SO-CALLED CLEAN eating has gained popularity in recent years and is part of many people’s health regimes.

It involves eating minimally processed foods that provide maximal nutritional benefits and, in most cases, forms part of healthy routine.

However, experts have warned that people should seek help if they feel they have taken the practice too far.

In a small number of cases, people develop an eating disorder called orthorexia nervosa. People who have the condition become obsessed with the composition and origin of food and may end up significantly limiting their diet to the detriment of their overall health.

Last week an inquest in Cork heard that the death of a man in his 40s was connected to orthorexia. The man developed pneumonia and died because his body weight was so low that he was unable to fight off the condition.

Like many people dealing with an eating disorder, he kept food diaries and became obsessive about what he ate. He weighed under seven stone when he died in April. His family and friends did not know he had an eating disorder, the inquest heard.

Barry Murphy, Communications Officer with Bodywhys – the Eating Disorders Association of Ireland, said clean eating “can certainly start as an enthusiastic interest in eating healthy food but could subsequently turn into an eating disorder” for a minority of people.

In some cases, he said an “obsession with perfection” can eventually “take over a person’s life” in terms of the food they eat.

“There’s often a narrowing of the person’s version of the world. They feel they have to live by certain rules or codes around food, and it they don’t adhere to that they experience anxiety or shame and ultimately their self-worth and happiness is hijacked by where this is coming from,” Murphy explained.

Knowledge gap 

Orthorexia was first identified in 1997 but it is still not formally recognised. As such, there has been a lack of research carried out into the condition. However, experts have said that, anecdotally, there has been an increase in cases in recent years. 

There is an important distinction between orthorexia and certain other eating disorders. Anorexia nervosa and bulimia nervosa involve a chronic concern about the quantity of food being consumed, whereas orthorexia is characterised by an over-concern with the quality of the food consumed.

Murphy said more research needs to be carried out on the condition so it can be better identified and treated. He stated that, like all eating disorders, the knowledge base around orthorexia is “still largely incomplete”.

“Across eating disorders, we have an information gap regardless of the actual diagnosis. Less than 1% of all eating disorder research is done on men, for example; there are 200,000 studies on depression, but just 15,000 on eating disorders.

“There is a lack of research but that is changing all the time, researchers and clinicians are very active in this area,” he said.

Orthorexia can sometimes be difficult to recognise as a person’s weight loss, unless very dramatic, may be attributed to them being on health kick. Murphy said signs for family members and friends to look out for include changes in a person’s personality.

“They may find it difficult to talk about food in a relaxed way, there could be a shift in the person’s thinking patterns. A lack of flexibility is often reported – that applies to all eating disorders.

The deeper the person goes into it the feel they have to increase the level of behaviour, and that can affect their quality of life and health and that’s quite troubling.

Murphy said people suffering from orthorexia often start to eliminate certain food and take the “cleansing aspect” of clean eating too far. He added that social isolation often occurs, noting that people sometimes cut themselves off from the world.

Treatment for orthorexia may require a multidisciplinary approach that includes nutrition education. Cognitive behavioural therapy, combined with medication, is also effective in some cases.

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Seeking help

In 2018 Bodywhys received almost 1,600 emails and over 700 calls from people seeking advice or support about an eating disorder.

About half of the people who emailed the organisation were seeking advice for themselves (52%, down from 82% in 2017), while 25% of people were a family member or friend (up from 15% in 2017) and 23% were classed as ‘other’ (up from 3% in 2017).

The majority of people with eating disorders seeking help were female (88.5%, down from 97% in 2017), 10.5% were male (up from 3% in 2017) and 1% were transgender or non-binary.

Most people were seeking information about anorexia (45%), bulimia (11%) and binge eating (13%); 6% were seeking advice about ‘Other Specified Feeding or Eating Disorders’, the category under which orthorexia falls. About one in four people sought general advice and did not refer to a specific condition, and Murphy noted that some orthorexia cases may also be included here.

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He said it can sometimes be difficult for a person with an eating disorder to seek help but advised anyone who wants advice to contact Bodywhys or their GP.

“It’s easy for me to say to ring a phone number, it’s another thing for a person to actually do it. Often people reach crisis point, they realise ‘I can’t do this on my own anymore’. Then it’s about picking up the phone or going to the GP or finding a service you can work with,” Murphy said. 

Need support? Call 01 210 7906 or email alex@bodywhys.ie