantly reading nutrition facts and ingredient labels, and may refuse to eat certain foods if the nutrition facts or other factors do not meet their ‘health’ standards. In addition to reading labels, someone who is orthorexic likely eats the same few foods or meals every day because they have deemed these specific foods as “acceptable.” People suffering from orthorexia may--in a similar way to those with eating disorders like anorexia-- completely cut out certain food groups from their diets. Things like “carbs” or “all meat” or “all animal products.” Or they may have other ways of deeming foods as acceptable such as if the food is grown organically or locally. They likely do this for a couple of reasons: the foods they are rejecting are not ‘pure’ or ‘healthy’ enough, but also because it makes it easier to continue with their orthorexic behavior in front of other people. Think about it: someone who randomly and completely stops eating meat looks suspicious, but if they can say to their friends that they have decided to adopt a vegetarian diet, now they have a reason to have cut an entire food group out of their diet without looking unhealthy. Lastly, another important sign of someone who may be suffering from orthorexia is someone who will become visibly distressed when there are no ‘healthy’ food options at an event, or if they are unable to find the nutrition facts or ingredients list for the food in front of them.
Orthorexia can look tremendously like a person who simply took the “eating a healthy diet” lifestyle to the extreme and is now obsessed with only eating very specific “healthy” foods. It is important to recognize and educate yourself on terms like orthorexia, because it has a likeliness to develop into other classified eating disorders, can lead to malnutrition based on the restriction and specificity involved, and can be very harmful to individuals suffering from it. Though orthorexia is not yet classified as its own official diagnosis (though it is currently diagnosed under “other specified feeding and eating disorders” in the DSM-5), the obsession our society has today with staying “fit” and “healthy” is sure to lead to increased prevalence of people becoming orthorexic. While reading this post you may have even had certain people in your life come to mind.
Awareness and education are powerful tools to utilize in helping people whose mantra of “living healthy” has ultimately become the dangerous opposite. The good news is: by reading this post, you just took the first step. See the links below for more information and signs/symptoms of people who may be suffering from Orthorexia.
If you need help recovering from Orthorexia, or another kind of eating disorder, reach out to our Dietitians today! Contact Dietitian Libby Parker HERE.
I'm speaking at the adorable local restaurant, Nourish SLO,
on July 19, 2019, and you are invited!
Get your ticket HERE they are going fast!
You can also contact firstname.lastname@example.org
Nourish SLO is excited to host registered dietitian and author, Libby Parker, for an evening of healthy discussion.
Join us at Nourish SLO with Libby Parker, MS, RD, for a Wellness Seminar on Intuitive Eating Friday, July 19 from 6-8pm.
In this seminar, you will learn:
-why you should ditch the tracking apps (never count calories or macros again!)
-how to check in with "what's eating you" before you eat.
-the difference between hunger and appetite, and that they don't always occur at the same time.
-about the physiological body systems that control our hunger and fullness.
-how to eat your favorite foods, and be healthy!
6:00-6:30 Meet & Greet w/ food from Nourish SLO
6:30-8:00 Intuitive Eating Seminar, followed by Q&A and book signing of Permission to Eat with Libby Parker (books will be available for purchase - $15)
Bring a notepad & pen - you're going to want to take notes!
Libby Parker, MS, RD, is a local Dietitian and author of "Permission To Eat: A practical guide to working yourself out of an eating disorder during college, while celebrating the awesomeness that is you!" Libby's private practice in SLO, Not Your Average Nutritionist, specializes in helping young adults and performers recover from eating disorders. Find her at www.NotYourAverageNutritionist.com or get social, @DietitianLibby
"A question I keep getting is, "when can we talk about specific foods?"
With all the "super foods" for health/weight loss/etc, everyone wants a magic bullet.
But, it's not that simple. There are other things we need to consider before we can think about how turmeric and kale are going to change your life.
I came up with the "hierarchy of nutrition needs" to explain what is most important for you to be working on right now. Start at the top of this upside-down pyramid and see where you are at.
1) Enough food. The most important piece is simply to make sure you are eating enough food/calories to support your body. Low calorie diets, famine, food insecurity, these need to be conquered before we can move on to the following steps (Consult a Registered Dietitian for your unique calorie needs - please don't use a book/article/formula to make up your own).
2) Balance of Macronutrients. Carbohydrates, fats, and proteins are our macronutrients, and we need all of them in proportion to have a healthy diet. In general carbs should make up 45-65% of your calories, fat should make up 20-35%, and protein 10-35%. Where on the range you fall depends on many factors including growth, type of activity, and medical issues like diabetes.
