Should Restricted Healing Diets Like Autoimmune Paleo Come With A Warning Label For Orthorexia? Yes.

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This is really curious to me. I am wondering what your thoughts are. After Mary joined the Nike team, (click on that link to read the NYT article) she was forced to lose weight, lost her period for 3 years, broke 5 bones, and was continually forced to eat in a specific way to be “race ready”. The result was severe disordered eating, suicidal thoughts and cutting herself from the pressure to be a certain kind of athlete.

How is this different than the pressure folks feel to heal, and restrict to do so? In the AIP world, the response to me saying that diets cause Orthorexia has been: “it isn’t the diet, it is you. It is your trauma. It is your past. It is how you are wired. Diets do not cause eating disorders.” Yet clearly, in this case, she was a normal athlete who under extraordinary pressure, suffered massive emotional consequences.

There are a few differences between this example and restricted healing diets: calorie restriction was the goal here. Orthorexia is a side effect of a common goal, however: better health. Here there was a goal too: becoming a better athlete. So does the kind of restriction matter? Calorie restriction vs. Food restriction? (what do you think?) From my perspective, the more restrictive the diet, the more likely a severe negative emotional effect. Therefore, really restrictive diets are more suspect than less restrictive diets. I don’t get overly concerned for instance when someone goes on the Mediterranean Diet to become more healthy. (Btw, The Minnesota Starvation Experiment is worth looking up. Normal men said they were pushed the brink of insanity by simple calorie restriction of 1650 per day)

Just this week, I have had clients who have said the following:

1. I was 6 months into AIP and at my last visit to my doctor’s nutritionist, she told me she did not know when AIP will end AND told me to restrict even more foods to include AIP + Low Histamine after 6 months of strict AIP already. (she cried)

2. I have been on AIP for a year, and my doctor just told me to do low FODMAP + AIP for the next few months and I am terrified.

3. I have been AIP for 3 months and now I have to do an AIP plus candida diet. I am confused and feeling so much anxiety.

What would you tell these folks? Go against what your doctor said? Your nutritionist is wrong?

These people are being told how to heal by professionals and then the response from the community is “this is your trauma causing your anxiety around food, not the diet.” There is not a specific point on the timeline we can say tips someone into Orthorexia. But, I DO think that the threshold for what tips someone into emotional dysregulation from a restrictive diet increases with how strict the diet is. In this story, Mary was on a team with other athletes doing the same thing, and mentally they could handle the extreme pressure. The same seems true of AIP.

So how do we even navigate this? My estimation is that many doctors and nutritionists simply do not know the signs of Orthorexia to look for, are not educated about it, do not educate their clients before going on a restricted diet, give no warnings, and do not follow up with clients during the diet to be sure they are not suffering quietly. The other (epidemic?) here is that patients are REALLY motivated to get their doctor’s approval and be the ideal patient, so they do not tell doctors what they are silently struggling with emotionally.

Doctors, Nutritionists and Health Coaches are not having a needed conversation before a restricted diet about the Orthorexia signs to look for. And would someone even care? If I was looking at losing my kidney from Lupus, I would restrict my diet with no questions asked. It really puts folks in a very, very hard position. Here, in the article, Mary was the fastest girl in America. Why would she question the Nike coach? She wanted to be the best. She was willing to do what it takes. Here, in our Restricted Diet To Heal World, the same thing is true: we want to heal and are willing to do what it takes. Now we are paying a dear price and I am raising the warning flag.



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