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Orthorexia is an eating disorder in which people are restricting or manipulating the foods that they eat to try to have healthy foods or what they deem to be healthy and what they deem to be pure foods.
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Think eating 100% clean is always healthy?
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Psychiatrist Dr.
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Brad Smith exposes orthorexia and why obsessing over pure food can sabotage your mental and physical health.
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Like many eating disorders, it can be very dangerous.
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It can be life-threatening because if we're dealing with restricting food intake and getting into areas of malnutrition, it'll be, you know, a significant risk for individuals if they're taking it to an extreme.
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Welcome to Recoverable.
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I'm your host, Terry McGuire.
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Today we continue our discussion with Dr.
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Brad Smith about lesser known eating disorders.
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Last week we talked about RFID, and today we will be diving into orthorexia.
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Dr.
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Smith, thank you for joining us.
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Thanks for having me.
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I appreciate it.
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We're going to start as we did last week with some truth or myth questions, and then we'll get into the longer answers if we can.
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All right.
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Myth or fact.
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Is orthorexia just extreme discipline with food?
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Myth.
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It's certainly has components of extreme discipline with food, but that's not as simple as that.
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Myth or fact.
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You have to be underweight to have orthorexia.
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Myth.
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It can be going on at any weight or any size.
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Myth or fact.
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Clean eating is the best way to prevent eating disorders.
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Myth.
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In fact, clean eating often promotes restrictive forms of eating, which can be a risk factor for eating disorders.
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Including orthorexia.
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Including orthorexia.
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Myth or fact.
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Orthorexia is just anorexia light.
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Myth.
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Very distinct differences between the two in terms of the underlying motivations and the reasons for the behaviors.
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Myth or fact.
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Orthorexia is about the fear of being fat.
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Myth.
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Anorexia nervosa and other eating disorders are often centered around the fear of being fat or the fear of weight gain.
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However, orthorexia is more about the discovery of food to have health benefits or to be pure about the eating process.
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We'll be talking about that pure.
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Myth or fact.
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It's interesting because it printed out as a fact.
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So I like your answer better.
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Myth or fact.
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Reading every ingredient label is a red flag for orthorexia.
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Myth.
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I think we're we're teaching people in our society, in our in our medical fields, are teaching people to read the ingredients.
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I think it has more to do with how many times you read the ingredients.
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Myth or fact, social media can make orthorexia worse.
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Fact.
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We know that social media can have um harmful or positive effects on people in the eating disorder world, including for people with orthorexia or at risk for orthorexia.
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Social media depictions and influencing behaviors tends to make them worse.
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There may be some specific health benefits that somebody's trying to achieve by that, but um carried out to their extreme, it's not a good thing.
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The last one here.
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Now we'll go to the internet questions.
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And not surprisingly, the first one is what is orthorexia?
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Well, orthorexia is an eating disorder in which people are restricting or manipulating the foods that they eat to try to have healthy foods or what they deem to be healthy and what they deem to be pure foods.
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Is that a moral component to eating?
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Well, it's interesting.
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I haven't really thought of it quite that way, but there could be a component of that involved.
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Um there's a mission-driven element to it.
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The mission is to eat things that are pure, meaning unspoiled, or being, you know, what we might think of as being the most pure form of garden to table, farm to table.
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Um they're not tainted with preservatives, they're not tainted with ultra-processed methods.
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Um they're they're not tainted by the medications that an animal may be given while they're growing.
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So it's a mission-driven component to it to eat as pure as possible, to eat foods that have not gone through these processing uh methods.
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And I suppose in a way, there's there is that sort of spiritual kind of part of it that there's a morality to it because, you know, well, not as a religious morality, but the moral morality of like trying to stay on course with this idea to eat as pure as possible.
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Eating foods farm to table, you know, it that sounds really healthy.
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Yes.
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No chemicals, no hormones, none of the things that are out there that probably are not good for us.
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So where does it go off the reels?
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Well, I think I, you know, this is not too unlike other forms of eating disorders in my experience, where a lot of times the development of the eating disorder has been after some noble attempts to change the patterns of eating to be healthier or to do something that had, you know, a not a harmful intent at first.
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I haven't run into anybody who started out their eating journey to try to get an eating disorder, so to speak.
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Um, it's not a choice, it just develops as people, you know, go through their life.
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So with orthorexia, it's about the extremes.
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Is it good for someone who is relying almost entirely on ultra-processed foods to make an attempt to eat cleaner?
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I would say yes.
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Um, but is it necessary or is it truly healthy for someone to have restricted their intake to an extent that it no longer resembles kind of a normal, normal portions of uh macronutrients to meet their nutritional needs?
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We'll get into it all more.
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So why don't we hear about orthorexia as much as we hear about things like bulimia, anorexia, binge eating?
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Well, first is because it hasn't really been recognized nearly as long.
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So I think the first, you know, the first use of this term orthorexia was in the late 90s, like it was around 1997, that someone coined this term or orthorexia.
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And what we have experienced since then is just continued discovery, exploration, and under trying to understand it in the medical world and in the eating disorder treatment world.
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Um, but the simple fact that it hasn't been around as long as other eating disorders is one of the features.
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The other is it may not be as common as anorexia nervosa or bulimia nervosa.
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It's hard to study it when you don't have agreed upon distinct diagnoses or diagnostic categories for this in the same way that we have them established for these other illnesses.
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So it's hard to hard to estimate the exact prevalence or incidence because we don't have agreed-upon terminology of exactly what it is or where that line is for it to be a disorder.
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Is the fact that it's based on the healthiest foods part of the problem with diagnosing it?
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Because it'd be so easy to say, look what I'm doing.
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You know, how could this be wrong?
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I think that is a part of it as well.
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Um, I mean, I think about it from the individual's standpoint, in contrast to some other eating disorders, like this may be very much aligned with their values and the way that they see health is going to be through trying to eat foods in this way.
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Among their health care providers, same thing.
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They're probably counseling a lot of their patients to try to move away from ultra-processed foods or fast foods and into more clean eating.
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And so, you know, it's going to go underappreciated until it probably causes some sort of physical consequence or social or functional consequence.
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So it kind of sounds like you're saying without bad, and I think that somebody with orthorexy would see any processed food as bad.
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I can't say I'm wild about them, that without bad foods, there's an imbalance.
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I mean, what what what's wrong with eating pure foods that makes it part of an eating disorder?
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I don't think there's anything categorically wrong about eating clean foods or foods that are considered clean.
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Um and I don't I don't think that's what is happening with someone who has more of the extreme form of like orthorexia nervosa, where they start to have the extreme form of it.
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Because what we'll see there is that people have carried this to an extreme that they've eliminated major opportunities for food, um, where they might continue this path towards something that would have to be, for example, grown themselves.
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Um they would have to be perhaps the only one to have tended the garden, so to speak.
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Um they may also eliminate the whole categories of foods, thinking that they're categorically bad, not just like whether they were processed differently, but like maybe it's all sugars.
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But some of our sugars come from natural sources like fruits and may not be good for the overall composition of the macronutrients that we need, or even the micronutrients.
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We may not be able to get all of the vitamins and minerals that we need if we go to very, very pure form of eating.
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Um, can it be done?
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Yes, with a lot of attention to detail on that.
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But that's where it slips into or the slippery slope starts for people who take it to the extreme because it will become part of an obsession for them.
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Okay.
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And that's where it starts to interfere with their life, where they may be constantly thinking about the next meal, where is that food going to come from?
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How am I going to get that food that is absolutely pure?
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And if they slip up, they have a lot of self-loathing around that.
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A lot of remorse and feeling bad.
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So this torturous kind of, you know, obsession around how to make it pure, how to make it right, and then beating themselves up if they get it wrong in their eyes.
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So it's not that eating the purest, healthiest foods is bad.
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It's that being part of a pattern that is unhealthy and leads down, as you called it, a slippery slope.
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Right.
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For the psychological, kind of emotional part of it and the social part of it, it's those consequences of how much obsession there is around this that is what turns this into something that is pathological for individuals versus it being just a healthy adjustment to, you know, trying to move away from processed foods or or preserved foods or, you know, something that they would might that most of the world might deem is is a good change.
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Um, but it can also, again, be that they can't have the physical consequences if they have started to restrict certain types of food out of the belief that something is not going to be pure.
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Like maybe they develop a thought that most forms of that would be carbohydrates are impure or not, you know, not meeting their definition of healthy.
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And that might not be from like the way somebody with anorexia might see that is they're trying to avoid the weight gain or the fat development that can happen with eating that carbohydrate, maybe because of these other purity reasons or health reasons that they are avoiding it, but they unin usually unintentionally cut out things that lead can lead to physical consequences.
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So you brought up anorexia.
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What is the difference between orthorexia and anorexia?
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Because they even kind of sound alike.
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They do.
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Um, and they sound alike, they they have some, you know, some common ground, so to speak, uh, because there is restriction of food.
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Um and it's more about what is the underlying reason for this change in eating.
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And so for orthorexia, as we're talking about, it's about I need to eat as pure as possible.
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I need to eat things that are sourced in the way that I believe they should be sourced.
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And um, this is all for my health benefit.
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This is usually not about weight change.
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They they may lose weight as a consequence of these changes, um, but it's not typically what's driving them.
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You know, they don't start out with the idea that um that I need to look a certain size or I need to have this body shape.
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And whereas someone with anorexia nervosa, the eating changes are a consequence of that underlying motivation of changing the size, changing the weight number, changing how I look, and uh gaining control over myself and my body through that change.
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So, how do you treat something if it's a part of someone's core values and beliefs as opposed to something that can be seen as, well, obviously that's not healthy.