3) Spacing food out over the day. Once you have figured out how much to eat, it will really behoove you to space it out over your waking hours. I don't care how popular intermittent fasting has become, your body likes a continuous trickle of nutrients coming in to keep it running at its best. Our body actually stores more fat when we eat too much food in a short period of time. If you had the same [foods/calories/everything exactly the same] on 2 different days, and one day you spaced it out with meals and snacks, and the other day you ate it all in a short time frame (2-4 hours), you would store more of that food as fat on he day you ate it all in a shorter period of time, and your body wouldn't be able to use all of the nutrients. When in doubt- space it out!
4) Micronutrients. Micronutrients are vitamins, minerals, and phytochemicals in our foods that are a necessary part of our body function. These are nutrients like calcium, iron, and zinc. I'll spare you the long boring lecture, but once you have the above mastered the next step is making sure you get the correct balance of micronutrients. In general, this is not something you need to calculate or be overly concerned about if you eat a wide variety and colors of foods.
5) Specific Foods. Only after figuring out the other steps should you think about what specific foods you are eating for health. As stated before, there are no "super foods" or "miracle foods." That being said, it never hurts to try out different fruits/veggies and dishes. Just don't take it to extremes. Even kale or carrots in excess can cause problems. As it is said, "the dose makes the poison" (-Paracelsus). Try to create balance in your diet and eat a rainbow of foods.
You'll feel better.
Check out this podcast episode I was interviewed in!
Episode 35 of "Ignite Her Fire"
Key takeaways: All foods fit in a healthy lifestyle, and you don't have to be hospitalized/look "sick" to get help with your eating, Registered Dietitians are different than "nutritionists" or "health coaches," sugar is not evil, keto is not a good diet plan, we need to STOP talking about our bodies!, a little about my acting...and I'm sorry you have to hear me sing (and yes, I know the lyrics are out of order).
http://www.igniteherfire.com/ or on itunes
A podcast full of stories of badass women living life on their own terms.
Thanks to Sabrina and Shawna for hosting me!
Want to learn more? Sign up for my monthly newsletter for free nutrition/health info, and body positive messaging!
With everyone and their brother having an opinion on how to eat or live a healthy life, how do you discern if information is legitimate?
It is important to remember that nutrition is a science, and not an opinion. And, scientific facts are allowed to change as we learn more through more advanced technology and research studies. Science is constantly evolving, so it is smart of us to double-check what the current best-practices are, especially when it comes to healthcare.
Several factors need to be considered when deciding if a product or diet plan is safe and effective. I review these in the following short video:
Health and diet does not need to be difficult or over-analyzed... But, you do need to know that studies done have been done in ways that can be extrapolated to larger populations, just like with any drug trial.
If you learn nothing else from me, I hope you watch this video and learn how to determine for yourself if what you are reading is true and safe.
Let me know what your top takeaways were in the comments. Did anything get you thinking?
I have been working on this for a while, and now can share that my first YouTube video has been posted!!!!
This first video is a shorter version of my free course on the different types of eating disorders.
Other videos are coming soon on debunking popular fad diets (starting with the "keto" diet) and medical complications of eating disorders.
Please go check out my channel, and subscribe to the channel to be notified when a new video comes out. Here is the link: www.youtube.com/channel/UCfmXodqj-5iWPqLYOVQI67Q
....and the video!
Make sure to sign up for the nutrition education newsletter for monthly education and inspiration!
As a RD, I have gotten so many questions about the fad diet du jour: the "Keto" or "Ketogenic" diet. I finally decided to just write down the research in a reader-friendly version. Additional video on the history and use of the ketogenic diet at the bottom of this post. Here you go-
The ketogenic (or “keto”) diet is just another fad diet.
The Keto diet is an amped-up Atkin’s diet (that we all know now was/is terrible for your cardiovascular system, and not a sustainable way to keep weight off) where the majority of what you eat comes from fat, and carbohydrates are extremely limited (In contrast, a healthy diet should be a much more balanced macronutrient distribution of 20-35% protein, 45-65% carbohydrate, and only 10-35% fat). This skewed macronutrient distribution is actually very dangerous for the human body for several reasons -
#1, We use carbohydrate as fuel for our brain. Glucose is needed for cognitive function, and many people on the Ketogenic diet experience brain fog and difficulty focusing. Ketone bodies (specifically: beta-hydroxybutyrate (built up in blood serum), acetoacetate (found in urine), and acetone (responsible for that bad breath)), which are created when carbohydrates are not present, are not as effective (or healthy) for our brain. This may also cause metabolic acidosis which is characterized by a reduced pCO2 and/or lower pH (we need to stay in balance!).
