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Orthorexia: When Healthy Eating Becomes Unhealthy

Updated: Aug 29, 2020



You know that eating healthy and nutritious foods is important for managing cancer treatment. Eating nutrient dense foods can help to prevent the recurrence of cancer, manage side effects of treatment, and very much support your survival. Your doctors, dietitians, family and friends may have told you numerous times how important it is to eat as healthy as possible, and you’re also reading internet sources that are telling you all sorts of things: completely avoid sugar and processed foods to stop tumor growth, soy is healthful or soy is toxic, you should be raw vegan, you should be Paleo or keto. The amount of nutrition information out there is ever growing - and you may feel like you are not sure what is correct or what you should follow. I don’t blame you!


So when does healthy eating become unhealthy? More quickly than you might imagine and suddenly the obsession over eating to beat cancer can take over your life and alienate you from others. Do you find yourself obsessing over every bite of food that enters your mouth and feeling guilt if you are not eating “clean”? Are you constantly thinking about how you need to eat healthy and to completely eliminate any unclean foods in your diet to help you manage your cancer treatment? If so, you might have a condition called orthorexia nervosa.


What is Orthorexia Nervosa?


The term orthorexia nervosa was coined by Steven Bratman, MD in 1996. The term orthorexia derives from the Greek word “orthos” which means “right” or “correct”. Orthorexia is characterized by an overwhelming obsession with eating healthy food, often involving strict and inflexible eating behaviors to promote overall diet “purity”. For people with orthorexia, healthy eating becomes an obsession with what food is eaten.


The term orthorexia has not yet been clinically defined as an eating disorder, but many doctors and dietitians are recognizing this condition as legitimate and potentially dangerous as it can cause nutritional imbalances and can severely impact mental health.


The really important difference between orthorexia and anorexia is that with orthorexia, there is no physical desire to be thin or lose weight. Often it’s the opposite; that with orthorexia, you’re losing weight unintentionally and it’s worrisome. There have even been instances of severe malnutrition and death because the desire to eat healthfully overrides the need to meet basic nutrient and calorie needs.


Being Diagnosed with Orthorexia


Do you feel like you may have orthorexia? Steven Bratman created a short questionnaire to help to screen for a potential diagnosis. If you answer yes to any of the following questions, you may have orthorexia and it is important to seek advice from a health professional. If you would like to take a look at the questionnaire, you can find it here. Keep in mind that this is no way diagnostic but it could give you some food for thought:


  • Do you spend so much of your time thinking about your diet that it interferes with other dimensions of your life including family, relationships, work, or school?

  • When you eat any food that you regard to be unhealthy, do you feel anxious, guilty, or impure?

  • Does your personal sense of peace, happiness, or joy depend on the purity/cleanliness of your food?

  • Do you find yourself not able to relax your diet for a special occasion such as a wedding or meal with family or friends?

  • Have you steadily increased the list of foods you have deemed “unhealthy” and expanded your rules about food or intake?


If you feel concerned about orthorexia, do not hesitate to reach out to your medical doctor, therapist or dietitian to help guide you through some potential therapeutic options, including counseling, nutrition education, and more. Healthy eating should never become stressful or overwhelming.





Orthorexia and Cancer


Orthorexia is becoming increasingly common in people who are undergoing cancer treatment or who are survivors. In a study conducted by Babilonia and colleagues, orthorexia is the most common eating disorder in people who have cancer. It was estimated that orthorexia has a prevalence of between 6 to 89% of all patients with cancer, compared to a 2% prevalence of anorexia nervosa and bulimia nervosa. The obsession with healthy eating in the cancer patient stems from the desire to prolong life, increase effectiveness of treatment, or from following medical advice that’s not quite correct. We know and understand that eating healthy is important during cancer treatment. But, when healthy eating becomes an obsession and impacts your everyday life, this becomes a problem. Orthorexia truly begins with a good intention of improving diet quality, but when it becomes obsessive it can cause anxiety, isolation, and psychological distress which can overall impact your treatment regime.


Eating healthy should not be something that causes excess stress or puts more pressure on you. A lot of the time, cancer treatment has side effects that can cause a loss of appetite, altered taste or smell, and difficulty chewing or swallowing. These side effects may make it difficult for you to eat healthy, nutritious foods consistently. If you are unable to chew or swallow, food just does not taste good to you, or you do not even feel hungry, it is definitely okay to place the emphasis on healthy eating on the backburner. You have to remember that you need to fuel your body and get some energy in, regardless if it is “healthy” or not. It’s important every day to do the best you can.


Cancer is a health condition that drastically increases the amount of calories you need, and making sure you eat enough can improve your overall quality of life and helps to better manage cancer. It is way more beneficial to eat something than to eat nothing at all when you’re feeling really ill.


Struggling with orthorexia and going through cancer treatment can increase stress. Cancer treatment already can be extremely stressful, and adding more stress can impact your mental health as well. The obsession with healthy eating can severely impact your life and can cause more harm than good. It is possible that orthorexia can cause you to not meet your nutritional needs, and malnutrition is something that we should truly avoid, if possible. Even when undergoing cancer treatment, diet should be balanced. Life does not stop when you are undergoing cancer treatment, so food is meant to be enjoyed as well!


Letting Go of Food Fear


If you are struggling with orthorexia, I know how difficult it can be. You may feel like you are doing everything correctly, but remember that mental health and being in a positive mental state is beneficial for managing your treatment as well. Orthorexia is an eating disorder that is just as valid as others, and deserves recognition and treatment. Establishing a healthy relationship with food can improve your overall quality of life and can help you to manage your treatment.


It may be hard to let go of some of the fear you have regarding food and your cancer treatment. Remember that it is important for you to eat and enjoy food just as much as any other individual. If you need some help regarding your current treatment regime and possibility of struggling with orthorexia, please reach out to your doctor, dietitian, or contact me here. Seeking help and being at peace with food and diet is essential for living an overall healthy lifestyle, and I can provide help.


#eatingdisorder #orthorexia #cancercare

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