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Does that complicate it?
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Absolutely.
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Um, you know, because this is often so aligned with their values and how they think of health.
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And um, and also, as we mentioned before, the their healthcare providers, maybe sending messages to them and other patients that, you know, these are kind of the movements in your diet that should be made all over, you know, media, social media around um, you know, and this is the you know, entire diet industry has existed based upon playing on people's fears about you know what foods could be bad for you, and it's you know, all good or all bad.
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And so there is a righteousness that comes with this, and not it's not like we said not a religious righteousness, but it's like I'm doing this the right way.
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I might even have good intentions about it, and it's reinforced.
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Yeah.
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The people in their lives reinforce it because they're like, oh wow, they were able to make this change.
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And uh their healthcare providers might reinforce it.
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They might be reinforced by just, you know, whenever we succeed with something and make a change in our habits, we feel the some good reward from that.
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Yeah, we feel proud about it.
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So it's just this constant feedback loop of like this is the right thing to do, on usually until they have some sort of consequence from it.
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And it just, this is anecdotal experience, but it's a lot of anecdotal experience with working with individuals with these disorders, is that this it takes longer most of the time for the physical consequences, for the social consequences and the emotional fallout from from this particular eating disorder, partially because of those factors.
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That and we don't we don't see as many people coming in, you know, wanting treatment as early.
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And we see probably a little bit more of people um having their arms twisted to get treatment, and um, you know, because it's part of what they think is you know is right about what they're doing, and the rest of the world has it wrong.
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When you say cut out whole categories, so somebody might say sugars are bad, carbs are bad, meat is bad, and so it ends up being, as other eating disorders are, highly restrictive and you're not having the physical needs of your body met.
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Is that correct?
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Correct.
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Yep.
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Even if it looks good.
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Even if it looks good, even if you're you know adhering to what you think is right or healthy, but it may be having negative consequences to your body.
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So when you were describing the mental part of it and the obsessive part of it, I think you use that word, it made it sound to me like is it related, is orthorexia related to OCD?
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Well, there's there's a fair amount of co-occurrence.
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Um, you know, and we see we see orthorexia happening more in people who tend to have more of an anxiety underpinning or in a more obsessive underpinning to kind of the way they interact with the world.
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And um, and then if they have something like OCD, there is a lot of cooccurrence of OCD and a variety of eating disorders, including orthorexia.
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So if orthorexia is less obvious than some other eating disorders, at least initially, how do I know if I have it or somebody I care about has it?
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Well, I think this has something to do with that extreme, you know, that this is a spectrum of behaviors people have.
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They're trying to learn more about what they're putting in their bodies.
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There's nothing wrong with that.
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So back when we did the myth, in fact, I was asked the question about reading a food label if that means that you have orthorexia.
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And I said, no.
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How many times?
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But it depends on how many times, because I think we're all being um educated around understanding what it is that's in food and what are the ingredients.
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And so if we read it once quickly and educate ourselves about what's in it, that's probably fine.
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If you're reading it five or six times and obsessing over it and not being able to kind of get that thought out of your mind, um, then you're getting into territory where this is impacting your life in a negative way.
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So when I when I get that question, like, how do I know it's a problem for me?
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That's kind of a common question.
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It's like, how many times do you read the food labels?
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And would you eat something if you didn't have a chance to read the food labels?
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And um, you know, if something did have like one ingredient you didn't recognize, would that be a deal breaker?
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Or is this an always a none situation?
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Like you just are never going to eat something that has any of the signs of ultra-processed foods.
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Um, so it's more about the extreme and how much it's starting to impact your selections and your life and taking you out of normal activities.
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And that would include family meals again and going out to a restaurant meeting with some friends, that sort of thing.
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Right.
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So if you've found yourself removing yourself from those situations, then I think it's impacted your life in a way that, you know, you at the very least should should have an assessment with someone who understands these issues.
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We were using the word righteousness earlier, and and I really mean no offense to anybody who might have orthorexia and feel that way, but it came up in what was described as the guilt factor, the difference between feeling unhealthy after a big meal and feeling morally wrong or dirty.
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Yeah.
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And I think there's the there's a lot that goes into the way people feel after we eat.
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Um that's a big underlying component for most of the eating disorders.
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Whether, you know, with slightly different, with different nuances.
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And for someone with anorexia nervosa, it may be the the fact that that bigger meal might lead to weight gain.
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And it might then be associated with an uncomfortable feeling with any sort of fullness or anything being in the stomach.
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Someone with orthorexia, it may be more about that I just slipped up.
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I had my path set.
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I was going to stay pure with this, and I slipped up and I feel awful about it.
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And several other iterations in between there.
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But um, but yeah, I mean no offense either by the righteousness comments before.
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It's it's about this path of trying to get to um, you know, purity and trying to get to uh healthiest foods, and that can feel like a path that, you know, trying trying to get perfection uh with what is happening there.
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And that's when it starts to throw off the rest of the person's life.
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And that's when it's that's when it's a problem that likely needs professional help.
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And is one of those factors that might lead to someone needing professional help the reaction they have to a slip-up?
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Yes.
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I think that's a good call out.
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That um, you know, if you're if you're beating yourself up, if you're if you're just not able to let this go, if you have, you know, eaten something that was ultra-processed, for example.
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Or there might be a piece of fruit if you said sugars are bad.
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Right.
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Yeah.
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Right.
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And if you if you can't let that go, and if you're if you're kept up at night because of those thoughts, then um it's probably not going to go away on its own.
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On Google and YouTube, one of the top searches on this topic is can you have orthorexia without wanting to lose weight?
00:22:52.479 --> 00:22:53.119
Yes.
00:22:53.599 --> 00:22:54.479
Absolutely.
00:22:54.719 --> 00:22:57.759
I've seen many people with that very clinical scenario.
00:22:58.159 --> 00:23:04.719
Never intended to lose weight, never were aiming towards a certain weight goal or body size difference.
00:23:05.919 --> 00:23:09.679
It's been about am I eating the right things for my body?
00:23:10.000 --> 00:23:11.199
Now, is there overlap?
00:23:11.439 --> 00:23:14.399
And do they sometimes equate one with another?
00:23:14.639 --> 00:23:15.199
Yes.
00:23:15.519 --> 00:23:31.919
But even there, it's still it will come across differently than someone who may have more classic anorexia nervoso, where it's very much about the number on the scale and or the size of the clothes and or how my body looks in the mirror.
00:23:32.479 --> 00:23:49.759
But someone with orthorexia who may have a hint of body image issues with it, it's more because they've associated that, you know, eating ultra-processed foods is a part of why I, you know, may not be at the at the weight that I think is healthy.
00:23:50.000 --> 00:23:55.839
Um, but it's not the same drive uh as someone with anorexia nervosa.
00:23:56.159 --> 00:24:01.679
And again, it's it's not as clear of a line as we might want to think.
00:24:01.839 --> 00:24:12.240
Um, you know, we have the diagnostic categories, of course, but um people often have overlapping symptoms of of a couple of different types of eating disorders.
00:24:12.719 --> 00:24:21.439
Is the fact that orthorexia is less clear, to use your word, part of why it's not currently in the DSM V, the diagnostic manual?
00:24:21.679 --> 00:24:25.119
I think the major factor is the newness of it.
00:24:25.359 --> 00:24:25.599
Okay.
00:24:25.839 --> 00:24:48.479
And then, you know, there's not really yet established because the DSM usually establishes it for us or pulls it together, is where you see the diagnostic category with all the clinical criteria laid out, because there's a lot of research that then goes into, you know, are these three criteria the ones that are reliable and valid across studies?
00:24:48.639 --> 00:24:54.959
And they take different criteria out and put them in over each iteration of the DSM.
00:24:55.199 --> 00:24:59.119
And so I think no, the topic we talked about the last time was RFID.
00:24:59.359 --> 00:25:00.559
RFID's a great example.
00:25:00.639 --> 00:25:16.479
It's kind of switched into having its own DSM category or diagnostic category with the DSM five because there then had been enough research, had been enough study around the specific diagnostic criteria.
00:25:16.719 --> 00:25:21.759
And orthorexia is new enough that it hasn't had that same type of study.
00:25:21.919 --> 00:25:28.879
Um, and the field is still it's not even that they don't agree because they're arguing with one another.
00:25:28.959 --> 00:25:36.240
It's just it's new enough that people are still taking inventory of, you know, what are the most characteristic features of this?
00:25:36.399 --> 00:25:44.240
We know the basics of it, but we don't know the exact criteria that are going to rule in or rule out this diagnosis as compared to others.
00:25:44.639 --> 00:25:59.759
I may be making an assumption here, but I'm thinking of someone who is committed to eating clean and healthy, no preservatives, all of it is probably also, again, correct me if I'm wrong, into fitness and other things that are good for them.
00:26:00.159 --> 00:26:14.159
So does the appearance of being ultra healthy and really committed to your health just make even admitting that there might be a problem or identifying if it's outside of you that there's a problem more complicated?
00:26:14.719 --> 00:26:15.839
Yes, I think so.
00:26:16.479 --> 00:26:17.359
I'll bet it sounds good.
00:26:17.519 --> 00:26:20.319
I'll bet it looks good, I'll bet it feels good until it doesn't.
00:26:20.559 --> 00:26:20.879
Right.
00:26:21.119 --> 00:26:36.159
Again, a lot of eating disorders have their origins in somebody having a noble intention of trying to eat better, trying to have their body look different, trying to, you know, lose the weight that their healthcare provider had recommended that they lose.