#2, On a ketogenic diet, your intake of fruits and vegetables is extremely limited (if eaten at all) and we all know how important the fiber, vitamins, minerals, and other compounds in fruits/veggies are. On that note…
#3, The keto diet is extremely low in fiber! Fiber is not only protective against many gastrointestinal cancers, it is also a big factor in fullness and weight loss. Furthermore, constipation is very common on low-fiber diets like the Keto diet.
#4, Ketosis/ketoacidosis is what is happening in the body/brain on a chemical level – this is the body making fat into something the brain can use when carbohydrates are not available. It's a lot of work for the the body to produce, not as efficient as carbohydrate, and can be incredibly dangerous for diabetics. Additionally, we have some cells with few-to-no mitochondria. These cells are carbohydrate-dependant and must be fueled by glucose. These cells include certain cells with no mitochondria in our blood (erythrocytes), eyes (cornea, lens, and retina); cells with few mitochondria include renal medulla, testis, and leukocytes. (https://link.springer.com/article/10.1007/s11883-003-0038-6)
#5, “Keto breath.” Halitosis (bad breath) from (acetone) ketone bodies makes for an acetone-like smell on your breath that no amount of brushing/mouthwash can fix. Medical professionals look for (smell for?) this in malnourished patients.
#6, High blood lipids/cholesterol/blood pressure. It’s a high fat diet- you didn’t see this coming? The body can only break nutrients down at a certain rate, and high levels of fat in the diet may lead to high levels of blood lipids are responsible for blockages (atherosclerosis), and other cardiovascular complications up to death. While you can reverse the numbers, the plaque buildup in arteries is almost impossible to reverse. Not worth it! (note: some people do see lowered blood lipid profiles on this diet).
#7, Following this diet is often a form of disordered eating or may lead to an eating disorder (just as with any restrictive diet). Cutting out whole food groups is not healthy. We need all 3 macronutrients in appropriate proportions (majority coming from carbohydrates) to have a healthy body. Our body needs a variety of foods for best health. The reason this diet “works” for weight loss is that it restricts the types of foods that people tend to over-do-it-on like chips, candy, pastries, etc. Any diet that cuts out your favorite foods will cause weight loss, but at what cost (physically and mentally?)
#8, Not all fats are created equal. Most people starting a Keto diet are not differentiating between saturated (solid at room temp, and not something we want in large quantities) and unsaturated fats (liquid at room temp, and “healthier”). Getting this wrong also increases complications from the diet. Additionally, many people who followed a diet high in medium-chain-triglycerides (MCT) experienced undesirable digestive issues.
#9, It may mess with your thyroid and other hormones – lowering your metabolism (isn’t the point of this diet weight loss? That’s counter-intuitive…), energy, and fertility. Every time we lower our metabolism through dieting it lowers the “set-point” of our metabolism, making it harder and harder to lose weight. This is an adaptive response for mammals in famine, but not what the average person wants nowadays.
Who it the Keto diet appropriate for?
The only population that the ketogenic diet is scientifically proven to be beneficial (and safe) for is a select group of people with epilepsy (seizure disorders). This is the position of the Academy of Nutrition and Dietetics.
The Keto diet especially sucks for athletes (and people working out to lose weight)
Since our preferred fuel source is glucose (carbohydrate) from either blood glucose or glycogen (fancy term for carbohydrate stores in the liver and muscle cells), running exclusively on fat slows athletic performance as the body works much harder to break down fat (dietary and adipose storage).
Additionally, the lower protein intake and change in hormones in the body with a keto diet lower the ability to build and maintain muscle mass. If “mirror muscles” like biceps are not motivating enough to keep you off it- remember that our organs like the heart are also muscle tissue that would be broken down by this diet, causing organ damage or failure.
It’ll get you, mentally and emotionally
Ketogenic diets cause headaches, brain fog, and often irritability and obsession with food. This type of diet will very likely make you think about food an unnecessarily large amount of time, and make it difficult to be social (not being able to eat at the same places as your friends; oh, and that bad breath!).
You may feel more depressed (especially if you are already prone to depression and/or taking antidepressants) as serotonin (the “happy” neurochemical) is produced from carbohydrates. If you take an SSRI know that this class of medications work directly on serotonin that is present, and the diet requires a minimum about of carbohydrate (as we learned from the works of Ancel Keys in his starvation study) to allow the SSRI medication to work.
So, what’s the verdict?
In case you didn’t get it from the above – the Keto diet sucks. Not only is it a fad-diet (aka – not suitable for long-term weight loss/lifestyle), it can be very dangerous.
If you need help figuring out what to eat, contact a Registered Dietitian. In the meantime, if you do need some structure, balanced eating like the Mediterranean diet or DASH diet is a better way to go.
For a YouTube video with more information on this diet: click the image below
Don’t give up the foods you love. There is room for all foods in a healthy diet. We just need to keep proportions and variety in mind to fuel our body optimally.
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Eating disorders affect approximately 10-13%
of college age females, and about 2-3% of college-age males.
Professionals have noted kids as young as 6 years old talking negatively about their bodies and trying to diet.
How can we help our kids navigate the world with
a healthy body image?
Over the next 3 weeks I am offering a free support group/class for parents in San Luis Obispo.
We will go over what eating disorders are, warning signs, how to talk to your kid/someone with an eating disorder, what you can do to model healthy behaviors, and whatever else you want to talk about.
This will be a safe space to talk about this stigmatized mental & physical illness.
Please invite your friends! This class is open to all.
While it is aimed at parents of middle/high schoolers, it is for anyone who wants to better understand what eating disorders are and how to help a loved-one.
I am not assuming that you or anyone in your family has an ED just because you showed up - this is good information for everyone, because we all know someone with an eating disorder.
Sundays at 6 pm, March 4, 11 & 18.
(Ideally come to all, but you can drop-in to any of them)
First Presbyterian Church (church library)
981 Marsh Street
San Luis Obispo, CA 93401
Hope to see you there!
Sign up for more free education whether or not you can make it to the classes:
I am thrilled to have this guest post about vegan nutrition!
Many of my eating disorder clients have adopted a vegan diet, for better or worse, and are not meeting their nutritional needs. Vegan and vegetarian diets are very healthy when done correctly, but if the whole purpose is to cut more things out in the name of restriction, then malnutrition is almost certain.
If you are vegan, or contemplating starting a vegan or vegetarian diet, read-on to learn about plant-based sources of certain nutrients that are often hard to get when animals are off the table.
The Vegan Diet - A Guide to Nutritional Needs
By: Emily Baird
Emily is a 1st year nutrition student at Cal Poly who plans to become a registered dietitian. She has been vegan for 2 years, and plans to incorporate that into her career.
Every year more and more people are making the transition to a vegan diet, and for good reason! The vegan diet can have so many health benefits for our bodies including disease prevention, weight management, and protection against cancers. But with being vegan, also comes the common questions about: “How do vegans get enough protein?” “How are they getting any B12 in their diet?” “How to vegans get calcium if they don’t drink cow’s milk?”. And although these are valid questions, a well-balanced diet full of fruits, vegetables, beans, legumes, and carbohydrates is all a vegan needs to fulfill their nutritional requirements.
Iron is an important component of the red blood cells that carry oxygen from the lungs to the rest of the body, as hemoglobin. Think of it like the engine to a car; the engine provides the car with the power it needs to make it move. Similarly iron allows hemoglobin to have the needed strength to get oxygen where it needs to go. Without it, the body cannot make hemoglobin, which means organs and tissues won’t get the oxygen they need.
There are two types of iron - heme and non-heme. “Non-heme” iron is found only in plants foods and is harder for the body to absorb than “heme” iron which is only found in meat products, so we need to eat more plant-based iron to truly get the same amount as if we were eating meat.
Many plant foods are naturally high in iron, but there are also many packaged foods that are now being fortified with iron. The recommended daily allowance (RDA) is between 8 - 18 mg (depending on age and gender, up to 27 mg during pregnancy). Be sure to include a source of vitamin C with your iron for better absorption.