00:26:36.319 --> 00:26:42.319
Um, and then it goes down that slippery slope and ends up to a place they can't really control.
00:26:42.479 --> 00:26:46.159
And orthorexia is in that same sort of category.
00:26:46.399 --> 00:27:05.199
These things, you know, get really difficult to sort out because there is so much positive reward and um in our society, in our, you know, among friends, among relatives, like if people make these changes that are deemed healthy, this is all going to be great.
00:27:05.519 --> 00:27:07.919
And as you said, it is until it isn't.
00:27:08.159 --> 00:27:12.799
So anything can have the extremes that make it pathological.
00:27:12.959 --> 00:27:23.199
And orthorexia is one of those areas where that we're continuing to learn about is it's gone to an extreme for individuals that has made it no longer helpful for them.
00:27:23.599 --> 00:27:26.079
Yeah, because I just keep thinking about the RFID conversation we had.
00:27:26.159 --> 00:27:33.759
If I knew someone who was eating three or four or five foods, period, it would be pretty clear to me that there may well be an issue.
00:27:34.000 --> 00:27:38.559
If somebody's eating vegetables and that they grew, I'd be like, cool.
00:27:38.639 --> 00:27:38.719
Right.
00:27:38.959 --> 00:27:39.279
You know?
00:27:39.679 --> 00:27:41.199
So it'd be harder, I think.
00:27:41.279 --> 00:27:50.399
But it also depends a little bit on what people are willing or or what they have negative connotations with in terms of diagnoses.
00:27:50.479 --> 00:27:57.119
And this is a whole other category, but the, you know, there's stigma associated with certain diagnoses.
00:27:57.519 --> 00:28:11.039
And so it may be more acceptable or tolerable for someone to say that they have orthorexia than to say they have anorexia nervosa, or to say that they have ARFID rather than orthorexia.
00:28:11.199 --> 00:28:16.399
And it could be different from person to person as to which diagnosis has a negative stigma.
00:28:16.959 --> 00:28:23.599
And, you know, thankfully, there's a lot less stigma about all mental health issues over the last five or six years.
00:28:23.679 --> 00:28:33.439
I think the pandemic had a had a very positive effect for that piece of our culture, that we have, you know, more awareness, more acceptance of mental health issues.
00:28:33.679 --> 00:28:48.959
Um, but it's still surprising and it's not universal like why one person might think that it's a negative connotation to have anorexia nervosa, while another person might think it's negative to have diagnosis of orthorexia.
00:28:49.439 --> 00:28:55.919
But they may acknowledge that there's a problem and that their life is off course because of their eating patterns.
00:28:56.159 --> 00:29:06.479
Um, so then you have, you know, difficult decisions around how much that clarity or that precision matters in their overall recovery.
00:29:06.559 --> 00:29:17.199
And it may at some point, but there may be an issue of timing of when it's most important for that precision to be, you know, something that they acknowledge more than they are right now.
00:29:17.519 --> 00:29:22.079
So it sounds like with orthorexia, what we see might not look at all bad.
00:29:22.159 --> 00:29:25.359
It might in fact look very good and healthy.
00:29:25.519 --> 00:29:45.919
It's what's happening inside the not inability to have any flexibility, the uh obsession with it and the planning and how much time you're spending every day thinking about sourcing your food and getting your food and what you'll eat and what you won't, and then the physical consequences of not having your nutritional needs met.
00:29:46.000 --> 00:29:46.479
Is that correct?
00:29:46.719 --> 00:29:47.039
Correct.
00:29:47.119 --> 00:29:47.279
Okay.
00:29:47.439 --> 00:29:47.599
Yep.
00:29:47.919 --> 00:29:48.719
Had to put it all together.
00:29:49.119 --> 00:29:49.759
It's all put together.
00:29:50.319 --> 00:29:51.679
My brain needs that.
00:29:51.839 --> 00:30:01.679
Um, so a lot of the internet searches, they were all over, but they essentially boil down to wanting a checklist so that you can determine do I have this?
00:30:01.839 --> 00:30:02.559
Does he have this?
00:30:02.639 --> 00:30:03.679
Does do they have this?
00:30:03.839 --> 00:30:11.759
So, what are common symptoms of orthorexia that we might be able to see if the problem seems to be more psychological?
00:30:12.399 --> 00:30:30.079
You know, a little bit of what we mentioned before, like if you find yourself removing yourself from normal um social activities, like having meals with family and friends, whether that's in your own home or in someone's home or it's going out to eat, like that's a big change in how you're interacting with the world.
00:30:30.240 --> 00:30:39.759
And I think it's about how much time you're spending on obsessing or ruminating about what's in the food and how you're sourcing it.
00:30:39.919 --> 00:30:49.759
And it's about how limited your food variety feels to you at this time and how much you notice that it's different than other people around you.
00:30:50.079 --> 00:31:18.240
So I think even among people we might think of as healthy in our society, whether it's whether it's fitness instructor or someone that, you know, you might think this this is someone like if you start seeing your patterns being farther in the extreme of what you're hearing being promoted from those sort of sources, I think that's a pretty good sign that you're, you know, you're beyond the extreme or you're going to be at an extreme where professional help is going to be necessary.
00:31:18.719 --> 00:31:30.479
So if somebody is listening to us and still isn't really sure whether they or somebody they care about might have orthorexia, are there any places where there's a checklist like there are for other disorders?
00:31:31.119 --> 00:31:35.599
Yes, I would say they're not as well established as what we might have for other disorders.
00:31:35.759 --> 00:31:44.479
But if someone is curious or if they want to check it out, the two that are probably the most common are the Bratman Orthorexia test.
00:31:45.039 --> 00:31:46.319
B-R-A-T-M-A-N.
00:31:46.799 --> 00:31:51.919
Yes, B-R-A-T-M-A-N, or the uh Dusseldorf Orthorexia scale.
00:31:52.159 --> 00:31:54.159
I'm not gonna guess how to spell that one.
00:31:54.479 --> 00:31:54.799
Okay.
00:31:55.039 --> 00:32:00.399
So if they Google or search for either one of those, they'll be able to come up with a list of okay.
00:32:00.559 --> 00:32:00.879
Thank you.
00:32:01.839 --> 00:32:13.599
So what is the connection between social media and emphasis and all the people out there, the influencers talking about clean eating, wellness, culture, gym culture, and orthorexia?
00:32:14.000 --> 00:32:18.399
Well, I think it's about you know, that message can be taken to the extreme.
00:32:19.119 --> 00:32:26.799
And influencers influence people, that's why they have the name, and that's why they get paid the money that they get paid.
00:32:27.119 --> 00:32:34.240
So um when they promote something like clean eating or orthorexia type patterns, it can take off.
00:32:34.639 --> 00:32:50.799
And just as we've talked about in the rest of our conversation, there could be some people who maybe are far on the extreme of uh relying mostly or heavily on ultra-processed foods or fast foods or things that we might not think is the healthiest for them.
00:32:51.119 --> 00:33:06.799
And so if the the influencers might be aiming at them, trying to get them to move into a little bit better place, but there are going to be some listeners who are more prone to an eating disorder and perhaps orthorexia, who might then take it to the extreme.
00:33:07.279 --> 00:33:12.639
Maybe not at first, but over time they get to that slippery slope and it just goes to the extreme.
00:33:14.000 --> 00:33:17.519
So the only reason it would be a problem is if it is dangerous.
00:33:18.000 --> 00:33:21.839
So how dangerous is orthorexia or how dangerous can it be?
00:33:22.879 --> 00:33:26.479
Like many eating disorders, it can be uh uh very dangerous.
00:33:26.639 --> 00:33:47.359
It can be life-threatening because uh if we're dealing with restricting food intake and uh getting into uh areas of malnutrition that uh you know can be life-threatening to various organ systems, it it'll be um, you know, a significant uh risk for individuals if they're taking it to an extreme.
00:33:48.159 --> 00:33:58.000
So that's probably the key point here is that restrictive eating can be dangerous and even fatal, even if the thing that you're eating is really, really healthy.
00:33:58.719 --> 00:33:59.039
Yes.
00:34:00.000 --> 00:34:15.760
But they're you know sometimes people with our most commonly understood eating disorder of anorexia nervosa, we oftentimes have people coming into treatment and the highest levels of care, maybe only eating a couple things also that might be salad and a vegetable.
00:34:16.559 --> 00:34:23.840
Things we might all think are very healthy, but they're extremely malnourished because that's all they've been able to eat.
00:34:24.160 --> 00:34:32.480
One of the sayings that I have often used is that um developing an eating disorder is not a choice, but recovery is.
00:34:33.280 --> 00:34:49.280
And I think that applies to orthorexia as it does to other eating disorders that I don't think anybody starts off their clean eating habits with the idea of this going to an extreme where they're not getting their nutritional needs met or they end up in the hospital, but it can happen.
00:34:49.760 --> 00:34:52.320
So if recovery is possible, let's talk about treatment.
00:34:52.480 --> 00:34:54.640
What does treatment for orthorexia look like?
00:34:55.120 --> 00:35:15.039
Well, treatment um looks a lot like other eating disorder treatment from the standpoint that because it's got many components that, you know, that affect the emotional or psychological health and the physical health, as well as overall social interactions, it's usually done best with a multidisciplinary team.
00:35:15.280 --> 00:35:27.440
So you have a team of professionals that can cover all of those bases, making sure that there's nutritional rehabilitation that's taking place, to add variety, to add volume to be able to meet the nutritional needs.
00:35:27.760 --> 00:35:28.800
Is that usually a dietitian?
00:35:29.440 --> 00:35:30.240
Usually a dietitian.
00:35:30.480 --> 00:35:30.880
Yep.
00:35:31.519 --> 00:35:45.760
And that the mental health side of this is being attended to with good therapy, psychotherapy through a social work therapist or master's level therapist or psychologist or psychiatry provider.
00:35:46.000 --> 00:35:58.320
Um, that we're doing some of the same things we might do in other forms of eating disorders to get the thoughts and the anxieties addressed to in a way that people can change their behaviors.
00:35:58.559 --> 00:36:14.480
We need a physical health ongoing monitoring and treatment from likely nursing and from primary care type medical providers who are continually assessing the effects on the body and how to safely do the refeeding process.
00:36:14.720 --> 00:36:23.440
Very important component to this that um, you know, these are dangerous illnesses when people are engaging their behaviors.
00:36:23.599 --> 00:36:33.120
They unfortunately can also be dangerous as people are coming out of them or changing their behaviors because the refeeding process has its own risks inherent in it.
00:36:33.280 --> 00:36:43.360
So it's important to have good dietitians, good medical and nursing observations and treatment as people are going through the refeeding process as well.
00:36:43.599 --> 00:36:53.599
So and the multidisciplinary team is going to be a key component for individuals with orthorexia who have gotten to the point of needing professional help with it.
00:36:54.400 --> 00:36:57.760
Refeeding is not a common term outside of your area.
00:36:57.840 --> 00:37:01.599
So does that mean learning to eat on your own after you're out?
00:37:02.000 --> 00:37:09.680
It it can, although the more common meeting in the eating disorder field is around just the process of renourishing the body.
00:37:09.920 --> 00:37:10.160
Okay.
00:37:10.400 --> 00:37:21.519
And so if somebody has been restricting or using behaviors that get rid of food right after they eat it, it's about getting the body accustomed to having regular food intake again.
00:37:21.840 --> 00:37:32.960
And that refeeding piece has to be done in a thoughtful and you know, medically supervised way to be to be less risky than it would otherwise be.
00:37:33.519 --> 00:37:46.720
So, you know, if you have somebody who's been eating literally maybe less a few less than a few hundred calories a day, and if you were to supply them now with a 3,000 calorie a day diet, their body would revolt with that.
00:37:46.800 --> 00:38:04.400
And you it actually a very dangerous situation called refeeding syndrome, where you have organ failure because the body's overwhelmed with the process of trying to take in the level of of food from a volume standpoint, um, and processing it over overwhelms the body.
00:38:04.720 --> 00:38:17.920
So if your digestive tract slowed down because little was passing through it, and you're trying to get your body back to a full meal, uh is it a matter of giving it time to start working again?
00:38:18.400 --> 00:38:19.680
Does it start to work again?
00:38:20.000 --> 00:38:20.559
It does.
00:38:20.880 --> 00:38:23.360
It's but it's a progressive increase.
00:38:23.760 --> 00:38:26.400
And so trying to start at a place where the body can manage it.
00:38:26.640 --> 00:38:27.039
Got it.
00:38:27.200 --> 00:38:34.559
And so while that process is taking place, it's usually accompanied by this medical monitoring.
00:38:34.640 --> 00:38:54.960
Um, it should be accompanied by this medical monitoring, of monitoring people's labs and their vitals and their overall health status as they start to eat more regularly, to look for signs of the organs failing or the organs being stressed, to look for signs of the GI system being stressed or failing.
00:38:55.120 --> 00:39:01.360
Um so then it can safely proceed of gradually increasing the food intake.
00:39:01.440 --> 00:39:13.599
Uh, and that refeeding process is what is kind of referred to in the eating disorder field as the process of re-restoring nutrition for someone after they've been malnourished from their eating disorder.
00:39:14.000 --> 00:39:25.840
So a multidisciplinary team for treatment at a level of care where you're getting that for a while until your body is back to a healthy level all sounds expensive and time consuming.
00:39:26.079 --> 00:39:33.280
Does the fact that orthorexia is not in the DSM V mean that there are issues covering it with insurance, covering treatment?
00:39:33.680 --> 00:39:35.120
The short answer is yes.
00:39:35.920 --> 00:39:51.200
Um, I it's not completely uncommon that if something isn't as clearly defined, that there could be challenges from insurance around the necessity of treatment and, you know, what are the established guidelines for treatment?
00:39:51.440 --> 00:40:16.960
And um, you know, the or even though there's not a separate diagnostic name or category for orthorexia in the DSM currently, um, it's considered one of several types of eating disorders that are not as clearly defined yet, but clearly cause problems that are listed under other specified feeding or eating disorders, or the acronym is OSFED.
00:40:17.120 --> 00:40:17.200
Okay.
00:40:17.519 --> 00:40:26.640
And so it encompasses a couple of different types of eating disorders that are awaiting more research to kind of identify the exact criteria for them.
00:40:26.960 --> 00:40:33.360
But they clearly have enough medical and functional and psychological impact that they need treatment.
00:40:34.000 --> 00:40:47.680
So by you know accurately diagnosing it under that category, then there's more acceptance from insurance payers to to go through the authorization process successfully.
00:40:48.320 --> 00:41:04.320
And a person who is in a compromised place because of having orthorexia or caring for somebody, caring about somebody who has it, may or may not be resourced enough to figure that out, to be able to work that the machinations of that.
00:41:04.960 --> 00:41:08.640
Does a treatment center help or get insurance coverage?
00:41:09.360 --> 00:41:09.519
Yes.
00:41:09.760 --> 00:41:35.519
Yeah, and that would be the responsibility of the treating professionals to know to you know diagnose that in the way that's most accurately representing the DSM, so that and that's a you know common practice for um for all diagnostic criteria is to make sure it's matching up the DSM, and then the insurance authorization uh follows those criteria.
00:41:35.760 --> 00:41:43.120
And um, that's more the treatment center's responsibility, not so much for the patient or their family members to sort that out.
00:41:43.360 --> 00:41:44.640
So we're not on our own with that.
00:41:44.880 --> 00:41:45.200
Correct.
00:41:45.360 --> 00:41:45.519
Good.
00:41:45.680 --> 00:41:46.400
Glad to hear it.
00:41:46.640 --> 00:41:56.640
So as we wrap up these two episodes, is there anything you want somebody who's watching and thinking either maybe this has gone too far?
00:41:56.800 --> 00:42:09.120
Maybe I started with the best of intentions and have put the best possible food in my body, but or I've been watching him or them for a while, and I think this is problematic.
00:42:09.280 --> 00:42:10.320
What do they do?
00:42:10.640 --> 00:42:11.920
I think check it out.
00:42:12.160 --> 00:42:29.599
And you know, most most uh eating disorder treatment centers uh will have opportunities on their, you know, connection points, whether that's website or phone numbers, to go through a screening process for eating disorders and including orthorexia.
00:42:29.760 --> 00:42:39.200
Um, you know, the treatment center that where I work, the Emily program has website www.emilyprogram.com, and certainly connect there.
00:42:39.519 --> 00:42:55.920
And then the Alliance for Eating Disorders has a lot of great resources for checking out whether treatment is needed, whether there are treatment services near you, and the National Eating Disorder Association, same thing, has some connection points to be able to sort that out.
00:42:56.480 --> 00:42:57.280
Check it out.
00:42:57.360 --> 00:43:04.400
And when I say that, I just mean, you know, check out the website, talk to your healthcare provider.
00:43:04.720 --> 00:43:14.320
If you feel like they're not as well versed in eating disorders, then check it out with one of these other options so that you can really get the help that you need.
00:43:14.720 --> 00:43:21.039
And when looking for a treatment center, you want to be specific that it is one that specializes in eating disorders?
00:43:21.360 --> 00:43:21.840
Yes.
00:43:22.240 --> 00:43:27.519
Yeah, there are many great, you know, behavioral health, mental health treatment centers out there.
00:43:27.680 --> 00:43:38.480
Um, but they themselves would likely say they don't have the expertise in eating disorders to work with somebody whose eating disorder has gotten to that point of needing a higher level of care.
00:43:38.800 --> 00:43:44.400
So an eating disorder treatment center and wanting to know if they work with individuals with orthorexia.
00:43:44.960 --> 00:43:46.960
So you specifically ask for that diagnosis.
00:43:47.039 --> 00:43:48.079
That's good information to have.
00:43:48.320 --> 00:44:05.440
And of course, recovery.com has all of the treatment centers listed, and you can search by your insurance and the condition, which in this case would be orthorexia or eating disorders in general, and then contact the organization and see if they have specialists in orthorexia.
00:44:05.680 --> 00:44:05.920
Correct.
00:44:06.800 --> 00:44:07.760
Thank you so much for your time.
00:44:07.840 --> 00:44:08.800
I really appreciate it.
00:44:09.200 --> 00:44:22.160
It's interesting to find out how many things there are that we don't know about, and maybe that's just because I'm not on TikTok, but it is uh important to know because we want to be able to keep ourselves healthy and the people we care about.
00:44:22.640 --> 00:44:23.120
Absolutely.
00:44:23.519 --> 00:44:23.760
Yes.
00:44:24.240 --> 00:44:25.599
Appreciate this opportunity very much.
00:44:25.920 --> 00:44:26.640
Yeah, I do too.
00:44:27.280 --> 00:44:27.920
Appreciate your time.
00:44:28.480 --> 00:44:33.599
And we will be back next week with another look into another behavioral health issue.
00:00:13.439 --> 00:00:27.679
Orthorexia is an eating disorder in which people are restricting or manipulating the foods that they eat to try to have healthy foods or what they deem to be healthy and what they deem to be pure foods.