VEGAN SOURCES OF IRON
1 cup soybeans: 8.8 mg
2 tbsp flax seeds: 4.1 mg
½ cup cooked lentils: 3.3 mg
½ cup fortified total whole grain cereals: 8 mg
(For a complete list click here)
Calcium is responsible for building and maintaining strong bones and teeth. When the body isn’t supplied with sufficient amounts, it increases the risk of developing disorders like - osteoporosis, hypercalcemia, kidney disease, and even alzheimer's. Calcium can be included either by nutrient dense foods or by incorporating calcium fortified foods. Most breakfast cereals, milks, breads, and juices contain added calcium, but be sure to read the nutrition label to be sure. The RDA is around 1000 - 1300 mg. Vitamin D intake is essential to adequate calcium absorption.
VEGAN SOURCES OF CALCIUM
100 g calcium set tofu: 350 mg
¾ cup calcium fortified plant milk: 240 mg
⅓ cup cooked kale: 110 mg
¼ cup dried figs: 95 mg
(For a complete list click here)
Zinc is essential for the body’s immune system to function properly. It also works in cell division, cell growth, the breakdown of carbohydrates, and wound healing. Although it is so important for our bodies, not much is actually needed; the RDA for zinc is 11 mg for men and 8 mg for women. Even though plant sources of zinc are not absorbed as easily as animal sources, vegans were shown to only have a slightly lower amount of zinc.
VEGAN SOURCES OF ZINC
Tofurky italian sausage: 9 mg
½ cup hummus: 2.3 mg
1 tbsp nutritional yeast: 2 mg
¼ cup roasted pumpkin seeds: 2.3 mg
(Click here for a complete list)
Your body must have vitamin D in order to properly absorb calcium in the body. Vitamin D is not typically a problem for vegans during the summer months, but those living in colder climate may be at risk of developing a vitamin D deficiency. The RDA is 600 - 800 IU. Just about 10 to 20 minutes (depending on skin tone) in the sun per day will provide the body with sufficient levels. But those living closer to the northern hemisphere, may need to include more vitamin D rich foods in their diet.
VEGAN SOURCES OF VITAMIN D
1 cup portabella mushrooms: 634 IU
1 serving instant oatmeal: 180 IU
1 cup fortified soymilk: 120 IU
1 cup fortified orange juice: 100 IU
(Click here for a complete list)
SHOULD I BE INCLUDING SUPPLEMENTS?
Eating a healthy variety of plants and grains will ensure that the body gets sufficient levels of nutrients. The exception to that is vitamin B12. Vitamin B12 is not as easily accessible through plant based foods, so it can be important to include a supplement in your diet. If you are overwhelmed by what kind of B12 supplement to choose, check out this article. Nutritional yeast is an example of a vegan food that does naturally contain B12. It is usually used as a cheese replacement or topping, and can supply 2.4 mcg per 3 tbsp (which is the RDA).
A well-balanced, plant based diet will supply the body with all the nutrients that it needs to thrive. There are many people who question the vegan diet and believe that vegans are lacking essential nutrients, but with the right knowledge of nutritional needs, a vegan diet can be very beneficial.
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I am so excited, because an idea I have had rolling around in my brain for months has finally come to fruition!
Yesterday, January 8th, I opened for enrollment my course for performers,
"Whole Health for Performers!" This course is "A scientifically-based mind-body approach to get the most out of yourself, so you can focus on creating the performance of a lifetime."
This class is aimed at non-pro level actors, dancers, singers, musicians, directors, drama teachers, and techies who get their heart rate up on (or back) stage.
We cover: Physical fitness, Eating healthy, even when you are busy, Avoiding digestive issues on stage, Hydration, Vocal health, Mental health in the theatre, Better coping skills, and more, with step-by-step "homework" with each module so you actually TAKE ACTION on your goals!
It is being offered at a low cost of $97 for beta testing. This means you get to be a voice in the creation of this course! I will be tweaking the course based on your suggestions, and will be offering free live Q & A sessions to overcome personal barriers in a private facebook group for those who sign up. I normally charge $125/hour for individual counseling, so this is a steal!
Keep your eyes peeled for more educational courses coming later this year! I have some free education available on the online education page under "services" - check them out too
(I admit they are my first online creation, and not the prettiest!).
If you are in the performing arts, and want to take better care of your body on and off stage, what are you waiting for? Go to the course now!
Don't just take my word for it, a wonderful article about this course was written by the creator of OnStage Blog. Here it is for more info:
Libby is a non-diet Registered Dietitian focusing on eating disorder treatment and prevention. She approaches health from the inclusive standpoint that any "body" can focus on health regardless of size. She is a ally in diversity.
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Disclaimer: This website is for educational & informational purposes only,
it is not a substitute for medical or mental health advice or treatment.