00:00:28.160 --> 00:00:31.280
Think eating 100% clean is always healthy?
00:00:31.519 --> 00:00:32.640
Psychiatrist Dr.
00:00:32.719 --> 00:00:40.480
Brad Smith exposes orthorexia and why obsessing over pure food can sabotage your mental and physical health.
00:00:40.799 --> 00:00:44.000
Like many eating disorders, it can be very dangerous.
00:00:44.159 --> 00:00:58.079
It can be life-threatening because if we're dealing with restricting food intake and getting into areas of malnutrition, it'll be, you know, a significant risk for individuals if they're taking it to an extreme.
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Welcome to Recoverable.
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I'm your host, Terry McGuire.
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Today we continue our discussion with Dr.
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Brad Smith about lesser known eating disorders.
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Last week we talked about RFID, and today we will be diving into orthorexia.
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Dr.
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Smith, thank you for joining us.
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Thanks for having me.
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I appreciate it.
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We're going to start as we did last week with some truth or myth questions, and then we'll get into the longer answers if we can.
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All right.
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Myth or fact.
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Is orthorexia just extreme discipline with food?
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Myth.
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It's certainly has components of extreme discipline with food, but that's not as simple as that.
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Myth or fact.
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You have to be underweight to have orthorexia.
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Myth.
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It can be going on at any weight or any size.
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Myth or fact.
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Clean eating is the best way to prevent eating disorders.
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Myth.
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In fact, clean eating often promotes restrictive forms of eating, which can be a risk factor for eating disorders.
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Including orthorexia.
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Including orthorexia.
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Myth or fact.
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Orthorexia is just anorexia light.
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Myth.
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Very distinct differences between the two in terms of the underlying motivations and the reasons for the behaviors.
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Myth or fact.
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Orthorexia is about the fear of being fat.
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Myth.
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Anorexia nervosa and other eating disorders are often centered around the fear of being fat or the fear of weight gain.
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However, orthorexia is more about the discovery of food to have health benefits or to be pure about the eating process.
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We'll be talking about that pure.
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Myth or fact.
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It's interesting because it printed out as a fact.
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So I like your answer better.
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Myth or fact.
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Reading every ingredient label is a red flag for orthorexia.
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Myth.
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I think we're we're teaching people in our society, in our in our medical fields, are teaching people to read the ingredients.
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I think it has more to do with how many times you read the ingredients.
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Myth or fact, social media can make orthorexia worse.
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Fact.
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We know that social media can have um harmful or positive effects on people in the eating disorder world, including for people with orthorexia or at risk for orthorexia.
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Social media depictions and influencing behaviors tends to make them worse.
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There may be some specific health benefits that somebody's trying to achieve by that, but um carried out to their extreme, it's not a good thing.
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The last one here.
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Now we'll go to the internet questions.
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And not surprisingly, the first one is what is orthorexia?
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Well, orthorexia is an eating disorder in which people are restricting or manipulating the foods that they eat to try to have healthy foods or what they deem to be healthy and what they deem to be pure foods.
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Is that a moral component to eating?
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Well, it's interesting.
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I haven't really thought of it quite that way, but there could be a component of that involved.
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Um there's a mission-driven element to it.
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The mission is to eat things that are pure, meaning unspoiled, or being, you know, what we might think of as being the most pure form of garden to table, farm to table.
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Um they're not tainted with preservatives, they're not tainted with ultra-processed methods.
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Um they're they're not tainted by the medications that an animal may be given while they're growing.
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So it's a mission-driven component to it to eat as pure as possible, to eat foods that have not gone through these processing uh methods.
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And I suppose in a way, there's there is that sort of spiritual kind of part of it that there's a morality to it because, you know, well, not as a religious morality, but the moral morality of like trying to stay on course with this idea to eat as pure as possible.
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Eating foods farm to table, you know, it that sounds really healthy.
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Yes.
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No chemicals, no hormones, none of the things that are out there that probably are not good for us.
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So where does it go off the reels?
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Well, I think I, you know, this is not too unlike other forms of eating disorders in my experience, where a lot of times the development of the eating disorder has been after some noble attempts to change the patterns of eating to be healthier or to do something that had, you know, a not a harmful intent at first.
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I haven't run into anybody who started out their eating journey to try to get an eating disorder, so to speak.
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Um, it's not a choice, it just develops as people, you know, go through their life.
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So with orthorexia, it's about the extremes.
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Is it good for someone who is relying almost entirely on ultra-processed foods to make an attempt to eat cleaner?
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I would say yes.
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Um, but is it necessary or is it truly healthy for someone to have restricted their intake to an extent that it no longer resembles kind of a normal, normal portions of uh macronutrients to meet their nutritional needs?
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We'll get into it all more.
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So why don't we hear about orthorexia as much as we hear about things like bulimia, anorexia, binge eating?
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Well, first is because it hasn't really been recognized nearly as long.
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So I think the first, you know, the first use of this term orthorexia was in the late 90s, like it was around 1997, that someone coined this term or orthorexia.
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And what we have experienced since then is just continued discovery, exploration, and under trying to understand it in the medical world and in the eating disorder treatment world.
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Um, but the simple fact that it hasn't been around as long as other eating disorders is one of the features.
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The other is it may not be as common as anorexia nervosa or bulimia nervosa.
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It's hard to study it when you don't have agreed upon distinct diagnoses or diagnostic categories for this in the same way that we have them established for these other illnesses.
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So it's hard to hard to estimate the exact prevalence or incidence because we don't have agreed-upon terminology of exactly what it is or where that line is for it to be a disorder.
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Is the fact that it's based on the healthiest foods part of the problem with diagnosing it?
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Because it'd be so easy to say, look what I'm doing.
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You know, how could this be wrong?
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I think that is a part of it as well.
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Um, I mean, I think about it from the individual's standpoint, in contrast to some other eating disorders, like this may be very much aligned with their values and the way that they see health is going to be through trying to eat foods in this way.
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Among their health care providers, same thing.
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They're probably counseling a lot of their patients to try to move away from ultra-processed foods or fast foods and into more clean eating.
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And so, you know, it's going to go underappreciated until it probably causes some sort of physical consequence or social or functional consequence.
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So it kind of sounds like you're saying without bad, and I think that somebody with orthorexy would see any processed food as bad.
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I can't say I'm wild about them, that without bad foods, there's an imbalance.
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I mean, what what what's wrong with eating pure foods that makes it part of an eating disorder?
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I don't think there's anything categorically wrong about eating clean foods or foods that are considered clean.
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Um and I don't I don't think that's what is happening with someone who has more of the extreme form of like orthorexia nervosa, where they start to have the extreme form of it.
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Because what we'll see there is that people have carried this to an extreme that they've eliminated major opportunities for food, um, where they might continue this path towards something that would have to be, for example, grown themselves.
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Um they would have to be perhaps the only one to have tended the garden, so to speak.
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Um they may also eliminate the whole categories of foods, thinking that they're categorically bad, not just like whether they were processed differently, but like maybe it's all sugars.
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But some of our sugars come from natural sources like fruits and may not be good for the overall composition of the macronutrients that we need, or even the micronutrients.
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We may not be able to get all of the vitamins and minerals that we need if we go to very, very pure form of eating.
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Um, can it be done?
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Yes, with a lot of attention to detail on that.
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But that's where it slips into or the slippery slope starts for people who take it to the extreme because it will become part of an obsession for them.
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Okay.
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And that's where it starts to interfere with their life, where they may be constantly thinking about the next meal, where is that food going to come from?
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How am I going to get that food that is absolutely pure?
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And if they slip up, they have a lot of self-loathing around that.
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A lot of remorse and feeling bad.
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So this torturous kind of, you know, obsession around how to make it pure, how to make it right, and then beating themselves up if they get it wrong in their eyes.
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So it's not that eating the purest, healthiest foods is bad.
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It's that being part of a pattern that is unhealthy and leads down, as you called it, a slippery slope.
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Right.
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For the psychological, kind of emotional part of it and the social part of it, it's those consequences of how much obsession there is around this that is what turns this into something that is pathological for individuals versus it being just a healthy adjustment to, you know, trying to move away from processed foods or or preserved foods or, you know, something that they would might that most of the world might deem is is a good change.
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Um, but it can also, again, be that they can't have the physical consequences if they have started to restrict certain types of food out of the belief that something is not going to be pure.
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Like maybe they develop a thought that most forms of that would be carbohydrates are impure or not, you know, not meeting their definition of healthy.
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And that might not be from like the way somebody with anorexia might see that is they're trying to avoid the weight gain or the fat development that can happen with eating that carbohydrate, maybe because of these other purity reasons or health reasons that they are avoiding it, but they unin usually unintentionally cut out things that lead can lead to physical consequences.
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So you brought up anorexia.
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What is the difference between orthorexia and anorexia?
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Because they even kind of sound alike.
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They do.
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Um, and they sound alike, they they have some, you know, some common ground, so to speak, uh, because there is restriction of food.
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Um and it's more about what is the underlying reason for this change in eating.
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And so for orthorexia, as we're talking about, it's about I need to eat as pure as possible.
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I need to eat things that are sourced in the way that I believe they should be sourced.
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And um, this is all for my health benefit.
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This is usually not about weight change.
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They they may lose weight as a consequence of these changes, um, but it's not typically what's driving them.
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You know, they don't start out with the idea that um that I need to look a certain size or I need to have this body shape.
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And whereas someone with anorexia nervosa, the eating changes are a consequence of that underlying motivation of changing the size, changing the weight number, changing how I look, and uh gaining control over myself and my body through that change.
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So, how do you treat something if it's a part of someone's core values and beliefs as opposed to something that can be seen as, well, obviously that's not healthy.
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Does that complicate it?
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Absolutely.
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Um, you know, because this is often so aligned with their values and how they think of health.
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And um, and also, as we mentioned before, the their healthcare providers, maybe sending messages to them and other patients that, you know, these are kind of the movements in your diet that should be made all over, you know, media, social media around um, you know, and this is the you know, entire diet industry has existed based upon playing on people's fears about you know what foods could be bad for you, and it's you know, all good or all bad.
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And so there is a righteousness that comes with this, and not it's not like we said not a religious righteousness, but it's like I'm doing this the right way.
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I might even have good intentions about it, and it's reinforced.
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Yeah.
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The people in their lives reinforce it because they're like, oh wow, they were able to make this change.
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And uh their healthcare providers might reinforce it.
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They might be reinforced by just, you know, whenever we succeed with something and make a change in our habits, we feel the some good reward from that.
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Yeah, we feel proud about it.
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So it's just this constant feedback loop of like this is the right thing to do, on usually until they have some sort of consequence from it.
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And it just, this is anecdotal experience, but it's a lot of anecdotal experience with working with individuals with these disorders, is that this it takes longer most of the time for the physical consequences, for the social consequences and the emotional fallout from from this particular eating disorder, partially because of those factors.
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That and we don't we don't see as many people coming in, you know, wanting treatment as early.
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And we see probably a little bit more of people um having their arms twisted to get treatment, and um, you know, because it's part of what they think is you know is right about what they're doing, and the rest of the world has it wrong.
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When you say cut out whole categories, so somebody might say sugars are bad, carbs are bad, meat is bad, and so it ends up being, as other eating disorders are, highly restrictive and you're not having the physical needs of your body met.
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Is that correct?
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Correct.
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Yep.
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Even if it looks good.
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Even if it looks good, even if you're you know adhering to what you think is right or healthy, but it may be having negative consequences to your body.
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So when you were describing the mental part of it and the obsessive part of it, I think you use that word, it made it sound to me like is it related, is orthorexia related to OCD?
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Well, there's there's a fair amount of co-occurrence.
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Um, you know, and we see we see orthorexia happening more in people who tend to have more of an anxiety underpinning or in a more obsessive underpinning to kind of the way they interact with the world.
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And um, and then if they have something like OCD, there is a lot of cooccurrence of OCD and a variety of eating disorders, including orthorexia.
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So if orthorexia is less obvious than some other eating disorders, at least initially, how do I know if I have it or somebody I care about has it?
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Well, I think this has something to do with that extreme, you know, that this is a spectrum of behaviors people have.
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They're trying to learn more about what they're putting in their bodies.
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There's nothing wrong with that.
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So back when we did the myth, in fact, I was asked the question about reading a food label if that means that you have orthorexia.
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And I said, no.
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How many times?
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But it depends on how many times, because I think we're all being um educated around understanding what it is that's in food and what are the ingredients.
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And so if we read it once quickly and educate ourselves about what's in it, that's probably fine.
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If you're reading it five or six times and obsessing over it and not being able to kind of get that thought out of your mind, um, then you're getting into territory where this is impacting your life in a negative way.
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So when I when I get that question, like, how do I know it's a problem for me?
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That's kind of a common question.
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It's like, how many times do you read the food labels?
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And would you eat something if you didn't have a chance to read the food labels?
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And um, you know, if something did have like one ingredient you didn't recognize, would that be a deal breaker?
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Or is this an always a none situation?
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Like you just are never going to eat something that has any of the signs of ultra-processed foods.
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Um, so it's more about the extreme and how much it's starting to impact your selections and your life and taking you out of normal activities.
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And that would include family meals again and going out to a restaurant meeting with some friends, that sort of thing.
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Right.
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So if you've found yourself removing yourself from those situations, then I think it's impacted your life in a way that, you know, you at the very least should should have an assessment with someone who understands these issues.
00:19:51.199 --> 00:20:08.079
We were using the word righteousness earlier, and and I really mean no offense to anybody who might have orthorexia and feel that way, but it came up in what was described as the guilt factor, the difference between feeling unhealthy after a big meal and feeling morally wrong or dirty.
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Yeah.
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And I think there's the there's a lot that goes into the way people feel after we eat.
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Um that's a big underlying component for most of the eating disorders.
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Whether, you know, with slightly different, with different nuances.
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And for someone with anorexia nervosa, it may be the the fact that that bigger meal might lead to weight gain.
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And it might then be associated with an uncomfortable feeling with any sort of fullness or anything being in the stomach.
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Someone with orthorexia, it may be more about that I just slipped up.
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I had my path set.
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I was going to stay pure with this, and I slipped up and I feel awful about it.
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And several other iterations in between there.
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But um, but yeah, I mean no offense either by the righteousness comments before.
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It's it's about this path of trying to get to um, you know, purity and trying to get to uh healthiest foods, and that can feel like a path that, you know, trying trying to get perfection uh with what is happening there.
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And that's when it starts to throw off the rest of the person's life.
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And that's when it's that's when it's a problem that likely needs professional help.
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And is one of those factors that might lead to someone needing professional help the reaction they have to a slip-up?
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Yes.
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I think that's a good call out.
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That um, you know, if you're if you're beating yourself up, if you're if you're just not able to let this go, if you have, you know, eaten something that was ultra-processed, for example.
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Or there might be a piece of fruit if you said sugars are bad.
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Right.
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Yeah.
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Right.
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And if you if you can't let that go, and if you're if you're kept up at night because of those thoughts, then um it's probably not going to go away on its own.
00:22:02.479 --> 00:22:05.839
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00:22:41.439 --> 00:22:43.919
Your recovery starts today.
00:22:45.359 --> 00:22:52.159
On Google and YouTube, one of the top searches on this topic is can you have orthorexia without wanting to lose weight?
00:22:52.479 --> 00:22:53.119
Yes.
00:22:53.599 --> 00:22:54.479
Absolutely.
00:22:54.719 --> 00:22:57.759
I've seen many people with that very clinical scenario.
00:22:58.159 --> 00:23:04.719
Never intended to lose weight, never were aiming towards a certain weight goal or body size difference.
00:23:05.919 --> 00:23:09.679
It's been about am I eating the right things for my body?
00:23:10.000 --> 00:23:11.199
Now, is there overlap?
00:23:11.439 --> 00:23:14.399
And do they sometimes equate one with another?
00:23:14.639 --> 00:23:15.199
Yes.
00:23:15.519 --> 00:23:31.919
But even there, it's still it will come across differently than someone who may have more classic anorexia nervoso, where it's very much about the number on the scale and or the size of the clothes and or how my body looks in the mirror.
00:23:32.479 --> 00:23:49.759
But someone with orthorexia who may have a hint of body image issues with it, it's more because they've associated that, you know, eating ultra-processed foods is a part of why I, you know, may not be at the at the weight that I think is healthy.
00:23:50.000 --> 00:23:55.839
Um, but it's not the same drive uh as someone with anorexia nervosa.
00:23:56.159 --> 00:24:01.679
And again, it's it's not as clear of a line as we might want to think.
00:24:01.839 --> 00:24:12.240
Um, you know, we have the diagnostic categories, of course, but um people often have overlapping symptoms of of a couple of different types of eating disorders.
00:24:12.719 --> 00:24:21.439
Is the fact that orthorexia is less clear, to use your word, part of why it's not currently in the DSM V, the diagnostic manual?
00:24:21.679 --> 00:24:25.119
I think the major factor is the newness of it.
00:24:25.359 --> 00:24:25.599
Okay.
00:24:25.839 --> 00:24:48.479
And then, you know, there's not really yet established because the DSM usually establishes it for us or pulls it together, is where you see the diagnostic category with all the clinical criteria laid out, because there's a lot of research that then goes into, you know, are these three criteria the ones that are reliable and valid across studies?
00:24:48.639 --> 00:24:54.959
And they take different criteria out and put them in over each iteration of the DSM.
00:24:55.199 --> 00:24:59.119
And so I think no, the topic we talked about the last time was RFID.
00:24:59.359 --> 00:25:00.559
RFID's a great example.
00:25:00.639 --> 00:25:16.479
It's kind of switched into having its own DSM category or diagnostic category with the DSM five because there then had been enough research, had been enough study around the specific diagnostic criteria.
00:25:16.719 --> 00:25:21.759
And orthorexia is new enough that it hasn't had that same type of study.
00:25:21.919 --> 00:25:28.879
Um, and the field is still it's not even that they don't agree because they're arguing with one another.
00:25:28.959 --> 00:25:36.240
It's just it's new enough that people are still taking inventory of, you know, what are the most characteristic features of this?
00:25:36.399 --> 00:25:44.240
We know the basics of it, but we don't know the exact criteria that are going to rule in or rule out this diagnosis as compared to others.
00:25:44.639 --> 00:25:59.759
I may be making an assumption here, but I'm thinking of someone who is committed to eating clean and healthy, no preservatives, all of it is probably also, again, correct me if I'm wrong, into fitness and other things that are good for them.
00:26:00.159 --> 00:26:14.159
So does the appearance of being ultra healthy and really committed to your health just make even admitting that there might be a problem or identifying if it's outside of you that there's a problem more complicated?
00:26:14.719 --> 00:26:15.839
Yes, I think so.
00:26:16.479 --> 00:26:17.359
I'll bet it sounds good.
00:26:17.519 --> 00:26:20.319
I'll bet it looks good, I'll bet it feels good until it doesn't.
00:26:20.559 --> 00:26:20.879
Right.
00:26:21.119 --> 00:26:36.159
Again, a lot of eating disorders have their origins in somebody having a noble intention of trying to eat better, trying to have their body look different, trying to, you know, lose the weight that their healthcare provider had recommended that they lose.
00:26:36.319 --> 00:26:42.319
Um, and then it goes down that slippery slope and ends up to a place they can't really control.
00:26:42.479 --> 00:26:46.159
And orthorexia is in that same sort of category.
00:26:46.399 --> 00:27:05.199
These things, you know, get really difficult to sort out because there is so much positive reward and um in our society, in our, you know, among friends, among relatives, like if people make these changes that are deemed healthy, this is all going to be great.
00:27:05.519 --> 00:27:07.919
And as you said, it is until it isn't.
00:27:08.159 --> 00:27:12.799
So anything can have the extremes that make it pathological.
00:27:12.959 --> 00:27:23.199
And orthorexia is one of those areas where that we're continuing to learn about is it's gone to an extreme for individuals that has made it no longer helpful for them.
00:27:23.599 --> 00:27:26.079
Yeah, because I just keep thinking about the RFID conversation we had.
00:27:26.159 --> 00:27:33.759
If I knew someone who was eating three or four or five foods, period, it would be pretty clear to me that there may well be an issue.
00:27:34.000 --> 00:27:38.559
If somebody's eating vegetables and that they grew, I'd be like, cool.
00:27:38.639 --> 00:27:38.719
Right.
00:27:38.959 --> 00:27:39.279
You know?
00:27:39.679 --> 00:27:41.199
So it'd be harder, I think.
00:27:41.279 --> 00:27:50.399
But it also depends a little bit on what people are willing or or what they have negative connotations with in terms of diagnoses.
00:27:50.479 --> 00:27:57.119
And this is a whole other category, but the, you know, there's stigma associated with certain diagnoses.
00:27:57.519 --> 00:28:11.039
And so it may be more acceptable or tolerable for someone to say that they have orthorexia than to say they have anorexia nervosa, or to say that they have ARFID rather than orthorexia.
00:28:11.199 --> 00:28:16.399
And it could be different from person to person as to which diagnosis has a negative stigma.
00:28:16.959 --> 00:28:23.599
And, you know, thankfully, there's a lot less stigma about all mental health issues over the last five or six years.
00:28:23.679 --> 00:28:33.439
I think the pandemic had a had a very positive effect for that piece of our culture, that we have, you know, more awareness, more acceptance of mental health issues.
00:28:33.679 --> 00:28:48.959
Um, but it's still surprising and it's not universal like why one person might think that it's a negative connotation to have anorexia nervosa, while another person might think it's negative to have diagnosis of orthorexia.
00:28:49.439 --> 00:28:55.919
But they may acknowledge that there's a problem and that their life is off course because of their eating patterns.
00:28:56.159 --> 00:29:06.479
Um, so then you have, you know, difficult decisions around how much that clarity or that precision matters in their overall recovery.
00:29:06.559 --> 00:29:17.199
And it may at some point, but there may be an issue of timing of when it's most important for that precision to be, you know, something that they acknowledge more than they are right now.
00:29:17.519 --> 00:29:22.079
So it sounds like with orthorexia, what we see might not look at all bad.
00:29:22.159 --> 00:29:25.359
It might in fact look very good and healthy.
00:29:25.519 --> 00:29:45.919
It's what's happening inside the not inability to have any flexibility, the uh obsession with it and the planning and how much time you're spending every day thinking about sourcing your food and getting your food and what you'll eat and what you won't, and then the physical consequences of not having your nutritional needs met.
00:29:46.000 --> 00:29:46.479
Is that correct?
00:29:46.719 --> 00:29:47.039
Correct.
00:29:47.119 --> 00:29:47.279
Okay.
00:29:47.439 --> 00:29:47.599
Yep.
00:29:47.919 --> 00:29:48.719
Had to put it all together.
00:29:49.119 --> 00:29:49.759
It's all put together.
00:29:50.319 --> 00:29:51.679
My brain needs that.
00:29:51.839 --> 00:30:01.679
Um, so a lot of the internet searches, they were all over, but they essentially boil down to wanting a checklist so that you can determine do I have this?
00:30:01.839 --> 00:30:02.559
Does he have this?
00:30:02.639 --> 00:30:03.679
Does do they have this?
00:30:03.839 --> 00:30:11.759
So, what are common symptoms of orthorexia that we might be able to see if the problem seems to be more psychological?
00:30:12.399 --> 00:30:30.079
You know, a little bit of what we mentioned before, like if you find yourself removing yourself from normal um social activities, like having meals with family and friends, whether that's in your own home or in someone's home or it's going out to eat, like that's a big change in how you're interacting with the world.
00:30:30.240 --> 00:30:39.759
And I think it's about how much time you're spending on obsessing or ruminating about what's in the food and how you're sourcing it.
00:30:39.919 --> 00:30:49.759
And it's about how limited your food variety feels to you at this time and how much you notice that it's different than other people around you.
00:30:50.079 --> 00:31:18.240
So I think even among people we might think of as healthy in our society, whether it's whether it's fitness instructor or someone that, you know, you might think this this is someone like if you start seeing your patterns being farther in the extreme of what you're hearing being promoted from those sort of sources, I think that's a pretty good sign that you're, you know, you're beyond the extreme or you're going to be at an extreme where professional help is going to be necessary.
00:31:18.719 --> 00:31:30.479
So if somebody is listening to us and still isn't really sure whether they or somebody they care about might have orthorexia, are there any places where there's a checklist like there are for other disorders?
00:31:31.119 --> 00:31:35.599
Yes, I would say they're not as well established as what we might have for other disorders.
00:31:35.759 --> 00:31:44.479
But if someone is curious or if they want to check it out, the two that are probably the most common are the Bratman Orthorexia test.
00:31:45.039 --> 00:31:46.319
B-R-A-T-M-A-N.
00:31:46.799 --> 00:31:51.919
Yes, B-R-A-T-M-A-N, or the uh Dusseldorf Orthorexia scale.
00:31:52.159 --> 00:31:54.159
I'm not gonna guess how to spell that one.
00:31:54.479 --> 00:31:54.799
Okay.
00:31:55.039 --> 00:32:00.399
So if they Google or search for either one of those, they'll be able to come up with a list of okay.
00:32:00.559 --> 00:32:00.879
Thank you.
00:32:01.839 --> 00:32:13.599
So what is the connection between social media and emphasis and all the people out there, the influencers talking about clean eating, wellness, culture, gym culture, and orthorexia?
00:32:14.000 --> 00:32:18.399
Well, I think it's about you know, that message can be taken to the extreme.
00:32:19.119 --> 00:32:26.799
And influencers influence people, that's why they have the name, and that's why they get paid the money that they get paid.
00:32:27.119 --> 00:32:34.240
So um when they promote something like clean eating or orthorexia type patterns, it can take off.
00:32:34.639 --> 00:32:50.799
And just as we've talked about in the rest of our conversation, there could be some people who maybe are far on the extreme of uh relying mostly or heavily on ultra-processed foods or fast foods or things that we might not think is the healthiest for them.
00:32:51.119 --> 00:33:06.799
And so if the the influencers might be aiming at them, trying to get them to move into a little bit better place, but there are going to be some listeners who are more prone to an eating disorder and perhaps orthorexia, who might then take it to the extreme.
00:33:07.279 --> 00:33:12.639
Maybe not at first, but over time they get to that slippery slope and it just goes to the extreme.
00:33:14.000 --> 00:33:17.519
So the only reason it would be a problem is if it is dangerous.
00:33:18.000 --> 00:33:21.839
So how dangerous is orthorexia or how dangerous can it be?
00:33:22.879 --> 00:33:26.479
Like many eating disorders, it can be uh uh very dangerous.
00:33:26.639 --> 00:33:47.359
It can be life-threatening because uh if we're dealing with restricting food intake and uh getting into uh areas of malnutrition that uh you know can be life-threatening to various organ systems, it it'll be um, you know, a significant uh risk for individuals if they're taking it to an extreme.
00:33:48.159 --> 00:33:58.000
So that's probably the key point here is that restrictive eating can be dangerous and even fatal, even if the thing that you're eating is really, really healthy.
00:33:58.719 --> 00:33:59.039
Yes.
00:34:00.000 --> 00:34:15.760
But they're you know sometimes people with our most commonly understood eating disorder of anorexia nervosa, we oftentimes have people coming into treatment and the highest levels of care, maybe only eating a couple things also that might be salad and a vegetable.
00:34:16.559 --> 00:34:23.840
Things we might all think are very healthy, but they're extremely malnourished because that's all they've been able to eat.
00:34:24.160 --> 00:34:32.480
One of the sayings that I have often used is that um developing an eating disorder is not a choice, but recovery is.
00:34:33.280 --> 00:34:49.280
And I think that applies to orthorexia as it does to other eating disorders that I don't think anybody starts off their clean eating habits with the idea of this going to an extreme where they're not getting their nutritional needs met or they end up in the hospital, but it can happen.
00:34:49.760 --> 00:34:52.320
So if recovery is possible, let's talk about treatment.
00:34:52.480 --> 00:34:54.640
What does treatment for orthorexia look like?
00:34:55.120 --> 00:35:15.039
Well, treatment um looks a lot like other eating disorder treatment from the standpoint that because it's got many components that, you know, that affect the emotional or psychological health and the physical health, as well as overall social interactions, it's usually done best with a multidisciplinary team.
00:35:15.280 --> 00:35:27.440
So you have a team of professionals that can cover all of those bases, making sure that there's nutritional rehabilitation that's taking place, to add variety, to add volume to be able to meet the nutritional needs.
00:35:27.760 --> 00:35:28.800
Is that usually a dietitian?
00:35:29.440 --> 00:35:30.240
Usually a dietitian.
00:35:30.480 --> 00:35:30.880
Yep.
00:35:31.519 --> 00:35:45.760
And that the mental health side of this is being attended to with good therapy, psychotherapy through a social work therapist or master's level therapist or psychologist or psychiatry provider.
00:35:46.000 --> 00:35:58.320
Um, that we're doing some of the same things we might do in other forms of eating disorders to get the thoughts and the anxieties addressed to in a way that people can change their behaviors.
00:35:58.559 --> 00:36:14.480
We need a physical health ongoing monitoring and treatment from likely nursing and from primary care type medical providers who are continually assessing the effects on the body and how to safely do the refeeding process.
00:36:14.720 --> 00:36:23.440
Very important component to this that um, you know, these are dangerous illnesses when people are engaging their behaviors.
00:36:23.599 --> 00:36:33.120
They unfortunately can also be dangerous as people are coming out of them or changing their behaviors because the refeeding process has its own risks inherent in it.
00:36:33.280 --> 00:36:43.360
So it's important to have good dietitians, good medical and nursing observations and treatment as people are going through the refeeding process as well.
00:36:43.599 --> 00:36:53.599
So and the multidisciplinary team is going to be a key component for individuals with orthorexia who have gotten to the point of needing professional help with it.
00:36:54.400 --> 00:36:57.760
Refeeding is not a common term outside of your area.
00:36:57.840 --> 00:37:01.599
So does that mean learning to eat on your own after you're out?
00:37:02.000 --> 00:37:09.680
It it can, although the more common meeting in the eating disorder field is around just the process of renourishing the body.
00:37:09.920 --> 00:37:10.160
Okay.
00:37:10.400 --> 00:37:21.519
And so if somebody has been restricting or using behaviors that get rid of food right after they eat it, it's about getting the body accustomed to having regular food intake again.
00:37:21.840 --> 00:37:32.960
And that refeeding piece has to be done in a thoughtful and you know, medically supervised way to be to be less risky than it would otherwise be.
00:37:33.519 --> 00:37:46.720
So, you know, if you have somebody who's been eating literally maybe less a few less than a few hundred calories a day, and if you were to supply them now with a 3,000 calorie a day diet, their body would revolt with that.
00:37:46.800 --> 00:38:04.400
And you it actually a very dangerous situation called refeeding syndrome, where you have organ failure because the body's overwhelmed with the process of trying to take in the level of of food from a volume standpoint, um, and processing it over overwhelms the body.
00:38:04.720 --> 00:38:17.920
So if your digestive tract slowed down because little was passing through it, and you're trying to get your body back to a full meal, uh is it a matter of giving it time to start working again?
00:38:18.400 --> 00:38:19.680
Does it start to work again?
00:38:20.000 --> 00:38:20.559
It does.
00:38:20.880 --> 00:38:23.360
It's but it's a progressive increase.
00:38:23.760 --> 00:38:26.400
And so trying to start at a place where the body can manage it.
00:38:26.640 --> 00:38:27.039
Got it.
00:38:27.200 --> 00:38:34.559
And so while that process is taking place, it's usually accompanied by this medical monitoring.
00:38:34.640 --> 00:38:54.960
Um, it should be accompanied by this medical monitoring, of monitoring people's labs and their vitals and their overall health status as they start to eat more regularly, to look for signs of the organs failing or the organs being stressed, to look for signs of the GI system being stressed or failing.
00:38:55.120 --> 00:39:01.360
Um so then it can safely proceed of gradually increasing the food intake.
00:39:01.440 --> 00:39:13.599
Uh, and that refeeding process is what is kind of referred to in the eating disorder field as the process of re-restoring nutrition for someone after they've been malnourished from their eating disorder.
00:39:14.000 --> 00:39:25.840
So a multidisciplinary team for treatment at a level of care where you're getting that for a while until your body is back to a healthy level all sounds expensive and time consuming.
00:39:26.079 --> 00:39:33.280
Does the fact that orthorexia is not in the DSM V mean that there are issues covering it with insurance, covering treatment?
00:39:33.680 --> 00:39:35.120
The short answer is yes.
00:39:35.920 --> 00:39:51.200
Um, I it's not completely uncommon that if something isn't as clearly defined, that there could be challenges from insurance around the necessity of treatment and, you know, what are the established guidelines for treatment?
00:39:51.440 --> 00:40:16.960
And um, you know, the or even though there's not a separate diagnostic name or category for orthorexia in the DSM currently, um, it's considered one of several types of eating disorders that are not as clearly defined yet, but clearly cause problems that are listed under other specified feeding or eating disorders, or the acronym is OSFED.
00:40:17.120 --> 00:40:17.200
Okay.
00:40:17.519 --> 00:40:26.640
And so it encompasses a couple of different types of eating disorders that are awaiting more research to kind of identify the exact criteria for them.
00:40:26.960 --> 00:40:33.360
But they clearly have enough medical and functional and psychological impact that they need treatment.
00:40:34.000 --> 00:40:47.680
So by you know accurately diagnosing it under that category, then there's more acceptance from insurance payers to to go through the authorization process successfully.
00:40:48.320 --> 00:41:04.320
And a person who is in a compromised place because of having orthorexia or caring for somebody, caring about somebody who has it, may or may not be resourced enough to figure that out, to be able to work that the machinations of that.
00:41:04.960 --> 00:41:08.640
Does a treatment center help or get insurance coverage?
00:41:09.360 --> 00:41:09.519
Yes.
00:41:09.760 --> 00:41:35.519
Yeah, and that would be the responsibility of the treating professionals to know to you know diagnose that in the way that's most accurately representing the DSM, so that and that's a you know common practice for um for all diagnostic criteria is to make sure it's matching up the DSM, and then the insurance authorization uh follows those criteria.
00:41:35.760 --> 00:41:43.120
And um, that's more the treatment center's responsibility, not so much for the patient or their family members to sort that out.
00:41:43.360 --> 00:41:44.640
So we're not on our own with that.
00:41:44.880 --> 00:41:45.200
Correct.
00:41:45.360 --> 00:41:45.519
Good.
00:41:45.680 --> 00:41:46.400
Glad to hear it.
00:41:46.640 --> 00:41:56.640
So as we wrap up these two episodes, is there anything you want somebody who's watching and thinking either maybe this has gone too far?
00:41:56.800 --> 00:42:09.120
Maybe I started with the best of intentions and have put the best possible food in my body, but or I've been watching him or them for a while, and I think this is problematic.
00:42:09.280 --> 00:42:10.320
What do they do?
00:42:10.640 --> 00:42:11.920
I think check it out.
00:42:12.160 --> 00:42:29.599
And you know, most most uh eating disorder treatment centers uh will have opportunities on their, you know, connection points, whether that's website or phone numbers, to go through a screening process for eating disorders and including orthorexia.
00:42:29.760 --> 00:42:39.200
Um, you know, the treatment center that where I work, the Emily program has website www.emilyprogram.com, and certainly connect there.
00:42:39.519 --> 00:42:55.920
And then the Alliance for Eating Disorders has a lot of great resources for checking out whether treatment is needed, whether there are treatment services near you, and the National Eating Disorder Association, same thing, has some connection points to be able to sort that out.
00:42:56.480 --> 00:42:57.280
Check it out.
00:42:57.360 --> 00:43:04.400
And when I say that, I just mean, you know, check out the website, talk to your healthcare provider.
00:43:04.720 --> 00:43:14.320
If you feel like they're not as well versed in eating disorders, then check it out with one of these other options so that you can really get the help that you need.
00:43:14.720 --> 00:43:21.039
And when looking for a treatment center, you want to be specific that it is one that specializes in eating disorders?
00:43:21.360 --> 00:43:21.840
Yes.
00:43:22.240 --> 00:43:27.519
Yeah, there are many great, you know, behavioral health, mental health treatment centers out there.
00:43:27.680 --> 00:43:38.480
Um, but they themselves would likely say they don't have the expertise in eating disorders to work with somebody whose eating disorder has gotten to that point of needing a higher level of care.
00:43:38.800 --> 00:43:44.400
So an eating disorder treatment center and wanting to know if they work with individuals with orthorexia.
00:43:44.960 --> 00:43:46.960
So you specifically ask for that diagnosis.
00:43:47.039 --> 00:43:48.079
That's good information to have.
00:43:48.320 --> 00:44:05.440
And of course, recovery.com has all of the treatment centers listed, and you can search by your insurance and the condition, which in this case would be orthorexia or eating disorders in general, and then contact the organization and see if they have specialists in orthorexia.
00:44:05.680 --> 00:44:05.920
Correct.
00:44:06.800 --> 00:44:07.760
Thank you so much for your time.
00:44:07.840 --> 00:44:08.800
I really appreciate it.
00:44:09.200 --> 00:44:22.160
It's interesting to find out how many things there are that we don't know about, and maybe that's just because I'm not on TikTok, but it is uh important to know because we want to be able to keep ourselves healthy and the people we care about.
00:44:22.640 --> 00:44:23.120
Absolutely.
00:44:23.519 --> 00:44:23.760
Yes.
00:44:24.240 --> 00:44:25.599
Appreciate this opportunity very much.
00:44:25.920 --> 00:44:26.640
Yeah, I do too.
00:44:27.280 --> 00:44:27.920
Appreciate your time.
00:44:28.480 --> 00:44:33.599
And we will be back next week with another look into another behavioral health issue.
